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NUR 239 > Test #6: Oxygenation > Flashcards

Test #6: Oxygenation Flashcards

1
Q

How long is a normal P wave?

A

0.06-0.12

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2
Q

If you count small boxes (R to R), how much must the nurse divide by to get the heart rate?

A

1500

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3
Q

If the nurse counts the large boxes (R to R), what must the nurse divide the count by to know the heart rate?

A

300

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4
Q

What is the normal range of B-type natriuretic peptide (BNP)?

A

less than 100

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5
Q

What common NSAID can worsen heart failure?

A

Ibuprofen

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6
Q

Why is Atropine given and what does it do?

A

It is given for bradycardia and speeds up the HR

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7
Q

Why is Adenosine given and what does it do?

A

Adenosine is given to treat SVT and/or convert a patient out of a irregular rhythm.

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8
Q

What is the intrinsic heart rate of the sinoatrial node?

A

60-100

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9
Q

What is the intrinsic heart rate of the atrioventricular node?

A

40-60

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10
Q

What is the intrinsic heart rate of the Purkinje fibers?

A

20-40

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11
Q

What is the first small upright wave seen on the EKG that represents contraction of the atrium?

A

P wave

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12
Q

What represents the travel of the electrical impulse between the atrium and the ventricles?

A

PR interval

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13
Q

Which wave indicates contraction of the ventricles?

A

QRS Complex

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14
Q

What measures the time between

depolarization and repolarization of the ventricles?

A

ST segment

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15
Q

What portion of the EKG tracing signifies ventricular repolarization?

A

T wave

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16
Q

What measurement represents total activity of the ventricles?

A

QT interval

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17
Q

Which wave represents repolarization of the Purkinje fibers of the heart?

A

U wave

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18
Q

Where would the U wave be seen?

A

After the T wave

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19
Q

What is a “Thoracentesis”?

A

Thoracentesis is a procedure to remove fluid from the space between the lining of the outside of the lungs (pleura) and the wall of the chest.

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20
Q

How should a patient be positioned for a thoracentesis?

A

Have the patient sit on a bed or on the edge of a chair or bed and lean forward

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21
Q

What is a pneumothorax?

A

A pneumothorax is an abnormal collection of air or gas in the pleural space that causes an uncoupling of the lung from the chest wall. (often called a collapsed lung)

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22
Q

What is a pleural effusion?

A

Pleural effusion is excess fluid that accumulates in the pleural cavity, the fluid-filled space that surrounds the lungs.

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23
Q

What is a “flail chest”?

A

when a segment of the thoracic cage is separated from the rest of the chest wall.

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24
Q

What is the classic symptom of flail chest?

A

Asymetrical respirations

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25
Q

What causes a closed pneumothorax?

A

Rupture of small blebs on the viseral pleura

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26
Q

What increases the risk of closed/spontaneous pneumothorax?

A

Smoking

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27
Q

What is the emergency management of a open pneumothorax?

A

An occlusive dressing taped on 3 sides

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28
Q

What is a common complication of tension pneumothorax?

A

Mediastinum shift and possible tracheal deviation

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29
Q

What is a “chylothorax”?

A

Lymph fluid in the pleural space

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30
Q

What are the symptoms of a small pneumothorax?

A

mild tachycardia and dyspnea

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31
Q

What are the symptoms of a large pneumothorax?

A

Respiratory distress, rapid, shallow respirations, dyspnea, air hunger and oygen desaturation

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32
Q

Which type of pneumo is considered most emergent?

A

Tension pneumo; if the tension is not relieved the patient is likely to die from inadequate cardiac output or severe hypoxemia

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33
Q

What is emergent treatment of a tension pneumo?

A

Insertion of a large bore needle into the anterior chest wall at the 4th or 5th intercostal space to release trapped air, then a chest tube

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34
Q

Why is it no longer recommended to clamp chest tubes for transport?

A

Because of possibly causing a tension pneumo

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35
Q

How much fluid is normally in the pleural space?

A

5-15 mL

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36
Q

What are common clinical manifestations of a pleural effusion?

A

Progressive dyspnea and decreased chest wall movement on the affected side

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37
Q

What is the clinical definition of Primary Pulmonary Hypertension?

A

Mean pulmonary arterial pressure greater than 25 at rest

38
Q

What is Epoprostanol?

A

A prostacyclin analog given for pulmonary hypertension

39
Q

How must Epoprostanol be administered?

A

Via central line and continuous infusion

40
Q

What is the half-life of Epoprostanol?

A

Less than 6 minutes

41
Q

What is “hypoxemic respiratory failure”?

A

PaO2 less than 60mmHg when the patient is on oxygen at 60% (or more)

42
Q

What is the normal range of PaO2?

A

80-100

43
Q

What is “hypercapnic respiratory failure”?

A

PaCO2 greater than 48 in combination with acidosis (pH less than 7.35)

44
Q

What is the normal range of PaCO2?

A

32-48

45
Q

What causes hypercapnic respiratory failure?

A

The inability of the respiratory system to remove enough CO2 to maintain a normal range

46
Q

Which patients are at an increased risk for hypercapnic respiratory failure?

A

Patients with COPD, asthma and cystic fybrosis

47
Q

What kind of ventilation does intrapulmonary shunting require?

