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Med Surg II > Resp flashcards1 > Flashcards

Resp flashcards1

1
Q

What are 2 human behaviors that effect disease?

A

social/cultural factors and motivation

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2
Q

What is ventilation?

A

Inspiration and expiration, movement of air between the atmosphere and alveoli and the distribution of air within the lungs to maintain appropriate conc. Of oxygen and CO2 in the blood

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3
Q

What is perfusion?

A

The movement of blood through the pulmonary capillaries

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4
Q

True or false, ventilation and perfusion occur simultaneously

A

TRUE

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5
Q

What is diffusion?

A

movement of gases between the alveoli, plasma, and RBCs

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6
Q

What is WOB?

A

Work of breathing, it?s a measurement of the amount of energy expended to move a litre of gas into a patient

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7
Q

True or False, Gas exchange problems enable the lungs to oyxgenate blood/eliminate CO2

A

FALSE, lungs cannot oxygenate blood or eliminate CO2

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8
Q

What is respiratory insufficiency?

A

Gas exchange is maintained at an acceptable level, but a much increase work of the cardiopulmonary system

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9
Q

How is respiratory failure different than respiratory insuficiency?

A

Respiratory failure is the inability of the cardiopulmonary system to maintain adequate gas exchange at the pulmonary level

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10
Q

What are 3 causes of impaired ventilation?

A

upper airway obstruction, chest wall injury, and weakness/paralysis

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11
Q

What are 4 possible causes of impaired ventilation/perfusion?

A

COPD, restricted lung disease, pneumonias, atelectasis

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12
Q

True or false, atelectasis is a partial or complete collapse of the lung

A

TRUE

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13
Q

Effects of narcotics, head trauma, and sleep apnea is an example of which factor for impaired ventilation/perfusion?

A

Decreased CNS drive to breath

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14
Q

What are 2 other factors that influence impaired ventilation/perfusion?

A

decreased respiratory muscle strength (endurance, paralysis) and increased load (bronchial edema, obstructed airway)

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15
Q

What can influence impaired diffusion?

A

increased pulmonary pressure, anemias, and pulmonary edema

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16
Q

Define dyspnea

A

subjective sensation of uncomfortable breathing

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17
Q

Define orthopnea

A

dyspnea when a person is lying down

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18
Q

What is paroxysmal nocturnal dyspnea?

A

attacks of severe shortness of breath and coughing that generally occur at night

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19
Q

True or False, dyspnea and angina are the key s/s of pulmonary disease

A

FALSE, Dyspnea and abnormal breathing patterns are the correct answers

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20
Q

What are 2 examples of abnormal breathing patterns?

A

Kussmaul respirations (hyperpnea) and Cheyne-Stokes respirations

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21
Q

What are 8 other s/s of Pulmonary Disease?

A

HHCH- Hypo/hyperventilation, Cough (acute & chronic), hemoptysis, cyanosis, pain, clubbing, and abnormal sputum

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22
Q

Stridor, noisy, retractions, flaring nares, and labored with use of accessory muscles are examples of what?

A

Inadequate airway

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23
Q

Inadequate ventilation causes the PaO2, PaCO2, ph to do what?

A

v PaO2, ^PaCO2, v pH

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24
Q

True or false, inadequate ventilation is the presence of air exchange

A

FALSE, it is the absence of air exchange w/ minimal/absent chest wall movement

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25
Q

What are the signs of an obstructed airway?

A

central cyanosis, decreased or absent breath sounds, anxiety, confusion

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26
Q

What are the s/s of impaired gas exchange?

A

tachypnea, increased dead space, cyanosis (late sign), and chest infiltrates

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27
Q

Will decrease O2 in the blood cause an effect on the CNS or PNS?

A

CNS

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28
Q

Restlessness, agitation, incoordination, euphoria, delirium, coma, death are all s/s of what?

A

hypoxemia

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29
Q

A patient presents with a tachycardia HR, cool and pale skin. Initially there was an increase in BP, HR. However, right before she died, she was hypotensive and bradycardic. What could she be suffering from?

A

hypoxemia

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30
Q

Hypercapnea is a direct _______

A

vasodialator

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31
Q

Suzie visits the clinic. She has a headache, flushed skin, conjunctiva hyperemia. She seems very disoriented to what is going on in the room right before her BP increases and goes into a coma. What could she be suffering from?

