Exam #2 Flashcards
what are some assessments for oxygenation?
ABG, Pulse Ox, work of breathing, skin color, secretions, auscultation
what is the O2 range for NC?
1-6
what is the FiO2 for NC?
24-44%
what is the O2 range for Face mask?
5-8
what is the FiO2 for facemask?
40-60
what is the O2 range for the venturi mask?
4-11
what is the FiO2 for the venturi mask?
24-50%
what is the O2 range for partial rebreather?
8-11
what is the FiO2 range for the partial rebreather
50-75%
what is the O2 range for a non rebreather?
10-15
what is the FiO2 range for a non rebreather?
80-95%
what is the O2 range for HFNC?
30-60
what is the FiO2 for a HFNC?
100%
what type of pressure is provided with CPAP and BPAP?
positive pressure
what flow of pressure does Bipap have?
in and out
why would someone need to be intubated?
swelling of airway, cant clear secretions, seizures, surgery, tired for work of breathing, 50/50 rule
what supplies are needed for intubatin?
et tube, stylet, lubricant, mac/miller blade, larnygoscospe, syringe, flushes, bougjie, CO2 detector
what happens to the CO2 detector if you have the ET tube in the right spot?
the color will change
what lab should be run before intubation?
potassium
what do you do while waiting on the patient to be intubated?
ambu bag at 100% FiO2
do you sedate or paralyze your patient first?
sedate
where should the ET tube be placed?
into the trachea 2 cm above the carina
right after intubation what assessment should you do?
auscultate the breath sounds x2
what imaging should be done after intubation?
x ray
what lab should be done after intubation?
abg
what is pantoprazole used for?
stomach ulcer prevention
what is propofol used for?
anesthetic used for sedation
is propofol fast or long acting?
fast
is propofol titratable?
yes
what are side effects of propofol?
hypotension, brady cardia, resp depression, hyperlipidemia, elevated triglycerides
what is midazolam used for?
sedative
is midazolam short or long acting????
is midazolam titratable?
yes
what are side effects of midazolam?
hypotension, bradycardia, resp depression
what is dexmedetomidine?
fast acting sedative
what is special about dexmedetomidine?
it has minimal resp effects
what are side effects of dexmedetomidine
bradycardia and hypotension
what is vecuronium?
fast acting paralytic
why is vecuronium used?
it is used to paralyze the patient decreasing any extra oxygen use
what should be done for the patient when giving paralytics?
breath for the patient with ambu
what is the main side effect to worry about when giving paralytics?
apnea
is vec tirtrable ?????
what is succinylcholine?
fast acting paralytic that is used for intubation
what is the way to give succinylcholine?
iv push
what side effect should you watch for when giving succinylcholine
apnea and hyperkalemia
how much will succinylcholine raise K
by a point
what are signs of hyperkalemia?
chest pain, palpitations, N/v, abdominal pain, weakness, sob
what does the rate setting on vent control?
controls how many respirations in a minute
what does tidal volume on vent control?
volume of air per breath
what is the range for tidal volume?
500-600 ml
what is the FiO2 setting on vent control?
the percent of o2 in the air the patient is getting
what is PEEP on the vent control?
positive pressure that is the alveoli on expiration
what is the purpose of PEEP?
to prevent the lung from collapsing
what is pressure support?
constant pressure that is on the long throughout the breat
what is the assist control setting on vent?
this setting allows the patient to determine the rate of breath but delivers a steady tidal volume
what happens if patient doesnt initiate breaths on AC
the vent breaths for them
are there set rate and tidal volume with AC?
yes
is there a set rate and tidal volume with SIMV?
yes
what is simv vent setting?
typically a weaning mode where the patient can control the rate and tidal volume
what mode on the vent is pressure support used?
simv
why is pressure support only used on simv
??????????????
what is the goal o2 sat for vent patient?
at least 94%
how do you perform a breathing trial?
turn down patients sedation??????????????????
what lab is constantly drawn on vent patients?
