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Adult Nursing II - Exam 2 > Mechanical Ventilation & Moderate Sedation (Week 2) > Flashcards

Mechanical Ventilation & Moderate Sedation (Week 2) Flashcards

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1
Q

What is the goal when administering oxygen as a medication?

Mechanical Ventilation

A

administer the lowest possible level to achieve a satisfactoroy PaO2 or SaO2

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2
Q

How many liters should a nasal canula run at?

Mechanical Ventilation

A

1 - 6 L per minute

(28 - 44% O2)

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3
Q

How many liters should a high flow nasal cannula run at?

Mechanical Ventilation

A

up to 60 liters per minute

delivers up to 100% heated & humidified O2

positive pressure helps open alveoli for gas exchange

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4
Q

What is unique about a High Flow Nasal Cannula?

A

It has positive pressure which helps to open alveoli for gas exchange

PEEP: Positive End-Expiratory Pressure

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5
Q

What type of oxygen therapy is the most accurate / precise?

Mechanical Ventilation

A

Venturi Mask

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6
Q

What is unique about a Venturi Mask?

Mechanical Ventilation

A

Most Accurate method of O2 delivery

  • used for patients with COPD
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7
Q

How many liters should a non-rebreather bag be set at? What is unique about a non-rebreather bag?

Mechanical Ventilation

A

10 - 15 liters per minute

  • Delivers up to 100% O2 – highest delivery O2 using low flow O2
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8
Q

Nursing Management of Oxygen Therapy

Mechanical Ventilation

A

Ensure O2 is being administered as ordered
* confirm device is properly positioned
* Replace if it’s dislodged
* Monitor O2 saturation w/ pulse ox
* Transport patient with O2

Observe for complications of therapy

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9
Q

What does it mean if the bands shift to the left in terms of labs?

A

There is a large grouping or number of immature neutrophils (immature WBCs)

Over time these will help people fight off infections

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10
Q

Memory Trick to Interpret ABGs

Mechanical Ventilation

A

Respiratory Opposite – pH & CO2 arrows move in opposite directions

Metabolic Equal – pH & CO2 arrows move in same direction

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11
Q

What are the normal ranges for pH, PaCO2, HCO3?

What are the normal ranges for paO2 & O2 Sat or SaO2?

KNOW THIS!!!!!!

A

pH: 7.35 - 7.45
PaCO2: 35 - 45
HCO3: 22 - 26

  • PaO2: 75 - 100
  • SaO2: 95 - 100%
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12
Q

Describe the pH, PaCO2, & HCO3 in respiratory acidosis

Mechanical Ventilation

A

pH: low
PaCO2: HIGH
HCO3: normal

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13
Q

Describe the pH, PaCO2, & HCO3 in respiratory alkalosis

Mechanical Ventilation

A

pH: HIGH
PaCO2: low
HCO3: normal

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14
Q

Describe the pH, PaCO2, & HCO3 in metabolic acidosis

Mechanical Ventilation

A

pH: low
PaCO2: normal
HCO3: low

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15
Q

Describe the pH, PaCO2, & HCO3 in metabolic alkalosis

Mechanical Ventilation

A

pH: HIGH
PaCO2: normal
HCO3: HIGH

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16
Q

What happens to the pH during acidosis vs. alkalosis?

Mechanical Ventilation

A

acidosis = low pH

ALKALOSIS = HIGH pH

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17
Q

Does the PaCO2 or HCO3 change during resipratory acidosis / alkalosis?

Mechanical Ventilation

A

PaCO2 changes

HCO3 = normal

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18
Q

Does the PaCO2 or HCO3 change during metabolic acidosis / alkalosis?

Mechanical Ventilation

A

PaCO2 = normal

HCO3 changes

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19
Q

What is the purpose of mechanical ventilation & when is it indicated?

Mechanical Ventilation

A

Replace or assists with respirations

Indications: apnea & ineffective breathing

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20
Q

What is the difference in Non-Invasive & Invasive mechanical ventilation?

Mechanical Ventilation

A

Non-Invasive: = BiPap
* positive airway pressure
* keeps alveoli open
* patient MUST be mentally oriented

Invasine = intubation
* endotrachial tube (ETT) is inserted through nose or mouth (can be left in for several weeks)

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21
Q

In what circumstance would you avoid doing endotracheal intubation (invasive mechanical ventilation) If endotracheal intubation cannot be used, what should be done?

A

Oral Trauma

Unable to intubate orally then you should intubate nasally unless you are concerned that the patient might have facial fractures

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22
Q

What are patients who are nasally intubated at a higher risk for?

