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D-Third semester > DoneCHA1- exam 2- respiratory > Flashcards

DoneCHA1- exam 2- respiratory Flashcards

1
Q

Metabolic disorder

change in what

A

-change in the bicarb concentration

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2
Q

Respiratory disorder-

change in what

A

change in the CO2

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3
Q

Metabolic acidosis-

ph
bicarb

A

pH < 7.35

bicarb less than 22 mEq/L

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4
Q

Metabolic alkalosis-

ph
bicarb

A

bicarb- pH > 7.45

bicarb > 26 mEq/L

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5
Q

Respiratory acidosis-

ph
paco2

A

pH < 7.35

PaCO2 > 45 mmHg

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6
Q

Respiratory alkalosis-

ph
paco2

A

pH> 7.45

PaCO2 < 35 mmHg

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7
Q

normal levels

ph
hco3
pac02

A

ph-7.35-7.45

hco3-22-26

pac02-45-35

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8
Q

acidic levels abg

ph
pac02
hco3

A

< 7.35 ph

> 45 paco2

<22 hc03

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9
Q

alkalosis levels abg

ph
pac02
hco3

A

> 7.45 ph
<35 pac02
26 hco3

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10
Q

primary imbalance

acid base imbalance

A

caused by one source

either resp or met

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11
Q

mixed imbalance

acid base imbalance

A

caused by both met and rest

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12
Q

Compensation-

A

how the body attempts to return homeostasis. It wants to balance the pH.

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13
Q

Primary imbalance

A

source of the problem

it is what is causing the imbalance

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14
Q

compensation how fast

respiration
renal

A

resp can happen quickly

renal takes longer

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15
Q

compensated

ph where

PaCO2 / HCO3 where

A

If pH is NORMAL,

PaCO2 and HCO3 are both ABNORMAL

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16
Q

Partially Compensated

ph where

PaCO2/ HCO3 where

A

If pH is ABNORMAL,

PaCO2 and HCO3 are both ABNORMAL

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17
Q

Uncompensated

ph where

PaCO2/ HCO3 where

A

If pH is ABNORMAL

PaCO2 OR HCO3 is ABNORMAL =

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18
Q

ABG Interpretation
1- ph
2 pco2/hco3
3if both
4look at/is pt

A

Is the pH normal, acidotic or alkalotic?

Is the pCO2 or HCO3 abnormal?

If they are both abnormal, which one deviates the most from the norm and is causing the change in pH?

Look at the Po2, is the pt hypoxic?

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19
Q

RO

when ph is up
when ph is down

ROME

A

Respiratory Opposite

When pH is up, PaCO2 is down = Alkalosis

When pH is down, PaCO2 is up = Acidosis

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20
Q

ME

when ph is up
when ph is down
ROME

A

Metabolic Equal

When pH is up, HCO3 is up = Alkalosis

When pH is down, HCO3 is down = Acidosis

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21
Q

acids to what to hydrogen

bases do what to hydrogen

A

Acids- release hydrogen in solution

Base- accepts hydrogen in solution

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22
Q

low ph=what=how much hydrogen //levels

high ph=what=how much hydrogen //levels

A

Low pH = acidic-more hydrogen-<7.35

High pH = alkaline-less hydrogen >7.45

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23
Q

Volital acids

how eliminated

A

can be elimated as a gas

such as carbonic acid from lungs

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24
Q

Non volital acids

how excreted

A

must be excreted as body fluids like lactic acid

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25
Q

excess acid
k
c d
buildup
h

A

ketones-dka,starvation

cell death- trauma,

lactic buildup

hypoxia

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26
Q

excess base(alkolotic)

a
loss

A

-antacids

loss of gi fluids-vomit, di suction

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27
Q

Body has 3 different systems to maintain normal pH

A

Buffer system-in the fluids

Respiratory system

Renal system

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28
Q

buffer system

what does it do

A

prevent major changes in pH by either removing or adding H ions-

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29
Q

When acidic buffer system

A
  • binds with hydrogen to minimize ph change
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30
Q

