NURS 4350 Final Exam Study Guide Questions
and answers
How do nurses assess the need for intubation in a critically ill patient? - ✅✅Ineffective gas exchange
Excessive work of breathing
Inability to mobilize secretions
Inability to maintain a patent airway
What basic equipment and medications do you need to have ready? - ✅✅Suction equipment
Medications (sedative, pain, paralytics)-- rocuronium, Propofol, succinylcholine
Ambu bag
List 3 potential complications of the intubation procedure. - ✅✅Laryngospasm (give succinylcholine
to open airway)
Hypoxemia
Vomiting
Trauma
Tube malplacement
Ventilator Complications - ✅✅Ventilator Induced Lung Injury- Barotrauma, pneumothorax
Intubation of right mainstem bronchus
ETT out of position; unplanned extubation
Tracheal damage, vocal cord damage (Pressure necrosis; tracheal stenosis)
Damage to oral, nasal mucosa, lips
Lung damage from high FiO2 (100% O2 →damage by oxygen radicals & atelectasis)
Aspiration (Oral secretions, Gastric contents, tube feeding)
,Inability to wean from ventilator
Decreased cardiac output
Stress ulcers and GI bleeding
Ventilator-Associated Pneumonia (VAP)
Psychosocial problems- Communication, Stress, anxiety, discomfort, Noise and frequent suctioning,
Psychological dependence on the vent
How are the basic vent settings such as Vt (tidal volume) determined? - ✅✅6 mL/kg of ideal body
weight (MUST KNOW)
Average about 450 ml
Lower if decreased lung compliance
How deep the breaths are
If the patient's CO2 is high, increase respiration rate not tidal volume
How is respiratory rate on vent determined? - ✅✅Adjusted to maintain pH, PaCO2
How is FiO2 determined on the ventilator? - ✅✅Adjusted between .21 - 1.0 based on PaO2
(button on vent allows: delivery of 100% O2 for 2 minutes)
Delivered with humidity
How does the nurse check for proper ET tube placement? - ✅✅CXR is gold standard
Auscultation
Aspirate tube
, Chest movement
CO2 detector on tube: if it changes color to yellow, placement is correct
Condensation
P-F ratio - ✅✅PaO2/FiO2
for ARDS
room is is 21% FiO2
<200 meets ARDS criteria
How often should patients be suctioned? - ✅✅PRN
Indications: coarse crackles over trachea, coughing, visible secretions, decreased oxygen saturation,
ARDS
What is pressure support? - ✅✅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
PEEP - ✅✅Positive pressure is applied at the end of the expiration of ventilator breaths.
Prevents collapse of small airways, keeps alveoli open, increases oxygenation
can increase PaO2 without having to change the patient's vent settings
standard is 5 but it can be increased
What is PEEP? Identify 2 complications of PEEP. - ✅✅low CO (decreased venous return), barotrauma
How do we assess readiness for weaning from the ventilator? - ✅✅Afebrile
Breathing over the ventilator
and answers
How do nurses assess the need for intubation in a critically ill patient? - ✅✅Ineffective gas exchange
Excessive work of breathing
Inability to mobilize secretions
Inability to maintain a patent airway
What basic equipment and medications do you need to have ready? - ✅✅Suction equipment
Medications (sedative, pain, paralytics)-- rocuronium, Propofol, succinylcholine
Ambu bag
List 3 potential complications of the intubation procedure. - ✅✅Laryngospasm (give succinylcholine
to open airway)
Hypoxemia
Vomiting
Trauma
Tube malplacement
Ventilator Complications - ✅✅Ventilator Induced Lung Injury- Barotrauma, pneumothorax
Intubation of right mainstem bronchus
ETT out of position; unplanned extubation
Tracheal damage, vocal cord damage (Pressure necrosis; tracheal stenosis)
Damage to oral, nasal mucosa, lips
Lung damage from high FiO2 (100% O2 →damage by oxygen radicals & atelectasis)
Aspiration (Oral secretions, Gastric contents, tube feeding)
,Inability to wean from ventilator
Decreased cardiac output
Stress ulcers and GI bleeding
Ventilator-Associated Pneumonia (VAP)
Psychosocial problems- Communication, Stress, anxiety, discomfort, Noise and frequent suctioning,
Psychological dependence on the vent
How are the basic vent settings such as Vt (tidal volume) determined? - ✅✅6 mL/kg of ideal body
weight (MUST KNOW)
Average about 450 ml
Lower if decreased lung compliance
How deep the breaths are
If the patient's CO2 is high, increase respiration rate not tidal volume
How is respiratory rate on vent determined? - ✅✅Adjusted to maintain pH, PaCO2
How is FiO2 determined on the ventilator? - ✅✅Adjusted between .21 - 1.0 based on PaO2
(button on vent allows: delivery of 100% O2 for 2 minutes)
Delivered with humidity
How does the nurse check for proper ET tube placement? - ✅✅CXR is gold standard
Auscultation
Aspirate tube
, Chest movement
CO2 detector on tube: if it changes color to yellow, placement is correct
Condensation
P-F ratio - ✅✅PaO2/FiO2
for ARDS
room is is 21% FiO2
<200 meets ARDS criteria
How often should patients be suctioned? - ✅✅PRN
Indications: coarse crackles over trachea, coughing, visible secretions, decreased oxygen saturation,
ARDS
What is pressure support? - ✅✅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
PEEP - ✅✅Positive pressure is applied at the end of the expiration of ventilator breaths.
Prevents collapse of small airways, keeps alveoli open, increases oxygenation
can increase PaO2 without having to change the patient's vent settings
standard is 5 but it can be increased
What is PEEP? Identify 2 complications of PEEP. - ✅✅low CO (decreased venous return), barotrauma
How do we assess readiness for weaning from the ventilator? - ✅✅Afebrile
Breathing over the ventilator
