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Nursing 4 Exam 1 > Unit 2 Acute Respiratory Imbalances/Mechanical Ventiliation > Flashcards

Unit 2 Acute Respiratory Imbalances/Mechanical Ventiliation Flashcards

1
Q

What are the normal ABG ranges?

What are the normal PaO2 and SaO2 levels and what do they mean?

A

pH 7.35-7.45
PaCO2 45-35
HCO3 22-26

PaO2 80-100 mmHg (amount of free O2 in blood not bound to anything)
SaO2 95-100% (amount of O2 bound to Hgb)

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2
Q

What is respiratory acidosis? metabolic?

What is respiratory alkalosis? metabolic?

A

Resp. Acidosis: Body maintains extra CO2 (ex: COPD)
Met. Acidosis: Impaired kidney function, excessive diarrhea

Resp. Alk: Increased Hyperventilating
Met. Alk: Losing too much acid from body (vomiting, NGT)

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3
Q

What are the hypoxemia levels?

A

Mild < 80

Moderate < 60

Severe < 40

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4
Q

What is the rule associated the oxyhemoglobin disassociation curve?

A

30,60,90 rule

As PaO2 increases, SaO2 increases

PaO2 30 = SaO2 60%
PaO2 60 = SaO2 90%
PaO2 90 = SaO2 100%

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5
Q

What is PVO2 (Venous Oxygen)?

What are the normal levels? What does it mean if the O2 levels are higher?

A

Amount of free flowing O2 left in the blood/ coming back to the heart after circulating through the body (deoxygenated blood)

Oxygen poor at 40 mmHg
Rich in CO2 at 45 mmHg

If O2 levels are higher here, body is not using O2 for whatever reason

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6
Q

What is SVO2 and the normal level? What is it a good indicator of?

A

The amount of saturated Hgb coming back to the heart after going through the body

(good indicator if PT can tolerate an activity)

Normal 60-80%

S- think saturated Hgb

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7
Q

What is true regarding SVO2 and a fever?

A

There are higher O2 demands with fever so when you decrease the fever, oxygen demands decrease and SVO2 increases.

Increase temp = Decreased SVO2
Decreased temp = Increase SVO2

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8
Q

What is considered Acute Respiratory Failure? What are the types?

A

PaO2 <60
SaO2 <90%
or PaCO2 >50

Seen to be acidotic; cannot eliminate CO2

Hypoxemic respiratory failure, ARDS, and ventilatory respiratory failure.

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9
Q

What is hypoxemic respiratory failure? What are examples?

A

Ex: ARDS, ARF

  • Perfusion problem
  • Abnormal Hgb won’t absorb O2
  • Shunting of blood past lungs without oxygenation

-Essentially it is impaired diffusion of O2 at the alveoli because they are compromised.

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10
Q

What are some reasons we could have oxygen failure?

A 
Pneumonia
Pneumothorax 
Hemothorax
PE
Atelectasis 
V/Q mismatch (ventilatory/perfusion mismatch)
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11
Q

What are signs and symptoms of hypoxemia?

A
  • Asymptomatic
  • Headache
  • Cognitive deficit
  • Tachypnea
  • Tachycardia
  • Bradycardia
  • Hypotension
  • Circumoral cyanosis (late sign)
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12
Q

What are diagnostic procedures for ARF?

A 
Monitor pulse ox
Chest x-ray
ABGs
Capnography (ETCO2)
Bronchoscopy 
V/Q scanning
CT scan
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13
Q

What is ETCO2?

A

“PaCO2” but without arterial stick

normal 45-35, typically expressed 5-6%

It’s the max CO2 at the end of expiration.

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14
Q

What are oxygenation failure interventions?

A

Give oxygen (nasal, mask, CiPap, ventilator if needed)
Bronchodialators (albuterol, etc)
Position of Comfort
C and DB

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15
Q

Describe how Carbon Monoxide (CO) poisoning.

A

At a rate of 200-250x more tightly than O2.
(oxygen levels will appear normal)

Can come from fires, or exposure to toxic gases.

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16
Q

What can be assessed in someone with CO poisoning?

A 
Headache
Dizziness
Malaise (general ill feeling)
Nausea 
AMS progressing to coma
Cherry red color
Normal PaO2/SaO2
Carboxyhemoglobin level > 8 (<8 is normal)
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17
Q

What is the treatment and prevention of CO poisoning?

A
  • Give 100% O2 with non-rebreather mask
  • Education
  • CO detector
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18
Q

What can ARDS come from and what is it?

A
  1. Catastrophic events, accidents, near drowning, shock, inhalation of toxic gases, burns, sepsis
  2. High altitude travel
  3. Aspiration of gastric contents

Essentially some type of acute lung injury, lung failure

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19
Q

What can be assessed in ARDS?

A
  • Increases work of breathing, signs and symptoms of hypoxemic failure
  • Decreased PaO2,
  • Poorly responsive to increased O2 and/or ventilation which is known as refractory hypoxemia
  • Increased shunting of blood
  • “white out” on chest x-ray from whatever is in the alveoli
20
Q

What are interventions for ARDS?

A

-Endotracheal intubation

  • Mechanical ventilation with PEEP (positive end expiratory pressure)
  • required when PT not responding to high amounts of O2*

-Aggressive therapy including prone position

21
Q

What is ventilatory respiratory failure? What does it result in?

A

A type of ARF where perfusion is normal, but ventilation is inadequate.

Results in hypercapnia (Increased CO2)

22
Q

What is a common goal of ARDS?

A

Too improve SaO2 and PaO2 within 24 hrs.

23
Q

What is the etiology of VRF? (How could it happen?)

A

-Mechanical abnormality of chest wall of lung ex: pneumothorax, tumor, hemothorax

  • Decreased respiratory drive
    ex: sedation, O.D, Neuro Impairment
  • Impaired respiratory muscles
    ex: muscular dystrophy, spinal cord injury
24
Q

What are signs and symptoms of hypercapnia?

A
  • Asterixis (abnormal muscle twitching)
  • Headache
  • Dizziness
  • Change in LOC
  • Miosis (contraction of pupils)
  • Hypertension
  • Flushed (pink/red face)
25
Q

What are intervention for VRF?

A
  • Open airway and provide manual ventilations
  • Treat underlying cause
  • Mechanical ventilation may be required
26
Q

What are indications for mechanical ventilation?

A

PaO2 cannot be maintained above 50mmHg

PaCO2 rises above 50mmHg

Airway protection

27
Q

What is the difference between positive pressure vs negative pressure?

A

Positive pressure pushes air into lungs (needs artificial airway) ex: Endotracheal tube

Negative pressure surrounds lungs and uses negative pressure to maximize ventilation ex: Iron lung

28
Q

What should always be available in a PT’s room on mechanical ventilation?

A

“ambu-bag”

Bag-valve mask

29
Q

What do you need for PP ventilation? Who sets the mode, rate, and FIO2 on a ventilator?

A

Ventilator - physician’s orders, respiratory therapist sets the mode, rate, and FIO2

Airway

O2 source with ambu-bag (bag-valve mask)

Suction equipment

30
Q

What is the purpose of the cuff on an ETT?

A

Cuff is inflated to make sure air goes into lungs.

31
Q

Describe the aspects of a tracheostomy tube.

A
  • More permanent than ETT
  • Directly into trachea, held by tape and dressing as well
  • Sx procedure needing pre and post op assessment
  • PT can speak with non-inflated cuff (fenestrated tube)
  • If misplaced could cause pneumothorax
32
Q

What are the nursing intervention for tube care?

A

Assess lung sounds

Suction

Secure (x-ray for placement)

Oral hygiene

cloraxehidine over betidine every 24 hrs

33
Q

What are the types of ventilator modes?

A

AC (Assisted control): Breath initiated by PT, but controlled by ventilator, delivers pre-set tidal volume
ex: ARDS, Respiratory failure, sedation

CMV (control mandatory ventilation): delivers set tidal volume and rate. used for PT’s who are chemically paralyzed or neuro status to breathe doesn’t exist

Support mode (SIMV-Synchronized intermittent mechanical ventilation): breath initiated and controlled by PT, however preset volume and rate is set for minimum

Spontaneous mode (Pressure Support): Breath is initiated and controlled by PT without any input from ventilator. Provides just PP usually 5-10 and FIO2.

Typical progression Assisted, Support, Spontaneous

34
Q

Describe the types of ventilator settings. Tidal volume, FIO2, PEEP, CPAP.

A

[Tidal Volume (Vt or TV)]
-Amount of air given in each breath, usually in PT’s weight

[FIO2]
- Amount of O2 % ventilator delivers
Goal is to keep < 50% because high amounts can be toxic.

{PEEP]
-Increases volume of gas remaining in the lungs at the end of expiration, keeps alveoli open.

[CPAP]
-Non invasive way to deliver PEEP, needs spontaneous breathing

35
Q

What can often be added to allow FIO2 to be decreased?

A

PEEP

36
Q

What are complications of Mechanical Ventilation?

A

Airway: displaced, obstruction

Infection: ventilator associated pneumonia

Barotrauma: ventilator associated lung injury

37
Q

What are general nursing measures/interventions for a PT on mechanical ventilation?

A

Monitor chest expansion, auscultate breath sounds. take VS Q2-4h

Note characteristics of secretions

Turn PT Q2h, mouth care Q2h

Comfort measures

38
Q

What is refractory hypoxemia?

A

Despite mechanical ventilation and oxygenation, unable to have obtain adequate O2

39
Q

What is VAP (ventilator associated pneumonia prevention) [bundle]

A
  • Prevention of aspiration by HOB 30-45 degress
  • Oral hygiene Q4h
  • Clorahexidine every 24hrs
  • GI prophylaxis
  • DVT prophylaxis
  • Drug holiday (wean down sedation to assess PT)
40
Q

What are medications used with mechanical ventilation? What is the goal with sedation?

A

pancuronium bromide

cisatracurium

  • neuromuscular blocking agents, PT will be paralyzed
  • still want to sedate*

propofol (Diprivan) - an anesthetic agent which causes hypnosis

To remove IV sedation after 3 days

41
Q

What are the methods of weaning from a vent?

A

Gradually decreasing RR until breaths are PT’s own

Pressure support (only PEEP and FIO2)

42
Q

During extubation what are the nursing responsibilities?

A
  • Give humidified O2 to prevent brocnhospasms via oxygen mask or NC
  • Teach C and DB exercises
  • Treatment with bronchodilator for laryngyspasm
43
Q

Describe what the High-pressure alarm and Low-pressure alarm indicates on he ventilator system. What should the nurse do?

A

High-pressure - Indicates resistance or obstruction of airflow from biting on ETT, kink in tubing, or something severe i.e pneumothorax

Nurse should check tubing, eliminate any water or kinks and assess status of PT

Low-Pressure - indicates disconnection from machine or displacement of airway

Nurse should look for disconnected tubing or an air leak. (most common places for leaks are around ETT cuff or poorly secured connections)

44
Q

What are the types of sedation scales?

A

Ramsey scale - 2 is normal the further up would be towards non responsive

Richmond agitation sedation scale (RASS) - 0 is normal. + numbers and higher mean increased agitation
- numbers and “higher” go towards unresponsiveness

45
Q

What does “white out” on a chest x-ray indicate?

A

ARDS

Nursing 4 Exam 1 (6 decks)

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