All Things Medications
You are preparing to intubate your patient and the provider orders the necessary medications. Which two classes of medication do you anticipate and what order do you administer them?
Anticipate a sedative and a paralytic. Always give the sedative before the paralytic.
Interpret this ABG
pH: 7.52; PaCO₂: 25 mmHg; HCO₃⁻: 24 mEq/L
Uncompensated Respiratory Alkalosis
Describe the pathology of Flail Chest and a common cause of the condition
Flail chest is most often caused by trauma. It is when the ribs are broken in more than one place causing floating sections of ribs. This section then move paradoxically to the regular motions of respiration.
Which statement indicates a patient understands how to use and incentive spirometer?
A- "I will use it only if I need to cough"
B- "I will blow into the device to make the ball move"
C- "I am young so I don't need to use it"
D- " I will inhale when I use the device"
D- " I will inhale when I use the device"
State one way that we can confirm proper placement of the Endotracheal tube after intubation
-End tidal Co2 detector
- Chest x-ray
- Auscultation of bilateral lung sounds
Your patient is ordered 45mg of Lasix IV push. The pyxis has 10mg/2ml vials. How many ml's will you administer?
9 ml's
Interpret this ABG
pH: 7.26; PaCO₂: 52 mmHg; HCO₃⁻: 24 mEq/L
Uncompensated Respiratory Acidosis
Allen is admitted to the Intensive care unit for acute hypoxic respiratory failure. After he has a central line placed he develops shortness of breathe and unilateral decrease in lung sounds on auscultation. What condition do you suspect and why?
Hemothorax, during his central line insertion a vessels was damaged causing bleeding into the pleural space.
There is new continuous bubbling in the chamber of the chest tube what does this indicate?
There is a leak in the system
Name three nursing interventions to help prevent Ventilator Associated Pneumonia (VAP)
Provide at least twice daily oral care with CHG
Maintain HOB at least 30 degrees
Manage oral secretions
Preform hand hygiene before touching the ventilator circuit or ETT
Jackson is a 20 year old man who presents to the Emergency department with sudden on set shortness of breathe, tachypnea and cough. He states that he has had a respiratory illness for the last week.
Temp: 38.2, HR 99, BP 110/75, Resp 26, Spo2 91%
Height: 6' 2" Weight: 150 lbs
What condition do you suspect?
Spontaneous Pneumothorax
This machine delivers a different level of pressure during inspiration and expiration. What is it?
A BiPAP machine
Mary is here for a planned surgery. She is feeling anxious about her surgery and the provider has ordered a medication with a mild sedative effect to help make her more comfortable while she waits. What should the nurse ensure is complete prior to administering the prescribed medication?
The nurse should ensure that the surgical consent form is completed and they have no further questions about their upcoming surgery. If the patient has received medication that can alter mentation they can no longer sign an informed consent.
Name three nursing interventions in the care of a client with ARDS
-Identify and treat underlaying cause
-Monitor vital signs
-Monitor Nutrition and Hydration
- Anticipate the need for intubation
-Manage sedatives as need for patient who are intubated
What assessment findings do you anticipate for a patient who has Acute Respiratory Distress Syndrome (ARDS)?
Tachypnea, increased WOB, accessory muscle use, Tachycardia, restlessness/agitation and potentially other changes in mental status
What are two complications that can arise form mechanical ventilation?
-pneumothorax
- VAP
-Decreased cardiac output in cases with high PEEP
- Vocal cord or laryngeal trauma
-Atelectasis
-Barotrauma
Your patient has a heparin infusion running, the concentration is 100units/ml. The provider orders for the patient to receive 1750 units per an hour at what rate will you infuse the heparin?
17.5 ml's per an hour
Mary was admitted to your unit for sepsis, despite starting antibiotics she continues to be hypoxic with an Spo2 of 90% despite her oxygen being increased from 2L/pm to 6L/pm. On admission her lungs sounds were clear and now are diminished with crackles. The provider orders an ABG with the following results
pH: 7.28 Co2:48 PaO2: 60 HCO3: 25
What condition do you suspect and what is your priority nursing intervention?
The patient has developed ARDS
The priority nursing intervention would be supporting oxygenation by switching from nasal cannula to a non-rebreather
Explain the difference between dead space and shunting
Dead space: High V/Q ratio. Ventilation is normal but circulation is impaired resulting in Co2 retention
Shunting: Low V/Q ratio. Perfusion occurs but ventilation is absent. Blood flows past the alveoli, but the airspaces are collapsed, filled with fluid, or consolidated so no fresh oxygen reaches them. Deoxygenated blood bypasses gas exchange
The patient had an arterial line placed earlier to day in their right radial artery. They call you into the room and express sudden onset pain around the insertion site that has new ecchymosis. Their right hand is also cool and pale. What complication do you suspect.