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Respiratory Therapy student 210-230 > RT230: Clinical Medicine II ( 230 study guide ) > Flashcards

RT230: Clinical Medicine II ( 230 study guide ) Flashcards

1
Q

Physiological effects of Peep/CPAP

A

All baseline pressers increase
MAP increases
FRC increases
Intrathoracic pressure increases
Increase Compliance

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2
Q

Goals of peep/CPAP

A

Increase tissue oxygenation
Maintain a PA02 >60 mmHg
Increase Lung compliance
Improve work of breathing
Prevent alveoli collapse and end-expiration

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3
Q

Hazards of PEEP/CPAP

A

Increase intrathoracic pressure
Decrease venous return
Decrease blood pressure
Decrease cardiac output, loss of the thoracic pump
Increase PVR
Increase ADH
Decrease lung compliance

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4
Q

Indications of PEEP/CPAP

A

Cardiogenic pulmonary edema
ARDS
Refractory hypoxemia
Recurrent atelectasis
Assist breath triggering with auto-peep

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5
Q

Contraindications of PEEP/CPAP

A

Unilateral lung disease
Hypovolemia
Hypotension
Increase ICP
Untreated tension pneumothorax

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6
Q

Indications of NIV

A

hypercapnic respiratory failure secondary to copd
Use of accessory muscles
Respiratory rate >25
Moderate to severe dyspnea

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7
Q

Exclusion criteria NIV

A

Apnea
Hemodynamic unstable
Uncooperative patient
Facial burns
Facial trauma
High risk of aspiration
Copious secretions
Anatomic abnormalities that interfere with gas delivery

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8
Q

Goals of NIV

A

Improve gas exchange
Rest respiratory muscles
Increase lung compliance
Avoid intubation
Decrease mortality, length of time on the ventilator, hospitalization, VAP, relieve symptoms of respiratory distress, improve patient-ventilator synchrony
Max patient comfort
Relieve/improve symptoms
Enhance the quality of life
Avoid hospitalization
Increase survival, mobility

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9
Q

Complications of NIV

A

Discomfort, facial skin necrosis, claustrophobic, nasal bride ulceration
Nasal congestion, sinus or ear pain
Nasal or oral dryness, eye irritation or gastric insufflation, air leaks
Aspiration pneumonia, hypotension, pneumothorax

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10
Q
  • *Respiratory acidosis ( lungs retaining too much Co2 )**
  • *how do kidneys compensate**
  • *pH <7.35, CO2 >45**
A

Kidneys excrete excess hydrogen & retain Bicarb

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11
Q
  • *Respiratory acidosis**
  • *Causes**
A

Drugs ( opioids & sedatives )
Edema ( fluid in the lungs)
Pneumonia
Respiratory center of brain is damaged
Emboli
Spasms of bronchial
Sac elasticity damage( COPD & emphysema )

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12
Q
  • *Respiratory Acidosis**
  • *Signs & symptoms**
A

Blood pressure
Respiration rate
Heart rate
Restlessness
Confusion
Headache
Sleepy/coma

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13
Q
  • *Respiratory acidosis**
  • *Interventions**
A

Administer O2
Semi Fowler position
Pneumonia: administer antibiotics
Monitor potassium level ( 3.5-5.0 range)

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14
Q
  • *Respiratory Alkalosis ( the lungs are losing too much CO2 )**
  • *How do the kidneys compensate**
  • *pH > 7.35, CO2 < 35**
A

The kidneys excrete excess Bicarb & retain Hydrogen

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15
Q

Causes of Respiratory Alkalosis

A

Increase in body temperature
Aspirin toxicity
Hyperventilation

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16
Q

Signs & Symptoms of Respiratory Alkalosis

A

Respiratory rate > 20
increase heart rate
Confused & tired
Tetany
EKG changes
(+) Chvosteke sign ( twitching of the facial muscles when tapping the facial nerve in response to hypocalcemia

