Podcast
Questions and Answers
A patient with acute respiratory failure has the following arterial blood gas results: pH 7.25, PaCO2 60 mm Hg, PaO2 55 mm Hg, and HCO3- 24 mEq/L. Which of the following interventions is the MOST appropriate initial action?
A patient with acute respiratory failure has the following arterial blood gas results: pH 7.25, PaCO2 60 mm Hg, PaO2 55 mm Hg, and HCO3- 24 mEq/L. Which of the following interventions is the MOST appropriate initial action?
- Administer sodium bicarbonate intravenously.
- Apply a non-rebreather mask with high-flow oxygen. (correct)
- Initiate mechanical ventilation.
- Administer a bronchodilator via nebulizer.
A patient with acute respiratory failure is receiving mechanical ventilation with positive end-expiratory pressure (PEEP). Which assessment finding would warrant the MOST immediate intervention?
A patient with acute respiratory failure is receiving mechanical ventilation with positive end-expiratory pressure (PEEP). Which assessment finding would warrant the MOST immediate intervention?
- Blood pressure decreasing from 120/80 to 90/60 mm Hg. (correct)
- End-tidal CO2 increasing from 35 to 40 mm Hg.
- Oxygen saturation of 92%.
- Crackles in the lung bases.
Which of the following interventions is MOST important for a patient with acute respiratory failure who is at risk for developing thick, tenacious secretions?
Which of the following interventions is MOST important for a patient with acute respiratory failure who is at risk for developing thick, tenacious secretions?
- Providing humidified oxygen and encouraging hydration. (correct)
- Initiating early ambulation to promote lung expansion.
- Restricting oral fluids to prevent pulmonary edema.
- Administering an antipyretic medication regularly.
A patient with acute respiratory failure is prescribed lorazepam. What is the primary purpose of this medication in this clinical scenario?
A patient with acute respiratory failure is prescribed lorazepam. What is the primary purpose of this medication in this clinical scenario?
Which of the following coughing techniques would be MOST appropriate for a patient with acute respiratory failure who has weak abdominal muscles?
Which of the following coughing techniques would be MOST appropriate for a patient with acute respiratory failure who has weak abdominal muscles?
In ARDS, what physiological process directly leads to decreased gas exchange in the alveoli?
In ARDS, what physiological process directly leads to decreased gas exchange in the alveoli?
A patient with ARDS is receiving 100% oxygen, but their hypoxemia is not improving. This is most likely due to what?
A patient with ARDS is receiving 100% oxygen, but their hypoxemia is not improving. This is most likely due to what?
Which of the following diagnostic findings is most indicative of ARDS on a chest X-ray?
Which of the following diagnostic findings is most indicative of ARDS on a chest X-ray?
A patient develops ARDS secondary to sepsis. What is the underlying mechanism by which sepsis leads to ARDS?
A patient develops ARDS secondary to sepsis. What is the underlying mechanism by which sepsis leads to ARDS?
What is the significance of the P/F ratio (PaO2/FiO2) in assessing a patient with ARDS?
What is the significance of the P/F ratio (PaO2/FiO2) in assessing a patient with ARDS?
A patient with ARDS is showing signs of increased work of breathing, tachypnea, and cyanosis. What intervention would be the priority?
A patient with ARDS is showing signs of increased work of breathing, tachypnea, and cyanosis. What intervention would be the priority?
Which of the following is an example of a direct cause of ARDS?
Which of the following is an example of a direct cause of ARDS?
A patient with ARDS develops pulmonary fibrosis. How does pulmonary fibrosis affect lung function?
A patient with ARDS develops pulmonary fibrosis. How does pulmonary fibrosis affect lung function?
A patient with a flail chest is being treated in the emergency department. Which of the following clinical manifestations would the nurse expect to observe?
A patient with a flail chest is being treated in the emergency department. Which of the following clinical manifestations would the nurse expect to observe?
A patient is admitted with a tension pneumothorax following a motor vehicle accident. Which intervention is the highest priority for the nurse?
A patient is admitted with a tension pneumothorax following a motor vehicle accident. Which intervention is the highest priority for the nurse?
Following a thoracentesis, the nurse should monitor the patient for which of the following complications?
Following a thoracentesis, the nurse should monitor the patient for which of the following complications?
While caring for a patient with a chest tube, the nurse notes continuous bubbling in the water-seal chamber. What does this typically indicate?
While caring for a patient with a chest tube, the nurse notes continuous bubbling in the water-seal chamber. What does this typically indicate?
The nurse is caring for a patient with a chest tube connected to a water-seal drainage system. During assessment, the nurse notes that the fluid in the water-seal chamber fluctuates with the patient's respirations. Which action should the nurse take?
The nurse is caring for a patient with a chest tube connected to a water-seal drainage system. During assessment, the nurse notes that the fluid in the water-seal chamber fluctuates with the patient's respirations. Which action should the nurse take?
