mechanical ventilation and ECGs

Question 1

criteria for PPV

Answer 1

obstruction
stridor
excessive secretions
RR <8 or >35
GCS <10

Question 2

OPA (oropharyngeal airway)

Answer 2

relieve tongue obstruction
used with BVM or airway mgmt

Question 3

nasopharyngeal airway

Answer 3

size 6-9 french
used long term to relieve airway obstruction
when oral intubation is impossible

Question 4

endotracheal tube (ETT) measurements

Answer 4

female 7.5
male 8.0
depth is 5 cm from carina

Question 5

tracheostomy tube

Answer 5

for prolonged intubation due to failure to wean off ventilator
can be permanent for long term airway mgmt

Question 6

BiPAP

Answer 6

2 levels of set pressure to support breathing (inhale and exhale)

Question 7

BiPAP indications

Answer 7

COPD exacerbation, acute cardiogenic edema, post op, difficulty to wean

Question 8

CPAP

Answer 8

one pressure to support spontaneous breathing

Question 9

tidal volume basic setting

Answer 9

4-8 mL/kg. vol delivered for each breath

Question 10

RR basic settings

Answer 10

8-24 breaths per min

Question 11

PEEP settings

Answer 11

5-20 cm H2o. keeps alveoli open at end exhalation

Question 12

Fio2 setting

Answer 12

fraction of inspired oxygen. start at 1 and wean down to 0.21 (RA)

Question 13

what is PPV

Answer 13

positive pressure ventilator
gas is delivered into lungs through circuitry
based on cycle (pressure, vol, flow)

Question 14

volume cycled PPV

Answer 14

when a certain volume is reached in lung, inspiration is done

Question 15

assessment of mechanical ventilation

Answer 15

size and type
depth
position in mouth *mouth care
cuff pressure
inspect securing method
observe skin for necrosis and irritation

Question 16

why do we use IBW for settings

Answer 16

organ sizes are the same for ppl of the same height regardless of fat

Question 17

respiratory hazards for mechanical ventilation

Answer 17

barotrauma: difference of pressure between lungs and surrounding tissue (subcut emphysema, pneumothorax)

pneumonia

volutrauma: overdistension of alveoli

atelectesis: from repeated collapsing and inflation

Question 18

cardio hazards from mechanical ventilation

Answer 18

altered venous return leading to hypotension

Question 19

renal hazards

Answer 19

decreased CO, UO
lasiks are used

Question 20

liver hazards

Answer 20

impaired liver function from decreased CO

Question 21

GI hazards

Answer 21

gastric distension if PPV is done by mask

Question 22

trach assessment includes

Answer 22

size and type
cuff pressure
inspection of stoma
securing method

Question 23

ventilator alarms from

Answer 23

pt disconnection
vent asynchrony
secretions (suction)

Question 24

admission criteria for ECG

Answer 24

48 hrs post MI
unstable angina
syncope with arrhythmias
pre/post pacemaker and cardiac catheterization
on low dose dobutamine

Question 25

bloodwork with cardiac monitoring

Answer 25

troponin, creatinine kinase, myoglobin

Question 26

normal QRS, PR and QT

Answer 26

QRS <0.12
PR 0.12-2.0
QT < 0.44

Question 27

Vaughan Williams classification system for arrhythmias

Answer 27

class 1- Na channel blockers
class 2- beta blockers
class 3- K channel blockers
class 4- Ca channel blockers

Question 28

assessment for pts with dysrhythmias

Answer 28

CO, oxygenation, changes in LOC, rate and rhythm of pulses, heart sounds, BP, fluid retention

Question 29

cardioversion

Answer 29

timed shock during QRS complex

Question 30

stable arrhythmia

Answer 30

abn rhythym w normal BP
asymptomatic

Question 31

unstable arrhythmia

Answer 31

compromises blood flow
symptomatic

Question 32

d/c criteria for ECG

Answer 32

sinus
no symptom 24 hrs
controlled a fib

order req if HR <40 or >100, PVC, diagnosed dysrhythmia or syncope

Question 33

first assessment for mechanical tube placement

Answer 33

end tidal CO2 monitoring