Test #2 Flashcards

Question

Why does oxygen diffuse out into the blood from the alveoli

Answer 1

Because the alveoli have a higher tension than in the pulmonary capillaries, such oxygen will diffuse down the concentration gradient into the pulmonary capillaries (opposite is true for carbon dioxide - that's why it diffuses out of the blood and into the alveoli)

Answer 2

To show how likely hemoglobin is to release oxygen to the tissues or hold onto oxygen based on the needs of the body

Answer 3

Hemoglobin is giving oxygen to the tissues, so there will be a higher PO2 amount (dissolved oxygen) Causes: - Acidosis (you have more hydrogen ions binding to hemoglobin, which reduces hemoglobins attraction or desire to hang onto oxygen) - Hyperthermia (uses more oxygen in the tissues, so hemoglobin will be releasing a lot more oxygen to the tissues) - Hypercapnia (increased altitude) (excessive CO2) - Increased 2,3 DPG (decreases hemoglobin affinity for oxygen)

Answer 4

Hemoglobin will bind more readily with oxygen Causes: - Alkalosis (less hydrogen ions to take up hemoglobin) - Hypothermia (tissues aren't needing as much oxygen) - Hypocapnia (low altitude) (less CO2) - Decreased - 2,3 DPG

Answer 5

NO! Quick shifts maybe life threatening.

Answer 6

PaO2 is the amount of oxygen in the arterial blood BEFORE it has attached to hemoglobin SaO2 is the amount of oxygen that has bound to hemoglobin

Answer 7

Non invasive display of CO2 concentration that is exhaled

Answer 8

For continuous monitoring during: - Surgical and procedural anesthesia - Post op recovery - Critical care - Evaluate the effectiveness of compressions during codes (basically monitors the effectiveness of ventilation)

Answer 9

V = ventilation Q = perfusion

Answer 10

Shows us how much air is moving into the alveoli (ventilation) compared to how much blood is going through the pulmonary capillaries (perfusion)

Answer 11

V = 4 liters of air flowing into the alveoli Q = 5 liters of blood flowing past the alveoli 4/5 = 0.8

Answer 12

Greater = Too much air is blowing by but not enough air is getting too the tissues Smaller = Not enough air is getting in to go to the tissues

Answer 13

It is gravity dependent - so where ever gravity is lowest based on the position of the lungs For example - in an upright position the most gas exchange is occurring in the lower lungs In a person laying on their tummy it will be the anterior part of the lungs See pg 297 in high acuity for examples

Answer 14

We want to position patients in a way that no long conditions, like pneumonia, will impair their gas exchange. Like if they have pneumonia in the upper lobes then we want to keep them upright so gas exchange occurs in the healthy lower lobes

Answer 15

Ventilation = Asthma, COPD, atelectasis (obstructive things) Perfusion = pneumonia, pulmonary hypertension, pulmonary fibrosis, pulmonary embolism (not getting enough perfusion to alveoli due to pneumonia secretions)

Answer 16

Amount of cardiac output that flows from the right heart into the left heart without undergoing pulmonary gas exchange

Answer 17

1. Anatomic 2. Capillary

Answer 18

1. Normally occurring, where 2-5% of the blood doesn't pass through alveoli, so it doesn't go through gas exchange 2. Abnormal anatomic shunt - like a ventricular septal defect, where there is a hole in the heart wall dividing the right side from the left

Answer 19

- Where blood passes through an unventilated alveoli, which causes it to not participate in gas exchange (basically the alveolis are not functioning correctly, so they cant do gas exchange) - Most commonly seen in high acuity patients usually caused by atelectasis, consolidation or fluid in the alveoli

Answer 20

No - because it's an issue with the blood and alveoli, not about getting enough oxygen (basically no matter how much oxygen is administered, diffusion cannot take place if alveoli are completely bypassed or nonfunctioning)

Answer 21

- Atelectasis (collapsed alveoli) - Alveolar fibrosis - Alveolar capillary destruction (like from emphysema) - Alveolar consolidation (like from pneumonia) - Interstitial edema (swelling pushing the alveoli in to collapse) - Frothy secretions (like pulmonary edema)

Answer 22

- Atelectasis (collapsed alveoli) - Alveolar fibrosis - Alveolar capillary destruction (like from emphysema) - Alveolar consolidation (like from pneumonia) - Interstitial edema (swelling pushing the alveoli in to collapse) - Frothy secretions (like pulmonary edema)

Answer 23

The combined amount of the anatomic shunt and a capillary shunt

Answer 24

More than 15%

Answer 25

Usually having more at least 20% of their blood shunted (not getting oxygenated)

Answer 26

Refractory hypoxemia (where no amount of supplemental oxygen will help the patient, because it is an issue with the blood and alveoli, not the oxygen)

Answer 27

PaO2 (partial pressure of arterial oxygen) / FiO2 (fraction of inspired oxygen, expressed as a decimal) (basically tells us how well our patient's oxygen level is based on what type of oxygen they are on (room air or supplemental)

Answer 28

PaO2 = measures 60 / FiO2 21% or 0.21 (room air) = 285

Answer 29

Tells us the level of hypoxemia our patient's may be experiencing - Used to trend progression of respiratory failure, who might need to be intubated...

Answer 30

286 (anything less than is worrisome)

Answer 31

20% + 4 x (liters per minute)

Answer 32

20% + 4 x (5 liters per minute) = 40% FiO2

Answer 33

Where your body maintains an acceptable level through cardiopulmonary compensatory mechanisms, because the respiratory insufficiency is progressive and slow, it gives the body enough time to compensate (like how COPDers can live at 88% oxygen)

Answer 34

Stressors, like an acute infection, where your body doesn't have enough time to compensate

Answer 35

- Tachypnea - Tachycardia - Increased use of accessory muscles - Nasal flaring - Abnormal chest wall movements - Labored breathing - Decreasing SpO2 - Restlessness/anxious - Air hunger

Answer 36

They will have: - PaCO2 greater than 50 - pH less than 7.30 and/or a PaO2 less than 60 - If an ARF, prepare for possible mechanical ventilation

Answer 37

Caused by alveolar hypoventilation, where air cannot move into the alveoli, which decreases gas exchange and leads to a buildup of CO2, which causes respiratory acidosis