A patient with a pneumothorax has a chest tube inserted. Which of the following nursing interventions promotes lung expansion and drainage?
A patient with a pneumothorax has a chest tube inserted. Which of the following nursing interventions promotes lung expansion and drainage?
Which of the following is the most significant risk factor for developing lung cancer?
Which of the following is the most significant risk factor for developing lung cancer?
Which of the following manifestations is most commonly associated with early-stage lung cancer?
Which of the following manifestations is most commonly associated with early-stage lung cancer?
A patient is scheduled for a lung biopsy to confirm a diagnosis of suspected lung cancer. Which nursing intervention is essential following this procedure?
A patient is scheduled for a lung biopsy to confirm a diagnosis of suspected lung cancer. Which nursing intervention is essential following this procedure?
A patient is being prepared for extubation after a period of mechanical ventilation. What is the most important initial step the nurse should take?
A patient is being prepared for extubation after a period of mechanical ventilation. What is the most important initial step the nurse should take?
The physician orders to resume sedation at 50% for a patient who failed extubation. What is the primary goal of this intervention?
The physician orders to resume sedation at 50% for a patient who failed extubation. What is the primary goal of this intervention?
What is the purpose of ensuring gentle bubbling in the suction control chamber of a chest tube drainage system?
What is the purpose of ensuring gentle bubbling in the suction control chamber of a chest tube drainage system?
A patient reports chest pain, dyspnea, and anxiety following a motor vehicle accident. Assessment reveals absent breath sounds on the left side and asymmetrical chest movement. Which condition should the nurse suspect?
A patient reports chest pain, dyspnea, and anxiety following a motor vehicle accident. Assessment reveals absent breath sounds on the left side and asymmetrical chest movement. Which condition should the nurse suspect?
A nurse is providing discharge instructions to a patient following a thoracotomy for lung cancer. What should the nurse emphasize?
A nurse is providing discharge instructions to a patient following a thoracotomy for lung cancer. What should the nurse emphasize?
During the intubation process, after inserting the ETT, what is the NEXT step?
During the intubation process, after inserting the ETT, what is the NEXT step?
A patient with acute respiratory failure is being treated with BiPAP. Despite this, the patient's PaCO2 remains elevated at 62 mm Hg and pH is 7.28. What is the most appropriate next step in managing this patient's respiratory status?
A patient with acute respiratory failure is being treated with BiPAP. Despite this, the patient's PaCO2 remains elevated at 62 mm Hg and pH is 7.28. What is the most appropriate next step in managing this patient's respiratory status?
Which of the following clinical scenarios requires the MOST urgent intubation and mechanical ventilation?
Which of the following clinical scenarios requires the MOST urgent intubation and mechanical ventilation?
A patient in acute respiratory failure is receiving mechanical ventilation with PEEP. The nurse observes a sudden drop in blood pressure and decreased urine output. What is the MOST likely cause of these changes?
A patient in acute respiratory failure is receiving mechanical ventilation with PEEP. The nurse observes a sudden drop in blood pressure and decreased urine output. What is the MOST likely cause of these changes?
A patient with acute respiratory failure is started on albuterol and IV steroids. What assessment finding would best indicate that these medications are having the intended therapeutic effect?
A patient with acute respiratory failure is started on albuterol and IV steroids. What assessment finding would best indicate that these medications are having the intended therapeutic effect?
A patient with a chest tube suddenly develops acute respiratory distress. Assessment reveals absent breath sounds on the affected side, and the trachea is deviated to the unaffected side. What is the MOST likely cause of this change in condition?
A patient with a chest tube suddenly develops acute respiratory distress. Assessment reveals absent breath sounds on the affected side, and the trachea is deviated to the unaffected side. What is the MOST likely cause of this change in condition?
In the pathophysiology of ARDS, what is the primary mechanism that leads to decreased gas exchange?
In the pathophysiology of ARDS, what is the primary mechanism that leads to decreased gas exchange?
A patient with ARDS has a PaO2/FiO2 ratio of 150. How should this be interpreted?
A patient with ARDS has a PaO2/FiO2 ratio of 150. How should this be interpreted?
A patient with ARDS is being mechanically ventilated. What ventilator strategy is MOST important to minimize further lung injury?
A patient with ARDS is being mechanically ventilated. What ventilator strategy is MOST important to minimize further lung injury?
If a patient with ARDS has a 'white-out' appearance on a chest X-ray, what does this finding suggest?
If a patient with ARDS has a 'white-out' appearance on a chest X-ray, what does this finding suggest?
A patient with a chest tube suddenly develops increased dyspnea and decreased oxygen saturation. The nurse assesses the insertion site and notes subcutaneous emphysema. What is the MOST appropriate immediate action?
A patient with a chest tube suddenly develops increased dyspnea and decreased oxygen saturation. The nurse assesses the insertion site and notes subcutaneous emphysema. What is the MOST appropriate immediate action?
