EMERGENCY (RESPI AND GI)

Question 1

• the sudden and life-threatening deterioration of the gas exchange function of the lung and indicates failure of the lungs to provide adequate oxygenation or ventilation for the blood.
• rapid onset respiratory impairment, which is severe enough to cause potential or actual morbidity or mortality if untreated.

Answer 1

acute respiratory failure

Question 2

decrease in arterial oxygen tension (PaO2) to less than 60mm Hg

Answer 2

hypoxemia

Question 3

increase in arterial carbon dioxide tension (PaCO2) to greater than 50 mm Hg

Answer 3

hypercapnia

Question 4

synonymous with perioperative respiratory failure and is related to atelectasis of the lung

Answer 4

Type III or “Perioperative” Respiratory Failure

Question 5

respiratory failure is related to an inability of (normal or relatively normal lungs) to keep up with increased ventilatory demands associated with systemic hypermetabolism (e.g., secondary to sepsis).

Answer 5

Type IV or “High –demand” Respiratory Failure

Question 6

most common form of respiratory failure and is defined by PaO2 < 60 mm Hg, with normal or decreased PaCO2

Answer 6

Type I or Classic “Hypoxemic” Respiratory Failure

Question 7

(PaCO2 > 45 mm Hg) represents the failure of the lungs to remove a sufficient amount of CO2 and is characterized by decreased alveolar minute ventilation

Answer 7

Type II or “Hypercapnic” Respiratory Failure

Question 8

beta 2 antagonist (relaxes smooth muscles) for ARF

Answer 8

albuterol, salbutamol

Question 9

anti-cholinergic (blocks acetylcholine and prevents bronchodilation)

Answer 9

ipratropium bromide, xanthine derivatives (theophylline)

Question 10

nursing considerations for xanthine derivatives

Answer 10

assess tachycardia, xerostomia (the sensation of oral dryness, which can result from diminished saliva production)

Question 11

Restlessness
Fatigue
Headache
Dyspnea
Air hunger
Tachycardia
Increased blood pressure

Answer 11

early signs associated with impaired oxygenation

Question 12

Confusion
Lethargy
Tachypnea
Central cyanosis
Diaphoresis, and finally respiratory arrest

Answer 12

S&S hypoxemia progress for ARF

Question 13

FOR ARF: Provide supplemental O2 to maintain Pao2 greater than ___ mmHg. The use of noninvasive methods for O2 administration (high flow nasal cannula or face masks)

Answer 13

60

Question 14

characterized by non-cardiac pulmonary edema caused by increased alveolar-capillary membrane permeability and usually affects both lungs.

Answer 14

Acute Respiratory Distress Syndrome (ARDS)

Question 15

chronic inflammation of the BRONCHI (3 consecutive months and 2 consecutive years)

Answer 15

chronic bronchitis

Question 16

• over dilatation of ALVEOLI
• absence of recoil of ALVEOLI
• hyperresonance due to overdistention, presence of air
• terminal stage of COPD
• INCREASED CO2 (above 45 mmHg)

Answer 16

pulmonary emphysema

Question 17

• negative test for acid fast bacilli
• no lesions in Xray
• no hemoptysis (coughing up blood)

Answer 17

chronic bronchitis DIFFERENCE from TB

Question 18

another name for CHRONIC BRONCHITIS (hypoxic, RSCHF or enlargement of the heart)

Answer 18

blue bloater

Question 19

etiology of chronic bronchitis

Answer 19

exposure to pulmonary irritants and infection including RTI and influenza

Question 20

NI for chronic bronchitis

Answer 20

• eliminate exposure to irritants
• clear airway with chest physical therapy (percussion, vibration, position)
• suctioning as ordered
• mucolytics
• deep breathing
• teaching of adequate nutri

Question 21

etiology of pulmonary emphysema

Answer 21

• age (usually geriatric)
• hereditary (decreased Alpha T antitrypsin: below 75 mg/dL)
• autoimmune deficiency
• smoking
• bronchitis
• air pollution
• chronic asthma (because it leads to OVERDISTENTION)

Question 22

ABG of pulmonary emphysema

Answer 22

respiratory alkalosis

Question 23

another name for pulmonary emphysema (pink skin color due to increased CO2)

Answer 23

pink puffer

Question 24

s&s of emphysema

Answer 24

• easy fatigue
• pursed lip breathing
• barrel chest (due to air trapping)
• wheezing on expiration
• clubbing of nails
• orthopnea

Question 25

EMPHYSEMA: Impaired gas exchange r/t impaired ventilation: perfusion mismatching

Answer 25

- monitor ABG - sx of respiratory acidosis - sx hypoxia - monitor pulse ox (Spo2) - bronchodilator: "ol" and "ium" meds (check HR and BP may be increased) - good humidification - liquify secretions (3 to 5 L/day of water) - suction PRN - avoid narcotics: opium, codeine, heroin, demerol, darvon, morphine, methadone, vicodin, oxycotin (depresses RR) - low flow if COPD: 1 to 3 L/min (to avoid dependency and decreased o2 drive)

Question 26

EMPHYSEMA: Ineffective airway clearance

Answer 26

- assess VS, cough, record sputum consistency, sx of hypoxia - respiratory therapy - antibiotics: "cillin", "mycin", or "in" meds or antihistamine: "ine" meds - administer steroids: "one" meds as ordered to decreased swelling of airway - avoid milk and cream products (can cause irritation = increase cough) - high fowler's

Question 27

EMPHYSEMA: Impaired breathing pattern r/t airway obstruction

Answer 27

- position (high fowler) - pursed lip breathing - blow bottle exercises (10 mins per day to encourage muscle strength) - IPPB with with nebulization (mechanical ventilator, intermittent positive pressure breathing) - alternate activities with vent

Question 28

EMPHYSEMA: High risk: complications

Answer 28

- ensure low flow o2 - monitor ABG - tracheostomy if necessary (if there is laryngospasm) - RISK FOR RSCHF: MEDS = diuretics due to edema, "ide" meds such as furosemide and "one" meds such as spironolactone and metolazone, FLUID = 1.5 - 1 L/day of o2 to not worsen edema, IV THERAPY = KVD 10 gtts/min to run for 24 hours