Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NUR 418 > Exam II > Flashcards

Exam II Flashcards

Airway, ABGs, ARDS, Renal Disease, DKA

1
Q

Nasal Cannula delivers between __ and __% or __ and __ fiO2 oxygen

A

24-44% (0.24-0.44)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Nasal Cannula Flow meter rate __ to __ per min unless high flow

A

1-6L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Nasal Cannula 1L/min increases oxygen by approximately __ to __ %

A

3-4%

Room air 21% so 1L = 24%, 2L = 28%, 3L = 32%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Nasal Cannula High Flow delivers __ to __ % or __ to __ L/min oxygen

A

60-90% (0.60-.090 fio2) or 15-40L/min oxygen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Simple face mask delivers between __ and __ % or __ and __ fiO2

A

30-60% oxygen or 0.30-0.60 fiO2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Simple face mask flow meter rate __ to __ L/min

A

5-12 L/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Non-rebreather mask meter flow rate __ L/min

A

15L/min (to the top)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Non-rebreather mask delivers __ to __% or __ to __ fiO2

A

60-80% or 0.60-0.80 fiO2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Non-rebreather mask reservoir bag allows __________

A

Inspiration O2 flows into mask and bag

One-way valves on expiration - ensuring
highest O2 delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Room air provides __% or __ fiO2

A

21% or 0.21 fiO2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

fiO2

A

Fraction of Delivered Oxygen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Bag Valve Mask AKA ____________ or __________

A

Ambu-bag or BVM system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Bag Valve Mask provides __L/min or __% O2

A

15L/min or 100% O2 (1.00 fiO2)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

ET tube cuff should be inflated to __ to __ cm H2O

A

25-30cm H2O

If pressure if off, call RT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

CXR for ETT should show tip at __ to __ cm above the ______ for adults

A

3-4cm above the carina for adults

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Tidal Volume (VT)

A

Amount of gas to be delivered with each breath

6-8 ml/kg based upon IDEAL body weight

Example: 70 kg patient should receive between
420 to 560ml

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Physiologic PEEP is __ to __ cm H2O

Vent settings range from __ to __ cm H20

A

PEEP - 3 to 5

Vent - 5 to 20

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Normal pH of blood

A

7.35 - 7.45

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

PCO2 (PaCO2) correlates with __________

A

Respiratory function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Normal PCO2 (PaCO2)

A

35-45 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

High PCO2 (PaCO2) is correlated with __________

A

Respiratory acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Low PCO2 (PaCO2) is correlated with __________

A

Respiratory alkalosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

HCO3 is associated with __________

A

Metabolic function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

High HCO3 indicates __________

A

Metabolic alkalosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Low HCO3 indicates __________

A

Metabolic acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Low pH
High PCO2
High HCO3

A

Compensated Resp. Acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

High pH
Low PCO2
Low HCO3

A

Compensated Resp. Alkalosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Low pH
Low PCO2
Low HCO3

A

Compensated Meta. Acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

High pH
High PCO2
High HCO3

A

Compensated Meta. Alkalosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Normal HCO3 levels

A

22-26 mEq/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q 
Interpret the following ABG: 
pH - 7.60
CO2 - 36 
HCO3 - 45
PaO2 - 87
A

Metabolic alkalosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q 
Interpret the following ABG: 
pH - 7.14
CO2 - 45 
HCO3 - 18
PaO2 - 80
A

Metabolic acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q 
Interpret the following ABG: 
pH - 7.78
CO2 - 44 
HCO3 - 60
PaO2 - 90
A

Metabolic alkalosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q 
Interpret the following ABG: 
pH-  7.08
CO2 - 56 
HCO3 - 26
PaO2 - 60
A

Respiratory acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Which Acid-Base imbalance do you suspect from the following scenario?

The patient is a 34 year old construction worker who has been having increased NV and severe abdominal pain. He has a CT scan of the abdomen that reveals a gastric obstruction. You have orders to place an NG Tube. He is placed on continuous high suction and now he feels light headed and is having numbness in his face and hands.

A

Metabolic alkalosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What additional assessment findings do you anticipate for the patient in metabolic alkalosis?

A

Restlessness
NVD
Lethargy
Confusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Which Acid-Base imbalance do you suspect from the following scenario?

