Study Guide Questions Exam 2 Critical Care Nursing

What is minute volume ventilation MV?

it is the amount of air entering the lungs per minute

What is the formula for MV (minute volume ventilation)?

RR x TV

What can MV indicate?

BIPAP is working or not, if the tidal volume is too high it is not working

What is the purpose of tidal volume?

monitor how much air is going in and to allow the expulsion of CO2

How many mL is used to calculate tidal volume?

5mL per kg

what can a high MV (minute volume ventilation) cause and what could be the cause of the high MV?

can cause acid to be blown out rapidly, can be caused inc RR ot TV in the ventilator

what can low MV (minute volume ventilation?

there is a leak in the machine or RR/TV is not high enough

What would be manipulated first, RR or TV?

RR should be manipulated first

What are causes of low PACO2?

anxiety, pain, fever, sepsis, elevated RR on machine

What are treatments of low PaCO2?

antianxiolytic, benzos, treat the fever, decrease RR on machine

What are causes of high PaCO2 and why does this happen?

lung conditions like COPD, ARDS, chest trauma, sedation, opioids

What are treatments of high PaCO2?

O2 therapy, antisedative rx, antinarcotic such as naloxone, bronchodilators for COPD

What are medications for Asthma?

bronchodilator (long acting or short acting beta adrenergic agonists), anti-inflammatory drugs (long acting acting or short acting/oral glucocorticoids)

What are examples of LABAs (Long acting beta adrenergic agonists) and SABAs (short acting beta adrenergic agonists)?

SABA: albuterol/levalbuterol + budesonide

LABA: salmeterol, -terol drugs

What are some examples of anti-inflammatory rx used for asthma?

long acting glucocorticoid: declamethasone, budesonide, salmeterol + fluticasone

Short acting/oral glucocorticoid: prednisone and methylprednisone

What are -terol drugs used for?

Usually long act Beta adrenergic agonists

What is a major drug used for COPD exacerbations?

Roflumilast

what are other medications besides roflumilast that is used for COPD?

LABAs (-terol rx),
bronchodilators aka short acting muscarinic antagonists and long acting muscarinic antagonists (SAMAs and LAMAs),
glucocorticoids (anti-inflammatory drugs)

What are some examples of bronchodilators for COPD?

SAMA (short acting muscarinic antagonists): ipratoprium
LAMA (long-acting muscarinic antagonists) : tiotropium

What is hypoxia?

inadequate oxygenation in the tissues

What are some manifestations of hypoxia early vs late?

Early: restlessness, anxiety, tachycardia/tachypnea, accessory muscle use, pale skin/ cool extremtities

Late: bradycardia, confusion, cyanosis, hypotension

what are manifestations of an airway obstruction?

stridor, inability to speak/breath/cough, accessory muscle use/retractions, cyanosis

What are assessment findings of respiratory failure hypoxemic?

if PaO2 goes below 60, **dyspnea, low SPo2, tachypnea,/tachycardia, cyanosis, confusion/fatigue, crackles if it is pulmonary

What are assessment findings of respiratory failure hypercapnia?

PaCO2 over 50, hypoventilation (bradypnea), decreased LOC, flushed skin, bounding pulses, resp acidosis

What are ways to prevent ventilator acquired pneumonia?

1 - wash your hands.

• Elevate HOB 30-45 degrees
• Awaken daily (via Spontaneous Awakening Trial, aka Sedation Vacation)
• assess readiness to wean ( CPAP - Spontaneous Breathing Trial) and extubate.
• Stress ulcer disease prophylaxis
• VTE prophylaxis
• Oral care
• Maintain clean environment & disinfect/clean respiratory equipment

What are ways to manage pneumonia and lung disease, pulmonary toileting?

• monitor respiratory status - breath sounds, Respiratory rate/rhythm/effort/depth.
• Assess for signs of hypoxemia (cyanosis, sob, tachypnea, tachycardia, confusion, fatigue)
• Keep head of bed > 30
• Reposition q2h - mobilizes secretions/promotes lung expansion.

• Encourage pt. to cough, deep breathe, and use incentive spirometry/nebulizers.
• PRN: Prone patients, use respiratory vest (uses high frequency chest wall oscillation to loosen/mobilize secretions).

What are some medications used to manage pneumonia and lung disease, pulmonary toileting?

• antibiotics/IV fluids/bronchodilators/antipyretics for fever/analgesics
• Guaifenesin -> loosens and thins mucus -> easier to cough up and clear airways.
• VTE and GI prophylaxis (heparin and pantoprazole) since they are usually immobile

Why would a client need broad spectrum antibiotics?

Reasons for broad spectrum antibiotics:
• Prophylactic measure to avoid infection (like procedures such as ETT -> VAP and other HAI)
• Severe immunocompromised patients
• Empiric therapy (before culture results)
• Sepsis/septic shock

Why do we prone clients? What are the benefits?

• used in patients with severe potentially reversible lung disease.
• Prone position affects the distribution and volume of air in the lungs and can have direct effects on the expansion/collapse of alveoli.

Proning allows for:
• better expansion of the dorsal lung region
• Mobilization of secretions
• Better ventilation/perfusion matching
• trying to get dependent lung fields

Why would lying supine not be effective as proning?

• Lying Supine -> lungs are compressed by gravity from other organs, causes hyperinflation of ventral lung alveoli and alveolar collapse in the dorsal lung.

What is BPAP used for?

1) Bilevel Positive Airway Pressure (BPAP) - oxygenation + ventilation
• used to relieve work of breathing when respiratory distress is believed to be reversible (CHF, COPD, exacerbation, Severe Obstructive sleep apnea);
• Delivers two pressure levels; higher pressure for inhalation and lower pressure for exhalation.
• The pressure delivered for exhalation allows clients to blow off more CO2

What is CPAP used for?

2) Continuous Positive Airway Pressure (CPAP) - oxygenation
• delivers a constant level of air pressure.
• Does not aid in ventilation just oxygenation (which means we don't blow off more CO2).
• More suited for patients with obstructive sleep apnea or mild hypoxemia (with no CO2
retention).

What are the steps for intubation?

Steps to intubation:
• Patient is put in supine position
• Hyper oxygenate/ventilate pt with an ambu bag until O2 sat is satisfactory.
• ETT will be inserted through vocal cords to approximately 3-4 cms above the carina.
• Initial verification: bilateral breath sounds (do not want it in one lung since it means it could have gone into the bronchus only, do not want gurgling sounds in stomach with absent breath sounds since that could mean its in the esophagus and not the lungs), use the end tidal CO2 detector to assess for color
change usually usually from purple or blue to yellow (indicating placement in the respiratory tract).

How is the confirmation of tube placement done?

• ONLY a chest X-ray will confirm the placement of the ETT.