Test 1 Flashcards
What is ventilation?
the inspiration and expiration of air, O2 exchange
If CO2 is decreased, what happens with the pH?
pH increases
If CO2 is increased, what happens with the pH?
pH decreases
What is alkalosis?
high pH >7.45
What is acidosis?
low pH <7.35
When do you hear crackles in lung sounds?
fluid overload
What is wheezing?
Rhonchi - inflammatory
What is stridor?
high-pitched during inspiration
What do you do if you hear stridor?
HUMIDIFY! Emergent!!
What are the local effects of respiratory disease?
cough, SOB, hemoptysis, pleuritic chest pain, clubbing of fingers ( long term), cyanosis, mucus production
What does rust colored sputum indicate?
pneumonia
What does pink foamy sputum indicate?
pulmonary edema or embolism
What are systemic effects of respiratory disease?
fever, anorexia, malaise, restlessness, anxiety, diaphoresis, changes of LOC, changes in oxygen saturation, cyanosis, tachycardia.
What are chest configurations of respiratory disease?
barrel chest, funnel chest, pigeon chest, and kyphoscoliosis
What causes barrel chest?
typical of COPD, caused by hyperinflated alveoli
What are modifiable risk factors of respiratory disease?
obesity, smoking, CAD, DM, stress and anxiety, and allergens
What are some diagnostic tests of respiratory disease?
CXR, culture & sensitivity & gram stain, incentive spirometry, ABG’s & CBC, pulmonary function test, bronchoscopy, thoroscopy, thoracentesis, pulmonary angiography, pulse ox, CT, MRI, & lung scans, and Capnography
What is the most noninvasive diagnostic test of respiratory function?
pulse ox
What does capnography measure?
exhaled CO2
When do you hear crackles in lung sounds?
fluid overload
What is wheezing?
Rhonchi - inflammatory
What is stridor?
high-pitched during inspiration
What do you do if you hear stridor?
HUMIDIFY! Emergent!!
What are the local effects of respiratory disease?
cough, SOB, hemoptysis, pleuritic chest pain, clubbing of fingers ( long term), cyanosis, mucus production
What does rust colored sputum indicate?
pneumonia
What does pink foamy sputum indicate?
pulmonary edema or embolism
What are systemic effects of respiratory disease?
fever, anorexia, malaise, restlessness, anxiety, diaphoresis, changes of LOC, changes in oxygen saturation, cyanosis, tachycardia.
What are chest configurations of respiratory disease?
barrel chest, funnel chest, pigeon chest, and kyphoscoliosis
What causes barrel chest?
typical of COPD, caused by hyperinflated alveoli
What are modifiable risk factors of respiratory disease?
obesity, smoking, CAD, DM, stress and anxiety, and allergens
What is the purpose of long-acting control meds?
prevents asthma attacks
What is the most noninvasive diagnostic test of respiratory function?
pulse ox
What does capnography measure?
exhaled CO2
What is the purpose of a bronchoscopy?
check for abnormalities, remove foreign objects, biopsy
What is important to remember post-procedure for a bronchoscopy?
their gag reflex must return before given liquids
What is the purpose of a thoracentesis?
to remove fluid from the thoracic cavity
What is a complication with a thoracentesis?
possible pneumothorax
What is the purpose of a pulmonary function test?
determine lung capacity
What are some general oxygenation interventions?
O2, HOB elevation, suction, incentive spirometer, flutter valve, nebulizer treatments, pharmacology, chest tubes, life style change, stop smoking, avoid irritants, pulmonary hygiene, exercise, and hydrate.
What is asthma?
a chronic inflammatory disease. intermittent obstruction due to inflammation of the airway.
What are clinical manifestations of asthma?
SOB, wheezing, tightness in chest, tachypnea, hyperventilation, tachycardia, non-productive cough ( night/early AM), wheezing noted in lung fields, anxiety and apprehension.