A

Sinus infection

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23
Q

What is the difference in volume cycled & pressure cycled ventilators?

Mechanical Ventilation

A

Volume Cycled: delivers constant volume of air with each breath

Pressure Cycled: delivers set volume pressure of air during inspiration
* once pressure is reached cycle turns off & exhalation occurs

24
Q

What is a volume cycled ventilator?

A

constant volume of air with each breath

25
Q

What is a pressure cycled ventilator?

A

set volume pressure of air during inspiration

  • once the pressure is reached the cycle is turned off & exhalation occurs
26
Q

What is the most common type of ventilator used?

KNOW THIS!!!

A

Volume Cycled

27
Q

Describe the type of pressure, rate, & volume of respirations with volume cycled ventilators

Mechanical Ventilation

A

Pressure: POSITIVE

Rate (respirations): constant
Volume (tidal volume): constant

28
Q

Describe the ventilator settings

Mechanical Ventilation

A
  • Respiratory Rate
  • Tidal volume (weight based)
  • FiO2 (under 50% is IDEAL)
  • PEEP (positive end expiratory pressure) (usually 5 - 10)
29
Q

What are some pros & cons fo volume cycled ventlators?

A

Pros:
* can be ued for patients who have spontaneous breathing
* Set number of breaths per minute
* Allows the body to rest
* Decreases anxiety

CONS:
* every breath is the same
* DECREASED work of expiratory muscles

30
Q

What is pressure support in terms of a ventilator?

A

Provides small amount of pressure during inspriation to encourage active breathing

  • patient regulates their own RR
  • Tidal volume is NOT set
  • helps patients “say I need to take a breath”

Larger breath gives patient larger tidal volume

Smaller breath gives patient smaller tidal volume

31
Q

Ventilator Alarms

KNOW THIS!!!

A
  • Always look at the patient first!
  • Do not automatically silence alarm
  • Alarm system svary
  • High pressure alarms = INCREASED resistance (cough, suction, water in tube that connects patient’s endotracheal tube to the ventilator)
  • Low pressure alarms = disconnect between patient & ventilator
32
Q

Ventilator Weaning Criteria

KNOW THIS!!!

A
  • Acceptable ABGs
  • Patient can breath on own
  • Intact gag reflex
  • Ability to cough & take deep breath
  • FiO2 under 50%
33
Q

What should be inspected during a focused physical exam for patients who are mechanically ventilated?

A
  • Respiratory rate, rhythm, & depth
  • Accessory muscle use, sputum, chest expansion, skin color, JVD
  • Chest tube fluctuating or bubbling; tube secured & untangled
  • Oxygen device & FiO2
  • Endotracheal tube well secured at ____, vent tubing freely draining & untangled, HOB >30 degrees, cuff pressure
  • Risk for premature extubation
34
Q

What should be palpated & percussed during a focused physical exam for patients who are mechanically ventilated?

A

Palpation
* subcutaneous emphysema (crepitus)
* Calf tenderness & size
* + Homan’s sign (calf pain with dorsiflexion of foot when knee is elevated)
* Tracheal position

Percussion
* suspicion of tension pneumothorax (hyper-resonant BS)

35
Q

What should be auscultated during a focused physical exam for patients who are mechanically ventilated? When should auscultations occur?

A

When: multiple times per shift

Auscultate: breath sounds & adventitious sounds (rales / crackles, rhonchi, & wheezes)

36
Q

What is the gold standard to establish that an endotracheal tube is in the correct place?

A

Chest X-Ray

37
Q

Symptoms of Acute Respiratory Distress Syndrome (ARDS)

Mechanical Ventilation

A
  • agitation
  • extreme anxiety
  • chest pain
  • mental changes
  • CV decompensation
  • diaphoresis
  • changes in respiratory pattern
  • arrhythmias
38
Q

How can Ventilator Associated Pneumonia (VAP) be prevented?

KNOW THIS!!!

A
  • handwashing
  • HOB 30 - 45 degrees
  • oral hygiene
  • type of endo tube/cuff
  • secretions
39
Q

What are potential complications of mechanical ventilation?

