combine Ch 10 Ventilatory Assistance

A patient is admitted to the cardiac surgical intensive care unit after cardiac surgery. Four hours after admission to the surgical intensive care unit at 4 PM, the patient has stable vital signs and normal arterial blood gases (ABGs), and is placed on a T-piece for ventilatory weaning. What interdisciplinary staff member does the nurse notify to assist in the care of this patient while preparing to give this patient diuretics? A. Respiratory therapist to adjust ventilator B. Social worker to notify family C. Phlebotomy to obtain another set of blood gasses D. Nursing assistant to help reposition the patient

A

The nurse is caring for a mechanically ventilated patient and responds to a high inspiratory pressure alarm. Recognizing possible causes for the alarm, the nurse assesses for which of the following? (Select all that apply.) A. Coughing or attempting to talk B. Disconnection from the ventilator C. Kinks in the ventilator tubing D. Need for suctioning E. Spontaneous breathing

A, C, D

The nurse is assisting with endotracheal intubation of the patient and recognizes that the procedure will be done in what order: _______________, _______________, _______________, _______________, _______________? A. Assess balloon on endotracheal tube for symmetry and leaks B. Assess lung fields for bilateral expansion C. Inflate balloon of endotracheal tube D. Insert endotracheal tube with laryngoscope and blade E. Suction oropharynx

A, E, D, C, B

The nurse is caring for a patient with an endotracheal tube. The nurse understands that endotracheal suctioning is needed to facilitate removal of secretions and that the procedure A. Decreases intracranial pressure. B. Depresses the cough reflex. C. Is done as indicated by patient assessment. D. Is more effective if preceded by saline instillation.

ANS: C Suctioning is performed as indicated by patient assessment. Suctioning is associated with increases in intracranial pressure; therefore, it is important to hyperoxygenate the patient before suctioning to reduce this complication. Suctioning can stimulate the cough reflex rather than depress this reflex. Saline instillation is associated with negative physiological outcomes and is not recommended as part of the suctioning procedure; it does not loosen secretions, which is a common misperception.

The nurse is assisting with endotracheal intubation and understands that correct placement of the endotracheal tube in the trachea would be identified by which of the following? (Select all that apply.) A. Auscultation of air over the epigastrium B. Equal bilateral breath sounds upon auscultation C. Position above the carina verified by chest x-ray D. Positive detection of carbon dioxide (CO2) through CO2 detector devices E. Fogging of the endotracheal tube

B, C, D

Select all of the factors that may predispose the patient to respiratory acidosis. (Select all that apply.) A. Anxiety and fear B. Central nervous system depression C. Diabetic ketoacidosis D. Nasogastric suctioning E. Overdose of sedatives

B, E

When assessing the patient for hypoxemia, the nurse recognizes that an early sign of the effect of hypoxemia on the cardiovascular system is A. Heart block. B. Restlessness. C. Tachycardia. D. Tachypnea.

C

The nurse is caring for a mechanically ventilated patient and is charting outside the patient's room when the ventilator alarm sounds. What is the priority order for the nurse to complete these actions: _______________, _______________, _______________, _______________? A. Check quickly for possible causes of the alarm that can be fixed B. After troubleshooting, connect back to mechanical ventilator and reassess patient C. Go to patient's bedside D. Manually ventilate the patient while getting a respiratory therapist

C, A, D, B

The nurse is caring for a mechanically ventilated patient. The providers are considering performing a tracheostomy because the patient is having difficulty weaning from mechanical ventilation. Related to tracheostomy, the nurse understands which of the following? A. Patient outcomes are better if the tracheostomy is done within a week of intubation. B. Percutaneous tracheostomy can be done safely at the bedside by the respiratory therapist. C. Procedures performed in the operating room are associated with fewer complications. D. The greatest risk after a percutaneous tracheostomy is accidental decannulation.

D

The nurse is caring for a patient whose ventilator settings include 15 cm H2O of positive end-expiratory pressure (PEEP). What complication does the nurse assess the patient for? A. Fluid overload secondary to decreased venous return B. High cardiac index secondary to more efficient ventricular function C. Hypoxemia secondary to prolonged positive pressure at expiration D. Low cardiac output secondary to increased intrathoracic pressure

D

A patient's ventilator settings are adjusted to treat hypoxemia. The fraction of inspired oxygen is increased from 0.6 to 0.7, and the positive end-expiratory pressure is increased from 10 to 15 cm H2O. Shortly after these adjustments, the nurse notes that the patient's blood pressure drops from 120/76 mm Hg to 90/60 mm Hg. What is the most likely cause of this decrease in blood pressure? A. Decrease in cardiac output B. Hypovolemia C. Increase in venous return D. Oxygen toxicity

ANS: A Positive end-expiratory pressure increases intrathoracic pressure and may result in decreased venous return. Cardiac output decreases as a result, and is reflected in the lower blood pressure. It is essential to assess the patient to identify optimal positive end-expiratory pressure—the highest amount that can be applied without compromising cardiac output. Although hypovolemia can result in a decrease in blood pressure, there is no indication that this patient has hypovolemia. As noted, higher levels of positive end-expiratory pressure may cause a decrease, not an increase, in venous return. Oxygen toxicity can occur in this case secondary to the high levels of oxygen needed to maintain gas exchange; however, oxygen toxicity is manifested in damage to the alveoli.

One of the early signs of hypoxemia on the nervous system is A. Cyanosis. B. Restlessness. C. Agitation. D. Tachypnea.

ANS: B Decreased oxygenation to the nervous system may result in restlessness and agitation—early signs of hypoxemia. Cyanosis is a late sign. Tachypnea may occur, but CNS changes tend to occur earlier. Agitation is not usually seen with hypoxemia.

The nurse is caring for a mechanically ventilated patient and notes the high pressure alarm sounding. The nurse cannot quickly identify the cause of the alarm and notes the patient's oxygen saturation is decreasing and heart rate and respiratory rate are increasing. The nurse's priority action is to A. Ask the respiratory therapist to get a new ventilator. B. Call the rapid response team to assess the patient. C. Continue to find the cause of the alarm and fix it. D. Manually ventilate the patient while calling for a respiratory therapist.

ANS: D The nurse must quickly assess the patient and determine possible causes of the alarm. If the cause is not assessed within seconds, the nurse must manually ventilate the patient and secure assistance in troubleshooting the problem. The patient must be treated while the causes are being assessed by the nurse and respiratory therapist. Continuing to assess for the cause without manually ventilating the patient can result in patient compromise. The respiratory therapist, not the rapid response team, will assess and remedy the problem. A new ventilator may be needed, but that would be determined after the respiratory therapist has assessed the situation.