Pulmonary Critical Care NUR 351/352 Diane E. White RN MS CCRN PhD (c)

Arterial Blood Gases  Look at PH: 7.40 or (alkalosis )  Look at CO2: 40 or =  Interpretation: if arrows go in same direction than it is METABOLIC; if arrows go in opposite directions than it is RESPIRATORY

Assessment of Oxygenation  Pulse Oximetry  Arterial Blood Gases  Patient Assessment ALWAYS!!

Oxygen Administration  Nasal Cannula  Face Mask  Face Mask with Reservoir  Venturi Mask  Bag-Valve Device (Ambu bag)  Mechanical Ventilation

Types of Mechanical Ventilation  Non-invasive positive pressure ventilation: bi-pap versus c-pap masks  Invasive Positive Pressure Ventilation: types Time-cycled ventilators Pressure-cycled ventilators Volume-cycled ventilators

Modes of Ventilator Therapy  Controlled – preset volume and rate  Assist-Control – preset TV at specified rate  Intermittent Mandatory Ventilation & Synchronized Intermittent Mandatory Ventilation – set TV at set RR  Oscillator Ventilators – high frequency ventilation

Adjuncts to Mechanical Ventilation  Positive –End – Expiratory Pressure (PEEP) 3-10 cm H20  Continuous Positive Airway Pressure (CPAP)  Pressure Support ( PS) 5-10 cm H20

Complications  Barotraumas  Right main stem intubations  OETT out of position  Infection  Aspiration  Ventilator dependency

Nursing Care  Medication Therapy: Pain, anxiety, sedation, & ETOH withdrawal  Awareness of Alarms: volume, pressure, apnea  Prevention of Infections & Ventilator- associated Pneumonia  Communication & teaching  Weaning is a team approach