NUR 265 EXAM 2 - QUESTIONS AND ANSWERS GRADED A

What is ARDS? - Acute Resp. Failure with these features: -Refractory hypoxemia -Decreased pulmonary compliance -Dyspnea What is refractory hypoxemia? - No matter how much oxygen the patient is on, the O2 sats are not getting any better Is ARDS reversible? - Yes, it is reversible but it needs to e caught early. It can progress to Resp. Failure! What are some common causes of an acute lung injury? - Shock Trauma Serious nervous system injury Pancreatitis Sepsis Fat and amniotic fluid emboli Inhalation of smoke Drug ingestion What are common assessment findings with ARDS? - *Clear lung sounds early and crackles late* *Dysrhythmias* Increased RR Hypoxia Pallor Cyanosis Sternal retractions Diaphoresing Bounding HR How is ARDS managed? - ECMO 100% oxygen and PEEP Antibiotics Sedation Nutritional Support Corticosteroids Minimal Fluids *Vasopressors (because they are hypotensive)* What is ECMO? - It rests the heart and the lungs. It oxygenates the blood and then puts it back into circulation. For a chest tube, is there supposed to be bubbling in the water seal chamber? - No. Bubbling means that there is an air leak For a chest tube, is there supposed to be bubbling in the suction control chamber? - Yes What is a pheochromocytoma? - A catecholamine producing tumor that arises in the adrenal medulla. The tumor releases an excess amount of epinephrine and NE. What is the hallmark symptom of a pheochromocytoma? - Hypertension True or False. It is appropriate to palpate the abdomen in a patient with a pheochromocytoma? - False. Palpating the abdomen could stimulate a sudden release of catacholamines and trigger severe HTN. What are the s/s of a pheochromocytoma? - HTN - Headaches - Palpitations - Severe Anxiety - Pallor - A-Fib - Diaphoresis How is a pheochromocytoma diagnosed? - HTN - Elevated levels of catecholamines - CT/MRI What is a major complication with a pheochromocytoma? - Hemorrhage. The tumor is highly vascularized. How is a pheochromocytoma treated? - Medication to lower the BP and surgery to remove the tumor on the adrenal gland How is an ET tube placement confirmed? - From first to last - ETCO2 20-40mmHg - Chest symmetry - Listen to left/right/abdomen - Chest X-Ray 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 some complications of PEEP? - Pneumothorax - SubQ Emphysema (crepatus) - Decreased pre-load 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* 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 them - Kinks 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 - Smoking What is the best way to prevent a PE? - *Move the patient post op.* 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