Term
| Strongest independent variable to increase a stay in the hospital. Reversible and acute mental state. May be hospital acquired. |
|
Definition
|
|
Term
| Not reversible; chronic mental status change. |
|
Definition
|
|
Term
|
Definition
Pain
Sedation
Altered Sleep/Wake cycles. |
|
|
Term
| The lack of this feature increases delirium. |
|
Definition
|
|
Term
| It takes ___ minutes to hit REM sleep. |
|
Definition
|
|
Term
| How can you decrease your chances of being sued? |
|
Definition
| Develop a rapport with family and patient. |
|
|
Term
| What is the number one thing patients and their families want from us? |
|
Definition
|
|
Term
| Patients will feel more in control and family will feel more useful if you let them do what? |
|
Definition
|
|
Term
| What aspects of changing care should you describe to a patient changing units? |
|
Definition
Different Meds
Less frequent assessments
Patient to nurse ratio |
|
|
Term
| What does teaching a patient about their condition do for them? |
|
Definition
|
|
Term
|
Definition
| Providing care at the end of life that is unnecessary. |
|
|
Term
Chaplain
Nurses
Physicians
Social Workers
Lay Person
These people are all part of what committee in the hospital? |
|
Definition
|
|
Term
| Failure of person to act in a reasonable and prudent manner. |
|
Definition
|
|
Term
| What two kinds of acts does negligence encompass? |
|
Definition
|
|
Term
| Unilateral severance of patient nurse relationship. |
|
Definition
|
|
Term
| What 3 aspects must be present in informed consent? |
|
Definition
Competence
Voluntary
Disclosure of information |
|
|
Term
| How old must a minor be to provide consent? |
|
Definition
|
|
Term
| How can a minor become emancipated? |
|
Definition
Married
Pregnant
Living on their own for at least 1 year |
|
|
Term
| Least limited form of DNR. |
|
Definition
|
|
Term
| Discontinuing care e.g. tube feeding/ventilator |
|
Definition
|
|
Term
| Electrical Conduction System |
|
Definition
| SA node --> AV node --> Bundle of HIS --> Right and Left Bundle Branches --> Purkinje Fibers -->Ventricular Cells |
|
|
Term
| Contraction; positive ions move from inside cell to outside the cell. |
|
Definition
|
|
Term
| Atrial depolarization; should be upright rounded & symmetrical with one to every QRS |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Ventricular depolarization; does not have to have a Q wave. |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Occurs when cellular membrane returns to the resting potential. |
|
Definition
|
|
Term
| Ventricular repolarization; stimulus during this period can send pt into Vfib or Vtach. |
|
Definition
|
|
Term
| Amount of time for ventricular depolarization and repolarization. |
|
Definition
|
|
Term
| Active part of breathing, shorter. |
|
Definition
|
|
Term
| Passive part of breathing due to intrapulmonary pressures being greater than atmospheric pressure. |
|
Definition
|
|
Term
| Considered negative due to the pull of the 2 pleural membranes in opposite directions. |
|
Definition
|
|
Term
| Equal to or greater than atmospheric pressure the lung will collapse. |
|
Definition
|
|
Term
| Elastic property of lung & airflow resistance . |
|
Definition
|
|
Term
| Lung compliance is increased with _____. |
|
Definition
|
|
Term
| ARDS, PE, lung disease and morbid obesity (Pickwickian's syndrome) do what to lung compliance. |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| pH is not back in the normal range but both CO2 & HCO3 are not out of the normal range. |
|
Definition
|
|
Term
| pH not in the normal range but CO2 & HCO3 are out of range. |
|
Definition
| Partially compensated ABG |
|
|
Term
| pH back in the normal range & CO2 & HCO3 are out of range. |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Measure of the partial pressure of oxygen dissolved in arterial blood plasma |
|
Definition
|
|
Term
| Amount of O2 bound to HgB (does not take into account low HgB levels) |
|
Definition
|
|
Term
| What kind of people have a normally lower PaO2 |
|
Definition
| Infants and >60 years old |
|
|
Term
| If PaO2 is less than ___ mm Hg it is a life threatening event. |
|
Definition
|
|
Term
| If PaO2 is less than ___ mm Hg the patient is considered hypoxic. |
|
Definition
|
|
Term
| The amount of HCO3 needed to return the pH to normal. |
|
Definition
|
|
Term
| In metabolic alkalosis there is too much _______. |
|
Definition
|
|
Term
| In metabolic _______ there is not enough HCO3 |
|
Definition
|
|
Term
| Measure of the total amount of O2 carried in the blood: including the amount dissolved in plasma and the amount bound to HgB. Accounts for HgB level. |
|
Definition
|
|
Term
| Measurement of the amount of O2 bound to hemoglobin; pulse ox reading, arterial saturation. |
|
Definition
|
|
Term
| This reading cannot measure CO2 levels or detect the amount of HgB. |
|
Definition
|
|
Term
| Measurement of CO2 at bedside. |
|
Definition
|
|
Term
| Measures the amount of CO2 in exhaled air. |
|
Definition
|
|
Term
| End tidal is usually 1-5 mm Hg less than _______. |
|
Definition
|
|
Term
| Collected in a sterile manner if suctioned via ET or trach. |
|
Definition
|
|
Term
| Visualization of lung tissue; samples may also be taken. |
|
Definition
|
|
Term
| When can a patient have fluids post bronchoscopy? |
|
Definition
| When fully awake & gag reflex has returned |
|
|
Term
| Ensure that a bronchoscopy patient has been ____ for 6-8 hrs prior to sedation. |
|
Definition
|
|
Term
| Removal of fluid from the pleural space. |
|
Definition
|
|
Term
| What must a patient not do during thoracentesis? |
|
Definition
|
|
Term
| What may happen if a patient moves or coughs during a bronchoscopy? |
|
Definition
|
|
Term
| What position should a patient be in for a thoracentesis? |
|
Definition
| Sitting on the side of the bed draped over bed side table. |
|
|
Term
| Evaluates pulmonary functioning through lung volumes, mechanics of breathing, diffusion & ABGs. |
|
Definition
| Bedside Pulmonary Function Tests |
|
|
Term
| Used when a discrepancy is thought to be occurring between ventilation and perfusion. |
|
Definition
| Ventilation Perfusion Scan |
|
|
Term
| This is most commonly used for suspected PEs but is not considered the gold standard for diagnosis of PEs. |
|
Definition
| Ventilation Perfusion Scan |
|
|
Term
| Patient inhales a radiolabeled gas and air mixture. |
|
Definition
|
|
Term
| Injecting the patient with radioisotope via vein. |
|
Definition
|
|
Term
|
Definition
|
|
Term
| This allows you to visualize bony structures; organs such as lung & heart, fluid & foreign objects. |
|
Definition
|
|
Term
| Lungs are not able to maintain adequate gas exchange (could be O2 and/or CO2) |
|
Definition
| Acute Respiratory Failure |
|
|
Term
| Damage to brain, spinal cord, neuromuscular, thorax, pleura and upper airways. |
|
Definition
|
|
Term
| Lower airways and alveoli, pulmonary circulation and alveolar capillary membrane. |
|
Definition
|
|
Term
| Hallmark signs of Acute Respiratory Failure |
|
Definition
Hypoxemia (PaO2 <60)
Hypercapnia (PaCO2 >50 - can be present but does not have to be) |
|
|
Term
| Alveolar hypoventilation, V/Q mismatch and intrapulmonary shunting are causes of what? |
|
Definition
|
|
Term
| Unoxygenated blood returns to the left side of the heart after passing through nonventilated alveoli. |
|
Definition
|
|
Term
| What can intrapulmonary shunting lead to? |
|
Definition
| MODS (multiple organ dysfunction syndrome) |
|
|
Term
| Headache, drowsiness and flushed skin are signs of _________. |
|
Definition
|
|
Term
| Decreased LOC, bradycardia, cool, clammy pale skin are sings of _____. |
|
Definition
|
|
Term
| Restlessness, confusion, agitation, tachycardia, chest pain, tachypnea, hyperventilation, dyspnea, decreased urinary output, polycythemia and cyanosis are signs of what? |
|
Definition
|
|
Term
| In patients with chronically high CO2 levels (COPD) pH should be what? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| What kind of tubefeed do you give a patient on a vent? |
|
Definition
|
|
Term
| If lung issue is unilateral place the _____ lung in dependent position. |
|
Definition
|
|
Term
| If bilateral lung problems try placing ____ lung dependent due to size and vascularity. |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Drugs to improve cardiac output |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Systemic process that is considered to be the pulmonary manifestation of MODS. |
|
Definition
| Acute Lung Injury (ALI) (ARDS) |
|
|
Term
| Noncardiogenic pulmonary edema b/c wedge pressure <18 mm Hg. |
|
Definition
|
|
Term
| Ratio of PaO2 to FiO2 less than or equal to 300 mm Hg that does not respond to supplemental O2 |
|
Definition
|
|
Term
| What CXR finding does ALI have? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Aspiration, near drowning, pulmonary contusion and pneumonia are ____ causes of ALI. |
|
Definition
|
|
Term
| Sepsis, embolism, shock states, DIC are _____ causes of ALI. |
|
Definition
|
|
Term
|
Definition
Exudative
Fibroproliferative
Resolution |
|
|
Term
| Within 72 hours of insult chemicals are released that cause injury to what? |
|
Definition
|
|
Term
| Injury to pulmonary capillaries increase capillary _______ ________ allowing fluid to leak into the lungs. |
|
Definition
|
|
Term
| Type I alveolar cells are damaged which leads to ________ _______. |
|
Definition
|
|
Term
| Type II alveolar cells are damaged which leads to decreased __________ production. |
|
Definition
|
|
Term
| Capillary damage and hypoxemia due to intrapulmonary shunting are part of the ______ phase of ALI |
|
Definition
|
|
Term
| This phase begins when healing in lungs begins. |
|
Definition
|
|
Term
| In the fibroproliferative phase _______ become enlarged and irregularly shaped. |
|
Definition
|
|
Term
| In the fibroproliferative phase ________ capillaries become scarred leading to ________ compliance of the lungs. |
|
Definition
|
|
Term
| In this phase Fluid is transported out of the lungs and type II cells begin to produce surfactant. |
|
Definition
|
|
Term
| Decreases surface tension so alveoli can expand. |
|
Definition
|
|
Term
| What kind of tidal volume is typically used on ALI patients? Why? |
|
Definition
| Low - to prevent lung barotrauma |
|
|
Term
| This helps to keep alveoli open |
|
Definition
| Positive End Expiratory Pressure (PEEP) |
|
|
Term
| What can low tidal volume lead to? |
|
Definition
| Hypercapnia & Vasodilation |
|
|
Term
|
Definition
