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A&C II > A&C II Exam 1 > Flashcards

A&C II Exam 1 Flashcards

1
Q

What should be ruled out before diagnosing anxiety?

A

Hypoxia

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2
Q

What are some causes of agitation?

A

Hypoxia, Painful procedures, Invasive tubes, Sleep deprivation, Fear, Anxiety, Stress

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3
Q

What is one possible cause of agitation?

A

Hypoxia

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4
Q

What can cause hypoxia?

A

Sleep deprivation, Invasive tubes, Fear, Anxiety, Stress

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5
Q

What is the common medication used for sedation before paralysis?

A

Etomidate

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6
Q

What is the medication used for paralysis?

A

Succinylcholine

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7
Q

How long does succinylcholine typically last?

A

7 minutes

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8
Q

What is the medication used for longer-lasting paralysis?

A

Rocuronium

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9
Q

How long does rocuronium typically last?

A

30 minutes

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10
Q

What is the medication used for even longer-lasting paralysis?

A

Vecuronium bromide

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11
Q

How long does vecuronium bromide typically last?

A

1 hour

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12
Q

What does ROSC stand for?

A

Return of Spontaneous Circulation

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13
Q

What is a treatment often used after ROSC?

A

Therapeutic Hypothermia

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14
Q

What is pulse oximetry?

A

Measurement of oxygen saturation in the blood

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15
Q

Where is a pulse oximeter typically placed?

A

On a finger

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16
Q

What is the maximum difference between pulse oximetry and actual SaO2?

A

3%

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17
Q

How accurate can pulse oximetry be for anemic patients?

A

Down to 2-3 hemoglobins

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18
Q

What substances are NOT detected by pulse oximetry?

A

Carboxyhemoglobin or methemoglobin

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19
Q

In what setting are special pulse oximeters used to detect carbon monoxide?

A

EMS/Fire setting

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20
Q

What can create a discrepancy between spo2 and sao2?

A

Dark fingernail polish

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21
Q

How much discrepancy may individuals with darker skin experience when o2 saturation is between 70-80?

A

Up to 10%

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22
Q

Is pulse ox helpful for patients experiencing carbon monoxide poisoning?

A

No

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23
Q

What should you do if someone has been exposed to carbon monoxide?

A

Put them on O2 and a lot of it

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24
Q

When should you give high levels of oxygen to someone with carbon monoxide exposure?

A

If they’re symptomatic and had exposure

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25
Q

What is a good site for ICU patients for pulse oximetry?

A

Forehead

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26
Q

Why is the forehead a good site for ICU patients?

A

Forehead arteries are less prone to vasoconstriction

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27
Q

How can venous congestion related to the ventilator affect forehead pulse oximetry?

A

Alters readings

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28
Q

How can the alteration of forehead pulse oximetry be tempered?

A

With an elastic band

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29
Q

What spo2 levels can generate a PaO2 of 60%?

A

92-95%

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30
Q

What is the normal range for PaO2?

A

80-100

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31
Q

What is the normal range for spo2?

A

93-99%

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32
Q

What is the ideal range for spo2?

A

96-99%

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33
Q

Why is pulse oximetry used?

A

To monitor oxygen levels in the body

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34
Q

What can pulse oximetry help diagnose?

A

Respiratory or cardiovascular problems

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35
Q

What are some common troubleshooting steps for pulse oximetry?

A

Check sensor placement, battery level, and patient movement

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36
Q

What can cause inaccurate pulse oximetry readings?

A

Sensor placement, poor circulation, or patient movement

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37
Q

What is the difference between early and late hypoxia signs and symptoms?

A

Not enough detail

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38
Q

What is the trachea?

A

Main airway in the respiratory system

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39
Q

What is the carina?

A

The point where the trachea splits into the left and right bronchi

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40
Q

What are the left and right bronchus?

A

The main branches that lead into the lungs

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41
Q

What are terminal bronchioles?

A

Small airways that lead to alveoli

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42
Q

How many lobes does the right lung have?