Your patient is a 27 year old female who has recently been on a very strict diet and exercise plan. She is complaining of severe headache, is breathing at 30bpm and has an increased HR.

A

Metabolic acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Which Acid-Base imbalance do you suspect from the following scenario?

Your patient is a 17 year old female who was brought in by EMS unconscious, she has track marks on her arms and legs and appears homeless.

A

Respiratory acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Which Acid-Base imbalance do you suspect from the following scenario?

Your patient is a 24 year old nursing student who has not started to study for the final exam. She presents to the ED with her clinical faculty and is short of breath, breathing rapidly and shallow.

A

Respiratory alkalosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q 
Here is the ABG for a 75yo male. Interpret the results: 
PaO2 - 78 mm Hg on room air
pH - 7.11
PaCO2 - 56 mm Hg
HCO3 - 28 mEq/L
A

Partially compensated respiratory acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q 
Interpret the following ABG: 
pH - 7.50
CO2 - 35
HCO3 - 34
PaO2 - 82
A

Metabolic alkalosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q 
Interpret the following ABG: 
pH - 7.22
CO2 - 60
HCO3 - 34
PaO2 - 60
A

Partially compensated respiratory acidosis with hypoxemia

43
Q 
Interpret the following ABG: 
pH - 7.28
CO2 - 30
HCO3 - 18
PaO2 - 80
A

Partially compensated metabolic acidosis

44
Q 
Interpret the following ABG: 
pH - 7.42
CO2 - 49
HCO3 - 34
PaO2 - 88
A

Compensated metabolic alkalosis

45
Q

Define: PaCO2

A

The pressure of tension exerted by dissolved CO2 gas in the blood, influenced only
by the lungs

46
Q

Define: CO2

A

CO2 gas is an acid, which is excreted from the body by the kidneys and respiration.

There is a direct relationship between ventilation and excretion of CO2. If the PaCO2 is low, (Alkaline) the lungs are hyperventilating. If the PaCO2 is high, (acidosis) The lungs are hypoventilating

47
Q

Define: HCO3 and base excess

A

Bicarbonate and Base excess are influenced only by metabolic processes, (ie: DKA, Uremia) not by respiratory causes. Positive values indicate metabolic alkalosis, and negative values indicate metabolic acidosis.

48
Q

Normal PaO2 level

A

80-100

49
Q

What is an OPA?

A

Oropharyngeal Airway

50
Q

How do you measure an OPA for a Pt?

A

Measure from the mouth to the earlobe

51
Q

What are the (3) indications for mechanical ventilation?

A
  1. Support oxygen
  2. Support CO2 clearance
  3. Reduce work of breathing
52
Q

Who has chronically high and compensated CO2?

A

Those with COPD and asthma

53
Q

What is PEEP?

A

Positive end-expiratory pressure

  • Used if FiO2 is over 50% on a ventilator
  • Keeps pressure in the lungs (improves gas exchange by keeping alveoli open)
54
Q

Nursing assessment of Pt with ETT?

A
  • Monitor ventilation with BVM (equal bilateral chest rise/fall)
  • Assess oxygenation by SPO2
  • Suction when necessary
  • Watch the clock with intubation attempts (less than 30 sec)
  • Identify cm mark at Pt’s lip and document (compare to previous measures, call provider and RT if tube moved)
  • Document size of ETT
  • ABG, if needed
55
Q

Preliminary assessment for all ETT?

A
  • Observe chest for symmetrical rise and fall
  • Auscultate lungs bilaterally
  • Auscultate over the stomach
  • CO2 detector
56
Q

Actions following ETT placement (after assessment)

A
  • VENTILATE
  • Secure the tube and identify ‘cm’ placement
  • Call RT (so they can inflate cuff)
57
Q

Capnography

A

Measures CO2

A-B: end inhalation
B-C: early exhalation
C-D: exhalation
D: END EXHALATION (CO2 stat, 35-45)
D-E: Inhalation
58
Q

CO2 detector

A

Confirms proper placement of ETT (yellow means yes, purple means problem)

59
Q

How do you assess a ventilator?

