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NURS 240 Exam 3 > Respiratory/ARDS/ETT/Vents/Sedation > Flashcards

Respiratory/ARDS/ETT/Vents/Sedation Flashcards

1
Q

Normal pH

A

7.35-7.45

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2
Q

Normal PaCo2

A

35-45 mmHg

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3
Q

Normal HCO3

A

22-26 mEq/L

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4
Q

Normal PaO2

A

80-100 mmHg

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5
Q

Normal SaO2

A

> 95%

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6
Q

Acute Respiratory Failure: Early S/S

A
  • restlessness
  • tachycardia
  • HTN
  • fatigue
  • HA
  • tachypnea
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7
Q

Acute Respiratory Failure: Later S/S

A
  • confusion
  • lethargy
  • central cyanosis
  • diaphoresis
  • respiratory arrest
  • fast RR slowing down
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8
Q

First Sign of Respiratory Failure

A

mental status change

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9
Q

S/S of Inadequate CO2 Removal

A
  • morning HA
  • slower respiratory rate
  • decreased LOC
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10
Q

Auscultating Inspiratory Crackles means there is…

A

pulmonary edema

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11
Q

Auscultating Expiratory Crackles

A

PNA or COPD

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12
Q

Auscultating Absent of Diminished Breath Sounds

A
  • atelectasis
  • effusion
  • hypoventilation
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13
Q

How does ARDS look on x-ray?

A

White-out

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14
Q

ARDS: S/S

A
  • sudden or slowly progressive pulmonary edema
  • increasing bilateral lung infiltrates
  • absence of left atrial pressure
  • rapid onset of severe dyspnea and V/Q mismatch <72 hours after precipitating event (hypoxemia that doesn’t respond to supplemental O2; crackles, intercostal retractions and BNP levels)
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15
Q

PaO2/FiO2 (P/F) Ratio Values

A
  • Normal: >400
  • Mild: >200 to <300
  • Moderate: 100 to <200
  • Severe: <100
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16
Q

ARDS: Injury or Exudative Phase

A
  • 1-7 days (usually 24-48 hours) after insult
  • Path: interstitial and alveolar edema, atelectasis, decreased surfactant production, refractory hypoxemia
  • Intervention: intubation d/t increased WOB
  • RECOVERABLE
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17
Q

ARDS: Reparative or Proliferative Phase

A
  • 1-2 weeks after initial lung injury
  • Patho: inflammatory response continues, lung compliance worsens, lung becomes dense, fibrous
  • Intervention: continue mechanical ventilation and lung support, prevent failure of other organs (MODS d/t poor perfusion)
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18
Q

ARDS: Fibrotic Phase

A
  • 2-3 weeks after initial injury
  • Patho: lung is remodeled by collagenous and fibrous tissues, pulmonary HTN
  • Intervention: long term mechanical vent
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19
Q

BNP

A
  • normal: <100pg/mL
  • helpful in distinguishing ARDS from cariogenic pulmonary edema (it is high in ARDS)
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20
Q

ARDS: Medical Management

A
  • ID and treat underlying cause
  • Intubation, mechanical ventilation with PEEP to keep alveoli open
  • treat hypovolemia to keep hemodynamically stable
  • Prone positioning is best for oxygenation
  • nutrition support (enteral feedings preferred)
  • Reduce anxiety, sedation, paralysis
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21
Q

ARDS: Risk Factors

A
  • aspiration
  • COVID-19 PNA
  • drug ingestion and overdose
  • fat or air embolism
  • hematologic disorders
  • localized infection
  • major surgery
  • metabolic disorders
  • prolonged inhalation of high concentrations of O2, smoke, or corrosive substances
  • sepsis
  • shock (any cause)
  • trauma
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22
Q

ARDS: Nutritional Therapy

A
  • require 35-45 kcal/kg/day to meet caloric requirements
  • enteral feeds is the first consideration, but parenteral nutrition also may be required
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23
Q

Why ETT?

A
  • provides patent airway
  • access for mechanical ventilation
  • facilitates removal of secretions
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24
Q

