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Respiratory Care Seminar > Ch. 12 Disorders of the Respiratory System (Test 2) > Flashcards

Ch. 12 Disorders of the Respiratory System (Test 2) Flashcards

1
Q

ARDS is a group of symptoms causing acute, catastrophic respiratory failure, resulting from pulmonary injury. For the lung condition to be considered ARDS, three criteria must be met:

A

a. Infiltrates on chest x-ray film confirm that fluid is leaking into the interstitial spaces.
b. Normal heart function as evidenced by normal PCWP.
c. PO2/FiO2 ratio of less than 200.

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2
Q

What causes ARDS

A

Diffuse lung injury
1. Sepsis
2. Aspiration
3. Near drowning
4. O2 toxicity
5. Shock
6. Thoracic trauma
7. Extensive burns
8. Inhalation of toxic gases
9. Fluid overload
10. Fat embolism
11. Narcotic overdose
12. Massive blood transfusion

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3
Q

Signs and symptoms of ARDS

A
  • Hypoxemia (refractory hypoxemia)
  • Cyanosis
  • Severe dyspnea and coughing
  • Decreased CL
  • Suprasternal and intercostal retractions
  • Widened A-a gradient w/ the use of 100% O2
  • Tachypnea
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4
Q

Characteristics of chest x-ray

A
  • Interstitial edema
  • Alveolar edema (fluffy infiltrate, ground glass)
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5
Q

Treatment for ARDS

A

High PEEP
LOW VT
PERMISSIVE HYPERCAPNIA
LOW FIO2

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6
Q

The degree of sleep apnea is determined by the apnea-hypopnea index (AHI). It represents the number of apneic and hypopneic episodes occuring per hour.

A

KNOW

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7
Q

Normal AHI

A

<5

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8
Q

Mild sleep apnea

A

5 to 15

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9
Q

Moderate sleep apnea

A

15 to 30

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10
Q

Severe sleep apnea

A

> 30

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11
Q

Which sleep apnea needs to be treated

A

moderate or severe

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12
Q

How long may the apneic period last?

A

20 seconds to more than 90 seconds

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13
Q

What are the types of sleep apnea? (3)

A
  • Obstructive sleep apnea
  • Central sleep apnea
  • Mixed sleep apnea
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14
Q

OSA is caused by what

A

The upper airway anatomic obstruction

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15
Q

What can be used to treat OSA?

A
  • CPAP
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16
Q

APAP allows for pressure adjustments to be made automatically due to increasing or decreasing obstruction.

A

know

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17
Q

OSA may be associated with:

A
  1. obesity
  2. Excessive pharyngeal tissue
  3. Deviated nasal septum
  4. Laryngeal web
  5. Laryngeal stenosis
  6. Enlarged adenoids or tonsils
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18
Q

Symptoms of OSA

A
  1. loud snoring
  2. Hypersomnolence (excessive sleeping during the day)
  3. Morning headache
  4. Nausea
  5. Personality
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19
Q

Central sleep apnea occurs because of the failure of the central respiratory centers (in the medulla) to send signals to the respiratory muscles.

A

know

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20
Q

CSA is characterized by the absence of inspiratory effort with no diaphragmatic movement (unlike obstructive sleep apnea).

A

KNOW

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21
Q

CPAP generally is not helpful. What is indicated?

A

NPPV

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22
Q

CSA is associated with

A

central nervous system (CNS) disorders

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23
Q

CSA may be associated with (4)

A
  1. Hypoventilation syndrome
  2. Encephalitis
  3. Spinal surgery
  4. Brainstem disorder
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24
Q

Symptoms of CSA

A
  1. Insomina
  2. Mild snoring
  3. Depression
  4. Fatigue during the
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25
Q

Some patients may have a combination of both obstructive and central sleep apnea, which is defined as mixed sleep apnea.

26
Q

This test refers to events that are recorded graphically while the individual is sleeping.

A

Polysomnography

27
Q

Soft tissue means the tongue

28
Q

If there is movement on the ECG strip except in Airflow then that is considered

29
Q

PRE TEST

Pursed-lip breathing would be most beneficial in which of the following lung disorders?

A. Emphysema
B. Pulmonary edema
C. Pneumonia
D. Pleural effusion

A

Emphysema

The airways of patients with emphysema collapse during exhalation, which traps air in the lungs. If pa- tients exhale through pursed lips, back pressure is generated in the airways, keeping them open longer so that more air is exhaled and less air stays trapped in the lungs.

30
Q

On assessing a patient’s laboratory results, you notice a sputum culture that reveals a high eosinophil count. This is characteristic of which of the following pulmonary conditions?

