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

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_______ is required when a patient has ECMO for pulmonary support.
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Systemic Anticoagulants
What happens if intrathoric pressure gets too high from pressure ventilation?
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Thoracid vessels are compressed; decreases venous return, decreases preload, decreases CO, hypotension, barotrauma, pneumothorax, and pneumomediastinum.
What 2 classes of medication must always be given to patients on PPV?
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Sedatives (propofol) and Analgesia (fentanye). *Concurrent administration.
What conditions are contraindications for BiPAP?
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Shock, altered mental status, and increased airway secretions. Patient must be able to cooperate and have patent airway.
To check ET tube placement, what areas do you auscultate?
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Bilateral lung apices, axillae, and stomach.
True for False? Patients with dentures should take them out prior to NPPV therapy.
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False, they should wear them to improve the mask seal.
_______ promotes CO2 removal and is a good choice if the main goal is the decrease the partial pressure of CO2 and unload respiratory muscles.
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BiPap (*CPAP just stents airway open)
Hypercapnic respiratory failure is defined as a PaCO2 higher than _______ with an arterial pH of _______.
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PaCO2 45 or more; pH 7.34 or less (acidotic)
How is ventilator asynchrony treated?
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Administration of a neuromuscular blockade like: vercuronium/Norcuron and cisatracurium/Nimbex.
What interventions can help move secretions into larger airways for suctioning?
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Postural drainage, percussion, and turning every 2 hours.
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What are the 4 physiologic mechanisms that can cause hypoxemic respiratory failure?
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Mismatch between V/Q (most common), shunt, diffusion limitation, and hypoventilation.
What are some indications a patient may be a good candidate for NPPV over intubation?
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Respiratory failure isn't acute and patient can sustain some respiratory reserve.
_______ senses patient effort and releases airflow to target a set inspiratory pressure. Once achieved, pressure drops.
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BiPap
What are causes of hypercapnic respiratory failure?
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Drug OD on CNS depressants, neuromuscular disease, trauma/disease of spinal cord, acute asthma, COPD, and CF.
Which value on an ABG is the best indicator of alveolar hyperventilation?
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PaCO2; decreases resp. alkalosis and increases acidosis.
What should you monitor for when a patient is on the vent?
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Increased PR, adventitious breath sounds, decreased SaO2, and dyspnea. *Every 4 hours and with every change in PEEP or VT.
What are the most common causes for a V/Q mismatch?
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Any with secretions in the airway like COPD, any with secretions in alveoli (like pneumonia), atelectasis, pain and PE.
DVTs develop in ventilator patients typically during the first _______ days in ICU.
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5
What is Virchow's triad?
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Venous stasis, hypercoagulability, and vessel wall damage.
What are 3 basic interventions for DVTs?
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Warm, moist compresses, elevate extremity, and anticoagulants, thrombolytics and analgesics.
_______ is the inspiratory effort needed to overcome the elasticity and viscosity of the lungs along with airway resistance.
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Work Of Breathing (WOB)
  
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