When alkalotic- buffer system

A

releases hydrogen ions and restores ph

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31
Q

repository system does what

how fast

A

Regulates levels of carbonic acid (CO2-

works quickly

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32
Q

respiratory system in metabloic acidosis

A

rr and depth of lung increases to relase co2

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33
Q

respiratory system in metabolic alkalosis

A

alkalosis- rr and depth of respiration decreases and retains co2

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34
Q

renal system

how fast
term

A

Kidneys respond more slowly to pH changes

Long term regulation of acid base balance

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35
Q

renal system in respitory acidosis

A

kindeys excrete hyodren and retain bicaronate

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36
Q

renal system in repository alkalosis

A

kidneys retain hydrogen and excrete bicarbonate

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37
Q

where are abg drawn

A

radial artery

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38
Q

Nursing interventions- ABG
p
education
apply
place

A

painful-

education, what doing and why doing,

apply pressure for 2-5 minutes after puncture,

place sample on ice

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39
Q

what does abg measure

A

ph

pco2

bicarb

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40
Q

PaCO2-

relfects what
regulated by what
normal values

A

reflects respiratory component of acid base regulation

Regulated by lungs

Normal values 45-35

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41
Q

PaO2

normal
under that =
evaluates/not
what’s

A

Normal PaO2 80-100

<80= hypoxemia

Evaluates respiratory function-not acid base balance

what’s available to cells

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42
Q

Serum bicarbonate- abg
reflects
what component
normal level

A

reflects renal regulation of acid base

Metabolic component of ABGs

Normal bicarb level: 22-26

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43
Q

Metabolic Acidosis

what level bicarb
what level ph
what fixes

A

<22mEq/L-

pH < 7.35

(resp. tries to fix)

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44
Q

Acute lactic acidosis-

Risk Factors for Metabolic Acidosis

A

tissue hypoxia from shock or cardiac arrest

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45
Q

D
a/c
excessive

Risk Factors for Metabolic Acidosis

A

Diabetic ketoacidosis- -ketones

Acute or chronic renal failure–impaired excretion of HCl

Excessive bicarb loss from GI loss-intestines, diarrhea or an ileostomy.

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46
Q

Accumulation of metabolic acids

Pathophysiology of Metabolic Acidosis

A
  • ketones, aspirin, lactic acid, fever, etoh
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47
Q

Excessive loss of bicarbonate-

Pathophysiology of Metabolic Acidosis

A

diarrhea, ileostomy

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48
Q

Increased level of chloride

Pathophysiology of Metabolic Acidosis

A

iv solutions, renal disease

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49
Q

GI-
4x

Manifestations of Metabolic Acidosis

A

Anorexia,

nausea

vomiting,

Abdominal pain

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50
Q

nuero x4

Manifestations of Metabolic Acidosis

A

Decreasing levels of consciousness

Weakness

fatigue/

headahce

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51
Q

Cardio- 2x

Manifestations of Metabolic Acidosis

A

dystyrhmia,

bradycardia

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52
Q

skin 3x

Manifestations of Metabolic Acidosis

A

Warm,

flushed

dry

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53
Q

respiratory manifestations

2x
why

Manifestations of Metabolic Acidosis

A

Hyperventilation

(Kussmaul respirations-labored deep rapid).-

compensatory to blow off

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54
Q

Metabolic Acidosis diagnosis

ABGs-

Serum electrolytes-

ECG- -

Blood glucose-

Renal functions-

A

ABGs- less then 7.35

Serum electrolytes-elevated k

ECG- hyperkalemia- peaked t

Blood glucose- elevated

Renal functions- cause

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55
Q

Medications to Treat Metabolic Acidosis

A

Sodium bicarbonate-

if ph less then 7.2- reduce acidosiss and affect on heart-

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56
Q

Diabetic ketoacidosis-

Medications to Treat Metabolic Acidosis

A

insulin and fluid

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57
Q

Alcoholic ketoacidosis

Medications to Treat Metabolic Acidosis

A

-saline solutions and glucose

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58
Q

Metabolic acidosis secondary to diarrhea

Medications to Treat Metabolic Acidosis

A
  • providing fluid/ electrolyte replacment
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59
Q

Metabolic acidosis decreases myocardial contractility-

monitor
monitor
montior

nursing interventions

A

monitor vs, pulses and cap refill

moinotor ecg for changes(k like changes)

monitor labs- creatinine and bun

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60
Q

As pH falls, mental function decreases-

monitor
safety precautions
keep

metabolic acidosis

A

-monitor loc and muscle strength

safety precautions-low bed and position alarm

keep familier objects at bedsode- clocks calanders// orainet to time and place

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61
Q

Metabolic Alkalosis

ph
bicarb
what tries to fix

A

pH- greater then >7.45

Bicarbonate- greather then>26

Respiratory system tries to fix- slows rr

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62
Q

Risk factors- metabolic alkalosis

h
h
tr

A

hospitalization,

hypokalemia,

treatment with alkalinizing solutions- bicarbonate

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63
Q

GI loss of H ions 2x

Pathophysiology of Metabolic Alkalosis

A
  • vomiting, gastric suction
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64
Q