A

Three

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43
Q

How many lobes does the left lung have?

A

Two

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44
Q

How can you avoid error in documentation?

A

Be thorough and accurate in recording information

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45
Q

What is the gold standard for checking CO2 levels?

A

Gold

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46
Q

What is the first step in checking for correct placement?

A

End positive CO2

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47
Q

What is the second step in checking for correct placement?

A

Bilateral check expansion

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48
Q

What is the third step in checking for correct placement?

A

Equal bilateral breath sounds

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49
Q

What is the fourth step in checking for correct placement?

A

Intermittent misting on the ET tube

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50
Q

What is the fifth step in checking for correct placement?

A

Absence of breath sounds over the epigastrium

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51
Q

What is the last step in checking for correct placement?

A

X-ray

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52
Q

Is X-ray the gold standard for confirming tube placement?

A

No

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53
Q

What are the steps for checking correct placement of an ET tube?

A

Step 1: end positive CO2, Step 2: bilateral chest expansion, Step 3: equal bilateral breath sounds (nurse, intu, Step 4: intermittent (should be moisture that is going into the tube when they exhale –misting on the ET tube), Step 5: absence of breath sounds over the epigastrium, Step 6: X ray last

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54
Q

What are the primary entry points for air into the respiratory system?

A

Mouth/nose

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55
Q

What is the tube that connects the mouth/nose to the lungs?

A

Trachea

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56
Q

What is the branching airway structure within the lungs?

A

Bronchial Tree

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57
Q

What are the smaller air passages that branch off from the bronchial tree?

A

Bronchioles

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58
Q

Where does gas exchange occur within the respiratory system?

A

Alveoli

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59
Q

Which part of the respiratory system is responsible for the exchange of oxygen and carbon dioxide between the lungs and blood?

A

Gas Exchange

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60
Q

Ventilation

A

Mechanical act of moving air into and out of the respiratory tree

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61
Q

Respiration

A

Transport of oxygen and carbon dioxide between alveoli and pulmonary capillaries

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62
Q

Respiratory Failure

A

Disruption of ventilation or respiration

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63
Q

What is ventilation?

A

The process of moving air in and out of the lungs

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64
Q

What is respiration?

A

The process of exchanging oxygen and carbon dioxide in the body

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65
Q

What is respiratory failure?

A

When the respiratory system is unable to adequately meet the body’s oxygenation needs

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66
Q

What is the role of the diaphragm in ventilation?

A

Contracts to create negative pressure

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67
Q

What muscles are considered accessory muscles in ventilation?

A

Intercostal muscles and sternocleidomastoid

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68
Q

What does increased work of breathing indicate?

A

Distress

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69
Q

What is compliance in terms of ventilation?

A

Ability of lungs to expand and contract

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70
Q

How is compliance changed in chronic lung diseases like COPD?

A

It is reduced

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71
Q

What is compliance?

A

Ability of lungs to expand and contract

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72
Q

What is dead space?

A

Where O2 cannot be exchanged

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73
Q

Can you increase your O2 in your mouth or trachea?

A

No. You need lung tissue for that.

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74
Q

What is physiological dead space?

A

No gas exchange occurs in this area.

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75
Q

What causes physiological dead space?

A

Under perfused alveoli or dead alveoli.

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76
Q

When does ventilation exceed perfusion?

A

When you can breathe but alveoli aren’t exchanging gas.

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77
Q

What are examples of conditions that result in physiological dead space?

A

Pulmonary embolism or pulmonary infarct.

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78
Q

What can anatomical and physiological dead space include?

A

Dead alveoli and other factors.

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79
Q

What happens to physiological dead space with Emphysema?

A

Increases

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80
Q

What happens to physiological dead space with low cardiac output?

A

Increases

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81
Q

What happens to physiological dead space with overdistended alveoli?

A

Increases

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82
Q

What is a shunt unit?

A

Plenty of perfusion but not enough ventilation

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83
Q

Give two examples of conditions that can cause a shunt unit.

