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Respiratory failure - artificial airwaysMedical-Surgical Nursing-7th edition

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Question Answer
Hypoxemic respiratory failure is defined as a PaO2 of _______ or less while a patient is on supplemental O2 _______% or more.
Show Answer
PaO2 = 65 or less; O2 = 60% or more
Type of ventilation? Treats acute respiratory failure in patients with COPD and heart failure, and OSA.
Show Answer
Bi Pap
How is CAP typically treated?
Show Answer
Guaifenesin: expectorant, minineb, albuterol, anticholinergic: Mucomyst (thins secretions), and steroid: decreases inflammation.
How often should a patient be monitored after extubation?
Show Answer
Immediately after (vitals, O2, resp. assessment); within one hour; and then per policy.
What are the major risks associated with oral ET?
Show Answer
Could cause injury if the patient has a spinal cord injury. Teeth can be chipped or dislodged. Salivation is increased and swallowing is difficult. Biting on the tube can obstruct it.
What intervention maximizes thoracic expansion, decreases dyspnea and improves secretion mobilization.
Show Answer
Elevating HOB 45 degrees or using a reclining char.
A patient shouldn't be suctioned if they are _______.
Show Answer
Bradycardic
What are the general guidelines for preventing VAP?
Show Answer
HOB 30-45 degrees. No routine changes of ventilator circuit tubing. Use ET tube with a dorsal lumen above the cuff to allow for continuous suctioning of secretions. Wash hands. Drain condensation in vent tubing.
When placing a patient prone, turn them towards _______ and use the chest and pelvic area. Allow the _______ to hang free.
Show Answer
towards vent; allow abdomen to hang free. *Prop chest and pelvis with pillows.
An SBT should be done at least _______ minutes, but no longer than _______ minutes.
Show Answer
30 minutes; no longer than 120 minutes
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What is of concern when selecting nutritional support for a patient on a vent? Why?
Show Answer
Carb content. Carbs increase CO2 which leads to need for increased minute ventilation.
Normal tracheal perfusion pressure is _______, therefore ET cuff pressure should be _______.
Show Answer
Normal is 30 mm Hg; cuff should be 20-25
What factors determine what ventilator mode is selected for a patient?
Show Answer
How much WOB a patient can perform. A patient's ventilatory status. A patient's respiratory drive. ABG's.
All patients undergoing intubation and receiving mechanical ventilation need to have what items available pre-procedure?
Show Answer
Self inflating bag-valve-mask (BVM) attached to oxygen; suction equipment; and IV access.
What impact does NPPV have on COPD patients?
Show Answer
Stents airways open, improves respiratory acidosis, decreases CO2, and shortens hospital stay and decreases mortality.
What are the benefits of using NPPV over intubation?
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No intubation problems, decreases pneumonia, decreases airway injury, preserves speech and swallowing, preserves airway defenses, and decreases need for sedation and/or paralytics.
Prior to intubation how long is a patient preoxygenated with 100% O2?
Show Answer
3-5 minutes
Type of ventilation? Used when a patient requires extensive support to breathe. Allows spontaneous breaths, used with neuro-muscular problems...
Show Answer
Assist Control Ventilation (ACV)
Type of ventilation? Prevents airway pressure from falling below 0. Used for OSA. Increases WOB.
Show Answer
Continuous Positive Airway Pressure (CPAP)
What can be causes of spontaneous hyperventilation?
Show Answer
Hypoxemia, pain, fear, anxiety, and compensation for metabolic acidosis.
What are the complications of ventilating mechanically?
Show Answer
Ventilator induced lung injury (VILI), DVT, decreased nutrition, and VAP.
  
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