ADVANCED CLINICAL CONCEPTS
• ARDS is an unexpected, catastrophic pulmonary complication
occurring in a person with no previous pulmonary problems.
The... [Show More] mortality rate is high (50%)
• In ARDS, a common laboratory finding is lowered PO2.
However, these clients are not very responsive to high
concentrations of oxygen.
• Think about the physiology of the lungs by remembering
PEEP: Positive End Expiratory Pressure is the instillation and
maintenance of small amounts of air into the alveolar sacs to
prevent them from collapsing each time the client exhales.
The amount of pressure can be set with the ventilator and is
usually around 5 to 10 cm of water.
• Suction only when secretions are present.
• Before drawing arterial blood gases from the radial artery,
perform the Allen test to assess collateral circulation. Make
the client’s hand blanch by obliterating both the radial and
ulnar pulses. Then release the pressure over the ulnar artery
only. If flow through the ulnar artery is good, flushing will be
seen immediately. The Allen test is then positive, and the
radial artery can be used for puncture. If the Allen test is
negative, repeat on the other arm. If this test is also negative,
seek another site for arterial puncture. The Allen test ensures
collateral circulation to the hand if thrombosis of the radial
artery should follow the puncture.
• If the client does not have O2 to his/her brain, the rest of the
injuries do not matter because death will occur. However,
they must be removed from any source of imminent danger,
such as a fire.
• PC)2 >45 or PO2 <60 on 50% O2 signifies respiratory failure.
• A child in severe distress should be on 100% O2.
• Early signs of shock are agitation and restlessness resulting
from cerebral hypoxia.
• If cardiogenic shock exists with the presence of pulmonary
edema, i.e., from pump failure, position client to REDUCE
venous return (HIGH FOWLER’s with legs down) in order to
decrease venous return further to the left ventricle.
• Severe shock leads to widespread cellular injury and impairs
the integrity of the capillary membranes. Fluid and osmotic
proteins seep into the extra vascular spaces, further reducing
cardiac output. A vicious cycle of decreased perfusion to ALL
cellular level activities ensues. All organs are damaged, and if
perfusion problems exist, the damage can be permanent.
• All vasopressors/vasodilator drugs are potent and dangerous
and require weaning on and off. Do not change infusion rates
• A client is brought into the hospital suffering shock symptoms
as a result of a bee sting. What is the first priority?
Maintaining an open airway (the allergic reaction damages the
lining of the airways causing edema). Also, keep the client
warm without constricting clothing; keep legs elevated [Show Less]