A

Pneumonia or atelectasis

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84
Q

What is atelectasis?

A

When the tiny air sacs within the lung become deflated or filled with alveolar fluid

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85
Q

What is a silent unit?

A

Impaired ventilation and perfusion

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86
Q

What are examples of conditions that can cause a silent unit?

A

Pneumothorax, ARDS

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87
Q

What is acute respiratory failure?

A

Failure to maintain adequate gas exchange.

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88
Q

How long does the onset of acute respiratory failure take?

A

Several hours up to several days.

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89
Q

What is the mortality rate of acute respiratory failure?

A

22-75%.

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90
Q

How is acute respiratory failure diagnosed?

A

Based on clinical presentation and ABGs.

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91
Q

What are the two types of acute respiratory failure?

A

Hypoxic and hypercapneic.

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92
Q

What does hypercapnic mean?

A

High levels of carbon dioxide in the blood

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93
Q

What is Type I hypoxemic respiratory failure?

A

Can’t get enough O2 to tissues

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94
Q

What are the causes of Type I hypoxemic respiratory failure?

A

Pneumonia, pulmonary edema, acute respiratory distress syndrome, aspiration, atelectasis

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95
Q

What is the nursing diagnosis for Type I hypoxemic respiratory failure?

A

Impaired Gas Exchange

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96
Q

What are the signs and symptoms of Type I hypoxemic respiratory failure?

A

Decreased SaO2/PaO2, increased respiratory rate

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97
Q

What is the treatment for Type I hypoxemic respiratory failure?

A

Oxygen therapy, treat underlying cause, possible PEEP

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98
Q

What is pulmonary edema?

A

Fluid buildup in the lungs

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99
Q

How is pulmonary edema treated?

A

Give Lasix

100
Q

What is the treatment for severe pulmonary edema?

A

Lasix and BiPAP

101
Q

What are the signs and symptoms of pulmonary edema?

A

Chest wall expansion, poor gas exchange

102
Q

What does ARDS stand for?

A

Acute Respiratory Distress Syndrome

103
Q

What does ARDS affect?

A

Respiration and circulation

104
Q

What is the problem with ventilation in ARDS?

A

Gas exchange is not occurring well

105
Q

What is the problem with circulation in ARDS?

A

Blood is not circulating well

106
Q

What is aspiration?

A

Foreign material in lungs affecting gas exchange

107
Q

How can atelectasis be solved?

A

With PEEP

108
Q

What is the cause of hypercapneic hypoxemic respiratory failure?

A

COPD, neurologic system failure, muscular failure, skeletal alterations

109
Q

What is the nursing diagnosis for hypercapneic hypoxemic respiratory failure?

A

Ineffective Breathing Pattern

110
Q

What are the signs and symptoms of hypercapneic hypoxemic respiratory failure?

A

Increased PaCO2, Decreased pH, Decreased SaO2/PaO2, RR may be increased or decreased (late vs early)

111
Q

What is the treatment for hypercapneic hypoxemic respiratory failure?

A

Improve ventilation, may require mechanical ventilation, treat underlying cause

112
Q

How well are they ventilating?

A

Ventilation

113
Q

How well are they oxygenating?

A

Oxygenation

114
Q

How well is this person breathing?

A

Respiration

115
Q

Deep or shallow?

A

Breathing pattern

116
Q

What can affect ventilation?

A

Respiratory rate and tidal volume

117
Q

What can affect oxygenation?

A

Peep and FIO2

118
Q

What are the ways to change CO2 levels?

A

tidal volume and respiratory rate

119
Q

How is tidal volume determined?

A

based on ideal body weight

120
Q

What is the recommended tidal volume per breath?

A

6-10mL/Kg

121
Q

What is a typical range for tidal volume?

A

400-600 mL

122
Q

What factor should be considered when determining tidal volume?

A

patient’s height

123
Q

Which parameter should be increased to blow off more CO2?

A

respiratory rate

124
Q

What are two ways to increase oxygen?

A

Increase FIO2, Increase PEEP

125
Q

What can be done to increase oxygen levels?

A

Increase FIO2, PEEP

126
Q

How should PEEP be adjusted?

A

Alter in increments of 3

127
Q

What are some ways to decrease CO2?

A

Increase ventilation, increase rate, increase tidal volume

128
Q

What does increasing ventilation mean?

A

Breathe faster and deeper

129
Q

What can decrease CO2 levels?

A

Increase respiratory rate and tidal volume

130
Q

What should patients do to decrease CO2 levels?

A

Breathe faster and deeper

131
Q

How can patients increase CO2 levels?

A

Breathe slower and more shallow or briefly hold breath

132
Q

How can patients increase oxygen levels?

A

Breathe through your nose with nasal cannula

133
Q

How can patients decrease oxygen levels?

A

Turn down or off oxygen

134
Q

What are some ways to decrease something?

A

Remove or decrease

135
Q

What are some ways to increase something?

A

Retain or increase

136
Q

What is another word for increase?

A

Increase

137
Q

What is the opposite of off?

A

Down

138
Q

What is the correct abbreviation for O2 Saturation?

A

o2 SAT

139
Q

What does the term ‘Stat’ mean?

A

now’ or ‘as soon as possible’

140
Q

What does the term ‘Stat’ also stand for?

A

statistics’

141
Q

Does ‘Stat’ represent the saturation of hemoglobin molecules with oxygen?

A

No

142
Q

What is the correct term for saturation of hemoglobin molecules with oxygen?

A

Sat’ or ‘saturation’

143
Q

What are some indications for mechanical ventilation?

A

Apnea with respiratory arrest, Acute lung injury, Respiratory rate > 30, Vital capacity < 15 mL/kg, Minute ventilation > 10 L/min, PaO2 with O2 <55 mmHg, COPD, Clinical deterioration

144
Q

Who generally makes this decision?

A

The physician

145
Q

What is the threshold for intubation in emergency medicine?

A

Less than 8

146
Q

What are indications for mechanical ventilation?

A

Respiratory muscle fatigue, Tachypnea or bradypnea, ABGs with persistent hypoxemia, PCO2 >50 mmHg with pH <7.25, Neuromuscular disease, Inspiratory pressure >-20cmH20, Vital capacity <1.0 or <30% or predicted

147
Q

What is neurogenic see-saw breathing?

A

Alternating contraction of the chest and abdomen muscles resulting in a see-saw pattern of breathing

148
Q

When is mechanical ventilation indicated in trauma?

A

GCS less than 8

149
Q

What is the purpose of mechanical ventilation?

A

To support life when breathing on their own is insufficient

150
Q

What does ABGS stand for?

A

Arterial Blood Gas Analysis

151
Q

Where can table 3-1 be found?

A

Page 56 of the assigned Perrin text

152
Q

What does Allen’s Test involve?

A

Assessing the patency of the radial and ulnar arteries

153
Q

What is the ALLEN test?

A

A test used to assess the blood supply to the hand

154
Q

When should the ALLEN test be done?

A

Always

155
Q

What diagnosis can you likely provide based on pco2 >50 and ph <7.25?

A

Respiratory acidosis

156
Q

What do you think about respiratory muscle fatigue and ABGs?

A

Respiratory muscle fatigue can affect ABG values

157
Q

Are our patients getting tired?

A

Consider the fatigue levels of our patients

158
Q

Would you be too tired to walk after you ran 10 miles?

A

Consider the impact of exercise on fatigue levels

159
Q

Would you be too tired to breathe if you breathed at 4x your normal respirations for 3 days?

A

Consider the impact of increased respiratory effort on fatigue levels

160
Q

Why improve ventilation?

A

Relief of symptoms of respiratory distress

161
Q

What should you not do with a patient’s GCS less than 8?

A

Put them on a BiPAP

162
Q

What is non-aggressive airway management?

A

Airway management without invasive techniques

163
Q

What is high flow oxygen therapy?

