Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Leadership > Seminar Exam 1 > Flashcards

Seminar Exam 1 Flashcards

1
Q

vertebral nerves in respiratory system

A

C 3, 4, and 5 - keep you alive

C 6 and 7 - raise your arms to heaven

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is the goal of cardiac catheterization post MI?

A
  • establish coronary artery reperfusion
  • limit damage
    • time is muscle
  • thrombolytic therapy if no cath lab
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

status asthmaticus and CPAP/BiPAP

A
  • NOT RECOMMENDED
  • b/c of instability of patients and inherent difficulty in providing ventilatory support during acute face
    • preventing hyperinflation, autoPEEP, barotrauma
  • few studies to support its use
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

obstructive shock

A
  • adequate fluid but not in right places d/t obstruction
  • embolus: big central PE
    • blocks flow from R to L side of heart
    • can’t fill ventricle (Starling’s law)
      • no stretch, no squeeze, no CO
  • cardiac tamponade: accumulation of fluid between pericardial sac and heart
    • puts pressure on heart so ventricles can’t squeeze
    • problem is not with heart, but with fluid - makes it obstructive not cardiogenic shock
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

structures of respiratory system

A
  • CNS (medulla)
    • rate and rhythm
  • peripheral nervous system (phrenic nerve)
    • diaphragm
  • respiratory muscles
  • chest wall
  • lungs
  • upper airway
  • bronchial tree
  • alveoli
  • pulmonary vasculature
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

hypovolemic shock

A
  • not enough volume (not necessarily due to blood loss)
  • also b/c of excessive diarrhea/vomiting
  • diabetes insipidus - really high renal losses
    • usually pituitary defect
  • primary characteristic:
    • not enough volume in person’s body
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what causes a febrile seizure?

A

dramatic change (spike) in temperature

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

patient intolerance of NPPV

A
  • restlessness/agitation/mask removal
  • dyssyncrhony
    • leaks, sensitivity, autoPEEP
  • hemodynamic instability
  • worsening respiratory failure/acidosis
    • hypoxemia, hypercarbia
  • inability to manage secretions
  • increasing lethargy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

muscles of respiration

A
  • diaphragm
    • phrenic nerve C3,4,5
  • intercostals
    • thoracic
    • lumbar - innervate abdominal muscles (accessory)
  • accessory muscles - neck and upper back
    • scalenus
    • trapezius
    • sternocleidomastoid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

medical students

A
  • 4 years after bachelor’s
  • structue varies - major clinical training in second two years
  • apprenticeship model - supervision by residents, fellow, and/or attending
  • many med students “passing through” - externs or 4th year students may have chosen rotations
  • no license to practice - must have orders co-signed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

volu/barotrauma r/t vent complications

A
  • excess volumes or pressures
  • floppy, overstretched lungs
  • permanent fibrotic changes (balloon analogy)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

sypmtoms of BV

A
  • gray, malodorous vaginal discharge
  • sometimes pain, itching, burning sensation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

detecting auto PEEP

A
  • occurs when expiratory time is insufficient to completely empty a delivered TV.
  • portion of TV is trapped in alveoli, pressure remainsi n lung at end expiration
  • consequence:
    • hemodynamic compromise, increased WOB, barotrauma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

cardiogenic shock

A
  • heart is not strong enough to pump volume throughout body
    • not moving (adequate) volume to perfuse tissue
  • causes: acute failure of heart’s pumping mechanisms
    • massive heart attack
    • unstable dysrhythmia (v.tach, v.fib, idioventricular rhythm)
    • chest trauma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

attending

A
  • physician/surgeon/dentist
  • fully licensed and credentialed and authorized to admit patients to an insitution or have patients admitted to care
  • member of medical/dental staff and usually member of faculty associated with agency
  • ultimately responsible for medical care of patient under care
  • may be episodic (based on situation)
  • ultimate decision maker re: medical treatment decisions when team involves trainees or other consultants
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

oropharyngeal airway

A
  • measure from mouth to angel of jaw
  • only for patients without gag reflex
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

BiPAP

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

causes of CPAP/BiPAP failure

A
  • development of complciations
    • MI, GI bleed, sepsis
  • limitation of ventilator
    • can’t deliver high FiO2
    • varied flow capabilities could result in dyssynchrony
  • patient-vent dyssynchrony
    • autoPEEP
    • worsening patient status
    • ventilator limitations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

staff development roles

A
  • orientation
  • nurse residency programs
  • continuing education
  • relationships with schools of nursing for student placement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

initial treatment for MI

A
  • MONA
  • Morphine - only for chest pain if refractory to nitrates
    • evidence of increased mortality
  • oxygen - only for hypoxemia if indicated (pulm edema)
    • titrate to SaO2 94%
  • nitro - promote vasodilation in coronary vasculature
    • not in BP < 90 or 30 mm below baseline
    • not in RV infarct 2/2 preload dependence - caution in inferior infarct
    • not if PDE inhibitor w/in 24-48 hrs
  • aspirin - decreases platelet aggregation, promote blood flow around thrombus
    • chew non-enteric 325 mg if no allergy or a PMH of PUD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

anemic hypoxia

A
  • low hemoglobin
  • hemoglobin can’t hold oxygen
    • carboxyhemoglobin - exposure to carbon monoxide
    • methemoglobin - topical lidocaine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

malnourishment r/t ventilation

A
  • reduced response to hypoxia and hypercarbia
  • muscle atrophy
  • respiratory tract infections
  • decreased surfactant production
  • slowed healing of damaged tissues
  • lower serum albumin levels
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

definition of chronic respiratory failure

A
  • PaO2
  • PaCO2 = 45 mmHg or greater (hypercapnia)
  • arterial pH - 7.36
  • chronic folks decompensate quickly b/c body is already compensating
  • 50-50 players - PaO2 and PaCO2 close to 50
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what does A, B, and C show?

