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RCP 210 > Test 1 Study Guide > Flashcards

Test 1 Study Guide Flashcards

1
Q

Signs and symptoms of mild hypoxemia

A

Shortness of breath
mild respiratory distress
excitement
overconfidence
restlessness
anxiety
euphoria
lightheadedness
nausea
dizziness
fatigue
Increased respiratory rate
increased heart rate
mild hypertension
peripheral vasoconstriction

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2
Q

Signs and symptoms of moderate hypoxemia

A

a
Increased respiratory distress
agitation
impaired judgment
confusion
decreased night vision
disorientation
listlessness
headache
tingling
loss of coordination
Tachycardia
tachypnea
hyperventilation (increased minute volume), accessory muscle use,
intercostal retractions,
hypertension,
and cardiac arrhythmias

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3
Q

Signs and symptoms of severe hypoxemia

A

Severe dyspnea
confusion
somnolence
severe headache
visual disturbances
and slowed reaction time.
Slowed, irregular breathing,
cyanosis,
hypertension followed by hypotension, tachycardia followed by bradycardia, unconsciousness,
and coma.

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4
Q

Can help assess for the presence of infection (e.g., changes in neutrophil count, lymphocyte count, or monocyte count).

A

WBC

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5
Q

Allergic reactions will cause an elevated level of ____ and ____

A

elevated eosinophil count, elevated basophil count

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6
Q

Kills bacteria, fungi and foreign debris

A

Neutrophils

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7
Q

Cleans up damaged cells

A

Monocytes

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8
Q

Kills parasites, cancer cells, and allergic response

A

Eosinophils

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9
Q

Helps fight viruses and make antibodies

A

Lymphocytes

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10
Q

Involved in allergic response

A

Basophils

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11
Q

Causes of electrolyte disorders

A

Renal failure
Acid-base disturbances
Dehydration

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12
Q

Can be caused by kidney disease or muscle tissue breakdown

A

Elevated creatinine

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13
Q

May increase with kidney disease, dehydration or a high-protein diet.

A

Blood urea nitrogen (BUN)

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14
Q

Associated specifically with kidney disease

A

Elevated (BUN) and serum creatinine

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15
Q

Associated with liver disease, biliary obstruction or a hemolytic disorder

A

Elevated total bilirubin

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16
Q

How do electrolyte imbalances affect the body?

A

Electrolyte disturbances can affect the body’s acid-base balance.

◦Low potassium (↓K+) may cause a metabolic alkalosis (i.e., hypokalemic alkalosis).

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17
Q

Uses for ultrasound in the ICU

A

Cardiac - Hemodynamics and volume status, Cardiac output, Myocardial contractility, Ventricular function, Pericardial effusion, Cardiac tamponade

Lung - Diagnosis of pneumothorax, Identification of pleural effusion, Differentiating between lung consolidation, interstitial syndrome, Distinguishing between atelectasis and pneumonia.

To evaluate cerebral blood flow, Aid in thoracentesis, Placement of arterial or central venous lines, During cardiac resuscitation to assess cardiac standstill and fine ventricular fibrillation.

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18
Q

What causes Exudative pleural effusions

A

infection, cancer or pulmonary embolus

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19
Q

What causes Transudative pleural effusions

A

congestive heart failure, renal failure, liver failure, or cirrhosis.

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20
Q

Transudative vs. exudative effusions

A

Transudative: Occurs due to increased hydrostatic pressure or low plasma oncotic pressure.
(CHF, Cirrhosis, Nephrotic syndrome, PE)
++ LOW in protein and LDH

Exudative: Occurs due to inflammation and increased capillary permeability.
(Pneumonia, Cancer, TB, Viral infection, PE, Autoimmune)
++ HIGH in protein and LDH

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21
Q

These drugs are central nervous system (CNS) depressants.

*Lipid soluble (need to cross blood-brain barrier).

*Reduce both physical and mental acuity levels.

*Effects are dosage dependent

Produce relaxation and calming effect

A

Sedatives

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22
Q

commonly used, safe group of drugs that treat anxiety and insomnia. Administered PO, IV, or IM

A

Benzodiazepines:

Diazepam (Valium), alprazolam (Xanax), Lorazepam (Ativan), Midazolam (Versed), and temazepam (Restoril)

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23
Q

Most opioids are (schedule ___) drugs due to the danger of addiction

Opioids = Sedatives

A

Schedule II

Morphine, fentanyl, and hydromorphone

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24
Q

an anesthesia drug used in surgery and during certain medical tests and procedures that may not be well tolerated by the patient. Administered IV or IM.

A

Ketamine

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25
Q

most used parenteral (IV) anesthetic in the (U.S.)

