Critical Care Test I

Front 1

What is the indication for mechanical ventilation?

Back 1

1) assist the pt who cannot maintain adequate alverolar ventilation

Front 2

What is negative pressure ventilation?

Back 2

alternation or intermittent ventilation

Front 3

What is positive pressure ventilation?

Back 3

ventilation which foces gas into the lungs, artificial airway is required.

Front 4

what is High frequency ventilation?

Back 4

constant flow, low pressure, high volume. requires artifical airway

Front 5

What is FIO2?

Back 5

the fraction of inspired oxygen or the concentration of oxygen the pt is to recieve

Front 6

If a patient has low ABG then you would ________ FIO2.

Back 6

increase

Front 7

If a patient has high ABG then you would _______ FIO2.

Back 7

decrease

Front 8

What is the tidal volume?

Back 8

the amount of air that the ventilator has been set to deliver to the patient WITH EACH BREATH.

Front 9

if a patient has high PaCO2 and low pH you need to ______ RR or tidal volume.

Back 9

increase

Front 10

Respiratory rate (in regards to ventilator)

Back 10

the number of positive pressure breaths that the ventilator delivers per minute

Front 11

Sigh

Back 11

allos for additional volumes of air to be delivered several times each hour

Front 12

Continuous mechanical ventilation (CMV)

Back 12

vent delivers preset tidal volume and respiratory. DOES NOT ALLOW FOR SPONTANEOUS BREATHS.

Front 13

Assist/control ventilation (A/C)

Back 13

Spontaneous inspiratory effort of pt prompts vent to deliver preset tidal volume. If no effort occurs than vent delviers breaths at preset respiratory rate. ALL BREATHS GET THE PRESET TIDAL VOLUME.

Front 14

Intermittent mandatory ventilation (IMV)

Back 14

vent delivers preset tidal volume and respiratory rate. Client can take UNASSISTED additional breaths.

Front 15

Synchronized intermittent mandatory ventilation (SIMV)

Back 15

preset ventilator breaths are synchronized with pts spontaneous breaths to avoid "stacking" of breaths.

Front 16

Positive end-expiratory pressure (PEEP)

Back 16

preset amount of pressure stays in the lungs at the end of exhalation, keeps alveoli open.

Front 17

With PEEP, the pts functional volume is increased or decreased?

Back 17

increased

Front 18

PEEP and CPAP both prevent ____________

Back 18

atelectasis

Front 19

Continuous positive airway pressure (CPAP)

Back 19

continous pressure for the client who is breathing entirely on their own without any ventilator-generated breaths.

Front 20

Pressure support ventilation (PSV)

Back 20

client breaths spontaneously and the vent provides a preset level of pressure assistance with each spontaneous breath

Front 21

PEEP gives pressure at __________

Back 21

end of expiration

Front 22

PSV gives pressure at _____________

Back 22

inspiration

Front 23

When suctioning an ET tube, suction for no longer than ___________.

Back 23

10 seconds

Front 24

Name 3 possible causes of a high-pressure alarm sounding on a ventilator.

Back 24

Pt. fighting the vent or biting tube
pneumothorax
bronchospams
obstructed tubing
ET tube displaced

Front 25

Name 3 possible causes of a low-pressure alarm sounding on a ventilator

Back 25

leak in the ventilator circuit preventing delivery of breath

clients stops breathing on SIMV or CPAP or PSV modes

cuff leak occurs in the tube

Front 26

Where is a PICC line usually placed?

Back 26

Brachial vein

Front 27

Pleural Effusion

Back 27

liquid in pleural space

Front 28

Empyema

Back 28

pus in pleural space

Front 29

Pneumothorax

Back 29

air in pleural space

Front 30

hemothorax

Back 30

blood in pleural space

Front 31

In tension pneumothorax blood pressure and breath sounds are often __________.

Back 31

decreased

Front 32

In tension pneumothorax neck veins are often __________.

Back 32

distended

Front 33

In tension pneumothorax excursion may become __________.

Back 33

assymetrical

Front 34

Tracheal deviation is a late and ominous sign of ______________ ___________.

