Hyper and hypo ventilation with PaCO2 levels

nurseprnRN, BSN, RN · Mar 20, 2012

"all the gobblty goop is fascinating but has nada to do with being an rn. i see many students failing tests because they get too deep in the patho weeds when they should be focusing on nursing interventions and collaborative care and patient safety....."

i would be astonished if nclex doesn't ask at least one question about abgs to see if the candidate knows what respiratory and metabolic alkalosis and acidosis are, and what the compensatory mechanisms are. understanding this is definitely within nursing practice; the nurse who is ignorant of them will not recognize kussmaul resps for what they signify and will be slapping high-flow oxygen on chronic lungers. i've seen it happen all too often.

mindlor · Mar 20, 2012

You are missing my point. Explanations given earlier in this thread were way beyond, in my opinion, the scope of anything you just posted grntea. You and I are exactly on the same page. The things you mentioned here are paramount.

GilaRRT · Mar 20, 2012

My problem with this Oxygen business are nurses who are practicing that truly believe any patient with COPD who receives more than 2 LPM via NC will spontaneously combust as their head pops of and rolls down the hallway. Perhaps not so dramatic, but the hypoxic drive is one of the biggest scarecrows in nursing. If a patient needs Oxygen, give them Oxygen. Yes, high FiO2's can be problematic. However, Oxygen can be a problem for everybody and not typically because of this hypoxic drive business. You put me with my healthy lungs in a very high FiO2 environment and it will eventually ghost me.

mindlor · Mar 20, 2012

You are ABSOLUTELY spot on Gila. Oxygen cannot be withheld when it is needed. But, the level must be increased with caution.

Everything you say is spot on :

FlyingScot, RN · Mar 20, 2012

You are missing my point. Explanations given earlier in this thread were way beyond, in my opinion, the scope of anything you just posted grntea. You and I are exactly on the same page. The things you mentioned here are paramount.

So what's wrong with expanding your knowledge base? Maybe some people find it interesting. Maybe some people want to go beyond the bare minimum. Maybe some people see it as a tool that will benefit their patients in whatever way they see fit. I'm not a robot. I don't blindly follow orders and sling pills. In many of my previous jobs I WAS the one directing care. Many of the nurses here don't have the benefit of having physicians on site 24/7. I'm stunned that you actually believe that nurses do not need advanced knowledge, and even more stunned that you act like it's a waste of time for anyone but BSN's and ANP's to become educated beyond the basics.

mindlor · Mar 20, 2012

So what's wrong with expanding your knowledge base? Maybe some people find it interesting. Maybe some people want to go beyond the bare minimum. Maybe some people see it as a tool that will benefit their patients in whatever way they see fit. I'm not a robot. I don't blindly follow orders and sling pills. In many of my previous jobs I WAS the one directing care. Many of the nurses here don't have the benefit of having physicians on site 24/7. I'm stunned that you actually believe that nurses do not need advanced knowledge, and even more stunned that you act like it's a waste of time for anyone but BSN's and ANP's to become educated beyond the basics.

I feel that you are completely misinterpreting what I have said. Please go back and read my posts. This is a student forum. It is paramount that the basics be understood and mastered before advanced learning takes place....in most cases. Also please explain how you as a nurse can direct care? You can certainly make suggestions to the HCP but ultimately they sign the orders. There are things nurses can do without an order but none of those would in my mind equate to directing care, unless of course you are an NP. If there is not an HCP on site and an issue comes up that requires a decision that is outside the RN's scope of practice, said RN best be on the horn to the HCP....

I have found that trying to introduce advanced concepts to the students that I tutor before they grasp the basics leads to frustration and often times avoidance of the material altogether...so I encourage you to please view my posts from a students perspective, not that of a practicing nurse with loads of experience.....

The purpose of nursing school is to get the student thinking like a nurse, not like a doctor. If people wish to think like doctors they are in the wrong program.

FlyingScot, RN · Mar 20, 2012

I feel that you are completely misinterpreting what I have said. Please go back and read my posts. This is a student forum. It is paramount that the basics be understood and mastered before advanced learning takes place....in most cases. Also please explain how you as a nurse can direct care? You can certainly make suggestions to the HCP but ultimately they sign the orders. There are things nurses can do without an order but none of those would in my mind equate to directing care, unless of course you are an NP. If there is not an HCP on site and an issue comes up that requires a decision that is outside the RN's scope of practice, said RN best be on the horn to the HCP....
I have found that trying to introduce advanced concepts to the students that I tutor before they grasp the basics leads to frustration and often times avoidance of the material altogether...so I encourage you to please view my posts from a students perspective, not that of a practicing nurse with loads of experience.....
The purpose of nursing school is to get the student thinking like a nurse, not like a doctor. If people wish to think like doctors they are in the wrong program.