A. Tuberculosis
B. Asthma
C. Pneumonia
D. Pulmonary embolism

A

Asthma

Eosinophil levels are increased in allergic conditions such as asthma.

31
Q

Which lung condition is characterized by consolidation on a chest x-ray?

A. Pulmonary edema
B. Emphysema
C. Pneumonia
D. Pleural effusion

A

Pneumonia

The inflammatory process seen with pneumonia results in consolidated material being produced in the gas exchange areas of the lung, which is evident on a chest film.

32
Q

A 17-year-old asthmatic patient enters the emergency department in moderate respiratory distress. The patient states that the attack began about 1 hour before coming to the emergency department. You would expect the ABG results to reveal:

A. Acute respiratory acidosis with hypoxemia
B. Metabolic acidosis with hypoxemia
C. Acute respiratory alkalosis with hypoxemia
D. Chronic metabolic alkalosis

A

Acute respiratory alkalosis with hypoxemia

During an asthma attack, the patient first becomes hypoxemic. As a result of the low PaO2, the patient begins to hyperventilate, which lowers the PaCO2 and increases the pH. This is an example of acute respiratory alkalosis with hypoxemia. If the attack is not reversed in 1 to 2 hours, the patient begins to tire and will go into respiratory acidosis—the PaCO2 will begin to increase and pH will decrease.

33
Q

A polysomnography indicates the patient has an apneahypopnea index (AHI) of 24. This is characterized as which of the following?

A. normal
B. mild sleep apnea
C. moderate sleep apnea
D. severe sleep apnea

A

moderate sleep apnea

Interpreting AHI: <5 normal, 5 to 15 mild sleep apnea, 15 to 30 moderate sleep apnea, >30 severe sleep apnea.

34
Q

The drug streptokinase is used to treat which of the following lung disorders?

A. Pneumonia
B. Pleural effusion
C. Pneumothorax
D. Pulmonary embolism

A

Pulmonary embolism

Streptokinase is an anticoagulant drug used to prevent and treat blood clots.

35
Q

The respiratory therapist is assessing a patient in the emergency department who states he has had a cough off and on for the past 3 years that often produces thick secretions. The therapist should suspect this patient most likely has:

A. Asthma
B. Emphysema
C. Chronic bronchitis
D. Pulmonary edema

A

Chronic bronchitis

Symptoms of chronic bronchitis are a cough and increased mucus production for at least 3 months of the year for more than 2 consecutive years.

36
Q

Which of the following pulmonary function values are increased in patients with emphysema?

A. FVC
B. FEF200-1200
C. FRC
D. MVV

A

FRC

FRC is defined as the volume of air left in the lungs following a normal expiration. Patients with emphysema have a loss of elasticity in the airways causing them to collapse during exhalation. This results in air getting trapped in the airways and increasing the FRC. Pursed-lip breathing can be helpful by creating a slight back pressure into the airways, keeping them open longer so more air can be exhaled.

37
Q

Which of the following criteria must be met to confirm a diagnosis for acute respiratory distress syndrome (ARDS)?

  1. PaO2/FiO2 of 250 mm Hg
  2. Bilateral infiltrates on chest radiograph
  3. Normal heart function as evidenced by normal
    PCWP

A. 1 and 2 only
B. 1 and 3 only
C. 2 and 3 only
D. 1, 2, and 3

A
  1. Bilateral infiltrates on chest radiograph
  2. Normal heart function as evidenced by normal
    PCWP

Choice #1 is not a correct selection since the PaO2/ FiO2 (P/F) ratio must be <200 mm Hg for the patient to be diagnosed with ARDS. The other choices are observed with ARDS.

38
Q

A lateral decubitus chest radiograph should be as- sessed to best determine which of the following?

A. Pleural effusion
B. Pneumothorax
C. Pneumonia
D. Atelectasis

A

Pleural effusion

A radiograph obtained with the patient in the lateral decubitus position (lying on the side) should confirm the effusion. The fluid moves with gravity as the patient lies on his or her side.

39
Q

PNA xray

A
  • consolidation
  • air bronchogram
40
Q

Types of PNA

A

Bacterial
(1) Most common causative organism is Streptococcus pneumoniae: called pneumococcal pneumonia; the most common bacterial pneumonia
(2) Haemophilus influenzae
(3) Klebsiella pneumoniae
(4) Legionella pneumoniae
(5) Pseudomonas aeruginosa

41
Q

This type of pneumonia is seen in 60% of AIDS cases. Definitive diagnosis is made from cultures of lung secretions and tissue.

