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Therapeutics > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

Oral Pharyngeal Airway (OPA): Indications

A

Tongue and/or epiglottis fall back against the posterior pharynx in anesthetized on unconscious patients

Patients who do not have a cough, gag, or swallow reflex

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2
Q

Oral Pharyngeal Airway (OPA): Contraindications

A

Person who is conscious and intact cough, gag, or swallow reflex

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3
Q

Oral Pharyngeal Airway (OPA): Measurement

A

Measure from corner of patient’s mouth to the angle of the jaw

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4
Q

Oral Pharyngeal Airway (OPA): Assessment after placement

A

Feel for breathing and breath sounds every 2-4 hours and PRN

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5
Q

Naso Pharyngeal Airway (NPA): Indications

A

Patients with intact, weak cough and gag reflex who require frequent suctioning but unable to clear secretions

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6
Q

Naso Pharyngeal Airway (NPA): Contraindications

A

Patients who are anticoagulated, have low platelet count, bibasilar skull fracture, basel formities, facial trauma, sometimes children because of risk of epistaxis

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7
Q

Naso Pharyngeal Airway (NPA): Complications

A

Trauma to nares, airway obstruction, laryngospasm, gagging and vomiting

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8
Q

Naso Pharyngeal Airway (NPA): Measurement

A

Measure from nares to the tragus of the ear

Circumference smaller than diameter of nostril

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9
Q

Naso Pharyngeal Airway (NPA): Assessment after placement

A

Feel for breathing
Check posterior airway
Auscultate lung sounds
Remove and replace with a new NPA every 8 hours and examine nasal mucosa and nares

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10
Q

Most effective method to clear the airway

A

Coughing and deep breathing

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11
Q

Incentive spirometry use

A

To promote deep breathing and good inspiratory effort

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12
Q

Peak flow measurements

A

Provide baseline of best maximal expiration to evaluate airway diameter

To determine meds to minimize further asthma attacks

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13
Q

Postural drainage and cupping: Contraindications

A

Head injuries, intracranial pressure, COPD, history of cardiac disorders

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14
Q

Resuscitation breathing bags: indications

A

Hypoxia, decreased O2 sats that don’t recover with increasing oxygenation

Hypoventilation (RR

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15
Q

BVM ventilation

A

Deliver breaths over 1 second

Deliver one every 6-8 seconds or 8-10 breaths per minute

Sync with patient effort to breathe, or inbetween patient’s breaths

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16
Q

BVM ventilation oxygen flow

A

15 L for teens and adults

10 L for infants and children

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17
Q

Pleural space: definition

A

Lies between the parietal and visceral pleura of the chest wall and lung

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18
Q

Inspiration

A

Passive, involuntary activity

Intrapulmonary pressure is lower than atmospheric pressure, causing air to flow into the lungs

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19
Q

Expiration

A

Intrapulmonic pressure is greater than atmospheric pressure, causing the air to flow fro the lungs and out to the atmosphere

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20
Q

Functions of surfactant

A

Increase compliance
Repvent atalectasis
Reduce fluid accumulation thereby keeping surface dry

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21
Q

Pneumothorax: definition

A

Air in pleural space

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22
Q

Types of pneumothorax

A

Spontaneous
Closed
Open

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23
Q

Pneumothorax: signs and symptoms

A

Signs: tachypnea, tachycardia, decreased or absent breath sounds over affected area

Symptoms: pain which worsens with inspiration, dyspnea, cough, sudden stabbing pain on the side of the pneumothorax

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24
Q

Spontaneous pneumothorax: causes

A 
Excessive coughing
Smoking
Tall, thin men
COPD and CF
Ruptured pulmonary blebs
High impact stress from sports
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25
Q

Spontaneous pneumothorax: treatments

A

High flow O2
Chest tube
High fowler’s position

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26
Q

Closed pneumothorax: causes

A

Air enters the pleural space from within the lung

Rib fracture that punctures the lung

Result of a medical procedure such as insertion of a central line or cardiac pacemaker wires via the subclavian vein

Blunt trauma

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27
Q

Open pneumothorax: causes

A

Air enters the pleural space from the atmosphere

Penetrating trauma

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28
Q

Hemothorax: causes

A

Blood in the pleural space

Thoracic or heart surgery

Blood clotting disorder

Pulmonary infarction

Lung cancer

Tear of a blood vessel when placing a central venous catheter

Sever hypertension

TB

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29
Q

Hemopneumothorax

A

Collection of blood and air in the pleural space

Requires to chest tubes (one for air, one for blood)