Answer 38

Anything that can affect air flow like: - Brain trauma - Neuromuscular dysfunction - ARDS - Heart failure - Ineffective airway clearance - Drug induced central nervous system depression

Answer 39

S/S of hypercapnia, where the high levels of CO2 are causing vasodilation, can be referred to as CO2 narcosis - Tachypnea - Headache - Flushed, wet skin - Bounding pulse - Increased BP - Increased HR - Lethargic - Drowsy - Coma (CO2 narcosis)

Answer 40

PaCO2 greater than 50 and pH less than 7.3

Answer 41

Hypoxemia (low oxygen) is occurring, where CO2 is diffusing quicker than oxygen, so CO2 leels remain normal, but oxygen levels show they are low

Answer 42

There is SHUNTING occurring, where perfusion is fine, but normal alveolar ventilation is lacking, so blood is trying to pick up oxygen in the alveoli, but the alveoli are not working properly, so the blood can't pick up the oxygen leading to poor oxygenation

Answer 43

A low V/Q ratio, because the ventilation number is going to be low, due to the alveoli not working, but the perfusion number will be fine, because it's not impacted

Answer 44

- Asthma - Pneumonia - COPD - Atelectasis

Answer 45

PaO2 less than 60

Answer 46

- Dyspnea - Tachypnea - Increased BP - Increased HR - Cardiac dysrhythmias - Altered LOW - Cyanosis - Thready pulse - Restlessness - Confusion

Answer 47

The patient is at risk for hypoperfusion or hypoxic organ shock complications like multiple organ dysfunction syndrome (MODS)

Answer 48

Impaired cellular function and the increase in CO2 can cause vasodilation, which can lead to increased intracranial pressure and decreased cardiac output

Answer 49

Ventilation failure - the buildup of CO2 creating an acidic environment can cause more damage to the body, more quickly

Answer 50

In general, an NPV lowers the air pressure around part of your body, making the pressure “negative.” This creates a vacuum effect that expands your lungs and chest, pulling air into your lungs. Then the machine removes that lower pressure to let your lungs and chest contract, helping you exhale.

Answer 51

- Improved communication - Ability eat & drink - No need for pressurized air or oxygen - Lower acuity care

Answer 52

Positive - increasing pressure on the outside to force air into your lungs Negative - decreasing pressure on the outside so air will be pulled into your lungs

Answer 53

They are non-invasive, so you don't have to force an artificial airway into someone and put them at risk for complications like infections and injuries to their airway

Answer 54

- BIPAP - CPAP - Hi-flow nasal cannula

Answer 55

CPAP just adjusts the pressure going into your lungs, where a BIPAP can also adjust the pressure coming out of your lungs

Answer 56

Effective for COPDers and CHF exacerbations Less effective for ARDS and pneumonia

Answer 57

- They have to be alert - They can't be restrained That way if they vomit or something they can wake up and pull off their mask and roll over

Answer 58

- Provides continuous positive airway pressure - Level of pressure remains the same throughout the breathing cycle - Pressure will be between 5-20

Answer 59

- Inspiratory positive pressure (PIP) - Expiratory positive airway pressure (PEEP) (helps you breath in oxygen and expel CO2)

Answer 60

They come with a mode called average volume-assured pressure support (AVAPS), which can automatically adjust tidal volumes based on the patients needs. This is very helpful for hypercapnic patients

Answer 61

- Unstable hemodynamic status (unstable cardiac output, etc) - Cardiac dysrhythmias - MIs - Inability to clear one's own secretions - Vomiting - Improper mask fit - Patient's in restraints

Answer 62

Skin integrity

Answer 63

- Humidified - More comfortable than a BIPAP - Allows the pt to eat or drink

Answer 64

- Provides oxygen with compressed air - Can go up to 100% FiO2 - Flow can be up to 60 L/min

Answer 65

Have the pt try to keep their mouth closed, because the PEEP can drop when the mouth is open

Answer 66

Yes - someone people may not want this "life support"

Answer 67

We give the pt a paralytic

Answer 68

Soft –cuffed ET tube in size requested Stylet to guide tube in place Topical anesthetic Laryngoscope (with blade attached and functional light source) Suction set up Syringe for cuff inflation Water-soluble lubricant (will be applied to tube) ET holding device or adhesive tape to secure the ET tube post insertion PPE Sedative medications IV access Stethoscope Manual resuscitation bag and mask (BVM)

Answer 69

- Oral surgery is needed - Patient has a limited ability to open their mouth - Mandible fractures

Answer 70

Paralytics: Rocuronium Vecuronium Succinylcholine Sedatives: Ketamine Propofol Versed Etomidate Analgesia: Fentanyl Remember that if you're giving a paralytic, you will also want to give a sedative so the pt doesn't feel themself being paralyzed Most can cause hypotension

Answer 71

Those with myasthenia gravis or another neuromuscular disorder

Answer 72

Rapid Sequence Intubation (RSI) kits

Answer 73

First: listen to the lungs bilaterally to confirm ETT placement Second: observe for color change on CO2 detector Third: obtain an order for a chest xray to confirm placement Fourth: secure airway, noting location of tube at teeth and document (basically want to make sure we know the tube length in case it moves)

Answer 74

RT Proper placement, oral care, etc.

Answer 75

Call a rapid response (may even be a code), stay with the patient and try to maintain their airway

Answer 76

Not routinely, only as needed. Suctioning is a risk because it can cause sudden respiratory distress, so it should only be done when necessary

Answer 77

Taking the pt off the ventilator for periods of time to see how they do, and slowly start increasing the length of time as they do better and better

Answer 78

Ventilator associated pneumonia, because we're sticking a tube directly into someone's airway, which increases the risk of introducing pathogens

Answer 79

NO! They should be weaned off

Answer 80

AC or CMV: Assist Control or Controlled Mandatory Ventilation Ventilator initiates the breath, ends the breath, or both. SIMV: Synchronous Intermittent Mandatory Ventilation Patient does most of the work, but the ventilator intermittently supplies a pre-set breath. PSV: Pressure Support Ventilation Mode Decreases the work of breathing by supplying additional pressure to overcome airway resistance. (pt initiates every breath - so pt is regulating everything) Spontaneous: A mode that allows the patient to breathe on their own. It has a backup rate in case the patient goes apneic.