Back 34

tension pneumothorax

Front 35

In tension pneumothorax the respiratory system exhibits _________ _______ ______.

Back 35

sudden respiratory distress

Front 36

What are 3 possible complicatiosn of CT insertion?

Back 36

Bleeding/organ puncture
ruptured airways
tension pneumothorax

Front 37

The first chamber in a chest tube drainage system....

Back 37

collects the fluid/drainage

Front 38

The second chamber in a chest tube drainage system....

Back 38

allows air to leave pleural space

Front 39

what does the second chamber in a chest tube drainage system prevent?

Back 39

air from re-entering the pleural space.

Front 40

The third chamber in a chest tube drainage system....

Back 40

regulates suction applied to pleural space

Front 41

what volume is dangerous in a chest tube and needs to be reported?

Back 41

> 100 ml/hr

Front 42

The P wave in a EKG represents....

Back 42

depolarization of the atria

Front 43

The QRS complex represents....

Back 43

depolarization of the ventricles

Front 44

The T wave represents

Back 44

Ventricular repolarization

Front 45

What is the normal PR interval?

Back 45

.12 to .20 seconds

Front 46

What is the normal QRS duration?

Back 46

< .10 seconds

Front 47

A U wave seen on an EKG may be normal, or it may indicate....

Back 47

hypokalemia

Front 48

Normal Sinus Rhythm (NSR)

Back 48

atrial Rate: 60-100 bpm
PRI: .12 or greater

Front 49

Sinus Tachycardia (ST)

Back 49

Atrial rate: 101-150 bpm
PRI: .12 or greater

Front 50

Sinus Bradycardia (SB)

Back 50

PRI: .12 or greater

Front 51

what 4 things can be used to treat symptomatic Sinus bradycardia?

Back 51

atropine, dopamine, epinephrine, or a pacemaker

Front 52

when is sinus bradycardia symptomatic?

Back 52

when cardiac output is decreased

Front 53

Sinus arrhythmia (SA)

Back 53

P-P waves are irregular in pattern

Front 54

Atropine side effects

Back 54

dried mucous membranes, constipation, tachycardia

Front 55

what do you need to watch when giving atropine?

Back 55

Monitor EKG for tachycardia, and urinary output

Front 56

Dopamine's affects are based on....

Back 56

the amount (dose) given

Front 57

Side effects of epinephrine/dopamine include

Back 57

Increased HR and BP

Front 58

If an IV infiltrates while dopamine/epi are being given what will occur?

Back 58

tissue necrosis

Front 59

to prevent tissue necrosis in when dopamine and epi are given what can be given sub- Q?

Back 59

Regitine

Front 60

atropine is an.....

Back 60

anticholinergic

Front 61

epinephrine and dopamine are...

Back 61

sympathomimetics

Front 62

what are the 5 categories of fmaily needs?

Back 62

1) recieve assurance
2) remain near pt
3) receive accurate information
4) comfort
5) support available

Front 63

What is the goal of AACN's Healthy work environment campaign?

Back 63

Respect, Responsibility and Acknowledgement of other htealth team members

Front 64

what are 5 elements of a healthy work environment

Back 64

collaberation, effective communication, effective decision making, appropriate staffing, positive reinforcement

Front 65

SBAR stands for

Back 65

Situation
Background
Assessment
Recommendation

Front 66

AACN

Back 66

American Association of Critical Care Nurses

Front 67

SCCM

Back 67

Society of Critical Care Medicine

Front 68

Beneficence

Back 68

taking action to benefit the patient

Front 69

non-maleficence

Back 69

do no harm

Front 70

veracity

Back 70

truth

Front 71

what 3 things are required for informed consent?

Back 71

mental competance

decision is entirely voluntary

decision is based on understanding.

