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168.362 > Week One > Flashcards

Week One Flashcards

1
Q

Definition of acute care?

A

The health system components, or care delivery platforms, used to treat sudden, often unexpected, urgent or emergent episodes of injury and illness that can lead to death or disability without rapid intervention

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2
Q

Types of admission?

A
  • Emergency or unplanned admission
  • Elective planned surgery or treatment
  • For review (outpatients)
  • Ongoing treatment
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3
Q

What timeframe of an illnesses is considered indicate acute illness?

A

3 months

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4
Q

What are the three functions of the respiratory system?

A
  • Ventilation
  • Diffusion
  • Perfusion
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5
Q

What is normal ventilation and diffusion?

A

Alveoli transfer oxygen into the vein and carry carbon dioxide out of the blood

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6
Q

What is respiratory failure?

A

A condition that occurs as a result of one or more diseases involving the lungs or other systems affects lung function, 02 delivery, cardiac output or baseline metabolic state

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7
Q

What is type one of respiratory failure?

A

Failure of oxygenation, resulting in hypoxia but normal PaCO2

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8
Q

What is type two of respiratory failure?

A

Failure of ventilation, resulting in both hypoxaemia and hypercapnia

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9
Q

What are signs and symptoms of respiratory failure?

A
  • Sudden or chronic

- Signs and symptoms relate to extent of change and patients ability to compensate for change

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10
Q

What is hypoxemia?

A

Low partial pressure of oxygen in the blood

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11
Q

What is hypoxia?

A

Low oxygenation of tissues

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12
Q

What is the most common cause of hypoxemia and a component of most causes of respiratory failure?

A

V/Q mismatch

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13
Q

What can affect V/Q ration and cause a V/Q mismatch?

A
  • Shunt

- Physiological dead space

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14
Q

What is seen in hypoxemia?

A
  • Normal PaCO2
  • Decreased Pa02 (< 60-80 mmHg)
  • Decreased Sa02
  • Poor oxygenation of the blood
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15
Q

What is seen in hypercapnia?

A
  • Increased PaC02 (> 50mmHg)
  • With a pH < 7.35mmHg
  • Failure of ventilation & insufficient C02 removal
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16
Q

What are causes of hypoxemia (type one)?

A
  • ARDS (acute respiratory distress syndrome)
  • Pneumonia
  • Shock
  • Massive pulmonary embolism
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17
Q

What are causes of hypercapnia (type two)?

A
  • Asthma
  • COPD
  • MS
  • Pneumothorax
  • Brain stem infarction
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18
Q

What are signs and symptoms relate to extent of change and patients ability to compensate for change?

A
  • Ability to talk in sentences or single words?
  • Restlessness
  • Exhaustion
  • Positioning
  • Respiratory rate changes from fast to slow
  • Paradoxical breathing
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19
Q

What are nursing assessments for ARF?

A
  • General presentation
  • Skin and is cyanosis present?
  • Auscultate
  • Posture
  • Speech
  • Accessory muscle use
  • Cardiac status, vital signs
  • ABG’s, pulse oximetry, PEFR, capnography.
  • Assess systems affected by ARF: CNS, CVS, fluids & electrolytes and renal system
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20
Q

What is ARDS?

A

Acute respiratory distress syndrome

  • 40% mortality rate
  • Sudden & progressive
  • Alveolar-capillary interface becomes damaged and more permeable. Fluid containing proteins fills the alveoli resulting in severe dyspnoea and hypoxemia refractory to supplemental 02, with reduced lung compliance and diffuse pulmonary infiltrates.
  • At the same time, an inflammatory chain reaction occurs
  • Damage to endothelium of the alveoli, damage to Type One alveolar lining cells allow for more fluid and debris into the alveolar space & Type II cells cause a loss of surfactant
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21
Q

What is treatment for ARDS?

A
  • Intubation & mechanical support
  • Oxygen
  • Circulatory support
  • Adequate fluid volume
  • Nutritional support
  • ABG monitoring
  • Continuous vital sign monitoring - Art line, cardiac monitor, SV02
  • Positioning in bed, rotated 2 hourly to evenly ventilate lungs
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22
Q

What is a Swan Ganz catheter?

A

A pulmonary artery catheter

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23
Q

What is pneumonia?

A
  • Acute inflammation of the lung parenchyma with associated symptoms
  • Common and some types have a high mortality
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24
Q

How do organisms reach lungs to cause pneumonia?