Increased renal loss of H ions due to what

Pathophysiology of Metabolic Alkalosis

A

hypokalemia

shifts out of cells

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65
Q

Excess bicarbonate-

ingesting
overzealous

Pathophysiology of Metabolic Alkalosis

A

ingesting antacids,

or overzealous administration of bicarbonate to treat metabolic acidosis

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66
Q

nuero x3

Manifestations of Metabolic Alkalosis

A

Confusion

Decreasing level of consciousness

Dizziness

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67
Q

cardio x2

Manifestations of Metabolic Alkalosis

A

Dysrhythmias

Hypotension

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68
Q

mimics what

Manifestations of Metabolic Alkalosis

A

Hyperreflexia

Trousseau sign

Muscle spasms.

Numbness and tingling around the mouth, fingers, and toes

Tetany

Seizures

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69
Q

respiratory
h
respitory

Manifestations of Metabolic Alkalosis

A

Respiratory failure

hypoxemia

respiratory acidosis

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70
Q

ABG
electrolytes
urine ph
ECG

Diagnoses of Metabolic Alkalosis

A

ABG- ph greater then 7.45

Serum electrolytes- hypokalemia, decreased chloride

Urine pH- low-1-3

ECG-hypokalemia- depressed st , u

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71
Q

restore
administer
administer
treat

Medications to Treat Metabolic Alkalosis

A

Restore normal fluid volume

Administer potassium chloride

Administer sodium chloride

Treat underlying cause

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72
Q

Respiratory Acidosis

vent
ph
pac02

A

Hypoventilation

pH less than <7.35

PaCO2 greater than 45

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73
Q

3x

Risk Factors for Respiratory Acidosis

A

Acute lung disease- pneumonia

Chronic lung disease copd/ cystic fibrosis

Depressed ventilation

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74
Q

depressed ventilation risk factors

resp acidosis

A

Narcotics

Airway obstruction

Neuromuscular disease- MS

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75
Q

what retention
what accompanies

Pathophysiology of Respiratory Acidosis

A

Carbon dioxide retention caused by alveolar hypoventilation

Hypoxemia frequently accompanies respiratory acidosis

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76
Q

Sudden ventilation failure-

c t
aspiration
acute
over

Acute Respiratory Acidosis

A

chest trauma,

aspiration of fierign body,

acute pneumonia,

overdoses or narcotics

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77
Q

S/S of acute respiratory acidosis

mental
vision
c
I
cardia

A
  • mental cloudiness,

blurred vision

confusion

, irritability,

tachycardia

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78
Q

Chronic Respiratory Acidosis

associated with

A

Associated with chronic problems-COPD, asthma, cystic fibrosis, or multiple sclerosis

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79
Q

acute Manifestations of Respiratory Acidosis

h
I
m c
loc
v
skin
pulse

A

headache,

irritability,

mental cloudiness,

loc decreased

,vfib. ,

skin warm flushed,

elevated pulse

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80
Q

chronic Manifestations of Respiratory Acidosis

w
d h
s d
d s
i m
p c

A

weakness,

dull headache,

sleep disturbances,

daytime sleepiness

, impaired memory,

personality changes

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81
Q

Diagnosis of Respiratory Acidosis

abg-ph / c02

serum electrolytes

pulmonary function test

cxr

A

ABGs- ph less then 7.35// c02 >45

Serum electrolytes- elevated k

Pulmonary function tests- cause

CXR- looking for pnemonua or pnemothroax

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82
Q

b
a
n

Medications to Treat Respiratory Acidosis

A

Bronchodilators- open airways

Antibiotics- infection

Naloxone- reverse narcotics

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83
Q

Respiratory Support

severe resp acidosis may__
cautious
p h

resp acidosis

A

severe may require intubation /ventilation

cautoius admisntrtaion of 02

pulmonary hygiene

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84
Q

Pulmonary hygiene

respiratory acidosis

A
  • breathing tx,

percussion,

drainage,

hydration

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85
Q

Impaired gas exchange-

assess
frequently
evalaute
place
as ordered

resp acidosis

A

assess rr,

frequently assess loc,

evaluate abg,

place in semifolwers,

admisnter oxygen as ordered

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86
Q

Ineffective airway clearance-

ausculate
lip
encourage
admisnter

resp acidosis

A

ausculate breath sounds,

pursed lip breathing

, encourage fluid intake,

amdinster bronchodialters

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87
Q

Respiratory Alkalosis

ph
pac02

A

pH greater than 7.45

PaCO2 less than 35

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88
Q

Risk factor- Respiratory alkalosis

1 risk factor
examples of it

A

hyperventialtoion

–pain, fear, infection,anxiety, faulty mechanical ventialtion

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89
Q

how will kidneys help

Pathophysiology of Respiratory Alkalosis

A

compensate by eliminating bicarb

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90
Q

Look for

Manifestations of respiratory Alkalosis

A

hypocalcemia- Tremors, positive Chvostek’s and Trousseau’s, tingling around mouth