A
  1. How is the breath delivered? (delivered by pressure or volume)
  2. What is the rate of delivery? (controlled rate, spontaneous rate, or combo)
60
Q

Ventilator: Pressure or volume?

A

Breath is delivered by set pressure or set volume

61
Q

Ventilator: Controlled, spontaneous, or combo

A

Controlled: set RR per minute
Spontaneous: Triggered by patient attempt to breathe
Combo: Triggered by patient but will deliver breath after set time of apnea (may be AC: Assist/Control ventilation)

62
Q

Ventilator: exhalation

A

Most ventilators are positive pressure with passive exhalation

63
Q

I:E ratio

A

1:2 (longer for COPD or asthma patients)

64
Q

What is the normal physiological PEEP range?

A

3-5 cm H2O

65
Q

Range for vent PEEP

A

5-20 cm H2O

66
Q

Monitor ___________, ____________, and __________ when Pt is on a vent

A

EV (exhaled tidal volume), PIP (Peak Inspiratory Pressure), and total expiratory rate

67
Q

What are the (3) waves to monitor on the vent?

A
  1. Pressure
  2. Flow
  3. Volume (Vt)
68
Q

SIMV (synchronized intermittent mandatory ventilation)

A
  • Preset RR (f) and tidal volume (Vt)
  • Vt of spontaneous breaths vary (machine allows Pt to complete WOB)
  • Good mode for weaning off vent
69
Q

CPAP (continuous positive airway pressure) invasive or noninvasive

A

Creates PEEP

70
Q

Vent: Low Pressure Alarm

A
  • Check all connections
  • Check ET placement
  • Check cuff pressure
  • Is the vent functioning?
  • Is there a leak in the system? (call RT)
71
Q

Vent: High Pressure Alarm

A
  • Is the patient biting the ETT?
  • Does Pt need suction?
  • Is Pt coughing or gagging?
  • Is Pt having bronchospasm?
  • Sudden change in Pt? Lung sounds?
  • Did the equipment fail?
72
Q

How long on mechanical vent before considering trach? (may be different now due to COVID)

A

3 days

73
Q

VAP bundle

A
  • Elevate HOB to 30-45 degrees
  • Daily awakening
  • Prophylaxis for DVT
  • Prophylaxis for PUD
  • Daily oral care
74
Q

DO NOT INSTILL __________ into ETT

A

Normal Saline

75
Q

Initial Sx of AKI

A

Decreased urine output

76
Q

Azotemia

A

High BUN and Cr

77
Q

Minimum urine output per hour ____ mL

A

30 mL

78
Q

Most common cause of AKI in hospitalized patients?

A

Contrast Induced

79
Q

Pre-renal AKI

A
  • Prolonged Hypotension
  • Prolonged low cardiac output
  • Prolonged volume depletion
  • Reno-vascular thrombosis
80
Q

Intra-renal AKI

A
  • Kidney ischemia
  • Endogenous toxins
  • Exogenous toxins
  • Infection
81
Q

Post-renal AKI

A

Obstruction

82
Q

Ways to prevent AKI

A
  • Avoid Nephrotoxins
  • – Use isoosmolar radiocontrast media & limit contrast volume to <100 mL.
  • – Use antibiotics cautiously with appropriate dose modification
  • – Stop certain medications (NSAIDs, ACE inhibitors, ARBs)
  • Optimize Volume Status Before Surgery or Invasive Procedures
  • – Aim for urinary output >40 mL/hr
  • – Hydrate with normal saline before and after procedures requiring radiocontrast media.
  • Reduce Incidence of Nosocomial Infections
  • – WTF? (Why The Foley) Remove indwelling urinary catheters when no longer needed
  • – Use strict aseptic technique with all intravenous lines.
  • Implement Tight Glycemic Control in the Critically Ill
83
Q

BUN: Creatinine ratio

A
  • Normal 10:1 to 20:1
  • More than 20:1, suspect nonrenal causes of laboratory
    abnormalities
84
Q

Normal GFR

A

Normal 84 to 138 mL/min

85
Q

Leading causes of CKD

A
  • Diabetes—50%
  • Hypertension—25%
  • Other: glomerulonephritis, cystic diseases, urologic diseases
86
Q

Why does CKD contribute to chronic anemia?

