January 23, 2018

The Working Nurse Podcast | Episode 1

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
Morphine is effective by oral administration. However, only 20% of the ingested morphine dose will reach tissues after first-pass metabolism, requiring a dose adjustment approximately five times that of an equipotent IV dose.

January 22, 2018

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
When administered via the IV route, morphine reaches a peak of action in 15 to 20 minutes, with a half-life of 1.5 to 2 hours in healthy young adults and slightly longer in older adults. Its duration of action is 3 to 4 hours.

January 21, 2018

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
Sedation and respiratory depression can occur with opioid administration for acute pain. Opioids decrease medullary sensitivity to carbon dioxide, resulting in respiratory depression.

January 20, 2018

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
Immunoglobulin-mediated allergies are rare for morphine and other opioids. Many patients experience pruritus of the trunk and face after parenteral administration. This side effect is related to histamine release from opioid receptors on mast cells.

January 19, 2018

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
The most common side effect of opioids is constipation. Constipation is attributed to opiate binding of receptors located in the antrum of the stomach and proximal small bowel. Constipation can be anticipated with long-term opioid use.

January 18, 2018

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
Whether delivered as a set volume or set pressure, invasive positive pressure ventilation forcibly distends the lung and can be injurious. Injuries from elevated lung volume or lung pressure are known as volutrauma and barotrauma.

January 17, 2018

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
Decreases in lung pressure, indicate decreased resistance or decreased airflow in the ventilatory circuit and should prompt investigation for leaks. Large or sudden decreases in pressure suggest disconnection or unintended extubation.

January 16, 2018

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
Acute increases in measured pressure indicate increased airway resistance or changes in compliance of the respiratory system (eg, those associated with pneumothorax) and can indicate potentially dangerous clinical deterioration.

January 15, 2018

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Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
The PIP measures the maximum amount of pressure in the ventilator circuit during a breath cycle. It reflects lung compliance and airway resistance, including resistance in the circuit itself.

January 14, 2018

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
In addition to maintaining adequate gas exchange, care should be taken to ensure that pressure in the ventilator circuit is appropriate. The two main measurements of pressure during mechanical ventilation are the PIP and plateau pressure (Pplat).

January 13, 2018

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
Changes to ventilator settings are guided dynamically by multiple factors, including pulse oximetry, end-tidal carbon dioxide (ETCO2) measurement, ventilation pressures and blood gas levels.

January 12, 2018

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
Although PEEP and CPAP represent positive airway pressure at the end of expiration, PEEP refers to pressure applied during invasive mechanical ventilation, whereas CPAP is the application of positive pressure during spontaneous breathing.

January 11, 2018

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
Continuous positive airway pressure (CPAP) provides constant pressure, whereas bilevel positive airway pressure (BiPAP) alternates between higher pressure during inspiration (IPAP) and lower pressure during expiration (EPAP).

January 10, 2018

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
Applied PEEP must be differentiated from intrinsic PEEP (iPEEP or auto-PEEP), which may result from improper assisted ventilation when adequate time is not allowed between breaths for complete exhalation.

January 9, 2018

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
Positive end-expiratory pressure (PEEP) increases intrapulmonary and intrathoracic pressures. Potential adverse effects of PEEP include decreased cardiac output, lung overdistention and pneumothorax.

January 8, 2018

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
Positive end-expiratory pressure (PEEP) is the maintenance of positive airway pressure after the completion of passive exhalation. PEEP increases functional residual capacity, improves oxygenation and decreases intrapulmonary shunting.

January 7, 2018

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
Synchronized intermittent mandatory ventilation (SIMV) allows mandatory and spontaneous breaths. A mandatory breath is given at a preset rate, but the breath is synchronized as much as possible with spontaneous patient effort.