(3) All Respiratory Flashcards
Respiratory Dysfunctions (Objective#22) 📈What is the best diagnostic study to use with a Pulmonary Embolism?
Ventilation / Perfusion Scan
Respiratory Dysfunctions (Objective#22) 📈 What is the most frequently used Diagnostic Test for a Pulmonary Embolism, requires IV Contrast and allows for 3D visualization of all regions of the lungs?
Spiral (Helical) CT Scan
Respiratory Dysfunctions (Objective#22) What are Pulmonary Embolisms caused by 90% of the time?
Deep Vein Thrombosis (DVT)
Respiratory Dysfunctions (Objective#22) 💉 What protein identifies that a blood clot was present, is elevated with any clot degradation and can give false negatives with small a small pulmonary embolism?
D-Dimer
Respiratory Dysfunctions (Objective #22) 💊 What type of medication is used if heart failure is present?
Diuretics
Respiratory Dysfunctions (Objective#22) 💉When monitoring laboratory results for pulmonary embolism, what do you want the the Warfarin / Coumadin therapeutic range to be?
2.0 - 3.0
Respiratory Dysfunctions
(Objective #22)
😷 Nursing Management for patient with a Pulmonary Embolism?
▪️Bed Rest in Semi-Fowlers Position ▪️IV Access ▪️O2 Therapy ▪️Frequent Assessments ▪️Monitor Laboratory Results ▪️Emotional Support and Reassurance ▪️
Respiratory Dysfunctions (Objective#22) 💊To wean patients off of Heparin, what is given before Heparin is stopped / discontinued?
Coumadin
Respiratory Dysfunctions (Objective#22) What percentage of patients with a Pulmonary Embolism die within the first hour?
10%
Respiratory Dysfunctions (Objective #22) 🚬 What type of medication therapy increases the risk for a Pulmonary Embolism?
Oral Contraceptives and Hormone Therapy
Respiratory Dysfunctions (Objective#22) What blockage of the pulmonary artery by thrombus can be stationary or an emboli?
Pulmonary Embolism
Respiratory Dysfunctions (Objective#22) What is put in the inferior vena cava through the femoral artery to prevent migration of clots in the pulmonary system?
Inferior Vena Cava Filters
Respiratory Dysfunctions (Objective#22) 📈What Diagnostic study involves inection and inhalation of a radioactive substance?
VQ Scan (Ventilation Perfusion Scan)
Respiratory Dysfunctions (Objective#22) 😰What symptoms are expected with a Massive Emboli?
Abrupt Hypotension and Shock
Respiratory Dysfunctions
(Objective #22)
💉 What is troponin and why are troponin levels tested?
Proteins that are found in the heart. Troponin levels are tested because the protein is released when there is damage to the heart such as a MI or CHF.
Respiratory Dysfunctions
(Objective #22)
😷 Respiratory measures to help prevent or treat atelectasis?
Turn, Cough, Deep Breathing, and Incentive Spirometry
Respiratory Dysfunctions (Objective#22) 💊 How long will a patient be on Coumadin when given to wean off Heparin?
3-6 months
Respiratory Dysfunctions
(Objective #22)
🚬 Surgery, especially pelvic and lower extremity surgery, within what time frame increases the risk for Pulmonary Embolism?
Last 3 months
Respiratory Dysfunctions (Objective #22) 🚬 What can lead to an increase in muscle mass, but the muscle does not increase its pumping ability, and instead accumulates myocardial scarring (collagen)?
Pathological Hypertension
Respiratory Dysfunctions (Objective#22) What is an emboli?
Something that travels from a different location
Respiratory Dysfunctions
(Objective #22)
💊 What medication helps to prevent new blood clots from forming and helps keep existing blood clots from getting worse?
Warfarin (Coumadin)
Respiratory Dysfunctions (Objective#22) In severe cases, what surgery can be performed for a massive pulmonary embolism that has a high mortality rate?
Pulmonary Embolectomy
Respiratory Dysfunctions
(Objective #22)
💊 What are Tissue Plasminogen Activators used for?
Clot busters
Respiratory Dysfunctions (Objective#22) ♿️Complications of a Pulmonary Embolism
▪️Pulmonary Infarction
▪️Pulmonary Hypertension
Respiratory Dysfunctions (Objective#22) 💊What medication is given to patients that have a predisposition for an emboli?
Heparin
Respiratory Dysfunctions (Objective#22) 😷How do you prevent DVT and Pulmonary Embolism?
▪️Early ambulation of post-op patients ▪️Avoid immobility ▪️Leg exercises for bedridden patients ▪️Prophylactic Anticoagulants ▪️Pneumatic device for lower extremities
Respiratory Dysfunctions
(Objective #22)
♿️ Occlusion of a large or medium-sized pulmonary vessel (<2mm), insufficient collateral blood flow from the bronchial circulation, and preexisting lung disease are factors most likely to be present in what complication?
Pulmonary Infarction (Death of Lung Tissue)
Respiratory Dysfunctions
(Objective #22)
💉 What hormone in the blood is produced mainly in the L. Ventricle and picks up any Ventricular volume expansion and pressure overload?
B-Type Natriuretic Peptide (BNP)
Respiratory Dysfunctions
(Objective #22)
💉 What is know as the “Cardiac Mirror Hormone”?
B-Type Natriuretic Peptide (BNP)
Respiratory Dysfunctions
(Objective #22)
🚬 What are the risk factors for a Pulmonary Embolism?
**FYI- I listed the 3 she talked about the most in other sides but here is the entire list incase you want to know all of them
▪️DVT ▪️IV or Syringe that hasn't been primed ▪️Fracture of long bone ▪️Immobility or Reduced Mobility ▪️Surgery ▪️History of DVT ▪️Malignancy ▪️Obesity ▪️Smoking ▪️Heart Failure ▪️Pregnancy / Delivery ▪️Clotting Disorders ▪️Atrial Fibrillation ▪️Central Venous Catheters
Respiratory Dysfunctions (Objective#22) 😷 What type of support should not be overlooked in patient with a Pulmonary Embolism and why?
Emotional support and reassurance because the patient is scared.
Respiratory Dysfunctions (Objective#22) 😷 How do you assess for bleeding in patients taking Anticoagulant Therapy?
Turn them over because bleeding tends to pool
Respiratory Dysfunctions (Objective#22) Describe the process of a Pulmonary Embolism.
Material gets access to the Venus system → Pulmonary Circulation → Travels with blood flow until it gets to smaller and smaller vessels → Obstructs alveolar perfusion → Stops
Respiratory Dysfunctions (Objective#22) 💉 What is a normal PTT?
25-35 seconds
Respiratory Dysfunctions (Objective #22) Most patients die within how long after the onset of a massive emboli?
1 - 2 hours
Respiratory Dysfunctions (Objective#22) What results from hypoxia associated with a massive or recurrent emboli?
Pulmonary Hypertension
Respiratory Dysfunctions (Objective#22) 💊 What is a low weight Heparin that is given SubQ and considered safer?
Lovenox
Respiratory Dysfunctions
(Objective #22)
What percentage die from a reoccurring Pulmonary Embolism?
30%
Respiratory Dysfunctions (Objective#22) 😷 In addition to turn, cough and deep breathing, how often should a patient use an inventive spirometer after surgery?
Every couple hours for the first 24 hours
Respiratory Dysfunctions
(Objective #22)
♿️ What complications can occur secondary to Pulmonary Infarction?
▪️Hemorrhaging ▪️Abscesses ▪️Pulmonary Hypertension ▪️Hypoxic ▪️️Pleural Effusion (Fluid build up between pleural space)
Respiratory Dysfunctions (Objective #22) 💉 What lab test can be done to determine if pulmonary hypertension or any other damage to the heart has occurred due to a Pulmonary Embolism?
