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D Semester Exam 4 > Traches, ARDS, Vents > Flashcards

Traches, ARDS, Vents Flashcards

1
Q

What is “anatomical dead space”?

A

The volume of air within the respiratory structures that never participates in gas exchange because it does not reach functional alveoli. In healthy people, this is limited to the airspace in the conducting structures, about 150 mL.

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2
Q

What is the difference between PaO2 and SaO2?

A

Pa is partial pressure - 80-100 mmHg. Sa is saturation - 95-100%.

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3
Q

What is important to remember about anemic patients’ SaO2?

A

It can appear high while they are hypoxemic due to low hemoglobin = low absolute O2.

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4
Q

What is the oxyhemoglobin dissociation curve?

A

Graphical representation of the relationship between PaCO2 and SaO2. Essentially, oxygen binds tightly (lowering SaO2) to hgb at high PaO2 and loosely at low PaO2. Temperature, blood pH, and DPG are most common sources of right / left curve-shift (binding looser / tighter, respectively).

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5
Q

Describe capnography.

A

Monitors ventilation via exhaled carbon dioxide. Used to monitor vent performance, need for airway interventions.

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6
Q

What is the use of acetylcysteine in respiratory cases?

A

It’s a mucolytic - breaks down mucus allowing easier breathing.

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7
Q

What is the use of methylprednisolone in respiratory cases?

A

Reduce inflammation of the airway structures.

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8
Q

Why are PPIs and H2 antagonists used in respiratory cases?

A

They can reduce mucus production, opening airways.

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9
Q

What are the 3 stages of ARDs?

A

Injury / exudate - within first week, widespread increase in permeability of pulmonary capillaries, allowing fluid to leak into alveolar spaces, resulting in pulmonary edema.

Reparative / proliferative - weeks 2 & 3, inflammatory response diminishes, but lung injury continues. Fibrosis develops.

Fibrotic - week 4+, extensive pulmonary fibrosis and scarring.

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10
Q

What is ARDS characterized by?

A

Sudden, progressive pulmonary edema.

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11
Q

How does ARDS generally present?

A

Severe dyspnea, 12-48 hours after initial insult, high PaCO2 and low PaO2 in ABG, reduced lung compliance, tachypnea, hypotension.

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12
Q

What is the goal PaO2 for ARDS pt?

A

> 60 mmHg

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13
Q

What is the priority treatment pathway for ARDS?

A

Improve gas exchange - reduce inflammation, open airways.

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14
Q

What are important nursing interventions in ARDS?

A

HOB elevated, oxygen, positioning, vent monitoring, psychological support.

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15
Q

What are major complications of ARDS?

A

MODS, pulmonary emboli, pneumothorax. Vent complications like VAPneumonia, barotrauma, infection.

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16
Q

What is important pt education for ARDS?

A

Report s/s: SOB, increased heart rate, non-productive coughing, restlessness and distress without identifiable cause.

17
Q

What are the two types of ARF?

A

Hypoxic - PaO2 <60% - not getting enough oxygen.

Hypercapnic - PaCO2 >45 mmHg - not releasing enough CO2.

18
Q

What is PEEP and why is it important in respiratory cases?

A

Positive End Expiratory Pressure - applied to keep alveoli open at the end of each breath, improving oxygenation.

19
Q

What is a pulmonary bleb and why is it significant?

A

COPD patients often have areas of damaged lung tissue that are no longer active in gas exchange. If one of these fragile blebs breaks open, it can result in pneumothorax.

20
Q

What are diagnostic tools for ARF?

A

ABG, CXR, CT, CBC, CRP, D-Dimer, lung function tests.

21
Q

What are common tools used in managing ARF?

A

Hemodynamic monitoring - arterial line, central venous pressure, PAP monitoring.
Ventilation, intubation.

22
Q

What types of medications are used in ARF?

A

Diuretics, vasodilators, morphine.

23
Q

What is a high priority in assessing an ARF pt?

A

Determine underlying cause.

24
Q

What respiratory tools are extremely important to keep at the bedside for an ARDS pt?

A

BVM and obturator.

25
Q

What is important to remember about speaking valves on traches?

A

Only attach them once the trach cuff is deflated, otherwise the patient can only inhale, but cannot exhale.

26
Q

What are some common complications of tracheostomies?

A

Bleeding, pneumothorax, pneumomediastinum, damage to esophagus / swallow function, trach tube blockage.

27
Q

What are the two types of mechanical ventilation?

A

Negative pressure (iron lung) and positive pressure (modern).

28
Q

Describe CPAP ventilation.

A

Continuous Positive Airway Pressure

Used in pts who are spontaneously breathing, but need help keeping airway open.

29
Q

Describe CMV (ventilation).

A

Controlled Mechanical Ventilation

Ventilator is in complete control, sets resp rate, volume, pressure.

Used in pts who are very sedated or have weak / absent respiratory drive.

30
Q

Describe ACV (ventilation).

A

Assist-Control Ventilation

Vent delivers set tidal volume or perssure in response to pt’s own breathing efforts.

Used in pts with inconsistent respiratory drive.

31
Q

Describe AMV (ventilation).

A

Adaptive Minute Ventilation.

Vent automatically adjusts parameters based on pt response.

Used in pts with varying respiratory demands.

32
Q

Describe IMV (ventilation).

A

Intermittent Mandatory Ventilation.

Vent provides set number of mandatory breaths where pt can breathe in between mandatories.

Used as a weaning mode.

33
Q

Describe SIMV (ventilation).

A

Synchronized Intermittent Mandatory Ventilation.

Vent provides a set number of mandatory breaths, but syncs these up with pt’s voluntary breaths.

Used as a weaning mode.

34
Q

What is important to know about propofol?

A

Drug with a rapid onset and offset used for the induction and maintenance of general anesthesia and ICU sedation.

35
Q

What is sucralfate / carafate? What is it used for?

A

A medication that becomes a thick, sticky film once in the stomach, and serves to protect from gastric ulcers and irritation.

36
Q

What is fremitus?

A

Vibration felt on the outside of the ribcage when the pt is speaking. Lack of fremitus indicates reduced airspace in the chest cavity.

37
Q

What is hyperresonance?

A

Unusually prominent sounds upon percussion of the chest.

38
Q

What is the primary problem in ARDS?

A

Impaired gas exchange at the alveolar / capillary level due to fluid accumulation.

D Semester Exam 4 (8 decks)

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