Respiratory Part 2 (Mech Vent) Flashcards

Question

The inflated cuff of an ETT prevents

Answer 1

air for passing to the vocal cords, nose, and mouth

Answer 2

Orotracheal Nasotracheal

Answer 3

The size and tube length of the ETT # at the teeth # at the lips *know if it moves or not*

Answer 4

support pt until underlying condition is corrected - Maintain and correct hypoxia/ventilation - provide supplemental O2 - prevent complications and maintain pt safety - Provide EBP - Holistic family centered care - integrate human caring

Answer 5

- Order if not emergent - Supplies and assist provider

Answer 6

- Assess End-tidal CO2 detector -Auscultate lungs bilaterally -Auscultate epigastric -Observe chest wall movement (SYMMETRICAL) -Monitor SpO2 and cardiac rhythm (stable or improved) - Purple to Yellow means CO2

Answer 7

GCS<8 color change ABGs cardiac and pulmonic VS low LOC

Answer 8

Paralytic (succinylcholine and rocuronium) - paralysis the muscles Sedative (Propofol, midazolam, versed, fentanyl) - sleepy and drowsy

Answer 9

Capnometer YELLOW for CO2

Answer 10

3-4cm above the Corina

Answer 11

<25 cm H2O - minimal leak technique - verify by RT and physician

Answer 12

tracheal necrosis

Answer 13

unplanned extubation aspiration

Answer 14

No, that means you have hit the Corina

Answer 15

lace the obturator placed immediately in the hole - call a CODE

Answer 16

pt in semi-fowler's position to decrease dyspnea - cover with a sterile dressing and ventilate with the BVM over the nose and mouth

Answer 17

replace the inner cannula and check the flanges

Answer 18

Obturator (clean sterile bag) Trach of the same size or smaller BMV Suction

Answer 19

obturator at bedside for emergencies clean face plate/flange clean stoma q shift and PRN change inner cannula q shift and PRN Reassess pt after procedure

Answer 20

sterile saline and dry change the dressing change securement ties if soiled (unless new then leave for orders)

Answer 21

Oral care Q4 hours In-line suctioning Q shift and PRN – need a reason, O2 down, tachypnea, tachycardic, cough, flem, Reposition & provide passive ROM Bathe patient Q24 hours Change pulse oximeter and ECG patches Q24 hours Patient/family teaching as needed Talk to the patient and family They can hear you! – only sedated and paralyzed Restraints for safety; **restraint release Q2 hours & skin** assessment (typically) Provide time for sleep and rest

Answer 22

10 secs -HESI 10-15 secs

Answer 23

Paralytics Sedatives Opioids Vasopressors/fluids/volume expanders Bronchodilators LEAN

Answer 24

Lidocaine, Epinephrine, Atropine, Narcan

Answer 25

BP to drop - give vasopressors

Answer 26

Ensure tube is secured** - Tube is marked, auscultate, cuff pressure <25 Keep tube patent - Suctioning, listening, alarm customized to pt Verify/maintain placement Monitor respiratory status Bag valve mask (BVM) in room (obturator at bedside) Keep scissors airway from external balloon

Answer 27

tolerance, color, breathing extent, cardiac monitor = PVCs, RR, environment, no clutter

Answer 28

only when they are a danger to themselves

Answer 29

10 seconds

Answer 30

resistance is met

Answer 31

while withdrawing the catheter - validate completely out of the ETT by black line visual - monitor ECG and SpO2 throughout procedure

Answer 32

continuous - tap before attempt preoxygenate anchor the hand and pull with the other suction pulling out fully out at the black line

Answer 33

closed system and protect the patient and staff from bacteria - prevent loss of PEEP and O2

Answer 34

Hypoxemia, bronchospasm Increased intracranial pressure Dysrhythmias – PVCs (Teresita pt) ↑ or ↓ BP Mucosal damage Pulmonary bleeding, pain, infection

