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Critical Care > Exam #2 > Flashcards

Exam #2 Flashcards

1
Q

Rapid deterioration to hypoxemia, hypercapnia, and respiratory acidosis refers to :

A

Acute Respiratory Failure

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2
Q

What are some EARLY signs of ARF?

A
  • Restlessness
  • Tachycardia
  • Hypertension
  • Fatigue
  • Headache
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3
Q

What are some LATER signs of ARF?

A
  • Confusion
  • Lethargy
  • Central cyanosis
  • Diaphoresis
  • Respiratory arrest
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4
Q

What are some clinical manifestations of ARF?

A
  • Use of accessory muscles
  • Decreased breath sounds
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5
Q

What device keeps the airway open throughout the respiratory cycle – improving gas exchange at the alveoli?

A

Continuous positive airway pressure (CPAP)

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6
Q

What device is used as treatment for sleep apnea?

A

CPAP

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7
Q

What device provides a set positive pressure when inspiration takes place and again, at a lower level, at the end of expiration (peep)

A

Bi-level positive airway pressure (BIPAP)

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8
Q

What are some nursing interventions that need to take place for patients on NON invasive ventilation

A
  • Assess skin around mask for breakdown due to the tight seal
  • Aspiration risk!! Monitor closely
  • Oral care
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9
Q

What are the indications of mechanical ventilation?

A
  • Poor/Low ventilation states
  • Hypoxemia
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10
Q

What device provides a patent airway, access for mechanical ventilation, and facilitated removal of secretions?

A

Endotracheal Tube

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11
Q

How is ET tube placement verified?

A

Chest XR ASAP

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12
Q

What premedication is given before intubation?

A
  • Versed
  • Fentanyl
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13
Q

What medications are given during the induction of intubation?

A
  • Ketamine
  • Etomidate
  • Paralytics
    - Succinylcholine
    - Rocuronium
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14
Q

When caring for an intubated patient, always make sure to have what at the beside?

A

Safety/Emergency equipment

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15
Q

Oral care for an intubated patient is important to decrease …

A

Ventilator-associated pneumonia

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16
Q

When air is pushed into the lungs until it reaches a preset PRESSURE in the lungs – TV varies per breath. What vent setting is this referring to?

A

Pressure Modes/ Pressure control

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17
Q

When air is pushed into the lungs until it reaches a preset VOLUME of air into the lungs – TV is set with each breath. What vent setting is this referring to?

A

Volume Modes/ Volume control

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18
Q

What represents the amount of air delivered to the lungs with each breath

A

Tidal volume

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19
Q

What kind of vent mode -has a preset rate and TV
-the patient requires deep sedation so they don’t fight it

A

Assist Control

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20
Q

What vent mode:
- has a preset rate and TV for machine breaths
- allows the client to initiate breaths that vary on respiratory effort
- known as the vent-weaning mode

A

Synchronized Intermittent Mandatory Ventilation (SIMV)

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21
Q

What Vent mode:
- May be tolerated by pts as volume varies as long as constant pressure is maintained in the lungs
- Waveform looks like a plateau

A

Continuous Mandatory Ventilation

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22
Q

What vent mode:
- Gives pt an extra bit of pressure on each inhale to support reaching an effective TV
- Needs patient to choose when to breath and how often

A

Pressure Support

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23
Q

What are some things that can cause a low pressure alarm on a ventilator?

A
  • Leak
  • Displacement/ Disconnection
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24
Q

What are some things that can cause a high pressure alarm on a ventilator?

A
  • Pneumothorax
  • Pulmonary Edema
  • Bronchospasm
  • Biting
  • Secretions
  • Coughing
  • Kinks
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25
Q

What complication is associated with excessively high levels of PEEP?

A

Barotrauma (pneumothorax)

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26
Q

What is the term that delivers a preset pressure during expiration and improves oxygenation by enhancing gas exchange?
** Prevents atelectasis and barotrauma

A

Positive End Expiratory Pressure (PEEP)

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27
Q

Nursing intervention: Promoting Effective Airway Clearance:

  • Assess _____ sounds every q__-__ hours
  • Measures to clear airway: suctioning, CPT, position changes, promote increased mobility
  • Humidification or airway
  • Administer Medications
    - _________
    - __________
  • ____________ ONLY if excessive _________
A

Lung, 2-4
Mucolytics, Bronchodilators
Suctioning, secretions

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28
Q

What is it called when a systemic inflammatory response injures the alveolar-capillary membrane and pulmonary vasculature – Leading to the lung space being filled with fluids and proteins

A

Acute Respiratory Distress Syndrome

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29
Q

What would an XR of a patient with ARDS look like?

A

Very Cloudy, filled with infiltrates

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30
Q

What type of V/Q mismatch does ARDS have?

A

Shunting

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31
Q

What kind of lung sounds would you hear in a patient who has ARDS

A

Crackles

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32
Q

What is the most common treatment method for a patient with a Pulmonary Embolus

A

Thrombolytic Therapy
- Alteplase, Reteplase, Tenecteplase

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33
Q

What are other ways to treat a PE?

A

Embolectomy to remove it
Inferior Vena Cava Filter: mostly for pts who cannot have thrombolytics; used to prevent a DVT from reaching the pulmonary vasculature

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34
Q

The concentration of hydrogen ions in the blood determining acidity or alkalinity of body fluids is known as:

A

pH

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35
Q

_____ shows the adequacy of gas exchange between the alveoli and the external environment or ventilation. Excess ____ combines with water forming carbonic acid which causes acidosis

A

PaCO2
Co2

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36
Q

This is an alkaline substance that makes up for over half of the total buffer base in the blood

A

HCO3

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37
Q

As hydrogen INCREASES the pH goes ______ making the blood more _________

A

DOWN
Acidotic

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38
Q

As Hydrogen DECREASES, the more _________ the blood is, and the pH goes _______

A

Alkalotic
UP

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39
Q

What is a normal pH range?

A

7.35-7.45

40
Q

What is a normal CO2 range?

A

35-45

41
Q

What is a normal HCO3 range?

A

22-26

42
Q

________ acidosis is caused by the kidneys not working well enough to keep the blood neutral

A

Metabolic

43
Q

_________ acidosis is caused by the lungs not working properly

A

Respiratory

44
Q

The lower the pH goes, the less the ______ works

A

body

45
Q

Most ______ only work well when they are given while the body’s pH is normal

A

drugs

46
Q

What are some clinical manifestations of Metabolic Acidosis?

A
  • Headache
  • Confusion
  • Drowsiness
  • Increased RR
  • peripheral vasodilation
47
Q

What is the respiratory response to metabolic acidosis

A
  • Breathe faster
  • Drops PCO2
48
Q

What is the kidneys response to metabolic acidosis?

A
  • Pees hydrogen away
  • Increases H+ excretion and increases bicarb reabsorption
49
Q

Respiratory acidosis is usually caused by a low ___________ state

A

ventilation

50
Q

What are some of the causes of metabolic alkalosis?

A
  • Severe gastric acid loss
    => Vomiting or gastric suctioning
  • Hypokalemia
    => Serum K+ low so nephrons in kidney reabsorb K+ and H+
    => Serum K+ low, so K+ in cells move into the blood, H+ then gets pulled into cell and out of serum
51
Q

What are the clinical manifestations of metabolic alkalosis

A
  • Confusion
  • Dysrhythmias (tachy for K+)
  • Hypoventilation
  • Dizzy, irritability
  • N/V/D
  • Anxiety
  • Seizures
52
Q

TREATMENT FOR METABOLIC ALKALOSIS

A
  • Give IV fluid
  • Replace K+
  • Give PPI like omeprazole to neutralize pH of gastric secretions
  • Frequent lab draws
53
Q

What is the most common cause of respiratory alkalosis?

A

Hyperventilation

54
Q

What are some causes of hyperventilation?

A
  • Anxiety/Panic
  • Hypoxemia (body is trying to correct the issue)
  • Aspirin/Pepto
55
Q

What are some clinical manifestations of respiratory alkalosis?

A
  • Dizziness (due to cerebral vasoconstriction and decreases cerebral blood flow)
  • Tachy and other dysrhythmias
  • Numbness around mouth due to low Ca+
56
Q

________ occurs as a result of circulatory failure - leading to tissue hypoxia, cellular death, and organ dysfunction

A

Shock

57
Q

The amount of force that the vasculature exerts to circulate blood

A

Systemic Vascular Resistance

58
Q

Too little O2 in the blood to feed organs - body switches from aerobic to anerobic metabolism - Lactic acids increases

What stage of shock is this?

A

Initial stage

59
Q

During this stage…
- Oliguria
- Altered LOC
- Pallor, cool clammy skin
- Electrolyte imbalance
- Hypotension
..Occurs - Which stage of shock is this?

A

Progressive

60
Q
  • Aldosterone is released to maintain BP
  • Vasoconstriction to shunt blood to vital organs
  • HR increases
  • Sympathetic NS releases catecholamines to compensate for low O2

What stage of shock is this?

A

Compensatory

61
Q
  • Irreversible cellular and organ failure and Impending death
  • Death is imminent
  • The client is comatose
  • Hypotension not responsive to vasopressors
  • Renal failure resulting in anuria
  • Respiratory failure despite O2 therapy

Which stage of shock is this?