A

Positive Pressure Ventilation (PPV) via Endotracheal tube or bipap

48
Q

Who is at risk for oxygen toxicity?

A

Intubated patients on more than 60% for over 48 hours

49
Q

Aduquate gas exchange depends on what?

A

Aduquate V/Q ration

50
Q

What are common causes of V/Q mismatch?

A

Increased secretions, atelectasis, and pain

51
Q

What is is first step to reverse hypoxemia caused by V/Q mismatch?

A

O2 therapy

52
Q

What is diffusion limitation?

A

Diffusion limitation is when the alveolar membrane becomes thickened, damaged or destroyed

53
Q

What test should be conducted to check for a suspected PE?

A

V/Q scan

54
Q

What is ARDS?

A

ARDS is a sudden, progressive form of acute respiratory failure where the alveolar capillary membrane is damaged and more permeable.

55
Q

Which is more likely to cause ARDS: aspiration or pneumonia?

A

Aspiration, because of the inflammatory response

56
Q

What virus causes SARS?

A

The coronavirus

57
Q

What is cardiomyopathy?

A

A disease of the heart muscle

58
Q

What is the “classic” electrolyte imbalance that occurs in cardiomyopathy?

A

Sodium

59
Q

What is the leading cause of heart transplant?

A

Cardiomyopathy

60
Q

What type of cardiomyopathy follows infectious myocarditis?

A

Dilated Cardiomyopathy

61
Q

What is “Takotsubo cardiomyopathy”?

A

It is a acute, stress-related syndrome that in

62
Q

What is charateristic of dilated cardiomyopathy?

A

Dilated ventricle without hypertrophy

63
Q

What is the leading cause of death with dilated cardiomyopathy?

A

Lethal dysrthymias

64
Q

What test distinguishes dilated cardiomyopathy from other diseases?

A

Doppler Echocardiography: it help identify the structures and function of the heart ***

65
Q

What is focus of interventions for dilated cardiomyopathy?

A

Focus on controlling heart failure–increased myocardial contractility and decrease afterload

66
Q

Why are nitrates and diuretics given to manage HF (or dilated cardiomyopathy)?

A

To decrease preload ***

67
Q

Why is it important to decrease preload?

A

Because it will ultimately decrease afterload

68
Q

Why would ACE-inhibitors (i.e. captopril) be given to a patient with HF (or dilated cardiomyopathy)?

A

To decrease afterload: reduce hypertension/relax blood vessels ***

69
Q

Why would a patient with dilated cardiomyopathy be given a beta-blocker?

A

To block the effects of epi and nor-epi/keep afterload low

70
Q

What is hypertrophic cardiomyopathy?

A

Left ventricular hypertrophy without ventricular dilation

71
Q

Which cardiomyopathy is genetic?

A

Hypertrophic cardiomyopathy; specifically autosomal dominant

72
Q

What is the most common cause of sudden cardiac death in an otherwise healthy individual?

A

Hypertrophic cardiomyopathy

73
Q

An apical pulse that is exaggerated and displaced laterally is indicative of what?

A

Hypertrophic cardiomyopathy

74
Q

How often and what should a patient with a ET tube be monitored?

A

Patient should be monitored q2-4 hours and placement should be verified

75
Q

If a patient with an ET tube can make audible sounds, what does that mean?

A

The cuff is not inflated enough ***

76
Q

Should vented patients be routinely suctioned?

A

NO! ***

77
Q

What is the 1st thing to do before suctioning a patient?

A

Assess lungs sounds and pulse oximetry *** (even before hyperoxygenation)

78
Q

What O2% indicates need to suction the ET tube?

A

92% or less

79
Q

Which indicates the need to suction the ET tube: RR of 32 or O2 stat of 93%?

A

the RR

80
Q

What is a benefit of a closed suctioning system?

A

It decreases hypoxemia

81
Q

How often should the ET tube be repositioned and re-taped?

A

Every 24hours (once a day)

82
Q

The nurse is caring for a patient and hears the vent alarming, upon entering the room it is seen that the patient self-extubated. What is the nurse’s first action?

A

Manually ventilate the patient

83
Q

What are the two groups of positive ventilation?

A

Volume and pressure

84
Q

What is “assist-control” ventilation?

A

The vent delivers a preset tidal volume at a preset frequency; patient initiates breath and then a preset volume is delivered (pt can breathe faster than setting, but not slower)

85
Q

What is SIMV?

A

Synchronized Intermittent Mandatory Ventilation; the vent delivers a preset tidal volume at a preset frequency inconjunction with pt’s breathing

86
Q

What is the difference between “assist-control” and SIMV?

A

The volume varies on voluntary breaths in SIMV

87
Q

What is pressure support mode of a vent?

A

Positive pressure is applied during inspiration only

88
Q

What is PEEP?

A

Positive End Expiration Pressure; keeps alveoli open

89
Q

What is CPAP?

A

Continuous Positve Airway Pressure; similar to PEEP but it is delivered continuously during spontaneous breathing

90
Q

When preparing to wean a patient from the vent, what is the most important thing for the nurse to have?

A

Baseline ABG levels

NUR 239 (8 decks)

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