What occurs with hyperventilation?
decrease CO2 (respiratory alkalosis) turns into increase CO2 (respiratory acidosis) if chronic
What is status asthmaticus?
asthma attack not responding to meds in 30 min. is an emergency. may lead to respiratory failure. possible intubation.
What are the long acting control (anti-inflammatory) drugs?
Steroids (corticosteroids)
Leukotriene modifiers
Mast Cell Stabilizers
What is the purpose of long-acting control meds?
prevents asthma attacks
What are the quick relief meds (bronchodilators)?
Beta 2 agonists
Anticholinergic
Methylxanthines
What is the drug of choice for bronchospasm?
short-acting beta 2
What are some examples of short acting beta 2 agonists?
albuterol, epinephrine, Advair, & alupent
What are some side effects of short acting beta 2 agonists?
nervousness, insomnia, tremors, tachycardia.
What is the purpose of short acting beta 2 agonists?
rapid onset, rescue. relieves air-flow obstruction
What are anticholinergics?
a potent bronchodilator
What is anticholinergics most used for?
COPD
What are some examples of anticholinergics?
Atrovent, Spiriva, and comibvent (albuterol & Atrovent)
What are some interventions with asthma?
assess patency of airway. administer humidified O2, monitor VS, pulse ox, skin, temp, & LOC, administer rescue inhaler. initiate IV line for dehydration, acidosis, or electrolyte imbalance, prepare to obtain ABGs, and relieve anxiety.
What are methylxanthines?
MDI or Dry powder inhaler. bronchodilator.. adjunctive threatment for ashtma
What are examples of methylxanthines?
aminophylline and theophylline
What is the therapeutic effect of theophylline?
10-20 mcg/mL
What are the long acting control (anti-inflammatory) drugs?
Steroids (corticosteroids)
Leukotriene modifiers
Mast Cell Stabilizers
What are some interventions for bronchitis?
monitor for respiratory distress. provide cool, humidified air. monitor for signs of dehydration, increase fluid intake, administer Tylenol for fever, short term steroid therapy.
What is important to remember with long acting control drugs?
administer AFTER bronchodilators
What does corticosteroids do?
increases effectiveness of beta 2s
What are some examples of corticosteroids?
Flovent, azmacort, solumedrol, and decadron
What are examples of leukotriene modifiers?
singulair, zyflo, accolate, ultair
What is important to remember with mast cell stabilizers?
its used in prevention not with acute asthma attacks
What are nursing interventions for a patient with emphysema?
assess respiratory status, low O2 concentration/pulse ox. fluid intake/I&O, positioning, administer appropriate medications, diet - decrease sodium, encourage smoking cessation. decrease exposure to irritants and allergens
What should you remember with O2 administration with COPD patients?
No more than 2L of oxygenation, body becomes used to more CO2 and can be normal for patients O2 SATs to be in the high 80s/low 90s
What are some good teaching for asthma?
Identify & avoid triggers, peak flow monitoring, medications, use of MDIs, what to do in an attack, pursed-lip breathing, fluids.
What are some interventions with asthma?
assess patency of airway. administer humidified O2, monitor VS, pulse ox, skin, temp, & LOC, administer rescue inhaler. initiate IV line for dehydration, acidosis, or electrolyte imbalance, prepare to obtain ABGs, and relieve anxiety.
What is chronic obstructive pulmonary disease?
Chronic airway obstruction
What is the biggest risk factor of COPD?
Smoking
What is chronic bronchitis?
cough w/mucous that lasts more than 3 months in 2 consecutive years. airway edema. increased mucous production. impaired airway clearance
What are bronchitis symptoms?
productive cough. right heart failure signs (edema, JVD, cyanosis, liver engorgement), cardiomegaly, lungs - rhonchi and wheezing, respiratory acidosis. hypoxemia, hypercapnia, decreased lung capacity, pulmonary hypertension.