A

Kidneys create erythropoietin

87
Q

What to teach patient with CKD

A
  • Check weight daily and report a gain of greater than 4 pounds
  • Medications that may affect renal function
  • Access to care and natural supports
  • Dialysis
  • Kidney transplant
88
Q

CLABSI

A

Central Line Associated Blood Stream Infection

89
Q

Intermittent hemodialysis - Nursing Care Notes

A
  • Very effective, done bedside in ICU over 3 to 4 hours
  • Weight patient daily
  • Monitor labs
  • Do not give water soluble meds before treatment, hold anti-hypertensives, do not give 6 hours before treatment
  • Assess access frequently
90
Q

Intermittent hemodialysis - Complications

A
  • Hypotension
  • – Preexisting hypovolemia
  • – Rapid fluid removal, too much removed
  • Dysrhythmias due to rapid shift in K+
  • Potential for decrease in arterial oxygen
  • Dialysis disequilibrium syndrome
91
Q

Who may need immediate hemodialysis on an acute basis?

A
  • Acute overdoses
  • Severe Edema (acute decompensated HF)
  • Hepatic Coma
  • Severe Metabolic Acidosis
  • Burns
  • Transfusion Reactions
  • Rhabdomyolysis
92
Q

CRRT

A

Continuous Renal Replacement Therapy

93
Q

SCUF

A

Slow Continuous Ultrafiltration

- goal is fluid removal – no waste removal, no replacement fluid

94
Q

CVVH

A

Continuous Venovenous Hemofiltration

- Fluid and some waste product removal – some replacement fluid is used to increase flow

95
Q

CVVHD

A

Continuous Venovenous hemodialysis

- Some fluid and Max waste product removal

96
Q

CVVHDF

A

Continuous Venovenous Hemodiafiltration

- Max Fluid and Waste product removal

97
Q

What kind of patients need low and slow hemodialysis?

A
  • Severe HF with cardiomyopathy (severe fluid overload)
  • Increased ICP
  • Post resuscitation/Targeted Temp Management
  • AKI secondary to liver failure
  • Late presenting AKI
  • Still “controversial” Sepsis and MODS (try it and see if it works but may not be able to resuscitate back)
98
Q

If a patient is in the diuretic phase of AKI, the nurse must monitor for which serum electrolyte imbalances?

a. Hyperkalemia and hyponatremia
b. Hyperkalemia and hypernatremia
c. Hypokalemia and hyponatremia
d. Hypokalemia and hypernatremia

A

c. Hypokalemia and hyponatremia

99
Q

____________ is caused by a profound deficiency of insulin

A

DKA (Diabetic Ketoacidosis)

100
Q

The 3 P’s of DKA

A

Polydipsia
Polyuria
Polyphagia

101
Q

Sx of DKA

A
  • Classic signs of dehydration
  • Orthostasis
  • Polyuria
  • Polydipsia
  • Polyphagia
  • Hyperventilation/kussmaul’s respirations
  • Fruity odor to breath
  • Flushed/dry skin
  • Lethargy/altered consciousness
  • Abdominal pain/nausea/vomiting
  • Blood glucose greater than 250mg/dl (as high as 900’s)
  • Ketonuria/glucosuria
  • Weight loss (may be profound)
  • Blood gas changes (metabolic acidosis)
102
Q

Emergency management of DKA

A
  • Ensure patent airway; administer O2
  • Establish IV access; begin fluid resuscitation to replace extracellular and intracellular fluid and correct electrolyte
    balance
    — Nacl 0.45% or 0.9%; add 5% to 10% dextrose when blood glucose level approaches 250 mg/dl
    — Restore urine output to 30 to 60 ml/hr
  • Protect from cerebral edema; monitor for fluid overload, renal or cardiac compromise
103
Q

Expected drop in blood glucose with Tx

A

36 to 54 mg/dl/hr drop in serum glucose will avoid complications

104
Q

Tx of DKA

A
  • IV regular insulin drip 0.1 U/kg/hr to correct hyperglycemia and ketosis (until glucose reaches 150-200)
  • Must have stable ABG before transitioning to SQ insulin
  • Monitor blood glucose at least q6-8h
  • MAY need bicarb

NUR 418 (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions