Adv Med Surg- Resp/cardiac Exam 1

Front 1

Prevent VAP

Back 1

• elevating HOB >30
• routine turning of pt Q2hr
• oral care Q4hr
• suction PRN
• prevent aspiration (prefer using postpyloric feeding tube)
• limit duration mechanical ventilator.

Front 2

Activase (Tpa, Alteplase)

Back 2

is a fibrinolytic drug used for the tx of stroke and PE.

Front 3

Criteria to use Activase (Tpa, Alteplase)

Back 3

massive PE (obstructs blood flow to a lobe or more then one segment) and emboli that enduce hemodynamic instability that includes failure to maintain BP without supportive measures.

Front 4

Contraindication for Activase (Tpa, Alteplase)

Back 4

history of CVA, hemorrhage, use of anticoagulants, uncontrolled HTN, trauma, aneurysm, etc.

Front 5

Peak Inspiratory pressure alarms:

Back 5

when there is an increased PIP due to bronchospasm, pinched tubing, increased secretions, pulmonary edema, decreased pulmonary compliance. Used to prevent barotraumas

Front 6

Endotracheal tube should be verified after placement by

Back 6

CXR and end tidal CO2 levels (wave capnogrophy) bilateral breath sounds, symmetrical chest movement, air emerging from ET tube.

Front 7

What to assess for if pt has ET tube

Back 7

Assess placement, minimal cuff leak, breath sounds, chest wall movement regularly, avoid pulling/tugging on tube.

Front 8

Indications for ET suctioning

Back 8

• To maintain patency and integrity of artificial airway
• the need to remove accumulated pulm secretions
• visible secretions in airway
• pt inability to generate effective spontaneous cough
• ARD
• suspected aspiration gastric/upper airway secretions

Front 9

What should be admin 6 hrs prior to extubation to prevent stridor?

Back 9

steroid therapy

Front 10

If pt on vent is hyercapnic what do we do to the settings

Back 10

set rate faster to blow off more CO2

Front 11

NL vent vol to be delivered

Back 11

about 500 mL

Front 12

I/E

Back 12

Flow- how fast they get the tidal volume

Front 13

The surgical team understands that time is crucial in diagnosing and treating an MH crisis. Once recognized, what is the treatment of choice?

Back 13

Dantrolene sodium

Front 14

All of the following are Inotropic agents except:
A. Nipride (nitroprusside)
B. Dopamine (intropin)
C. Lanoxin (digoxin)
D. Epinephrine

Back 14

Nipride (nitroprusside)

Front 15

The term "OASIS' stands for:

Back 15

Outcome and Assessment Information Sets

Front 16

The major source of reimbursement for skilled home care services is what?

Back 16

Medicare

Front 17

Stenotic valves cause only forward flow problems. T/F?

Back 17

False

Front 18

Direct measure of right atrial pressure?

Back 18

Central Venous Pressure (CVP)

Front 19

Measures blood flow to lungs and the state of vascular resistance in lung tissue.

Back 19

Pulmonary artery pressure (PAP)

Front 20

Reflects the left atrium and left ventricular end-diastolic pressures.

Back 20

Pulmonary (artery) capillary wedge pressure (PCWP)

Front 21

Measures right ventricular pressure directly.

Back 21

Right ventricular pressure (RVP)

Front 22

Distensibility of the ventricles is termed:

Back 22

Compliance

Front 23

The valve which is most likely to be affected by Rheumatic Fever is the :

Back 23

Mitral Valve

Front 24

Positive pressure throughout the entire respiratory cycle to prevent alveolar collapse

Back 24

Continuous Positive Airway Pressure (CPAP)

Front 25

Number of ventilations delivered per minute

Back 25

Breaths Per Minure (BPM)

Front 26

Volume of air the patient receives with each breath

Back 26

Tidal Volume (VT or TV)

Front 27

Set tidal volume and set rate delivered to the patient who can add breaths but still receives the set tidal volume

Back 27

Assist Control Mode (AC)

Front 28

Positive pressure exerted during expiration to keep the lungs partially inflated

Back 28

Positive End-Expiratory Pressure (PEEP)

Front 29

Volumes of air that are 1.5 to 2 times the tidal volume

Back 29

Sighs

Front 30

Oxygen concentration delivered to the patient

Back 30

Fraction of Inspired Oxygen (FIO2)

Front 31

Ventilator delivers mandatory breaths at a preset rate and tidal volume then allows the patient to breathe at his own rate and tidal volume spontaneously between the set rate

Back 31

Synchronized Intermittent Mandatory Ventilation (SIMV)

Front 32

Pressure needed to deliver a set tidal volume

Back 32

Peak Airway Inspiratory Pressure (PIP)

Front 33

Ventilator takes over the work of breathing for the patient by delivering a set rate and tidal volume

Back 33

Controlled Ventilation

Front 34

DIC may play a role in some clients with ARDS due to...