Troponin Levels (Troponin i & Troponin T)
Respiratory Dysfunctions
(Objective #22)
♿️ What can develop secondary to Pulmonary Hypertension?
Right Ventricular Hypertrophy
Respiratory Dysfunctions (Objective#22) ♿️ What complication can manifest from unrelieved Pulmonary Hypertension?
Right Ventricular Hypertrophy
Respiratory Dysfunctions (Objective#22) 📈 Although it is NOT diagnostic of a Pulmonary Embolism, what might a Electrocardiogram reveal?
ST segment or T-Wave Changes
Respiratory Dysfunctions
(Objective #22)
😷 Nursing Management for a Pulmonary Embolism?
▪️Bed Rest in a Semi-Fowlers Position ▪️IV access ▪️Oxygen therapy for support ▪️Frequent Assessments ▪️Monitor Lab Results ▪️Emotional Support and Reassurance ️▪️Vital Signs ▪️Cardiac Rhythm ▪️Pulse Oximetry ▪️ABG's if ordered ▪️Listen to Lung Sounds
Respiratory Dysfunctions (Objective#22) 😰Clinical Manifestations of a Pulmonary Embolism
▪️Dyspnea ▪️Tachypnea ▪️Cough ▪️Chest Pain ▪️Hemoptysis ▪️Fever ▪️Tachycardia ▪️Syncope ▪️Change in LOC
Respiratory Dysfunctions (Objective#22) 💉 Due to inadequate oxygenation to an occluded vessel, what results may appear with ABG's?
↓PaO2
Respiratory Dysfunctions (Objective#22) What blocks the pulmonary arteries to cause a Pulmonary Embolism?
Thrombus, Fat or Air Embolus, or Tumor Tissue
Respiratory Dysfunctions (Objective#22) 😷 What is the first thing you want to do if a pulmonary embolism is suspected?
Sit the patient up in the semi-fowlers position
Respiratory Dysfunctions (Objective#22) What type of obstruction can be caused by a IV or Syringe that hasn't been primed?
Air Embolism
Respiratory Dysfunctions (Objective#22) What injury causes a Fat Embolism?
Fractured Long Bone
Respiratory Dysfunctions (Objective#22) 📈 What Diagnostic Test is done first with a Pulmonary Embolism?
X-Ray
Respiratory Dysfunctions (Objective#22) 😷 What complications do you want to asses for when a patient is on Anticoagulant Therapy?
Petechia
Bruising
Bleeding
Respiratory Dysfunctions (Objective#22) 📈 What does an X-Ray reveal with a Pulmonary Embolism?
Flattening diaphragm, and respiratory distress or atelectasis (alveolar collapsing).
Respiratory Dysfunctions
(Objective #22)
😷 What are the objectives when a PE is suspected or present?
▪️Prevent further growth or multiplication of thrombi in the lower extremities
▪️Prevent embolization from the upper or over extremities to the pulmonary vascular system
▪️Provide cardiovascular support if indicated
Respiratory Dysfunctions
(Objective #22)
If minimal or no other oxygen supply reaches the essential parts of the pulmonary system, either from the airways or from the bronchial arterial circulation, what will occur due to necrosis of the lung tissue?
Pulmonary Infarction
Respiratory Dysfunctions (Objective#22) ♿️ What complication of a Pulmonary Embolism is most likely due to an occlusion in a large vessel, insufficient circulation in the bronchial system, or preexisting lung disease?
Pulmonary Infarction
Respiratory Dysfunctions (Objective#22) What type of Emboli can be taken care of by out circulatory system?
Small Emboli
Respiratory Dysfunctions (Objective #22) 📈 Patients with a suspected PE and an elevated D-dimer level but normal venous ultrasound may need what diagnostic tests done?
Spiral CT or Lung Scan
Respiratory Dysfunctions (Objective#22) A Pulmonary Embolism is usually found in what part of the lungs?
Smaller vessels in the lower lobes
Respiratory Dysfunctions
(Objective #22)
😷 What is administered if manifestations of shock are present?
IV Fluids followed by vasopressor agents as needed to support perfusion.
Respiratory Dysfunctions (Objective#22) 😰What sounds may be heard in the lungs with a Pulmonary Embolism?
▪️Crackles
▪️Wheezing
Respiratory Dysfunctions
(Objective #22)
🚬 What risk factors are the less common causes of Pulmonary Embolism?
▪️Fat Emboli ▪️Air Emboli ▪️Bacterial Vegetations ▪️Amniotic Fluid ▪️Tumors
Respiratory Dysfunctions (Objective#22) 💉 What is the PTT therapeutic range for patient receiving Heparin?
1.5 - 2 times the normal value.
Respiratory Dysfunctions (Objective#22) 😰What is the most common symptom of a Pulmonary Embolism and is present in 85% of cases?
Dyspnea (Shortness of Breath)
Respiratory Dysfunctions (Objective#22) 💊 What pain medication is given r/t coronary blood flow?
Morphine
Respiratory Dysfunctions (Objective#22) What tissue plasminogen activator in our body causes blood clots to dissolve?
Alteplase
Respiratory Dysfunctions
(Unit II C, Objectives 3-5)
💹 What are the best diagnostic studies for Asthma?
▪️Peak Flow Monitoring / PERF
▪️Pulmonary Function Test
Respiratory Dysfunctions (Unit II C, Objectives 3-5) 💊 Albuterol and Pirbuterol are what type of drug used for the treatment of Asthma?
β-Adrenergic Agonist (SABA’s)
Respiratory Dysfunctions (Unit II C, Objectives 3-5) How often does Moderate Persistent Asthma occur?
Daily
Respiratory Dysfunctions (Unit II C, Objectives 3-5) 📚 When do you teach patients with Asthma?
Start at time of diagnosis and integrate through care
Respiratory Dysfunctions
(Unit II C, Objectives 3-5)
💊 What is treatment for Asthma based on?
Severity and response to therapy
Respiratory Dysfunctions
(Unit II C, Objectives 3-5)
💊💥 What medications are given to treat Severe and Life-Threatening Exacerbations?
▪️IV Corticosteroids
▪️IV Magnesium Sulfate
▪️IV Fluid
Respiratory Dysfunctions
(Unit II C, Objectives 3-5)
♿️ When Severe and Life-Threatening Exacerbations occur with Asthma, what is the expected HR and Peak with Flow Reader?
▪️Pulse >120
▪️Peak with Flow Reader is 40% at best even when they are at rest
Respiratory Dysfunctions (Unit II C, Objectives 3-5) What is a chronic inflammatory disorder of the airways that is associated with variable airflow obstruction?
Asthma
Respiratory Dysfunctions (Unit II C, Objectives 3-5) 📚 When teaching patients with Asthma about reading / interpreting Peak Flow Meter results, what information do they need to know about the "Red Zone"?
It indicates that the regimen isn’t working. There is a serious problem and action must be taken with the HCP.
Respiratory Dysfunctions (Unit II C, Objectives 3-5) 💊 What type of Corticosteroid is used for long-tern control?
Inhaled form
Respiratory Dysfunctions (Unit II C, Objectives 3-5) When you're exposed to something, what cells attack and remember so that next time they know how to respond to it next time? They are known to have a long memory.
T & B Lymphocytes
Respiratory Dysfunctions
(Unit II C, Objectives 3-5)
💊 Which Bronchodilator is most likely not going to be used due to is its side effects and reaction with other medications?
Methylxanthines- Theophylline
Respiratory Dysfunctions
(Unit II C, Objectives 3-5)
😰 What Vital Sign changes are expected during an Asthma Attack?
