ABG interpretation
Breath Sounds
ARDS/COPD
Vent Modes
Misc
100
pH: 7.28
PaCO2: 52 mmHg
HCO3-: 24 mEq/L
Uncompensated Respiratory Acidosis
pH is low (acidic), PaCO2 is high (retaining CO), and HCO3- is normal.
100
What respiration pattern is more than 24 breaths/min and shallow.
Extra: what are some causes?
Tachypnea
Causes: Anxiety, exercise, pneumonia.
100
What condition is Air-Trapping seen in?
COPD
Rationale: Air is trapped in the lungs during forced expiration.
100
what category do these vent modes fall under:
V- A/C
SIMV
Volume Control Ventilation
100
True or False?
PEEP increases BP and CO
False
PEEP can decrease venous return and therefore decreases BP and CO
200
pH: 7.58
PaCO2: 40 mmHg
HCO3-: 32 mEq/L
Uncompensated Metabolic Alkalosis
pH is high (alkalotic), PaCO2 is normal, HCO3- is high (excess base).
200
What respiratory pattern has decreased rate, decreased depth and an irregular pattern? Also what can ABG's show with this pattern?
Hypoventilation
Respiratory Acidosis (overdose of narcotics or anesthetics)
200
Hallmark sign and symptom of ARDS
Extra: what does it mean?
Refractory Hypoxemia
No matter how much supplemental oxygen you give the pt's oxygen doesn't increase.
200
What modes are included in PSV?
CPAP, BiPAP, and PSV
200
List three things included in a VAP Prevention Bundle.
Elevate HOB 30-45°, SBT, DVT prophylaxis, oral care q2h with chlorhexidine, stress-ulcer prophylaxis, hand washing, repositioning q2h, sedation vacation, ETT suctioning.
300
pH: 7.31
PaCO2: 52 mmHg
HCO3-: 29 mEq/L
Partially Compensated Respiratory Acidosis
pH is low (acidic), PaCO2 is high, HCO3 is high and compensating.
300
What pattern is this and what are the three characteristics of this pattern? 
Kussmauls Respirations
Rapid, Deep, and Labored
300
What are two interventions for ARDS?
PEEP: PEEP is usually kept high to keep the alveoli open.
Prone Positioning can help raise oxygen levels and access other areas of the lungs.
300
On this setting the ventilator delivers the set tidal volumes, pressure is variable, and the patients additional breaths are not supported. Which setting is this?
SIMV
300
List 4 criteria to stop a weaning trial.
RR >35, SaO2 <90%, VT ≤5 mL/kg, diaphoresis, anxiety, HR changes 20% from baseline, SBP >180 or <90.
400
pH: 7.37
PaCO2: 50 mmHg
HCO3-: 29 mEq/L
Compensated Respiratory Acidosis
pH is normal but leaning acidic, PaCO2 is high, HCO3 is high and compensated.
400
What is this pattern, key characteristic, and 1 cause. 
Cheyne-Stokes Respirations
Alternating periods of deep rapid breathing followed by periods of apnea.
Causes: severe CHF, drug overdose, ICP, or kidney failure.
400
A pt with COPD becomes lethargic after an increase in oxygen delivery, what labs should the nurse expect to check next?
ABGs, specifically PaCO2 because COPD can cause rising CO2 and respiratory depression.
400
What is the criteria required for a patient to be on PSV?
An intact respiratory drive and able to initiate spontaneous breaths. PSV shouldn't be used when pt has reduced spontaneous breathing and avoided in acute bronchospasm.
400
What things should a patient be able to do to before extubation?
Extra: What to assess for after extubation?
protect their airway, alert enough to respond, have a good cough and gag reflex, airflow around the ETT cuff deflated.
Extra: Assess for stridor, dyspnea, and falling SaO2.
500
pH: 7.24
PaCO2: 53 mmHg
HCO3-: 17 mEq/L
Mixed Respiratory and Metabolic Acidosis
pH is low (acidic), PaCO2 is high, HCO3 is low, both abnormalities are going in the same direction and are not compensating.
500
What is the key similarity between Cheyne-Stokes respirations and Biot respirations?
They both have periods of apnea. Biot is varying depth and rate while Cheyne-Stokes are cyclical.
500
What are four complications of ARDS and why do they occur?
Pneumothorax: High PEEP and VT's can cause volutrauma.
MODS: Multiorgan dysfunction syndrome because of hypoxemia and tissue hypoxia. Organs aren't receiving enough oxygen.
Sub-q emphysema: Alveoli rupture and air leaks into the tissues under the skin.
VAP: Prolonged mechanical ventilation so look at the bundles.
DVT: Prolonged immobility, sedation, and paralysis.
500
A pt that weighs 70K is on PRVC with a target VT of 430mL. Over several breaths lung compliance worsens. What is the ventilator likely to do?
a. maintains the same inspiratory pressure as VT falls, b. increases inspiratory pressure as needed for target VT, c. decreases delivered tidal volume to prevent pressure from rising, d. ventilator mode changes to SIMV
B. Increases inspiratory pressure as needed for target VT.
In PRVC you set a VT and the ventilator adjusts inspiratory pressure breath-to-breath. If compliance decreases -> more pressure. If compliance increases -> less pressure. It is still categorized under PCV.
500
A ventilated pt suddenly has a high-pressure alarm, decreased SpO2, course breath sounds, and thick secretions in the ETT. What is the most likely cause?
a. circuit disconnection, b. cuff leak, c. airway obstruction, d. accidental extubation. Extra: What should the nurse do next?
C. Airway obstruction
Rationale: High pressure alarms are due to blockages like the thick secretions this pt had in the tube.
Extra: Suction (hyper-oxygenate first and only suction during withdrawal in 10sec increments)