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O2 uptake B
nursing 212 O2 uptake B 2-18
| Question | Answer |
|---|---|
| def hypoxia; def hypoxemia; what will occur first hypoxemia or hypoxia | decreased o2 in the tissues; decreased o2 in the blood; hypoxemia |
| what is the percentage of room o2 | 21% |
| mechanical ventilation: def; is ventilation a cure; def apnea; | processby which FIO2 is >21% and is moved in and out of the lungs via a mechanical vent; no only supports pt until they can breath independently; pt cannot breath on their own |
| mechanical ventilation: indication pt may need ventilation; CO2 retention can be due to inadequate ____ ventilation | apnea, acute resp failure, severe hypoxia, resp muscle fatigue, pt may have acute failure; alveolar ventilation |
| endotracheal tube: why is it inserted; what are signs of successful intubation; what is a common complication; | pt needs to be on a vent; lungs sounds bilaterally, movement of chest wall symmetrical; trauma to resp structures, pt extubating themselves; |
| mechanical ventilation: laryngospasms- when do these occur; what are interventions when these occur | after the removal of the ET tube; O2 positive pressure ventilation, IV muscle relaxants, lidocaine, corticosteroids; |
| what is the most common type of ventilation that we see in the ICU | positive pressure ventilation |
| negative pressure ventilation: this was called aka; def; what pt dx would this be used on; as it expands the thorax it pulls air where | iron lung; chambers encase the chest or body and surround it with intermittent negative pressure; polio and neuromuscular disease; in |
| positive pressure ventilation: what causes the inspiration; what causes expiration; inspiratory phase ends by what 3 things; | positive driving force; when positive force is release expiration is done passively; pressure, volume and time; |
| positive pressure ventilation: what are the 2 types; how is it volume cycled; def tidal volume; in volume cycled what is constant; what isvariable in volume cycled; | volume cycled, pressure cycled; set to deliver a certain tidal volume and pressure changes based on pt needs; this is the air moved in and out with breathe; volume; pressure |
| positive pressure ventilation: pressure cycled- what is constant; what is variable; | pressure; volume; |
| positive pressure ventilation: what is the most common volume cycled or pressure cycled | volume cycled |
| positive pressure ventilation: pressure cycled- because airway resistance may vary from breath to breath what may vary alot | tidal volume; |
| positive pressure ventilation: volume cycled- when is inspiration terminated; how is the volume determined; | when a preset volume of gas is delivered; 10-15 ml/kg body wt; |
| modes of mechanical ventilation- continuous mechanical ventilation (CMV): def; what does everything; what is controlled; what is assisted; | automatic cycling with set rate and tidal volume; machine; intra thoracic pressure always positive; some atmospheric pressure in circuit |
| modes of mechanical ventilation- assist/control ventilation (ACV)- pt own breath triggers what; this is for what type of pt; | ispiration at preset tidal volume; pt that is not breathing enough, when pt is weaning off vent |
| modes of mechanical ventilation- synchronized intermittent mandatory ventilation (SIMV)- def; vent will breath when; why is this used | vent breaths synchronized between pt's own breaths; between pt own breaths; for pt who is not breathing enough times; |
| modes of mechanical ventilation: pressure support ventilation (PSV)- it provided specific amount of airway pressure thru vent to help pt aovercome what; what triggers flow until preset pressure is reached; does this assist with each breath | resistance he fells while breathing spontaneously thru vent circuit; pt inspiratory effort; yes |
| positive end expiratory pressure (PEEP): this improves what; this does not allow airway pressure to return to normal so ____ opens slightly at the end of expiration; there will be a higher __ O2 and less __02; more gas exchange increases the what | gas exchange; the alveoli; Pa and less Fi; functional residual capacity |
| peep: why is it bad for the heart; why is the chest cavity crowded; with increased pressure in the chest what is slowed; slowed blood return to heart thus equal decreased ___ | this pressure at all times crowds the chest cavity; bc the alveoli are open; the venous blood return to the heart; CO |
| Continuous positive airway pressure- CPAP: def; is there a preset pressure; the preset pressure allows for what; who uses this; how can it be administered | pressure is delivered continuously during spontaneous breathing; yes; to stay open; weaning from vent and sleep apnea; mask, ET or trach |
| bilevel positive airway pressure (BIPAP): def; when is there higher pressure; when is there lower pressure; when is the airway most likely to be occluded; is o2 used; does pt breath on their own | provides 2 levels of positive pressure support; during ispiration; expiration; during inspiration; yes; yes |
