TEST 2 Flashcards
1
Q
what is important to know about simple masks
A
5-10 LPM
30-55% FiO2 (not exact)
can be humidified
must have 5+ LPM to prevent rebreathing
2
Q
uses and contraindications of simple mask
A
uses- non acute situation
mild hypoxia
contraindications- needs below 5LPM
acute respiratory distress
Severe hypoxia
3
Q
what is important to know about non-rebreather mask
A
10-15 LPM (high flow)
80-100% FiO2
unable to be humidified
reservoir bag MUST be inflated
4
Q
Uses and contraindications of non-rebreather mask
A
uses- acute respiratory distress
short term high oxygen needs
contraindications- long term use
5
Q
what is important to know about venturi mask
A
2-15 LPM
24-50% FiO2
prevents over oxygenation
different colors designed for exact FiO2
can be humidified
6
Q
uses and contraindications of venturi mask
A
uses- underlying lung disease
contraindications- O2 needs over 50% FiO2
7
Q
what is important to know about nasal cannula
A
1-6 LPM
24-45% FiO2
can be humidified
8
Q
uses and contraindications of nasal cannula
A
uses- non acute situation
mild hypoxia
mouth breathing
contraindications- acute resp distress
severe hypoxia
mouth breathing
** i dont understand how mouth breathing is a use and a contraindication but thats what her poster says)
9
Q
what is important to know about trach masks
A
5-15 LPM
35-90% FiO2
minimum of 5L required to prevent rebreathing
must be humidified
if O2 is not needed, compressed air with humidification is used
10
Q
uses and contraindications of trach masks
A
uses- delivery of humidification and O2
for trach patients (duh??)
contraindications
patients without a trach (is this a joke)
11
Q
what is important to know about 1/2 mask/face tent/shovel mask and what are the uses
A
5-15 LPM
35-50% FiO2
uses- delivery of higher amounts of humidification
postop oral/nasal surgery
12
Q
Risk factors for TB
A
close contact with someone w/ active tb
immigration from other countries w/ a high prevalence(southeast asia, africa)
institutionalism (close proximity)
living in overcrowded, substandard housing
caring for immunosuppressed patients
exposure during high risk procedures
13
Q
what groups of people are at risk for tb
A
immunocompromised (most at risk)
substance abusers
inadequate healthcare( homeless, minorities)
pre-existing medical conditions
14
Q
clinical manifestations of tb
A
Cough lasting 3 weeks or longer
Hemoptysis
Sputum production
Weakness
Fatigue
Anorexia, weight loss
Low-gradefever, chills
Night sweats
Pleuritic chest pain
15
Q
how is tb diagnosed
A
mantoux test (PPD)- skin test
ntiFERON-TB Gold (QFT-G)- blood test
sputum smear- Presence of AFB(acid fact bacteria) on a sputum smear may indicate disease but does not confirm the diagnosis
sputum culture- gold standard for diagnosis
chest x ray- lesions will be visible
ct thorax- show extent of damage to lung tissue
CBC- elevated WBC
16
Q
non pharmacological treatment for tb
A
rest initially
well balanced high calorie diet
smoking cessation
17
Q
pharmacological treatment for tb
A
pulmonary tb- Anti-TB agents (antibiotic) 6 to 12 months
administer humidified oxygen as prescribed
18
Q
what are the most common tb antibiotics
A
rifampin(RIF)
isoniazid (INH)
pyrazinamide(PZA)
ethambutol(EMB)
all are bactericidal but work on different parts of bacilli
remember RIPE for the meds names
19
Q
what is tb
A
Primarily infection of lung parenchyma
-Leads to impaired gas exchange
-May be transmitted and infect other areas of the body: meninges, kidneys, bones, lymph nodes and GI tract.