A
  • Aspiration of normal flora nasopharynx or oropharynx
  • Inhalation of microbes
  • Haematogenous spread from primary infection elsewhere
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25
Q

What are the types of pneumonia?

A
  • Bacteria
  • Viruses
  • Mycoplasma organisms
  • Fungi
  • Parasites
  • Chemical
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26
Q

What are the classifications of pneumonia?

A
  • Community acquired pneumonia (CAP)

- Medical care acquired pneumonia (MCAP)

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27
Q

What is community acquired pneumonia (CAP)?

A

Developed pneumonia after not being hospitalised or in a long-term care facility for >14 days

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28
Q

What is medical care acquired pneumonia (MCAP)?

A

MCAP – three forms:

  1. Hospital-associated pneumonia (HAP) – 48 hours or greater after hospitalisation
  2. Ventilator-associated pneumonia (VAP)
  3. Healthcare-associated pneumonia (HCAP)
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29
Q

What is the pathological course of pneumonia?

A

Inflammatory response causing either:
- Alveoli filled with fluid and debris (consolidation)
- Increased production of mucosa (airway obstruction)
Causing decreased gas exchange

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30
Q

What are signs and symptoms of pneumonia?

A
  • Fever
  • Cough
  • SOB
  • Low blood pressure
  • Nausea and vomiting
31
Q

What to do for a nursing assessment for a patient with acute respiratory infection?

A 
Subjective data:
- Past history
- Medications
- Surgery or other treatment
Objective data:
- General
- Respiratory
- Cardiovascular
- Neurological 
- Possible diagnosis findings
32
Q

What are diagnostic studies for pneumonia?

A
  • History and physical examination
  • CXR
  • Gram strain sputum
  • Sputum culture
  • ABG’s
  • Blood cultures (if fever present)
  • FBC & Lytes
33
Q

What is collaborative care for pneumonia?

A
  • Appropriate antibiotic therapy
  • Increased fluid intake/IVF
  • Limited activity and rest
  • Antipyretics
  • Analgesics
  • Oxygen therapy-SP02/ABG dependent
  • Chest physiotherapy
  • Nutritional therapy & hydration
34
Q

What are interventions for respiratory failure?

A
  • Oxygen therapy
  • Mobilisation of secretions
  • Drug therapy
  • Medical supportive therapy
  • Nutritional therapy
35
Q

What are interventions to mobilise secretions for respiratory failure?

A
  • Effective coughing and positioning
  • Hydration and humidification
  • Chest physiotherapy
  • Airway suctioning
36
Q

What are drug therapies for respiratory failure?

A
  • Relief of bronchospasm
  • Reduction of airway inflammation
  • Reduction of pulmonary congestion
  • Treatment of pulmonary infections
  • Reduction of anxiety, pain and agitation
37
Q

What are medical supportive therapies for respiratory failure?

A
  • Treating the underlying cause
  • Maintaining adequate cardiac output
  • Maintaining adequate haemoglobin concentration
38
Q

How long does the early phase of asthma last?

A

30-60 minutes

39
Q

How long does the last phase of asthma last?

A

Can recur 4-6 hours after early phase

40
Q

What is the early phase of asthma and what is an intervention?

A

Bronchospasm - provide bronchdialator

41
Q

What is the early late of asthma and what is an intervention?

A

Bronchial hyper-responsiveness

42
Q

What occurs when a patient has a severe and life threatening asthma exacerbation?

A
  • Dyspnoeic
  • Speaks in words not sentences
  • Sitting forward to maximise diaphragmatic movement with prominent wheeze
  • Respiratory rate > 30
  • Accessory muscles in neck are straining
  • Patient agitated
43
Q

What is step one in the step wise approach for managing asthma?

A

SABA as needed

44
Q

What is step two in the step wise approach for managing asthma?

A

Low dose ICS and LABA

Alternatively: LTRA or theophylline

45
Q

What is step three in the step wise approach for managing asthma?

A

Low dose ICS and LABA or medium dose ICS

Alternatively: low dose ICS and either LTRA or theophylline

46
Q

What is step four in the step wise approach for managing asthma?

A

Medium dose ICS and LABA

Alternatively: medium dose ICS and either LTRA or theophylline

47
Q

What is step five in the step wise approach for managing asthma?

A

High dose ICS and LABA and consider omalizumab for patient who have allergies

48
Q

What is step six in the step wise approach for managing asthma?