| bilevel positive airway pressure (BIPAP): the pressure opens what structures; how can it be delivered; does pt need to be able to breath on their own | the oropharynx and nasopharynx; via tight fitting mask, nasal mask or nasal pillows; yes |
| High frequency ventilation (HFV): this is aka; what is the vent rate; what is the tidal volume set at; it is used to decrease what; who gets these; what adult dx may receive this; what does pt need to be before this | jet vent; 100-300/ min; 1-5 ml/ kg; itrapulmonary shunting; peds and neonatal; ARDS; paralyzed; |
| extracorporeal membrane oxygenation (ECMO): aka; this is a modification of what; this involves partial removal of what; what is done with blood; | dialysis of the lungs; cardiac bypass; pt blood; it is infused with 02 and co2 is removed and then is it returned to pt |
| adverse effects of peep/cpap: what can become overdistended; the overdistention of the alveoli can cause what; why can CO fall; | alveoli; pneumothorax; b/c there is decreased venous return r/t increased intrathoracic pressure; |
| CPAP increases the work of what; this increase in breathing causes pt to feel resistance to initiating what | breathing; the breath |
| mechanical vent setting: def resp rate; what is the average resp rate for vent; what happens to the rate as pt is weaned | how many breaths are being delivered to the pt; 4-20; it is decreased |
| mechanical vent setting: what is the average tidal volume; def tidal volume; | 5-15 ml/kg; this is the volume of inspired air set to go in and out of the lungs each resp cycle; |
| mechanical vent setting: what should FiO2 be; we should give how much; the O2 concentration is delivered thru what; the goal is to adjust it to maintain paO2 > ____ and SaO2 >____; | 21-100%; as little as possible; the vent; 60; 90% |
| mechanical ventilation: sigh- def; this prevents what; when is it given through the vent; this also prevents decreased ___ compliance | this is a periodic deep breath; micro-atelectasis; every now and then; lung |
| mechanical ventilation: CO2 low- is this alkalosis or acidosis; what will we do to vent if this happens; this happens if resp rate is too fast or slow; when you breath too fast what happens to CO2; | alkalosis; decrease rate and tidal volume; to fast; it is blown off |
| mechanical ventilation: CO2 high- is this alkalosis or acidosis; what do we do to vent settings when we see this; is resp rate slow or fast; to slow resp rate causes what to happen to CO2; | acidosis; we increase rate are tidal volume; it is too slow; Co2 accumulates; |
| mechanical ventilation: pulmonary complications- barotrauma- this is damage to what; s/s or this | damage to lung tissues and resp structures; pneumothorax and subq emphysema; |
| mechanical ventilation: pulmonary complications- alveolar hypoventilation: what causes this | system leaks, increased secretions; |
| mechanical ventilation: pulmonary complications- alveolar hyperventilation- this can lead to what | resp alkalosis |
| mechanical ventilation: pulmonary complications- ventilator-associated pna- aka; what is an important intervention to prevent this | VAP; mouth care very important |
| mechanical ventilation: pulmonary complications- what should nursing monitor; what volume should be kept low; | lungs sounds, assess for crepitus; tidal volume; |
| mechanical ventilation: pulmonary complications- upper airway damage- how should it be inserted; why should it be himidified | gentle insertion; to prevent drying; |
| mechanical ventilation: pulmonary complications- how to prevent O2 toxicity- what should be monitored; how can we decrease O2 need; keep pt fever free, giving block care,sedating pt; why is Hgb monitored; what vent setting would help | O2 sats, Hgb; shows pt will not be oxygenated properly; increase PEEP |
| mechanical ventilation: pulmonary complications- how to prevent O2 toxicity- why add peep; does O2 toxicity develop faster or slowly | this can help keep O2 low; slowly |
| mechanical ventilation complications -hemodynamic alterations: PEEP increases pressure where; this comprimises what; peep restricts ___ filling; PEEP restricts blood flow thru where; why do dysrhythmias occur with PEEP | intrathoracic pressure; thoracic vessels; ventricular; the lungs; b/c there is less O2 |
| mechanical ventilation complications -hemodynamic alterations: Nursing interventions- what should we monitor; why should feet elevate; why is SIMV good; | vitals, EKG; to promote venous return if in shock; preserve intrathoracic pump and hleps pump blood to the heart; |
| mechanical ventilation complications - fluid retension- when does it occur; what are s/s of it; what system is activated with dec CO2; why is there increased ADH; why is there decreased fluid loss | 48-72 hours of PPV or peep; decreased urinary output and Na retention; renin-angiotensin; stress response; we are hanging onto fluid that we normally breath off |
| mechanical ventilation complications - fluid retention- what should be monitored; | I&O, daily wts, monitor lytes |