A patient with a chest tube is being transferred to a different unit. What is the MOST important consideration for managing the chest tube during transport?
A patient with a chest tube is being transferred to a different unit. What is the MOST important consideration for managing the chest tube during transport?
Following a motor vehicle accident, a patient is diagnosed with a flail chest. Besides pain management, what is the MOST important initial intervention?
Following a motor vehicle accident, a patient is diagnosed with a flail chest. Besides pain management, what is the MOST important initial intervention?
A patient with a flail chest is complaining of severe pain. Besides oxygen administration, which intervention is the MOST appropriate initial nursing action?
A patient with a flail chest is complaining of severe pain. Besides oxygen administration, which intervention is the MOST appropriate initial nursing action?
A patient with a tension pneumothorax is being prepared for needle decompression. The nurse anticipates the insertion site to be which of the following?
A patient with a tension pneumothorax is being prepared for needle decompression. The nurse anticipates the insertion site to be which of the following?
The nurse is assessing a patient with a chest tube connected to a water-seal drainage system. Which finding requires immediate intervention?
The nurse is assessing a patient with a chest tube connected to a water-seal drainage system. Which finding requires immediate intervention?
A patient is post-extubation. Which of the following assessment findings would warrant immediate notification of the physician?
A patient is post-extubation. Which of the following assessment findings would warrant immediate notification of the physician?
A patient with lung cancer develops superior vena cava syndrome. Which of the following nursing interventions is MOST appropriate to manage this complication?
A patient with lung cancer develops superior vena cava syndrome. Which of the following nursing interventions is MOST appropriate to manage this complication?
A patient with a history of smoking is undergoing diagnostic testing for suspected lung cancer. What diagnostic test will provide a definitive diagnosis?
A patient with a history of smoking is undergoing diagnostic testing for suspected lung cancer. What diagnostic test will provide a definitive diagnosis?
A patient is ambulating after a thoracotomy procedure for lung cancer. The patient reports increased pain at the chest tube insertion site. Which of the following nursing interventions is MOST appropriate?
A patient is ambulating after a thoracotomy procedure for lung cancer. The patient reports increased pain at the chest tube insertion site. Which of the following nursing interventions is MOST appropriate?
The physician orders to resume sedation at 50% for a patient who failed extubation. What nursing assessment finding would indicate the sedation is achieving the desired effect?
The physician orders to resume sedation at 50% for a patient who failed extubation. What nursing assessment finding would indicate the sedation is achieving the desired effect?
After assisting with the insertion of a chest tube, the nurse observes continuous bubbling in the water-seal chamber of the chest drainage system. What is the appropriate initial nursing action?
After assisting with the insertion of a chest tube, the nurse observes continuous bubbling in the water-seal chamber of the chest drainage system. What is the appropriate initial nursing action?
A patient with a chest tube is being transferred from the ICU to a general medical floor. Which instruction is MOST important for the nurse to provide to the receiving nurse?
A patient with a chest tube is being transferred from the ICU to a general medical floor. Which instruction is MOST important for the nurse to provide to the receiving nurse?
A patient involved in a motor vehicle accident has suffered blunt chest trauma. Which assessment finding is MOST indicative of a developing pneumothorax?
A patient involved in a motor vehicle accident has suffered blunt chest trauma. Which assessment finding is MOST indicative of a developing pneumothorax?
A patient has just undergone a thoracentesis for a pleural effusion. Which of the following nursing interventions is appropriate immediately following the procedure?
A patient has just undergone a thoracentesis for a pleural effusion. Which of the following nursing interventions is appropriate immediately following the procedure?
A patient is being discharged after treatment for a pneumothorax with chest tube placement. Which statement indicates the patient understands important discharge instructions?
A patient is being discharged after treatment for a pneumothorax with chest tube placement. Which statement indicates the patient understands important discharge instructions?
Which of the following is the MOST important step in preparing a non-rebreather mask for optimal oxygen delivery?
Which of the following is the MOST important step in preparing a non-rebreather mask for optimal oxygen delivery?
A patient with lung cancer is experiencing anorexia and significant weight loss. What dietary recommendation is MOST appropriate for the nurse to suggest?
A patient with lung cancer is experiencing anorexia and significant weight loss. What dietary recommendation is MOST appropriate for the nurse to suggest?
A patient with acute respiratory failure has been started on BiPAP therapy. Which assessment finding indicates the MOST effective response to this intervention?
A patient with acute respiratory failure has been started on BiPAP therapy. Which assessment finding indicates the MOST effective response to this intervention?
Which of the following interventions is MOST appropriate to prevent complications associated with thick, tenacious secretions in a patient with acute respiratory failure?
Which of the following interventions is MOST appropriate to prevent complications associated with thick, tenacious secretions in a patient with acute respiratory failure?
A patient with acute respiratory failure is ordered to receive staged coughing exercises. What instruction should the nurse provide to the patient regarding this technique?
