Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Kol- 410 Med Surg II > Exam 1 Review- Oxygenation part > Flashcards

Exam 1 Review- Oxygenation part Flashcards

1
Q

ARDS vs ARF - what causes it ?

A

ARDS= systematic inflammation or direct injury from aspiration or pneumonia

ARF= ventilation (physical problem like rib injury/ paralysis/drug overdose) and/or oxygenation problem (exchange- pneumonia/PE)
–> vent/oxy combined = cystic fibrosis, ARDS, asthma

ARF >ARDS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

times you cardiovert vs times you defib?

A

cardiovert = SVT, Afib, V Tach with Pulse

defib = V tach with no pulse, V fib

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

top concerns with trachs for nurses

A

-gas exchange
-communication
-nutrition
-infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

top priority for post op trach?

A

maintain patent airway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

complications from trach? top one?

A

-tube dislodgement
-pneumothorax
-bleeding
-infection
-tube obstruction**

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

____ _____ is a sign of pneumothorax realted to trach placement

A

subcutaneous emphysema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

signs of tube obstruction

A

• Difficulty breathing
• Loud breathing
• Difficult to insert a suction catheter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

prevention for complications re: tube obstruction?

A

• Pulmonary Hygiene: mobility! - dangling
• Inner Cannula Care - changed , 1/shift
• Suction as needed- not routinely
• Humidified Oxygen

PISH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

how often do we suction trach?

A

as needed only!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

how often should the inner cannula be changed/cleaned?

A

changed 1/day , 1/shift

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what kind of oxygen do trachs need?

A

humidfied

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

how do trach patients end up with a pneumothorax?

A

◦ Occurs as a result of tracheostomy placement if the provider inadvertently enters the chest cavity
‣ need chest tube to regulate pressure to pull the lung back to inflation
◦ Subcutaneous emphysema - sign of pneumothorax
‣ sounds like rice crispies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

You get report on your patient at the bedside from the day nurse. Your patient
has a #8 XL Shiley tracheostomy tube, which was placed two days ago. The
day nurse tells you she just did tracheostomy care about an hour ago, and other than a scant amount of serosanginous drainage, everything looks great. The CRNA had a difficult time placing the patient’s airway, so the patient has a
“Difficult Airway” sign hanging above his bed. As you scan the patient and the room, what observation would you be most concerned about:

A) The patient’s tracheostomy is only secured with ties, not sutures
B) There is a #9 XL Shiley tracheostomy tube on the bedside table with an obturator nearby.
C) There are no suction catheter kits in the room
D) The patient has audibly rhonchorous breath sounds and is coughing

A

B) There is a #9 XL Shiley tracheostomy tube on the bedside table with an obturator nearby.
◦ need one size smaller NOT bigger! + need obturator + suction set up + O2 + ambu bag

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

trach cuff pressure should be < ____ - ____mmHG

A

‣ <14-20 mm Hg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

• Which patients with a tracheostomy need to be suctioned?
A) Everyone with a tracheostomy should be suctioned routinely
B) The patient with mucus in the artificial airway
C) The patient with noisy secretions
D) The restless patient with tachycardia and tachypnea

A

B) The patient with mucus in the artificial airway
C) The patient with noisy secretions
D) The restless patient with tachycardia and tachypnea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

max time suctioning down the trach hole

A

10 seconds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

sterile or clean technique for suctioning

A

sterile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

max # times you can go down with catheter?

A

3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what do we do if vagal stimulation occurs when suctioning? what are the signs of vagal stimulation?

A

stop suctioning !!

◦  Bradycardia
◦  Hypotension
◦  Dysrhythmias
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

You are observing your preceptor perform tracheostomy suctioning. You become concerned when he…
A) Tells the patient that he is going to perform tracheostomy suctioning, letting the patient know that it may be painful and may cause coughing
B) Uses a sterile kit, remaining sterile through the entire process of suctioning
C) During suctioning, the patient’s heartrate drops from 89 to 53 and the nurse reassures the patient that he is almost done
D) Suctions for about 10-15 seconds, only during withdrawal of the catheter

A

C) During suctioning, the patient’s heartrate drops from 89 to 53 and the nurse reassures the patient that he is almost done

