Mechanical Ventilation Best Practices
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Questions and Answers

Which of the following interventions is used to prevent alveolar collapse in mechanically ventilated patients?

  • Daily spontaneous awakening trials
  • Subglottic secretion drainage
  • Postpyloric feeding
  • Positive End-Expiratory Pressure (PEEP) (correct)

Monitoring plateau pressure helps clinicians assess the compliance (or 'stiffness') of the patient's lungs.

True (A)

What is the primary purpose of using sedation and paralysis in mechanically ventilated patients?

To reduce restlessness and muscle activity, preventing patients from fighting the ventilator.

Which of the following is an essential recommendation for preventing Ventilator-Associated Events (VAEs)? (Select all that apply)

<p>Daily toothbrushing (A), Avoid intubation if possible; consider HFNC (B)</p> Signup and view all the answers

________ involves periodically waking up the patient to assess their sedation level and ability to breathe.

<p>Daily spontaneous awakening trials</p> Signup and view all the answers

A clinician is considering methods to reduce the risk of aspiration in a mechanically ventilated patient. Which of the following strategies would address this concern?

<p>Considering postpyloric feeding (A)</p> Signup and view all the answers

Early tracheostomy is typically considered only when a patient requires prolonged intubation and mechanical ventilation.

<p>True (A)</p> Signup and view all the answers

Which of the following practices reduces the risk of Ventilator-Associated Pneumonia (VAP) by removing accumulated secretions above the endotracheal tube cuff?

<p>Subglottic secretion drainage (C)</p> Signup and view all the answers

Which of the following are typical early symptoms of acute respiratory failure?

<p>Restlessness (A), Dyspnea (B), Anxiety (E)</p> Signup and view all the answers

In patients with COPD, the primary drive to breathe is typically stimulated by elevated carbon dioxide levels in the blood.

<p>False (B)</p> Signup and view all the answers

Explain why hyperventilation is an early compensatory mechanism in hypoxemic respiratory failure.

<p>In the early stages of hypoxemic respiratory failure, the body attempts to compensate for low oxygen levels by increasing the rate and depth of breathing (hyperventilation). This aims to expel more carbon dioxide and increase oxygen intake.</p> Signup and view all the answers

The ideal pulse oximetry (SpO2) reading for a patient post initial treatment for hypoxemic respiratory failure is generally greater than ______%.

<p>94</p> Signup and view all the answers

Match the stage of acute respiratory failure with its corresponding symptom:

<p>Early = Restlessness Intermediate = Confusion Late = Cyanosis</p> Signup and view all the answers

What are the expected initial arterial blood gas (ABG) findings in a patient experiencing early hypoxemic respiratory failure (Type I)?

<p>Decreased PaO2 and increased pH (respiratory alkalosis) (A)</p> Signup and view all the answers

The appearance of pink skin in a patient experiencing respiratory distress is a sign of improvement and indicates adequate oxygenation.

<p>False (B)</p> Signup and view all the answers

Describe the normal physiological mechanism that triggers breathing in a healthy individual.

<p>In a healthy individual, the primary trigger for breathing is the level of carbon dioxide (CO2) in the blood. When CO2 levels rise, chemoreceptors in the brain detect this increase and stimulate the respiratory center to increase breathing rate and depth, thereby expelling excess CO2.</p> Signup and view all the answers

Which of the following statements best describes the primary difference between BiPAP and CPAP?

<p>BiPAP delivers two different pressures, while CPAP delivers a single, continuous pressure. (B)</p> Signup and view all the answers

Invasive positive pressure ventilation always requires the use of a face mask.

<p>False (B)</p> Signup and view all the answers

What is the primary purpose of Positive End-Expiratory Pressure (PEEP) in mechanical ventilation?

<p>To maintain continuous pressure in the lungs, preventing alveolar collapse</p> Signup and view all the answers

To cope with respiratory failure, the body requires extra ______ to function effectively.

<p>calories and energy</p> Signup and view all the answers

Which of these medications helps to open the airways by stimulating beta-2 receptors in the lungs?

<p>Inhaled Bronchodilators (D)</p> Signup and view all the answers

What is the primary mechanism by which inhaled steroids help improve breathing in patients with respiratory failure?

<p>Reducing inflammation in the airways (D)</p> Signup and view all the answers

Which of the following assessment findings would indicate a patient is experiencing hypoxemia related to respiratory failure?

<p>Cyanosis around the lips and fingers (B)</p> Signup and view all the answers

What is the most appropriate action of diuretics in treating someone with acute respiratory failure?

<p>To reduce fluid buildup in the lungs (D)</p> Signup and view all the answers

In Type I respiratory failure, arterial blood gas (ABG) results typically indicate low oxygen levels and may also reveal a higher than normal pH.

<p>True (A)</p> Signup and view all the answers

A patient with respiratory failure is exhibiting increased anxiety and agitation. What is the most likely underlying cause for this change in mental status?

