BKAT Study Set Questions and Answers 2023

BKAT Study Set Questions and Answers 2023 Normal blood gases; pH 7.35-7.45 Normal blood gases: CO2 35-45 Normal blood gases: HcO3 22-26 Normal blood gases: PO2 80 or above Normal vacuum pressures for suction? 120-140 mmHg What may a high pressure vent alarm indicate? Pt is biting on the tubing, excessive secretions in the tubing, kinked tubing What may a low pressure vent alarm indicate? cuff leak or the tubing is disconnected somewhere How do you verify positioning of an endotracheal tube? -auscultate lung bases and apices for bilateral breath sounds -observe chest for symmetric chest wall movement -confirm with end tidal CO2 measure GOLD STANDARD: chest x-ray t/f: people with ET tubes should be suctioned routinely FALSE-- they should be suctioned on an as needed basis what should ET tube cuff pressure be kept at? 20-25 mmHg What measures should nurses take to avoid ET tube problems? -confirm that exit mark on ET tube remains constant when providing patient care, repositioning, and transporting patient -maintain proper cuff inflation (listen for an air leak-- if pt can talk, you must inflate more) -continually monitor SpO2, RR, HR and rhythm, mental status, and ABGs -pre-oxygenate before suctioning What should be done if a patient is not tolerating ET tube suctioning? STOP and manually hyperventilate with 100% oxygen Measures to prevent aspiration? -avoid bolus tube feedings -monitor tube feeding residuals -maintain HOB at LEAST 30 degrees or greater -maintain proper ET tube cuff inflation -perform frequent oral pharyngeal suctioning -maintain an NG tube connected to low, intermittent suction if feeding tube is placed below the pylorus what are recommendations for preventing ventilator associated pneumonia? -manage ventilated patients without sedatives whenever possible -interrupt sedation once a day (spontaneous breathing trials) -provide early exercise and mobility -provide regular oral care -minimize pooling of secretions above the ET tube cuff -use ET tubes with subglottic secretion drainage for patients likely to require greater than 72 hours of intubation -keep HOB elevated 30-45 degress -change ventilator circuit only if visibly soiled or malfunctioning What is the biggest complication associated with high cervical spinal cord injuries? BREATHING-- the diaphragm is innervated by C3-C5 levels C4-diaphragm will likely need mechanical ventilation mgmt signs and symptoms of increased intracranial pressure? -altered LOC -headache -bradycardia -decreased respirations -acute HTN with widening pulse pressure -N/V -worsening neuro deficits -pupils that are nonreactive What are the components of a neuro exam? (7) 1. LOC 2. mental status and cognitive function 3. cranial nerves 4. motor 5. sensory 6. coordination 7. reflexes What are the three components of the glasgow coma scale? 1. eye opening 2. motor 3. verbal What is a negative and positive babinski reflex? what do each indicate? negative (normal) response: toes curl downward positive (pathologic) response= toes curl upward a positive babinski in adults indicates dysfunction in the motor pathways of the brain or spinal cord what is the initial dosing of tpa? -0.9 mg/kg -10% as a bolus over 1 minute and 90% as continuous infusion over 60 minutes What are the requirements for receiving tpa? -onset of stroke was within 3-4.5 hours -CT negative for bleed or lesion -glucose 50 During the thrombolytic infusion of tpa, neuros need to be assessed every ___ minutes 15 What are the frequency of neuro checks after receiving thrombolytic tpa infusion? -VS and neuro checks every 15 min for 1 hour -every 30 min for 6 hours -then every hour for 16 hours what are possible complications of rTPA? -signs of ICH or ICP -systemic bleeding (wait 6 hours before inserting devices like foleys, etc) -angioedema of airway for patients receiving rTPA or IA therapy, treat prn for SBP ____ mmHg or DBP ____ mmHG treat for SBP 180 or DBP 105 mmHG we want to manage hypertension!!! Acute mgmt measures for ischemic stroke patients? 