A

Hypercapnea

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32
Q

Normal pH is?

A

7.35-7.45

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33
Q

Normal PaO2 is?

A

75-100

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34
Q

Normal PCo2 is?

A

35-45

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35
Q

Normal HCO3 is?

A

22-26

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36
Q

If a person has a O2 sat of 84 or 85%, what would you do?

A

Call code b/c they are barely life sustaining

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37
Q

If a person has a O2 sat of 35 %, describe what is going on?

A

They are either dead or O2 sat is wrong

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38
Q

Normal O2 sat is ?

A

96-100%

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39
Q

Intubated patients, persons on mechanical ventilators, persons with increased flow and O2% are at risk for what?

A

Oxygen toxicity

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40
Q

What does hyperoxia cause?

A

release of free O2 radicals, which causes alveolar/capillary membrane damage, absorption atelectasis from nitrogen washout, and CO2 retention

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41
Q

Gloria presents to the community clinic with a non-productive cough, substernal chest pain, GI upset, and dyspnea. She suddenly stops breathing. What could this be a sign of?

A

Oxygen toxicity

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42
Q

What are 3 types of pleural abnormalities?

A

Pneumothorax, hemothorax and pleural effusion

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43
Q

What is the difference between open and closed pneumothorax?

A

open is an opening in thorax from the outside and closed is something internal has created the collapse

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44
Q

What are the 4 types of pneumothorax?

A

open pneumothorax/traumatic, tension pneumothorax, spontaneous pneumothorax, and secondary pneumothorax

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45
Q

What will a full collapsed lung do?

A

push things over, interfere with the other lungs from ventilating and cause the heart to stop beating

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46
Q

Why is a tension pneumothorax so bad?

A

it can push and affect the other side

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47
Q

A spontaneous pneumothorax is common in what gender and what causes it?

A

in tall thin men, nothing causes it, it just happens

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48
Q

Collecting liquid in the pleural space is called what?

A

pleural effusion

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49
Q

What happens when you fill the pleural space with liquid?

A

if you fill it with fluid, negative pressure will become pos. and interfere with ventilation

50
Q

What are the 3 types of pleural effusion?

A

transudative effusion, exudative effusion, and empyema

51
Q

A pneumothorax refers to a collection of gas in the pleural space resulting in collapse of the lung on the affected side is called what?

A

Pneumothorax

52
Q

True or False, Air in pleural space under pressure that displaces mediastinal structures and affects cardiac function is also called a soft pneumothorax?

A

FALSE, it is called a Tension Pneumothorax

53
Q

True or False, pneumothorax can be open or closed

A

TRUE

54
Q

Blunt or penetrating injury that disrupts parietal or visceral pleura is called _______ Pneumothorax

A

Traumatic Pneumothorax

55
Q

Injuries secondary to medical or surgical procedures are called ________ pneumothorax

A

Iatrogenic Pneumothorax

56
Q

Whose fault is it if a patient gets atelectasis post-op?

A

Nursing, because we know that post-op patients don?t like to take deep breaths b/c it hurts

57
Q

True or False atelectasis leads to pneumonia

A

TRUE

58
Q

Describe 6 ways to prevent post-op respiratory failure

A

incentive spirometry, deep breathing, early ambulation, frequent turning, air humidification

59
Q

Describe 4 post-op resp. failures

A

Atelectasis, pneumonia, pulmonary edema, pulmonary emboli

60
Q

Back up of left sided pressure leads to what?

A

Pulmonary Edema

61
Q

Give one example of how a surgery could release a pulmonary emboli

A

If you cut bone marrow, it could release fat and that could go into the blood stream into the lungs

62
Q

What cardiac conditions can lead to pulmonary edema?

A

left sided failure and congested heart failure

63
Q

What are the 4 types of pleural effusion?

A

Transudative effusion, exudative effusion, and pleurisy, and hemothorax

64
Q

True or False, leaking of pressure of serum cells& protein is called exudative effusion

A

FALSE, it is called Transudative Effusion

65
Q

What substance is in exudative effusion that is not in transudative effusion?

A

Pus

66
Q

Is empyema infected or non-infected pleural effusion?

A

Infected

67
Q

What does ARDS stands for?

A

Adult respiratory distress syndrome

68
Q

What are parenchymal?

