Chapter 66

Front 1

Normal Gass Exchange Unit in the Lung.
Hypoxemic or Hypercapnic

Back 1

What is this image reprensenting? Respiratory Failure can be classified as _____________ or _____________

Front 2

PaO2 is less than or equal to 60mm HG on 60% oxygen

PaCo2 is greater than 45mm HG and pH is less than normal 7.35 which makes is acidic pH.

Back 2

Memorize this and know that in Respiratory Failure with Oxygenation Failure you have ________________________ and with Ventilatory Failure you have _____________________________

Front 3

3.3
1.0
0.63
Higher
Lower
Opposite

Back 3

Regional V/Q differences in the normal lung. At the lung apex, the V/Q ratio is _____ at the midpoint ____, and at the base _____. This difference causes the PaO2 to be ____________ at the apex of the lung and _________ at the base. Values for PaCo2 are the __________. Blood that exits the lung is a mixture of these values

Front 4

Major function of the respiratory system is ________________

Back 4

Gas Exchange

Front 5

Gas exchange involves the transfer of O2 and CO2 between the _________ and __________

Back 5

Atmosphere
Blood

Front 6

Results when one or both of these gas exchanging functions are inadequate (O2 or Co2)

Back 6

Respiratory Failure

Front 7

Clinical states that interfere with adequate O2 transfer result in ____________

Back 7

Hypoxemia

Front 8

Hypoxemia is manefested by a/an ___________ in arterial O2 tension (PaO2) and a/an _________ in arterial O2 saturation

Back 8

decrease
decrease

Front 9

Insufficient removal of CO2 results in

Back 9

hypercapnia

Front 10

Hypercapnia is manifested by an ___________ in Arterial Co2 tension PaCO2

Back 10

Increase

Front 11

Respiratory Failure can be classified as __________ or __________-

Back 11

Hypoxemic
Hypercapnic

Front 12

Hypoxemic respiratory failure is also reffered to as _______________ becasue the primary problem is inadequate O2 transfer between the alveoli and the pulmonary capilliary bed

Back 12

oxygenation failure

Front 13

Hypoxemic Respiratory Failure is commonly definned as a PaO2 of _____ or less when the patient is receiving an inspired O2 concentration of _____% or greater

Back 13

60mmHg 60% also known as the 60/60 club

Front 14

The PaO2 of 60mmHg is at a level that indicates

Back 14

inadequate O2 saturation of hemoglobin

Front 15

the PaO2 level exists despite administration of supplemental O2 at a percentage _____% that is about three times that in room air (____%)

Back 15

60%
21%

Front 16

Disorders that interfere with O2 transfer into the blood are:

Back 16

pneumonia
pulmonary edema
pulmonary embolism
alveolar injury related to inhalation of toxic gases (smoke)
Inaddition low cardiac output states
congestive heart failure
shock
anatomical shunt

Front 17

Hypercapnic respiratory failure is also referred to as ______________. Its primary problem is insufficient _______ _________

Back 17

ventilatory failure
Co2 removal

Front 18

Hypercapnic Respiratory Failure is commonly defined as a PaCo2 __________ in combination with acidemia _________

Back 18

above normal greater than 45
a pH less than 7.35

Front 19

Three important concepts to remember about Hypercapnic Respiratory Failure:
1.
2.
3.

Back 19

1. the Paco2 is higher than normal
2. there is evidence of the body's inability to compensate for this increase (Acidemia)
3. the pH is at a level where a further decrease may lead to severe acid base imbalance

Front 20

Disorders that compromise lung ventilation and subsequent Co2 removal include:

Back 20

drug overdoses with CNS depressants
neuromuscular diseases (myasthenia gravis)
trauma or diseases involving the spinal cord and its role in lung ventilation

Front 21

Hypoxemic Respiratory Failure Common Causes for the Respiratory System
1.
2.
3.
4.
5.

Back 21

1. ARDS
2. Pneumonia
3. Toxic Inhalation Smoke
4. Hepatopulmonary Syndrome
5. Massive Pulmonary Embolism

Front 22

Hypoemic Respiratory Failure common causes for the cardia system:
1.
2.
3.

Back 22

1. Anatomic Shunt (ventricular septal defect)
2. Cardiogenic Pulmonary Edema
3. Shock (decreaseing blood flow through pulmonary vasculature)

Front 23

Hypercapnic Respiratory Failure common causes related to the Respiratory System:
1.
2.
3.

Back 23

1.Asthma
2.COPD
3.Cystic Fibrosis

Front 24

Hypercapnic Respiratory Failure Common Causes related to the CNS
1.
2.
3.
4.

Back 24

1. Brainstem Infarction
2. Sedative and Narcotic Overdose
3. Spinal Cord Inury
4. Severe Head Injury

Front 25

Hypercapnic Respiratory Failure Common Causes related to the Chest Wall:
1.
2.
3.
4.

Back 25

1. Thoracic Trauma Flail Chest
2. Kyphocoliosis
3. Pain
4. Massive Obesity

Front 26

Hypercapnic Respiratory Failure Common Causes related to the Neuromuscular System:
10 of them

Back 26

1. myasthenia gravis, 2. critical illness polyneuropathy, 3. Acute myopathy, 4. Toxic ingestion 5. Amyotrophic lateral sclerosis 6. Phrenic nerve injury 7. Guillain-Barre syndromw, 8. Poliomyelitis 9. Muscular dystrophy 10. Multiple Sclerosis

Front 27

Four physiologic mechanisms may cause hypoxemic and subsequent hypoxemic respiratory failure:
1.
2.
3.
4.

Back 27

1. V/Q Mismatch
2. Shunt
3. diffusion limitation
4. Hypoventalation

Front 28

The most common causes of Hypoxemic Respiratory failure are:
1:
2:

Back 28

V/Q mismatch and shunt

Front 29

Amount of blood perfusing the lungs each minute is

Back 29

4-5 liters

Front 30

Amount of fresh gas that reaches the alveoli each minute

Back 30

4-5 liters

Front 31

At the lung _______ V/Q ratios are greater than 1: more ventilation than perfusion

Back 31

apex

Front 32

At the lung _______ V/Q ratios are less than 1: less ventilation than perfusion

Back 32

base

Front 33

Many diseases and conditions alter overall V/Q matching and thus cause a V/Q mismatch. The most common are those in which increased secretions are present in the airways such as

Back 33

COPD

Front 34

Many diseases and conditions alter overall V/Q matching and thus cause a V/Q mismatch. The most common are those alveoli:

Back 34

pneumonia

Front 35

Many diseases and conditions alter overall V/Q matching and thus cause a V/Q mismatch. The most common are those in bronchospasm is present

Back 35

asthma

Front 36

V/Q mismatch may also result from alveolar collapse _______ or as a result from ____

Back 36

atelectasis
Pain

Front 37

Unrelieved or inadequately relieved pain interferes with chest and _________________ compromising ____________

Back 37

abdominal wall movement
lung ventilation

Front 38

Pain increases ______ and _____ tension, producing generalized muscle rigidity, causes _________ __________and activation of the stress response; and _______ O2 consumption and Co2 Production

Back 38

muscle
motor
systemic vasoconstriction
increases

Front 39

What affects the perfusion portion of the V/Q relationship by limiting blood flow and not having an effect on airflow to the alveoli.

