Resp flashcards1
What are 2 human behaviors that effect disease?
social/cultural factors and motivation
What is ventilation?
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
What is perfusion?
The movement of blood through the pulmonary capillaries
True or false, ventilation and perfusion occur simultaneously
TRUE
What is diffusion?
movement of gases between the alveoli, plasma, and RBCs
What is WOB?
Work of breathing, it?s a measurement of the amount of energy expended to move a litre of gas into a patient
True or False, Gas exchange problems enable the lungs to oyxgenate blood/eliminate CO2
FALSE, lungs cannot oxygenate blood or eliminate CO2
What is respiratory insufficiency?
Gas exchange is maintained at an acceptable level, but a much increase work of the cardiopulmonary system
How is respiratory failure different than respiratory insuficiency?
Respiratory failure is the inability of the cardiopulmonary system to maintain adequate gas exchange at the pulmonary level
What are 3 causes of impaired ventilation?
upper airway obstruction, chest wall injury, and weakness/paralysis
What are 4 possible causes of impaired ventilation/perfusion?
COPD, restricted lung disease, pneumonias, atelectasis
True or false, atelectasis is a partial or complete collapse of the lung
TRUE
Effects of narcotics, head trauma, and sleep apnea is an example of which factor for impaired ventilation/perfusion?
Decreased CNS drive to breath
What are 2 other factors that influence impaired ventilation/perfusion?
decreased respiratory muscle strength (endurance, paralysis) and increased load (bronchial edema, obstructed airway)
What can influence impaired diffusion?
increased pulmonary pressure, anemias, and pulmonary edema
Define dyspnea
subjective sensation of uncomfortable breathing
Define orthopnea
dyspnea when a person is lying down
What is paroxysmal nocturnal dyspnea?
attacks of severe shortness of breath and coughing that generally occur at night
True or False, dyspnea and angina are the key s/s of pulmonary disease
FALSE, Dyspnea and abnormal breathing patterns are the correct answers
What are 2 examples of abnormal breathing patterns?
Kussmaul respirations (hyperpnea) and Cheyne-Stokes respirations
What are 8 other s/s of Pulmonary Disease?
HHCH- Hypo/hyperventilation, Cough (acute & chronic), hemoptysis, cyanosis, pain, clubbing, and abnormal sputum
Stridor, noisy, retractions, flaring nares, and labored with use of accessory muscles are examples of what?
Inadequate airway
Inadequate ventilation causes the PaO2, PaCO2, ph to do what?
v PaO2, ^PaCO2, v pH
True or false, inadequate ventilation is the presence of air exchange
FALSE, it is the absence of air exchange w/ minimal/absent chest wall movement
What are the signs of an obstructed airway?
central cyanosis, decreased or absent breath sounds, anxiety, confusion
What are the s/s of impaired gas exchange?
tachypnea, increased dead space, cyanosis (late sign), and chest infiltrates
Will decrease O2 in the blood cause an effect on the CNS or PNS?
CNS
Restlessness, agitation, incoordination, euphoria, delirium, coma, death are all s/s of what?
hypoxemia
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?
hypoxemia
Hypercapnea is a direct _______
vasodialator
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?
Hypercapnea
Normal pH is?
7.35-7.45
Normal PaO2 is?
75-100
Normal PCo2 is?
35-45
Normal HCO3 is?
22-26
If a person has a O2 sat of 84 or 85%, what would you do?
Call code b/c they are barely life sustaining
If a person has a O2 sat of 35 %, describe what is going on?
They are either dead or O2 sat is wrong
Normal O2 sat is ?
96-100%
Intubated patients, persons on mechanical ventilators, persons with increased flow and O2% are at risk for what?
Oxygen toxicity
What does hyperoxia cause?
release of free O2 radicals, which causes alveolar/capillary membrane damage, absorption atelectasis from nitrogen washout, and CO2 retention
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?
Oxygen toxicity
What are 3 types of pleural abnormalities?
Pneumothorax, hemothorax and pleural effusion
What is the difference between open and closed pneumothorax?
open is an opening in thorax from the outside and closed is something internal has created the collapse
What are the 4 types of pneumothorax?
open pneumothorax/traumatic, tension pneumothorax, spontaneous pneumothorax, and secondary pneumothorax
What will a full collapsed lung do?
push things over, interfere with the other lungs from ventilating and cause the heart to stop beating
Why is a tension pneumothorax so bad?
it can push and affect the other side
A spontaneous pneumothorax is common in what gender and what causes it?
in tall thin men, nothing causes it, it just happens
Collecting liquid in the pleural space is called what?
pleural effusion
What happens when you fill the pleural space with liquid?
if you fill it with fluid, negative pressure will become pos. and interfere with ventilation
What are the 3 types of pleural effusion?
transudative effusion, exudative effusion, and empyema
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?
