Final Flashcards by Student .

Which of the following ABG values is expected from someone who suffers from a pneumothorax?

Respiratory acidosis

Explanation:
Pneumothorax = collapsed lung –> hypoventilation/poor ventilation –> decreased gas exchange, CO2 isn’t leaving the body –> results in respiratory acidosis

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What are the causes of respiratory alkalosis vs metabolic alkalosis?

Respiratory alkalosis is caused by the lungs removing TOO MUCH CO2…
-Hyperventilation:
–> hyperventilation can be caused by anxiety, pain, or the ventilator may be hyperventilating the patient

Metabolic alkalosis is caused by a loss of acid in the body or bicarbonate excess
-Loss of acid:
–> NGT suctioning or vomiting may cause loss of stomach acid
–> Drugs causing hypokalemia (ex. thiazide diuretics) = acid loss
-Bicarbonate excess:
–> antacid overdose
–> overdose of bicarbonate

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What are the ABGs for aspirin (ASA) overdose?

metabolic acidosis

pH: acidic (below 7.35)
PaCO2: normal or low (below 35)
HCO3: low (below 22)

Acetylsalicylic acid overdose = build up of acid = metabolic acidosis

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You are given an ABG and it is metabolic acidosis, what would you give for this?

administer bicarbonate
(metabolic acidosis is caused by acid build up or a loss of bicarbonate)

Other solutions:
-if it is caused by diarrhea –> antidiarrheal
-caused by renal failure –> dialysis
-caused by DKA –> insulin

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What are causes of metabolic acidosis?

metabolic acidosis = build up of acid in the body or bicarb loss

-DKA (accumulation of ketoacids)
-intoxication (ASA OD)
-Renal failure (uric acid build up)
-Shock (lactic acid build up)
-diarrhea (bicarb loss)

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What is associated with metabolic alkalosis?

vomiting (bc loss of stomach acid)

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What is associated with metabolic acidosis?

diarrhea (bicarb loss)

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ABG normal values

pH: 7.35-7.45
PaO2: 80-100
PaCO2: 35-45
HCO3: 22-26
SaO2: >95%

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SaO2 vs PaO2

SaO2: oxygen saturation, percentage of hemoglobin bound to oxygen

PaO2: partial pressure of oxygen, the amount of oxygen dissolved in the blood

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There is an ABG showing respiratory alkalosis, what would be an intervention?

turn down respiratory rate on ventilator and increase sedation

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You have a patient who is taking a thiazide diuretic, what will their ABGs look like?

metabolic alkalosis

Drugs causing hypokalemia (ex. thiazide diuretics) = acid loss

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How long can the lungs compensate for?

24 hours

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Which system can compensate for 24 hours?

lungs/respiratory

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What are some accurate assessment parameters for a nurse to determine adequate tissue perfusion to assess for shock?

BP, HR, RR

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SATA for causes of respiratory alkalosis

-low PaCO2
-anxiety
-chest trauma

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SATA for causes of metabolic acidosis

-diarrhea (poop out ur base)
-DKA

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SATA for causes of metabolic alkalosis

-vomiting

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Which of the following identifies the proper compensatory mechanism?

-the renal system compensates for alkalosis by excreting bicarb

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What should you do with the ventilator for ARDS?

increase the PEEP

Pts with ARDS have decreased lung compliance (stiff lungs). PEEP is pressure applied by the ventilator at the end of each breath

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Why are corticosteroids used in ARDS?

helps decrease inflammation in the lungs and pulmonary edema

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What are appropriate collaborative interventions for ARDS?

-treat the cause
-proning (only if PaO2/FiO2 ratio is below 100)
-minimize oxygen demand
-optimize O2 delivery
-maintain airway
-prevent complications

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What happens to a patient’s PaO2 with ARDS?

it drops (due to respiratory acidosis)

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What are early signs of respiratory failure?

-change in mental status
-anxiety
-morning headache

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Respiratory failure due to a decrease in perfusion and V/Q relationships, what causes the V/Q mismatching?

-Happens in the PROGRESSIVE stage due to a blockage (PE, HF)

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What nursing interventions are important for a pt on ECMO?

-monitor drain and return links to reduce risk of decannulation

You have an old man who is stating horribly, laying flat, and you have already turned up his oxygen. What would you do next?

Raise the head of the bed

You have a client on ECMO, what should you do?

Check for connections, risk for decannulation

What is a cause for failure of perfusion?

Pulmonary embolism a sudden blockage in a lung artery

What is a common finding within a patient who has ARDS?

refractory hyperemia (where oxygen level in blood is low despite receiving high amounts of FiO2), would need to be ventilated

what is an early sign of ARDS?

restlessness

risk factors for ARDS

drawing, chest trauma?

which two ventilator settings are pressure modes?

CPAP, PS

which two vent settings are volume modes?

SIMV and AC

CPAP

provides continuous positive pressure and oxygen pt takes their own breaths settings: PEEP and FiO2

supports every triggered breath settings: PEEP, FiO2, PS

SIMV

machine gives pt a set amount of breaths, but pt can also take their own extra breaths with NO support settings: PEEP, FiO2, Tidal volume, RR every SET breath gets volume to support it

machine gives pt SET breaths and if they take extra those are also supported settings: PEEP, FiO2, TV, RR EVERY breath gets volume

Match the ventilator mode to description 1. Tidal volume, Patient triggered breaths do not have all tidal volume 2. Tidal volume of spontaneous breaths does not vary and ventilator will support all breaths. Tidal volume delivery on every breath, even when the patient takes a breath on their own

1. SIMV 2. AC

What is tidal volume?

How much lungs expand

Which of the following is true regarding pressure support (PS)?

The patient will have to trigger their own breaths or they will not receive any

How can you prevent ventilator associated pneumonia?

oral care also... -hand washing -elevate HOB to 30-40 degrees -daily sedation vacation -assess readiness to wean -suction Q2H

41-year-old admitted to ED for heroin OD and is receiving 15L O2 via simple mask. She is acidotic and her PaO2 is 50. What is the interpretation and recommendation?

failure to ventilate causing respiratory failure; recommend intubation

WHich is a complication of a poorly secured ET tube?

-unplanned extubation -aspiration -infection -laryngospasm

The patient is to receive 10 breaths per minute at a set volume on the vent, but can take additional breaths on natural volume, what mode is this?

SIMV

How do you ensure ET tube is placed right when they intubated?

Auscultate breath sounds and stomach

If your train of 4 is 4/4, what would you do to your medication?

increase pancuronium (proper paralyzation is 2/4)

Readiness to wean SATA

-hemodynamics are stable -adequate CO -RR <30 -PaO2> or = 80 mmHg -adequate oxygenation without FiO2 over 50% or high PEEP over 8 -taking their own breaths -minimal secretions -underlying cause for ventilation is resolved -acceptable vitals -hemodynamically stable -mental readiness -adequate oxygenation -acceptable chest x-ray -acceptable ABG

If a patient is hyperventilating and hyperoxygenating (over the vent) what would you do to RR?

decrease RR

What is tidal volume?

how much air enters the lungs when they expand

Drag and drop: low and high pressure alarm causes

Low: -tube disconnected -ET displaced -cuff deflated HIgh: -biting on ET tube -secretions -coughing, gagging

You have a pt who was on pressure setting (PS) and got switched to AC, why?

because they were unable to initiate breaths on their own

What is poor ventilation?

inability to move air in and out of lungs

What is a normal ICP?

5-15 mmHg

What is a normal CPP?

60-100 mmHg

How to calculate CPP

MAP-ICP = CPP

Pt's MAP is 50, ICP 10. What is the CPP and what do you do?

CPP is 40 (low), give norepinephrine

4 patients, which is most critical?

pt in MVA with nonreactive 5mm pupils

low pressure alarm on the mechanical ventilator is going off, what could be the cause?

check all the connections on the tubing

The patient has something going on and has deep rapid breathing with periods of apnea, what type of breathing is this?

Cheyne stokes

A pt comes in with severe head injury, vomiting, tachypneic, HR is 44. What do you think needs to be placed?

External ventricular drainage (EVD)

Your pt has an ICP of 38, pupils are sluggish, what medication can you give?

mannitol

What do you do to EVD when pt needs to go for CT scan?

closed/turn off

Pt is having deep, rapid breathing with periods of apnea. What type of breathing is this?

cheyne stokes

MAP 120, ICP 5-15, what is appropriate?

start ordered metoprolol

What are appropriate/inappropriate nursing interventions for a patient with an EVD?

Appropriate: -use aseptic technique during dressing change -close for at least 6 minutes for accurate reading -transducer level with tragus of ear -signage that pt has EVD -drain closed during repositioning Inappropriate: -flush clot -flush with NS -keep drain open during reposition

ICP of 48, pt has an art line. What should you immediately assess?

level of transducer

Signs of increased ICP

-cushings triad --> widened pulse pressure (increasing systolic, decreasing diastolic) --> bradycardia --> irregular respirations.

Final Flashcards

(67 cards)