pulmonary pt. 3

Question 1

what does the ABCDEF bundle do?

Answer 1

improves collaboration to break the cycle of over sedation and prolonged ventilation in critically ill

Question 2

ABCDEF bundle meaning

Answer 2

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

Question 3

lipid-based short-acting anesthetic

Answer 3

propofol

Question 4

main side effect of propofol

Answer 4

hypoTN, extravasation

Question 5

how often does tubing need changed on propofol?

Answer 5

q12h

Question 6

what is propofol contraindicated with?

Answer 6

egg, soybean, peanut allergy

Question 7

what pharm class is precedex in?

Answer 7

alpha 2 adrenergic agonist (sedative)

Question 8

what may occur from precedex

Answer 8

bradycardia, hypoTN

Question 9

how often can precedex be titrated

Answer 9

no kore than q30mins

Question 10

what is a positive of precedex over propofol?

Answer 10

no resp depression

Question 11

what can be used when propofol/precedex are unavailable or contraindicated

Answer 11

anxiolytics (benzodiazepines “olam”)

Question 12

reversal agent of benzos

Answer 12

flumazenil/romazicon

Question 13

do benzos cause resp depression?

Answer 13

yes

Question 14

levels of richmond agitation sedation scale

Answer 14

0= alert/calm
+4= overly combative/violent
-5= no respinse to voice and physical stimulation

Question 15

what is used to decrease oxygen demand in severely compromised patient (ARDS)

Answer 15

neuromuscular blocking agent

Question 16

what is needed with NMBAs?

Answer 16

sedation/pain control

Question 17

what does BIS monitoring (bispectral index monitoring) do?

Answer 17

measures level of sesation

Question 18

describe BIS scale

Answer 18

range 0-100
lower means more sedated
80= light/mod sedation
40-60 = general anesthesia (GOAL)

Question 19

what checks the patients baseline prior to starting NMBA?

Answer 19

peripheral nerve stimulatior (train of four)

Question 20

considerations for using NMDAs

Answer 20

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

Question 21

most fatal HAI

Answer 21

ventilator associated pneumonia (VAP)

Question 22

what is ventilator associated pneumonia?

Answer 22

aspirated bacteria or bacteria leakage from around ET cuff

Question 23

how often is oral care provided to lips/oral mucosa

Answer 23

q4h

Question 24

how many times can you suction before needing to stop?

Answer 24

3

Question 25

what is used for stress ulcer prophylaxis?

Answer 25

protonix

Question 26

what does the SaO2, FiO2, and PEEP need to be at to wean from vent?

Answer 26

SaO2 > 90
FiO2 50% or less
PEEP 8 or less

Question 27

what vent settings are being used in a spontaneous breathing trial?

Answer 27

pressure support, PEEP, FiO2

Question 28

criteria for stopping a spontaneous breathing trial

RR,SaO2,TV,work of breathing,HR,SBP

Answer 28

RR > 35
SaO2 < 90
dec. tidal volume
inc. work of breathing/anxiety
HR > 140
SBP > 180 or < 90

Question 29

respiratory rate and negative inspiratory force criteria for extubation

Answer 29

RR < 30
NIF > -20 cm water

Question 30

which setting provides tidal volume?
1) PEEP
2) CPAP
3) AC
4) pressure support

Answer 30

3) AC

Question 31

which vent setting augments spontaneous breaths by decreasing resistance on inspiration?
1) AC
2) SIMV
3) PEEP
4) pressure support

Answer 31

4) pressure support

Question 32

which vent setting can be increased to help improve oxygenation?
1) AC
2) SIMV
3) PEEP
4) pressure support

Answer 32

3) PEEP

Question 33

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

Answer 33

3) inc. rate