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Med surg > Lecture Week 2 > Flashcards

Lecture Week 2 Flashcards

1
Q

How does an intraaortic ballon pump work

A

cath goes from the femoral artery into the aortic arch. During ventricular diastole (when the aortic valve closes) the ballon inflates pushing blood back toward the left ventricle where it can enter the coronary artery orifaces

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2
Q

what should you do to decrease cardiac workload

A
  1. give o2

2. decrease SVR

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3
Q

what are the two types of respiratory failure

A
  1. hypoxic (such as in pneumonia)

2. hypercapnic (such as in COPD)

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4
Q

what are the early signs of hypoxic respiratory failure

A
  1. restless

2. premature ventricular contractions

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5
Q

what are the early signs of hypercapnic respiratory failure

A

1.lethargic

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6
Q

what do you do to treat hypercapnic respiratory failure

A

give BiPaP to reduce CO2 levels, but the patient needs to be awake because unlike cPAP it does not push the air in and the patient actually has to breath.

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7
Q

normal CO2 levels for COPD patients

A

60-70 you really dont wanna drop them lower then that because their instinct to breath is dependent on CO2 rather then O2 like us

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8
Q

what kind of people end up getting elective intubations

A

surgery and CVA patients

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9
Q

what are the ET sizes in men vs women

A

women: 7-7.5
men: 7.5-8

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10
Q

where is a normal ET placement? what happens if the ET tube gets pushed down? what happens if it gets pulled up?

A

about 1 inch above the carina. If it gets pushed down it will go down the right lung and cause the left lung to collapse. If it goes up neither lung will receive proper oxygenation.

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11
Q

what drugs do you give patients before intubation

A
  1. benzo(versed)

2. paralytic agent (succenylcholine, proprofol, vecuronium)

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12
Q

which patients are hardest to put an ET in? what are they at risk for? how do you care for these patients

A

1.short necks
2.obese
at risk for hypoxia (due to multiple attempts) watch for bradycardia and hypoxia(observe monitor) during insertion

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13
Q

how do you confirm ET placement and which landmark is the carina at?

A

CXR, 4th intercostal space at the nipple line.

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14
Q

what will happen if you have no fully inflated an ET cuff

A

you will hear gurgling

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15
Q

What are the different modes on a vent and what do they do

A
  1. AC (assisted control)-machine does all the work
  2. SIMV(synchronized intermittent mandatory ventilation) -it will help the patient reach some goal. such as if the patient inhales 200 it will push the extra 300 in.
  3. CPAP (continous positive airway pressure)-patient does all the work the machine just helps keep the alveoli open
  4. PEEP (positive end expiratory pressure) - increases oxygenation by keeping the alveoli open. It is contraindicated in hypotension because it increases intrathoracic pressure which decreases preload. You need an order to add PEEP to patients post CABG. Normal PEEP (5-10)
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16
Q

What is the VT setting on vent

A

Tidal volume, it is dependent on weight normal tidal volume is 6-8 ml/kg

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17
Q

what is the normal RR on a vent

A

14 plus minus 2

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18
Q

what vent setting would you adjust first if a patient is hypoxic

A

set FiO2 to 100%

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19
Q

what is hyperventilation

A

has nothing to do with oxygen and everything to do with RATE of respirations and flushing of CO2

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20
Q

what vent setting would you adjust to lower CO2

A

increase the RR

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21
Q

what is the difference between O2 sat and PO2

A
  1. O2 sat is the % of hemoglobin that has oxygen attached to it
  2. PO2 is the amount of oxygen dissolved in blood. (80-100)
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22
Q

what is the difference between hypoxemia and hypoxia

A

hypoxemia means the PO2 levels are dropping (60-80)
hypoxia means that the PO2 levels have dropped below 60 and due to the oxyhemoglobin dissociation curve the tissues are now not getting enough oxygen.

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23
Q

describe the oxyhemoglobin dissociation curve

A

O2 sat lateral and PO2 level horizontal. It looks like the graph of pH buffers the magic numbers being PO2 of 60 and O2 sat of 90%

24
Q

what is the general purpose of the pulmonary function test (PFT)

A

tell us how good the lungs are

25
Q

what can you do with a bronchoscopy other then visualize the throat

A
  1. deep suctioning

2. bronchial wash(biopsy)

26
Q

distinguish between a pneumothorax

hemothorax, pleural effusion and pulmonary edema

A
  1. pneumothorax is air trapped within the pleural space
  2. hemothorax is blood trapped in the pleural space
  3. pleural effusion-transudate/exudate in the lungs
  4. pulmonary edema-fluid in the lungs
27
Q

what is the difference between an open pneumothorax vs a closed(tension) pneumothorax

A
  1. open requires penertration of the chest wall (e.g: stabbing) air goes in and doesnt come out
  2. closed is worse because its not obvious you have a one way leak
28
Q

what is a major risk for clients on vents and why

A

tension pneumothorax because of the high pressure

29
Q

does CPR help in pneumothorax?why

A

no, the pressure increase pushes down on organs and vessels. The heart will not be able to accept venous return.

30
Q

how would you poisiton a patient for CXR for fluid in the lungs

A

sitting upright so that the fluid collects at the bottom

31
Q

describe what you see on xrays and what they mean for example what does black mean

A

black means air

white are fluids

32
Q

what diagnositic do you have to run before and after placement of a swan gauz

A

CXR

33
Q

indiciation for chest tube insertion

A

if you do a CXR and there are fluids from ICS 8-12

34
Q

how is patient positioned for chest tube insertion

A

lying on unaffected side

35
Q

what do you do first if a chest tube gets disconnected from the machine?

A

put the end of the tube into sterile water to maintain negative pressure

36
Q

how much chest tube drainage is to much per hour

A

over 70 mL you should call the doctor

37
Q

are air bubbles normal in the water seal chamber?

A

kinda, up to the 2 cm mark is okay because the lung is damaged as it heals the bubbles will go away. Once they fully go away it indicates the lung is fully healed. Also it should not continously bubble

38
Q

what is subcutaneous emphysema

A

a chest tube complication where air collects inside the skin causing it to swell. It will crackle on paplitation

39
Q

should you milk a chest tube?

A

no you risk pulling it out instead hit the tube with a clamp to break up clots

40
Q

what diagnostics should be done for PE

A

pulmonary angiogram(gold standard)
V/Q scan
D-Dimer (.44-2.33)

41
Q

what drugs do you give for PE

A

TPA then lovenox 1mg/kg

42
Q

what is ARF

A

severe lung injury that causes insufficent O2 transfer to blood and insufficent removal of CO2

43
Q

what drugs do you give in ARF

A

sedation(benzos)
paralytics(proprofol, vecuronium)
These are to decrease the metabolicc requirements of the body
lasixs-to remove fluid from capillary leaks

44
Q

s/s of tension pneumothorax

A
  1. mediastinal shift(severe)
  2. dyspnea
  3. assymeterical chest rise
45
Q

how much water should be added to the water seal chamber? suction control chamber?

A
  1. 2cm

2. 20 cm

46
Q

procedure for Chest tube removal

A

one quick movement while patient does Valsalva maneuver. Apply sterile cause. Monitor respiratory status. Get chest xray

47
Q

s/s of PE

A
  1. chest pain
  2. dyspnea
  3. hemoptysis
  4. tachycardia
  5. low grade fever
  6. pleural effusion
  7. anxiety
    - impending doom
  8. petechiae
  9. cough
  10. diaphoresis
  11. hypotension
48
Q

s/s of PE again

A
  1. vitals
    - tachycardia, hypotension, low grade fever, chest pain, hypoxia, tachypnea(decrease CO2)
  2. Respiratory
    - dyspnea, cough, crackles, pleural effusion, hemoptysis
  3. Integumentary
    - Petechiae,diaphoresis
49
Q

causes of hypercapnic RF

A

1.CNS problems
-drug overdose, brainstem infarction, spinal cord injury
2.chest wall problems
-flail chest, kyphosis,obesity
fracture
3.Neuro
-Muscular dystrophy, MS, guillain barre syndrome

50
Q

what is the main problem in ARDS

A

capillary membrane is dilated due to injury to the alveolar-capillary membrane. therefore it leaks into the pulmonary interstitum(pulmonary edema)

51
Q

what are the two possible outcomes of injury to the alveolar capillary membrane

A
  1. damage to the type 2 alveloar cells

2. release of inflammatory mediators

52
Q

what occurs when type 2 alveolar cells are damaged

A
  1. decreased surfactant production
    - >decreased alveolar compliance and recoil
    - >atelectasis
    - >(1)hyaline membrane formation ->impaired gas exchange
    (2) decreased lung compliance->impaired gas exchange
53
Q

what happens when inflammatory mediators are released

A
  1. Bronchoconstriction
    (1) ->impaired gas exchange
    (2) pulmonary HTN
    - >impaired gas exchange
  2. Increased alveolar capillary membrane permeability
    - >capillary leak of blood cells and fluids
    - >pulmonary edema
    - >impaired gas exchange
54
Q

what kind of breathing will patients with ARDS present with

A

1.rapid shallow with dyspnea

55
Q

what signs will ARDS present with

A
  1. severe morning headaches
  2. early signs
    - tachycardia,tachypnea, mild hypertension
56
Q

interventions ARDS

A
  1. maintain PaO2 above 55
  2. Positive pressure ventilation
    - BiPaP, CPAP,vent
  3. mobilize secretions
    - hydration,chest physiotherapy, suction
  4. for airway inflammation use steroids
  5. for pulmonary congestion use diuretics and nitrates if HF is present
57
Q

what are the features of moderate sedation

A
  1. can respond to verbal stimuli
  2. has gag reflex
  3. independently maintains patent airway

Med surg (35 decks)

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