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91
Q

L
p
d c
s
loss

Manifestations of respiratory Alkalosis

A

Lightheadedness

Panic,

difficulty concentrating

Seizures-

loss of consciousness

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92
Q

respiratory x2

Manifestations of respiratory Alkalosis

A

Dypnea

hyperventilation

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93
Q

ear

Manifestations of respiratory Alkalosis

94
Q

cardio x 3

Manifestations of respiratory Alkalosis

A

Chest tightness

Tachy cardia/ hypotension

palpitation

95
Q

diagnosis respiratory Alkalosis

abg
paco2

A

ABGs ph >7.45

paco2 <35

96
Q

Medications-

a
p
a

respiratory Alkalosis

A

, antianxiety,

pain reliever,

antibiotics

97
Q

Respiratory help

respiratory Alkalosis

A
  • breath slowly
98
Q

Tidal volume-

what is
normal

A

Amount of air that moves in and out of lungs-

normal amount of air in is 500 ml

99
Q

vital capacity

100
Q

Inspiration- how does it work

A

diagraphm and intercostals contract and cause air to flow into lungs because pressure drops

101
Q

Expiration- how does it work

A

muscle relaxes, cuases positive pressure, and mvoes air out of lungs

102
Q

f
c
m
t
all do what

Respiratory passageway resistance:
Factors that affect breathing

A

friction,

constriction,

mucus

tumours–

all will increase resistance and decrease air flow

103
Q

Lung compliance-

how what
what decreases

Factors that affect breathing

A

how structurally the lungs and ribs are

elasticity will decease with age and disease

104
Q

Sputum studies-

can give
afb
culture used when
Respiratory Diagnostic Tests

A

can give cancer diagnosis

afb- tb

culture used for bacterial infection

105
Q

AGBs- can tell

Respiratory Diagnostic Tests

A

can tell ph, co2 , 02, bicarb

106
Q

cxr

Respiratory Diagnostic Tests

A

CXR-abnomralties of chest and lungs

107
Q

MRI

Respiratory Diagnostic Tests

A

MRI -masses or fluids

108
Q

CT scan-

Respiratory Diagnostic Tests

A

images and cross sections

109
Q

PET- Positron emission tomography- why

Respiratory Diagnostic Tests

A

PET lung cancer and meds

110
Q

pulse ox

Respiratory Diagnostic Tests

A

Pulse oximetry- can be inaccurate

111
Q

V/Q scan
inhales
reduced in
used if

Respiratory Diagnostic Tests

A
  • inhales a radioactive gas

, reduced uptake in pe-

used if allergic to contrast in ct scan and need to diagnose pe

112
Q

Bronchoscopy
visualization
what to pt
remain

Respiratory Diagnostic Tests

A

-visalstion of bronchioles-

sedate pt,
remain npo for 2 hours pre op

113
Q

Lung biopsy
through

Respiratory Diagnostic Tests

A
  • through chest wall or in surgery
114
Q

Thoracentesis-

Respiratory Diagnostic Tests

A
  • needle removes fluid from pleural space
115
Q

Respiratory Assessment

Demographics-
Family history-
Personal history-
Occupational history-
Lifestyle-
Auscultation-
Pulse oximetry-
Breathing