A
  • A: peaked T waves
    • hyperkalemia if generalized (all 12 leads)
    • myocardial injury if in isolated, contiguous leads
  • B: t-wave inversion
    • sign of MI
    • no Q waves if initial insult is not full thickness or only several hours after initial insult
  • C: ST segment elevation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

disadvantages of AC ventilation

A
  • all breaths have tidal volume preset, which could lead to respiratory alkalosis
    • no spontaneous compensation by patient (take small breath, exhale more)
    • respiratory alkalosis makes oxygen less available to dissociate to tissues
  • all breaths are positive pressure breaths
  • barotrauma, autoPEEP
  • no normal spontaneous breathing
  • patient can be dyssynchronous
  • panic d/t lack of ventilatory control
  • more sedation for patient tolerance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

remote monitoring units (VISICU)

A
  • rural areas
  • specialty units
  • consultations i.e. wound care
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

schematic of physiologic respiration

A
  • pressure support modes allow for varying inspiratoryf low, whereas volume-cycled modes deliver volume
  • volume-cycled are more uncomfortable b/c less physiologic and requires more sedation for patient tolerance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

non-acute care hospital settings

A
  • out patient clinics
  • nursing facilities: skilled nursing, rehab, long term care
  • highly variable structure
    • often flat compared to highly bureaucratic teaching hospitals
  • nurses may not be supervising nurses
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

info needed to wean off vent

A
  • adequate PaO2, pH, PaCO2
  • FiO2 is .4-.5
  • low or no PEEP
  • reasonable RR
  • weaning individualized
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

ventilation support

A
  • BiPAP
  • mehcanical ventilation
  • goals:
    • PaCO2 to pre-exacerbation level
    • normalize pH
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

S in SBAR

A
  • Identify person to whom you are speaking
  • Identify self, occupation, location
  • Identify patient by name, age, sex, admission
  • Identify what is wrong with patient
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

mask fit/intolerance and CPAP/BiPAP

A
  • NOT RECOMMENDED WHEN:
  • claustrophobia, facial deformities, absence of teeth
  • different non invasive options hsould be considered if intolerance is evident
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

flow of medical work in teaching institutions

A
  • sustdents/residents/fellows/NPs/PAs will often pre-found
  • rounds with team - who is present?
  • general play for day is set
  • may involve nursing and other disciplines
  • discharge decisions often made
  • good time to clarify questions and bring entire team’s attention to important issues
  • be part of the team!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

continuous positive airway pressure

A
  • spontaneous breathing
  • postiive end expiratory pressure applied
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

recruitment maneuver

A
  • not so much now we have advanced pressure support modes
  • high pressure for 5-1 min to minimize barotrauma but facilitate recruitment
    • difficult to coordinate with docs, etc.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

non-invasive ventilation indications

A
  • impending respiratory failure
  • transient respiratory distress
  • acute COPD exacerbation
  • cardiogenic pulmonary edema
  • hypoventilation syndrome
  • nocturnal sleep disorder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

distributive shock

A
  • loss of normal vascular response to stress and position change
  • septic shock
  • neurogenic/spinal shock
  • anaphylactic shock
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

priority interventions for PVCs

A
  • CXR, ABG
  • treat underlying cause, monitor for R on T or increasing ventricular ectopy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

ventilator complications

A
  • auto PEEP
  • hemodynamic instability
  • positive H2O balance
  • infection - VAP
  • GI bleed d/t stress ulcer
  • volutrauma/barotrauma
  • oxygen toxicity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

definition of acute respiratory failure

A
  • PaO2 < 50 mmHg (hypoxemia)
  • PaCO2 > 45 mmHg (hypercapnia)
  • arterial pH < 7.35
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

noninvasive ventilation

A
  • to rest patients with chronic ventilatory failure
    • CPAP –> BiPAP
  • nasal mask or full face mask attached to bilevel pressure generator
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

schematic of AC / CMV ventilation

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

R in SBAR

A
  • explain what you require
    • how urgent, timeframe
  • suggestions of actions to take
  • clarify what actions you expect to be taken
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

best treatment for febrile seizure

A

tylenol (for prevention) or if fever spikes beyond 101.5 (want to let normal fever burn out if possible)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

medicine, surgery, and other specialties

A
  • surgery refers to spcialties where surgical operations/procedures are part of patient management
  • medicine and surgery co-manage many patient
  • service to which patient is admitted has ultimate say
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

initial CPAP/BiPAP settings

A
  • CPAP
    • 3-5 cm H2O
      • titrated to relieve dyspnea, improved oxygenation
  • BiPAP
    • pressure support (I-PAP)
      • 5 cm H2O (10-15 cm H2O)
    • PEEP (E-PEEP)
      • 3-5 cm H2O
    • sensitivity
      • pressure trigger (-0.5 cm H2O
      • flow trigger (1 Lm)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

how can nurses prevent febrile seizures?

