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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
Q

Can the patient eat or drink immediately after extubation?

A
  • NO
  • patient needs to be evaluated by speech and swallow
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26
Q

Barotrauma

A
  • air goes into pleural space and is unable to escape
  • can lead to pneumothorax
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27
Q

Volutrauma

A
  • too much tidal volume
  • leads to subcutaneous emphysema
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28
Q

Pneumothorax

A
  • absent breath sounds
  • bag the patient, 8-10 breaths per minute
  • Patient will be getting a chest tube
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29
Q

Trach Cuff Pressure

A

between 20-25 mmHg

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30
Q

Intubation for no longer than…

A

14-21 days (after will require a tracheostomy

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31
Q

Vent Settings: Assist Control

A
  • does everything for the patient (when the patient is too weak to perform spontaneous breathing)
  • usually used when patient is first intubated
32
Q

Vent Settings: Respiratory Rate

A
  • 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
Q

Vent Settings: Tidal Volume

A
  • 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
Q

Vent Settings: FiO2

A
  • amount of oxygen being delivered
  • room air = 21%
35
Q

Vent Settings: PEEP

A
  • 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
Q

Ventilator Alarm Reasons: High Pressure

A
  • secretions, coughing, or gagging
  • asynchrony (fighting the vent, biting tube, etc.)
  • water in the tubing (dump out the tube)
37
Q

Ventilator Alarm Reasons: Low Pressure

A
  • disconnect from the vent
  • partial or complete extubation
38
Q

Ventilator Alarm Reasons: Apnea

A
  • change in condition
  • loss of airway
39
Q

Nursing Interventions: Promoting Effective Airway Clearance

A
  • 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
Q

Nursing Interventions: Preventing Injury and Infection

A
  • infection control measures
  • tube care
  • cuff management
  • oral care
  • elevation of HOB (unless prone)
41
Q

Possible Medications for Patient on a Vent

A
  • bronchodilators
  • corticosteroids
  • diuretics
  • ABX
  • anti-anxiety agents
  • analgesics
  • sedatives if patient has endotracheal intubation
42
Q

Hospital Acquired PNA

A
  • 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
Q

Ventilator Associated PNA

A
  • received mechanical ventilation for at least 48 hours
44
Q

VAP Bundle

A
  • 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
Q

VAP Risk Factors

A
  • impaired host defenses
  • contaminated equipment
  • invasive monitoring
  • aspiration of GI contents
  • prolonged mechanical ventilation
46
Q

Reasons for Sedation

A
  • alleviate anxiety
  • alleviate pain
  • ease agitation
  • provide comfort
  • improve patient-ventilatory synchrony
47
Q

ABCDEF Bundle

A
  • 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
Q

Early Mobility r/t ABCDEF Bundle

A
  • 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
Q

Family Engagement r/t ABCDEF Bundle

A
  • ensures unrestricted access for designated family support person
  • control excess noise, hearing aids, glasses, reorient
50
Q

Goals of ABCDEF Bundle

A
  • Decrease: delirium days, ventilator days, and hospital days
  • Increase: early mobility, survival, return to physical and cognitive baseline
51
Q

What RASS score do you want a patient at to extubate?

A

0

52
Q

What RASS score do you want a patient at when first intubated?

A

-2

53
Q

Insufficient removal of CO2 is…

A

hypercapnia

54
Q

A nurses’ greatest tool is…

A

their assessment skills

55
Q

The ABCDEF Bundle will…

A

decrease days on ventilator

56
Q

A complication of intubation is…

A

VAP

57
Q

Is it possible to communicate with an intubated patient?

A

YES (communication boards, etc.)

58
Q

ARDS can cause…

A

lung remodeling and pulmonary HTN

59
Q

Alarm fatigue is….

A

a real thing

60
Q

Can a patient with a tracheotomy eat?

A

yes, with the valve

61
Q

Is ARDS expected in a patient with PNA?

A

NO

62
Q

A change in PEEP could lead to…

A

hypotension

63
Q

What are the phases of ARDS?

A
  • proliferation
  • exudative
  • injury
64
Q

Common test to differ ARDS from edema is…

A

BNP

65
Q

Part of the management of ARDS is:

A
  • prone positioning
  • intubation
  • ID and treat underlying cause
66
Q

Trach care and assessment should be done at least every…

A

8 hours and when needed

67
Q

A patient can only be intubated for no longer than…

A

14-21 days

68
Q

Ventilators can alarm for…

A

high pressure, apnea, and low pressure

69
Q

The RASS is used to…

A

titrate sedation

70
Q

ICU delirium is…

A

real

71
Q

Nurses should make every effort to provide…

A
  • aggressive s/s management at EOL
72
Q
  • Nurse needs to assess the following for patient with a trach:
A
  • 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
Q

Will an ARDS patient remain hypoxic despite increased FiO2?

A

Yes

74
Q

The higher the PEEP on the vent the greater risk for…

A

Barotrauma

75
Q

The ventilator mode that is used most often after a patient is initially intubated is…

A

assist control

76
Q
  • The members of the inter professional team caring for an intubated patient are:
A
  • MD
  • RN
  • respiratory therapy
  • PT
  • nutrition
  • pharmacy
77
Q

If the patient has a RASS score of +3. The RN would expect the patient to be…

A

agressive and pulling at tubes

NURS 240 Exam 3 (8 decks)

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