FISDAP OKC STUDENT Missed Test Questions Flashcards
Managing Chronic Bronchitis and Emphysema
Specifically know what is the initial treatment of a pt with Chronic Bronchitis
The goal of treating emphysema or chronic bronchitis is to relieve hypoxia and reverse any bronchoconstriction.
Remember that these pts may be dependent on a hypoxic respiratory drive (their decreased levels of O2 stimulate respiration actions instead of a high CO2).
First treat with establishing an airway and then positioning them in a seated or semi-seated position to help the accessory muscle use.
Low flow O2 with a NC or CPAP with a peep of 10cm/H2O should be used and if medication is needed you may use:
- Bronchodilator (albuterol, levalbuterol, or metaproterenol)
- Ipratropium Bromide (Atrovent) to dry secretions (this is an anticholinergic drug)
- Corticosteroids for longer lasting relief
Indications for CPAP
Remember CPAP can only be used on a pt who is alert and able to follow commands.
CPAP helps to keep the upper airway structures open, which is especially beneficial for people with sleep apnea caused by a relaxation of upper airway structures that leads to blockage
It is helpful to reduce the work of breathing for pts with COPD or CHF, as well as infants that may have bronchiolitis or pneumonia. This can also be helpful for pts who are breathing too fast.
Physiology of the Pulmonary System
The upper airway parts are:
- Nasal Cavity
- Pharynx (Naso, oro, and Laryngopharynx)
- Larynx (Has 3 pieces of cartilage top to bottom is thyroid cartilage (arytenoid), cricoid (corniculate), and epiglottis (cuneiform); there are 2 folds within the larynx the Vestibule (false vocal chords) and the lower pair that are the True vocal chords)
The lower airway parts are:
- Trachea (composed of C shaped cartilaginous rings carina, has cilia to move particles up, stimulation will cause coughing reflex, but damage from things like smoking can reduce this reflex)
- Bronchi (L.&R. mainstem bronchi (R. stem is more straight while the left angles off), Lobar bronchi, segmental bronchi, bronchioles)
- Alveoli (from bronchioles to alveolar ducts, to alveolar sacs, to alveoli; respiratory membrane is made up of alveolar lining, supportive tissue, and the capillaries; physiologic shunt refers to blood that passes by alveoli without gas exchange b/c not all alveoli are recruited at the same time)
- Lungs (R. lung has 3 lobes, L. lung has 2 lobes; covered by connective tissue called pleura which attaches at the Hilum; the visceral pleura covers the lungs and does not have nerve fibers, the parietal pleura lines the thoracic cavity and has nerve fibers)
Medulla (lower part of brain stem) controls ventilation!
Signs and symptoms of Pneumonia
- Pneumonia is an infection of the lungs, bacterial or viral. It is primarily a ventilatory disorder caused by inflammation and fluid accumulation in the alveoli.
- At high risk include those with immunodeficiencies, alcoholics, smokers, and exposure to cold temps; basically anything that defects mucus production and/or ciliary action
- Pt will show signs and symptoms of:
Appear ill, gen weakness, malaise
Fever/Chills
Deep, PRODUCTIVE cough with yellow/brown sputum that can sometimes be tinged with blood
Pleuritic chest pain
Tachypnea/Tachycardia
Crackles (rales) but wheezing or rhonchi can sometimes be heard
- Management: Place in position of comfort Supp O2, vent or intubate as needed IV access and fluids as needed Beta agonist Antipyretic
Signs and Symptoms of Pulmonary Edema
- Shortness of breath
- cough, with pink frothy sputum
- decreased exercise tolerance
- chest pain
- excessive sweating
- anxiety and restlessness
- feelings of suffocation
- pale skin
- Crackles (rales)
- rapid or irregular heart rhythm (palpitations)
- fatigue
- nocturnal dyspnea
- pedal or leg edema
- rapid weight gain from excess fluids
Suctioning a pt with trismus
You just RSI them
Treating a pt with a stoma
The most common problem with them is a mucus plug forming in the internal cannula b/c of a reduced coughing reflex. To solve this just remove the internal cannula and clean it, DO NOT REMOVE THE EXTERNAL CANNULA.
If the external cannula becomes dislodged you can use the largest size ET tube that will fit fast the stoma, insert 1-2cm past the end and inflate the tube, ensuring comfort and patency.
