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211 > TEST 2 > Flashcards

TEST 2 Flashcards

1
Q

What is the neurochemical control of ventilation?

A

Respiratory center
Central and peripheral chemoreceptors

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2
Q

What are the mechanics of breathing?

A

Major and accessory muscles
Lung elasticity
AIrway resistance
Alveolar surface tension
Work of breathing

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3
Q

What is Gas Transport for breathing

A

Distribution of ventilation and perfusion
Oxygen transport
Carbon dioxide transport

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4
Q

What is control of pulmonary circulation

A

Distribution of pulmonary blood flow

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5
Q

What is negative pressure breathing

A

Air moves from higher pressure to lower pressure

During inspiration: Diaphram and intercostal muscles contract expanding lungs. This creates an increase in volume and a decrease in pressure causing outside air to flow in

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6
Q

Hypoxemia

A

Low levels of 02 in blood

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7
Q

Hypoxia

A

Decreased tissue oxygenation

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8
Q

How many liters can a nasal cannula give

A

2-6L
After 4 make sure it is humidified

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9
Q

How many liters can a simple face mask give?

A

6-10L

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10
Q

How many liters can a non-rebreather give?

A

10-15L

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11
Q

**

Difference between a partial and full non-rebreather?

A

Partial - No one-way valves, allows patient to rebreathe some exhaled air which mixed with fresh oxygen, typically delivers 40-70% oxygen

**Non-rebreather **- one-way valves which prevent patient from inhaling exhaled air, delivering only fresh oxygen 60-100%

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12
Q

What is a venturi mask?
O2 concentration ranging from?
Which allows?

A

Adjustable oxygen concentration - typically ranging from 24-60%
Mixes fresh 02 with room air in precise ratios allowing for accurate control of Fio2**

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13
Q

CPAP
Continuous Positive Airway Pressure

*primarily used for?

A

Provides 1 continuous pressure level into airway to keep it open during inspiration and expiration / Patient must be able to breathe independently

*Primarily used for Sleep apnea
**Goal is to prevent airway collapse and maintain regular breathing patterns

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14
Q

BiPap
Bilevel Positive Airway Pressure
*commonly used for?

A

2 levels of pressure - one for inhalation and a lower pressure for exhalation
The pressure changes between inhalation and exhalation

*Commonly used for COPD, central sleep apnea or resp failure

**Goal to assist both with inhaling more effectively and reducing effort required to exhale

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15
Q

Define Ventilator Modes

A

How many breathes are delivered to the patient.

Many different modes

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16
Q

A/C Assist Control or CMV Continuous mandatory ventilation

A

Delivers a preset tidal volume or pressure at a preset rate of respirations
Every breath is the preset volume whether initiated by patient or machine

*pts who need total assistance from vent

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17
Q

SIMV
Synchronized intermittent mandatory ventilation

A

Delivers preset tidal and # of breaths per min
Patient can also breath spontaneously with no assistance from vent

*Pt doesnt need as much assistance from ventilator

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18
Q

In what ways can a patient be weaned off ventilator?

A

CPAP
SIMV - rate slowly decreased

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19
Q

Tidal volume
Vents give?

A

Amount of air delivered with each breath

Vents 10-15Ml/kg of body weight

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20
Q

Fi02

A

Fraction of inspirated oxygen concentration / % of oxygen delivered to pt

Normal 21% / on vent close to 30%

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21
Q

PEEP

A

Positive End Expiratory Pressure

Like keeping a small amount of air in lungs to prevent them from collapsing after breathing out

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22
Q

Pneumothorax
What to do?
Open-
Closed-

A

OPEN - Cover it immediately w/ occulsive dressing go to surgery or chest tube insertion
CLOSED - CHEST TUBE!
-Chest tubes are removed when lung is expanded (2-10days) or fluid is removed (3-4 days)

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23
Q

Hemothorax

A

Blood accumulation between chest wall and lung; often associated with pneumothorax

Same treatment as pneumothorax - maybe surgery to control bleeding

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24
Q

Empyema?

S/S
Treatment

A

Pus collected in pleural space

*Fever, chest pain, cough, SOB
Chest tube, surgery, antibiotics

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25
Q

Steps for chest tube removal?

A

Tell pt to take deep breath IN and bear down slightly on inspiration. so no air enters the pleural space

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26
Q

Hemopneumothorax

A

Both blood and air in chest cavity

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27
Q

Open pneumothorax

A

wound is large enough to allow air to pass freely in and out of thoracic cavity with each attempted respiration. “Sucking chest wounds”

*Lungs collapse, heart and vessels shift toward noninjured side with each inspiration and opposite side with each expiration “mediastinal flutter or swing” causes major circulatory problems

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28
Q

Nursing assessment of pneumothorax

A

Simple - Trachea midline, expansion of chest is decreased, breath sounds diminished, percussion may reveal normal or hyperresonance

Tension - trachea is shifted away from affected side, Chest expansion increased or decreased, breath sounds diminished, percussion on affected side is hyperresonant

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29
Q

Small chest tube is inserted where?
Large?
Suction?