A
  • education
    • can happen up to 5 mo old
    • some family hx as risk factor
  • safety
    • time the seizure
    • remove objects
    • put child on side in case of vomiting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

risk factors for BV

A
  • new/multiple sexual partners
  • frequent sexual intercourse
  • douching
  • smoking
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

diagnostic criteria for preeclampsia

A
  • systolic BP _>_140, diastolic > 90 x 2 within 4 hours
  • porteinuria
    • 24 hr urine > 300 mg
    • protein:creat ratio > 0.3 g
    • persistent + 1 urine dipstick
  • without proteinuria:
    • thrombocytopenia
    • renal insufficiency
    • impaired liver function
    • cerebrovascular changes
    • pulm edema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

VAP bundle overview

A
  • some vented patients are at high risk for complications:
    • VAP, VTE, GI bleed
  • four elements of care to prevent these events
  • when all 4 are used, dramatic reduction in VAP rates and moribidity and mortality
    • in addition to insitution-specific VAP prevention protocol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

SIMV advantages

A
  • synchronized to patient breathing
  • less breath stacking and air trapping
  • exercsie respiratory muslces
  • may improve CO in select patients
  • potentially less respiratory alkalosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

reciprocal changes in EKG leads

A

oppositive deflection in opposing lead

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

GYN exam

A
  • general apperaance
  • lungs
  • CV
  • breasts - masses, nipple discharge
  • abdomen
  • external genitalia - appearance, odor, discharge
  • cervix - apperance, diameter, discharge
  • vaginal walls - appearance, discharge
  • bimanual - to fingers, pressing on uterus from outside
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

treatment for preeclampsia

A
  • magnesium sulfate - seizure ppx
  • birth - induce labor via ocytocin or pitocin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

clinical management of respiratory failure

A
  • maintain/establish airway
  • oxygenation
  • ventilatory support
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

causes of inadequate ventilation (NORMAL lungs)

A
  • brain injury
  • SCI
  • drug overdose
  • muscle weakness (MS)
  • nerve disorders (myasthenia gravis)
  • structural abnormality of chest
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

adjunct ventilator therapies

A
  • pressure support (PSV)
  • positive end expiratory pressure (PEEP)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

definition of shock

A

a state of hypoperfusion in which there is no or not enough oxygen and the tissues ultimately die

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

STI screening grade definitions

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

hypoxemic hypoxia

A

decreased arterial O2 tension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

CCU priorities when post MI, post cath patient arrives

A
  • oxygenation, assessment, vitals, pulse checks, groin checks, labs
  • why intubation? too sick - needs airway, ventilation, oxygenation support
  • 14 gauge cortiss cath with swan-ganz catheter to introduce invasive hemodynamic monitoring
    • mointor flow through R side to infer info about L side
    • CO, SV, ejection fraction, pulmonary artery bed pressure)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

assess this rhythm

A
  • stable b/c blood pressure high enough to perfuse
  • interventions: antiarrhythmic to get more stable rhythm
  • if BP 50/30 with a pulse: cardioversion
  • pulseless? defibrillation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

VQ mismatch - dead space

A

ventilation w/o perfusion (PE)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q
A
  • Venturi
  • 24-60%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

potential exclusions for use of CPAP and BiPAP

A
  • status asthmaticus
  • hemodynamic instability
  • airway and mental status
  • mask fit or intolerance
  • excessive secretions
  • severe agitation
  • high FiO2 requirements
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

normal ABGs

A
  • pH 7.35 - 7.45
  • PaCO2 - 35-45 mmHg
  • PaO2 - 80-100 mm Hg
  • bicarb: 22-26
  • O2 Sat: 90-100%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

volume cycled ventilation

A
  • delivers preset tidal volume w/ each ventilator-initiated breath
  • most frequently used type in adults/large children
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

organization of medical teams

A
  • providers grouped into services
  • team manages patients with similar diagnoses
  • nurses call page operators to find out who is “covering” specific team at any given moment
  • interns/residents rotate teams eveyr few weeks
    • medicine stays with medicine, etc.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

physician assistants

A
  • utilized in different specialties
    • ED, L&D
  • orders need to be co-signed by physician
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

volume cycled ventilation modes

A
  • Assist-Control (A/C) or Continuous Mandatory Ventilation (CMV)
  • Synchronized Intermittent Mandatory Ventilation (SIMV)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

auto-PEEP

A
  • breath stacking / air trapping from incomplete exhalation (residual end pressure at start of next breath)
  • mode that gives new breath doesn’t allow patient to fully exhale last breath
    • volume and pressure left in alveolar bed
  • results in volu/barotrauma to lungs (pneumo if too much)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

SBAR

A
  • Situation
  • Background
  • Assessment
  • Recommendation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

