Exam 2 Flashcards

1
Q

______________________:

  • Usually occurs after an acute traumatic event in those w/no previous pulmonary disease
  • 50% mortality rate
  • Alveolar capillary membrane becomes damaged & more permeable to intravascular fluid, alveoli fill w/fluid
  • Lung Inflammation & injury to the lung itself
A

Acute Respiratory Distress Syndrome (ARDS)

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2
Q

In terms of Respiratory…
Q = ____________ (Hypoxemic)
V = ____________(Hypercapnic)

A

Q= O2 exchange failure

V= Ventilator Failure
Mechanical act of breathing failure

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3
Q

What occurs with Hypoxic ARF?

A
  • “Q” is the problem
  • Hypoxemia/normocapnia/hypocapnia
  • PaO2 <60
  • Restlessness, △LOC
  • HTN, Tachycardia
  • DYSPNEA, TACHYPNEA
  • Nasal Flaring/Retractions
  • Breaths to finish sentence
  • Cool/Clammy/Diaphoretic
  • Cyanosis (Late)
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4
Q

_________ is a type of ARF where the O2 being transferred between the alveoli and the capillary bed in the lungs is insufficient for the body’s needs.

A

Hypoxemic (O2) Failure

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5
Q

__________ is a type of ARF that happens when the actual mechanics of the lungs become insufficient to provide an adequate O2/CO2 exchange.

A

Hypercapnic (Ventilatory) Failure

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6
Q

What occurs with Hypercapnic (Vent) ARF?

A
  • DYSPNEA, ↘️ RR/Rapid shallow RR
  • PaCO2 >48, pH<7.35
  • Morning headache/↗️ ICP/bounding pulse
  • Muscle weakness, ↘️DTR
  • Flushed/warm
  • Pursed lip breathing
  • Seizures (Late)
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7
Q

___________ is a life-threatening lung condition that prevents enough oxygen from getting to the lungs and into the blood. Characterized by noncardiogenic pulmonary edema; Increased-permeability pulmonary edema

A

ARDS; Acute Respiratory Distress Syndrome.

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8
Q

Early General Symptoms of ARDS?

A
  • Dyspnea
  • Restlessness
  • Tachypnea
  • Cough
  • Crackles
  • Hypoxemia
  • Resp alkalosis d/t hyperventilation
  • Change in LOC
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9
Q

Late General Symptoms of ARDS?

A
  • Noisy respiration
  • Sterna retractions
  • Bradycardia/↘️ BP
  • Oliguria
  • Cyanosis
  • Hypercapnia; resp/metabolic acidosis
  • V-fib/ asystole
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10
Q

_________ _________: Hypoxemia despite increased O2 by mask, cannula, or ET is Hallmark of ARDS, b/c lungs are filled w/water & O2 can’t pass through fluid

A

Refractory Hypoxemia

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11
Q

4 key elements of ARDS?

A
  • Refractory Hypoxemia
  • Dense Pulmonary Infiltrates (Drowning in own fluids) on CXR
  • NONcardiogenic pulmonary edema
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12
Q

What occurs in Phase 1 (Exudative Phase) of ARDS?

A

a. Occurs 1-7 days after injury (Primary Patho △’s)
b. Respiratory alkalosis- hyperventilating (loss of CO2)
c. Increased CO
d. Increased RR
e. Refractory Hypoxemia
f. Decrease tidal volume
g. Atelectasis*
h. Pulmonary edema (not r/t cardiac)- interstitial & alveolar*
i. Decrease in surfactant b/c fluid inactivates it, causing “stiff lungs”

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13
Q

What occurs in Phase 2 (Reparative/Proliferative) of ARDS?

A

a. occurs 1-2 wks after injury
b. Increased pulmonary vascular resistance & pulmonary HTN
c. Lung compliance continues to decrease d/t interstitial fibrosis & hypoxemia
d. Thickened alveolar membranes cause diffusion limitation & shunting worsening hypoxemia

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14
Q

What occurs in phase 3 (Fibrotic/Chronic) of ARDS?