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

causes of pulmonary edema

A

• Happens a lot in older folks –> decreased heart/kidney function
◦ HF
◦ Renal failure
◦ ARDS
◦ High altitudes
◦ Brain trauma
◦ Rapidly expanding lungs
— pneunothorax –> Pulling fluid off lungs too quickly when re-expanding the lung
◦ Most common: When giving too much fluid too quickly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

on a patho level what is causing pulmonary edema (not diseases)

A

• Increased pulmonary pressure increases, fluid leaks across pulmonary capillaries into airway and tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

who is highest risk of acute pulmonary edema

A

• HF, renal, older folks
• Laboring parents on a lot of fluid can happen
◦ Results from severe fluid overload

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

acute pulmonary edema assessment findings

A

• Coarse Crackles (especially in bases)
• Cough
• SOB
• Pink, frothy sputum**
• Dyspnea
• Confusion
• Tachy/Dysrythmias
• Altered BP (low , high, or normal)
• Reduced urinary output (low cardiac output)
• Restlessness/anxiety
• Lethargy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

interventions for pulmonary edema

A

• Reassurance
• HOB raised
• O2 increase
• Monitor SpO2, Vital signs
- Meds
• FIX UNDERLYING CAUSES
• Ultrafiltration
• Use ABC’s
• O2
◦ Face mask
◦ Noninvasive positive pressure ventilation (Bipap cpap)
◦ Intubation/Mechanical ventilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

which drug reduces preload (pulmonary venous return) :

diuretic, antihypertensive, or dobutamine

A

diuretic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

which drug provide ionotropic support (heart contraction):

diuretic, antihypertensive, or dobutamine

A

dobutamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

which drug reduces the afterload (systemic vascular resistance):

diuretic, antihypertensive, or dobutamine

A

antihypertensive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

goals for managing pulmonary edema long term? who do you want on the team for helping to manage them?

A

-manage underlying diseases that cause pulmonary edema
-HF core measures
◦ Discharge instructions
◦ Left ventricular systolic function
◦ ACE or ARB
◦ Smoking cessation
-• Activity as tolerated / Work up to routine exercise

-case management/social worker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Take me through the patho of what happens when you have a PE

A

• Reduced gas exchange
• Reduced oxygenation
• Pulmonary tissue hypoxia
• Decreased perfusion –> increases resistance in pulmonary vasculature –> increase work of R side of heart to push blood out into the lungs –> R sided HF –> poor perfusion to rest of body
• Possible death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Most common cause of a PE =

A

DVT! VTE (venous thromboembolism)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

When the DVT dislodge and goes into your pulmonary vasculature what happens to the right side of the heart?

A

becomes hard to the right ventricle to push blood into the lungs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What puts someone at increase risk of DVT/PE

A

• Increased age
• Hypercoagulable states
• Obesity
• hypercoagulable state
• Prolonged immobility
• Central venous catheter
• IV drug use
• Sepsis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

virchow’s triad =

A

= increase risk of developing a blood clot from
1.) damage to vessel (trauma)
2.) immobility (stasis of blood flow)
3.) hypercoagulability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

The best way to manage a DVT is to ….

A

prevent it!!

use anticoagulant, mobility, SCD’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

asssesment findings for PE

A

• Resp compromise
• Dyspnea
• Chest pain – stabbing, sharp
◦ heart attack = squeezing, crushing
• Restlessness
• Agitation
• Cough
• Bloody sputum from infarcted lung (Pulmonary Edema = pink frothy)
• Abnormal breath sounds
• Tachypnea
• Tachycardia
• Diaphoresis
• Fever- inflammation
• Petechiae (throwing blood clots, hemorrhaging of small capillaries)
• Showering clots
• Increased O2 demands
• Hypotension from decreased cardiac output
• Abnormal heart sounds
• EKG changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

sputum with PE vs sputum with Pulmonary edema

A

PE = bloody from infarcted lung
Pulm Edema = pink frothy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

heart attack chest pain vs PE chest pain

A

heart attack = squeezing crushing
PE = stabbing, sharp

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

this lab value tells us there is clot somewhere but not specifically where

A

D- dimer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

gold standard for diagnosing a PE

A

pulmonary angiography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What do you do if you suspect someone has a PE?

A

get some help!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

3 priority responses for PE management

A

• ABG’s with normal limits
• Give O2 to maintain SpO2 > 95%
• Patient maintain baseline cognitive status

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Interventions for PE

A

• HOB
• Increase O2 to maintain SpO2 > 95%
• Call RR
• Reassure your patient
• Assess, assess, assess
◦ Respiratory
◦ Cardiac
◦ Skin
• Imaging
• Prescribed anticoagulants (monitor bleeding!!)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Which anticoag med works the fastest?