B in SBAR

A
  • give patient’s presenting complaint
  • give patient’s relevant PMH
  • briefy summary of background
    • events leading up to current situation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

diagnostic studies of respiratory failure

A
  • ABGs
    • acid/base balance
    • ventilation
    • oxygenation
  • CXR
  • CT (for PEs - CXR cannto detect)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q
A

ST segment depression

myocardial ischemia - reversible!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

residents

A
  • most hands-on work
  • progressive increase in responsibility for patient management and supervision/training of more junior traineess
  • often rotate through patients in a specialty - “house officers”
  • interns (1st year) may be generalists in area of care and are there to laern about area and refine skills
  • “senior resident” has more hands-on experience
  • PGY-1 or R3 (for post grad year x or residency year x)
  • “chief resident” takes on management and additional teaching responsibility within residency program
77
Q

optimizing PEEP

A
  • inverse relationship btwn airway resistance and volume
  • highest resistance at lowest lung vol
  • atelectasis occurs as # of alveoli are closed
    • compliance decreases
  • PEEP routinely used to overcome
  • use as little PEEP as posible to affect positive lung changes (recruiting alveoli)
78
Q
A
  • LEFT: ST segment elevation
    • myocardial infarction
    • STEMI - ST elevated MI
  • RIGHT: t -wave inversion
    • another indication of myocardial injury, w/ possibly more damage
  • NSTEMI - non ST elevated MI
    • risk factors, suspicious chest pain, non-suspicious EKG, and NO STEMI
    • high clinical suspicion - they need to be ruled out via lab work
79
Q

GI bleed r/t ventilator complications

A
  • stress ulcer formation d/t tissue hypoxemia or flow issues 2/2 pressure changes
  • poor perfusion of gastric mucosa leads to loss of goblet cells that secrete protective layer
  • physiologic stress literally making GI vulnerable to ulcer formation
    • PPI or H2 blocker
80
Q

determining ventilatory settings

A
  • tidal volume (VT)
  • respiratory rate
  • fraction inspired oxygen (FiO2)
  • PEEP
  • pressure support
  • I:E ratio
  • based on ideal body weight (height, weight)
81
Q

excessive secretions and CPAP/BiPAP

A
  • NOT RECOMMENDED
  • presence of secretions requires patient to effectively clear airway
  • work associatd with effective clearance may quicly overwhelm patient’s endurance and result in respiratory failure
82
Q

PSV disadvantages

A
  • TV can decrease if:
    • compliance decreases (atelectasis, de-recruited alveoli)
    • WOB increases
    • fatigue
83
Q

airway management

A
  • encourage cough
  • nasopharyngeal/tracheal suctioning
  • endotracheal intubation/tracheostomy
  • bronchodilator therapy
  • mucolytics
    • COPDers
    • thick secretions
    • dehydrated patients
    • usually need hydration to work
84
Q

main uses of noninvasive ventilation

A
  • prevent airway obstruction during sleep
  • maintain or improve oxygenation
  • maintain or improve ventilation
  • provide respiratory muscle rest in different categories of patients in whom invasive mechanical ventilation through an artifical airway is not desired
85
Q

nursing responsibilities in vent weaning

A
  • vitals
  • anxiety
  • support and encourage
  • patient positioning (high fowlers)
  • suction only when needed
  • stress-free environment
  • weaning individualized
86
Q

nurse practitioner based units

A
  • fellow with NPs
  • as effective as residents in providing care
87
Q

non-invasive ventilation contraindications

A
  • hemodynamic instability
  • inability to protect airway, aspiration risk
  • impaired mental status
  • uncontrolled arrhythmia
  • life threatening hypoxemia (< 60 on 100%)
  • postop vertical band gastroplasty
  • severe claustrophobia
  • facial deformity
88
Q

causes of acute respiratory failure

A
  • decreased respiratory drive
    • severe brain injury, sedatives, cancer
  • dysfxn of chest wall
    • muscular dystrophy, myasthenia gravis, ALS
  • dysfxn of lung parenchyma
    • pleural effusion, hemothorax, obstruction, PNA, pulmonary emboli
  • post-op after major thoracic or abdominal surgery
    • pain
89
Q

hemodynamic instability r/t ventilation complications

A
  • decreased venous return 2/2 positive pressure in intrathoracic cavity
    • decreased CO, RAP/CVP, LV
  • baroreceptors think patient is intravascularly depleted b/c decreased CO 2/2 vent change
    • activate renin-angiotensin-aldosterone system leading to water retention
  • will happen to some degree in any patient - anticipate
90
Q

Bohr Effect

A
  • oxyhemoglobin shift
  • to the RIGHT:
    • fever, acidosis
    • oxygen more readily availble to dissociate to tissues
  • to the LEFT:
    • cold, alkalosis
    • oxygen less readily available to dissociate to tissues
91
Q

why does respiratory failure occur?

