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Nursing In a Flash 
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Question Answer
At what point after intubation can a nurse cease manual ventilation and switch the patient to an oxygenation source? (4)
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Once CO2 is detected, the lungs are auscultated bilaterally, the chest wall movement has been observed to be symmetric, and the SpO2 is stable or improved.
What ventilator settings can impair cerebral blood flow and increase intracranial pressure in patients with head injuries? (2)
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Positive Pressure Ventilation, especially with PEEP
What is rapid sequence intubation (RSI)?
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The rapid, concurrent administration of a paralytic and sedative during emergency airway management (intubation).
What should be done if an endotracheal tube (ET) is not positioned properly (i.e. the patient is extubated)? (4)
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Stay with the patient, maintain their airway, support their ventilation (AMBU bag usually), and call for help.
Type of Ventilation? Positive pressure is applied in two levels. Higher positive pressure is supplied during inspiration and lower positive pressure is applied during expiration?
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BiLevel Positive Airway Pressure (BiPAP)
________ is a medication used during intubation on a client who is agitated, combative or disoriented.
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Versed/midazolam
Positive or Negative Pressure Ventilation? Pressure is pushed into the lungs during inspiration. Intrathoracic pressure increases. Expiration is passive.
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Positive Pressure Ventilation
__________ often occurs after 48 to 72 hours of positive pressure ventilation and is associated with a decreased urinay output, increased sodium retention due to decreased cardiac output and decreased renal perfusion.
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Progressive fluid retention
To minimize sinus pain and gastric insufflation, pressure on NPPV should be no higher than _______.
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20 cm H2O
What interventions can decrease intracranial pressure in a patient with head injuries on a ventilator?
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Elevate the head of the bed and keep the head aligned in a neutral position.
What is involved in peptic ulcer prophylaxis for patients on a ventilator?
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Administration of H2 receptor blockers like Zantac, proton pump inhibitors (PPIs) like Prilosec, and tube feedings.
Type of ventilation? Positive pressure is applied to prolong respirations, achieving a 1:1 to a 4:1 inspiration to expiration ratio?
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Pressure controlled inverse ratio ventilation (PC-IRV)
Type of ventilation? Set rate, set volume, set FiO2, the patient has no spontaneous breaths?
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Controlled mandatory ventilation (CMV)
What interventions can help manage spontaneous hyperventilation for a patient on a ventilator? (3)
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Sit with the patient to reduce their anxiety and fear, coach them to breathe with the ventilator, manually ventilate the patient at a slow rate with 100% O2 to slow breathing and bring it in synchrony with the ventilator.
Ventilator associated pneumonia (VAP) is one that occurs _________ or more days after ventilation.
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48 hours
50% of all ventilator associated pneumonia (VAP) occurs within _________ of pneumonia.
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4 days
What are common causes of pain or anxiety in patients on a ventilator?
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Positive Pressure Ventilation, nutritional deficits, pain, hypoxemia, hypercapnia, drugs, or environmental stressors like a lack of sleep.
__________ ventilation is the type used when the patient has no drive to breathe.
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Controlled mandatory ventilation (CMV)
What time of day is ventilator weaning typically performed?
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During the day. At night, the patients are then ventilated to allow the respiratory muscles to rest.
How long can it take respiratory muscles that are fatigued from weaning trials to recover?
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12 to 24 hours
Type of ventilation? Set rate, set volume, set FiO2, during spontaneous breaths the patient controls the volume and FiO2?
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Synchronized Intermitten Mandatory Ventilation (SIMV)
_________ is a drug commonly used during intubation to limit secretions.
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Atropine
What is used during nasal intubation to decrease trauma and bleeding?
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Xylocaine/lidocaine is used for anesthesia and epinephrine (sprayed into the nose) for vasoconstriction.
What is a normal V/Q?
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1:1, 1 milliliter of air for each milliliter of blood flow. V/Q stands for ventilation:perfusion.
What happens during the weaning outcomes phase of ventilation?
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The patient is extubated or all attempts at weaning are stopped.
How are the most effective settings for a patient on Non-Positive Pressure Ventilation (NPPV) selected?
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Trial and error
________ is for a spontaneously breathing patient. It counteracts intrinsic PEEP and promotes exhalation by stenting the airways open.
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CPAP
How can you evaluate a patient's fluid volume status while they are on a ventilator?
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Blood pressure measurements, respiratory related variations of pulmonary and systemic arterial pulse pressures, central venous pressures and urine output.
How can a patient's intravascular status be evaluated while they are on a ventilator?
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Pulmonary artery catheter, cardiac output, cardiac index, pulmonary vascular resistance, and venous O2 saturation (essentially, using a Swan-Ganz and a pulse ox).
How can positive pressure ventilation (PPV) result in a pneumothorax?
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Increased pressure can cause air to escape into the pleural spaces from the alveoli or the insterstitium. This increases the pressure of the pleura and collapses the lung.


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