QUIZ 1

Question 1

ARDS

Answer 1

Not an actual disorder, this is just caused by trauma to the lungs such as sepsis, burns, aspiration, transfusions, resulting in fluid accumulation in the alveoli preventing adequate gas exchange.

Expected findings: dyspnea, bilateral noncardiogenic edema, reduced lung compliance, decrease patchy bilateral pulmonary infiltrates, severe hypoxemia despite 100% oxygen, cyanosis, pallor, intercostal and substernal retractions.

ARDS can last a while on a vent and sometimes might not even come off.

Complications associated with ARDS are cognitive loss, muscle tissue wasting, have trouble doing ADLS (will need PT) and focus on protein to rebuild loss muscle and do ROM.

If maxed out on ventilator, then give a paralytic to have the vent fully take over their breathing. Restraints can’t be on if on paralytics.

Last treatment for ARDS would be to treat underlying cause. Ex: if the patient has covid, then give antivirals.
Put the patient in prone position to take pressure off the alveoli and allow the alveoli on the back to expand.

Question 2

DKA VS HHS:

Answer 2

DKA is insulin deficient related to undiagnosed or poorly treated DM I or non adherence to insulin. Blood glucose is > 300 mg/dl. The main focus is to treat ketosis by administering insulin drip and bicarbonate, because there’s protein breakdown causing ketosis.

Manifestations: N/V, 3p’s, abdominal pain, blurred vision, headache, weakness, orthostatic hypotension, fruity odor breath, metabolic acidosis, mental status change.

HHS typically happens in DM II, NO ACIDOSIS, NO KETONES present, simply just too much glucose in the blood. Blood so thick the priority is to administer FLUIDS.

Question 3

ABGs: :

Answer 3

Ph: 7.35-7.45
CO2: 35-45
HCO3: 22-26

Remember “ROME” Respiratory Opposite, Metabolic Equal
Respiratory -> pH and CO2
Metabolic -> pH and HCO3

Question 4

Respiratory acidosis:

Answer 4

Low ph, high CO2.
Administer oxygen, BIPAP, intubate patient if needed to help control breathing, administer bronchodilators. If intubated monitor correct placement (if 24cm, then has to be 24cm next day) monitor respiratory status, oxygen, turn/cough/deep breathe, ABGS

Question 5

Respiratory alkalosis:

Answer 5

High ph, low co2.
Rebreather into paper bag, encourage deep breathing, give anxiolytics or sedative to help with hyperventilation (decrease breathing rate)

Question 6

Metabolic acidosis:

Answer 6

Low ph, low HCO3.
Monitor I&O, K+, EKG, VS, administer SODIUM BICARBONATE to increase base and decrease acid, seizure precautions

Question 7

Metabolic alkalosis:

Answer 7

High ph, high co2.
IV fluids, replace K+, antiemetics, monitor for respiratory distress

Question 8

Triage, primary survey, secondary survey:

Answer 8

Emergent (life threatening)
Urgent (treat within 2 hours)
Non-urgent (delayed)

Primary survey is the first interaction with the patient (ABCDE)

Secondary survey is following up with anything you may have missed from primary survey. Something can be off from their baseline.

Question 9

Bundle to prevent VAP:

Answer 9

Spontaneous breathing, awakening trials (to see if we can wean off sedation) if they’re awake and follows commands then OK. If sedated, try again next day. Spontaneous breathing have them breathe on their own without vent, failure means tachycardia and rhythm change.
Oral care, SVT, PPI ppx, DVT ppx, HOB elevated.

Question 10

What happens if a patient self extubates?

Answer 10

ASSESS to see if re-intubation is needed. If not breathing then you need to disconnect and bag the patient.

Question 11

Chest tube during transport:

Answer 11

Drainage system below the patients chest, NEVER clamp he tubing. If dislodged, cover with sterile dressing. If chamber damaged, place tubing in sterile water while waiting for new system.

Question 12

Freebies:

Answer 12

1. Evaluating CVP- HYPOVOLEMIA
2. Triage who to care for FIRST- Tension pneumothorax
3. VAP bundle- oral care as needed, not 2 hours because it can cause trauma
4. Respiratory acidosis bow tie- oxygen, bipap, intubate, bronchodilators. If intubated monitor correct placement, abgs, respirations, daily CXR

Question 13

Why do we assess central venous pressure (CVP)?

Answer 13

Good indicator of FLUID status- hypovolemic or fluid overload?

Question 14

Pulmonary venous pressure:

Answer 14

Focuses on pulmonary system. Ex: Levophed causes vasoconstriction.

Question 15

Systemic vascular resistance:

Answer 15

Blood flow offered by all systemic vasculature. Resistance throughout whole body.
L side HF, hypotension, constricted vessels causes increase flow can increase systemic vascular pressure.