A
  • R main stem intubation
  • Esophageal intubation
  • Self extubation
  • Mucus plug
  • Barotrauma (pneumothorax, pnemomediastium, subcutaneous emphysema)
  • GI (gastric distension or GI bleed / stress ulcer)
  • Patient-ventilator dys-synchrony or asynchrony
  • Failure to wean
40
Q

A patient with a history of COPD requires O2 therapy. THe nurse knows that the practitioner will probably start with a low-flow system & evaluate the patient once the therapy is started. Which device should the nurse anticipate an order for?

a.) Nasal cannula
b.) Simple face mask
c.) Reservoir cannula
d.) Air-entrainment nebulizer

Mechanical Ventilation

A

a.) Nasal Cannula

41
Q

A patient with acute lung failure has been mechanically ventilated for 3 days & is being evaluated for a spontaneous breathing trial. When the nurse enters the room, the ventilator inoperative alarm sounds. WHich action should the nurse perform FIRST?

a.) Troubleshoot the ventilator until the problem is found
b.) Take the patient off the ventilator & manually ventilate the patient
c.) Call the respiratory therapist for help
d.) Silence the ventilator alarms until the problem is resolved

Mechanical Ventilation

A

b.) Take the patient off the ventilator & manually ventilate the patient

42
Q

What are the 4 levels of communication?

Mechanical Ventilation

A
  • Intrapersonal
  • Interpersonal
  • Group
  • Cultural
43
Q

What is unique about moderate sedation?

Moderate & Deep Sedation

A

No interventions are required to maintain a patent airway & spontaneous ventilation is adequate

44
Q

Describe the LOC / responsiveness, airway, & spontaneous ventilation CV function of moderate sedation

Moderate & Deep Sedation

A
  • LOC / Responsiveness: purposeful to verbal or tactile
  • Airway: NO intervention required
  • Spontaneous Vent CV function: adequate, usually maintained
45
Q

Describe the ASA Classification levels

Moderate & Deep Sedation

A
  • ASA I: normal healty patient with no disease
  • ASA II: patient with mild to moderate systemic disturbance or disease
  • ASA III: patient with severe systemic disturbance or disease
  • ASA IV: patient with severe & life-threatening systemic disease or disorder
  • ASA V: patient who is unlikely to survive without the planned procedure
46
Q

Describe the Mallampti Scoring for Airway Assessment

Moderate & Deep Sedation

A

Class I: full visualization

Class II: slightly obstructed

Class III: almost completely obstructing back of the throat

Class IV: visualization of hard palate only

47
Q

What should be asked to determine if a patient requires / qualifies for moderate or deep sedation?

Moderate & Deep Sedation

A
  • What is the ASA
  • What is the threshold for the drug?
  • One or 2 medications used?
  • Hospital policy about moderate / deep sedation drugs
48
Q

What two medications are ALWAYS used for moderate / deep sedation in any hospital in a non-intubated patient?

Moderate & Deep Sedation

A

Propofol & Ketamine

49
Q

What are the antedotes for reversing opioids & benzodiazepines?

Moderate & Deep Sedation

A

Benzodiazepine Antedote = flumazenil (Romazicon)
* Versed
* Valium
* Ativan

Opioid Antedote = naloxone (Narcan)
* Dilaudid
* Fentanyl
* Morphine

50
Q

What are signs & symptoms of delirium?

Moderate & Deep Sedation

A
  • lack of sleep
  • confusion
  • restlessness
51
Q

What are non-pharmacologic interventions to prevent delirium?

Moderate & Deep Sedation

A
  • Spontaneous awakening trials
  • Early mobility (can get in chair if ventilated)
  • Daily delirium monitoring
  • Sleep protocols
52
Q

When listening to a patient after intubation, how can you tell if they were intubated in the R main stem?

KNOW THIS!!!!!

A

Few or NO breath sounds on the L side

53
Q

A patient with pneumonia is reporting shortness of breath. The nurse suspects the patient is hypoxemic and may need additional oxygen therapy. Which arterial blood gas (ABG) value would validate the nurse’s suspicions?

a.) PaO2 of 80 mm Hg
b.) PaCO2 of 35 mm Hg
c.) HCO3- of 24 mEq
d.) SaO2 of 87%

A

d.) SaO2 of 87%

54
Q

A patient with a history of COPD requires oxygen therapy. The nurse knows that the practitioner will probably start with a low-flow system & evaluate the patient once therapy is started. Which device should the nurse anticiapte an order for?

a.) Nasal cannula
b.) Simple face mask
c.) Reservoir cannula
d.) Air-entrainment nebulizer

A

a.) Nasal cannula

55
Q

A patient with acute lung failure has been mechanically ventilated for 3 days & is being evaluated for a spontaneous breathing trial. WHen the nurse enters the room, the ventilator inoperative alarm sounds. Which action should the nurse perform FIRST?

a.) Troubleshoot the ventilator until the problem is found
b.) Take the patient off the ventilator & manually ventilate the patient
c.) Call the respiratory therapist for help
d.) Silence the ventilator alarms until the problem is resolved

A

b.) Take the patient off the ventilator & manually ventilate the patient

Adult Nursing II - Exam 2 (4 decks)

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