<p>Low oxygen levels</p> Signup and view all the answers

Which of the following statements is true regarding the synergistic response of combining bronchodilators and inhaled steriods?

<p>The combined effect is greater than the sum of the effects of the individual drugs. (B)</p> Signup and view all the answers

In patients with respiratory failure, the immediate goal of treatment is to improve the lungs' ability to exchange oxygen and carbon dioxide effectively, also known as ______.

<p>gas exchange</p> Signup and view all the answers

Match the following clinical manifestations with their potential underlying cause in respiratory failure:

<p>Somnolence = High carbon dioxide levels Crackles in the lungs = Fluid accumulation in the alveoli Cardiac dysrhythmias = Low blood oxygen Anxiety and agitation = Low oxygen levels</p> Signup and view all the answers

Which of the following nursing interventions is most important to include in the care plan for a patient with respiratory failure to prevent complications?

<p>Encouraging good hygiene and vaccinations (C)</p> Signup and view all the answers

Which of the following components are typically included in pulmonary rehabilitation programs for patients recovering from acute respiratory failure? (Select all that apply)

<p>Exercise training (A), Nutritional counseling (C)</p> Signup and view all the answers

What instructions should the nurse provide to the patient with a history of smoking to improve lung health and reduce further complications from respiratory issues? (Select all that apply)

<p>Immediately discontinue smoking (B), Seek resources and support for smoking cessation (D)</p> Signup and view all the answers

Why is fentanyl often preferred in ARDS patients?

<p>It decreases the patient's response to carbon dioxide. (C)</p> Signup and view all the answers

Midazolam's primary effect is pain relief.

<p>False (B)</p> Signup and view all the answers

A reversal agent for Fentanyl is ______.

<p>Naloxone</p> Signup and view all the answers

Which of the following is a key nursing implication when administering dexmedetomidine (Precedex)?

<p>Monitoring for bradycardia (B)</p> Signup and view all the answers

What is the primary mechanism of action for neuromuscular blocking agents (NMBAs)?

<p>Blocking signals at the neuromuscular junction (C)</p> Signup and view all the answers

Which of these options are correct regarding Fentanyl? (Select all that apply)

<p>It is 100 times more potent than morphine (A), Its effects wear off quickly. (B)</p> Signup and view all the answers

Match the following medications with their primary effects in the ICU:

<p>Fentanyl = Pain Relief and Sedation Midazolam = Sedation, Anxiety Reduction, and Amnesia Dexmedetomidine = Sedation with Reduced Drowsiness NMBAs = Muscle Paralysis</p> Signup and view all the answers

What tool is used to assess a patient's level of sedation?

<p>Richmond Agitation-Sedation Scale (RASS)</p> Signup and view all the answers

Which of the following is an example of direct lung injury leading to Acute Respiratory Distress Syndrome (ARDS)?

<p>Pulmonary Contusion (C)</p> Signup and view all the answers

Indirect lung injuries involve damage that directly affects the respiratory system.

<p>False (B)</p> Signup and view all the answers

Which of the following conditions is classified as an indirect cause of Acute Respiratory Distress Syndrome (ARDS)?

<p>Severe Burns (D)</p> Signup and view all the answers

A PaO2/FIO2 ratio is calculated to measure the ______ of ARDS.

<p>severity</p> Signup and view all the answers

Which of the following injuries is most likely to cause direct trauma to the lungs, potentially leading to ARDS?

<p>Chest Trauma (A)</p> Signup and view all the answers

Which of these conditions can lead to Acute Respiratory Distress Syndrome (ARDS) due to whole-body inflammation?

<p>Sepsis (C)</p> Signup and view all the answers

Which of the following conditions can result in direct lung injury that may lead to ARDS?

<p>Pneumonia (C)</p> Signup and view all the answers

Which of the following conditions can cause direct lung injuries? (Select all that apply)

<p>Pulmonary Embolus (B), Aspiration (D)</p> Signup and view all the answers

Which of the following findings from a patient with ARDS indicates a progression towards respiratory acidosis?

<p>Arterial blood gases showing a decreased pH (C)</p> Signup and view all the answers

Renal failure in ARDS primarily results from hyperthermia and an increased use of diuretics.

<p>False (B)</p> Signup and view all the answers

What auscultation finding suggests fluid buildup in the lungs of an ARDS patient?

<p>crackles</p> Signup and view all the answers

The use of ______ muscles indicates that a patient is experiencing increased work of breathing.

<p>accessory</p> Signup and view all the answers

What is the primary cause of anxiety and agitation in patients with ARDS?

<p>Low oxygen levels (hypoxemia) (D)</p> Signup and view all the answers

Which of the following complications indicates the progression of ARDS to multisystem organ dysfunction syndrome (MODS)?

<p>Renal failure (D)</p> Signup and view all the answers

Which assessment finding indicates that a patient is experiencing difficulty breathing?

