unit 1&2 Flashcards by britt rank

4 signs after extubation that are not good

Stridor
Hoarseness
Change in vital signs
Low oxygen saturation

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4 ventilator settings

FiO2 (usually starting around 50%)

Tidal Volume (VT)

6 to 8 mL/kg (ideal weight)
Adjusted according to peak and plateau pressures

Respiratory rate
-12-20 breaths initially

I:E ratio; normal 1:2

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Treatment of ARDS

Positioning

Prone positioning/Continuous lateral rotation therapy

Weight of heart off of the lungs

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Informed consent, refusal of consent, or withdrawal of consent for health care, unless stated in the advance directive.

Health care decision

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Actions intended to benefit the patients or others

Beneficence

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type of ventillator alarm that patients biting on tube, secretions blocking tube

High pressure alarm-

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spontaneous breathing with ventilator on ‘flow by’ and PS=0 with PEEP=0

weaning trial

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Delivery of positive-pressure ventilation (PPV) without artificial airway

Nasal Continuous Positive Airway Pressure (CPAP)

- Bi-level Continuous Airway Pressure (BiPAP)

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what is used for the reversal of opioids

naloxone

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ROME=

respiratory opposite metabolic equal

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deliver oxygen at 1L to 6L/min (24-44% FiO2)

Nasal Cannula

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pH- 7.39 =
PaCO2- 50 ↑
PaO2- 60 ↓
HCO3- 30 ↑

is an example of ________ that is _____ compensated

respiratory acidosis that is fully compensated

normal pH but more toward the acidic side

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Being fair or just to the wider community in terms of the consequences of an action. In health care, justice is described as the fair allocation or distribution of health care resources

Justice

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normal pH value

7.35-7.45

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if the HCO3 is ______, that means the body has more base

elevated

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4 ways to verify placement of endotrachial tube placement

symmetrical chest rising
listen for bilateral lung sounds
end tidal co2 decector (change of color)
chest xray

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A competent adult who has not been expressly designated to make health care decisions for an incapacitated person, but is authorized by state statute to make health care decisions for the person.

Proxy

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room air is ____%

21 %

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3 main adverse effects of benzodiazipines

respiratory depresion 
lower bp (ortho hypo)
paradoxal agitation

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With hyperventilation, the PaCO2 is ___ and a greater amount of___ is leaving the body

low

CO2

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7 Symptoms of ARDS

Dyspnea and tachypnea
Hyperventilation with normal breath sounds
Respiratory alkalosis
Increased temperature and pulse
Worsening chest x-rays that progress to “white out”
Increased PIP on ventilation
Eventual severe hypoxemia

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type of ventillator alarm that patients not breathing

Apnea alarm

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An alternate term with less-negative connotations, but essentially meaning DNR.

Allow natural death

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With hypoventilation, the PaCO2 is____

—the patient is not breathing adequately ( the respiratory rate may be fast but the depth of the respirations may be shallow, the respiratory rate may be slow which means not as much ventilation)

high

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A ________ blood gas will have an abnormal pH and will have abnormal values for both the PaCO2 and the HCO3

partially compensated

7 most common reasons for Acute Respiratory Distress Syndrome (ARDS)

``` Sepsis Aspiration Trauma Near drowning Drug overdose Oxygen toxicity Fat embolism ```

Actions intended not to harm or bring harm to others

Nonmaleficence

3 main types of opioids

fentanyl mopphine hydromorphone

8 Late signs of hypoxia

``` confusion stupor bradypnea bradycardia (an ominous sign) hypotension cyanotic skin respiratory acidosis. dysrthymias ```

Movement of gases into lungs through positive pressure

Positive Pressure Ventilation

4 things Endotracheal intubation are used to do

Maintain an airway Remove secretions Prevent aspiration Provide mechanical ventilation

3 things needed at the bedside when you have a patient with a Tracheostomy

Suction, size down cannula, obturator needed at the bedside

Provide humidification flow for rates greater than __L/min

A ______ bood gas will have an abnormal pH and one of the values (either the PaCO2 or the HCO3) will be abnormal and the other will be normal depending on the acid/base imbalance.

uncompensated

for ventilator settings how do you set tidal volume

Take 6-8 ml and multiply by the weight in kg (start at 6)

Intervention with the intent of preserving life, restoring health, or reversing clinical death.

