Complex Care Exam 1 Study Guide question and answers rated A+ 2023

Complex Care Exam 1 Study Guide question and answers rated A+ 2023 What is priority nursing care for Low Pressure Alarms? - correct answer tubing disconnection extubation cuff tube/leak What is priority nursing care for High Pressure Alarms? - correct answer secretions, coughing, gagging pt fighting vent condensation in tube kinked/biting tube increased resistance (bronchospasm) decreased compliance (pulm. edema, pneumothorax) What are the clinical indications for Mechanical Ventilation? - correct answer Apnea Acute respiratory failure Severe Hypoxia Respiratory muscle fatigue PEEP = ARDS (pushing air end exhale) PSV = weening (pushes air w/ inhale) What are complications of Positive Pressure Ventilation? - correct answer Barotrauma - air escapes alveoli causing pneumothorax (collapse lung) Pneumomediatinum - ruptured alveoli, air to mediastinum or neck; pneumothorax Volutrauma - large Vt, noncompliant lungs, fluid in alveolar space VAP - pneumonia 48hrs after intubation How do you prevent VAP? - correct answer HOB elevation no routine changes of ventilator tubing continuous subglottic suction strict hand hygiene drain water from tubing always wear gloves and change gloves between activities How do you prevent Aspiration? - correct answer HOB elevated suction mouth frequently maintain proper cuff inflation (20-25 cm H20) How do you prevent Suctioning Complications? - correct answer assess pt before, during, & after hyperoxygenate before & after each pass (30sec) limit pass to 10 sec assess SPO2 and ECG use 100-120mmHg use aseptic technique How is ET tube placement confirmed? - correct answer chest x-ray end-tidal CO2 detector (exhaled CO2) color change or number auscultate bilateral LS and epigastrium observe symmetric chest mvmt SPO2 improvement How is ET tube placement Evaluated? - correct answer ABGs end tidal CO2 monitoring SPO2 monitoring How do you maintain ET tube placement? - correct answer place an exit mark on tube confirm mark remains constant