Palliative Sedation and Euthanasia: Pharmacology and Ethics
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Questions and Answers

What is the primary purpose of palliative sedation?

  • To reduce pain in patients with reversible diseases
  • To hasten death in patients with incurable diseases
  • To relieve suffering in patients with incurable diseases (correct)
  • To induce coma in patients with painful diseases

    • Which of the following drugs is NOT commonly used in palliative sedation?

  • Ketamine
  • Midazolam
  • Fentanyl
  • Metoprolol (correct)

    • What is a unique characteristic of Propofol?

  • It is a water-soluble medication and can cause tachycardia
  • It is a gas anesthetic and can cause respiratory depression
  • It is a fat emollient and can cause hypotension (correct)
  • It is a fat emollient and can cause hypertension

    • What is the normal range of PaO2?

    <p>80-100 mmHg</p> Signup and view all the answers

    What is the role of the lungs in regulating pH?

    <p>To rapidly correct pH imbalances in minutes</p> Signup and view all the answers

    What is the relationship between the lungs and kidneys in regulating pH?

    <p>They work together and compensate for each other</p> Signup and view all the answers

    What is the usual order of interventions for respiratory management if a patient's condition is worsening?

    <p>Ventimask → Bipap → Intubation</p> Signup and view all the answers

    What is the correct mnemonic for remembering the regulation of pH?

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

    What is a possible complication of Propofol use?

    <p>Hypotension and bradycardia</p> Signup and view all the answers

    What is the primary concern when dealing with anaphylaxis and a blocked airway?

    <p>Giving 100% oxygen</p> Signup and view all the answers

    What is the recommended initial intervention for a patient with an upper airway obstruction who is conscious?

    <p>Having the patient cough or clear their own airway</p> Signup and view all the answers

    What is the purpose of elevating the head of the bed to 30 degrees in a patient with altered LOC?

    <p>To prevent aspiration</p> Signup and view all the answers

    What is the primary concern when dealing with a patient who has a tumor putting pressure on the walls of the airway?

    <p>The risk of airway obstruction</p> Signup and view all the answers

    What is the typical measurement of an endotracheal tube at the lip line?

    <p>21 sonometers</p> Signup and view all the answers

    What is the recommended intervention for a patient with a serious nosebleed or epistaxis?

    <p>Using an emergency kit with pack, saline, and afrin</p> Signup and view all the answers

    What is the primary concern when dealing with a patient who has lost tone in their pharyngeal muscles and tongue?

    <p>The risk of aspiration</p> Signup and view all the answers

    What is the primary purpose of a Nasogastric tube in a ventilated patient?

    <p>To provide nutrition</p> Signup and view all the answers

    What is the purpose of inspecting, palpating, and auscultating the patient in respiratory management?

    <p>To evaluate the patient's airway</p> Signup and view all the answers

    What is the normal range of Pulse Oximetry in a healthy individual?

    <p>95-100%</p> Signup and view all the answers

    Which of the following can cause difficulties in Pulse Oximetry readings?

    <p>Poor circulation</p> Signup and view all the answers

    What is the purpose of a Chest X-Ray (CXR) in a ventilated patient?

    <p>To evaluate the placement of the ETT</p> Signup and view all the answers

    What is the advantage of a Cat Scan over a CXR in a ventilated patient?

    <p>It can detect masses and PE in the lungs</p> Signup and view all the answers

    What is the primary purpose of ABGs in a ventilated patient?

    <p>To detect respiratory acidosis</p> Signup and view all the answers

    What is the difference between an Arterial Blood Gas (ABG) and a Venous Blood Gas (VBG)?

    <p>The doctor may accidentally obtain a VBG if they miss the artery</p> Signup and view all the answers

    What is the mortality rate for patients with severe ARDS?

    <p>45%</p> Signup and view all the answers

    What is the primary complication seen in ICU patients?

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

    What is the normal PAO2/FIO2 ratio?

    <p>300-500</p> Signup and view all the answers

    What is the treatment goal for patients with ARDS?

    <p>High level of PEEP and high level of O2</p> Signup and view all the answers

    What is the primary reason for using prone positioning in ARDS patients?

    <p>To improve oxygenation</p> Signup and view all the answers

    What is the purpose of neuromuscular blockade in ARDS patients?

    <p>To allow the body to recover and not fight the ventilator</p> Signup and view all the answers

    What is the device used to determine the threshold of stimulation in paralytic therapy?

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

    What is the caloric requirement for ARDS patients?