A

Heparin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

what labs do we check with heparin ? what labs do we check with warfarin?

A

heparin = ptt or APTT
warfarin = INR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

how soon do we check aptt or ptt with heparin

A

within 6 hours check ptt or aptt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

if your patient is going for a prcedure and they are heparin how long do you have to wait after stopping the heparin for them to go have the procedure?

A

stops working within 1 hour of turning off the infusion

48
Q

antidote for heparin? antidote for warfarin?

A

heparin= protamine sulfate
warf = vitamin k

49
Q

how long after stopping lovenox can patient or procedure?

A

12 hours

50
Q

which are the 2 acute anticoags and who is our typical extended?

A

acute = heparin, lovenox
extended = warfarin

51
Q

How do we know the anticoagulant meds are working to treat the PE?

A

clot is getting smaller = breathing better

52
Q

what do we do to treat hypotension related to HF from a PE

A

-in fluids
-iv drug therapy
-positive inotropic meds
-vasopressors
-vasodilators

53
Q

what is a pulmonary contusion?

A

lung bruise ! fluid accumulates and takes up space, painful , can lead to resp failure

54
Q

Pulmonary Contusion Assessment

A

• Trauma to the chest
• Dyspnea
• Hypoxemic
• Decreased breath sounds
• Crackles
• Wheezes
• Cough
• Tachypnea- compensation- tire out, can’t do it for a long time –> can lead to low CO2 and dehydration
• Tachycardia- compensation
• Shortness of breath
• Pain (especially when breathing)
• Shallow breathing- atelectasis–> pneumonia !

55
Q

how is someone with a pulmonary contusion at risk for pneumonia?

A

• Shallow breathing (painful to breathe deep)- atelectasis–> pneumonia !

56
Q

how does someone with a pulmonary contusion have risk for dehydration and low CO2

A

Tachypnea- compensation- tire out, can’t do it for a long time –> can lead to low CO2 and dehydration

57
Q

nursing intreventions for pulm contusion

A

• Apply oxygen
• Bed position? - sitting up can hurt, spinal precautions can’t sit up, it depends!
• Minimize anxiety
• Rest
• IV Fluids needed

Monitor! can decline quickly

58
Q

typical cause of rib fracture?

A

blunt force to chest

59
Q

types of secondary injuries a rib fracture?

A

◦ Pneumothorax
◦ Hemothorax
◦ Pulmonary contusion

60
Q

rib fracture assessment and management

A

• Pain –> pain medication, some need so much pain medication that they lose drive to breathe –> mechanically ventilate
• Splinting
• Shallow breathing
• If injury is uncomplicated: Relieve pain to optimize deep breathing (and avoid pneumonia and
atelectasis)

61
Q

3 characteristics that define a deep chest injury from rib fracture?

A

• Injury to first and second ribs
• Injury to more than seven ribs
• Expired volume of air is <15ml/kg

• high mortality rate, likely intubated

62
Q

what is flail chest ? when does it occur?

A

aradoxical chest wall movement caused by fractured ribs
◦ chest seeks in when you breathe not expand like normal

-occurs with toher injuries, 2 or > broken ribs that become free floating

63
Q

flail chest interventions

A

• Monitor vital signs, ABG’s
• Assess for worsening respiratory status/ increased O2 demand
• Oxygenate
• Pain Relief
• Pulmonary hygiene
• Aggressive Respiratory care
• Reduce anxiety

64
Q

pneumothorax vs tension pneumothorax

A

Pneumothorax
• Air enters the pleural space
• Puts pressure on the lung –> lung collapses

Tension Pneumothorax
= Complete lung collapse involving air entering the lung without exit
• Air enters pleura during inhalation, does not exit during exhale
◦ Increased pressure in chest cavity, puts pressure on other side of chest/ other lung can collapse
◦ Decreased cardiac output, puts pressure on heart
◦ can result in complete hemodynamic collapse

65
Q

pneumothorax assessment

A

• Tachypnea
• Subcutaneous emphysema
• Pain
• Diminished/ absent breath sounds on affected side
• Reduced movement of chest wall
• Increased O2 demand/ Shortness of breath

66
Q

how does a chest tube treat a pneumiothorax?