<p>Use of accessory muscles (C)</p> Signup and view all the answers

A nurse assesses a patient with ARDS who has diminished breath sounds. What could this indicate?

<p>Development of scar tissue (fibrosis) and alveolar collapse (atelectasis) (C)</p> Signup and view all the answers

Which of the following signs and symptoms may indicate pneumonia in a ventilated patient with ARDS?

<p>Increased respiratory effort (A)</p> Signup and view all the answers

Sputum cultures are not helpful in confirming the presence of bacteria in suspected pneumonia cases.

<p>False (B)</p> Signup and view all the answers

Which of the following is NOT a recommended preventative measure for ventilator-associated pneumonia (VAP)?

<p>Infrequent ET suctioning (B)</p> Signup and view all the answers

What does a buildup of carbon dioxide in ARDS patients potentially lead to?

<p>Metabolic acidosis (D)</p> Signup and view all the answers

__________ is a type of lung injury resulting from excessive pressure in the chest cavity, commonly associated with mechanical ventilation.

<p>Barotrauma</p> Signup and view all the answers

Testing serum lactate levels helps confirm a shift to anaerobic metabolism when tissues are deprived of oxygen.

<p>True (A)</p> Signup and view all the answers

A patient with ARDS is on a ventilator. The nurse notices the patient is increasingly short of breath and the oxygen saturation is dropping. Which of the following complications should the nurse suspect?

<p>Pneumothorax (A)</p> Signup and view all the answers

Which nursing intervention is most important in preventing barotrauma in a ventilated patient with ARDS?

<p>Monitoring peak pressures on the ventilator (C)</p> Signup and view all the answers

Why is it important to perform liver and renal function tests on patients with ARDS?

<p>To monitor for complications affecting these organ systems. (B)</p> Signup and view all the answers

Which of the following ventilation strategies is used to minimize lung damage in patients with ARDS?

<p>Low tidal volume (D)</p> Signup and view all the answers

Which of the following is crucial in preventing infections related to central lines in ARDS patients?

<p>Using strict sterile techniques during insertion and maintenance. (A)</p> Signup and view all the answers

Regular Foley catheter care, including proper cleaning and frequent ______, is essential to prevent UTIs in ARDS patients.

<p>monitoring</p> Signup and view all the answers

Which of the following can lead to alveolar rupture in a patient with ARDS on mechanical ventilation?

<p>Increased pressure in the cheast cavity (C)</p> Signup and view all the answers

What oral care measures are essential for patients on ventilators to decrease the risk of VAP?

<p>Brushing teeth daily and performing regular oral care every 2 hours. (D)</p> Signup and view all the answers

Which of the following should be included when educating ARDS patients and their families?

<p>Detailed explanation of the ARDS pathophysiology and severity. (A)</p> Signup and view all the answers

Which of the following statements are correct regarding diligent mouth care for ventilated patients? (Select all that apply)

<p>Perform regular oral care every 2 hours (including mouth rinsing) to decrease the risk of VAP. (B), Brush teeth daily to decrease the risk of VAP. (C)</p> Signup and view all the answers

Which of the following lifestyle modifications can help reduce the risk of recurrent pulmonary embolism (PE)?

<p>Quitting smoking to improve blood vessel health (A)</p> Signup and view all the answers

In Type I (Hypoxemic) respiratory failure, the primary issue is the ineffective removal of carbon dioxide from the blood.

<p>False (B)</p> Signup and view all the answers

What is the immediate action a nurse should take if they suspect a patient is experiencing a pulmonary embolism (PE)?

<p>Call for help immediately</p> Signup and view all the answers

High levels of carbon dioxide in the blood, a condition associated with Type II respiratory failure, is known as ______.

<p>hypercapnia</p> Signup and view all the answers

Which of the following factors contributes to the high mortality rate associated with pulmonary embolism (PE)?

<p>The potential for large PEs leading to significant complications (B)</p> Signup and view all the answers

Select all of the interventions below that are appropriate to help prevent a recurrent PE:

<p>Maintaining adequate hydration (A), Adhering to prescribed anticoagulant therapy (C), Engaging in regular physical activity (D)</p> Signup and view all the answers

Match the type of respiratory failure with its primary characteristic:

<p>Type I (Hypoxemic) = Low blood oxygen levels Type II (Hypercapnic) = High levels of carbon dioxide in the blood</p> Signup and view all the answers

What is the underlying cause of Type I (Hypoxemic) respiratory failure?

<p>Difficulty getting oxygen into the bloodstream (D)</p> Signup and view all the answers

Which of the following is the MOST significant reason for involving family members in the care of a patient with ARDS?

<p>To provide emotional support to the patient and enhance their understanding of the condition and treatment. (B)</p> Signup and view all the answers

A complete return to normal lung function is always achieved in patients recovering from ARDS.

<p>False (B)</p> Signup and view all the answers

Besides physical weakness and fatigue, what is one lifestyle change that patients may experience after recovering from ARDS?