- infectious agent is M. tuberculosis
20
Q
what do we teach patient to report with each tb antibiotic
rifampin(RIF)
isoniazid (INH)
pyrazinamide(PZA)
ethambutol(EMB)
A
rifampin(RIF)- orange urine/secretions, report jaundice, pain, swelling joints, anorexia, malaise
isoniazid (INH)- report s/s of hepatotoxicity, jaundice, malaise, anorexia, nausea, fatigue
pyrazinamide(PZA)-report jaundice, pain, swelling joints, anorexia, malaise
ethambutol(EMB)- report changes in vision
rifampin & pyrazinamide have the same s/s to report
21
Q
what is the medication regimen for newly diagnosed active tb
A
all 4 oral antibiotics for the first 2 months
followed by an additional 4 months of rifampin and isoniazid
22
Q
what is primary drug resistance in regards to tb
A
Resistance to one of the first line anti-TB agents in people who have not had previous treatment
23
Q
what is secondary or acquired drug resistance in regards to tb
A
Resistance to one or more anti-TB agents in patients undergoing therapy
24
Q
what is multidrug resistance in regards to tb
A
Resistance to two agents, isoniazid (INH) and rifampin. The populations at greatest risk for multidrug resistance are those who are HIV positive, institutionalized, or homeless.
25
what is DOT
direct observation therapy-Evidence is finding that meds can be given 3X /wk with DOT and not have any difference in outcomes
26
what are some tb medication considerations
Crosses placental barrier
Hepatotoxicity
Audiometric testing
Compliance- difficult
Evaluate at follow up visits
Non compliance
27
nursing interventions for tb ( acute and continuing)
acute- Promote Airway Clearance/Secretions
Prevent Transmission
-Airborne precautions
-Negative pressure room
-Patient education
Continuing
Promote Treatment Adherence
-Multiple-medication regimen complex,
-Many side effects
Promote Activity and Adequate Nutrition
Prevent Transmission
-Patient & family education
28
classifications of pneumothorax
1.Spontaneous
-Primary - no identifiable pathology
-Secondary - underlying pulmonary disorder
2.Traumatic
-Blunt or penetrating thoracic trauma
3.Iatrogenic
-Postoperative
-Mechanical ventilation
-Thoracentesis
-Central venous cannulation
4.Tension pneumothorax
-Build up of pressure in thorax
-Compresses heart and great vessels
-Medical Emergency!!!!
29
symptoms of pneumothorax
Most common acute pleuritic chest pain
Dyspnea from pulmonary compression
Symptoms proportional to size of the pneumothorax
Depend on the degree of pulmonary reserve
Physical signs include: tachypnea, increase resonance, absent breath sounds
30
treatments for pneumothorax
1. conservative watch & evaluate
-15-25% pneumothorax
-Resolves about 1.25% per day
-Supplemental O2 can increase resolution
2. chest tube
->25% pneumothorax
-Result of mechanical ventilation
3. thoracic vent
-option for smaller pneumothorax
-able to go home
31
what are the stages of HIV
Stage 1
-Lack of AIDS defining condition
-CD4 count higher than 500cells/ml or
-Total lymphocytes over 29%
Stage 2
-Lack of AIDS defining condition
-CD4 count between 200 and 499 cells/ml or
-Total lymphocytes between 14-28%
Stage 3: AIDS:
-Presence of AIDS defining condition or
-CD4 lower than 200 cells/ml or
-Total lymphocytes less than 14%
32
HIV patient education
Reduce the number of sexual partners to one
Always use latex condoms; do not reuse
Use dental dams for oral-genital or anal stimulation
Avoid anal intercourse
Do not ingest urine or semen
Non-penetrative sexual activities
Don’t share: needles, razors, toothbrushes, sex toys
Abstinence
Mutually monogamous relationships
33
diagnostic tests for HIV
-Point of Care HIV testing (formally Rapid)- usually results in 30-60 minutes; not always accurate
-Further testing to confirm reactive test-used when POC HIV is positive- Enzyme-linked immunosorbent assay (ELISA)
-Western blot antibody testing-More reliable than ELISA,More expensive,Takes longer
-HIV viral load tests-Measures amount of actively replicating HIV
-CBC
-CD4 cell count- monitors progress of disease
34
HIV pharmacology treatment
highly active antiretroviral therapy (HAART)- combines 3-4 drugs
protease inhibitors
most of these drugs end in -vir
*** there is a slide with a handful of meds but i wrote we are not tested on them***
35
what drugs are given to patients at high risk for being infected with HIV
truvada
descovy
dapivire
35
what drugs are given to patients at high risk for being infected with HIV
truvada
descovy
dapivire
36
what kind of precautions is a patient with HIV on
standard
37
what is acute stress disorder
A reaction to an event causing fear, hopelessness, and horror, starts soon after event lasting about 1 month
38
what is ptsd
A disturbing patter of behaviors by someone who experienced, witnessed or has been confronted with a traumatic event