A
  • mechanical abnormality of lungs/chest wall
  • defect in respiratory controlc enter of brain (trauma, central lesion)
  • impairment in respiratory muscle function - MS, ALS, SCI
  • inadequate ventilation
  • inadequate oxygenation
  • both
92
Q

goal of lasix in post MI

A

decrease pulmonary edema

93
Q

selecting CPAP/BiPAP interface

A
  • full mask, nasal mask, nasal pillow
  • consider
    • size and shape of face/nose
    • deformity
    • skin integrity
    • presence of tubes
    • patient preferences
  • chin strap, harness
94
Q

trouble-shooting vent

A
  • guard against incorrect settings
  • vent disconnect is common first problem
    • check patient FIRST
95
Q

goal for door to balloon time in a STEMI

A

90 min or less

96
Q

disadvantages of SIMV

A
  • limited capacity for patient to meet demand (increased WOB)
    • fatigue, conscious sedation for bedside procedure
      • IMV drive may not give enough support at that point
  • respiratory acidosis if ventilatory support is insufficient (mismatch between patient and vent)
  • sedation may require more support, mode switch
  • may fatigue respiratory muscles
97
Q

differential diagnoses when a child comes in with a seizure

A
  • febrile seizure
  • infection - meningitis
  • head trauma
  • seizure dx (more unlikely)
  • brain tumor
  • ingestion of med or toxin
98
Q

nursing care of A line

A
  • aseptic during set-up of tubing and insertion
  • Allen’s test to assess collateral circulation (if placed in radial artery)
  • shift assessments of dressing for sterility, intactness and site for infection, infiltration
  • continuous monitoring b/c of risk of bleeding if disconnected
  • assess line set up for patency, pressure gauge at 300 mm, prover IV solution (NSS), proper IV voluem to avoid air embolus
  • removal as directed with direct pressure to puncture site for 5-10 minutes to prevent bleeding/hematoma
99
Q

causes of inadequate ventilation (ABNORMAL lungs)

A
  • COPD
    • asthma
    • emphysema
    • chronic bronchitis
  • fibrotic lungs
  • trauma
100
Q

clinical signs indicating need for ventilation

A
  • acute dyspnea
  • PaO2
  • a PaCO2 > 50 mmHg
  • significant respiratory acidemia pH
101
Q

residencies

A
  • some post-grad training
  • used to stay in hospitals (i.e. residencies)
  • highly structured and meet accreditation standards
    • graduates become “board eligible” or qualified to sit for exam leading to national certification in specialty or subspecialty
  • training programs - first in line to respond to many clinical situations
102
Q

proceduralists

A
  • physician does same procedure every day on as many patients as can be accomodated
  • at many academic medical centers
103
Q

Mrs. Mann, a 56-year-old retired school teacher, presented to the ED w/ 2 hr hx of chest discomfort, diaphoresis (cool and clammy) and orthopnea. Never had a hx of similar Sx, takes no medications and has no hx of HTN or CAD. She arrived at the hospital at 0100 due to severe orthopnea and difficulty sleeping.

Primary interventions?

A
  • VS
  • IV
  • labs - trop, BMP, BNP, ABGs, CBC
  • continuous pulse ox
  • continuous cardiac monitoring - tele
    • 12 lead EKG w/in 10 min of c/o chest pain
  • O2 via nasal cannula
  • high fowler’s with pillows under arms
    • promote chest expansion, take weight of chest off by elevating arms, trouble when lying flat
    • facilitate respiratory effort
104
Q

pathologic dead space

A

gas exchange without perfusion (i.e., a PE)

105
Q

fellows

A
  • completed residencies and are pursuing training in subspecialty
  • “right hand” to attending
  • may have teaching involvement
  • may have broad or narrow role in patient management
  • function as attending
106
Q

A in SBAR

A
  • vitals
  • concerns/abnormals
    • clinical impression?
  • severity of patient, additional concern
107
Q

impact of ventilation on intrathoracic cavity

A
  • positive pressure ventilation changes pressure in intrathoracic cavity
  • will impact venous return, impacting CO
  • results in chain of events that we need to anticipate
108
Q

hemodynamic instability and CPAP/BiPAP

A
  • NOT RECOMMENDED
  • patients requiring high vasopressor and/or other supportive therapies
  • require full ventilatory support to assure acid-base stability and adequacy of oxygenation and ventilation
109
Q

intensivists

A
  • to address need for knowledge of special aspects of critical care
  • embraced by hospitals in interest of patient safety and QI
  • used many times in community hospitals
110
Q

mask intolerance and leaks in CPAP/BiPAP

A
  • careful interface selection is essential
    • patient facial characteristics
    • process of applying mask - gently and gradually
  • if mask leaks are large:
    • patient generated cycling may be adversely affected and result in dyssynchrony (time cycled modes can be helpful)
111
Q

pressure-cycled ventilation modes

A
  • Continuous Positive Airway Pressure (CPAP)/ Pressure Support Ventilation (PSV)
  • advanced modes i.e. APRV/ Bi-Level
112
Q

nurse practitioners

A
  • can be unit based or service based
  • orders co-signed by physician
  • job descriptions depending on education and certification based on patient population
113
Q

non-invasive ventilation clinical benefits

A
  • decrease WOB
  • dyspnea relief
  • improved gas exchange
  • avoid endotracheal intubation
  • decrease length of ICU stay
  • decrease sedation use
  • decrease nosocomial infections
114
Q

