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FCCN level 2 Exam With Complete
Solutions.
restore perfusion - CORRECT ANSWER>>-increase preload w/ fluid boluses -optimize afterload after fluid resuscitation, use pressors -increase contractility using inotropes
antimicrobial therapy - CORRECT ANSWER>>from onset of hypotension due to sepsis, every hour counts. antibiotics during first hour = 80% survival
source control - CORRECT ANSWER>>goal for identification and control within 12 hours. debride wound or remove line
glycemic control - CORRECT ANSWER>>glucose will be elevated from stress and pressors. utilize insulin infusions per area protocol
Swan-Ganz catheter - CORRECT ANSWER>>a cardiac catheter with a balloon at the tip that is used to measure pulmonary arterial pressure; it is flow guided through a vein into the right side of the heart and then into the pulmonary artery
inserted under sterile technique by provider. IJ, sublavian, or femoral
pulmonary arterial pressure - CORRECT ANSWER>>15-30/8-
thermistor port - CORRECT ANSWER>>measures body temperature
what can be injected into the red balloon port? - CORRECT ANSWER>>1.5 mL or less of air
which port should you use to infuse calcium chloride? - CORRECT ANSWER>>clear/white
what can be infused through the yellow port? - CORRECT ANSWER>>3mL/hr NS flush
RN role with PAC - CORRECT ANSWER>>-use ports appropriately -level, zero, square wave, waveform analysis -prevent infection -measure skin to tip q4h and document changes from placement measurement -print PA wave strip and ECG strip -site care prn or once a week -d/c lines asap w/ order
PAC safety - CORRECT ANSWER>>-secure device -do not tape over plastic sheath -monitor for wedging -monitor for ventricular placement -assure you are getting quality data
osmosis - CORRECT ANSWER>>diffusion of water across a selectively permeable membrane
breathe too fast, not retaining enough CO
HCO3 - CORRECT ANSWER>>22-
metabolic acidosis - CORRECT ANSWER>>low pH, low HCO
causes: diarrhea, DKA, hyperkalemia
metabolic alkalosis - CORRECT ANSWER>>high pH, high HCO
causes: vomiting, suctioning, hypokalemia
pH - CORRECT ANSWER>>7.35-7.
reading ABGs - CORRECT ANSWER>>1. evaluate pH to identify acidosis or alkalosis
- match CO2 or HCO3 with pH state using ROME to determine respiratory or metabolic
- assess whether CO2 or HCO3 state is opposite of pH to determine if it is uncompensated, partially compensated, fully compensated, or corrected
non-invasive ventilation - CORRECT ANSWER>>CPAP/BiPAP
CPAP - CORRECT ANSWER>>continuous positive airway pressure; provides inspiratory pressure
BiPAP - CORRECT ANSWER>>bilevel positive airway pressure; provides inspiratory and expiratory pressure
intubation - CORRECT ANSWER>>insertion of ETT into trachea
RSI - CORRECT ANSWER>>administration of induction agent and neuromuscular blockade agent simultaneously
intubation kit medications - CORRECT ANSWER>>premeds - versed and fentanyl
sedatives - propofol, etomidate, ketamine
paralytics - succinylcholine, rocuronium
pressor - phenylephrine
intubation preparation - CORRECT ANSWER>>-notify RT and pharmacist -discuss need for intubation and obtain consent, ensure pt does not have DNI order. -evaluate whether pt has difficult airway -verify equipment and PPE -assure functioning IV access -position pt -ensure verbalization of procedural pause -preoxygenate
PEEP - CORRECT ANSWER>>positive end-expiratory pressure, provides positive pressure to airways during expiration and helps keep alveoli open
common mechanical ventilator setting in which airway pressure is maintained above atmospheric pressure
disadvantages: increased thoracic pressure decreases venous return to the heart. high levels can cause barotrauma, tension pneumo
respiratory rate - CORRECT ANSWER>>minimum number of breaths per minute the vent will ensure your pt takes
increase the rate to blow off CO2, decrease rate to retain
tidal volume - CORRECT ANSWER>>amount of air that moves in and out of the lungs during a breath. calculated based on predicted body weight (height and gender)
6mL/kg is ideal
minute ventilation - CORRECT ANSWER>>tidal volume x respiratory rate
volume inspired during 1 minute
normal is 5-8L/min
pressure support - CORRECT ANSWER>>-eases the work of breathing, helps to overcome airway resistance of breathing through artificial airway -cannot be used with AC or CMV -CAN be used with SIMV -Patient can take breaths between mandatory breaths -used to wean from ventilator
peak airway pressure - CORRECT ANSWER>>highest pressure recorded at the end of inspiration
SIMV - CORRECT ANSWER>>synchronized intermittent mandatory ventilation
mandatory breaths have a set tidal volume, pt initiated breaths have varying tidal volume
initial mode for ventilation or weaning mode
disadvantage: increased work of breathing and can lead to pt/vent asynchrony
AC/CMV - CORRECT ANSWER>>Assist control or continuous mandatory ventilation
pt initiated or ventilator control breaths have set tidal volume
disadvantages: hyperventilation which may cause respiratory alkalosis or hyperinflation, less comfortable for pt
-check placement of tube frequently -move oral tubes from one side of the mouth to the other
ICU liberation bundle - CORRECT ANSWER>>Assess and manage pain - IV opioids Breathing/awakening trials - determine extubation readiness Choice of analgesia and sedation - sedate to RASS goal, treat pain prior to administering analgesia Delirium prevention - CAM screening, reorientation, avoid benzos Family engagement - family presence, involvement in making decisions Goals of care - honor pt wishes
weaning criteria - CORRECT ANSWER>>FiO2 50% or less PEEP 10 or less LOC acceptable stable hemodynamics ABGs WDL
primary pulmonary function review - CORRECT ANSWER>>exchange of gases between ambient air and the blood
relatively dry alveoli and adequately perfused capillaries = healthy lungs
overall goal is to exhale CO2 and ensure proper oxygenation
ventilation - CORRECT ANSWER>>movement of air in and out of the lungs
oxygenation - CORRECT ANSWER>>the process of delivering oxygen to the blood
diffusion - CORRECT ANSWER>>movement of gases between air spaces in lungs and bloodstream
how do we know that ventilation and/or oxygenation is less than optimal in our pts? - CORRECT ANSWER>>-respiratory assessment -pulse oximetry -ABGs -imaging -P/F ratio
perfusion - CORRECT ANSWER>>movement of blood in and out of capillary beds
P/F ratio - CORRECT ANSWER>>tells us the degree of sickness of our pt's lungs, and helps assess oxygenation
PaO2/FiO
normal is 300-
pneumonia - CORRECT ANSWER>>inflammation of the lungs due to presence of infection. alveoli fill with sludge, leading to poor ventilation and oxygenation
less air flows in and out of airways because: alveoli lose their elasticity, lining of airways becomes thick and inflamed, excess mucous is produced
COPD exacerbation s/s - CORRECT ANSWER>>productive cough, SOB, wheezing, chest tightness
tachypnea, dyspnea, orthopneic, barrel chest
COPD exacerbation treatment - CORRECT ANSWER>>- bronchodilators (open airway) -steroids (decrease inflammation of airways) -antibiotics (if needed depending on cause of exacerbation) -CPAP or BiPAP (positive pressure ventilation)
steroids nursing considerations - CORRECT ANSWER>>hyperglycemia, adrenal function, hypokalemia
pneumothorax - CORRECT ANSWER>>accumulation of air in the pleural space
can be caused by trauma, surgery, or idiopathic
spontaneous pneumothorax - CORRECT ANSWER>>pneumothorax that occurs when a weak area on the lung ruptures in the absence of major injury, allowing air to leak into the pleural space
tension pneumothorax - CORRECT ANSWER>>a type of pneumothorax in which air that enters the chest cavity is prevented from escaping
hemothorax - CORRECT ANSWER>>blood in the pleural cavity
pneumothorax s/s - CORRECT ANSWER>>-dyspnea -tachypnea -pleuritic chest pain -tachycardia -restlessness
-decreased chest wall movement -progressive cyanosis -absent breath sounds unilaterally
