Med/surg 371 Test 1/25/07

Front 1

Accidental Decanulation

Back 1

1. Call for help
2. Reinsert the tube, if possible
3. Call a respiratory arrest
4. Auscultate for BS
5. Maintain ventilation and oxygenation by bag and mask

Front 2

The client's biggest concern about weaning is:

Back 2

fear of not being able to breathe.

Front 3

Clinical assessments indicating respiratory distress during the weaning process

Back 3

1. abnormal rr & pattern
2. use of accessory muscles
3. abnormal P & BP
4. abnormal skin & muscous MB color
5. abnormal ABG levels or O2 sats

Front 4

4 functions of heart

Back 4

automaticity
conductivity
excitablility
contractibility

Front 5

Places to avoid placing leads:

Back 5

joints, pacemaker, breast tissue, significant muscle mass, scar tissue

Front 6

Artifact:

Back 6

rhythmic moving on a strip

Front 7

P-R interval facts:

Back 7

should be 3-5 squares (0.04 per square) or not more than a big block. > than 1 block is 1st degree HB
0.12-.20

Front 8

QRS wave facts:

Back 8

0.04-0.12 Mike says 0.06-0.10 or 1 1/2 to 2 boxes

Front 9

A-flutter:

Back 9

can be as high as 300, 250-350 is common; can have 4:1 Pwave:QRS
controlled: <100
uncontrolled: >100

Front 10

Idioventricular

AIOV

Back 10

20-40 BPM

40-100 BPM

Front 11

Focus on increase HR & CO

Back 11

NO lidocaine!!!

Can use epi, adenosiene, nitro

Front 12

Asystole

Back 12

ventricular standstill (inadequate blood flow to heart)
TX: CPR
check 2 different leads; check the "gain" button--rarely pulls out of this rhythm

Front 13

Documentation

Back 13

label name, date, time
time of onset
s/sx
methods of tx
pt teaching

Front 14

If QRS aren't coming @ regular intervals, most likely it is

Back 14

A-fib

Front 15

tx of 3rd degree HB

Back 15

pacer

Front 16

if P-R is extended?

Back 16

first degree HB

Front 17

definition/s/sx of hypoperfusion

Back 17

diaphoresis
confusion
CP
dizzy
open IV & give bolus

Front 18

tachy is how many BPM

PSVT is how many BPM

Back 18

>100 bpm

>180 bpm

Front 19

A-fib

Back 19

no P distinquishable
no QRS after
decreased BP & filling time
s/sx of hypoperfusion

Front 20

Stable tachy? what do you do?

Back 20

administer O2
start iv
attach monitor
obtain 12-lead ecg
obtain portable cxr

Front 21

sample of 3rd degree

Back 21

complete heart block

Atrial rate 80
Vent rate 35
totally unique rhythms

Front 22

normal pH equals?

Back 22

20:1 ratio of base to acid

Front 23

If pH goes one way and the PaCO2 goes another it is

Back 23

a respiratory problem!

Front 24

If pH and PaCO2 are going the same way, it is

Back 24

a metabolic problem!

Front 25

Pressure Support

Back 25

A positive inspiratory pressure that “pushes” air into the lungs as the patient inhales.
Used to reduce the work of breathing, reduce respiratory fatigue, and i respiratory rate.
PS of 10 mimics atmospheric breathing.

Front 26

Positive End Expiratory Pressure (PEEP)

Back 26

A positive back pressure as the patient exhales.
Keeps the alveoli open longer during exhalation.
Used to h sats when h O2 doesn’t help.

Front 27

FiO2:

Back 27

Fraction of inspired oxygen, as a percentage.

Room air = 21% FiO2. 5L/NC = 40% FiO2.

Front 28

Frequency (f):

Back 28

# of breaths/min (resp. rate)
Range: 16-25 <12 or >38 not good.

Front 29

End Tidal Volume (Vte):

Back 29

the size of each breath in mL.
Range: 8-10mL/kg. (500-800mL)

Front 30

Minute Ventilation (Ve tot):

Back 30

The amount of air in/out of the lungs in 1 minute.
Range 6-10 L/min.