<p>Changes in how they approach their daily life</p> Signup and view all the answers

Patients recovering from ARDS may experience flashbacks, nightmares, and difficulty relaxing, which are symptoms of ______.

<p>post-traumatic stress disorder</p> Signup and view all the answers

Select all of the following that are potential long-term mental health challenges for both ARDS patients and their families:

<p>Post-traumatic stress disorder (C), Depression (D)</p> Signup and view all the answers

Match the following interventions with their respective goals in ARDS recovery:

<p>Mental healthcare = Address psychological conditions such as depression Consistent medical attention = Monitor progress and adjust treatment as needed Family engagement = Provide emotional support to the patient</p> Signup and view all the answers

Why is a patient's successful recovery from ARDS considered a significant achievement?

<p>Because ARDS mortality rates are very high. (C)</p> Signup and view all the answers

What is the primary benefit of providing patients with adequate information about their condition and treatment?

<p>It reduces anxiety by giving patients a greater sense of control. (C)</p> Signup and view all the answers

Which of the following best describes the V/Q mismatch in the context of pulmonary edema?

<p>Reduced airflow to adequately perfused alveoli due to fluid accumulation (C)</p> Signup and view all the answers

In noncardiogenic pulmonary edema, the fluid buildup in the lungs is a direct result of heart failure.

<p>False (B)</p> Signup and view all the answers

What is the primary role of surfactant in the alveoli, and how does its damage contribute to respiratory distress?

<p>Surfactant reduces surface tension in the alveoli, preventing their collapse. Damage to surfactant-producing cells leads to alveolar collapse (atelectasis), impairing gas exchange.</p> Signup and view all the answers

In the proliferative phase of lung injury, white blood cells called ______ release toxic mediators that damage the alveolar-capillary membrane.

<p>neutrophils</p> Signup and view all the answers

Match the following clinical manifestations with their underlying cause in pulmonary edema:

<p>Hyperventilation = Compensatory mechanism for low oxygen levels. Pulmonary hypertension = Narrowing of blood vessels in the lungs. Refractory hypoxemia = Severe V/Q mismatch unresponsive to supplemental oxygen. Respiratory alkalosis = Increased respiratory rate leading to excessive carbon dioxide exhalation.</p> Signup and view all the answers

Which of the following arterial blood gas (ABG) findings is most likely to be observed in the early stages of pulmonary edema?

<p>Respiratory alkalosis (high pH, low PaCO2) (A)</p> Signup and view all the answers

Select all of the following that are consequences of the damages caused during the proliferative phase:

<p>Pulmonary Hypertension (A), Worsening V/Q mismatch (B), Decreased lung compliance (C)</p> Signup and view all the answers

Which of the following is the main reason why hypoxemia occurs in individuals with pulmonary edema?

<p>Blood flows directly past fluid-filled alveoli (B)</p> Signup and view all the answers

Which of the following conditions can lead to impaired ventilation (hypoventilation)?

<p>Airway Obstruction (C)</p> Signup and view all the answers

Ventilation-Perfusion Mismatch occurs when the amount of air moving into the lungs matches the blood flow through the lungs.

<p>False (B)</p> Signup and view all the answers

What is one potential cause of respiratory muscle weakness leading to impaired ventilation?

<p>myasthenia gravis</p> Signup and view all the answers

Administration of ______ can suppress breathing and lead to hypoventilation.

<p>opioids</p> Signup and view all the answers

Which of the following is NOT a typical cause of Ventilation-Perfusion Mismatch?

<p>Chest-wall Injury (A)</p> Signup and view all the answers

Which conditions may directly contribute to the development of Acute Respiratory Distress Syndrome (ARDS)? (Select all that apply)

<p>Pneumonia (A), Trauma (B), Sepsis (D)</p> Signup and view all the answers

Which of the following factors can contribute to the development of atelectasis?

<p>Anesthesia (B)</p> Signup and view all the answers

Match the following respiratory conditions with their primary underlying mechanism:

<p>Airway Obstruction = Impaired Ventilation Pulmonary Embolus = Ventilation-Perfusion Mismatch Restrictive Lung Diseases = Impaired Ventilation Pulmonary Edema = Ventilation-Perfusion Mismatch</p> Signup and view all the answers

Which of the following interventions helps prevent alveolar collapse in mechanically ventilated patients?

<p>Applying PEEP (Positive End-Expiratory Pressure) (A)</p> Signup and view all the answers

Which of the following mental status changes may indicate inadequate cerebral perfusion?

<p>Confusion or lethargy (C)</p> Signup and view all the answers

Monitoring plateau pressure helps assess lung compliance and the risk of lung injury in ventilated patients.

<p>True (A)</p> Signup and view all the answers

What is the purpose of daily spontaneous awakening trials in ventilated patients?

<p>To assess sedation levels and readiness for weaning</p> Signup and view all the answers

Agitation is often associated with hypercapnia, a high level of carbon dioxide in the blood.