Back 39

Pulmonary embulous

Front 40

What affects the the airflow to the alveoli but have not affect on the blood flow to the gas exchange

Back 40

Unrelieved or inadequate Pain control

Front 41

What is the first step to reverse hypoxemia caused by a V/Q mismatch becasue not all gas exchange units are effected

Back 41

Oxygen Therapy

Front 42

Explain how Oxygen Therapy works as the first line treatment in hypoxemia?

Back 42

O2 increases the PaO2 in the blood leaving normal gas exchange units causing a higher than normal PaO2.

Front 43

What happens to the well oxygenated blood when it mixes with poorly oxygenated blood?

Back 43

It raises the over all PaO2 of blood leaving the lungs.

Front 44

The optimal approach to hypoxemia caused by a V/Q mismatch is one directed at the _______

Back 44

Cause

Front 45

A shunt occurs when ________________________

Back 45

blood exists the heart without having participated in gas exchange

Front 46

A __________ is viewed as an extreme V/Q Mismatch

Back 46

Shunt

Front 47

There are two types of shunts:
1.
2.

Back 47

1. Anatomic
2. Intrapulmonary

Front 48

An anatomical shunt occurs when:

Back 48

blood passes through an anatomic channel in the heart and there for does not pass throught the lungs

Front 49

An intrapulmonary Shunt occurs when:

Back 49

blood flows through the pulmonary capilliaries without participating in gas exchange

Front 50

Intrapulmonary Shunts are seen in conditions in which the alveoli fill with fluid as seen in these diseases:
1.
2.
3.

Back 50

ARDS
Pneumonia
Pulmonary Edema

Front 51

If hypoxemia is due to a shunt, what is ineffective in increaseing PaO2

Back 51

Oxygen therapy

Front 52

Why would oxygen be ineffect for an anatomic shunt?

Back 52

Becasue blood passes from the right to the leftside of the heart without passing through the lungs

Front 53

Why would oxygen be ineffective for an intrapulmonary shunt?

Back 53

because the alveoli are filled with fluid, which prevents gas exchange

Front 54

What is an example of an anatomic shunt

Back 54

(A Ventricular septal Defect)

Front 55

Patients with shunt are usually more ___________ than patients with V/Q mismatch

Back 55

hypoxemic

Front 56

Patients with Shunts may require:
1.
2.
to improve gas exchange

Back 56

1. Mechanical Ventilation
2. FIO2 (high fraction of inspired oxygen

Front 57

Diffusion limitation occurs when gas exchange across the alveolar-capillary membrane is :

Back 57

compromised by a process that thickens or destroys the membrane

Front 58

Diffusion limitation can also be worsend by conditions that affect the pulmonary vascular bed such as severe ____________ or recurrant ______________.

Back 58

emphysema
pulmonary embuli

Front 59

Some disease cause the alveolar capilliary machine to become thicker (fibrotic) which would slow gas transport. Such disease are:
1.
2.
3.

Back 59

1. pulmonary fibrosis
2. interstitial lung disease
3. ARDS

Front 60

Diffusion limitation is more likely to occure during _________ than at ________

Back 60

excercise
rest

Front 61

During excercise blood moves more rapidly through the lungs. Because transit time is increased, red blood cells are in the lings for a shorter time, decreasing the time for _________________ across the alveolar-capilliary membrane.

Back 61

diffusion of O2

Front 62

Classical sign of diffusion limitation is:

Back 62

hypoxemia that is present during excercise and not during rest

Front 63

ALveolar hypoventilation is a generalized decrease in __________ that results in an increase in the ________

Back 63

ventilation
PaCo2

Front 64

Alveolar hypoventilation may be the result of:
1.
2.
3.
4.

Back 64

restrictive lung disease
CNS disease
Chest Wall Dysfunction
Neuromuscular Disease

Front 65

Alveolar Hypoventilation is primarliy a mechanism of ______________respiratory failure it can also cause __________

Back 65

hypercapnic
hypoxemia

Front 66

What are the four ways hypoxemic respiratory failure can occur:
1.
2.
3.
4.

Back 66

V/Q mismatch
Shunt
Diffusion Limitation
Hypoventilation

Front 67

A patient with acute respiratory failure scondary to pneumonia may have a combination of V/Q mismatch and shunt becasue inflammation, edema, and hypersecretions of exudate within the bronchioles and terminal respiratory units:
1.
2.

Back 67

1. obstruct the airways V/Q
2, Fill the alveoli with exudate Shunt

Front 68

Shunt may occur becasue of

Back 68

improper positioning

Front 69

if you had a patient with an affect lung which way should you position the affect lung

Back 69

the affected lung should always be up allowing it to drain down

Front 70

WHat causes the affected lung up to drain down?

Back 70

Gravity

Front 71

A shunt may be increased as with Endogenous vasodilator mediators as is the case with

Back 71

Pneumococcal pneumonia

Front 72

A patient may have a combination of shunt and V/Q mismatch because some alveoli are completely filled from edema (shunt) and others are partially filled with fluid (V/Q) Mismatch in these 2 situations:
1.
2.

Back 72

Cardiogenic Pulmonary Edema
ARDS

Front 73

Hypercapnic respiratoyr failure results from an imbalance between ____________ and ___________

Back 73

ventilatory supply
ventilatory demand

Front 74

Ventilatory supply is:_____________________that the patient can sustain without developing respiratory muscle fatigue

Back 74

the maximum ventilation (gas flow in and out of the lungs)

Front 75

Ventilatory Demand is:

Back 75

the amount of ventilation needed to keep the PaCO2 with in normal limits

Front 76

Why can normal individuals can engage in strenous excercise, which greatly increases CO2 production without an elevation in PaCo2

Back 76

becasue the ventilatory supply far exceeds the ventilatory demand

Front 77

Patients with lung disease can not effectivly increase lung ventilation in response to excercise or metabolic needs. Name an example of the lung disease that this would be

Back 77

emphysema

Front 78

What is typically present before ventilatory demand exceeds ventilatory supply

Back 78

considerable dysfunction of the lung

Front 79

When Ventilatory demand does exceed ventilatiry supply, the PaCo2 can no longer be sustained within normal limits and __________ occurs

Back 79

hypercapnia

Front 80

Hypercapnia reflects sustained

Back 80

lung dysfunction

Front 81

Hypercapnic respiratory Failure is sometimes called

Back 81

ventilatory failure

Front 82

Ventilatory failure's primary problem is the inability of the respiratory system to: _______________ to maintain a normal PaCo2

Back 82

ventilate out CO2

Front 83

Many different diseases can cause a limitation in ventilatory supply. Name the four categories:
1.
2.
3.
4.