A

Refractory

62
Q

What type of shock is caused by the result of a decreased systemic vascular resistance and perfusion

A

Distributive

63
Q

What type of shock is due to the loss of 25-30% of circulating blood volume

A

Hypovolemic

64
Q

What type of shock is due to systemic hypoperfusion as a result of decreased cardiac output

A

Cardiogenic shock

65
Q

What type of shock occurs when blood flow is blocked, disrupting circulation to the major arteries

A

Obstructive

66
Q

What type of shock occurs as a result of the release of inflammatory cytokines which cause damage to the internal layer of blood vessels and initiates clotting mechanisms

A

Septic

67
Q

What kind of shock occurs in response to severe hypersensitivity to an allergen mediated by IgE increasing vascular permeability and vasodilation and a decreased SVR

A

Anaphylactic

68
Q

What kind of shock occurs due to autonomic dysregulation caused by a spinal cord injury above the level of T6

A

Neurogenic

69
Q

What type of shock involved infection from Staphylococcus aureus causing excessive activation of cytokines and inflammatory cells

A

Toxic

70
Q

What is the number one line of treatment for anaphylactic shock

A

IM Epinephrine

71
Q

What kind of fluids should be given to a patient with non-hemorrhagic hypovolemic shock

A

Isotonic crystalloids => NS, LR (30mL/kg)

72
Q

During hypovolemic shock, there is not enough blood volume. This causes low CO, and decreased cell contractility because the cells switch from _________ to ___________ metabolism causing _________ _________

A

aerobic
anaerobic
Lactic acidosis

73
Q

During cardiogenic shock, in response to decreased CO, the body’s compensatory mechanism activate the _____________ nervous system causing vasoconstriction and tachycardia in attempt to meet the oxygen needs of the myocardium

A

sympathetic

74
Q

What does the treatment of cardiogenic shock focus on?

A
  • Vasopressors (***Norepinephrine)
  • Inotropes
    (Dobutamine and milrinone)
  • Optimization of fluid status
  • Diuretics if pt becomes hypervolemic
  • Treatment of underlying cause/ mechanical support
75
Q

what is caused by tissue injury/infection - Cytokines are released into the circulation as a result of the tissue injury and the body cannot return to homeostasis - Activation of the inflammatory cascade causes inadequate perfusion and organ failure.

This is known as …

A

Systemic Inflammatory Response Syndrome

76
Q

What are some things that can cause SIRS?

A
  • Pancreatitis
  • Trauma
  • Burns
77
Q

To meet the criteria of sepsis, the patient must have at least ___ SIRS criteria and an ________ with positive cultures

A

2
infection

78
Q

What are some of the surgical interventions for SIRS?

A

Wound debridement
Abscess drainage

79
Q

What are some of the pharmacological treatments for SIRS

A
  • ABX
  • Glucocorticoids
  • Glucose Control
  • Vasopressors and Inotropes
80
Q

What is known as an EXTREME response after injury, sepsis, or burns that leads to the constant release of immune mediators in the blood causing altered organ function and failure

A

Multiple Organ Dysfunction Syndrome (MODS)

81
Q

Decreased cellular oxygen convert cells to ________ metabolism which leads to ________ acidosis

A

anerobic
Lactic

82
Q

MODS causes the breakdown of muscle tissue and vital organs (TRUE OR FALSE)

A

TRUE

83
Q

What are some risk factors for MODS?

A
  • Chronic disease
  • Preexisting organ dysfunction
  • Immunosuppressive therapy
  • Extreme age
  • Malnutrition
  • Cancer
  • Trauma
  • Alcoholism
  • Severe Trauma
  • Sepsis
84
Q

________ is the leading cause of MODS after trauma

A

Infection

85
Q

MODS has a very ______ mortality rate

A

HIGH - Death rate increases as the number of involved organs increases

86
Q

Not A Question
Treatment for MODS is more specific since we know what organs are affected. So tx is more organ dependent. Also similar to sepsis treatment

A

:)

87
Q

What pain scale assigns numerical scores to a patient’s facial expressions and body positions

A

Behavioral Pain Scale

88
Q

What pain scale has limited use in patients unable to display behavior due to paralysis, physical or chemical, heavy sedation, and brain injury

A

Critical Care Pain Observation Tool

89
Q

What device is used to reflect parasympathetic activity and can be used in the OR or ICU

A

Analgesia Nociception Index – High values = high parasympathetic activity or less pain stimulation

90
Q

Opioid analgesics act on the ____ to inhibit activity of ascending nociceptive pathways

A

CNS

91
Q

NSAIDS decrease pain by inhibiting _________________

A

Cyclo-oxygenase – enzyme involved in production of prostaglandin

92
Q

Local anesthetics block _____ conduction when applied to nerve fibers

A

nerve

93
Q

What are some examples of NSAIDs/ Cox inhibitors?

A

Naproxen
Ibuprofen
Ketorolac
Aspirin
Celecoxib

94
Q

What 2 medications are dual mechanism analgesic agents?

A

Tramadol
Ultram

95
Q

What medications binds to opioid receptors and blocks the reuptake of norepi and serotonin in the CNS

A

Tramadol
Ultram

96
Q

What medications are known as Opioids?

A

Morphine
Hydromorphone
Fentanyl
Oxycodone

97
Q

What are some examples of Adjunctive Analgesics?

A
  • Local Anesthetics
  • Anticonvulsants
    Gabapentin, Pregabalin

Critical Care (6 decks)

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