Control Comp #2 (Capnography (Mech Vent), CXR for Tubes and Lines, Adult Extubation, Adv Weaning Parameters)

Question 1

Ventilatory Support - Capnography (Vent) (1)
Procedure Steps (11 Steps)

Answer 1

Procedure Steps
1. Verifies physician’s order* for ETCO2
2. Scans chart for any other pertinent data
3. Gathers and assembles equipment
4. Washes hands and applies appropriate PPE*
5. Identifies patient, introduces self and department*
6. Plugs monitor into electrical source, calibrates monitor, and connects to patient airway
7. Troubleshoots as necessary
8. Correlates ETCO2 reading to ABG
9. Thanks patient, assures patient safety*
10. Washes or gels hands, and disposes of PPE
11. Documents the treatment appropriately*

Question 2

Ventilatory Support - Capnography (Vent)
Procedure Steps (Steps 1-5)

Answer 2

Procedure Steps
1. Verifies physician’s order* for ETCO2
2. Scans chart for any other pertinent data
3. Gathers and assembles equipment
4. Washes hands and applies appropriate PPE*
5. Identifies patient, introduces self and department*

Question 3

Ventilatory Support - Capnography (Vent)
Procedure Steps (Steps 6-8)

Answer 3

6. Plugs monitor into electrical source, calibrates monitor, and connects to patient airway
7. Troubleshoots as necessary
8. Correlates ETCO2 reading to ABG

Question 4

Ventilatory Support - Capnography (Vent)
Procedure Steps (Steps 9-11)

Answer 4

9. Thanks patient, assures patient safety*
10. Washes or gels hands, and disposes of PPE
11. Documents the treatment appropriately*

Question 5

Diagnostic Testing - Chest X-ray Interpretation (2)
Procedure Steps (12 Steps)

Answer 5

Procedure Steps
1. Confirms correct patient’s CXR
2. Confirms right and left sides
3. Assesses patient to see if they are rotated or not
4. Assesses for inspiratory film
5. Assesses for good level of density used (meaning the film is not too dark and not too light). Are spinal processes visible?
6. Locates the trachea
7. Locates the carina
8. Locates the ETT or tracheostomy tube and assures that it is above the carina and midline in the trachea
9. Locates other tubes (chest tubes, drains….)
10. Locates central lines (swan, TLC…)
11. Assesses for infiltrates, consolidation, pulmonary edema, ARDS
12. Compares to previous CXR for changes in any of the above

Question 6

Diagnostic Testing - Chest X-ray Interpretation
Procedure Steps (Steps 1-5)

Answer 6

Procedure Steps
1. Confirms correct patient’s CXR
2. Confirms right and left sides
3. Assesses patient to see if they are rotated or not
4. Assesses for inspiratory film
5. Assesses for good level of density used (meaning the film is not too dark and not too light). Are spinal processes visible?

Question 7

Diagnostic Testing - Chest X-ray Interpretation
Procedure Steps (Steps 6-12)

Answer 7

6. Locates the trachea
7. Locates the carina
8. Locates the ETT or tracheostomy tube and assures that it is above the carina and midline in the trachea
9. Locates other tubes (chest tubes, drains….)
10. Locates central lines (swan, TLC…)
11. Assesses for infiltrates, consolidation, pulmonary edema, ARDS
12. Compares to previous CXR for changes in any of the above

Question 8

Ventilatory Support - Weaning Parameters - Ventilator (3)
Procedure Steps (14 Steps)

Answer 8

Procedure Steps
1. Verifies physician’s orders, scans chart for any other pertinent data
2. Gathers and assembles equipment, washes / gels hands and applies appropriate PPE*
3. Identifies patient, introduces self and department*
4. Explains purpose of the procedure, assesses patient and places in proper position*
5. Places the patient into CPAP with pressure support (per hospital policy and assesses patient for distress)
6. Records the patient’s spontaneous VT, RR and Ve
7. Instructs the patient in how to perform a Vital Capacity (FVC or SVC) per hospital policy
8. Repeats the Vital Capacity (FVC or SVC) Maneuver 3 times with appropriate rest period between each attempt; records volume
9. Returns the patient to ventilator support and allows the patient to rest as needed
10. Instructs the patient on how to perform a NIF/MIP (per hospital policy)
11. Coaches the patient through the NIF/MIP
12. Places patient back on appropriate settings and confirms patient’s respiratory status is stable
13. Correctly cares for equipment and cleans up area
14. Washes / gels hands and documents appropriately