    <p>35-45 kcal/day</p> Signup and view all the answers

    What is the primary function of Intermittent Mandatory Ventilation (IMV)?

    <p>To allow for a combination of assisted and spontaneous breaths</p> Signup and view all the answers

    What determines the volume of spontaneous breaths in IMV?

    <p>The patient's own muscles and lung capacity</p> Signup and view all the answers

    What is the benefit of allowing patients to breathe spontaneously in IMV?

    <p>It allows the patient to use their own muscles for ventilation</p> Signup and view all the answers

    What happens if the patient breathes over the prescribed amount of ventilations in IMV?

    <p>The patient receives only oxygen, without tidal volume or PEEP</p> Signup and view all the answers

    What is the purpose of setting a prescribed amount of ventilations in IMV?

    <p>To encourage the patient to work harder to breathe</p> Signup and view all the answers

    What is the potential issue with IMV, according to the text?

    <p>Mandatory breaths can be a problem</p> Signup and view all the answers

    What is the significance of the setting '16 breaths, 450, 5 PEEP' in IMV?

    <p>It prescribes the amount of ventilations and tidal volume, with PEEP</p> Signup and view all the answers

    Why is the patient encouraged to breathe over the prescribed amount of ventilations in IMV?

    <p>To wean them off the ventilator</p> Signup and view all the answers

    What is the primary complication of Pulmonary Embolism?

    <p>Refractory hypoxemia</p> Signup and view all the answers

    What is the purpose of V/Q scan in Pulmonary Embolism?

    <p>To show a mismatch of inhaled and injected compounds</p> Signup and view all the answers

    What is the treatment of choice for a patient with Pulmonary Embolism who is hemodynamically unstable?

    <p>Thrombolytic therapy</p> Signup and view all the answers

    What is the primary goal of medical management in Pulmonary Embolism?

    <p>To improve respiratory and cardiovascular status</p> Signup and view all the answers

    What is the significance of D-dimer test in Pulmonary Embolism?

    <p>It can show clotting somewhere in the body</p> Signup and view all the answers

    What is the primary reason for using sequential compression devices in Pulmonary Embolism prevention?

    <p>To reduce the risk of DVT</p> Signup and view all the answers

    What is the purpose of transitioning patients from heparin to coumadin when they are discharged?

    <p>To prevent new emboli from forming</p> Signup and view all the answers

    What is the primary characteristic of Acute Respiratory Failure?

    <p>Sudden and life-threatening decline in gas exchange function</p> Signup and view all the answers

    What is the primary focus of treatment for patients with blunt chest trauma?

    <p>Managing pain and ensuring oxygenation</p> Signup and view all the answers

    Which type of injury is commonly seen in older patients with three or more rib fractures?

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

    What is the primary purpose of inserting a chest tube in patients with blunt chest trauma?

    <p>To re-expand the lungs</p> Signup and view all the answers

    What is the recommended approach for managing patients with sternal or rib fractures?

    <p>Encouraging patients to be up and about, while avoiding excessive activities</p> Signup and view all the answers

    What is the purpose of educating patients with sternal or rib fractures to cough and deep breathe?

    <p>To prevent pneumonia and atelectasis</p> Signup and view all the answers

    Which of the following is a common cause of blunt chest trauma?

    <p>All of the above</p> Signup and view all the answers

    What is the primary goal of intravascular support in patients with blunt chest trauma?

    <p>To maintain blood pressure and perfusion</p> Signup and view all the answers

    What is the purpose of decompressing the pericardium in patients with blunt chest trauma?

    <p>To treat pericardial tamponade</p> Signup and view all the answers

    What is the primary reason for monitoring pulse oximetry during intubation?

    <p>To monitor for potential cardiac arrest</p> Signup and view all the answers

    Why is the head of the bed elevated to at least 30 degrees in a ventilated patient?

    <p>To reduce the risk of aspiration</p> Signup and view all the answers

    What is the purpose of a sedation vacation in a ventilated patient?

    <p>To facilitate weaning from the ventilator</p> Signup and view all the answers

    What is the primary reason for performing a capnography test after intubation?

    <p>To ensure proper placement of the endotracheal tube</p> Signup and view all the answers

    Why is oral care with chlorhexidine performed in a ventilated patient?

    <p>To prevent mucous membrane cracking and infection</p> Signup and view all the answers

    What is the purpose of turning and positioning a ventilated patient?

    <p>To reduce the risk of skin breakdown and pressure ulcers</p> Signup and view all the answers

    What is the primary benefit of using SIMV over IMV?