What causes stridor?
obstruction of the upper airway
What is a pink puffer?
patient with emphysema
thin, pursed lips, barrel chest
What is a blue bloater?
Chronic bronchitis.
cyanotic. edema.
What is emphysema?
enlarged alveoli, trapped air. easy to breathe in, hard to breathe out.
What are symptoms of emphysema?
exertional dyspnea. cough. absent or mild scant clear sputum. weight loss. barrel chest. diminished breath sounds. use of accessory muscles. position of choice, lean forward or sitting. expiratory phase prolonged. pursed-lips
What is the treatment for emphysema?
bronchodilators, antibiotics, vaccines, oxygen, pulmonary rehabilitation, steroids, AT replacement therapy, surgery, complementary therapies.
What are nursing interventions for a patient with emphysema?
assess respiratory status, low O2 concentration/pulse ox. fluid intake/I&O, positioning, administer appropriate medications, diet - decrease sodium, encourage smoking cessation. decrease exposure to irritants and allergens
What should you remember with O2 administration with COPD patients?
No more than 2L of oxygenation, body becomes used to more CO2 and can be normal for patients O2 SATs to be in the high 80s/low 90s
What are Cheyne-stokes respirations?
a breathing pattern characterized by a period of apnea, followed by gradually increasing depth and frequency of respirations.
What is fremitus?
vibrations felt while a patient is speaking and the examiners hands are held against the chest.
Most common types of prerenal acute renal failure?
trauma, surgery, critically ill patients - HTN, hypovolemia, burns, sepsis.
What is kussmal breathing?
very deep, gasping type of respirations associated with DKA and coma.
What is pleura?
serous membrane covering both lungs and the walls of the thorax and diaphragm.
What is pursed lip breathing?
partial closing of the lips to allow air to be expired slowly, used by patients with COPD.
What causes stridor?
obstruction of the upper airway
What is the purpose of the kidney?
regulates body fluids, filters waste, and eliminates metabolic wastes
What is urine output is indicative of kidney failure?
400mL/day or less
What happens with your potassium levels when you hold urine?
potassium increases
What is kidney failure?
kidneys unable to remove metabolites from blood
Is kidney failure reversible?
only if caught in time, less than 3 months.
What is acute renal failure?
rapid decline in renal function with azotemia (increased level of nitrogen), electrolyte imbalances
What are the most common causes of acute renal failure?
ischemia and exposure to nephrotoxins
What are the risk factors for Acute Renal Failure?
major trauma or surgery, infection, hemorrhage, severe heart failure, severe liver disease, lower urinary tract obstructions, older adults, children with renal insufficiency
What is prerenal acute renal failure?
results from conditions that affect renal blood flow into the kidney and perfusion.
Most common types of prerenal acute renal failure?
trauma, surgery, critically ill patients - HTN, hypovolemia, burns, sepsis.
What reverses prerenal ARF?
blood flow being restored
What is intrinsic (intrarenal) ARF?
acute damage to renal parenchyma and nephrons
What causes intrinsic ARF?
kidney disease, acute tubular necrosis, NSAIDs. acute glomerulonephritis, vascular disorders.
What is the most common intrinsic ARF?
acute glomerulonephritis - inflammation reduces renal blood flow.
What is the most common kidney disease?
acute tubular necrosis
What is acute tubular necrosis?
destruction of tubular epithelial cells, primarily caused by prolonged ischemia.
What is a normal phosphate level?
2.5-4.5 mg/dL
What are some nephrotoxins associated with ATN?
aminoglycoside antibiotics, radiological contrast media, other drugs (NSAIDs, chemotherapy), heavy metals,, and common chemicals.
What is Rhabdomyolysis?
muscle breakdown, causing tea-colored urine
What is postrenal ARF?
obstructive cause of renal failure that prevents urine excretion. urine backs up into kidney
What are causes of postrenal ARF?