<p>False (B)</p> Signup and view all the answers

Using medications to reduce a patient’s restlessness and muscle activity to prevent them from fighting against the ventilator is known as ______ and paralysis.

<p>sedation</p> Signup and view all the answers

What is the term for difficulty breathing that starts suddenly, often an early sign of a deteriorating respiratory condition?

<p>New-onset dyspnea</p> Signup and view all the answers

Which strategy is recommended as an essential measure to prevent VAEs, potentially avoiding intubation?

<p>High-flow nasal cannula (HFNC) (A)</p> Signup and view all the answers

Rapid breathing, also known as __________, can be an early sign of respiratory distress.

<p>Tachypnea</p> Signup and view all the answers

The body's compensatory responses to hypoxemia often include which of the following?

<p>Increased heart rate and blood pressure (B)</p> Signup and view all the answers

Which of the following is an essential recommendation for preventing ventilator-associated events (VAEs) in critically ill patients?

<p>Implementing daily toothbrushing (D)</p> Signup and view all the answers

What is the primary purpose of subglottic secretion drainage in intubated patients?

<p>Removing secretions that accumulate above the ETT cuff (B)</p> Signup and view all the answers

Which of the following vital sign changes is typically observed in response to hypoxemia as the body attempts to compensate?

<p>Increased pulse rate (B)</p> Signup and view all the answers

Why might postpyloric feeding be considered for ventilated patients?

<p>To reduce the risk of aspiration. (A)</p> Signup and view all the answers

Which of these indicates worsening respiratory failure?

<p>Slow breathing or no breathing (C)</p> Signup and view all the answers

Which arterial blood gas (ABG) finding is characteristic of Type II respiratory failure?

<p>High carbon dioxide levels and low pH (C)</p> Signup and view all the answers

What is the primary reason prone positioning is used as an adjunctive therapy in ARDS patients?

<p>To improve the effectiveness of existing treatments like mechanical ventilation. (B)</p> Signup and view all the answers

Prone positioning primarily aids in secretion removal and reducing pressure on lung tissue by draining fluids away from the front of the lungs.

<p>False (B)</p> Signup and view all the answers

How does prone positioning improve alveoli recruitment in ARDS patients?

<p>By opening up collapsed or under-ventilated alveoli in the back of the lungs. (D)</p> Signup and view all the answers

Prone positioning can lead to a reduced need for ______ support, decreasing the risk of further lung injury.

<p>ventilation</p> Signup and view all the answers

Which of the following is a key consideration when implementing prone positioning for a critically ill patient?

<p>It requires a coordinated effort from several healthcare professionals. (A)</p> Signup and view all the answers

What is the generally recommended duration for prone positioning in ARDS patients to achieve the best results?

<p>Up to 20 hours per day. (B)</p> Signup and view all the answers

What is the benefit of prone positioning regarding V/Q mismatch?

<p>Reduces V/Q mismatch by directing blood flow to better-ventilated areas. (B)</p> Signup and view all the answers

Starting prone positioning early, typically after 7 days of ARDS diagnosis, yields the best patient outcomes.

<p>False (B)</p> Signup and view all the answers

A patient presents with sudden dyspnea, pleuritic chest pain, and tachypnea. Which condition should the nurse suspect?

<p>Pulmonary embolism (B)</p> Signup and view all the answers

A chest X-ray is the definitive diagnostic test for pulmonary embolism.

<p>False (B)</p> Signup and view all the answers

Which of the following is a sign of right ventricular failure that may be observed in a patient with a massive pulmonary embolism?

<p>Jugular venous distention (JVD) (B)</p> Signup and view all the answers

A postoperative patient following a long-bone surgery presents with shortness of breath. A nurse should suspect a ______.

<p>PE/pulmonary embolism</p> Signup and view all the answers

Which test is most commonly ordered to diagnose a pulmonary embolism?

<p>Spiral computed tomography (CT) scan with intravenous contrast (C)</p> Signup and view all the answers

Which factors contribute to a fast heart rate in a patient with a pulmonary embolism? Select all that apply.

<p>Increased dead-space ventilation (C), Low oxygen levels (D)</p> Signup and view all the answers

Match the type of pulmonary embolism with its description:

<p>Central PE = Clot sits in the main branch of the pulmonary artery, or one of the big branches to the right or left lung Peripheral PE = Embolism in the smaller branches of the pulmonary artery.</p> Signup and view all the answers

A patient is receiving intravenous heparin. Which laboratory value is most important for the nurse to monitor?

<p>Activated Partial Thromboplastin Time (aPTT) (B)</p> Signup and view all the answers

A patient with a pulmonary embolism coughs up blood. What is the medical term for coughing up blood?

<p>hemoptysis</p> Signup and view all the answers

Low Molecular Weight Heparin (LMWH) primarily focuses on inhibiting Factor Xa and has enhanced bioavailability compared to unfractionated heparin.