A

Demographics-age/comliance

Family history-asmtha

Personal history-what job

Occupational history-job

Lifestyle-sedentary, smoke

Auscultation- lung sounds

Pulse oximetry-can be inacurate

Breathing effort

116
Q

laryngeal tumor

s/s-
changes
h
dys
breath
neck
e

Nursing Care for Client’s With Upper Respiratory Disorders

A

usually from laryngeal Cancer

s/s
Changes in voice,
hoarseness,
dysphagia,
foul breath,
lump in neck,
earache

117
Q

Total larygnectomy

s/s
require

A
  • speech loss,

require permanent trach

118
Q

Partial larygenctomy-

have
sounds

A

have some speech

, sounds different

119
Q

apply what with largenctomy

do what for speech

promote what

A

cold ice packs

give alternative speech things like paper and pencil

promote swallowing

120
Q

Pleuritis- s/s

s
s
pain where

A

stabbing

sharp

pain in neck or shoulder

121
Q

Pleuritis treatemnt

A

nsaids and analgesics

splinting

122
Q

Pleural effusion-

A

fluid in pleural space

123
Q

Transudate plural effusion from what x4

A
  • from heart failure

, renal failure,

liver failure or

malignancy

124
Q

exudate plural effusion

A

-from inflammatory response such as infections

125
Q

pleurale effusion may require

what
does what
puts pt at risk for what
how much

A

Thoracentesis-

removes fluid –

puts pt at risk for pneumothorax

1200-1500 ml at one time

126
Q

risk for pneumothorax-

check
put where

pleural effusion

A

check dressing

, put pt on unaffected side for 1 hr afterwards

127
Q

Pneumothorax

what
types

A

Accumulation of air in pleural space

Spontaneous-
Traumatic-
Tension-
Hemothorax-

128
Q

Spontaneous Pneumothorax

related to what
onset

A

Can be related to air pressure changes- flying, SCUBA diving, TB, ARDs

Onset- abrupt

129
Q

s/s Spontaneous Pneumothorax

pain where
breath
breath sounds

A

chest pain,

sob,

decreases breath sounds on affected side

130
Q

closed Traumatic Pneumothorax

examples

A

no obvious opening in thorax- fall, cpr, mva

131
Q

open Traumatic Pneumothorax

exmaples

A

obvius stab wound, gun shot- has chest open and punctured lung

132
Q

s/s of Traumatic Pneumothorax

pain where
d
breath

A

chest pain,

dyspnea,

absent breath sounds

133
Q

Tension Pneumothorax

why need to know
what happens

A

EMERGENCY-LIFE OR DEATH CARE NEEDED!

Chest wall or lungs allow air to enter pleural space but prevents it from escaping

134
Q

Ventilation compromised- causes what in Tension Pneumothorax

A

causes increased pressure on heart and cardiac output drops

135
Q

S/S- tension pneumothorax

bp
rr
hr
neck veins
breath sounds
tracheal

A

bp drop

tachypnea,

tachycardia,

, neck veins distended,

absent breath sounds,

tracheal deviation to unaffected side

136
Q

Needle Decompression-

treatment
Tension Pneumothorax

A

18/16 guage- puncture into rib and md will let out air

137
Q

after needle decompression->

what
what does

tension pnemo

A

chest tube

removes out air and equalizes air into negative suction to allow lungs to reexpand

138
Q

what to watch for in chest tube

A

pneumothorax

sob

139
Q

Hemothorax

what is it
result of

A

Blood in pleural space

Usually result of trauma or surgery

140
Q

treatment for all types pnemothroax

A

Chest tube

Surgery

141
Q

Pleurodesis-what does
utilize

other treatments Hemothorax

A

stops fluid or air to enter plueral space/

utlize doxycycline or talk to roughen up pleura and allow it to stick to thorax

142
Q

Rib fracture

pain when
no what
what when coughing
more significant

Other Thoracic Injuries

A
  • pain with inspiration-

no wrapping,

splint when coughing

more significant in elderly

143
Q

Flail chest-
what need to know
multiple
chest wall

Other Thoracic Injuries

A

painful and dangerous-

multiple fractures of rib on one side of rib

  • chest wall sucks in with inspiration and outward with exhalation-paradoxical movemeents
144
Q

Pulmonary contusion-

what is it
may not

Other Thoracic Injuries

A

internal bruising from trauma

  • may not see s/s until 12-24 hrs of trauma
145
Q

Smoke inhalation
what damage
what poison
what damages
monitor airway why

Other Thoracic Injuries

A

-thermal damage to airway

, carbon monoxide poisoning,

chemical damages-

monitor airway In pt because it can cause edema and airway to close

146
Q

Near drowning-

Other Thoracic Injuries

A

afixiation and aspiration

147
Q

Pulmonary Embolism

what happens
stems from what

A

Particulate matter enters venous circulation and lodges in pulmonary vessels

Usually stemming from DVT

148
Q

Pathophysiology of PE

what embolisms
what accumulates//causes
that leads to what
what’s impaired
what enters circualtion
results in