39
what is adjustment disorder
A reaction to a stressful event that causes problems for the individual
40
what is dissociation
A subconscious defense mechanism that helps protect a person from experiencing the full effects of some horrific or traumatic events
41
symptoms of acute stress disorder
Loss of event recollection
Absent emotional response
Reliving event via flashbacks
Dissociation and Depersonalization
Increased irritability
Issues with sleep
42
what is a maturational/developmental crisis
Expected naturally occurring in life
ex. leaving for college
43
what is a situational crisis
sudden in nature, unanticipated
ex loss of job/spouse
44
what is a adventitious/ social crisis
natural disasters
45
risk factors for PTSD
Directly involved in traumatic event
Experience physical injury
Loss of loved one(s)
Lack of social supports
Previous psychiatric hx , family psych hx(esp. anxiety) or personality factors
Early separation from parents
Parental poverty
Childhood behavioral problems
Abuse in child hood
Adverse life events prior to trauma
Limited education
Female
46
ptsd diagnostic criteria
symptoms grouped in clusters:
A.Exposure to threat
B.Intrusion symptoms
C.Avoidance of stimuli
D.Negative mood and cognitive association with the event
E.Changes in arousal and reactivity
F.Duration of symptoms of B,C,D,E > 1 month
G.Clinical distress is noted
H.Distress not attributed to physiological disorder or substance
47
what is involved in ptsd assessment
-History of trauma/stress/abuse
-Observation of patient(appearance, behaviors etc)
-mood and affect range
-thought process/content (nightmares, hallucinations)
- sensorium/intellectual processes (memory gaps, poor decisions)
-roles/relationships (issues with)
-physiologic concerns(change in sleep, appetite, drug use)
48
therapeutic interventions for ptsd
-Focus on improving self-esteem & promote empowerment
-Refer to patient as a “Survivor” not victim
-Keep conversations/interactions structured
-Monitor use of humor and abstract conversations
-Assess for comorbidities
-Help Identify flashback triggers
-Reassure them they are safe during traumatic flashbacks
-Help with problem solving
-Watch for self harm behaviors
-Remind about past achievements
-Help to identify helpful defense mechanisms
49
ptsd treatments
psychotherapy
meds
self help groups
behavioral therapies
mental health promotion
50
ptsd medications
antidepressants:
SSRIs- Sertraline (Zoloft)
Paroxetine (Paxil)
Fluoxetine (Prozac)
SNRIs- Venlafaxine (Effexor)
Duloxetine (Cymbalta)
51
Normal respirations for newborns
30-60
52
normal respirations for infants
20-40
53
normal respirations for toddlers
20-30
54
normal respirations for elderly
12-24
55
normal respiratory physiology
Hypercarbia drives breathing
-Receptor sites in aortic arch
Requirements for normal O2 delivery
-Inflated, well-oxygenated alveolus
-Alveoli capillary association
-Free-flowing blood and adequate BP
56
Normal Ventilation/ Normal Perfusion
Intact breathing, oxygenation, perfusion;
If dyspnea present,
non-cardiopulmonary, ex neuromuscular
57
Inadequate Ventilation/Normal Perfusion
Reduced ventilation (into alveoli) to lungs
*Unoxygenated blood moves through heart into systemic circulation
*Obstruction in distal airways
*Pneumonia
*Atelectasis
*Tumor
*Mucus plug
*COPD
*Asthma
*Alveoli have collapsed or fluid filled
58
Normal Ventilation/ Inadequate Perfusion
Blood flow not able to reach capillaries to exchange
*Low cardiac output poor blood flow through capillaries
*Pulmonary hypertension
*Pulmonary Emboli
59
Inadequate Ventilation/ Inadequate Perfusion
Little or no ventilation and perfusion are present
*ARDS
60
alterations in oxygenation in infants due to their altered physiology
their airway diameter
61
alterations in oxygenation in elderly due to their altered physiology
DECREASED
-cough reflex
-Cilia
-Elasticity
-Chest wall movement
-Exercise
INCREASED
-Infection rate
-Chronic disease
-Kyphosis
62
Short Acting Beta Agonists
(for airway constriction)
-Albuterol
-Levalbuterol
63
Long Acting Beta Agonists
(for airway constriction)
-Serevent (Salmeterol)
-Foradil (Formoterol)
64
Long Acting Beta Agonists/ Corticosteroid combination
(for airway constriction)
-Symbicort (Formeterol-Budesonide)
-Advair (Salmeterol-Fluticasone)
65
Corticosteroids
-Short acting Oral/IV- Prednisone/ Solu-Medrol (Methylprednisolone)
-Long acting inhaled- Pulmicort (Budesonide)/ Asmanex (Mometasone)
66
Anticholinergics
-Atrovent (Ipatroprium)
-Spiriva (Tiotropium)
67
Xanthines
-Aminophylline (Theophylline)
68
ABG's
PH, PaCO2, HCO3, PaO2, SaO2
69
normal PaCO2
35-45
70
normal HCO3
22-26
71
normal PaO2
80-100
(less than 80 is hypoxemia)
72
normal SaO2
95-100
(less than 95% is hypoxia)
73
Positive Communication
-“Before I go, do you have any questions?”
-“I brought this blanket, so you’ll stay warm during your radiology test.”
-“For your privacy, I’m closing this door.”
-“Is this a good time to...?”
-“Can you reach everything?”
-“Can I help you with that?”
74
Negative Communication
-“It’s not my job...it’s not my problem.”
-“We’re short staffed.”
-“I can’t believe they kept you waiting so long.”
-“No one told me you were here.”
-“We have REAL emergencies ahead of you.”
-“You know how administration is around here.”
75
Assertive Communication
-“I” statements
-Repetition
-Confidence
-Managing nonverbal communication
-Thinking before speaking
-Avoiding apologizing whenever possible
-Performing a post conversation evaluation
76
Aggressive Communication
-Is negative
-It violates the rights of
people
-Not based on caring
-Often involves anger,
yelling
-Achieves short term
results
77
Passive Communication
-Usually done to placate
-Causes negative feelings
-Continues until the passive person is overwhelmed
-Sometimes is seen in abusive relationships
78
types of conflict
-Intrapersonal: Internal conflict
-Interpersonal: Between individuals
- Intergroup: Between different groups or departments
-Organizational: Within an organization
79
Informal Leaders
-Respected for wisdom &
willingness to share it
-Role model for excellent
leadership
-Quietly lead care team
-High standards of performance
-No official title or office
-The go to person
-Power is earned
80
Formal Leaders
-Responsible to anticipate the changes in health care systems and to lead the organization to success
-Little room for error
-Identifies, seeks out informal leaders
-Establishes a positive relationship with informal leaders
81
Effective Leaders
They are expert at making people feel good about their jobs and their work environment
-Constancy
-Congruity
-Reliability
-Integrity
82
Autocratic Leadership
-Task oriented
-Makes decisions for the group
-Motivates through
-Praise
-Blame
-Reward
-Best leader in an emergency
-Issues commands, not requests
-Maslow
-One way: top down
83
Democratic Leadership
-Focuses on individual
-Uses group process
-Likely to give suggestions, share info
-Emergencies pose problem
-Usually no power struggles
-Maslow
-Two way: giving-seeking
84
Laissez-Faire
-Refuses to assume the leadership role
-Workers have no supervision, direction
-No praise, criticism, feedback, info
-Frustrating situation for all employees
-Chaos in the system
-Maslow
-Little communication with employees
85
Paradigm
A paradigm is a box or rules that restrict or
constrict our thoughts and beliefs.
-A Paradigm shift
-Changing the way we look at things
-A challenge to one’s views, perceptions or beliefs
-Like rewriting a fairy tale or nursery rhyme
86
Lewin’s Theory: Unfreezing
-Educating about the planned change
-What, Why
-Decreases resistance against “threat”
-2 rules with unfreezing
-Don’t implement until unfreezing occurs
-Provide psychological safety everyone involved
87
Lewin’s Theory: Change
-Change happens
-Mistakes can be made
-Provide support
-View as a learning experience
-Managers need to express appreciation
-Combat resistance!
88
Lewin’s Theory: Refreezing
-Environment stabilizes
-Change integrated
-Policies & procedures related to change
are imbedded
-Refreezing in the new reality
-Change becomes new comfort zone
89
Delegation Per the American Nurses Association (ANA)
“....reassigning a responsibility for the performance
of a job from one person to another.
-“It is crucial to understand that states have different
laws and rules/regulations about delegation, and it is
the responsibility of all licensed nurses to know what
is permitted in their state (NCSBN, 2017)
90
Delegation vs. Supervision
-They are not the same!!!!
-Supervision is directly overseeing the work or
performance of another
-May supervise and delegate tasks and activities
91
Qualities of a leader
Empathy Caring Respectful Initiative
Positive
Attitude
Problem
Solver
Critical
Thinker
Self
Directed
Confident Energetic
92
Transformational
Leadership
-Guides staff by inspiring followers
-High level of engagement enhances satisfaction
- Promotes positive work environment
-Decreases staff turn over
-Reward good performance
-Correct bad performance
-Self-confident, self-directed, honest, loyal,
committed
-Empowers staff
93
Management behaviors and qualities
Behaviors: Interpersonal, Decisional, Informational activities
Qualities: Leadership skills, Clinical expertise, Business sense
94
Vicarious PTSD
Also called: Trauma exposure response, Compassion fatigue, Secondary traumatic stress disorder, Empathic strain
who is being diagnosed?* Could be anyone who is exposed to human suffering
-Veterinarians
-Animal rescue workers
-Biologists
-Ecologists
95
PTSD Education
Goals:
-Patients are able to identify symptoms of anxiety
-Patients know when to notify provider of increased
symptoms
-Patients understand medication
-Patients have access to different coping strategies
96
Trauma/Abuse Treatment Outcomes
The client will:
-Be physically safe
-Distinguish between ideas of self-harm and taking
action on those ideas
-Demonstrate healthy, effective ways of dealing with
stress
-Express emotions nondestructively
-Establish a social support system in the community
97
Pediatric Considerations for respiratory
At birth
-Only about 25 million alveoli
-Child’s airway shorter, narrower
-Narrower airway causes increased resistance
-Trachea length increases in first 5 years
-Diminished cough reflex
-Immature immune system
-Environmental exposure
-High risk of adverse outcomes
-Pneumonia often resolves much sooner
98
Acute Respiratory Distress Syndrome (ARDS)
*NOT A DISEASE*
*A STATE OF RESPIRATORY FAILURE*
-Rapid onset severe inflammatory process causing a malfunction in the
lungs ability to take in oxygen
-Alveoli capillary membrane damage leads to intravascular fluid leakage
-Diffuse alveolar dysfunction
-Alveolar cellular lining begins sloughing
-Mortality 30-40%
-Not primary diagnosis
99
Acute Respiratory Distress Syndrome (ARDS): Causes
Direct Lung injury
-Aspiration
-Pneumonia
-PE
-Pulmonary Contusion
-Near Drowning
-Smoke inhalation
Indirect Lung injury- release of inflammatory cytokines
-Sepsis
-Trauma
-Massive Transfusion
-Overdose
-Burns
-DIC
-Pancreatitis
-Uremia
-Amniotic and air emboli
-Open heart surgery with bypass
100
Acute Respiratory Distress Syndrome (ARDS): Signs & Symptoms
*NON-CARDIAC PULMONARY EDEMA
REFRACTORY HYPOXEMIA
-Cyanosis refractory to O2
-Rapid onset severe dyspnea < 72 hours from event
-Labored breathing
-Tachypnea
-Retractions
-Moist skin
-Decreasing LOC
-Scattered crackles and Rhonchi in all lung fields (alveolar condition)
-Bilateral infiltrates on CXR
101
Acute Respiratory Distress Syndrome (ARDS): Testing
Labs:
-CBC
-Chemistry panels
-Lactic acid
-ABGs
-Sputum specimen
Imaging:
-CXR or CT
102
Acute Respiratory Distress Syndrome (ARDS): Treatment
*Treat underlying cause*
-Control process causing fluid leakage
Ventilator support:
-Intubation
-IV fluids to maintain
hemodynamic status
-Nutritional support
-HOB 30◦ or greater
-Positioning
103
Acute Respiratory Distress Syndrome (ARDS): Pharmacologic Treatment
-Bronchodilators
-Surfactant
-Corticosteroids
-Meds to support
ventilated patients
104
Acute Respiratory Distress Syndrome (ARDS): Complications
-Unregulated inflammatory response prevents O2/CO2 exchange
-Leads to multisystem failure
–GI
–Kidneys
–Extremities
–Bones
The body’s protective mechanism to save brain and heart at expense of other organs
105
what are the most common infectious cause of death in the US?
pneumonia and influenza
106
what is pneumonia?
inflammation of lung parenchyma, disorder of lower respiratory system that affects respiration, ability to ventilate, and airway patency
107
bacterial pneumonia is ______.
unilateral lobar pneumonia
108
viral pneumonia is _______.
scattered patchy pattern of bronchopneumonia
109
aspiration pneumonia is ______.
chemical injury causing inflammatory response- open to bacterial invasion
110
etiology and pathophysiology of pneumonia
Once organism is in the upper airways, it multiplies in the epithelium and spreads to the lungs
A gel-like substance forms as microorganisms and phagocytic cells break down
Forms consolidation within the lower airway structures
Inflammation occurs and involves the alveoli, ducts and interstitial spaces around alveoli
PNA can also result from bloodborne organisms that enter the pulmonary circulation and are trapped in the pulmonary-capillary bed
111
clinical manifestations of pneumonia?
cough
fever
chills
tachy
tachypnea
dyspnea
hemoptysis
excessive mucus production
chest pain
diminished appetite
cyanosis
manifestations of impaired gas exchange
112
classifications of pneumonia?
community acquired, health care associated, hospital acquired, ventilator associated
113
symptoms of community-acquired pneumonia?
develops quickly, SOB, cough, heavy sputum, fever, chill, chest pain, n/v
114
what is an important distinction in health-care associated pneumonia?
causative pathogens often multi-drug resistive- difficult to treat due to MDR pathogen
115
usual presentation of hospital acquired pneumonia?
new pulmonary infiltrate on CXR, evidence of infection (fever, resp. sx, purulent sputum, leukocytosis), develops > 48hrs after admission
116
what is consolidation?
tissue that solidifies as a result of collapsed alveoli or infectious process, such as pneumonia, and bacteremia
(white patchy area on CXR)
117
risk factors for hospital acquired pneumonia?
Impaired host defenses
Acute or chronic illness
Supine positioning – not getting out of bed
Aspiration
Coma
Malnutrition
Prolonged hospitalization
Emergency surgery
Depressed cough
Weak gag reflex
Impaired swallowing
118
nursing interventions for hospital acquired pneumonia?
Keep HOB up 30 degrees
Avoid stimulation of gag reflex with suctioning
Check tube placement
Thickened liquids
TCDB
Early ambulation
Mouth Care
119
ventilator-associated pneumonia requirement
endotracheal intubation with ventilator support for > 48 hours; form of HAP; most common infection in ICU
120
how many alveoli do adults and children have?
adults- 600 million; at birth only 25 million
121
pediatric considerations for pneumonia?
Child’s airway shorter, narrower
Narrower airway causes increased resistance
Trachea length increases in first 5 years
Diminished cough reflex
Immature immune system
Environmental exposure
High risk of adverse outcomes
Pneumonia often resolves much sooner
122
pediatric pneumonia clinical manifestations
Children under 6 use diaphragm to breath
Leads to retractions
Oxygen consumption higher in children;
kids don't have a decline like adults- they're compensatory mechanisms just shut off
123
pneumonia complications
Continuing symptoms after initiation of therapy
Sepsis and septic shock
Respiratory failure
Atelectasis
Pleural effusion
Changes in mental status
124
diagnostic tests for pneumonia
CXR
CT
Sputum Gram stain, culture and sensitivity
CBC with WBC differential
Serology testing
Pulse oximetry, ABG’s
Fiberoptic Bronchoscopy
125
tx for pneumonia?
Antibiotic therapy as indicated
IV then PO
Humidified O2 support
Antitussives (help with cough)
Expectorants: Mucinex (Guaifenesin)
Bronchodilators, inhalers and/or neb treatments
Antipyretics
IV fluids
Corticosteroids for inflammation (solumedrol)
126
robitussin vs mucinex
both guaifenesin, robitussin is short acting and mucinex is long acting
127
pneumonia vaccine information
antigens from 23 types of pneumococcus, recommended for all patients 65+ and those with chronic diseases, pneumococcal vaccine provides lifetime immunity
128
indications for endotracheal intubation?
trauma to trachea or to face to ensure patient can breathe, resp arrest, ARDS, anytime patient is unable to oxygenate or protect their airway this will be a discussion
129
cuffed vs uncuffed ET intubation
cuffed has balloon that inflates (used to be used primarily for kids); uncuffed- no balloon
130
how long can patient be intubated for?
Pt can be intubated for 14 days before they need to be extubated or trached and pegged due to the damage to the trachea it will cause (fragile tissue), causes scar tissue and pressure injuries
131
what is tracheostomy for?
long term vent use to bypass upper airway; can be cuffed, uncuffed, or fenestrated
132
what can pt have if suctioning with trach and you hit carina?
bradycardia
133
tracheostomy complications?
mucus plug
134
what is PEEP?
positive end expiratory pressure; pressure within lungs during exhalation - measured in cm of H2O, helps leave alveoli open to avoid atelectasis
135
normal tidal volume?
400-800mL, based on ml/kg
136
what is FiO2 for with ventilator?
% of oxygen to maintain normal PaO2 at lowest O2 setting
137
RR to be kept for vented pts?
12-18
138
how long can weaning from a vent take?
hours to weeks; pressure support for weaning similar to BiPap
139
ventilator complications?
Improper ET placement
Hospital-acquired pneumonia or VAP
Barotrauma
Pneumothorax
GI effects
Alarms
140
causes of high pressure vent alarms?
increased secretions in airway; decreased airway size due to wheezing or bronchospasm; displacement of ET tube; obstructed ET tube (water/kink); pt coughs, gags, or bites ET tube; anxious pts- bucking on vent
141
causes of low pressure vent alarms?
disconnection/leak in the ventilator or airway cuff; pt stops spontaneously breathing
142
trouble shooting vent problems: DOPES
displacement
obstruction
pneumothorax
equipment
stacked pants
143
post weaning for vent interventions
O2 therapy, ABG’s pulse Ox, bronchodilator therapy, Chest pt, nutrition, hydration, humidification, IS
144
what makes up the immune system?
neutrophils, eosinophils, basophils, monocytes, b-lymphocytes, t-lymphocytes, natural killer cells
145
neutrophil function?
immune defenses
146
eosinophil function?
defense against pathogens
147
basophil function?
inflammatory response
148
monocyte function?
immune surveillance
149
b-lymphocyte function?
antibody production
150
t-lymphocyte function?
cellular immune response
151
normal WBC count?
5,000 - 10,000
152
WBC count for leukopenia?
WBC under 4,500
153
WBC count for neutropenia?
under 2,000
154
what is left shift?
increase in banded or immature neutrophils, infectious process
155
what are T-cells?
Created in thymus
Approx. 75% of all lymphocytes
Mature into
Active helper T cells
Cytotoxic T cells
Memory T cells
156
what are B-cells?
Created in bone marrow
Approx. 10% of lymphocytes
Mature when activated into:
Plasma cells
Secrete antibodies or memory cells
157
what are natural killer cells?
Found in
Spleen,
Lymph nodes,
Bone marrow
Blood
Immune surveillance and resistance to infection
Destruction of early malignant cells
They are cytotoxic
158
what is reactive oxygen species? (ROS)
an molecule that is formed with oxygen and is imbalanced due to an odd number of electrons- it takes electrons from other molecules to stabilize and excessive amounts of them causes cell damage and death
159
ROS works with NK cells to _________.
attack cancer cells
160
what are examples of molecules formed with oxygen?
peroxide, superoxide, hydroxyl radical, singlet oxygen, alpha-oxygen
161
what can ROS cause?
cellular apoptosis *why we only use hydrogen peroxide for wound care with external fixators
162
What is the problem with too much oxygen and ROS?
excess oxygen causes production of peroxynitrite which is an ROS-
ROS causes deterioration/aging/death of cells
ROS causes changes to DNA that can cause cancer
ROS effects on LDL believed to be cause of heart disease
ROS can cause damage to any cell in the body
163
How can ROS be treated?
*neutralization of ROS or free radicals*
antioxidants provide electron for balance (vit E, vit C, beta carotene)
