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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
what is high flow oxygen
Constant and precise concentration of oxygen Over long period of time, can cause barrel trauma Venturi, non rebreather
26
what is hypoxemia
Below normal level of oxygen in the blood
27
what is hypoxia
Decrease in oxygen supply to the tissues and cells
28
what causes hypoxemic hypoxia
Hypoventilation, high altitude, ventilation perfusion mismatch, shunts
29
what causes circulatory hypoxia
Decreased cardiac output, local vascular obstruction (normal PaO2, but tissue partial pressure is reduced)
30
what causes histotoxic hypoxia
cyanide, toxic substance prevents the tissue to utilize oxygen
31
what are the percentages associated with liters of oxygen in a nasal cannula
1 liter: 24% (FiO2) 2 liter: 28% 3 liter: 32% 4 liter: 36% 5 liter: 40% 6 liter: 44%
32
what are the different face masks
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
what are the respiratory diagnostic procedures
Thoracentesis Bronchoscopy Chest tube and drainage Three bottle system
34
how is thoracentesis done
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
why is a thoracentesis done
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
what should a nurse monitor for after a thoracentesis
Signs of infection, bleeding, respiration status Complications: pneumothorax, puncture lung DYSPNEA IS BAD
37
how is a bronchoscopy done
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
what should a nurse monitor for after a bronchoscopy
gag reflex cant eat or drink anything until its back
39
what are the indications for chest tube and drainage
removes excess air, fluid, and blood
40
what are the different types of drainage systems
dry and wet depends on institutions
41
what is the advantage of a dry chest tube
Has an air gauge dial, can have more precision and is quieter
42
what is the nurses responsibility when monitoring a chest tube
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
what do water levels in a water seal chamber indicate
changes in intrathoracic pressure during respiration
44
what do consistent water levels in a water seal chamber indicate
lung fully expanded Blocked or occluded system Disconnected tubing Incorrect water seal level
45
What does continuous bubbling in a water-seal chamber indicate?
Air leak
46
What does gentle bubbling during expiration in a water-seal chamber indicate?
Pneumothorax
47
What does slow and sturdy (continuous) bubbling in a suction chamber indicate?
Expected when suction is applied
48
What does intermittent suction in a suction chamber indicate?
Fluid drainage
49
how is the clamping of a chest tube done
Done under close monitoring Only temporarily: check air leak, change tubing
50
what should the nurse do if the tube is dislodged from the patients side
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
What should the nurse do if the chest tube is dislodged from the drainage system’s side?
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
What may happen after chest tube insertion?
Slight subcutaneous emphysema might be present (should not spread)
53
How is chest tube removal done?
Ask the patient to take a deep breath, hold it & bear down (valsalva maneuver) while the tube is removed
54
What should a nurse never do with a chest tube?
Never milk the tube → can change the pressure inside the system

critical care exam 1 questions (5 decks)

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