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Med Surg > Respiratory 12 Q > Flashcards

Respiratory 12 Q Flashcards

1
Q

Nasal cannula provides O2 at ___ to ___ % (1 to 6 L)

A

24 - 44%

At 3 - 4 L/min mark, need to provide humidification

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2
Q

When does humidification need to be provided?

A

At the 3 - 4 L/min mark

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3
Q

Simple face mask provides O2 at 40 to 60%. What rate does it need to be higher than to prevent rebreathing of CO2?

A

5 L/min

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4
Q

When is a face tent used?

A

oral surgeries/trach

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5
Q

When ____ and ____ are used, the pt must be able to breathe on their own.

A

trach collar; t-piece

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6
Q

What delivery method is most precise?

A

Venturi mask

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7
Q

A nonrebreather mask delivers the highest % of O2 without intubation (100% at 10 L), the ________ needs to be filled with air BEFORE placing on pt, making sure it does not collapse on itself.

A

O2 reservoir

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8
Q

What is NIPPV?

A

Ventilation without intubation (CPAP or BiPAP); pt needs to be alert, cooperative, and not requiring emergent intubation

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9
Q

What are the adverse effects of NIPPV?

A

Sinus pain, gastric insufflation, and non-compliance

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10
Q

What benzos are used for continuous sedation infusion?

A

Ativan (Lorazepam) and Versed (Midazolam) are used to relieve anxiety and promote sedation for those being mechanically ventilated or prior to being intubated or for those receiving paralytics.

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11
Q

What is the antidote used for Ativan/Versed?

A

flumazenil (Romazicon)

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12
Q

____ is thick and needs to be diluted in NS; not pushing any quicker than __ mg/min.

A

Ativan; 2

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13
Q

Propofol (Diprivan) is used for…

A

rapid induction of anesthesia and sedation

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14
Q

What is our sedation range for propofol?

A

5 to 50 mcg/kg/min; can not go over 50 mcg as this is considered the “gray area” and reaches a level of anesthesia

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15
Q

Propofol is contraindicated in pts with a hypersensitivity to…

A

soybean oil, glycerol, and eggs

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16
Q

Propofol tubing must be changed every ___ hrs to prevent the growth of bacteria

A

12

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17
Q

NMBAs (or paralytics) are used to…

A

paralyze skeletal muscles WITHOUT loss of consciousness

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18
Q

True or false: paralytics provide pain and anxiety relief

A

FALSE - they do not provide relief from pain or anxiety, we need to administer other meds for this.

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19
Q

Zemuron (rocuronium) has an onset of ___ to ___ minutes and a duration of 20 to 35 minutes

A

1 to 2 minutes

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20
Q

Norcuron (vecuronium) has an onset of ___ to ___ minutse and a duration of 20 to 35 minutes

A

3 to 5 minutes

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21
Q

The depolarizing agent, _________, is contraindicated in pts with a history of malignant hyperthermia and hyperkalemia

A

succinylcholine (sux)

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22
Q

We must monitor the patient with a peripheral nerve stimulator (TOF) in order to monitor when the NMBA has worn off. What are the twitches/blockades?

A 
4 of 4 twitches = < 75% blockade
3 of 4 twitches = about 75% blockade
2 of 4 twitches = 80% blockade
1 of 4 twitches = 90% blockade
0 of 4 twitches = 100% blockade
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23
Q

______ is the antidote for NMBAs and is given with 3/4 or 4/4 twitches.

A

Neostigme

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24
Q

NMBAs have no analgesic, amnesia, anxiolytic, or sedative effects, so it is essential that we use _____ and _____ concurrently.

A

sedation and analgesia

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25
Q

Nurse assist with intubation as follows:

A

pre-oxygenate pt with BMV device (Ambu bag) with 100% O2; suction needs to be readily available and functioning; obtain intubation tray; check laryngoscope function and blade selection; check cuff integrity (10mL syringe and KY jelly); remove headboard and raise bed height; remove dentures; position pt in “sniff” position; monitor time taken to intubate (no longer than 30 seconds); monitor ECG for ventricular dysrhythmias; apply cricoid pressure PRN

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26
Q

Cricoid pressure pushes the ___ ___ down toward the field of vision while sealing the esophagus

A

vocal cords

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27
Q

In rapid sequence intubation (RSI), there is rapid and concurrent administration of a ____ and a ____.

A

sedative and paralytic (NMBA)

28
Q

How do we confirm ETT placement?

A
  1. auscultate bilateral apices, axillae, and stomach
  2. use an end-tidal CO2 detector
  3. observe for chest vs stomach rising
  4. obtain CXR (should be 2 to 6 cm above carina)
29
Q

When using an end-tidal CO2 detector, how do we know it’s in the right location?

A

Will change color (purple)

30
Q

If there are no breath sounds noted at bilateral apices, no breath sounds noted as bilateral axillar, the stomach is enlarging with each forced breath, and the CO2 detector indicates no change…

A

The ETT is most likely in the esophagus

31
Q

If breath sounds are heard only in the right lung and no breath sounds are heard in the left lung..

