panamabrt

The nebulizer will hook up to the corrugated tubing...you will see...it just runs inline with the oxygen tubing from the 02 source to the patient. Put it inline b/t the T-piece OVER the trach and the corrugated tubing. Many home trachs you just take out the inner cannula and clean them and put them back in. Good Luck!

Maybe someone can make heads or tails of this:w00t: good luck!

metabolic acidosis and alkalosis page index metabolic acidosis. metabolic alkalosis emergency therapy treating metabolic acidosis calculating the dose use half the calculated dose reasons to limit the bicarbonate dose: injected into plasma volume fizzes with acid causes respiratory acidosis raises intracellular pco2 subsequent residual changes metabolic acidosis. the following is a brief summary. for additional information visit: e-medicine (christie thomas) or wikepedia etiology: there are many causes of primary metabolic acidosis and they are commonly classified by the anion gap: metabolic acidosis with a normal anion gap: longstanding diarrhea (bicarbonate loss) uretero-sigmoidostomy pancreatic fistula renal tubular acidosis intoxication, e.g., ammonium chloride, acetazolamide, bile acid sequestrants renal failure metabolic acidosis with an elevated anion gap: lactic acidosis ketoacidosis chronic renal failure (accumulation of sulfates, phosphates, uric acid) intoxication, e.g., salicylates, ethanol, methanol, formaldehyde, ethylene glycol, paraldehyde, inh, toluene, sulfates, metformin. rhabdomyolysisfor further details visit: e-medicine (christie thomas). treating severe metabolic acidosis. the ideal treatment for metabolic acidosis is correction of the underlying cause. when urgency dictates more rapid correction, treatment is based on clinical considerations, supported by laboratory evidence. the best measure of the level of metabolic acidosis is the standard base excess (sbe) because it is independent of pco2. if it is decided to administer bicarbonate, the sbe and the size of the treatable space are used to calculate the dose required: metabolic alkalosis etiology: primary metabolic alkalosis may occur from various causes including: loss of acid via the urine stools, or vomiting transfer of hydrogen ions into the cells excessive bicarbonate administration, e.g. alkali given to patients with renal failure. contraction of the extracellular space due to excessive diuretic treatmentprolonged metabolic alkalosis may be caused by a number of different mechanisms: decrease in renal perfusion: occurs in dehydration, cardiac failure, or cirrhosis, stimulates the renin-angiotensis system which increases sodium reabsorption in the nephron. chloride depletion: may occur via vomiting or through the use of loop diiuretics and this enhances bicarbonate reabsorption with associated hydrogen ion loss. hypokalemia: metabolic alkalosis may be associated with hypokalemia which can then maintain metabolic alkalosis by various mechanisms:shift of hydrogen ions intracellularly which enhances bicarbonate reabsorption in the collecting duct. stimulation of the h+/k+ atpase in the collecting duct: this leads to potassium ion reabsorption and hydrogen ion secretion. the net gain of bicarbonate maintains the metabolic alkalosis. renal ammonia genesis: ammonium ions (nh4+) are produced in the proximal tubule from glutamine metabolism. alpha-ketoglutarate is produced the metabolism generates bicarbonate. impaired chloride ion reabsorption in the distal nephron increases luminal electronegativity with enhanced hydrogen ion secretion. lowered glomerular filtration rate (gfr). hypokalemia may decrease gfr, which in turn decreases the filtered load of bicarbonate. in volume depletion this impairs excretion of the excess bicarbonate. treating severe metabolic alkalosis physiological response: adequate hydration normally allows the kidneys to correct the problem. however, in severe cases accompanied by hypokalemia, correction of the hypokalemia may be necessary first. as with metabolic acidosis, ideal treatment is the correction of the underlying abnormality. more active intervention is occasionally required and various techniques are available. a common transient cause is iatrogenic; correction of acute metabolic acidosis with sodium bicarbonate leaves a residual metabolic alkalosis. time, hydration, and renal function should gradually correct this. contraction alkalosis is one of the easier causes to understand and treat. dehydration concentrates the body's electrolytes. as the extracellular fluid (ph = 7.4) is on the alkaline side of neutral (ph = 6.8), the relative alkaline mixture of electrolytes is concentrated and shifts the ph to more alkaline value. rehydration, e.g., with oral fluids or intravenous ringer's lactate, restores the normal electrolyte concentration and, therefore, the ph. other therapies: intravenous dilute hydrochloric acid is occasionally used but carries the risk of hemolysis. potassium chloride may also be used unless there is kidney failure. in severe cases which are unresponsive to other measures ammonium chloride may be given (1 to 2 g orally every 4 to 6 hours up to 4 g every 2 hours. it may also given by intravenous infusion (100 to 200 meq dissolved in 500 to 1000 ml of isotonic saline) in addition to potassium replacement. in severe unresponsive metabolic alkalosis it may be necessary to administer hydrochloric acid or institute peritoneal dialysis. specific therapy depends on the underlying pathology. for details visit: e-medicine (christie thomas). emergency therapy. the body's metabolism produces respiratory (carbonic) acid and, in ischemia or cardiorespiratory failure, metabolic (lactic) acid. in emergencies, therefore, urgent correction is most commonly required for metabolic or respiratory acidosis. calculating the bicarbonate dose. (move mouse over the diagram) the diagram shows an example of a patient with a (pure) metabolic acidosis, sbe = -18 meq/l. to achieve complete correction for someone weighing 70 kg: dose (meq) = 0.3 x wt (kg) x sbe (meq/l) 378 = 0.3 x 70 x 18 this assumes that the treatable compartment is about 30% of the body, i.e., about 21 liters. our intention , of