A patient with acute respiratory failure is ordered to receive staged coughing exercises. What instruction should the nurse provide to the patient regarding this technique?
A patient with acute respiratory failure is being mechanically ventilated and requires frequent suctioning. Which nursing intervention is MOST important to minimize complications associated with suctioning?
A patient with acute respiratory failure is being mechanically ventilated and requires frequent suctioning. Which nursing intervention is MOST important to minimize complications associated with suctioning?
A physician ordered Vancomycin for a patient; what condition does this patient MOST likely have?
A physician ordered Vancomycin for a patient; what condition does this patient MOST likely have?
In the early stages of ARDS, a patient might not respond well to oxygen administration alone due to what underlying issue?
In the early stages of ARDS, a patient might not respond well to oxygen administration alone due to what underlying issue?
A patient with ARDS is being mechanically ventilated. The physician mentions a strategy to minimize further lung injury. What specific ventilator strategy would be most appropriate?
A patient with ARDS is being mechanically ventilated. The physician mentions a strategy to minimize further lung injury. What specific ventilator strategy would be most appropriate?
A patient with ARDS develops pulmonary fibrosis. How does this complication affect the patient's respiratory function?
A patient with ARDS develops pulmonary fibrosis. How does this complication affect the patient's respiratory function?
After a motor vehicle accident, a patient develops ARDS secondary to multiple trauma and shock. What is the underlying mechanism by which shock contributes to ARDS?
After a motor vehicle accident, a patient develops ARDS secondary to multiple trauma and shock. What is the underlying mechanism by which shock contributes to ARDS?
A patient with ARDS has a PaO2/FiO2 ratio of 150. How should this finding be clinically interpreted?
A patient with ARDS has a PaO2/FiO2 ratio of 150. How should this finding be clinically interpreted?
A patient admitted with a chest trauma is suspected of having a pneumothorax. Which assessment finding would be MOST indicative of this condition?
A patient admitted with a chest trauma is suspected of having a pneumothorax. Which assessment finding would be MOST indicative of this condition?
After a motor vehicle accident, a patient is diagnosed with a flail chest. What is the primary concern related to the patient's ventilation?
After a motor vehicle accident, a patient is diagnosed with a flail chest. What is the primary concern related to the patient's ventilation?
A patient with a chest tube develops subcutaneous emphysema around the insertion site. What is the most appropriate initial nursing intervention?
A patient with a chest tube develops subcutaneous emphysema around the insertion site. What is the most appropriate initial nursing intervention?
After extubation, a patient exhibits mild stridor and an Spo2 of 92% on room air. What is the MOST appropriate immediate nursing intervention?
After extubation, a patient exhibits mild stridor and an Spo2 of 92% on room air. What is the MOST appropriate immediate nursing intervention?
A patient with a flail chest is being mechanically ventilated. Which ventilator setting adjustment would be MOST beneficial in promoting chest wall stability and improving gas exchange?
A patient with a flail chest is being mechanically ventilated. Which ventilator setting adjustment would be MOST beneficial in promoting chest wall stability and improving gas exchange?
A patient with a pneumothorax has a chest tube connected to a water-seal drainage system. The nurse observes that the fluid in the water-seal chamber is not fluctuating with respirations. What could be the MOST likely cause of this?
A patient with a pneumothorax has a chest tube connected to a water-seal drainage system. The nurse observes that the fluid in the water-seal chamber is not fluctuating with respirations. What could be the MOST likely cause of this?
When assessing a patient with a chest tube, the nurse notes continuous bubbling in the water-seal chamber. What is the MOST appropriate initial nursing intervention?
When assessing a patient with a chest tube, the nurse notes continuous bubbling in the water-seal chamber. What is the MOST appropriate initial nursing intervention?
A patient with a chest tube is being transferred from the ICU to a medical floor. What information is MOST important for the nurse to communicate to the receiving nurse during the handoff report?
A patient with a chest tube is being transferred from the ICU to a medical floor. What information is MOST important for the nurse to communicate to the receiving nurse during the handoff report?
A patient with a long-standing smoking history is undergoing evaluation for suspected lung cancer. While reviewing the diagnostic results, which finding would MOST strongly suggest a definitive diagnosis of lung cancer?
A patient with a long-standing smoking history is undergoing evaluation for suspected lung cancer. While reviewing the diagnostic results, which finding would MOST strongly suggest a definitive diagnosis of lung cancer?
A patient with lung cancer develops superior vena cava syndrome. Which clinical manifestation would the nurse expect to observe?
A patient with lung cancer develops superior vena cava syndrome. Which clinical manifestation would the nurse expect to observe?
A patient is diagnosed with a tension pneumothorax after a motor vehicle accident. The nurse understands that the underlying pathophysiology of a tension pneumothorax involves:
A patient is diagnosed with a tension pneumothorax after a motor vehicle accident. The nurse understands that the underlying pathophysiology of a tension pneumothorax involves:
A patient is being prepared for emergency needle decompression due to a tension pneumothorax. What is the MOST appropriate anatomical location for the nurse to prepare for insertion?
