Respiratory 1

Question 1

a) What is ventilation?
b) When inheal diaphragm moves?
c) When exheal lung moves?

Answer 1

a) the movement of air into & out of the lungs
b) diaphragm contracts and moves downward
Creating a negative pressure that draws air into the lungs
Inspiration > diaphragm goes down > pressure decreases
c) diaphragm relax

Question 2

a) Lung complicance?
b) High lung compliance means?
c) Compliance influebced by?
d) Elasticity?

Answer 2

a) mesueremnt of the lung’s ability to stretch
b) lung can expand easily
c) Elasticity
Surfece tention of alveoli
Resistance of the airways
d) tendency to return proginal shape after streched

Question 3

Breathing is an involuntary action
a) What part is control of respiratory muscle?
b) pons & medulla control what?

Answer 3

a) CNS
brain stem transmits impulses to the respiratory muscles
pons & medulla
b) rhythm, depth & volume of ventilation.

Question 4

Restrictive Lung Problems
a) Deffinistion?
b) What is alteration in compliance?
c) Example

Answer 4

a) Any resp disorder that decreases compliance & elasticity is a RESTRICTIVE issue:
b) problems getting air in
c) Head injury, tumor, spinal cord injury, stroke
GB, ALS, MG, MD
Chest wall trauma, Obesity, Kyphoscoliosis
Pleural effusion, Pneumothorax

Question 5

Obstructive Lung Problems
a) Definition
b) Example

Answer 5

a) Any resp disorder that narrows or obstructs the airways during inspiration or expiration is an OBSTRUCTIVE issue
b) Mucous plug
Bronchospasm
Endotracheal tube (ET)
Asthma
Chronic COPD

Question 6

a) Alveoli main function?
b) Type 1?
c) Type 2?

Answer 6

a) Primary gas-exchange units
b) Provide the structure
c) Produce surfactant

Question 7

Gas Exchange
All about?

Answer 7

-O2 getting on hgb and CO2 getting off!
-PaO2 drives the loading of the hemoglobin
(pressure at which the oxygen dissolves in your blood.)

Question 8

a) Ventlation(V)?
b) Purfusion(Q)?
c) If Low V/Q?
d) If High V/Q?

Answer 8

a) amount of gas moving into and out of the alveoli
b) amount of the blood pass the alveoli
We want make match as close as possible 1:1
c) something wrong with lung
d) Imparied perfusion(this is only mismach that affects perfusion)

Question 9

a) Shunt VQ
b) High VQ

Answer 9

a) 0/1 no O2 entering alveoli
CO2 doen’t get out the body
Punemothroax,atelectasis
pneumonia,pulmonary edema
b) 1/0 good O2 but lack of blood
cardiogenetic shocks, HE, PE,embolisum
Hypoxic

Question 10

Exam
Respiratory Changes and Aging
a) Dec what foctors?
b) Inc risk for?

Answer 10

a) Dec elastic recoil
Dec compliance
Dec muscle
Dec cough reflex
Inc in AP diameter

b) Infection
Poor gas exchange
Respiratory distress
Respiratory failure

Question 11

Oxyhemoglobin Curve
a) right shift
b) Left shift

Answer 11

a) less O2 attached to heg, more CO2 attached
Acidosis
hypercapnia
Inc temp
b) More O2 attached to heg
Alkalosis
hypocapnia
Dec temp

Question 12

Pneumothorax?

Answer 12

air gets into pleural space
extra pressure on the lungs can cause them to collapse partially or completely

Question 13

a) Closed pneumothorax?
b) Spontaneous pneumothorax?
c) causes?

Answer 13

a) Rupture of visceral or parietal pleura
Air destroys negative pressure, lung collapses
b) If a pneumothorax occurs for no known reason
Tall, thin men between the ages of 20-40
Marfan syndrome
Emphysema
Cystic fibrosis
Tuberculosis
c) Fractured rib (blunt trauma)

Question 14

Open pneumothorax
Causes?

Answer 14

An accident
Trauma
Injury to the chest cavity

Question 15

Hemothorax
a) what is it?
b) causes?
c) manifestations?

Answer 15

a) Blood in pleural space!
Can have both air and blood = hemopneumothorax
b) penetrating trauma
Rib fractures
Lung parenchymal (pulmonary contusion)
c) Decr/absent breath sounds
Dec chest expansion
Dec percussion noted
Effects hemodynamics

Question 16

Tension Pneumothorax
a) What is it?
b) Causes?

