A&C II Exam 1 Flashcards
(247 cards)
1
Q
What should be ruled out before diagnosing anxiety?
A
Hypoxia
2
Q
What are some causes of agitation?
A
Hypoxia, Painful procedures, Invasive tubes, Sleep deprivation, Fear, Anxiety, Stress
3
Q
What is one possible cause of agitation?
A
Hypoxia
4
Q
What can cause hypoxia?
A
Sleep deprivation, Invasive tubes, Fear, Anxiety, Stress
5
Q
What is the common medication used for sedation before paralysis?
A
Etomidate
6
Q
What is the medication used for paralysis?
A
Succinylcholine
7
Q
How long does succinylcholine typically last?
A
7 minutes
8
Q
What is the medication used for longer-lasting paralysis?
A
Rocuronium
9
Q
How long does rocuronium typically last?
A
30 minutes
10
Q
What is the medication used for even longer-lasting paralysis?
A
Vecuronium bromide
11
Q
How long does vecuronium bromide typically last?
A
1 hour
12
Q
What does ROSC stand for?
A
Return of Spontaneous Circulation
13
Q
What is a treatment often used after ROSC?
A
Therapeutic Hypothermia
14
Q
What is pulse oximetry?
A
Measurement of oxygen saturation in the blood
15
Q
Where is a pulse oximeter typically placed?
A
On a finger
16
Q
What is the maximum difference between pulse oximetry and actual SaO2?
A
3%
17
Q
How accurate can pulse oximetry be for anemic patients?
A
Down to 2-3 hemoglobins
18
Q
What substances are NOT detected by pulse oximetry?
A
Carboxyhemoglobin or methemoglobin
19
Q
In what setting are special pulse oximeters used to detect carbon monoxide?
A
EMS/Fire setting
20
Q
What can create a discrepancy between spo2 and sao2?
A
Dark fingernail polish
21
Q
How much discrepancy may individuals with darker skin experience when o2 saturation is between 70-80?
A
Up to 10%
22
Q
Is pulse ox helpful for patients experiencing carbon monoxide poisoning?
A
No
23
Q
What should you do if someone has been exposed to carbon monoxide?
A
Put them on O2 and a lot of it
24
Q
When should you give high levels of oxygen to someone with carbon monoxide exposure?
A
If they’re symptomatic and had exposure
25
What is a good site for ICU patients for pulse oximetry?
Forehead
26
Why is the forehead a good site for ICU patients?
Forehead arteries are less prone to vasoconstriction
27
How can venous congestion related to the ventilator affect forehead pulse oximetry?
Alters readings
28
How can the alteration of forehead pulse oximetry be tempered?
With an elastic band
29
What spo2 levels can generate a PaO2 of 60%?
92-95%
30
What is the normal range for PaO2?
80-100
31
What is the normal range for spo2?
93-99%
32
What is the ideal range for spo2?
96-99%
33
Why is pulse oximetry used?
To monitor oxygen levels in the body
34
What can pulse oximetry help diagnose?
Respiratory or cardiovascular problems
35
What are some common troubleshooting steps for pulse oximetry?
Check sensor placement, battery level, and patient movement
36
What can cause inaccurate pulse oximetry readings?
Sensor placement, poor circulation, or patient movement
37
What is the difference between early and late hypoxia signs and symptoms?
Not enough detail
38
What is the trachea?
Main airway in the respiratory system
39
What is the carina?
The point where the trachea splits into the left and right bronchi
40
What are the left and right bronchus?
The main branches that lead into the lungs
41
What are terminal bronchioles?
Small airways that lead to alveoli
42
How many lobes does the right lung have?
Three
43
How many lobes does the left lung have?
Two
44
How can you avoid error in documentation?
Be thorough and accurate in recording information
45
What is the gold standard for checking CO2 levels?
Gold
46
What is the first step in checking for correct placement?
End positive CO2
47
What is the second step in checking for correct placement?
Bilateral check expansion
48
What is the third step in checking for correct placement?
Equal bilateral breath sounds
49
What is the fourth step in checking for correct placement?
Intermittent misting on the ET tube
50
What is the fifth step in checking for correct placement?
