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Med Surg II > Exam 1: oxygenation > Flashcards

Exam 1: oxygenation Flashcards

1
Q

how many fingers should fit beneath trach ties?

A

1 finger

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2
Q

what is the approximate time someone can have an ET tube? after that time is up, what would they have placed?

A

~ 2 weeks –> tracheostomy

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3
Q

there are a ton of reasons someone might need a tracheotomy, but name some major (generalized) reasons…. (4)

A
  1. obstruction
  2. trauma
  3. paralysis
  4. head/neck surgery
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4
Q

how would you communicate with person that had impaired communication r/t tracheostomy or ventilator? (3)

A

yes/no questions
white board
picture board

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5
Q

how do we verify placement of tracheostomy tube?

A

chest x ray

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6
Q

what is focus of post op care after tracheostomy tube is inserted?

A

maintaining patent airway: normal rate, depth, clear sounds, O2 sat + assessing for complications

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7
Q

tracheostomy tube dislodgement within 72 hours of placement = ???

and what do we do?

A

= MEDICAL EMERGENCY!!!

= CALL CODE!!!

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8
Q

a tracheostomy can cause what major complication?

A

pneumothorax

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9
Q

hallmark sign of pneumothorax + describe it.

A

subcutaneous emphysema: sounds and feels like rice crispies

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10
Q

what is most likely cause of trach tube obstruction?

A

secretions

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11
Q

s+s of tube obstruction w/ trach (3)

A
  1. dyspnea
  2. loud breathing
  3. difficulty suctioning
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12
Q

main focus for trach tube obstruction is PREVENTION. what are some ways we can do this? (4)

A
  1. pulmonary hygiene
  2. change inner cannulas (BID)
  3. suctioning PRN
  4. O2
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13
Q

cuff pressure for trach should stay below what range? why?

A

<14-20 mmHg

to prevent tissue damage / pressure injuries in trachea

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14
Q

what type of O2 should be used w/trachs?

A

warm, humidified air

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15
Q

when suctioning a patient and starting to see hypotension and bradycardia, what should you do? what could it be?

A

STOP!!! - could be vagal stimulation (risk of dysrhythmias)

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16
Q

re: trach, suction time and passes should be limited to what?

A

10-15 seconds x 3

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17
Q

how often do ties get changed with trach?

A

PRN

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18
Q

how often should oral hygiene be performed with trach?

A

q2

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19
Q

term: excessive fluid inside the lungs / alveoli

A

pulmonary edema

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20
Q

what are the 3 populations of patients that are at great risk of pulmonary edema?

A
  1. HF
  2. renal failure
  3. elderly
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21
Q

acute pulmonary edema (aka “flash pulmonary edema”) =

A

MEDICAL EMERGENCY

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22
Q

s+s of pulmonary edema (5)

A
  1. pink, frothy sputum coarse crackles
  2. cough
  3. coarse crackles
  4. anxiety, restlessness (r/t dyspnea)
  5. confusion (O2 not getting to brain)
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23
Q

interventions for pulmonary edema (3 main, 2 others)

A
  1. increase O2
  2. raise HOB
  3. vitals (O2 sats)

others…
4. diuretic
5. morphine

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24
Q

term: blockage in a pulmonary vessel in the lungs (solid, liquid, air)

A

pulmonary emboli

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25
Q

PE’s are most often caused by what?

A

DVT

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26
Q

virchow’s triad components

A
  1. hypercoagulability
  2. damage to tissue vessel
  3. immobility / stasis of blood flow
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27
Q

what is most common assessment finding with PE? + others (5 total)

A
  1. shortness of breath
  2. chest pain
  3. restlessness/agitation
  4. cough
  5. bloody sputum (infarct of lung)

typically rapid onset

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28
Q

what does an elevated d-dimer indicate?

