Exam II Flashcards
Airway, ABGs, ARDS, Renal Disease, DKA (104 cards)
1
Q
Nasal Cannula delivers between __ and __% or __ and __ fiO2 oxygen
A
24-44% (0.24-0.44)
2
Q
Nasal Cannula Flow meter rate __ to __ per min unless high flow
A
1-6L
3
Q
Nasal Cannula 1L/min increases oxygen by approximately __ to __ %
A
3-4%
Room air 21% so 1L = 24%, 2L = 28%, 3L = 32%
4
Q
Nasal Cannula High Flow delivers __ to __ % or __ to __ L/min oxygen
A
60-90% (0.60-.090 fio2) or 15-40L/min oxygen
5
Q
Simple face mask delivers between __ and __ % or __ and __ fiO2
A
30-60% oxygen or 0.30-0.60 fiO2
6
Q
Simple face mask flow meter rate __ to __ L/min
A
5-12 L/min
7
Q
Non-rebreather mask meter flow rate __ L/min
A
15L/min (to the top)
8
Q
Non-rebreather mask delivers __ to __% or __ to __ fiO2
A
60-80% or 0.60-0.80 fiO2
9
Q
Non-rebreather mask reservoir bag allows __________
A
Inspiration O2 flows into mask and bag
One-way valves on expiration - ensuring
highest O2 delivery
10
Q
Room air provides __% or __ fiO2
A
21% or 0.21 fiO2
11
Q
fiO2
A
Fraction of Delivered Oxygen
12
Q
Bag Valve Mask AKA ____________ or __________
A
Ambu-bag or BVM system
13
Q
Bag Valve Mask provides __L/min or __% O2
A
15L/min or 100% O2 (1.00 fiO2)
14
Q
ET tube cuff should be inflated to __ to __ cm H2O
A
25-30cm H2O
If pressure if off, call RT
15
Q
CXR for ETT should show tip at __ to __ cm above the ______ for adults
A
3-4cm above the carina for adults
16
Q
Tidal Volume (VT)
A
Amount of gas to be delivered with each breath
6-8 ml/kg based upon IDEAL body weight
Example: 70 kg patient should receive between
420 to 560ml
17
Q
Physiologic PEEP is __ to __ cm H2O
Vent settings range from __ to __ cm H20
A
PEEP - 3 to 5
Vent - 5 to 20
18
Q
Normal pH of blood
A
7.35 - 7.45
19
Q
PCO2 (PaCO2) correlates with __________
A
Respiratory function
20
Q
Normal PCO2 (PaCO2)
A
35-45 mmHg
21
Q
High PCO2 (PaCO2) is correlated with __________
A
Respiratory acidosis
22
Q
Low PCO2 (PaCO2) is correlated with __________
A
Respiratory alkalosis
23
Q
HCO3 is associated with __________
A
Metabolic function
24
Q
High HCO3 indicates __________
A
Metabolic alkalosis
25
Low HCO3 indicates __________
Metabolic acidosis
26
Low pH
High PCO2
High HCO3
Compensated Resp. Acidosis
27
High pH
Low PCO2
Low HCO3
Compensated Resp. Alkalosis
28
Low pH
Low PCO2
Low HCO3
Compensated Meta. Acidosis
29
High pH
High PCO2
High HCO3
Compensated Meta. Alkalosis
30
Normal HCO3 levels
22-26 mEq/L
31
```
Interpret the following ABG:
pH - 7.60
CO2 - 36
HCO3 - 45
PaO2 - 87
```
Metabolic alkalosis
32
```
Interpret the following ABG:
pH - 7.14
CO2 - 45
HCO3 - 18
PaO2 - 80
```
Metabolic acidosis
33
```
Interpret the following ABG:
pH - 7.78
CO2 - 44
HCO3 - 60
PaO2 - 90
```
Metabolic alkalosis
34
```
Interpret the following ABG:
pH- 7.08
CO2 - 56
HCO3 - 26
PaO2 - 60
```
Respiratory acidosis
35
Which Acid-Base imbalance do you suspect from the following scenario?