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30
Q

Tension pneumothorax: definition

A

Air leaks into the pleural space through a tear in the lung and has no way to escape

With each breath, air accumulates in the pleural space, increasing positive pressure which compresses the lung and shifts the mediastinum to the unaffected side of the chest

Venous return and cardiac output ar edecreased

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31
Q

Tension pneumothorax: treatment

A

Chest tube will NOT prevent this

Thorocostomy

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32
Q

Tension pneumothorax: complications and signs/symptoms

A

Unaffected lung may collapse –> life threatening emergency

Rapid, labored respirations
Tachycardia
Cyanosis
Hypoxemia
Sudden chest pain that extends to the shoulders
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33
Q

Pleural effusion: causes

A

Excess fluid in the pleural space

Left ventricular failure, pulmonary embolism, pneumonia, cancer, tumors, complications of surgery, previously placed chest tube is removed prematurely

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34
Q

Chylothorax: causes

A

Accumulation of lymphatic fluid in the pleural space

Chest trauma, expanding tumor, surgery on mediastinal structures

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35
Q

Empyema

A

Purulent drainage of pus from an infection such as pneumonia or lung abscess

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36
Q

Empyema: signs and symptoms

A

Cough, chest pain, SOB, fever

37
Q

Empyema: treatment

A

Thorocentesis “tap the lung”

38
Q

High chest tube placement

A

2nd intercostal space

39
Q

Low chest tube placement

A

5th or 6th intercostal spaces

40
Q

Suction control chamber

A

Dry suction control

Automatic control valve inside the regulator adjusts to the patient and suction source

Expansion of the red bellows helps determine whether or not suction is operating

41
Q

Suction tube

A

NEVER kink or clamp

May be milked w/o order to remove clots

42
Q

Collection chamber

A

Fluid/blood drains here
Checked every hour initially
Notify provider if there is >100mL/hr drainage

43
Q

Water seal chamber: normal intermittent bubbling

A

Normal if chest tube drainage unit is on suction

Caused by fluid being displaced by air or when there is an air leak in the pleural space, coughing or exhaling

44
Q

Water seal chamber: large amount of bubbling

A

Usually caused by a large patient leak or a leak in the system

45
Q

Water seal chamber: unexpected absence of bubbling

A

May be a blockage in the tubing

Verify tubing is attached, water level is filled to prescribed level and check wall suction

46
Q

Tidaling

A

Fluctuations in fluid level indicates pressure changes in pleural space

Fluctuates up with inspiration, down with expiration

Diminishes as lung re-expands

47
Q

Leaks

A

Evidenced by continuous rapid bubbling in the water seal chamber

48
Q

Jackson Pratt

A

Use to remove fluids from a surgical area

Removes fluids by creating suction in the tube/bulb. The bulb expands as it fills with fluid

Removed when

49
Q

Penrose

A

Open drainage system

Acts like a straw to pull fluids out of the wound and rain outside the wound

50
Q

Hemovac

A

Portable wound suction device that is compressed to provide gentle suction

Creates a negative pressure of ~45mmHg

Closed drainage system

51
Q

VAC device

A

Negative pressure wound therapy

Area covered with a transparent adhesive membrane

Foam placed within wound area

Causes blood vessels to dilate and greater cell proliferation

Enhances the formation of granulation tissue

52
Q

P wave represents…

A

atrial depolarization

53
Q

QRS complex represents…

A

ventricular depolarization

54
Q

R wave represents…

A

ventricular repolarization

55
Q

U wave represents…

A

repolarization of Purkinje fibers

May indicate an old MI

56
Q

PR interval normal duration

A

0.12-0.20 seconds

57
Q

QRS complex normal duration

A

= 0.12 seconds

58
Q

QT interval normal duration

A

0.35-0.40 seconds

59
Q

ST interval

A

isoelectric, above or below isoelectric

60
Q

TP interval

A

isoelectric

61
Q

PP interval signifies…

A

atrial rhythm and rate

62
Q

RR interval signifies…

A

ventricular rhythm and rate

63
Q

Five steps to analyze a strip:

