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Exam 2 Flashcards

1
Q

Oral Pharyngeal Airway (OPA): Indications

A

Tongue and/or epiglottis fall back against the posterior pharynx in anesthetized on unconscious patients

Patients who do not have a cough, gag, or swallow reflex

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2
Q

Oral Pharyngeal Airway (OPA): Contraindications

A

Person who is conscious and intact cough, gag, or swallow reflex

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3
Q

Oral Pharyngeal Airway (OPA): Measurement

A

Measure from corner of patient’s mouth to the angle of the jaw

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4
Q

Oral Pharyngeal Airway (OPA): Assessment after placement

A

Feel for breathing and breath sounds every 2-4 hours and PRN

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5
Q

Naso Pharyngeal Airway (NPA): Indications

A

Patients with intact, weak cough and gag reflex who require frequent suctioning but unable to clear secretions

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6
Q

Naso Pharyngeal Airway (NPA): Contraindications

A

Patients who are anticoagulated, have low platelet count, bibasilar skull fracture, basel formities, facial trauma, sometimes children because of risk of epistaxis

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7
Q

Naso Pharyngeal Airway (NPA): Complications

A

Trauma to nares, airway obstruction, laryngospasm, gagging and vomiting

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8
Q

Naso Pharyngeal Airway (NPA): Measurement

A

Measure from nares to the tragus of the ear

Circumference smaller than diameter of nostril

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9
Q

Naso Pharyngeal Airway (NPA): Assessment after placement

A

Feel for breathing
Check posterior airway
Auscultate lung sounds
Remove and replace with a new NPA every 8 hours and examine nasal mucosa and nares

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10
Q

Most effective method to clear the airway

A

Coughing and deep breathing

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11
Q

Incentive spirometry use

A

To promote deep breathing and good inspiratory effort

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12
Q

Peak flow measurements

A

Provide baseline of best maximal expiration to evaluate airway diameter

To determine meds to minimize further asthma attacks

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13
Q

Postural drainage and cupping: Contraindications

A

Head injuries, intracranial pressure, COPD, history of cardiac disorders

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14
Q

Resuscitation breathing bags: indications

A

Hypoxia, decreased O2 sats that don’t recover with increasing oxygenation

Hypoventilation (RR

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15
Q

BVM ventilation

A

Deliver breaths over 1 second

Deliver one every 6-8 seconds or 8-10 breaths per minute

Sync with patient effort to breathe, or inbetween patient’s breaths

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16
Q

BVM ventilation oxygen flow

A

15 L for teens and adults

10 L for infants and children

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17
Q

Pleural space: definition

A

Lies between the parietal and visceral pleura of the chest wall and lung

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18
Q

Inspiration

A

Passive, involuntary activity

Intrapulmonary pressure is lower than atmospheric pressure, causing air to flow into the lungs

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19
Q

Expiration

A

Intrapulmonic pressure is greater than atmospheric pressure, causing the air to flow fro the lungs and out to the atmosphere

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20
Q

Functions of surfactant

A

Increase compliance
Repvent atalectasis
Reduce fluid accumulation thereby keeping surface dry

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21
Q

Pneumothorax: definition

A

Air in pleural space

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22
Q

Types of pneumothorax

A

Spontaneous
Closed
Open

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23
Q

Pneumothorax: signs and symptoms

A

Signs: tachypnea, tachycardia, decreased or absent breath sounds over affected area

Symptoms: pain which worsens with inspiration, dyspnea, cough, sudden stabbing pain on the side of the pneumothorax