A

◦ Inserted through chest wall
◦ Suctions air from the pleura
◦ Creates negative pressure in pleura
◦ Lung reexpands

67
Q

causes of tension pneumothorax

A

• Blunt force trauma to chest –> regular pneumo can cause it
• Mechanical ventilation
• Chest tubes
• Central venous catheter insertion

68
Q

tension pneumothorax assessment

A

• Tracheal deviation (away from affected side) = hallmark finding of tension pneumothorax
◦ call a code!
◦ moves away from the side where the pneumo is –> all the pressure is pushing on the trachea
• Asymmetrical thorax
• Respiratory distress/ failure
• Distended neck veins
• Hypotension
• Tachycardia
• Confusion
• Decreased/absent breath sounds
• fluid is backing up and pressing on the heart, fluid can’t go anywhere
(everything but first 2 is same as cardiac tamponade)

69
Q

tension pneumo interventions

A

• Needle Thoracostomy
◦ Large bore needle pokes through the pleural space not into lung
• Chest tube placed after needle
YOUR ROLE?
• Support patient
• Call for help
• Assist provider
• Monitor patient
• Pain relief

70
Q

bleeding into the pleura of lung =

A

hemothorax

71
Q

causes of hemothorax?

A

• liver failure/ renal failure/ heart failure at greatest risk for developing due to extra fluid

72
Q

hemothorax assessment

A

• Vary from no changes to severe
• Respiratory distress
• Diminished breath sounds

73
Q

if chest tube output is > ___ cc / hour report it to provider

A

> 50 cc = report!

74
Q

ventilation vs perfusion

A

• Ventilation (V) AIR MOVEMENT
• Perfusion (Q) BLOOD FLOW

75
Q

what happens when ventilation and perfusion are mismatched?

A

When they do not match in the lung (or an area of the lung
)–> Respiratory failure

76
Q

is a PE a perfusion or ventilation issue?

A

perfusion

77
Q

is pneumothorax a perfusion or a ventilation issue?

A

ventilation

78
Q

causes of ventilation failure

A

• Drug overdose
• Rib Fractures
• Pneumothorax
• Airway obstruction
• Paralysis
• Brain injury
• Spinal Cord injury

• Physical Problems with chest and lungs
• Injury or failure of the respiratory control center
• Inability to control function of respiratory muscles

79
Q

causes of perfusion failure

A

• Pulmonary emboli
• Pneumonia
• Pulmonary edema

80
Q

causes of combined oxygen and perfusion failure?

A

• Leads to worse respiratory failure/ hypoxemia than ventilation or perfusion failure alone
• Abnormal lungs seen with
–Chronic bronchitis
–Asthma
–Cystic fibrosis
–Emphysema
–ARDS

81
Q

assessment findings for acute resp. failure?

Heart rate? pulses? breathing style? bp? mental status?

A

• Dyspnea
• Orthopnea
• Respiratory Pattern
• Lung Sounds
• Pulse Oximetry
• ETCO2 (end tidal co2 monitoring- Co2 breathing out at end of breath, 35-45)
• ABG’s
• Restlessness, agitation, irritability
• Confusion
• Change in LOC
• Hypotension
• Bradycardia
• Weak pulses

82
Q

interventions for acute resp. failure?

A

Oxygen, Oxygen, Oxygen
• Treat underlying cause
• Positioning
• Assist with anxiety
• Energy conserving measures

83
Q

ARDS assessment findings

A

• Increased work of breathing
• Loud breathing- adventitious breathing sounds
• Cyanosis
• Use of accessory muscles for breathing
• Confusion

84
Q

ards diagnostics (4)

A

• ABG
• Chest X-ray
• Sputum culture – bacterial component for underlying thing we could treat like pneumonia
• PF ratio (PaO2, FiO2 ration) <300 = indicative ARDS

85
Q

why do a sputum culture with ards?

A

test for bacterial component for underlying thing we could treat like pneumonia

86
Q

PF Ratio < _____ = indicative of ARDS

A

<300

87
Q

Why do we give ARDS patients PEEP?

A

◦ alveoli collapsed at end of respiration in ARDS, give a little bit of positive pressure prevents collapse of alveoli
◦ a normal person does not have collapsed alveoli at end of breath becuase we have the surfactant we need to keep them open

88
Q

why put ARDS patients in prone position?

