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Oxygenation
| Question | Answer |
|---|---|
| severe form of acute lung injury; characterized by sudden, progressive pulmonary edema, increasing bilat lung infiltrates visible on CXR, decreased lung compliance | ARDS |
| diagnostics for ARDS | ABGs, CXR, CT scan |
| some risk factors: -aspiration (gastric secretions, drowning) -drug ingestion/overdose -hematologic (DIC, massive transfusions, CP bypass) -prolonged inhalation of high concentrations (O2, smoke, corrosive substances) | ARDS |
| some risk factors: -localized infection (bacterial, fungal, viral pneumonia) -metabolic disorders (pancreatitis, uremia) -shock (any cause) -trauma (pulmonary contusion, multiple fractures, head injury) -major surgery -fat or air embolism -sepsis | ARDS |
| S/Sx: -rapid onset of severe dyspnea, SOB -refractory hypoxemia -tachypnea, ***resp. alkalosis*** -crackles -anxiety -pale, cyanotic -decreased O2 sat, decreased BP, increased HR -confusion, change in mental status/LOC, lethargic | ARDS |
| Tx/Meds: -prone position -ventilator -->oral care, suctioning, sedation -IV fluids -vasoconstrictors -nutritional support (OG) -bronchodilators -steroids | ARDS |
| acid-base imbalance with ARDS? | resp. alkalosis |
| sedative commonly used for vent pt? (gets out of system faster; adverse effect--decreases BP) | propofol (Diprivan) |
| other sedatives used for vent pts; take longer to get out of system; can't be used with head injury pts | fentanyl, versed |
| Sx: substernal discomfort, paresthesias, dyspnea, restlessness, fatigue, malaise, progressive resp difficulty, refractory hypoxemia, alveolar atelectasis, alveolar infiltrates on x-ray | oxygen toxicity |
| prevention: use lowest effective concentrations of O2; PEEP or CPAP prevent or reverse atelectasis and allow lower oxygen percentages to be used | oxygen toxicity |
| provides patent airway, access for mechanical ventilation, facilitates removal of secretions | endotracheal intubation |
| these Sx indicate what may be needed? -apnea or bradypnea -resp distress with confusion -increased work of breathing not relieved by other interventions -confusion with need for airway protection -circulatory shock | mechanical ventilation |
| #1 thing to check immediately after intubation? other things to check as well? | capnography (CO2 detector); bilat chest rise, breath sounds (anterior and posterior bilat), CXR, tube location at teeth |
| vent placement: check ABGs when? | before vent placement, then 30-60 mins after placement |
| depth of ETT at teeth for male and female? | male 21-23 cm, female 19-21 cm |
| vent mode? delivers pre-set volumes at a pre-set rate and a pre-set flow rate; pt CANNOT generate spontaneous breaths, volumes, or flow rates in this mode; VENT DOES ALL THE WORK | control mode |
| vent mode? delivers pre-set volumes at a pre-set rate and a pre-set flow rate; pt CANNOT generate spontaneous volumes or flow rates in this mode; each pt generated resp effort over and above the set rate are delivered at the set volume and flow rate | assist/control (A/C) mode |
| vent mode? delivers pre-set # of breaths at set volume and flow rate; allows pt to generate spont. breaths/volumes/flow rates b/w the set breaths; detects a pt’s spont. breath attempt and doesn’t initiate a vent breath – prevents breath stacking | synchronized intermittent mandatory ventilation (SIMV) |
| this is NOT a specific mode, but is rather an adjunct to any of the vent modes; it is the amt of pressure remaining in the lung at the END of the exp. phase; utilized to keep otherwise collapsing lung units open while hopefully also improving oxygenation | positive end expiratory pressure (PEEP) |
| vent mode? pre-set pressure is present in circuit and lungs throughout both insp. and exp. phases of the breath; serves to keep alveoli from collapsing (better oxygenation and less WOB); very commonly used to evaluate the pts readiness for extubation | continuous positive airway pressure (CPAP) |
| FiO2 (% of O2) setting on vent? | 30-100% |
| tidal volume (lung expansion) setting on vent? | 400-800 |
| PEEP setting on vent? | 5-25 |
| rate setting on vent? | 12-20 |
| how long can an ETT be in? | 14 days (then place trach, PEG) |
| vent pressure alarm? usually d/t a leak in the circuit or tubing disconnected; attempt to quickly find the problem; bag the patient and call your RT | low pressure alarm |
| vent pressure alarm? usually caused by a blockage in the circuit (water condensation), pt biting ETT, mucus plug in the ETT; you can attempt to quickly fix the problem; bag the patient and call for your RT | high pressure alarm |
| what do you do when pt biting ETT? | sedation and/or bite block |
| vent pressure alarm? usually caused by apnea of your patient (CPAP) or disconnection of the patient from the ventilator; you can attempt to quickly fix the problem; bag the patient and call for your RT | low minute volume alarm |
| what do you do for accidental extubation? | -ensure the Ambu bag is attached to the oxygen flowmeter and it is on! -attach the face mask to the Ambu bag and after ensuring a good seal on the patient’s face; supply the patient with ventilation -bag the patient and call for your RT |
| A client diagnosed with pulm edema has a PaCO2 of 72 and an O2 sat of 84%. What method of oxygen delivery would best meet the needs of this client? Intubation and mechanical ventilation Face mask with nonrebreather O2 at 6 L/minute Venturi mask at 35% | Intubation and mechanical ventilation (resp status severely compromised, has developed signs of resp failure; when resp failure occurs, client is intubated and O2 is given via CPAP or w/mechanical ventilation with PEEP) |
| A young male client has muscular dystrophy. His PaO2 is 42 mm Hg with a FiO2 of 80%. Which of the following treatments would be least invasive and most appropriate for this client? Negative–pressure ventilator Positive–pressure ventilator CPAP Bi-PAP | Negative–pressure ventilator |
| Which finding would indicate a decrease in pressure with mechanical ventilation? Kinked tubing Increase in compliance Decrease in lung compliance Plugged airway tube | Increase in compliance (A decrease in pressure in the mechanical ventilator may be caused by an increase in compliance. Kinked tubing, decreased lung compliance, and a plugged airway tube cause an increase in peak airway pressure.) |
| a decrease in the partial pressure of oxygen in the blood | hypoxemia |
| reduced level of tissue oxygenation | hypoxia |
| Which of the following is a potential complication of a low pressure in the endotracheal cuff? Aspiration pneumonia Tracheal bleeding Tracheal ischemia Pressure necrosis | Aspiration pneumonia (Low pressure in the cuff can increase the risk for aspiration pneumonia. High cuff pressure can cause tracheal bleeding, ischemia, and pressure necrosis.) |
| hypoxemia usually leads to _____, a decrease in oxygen supply to the tissues | hypoxia |
| A patient in the process of being weaned from the ventilator will have a _____ connected to the endotracheal tube. | t-piece |
| what are five assessment findings determine oxygen toxicity? | substernal discomfort, paresthesias, dyspnea, restlessness, fatigue, malaise, progressive resp. difficulty, refractory hypoxemia, alveolar atelectasis, alveolar infiltrates on x-ray |
| what function does bilevel positive airway pressure (bi-PAP) ventilation serve for the patient? | offers independent control of inspiratory and expiratory pressures while providing pressure support ventilation; delivers two levels of positive airway pressure (via nasal or oral mask, nasal pillow, or mouthpiece w/tight seal and portable ventilator) |
| how do positive pressure ventilators work? | inflate lungs by exerting pressure on airway, pushing air in, forcing alveoli to expand during inspiration |
Created by:
nurse savage
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