complex final Flashcards
Pulm: Describe the expected finding of a chest tube suction control chamber and water seal chamber
Gentle, continuous bubbling of the suction control chamber is normal and expected. Bubbling in the water seal chamber during exhalation or coughing indicates that air is being pulled from the pleural space. The bubbling should not be excessive or continuous. If it does, there is an air leak somewhere in the chest tube
Pulm: Describe why a patient with a spontaneous pneumothorax is at risk of developing a tension pneumothorax
Air in the pleural space compresses the vessels in the chest cavity and compromises blood return to the heart. As more air accumulates, there is greater risk of displacing the trachea (tension pneumothorax). This is an emergency.
Pulm: Describe the rationale for placing a patient who was recently extubated in the semi-fowler’s position
Patients who are extubated are at high risk for airway compromise due to the trauma in the airway. The semi-fowler’s position is safest for the patient because it maximizes ventilation and comfort for the patient
Pulm: Describe the circumstances and rationale for placing a patient on a specialty bed that rotates to prone position
Patients with ARDS, COVID-19, and other profound respiratory compromise benefit from frequently being placed in the prone position. This promotes gas exchange and decreases the risk of secretions which can cause other complications
Pulm: Discuss the rationale of performing high quality oral care for mechanically ventilated patients
Oral care should be performed using a suction toothbrush at least every 12 hours on patients who are mechanically ventilated in order to prevent Ventilator Acquired Pneumonia.
Pulm: Explain the post-op priorities to conserve lung health
Ambulate early and often
Turn, cough, deep breath
Use incentive spirometer at 10 times per hour
Describe the rationale for prioritizing airway management when a patient is moved into prone position
The process of moving a patient into prone position places risk to the vulnerable lines and tubes
Pulm: Describe symptoms of pulmonary embolism and how a PE is diagnosed
Patient’s with a new onset PE will manifest with symptoms like dyspnea, diaphoresis, and signs of hypoxia diagnosed with a CXR, ABGs, and an EKG to rule out underlying cardiac problems
Describe why a nurse might use an ambu bag to manage a patient on mechanical ventilation.
A nurse may use an ambu bag to mainain an artifical airway of a patient with mechanical ventilation when they are transporting to another department and when a ventilator malfunctions and a respiratory therapist is preparing an alternative ventilator for the patient
Cardio: What is Mean Arterial Pressure and how is it calculated?
Used to assess perfusion pressure
Normal: 70-100 mm Hg
<70 indicates poor tissue perfusion: decrease urine output, mental status change, things are changing in trend poorly
low 70s are worth notifying doctor over
Calculating MAP:
SBP + (2xDBP)/3
Cardio: Explain why defibrillation takes priority over any other intervention when a patient is in ventricular fibrillation
The greatest risk to the client is death from a lack of cardiac output. Ventricular fibrillation is a lethal rhythm in which the ventricles are in a quivering pattern and there is no atrial activity. Defibrillation is essential to resolve ventricular fibrillation promptly and convert the rhythm to restore cardiac output. The nurse should follow defibrillation with cardiopulmonary resuscitation and repeated defibrillation, if necessary, to convert the ventricular fibrillation into a sustainable rhythm.
Cardio: Explain the difference between V. Tach with a pulse and pulseless V. Tach
V. Tach with a pulse is typically intermittent and the patient should be observed and treated for symptoms. Pulseless V. Tach is a shockable rhythm and defibrillation is the priority action
Cardio: Describe why pulmonary embolism is a high risk complication of atrial fibrillation
Altered atrial contractions can cause blood pooling and thrombus formation. The client is at risk for developing a pulmonary embolism or embolic stroke. The client should monitor and report immediately manifestations, such as shortness of breath, or neurological changes.
Cardio: What specific assessment must be done before administering Digoxin and why?
Digoxin decreases the heart rate, so the nurse should count the apical pulse for at least 1 min before administering. The nurse should hold the medication and notify the provider if the client’s heart rate is below 60/min or if a change in heart rhythm is detected.
Cardio: Describe the use of dopamine for left ventricular failure
Dopamine is a pressor. When dopamine has a therapeutic effect, it causes vasoconstriction peripherally and increases systolic blood pressure. It helps to increase cardiac output and urine output.
Cardio: State the arrhythmias that are shockable and describe why defibrillation is the priority action
Ventricular Fibrillation and Pulseless Ventricular Tachycardia
Both of these are incompatible with life because there is virtually no cardiac output due to the left ventricle not squeezing efficiently.
Cardio: Describe the characteristics of Atrial Fibrillation
In A. Fib, there are multiple foci of electrical stimulation in the atria which makes the isometric line of the ECG appear squiggly and without a visible P wave. The QRS complex is present because occasional beats are fully conducted.
Cardio: Describe why Amiodarone is the treatment of choice for a patient who converts into ventricular tachycardia but has a pulse
Ventricular tachycardia with a pulse is not defibrillated nor is CPR started. Pacing is not indicated. The rhythm will be treated with antiarrhythmics
Cardio: Describe vagal maneuvers and why you would use them
Vagal maneuvers refer to actions that stimulate the vagus nerve and causes the heart rate to slow down. Things like baring down and carotid stimulation are considered vagal maneuvers and are used for patients with stable supraventricular tachycardia (SVT)
Cardio: Describe the priority nursing action for a patient in asystole and why
A patient in asystole should be given high-quality CPR as a priority. Defribrillation is not indicated for asystole because there is no electrical activity.
Cardio: State proper delivery of adenosine for tachycardic arrhythmias
Adenosine must be delivered in a controlled environment such as an ICU setting where advanced cardiac life support resources are readily available.
Cardio: Describe the rationale for using IV amiodarone
Amiodarone is used as an antiarrhythmic for maintenance of normal rhythms
Pulm: Signs of respiratory stress post extubation
stidor: high pitch whistling sound while taking a breath
respirations either increase or decrease intensely
increased heart rate
cyanosis
Pulm: Respiratory acidosis
Respiratory acidosis occurs when everything SLOWS down. High CO2 combined with low pH.
Low and slow RR
Sleep apnea, head trauma “knocked out,” post-operative, pneumonia, COPD or asthma attack
Drugs = CNS depressants – opioid overdose, alcohol intoxication, benzodiazepines
Pulm: Respiratory alkalosis
Respiratory alkolosis occurs when everthing SPEEDS up. Low CO2 and high pH.
Fast RR
Panic attack
Pulm: Metabolic alkalosis
Metabolic alkalosis occurs when the normal acids in the body are depleted. High bicarb and high pH.
vomiting, NGT suctioning