Back 83

1. airways and alveoli
2. Abnormalities of CNS
3. Abnormalities of the Chest Wall
4. Neuromuscular Conditions

Front 84

Patients with asthma, emphysemia, chronic bronchitis and cystic fibrosis are at high risk for hypercapnic respiratory failure becasue the underlying pathophysiology of these condition result from:

Back 84

airflow obstruction and air trapping

Front 85

What is a common example of a problem that my suppress the drive of the CNS to breathe?

Back 85

an overdose of a narcotic or respiratory depressant drug

Front 86

A ____________ or ___________- may also interfere with the normal function of the respiratory center because the __________ does not alter the respiratory rate in response to a change in PaCo2

Back 86

brainstem infarction
severe head inury
Medulla

Front 87

the respiratory center is located in the

Back 87

medulla

Front 88

CNS dysfunction may also include ________________ that limit innervation to the respiratory muscles

Back 88

spinal cord injury

Front 89

In patients with a flain chest __________ prevent the rib cage from expanding normally becasue of
1.
2.
3.

Back 89

FRACTURES
pain
mechanical restriction
muscle spasm

Front 90

In patients with Kyphoscoliosis the change in _____________ compresses the lungs and prevents normal expansion of the chest wall.

Back 90

spinal configuration

Front 91

In patients with massive obesity the weight of the chest and abdominal contents may:

Back 91

limit lung expansion

Front 92

Patients with chest wall conditions are at risk for respiratory failure becasue
1. limits
2. limits
3. limits

Back 92

limits lung expansion
limits diaphramatic movement
limits gas exchange

Front 93

Certian diseases make patients at risk for respiratory failure becasue it may result in muscle weakness or paralysis. Patients with such risks are those with
1.
2.
3.
Therefore unable to maintain a normal PaCo2

Back 93

Guillian Barre Syndrome
Muscular Dystrophy
Multiple Sclerosis

Front 94

Bottom line is that respiratory may occur because the medulla, chest wall, peripheral nerves, or respiratory muscles are not functioning normally. Patient may have no damage to tissue but may be unable to :

Back 94

inspire a tidal volume sufficient to expel CO2 from the lungs

Front 95

What determines the definition of respiratory failure

Back 95

Paco2 and the PaCo2

Front 96

What is the major threat of respiratory failure

Back 96

the inability of the lungs to meet the oxygen demands of the tissues

Front 97

What determines Tissue O2 delivery?
1.
2.

Back 97

the amount of O2 carried by the Hemoglobulin, and the Cardiac output

Front 98

The inability of the lungs to meet the oxygen demands of the tissues may occur as a result of:
1.
2.
3.
4.

Back 98

1. inadequate tissue O2 delivery
2. Tissues unable to use the O2
3. Stress response
4. Increase in tissue O2 consumption

Front 99

Respiratory failure places the patient at greater risk if there are coexisting:
1.
2.

Back 99

cardiac problems
anemia

Front 100

Failure of O2 utilization most commonly occurs as a result of

Back 100

septic shock

Front 101

Adequate O2 may be delivered to the tissues, but an abnormally high amount of O2 returns in the venous blood, indicating that it is not being extracted and used at the tissue level. This is what we would classify as

Back 101

septic shock

Front 102

A sudden decrease in PaO2 or a rapid increase in PaCo2 implies a serious condition and may be considered a life-threatning emergancy. A clinical example of this would be a patient with ________ who develops severe ________ and a marked decrease in __________ resulting in respiratory arrest

Back 102

asthma
bronchospasm
airflow

Front 103

A more gradual change in PaO2 and PaCo2 is better tolerated because compensation can occur. An example of of this would be a patient with COPD who develops a progressive in PaCo2 over several days following the onset of a

Back 103

respiratory infection

Front 104

Becasue the respiratory infection happened over a couple of days there was time for renal compensation (retention of bicarbonate) which will minimize the change in _______ compensating from ________

Back 104

arterial pH
respiratory acidosis

Front 105

Manifestations of respiratory failure are related to the extent of change :
1.
2.
3.

Back 105

1. Pao2 or Paco2
2. Rapidity of change acute vs chronic
3. ability to compensate for this change

Front 106

When the patients compensatory mechanism fails then this happens:

Back 106

respiratory failure

Front 107

Becasue clinical manifestations are variable it is important to monitor trends in _______ and or _________ to evaluate the extent of change

Back 107

ABG's
Pulse Oximetry

Front 108

The initial indication of respiratory failure is a change in the patients

Back 108

mental status

Front 109

becasue the cerebral cortex is so sensitive to variations of oxygenation and acid-base imbalances __________changes will occurearly and frequenty before the ABG results are obtained

Back 109

mental status

Front 110

Restlessness, confusion, agitation, and combative behavior suggest _________ to the brain and should be fully investigated

Back 110

inadequate O2 delivery

Front 111

Nurse may detect manifestations of respiratory failure that are specific (arise from the __________ system) and nonspecific (arise from the _______ system)

Back 111

respiratory
body

Front 112

___________ and __________ can also be early signs of respiratory failure

Back 112

tachycardia
mild hypertension

Front 113

Tachycardia and hypertension may indicate an attept by the heart to _________ for the decreased O2 delivery

Back 113

compensate

Front 114

A severe morning _________ may indicate that hypercapnia may occured at night, increaseing cerebral blood flow by ___________ and causing a morning __________

Back 114

headache
vasodilation
headache

Front 115

Rapid shallow breaths may indicate that the _________ may be inadequate to remove CO2 from the lungs.

Back 115

Tidal Volume

Front 116

__________- is an unreliable indicator of hypoxemia and is a late sign of respiratory failure becasue it does not occur until hypoxemia is severe (Pao2 is less than or equal to 45 mm Hg

Back 116

Cyanosis

Front 117

__________ occurs when the PaO2 has fallen sufficiently to cause signs and symptoms of inadequate oxygenation

Back 117

Hypoxia

Front 118

If hypoxia or hypoxemia is severe the cells shift from ______ to ______ metabolism.

Back 118

aerobic.
anaerobic

Front 119

The waste product of anaerobic metabolism is ________ which is much harder to remove from the body than CO2 because _________ has to be buffered with ________

Back 119

lactic acid
lactic acid
sodium bicarbonate

Front 120

When the body does not have adequate amounts of sodium bicarbonate to buffer the lactic acid produced by anaerobic metabolism, ___________ results and cell death may occur

Back 120

metabolic acidosis

Front 121

Hypoxia and metabolic acidosis have adverse effects on the body especially in the:
1.
2.

Back 121

Heart
CNS

Front 122

The heart tries to compensate for the decreased O2 level in the blood by increasing the :
1.
2.

Back 122

heart rate
cardiac output

Front 123

As the PaO2 decreases and acidosis increases, the heart muscles may become dysfunctional and _________ may decrease. In addition
1.
2.
May occur

Back 123

cardic output
Angina
Arrythmias

Front 124

Permanent _________- may occure due to the decrease of oxygenation

Back 124

brain damage

Front 125

Renal function may also be impaired such as:
1.
2.
3.
4.

Back 125

sodium retention
edema formation
acute tubular necrosis and
Uremia

Front 126

GI alterations include
1.
2;
3.

Back 126

1. tissue ischemia
2. increased permability of intestinal wall
3. possible translocation of bacteria from Gi into circulation

Front 127

The changes that dispose to insufficient CO2 removal in respiratory failure are:
1.
2.

Back 127

1. rapid shallow breathing pattern
2. respitory rate slower than normal

Front 128

A common position to be in that will help decrease he work of breathing becasue propping the arms increases the anterior-posterior diameter of the chest and changes pressure in the thorax

Back 128

tripod position

Front 129

This technique may be used in which causes an increase in SAO2 becasue it slows respirations and allows for more time for expiration and prevents the small bronchiles from collapsing thus facilitating air exchange

Back 129

purse lip breathin

Front 130

Another assessment parameter is the number of pillows that the patient requires to breathe comfortably when resting, this is termed

Back 130

orthopnea

Front 131

When a patient is experiencing dyspnea a patient my speak with out pausing. This is an indication of the severity. Patient is speaking in sentences ___________ distress
Patient is speaking words _____ distress, Patient is speaking in phrases ______ distress.

Back 131

mild or no
severe
moderate

Front 132

The normal I:E ration is ____ which means the expiration is twice as long as inspiration

Back 132

1:2

Front 133

With patients in respiratory distress the ratio may increase to ________--

Back 133

1:3-1:4

Front 134

The change of I:Es signifies _________ and that more time is required to empty the lungs

Back 134

aifflow obstruction

Front 135

The nurse may observe _________ (inward movement) of the intercostal spaces or the supraclavicular area and use of the accessory muscles during inspiration and exhalation

Back 135

retraction

Front 136

use of the accessory muscles signfies _________ distress

Back 136

moderate

Front 137

paradoxal breathing signifies _________- distress

Back 137

severe

Front 138

During Paradoxal breathing the abdomen and chest move in the opposite manner- _________- during exhalation and _________ during inhalation

Back 138

outward
inward

Front 139

Normal breathing the thorax and abdomen move ________ on inspiration and _________ exhalation

Back 139

outward
inward

Front 140

This results from maximal use of repiratlory muscles in respiration

Back 140

paradoxal breathing

Front 141

_________ and _________ may indicate pulmonary edema or emphysema

Back 141

crackles or Rhonchi

Front 142

absent or diminished breath sounds may indicate
1.
2.

Back 142

atelaectasis
pneumonia

Front 143

Crackles and Rhonchi may indicate :
1.
2.

Back 143

pulmonary edema
emphysema

Front 144

The presence of bronchial breath sounds over the lung periphery often results from lung consolidation that is seen with _________---

Back 144

pneumonia

Front 145

a __________ may also be heard in the presence of pneumonia that has involved the pleura

Back 145

pleural friction rub

Front 146

Patients with end stage severe chronic lung disease may have low PaO2 values or elevated PaCo2 levels and _________- in their normal baseline

Back 146

crackles

Front 147

It is especially important to monitor specific and nonspecific changes in patients with ______ becasue a small change can cause significant decompensation

Back 147

COPD

Front 148

Any deterioration in mental status such as agitation, combative behavior, confusion, or decreased level of consciousness must be reported immediately because the change may indicate a rapid deterioration in clinical status and the need for _______-

Back 148

Mechanical ventilation

Front 149

After physical assessment the most common diagnostic study used to determine respiratory failure is __________-

Back 149

ABG Analysis

Front 150

AN _______________ may be inserted into a peripheral artery for monitoring systemic blood pressure and obtaining blood for ABGS

Back 150

indwelling cathether

Front 151

__________ frequently used for monitoring oxygenation status, but tells little regarding lung ventilation

Back 151

pulse oximetry

Front 152

Diagnostic studies that may be done include:
1.
2.
3.
4.
5.

Back 152

Chest X-Ray
CBC
Serum Eletrolytes
Urinalysis
ECG

Front 153

This may be used to assess tube placement within the trachea immediately following intubation:

Back 153

End tidal Co2 EtCO2

Front 154

EtCO2 may also be used during ventilator management to assess trends in ________ as determined by expired CO2

Back 154

lung ventilation

Front 155

In severe respiratory failure a pulmonary artery cathether may be inserted to measure
1.
2.
3.
This information is helpfull at determining the adequacy of tissue perfusion and the patients response to treatment

Back 155

heart pressures
cardiac output
mixed venous oxygenation saturation

Front 156

Pulmonary artery, pulmonary artery wedge, and left atrial pressures are monitored to determine whether the accumulation of fluid within the lungs is a result or _________ or _______ problems

Back 156

cardiac
pulmonary

Front 157

The overal goals for a patient with respiatory failure is :
1.
2.
3.
4.

Back 157

1. ABG Valueswithin the patients baseline
2, breath sounds wth in patients baseline
3, no dyspnea or breathing sounds wiithin the patients baseline
4. effective cough and ability to clear secretions

Front 158

The most important plan of care for any patient who might be At Risk for respiratory failure is to:
1,
2,

Back 158

1, prevention
2,early recognition

Front 159

Prevention involves
1.
2.
3.

Back 159

1. Throughal Physical assessment
2. Health History to identify risk factors
3. initation of interventions
3.

Front 160

Patient at risk with respiratory failure should receive appropriate patient teaching regarding:
1.
2,
3.
4.

Back 160

1. coughing
2, deep breathing
3. incentive spirometry
4. ambulation

Front 161

What can decrease the risk of respiratory failure in the acutely or critically ill patient?
1.
2.
3.
4.

Back 161

1. Education of PREVENTION OF ATELECTASIS
2. education of prevention of pneumonia
3. Education on Optimizing hydration and nutrition

Front 162

The majory goals for acute respiratory failure include
1.
2.

Back 162

1. maintaing adequate o2
2. maintaing adequate ventilation

Front 163

Interventions usedin respiratory therapy are
1.
2.
3.

Back 163

O2 therapy
mobilization of secretions
positive pressure ventilation

Front 164

Primary goal of oxygen therepy is to

Back 164

correct hypoxemia

Front 165

Hypoxemia is secondary to V/Q mismatch what will you do?

Back 165

supplemental O2 administered 1-3 L min by nasal canula or by 24% to 32% SIMPLE FACE MASK or venturi mask

Front 166

Hypoxemia secondary to an intrapulmonary shunt is usually not responsive to high O2 concentrations and the patient will usually require ___________--

Back 166

PPV Positive Pressure Ventilation

Front 167

PPV offers a means of :
1.
2.
3.

Back 167

1. Proving O2 and Humidification
2. Decreases work of breathing
3. Reduces respiratory fatigue

Front 168

Positive pressure may assist in ________________and and decreasing the shunt

Back 168

opening collapsed airways

Front 169

How is PPV provided?
1.
2.

Back 169

1. Endotracheal Tube Most common
2. noninvasive tight fitting mask

Front 170

Type of O2 delivery system chosen for the patient in acute respiratory failure should be 1. tolerated by the patient because :
_____________________ and 2. Maintain PaO2 at ________ mm Hg or more and the SaO2 at ____% or more at the lowest O2 concentration possible

Back 170

anxiety caused by feelings of claustroophobia related to the face mask or dyspnea may prompt the patient to remove the mask
2. 55-60, 90%

Front 171

High O2 concentration replaces the nitrogen gas normally present in the alveoli causing instability and ________--

Back 171

atelectasis

Front 172

In intubated patients, exposure to 60% or greater O2 for longer than 48 hours poses a significant risk for O2 ________---

Back 172

Toxicity

Front 173

In nonintubated patients the risk is less clear, the effects of prolonged exposure to be high levels of O2 include increased pulmonary microvascular permability, decreased surfactant production, and surfactant inactivation and fibrotic changes in the _______

Back 173

alveoli

Front 174

Chronic Hypercapnia may blunt the response of chemoreceptors in the medulla, and condition known as _________

Back 174

Co2 narcosis

Front 175

In Co2 Narcosis respirations are stimulated by _________

Back 175

hypoxia

Front 176

Patients with chronic hypercapnia should receive O2 through a
1.
2.

Back 176

1. low flow nasal cannula at 1-2 liters/min
2. venturi mask at 24% to 28%

Front 177

______________ may cause or exacerbate acute respiratory failure by blocking movement of O2 into the alveoli and pulmonary capilliary blood and removal of Co2 during the respiratory cycle.

Back 177

Retained Pulmonary Secretions

Front 178

Secretions can be mobilized through:
1.
2.
3.
4.

Back 178

1. effective coughing
2. adequate hydration and humidification
3. chest physical therapy
4. tracheal suctioning

Front 179

If secretions are obstructing the airway patient should be encouraged to

Back 179

cough

Front 180

This type of coughing may be benefit for patients with neuromuscular weakness from disease or exhaustion may not be able to generate sufficient airway pressures to produce an effective cough

Back 180

Augmented Breathing

Front 181

Explain what Augmented Coughing is and how it is done:

Back 181

performed by placing the palm of the hand on the abdominal musculature below the xiphoid process. As the patient ends a deep inspiration and begins the expiration the hand shoud be moved forcefully downward increasing abdominal pressure resulting in a forceful cough

Front 182

What does the Augmented Coughing actually do?

Back 182

It helps increase expiratory flow and thereby facilitate secretion clearance

Front 183

What kind of coughing is a series of coughs while saying a specific word

Back 183

Huff coughing stating the word Huff

Front 184

What does Huff coughing prevent

Back 184

It prevents the glottis from closing during the cough

Front 185

Patients with _____ generate higher flow rates with a huff cough than is possible with a normal cough

Back 185

COPD

Front 186

the Huff cough is effective in clearing only the _________- airways but it may assist in moving secretions upward

Back 186

central

Front 187

the Staged cough helps

Back 187

move secretions upwards

Front 188

Explain how the staged cough is done:

Back 188

the patient sits in a chair breathes three to four times in and out through the mouth, and coughs while bending forward and pressing a pillow inward against the diaphram

Front 189

What will maximize the thoracic expansion, therby decreasing dyspnea and improving secretion mobilization?
1.
2.

Back 189

positioning the patient
1. elevating the head of the bed at least 45 degrees
2. reclining chair or chair bed

Front 190

A sitting position improves pulmonary function and assists in venous pooling in dependant body areas such as the

Back 190

lower extremities

Front 191

What kind of positioning may be used in patients with disease in one lung

Back 191

sidelying position
lateral position

Front 192

This position termed down with the good lung, allows for ________ in the affected lung

Back 192

Improved V/Q mismatch

Front 193

What is optimal in dependent lung areas?
1.
2.

Back 193

pulmonary blood flow and ventilation

Front 194

Optimal positioning would be to place the patient on their _______ to maximize ventilation and perfusion in the good lung and facilitate secretion removal from the affected lung. This is also called

Back 194

left side
Postural drainage

Front 195

All patient must be __________ if there is any posibility that the tongue will obstruct the airway ot that aspiration may occur

Back 195

side lying

Front 196

An _____ or ____ airway should be kept by the bed side for use if necessary

Back 196

oral or nasal

Front 197

Adequate fluid intake is necessary to keep secretions thin and easy to expel. What is normal?

Back 197

2-3 Liters per day

Front 198

Some assessment signs for fluid overload include:
1.
2.
3.

Back 198

crackles
dyspnea
increased central venous pressure

Front 199

Aerosols of sterile normal saline may be administered through a _____ which may be used to liquify secretions

Back 199

nebulizer

Front 200

Mucolytic agents such as nebulized __________ mixed witha bronchodilator may be used to thin secretions but as a side effect it may also cause airway :
1.
2.

Back 200

acetylcysteine Mucomyst
erythemia
bronchospasm

Front 201

what procedure do we use the mucolytic agent and bronchodilator for?

Back 201

bronchoscopy

Front 202

Chest Physical therapy is indicated in patients who produce more than _____ml or sputum per day or have evidence of severe _______ or pulmonary iniltrates

Back 202

30
atelaectasis

Front 203

If a patient is unable to expectorate secretions what are we suppose to do?

Back 203

blind sunctioning

Front 204

Which trach may be used to suction patients who have difficulty mobilizing secretions and when blind suctioning may be difficult or ineffective

Back 204

the mini trach

Front 205

The mini trach is a 4mm indwelling plastic cuffless cannula inserted through the __________ membrane

Back 205

cricothyroid

Front 206

Contraindications for the mini-trach is
1.
2.
3.

Back 206

absent gag reflex
history of aspiration
need for long term mechanical respiration

Front 207

__________ may be provided invasively through an endotracheal or nasotracheal intubation or non invasively through a nasal of facial mask

Back 207

PPV Positive pressure ventilation

Front 208

A ________ is a mask that is placed over a patients nose or nose and mouth and the patient breathes spontaneously.

Back 208

NIPPV: non invasive positive pressure ventilation

Front 209

With a NIPPV it is possible to ____________ with out the need for an endotracheal intubation

Back 209

Reduce the work of breathing

Front 210

A form of NIPPV is called ______ in which different possitive pressure levels are set for inspiration and expiration

Back 210

BIPAP Bilevel positive airway pressure

Front 211

A _________ is another form of NIPPV which is a constant positive pressure that is delivered to the airway during inspiration and expiration

Back 211

CPAP continous positive airway pressure

Front 212

What is the most useful in managing chronic respiratory failure in patients with chest wall and neuromuscular disease

Back 212

NIPPV

Front 213

Certian patients may refuse mechanical vetillation by intubation but will desire NIPPV with some palliative ventilatory support for example patients who may be in

Back 213

end stage COPD

Front 214

NIPPV is not appropriate for the patient who has:
1.
2.
3.

Back 214

absent respirations
excessive secretions
decreased level of consciouness
high o2 requirements
facial trauma
hemodynamic instability

Front 215

The goals of drug therapy for patients with acute respiratory failure include:
1.
2.
3.
4.

Back 215

Relief of bronchospasms
reduction of airway inflammation and pulmonary congestion
treatment of pulmonary infection
reduction in anxiety and restlessness

Front 216

Short acting bronchodillators such as
1.
2.
ar frequently administered to reduce bronchospasm using either a hand held nebulizer or meter does inhaler with spacer

Back 216

metaproterenol Alupent
albuterol Ventolin

Front 217

During an acute bronchospasm these bronchodilators can be given how ofter?

Back 217

30-60 minute intervals untila response has occured

Front 218

What happend is several bronchospasms occur what can be given by IV for the patient

Back 218

aminophylline

Front 219

Bronchodilator effects may sometimes cause a worsening of arterial ________ by redistruibuting the inspired gas to areas of decreased perfusion

Back 219

hypoxemia

Front 220

What will alliviate the arterial hypoxemia. What could you give with the bronchodilators

Back 220

O2-rich gas mixture

Front 221

What type of medication should reduce an airway inflammation

Back 221

corticosteriods

Front 222

What corticosteriod may be used in conjunction with a brochodilator when inflammation if present

Back 222

solumedrol methlyprednisolone

Front 223

WHat kind of effect does corticosteriod have on the body when it is given by IV

Back 223

immediate onset

Front 224

What is the therapuetic effect of inhaled corticosteriods

Back 224

4-5 days

Front 225

Are inhaled corticosteriods used with acute respiratory failiure?

Back 225

No becasue it takes too long to have a therapeutic effect

Front 226

What type of drugs reduces pulmonary congestion

Back 226

Diuretics

Front 227

What can occur as a consequence of direct or indirect injury to the alveolar capilliary membrane, ARDS or from right or left side heart failure and therefore can be cardiac or non cardiac in orgion

Back 227

pulmonary interstitial fluid

Front 228

What happens when you have pulmonary interstitial fluid in the lungs?

Back 228

You will have a decrease in ventilation and hypoxemia

Front 229

What type of drug is given to reduce pulmonary congestion caused by heart failure

Back 229

IV diurectis Furosemide Lasix

Front 230

What may also be used if heart failure or atrial fibrilliation is present to increase contractility and decrease heart rate?

Back 230

Digitalis

Front 231

Pulmonary infections such as
1.
2.
result in excessive mucus roduction, fever, increased O2 consumption, inflammed fluid filled or collapsed alveoli

Back 231

pneumonia
acute bronchitis

Front 232

Axniety, restlessness, and agitation result from what?

Back 232

cerebral hypoxia

Front 233

Fear caused by the inability to breathe and a sense of loss of control may exacerbate what?

Back 233

anxitey

Front 234

Anxiety, pain, and agitation ________ o2 consumption which may worsen the degree of hypoxemia

Back 234

increase

Front 235

Anxiety , pain, and agitation _________ CO2 production affects ventilator management, and increases morbitity

Back 235

increases

Front 236

Certian benzodiazepines may be used to decrease anxiety, agitation and pain.
1.
2.

Back 236

Ativan
Versed

Front 237

Some narcotics are used to reduce anxiety, agitation, and pain.
1.
2.

Back 237

morphine
fentanyl

Front 238

What kind of risk for injury related to continued agitation will increased the patients wor of breathing, o2 consumption and CO2 production

Back 238

accidential extubation

Front 239

What kinds of depression muct the patient be monitored for when using sedatives?

Back 239

respiratory and cardiovascular depression

Front 240

Patients who breathe asynchronously with mecanitcal ventilation may also benefit from titration of ventilator flow rates and other settings, as well as adressing treatable causes of agitation such as:
1.
2.
3.

Back 240

hypoxemia
pain
hypercapnia

Front 241

Patients who remain asynchronous with mechanical ventilatio may require nueromuscular blockaid with agents such as Norcuron or Numbex to produce what effect on the body?

Back 241

skeletal muscle relaxation and synchrony breathing on mechanical ventilation

Front 242

_________ may also decrease the patients risk of lung injury related to excessive inspiratory/intrathoracic pressures.

Back 242

Neuromuscular Blockade

Front 243

What should patients receiving neuromuscular blockade receive?

Back 243

sedatives and analgesic to the point of unconsciousness

Front 244

Why is a patient suggested to be unconscious during neuromuscular blockade?
1.
2.
3.

Back 244

Comfort
eliminate awareness to terrifying experience
and pain

Front 245

What is the medical supportive therapy primary goal?

Back 245

treat underlying cause

Front 246

What are two other goals that the medical supportive therapy try and accomplish
1.
2.

Back 246

maintain adequate cardiac output
maintain hemoglobin concentration

Front 247

What does cardiac output reflect?

Back 247

BLOOD FLOW REACHING THE TISSUES

Front 248

WHat is an important indicator of cardiac output?

Back 248

blood pressure

Front 249

Usually a systolic blood pressure of at least ____ is adequate to maintain perfusion to vital organs

Back 249

90

Front 250

How is decreased cardiac output treated?

Back 250

by administration of IV fluids and medications or both

Front 251

cardiac output may also decrease by changes in intrathoracic or intrapulmonary pressures from

Back 251

PPV positive pressure ventilation

Front 252

WHat is the primary carrier when delivering O2 to the tissues?

Back 252

Hemoglobin

Front 253

If the patient is anemic tissue O2 delivery will be ________

Back 253

compromised

Front 254

A hemoglobin of _______ or greater is typically ensures adequate O2 saturation of hemoglobin

Back 254

9-10

Front 255

If patient does not have an adequate hemoglobin concentration and it can not be maintained what should be monitored? _______ what should it be transfused with? ________

Back 255

blood loss
Packed RBC

Front 256

Maintenance of _____ and _____ stores is especially important in patients who experience acute respiratory failure.

Back 256

protein
energy

Front 257

Nutritional depletion causes a loss of ______ mass including those of the respiratory system

Back 257

muscle

Front 258

During acute manifestations of respiratory the risk of aspiration typically prevents ________

Back 258

oral nutritional intake

Front 259

WHat kind of nutrition will be administered to the respiratory failure patient

Back 259

enteral or parenteral

Front 260

What kind of diet should be avoided in patients who retian CO2?

Back 260

High Carbohydrate

Front 261

Why must the patient avoid carbs?

Back 261

carbs metabolize into CO2 and increase the Co2 load on the patient

Front 262

Older adults are at higher risk for developing respiratory failure becasue of the ?

Back 262

reduction in ventilatory capacity that accompanies aging

Front 263

Physiological aging of the lung may produce?
1.
2.
3.

Back 263

larger air spaces
loss of surface area
dilated alveoli

Front 264

There are a few other things that happens with aging what are they?
1.
2.
3.

Back 264

diminished Elastic recoil within the airways
decreased chest wall compliance
decreased respiratory muscle strength

Front 265

What is a big risk factor for respiratory failure in the older adult that their PaO2 falls further and the PaCo2 rises to a higher level before the respiratory system is stimulated to alter the rate and depth of breathing

Back 265

smoking

Front 266

A sudden and progressive form of acute respiratory failure is called

Back 266

ARDS: Acute respiratory Distress syndrome

Front 267

When ArDS happens the alveolar capilliary membrane becomes damaged and more permeable to __________

Back 267

intravascular fluid

Front 268

The alveoli fill with fluid resulting in:
1.
2.
3.
4.

Back 268

Severe dyspnea
hypoxemia
reduced lung compliance
infuse pulmonary infiltrates

Front 269

Mortality rate is about ___% Patients with both gram negative septic shock and ARDS you will have a mortality rate of ___% to ___%

Back 269

50%
70-90%

Front 270

Direct Lung Injury: Common casues are:
1.
2.

Back 270

Aspiration
Pneumonia

Front 271

Less Common Causes of Direct Injury to the lungs are:
1.
2.
3.
4.
5.

Back 271

embolism
trauma
near drowning
O2 toxicity
Radiation Pneumonitits
Inhalation of toxic substances

Front 272

Indirect lung injury common causes include
1.
2.

Back 272

Sepsis
Trauma

Front 273

Less Common causes of indirect lung injury are:
1.
2.
3.
4.
5.
6.
7.

Back 273

pancreatitis
anaphylaxis
cardiopulmonary bipass
disseminated intravascular coagulation
blood transfusions
overdose narcotics
nonpulmonary system distress
head injury
shock states

Front 274

Injury to the alveolar capilliary membrane is by two main events
1. Damage to the Type ____ alveolar cell and by 2. release of _________ mediators

Back 274

II
Inflammatory

Front 275

Most common cause of ARDS is

Back 275

SEPSIS

Front 276

Direct lung inury my cause ARDS or ARDS may develop as a consequence of the _____

Back 276

SIRS Systemic inflammatory response syndrome

Front 277

SIRS may have an infectious or a noninfectious etiology and is characterized by _____________ or clinical responses to _____________ following a ariety of Psysiologic insults including:
1,
2.
3.
4.

Back 277

severe trauma
gut ischemia
lung injury
sepsis

Front 278

ARDS may also develop from _____which results from Organ system dysfunction that progressively increases in severity and ultimately results in multisystem organ failure

Back 278

MODS multiple organ dysfunction system

Front 279

Pathophysiology changes of ARDS are though to be due to stimulation of the ________ and ________ systems which causes an attraction of neutraphills to the pulmonary interstituim

Back 279

inflammatory and immune systems

Front 280

Neutraphils cause a release of humeral, biochemical, and cellular __________-

Back 280

mediators

Front 281

These changes such as : increased pulmonary apilliary membrane permeability, destruction of elastin and collagen, formation of pulmonary microemboli, and pulmonary artery vasoconstriction is by the

Back 281

neutrophilsbiochemical, humeral and cellular mediators

Front 282

There are three pathophysiology changes in ARDS that are divided into three phases. These phases are
1.
2.
3

Back 282

injury or exudative phase
reparative or proliferative phase
fibrotic phase

Front 283

in the earliest phase of injury there is engorgement of the peribronchial and perivascular interstitial space which produces ______________

Back 283

interstitial edema

Front 284

Neutrophils adhere to the pulmonary microcirculation causeing damage to the ____________ and increased capillary permeability

Back 284

vascular endothilium

Front 285

Intrapulmonary shunt develops after the fluid from the interstitial space crosses the alveolar epithelium and enters the alveolar space why??

Back 285

alveoli become filled with fluid and the bloodpassing through them cannont be oxygenated

Front 286

Alveolar type I and type II cells do what?

Back 286

produce surfactant

Front 287

the function of surfactant is to maintain alveolar stability by

Back 287

decreasing alveolar surface tension and preventing alveolar collapse

Front 288

Decreased synthesis of surfactant and inactivation of existing surfactant cause the alveoli to become unstable which is know also as

Back 288

atelectasis

Front 289

Wide spread atelectasis further does what?

Back 289

decreases lung compliance,
compromises gas exchange
contributes to hypoxemia

Front 290

this type of membrane is composed of necrotic cells, protein, fibrin, and lies adjacent to the alveoli wall

Back 290

hyaline

Front 291

Hyaline membranes contribute to the development of _____ and ______ leading to a decrease in gas exchange capability and lung compliance

Back 291

atelectasis
fibrosis

Front 292

Primary pathopghysiology changes that characterize in the injury or exudative phase or ARDS is
1.
2.

Back 292

edema
atelectasis

Front 293

this is the termed used for a severe V/Q mismatch and shunting of pulmonary capilliary blood result in hypoxemia unresponsive to increasing concentrations of O2

Back 293

refractory hypoxemia

Front 294

Reduced lung compliance greatly increases the patients what?

Back 294

work of breathing

Front 295

Hypoxemia and the stimulation of juxtacapilliary receptors in the stiff lung parenchyma (J reflex) initially cause an

Back 295

increase in respiratory rate and a decrease in tidal volume

Front 296

When you have a breathing pattern that increases the CO2 removal what kind of state would you be in that you would be in stated from ABGS?

Back 296

respiratory Alkalosis

Front 297

Cardiac Output increases in response to hypoxemia a compensatory mechanism to increase what

Back 297

pulmonary blood flow

Front 298

Second phase reparative or proliferative phase of ARDS begins 1-2 weeks after initial lung injury. During this phase there is an influx of neutrophils, monocytes and lymphocytes and fibroblast proliferation as part of the

Back 298

Inflammatory response

Front 299

The proliferated phase is complete when the diseased lung becomes characterized by dense _______

Back 299

fibrious tissue

Front 300

Hypoxemia worsens becasue of thickened alveolar membrane, causing diffusion limitation and ______

Back 300

shunting

Front 301

The third phase is the fibrotic phase which occurs 2-3 weeks. by this time the lung is completely what

Back 301

remodeled by sparsely collagenous and fibrous tissues

Front 302

There is a diffuse scarring and fibrosis, resulting in

Back 302

decreased lung compliance

Front 303

This results from pulmonary vascular destruction and fibrosis

Back 303

pulmonary hypertension

Front 304

Several factors seem to be important in determining the course of ARDS including
1.
2.
3.

Back 304

nature of the initial injury
extent and severity of the coexisting diseases
pulmonary complication

Front 305

Some symptoms that the patient may experience at first would be :
1.
2.
3.
4.

Back 305

dyspnea
tachynpnea
cough
restlessness

Front 306

Chest auscultation may be normal or reveal fine, scattered what

Back 306

crackles

Front 307

ABGS usually indicate mild hypoxemia and respiratory alkalosis casued by ______

Back 307

hyperventillation

Front 308

This results from hypozemia and stimulation of J receptors

Back 308

respiratory alkalosis

Front 309

Pulmonary function tests in ARDS reveal decreased compliance and decreased lung volumes particularily a decrease in _______

Back 309

functional residual capacity FRC

Front 310

As ARDS progresses chest auscultation will reveal scattered to diffuse

Back 310

crackles and rhonchi

Front 311

X-Ray demonstrates diffuse and extensive ?

