Exam 1 - Vents Flashcards
1
Q
normal pH range
A
7.35-7.45
2
Q
normal PaCO2
A
45-35
3
Q
normal HCO3
A
22-26
4
Q
end-tidal is compared with ___ and used for trending
A
ABGs
5
Q
End-tidal values are usually __ to __ LESS than PaCO2
A
2 to 5 less than
6
Q
when is humidification added to O2?
A
> 4L/min
mechanical ventilation
7
Q
what is FiO2
A
fraction of oxygen delivery
8
Q
FiO2 of RA
A
21% or 0.21 FiO2
9
Q
nasal cannula FiO2
A
0.24-0.44
10
Q
high flow cannula FiO2
A
0.6-0.9
11
Q
simple face mask FiO2
A
0.4-0.6
12
Q
what must you ensure before applying a face mask with a reservoir to a pt
A
make sure the bag is inflated
13
Q
partial rebreather FiO2
A
0.4-0.7
14
Q
Non-rebreather FiO2
A
0.8-0.95
15
Q
best method of O2 delivery for COPD pts
A
venturi mask
16
Q
3 different types of airway management devices
A
oral airway
nasopharyngeal airway
endotracheal intubation
17
Q
oral airways are best if they do not have which reflex?
A
gag
18
Q
endotracheal intubation (ETT) can be inserted in which 2 locations?
A
mouth or nose
mouth is the preferred method to reduce infection
19
Q
ETT are used to do what 4 things?
A
maintain airway
remove secretions
prevent aspiration
provide mechanical ventilation
20
Q
what age is a cuff applied for ETT
A
> 3-4 y/o
21
Q
nurse responsibility regarding ETT placement
A
asking the size of the ETT and where the lip line is marked
22
Q
what to always assess first with ETT
A
airway!
23
Q
when is nasal ET intubation needed
A
head and neck manipulation is risky
24
Q
tracheostomy is used when artificial airway is expected to be ___ ___
A
long term
25
rapid sequence intubation (RSI) is what?
rapid, concurrent administration of paralytics and sedatives during emergent management
26
RSI decreases risk for which 3 things?
aspiration
combativeness
injury to pt
27
when is RSI contraindicated
comatose, cardiac arrest pts
28
when using an ambubag, where should you be?
HOB
29
what should be monitored during intubation
telemetry
O2 SAT
VS
30
what is the maximum time frame to drop an ETT
30 seconds
31
where are ETT meds kept?
in the fridge
32
what should be done prior to ETT?
hyper-oxygenate with 100% O2 for 3-5 minutes
33
pt positioning for oral intubation
supine, head extended and the neck flexed (sniffing position)
34
where is the ETT if there is no CO2 detected
esophagus, must be reinserted
35
what device measures CO2
end-tidal
36
CO2 color change that confirms placement
change from yellow to purple
37
what is needed to confirm tube placement
CXR
38
where should ETT be on adults?
3-5 cm above carina
39
maximum amount of time an ETT is left in place
14 days; trach is needed if any longer
40
what needs to be performed daily with the ETT
rotate from L, R daily
must always know the lip line before and after transfer
41
when are ABGs needed after intubation
within 25 minutes
42
RSI medications
fentanyl (submlimaze)
midazolam (versed)
propofol (diprivan)
etomidate (amidate)
43
fentanyl (submlimaze) and propofol (diprivan) side effect
bradycardia
44
RSI antidoates
atropine
robinul (glycopyrolate)
lidocaine
45
paralyzing agents
succinylcholine (anectine)
vercuronium (norcuron)
pancuronium (pavulon)
46
if intubation can not be achieved within 30 seconds, what is done next?
ventilate with 100% O2 (bag the pt)
47
5 points of auscultation for ETT confirmation
L, R anterior chest
L, R mid axillary line
epigastric region
48
methods of ETT confirmatin
chest rise
5-point auscultation
capnography (normal is 35-45)
CO2 detector
CXR
O2 SAT (>94%)
secure ETT
49
DOPE mnemonic re: ETT
D isplacement
O bstruction
P neumnothorax
E quipment failure (bag the pt!)