    <p>Minimized 'bucking the ventilator'</p> Signup and view all the answers

    What is the primary effect of PEEP on alveoli?

    <p>Increased oxygenation</p> Signup and view all the answers

    What is the primary reason for performing a CXR after intubation?

    <p>To ensure proper placement of the endotracheal tube</p> Signup and view all the answers

    Why is the nurse responsible for ensuring the respiratory therapist has the necessary equipment for intubation?

    <p>To facilitate the intubation process</p> Signup and view all the answers

    What is the primary complication of using PEEP?

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

    What is the primary purpose of Pressure Support (PS)?

    <p>To assist spontaneous breathing</p> Signup and view all the answers

    What is the primary difference between SIMV and IMV?

    <p>SIMV senses the patient's breath, while IMV does not</p> Signup and view all the answers

    What is the primary advantage of using SIMV over other modes of ventilation?

    <p>Synchronized breathing with the ventilator</p> Signup and view all the answers

    What is the primary effect of PEEP on venous return?

    <p>Decreased venous return</p> Signup and view all the answers

    What is the primary purpose of using PEEP and PS together?

    <p>To improve oxygenation and reduce work of breathing</p> Signup and view all the answers

    What is the primary purpose of applying a continuous pressure throughout the respiratory cycle in a spontaneously breathing patient?

    <p>To reduce the work of breathing for the patient</p> Signup and view all the answers

    What is the result of combining PS and PEEP?

    <p>Constant Positive Airway Pressure</p> Signup and view all the answers

    What is the primary focus of a systematic assessment of a patient?

    <p>All body systems</p> Signup and view all the answers

    What is the purpose of checking the ventilator during a patient's care?

    <p>To perform a THREE POINT CHECK</p> Signup and view all the answers

    What is the primary reason for allowing a patient to breathe spontaneously on CPAP?

    <p>To test their progress and strength</p> Signup and view all the answers

    What is the primary purpose of administering oxygen to a patient with sleep apnea?

    <p>To treat their oxygen problem only</p> Signup and view all the answers

    What is the primary benefit of using an alphabet board or writing for patient communication?

    <p>To facilitate patient communication</p> Signup and view all the answers

    What is the primary purpose of checking the patient's RAS Score?

    <p>To monitor the patient's sedation level</p> Signup and view all the answers

    A patient with a pH above 7.45 and a PaCO2 below 35 is likely experiencing which type of acid-base disorder?

    <p>Respiratory alkalosis</p> Signup and view all the answers

    What is the primary cause of metabolic acidosis in ICU patients?

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

    A patient with a pH below 7.35 and a PaCO2 above 45 is likely experiencing which type of acid-base disorder?

    <p>Respiratory acidosis</p> Signup and view all the answers

    What is the treatment for contraction alkalosis?

    <p>Discontinuation of diuretics</p> Signup and view all the answers

    Which of the following is a cause of metabolic alkalosis?

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

    What is the relationship between pH and PaCO2 in respiratory acidosis?

    <p>pH decreases and PaCO2 increases</p> Signup and view all the answers

    What is the primary cause of respiratory alkalosis?

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

    What is the result of excessive antacid use on acid-base balance?

    <p>Metabolic alkalosis</p> Signup and view all the answers

    What is the primary purpose of assessing oxygen saturation levels in bloodwork?

    <p>To determine if the sample is arterial or venous</p> Signup and view all the answers

    Why is the right lung more likely to be intubated by mistake?

    <p>Because the right bronchus is more direct and at a lower angle</p> Signup and view all the answers

    What is the primary function of the upper respiratory tract?

    <p>To filter impurities and warm the air</p> Signup and view all the answers

    What is the purpose of a biopsy in assessing respiratory status?

    <p>To evaluate respiratory function after bloodwork</p> Signup and view all the answers

    What is the significance of the heart's location on the left side of the body?

    <p>It affects the development of the left lung</p> Signup and view all the answers

    What is the primary benefit of using an EKG in COPD patients?

    <p>It shows distress on the right side of the heart</p> Signup and view all the answers

    Why is it important to inspect, palpate, and auscultate the patient in respiratory management?

    <p>To evaluate the patient's respiratory status</p> Signup and view all the answers

    What is the primary function of the lower respiratory tract?

    <p>To exchange oxygen and carbon dioxide</p> Signup and view all the answers

    What is the primary purpose of intraosseous infusion in emergency situations?

    <p>To access the blood supply in the bone marrow</p> Signup and view all the answers

    What is a sign of hypovolemic shock?

    <p>Cold and clammy skin</p> Signup and view all the answers

    What is the primary indication for removing a chest tube?