Question 9

Ventilatory Support - Weaning Parameters - Ventilator
Procedure Steps (Steps 1-4)

Answer 9

Procedure Steps
1. Verifies physician’s orders, scans chart for any other pertinent data
2. Gathers and assembles equipment, washes / gels hands and applies appropriate PPE*
3. Identifies patient, introduces self and department*
4. Explains purpose of the procedure, assesses patient and places in proper position*

Question 10

Ventilatory Support - Weaning Parameters - Ventilator
Procedure Steps (Steps 5-12)

Answer 10

5. Places the patient into CPAP with pressure support (per hospital policy and assesses patient for distress)
6. Records the patient’s spontaneous VT, RR and Ve
7. Instructs the patient in how to perform a Vital Capacity (FVC or SVC) per hospital policy
8. Repeats the Vital Capacity (FVC or SVC) Maneuver 3 times with appropriate rest period between each attempt; records volume
9. Returns the patient to ventilator support and allows the patient to rest as needed
10. Instructs the patient on how to perform a NIF/MIP (per hospital policy)
11. Coaches the patient through the NIF/MIP
12. Places patient back on appropriate settings and confirms patient’s respiratory status is stable

Question 11

Ventilatory Support - Weaning Parameters - Ventilator
Procedure Steps (Steps 13-14)

Answer 11

13. Correctly cares for equipment and cleans up area
14. Washes / gels hands and documents appropriately

Question 12

Ventilatory Support - Extubation (4)
Procedure Steps (16 Steps)

Answer 12

Procedure Steps
1. Verifies physician’s order*
2. Scans chart for pertinent data and notes, laboratory results
3. Gathers equipment, gels and or washes hands, applies appropriate PPE*
4. Identifies patient, introduces self and department, explains procedure, confirms understanding
5. Assesses patient before beginning procedure
6. Places patient in proper position, ensures secondary O2 therapy device is assembled and turn on
7. Oxygenates the patient with 100% oxygen via manual resuscitator
8. Suctions the patient’s ETT and mouth
9. Removes the securing device from the tube, and deflates the cuff
10. Extubates at peak inspiration (may use positive pressure)
11. Instruct Patient to cough after tube is removed and suctions mouth as needed, applies oxygen device
12. Assesses patient for stridor, breath sounds, HR, RR, BP, saturation, WOB, and patient phonation
13. Correctly cares for the equipment following the procedure
14. Thanks patient, assures patient’s safety and disposes of PPE*
15. Gels or washes hands*
16. Documents the procedure appropriately

Question 13

Ventilatory Support - Extubation
Procedure Steps (Steps 1-6)

Answer 13

Procedure Steps
1. Verifies physician’s order*
2. Scans chart for pertinent data and notes, laboratory results
3. Gathers equipment, gels and or washes hands, applies appropriate PPE*
4. Identifies patient, introduces self and department, explains procedure, confirms understanding
5. Assesses patient before beginning procedure
6. Places patient in proper position, ensures secondary O2 therapy device is assembled and turn on

Question 14

Ventilatory Support - Extubation
Procedure Steps (Steps 7-12)

Answer 14

7. Oxygenates the patient with 100% oxygen via manual resuscitator
8. Suctions the patient’s ETT and mouth
9. Removes the securing device from the tube, and deflates the cuff
10. Extubates at peak inspiration (may use positive pressure)
11. Instruct Patient to cough after tube is removed and suctions mouth as needed, applies oxygen device
12. Assesses patient for stridor, breath sounds, HR, RR, BP, saturation, WOB, and patient phonation

Question 15

Ventilatory Support - Extubation
Procedure Steps (Steps 13-16)

Answer 15

13. Correctly cares for the equipment following the procedure
14. Thanks patient, assures patient’s safety and disposes of PPE*
15. Gels or washes hands*
16. Documents the procedure appropriately