50
how often should ETT be monitored?
q2-4 hours
51
when should ETT exit mark/lip line be assessed
at rest
after providing pt care
repositioning
transporting pt
52
what should be done if the ETT is incorrectly placed
pt with pt, maintain airway
support ventilation
secure help immediately
ventilate with BVM and 100% O2
53
dislodge ETT place pt at risk for ___
pneumnothroax
54
cuff pressure should be maintained at __ to __ mmHg
20-25 mmHg
55
normal arterial tracheal perfusion
30 mmHg
56
when to measure and record cuff pressure
after intubation, routine basis
57
what are the 2 methods to assess cuff pressure
minimal occluding volume (MOV)
minimal leak technique (MLT)
58
how to perform MLT
auscultate at the trach area
leak will be heard while deflating the cuff
re-inflate the cuff until leak is no longer heard
59
what could be occurring if cuff pressure can not be maintained?
cuff could be leaking air
tracheal dilation
60
what should you do if the cuff pressure can not be maintained
notify the HCP for repositioning or change
61
s/sx of hypoxemia
change in mental status (confusion)
anxiety
dusky skin
dysrhythmias
restlessness, agitation
cyanosis (late sign)
62
clinical s/sx of respiratory distress
AMU
hypoventilation with dusky skin
hyperventilation with peripheral numbness, tingling
63
what does PETCO2 monitor
patency of airway and presence of breathing
64
PETCO2: increase CO2 production indicates ___
sepsis
65
PETCO: decrease in CO2 indicates ___
hypothermia
66
are ETT suctioned routinely?
No
67
indications for ETT suctioning
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
how often is the closed suction technique (CST) changed
q24h
69
complications r/t ETT suctioning
hypoxemia
bronchospasm
increase ICP
dysrhythmias
hyper/hypotension
mucosal damage/bleeding
pain
infection
70
how long should suctioning be limited to?
< 10 decrease
71
are dentures removed for ETT placement?
Yes but okay to leave in during bagging
72
if dysrhythmia occurs while suctioning, what should you do?
stop suctioning
73
suction pressure should be < ___ mmHg
< 120 mmHg
74
how often should oral care be provided
q2-4h and PRN (suction while providing care - like a teeth cleaning)
brush teeth BID
75
unplanned intubation can lead to which complications
pt vocalization/hoarseness
low-pressure ventilation
diminished, absent breath sounds
respiratory distress
gastric distention
76
when repositioning a pt with ETT, what is the person at the HOB responsible for?
counting, holding the tube
77
HOB positioning for ETT pts
30-45 degrees
78
FiO2 range on a ventilator
21-100%
79
PaO2 and O2 SAT ventilation goal
PaO2: 60-100
O2 SAT: at least 90%
80
indications for mechanical ventilation
apnea, impending inability to breathe
acute respiratory failure
severe hypoxia
respiratory muscle fatigue
81
tidal volume (TV) lung compliance and resistance setting is __ to __ mL
500-750 mL
82
TV starting point is __ to __ mL/kg
8-10 mL/kg
83
when does positive pressure ventilation (PPV) deliver air into the lungs
under positive pressure during inspiration
expiration occurs passively
84
controlled vs. assisted ventilator support
C: vent does all the WOB
A: vent + pt share WOB
85
which 3 devices have been used to treat critically ill pts
controlled mandatory vent (CMV)
assist controlled vent (ACS)
synchronized intermittent mandatory vent (SIMV)
86
examples of pts who benefit from ACV
neuromuscular disorders (Guillain-Barre)
pulmonary edema
acute respiratory failure
87
ACV allows breathes ___ but not ___
faster; slower
88
SIMV delivers a present volume and ___ while allowing the pt to ___ ___
RR; breathe spontaneously
89
when is pressure support ventilation (PSV) applied to airway
only during inspiration
used in conjunction with spontaneous respirations
90
what must a pt be able to do to have PSV
initiate a breath
91
when is PSV used?
during weaning
92
advantages to PSV
increase pt comfort
low WOB
low O2 consumption
increase endurance conditioning
93
normal inspiration: expiration ratio
1:2
94
pressure-controlled/inverse ratio ventilation beginning ratio vs. progression ratio
B: 1:1
P: 4:1
95
PC-IRV helps expand collapsed ___
alveoli
96
positive end-expiratory pressure (PEEP) applies positive pressure during ___
exhalation
PEEP improves oxygenation
97
adverse effects of PEEP
decrease CO2
low venous return
pneumothroax
98
PEEP contraindications
pt with highly compliant lungs
unilateral, nonuniform disease
hypovolemia
low CO
PTX
99
what to monitor with PEEP
HTN
HR
UOP
***causes low CO, low venous return
100
PEEP will ___ functional residual capacity (FRC)
increase
101
physiologic PEEP requires ___ cm of H2O
5 cm
102
purpose of physiologic PEEP
replace glottic mechanism
help maintain normal FRC
prevents alveolar collapse
103
what is require for cpap?