A

Clot embolizes

Platelets accumulate and chemicals cause vasoconstriction

Pulmonary vasoconstriction leads to pulmonary hypertension

Ventilation and perfusion are impaired

Deoxygenated blood enters arterial circulation

Hypoxemia

149
Q

PE Risk Factors

history
oral
prolonged
wt
age
what disease
what else

A

History of dvt

Oral contraceptives

Prolonged immobility- bedrest/surgery/flyingBirth

Obesity

edlely

Mi/heart failure

fractures

150
Q

Respiratory signs and symptoms

s
c
t

Assessment for PE

A

Sob

cough

tachypnea

151
Q

Cardiac signs and symptoms-
what pain
cardia
tension
neck veins
decreased

Assessment for PE

A

chest pain

tahcycardia

hypotension

distended neck veins

decreased co

152
Q

Lab tests-
d
a

Assessment for PE

A

-d dimer- elevated means positive dvt/pe

Abg- resp alkalosis

153
Q

Diagnostics-
c
c
v

Assessment for PE

A

,chest x ray

chest ct with contrast

vq scan

154
Q

Management of PE

what therapy/what else
check what

A

Oxygen therapy and ABGs

VS- ABCs

155
Q

Anticoagulation- x2

Management of PE

A

heparin drip,

warfarin

156
Q

Thrombolytic therapy
treats
give
what does it do

Management of PE

A
  • treats massive pe –

give tpa at site

breaks down clots

157
Q

Support cardiac output
iv
positive

Management of PE

A

– iv fluids,

positive inotropic drugs like digoxin to increase co//

158
Q

Surgical intervention-
what main one
what filter

Management of PE

A

elbolectomy- get clot out

IVC filter catch clot and will catch clot before gets into lungs

159
Q

Medications for PE Treatment

what//based on what
original bolus->
followed by what->

A

Heparin- bases on wt and patients repsonse

Heparin therapy initiated as bolus(5000-10000 units)

followed by continuous infusion( 1000-1500 per hour

160
Q

monitor what with heparin
what will it do to that level
what normal
what’s therpatic
check how often

PE

A

PTT monitored frequently-

increases ptt

normal 30-40 seconds-

theraptic 1.5-2x that-

check every 2-6 hours

161
Q

antidote heparin

how does hep work

PE treatment

A

protamine sulfate

hep prevents more clots from forming

162
Q

examples
usually used
route
risk

Medications low molecular wt heparin
PE treatment

A

Enoxaparin, Deltaparin

Usually used to prevent and treat venous thrombosis

Route: Administered SQ

Risk for bleeding

163
Q

PT- normal- therapeutic

INR normal- therapeutic

low molecular weight heparins

A

PT- normal 10-15- want it to be 2x grater then that

INR- normal- 0.8-1.2- want ot to be 2-3 for therapy

164
Q

warfarin
alters what
therapy how long
antidote

Medications for PE

A

Alters vitamin K synthesis

Therapy for 2-3 months

Antidote- vitamin k and ffp

165
Q

warfarin

monitor what labs
how often first 3 weeks
then how often
goal of inr

Medications for PE

A

Monitor PT levels and INR-

daily for 3 weeks then
2-3 times per week

Goal of INR -2-3

166
Q

New Anti-coagulant Drugs

r
d
a
is there reversal agent

A

Rivaroxaban ()

Dabigatran ()

Apixaban ()

No reversal agent yet

167
Q

Prevention of PE

what med
range
a
avoiding
stop
utilize

A

Prophylactic heparin

Range of motion

Ambulation

Avoiding pressure points

Stop smoking

TEDS and SCDs

168
Q

when stop anticoagulation preop

A

3-5 days pre-op

169
Q

may need what if Hx of DVT in less than 1 month

Pre-operative Care of Client on Anti-Coagulants

A

May need heparin or LWMH

170
Q

after surgery

what anticoagulants

how quick to adminster anticoagulants

A

heparin IV or LMW and oral warfarin

12 hours after surgery

171
Q

teaching with anticaogualnts

what precautions
what meds
d
s
e/s
s

A

Bleeding precautions

Pain relievers- nsaids can cause thinning

Dentistry

Sports

Enemas/suppositories- might bleed

Shaving

172
Q

Pulmonary Hypertension

changes in
leads to
increased

A

Changes in pulmonary artery

leads to abnormal vasoconstriction

increased pulmonary artery pressure

173
Q

Pulmonary Hypertension

increased risk

increases workload

leading

A

Increased risk of clot formation

Increases workload of right ventricle,

leading to heart failure

174
Q

S/S- Pulmonary Hypertension

d
f
fatal when

A

dspynea,

fatigue

, fatal 3-4 years later

175
Q

complications Pulmonary Hypertension

s/s

A

right ventricular hypertrophy

right sided heart failure and chronic cough with dyspnea

176
Q

treatment Pulmonary Hypertension

A

sildenafil(viagra)

