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Critical Care
Critical Care Test #1 (Respiratory System)
98
Nursing
Undergraduate 3
02/09/2014

Additional Nursing Flashcards

 


 

Cards

Term
How do you know if the patients airway is patent?
Definition
The patient will be alert and oriented, feel their breath, their skin color, and they will respond.
Term
How do you know if breathing is occurring?
Definition
Their chest will rise and fall, LOC, skin color, SPO2, feel their breath, condensating in facial mask.
Term
What nursing interventions can help if a patient is showing signs of difficulty of breathing?
Definition
Reposition the patient (high fowlers), O2, assist as necessary, coughing and deel breathing, remain calm.
Term
Cause of crackles.
Definition
Fluid present
Term
Cause of rhonchi
Definition
There is a blockage by mucous
Term
Cause of wheezing.
Definition
There is constriction by inflammation.
Term
Cause of stridor
Definition
There is constriction of upper airway
Term
Smokers will show ______ levels of carbon monoxide.
Definition
Higher
Term
Symptoms of hyperventilation
Definition
Tetany, diaphoresis, anxious, tingling of fingers.
Term
Capnography measures what?
Definition
CO2 at end of exhalation
Term
______________ is useful when weaning from the vnet, in CPR, and to confirm endotracheal tube placement.
Definition
Capnography
Term

Normal values of ABGs

 

pH

pCO2

pO2

HCO3

COHB

Definition

pH: 7.35-7.45

pCO2: 35-45

pO2: 80-100

HCO3: 22-26

COHB: <5%

Term
Respiratory acidosis
Definition
Inadequate elimination of CO2 by lungs.
Term
Respiratory alkalosis
Definition
Excessive elimination of CO2 by lungs.
Term
Metabolic acidosis
Definition
Increased acids
Term
Metabolic alkalosis
Definition
Gaining of bases
Term
SOB, hypoventilation, decreased LOC, restlessness, mental status change, and increased HR are symptoms of what acid-base disorder?
Definition
Respiratory acidosis
Term
Hyperventilation, anxious, tingling, lightheadedness, and tetany are symptoms of what acid-base disorder?
Definition
Respiratory alkalosis
Term
Altered LOC, confusion, fruity breath, hyperventilation, increased respiratory rate, N/V, diaphoresis are symptoms of what acid-base disorder?
Definition
Metabolic acidosis
Term
Hypoventilation, tetany, dizziness, and N/V are symptoms of what acid-base disorder?
Definition
Metabolic alkalosis
Term

Manual airway patency techniques

 

Contraindications for these?

Definition

Head tilt, chin lift

 

Jaw thrust

 

Spinal cord injuries and babies

Term
After ET tube is placed what should the nurse assess?
Definition
Vitals, placement of ET tube/ measure placement, lung sounds at least q4hrs, CXR q24 hrs, skin/lip care, cough, respiratory distress= check tube!
Term
When suctioning a ET tube...
Definition

- Explain procedure to patient.

- Always oxygenate prior to suctioning.

- Only apply suction when removing catheter.

- Assess for tolerance (desat., braycardia)

Term
When ventilating ET tube patient...
Definition

- Raise HOB

- BVM or intubation may be needed.

Term
Oxygen therapy is prescribed when?
Definition
The oxygen needs of the patient cannot be met by "room air".
Term
What % of atmospheric air is oxygen?
Definition
21%
Term
What element is most abundant in atmospheric air?
Definition
Nitrogen
Term

Nasal cannula

 

L/ min?

 

% of O2 concentration?

Definition

1-6L/min

 

24-44%

Term

Simple mask

 

L/min?

 

% of O2 concentration?

Definition

5L/min

 

40-60%

Term

Partial rebreather mask

 

L/min?

 

% of O2 concentration?

Definition

6-11L/min

 

60-75%

Term

Non-rebreather mask

 

L/min?

 

% of O2 concentration?

Definition

10-15L/min

 

90-100% 

Term

Venturi mask

 

L/min?

 

% of O2 concentration?

Definition

8-15L/min

 

24-100%

Term

Provides hi/low levels of positive pressure 

 

(improves tidal volume)

Definition
BiPAP
Term

Provides continuous levels of positive pressure 

 

(open collapsed aveoli)

Definition
CPAP
Term
What is the danger of administering too much O2 to a COPD patient?
Definition
Their body naturally tells them not to breathe.
Term
S/S of oxygen toxicity
Definition
Nonproductive cough, substernal chest pain, GI upset, dyspnea
Term
S/S of absorption atelectasis
Definition
Crackles, decreased breath sounds
Term

In acute respiratory failure. These results are..

 

paO2 less than_________.

paCO2 more than__________.

