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Advanced Med/Surg > Advanced Respiratory > Flashcards

Advanced Respiratory Flashcards

1
Q

Pulmonary embolus is most commonly caused by ________.

A

a DVT that breaks off and lodges in the pulmonary artery

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2
Q

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

A

greater; hypoxemia

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3
Q

low arterial blood oxygen level

A

hypoxemia

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4
Q

The pulmonary artery is the only artery that carries ____________ blood

A

de-oxygenated

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5
Q

_______ embolism is almost always deadly

A

Saddle

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6
Q

What can cause a PE?

A

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

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7
Q

What are the risk factors for PE?

A

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

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8
Q

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

A

Trousseau’s Syndrome

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9
Q

What are the signs of DVT?

A

Redness, Warmth, Pain, Edema

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10
Q

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

A

immobility

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11
Q

What are the respiratory manisfestations of PE?

A

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

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12
Q

What are the cardiac manifestations of PE?

A

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

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13
Q

pain on inspiration

A

pleuritic chest pain

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14
Q

What are late and uncommon signs of PE?

A

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

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15
Q

What are the classic symptoms of PE?

A

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

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16
Q

What are the gold standard diagnostic tests for PE?

A

VQ scan, spiral CT w/ contrast, and angiogram

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17
Q

What are other tests for PE?

A

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

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18
Q

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

A

low; low; alkalosis

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19
Q

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

A

low; risking; acidosis

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20
Q

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

A

lactic acid; acidosis

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21
Q

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

A

initial stage

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22
Q

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

A

middle stage

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23
Q

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

A

late stage

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24
Q

What kind of diet helps prevent PE?

A

low fat, high fiber

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25
Q

What is the most common symptom of PE?

A

pleuritic chest pain

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26
Q

What are the priority problems for a patient with PE?

A

hypoxemia, hypotension, potential for bleeding, and anxiety

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27
Q

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

A

lung perfusion and ventilation (V/Q mismatch)

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28
Q

Hypotension in a PE is related to _________________.

A

inadequate circulation to the left ventricle (decreased cardiac output)

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29
Q

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

A

apply oxygen

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30
Q

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

A

promotion of gas exchange and tissue perfusion

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31
Q

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

A

High Fowler’s

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32
Q

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

A

q 30 minutes

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33
Q

What drug is given initially to PE patient?

A

Heparin

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34
Q

How long is heparin given to PE patient?

A

for the first 5-10 days

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35
Q

What day is coumadin started for a PE patient?

A

Day 3

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36
Q

What drug is given for a massive PE?

A

tPA or activase

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37
Q

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

A

vasopressin to raise the BP

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38
Q

PT/INR Therapeutic Level with Coumadin

A

2.5-3.0

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39
Q

PTT Therapeutic Level with heparin

A

40-75 seconds

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40
Q

surgical removal of the clot that caused a PE

A

emoblectomy

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41
Q

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

A

inferior vena cava interruption

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42
Q

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

A

crystalloids

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43
Q

PE patient will be on continuous __________ and _________ monitoring.

A

EKG and respiratory

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44
Q

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

A

Acute Respiratory Failure

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45
Q

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

A

60; 90%; 50

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46
Q

Use ______ for Acute Respiratory Failure patients.

A

bi-pap

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47
Q

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

A

hypoxemic

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48
Q

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

A

ventilatory failure

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49
Q

What causes extrapulmonary ventilatory respiratory failure?

A

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

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50
Q

What causes intrapulmonary ventilatory respiratory failure?

A

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

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51
Q

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

A

normal; inadequate

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52
Q

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

A

decreased; normal

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53
Q

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)

A

Oxygenation Failure

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54
Q

decreased oxygen supply in the tissues

A

hypoxia

55
Q

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

A

Combined Ventilatory and Oxygenation Failure

56
Q

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

A

cardiac; respiratory

57
Q

What are the clinical manifestations of Acute Respiratory Failure?

A

hypoxemia, hypercapnia, and respiratory acidosis

58
Q

What are the symptoms of Acute Respiratory Failure?

A

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
Q

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

A

exhaustion

60
Q

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

A

adequate oxygenation

61
Q

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

A

bi-pap

62
Q

How is Acute Respiratory Failure diagnosed?

A

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

63
Q

Elevating the HOB, lowers the ___________.

A

diaphragm

64
Q

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

A

Acute Respiratory Distress Syndrome (ARDS)

65
Q

ARDS acronym

A

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

66
Q

Direct Lung Injury (Primary Insults) Risk Factors for ARDS

A

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
Q

Indirect Lung Injury (Secondary Insults) Risk Factors for ARDS

A

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
Q

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

A

TRALI

69
Q

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

A

Acute exudative phase

70
Q

The diffuse alveolar collapse in ARDS inactivates __________.

