Test #6: Oxygenation Flashcards
How long is a normal P wave?
0.06-0.12
If you count small boxes (R to R), how much must the nurse divide by to get the heart rate?
1500
If the nurse counts the large boxes (R to R), what must the nurse divide the count by to know the heart rate?
300
What is the normal range of B-type natriuretic peptide (BNP)?
less than 100
What common NSAID can worsen heart failure?
Ibuprofen
Why is Atropine given and what does it do?
It is given for bradycardia and speeds up the HR
Why is Adenosine given and what does it do?
Adenosine is given to treat SVT and/or convert a patient out of a irregular rhythm.
What is the intrinsic heart rate of the sinoatrial node?
60-100
What is the intrinsic heart rate of the atrioventricular node?
40-60
What is the intrinsic heart rate of the Purkinje fibers?
20-40
What is the first small upright wave seen on the EKG that represents contraction of the atrium?
P wave
What represents the travel of the electrical impulse between the atrium and the ventricles?
PR interval
Which wave indicates contraction of the ventricles?
QRS Complex
What measures the time between
depolarization and repolarization of the ventricles?
ST segment
What portion of the EKG tracing signifies ventricular repolarization?
T wave
What measurement represents total activity of the ventricles?
QT interval
Which wave represents repolarization of the Purkinje fibers of the heart?
U wave
Where would the U wave be seen?
After the T wave
What is a “Thoracentesis”?
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.
How should a patient be positioned for a thoracentesis?
Have the patient sit on a bed or on the edge of a chair or bed and lean forward
What is a pneumothorax?
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)
What is a pleural effusion?
Pleural effusion is excess fluid that accumulates in the pleural cavity, the fluid-filled space that surrounds the lungs.
What is a “flail chest”?
when a segment of the thoracic cage is separated from the rest of the chest wall.
What is the classic symptom of flail chest?
Asymetrical respirations
What causes a closed pneumothorax?
Rupture of small blebs on the viseral pleura
What increases the risk of closed/spontaneous pneumothorax?
Smoking
What is the emergency management of a open pneumothorax?
An occlusive dressing taped on 3 sides
What is a common complication of tension pneumothorax?
Mediastinum shift and possible tracheal deviation
What is a “chylothorax”?
Lymph fluid in the pleural space
What are the symptoms of a small pneumothorax?
mild tachycardia and dyspnea
What are the symptoms of a large pneumothorax?
Respiratory distress, rapid, shallow respirations, dyspnea, air hunger and oygen desaturation
Which type of pneumo is considered most emergent?
Tension pneumo; if the tension is not relieved the patient is likely to die from inadequate cardiac output or severe hypoxemia
What is emergent treatment of a tension pneumo?
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
Why is it no longer recommended to clamp chest tubes for transport?
Because of possibly causing a tension pneumo
How much fluid is normally in the pleural space?
5-15 mL
What are common clinical manifestations of a pleural effusion?
Progressive dyspnea and decreased chest wall movement on the affected side
What is the clinical definition of Primary Pulmonary Hypertension?
Mean pulmonary arterial pressure greater than 25 at rest
What is Epoprostanol?
A prostacyclin analog given for pulmonary hypertension
How must Epoprostanol be administered?
Via central line and continuous infusion
What is the half-life of Epoprostanol?
Less than 6 minutes
What is “hypoxemic respiratory failure”?
PaO2 less than 60mmHg when the patient is on oxygen at 60% (or more)
What is the normal range of PaO2?
80-100
What is “hypercapnic respiratory failure”?
PaCO2 greater than 48 in combination with acidosis (pH less than 7.35)
What is the normal range of PaCO2?
32-48
What causes hypercapnic respiratory failure?
The inability of the respiratory system to remove enough CO2 to maintain a normal range
Which patients are at an increased risk for hypercapnic respiratory failure?
Patients with COPD, asthma and cystic fybrosis
What kind of ventilation does intrapulmonary shunting require?
Positive Pressure Ventilation (PPV) via Endotracheal tube or bipap
Who is at risk for oxygen toxicity?