Answer 35

* Assess for adverse effects during suctioning, such as dysrhythmias. * Evaluate the patient’s respiratory status after suctioning. * Maintain appropriate cuff inflation pressure at 20 to 25 cm H2O or use minimal leak technique to maintain cuff pressure. * Assess tracheostomy site at least once per shift for any signs of inflammation or infection. * Provide tracheostomy care using sterile technique * Notify the CN of any changes in the patient’s respiratory status

Answer 36

amount of oxygen dissolved in plasma – seen on ABG

Answer 37

pulse ox and is only an estimate

Answer 38

uncontrollable coughing dyspnea for a long period of time - leads to fibrosis

Answer 39

pressure to keep alveoli from collapsing at the end of expirations

Answer 40

peak inspiratory pressure

Answer 41

maximum pressure of inspiration, mucous plugs will increase PIP

Answer 42

increase RR increase Vt - VOLUME OF THE BREATH

Answer 43

increase PaO2 increase FiO2 increase PEEP - keep alveoli open, give more O2

Answer 44

O2 from 21-100% 60L/min humidification

Answer 45

Clears physiological dead space of expired air Keeps alveoli open at end of expiration

Answer 46

limit pt mobility - need good ft

Answer 47

adequate spontaneous RR - able to breathe on their own

Answer 48

volume of ventilated air that does not participate in gas exchange

Answer 49

present pressure provided throughout inspiratory and expiratory breaths

Answer 50

Goal- keeps alveoli from collapsing, resulting in better oxygenation and less work of breathing

Answer 51

face mask non-intubated ventilator intubated or trached pt

Answer 52

breath spontaneously - PT DOES ALL THE WORK

Answer 53

airway pressure

Answer 54

pt's readiness for extubation

Answer 55

ventilate non-intubated pts **help prevent intubation**

Answer 56

spontaneously breathe and cooperate with the tx

Answer 57

ventilation

Answer 58

oxygenation

Answer 59

COPD pts unable to exhale against higher airway pressures to help resolve CO2 problems - HEART FAILURE - ACUTE RESPIRATORY FAILURE

Answer 60

shock AMS increased airway secretions

Answer 61

BIPAP has inspiratory pressure in addition to expiratory pressure of CPAP

Answer 62

Tolerate tx till exacerbation or tx is complete ABG CXr Color Auscultation Gas exchange LOC Awake for breathe Bilateral does not Need to work or labor to breathe not Exhausted

Answer 63

**Assist Control AC** Synchronized Intermittent Mandatory Ventilation (SIMV)

Answer 64

Pressure Support Ventilation (PSV) Positive End Expiratory Pressure (PEEP)

Answer 65

inflates the lungs by introducing positive pressure and/or volume

Answer 66

Verify settings/order Assess patient Ensure patient safety (medications turns, oral care) Troubleshoot as needed Monitor ABG’s

Answer 67

**full support mode; Controls the work of breathing** - fixed tidal Volume (Vt) that the ventilator will deliver at set intervals of time or when the patient initiates a breath

Answer 68

remain the same for patient-initiated breath or ventilator breath

Answer 69

Assist control - very sick pt

Answer 70

If the ventilator setting is set at a certain bpm but the ventilator shows pt receiving a higher number

Answer 71

set airway pressure to assist the patient with spontaneous breaths - Decreases work of breathing by giving the patient a little boost on the breaths they initiate on their own

Answer 72

improves - overcomes resistance -trials with spontaneous breaths - positive pressure only during inspirations and with spontaneous breaths - must be able to initiate breath by themselves

Answer 73

apply positive pressure during exhalation 3-20 cm - improves O2 by restoring lung vol

Answer 74

increased ICP low CO = hypotension hypovolemia

Answer 75

Aspiration/abdominal distension, ileus Oxygen Toxicity Barotrauma PEEP-related Anxiety Stress Ulcers Infections Muscular deconditioning Malnutrition Ventilator dependence - not able to wean off VAP