BPH-most common, renal tumors, urinary tract calculi
What are the risk factors for Acute Renal Failure?
major trauma or surgery, infection, hemorrhage, severe heart failure, severe liver disease, lower urinary tract obstructions, older adults, children with renal insufficiency
What are diagnostic test of ARF?
urinalysis, serum creatinine, BUN, electrolytes, ABGs, CBC, renal ultrasound, CT, IVP, retrograde, antegrade pyelography. Renal biopsy, radiographic studies.
What are the phases of acute renal failure?
Initiation phase
Maintenance phase - oliguric & diuretic
Recovery phase
What occurs with the initiation phase of ARF?
onset until S/S. lasts hours to days. begins with event, ends with tubular injury. often asymptomatic.
What occurs with the maintenance phase of ARF?
significate fall in GFR. tubular necrosis. oliguria, edema, muscle weakness, nausea, diarrhea, ECG changes, possible cardiac arrest, hyperphosphatemia, hypocalcemia, metabolic acidosis, anemia, confusion, seizures, coma, hyperreflexia, uremic syndrome.
What occurs in the recovery phase?
kidney gradual return to normal. improvements seen in 5-25 days. takes up to one year. tubule cell repair, regeneration. Serum creatinine, BUN, Potassium, phosphate levels remain high.
What to remember with AV fistulas?
no BPs on arm with AV fistula.
assess AV fistula for brute (listen) or thrill (feel). Do not draw blood on arm with AV fistula.
What is a normal BUN level?
7-20 mg/dL
What is a normal potassium level?
3.5-5.3 mEq/L
What does it mean when the liquid of the peritoneal dialysis is cloudy?
infection, peritonitis.
How to prevent ARF?
maintain vascular volume, cardiac output, blood pressure, avoid nephrotoxic drugs, if nephrotoxic drug necessary - use minimum effective dose, maintain hydration, eliminate other known nephrotoxins.
What is Chronic Kidney Disease?
gradual destruction of nephron units. progresses over months, years. proteinuria contributes to tubule injury. nephron loss may continue after initial disease process resolved
What diet should someone with ARF follow?
decrease Na, decrease K, decrease protein. Increase carbs, increase biologic proteins.
What are some S/S of ARF?
anemia, fatigue, pallor, dizziness, tachycardia, tachypnea, hypotension. fluid volume excess, pitting edema, crackles, tachycardia. hyperkalemia, tall peaked waves, paresthesia, muscle weakness.
What should you give an ARF patient with hyperkalemia?
give kayexolate
What are diagnostic test of ARF?
urinalysis, serum creatinine, BUN, electrolytes, ABGs, CBC, renal ultrasound, CT, IVP, retrograde, antegrade pyelography. Renal biopsy, radiographic studies.
What is the pharmacologic therapy for ARF?
Dopamine - increases renal blood flow, vasodilator
loop diuretic (furosemide, Lasix) - pee it out
osmotic diuretics (mannitol) - rid of edema
electrolytes - fix electrolyte imbalance
blood volume expanders
IV fluids
What is important with nutrition in ARF?
limit protein to 0.6 g/kg, proteins of high biological value (red meat, fish, gg), increase carbs.
What is dialysis?
renal replacement therapy. acts as kidneys. diffusion of solutes across semipermeable membrane. rapidly removes nephrotoxins in ATN
What is hemodialysis?
removes electrolytes, waste products, and excess water. not used in hemodynamically unstable patients. done 3-4 x a week.
What is the dietary modifications for chronic kidney disease?
restrict protein intake. increase carbs. avoid salt substitutes, eggs, dairy products, and meat.
What is Continuous renal replacement therapy?
allows gradual fluid, solute removal. blood continuously circulated for 12 hours. for patients who are unable to tolerate hemodialysis.
What is peritoneal dialysis?
dialysate instilled into peritoneal cavity for every 4-6 hours. peritoneal membrane serves as dialyzing surface. the fluid removed. less risk for unstable patient. fluid, solutes removed gradually. increased risk for peritonitis.
What does it mean when the liquid of the peritoneal dialysis is cloudy?
infection, peritonitis.
What are signs of renal failure?
weakness, shortness of breath, lethargy, confusion, and generalized swelling.
What is Chronic Kidney Disease?
gradual destruction of nephron units. progresses over months, years. proteinuria contributes to tubule injury. nephron loss may continue after initial disease process resolved
What is oliguria?
<400 mL/day or <30 mL/hr
What are causes of Chronic Renal Failure?
diabetic nephropathy, hypertensive nephrosclerosis, chronic glomerulonephritis, chronic pyelonephritis, polycystic kidney disease, and systemic lupus erythematosus.
What are risk factors for chronic kidney disease?
bilateral kidney disease, diabetes mellitus, hypertension, older adults, and African American
How do you prevent chronic kidney disease?
aggressive management of chronic disease. low sodium diet. regular exercise. avoid smoking. limit alcohol intake.
What are clinical manifestations of chronic kidney disease?
**see notes
What are the goals for treatment of chronic kidney disease?
maintain nutritional status. identify, treat complications. prepare for renal replacement therapies.
What are the diagnostic tests for chronic kidney disease?
urinalysis. urine culture. BUN and serum creatinine levels. creatinine clearance. serum electrolytes. CBC. renal ultrasound. kidney biopsy.
What is the pharmacologic therapy for hyperkalemia?
bicarb, glucose, and insulin.
What is the treatment for Chronic Kidney Disease?
hemodialysis, peritoneal dialysis, kidney transplant.
What is the treatment of choice for ESRD?
kidney transplant
What are the complications of rejection of kidney transplant?
HTN, nephrosis, increased risk of MI, stroke, infection.
What is a normal pH?
7.35 to 7.45
What is normal paCO2?
45-35
What is normal HCO3?
22-26
What occurs when you increase the rate and depth of inspiration?
eliminates co2. increases pH
What is acidosis?
pH below 7.35
What is alkalosis?
pH above 7.45
What are the S/S of metabolic acidosis?
weakness, fever, malaise, headache, changes in LOC, cardiac dysrhythmias, low BP, warm, flushed skin, muscle twitches, kussmaul respirations.
What are risk factors of metabolic acidosis?
shock or cardiac arrest. ketoacidosis. diarrhea. acute or chronic renal failure.
Treatment of metabolic acidosis?
sodium bicarb. insulin. o2. iv fluids.
What is metabolic acidosis?
pH below 7.35
low bicarb, less than 22
What is metabolic alkalosis?
high pH >7.45
high bicarb, >26
What causes metabolic alkalosis?
steroid use. ng suctioning. vomiting. diuretics
What are risk factors of metabolic alkalosis?
hospitalization. hypokalemia. treatment with bicarb.
What are S/S of metabolic alkalosis?
numbness/tingling around mouth, fingers, and toes. dizziness. trousseau signs. muscle spasms. decreased respirations. respiratory acidosis.
What is respiratory acidosis?
pH less than 7.35
PaCO2 greater than 45
What are causes of respiratory acidosis?
chest trauma. aspiration of foreign body. acute pneumonia. overdose. COPD. asthma. cystic fibrosis. MS.
What are S/S of respiratory acidosis?
Acute: blurred vision. irritability. mental cloudiness. skin warm, flushed. pulse elevated.
Chronic: weakness, dull headache, sleep disturbances, impaired memory. personality changes.
What is respiratory alkalosis?
pH greater than 7.45
paCO2 is less than 35
What is always the cause of respiratory alkalosis?
hyperventilation
What are the causes of hyperventilation?
high fever. hypoxia. gram-neg bacteria. anesthesia. mechanical ventilation. aspirin overdose.
What are S/S of respiratory alkalosis?
light-headedness. feeling of panic and difficulty concentrating. tremors. Chvostek sign and trousseau sign. tinnitus. chest tightness, palpitations. seizures and LOC.
