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life 2 test 2
Terms in this set (95)
is supplemental Fio2 usred with CPAP for patients with oSA?
supplemental Fio2 is NOT used for OSA but can be added to CPAP for other conditions if needed
why would you want to talk with the MD and RT about increasing the IPAP and EPAP for patients in NIPPV who are having the issue of a rise in CO2 due to rebreathing?
higher pressures produce more flow through the exhalation port which helps to purge co2 from the mask and circuit to prevent rebreathing
on a high flow nasal cannula, the active heated humidifier is capable of providing ___________ body humidity
100% body humidity
with a non rebreather mask, the liter flow rate must be high enough to keep the bag 2/3rd inflated otherwise??????
itll just have the same Fio2 as a simple face mask
on a non rebreather mask, the resevior bag is filled with????
on a non rebreather mask, why is one exhalation port covered?
to prevent Co2 build up in the mask
what is ventilation perfusion mismatch?
when it doesnt match!
usually the volume of blood perfusing the lungs each minute is about equal to the amount of gas that reaches the alveoli each minute
- has a Ventilation (V) and perfusion (Q) ratio of 1:1
what are the mechanisms that cause ventilation perfusion mismatch?
- diffusion elimination
- alveolar hypoventilation
what is shunting?
when blood exits the heart without gas exchnage occuring
what are diffusion limitations?
when gas exchange accross the alveolar-capillary membrane is compromised by
- thickened, damaged, or destroyed alveolar membranes
- impaired blood flow through pulmonary capillaries
what is the classic sign of diffusion limitation?
hypoxia that is present with exercise but not with rest
direct causes of ARDS are caused by?????
indirect causes of ARDS are caused by??????
DIRECT: epithelial injury
INDIRECT: endothelial injury
what are examples of direct causes of ARDS?
- near drowing
- ven induced lung injury
what are examples of indirect causes of ARDS?
- TRALI/ massive transfusion
- trauma and burns
- acute pancreatitis
- air/fat/amniotic embolism
how do we assess the degree of impairement in gas exchange accross the lungs for a person with ARDS?
how do we decide that tidal volume to set a persons vent at?
IDEAL body weight based on their height
a patients vent alarm goes off. what is the first thing you do?
assess if they are experiencing significant respiratory distress!!!!!
- if yes, immedietely start mannuel resusitation with ambu bag and 100% FiO2 and call for help
if no, trouble shoot the alarm
VAP is pneumonia that occurs _____ or more after endotrachial intubation
in order to prevent VAP through minimizing pooling of secretions above the tube cuff, a patient who is likely going to have a ET tube for over 72 hours should have a ETT with????
subglottic secretion drainage
what is the goal of rapid sequence intubation?
to intubate the patient without having to use a BVM
rapid sequence intubation is not indicated for a patient who is _________ and ________
unconcious and apneic
what do you need to obtain 30 minutes after intubation in order to determine ventilation and oxygenation status?
after the intubation procedure, what do you need to do once right away and then every 4 hours?
- auscultate to conform bilateral breath sounds
- observe for symetric chest movement
what does capno assess? what does it measure
assesses how effectively co2 is being eliminated by the pulmonary system
measues end-tidal CO2 (ET Co2), which is the partial pressure of Co2 detected at the end of exhalation
what should you do if a vented patient does not tolerate suctioning?
stop, and manually hyperventilate with 100% oxygen
what should you do in between intubation attemtps?
suction and/or ventilate unconcious patient using BVM with 100% o2
an Et tube cuff is inflated _______ the vocal cords
what are consequences on an under inflated cuff?
- escape of ventilator gasses
- vent will alarm for low minute ventilation
what are the advantages of closed suctioning compared to open suctioning?
maintains oxygenation better and decreases the nurses exposure to secretions
accroding to the ICu liberation recommendations, what drugs are the first line for nociceptive pain?
according to the ICU liberation recommendations, what should be treated first before considering sedative therapy?
spontaneous breathing trials are usually performed with __________ and _________ and they should last at least _______ minutes
performed with PS and PEEP and should last at least 30 minutes
ventilated patietns should have a sedation vacations at least _________ in order to prevent VAP
once per day
low flow oxygen therapy systems provide flow rates that are ___________ than the patient's inspiratory demands
high flow oxygen therapy systems provide constant FiO2 by delivering the gas at flow rates that _______ the patients peak inspiratory flow rate and by using devices that draw in a _____ ____________ of room air
why does using pressure support decrease the WOB?
helps to overcome the resistance of the small ET tube diameter (breathing through tube is like breathing through a straw)
why would pressure support ventilation be added to a IMV mode?
to decrease WOB
what is the advantage of pressure controlled ventilation compaired to volume controlled
gas flow synchronizes with the patients respiratory demands
preset positive pressure used to augument the patients inspiratory effort is known as?
pressure support ventilation
what condition is congential softening of the tissues of the larynx?
what are key characteristics of laryngomalacia
- difficulty feeding
- poor weight gain
- issues with breathing but NO OTHER TYPICAL SIGNS OF RESP INFECTION SUCH AS FEVER
***seen in newborn or within a month old who has expiratory stridor
a child had a cold last week, now this week came in and is super snotty and having issues breathing. what might they have
what age group has the highest risk for foreign body aspiration
6 months- 3 years
a child with foreign body aspiration should have no liquids until????
gag reflex present
what should you never do when you suspect a child might have epiglottis?