| mechanical ventilation complications - nutritional needs: inadequate nutrition leads to what; why should carbs be limited; what is the biproducts of cards; | anemia, decreased resp muscle strength, decreased serum proteins, delayed weaning, decreased resistance to infection; it can increase CO2 production and vent demand; CO2; |
| mechanical ventilation complications - nutritional needs increase in CO2 increases or decreases the work of breathing; what is the pulmocare diet; | increases; high in protein and fat, low in carbs; |
| mechanical ventilation complications - GI complications- what can occur; what is tx of GI ulcers; ex of histamine H2 receptor blockers; ex of proton pump inhibitors | gi bleeding and ulcers, constipation/ileus; histamine H2-receptors blockers, proton pump inhibitors; Zantac- rantitidine; Prilosec-omeprazole |
| mechanical ventilation complications - GI complications- what re nursing interventions for constipation/ileus | monitor bowel sounds, monitor TF residuals |
| mechanical ventilation complications - infection- the Endotracheal tube bybasses normal what; suctioning allows and entrance for what; what are nursing interventions for infection; | filtering, cleansing, humidifying of nasal and oral pharynx; bacteria; use humidified air, mouthwash, hand washing, sterile technique, change tubing per protocol, use in line suctioning |
| mechanical ventilation complications -musculoskeletal system: what do we want to prevent; what are nursing inverventions | problems associated with immobility; ROm, up in chair when possible, proper positioning; |
| mechanical ventilation complications -psychosocial implications- why do pt have issues; what are nursing interventions | b/c they are unable to eat, move or breath normally; explain all procedures, use alternate communication methods such as magic slate, writing tab, allow frequent family interaction, accept pts feelings and frustration |
| mechanical ventilation complications -psychosocial implications- meds- what sedative meds are used; what analgesics are used; what neuromuscular blocking agents are there; | diprivan (propofol),precede, deep sedation is versad; sublimaze (fentanyl); MS (morphine sulfate); PAvulon; |
| mechanical ventilation complications -psychosocial implications- what does pavulon do; doe pavulon sedate, stop pain or treat anxiety | paralyzes pt to decrease O2 consumption; no; |
| endotracheal tube machine disconnection/malfunction: what should we assess on pt; what should we check on the machine | equal chest expansion and lung sounds, adventitious sounds; setting correct, intact lines, air leak around the tube, condensation of water in tube, what alarm is sounding; |
| endotracheal tube high pressure alarm: what does this mean; what could this mean; | that it is requiring too much pressure to get air into the patient; suctioning, kink in the tube, pt coughing as breath is delivered, broncospasm, herniated cuff, ET tube becomes blocked, ET tube misplaced,water in tube, dec pulmonary compliance, |
| endotracheal tube low pressure alarm: what does this mean; what causes this | machine is trying to deliver air and it is meeting little to no resistance; tube loose, air leak, disconnection from the vent |
| weaning from positive pressure ventilation: what should gradually be decreased; when is pt easier to wean; | the vent settings; the shorter the time on the vent the easier it is to wean; |
| weaning from positive pressure ventilation: what are the 3 phases of weaning; what is the preweaning phase; what is the weaning phase; what is the outcome phase; what is a spontaneous breathing trial | pre-weaning, weaning process, outcome phase; assessment; weaning protocol; extubated or discontinued; 30-120 mint to 2 hours of non breathing |
| weaning from positive pressure ventilation: when is the best time to wean; resp rate should be <___ min before weaning; what are nursing interventions for weaning | in the morning- pt is more rested; 25; promote trust, reduce anxiety, reinforce self esteem, optimize comfort status, include pt in plan, control energy demands, promote optimal energy resources |
| what are indications what vent needs to be reconnected: what is dangerous pulse rate; what is dangerous rr, pH; PaCO2; PaO2; what would spontaneous TV be less then | 110/min; rr increase 10/min, or rate more than 30/min; pH <7.35; PaCO2 >55; PaO2 <60; 300 ml; |
| what comes first resp insufficiency or resp failure | resp insufficiency |
| Resp insufficiency: the resp function is not adequate to meet what; what mechanisms are working in body to prevent harm; can this be acute or chronic; | needs of body; compensatory mechanisms; both; |
| resp failure: the pt cannot ahieve adequate gas exchange when; are compensatory mechanisms working; is there enough O2 in tissues; are there acid base disturbances; | at rest; no; no; yes; |
| resp failure: compensatory mechanisms- why does pt hyperventilate; why is there renal compensation | to decrease CO2; to increase HCO3 |