A patient is being prepared for emergency needle decompression due to a tension pneumothorax. What is the MOST appropriate anatomical location for the nurse to prepare for insertion?
A patient with a chest tube is ambulating when the chest tube becomes dislodged from the drainage system. What is the MOST appropriate immediate nursing action?
A patient with a chest tube is ambulating when the chest tube becomes dislodged from the drainage system. What is the MOST appropriate immediate nursing action?
Following a motor vehicle accident, a patient is diagnosed with a flail chest. Which of the following assessment findings is the MOST critical to report immediately to the physician?
Following a motor vehicle accident, a patient is diagnosed with a flail chest. Which of the following assessment findings is the MOST critical to report immediately to the physician?
A patient with a history of smoking is undergoing diagnostic testing for suspected lung cancer. The nurse is reviewing the patient's scheduled procedures. What instructions should the nurse give this patient?
A patient with a history of smoking is undergoing diagnostic testing for suspected lung cancer. The nurse is reviewing the patient's scheduled procedures. What instructions should the nurse give this patient?
A patient had an extubation but now complains of increased difficulty breathing, and the nurse auscultates stridor. What medication is MOST likely to be administered?
A patient had an extubation but now complains of increased difficulty breathing, and the nurse auscultates stridor. What medication is MOST likely to be administered?
A patient is being monitored for a thoracentesis. Which of the following signs and symptoms should be monitored for?
A patient is being monitored for a thoracentesis. Which of the following signs and symptoms should be monitored for?
A patient who is a smoker is being assessed for lung cancer presents wheezing, hemoptysis and dyspnea on exertion. The nurse understands that:
A patient who is a smoker is being assessed for lung cancer presents wheezing, hemoptysis and dyspnea on exertion. The nurse understands that:
Flashcards
Target Oxygenation
Target Oxygenation
PaO2 > 60 mmHg and SaO2 > 90%
Target Ventilation (ABGs)
Target Ventilation (ABGs)
PaCO2 < 50 mmHg and pH > 7.30
Non-Invasive Respiratory Support
Non-Invasive Respiratory Support
High-flow O2, BiPAP/CPAP
Medications for Respiratory Failure
Medications for Respiratory Failure
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ARDS Definition
ARDS Definition
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ARDS Causes
ARDS Causes
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ARDS Pathophysiology
ARDS Pathophysiology
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ARDS Chest X-ray
ARDS Chest X-ray
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Early ARDS Manifestations
Early ARDS Manifestations
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Late ARDS Manifestations
Late ARDS Manifestations
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Intrapulmonary Shunt
Intrapulmonary Shunt
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ARDS Nursing Management
ARDS Nursing Management
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Sedation Weaning & Ventilatory Support
Sedation Weaning & Ventilatory Support
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Tension Pneumothorax
Tension Pneumothorax
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Needle Decompression
Needle Decompression
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Chest Tube Tidaling
Chest Tube Tidaling
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Chest Tube Air Leak
Chest Tube Air Leak
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Chest Tube Positioning
Chest Tube Positioning
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Excessive Chest Tube Drainage
Excessive Chest Tube Drainage
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Lung Cancer Risk Factors
Lung Cancer Risk Factors
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Lung Cancer Early Sign
Lung Cancer Early Sign
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Thoracentesis
Thoracentesis
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Lung Cancer Diagnosis
Lung Cancer Diagnosis
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Chest X-Ray for Lung Cancer
Chest X-Ray for Lung Cancer
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Flail Chest
Flail Chest
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Paradoxical Chest Wall Movement
Paradoxical Chest Wall Movement
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Post-Extubation Monitoring
Post-Extubation Monitoring
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Rest Ventilator Muscles
Rest Ventilator Muscles
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Pulmonary Hygiene: Coughing
Pulmonary Hygiene: Coughing
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Steroids for Airway Inflammation
Steroids for Airway Inflammation
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Albuterol for Bronchospasms
Albuterol for Bronchospasms
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Expectorants and Mucolytics
Expectorants and Mucolytics
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ARDS
ARDS
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Primary/Direct & Secondary/Indirect ARDS Causes
Primary/Direct & Secondary/Indirect ARDS Causes
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ARDS & Hypoxia
ARDS & Hypoxia
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ARDS & Intrapulmonary Shunt
ARDS & Intrapulmonary Shunt
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ARDS Chest X-Ray Findings
ARDS Chest X-Ray Findings
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ARDS Clinical Manifestations
ARDS Clinical Manifestations
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ARDS - Late ABG Changes
ARDS - Late ABG Changes
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Extubation
Extubation
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Extubation Equipment
Extubation Equipment
