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PA 2 (RESP 262) > General review > Flashcards

General review Flashcards

1
Q

What basic examinations and physical examinations are done as part of a neurological assessment?

A

Pupils

Reflexes/posturing

LOC - GCS and/or sedation assessment (RASS)

Delirium Screening (Cam-ICU)

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2
Q

How is a critically ill patients LOC consciousness best evaluated?

A

The level of stim required is the guide:

  1. Full consciousness - pt alert, attentive, follows commands etc.
  2. lethargy - pt drowsy but awakens to stimulus
  3. Obtundation - pt difficult to rouse, needs constant stimulus
  4. stupor - pt rouses to vigorous and constant stimulus
  5. coma - pt does not respond to stimulus
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3
Q

How is the GCS level modified when the patient is intubated?

A

Verbal is eliminated and a “T” is charted to indicate a tube in place.

Max GCS score than changes to 11T

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4
Q

A patient has a cervical spine fracture at C4 w/spinal cord involvement.

what is the affect on the respiratory system?

A

Can result in partial or complete paralysis of the diaphragm

  • Pts with high cervical cord lesions seldom survive w/o immediate ventilatory support.
  • Phrenic nerve (C3 to C5) control the diaphragm.
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5
Q

How can motor strength be assessed in an unconscious patient?

A

Noxious stimulus - a test to elicit withdrawal from pain.

i.e eternal rub, trap squeeze, nail bed pressure etc.

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6
Q

what brainstem reflexes do RTs typically assess?

which cranial nerves are responsible for these?

A

Gag reflex (9)

Cough (10)

Pupils (2 and 3)

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7
Q

Define delirium

A

An acutely disturbed state of mind typically resulting in confusion, illusions, hallucinations, and incoherence of thought.

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8
Q

What does delirium in the ICU patient indicate?

“Think delirium” mnemonic

A

Presence of a underlying medical problem

T: Toxic situation
H: Hypoxemia
I: Infection/Sepsis
N: Non-pharmco interventions
K: Potassium/Electrolyte problem

D: Drugs
E: Electrolyte
L: Lack of drugs
R: Infection
I: Intracranial
U: Urinary retention
M: Myocardial

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9
Q

ABCDE protocol for recognition and management of traumatic head injury

A

ABC - awakening and breathing coordination

D - delirium management/interventions

E - early exercise and mobility

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10
Q

Describe why spontaneous awakening trials are coordinated with respiratory care?

A

promotes earlier extubation

fewer days in hospital

less time in coma

reduced exposure to benzos

forces RN and RT to communicate

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11
Q

how do you calculate cerebral perfusion pressure (CPP)?

A

CPP = MAP - ICP

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12
Q

Describe the purpose of jugular venous oxygen saturation monitoring?

A

aproximates global cerebral oxygenation

  • monitoring in TBI
  • can provide early detection of cerebral ischemia
  • normal = 50-75%
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13
Q

Describe the purpose of Licox monitoring

A

measure brain tissue oxygenation

  • monitor is connected to a catheter that is inserted in brain tissue
  • measures O2 and temp
  • normal 25-35mmHg
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14
Q

How does Licox monitoring differ from SjvO2 monitoring?

A

-SjvO2 reflects overall brain oxygenation as a whole.

-PbtO2 (licox) reflects oxygenation in the area localized around where the catheter is inserted.

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15
Q

Left off at 17 (prelab 2 or 3 review)

A
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16
Q

risk factors if MAP drops below the safe threshold (and what is it)

A

Ischemia and infarction

  • MAP < 60mmHg is dangerous.
  • tldr; insufficient blood flow or restriction.
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17
Q

Where does the apneustic and pneumotaxic Centre reside?

A

The pons (in the brainstem)

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18
Q

Where does the dorsal and ventral groups reside?

A

Medulla (brainstem)

  • primary control of breathing
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19
Q

What other factor other than the medulla and pons affects control of respiration?

A

Central and peripheral chemoreceptors.

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20
Q

What does acronym “BMOS” mean?

A

Bagger, mask, OPA, Syringe.

Describes the bare minimum to have at the bedside during transfer?

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21
Q

What do the following ICP values/ranges indicate?

  1. 10-15
  2. 15-20
  3. 30-35
  4. 40-50
A
  1. Normal ICP = 10-15
  2. Capillary bed compression/microcirculation compromised = 15-20
  3. Venous drainage impeded = 30-35
  4. 40-50 = cerebral perfusion not possible
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22
Q

Elements that should be assessed on a ETT (artificial airway)

A
  1. size/type
  2. Depth (confirm w/CxR)
  3. position at teeth
  4. Cuff pressure
  5. Inspiration (monitor ventilation w/etCo2)
  6. Skin necrosis (irritation)
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23
Q

Elements that should be assessed on a trach (artificial airway)

A
  1. size/type
  2. Cuff/Cuff pressure
  3. Secretions/discharge
  4. securement
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24
Q

What maintenance is typically required of an ETT during a routine assessment?

