Test 2

Question 1

Normal Ph for blood?

Answer 1

7.35-7.45

Question 2

Normal SpCO2 levels?

Answer 2

35-45

Question 3

Normal HCO3 levels?

Answer 3

22-26

Question 4

What would be considered respiratory acidosis?

Treatment?

Answer 4

Blood Ph is less than 7.35 and SpCO2 is above 45

Question 5

What would be considered respiratory alkalosis?

Treatment?

Answer 5

Blood Ph is above 7.45 and SpCO2 is below 35

Treated by using an antianxiety to reduce hyperventilation
Correcting heart rhythms using medication or cardioversion

Question 6

What would be considered metabolic acidosis?

Treatment?

Answer 6

Blood Ph is below 7.35 and HCO3 is below 22

Treated using sodium bicarbonate or using activated charcoal to detoxify any ingested substances

Question 7

What would be considered metabolic alkalosis?

Treatment?

Answer 7

Blood Ph is above 7.45 and HCO3 is above 26

Question 8

What does an assist control ventilator do?

Answer 8

Assist control ventilators (AC) will deliver ventilation at a set rate and will deliver the tidal volume either automatically or when the patient attempts to take a breath themselves. The tidal volume will be delivered in full with this setting no matter if the ventilator is initiating the breath or the patient is

Question 9

What does a synchronized intermittent mandatory ventilator do?

What is a reason a SIMV may be used over an AC?

Answer 9

Synchronized intermittent mandatory ventilators (SIMV) will deliver the tidal volume at a set rate BUT, if a patient attempts to take a breath the tidal volume will not be delivered and the appropriate intake of tidal volume will be left to the patient

One reason that a SIMV may be used over an AC will be due to the fact that the SIMV allows the patient to use their respiratory muscles to maintain strength. Once the patient is able to take a certain number of unassisted breaths the patient may be viable to be extubated

Question 10

What is high frequency oscillatory ventilation and what is it used for?

Answer 10

High frequency oscillatory ventilation is mostly used for emergency situations such as patients experiencing ARDS or neonates with meconium aspiration or neonate respiratory distress syndrome. The ventilator is used when other methods of ventilation have failed and maintains high PEEP continuously. This high PEEP can reopen collapsed alveoli but may also cause barotrauma or pneumothorax

Question 11

What is pneumothorax?

Answer 11

Pneumothorax is a collapsed lung that can be caused by many conditions such as trauma, disease, or surgical procedures

Question 12

How in pneumothorax treated?

Answer 12

Needle aspiration may be done in order to remove air or a chest tube may be inserted in order to remove air

Question 13

What is hemothorax?

Answer 13

Hemothorax is where blood has leaked into the chest cavity causing pressure to collapse the lung. Additionally, blood can put pressure on the heart and cause dysrhythmias

Question 14

What are some ways to treat hemothorax?

Answer 14

Needle aspiration in order to remove fluids as well as a chest tube to drain fluid

Question 15

Where is a chest tube inserted?

Answer 15

Within the pleural space along the fourth or fifth intercostal space above the rib for pneumothorax

Question 16

How is a chest tube placement confirmed?

Answer 16

X-ray or ultrasound

Question 17

How does a wet suction drain work for chest tubes?

Answer 17

Water is placed in the chamber (usually up to -20) while hooked up to wall suction and the suction level is regulated by the amount of water in the chamber at the time

Bubbling will be present while the suction is active but should be intermittent

Water will evaporate eventually so monitoring is required

Question 18

How does a dry suction drain work for chest tube?

Answer 18

Bellows is used instead of water and suction rate is set using a dial

Question 19

What should be maintained and monitored after chest tube placement?

Answer 19

Chest tube must remain below patients chest level

Chest tube must be kept free from kinks or clots (water seal will not fluctuate if tubing is clamped or clotted)

Drainage must be monitored. Color should be noted as well as the amount draining which is typically less than 100cc per hour

Monitor the fluctuation of the water seal chamber
With a negative pressure pump the water should rise with inspiration and fall with expiration
Opposite is shown with positive pressure

If the water level does not fluctuate this could mean that the lung could have re-expanded or the tubing has a kink

Intermittent bubbling should be present but constant or excessive bubbling could be an indicator of an air leak

Question 20

What should be assessed on a patient with a chest tube?

Answer 20

Monitor patient lung sounds and assess for dyspnea

Insertion site should be monitored

SubQ crepitus should be looked for (Co2 escaping below the skin, should feel like crackles)

Question 21

What should be done if the patients chest tube system breaks?

Answer 21

If the patient system breaks the end of the tube should be placed 1 inch into sterile water in order to maintain the seal and a new system should be obtained

Question 22

What should be done if the patients chest tube becomes dislodged?

Answer 22

If the patients chest tube becomes dislodged, a sterile dressing must be placed over the insertion site and taped over three sides in order to form a seal which allows air to escape and prevents tension pneumothorax

Question 23

What should be done at bedside to remove a chest tube?

Answer 23

Chest x-ray must be done to assess the lungs

Sterile gloves and equipment required

Put patient in semi fowlers position

Pre medicate for pain

Monitor respiratory status