Exam 3- ARDS, Mechanical Ventilation, Pulmonary Edema, Larnyx Cancer

Question 1

What accounts for half of all head and neck cancers?

Answer 1

Larynx Cancer

Question 2

In which age group is larynx cancer most common?

Answer 2

People older than 65

Question 3

How much more common is larynx cancer in men compared to women?

Answer 3

Four times more common

Question 4

What type of carcinoma is laryngeal cancer classified as?

Answer 4

Squamous cell carcinoma

Question 5

What percentage of all laryngeal cancers present with involved lymph nodes at diagnosis?

Answer 5

55%

Question 6

When does recurrence of laryngeal cancer typically occur after diagnosis?

Answer 6

2-3 years

Question 7

What are common clinical manifestations of laryngeal cancer?

Answer 7

• Horsness
• Persistent cough or sore throat
• Pain and burning in the throat (especially w hot liquids and citrus juices)
• Lump in neck

Question 8

Name the later symptoms of laryngeal cancer.

Answer 8

• Dysphasia
• Dyspnea
• Unilateral nasal obstruction or discharge
• Foul breath
• Persistent ulceration

Question 9

What diagnostic procedures are used for laryngeal cancer assessment?

Answer 9

• Laryngoscopy
• Fine-needle aspiration (FNA) biopsy
• Barium swallow
• Endoscopy
• CT or MRI scan
• Positron emission tomography (PET) scan

Question 10

What is the medical management for early-stage laryngeal tumors?

Answer 10

• External beam radiation
• Conservation surgery (vocal cord stripping or cordectomy)

Question 11

What is a total laryngectomy?

Answer 11

Surgical removal of the entire larynx

Question 12

What are the side effects of radiation therapy for laryngeal cancer?

Answer 12

• Mucositis
• Ulceration of mucous membranes
• Pain
• Xerostomia (dry mouth)
• Loss of taste
• Dysphasia
• Fatigue
• Skin reactions

Question 13

What is esophageal speech?

Answer 13

A method where air is compressed into the esophagus and expelled to produce sound

Question 14

Tracheoesophageal puncture?

Answer 14

Most widely used, most resembles normal speech. Valve is places into the stoma to divert air into the esophagus and out the mouth

Question 15

What does mechanical ventilation improve?

Answer 15

Gas exchange and decreases the work of breathing

Question 16

What causes low tidal volume alarms in mechanical ventilation?

Answer 16

Leaks via disconnection, cuff leaks, tube displacement

Question 17

What does the I:E ratio represent in mechanical ventilation?

Answer 17

Duration of inspiration to expiration

Question 18

What is PEEP in mechanical ventilation?

Answer 18

Positive end-expiratory pressure applied at the end of expiration

Question 19

What are the types of ventilators?

Answer 19

• Volume-Cycled Ventilators
• Pressure-Cycled Ventilators
• High-Frequency Oscillatory Support Ventilators
• Noninvasive Positive-Pressure Ventilation (CPAP and BiPAP)

Question 20

What are risk factors associated with acute respiratory failure?

Answer 20

• Atelectasis
• COPD
• Cystic fibrosis
• HF
• Pneumonia
• Pneumothorax
• Pulmonary embolism

Question 21

What is the difference between acute and chronic respiratory failure?

Answer 21

• Acute: Sudden, often due to CNS or pulmonary dysfunction
• Chronic: Insidious deterioration, often due to COPD

Question 22

What are some clinical manifestations of acute respiratory failure?

Answer 22

• Restlessness
• Confusion
• Lethargy
• Fatigue
• Headache
• Use of accessory muscles
• resp distress
• tachycardia
• dysrhythmias

Question 23

What lab values indicate acute respiratory failure?

Answer 23

PH <7.35, CO2 > 50, PaO2 < 50

Question 24

What causes Acute Respiratory Distress Syndrome (ARDS)?

Answer 24

• Pneumonia
• Shock
• Sepsis
• Drug overdose
• Aspiration
• Trauma
• inhalation of chemicals
• pancreatitis

Question 25

What are common diagnostics for ARDS?

Answer 25

- ABGs - Chest X-ray (you will see bilateral infiltrates) - BNP to rule out heart issues

Question 26

What is a major treatment for ARDS?

Answer 26

- correcting underlying cause - O2 supplementation - mechanical ventilation

Question 27

What is pulmonary edema?

Answer 27

Fluid accumulation in the lungs

Question 28

What distinguishes cariogenic from non-cariogenic pulmonary edema?

Answer 28

* Cariogenic: Related to heart issues * Non-Cariogenic: Damage to the capillary lining

Question 29

What is a common symptom of pulmonary edema?

Answer 29

Extreme hypoxia even with high oxygen levels

Question 30

High Pressure alarms due to… (two PB sandwiches can make you SCK)

Answer 30

increased pressure aka P1- pulmonary edema P2- pneumothorax B1- bronchospasm B2- biting S- secretions C- cough K- kink

Question 31

Tidal Volume Vt

Answer 31

volume of gas delivered with each breath

Question 32

FiO2 is…

Answer 32

The fraction of inspired oxygen, o2 concentration of air being delivered to the pt RA is 21% FiO2, 1 L is 24% and each L after that goes up by 4%

Question 33

AC is

Answer 33

Assist control - vent is doing the work but the pt can take their own breath

Question 34

Nursing care (ventilation)

Answer 34

Manual resuscitation bag with reintubation equipment at bed side with two different tube sizes Regularly assess pts level of consciousness vitals breath sounds pulse ox and ABGs Suction oral and tracheal suggestions as needed Reposition ET tube every 24 hours to prevent skin break down Frequent oral care Monitor for complications such as ventilator associated pneumonia Post ventilation encourage pts to take deep breaths and cough, and use IS

Question 35

Volume-Cycled Ventilators –

Answer 35

delivers a preset volume of air with each inspiration, once that inspiration is delivered it cycles off and expiration happens passively

Question 36

Pressure-Cycled Ventilators-

Answer 36

it delivers a flow of air until it reaches a preset pressure and then it cycles off and expiration occurs

Question 37

High-Frequency Oscillatory Support Ventilators-

Answer 37

these types of ventilators deliver high respiratory rates (180-900 Breaths/min) with a very low tidal volume

Question 38

Ventilation Perfusion Ratios

Answer 38

A= Normal Ratio: 1:1 B= Blockage of some kind keeping blood from being oxygenated C= dead space within capillaries- ventilation exceeds profusion- no blood is getting to the alveoli D= blockage in alveoli and capillary- no ventilation or profusion

Question 39

ARDS characteristics

Answer 39

- sudden and progressive pulmonary edema - increasing bilateral infiltrates on chest x-ray - hypoxemia unresponsive to oxygen supplementation (regardless of the amount of PEEP) - absence of an elevated left atrial pressure - Leads to increased alveolar dead space - Very difficult to ventilate (Resembles pulm edema)

Question 40

Pathophysiology of ARDS

Answer 40

Alveolar damage leads to pulmonary edema, causing them to be extremely hypoxia, unresponsive to increased O2 etc.

Question 41

Medications for ARDS

Answer 41

paralytic, sedatives, analgesics, nitric oxide (helps with V:P ratio), vasopressors, inotropes, steroids

Question 42

Non-Cariogenic pulmonary edema direct causes

Answer 42

damage from chest trauma, smoking, infection, or aspiration Tx: treat the cause, and manage symptoms

Question 43

Non-Cariogenic pulmonary edema indirect causes

Answer 43

damage from sepsis or burns (pancreatitis can be something that sets off the inflammatory process) Tx: treat the cause, and manage symptoms

Question 44

With pulmonary edema pts will be extremely _______________ even with ______________, ________________, and ______________

Answer 44

Hypoxic; High O2; High PEEP; High FiO2

Question 45

Signs and symptoms of ARDS

Answer 45

- Dyspnea - Rapid and shallow breathing - Substernal retractions - Tachycardia - Cyanosis or pallor - Crackles in lungs

Question 46

Treatment of Acute Respiratory Distress syndrome

Answer 46

- O2 therapy - Mechanical ventilation - chest physiotherapy - BiPAP and CPAP - Bronchodilators - corticosteroids - antibiotics - inotropic agents such as digoxin - vasopressors and diuretics

Question 47

ARDS Patho

Answer 47

An injury (direct or indirect) to the lungs that results in systemic inflammation which increases the permeability of the alveoli, allowing fluid to get in and collect in the lungs making it increasingly difficult to breath.