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Advanced MedSurg > Med Surg Exam 1 (#2) > Flashcards

Med Surg Exam 1 (#2) Flashcards

1
Q

paCO2 level EXCEEDS 50 mmHg?

A

hypercapnic RF

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2
Q

paO2 falls below 60 mmHg

A

hypoxic RF

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3
Q

Consequence of hypoxemic RF

A

cells shift from aerobic to anaerobic metabolism : increases lactic acid and causes metabolic acidosis : cell and tissue death

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4
Q

Hypercapnic RF will NOT

A

show changes in LOC

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5
Q

Clinical manifestations in order of decreased O2 - hypoxemia (5)

A
  1. change in LOC
  2. restlessness
  3. confusion
  4. agitation
  5. cyanosis
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6
Q

Clinical manifestations in order of increased O2 (3)

A
  1. morning headache
  2. decreased RR
  3. decreased LOC
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7
Q

Describe the breathing pattern for:

  • hypercapnia
  • hypoxemia
A
  • hypercapnia: slow RR

- hypoxemic: rapid, shallow

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8
Q

Change from rapid to slow RR indicates severe muscle fatigue characterizes?

A

respiratory arrest

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9
Q

What are management factors to consider? (4)

A
  1. age
  2. severity
  3. underlying comorbidities
  4. suspected or most likely cause
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10
Q

Oxygen toxicity

A

greater than 60% O2 for longer than 24 hours (textbook) from O2 administration (48 hours in lecture)

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11
Q

2 components of oxygenation?

A
  • respiration

- circulation

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12
Q

What are the 4 processes of respiration?

A
  1. ventilation: exchange of air between lungs and the atmosphere
  2. gas exchange: in the alveoli
  3. transport: oxygen is transported to the tissues for uptake
  4. perfusion: oxygen is carried by the hemoglobin to the capillaries
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13
Q

Respiratory acidosis

  • s/s (4)
  • d/t
A
  • dyspnea, lethargy, stuport, comatose

- hypoventilation d/t over sedation, poor ventilation, inadequate ventilator settings

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14
Q

Respiratory alkalosis

  • s/s (3)
  • d/t
  • contributing complications (2)
A
  • palpitations, paresthesias, pain
  • hyperventilation / losing too much CO2
  • ventilator settings, anxiety
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15
Q

Metabolic acidosis

  • s/s (4)
  • d/t
  • contributing complication
A
  • respiratory distress, seizures, headache, drowsiness
  • excessive acid in the bloodstream (keto or lactic acids)
  • diabetic ketoacidosis
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16
Q

Metabolic alkalosis

  • s/s (2)
  • d/t
  • contributing complications (3)
A
  • Chvostek’s sign, Trousseau’s sign
  • excessive base in the bloodstream s/t high loss of H+
  • excessive vomiting, over-administration of alkalinizing agents (ex: sodium bicarb), excessive GI aspiration
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17
Q

Respiratory failure results when:

  • pCO2 level
  • pO2
A
  • pCO2 level = exceeds 50 mmHg (hypercapneic RF)

- pO2 level = falls below 60 mmHg (hypoxic RF)

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18
Q

Acute vs chronic respiratory failure?

A

if pH is LESS THAN 7.30 = acute

if pH is GREATER THAN 7.30 = chronic

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19
Q

Is SpO2 a reliable measurement of how much oxygen reaches the cell ?

A

NO (oxygen delivery is related to the saturation of hemoglobin = SaO2)

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20
Q

Can patients have both types of respiratory failure at the same time?

A

Yes, acute-on-chronic

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21
Q

What are the most common etiologies of hypoxemic RF?

A

V/Q mismatch and shunting

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22
Q

Failure of compensatory mechanisms can lead to respiratory failure, what is a priority intervention?

A

Frequent assessment

23
Q

Nonspecific manifestations of hypercapnia - CNS (2)

A
  1. morning headache

2. coma (LATE)

24
Q

Nonspecific manifestations of hypercapnia - cardiac (4)

A
  1. tachycardia (early)
  2. tachypnea (early)
  3. mild HTN
  4. cyanosis (not reliable)
25
Q

Nonspecific manifestations of hypercapnia - neuromuscular (2)

A
  1. muscle weakness

2. seizures (LATE)

26
Q

Priority intervention for hypercapnia

A

immediate assessment of ability to breathe and provide assistive measures (may require intubation and mechanical vent)

27
Q

Most common dx studies for ARDS?

A

chest x-ray and ABG analysis/pulse ox

28
Q

If patient is at risk for aspiration, what position should they be placed in?