A

a. Occurs approx. 3 wks after injury
b. Pulmonary vessels destroyed
c. Tissue is fibrotic & leads to vascular occlusion & pulmonary HTN
d. Decreased lung compliance
e. Surface area for gas exchange significantly reduce & hypoxemia continues

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15
Q

These are all examples of ______ injuries that can cause ARDS?

  1. Pneumonia**
  2. Gastric aspiration**
  3. Lung contusion
  4. Fat emboli
  5. Near drowning
  6. Inhalation injury
  7. Reperfusion (lung transplant, pulmonary embolectomy)
A

Direct injuries

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16
Q

These are all examples of _______ injuries that can cause ARDS

  1. Sepsis*
  2. Severe trauma w/shock & DIC, multi-transfusions*
  3. Cardiopulmonary bypass
  4. Drug overdose
  5. Acute pancreatitis
  6. Blood transfusion
  7. Burns
A

Indirect injuries

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17
Q

____________?serious condition in which proteins that control blood clotting become abnormally active. Small blood clots form in blood vessels. Can clog up vessels & cut off flow to organs like brain, liver, kidneys. Overtime, clotting proteins are consumed & pt is at high risk for bleeding even without injury.

A

DIC; Disseminated Intravascular Coagulation

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18
Q

What nutritional support do we offer those with ARF?

A

a. 35-45 kcal/kg/day: they are in high metabolic demand & need the nutrition
b. High protein
c. Watch milk products- cause high secretions
d. Low carbs (d/t breakdown into CO2)
e. High fluids

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19
Q

Name this equipment:

i. One setting, you have to be able to breathe out at the same pressure as it is blowing in
ii. Good for pt w/MS or problem w/muscle strength, must be able to blow out strongly on your own

A

CPAP (Cont Pos Airway Pressure)

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20
Q

Name this equipment:

i. Allows you to set level of pressure to blow in at one level & pressure to blow out at another level (usually lower).
ii. Better suited for those w/neuromuscular diseases

A

BiPAP (Bilevel Pos Airway Pressure)

21
Q

Drug Therapy for ARF?

A
  1. Albuterol, Proventil: relief of bronchospasm
  2. Steriods: reduction of airway inflammation (watch for infection & high blood sugar)
  3. Treatment of pulmonary congestion and infections
  4. Ativan: treat anxiety & ease work of breathing
22
Q

This organ removes the soluble waste products and access fluid from the blood, helps maintain Ca and phosphate levels, activate vit D to stimulate the intestinal absorption of Ca, helps control BP by secreting renin, helps control acid base balance, and stimulates RBC production.

23
Q

__________: removal from the body.
Ex: H+ ions if acidodic or K+

24
Q

__________: substances being produced & discharged from a cell, gland, or organ for particular use or function, things the kidneys release.
Ex: Erythropoietin, Calictriol, aldosterone