The patient is a 34 year old construction worker who has been having increased NV and severe abdominal pain. He has a CT scan of the abdomen that reveals a gastric obstruction. You have orders to place an NG Tube. He is placed on continuous high suction and now he feels light headed and is having numbness in his face and hands.
Metabolic alkalosis
36
What additional assessment findings do you anticipate for the patient in metabolic alkalosis?
Restlessness
NVD
Lethargy
Confusion
37
Which Acid-Base imbalance do you suspect from the following scenario?
Your patient is a 27 year old female who has recently been on a very strict diet and exercise plan. She is complaining of severe headache, is breathing at 30bpm and has an increased HR.
Metabolic acidosis
38
Which Acid-Base imbalance do you suspect from the following scenario?
Your patient is a 17 year old female who was brought in by EMS unconscious, she has track marks on her arms and legs and appears homeless.
Respiratory acidosis
39
Which Acid-Base imbalance do you suspect from the following scenario?
Your patient is a 24 year old nursing student who has not started to study for the final exam. She presents to the ED with her clinical faculty and is short of breath, breathing rapidly and shallow.
Respiratory alkalosis
40
```
Here is the ABG for a 75yo male. Interpret the results:
PaO2 - 78 mm Hg on room air
pH - 7.11
PaCO2 - 56 mm Hg
HCO3 - 28 mEq/L
```
Partially compensated respiratory acidosis
41
```
Interpret the following ABG:
pH - 7.50
CO2 - 35
HCO3 - 34
PaO2 - 82
```
Metabolic alkalosis
42
```
Interpret the following ABG:
pH - 7.22
CO2 - 60
HCO3 - 34
PaO2 - 60
```
Partially compensated respiratory acidosis with hypoxemia
43
```
Interpret the following ABG:
pH - 7.28
CO2 - 30
HCO3 - 18
PaO2 - 80
```
Partially compensated metabolic acidosis
44
```
Interpret the following ABG:
pH - 7.42
CO2 - 49
HCO3 - 34
PaO2 - 88
```
Compensated metabolic alkalosis
45
Define: PaCO2
The pressure of tension exerted by dissolved CO2 gas in the blood, influenced only
by the lungs
46
Define: CO2
CO2 gas is an acid, which is excreted from the body by the kidneys and respiration.
There is a direct relationship between ventilation and excretion of CO2. If the PaCO2 is low, (Alkaline) the lungs are hyperventilating. If the PaCO2 is high, (acidosis) The lungs are hypoventilating
47
Define: HCO3 and base excess
Bicarbonate and Base excess are influenced only by metabolic processes, (ie: DKA, Uremia) not by respiratory causes. Positive values indicate metabolic alkalosis, and negative values indicate metabolic acidosis.
48
Normal PaO2 level
80-100
49
What is an OPA?
Oropharyngeal Airway
50
How do you measure an OPA for a Pt?
Measure from the mouth to the earlobe
51
What are the (3) indications for mechanical ventilation?
1. Support oxygen
2. Support CO2 clearance
3. Reduce work of breathing
52
Who has chronically high and compensated CO2?
Those with COPD and asthma
53
What is PEEP?
Positive end-expiratory pressure
- Used if FiO2 is over 50% on a ventilator
- Keeps pressure in the lungs (improves gas exchange by keeping alveoli open)
54
Nursing assessment of Pt with ETT?
- Monitor ventilation with BVM (equal bilateral chest rise/fall)
- Assess oxygenation by SPO2
- Suction when necessary
- Watch the clock with intubation attempts (less than 30 sec)
- Identify cm mark at Pt's lip and document (compare to previous measures, call provider and RT if tube moved)
- Document size of ETT
- ABG, if needed
55
Preliminary assessment for all ETT?
