wk 3 respiratory ppt/3

Question 1

ARDS collab mgmt - medical supportive therapy

3

Answer 1

1. maintenance of CO and tissue perfusion
2. maintenance of fluid balance
3. minimize hypotension and decreased CO from mechanical ventilation and PEEP

Question 2

artificial airway indications include

5

Answer 2

1. upper airway obstruction i.e. tumor
2. apnea
3. high risk for aspiration
4. ineffective clearance of secretions
5. respiratory distress

Question 3

what would sound the low pressure alarm?

3

Answer 3

1. leak
2. tubing disconnect
3. balloon deflated

Question 4

artificial airways - what is the procedure of choice

Answer 4

oral ET intubation

Question 5

oral ET intubation - pros

2

Answer 5

1. airway can be secured rapidly

2. larger diameter tube can be used

Question 6

nasal ET intubation is indicated when

Answer 6

head and neck manipulation is risky

Question 7

artificial airway that is indicated when head and neck manipulation is risky

Answer 7

nasal ET intubation

Question 8

tracheostomy

Answer 8

surgical procedure performed when need for an artificial airway is expected to be long term

Question 9

surgical procedure performed when need for an artificial airway is expected to be long term

Answer 9

tracheostomy

Question 10

ET intubation equipment

3

Answer 10

1. self inflating BVM attached to oxygen
2. suctioning equipment
3. intravenous access

Question 11

ET intubation procedure - premedication depends on

2

Answer 11

1. pts level of consciousness

2. nature of procedure

Question 12

RSI stands for

Answer 12

rapid sequence intubation

Question 13

rapid sequence intubation RSI

Answer 13

rapid, concurrent administration of a paralytic agent and a sedative agent during emergency airway mgmt

Question 14

rapid, concurrent administration of a paralytic agent and a sedative agent during emergency airway mgmt

Answer 14

rapid sequence intubation RSI

Question 15

RSI decreases what

Answer 15

risk for aspiration, combativeness, and injury to pt

Question 16

RSI is not indicated for

Answer 16

comatose or cardiac arrest pts

Question 17

RSI - what do we do beforehand

Answer 17

preoxygenate, we don’t hyperventilate

Question 18

ET intubation procedure - before intubation

3

Answer 18

1. preoxygenate using BVM with 100% O2 for 3-5 mins
2. limit each intubation attempt to <30 s
3. ventilate pt between successive attempts using BVM with 100% O2

Question 19

ET intubation procedure - following intubation
6
-inflate
-end
-auscultate
-observe
-obtain
-secure
-obtain

Answer 19

1. inflate cuff and confirm placement of ET tube while manually ventilating pt with 100% O2
2. end-tidal CO2 detector is place between BVM and ET tube - measures exhaled CO2 from lungs
3. auscultate lung bases and apices for bilateral breath sounds
4. observe for symmetric chest wall movements
5. obtain chest x ray
6. secure ETT and connect to mechanical ventilator
7. obtain ABGs and continuously monitor pulse ox

Question 20

ET intuabtion - what should to tube typically fall on adults

Answer 20

3-5 cm above carina

Question 21

increase Vt and RR will do what

Answer 21

drop CO2

Question 22

what to parameters, if increased will drop CO2

Answer 22

Vt

RR

Question 23

decrease the Vt and RR will do what

Answer 23

help bring CO2 back up if it’s low

Question 24

what to parameters will help bring CO2 back up if it’s low and you decrease these

Answer 24

Vt and RR

Question 25

``` ET tube intubation nursing mgmt 6 -maintain -maintain -monitor -maintain -providing -fostering ```

Answer 25

1. maintain correct tube placement 2. maintain proper cuff inflation (20-25 mm Hg) 3. monitor oxygentation and ventilation 4. maintain tube patency 5. providing oral care and maintaining skin integrity 6. fostering comfort and communication

Question 26

what should ET tube cuff pressure be maintained at

Answer 26

20-25 mm Hg

Question 27

what should ET tube suction be suctioned at

Answer 27

80-120 suction, intermittent

Question 28

ET tube intubation - indications for suctioning include | 2

Answer 28

1. visible secretions in ET tube | 2. sudden onset of respiratory distress

Question 29

``` ET tube indication for suctioning - sudden onset of respiratory distress 5 -suspected -increase in -auscultation -increase in -sudden or ```

Answer 29

1. suspected aspiration of secretions 2. increase in peak airway pressures 3. auscultation of adventitious breath sounds over trachea and/or bronchi 4. increase in RR and/or sustained coughing 5. sudden or gradual decrease in PaO2 and/or SpO2

Question 30

potential complications associated with suctioning include | 8

Answer 30

1. hypoxemia 2. bronchospasm 3. increased intracranial pressure 4. dysrhythmias 5. hyper/hypotension 6. mucosal damage, bleeding 7. pain 8. infection