ABG
when should extubation be considered?
when FiO2 is on low setting and ABGs are godo
what is the max amount of time you should suction vent patietn?
10-15 seconds
what oral care should be done for vent patien?
brushing teeth, mouth swabs,
what is VAP?
vent associated pneumonia
what are symptoms of VAP?
fever, chills, pleuritic chest pain, tachypnea, SOB, orthopnea, poor appetite, bloody sputum
if a gastric tube has to be placed what type is preffered?
OG tube
what should HOB be at for vent patient?
30 degrees
what should be check frequently on ET?
placement, position, and cuff pressure
how often should you reposistion et tub?
q 12
what should you with tube feedings when laying patient down?
pause
what are complications of intubation?
hypotension, fluid retention, barotrauma, tension pnuemo, volutruama, self extubation
what should be done if your patient self extubates?
ambu until md crna arives
why does intubation cause hypotension?
it reduces cardiac output
how do you extubate??? need to know?/??
what can cause ARDS?
Aspiration, pneumonia, covid, sepsis, burns, trauma, shock
what is occurring inside the lung during ARDS?
alveolar membrane is injured, more fluid, and less surfactant
what are symptoms of ARDS?
hypoxia, stiff lungs, pulmonary edema, infiltrates on x ray
how do you diagnose ARDS?
chest x ray, Pa O2 consistnetly low despite being on 100% FiO2, lungs might sound okay initally,
what lab is drawn to differentitate between CHF and ARDS
BNP
what does it mean if BNP is above 100?
most likely HF
what are vent settings for ARDS?
intubation, low tidal volume and high peep, prone, monitoring for fluid overload
what is a tracheostomy?
a hole is placed into the neck
what are indications for trach?
long term intubation, efficient suction, less or no sedation, less stress on larnyx/vocal cords, and easier to wean ff
what should be done before the trach procedure?
hold anticoags a shift before, NPO at midnight, prepare the room
what should be done post op for freshly intubated trach patient?
chest x ray, listen, assess site
what is the next step after taking trach patient off vent?
trach collar
is CO2 acidic or alkaline?
acidic
if CO2 increases what happens to pH
it goes down
if HCO3 increases what happens to pH
it goes up
is resp acid/alk a quick fix or long term fix?
quick
what do your lungs do if your pH is too low?
increased RR to blow off the acidic CO2
what do your lungs do if your pH is too high?
decreased RR to retain CO2
how long does metabolic acid/alk take to correct?
24 to 48 hours
how do your kidney control pH?
excreting or retaining hydrogen and bicarb
what do your kidneys do in metabolic acidosis?
excrete hydrogen and retain bicarb
what do your kidneys do in metabolic alkalosis?
retain hydrogen and excrete bicarb
on the test if ABG comes back odd what do you never do?
REDRAW
what can cause resp acidosis?
hypoventilation, COPD, Pneumonia, Obstruction, OD, Pulmonary edema,
what are symptoms of metabolic acidosis
headache, confusion, tired, tachypnea, N/v, decreased bp, and cold/clammy skin
what can cause metabolic acidosis?
ketoacidosis and lactic acidosis
what can cause lactic acidosis?
shock, kidney failure, aspirin, hypotension, diarrhea
what can cause metabolic alkalosis?
stomach acid loss, vomit, abusing diuretics, antacids
what can cause resp alkalosis?
hyperventilation, fever, hypoxia, aspirin tox,
what is the range for pH?
7.35 - 7.45
what is the range for Co2?
35-45
what is the range for HCO3?
22-26
what is the range for PaO2?
80-100
what is a uncomped abg?
abnormal ABG that
what is a partially comped abg?
abnormal abg where the body is attempting to return balance by adjusting other values
what is a comped abg?
pH is normal range but other values are not normal
what does the SA node do?
the natural pace maker of the heart that send electrical signals to the atria of the heart