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Patient Centered Care 3 > Final - 6 Oxygenation > Flashcards

Final - 6 Oxygenation Flashcards

1
Q

ARF =
PaO2 < _____
PaCO2 > _____

A

PaO2 < 50

PaCO2 > 50

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2
Q

Syndrome characterized by sudden, progressive pulmonary edema, increasing bilateral lung infiltrates on CXR, hypoxemia refractory to oxygen therapy, decreased lung compliance

A

acute respiratory distress syndrome (ARDS)

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3
Q

symptoms of ARDS

A
  • severe dyspnea
  • restlessness
  • tachycardia
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4
Q

diagnostic test for early stages of ARDS

A

BPM (plasma brain natriuretic peptide)

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5
Q

works with cardiac ventricles and increases in response to volume expansion

A

BNP

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6
Q

BNP > 100 =

A

HF

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7
Q

BNP > 400 =

A

severe HF

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8
Q

T/F: if pt’ has HF and is going into ARDS, BNP is not helpful

A

True

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9
Q

PEEP

A

positive end expiratory pressure

- really scary to families

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10
Q

ARDS pt’s need _____ calories

A

extra

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11
Q

An initial symptom of a simple pneumothorax is a sudden onset of…

A

chest pain

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12
Q

The _____ mask is the most accurate way to deliver
oxygen and is primarily used for patients with _____. It provides appropriate levels, thus avoiding the risk of suppressing
the hypoxic drive.

A

Venturi

COPD

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13
Q

Oxygen concentrations of greater than _____ for extended periods of time (longer than 24 hours) can cause an overproduction of free radicals which can severely damage cells.

A

50%

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14
Q

_____ or _____ prevent or reverse atelectasis and allow lower oxygen percentages to be used.

A

PEEP or CPAP

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15
Q

Placement of a tube thorough the nose or mouth into the trachea. The oral route is preferred.

A

endotracheal intubation

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16
Q

Immediately after intubation check _____ of chest expansion and auscultate breath sounds

A

symmetry

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17
Q

The position of the endotracheal tube is verified by checking end-tidal carbon dioxide levels and confirmed with…

A

chest x-ray.

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18
Q

endotracheal intubation should be positioned…

A

above 2cm above carina

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19
Q

a disorder of the lower respiratory tract that occurs most commonly in young children and is caused by infection with seasonal viruses.

A

bronchiolitis

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20
Q

is the leading cause of acute illness and hospitalization of young children. Although the number of hospitalizations seems to have increased the Mortality rate is low.

A

viral bronchiolitis

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21
Q

most common type of viral bronchiolitis

A

RSV (Respiratory syncytial virus)

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22
Q

sputum test is usually done first; if it is negative or inconclusive then the viral PCR is done.

A

DFA (direct fluorescent antibody)

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23
Q

The DFA (does, does not) cover the H1N1

A

does not

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24
Q

study is the most accurate and costs more than DFA

A

Viral PCR (polymerase chain reaction)

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25
Q

When do you test with the DFA & Viral PCR

A

when the rapid RXV is negative, then DFA, then Viral PCR

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26
Q

to detect infectious organisms in lung secretions (sputum)

A

DFA

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27
Q

_____-tagged antibodies made in the laboratory will react with a specific antigen from the infectious agent if present in the sputum; _____ indicates a positive result

A

fluorescence

28
Q

3 things tested with bronchiolitis scoring

A
  • RR
  • wheeze
  • retractions
29
Q

3 types retractions

A
  • supraclavicular/subrasternal
  • intracostal
  • subcostal
30
Q

One of the first things we do when the children are admitted is a base line _____ _____. It takes only seconds to do with a little practice.