(BP/HR/Resp)
▪️↑B/P
▪️↑HR
▪️↑Resp (>30)
Respiratory Dysfunctions
(Unit II C, Objectives 3-5)
💊💥 How often and by what route are Anti-IgE drugs administered?
SubQ injection Q2-4 Weeks
Respiratory Dysfunctions (Unit II C, Objectives 3-5) 💊💥 What patient using Corticosteroids for the treatment of Asthma need to make sure they're taking more Calcium, Vitamin D and doing weight bearing exercises?
Post-Menopausal
Respiratory Dysfunctions
(Unit II C, Objectives 3-5)
What gender is 76% more likely to have asthma?
Woman
Respiratory Dysfunctions (Unit II C, Objectives 3-5) 💊💥 What Leukotriene Modifier Drug that is used to treat or prevent Asthma is used as prophylaxis and maintenance therapy?
Montelukast (Singulair)
Respiratory Dysfunctions
(Unit II C, Objectives 3-5)
😰 What breath sounds will be heard during a Minor Asthma Attack?
Inspiratory and Expiratory Wheezing
Respiratory Dysfunctions
(Unit II C, Objectives 3-5)
♿️ What are the S/S of Life-Threatening Asthma?
▪️Cant Speak ▪️Perspiring ▪️Confused ▪️Drowsy - Low Oxygen ▪️Peak Expiratory Flow Rate <25%
Respiratory Dysfunctions
(Unit II C, Objectives 3-5)
💊💥 What 3 Anti-Inflammatory Drugs are used for the treatment of Asthma?
▪️Conticosteroids
▪️Leukotriene
▪️Monoclonal Antibody (Anti-IgE)
Respiratory Dysfunctions (Unit II C, Objectives 3-5) How often does Mild Persistent Asthma occur?
Greater than 2 days/week but not daily
Respiratory Dysfunctions
(Unit II C, Objectives 3-5)
💊💥 What Leukotriene Modifier drug is used for the treatment of Asthma?
Singulair
Respiratory Dysfunctions
(Unit II C, Objectives 3-5)
💊💥 How often are IV Corticosteroids administered?
Q4-6hrs & then are given orally
Respiratory Dysfunctions (Unit II C, Objectives 3-5) 💊💥 What is important to remember if it is the patients first dose of Anti-IgE?
1st Dose given in MD office
Respiratory Dysfunctions
(Unit II C, Objectives 3-5)
Symptoms in the Early Phase of Asthma that is common with substances such as cleaning supplies, occurs within what amount of time?
30-60 minutes
Respiratory Dysfunctions
(Unit II C, Objectives 3-5)
💊 What are the side effects of Corticosteroids?
▪️Thrush
▪️Dry Hacking Cough
▪️Hoarseness
Respiratory Dysfunctions
(Unit II C, Objectives 3-5)
♿️ What complication of Asthma usually requires admission to ICU?
Life-Threatening Asthma
Respiratory Dysfunctions
(Unit II C, Objectives 3-5)
😰 An Acute Asthma Attack usually reveals signs of what symptom?
Hypoxermia
Respiratory Dysfunctions
(Unit II C, Objectives 3-5)
💊💥 What is given as a Bronchodilator for the treatment of Severe and Life-Threatening Exacerbations and relaxes smooth muscle?
IV Magnesium Sulfate
Respiratory Dysfunctions
(Unit II C, Objectives 3-5)
🚬 What are the risk factors / triggers for asthma?
▪️Genetics - Inherited component is complex ▪️Immune Response ▪️Allergens ▪️Exercise ▪️Air Pollutants ▪️Occupational Factors ▪️Respiratory Infections ▪️Nose & Sinus Problems ▪️Drug & Food Additives ▪️GERD ▪️Emotional Stress ▪️Aspirin Triad
Respiratory Dysfunctions
(Unit II C, Objectives 3-5)
💊💥 What is used to treat inflammation Asthma in Late Phase of the response?
Corticosteroids
Respiratory Dysfunctions
(Unit II C, Objectives 3-5)
♿️ What are the complications of Asthma?
▪️Severe and Life-Threatening Exacerbations
▪️Life-Threatening Asthma
Respiratory Dysfunctions (Unit II C, Objectives 3-5) 💊 Xolair is what type of drug used for the treatment of Asthma?
Anti-IgE
Respiratory Dysfunctions
(Unit II C, Objectives 3-5)
💊💥 What drug used for the treatment of Asthma inhibits chemicals your body releases that causes swelling in the lungs and tightening of the muscles in the airways when you breathe in allergen?
Montelukast (Singulair)
Respiratory Dysfunctions (Unit II C, Objectives 3-5) What 3 factors cause obstruction in Asthma?
▪️Muscle Spasms
▪️Swollen Mucosa
▪️Mucus
Respiratory Dysfunctions
(Unit II C, Objectives 3-5)
What is the response / role of Macrophages, Eosinophils and Neutrophils?
They respond to invaders and fight infection
Respiratory Dysfunctions (Unit II C, Objectives 3-5) 🚬💥 How do Short Term Agonist Drugs effect GERD?
Short Acting Bronchodilators relax the small airway and smooth muscle → Esophagus / Esophageal Flap gets lazy → Reflux
Respiratory Dysfunctions (Unit II C, Objectives 3-5) 💊 How long is the onset of action and duration of β-Adrenergic Agonist (SABA's) used for the treatment ofAsthma?
Onset = within minutes Duration = 4 - 8 hours
Respiratory Dysfunctions (Unit II C, Objectives 3-5) 🚬💥 How does GERD trigger Asthma?
Due to drugs (Short Term Agonist)
Respiratory Dysfunctions (Unit II C, Objectives 3-5) 😰 What behavioral changes occur during an Asthma Attack?
▪️Restlessness
▪️Anxiety
▪️Panic
Respiratory Dysfunctions (Unit II C, Objectives 3-5) 📚💥 When teaching patients with Asthma about reading / interpreting Peak Flow Meter results, what three color zones will you teach them about?
🚦Green Zone
🚦Yellow Zone
🚦Red Zone
Respiratory Dysfunctions
(Unit II C, Objectives 3-5)
💊 What drug is effective for relieving acute bronchospasms r/t Asthma?
β-Adrenergic Agonist (SABA’s)
Respiratory Dysfunctions (Unit II C, Objectives 3-5) 😰 How do you gauge the severity of an Asthma Attack by the extent of wheezing?
Wheezing is unreliable to gauge severity
Respiratory Dysfunctions
(Unit II C, Objectives 3-5)
📚 What should you teach patients with Asthma about non-prescription drugs?
Non-Prescription combination drugs should be avoided.
Respiratory Dysfunctions (Unit II C, Objectives 3-5) 💊 What 3 types of Bronchodilators are used for the treatment of Asthma?
▪️β-Adrenergic Blocker
▪️Anticholinergics
▪️Methylxanthines
Respiratory Dysfunctions
(Unit II C, Objectives 3-5)
What antibody is present in minute amounts in the body but plays a major role in allergic diseases by binding to allergens → triggers the release of substances from mast cells that cause inflammation → to begin a cascade of allergic reactions?
IgE
Respiratory Dysfunctions
(Unit II C, Objectives 3-5)
💊💥 Monoclonal Antibody binds to IgE Antibody to decrease what symptom of Asthma?
Bronchoconstriction
Respiratory Dysfunctions (Unit II C, Objectives 3-5) 🚬 What type of nose and sinus problems can be a risk factor or trigger Asthma?
▪️Inflammation of mucus membranes
▪️Polyps that need to be removed
▪️History of allergic rhinitis
Respiratory Dysfunctions
(Unit II C, Objectives 3-5)
💊 What treatment is used for Moderate Asthma Exacerbations?
▪️Short Term Beta Agonist
▪️Oral Corticosteroids (Advair)
▪️O2 therapy may be started & monitored
Respiratory Dysfunctions (Unit II C, Objectives 3-5) 📚 What should patients with Asthma be taught to do if bronchospasms occur?
Seek medical attention.
Respiratory Dysfunctions (Unit II C, Objectives 3-5) How often does Intermittent Asthma occur?
Less than or equal to 2 days a week
Respiratory Dysfunctions
(Unit II C, Objectives 3-5)
♿️ What can occur if inflammation of Asthma isn’t treated or resolved?
It can lead to irreversible lung damage
Respiratory Dysfunctions
(Unit II C, Objectives 3-5)
💉 What labs may be drawn on patient with Asthma?
ABG’s
Respiratory Dysfunctions
(Unit II C, Objectives 3-5)
🚬💥 What is Aspirin Triad?
Complex medical condition that causes patients to have Asthma, Nasal Polyps and Chronic Sinusitis due to sensitivity to Salicylate’s / Aspirin.
Respiratory Dysfunctions (Unit II C, Objectives 3-5) 📚💥 When teaching patients with Asthma about reading / interpreting Peak Flow Meter results, what percentage is within the "Red Zone"?
<50%
Respiratory Dysfunctions (Unit II C, Objectives 3-5) 📚 When teaching patients with Asthma about reading / interpreting Peak Flow Meter results, what information do they need to know about the "Green Zone"?
To remain on their medication
Respiratory Dysfunctions
(Unit II C, Objectives 3-5)
💊 What form of Corticosteroid is used to control Exacerbations and manage Persistent Asthma?
Systemic
Respiratory Dysfunctions
(Unit II C, Objectives 3-5)
💊💥 What Oxygen therapy is given as treatment for Severe Life-Threatening Exacerbations?
▪️Keep oxygenated to improve ventilation
▪️Heliox- (Mixture of Oxygen & Helium)
▪️Supplemental O2 by mask or cannula for 90% Sat.
Respiratory Dysfunctions
(Unit II C, Objectives 3-5)
💊💥 Heliox (Combination of Helium & Oxygen) is used to treat Severe Life-Threatening Exacerbation because helium has low density and may help improve bronchodilation of what drug?
Albuterol
Respiratory Dysfunctions
(Unit II C, Objectives 3-5)
💊 What treatment is used for Acute Asthma Exacerbations / Respiratory Distress?
Rescue Plan → 2-4 puffs of Albuterol Q20 min x3
Respiratory Dysfunctions (Unit II C, Objectives 3-5) 💊💥 What Bronchodilator alleviates the early phase of Asthma attacks but has little effect on bronchial hyper-responsiveness, is considered a less effective long-term Bronchodilator and has a 💥NARROW MARGIN OF SAFETY?
Methylxanthines
Respiratory Dysfunctions (Unit II C, Objectives 3-5) 😰 During an Asthma Attack, what changes occur related to breathing?
▪️Feeling of suffocation due to difficulty with air movement ▪️Prolonged Expiration ▪️Cant take a deep breath ▪️Hard time speaking ▪️Using accessory muscles to breathe
Respiratory Dysfunctions (Unit II C, Objectives 3-5) 💊 Zafirlukast, Montelukast, and Zileuton are what type of drugs used for the treatment of Asthma?
Leukotriene Modifiers / Inhibitors
Respiratory Dysfunctions (Unit II C, Objectives 3-5) What Worldwide program produce guidelines, reports and resources about Asthma?
Global Initiative for Asthma (GINA)
Respiratory Dysfunctions
(Unit II C, Objectives 3-5)
🚬💥 What is Hygiene Hypotheses?
Increased susceptibility to allergic diseases due to suppressing the natural development of the immune system by lack of early childhood exposure to infectious agents, microorganisms and parasites.
Respiratory Dysfunctions (Unit II C, Objectives 3-5) 💊💥 Why is the first dose of Anti-IgE drugs given at the MD office?
Because they can have a severe allergic reaction.
Respiratory Dysfunctions (Unit II C, Objectives 3-5) 💊💥 What can the patient do to reduce the dry, hacking cough caused by Corticosteroid therapy?
▪️Use a spacer
▪️Gargle / Rinse after each use
Respiratory Dysfunctions
(Unit II C, Objectives 3-5)
💊 What drugs have both Bronchodilator and Anti-Inflammatory effects but is not indicated for acute attacks?
Leukotriene Modifiers / Inhibitors
Respiratory Dysfunctions (Unit II C, Objectives 3-5) What are the classifications of Asthma?
▪️Intermittent
▪️Mild Persistent
▪️Moderate Persistent
▪️Severe Persistent
Respiratory Dysfunctions
(Unit II C, Objectives 3-5)
😷💥 How often should the patient with Critical, Severe and Life -Threatening Exacerbations be monitored ?
Continuous Monitoring
Respiratory Dysfunctions (Unit II C, Objectives 3-5) The Late Phase response of Asthma occurs within how long after the initial attack?
4 - 6 hours
Respiratory Dysfunctions
(Unit II C, Objectives 3-5)
💊💥 What drug is used to treat thrush caused by Corticosteroid therapy?
Nystatin
Respiratory Dysfunctions (Unit II C, Objectives 3-5) 💊💥 What are the two different types of inhalers that are used as a means of delivering Asthma medication?
▪️Metered Dose Inhaler (MDI)
▪️Dry Powder Inhaler (DPI)
Respiratory Dysfunctions
(Unit II C, Objectives 3-5)
💊 What drug used for the treatment of Asthma suppresses inflammatory response, reduces bronchial hyper-responsiveness and decreases mucus production?
Corticosteroid
Respiratory Dysfunctions (Unit II C, Objectives 3-5) How often does Severe Persistent Asthma occur?
Continuous
Respiratory Dysfunctions (Unit II C, Objectives 3-5) 📚💥 When teaching patients with Asthma about reading / interpreting Peak Flow Meter results, what percentage is within the "Green Zone"?
> 80%
Respiratory Dysfunctions
(Unit II C, Objectives 3-5)
🚬 How can overuse of Antibiotics cause an immune response that is a risk factor or triggers Asthma?
Building up resistance
Respiratory Dysfunctions
(Unit II C, Objectives 3-5)
🚬 Sensitivity to what chemical found in aspirin and pain relievers can be a risk factor or trigger Asthma?
Salicylates
Respiratory Dysfunctions
(Unit II C, Objectives 3-5)
What are the two phases of Asthma?
Early & Late
Respiratory Dysfunctions (Unit II C, Objectives 3-5) 💊 Beclomethasone and Budesonide are what type of drugs used to treat Asthma?
Inhaled Corticosteroids (ICS)
Respiratory Dysfunctions
(Unit II C, Objectives 3-5)
😰 Asthma leads to recurrent episodes of what symptoms?
▪️Wheezing
▪️Breathlessness
▪️Chest Tightness
▪️Cough
Respiratory Dysfunctions (Unit II C, Objectives 3-5) 💊💥 What type of inhaler is usually easier to use for the treatment of Asthma?
Dry Powder Inhaler (DPI)
Advair is in a diskus
Respiratory Dysfunctions (Unit II C, Objectives 3-5) 💊💥 What type of inhaler is used to administer Advair for the treatment of Asthma?
Dry Powder Inhaler (DPI)
Respiratory Dysfunctions
(Unit II C, Objectives 3-5)
😰 What breath sounds will be heard during a Major Asthma Attack?
“Silent Chest”
Airway is completely restricted
No Wheezing
Respiratory Dysfunctions
(Unit II C, Objectives 3-5)
🚬💥 In what two ways can an immune response be a risk factor or trigger asthma?
▪️Hygiene Hypothesis
▪️Overuse of Antibiotics
Respiratory Dysfunctions
(Unit II C, Objectives 3-5)
🚬💥 What is the most common risk factor / trigger for Asthma?
Gastroesophageal Reflux Disease (GERD)
Respiratory Dysfunctions (Unit II C, Objectives 3-5) 🚬 What type of allergen exposure can trigger or be a risk factor for Asthma?
Overexposure
Cats, Dogs, Fungi, Mold & Seasonal Changes
Respiratory Dysfunctions
(Unit II C, Objectives 3-5)
💊💥 What Anti-Inflammatory Corticosteroid is used for the treatment of Asthma?
Flovent
Respiratory Dysfunctions (Unit II C, Objectives 3-5) 💹 Besides the preferred tests (PEFR and Pulmonary function), what other diagnostic study may be used for Asthma?
X-Ray
Respiratory Dysfunctions (Unit II C, Objectives 3-5) Late Phase Response of Asthma can be more severe than early phase and can last for how long?
24 hours or longer
Respiratory Dysfunctions (Unit II C, Objectives 3-5) 📚 When teaching patients with Asthma about reading / interpreting Peak Flow Meter results, what information do they need to know about the "Yellow Zone"?
That it indicates caution and something is triggering asthma.
Respiratory Dysfunctions (Unit II C, Objectives 3-5) 💊💥 What type of inhaler gives a specific amount of medication into the lungs?
Metered Dose Inhaler (MDI)
Respiratory Dysfunctions (Unit II C, Objectives 3-5) 📚💥 When teaching patients with Asthma about reading / interpreting Peak Flow Meter results, what percentage is within the "Yellow Zone"
50-80%
Respiratory Dysfunctions (Unit II D, Objective 2 & 3) ♿️ What complication of mechanical ventilation can occur if the setting is too high or the pressure is too high?
Alveolar Hyperventilation
Respiratory Dysfunctions (Unit II D, Objective 2 & 3) 😷 Train-of-Four (TOF) Peripheral Nerve Stimulation delivers how many successive currents to stimulate muscle twitches in paralyzed patients on a ventilator?
4
Respiratory Dysfunctions
(Unit II D, Objective 2 & 3)
What will set off the High-Pressure Limit alarm?
Occlusion
Respiratory Dysfunctions
(Unit II D, Objective 2 & 3)
What are the three phases of weaning/extubating?
▪️Preweaning / Assessment Phase
▪️Weaning Process
▪️Weaning Outcome
Respiratory Dysfunctions (Unit II D, Objective 2 & 3) What type of ventilation is noninvasive and allows lungs to inflate by pulling chest outward?
Negative Pressure Ventilation
Respiratory Dysfunctions
(Unit II D, Objective 2 & 3)
What is the Fio2 percentage of room air?
21%
Respiratory Dysfunctions
(Unit II D, Objective 2 & 3)
🍓 Why should carbohydrates be limited in patients on a ventilator?
Carbs tend to increase CO2 production
Respiratory Dysfunctions (Unit II D, Objective 2 & 3) 😷 What position does the patient need to be in during Extubation?
Sitting up
Respiratory Dysfunctions (Unit II D, Objective 2 & 3) 😷 What intervention is needed to prevent/help complications of the musculoskeletal system that may occur with long term ventilation?
Passive & Active ROM
Respiratory Dysfunctions (Unit II D, Objective 2 & 3) ♿️ What complications of the neurologic system can occur with Mechanical Ventilation?
Impaired Venous Drainage
Increased Cerebral Volume
Respiratory Dysfunctions
(Unit II D, Objective 2 & 3)
What is the process of weaning and extubation based on?
▪️ABG’s
▪️X-Rays
▪️Patients Response
Respiratory Dysfunctions
(Unit II D, Objective 2 & 3)
🍓 What nutritional therapy is needed due to inadequate nutrition caused by Positive Pressure Ventilation (PPV) and hypermetablolism?
TPN Lipids
Respiratory Dysfunctions
(Unit II D, Objective 2 & 3)
😷 Besides the Weaning Outcome of extubation, what other reason is weaning stopped?
No further progress is made
Respiratory Dysfunctions
(Unit II D, Objective 2 & 3)
What can cause a high Tidal Volume and/or Respiratory Rate?
Pain and Anxiety
Respiratory Dysfunctions (Unit II D, Objective 2 & 3) ♿️ What complications of the gastrointestinal system can occur with Mechanical Ventilation?
Stress Ulcers
Excess Air in the Stomach
Respiratory Dysfunctions (Unit II D, Objective 2 & 3) 😷 After deflating the cuff, at what point in breathing is the tube removed for Extubation?
Tube is removed at peak of deep inspiration
Respiratory Dysfunctions (Unit II D, Objective 2 & 3) What setting controls the volume of gas that is delivered to the patient during each ventilator breath?
Tidal Volume (VT)
Respiratory Dysfunctions
(Unit II D, Objective 2 & 3)
What is Controlled Ventilatory Support?
Ventilator does all the work of breathing
Respiratory Dysfunctions (Unit II D, Objective 2 & 3) What type of occlusions will set off the High-Pressure Limit alarm?
▪️Coughing
▪️Fighting the Ventilator
▪️Water Condensation
▪️Bronchospasms
Respiratory Dysfunctions
(Unit II D, Objective 2 & 3)
😷 During the Weaning Phase of Ventilator weaning, what baseline assessment needs to be obtained to monitor the patients progress?
Baseline Vital Signs
Respiratory Dysfunctions
(Unit II D, Objective 2 & 3)
😷 During the Weaning Phase of Ventilator weaning, what are comfortable positions for the patient to be in?
Sitting or Semirecumbent
Respiratory Dysfunctions (Unit II D, Objective 2 & 3) What are the indications for using mechanical ventilation?
▪️Upper Airway Obstruction ▪️Apnea ▪️High Risk for Aspiration ▪️Ineffective Clearance of Secretions ▪️Respiratory Distress
Respiratory Dysfunctions (Unit II D, Objective 2 & 3) 😷 How do you correct the complication of excess air in the stomach that can occur with mechanical ventilation?
NG Tube to help with decompression
Respiratory Dysfunctions (Unit II D, Objective 2 & 3) What Ventilatory support does the patient have to be able to initiate a breath because the ventilator is only there to support inspiration?
Pressure Support Ventilation (PSV)
Respiratory Dysfunctions (Unit II D, Objective 2 & 3) Which setting is longer in I:E Ratio?
E - Exhalation
Respiratory Dysfunctions (Unit II D, Objective 2 & 3) In the inspiratory flow rate and time (IT Time), speed which the volume is delivered, is usually between what settings?
0.8-1.2
Respiratory Dysfunctions (Unit II D, Objective 2 & 3) How is FiO2 monitored to ensure that oxygen doesn't get too high?
Blood Gasses are monitored
Respiratory Dysfunctions (Unit II D, Objective 2 & 3) What type of Ventilatory support shares responsibility with the patient?
Assisted Ventilatory Support
Respiratory Dysfunctions (Unit II D, Objective 2 & 3) The respiratory rate is the number of breaths that the ventilator delivers per minute and is usually set between what numbers for adults?
6 - 20
Respiratory Dysfunctions (Unit II D, Objective 2 & 3) 😷 If a tracheostomy is performed on a patient using long term mechanical ventilation, the patient will be able to eat but it takes a lot of work and there's a high risk for what complication?
Aspiration
Respiratory Dysfunctions (Unit II D, Objective 2 & 3) 😷 What intervention can be done if the patient is on long term mechanical ventilation and having difficulty with oral intake?
Tracheostomy
Respiratory Dysfunctions (Unit II D, Objective 2 & 3) What type of Ventilatory Support does the patient have to be sedated and paralyzed and is used in severe premature babies and severe ARDS?
High-Frequency Oscillatory Ventilation (HFOV)
Respiratory Dysfunctions (Unit II D, Objective 2 & 3) 😷 Who sets up ventilators and does vent changes?
Respiratory Therapist
Respiratory Dysfunctions (Unit II D, Objective 2 & 3) What type of ventilation provides the pressure to inflate the lungs?
Positive Pressure Ventilation (PPV)
Respiratory Dysfunctions (Unit II D, Objective 2 & 3) ♿️ What musculoskeletal problems can occur with long term ventilation?
Atrophy
Respiratory Dysfunctions (Unit II D, Objective 2 & 3) What type of Ventilatory support allows the patient to breath spontaneously through the ventilatory circuit because it delivers the tidal volume in sync with the patients breathing?
Synchronized Intermittent Mandatory Ventilation (SIMV)
Respiratory Dysfunctions (Unit II D, Objective 2 & 3) ♿️ Mechanical Ventilation can cause what type of complications in the cardiovascular system?
↓Cardiac Output
Respiratory Dysfunctions (Unit II D, Objective 2 & 3) What type of Ventilatory Support is pressure delivered continiously during spontaneous breathing and doesn't allow pressure to drop below a certain level?
Continuous Positive Airway Pressure (CPAP)
Respiratory Dysfunctions (Unit II D, Objective 2 & 3) 😷 During Extubation, when is the patient instructed to cough or Valsalva Maneuver?
When removing tube. Valsalva Maneuver or Cough and remove all at the same time.
Respiratory Dysfunctions (Unit II D, Objective 2 & 3) 😷 During the Preweaning Phase of Ventilator weaning, why are Spontaneous Breathing Trials done every day or every other day instead of multiple attempts in one day?
It is important that the patient rest between trials
Respiratory Dysfunctions (Unit II D, Objective 2 & 3) 😷 Spontaneous Breathing Trials are done daily or every other day during the Preweaning Phase of Ventilator weaning and are usually done on day shift for what reason?
Physicians are available
Respiratory Dysfunctions (Unit II D, Objective 2 & 3) What type of support has a higher inspiratory positive airway pressure and a lower expiratory positive airway pressure?
Bi-PAP
Respiratory Dysfunctions
(Unit II D, Objective 2 & 3)
😷 During the Weaning Phase of Ventilator weaning, tachypnea, tachycardia, hypertension, and hypotension are signs of what?
Signs of Intolerance
Respiratory Dysfunctions (Unit II D, Objective 2 & 3) 😷 During the Weaning Phase of Ventilator weaning, what sustained VT is a sign of intolerance?
Sustained VT < 5 mL/kg
Respiratory Dysfunctions
(Unit II D, Objective 2 & 3)
What compound helps with vasodilation, treats ARDS, and causes pulmonary vasodilation when continuously inhaled?
Nitric Oxide (NO)
Respiratory Dysfunctions (Unit II D, Objective 2 & 3) What type of support is commonly used in patients with COPD that delivers oxygen and two levels of positive pressure support?
Bi-PAP
Respiratory Dysfunctions (Unit II D, Objective 2 & 3) Pressure Support Ventilation (PSV) gives pressure and allows the patient to do what on their own?
Expire
Respiratory Dysfunctions (Unit II D, Objective 2 & 3) ♿️ How do you monitor for increased cerebral volume that occurs as a complication of Mechanical Ventilation?
Watch for intracranial pressure
Respiratory Dysfunctions (Unit II D, Objective 2 & 3) What are the settings based on when using Mechanical Ventilation?
▪️ABG’s
▪️LOC
▪️Body Weight
▪️Muscle Strength
Respiratory Dysfunctions (Unit II D, Objective 2 & 3) What range can the FiO2 be set on when ventilating a patient?
21-100%
Respiratory Dysfunctions
(Unit II D, Objective 2 & 3)
What is the pressure that’s applied at the end of the expiration of the ventilator breath?
Positive End-Expiratory Pressure (PEEP)
Respiratory Dysfunctions
(Unit II D, Objective 2 & 3)
What is High-Pressure Limit?
Ventilator or Patient is breathing in too high of pressure
Respiratory Dysfunctions (Unit II D, Objective 2 & 3) 😷 When using Train-of-Four (TOF) Peripheral Nerve Stimulation on paralyzed patients on a ventilator, how many twitching responses do you want to see?
1-2
Respiratory Dysfunctions
(Unit II D, Objective 2 & 3)
What is the I:E Ratio usually set at when using a ventilator?
1-2 or 1-1.5
Respiratory Dysfunctions
(Unit II D, Objective 2 & 3)
😷 Train-of-Four (TOF) peripheral nerve stimulation is used for what patients on a ventilator?
Paralyzed Patients
Respiratory Dysfunctions (Unit II D, Objective 2 & 3) ♿️ Air that is stuck and not where its supposed to be explains what complication of Mechanical Ventilation?
Barotrauma
Respiratory Dysfunctions (Unit II D, Objective 2 & 3) High-Frequency Oscillatory Ventilation (HFOV) delivers a small Tidal Volume (VT) and high respiratory rate at how many breaths per minute?
100-300 breaths/ min
Respiratory Dysfunctions (Unit II D, Objective 2 & 3) 🍓 The patient should have a nutritional assessment within how long after receiving mechanical ventilation?
24-48 hours
Respiratory Dysfunctions (Unit II D, Objective 2 & 3) 😷 During the Preweaning Phase of Ventilator weaning, a spontaneous breathing trial is performed for at least 30 minutes but no longer than what amount of time?
2 hours
Respiratory Dysfunctions (Unit II D, Objective 2 & 3) 😷 What interventions need to be done before removing the tube during the extubation process.
▪️Sit them up
▪️Hyperoxygenate
▪️Suction
▪️Deflate Cuff
Respiratory Dysfunctions (Unit II D, Objective 2 & 3) What do you want to make sure that you have control over when using Positive Pressure Ventilation?
Tidal Volume (Time between inhalation and exhalation)
Respiratory Dysfunctions
(Unit II D, Objective 2 & 3)
What can cause a low Tidal Volume with ventilation?
Change in the patients breathing
Respiratory Dysfunctions (Unit II D, Objective 2 & 3) What type of alarm will be set off if the ventilator gets disconnected, the ET Tube has come out, or patient is in cardiac arrest?
Low-Pressure Limit
Respiratory Dysfunctions
(Unit II D, Objective 2 & 3)
When is heavy sedation usually stopped when weaning from ventilator support?
Usually stops right before
Respiratory Dysfunctions (Unit II D, Objective 2 & 3) ♿️ What complication of Mechanical Ventilation can occur if the ventilator isn't set correctly, theres a leak, or the patient isn't getting the volume they need?
Alveolar Hypoventilation
Respiratory Dysfunctions (Unit II D, Objective 2 & 3) What type of artificial airway uses a cuff and holds the airway in place?
Endotracheal Tube
Respiratory Dysfunctions (Unit II D, Objective 2 & 3) 😷 During the Preweaning Phase of Ventilator weaning, what type of support is usually used at low levels?
CPAP
Respiratory Dysfunctions (Unit II D, Objective 2 & 3) Extracorporeal Membrane Oxygenation (ECMO) will bypass what organs to allow them to rest by partially removing the patients blood, infusing O2 and returning the blood to the patient?
