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RTH 132 Hannah > Basic Patient Assessment > Flashcards

Basic Patient Assessment Flashcards

1
Q

The view from the door

A
  • color
  • RR
  • breathing pattern
  • use of accessory muscles
  • chest movement
  • easily audible breath sounds
  • WOB
  • LOC
  • monitor displays
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2
Q

Specific doc orders or protocol

A
  • must have a specific order for the vent or a protocol to follow
  • protocols are unique for each setting
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3
Q

What is OVP?

A

a self test and required paperwork

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4
Q

AARC ventilator check

A
  • recorded and are parts of the medical record
  • includes patient info and observations at time of check
  • record should include drs. ordered settings
  • other information is imperative regarding pt-vent interface and observations
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5
Q

What is charting by exception?

A

don’t have to chart the normal stuff but do have to chart abnormal stuff

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6
Q

What is included in a vent check?

A
  • modes
  • sensitivity
  • auto-PEEP (must be measured. may be difficult to trigger if auto-PEEP)
  • accessory muscle usage - ex flow
  • can increase flow to shorten IT. change mode to allow for more spontaneous breaths
  • if auto-PEEP and you increase PEEP, plat/peak will not change (or if PV, VT won’t change)
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7
Q

What should you keep in mind during a vent check?

A
  • IMV and demand flow. watch triggering
  • VE, VT and F - measure by hand
  • correcting for tubing compliance
  • PB 7200/840 corrects for tubing compliance
  • set volume = delivered volume
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8
Q

How can you tell if you have auto-PEEP?

A

by doing an expiratory hold or adding PEEP but nothing changes

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9
Q

What is the tubing compliance for most circuits?

A

3-4

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10
Q

Why do you subtract PEEP when calculating tubing compliance?

A

we want to figure out what the driving pressure is

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11
Q

First 30 mins of intubation

A
  • breath sounds = volume and tube placement
  • vital signs checked - HR, BP
  • alarms set - at least high/low pressure, low VT and apnea
  • ABG within 15 minutes
  • chest xray
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12
Q

What is the first thing you should do when assessing a patient?

A

listen to breath sounds

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13
Q

What should you set the FiO2 as when first intubating unless a blood gas says otherwise?

A

100%

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14
Q

Vitals, exam of chest

A
  • EKGs
  • temp increase or decrease
  • BP
  • CVP
  • PAP
  • PE exam
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15
Q

What would cause an increase in temperature?

A
  • atelectasis
  • infection
  • tissue necrosis
  • CA Hodgkins
  • leukemia hyperthyroidism
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16
Q

What would cause a decrease in temperature?

A
  • met disease
  • CNS disorders
  • drugs
  • alcohol, heroin, CO
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17
Q

For every degree high in temp, your metabolic rate increases by what?

A

10%

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18
Q

How do you set the trigger sensitivity?

A

select lowest level to cycle without auto cycling

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19
Q

What are the top reasons a machine will not cycle?

A
  • sensitivity set too low
  • auto-PEEP
  • high bias flow
  • abdominal paradox
20
Q

What does “alveolar ventilation is not ventilation” mean?

A

just because air is going in and out doesn’t mean it’s in contact with alveolus

21
Q

Normal alveolar ventilation

A

3.5 L

22
Q

Normal CO2

A

40

23
Q

Normal minute ventilation

A

5 L

24
Q

Normal dead space

A

1.5 L

25
Q

What does it mean if someone’s CO2 was 41 one day and 52 the next?

A

his dead space went up

26
Q

What should you keep an eye on when monitoring airway pressure?

A
  • peak inspiratory pressure
  • plateau pressure
  • Raw
  • EEP
  • MAP
  • pressure limit
  • low pressure alarm
  • checking for leaks
27
Q

What should plateau pressure always be below?

A

30

28
Q

What is mean airway pressure?

A

the average pressure of an airway

29
Q

What is plateau pressure?

A

no airflow

30
Q

What is the difference between plateau and mean airway pressures?

A

plateau pressure is usually higher because it only includes the inspiratory phase while the mean airway pressure includes both inspiratory and expiratory phases

31
Q

What is the purpose of the five-step protocol?

A

to minimize over inflation leading to tracheal necrosis

32
Q

What is the first step of the five-step protocol?

A

the minimal leak technique (MLT) should be used whenever possible

33
Q

What is the second step of the five-step protocol?

A

a reasonable MLT should be established, one in which only 50 to 100 mL of VT is lost during inspiration. for example, in vc-cmv with a 600 mL VT setting and delivery, the VTe is 500-550 mL

34
Q

What is the third step of the five-step protocol?

A

a high-volume low-pressure cuff should not require more than 5 mL for inflation. if it does, the tube is probably too small

35
Q

What is the fourth step of the five-step protocol?

A

if a minimal leak cannot be maintained with a cuff volume of less than 5 mL then the practitioner should make sure that the intracuff pressure is less than 25 mmHg and that the cuff-to-tracheal diameter ratio checked on chest radiograph is 1:1.5 or less

36
Q

What is the fifth step of the five-step protocol?

A

if steps 1 through 4 cannot be achieved, follow-up evaluation of the patient for tracheal stenosis should be performed for at least 1 year after discharge

37
Q

What should you keep an eye on when monitoring compliance?

A
  • static compliance
  • dynamic compliance
  • airway resistance
  • bedside measuring of press-volume curve
38
Q

What does it mean if there are no changes in compliance and resistance when measuring the pressure-volume curves?

A

it’s not the lung

39
Q

What does it mean when there is a decrease in compliance?

A

large change in pressure but no change in volume

40
Q

What does compliance mean?

A

how much work 1 cmH2O is doing. if it is distending one at 20 and another at 30, the second lung has better compliance

41
Q

What happens when there is a decrease in dynamic compliance in PCV?

A

pressure will not change but VT delivery will fall

42
Q

What happens when there is a decrease in dynamic compliance in CMV?

A

VT will not change but pressure will fall

43
Q

When you change static compliance, you will also change ___

A

dynamic compliance

44
Q

What does it mean when there is no change in peak or plateau pressures?

A

no change in airway resistance since peak-plat = Raw

45
Q

What happens when plateau stays the same but peak changes?

A

change in airway resistance

46
Q

If plateau stays the same, there is no change in what?

A

static compliance

RTH 132 Hannah (12 decks)

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