    <p>If the lung is inflated</p> Signup and view all the answers

    Why is it important to monitor for stridor in patients with chest trauma?

    <p>Because it is a sign of respiratory distress</p> Signup and view all the answers

    What is the consequence of clamping a chest tube with suction on?

    <p>Air leak into the thoracic cavity</p> Signup and view all the answers

    What is the primary risk factor for developing pulmonary embolism?

    <p>All of the above</p> Signup and view all the answers

    What is the primary purpose of giving isotonic solutions in the management of chest trauma?

    <p>To re-establish fluid volume</p> Signup and view all the answers

    What is the source of a thrombus that causes pulmonary embolism?

    <p>Venous system</p> Signup and view all the answers

    What is the benefit of using packed RBCs in transfusion?

    <p>To increase oxygen-carrying capacity</p> Signup and view all the answers

    What is the purpose of inserting a chest tube in patients with chest trauma?

    <p>To drain blood and re-establish negative pressure</p> Signup and view all the answers

    What is the consequence of having a DVT in the context of pulmonary embolism?

    <p>Increased risk of pulmonary embolism</p> Signup and view all the answers

    What is the primary reason for administering heparin to a patient with new atrial fibrillation?

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

    What is the primary concern in patients with recent alcohol use and chest trauma?

    <p>Clouding of sensorium</p> Signup and view all the answers

    What is the term for the combination of DVT and pulmonary embolism?

    <p>Venous thromboembolism (VTE)</p> Signup and view all the answers

    What is the primary focus of treatment in patients with chest trauma?

    <p>Management of respiratory distress</p> Signup and view all the answers

    What is the primary complication of not removing a chest tube properly?

    <p>Air leak into the thoracic cavity</p> Signup and view all the answers

    What is the primary goal of judicious use of analgesics in ventilated patients?

    <p>To manage pain without delaying extubation</p> Signup and view all the answers

    What is the recommended tidal volume setting for a patient with ARDS?

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

    What is the primary concern when setting FiO2 in patients with COPD?

    <p>Maintaining a lowest concentration of oxygen to maintain normal PaO2</p> Signup and view all the answers

    What is the primary benefit of using PEEP in ventilated patients?

    <p>It improves oxygenation and prevents alveolar collapse</p> Signup and view all the answers

    What is the primary goal of monitoring fluid balance in ventilated patients?

    <p>To achieve a zero or negative fluid balance</p> Signup and view all the answers

    What is the primary indicator of hypoxia in ventilated patients?

    <p>Confusion and restlessness</p> Signup and view all the answers

    What is the primary benefit of using a low tidal volume in patients with ARDS?

    <p>It reduces the risk of barotrauma and lung trauma</p> Signup and view all the answers

    What is the primary purpose of following trends in ABGs in ventilated patients?

    <p>To monitor the patient's response to changes in ventilator settings</p> Signup and view all the answers

    What is the primary advantage of SIMV over IMV?

    <p>Decreased risk of 'bucking the ventilator'</p> Signup and view all the answers

    What is the primary function of PEEP in ventilated patients?

    <p>To open collapsed alveoli and improve oxygenation</p> Signup and view all the answers

    What is the primary difference between SIMV and IMV?

    <p>SIMV anticipates and synchronizes with the patient's breathing</p> Signup and view all the answers

    What is the primary purpose of using Bi-level Positive Airway Pressure (Bi-PAP) in a patient?

    <p>To help with O2 and CO2 exchange in patients with COPD</p> Signup and view all the answers

    What is the primary complication of using PEEP?

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

    A patient is on Continuous Positive Airway Pressure (CPAP) and is not showing any signs of respiratory distress. What is the primary goal of CPAP in this patient?

    <p>To improve oxygenation and prevent carbon dioxide retention</p> Signup and view all the answers

    What is the primary purpose of Pressure Support (PS)?

    <p>To assist the patient's spontaneous breathing</p> Signup and view all the answers

    A patient is on Intermittent Mandatory Ventilation (IMV) and is breathing at a rate of 20 breaths per minute. What will the ventilator do if the patient initiates a breath before the preset rate?

    <p>Deliver the preset tidal volume and provide full ventilatory support</p> Signup and view all the answers

    What is the primary difference between Synchronized Intermittent Mandatory Ventilation (SIMV) and Assist Control (AC) ventilation modes?

    <p>SIMV synchronizes with the patient's breaths, while AC does not</p> Signup and view all the answers

    A patient is on CPAP and is not responding to treatment. What is the primary concern when considering increasing the FiO2 in this patient?