Answer 76

Insert NG/OG to decompress the stomach – stop aspiration of acid and feed them

Answer 77

FIO2 >50% for more than 24 – 48 hours

Answer 78

restlessness, dyspnea, chest discomfort, fatigue, atelectasis

Answer 79

a smaller VT (e.g., 4 to 8 mL/kg) and varying amounts of PEEP minimizes the risk for barotrauma

Answer 80

decreased urinary output and increased sodium retention - lowers CO and renal perfusion - RAAS stim = retaining Na and water

Answer 81

increased airway pressure distends the lungs and possibly ruptures fragile alveoli or emphysematous blebs - lead to pulmonary interstitial emphysema, pneumothorax, subcutaneous emphysema, pneumopericardium, and tension pneumothorax

Answer 82

hypotension, H2O retention : INTRATHORASIC PRESSURE -48-72 hours after

Answer 83

CONFUSED AND RESTRAINED – TEACH PT AND HAVE FAMILY COME IN, MEDS

Answer 84

WBCs, oral care, turning

Answer 85

OG,NG tubes, rest the belly

Answer 86

48+ hours after intubation

Answer 87

Contaminated respiratory equipment Inadequate hand washing Environmental factors – no suctioning or oral care, no moisture Impaired cough Colonization of oropharynx

Answer 88

Minimize sedation and sedation vacation Provide early exercise and mobilization – ROM, ambulation, turning Conduct subglottic secretion removal Elevate HOB 30- 45 degrees unless contraindicated Routine oral care with Chlorohexidine Strict hand washing, wear gloves

Answer 89

feel safe know (information) regain control hope trust Involve patients and caregivers in decision making

Answer 90

Assess respiratory status & vital signs Q 1-2 hours Monitor labs Review chest x-ray/results Turn as tolerated/Assess skin for breakdown Prevent Ventilator Acquired Pneumonia (VAPS) DVT prophylaxis** Provide adequate Nutrition NGT, OGT, Peg

Answer 91

BVM Suction set up and ready Are the alarms pulled in and functioning properly, set within parameters Are restraints secured properly Are lines and tubes secured Can the caregiver adequately monitor the patient and monitor

Answer 92

Wash hand and don appropriate PPE for universal precautions Maintain closed circuit of ventilator Be mindful of stance and actions with suctioning with trach Perform patient positioning (prone or supine) with proper ergonomics and patient handling equipment Have adequate staff to reposition patient/airway Monitor restraint use as needed/ordered Have a plan for agitation/restlessness: trend with settings

Answer 93

every hour with appropriate scale

Answer 94

Use variety of methods to communicate IV Sedatives as needed If on IV sedation - Assess level of sedation q hour using appropriate scale as ordered (RASS, delirium scale, music therapy Relaxation therapy Provide a calm and relaxing environment Mobility- bedrest, passive range of motion, active range of motion

Answer 95

severe oxygenation issues

Answer 96

- Improve oxygenation by decreasing the pressure on the lungs from the abdominal contents, the heart and supporting structures, and the added weight of the lungs - improve gas exchnage

Answer 97

Shock Multiple fractures or trauma Pregnancy Raised ICP Tracheal surgery or sternotomy within two weeks

Answer 98

12-20 hours if showing improvement and hemodynamically stable

Answer 99

breathing spontaneously? supporting adequate oxygenation? maintaining normal hemodynamics? Has original reason for intubation resolved? good tolerance

Answer 100

↑ or ↓ RR, ↑ HR, ↓SaO2 sustained <90%, Respiratory distress, LOC change, arrhythmias, agitation or anxiety, low tidal volumes <5mL/kg - hypertension or hypotension diaphoresis

Answer 101

Have towel, BVM, and suction ready. Monitor for respiratory difficulty. Semi-fowlers inhales and deflate at peak inspiration Cough and deep breath apply NC or face mask

