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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
Q

when do we auscultate

A

baseline
after treatments
after intubation
after repositioning ET
suspected hypoxemia
sudden detonation in patient or new onset dyspnea

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26
Q

what would we do if the patient has sudden deterioration in patient

A

auscultate

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27
Q

what do we do if the patient has new onset dyspnea

A

auscultate

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28
Q

which side is the bulk of the lung tissue on

A

posterior

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29
Q

we should listen on inspiration, expiration, or both

A

both

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30
Q

crackles may represent

A

fluid

31
Q

how might we treat crackles

A

diuretics

32
Q

rhonchi and wheezes is smaller or larger airways

A

larger

33
Q

nasal cannula can deliver

A

1-6L

34
Q

when will we humidifiy nasal canal

A

above 2 L

35
Q

high flow NC can deliver

A

100% heated and humidified

36
Q

high flow NC can deliver how many liters

A

60

37
Q

what is the most accurate delivery of oxygen

A

venturi mask

38
Q

what patient might we use a Venturi mask on

A

COPD

39
Q

what is the highest delivery of oxygen using low flow

A

non rebreather mask

40
Q

what should the O2 meter be set at for a non reabreather

A

10-15L

41
Q

what type of breathing can lead to drying of secretions and then cause obstruction

A

open mouth breathing

42
Q

how might we help eliminate airway issues

A

oral care

43
Q

when might we suction

A

based on assessed need

44
Q

suctioning the ET might help prevent

A

hypoxemia

45
Q

the ET cuff should be inflated to

A

20-25 mm

46
Q

what happens if the ET cuff is inflated above 20-25

A

could cause ischemia from loss of blood flow which can lead to necrosis

47
Q

what is the average lip line for men and women

A

women is 21
men is 23

48
Q

when might we use mechanical ventilation

A

prevent airway obstruction
prevent aspiration
guarantee FIo2
Glasgow under 8
reduce ICP

49
Q

tidal volume setting

A

6-8mL/kg

50
Q

we want the FIo2 to be set to highest or lowest? why?

A

lowest to prevent hypoxemia

51
Q

ventilator rate settings

A

8-14

52
Q

assist control is

A

same tidal volume with each breath

53
Q

synchronized intermittent mandatory ventilation

A

same TV with breaths established rate

54
Q

what is positive end expiration pressure (PEEP)

A

extra pressure to pop open alveoli which leads to better oxygenation

55
Q

what is important to have in the room

A

bag valve mask

56
Q

symptoms of acute respitrory distress in a mechanically ventilated patient

A

agitation
anxiety
chest pain
mental changes
bucking
arrhythmias

57
Q

if you advance the ET too far, what might happen

A

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
Q

barotrauma

A

trauma due to the expansion of the lungs, over expanded

59
Q

how to prevent ventilator associated pneumonia

A

oral care with antiseptics
maintain HOB at 30-45

60
Q

vesicular breath sounds

A

inspiratory sounds longer than expiratory
soft intensity
low pitch
over most of both lungs

61
Q

bronchovesicular breath sounds

A

inspiratory and expiratory are equal
intermediate intensity
intermediate pitch
1st and 2nd intercostal and between scapula

62
Q

bronchial breath sounds

A

expiratory sounds longer than inspiratory
loud intensity
high pitch
mandibrum

63
Q

tracheal breath sounds

A

equal
loud intensity
high pitch
over trachea and neck

64
Q

fine crackles

A

discontinuous
high pitched
end of inspiration

65
Q

course crackles

A

discontinuous
low pitch
early in inspiration and extend into expiration

66
Q

wheeze

A

continuous
high pitch
more common in expiration

67
Q

rhonci

A

continuous
low pitch
expiration

68
Q

plural friction rub

A

low pitch
course rubbing
inspiration and expiration

69
Q

risk factor for HAP
- host related

A

advanced age
altered LOC
COPD
altered immune system
severity of illness
poor nutrition
hemodynamic compromise
trauma
smoking
dental plaque

70
Q

risk factors for HAP
- treatment related

A

mechanical ventilation
endotracheal intubation
unintentional extubation
bronchoscopy
Ng tube
previous antibiotic theapy
elevated Gastric pH
upper abdominal surgery
thoracic surgery
supine position

71
Q

risk factors for HAP
- infection control related

A

poor handwashing practices

72
Q

why do we want to monitor the patient closely after giving a reverseal agent

A

they can have shorter half lives compared to the sedative

73
Q
A

Med surge 2024 (6 decks)

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