Front 72

brain death

Back 72

complete and irreversible cessation of brain function

Front 73

vegetative state

Back 73

condition in which person does not meet criteria for brain death but displays profound neurological impairment with little to no chance of recovering

Front 74

PVS

Back 74

persistent vegetative stateq

Front 75

Persistent vegetative state

Back 75

no evidence of purposeful movement

Front 76

Karen quinlan (date of case)

Back 76

1975

Front 77

Nancy Cruzan (date of case)

Back 77

1983

Front 78

Terri Shiavo (date of case)

Back 78

1990

Front 79

When withdrawing support and a patient is experiencing fear/anxiety:

Back 79

give benzodiazapenes (midazolam)

Front 80

When withdrawing support and pt is experiences pain/dyspnea:

Back 80

give morphine sulfate

Front 81

Before a DNR/DNI order is official....

Back 81

an MD MUST write the order

Front 82

Can family members override a signed donor card?

Back 82

yes

Front 83

elastance

Back 83

ability of the lung to recoil

Front 84

shunting

Back 84

blood flowwing past a non-ventilated alveoli

Front 85

compliance

Back 85

lungs ability to expand

Front 86

Before a DNR/DNI order is official....

Back 86

an MD MUST write the order

Front 87

residual volume

Back 87

air left in lungs after forced experation

Front 88

Can family members override a signed donor card?

Back 88

yes

Front 89

Functional residual capacity

Back 89

air left in lungs after normal expiration

Front 90

elastance

Back 90

ability of the lung to recoil

Front 91

deadspace

Back 91

air sacs full of air with no blood passing...ventilated but not pefrused

Front 92

shunting

Back 92

blood flowwing past a non-ventilated alveoli

Front 93

resistance

Back 93

force to be overcome to ventilate

Front 94

compliance

Back 94

lungs ability to expand

Front 95

anatomic deadspace is...

Back 95

normal

Front 96

residual volume

Back 96

air left in lungs after forced experation

Front 97

Functional residual capacity

Back 97

air left in lungs after normal expiration

Front 98

deadspace

Back 98

air sacs full of air with no blood passing...ventilated but not pefrused

Front 99

resistance

Back 99

force to be overcome to ventilate

Front 100

anatomic deadspace is...

Back 100

normal

Front 101

Before a DNR/DNI order is official....

Back 101

an MD MUST write the order

Front 102

Can family members override a signed donor card?

Back 102

yes

Front 103

elastance

Back 103

ability of the lung to recoil

Front 104

shunting

Back 104

blood flowwing past a non-ventilated alveoli

Front 105

compliance

Back 105

lungs ability to expand

Front 106

residual volume

Back 106

air left in lungs after forced experation

Front 107

Functional residual capacity

Back 107

air left in lungs after normal expiration

Front 108

deadspace

Back 108

air sacs full of air with no blood passing...ventilated but not pefrused

Front 109

resistance

Back 109

force to be overcome to ventilate

Front 110

anatomic deadspace is...

Back 110

normal

Front 111

Chronic lungers have issues with....

Back 111

elastance

Front 112

ARDS patients have problems with

Back 112

compliance

Front 113

work of breathing

Back 113

oxygen required just to ventilate (1-2% at rest)

Front 114

Bronchoconstriciton will ________ resistance

Back 114

increase

Front 115

What is PaO2 in respiratory failure?

Back 115

<60 mmHg

Front 116

what is SaO2 in respiratory failure?

Back 116

<90%

Front 117

what is PaCO2 in respiratory failure?

Back 117

> 45 mmHg with acidemia

Front 118

definition of respiratory failure

Back 118

inability of the respiratory system to maintain adequate ventilation and oxygenation of tissues

Front 119

what are the 3 possible causes of respiratory failure?

Back 119

Mechanical abnormailities
CNS abnormalities
Dysfuncion resp. muscles

Front 120

What kills your patient in respiratory failure?

Back 120

Hypoxemia

Front 121

a decrease in compliance and increase in resistance will _______ work of breathing

Back 121

increase

Front 122

a increase in compliance and decrease in resistance will ________ work of breathing

Back 122

decrease

Front 123

what is the first indicaton of hypoxemia?

Back 123

restlessness

Front 124

Decreased breath sounds are heard with..

Back 124

shunting

Front 125

Low flow systems....