If bleeding at a stoma site occurs it is not a big deal if it is external but internal bleeding requires transport.
Some other questions that have popped up is how to ventilate with a stoma in place. Just remember that the mouth and nose must be closed in order to ventilate through one and it is best done with a Pediatric mask but an ADULT bad.
Identifying and treating v-tach
Rules for V-Tach: Regularity - Regular Rate - 100+ P waves - none PRI - none QRS - 0.12+ (wide)
ACLS:
- Heart rate must be above 150 before major treatment
- IF SYMPTOMATIC:
a) Synchronized cardiovert (consider sedation but do not prolong care if it is needed)
b) if regular and NARROW complex, consider adenosine (6,12,12) - IF NOT SYMPTOMATIC: IS IT WIDE?
a) if YES then, Adenosine (6,12,12)only if also regular and monomorphic; next move to antiarrhythmic procainamide IV (20-50mg/min), Amiodarone (150 over 10min), or Sotalol (100mg over 5 minutes), next move to expert consultation
b) if NO then, vagal maneuvers (if regular), then Adenosine (if regular), then B-Blocker or CCB, then expert consultation
Anatomy and Physiology of the Cardiovascular System
Anatomy and Physiology of the Cardiovascular System on pg 53 vol.3
Identify and treat SYMPTOMATIC Bradycardia
RULES: (if sinus) regularity - regular rate - less than 60 P waves - 1 per QRS PRI - 0.12-0.20sec QRS - less than 0.12sec
ACLS:
- Must be under 50bpm
- SYMPTOMATIC?
- if NO then monitor and observe
- if YES then Atropine (1mg every 3-5min up to 3mg); if Atropine is ineffective then move to TCPacing and/or dopamine (5-20mcg/kg/min) or epinephrine infusion (2-10mcg/min)
Medication for Cardiac Arrest
- Epinephrine 1mg every 3-5min (remember only epi for asystole or PEA)
- Amiodarone 300mg then 150mg, max 450mg
- Lidocaine 1-1.5mg/kg then 0.5-0.75mg/kg for 2nd dose
Risk Factors for Strokes
From Book:
- Hypertension (the biggest one)
- A-Fib (second biggest one)
- Middle aged and older patients due to disability
- Atherosclerosis
- Heart disease
From Online:
- Diabetes
- Smoking
- Birth Control Pills
- History of TIAs
- High counts of RBCs, cholesterol, or lipids
Signs and Symptoms of a stroke
- Facial Drooping
- Headache
- Confusion and agitation
- Dysphasia (difficulty speaking)
- Aphasia (cannot speak)
- Dysarthria (impairment of tongue and muscles essential for speech)
- Vision Problems
- Hemiparesis (one sided weakness)
- Hemiplegia (paralysis of one side)
- Paresthesia (numbness or tingling)
- Inability to recognize by touch
- Gait disturbances
- Dizziness
- Incontinence
- Coma
Treating a pt with unstable angina
Angina = “pain in the chest”
Occurs when the heart’s blood supply is transiently exceeded by myocardial O2 demands. This can result from atherosclerosis (mostly) or Prinzmetal’s angina (vasospastic angina).
Stable angina occurs during activity when the O2 demands of the heart are increased, this is often precipitated by physical or emotional stress and responds readily to treatment.
Unstable angina occurs at rest and may not readily respond to treatments. B/c this is often caused by severe atherosclerosis it is often also called Preinfarction angina.
To treat angina, place in a position of rest and administer O2, then without delay in transport get a 12 lead and start an IV. Next administer Nitro as this will decrease the heart’s workload and may have some dilatory effects on the coronary arteries. IF the pts pain persists after Nitro then consider using a CCB as a vasodilator. If chest pain still persists after Nitro and a CCB then try Morphine or Fentanyl. Aspirin may also be a good idea in the thoughts of reducing any damage by the possibility of an MI especially if CP is refractory to treatment.
If the Angina is new in onset or persists after O2 and Nitro then the pt needs to be immediately transported.
How to communicate with a pt that has a language barrier
- Never assume the person lacks intelligent
- Do not rush the pt or predict the answer
- Try to form questions that require a short, direct answer
- Prepare to spend extra time during your interview
- If you did not understand the pt politely ask them to
repeat the question