Delirium
Describe the differences between Delirium and Dementia.
Dementia: Progressive cognitive decline that affects a person’s social and occupational functioning.
Delirium: Sudden onset, short-term, acute loss of some cognitive abilities
Where in the lungs does gas exchange occur?
Alveoli
What are the differences between an ET tube and a tracheostomy
ET tube: a small plastic tube inserted (through intubation) into the trachea through the mouth or nose to establish an open airway
Trach: the surgical formation of an opening (stoma) into the trachea through the neck, through which a small tube is placed to maintain an open airway
Bonus: when do you consider a tracheostomy vs. an ET tube? +100
High levels of PEEP can lead to ____.
Barotrauma
What are two important things to assess with someone wearing a BiPAP mask?
1. Skin under mask
2. Mouth
List 1 tool to help identify delirium
1. CAM-ICU
2. ICDSC (Intensive Care Delerium Screening Checklist)
1. Explain the difference between Oxygenation and Ventilation
2. Which is PaO2 & which is PaCO2?
1.
Oxygenation: The delivery of O2 to the body tissues and cells via the pulmonary, hematologic, and cardiovascular systems. This does not include the utilization of O2
Ventilation: Mechanical work of breathing that exchanges air between the lungs and the atmosphere so gas exchange can occur.
2.
PaO2- Oxygenation
PaCO2- Ventilation
What must you confirm with your RT and document after oral intubation?
Placement of ET tube
1. What is an I:E ratio?
2. What is a normal I:E ratio during spontaneous breathing?
1. The ratio of the duration of inspiration to the duration of expiration
2. 1:2
Why are restraints contraindicated for someone on Bipap?
Risk for aspiration
List 3 interventions to promote patient orientation.
1. Provide Visual and Hearing Aids
2. Encourage communication and frequent reorientation.
3. Familiar objects from home
4. Consistency in nursing staff
5. Allow television with daily news
6. Music (Instrumental, no words)
List 5 noninvasive modes of oxygen delivery
1. Nasal cannula
2. simple face mask
3. partial rebreather
4. nonrebreather
5. High-flow nasal cannula
6. venturi mask
7. optiflow
8. CPAP
9. BIPAP
Describe trach care..
1. How often?
2. What do you change?
3. What do you use for cleaning
1. Once per shift & PRN
2. Change the inner cannula, trach ties, and drain sponge
3. Hydrogen peroxide (can be mixed with NS *sterile)
Oral/ bronchial hygiene --> suctioning
1. What is normal PEEP?
2. What respiratory condition may require up to 20cm H2O?
1. 5 cm H2O
2. ARDS
List 4 common reasons for HIGH-pressure limit alarm on the vent
1. Obstruction/Occlusion
2. Coughing (stacking breaths)
3. Secretions/Mucus Plug
4. Aspiration
5. Kinked/occluded ETT or vent circuit
6. Bronchospasm or mucosal edema
7. Decreasing lung compliance (ARDS)
8. Pneumothorax
BONUS: List three reasons for low-pressure limit alarms. +200
List and describe the three types of delirium
1. Hyperactive: increased psychomotor activity- rapid speech, irritability, agitation, restlessness
2. Hypoactive: reduced psychomotor activity- slowed speech, decreased, alertness, lethargic, apathy
3. Mixed: alternating between the two
CPAP: Patients must be able to take _____ _____.
spontaneous breaths
BONUS* how is CPAP different from BiPAP? +100
What are three methods to verify ET tube placement?
1. Look and listen
2. ETCO2
3. STAT CXR
NAME and DESCRIBE these Ventilator Settings
RR
Vt
FiO2
PEEP
PS
Respiratory rate: # of breaths the vent delivers/ minute
Tidal volume: The amount of air delivered with each breath
Fraction of Inspired Oxygen: fraction of inspired air delivered to the client
Positive End Expiratory Pressure: Maintenance of positive pressure within the lungs at the end of expiration to prevent alveolar collapse
Pressure Support: Positive pressure is applied to the airway when an inspiratory trigger is detected and released once expiration is detected
What safety device for a trach must always be at the bedside?
Obturator
Explain the ABCDEF of Delirium Prevention
Assess/Prevent & manage pain
Breathing Trials
Choice of Analgesia and Pain
Delirium monitoring/management
Early mobility/exercise
Family Engagement
What are the three main settings for BiPAP?
1. IPAP - inspiratory airway pressure
2. EPAP - expiratory positive airway pressure
3. FiO2
What are the four complications of suctioning a trach?
1. Hypoxia
2. Tissue trauma
3. Infection
4. Vagal stimulation/ cardiac dysrhythmias
Explain the difference between the ventilator modes AC, PRVC, SIMV, and CPAP
AC: Full machine control, but the pt. can deliver a spontaneous breath that is assisted. If the pt. triggers a breath, the vent will assist.
SIMV: The patient controls breathing mainly, but this setting allows the pt to initiate spontaneous breaths in between the mandatory breaths
PRVC: A preset volume is delivered at a set rate but with the lowest possible pressure. Constant pressure is applied throughout inspiration, regardless of whether the breath is a vent or client breath.
CPAP: No ventilator breaths are provided; only the PEEP, pressure support, and FiO2 are set in this mode
List 4 methods to prevent VAP
1. Oral ETT preferred over nasal ETT
2. Hand Washing
3. Mouth care & suctioning per policy
4. HOB elevated 30o-45o (unless contraindicated)
5. Turn q2h, mobilize if able
6. Gastric ulcer prophylaxis: PPI such as Protonix
7. DVT prophylaxis: SCDs, anticoagulants
8. Nutrition
9. Daily weaning trials and Sedation Vacation (limit time on a ventilator)
10. Limit re-intubation; Early tracheostomy