Answer 16

The most DANGER!
a) pleural rupture acts as one-way valve
air doesn’t escape during expiration
pressure compress heart
b) Injuries/Trauma
Lung Disease
Asthma
Chronic bronchitis
Emphysema

Question 17

Tension Pneumothorax
a) Clinical Manifestations
b) Collaborative Care-Emergency Situation

Answer 17

a) Severe dyspnea/hypoxemia
Hypotension
Absent breath sounds affected side
Neck vein distention
Hypoximea
b) Oxygen (high flow)
Needle thoracotomy/Chest tube insertion
2nd ICS on affected side
Monitor EKG, VS
Possible intubation

Question 18

Close +Open Pneumothorax
treatment

Answer 18

ABCs!!!! = basic care package
Oxygen therapy
Chest tube
Vented dressing with open phneumothroax
Surgical

Question 19

NDX pneumothorax
Impaired gas exchange, Ineffective breathing pattern, Ineffective airway clearance
What to do?

Answer 19

• Maintain open airway
• Assess VS, Breath sounds, SpO2 (q4hrs)
• Position in Fowler’s or semi-Fowler’s
• Administer oxygen/assess effectiveness
• Maintain/monitor chest tube function (q2hrs)
• Provide for adequate rest
• Increase patient mobility (once stabilized)

Question 20

NDX pneumothorax
Risk for infection
What to do?

Answer 20

• Chest tube care/site care
• Wound care (open pneumothorax)
• Monitor/interpret labs
• Monitor VS
• Administer antibiotics

Question 21

NDX pneumothorax
Decreased cardiac output (tension pneumothorax; hemothorax)

Answer 21

• Monitor VS
• Administer fluids (crystalloids, colloids)
• Monitor I&O
• Monitor H&H, RBCs, platelets

Question 22

Flail chest
a) what is it?
b) result in?
c) causes?

Answer 22

a) 3 or more ribs broken in 2 or more places
b) Impairs movement of oxygen & CO2
Causes hypoxemia and acidosis
c) motor vehicle accidents
40 % mortality

Question 23

Flail chest
Manifestations

Answer 23

Pain
Unequal chest expansion
Hypoxemia (ABGs)
Dyspnea, tachypnea
Tachycardia
Crepitus (over ribs)

Question 24

Flail chest
care

Answer 24

ABCs, then
high fowlers position
Surgical Stabilization
Prevent hypoxemia/oxygen administration
Intubate & ventilate; PEEP often required
(Positive end-expiratory pressure)
IV fluid administration
Control pain
Monitor EKG, SpO2, VS, ABGs

Question 25

Nursing DX
Flail Chest

Answer 25

Impaired Gas exchange r/t tissue edema
decreased compliance and decreased area for gas exchange
Ineffective airway clearance r/t bronchial irritation or pain
Pain r/t traumatic disruption of tissue
Ineffective coping, individual and family r/t crisis of critical injury and fear of impending death
High risk for infection r/t trauma and depressed immune system from stress response
Related injuries
Respiratory failure

Question 26

Pulmonary embolism
S/S?

Answer 26

Chest pain
Chest wall tenderness
Back and shoulder pain
Upper abdominal pain
Syncope
SOB
Painful respiration and new onset of wheezing
EKG may show new cardiac arrhythmia

Question 27

PE
Mortality/Morbidity
a) Massive pulmonary embolism
b) Nonmassive pulmonary embolism

Answer 27

a) systolic arterial pressure less than 90 mm Hg
mortality 30% to 60%
deaths occur in the first 1-2hr
b) systolic arterial pressure greater than or equal to 90 mm Hg
More common 95%

Question 28

Medical Treatment 4

Answer 28

Anticoagulation
Inferior Vena Cava Filters
Thrombolysis
Embolectomy

Question 29

a) Anticoagulation
b) Inferior Vena Cava Filters

Answer 29

a) should be started immediately
Heparin
oral Warfarin (Coumadin) should be started
b) traps any blood clots before they reach the lungs
Inserted percutaneously (through the skin) to prevent further PE

Question 30

PE, DX

Answer 30

D-dimer, Enzyme-linked immunosorbent assay (ELISA)
-positive if the level is greater than 500 ng/mL
Multidetector Computed Tomographic Angiography (MDCTA)
Pulmonary Angiography (harder and more invasive)
Ventilation-Perfusion (V/Q) scanning of the lung
Duplex ultrasonography (look for DVT)

Question 31

Impending Respiratory Failure

Answer 31

declining mental clarity,
worsening fatigue
PCO2 of ≥42 mm Hg
When wheezing stops
ONE ATTACK IS TOO MANY!