Unit 2 Outline Flashcards
What is the nurse’s role in maintaining ventricular-assistive devices (VADs)?
The nurse’s role includes patient assessment, device monitoring, patient education, maintenance of equipment, emergency preparedness, documentation, collaboration, and psychosocial support.
What is Acute Coronary Syndrome (ACS)?
ACS is an umbrella term for conditions associated with sudden, reduced blood flow to the heart, primarily caused by coronary artery disease.
What are the characteristics of Acute Coronary Syndrome (ACS)?
Includes unstable angina, NSTEMI, and STEMI. Symptoms include chest pain, shortness of breath, sweating, nausea, and lightheadedness.
What is Myocardial Infarction (MI)?
MI is a type of ACS that refers to the death of heart muscle tissue due to prolonged ischemia.
What are the symptoms of Myocardial Infarction (MI)?
Symptoms are similar to ACS but often more severe and persistent, including ‘crushing’ chest pain.
What is Heart Failure (HF)?
HF is a chronic condition where the heart cannot pump sufficiently to maintain blood flow to meet the body’s needs.
What are the types of Heart Failure (HF)?
Types include systolic heart failure (HFrEF) and diastolic heart failure (HFpEF).
What is Acute Respiratory Distress Syndrome (ARDS)?
ARDS is an acute inflammatory response in the lungs leading to increased permeability of the alveolar-capillary membrane, resulting in pulmonary edema and respiratory failure.
What are the clinical features of ARDS?
Symptoms include sudden onset of dyspnea, tachypnea, and hypoxemia, with physical examination showing use of accessory muscles for breathing and cyanosis.
What are the diagnostic criteria for ARDS?
The Berlin Definition categorizes ARDS based on the degree of hypoxemia: mild, moderate, and severe.
What is the interpretation process for arterial blood gas (ABG) results?
Interpretation involves assessing pH, analyzing PaCO2, evaluating HCO3-, and checking PaO2 and SaO2.
What are common nursing problems for clients on mechanical ventilation?
Common problems include impaired gas exchange, risk of ventilator-associated pneumonia, sedation and anxiety, barotrauma, infection, immobility, nutritional deficiencies, and psychosocial issues.
What are the characteristics of a Nasal Cannula?
A lightweight device delivering 1 to 6 L/min, providing 24% to 44% oxygen concentration. It’s comfortable and allows for oral communication.
What are the characteristics of a Simple Face Mask?
Covers the nose and mouth, delivering 5 to 10 L/min with 40% to 60% oxygen concentration. It can be uncomfortable for long-term use.
What is a Venturi Mask?
A mask with interchangeable adapters for precise oxygen control, delivering 24% to 50% oxygen concentration at 4 to 15 L/min.
What is a Non-Rebreather Mask (NRB)?
A mask with a reservoir bag and one-way valves that prevent exhaled air from entering the bag, providing high concentrations of oxygen.
What is the oxygen flow rate for a Non-Rebreather Mask (NRB)?
Delivers high concentrations of oxygen, typically > 90% when properly fitted and used at a flow rate of 10 to 15 L/min.
What are the indications for using a Non-Rebreather Mask (NRB)?
Used for patients with severe hypoxemia or respiratory distress, such as in cases of pneumonia or acute respiratory failure.
What are the advantages of using a Non-Rebreather Mask (NRB)?
Provides a high concentration of oxygen, useful in emergencies.
What are the disadvantages of using a Non-Rebreather Mask (NRB)?
Can be uncomfortable; prolonged use may lead to CO2 retention if not monitored.
What is the description of a High-Flow Nasal Cannula (HFNC)?
A specialized nasal cannula system that delivers heated and humidified oxygen at high flow rates.
What is the oxygen flow rate for a High-Flow Nasal Cannula (HFNC)?
Delivers up to 60 L/min, providing accurate and adjustable oxygen concentrations (21% to 100%).
What are the indications for using a High-Flow Nasal Cannula (HFNC)?
Used for patients with moderate to severe respiratory distress, especially in conditions like pneumonia, asthma exacerbations, or post-extubation.
What are the advantages of using a High-Flow Nasal Cannula (HFNC)?