A

Oxygen therapy at a flow rate higher than the patient’s inspiratory flow rate

164
Q

What are some examples of high flow oxygen delivery devices?

A

Wide nasal cannula, nasal pillow, facemask

165
Q

How does high flow oxygen therapy help immobilize secretions?

A

Provides heated and humidified air to the upper airways

166
Q

What is CPAP?

A

Continuous Positive Airway Pressure

167
Q

What is BiPAP?

A

Bilevel Positive Airway Pressure

168
Q

What is the difference between CPAP and BiPAP?

A

CPAP delivers a constant pressure, while BiPAP delivers different pressures for inhalation and exhalation.

169
Q

What is C PAP?

A

Continuous pressure

170
Q

What is Bipap?

A

Continuous pressure with extra pressure during inspiration

171
Q

What are the contraindications for using Cpap/BiPap?

A

GCS <8

172
Q

What do adults tend to use for Cpap/BiPap?

A

nose/mouth covering devices

173
Q

What are the benefits of using Cpap/BiPap?

A

Increase patient comfort, Decrease work of breathing

174
Q

Who can benefit from using Cpap/BiPap?

A

patients with COPD AND CHF

175
Q

What should be closely monitored for when using Cpap/BiPap?

A

hypotension-decreases preload and afterload, cardiac output

176
Q

Is it okay if the patient falls asleep while using Cpap/BiPap?

A

Yes, sleep is okay

177
Q

What should be avoided while using Cpap/BiPap?

A

active vomiting

178
Q

What is the effect of cpap and bipap on cardiac output?

A

Decreases cardiac output

179
Q

How does cpap or bipap affect heart rate and blood pressure?

A

Heart rate and blood pressure will drop

180
Q

When should cpap or bipap not be used?

A

When someone is actively vomiting

181
Q

What are CPAP and BIPAP?

A

Continuous Positive Airway Pressure (CPAP) and Bi-level Positive Airway Pressure (BIPAP)

182
Q

What do CPAP and BIPAP stand for?

A

Continuous Positive Airway Pressure (CPAP) and Bi-level Positive Airway Pressure (BIPAP)

183
Q

What are some examples of artificial airways?

A

Pharyngeal airways, endotracheal intubation, Laryngeal mask airway (LMA), Tracheostomy

184
Q

What is the purpose of an artificial airway?

A

To provide a way for air to enter and exit the lungs when a person is unable to breathe on their own

185
Q

What is the technique used to insert a tube into the trachea?

A

Endotracheal intubation

186
Q

What is the most advanced airway?

A

ET tube

187
Q

What is airway management?

A

Management of the upper airway

188
Q

What is the purpose of pharyngeal airways?

A

Preventing tongue obstruction

189
Q

What is the top type of pharyngeal airway?

A

Oropharyngeal airway

190
Q

What is the bottom type of pharyngeal airway?

A

Nasopharyngeal airway

191
Q

What is the recommended way to measure the length from the corner of the mouth to the end of the ear in an awake or responsive patient?

A

Never go into the patient’s mouth.

192
Q

(OPA) Oropharangeal Airway

A

What does OPA stand for?

193
Q

What is contraindicated for having a GAG reflex?

A

Mouth!

194
Q

What is contraindicated for being alert?

A

Mouth!

195
Q

What is a Nasopharyngeal Mask NPA?

A

Soft plastic/rubber

196
Q

Can a Nasopharyngeal Mask NPA be used with a gag reflex?

A

Yes

197
Q

Can a Nasopharyngeal Mask NPA be used if the person is conscious?

A

Yes

198
Q

How should the Nasopharyngeal Mask NPA be inserted?

A

Slide the lubricated tip through the nares toward the posterior pharynx

199
Q

What size should be chosen for the Nasopharyngeal Mask NPA?

A

Smaller than the nare

200
Q

When can anesthesia be used?

A

On an awake patient

201
Q

What is a laryngeal mask airway (LMA)?

A

A device used for airway management

202
Q

What should you do with the bulb of the LMA?