Answer 81

Applied positive pressure into the airway at the end of expiration to prevent the alveoli from collapsing

Answer 82

Peep will keep the alveoli open throughout the breathing cycle, which increases gas diffusion time, which increases gas exchange and stops shunting.

Answer 83

The amount of pressure it takes to deliver the amount of volume needed based on airway resistance and lung compliance

Answer 84

Usually 40 or less

Answer 85

This means that the pt is needing more pressure to deliver the preset tidal volume, which means that their pulmonary condition may be worsening (we want to see less pressure needed)

Answer 86

High and low pressure alarms

Answer 87

Telling us that there is an increase in airway resistance Check pt first! Look for any coughing, biting on the tube, bucking, secretions in the airway or water in the tubing (all things that may be blocking the tube)

Answer 88

Indicates no resistance Check pt first! Check the connections for an air leak, cuff leak (maybe it deflated), disconnection in the tubing

Answer 89

- Hypotension due to increased intrathoracic pressure (because we're adding more pressure into the chest, which may decrease venous return to the heart, which can lead to low cardiac output) - Barotrauma/volutrauma (barotrauma - increased pressure rupturing alveoli - greatest risk with noncompliant lungs, like COPDers, volutrauma - large tidal volumes to noncompliant lungs) - Oxygen toxicity - Ventilator associated pneumonia - Gastric ulcers - Increased ICP and decreased cerebral perfusion - Tracheomalacia (weaking or erosion of tracheal cartilage)

Answer 90

If they are tachycardic, tachypneic or restless

Answer 91

Coarse (wet/Rales) lung sounds

Answer 92

A need to be suctioned

Answer 93

The Richmond Agitation-Sedation Scale (RASS) (basically helps us determine how to titrate their sedation medications so they aren't overly or underly sedated)

Answer 94

- Cause of respiratory failure is resolved or significantly improved - Adequate oxygenation- FiO2 less than 50% and PEEP less than 8 (shows that pt doesn't need as much support) - Spontaneous ventilatory effort - Successful spontaneous breathing trial

Answer 95

Turn off the sedation/analgesia

Answer 96

An obturator

Answer 97

Uncuffed (balloon deflated) - allows for airway clearance but doesn't protect from aspiration (these are for long-term, where there isn't a need for mechanical ventilation and there isn't a high risk for aspiration - like the guy I saw at Jiffy Lube, they can eat and talk better with these) Cuffed (inflated balloon)- allows for secretion clearance, mechanical ventilation and some protection from aspiration

Answer 98

It has a little hole in the top of the tube that allows for air to pass, which can help promote spontaneous breathing and possibly allow for "talking" (without a hole here, air can't get out)

Answer 99

NO, because air is not able to get out and up past the tube

Answer 100

- Performing suctioning only as needed (remember the risks of scheduled suctioning) - Inner cannula changes if disposable - Use sterile technique - Clean the stoma with a moist cotton tip swab - Change trach ties if wet or soiled - Makes sure ties are tight enough so they won't become dislodged (only one finger should fit underneath (book says 2 fingers)) - Dressing goes under face plate

Answer 101

- Obturator at the bedside - New tracheostomy of the same size and one size smaller (so if you can't fit the same size one back in, you can use the one size smaller) - Oxygen - Suction - Ambu-bag (these supplies need to go everywhere with the pt, like even to imaging or somewhere else in the hospital)

Answer 102

Ways that we can help prevent ventilator associated pneumonia (VAP)

Answer 103

- Provide oral care every 2-4 hours - Keep HOB between 30-45 degrees - Keep ET tube cuff pressure between 20-25 to minimize aspiration risk - Hand washing Other interventions: - Stress ulcer prophylaxis - DVT prophylaxis - Daily sedation breaks and spontaneous breathing trials

Answer 104

- Changes in mental status - Altered level of consciousness - Seizures - Rapid change in neuro status - Changes in vital signs- hypotension, bradycardia, tachycardia - Respiratory problems Your “gut feeling”

Answer 105

The pt doesn't have a pulse and/or respirations

Answer 106

- Epinephrine (helps with dysrhythmias, like asystole) - Atropine (can help with bradycardia) - Sodium bicarbonate (treat acidosis) - Amiodarone (for ventricular dysrhythmias)

Answer 107

- Recorder- Typically the primary nurse - Medication administrator- should be familiar with code drugs. - Compressor- a team of people should be available to prevent fatigue. Feedback on compression quality is important. - Airway- typically respiratory therapy if they are available. - Monitor/Defibrillator: May be assigned to the leader or recorder. They pay attention to the rhythm, vital signs, ETCO2. - Leader-someone who is ACLS trained, typically a provider, may be a rapid response nurse. - Family supporter-typically the chaplain if they are available (we can all be family supporters)

Answer 108

More acidic

Answer 109

These need to be excreted from the kidneys, which can take days (they cannot be excreted through expirations)

Answer 110

Yes, acids are a product of normal metabolism (like from carbs) or from abnormal metabolism (like from ketone diets)

Answer 111

Bicarbonate HCO3 - it acts like a buffer (where it can combine with hydrogen protons to make the body less acidic)

Answer 112

Say you have excess CO2 that your body needs to get rid of, so water will combine with this excess CO2 creating carbonic acid, which then frees

Answer 113

Say you have excess hydrogen floating around creating an acidic environment, to help create a balance in the pH, bicarbonate will combine with these excess hydrogens (why it's called a buffer) to form sodium bicarbonate (basically bicarbonate soaks up the extra hydrogen ions)

Answer 114

- Buffering (where bases can form with excess hydrogen ions or let hydrogen ions go depending on what is needed) - Respiratory - the depth and rate of respirations can adjust based on acid imbalances - Kidneys - can adjust the amount of bicarb and hydrogen that is reabsorbed or excreted

Answer 115

- COPD (emphysema/bronchitis) - Hypoventilation - Oversedation - Overdose - Neuromuscular disease - Underventilation on mechanical ventilation - Pulmonary edema - Atelectasis - Pneumonia - Bronchospasm (basically anything that inhibits you from blowing off CO2)

