Care of the Respiratory Patient

Question 1

V/Q

Answer 1

ventilation to perfusion ratio

Question 2

what is V

Answer 2

air moving in and out of the lung

Question 3

what is Q

Answer 3

blood circulating to the areas of the lung

Question 4

regional mismatches - lung apex and bases

Answer 4

apex - less ventilation and perfusion

bases - more ventilation and perfusion

Question 5

X2 causes of hypoxemic respiratory failure

Answer 5

lungs are adequately ventilated but not perfused

the lungs are perfused but inadequately ventilated

Question 6

intrapulmonary shunt

Answer 6

extreme V/Q mismatch or imbalance

blood shunted past collapsed alveoli

Question 7

what is the first step in reversing hypoxemia

Answer 7

oxygen therapy

Question 8

what is hypoxemic respiratory failure

Answer 8

oxygenation failure

insufficient O2 transferred to blood

Question 9

what is hypercapnic respiratory failure X3

Answer 9

ventilatory failure

decreased ventilation or CO2 removal

hypoventilation

Question 10

Hypoxemic respiratory failure PaO2 and O2

Answer 10

PaO2 - <60 mmHg

O2 >60%

Question 11

hypercapnic respiratory failure PaCO2 and pH

Answer 11

PaCO2 >50 mmHg

pH <7.35

Question 12

X3 conditions that cause hypoxemia

Answer 12

V/Q mismatch

shunt around alveoli

blockages in alveoli or bronchioles

Question 13

X2 conditions that increase O2 demand and contribute to hypoxia

Answer 13

anxiety

unrelieved pain

Question 14

conditions causing impaired ventilation X4

Answer 14

CNS problems

NM conditions

Chest wall abnormalities

conditions affecting that airways and/or alveoli

Question 15

can the body tolerate high CO2 or low O2 better

Answer 15

high CO2

Question 16

increased CO2 leads to X3

Answer 16

morning HA

decreased RR

decreased LOC

Question 17

X5 Clinical s/s of acute respiratory failure

Answer 17

increased Co2

cyanosis

dysrhythmias

stupor

lethargy

Question 18

when is cyanosis a late sign of respiratory failure

Answer 18

when PaO2 is <45

Question 19

late signs of respiratory failure X3

Answer 19

dysrhythmias

stupor

lethargy

Question 20

general s/s of respiratory failure X11

Answer 20

AMS

dyspnea

tachypnea

nasal flaring

use of accessory/intercostal muscles

paradoxical breathing

tachycardia

HTN

diaphoresis

fatigue

non-verbal

Question 21

what should the nurse assess in respiratory failure X6

Answer 21

position

work of breathing

breathing pattern

ability to speak

pursed lip breathing

retractions

Question 22

X3 labs in respiratory failure

Answer 22

H&H

ABGs

Albumin

Question 23

when should nutritional therapy start in acute respiratory failure

Answer 23

within 24-48 hours

Question 24

MAP

Answer 24

how well the organs are being perfused

Question 25

ideal MAP

Answer 25

>65

Question 26

tidal volume

Answer 26

amount of air that moves in and out of the lungs with each respiratory cycle

Question 27

good tidal volume

Answer 27

500 mL in male 400 mL in female

Question 28

tidal volume

Answer 28

volume of gas that is moved in and out of the lungs per breath

Question 29

normal tidal volume

Answer 29

6-8 mL/kg

Question 30

total lung capacity

Answer 30

volume of gas present in lung with maximal inflation

Question 31

vital capacity

Answer 31

volume of air breathed out after deepest inhalation

Question 32

FiO2

Answer 32

fraction of inspired oxygen

Question 33

room air FiO2

Answer 33

21%

Question 34

Pulmonary embolism s/s X5

Answer 34

dull chest pain pain in calf/thigh wheezing coughing up blood sudden SOB Loss of consciousness

Question 35

pulmonary embolism lab and why

Answer 35

D-Dimer shows fibrin breakdown

Question 36

how is pulmonary embolism dx

Answer 36

CT - shows where/how many

Question 37

PE Meds X4

Answer 37

anticoagulants lovenox heparin drip coumadin

Question 38

when would heparin be CI

Answer 38

if still actively bleeding r/t trauma

Question 39

PE causes X4

Answer 39

DVT** fatty emboli bacterial vegetation on heart valves cancer

Question 40

is ARDS it's own diagnosis

Answer 40

no - caused by something else like pneumonia, sepsis or aspiration

Question 41

what is ARDS

Answer 41

sudden, progressive form of acute respiratory failure

Question 42

how is ARDS severity defined

Answer 42

PaO2, FiO2 ratio

Question 43

leading COD in ARDS

Answer 43

multiorgan dysfunction syndrome (MODS)

Question 44

initial ARDS s/s X4

Answer 44

severe dyspnea rapid, shallow breathing inspiratory crackles hypoxemia unresponsive to O2

Question 45

progressing ARDS s/s X3

Answer 45

increased work of breathing tachypnea, intercostal and suprasternal retractions tachycardia, diaphoresis, AMS, cyanosis, pallor

Question 46

ARDS dx X2

Answer 46

serial chest x-rays: classic ground glass/white out appearance severity per PaO2/FiO2 ratio

Question 47

ARDS labs X2

Answer 47

ABG's CBC

Question 48

ARDS Tx X4

Answer 48

O2 mechanical ventilations general respiratory failure care prone positioning

Question 49

normal lung PaO2/FiO2 ratio

Answer 49

300-500

Question 50

acute lung injury PaO2/FiO2 ratio

Answer 50

200-300

Question 51

ARDS very significant PaO2/FiO2 ratio

Answer 51

<200

Question 52

ARDS severe with high mortality PaO2/FiO2 ratio

Answer 52

<100

Question 53

pneumothorax

Answer 53

air leaks into the space between the lungs and chest wall

Question 54

what does a chest tube do

Answer 54

returns negative pressure to the lung

Question 55

chest tube collection chamber

Answer 55

collects blood in hemothorax - may not have fluid in pneumothorax

Question 56

chest tube water seal chamber

Answer 56

provides a seal so air/fluid cannot go back into patient

Question 57

tidaling

Answer 57

water goes up in inspiration and down in exhalation

Question 58

constant bubbling in water seal chamber

Answer 58

leak in system

Question 59

suction chamber pressure (?)

Answer 59

generally 20 cm H2O