Absence of breath sounds over the epigastrium
51
What is the last step in checking for correct placement?
X-ray
52
Is X-ray the gold standard for confirming tube placement?
No
53
What are the steps for checking correct placement of an ET tube?
Step 1: end positive CO2, Step 2: bilateral chest expansion, Step 3: equal bilateral breath sounds (nurse, intu, Step 4: intermittent (should be moisture that is going into the tube when they exhale –misting on the ET tube), Step 5: absence of breath sounds over the epigastrium, Step 6: X ray last
54
What are the primary entry points for air into the respiratory system?
Mouth/nose
55
What is the tube that connects the mouth/nose to the lungs?
Trachea
56
What is the branching airway structure within the lungs?
Bronchial Tree
57
What are the smaller air passages that branch off from the bronchial tree?
Bronchioles
58
Where does gas exchange occur within the respiratory system?
Alveoli
59
Which part of the respiratory system is responsible for the exchange of oxygen and carbon dioxide between the lungs and blood?
Gas Exchange
60
Ventilation
Mechanical act of moving air into and out of the respiratory tree
61
Respiration
Transport of oxygen and carbon dioxide between alveoli and pulmonary capillaries
62
Respiratory Failure
Disruption of ventilation or respiration
63
What is ventilation?
The process of moving air in and out of the lungs
64
What is respiration?
The process of exchanging oxygen and carbon dioxide in the body
65
What is respiratory failure?
When the respiratory system is unable to adequately meet the body's oxygenation needs
66
What is the role of the diaphragm in ventilation?
Contracts to create negative pressure
67
What muscles are considered accessory muscles in ventilation?
Intercostal muscles and sternocleidomastoid
68
What does increased work of breathing indicate?
Distress
69
What is compliance in terms of ventilation?
Ability of lungs to expand and contract
70
How is compliance changed in chronic lung diseases like COPD?
It is reduced
71
What is compliance?
Ability of lungs to expand and contract
72
What is dead space?
Where O2 cannot be exchanged
73
Can you increase your O2 in your mouth or trachea?
No. You need lung tissue for that.
74
What is physiological dead space?
No gas exchange occurs in this area.
75
What causes physiological dead space?
Under perfused alveoli or dead alveoli.
76
When does ventilation exceed perfusion?
When you can breathe but alveoli aren't exchanging gas.
77
What are examples of conditions that result in physiological dead space?
Pulmonary embolism or pulmonary infarct.
78
What can anatomical and physiological dead space include?
Dead alveoli and other factors.
79
What happens to physiological dead space with Emphysema?
Increases
80
What happens to physiological dead space with low cardiac output?
Increases
81
What happens to physiological dead space with overdistended alveoli?
Increases
82
What is a shunt unit?
Plenty of perfusion but not enough ventilation
83
Give two examples of conditions that can cause a shunt unit.
Pneumonia or atelectasis
84
What is atelectasis?
When the tiny air sacs within the lung become deflated or filled with alveolar fluid
85
What is a silent unit?
Impaired ventilation and perfusion
86
What are examples of conditions that can cause a silent unit?
Pneumothorax, ARDS
87
What is acute respiratory failure?
Failure to maintain adequate gas exchange.
88
How long does the onset of acute respiratory failure take?
Several hours up to several days.
89
What is the mortality rate of acute respiratory failure?
22-75%.
90
How is acute respiratory failure diagnosed?
Based on clinical presentation and ABGs.
91
What are the two types of acute respiratory failure?
Hypoxic and hypercapneic.
92
What does hypercapnic mean?
High levels of carbon dioxide in the blood
93
What is Type I hypoxemic respiratory failure?
Can't get enough O2 to tissues
94
What are the causes of Type I hypoxemic respiratory failure?
Pneumonia, pulmonary edema, acute respiratory distress syndrome, aspiration, atelectasis
95
What is the nursing diagnosis for Type I hypoxemic respiratory failure?
Impaired Gas Exchange
96
What are the signs and symptoms of Type I hypoxemic respiratory failure?
Decreased SaO2/PaO2, increased respiratory rate
97
What is the treatment for Type I hypoxemic respiratory failure?