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17
Q

Interventions for Respiratory Alkalosis

A

Provide emotional support
Fix the breathing problem
Encourage good breathing patterns
Rebreathing into a paper bag
Give anti-anxiety medications or sedatives to decrease the breathing rate
Monitor K+ and Ca levels

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18
Q

Flow of blood

A

Superior/inferior Vena Cava, right atrium, tricuspid valve, right ventricle, pulmonary valve, pulmonary artier, pulmonary capillaries, pulmonary veins, left atrium, mitral(bicuspid) valve, left ventricle, aortic valve, aorta, systemic

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19
Q

How to fix auto-peep

A

Decrease respiratory rate
Decrease tidal volume
decrease I time on I:E ratio ( increase E time )
( decrease minute ventilation which is the respiratory rate and tidal volume )

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20
Q

What are the three kinds of dead space

A

Anatomical
Alveolar
Physiological

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21
Q

What are three ways to improve ventilation

A

Tidal volume (the first thing you look at )
Respiratory rate
Dead space

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22
Q

What are three ways to improve oxygenation

A

FiO2
PEEP/CPAP/EPAP
MAP

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23
Q

What are the two methods of collection for end-tidal CO2 ( PETCO2 )

A

Mainstream uses an in-line analyzer placed between the airway and the ventilator circuit that heats the air and monitors the gas using an infrared source.
Sidestream uses a sampling tube to pump a small volume of gas continually from the ventilator circuit to an external device that measures the CO2

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24
Q

What are the uses of PETCO2

A

Assess trends in alveolar ventilation
Detect V/Q imbalance
Measure physiologic dead space
Detect esophageal intubation
Assess blow flow during cardiac arrest

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25
Q

Purpose of ventilator waveforms

A

Detect auto-PEEP, monitor patient-ventilator asynchrony, assess patient trigger effort, troubleshoot ventilator, determine breathe type, identify lung over-distention, minimize WOB, determine appropriate peep, assess effectiveness of bronchodilator administration, monitor patients disease status

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26
Q

Indications for CMV

A

Apnea, Inability to protect airway, hypoxemic respiratory failure, hypercapnia respiratory failure, impending respiratory failure, inadequate lung expansion, inadequate muscle strength, increase work of breathing

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27
Q

Goals of CMV

A

Support/manipulate gas exchange, maintain alveolar ventilation and arterial oxygenation, increase FRC, reduce WOB, minimize cardiovascular impairment, ensure patient-ventilatory synchrony, avoid lung damage, reverse hypoxemia, reverse acute respiratory acidosis, prevent or reverse atelectasis, reverse ventilator muscle dysfunction, decrease systemic or myocardial O2 consumption, maintain/improve cardiac output reduce icp, stabilize the chest

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28
Q

Negative effects of CMV

A

increase mean intrathoracic pressure
Ventilator-associated lung injury
Ventilator-associated pneumonia
oxygen toxicity

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29
Q

Positive effect of CMV

A

Decrease WOB
increase FRC
improve acid base imbalances

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30
Q

MODE OF VENTILATION ( in order from least to most imposed WOB )

A

CMV/AC
SIMV
PSV
CPAP

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31
Q

Tidal Volume(TV)

A

Volume of air inhaled or exhaled during each normal breath

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32
Q

Inspiratory Reserve Volume(IRV)

A

maximum volume of air that can be inhaled over and above the inspired tidal volume

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33
Q

Expiratory Reserve Volume(ERV)

A

maximum amount of volume that can be exhaled after exhaling a normal tidal breath

34
Q

Residual Volume(RV)

A

volume of air remaining in the lungs after a maximal exhalation

35
Q

Inspiratory capacity(IC)

A

the maximum amount of air that can be inhaled from resting end-expiratory level

36
Q

Total Lung Capacity(TLC)

A

maximum volume of gas in the lungs after a maximum inspiration

37
Q

Vital Capacity(VC)

A

maximum amount of air exhaled after maximal inhalation.