|
|
Term
| Neuromuscular blocking agents to chemically paralyze vent patients and decrease O2 needs. |
|
Definition
|
|
Term
| Give your patient what to increase cardiac output? |
|
Definition
|
|
Term
| What position improves perfusion to less damaged areas of the lungs? (More effective during early ALI) |
|
Definition
|
|
Term
| Promising treatment for ALI that is not yet fully developed. |
|
Definition
| Partial liquid ventilation |
|
|
Term
| Machine to bypass the lungs and let the machine oxygenate. |
|
Definition
| ECMO (Extra corporeal membrane oxygenation) |
|
|
Term
| What can people inhale to vasodilate and get more HgB to the pulmonary area? |
|
Definition
|
|
Term
| This therapy for ALI is very expensive and not very helpful. |
|
Definition
|
|
Term
| Acute inflammation of the lung parenchyma that is caused by an infectious agent that can lead to alveolar consolidation. |
|
Definition
|
|
Term
| Why is aspiration pneumonia common in ICUs? |
|
Definition
Tube feedings
Sedation
Ventilation |
|
|
Term
| Oral care for vent patients. |
|
Definition
| Brush teeth Q8 hrs, cleanse mouth Q2 hrs |
|
|
Term
|
Definition
|
|
Term
| A clot (blood or other matter) that occurs in body and travels through venous circulation to the pulmonary circulation and partially or completely occludes a pulmonary artery. |
|
Definition
|
|
Term
| 50% or more of pulmonary bed is occluded |
|
Definition
|
|
Term
Damage to vessels
Venous stasis
Hypercoagulability |
|
Definition
| Virchow's triad (predisposing factors for PE) |
|
|
Term
Bedrest/immmobility
Pregnancy
Decreased CO
Infection
Dehydration
Trauma
Ortho surgery
Type A blood group
A fib
These are risk factors for what? |
|
Definition
|
|
Term
| Your patient has pleuritic chest pain and a cough with pink, frothy sputum. What is the likely Dx? |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| Initial specific Dx test for PE |
|
Definition
|
|
Term
|
Definition
|
|
Term
| This test shows how much of lung is blocked and where blockage is located for PE. |
|
Definition
|
|
Term
|
Definition
|
|
Term
| When can you use thrombolytics to reverse a PE clot? |
|
Definition
|
|
Term
| Meds used simultaneously to reduce risk for additional clotting in PE. |
|
Definition
|
|
Term
| Desired PTT for Heparin c PE |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| What INR value is Heparin DC'd at? |
|
Definition
|
|
Term
| How long does a PE pt remain on Coumadin? |
|
Definition
|
|
Term
| What surgeries can be performed for PE? |
|
Definition
Filter placement
Embolectomy |
|
|
Term
| What surgery may be used for a PE pt with massive PE or decompensating? |
|
Definition
|
|
Term
| How should you put a patients bed to prevent PE? |
|
Definition
| Elevate knees c no gatch to prevent pooling of blood. |
|
|
Term
| A severe asthma attack that does not respond to conventional Tx c bronchodilators |
|
Definition
|
|
Term
| Status asthmaticus is bronchial constriction with air _______ and excessive ________ obstruction. |
|
Definition
|
|
Term
| IgE-->mast cell release--> _______ release (status asthmaticus) |
|
Definition
|
|
Term
| Typical triggers for status asthmaticus |
|
Definition
|
|
Term
| Noncompliance with ______ and _______ infections can cause status asthmaticus. |
|
Definition
|
|
Term
| When do you expect to see more status asthmaticus |
|
Definition
|
|
Term
| What three medications are risk factors for status asthmaticus? |
|
Definition
NSAIDs
ASA
Overuse of bronchodilators |
|
|
Term
| Difficulty speaking, decreased LOC, diminished or absent LS & inability to lie supine are bad signs of what? |
|
Definition
|
|
Term
| In status asthmaticus the patient has a prolonged _________ phase and increased use of accessory muscles. |
|
Definition
|
|
Term
| A patient with status asthmaticus may have what lung percussive finding? |
|
Definition
|
|
Term
| ______ is usually <40% of normal values based on gender age and height in status asthmaticus. |
|
Definition
| PEFR (Peak expiratory flow rate) |
|
|
Term
Status asthmaticus:
PaO2 <___%
SaO2 <___% |
|
Definition
|
|
Term
| What is the pattern of PaCO2 in status asthmaticus? |
|
Definition
| Lower/normal initially (hyperventilation) may become elevated as air trapping progresses. |
|
|
Term
| Diminished BP with breath (ominous sign of status asthmaticus) |
|
Definition
|
|
Term
| Your patient with status asthmaticus has stopped wheezing, what do you do? |
|
Definition
| Assess further to determine if this is a good or bad sign. |
|
|
Term
| CXR finding with status asthmaticus. |
|
Definition
| Hyperinflated lung c secretions/mucus |
|
|
Term
| pH patients with status asthmaticus |
|
Definition
| May be alkalotic at first --> acidotic later |
|
|
Term
| What vent setting should you NOT use on a status asthmaticus patient due to the risk of pneumothorax? |
|
Definition
|
|
Term
| This class of drugs has a synergistic effect with used with bronchodilators and includes Ipratropium. |
|
Definition
|
|
Term
| Fastest working medications to decrease inflammation, mucous production and potentiate B2 agonists in status asthmaticus. |
|
Definition
|
|
Term
| Two things to watch for when your patient is on corticosteroids. |
|
Definition
| High glucose; infection (pneumonia) |
|
|
Term