PSV overview

A
  • usually when patients require intubation but not vent support
  • or last stage of weaning in some patients
  • also used as component of other vent settings: to support ventilation along with low SIMV and CPAP
115
Q

indications for mechanical ventilation

A
  • inability to maintain adequate ventilation
  • inability to maintain adequate oxygenation
  • WOB is greater than patient can maintain
    • patient cannot breathe on their own
  • profound distress/impending failure/failure
    • inability to maintain airway
  • GCS - less than 8, intubate
116
Q

preparing for vent weaning

A
  • describe process to patient
  • vital signs before and throughout
  • evaluate LOC
  • review meds for drugs that could hamper weaning
  • possibly correct anemia
  • K, phos, mag levels adequate
  • hydration
117
Q

advantages of PSV

A
  • pressure support overcomes resistance of tubing
  • useful with weaning
  • WOB decreased
  • patient controls frequency and volume
  • patient determines inspiratory gas flow - more physiologic
118
Q

inter-department committees in hospitals

A
  • recruitment and hiring
  • quality management
  • safety committees
  • supply/equipment selection
  • risk management
  • infection control
  • public relations/marketing
  • credentialing
119
Q

treatment options for BV

A
  • Flagyl/metronidazole 500 mg po qd x 7 days
    • high risk 250mg tid x 7 days
  • Flagyl 2 g po ONCE
  • Flagyl 0.075% gel intravaginally bid x 5 days
  • clindamycin 2% cream, 5g intravaginally qd at bed x 7 days
  • clinda 300 mg po bid x 7 days
120
Q

causes of hypoxemia

A
  • aerohypoxia - high altitude (not enough oxygen in air and people can’t compensate immediately)
  • hypoventilation - asthma (airway restriction)
  • diffusion abnormalities
  • VQ mismatch
121
Q

septic shock

A
  • type of distributive shock
  • insult of infection resulting in systemic inflammatory response with:
    • dilated, poorly responsive peripheral vasculature that cannot move fluid to central vasculature
    • leaky capillary bed –> third spacing of fluid
122
Q

oxygenation goals for hypoxemia

A
  • acute - PaO2 60-70 mmHg
  • chornic - PaO2 - 50-60 mmHg
123
Q

oxygenation

A

oxygen into blood and tissue cell

124
Q

severe agitation and CPAP/BiPAP

A
  • NOT RECOMMENDED
  • agitation makes adjustment to non-invasive interface difficult
  • leaks increase when interface is displaced
    • ventilation unreliable and ineffective
125
Q

ventilation

A

movement of air in and out of the lungs

126
Q

potential effects of anterolateral MI

A
  • CHF
  • pulmonary edema
  • hemodynamic compromise
  • cardiogenic shock
  • intraventricular conduction disturbances
127
Q

SIMV overview

A
  • patient receives present tidal volume at set ventilator rate AND
  • can initiate spontaneous breaths on own (variable tidal volumes)
  • more flexible support than AC, may require less sedation
  • allows exercise of respiratory muscles
128
Q

low pressure alarm on vent

A
  • leak
  • check circuit (at y site)
129
Q

what is BV?

A
  • bacterial vaginosis
  • most common vaginal infection, often during pregnancy
  • imbalance of vaginal flora with predominance of harmful bacteria
  • not an STI
130
Q

low exhaled minute ventilation / VTe

A
  • fatigue
  • sleeping
  • cuff leak
  • circuit leak
131
Q

complications of CPAP/BiPAP masks

A
  • gatsric distention and vomiting
  • nasal congestion
  • eye irritation from leaks
  • discomfort
  • claustrophobia
  • nasal and facial skin breakdown
132
Q
A
  • for FiO2 > 40%
  • rate of flow is very drying to mucous membranes of upper airway
  • can lead to dried secretions, mucus plugging
133
Q

apnea alarm on vent

A
  • vitals
  • fatigue, sedation
  • central apnea
134
Q

immediate concern for pediatric postop patient

A
  • emerging from anesthesia
  • respiratory - supplemental oxygen?
    • raise HOB
    • wake patient up, stimulate them
135
Q

the “pecking” order in medicine

A

high to low in years/experience:

  • attending physician
  • fellow
  • resident
  • intern
  • medical student
136
Q

neurogenic/spinal shock

A
  • type of distributive shock
  • adequate fluid but vasculature is too dilated to pump it
    • d/t neurogenic/spinal injury and loss of vascular tone/response
  • fluid pools in periphery (mal distributed)
137
Q

nurse manager

A
  • front-line manager
  • 24 hours, 7 days a week
  • functioning of nit
  • supervises nursing staff across all shifts
  • represents unit concerns of nurses and nursing care to middle/executive level management
  • The Boss!
    • sometimes an assistant Nurse Manager too
  • blend of models - best clinical skills (pre 1980s) + administrative background (post 1980s)
138
Q

CPAP / PSV overview

A
  • CPAP is analogous with PEEP
  • both CPAP (noninvasive) and PSV (ETT), patient breathes independently through ventilator circuit
  • no tidal volume preset, no rate preset
  • only FiO2 and gas pressure at end-exhalation (PEEP) are controlled
  • patient always breathing spontaneously
139
Q

dys-synchronous ventilation

A
  • patient limited in communication, fighting vent
  • positive pressure is to provide adquate alveolar ventilation
    • avoid dyssyncrhony at all costs
  • risk:
    • valsalva / increased positive pressure
    • barotrauma
    • increased WOB
    • impaired cardiac function
140
Q

dobutamine for post MI

A
  • positive inotrope
  • enhances cardiac contractility
  • better squeezing power to move fluid forward
141
Q

clinical nurse specialists

A
  • MSN degree and are certified
  • orienting new staff, continuing education, and/or research
  • QI
  • unit, department, or hospital based
  • consultant role: wound care, specialty
  • assists with complex patients
142
Q

shift/house supervisors

A
  • middle management
  • 8 or 12 hrs
  • broad spectrum of responsibilities - operational to personnel
    • staffing or bed issues
  • multiple different names
    • NCC, PCC, NAC
143
Q

nursing measures for preeclampsia

A
  • IV access
  • foley + strict I/O
  • oxygen + face mask available
  • continuous fetal monitoring
  • baseline labs
  • monitor vitals
  • family/patient support + education
  • decrease external stimuli
  • assess every hour
    • respirations, clonus, DTR, epigastric pain, N/V, back pain
  • SCD
  • incentive spirometer
144
Q

high pressure alarm on vent

A
  • suctioning
  • biting tube
  • trach tube displaced
  • lungs stiffer
  • volu/barotrauma
  • bronchconstriction
145
Q

lab workup for a suspected MI

A
  • troponin - most specific and sensitive for myocardial insult
    • only released with myocardial injury
  • CK - released with any muslce injury
    • rhabdomyolysis
  • CK-MB - more specific to cardiac tissue than CK
    • not as sensitive
  • onset 2-4hr and peak 12-24 hr for trop and CK-MB
  • duration 7 day for trop, 2-3 days for CK-MB
146
Q

pediatric fluid balance calculation

A

(4ml * 10kg ) + (2ml * 10 kg) + (1ml * remaining kg)

expected urine output: 1-2 ml/kg/hr

147
Q

high FiO2 requirements and CPAP/BiPAP

A
  • most NPPV ventilators do not provide high FiO2
  • patient may require invasive ventilation or NPPV with conventional ventilator to assure required FiO2
148
Q

relationship between cardiogenic shock and renal failure

149
Q

histotoxic hypoxia

A

inability to use oxygen supplied (cyanide)

150
Q

O2 toxicity r/t vent complications

A
  • 0.6 L for > 48 hours w/ positive pressure
  • permanent lung injury, neuro changes
    • similar to nitrogen poisoning
  • be aware - some may need 100% FiO2 and they will have some degree of toxicity
  • be on the look out for weaning opportunities
151
Q
A

100% non-rebreather

152
Q

prognosis for BV

A
  • excellent when treated
  • if not:
    • at risk for HIV, chlamydia or gonorrhea
      • possibly leading ot PID
    • at risk for preterm labor/birth
153
Q

vent weaning failure

A
  • BP pressure devation of 20 mm Hg or more
  • alteration in HR of 20 bpm or more
  • cardiac dysrhythmias deviating from baseline
  • change in LOC
  • RR elevation
154
Q

VQ mismatch - shunting

A

normal alveolar interface but blood can’t get in or out so it is passing by alveolar unit and can’t be oxygenated

perfusion w/o ventilation - R side to L side of heart w/o oxygenation

155
Q

CPAP - non invasive ventilation

A
  • denotes spontaneous breathing
  • to treat hypoventilation syndrome or obstructive sleep apnea
  • via full face mask, nasal mask, or nasal pillows
  • FiO2 variable
  • same as BiPAP w/o pressure change
156
Q

diagnosing BV

A

wet mount, gram stain

157
Q

cause and effects of chronic respiratory failure

A
  • deterioration in gas exchange over long period of time
  • absence of acute Sx and presence of chronic respiratory acidosis
  • patient has developed tolerance to gradual worsening hypoxemia and hypercapnia
  • COPD and neuromuscular diseases
158
Q

flagyl patient education

A

DO NOT DRINK - will vomit violently

159
Q

elements of VAP bundle

A
  1. HOB 30-45 degrees
  2. daily sedation vacation and assessment of extubation readiness
  3. peptic ulcer disease ppx
  4. DVT ppx (unless contra)
160
Q

PEEP

A
  • component manipulated in almost every mode
  • usually for refractory hypoxemia
  • improves oxygenation via alveoli recruitment
  • may decrease CO via dereasing venous return
  • may increase ICP via decreasing venous return (venous congestion in head)
161
Q

hospitalists

A
  • physician who is employed by the hospital to care directly for patients who are admitted by another doctor
  • typically internists
162
Q

