Concepts Exam #2 (Ch. 32)

Question 1

Pulmonary Embolism

Answer 1

Collection of particulate matter (solids, liquids, air) that enters venous circulation and lodges in the pulmonary vessels.

Question 2

Major Risk Factors leading to PE (pulmonary embolism)

Answer 2

Prolonged immobility, central venous catheters, surgery, obesity, advancing age, conditions that increase blood clotting, Hx of thromboembolism.

Question 3

Virchow’s Triad

Answer 3

3 Factors or elements that lead to thrombosis - Blood stasis, hyper coagulability, and intimal change or alteration to a vein wall.

Question 4

Pulmonary Edema

Answer 4

Often caused by Congestive heart failure, it is a condition caused by excess fluid in the lungs, making it difficult to breathe.

Question 5

Acute Respiratory Distress Syndrome (ARDS)

Answer 5

Its Features: Hypoxemia that persists even when 100% o2 is given, decreased pulmonary compliance, dyspnea, non cardiac-assoc. bilateral pulmonary edema.

Question 6

ARDS

Answer 6

Increased genetic risk is suspected in ARDS.

Question 7

How to Diagnose ARDS

Answer 7

Established by a lowered partial pressure of arterial oxygen (Pao2) value (decreased gas exchange and oxygenation), determined by arterial blood gas (ABG) measurements.

Question 8

Interventions for ARDS patients

Answer 8

Intubation, mechanical ventilation with positive end-expiratory pressure (PEEP) or CPAP. Best position for patient is still controversial: Some pts. do better in prone position. Manually turn pts. q2h improves perfusion

Question 9

Nursing Interventions or protocols for emergency intubation and ventilation

Answer 9

Bring code cart, airway equipment box, and suction equipment to bedside. Maintain patent airway (Head-tilt, chin-lift) and insertion of oral or nasopharyngeal airway until patient is intubated.

Question 10

DOPE

Answer 10

Displaced tube, Obstructed tube (most often with secretions), Pneumothorax, and Equipment problems. If an intubated pt. shows manifestations of decreased oxygenation, check for DOPE.

Question 11

Severe Acute Respiratory Syndrome (SARS)

Answer 11

Contagious and sometimes fatal respiratory illness, viral infection caused by a previously unrecognized virus from the Coronaviridae family. Symptoms: Fever, fatigue, headaches, chills, myalgia, dry cough, dyspnea.

Question 12

Nursing Priorities for Mechanical Ventilation

Answer 12

Monitoring and evaluating patient responses, managing the ventilator system safely, and preventing complications. If patient develops respiratory distress, remove ventilator ASAP and provide ventilation with a bag-valve-mask device. This action allows quick determination of whether the problem is with ventilator or with patient.

Question 13

Nursing Alert for Mechanical Ventilation

Answer 13

To prevent bacterial contamination, do NOT allow moisture and water in the ventilator tubing to enter the humidifier.

Question 14

Nursing Alert if you hear stridor or other manifestations of obstruction occur after extubation

Answer 14

CALL Rapid Response Team ASAP before airway becomes completely obstructed.

Question 15

Nurses to Monitors the patient for what during intubation

Answer 15

Vital signs, signs of hypoxia or hypoxemia, dysrhythmias, and aspiration.

Question 16

How long should you take for each intubation attempt?

Answer 16

No longer than 30 seconds, preferably less than 15 seconds. After 30 seconds, provide oxygen by means of a mask and manual resuscitation bag to prevent hypoxia and cardiac arrest.

Question 17

Fraction of Inspired Oxygen (FiO2)

Answer 17

Oxygen level delivered to the patient. Prescribed FiO2 is based on the ABG values and the patient’s condition. The range is 21% - 100% oxygen.

Question 18

Tidal Volume

Answer 18

Volume of air the patient receives with each breath, as measured on either inspiration or expiration. Average prescribed volume ranges between 7-10mL/kg of body weight.

Question 19

Pressure-Regulated Volume Control (PRVC)

Answer 19

Mode of mechanical ventilation, alternative to strict pressure control, representing an attempt to obtain the best of both volume and pressure control.

Question 20

Synchronized intermittent mandatory ventilation (SIMV)

Answer 20

similar to AC ventilation in that tidal volume and ventilatory rate are preset. However, SIMV allows spontaneous breathing at the patient’s own rate and tidal volume between the ventilator breaths.

Question 21

Assist-control Ventilation (AC)

Answer 21

Mode used often as a resting mode. Ventilator takes over the work of breathing for the patient. Tidal Volume and ventilatory rate are preset.

Question 22

Positive End-expiratory Pressure (PEEP)

Answer 22

Positive pressure exerted during expiration. Improves oxygenation by enhancing gas exchange and preventing atelectasis. Treats persistent hypoxemia

Question 23

Pressure Support Ventilation (PSV)

Answer 23

Allows patient’s respiratory effort to be augmented by a predetermined pressure assist from ventilator.

Question 24

PSV

Answer 24

As the weaning process ensues, the amount of pressure applied to inspiration is gradually decreased. Another method of weaning with PSV is to maintain the pressure but gradually decrease the ventilator’s preset breaths/min rate.

Question 25

Ventilator Assoc. Pneumonia (VAP)

Answer 25

ET tube bypasses the body’s filtering process and provides a direct access for bacteria to enter the lower respiratory system. Artificial airway is colonized with bacteria within 48 hours.

Question 26

How to prevent or reduce VAP

Answer 26

Use NaCl solutions combined with mouth swabbing or tooth brushing q2h. Use chlorhexidine oral rinses twice daily.

Question 27

Manifestations of PE

Answer 27

Dyspnea, sharp stabbing chest pain, apprehension, restlessness, feeling of impending doom, cough, hemoptysis.

Question 28

Signs of PE

Answer 28

Tachypnea, crackles, pleural friction rub, tachycardia, S3 or S4 heart sound, diaphoresis, fever, petechiae over chest and axillae, decreased SaO2.

Question 29

Interventions for PE

Answer 29

Apply Oxygen, Place patient in High-Fowlers, Apply telemetry monitor on patient, obtain adequate venous access, assess oxygenation with pulse oximetry, Assess resp. status q30 minutes, assess cardiac status, Ensure prescribed chest imaging and lab tests are obtained ASAP, examine thorax for petechiae, give anticoagulants, assess for bleeding. (wheww! That’s a lot!)

Question 30

Ways to prevent injury and Bleeding when taking anticoagulants

Answer 30

Use electric shaver, soft-bristled toothbrush, do not floss, no contact sports, do not take aspirin, apply ice to area if you are bumped into, avoid hard foods, eat warm, cool, or cold foods to prevent burning mouth, stool softeners.