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Cadiopulmonary Medicine > Test 2, Ch 10 and 11 > Flashcards

Test 2, Ch 10 and 11 Flashcards

1
Q

Patient Protection and Affordable Care also called……….. was made law in 2010 and came into effect in

A

Affordable care Act (ACA) ; 2014

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2
Q

One of the earliest effects of ACA was to institute a system whereby hospitals would be

A

penalized for wasteful excessive use of resources

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3
Q

There are 7 index conditions that are monitored as pat of ACA. 5 of them involve respiratory therapy

A
  • acute PNA
  • COPD exacerbation
  • VAP
  • CHF/ pulmonary edema
  • myocardial infarction
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4
Q

Excessive use of resources , results in a longer

A

length of stay (LOS)

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5
Q

Therapist driven protocols goal is to

A
  • deliver individualized diagnostic and therapeutic respiratory care to pts
  • assist physician w/ evaluating pt’s respiratory care needs and optimize the allocation of respiratory care services
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6
Q

TDP’s give therapist specific authority to (3)

A
  1. gather clinical information related to the pt’s respiratory
  2. make assessment of clinical data collected
  3. start, increase, decrease, or discontinue certain respiratory therapies
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7
Q

TDP safe and ready will be qualified to

A
  1. collect approbate data
  2. formulate a uniform and accurate assessment
  3. select a uniform and optimal treatment plan with the limits set by the protocol
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8
Q

The essential knowledge base for a successful TDP programs includes (ms roach fav word)

A
  1. anatomic alterations of the lungs
  2. pathophysiologic mechanism activated
  3. clinical manifestations
  4. treatment modalities used to correct them
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9
Q

What fixes pulmonary edema

A

fixing the heart and diuretics ( lasix)

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10
Q

What fixes bronchospasm

A

bronchodilator

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11
Q

what fixes a pt that’s not oxygenated well

A

oxygen

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12
Q

If pt comes wheezing what clinical manifestations could it possibly be?

A

Bronchospasm or bronchconstriction issue

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13
Q

If pt comes in with crackles and feet swelling what clinical manifestations could it be?

A

CHF, pulmonary edema

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14
Q

Assessment skills you need

A

SOAP
1.systemically gather clinical information
2. formulate an accurate assessment
3. select a treatment
4. document the use and evaluation of this process

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15
Q

Clinical data: for increased breathing rate , bp, pulse
Assessment: Respiratory distress and dyspnea
What is the treatment

A

Treat underlying cause

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16
Q

Clinical data: Wheezing
Assessment: Bronchospasm
Treatment :

A

Bronchodilator treatment

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17
Q

Clinical data: Inspiratory stridor
Assessment:Laryngeal edema
What is the Treatment:

A

Racemic epi

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18
Q

Clinical data: Coarse crackles
Assessment: Secretions in large airways
What is the Treatment?

A

Airway clearance therapy

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19
Q

Clinical data: Fine and medium crackles
Assessment: Secretions in distal airways
What is the Treatment?

A

Treat underlying cause such as CHF; Hyperinflation therapy

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20
Q

Clinical data: strong cough
Assessment: Good ability to mobilize secretions
What is the Treatment?

A

None

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21
Q

Clinical data: Weak cough
Assessment: Poor ability to mobilize secretions
What is the Treatment?

A

Airway clearance therapy

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22
Q

Clinical data: Secretions > 25 mL/ 24 h
Assessment: Excessive bronchial secretions
What is the Treatment?

A

Airway clearance therapy

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23
Q

Clinical data: White and translucent sputum
Assessment: Normal sputum
What is the Treatment?

A

None

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24
Q

Clinical data:Yellow and opaque sputum
Assessment: Acute Airway infection
What is the Treatment?

A

Treat underlying cause

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25
Q

Clinical data: Green sputum
Assessment: Old retained secretions and infections
What is the Treatment?

A

Airway clearance therapy

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26
Q

Clinical data: Brown sputum
Assessment: Old blood
What is the Treatment?

A

Airway clearance therapy

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27
Q

Clinical data: Red sputum
Assessment: Fresh blood
What is the Treatment?

A

notify physician

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28
Q

Clinical data: Frothy secretions
Assessment: pulmonary edema
What is the Treatment?

A

Treat underlying cause, such as CHF; hyperinflation therapy

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29
Q

Clinical data:Bronchial breath sounds
Assessment: atelectasis
What is the Treatment? (2)

A

Hyperinflation therapy, oxygen therapy

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30
Q

Clinical data:Dull percussion note
Assessment: infiltrates or effusion
What is the Treatment?