A

Deflate it

203
Q

Should you lubricate the device or the patient’s airway?

A

The device

204
Q

What should you do to the tongue when using an LMA?

A

Displace it

205
Q

How should you follow the curve of the airway with the LMA?

A

Follow it

206
Q

How much air should you inflate the LMA with?

A

Usually 30+ ml air

207
Q

What should you do after inflating the LMA?

A

Ventilate and confirm CO2 waveform or ‘gold is good’

208
Q

What is endotracheal intubation?

A

Inserting a tube into the trachea to maintain an open airway

209
Q

What is the preferred and most common method of endotracheal intubation?

A

Oral endotracheal tube

210
Q

What is the alternative method of endotracheal intubation?

A

Nasal endotracheal tube

211
Q

What does ETT stand for?

A

Endotracheal tube

212
Q

What is the first step in airway management with ETT?

A

Preoxygenate/Hyperoxygenate

213
Q

What should be monitored and documented during intubation?

A

Oxygenation status and cardiac status

214
Q

What does NADIR stand for?

A

Lowest SPO2 during intubation

215
Q

When should sedatives be administered?

A

In the presence of a provider capable of intubation

216
Q

When should the paralytic be given?

A

When the provider capable of intubation is ready and after sedation

217
Q

How should the successful placement of the tube be documented?

A

In the chart with the size, depth, and confirmation methods

218
Q

What is the purpose of pre-oxygenating the patient?

A

To ensure adequate oxygenation before a procedure.

219
Q

What are the 6 methods of ETT confirmation?

A

Positive end tidal CO2, equal rise and fall of the chest, equal bilateral breath sounds, absence of breath sounds over the epigastrum, intermittent misting of tube, chest x-ray

220
Q

What is the desired range for end tidal CO2?

A

35-45

221
Q

What is the preferred method for ETT confirmation?

A

Positive end tidal CO2

222
Q

What device is commonly used for ETT confirmation?

A

Gold-is-good device

223
Q

What are two additional methods of ETT confirmation?

A

Chest x-ray and intermittent misting of tube

224
Q

Why is a chest x-ray preferred for ETT confirmation?

A

Provides a definitive confirmation

225
Q

How was the patient pre-oxygenated?

A

15LPM via nasal cannula

226
Q

What was the patient’s O2 saturation before intubation?

A

99%

227
Q

What was the size of the endotracheal tube (ETT)?

A

7.5

228
Q

Where was the ETT placed?

A

23cm at the teeth

229
Q

How was the ETT placement confirmed?

A

Waveform capnography

230
Q

What was the range of waveform capnography maintained?

A

35-45

231
Q

What were the signs of correct ETT placement?

A

Equal rise and fall of the chest, equal bilateral breath sounds

232
Q

Who confirmed the ETT placement?

A

Danielle, RN and Jimmy, RT

233
Q

What is in progress for further confirmations?

A

Xray

234
Q

What should you do with your medications?

A

Document on the MAR

235
Q

How long should sedatives be given before paralytics?

A

Around 60 seconds

236
Q

What should you always document?

A

NADIR

237
Q

What should you document regarding intubation?

A

How long it took

238
Q

What should you document regarding teeth?

A

Measurement of tooth location (use gums if no teeth)

239
Q

What should you measure when maintaining an endotracheal tube?

A

Depth, cuff pressure, patient secretions

240
Q

What device can be used to measure cuff pressure?

A

Cuffalator

241
Q

What does the color green indicate?

A

Go

242
Q

What does the color red indicate?

A

Stop

243
Q

What should you do to stay safe?

A

Stay in the green zone!

244
Q

What can happen if you are in the red zone?

A

Tracheal necrosis

245
Q

Why does elevating the HOB help prevent aspiration while ventilated?

A

Prevents gastric contents from flowing back into the lungs

246
Q

What temperature helps prevent vap?

A

at least 30 degrees

247
Q

What does heating to at least 30 degrees help prevent?

A

vap

A&C II (3 decks)

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