Exam 1 - Resp. Flashcards by Ashley Burkhalter

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

droplet
airborne
contact

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SARS causes an interference with what

gas exchange

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___ is responsible for SARS

coronavirus

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SARS incubation period

2-7 days

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SARS incubation period s/sx

initially: high fever, chills

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

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

respiratory failure
ARDS
multi-organ dysfunction

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PPE for SARS

gown
goggles
gloves
N95

infection control measures begin immediately

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WBC in SARS is usually ___

low

leukopenia and thrombocytopenia may develop at peak stage

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CPK + Liver enzymes in SARS are usually ___

elevated

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are there any meds proven to be effective for SARS?

No, it’s a virus!

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SARS: 4 treatment methods

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

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SARS goal

preventing spread and respiratory support

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sarcoidosis is common in this race, age group and gender

African American females between 20-40 y/o

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sarcoidosis s/sx

fever
dyspnea
fatigue
anorexia, weight loss
myalgia
arthralgia

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definitive way to Dx sarcoidosis

bx of granuloma

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sarcoidosis treatment is aimed at ___ immune response

suppressing

daily corticosteriods

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medications used with sarcoidosis treatment

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

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symptoms sarcoidosis pts must report to HCP

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

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corticosteroid education

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

asthma

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strongest predisposing factor for asthma

allergies

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asthma triggers

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

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asthma exacerbation s/sx

cough
wheezing
chest tightness
dyspnea
diaphoresis
tachycardia
hypoxemia, central cyanosis

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quick-relief asthma meds

beta-2 adrenergic agonist
anticholinergics

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long-acting asthma meds

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

review respiratory meds

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

inadequate gas exchange

ARF inadequate gas exchange is r/t

insufficient O2 in the blood (hypoxemia) inadequate CO2 removal (hypercapnia)

is ARF a diease?

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

2 classifications of ARF

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

what values determine hypoxemic respiratory failure

PaO2 < 60 with an FiO2 of 60%

what values determine hypercapnic respiratory failure

PaCO2 >45 and pH < 7.35

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

oxygenation; ventilatory

Will Hgb be high or low with hypoxemic respiratory failure

low

what is an appropriate V:Q ratio

1 mL of air (ventilation) for each 1 mL of blood flow (perfusion) this is called V/Q 1

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

VQ mismatch

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

4-5 L/minute

causes of VQ mismatch

COPD PNA asthma atelectasis pain PE

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

shunt

anatomic vs. intrapulmonary shunt

A: passes through an anatomic channel in the heart, bypassing the lungs I: blood flows through pulmonary capillaries without participating in gas exchange

what is diffusion limitaiton?

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

causes of diffusion limitation

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

causes of alveolar hypoventilation

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

causes of hypoxemia respiratory failure

VQ mismatch shunt diffusion limitation alveolar hypoventilation

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

ventilatory supply

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

ventilatory demand

respiratory causes of hypercapnic respiratory failure

asthma emphysema CF

CNS causes of hypercapnic respiratory failure

drug OD brainstem infarction spinal cord injury

chest wall causes of hypercapnic respiratory failure

flail chest kyphoscoliosis morbid obese fracture mechanical restriction muscle spasm

neuromuscular causes of hypercapnic respiratory failure

muscular dystrophy guillain-barre MS

early s/sx of respiratory failure

tachycardia tachypnea mild HTN severe AM HA

consequences of hypoxemia

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

SaO2 is ___ points higher than PaO2 will be

when is NIPPV contraindicated

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

benzodiazepine antidote

Rimazacon

how often to change eternal or parental nutrition bags + tubing

every 24 hours

aging considerations re: respiratory

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

sudden progressive form of acute respiratory failure

acute respiratory distress syndrome (ARDS)

acute lung injury vs. ARDS

ALI: PaO2/FiO2 ratio is 200-300 ARDS: ratio is < 200

what is an early sign of ARDS

increased RR

most common cause of ARDS

sepsis

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

24-48 hours

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

No severe VQ mismatch

ARDS: respiratory acidosis or alkalosis

alkalosis d/t increase CO2 removal

ARDS: when does the reparative/proliferative phase occur

1-2 weeks after initial lung injury

ARDS: when does the fibrotic/late phase occur

2-3 weeks after initial lung injury aka chronic or late phase ARDS

early s/sx of ARDS

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

late s/sx of ARDS

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

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

ET intubation; PPV

why is ARDS CXR termed "whiteout"

widespread consolidation and infiltrates throughout

MAP shows how the ___ are being ___

organs; perfused

why would abdominal distention or ascites be present in ARDS

r/t liver dysfunction, sepsis

when is there a risk for oxygen toxicity

FiO2 exceeds 60% for longer than 48 hours

high levels of ___ can compromise venous return

PEEP decrease preload, CO, and BP

major cause of death in ARDS

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

3 organ systems commonly affected by ARDS

CNS hematologic GI

3 most vital organs commonly affected by ARDS

kidneys liver heart

complications of ARDS treatment

VAP barotrauma volutrauma high risk for stress ulcers renal failure

___ occurs when large TV used to ventilate noncompliant lungs

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

T or F. renal failure will cause erythropenia

True

purpose of administering albumin

pull fluid into interstitial space (to prevent or treat third spacing) diuretic also given to pull the flood out once in correct place