Definition

60 

 

50 w/ acidemia

Term

Ventilation vs. Perfusion in ventilatory failure.

 

Treatment?

Definition

Ventilation is abnormal and perfusion is normal.

 

Ventilation

Term

Ventilation vs perfusion in Oxygenation failure.

 

Treatment?

Definition

Ventilation is normal and perfusion is decreased.

 

Increasing O2 will not help. 

Term
V/Q Mismatch
Definition

Both ventilation and perfusion are abnormal.

 

Common in COPD patients. 

Term

What percentage of O2 will a NC deliver to a pt. if set at 4L/min?

 

 

Definition
about 34 %
Term
Symptoms of ARF
Definition

- Dyspnea

- Hypoxia, hypoxemia, and hypercarbia

- Abnormal lung sounds

Term
Diagnosis of ARF is done by?
Definition

- CXR

- ABGs

- CBC

Term

Progressive type of acute respiratory failure, 50%-60% mortality rate, and 40% of survivors have permanent changes in pulmonary function. 

 

What does this patient have?

Definition
ARDS
Term

Previous damage causes protein build up, pulling fluid into the alveolar spaces and causes non-cardiac pulmonary edema.  The edema and reduced surfactant levels further compromise gas exchange.  Progressive alveolitis and fibrosis occur in the lungs.

 

What does this patient have?

Definition
ARDS
Term
Symptoms of ARDS
Definition
Dyspnea, tachypnea, dry cough possibly progressing to a cough producing frothy pink sputum, fatigue, and tachycardia
Term

Anyone who has a hx of a lung assault who develops profound dyspnea and tachypnea... or

 

who doesn't respond to increases in O2 therapy...

 

You should suspect what?

Definition
ARDS
Term
Interventions for ARDS?
Definition

Maintain airway

 

Provide adequate oxygenation

 

Support hemodynamic functioning

Term
Drug therapy for adequate oxygenation?
Definition

Bronchodilators (albuterol, zopenex): opens airway

 

Corticosteroids: decreases inflammation

 

Antibiotics: if infection is present

Term
Mechanical ventilation provides what?
Definition
adequate ventilation and oxygenation while decreasing patient's work of breathing.
Term
Benefits of positive pressure ventilation?
Definition
forced/enhanced lung expansion, improved gas exchange, decreased work for breathing, and delivers lower amounts of O2.
Term

Preset ventilator rate and tidal volume, pt. can initiate, pt controls own rate, but ventilator can take over.

 

What ventilator mode is described?

Definition
AC (Assist control)
Term

Client initiated breaths, TV is patients own. Ventilator initiated breaths synchronized (helpful for weaning).

 

What ventilator mode is described?

 

Definition
SIMV (synchronized intermittent mechanical ventilation)
Term

Preset pressure delivered during spontaneous inspirator (reduces work).

 

What ventilator mode is described?

Definition
PSV (pressure support ventilation)
Term

pressure applied at end of expiration to keep alveoli open (used with AC or SIMV, cannot be used alone)

 

What ventilator mode is described?

Definition
PEEP (positive end expiratory pressure)
Term
Monitoring of ventilators
Definition

10-15 minutes after any ventilator changes (ABG)

 

SpO2 monitor continuous

 

Observe for restlessness, lethargy

 

Ventilator alarms should be on at all times

 

When in doubt.... VENTILATE!! 

Term
Low exhaled volume due to disconnection, cuff leak, or tube displacement are all indications of what type of ventilator alarm?
Definition
Volume low pressure
Term
Excess secretions, client biting on tubing, kinks, client coughing, and bronchospasms are all indications of what ventilator alarm?
Definition
High pressure alarm
Term
Ventilator does not detect spontaneous breathing is an indication for what ventilator alarm?
Definition
Apnea alarm
Term

Sedation for a ventilator..

 

Medication of choice for sedation?

 

Assessments? Times?

 

Ramsay Scale scoring?

Definition

Propofol 

 

Neuro assessment q8hrs.

Wake up assessment q24hrs.

Continuous BP, HR, ECG, SpO2, and hemodynamic monitoring.

 

We want a level of 2 or 3. 

