Pulmonary Day Three Med Surg 2

Front 1

when do you get put on mechanical ventilation in normal people

Back 1

: pO2 of 50 mmHg or lower and a pCO2 of 50 or higher. When get to 50/50 then you’ll need the mechanical ventilation. If have another problem like chest trauma the numbers will be less strict when being put on mechanical ventilation.

Front 2

when do you get put on mechanical ventilation with COPD

Back 2

a pCO2 of 5 mmHg (or more) higher than their stable state.

Front 3

whats the problem of putting people iwth COPD on mechanical ventilation

Back 3

its hard to ween them off of it

Front 4

treatment of acute respiratory failure

Back 4

mechanical ventilation

Front 5

how does the iron lung work

Back 5

Pressure would incase whole body and force exhalation and then they’d make pressure go away and make it like a vacuum so air would then come in.

Front 6

how does a ventilator work

Back 6

Initiates a preset number of breaths and a preset tidal volume and present pressure and wont shut off until it reaches that tidal volume

Front 7

why does the alarm on the ventilator go off when the pressure increases

Back 7

it means Tidal volume is being reached but is using too much pressure it means they might need to be suctioned or they are biting down on ET tube.


Can blow a lung and cause pnumothorax if you are using too much pressure\

Front 8

sensitivity dial

Back 8

If you set it to be more sensitive, the pt inititing the breath will need less effort bc the machine is mores sensitive, so a breath will be taken easier.

You’d set it less sensetive, if they are hyperventilting to slow breathing.
Might increase sensitivity bc it decreases the work load of the pt to breath.

Front 9

Spontaneous ventilation

Back 9

Normal Breathing. Patients control everything, how often, how deep etc. RARE

Front 10

Controlled mechanical ventilation (CMV)

Back 10

Ventilator delivers preset tidal volume and respirator rate. No allowance for spontaneous breaths. PT HATE

Front 11

Assist/control ventilation (A/C)

Back 11

Spontaneous inspiration effort of client triggers ventilator to deliver preset tidal volume. If client does not trigger an assisted breath, ventilator delivers breaths at preset respiratory rate. Common. Pt away enough. Enough neural control to have a part and start the breath. Allows you to take breaths when you want them as long as respiratory rate doesn’t go under 18.
Tidal volume is what is exhaled, NOT what is set at.

Front 12

Intermittent mandatory ventilation (IMV)

Back 12

Ventilator delivers preset tidal volume and respiratory rate. Client can take unassisted spontaneous breaths between preset breaths. COMMON

Front 13

Synchronized intermittent mandatory ventilation (SIMV)

Back 13

Similar to IMV except that preset ventilator breaths are synchronized with client’s spontaneous breaths to avoid “stacking breaths” (i.e., ventilator breath delivered before client has time to exhale fully). COMMON. Vent will give you some wiggle room to see if you will take a breath before it forces the breath. Used for weening. Can turn down ventilation to 12 and see if the pt will breath at 18 by himself. See if he needs the ventilator anymore. Decreases reliance on ventilator

Front 14

Positive end-expiratory pressure (PEEP)

Back 14

Preset amount of pressure that stays in the lungs at the end of exhalation, keeping the alveoli open. Used in conjunction with CMV, A/C, IMV, or SIMV

Front 15

Continuous positive airway pressure (CPAP)

Back 15

Similar to PEEP, but for the client who is breathing entirely on own (i.e., no ventilator-generated-breaths). Pt has ET tube and has ventilator but breathing by itself. Least invasive. When you don’t want to take out the vent yet bc you’re worried that you’ll have a problem again and don’t want to have to put you back on the vent bc its so tramatic

Front 16

what kinds do you match wtih types of ventilators

Back 16

Positive end-expiratory pressure (PEEP)




Continuous positive airway pressure (CPAP)


Pressure support ventilation (PSV)




High-frequency ventilation (HFV)

Front 17

Pressure support ventilation (PSV)

Back 17

Client breathes spontaneously but ventilator provides a preset level of pressure assistance with each spontaneous breath (inspiration only). Decreases work of breathing

Front 18

High-frequency ventilation (HFV)

Back 18

Ventilator delivers breaths at a rate of greater than 60/min and high as 300/ min and at tidal volumes considerably lower than normal. Only in Peds.