Intubated patients on more than 60% for over 48 hours
Aduquate gas exchange depends on what?
Aduquate V/Q ration
What are common causes of V/Q mismatch?
Increased secretions, atelectasis, and pain
What is is first step to reverse hypoxemia caused by V/Q mismatch?
O2 therapy
What is diffusion limitation?
Diffusion limitation is when the alveolar membrane becomes thickened, damaged or destroyed
What test should be conducted to check for a suspected PE?
V/Q scan
What is ARDS?
ARDS is a sudden, progressive form of acute respiratory failure where the alveolar capillary membrane is damaged and more permeable.
Which is more likely to cause ARDS: aspiration or pneumonia?
Aspiration, because of the inflammatory response
What virus causes SARS?
The coronavirus
What is cardiomyopathy?
A disease of the heart muscle
What is the “classic” electrolyte imbalance that occurs in cardiomyopathy?
Sodium
What is the leading cause of heart transplant?
Cardiomyopathy
What type of cardiomyopathy follows infectious myocarditis?
Dilated Cardiomyopathy
What is “Takotsubo cardiomyopathy”?
It is a acute, stress-related syndrome that in
What is charateristic of dilated cardiomyopathy?
Dilated ventricle without hypertrophy
What is the leading cause of death with dilated cardiomyopathy?
Lethal dysrthymias
What test distinguishes dilated cardiomyopathy from other diseases?
Doppler Echocardiography: it help identify the structures and function of the heart ***
What is focus of interventions for dilated cardiomyopathy?
Focus on controlling heart failure–increased myocardial contractility and decrease afterload
Why are nitrates and diuretics given to manage HF (or dilated cardiomyopathy)?
To decrease preload ***
Why is it important to decrease preload?
Because it will ultimately decrease afterload
Why would ACE-inhibitors (i.e. captopril) be given to a patient with HF (or dilated cardiomyopathy)?
To decrease afterload: reduce hypertension/relax blood vessels ***
Why would a patient with dilated cardiomyopathy be given a beta-blocker?
To block the effects of epi and nor-epi/keep afterload low
What is hypertrophic cardiomyopathy?
Left ventricular hypertrophy without ventricular dilation
Which cardiomyopathy is genetic?
Hypertrophic cardiomyopathy; specifically autosomal dominant
What is the most common cause of sudden cardiac death in an otherwise healthy individual?
Hypertrophic cardiomyopathy
An apical pulse that is exaggerated and displaced laterally is indicative of what?
Hypertrophic cardiomyopathy
How often and what should a patient with a ET tube be monitored?
Patient should be monitored q2-4 hours and placement should be verified
If a patient with an ET tube can make audible sounds, what does that mean?
The cuff is not inflated enough ***
Should vented patients be routinely suctioned?
NO! ***
What is the 1st thing to do before suctioning a patient?
Assess lungs sounds and pulse oximetry *** (even before hyperoxygenation)
What O2% indicates need to suction the ET tube?
92% or less
Which indicates the need to suction the ET tube: RR of 32 or O2 stat of 93%?
the RR
What is a benefit of a closed suctioning system?
It decreases hypoxemia
How often should the ET tube be repositioned and re-taped?
Every 24hours (once a day)
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?
Manually ventilate the patient
What are the two groups of positive ventilation?
Volume and pressure
What is “assist-control” ventilation?
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)
What is SIMV?
Synchronized Intermittent Mandatory Ventilation; the vent delivers a preset tidal volume at a preset frequency inconjunction with pt’s breathing
What is the difference between “assist-control” and SIMV?
The volume varies on voluntary breaths in SIMV
What is pressure support mode of a vent?
Positive pressure is applied during inspiration only
What is PEEP?
Positive End Expiration Pressure; keeps alveoli open
What is CPAP?
Continuous Positve Airway Pressure; similar to PEEP but it is delivered continuously during spontaneous breathing
When preparing to wean a patient from the vent, what is the most important thing for the nurse to have?
Baseline ABG levels
