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Critical Care Nursing Exam 1 > Airway management > Flashcards

Airway management Flashcards

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1
Q

What is an ABG?

A

Arterial blood gas; invasive

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2
Q

What is a noninvasive method of obtaining CO2 status?

A

End-tidal CO2

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3
Q

Normal Range of End-tidal CO2

A

35-45

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4
Q

A most important way to tell if a patient is going into respiratory distress?

A

If they change from baseline, KNOW YOUR TRENDS!!!

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5
Q

What is colorimetric?

A

an inexpensive alternative to capnometry

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6
Q

What does colorimetric paper turn if the CO2 is not detected or is low?

A

Purple

Remember PURPLE=PROBLEM

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7
Q

what does the colorimetric paper turn if the CO2 is adequate?

A

Yellow
REMEMBER YELLOW=YES
and it should be from 35-45 to turn yellow.

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8
Q

What is capnometric?

A

the numeric reading of CO2 level

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9
Q

What is Capnographic?

A

Includes numeric and waveforms to visualize and detect CO2 levels

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10
Q

What is a filterline?

A

A nasal cannula with a bulb at the end to detect CO2 levels can deliver up to 5 liters of oxygen

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11
Q

What should you do before calling the doctor if the patient’s sats are off on a filterline?

A

Check the tubing for occlusion or blockage

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12
Q

When do we use ETCO2?

A

in patients with sleep apnea
in patients on PCA pumps
Patients receiving procedural sedation

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13
Q

will you get an ETC02 reading on a patient that is coding?

A

NOOOOOO
the patient is temporarily (or permanently) dead, therefore they have no perfusion, which means no oxygen is perfusing throughout the body.

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14
Q

causes of low ETC02?

A
  1. Pulmonary embolism
  2. DKA
  3. Respiratory conditions ( COPD….etc)
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15
Q

Why would a pulmonary embolism cause low ETC02?

A

this means there is a blocked pulmonary artery which causes less C02 rich blood to return to the lungs, therefore less c02 is exhaled.

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16
Q

why would DKA cause low ETC02?

A

DKA presents with rapid and shallow breathing, difficulty breathing, and low ETC02 as the body tries to compensate. Respiratory compensation for this acidotic condition results in Kussmaul respirations and this causes the acidosis to become more severe.

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17
Q

signs and symptoms of a PE?

A

SOB, Chest pain, SOA, anxiety, sense of doom

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18
Q

What intervention can be used in between needing a ventilator

A

BiPap can be used in the meantime!

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19
Q

Why does respiratory failure occur with a high ETC02?

A

increased effort to breathe doesn’t eliminate the excess C02, causing C02 to accumulate in the lungs and more of it is excreted with each breath, causing the ETC02 level to rise.

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20
Q

What can increased work of breathing and C02 retention lead to?

A

respiratory arrest and assisted ventilation

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21
Q

What is the best way to prevent respiratory arrest?

A

Continue to monitor!!!

The earlier you catch this, the better off the patient will be!!!!!

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22
Q

Causes of elevated EtC02?

A

Metabolism: Pain, Hyperthermia, Shivering
Respiratory: Insufficiency, Depression, COPD, Analgesia and sedation
Circulatory: Increased Cardiac output
Medications: Bicarbonate administration

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23
Q

Causes of decreased EtC02?

A

Metabolic: Hypothermia, Metabolic acidosis
Respiratory: Alveolar hyperventilation, bronchospasm, and mucus plugs
Circulatory: Hypotension, sudden hypovolemia, cardiac arrest, and pulmonary emboli

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24
Q

True or False? EtC02 is a noninvasive method, which continuously monitors inhaled C02 concentration?

A

FALSE

It is a non invasive method; but it measures exhaled C02, not inhaled.

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25
Q

What is the most common ET tube size?

A

7.5 and 8.0

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26
Q

What are the 2 places ET tubes can be placed?

A

Nose and Mouth

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27
Q

Why would the nose be used instead of the mouth?

A

if there is trauma to the mouth

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28
Q

Indications for endotracheal intubation?

A 
Maintains airway patency
Manage the airway
Deliver high percentage of oxygen
Bypass an obstruction
protect airway from aspiration
alternative route for meds
29
Q

What meds can be used through the endotracheal route?

A

N-Narcan (opioid displacement)
A:Atropine (Increase HR with symptomatic bradycardia)
V: Vasopressin (Increase HR and BP, vasoconstrict)
E: Epinephrine (Increase HR and BP and vasoconstrict)
L: Lidocaine (rate control and heart support)

30
Q

When do you sedate the patient for an ET insertion?

A

If the patient is awake, and not unconscious

31
Q

What is the best way to prepare for intubation?

A

KNOW THE SIGNS OF RESPIRATORY DISTRESS AND ACT BEFORE IT GETS TO THIS POINT

32
Q

What is a RSI?

