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M/S 3 > Exam 1 - Vents > Flashcards

Exam 1 - Vents Flashcards

1
Q

normal pH range

A

7.35-7.45

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2
Q

normal PaCO2

A

45-35

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3
Q

normal HCO3

A

22-26

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4
Q

end-tidal is compared with ___ and used for trending

A

ABGs

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5
Q

End-tidal values are usually __ to __ LESS than PaCO2

A

2 to 5 less than

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6
Q

when is humidification added to O2?

A

> 4L/min
mechanical ventilation

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7
Q

what is FiO2

A

fraction of oxygen delivery

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8
Q

FiO2 of RA

A

21% or 0.21 FiO2

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9
Q

nasal cannula FiO2

A

0.24-0.44

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10
Q

high flow cannula FiO2

A

0.6-0.9

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11
Q

simple face mask FiO2

A

0.4-0.6

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12
Q

what must you ensure before applying a face mask with a reservoir to a pt

A

make sure the bag is inflated

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13
Q

partial rebreather FiO2

A

0.4-0.7

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14
Q

Non-rebreather FiO2

A

0.8-0.95

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15
Q

best method of O2 delivery for COPD pts

A

venturi mask

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16
Q

3 different types of airway management devices

A

oral airway
nasopharyngeal airway
endotracheal intubation

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17
Q

oral airways are best if they do not have which reflex?

A

gag

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18
Q

endotracheal intubation (ETT) can be inserted in which 2 locations?

A

mouth or nose

mouth is the preferred method to reduce infection

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19
Q

ETT are used to do what 4 things?

A

maintain airway
remove secretions
prevent aspiration
provide mechanical ventilation

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20
Q

what age is a cuff applied for ETT

A

> 3-4 y/o

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21
Q

nurse responsibility regarding ETT placement

A

asking the size of the ETT and where the lip line is marked

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22
Q

what to always assess first with ETT

A

airway!

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23
Q

when is nasal ET intubation needed

A

head and neck manipulation is risky

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24
Q

tracheostomy is used when artificial airway is expected to be ___ ___

A

long term

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25
Q

rapid sequence intubation (RSI) is what?

A

rapid, concurrent administration of paralytics and sedatives during emergent management

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26
Q

RSI decreases risk for which 3 things?

A

aspiration
combativeness
injury to pt

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27
Q

when is RSI contraindicated

A

comatose, cardiac arrest pts

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28
Q

when using an ambubag, where should you be?

A

HOB

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29
Q

what should be monitored during intubation

A

telemetry
O2 SAT
VS

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30
Q

what is the maximum time frame to drop an ETT

A

30 seconds

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31
Q

where are ETT meds kept?

A

in the fridge

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32
Q

what should be done prior to ETT?

A

hyper-oxygenate with 100% O2 for 3-5 minutes

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33
Q

pt positioning for oral intubation

A

supine, head extended and the neck flexed (sniffing position)

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34
Q

where is the ETT if there is no CO2 detected

A

esophagus, must be reinserted

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35
Q

what device measures CO2

A

end-tidal

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36
Q

CO2 color change that confirms placement

A

change from yellow to purple

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37
Q

what is needed to confirm tube placement

A

CXR

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38
Q

where should ETT be on adults?

A

3-5 cm above carina

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39
Q

maximum amount of time an ETT is left in place

A

14 days; trach is needed if any longer

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40
Q

what needs to be performed daily with the ETT

A

rotate from L, R daily

must always know the lip line before and after transfer

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41
Q

when are ABGs needed after intubation

A

within 25 minutes

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42
Q

RSI medications

A

fentanyl (submlimaze)
midazolam (versed)
propofol (diprivan)
etomidate (amidate)

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43
Q

fentanyl (submlimaze) and propofol (diprivan) side effect

A

bradycardia

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44
Q

RSI antidoates

A

atropine
robinul (glycopyrolate)
lidocaine

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45
Q

paralyzing agents

A

succinylcholine (anectine)
vercuronium (norcuron)
pancuronium (pavulon)

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46
Q

if intubation can not be achieved within 30 seconds, what is done next?

A

ventilate with 100% O2 (bag the pt)

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47
Q

5 points of auscultation for ETT confirmation

A

L, R anterior chest
L, R mid axillary line
epigastric region

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48
Q

methods of ETT confirmatin

A

chest rise
5-point auscultation
capnography (normal is 35-45)
CO2 detector
CXR
O2 SAT (>94%)
secure ETT

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49
Q

DOPE mnemonic re: ETT

A

D isplacement
O bstruction
P neumnothorax
E quipment failure (bag the pt!)

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50
Q

how often should ETT be monitored?

