Fluid bolus with BP 140s/100s? - page 3

Hello wise nurses, Perhaps you can help me understand this. Patient comes up to the unit with pneumonia, rules in for sepsis. Pressures in 140s/100s during time in the ED even higher in the unit... Read More

  1. Visit  MC1906 profile page
    2
    Based on the information provided.....there could be various possibilities. Looking back, we can all say what we would have done or take a different course. In regards to the BP....if the O2 Sats were 60%, the patient could have been confused. Could they have been slightly combative or moving around and the cuff went off at the same time? What was the trend in BPs? Was the SaO2 verified on a different hand? Or what did the ABG state the numbers were? Metabolic acidosis? :::scratching head..thinking.....ARDS? SIRS?::::::

    In the initial stages of sepsis, cardiac output can be well maintained or can be even higher than what we would expect to see. That could also be another reason why the BP was high. Tachycardia could be present to help increase cardiac output the patient. It's important to know WHY the tachycardia is present--- early shock? fluid volume deficit? anxiety? confusion? ---remember.....treat the cause! Tachycardia can still be present in shock, even though adequate fluid repletion.

    Fluids---based on my knowledge, septic patients need lots of fluids. It's important because not having enough fluids can result in tissue hypoperfusion and worsen organ dysfunction. CVP should be monitored to help determine how much fluids you want to give the patient. A CVP of 8-12mm Hg should be suffice. If having other issues, then this range may be suggested to be higher.

    Interesting patient overall...hopefully he is doing well. Please follow up with any additional information!
    Anna Flaxis and Esme12 like this.
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  3. Visit  Esme12 profile page
    0
    Yep, we all agree!!!
  4. Visit  NCRNMDM profile page
    1
    Thank you, Esme12. This was great information, and it was a great breakdown of what is happening in the body during sepsis.
    Esme12 likes this.
  5. Visit  meandragonbrett profile page
    1
    Quote from Esme12
    Yep, we all agree!!!
    Definitely that! We need more clinical discussion on this side of the board! It's been kind of bland lately.

    @MattRNStudent23.......ask us more questions that you want clarification on anytime!
    Esme12 likes this.
  6. Visit  NRSKarenRN profile page
    0
    Last edit by NRSKarenRN on Jan 1, '12
  7. Visit  angelique777 profile page
    0
    [color=#363636]bipap or bilevel positive airway pressure, keeps the airways open by providing a flow of air delivered through a face mask. with bipap the pressures that the doc prescribes alternate, a higher pressure is used to breathe in, called ipap, and a lower pressure is used when breathing out, called epap. bipap is the preferred method for severe, obstructive sleep apnea and copd

    medically necessary:
    the use of non-invasive positive pressure respiratory assist devices (bipap) for the treatment of severe copd is considered medically necessary when all of the following are met:
    • an arterial blood gas paco2, done while awake and breathing the individual's usual fio2, is greater than or equal to 52 mm hg; and
    • sleep oximetry demonstrates oxygen saturation less than or equal to 88% for at least five continuous minutes, done while breathing oxygen at 2 l/min. or the individual's usual fio2(whichever is higher); and
    • prior to initiating therapy, obstructive sleep apnea and treatment with cpap has been considered and ruled out.
    note: when the above medical necessity criteria for individuals with the indication of severe copd are met, a non-invasive positive pressure bi-level respiratory assist device, without back-up rate feature, will be considered medically necessary.


    for central sleep apnea, (i.e., apnea not due to airway obstruction)
    medically necessary:
    the use of a non-invasive positive pressure respiratory assist device (bipap) for the treatment of central sleep apnea is considered medically necessary when, prior to initiating therapy, a complete, facility-based, attended polysomnography has been performed and the test results have revealed all of the following:
    • the diagnosis of central sleep apnea (csa) has been confirmed; and
    • the presence of obstructive sleep apnea (osa) has been excluded, as the predominant cause of the sleep-associated hypoventilation; and
    • if osa is a component of the sleep-associated hypoventilation, cpap has been ruled out as an effective therapy; and
    • oxygen saturation level is less than or equal to 88% for at least five continuous minutes, done while breathing the individual's usual fio2; and
    • significant clinical improvement of the sleep-associated hypoventilation has been demonstrated with the use of a bi-level positive pressure device, either with or without the back-up rate feature, adjusted to the settings that will be prescribed for initial home use, while breathing the individual's usual fio2.
    note: when the above medical necessity criteria for individuals with the indication of csa are met, a non-invasive positive pressure bi-level device, either with or without the back-up rate feature, will be considered medically necessary.


    basically yes copd and osa patients very often placed on bipap also when pt on this device and nebulizer treatments are order respiratory therapy can hook it up so nebs can be given while on machine which i find much more effective.




  8. Visit  Esme12 profile page
    0
    Quote from angelique777
    [color=#363636]bipap or bilevel positive airway pressure, keeps the airways open by providing a flow of air delivered through a face mask. with bipap the pressures that the doc prescribes alternate, a higher pressure is used to breathe in, called ipap, and a lower pressure is used when breathing out, called epap. bipap is the preferred method for severe, obstructive sleep apnea and copd

    medically necessary:
    the use of non-invasive positive pressure respiratory assist devices (bipap) for the treatment of severe copd is considered medically necessary when all of the following are met:
    • an arterial blood gas paco2, done while awake and breathing the individual's usual fio2, is greater than or equal to 52 mm hg; and
    • sleep oximetry demonstrates oxygen saturation less than or equal to 88% for at least five continuous minutes, done while breathing oxygen at 2 l/min. or the individual's usual fio2(whichever is higher); and
    • prior to initiating therapy, obstructive sleep apnea and treatment with cpap has been considered and ruled out.
    note: when the above medical necessity criteria for individuals with the indication of severe copd are met, a non-invasive positive pressure bi-level respiratory assist device, without back-up rate feature, will be considered medically necessary.


    for central sleep apnea, (i.e., apnea not due to airway obstruction)
    medically necessary:
    the use of a non-invasive positive pressure respiratory assist device (bipap) for the treatment of central sleep apnea is considered medically necessary when, prior to initiating therapy, a complete, facility-based, attended polysomnography has been performed and the test results have revealed all of the following:
    • the diagnosis of central sleep apnea (csa) has been confirmed; and
    • the presence of obstructive sleep apnea (osa) has been excluded, as the predominant cause of the sleep-associated hypoventilation; and
    • if osa is a component of the sleep-associated hypoventilation, cpap has been ruled out as an effective therapy; and
    • oxygen saturation level is less than or equal to 88% for at least five continuous minutes, done while breathing the individual's usual fio2; and
    • significant clinical improvement of the sleep-associated hypoventilation has been demonstrated with the use of a bi-level positive pressure device, either with or without the back-up rate feature, adjusted to the settings that will be prescribed for initial home use, while breathing the individual's usual fio2.
    note: when the above medical necessity criteria for individuals with the indication of csa are met, a non-invasive positive pressure bi-level device, either with or without the back-up rate feature, will be considered medically necessary.


    basically yes copd and osa patients very often placed on bipap also when pt on this device and nebulizer treatments are order respiratory therapy can hook it up so nebs can be given while on machine which i find much more effective.



    can you please reference your information so we can all look up what you found and learn. i find i like to follow the links and read the information in total to get the whole perspective about the information provided. thanks!!
  9. Visit  dorie43rn profile page
    0
    The patients kidneys arent funtioning, he's septic, enough said


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