A

Pneumocystis jiroveci pneumonia.

42
Q

P. jiroveci pneumonia is commonly treated with the antiprotozoal drug

A

pentamidine (Nebupent) via aerosolization.

43
Q

Treatment for PNA

A

a. Antibiotics
b. Supplemental O2
c. Bronchial hygiene therapy
d. Adequate hydration
e. Adequate nutrition
f. Tracheal suctioning

44
Q

an excessive amount of fluid in the
lung tissues or alveoli, caused by an increase in pulmonary capillary pressure resulting from increased left-sided heart pressure

A

Pulmonary Edema (Cardiogenic)

45
Q

Causes of Pulmonary edema

A

a. Left-sided heart failure
b. Aortic stenosis
c. Mitral valve stenosis
d. Systemic hypertension

46
Q

These four mechanisms cause backup of fluid from the heart into the pulmonary capillaries until they become engorged, which leads to pulmonary edema; PCWP and pulmonary artery pressure (PAP) levels are also increased.

A

^^^^^^^^^^^^

47
Q

Xray for pulmonary edmea

A

a. Increased vascular markings
b. Interstitial edema
c. Enlarged heart shadow
d. Bat’s wing appearance
e. Kerley B lines

48
Q

Treatment for pulmonary edmea

A

a. O2 administration (percentage based on PaO2)
b. CPAP/NPPV
c. Ventilatory support with PEEP (if condition
results in acute respiratory failure)
d. Shallow suctioning to maintain a patent airway
e. Morphine
f. Diuretics such as furosemide
g. Cardiac glycosides

49
Q

2 types of pleural effusions

A

Transudate
Exudate

50
Q

Transudate: fluid caused by an imbalance between transcapillary pressure and plasma oncotic pressure resulting in fluid from the capillaries entering the pleural space. The fluid is thin and watery, containing few cells and little protein.

51
Q

Exudate: fluid caused by increased capillary permeability, caused by inflammation, infection, or malignancy. Has a high protein count with cellular debris.

52
Q

Causes of transudative pleural effusion

A

(1) Congestive heart failure (CHF) (most common cause)
(2) Cirrhosis of the liver
(3) Kidney disease

53
Q

Causes of exudative pleural effusion

A

(1) Infections (may result in empyema or pus in the pleural space)
(2) Trauma (may result in hemothorax or blood in the pleural space)
(3) Surgery
(4) Tumors
(5) Tuberculosis

54
Q

Clinical signs of pleural effusion

A

a. Chest pain
b. Dyspnea
c. Dullness to percussion
d. Absent breath sounds over the fluid

55
Q

Xray for plueral effusion

A

a. Blunting of costophrenic angle
b. Homogeneous density in dependent part of the hemithorax

56
Q

EXAM NOTE:
A radiograph obtained with the patient in the lateral decubitus position (lying on the side) should confirm the effusion. The fluid moves with gravity as the patient lies on his or her side.

57
Q

Treatment for pleural effusion

A

a. Drain fluid by thoracentesis. (See Chapter 5.)
b. Chest tube drainage may be necessary in
chronic cases and with large pleural effusions.
c. Supplemental O2 as needed (monitor ABG
levels and/or SpO2)

58
Q

Atelectasis

A

Partial or complete collapse of alveoli. It may involve small localized areas of the lung, a lobe, or the entire lung.

59
Q

Causes of atelectasis

A
  • obstructed airways
  • loss of pleural pressure
  • right mainstem bronchus intubation
  • Hypoventilation
  • Decreased pulmonary blood flow
60
Q

signs and symptoms of atelectasis

A

a. Asymptomatic in mild atelectasis b. Hypoxemia
c. Dyspnea
d. Cough
e. Dullness to percussion
f. Elevated diaphragm
g. Late inspiratory crackles in lung bases
h. Diminished or absent breath sounds
i. Tracheal deviation toward the atelectatic lung in severe cases

61
Q

Xray for atelectasis

A

a. Increased density (white)
b. Elevated diaphragm
c. Displaced interlobar fissures
d. Mediastinal shift
e. Altered bronchial and carinal angles

62
Q

Treatment for atelectasis

A
  • Prevention of postoperative atelectasis by administration of incentive spirometry.
  • Adequate pulmonary hydration to prevent mucus plugs and for mobilization of secretions.
  • O2 as needed, up to 0.50 to 0.60 maximum.
  • Initiation of CPAP if patient has hypoxemia with the use of 50% to 60% O2 or more.
  • Initiation of PEEP if patient is receiving mechanical ventilation.

Respiratory Care Seminar (19 decks)

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