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168.362 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What is ventilation?

A

The exchange of air between the lungs and the external atmosphere so oxygen can be exchanged for CO2 in the alveoli

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2
Q

What is diffusion?

A

The exchange of gases (O2 and CO2) between the lungs and the blood

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3
Q

What is perfusion?

A

The passage of fluid through the circulatory system to organs in the body

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4
Q

What is normal ventilation?

A

Normal transfer of oxygen into the lungs and transfer of carbon dioxide through the blood

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5
Q

What is respiratory failure?

A

A condition that occurs as a result of one or more diseases involving the lungs or other systems. Pathophysiological condition affecting lung function, O2 delivery, cardiac output or the baseline metabolic state

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6
Q

What is type 1 respiratory failure?

A

Failure of oxygenation resulting in hypoxia with normal PaCo2

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7
Q

What is type 2 respiratory failure?

A

Failure of ventilation resulting in both hypoxemia and hypercapnia

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8
Q

What is hypoxemia?

A

Normal PaCO2
Decreased Pao2
Decreased Sao2
Poor oxygenation of the blood

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9
Q

What is hypercapnia?

A

Increased PaCO2
pH over 7.35mmHg
Failure of ventilation and insufficient CO2 removal

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10
Q

What are examples of hypoxemia?

A

Pneumonia, Shock, Pulmonary edema, Asthma, PE, Pneumothorax

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11
Q

What are examples of hypercapnia?

A

Asthma, COPD, Sedative and or opioid overdose, Brain stem infarction,

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12
Q

What are some signs and symptoms of respiratory failure?

A

Sudden development or chronic

Gradual change in Pao2 and PaCo2 - compnensation

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13
Q

What would be the expected signs and symptoms patients would exhibit as their respiratory function decreased?

A

Restlessness
Paradoxical breathing
Change in manner of speech (sentences to jumbled up words)
Respiratory rate (Change from fast to slow)
Posture,
Air hungry
Accessory muscle use

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14
Q

What is ARDS?

A

High mortality rate
Sudden and progressive form of ARF where the alveolar capillary interface becomes damaged and more permeable. Fluid containing proteins fills alveoli resulting in severe dyspnoea and hypoxemia refractory to supplemental O2.
Causes an inflammatory chain reaction

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15
Q

What is the treatment for ARDS?

A 
Intubation & mechanical
support
Oxygen
Circulatory support
Adequate fluid volume
Nutritional support
ABG monitoring
Continuous vital sign
monitoring –Art line,
cardiac monitor, SV02
Positioning in bed
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16
Q

What is pneumonia?

A

An acute inflammation of the lung parenchyma with associated symptoms.

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17
Q

How do organisms reach the lung?

A

Aspiration of normal flora nasopharynx or oropharynx
Inhalation of microbes
Haematogenous spread from primary infection elsewhere.

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18
Q

What are the types of pneumonia?

A 
Bacteria
Virus
Mycoplasma organism
Fungi
Parasite
Chemical
Community (CAP)
Medical care acquired (MCAP)
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19
Q

What are the three forms of MCAP?

A

Hospital (HAP) - 48 hrs or greater after hospitilisation
Ventilator (VAP)
Healthcare (HCAP)

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20
Q

Main symptoms of pneumonia?

A 
High fever
Chills
Cough with sputum or phlegm
Shortness of breath
Pleuritic chest pain
Fatigue
Muscle ache
Headache
Appetite loss
Low BP
High HR
Nausea, vomiting
Pain
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21
Q

What is CURB-65?

A

C- confusion
U- BUN (Greater than 19.6 mg/dL)
R- Respiratory rate (30 or greater breaths/min)
B- BP (SBP less than 90, DPB less than 60)
65- Patient age is 65 or older.

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22
Q

What are some subjective nursing assessment for patient with acute resp, infection

A

Past health history
Medications
Surgery or other treatment
Functional health patterns

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23
Q

What are some objective nursing assessments for patient with acute resp. infection?

A 
General
Respiratory
Cardiovascular
Neurological
Possible diagnosis findings
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24
Q

What are some diagnositc studies for pneumonia?

A 
History and physical examination
CXR
Gram stain sputum
Sputum culture
ABG's
Blood cultures (if fever present)
FBC and Lytes
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25
Q

Collaborative care for pneumonia?

A 
Appropriate antibiotic therapy
Increased fluid intake/IVF
Limited activity and rest
Antipyretics
Analgesics
O2 therapy - SPo2/ABG dependent
Chest physiotherapy
Nutritional therapy and hydration
26
Q

What are interventions foe pneumonia?

A 
O2 therapy
Mobilisation of secretions
Effective coughing and positioning
Hydration and humidification
Chest physiotherapy
Airway suctioning
Drug therapy
Relief of bronchospasm
Reduction of airway inflammation, pulmonary congestion
Treatment of pulmonary infections
Reduction of anxiety, pain and agitation
Medical supportive therapy
Treating the underlying cause
Maintaining adequate cardiac output
Maintaining adequate hemoglobin concentration
Nutritional therapy
27
Q

What is the early phase of asthma?

A

Peak is 30-60 min

28
Q

What is the late phase of asthma?

A

Can recur 4-6 hours after the early phase

29
Q

What happens during an asthma attack?