| acute resp failure: what is PaO2; what is pulse ox; what is PaCO2; what is resp rate; what is vital capacity; what is goal of ABGs; | <60 mm HG on room air; 90%; >50 mm HG; >30 or <8; <15 ml/kg; to restore PaO2 and PaCO2 to previous levels |
| acute resp failure: why are the ABG parameters not applicable for COPD pt; what cannot be increased too much in COPD pt; | b/c they will often have dec PaCO2 levels and elevated PaCO2 levels; O2 |
| ARDS: aka; what is there severe __ & __; why do diffuse bilateral infiltrates occur; this develops after what; what is the most common cause; where in body does this occur; is PO2 up or down; is CO2 up or down | adult resp distress syndrome; dyspnea and hypoxemia; after lung injury in healthy person; shock; sepsis; alveolar capillary membrane; down; normal |
| ARDS: what other names did this use to becalled; | shock lung, traumatic wet lung, post perfusion lung, hyperpermeability pulmonary edema; |
| ARDS: who is at high risk; what is common bacteria for infection; what is common trauma; what type of aspiration; what are ex of inhaled toxins; what are hemato complications; | sock, infection, trauma, inhaled toxins, drug overdose, fat emboli, aspiration, hematological, metabolic disorders, radiation; gram neg; contusionto lung; near drowning; 02 toxicity, smoke inhalation, chemicals; DIC, massive blood transfusions |
| ARDS: what happens to the lungs; the lungs not being perfused is called aka; what happens to the platelets in the pulmonary capillaries; the platelet aggregates causes obstruction why; stagnation of blood does what to capillary and bronchial permeability | they are not being perfused; hypoperfusion; the aggregate; from micro thrombi; increases it |
| ARDS: where does the fluid and plasma protein leak into; what type of pulmonary edema is there; what does nont cardiogenic pulmonary edema mean; | the tissues; noncardiogenic pulmonary edema; it is not r/t the heart but resp |
| ARDS: why is there pulmonary edema; is there increased or decreased pulmonary compliance; atelectasis causes further what; why do alveoli not work | there is decreased surfactant due to damage of type II pneuocytes; decreased; hypoxemia,hyperventilation and hypocapnia; b/c they are filled with fluid or they are collapsed |
| ARDS: what are early s/s; what are middle s/s; why is O2 and CO2 low; s/s of late; | subtle minor change in orientation, restless, change in VS; hypocapnia and hypoxemia, dyspnea, hyperventilation, b/c they have been hyperventilating; crackles tachycardia, hypertension, confusion, restless; |
| ARDS: dx- what will xray show; does PO2 stay low or high in spite of O2 tx; why is PaCO2 low; | white out with pulmonary infiltrates; it stays low; due to hyperventilation; |
| ARDS: in COPD what will CO2 be; what will CO2 be with ARDS; what will O2 be with COPD; what is O2 be with ARDS; | high; low to normal; low; low |
| ARDS: tx- what do we want to improve; we want to decrease the consumption of what; what do we want to improve; what do we want to maintain; | oxygenation; O2; pulmonary function; fluid balance |
| ARDS: Nursing interventions- what do we want to do with O2; what should vent settings have; what other interventions; | at lowest to produce oxygenation; PEEP; correct underlying cause, chest and physical therapy, prevent and control infection, frequent position changes |
| ARDS: tx- Extracorporeal membrane oxygenator- what is done with blood; | it is externally oxygenated it is removed, oxygenated and returned to body without use of heart and lung |
| ARDS: tx- jet vent/high frequency- | |
| respiratory failure: def hypercapnic; def hypoxemic resp failure; | PaCO2 above norm with acidemia; ventilation and perfusion mitchmatched v/q mitch-matched and hypoventilation |
| ARDS: what happens when the alveolar capillary membrane becoems damaged; | it is more premeable to intravascular fluid |
| ARDS: what is the most common cause; what is stimulated; this stimulation causes what; the neutraphils cause a release of what; this release changes what | sepsis; the inflammatory and immune systems; attraction of neutraphils to the pulmonary interstitium; biochemical, humoral and cellular mediators; |
| ARDS: what happens to pulmonary capillary membrane; what happens to colagen; what is formed; pt may not experience s/s for how long; | it is more permeable; it is destroyed; pulmonary microemboli; 1-2 days; |
| ARDS: as it progresses s/s worsen why; why does pulmonary artery wedge pressure not increase | increased fluid accumulation and decreased lung compacity; pt cause if noncardiogenic |
| ARDS: what is chest xray often termed as; what are 4 things that cause clinicians to dx with ards; | white lung; refractory hypoxemia, chest xray new infiltrate (original xray ok), no evidence ht failure and chest xray ok; predisposing condition for ards w/in 48 hours |
| ARDS: def barotrauma; what position may help; what shoulod be given in adition to ventilation; | result from rupture of over distended alveoli during mechanical venilation b/c the high peak pressure needed for tx; prone position; peep; |
Created by:
jmkettel
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