Acute respiratory alterations

Question 1

Acute respiratory failure is diagnosed when the patient is unable to maintain adequate gas ______. Generally present with ______ or ______ or both.

Answer 1

EXCHANGE

HYPOXEMIA, HYPERCAPNIA

Question 2

______ respiratory failure is defined as a PaO2 of 60 mmHg or less when patient is receiving oxygen at 60% or greater

Answer 2

HYPOXEMIC

Question 3

Hypoxemia can result from inadequate ______ or poor ______.

Answer 3

VENTILATION

OXYGENATION

Question 4

______ is defined as PaCO2 (>50mmHg) above normal in combination with acidosis

Answer 4

HYPERCAPNIA

Question 5

Hypercapnia results from ______ failure which the body cannot adjust to

Answer 5

VENTILATORY

Question 6

Acute Respiratory Distress Syndrome (ARDS) is a group of disorders with diverse causes but similar pathophysiology, symptoms, and treatment. Name causes (10)

Answer 6

SEPSIS, PNEUMONIA, TRAUMA, SHOCK, NARCOTIC OVERDOSE, INHALATION, BURNS, PANCREATITIS, ASPIRATION, SIRS, AND OTHERS

Question 7

ARDS is sudden and ______. The chain of events leads to alviolar-capillary membrane damage and non-cardiac pulmonary ______.

Answer 7

PROGRESSIVE

EDEMA

Question 8

ARDS S&S: Predisposing condition within ______ hours, symptoms progress, dyspnea, tachypnea, crackles, eventual cyanosis, respiratory alkalosis from initial increase in r_____ then respiratory acidosis, d_____ lung compliance and lung volumes, change in mental status from ______, CXR shows diffuse infiltrates, PAWP

Answer 8

48

RESPIRATIONS

DECREASED

HYPOXEMIA

OXYGEN

Question 9

Complications of ARDS include nosocomial pneumonia, barotrauma, volume pressure trauma, stress ulcers, real failure, heart failure, DIC (disseminated intravascular coagulation)

Answer 9

Collaborative and nursing treatment for ARDS include oxygen >= PaO2 of 60 mmHg, mechanical ventilation with PEEP, extracorporeal membrane oxygenation, positioning, diuretics, antibiotics, TPN

Question 10

Severe Acute Respiratory Syndrome (SARS) is spread primarily through ______. Symptoms include fever greater than 100.4, headache, muscle ache. After ______ days, dry cough and difficulty breathing. 80-90% recover.

Answer 10

DROPLETS

2-7 DAYS

Question 11

Collaborative treatment for SARS includes i______, a______ medications, antibiotics, corticosteroids. 10-20% require mechanical ventilation. Risk of death increases with age and preexisting health conditions.

Answer 11

ISOLATION

ANTIVIRAL

Question 12

Normal: 30 Y, 80 Y, COPD
pH:  7.35-7.45
PaO2:   80-100, 70, 45-55
SaO2:   96-100, 95, 85-90
PaCO2: 35-45, 35-45, 50-60
HCO3:  22-26, 22-26, 26-30

Answer 12

R: Respiratory
O: Opposite
     pH high, pCO2 low = alkalosis
     pH low, pCO2 high = acidosis
M: Metabolic
E: Equal
     pH high, HCO3 high = alkalosis
     pH low,   HCO3 low = acidosis

Question 13

______ are a very potent antibiotic group that destroys bacteria rather than inhibiting growth. Reserved for serious or life-threatening infections because they have toxic effects. Kills gram-negative and gram-positive bacteria.

Answer 13

AMINOGLYCOSIDES
(GENTAMICIN, TOBRAMYCIN, AMIKACIN)
Nephrotoxicity, Ototoxicity
Therapeutic drug levels are carefully monitored to give only as much drug as needed to reach therapeutic level.

Question 14

How do we know what therapeutic antibiotic levels are?

Answer 14

Start with the MIC (minimum inhibitory concentration), report (AKA sensitivity report), compare MIC with SE from drug & patient condition, Select drug that will work at non-toxic levels, measure peak and trough

Question 15

The maximum therapeutic response is called ______ level. The minimum therapeutic responses called ______ level.

Answer 15

PEAK

TROUGH

These are measured by using a blood sample at specified times before and after the drug is given.

Question 16

The reference range for vancomycin peak is ______ while the range for trough is ______.

Answer 16

PEAK 30-40 ug/ml

TROUGH 5-10 ug/ml

Question 17

Collaborative and nursing responsibilities regarding aminoglycosides prior to administration include checking the ______ and ______ levels, C&S, assessing peak and trough, and assessing patient for n_____, o_____, and n_____.

Answer 17

BUN

CREATININE

NEPHROTOXICITY

OTOTOXICITY

NEUROTOXICITY

Question 18

There are two classes of bronchodilators x_____ derivatives and b_____/stimulants. Should be used with caution in patients with HTN, DM, narrow angled glaucoma. SE: palpitations, tachycardia, hyperglycemia, decreased clotting time.

Answer 18

XANTHINE

BETA-AGONISTS

Question 19

______ is a salt of theophylline that relaxes respiratory smooth muscle causing ______. SE: nervousness, nausea, vomiting, anorexia, arrhythmias, hypotension, death

Answer 19

AMINOPHYLLINE

BRONCHODILATION

Question 20

Aminophylline nursing responsibilities include monitoring for t______, monitoring therapeutic level (______ mcg/ml), monitoring for side effects, safety (d______ is common), IV administered slowly using infusion pump.

Answer 20

TOXICITY

10-20

DIZZINESS

Question 21

C______/g______ frequently given to patients with respiratory inflammation because they cause systemic inhibition of inflammation immune responses. SE: insomnia, psychosis, electrolyte imbalances, Cushing’s syndrome, G.I. upset, weight gain, edema, hypokalemia

Answer 21

CORTICOSTEROIDS

GLUCOCORTICOIDS