  • A tracheostomy tube?
A
  1. Oral care/trach care
  2. Reposition of ETT (side to side)
  3. suction
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25
Q

What is the importance of monitoring/maintaining cuff pressures of airways:

  1. Too high?
  2. Too low?
A
  1. Cuff pressure too high =Tracheal necrosis/damage
  2. Cuff pressure too low = Aspiration and increased risk of VAP
26
Q

What are some complications/considerations of NIV on pts?

A
  1. mask fit/leak
  2. Pt comfort
  3. skin necrosis/irritation
27
Q

What elements should be considered when evaluating bronchopulmonary hygiene of a pt?

A
  1. color/consistency
  2. Pt tolerance
  3. Cough effectiveness (clear secretions)
  4. Total
  5. Trends (q24hr)
28
Q

How does PPV impact V/Q matching?

A

Worsens it

  • Increases intrapulmonary shunt and deadspace
  • perfusion and ventilation are gravity dependent,
29
Q

How can PPV impact pulmonary vascular resistance (PVR)?

A

Increases/decreases intrathoracic pressure altering venous return, which affects the volume of blood in the RV

  • On inspiration: Increase PVR by increasing R.ventricle afterload
  • On expiration: decrease PVR because of decreased PVR (or over distension can decrease perfusion)
30
Q

How does PPV impact venous return and CO?

A
  1. Venous return generally decreases which can decrease CO
  2. BP will decrease as well
31
Q

CaO2 and CvO2 formula

A
  • CaO2= (Hb * 1.34ml/g *SaO2) + (PaO2 x 0.003)
  • CvO2= (Hb1.34 ml/gSvO2) + (PvO2 * 0.003)
32
Q

what types of arrhythmias the following electrical therapies are used to treat:

  1. Defibrillation
  2. Cardioversion
  3. Pacemakers
A
  1. Pulseless V-Tach or V-fib
  2. Unstable tachyarrhythmias
  3. Unstable bradyarrythmias
33
Q

When does the intraaortic balloon pump inflate and deflate on?

A
  1. Inflates on diastole
  2. Deflates on systole
34
Q

What are physiological effects of the intraaortic balloon pump during diastole

A

Inflation causes blood retention in proximal vascular compartments which result in increased diastolic pressures and dramatic increase of myocardial perfusion.

35
Q

What are physiological effects of the intraaortic balloon pump during systole

A
  • Deflation causes sudden volume and pressure drop in the aorta = decreased afterload and decreased O2 demand on the left ventricle.
  • Allows for further emptying of the LV which equates to a higher SV -> increasing CO
  • Less volume left causes a decreased preload therefore a decrease in PAWP which can also lessen any edema
  • The increased SV and CO are also equating to
    a longer diastolic period which aids myocardial perfusion
36
Q

Where are Alpha 1 receptors located and what effects do they have?

A
  1. Peripheral vasculature
  2. Causes vasoconstriction:
  • Increases SVR, BP and Myocardial O2 demand
  • Levophed, Epi, dopamine (high dose), phenylephrine (Neo-Synephrine )
37
Q

Where are Beta 1 receptors located and what effects do they have?

A
  1. Located in heart (sinus nodes, ventricles)
  2. Results in positive inotropic, dromotropic and chronotropic effect
  • Increases HR, Stroke volume, and increased myocardial irritability
  • Dopamine (moderate dose), norepi, epi, dobutamine
38
Q

Where are beta 2 receptors located and what effects do they have?

A
  1. heart, vascular beds, and bronchial smooth muscles
  2. results in bronchodilation + slight peripheral vasodilation
  • Decreases SVR and BP
  • Norerpi (only affects vasculature, Epi)
39
Q

3 drugs used to treat hypotension due to a distributive shock

A
  1. Norepi
  2. Dopamine
  3. phenylephrine
40
Q

non-adrenergic drug that increases SVR

A

Vasopressin (antidiuretic)

41
Q

Two drugs that are both a positive inotrope and a vasopressor

A

Norepi and dopamine

42
Q

What drug is used to manage a hypertensive crisis?

A

Nitroglycerin and sodium nitroprusside (nipride)

43
Q

What are the indications for anticoagulation?

A
  1. Prevention and treatment of venous or arterial thromboembolism and PE
  2. Atrial fibrillation
  3. disseminated intravascular coagulation
44
Q

Difference between and anti-coagulant and a thrombolytic?

A
  1. Anticoagulant: prevents the formation of a fibrin clot and further clot formation in existing thrombi
  2. Thrombolytic: lyse formed thrombi by degrading fibrin; converts plasmogen -> plasmin -> degrades fibrin clot aka clot busters
45
Q

when are anti-platelet drugs indicated

A

Antiplatelets inhibit the action of platelets in the clotting mechanism.

