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CCN > exam 3 simple > Flashcards

exam 3 simple Flashcards

1
Q

what is normal and abnormal for chest tubes

A

continuous bubbling in the H2O or collection chamber is air leak

want tidaling in drainage tubing and gentle fluctuation in H2o seal chamber with respirations

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2
Q

IMv/acv used for

A

respiratory rate

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3
Q

fio2 used

A

to meet needs with aim <60%

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4
Q

tidal volume amount given

A

4-8

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5
Q

most common complications of ventilation 2

A

VAP, lung injury

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6
Q

“alveolar dead space”
shunt unit
silent unit

A

a. “alveolar dead space” = alveolar not perfused -> no gas exchange occurring
Examples: PE and pulmonary infarct
b. “shunt unit” = alveoli not ventilated but perfusion intact -> perfusion > ventilation
Examples: pneumonia and atelectasis
c. “silent unit” = perfusion AND ventilation impaired
Examples: ARDS and pneumothorax

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7
Q

how is O2 transported

A

Oxygen transported in 2 ways:
1. 97% bound to Hgb (aka O2 saturation)
2. 3% dissolved in serum

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8
Q

what does a shift in the oxyhgb curve mean

A

that affinity of Hgb to O2 is changed

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9
Q

shift to the left
3 meanings and the factors

A

Hgb HOLDS onto O2
Increased O2 saturation
Impaired O2 delivery to tissues

Factors that shift the curve to the Left:

Low temperature (hypothermia)
ALkalosis (a rise in pH)
Low CO2
Low 2,3 diphosphoglycerate (in septic shock, hypophosphatemia, and blood transfusions)

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10
Q

shift to the right
3 meanings and the factors

A
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11
Q

ph

A

measures hydrogen concentration in blood. Normal 7.35-7.45

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12
Q

SaO2

A

percent of hemoglobin saturated by O2. Normal 93-97%

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13
Q

PaO2

A

pressure of O2 in the blood. Normal 80-100 mmHg

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14
Q

PaCO2

A

tension of dissolved CO2 gas in arterial blood. Regulated by the lungs (respiratory process). Thought of as acid in interpreting ABGs. Normal 35-45 mmHg

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15
Q

HCO3

A

bicarbonate, main base in serum, helps regulate pH because it can accept hydrogen. Regulated by kidneys (metabolic process). Normal 22-26 mEq/ml

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16
Q

1 cause of ARDS

A

1 : Sepsis leading cause bc its in inflammatory process

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17
Q

goal of mechanical ventilation

A

The goal is to use the least amount of O2 needed (ideally < 60%) to keep SaO2 88-95%, and P/F ratio>200

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18
Q

are abx used for mechanical vent

A

only if infection present

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19
Q

PEEP

A

at the end of expiration, it will deliver pressure to keep lungs open for longer to facilitate gas xchange instead of always adding O2

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20
Q

rapid sequence of intubation meds

A
  1. anesthetizing agents with a short half-life (diprivan (Propofol), midazolam (Versed), or etomidate
  2. paralytics such as succinylcholine, rocuronium
  3. long-term anesthetics and analgesics to reduce anxiety and promote comfort of the patient while intubated
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21
Q

diprivan - class, use, monitoring

A
  • very short-acting anesthetic
  • no analgesic properties
  • less amnesia properties than benzodiazepines
  • continuous infusion, titrated slowly
  • Monitor for hypotension and lipid levels (after 2 days of infusion)
  • High or excessive doses may result in Propofol infusion syndrome, hypotension, and zinc deficiencies.
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22
Q

how to prevent barotrauma in mechanical vent 2

A
  • Use of lower tidal volumes (remember this is amt of air coming in from ventilator) (4-8 mL/kg of body weight) and permissive hypercapnia – prevents barotrauma and volutrauma
  • Use of inverse ratio ventilation (IVR) – promotes slower delivery of tidal volume and helps prevent barotrauma

Keep the plateau pressure ≤ 30 cm H2O.**

Assess arterial blood gas values for a PaCO2 to be between 60-100.

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23
Q

1 prevention of VAP

A

hand hygiene

24
Q

2 types of pneumothorax

A
  • Closed – rupture of blebs on the visceral pleural space
  • Tension – rapid accumulation of air in the pleural space resulting in extremely high intrapleural pressure with resulting tension on the heart and great vessels. A tension pneumothorax is an emergency situation.
25
Q

small vs large s/s pneumot

A
  • Small – tachycardia, dyspnea
  • Large – respiratory distress, shallow, rapid respirations, dyspnea, air hunger, O2 desaturation, no breath sounds over affected area, presence of air or fluid on chest x-ray
26
Q

3 compartments of drainage system in chest tube

A
  • First compartment – collection chamber
  • Second compartment – H2O seal chamber
  • Third compartment – suction control chamber
27
Q

5 things to assess for sedation

A

a. level of consciousness, using Glasgow Coma Scale or Reaction Level Scale
b. For agitation and restlessness, using the Ramsey Sedation or Riker Sedation/Agitation Scale (RASS)
c. For anxiety
d. For sleep
e. For patient-ventilator synchrony (an indicator of comfort level)!!!!

28
Q

3 classes of sedation meds with examples

A

a. Ativan (Lorazepam) – benzodiazepine***

b. Diprivan (Propofol) – short-acting general anesthetic***

c. Dexmedetomidine (Precedex) – an a2 agonist

ALL COMBINED WITH ANALGESIC

29
Q

lorazepam - class, use, onset, SE

A
  • benzodiazepine with anti-anxiety, sedative, and anti-convulsant effects.
  • Slower onset (15-30 minutes), but longer duration (8 hours) than midazolam.
  • Side effects include reversible renal tubular necrosis, lactic acidosis, hyperosmolar states, and delirium.
  • Physical and psychological dependence can develop.
  • Is not a first-line choice due to the risk for delirium.
30
Q

dexmedatomidine - class, use, SE and tx of SE

A
  • for short-term sedation, having anxiolytic, anesthetic, hypnotic
    amd analgesic properties
  • Recommended for use of less than 24 hours.
  • The most common side effect is hypotension requiring fluid replacement and slower administration
  • Symptomatic bradycardia and heart block may develop, but usually resolve spontaneously.
31
Q

how and when to assess for delirium

A

Assessment using the Confusion Assessment Method of the Intensive Care Unit (CAM-ICU) should be done at least once/shift.

32
Q

6 risk factors for sepsis

A

> 85
immunocomp
chronic illness
invasive procedures
malnutrition
abx use

33
Q

1 sepsis area for <65 and >65

A

> 65 urinary
<65 lungs

34
Q

when should severe sepsis bundle be used time frame

A

3-6 hours

35
Q

1 cause of DIC

A

sepsis

36
Q

5 functions of erythropoetin

A
  • stimulates the production of RBCs
  • secretes renin
  • regulate BP
  • produce active vitamin D
  • regulation of calcium balance.
37
Q

normal gfr

A

85-135

38
Q

factors that decrease GFR - 5

A

diabetes, CAD, HTN, CKD, shock (anything that decreases CO)

39
Q

1 risk of AKI

A

preexisting kidney disease

40
Q

cause of post renal aki

A

obstruction, bph, stones

41
Q

hallmark s/s of postrenal aki

A

sudden onset of anuria <50mL/ day

42
Q

1 intervention for postrenal aki

A

bladder scan and catheter

43
Q

diffusion

A

high to low

44
Q

osmosis

A

low to high

45
Q

when to use intermit dialysis vs CRRT

A

intermit =
indicated in patients with severe fluid overload and electrolyte imbalances, AKI, high creatinine but stable BP or chronic renal failure, certain types of drug overdoses or poisoning, and transfusion reactions.

CRRT=
unstable BP and shock

46
Q

complications of intermit dialysis

A

rapid shifts in plasma volume leading to hypotension, arrhythmias due to rapid shifts in electrolytes, difficulties with vascular access, and dialysis disequilibrium syndrome.

47
Q

when can pt be weaned from CRRT

A

when spontaneous urine output is > 400 mL/day.

48
Q

normal RBC
hgb
wbc
platlet

A

3-5
12-16 male /11-15 female
4500-11,000
150-450k

49
Q

normal BUn/ creatinine

A

6-20
0.8-1.2

50
Q

nromal gluocse

A

64-100

51
Q

normal Na

A

135-145

52
Q

normal Ca

A

8.5-10.2

53
Q

normal prothombin time
normal aptt
fibrinogen

A

11-15 sec
25-40
1.5-4.5

54
Q

normal inr

A

0.9-1.3

55
Q

CRRT complications

A

hypotension, hypothermia, electrolyte imbalances, coagulation abnormalities, bleeding, and sepsis.

56
Q

3 indications for RRT

A

severe fluid volume overload

severe acidosis,

severe electrolyte disturbances

CCN (9 decks)

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