| This class of drugs has a very narrow therapeutic range and no antidote. IT has not been shown to be useful for status asthmaticus. |
|
Definition
|
|
Term
| This type of trauma includes pulmonary contusion, fractured ribs, flail chest, pneumo/hemothorax, diaphragmatic rupture and cardiac contusion. |
|
Definition
| Thoracid trauma (serious in elderly, obese and pt with cardiac or pulmonary disease) 6/10 MVAs |
|
|
Term
|
Definition
|
|
Term
| Sharp stabbing pain in chest that makes it hard to breathe. |
|
Definition
|
|
Term
| Fractured ribs can lead to what? |
|
Definition
| Pneumonia r/t not deep breathing |
|
|
Term
| Most effective pain control for fractured ribs that does not interfere c coughing, sighing or deep breathing. |
|
Definition
|
|
Term
| How do you stabilize fractured ribs? |
|
Definition
| You don't! Binders are not recommended |
|
|
Term
| Medication used in intercostal nerve block |
|
Definition
|
|
Term
| Important nursing intervention c fractured ribs |
|
Definition
| Bronchial hygiene (coughing, deep breathing, sighing) |
|
|
Term
| This injury is treated with traction c ET tube and mechanical ventilation (PEEP) Occurs when pt hits steering wheel (No air bag) |
|
Definition
|
|
Term
| Usually 3 or more ribs in a row that are fractured/detached from thoracic cage. |
|
Definition
|
|
Term
| Paradoxical movement of thoracic wall when patient breathes |
|
Definition
|
|
Term
| Severe chest wall pain, bony crepitation at site of fracture, paradoxical chest movement and rapid shallow respirations are common in what condition? |
|
Definition
|
|
Term
| What is the usual course of Tx for flail chest? |
|
Definition
| Stabilization of flail, intubation, PEEP, blocking agent, sedation & pain control |
|
|
Term
| Accumulation of blood in the thorax; often accompanied by pneumothorax. |
|
Definition
|
|
Term
| Blunt penetrating thoracic trauma, thoracic surgery, anticoagulation therapy and a dissecting thoracic aneurysm are all causes of what? |
|
Definition
|
|
Term
| Guidleine (in mLs) for hemothorax. |
|
Definition
<400 minimal
>400 signs of shock, diminished or absent breath sounds |
|
|
Term
| In Hemothorax PaO2 is_____, PaCO2 is _______ and pH is _______. |
|
Definition
| decreased, increased, low |
|
|
Term
| In Hemothorax H/H is _______. |
|
Definition
|
|
Term
| The results of this test show a bloody return with hemothorax. |
|
Definition
|
|
Term
| What does a CXR show with a hemothorax? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Where is chest tube inserted with hemothorax? |
|
Definition
| Between 5th & 6th ICS at midaxillary line |
|
|
Term
| What are chest tubes connected to with hemothorax? |
|
Definition
| Water sealed drainage system |
|
|
Term
| What can be used for loss of 1 or more L of blood with hemothorax? |
|
Definition
|
|
Term
| The causes of this condition are blunt/penetrating trauma, rupture/bled or emphysematous area, PEEP at high pressures or with lungs that have lost elasticity. |
|
Definition
|
|
Term
| Air enters pleural space from the airways. |
|
Definition
|
|
Term
| Penetrating injuries cause this type of pneumothorax. |
|
Definition
|
|
Term
| One way valve system is created - air can enter pleural space but cannot escape. |
|
Definition
|
|
Term
| What is restlessness a common sign of? |
|
Definition
|
|
Term
| This type of chest wall movement is associated with pneumothorax. |
|
Definition
|
|
Term
| Which way will the trachea deviate towards in pneumothorax? |
|
Definition
|
|
Term
| What shifts can occur with pneumothorax? |
|
Definition
|
|
Term
| Needle aspiration, thoracentesis, small catheter c flutter valve & chest tube insertion with use of low suction are all treatments for what? |
|
Definition
|
|
Term
| Your patients chest tube is moving down. They are connected to suction. What is wrong? |
|
Definition
|
|
Term
| Your patients waterseal pleurovac is bubbling. What is the problem? |
|
Definition
|
|
Term
| This form of endotracheal tube is more comfortable for the patient but harder to get. |
|
Definition
|
|
Term
| A larger ET tube can be used for this. |
|
Definition
|
|
Term
| Max use of nasal/oral endotracheal tubes. |
|
Definition
|
|
Term
| If your patient has been on a ventilator for greater that 6 wks what is likely to happen? |
|
Definition
|
|
Term
| What is a big advantage of having a tracheostomy with a vent patient? |
|
Definition
| Easier to wean off ventilator |
|
|
Term
| What must you have at bedside when your patient is on a ventilator |
|
Definition
| Extra trach, obturator, ambubag, mask, suction |
|
|
Term
|
Definition
1. Sedation
2. Intubation
3. Ambubag
4. Auscultation
5. Secure tube
6. Xray confirmation |
|
|
Term
| Where should ET tube be in intubation? |
|
Definition
| About 1 inch above carina |
|
|
Term
| What is a telltale sign that your ET tube is too far down? |
|
Definition
| Only one lung will be inflating |
|
|
Term
| When are nasal ET tubes contraindicated? |
|
Definition
| Increased ICP, head trauma & sinusitis |
|
|
Term
| How often must ET be repositioned? |
|
Definition
|
|
Term
| Vent patients: teeth should be brushed Q__ and oral care Q___. |
|
Definition
|
|
Term
| ET size determined by the diameter of the ____ tube. |
|
Definition
|
|
Term
|
Definition
|
|
Term
| ET balloon can cause ________ injury to the trach. |
|
Definition
|
|
Term
| What kind of ET tube doesn't always have a balloon? |
|
Definition
|
|
Term
| Why don't children's ET tubes have balloons always? |
|
Definition
| Airway is flobby and can seal around tube |
|
|
Term
| What can happen with tracheal damage? |
|
Definition
| Hemorrhage (arteries right outside trach) |
|
|
Term
| How do you know to sxn a patient? |
|
Definition
|
|
Term
| ^ vent pressures, gurgling, coughing, decreased O2 sat and ^RR are indications for what? |
|
Definition
|
|
Term
| What should you do before suctioning a patient? |
|
Definition
|
|
Term
| What do you preoxygenate with when suctioning a patient? |
|
Definition
| 100% O2 if receiving FiO2 >40% |
|
|
Term
| How do you keep secretions liquefied? |
|
Definition
| Humidification & adequate fluid intake |
|
|
Term
| What should you do if you suspect the ET tube is in wrong position? |
|
Definition
| Assess LS, manually bag & notify provider |
|
|
Term
| Bleed from erosion of artery; ET tube will fluctuate with pulse. What is this and what must you do? |
|
Definition
| Tracheostomy exsanguination; Notify MD |
|
|
Term
| Causes air to be sucked into lungs and includes Iron Lung & Turtle |
|
Definition
|
|
Term
| Forces air into lungs and reverses normal breathing patterns. |
|
Definition
| Positive pressure (Bennett, Bear & Servo) |
|
|
Term
| This type of ventilation is given to patients with little or no respiratory drive, excessive repiratory drive and does not respond to patient's respiratory effort. |
|
Definition
| Continuous Mandatory Ventilation/ Control mode ventilation (CMV) |
|
|
Term
| What must you do for a patient on CMV? |
|
Definition
|
|
Term
| This type of ventilation has a preset tidal volume/pressure and a preset minimum breaths/minute but the patient can change the RR and pattern of breathing. |
|
Definition
|
|
Term
| What patients do you use AC ventilation with? |
|
Definition
| Normal respiratory drive c weak respiratory muscles |
|
|
Term
| This type of ventilation has a preset minimum number of breaths and will make them do the TV only for the preset breaths, but not for any extra. |
|
Definition
| Synchronized Intermittent Mandatory Ventilation (SIMV) |
|
|
Term
| This type of ventilation makes the patient breathe the set TV no matter how many breaths they choose to take. |
|
Definition
|
|
Term
| The goal of this kind of ventilation is to reduce respiratory muscle atropohy and progress towards weaning. |
|
Definition
|
|
Term
| With this type of ventilation the patient has to be able to initiate the breath. You use this right before you are ready to extubate. |
|
Definition
| Pressure support ventilation (PS) |
|
|
Term
| In this type of ventilation the TV varies depending on the patient's breathing. |
|
Definition
| Pressure support Ventilation |
|
|
Term
| This type of ventilation can deliver small volumes at a rapid rate eg 300 breaths/minute. |
|
Definition
| High frequency ventilation |
|
|
Term
| Two methods of delivering High Frequency Ventilation |
|
Definition
|
|
Term
| Instances in which High Frequency ventilation is used |
|
Definition
NICU/PICU
Drowning
Inhalation injury |
|
|
Term
| Potential harms of high frequency ventilation |
|
Definition
|
|
Term
| These methods of ventilation can be pressure or volume controlled (3) |
|
Definition
| Control, assist control & SIMV |
|
|
Term
| With this method of control ventilation volume is delivered until a preset pressure is reached; helps to decrease volutrauma; TV varies |
|
Definition
|
|
Term
| This type of vent control delivers breath until a preset volume is reached, pressure will vary (More rare) |
|
Definition
|
|
Term
| More common form of ventilation control |
|
Definition
| Pressure regulated volume control (PRVC) |
|
|
Term
| Most sensitive form of ventilation |
|
Definition
| PRVC (Pressure regulated volume control) |
|
|
Term
| Used to keep alveoli open, used to treat PaO2<60% on FiO2>50% |
|
Definition
|
|
Term
| What can PEEP do to the cardiac system? |
|
Definition
| Decrease CO and venous return |
|
|
Term
| Risk associated with PEEP |
|
Definition
|
|
Term
| All breaths and TV controlled by the patient. Used with face mask or t-piece. Breaths are spontaneous. |
|
Definition
|
|
Term
|
Definition
To not intubate
Obstructive sleep apnea |
|
|
Term
| These two forms of ventilation assistance can cause reduced CO, UO and a pneumothorax |
|
Definition
|
|
Term
| Controlled + pressure ventilation that reverses normal inspiratory/expiratory rate causing inspiratory rate > expiratory rate. |
|
Definition
| Inverse ratio ventilation |
|
|
Term
| What condition must pt be in to use inverse ratio ventilation? |
|
Definition
|
|
Term
| Inverse ratio ventilation is used for severe ______ to increase PaO2 and SaO2. |
|
Definition
|
|
Term
| 4 things you must have with ventilator |
|
Definition
|
|
Term
| If ventilator has too low pressure/volume settings what can it cause? |
|
Definition
|
|
Term
| How can you prevent atelectasis if you must use a low TV or pressure? |
|
Definition
| Add sigh or manually bag pt with sxning |
|
|
Term
| Use of this during suctioning has been shown to lead to respiratory infections |
|
Definition
|
|
Term
Asceptic technique
Drain vent tubing of moisture
Vent tubing changed q48 hrs. |
|
Definition
| Methods to prevent infection from pulmonary toileting. |
|
|
Term
| What is the cause of the decreased CO, UO and cardiac dysrthymias due to PEEP and CPAP? |
|
Definition
| Increased thoracic pressure (makes it harder for heart to pump) |
|
|
Term
| Hyperventilation leads to ______ (pH change) alkalosis whereas hypoventilation leads to _______. |
|
Definition
|
|
Term
| nasal/mask continuous baseline pressure |
|
Definition
|
|
Term
| Non-invasive ventilation with different pressures set for inspiratory and expiratory phase |
|
Definition
|
|
Term
| Why would an increased temperature keep someone from successfully weaning off a vent? |
|
Definition
| Higher metabolic/O2 demands |
|
|
Term
| If this lab value is decreased it might keep a patient from weaning off a vent r/t decreased O2 carrying capacity. |
|
Definition
|
|
Term
| Take off vent for a few minutes each hour and observe RR and ABGs (method of vent weaning) |
|
Definition
| Spontaneous breathing c t-tube |
|
|
Term
| Non-invasive form of helping someone wean off a vent and maintain some pressure |
|
Definition
|
|
Term
| Method of venting used to slowly reduce number of ventilator breaths/minute to wean from vent. |
|
Definition
|
|
Term
| Rate at which you decrease vent breaths/minute to wean off a vent. |
|
Definition
|
|
Term
| Pressure gradually reduced method of weaning off a vent. Can be used with SIMV, reduce # of breaths to 0. |
|
Definition
| PSV weaning (pressure support ventilation) |
|
|
Term
| Two major components to check for readiness to wean from vent. |
|
Definition
Muscle fatigue
Oxygenation |
|
|
Term
| What must be done before weaning a patient off a vent? |
|
Definition
| General assessment, call RT for respiratory assessment, vital signs |
|
|
Term
| What will happen to vitals if pt is not tolerating weaning from vent? |
|
Definition
|
|
Term
| If a patient is not tolerating vent weaning and their respiratory muscles are severely fatigued what VS changes will you see? |
|
Definition
|
|
Term
| Telltale sign that your vent weaning pt is becoming hypoxic |
|
Definition
|
|
Term
| Skin temp/moisture in pt not tolerating vent weaning |
|
Definition
| Diaphoretic, cold & clammy |
|
|
Term
| What reflex must be present for extubation |
|
Definition
|
|
Term
| HOB position for extubation |
|
Definition
|
|
Term
| What should you do before extubation (procedure-wise+ |
|
Definition
| Suction ET tube and oral cavity |
|
|
Term
| What do you have patient to when tube is being removed? |
|
Definition
| Take deep breath and cough forcefully (do not want to aspirate any gunk) |
|
|
Term
| What should you put your patient on after extubation? |
|
Definition
| Humidified face mask for at least a couple hours to soothe membranes & liquefy secretions |
|
|
Term
| this may be present post-extubation due to inflammation caused by tube irritation to the trachea |
|
Definition
|
|
Term
| How do you treat post-extubation stridor? |
|
Definition
|
|
Term
| What medication may be started 24 hrs before extubation? |
|
Definition
|
|
Term
| What do you always need to get in report with an intubated patient? |
|
Definition
|
|
Term
| This can cause vocal cord problems, hemorrhage and permanent damage. |
|
Definition
|
|
Term
| B2 adrenergic agonists for lower respiratory |
|
Definition
epinephrine
metaproterenol (Alupent)
albuterol
salmeterol
xopenex
terbutaline |
|
|
Term
| Methods of administering B2 agonists |
|
Definition
| MDI, continuous nebulizers |
|
|
Term
| This B2 agonist is delivered SQ or IV and is also used to stop preterm labor |
|
Definition
|
|
Term
| This B2 agonist should not be used during an attack b/c it is long acting. |
|
Definition
|
|
Term
| This B2 agonist is new and has decreased side FX when compared c albuterol |
|
Definition
|
|
Term
| Common side effects of B2 agonists |
|
Definition
| Nervousness, irritability, tachycardia, cardiac dysrhythmias |
|
|
Term
| bronchodilator class for long term use |
|
Definition
|
|
Term
|
Definition
| theophylline (PO)/ aminophylline (IV) |
|
|
Term
|
Definition
| Narrow therapeutic window, no antidote, toxicity |
|
|
Term
| Xanthines stabilize ____ cells. |
|
Definition
|
|
Term
| When giving IV aminophylline mix with _______ and water or ______. |
|
Definition
|
|
Term
| Signs of xanthine toxicity |
|
Definition
| anorexia, nausea, vomiting, dysrhthmias, seizures |
|
|
Term
| This class of drug is a bronchodilator that decreases respiratory secretions |
|
Definition
|
|
Term
| Anticholinergics used for respiratory issues |
|
Definition
| ipratropium (only as inhaler) & atropine |
|
|
Term
|
Definition
| Dries out mucus membranes |
|
|
Term
| This drug class decreases inflammatory process that is part of asthma and also stops further bronchoconstriciton & mucous secretion |
|
Definition
|
|
Term
| Leukotriene antagonists (also help with allergies) |
|
Definition
zileuton
zafirlukast
montelukast |
|
|
Term
| Side effect leukotriene antagonists |
|
Definition
|
|
Term
| This class of meds is not used to Tx acute asthma attack but can be continued during acute Tx. |
|
Definition
|
|
Term
| Anti-inflammatory class for prevention & TX acute asthma episodes. |
|
Definition
|
|
Term
| Inhalation glucocorticoids |
|
Definition
beclomethasone
triamcinalone
dexamethasone sodium phosphate |
|
|
Term
| Systemic anti-inflammatories |
|
Definition
prednisone
methylprednisone |
|
|
Term
|
Definition
Wt gain
E-lyte imbalances
osteoporosis
mood swings |
|
|
Term
| What should your pt do after taking PO glucorticoids? |
|
Definition
| Gargle & rinse to prevent oral thrush |
|
|
Term
| Diuretic for pulmonary edema. Highest potency diuretic besides mannitol |
|
Definition
|
|
Term
| Inhaled antibiotic (CFers) |
|
Definition
|
|
Term
|
Definition
|
|
Term
| methods of taking cromolyn |
|
Definition
|
|
Term
| Mast cell stabilizers prevent the release of ___ to decrease frequency & intensity of allergic rxn. |
|
Definition
|
|
Term
|
Definition
| unpleasant metallic taste; throat & nasal irritation |
|
|
Term
| Drug class on which pts must be ventilated |
|
Definition
| Neuromuscular blocking agents |
|
|
Term
| Neuromuscular blocking agents |
|
Definition
|
|
Term
|
Definition
neostigmine OR
pyridostigmine & atropine |
|
|
Term
| blocking agents do not affect what? |
|
Definition
|
|
Term
| What types of meds should be given c paralytis? |
|
Definition
|
|
Term
| Sedative/hypnotic with no analgesic properties. Rapid onset & short duration. Not much grogginess |
|
Definition
|
|
Term
| Weird side effect of propofol |
|
Definition
|
|
Term
| What may you want to give before propofol? |
|
Definition
| lidocaine IVP (burns in PIV) |
|
|
Term
| How do you assess for pain when your pt is under propofol? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| What very important reflex (eye) is suppressed during paralyzation? |
|
Definition
|
|
Term
| Tx suppressed blink reflex |
|
Definition
| Artificial tears/lacrilube. Tape eyes close with clear tape |
|
|
Term
| What can happen if the eyes totally dry out? |
|
Definition
|
|
Term
| Peripheral nerve sitmulator used to assess level of paralysis |
|
Definition
|
|
Term
Ulnar nerve
7th cranial
peroneal nerve of ankle |
|
Definition
|
|
Term
| Ideal # of twitches for TOF paralyzation. |
|
Definition
|
|
Term
| This med causes vasodilation of pulmonary vasculature; can be used to Tx pulm. HTN & intrapulmonary shunting |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Most common cause of burns |
|
Definition
|
|
Term
| Population most burned by scald injuries |
|
Definition
|
|
Term
| Most common place for burns to occur |
|
Definition
|
|
Term
| Criteria for sending someone to burn unit. |
|
Definition
2x size of palm
Involved face, hands, feet, joints or groin
Chemical/electrical bur
Child/senior/comorbidities
Uncomfortable caring for own burn |
|
|
Term
| Why must you go to the BU with a joint burn? |
|
Definition
|
|
Term
| Problem with chemical burns |
|
Definition
|
|
Term
| Problem with electrical burns |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| >40% burn or smaller burn with inhalation injury |
|
Definition
|
|
Term
| This type of burn involves episdermis only, eg sunburn c no blistering. Not calculates in TBSA. |
|
Definition
|
|
Term
| Superficial or deep partial thickness burn c blisters, skin sloughing, red, pink moist tissue, tender to touch |
|
Definition
| Partial thickness/2nd degree |
|
|
Term
| Most painful type of burn |
|
Definition
|
|
Term
| Whitish/charred skin with no sensation |
|
Definition
| Full thickness/3rd degree |
|
|
Term
| Full thickness burns there is a problem if it is _________. |
|
Definition
| Circumferential (compartment syndrome) |
|
|
Term
|
Definition
|
|
Term
| When do people with full thickness burns feel pain? |
|
Definition
|
|
Term
| Necessary Tx for full thickness burns |
|
Definition
|
|
Term
| Burn extends through muscle to bone |
|
Definition
| Full thickness/4th degree |
|
|
Term
| Causes of 4th degree burns (2) |
|
Definition
Electrical injury
Long duration flame burn |
|
|
Term
|
Definition
thermal
chemical
electrical
radiation |
|
|
Term
| Pts that have most radiation burns |
|
Definition
|
|
Term
This type of burn includes:
Dry or moist heat, fire, flame, hot object contact & scalding. |
|
Definition
|
|
Term
| Direct contact with acidic or basic compound, bleach, anhydrous ammonia or industrial chemicals causes this kind of burn. |
|
Definition
|
|
Term
| If an electrical burn has an entrance and exit wound what do you expect? |
|
Definition
|
|
Term
| What do household electrical (AC) burns lead to? |
|
Definition
muscle tetany
no respiratory effort |
|
|
Term
| How do you get a household burn? |
|
Definition
| Sticking objects in a light socket |
|
|
Term
| population often struck by lightning |
|
Definition
|
|
Term
| Sunburn & nuclear bombs are forms of this burn. |
|
Definition
|
|
Term
| How long does it take for burn shock to reverse? |
|
Definition
|
|
Term
| Watch for fluid ______ esp in elderly or young. |
|
Definition
|
|
Term
| Why do burn pts get hypotensive? |
|
Definition
| Fluid shift to interstitium |
|
|
Term
| Pts with burns develop a state of acquired immunodeficiency due to decreased production of what? |
|
Definition
|
|
Term
| Complication of inhalation injury seen 24-48 hrs after burn. |
|
Definition
|
|
Term
| If your patient has soot around their mouth and a hoarse voice that is not their norm, what do you expect to do? |
