wards Flashcards

1
Q

When to do home oxygen assessment

A

72 hrs prior to discharge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Funding for oxygen at rest

A

Pt rested for min 10 minutes on RA and shows ABG PaO2 < 55mmHg OR if they have CHF or pulm HTN + PaO2 < 60mmHg OR if palliative or cannot do ABG, shows SpO2 < 88% for 6 mins continuously

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Funding for oxygen with ambulation

A

SpO2 < 88% for > 1 minute on RA during 6 minute walk test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Funding for nocturnal home O2

A

OSA must be absent or maximally treated, SpO2 < 88% for >30% of 4hr night sleep OR if CHF or pulm HTN, for >20% of night.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

indications tracheostomy suctioning

A

(open in wards)

  • coarse br/s or decreased br/s
  • desat/compromised oxygenation
  • unable to clear secretions on their own with cough
  • seeing secretions at end of T-piece or trach tube
  • changing inner cannula
  • assessing patency of the tube
  • resp distress
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

complications of trach suctioning

A
  • bleeding/hemorrhage
  • vomiting
  • bronchospasm
  • infection
  • hyper or hypotension
  • resp arrest
  • increased ICP
  • hypoxemia
  • dysrhythmias/bradycardia
  • mechanical trauma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

safety equipment for tracheostomies

A

(must be at bedside AND transport)

  • trach emergency equip bag: syringe, scissors, dilator, lube, 5 cuffed proximal XLT
  • spare inner cannula
  • obturator
  • resusc bag and mask
  • OPA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

codes

A

Full: do everything
DNR-5: everything including intubation but no compression
DNR-4: everything but no intubation or compression
DNR-3: everything but no intubation, compression or BiPAP
DNR-1: palliative
**dont do ABGs on DNR-3s bc you can use other oxygenation parameters (e.g. venous samples)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

PvO2

A

35-40mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

PvCO2

A

40-50mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

indications for deep suctioning

A
  • unable to clear secretions
  • less invasive methods do not work
  • retained secretions compromising Pt resp status (increased WOB & O2 requirements)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

deep suctioning complications

A
  • mechanical trauma
  • mucosal hemorrhage
  • hyper/hypotension
  • bradycardia
  • resp distress
  • hypoxemia
  • atelectasis
  • infection
  • increased ICP
  • vomit/gag
  • dysrhythmia
  • laryngospasm
  • bronchospasm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

deep suctioning contraindications

A
  • INR >1.3 or PTT < 50,000
  • epiglottitis, croup
  • bleeding around mouth/nares
  • laryngospasm
  • irritable airway
  • gastric surgery with high anastomosis
  • head/neck/facial injury (basal skull fracture, battle signs, raccoon eyes)
  • occluded nasal passages
  • loose teeth
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

heliox indications

A

low density gas, short term support to reduce airway resistance and WOB in Pts with airway narrowing secondary to inflammation, bronchoconstriction, or partial mechanical obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what is the lowest helium mixture possible and why

A

below 50% helium, no benefit due to inadequate difference in density compared to conventional gas mixture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

when should intubation/alternative therapy be considered for a Pt on Heliox

A

if they need NP > 6LPM

17
Q

determine flowrate to set on the oxygen flowmeter for heliox cylinder

A

80: 20 desired flow = 1.8 x (flowmeter reading)
70: 30 desired flow = 1.6 x flowmeter
60: 40 = 1.4 x flowmeter

18
Q

calculate tank duration using heliox

A

[(tank - safety (500 = E, 300 = H)) x conversion(3.14 H, 0.28 E)] / flow x heliox conversion

19
Q

compare procedure for heliox if SpO2 >92% vs. if SpO2 <92%

A

SpO2 > 92% = no supplemental O2 needed, attach NRB to heliox and flowrate of 8-10LPM, auscultate and note SpO2 pre-therapy.
SpO2 < 92% = use NP 1-6LPM to maintain sats and place NRB attached to heliox on top

20
Q

CSA vs. OSA

A
CSA = central sleep apnea; apnea/no airflow for 10 seconds AND no effort; AHI >5
OSA = obstructive sleep apnea; apnea/reduced airflow for 10 seconds WITH resp effort; AHI<5 = mild, AHI >15 = moderate, AHI >30 = severe
21
Q

Level 1 vs. Level 3 sleep study

A

Level 1 = can tell if you are actually sleeping or are awake; additionally monitors chin movement/tension, leg movement, eye movement + what L3 monitors; best Dx for CSA and other complex SDB
Level 3 = monitors body position, effort, airflow, RR, SpO2, HR and helps distinguish between CSA and OSA

22
Q

OSA diagnosis

A

1)sleepiness/daytime fatigue OR 2 of: choking/gasping, impaired concentration, daytime fatigue, unrefreshing sleep, recurrent awakening
and
2) sleep study AHI>5

23
Q

MAP formula

A

(2xdiastolic + systolic) / 3

24
Q

ABMP normal asleep dip

A

BP should normally drop >15% when asleep; if not, could be hypertension