25
__________: end product of protein breakdown (BUN) Normal Level?
- Urea | - 10-20
26
____________: end product of muscle breakdown ←good indicator of kidney function; Best indicator of AKI. Normal Level?
- Creatinine | - 0.6-1.3
27
________: urine output <100ml/day ________: build up of nitrogenous wastes
- Oliguria - Anuria - Azotemia (Uremia when it affects other systems)
28
_________: rate at which kidneys are filtering blood. Normal Levels?
- GFR | - 125mL/min
29
________: max concentrating ability of kidne; should flux throughout the day. Normal Levels?
-1-1.03
30
Prerenal causes of AKI? | Systemic Causes
- Hypovolemia - ↘️ CO (Renals need 25% of CO) - ↘️ Periph Vascular Resistance - ↘️ Renal Perfusion
31
Intrarenal Causes of AKI? | Damage to renal tissue
- Prolonged prerenal ischemia** - Nephrotoxic injury - Acute Glomerulonephritis - Malignant HTN - Systemic Lupus - Acute Tubular Necrosis
32
Postrenal causes of AKI? | Backflow; Obstruction
-Build-up of pressure which leads to ↘️ in function & damage. Ex: BPH, Cancer, Trauma
33
Phase 1 of AKF?
- Begins at time of insult. - UO<20mL/hr - Pt may not notice - not excreting H+
34
Phase 2 of AKF (Oliguria phase)?
- Kidneys are "Insulted" - Azotemia apears 1-7days - UO< 400mL/24hr - lasts 10-14 days - GFR fixed
35
Phase 3 of AKF (Diuretic phase)?
- The "Back Up Plan" - ↗️ OU & Dilute urine - lasts 1-3 weeks - Renal tubules begin to heal
36
Phase 4 of AKF (ESRD "or" Recovery phase)?
- Lab values return to normal - GFR normalizes - Extremely vulnerable - 12 months until stabilization
37
Stage 1 of Chronic Kidney Disease (CKD)?
GFR>/=90 Normal Kidney function, urine & albumin point to kidney disease - Tx: Observe, control BP, restrict proteins, watch infection, hydrate well - Goal: to stay in stage 1 or 2 through BP control, BS control, weight loss, etc.
38
Stage 2 of Chronic Kidney Disease (CKD)?
GFR= 60-89, mildly reduced kidney function, urine or other abnormalities point to kidney disease -Tx: BP control, monitoring, find out why, watch weight for water retention
39
Stage 3 of Chronic Kidney Disease (CKD)?
GFR= 30-59, moderately reduced kidney function | -Control BP, probable diagnosis of CKD if not already, watch weight for water retention
40
Stage 4 of Chronic Kidney Disease (CKD)?
GFR= 15-29, severely reduced function | -Planning for ESRD, RRT
41
Stage 5 of Chronic Kidney Disease (CKD)?
GFR= 14 or less, very severe or ESRD, uremic syndrome develops -Tx choices for ESRD, RRT or transplant
42
3 Conditions Caused by Chronic Kidney Disorder (CKD)?
- Metastatic Calcification: deposits of calcium salts in otherwise normal tissue. - Osteomalacia: Softening of bone via Vit D deficiency. - Osteitis Fibrosa: excessive parathyroid hormone production, in which bone tissue becomes soft and deformed.
43
``` Jumpstarting the kidneys... H:_______ D:_______ T:_______ V:_______ ```
- Hyperkalemia; address it. - Dopamine; ↗️ Renal Perfusion/MAP (Vasodialates intrarenal/ Vasoconstricts Periph) - Total Vol; Fluid challenge test; admin 500-1000 bolus to flush out kidney to try and jump-start it. - Volume Excess: Pull out spare fluid; Mannitol/Lasix/Bumex
44
___________ is the most common cause of death in those with AKI.
Infection (UTI/Respiratory)
45
Nutrition in those with AKI?
- Proteins limited: 0.8-1.0gm/kg during to minimize protein breakdown & prevent accumulation of toxic end products - Spare proteins: LIMIT NUTS, BEANS, MEATS b/c break down into urea nitrogen - Increase carbohydrates, fats, essential amino acids to spare proteins - Restrict: Na+, K+, PO4 depending on the serum levels - No salt substitute d/t potassium (watch WHITE POTATOES, BANANAS, CANTALOUPES, GRAPES d/t potassium - Pt NEEDS Calcium: DAIRY! - Reduce metabolic state through: rest, cluster activities, calm, avoid infection, physiological support
46
BUN DILANTIN THEOPHYLLINE
10 - 20
47
SERUM CREATINE
0.5 - 1.2
48
pH pCO2 HCO3 pO2
7.35-7.45 35-45 21-28 80-100
49
Glucose Specific gravity BUN Serum creatinine
70-110 1.005-1.03 10-20 0.5-1.2