MISC
Q4 hours
How frequently should you turn your patient to decrease risk of VAP
Q2
What is the typical suction range for pediatric patients
-15 to -20 cm H20
True or false
HFOV works using small number of breaths that are large in tidal volume
FALSE
HFOV give LARGE number of breaths that are SMALL in tidal volume
A patient with the following blood gases is admitted to the critical care unit. Which of the following changes in ventilatory therapy would be the most likely to improve the blood gases?
Ph 7.31/pO2 88/ pCO3 53 / HCO3 19
A - increase FiO2 by 10%
B- increase respiratory rate
C- decrease the peak inspiratory pressure
D- increase the inspiratory/expiratory ratio
B - increase respiratory rate
What must be administered prior to starting a paralytic
sedative
True or False
Saline lavage before suctioning increases the risk of VAP
True
It dislodges bacteria from the ETT into the lower airways
What should be present on all chest tube connection sites and how often should you assess them
All connection sites should be taped and you should check all sites Q4 hours
True or false
There are age and weight restrictions for placing pt on HFOV
False
PEEP improve respiratory status by:
A - opening collapsed bronchioles
B - moving edema from the site of gas exchange
C - assuring airway patency
D - improving the ventilator effort
B - moving edema from the site of gas exchange
sterile water soaked gauze to clean gums and tongue
What is the time period after intubation when early onset VAP is most likely to occur
48-96 hours after intubation
How do you place a chest tube to water seal
disconnect the suction tubing
Is the HFOV better at oxygenation or ventilation
Oxygenation
(b/c it hold lungs open for gas exchange to happen, but uses small tidal volumes so poor CO2 removal)
Atropine should not be used routinely during intubation to prevent vagal bradydysrhymias because it may:
A- cause laryngospasms and airway obstruction
B- increased hypoxia by decreasing respiratory drive and chest wall excursion
C- mask bradydysrhythmias from hypoxia associated with intubation
D - increase the risk of aspiration as a result of increased production of secretions
Where are you looking for movement when performing TOF
Thumb
What pharmacological agent do we use to decrease risk of VAP
Chlorhexidine oral rinse
In order to promote drainage how far below the insertion site should the suction chamber be kept
At least 12 inches
Will you hear breath sounds when a pt is on the HFOV
No-
because the tidal volumes are so small, but you will hear and see a "chest wiggle"
HFOV in helpful in reducing barotrauma by:
A - using large tidal volumes delivered at low pressures
B - using large tidal volumes delivered at reduced peak inspiratory pressure
C - using small tidal volumes delivered at the mean airway pressure
D - using normal tidal volumes delivered at low pressure
C - using small tidal volumes delivered at the mean airway pressure
How long after starting a paralytic gtt should you re-check TOF
2 hours
Elevating the HOB to at least 30 degrees help decrease risk of VAP by decreasing likelihood of what happening
What are the 2 ways samples of chest tube drainage can be obtained
1 - needleless luer port
2 - swab the tubing with alcohol/CHG and insert 20G or smaller needle
1 Hertz (HZ) is equal to how many breaths
60
Which of the following most influences oxygen exchange during mechanical ventilation?
A - changes in tidal volume
B - changes in respiratory rate
C - changes in mean airway pressure
D - changes in oxygen consumption