Gas Exchange Lab

Question 1

initial assessment before you suction a patient with ET

Answer 1

obtain baseline breath sounds and VS. SaO2

Question 2

correct amount of pressure for suctioning an adult, nonate, a child

Answer 2

• neonate - 60-80
• child - 80-100
• adult - 80-120

Question 3

is suctioning ET sterile?

Answer 3

yes

Question 4

how to hyperventilate the patient

Answer 4

using your nondominant hand and a manual resuscitation bag and delivery three to six breaths or use sigh mechanism on a mechanical vent

Question 5

risk factor for spontaneous pneumothorax

Answer 5

a closed or occluded chest tube

Question 6

where is the chest tube located within the body

Answer 6

within the pleural space and the chest wall

Question 7

what conclusion would you draw if the chest tube water chamber was not bubbling?

Answer 7

the tube is above the water line (more water needs to be added)

Question 8

what conclusion would you draw if the water chamber was not tidling

Answer 8

there may be an obstruction within the system or lung reexpansion may be happening

Question 9

if your patient had an open heart surgery, where would the drainage chest tube be located inside the body

Answer 9

mediastynal

Question 10

if chest tube stopped draining what might have happened

Answer 10

lungs may have re-expanded and/or there may be no more fluid to drain

Question 11

supplies for chest drainage system

Answer 11

• 2kelly clamps
• new drainage system
• sterile water

Question 12

how do you position a patients head for using a hand held resuscitation bag?

Answer 12

tilt head/lift chin - opens airway, allows air to flow directly into trachea

Question 13

how do you position your patients head prior to inserting an NG tube?

Answer 13

pt slightly flexs head back against pillow for insertion to allow for normal contour of nasal passage, then once pharynx is reached bring head forward to help close epiglottis and open esophagus

Question 14

how often do you change an in-line catheter for closed/sleeve/in-line suction

Answer 14

q7days; or if needed

Question 15

indication for suction of artifivial airways:

Answer 15

• high pressure alarm
• cough
• gurgling
• coarse breath sounds
• decreased 02sat.

Question 16

do you suction artificial airways prn or routine?

Answer 16

only suction prn - never routine

Question 17

for inline suction how do you hyperventilate?

Answer 17

2min. 100% 02 setting on vents

Question 18

for in-line suctioning what do you do when you withdraw the catheter?

Answer 18

1cm and initiate continuous suction while withdrawing the cath. no longer than 15sec @ a time

Question 19

how long is an endo placed for

Answer 19

2weeks; trach if needed for longer

Question 20

indications for ET

Answer 20

• surgery (anesthesia)
• trauma
• resp
• muscle fatigue
• resp failure

Question 21

Keep trach cuff pressure @ __-__mmHg or less

Answer 21

14-20mmHg or less to prevent mucosal ischemia

Question 22

accumulation of air in the pleural space

Answer 22

pneumothorax

Question 23

accumulation of fluid in the pleural space

Answer 23

pleural effusion

Question 24

collection of lymphatic fluid in pleural space

Answer 24

chylothorax

Question 25

a pyogenic infection of the pleural space

Answer 25

empyema

Question 26

accumulation of blood in the pleural space

Answer 26

hemothorax

Question 27

accumulation of serous fluid in the pleural space

Answer 27

hydrothorax

Question 28

acts as a one-way valve; maintains neg. pressure w/in pleural space; fill w water to 2cm mark; re-fill if low; water should fluctuate with respiration, but not bubble; no fluctuation indicates blockage or resolution of pneumothorax; continuous bubbling signifies an air leak in the system

Answer 28

water seal chamber

Question 29

collects pleural drainage; do not empty, but replace pleura-vac if full; measure output q1hr-q.shift & mark on chamber; never allow to fill to top or drainage will be obstructed

Answer 29

collection chamber

Question 30

where is a chest tube inserted for air removal

Answer 30

2nd anterior ICS (apex)

Question 31

wherre is a chest tube placed for fluid removal

Answer 31

in 8-9th posterior ICS

Question 32

how do you dislodge clots in a chest tube

Answer 32

use proximal to distal gentle hand-over-hand squeezing to dislodge clots

Question 33

percent 02 delivered by vent (.21-1.0)

Answer 33

Fi02

Question 34

volume of air delivered w/ each inspiration. based on wt.

Answer 34

Vt

Question 35

breaths/minute (10-24)

Answer 35

resp. rate

Question 36

positive pressure at end-expiration to keep alveoli open. Used if >50% 02 required. Used w/ mandatory vent modes

Question 37

mechanical ventilation: high pressure alarm

Answer 37

• check need for suction
• check tube for biting
• check for kinked ET tube
• Check need for sedation (restlessness)
• check for pneumothorax

Question 38

pH

Answer 38

7.35-7.45

Question 39

pCO2

Answer 39

35-45mmHg

Question 40

HCO3

Answer 40

22-26meq/L

Question 41

Respiratory = Opposite

pH is high,

pH is low,

Answer 41

pH is high, PCO2 is down (alkalosis)

pH is low, PCO2 is up (acidosis)

Question 42

Metabolic = Equal

pH is high,

ph is low,