Enhances comfort, provides humidification, and can improve oxygenation without the need for invasive ventilation.
What are the disadvantages of using a High-Flow Nasal Cannula (HFNC)?
Requires careful monitoring; not universally available in all settings.
What is the description of a Tracheostomy Collar?
A device that fits over a tracheostomy tube, delivering oxygen directly to the airway.
What are the indications for using a Tracheostomy Collar?
Used for patients with tracheostomy needing supplemental oxygen.
What are the advantages of using a Tracheostomy Collar?
Allows for oxygen delivery while maintaining airway patency.
What are the disadvantages of using a Tracheostomy Collar?
Requires careful monitoring to ensure proper fit and function.
What is the nurse’s role in titrating critical drips?
Conduct a thorough assessment of the patient’s baseline vital signs, laboratory values, and clinical status before initiating any critical drip.
What should a nurse continuously monitor when titrating critical drips?
Regularly monitor vital signs (heart rate, blood pressure, respiratory rate, oxygen saturation) and other relevant parameters.
What is the treatment for Sinus Bradycardia?
Asymptomatic: Monitor and evaluate for underlying causes. Symptomatic: Administer atropine (0.5 mg IV every 3-5 minutes, up to 3 mg total) or consider transcutaneous pacing if unstable.
What is the treatment for Ventricular Fibrillation (VFib)?
Start CPR and defibrillation (shock) as soon as possible. Administer epinephrine (1 mg IV every 3-5 minutes) after the second shock.
What is the normal range for Hemoglobin (Hgb)?
12-16 g/dL (women), 14-18 g/dL (men).
What does a low White Blood Cell Count (WBC) indicate?
Leukopenia (increased risk of infection).
What is the normal range for Sodium (Na+)?
135-145 mEq/L.
What is the nurse’s role in the ventilator care bundle?
Maintain the patient’s head of bed elevation at 30-45 degrees to reduce the risk of aspiration.
What is the purpose of daily sedation vacations in ventilator care?
To evaluate the patient’s readiness for extubation and adjust sedation protocols based on patient responses.
What should a nurse monitor for in patients receiving anticoagulants?
Monitor patients closely to ensure therapeutic levels are maintained.
What is the purpose of regular interdisciplinary rounds in patient care?
Regular interdisciplinary rounds facilitate communication and adherence to the care bundle.
How can patient and family engagement improve care?
Educating patients and their families about the ventilator care bundle and involving them in the care process can enhance adherence to protocols and improve patient comfort.
What is Continuous Quality Improvement (CQI) in healthcare?
CQI involves reviewing cases of VAP, identifying contributing factors, and implementing corrective actions to foster a culture of safety and continuous improvement.
What are vital signs?
Vital signs include heart rate, blood pressure, respiratory rate, temperature, and oxygen saturation, providing essential information about a patient’s physiological status.
Why is monitoring vital signs important during medication titration?
Monitoring vital signs is crucial for detecting changes in patient condition, guiding medication adjustments, and ensuring patient safety.
What is the nurse’s role in baseline assessment of vital signs?
Nurses establish baseline vital signs prior to medication therapy and document them accurately in the patient’s medical record.
How often should vital signs be monitored during medication titration?
The frequency of vital sign checks should be based on the patient’s condition, the medication being titrated, and institutional protocols.
What is telemetry monitoring?
Telemetry monitoring is used for patients on continuous cardiac medications to monitor heart rate and rhythm continuously.
How should nurses interpret vital signs?
Nurses should analyze vital sign trends and understand normal ranges, which may vary based on age, comorbidities, and specific patient populations.
What are titration protocols?
Titration protocols involve following established guidelines for adjusting medication doses based on vital sign thresholds.
How can nurses educate patients about vital sign monitoring?
Nurses should inform patients about the importance of vital sign monitoring, potential side effects, and what symptoms to report.
What is the importance of documentation and reporting in vital sign monitoring?
Accurate record-keeping and prompt reporting of concerning changes in vital signs facilitate effective communication among the healthcare team.
What should nurses do in case of critical changes in vital signs?
Nurses should recognize critical changes that may indicate adverse reactions and know the institution’s emergency protocols to initiate appropriate interventions.