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24
Q

Spontaneous pneumothorax: causes

A 
Excessive coughing
Smoking
Tall, thin men
COPD and CF
Ruptured pulmonary blebs
High impact stress from sports
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25
Spontaneous pneumothorax: treatments
High flow O2 Chest tube High fowler's position
26
Closed pneumothorax: causes
Air enters the pleural space from within the lung Rib fracture that punctures the lung Result of a medical procedure such as insertion of a central line or cardiac pacemaker wires via the subclavian vein Blunt trauma
27
Open pneumothorax: causes
Air enters the pleural space from the atmosphere Penetrating trauma
28
Hemothorax: causes
Blood in the pleural space Thoracic or heart surgery Blood clotting disorder Pulmonary infarction Lung cancer Tear of a blood vessel when placing a central venous catheter Sever hypertension TB
29
Hemopneumothorax
Collection of blood and air in the pleural space Requires to chest tubes (one for air, one for blood)
30
Tension pneumothorax: definition
Air leaks into the pleural space through a tear in the lung and has no way to escape With each breath, air accumulates in the pleural space, increasing positive pressure which compresses the lung and shifts the mediastinum to the unaffected side of the chest Venous return and cardiac output ar edecreased
31
Tension pneumothorax: treatment
Chest tube will NOT prevent this Thorocostomy
32
Tension pneumothorax: complications and signs/symptoms
Unaffected lung may collapse --> life threatening emergency ``` Rapid, labored respirations Tachycardia Cyanosis Hypoxemia Sudden chest pain that extends to the shoulders ```
33
Pleural effusion: causes
Excess fluid in the pleural space Left ventricular failure, pulmonary embolism, pneumonia, cancer, tumors, complications of surgery, previously placed chest tube is removed prematurely
34
Chylothorax: causes
Accumulation of lymphatic fluid in the pleural space Chest trauma, expanding tumor, surgery on mediastinal structures
35
Empyema
Purulent drainage of pus from an infection such as pneumonia or lung abscess
36
Empyema: signs and symptoms
Cough, chest pain, SOB, fever
37
Empyema: treatment
Thorocentesis "tap the lung"
38
High chest tube placement
2nd intercostal space
39
Low chest tube placement
5th or 6th intercostal spaces
40
Suction control chamber
Dry suction control Automatic control valve inside the regulator adjusts to the patient and suction source Expansion of the red bellows helps determine whether or not suction is operating
41
Suction tube
NEVER kink or clamp May be milked w/o order to remove clots
42
Collection chamber
Fluid/blood drains here Checked every hour initially Notify provider if there is >100mL/hr drainage
43
Water seal chamber: normal intermittent bubbling
Normal if chest tube drainage unit is on suction Caused by fluid being displaced by air or when there is an air leak in the pleural space, coughing or exhaling
44
Water seal chamber: large amount of bubbling
Usually caused by a large patient leak or a leak in the system
45
Water seal chamber: unexpected absence of bubbling
May be a blockage in the tubing Verify tubing is attached, water level is filled to prescribed level and check wall suction
46
Tidaling
Fluctuations in fluid level indicates pressure changes in pleural space Fluctuates up with inspiration, down with expiration Diminishes as lung re-expands
47
Leaks
Evidenced by continuous rapid bubbling in the water seal chamber
48
Jackson Pratt
Use to remove fluids from a surgical area Removes fluids by creating suction in the tube/bulb. The bulb expands as it fills with fluid Removed when
49
Penrose
Open drainage system Acts like a straw to pull fluids out of the wound and rain outside the wound
50
Hemovac
Portable wound suction device that is compressed to provide gentle suction Creates a negative pressure of ~45mmHg Closed drainage system
51
VAC device
Negative pressure wound therapy Area covered with a transparent adhesive membrane Foam placed within wound area Causes blood vessels to dilate and greater cell proliferation Enhances the formation of granulation tissue