A

Treat underlying cause

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31
Q

The ability of the respiratory system to establish and maintain adequate o2 up take and carbon dioxide removal from the body

A

Respiratory failure

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32
Q

Abg criterial for respiratory failure in a. normal individual is Pao2

A

PaO2 < 60 mm Hg, PaCo2 > 50 mm Hg or mixture of both

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33
Q

Respiratory failure is commonly classified as (3)

A
  1. hypoxemia respiratory failure ( type I respiratory failure pao2 <60)
  2. hypercapnic respiratory failure ( type II respiratory failure co2 >50)
  3. combination of both
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34
Q

Ventilation =

A

co2

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35
Q

Oxygentaion =

A

po2

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36
Q

Anything related to co2 is

A

ventilatory failure

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37
Q

hypercapnic respiratory is commonly called VF is classified as 2 different categories

A
  1. acute ventilatory failure (uncompensated high paco2 and low pH)
  2. chronic ventilatory failure (compensated high paco2 and normal pH)
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38
Q

Alveolar hypoventilation is classified as __________ paco2 and __________ pao2

A
  • increased PaCO2
  • decreased PaO2 (hypoxemia)
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39
Q

Common causes for Alveolar hypoventilation (6)

A
  • head trauma
  • pain
  • sleep apnea
  • COPD
  • obesity
  • neuromuscular disorders
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40
Q

Cor pulmonale=

A

right sided heart failure

41
Q

CHF =

A

left sided heart failure

42
Q

What is the treatment for alveolar hypoventilation

A

primarily Ventilatory support

43
Q

Portion of the cardiac output that moves from the right side to the left side without being exposed to alveolar o2

A

Pulmonary shunting

44
Q

What are the 2 types of shunts

A

Absolute and relative

45
Q

6 basic anatomic alterations that can cause respiratory failure

A

1.atelectasis
2. alveolar consolidation
3. increased alveolar- capillary membrane thickness
4. bronchospasm
5.excessive bronchial secretions
6. distal airway and alveolar weakening

46
Q

Absolute shunts ( true shunts) are classified into 2 groups

A

anatomic and capillary shunts

47
Q

occurs when blood flows from the right side of the heart to the left side w/o coming in contact with an alveolus for gas exchange

A

Anatomic shunts

48
Q

normal anatomic shunt is

A

3%

49
Q

AA gradient normal range is

A

7 to 15 mm hg

50
Q

Common abnormal causes of anatomic shunt include ( 3diseases)

A

CHF
Intrapulmonary fistula
vascular lung tumors

51
Q

Capillary shunts are caused by (3 diseases aaa)

A
  1. alveolar collapse or atelectasis
  2. alveolar fluid accumulation
  3. alveolar consolidation or PNA
52
Q

The sum of the anatomic and capillary shunt makes up the

A

absolute shunt

53
Q

What is the purpose of PEEP, and is a treatment for what kind of hypoxemia

A

To keep alveoli open and a treatment for refractory hypoxemia
pushing fluid and consolidation out and keeps alveoli open

54
Q

Relative shunts ( shunt like effect) common causes are (3)

A
  • airway obstruction
  • alveolar- capillary diffusion defect
  • combination of both
55
Q

When pulmonary capillary perfusion in excess of alveolar ventilation, what shunt is said to be present

A

relative shunt

56
Q

Capillary blood flow does not have enough time to equilibrate w/ the alveolar oxygen tension

A

Alveolar capillary diffusion defect

57
Q

How long does it take for Alveolar capillary diffusion defect process

A

0.75 seconds

58
Q

Common causes of Alveolar capillary diffusion defect include 2 interstitials

A
  • interstitial pulmonary edema
  • interstitial lung disorders
59
Q

Mixing of shunting non oxygenated blood w/ reoxygenated blood distal to the alveoli

A

venous admixture

60
Q

Higher pao2 downstream
Lower pao2 than the reoxygenated blood
Is classified as

A

venous admixture

61
Q

Under normal conditions the overall alveolar ventilation is about ____ and the pulmonary capillary blood flow is about _____

A

4 L/min and 5 L/min (4:5 or 0.8)

62
Q

In some disorders the lungs receive less ______ ______ in relation to ventilation

A

blood flow

63
Q

What disorders will the lungs receive less ventilation in relation to blood flow? (4)

A
  • Asthma
  • emphysema
  • pulmonary edema
  • PNA
64
Q

The pt’s alveolar dead space is often expressed as

A

dead space/ tidal volume ( Vd/ Vt) ratio

65
Q

How would you interpret this ABG
pH: 7.51
PaCO2: 52
HCO3: 40
PaO2: 49

A

Acute Alveolar Hyperventilation superimposed on Chronic Ventilatory Failure

pH: increased
PaCO2: increased (but lower than pts typical elevated baseline level)
HCO3-: increased (significantly) (but lower than pt’s typical elvated baseline level)
PaO2: decreased ( but lower than the pts typical baseline level)

