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Flashcards in Advanced Respiratory Deck (133):
1

Pulmonary embolus is most commonly caused by ________.

a DVT that breaks off and lodges in the pulmonary artery

2

In pulmonary embolus ventilation is _______ than perfusion so _________ results.

greater; hypoxemia

3

low arterial blood oxygen level

hypoxemia

4

The pulmonary artery is the only artery that carries ____________ blood

de-oxygenated

5

_______ embolism is almost always deadly

Saddle

6

What can cause a PE?

air, tumor cells, amniotic fluid, foreign objects, injected particles, infected clots, exudate, fat emboli, or oil (diagnostic procedure)

7

What are the risk factors for PE?

pregnancy, immobility, obesity, central line, pacemaker, trauma, medications (oral contraceptives, hormone replacement)

8

Syndrome consisting of Venous stasis, Hypercoagulability, and Vessel wall inflammation

Trousseau's Syndrome

9

What are the signs of DVT?

Redness, Warmth, Pain, Edema

10

What is the most common predisposing factor for the development of DVT?

immobility

11

What are the respiratory manisfestations of PE?

dyspnea, pleuritic chest pain, tachypnea, crackles, dry cough, hemoptysis, and decreased O2 saturation

12

What are the cardiac manifestations of PE?

tachycardia, distended neck veins, syncope, cyanosis, hypotension, abnormal heart sounds (S3 S4), abnormal electrocardiogram findings, shock, and dizziness

13

pain on inspiration

pleuritic chest pain

14

What are late and uncommon signs of PE?

low-grade fever, petechiae, symptoms of flu, N/V

15

What are the classic symptoms of PE?

feeling of impending doom, dyspnea, sharp chest pain, apprehension, restlessness, cough, hemoptysis

16

What are the gold standard diagnostic tests for PE?

VQ scan, spiral CT w/ contrast, and angiogram

17

What are other tests for PE?

ABGs, EKG, CXR, D-dimer blood test, Echo

18

In the initial stage of PE, the PaO2 is _____ and the PaCO2 is _____, which means respiratory _________.

low; low; alkalosis

19

In the middle stage of PE, the PaO2 is _____ and the PaCO2 is _____, which means respiratory _________.

low; risking; acidosis

20

In the late stage of PE, Tissue hypoxia develops and _______ builds up , which means metabolic _________.

lactic acid; acidosis

21

stage of PE in which the patient hyperventilates causing hypoxia and pain

initial stage

22

stage of PE in which blood begins to shunt leading to PaO2 being low, PaCO2 rising causing respiratory acidosis

middle stage

23

stage of PE in which tissue hypoxia occurs with build up of lactic acid causing metabolic acidosis (pH

late stage

24

What kind of diet helps prevent PE?

low fat, high fiber

25

What is the most common symptom of PE?

pleuritic chest pain

26

What are the priority problems for a patient with PE?

hypoxemia, hypotension, potential for bleeding, and anxiety

27

Hypoxemia in a PE is related to a mismatch of __________ and ___________.

lung perfusion and ventilation (V/Q mismatch)

28

Hypotension in a PE is related to _________________.

inadequate circulation to the left ventricle (decreased cardiac output)

29

What does the nurse do first for a patient with PE?

apply oxygen

30

What is the priority nursing intervention for a patient with a PE?

promotion of gas exchange and tissue perfusion

31

What position should the nurse put the patient with a PE?

High Fowler's

32

How often should the nurse re-assess respiratory status in the patient with a PE?

q 30 minutes

33

What drug is given initially to PE patient?

Heparin

34

How long is heparin given to PE patient?

for the first 5-10 days

35

What day is coumadin started for a PE patient?

Day 3

36

What drug is given for a massive PE?

tPA or activase

37

What additional drug will a patient need while on tPA to raise the BP?

vasopressin to raise the BP

38

PT/INR Therapeutic Level with Coumadin

2.5-3.0

39

PTT Therapeutic Level with heparin

40-75 seconds

40

surgical removal of the clot that caused a PE

emoblectomy

41

umbrella that is put in the inferior vena cava that keeps clot from moving up from the legs

inferior vena cava interruption

42

What kind of IV fluid will be given to a PE patient?

crystalloids

43

PE patient will be on continuous __________ and _________ monitoring.

EKG and respiratory

44

impairment of the lung’s ability to maintain adequate oxygen and carbon dioxide homeostasis occuring over minutes to hours that results in a rapid change in respirations resulting in hypoxemia, hypercapnia or both

Acute Respiratory Failure

45

Acute Respiratory Failure is based on ABG value of PaO2 50 with a pH

60; 90%; 50

46

Use ______ for Acute Respiratory Failure patients.

bi-pap

47

Whatever the underlying problem, the patient in acute respiratory failure is always _________.

hypoxemic

48

type of respiratory failure in which the patient is unable to move air adequately out of the alveoli, allowing buildup of CO2

ventilatory failure

49

What causes extrapulmonary ventilatory respiratory failure?

neuromuscular disorders, spinal cord injury, CNS dysfunction (stroke), chemical depression (overdose), kyphoscoliosis, massive obesity, sleep apnea, and external obstruction or constriction

50

What causes intrapulmonary ventilatory respiratory failure?

airway disease (COPD, asthma), V/Q mismatch (PE, pneumothorax, ARDS, amyloidosis, pulmonary edema, and interstitial fibrosis

51

In ventilatory respiratory failure, perfusion is __________ but ventilation is ____________.

normal; inadequate

52

In oxygenation respiratory failure, perfusion is __________ but ventilation is ____________.

decreased; normal

53

type of respiratory failure in which thoracic pressure changes are normal, and air moves in and out without difficulty (Ventilation) but does not oxygenate the pulmonary blood sufficiently (perfusion)

Oxygenation Failure

54

decreased oxygen supply in the tissues

hypoxia

55

A combination of ventilatory and oxygenation failure involving both hypoventilation and profound hypoxemia which often occurs in patients who have abnormal lungs such as those with chronic bronchitis or emphysema or during asthma attacks

Combined Ventilatory and Oxygenation Failure

56

Combined Ventilatory and Oxygenation Failure usually involves _________ failure along with ____________ failure.

cardiac; respiratory

57

What are the clinical manifestations of Acute Respiratory Failure?

hypoxemia, hypercapnia, and respiratory acidosis

58

What are the symptoms of Acute Respiratory Failure?

Dyspnea, Orthopnea (sleep on 2-3 pillows, tripod position), Alterations in respirations and breath sounds, Tachypenia, Irritability/restlessness. Confusion, Headache, Increasing somnolence, coma, Cardiac dysrhythmias ( PVC), and Tachycardia

59

In Acute Respiratory Failure, increased work of breathing causes ___________.

exhaustion

60

If a ventilated patient is picking at the bed sheets, what does the nurse assess first?

adequate oxygenation

61

Besides mechanical ventilation, what is the only other therapy that blows off CO2?

bi-pap

62

How is Acute Respiratory Failure diagnosed?

ABGs, CXR, Pulmonary Spirometry, sputum culture, CT or CBC

63

Elevating the HOB, lowers the ___________.

diaphragm

64

Hypoxia that persists even when oxygen is administered at 100% in which the lungs cannot expand or contract and dense pulmonary infiltrates are seen on CXR

Acute Respiratory Distress Syndrome (ARDS)

65

ARDS acronym

Assault to pulmonary system, Respiratory distress, Decreased lung compliance (lung tissue becomes fibrotic – irreversible), Severe respiratory failure

66

Direct Lung Injury (Primary Insults) Risk Factors for ARDS

Aspiration of gastric contents, Severe thoracic trauma
including pulmonary contusions, Diffuse pulmonary infections (pneumonia), bacterial, viral, or fungal infections, Toxic gas inhalation including smoke, nitrous oxide, ammonia, and chlorine, Near-drowning, and TRALI-Transfusion related acute lung injury (Hemorrhagic)