A

essential functional cells of that organ system

69
Q

Define ARDS

A

a diffuse pulmonary parenchymal injury associated with noncardiogenic pulmonary edema

70
Q

What does ARDS result in?

A

severe respiratory distress and hypoxemic respiratory failure

71
Q

True or False, the hallmark of ARDS is diffuse bronchial damage

A

FALSE, diffuse ALVEOLAR damage (DAD)

72
Q

What are the 5 results of DAD?

A

integrity of the alveolar-capillary barrier, transudation of protein-rich fluid across the barrier, pulmonary edema, and hypoxemia from intrapulmonary shunting

73
Q

The other names for ARDS are: ______ respiratory distress syndrome, ____ lung, Shock _____, and ______ lung

A

Adult respiratory distress syndrome, stiff lung, shock lung, and wet lung

74
Q

What does surfactant do? What happens if you don?t have it?

A

Keeps alveoli open. Without it, the alveoli collapse, which leads to less gas exchange and build up of pressure

75
Q

What does fulminant mean?

A

sudden, quick, severe form

76
Q

True or false, ARDS is fulminant form of respiratory failure characterized by acute lung inflammation and diffuse alveocapillary injury

A

TRUE

77
Q

ARDS includes ______ to the _____capillary endothelium, inflammation and platelet ______, surfactant ________,and atelectasis

A

Injury to the pulmonary capillary endothelium, inflammation and platelet activation, surfactant inactivation and atelectasis

78
Q

Describe direct lung injury causes for ARDS

A

pneumonia, aspiration of gastric contents, pulmonary contusion, fat embolism, smoke/chemical inhalation, near drowning

79
Q

Describe indirect lung injury causes

A

sepsis, burns, acute pancreatitis, drug overdose, multiple transfusion, cardio-pulmonary bypass, multiple trauma

80
Q

What is the effect of having alveolar-capillary damage and mediator release

A

increased endothelial & epithelial membrane permeability, changes in small airway diameter, injury to pulmonary vasculature, disruption in system o2 transport, and alveolar flooding of protein rich fluid

81
Q

What are the 3 phases of ARDS?

A

Exudative/Inflammatory days, proliferative, and fibrotic. Followed by a resolution and recovery phase

82
Q

How long does the exudative phase last?

A

0-7 days

83
Q

Capillary congestion around alveoli, alveolar necrosis, edema & hemorrhage, neutrophil w/ capillaries, and formation of hyaline membranes in alveoli spaces and ducts describes which stage of ARDS?

A

Exudative/ Inflammatory Days

84
Q

Production of type 2 pneumocytes, ingestion of hyaline membranes by macrophages, and resolution of neutrophilic inflammation describes which phase of ARDS

A

Proliferative

85
Q

Interstitial fibrosis, parenchymal restructuring of the alveoli shape describes which phase of ARDS?

A

Fibrotic

86
Q

Describe what happens in the resolution and recovery stage of ARDS

A

lung reorganizes and recovers. Lung function may continue to improve for as long as 6-12 months

87
Q

What will wedge pressure show us if a patient is also having lung problems

A

It will show us if it is cardiac related. Elevated = cardiac cause ad not ARDS

88
Q

What are the criteria used to dx ARDS?

A

Acute onset, bilateral infiltrates, wedge pressure less than 19 ( on no clinical signs of CHF),PaO2/FlO2 less than 300

89
Q

Which lab test is best for dx hypoxemia?

A

Arterial blood gasses ABGs

90
Q

________ is a typical finding early in ARDS, but _________ can be seen later as ventilatory failure progresses

A

Hypocapnea, hypercapnea

91
Q

_________ __________ reveals characteristic diffuse alveolar-interstitial infiltrates in all lung fields

A

Chest radiograph

92
Q

What are the S/S of ARDS?

A

rapid & shallow breathing, retractions, cyanosis, mottling, respiratory alkalosis, dyspnea, adventitious sounds, decreased lung compliance, unresponsive hypoxemia, and infiltrates in lung by x-ray

93
Q

You are caring for a patient with ARDS, what would you expect to see as common orders for treatments/ interventions for this patient?

A

mechanical ventilation, oxygenation, measurement of cardiac flow & pressures by PAC, fluid management, infection control & mgmt., supportive care, and prevention of organ failure

94
Q

A patient is getting admitted to the ER for ARDS, what are the investigative drugs that may be ordered?