They're called protocols. I assessed the patient and decided which course of action to take depending on my assessment, provided the care, re-evaluated and changed it as needed. I did critical care transport and HEMS. We did not take a physician with us. So yes I directed the care. But thank you for your explanation of how it works. Also, it's not just students who read these posts. Students can take what they need to understand the process but I bet there are quite a few who have the capacity to understand it on a deeper level and enjoy the challenge. I can attest that, as a student, I was one of those people. What really frosted my cookies was your assumption that only BSN's and APN's would ever have need for extra knowledge.

mindlor · Mar 20, 2012

They're called protocols. I assessed the patient and decided which course of action to take depending on my assessment, provided the care, re-evaluated and changed it as needed. I did critical care transport and HEMS. We did not take a physician with us. So yes I directed the care. But thank you for your explanation of how it works. Also, it's not just students who read these posts. Students can take what they need to understand the process but I bet there are quite a few who have the capacity to understand it on a deeper level and enjoy the challenge. I can attest that, as a student, I was one of those people. What really frosted my cookies was your assumption that only BSN's and APN's would ever have need for extra knowledge.

In my vocabulary, using sound nursing assessment and judgement to then make decsions based on protocols does not equate to directing care. We are obviously dealing with a semantics issue. Who do you think dictates those protocols? HCP's you think? If that is the case it can be interpolated that by you following those protocols that the HCP is the de facto director of care......and you are following orders....again, in my opinion stating such things especially in a student forum borders on the dangerous....I direct you to the ANA Scope and Standards of Practice.....

If you can show me where I said that ONLY BSN's and APN's would EVER have a need for extra knowledge, I would be grateful and will happily eat those words. I am pretty sure you are taking liberties with what was said.

I realize that other people besides students read student forums. I would ask though that replies to students by experienced people is kept at the expected level of knowledge for a student. Most nursing students, especially ADNs have only a rudimentary knowledge of A&P.....at best.....there are of course exceptions and that statement was made solely based upon my own observations. My experience is that sometimes people who respond with these complex, deeply detailed, obviously advanced explanations are doing so to draw attention to themselves and do a little tooting of their own horn perhaps.....hell who knows maybe I am even guilty of this...

FlyingScot, RN · Mar 20, 2012

All I was trying to say is that ADN nursing students (the bulk of the audience here) dont need to know these concepts in such detail.
Yes, pH is a very simple concept, until it is not. Now if they plan on going for a BSN, ARNP, PA or even med school, then of course a deeper understanding of patho is essential

Would you like mayo with that?

Guttercat, ASN, RN · Mar 20, 2012

Would you like mayo with that?

>snicker

GilaRRT · Mar 20, 2012

In my vocabulary, using sound nursing assessment and judgement to then make decsions based on protocols does not equate to directing care. We are obviously dealing with a semantics issue. Who do you think dictates those protocols? HCP's you think? If that is the case it can be interpolated that by you following those protocols that the HCP is the de facto director of care......and you are following orders....again, in my opinion stating such things especially in a student forum borders on the dangerous....I direct you to the ANA Scope and Standards of Practice.....If you can show me where I said that ONLY BSN's and APN's would EVER have a need for extra knowledge, I would be grateful and will happily eat those words. I am pretty sure you are taking liberties with what was said.I realize that other people besides students read student forums. I would ask though that replies to students by experienced people is kept at the expected level of knowledge for a student. Most nursing students, especially ADNs have only a rudimentary knowledge of A&P.....at best.....there are of course exceptions and that statement was made solely based upon my own observations. My experience is that sometimes people who respond with these complex, deeply detailed, obviously advanced explanations are doing so to draw attention to themselves and do a little tooting of their own horn perhaps.....hell who knows maybe I am even guilty of this...

No horn tooting here. I happen to have a good appreciation of these particular topics because I am both a respiratory therapist and registered nurse, therefore I think I have something to offer. However, you will not often find me posting on threads that deal with mother/baby issues because I'm probably too busy appreciating the information that some of the "experts" in that area are presenting. Believe me, my credentials are probably not going to impress any seasoned nurse, but hopefully the information I present can be helpful.

Esme12, ASN, BSN, RN · Mar 20, 2012

No horn tooting here. I happen to have a good appreciation of these particular topics because I am both a respiratory therapist and registered nurse, therefore I think I have something to offer. However, you will not often find me posting on threads that deal with mother/baby issues because I'm probably too busy appreciating the information that some of the "experts" in that area are presenting. Believe me, my credentials are probably not going to impress any seasoned nurse, but hopefully the information I present can be helpful.

Don't sell yourself short....you're a smart cookie! I love your posts.