A

clot somewhere in the body (byproduct of fibrin breaking down)

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29
Q

gold standard for PE imaging

A

pulmonary angiography

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30
Q

interventions for PE

A
  1. O2 (SpO2 >95%)
  2. raise HOB
  3. get help! (rapid)
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31
Q

for evaluating effectiveness of anticoags for PE, what assessment would be appropriate?

A

respiratory
(patient going from intubated to extubated and from 10L to 2L with less dyspnea….)

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32
Q

if a patient has hypotension r/t PE, what type of meds would you expect to see given? (general)

A

positive inotropic meds (increase CO)
vasopressors (increase afterload)

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33
Q

what specific assessments should be done with patient on anticoagulants?

A

bleeding (including neuro checks)

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34
Q

antidote for warfarin

A

vitamin K

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35
Q

antidote for apixaban

A

andexanet

36
Q

antidote for heparin

A

protamine sulfate

37
Q

labs for heparin

A

aPTT + platelets (b/c of risk of HITT)

38
Q

labs for warfarin

A

PT + INR

39
Q

what is normal PaO2?

A

80-100 (arterial blood oxygen level)

40
Q

term: inadequate oxygen supply to tissue

A

hypoxia

41
Q

term: low arterial blood oxygen levels

A

hypoxemia

42
Q

term: air movement

A

ventilation

43
Q

term: blood flow

A

perfusion

44
Q

term: when ventilation and perfusion do NOT match

A

mismatch –> respiratory failure

45
Q

respiratory failure indicated by what level of PaO2?

respiratory failure indicated by what level of PaCO2?

A

PaO2: <80

PaCO2: >45 (hypercapnic respiratory failure)

46
Q

ventilation failure leads to….

A

decreased O2 in alveoli and increased CO2 in alveoli

47
Q

oxygenation/perfusion failure leads to….

A

deoxygenated blood (b/c of shunting)

48
Q

s+s of acute ARF (3)

A
  1. dyspnea
  2. changes in respiratory pattern
  3. confusion
49
Q

intervention for ARF (2)

A
  1. O2
  2. positioning
    + treat underlying cause
50
Q

ARDS is a type of acute respiratory failure WITH…..

A

reduced compliance*
profound dyspnea
increased work of breathing
loud breathing
pulmonary edema
severe hypoxemia regardless of increased O2*

51
Q

ARDS caused by what? (generalized)

A

another disease process with a major systemic inflammatory response or direct injury to lungs –> injury to alveoli –> fluid collects in alveoli

52
Q

3 ways to diagnose ARDS

A
  1. ABG
  2. chest x-ray
  3. sputum culture
53
Q

ARDS interventions (3 main)

A
  1. PEEP (positive end-expiratory pressure): to prevent alveoli from completely collapsing at end of expiration
  2. prone (more alveoli in posterior lungs)
  3. sedation (stop work of breathing)
54
Q

when do we tend to use ET tubes? (r/t time frame of use)

A

when they need an artificial airway for less than 10-14 days

55
Q

tip of ET tube should lie where?

A

2cm above carina

56
Q

the purpose of the ET tube cuff is to __________, NOT to hold it in place.

A

purpose: create a seal and prevent secretions from being aspirated

57
Q

when intubating patient, what are some of the RN’s role? (4)

A
  1. oxygenate patient
  2. raise HOB (before intubation, then lay flat)
  3. reduce anxiety: talk with patient, hold hand, keep calm
  4. admin meds
58
Q

what meds do we typically want for intubation?

A
  1. sedation
  2. pain meds
  3. paralytic
59
Q

how long should intubation attempts be limited to?

A

30 seconds (then use bag valve mask)

60
Q

what things main should be monitored with intubation? (3)

A
  1. frequent BP (q5mins, but can be more often)
  2. continuous SpO2
  3. continuous telemetry
61
Q

RN role immediately after intubation (3)

A
  1. auscultation (bilateral breath sounds and NO air in abdomen)
  2. observation (bilateral chest movement)
  3. assess and document where tube is (ex: “26cm at the lips/teeth”)
62
Q

what is GoLd StAnDaRd for ET tube placement confirmation?