Answer 102

sore throat hoarseness

Answer 103

Assess patient quickly. How is patient’s respiratory effort and O2 sat? Possibly able to breath on their own, gasping move to next step Call for help! If patient needs ventilation assistance, ensure the bag valve mask (BVM) is attached to the O2 flowmeter and O2 is on! Attach the face mask to the BVM bag and after ensuring a good seal on the patient’s face, supply the patient with ventilation

Answer 104

**leaks** Cuff leak Leak in the ventilator circuit Patient stops breathing in the pressure support modes of SIMV Unintentional extubation Tube disconnected from circuit Barotrauma

Answer 105

**blockage** Mucous plug or increased secretions Patient bites ETT Pneumothorax Patient anxious and fighting the ventilator Kink in the tubing Water collected in the ventilator tubing Patient is coughing Bronchospasm Pulmonary Edema Decreased lung compliance

Answer 106

Assess for cuff leak, check cuff pressure, call RT and physician

Answer 107

Assess all connections and tubing; call RT and physician, a new ventilator may be needed

Answer 108

Assess the patient; notify RT and physician; may need to provide manual breathes via BVM

Answer 109

Assess patient for need to be reintubated; apply oxygen; may need to give manual breathes via BVM

Answer 110

Reconnect tubing to circuit; assess patient

Answer 111

Assess subcutaneous emphysema - notify RT and physician if present

Answer 112

injury to your body (ears or lungs) because of changes in barometric (air) or water pressure in this case caused by the ventilator. Increased alveolar pressure during mechanical ventilation can cause barotrauma or pneumothorax

Answer 113

Suction as needed

Answer 114

Insert an oral airway to prevent biting (bite block)

Answer 115

Assess for asymmetrical chest rise, decreased breath sounds over pneumothorax site; notify physician

Answer 116

Assess the patient, provide emotional support, re-evaluate sedation/analgesic need

Answer 117

Assess the tubing from ventilator to patient to ensure no kinking of the tube is present

Answer 118

Empty the water from the tubing

Answer 119

Continue to monitor

Answer 120

Assess for non-productive consistent coughing; give a breathing treatment

Answer 121

Assess lung sounds and ETT for fluid; suction needed, may need to be placed prone and given diuretics

Answer 122

Assess lung sounds, RR, BP and SaO2; notify RT and physician, ventilator mode may need to be changed

Answer 123

Placed for continuous vital sign monitoring and frequent blood draws especially ABG’s - Usual Location: Radial or femoral artery - continuous slow 3mL/hr flushing and mechanism for fast flushing of lines

Answer 124

0.9% NS used as fluid for pressurized system **NO meds given per arterial line** - Blood glucose and ABGs testing and no wasting and give back when done Monitor extremity circulation Pressure system 300 mmHg Transducer level at phlebostatic axis No circumferential dressing/tape and look visibly healthy **closed system**

Answer 125

reference point for zeroing the hemodynamic monitoring device (transducer) **4th intercostal space at the sternum** - correlates with right atrium

Answer 126

Retracting, how labored VS – RR, O2Sat, HR Color oral muscosa Chest mvmt Auscultating sounds Airway patency GCS = less than 8 intubate Perfusion ABG Chest Xray

Answer 127

Intubation Gather supplies, support pt and family, prep meds (sedative/hypnotic/paralytic) Listen over epigastric and lungs On one side = pull up not out CO2 detector should be yellow

Answer 128

Oral care (prevent VAP, WBC high, C&S, timing, fever) Turn q 2 hours prevent skin breakdown Passive ROM Nutrition – OG/NG Give belly a rest = TPN Decompress stomach Suction As needed /q shift = increase RR Prevent stress ulcers Prevent anxiety RAS score and doctor parameters for tolerance and ABGs going to normal (get CO2 off increase tidal) Proning if declining Artery Line 4th intercostal line 300 pressure Continuous No meds Should be the same for normal BP Skin and extremity assessments High alarm – blockage assessment, personal or tidal volume

Respiratory Part 2 (Mech Vent) Flashcards

(158 cards)