A 
Bronchospasm
Vascular congestion
Oedema formation
Mucus secretion
Impaired mucocilliary function
Thickening of airway walls
Leads to Bronchial hyper-responsiveness and airway obstruction
30
Q

When do severe and life-threatening asthma exacerbation occur?

A 
Dysponeic
Speaks in words not sentences
Sitting forward to maximise diaphragmatic movement with prominent wheezing
Respiratory rate greater than 30
Accessory muscles in neck are straining
Patient is agitated
31
Q

What is step 1 to treating asthma?

A

SABA as required

32
Q

What is step 2 to treating asthma?

A

Low-dose ICS
LTRA
Theophyllin

33
Q

What is step 3 to treating asthma?

A

Low dose ICS + LABA
Medium-dose ICS
Low dose ICS + LTRA/theophyllin

34
Q

What is step 4 to treating asthma?

A

Medium dose ICS + LABA

Medium dose ICS + LTRA/theophyllin

35
Q

What is step 5 to treating asthma?

A

High dose ICS + LABA

Consider omalizumab for patients who have allergies

36
Q

What is step 6 to treating asthma?

A

High dose ICS + LABA + oral corticosteroid

Consider omalizumab for patients who have allergies.

37
Q

What is pursed lipped breathing?

A 
Helps prolong exhalation
Prevents collapse of bronchioles
Prevent air trapping
Slows respiratory rate
Inhale slowly through the nose and exhale slowly three times and more through pursed lips.
38
Q

What is Arterial Blood Gas (ABG)?

A

Blood sample taken from an artery by a special syringe and needle
Measures acidity (pH)
Measures levels of oxygen (pO2) and carbon dioxide (pCO2)
Measures how well lungs are functioning
Performed by Dr’s or advanced practice nurses

39
Q

What are the ABG components?

A 
pH
PaO2
PaCO2
HCO3
SaO2
40
Q

What is normal pH?

A

Acid Alkaline

41
Q

What is normal PaO2?

A

Hypoxemia Over-oxygenated.

42
Q

What is normal PaCO2?

A

Alkaline, Hypocapnia Hypercapnia, Acid

43
Q

What is normal HCO3?

A

Acid, Metabolic acidosis Metabolic alkalosis, Alkalosis

44
Q

What is normal SaO2

A

Low saturations

45
Q

What happens in acid conditions of the body?

A

Presence of ketoacids (ketones)
Lactic acids
Hydrochloric acids

46
Q

What happens in alkaline conditions of the body?

A

A result of several metabolic processes
Ingestion of too much antacids
Prolonged D&V’s, gastric suctioning
Some diuretics, hypokalemia, hypomagnesemia, laxative abuse

47
Q

What are the types of buffers?

A

Buffer System (chemical) - most rapid regulation
Respiratory Buffer - controls CO2, rapid regulation
Renal Buffer - controls bicarbonate, slowest regulation

48
Q

What is the main extracellular buffer?

A

Bicarbonate - carbonic acid buffer

49
Q

What is pH?

A

Measures acidity or alkalinity of a solution which depends on the number//concentration of H+ ions
Higher H+ = acidosis
Lower H+ = alkalosis

50
Q

How to interpret an ABG result?

A

Focus on pH, PaCO2 and HCO3

1: check each component against it’s normal value
2: assess the PaCO2 to determine the primary problem - respiratory or metabolic
3: assess the HCO3 to determine the type of problem by matching pH with PaCO2 and HCO3

51
Q

What are the ABG indications of respiratory acidosis?

A

pH less than 7.35

CO2 greater than 45

52
Q

What causes respiratory acidosis?

A

Obstruction of gas exchange or hypoventilation
Severe pneumonia, pulmonary oedema, asthma
Impaired mechanics of breathing

53
Q

What are the symptoms of respiratory acidosis?

A

H/A, blurred vision, restlessness, confusion, lethargy, dyspnea,
tachycardia, respiratory distress, shallow resps, convulsions, coma

54
Q

What are the ABG indications for respiratory alkalosis?

A

pH greater than 7.45

CO2 less than 35

55
Q

What causes respiratory alkalosis?

A

Hyperventilation, pain, fear, anxiety, leads to elimination of lots of Co2 (hypocapnia) being blown off by tachypnea

56
Q

What are the ABG indications for metabolic acidosis?

A

pH less than 7.35

HCo3 less than 22

57
Q

What are the causes of metabolic acidosis?

A

Not enough base or alkali in the blood and too much acid, shock, DKA, renal failure, diarrhoea, diuretics, certain drugs

58
Q

What are the manifestations of respiratory alkalosis?

A

Dizziness, confusion, paraesthesia, convulsions, restlessness, spasms
in fingers/toes, tetany, coma

59
Q

What are the manifestations of metabolic acidosis?

A

H/A, lethargy, Kussmaulresps, N&V, diarrhoea, arrhythmias, coma,
death

60
Q

What are the ABG indications for metabolic alkalosis?

A

pH greater than 7.45

HCo3 greater than 26

61
Q

What are the causes for metabolic alkalosis?

A

Excess base/bicarbonate or too little acid, excessive antacids, gastric suctioning, excessive vomiting

62
Q

What are the manifestations of metabolic alkalosis?

A

Dizziness, lethargy, weakness, muscle cramps & twitching, cramps,
tetany, shallow & slow resps, tachycardia, coma

168.362 (8 decks)

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