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High Acuity Exam 2 > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

bronchoscopy indications

A

stent placement, foreign object removal, collecting/culturing specimens, secretion removal, investigating hemoptysis

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2
Q

interventions pre-bronch

A

consent, remove dentures, NPO 4-8h before, check coag labs, cough/gag, prepare sedation

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3
Q

interventions during bronch

A

monitor vitals, respiratory pattern, RASS goal - no cough/gag

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4
Q

expected findings post-bronch

A

blood-tinged secretions, sore throat, cough + gag back within 2 hours

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5
Q

laryngospasm

A

risk after bronch - airway occlusion; SOB, can’t talk

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6
Q

uses for naso+oropharyngeal airways

A

hyperoxygenation before intubation, tongue swelling, intoxication/OD

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7
Q

arterial stick interventions

A

check Allen’s test before, hold pressure for 5 min, neurovascular checks

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8
Q

normal pH

A

7.35-7.45

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9
Q

normal PaCO2

A

34-45

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10
Q

normal HCO3

A

21-28

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11
Q

normal PaO2

A

75-100

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12
Q

normal SaO2

A

93-100%

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13
Q

causes of respiratory acidosis

A

OD, pulmonary edema, pneumonia, COPD, sleep apnea

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14
Q

s/s of respiratory acidosis

A

decreased LOC, hypotension, hyperK, compensatory hyperventilation

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15
Q

causes of metabolic acidosis

A

renal failure, severe diarrhea/vomiting, DKA, aspirin OD

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16
Q

s/s of metabolic acidosis

A

compensatory hyperventilation, hyperK

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17
Q

causes of respiratory alkalosis

A

anxiety, PE, hypoxia

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18
Q

s/s of respiratory alkalosis

A

compensatory hypoventilation, dizziness, paresthesia, decreased LOC

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19
Q

causes of metabolic alkalosis

A

vomiting, gastric suction, K loss, bicarb/antacid admin

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20
Q

s/s of metabolic alkalosis

A

compensatory hypoventilation, paresthesia, muscle cramping, n/v/d, hypoK

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21
Q

how long can an ETT stay in?

A

10-14 days before trach

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22
Q

intubation indications

A

pt cannot maintain own airway

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23
Q

can meds be given through ETT?

A

yes, just less effective - narcan, epi, vaso, atropine

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24
Q

interventions pre-intubation

A

education, note allergies + coag labs, remove dentures, 2 patent IVs, gather supplies