Term

Mechanical ventilation complications: 

 

Cardiac complications and respiratory complications

Definition

Cardiac (hypotension and fluid retention)

 

Respiratory (oxygen toxicity, risk for aspiration, ventilator induced lung injury)

 

Nutrition

 

Infection

 

Stress Ulcer

Term
Types of PEs
Definition
Air, fat, blood, amniotic
Term
Causes of PEs
Definition
Post-surgical, immobility, heart disease, fractures
Term
S/S of PEs
Definition
Restlessness, apprehension, chest pain, sudden onset dyspnea, tachypnea, decreased breath sounds, and hemoptysis
Term
Physical assessment findings for PE include
Definition
Tachypnea, crackles, pleural friction rubs, tachycardia, S3 or S4, diaphoresis, and petechiae
Term
Diagnostic tests for PEs
Definition

ABG (decreased PaO2)

D-Dimer test 

CT Scan with contrast (positive D-Dimer)

TEE 

Term
Nursing diagnosis for PEs
Definition

Impaired gas exchange

 

Pain

 

Anxiety

 

Confusion

 

Risk for Bleeding

Term
Medications for PE
Definition

Heparin (antidote: Protamine Sulfate)

 

Coumadin (antidote: Vitamin K)

 

Thrombolytics

Term
Ocean Chest Tube
Definition
Wet Suction
Term
Oasis Chest Tube
Definition
Dry Suction
Term

Pulmonary Contusion 

 

S/S

 

Treatment

Definition

difficulty breathing, rhonchi or crackles, CXR, hx. of trauma

 

O2, prevention of symptoms

Term

Rib fractures

 

 

Treatment

Definition
pain management (ibprophen)
Term

Flail chest

 

S/S 

 

Treatment

Definition

See saw respirations

 

pain and intense respiratory management

Term
Collection of air (blood, exudate) in the pleural space
Definition
Pneumothorax
Term
S/S of pneumothorax
Definition

acute onset of dyspnea

 

tachypnea

 

decreased breath sounds

 

crepitus

Term
Tx. for pneumothorax
Definition

chest tube.

 

HOB 30 degrees

 

Pain control

Term
When ambulating pt., keep collection device __________ level of insertion site.
Definition
Below
Term
If chest tube accidentally becomes dislodged..
Definition

cover sit with occlusive dressing 

 

listen to lung sounds

 

observe for respiratory distress

 

notify physician 

Term
Indications for epidural anesthesia
Definition

acute post-op pain

 

labor and delivery

 

chronic pain

 

multiple trauma

 

therapy which may last 48 hours to several weeks

Term

Medications used for epidural anesthesia

 

SE?

 

Antidote?

Definition

Fentanyl and Meperdine

 

Sufenta ( 7x more concentrated than fentanyl)

 

Morphine and Hydromorphone 

 

chest rigidity, itching, urinary retention

 

NARCAN

Term
Epidural anesthesia complications
Definition

Hypotension

 

Respiratory distress

 

N/V

 

Urinary retention

Term
Nursing care for epidural anesthesia includes
Definition

checking the catheter site

 

changing the tubing and medication bag

 

assessing the patient, including VS

 

checking the pump and assessing the alarms

Term
Nursing actions for epidural anesthesia
Definition

- place a sign on the head of bed "epidural analgesia only"

- two ampules of Narcan at bed

- assure pateint IV or saline lock in place during and until 6 hours after catheter removal

- assess respiratory rate every 1 hr

- effectiveness of pain relief and side effects every 2 hrs.

- insertion side every 8 hrs.

- I&O

- evaluate urinary bladder distention

- maintain a sterile, occlusive dressing

Term
S/S of epidural toxicity
Definition

- metallic taste

- numbness of tongue or lips

- tinnitus

- dizziness

 

 

Term
Partial or complete loss of sensation with or without LOC
Definition
Anesthesia
Term
How is it decided which type of anesthesia to use?
Definition
Type of procedure and duration, area of body, emergency or not, time since last eaten, position needed for OR
Term
Complications of regional anesthesia
Definition
Local irritation, systemic absorption, and anaphylaxis
Term
Administered when the needle passes between the vertebrae of the spinal column through the dura where the CSF is located
Definition
Spinal Anesthesia
Term
Spinal Anesthesia complications
Definition

Hypotension

 

Respiratory depression

 

N/V

 

Urinary retention

Term
When the needle is inserted between the vertebrae to the epidual space.  contains fat which functions as a depot for opiods and local anesthetics.
Definition
Epidural Anesthesia
Term
Patient must be able to manage own respirations and respond.
Definition
Conscious Sedation
Term
Characterizations of general anesthesia
Definition
Analgesia, amnesia, unconsciousness, loss of muscle tone, and reflexes
Term
Stage 1 of Anesthesia
Definition

Sedation and relaxation

 

Hearing is exaggerated

 

QUIET

Term

Stage 2 of Anesthesia

 

Definition

Excitement

 

Irregular breathing, increased muscle tone, laryngospasms

 

Stay beside patient, keep from harm, assist CRNA

Term
Stage 3
Definition

Operative stage

 

 

Term
Stage 4
Definition

Danger

 

OVERDOSE

 

Prepare for and assist with resuscitation 

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