Exam 1 Caring for the Client with Upper Airway Conditions Flashcards

Question

What is medical management of ARDS?

Answer 1

Identification and treatment of underlying causative condition Intubation and mechanical ventilation Adequate fluid volume Supplemental 02 Positive End-Expiratory Pressure Pharmacologic Therapy Nutritional Therapy

Answer 2

Helps to keep the alveoli expanded Increases oxygenation and improve lung expansion

Answer 3

Pa02 >60 OR 02 sats >90% at lowest possible Fi02 Need higher levels of PEEP for moderate/severe ARDS 10-20 mm H20 Done with ventilators; may require sedation

Answer 4

Increased thoracic pressure Puts pressure on the heart; Decreases preload on heart  decreased cardiac output and hypotension Give inotropic or vasopressors, IV crystalloids or colloids Monitor pulmonary wedge pressures Barotrauma  hyperinflation of the lung  pneumothorax or SQ emphysema Monitor high pressure alarms; chest tube

Answer 5

Sedatives (benzos) To calm anxiety and agitation Use with caution Neuromuscular blocking agents Paralyzes client to facilitate ventilation and decrease oxygen consumption; Doesn’t sedate or relieve pain! ONLY given to clients on mechanical ventilation DVT and GI prophylaxis Corticosteroids Antibiotics

Answer 6

Enteral nutrition Aspiration precautions Confirm placement Daily weights I&Os

Answer 7

Turns frequently Prone position Improves oxygenation; mobilizes secretions; improves ventilation and perfusion Explain all procedures Prevent infection and complications from immobility Vent care Suction PRN Provide emotional support Collaboration with interdisciplinary team

Answer 8

Temporary or permanent Endotracheal Tracheostomy

Answer 9

Provides adequate ventilation; can be used in conjunction with mechanical ventilation

Answer 10

Discomfort Thicker secretions Ulceration Inability to communicate Decreased swallowing reflexes  increases risk of aspiration

Answer 11

if ventilator support required is less than 10 days

Answer 12

to prevent air leak, prevent movement, and prevent aspiration

Answer 13

increased aspiration pneumonia

Answer 14

tracheal bleeding, ischemia, pressure necrosis

Answer 15

Chest X-ray Auscultate B/L lung sounds

Answer 16

can be temporary or permanent : bypass upper airway obstruction, allows removal of tracheobronchial secretions, long-term use of mechanical ventilation, prevent aspiration, replace ETT

Answer 17

Obturator guides insertion of cuffed trach; removed immediately after placement ALWAYS HAVE OBTURATOR AND SPARE CUFFED TRACH (SAME SIZE) AT BEDSIDE Held in place by trach tie

Answer 18

Cuffed trach

Answer 19

Fenestrated

Answer 20

Uncuffed patient covers end of tube to talk

Answer 21

Bleeding Pneumothorax Air embolism SQ or mediastinal emphysema Laryngeal nerve damage Posterior tracheal wall penetration Dysphagia Tracheal dilation, ischemia, and necrosis Infection Accumulation of secretions

Answer 22

Warmed humidified 02 Maintain cuff pressure Skin, lung assessment Maintain adequate hydration & skin integrity Prevention of VAP Sterile technique with care

Answer 23

Semi-fowler’s Prevent infection Trach care Provide effective means of communication Passy-Muir Valve: positive-closure, one-way speaking valve; allows client to talk with exhalation Tracheal suction Sterile procedure Can use in-line suctioning Managing the cuff Keep inflated; monitor every 8 hours Must be < 25 mm H20

Answer 24

can be temporary or permanent - Airway protection - Helps with airway clearance for those who can’t manage secretions - Management of respiratory function during surgery - Rest for muscular fatigue - Increased Fi02 for hypoxic client - Increased flow and pressure to ensure adequate ventilation

Answer 25

Stop inspiration at a preset time; time regulates the amount of air delivered

Answer 26

Volume of air delivery is preset and relatively consistent Once air is delivered, vent cycles off and allows for passive exhalation

Answer 27

Deliver flow of air on inspiration at preset pressure to allow for passive exhalation Volume of air varies and inconsistent

Answer 28

Controlled Mandatory Ventilation Assist Control Synchronized Intermittent Mandatory Ventilation Pressure support ventilation PEEP

Answer 29

delivers set tidal volume at a set rate

Answer 30

delivers a set tidal volume but allows the client to breath their own resp. rate

Answer 31

delivers a number of breathes at a preset tidal volume; ensures minimum amt of breaths with adequate tidal volume; client breathes spontaneously, and machine supports; can be used for weaning MAKES SURE PT IS ACHIEVING TARGET NUMBER OF BREATHS IN MINUTE

Answer 32

the patient breathes spontaneously but uses additional pressure during inspiration; used in weaning

Answer 33

preset pressure delivered during expiration; treats persistent hypoxemia; add 5-10 cm H20

Answer 34

Continually assess respiratory status (Q1-2 hr) Administer meds: sedation, analgesics, GI and DVT prophylaxis, Adequate suctioning Meticulous oral and skin care Turn and repositioning Early mobility (ROM) Document ETT placement at the teeth/lips Provide adequate nutrition Soft wrist restraints per protocol Develop alternative methods of communications Coping interventions and stress reduction techniques

Answer 35

Assess the ventilator frequently Have an AMBU bag, obturator, and spare tube at bedside ALWAYS Assess cuff pressure Be aware of alarms Don’t just rely on the monitor, always assess the client!

Answer 36

Low exhaled volume Causes: disconnection from the machine/tubing, low cuff pressure, tube displacement

Answer 37

Resistance or obstruction so pressure increases Causes: kink in the tubing, pneumo, bronchospasm, coughing, pulmonary edema, client biting the tube, excessive secretions

Answer 38

Process of removing mechanical ventilation Various criteria for weaning Suction Deflate the cuff before removing Remove the tube during peak inspiration Assess VS Q5 minutes Encourage coughing, deep breathing, and IS