spontaneous respirations
104
device used for OSA
cpap
mask, ET, tracheal tube
105
caution using a cpap in pts with ___ ___
myocardial compromise
106
example of non-invasive positive pressure ventilation (NPPV)
bi-pap
107
what are the 2 levels of bipap
higher inspiratory positive airway pressure
lower expiratory positive airway pressure along with O2
108
bipap requires a ___ ___ mask
total face
109
indications for bipap
acute respiratory failure with COPD and CHF
sleep apnea
palliative care
110
NPPV use poses risk for
aspiration
gastric dilation
111
bipap can be used after extubation to prevent ___
reintubation
112
bipap contraindication
shock
AMS
increase airway secretions
113
what to monitor for with proning
gastric secretions
114
extracorporeal membrane oxygenation (ECMO)
alternative form of pulmonary support for pts with severe respiratory failure
115
ecmo is common in which age groups
pediatric, neonates
116
what is barotrauma
air can escape into pleural space from alveoli or interstitium, accumulate, and become trapped in ptx
117
new, unexplained subq emphysema requires immediate ___
CXR
118
causes of alveolar hypoventilation
inappropriate vent settings
leak of air from vent tubing or trach cuff
lung secretions or obstruction
low vent:perfusion ratio
excessive lung secretions
119
alveolar hypoventilation
turn q1-2h
CPT
deep breathing, coughing
suction PRN
120
causes of respiratory alkalosis
RR or TV too high
121
how long before a sodium + H2O imbalance can occur
24-48 hours
122
results of sodium + H2O imbalance
diminished renal perfusion
release of RAA (Na, H2O retention)
123
T or F. mild water retention is associated with PPV
True
124
medications given to reduce gastric acidity and reduce risk of stress ulcer/hemorrhage
H2 receptro blocker
PPI
tube feeding
125
irritation of an artificial airway can cause excessive air swallowing and ___ ___
gastric dilation
126
4 identified needs of vent pts
need to know (information)
need to regain control
need to hope
need to trust
127
T or F. sedation and analgesia must always ben administered concurrently
True
128
Can paralyzed pt hear, see, think, and feel?
Yes
129
test used to assess paralyzed pt
train-of-four peripheral nerve stimulation
130
where are electrodes placed for peripheral nerve stimulation
ulnar nerve
131
goal of peripheral nerve stimulation
1-2 twitches out of 4
132
VAP occurs ___ hours or more after ET intubation
48 hours
133
s/sx of VAP
fever
elevated WBC
purulent, odorous sputum
crackles, rhonchi
pulmonary infiltrates
134
how to prevent VAP
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
VAP bundle
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
what must you always do before leaving a pt room
make sure vent alarm is activated
137
what should you plug the vent into?
red/emergency outlet
138
high pressure alarm can indicate what?
increase pressure amount
require to deliver
tidal volume
139
low pressure alarm means
disconnection
140
short term vent is < ___ days; long term is > ___ days
3 days
141
short term extubation is a ___ process where as prolonged consists of ___ and ___
linear
peaks; valleys
142
should sedatives and analgesics be d/c prior to/during weaning
No, but should be titrated to achieve comfort but not excessive drowsiness
143
spontaneous breathing trial (SBT) should be at least ___ minutes but no more than ___ minutes
30; 120 minutes
144
what is used after extubation to assist with breathing
face mask, then nasal cannula
145
what to monitor for after extubation
tachypnea
tachycardia
dysrhythmias
sustained deSAT
HTN
agitation, anxiety
sustained TV < 5 mL/kg
change in LOC
diaphoresis
146
what is rest mode?
weaning occurs during the day, pt is vented at night
stable, nonfatiguing, comfortable form of support for the pt
147
when should VS, respiratory status, and oxygenation be assessed after extubation
immediately after
within 1 hour
and per policy
148
what can occur post extubation
laryngeal spasm or edema
149
what indicates laryngeal edema within 24 hours of extubation
stridor: must re-intubate
150
obstruction / high pressure alarm can be caused by....
mucous plug
teeth clamped on the tube