A
  1. Determine regularity
  2. Determine rate
  3. Presence and quality of P waves
  4. PR interval consistency
  5. QRS duration
64
Q

Sinus Bradycardia: description

A

Rate

65
Q

Sinus Bradycardia: causes

A

Athletic rate, hypoxia, hypothermia, drug reactions, excessive vagal stimulation

66
Q

Sinus Bradycardia: management

A

Depends on cause: atropine, dopamine, epinephrine

67
Q

Sinus Bradycardia: S&S

A

May be asymptomatic; syncope, dizziness/weakness, hypotension, diaphoresis, SOB, chest pain

68
Q

Sinus Tachycardia: description

A

Rate > 100

69
Q

Sinus Tachycardia: causes

A

Exercise, infection, hypovolemia, hypoxia, MI, increased tissue oxygen demand, fever, vagal inhibition, stimulant meds (catecholamines, atropine, caffeine, alcohol, nicotine, aminophylline, thyroid meds)

70
Q

Sinus Tachycardia: management

A

Depends on cause

71
Q

Sinus Tachycardia: S&S

A

May be asymptomatic; fatigue, weakness, SOB, orthopnea, neck vein distension, decrease O2 sat, decreased BP, restlessness, anxiety, impaired renal function

72
Q

PAC’s: description

A

Occur when atrial tissue becomes irritable

Ectopic focus is fired before the next sinus episode is due

73
Q

PAC’s: causes

A

Stress, fatigue, anxiety, infection, caffeine, meds, ischemia, electrolyte imbalance, nicotine, alcohol

74
Q

PAC’s: management

A

If symptomatic, treat with anti-arrhythmic drugs

75
Q

Atrial Fibrillation: description

A
  1. Irregular rhythm and rate
  2. F waves
  3. Indeterminate PRI
  4. Most common dysrhythmia
76
Q

Atrial Fibrillation: causes

A

Hypertension, ischemic, rheumatic, mitral, myocardial and pericardial disease, thyrotoxicosis, aging

77
Q

Atrial Fibrillation: risks

A

Blood pooling may lead to embolic event

Decreased CO

78
Q

Atrial Fibrillation: S&S

A

Decreased BP, SOB, fatigue, angina, syncope, inconsistent peripheral pulses

79
Q

Atrial Fibrillation: management

A
  1. Drugs to slow conduction (amiodarone) or calcium channel blockers (cardizem)
  2. Anticoagulation to decrease risk of thrombus formation
  3. Synchronized cardioversion
80
Q

Atrial Flutter: description

A
  1. Regularly rhythm
  2. Variable rhythm
  3. F waves
81
Q

Atrial Flutter: causes

A

Hypertension, ischemic, mitral, myocardial and pericardial disease, aging

82
Q

Atrial Flutter: management

A
  1. Drugs to slow conduction

2. Synchronized cardioversion

83
Q

Atrial flutter: S&S

A

Palpitations, weakness, fatigue, SOB, nervousness, anxiety, syncope, angina, signs of heart failure, shock

84
Q

Supraventricular Tachycardia: description

A
  1. Regular or irregular rhythm
  2. Elevated rate
  3. No P wave
85
Q

Supraventricular Tachycardia: causes

A

Hypoxia, stimulant drugs, ischemia, mitral valve disease

86
Q

Supraventricular Tachycardia: management

A

Vagal maneuvers, antidysrhythmic drugs, synchronized cardioversion, ablation,

87
Q

Supraventricular Tachycardia: S&S

A

Same as Atrial Flutter: palpitations, weakness, fatigue, SOB, nervousness, anxiety, syncope, angina, signs of heart failure, shock

88
Q

Tracheostomy: Indications

A

Bypass severe recurrent upper airway obstruct: (repeated aspiration, anatomic narrowing/stenosis, tracheal malacia); Prolonged mechanical ventilation after failure to wean/extubate; facial trauma, inability to remove secretions from airway; head and neck surgery

89
Q

Tracheostomy: Risks/Complications

A

Bleeding, infection, erosion of mucosal lining with granuloma formation, compromised breathing, plugging with mucus/secretions, tracheal esophogeal fistula, accidental decannulation, “false pocket” when reinserting tube, subcutaneous emphysema/crepitus

Therapeutics (9 decks)

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