FCCN 2 CORE EXAMS MAIN QUESTIONS AND
ANSWERS SURE A+
✔✔respiratory rate - ✔✔minimum number of breaths per minute the vent will ensure
your pt takes
increase the rate to blow off CO2, decrease rate to retain
✔✔tidal volume - ✔✔amount of air that moves in and out of the lungs during a breath.
calculated based on predicted body weight (height and gender)
6mL/kg is ideal
✔✔minute ventilation - ✔✔tidal volume x respiratory rate
volume inspired during 1 minute
normal is 5-8L/min
✔✔pressure support - ✔✔-eases the work of breathing, helps to overcome airway
resistance of breathing through artificial airway
-cannot be used with AC or CMV
-CAN be used with SIMV
-Patient can take breaths between mandatory breaths
-used to wean from ventilator
✔✔peak airway pressure - ✔✔highest pressure recorded at the end of inspiration
✔✔SIMV - ✔✔synchronized intermittent mandatory ventilation
mandatory breaths have a set tidal volume, pt initiated breaths have varying tidal
volume
,initial mode for ventilation or weaning mode
disadvantage: increased work of breathing and can lead to pt/vent asynchrony
✔✔AC/CMV - ✔✔Assist control or continuous mandatory ventilation
pt initiated or ventilator control breaths have set tidal volume
disadvantages: hyperventilation which may cause respiratory alkalosis or hyperinflation,
less comfortable for pt
✔✔spontaneous (CPAP) - ✔✔used to strengthen respiratory muscles and evaluate
readiness to extubate
✔✔ASV - ✔✔Adaptive support ventilation, adjusts ventilation breath by breath
depending on pts lung mechanics. If pt does not initiate breath, vent will deliver
pressure control breath. if pt does take a breath, ASV will give however much pressure
support is needed to meet VT
✔✔vent alarms - ✔✔Happens when there is too much or too little pressure.
Low pressure=vent came out, apnea, disconnection, cuff leak
High pressure=pt coughs, mucous plug in the resp tract you as the nurse want to
suction the pt
Make sure you perform good oral hygiene to prevent VAP
✔✔ETT suctioning - ✔✔preoxygenate prior to each pass, use sterile catheter, wear
PPE, watch for hemodynamic changes, assess lung sounds
✔✔nursing care of intubated patient - ✔✔-sedation vacation
-oral cares q2h
-GI prophylaxis
-increase HOB
-check placement of tube frequently
-move oral tubes from one side of the mouth to the other
✔✔ICU liberation bundle - ✔✔Assess and manage pain - IV opioids
Breathing/awakening trials - determine extubation readiness
Choice of analgesia and sedation - sedate to RASS goal, treat pain prior to
administering analgesia
Delirium prevention - CAM screening, reorientation, avoid benzos
Family engagement - family presence, involvement in making decisions
Goals of care - honor pt wishes
, ✔✔weaning criteria - ✔✔FiO2 50% or less
PEEP 10 or less
LOC acceptable
stable hemodynamics
ABGs WDL
✔✔primary pulmonary function review - ✔✔exchange of gases between ambient air and
the blood
relatively dry alveoli and adequately perfused capillaries = healthy lungs
overall goal is to exhale CO2 and ensure proper oxygenation
✔✔ventilation - ✔✔movement of air in and out of the lungs
✔✔oxygenation - ✔✔the process of delivering oxygen to the blood
✔✔diffusion - ✔✔movement of gases between air spaces in lungs and bloodstream
✔✔how do we know that ventilation and/or oxygenation is less than optimal in our pts? -
✔✔-respiratory assessment
-pulse oximetry
-ABGs
-imaging
-P/F ratio
✔✔perfusion - ✔✔movement of blood in and out of capillary beds
✔✔P/F ratio - ✔✔tells us the degree of sickness of our pt's lungs, and helps assess
oxygenation
PaO2/FiO2
normal is 300-500
✔✔pneumonia - ✔✔inflammation of the lungs due to presence of infection. alveoli fill
with sludge, leading to poor ventilation and oxygenation
✔✔types of pneumonia - ✔✔-Community Acquired: onset in the community
-Hospital Acquired: 48 hrs or longer after hospital admission
-Ventilator associated: within 48-72 hrs of intubation
-Aspiration: breathing in food or liquid
✔✔pneumonia s/s - ✔✔-cough, likely productive
ANSWERS SURE A+
✔✔respiratory rate - ✔✔minimum number of breaths per minute the vent will ensure
your pt takes
increase the rate to blow off CO2, decrease rate to retain
✔✔tidal volume - ✔✔amount of air that moves in and out of the lungs during a breath.
calculated based on predicted body weight (height and gender)
6mL/kg is ideal
✔✔minute ventilation - ✔✔tidal volume x respiratory rate
volume inspired during 1 minute
normal is 5-8L/min
✔✔pressure support - ✔✔-eases the work of breathing, helps to overcome airway
resistance of breathing through artificial airway
-cannot be used with AC or CMV
-CAN be used with SIMV
-Patient can take breaths between mandatory breaths
-used to wean from ventilator
✔✔peak airway pressure - ✔✔highest pressure recorded at the end of inspiration
✔✔SIMV - ✔✔synchronized intermittent mandatory ventilation
mandatory breaths have a set tidal volume, pt initiated breaths have varying tidal
volume
,initial mode for ventilation or weaning mode
disadvantage: increased work of breathing and can lead to pt/vent asynchrony
✔✔AC/CMV - ✔✔Assist control or continuous mandatory ventilation
pt initiated or ventilator control breaths have set tidal volume
disadvantages: hyperventilation which may cause respiratory alkalosis or hyperinflation,
less comfortable for pt
✔✔spontaneous (CPAP) - ✔✔used to strengthen respiratory muscles and evaluate
readiness to extubate
✔✔ASV - ✔✔Adaptive support ventilation, adjusts ventilation breath by breath
depending on pts lung mechanics. If pt does not initiate breath, vent will deliver
pressure control breath. if pt does take a breath, ASV will give however much pressure
support is needed to meet VT
✔✔vent alarms - ✔✔Happens when there is too much or too little pressure.
Low pressure=vent came out, apnea, disconnection, cuff leak
High pressure=pt coughs, mucous plug in the resp tract you as the nurse want to
suction the pt
Make sure you perform good oral hygiene to prevent VAP
✔✔ETT suctioning - ✔✔preoxygenate prior to each pass, use sterile catheter, wear
PPE, watch for hemodynamic changes, assess lung sounds
✔✔nursing care of intubated patient - ✔✔-sedation vacation
-oral cares q2h
-GI prophylaxis
-increase HOB
-check placement of tube frequently
-move oral tubes from one side of the mouth to the other
✔✔ICU liberation bundle - ✔✔Assess and manage pain - IV opioids
Breathing/awakening trials - determine extubation readiness
Choice of analgesia and sedation - sedate to RASS goal, treat pain prior to
administering analgesia
Delirium prevention - CAM screening, reorientation, avoid benzos
Family engagement - family presence, involvement in making decisions
Goals of care - honor pt wishes
, ✔✔weaning criteria - ✔✔FiO2 50% or less
PEEP 10 or less
LOC acceptable
stable hemodynamics
ABGs WDL
✔✔primary pulmonary function review - ✔✔exchange of gases between ambient air and
the blood
relatively dry alveoli and adequately perfused capillaries = healthy lungs
overall goal is to exhale CO2 and ensure proper oxygenation
✔✔ventilation - ✔✔movement of air in and out of the lungs
✔✔oxygenation - ✔✔the process of delivering oxygen to the blood
✔✔diffusion - ✔✔movement of gases between air spaces in lungs and bloodstream
✔✔how do we know that ventilation and/or oxygenation is less than optimal in our pts? -
✔✔-respiratory assessment
-pulse oximetry
-ABGs
-imaging
-P/F ratio
✔✔perfusion - ✔✔movement of blood in and out of capillary beds
✔✔P/F ratio - ✔✔tells us the degree of sickness of our pt's lungs, and helps assess
oxygenation
PaO2/FiO2
normal is 300-500
✔✔pneumonia - ✔✔inflammation of the lungs due to presence of infection. alveoli fill
with sludge, leading to poor ventilation and oxygenation
✔✔types of pneumonia - ✔✔-Community Acquired: onset in the community
-Hospital Acquired: 48 hrs or longer after hospital admission
-Ventilator associated: within 48-72 hrs of intubation
-Aspiration: breathing in food or liquid
✔✔pneumonia s/s - ✔✔-cough, likely productive