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ETT Removal Technique
ETT Removal Technique
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Post-Extubation Interventions
Post-Extubation Interventions
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Blunt Trauma
Blunt Trauma
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Penetrating Trauma
Penetrating Trauma
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Paradoxical Chest Movement
Paradoxical Chest Movement
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Flail Chest Management
Flail Chest Management
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Pneumothorax
Pneumothorax
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Hemothorax
Hemothorax
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Pneumothorax Signs
Pneumothorax Signs
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Pneumothorax Treatment
Pneumothorax Treatment
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Chest Tube Water-Seal Chamber
Chest Tube Water-Seal Chamber
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Main Lung Cancer Risk Factor
Main Lung Cancer Risk Factor
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Patent Airway & Monitoring
Patent Airway & Monitoring
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Augmented Coughing
Augmented Coughing
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Huff Coughing
Huff Coughing
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Staged Coughing
Staged Coughing
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Benzodiazepines (lorazepam)
Benzodiazepines (lorazepam)
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P/F Ratio in ARDS
P/F Ratio in ARDS
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Primary ARDS
Primary ARDS
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Secondary ARDS
Secondary ARDS
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ARDS White-Out
ARDS White-Out
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ARDS Refractory Hypoxemia
ARDS Refractory Hypoxemia
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ARDS: Early Signs
ARDS: Early Signs
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ARDS: Late Signs
ARDS: Late Signs
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Extubation Prep
Extubation Prep
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Blunt Chest Trauma
Blunt Chest Trauma
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Penetrating Chest Wound
Penetrating Chest Wound
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Pneumothorax Diagnostics
Pneumothorax Diagnostics
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Chest Tubes
Chest Tubes
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Chest Tube Function
Chest Tube Function
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Suction Control Chamber
Suction Control Chamber
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Water-Seal Chamber
Water-Seal Chamber
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Lung Cancer Main Risk
Lung Cancer Main Risk
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Initial Lung Cancer Test
Initial Lung Cancer Test
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ETT Placement Confirmation
ETT Placement Confirmation
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Study Notes
Okay, I have updated the study notes with the new information you provided. Here are the updated study notes.
Arterial Blood Gas (ABG) Analysis
- Normal pH range: 7.35-7.45
- Normal PaCO2 range: 45-35 mmHg
- Normal HCO3 range: 22-26
- Normal PaO2 range: 80-100 mmHg
- Normal O2% range: 95-100%
- PaCO2 indicates the effectiveness of ventilation in the lungs, and moves in the opposite direction of the pH.
- HCO3 is part of the body's acid-base balance buffer, and moves in the same diection as pH
- PaO2 is a measurement of the partial pressure exerted by O2 dissolved in arterial blood.
- O2% represents the percentage of hemoglobin actually carrying O2 as opposed to the percentage that could carry O2 (100%).
Acute Respiratory Failure (ARF)
- Failure to ventilate and/or oxygenate causes failure of gas exchange (O2, CO2, both).
- ARF criteria based on ABG values
- Hypoxemic (Type 1) of ARF noted as PaO2 < 60 mmHg.
- Hypercapnic (Type 2) of ARF noted as PaCO2 > 50 mmHg and pH < 7.35.
- Multi organ failure & Death happen if gas exchange fails
Causes of ARF: Impaired Ventilation
- Impaired ventilation/hypoventilation (extrapulmonary) of ARF is due to impaired muscle function or neurological depression.
- Neurological depression within Impaired ventilation is related to:
- Medications or drug overdose like narcotics analgesia or sedatives or anesthesia
- Increased ICP (head injury, stroke)
- Nerve impairment as cause of impaired ventilation includes:
- Spinal cord injury (C4 and up)
- Inflammation/diseases like myasthenia gravis
- Fatigue of respiratory muscles or chest wall injury is included with impaired ventilation
Causes of ARF: Impaired Gas Exchange
- Impaired gas exchange/oxygenation (pulmonary) of ARF occurs because alveoli cannot exchange gas & lack of perfusion to capillary beds.
- Gas exchange is altered by:
- Inhalation of toxic gasses
- Pneumonia or sepsis
- Pulmonary edema or pneumothorax
- Pleural effusion or atelectasis
- Emphysema
Causes of ARF: Airway Obstruction
- Airway obstruction included in ARF prevents flow into lungs.
- Thickening of airway wall, blockage, compression are elements of Airway Obstruction
- Pulmonary edema, cystic fibrosis, asthma, COPD, blockage of foreign body are causes of obstruction
Diagnostics of ARF
- ABGs are the gold standard in measuring ARF
- Diagnostic ABGs of ARF
- PaO2 < 60
- PaCO2 > 50
- pH < 7.30
- SaO2 < 90
- Chest x-ray aids in determining underlying cause
Clinical Manifestations of ARF
- Altered mental status is the first sign of hypoxia
- Altered mental status includes agitation, restlessness or confusion.
- Tachypnea (rapid, shallow breathing).
- Pallor
- Mild increased work of breathing- paradoxical breathing
- Use of accessory muscles
- Shortness of breath(SOB)
Nursing Management of ARF
- Goal of nursing managmenet requires: Support oxygenation & ventilation.