Resuscitation

``` pH = 7.49 PaCO2 = 28 PaO2 = 70 HCO3 = 24 mEq/L ``` is an example of ________ that is _____ compensated

respiratory alkalosis uncompensated

Be aware of the hepatotoxic effects of acetaminophen. Clients who have a healthy liver should take no more than _ g/day. Make sure clients are aware of opioids that contain acetaminophen, such as hydrocodone bitartrate 5 mg/acetaminophen 500 mg.

5 things in the Ventilator bundle

Head of bed 30 degrees (prevent aspiration) Awaken daily and assess readiness to wean Stress ulcer prophylaxis DVT prophylaxis Oral care (chlorhexidine in some bundles)

A medical order that prohibits the use of cardiopulmonary resuscitation and emergency cardiac care to reverse signs of clinical death. The DNR order may or may not be specified in patients’ advance directives.

Do not resuscitate (DNR) order

Insertion of an endotracheal tube (ETT) through the mouth or nose

Endotracheal intubation

normal paC02 value

35-45

if properly placed an endotrachial tube will end up 3-4 cm above the ______

corina

4 signs that a pateint can be weaned off vent

Follow Simple commands Hemodynamic stable No cardiac dysthymias Adequate muscle strength

The obligation to tell the truth

Veracity

Head and neck cancer, cant be taken off of endotracheal tube ventilator within 10-14 days are common reasons for

Tracheostomy

refers to not enough oxygen in the blood

hypoxemia

2 types of Neuromuscular blockade needed for Treatment of ARDS

Pancuronium | Vecuronium

Treatment of ARDS 3 Comfort measures

Sedation Pain relief Neuromuscular blockade (paralytic need to be intubated)

– end of life situation where patient decided they do not want to be intubated anymore and code status turns to DNR and extra opioids are given but not reintubated

Terminal weaning

deliver oxygen at 4-10 L/min (24-50% FiO2)

Venturi Mask

pH- 7.30 ↓ PaCO2- 50 ↑ PaO2-60 ↓ HCO3- 27 ↑ is an example of ________ that is _____ compensated

respiratory acidosis that is partialy compensated

The moral duty to be faithful to the commitments that one makes to others

Fidelity

A permanent, irreversible unconsciousness condition that demonstrates an absence of voluntary action or cognitive behavior, or an inability to communicate or interact purposefully with the environment.

Persistent vegetative state

Patient is physically or mentally unable to communicate a willful and knowing health care.

Incapacity or incompetent decision

soft flexable plastic inserted into nares helps facilitate suctioning and protect tissue used for potential stroke patient

Nasopharyngeal airway

Complete and irreversible cessation of brain function.

Brain death

Witnessed written document or oral statement in which instructions are given by a person to express desires related to health care decisions. The directive may include, but is not limited to, the designation of a health care surrogate, a living will, or an anatomic gift.

Advance directive

``` pH = 7.39 PaO2 = 60 mmHg HCO3 = 30 mEq/L PaCO2 = 51 mmHg ``` is an example of ________ that is _____ compensated

respiratory acidosis

every liter is __% more of FIO2

should check gastric residual every __ hours

with a Tracheostomy No more than _____ seconds for suctioning

10-15

A ________ blood gas will have a pH within the normal range and will have abnormal values for both the PaCO2 and the HCO3

fully compensated

Respect for the individual and the ability of individuals to make decisions with regard to their own health and future (the basis for the practice of informed consent)

Autonomy

for ventilator settings I:E ratio

1:2

* Noise reduction (quiet periods) * Calming music * Private areas for communication with family * Providing unrestricted visitation * Opening the curtains are all Interventions to reduce ________

Interventions to reduce sensory overload

A condition in which there is no reasonable medical probability of recovery and can be expected to cause death without treatment.

Terminal condition

Treatment of ARDS 3 Oxygenation and ventilation

- Positive end-expiratory pressure (PEEP) - Possible non-traditional modes of ventilation - Decrease Oxygen consumption

A witnessed written document or oral statement voluntarily executed by a person that expresses the person’s instructions concerning life-prolonging procedures.