A

High dose ICS and LABA and oral corticosteroid and consider omalizumab for patient who have allergies

49
Q

What is pursed lip breathing?

A 
Inhale slowly through the nose and
exhale slowly (3 times more) through pursed lips
- Prolongs exhalation
- Prevent collapse of bronchioles
- Prevent air trapping
- Slows respiratory rate
50
Q

What are different types of NIPPV (Nasal intermittent positive pressure ventilation)?

A
  • CPAP - one pressure setting, constant flow

- BiPAP - inspiratory and expiratory settings

51
Q

What is an arterial blood gas (ABG)?

A
  • Blood sample taken from an artery
  • Measures:
    Acidity (pH), levels of oxygen (pO2) and carbon dioxide (pCO2)
  • Measures how well lungs are functioning
  • Performed by Dr’s or advanced practice nurses
52
Q

What are the components of ABG and their normal values?

A
  • pH: 7.35 - 7.45
  • PaO2: 80 -100mmHg
  • PaCO2: 35 - 45 mmHg
  • HCO3: 22 - 26
  • SaO2: 94% - 100%
53
Q

What are acid conditions?

A
  • Presence of ketoacids (ketones)
  • Lactic acids
  • Hydrochloric acid
54
Q

What are alkaline conditions?

A
  • Result of several metabolic processes
  • Ingestion of too much antacids
  • Prolong D&V’s, gastric suctioning
  • Some diuretics, hypokalemia, hypomagnesemia, laxative abuse
55
Q

What are the buffer systems?

A
  • Buffer System (chemical sponge) (Most rapid regulation)
  • Lungs (respiratory buffer) (Rapid regulation)
  • Kidneys (renal buffer ) (Slowest regulation)
56
Q

What ph has a high amount of H ions?

A

Acid

57
Q

What ph has a low amount of H ions?

A

Base

58
Q

What are ABG indicators of respiratory acidosis?

A

pH: <7.35
C02: >45

59
Q

What are ABG indicators of respiratory alkalosis?

A

pH: >7.45
C02: <35

60
Q

What are ABG indicators of metabolic acidosis?

A

pH: <7.35
HC03: <22

61
Q

What are ABG indicators of metabolic alkalosis?

A

pH: >7.45
HC03: >26

62
Q

What are causes of respiratory acidosis?

A
  • Obstruction of gas exchange or hypoventilation
  • Emphysema, chronic bronchitis, severe pneumonia, pulmonary oedema, asthma
  • Impaired mechanics of breathing
  • Drugs
63
Q

What are causes of respiratory alkalosis?

A

Common – hyperventilation, pain, fear, anxiety, leads to elimination of lots of C02 (hypocapnia) being blown off by tachypnea

64
Q

What are causes of metabolic acidosis?

A
  • Not enough base or alkali in the blood and too much acid

- Shock, DKA, renal failure, diarrhoea, diuretics, certain drugs

65
Q

What are causes of metabolic alkalosis?

A

Excess base/bicarbonate or too little acid

Excessive antacids, gastric suctioning, excessive vomiting

66
Q

What are manifestations of respiratory acidosis?

A

H/A, blurred vision, restlessness, confusion, lethargy, dyspnea, tachycardia, respiratory distress, shallow resps, convulsions, coma

67
Q

What are manifestations of respiratory alkalosis?

A

Dizziness, confusion, paraesthesia, convulsions, restlessness, spasms in fingers/toes, tetany, coma

68
Q

What are manifestations of metabolic acidosis?

A

H/A, lethargy, Kussmaul resps, N&V, diarrhoea, arrhythmias, coma, death

69
Q

What are manifestations of metabolic alkalosis?

A

Dizziness, lethargy, weakness, muscle cramps & twitching, cramps, tetany, shallow & slow resps, tachycardia, coma

70
Q

What is treatment for respiratory acidosis?

A
  • Supportive therapies
  • Bi-pap
  • Treat underlying cause
71
Q

What is treatment for respiratory alkalosis?

A
  • Reassurance
  • Rebreathing into a paper bag during acute episodes
  • Treatment for underlying psychological stress
72
Q

What is treatment for metabolic acidosis?

A
  • Sodium citrate for kidney failure

- IV fluids and insulin for ketoacidosis

73
Q

What is treatment for metabolic alkalosis?

A
  • Potassium-sparing diuretics e.g. aldosterone antagonist spironolactone
  • Surgical removal of adrenal adenoma or carcinoma if this is the cause

168.362 (6 decks)

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