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NUR 213 > Exam 2 > Flashcards

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.

A

Kidneys

23
Q

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

A

Excretion

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

A

Secretion

25
Q

__________: end product of protein breakdown (BUN)

Normal Level?

A
  • Urea

- 10-20

26
Q

____________: end product of muscle breakdown ←good indicator of kidney function; Best indicator of AKI.

Normal Level?

A
  • Creatinine

- 0.6-1.3

27
Q

________: urine output <100ml/day

________: build up of nitrogenous wastes

A
  • Oliguria
  • Anuria
  • Azotemia (Uremia when it affects other systems)
28
Q

_________: rate at which kidneys are filtering blood.

Normal Levels?

A
  • GFR

- 125mL/min

29
Q

________: max concentrating ability of kidne; should flux throughout the day.

Normal Levels?

A

-1-1.03

30
Q

Prerenal causes of AKI?

Systemic Causes

A
  • Hypovolemia
  • ↘️ CO (Renals need 25% of CO)
  • ↘️ Periph Vascular Resistance
  • ↘️ Renal Perfusion
31
Q

Intrarenal Causes of AKI?

Damage to renal tissue

A
  • Prolonged prerenal ischemia**
  • Nephrotoxic injury
  • Acute Glomerulonephritis
  • Malignant HTN
  • Systemic Lupus
  • Acute Tubular Necrosis
32
Q

Postrenal causes of AKI?

Backflow; Obstruction

A

-Build-up of pressure which leads to ↘️ in function & damage.

Ex: BPH, Cancer, Trauma

33
Q

Phase 1 of AKF?

A
  • Begins at time of insult.
  • UO<20mL/hr
  • Pt may not notice
  • not excreting H+
34
Q

Phase 2 of AKF (Oliguria phase)?

A
  • Kidneys are “Insulted”
  • Azotemia apears 1-7days
  • UO< 400mL/24hr
  • lasts 10-14 days
  • GFR fixed
35
Q

Phase 3 of AKF (Diuretic phase)?

A
  • The “Back Up Plan”
  • ↗️ OU & Dilute urine
  • lasts 1-3 weeks
  • Renal tubules begin to heal
36
Q

Phase 4 of AKF (ESRD “or” Recovery phase)?

A
  • Lab values return to normal
  • GFR normalizes
  • Extremely vulnerable
  • 12 months until stabilization
37
Q

Stage 1 of Chronic Kidney Disease (CKD)?

A

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
Q

Stage 2 of Chronic Kidney Disease (CKD)?

A

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
Q

Stage 3 of Chronic Kidney Disease (CKD)?

A

GFR= 30-59, moderately reduced kidney function

-Control BP, probable diagnosis of CKD if not already, watch weight for water retention

40
Q

Stage 4 of Chronic Kidney Disease (CKD)?

A

GFR= 15-29, severely reduced function

-Planning for ESRD, RRT

41
Q

Stage 5 of Chronic Kidney Disease (CKD)?

A

GFR= 14 or less, very severe or ESRD, uremic syndrome develops
-Tx choices for ESRD, RRT or transplant

42
Q

3 Conditions Caused by Chronic Kidney Disorder (CKD)?

A
  • 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
Q 
Jumpstarting the kidneys...
H:\_\_\_\_\_\_\_
D:\_\_\_\_\_\_\_
T:\_\_\_\_\_\_\_
V:\_\_\_\_\_\_\_
A
  • 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
Q

___________ is the most common cause of death in those with AKI.

A

Infection (UTI/Respiratory)

45
Q

Nutrition in those with AKI?

A
  • 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
Q

BUN
DILANTIN
THEOPHYLLINE

A

10 - 20

47
Q

SERUM CREATINE

A

0.5 - 1.2

48
Q

pH
pCO2
HCO3
pO2

A

7.35-7.45
35-45
21-28
80-100

49
Q

Glucose
Specific gravity
BUN
Serum creatinine

A

70-110
1.005-1.03
10-20
0.5-1.2

NUR 213 (4 decks)

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