Living will

complications with vents where Extended times of intubation alveoli capillary membrane is damaged and allows fluid to go into alveoli

Volutrauma

deliver oxygen at 10-15l/min (80-95% FiO2)

Nonrebreather Mask

suctiong a Tracheostomy is a _______ technique in the hospital but not in the home

sterile

``` pH= 7.31 PaCO2 = 32 mmHg PaO2 = 89 mmHg HCO3 = 20 mEq/L ``` is an example of ________ that is _____ compensated

metabolic acidosis partially compensated

Life-threatening episode of airway obstruction that may be unresponsive to common treatment.

Status Asthmaticus

3 Indications for Ventilation

Hypoxemia -PaO2 ≤ 60 mm Hg on FiO2 > .50 Hypercapnia -PCO2 ≥ 50 mm Hg with pH ≤ 7.25 Progressive deterioration - Increasing RR - Decreasing VT (tidal volume) - Increase Work of breath

6 nursing actions for Status Asthmaticus

oxygen bronchodilators Prepare for emergency intubation IV fluids epinephrine. systemic steroid therapy

Irreversible cessation of spontaneous ventilation and circulation.

Clinical death or cardiac death

5 main adverse effects of opioids

``` resp. depression constipation n&V urinanry retnetion lower bp (orthostatic hypotension) ```

The POLST form is a medical order indicating a patient’s wishes regarding treatments that are commonly used in a medical crisis. The POLST complements the advance directive; it is not intended to replace it.

Physician Orders for Life-Sustaining Treatment (POLST)

Monitors alveolar CO2-assesses trends in patient’s ventilation status Exhalation at peak May be used with any patient with a tracheostomy or ETT; patients with PCA; brain injured patients. (Or any patient where ventilation is a concern).

ETCO2 Monitoring

how to measure a oral airway

corner of lip and angle of jaw

Consent voluntarily given after a sufficient explanation and disclosure of information.

Informed consent

if you inflate PEEP too high what can happen

Can cause reduced cardiac output if high and impedes venous return

normal HCO3 value

22-26

Normal ETCO2 values: _____mm HG

30-43

deliver oxygen at 5L-12L (40-60% FiO2)

Simple Face Mask

if the PaCO2 is elevated, that means the body has more ____

acid

top 4 interventions for respiratory distress

raise head of bed supplemental oxygen suction pain/ anxiety

A competent adult designated by a person to make health care decisions should that person become incapacitated.

Surrogate

Delivers the most precise flow of oxygen and is most commonly used for copd patients

venturi mask

type of ventillator alarm that goes off if low exhaled volume (tube got disconnected)

Low pressure alarm

deliver oxygen at 6-11 (40-75% FiO2) mixture of oxyen and co2

Partial Nonrebreather Mask

two meds that are used to prevent stress ulcers with vents

famotidine or pantoprazole (prevention)

8 Early signs of poor oxygenation

``` poor oxygenation restlessness pale skin elevated blood pressure tachycardia tachypnea respiratory alkalosis symptoms of respiratory distress (use of accessory muscles, nasal flaring, adventitious lung sounds ) ```

normal O2 value

80-100

Positive end-expiratory pressure (PEEP) settings

5-20 cm H2O

Hard Plastic device to keep the tongue down and prevent occlusion of the airway only used for patients with decreased LOC

Oral airway

Oxygen toxicity can result from high concentration of oxygen (typically above ___%), long duration of oxygen therapy (typically more than __ to __ hr)

50% 24-48

Any medical procedure or treatment, including sustenance and hydration, that sustains, restores, or supplants a spontaneous vital function. Does not include the administration of medication or treatments deemed necessary to provide comfort care or to alleviate pain.

Life-prolonging procedure

Hypoxemia | -PaO2 ≤ __ mm Hg on FiO2 > ___

60 .50

Hypercapnia | -PCO2 ≥ __ mm Hg with pH ≤ ___

50 7.25

Progressive deterioration includes what 3 things

- Increasing RR - Decreasing VT (tidal volume) - Increase Work of breath