- Observe chest for symmetrical rise and fall
- Auscultate lungs bilaterally
- Auscultate over the stomach
- CO2 detector
56
Actions following ETT placement (after assessment)
- VENTILATE
- Secure the tube and identify 'cm' placement
- Call RT (so they can inflate cuff)
57
Capnography
Measures CO2
```
A-B: end inhalation
B-C: early exhalation
C-D: exhalation
D: END EXHALATION (CO2 stat, 35-45)
D-E: Inhalation
```
58
CO2 detector
Confirms proper placement of ETT (yellow means yes, purple means problem)
59
How do you assess a ventilator?
1. How is the breath delivered? (delivered by pressure or volume)
2. What is the rate of delivery? (controlled rate, spontaneous rate, or combo)
60
Ventilator: Pressure or volume?
Breath is delivered by set pressure or set volume
61
Ventilator: Controlled, spontaneous, or combo
Controlled: set RR per minute
Spontaneous: Triggered by patient attempt to breathe
Combo: Triggered by patient but will deliver breath after set time of apnea (may be AC: Assist/Control ventilation)
62
Ventilator: exhalation
Most ventilators are positive pressure with passive exhalation
63
I:E ratio
1:2 (longer for COPD or asthma patients)
64
What is the normal physiological PEEP range?
3-5 cm H2O
65
Range for vent PEEP
5-20 cm H2O
66
Monitor ___________, ____________, and __________ when Pt is on a vent
EV (exhaled tidal volume), PIP (Peak Inspiratory Pressure), and total expiratory rate
67
What are the (3) waves to monitor on the vent?
1. Pressure
2. Flow
3. Volume (Vt)
68
SIMV (synchronized intermittent mandatory ventilation)
- Preset RR (f) and tidal volume (Vt)
- Vt of spontaneous breaths vary (machine allows Pt to complete WOB)
- Good mode for weaning off vent
69
CPAP (continuous positive airway pressure) invasive or noninvasive
Creates PEEP
70
Vent: Low Pressure Alarm
- Check all connections
- Check ET placement
- Check cuff pressure
- Is the vent functioning?
- Is there a leak in the system? (call RT)
71
Vent: High Pressure Alarm
- Is the patient biting the ETT?
- Does Pt need suction?
- Is Pt coughing or gagging?
- Is Pt having bronchospasm?
- Sudden change in Pt? Lung sounds?
- Did the equipment fail?
72
How long on mechanical vent before considering trach? (may be different now due to COVID)
3 days
73
VAP bundle
- Elevate HOB to 30-45 degrees
- Daily awakening
- Prophylaxis for DVT
- Prophylaxis for PUD
- Daily oral care
74
DO NOT INSTILL __________ into ETT
Normal Saline
75
Initial Sx of AKI
Decreased urine output
76
Azotemia
High BUN and Cr
77
Minimum urine output per hour ____ mL
30 mL
78
Most common cause of AKI in hospitalized patients?
Contrast Induced
79
Pre-renal AKI
- Prolonged Hypotension
- Prolonged low cardiac output
- Prolonged volume depletion
- Reno-vascular thrombosis
80
Intra-renal AKI
- Kidney ischemia
- Endogenous toxins
- Exogenous toxins
- Infection
81
Post-renal AKI
Obstruction
82
Ways to prevent AKI
- Avoid Nephrotoxins
- -- Use isoosmolar radiocontrast media & limit contrast volume to <100 mL.
- -- Use antibiotics cautiously with appropriate dose modification
- -- Stop certain medications (NSAIDs, ACE inhibitors, ARBs)
- Optimize Volume Status Before Surgery or Invasive Procedures
- -- Aim for urinary output >40 mL/hr
- -- Hydrate with normal saline before and after procedures requiring radiocontrast media.
- Reduce Incidence of Nosocomial Infections
- -- WTF? (Why The Foley) Remove indwelling urinary catheters when no longer needed
- -- Use strict aseptic technique with all intravenous lines.
- Implement Tight Glycemic Control in the Critically Ill
83
BUN: Creatinine ratio
- Normal 10:1 to 20:1
- More than 20:1, suspect nonrenal causes of laboratory
abnormalities
84
Normal GFR
Normal 84 to 138 mL/min
85
Leading causes of CKD
- Diabetes—50%
- Hypertension—25%
- Other: glomerulonephritis, cystic diseases, urologic diseases
86
Why does CKD contribute to chronic anemia?