A

q2-4 hours

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51
Q

when should ETT exit mark/lip line be assessed

A

at rest
after providing pt care
repositioning
transporting pt

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52
Q

what should be done if the ETT is incorrectly placed

A

pt with pt, maintain airway
support ventilation
secure help immediately
ventilate with BVM and 100% O2

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53
Q

dislodge ETT place pt at risk for ___

A

pneumnothroax

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54
Q

cuff pressure should be maintained at __ to __ mmHg

A

20-25 mmHg

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55
Q

normal arterial tracheal perfusion

A

30 mmHg

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56
Q

when to measure and record cuff pressure

A

after intubation, routine basis

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57
Q

what are the 2 methods to assess cuff pressure

A

minimal occluding volume (MOV)
minimal leak technique (MLT)

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58
Q

how to perform MLT

A

auscultate at the trach area
leak will be heard while deflating the cuff
re-inflate the cuff until leak is no longer heard

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59
Q

what could be occurring if cuff pressure can not be maintained?

A

cuff could be leaking air
tracheal dilation

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60
Q

what should you do if the cuff pressure can not be maintained

A

notify the HCP for repositioning or change

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61
Q

s/sx of hypoxemia

A

change in mental status (confusion)
anxiety
dusky skin
dysrhythmias
restlessness, agitation
cyanosis (late sign)

62
Q

clinical s/sx of respiratory distress

A

AMU
hypoventilation with dusky skin
hyperventilation with peripheral numbness, tingling

63
Q

what does PETCO2 monitor

A

patency of airway and presence of breathing

64
Q

PETCO2: increase CO2 production indicates ___

65
Q

PETCO: decrease in CO2 indicates ___

A

hypothermia

66
Q

are ETT suctioned routinely?

67
Q

indications for ETT suctioning

A

visible secretions
sudden onset of respiratory distress
suspected aspiration of secretions
increase in peak airway pressures
adventitious breath sounds at trachea and/or bronchi
increased RR
sudden, gradual decrease in PaCO2 and/or O2

68
Q

how often is the closed suction technique (CST) changed

69
Q

complications r/t ETT suctioning

A

hypoxemia
bronchospasm
increase ICP
dysrhythmias
hyper/hypotension
mucosal damage/bleeding
pain
infection

70
Q

how long should suctioning be limited to?

A

< 10 decrease

71
Q

are dentures removed for ETT placement?

A

Yes but okay to leave in during bagging

72
Q

if dysrhythmia occurs while suctioning, what should you do?

A

stop suctioning

73
Q

suction pressure should be < ___ mmHg

A

< 120 mmHg

74
Q

how often should oral care be provided

A

q2-4h and PRN (suction while providing care - like a teeth cleaning)
brush teeth BID

75
Q

unplanned intubation can lead to which complications

A

pt vocalization/hoarseness
low-pressure ventilation
diminished, absent breath sounds
respiratory distress
gastric distention

76
Q

when repositioning a pt with ETT, what is the person at the HOB responsible for?

A

counting, holding the tube

77
Q

HOB positioning for ETT pts

A

30-45 degrees

78
Q

FiO2 range on a ventilator

79
Q

PaO2 and O2 SAT ventilation goal

A

PaO2: 60-100

O2 SAT: at least 90%

80
Q

indications for mechanical ventilation

A

apnea, impending inability to breathe
acute respiratory failure
severe hypoxia
respiratory muscle fatigue

81
Q

tidal volume (TV) lung compliance and resistance setting is __ to __ mL

A

500-750 mL

82
Q

TV starting point is __ to __ mL/kg

A

8-10 mL/kg

83
Q

when does positive pressure ventilation (PPV) deliver air into the lungs

A

under positive pressure during inspiration

expiration occurs passively

84
Q

controlled vs. assisted ventilator support

A

C: vent does all the WOB

A: vent + pt share WOB

85
Q

which 3 devices have been used to treat critically ill pts

A

controlled mandatory vent (CMV)
assist controlled vent (ACS)
synchronized intermittent mandatory vent (SIMV)

86
Q

examples of pts who benefit from ACV

A

neuromuscular disorders (Guillain-Barre)
pulmonary edema
acute respiratory failure

87
Q

ACV allows breathes ___ but not ___

A

faster; slower

88
Q

SIMV delivers a present volume and ___ while allowing the pt to ___ ___

A

RR; breathe spontaneously

89
Q

when is pressure support ventilation (PSV) applied to airway

A

only during inspiration

used in conjunction with spontaneous respirations

90
Q

what must a pt be able to do to have PSV

A

initiate a breath

91
Q

when is PSV used?

A

during weaning

92
Q

advantages to PSV

A

increase pt comfort
low WOB
low O2 consumption
increase endurance conditioning

93
Q

normal inspiration: expiration ratio

94
Q

pressure-controlled/inverse ratio ventilation beginning ratio vs. progression ratio

A

B: 1:1
P: 4:1

95
Q

PC-IRV helps expand collapsed ___

96
Q

positive end-expiratory pressure (PEEP) applies positive pressure during ___

A

exhalation

PEEP improves oxygenation

97
Q

adverse effects of PEEP

A

decrease CO2
low venous return
pneumothroax

98
Q

PEEP contraindications

A

pt with highly compliant lungs
unilateral, nonuniform disease
hypovolemia
low CO
PTX

99
Q

what to monitor with PEEP

A

HTN
HR
UOP

***causes low CO, low venous return

100
Q

PEEP will ___ functional residual capacity (FRC)

101
Q

physiologic PEEP requires ___ cm of H2O

102
Q

purpose of physiologic PEEP

A

replace glottic mechanism
help maintain normal FRC
prevents alveolar collapse

103
Q

what is require for cpap?

