Term
| when is oxygen toxicity most likely to occur? |
|
Definition
| in any patient who breathes oxygen concentrations of greater than 50% for longer than 24 hours. |
|
|
Term
| what types of patients are most likely to get oxygen toxicity? |
|
Definition
| those who require intubation, mechanical ventilation, and high oxygen concentrations for extended periods |
|
|
Term
| what is the damage caused to the body by oxygen toxicity |
|
Definition
| increased oxygen leads to increased free radicals that damage the alveolar-capillary membrane. |
|
|
Term
| what causes Absorption Atelectasis |
|
Definition
| the lack of nitrogen in high flow oxygen systems. |
|
|
Term
| how does nitrogen benefit the alveoli |
|
Definition
nitrogen helps hold the alveoli open (residual volume)
|
|
|
Term
| what is an endotracheal tube (ETT)? |
|
Definition
| the most commonly used artificial airway for providing short-term airway management. |
|
|
Term
| why might the patient need an ETT? |
|
Definition
maintenance of airway patency,
protection of the airway from aspiration,
application of positive-pressure ventilation,
facilitation of pulmonary toilet,
and use of high oxygen concentrations. |
|
|
Term
| in what type of patient is a nasotracheal tube preferred? |
|
Definition
| patients with a broken jaw |
|
|
Term
| why are ETT tubes preferred for most patients? |
|
Definition
nasal tissue is easily damaged
it decrease risk of infection compared to nasal tracheal tubes |
|
|
Term
endotracheal tubes have the balloon cuff that inflates at the end of the tube. What type it cuff is preferred.
A. high-pressure, low volume
B. low-pressure, high-volume |
|
Definition
B. low-pressure, high-volume
|
|
|
Term
| when the patient is to be intubated what equipment should you gather? |
|
Definition
a suction system, an manual resuscitation bag (MRB) with a mask connected to 100% oxygen, a laryngoscope handle with assorted blades, a variety of sizes of ETTs, and a stylet.
a patent IV, and pulse oximeter |
|
|
Term
| how long should each intubation attempts be |
|
Definition
|
|
Term
| how should the nurse prepare the patient before each intubation attempt? |
|
Definition
| hyper oxygenat with MRB mask with 100% oxygen |
|
|
Term
| what should the nurse assess after ETT is placed |
|
Definition
| bilateral breath sounds and chest movement. |
|
|
Term
| after an ETT was placed I nursed assess the patient for breath sounds but was unableto hear any sounds. What should the nurse assume is the problem? |
|
Definition
| an esophageal intubation. The procedure will need to be done again |
|
|
Term
| after an ETT placement the nurse hears breath sounds over only one side. what should the nurse assume the problem is |
|
Definition
a main stem intubation.
a tuple need to be placed again |
|
|
Term
| what test is ordered after ETT placement to confirm it is in the right position? |
|
Definition
|
|
Term
| the size of an ETT the patient will need is based on what factor |
|
Definition
|
|
Term
| men typically need what size of ETT |
|
Definition
7.5 - 10 french length 20-28 cm |
|
|
Term
| women typically need what size of ETT |
|
Definition
7 - 9 french length 19-24 cm |
|
|
Term
| if ETT for patient is too large what complications may arise |
|
Definition
| of ischemia to tracheal tissue leading to necrosis and a esophageal tracheal fistula |
|
|
Term
if ETT for patient is too small what complications may arise
|
|
Definition
Occlusion from secretions, increased respiratory rate- patient feels like they are breathing through a straw |
|
|
Term
| a complication that can arise from endotracheal tubes is tube obstructions. what can a nurse do to prevent this |
|
Definition
Place bite block.
Sedate patient PRN.
Suction PRN.
Humidify inspired gases. |
|
|
Term
| a complication that can arise from endotracheal tubes is tube displacement. what can a nurse do to prevent this |
|
Definition
Secure tube to upper lip.
Restrain patient's hands as needed.
Sedate patient PRN.
Ensure that only 2 inches of tube extend beyond lip. Support ventilatory tubing. |
|
|
Term
| a complication that can arise from endotracheal tubes is tracheoesophageal fistula. what can the nurse do to prevent this |
|
Definition
Inflate cuff with minimal amount of air necessary.
