Test 2, Ch 10 and 11 Flashcards
(98 cards)
1
Q
Patient Protection and Affordable Care also called……….. was made law in 2010 and came into effect in
A
Affordable care Act (ACA) ; 2014
2
Q
One of the earliest effects of ACA was to institute a system whereby hospitals would be
A
penalized for wasteful excessive use of resources
3
Q
There are 7 index conditions that are monitored as pat of ACA. 5 of them involve respiratory therapy
A
- acute PNA
- COPD exacerbation
- VAP
- CHF/ pulmonary edema
- myocardial infarction
4
Q
Excessive use of resources , results in a longer
A
length of stay (LOS)
5
Q
Therapist driven protocols goal is to
A
- deliver individualized diagnostic and therapeutic respiratory care to pts
- assist physician w/ evaluating pt’s respiratory care needs and optimize the allocation of respiratory care services
6
Q
TDP’s give therapist specific authority to (3)
A
- gather clinical information related to the pt’s respiratory
- make assessment of clinical data collected
- start, increase, decrease, or discontinue certain respiratory therapies
7
Q
TDP safe and ready will be qualified to
A
- collect approbate data
- formulate a uniform and accurate assessment
- select a uniform and optimal treatment plan with the limits set by the protocol
8
Q
The essential knowledge base for a successful TDP programs includes (ms roach fav word)
A
- anatomic alterations of the lungs
- pathophysiologic mechanism activated
- clinical manifestations
- treatment modalities used to correct them
9
Q
What fixes pulmonary edema
A
fixing the heart and diuretics ( lasix)
10
Q
What fixes bronchospasm
A
bronchodilator
11
Q
what fixes a pt that’s not oxygenated well
A
oxygen
12
Q
If pt comes wheezing what clinical manifestations could it possibly be?
A
Bronchospasm or bronchconstriction issue
13
Q
If pt comes in with crackles and feet swelling what clinical manifestations could it be?
A
CHF, pulmonary edema
14
Q
Assessment skills you need
A
SOAP
1.systemically gather clinical information
2. formulate an accurate assessment
3. select a treatment
4. document the use and evaluation of this process
15
Q
Clinical data: for increased breathing rate , bp, pulse
Assessment: Respiratory distress and dyspnea
What is the treatment
A
Treat underlying cause
16
Q
Clinical data: Wheezing
Assessment: Bronchospasm
Treatment :
A
Bronchodilator treatment
17
Q
Clinical data: Inspiratory stridor
Assessment:Laryngeal edema
What is the Treatment:
A
Racemic epi
18
Q
Clinical data: Coarse crackles
Assessment: Secretions in large airways
What is the Treatment?
A
Airway clearance therapy
19
Q
Clinical data: Fine and medium crackles
Assessment: Secretions in distal airways
What is the Treatment?
A
Treat underlying cause such as CHF; Hyperinflation therapy
20
Q
Clinical data: strong cough
Assessment: Good ability to mobilize secretions
What is the Treatment?
A
None
21
Q
Clinical data: Weak cough
Assessment: Poor ability to mobilize secretions
What is the Treatment?
A
Airway clearance therapy
22
Q
Clinical data: Secretions > 25 mL/ 24 h
Assessment: Excessive bronchial secretions
What is the Treatment?
A
Airway clearance therapy
23
Q
Clinical data: White and translucent sputum
Assessment: Normal sputum
What is the Treatment?
A
None
24
Q
Clinical data:Yellow and opaque sputum
Assessment: Acute Airway infection
What is the Treatment?
A
Treat underlying cause
25
Clinical data: Green sputum
Assessment: Old retained secretions and infections
What is the Treatment?
Airway clearance therapy
26
Clinical data: Brown sputum
Assessment: Old blood
What is the Treatment?
Airway clearance therapy
27
Clinical data: Red sputum
Assessment: Fresh blood
What is the Treatment?
notify physician
28
Clinical data: Frothy secretions
Assessment: pulmonary edema
What is the Treatment?
Treat underlying cause, such as CHF; hyperinflation therapy
29
Clinical data:Bronchial breath sounds
Assessment: atelectasis
What is the Treatment? (2)
Hyperinflation therapy, oxygen therapy
30
Clinical data:Dull percussion note
Assessment: infiltrates or effusion
What is the Treatment?
Treat underlying cause
31
The ability of the respiratory system to establish and maintain adequate o2 up take and carbon dioxide removal from the body
Respiratory failure
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Abg criterial for respiratory failure in a. normal individual is Pao2
PaO2 < 60 mm Hg, PaCo2 > 50 mm Hg or mixture of both
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Respiratory failure is commonly classified as (3)
1. hypoxemia respiratory failure ( type I respiratory failure pao2 <60)
2. hypercapnic respiratory failure ( type II respiratory failure co2 >50)
3. combination of both
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Ventilation =
co2
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Oxygentaion =
po2
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Anything related to co2 is
ventilatory failure
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hypercapnic respiratory is commonly called VF is classified as 2 different categories
1. acute ventilatory failure (uncompensated high paco2 and low pH)
2. chronic ventilatory failure (compensated high paco2 and normal pH)
38
Alveolar hypoventilation is classified as __________ paco2 and __________ pao2
- increased PaCO2
- decreased PaO2 (hypoxemia)
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Common causes for Alveolar hypoventilation (6)
- head trauma
- pain
- sleep apnea
- COPD
- obesity
- neuromuscular disorders
40
Cor pulmonale=
right sided heart failure
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CHF =
left sided heart failure
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What is the treatment for alveolar hypoventilation
primarily Ventilatory support
43
Portion of the cardiac output that moves from the right side to the left side without being exposed to alveolar o2
Pulmonary shunting
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What are the 2 types of shunts
Absolute and relative
45
6 basic anatomic alterations that can cause respiratory failure
1.atelectasis
2. alveolar consolidation
3. increased alveolar- capillary membrane thickness
4. bronchospasm
5.excessive bronchial secretions
6. distal airway and alveolar weakening
46
Absolute shunts ( true shunts) are classified into 2 groups
anatomic and capillary shunts
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occurs when blood flows from the right side of the heart to the left side w/o coming in contact with an alveolus for gas exchange
Anatomic shunts
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normal anatomic shunt is
3%
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AA gradient normal range is
7 to 15 mm hg
50
Common abnormal causes of anatomic shunt include ( 3diseases)
CHF
Intrapulmonary fistula
vascular lung tumors
51
Capillary shunts are caused by (3 diseases aaa)
1. alveolar collapse or atelectasis
2. alveolar fluid accumulation
3. alveolar consolidation or PNA
52
The sum of the anatomic and capillary shunt makes up the
absolute shunt
53
What is the purpose of PEEP, and is a treatment for what kind of hypoxemia
To keep alveoli open and a treatment for refractory hypoxemia
**pushing fluid and consolidation out and keeps alveoli open**
54
Relative shunts ( shunt like effect) common causes are (3)
- airway obstruction
- alveolar- capillary diffusion defect
- combination of both
55
When pulmonary capillary perfusion in excess of alveolar ventilation, what shunt is said to be present
relative shunt
56
Capillary blood flow does not have enough time to equilibrate w/ the alveolar oxygen tension
Alveolar capillary diffusion defect
57
How long does it take for Alveolar capillary diffusion defect process
0.75 seconds
58
Common causes of Alveolar capillary diffusion defect include 2 interstitials
- interstitial pulmonary edema
- interstitial lung disorders
59
Mixing of shunting non oxygenated blood w/ reoxygenated blood distal to the alveoli
venous admixture
60
Higher pao2 downstream
Lower pao2 than the reoxygenated blood
Is classified as
venous admixture
61
Under normal conditions the overall alveolar ventilation is about ____ and the pulmonary capillary blood flow is about _____
4 L/min and 5 L/min (4:5 or 0.8)
62
In some disorders the lungs receive less ______ ______ in relation to ventilation
blood flow
63
What disorders will the lungs receive less ventilation in relation to blood flow? (4)
- Asthma
- emphysema
- pulmonary edema
- PNA
64
The pt's alveolar dead space is often expressed as
dead space/ tidal volume ( Vd/ Vt) ratio
65
How would you interpret this ABG
pH: 7.51
PaCO2: 52
HCO3: 40
PaO2: 49
**Acute Alveolar Hyperventilation superimposed on Chronic Ventilatory Failure**
**pH:** increased
**PaCO2:** increased (but lower than pts typical elevated baseline level)
**HCO3-:** increased (significantly) (but lower than pt's typical elvated baseline level)
**PaO2:** decreased ( but lower than the pts typical baseline level)
66
How would you interpret this ABG
pH: 7.28
PaCO2: 97
HCO3-: 44
PaO2: 39
**Acute Ventilatory Failure Superimposed on Chronic Ventilatory Failure**
**pH:** decreased
**PaCO2:** increased (but higher than pt's typical elevated baseline level)
**HCO3-** increased increased (significantly) but higher than pt's typical elevated baseline level
**PaO2:** decreased (but lower than the pt's typical low baseline level
67
pathophysiology cause of hypoxemia respiratory failure are (3)
1. alveolar hypoventilation
2. pulmonary shunting
3. v/q mismatch
68
causes of alveolar hypoventilation (diseases)
CNS depressants, head trauma, COPD, obesity, sleep apnea, neuromuscular disorders
69
causes of anatomic shunts are (diseases)
CHF, intrapulmonary fistula, vascular lung tumors
70
Under normal conditions alveolar ventilation is about...