Pneumothorax
True or False, Air in pleural space under pressure that displaces mediastinal structures and affects cardiac function is also called a soft pneumothorax?
FALSE, it is called a Tension Pneumothorax
True or False, pneumothorax can be open or closed
TRUE
Blunt or penetrating injury that disrupts parietal or visceral pleura is called _______ Pneumothorax
Traumatic Pneumothorax
Injuries secondary to medical or surgical procedures are called ________ pneumothorax
Iatrogenic Pneumothorax
Whose fault is it if a patient gets atelectasis post-op?
Nursing, because we know that post-op patients don?t like to take deep breaths b/c it hurts
True or False atelectasis leads to pneumonia
TRUE
Describe 6 ways to prevent post-op respiratory failure
incentive spirometry, deep breathing, early ambulation, frequent turning, air humidification
Describe 4 post-op resp. failures
Atelectasis, pneumonia, pulmonary edema, pulmonary emboli
Back up of left sided pressure leads to what?
Pulmonary Edema
Give one example of how a surgery could release a pulmonary emboli
If you cut bone marrow, it could release fat and that could go into the blood stream into the lungs
What cardiac conditions can lead to pulmonary edema?
left sided failure and congested heart failure
What are the 4 types of pleural effusion?
Transudative effusion, exudative effusion, and pleurisy, and hemothorax
True or False, leaking of pressure of serum cells& protein is called exudative effusion
FALSE, it is called Transudative Effusion
What substance is in exudative effusion that is not in transudative effusion?
Pus
Is empyema infected or non-infected pleural effusion?
Infected
What does ARDS stands for?
Adult respiratory distress syndrome
What are parenchymal?
essential functional cells of that organ system
Define ARDS
a diffuse pulmonary parenchymal injury associated with noncardiogenic pulmonary edema
What does ARDS result in?
severe respiratory distress and hypoxemic respiratory failure
True or False, the hallmark of ARDS is diffuse bronchial damage
FALSE, diffuse ALVEOLAR damage (DAD)
What are the 5 results of DAD?
integrity of the alveolar-capillary barrier, transudation of protein-rich fluid across the barrier, pulmonary edema, and hypoxemia from intrapulmonary shunting
The other names for ARDS are: ______ respiratory distress syndrome, ____ lung, Shock _____, and ______ lung
Adult respiratory distress syndrome, stiff lung, shock lung, and wet lung
What does surfactant do? What happens if you don?t have it?
Keeps alveoli open. Without it, the alveoli collapse, which leads to less gas exchange and build up of pressure
What does fulminant mean?
sudden, quick, severe form
True or false, ARDS is fulminant form of respiratory failure characterized by acute lung inflammation and diffuse alveocapillary injury
TRUE
ARDS includes ______ to the _____capillary endothelium, inflammation and platelet ______, surfactant ________,and atelectasis
Injury to the pulmonary capillary endothelium, inflammation and platelet activation, surfactant inactivation and atelectasis
Describe direct lung injury causes for ARDS
pneumonia, aspiration of gastric contents, pulmonary contusion, fat embolism, smoke/chemical inhalation, near drowning
Describe indirect lung injury causes
sepsis, burns, acute pancreatitis, drug overdose, multiple transfusion, cardio-pulmonary bypass, multiple trauma
What is the effect of having alveolar-capillary damage and mediator release
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
What are the 3 phases of ARDS?
Exudative/Inflammatory days, proliferative, and fibrotic. Followed by a resolution and recovery phase
How long does the exudative phase last?
0-7 days
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?
Exudative/ Inflammatory Days
Production of type 2 pneumocytes, ingestion of hyaline membranes by macrophages, and resolution of neutrophilic inflammation describes which phase of ARDS
Proliferative
Interstitial fibrosis, parenchymal restructuring of the alveoli shape describes which phase of ARDS?
Fibrotic
Describe what happens in the resolution and recovery stage of ARDS
lung reorganizes and recovers. Lung function may continue to improve for as long as 6-12 months
What will wedge pressure show us if a patient is also having lung problems
It will show us if it is cardiac related. Elevated = cardiac cause ad not ARDS
What are the criteria used to dx ARDS?