relaxes blood vessels and allows blood into tissues

177
Q

Caused by

Legionnaires Disease

A

bacteria in water, circulating in air, fountains, shower heads, AC

178
Q

Legionnaires Disease Causes what

treat that with what

A

Bronchopneumonia-\

treat with floxins and mycins

179
Q

Persons at risk-3x

Legionnaires Disease

A

smokers

-elderly,

compromised status

180
Q

Legionnaires Disease Signs/symptoms

what cough
d
f
h
a

A

-dry cough,

dsypnea

, fever,

headache,

anorexia

181
Q

Histoplasmosis-
caused by
(f/c/d)

Fungal Lung Infections

A

causes by soils from birds or bat droppings

fever cough or dyspnea

182
Q

Coccidioidomycosis-
where found
s/s-if

Fungal Lung Infections

A

mold in soil-

asymptomatic- if do appear then look like fever with rashes

183
Q

Fungal Lung Infections
Tx-
not compatible
can cause x4

A

strong amphotericin b-

not compatible woth normal saline

can cause n/v/hives and skin blistering

184
Q

Acute Respiratory Failure s/s

always
failure of x2
normal

A

always hypoxic

oxygenation/ventilation failure

normal ventilation w/ decreased perfusion

185
Q

Causes acute respiratory failure

a
ao
c
e
a
c

A

-asthma,

airway obstruction,

copd,

edema,

ards,

chf

186
Q

dyspnea on what/might do what
full
get what

Assessment For Acute Respiratory Failure

A

Dyspnea on mild exertion- might lean forward to breathe better

Full respiratory assessment

Pulse oximetry

187
Q

ABGs- if hypoventilation-
what’s retained
ph
causing

Assessment For Acute Respiratory Failure

A

co2 is retained-

low ph

causing resp acidosis

188
Q

ETCO2
increased when
decreased when

Assessment For Acute Respiratory Failure

A

-increased when vent is low

decreased when pulmonary perfusion is impaired

189
Q

therapy/goal
treat
bed
conserve
releif
breath
pressure

Interventions Acute Respiratory Failure

A

Oxygen therapy-may need ventilation or intubation- goal is greater then 90%

Treat underlying cause

HOB

Energy conservation

Anxiety relief

Cough and deep breathing

Pressure-CPAP keeps lung open

190
Q

ARDS

persistent
decreased
pnea
bilateral
dense

A

Persistent hypoxemia-

Decreased pulmonary compliance

Dyspnea

bilateral pulmonary edema

Dense pulmonary infiltrates

191
Q

ARDS
devleops as a
leads to
leads to

A

a complication of tissue hypoxia

-leads to metabolic acidosis and sepsis-

leads to multiorgan failure and death

192
Q

Common Causes of ARDS

s
t
injuries
p
s
near
bypass
c

A

Shock

Trauma

Nervous system injuries

Pancreatitis

Sepsis

Near drowning

Cardiopulmaory bypass

Covid 19

193
Q

Manifestations of ARDS

d
a
use of
changes
s/r

A

Dyspnea

Anxiety

Intercoastal/accessory muscles

Mental status changes

Stridor and retractions

194
Q

Manifestations of ARDS

pnea
what hypoxemia
what lung sounds
what color

A

Tachypnea

Refractory hypoxemia- does not improve with 02

Crackles/bronchi in lungs

Cyanosis

195
Q

Diagnostic testing

Medical Care of Client With ARDS

A

chest x ray and abg

196
Q

Medications-

Medical Care of Client With ARDS

A

antibiotics and steroids

197
Q

Medical Care of Client With ARDS

careful
use of
nutrition
correct

A

Careful fluid replacement-

Use of Swan Ganz catheter

Nutrition- tpn

Correct underlying condition

198
Q

main medical care with ARDS

A

Mechanical ventilation with PEEP

199
Q

what position

what does

ARDS

A

Prone position

open airways and lungs by pushing dirapagm

200
Q

Nursing Interventions ARDS

position
n
o
a
care
t

A

Positioning-PRONING

Nutrition

Oxygenation

Assessment

Skin care

Teaching and emotional support

201
Q

Intubation and Ventilation

1-h
2-progressive_ w/
3- to

A

Hypoxemia

Progressive hypoventilation with respiratory acidosis

To conserve energy

202
Q

Oral endotracheal tube-
secure
no
most

Intubation Types

A

difficult to secure,

no communication

-most common inital

203
Q

tracheostomy

no what
tube can
emergency when
what in place
keep what at bedside

A

No natural warming and humidification,

tube can become dislodged-

emergency especially in first 72 hours,

sutured in place,

keep obturator and trach kit at bedside