NEVER look in the back of their throat
inspiratory stridor that appears at birth or shortly after birth is typically caused by????
a patient has a high pressure alarm go off and they are not in respiratory distress. while trouble shooting the alarm you realize it was due to a decrease in lung compliance. what is the next intervention?
obtain PIP and plateu pressures and SBAR RT or MD
patient has the apnea alarm go off. what is your intverntion
manually ventilate with ambu bag
what are ways to help with eye iritation or sinus pain for a patient using NIPPV
reduce positive air pressure if possible
a patient on NIPPV has a ride in CO2 values due to rebreathing. what should you monitor and what should you talk about with the MD or RT?
monitor: LOC, vitals, ABGs
talk about increasing IPAP and EPAP. higher pressures produce more flow through the exhalation port which helps to purge CO2 from the mask and circuit to prevent rebreathing
what are contraindications for the use of NIPPV?
- lack of spontanous breathing
-those who cant handle respiratory secretions
- impaired cough
- impaired swallowing
- potential for airway obstruction (issues with head, neck, throat, etc)
- lethargic or comatose ppl
- severe acidosis (<7.1) or hypoxemia
- uncooperative or agitated ppl
- those who are hemodynamicly unstable ( shock, ACS)
what are indications of suctioning
- sudden onset of resp distress
- drop in o2 sats
- visable secretions
- increase in RR
- high pressure alarm
- course breath sounds heard over trachea and/or bronchi
- sustained cough
what are reasons that. a child with croup can discharge after 3-4 hours
- if they have no stridor at rest
- good air exchange
- oral fluid intake
- good pulse ox
what are reasons that a child with croup needs to be hospitalized
- impending respiratory failure
- need for oxygen therapy
- deteriorating respiratory distress after treatment
- severe dehydration
what childhood condition is inflammation of cartilage that covers the trachea
explain the procedure for MOV for an intubated patient
add air until no air leak is heard peak inflation
explain the procedure for MIV
remove a small amount of air from the cuff until a slight air leak is auscultated at peak inflation
what acid-base inbalance develops during stage one (exudative) of ARDS? why?
as physiologic dead space increases, patients must increase their minute ventilation to maintain their near-normal PCO2
what are the major causes of hypoxemia in an ards patient (symptoms of impaired gas exchange)
V/Q mismatching and shunting
what type of ARDS is the only type to get steroid treatment
what do you do before you place the patient in the correct position for intubation
oxygenate with BVM for several minutes
what diagnostic test will provide the nurse with the MOST specific information to evaluate the effectiveness for a patient with ventilatory failure
what vent setting can increase WOB if it is not combined with pressure support
what are characteristics specific to kids
- larger head
- larger tongue
- larynx is more superior
- airway is narrow
- more flexible trachea and its more anterior and superior
- epiglottis is larger and at a 45 degree angle
why do infants have decreased ability to create forceful inspirations?
in infants the diaphragm inserts into the chest wall more horizonatally than in older children or adults
Where is the narrowest portion of the pediatric airway?
cricoid cartilage ring
the chest wall is very _______ in infants compared to older children and adults
due to the increased compliance, when an infant is in distress, contraction of the diaphragm down will result in __________ and _________ retractions rather than inflation of the lungs
intercostal and sternal retractions
what is the big presentation symptom to know for pediactric ards
changes in LOC
in a child, altered LOC can be an indicator of?
hypoxia or hyercarbia
what GI symptoms might pediactric patients expeirence with low oxygen
- generalized abdominal pain
- use of accessory muscles
- occasional vomiting
how are most cases of laryngomalacia resolved
90% resolve on their own by age 2
what is a child monitored for with foreign body aspiration
what should not be given to a child with foreign body aspiration
what are signs of respiratory FAILURE in kids
- DECREASED LOC
- grunting respirations/increased WOB
- poor air entry and decreased breath sounds
- apnea / slowed respirations
- brady cardia
- dusky color/cyanosis
kids with epiglottis will have a _______ fever
if a patient who is on NIPPV is receiving full ventilator support for respiratory distress how often should you document an assessment of them?
what is FRC
the volume of air present in the lungs at the end of passive expiration
true or false, upper gastrointestinal bleeding is a contraidction for NIPPV
sign of airway OBSTRUCTION in kid
leaning forward, chin trusted out
how to positoon a kid with bronchitis from RSV
head and chest 30-45 degree angle, neck slightly extended to maintain open airway and decrease pressure on diaphragm
how often should ppl have sedation vaca
once per day
reasons for high pressure alarm
- tube kinked
- water in tube
- pt coughing
- pt having bromchospasms
- pt trying to talk
- pt breathing dyssynchronous
- pt biting on ET tube
- pt has decrease in pulmonary compliance
what is a common reasosn for over sedation in the ICU patient
what are manifestations of patient vent dyssynchrony
- agitation, coughing, grimacing
- tachy crdia, tachypnea, hypoxia
- forceful exhalation, use of accessory muscles, nasal flaring
what might be added for vent settings due to refractory hypoxemia
what symptom of laryn increases when the baby is supine or crying
child is brought to the emergency department with copious drooling and a croaking sound on inspiration. Her mother states that the child is very agitated and only wants to sit upright. What should be the nurse's first thought
A school-age child had an upper respiratory tract infection for several days and then began having a persistent dry, hacking cough that was worse at night. The cough has become productive in the past 24 hours. This is most suggestive of
Why do infants and young children quickly have respiratory distress in acute and chronic alterations of the respiratory system?
Mucus and edema obstruct small airways
The nurse should implement which interventions for an infant experiencing apnea?
An infant with apnea should be stimulated by gently tapping the foot. Resuscitative equipment should be available and the infant should be maintained in a neutral thermal environment.
what meds are used for croup and what order?
do dex first cuz it takes longer to kick in
what kid problem is treated with antibiotics
pressure points of the proned patient
- acromian process
- anterior superior spinous process
with respiratory fialure hypoxemia secondary to intrapulmonary shint, it usually isnt responsive to high o2 concentrations for therapy. what respiratory intervention is better
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