A

rapid sequence intubation; when they push the paralytic and intubate at the same time

33
Q

When can a RSI not be done?

A

with a patient that is comatose or in cardiac arrest

34
Q

Why is a RSI performed?

A

Decreases risks of aspiration, combativeness, and injury to the patient

35
Q

What is the Train Of Four?

A

delivers electrical impulse to the radial or temporal artery, this is done to check for effectiveness of the paralytics.

36
Q

what is the goal for a Train of Four?

A

2 of 4 is the goal; The artery will flicker twice if effective.

37
Q

When do we use the temporal artery instead of the radial for the Train of Four?

A

If the Radial doesn’t work.

38
Q

What does a high train of four indicate?

A

That the paralytic is not strong enough

39
Q

What does a low train of four indicate?

A

that the paralytic is too strong

40
Q

What is the most common sedative used?

A

Midazolam (versed)

41
Q

Why are paralytics used for intubation?

A

to prevent the patient from being combative, bucking the vent, pulling the ETT and increases the ease of ventilation

42
Q

Examples of paralytics?

A

Succinylcholine, Vecuronium, Mivacurium, Rocuronium, Pancuronium, Curare

43
Q

How long do you ventilate before ET placement?

A

100% 02 for 3-5 minutes

44
Q

what is the longest an intubation attempt should last?

A

30 seconds MAXIMUM

45
Q

How to confirm ET placement?

A

XRAY

46
Q

Why is C02 not detected during cardiac arrest?

A

There is no perfusion

47
Q

How can you tell if the tube has gone in the right main stem?

A

Not bilateral lung sounds

48
Q

can you get a false positive on a Colorimetric detector?

A

Yes, if there is the presence of gastric acid, and acidic drugs, such as trach administered epinephrine, it can give a false positive.

49
Q

why is incorrect tube placement considered an emergency?

A

The patient is not ventilating

50
Q

Nursing management related to incorrect placement

A

Stay with pt and maintain airway ( BVM 100% 02), Support ventilation, prepare for reintubation, monitor VS, EKG, and pulse ox

51
Q

What do we chart as the nurse?

A

cm of placement at a landmark (ex. 38cm at lip) and size of tube (ex. 8.0 French)

52
Q

Complications of intubation?

A

Injury to the lips, teeth and oropharynx, vocal cords; vomiting and aspiration, trigger of the vagus nerve causing bradycardia, esophageal intubation, right main stem intubation

53
Q

Where should the ET be placed?

A

3-5cm above the carina

54
Q

NSG management related to ET cuff

A

maintain proper cuff inflation
Stabilize and seals ET within trachea
prevent escape of vent gases
cuff can cause tracheal damage from pressure on mucosa

55
Q

how to prevent tracheal trauma from ET cuff?

A

measure and record ET cuff pressure

IF IN DOUBT CALL RT!!!!!!!!!!

56
Q

When do you suction?

A

when secretions are visible, mouth is full, or decrease in 02!

57
Q

Why do we not suction unless absolutely necessary?

A

can alter the ABG, cause the pt extra stress

58
Q

Indications for suctioning?

A

Visible secretions, sudden onset of respiratory distress, potential aspirations of secretions, increase in peak airway pressures alarming, auscultation of extra breath sounds over trachea and bronchi (fluid buildup in lungs), increased RR, and coughing, drop in Pa02 or SP02.

59
Q

complications r/t suctioning

A

hypoxia, bronchospasm (coughing), increased ICP, dysrhythmias, PVCs, Hyper or hypotension, mucosal damage, bleeding, infection

60
Q

technique for suctioning?

A 
hyperoxygenate before and after each suctioning pass
insert catheter the length of the tube
limit each pass to 10 seconds or less
assess trends in SP02
limit pressures to 120mmHG or less
avoid vigorous catheter insertion
61
Q

Indications for suctioning?

A

visible secretions, decrease in 02, bucking the ventilator

62
Q

How to prevent Ventilator Associated Events (VAE)?

A
  1. Q2H oral care
  2. DVT prophylaxis (heparin, lovenox (SQ or drip))
  3. Gut feedings
  4. Elevating HOB (30 degrees)
  5. handwashing and gloving
  6. prevention of pressure ulcers.
63
Q

ET med dosage?

A

2-2.5 times higher through the ETT, mixed with NS, followed by 1-2 ventilations/

64
Q

preferred route for NAVEL medications?

A

IV and IO

65
Q

Liters used on Nasal Cannula?

A

1-6 liters/min delivering 25-45% 02

66
Q

Liters used on Simple Face Mask?

A

6- 10 Liters/min delivering 35-60% 02

67
Q

Liters used on nonrebreather mask?

A

10-15 L/min delivering up to 100% 02

68
Q

liters used on venturi mask?

A

4-8 l/min delivering 24-60% oxygen

Critical Care Nursing Exam 1 (3 decks)

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