Back 34

-Small emboli remain in the lung.
- Fibrinolysis is prevented.
-The production of plasminogen activase inhibitors by the liver is enhanced.

Front 35

The main physiologic problem with ARDS is:

Back 35

C. Injury to the alveolar/capillary membrane.

Front 36

True/False
ARDS may be caused by direct injury to the lung and/or injury to other body systems which then affect lung function and cause injury to lung tissue.

Back 36

True

Front 37

A/C mode

Back 37

pt takes own breaths and machine helps, if pt does not take breath at rate machine is programmed, machine will take the breath for the pt

Front 38

CMV mode

Back 38

machine ignores pts attempts to take breaths and breaths for pt at set rate and volume

Front 39

SIMV mode

Back 39

Lets pt take own breath and helps at set rate, but if pt takes own breath and it's not at the set rate machine will not help the pt

Front 40

V.I.L.I

Back 40

Ventilator induced lung injury

Front 41

PEEP is a critical prt of treatment in what?

Back 41

ARDS

Front 42

Peep is used to do what?

Back 42

keep the alveoli open

Front 43

What is the normal Tidal Volume set at?

Back 43

6-8 ml/kg

Front 44

what will FiO2 normally be set at?

Back 44

100% initially and then quickly brought down

Front 45

I/E ratio

Back 45

Lower the I the bigger the E
normal ratio is 1:2, 1:3, 1:4 etc

Front 46

What does it mean if I/E ratio is high?

Back 46

1:1 is high. Can cause hemodynamic complications

Front 47

What does it mean if I/E ratio is low?

Back 47

ratios lower than 1:2 indicate lower mean airway pressure and fewer associated hazards.

Front 48

Resp Rate usually set at?

Back 48

10-12 BPM

Front 49

PEEP is usually set at?

Back 49

+ 5. That is the amount of air that remains in the lungs at end of expiration.

Front 50

What to assess for vent pts

Back 50

o Resp status q 4 first 24 hrs, then PRN, VS q 4, Pt’s color, chest for bilat expansion, placement of ET or NG tube, check pulse ox, evaluate ABG’s, HOB ≥30°, check ventilator setting q 8, check alarms, if on PEEP ck airway pressure level, ck tidal volume, empty moisture from tubing, warm humidified air to body temp, be sure trach cuff is properly inflated,

Front 51

Who needs vent support?

Back 51

For those who have severe problems with gas exchange & need to be supported until underlying problem improves or resolves. Some chronic issues need lifelong vent support and also for sedation/anesthesia for surgery.

Front 52

Vent rate too fast can cause..?

Back 52

Resp Alkalosis - decrease rate!

Front 53

Vent rate too slow can cause..?

Back 53

Resp acidosis... increase rate!

Front 54

What happens if the vent stops working?

Back 54

Metabolic Acidosis is hypoxia

Front 55

Which ABG disorder may be caused by Renal Failure?

Back 55

Metabolic Acidosis

Front 56

Acute respiratory failure is caused by failure to _______

Back 56

ventilate

Front 57

Type I – When respiratory failure causes low levels of oxygen in the blood, it’s called

Back 57

hypoxemia respiratory failure

Front 58

What can cause hypoxemia respiratory failure?

Back 58

V/Q mismatch can be d/t morphine ↓ resp rate, ↓ volume d/t PNA, ↓ levels of hemoglobin, ARDS, PE…

Front 59

What would ABGs look like for hypoxic resp failure?

Back 59

PaO2 Low < 60 mm/Hg
PaCO2 Normal or low
PA-aO2 Increased

Front 60

Type II – When respiratory failure causes a high level of carbon dioxide in the blood, it’s called

Back 60

hypercapnic respiratory failure.
Failure to exchange or remove carbon dioxide, both O2 & CO2 are affected

Front 61

What can cause hypercapnic respiratory failure?

Back 61

OD, poison, neuromuscular disease, Asthma, COPD, obesity…

Front 62

What would ABGs look like for hypercapnic reap failure?

Back 62

PaO2 Decreased
PaCO2 > 50 mm/Hg
PA-aO2 Normal
pH Decreased

Front 63

Treatments for resp failure?

Back 63

Frequent turning & early mobilization, breathing exercises IS, remove secretions by coughing, suctioning, physiotherapy, PEEP, bronchoscopy to remove obstruction; O2, energy-conversation, meds to open bronchi

Front 64

What can cause ARDS?

Back 64

An acute lung injury occurs, (sepsis, PE, shock, aspiration, or inhalation inury)

Front 65

Does supp O2 help ARDS?

Back 65

No, not even at 100%

Front 66

Pulse Pressure

Back 66

Systolic-diastolic

Example: 120-80=40