|
Definition
|
|
Term
| Dx test to see if inhalation injury |
|
Definition
|
|
Term
| What may pt with inhalation injury have increased levels of? |
|
Definition
|
|
Term
| Why should you suction a patient with an inhalation injury? |
|
Definition
|
|
Term
| this is characterized by abdominal pain, acidic pH, hematemesis & tarry stools in burn pts. What is the treatment? |
|
Definition
| Curling's ulcer (esomeprazole) |
|
|
Term
| Patients iwth burns can develop this condition r/t fluid shifts & pain meds. High risk |
|
Definition
|
|
Term
| Pts with burns can go into renal failure due to ________________ - appears as dark tea colored urine. |
|
Definition
|
|
Term
| Why does myoglobinuria lead to ARF? |
|
Definition
| Blocks tubules & damages them |
|
|
Term
| All organs shutting down after burn r/t myoglobin & HoTN. |
|
Definition
|
|
Term
| Metabolism of MODS burn pt |
|
Definition
|
|
Term
| Why might a burn patients temp decrease even if they have MODS? |
|
Definition
| Inability to regulate temp due to skin damage |
|
|
Term
|
Definition
ABCs
Prevent heat loss
Start IV-LR
Dry dressings
transport |
|
|
Term
| Rule of thumb for calcuating TBSA |
|
Definition
|
|
Term
| SA measurements are assigned to each body part in terms of age of pt. |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Shot given to burn patients |
|
Definition
|
|
Term
| electrolyte imbalances in resuscitative stage |
|
Definition
hyper/hypokalemia due to cell rupture
hyponatremia due to aggressive fluids |
|
|
Term
| Med class given to keep BP up in burn pts |
|
Definition
|
|
Term
|
Definition
| 2-4 mLx Kg X TBSA% (eg for 40% TBSA multiply x 40) |
|
|
Term
| What does parkland formula give you? |
|
Definition
| Total fluids for the first 24 hrs |
|
|
Term
| You should give half fluids in __ hrs and the other have in __ hrs. |
|
Definition
|
|
Term
| When does the clock start ticking for giving fluids with burns. |
|
Definition
|
|
Term
| Stage from diuresis to wound closure during which fluid comes back into vascular space. |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Most popular method of removing exudates from wound. |
|
Definition
|
|
Term
| This Tx may be used initially for chemical burns. |
|
Definition
|
|
Term
| what can you cleanse wound with? |
|
Definition
| Sterile NS, tap H20 or antimicrobial cleansing agent |
|
|
Term
| Do you want to keep a burn wound dry or moist? |
|
Definition
|
|
Term
| What do you still have to worry about in acute stage? |
|
Definition
| Hypo/hyper kalemia & hyponatremia |
|
|
Term
|
Definition
Manual removal
enzymatic (topical but can't tell good from bad tissue) |
|
|
Term
| If you don't think a graft will take what should you do? |
|
Definition
| Use a temporary skin substitute |
|
|
Term
Biobrane
Hydrocolloid
Transcyte
Integra |
|
Definition
| Biosynthetic dressings for burns |
|
|
Term
| Only graft that provides permanent coverage of wound. |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Make sure that _____ does not collect under graft. It will not adhere properly. |
|
Definition
|
|
Term
| Which site on burn pt is typically more painful, donor or burn site? |
|
Definition
|
|
Term
|
Definition
| Cover with tegaderm, acticoat or xeroform & remove edges as they come up |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| anabolic steroid used to increase protein metabolism & decrease its catabolism |
|
Definition
|
|
Term
| Stress causes high glucose so some pts with be on what? |
|
Definition
| Insulin drip c regular/short acting insulin |
|
|
Term
|
Definition
| A C & Zinc to promote skin/muscle growth |
|
|
Term
| What psych issue can burn patients have? |
|
Definition
|
|
Term
| Compression garments for burns |
|
Definition
|
|
Term
| Need to wear jobst stockings at least __ hrs/day. |
|
Definition
|
|
Term
| Burn patients should be taught to avoid _____ ____ and always wear sun screen. |
|
Definition
|
|
Term
| This burn med has a painless application but may produce transient leukopenia by suppressing bone marrow. Must monitor WBCs. |
|
Definition
|
|
Term
| This burn med has little eschar penetration. Must watch for tunneling and sub-eschar infection. Broad spectrum, easy application, rare sensitivities, some gram- resistance. |
|
Definition
|
|
Term
Broad spectrum burn med (abx) that penetrates eschar and has ease of application, esp useful for pseudomonas.
Application is painful, frequent sensitivities, rare acid/base imbalances, provide analgesia, monitor ABGs and for hyperventilation and rash. |
|
Definition
| mafenide acetate (Sulfamylon) |
|
|
Term
| Painless application antibiotic, non-irritating/nontoxic & transparent. No eschar penetration or gram-/fungal coverage. |
|
Definition
|
|
Term
Painless application Keep moist with sterile water, not saline Maintain dry linens
Broad spectrum, including No reported side effects
Fungus, and resistant organisms
Rare sensitivity
Less frequent dressing changes |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
Keep alveoli open.
Decrease amt FiO2 |
|
|
Term
| Positioning for pt c spinal injury w/ TF |
|
Definition
| Reverse trendelenberg HOB >30 |
|
|
Term
| Clot has to be ________ to become a PE. |
|
Definition
|
|