- Many causes of resp failure are treatable.
- May require aggressive support to allow time for underlying problems to resolve.
- Goal of nursing managmenet requires proper oxygenation (correct hypoxemia)
- PaO2 > 60
- SaO2 > 90%
- Goal of nursing management requires improved ventilation (correct resp. acidosis)
- PaCO2 < 50
- pH > 7.30
- There should be ventilator muscle rest
- ETCO2 indicates the level of CO2 that is released at the end of an exhaled breath, normal is 35-45
- Maintain a patent airway and monitor respiratory status every hour and more often as needed.
- Mechanical ventilation:
- Proper oxygenation needs PaO2 > 60, SaO2 > 90%
- Mechanical ventilation:
- P/F Ratio Condition and its P02
- greater or equal to 400 / greater or equal to 80 is normal
- Less the 400 equals 60-79 means Hypoxemi
- Less the 300 equals 50-59 means Respiratory failure
- Less the 250 equals 40-49 means Severs respiratory failure
- Less the 200 equals less than 40 mens Critical respiratory failure
- Mechanical ventilation:
- Hemodynamic stability requires absence of dysrhythmias and hypotension
- Client needs to be awake, alert, easily arousable
Respiratory Support of ARF
- Non-invasive ventilation includes non-rebreather mask or High-flow O2 as well as BIPAP/CPAP if pt condition dictates
- Invasive support includes intubation & mechanical ventilation for better airway & proper ventilation and Hemodynamic monitoring if needed (PEEP)
Medications of ARF
- Medications of ARF inlcude Steroids for airway inflammation and Albuterol for bronchospasms.
- Further medications expeorant and mucolyics as well as benzodiazepines may be administered to reduce anxiety and ease ventilation
- Augumented coughing: pressure of base of lungs when coughing.
- Huff coughing or staged coughing helps
- Use suction or humidification/hydration
Acute Respiratory Distress Syndrome (ARDS)
- Sudden progressive form of acute respiratory failure that is life threatening.
- Damage to alveolar capillary membrane occurs by direct damage or systemically inflammatory response like sepsis
- Reduction is surfactant weakens the alveoli, which causes collapse or filling of fluid, leading to worsening edema
- Decrease gas exchange in alveoli due to less surface area and collapse from fluid entering, which leads to hypoxia
- Intrapulmonary shunt (V/Q mismatch) leads to good perfusion without good gas exchange which does not repond to just O2, and can lead to pulmonary fibrosis
Causes of ARDS
- ARDS is a response to many etiologies, not just one disease
- Primary/direct causes of ARDS relate to direct damage to the alveolar membrane by damage & inflammation and include:
- Aspiration
- Pneumonia or drowning
- Toxic inhalation or blunt trauma (pulmonary contusion)
- Secondary/Indirect causes of ARDs relate to damage to capillary membranes by systemic inflammation:
- Sepsis is most common cause
- Shock
- Fat embolism, trauma or blood transfusion
Klinical Manifestations of ARDS
- Clinical Manifestations included dyspnea, tachypnea, cough and restlessness
- Late manifestations of ARDS include:
- Increased WOB, tachypnea, cyanosis and pallor
- Diffuse crackles
- ABGs- refractory hypoxemia & hypercapnia (more severe)
- P/F ratio poor (PaO2:FiO2: the worse it is = more severe respiratory failure)
- Chest x-ray: white-out (diffuse- extensive bilateral)
Mechanical Ventilation of ARDS
- Supporting oxygenation of ARDS should start with Bi-PAP as least invasive intervention, and intubation if hypoxemia worsens
- Use only Lung protective Mechanical ventilation/volume settings to reduce risk of lung damage because there is high risk of barotrauma & volutrauma from resistance of ARDs lungs
- Low tidal volume and pressure
- Permissive hypercapnia
- PEEP: positive end expiratory pressure to prevent alveolar collapse during expiration
ARDS Complications
- Paralytic therapy using Neuromuscular blocking agents (NMBAs) is a ARDS complication.
