Ventilators
How would you know a patient is not tolerating extubation?
Answer : The patient shows signs of respiratory distress.
What is the nursing priority for a patient with epiglottitis?
Maintain the airway!
Explanation : This is a medical emergency! Patient will need to be intubated or have a trach placed.
What amount of supplemental oxygen should be administered to COPD patients ?
Answer : The least amount of low flow volume that produces a therapeutic result.
How can you determine is a patient is compensated or uncompensated ?
Based on pH!
Explanation : pH within normal range = compensated, pH outside of normal range = uncompensated
What is the purpose of the PEEP valve ?
Answer : Prevents the alveoli from collapsing.
Explanation: The PEEP valve mimics the action of the epiglottis.
A patient is admitted to the ED with an acute diagnosis of RSV. What are the two possible scenarios that would result in a child being admitted for a respiratory infections ?
Increased work of breathing and Insufficient Fluid Volume
Explanation: Increased work of breathing would require nursing intervention and observation, Insufficient Fluid Volume would require IV fluids
Which of the following is expected for a patient with chronic COPD? Select all that apply.
A. Barrel chest B. Finger-nail Clubbing
C. Wheezing D. Jugular Vein Distension
E. FEV1 > 75
Answer : A, B, D
Explanation: Barrel chest is a result of air trapping associated with COPD, Finger nail clubbing is a long term effect of poor perfusion with COPD, and JVD is a result of Cor Pulmonale.
Wheezing would be expected for asthma, and FEV1 <70 is one diagnostic criteria of COPD.
What is the diagnostic criteria for hypoxemic respiratory failure ?
A pO2 less than 60 while on 60% or higher supplemental oxygen.
What should the nurse do if a ventilator alarm is sounding and the nurse is unable to troubleshoot the issue?
Answer : Mechanically bag the patient and call the provider or respiratory team.
An infant is diagnosed with RSV and is experiencing copious secretions. Which interventions would be appropriate for this patient ? Select all that apply.
A. Rescue inhaler B. Corticosteroids
C. Nebulized saline solution D. Bulb Suction
E. Chest Physiotherapy
Answer: C and D
Explanation: RSV causes Bronchiolitis in pediatric patients. Bronchiolitis is a secretion issue. A rescue inhaler and corticosteroids would not help with the secretions. Chest Physiotherapy is contraindicated for bronchiolitis due to the risk of aspiration.
A patient is newly diagnosed with COPD due to chronic bronchitis. You're providing education to the patient about this disease process. Which statement by the patient indicates they understood your teaching about this condition?
A. "If I stop smoking, it will cure my condition."
B. "Complications from this condition can lead to pulmonary hypertension and right-sided heart failure."
C. "I'm at risk for low levels of red blood cells due to hypoxia and may require blood transfusions during acute illnesses."
D. "My respiratory system is stimulated to breathe due to high carbon dioxide levels rather than low oxygen levels.
Answer B
Explanation : Smoking cessation will decrease the progression of COPD but will not cure it. COPD patients typically have high RBC and Hemoglobin to compensate for hypoxemia.
Based on the ABG below, what type of respiratory failure is the patient at risk of?
pH 7.36 , SpO2 90, HCO3 33 , pO2 87, pCO2 70
Hypercapnic Respiratory Failure
Explanation : The criteria for hypercapnic respiratory failure is a pH less than 7.35 and a pCO2 greater than 50. The patient already has a pCO2 greater than 50, and when the kidneys stop compensating the pH will fall below 7.35
Which of the following is included in the ventilator bundle ? Select all that apply.
A. Elevation of the head of the bed 30-45 degrees
B. Daily extubation readiness assessment
C. Stress ulcer prophylaxis
D. DVT prophylaxis
E. Oral care daily with chlorhexidine solution
F. Prophylactic antibiotic therapy
Answer : A, B, C, D, E
For each of the Pediatric respiratory infections indicate whether they are viral or bacterial.
Epiglottitis = Bacterial !
Laryngotracheobronchitis (croup) = Viral!
Bronchiolitis = Viral
Pneumonia = Bacterial or Viral
What is polycythemia and how do you treat it ?
Answer : Increased volume of RBC as the body's compensatory way to treat hypoxemia. The treatment is to administer supplemental oxygen.
After receiving change if shift report on a medical unit, which patient should the nurse assess first?
A. A patient with pneumonia who has crackles bilaterally in the lung bases
B. A patient with COPD with an O2 saturation of 88% on 2L O2
C. A patient with sepsis who has intercostal and sternal retractions.
D. A patient who is has a resting pulse of 120 following their albuterol nebulizer treatment.
Answer : C
Intercostal and sternal retractions suggest the onset of acute respiratory distress.
The other patients should also be assessed as quickly as possible, but their assessment data are typical of their disease processes and do not suggest deterioration in their status.