Back 125

depend on the pts respiratory effort to deliver oxygen

Front 126

high flow systems

Back 126

deliver set amount of oxygenation regardless of pts effort

Front 127

High flow or low flow: nasal cannula

Back 127

low

Front 128

High flow or low flow: simple face mask

Back 128

low

Front 129

High flow or low flow: venti mask

Back 129

high

Front 130

High flow or low flow: non-rebreather

Back 130

low

Front 131

High flow or low flow: face tent

Back 131

high

Front 132

High flow or low flow: trach collar

Back 132

high

Front 133

High flow or low flow: pratial rebreather

Back 133

low

Front 134

High flow or low flow: T piece

Back 134

high

Front 135

BiPAP and CPAP differ in that....

Back 135

with BiPAP the exhale pressure is lower than inhale pressure, with CPAP pressure is continuous

Front 136

NPPV

Back 136

CPAP mask with ventilator set up to it

Front 137

Definition of Acute Respiratory Distress Syndrome

Back 137

most severe acute lung injury resulting in respiratory failure

Front 138

4 manifestations of ARDS:

Back 138

1) hypoxemia refractory to increased lvls of oxygen

2) non-cardiogenic pulmonary edema

3) atelectasis

4) decreased compliance (stiff lungs)

Front 139

What is the mortality of ARDS:

Back 139

40-70%

Front 140

what 4 things account for 85% of ARDS?

Back 140

Aspiration
Chest trauma
Pneumonia
Sepsis

Front 141

Sepsis accounts for over _____ of ARDS cases

Back 141

1/2

Front 142

______ of patients who aspirate develop ARDS

Back 142

1/3

Front 143

What 4 things are used to determine the severity of lung injury in ARDS?

Back 143

Severity of infiltrates
degree of hypoxemia
amoung of PEEP
Lung compliance

Front 144

Patho of ARDS

Back 144

overwhelming inflammatory response (SIRS) --> excessive chemical release --> holes in the alveoli --> vascular fluid entering the lungs --> pulmonary edema -->hypoxemia

Front 145

A "white out" x-ray image with patchy infiltrates is a sign of...

Back 145

ARDS

Front 146

What components are part of the "protective lung strategy"?

Back 146

1) decreasing tidal volume to 4-6 ml/kg instead of 10-15 ml/kg

2) lowest FIO2 possible to maintain SpO2 >60%

3) PEEP used to prevent atelectasis

Front 147

Paralytics should never be given without.....

Back 147

Sedatives being given first

Front 148

With a patient with ARDS calorie requirement is...

Back 148

1-2 x's normal

Front 149

Aspiration precautions include what 2 interventions?

Back 149

HOB 30-45 degrees
residual volumes q 4-6 hours

Front 150

A PE is...

Back 150

a non-soluble material that travels through pulmonary circulation and lodges in a pulmonary vessel

Front 151

A "massive" PE is considered one that....

Back 151

affects > 50% of pulmonary vasculature

Front 152

Virchow's Triad

Back 152

Venous Stasis
ALtered blood coagulability
Damage to vessel wall

Front 153

80% of patients with PE experience what 3 symptoms?

Back 153

1) sudden onset dyspnea
2) chest pain that worsens with inspiration
3) tachycardia

Front 154

what is the typical PCO2 of a patient in early PE?

Back 154

PCO2 < 36

Front 155

what is the typical PO2 of a patient early with PE?

Back 155

<80%

Front 156

tPa is only used on PE's that are

Back 156

severely lart and hemodynamically unstable

Front 157

Normal pH?

Back 157

7.35-7.45

Front 158

Normal PaCO2?

Back 158

35-45

Front 159

CO2 is...

Back 159

acidic

Front 160

CHO3 is...

Back 160

basic

Front 161

Normal HCO3?

Back 161

22-26

Front 162

excessive vomitting will cause...

Back 162

metabolic alkylosis because of the loss of chloride

Front 163

excessive diahrrea will cause

Back 163

metabolic acidosis because of the loss of HCO3

Front 164

s/s of alkalosis:

Back 164

excitability, anxiety, tremors, seizures, numbness/tingling

Front 165

s/s of acidosis:

Back 165

decreased LOC, headache, vomitting, hyperventilation