Monitor cuff pressures every 8 hr. |
|
|
Term
| a complication that can arise from endotracheal tubes is mucosal lesion. what can the nurse do to prevent this? |
|
Definition
| Inflate cuff with minimal amount of air necessary. Monitor cuff pressures every 8 hr. |
|
|
Term
| a complication that can arise from endotracheal tubes is a cricoid abscess. what can the nurse do to prevent this? |
|
Definition
Inflate cuff with minimal amount of air necessary. Monitor cuff pressures every 8 hr.
Suction area above cuff frequently. |
|
|
Term
|
Definition
| Excessive pressure in the alveoli that causes alveolar wall stress and damage to the alveolar-capillary membrane, resulting in escape of air into the surrounding spaces. |
|
|
Term
| there are three criteria for ventilation. The patient needs to meet one of the three. What are the criteria? |
|
Definition
acute ventilation failure
hypoxemia
pulmonary mechanical failure |
|
|
Term
| what are the parameters for acute ventilation failure? |
|
Definition
|
|
Term
| what are the parameters for hypoxemia |
|
Definition
|
|
Term
| what are the parameters for pulmonary mechanical failure |
|
Definition
heart rate >35
vital capacity (VC) <15 ML/KG
MIF < -20 cmH2O |
|
|
Term
| what is a negative pressure ventilator and how does it work. |
|
Definition
| is referred to as the iron lung. It works by enclosing it patient's chest wall within a chamber and exerting negative pressure on the chest wall. |
|
|
Term
| what are the drawbacks of the negative pressure ventilator? |
|
Definition
| unable to assess patient as a whole, change linens, perform bowel and bladder care or skincare. |
|
|
Term
| what is a positive pressure ventilator and how does it work? |
|
Definition
| these types of ventilators use an endotracheal tube and pressure being exerted from the inside of the chest wall to produce movement of the chest. |
|
|
Term
| positive pressure ventilators are controlled by different cycles. What are the three different types of cycles? |
|
Definition
pressure cycle
volume cycle
time cycle |
|
|
Term
| what is a pressure cycle or pressure controlled ventilation? |
|
Definition
| with each breath that the patient receives the amount of pressure will remain constant and the volume will very. |
|
|
Term
| what benefit is gained from using pressure control ventilation? |
|
Definition
| control seamount pressure in the lungs and decreases the incidence of volutrama. |
|
|
Term
| when using pressure control ventilation where do you want the patient's pressure to be? |
|
Definition
|
|
Term
| what are the problems with using pressure controlled ventilation? |
|
Definition
as the patient's lung gets stiffer it becomes harder and harder to maintain adequate tidal volume and severe hypoxemia can occur
can cause barrowtrama |
|
|
Term
| what is volume cycle or volume controlled ventilation? |
|
Definition
| the ventilatory is set to deliver a certain volume regardless of pressure reached. |
|
|
Term
| what are the benefits of using a volume controlled ventilator |
|
Definition
| the patient will avoid hypoventilation. |
|
|
Term
| what are the drawbacks of using volume controlled ventilators |
|
Definition
| risk of pneumothorax and barotrauma |
|
|
Term
| what is a time cycle controlled ventilator |
|
Definition
inspiratory and expiratory times are set without regards to pressure or volume
( inspiratory time is constant/pressure and volume very) |
|
|
Term
| what are the benefits of using the time cycle ventilator |
|
Definition
|
|
Term
| what are the drawbacks of using a time cycle ventilator |
|
Definition
| risk of barotrauma, hypoventilation |
|
|
Term
| your patient that is on a ventilator has a high pressure alarm go off. What does this indicate? |
|
Definition
| indicates obstruction or decreased compliance |
|
|
Term
| you patient that is on a ventilator alarm goes off for low inspiratory/expiratory pressure. What does this indicate? |
|
Definition
he indicates a leak in the system , system disconnect or
pneumothorax |
|
|
Term
| your patient's ventilator alarm has gone off and is alarming high respiratory rate. What does this indicate |
|
Definition
| the patient's respiratory rate is higher than the parameter set |
|
|
Term
| you patient who is on a ventilator has a high pressure alarm going off. What should you do first? |
|
Definition
|
|
Term
| what might happen if you ignore high respiratory alarm |
|
Definition
| this can cause the patient to have atelectasis, hyperventilation, CO2 retention |
|
|
Term
| what might a rapid respiratory rate on a ventilator indicate? |
|
Definition
| pain, anxiety, under sedation, changing disease state |
|
|
Term
| what are the types of non-invasive positive pressure ventilation? |
|
Definition
|
|
Term
| why is it important to wean patients as quickly as possible from ventilators? |
|
Definition
| to prevent ventilator associated pneumonia |
|
|
Term
| in order to extubated patient what must the oxygen saturation be maintained at? |
|
Definition
greater than 95%
( with FiO2 less than 40%) |
|
|
Term
| when switching the patient from ventilator to CPAP the patient needs to maintain O2 saturation's above 95% and FiO2 less than 40%. What are the max parameters for the CPAP peep? |
|
Definition
|
|
Term
| your patient is able to maintain greater than 95% oxygen with a FiO2 less than 40% and is receiving dobutamine. is this patient a good candidate for extubation? |
|
Definition
| no patients who are receiving extensive vasopressor support should not be extubated |
|
|
Term
| what should patients PaO2 be before considering extubation |
|
Definition
|
|
Term
| what should the patient max inspiratory force be before considering extubation |
|
Definition
|
|
Term
| what laboratory values need to be checked before extubation |
|
Definition
all chemistry's (especially K) need to be within normal limits
and hemoglobin >8 mg/dl
ABG's |
|
|
Term
| some patients do not meet requirements of extubation due to thick mucus secretions and muscle weakness. What could be done for patient like this? |
|
Definition
| adequate hydration and nutritional support |
|
|
Term
What is the risk for using a larger tube for ETT?