A

spontaneous respirations

104
Q

device used for OSA

A

cpap

mask, ET, tracheal tube

105
Q

caution using a cpap in pts with ___ ___

A

myocardial compromise

106
Q

example of non-invasive positive pressure ventilation (NPPV)

107
Q

what are the 2 levels of bipap

A

higher inspiratory positive airway pressure
lower expiratory positive airway pressure along with O2

108
Q

bipap requires a ___ ___ mask

A

total face

109
Q

indications for bipap

A

acute respiratory failure with COPD and CHF
sleep apnea
palliative care

110
Q

NPPV use poses risk for

A

aspiration
gastric dilation

111
Q

bipap can be used after extubation to prevent ___

A

reintubation

112
Q

bipap contraindication

A

shock
AMS
increase airway secretions

113
Q

what to monitor for with proning

A

gastric secretions

114
Q

extracorporeal membrane oxygenation (ECMO)

A

alternative form of pulmonary support for pts with severe respiratory failure

115
Q

ecmo is common in which age groups

A

pediatric, neonates

116
Q

what is barotrauma

A

air can escape into pleural space from alveoli or interstitium, accumulate, and become trapped in ptx

117
Q

new, unexplained subq emphysema requires immediate ___

118
Q

causes of alveolar hypoventilation

A

inappropriate vent settings
leak of air from vent tubing or trach cuff
lung secretions or obstruction
low vent:perfusion ratio
excessive lung secretions

119
Q

alveolar hypoventilation

A

turn q1-2h
CPT
deep breathing, coughing
suction PRN

120
Q

causes of respiratory alkalosis

A

RR or TV too high

121
Q

how long before a sodium + H2O imbalance can occur

A

24-48 hours

122
Q

results of sodium + H2O imbalance

A

diminished renal perfusion
release of RAA (Na, H2O retention)

123
Q

T or F. mild water retention is associated with PPV

124
Q

medications given to reduce gastric acidity and reduce risk of stress ulcer/hemorrhage

A

H2 receptro blocker
PPI
tube feeding

125
Q

irritation of an artificial airway can cause excessive air swallowing and ___ ___

A

gastric dilation

126
Q

4 identified needs of vent pts

A

need to know (information)
need to regain control
need to hope
need to trust

127
Q

T or F. sedation and analgesia must always ben administered concurrently

128
Q

Can paralyzed pt hear, see, think, and feel?

129
Q

test used to assess paralyzed pt

A

train-of-four peripheral nerve stimulation

130
Q

where are electrodes placed for peripheral nerve stimulation

A

ulnar nerve

131
Q

goal of peripheral nerve stimulation

A

1-2 twitches out of 4

132
Q

VAP occurs ___ hours or more after ET intubation

133
Q

s/sx of VAP

A

fever
elevated WBC
purulent, odorous sputum
crackles, rhonchi
pulmonary infiltrates

134
Q

how to prevent VAP

A

HOB at least 30-45 degrees
no routine changes to ventilation circuit or tubing
ET tubing with continuous suction
hand hygiene BEFORE and AFTER

135
Q

VAP bundle

A

elevate HOB 30-45 degrees
awaken daily, assess readiness to wean
stress ulcer prophylaxis
VTE prophylaxis
oral care (role of the nurse)
NGT to prevent vomiting

136
Q

what must you always do before leaving a pt room

A

make sure vent alarm is activated

137
Q

what should you plug the vent into?

A

red/emergency outlet

138
Q

high pressure alarm can indicate what?

A

increase pressure amount
require to deliver
tidal volume

139
Q

low pressure alarm means

A

disconnection

140
Q

short term vent is < ___ days; long term is > ___ days

141
Q

short term extubation is a ___ process where as prolonged consists of ___ and ___

A

linear

peaks; valleys

142
Q

should sedatives and analgesics be d/c prior to/during weaning

A

No, but should be titrated to achieve comfort but not excessive drowsiness

143
Q

spontaneous breathing trial (SBT) should be at least ___ minutes but no more than ___ minutes

A

30; 120 minutes

144
Q

what is used after extubation to assist with breathing

A

face mask, then nasal cannula

145
Q

what to monitor for after extubation

A

tachypnea
tachycardia
dysrhythmias
sustained deSAT
HTN
agitation, anxiety
sustained TV < 5 mL/kg
change in LOC
diaphoresis

146
Q

what is rest mode?

A

weaning occurs during the day, pt is vented at night

stable, nonfatiguing, comfortable form of support for the pt

147
Q

when should VS, respiratory status, and oxygenation be assessed after extubation

A

immediately after
within 1 hour
and per policy

148
Q

what can occur post extubation

A

laryngeal spasm or edema

149
Q

what indicates laryngeal edema within 24 hours of extubation

A

stridor: must re-intubate

150
Q

obstruction / high pressure alarm can be caused by….

A

mucous plug
teeth clamped on the tube

M/S 3 (17 decks)

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