38
Q

Function Residual Capacity(FRC)

A

volume of air present in the lungs at end-expiration during tidal breathing

39
Q

PFT Indications

A

to identify and quantify changes in pulmonary functions
evaluate need and quantify therapeutic effectiveness
screen for pulmonary disease
assess patients for risk for postoperative pulmonary complications
determine pulmonary disability
differentiate between restrictive and obstructive diseases

40
Q

PFT contraindications

A

Hemoptysis
Pneumothorax
Myocardial infarction
pulmonary embolism
Nausea with recent vomiting-risk of aspiration
Recent cataract surgery
Patients with dementia or confusion

41
Q

PFT problems

A

Poor patient cooperation
Patient unable to follow commands
Patient unable to perform test
Failure to convert ATPS to BTPS
Poor quality assurance techniques

42
Q

What do spirometers measure?

A

everything but TLC, FRC, and RV

43
Q

What does respirometers measure

A

measure flow but display volume ( can measure Vt, Ve and VC )

44
Q

(PFT principles of measurement ) Sensitivity and specificity

A

this addresses the tests ability to detect disease or absence of it

45
Q

(PFT principles of measurement ) Validity

A

relates to the tests meaningfulness or the ability to measure what it is intended to measure

46
Q

(PFT principles of measurement ) Reliability

A

is the test consistency

47
Q

(PFT principles of measurement ) Capacity

A

refers to an instruments range or limits of how much it can measure

48
Q

(PFT principles of measurement ) Accuracy

A

how well an instrument measures a known reference value

49
Q

(PFT principles of measurement ) Error

A

difference between reference values and measured values

50
Q

(PFT principles of measurement ) Resolution

A

the smallest detectable measurement an instrument can make

51
Q

(PFT principles of measurement ) Linearity

A

accuracy of the instrument over its entire range of measurement

52
Q

(PFT principles of measurement ) Output

A

specific measurements made or computed by the instrument

53
Q

What are the three primary tests of PFT

A 
Spirometry (FVC, MVV, Reversibility, Bronchoprovocation Test )
Static lung volumes ( Helium Dilution, Nitrogen Washout, Plethysmography body box)
Diffusing capacity( Diffusing Capacity of the lungs for carbon monoxide [DLCO] )
54
Q

Candidates for Use of SIMV

A

Patients who are being weaned from CMV
Difficult to wean patients
May be used in place of CMV for most patient

55
Q

SIMV Advantages

A

May lower MAP as compared to CMV
Physiological advantage of spontaneous breathing
Variable work of breathing may maintain muscle strength and reduce muscle atrophy
Can be use for weaning and protocols
May reduce alkalosis and increased WOB associated with CMV
Full or partial support can be adjusted to meet patients needs
Patient may regulate their own acid base balance
sedation or paralysis are not required

56
Q

SIMV disadvantages

A

May not reduce MAP
Can increase WOB
Acute hypoventilation
Weaning is prolonged

57
Q

Indications of pressure support

A

use with any spontaneous breath
Any mode that allows spontaneous breathing
Very effective mode of weaning
Rebuild respiratory muscle strength
NIV BiPAP mode

58
Q

Pressure support Application ( what it does )

A

Assists patient’s inspiratory efforts, Decrease length of CMV, Decrease occurrence of VAP
Augment spontaneous volumes with minimal control of the breath, Decrease patient mortality, Used to overcome the imposed WOB ( Pouiselle’s law ), improve patient-ventilator asynchrony, patient-triggered, pressure-limited, flow cycled breath

59
Q

Pressure support Problems

A

Flow-cycled must be appropriately set to prevent patient-ventilator asynchrony, Patient trigger must be adequate to prevent asynchrony and increase WOB if level of PS exceeds Raw, ventilation is provided, Inadequate PS may increase RR, O2 consumption, and muscle fatigue

60
Q

Visceral pleura

A

Covers the lungs

provides mechanical support to the lungs

limits expansion which protects the lungs

61
Q

Parietal pleura

A

lines the inside of the thoracic cavity

62
Q

Pleural space

A

reduce friction between the two pleural surfaces as lungs expands and contract

63
Q

Chest Tube indications

A

remove blood, (pus, pleural fluid, or air) mediastinal drain post-operatively, prevent cardiac tamponade post-cardiac surgery, manage barotrauma from mechanical ventilation, Hemothorax, empyema, pneumothorax