    <p>The patient may develop barotrauma</p> Signup and view all the answers

    What is the primary benefit of allowing a patient to breathe spontaneously on IMV?

    <p>Increased patient effort</p> Signup and view all the answers

    What is the primary difference between IMV and SIMV?

    <p>SIMV allows for spontaneous breaths, while IMV does not</p> Signup and view all the answers

    How does the ventilator respond if a patient breathes over the prescribed amount of ventilations in IMV?

    <p>The ventilator only provides oxygen for the additional breaths</p> Signup and view all the answers

    What is the primary advantage of using BIPAP over CPAP?

    <p>BIPAP allows for more precise control of inspiratory and expiratory pressures</p> Signup and view all the answers

    What is the primary goal of using IMV in weaning patients from mechanical ventilation?

    <p>To make the patient work harder to breathe</p> Signup and view all the answers

    What is the primary advantage of using BIPAP over CPAP in patients with chronic heart failure?

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

    What is the primary difference between IMV and SIMV in mechanical ventilation?

    <p>SIMV allows for spontaneous breathing, while IMV does not</p> Signup and view all the answers

    In which of the following scenarios would CPAP be contraindicated?

    <p>Patients with respiratory failure and hypotension</p> Signup and view all the answers

    What is the primary advantage of using SIMV over IMV in patients with respiratory failure?

    <p>Allows for spontaneous breathing and patient interaction</p> Signup and view all the answers

    What is the primary indication for using BIPAP in patients with chronic heart failure?

    <p>Fluid overload and congestion</p> Signup and view all the answers

    What is the main difference between PS and CPAP?

    <p>PS is used for weaning, while CPAP is used for oxygenation</p> Signup and view all the answers

    What is the primary benefit of allowing patients to breathe spontaneously on CPAP?

    <p>It decreases the work of breathing for the patient</p> Signup and view all the answers

    How is CPAP administered to a patient?

    <p>Via a mask or endotracheal tube</p> Signup and view all the answers

    What is the primary purpose of using CPAP in a patient with sleep apnea?

    <p>To promote alveolar and airway stability</p> Signup and view all the answers

    What happens when PS is added to PEEP?

    <p>It becomes CPAP</p> Signup and view all the answers

    What is the primary goal of CPAP trials in weaning patients from mechanical ventilation?

    <p>To assess the patient's ability to breathe spontaneously</p> Signup and view all the answers

    Which mode of ventilation is characterized by a set rate of mandatory breaths, but allows the patient to breathe spontaneously between these breaths?

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

    What is the primary difference between SIMV and IMV modes of ventilation?

    <p>IMV allows for more spontaneous breathing</p> Signup and view all the answers

    What is the primary benefit of using BIPAP over CPAP in patients with respiratory failure?

    <p>BIPAP provides more pressure support</p> Signup and view all the answers

    What is the Rapid Shallow Breathing Index used to assess in patients undergoing a weaning trial?

    <p>The patient's respiratory rate and tidal volume</p> Signup and view all the answers

    What is the primary limitation of a Pressure-Cycled Ventilator?

    <p>Volume delivered is varied</p> Signup and view all the answers

    What is the purpose of a High Frequency Oscillatory Ventilator?

    <p>To provide lung protective ventilation</p> Signup and view all the answers

    What is the primary difference between a Volume-Cycled Ventilator and a Pressure-Cycled Ventilator?

    <p>Volume-Cycled Ventilators deliver a preset volume</p> Signup and view all the answers

    What is the nursing care requirement for patients on a High Frequency Oscillatory Ventilator?

    <p>They must be sedated and paralyzed</p> Signup and view all the answers

    What is the primary advantage of a Volume-Cycled Ventilator?

    <p>It delivers a constant volume</p> Signup and view all the answers

    What is the primary purpose of a train of four test in patients on a High Frequency Oscillatory Ventilator?

    <p>To establish the patient's baseline</p> Signup and view all the answers

    What is the primary difference between IMV and SIMV?

    <p>IMV allows for patient-initiated breaths</p> Signup and view all the answers

    What is the primary benefit of using BIPAP over CPAP?

    <p>BIPAP allows for both inspiratory and expiratory pressure support</p> Signup and view all the answers

    What is the primary purpose of CPAP in a patient who is not showing any signs of respiratory distress?

    <p>To support the patient's respiratory efforts</p> Signup and view all the answers

    What is the primary limitation of IMV?

    <p>It can lead to respiratory muscle fatigue</p> Signup and view all the answers

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