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25
what supplies are needed for intubation?
blue box/intubation kit, suction setup, monitor, crash cart, RSI meds, may need IVF
26
what are RSI meds?
sedative + paralytic
27
interventions during intubation
pt laying supine, hyper-oxygenate, only 30s per attempt
28
how do you verify ETT placement?
CO2 detector, auscultate, equal chest expansion, CXR - 2-3 cm away from carina
29
intubated patient assessments
@ RASS goal? vent complaint? oral care, restraints, focused resp assessment, check placement
30
indications for tracheostomy
airway obstruction, long term need for mechanical ventilation, laryngeal or facial trauma/burns
31
advantages of trach over ETT
less sedation needs, less pain, more mobility, can eat, better oral care
32
why do ETTs have to be switched to a trach?
aspiration risk, can cause tracheal ulcers & necrosis if in too long
33
VAP
ventilator associated pneumonia, onset/dx within 48-72h of intubation
34
VAP prevention
elevate HOB, suction PRN, sedation vacation, CHG BID, oral care q2h, DVT & GI ulcer ppx
35
risk factors for VAP
increased secretions, bad mouth care, breaks in circuits/tubing, decreased mobility, diminished cough/gag/swallow
36
trached patient assessment
assess site, resp assessment, vent compliance, secretions, sedation
37
interventions for excess secretions
suction, chest PT, breathing treatments, IVF to thin out
38
what should you do if your patient self-extubates?
resp assessment, bag & call for help
39
what should you do if your patient's trach dislodgement?
resp assessment, use obturator to put back in OR cover stoma, extend neck & bag
40
trach safety interventions
ALWAYS have extra trach kit & obturator at bedside
41
how is the rate on a ventilator determined?
PaCO2
42
what is tidal volume?
Vt; 450-500 mL; volume of one inhalation & expiration
43
what is pressure support?
pressure applied at beginning of inspiration to decrease WOB, typically 5-10
44
what is PEEP
positive end expiratory pressure, typically 3-10+
45
what to watch with high peep
monitor BP - vena cava can become compressed which reduces preload
46
what does PEEP do?
keeps alveoli open/from collapsing, can bring back collapsed alveoli
47
most invasive ventilator setting
pressure control ventilation (PCV)
48
pressure control ventilation
vent has complete control of all aspects of breath, no pt initiated breaths
49
pressure control ventilation considerations
very uncomfortable, pt often has to be paralyzed
50
assist control/volume control
preset rate & Vt, pt can initiate own breaths - vent will give them the preset Vt
51
synchronized intermittent mandatory ventilation
preset rate & Vt, pt can initiate own breaths & decides own volume
52
continuous positive airway pressure
pt controls RR & Vt, vent gives PEEP & PS
53
what ventilator modes are used for weaning?
SIMV & CPAP
54
causes of low pressure alarm
circuit leak, cuff leak
55
s/s of cuff leak
SOB, swallowing/verbalizing, gurgling with respiration
56
what should you do if u hear a cuff leak?
call RT!
57
risks of high cuff pressure
tracheal rupture, laryngeal damage
58
normal cuff pressure
20-30 mmHg, checked with manometer
59
cause of high pressure alarm
coughing, mucus plug, secretions, biting/kinked tubing, pneumothorax
60
apnea alarm
only goes off in CPAP mode, vent will switch them back to settings
61
barotrauma
alveolar rupture or spontaneous pneumo from mechanical ventilation, can happen if ET is too close to carina
62
vent weaning criteria
normal PaCO2 & PaO2, FiO2 under 40; PEEP under 5; hemodynamic stability, initiating own breaths, RSBI under 105
63
RSBI
rapid shallow breathing index, RR/Vt
64
indicators patient is NOT tolerating weaning
low Vt, tachycardia, PVCs, accessory muscle use, high RR
65
criteria for extubation
off sedation, positive cuff leak, can lift head
66
what to do right before extubation
have NC & re-intubation kit ready, hyperoxygenate & suction
67
what to do right after extubation
have pt cough & say their name, listen to lungs for stridor
68
s/s of PE
anxiety, impending doom, dyspnea, pleural friction rub, hemoptysis, tachy, petechiae
69
ABG with PEs
respiratory alkalosis at first, then respiratory acidosis
70
what labs can indicate PE?
low H&H, positive d-dimer
71
PE treatment
anticoagulation - heparin, warfarin, enoxaparin fibrinolytics - alteplase, retaplase
72
acute respiratory failure
sudden impairment in gas exchange
73
hypoxic respiratory failure
failure to oxygenate - problem in blood flow - poor gas exchange
74
hypercapnic respiratory failure
ventilatory failure, problem in O2 intake
75
s/s of acute respiratory failure
restlessness, fatigue, air hunger, accessory muscle use, tripoding, confusion, central cyanosis, lethargy/agitation
76
mgmt of acute respiratory failure
treat cause! manage O2, vent, & airway
77
what is acute respiratory distress syndrome
inflammatory disorder that damages alveoli
78
causes of ARDS
direct - PE, trauma, infection, aspiration, COVID indirect - TRALI, sepsis, burns, OD
79
s/s of ARDS
same as acute respiratory failure PLUS - hypoxia despite 100% oxygenation, pulm HTN causing R sided HF
80
ARDS ABG
low PaO2; initially low CO2 but increases as disease progresses
81
ARDS CXR
pulmonary edema, infiltrates, alveolar fibrosis
82
nitric oxide
used in ARDS, relaxes pulmonary blood vessels
83
ARDS management
vent - high PEEP low volumes, prone, early paralytics, early tube feeds, abx, nitric
84
pleural effusion
clear, serous fluid in pleural space
85
hemothorax
blood in pleural space
86
empyema
purulent fluid in pleural space
87
chylothorax
lymphatic/milky fluid
88
uses of thoracentesis
draining fluid, pneumonia, empyema, instilling drugs
89
how should a pt be positioned for thoracentesis
sitting upright, leaning forward with arms on bedside table
90
post-thoracentesis complications
pneumothorax, bleeding
91
indications for chest tubes
empyema, pneumo/hemothorax, pleural effusion, post-thoracic surgery
92
what should u do if the chest tube comes out of the patient?
dressing taped on 3 sides
93
what should u do if the chest tubes comes out of the collection box?
put end of it in sterile water container
94
what to assess with chest tube
device below chest level, no loops/kinks, check for subQ emphysema, tidaling & bubbling

High Acuity Exam 2 (2 decks)

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