Intubated Patient Nursing Considerations

A
  • ETT size
  • location
  • mouth care
  • sedation level (LOC, RASS)
  • Positioning (prone, 30 degrees or higher)
  • respiratory assessment
  • equipment assessment
  • interprofessional team
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25
Can the patient eat or drink immediately after extubation?
- NO - patient needs to be evaluated by speech and swallow
26
Barotrauma
- air goes into pleural space and is unable to escape - can lead to pneumothorax
27
Volutrauma
- too much tidal volume - leads to subcutaneous emphysema
28
Pneumothorax
- absent breath sounds - bag the patient, 8-10 breaths per minute - Patient will be getting a chest tube
29
Trach Cuff Pressure
between 20-25 mmHg
30
Intubation for no longer than...
14-21 days (after will require a tracheostomy
31
Vent Settings: Assist Control
- does everything for the patient (when the patient is too weak to perform spontaneous breathing) - usually used when patient is first intubated
32
Vent Settings: Respiratory Rate
- minimum amount of breaths the patient will be able to take - often set between 12-18 - rate would be higher if the patient needs to blow off CO2
33
Vent Settings: Tidal Volume
- amount of air that will go into the patient's lungs with each breath - based on the ideal body weight of the patient (10mL/kg) - may be less d/t poor lung compliance
34
Vent Settings: FiO2
- amount of oxygen being delivered - room air = 21%
35
Vent Settings: PEEP
- increases end-expired lung volume and reduces airspace closure at the end of expiration - unnatural breathing and feels strange for patient - PEEP that is too high can cause a pneumothorax, barotrauma, decreased cardiac output, and decreased BP
36
Ventilator Alarm Reasons: High Pressure
- secretions, coughing, or gagging - asynchrony (fighting the vent, biting tube, etc.) - water in the tubing (dump out the tube)
37
Ventilator Alarm Reasons: Low Pressure
- disconnect from the vent - partial or complete extubation
38
Ventilator Alarm Reasons: Apnea
- change in condition - loss of airway
39
Nursing Interventions: Promoting Effective Airway Clearance
- assess lung sounds at least every 2-4 hours - measures to clear airway: suctioning, CPT, position changes, promote increased mobility - humidification of airway - administer bronchodilators and mucolytics - suctioning only if excessive secretions - check for oral ulcers
40
Nursing Interventions: Preventing Injury and Infection
- infection control measures - tube care - cuff management - oral care - elevation of HOB (unless prone)
41
Possible Medications for Patient on a Vent
- bronchodilators - corticosteroids - diuretics - ABX - anti-anxiety agents - analgesics - sedatives if patient has endotracheal intubation
42
Hospital Acquired PNA
- develops 48 hours or more after hospitalization - potential for infection from many sources - high mortality rate - colonization by multiple organisms d/t overuse of antimicrobial agents - pleural effusion, high fever, and tachycardia - common with debilitated, dehydrated patients with minimal sputum production
43
Ventilator Associated PNA
- received mechanical ventilation for at least 48 hours
44
VAP Bundle
- HOB 30 degrees - daily sedation vacations and assessment of readiness to extubate - peptic ulcer disease prophylaxis - VTE prophylaxis - frequent mouth care with chlorhexidine (0.12%)
45
VAP Risk Factors
- impaired host defenses - contaminated equipment - invasive monitoring - aspiration of GI contents - prolonged mechanical ventilation
46
Reasons for Sedation
- alleviate anxiety - alleviate pain - ease agitation - provide comfort - improve patient-ventilatory synchrony
47
ABCDEF Bundle
- A --> Assess, prevent, and manage pain - B --> Both SATs and SBTs (coordinate Wake up and Breathe approach) - C --> Choice of analgesia and sedation (thoughtful sedative/analgesic administration and meds to avoid) - D --> Delirium (assess, prevent and manage) - E --> Early mobility (optimize mobility and advance as clinically stable) - F --> Family engagement and empowerment
48
Early Mobility r/t ABCDEF Bundle
- nurse assess: - patient able to respond to verbal stimuli - patient is receiving less than 60% FiO2 and less than 10 cm of PEEP - patient has not circulatory or central catheters or injuries that may contraindicate mobility
49
Family Engagement r/t ABCDEF Bundle
- ensures unrestricted access for designated family support person - control excess noise, hearing aids, glasses, reorient
50
Goals of ABCDEF Bundle
- Decrease: delirium days, ventilator days, and hospital days - Increase: early mobility, survival, return to physical and cognitive baseline
51
What RASS score do you want a patient at to extubate?
0
52
What RASS score do you want a patient at when first intubated?
-2
53
Insufficient removal of CO2 is...
hypercapnia
54
A nurses' greatest tool is...
their assessment skills
55
The ABCDEF Bundle will...
decrease days on ventilator
56
A complication of intubation is...
VAP
57
Is it possible to communicate with an intubated patient?
YES (communication boards, etc.)
58
ARDS can cause...
lung remodeling and pulmonary HTN
59
Alarm fatigue is....
a real thing
60
Can a patient with a tracheotomy eat?
yes, with the valve
61
Is ARDS expected in a patient with PNA?
NO
62
A change in PEEP could lead to...
hypotension
63
What are the phases of ARDS?
- proliferation - exudative - injury
64
Common test to differ ARDS from edema is...
BNP
65
Part of the management of ARDS is:
- prone positioning - intubation - ID and treat underlying cause
66
Trach care and assessment should be done at least every...
8 hours and when needed
67
A patient can only be intubated for no longer than...
14-21 days
68
Ventilators can alarm for...
high pressure, apnea, and low pressure
69
The RASS is used to...
titrate sedation
70
ICU delirium is...
real
71
Nurses should make every effort to provide...
- aggressive s/s management at EOL
72
- Nurse needs to assess the following for patient with a trach:
- assess secretions and ability to clear them - note size of trach and when it was placed - assess if cuff is inflated/deflated - assess when trach care was last done
73
Will an ARDS patient remain hypoxic despite increased FiO2?
Yes
74
The higher the PEEP on the vent the greater risk for...
Barotrauma
75
The ventilator mode that is used most often after a patient is initially intubated is...
assist control
76
- The members of the inter professional team caring for an intubated patient are:
- MD - RN - respiratory therapy - PT - nutrition - pharmacy
77
If the patient has a RASS score of +3. The RN would expect the patient to be...
agressive and pulling at tubes

NURS 240 Exam 3 (8 decks)

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