Respiratory Exam 1

Question 1

pulmonary embolism s/s

Answer 1

sudden onset dyspnea
pleuritic chest pain
tachypnea
anxious
scared

-hypoxemia
-cough
-hemoptysis
-wheezing
-shallow respirations
-edema (lower)
-crackles

Question 2

pulmonary embolism vitals

Answer 2

tachycardia
tachypnea
hypotension
low fever
low O2 sat

Question 3

pulmonary embolism risks

Answer 3

smoking
air travel
reduced activity
hx of clotting disorder
hx of DVT
hx of cancer
HTN
obesity

-hx of a-fib
-oral contraceptives
-recent surgery / trauma
-older age

Question 4

Pulmonary embolism labs

Answer 4

d-dimer
CBC
ABG
BNP
EKG
CXR
Spiral chest CT

-coagulation study
-duplex ultrasonography
-pulmonary angiography
- v/q scan

Question 5

pulmonary embolism patho

Answer 5

occlusion of pulmonary arteries from a clot , decreased blood flow to alveoli allowing no gas exchange

-v/q mismatch prevents gas exchange

Question 6

PE can lead to….

Answer 6

increase pulmonary vascular resistance because blood flow cannot move past the clot

**lead to HTN –> back flow of blood to R ventricle –> R sided HF

Question 7

v / q scan

Answer 7

identifies lungs are ventilated but not perfused

*high probability = clot

Question 8

pulmonary angiography

Answer 8

definitive PE study , invasive , only done when pt is stable and other tests are inconclusive

Question 9

Pulmonary embolism action

Answer 9

1. Provide O2 and ventilation
2. anticoagulants
3. IV fluids
4. baseline aPTT / INR

Question 10

pulmonary embolism meds

Answer 10

1. oral xa inhibitors
2. lovenox
3. warfarin
4. heparin
5. tPA

Question 11

oral xa inhibitors

Answer 11

used in asymptomatic PE pts w/ low risk clot

-eliquis , xarelto , prodaxa

Question 12

lovenox

Answer 12

anticoagulant , low molecular weight heparin

Question 13

heparin

Answer 13

anticoagulant , IV admin in emergency

Question 14

heparin antidoate

Answer 14

protamine sulfate

Question 15

tPA

Answer 15

dissolve current clot , occurs within 3 hours of event

given to UNSTABLE PTS

Question 16

IV heparin

Answer 16

given for emergency PE
-complaints of chest pain
-hypoxemia
-tachypnea
-tachycardia

Question 17

Heparin admin considerations

Answer 17

-bleeding precautions
-IV access
-protamine sulfate on hand
-aPTT levels

Question 18

venous doppler US

Answer 18

evaluate blood flow of vessels
-check for DVT

Question 19

inferior vena cava filter

Answer 19

allows for blood passage and traps other emboli
-used when pts have recurrent PE despite therapies

Question 20

PE lifestyle change

Answer 20

1. exercise
2. cardiac diet
3. adequate fluids
4. no smoking

-bleeding precautions

Question 21

PE home medications

Answer 21

explain Coumadin
follow ups for INR check
lasix and s/s of hypokalemia

Question 22

PE bleeding precautions

Answer 22

soft toothbrushes
electric razor
limit activity with bleeding risk
fall precautions

Question 23

warfarin antidote

Answer 23

vitamin K

Question 24

s/s of DVT

Answer 24

lower edema
redness / warmth

Question 25

warfarin and vit k foods

Answer 25

need to be limited -leafy greens -kale -broccoli -spinach -cabbage -lettuce

Question 26

acute respiratory failure s/s

Answer 26

SOB fever cough altered mental status dyspnea rapid shallow breathing accessory muscle use flushed skin

Question 27

acute respiratory failure vitals

Answer 27

hypertension tachycardia tachypnea low O2 sat temp

Question 28

ARF can include both what...

Answer 28

hypoxemia and hypercapnia

Question 29

acute respiratory failure interventions

Answer 29

oxygen : NRBM 100% cardiac monitoring immediate IV access HOB elevated -neuro assessment -vitals -breath sounds -IV fluids

Question 30

acute respiratory failure oxygen option

Answer 30

BiPAP if nonrebreather isn't enough -maintains high pressure

Question 31

acute respiratory failure labs

Answer 31

1. CXR 2. ABGs 3. CBC 4. EKG 5. cardiac enzymes 6. BNP 7. sputum culture 8. blood culture

Question 32

acute respiratory failure meds

Answer 32

1. IV antibiotics 2. bronchodilators: albuterol 3. corticosteroids : solumedtrol , solucortef 4. sedatives : ativan 5. diuretics : lasix

Question 33

ARF complications

Answer 33

1. sepsis 2. dysrhythmias and decreased CO 3. VAP 4. stress ulcers

Question 34

ARF sepsis complication

Answer 34

underlying pneumonia with hypoxemia and decrease CO leads to MODS

Question 35

VAP prevention

Answer 35

sterile technique handwashing oral care suctioning

Question 36

ARDS interventions

Answer 36

1. monitor vitals 2. monitor O2 sat 3. neuro assessment 4. resp assessment 5. monitor UO 6. monitor ventilation

Question 37

ARDS labs

Answer 37

ABGs CBC serum lactate renal / liver tests blood and sputum culture

Question 38

ARDS meds

Answer 38

1. antibiotics 2. corticosteroids 3. bronchodilators 4. sedatives 5. paralytic agent 6. analgesics 6. inotropic agents

Question 39

ARDS tx

Answer 39

PRONING POSITION -allows for better alveoli recruitment ECMO

Question 40

ECMO

Answer 40

pump that circulates blood through artificial lung , CO2 is removed and oxygenation happens -blood is returned to pt

Question 41

obstructive sleep apnea s/s

Answer 41

fatigue daytime sleepiness restless sleep loud snoring snorting witnessed apnea during sleep gasping / choking during sleep

Question 42

OSA risks

Answer 42

type II DM HTN hyperlipidemia obesity smoking male a-fib nocturnal dysrhythmias HF age 40-65

Question 43

OSA patho

Answer 43

upper airway is obstructed / narrowed during sleep related to pressure being put on airway

Question 44

OSA complication

Answer 44

1. can lead to cardiovascular disease 2. endothelial damage 3. cardiac ischemia, MI , ED , a-fib , HF , cardiac death

Question 45

OSA tests

Answer 45

polysomnography -EKG -pulse ox -eye / skeletal muscle movement -EEG -apnea - hypoapnea events -respiratory airflow

Question 46

OSA tests

Answer 46

-CXR : R ventricle -echo : R ventricle measurement -12 lead EKG -R heart cath : HTN check

Question 47

OSA treatment

Answer 47

CPAP -prevents collapse of airway using continues positive pressure

Question 48

OSA education

Answer 48

1. weight loss 2. DM management 3. disease process 4. med compliance 5. CPAP use