Respiratory

Question 1

normal ABG values:

Answer 1

pH: 7.35-7.45
pCO2: 35-45 mmHg
HCO3: 22-26 mEq/L
pO2: 80-100 mmHg

Question 2

lab changes for allergic asthma

Answer 2

elevated serum eosiniphil

elevated IgE

Question 3

pulmonary function tests for asthma (3)

Answer 3

• forced vital capacity (FVC)
• forced expiratory volume in first second (FEV1)
• peak expiratory flow rate (PEFR) - green, red, yellow light

Question 4

preventative therapy drugs for asthma (3)

Answer 4

• inhaled corticosteroids - fluticasone
• long-acting beta-2 agonists (LABA) - salmetrol
• leukotriene receptor antagonists (LTRA) - Singulair pill

Question 5

rescue drugs for asthma (2)

Answer 5

• short-acting beta-2 agonists (SABA) - albuterol, salbutamol
• anticholinergics - Atrovent

Question 6

what is the cornerstone of drug therapy for moderate persistent asthma?

Answer 6

inhaled corticosteroids

Question 7

treatment for status asthmaticus (5)

Answer 7

• emergency! go to ER
• IV fluids
• IV steroids
• potent systemic bronchodilator
• epinephrine
• O2 therapy

Question 8

risks for COPD

Answer 8

• cigarette smoking
• alpha-1 antitrypsin (AAT) deficiency - emphysema
• air pollution (occupation, etc.)

Question 9

complications of COPD

Answer 9

• hypoxemia, acidosis
• respiratory infections
• cardiac dysrhythmias, cardiac failure (cor pulmonale)
• acute respiratory failure

Question 10

CBC changes in COPD

Answer 10

high hemoglobin and hematocrit to compensate for decreased oxygenation

Question 11

drug therapy for COPD (5)

Answer 11

• beta-adrenergic agents
• anticholinergics
• methylxanthines
• mucolytics
• corticosteroids

Question 12

warning signs of lung cancer (5)

Answer 12

• hoarseness
• blood in sputum, hemoptysis
• persistent cough
• chest tightness/pain
• shoulder pain

Question 13

post-op care of lung cancer (lobectomy, wedge resection)

Answer 13

• chest-tube placement and care
• pain management
• respiratory management - possible mechanical ventilation

Question 14

obstructive sleep apnea (OSA) definition

Answer 14

breathing disruption during sleep that lasts at least 10 seconds and occurs at least 5 times an hour

Question 15

OSA manifestations

Answer 15

• heavy snoring
• excessive daytime sleepiness
• irritability, personality changes
• inability to concentrate
• headache

Question 16

how do you manage OSA?

Answer 16

non-invasive positive pressure ventilation (NPPV) during sleep:

• BiPAP - high pressure during inspiration, low pressure during exhalation
• CPAP - continuous positive airway pressure

Question 17

ABG changes for acute respiratory failure (ARF)

Answer 17

pO2 < 60 mmHg AND pCO2 > 50 mmHg

Question 18

what do you need to monitor for someone who is on mechanical ventilation? (9)

Answer 18

• vital signs
• ABGs
• breathing pattern (focused assessment)
• monitor for pulmonary infections (VAP)
• alarms - recognition and intervention
• DOPE = displaced tube, obstruction, pneumothorax, equipment problems

Question 19

causes of high pressure ventilator alarm (6)

Answer 19

• secretions, mucus plugs
• coughing, gagging, biting tube
• obstruction
• asynchrony (“fighting” ventilator)
• airway displaced or moved
• pulmonary complications - bronchospasm, pneumothorax, pneumonia

Question 20

causes of low pressure ventilator alarm (2)

Answer 20

• leak in circuit or cuff

- loss of spontaneous breathing or decreased respiratory effort