A

Small - 28 french, 2nd intercostal space
Large - 32 french, 4th or 5th intercostal at midaxillary line

Suction - 20mmHg

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30
Q

When is a thoracotomy performed?

A

If more than 1500 ML blood aspirated by thoracentesis or chest tube output is greater than 200mL/H

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31
Q

ARDS classification
MILD
MODERATE
SEVERE

A

Mild - Pa02/FIO2 >200mmHg but <=300nnHg
Moderate - Pa02/FIO2 - >100mmHg but <=200mmHg
Severe = Pa02/FIO2 - <=100mmHg

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32
Q

BNP level is helpful in distinguishing ARDS from

A

Cardiogenic pulmonary edema

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33
Q

What could be some causes of ARDS?

A

Trauma
Pulm infection
Prolonged cardiopulmonary bypass
Shock
Fat emboli
Sepsis

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34
Q

What are ABGS for ARDS

A

Decreased P02 increased dyspnea

*pt not getting better even with higher FIO2

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35
Q

If the rhythm starts with a P wave then its?

A

Sinus

36
Q

Inappropriate sinus tachycardia?

A

Enhanced automaticity of SA node or excessive sympathetic tone with reduces parasympathetic tone that is out of porportion to physiologic demands

37
Q

What is POTS
Postural Orthostatic Tachycardia Syndrome

A

Tachycardia without hypotension and by presyncopal symptoms such as palpitations, lightheadedness, weakness and blurred vision that occur with sudden postural changes

38
Q

AFIB Classification
Paroxysmal

A

Sudden onset w/ termination that occurs spontaneously or after treatment
Last less than 7 days but may reoccur

39
Q

AFIB Classification
Persistent
Long-standing persistent
Permanent
Nonvalvular

A

Persistent - Lasting more than 7 days
**Long-standing persistent ** - Lasting more than 12 mo
Permanent - Persistent, but decision made not to restore sinus rhythm
Nonvalvular- Absence of mod-severe mitral stenosis or mechanical heart valve

40
Q

Preload
Define
Increased in:

A

Amount of blood remaining in ventricles at end of diastole.

*degree of stretch the heart muscle fibers at end of diastole

Increased in: hypervolemia, regurgitation of cardiac valves, heart failure

41
Q

Afterload
Define
Increased in

A

Resistance or pressure that the heart muscle must overcome to eject blood from ventricles during systole (contraction)
*The force that the ventricles need to generate to push blood into circulation

Increased in: Hypertension, vasoconstriction

42
Q

Contractility
Factors affecting?

A

Intrinsic ability of the heart muscle to contract, independent of preload and afterload

Factors affecting: Symoathetic nervous system, Inotropic agents, Oxygen supply

43
Q

How much 02 does the myocardium need?

A

70-75% of what is delivered by coronary arteries

44
Q

Echocardiogram

A

Apical 4 chamber view / front of heart
Visualizes structure, looks at valves and can get ejection fraction

45
Q

ETT

A

More invasive than echocardiogram
Looks at back of heart

46
Q

Stress test
What are they looking for?
What do they give?

A

CAD
Thallium - it does not enter infarcted or scared areas

47
Q

CBK
Troponin

A

biomarker to diagnose heart damage
CPK - Elevated, suggest cardiac muscle damage. Rise 4-6hrs after & return to normal 48-72hrs
Troponin - Proteins specific to cardiac muscle. Elevate when injury or stress to heart. Rise within 3-4 hours and may remain elevated 1-2weeks

CPK can also be found in skeletal muscles and brain and troponin is highly specific to heart.

48
Q

In cardioversion what wave are we trying to synchronize?

A

R wave

49
Q

What is CABG?

A

Surgical procedure taking a blood vessel from another part of the body (leg or chest) and grafting it to bypass the blocked coronary artery

50
Q

Colladeral circulation

A

as we age we develop ‘Shunts” away from the blockage in heart to continue to get blood flow

Not in younger patients

51
Q

What would we ask in patients with heart issues?
P
Q
R
S
T

A

P - What were they doing?
Q - How does it feel?
R - Where does pain go
S - 1-10
T- How long has this been going on?

52
Q

Unstable angina

A

The patient has clinical manifestations of coronary ischemia but ECG and biomarkers show no evidence of MI

53
Q

STEMI

A

ECG evidence of acute MI with characteristics changes in two contiguous leads on a 12 lead ECG. There is significant damage to myocardium

54
Q

NSTEMI

A

Elevated cardiac biomarkers but no definite ECG evidence of acute MT. May be less damage

55
Q

What does it mean when ECG shows inverted T wave

A

ISCHEMIA

56
Q
A

INJURY

57
Q
A

INFARCTION

58
Q
A

Acute inferior MI

59
Q

How much Aspirin would you give if a pt comes in for MI

A

325mg

60
Q

What is happening in the P wave? QRS? T?