Oxygen therapy, treat underlying cause, possible PEEP
98
What is pulmonary edema?
Fluid buildup in the lungs
99
How is pulmonary edema treated?
Give Lasix
100
What is the treatment for severe pulmonary edema?
Lasix and BiPAP
101
What are the signs and symptoms of pulmonary edema?
Chest wall expansion, poor gas exchange
102
What does ARDS stand for?
Acute Respiratory Distress Syndrome
103
What does ARDS affect?
Respiration and circulation
104
What is the problem with ventilation in ARDS?
Gas exchange is not occurring well
105
What is the problem with circulation in ARDS?
Blood is not circulating well
106
What is aspiration?
Foreign material in lungs affecting gas exchange
107
How can atelectasis be solved?
With PEEP
108
What is the cause of hypercapneic hypoxemic respiratory failure?
COPD, neurologic system failure, muscular failure, skeletal alterations
109
What is the nursing diagnosis for hypercapneic hypoxemic respiratory failure?
Ineffective Breathing Pattern
110
What are the signs and symptoms of hypercapneic hypoxemic respiratory failure?
Increased PaCO2, Decreased pH, Decreased SaO2/PaO2, RR may be increased or decreased (late vs early)
111
What is the treatment for hypercapneic hypoxemic respiratory failure?
Improve ventilation, may require mechanical ventilation, treat underlying cause
112
How well are they ventilating?
Ventilation
113
How well are they oxygenating?
Oxygenation
114
How well is this person breathing?
Respiration
115
Deep or shallow?
Breathing pattern
116
What can affect ventilation?
Respiratory rate and tidal volume
117
What can affect oxygenation?
Peep and FIO2
118
What are the ways to change CO2 levels?
tidal volume and respiratory rate
119
How is tidal volume determined?
based on ideal body weight
120
What is the recommended tidal volume per breath?
6-10mL/Kg
121
What is a typical range for tidal volume?
400-600 mL
122
What factor should be considered when determining tidal volume?
patient's height
123
Which parameter should be increased to blow off more CO2?
respiratory rate
124
What are two ways to increase oxygen?
Increase FIO2, Increase PEEP
125
What can be done to increase oxygen levels?
Increase FIO2, PEEP
126
How should PEEP be adjusted?
Alter in increments of 3
127
What are some ways to decrease CO2?
Increase ventilation, increase rate, increase tidal volume
128
What does increasing ventilation mean?
Breathe faster and deeper
129
What can decrease CO2 levels?
Increase respiratory rate and tidal volume
130
What should patients do to decrease CO2 levels?
Breathe faster and deeper
131
How can patients increase CO2 levels?
Breathe slower and more shallow or briefly hold breath
132
How can patients increase oxygen levels?
Breathe through your nose with nasal cannula
133
How can patients decrease oxygen levels?
Turn down or off oxygen
134
What are some ways to decrease something?
Remove or decrease
135
What are some ways to increase something?
Retain or increase
136
What is another word for increase?
Increase
137
What is the opposite of off?
Down
138
What is the correct abbreviation for O2 Saturation?
o2 SAT
139
What does the term 'Stat' mean?
now' or 'as soon as possible'
140
What does the term 'Stat' also stand for?
statistics'
141
Does 'Stat' represent the saturation of hemoglobin molecules with oxygen?
No
142
What is the correct term for saturation of hemoglobin molecules with oxygen?
Sat' or 'saturation'
143
What are some indications for mechanical ventilation?
Apnea with respiratory arrest, Acute lung injury, Respiratory rate > 30, Vital capacity < 15 mL/kg, Minute ventilation > 10 L/min, PaO2 with O2 <55 mmHg, COPD, Clinical deterioration
144
Who generally makes this decision?
The physician
145
What is the threshold for intubation in emergency medicine?
Less than 8
146
What are indications for mechanical ventilation?
Respiratory muscle fatigue, Tachypnea or bradypnea, ABGs with persistent hypoxemia, PCO2 >50 mmHg with pH <7.25, Neuromuscular disease, Inspiratory pressure >-20cmH20, Vital capacity <1.0 or <30% or predicted
147
What is neurogenic see-saw breathing?