Answer 116

- Kidney disease - Build up of waste products due to renal failure - Buildup of acids due to ketoacidosis - Excess losses of bicarb, like from severe diarrhea - Accumulation of lactic acid, which can happen during sepsis - Aspirin poisoning

Answer 117

- Extreme loses of chloride or hydrogen ions like from extreme vomiting for gastric suctioning - Hypokalemia

Answer 118

The Allen test

Answer 119

No - because central lines are venous

Answer 120

pH is low HCO3 is normal or high PCO2 is high (remember ROME, respiratory opposite, metabolic equal)

Answer 121

pH is high HCO3 is normal or low PCO2 is low

Answer 122

pH is low HCO3 is low PCO2 is normal or low

Answer 123

pH is high HCO3 is high PCO2 is normal or high

Answer 124

The lungs are eliminating too much CO2

Answer 125

Caused by hyperventilation, where we are "blowing off" too much CO2 Hyperventilation can be caused by: - Hypoxia - Brain injury - Fever - Overventilation on a ventilator - Pain - Anxiety - Fear

Answer 126

- High altitudes - Tumors - Trauma - Anemia - Liver disease

Answer 127

- Hyperventilation - Dizziness - Light-headedness - Confusion - Headache - Tachycardia - Dysrhythmias due to hypokalemia - N/V - Tetany - Numbness, tingling in extremities - Seizures (think about when I had a panic attack)

Answer 128

It can cause hypokalemia because it causes the body to excrete potassium and the kidneys are less likely to absorb it Acidosis can cause hyperkalemia

Answer 129

Well we want to try and increase our CO2 level, so if we are exhaling into a paper bag, then when we inhale we can reabsorb that CO2

Answer 130

- High altitudes - Tumors - Trauma - Anemia - Liver disease

Answer 131

Lungs aren't blowing off enough CO2, so we have hypoventilation

Answer 132

- Shock - Strokes - Oversedation - Overdose - Brain injury - Neuromuscular disease - Pulmonary edema - Pneumonia - Bronchospasm - Severe atelectasis (anything that isn't letting you breath enough)

Answer 133

- SOB - Fatigue - Exhaustion - Headache - Drowsiness - Confusion - Sweating - Flushed skin - Memory loss - Irregular sleep patterns - Tremors - Difficulty walking

Answer 134

- COPD - Emphysema - Chronic bronchitis

Answer 135

- Shock - Organ failure - Seizures - Increased ICP (remember too much CO2 leads to vasodilation - which can increase the pressure in the brain) - Coma - Severe kidney disease

Answer 136

- Medications to help widen bronchi - Anti-inflammatory meds - CPAPs and BIPAPS - Stopping smoking (basically what can we do to help decrease the cause)

Answer 137

A measure of the amount of buffer required to return the blood to a normal pH, this is specific for metabolic imbalances

Answer 138

+/- 2 mEq/L Greater than +2 (basically anything positive is alkalosis) Less than 2 (basically anything negative show acidosis)

Answer 139

How much bicarbonate or carbonic acid is needed to help normalize pH

Answer 140

- Overuse of alkaline drugs, like Tums - Loss of gastric fluids, like from vomiting or gastric suctioning - Steroids - Excessive diuretics - Overuse of bicarbonates with CPR - Baking soda - Severe dehydration - Cystic fibrosis - Electrolyte imbalances

Answer 141

- Irritable - Muscle twitching - Muscle cramping - Muscle spasms - Fatigue - Confusion - Tremors - Tingling and numbness - Arrythmias due to hypokalemia - Seizures - Coma

Answer 142

- Saline infusion - Give potassium - Give hydrochloric acid - Stopping any meds, like diuretics that are causing it

Answer 143

- Diabetic ketoacidosis - Uremia with increased phosphates and sulfates - Ingestions of acids (aspirin (salicylate) overdose) - Lactic acidosis - *Diarrhea (you're loosing too many HCO3s to help balance the acid) - GI fistulas - Loss of body fluids from GI drains - Laxative overuse - Hyperaldosteronism

Answer 144

- Accelerated HRs - Confusion - Dizziness - Lethargic - Loss of appetite - Headaches - Nausea - Weakness - Fruity smelly breath if (ketoacidosis)

Answer 145

- Sodium citrate - IV fluids - Insulin drip if dka - Remove toxins, like from an overdose

Answer 146

Helps us determine the cause of metabolic acidosis so we know how to treat it based on the difference between cations (sodium, potassium) and anion (chloride, bicarbonate) (basically how many more cations there are than anions)

Answer 147

Things that can increase organic acid like the following: - aspirin toxicity - DKA - Uremia

Answer 148

- GI loss of bicarbonate, like from diarrhea - Failure of the kidneys to excrete acids

Answer 149

High = there has been an increase in acid in the body Normal = bicarb is being lost or the kidneys can't excrete the acids (more of a body issue)

Answer 150

- N/V - Malaise - Hypercapnia - Fatigue - Cardiac disfunction

Answer 151

- Treat the cause - For example, if the anion gap is normal, then give the pt bicarb

Answer 152

Impaired tissue oxygenation (either from decreased oxygen delivery or deficient mitochondrial utilization)

Answer 153

- Sepsis (where too little oxygen is reaching the body tissues - which is true for all of the below) - AIDS - Alcoholism - Cancer - Cirrhosis - Cyanide poisoning - kidney failure - Respiratory failure - Severe dehydration - DKA

Answer 154

- N/V - Weakness

Answer 155

- Treat the underlying cause - Administer sodium bicarb - Admin IV fluids

Answer 156

pH = 7.35-7.45 HCO3 = 22-26 CO2 = 35-45

Answer 157

A life threatening sudden onset of respiratory failure not caused by heart failure or fluid overload

Answer 158

- Pulmonary injuries - Aspiration pneumonia - *Sepsis* - Blood transfusion reactions - TBIs - Shock

Answer 159

- Rapid, onset, widespread inflammation of the lungs caused by a condition such as sepsis 1. Injury/Exudative phase - This leads to an increase in pulmonary capillary permeability, where fluid accumulates and causes alveoli surfactant to wash away leading to alveoli collapse. This leads to shunting, where it doesn't matter how much oxygen you give, blood won't get oxygenated (refractory hypoxemia) 2. Reparative or proliferative phase - Lung tissue gets invaded by neutrophils, monocytes, lymphocytes and fibroblasts (leads to an increase in fibrosis, as these immune system cells destroy pulmonary vascular) Continued shunting and airway resistance 3. This increase in fibrosis causes remodeling of the lung leading to poor lung compliance

Answer 160

- SOB - Wet lungs/crackles - ABG could should respiratory alkalosis from hyperventilation - Chest x-ray can show some infiltrates

Answer 161

- Severe SOB - Accessory muscle use - Increased anxiety - Decreased LOC - Cyanosis - Diaphoresis - Tachycardia - Cough with sputum - - Switching over from resp alkalosis to resp acidosis - Organ disfunction - x-ray shows diffuse infiltrates "White out"

Answer 162

They will rule out other conditions, like HF, if other conditions aren't causing it then they determine it's ARDS

Answer 163

- Infections- CAUTI, VAP (ventilator associated pneumonia), CLABSI - Respiratory- O2 toxicity, barotrauma (explosion of the alveoli during mechanical ventilation), pulmonary emboli, pulmonary fibrosis - GI- hypermetabolic state, paralytic ileus, pneumoperitoneum, stress ulcerations & hemorrhage - Renal- acute kidney injury (if pt goes into shock, because ARDS puts a pt at a high risk for kidney injuries) - Cardiac- decreased cardiac output, dysrhythmias - Hematologic- anemia, DIC, thrombocytopenia, VTE - ETT related- airway injuries - CNS- delirium, PTSD, sleep deprivation, impaired memory

Answer 164

- Oxygenation - Possible ventilation - Maintain PEEP to stop alveoli from closing - Use low tidal volume to stop overdistention of alveoli since they are already damaged from ARDS due to the fibrosis (the alveoli can't withstand much pressure) - Diuretics to try and get rid of fluid - Corticosteroids - Reposition every 2 hours - Prone positioning - Permissive hypercapnia (letting there be a little more CO2 than normal so we don't push too much air into the alveoli and destroy them) - Oral care every 4 hours

Answer 165

- Decreased urine output - desatting (hypoxemia) - Persistent hypotension - Really high, extended fever

Answer 166

- In the prone position, the lungs aren't being compressed by the heart and abdominal organs, like it is in the supine position - The prone position redistributes blood and airflow evenly, which helps improve gas exchange - Helps with the removal of secretions - These pts may require less help from mechanical ventilation, which can help reduce the risks of ventilation, like barotrauma. - May improve heart function in some patients - Constrictions of the lungs be decreased

Answer 167

- Difficult to move patients into this position - Can be difficult if intubated - Can develop hemodynamic instability - Can cause someone people to have worse oxygenation - ET tube can get knocked out

Answer 168

- Corticosteroids (want to give early in *low* doses (do not give high doses or late) - Nitric oxide - Neuromuscular blockages (paralytics) - ECMO

Answer 169

Use the "train of four" "looking for 4 twitches, which indicates baseline" "go to baseline after receiving paralytic, test with the device looking for 2 twitches, if there are 4 then the pt is too paralyzed, if there are less than 2 then they are not paralyzed enough"

Answer 170

- Helps with compliance with the ventilator - Improves PaCO2 and decreases CO2

Answer 171

They can cause profound weakness

Answer 172

- A machine used to bypass the lungs when the lungs are not working, where CO2 is taken out and oxygen is put in.

Answer 173

No, it can also be used to help increase the BP when the oxygenated blood is put back in, which can help cardiac output, because you can either put blood back into the veins (where you would not be affecting pressure or you can put it back into the arteries, where you could increase the pressure to help with cardiac output)

Answer 174

ARDS per definition and at least one of the following: - PaO2/FiO2 ratio <150 - Murray Score ≥3 - And/or pH <7.2 for at least 3 hours despite standard care at transferring facility - Age ≤ 80 - Mechanical ventilation for ≤ 7 days - No known CNS catastrophe or chronic CNS deficit

Answer 175

- Diaphragm flattens - Chest wall becomes more rigid due to cartilage calcification - Respiratory muscles weaken - Anterior-posterior diameter of the chest increases - Decreased lung compliance - Increased air trapping (where we retain air during exhalation, which can lead to an increase in CO2 retention)

Answer 176

- Decrease their risks for aspiration - Vaccines - Encourage exercise - Coughing - Deep breathing - Regular check-ups - Watching their weight

Answer 177

Bronchial hyperreactivity with reversible expiratory airflow limitation

Answer 178

Can trap expiratory air, which is CO2, which can lead to an increase in CO2 in the body, which is respiratory acidosis

Answer 179

- Dyspnea - Wheezing - Cough

Answer 180

inflammation in your airway, the muscle bands around your airways constricting (bronchospasm), increase in mucous

Answer 181

Helps to loosen the tight muscle bands

Answer 182

No - it only helps loosen the tight muscles This is why you need a controller medication to help decrease the inflammation

Answer 183

Having another flare up within a few days

Answer 184

- Avoid stressors - Know your triggers - Avoid getting sick, as this might trigger an attack

Answer 185

Irreversible Remodeling of the lung tissue

Answer 186

- Genetics - Environmental (smoke, pollen, etc) - GERD - Exercise induced - Respiratory infections as a child

Answer 187

1. Quick relief (rescue) medications 2. Long-term control medications

Answer 188

Short acting beta-adrenergic agonist (SABA), most common - albuterol

Answer 189

1. They stimulate beta adrenergic receptors in the bronchioles to produce bronchodilation 2. They work within minutes and can last for 4-8 hours 3. Should be used cautiously in pts with cardiac disorders, because they can increase BP, HR and increase the risk for dysrhythmias 4. Don't want to overuse this drug - because overuse can decrease effectiveness

Answer 190

1. Inhaled corticosteroids (like Flovent) 2. Leukotriene modifiers (like Singulair) can be used to block leukotrienes, which decreases inflammation and helps promote bronchodilation. 3. Long-term beta agonists (LABAs) () open the airway and reduce swelling for 12 hours

Answer 191

1. Inhaled corticosteroids (like Flovent) 2. Leukotriene modifiers (like Singulair) can be used to block leukotrienes, which decreases inflammation and helps promote bronchodilation. 3. Long-term beta agonists (LABAs) (solumedrol) open the airway and reduce swelling for 12 hours. Only taken in combination with corticosteroids. 4. Long acting Muscarinic (if LABAs don't work) (combined with steroids)

Answer 192

They are not responding to the standard tx of asthma

Answer 193

- Use of accessory muscles - Reduced peak expiratory flow rate - Inability to speak - Severe SOB - Anxiety - *Fatigue - *Decreased LOC - ABGs showing hypoxemia

Answer 194

- Hypoxemia - Sudden cardiac arrest - Complications from mechanical ventilation

Answer 195

When a pt has been wheezing, and then suddenly there is an absence of wheezing and the pt is struggling to breath (this is a life-threatening emergency and can be a sign of status asthmaticus)

Answer 196

We classify using a peak flow meter Mild (green) = FEV1 greater than 80% Moderate (yellow) = FEV1 between 50-80% Severe (red) = FEV1 less than 50% (this is a medical emergency

Answer 197

Having a severe attack

Answer 198

Because they are hyperventilating, and their airways are constricting, so they can get some air in, but they can't get air out, so that CO2 gets trapped in there (remember - hyperventilation = CO2 retention)

Answer 199

- Give IV corticosteroids - Give SABA - Theophylline (help promote muscle relaxation and get rid of extra fluid) (nasty side effects/drug interactions, need to have levels monitored) - Anticholinergics (Ipratropium bromide) (helps with bronchodilation - more effective for COPDers) - Helium/oxygen mixture

Answer 200

Ventilation - Bronchoconstriction can worsen directly after placement of ET tube - Also the increase pressure from ventilation can damage the airway

Answer 201

A mixture of lower density oxygen and helium that can be used to decrease the resistance and work of breathing

Answer 202

- RR over 40 - Can't talk - Accessory muscle use - Intercostal retractions - Fatigue - Solumence - Hypoxia - Hypercapnia

Answer 203

- Have the ventilator set to a low tidal volume (so we're not forcing air into airways that are constricted, otherwise we can make air trapping worse)

Answer 204

Chronic inflammation that causes the obstruction of airflow being able to get out

Answer 205

- Changing and narrowing of lungs - Increases goblet cells (increase in thick mucus) - Scar formation - Long-term narrowing - Destruction of alveoli walls, which leads to a decrease in elasticity and recoil - Thickening of lining of airway due to hypertrophy

Answer 206

Presence of a cough and sputum production for at least 3 months in each of the 2 consecutive years Termed blue bloaters

Answer 207

When things like allergens or an infection triggers it

Answer 208

Destruction of alveoli without fibrosis Pink puffers

Answer 209

- Purse their lips on expiration (why they're called puffers) - Barrel chest due to hyperinflation of the lungs (air is trapped in the lungs) - Thin (burning off a lot of calories from breathing so much) - SOB - Severe dyspnea (happens early compared to bronchitis) - HYPERVENTILATION (these guys are going to be breathing fast to try and get rid of CO2) - Hypoxemia occurs late - Damage occurs distally, so they don't have an issue getting CO2 out early in the disease

Answer 210

- Overweight (due to air trapping) - Cyanotic (hypoxemia occurs early) - Peripheral edema - Rhonchi and wheezing - Chronic cough - Have CO2 retention because the damage occurs distally in the bronchioles, therefore trapping CO2 - Dyspnea later (compared to emphysema)

Answer 211

Heart disease

Answer 212

It's obstructive - so you can't get the air out

Answer 213

Sometimes we can find a cause, like smoking, but others don't have a cause at all (it's random)

Answer 214

- Positive pressure ventilation - Mechanical ventilation - Small, frequent meals to conserve energy - Plan care appropriately to conserve energy

Answer 215

- Chest tightness - Tachycardia - Decrease in energy - Decreased LOC (due to CO2 retention) - Increase in sputum - Increase in wheezing - Increase in accessory muscle use

Answer 216

- Increased dose of a SABA (like albuterol) - Antibiotics if they have an infection - Oxygen - IV corticosteroids - CPAP, BIPAP, ventilator

Answer 217

- Spontaneous pneumothorax - Cor pulmonale (enlarging of heart)

Answer 218

It allows better expiration by increasing airway pressure, which can help keep air passages opening during exhalation leading to an increase in CO2 exhalation (so we're not retaining so much CO2)

Answer 219

They are actually stimulated by oxygen to breath, so if you give them a bunch of oxygen they will lose their drive to breath (Max 2 liters)

Answer 220

The lower lobes

Answer 221

PEs (basically preventing PEs from occurring can save a lot of people)

Answer 222

- Fat embolism - Amniotic embolism - Septic embolism - Venous air embolism

Answer 223

1. Long bone trauma and/or orthopedic surgery (basically fat in our bones can become dislodged and travel) 2. Petechiae, tachypnea, hypoxia, confusion, drowsiness, fever, tachycardia, dyspnea, coma. (symptoms occur 12-72 hours after event) 3. Supportive care, no specific tx

Answer 224

1. When amniotic fluid mixes with mom's blood and the mother suffers an immune response from the baby's blood, which can lead to hypercoagulability, which puts them at a greater risk for clots. 2. Shock, severe hypoxemia, DIC, neurologic changes (seizures). 3.Obstruction, vasoconstriction, coagulopathy and ARDS. 4. Treat the heart and lung failure, CPR, DIC (treat hemorrhage), replenish volume (this one sounds really serious, and sounds like it puts women at a high risk of death - treat as if they are coding)

Answer 225

1. IV drug use, central lines, endocarditis, implanted devices, periodontal disease. 2. Fever, cough, hemoptysis (coughing up blood) 3. Treat the infection with antibiotics and/or remove the infection source

Answer 226

1. Can be from air in an IV line, from trauma where air enters into circulation, from a surgery with an incision above the heart, scuba divers can have this happen. 2. 3-5 mL/kg 3. Vasoconstriction in the lungs, pulmonary HTN, injury to capillary epithelium, pulmonary edema. 4. Oxygen, position on the left side in Trendelenburg

Answer 227

Prevents the air bubble from traveling out of the right ventricle and into the lung

Answer 228

Prevents the air bubble from traveling out of the right ventricle and into the lung

Answer 229

- Venous stasis (from immobility, severe varicose veins, polycythemia vera (thickening of the blood and high RBC count) - Hypercoagulability (genetic, birth control pills, sepsis, pregnancy, cancer) - Venous (endothelial injury) (like from surgery, trauma, infection, central venous catheters)

Answer 230

- Tachypnea - Dyspnea - Pleuritic chest pain (pain with inspiration, especially on the side where the embolism is lodged) - Apprehension (Sense of impending doom) - Cough - Fever - Tachycardia - Findings of a DVT - Hemoptysis (coughing up blood) - Shock

Answer 231

- Crackles, wheezing in lungs - Fever - Massive PEs we see hypoxemia, decreased LOC, hypotension, feeling of impending doom

Answer 232

- Massive (5% of people) - Submassive (20-25%) - Usual (majority)

Answer 233

Hemodynamic issues like: - Pulmonary HTN (all this blood is trying to get to the area that is blocked, this increases the pressure in the lungs) - Right sided failure (caused by heart working really hard to get blood to the blocked part of the lung) - Sustained hypotension, where SBPs are less than 90 for over 15 minutes

Answer 234

It can cause right sided heart failure, because the heart has been working so hard to overcome those blockages.

Answer 235

- Pulmonary infarction (death of lung tissue) which can cause alveolar necrosis, hemorrhage, pleural effusions or abscesses - Pulmonary hypertension (occurs when over 50% of the pulmonary vasculature bed is affected - usually from multiple PEs)

Answer 236

- When the occlusion is in the medium-large vessels - When there is insufficient collateral blood flow - When there are 2 or more pre-existing lung conditions

Answer 237

- Spiral CT using contrast

Answer 238

They can do a V/Q scan (ventilator/perfusion) - it examines airflow and perfusion in the lungs

Answer 239

- Give oxygen - Anticoagulation to help prevent further emboli (either unfractionated heparin or lower molecular weight heparin) (warfarin started and pt should continue at home use for 3-6 months) - Thrombolytic therapy (tpa) for severe cases to dissolve the clot (risk for bleeding) - Embolectomy (removing the emboli) (requires bypass - very big surgery!) - Vena cava filter to prevent the migration of clots if someone is having a lot of them or they can't go on anticoagulant therapy

Answer 240

- Fluid - Vasopressors

Answer 241

Homans sign, where there may be a DVT present if there is pain when the foot is flexed

Answer 242

- Unilateral leg swelling (one leg) - Pain/tenderness - Cramping

Answer 243

- Monitoring their ABGs - Lung assessments - O2 therapy - Monitor ptt if on heparin - Platelets if they're having thrombocytopenia - Monitor for heparin induced thrombocytopenia (HIT) - Monitor for signs of bleeding (bruising, etc) - Monitor INR if on warfarin.

Answer 244

Low platelets (platelets are needed to clot blood) Normal platelet range is 150,000-400,000

Answer 245

Normal = less than 1 On warfarin = 2-3

Answer 246

Normal = 30-40 seconds On heparin = 47-70 seconds (2 times the normal value)

Answer 247

When 3 or more adjacent ribs are fracted in two or more places causing the segment to separate from the rib cage, this causes the lung to deviate when inhaling and exhaling (very painful!)

Answer 248

- Pain!!! - SOB - Tachypicnia - Increase in HR - Shallow breathing (taking big breaths is painful) = causes hypoxemia - *Paradoxical chest movements (chest isn't moving symmetrically) - Crepitus

Answer 249

Pneumo or hemothorax

Answer 250

- Pain meds - Surgery (may also heal on its own) - Possible ventilation to fix hypoxemia

Answer 251

When air enters the pleural cavity

Answer 252

- Open (air is coming in through the chest wall from the outside, like from a penetrating wound) - Closed (No external wound, but a rib may have punctured it)

Answer 253

Pneumothroax

Answer 254

- Small blebs (air-filled sacs) on the surface of the lung rupture, which can lead to a pneumothorax - Causes: COPD, asthma, cystic fibrosis, pneumonia, tall and thin patients, asthma, smoking, pneumonia

Answer 255

Healthcare procedure

Answer 256

When air enters the pleural space but it can't get out, this increase in pressure causes the lung to collapse.

Answer 257

Presence of lymphatic fluid in the pleural space due to trauma or malignancy

Answer 258

- Signs of chest trauma - Tachypnea - Tachycardia with possible dysrhythmias - SOB - Diminished or absent breath sounds on the affected side - ABG (see a decrease in PaO2 and SaO2, and respiratory alkalosis - Sharp pain on the affected side - Shallow breaths

Answer 259

Tension pneumothorax

Answer 260

- Tenderness over the site (usually around the chest tube and crepitus) - It usually doesn't need to be treated as it will typically resolves on its own by being reabsorbed.

Answer 261

Where air is sucked in, basically through a one way valve, and can't get back out (think of the valve on my paddle board)

Answer 262

It increases pressure on things like your trachea, heart, esophagus, and great vessels and shifts them towards the unaffected side.

Answer 263

- SOB - Chest pain - Tachycardia - decreased or absent breath sounds on affected side - Severe dyspnea - Profuse diaphoresis - Hypotension and shock - *Tracheal deviation (late sign)

Answer 264

- rubber tipped hemostat (clamps) - Sterile water (she didn't say this one in lecture) - Occlusive petroleum dressing

Answer 265

- Position pt with the affected side's arm raised above their head - HOB at 30-60 degrees - Prepare local anesthetic like lidocaine for the provider - Cover chest tube site with occlusive dressing with petroleum jelly - Give pain medications - Check connections - Make sure they get an x-ray to confirm placement

Answer 266

1. Collection chamber (collects air or fluid) 2. Water seal chamber (acts as a one-way valve allowing air out but preventing air from flowing back into the patient) 3. Suction control chamber (regulates the amount of negative pressure that is being exerted into the pleural space)

Answer 267

To restore the negative pressure in the thoracic cavity

Answer 268

assess amount, color and consistency every 1 hour after insertion of chest tube for the first 8 hours then once every 8 hours and prn.

Answer 269

2cm of sterile water

Answer 270

Yes, usually right when the chest tube is placed there will be brisk bubbling

Answer 271

Movement of water in the chamber with breathing It is expected and should go away once a lot of air has been removed and the lung is getting back to normal

Answer 272

More than 100mL of drainage within the 1st hour of placement Drainage turns from a dark brown color to a bright red color Eyelets sticking out (cover and notify the doctor) (note - changing positions can cause an increase in output or changes in drainage color, etc)

Answer 273

Continuous bubbling

Answer 274

Yes, it usually happens when the pt is moving around, this just indicates that there is still air in the intrapleural space

Answer 275

No - it can cause a tension pneumo

Answer 276

1. Dry 2. Water

Answer 277

High levels of water = more suctioning Low levels of water = less suctioning going on

Answer 278

Yes, we will see continuous bubbling.

Answer 279

Yes, we can use gentle "milking", but no stripping

Answer 280

Start with clamping the tube close to the chest - if the bubbling stops, then we know that the leak is coming from the insertion site or in the chest. Reinforce the dressing and notify the provider

Answer 281

NO! This may cause a tension. Their drainage system can go with them.

Answer 282

1. Immediately cover insertion site with sterile occlusive petroleum dressing 2. Tape three sides of the dressing, leaving one side open for air to escape. 3. Notify provider asap. 4. Stay with the pt and monitor for signs of respiratory distress.

Answer 283

Reestablish the water seal by immersing the tube into sterile water while a new system can be setup

Answer 284

- Pt status has improved - Decreased drainage (less than 100 mLs/24 hours) - Air leak resolved - X-ray shows re-inflated lung

Answer 285

1. Pneumonectomy: removal of one entire lung 2. Lobectomy: removal of one or more lobes of the lung 3. Segmentectomy: removal of one or more portions of a lobe 4.Wedge resection: removal of a small wedge (triangle shape) section of the peripheral lung

Answer 286

NO! We want them to deep breath to avoid getting pneumonia.

Answer 287

- Possible vocal cord dysfunction - Pulmonary edema - Empysema (collection of pus in the pleural cavity) - Postpneumonectomy syndrome (where there is a medial sternal shift towards the side where the lung was removed -causing tracheal obstruction)

Answer 288

- Dyspnea - Cough - Stridor - Dysphagia

Answer 289

Usually will have to have surgery to have a prosthetic placed to keep the sternum from shifting

Answer 290

Lung cancer

Answer 291

The whole lung and associated vessels are removed leaving an empty space that eventually fills with fluid

Answer 292

Right down the middle, like for heart surgeries

Answer 293

Right under the boob in the front (laterally - like horizontal) Right under the shoulder on the back (horizontal as well) Between the 4th and 5th intercostal space

Answer 294

It is minimally invasive

Answer 295

- Diagnosis conditions like obtaining biopsies - Lung resections (like taking out a small piece of lung) - Pleural effusions

Answer 296

- Pain control (especially because we want to encourage them to cough and deep breath, which they are more likely to do if they are not in pain) - IS, coughing, deep breathing - Splinting - "Huff coughing" (get a little bit up at a time) - Monitor CBC, especially watching hemoglobin, as low hemoglobin can lead to hypoxia (oxygen doesn't have anything to bind with)

Answer 297

There is so much resistance in the pulmonary system, that the right ventricle has to work really hard to pump blood out to the lungs, but it can't pump it all out, so this leads to an increase in afterload, which leads to right heart failure.

Answer 298

constriction

Answer 299

Conditions that cause chronic hypoxia will increase vascular resistance through constriction, edema, etc.

Answer 300

Pulmonary hypertension

Answer 301

Elevated pulmonary artery pressure due to an increase in resistance to blood flow - typically pressure is greater than 25 at rest and 30 with exercise (normal should be 12-16)

Answer 302

1. Idiopathic (unknown) 2. Caused by a condition

Answer 303

- SOB - Extreme fatigue - Syncope - Symptoms worsen with movement - Dizziness - High HR - Chest pain - Palpitations - Peripheral edema (they have edema because fluid and backed up into their body) (it causes right sided HF, so think of symptoms of right sided HF)

Answer 304

Cor pulmonale

Answer 305

Cardaic Catheterization looking for the average pressure in the pulmonary artery (high pressure at 25 at rest or 30 with exercise can indicate pulmonary hypertension )

Answer 306

- Oxygen - Sildenafil (viagra) = vasodilation - Epoprostenol (Flolan) - Lung transplant - Calcium channel blockers to decrease HTN - Furosemide to decrease preload - Warfarin to decrease clotting

Answer 307

In the alveoli and interstitial spaces, where there is a rapid accumulation of fluid (don't confuse with pleural effusion, where pleural effusion is fluid in the pleural space)

Answer 308

- *Left sided HF (where fluid is backing up into the lungs) - Complication from thoracic surgery - Hypertensive crisis - ABRUPT change in heart condition (body doesn't have time to compensate)

Answer 309

- *pink/red colored froth sputum - SOB - Decreased O2 - Tachycardia - Chest pain - Cold clammy skin - Dizziness - Diaphoresis - Anxiety - Fear (feelings of drowning)

Answer 310

- Oxygen - Diuretics to get rid of sudden excessive fluid - Nitro to help open up constricted vessels - Morphine to help with SOB feeling - Ventilation if needed

Answer 311

Abnormal collection of fluid in the pleural space

Answer 312

1. Transudative (caused by protein poor fluid, *HF (most common cause), liver disease) 2. Exudative (caused by inflammation usually from infection, where there can be empyema (which is a collection of purulent fluid in the pleural space))

Answer 313

- Chest pain that is usually worse in coughing and deep breathing - Fever - Chills - Rapid breathing - SOB - Diminished breath sounds over that area

Answer 314

- Thoracenteisis

Answer 315

Rapid removal of too much fluid can lead to hypotension, hypoxemia, or re-expansion of pulmonary edema (this is why we want to remove fluid slowly and not too much so we don't cause this)

Answer 316

Chemical pleurodesis, which uses chemicals to create fibrous tissue to help prevent the effusion

Test #2 Flashcards

(368 cards)