A

P wave - atrial depolarization / Atrial contraction
QRS - Ventricle depolariztion / ventricle contraction
T - Ventricle repolarization /

61
Q

Difference between synchronized cardioversion vs defibrillation?

A

Synchronized - hit on R wave, Done when they have a pulse
Afib, pSVT, Vtach, –less life threatening confitions

Defibrillation - Delivered immediately without syndronizing to hearts rhythm
Life threatening arrhythmias that can lead to sudden cardiac arrest
Vent fib, Pulseless vent tach, Torsades de pointes

62
Q

what do hormones do?

A

Fluid and electrolyte balance
Host defenses
Response to injury and stress
Energy metabolism
Growth and development
Reproduction

63
Q

Hormones are apart of what system

A

Endocrine

64
Q

What is antidiuretic hormone?
Aka vasopressin

A

Produced by hypothalamus and released by post pit
Role: Regulating water balance / retain fluids
Maintainin blood pressure, fluid balance, blood volume

65
Q

What two disorders happen from issues with ADH?

A

Diabetes insipidus
Syndrome of inappropriate antidiuretic hormone secretion

66
Q

What is the process of SIADH to water intox?

A

ADH elevated
Kidneys retain water / plasma volume expands
BP rises
Body sodium diluted
Water intox!

67
Q

Differences between ICP and Shock

A

ICP
BP -up
PULSE - down
RESP - down

SHOCK
BP -down
PULSE -up
RESP- up

68
Q

What is occipital lobe responsible for?

A

Analyzes visual input
Helps recognize objects, faces, written
Depth perception
Stores info and helps with recognition

69
Q

What is Temporal lobe responsible for?

A

Process sounds - speech, music, environmental noise
**Language comprehension **- Wernickes area (understanding spoken/written)
**Memory formation **-
Emotional processing
Recognition - faces, objects, scenes, visual memory

70
Q

What is frontal lobe responsible for?

A

Decision making, problem solving, planning, reasoning, judgement
Motor control
Speech production - Broca’s area (speech production)
Personality
Attention/focus
Short term memory functions

71
Q

What is parietal lobe responsible for?

A

sensory perception (touch, temp, pain, pressure)
Depth perception, hand-eye
Sense of body position and mvmt
Mathematical and analytical skills
Language processing

72
Q

Autoregulation

A

brains ability to change the diameter of its blood vesssels to maintain constant cerebral blood flow during alterations in systemic blood pressure

73
Q
A

EPIDURAL - above dura mater, between skull and dura mater

74
Q
A

SUBDURAL - Between dura mater and brain

75
Q

What does CSF do?

A

Acts as shock absorber to brain and spinal cord
Bathes neurons
Decreases when brain tissue or blood flow increases to compensate

76
Q

What % of brain is
CSF
Intravascular blood
Brain tissue

A

CSF - 10%
Intravascular blood - 12%
Brain tissue - 78%

Any increase is ICP

77
Q

Super ventricular
Epidural
Subdural

A

Super ventricular - nost accurate, highest rate of infection
Epidural - least invasive, least accurate
Subdural - Decreased accuracy at high pressures

78
Q

What is formular for CPP?
Ideal number?>
No autoregulation between?

A

Cerebral perfusion pressure = MAP-ICP
Ideally 70-80

We dont get autoregulation when ICP falls below 50 or above 150

79
Q

What is Cushings triad?

A

Icreased in BP
Bradycardia
irregular Respiratory
+Some add Wide pulse pressure
*this is a LATE sign

80
Q

What is Decorticate posturing
Decerebrate
Pressure where?

A

Decorticate - pressure on cortical structures. Towards core
Decerebrate - Pressure on cerebellum. at sides

81
Q

If someone has complete spinal cord damage what are symptoms?

A

Total loss of motor, sensory and reflex activity below area of damage

82
Q

Relay activity

A

Signal goes up spinal cord, information is processed and impulses down decending tracts to signal movement

83
Q

RESPIRATORY IMPAIRMENT in spinal injuries

A

Injury at or above C5 may result in instant death
Below C4 spare diaphragm but can involve impairment of intercostal and abdominal muscles

84
Q

Spinal Shock

A

Temporary - sympathetic function impaired. Parasympathetic take over
Hypoxia, hypotension, bradycardia, temp flucations
Vasodilation, venous pooling, decreased C/o, loss of reflexes and sensation

*Could mask the extent of injury. This is caused by swelling.

Sign its over: get reflexes back

85
Q

Side effects of Nitro

A

Headache, Flushing, dizziness
Postural hypotension, tachycardia, collapse, palpitations
Nausea, vomit,
Pallor, sweating, rash

NEVER TAKE WITH VIAGRA

86
Q

GCS - What does score mean?
15
9-12
8
3

A

15 - Good
9-12 - Maybe hospitalization, freq orientation
8 = intubate and ventilation
3 = Severe TBI. Must be kept artificially alive

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