pneumothorax treatment - CORRECT ANSWER>>-supplemental O -evacuation of the air from the pleural space w/ large bore needle decompression -chest tube insertion 2nd intercostal space, mid-clavicular line. placed to chest drainage system that provides water-seal and suction
ARDS - CORRECT ANSWER>>-hypoxemia within 7 days of pulmonary insult -alveoli fill with fluid and may collapse -bilateral opacities that isn't explained by pleural effusions, pneumothorax, or pulmonary nodules -respiratory failure not attributed to volume overload -mild, moderate or severe P/F ratios in presence of PEEP
-rapid deterioration -increasing demand for supplemental oxygen
ARDS treatment - CORRECT ANSWER>>-treat underlying cause -prevent progression of lung injury -promote gas exchange -high pressure ventilation (PEEP) -high level O2 therapy to keep PaO2 > -support tissue oxygenation -prevent complications
ARDS management strategies - CORRECT ANSWER>>-low tidal volume ventilation -recruit PEEP -monitor plateau pressure -pulmonary vasodilatos -neuromuscular blockers -proning -ECMO
low tidal volume ventilation - CORRECT ANSWER>>goal is <6mL/kg to prevent over distending alveoli. helps sustain surfactant production
recruiting PEEP - CORRECT ANSWER>>keeps alveoli open, improving oxygenation using lower FiO2. this however can drop pt's BP due to decreased venous return and can also cause barotrauma
plateau pressure - CORRECT ANSWER>>the pressure exerted on small airways and alveoli during mechanical ventilation. measures
compliance of the entire lung. keep below 30 to prevent over distention of alveoli
pulmonary vasodilators - CORRECT ANSWER>>specifically dilate pulmonary blood vessels
ex: -epoprostenol (continuous infusion) -alprostadil (inhaled) -nitric oxide (inhaled)
neuromuscular blockers - CORRECT ANSWER>>to paralyze our pt, which decreases O2 consumption
proning - CORRECT ANSWER>>optimizes ventilation and perfusion to lungs. improves gas exchange, reduces pleural pressure, improves secretion removal. prone for 16hrs then supine for 8
risks: hemodynamic instability, skin breakdown, facial edema, emesis, unintentional extubation
ECMO - CORRECT ANSWER>>extracorporeal membrane oxygenation. large-bore catheters are inserted, blood is removed, oxygenated, CO2 is removed, and then returned to body
peripheral nerve stimulator - CORRECT ANSWER>>a battery- operated device used to assess the level of neuromuscular blockade by causing muscle contractions
Bind to ACh receptor on motor end plate and depolarize post junctional neuromuscular membrane. paralysis occurs because depolarized membrane can't respond to subsequent stimuli by ACh
succinylcholine
succinylcholine - CORRECT ANSWER>>rapid onset 30-60 seconds, ultra short duration, absence of adverse effects on smooth muscle
metabolized in blood and excreted by kidneys
side effects: hypotension, bradycardia, hyperkalemia, malignant hyperthermia
non-depolarizing agents - CORRECT ANSWER>>competitively block ACh transmission at post-junctional receptor sites. level of paralysis increases as number of receptor sites occupied by drug increases
pancuronium, atracurium, cisatracurium, vec, roc
NMB considerations - CORRECT ANSWER>>NMBs do not have sedative analgesic or amnestic properties. assure pain and sedation medication given beforehand.
precedex should not be used due to light sedative properties
assessments for effectiveness of NMB - CORRECT ANSWER>>-TOF -spontaneous breathing or movement -resistance to turning
-diaphoresis -vitals -ETCO
Train of four monitoring - CORRECT ANSWER>>-series of four twitches at 2 hz, every half second for 2 sec. -reflects blockade percentage -TOF based on provider order for pt's clinical goals
4 twitches: 0-75% of receptors blocked 3: 80% 2: 85% 1: 90% 0: 100%
must establish baseline before initiating NMB
NMB risks - CORRECT ANSWER>>-disconnection from ventilator -failure to cough -generalized deconditioning -skin breakdown -DVT -awake and paralyzed
NMB nursing care - CORRECT ANSWER>>-alarms on -monitor ABG and pulse ox -hemodynamics -frequent skin care and assessment, turn and rub, specialty bed/mattress