  • Decrease risk for thrombosis, preventing recurrent transient ischemic attacks or stroke; prophylaxis of thrombus formation and MI.
46
Q

Which of the following is true in regard to PPV?

a. Increased CVP

b. Increased ICP

c. Decreased cardiac output (CO)

d. decreased urine output (u/o)

e. all of the above

A

E. All of the above

47
Q

VILI:

Difference between atelectrauma and volutrauma

A
  1. Volutrauma is caused by excessive tidal volumes that lead to overdistention (stretch) or rupture of the alveoli.
  2. Atelectrauma is caused by repeated collapse and reopening of poorly aerated alveoli.
48
Q

What is a normal static compliance range?

A

60-100 cmH2O

needs checking

if it comes down to 40-60, choose it given that dynamic is probably 30-50

49
Q

what is pressure equilibrium on a mechanical vent?

A

pressure equilibrium refers to the point during inspiration when the pressure inside the patient’s airways, called airway pressure (Paw), is equal to the pressure delivered by the ventilator, called peak inspiratory pressure (PIP).

  • At this point, the airflow stops and the lung is fully inflated.
50
Q

why does total cycle time on a vent decrease when the respiratory rate of the patient increases?

A

When the respiratory rate (RR) of the patient increases, each breath takes less time to complete, which means that TI and TE are both shorter. As a result, the TCT decreases.

51
Q

What are the mechanisms of action for atropine and adenosine?

A
  1. Atropine increases heart rate by blocking the action of acetylcholine.
  2. Adenosine decreases heart rate by activating adenosine receptors and reducing the conduction of electrical impulses through the heart.
52
Q

Does the neurotransmitter acetylcholine (ach) cause vasoconstriction or vasodilation?

A

Vasodilation

Example: Nitric oxide

53
Q

How does a increase in PEEP or Ti improve oxygenation?

A

PEEP or Ti increases mean airway pressure (MAP)

  • More MAP means there is more surface area for gas exchange.
54
Q

How does Co-oximetry differs from pulse oximetry?

A

Cooximetry differs in 2 ways.

  1. requires a blood sample
  2. measures more wavelength values than a standard pulse ox
55
Q

If PaCO2 is 15 mmHg greater than PETCO2, what would that indicate?

A

VQ mismatch

56
Q

What electrolyte values are affected by: Lactic acidosis

  1. what is lactic acidosis
  2. Electrolyte affects and anion gap
  3. what can it cause
A
  1. Excess of lactic acid in the blood (Normal = 0.5-1)
  2. Increases hydrogen ions which decreases bicarb levels = Increases anion gap
  3. can cause hyperkalemia (high potassium lvls) and hypocalcemia (low calcium levels) -> liver failure and shock
57
Q

What electrolyte values are affected by: Renal tubular acidosis (RTA)

  1. what is RTA
  2. Electrolyte affects and anion gap
  3. what can it cause
A
  1. Disorder where kidneys ability to maintain acid-base levels are ineffective - > caused by UTIs
  2. Cannot effectively excrete acid or reabsorb bicarb = increase anion gap.
  3. RTA can cause hypokalemia and hyperchloremia
58
Q

What electrolyte values are affected by: diabetic acidosis

  1. what is diabetic acidosis
  2. Electrolyte affects and anion gap
  3. what can it cause
A
  1. uncontrolled diabetes where body cannot effectively use glucose for energy, uses fat for energy
  2. Electrolyte affects and anion gap: production of ketones = increased hydrogen ions and decreased bicarb lvls = Increased anion gap
  3. what can it cause: hyperkalemia due to acidosis and insulin deficiency
59
Q

What electrolyte values are affected by: ASA

  1. what is ASA
  2. Electrolyte affects and anion gap
  3. what can it cause
A
  1. ASA = analgesic and anti inflammatory
  2. ASA can cause metabolic acidosis by increasing the production of lactic acid and reducing bicarbonate = Increased anion gap
  3. ASA toxicity can cause hyperkalemia, hypokalemia, and hypoglycemia.
60
Q

Generally, what do high and low anion gap levels indicate?

A
  1. High anion gaps indicate metabolic acidosis, toxins, inherited disorders, or drugs.
  2. Low anion gap indicate hypoalbuminemia, hypercalcemia, hyperkalemia.
61
Q
  1. What is PETCO2
  2. How is PETCO2 measured?
A
  1. End tidal CO2 (max conc. of CO2 at end expiration)
  2. Capnography device
62
Q

Why is PETCO2 important?

A

Provides info about pts resp. status

  • if not functioning properly, (values fall below 35-45) PETCO2 lvls may be elevated or decreased

PA 2 (RESP 262) (14 decks)

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