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Question 1

What is ventilation?

Answer 1

Active breathing. Inspiration and expiration.

Question 2

What is hyperventilation and what can it cause?

Answer 2

Breathing off CO2 and respiratory alkalosis.

Question 3

What is hypoventilation and what can it cause?

Answer 3

Retain CO2 and respiratory acidosis.

Question 4

What is hypoxemic respiratory failure?

Answer 4

Low O2 leading to low blood O2 levels.

Question 5

What is hypercapnic respiratory failure?

Answer 5

Lungs can’t remove CO2 causing high CO2 levels in blood, causing an increase in rate and depth of respirations.

Question 6

What should you look for in hypercapnic patients and how should they be treated?

Answer 6

Mental status change and give them a BIPAP.

Question 7

High CO2 is a PaCO2 above?

Answer 7

45.

Question 8

What is gas exchange? How does it affect your patient?

Answer 8

CO2 out and O2 in. Exchange of gas between alveolar air and blood.

Question 9

Hypoxemia is an PaO2 of?

Answer 9

Less than 80 as normal range is 80-100.

Question 10

What are early signs of hypoxemia?

Answer 10

AMS- restlessness, agitation, confusion. High vitals- tachypnea, tachycardia, hypertension.

Question 11

Why might vitals be high early on with hypoxemia?

Answer 11

The body is desperately trying to push the little amounts of oxygen it does have around.

Question 12

What are the late vital signs of hypoxemia?

Answer 12

Low vital signs like bradypnea, bradycardia, hypotension, cyanosis, dysrhythmias.

Question 13

What are the expected ABG numbers of a COPD patient?

Answer 13

Low PaO2 which correlates to hypoxemia - low O2. High PaCO2 over 45 (acidosis) that correlates to hypercapnia - too much CO2. pH less than 7.35 acidosis.

Question 14

Is anemia common in COPD patients? And how does the RBCs cause risk to the patient?

Answer 14

No as RBC are actually increased due to hypoxia and they are also thicker blood causing risk of CVA or stroke.

Question 15

What is COPD?

Answer 15

Irreversible damage to the alveoli and bronchi of the lungs that causes decreased gas exchange.

Question 16

How does decreased gas exchange in COPD patients affect the lungs?

Answer 16

The double C’s- Chronic air trapping causing decreased gas exchange and decreased inflammatory damage. CO2 high which limits airflow and prevents exhalation.

Question 17

What are some possible causes of COPD?

Answer 17

Smoking and car mechanics, Alpha antitrypsin deficiency - genetic disorder affecting protein used to protect the lungs.

Question 18

How does smoking affect the lungs in COPD patients?

Answer 18

It damages the alveoli and ciliary action.

Question 19

What are some parts or subsections of COPD?

Answer 19

Chronic bronchitis, emphysema, hyperactivity airway disease.

Question 20

What does emphysema cause?

Answer 20

PINK- pursed lips and pink skin, increased chest (barrel chest), no chronic cough, tripoding.

Question 21

What is emphysema?

Answer 21

Loses lung elasticity and inflation due to loss of surfactant which helps the lungs stretch.

Question 22

Advanced emphysema can cause?

Answer 22

Frequent infections and risk of pneumothorax.

Question 23

Chronic Bronchitis Signs and symptoms?

Answer 23

BLUE- Bluish skin (cyanosis), long term (chronic) cough/sputum, unusual lung sounds (crackles and wheezes), edema peripherally (due to cor pulmonale). Last 3 months more, productive cough and mucous, more severe in the morning.

Question 24

What is cor pulmonale?

Answer 24

Caused from COPD. Patient experiences right-sided heart failure and body is rocked with fluids which can increase pressure in the lungs due to pulmonary hypertension.

Question 25

What are COPD manifestations?

Answer 25

New dyspnea, weight loss, clubbing (chronic hypoxia - vasodilation), prolonged expiration, respiratory acidosis, compensatory polycythemia.

Question 26

When assessing someone showing signs of polycythemia in COPD patients, they may need what drug and why?

Answer 26

Low dose heparin due to increased thickness in RBC that can cause stroke.

Question 27

What must you report with a patient exhibiting polycythemia?

Answer 27

High hemoglobin levels.

Question 28

When treating COPD medications, it is important to not use what kind of medications?

Answer 28

Opioids or benzos.

Question 29

What are some examples of a short and long acting bronchodilator?

Answer 29

Albuterol and salmeterol.

Question 30

What are bronchodilators?

Answer 30

Widen airway to breathe easier.

Question 31

What is a common beta 2 agonist?

Answer 31

Albuterol.

Question 32

What is albuterol used for? and why?

Answer 32

Brutal asthma attack because it is the only rescue inhaler.

Question 33

What is a common anticholinergic? and what does it do? When should it be used in an asthma attack?

Answer 33

Dries out the body. Ipratropium. 2nd.

Question 34

Why are methylxanthines so toxic especially theophylline?

Answer 34

They can cause seizures if given over 20 mcg, fast HR, and dysrhythmias.

Question 35

What are methylxanthines examples?

Answer 35

Theophylline, aminophylline.

Question 36

What should be avoided when taking methylxanthines?

Answer 36

Beta blockers as they lower heart rate, cimetidine and ciprofloxacin as they increase toxicity and caffeine.

Question 37

What is important to let the doctor know of before giving the next dose of methylxanthine?

Answer 37

Tachycardia.

Question 38

How do xanthine bronchodilators work?

Answer 38

Inhibit phosphodiesterase and increase cAMP causing bronchodilation.

Question 39

What issues can beta agonists cause?

Answer 39

Tachycardia, hypertension, palpitations.

Question 40

After using beta 2 agonist, a patient may feel?

Answer 40

Increased productive cough, decreased anxiety, mild hand tremors, and difficulty sleeping.

Question 41

What should be avoided with beta 2 agonists?

Answer 41

Beta blockers as they can cause bronchospasm.

Question 42

How do you know a beta 2 agonist is effective? And what should you monitor?

Answer 42

Decreased respirations, 90% or more oxygen saturation. Heart rhythm and B/P.

Question 43

Routes for beta 2 agonists?

Answer 43

PO or inhalant but inhalant is preferred.

Question 44

Examples of inhaled corticosteroids?

Answer 44

Beclomethasone, budesonide, fluticasone, and methylprednisolone.

Question 45

When should inhaled corticosteroids be used in an asthma attack and which one is typically used?

Answer 45

3rd and methylprednisolone.

Question 46

What are common side effects of inhaled corticosteroids?

Answer 46

Sugar increase and sores in mouth (infection).

Question 47

After using inhaled corticosteroids, it is important to do what?

Answer 47

Rinse the mouth out to prevent thrush and candida and don't swallow the water or use spacers.

Question 48

What is important with oxygen therapy in COPD patients?

Answer 48

O2 goal isn't as high as people without COPD. Avoid large amounts, remove apnea, CO2 poisoning, remove COPD respiratory drive.

Question 49

What is a common antibiotic for COPD?

Answer 49

Ancef.

Question 50

How should metered dose inhalants be used?

Answer 50

Patient sit upright, shake before you take, hold breath for 10 seconds so med can get deep in airway, exhale with pursed lips, 3 mins between puffs, rinse mouth.

Question 51

What are examples of corticosteroids?

Answer 51

Prednisone (oral), inhaled corticosteroids, Advair.

Question 52

What are some side effects of oral prednisone?

Answer 52

Hypernatremia, hyperglycemia, hypokalemia, GI bleed (black tarry stool).

Question 53

What are the side effects of anticholinergics?

Answer 53

Can't see, pee, poop, or spit.

Question 54

How should you treat the side effects from anticholinergics?

Answer 54

Gum or fluids.

Question 55

When are anticholinergics contraindicated?

Answer 55

If already dry, glaucoma, urinary retention, bowel obstruction.

Question 56

Examples of anticholinergics? Short and long acting.

Answer 56

Atrovent (short acting), Respimat (short), Spiriva (long).

Question 57

Example of a mucolytic?

Answer 57

Acetylcysteine (Mucomyst).

Question 58

What is Acetylcysteine used for overdose wise?

Answer 58

Tylenol poisoning.

Question 59

Acetylcysteine is contraindicated in?

Answer 59

Asthma patients as it causes bronchospasms.

Question 60

Nursing considerations for Acetylcysteine?

Answer 60

Resp insufficiency, inadequate coughing mechanism, gag reflex depression, secretions may occlude if not cleared.

Question 61

What is asthma?

Answer 61

Chronic inflammatory disease in pathway of lungs bronchi, or bronchioles.

Question 62

What occurs during an asthma attack?

Answer 62

Bronchoconstriction, inflammation causing tightness and increased mucous production from goblet cells in respiratory tract.

Question 63

Why is it hard to exhale with asthma attacks?

Answer 63

Resp tract is constricted so O2 can't get in and CO2 can't get out causing air to be trapped preventing exhalation.

Question 64

Etiology of asthma?

Answer 64

Genetic disorders and environmental factors triggered by allergens.

Question 65

Signs and symptoms of asthma?

Answer 65

A-accessory muscle use, S-SOB, T-tight chest, H-high pitch wheezing, M-minimal diminished breath sounds, A-3 A's absent breath sounds (silent chest), acidosis (O2 retention), air trapping (prolonged exhalation).

Question 66

Test for asthma?

Answer 66

Pulmonary function test - how well lungs work.

Question 67

Peak Expiratory Flow Rate (PEFR)?

Answer 67

Measure of the fastest flow of exhaled air after a maximal inspiration.

Question 68

Treatments for asthma?

Answer 68

Bronchodilators and corticosteroids, antinflammatories, epinephrine injections, inhaler, leukotriene inhibitors.

Question 69

What are leukotriene inhibitor examples? And what are they used for?

Answer 69

"Lukast" Montelukast (Singulair). Used for long-term management.

Question 70

Are leukotriene inhibitors used for asthma attacks?

Answer 70

Not for acute asthma attacks. They are for long onset and used to prevent inflammation that causes asthma attacks.

Question 71

What is cromolyn?

Answer 71

Mast cell stabilizer used for asthma to block the massive swelling.

Question 72

When is the best time to use Cromolyn?

Answer 72

10-15 minutes before activity.

Question 73

Nasal Cannula?

Answer 73

1-6 lpm. Short- low O2 after surgery. Long- can dry out membranes need humidification.

Question 74

Partial rebreather?

Answer 74

6-10 lpm.

Question 75

NRB?

Answer 75

10-15 lpm for carbon monoxide poisoning. If bag deflates, increase O2.

Question 76

Simple face mask?

Answer 76

In exchange for partial rebreather. 6-10 lpm.

Question 77

Venturi mask?

Answer 77

A face mask and reservoir bag device that delivers the most accurate oxygen. Used for unstable COPD.

Question 78

Face tent?

Answer 78

Facial trauma high humidification.