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critical care exam 1 questions > respiratory > Flashcards

respiratory Flashcards

1
Q

where are foreign objects more likely to dislodge

A

The right side because the branch is straight while the left is forked

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2
Q

What are the components of respiration?

A

Inspiration: shorter, takes energy
Expiration: longer (⅓ : ⅔), passive movement

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3
Q

What is respiration?

A

Phases: gas exchange between the atmosphere and the body and the body and the gas exchange within the cells (air and blood, and blood and cells)

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4
Q

what is ventilation

A

Movement of air
Air pressure variance (from high pressure to low pressure)
Resistance to airflow

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5
Q

what is perfusion

A

The circulation of the blood that must be able to transport oxygen to the tissues and cells

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6
Q

For inspiration to occur, barometric pressure (outside) must be _____ alveolar pressure?

A

Higher

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7
Q

During expiration, the volume of the thorax _____, as the diaphragm _____?

A

Decreases, relaxes

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8
Q

What is the relationship between lung compliance (elasticity) and ventilation?

A

Overcompliance and under compliance reduce ventilation

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9
Q

What reduces lung compliance?

A

Pneumothorax, hemothorax, and obesity

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10
Q

What causes an over compliant lung

A

COPD and emphysema

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11
Q

what is V/Q ratio

A

ventilation: perfusion

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12
Q

what is a normal V/Q ratio

A

0.8 alveoli perfused and ventilated

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13
Q

what causes low V/Q

A

shunt perfusion
alveoli perfused but not ventilated

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14
Q

what causes high v/q

A

dead space ventilation
ventilated but not perfused

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15
Q

what is a silent unit (V/Q)

A

Absence/limitation of ventilation and perfusion
Pneumothorax and severe acute respiratory distress syndrome

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16
Q

where is V/Q highest

A

Apex of the lung

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17
Q

what determines oxygen delivery

A

Cardiac output x O2 content of the blood

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18
Q

What determines the amount of O2 in the blood?

A

O2 binding capacity: Determined by hemoglobin
Hemoglobin saturation: Determined by pulse oximetry
Dissolved O2: Negligible in humans

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19
Q

What is a limiting factor of pulse oximetry?

A

Cannot distinguish Hb bound to CO from that bound to O2
- Normal O2% sat (detector), low O2% sat (reality)
- Those who have carbon monoxide poisoning, they will still be short of breath even though they’re satting high
An anemic patient with 97% of O2 sat can still have poor oxygen delivery to tissues
- Hypoxia without hypoxemia

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20
Q

what are V/Q findings of a patient in the ICU laying on their back?

A

Anterior have a higher V/Q, more ventilation less perfusion
Posterior have a lower V/Q, less ventilation more perfusion

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21
Q

What is PaO2?

A

Partial pressure of oxygen in the arteries
The higher the PaO2, the greater the amount of oxygen dissolved in plasma

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22
Q

what is SaO2

A

% oxygen saturation of the blood in the arteries (% of hemoglobin carrying oxygen)

23
Q

What is PO2

A

Partial pressure of oxygen in the air

24
Q

what is low flow oxygen

A

Patient breathes some room air along with the oxygen
Not constant and precise concentration of inspired oxygen
Nasal cannula

25
Q

what is high flow oxygen

A

Constant and precise concentration of oxygen
Over long period of time, can cause barrel trauma
Venturi, non rebreather

26
Q

what is hypoxemia

A

Below normal level of oxygen in the blood

27
Q

what is hypoxia

A

Decrease in oxygen supply to the tissues and cells

28
Q

what causes hypoxemic hypoxia

A

Hypoventilation, high altitude, ventilation perfusion mismatch, shunts

29
Q

what causes circulatory hypoxia

A

Decreased cardiac output, local vascular obstruction (normal PaO2, but tissue partial pressure is reduced)