KNOW

A

Waveform Capnography (ETCO2)

best indicator that we’re in the trachea

63
Q

what is normal range of ETCO2?

A

35-45

64
Q

after auscultation and waveform capnography, what should also be done to confirm placement?

A

chest X-ray

65
Q

what is mnemonic for complications of intubation?

A

DOPE
dislodgement
obstruction
pneumothorax
equipment failure

66
Q

what is most common site of ET tube misplacement?

A

right side mainstem (b/c right side is larger and straighter)

67
Q

what are some ventilator interventions? (9)

A
  1. suction PRN!
  2. oral care q2h
  3. keep HOB >30 degrees
  4. reposition q2h
  5. pulmonary hygiene
  6. mobility
  7. delirium prevention
  8. CHG bath daily from neck down
  9. antacids (b/c esophagus always open)
68
Q

what is ultimate goal of intubation and mehanical ventilation?

A

GET THEM OFF THE VENT!

69
Q

what are the components of the ABCDEF ventilator bundle?

KNOW

A

Awake (turn off sedation everyday)
Breathe (trials)
Choice of sedation/Coordination
Delirium prevention/assessment
Early mobility
Family presence

70
Q

term: lung bruise

A

pulmonary contusion

71
Q

what happens after a pulmonary contusion?

A

fluid accumulates in the lung –> respiratory failure

72
Q

nursing interventions for pulmonary contusion (3)

A
  1. increase O2
  2. raise HOB (if appropriate positioning for this trauma pt)
  3. pain meds
73
Q

main intervention for rib fracture

A

pain management - to allow them to take proper breaths (PCA)

74
Q

deep chest injury (internal organ damage) is much more likely with which types of rib fracture?

KNOW

A

fracture to 1st and 2nd ribs or fracture of 7 ribs or more

higher mortality rate

75
Q

term: paradoxical chest wall movement caused by fractured ribs

A

flail chest (ribs become free floating)

76
Q

interventions for flail chest (5)

one major difference from other respiratory trauma interventions

A
  1. O2
  2. ABG
  3. telemetry
  4. respiratory monitoring
  5. good lung down (encourages V/Q matching)

DON’T PUT IN HIGH FOWLERS, CAN SEND THEM INTO SHOCK

77
Q

term: air enters the pleural space

A

pneumothorax (pressure on lung and lung collapses)

78
Q

s+s of pneumothorax (4)

A
  1. subcutaneous emphysema**
  2. absent or diminished breath sounds (unilateral breath sounds)
  3. reduced movement of chest wall
  4. increased O2 demand
79
Q

diagnostic for pneumo

A

chest x ray

80
Q

intervention for pneumo

A

chest tube (allows for re-expansion of lung and establishing negative pressure again)

81
Q

term: complete lung collapse involving air entering the lung without exit

A

tension pneumothorax

82
Q

hallmark finding of tension pneumothorax

KNOW

A

tracheal deviation

83
Q

aside from tracheal deviation (hallmark), what are other s+s of tension pneumo? (4)

A
  1. respiratory distress
  2. distended neck veins (blood cannot flow into heart)
  3. hypotension (b/c of increased pressure, heart cannot push blood out)
  4. tachycardia (compensation for pressure on heart)
84
Q

intervention for tension pneumo

A

CALL CODE
needle thoracostomy w/ large bore needle (releases air in the thoracic cavity)

85
Q

term: bleeding into pleura

A

hemothorax

86
Q

difference in chest tube placement from pneumothorax vs hemothorax

A

hemothorax chest tube = positioning lower (b/c of blood pooling near bottom of lungs) + larger tube

87
Q

when should we notify provider with chest tube output?

A

output is > 60/hr

Med Surg II (6 decks)

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