Acute onset, bilateral infiltrates, wedge pressure less than 19 ( on no clinical signs of CHF),PaO2/FlO2 less than 300
Which lab test is best for dx hypoxemia?
Arterial blood gasses ABGs
________ is a typical finding early in ARDS, but _________ can be seen later as ventilatory failure progresses
Hypocapnea, hypercapnea
_________ __________ reveals characteristic diffuse alveolar-interstitial infiltrates in all lung fields
Chest radiograph
What are the S/S of ARDS?
rapid & shallow breathing, retractions, cyanosis, mottling, respiratory alkalosis, dyspnea, adventitious sounds, decreased lung compliance, unresponsive hypoxemia, and infiltrates in lung by x-ray
You are caring for a patient with ARDS, what would you expect to see as common orders for treatments/ interventions for this patient?
mechanical ventilation, oxygenation, measurement of cardiac flow & pressures by PAC, fluid management, infection control & mgmt., supportive care, and prevention of organ failure
A patient is getting admitted to the ER for ARDS, what are the investigative drugs that may be ordered?
Anti-inflammatory, steroids, nitrous oxide, exogenous surfactant, recombinant human protein C
Occlusion of a portion of the pulmonary vascular bed by a thrombus, embolus, tissue fragment, lipids, or an air bubble is described as?
Pulmonary embolism
True or False, PE commonly arise for the deep veins in the brain
FALSE, deep veins in the thigh, but can arise from anywhere ( upper body, pelvis)
True or False, when a person has all the factors of Virchow triad they will get an thrombi
False, they will get an emboli
What are the three components of Virchow triad?
venous stasis, hypercoagulabilty, and injuries to the endothelial cells that line the vessels
What are the classic triad of PE?
Dyspnea, chest pain, hemoptysis
What are the atypical manifestations assoc. with PE?
back pain, abdominal pain, syncope, asthma like, pleuritic pain
TRUE or FALSE, PE is diagnosed with s/s and S/Q scanning?
FALSE, V/Q scanning and S/s
You patient was just admitted for PE, what meds can you give her?
Fibrinolytics- tPa, heparin, oxygen, fluid replacement for hypotension, and compression stockings
What does tPa do?
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
What is Heparin?
it is an anticoagulant, prevents clots from forming, and limits clots from getting bigger
You are the nurse caring for a patient that was just dx with PE. As the nurse, what are you going to be doing?
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)
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 ___________
Pulmonary Hypertension
What are the 2 types of pulmonary hypertension?
Primary-idiopathic, secondary- cardiac & pulmonary diseases
Right sided failure caused by emphysema is called ________
Cor pulmonale
peripheral edema, hepatomegaly, JVD are all s/s for _____ sided failure
right
pulmonary edema, decrease oxygenation, decrease CO, gallop, and crackles are s/s of _____ sided failure
left
hypoxic vasoconstriction, decreased pulmonary vascular bed, and volume/pressure overload describe the patho behind which disease?
Pulmonary HTN
Secondary pulm HTN is caused by?
Oxygen (COPD, sleep apnea), pulmonary vasculature ( collagen dz, PE, HIV infection), volume/pressure (cardiac defects)
Sarah comes to the ER with difficulty breathing (dyspnea), feeling dizzy, angina, and syncope. What is her dx?
Pulmonary HTN
How might you diagnose Pulm HTN?
R heart cardiac cath
What is a cardiac cath?
you thread a cath up from the femoral artery to the heart and get reading and pictures
What are 6 meds used for pulm HTN?
prostacyclin analogues, endothelin receptor antagonists, phosphiesterase- 5 inhibitors, high dose Ca channel blockers, anticoagulants, diuretics
What do prostacyclin analogues do?
enable the vessels in the lungs to expand and allow the blood to move through the veins with less resistance
Prostacyclin and treprostinil are examples of which drug catg.?
protacyclin analogues
What do endothelin receptor antagonists do?
in pill form, they help reverse the effects of endothelin, a substance in blood vessels that causes the vessels to constrict
What is an example of endothelin receptor antagonists?
Bosentan
What is Sildenafil? What catg. does it belong to and what does it do?
it is a Phosphodiesterase-5 inhibitor, it works by opening the blood vessels in the lungs… Increases blood flow to the lungs
Treatments for pulm HTN include:
oxygen, surgery (lung/ heart& lung transplant), and meds