Front 19

when do you use peep

Back 19

Use when blood gases have gone bad. This will change CO2 until o2 that will only change o2

Front 20

how much h20 is given with peep

Back 20

Typically 5 to 10 cm H2O

Front 21

what does PEEP do

Back 21

PEEP prevents collapse of alveoli and holds alveoli open longer - increasing diffusion
***Increases pressure in chest and can decrease venous return and decrease cardiac output***

Front 22

how much h20 given with Continuous Positive Airway Pressure

Back 22

4 – 25 cm H2O pressure

usually 10 cm

Front 23

BiPAP

Back 23

BiPAP delivers CPAP but also senses when an inspiratory effort is being made and delivers a higher pressure during inspiration.

Front 24

when can u use CPAP or BiPAP w ppl in respiratory failure in ER

Back 24

Normal level of consciousness
No major secretion problems
Hemodynamically stable

Front 25

whats a potential problem of tracheostomy tubes and chest tubes.

Back 25

Subcutaneous Emphysema ie crepitis

Front 26

how does Subcutaneous Emphysema ie crepitis occur

Back 26

It develops when air escapes from the tracheostomy (or chest tube) incision into the tissues. It dissects the fascial planes under the skin and accumulates around the face, neck and upper chest.
These areas appear puffy, and slight finger pressure produces a crackling sound bc of movement of fluid away from the finger

Front 27

types of Ventilator Associated Pneumonia

Back 27

Early = 48 -96 hrs after intubation and associated with antibiotic-susceptible organisms
Late = more than 96 hrs after intubation and associated with antibiotic-resistant organisms
From several sources of organisms

Front 28

Strategies to PreventVentilator Associated Pneumonia

Back 28

Change ventilator circuit no more than every 48 hours
Use oral decontamination – chlorhexidine oral rinse
good oral care
Use stress ulcer prophylaxis bc acid into esophagus can get into trach
Position head of bed greater than 30 degrees
Thoroughly suction oropharynx using aseptic technique
Some early studies say closed suction system is best
Maintain adequate hydration and proper humidification

Front 29

2nd part of prevention of ventilator associate pneumonia

Back 29

Monitor gastric residual volumes for overdistention
Maintain adequate ET tube cuff pressure at least 20 cm H2O pressure
Use endotracheal tubes that have continuous subglottic suction ports
Turn pt every 2 hours to increase pulmonary drainage
Minimize use of narcotics and sedatives
Interrupt continuous sedative infusions daily, if possible to wake them up. More pneumonia when higher levels of sedation

Front 30

when do you have ET tubes up or down

Back 30

down(insertion and excavation)
Up(when on ventilator ie rest of time, esp w ambu bag)

Front 31

when do you have a trach up and down

Back 31

Trach-down (when not hooked to vent, insertion and excavation)
Up when on vent

Front 32

Extracorporeal membrane oxygenation

Back 32

-heart and lung machine-take your blood out of body-runs through machine and runs back into body and don’t need lungs or heart working to do it!

Front 33

when can you wean a person off of ventilation

Back 33

Need Max inspiratory pressure at least -20 cm H2O
Good tidal volume

Front 34

what is important for a nurse to do before removing ventilation

Back 34

suction, esp around the balloon

Front 35

how long do you wait when weaning and what BP do you stop weaning

Back 35

Watch pt for 20 min before leaving room and every 5 min after that

If HR increases by 20 or BP up by 20 sys or O2 Sat less than 90….

Front 36

Adult Respiratory Distress Syndrome

Back 36

Sudden and severe form of respiratory failure
in previously healthy persons
in response to some assault (trauma, infection, shock, childbirth)
The precipitating event 1 – 100 hrs earlier
Defined as diffuse, acute pulmonary edema and hypoxemia, despite supplemental O2

Front 37

how does adult respiratory distress syndrome physically do to a person

Back 37

Insult causes damage to alveolar-capillary membrane
Causes increased capillary permiability
Fluid first leaks into interstitial space
Then leaks into the alveoli
This fluid interferes with gas exchange > hypoxemia
Lungs become less compliant
Requires more pressure to deliver same volume

Front 38

phases of Adult Respiratory Distress Syndrome

Back 38

inflammation
pulmonary edema
Fluid in Alveoli & Alveolar Collapse
End Stage. Minimal or No Diffusion

Front 39

what happens during the third stage of ARDS

Back 39

Increase membrane permeability
Damage to surfactant which is important part in allowing alveli to stretch out-increases compliance so decreased lung compliance so need increased pressure to open lungs.

