pulmonary pt. 3 Flashcards
what does the ABCDEF bundle do?
improves collaboration to break the cycle of over sedation and prolonged ventilation in critically ill
ABCDEF bundle meaning
Assess, prevent/manage pain
Both awakening trials and breathing trials daily
Choice of anesthesia/sedation
Delirium assessment/prevention
Early mobility and exercise
Family engagement/empowerment
lipid-based short-acting anesthetic
propofol
main side effect of propofol
hypoTN, extravasation
how often does tubing need changed on propofol?
q12h
what is propofol contraindicated with?
egg, soybean, peanut allergy
what pharm class is precedex in?
alpha 2 adrenergic agonist (sedative)
what may occur from precedex
bradycardia, hypoTN
how often can precedex be titrated
no kore than q30mins
what is a positive of precedex over propofol?
no resp depression
what can be used when propofol/precedex are unavailable or contraindicated
anxiolytics (benzodiazepines “olam”)
reversal agent of benzos
flumazenil/romazicon
do benzos cause resp depression?
yes
levels of richmond agitation sedation scale
0= alert/calm
+4= overly combative/violent
-5= no respinse to voice and physical stimulation
what is used to decrease oxygen demand in severely compromised patient (ARDS)
neuromuscular blocking agent
what is needed with NMBAs?
sedation/pain control
what does BIS monitoring (bispectral index monitoring) do?
measures level of sesation
describe BIS scale
range 0-100
lower means more sedated
80= light/mod sedation
40-60 = general anesthesia (GOAL)
what checks the patients baseline prior to starting NMBA?
peripheral nerve stimulatior (train of four)
considerations for using NMDAs
airway in place
ambu bad/mask/airway at bedside
infuse after patient is sedated
stop med and keep sedation on until TOF is 4/4
skin/eye care
most fatal HAI
ventilator associated pneumonia (VAP)
what is ventilator associated pneumonia?
aspirated bacteria or bacteria leakage from around ET cuff
how often is oral care provided to lips/oral mucosa
q4h
how many times can you suction before needing to stop?
3
what is used for stress ulcer prophylaxis?
protonix
what does the SaO2, FiO2, and PEEP need to be at to wean from vent?
SaO2 > 90
FiO2 50% or less
PEEP 8 or less
what vent settings are being used in a spontaneous breathing trial?
pressure support, PEEP, FiO2
criteria for stopping a spontaneous breathing trial
RR,SaO2,TV,work of breathing,HR,SBP
RR > 35
SaO2 < 90
dec. tidal volume
inc. work of breathing/anxiety
HR > 140
SBP > 180 or < 90
respiratory rate and negative inspiratory force criteria for extubation
RR < 30
NIF > -20 cm water
which setting provides tidal volume?
1) PEEP
2) CPAP
3) AC
4) pressure support
3) AC
which vent setting augments spontaneous breaths by decreasing resistance on inspiration?
1) AC
2) SIMV
3) PEEP
4) pressure support
4) pressure support
which vent setting can be increased to help improve oxygenation?
1) AC
2) SIMV
3) PEEP
4) pressure support
3) PEEP
if patient has elevated PaCO2 and normal PaO2, which vent change is made?
1) inc. PEEP
2) dec. FiO2
3) inc. rate
4) dec. TV
3) inc. rate
