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M/S 3 > Exam 1 - Resp. > Flashcards

Exam 1 - Resp. Flashcards

1
Q

severe acute respiratory syndrome (SARS) is spread by which 3 methods

A

droplet
airborne
contact

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2
Q

SARS causes an interference with what

A

gas exchange

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3
Q

___ is responsible for SARS

A

coronavirus

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4
Q

SARS incubation period

A

2-7 days

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5
Q

SARS incubation period s/sx

A

initially: high fever, chills

after 1-2 days: non-productive cough, SOB, dyspnea, possible hypoxemia

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6
Q

progression phase (2nd week) of SARS can lead to what

A

respiratory failure
ARDS
multi-organ dysfunction

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7
Q

PPE for SARS

A

gown
goggles
gloves
N95

infection control measures begin immediately

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8
Q

WBC in SARS is usually ___

A

low

leukopenia and thrombocytopenia may develop at peak stage

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9
Q

CPK + Liver enzymes in SARS are usually ___

A

elevated

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10
Q

are there any meds proven to be effective for SARS?

A

No, it’s a virus!

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11
Q

SARS: 4 treatment methods

A

supportive
O2 if needed
intubation if needed
mechanical vent (BiPap) if needed

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12
Q

SARS goal

A

preventing spread and respiratory support

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13
Q

sarcoidosis is common in this race, age group and gender

A

African American females between 20-40 y/o

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14
Q

sarcoidosis s/sx

A

fever
dyspnea
fatigue
anorexia, weight loss
myalgia
arthralgia

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15
Q

definitive way to Dx sarcoidosis

A

bx of granuloma

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16
Q

sarcoidosis treatment is aimed at ___ immune response

A

suppressing

daily corticosteriods

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17
Q

medications used with sarcoidosis treatment

A

corticosteroids
immune-modifiers (Imuran)
anti-inflammatory (Indocin, MTX)
***risk for GI bleed

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18
Q

symptoms sarcoidosis pts must report to HCP

A

SOB
tearing, eye inflammation
CP, irregular pulse
skin lesions
painful joints

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19
Q

corticosteroid education

A

take as Rx
do not stop abruptly
limit Na
increase K+ in diet
take with food or milk to minimize gastric irritation
early s/sx of infection

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20
Q

chronic inflammatory disease of the airways that causes hyperresponsiveness, mucosal edema, and mucous production

A

asthma

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21
Q

strongest predisposing factor for asthma

A

allergies

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22
Q

asthma triggers

A

sulfites/sulfa
smoke
GERD
cold, windy weather
cockroaches
cat dander

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23
Q

asthma exacerbation s/sx

A

cough
wheezing
chest tightness
dyspnea
diaphoresis
tachycardia
hypoxemia, central cyanosis

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24
Q

quick-relief asthma meds

A

beta-2 adrenergic agonist
anticholinergics

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25
Q

long-acting asthma meds

A

corticosteroids
long-acting beta 2 adrenergic agonists
Leukotriene modifiers (Sinular; Montelukast)

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26
Q

review respiratory meds

A

review respiratory meds

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27
Q

acute respiratory failure (ARF) is d/t ___ ___ ___

A

inadequate gas exchange

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28
Q

ARF inadequate gas exchange is r/t

A

insufficient O2 in the blood (hypoxemia)

inadequate CO2 removal (hypercapnia)

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29
Q

is ARF a diease?

A

no, it’s a condition d/t 1+ diseases involving the lungs or other body systems

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30
Q

2 classifications of ARF

A

hypoxemic (tachypnea; shallow respirations)
hypercapnic (hyperventilation; deep respirations)

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31
Q

what values determine hypoxemic respiratory failure

A

PaO2 < 60 with an FiO2 of 60%

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32
Q

what values determine hypercapnic respiratory failure

A

PaCO2 >45 and pH < 7.35

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33
Q

hypoxemic respiratory failure is ___ issue where as hypercapnic respiratory failure is a ___ issue

A

oxygenation; ventilatory

34
Q

Will Hgb be high or low with hypoxemic respiratory failure

A

low

35
Q

what is an appropriate V:Q ratio

A

1 mL of air (ventilation) for each 1 mL of blood flow (perfusion)

this is called V/Q 1

36
Q

what is it called when the VQ ratio does not match 1:1

A

VQ mismatch

37
Q

how much blood is perfused to the lung each minute? how much gas reaches the alveoli each minute?

A

4-5 L/minute

38
Q

causes of VQ mismatch

A

COPD
PNA
asthma
atelectasis
pain
PE

39
Q

___ occurs when blood exits the heart without having participated in gas exchange

A

shunt

40
Q

anatomic vs. intrapulmonary shunt

A

A: passes through an anatomic channel in the heart, bypassing the lungs

I: blood flows through pulmonary capillaries without participating in gas exchange

41
Q

what is diffusion limitaiton?

A

gas exchange is compromised d/t thickened, damaged, or destroyed membranes

42
Q

causes of diffusion limitation

A

severe emphysema
recurrent PE
pulmonary fibrosis
ARDS
interstitial lung disease
hypoxemia present during exercise

43
Q

causes of alveolar hypoventilation

A

restrictive lung disease (COPD)
CNS disease
chest wall dysfunction
neuromuscular disease

44
Q

causes of hypoxemia respiratory failure

A

VQ mismatch
shunt
diffusion limitation
alveolar hypoventilation

45
Q

___ ___ is the maximum ventilation a pt an sustain without developing muscle fatigue

A

ventilatory supply

46
Q

___ ___ is the amount of ventilation needed to keep the PaCO2 WNL

A

ventilatory demand

47
Q

respiratory causes of hypercapnic respiratory failure

A

asthma
emphysema
CF

48
Q

CNS causes of hypercapnic respiratory failure

A

drug OD
brainstem infarction
spinal cord injury

49
Q

chest wall causes of hypercapnic respiratory failure

A

flail chest
kyphoscoliosis
morbid obese
fracture
mechanical restriction
muscle spasm

50
Q

neuromuscular causes of hypercapnic respiratory failure

A

muscular dystrophy
guillain-barre
MS

51
Q

early s/sx of respiratory failure

A

tachycardia
tachypnea
mild HTN
severe AM HA

52
Q

consequences of hypoxemia

A

metabolic acidosis, cell death
decreased CO (decreasing perfusion to organs)
impaired renal function
brain damage if prolonged

53
Q

SaO2 is ___ points higher than PaO2 will be

A

30

54
Q

when is NIPPV contraindicated

A

absent respirations
excessive secretions
decreased LOC
high O2 demands
facial trauma
hemodynamic instability

55
Q

benzodiazepine antidote

A

Rimazacon

56
Q

how often to change eternal or parental nutrition bags + tubing

A

every 24 hours

57
Q

aging considerations re: respiratory

A

low ventilatory capacity
alveolar dilation
larger air space
loss of surface area
diminished elastic recoil
decrease respiratory muscle strength
decrease chest wall compliance

58
Q

sudden progressive form of acute respiratory failure

A

acute respiratory distress syndrome (ARDS)

59
Q

acute lung injury vs. ARDS

A

ALI: PaO2/FiO2 ratio is 200-300

ARDS: ratio is < 200

60
Q

what is an early sign of ARDS

A

increased RR

61
Q

most common cause of ARDS

A

sepsis

62
Q

ARDS: injury/exudative phase being how soon after lung injury

A

24-48 hours

63
Q

ARDS: during the injury/exudative phase, is the body responsive to increase O2

A

No

severe VQ mismatch

64
Q

ARDS: respiratory acidosis or alkalosis

A

alkalosis d/t increase CO2 removal

65
Q

ARDS: when does the reparative/proliferative phase occur

A

1-2 weeks after initial lung injury

66
Q

ARDS: when does the fibrotic/late phase occur

A

2-3 weeks after initial lung injury

aka chronic or late phase ARDS

67
Q

early s/sx of ARDS

A

dyspnea, tachypnea
cough
restlessness
fine, scattered crackles
mild hypoxemia, respiratory alkalosis
minimal infiltrates on CXR

68
Q

late s/sx of ARDS

A

evident discomfort
increased WOB
tachypnea
intercostal, suprasternal retractions
diaphoresis
cyanosis
tachycardia
decreased LOC

69
Q

profound respiratory distress in ARDS requires ___ ___ and ___ ___ ___

A

ET intubation; PPV

70
Q

why is ARDS CXR termed “whiteout”

A

widespread consolidation and infiltrates throughout

71
Q

MAP shows how the ___ are being ___

A

organs; perfused

72
Q

why would abdominal distention or ascites be present in ARDS

A

r/t liver dysfunction, sepsis

73
Q

when is there a risk for oxygen toxicity

A

FiO2 exceeds 60% for longer than 48 hours

74
Q

high levels of ___ can compromise venous return

A

PEEP

decrease preload, CO, and BP

75
Q

major cause of death in ARDS

A

multi-organ dysfunction syndrome (MODS) often accompanied by sepsis

76
Q

3 organ systems commonly affected by ARDS

A

CNS
hematologic
GI

77
Q

3 most vital organs commonly affected by ARDS

A

kidneys
liver
heart

78
Q

complications of ARDS treatment

A

VAP
barotrauma
volutrauma
high risk for stress ulcers
renal failure

79
Q

___ occurs when large TV used to ventilate noncompliant lungs

A

volutrauma

this can be avoided by using smaller tidal volumes or pressure ventilation

80
Q

T or F. renal failure will cause erythropenia

A

True

81
Q

purpose of administering albumin

A

pull fluid into interstitial space (to prevent or treat third spacing)

diuretic also given to pull the flood out once in correct place

M/S 3 (17 decks)

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