NUR 265 Exam 2 (2023/2024) 63 Questions and Answers.

NUR 265 Exam 2 How is an ET tube placement confirmed? - Correct Answer -From first to last ETCO2 20-40mmHg Chest symmetry Listen to left/right/abdomen Chest X-Ray Describe the A/C vent mode. - Correct Answer -The vent does everything for the patient. It delivers a set amount of breaths per minute Describe SIMV vent mode. - Correct Answer -The pt attempts to breath and the vent assists with their breaths What are the different ventilator settings? - Correct Answer -Mode FiO2 Rate Tidal Volume (Vt) PEEP What is PEEP? - Correct Answer -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? - Correct Answer -Pneumothorax SubQ Emphysema (crepatus) Decreased pre-load What are the 3 buttons that a nurse is able to touch on a vent? - Correct Answer -Silence Restart 100% Oxygen (before suctioning a patient) When is it acceptable to shut off a vent alarm? - Correct Answer -NEVER What should be done when a patient is in respiratory distress? - Correct Answer -*Call for help, disconnect the vent, start bagging the patient, then reassess* What are ways to prevent VAP? - Correct Answer -*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. - Correct Answer -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. - Correct Answer -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? - Correct Answer -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? - Correct Answer -Immobility Central Lines Surgery Obesity DVT's Birth Control Pills Smoking What is the best way to prevent a PE? - Correct Answer -*Move the patient post op.* What should be done immediately after the nurse notes s/s of a PE? - Correct Answer -*Notify the Rapid Response Team* What are ways to manage the symptoms of a PE? - Correct Answer -ABC: might need intubation Anticoags (heparin/warfarin/fibrinolytics) High Fowlers Telemetry Safety/bleeding precatutions 100% non rebreather What is a pulmonary contusion? - Correct Answer -A "bruise" of the lung What is the treatment/nursing interventions for a pulmonary contusion? - Correct Answer -PEEP to try and fix itself (bruise will desolve itself) Monitor ABC's Is an increase in output from a chest tube expected? - Correct Answer -*NO* What are s/s of a pulmonary contusion? - Correct Answer -Hemorrhaging and edema in the lungs Hyposix Dyspneic Hemoptysis *Crackles,wheezes, decreased O2 sat* Describe flail chest. - Correct Answer -2 or more completely broken ribs with no support. Creates a paradoxical chest movement. What are the nursing interventions for flail chest? - Correct Answer --ABC/pain/safety -Normally on a vent -Manage the symptoms with fluids and vasopressors What is the treatment for a pneumothorax? - Correct Answer -Chest tube *have intubation kit at the bedside* Describe a tension pneumothorax. - Correct Answer -An air leak in the lung or chest wall which causes complete collapse of the affected lung. Air collects under pressure compressing the blood vessels and limiting blood return. *THIS IS AN EMERGENCY* What are symptoms of a tension pneumothorax? - Correct Answer -Absent breath sounds Cyanosis Distended neck veins Dyspnea What is the treatment for a tension pneumothorax? - Correct Answer -Mechanical Vent Chest Tube What is ARDS? - Correct Answer -Acute Resp. Failure with these features: -Refractory hypoxemia -Decreased pulmonary compliance -Dyspnea What is refractory hypoxemia? - Correct Answer -No matter how much oxygen the patient is on, the O2 sats are not getting any better Is ARDS reversable? - Correct Answer -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? - Correct Answer -Shock Trauma Serious nervous system injury Pancreatitis Sepsis Fat and amniotic fluid emboli Inhalation of smoke Drug ingestion