A

surfactant

71
Q

What is the result of surfactant inactivating?

A

worsening hypoxemia that doesn’t respond to oxygen administration

72
Q

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.

A

Proliferative phase

73
Q

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

A

Fibrotic phase

74
Q

What is the hallmark sign of ARDS?

A

accessory muscle use including intercostal and suprasternal retractions

75
Q

The symptoms of ARDS

A

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

76
Q

How is ARDS diagnosed?

A

ABGs, CBC, CXR, CT, Echo, PFTs

77
Q

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

A

low; normal or low; elevated

78
Q

Initially in ARDS, the patient is in respiratory ___________.

A

alkalosis

79
Q

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

A

decreases; increases

80
Q

As ARDS worsens, the patient is in repiratory _________.

A

acidosis

81
Q

APRV

A

Airway Pressure-Release Ventilation

82
Q

Normal I/E ratio

A

1:2 or 1:4

83
Q

In APRV, the I/E ratio is ______.

A

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

84
Q

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

A

6

85
Q

ARDS patients will have a PEEP of _______.

A

10-15

86
Q

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

A

30-45

87
Q

It is very important to ______ an ARDS patient.

A

TURN

88
Q

What are the signs of a tension pneumothorax?

A

absent breath sounds, high ventilation pressure, and hypotension

89
Q

What drugs are given to ARDS patients?

A

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

90
Q

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

A

Prostacyclin

91
Q

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

A

inhaled nitric oxide

92
Q

What are the common complications associated with ARDS?

A

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
Q

What is the most common indirect predisposing disorder of ARDS?

A

sepsis

94
Q

Pulmonary edema associated with ARDS is caused by ________.

A

alveolar injury

95
Q

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

A

fractured ribs, flail chest, and tension pneumothorax

96
Q

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

A

Open pneumothorax, Hemothorax, and Tracheobronchial injury

97
Q

What causes blunt, nonpenetrating chest trauma?

A

direct impact, compression, or rapid deceleration/ acceleration

98
Q

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

A

Pulmonary Contusions

99
Q

Pulmonary Contusions are diagnosed by _______ or ______.

A

CT or CXR

100
Q

What is the hallmark sign of a Pulmonary Contusion?

A

increased bronchial secretions

101
Q

Pulmonary Contusions symptoms include?

A

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

102
Q

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

A

45-60 Fowler’s

103
Q

Pulmonary Contusion patient will _________ over time since injury.

A

worsen

104
Q

Pulmonary Contusion patients need pain control so they can ___________.

A

take a deep breath

105
Q

What is the hallmark sign of severe trauma?

A

Fracture of ribs 1 and 2

106
Q

What is the most common type of blunt chest trauma?

A

fractured ribs

107
Q

With fractured ribs, patient will be in respiratory _________.

A

acidosis

108
Q

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

A

shallow respirations due to pain

109
Q

What position should the patient be placed with fractured ribs?

A

Fowler’s

110
Q

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

A

intercostal nerve block

111
Q

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

A

flail chest

112
Q

paradoxical motion of the chest

A

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

113
Q

What is the hallmark sign of fail chest?

A

paradoxical motion of the chest

114
Q

What are the symptoms of flail chest?

A

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

115
Q

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

A

shallow respirations due to pain

116
Q

What position should the flail chest patient be placed in?

A

Fowler’s

117
Q

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

A

ARDS

118
Q

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

A

open pneumothorax

119
Q

Spontaneous pneumothorax occurs with ____________.

A

rupture of a pulmonary bleb

120
Q

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

A

closed or tension pneumothorax

121
Q

ABG of pneumothorax patient will show respiratory ________ and _______.

A

alkalosis; hypoxia

122
Q

pneumothorax symptoms

A

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
Q

Tension pneumothorax can cause ____________ which is a medical emergency.

A

tracheal deviation

124
Q

With tracheal deviation, immediate treatment is _________.

A

insertion of a chest tube

125
Q

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

A

left

126
Q

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

A

right

127
Q

hemothorax that causes less than 1500 mL blood loss

A

simple

128
Q

hemothorax that causes more than 1500 mL blood loss

A

massive

129
Q

Percussion during pneumothorax is ___________.

A

hyper resonant

130
Q

Percussion during hemothorax is __________.

A

dull

131
Q

Hemothorax can be caused by what?

A

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

132
Q

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

A

increased bronchial secretions

133
Q

What are the treatments for hemothorax?

A

chest tube, thoracentesis, or thoracotomy

Advanced Med/Surg (10 decks)

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