|
|
Definition
You run the risk of ischemia to tracheal tissue leading to necrosis and an espphageal tracheal fistula
(you know this by gastric contents, tube feed in your tracheal suction) |
|
|
Term
Who needs a Ventilator
What is the criteria for Acute Ventilation Failure?
pH?
PaCO2? |
|
Definition
The pH is <7.30
The PaCO2>50 |
|
|
Term
Who needs a Ventilator
What is the criteria for hypoxemia?
PaO2? |
|
Definition
|
|
Term
Different types of Ventilation
What is the Pressure Cycle? |
|
Definition
Gas Pressure is constant/volume varies |
|
|
Term
Different types of Ventilation
What is the Cycle that is set at
Volume is Constant/Pressure Varies? |
|
Definition
|
|
Term
Different Types of Ventilation
What does the Time Cycle set to do? |
|
Definition
Inspiratory time is Constant/ Pressure and Volume vary |
|
|
Term
What are the Pro's and Con's to the
Volume Cycle? |
|
Definition
(Volume is contant/pressure varies)
Pro's: No Hypoventilation
Con's: Risk of Pneumothorax and Barotraumas |
|
|
Term
What are the Pro's and Con's of the
Time Cycle? |
|
Definition
(Inspiratory time is constant/pressure and volume varies)
Pro's: I:E ratio can be set
Con's: Risk of barotraumas, hypoventilation |
|
|
Term
What alarm would go off in the case of Obstruction or Decreased Compliance? |
|
Definition
|
|
Term
What alarm indicates a leak in the system or system disconnect? |
|
Definition
Low inspiratory/expiratory pressure
(This could be a pneumothorax)
|
|
|
Term
What alarm would go off for a
High Respiratory Rate? |
|
Definition
The High Respiratory Rate Alarm
(often when pt are taking small shallow breaths)
"guppy breaths" |
|
|
Term
What can a high respiratory rate lead to if not
controlled?
|
|
Definition
atelectasis, hyperventilation, CO2 retention |
|
|
Term
What can a high respiratory rate indicate? |
|
Definition
Pain, Anxiety, Under-sedation
also may indicate-change in disease state
increasing hypoxia |
|
|
Term
What are the priority steps in order 1-3 when a
High Pressure Alarm goes off? |
|
Definition
1-First assess the patient
2-Then assess oxygenation
3rd- Peak Airway Pressure
(the pt may need suctioning or repositioning) |
|
|
Term
On ventilator settings-what can we manipulate to change respiratory acidosis or alkalosis? |
|
Definition
The Respiratory Rate
and tid. Vol. |
|
|
Term
What setting on Ventilation is based on
ideal body weight? |
|
Definition
|
|
Term
Why does the Tidal Volume need to be
set to ideal body weight?
Too High
Too Low |
|
Definition
Too High-can cause barotrauma or pneumothroax
Too Low-alveoli under ventilated or unventilated which wil lead to atelectasis |
|
|
Term
PEEP is usually at a __ level because too high
it increases the risk of barotrauma? |
|
Definition
Level 5
(with the exception of ARDS pts) |
|
|
