NSG 233 Med-Surg III Exam 3 Study Guide with complete solutions (Herzing University)
NSG 233 Med Surg III
EXAM 3 STUDY GUIDE
Topic Location Student Notes
1. Ventilator NSG233.07.01.02 - Increased adventitious breath sounds may indicate a need for
management suctioning. The nurse maintains the patient’s head of the bed so that it
is elevated 30 degrees or higher unless contraindicated to prevent the
risk of aspiration and VAP
- Controlling mode (e.g., CMV ventilation and SIMV).
- Tidal volume and rate settings (tidal volume is usually set at 6 to 10
mL/kg [ideal body weight] or 4 to 8 mL/kg for the patient with ARDS
[ideal body weight]; rate is usually set at 12 to 16 breaths/min).
- FiO2 setting may be set between 21% and 100% to maintain an optimal
PaO2 level (e.g., greater than 60 mm Hg) or SpO2 level greater than
92%.
- Peak inspiratory pressure (PIP) (normal is 15 to 20 cm H2O; this
increases if there is increased airway resistance or decreased
compliance).
- Sensitivity (A 2 cm H2O inspiratory force should trigger the ventilator).
- Inspiratory-to-expiratory ratio (usually 1:2 [1 second of inspiration to 2
seconds of expiration] unless inverse ratio is ordered).
- Minute volume (tidal volume × respiratory rate).
- Sigh settings (usually set at 1.5 times the tidal volume and ranging from
1 to 3 per hour), if applicable.
- Water in the tubing, disconnection or kinking of the tubing, which, if
present, are corrected.
- Humidification (humidifier filled with water) and temperature.
- Alarms (turned on and functioning properly at all times per The Joint
Commission [TJC] Alarm Safety Goal) (TJC, 2020).
- PEEP and pressure support level, if applicable.
- assesses the patient’s comfort level and ability to communicate as well
- assess the patient’s gastrointestinal system and nutritional status
, NSG 233 Med-Surg III Exam 3 Study Guide with complete solutions (Herzing University)
2. Types of Ventilation NSG233.07.01.01 - mechanical ventilator is a positive- or negative-pressure breathing
device that can maintain ventilation and oxygen delivery for a prolonged
Positive-Pressure Ventilators
- Positive-pressure ventilators inflate the lungs by exerting positive
pressure on the airway, pushing air in, similar to a bellows mechanism,
and forcing the alveoli to expand during inspiration. Expiration occurs
passively. ET intubation or tracheostomy is usually necessary. These
ventilators are widely used in the hospital setting and are increasingly
used in the home for patients with primary lung disease. Three types of
positive-pressure ventilators are classified by the method of ending the
inspiratory phase of respiration: volume-cycled, pressure-cycled, and
high-frequency oscillatory support. The fourth type, noninvasive
positive-pressure ventilation (NIPPV), does not require intubation
(Wiegand, 2017).
-
- d period
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3. Care of a patient on NSG233.07.01.02 Two general nursing interventions that are important in the care of the patient
mechanical ventilation who is mechanically ventilated are pulmonary auscultation and interpretation
of arterial blood gas measurements.
Nursing interventions to promote optimal gas exchange include judicious
administration of analgesic agents to relieve pain without suppressing the
respiratory drive and frequent repositioning to diminish the pulmonary effects
of immobility. The nurse also monitors for adequate fluid balance by assessing
for the presence of peripheral edema, calculating daily intake and output, and
monitoring daily weights. The nurse administers medications prescribed to
control the primary disease and monitors for their side effects.
PROMOTING EFFECTIVE AIRWAY CLEARANCE
Continuous positive-pressure ventilation increases the production of secretions
regardless of the patient’s underlying condition. The nurse assesses for the
presence of secretions by lung auscultation at least every 2 to 4 hours.
Measures to clear the airway of secretions include suctioning, CPT, frequent
position changes, and increased mobility as soon as possible. Frequency of
suctioning should be determined by patient assessment. If excessive secretions
are identified by inspection or auscultation techniques, suctioning should be
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