A

Propofol (Diprivan)

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26
Q

a sedative used in the critical care setting to sedate mechanically ventilated patients. Administration IV

A

Dexmedetomidine (Precedex)

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27
Q

defined as the feeling of no pain

A

Analgesia

(Aspirin, Tylenol, NSAIDS)

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28
Q

most used nonopioid analgesic

A

Aspirin

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29
Q

The only depolarizing neuromuscular blocking agent (acetylcholine agonist). Administered IM or IV

A

Succinylcholine

30
Q

used clinically to facilitate endotracheal intubation and to provide skeletal muscle relaxation during surgery. Administered IM or IV.

A

Neuromuscular blocking agents

31
Q

a reversal agent for the treatment of opioid overdose. Administration SC, IM, or IV.

A

Narcan/Naloxone

32
Q

injection is used to revers the effects of nondepolarizing neuromuscular blocking agents. (3)

A

Edrophonium (Tensilon)
Neostigmine
Sugammadex

33
Q

reverses the effects of benzodiazepine

A

Flumazenil/Romazicon

34
Q

not a reversal agent but is effective in treating acetaminophen (Tylenol) overdose.

A

N-Acetylcysteine

35
Q

change the myocardial strength of contraction

A

Inotropes
Β1-adrenergic

36
Q

Inotropes

A

Norepinephrine
Phenylephrine
Epinephrine
Dopamine
Dobutamine

37
Q

Used in ACLS when patient fails to respond to adequate ventilation, defibrillation, and compressions or is refractory to vasopressors

Used when (pH) is (<7.15)
Will increase CO2 levels!!

A

Sodium Bicarbonate

38
Q

indicated for symptomatic bradycardia

A

Atropine

39
Q

due to the release of cellular inflammatory mediators associated with the use of large tidal volumes and pressures.

A

Ventilator Induced Lung Disease

40
Q

How do we prevent or minimize ventilator induced lung injury?

A

Pulmonary over-distension: ◦Tidal volumes reduced to (4 to 8 mL/kg) from (10 to 15 mL/kg (used since 1970’s)).

◦Atelectasis:◦Utilization of (PEEP) to avert atelectrauma

.◦Barotrauma:◦Minimizing alveolar distending pressures by keeping plateau pressures (<30 cm H2O)

.Additional strategies include; lung recruitment, permissive hypercapnia, the introduction of newer modes of pressure limited ventilation, and noninvasive ventilation.

41
Q

What is the (I:E ratio) if the (I-time) is (0.8 seconds) and (E-time) is (2.4 seconds)?

A

E-time/ I-time = I:E ratio

2.4 / .8 = 3
Answer = 1:3 ratio
E-time is (3 times) longer than I-time

42
Q

What is the (I:E ratio) if the (I-time) is (25% or .25

A

.25 / .25 : (1 – .25) / .25
1: .75 / .25
Answer = 1:3

43
Q

What is the (I:E ratio) if the (I-time) is (1.2 seconds) and the respiratory rate is (12)?

A

(E-time) = (60 / 12) – 1.2
(E-time) = 5 – 1.2
(E-time) = 3.8
(I:E) = 1.2 : 3.8
 Needs to be reduced.
Answer = 1 : 3.2

44
Q

Alveolar Ventilation Equation

A

(A) = (VT – VD) × f )
◦(500 – 150 mL) x 12 breaths = 4200 mL/min or 4.2 L/min

The alveolar ventilation equation is:
VA = (VT - VD) x RR, where:
VA: represents alveolar ventilation
VT: represents tidal volume
VD: represents dead space volume
RR: represents respiratory rate

45
Q

Approximately (1 mL/lb/IBW) or 2.2 mL/kg

Reduced in (½) when bypassing upper airway with an artificial airway

A

Anatomical Dead Space

46
Q

Examples include
Heat and moisture exchangers
Suction catheters
(MDI) or (SVN) adapters
Additional corrugated tubing

A

Mechanical Dead Space

47
Q

What is a healthy number for plateau pressure?

A

<30

48
Q

What is a healthy number for static compliance?

A

Untinbuated: 60-100
Intubated: 40-60

49
Q

Formula for static compliance

A

CST= VT/ Pplateau – PEEP

50
Q

Air trapping (dynamic hyperinflation) during expiration with positive pressure ventilation is called ______, or (intrinsic PEEP)

A

Auto PEEP

51
Q

How to calculate auto peep

A

(Total PEEP – set PEEP = auto-PEEP).

52
Q

Healthy number for mean airway pressure

A

5-10

53
Q

Factors that can increase mean airway pressure

A

Increased inspiratory time, (I:E ratio)
tidal volume
and extrinsic (PEEP)
decreased expiratory time and spontaneous breathing,
auto-PEEP,
decreasing inspiratory flow pattern,
low lung compliance,
and high airway resistance (RAW)

54
Q

What it means to Increase (PEEP) incrementally until adequate oxygen delivery (O2) or other related parameters are achieved

A

Optimal PEEP

Allows the alveoli to remain open with less pressure required to expand the lung

55
Q

The mechanism by which a ventilator initiates a patient breath is the ____ variable

A

Trigger Variable

56
Q

In this mode, The control variable can be either volume or pressure, and every breath is mandatory.

The patient may trigger inspiration (assisted breath), but every breath is machine cycled to expiration.
◦Commonly referred to as “assist control” ventilation.

A

Continuous Mandatory Ventilation (CMV or Assist/Control)

57
Q

In this mode, The control variable is volume and every breath is mandatory.

◦The patient can initiate inspiration, and the clinician set tidal volume is delivered with each breath

A

Volume Control - Continuous Mandatory Ventilation (VC-CMV) or (AC-VC)

58
Q

In this mode, The control variable is pressure, and the set inspiratory pressure is delivered with each breath.

◦The patient can initiate inspiration, and the clinician set inspiratory pressure is delivered with each breath

A

Pressure Control - Continuous Mandatory Ventilation (PC-CMV) or (AC-PC)

59
Q

This mode provides an inverse the (I:E ratio) and to improve gas distribution and (PaO2).

◦Commonly used for patients with (ARDS)

A

Pressure Control – Inverse Ratio Ventilation (PC-IRV)

60
Q

In this mode, The control variable can be either volume or pressure, and every breath is mandatory.

Combined time-triggered mandatory respiratory rate with a system to allow the patient to breathe spontaneously in between mandatory breath

A

Intermittent Mandatory Ventilation (IMV)

61
Q

Initial ventilator settings are usually set to provide full ventilatory support.

Based on patient’s response, the number of mandatory breaths can be then reduced, to provide partial ventilatory support, whereby patient must contribute a sufficient level of his or her required ventilation in the form of spontaneous breathin

A

Synchronized Intermittent Mandatory Ventilation (SIMV)

62
Q

provides patient triggered and patient cycled breaths at an elevated baseline pressure to increase (FRC) and improve gas exchange

Patient must be spontaneously breathing

A

CPAP

63
Q

Indications for CPAP

A

Improving oxygenation in patients with respiratory failure, prevention of atelectasis, treatment of cardiogenic pulmonary edema, patients undergoing spontaneous breathing trials (SBT’s) prior to extubation, and obstructive sleep apnea (OSA

64
Q

Provides for patient-triggered, pressure limited, flow-cycled ventilation which may be used as a stand-alone mode or in conjunction with IMV/SIMV.

May be further described as spontaneous breathing with inspiratory pressure augmentation, and may include the addition an elevated baseline (PEEP/CPAP

A

Pressure Support Ventilation (PSV)

65
Q

The intent of this mode is for ventilation and oxygenation in patients with regional lung compliance heterogeneity and severe oxygenation problems, most commonly for (ARDS) patients

Provides two levels of (CPAP) that are time triggered, and time cycle. Patient may breathe spontaneously at both levels

A

Airway Pressure Release Ventilation (APRV)

66
Q

Automated form of ventilatory support that adjusts level of support provided based on patient’s measured inspiratory flow, elastance, and resistance

A

Proportional Assist Ventilation (PAV)

67
Q

Delivers a volume-targeted, pressure-controlled breath.
An adaptive targeting scheme is employed in which the ventilator automatically adjusts pressure between breaths to reach the targeted volume in response to varying patient conditions.

A

Pressure-regulated Volume Control (PRVC

68
Q

Can be used in spontaneously breathing patients not requiring time-cycled, machine delivered breaths

, the (PSV) level is automatically adjusted to achieve a volume target

A

Volume Support (VS)

69
Q

A dual control mode available for a patient with variable respiratory drive (fatigue, irritability, pain, changing lung mechanics, intermittent apnea) which switches between controlled and supported ventilation based on the patient effort

A

Auto mode

70
Q

Closed-loop, automated ventilation that combines aspects of pressure support and pressure control to adjust the amount of support needed to achieve the target minute volume based on changes in respiratory mechanics and patient inspiratory effort

A

Adaptive Support Ventilation (ASV)

71
Q

Dual control mode that monitors gas flow and volume during inspiration to ensure a preset (VT) is delivered. ◦Breaths are patient-triggered, pressure limited, and flow cycle

A

Volume Assured Pressure Support (VAPS)

72
Q
A

RCP 210 (5 decks)

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