Assist-Control Ventilation / CMV overview

A
  • patient receives a preset tidal volume w/ each breath
    • if patient initiates breath, receives full preset tidal volume set on vent
  • CMV = continuous mandatory breathing
  • doesn’t allow for spontaneous breathing
163
Q

oxyhemoglobin dissociation curve

A
  • PaO2 affected by core temp, serum pH, CO2
  • SaO2 (% of oxygen) affected by CO2, [H+], temp, 2,3, diphophoglyycerate
164
Q

circulatory hypoxia

A
  • decreased blood supply
    • decreased CO
    • arterial occlusion
165
Q

possible causes of PVCs

A
  • hypoxia
  • infarcted tissue
  • hypokalemia (k is the electrolyte of cardiac relaxation)
  • hyperkalemia
166
Q

specimens obtained for pap and wet mount

A
  • swab of cervix for pap
  • small amount of vaginal discharge via swab
    • smeared on glass slide with 1 drop saline
    • another sample with one drop KOH for whiff test
      • KOH breaks down epithelial cells, leaving yeast and hyphae
    • assess pH
167
Q

clinical directors

A
  • middle management
  • cover multiple units, usually same specialties
  • nurse managers report to them
  • relays information and concerns between exectuive level and units
  • often handles broader concerns and operational concerns
168
Q

pressure cycled ventilation

A
  • decelerating flow patterns rather than constant, mandatory flow
  • spontaneous patient breathing (syncs better w/ patient breathing)
  • primarily involves manipulation of FiO2, PEEP, PSV
169
Q

clinical examination of respiratory distress

A
  • dyspnea
  • tachypnea (> 30-35)
  • labored breathing - accessory muscles
  • poor skin color
  • sweating
  • tachycardia
  • abnormal lung sounds
170
Q

consultants

A
  • when team or attendant asks for help from spcialists
  • make recommendations that team rolls into orders/care
  • attending makes final decisions
    • especially when treatment plans in conflict
  • may or may not be admitting team
    • infectious disease, pods, ortho
171
Q

Chief Nursing Officer/Executive / Director of Nursing

A
  • executive level nursing management
  • sets vision and direction for nursing practice
  • interfaces with executives from other areas
  • handles high profile/high cost operations
  • slects, supervises, develops other executives/middle line managers
  • may supervise other departments such as pharmacy, rehab, patient services
172
Q

airway and mental status and CPAP/BiPAP

A
  • NOT RECOMMENDED WHEN:
  • inadequate airway protective reflexes
    • cough and swallow essential for airway protection
    • absence puts patient at risk for aspiration
  • encephalopathy or coma
    • inability to protect airway and remove mask when neccessary increases risk of aspiration
173
Q
A
  • upper right - trach collar
  • lower right - another way to deliver humidified air to trach
174
Q
A
  • Up to 6L (FiO2 = 38%)
  • Aquanox: nasal cannulas with high flow, humidified nasal passages to get higher FiO2 (80-100%)
175
Q

high RR alarm on vent

A
  • anxiety
  • fatigue
176
Q

CPAP/BiPAP mode options

A
  • spontaneous
    • patient initiates all breaths
  • spontaneous-timed
    • spontaneous w/ back-up rate
  • control mode
    • Rate and inspiratory time set
177
Q

nasopharyngeal airway

A
  • not when there is an NG or facial trauma
    • easiest way to brain is through nose
    • can go into brain if nasal passage is compromised
178
Q

screening recommendations for specific STIs

A
  • chlamydia - B
  • gonorrhea - B
  • syphilis - A
  • HIV - A
  • HSV - D
  • HPV - A
  • Hep B - D (B for high risk)
  • Hep C - I (B for high risk)
179
Q

charge nurse / team leader

A
  • shift-level manager on units
  • care on specific unit for specific shift
  • work flow and staff
  • admission discharges and transfers
  • resource person
  • experienced nurse
  • may or may not have own patient load
180
Q

concerns for fetus with magnesium sulfate

A
  • fetal well-being
    • lethargic on mag
    • desaturations
  • increases risk of C-section
181
Q

hypoxia

A

insufficient oxygen availability at cellular level

182
Q

ABG progression

A
  1. increased WOB
    • PaCO2 may be low (hyperventilation)
  2. patient becomes tired
    • PaCO2 rises to normal
  3. patient cannot maintain WOB
    • PaCO2 rises above normal (hypercapnia)
183
Q

what dysfunction are we worried about with inferior damage to heart?

A
  • injury to LV that impairs cardiac pumping
    • risk for cardiogenic shock
  • heart failure due to acute process of injury to myocardium
    • risk for pulmonary edema
      • not moving blood forward (explains orthopnea)
  • injury to electrical conduction system
    • heart block (if injury to junction)
    • v.tach, v.fib, PVCs
184
Q

advantages of AC ventilation

A
  • ventilator assumes patient’s WOB
  • patient gets full tidal volume when breathin above set ventilator rate
185
Q

PVCs

A
  • originate in ventricle - not preceded by p wave
  • no atrial kick
  • risk for R on T –> V.tach, v.fib
  • decreases diastolic filling time (75% normally)
  • decreases coronary artery perfusion
186
Q

FiO2 of CPAP/BiPAP

A
  • titrated by flowmeter
  • oxygen blender
  • high FiO2 requiremetns may require conventional ventilator in NPPV mode
187
Q

anaphylactic shock

A
  • type of distributive shock
  • inflammation caused by molecule in environment
    • usually large, proteinacious molecules
  • body sees it as threatening and mounts big inflammatory response
  • loss of normal vaso tone and pooling of blood in periphery
188
Q

physiologic dead space

A

space in upper airways that don’t have units for gas exchange (nose, pharynx, etc.)

Leadership (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions