NUR 265- Exam 2 (Questions + Answers) Verified 100% Correct!!.

What is refractory hypoxemia? - No matter how much oxygen the patient is on, the O2 sats are not getting any better What is a pheochromocytoma? - A catecholamine producing tumor that arises in the adrenal medulla. The tumor releases an excess amount of epinephrine and NE. Describe flail chest. - 2 or more completely broken ribs with no support. Creates a paradoxical chest movement. What are symptoms of a tension pneumothorax? - Absent breath sounds Cyanosis Distended neck veins Dyspnea Describe the A/C vent mode. - The vent does everything for the patient. It delivers a set amount of breaths per minute Describe SIMV vent mode. - The pt attempts to breath and the vent assists with their breaths What are the different ventilator settings? - Mode FiO2 Rate Tidal Volume (Vt) PEEP What is PEEP? - It is positive pressure that tells the alveoli in the lungs to stay open a little longer. It helps with gas exchange.What are the 3 buttons that a nurse is able to touch on a vent? - Silence Restart 100% Oxygen (before suctioning a patient) When is it acceptable to shut off a vent alarm? - NEVER What should be done when a patient is in respiratory distress? - *Call for help, disconnect the vent, start bagging the patient, then reassess* How is an ET tube placement confirmed? - From first to last ETCO2 20-40mmHg Chest symmetry Listen to left/right/abdomen Chest X-Ray What are ways to prevent VAP? - *Remove water from circuits* *HOB up to 30 degrees* Turn Q2h Suction Oral care Q2H Prevent aspiration Lip moisturizer Percussion Give examples of what could cause a high pressure alarm. - Blocked airway Coughing Tension pneumothorax Anxiety/Pain: Sedate themKinks in tubing Decreased lung compliance: ARDS *Assess the patient not the monitor* Give examples of what could cause a low pressure alarm. - Not getting enough air (in or out) Air leak in the cuff: Check the pilot balloon Disconnected tubing Low Vt *Assess the patient not the monitor* What are some things we have to do when caring for a vented patient? - Lung assessment Frequent vital signs (every 4 hours) I&O (look at balances) Foley NPO Nutrition (NG Tube for all vent patients) Skin Care Monitor ABG/labs VTE prophylaxis What are some risk factors for a PE? - Immobility Central Lines Surgery Obesity DVT's Birth Control Pills SmokingWhat is the best way to prevent a PE? - *Move the patient post op.* What are some complications of PEEP? - Pneumothorax SubQ Emphysema (crepatus) Decreased pre-load What should be done immediately after the nurse notes s/s of a PE? - *Notify the Rapid Response Team* What are ways to manage the symptoms of a PE? - ABC: might need intubation Anticoags (heparin/warfarin/fibrinolytics) High Fowlers Telemetry Safety/bleeding precatutions 100% non rebreather What is a pulmonary contusion? - A "bruise" of the lung What is the treatment/nursing interventions for a pulmonary contusion? - PEEP to try and fix itself (bruise will desolve itself) Monitor ABC's Is an increase in output from a chest tube expected? - *NO* What are s/s of a pulmonary contusion? - Hemorrhaging and edema in the lungs Hyposix Dyspneic Hemoptysis*Crackles,wheezes, decreased O2 sat* What are the nursing interventions for flail chest? - -ABC/pain/safety -Normally on a vent -Manage the symptoms with fluids and vasopressors