Exam #2 Flashcards
Rapid deterioration to hypoxemia, hypercapnia, and respiratory acidosis refers to :
Acute Respiratory Failure
What are some EARLY signs of ARF?
- Restlessness
- Tachycardia
- Hypertension
- Fatigue
- Headache
What are some LATER signs of ARF?
- Confusion
- Lethargy
- Central cyanosis
- Diaphoresis
- Respiratory arrest
What are some clinical manifestations of ARF?
- Use of accessory muscles
- Decreased breath sounds
What device keeps the airway open throughout the respiratory cycle – improving gas exchange at the alveoli?
Continuous positive airway pressure (CPAP)
What device is used as treatment for sleep apnea?
CPAP
What device provides a set positive pressure when inspiration takes place and again, at a lower level, at the end of expiration (peep)
Bi-level positive airway pressure (BIPAP)
What are some nursing interventions that need to take place for patients on NON invasive ventilation
- Assess skin around mask for breakdown due to the tight seal
- Aspiration risk!! Monitor closely
- Oral care
What are the indications of mechanical ventilation?
- Poor/Low ventilation states
- Hypoxemia
What device provides a patent airway, access for mechanical ventilation, and facilitated removal of secretions?
Endotracheal Tube
How is ET tube placement verified?
Chest XR ASAP
What premedication is given before intubation?
- Versed
- Fentanyl
What medications are given during the induction of intubation?
- Ketamine
- Etomidate
- Paralytics
- Succinylcholine
- Rocuronium
When caring for an intubated patient, always make sure to have what at the beside?
Safety/Emergency equipment
Oral care for an intubated patient is important to decrease …
Ventilator-associated pneumonia
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?
Pressure Modes/ Pressure control
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?
Volume Modes/ Volume control
What represents the amount of air delivered to the lungs with each breath
Tidal volume
What kind of vent mode -has a preset rate and TV
-the patient requires deep sedation so they don’t fight it
Assist Control
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
Synchronized Intermittent Mandatory Ventilation (SIMV)
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
Continuous Mandatory Ventilation
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
Pressure Support
What are some things that can cause a low pressure alarm on a ventilator?
- Leak
- Displacement/ Disconnection
What are some things that can cause a high pressure alarm on a ventilator?
- Pneumothorax
- Pulmonary Edema
- Bronchospasm
- Biting
- Secretions
- Coughing
- Kinks
What complication is associated with excessively high levels of PEEP?
Barotrauma (pneumothorax)
What is the term that delivers a preset pressure during expiration and improves oxygenation by enhancing gas exchange?
** Prevents atelectasis and barotrauma
Positive End Expiratory Pressure (PEEP)
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 _________
Lung, 2-4
Mucolytics, Bronchodilators
Suctioning, secretions
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
Acute Respiratory Distress Syndrome
What would an XR of a patient with ARDS look like?
Very Cloudy, filled with infiltrates
What type of V/Q mismatch does ARDS have?
Shunting
What kind of lung sounds would you hear in a patient who has ARDS
Crackles
What is the most common treatment method for a patient with a Pulmonary Embolus
Thrombolytic Therapy
- Alteplase, Reteplase, Tenecteplase
What are other ways to treat a PE?
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
The concentration of hydrogen ions in the blood determining acidity or alkalinity of body fluids is known as:
pH
_____ 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
PaCO2
Co2
This is an alkaline substance that makes up for over half of the total buffer base in the blood
HCO3
As hydrogen INCREASES the pH goes ______ making the blood more _________
DOWN
Acidotic
As Hydrogen DECREASES, the more _________ the blood is, and the pH goes _______
Alkalotic
UP
What is a normal pH range?
7.35-7.45
What is a normal CO2 range?
35-45
What is a normal HCO3 range?
22-26
________ acidosis is caused by the kidneys not working well enough to keep the blood neutral
Metabolic
_________ acidosis is caused by the lungs not working properly
Respiratory
The lower the pH goes, the less the ______ works
body
Most ______ only work well when they are given while the body’s pH is normal
drugs
What are some clinical manifestations of Metabolic Acidosis?
- Headache
- Confusion
- Drowsiness
- Increased RR
- peripheral vasodilation
What is the respiratory response to metabolic acidosis
- Breathe faster
- Drops PCO2
What is the kidneys response to metabolic acidosis?
- Pees hydrogen away
- Increases H+ excretion and increases bicarb reabsorption
Respiratory acidosis is usually caused by a low ___________ state
ventilation
What are some of the causes of metabolic alkalosis?
- 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
What are the clinical manifestations of metabolic alkalosis
- Confusion
- Dysrhythmias (tachy for K+)
- Hypoventilation
- Dizzy, irritability
- N/V/D
- Anxiety
- Seizures
TREATMENT FOR METABOLIC ALKALOSIS
- Give IV fluid
- Replace K+
- Give PPI like omeprazole to neutralize pH of gastric secretions
- Frequent lab draws
What is the most common cause of respiratory alkalosis?
Hyperventilation
What are some causes of hyperventilation?
- Anxiety/Panic
- Hypoxemia (body is trying to correct the issue)
- Aspirin/Pepto
What are some clinical manifestations of respiratory alkalosis?
- Dizziness (due to cerebral vasoconstriction and decreases cerebral blood flow)
- Tachy and other dysrhythmias
- Numbness around mouth due to low Ca+
________ occurs as a result of circulatory failure - leading to tissue hypoxia, cellular death, and organ dysfunction
Shock
The amount of force that the vasculature exerts to circulate blood
Systemic Vascular Resistance
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?
Initial stage
During this stage…
- Oliguria
- Altered LOC
- Pallor, cool clammy skin
- Electrolyte imbalance
- Hypotension
..Occurs - Which stage of shock is this?
Progressive
- 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?
Compensatory
- 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?
Refractory
What type of shock is caused by the result of a decreased systemic vascular resistance and perfusion
Distributive
What type of shock is due to the loss of 25-30% of circulating blood volume
Hypovolemic
What type of shock is due to systemic hypoperfusion as a result of decreased cardiac output
Cardiogenic shock
What type of shock occurs when blood flow is blocked, disrupting circulation to the major arteries
Obstructive
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
Septic
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
Anaphylactic
What kind of shock occurs due to autonomic dysregulation caused by a spinal cord injury above the level of T6
Neurogenic
What type of shock involved infection from Staphylococcus aureus causing excessive activation of cytokines and inflammatory cells
Toxic
What is the number one line of treatment for anaphylactic shock
IM Epinephrine
What kind of fluids should be given to a patient with non-hemorrhagic hypovolemic shock
Isotonic crystalloids => NS, LR (30mL/kg)
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 _________ _________
aerobic
anaerobic
Lactic acidosis
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
sympathetic
What does the treatment of cardiogenic shock focus on?
- Vasopressors (***Norepinephrine)
- Inotropes
(Dobutamine and milrinone) - Optimization of fluid status
- Diuretics if pt becomes hypervolemic
- Treatment of underlying cause/ mechanical support
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 …
Systemic Inflammatory Response Syndrome
What are some things that can cause SIRS?
- Pancreatitis
- Trauma
- Burns
To meet the criteria of sepsis, the patient must have at least ___ SIRS criteria and an ________ with positive cultures
2
infection
What are some of the surgical interventions for SIRS?
Wound debridement
Abscess drainage
What are some of the pharmacological treatments for SIRS
- ABX
- Glucocorticoids
- Glucose Control
- Vasopressors and Inotropes
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
Multiple Organ Dysfunction Syndrome (MODS)
Decreased cellular oxygen convert cells to ________ metabolism which leads to ________ acidosis
anerobic
Lactic
MODS causes the breakdown of muscle tissue and vital organs (TRUE OR FALSE)
TRUE
What are some risk factors for MODS?
- Chronic disease
- Preexisting organ dysfunction
- Immunosuppressive therapy
- Extreme age
- Malnutrition
- Cancer
- Trauma
- Alcoholism
- Severe Trauma
- Sepsis
________ is the leading cause of MODS after trauma
Infection
MODS has a very ______ mortality rate
HIGH - Death rate increases as the number of involved organs increases
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
:)
What pain scale assigns numerical scores to a patient’s facial expressions and body positions
Behavioral Pain Scale
What pain scale has limited use in patients unable to display behavior due to paralysis, physical or chemical, heavy sedation, and brain injury
Critical Care Pain Observation Tool
What device is used to reflect parasympathetic activity and can be used in the OR or ICU
Analgesia Nociception Index – High values = high parasympathetic activity or less pain stimulation
Opioid analgesics act on the ____ to inhibit activity of ascending nociceptive pathways
CNS
NSAIDS decrease pain by inhibiting _________________
Cyclo-oxygenase – enzyme involved in production of prostaglandin
Local anesthetics block _____ conduction when applied to nerve fibers
nerve
What are some examples of NSAIDs/ Cox inhibitors?
Naproxen
Ibuprofen
Ketorolac
Aspirin
Celecoxib
What 2 medications are dual mechanism analgesic agents?
Tramadol
Ultram
What medications binds to opioid receptors and blocks the reuptake of norepi and serotonin in the CNS
Tramadol
Ultram
What medications are known as Opioids?
Morphine
Hydromorphone
Fentanyl
Oxycodone
What are some examples of Adjunctive Analgesics?
- Local Anesthetics
- Anticonvulsants
Gabapentin, Pregabalin