30
Q

what causes histotoxic hypoxia

A

cyanide, toxic substance prevents the tissue to utilize oxygen

31
Q

what are the percentages associated with liters of oxygen in a nasal cannula

A

1 liter: 24% (FiO2)
2 liter: 28%
3 liter: 32%
4 liter: 36%
5 liter: 40%
6 liter: 44%

32
Q

what are the different face masks

A

Venturi mask: precise fiO2
Non-rebreathing mask: high O2 concentration 82-100% fiO2
During transportation from med surg to ICU: non-rebreather (step right before intubation)
Non-rebreathing masks have three one-way valves
Theoretically, it is possible for the patient to receive 100% oxygen (depends on the fit of the mask)
Partial rebreather has two way valves
BIPAP: used for COPD patients, ventilation not oxygenation

33
Q

what are the respiratory diagnostic procedures

A

Thoracentesis
Bronchoscopy
Chest tube and drainage
Three bottle system

34
Q

how is thoracentesis done

A

Done at the bedside with aseptic technique
Put pillow on bedside and lean on table to expose the back and expand area
Use auscultation to position the needle → dull
Hold breath as catheter is removed
X-ray after in order to evaluate effectiveness
Follow up in order to receive results of testing

35
Q

why is a thoracentesis done

A

Need to get fluid out of pleural space (between lung and chest cavity) in order to test it
Patient presents with SOB and chest pain → do a chest X-ray (air shows up black, fluid shows up cloudy and tissues are white)

36
Q

what should a nurse monitor for after a thoracentesis

A

Signs of infection, bleeding, respiration status
Complications: pneumothorax, puncture lung
DYSPNEA IS BAD

37
Q

how is a bronchoscopy done

A

Using a bronchoscope to view the airways and check for any abnormalities
Start with X-ray, MRI, CT, then use bronchoscopy to find nodules and then do a biopsy
Repeat CAT scan and PET scan to note change

38
Q

what should a nurse monitor for after a bronchoscopy

A

gag reflex
cant eat or drink anything until its back

39
Q

what are the indications for chest tube and drainage

A

removes excess air, fluid, and blood

40
Q

what are the different types of drainage systems

A

dry and wet
depends on institutions

41
Q

what is the advantage of a dry chest tube

A

Has an air gauge dial, can have more precision and is quieter

42
Q

what is the nurses responsibility when monitoring a chest tube

A

When using a wet drainage, we need to maintain fluid
Do not remove fluid, mark the times of monitoring
When it gets full, switch the whole thing out

43
Q

what do water levels in a water seal chamber indicate

A

changes in intrathoracic pressure during respiration

44
Q

what do consistent water levels in a water seal chamber indicate

A

lung fully expanded
Blocked or occluded system
Disconnected tubing
Incorrect water seal level

45
Q

What does continuous bubbling in a water-seal chamber indicate?

A

Air leak

46
Q

What does gentle bubbling during expiration in a water-seal chamber indicate?

A

Pneumothorax

47
Q

What does slow and sturdy (continuous) bubbling in a suction chamber indicate?

A

Expected when suction is applied

48
Q

What does intermittent suction in a suction chamber indicate?

A

Fluid drainage

49
Q

how is the clamping of a chest tube done

A

Done under close monitoring
Only temporarily: check air leak, change tubing

50
Q

what should the nurse do if the tube is dislodged from the patients side

A

Ask the patient to cough and exhale to prevent air back into the body
Cover the site with a sterile occlusive dressing to prevent air from entering the pleural space → three way tape: one way valve system

51
Q

What should the nurse do if the chest tube is dislodged from the drainage system’s side?

A

Immerse the end of the tube into a bottle of sterile water (tip of the tube is about 2 cm below the water level)

52
Q

What may happen after chest tube insertion?

A

Slight subcutaneous emphysema might be present (should not spread)

53
Q

How is chest tube removal done?

A

Ask the patient to take a deep breath, hold it & bear down (valsalva maneuver) while the tube is removed

54
Q

What should a nurse never do with a chest tube?

A

Never milk the tube → can change the pressure inside the system

critical care exam 1 questions (5 decks)

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