Front 40

treatment of ARDS

Back 40

Treatment-mechanical ventilation, increased oxygenation, sedation, PEEP
they might still fight the ventilater, and it becomes counter preductive, in that case you might use the neuromusclar blockade

Front 41

Neuromuscular Blockade
including meds

Back 41

Medications used to prevent the patient from ‘bucking’ or fighting the ventilator. Decrease work of breathing so less requirement of o2
Pavulon or Norcuron,
Results in muscle paralysis

Front 42

what's requiremd with a neuromuscular blockade

Back 42

ventilator bc it even paralyses the diaphragm
Give with morphine and sedative!!! So they aren’t as aware of what’s going on

Front 43

onset and peak of neuromusclar blockade

Back 43

30-45 second onset and peaks in 3-5 minutes so you can get them off it quickly

Front 44

dead space

Back 44

lung is open and air is going in and out of alveli, but no perfusion

Front 45

shunt

Back 45

perfusion but no air in and out of alveli

Front 46

Silent-

Back 46

no perfusion or ventilation

Front 47

shock

Back 47

impaired tissue perfusion

Front 48

categories of shock

Back 48

Hypovolemic = loss of circulating volume
Cardiogenic = inadequate pumping of heart. DON’t loose volume just don’t have enough pressure to keep it moving
Distributive = change in size of vascular bed without increasing circulating volume. Blood doesn’t go away, but decreased pressure with increased vascular bed
Ex = anaphylactic, neurogenic, septic shock

Front 49

Septic Shock

Back 49

Caused by toxins from microorganisms

Massive infection causes vasodilation
Capacity has increase, but
inadequate tissue perfusion

relative hypovolemia

Cellular death begins d/t decreased perfusion and related decreased oxygen delivered to tissues

Front 50

2 stages of septic shock

Back 50

Early = hyperdynamic stage - warm stage
2. Late = hypodynamic stage - cold stage

Front 51

Hyperdynamic stage

Back 51

massive vasodilation of venus system leading to decreased venus return.
Symptoms: fall in BP, pink skin (vasodilation),  HR to compensate for fall of bp, inc temp bc of infection, dec urine bc not perfusion kidney well, rales (inc cap perm/leaking out fluid), anxiety (may be first sign), neuro status change

Front 52

first signs of hyperdynamic stage

Back 52

High temp, low blood pressure and pink skin are first signs!!!!!

Front 53

Hypodynamic Stage

Back 53

Cardiac output falls > profound hypotension
in HR (trying to compensate for dec CO
Dysrhythmias occur ( bc of myocardial ischemia)
 Resp rate, ARDS develops, hypoxemia
ABGs = severe hypoxemia, resp acidosis d/t respiratory failure ,metabolic acidosis d/t lactic acidosis
Decreased LOC
Temperature control failsi

Front 54

Treatment of Septic Shock

Back 54

Administer fluids during hyperdynamic stage to increase preload to get enough blood to heart
Use vasoconstrictors during hyperdynamic s to reverse vasodilation.
Use vasodilators during hypodynamic stage to decrease systemic vascular resistance
Mechanical ventilation to keep ph within normal
Temperature control with hypothermia blankets
Nutritional support high protein high calorie
Experimental treatments-steroid

Front 55

meds used to treat diseases that limit airflow

Back 55

bronchodilators
anti-inflammatories
anti-histamines
mucolytics
antitussives

Front 56

antitussives

Back 56

cough supressions

Front 57

bronchodilators help to do what?

Back 57

decrease wheezing
relief of cough
increase ease of breathing

Front 58

three common types of bronchodilators

Back 58

beta-andrenergeics agnostics (symp)
anticholenergics
xanthines

Front 59

automatic nervous system works on what?

Back 59

sympathetic and parasympathetics

Front 60

where are beta 2 receptors found

Back 60

bronchi

Front 61

where are beta 1 receptors found

Back 61

on the heart

Front 62

why are nonselevective beta angrenergics rarely used

Back 62

dangerous cardiac side effects because it cant differentiate between beta 1 and 2 receptors

Front 63

if you're taking beta andrenergics why should you avoid OTC

Back 63

bc many have sympathetic acting agentsand when they are combined, it can badly affect the heart

Front 64

anticholinergics block what

Back 64

parasympathetics-acetylcholine blocker

Front 65

most common anticholinergics bronchodilator

and when are they used

Back 65

atrovent ie ipratropium

used when they dont respond to beta blockers

Front 66

what causes bronchospasms

Back 66

release of acetylcholine

Front 67

how should atrovent or ipratropium be
taken and when does it peak

Back 67

on a consistant basis NOT as needed

peak 1.5 hrs

Front 68

xanthines

Back 68

used to open constricted airwas
and dilate bronchi

same side effects of caffeine

Front 69

QVAR

Back 69

long term management of asthma
inhalled

Front 70

deltasone

Back 70

short term management of asthma
oral

Front 71

beconase

Back 71

reduces inflammation of rhinitis
nasal