A

◦ more alveoli in posterior portion of lungs, proning allows for their expansion

89
Q

how long can a person have an ET tube in?

A

<10-14 days

90
Q

can you put an ET tube in your nose?

A

sure betchya

91
Q

how far down do we want the ET tube to be?

A

2 inches above the carina

92
Q

who can put in an ET tube?

A

◦ Anesthesiologist, Critical Care Provider, Hospitalist (and more)
◦ Respiratory Therapist
◦ Certified Nurse Anesthetist

in other terms- NOT YOU. not for RN!

93
Q

doctor says- lets intubate! what are you going to do my new nursing school grad?

A

• Provide oxygen
• Lift head of bed
• **Keep talking to your patient **
• Call for help/ Coordinate care
• Gather supplies
• Assess, assess, assess

94
Q

3 meds we are giving for intubation- sedation, anaglesics, and paralytics: which one do we give first?

A

sedation

*not everyone gets a paralytic

95
Q

how long do we limit the intubation attempt time to?

A

30 seconds

96
Q

how often do we monitor the BP during intubation?

A

every 5 minutes at least

97
Q

how do we verify ET tube placemnt?

A

xray
waveform capnography
auscultation
bronchoscope
esophageal detector

98
Q

priority for maintaining ET tube function after palcement

A

frequently check that it is in the correct place –> look at number

99
Q

being intubated puts patients at risk for ______ later in life

A

delirium

100
Q

do we put restraints on all intubated patients?

A

nope! only if they needs
–> consider using a mitt instead

101
Q

DOPE is an acronym for complications from intubations, what does it stand for? whats the last thing you check for?

A

• Dislodgement
• Obstruction (sputum)
• Pneumothorax
• Equipment failure (last thing you should be checking for)

102
Q

which side is more common for ET tube misplacement ?

A

right side- most common, bigger and straighter

103
Q

• Your patient is intubated and is becoming agitated, moving around the bed a lot.
You notice that he becomes tachypneic and tachycardic and his SpO2 falls from
94% to 87%. Upon your assessment, he has diminished breath sounds on the left.
You check the ET tube placement and note that the ET tube is no longer 24 cm, as
you documented this morning. It is now 27 cm at the lips. Your first action is to
• Notify the provider
• Notify Respiratory therapy
• Order a PRN x-ray
• Move the tube back to where it was on your morning assessment

A

• Notify the provider

104
Q

re mechanical ventilation FiO2 % should be between

A

21-100

105
Q

Vent resp rates should be

A

10-14

106
Q

what is the tidal volume?

A

air going in or air goig out (7-10 mL/kg)

107
Q

the higher the peep the ____ the risk of damaging the alveoli

A

the > the risk

108
Q

interventions for intubated patient

A

• ANXIETY
• Suctioning as needed, 5-10 sec, preoxygenate, <3 passes
• Oral Care - every 2 hours
• Head of Bed >30 degrees
• Pulmonary hygiene
• Mobility
• Delirium prevention- assess every shift , reorient, day and night differential
• Chlorhexidine bath daily from neck down (no genitals) for every ventilsted person
• Anti-Acid pharmacologic agent- risk of stomach acid in lungs
• Nutrition

109
Q

head of bed for intubated patient = > __

A

30 degrees

110
Q

why do we give ant acids for intubated patients?

A

risk of stomach acid in liungs

111
Q

what is really important for preventing delirium in ICU?

A

orient to day nad night

112
Q

ventilatior complications include….

A

• Hypotension
• Barotrauma
• Pneumothorax
• Pneumomediastinum
• Volutrauma
• Atelectrauma
• Biotrauma
• Ventilator-associated lung injury
• Ventilator-acquired pneumonia
• Peptic Ulcer
• Malnutrition
• Failure to Wean
• Muscle Deconditioning

113
Q

ACDEF ventilator bundle =

A

• Awake(TURN OFF SEDATION)
• Breathe (TRIAL)
• Coordinate/ Choice of sedation (RN/RT
• Delirium Prevention
• Early Mobility
• Family Presence

114
Q

extubating requires what from the provider?

A

an order to do so

115
Q

what do we assess for with extubation?

A

• Assess your patient’s ability to remain off ventilator
• Assess for stridor

Kol- 410 Med Surg II (27 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions