Exam 1

Question 1

ABG Interpretation

Answer 1

Ph 7.35 - 7.45
PaCO2 35-45 (respiratory)
HCO3 - 22-26 (metabolic/bicarb)

Question 2

Compensation

Answer 2

Ph normal - fully compensated
Idle - uncompensated
helping - patrial

Question 3

Postop care for CABG

Answer 3

Maintain airway patency. …
Monitor vital signs and record intake and output hourly.
Assess the patient’s hemodynamic and cardiac status.
Perform peripheral and neurovascular assessments hourly for the first 8 hours
Assess pain

Question 4

Interventions to prevent VAP

Answer 4

• Good hand washing before, during (as needed), and after delivery of patient care
• Elevate head of the bed 30 to 45 degrees
• Daily assessment of readiness for extubation (sedation vacation)
• Stress ulcer prophylaxis
• VTE prophylaxis
• Daily oral care with chlorhexidine (0.12%) solution

Question 5

Steps to manage unplanned extubation

Answer 5

Stay with pt - yell for help
assess, administer o2 nasal canula/ambu bag
notify respiratory and MD
assess respiratory distress/listen for stridor - need for reintubation
prep for reintubation if unable to protect airway/resp. distress

Question 6

Pancuronium indications

Answer 6

to induce skeletal muscle relaxation during anesthesia and to facilitate the management of patients undergoing mechanical ventilation/trach

Question 7

Pancuronium MOA

Answer 7

blocks the nicotinic acetylcholine receptor at the neuromuscular junction

Question 8

Pancuronium side effects

Answer 8

flushing,
increased saliva,
rash,
bronchospasm,
muscle weakness,
low or high blood pressure, and.
rapid heartbeat.

Question 9

Nursing responsibility using Pancuronium

Answer 9

Assess cardiovascular and respiratory status continuously.
Observe patient closely for residual muscle weakness and signs of respiratory distress
Monitor BP and vital signs.
Note: Consciousness is not affected by pancuronium. Patient will be awake and alert but unable to speak.

Question 10

Proper positioning post extubation

Answer 10

HOB elevated 30-45, high fowlers

Question 11

Parameters for weaning from vent

Answer 11

1. Reversal of the underlying cause of respiratory failure
2. Adequate oxygenation
   * PaO2/FIO2 >150–200
   * SpO2 ≥90%
   * PEEP ≤5–7 cm H2O
   * FIO2 ≤40%–50%
   * pH ≥7.25
3. Hemodynamically stabile
   * Absence of myocardial ischemia
   * Absence of clinically significant hypotension (low dose or no vasopressor therapy)
4. Patient ability to initiate respirations
5. Optional criteria
   * Hemoglobin ≥7–10 g/dL
   * Core temperature ≤100.4° F (38° C) to 101.3° F (38.5° C)
   * Mental status awake and alert or easily arousable