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NUR305 (2017) > Week 2 > Flashcards

Week 2 Flashcards

1
Q

What may a decreased chest wall expansion be caused by?

A
  • post operative pain
  • rib fractures
  • Pneumothorax
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2
Q

What may increase airway resistance?

A
  • asthma

- COPD

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3
Q

What may cause a decrease in respiratory muscle strength?

A
  • Gillian-Barre syndrome
  • poliomyelitis
  • Myasthenia graves
  • spinal cord injury
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4
Q

What may cause a decreased respiratory drive?

A
  • brain trauma
  • drug overdose
  • anaesthesia/sedation
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5
Q

Decreased capacity for gas exchange may be caused by?

A
  • impairment of ventilation (pulmonary oedema, pneumonia, COPD, ALI)
  • impairment in pulmonary perfusion (pulmonary embolism)
  • combination of both
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6
Q

List the 3 largest groups of presentations that require hospital admission?

A
  • influenza
  • pneumonia
  • COPD / asthma
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7
Q

When does respiratory failure occur?

A

When the respiratory system fails to achieve one or both of its essential gas exchange functions. (Oxygenation or elimination of carbon dioxide)

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8
Q

What is Type 1 respiratory failure?

A

Failure to oxygenate or “hypoxaemia” presents with a low partial pressure of oxygen (PaO2) and a normal or low partial pressure of carbon dioxide (PaCO2).

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9
Q

What might cause hypoxaemic respiratory failure?

A

Hypoxaemic respiratory failure may occur due to:

  • extreme altitude
  • hypoventilation
  • impaired diffusion
  • ventilation-perfusion mismatch
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10
Q

What is Intrapulmonary shunting?

A

It is a severe form of ventilation perfusion mismatch

-occurs when adequate perfusion exists but there are sections of lung tissue that are not ventilated.

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11
Q

What is dead space ventilation?

A

It is when the lungs continue to be ventilated but there is limited or no perfusion and therefore no gas exchange.

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12
Q

What is Type II respiratory failure?

A
  • failure to ventilate

- Pt presents with a high PaCO2 and low PaO2

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13
Q

What may cause type II respiratory failure?

A

Conditions that affect the respiratory drive

  • neuromuscular diseases
  • chest wall abnormalities
  • severe airway disease (COPD, asthma)
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14
Q

What is the most common symptom associated with acute respiratory failure?

A

-Dyspnoea

This is generally accompanied by increased rate and depth of breathing and the use of accessory muscles.

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15
Q

What clinical assessments may be performed on a pt with acute respiratory failure?

A

-assess the cause of respiratory failure to work out how to proceed
-continuous monitoring of oxygen saturation
- may monitor pt response to O2 supplements if implemented
- arterial blood analysis
-CXR
-CT of the chest may be used
-microbial cultures may be taken in special circumstances
-

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16
Q

What management might be performed on a pt presenting with acute respiratory failure?

A

-primary survey (A,B,C’s)
-frequent assessment and monitoring of respiratory assessment including pt response to O2 supplement or ventilator support
-pt comfort and compliance with ventilator mode
-ABG analysis and O2 says
The key goals of management are to treat primary cause of respiratory failure, maintain adequate gas exchange and prevent or minimise the potential for complications of positive pressure mechanical ventilation

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17
Q

List at least 3 commonly prescribed medications for respiratory failure.

A
  • inhalation/intravenous steroids
  • bronchodilators
  • antibiotic therapy
  • analgesia and sedation (to maintain pt-ventilator synchrony)
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18
Q

List at least 4 causes that result in direct lung injury.

A
  • pneumonia
  • aspiration of gastric contents
  • pulmonary contusion
  • near drowning
  • inhalation injury (smoke/chemical)
  • repercussion pulmonary oedema
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19
Q

List at least 4 causes that result in indirect lung injury.

A
  • sepsis
  • multiple trauma
  • cardiopulmonary bypass
  • drug overdoes
  • acute pancreatitis
  • transfusion of blood products
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20
Q

List at least 4 indications for intubation or mechanical ventilation.

A
  • apnoea
  • Inability to protect airways (decreased LOC)
  • clinical signs of respiratory distress
  • inability to sustain adequate oxygenation for metabolic demands
  • respiratory acidosis
  • shock
  • respiratory failure
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21
Q

List 4 indications for NIV (non-invasive ventilation).

A
  • asthma
  • pulmonary infiltrates in immunocompromised pt’s
  • neuromuscular disorders
  • fractured ribs
  • Obesity and central hypoventilation syndromes
  • palliative
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22
Q

Pneumonia can be classified into 2 types, what are they?

A
  1. Community-acquired pneumonia (CAP)

2. Ventilator-associated pneumonia (VAP)

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23
Q

Currently lung transplantation take 2 main forms, what are they?

A
  1. Bilateral sequential lung transplantation (BSLTx)

2. single-lung transplantation (SLTx)

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24
Q

High oxygen concentrations may lead to oxygen toxicity. List (3 of each) signs and symptoms that may occur in the CNS and pulmonary.

A 
CNS:
-nausea and vomiting
-anxiety
-visual changes
-hallucinations
-tinnitus
-vertigo
-hiccups
-seizures
Pulmonary
-cry cough 
-sub sternal chest pain
-pulmonary oedema
-pulmonary fibrosis
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25
Q

There are 2 types of oxygen delivery systems. What are they?

A

High flow devices (Venturi mask) and low flow devices (all other devices).

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26
Q

What does FiO2 stand for?

A

Fraction of inspired oxygen concentration.

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27
Q

What is the FiO2 for nasal prongs/cannula?

A

Nasal cannula 2-4 L = 0.28-0.36%

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28
Q

What is the FiO2 % and flow rates of a Hudson mask?

A

Flow rate 6-10 L which is 0.4-0.6.

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29
Q

What is the flow rate and FiO2 values of a non rebreather mask?

A

Flow rates for a non rebreather is 10-15L/min and FiO2 ranges is between 0.60-0.90.

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30
Q

Respiratory acidosis is cause by?

A
  • alveolar hypoventilation
  • alveolar hyperventilation
  • mechanical ventilation
  • inadequate perfusion
31
Q

When looking at ABG values what is the “ normal range” for pH?

A

pH is between 7.35-7.45

32
Q

When looking at ABG values what is the “ normal range” for PaO2?

A

PaO2 normal range 80-100mmHg

33
Q

When looking at ABG values what is the “ normal range” for PaCO2?

A

PaCO2 35-45mmHg

34
Q

When looking at ABG values what is the “ normal range” for HCO3?

A

HCO3 22-26mEq/l

35
Q

When looking at ABG values what is the “ normal range” for BE

A

BE +- 3Eq/l

36
Q

What is the most important inspiration you muscle?

A

The diaphragm as this performs 80% of the work breathing

37
Q

Intrapleural pressure in the pleural space under normal circumstances is always negative. what is it range?

A

-4 to -10cm H2O

38
Q

Intrapleural pressure is always negative, why is this?

A

Negative pressure keeps the lungs inflated.

39
Q

Circulatory system of the lungs operate as a?

A

Low pressure system

40
Q

The medulla oblangata and pons regulate?

A

Automatic ventilation

41
Q

The dorsal respiratory group triggers?

A

Inspiration

42
Q

The cerebral cortex regulates?

A

Voluntary ventilation

43
Q

Expiration is a ?

A

Passive act

44
Q

Emotional and autonomic activities affect?

A

The pace and depth of breathing

45
Q

What is tidal volume?

A

The volume of air entering the lungs during a single inspiration

46
Q

What is functional residual capacity?

A

The remaining volume of air in the lungs after normal expiration

47
Q

What is closing capacity?

A

Closing volume plus residual volume

48
Q

What is alveolar ventilation?

A

The amount of air inhaled that reaches the alveoli each minute

49
Q

What is minute volume?

A

The volume of gas inhaled or exhaled in one minute

50
Q

What is. Elastic/compliance work?

A

The ease with which lungs expand under pressure

51
Q

What is airway resistance work?

A

Movement of air into the lungs via the airways

52
Q

What is hypoxia?

A

Abnormally low PO2 in the tissues

53
Q

What is pulmonary oedema?

A

Abnormal accumulation of extravascular fluid in the lungs

54
Q

What are the 3 phases of ARDS?

A
  1. Oedematous phase = significant V/Q mismatch
  2. Proliferation phase = begins after 1-2 weeks as pulmonary infiltrates resolve and fibrosis and remodelling occurs
  3. Fibrotic phase =alveoli become fibrotic and the lung is left with emphysema
55
Q

Pneumothorax can be classified into 3 categories. What are they?

A

Spontaneous, traumatic or iatrogenic.

56
Q

What is traumatic pneumothorax?

A

It is blunt or penetrating injury.

57
Q

What is a iatrogenic pneumothorax?

A

Caused by complications from diagnostic or therapeutic intervention

58
Q

What is a tension pneumothorax?

A

When air enters the pleural cavity on inspiration but unable to exit on expiration.

59
Q

What is hypercapnoea?

A

Inadequate ventilation

60
Q

What are the normal inspiration flow ranges?

A

25-35L min for an adult

61
Q

What does CPAP stand for?

A

Continuous Positive airway pressure
this does not actively assist inspiration but provides a constant positive airway pressure throughout inspiration and expiration

62
Q

what is the pt management for a pneumothorax?

A
  • ABCD is essential in all pt’s with chest trauma
  • upright positioning may be beneficial
  • penetrating wounds should be immediately covered with a pressure bandage
  • for tension pneumothorax small syringe inserted to relieve pressure and reinflate lung
  • pain management
  • O2 therapy
  • monitor chest tubes and drainage system
63
Q

What is the process of respiration?

A

Respiration is the process in which the body’s cells are supplied with O2 and CO2 is eliminated from the body.

64
Q

What is the VQ ratio?

A

The VQ ratio is the relationship between ventilation (V) and perfusion (Q). It is the balance between alveoli ventilation and vascular perfusion.

65
Q

The normal alveolar ventilation rate is?

A

4L/min

66
Q

The normal pulmonary perfusion rate is?

A

5L/min

67
Q

What happens when ventilation is reduced in the VQ ratio?

A

The VQ ratio is reduced and the pt becomes hypoxic

68
Q

What happens to the patient and the VQ ratio if the perfusion is reduced?

A

-VQ ration increases and the pt becomes hypoxaemic

69
Q

What is mechanical ventilation?

A

Invasive positive pressure ventilation, is used when a pt’s breathing pattern or rate becomes inadequate

70
Q

What is non-invasive ventilation?

A

A non-invasive system which delivers positive pressure breaths to a pt who is spontaneously breathing.

71
Q

Discuss the nursing care of the pt with altered gas exchange

A
  • monitor respiration rate and pattern
  • monitor tidal volume
  • check GCS
  • check for cyanosis
72
Q

What are the clinical symptoms of type 1 respiratory failure?

A
  • there is a mismatch between V/Q
  • PaCO2 may be normal or low
  • PaO2 is low
  • hypoxaemic
73
Q

What are the clinical manifestations of type 2 respiratory failure?

A
  • hypercapnoeic or hypoxaemic
  • alveolar hypoventilation
  • high PaCO2
  • low PaO2
74
Q

What is the oxygen cascade?

A

It describes the process of decreasing oxygen pressure from the atmosphere to the mitochondria

NUR305 (2017) (13 decks)

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