Back 311

bilateral interstitial and alveolar infiltrates

Front 312

HALLMARKS of ARDS include
1.
2. ____ ratio below 200

Back 312

hypoxemia
PaO2/FIO2

Front 313

ARDS progresses it is associated with profound respiratory distress requiring :
1.
2.

Back 313

Intubation or PPV ventillation

Front 314

A chest X-Ray at this stage is usually termed :

Back 314

white out or white lung

Front 315

Diagnostic Findings in ARDS:
PaO2<50mm Hg on FIO2>40% with PEEP.5 cm H20 PaO2/FIO2 ration<200

Back 315

Refractory Hypoxemia

Front 316

Diagnostic Findings in ARDS:
New bilateral interstitial and alveolar infiltrates are found by

Back 316

chest x ray

Front 317

Diagnostic Findings in ARDS:
<18mm Hg and no evidence of heart failure is the

Back 317

Pulmonary Artery Wedge Pressure

Front 318

Complications associated with ARDS include:
Infection:
1.
2.
3.

Back 318

catherter related infection
nosocomial pneumonia
sepsis

Front 319

Complications associated with ARDS include:
Respiratory Complications
1.
2.
3.
4.
5.

Back 319

O2 oxicity
Trauma
Emboli
Fibrosis

Front 320

Complications associated with ARDS include:
Gastrointestinal
1.
2.
3.

Back 320

Paralytic Ileus
Pneumoperitoneu,
Stress Ulceration and Hemorrhage

Front 321

Complications associated with ARDS include:
Renal
1.

Back 321

Acute Renal failure

Front 322

Complications associated with ARDS include:
Cardiac
1.
2.

Back 322

arrhythmias
decreased cardiac output

Front 323

Complications associated with ARDS include:
Hematologic
1.
2.
3.

Back 323

Anemia
disseminated intravascular coagulation
Thrombocytopenia

Front 324

Complications associated with ARDS include:
ET intubation
1.
2.
3.
4.

Back 324

laryngeal ulceration
tracheal malacia
Tracheal stenosis
Tracheal ulceration

Front 325

The major cause of death in ARDS is often accompanied with sepsis

Back 325

MODS

Front 326

The vital organs most commonly involved are :
1.
2.
3.

Back 326

Kidneys
Liver
Heart

Front 327

the organ systems most commonly involved are
1.
2.
3.

Back 327

CNS
Hematologic
gastrointestinal

Front 328

These are all risk factors for what?
host defenses
contaminated medical equipment
invasive monitoring
aspiration
prolonged mechanical ventilation
well colonization of respiratory tract

Back 328

nosocomial Pneumonia

Front 329

In order to prevent nosocomial pneumonia we must :
1.
2.

Back 329

Infection control
elevation of head of bed 45 degrees

Front 330

This may result from rupture of overdistended alveoli during mechanical ventillation

Back 330

Barotrauma

Front 331

Barotrauma results in the presence of alveolar ____in locations where it is not usually found

Back 331

air

Front 332

TO avoid barotrauma patient with ARDS is sometimes ventilated with smaller _______ volumes resulting in higher PaCo2. This method of ventilation is called _______________

Back 332

tidal
permissive hypercapnia

Front 333

this can occur in patients with ARDS when large tidal volumes results in alveolar fractures and movement of fluids and proteins fo in to the ________--

Back 333

Volu-pressure trauma
alveolar spaces

Front 334

To limit Volu-pressure trauma it is reommended that smaller ______- volumes or pressure ventilation are used with these patients with ARDS

Back 334

tidal

Front 335

Stress ulcers occure and management strategies include correction of predisposing conditions such as
1.
2.
3.

Back 335

hypotension
shock
acidosis

Front 336

Prophylactic management includes antiulcer agents such as
1.
2.
3.

Back 336

Pepcid
Prilosec
Carafate

Front 337

Renal failure can occur from decreased ________ as a result from hypostension hypoxemia or hypercapnia

Back 337

tissue oxygenation

Front 338

Renal failure may also be because of administration of nephrotic drugs such as _____

Back 338

aminoglycosides

Front 339

The overall goals for a patient with ARDS is
1.
2.
3.

Back 339

PaO2 of at least 60
good lung ventilation
normal pH

Front 340

There are three main respiratory therapies for the patient with ARDS
1.
2.
3.

Back 340

Oxygen Administration
Mechanical Ventilation
Positioning Strategies

Front 341

Primary goal of O2 thereapy is to

Back 341

correct hypoxemia

Front 342

This is commonly used to monitor and assess the effectiveness of O2 therapy

Back 342

Pulse Ox

Front 343

during mechanical ventilation PEEP at 5 cm H20 is to compensate for loss of ______ from et tube

Back 343

glottic function

Front 344

ECMO and ECCO2R pass blood across a gas-exchanging membrane outside the body and then returned oxygenated blood where?

Back 344

back to the body

Front 345

ECCO2R with low frequency PPV allws the lungs to do what while the lung is not functioning

Back 345

heal

Front 346

Positioning is also a good way what position to what position is commonily used

Back 346

supine to prone

Front 347

what position is usually reserved for patients with refractory hypoxemia

Back 347

prone

Front 348

lateral rotational therapy provides continous rotation allowing 2 things
1.
2.

Back 348

postural drainage
mobilize pulmonary secretions

Front 349

If cardia output fails it is necessary to administer
1.
2.

Back 349

crystalloid fluids
colloid solutions

Front 350

Inotropic drugs such as may be necessary

Back 350

dobutrex
intropin

Front 351

this is a serious acute respiratory infection caused by a coronavirus spread through air droplets in the air

Back 351

SARS severe acute respiratory syndrome

Front 352

SARS begins with ________--

Back 352

fever greater than 100.4

Front 353

Other manifestations include

Back 353

headache and discomfort

Front 354

Patient should be placed where in the hospital

Back 354

isolation

Front 355

Medications given to a patient with SARS is
1.
2.
3.

Back 355

antiviral meds ribavirin
antibiotics
corticosteriods

Front 356

Hypercapnic respiatory failure can be casued by

Back 356

asthma

Front 357

Early sign of acute respiratory failure is

Back 357

restlessness

Front 358

O2 delivery system chosen for a patient in acute respiratory failure should be

Back 358

maintain the PaO2 at 60 mm Hg or greater at the lowest O2 concentration possible

Front 359

Most common early clinical manifestations of ARDS that the nurse may observe are

Back 359

dyspnea and tachypnea

Front 360

Maintenance of fluid balance in the patient with ARDS involves

Back 360

mild fluid restriction and diuretics as necessary

Front 361

Which of the following interventions is designed to prevent or limit barotrauma in the patient with ARDS who is mechanically ventillated?

Back 361

the use of permissive hypercapnia