Heart and Lung
Respiratory Dysfunctions (Unit II D, Objective 2 & 3) What type of artificial airway goes in and covers the glottis?
LMA Masks
Respiratory Dysfunctions (Unit II D, Objective 2 & 3) What are the types of Artificial Airways?
LMA Masks
Nasopharyngeal Airway
Trach Tube
Endotracheal Tube
Respiratory Dysfunctions (Unit II D, Objective 2 & 3) What occurs passively when using Positive Pressure Ventilation?
Expiration
Respiratory Dysfunctions (Unit II D, Objective 2 & 3) If a patient is coming off a ventilator that has been on high settings, what step down ventilatory support is used because it allows a little more comfort so they don't feel like they're fighting the vent?
Pressure Support Ventilation (PSV)
What symptoms would the nurse expect to find in a severely anemic patient?
Dyspnea and Tachycardia
Chapter 31 (End of Chapter Questions)
What is the major difference between Hodgkin’s lymphoma and non-Hodgkin’s lymphoma?
Non-Hodgkin’s Lymphoma can manifest in multiple or organs.
Chapter 31 (End of Chapter Questions)
What is the major advantage of the Venturi mask?
It can deliver a precise concentration of O2
Chapter 29 (End of Chapter Questions)
When caring for a patient with a lung abscess, what is the nurse’s priority intervention?
Antibiotic Administration
Chapter 28 (End of Chapter Questions)
What nursing action would be of highest priority when suctioning a patient with a tracheostomy?
Assessing the patient’s oxygenation saturation before, during, and after suctioning.
Chapter 27 (End of Chapter Questions)
What is the priority nursing intervention for a patient who has just undergone a chemical Pleurodesis for recurrent pleural effusion?
Administer ordered Analgesia
Chapter 28 (End of Chapter Questions)
While in the recovery room, a patient with a total Laryngectomy is suctioned and has bloody mucus with some clots. What nursing intervention would you apply?
Continue your assessment of the patient, including O2 saturation, respiratory rate, and breath sounds.
Chapter 27 (End of Chapter Questions)
What hematologic laboratory values are expected after a splenectomy?
Increased Platelet Count
Chapter 31 (End of Chapter Questions)
What is the best method for determining the risk for aspiration in a patient with a tracheostomy?
Consult a speech therapist for swallowing assessment
Chapter 27 (End of Chapter Questions)
If a lymph node is palpated, what is a normal finding?
Firm, mobile nodes.
Chapter 30 (End of Chapter Questions)
When using a prosthesis for transesophageal speech, what does the patient use to block the stoma entrance?
Finger
Chapter 27 (End of Chapter Questions)
If a patient has been exposed to a chlorine leak from a factory, what would you closely monitor these patients for?
Pulmonary Edema
Chapter 28 (End of Chapter Questions)
What is priority when caring for a patient at risk for pulmonary embolism?
Using Sequential Compression Devices
Chapter 28 (End of Chapter Questions)
Respiratory Dysfunctions
(Unit II D, Objective 1)
😰 Chest auscultation of a patient with ARDS may be normal or may reveal what fine and scattered sound?
Fine, Scattered Crackles
Respiratory Dysfunctions (Unit II D, Objective 1) In what phase of ARDS does fluid start to build up due to interstitial and alveolar edema?
Injury Phase
Respiratory Dysfunctions
(Unit II D, Objective 1)
📈 What will a Pulmonary Function Test reveal in the late stage of ARDS?
↓Compliance
↓Lung Volume
↓Functional Residual Capacity
Respiratory Dysfunctions
(Unit II D, Objective 1)
Why is high pressure ventilation used for patients with ARDS?
Because there is no place for the air to go in due to interstitial and alveolar edema. No oxygen exchange
Respiratory Dysfunctions (Unit II D, Objective 1) How long after the initial lung injury does the Reparative Phase (2nd Phase) occur?
1-2 Weeks
Respiratory Dysfunctions
(Unit II D, Objective 1)
ARDS usually starts how many hours after lung injury due to chest trauma.
72 hours
Respiratory Dysfunctions
(Unit II D, Objective 1)
♿️ What complication for the treatment of ARDS is know as large tidal volumes that are used to inflate the lungs?
Volutrauma
Respiratory Dysfunctions
(Unit II D, Objective 1)
The injury phase usually starts within 24-48 hours after the initial injury but can be within how many days after direct lung injury or host insult?
1-7 days
Respiratory Dysfunctions (Unit II D, Objective 1) 😰 What clinical manifestations changes occur with a patients respiratory rate and Tidal Volume in the Injury Phase of ARDS?
↑ Respiratory Rate
↓ Tidal Volume
Respiratory Dysfunctions (Unit II D, Objective 1) What role does sparsely collagenous and fibrous tissues play in the Fibrotic Phase of ARDS?
Remodel the Lungs
Respiratory Dysfunctions
(Unit II D, Objective 1)
What are the three phases of ARDS?
▪️Injury
▪️Reparative
▪️Fibrotic
Respiratory Dysfunctions
(Unit II D, Objective 1)
What is the second phase of ARDS?
Reparative Phase
Respiratory Dysfunctions
(Unit II D, Objective 1)
📈 X-Ray may not show edema until what percentage of lung fluid content is present?
30% increase
Respiratory Dysfunctions (Unit II D, Objective 1) 😰 Why does hypoxemia worsen in the Reparative Phase?
Alveolar membrane is thickened
Respiratory Dysfunctions (Unit II D, Objective 1) ♿️ What complication for the treatment of ARDS results in damage to the lung caused by too much Tidal volume and they don't get enough break between inspiration and expiration?
Volutrauma
Respiratory Dysfunctions (Unit II D, Objective 1) 😷 Patients with ARDS will need what type of pressure support oxygen?
Mechanical Ventilation or CPAP
Respiratory Dysfunctions (Unit II D, Objective 1) 😰 Vollman Prone Positioner and Continuous Lateral Rotation Therapy are positioning strategies used to prevent complications in intubated and mechanically ventilated patients with what respiratory dysfunction?
ARDS
Respiratory Dysfunctions (Unit II D, Objective 1) 😰 Risk for O2 toxicity increases when Fio2 exceeds 60% for more than how long?
48 hours
Respiratory Dysfunctions
(Unit II D, Objective 1)
😰 What clinical manifestations are present in the late stage of ARDS?
Tachycardia Diaphoresis Cyanosis Pallor Decreased Mentation
Respiratory Dysfunctions
(Unit II D, Objective 1)
😰 What early manifestations are present in patients with ARDS?
▪️Dyspnea
▪️Tachypnea
▪️Cough
▪️Restlessness
Respiratory Dysfunctions
(Unit II D, Objective 1)
What is the volume between inspiration and expiration?
Tidal Volume
Respiratory Dysfunctions (Unit II D, Objective 1) How long can it take to recover from an ARDS attack?
Up to 12 months
Respiratory Dysfunctions
(Unit II D, Objective 1)
😰 In the late stage of ARDS what diffuse breath sounds are heard when auscultating?
Crackles and Rhonchi
Respiratory Dysfunctions
(Unit II D, Objective 1)
The injury phase usually starts within how many hours after the initial lung injury?
24-48 hours
Respiratory Dysfunctions (Unit II D, Objective 1) What is the calculation that you can do to determine how well the lungs absorb oxygen and how well the lungs are working?
PF Ratio
Respiratory Dysfunctions (Unit II D, Objective 1) ♿️ What type of pneumonia is a complication of the treatment for ARDS?
Ventilator-Associated Pneumonia
Respiratory Dysfunctions (Unit II D, Objective 1) What long term therapy is need if the patient is in the Fibrotic Phase of ARDS and not showing improvement?
