Test 2: Respiratory

Question 1

How do we assess gas exchange?

Answer 1

RR
ABG
End Tidal Volume
SpO2

Question 2

How do we assess ABGs?

Answer 2

1) Look at pH
2) Look at BiCarb (HCO3)
3) Look at CO2
4) Which matches pH?
5) Are CO2 and HCO3 opposite (compensation) or same (no compensation)
6) Look at 02 - if <80 then hypoxic

Question 3

pH

Answer 3

7.35-7.45

Question 4

HCO3

Answer 4

(ac) 22-26 (alk)

Question 5

CO2

Answer 5

(alk)35-45(ac)

Question 6

Acute Respiratory Failure

Answer 6

Occurs due to v/q mismatch because…

1) Ventilation Issue - inadequate lung movement, but perfusion is normal

• pneumothorax
• COPD
• Asthma
  -Eschar/Scarring
  -Trauma

2) Oxygenation - normal ventilation, but abnormal perfusion and diffusion

-CF
-pneumonia
-emphysema

3) Both - ventilation and oxygenation issue

-COPD
-Smoking
Cancer

Question 7

Acute Respiratory Classifications

Answer 7

Classifications:

Decrease PaO2
Increase CO2 (acidosis)

**Both always have SaO2 <90%)

Question 8

Acute Respiratory: Signs/Symptoms with Interventions

Answer 8

Restlessness/anxiety
Increase HR, RR
Tripod Position
Orthopnea
DOE
SOB
AMS
Decrease Cap Refill
Cyanosis

Interventions:

1) GIve O2
-NC (up to 6L)
-NRB (12-15L)
- Facemask (<12)

We are not changing position or calling doctor`

2) Treat Underlying Cause - Why are they going into respiratory failure?

• Bronchodialtor/nebulizer
  -Corticosteroid
  -Antibiotics - pneumonia
• Anticholinergic - is this secretion issue like CF?

Question 9

How can we prevent ARF?

Answer 9

Movement
IS
Chest physiotherapy
Increase Fluids

Question 10

Non Invasive Positive Pressure Ventilation: Function, Type, Contraindications

Answer 10

Designed to increase PEEP

1) CPAP - continuous low pressure
2) BiPap - bi-level - inhale/exhale; tidal volume

Contraindicated for confused patients because they are not able to protect their airway and have decreased gag reflex

Question 11

Invasive Positive Pressure Ventilation: Type, Risks

Answer 11

Intubation (ET 6-9Fr)

Risks:

Vent associated pneumonia
Pneumothorax
Pulmonary Embolism

Question 12

Ventilator Associated Pneumonia: What is it? Care Bundle

Answer 12

Onset is 48-72 hours post intubation

Care Bundle:

• HOB > 30
• sedation vacation
• DVT prophylaxis
• prone position/turn
  -oral care
  -stress ulcer prophylaxis
  -PRN suction

Question 13

Interventions for Pneumothorax

Answer 13

1) Temporary - Thorocentesis (8g)
2) Chest Tube

Question 14

Chest Tubes: 3 Chambers, Dos/Donts

Answer 14

3 Chambers:

Drainage - collects fluids, never O2 or blood
Water Seal - allows air to be removed w/o outside air coming in
Suction Control - bellows w/ good suction

Do/Don’t

• Never clamp
• keep below lungs
• NO Loops - should go in one direction
• Tell family to avoid atrium

Question 15

Pulmonary Embolism: Risks, Prevention, S/Sx, Interventions, Dx

Answer 15

Risks:

Stasis
Vessel injury
Coagulation

Prevention:

• Heparin
• Pressure Device
• ROM exercise

S/Sx/ Give O2 for:

-SOB/dyspnea w/o heart s/x
- Chest Pain

Interventions:
- Fibrinolytics/clot busters
-Thrombolytic
- Anticoag - heparin drip - Pt, INR, PTT
Warfarin/eloquist while on drip until therapeutic level reached then drip removed

Dx

• CT w/ contrast
• Positive D-dimer (shows clot, but not location)
• VQscan if not able to have CT

Question 16

Vent Settings: Assist Control/ AC

Answer 16

Machine is breathing for patient

Question 17

Vent Settings: Synchronized Intermittent Mandatory Ventilation/SIMV

Answer 17

Machine only breathes when patient does not

TV
PEEP
FiO2

Question 18

Vent Settings: Pressure Support Ventilation

Answer 18

Sedation Vacation

Question 19

Tidal Volume/TV

Answer 19

Increased TV = Increased Oxygen

Air movement in/out of lungs with each respiration

Too much TV affects heart

Question 20

PEEP

Answer 20

Positive end expiratory pressure

Air left in airway

Keeps airway open and applies at end of breath to keep airway open

Question 21

FiO2

Answer 21

Fraction Inspired Air (20% on RA)

Air breathed in

Question 22

Why might oxygen still be low when on ventilator?

Answer 22

Dislodged ET
Obstruction - saliva Mucus, debris
Pneumothorax
Equipment Problem - treat pt, not machine

Question 23

Signs of Pneumothorax

Answer 23

flail chest
increased rr
unequal breath sounds
anxious
restless

Question 24

Acute Respiratory Distress Syndrome: Pathophysiology

Answer 24

SIRS
Alveoli Inflammation
Cytokine Storm
Cellwall injury
Exudate (protein, mucus, fluid, debris)
Thick sputum (causing diluted surfactant)
decreased gas exchange

ARDS is why patients can not come off vent

Question 25

Acute Respiratory Distress Syndrome: S/Sx

Answer 25

Retraction
diaphoretic breathing
JVD
lethargic
AMS
pulmonary edema/pulmonary infiltration
cyanosis