204
Q

trach care

what for cleaning
what for stoma

A

½ H2O2 and sterile water or NS for cleaning the plastic

, only NS for stoma

205
Q

Preparing- Intubation

creating
giving

A

creating pt airway

giving oxygen

206
Q

Tube placement- Intubation

do what right away
measure
listen

A
  • document right away

measuring form teeth-

listen to lung sounds bil to see correct spot

207
Q

Stabilizing- where

Intubation

A

securing to mouth nose or neck

208
Q

Keep the trach midline-
no
on one side

Intubation

A

no pressure-

pressure on one side can cause narrowing

209
Q

Mechanical pressure injury-
if when

Intubation

A

if too much air is pushed in at one time

210
Q

Assessment intubation

p
need for
__assessment
adequate
sounds

A

Placement

Need for suctioning

Chest assessment

Adequate sedation

Lung sounds

211
Q

Mechanical Ventilation

goals

is not

A

Goals- have for for shortest period or time

Is not a cure

212
Q

long term mechanical ventilation

short term mechanical ventilation

A

Long term-MD, SCI, ALS

Short term- any resp issue/ post mi or cpr, ards, pe brain surgery

213
Q

Synchronized Intermittent Mandatory Ventilation-

Ventilator Modes

A

patient breathes spontaneously between vent breaths

214
Q

Assisted control
used
triggered by
if

Ventilator Modes

A

most often used-

triggered by inspiratory effort

, if effort is low, the vent kicks in

215
Q

CPAP-
all
maintain

Ventilator Modes

A

all breathing triggered by patient,

maintains the airway

216
Q

Ventilator Controls and Settings

tidal volume
rate
fraction

A

Tidal volume- 500-750ml

Rate-12-15/min for adults

Fraction of inspired O2 (FIO2)- adjusted per the ABGs

217
Q

If vent is alarming figure out why ventilatior

tube occluded
tachypenic
bradypenic

A

TO-suction needed

T–need sedation or slow breathing

B–requires different vent setting

218
Q

a
u
dry
pneumonia->
s e
p
ulcer
tubes

Potential Complications of ventilator

A

Anxiety

Uncomfortable

Dry mucous membranes

Pneumonia-frequent oral hygiene- hob raised- every 2 hours- early weening, standard precautions

Subcutaneous emphysema

Pneumothorax

Stress ulcers

Og/ng tube

219
Q

Nursing Management-Ventilators

Assess client’s response-
Assess anxiety
suction

A

Assess client’s response- vs, breath sounds, abg

Assess anxiety- are they tachypnea

Suction- clear airway –unable to swallow

220
Q

nursing Management-Ventilator

education
communication
always do what

A

Education-why they are restrained and cant speak

Communication- cant speak with tube- might be restrained//if no restraint white board

Always treat client first-

221
Q

Nursing’s role in

Weaning From Ventilator

A

-monitors for patients readiness to start weaning

222
Q

if Concern for pneumonia,

who does extruding

Weaning From Ventilator

A

get them off of the vent ASAP
keep on trialing them

MD, and RT

223
Q

Prevent Infection/pnemonia

h
care
bed
food
s

Weaning From Ventilator

A

HH,

trach care

, HOB up,

NPO,

suction

224
Q

Pediatric Concerns

kids airway grows
higher risk for

A

kids airway grows until 12

higher risk for obstruction dt small short airway

225
Q

SIDS s/s

arrest
mouth
diagnosed how

A

cardiopulomary arrest

frothy blood secretions from mouth

diagnosed on autopsy if no outwards cause

226
Q

SIDS risk factors

what race
what gender
what age
what wt
what season/why
p
c
what bedding
what sleeping
second

A

black

males

2-3 month

low birth weight

winter-blanket

positioning

cosleepig

soft bedding

prone or side sleeping

second hand smoke

227
Q

Parent teaching for all newborns SIDS

what position
what at bedtime

A

Supine,

pacifier at bedtime,

228
Q

Laryngotracheobronchitis

known as
affects
caused by

A

Croup

Affects larynx, trachea and bronchi

Can be caused by bacteria or virus but usually a virus

229
Q

croup s/s
s
b
sometimes

A

Stridor,

barking cough,

sometimes a fever

230
Q

treatment croup

expose
e
c
a

A

expose child to cool air-(freezer, outside)

epinephrin

corticosteroids

albuterol

D-Third semester (19 decks)

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