Long Term Mechanical Ventilation
Respiratory Dysfunctions
(Unit II D, Objective 1)
😰 What permanent injury to the lungs results due to ARDS?
Lungs will alway be scarred
Respiratory Dysfunctions (Unit II D, Objective 1) In what phase does the lung start to repair itself if it can?
Fibrotic (3rd Phase)
Respiratory Dysfunctions
(Unit II D, Objective 1)
♿️ Patients receiving treatment for ARDS are at risk for failure of what organ?
Renal Failure
Respiratory Dysfunctions
(Unit II D, Objective 1)
In what phase are there fibroblast in the inflammatory cells that start destroying the pulmonary vasculature?
Reparative Phase (2nd Phase)
Respiratory Dysfunctions (Unit II D, Objective 1) ♿️ During Mechanical Ventilation, what complication for the treatment of ARDS results in the presence of alveolar air being forced into locations where it usually isn't?
Barotrauma
Respiratory Dysfunctions
(Unit II D, Objective 1)
😰 Why are Normal Saline or Inotropic Agents increased in patients with ARDS?
Help with muscle contractions
Respiratory Dysfunctions
(Unit II D, Objective 1)
♿️ Patients receiving treatment for ARDS are at high risk for what due to circulation to the different areas?
Stress Ulcers
Respiratory Dysfunctions (Unit II D, Objective 1) What sudden fluid build up in the alveoli that doesn't allow gas exchange requires immediate action?
ARDS
Respiratory Dysfunctions
(Unit II D, Objective 1)
What is the third phase of ARDS which is also known as the chronic or late phase?
Fibrotic
Respiratory Dysfunctions (Unit II D, Objective 1) The Fibrotic Phase of ARDS occurs how long after the initial lung injury?
2-3 weeks
Respiratory Dysfunctions
(Unit II D, Objective 1)
📈 ABG’s in the early phase of ARDS will reveal what results due to mild hypoxemia?
Respiratory Alkalosis
Respiratory Dysfunctions
(Unit II D, Objective 1)
What is the thin membrane or layer of tissue that covers the surface of alveoli or cavity?
Hyaline Membranes
Respiratory Dysfunctions (Unit II D, Objective 1) At what PF Ratio is the patient going into ARDS?
Ratio <200
Respiratory Dysfunctions (Unit II D, Objective 1) ♿️ What complication for the treatment of ARDS is defined as over-inflating a lung?
Barotrauma
Adequate suction is confirmed by noting a gentle bubbling in what chamber?
Suction Control Chamber
What is a normal occurrence in the water seal chamber with respiratory effort?
Tidaling
What do you want to make sure is done before a chest tube is inserted?
Verify that consent is signed
What is Pneumothorax?
Air in the pleural space
How do you prevent another pneumothorax when the Chest Tube is being removed?
Have the patient exhale and bear down during chest tube removal.
If the Chest Tube becomes dislodged from the patient, what action is taken?
Apply an occlusive dressing at the insertion sire and take on 3 sides.
If there is a leak in the thoracic cavity, what occurs in the chamber if the tube is clamped?
Bubbling stops
What type of pneumothorax causes a mediastinal shift?
Tension Pneumothorax
How often do you monitor drainage for the first 24 hours after insertion of a chest tube?
Q Hourly
How does the nurse position the patient for chest tube insertion?
Supine with small bolster at shoulder blades
How often are dressings changed for Chest Tubes?
Q Shift
Chest Tubes go into what area to re-expand the lung and reestablish negative pressure?
Chest Tubes go into pleural space
What short term portable chest tube can be put in quickly for emergency situations and has a one way valve that allows whats in pleural space to come out but not go back in?
Heimlich Chest Drain
What is pleural effusion?
Abnormal amount of fluid around the lungs
What action do you take if the chest tube is disconnected from the CVU?
Submerge the tube 1-2” below the surface of a 250 mL bottle of Sterile Water or Saline Solution until a new CVU is set up?
When may Mediastinal shift occur
Tension Pneumothorax
The nurse understands that a water seal system is necessary when a chest tube is in place because during the inspiratory phase of normal breathing, compared to atmospheric pressure, intrapulmonary pressure is:
Negative
What is the #1 cause of air / fluid in the pleural space?
Trauma - Motor Vehicle Accidents
What is hemopneumothorax?
Blood and Air in the pleural space
In what chamber is bubbling normal?
In the suction control chamber
Bubbling in what chamber indicates an air leak?
Water Seal Chamber
What is Hemothorax?
Blood in the pleural space
When can a catheter can be clamped?
Changing the unit or looking for a leak
What is Pleural Empyema?
Puss in the Pleural Space
What do you instruct the patient to do when the Chest Tube is being removed?
Take a deep breath, exhale and bear down.
What is avoided if there is a clot in the tubing of a Chest Tube?
Stripping or Milking
What is Chylothorax?
Lymphatic fluid in the pleural space
Respiratory Dysfunctions
(Unit II A & B, Objective 17)
😰 What may be the only symptoms of Histoplasmosis if the individual isnt immunosuppressed?
Sore on the lip or a small rash
Respiratory Dysfunctions
(Unit II A & B, Objective 17)
What is Pleurisy?
Inflammation of Pleura
Respiratory Dysfunctions
(Unit II A & B, Objective 17)
What are the most common causes of Pleurisy?
Viral Infection and Pneumonia Tuberculosis
Respiratory Dysfunctions
(Unit II A & B, Objective 17)
📈 How is histoplasmosis diagnosed?
Sample from mid chest / mediastinal area
Respiratory Dysfunctions
(Unit II A & B, Objective 17)
😰 What symptom of Histoplasmosis occurs 3-17 days after exposure?
Rash
Respiratory Dysfunctions
(Unit II A & B, Objective 17)
Histoplasmosis is commonly seen in people that have come in contact with what?
Birds and Bat droppings
Respiratory Dysfunctions
(Unit II A & B, Objective 17)
💊 What treatment is used for Pleurisy?
▪️Relieve symptoms
▪️Remove fluid, air, or whatever is causing inflammation
▪️Treat other diseases such as Pneumonia and Tuberculosis
Respiratory Dysfunctions
(Unit II A & B, Objective 17)
💊 What treatment is used for patients with Histoplasmosis?
Antifungal
Treat Symptoms
Usually just needs time
Respiratory Dysfunctions
(Unit II A & B, Objective 17)
📈 Why is a Chest X-Ray used to diagnose Histoplasmosis?
40-70% of Chest X-Ray results are normal
Respiratory Dysfunctions (Unit II A & B, Objective 17) 😰 Patients with Pleurisy will exhibit what type of breathing?
Shallow and Rapid Breathing
Respiratory Dysfunctions
(Unit II A & B, Objective 17)
Ohio Valley Disease, Splonkers Disease, and Caves Disease and other names for what Pulmonary Infection?
Histoplasmosis
Respiratory Dysfunctions (Unit II A & B, Objective 17) 💊 If mediostanosis develops, how do you want to treat it?
Look at pulmonary activity and treat underlying causes
Respiratory Dysfunctions
(Unit II A & B, Objective 17)
Histoplasmosis is the most common cause of what disease?
Mediastanitis
Respiratory Dysfunctions (Unit II A & B, Objective 17) 😰 When auscultating breath sounds on a patient with Pleurisy, what sound will be heard that is similar to the sound of a squeaking door?
Pleural Friction Rub
Respiratory Dysfunctions
(Unit II A & B, Objective 17)
😰 The first symptom of Histoplasmosis is a skin lesion in what area?
On the upper lip because they inhaled it