64
Q

Complications of chest tube

A

infection, bleeding from intercostal artery laceration, extreme negative intrathoracic pressures from chest tube manipulation due to clotting, blood clots in tubing, subcutaneous emphysema

65
Q

Chest tube drainage systems

Collection, water seal, and suction chamber

A

collection- collects and measures fluid from the patient

water seal- acts as a one-way valve that prevents air from re-entering the lungs

suction- controls amount of suction

66
Q

Thoracentesis indication

A

Treatment of symptomatic pleural effusion

Treatment of empyema

Diagnostic analysis of pleural fluid

67
Q

Thoracentesis complications

A

Pneumothorax

infection

bleeding from lacerate intercostal artery

68
Q

Ventilator Waveforms Purpose

A

Detect auto-PEEP, Monitor patient-ventilator asynchrony, Assess patient trigger effort, Troubleshoot ventlator, Identify lung over-distention, minimize WOB, Determine appropriate PEEP, Assess effectiveness of bronchodilator, monitor patients disease status

69
Q

Factors affecting MAP

A

PEEP/CPAP, Peak pressure, Inspiratory time, Inspiratory pause, Vt, RR, Expiratory time, I:E ratio, Inspiratory flow wafeform

70
Q

Chronic Obstructive Pulmonary disease ( COPD is the third leading cause of death, according to 2010 results it caused 715,000 hospital admissions with total expenditure of 49.9 billion )

A

Cysitic Fibrosis, Bronchitis, Asthma, Broncheiectasis, Emphysema, Bronchiolitis

71
Q

Chronic Bronchitis

A

Chroic productive cough of unknown etiology for 3 consecutive months, for 2 or more successive years

72
Q

What causes Chronic Bronchitis

A

smoking, repeated infections, biomass and occupational exposure, outdoor air pollution

73
Q

Treatment of Chronic Bronchitis

A

remove patient from irritansts, bronchodilators, steroids, mucolytic, antibiotics, diuretics for fluid control, oxygen, bronchial hygiene, pulmonary rehabilitation

74
Q

Emphysema

A

condition characterized by abnormal, permant enlargement of the airspace beyond the terminal bronchiole, accompanied by destruction of the walls of the airspace without fibrosis

75
Q

Causes of Emphysema

A

smoking, long standing obstructive disease, outdoor air pollution, genetic emphysema

76
Q

Treatment of Emphysema

A

Remove from irritants, bronchodilators, steroids, antibotics, diuretics, oxygen, pulmonary rehabilitation, IV

77
Q

Asthma

A

inflammatory disease process with clincial manifestations of airway hyperresponsiveness and airway obstruction

78
Q

Asthma Epidemiology

A

Affects more than 25 millions Americans ( 8%of population ), over 27% are children, accounts for 25% of all emergency room visits, 14.2 million outpatient visits, 439,000 hospitalizations, 3,400 deaths, cost 56 billion in 2007 and growing

79
Q

Causes of Asthma

A

dust mites, cockroach, pollens, molds, pet dander, rodents, cigarette smoke, air pollution, wood and charcoal fire, strong fumes ( vapors, paint, perfume, gasoline, scented lotion/soap ), chemicals, dusts, colds, influenza, sinus infection, pneumonia, exercise, weather, emotions, medicines

80
Q

Treatment for asthma

A

NIV CPAP or BiPAP, mechanical ventilation with low tidal volume( possible permissive hypercapnia ), IV steroids and hour long bronchodilators, Belomethasone(QVAR),Fluticasone(Flovent), Budesonide(Pulmicort),Fluticasone/Salmeterol(Advair),Albuterol, Ipratropium bromide(Atrovent),Tiotropium(Spiriva),Acetylcysteine(Mucomyst), environmental control (remove or minimize triggers), patient education

Respiratory Therapy student 210-230 (2 decks)

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