<p>True (A)</p> Signup and view all the answers

A patient receiving heparin develops signs of heparin-induced thrombocytopenia (HIT). What specific lab value should the nurse monitor closely?

<p>Platelets</p> Signup and view all the answers

The reversal agent for unfractionated heparin is ______.

<p>protamine sulfate</p> Signup and view all the answers

Which medication requires close monitoring due to the high risk of bleeding, particularly in the brain?

<p>Thrombolytics (A)</p> Signup and view all the answers

Which of the following is NOT a common route of administration for Xa inhibitors?

<p>IV (intravenous) (B), IM (intramuscular) (D)</p> Signup and view all the answers

Select all the true statements about Inferior Vena Cava (IVC) filters. (Select all that apply)

<p>IVC filters are placed in a vein that carries blood from the legs to the heart. (A), IVC filters can prevent blood clots from reaching the heart and lungs. (B)</p> Signup and view all the answers

Match the following medications with their corresponding reversal agents:

<p>Heparin = Protamine Sulfate Xa Inhibitors (e.g., Rivaroxaban, Apixaban) = Andexanet Alfa Thrombolytics = Tranexamic Acid</p> Signup and view all the answers

Flashcards

PEEP (Positive End-Expiratory Pressure)

Keeps a small amount of pressure in the lungs at the end of each breath, preventing alveolar collapse.

Monitor Plateau Pressure

Regularly check the pressure inside the lungs after airflow to gauge lung stiffness.

Sedation and Paralysis (Ventilator)

Use medications to reduce patient restlessness and muscle activity.

Avoid Intubation if Possible; Consider HFNC

Using less invasive methods of oxygen delivery like high-flow nasal cannula instead of intubation

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Daily Toothbrushing (VAE Prevention)

Good oral hygiene is crucial for preventing pneumonia, a common VAE.

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Daily Spontaneous Awakening Trials

Periodically waking up the patient to assess sedation and breathing ability.

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Subglottic Secretion Drainage

An extra port above the cuff connected to suction to remove secretions that can build up above the cuff and decrease the risk of infection.

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Postpyloric Feeding

Feeding the patient through a tube that passes the stomach which may reduce the risk of aspiration.

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Early Hypoxemic Respiratory Failure ABGs

Low blood oxygen, high pH (respiratory alkalosis).

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Hyperventilation in Early Respiratory Failure

Breathing faster to expel more CO2.

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COPD Hypoxemic Drive

COPD patients breathe based on low oxygen, not high CO2.

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Dyspnea

Shortness of breath.

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Restlessness (Early Respiratory Failure)

Agitation or uneasiness.

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Tachycardia (Intermediate)

Faster than normal heart rate.

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Cyanosis (Late)

Skin turns blue from low blood oxygen.

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Coma (Late)

Unconsciousness.

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Noninvasive Positive Pressure Ventilation (NPPV)

NPPV uses a mask to deliver BiPAP or CPAP.

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BiPAP

Delivers two pressure levels: Higher on inhale, lower on exhale.

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CPAP

Delivers continuous, constant pressure during breathing.

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Invasive Positive Pressure Ventilation

Requires an ETT or tracheostomy with a mechanical ventilator.

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Positive End-Expiratory Pressure (PEEP)

Maintains pressure at the end of exhalation.

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Inhaled Bronchodilators

Open airways by stimulating beta-2 receptors in the lungs.

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Inhaled Steroids

Reduce airway inflammation, decreasing bronchoconstriction.

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Diuretics

Reduce fluid buildup (pulmonary edema) in the lungs.

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Fentanyl

A potent opioid, 100 times stronger than morphine, used for ICU sedation.

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Richmond Agitation-Sedation Scale (RASS)

Tool used to assess a patient's sedation level.

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Naloxone (Narcan)

Used to reverse the risks involved with Fentanyl.

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Benzodiazepines Mechanism

Enhance the effects of GABA, a neurotransmitter that promotes relaxation.

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Midazolam

A benzodiazepine used for sedation, anxiety reduction, and amnesia in the ICU.

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Dexmedetomidine (Precedex)

A sedative that activates α2-adrenoceptors, reducing sympathetic activity and delirium.

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Neuromuscular Blocking Agents (NMBAs)

Paralyze muscles by blocking signals at the neuromuscular junction.

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NMBA Purpose

Medication to that improves coordination with the ventilator by reducing muscle activity, oxygen needs, and improving oxygenation.

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Direct Lung Injury

Damage directly to the respiratory system, affects the lungs directly.

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Indirect Lung Injury

Damage to the lungs from another issue not directly related to the respiratory system.

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Aspiration

Inhaling foreign material into the lungs.

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Pulmonary Contusion

Bruising of the lung tissue.

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Pulmonary Embolus

A blood clot blocking a lung blood vessel.

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ARDS from Pancreatitis

Inflammation of the pancreas affecting the lungs.

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Sepsis induced ARDS

Severe infection causing whole-body inflammation and potential lung damage.

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PaO2/FIO2 Ratio

A formula assessing lung oxygen delivery.

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Respiratory Failure (CO2)

Inadequate CO2 removal by the lungs.

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Type I Respiratory Failure

Low oxygen levels, possibly with a higher pH, indicating difficulty getting oxygen into the bloodstream.

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Cardiac Monitoring (Respiratory)

Continuous monitoring of heart rhythm to detect dysrhythmias caused by low blood oxygen.

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Neurological Assessment (Respiratory)

Assessment of mental state to detect changes indicating worsening respiratory failure.

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Cyanosis

A bluish discoloration of the skin, indicating low oxygen levels.

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Energy Conservation

Prioritizing activities and taking breaks to conserve energy.

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Initial Goal of Treatment (Respiratory Failure)

Improving the lungs' ability to exchange oxygen and carbon dioxide effectively.

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Pulmonary Rehabilitation

Exercise training to strengthen lung muscles and nutritional counseling to ensure proper nutrient intake for healing.

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Fever (Ventilated Patient)

Elevated temperature, signaling potential infection.

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Leukocytosis (Ventilated Patient)

Elevated number of white blood cells, indicating infection.

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Increased Respiratory Effort

Noticeable struggling or increased work to breathe.

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Purulent Secretions

Thick, discolored mucus, usually yellow or green.

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Regular Mouth Care

Regular cleaning to reduce oral bacteria.

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ET Suctioning

Removes secretions from the endotracheal tube.

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Barotrauma

Excessive pressure in chest cavity leading to lung injury.

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Peak Pressure Monitoring

Continuously assessing ventilator pressures to avoid lung damage.

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Acidosis in ARDS

Elevated carbon dioxide levels in the blood, leading to a decrease in blood pH.

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Metabolic Acidosis

Acidosis resulting from poor oxygen delivery, causing the body to use less efficient energy pathways.

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Serum Lactate

A blood test that confirms the body is using anaerobic metabolism due to lack of oxygen.

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Liver and Renal Function Tests

Checking the health of the liver and kidneys, as these organs may be affected by ARDS or its complications.

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Central Line Infection Risk

Central lines, large intravenous catheters, are a common source of infection.

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Central Line Infection Prevention

Strict sterile techniques, regular monitoring, and adherence to hospital protocols.

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Foley Catheter Care

Regular cleaning and frequent monitoring.

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Diligent Mouth Care

Regular cleaning to prevent potential infections.

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Tachypnea

Rapid breathing rate.

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Accessory Muscle Use

Using muscles not usually needed for breathing, such as neck or rib muscles.

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Crackles (Lungs)

Crackling sounds in the lungs, indicating fluid buildup.

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Diminished Breath Sounds

Decreased or absent breath sounds, possibly due to fibrosis or collapsed alveoli.

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Hypoxemia

Low blood oxygen levels.

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Renal Failure in ARDS

Kidney failure, often due to low blood pressure or nephrotoxic medications.

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MODS (ARDS)

Multiple organ failure due to widespread inflammation, hypoxia, and unstable blood pressure (SATA).

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Anxiety Reduction (Education)

Giving patients facts about their condition and treatment to ease worries.

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Family Engagement

Actively including relatives in care and teaching to boost support and involvement.

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Optimal Outcome (ARDS)

In ARDS, the desired outcome is complete restoration of lung function to pre-illness condition.

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Physical Weakness (ARDS)

Fatigue, weakness, and changes to daily routines after ARDS.

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Consistent Medical Attention

Regular check-ups to track progress and modify treatments as needed.

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Depression (ARDS)

Feelings of despair, sadness, and hopelessness.

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PTSD (ARDS)

Flashbacks, nightmares, and heightened anxiety after a traumatic event.

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Pulmonary Fibrosis (ARDS)

After ARDS, some patients may experience lungs becoming stiff due to scarring.

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PE Recurrence Risk

Patients who have had a pulmonary embolism (PE) have a higher chance of experiencing another one.

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Medication Adherence (PE)

Following prescribed anticoagulant medication regimens to prevent new clot formation.

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Lifestyle Changes (PE)

Eating a balanced diet, exercising regularly, staying hydrated, and quitting smoking.

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Acute Respiratory Failure

Oxygenation impairment, or ventilation impairment, or both.

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Hypercapnia

High levels of carbon dioxide in the blood.

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V/Q Mismatch (ARDS)

Fluid buildup in alveoli causing mismatch between airflow and blood flow.

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Hypoxemia (ARDS)

Low blood oxygen due to V/Q mismatch in the lungs.

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Surfactant Damage (ARDS)

Damage to alveolar type II cells reduces surfactant, leading to alveolar collapse.

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Hyperventilation (ARDS)

Increased breathing rate to compensate for low oxygen levels.

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Neutrophil Damage (ARDS)

Worsening V/Q mismatch and difficulty in oxygenating blood.

