Exam 1 - Resp. Flashcards
severe acute respiratory syndrome (SARS) is spread by which 3 methods
droplet
airborne
contact
SARS causes an interference with what
gas exchange
___ is responsible for SARS
coronavirus
SARS incubation period
2-7 days
SARS incubation period s/sx
initially: high fever, chills
after 1-2 days: non-productive cough, SOB, dyspnea, possible hypoxemia
progression phase (2nd week) of SARS can lead to what
respiratory failure
ARDS
multi-organ dysfunction
PPE for SARS
gown
goggles
gloves
N95
infection control measures begin immediately
WBC in SARS is usually ___
low
leukopenia and thrombocytopenia may develop at peak stage
CPK + Liver enzymes in SARS are usually ___
elevated
are there any meds proven to be effective for SARS?
No, it’s a virus!
SARS: 4 treatment methods
supportive
O2 if needed
intubation if needed
mechanical vent (BiPap) if needed
SARS goal
preventing spread and respiratory support
sarcoidosis is common in this race, age group and gender
African American females between 20-40 y/o
sarcoidosis s/sx
fever
dyspnea
fatigue
anorexia, weight loss
myalgia
arthralgia
definitive way to Dx sarcoidosis
bx of granuloma
sarcoidosis treatment is aimed at ___ immune response
suppressing
daily corticosteriods
medications used with sarcoidosis treatment
corticosteroids
immune-modifiers (Imuran)
anti-inflammatory (Indocin, MTX)
***risk for GI bleed
symptoms sarcoidosis pts must report to HCP
SOB
tearing, eye inflammation
CP, irregular pulse
skin lesions
painful joints
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
chronic inflammatory disease of the airways that causes hyperresponsiveness, mucosal edema, and mucous production
asthma
strongest predisposing factor for asthma
allergies
asthma triggers
sulfites/sulfa
smoke
GERD
cold, windy weather
cockroaches
cat dander
asthma exacerbation s/sx
cough
wheezing
chest tightness
dyspnea
diaphoresis
tachycardia
hypoxemia, central cyanosis
quick-relief asthma meds
beta-2 adrenergic agonist
anticholinergics
long-acting asthma meds
corticosteroids
long-acting beta 2 adrenergic agonists
Leukotriene modifiers (Sinular; Montelukast)
review respiratory meds
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
30
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