A

side-lying or lateral

29
Q

Types of coughing to increase effectiveness in clearing secretions (2)

A
  • Huff coughing

- Staged coughing

30
Q

Huff coughing

A

series of coughs performed while saying “huff” to clear central airways

31
Q

Staged coughing

A

sit leaning forward, take 3-4 deep breathes through the mouth, then cough while leaning forward and pressing a pillow against diaphragm

32
Q

Hydration (to improve airway clearance)

A
  • oral intake 2-3 L/day (unless contraindicated) or IV fluids
  • monitor for fluid overload
33
Q

Humidification (to thin secretions)

A
  • aerosols of normal saline via nebulizer, O2 via aerosil mask
  • monitor for bronchospasm and severe coughing
34
Q

Nutrition

A
  • collaborate with dietician
  • maintain protein and energy stores
  • start enteral or parenteral nutrition within 24-48 hours to avoid depletion and delayed recovery
35
Q

Injury or exudative phase (4)

A
  • 24-71 hrs after initial lung injury
  • widespread atelectasis : decreased gas exchange and lung compliance
  • refractory hypoxemia
  • patients CAN survive and edema will resolve within a week
36
Q

Reparative or proliferative phase (4)

A
  • 1-2 weeks after initial lung injury
  • lung compliance continues to decline
  • lungs are replaced by dense, fibrous tissue
  • if phase stops, lesions resolve
37
Q

Fibrotic and fibroproliferative phase

A
  • 2-3 weeks after initial injury
  • if phase persists, lungs are COMPLETELY REMODELED
  • scarring and fibrosis decreases lung compliance and gas exchange
  • **survival chances are low and requires long-term mechanical ventilation)
38
Q

What is the most classical characteristic of ARDS progression?

A

Refractory hypoxemia

39
Q

What will a patient report when experiencing abnormal lung function d/t ARDS? (4)

A
  1. extreme tiredness
  2. chest pain
  3. SOB after minimal activity
  4. persistent dyspnea
40
Q

Complication of ARDS - AKI management (3)

A
  • monitor I&Os and body weight
  • daily BUN and creatinine
  • dialysis or continuous renal replacement therapy (CRRT)
41
Q

Prone position (4)

A
  • position prone in early ARDS
  • up to 16 hours per day
  • attentive to secure airway
  • once prone, position in a side-lying position
42
Q

During permissive hypercapnia, patients will have a ______

A

continuous IV analgesia and sedation infusion

43
Q

ET intubation before (3)

A
  • sniffing position
  • limit each intubation attempt to less than 30 seconds
  • ventilate patient between successive attempts using BVM with 100% O2
44
Q

Proper ET tube placement

A

2-6 cm above carina

45
Q

Monitoring OXYGENATION

A
  • SCVO2 (central venous O2 sat)

- SVO2 (mixed venous O2 sat)

46
Q

What are four nursing diagnosis for acute respiratory failure?

A
  1. impaired gas exchange
  2. impaired airway clearance
  3. impaired breathing
  4. impaired nutritional status
47
Q

closed suctioning (3)

A
  • used for patients with PEEP requirement
  • high levels of FiO2
  • bloody, infected secretions
48
Q

When caring for older patients with RF, the nurse will add which intervention to the plan of care?

A

assess frequently for manifestations of delirium

49
Q

The nurse is admitting a patient with asthma in acute respiratory distress. The nurse auscultates the patient’s lungs and notes cessation of the inspiratory wheezing. The patient has not yet received any medication. What should the finding suggest to the nurse?

A

Airway constriction requiring immediate interventions

50
Q

Arterial blood gas results are reported to the nurse for a patient admitted with pneumonia: pH 7.31, PaC02 49 mm Hg, Hco3 26 mEq/L, and Pa02 52 mm Hg. What order should the nurse complete first?

A

Start oxygen at 2L/min by nasal cannula

51
Q

The nurse is caring for a patient who developed acute respiratory failure. Which medication is used to treat pulmonary congestion and agitation?

A

Morphine

52
Q

The nurse is caring for a patient with multiple fractured ribs from a motor vehicle crash. Which assessment findings would be an early indication that the patient is developing RF?

A

Frequent position changes and agitation

53
Q

When is closed-suctioning used?

A

When patients require high levels of PEEP (>10 cm H20) to prevent the loss of PEEP that occurs when disconnecting the patient from the ventilator

54
Q

What is the normal PTT parameters for patients receiving heparin?

A

20-25 seconds

Advanced MedSurg (11 decks)

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