- Ensure deep sedation before paralytics started
- Prone positioning improves oxygenation and ECMO (for severe ARDS when life threatening)
- Continuous lateral rotation uses Bed that rotates laterally alters client positioning to reduce atelectasis and improve ventilation
ARDS Complications: Ventilation
- Ventilator associated pneumonia (VAP) is related to Ventilation protocol:
- Elevate HOB 30-45 degrees
- Use "sedation holidays” (waking up patient to assess neuro & readiness to extubate)
- VTE prophylaxis
- Oral care every 4 hours with chlorhexidine
- Barotrauma damages lungs by positive pressure (PEEP). Always:
- Monitor oxygenation status & chest x-ray
- Assess for crackles and use high-pressure ventilator alarm
Complications of ARDS
- Volutrauma: damage to lungs by volume delivered from one lung to the other (lung overdistention)
- High risk for stress ulcers and VTE
- AKI (acute kidney injury) from dialysis/CRRT
- Continuous renal replacement-therapy (CRRT) is a complication of ARDS
Oxygen Delivery Devices
- Oxygen masks include Nasal cannula using 02: 24-44%
- Venturi mask uses O2: 24-60% at Flow rate: 1-6 L/min
- Non-rebreather mask using O2: 60-90% and Flow rate: 10-15 L/min
- High-flow Nasal Cannula gives O2: up to 100% and Flow rate: up to 60 L/min
Nursing Management of Oxygen Delivery
- Ensure accurate oxygen flow rate and ensure the tubing is free of kinks
- Check mask for skin breakdown
- Monitor oxygen saturation
- Implement Noninvasive Positive-Pressure Ventilation -(usually used post extubation):
- CPAP delivers same amt of pressure at all times, pt breathes at own spontaneous tidal volumes useful for any hypoxemia
- Useful for Ventilation
- BIPAP is 2 levels of pressure support:
- Inspiratory (IPAP): high pressure during inspiration helps remove CO2
- Expiratory (EPAP): lower pressure during expiration keeps alveoli open
- Nursing can includes assessement of Pt LOC during procedure and to prevent or catch possible Aspiration.
Nursing Care for Ventilation
- Note patient LOC, hemodynamic stability, and WOB
- Assess mask size and check skin
- Raise HOB 30-45 degrees
Intubation
- Insertion of an ETT (endotracheal tube) into the trachea through the mouth (easier) or nose.
- Key equipment in intubation is stylet,syringe, water-soluble lubricant, tape and and stethoscope
Intubation: Nurse Actions
- With intubation, ensure intubation attempts last no longer than 30 seconds
- Auscultate for breath sounds bilaterally and ensure positioning
- Monitor vital signs and verify ET tube placement
Endotracheal Intubation: Assess Placement
- To check if the tube is in the trachea, listen to breath sounds and ensure expansions
- Ensure a portable CXR is ordered to confirm tube placement
Post Intubation Care
- Maintain & monitor cuff pressure, and monitor oxygenation,Always get vitals and hyperoxygenate before suctioning
- Provide oral care and Sedate
- (Analgesics: morphine Sedatives: propofol, diazepam)
Types of ETT tubes
- Types of ETT: cuffed, uncuffed, LMA or Subglottic suction
- Ulcer preventing meds: PPIs (omeprazole) and Antibiotics are used for infection
Post Intubation: Weaning
- Start at the lowest flow to correct hypoxemia and gradually discontinue oxygen in order, and then Monitor the client during the weaning process for signs of weaning intolerance.
- After extubation, assess O2 and vitals every 5 minutes and watch for s/s of distress
- Tracheotomy is used when intubation lasts longer than 7-10 days:
- Post tracheotomy kit is must be kept at bedside in case of accidental decannulation
Intubation: Terms
- Terms to know: FiO2, tidal volume and tidal Pressure
Indications of Mechanical Ventilation
- Ventilation is indicated when respiratory rate is <8 and >30 and if PaO2 < 55 and supplementary 02
Mechanical Ventilation
- Modes of Ventilation: describes how breaths are delivered to the patient
- Assist-control (AC): Total ventilation: ○ preset tidal volume and rate, no pressure support
- Pressure-control (PC): Total ventilation (Preset: inspiratory pressure (PIP)) and breaths
- Synchronized Intermittent (SIMV): partial support
Pressure Support
- Support includes: PUSH of air to help patient with spontaneous breath
- Breathing of Spont is dependent on Patient
Weaning Conditions
- Pt needs to have be free from: Reversal of cause of respiratory failure, absence of dysrhythmias, alert, easily arousable and stable hemoglobin
- Breaths are to take for: 30-120 min and what to do if pt cant breathe if there is high anxiety
Extubation
- Equipments Preparation, Suction and oxygen
- Process for pulling tubing
- After pulling ensure monitoring and support patient recovery for strength for activity
Characteristics of Flail Chests
- Unequal chest expansion, Paradoxical chest wall movement, and more
Pneumothorax
- Treatment of emergent treatment of pleural space is needed and insert needle
Chest tube placement locations and purpose
- Reestablish pressure as well assist to re- expand lungs
- Suction chamber assists in proper suction as well encourging diaphragmatic breathing
Lung cancer
-
Diagnoses of Lung Cancer
- Open the space
- Then pull cancer liquid and analze for cancer cells
-
Lung Cancer Management must encourage - Promote adequate nutrition - Monitor weight and any anorexia
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Description
This quiz focuses on the assessment, interventions, and management of acute respiratory failure and ARDS including ABG analysis, mechanical ventilation, secretion management, medication use, and effective coughing techniques. It covers key aspects of ARDS pathophysiology and its impact on gas exchange. It also tests knowledge of PEEP and associated risk factors
