Respiratory

Question 1

Risk factors for opioids

Answer 1

resp depression
hypotension
constipation
CNS depression

Question 2

risk factors for ketamine/acetaminophen

Answer 2

increased risk for liver/kidney damage

Question 3

What are the indications neuromuscular blockade?

Answer 3

Emergency intubation
Manage elevated ICP
improve tolerance of ventilation

Question 4

How do we determine if neuromuscular blockade is enough?

Answer 4

Train-of-four

Question 5

What is the care of immobile, paralyzed patient?

Answer 5

eye lubrication
DVT prophylaxis
oral care
urinary catheter
vital signs and assessments
Repositioning and ROM

Question 6

ARF is defined as…?

Answer 6

inability of the resp system to provide oxygenation and/or remove CO2

Question 7

Two ways ARF can be classified

Answer 7

oxygen failure resulting in hypoxemia but no rise in CO2
or
ventilation failure resulting in hypercapnia and hypoxemia

Question 8

What is type 1 ARF?

Answer 8

oxygenation failure
PaO2 LOWER THAN 60 mm hg WITH NORMAL-DECREASED CO2

Question 9

What is type 2 ARF?

Answer 9

ventilation failure (hypercapnic)
PaCO2 GREATER THAN 45 mm hg

Question 10

what are the 4 mechanisms that reduce PaO2 causing oxygenation failure?

Answer 10

Hypoventilation
V/Q mismatch
intrapulmonary shunting
diffusion defects

Question 11

What is ventilation?

Answer 11

amount of gas that enters the alveoli per minute

Question 12

What factors can lead to hypoventilation?

Answer 12

drug overdose
neuro disorders
abd/thoracic surgery (pain)

Question 13

what is intrapulmonary shunting?

Answer 13

blood passes thru lungs w/o picking up any oxygen

Question 14

What can cause intrapulmonary shunting?

Answer 14

atelectasis
pneumonia
pulmonary edema

Question 15

What is V/Q mismatch?

Answer 15

ventilation and perfusion mismatch
the rate of ventilation does not match rate of perfusion

Question 16

What is normal ventilation?

Answer 16

4 L/min

Question 17

What is normal perfusion?

Answer 17

5 L/min or 0.8 ratio

Question 18

What are some causes of V/Q mismatch?

Answer 18

pneumonia
PE
pulmonary edema

Question 19

What are diffusion defects?

Answer 19

oxygen has a difficult time moving across membrane

Question 20

what can cause diffusion defects?

Answer 20

fluid in alveoli
pulmonary fibrosis

Question 21

Oxygenation effects 3 things?

Answer 21

Cardiac output
hemoglobin
tissues

Question 22

what is a normal cardiac output?

Answer 22

600-1000 mL

Question 23

What 2 things cause failure of ventilation?

Answer 23

V/Q mismatch
hypoventilation

Question 24

What do you assess for ARF?

Answer 24

manifestations of hypoxia and hypercapnia
vital signs
breath sounds
neuro function

Question 25

What are EXPECTED findings for ARF?

Answer 25

dyspnea vital sign abnormalities cough chest pain alteration in cognition

Question 26

what are UNEXPECTED findings for ARF?

Answer 26

resp rate above 30 O2 sat less than 90 and doesn't respond to oxygen therapy signs of shock abnormal ABGs resp arrest

Question 27

Interventions for treating ARF

Answer 27

maintain patent airway optimize oxygen delivery minimize oxygen demand treat underlying cause

Question 28

signs of respiratory muscle fatigue

Answer 28

diaphoresis nasal flaring tachycardia retractions

Question 29

What is Acute Respiratory Distress Syndrome and what is the criteria?

Answer 29

severe form of ARF 1.) acute onset within 1 week 2.) bilateral pulmonary opacities not explained by other conditions 3.) altered PaO2/FiO2 ratio

Question 30

What are some common causes of ARDS?

Answer 30

sepsis pneumonia aspiration

Question 31

What are the risk factors for ARDS?

Answer 31

alcohol use disorder female older than 60

Question 32

Explain acute stage of ARDS

Answer 32

uncontrolled inflammation damage to the alveolar epithelium, becomes more permeable and fluid leaks

Question 33

Explain proliferative phase of ARDS

Answer 33

lungs try to heal itself but causes scarring making lungs stiffer further worsening hypoxemia

Question 34

Explain fibrotic stage of ARDS

Answer 34

lungs become stiff and fibrotic decreased residual capacity Rt > Lt shunting

Question 35

Expected assessment findings for ARDS

Answer 35

Agitation restlessness dyspnea increased RR and WOB increased HR decreased Cardiac output

Question 36

What tests would you look at for ARDS?

Answer 36

chest XR pulmonary function tests BNP and coags ABGs

Question 37

What are unexpected findings of ARDS?

Answer 37

labs indicating organ failure delirium ET-tube mispositioning

Question 38

What is prone positioning?

Answer 38

placing patients on their stomach to help them breathe better

Question 39

Benefits of prone positioning

Answer 39

less lung compression improve heart function better drainage of secretions

Question 40

Management of ARDS

Answer 40

Low tidal volume ventilation to minimize trauma PEEP to keep alveoli open Prone positioning ECMO

Question 41

VAP Bundle

Answer 41

HOB 30-35 Oral care q 2 hours Ulcer prophylaxis DVT prophylaxis Spontaneous awaking trials

Question 42

CLABSI bundle

Answer 42

Hand hygiene CHG Barrier precautions Catheter Care maintenance