67

Indirect Lung Injury (Secondary Insults) Risk Factors for ARDS

severe sepsis, anaphylaxis, acute pancreatitis, severe non-thoracic trauma, multiple long bone fractures (fat emboli), hypovolemic shock, drug overdose, Multiple transfusions (TRALI), reperfusion therapy (following transplant and bypass surgeries)

68

Transfusion Related Acute Lung Injury causing indirect lung injury due to inflammatory response to multiple transfusions

TRALI

69

phase of ARDS lasting up to a week that is associated with damage to the alveolar capillary cells and alveolar cells as well as proteinaceous fluid flooding the alveoli which compromises normal gas exchange and triggers diffuse alveolar collapse

Acute exudative phase

70

The diffuse alveolar collapse in ARDS inactivates __________.

surfactant

71

What is the result of surfactant inactivating?

worsening hypoxemia that doesn't respond to oxygen administration

72

phase of ARDS marked by resolution of the acute phase and initial repair of the lung. A patient who reaches this phase may recover fully, or move on to the third phase.

Proliferative phase

73

phase of ARDS in which fibrotic tissue replaces the normal lung structure, generally causing progressive vascular occlusion, pulmonary hypertension, and eventually decreased lung compliance

Fibrotic phase

74

What is the hallmark sign of ARDS?

accessory muscle use including intercostal and suprasternal retractions

75

The symptoms of ARDS

dyspnea, tachypnea, pallor, diaphoresis, wheezes and crackles, decreased breath sounds in all fields, restlessness, apprehension, decreased level of consciousness, motor dysfunction, and tachycardia

76

How is ARDS diagnosed?

ABGs, CBC, CXR, CT, Echo, PFTs

77

Initially in ARDS, the PaO2 is ______, the PaCO2 is ________ or _______, and the pH is ___________.

low; normal or low; elevated

78

Initially in ARDS, the patient is in respiratory ___________.

alkalosis

79

As ARDS worsens, the pH __________ and lactic acid ________.

decreases; increases

80

As ARDS worsens, the patient is in repiratory _________.

acidosis

81

APRV

Airway Pressure-Release Ventilation

82

Normal I/E ratio

1:2 or 1:4

83

In APRV, the I/E ratio is ______.

2:1 (breathing in more than they breathe out)

84

In APRV, the tidal volume is ____ mL/kg.

6

85

ARDS patients will have a PEEP of _______.

10-15

86

For ARDS patient when supine, HOB needs to be _____ degrees.

30-45

87

It is very important to ______ an ARDS patient.

TURN

88

What are the signs of a tension pneumothorax?

absent breath sounds, high ventilation pressure, and hypotension

89

What drugs are given to ARDS patients?

sedatives, surfactant, corticosteroids, antibiotics, fluids, and diuretics

90

Short acting prostaglandin drug that can improve blood flow and oxygenation in the lungs and reduce inflammation

Prostacyclin

91

drug for ARDS patients that improve soxygenation and reduces pulmonary vascular resistance

inhaled nitric oxide

92

What are the common complications associated with ARDS?

Pulmonary hypertension, Myocardial dysfunction, Dysrhythmias (V.fib or V. tach), MODS, Barotrauma, and volutrauma, Ventilator Associated Pneumonia, Stress Ulcers (Cushing’s and Curling’s), Skin Breakdown, Nutrition problems

93

What is the most common indirect predisposing disorder of ARDS?

sepsis

94

Pulmonary edema associated with ARDS is caused by ________.

alveolar injury

95

The blunt, nonpenetrating chest traumas are _______, ________, and _________.

fractured ribs, flail chest, and tension pneumothorax

96

The penetrating chest traumas are _______, ________, and _________.

Open pneumothorax, Hemothorax, and Tracheobronchial injury

97

What causes blunt, nonpenetrating chest trauma?

direct impact, compression, or rapid deceleration/ acceleration

98

The most common chest injury seen in the US in which a blow to the chest causes Interstitial hemorrhage associated with intra-alveolar hemorrhage, resulting in decreased pulmonary compliance and respiratory failure develops over time

Pulmonary Contusions

99

Pulmonary Contusions are diagnosed by _______ or ______.

CT or CXR

100

What is the hallmark sign of a Pulmonary Contusion?

increased bronchial secretions

101

Pulmonary Contusions symptoms include?

Hemoptysis, Hypoxemia, Increased bronchial secretions, Restlessness, Dyspnea, Decreased breath sounds, Crackles and wheezes

102

For a patient Pulmonary Contusion, the HOB should be ______ degrees.

45-60 Fowler's

103

Pulmonary Contusion patient will _________ over time since injury.

worsen

104

Pulmonary Contusion patients need pain control so they can ___________.

take a deep breath

105

What is the hallmark sign of severe trauma?

Fracture of ribs 1 and 2

106

What is the most common type of blunt chest trauma?

fractured ribs

107

With fractured ribs, patient will be in respiratory _________.

acidosis

108

With fractured ribs, hypoxia and respiratory acidosis results from _____________.

shallow respirations due to pain

109

What position should the patient be placed with fractured ribs?

Fowler's

110

If the pain is severe with fractured ribs, the patient will receive an ___________.

intercostal nerve block

111

A thoracic injury resulting in paradoxical motion of chest wall segments that is often the result of direct impact, high-speed injury

flail chest

112

paradoxical motion of the chest

Chest will puff up when exhaling and will sink in when inhaling

113

What is the hallmark sign of fail chest?

paradoxical motion of the chest

114

What are the symptoms of flail chest?

Severe chest pain, Dyspnea, Cyanosis, Tachycardia, Hypotension, Tachypnea, shallow respirations, and Diminished breath sounds

115

In flail chest, hypoxia and respiratory acidosis results from ___________.

shallow respirations due to pain

116

What position should the flail chest patient be placed in?

Fowler's

117

All respiratory patients are in Fowler's position except for _______ patients who are prone.

ARDS

118

injury that occurs when an opening through the chest wall allows the entrance of positive atmospheric air pressure into the pleural space

open pneumothorax

119

Spontaneous pneumothorax occurs with ____________.

rupture of a pulmonary bleb

120

injury that occurs from a blunt chest injury or from mechanical ventilation (volutrauma or barotrauma)

closed or tension pneumothorax

121

ABG of pneumothorax patient will show respiratory ________ and _______.

alkalosis; hypoxia

122

pneumothorax symptoms

Absent breath sounds on affected side, Cyanosis, Decrease chest expansion unilaterally, Dyspnea, Hypotension, Sharp chest pain, Subcutaneous emphysema as evidence by crepitus on palpation, Sucking sound with open chest wound, Tachycardia, Tachypnea

123

Tension pneumothorax can cause ____________ which is a medical emergency.

tracheal deviation

124

With tracheal deviation, immediate treatment is _________.

insertion of a chest tube

125

Right lung tension pneumothorax will cause contents of the chest to move _______.

left

126

Left lung tension pneumothorax will cause contents of the chest to move _______.

right

127

hemothorax that causes less than 1500 mL blood loss

simple

128

hemothorax that causes more than 1500 mL blood loss

massive

129

Percussion during pneumothorax is ___________.

hyper resonant

130

Percussion during hemothorax is __________.

dull

131

Hemothorax can be caused by what?

CVL insertion, Lung contusions or lacerations, Chest trauma, Cancer (leaking blood)

132

Which assessment finding alerts the nurse to a possible pulmonary contusion?

increased bronchial secretions

133

What are the treatments for hemothorax?

chest tube, thoracentesis, or thoracotomy