Front 31

Peak Inspiratory Pressure (Pi end):

Back 31

Range 16-25 mmHg, >30 Tx and watch, >40 ouch!

Front 32

Volume Controlled Ventilation (VCV):

Back 32

Machine breath volumes are constant, lung pressures are variable.
As lung gets sicker, PIPs will increase, so watch!

Front 33

Pressure Controlled Ventilation (PCV):

Back 33

Machine breaths pressures are constant, lung volumes are variable.
As lung gets sicker, Vte will decrease, so watch!

Front 34

Pressure Support Ventilation (PSV, CPAP, or SPONT).

Back 34

No machine breaths (rate
of 0).
Will use PS and/or PEEP to help a pt breathe.

Front 35

Synchronized Intermittent Mandatory Ventilation (SIMV):

Back 35

Some machine breaths (set a rate).
PCV or VCV, will use PS and/or PEEP.
If pt. over breathes the rate, won’t get machine breath

Front 36

Assist Controlled Ventilation (AC):

Back 36

All machine breaths (set rate), PCV or VCV.
If pt. over breathes the rate, still get machine breath.

Front 37

Weaning From the Ventilator

Back 37

Move from invasive modes to less invasive modes (i.e. A/C a SIMV a SPONT)
Wean PEEP and PS to atmospheric levels.
Can do a “room air trial” and/or weaning parameters.
Extubate patient (Yea!).

Front 38

Monitor the healing process:

Back 38

Watch VS/sats to see if pt. tolerates settings.
Evaluates vent wean for pt decompensation.
Troubleshoots vent alarms (suction, sedation

Front 39

Prevents further injury:

Back 39

Prevents VAP by oral care, suctioning.
Positions pt to prevent immobility, VAP.

Front 40

Disadvantages of Mechanical Ventilation--immediately

Back 40

Immediate complications
Pneumothorax
Tracheal trauma/bleeding

Front 41

Disadvantages of Mechanical Ventilation--long term

Back 41

Long-term complications
Ventilator Assisted Pneumonia
Aspiration
Immobility Deficits
Failure to wean

Front 42

Pressure Monitor Set Up

Back 42

1. Pressure bag
2. IV solution
3. IV tubing (with 1,2,3 chambers)
4. Transducer with flush & monitor connection
5. Tubing- art line (rigid), PA line IV tubing
6. Catheter & sutures
7. Pressure monitor

Front 43

ARTERIAL LINES

Back 43

Arterial Lines: Catheters are placed in the radial or femoral artery and allows for direct monitoring of the
arterial blood pressure.
Purpose: 1) provides direct continuous observation of SBP, DBP, MAP; 2) allows for frequent blood
sampling.

Front 44

Preparation of ART LINE

Back 44

1. Location:

Front 45

Normal findings on art lines

Back 45

1. Usual Pressures
SBP (120): compliance
DBP (80) elasticity
MAP (95): SBP + 2(DBP)/ 3
Ex: 120 + 2 (80)/3= 120 + 160/3= 280/3= 93

Front 46

Pulmonary artery pressure monitoring

Back 46

(PA pressures, Swanz-Ganz catheter monitoring, right-sided
cardiac catheterization, hemodynamic monitoring)is the placement of a flow-directed catheter into the
right side of the heart and pulmonary artery.

Front 47

art lines--high pressure systems

Back 47

PA pressure monitoring provides information about left
ventricular function and allows for direct cardiac measurements.

Front 48

Possible complications of art lines

Back 48

Hemorrhage is #1

Front 49

pulmonary artery lines--low pressure system

Back 49

Purpose: to measure several variables that provide information related to:
1. Cardiac pressures

Front 50

Serves as a central line and can be used for:

Front 51

Watch for complications

Front 52

phlebostatic axis

Back 52

marks the location of the right atrium and the PA catheter tip

Front 53

zero-referenced stopcock must remain____

Back 53

at the level fo the phlebostatic axis

Front 54

most common complication associated with insertion

Back 54

ventricular arrhythmias

Front 55

preventing injury is a primary goal w/temporary pacemaker pts because

Back 55

at risk for microshock--minute electrical charges deliver to the heart through the pacing electrode that could cause lethal v-fib