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Pulmonary Hypertension (ARDS)

Narrowing of blood vessels in the lungs, increasing pressure.

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Hypercarbia in ARDS

High carbon dioxide levels in the blood.

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Refractory Hypoxemia (ARDS)

Low blood oxygen levels that don't improve with extra oxygen.

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VAE Prevention Strategies

A strategy to prevent Ventilator-Associated Events (VAEs) in critically ill patients, especially those with ARDS.

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Avoid Intubation (VAE)

Prioritizing non-invasive methods of oxygen delivery, such as high-flow nasal cannula (HFNC), over intubation.

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Daily Toothbrushing (VAE)

Regular oral hygiene, using toothbrushing, to reduce the risk of pneumonia.

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Spontaneous Awakening Trials (SATs)

Periodically awakening the patient to assess sedation levels and breathing ability.

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Postpyloric Feeding (VAE)

Feeding the patient through a tube that bypasses the stomach to reduce aspiration risk (SATA).

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Early Tracheostomy

Consideration of early tracheostomy for patients requiring prolonged intubation to decrease VAE risk.

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Plateau Pressure Monitoring

Plateau pressure indicates the pressure inside the lungs after the air has flowed in, assessing lung stiffness.

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Prone Positioning

Turning a patient onto their stomach, chest facing up.

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Adjunctive Therapy

Additional treatment to improve existing ones, like mechanical ventilation.

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Improve Alveoli Recruitment

Helps open collapsed alveoli in the back of the lungs.

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Reduce V/Q Mismatch

Improves balance between airflow and blood flow in the lungs.

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Improved Oxygenation

Increases oxygen levels in the blood.

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Aiding in Secretion Removal

Assists the body to drain fluids and secretions away from the lungs.

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Reduced Need for Ventilation Support

Decreases ventilator dependence, reducing risk of further lung injury.

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Timely Implementation

Starting prone positioning early, within 72 hours of ARDS diagnosis.

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Respiratory Failure

Inadequate breathing leading to insufficient oxygen and/or carbon dioxide exchange.

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Chest-Wall Problems

Conditions hindering chest muscle movement (e.g., asthma attacks, narcotic overdose).

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Nerve Disorders (Breathing)

Conditions affecting nerve signals to breathing muscles (e.g., myasthenia gravis).

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Chest-Wall Injuries

Trauma limiting lung expansion.

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Airway Obstruction

Anything blocking airflow into the lungs.

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Respiratory Muscle Weakness/Paralysis

Muscle weakness preventing lung expansion.

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V/Q Mismatch

Mismatch between air and blood flow in the lungs. SATA

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Pulmonary Embolus (PE)

A blood clot blocking a lung blood vessel. SATA

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Central Pulmonary Embolism (PE)

A clot in the main pulmonary artery branch or large branches to the lungs.

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Peripheral Pulmonary Embolism (PE)

A clot in the smaller branches of the pulmonary artery.

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Key PE Symptoms

Sudden, intense dyspnea, pleuritic chest pain, and tachypnea.

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Postoperative PE Risk

PE should be suspected, especially after long-bone surgeries.

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Jugular Venous Distention (JVD) in PE

Sign of right ventricular failure due to massive PE.

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PE Vital Sign Changes

Hypoxemia, low blood pressure, and fast heart rate due to heart not pumping blood well and blood low in oxygen.

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PE Neurological Signs

Patient may be anxious, restless, or confused.

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Gold Standard PE Diagnosis

Spiral CT scan with IV contrast.

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Mental Status Change

A change in mental state (confusion, lethargy) indicating the brain isn't getting enough oxygenated blood.

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Agitation (Respiratory)

Restlessness or anxiety, often due to low blood oxygen levels.

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Somnolence (Respiratory)

Drowsiness or sleepiness, often caused by high carbon dioxide levels in the blood.

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New-Onset Dyspnea

Difficulty breathing that starts suddenly.

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Increased Work of Breathing

Needing more effort than usual to breathe.

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Tachypnea (Early Sign)

Breathing at an abnormally rapid rate.

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Tripod Position

Leaning forward with hands on knees or a table to facilitate breathing.

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Type II Respiratory Failure ABGs

High carbon dioxide levels and low pH (acidity) in arterial blood.

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aPTT monitoring (Heparin)

Monitored every 4-6 hours when on heparin due to risk of bleeding.

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Heparin - Nursing Considerations (SATA)

Bleeding precautions, aPTT monitoring, platelet monitoring, and kidney function monitoring.

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Protamine Sulfate

Heparin reversal agent.

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LMWH mechanism of action

Targets factor Xa, works better in the body.

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Xa Inhibitors - Action

Selectively inactivate factor Xa to prevent blood clots.

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Xa Inhibitors - Nursing

Monitor for bleeding risk.

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Thrombolytics - Action

Breaks down fibrin to dissolve blood clots.

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Thrombolytics - Risks

Breaks down blood clots to save lives, but carries a risk of serious bleeding, especially in the brain.

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