Cor Pulmonale and Artifical Airways

Question 1

What is cor pulmonale?

Answer 1

enlargement of right ventricle

Question 2

What is the most common cause of cor pulmonale?

Answer 2

most common cause is COPD because of airway collapse, air trapping , and still alveoli –> increased pulmonary pressure

Question 3

What are clinical manifestations of cor pulmonale?

Answer 3

1. dyspnea on exertion
2. lethargy
3. low O2
4. right sided HF signs such as JVD, peripheral edema, ascites, and hepatomegaly

Question 4

What is apnea?

Answer 4

absence of breathing

Question 5

What is dyspnea?

Answer 5

shortness of breath

Question 6

What is orthopnea?

Answer 6

difficulty breathing when supine

Question 7

What are Kussmaul breathing patterns?

Answer 7

rapid, deep breathing and is a compensatory mechanism to blow off CO2, and this is body’s response to acidosis so this is normal for these patients (DKA is an example)

Question 8

What are Biot respirations?

Answer 8

rapid, shallow breathing followed by apnea every 4-5 cycles . pattern appears normal with a sudden stop in breathing

Question 9

What does biot respirations progress into?

Answer 9

progresses to Cheyne-Stokes

Question 10

What is Cheyne-Stokes breathing pattern?

Answer 10

irregular breathing with apnea every 4-5 cycles, pattern looks like a football. can cause poor perfusion to brain stem

Question 11

What are the routes of placement for mechanical ventilation?

Answer 11

oral and nasal

Question 12

Explain nasal route of placement for mechanical ventilation?

Answer 12

1. patient must be awake and breathing
2. never used with facial/head trauma
3. placed blindly

Question 13

What is the rapid sequence that is used in emergent situations where a ventilator is needed?

Answer 13

1. sedative hypnotics such as etomidate, midazolam, and propofol - FIRST
2. paralytics (succinylcholine)
3. opioid analagesic (fentanyl)
4. positioning
5. preoxygenate

Question 14

How should nurse intervene if patient is crying in rapid sequence of ventilator set up?

Answer 14

if patient is crying, give more sedatives and then give more pain medications to relax the muscle and relieve pain

Question 15

how should the patient be positioned prior to ventilation?

Answer 15

position should be supine with head extended and neck flexed

Question 16

how should the nurse help preoxygenate the patient prior to ventilation?

Answer 16

limit each attempt to less than 30 seconds and ventilate between attempts with AMBU bag

Question 17

What is the End Tial CO2 (ETCO) monitor?

Answer 17

It is a monitor that will change from purple to yellow as it touches CO2 which indicates the tube is in the lungs, if it stays purple the tube is in the esophagus

Question 18

How can the nurse confirm the ventilation tube location?

Answer 18

Confirm tube placement with ABGs and chest x-ray

Question 19

Why is a cuff important in mechanical ventilation of a patient?

Answer 19

leave cuff inflated inside the trachea because the cuff makes sure that air is entering the lungs and not escaping through the nose and mouth.

Question 20

What are important suctioning points that a nurse should follow when taking care of a patient on mechanical ventilation?

Answer 20

1. hyperoxygenate
2. limit each attempt to 10 seconds or less
3. only suction on the way out

Question 21

How can nurse provide oral care with a mechanical ventilation patient?

Answer 21

1. change ET tube position and tape every 24 hours

2. Provide good oral care with mouth moisturizers every 2-4 hours

Question 22

How can the nurse prevent ventilator associated pneumonia from occurring?

Answer 22

1. HOB at 30-45 degree angle (semi fowlers)
2. No routine changes of circuit tubing, keep the system closed
3. ET tube with dorsal lumen above cuff to allow continuous suctioning
4. drain tubing condensate away from patient
5. always wash hands and wear gloves

Question 23

What is Vt on a ventilator?

Answer 23

tidal volume which is the amount of air delivered in one breath to the patient, this is also set on the vent

Question 24

What happens if there is a high tidal volume?

Answer 24

higher the tidal volume, higher the positive pressure in the lungs which can cause barotrauma –> pneumothorax

Question 25

What is positive end expiratory pressure? (PEEP)

Answer 25

setting that you provide on the ventilator that keeps alveoli open by putting in the amount of pressure in lungs at the end of expiration

Question 26

What is peak inspiratory pressure? (PIP)

Answer 26

measurement of pressure in the lungs at the end of inspiration and is a reading on the vent and is not a setting!

Question 27

What can peak inspiratory pressure tell the nurse?

Answer 27

tells the nurse how much pressure you are putting in the lungs and if you are causing barotrauma

Question 28

What are three different types of ventilator modes?

Answer 28

Assist control, synchronized intermittent mechanical ventilation, and pressure support ventilation

Question 29

What is the purpose of an assist control ventilator?

Answer 29

takes over full control of breathing by providing full ventilatory support, and delivers a preset RR, Vt, FiO2, or PEEP

Question 30

What is the purpose of a synchronized intermittent mechanical ventilation?

Answer 30

advance to this ventilator as patient improves and here both the patient and ventilator will do work breathing. also allows patient to take spontaneous breaths without help

Question 31

What happens as the patient improves when using a SIMV?

Answer 31

as patient improves , the number of vent breaths is reduced

Question 32

What is the purpose for a patient to be on a pressure support ventilation?

Answer 32

maintains a set airway pressure to assist patient with spontaneous breaths . also decreases the work of breathing but patient does nearly all of the work

Question 33

What is a continuous positive airway pressure?

Answer 33

Used in the same way as a PSV but can be used on a patient who is not intubated and is used with a face mask, and supports all spontaneous breaths

Question 34

Who is contraindicated to receiving a CPAP?

Answer 34

not good for COPD patients because they cannot exhale against higher airway pressure

Question 35

What is a Bi level positive airway pressure?

Answer 35

same as PSV but can be used on a patient who is not intubated, the main point is that this type of ventilation can be used with patients who have severe COPD

Question 36

How is the pressure set for a BIPAP?

Answer 36

set inspiratory pressure of 10-15 H20 and reduce expiratory pressure to 5-10 H20