Kidneys create erythropoietin
87
What to teach patient with CKD
- Check weight daily and report a gain of greater than 4 pounds
- Medications that may affect renal function
- Access to care and natural supports
- Dialysis
- Kidney transplant
88
CLABSI
Central Line Associated Blood Stream Infection
89
Intermittent hemodialysis - Nursing Care Notes
- Very effective, done bedside in ICU over 3 to 4 hours
- Weight patient daily
- Monitor labs
- Do not give water soluble meds before treatment, hold anti-hypertensives, do not give 6 hours before treatment
- Assess access frequently
90
Intermittent hemodialysis - Complications
- Hypotension
- -- Preexisting hypovolemia
- -- Rapid fluid removal, too much removed
- Dysrhythmias due to rapid shift in K+
- Potential for decrease in arterial oxygen
- Dialysis disequilibrium syndrome
91
Who may need immediate hemodialysis on an acute basis?
- Acute overdoses
- Severe Edema (acute decompensated HF)
- Hepatic Coma
- Severe Metabolic Acidosis
- Burns
- Transfusion Reactions
- Rhabdomyolysis
92
CRRT
Continuous Renal Replacement Therapy
93
SCUF
Slow Continuous Ultrafiltration
| - goal is fluid removal – no waste removal, no replacement fluid
94
CVVH
Continuous Venovenous Hemofiltration
| - Fluid and some waste product removal – some replacement fluid is used to increase flow
95
CVVHD
Continuous Venovenous hemodialysis
| - Some fluid and Max waste product removal
96
CVVHDF
Continuous Venovenous Hemodiafiltration
| - Max Fluid and Waste product removal
97
What kind of patients need low and slow hemodialysis?
- Severe HF with cardiomyopathy (severe fluid overload)
- Increased ICP
- Post resuscitation/Targeted Temp Management
- AKI secondary to liver failure
- Late presenting AKI
- Still “controversial” Sepsis and MODS (try it and see if it works but may not be able to resuscitate back)
98
If a patient is in the diuretic phase of AKI, the nurse must monitor for which serum electrolyte imbalances?
a. Hyperkalemia and hyponatremia
b. Hyperkalemia and hypernatremia
c. Hypokalemia and hyponatremia
d. Hypokalemia and hypernatremia
c. Hypokalemia and hyponatremia
99
____________ is caused by a profound deficiency of insulin
DKA (Diabetic Ketoacidosis)
100
The 3 P's of DKA
Polydipsia
Polyuria
Polyphagia
101
Sx of DKA
- Classic signs of dehydration
- Orthostasis
- Polyuria
- Polydipsia
- Polyphagia
- Hyperventilation/kussmaul’s respirations
- Fruity odor to breath
- Flushed/dry skin
- Lethargy/altered consciousness
- Abdominal pain/nausea/vomiting
- Blood glucose greater than 250mg/dl (as high as 900's)
- Ketonuria/glucosuria
- Weight loss (may be profound)
- Blood gas changes (metabolic acidosis)
102
Emergency management of DKA
- Ensure patent airway; administer O2
- Establish IV access; begin fluid resuscitation to replace extracellular and intracellular fluid and correct electrolyte
balance
***--- Nacl 0.45% or 0.9%; add 5% to 10% dextrose when blood glucose level approaches 250 mg/dl***
--- Restore urine output to 30 to 60 ml/hr
- Protect from cerebral edema; monitor for fluid overload, renal or cardiac compromise
103
Expected drop in blood glucose with Tx
36 to 54 mg/dl/hr drop in serum glucose will avoid complications
104
Tx of DKA
- IV regular insulin drip 0.1 U/kg/hr to correct hyperglycemia and ketosis (until glucose reaches 150-200)
- Must have stable ABG before transitioning to SQ insulin
- Monitor blood glucose at least q6-8h
- MAY need bicarb