A

Anti-inflammatory, steroids, nitrous oxide, exogenous surfactant, recombinant human protein C

95
Q

Occlusion of a portion of the pulmonary vascular bed by a thrombus, embolus, tissue fragment, lipids, or an air bubble is described as?

A

Pulmonary embolism

96
Q

True or False, PE commonly arise for the deep veins in the brain

A

FALSE, deep veins in the thigh, but can arise from anywhere ( upper body, pelvis)

97
Q

True or False, when a person has all the factors of Virchow triad they will get an thrombi

A

False, they will get an emboli

98
Q

What are the three components of Virchow triad?

A

venous stasis, hypercoagulabilty, and injuries to the endothelial cells that line the vessels

99
Q

What are the classic triad of PE?

A

Dyspnea, chest pain, hemoptysis

100
Q

What are the atypical manifestations assoc. with PE?

A

back pain, abdominal pain, syncope, asthma like, pleuritic pain

101
Q

TRUE or FALSE, PE is diagnosed with s/s and S/Q scanning?

A

FALSE, V/Q scanning and S/s

102
Q

You patient was just admitted for PE, what meds can you give her?

A

Fibrinolytics- tPa, heparin, oxygen, fluid replacement for hypotension, and compression stockings

103
Q

What does tPa do?

A

it is a fibrinolytic drug and break down anything. If it goes into the circulation, it could break down other useful clots and makes the pt. at risk for bleeding

104
Q

What is Heparin?

A

it is an anticoagulant, prevents clots from forming, and limits clots from getting bigger

105
Q

You are the nurse caring for a patient that was just dx with PE. As the nurse, what are you going to be doing?

A

Monitor Oxygenation (ABGs, SaO2, WOB), Vital signs, hemodynamic monitoring, fluid balance (Ins and outs), treat underlying causes (sepsis), monitor for complications ( GI bleeding, lung fibrosis)

106
Q

Constriction of pulmonary arteries causing decreased movement of Oxygenated blood to L side of hearts and backflow to the R side of heart is defined as ___________

A

Pulmonary Hypertension

107
Q

What are the 2 types of pulmonary hypertension?

A

Primary-idiopathic, secondary- cardiac & pulmonary diseases

108
Q

Right sided failure caused by emphysema is called ________

A

Cor pulmonale

109
Q

peripheral edema, hepatomegaly, JVD are all s/s for _____ sided failure

A

right

110
Q

pulmonary edema, decrease oxygenation, decrease CO, gallop, and crackles are s/s of _____ sided failure

A

left

111
Q

hypoxic vasoconstriction, decreased pulmonary vascular bed, and volume/pressure overload describe the patho behind which disease?

A

Pulmonary HTN

112
Q

Secondary pulm HTN is caused by?

A

Oxygen (COPD, sleep apnea), pulmonary vasculature ( collagen dz, PE, HIV infection), volume/pressure (cardiac defects)

113
Q

Sarah comes to the ER with difficulty breathing (dyspnea), feeling dizzy, angina, and syncope. What is her dx?

A

Pulmonary HTN

114
Q

How might you diagnose Pulm HTN?

A

R heart cardiac cath

115
Q

What is a cardiac cath?

A

you thread a cath up from the femoral artery to the heart and get reading and pictures

116
Q

What are 6 meds used for pulm HTN?

A

prostacyclin analogues, endothelin receptor antagonists, phosphiesterase- 5 inhibitors, high dose Ca channel blockers, anticoagulants, diuretics

117
Q

What do prostacyclin analogues do?

A

enable the vessels in the lungs to expand and allow the blood to move through the veins with less resistance

118
Q

Prostacyclin and treprostinil are examples of which drug catg.?

A

protacyclin analogues

119
Q

What do endothelin receptor antagonists do?

A

in pill form, they help reverse the effects of endothelin, a substance in blood vessels that causes the vessels to constrict

120
Q

What is an example of endothelin receptor antagonists?

A

Bosentan

121
Q

What is Sildenafil? What catg. does it belong to and what does it do?

A

it is a Phosphodiesterase-5 inhibitor, it works by opening the blood vessels in the lungs… Increases blood flow to the lungs

122
Q

Treatments for pulm HTN include:

A

oxygen, surgery (lung/ heart& lung transplant), and meds

Med Surg II (12 decks)

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