A

The ETT is probably past the carina and in the right mainstem bronchus - have to deflate, pull back 1 - 3cm, re-inflate cuff and reassess for breath sounds.

32
Q

When placement is confirmed, the position is recorded as the lip. What are the estimated measurements for males and females?

A 
Women = 21 cm
Men = 23 to 24 cm
33
Q

The cuff pressure should remain at “minimal leak,” or ___ to ___ mmHg

A

20 to 25

34
Q

The patient is at risk of aspiration if the pressure is less than ___

A

20

35
Q

What is drawn 15 to 30 minutes after ETT placement to provide a baseline and guide treatment?

A

ABGs

36
Q

What is the normal tidal volume range?

A

10 mL/kg

37
Q

PEEP maintains airway pressure at the end of expiration by keeping the ___ open

A

alveoli

38
Q

Normal PEEP levels are ___ cm H2O

A

5

39
Q

High levels of PEEP (> 5 cm H2O) are used with ____; may lead to ____ and decreased cardiac output

A

ARDS; barotrauma

40
Q

Assist-Control Ventilation (ACV) delivers breaths at a set rate and TV. When the pt initiates a spontaneous breath, the ___ ___ is delivered.

A

preset TV

41
Q

With this ventilator mode, the pt self-regulates RR and TV; may be used with SIMV for weaning.

A

PSV

42
Q

What mode delivers breaths at a set ret and TV but allows the pt to initiate spontaneous breaths between mandatory ones and can be used for weaning with PSV?

A

SIMV

43
Q

PCV provides a ________ breath delivered at a set rate and may permit spontaneous breathing; TV is not set

A

pressure-limited

44
Q

PC-IRV has the _____ amount of control, prolonging the inspiratory time and requiring sedation and sometimes paralysis.

A

greatest

45
Q

What mode provides continuous pressure throughout inspiration and expiration?

A

CPAP

46
Q

High pressure alarms indicate…

A

kinked tubing, kinked ETT, secretions/mucus plug, or decreasing lung compliance/ARDS

47
Q

Low pressure alarms indicate…

A

disconnected tubing, leak in ETT cuff, and extubation or incomplete extubation

48
Q

If the pt is easy to ventilate with bagging and it solves the distress, it is a _____ problem

A

ventilator

49
Q

If the pt is difficult to ventilate with bagging and remains in distress, it is a _____ problem

A

patient

50
Q

What are the 5 Ps for the management of ARDS?

A
  1. Perfusion (swan-ganz cath)
  2. Positioning (continuous lateral rotation therapy, semi/high-fowler’s, prone)
  3. Protective lung ventilation (high PEEP > 5 cm H2O; lower TV of 6 mL/kg rather than 10 mL/kg)
  4. Protocol weaning (SBTs, sedation vacation)
  5. Prevent complications
51
Q

A spontaneous breathing trial should be at least ___ minutes but no more than ___ minutes

A

30; 120

52
Q

Nurse helps with extubation as follows:

A

obtain 10 mL syringe and nasal cannula; suction readily available (suctioning before extubation and as cuff is being pulled out); place pt on O2; encourage TCDB; pt will be NPO if intubated more than 3 days until a swallow study if performed.

53
Q

What are the signs that the pt is failing to wean?

A

tachypnea, tachycardia, dysrhythmias, sustained desaturation, HTN, agitation/anxiety, changes in LOC

54
Q

What is the normal PaO2/FiO2 ratio?

A

> 400 mmHg

55
Q

A PaO2/FiO2 ratio ____ is indicative of ARDS

A

< 200 mmHg

56
Q

True or False: COPD is characterized by an increased anterior-posterior chest diameter (barrel chest), CO2 retention, and cyanosis.

A

TRUE

57
Q

What is the cause of a large % of acute COPD exacerbations?

A

Respiratory tract infections

58
Q

COPD patient presents with ____ acidosis

A

respiratory (decreased pH, increased CO2, decreased O2)

59
Q

Vrichow’s Triad is a risk factor for pulmonary embolus, what does this include?

A
  1. Changes in the vessel wall (injury)
  2. Changes in the pattern of blood flow (flow volume)
  3. Changes in the constituents of blood (hypercoagulability)
60
Q

What is the BEST diagnostic for pulmonary embolus?

A

Helical (spiral) CT

61
Q

What is the NORMAL V/Q ratio?

A

0.8

62
Q

A high V/Q ratio ( > 0.8 ) indicates dead-space, this is seen with…

A

pulmonary embolus

63
Q

A low V/Q ratio ( < 0.8 ) indicates shunting, this is seen with…

A

COPD, pneumonia, and asthma

64
Q

What is the pH range?

A

7.35 to 7.45

65
Q

What is the HCO3 range?

A

22 to 26

66
Q

What does the ROME acronym stand for (with ABGs)?

A

Respiratory Opposite, Metabolic Equal

67
Q

What is the PaCO2 range?

A

35 to 45

Med Surg (19 decks)

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