1. aspirin within 24 hours 2. NS (Avoid hypotonic IV solutions) 3. blood glucose maintain less than or equal to 150 mg/dL 4. surgical consult 5. no indication for steroids or anticonvulsants 6. rehab (PT/OT/SLP consults) in HEMORRHAGIC stroke patients, what do we want to keep their blood pressure at? SBP 150 mmHG and DBP 105 what do we want to keep ischemic stroke pt's BPs who have not received tpa? Treat PRN if SBP 220 mmHg, DBP 120 mmHG or MAP 130 what is the main complication with IV dilantin? must ONLY be combined with NS what occurs in SIADH? too much ADH!!! what are some neuro causes of SIADH? TBI SAH stroke CNS infection brain tumors Guillian-Barre (GBS) MS pituitary adenoma What is the recommended treatment for SIADH? (3) 1. fluid restriction 2. diuresis (Lasix) 3. administer sodium -- 3% saline (Frequent Na labs) Do not increase Na more than ___ mEq/L in 24 hours period d/t risk for central pontine myelinolysis 10 what is occurring in diabetes insipidus? not enough production of ADH!!! What are s/sx of DI? -increased urine output (250 cc/hr) -increased thirst -dehydration symptoms -dilute urine (low specific gravity 1.001-1.005) -decreased urine osmolality (400 mOsm/kg H20) -low urine Na -concentrated blood (serum osmolality 295 mOsm/L) -hypernatremia (145) Treatment for Diabetes Insipidus (DI)? 1. replace volume (oral fluids/IV fluids) 2. replace ADH by giving DDAVP or Vasopressin drugs given for increased ICP? 3% mannitol 23% what are s/sx of DKA? patient history -polyuria -polydipsia -weight loss -vomiting -blurry vision -weakness -abdominal pain Physical findings -poor skin turgor -kussmaul respirations -fruity breath -tachycardia -hypotension -mental status changes what are the three main components of treatment for DKA? 1. REHYDRATE 2. RESTORE GLUCOSE METABOLISM 3. CORRECT ELECTROLYTES AND ACIDOSIS what is the progression of IVF administration during DKA? -start with 1 L bolus NS over 1 hour -500 mL/hr for 2 hours -150 mL/hr for 1 hour -once glucose 250 mg/dL, change to D5 NS 0.45% 125 mL/hr why do we add D5 to solutions for DKA treatment later on? because hyperglycemia is corrected much faster than acidosis!! -the addition of dextrose to the fluids allows continued insulin administration until the ketonemia is cleared, while preventing hypoglycemia Do not start an insulin infusion for treatment of DKA until it is confirmed that the L level is greater than ____ 3.3 mEq/L what do we give to correct electrolytes and acidosis in DKA? potassium and bicarbonate! Why can hypokalemia occur in dka treatmnet/ because potassium shifts with insulin what are s/sx of hyperglycemia? polydipsia polyphagia polyuria fruity breath nausea/vomiting What are s/sx of hypoglycemia? increased HR, sweating, shaking, HA, vision changes (blurred) What is treatment for hypoglycemia? 1. if eating, give 15 g of fast acting carbohydrate like juice, oral gel, or glucose tablets -NOTE: repeat up to three times 2. if pt is NPO, administer 15-20 grams 50% dextrose 3. give glucaagon 1 mg IM if IV access not prompty available Treatment for hyperglycemia? usually insulin -follow endotool what is the impact of critical illness on blood sugars? critical illness causes hyperglycemia-- the patient will require increased dosages of insulin what meds should be tapered to prevent adrenal problems? corticosteroids Onset/Peak/Duration of Rapid-acting insulin? (Novolog) Onset: 15-30 minutes Peak: 0.5-3 hours Duration: 3-6 hours Onset/Peak/Duration of REGULAR insulin (humulin r)? Onset: 30-60 minutes Peak: 1-5 hours Duration: 6-10 hours Onset/Peak/Duration of intermediate acting insulin (NPH)? Onset: 1-2 hours Peak: 6-14 hours Duration: 16-24 hours Onset/Peak/Duration of Long-acting insulin (Lantus)? Onset: 1-2 hours Peak: relatively peakless Duration: 18-24 hours Lab indicators of renal failure INCREASED CREATININE (1.2) INCREASED BUN (20) INCREASED POTASSIUM FlUID OVERLOAD what adjustments are made with meds in renal failure? med dosages are decreased or the time between subsequent dosages is increased diet restrictions in acute renal failure (What would a tube feed consist of)? low potassium low sodium low phos low protein