52
P wave represents...
atrial depolarization
53
QRS complex represents...
ventricular depolarization
54
R wave represents...
ventricular repolarization
55
U wave represents...
repolarization of Purkinje fibers May indicate an old MI
56
PR interval normal duration
0.12-0.20 seconds
57
QRS complex normal duration
= 0.12 seconds
58
QT interval normal duration
0.35-0.40 seconds
59
ST interval
isoelectric, above or below isoelectric
60
TP interval
isoelectric
61
PP interval signifies...
atrial rhythm and rate
62
RR interval signifies...
ventricular rhythm and rate
63
Five steps to analyze a strip:
1. Determine regularity 2. Determine rate 3. Presence and quality of P waves 4. PR interval consistency 5. QRS duration
64
Sinus Bradycardia: description
Rate
65
Sinus Bradycardia: causes
Athletic rate, hypoxia, hypothermia, drug reactions, excessive vagal stimulation
66
Sinus Bradycardia: management
Depends on cause: atropine, dopamine, epinephrine
67
Sinus Bradycardia: S&S
May be asymptomatic; syncope, dizziness/weakness, hypotension, diaphoresis, SOB, chest pain
68
Sinus Tachycardia: description
Rate > 100
69
Sinus Tachycardia: causes
Exercise, infection, hypovolemia, hypoxia, MI, increased tissue oxygen demand, fever, vagal inhibition, stimulant meds (catecholamines, atropine, caffeine, alcohol, nicotine, aminophylline, thyroid meds)
70
Sinus Tachycardia: management
Depends on cause
71
Sinus Tachycardia: S&S
May be asymptomatic; fatigue, weakness, SOB, orthopnea, neck vein distension, decrease O2 sat, decreased BP, restlessness, anxiety, impaired renal function
72
PAC's: description
Occur when atrial tissue becomes irritable Ectopic focus is fired before the next sinus episode is due
73
PAC's: causes
Stress, fatigue, anxiety, infection, caffeine, meds, ischemia, electrolyte imbalance, nicotine, alcohol
74
PAC's: management
If symptomatic, treat with anti-arrhythmic drugs
75
Atrial Fibrillation: description
1. Irregular rhythm and rate 2. F waves 3. Indeterminate PRI 4. Most common dysrhythmia
76
Atrial Fibrillation: causes
Hypertension, ischemic, rheumatic, mitral, myocardial and pericardial disease, thyrotoxicosis, aging
77
Atrial Fibrillation: risks
Blood pooling may lead to embolic event Decreased CO
78
Atrial Fibrillation: S&S
Decreased BP, SOB, fatigue, angina, syncope, inconsistent peripheral pulses
79
Atrial Fibrillation: management
1. Drugs to slow conduction (amiodarone) or calcium channel blockers (cardizem) 2. Anticoagulation to decrease risk of thrombus formation 3. Synchronized cardioversion
80
Atrial Flutter: description
1. Regularly rhythm 2. Variable rhythm 3. F waves
81
Atrial Flutter: causes
Hypertension, ischemic, mitral, myocardial and pericardial disease, aging
82
Atrial Flutter: management
1. Drugs to slow conduction | 2. Synchronized cardioversion
83
Atrial flutter: S&S
Palpitations, weakness, fatigue, SOB, nervousness, anxiety, syncope, angina, signs of heart failure, shock
84
Supraventricular Tachycardia: description
1. Regular or irregular rhythm 2. Elevated rate 3. No P wave
85
Supraventricular Tachycardia: causes
Hypoxia, stimulant drugs, ischemia, mitral valve disease
86
Supraventricular Tachycardia: management
Vagal maneuvers, antidysrhythmic drugs, synchronized cardioversion, ablation,
87
Supraventricular Tachycardia: S&S
Same as Atrial Flutter: palpitations, weakness, fatigue, SOB, nervousness, anxiety, syncope, angina, signs of heart failure, shock
88
Tracheostomy: Indications
Bypass severe recurrent upper airway obstruct: (repeated aspiration, anatomic narrowing/stenosis, tracheal malacia); Prolonged mechanical ventilation after failure to wean/extubate; facial trauma, inability to remove secretions from airway; head and neck surgery
89
Tracheostomy: Risks/Complications
Bleeding, infection, erosion of mucosal lining with granuloma formation, compromised breathing, plugging with mucus/secretions, tracheal esophogeal fistula, accidental decannulation, "false pocket" when reinserting tube, subcutaneous emphysema/crepitus

Therapeutics (9 decks)

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