66
Q

How would you interpret this ABG
pH: 7.28
PaCO2: 97
HCO3-: 44
PaO2: 39

A

Acute Ventilatory Failure Superimposed on Chronic Ventilatory Failure

pH: decreased
PaCO2: increased (but higher than pt’s typical elevated baseline level)
HCO3- increased increased (significantly) but higher than pt’s typical elevated baseline level
PaO2: decreased (but lower than the pt’s typical low baseline level

67
Q

pathophysiology cause of hypoxemia respiratory failure are (3)

A
  1. alveolar hypoventilation
  2. pulmonary shunting
  3. v/q mismatch
68
Q

causes of alveolar hypoventilation (diseases)

A

CNS depressants, head trauma, COPD, obesity, sleep apnea, neuromuscular disorders

69
Q

causes of anatomic shunts are (diseases)

A

CHF, intrapulmonary fistula, vascular lung tumors

70
Q

Under normal conditions alveolar ventilation is about…
and pulmonary capillary blood flow is…. making the overall ratio of alveolar ventilation to blood flow…..

A

4 L/min ; 5 L/ min; 4:5 or 0.8

71
Q

In asthma, emphysema , pulmonary edema, PNA the lungs receive

A

less ventilation in relation to blood flow

72
Q

AA gradient is used to identify the cause of hypoxemic respiratory failure——- (3)

A

alveolar hypoventilation, pulmonary shunting, v/q mismatch

73
Q

AA gradient should not exceed

A

30 mmHg

74
Q

Oxygen can increase the

A

AA gradient

75
Q

When pulmonary shunting, v/q mismatch or diffusion blockade is primary cause of hypoxemia respiratory failure the AA gradient is

A

elevated

76
Q

major pathophysiologic mechanisms that result in hypercapnic respiratory failure (same as hypoxemia but more severe)

A
  1. Alveolar hypoventilation
  2. increased dead space
  3. severe v/q mismatch
77
Q

Hypercapnic respiratory failure is vent failure and is classified as 2 groups

A
  1. acute ventilatory failure
  2. chronic ventilatory failure
78
Q

Short term disease process are called
and examples of that are

A

acute ventilatory failure; flu, acute bronchitis

79
Q

Long term disease process is called…..
and examples of that are

A

chronic ventilatory failure; COPD, obesity

80
Q

4 standards for MV

A
  1. Apnea
  2. Acute vent failure
  3. Impending vent failure
  4. severe refractory hypoxemia
81
Q

apnea cause pao2 to rapidly ______, and paco2 to ______

A

decrease, increase

82
Q

Acute vent failure is sudden increase of PaCO2 to greater than ____ w/ a low ___ , <7.3

A

50 mm Hg ; pH

83
Q

Increase WOB w/ borderline acceptable ABG

A

impending vent failure

84
Q

Does not respond to o2 therapy PaCO2 <40 mm Hg, SaO2 <75%

A

severe refractory hypoxemia

85
Q

What can help with severe refractory hypoxemia

A

PEEP, CPAP, Lung expansion

86
Q

Severe PNA, interstitial lung disease and ARDS are often seen in

A

Severe refractory hypoxemia

87
Q

Hypoxemia respiratory failure is treated with

A

o2 therapy

88
Q

Hypercapnic respiratory failure is treated with _________ _________ to manage PaCO2 and____

A

ventilatory support; pH

89
Q

Both oxygen and ventilatory support are used when a pt demonstrates both and is called

A

Type III respiratory failure

90
Q

Primary indication for hypercapnic respiratory failure is

A

secondary to COPD exacerbation

91
Q

NIV is benficial for pts who ARE able to protect their airways

A

Asthma
mild to moderate atelectasis
community acquired PNA

92
Q

NIV is very safe and effective means of support but may be poorly tolerated, contraindication, or harmful in pts with

A

respiratory arrest
cardiac arrest
upper airway obstruction
poor ability to clear secretions
profound refractory hypoxemia

93
Q

Less than 1% are

A

unweanable

94
Q

5% require

A

days to weeks to weaned

95
Q

require a systematic approach to being weaned

A

15- 20%

96
Q

over expansion of the alveolar structure

A

Barotrauma

97
Q

Caused by high ventilator pressures and volumes, alveolar rapture does not occur

A

Volutrauma

98
Q

CPAP, SBT, SIMV, VSV, ASV are some modes to

A

wean pts

Cadiopulmonary Medicine (24 decks)

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