and pulmonary capillary blood flow is.... making the overall ratio of alveolar ventilation to blood flow.....
4 L/min ; 5 L/ min; 4:5 or 0.8
71
In asthma, emphysema , pulmonary edema, PNA the lungs receive
less ventilation in relation to blood flow
72
AA gradient is used to identify the cause of hypoxemic respiratory failure——- (3)
alveolar hypoventilation, pulmonary shunting, v/q mismatch
73
AA gradient should not exceed
30 mmHg
74
Oxygen can increase the
AA gradient
75
When pulmonary shunting, v/q mismatch or diffusion blockade is primary cause of hypoxemia respiratory failure the AA gradient is
elevated
76
major pathophysiologic mechanisms that result in hypercapnic respiratory failure (same as hypoxemia but more severe)
1. Alveolar hypoventilation
2. increased dead space
3. severe v/q mismatch
77
Hypercapnic respiratory failure is vent failure and is classified as 2 groups
1. acute ventilatory failure
2. chronic ventilatory failure
78
Short term disease process are called
and examples of that are
acute ventilatory failure; flu, acute bronchitis
79
Long term disease process is called.....
and examples of that are
chronic ventilatory failure; COPD, obesity
80
4 standards for MV
1. Apnea
2. Acute vent failure
3. Impending vent failure
4. severe refractory hypoxemia
81
apnea cause pao2 to rapidly ______, and paco2 to ______
decrease, increase
82
Acute vent failure is sudden increase of PaCO2 to greater than ____ w/ a low ___ , <7.3
50 mm Hg ; pH
83
Increase WOB w/ **borderline** acceptable ABG
impending vent failure
84
Does not respond to o2 therapy PaCO2 <40 mm Hg, SaO2 <75%
severe refractory hypoxemia
85
What can help with severe refractory hypoxemia
PEEP, CPAP, Lung expansion
86
Severe PNA, interstitial lung disease and ARDS are often seen in
Severe refractory hypoxemia
87
Hypoxemia respiratory failure is treated with
o2 therapy
88
Hypercapnic respiratory failure is treated with _________ _________ to manage PaCO2 and____
ventilatory support; pH
89
Both oxygen and ventilatory support are used when a pt demonstrates both and is called
Type III respiratory failure
90
Primary indication for hypercapnic respiratory failure is
secondary to COPD exacerbation
91
NIV is benficial for pts who ARE able to protect their airways
Asthma
mild to moderate atelectasis
community acquired PNA
92
NIV is very safe and effective means of support but may be poorly tolerated, contraindication, or harmful in pts with
respiratory arrest
cardiac arrest
upper airway obstruction
poor ability to clear secretions
profound refractory hypoxemia
93
Less than 1% are
unweanable
94
5% require
days to weeks to weaned
95
require a systematic approach to being weaned
15- 20%
96
over expansion of the alveolar structure
Barotrauma
97
Caused by high ventilator pressures and volumes, alveolar rapture does not occur
Volutrauma
98
CPAP, SBT, SIMV, VSV, ASV are some modes to
wean pts