Met. Alkalosis......(to much Hc03 in blood)--------trmt:give fluids This is kinda basic but dont put to much more into it. www.theabgsite.com. www.treatingmetabolicalkalosiscaremark.com. good luck

If pH and Hc03 is elevated it is metabolic alkalosis. Just try to remember there are 4 types of interpretation...and 4 'relative' treatments: Resp. Acidosis.....(not ventilating)most common--------trmt:Ventilate Resp. alkalosis.....(hyperventilating)--------------------trmt:slow down or decrease ventilation. Met. Acidosis........(not enough Hc03 in blood)------------------trmt:Hc03 Met

You must 'ventilate' b/f respirations therefore the better terminology is ventilation. They are used interchangeably but again the ventilator has settings and one is the 'respiratory rate'. Good luck. ?

ferrous sulphate is a higher iron content at 20% vs. gluconate which has an iron content of 11%...If I remember correctly

CPAP is a constant flow and sometimes difficult to use b/c of the continuous flow in Inspiration and expiration. BiPAP gives a inhaled flow vs when having the exhale flow (which is usually less flow) CPAP is being used for people with CHF more these days b/f intubation and for major sleep apnea. BiPAP just allows for easier adjustments...more user friendly.

Go to your computer and look up any articles (studies) that show the efficacy of pro-air. If Maxair works better than stay with it. You can go to the competitors website such as the pharmaceutical company called "sepracor" or I believe glaxo-smithkline who has the powdered inhaler and they will give you some insight. I will look quickly for you and see what I can find. What you are looking for is the drug with a higher Beta 2 adrenergic catacholamine. ( just see which one has a higher Beta 2 effect which stimulates bronchodilitation. Good luck...

Sasha1224 has witnessed a lazy therapist. A good therapist takes time to know the whole patient picture and not limit themselves to just respiratory. The fact is, respiratory is a difficult field and requires alot of knowledge. I am an RRT and an RN...I went back to get my RN to increase my knowledge base...so so much to learn:) Get into respiratory, then go back and get your nursing...nursing was competative for my area also but after RRT school, I was accepted to the BSN program... Good luck!

try respiratory journals. Go to your respiratory dpt. Ask a therapist to help you...I wish I could but dont know how I could this close in time. There is a magazine I get weekly on respiratory articles. Its called advance. Hope this will help. Look in your local hospital libraries or online if you can. Good luck...You can do this! Hang in there and holla' if you need help.

I barely graduated from high school and barely got through respiratory school. Yet the older I got the easier it got. Also, High school is not like college. Math was my downfall.....Here is what I did at the age of 34 to graduate from nursing school... After putting off algebra for so many years with the two degrees and my RN graduating year coming up, I took a year off of school(yes at the age of 34), tested out at sylvan learning center at a 6th grade math level (right on target) began sylvan and hired two tutors until the next semester of algebra and used them through the semester and passed with an 'A'. It cost me a couple gran but to me, if you want an education, where there is a will there is a way....even if it meant I graduated a year later and was broke off my butt...I did it...now...I dont use it. Buck up lil' soldier :innerconfthe nurse angels are on your side...me included! Follow your dream....Let us know how you are doing...:)

For x-ray; "Gammagrbrr" For Nursing "With friends like us, who needs enemas?" (to long for a liscense plate but great for a t-shirt) For Respiratory "mucusmaid"

why thank you danissa :) Have a good day and write back some time :) !:w00t:

Way to say it 'page respiratory'...!!! For some reason it seems to be a constant challenge b/t the two. I am an RRT and a BSN and to be honest RRT was extremely difficult but then nursing was difficult in a different way. As the nurse learns about the systems (Heart, Lung, Liver, Bladder etc...) The RRT must learn how these systems affect ventilation which include very detailed information. Our field is more about precise measurments of how ventilation occurs, nursing hits just the main topics. So really if we all learn to love what we have learned in school and expand our knowledge base and work as a team, we can all be an integral, interdisciplinary team player for the patient :) With friends like us...who needs enemas:cheers: !!!