NURS 4350: FINAL EXAM QUESTIONS & ANSWERS
SOLVED 100% CORRECT!!
How do nurses assess the need for intubation in a critically ill patient? Answer
- -Artificial airway indiciations:
1. Ineffective gas exchange
2. Excessive work of breathing
3. Inability to mobilize secretions
4. Inability to maintain patent airway
-Assessment: Inspection (breathing, LOC), percussion, auscultation, diagnostic
tests (CXR, ABGs, sputum analysis)
What basic equipment and medications do you need to have ready? Answer -
1. Tray/equipment
2. Positioning (lie flat), monitor patient, hyper-oxygenate
3. Provide suction, meds (sedatives, pain meds, paralytics)
4. Limit time of attempts, bag patient (1 breath q 10 seconds), connect vent
5. *Verify tube placement: auscultation, chest movement, CO2 detector, CXR*
6. Secure tube: note # of placement of tube
7. Sedate and restrain
List 3 potential complications of the intubation procedure Answer - 1.
Laryngospasm: succinylcholine to open airway
2. Hypoxemia
3. Vomiting
,4. Trauma
5. Tube malplacement
How are the basic vent settings such as Vt determined? (I) Answer - 1.
Respiratory rate: # of breaths ventilator delivers per minute. Adjusted to
maintain pH and PaCO2; *if pts CO2 is high, increase respiration rate not tidal
volume*
2. Tidal volume: volume of gas delivered to patient during each breath. Set at
*6 ml/kg* ideal weight, average about 450 mL; lowered if decreased lung
compliance
3. FiO2: adusted between .21-1.0 based on PaO2; delivered with humidity
4. Minute volume: breaths in a minute; Vt x RR
How are basic vent settings determined? (II) Answer - 5. Peak inspiratory
pressure: highest level of pressure applied to lungs during inhalation. Normal
20-30 cm; rises as compliances decreases or resistance increases
6. High pressure limit: maximal pressure ventilator is allowed to generate
before it terminates breath
7. Inspiratory to expiratory ratio: normally 1:2 ratio
How does the nurse check for proper ET tube placement? Answer - 1. Listen to
breath sounds, stomach sounds
2. Chest x-ray: gold standard but takes time
3. Aspirate tube
4. *Use CO2 detector on tube: if changes color (yellow) it's in correct
placement*
5. Condensation: when blowing into tube, it will condensate
, How often should patients be suctioned? Answer - Only when the patients
needs it. Indications include coarse crackles over trachea, coughing, visible
secretions, decreased oxygenation saturation, or ARDS
What is pressure support? Answer - -Preset positive pressure used to augment
patient's inspiratory efforts; patient controls rate, inspiratory flow, and tidal
volume
-Patient receives a boost of pressure with each breath
What is PEEP? Identify 2 complications of PEEP Answer - -Definition: Positive
pressure applied at end of expiration of ventilator breaths. Prevents collapse of
small airways, keeps alveoli open, increasing oxygenation
-Usual setting is +5, but can go to 20
-Complications: *low CO, barotrauma*
How do we assess readiness for weaning from the ventilator? Answer - 1.
General considerations: afebrile, off vasopressors, H/H ok, nutritional status
good
2. Stable cardiac rhythm
3. ABGs ok on <.5 FiO2
4. CXR improving
5. Mental status ok
6. Respiratory parameters: minimal secretions
-RR <25, NIF >-20
-Spontaneous tidal volume >5 ml/kg
Describe the most common weaning method Answer - *Spontaneous
breathing trials*: can be done with patient either on or off ventilator
SOLVED 100% CORRECT!!
How do nurses assess the need for intubation in a critically ill patient? Answer
- -Artificial airway indiciations:
1. Ineffective gas exchange
2. Excessive work of breathing
3. Inability to mobilize secretions
4. Inability to maintain patent airway
-Assessment: Inspection (breathing, LOC), percussion, auscultation, diagnostic
tests (CXR, ABGs, sputum analysis)
What basic equipment and medications do you need to have ready? Answer -
1. Tray/equipment
2. Positioning (lie flat), monitor patient, hyper-oxygenate
3. Provide suction, meds (sedatives, pain meds, paralytics)
4. Limit time of attempts, bag patient (1 breath q 10 seconds), connect vent
5. *Verify tube placement: auscultation, chest movement, CO2 detector, CXR*
6. Secure tube: note # of placement of tube
7. Sedate and restrain
List 3 potential complications of the intubation procedure Answer - 1.
Laryngospasm: succinylcholine to open airway
2. Hypoxemia
3. Vomiting
,4. Trauma
5. Tube malplacement
How are the basic vent settings such as Vt determined? (I) Answer - 1.
Respiratory rate: # of breaths ventilator delivers per minute. Adjusted to
maintain pH and PaCO2; *if pts CO2 is high, increase respiration rate not tidal
volume*
2. Tidal volume: volume of gas delivered to patient during each breath. Set at
*6 ml/kg* ideal weight, average about 450 mL; lowered if decreased lung
compliance
3. FiO2: adusted between .21-1.0 based on PaO2; delivered with humidity
4. Minute volume: breaths in a minute; Vt x RR
How are basic vent settings determined? (II) Answer - 5. Peak inspiratory
pressure: highest level of pressure applied to lungs during inhalation. Normal
20-30 cm; rises as compliances decreases or resistance increases
6. High pressure limit: maximal pressure ventilator is allowed to generate
before it terminates breath
7. Inspiratory to expiratory ratio: normally 1:2 ratio
How does the nurse check for proper ET tube placement? Answer - 1. Listen to
breath sounds, stomach sounds
2. Chest x-ray: gold standard but takes time
3. Aspirate tube
4. *Use CO2 detector on tube: if changes color (yellow) it's in correct
placement*
5. Condensation: when blowing into tube, it will condensate
, How often should patients be suctioned? Answer - Only when the patients
needs it. Indications include coarse crackles over trachea, coughing, visible
secretions, decreased oxygenation saturation, or ARDS
What is pressure support? Answer - -Preset positive pressure used to augment
patient's inspiratory efforts; patient controls rate, inspiratory flow, and tidal
volume
-Patient receives a boost of pressure with each breath
What is PEEP? Identify 2 complications of PEEP Answer - -Definition: Positive
pressure applied at end of expiration of ventilator breaths. Prevents collapse of
small airways, keeps alveoli open, increasing oxygenation
-Usual setting is +5, but can go to 20
-Complications: *low CO, barotrauma*
How do we assess readiness for weaning from the ventilator? Answer - 1.
General considerations: afebrile, off vasopressors, H/H ok, nutritional status
good
2. Stable cardiac rhythm
3. ABGs ok on <.5 FiO2
4. CXR improving
5. Mental status ok
6. Respiratory parameters: minimal secretions
-RR <25, NIF >-20
-Spontaneous tidal volume >5 ml/kg
Describe the most common weaning method Answer - *Spontaneous
breathing trials*: can be done with patient either on or off ventilator