Alternating contraction of the chest and abdomen muscles resulting in a see-saw pattern of breathing
148
When is mechanical ventilation indicated in trauma?
GCS less than 8
149
What is the purpose of mechanical ventilation?
To support life when breathing on their own is insufficient
150
What does ABGS stand for?
Arterial Blood Gas Analysis
151
Where can table 3-1 be found?
Page 56 of the assigned Perrin text
152
What does Allen's Test involve?
Assessing the patency of the radial and ulnar arteries
153
What is the ALLEN test?
A test used to assess the blood supply to the hand
154
When should the ALLEN test be done?
Always
155
What diagnosis can you likely provide based on pco2 >50 and ph <7.25?
Respiratory acidosis
156
What do you think about respiratory muscle fatigue and ABGs?
Respiratory muscle fatigue can affect ABG values
157
Are our patients getting tired?
Consider the fatigue levels of our patients
158
Would you be too tired to walk after you ran 10 miles?
Consider the impact of exercise on fatigue levels
159
Would you be too tired to breathe if you breathed at 4x your normal respirations for 3 days?
Consider the impact of increased respiratory effort on fatigue levels
160
Why improve ventilation?
Relief of symptoms of respiratory distress
161
What should you not do with a patient's GCS less than 8?
Put them on a BiPAP
162
What is non-aggressive airway management?
Airway management without invasive techniques
163
What is high flow oxygen therapy?
Oxygen therapy at a flow rate higher than the patient's inspiratory flow rate
164
What are some examples of high flow oxygen delivery devices?
Wide nasal cannula, nasal pillow, facemask
165
How does high flow oxygen therapy help immobilize secretions?
Provides heated and humidified air to the upper airways
166
What is CPAP?
Continuous Positive Airway Pressure
167
What is BiPAP?
Bilevel Positive Airway Pressure
168
What is the difference between CPAP and BiPAP?
CPAP delivers a constant pressure, while BiPAP delivers different pressures for inhalation and exhalation.
169
What is C PAP?
Continuous pressure
170
What is Bipap?
Continuous pressure with extra pressure during inspiration
171
What are the contraindications for using Cpap/BiPap?
GCS <8
172
What do adults tend to use for Cpap/BiPap?
nose/mouth covering devices
173
What are the benefits of using Cpap/BiPap?
Increase patient comfort, Decrease work of breathing
174
Who can benefit from using Cpap/BiPap?
patients with COPD AND CHF
175
What should be closely monitored for when using Cpap/BiPap?
hypotension-decreases preload and afterload, cardiac output
176
Is it okay if the patient falls asleep while using Cpap/BiPap?
Yes, sleep is okay
177
What should be avoided while using Cpap/BiPap?
active vomiting
178
What is the effect of cpap and bipap on cardiac output?
Decreases cardiac output
179
How does cpap or bipap affect heart rate and blood pressure?
Heart rate and blood pressure will drop
180
When should cpap or bipap not be used?
When someone is actively vomiting
181
What are CPAP and BIPAP?
Continuous Positive Airway Pressure (CPAP) and Bi-level Positive Airway Pressure (BIPAP)
182
What do CPAP and BIPAP stand for?
Continuous Positive Airway Pressure (CPAP) and Bi-level Positive Airway Pressure (BIPAP)
183
What are some examples of artificial airways?
Pharyngeal airways, endotracheal intubation, Laryngeal mask airway (LMA), Tracheostomy
184
What is the purpose of an artificial airway?
To provide a way for air to enter and exit the lungs when a person is unable to breathe on their own
185
What is the technique used to insert a tube into the trachea?
Endotracheal intubation
186
What is the most advanced airway?
ET tube
187
What is airway management?
Management of the upper airway
188
What is the purpose of pharyngeal airways?
Preventing tongue obstruction
189
What is the top type of pharyngeal airway?
Oropharyngeal airway
190
What is the bottom type of pharyngeal airway?
Nasopharyngeal airway
191
What is the recommended way to measure the length from the corner of the mouth to the end of the ear in an awake or responsive patient?
Never go into the patient's mouth.
192
(OPA) Oropharangeal Airway
What does OPA stand for?
193
What is contraindicated for having a GAG reflex?
Mouth!
194
What is contraindicated for being alert?
Mouth!
195
What is a Nasopharyngeal Mask NPA?
Soft plastic/rubber
196
Can a Nasopharyngeal Mask NPA be used with a gag reflex?
Yes
197
Can a Nasopharyngeal Mask NPA be used if the person is conscious?
Yes
198
How should the Nasopharyngeal Mask NPA be inserted?
Slide the lubricated tip through the nares toward the posterior pharynx
199
What size should be chosen for the Nasopharyngeal Mask NPA?
Smaller than the nare
200
When can anesthesia be used?
On an awake patient
201
What is a laryngeal mask airway (LMA)?
A device used for airway management
202
What should you do with the bulb of the LMA?
Deflate it
203
Should you lubricate the device or the patient's airway?
The device
204
What should you do to the tongue when using an LMA?
Displace it
205
How should you follow the curve of the airway with the LMA?
Follow it
206
How much air should you inflate the LMA with?
Usually 30+ ml air
207
What should you do after inflating the LMA?
Ventilate and confirm CO2 waveform or 'gold is good'
208
What is endotracheal intubation?
Inserting a tube into the trachea to maintain an open airway
209
What is the preferred and most common method of endotracheal intubation?
Oral endotracheal tube
210
What is the alternative method of endotracheal intubation?
Nasal endotracheal tube
211
What does ETT stand for?
Endotracheal tube
212
What is the first step in airway management with ETT?
Preoxygenate/Hyperoxygenate
213
What should be monitored and documented during intubation?
Oxygenation status and cardiac status
214
What does NADIR stand for?
Lowest SPO2 during intubation
215
When should sedatives be administered?
In the presence of a provider capable of intubation
216
When should the paralytic be given?
When the provider capable of intubation is ready and after sedation
217
How should the successful placement of the tube be documented?
In the chart with the size, depth, and confirmation methods
218
What is the purpose of pre-oxygenating the patient?
To ensure adequate oxygenation before a procedure.
219
What are the 6 methods of ETT confirmation?
Positive end tidal CO2, equal rise and fall of the chest, equal bilateral breath sounds, absence of breath sounds over the epigastrum, intermittent misting of tube, chest x-ray
220
What is the desired range for end tidal CO2?
35-45
221
What is the preferred method for ETT confirmation?
Positive end tidal CO2
222
What device is commonly used for ETT confirmation?
Gold-is-good device
223
What are two additional methods of ETT confirmation?
Chest x-ray and intermittent misting of tube
224
Why is a chest x-ray preferred for ETT confirmation?
Provides a definitive confirmation
225
How was the patient pre-oxygenated?
15LPM via nasal cannula
226
What was the patient's O2 saturation before intubation?
99%
227
What was the size of the endotracheal tube (ETT)?
7.5
228
Where was the ETT placed?
23cm at the teeth
229
How was the ETT placement confirmed?
Waveform capnography
230
What was the range of waveform capnography maintained?
35-45
231
What were the signs of correct ETT placement?
Equal rise and fall of the chest, equal bilateral breath sounds
232
Who confirmed the ETT placement?
Danielle, RN and Jimmy, RT
233
What is in progress for further confirmations?
Xray
234
What should you do with your medications?
Document on the MAR
235
How long should sedatives be given before paralytics?
Around 60 seconds
236
What should you always document?
NADIR
237
What should you document regarding intubation?
How long it took
238
What should you document regarding teeth?
Measurement of tooth location (use gums if no teeth)
239
What should you measure when maintaining an endotracheal tube?
Depth, cuff pressure, patient secretions
240
What device can be used to measure cuff pressure?
Cuffalator
241
What does the color green indicate?
Go
242
What does the color red indicate?
Stop
243
What should you do to stay safe?
Stay in the green zone!
244
What can happen if you are in the red zone?
Tracheal necrosis
245
Why does elevating the HOB help prevent aspiration while ventilated?
Prevents gastric contents from flowing back into the lungs
246
What temperature helps prevent vap?
at least 30 degrees
247
What does heating to at least 30 degrees help prevent?
vap
