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Med surge 2024 > Basic Guidelines for Safe Care of the Patient Receiving Pulmonary Therapeutic Management > Flashcards

Basic Guidelines for Safe Care of the Patient Receiving Pulmonary Therapeutic Management Flashcards

1
Q

included on pulmonary assessment
- history

A

smoker or past diagnosis

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2
Q

pulmonary assessment
- insepction

A

respiratory rate
accessory muscles
sputum
skin color
skin turgor

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3
Q

Palpation

A

subcutaneous emphysema (crepitus)

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4
Q

pulmonary assessment
- auscultation

A

bilateral lung sounds

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5
Q

pulmonary assessment

A

last ABG
SpO2
O2 delivery system
airway
WBC
weaning parameters

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6
Q

bands

A

immature forms of neutrophils

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7
Q

what do bands indicated

A

infection

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8
Q

shift to the left is

A

6% or greater

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9
Q

where is a ABG usually drawn from

A

radial artery

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10
Q

ABG is a measurement of

A

gases (oxygenation and ventilation)

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11
Q

ABG normal values

A

pH: 7.35-7.45
PO2: 80-100
PCO2: 35-45
HCO3: 22-26

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12
Q

hypoxemia value

A

O2 less than 80

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13
Q

severe hypoxemia value

A

less than 60

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14
Q

why might respiratory alkalosis happen

A

hyperventilation
anxiety
fear

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15
Q

why might respiratory acidosis happen

A

decrease is respiratory rate or volume
hypoventilation
CNS depression
airflow obstruction: OSA, COPD, asthma

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16
Q

why might metabolic acidosis happen

A

decrease in perfusion
sepsis
cardiac arrest
hypovolemia
diarrhea

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17
Q

why might metabolic alkalosis happen

A

vomiting
NGT suction
excessive diuretics

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18
Q

why might mixed metabolic and respiratory acidosis happen

A

anoxia
cardiac arrest

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19
Q

how to we know the ET is placed above the carina

A

CXR

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20
Q

how far above the carina do we want the ET

A

4 cm

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21
Q

what information might a chest Xray provide

A

chest infiltrates
heart failure
pneumothorax
pleural effusuon
pneumonia
ARDS

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22
Q

will atelectasis require intubation?

A

maybe, it will help pop open the alveoli

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23
Q

for safety what do we want to check on the ET

A

well secured at the lip line

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24
Q

what is the lip line

A

number at lips to make sure tube didn’t move in or out

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25
when do we auscultate
baseline after treatments after intubation after repositioning ET suspected hypoxemia sudden detonation in patient or new onset dyspnea
26
what would we do if the patient has sudden deterioration in patient
auscultate
27
what do we do if the patient has new onset dyspnea
auscultate
28
which side is the bulk of the lung tissue on
posterior
29
we should listen on inspiration, expiration, or both
both
30
crackles may represent
fluid
31
how might we treat crackles
diuretics
32
rhonchi and wheezes is smaller or larger airways
larger
33
nasal cannula can deliver
1-6L
34
when will we humidifiy nasal canal
above 2 L
35
high flow NC can deliver
100% heated and humidified
36
high flow NC can deliver how many liters
60
37
what is the most accurate delivery of oxygen
venturi mask
38
what patient might we use a Venturi mask on
COPD
39
what is the highest delivery of oxygen using low flow
non rebreather mask
40
what should the O2 meter be set at for a non reabreather
10-15L
41
what type of breathing can lead to drying of secretions and then cause obstruction
open mouth breathing
42
how might we help eliminate airway issues
oral care
43
when might we suction
based on assessed need
44
suctioning the ET might help prevent
hypoxemia
45
the ET cuff should be inflated to
20-25 mm
46
what happens if the ET cuff is inflated above 20-25
could cause ischemia from loss of blood flow which can lead to necrosis
47
what is the average lip line for men and women
women is 21 men is 23
48
when might we use mechanical ventilation
prevent airway obstruction prevent aspiration guarantee FIo2 Glasgow under 8 reduce ICP
49
tidal volume setting
6-8mL/kg
50
we want the FIo2 to be set to highest or lowest? why?
lowest to prevent hypoxemia
51
ventilator rate settings
8-14
52
assist control is
same tidal volume with each breath
53
synchronized intermittent mandatory ventilation
same TV with breaths established rate
54
what is positive end expiration pressure (PEEP)
extra pressure to pop open alveoli which leads to better oxygenation
55
what is important to have in the room
bag valve mask
56
symptoms of acute respitrory distress in a mechanically ventilated patient
agitation anxiety chest pain mental changes bucking arrhythmias
57
if you advance the ET too far, what might happen
right main stem intubation since the left lung is on an angle because of the heart so you will have absent left lung sounds
58
barotrauma
trauma due to the expansion of the lungs, over expanded
59
how to prevent ventilator associated pneumonia
oral care with antiseptics maintain HOB at 30-45
60
vesicular breath sounds
inspiratory sounds longer than expiratory soft intensity low pitch over most of both lungs
61
bronchovesicular breath sounds
inspiratory and expiratory are equal intermediate intensity intermediate pitch 1st and 2nd intercostal and between scapula
62
bronchial breath sounds
expiratory sounds longer than inspiratory loud intensity high pitch mandibrum
63
tracheal breath sounds
equal loud intensity high pitch over trachea and neck
64
fine crackles
discontinuous high pitched end of inspiration
65
course crackles
discontinuous low pitch early in inspiration and extend into expiration
66
wheeze
continuous high pitch more common in expiration
67
rhonci
continuous low pitch expiration
68
plural friction rub
low pitch course rubbing inspiration and expiration
69
risk factor for HAP - host related
advanced age altered LOC COPD altered immune system severity of illness poor nutrition hemodynamic compromise trauma smoking dental plaque
70
risk factors for HAP - treatment related
mechanical ventilation endotracheal intubation unintentional extubation bronchoscopy Ng tube previous antibiotic theapy elevated Gastric pH upper abdominal surgery thoracic surgery supine position
71
risk factors for HAP - infection control related
poor handwashing practices
72
why do we want to monitor the patient closely after giving a reverseal agent
they can have shorter half lives compared to the sedative
73

Med surge 2024 (6 decks)

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