A

bronchiolitis score

31
Q

bronchiolitis score 0-1 =

A

normal

32
Q

bronchiolitis score 4-6 =

A

moderate

33
Q

bronchiolitis score 2-3

A

mild

34
Q

bronchiolitis score 7-9

A

severe

35
Q

T/F: medications are not as important as suction

A

T

36
Q

the first and easiest way to suction

A

BBG (baby booger grabber)

37
Q

Second way to suction

A

NP (nasal pharyngeal)

38
Q

the highest you want to turn the suction to is _____ hg for peds patients

A

100

39
Q

remember with suction you need protection…

A

gown, mask, googles, gloves

40
Q

T/F: suction alone is better if it will work

A

T

41
Q

the meds are effective if the score decreases _____-_____ minutes post-tx

A

15-30 minutes

42
Q

Do not oral/PO feed if RR greater than or equal to _____ or bronchiolitis score >_____ or on a _____ _____ nasal cannular

A
  • RR > 65
  • bronchiolitis score > 6
  • high flow nasal cannula
43
Q

A 16-month old bronchiolitis patient with a baseline score of 5 is suctioned, and the post-suction score is 2. Following an albuterol trial, the RR = 42, subcostal & intercostal retractions are present and there are crackles bilaterally.What would you suggest for a plan of care?

A

Continue suctioning prn and discontinue albuterol treatments as the patient worsened post treatment.

44
Q

You are asked to evaluate a 2 year old bronchiolitis patient who hasQ4 albuterol treatments ordered. The baseline score is 3 for increased RR & wheezing. After suctioning, the RR is 26 with no retractions or wheezing. What would you suggest for the plan of care?

A

Continue suctioning since there were no wheezes post-suction; discontinue albuterol treatments

45
Q

A 20 month old bronchiolitis patient had a post suction score of 7 for RR 46, subcostal & intercostal retractions and inspiratory & expiratory wheezing. The post albuterol score was 6 for RR 45 (only change).Did the patient respond positively to the albuterol?

A

No—the drop in score was due to the drop in RR by one. Truly, this patient did not respond as breath sounds and work of breathing (retractions) did not change.

46
Q

You are evaluating a 13 month old for treatment need. The patient has already been suctioned and has both albuterol & epinephrine trials ordered. You find a RR of 62, subcostal & intercostal retractions, head-bobbing, grunting & diminished breath sounds, but no wheezing. There is no family history to suggest atopy (The genetic tendency to develop the classic allergic diseases).
Which medication would you use first?

A

Epinephrine since the patient is not wheezing and there is no family history to suggest atopy. It also may work faster.

47
Q

Volume of air inspired and expired with a normal breath

A

Tidal Volume

48
Q

volume of air based on idea body wt

A

6 mL/kg

49
Q

low tidal volumes can cause…

A

hypercapnic acidosis

50
Q

hig tidal volumes cause…

A

lung injury or barotrauma

51
Q

amt of O2 delivered to the pt

A

FIO2

52
Q

Room air is _____-_____ compared to a nasal cannula…for every L the FIO2 is approximately 4% so, 1 L is about _____%

2L = \_\_\_\_\_%
4L = \_\_\_\_\_%
A

20-21%
1 L = 24%
2 L = 28%
4 L = 36%

53
Q

used to ween from ventilator

A

PSV or CPAP

54
Q

delivers air pressure at a single level. The air pressure cannot be altered.

A

CPAP

55
Q

has two levels of airway pressure - high, when the patient inhales, and low when the patient exhales. The air pressure in the _____ can be altered.

A

BiPAP

56
Q

All spontaneous breaths are volume support ventilation

A

PSV or CPAP

57
Q

Provides preset pressure to augment the tidal volume of each spontaneous breath

A

PSV or CPAP

58
Q

Use of mask or other device to maintain a seal and permit ventilation.

A

Noninvasive Positive–Pressure Ventilation

59
Q

Every breath is ventilator-generated or patient triggered and will be augmented to the preset tidal volume or pressure limit

A

A/C

60
Q

The patient receives full ventilator support for all spontaneous breaths

A

A/C

61
Q

Rate and Tidal Volume are set

A

A/C

62
Q

Provides full support to the preset tidal volume or pressure limit for only the ventilator programmed breath rate or frequency

A

SIMV

63
Q

Any additional breaths will be from patient’s own efforts

A

SIMV

64
Q

Patient may breathe above the set machine rate, during which the ventilator will not assist and tidal volume will be determined by patient

A

SIMV

65
Q

Prevents alveoli collapse

A

PEEP

66
Q

If you get it too high PEEP, it can _____ your cardiac output

A

decrease

Patient Centered Care 3 (13 decks)

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