Exam 1 Nuggets

Card Set Information

Exam 1 Nuggets
2014-09-15 16:07:21
Exam One Nuggets

Stuff to remember
Show Answers:

  1. What adventitious breath sounds are cleared with suctioning, or coughing?
  2. ABG's that confirm respiratory failure are
    • PaO2 <60
    • FiO2 60% (amt. of o2 being delivered)
    • PaCO2 >50
    • Ph <7.25
  3. What is the problem with oxygenation failure?
    Oxygen is being inhaled but it cant get across the alveoli membrane
  4. Illness that cause oxygenation failure
    • ARDS
    • PNA
    • Pulmonary embolism
    • acute lung disease
  5. What is the problem with ventilation failure?
    perfusion is normal, but ventilation is inadequate cuz thoracic pressure cant be changed enough to move air in and out of the lungs
  6. What is the defining lab of ventilation failure?
    PaCO2 >45
  7. Intrapulmonary problems that cause ventilation failure
    • COPD 
    • Pulmonary fibrosis
    • Pulmonary HTN
  8. Extrapulmonary problems that cause ventilation failure
    • Head trauma
    • spinal cord injury
    • over sedation
  9. When a person is in respiratory failure what do I look at to determine if they are being given the proper amount of O2?
    • SpO2
    • ABG

    Always give the lowest level that will provide the best response
  10. What do anxiety, pain and agitation do to a patient?
    increases their O2 demand....so may need to sedate them to decrease O2 demands
  11. Result of not being alert and oriented?
    cant keep a patent airway
  12. Where is the ET tube inserted?
    through the vocal cords and sits above the carina
  13. Difference between ET intubation and Trach
    ET is used when you dont know how long it will take to resolve this problem...or you know if is short term.

    Trach is used when you know it will be a long term solution to their problem
  14. PEEP
    Positive End Expiratory Pressure

    keeps alveoli open with pressure exerted at the end of expiration

    This allows for gas exchange
  15. 3 Levels of proof for ET tube placement
    • CO2 monitor turns gold
    • Auscultate lungs...abdomen
    • X ray...definitive check
  16. TV is usually set at around
  17. Common place the ET tube slides to...and how will I know this has happened?
    rt main stem bronchus

    • rt side rising only
    • uneven breath sounds and rise and fall
  18. What does it mean to maintain vent circuits?
    ventilator provides humidified air, so there tends to be an accumulation of water in tube.

    Need to remove the water away from the patient do decrease likelihood of VAP
  19. What does it mean to have separate suction set ups on a ventilated patient?
    to prevent VAP you need to have different suction apparatus for your G tube, oral care and end line
  20. If you have a patient with a facial fracture what kind of ventilator will they be on?
    Invasive....cpap and bipap have too large and tight of masks for them
  21. Invasive ET tube ventilators settings are all classified by....
    when inspiration ends
  22. Volume cycled ventilator
    inspiration ends when a preset volume is delivered
  23. Pressure cycled ventilator
    inspiration ends when a preset pressure is reached
  24. Time cycled ventilator
    inspiration ends when a preset time has elapsed
  25. Micropressor ventilator
    • has components of 
    • time 
    • volume
    • pressure
  26. Who gets controlled mandatory ventilation?
    • a person who is having surgery
    • or has a spinal cord injury

    a set tidal volume is delivered at a set rate...requiring no spontaneous effort from the patient
  27. How do you know a person on an assist control ventilator is ready to be weaned?
    they are taking lots of breaths on their own and you will see respiratory alkalosis
  28. Assist control ventilator
    ventilator takes over the work of breathing for the client and delivers a set tidal volume

    but patient regulates breathing rate
  29. Pressure Regulated Volume Control ventilator
    pressure determines how much TV will be delivered

    adjustments are made by breath to breath....made by patient or the vent
  30. Which invasive ventilator assists with weaning?
    pressure support ventilator....they must be spontaneously breathing on their own
  31. How do you wean a patient off of a ventilator?
    • Put on CPAP and turn down the number of breaths per minute and watch.....
    • TV
    • O2 saturations
    • HR for increase
    • BP for increase or decrease
    • How deep are they breathing on their own?
  32. PEEP adds what kind of pressure?
    Positive pressure

    prevents small airway collapse at the end of expiration to increase oxygenation
  33. When a person has high PEEP it is common to have ?  Intervention?

    give fluids
  34. Tidal volume tells
    the amount of air being delivered with each preset breath
  35. IF a person is on the ventilator and the RR is different from what you are counting...which is right?
  36. FiO2 tells
    the percentage of oxygen delivered with each breath
  37. Room air Fio2?
  38. What is a sigh breath and when is it used?
    a breath that is delivered that has 1.5-2.5greater tidal volume than what is set on the vent

    given before suctioning
  39. Things done daily when on a ventilator
    • ABG (until less chronic)
    • and chest x ray
  40. When suctioning how do you know the tube is in as far as it needs to go?
    patient coughs
  41. If you are suctioning and you notice the patient is having a dysrhythmia or the O2 falls below 85%....what 2 things do I do?
    STOP and give them 100% O2
  42. Best type of feeding for a ventilated patient?
  43. How do you calculate the minute ventilation?
    What is normal?
    RR x TV

  44. Hypervnetilation and hypoventilation and Tidal volume
    hyperventilating causes the TV to decrease cuz breathing too fast to get good O2 in

    hypoventilation or normal rate of breathing = good breath and tidal volume
  45. How long does a sedation vacation last....
    60 min/day
  46. When you extubate a person what adventitious breath sounds can occur?
  47. Refractory hypoxemia
    no matter how much oxygen you give the patient is staying hypoxic

    Seen with ARDS
  48. Putting a patient with ARDS prone it is common to see these VS changes
    decrease HR and BP....cant tolerate it.  Dont do
  49. What is the problem with a pulmonary embolism?
    a problem of PERFUSION....not ventilation

    the clot in the capillary prevents gas exchange
  50. Virchows Triad
    • Venous Stasis
    • Hypercoagulability
    • Vessel Damage
  51. VQ lung scan to dx PE
    inhale isotope and take pic of lungs

    difference btwn ventilation and perfusion shows PE
  52. Collaborative care for PE
    • provide respiratory and hemodynamic support
    • anti coagulation therapy 
    • IVC insertion
  53. What will be administered if suspected PE
    Heparin IVP...has a short half life so it is ok
  54. PTT- Normal
    Normal 25-35

    Goal 60-75
  55. INR Goal
  56. PT-Normal
    • Normal-12
    • Goal-18-24
  57. Going from heparin to coumadin
    give both until coumadin is at a therapeutic level
  58. Drug given if dx of embolis
  59. Normal Cardiac Index
  60. What two interventions increase CO
    fluids and vasoactive drugs
  61. #1 way to prevent a PE
    OOB ....early and frequent ambulation
  62. Coumadin and green leafy veggies
    either teach dont eat at all....or teach if you are going to eat it always be consistent in the amount you consume
  63. Central venous pressure measures pressure where?
    in the right atrium
  64. Pulmonary artery pressure measures pressure where?
    rt. atrium, pulmonary artery and left ventricle
  65. Which hemodynamic monitor measures overall cardiac function?
    Pulmonary artery pressure....cuz looks at left ventricle too
  66. Normal range for central venous pressure
  67. Normal range for pulmonary artery pressure
    15-25 over 8-15
  68. Low pulmonary artery pressure means....
    low volume
  69. High pulmonary artery pressure means....
    high volume or impedence to pulmonary blood flow
  70. What does pulmonary capillary wedge pressure measure?
    function of the left ventricle by looking at pressures generated by it.....but really tells us how CO is doing.

    Want 4-8L
  71. Preload
    the volume that fills the L ventricle at the end of Diastole
  72. Afterload
    wall tension generated by the LV during systole to open the aortic valve and eject it's contents
  73. What does SVO2 tell me?
    • tells me the balance between oxygen supply and demand.....
    • normal is 60-80%
  74. Whats the problem if you have really low SVO2?
    • the cells  and tissues have used a lot of O2 so they probably have 
    • sepsis
    • infection....but needs more investigation
  75. What does systemic vascular resistance measure?
    • afterload
    • normal is 800-1200
  76. Low SVR?
    not a lot of pressure....so probably vasodilated
  77. High SVR
    lots of pressure....so probably vasoconstricted
  78. How often do I monitor arterial blood pressure and correlate it to cuff BP?
    q shift
  79. What increases pre load
    • fluids
    • blood products
  80. What decreases pre load
    • diuretics
    • venous dilators
    • diuretics
  81. What increases after load
    • vasopressin
    • epi
    • dopa
    • norepi
  82. What decreases afterload
    • nitro
    • ca channel blockers-anti hypertensives
  83. 4 primary goals of intubation
    • maintain patent airway
    • reduce WOB
    • provide a way to remove secretions
    • provide ventilation and oxygenation
  84. List the equipment needed for emergency intubation
    • ambu bag
    • 100% o2 source
    • suction
    • oral airway
  85. Correct ET tube placement is conclusively verified when
    breath sounds are equal bilaterally
  86. Nursing care for the client on a vent includes....
    • monitor clients response
    • apply soft wrist restraints as ordered
    • maintain correct placement of ET Tube

    NOT suctioning every hour to prevent complications
  87. Number of ventilations delivered per minute
    breaths per minute
  88. positive pressure throughout the entire respiratory cycle to prevent alveolar collapse
  89. Set Tidal Volume and Set rate delivered to the client
    controlled ventilation
  90. Pressure needed to deliver a set tidal volume
    Peak Airway Inspiratory Pressure
  91. Positive pressure delivered during EXPIRATION to keep lungs partially inflated
  92. Allows client to breathe at own rate and tidal volume, but breathes for client when needed
    Synchronized intermittent mandatory pressure
  93. volume of air client receives with each breath
    tidal volume
  94. Intervention for normal pH with low PaO2?
    administer O2
  95. Intervention for metabolic acidosis
    correct the cause of metabolic acidosis
  96. Intervention for respiratory acidosis
    increase ventilation....especially the length of ventilation

    pursed lipped breathingg
  97. Intervention for respiratory alkalosis
    decrease ventilations
  98. Intervention for respiratory acidosis with low oxygenation
    increase O2 and increase ventilation
  99. When weaning a client from the ventilator the nurse should....
    observe the monitoring device regularly from a distance but within the clients sight
  100. An expected assessment finding in a recently extubated client is....
  101. Which electrolytes cause PVC's (vent irregularities)
    hypomagnesia and hypokalemia
  102. How do you measure the effectiveness of anti dysrhythmic meds?
    • continuous cardiac monitoring
    • treadmill test
  103. What lab tells a person is in heart failure?
    • Elevated BNP
    • b type natriueretic peptide
  104. ICD is used to control....
    life threatening dysrhythmias
  105. Person with ARDS will receive
    Mechanical Vent with PEEP
  106. Amioderone treats
    V fib and Pulseless V tach
  107. Dopamine treats
  108. Atropine treats
  109. Adenosine treats
    • SVT
    • A Fib...with a wide QRS, asymptomatic
  110. Epi Treats
    • PEA
    • Asystole
    • V fib
    • Pulseless V Tach
    • Brady
  111. Digoxin treats
    A fib
  112. BB and CCB treat
    • A fib
    • PVC
    • PAC with underlying heart issues