Nur144 Exam 2C

Front 1

Respiratory
I. Assessment
A. Subjective Data
1. Past Health History--______, ________, _________, ________, previous hospitalizations, allergies, COPD, pneumonia, bronchitis, TB, weight loss (early lung cancer, TB, and COPD), sleep apnea, recent travel, flu vaccination
2. Symptoms--SOB (when, etc.), # of pillows for sleep, DOE (how far can they walk), associated symptoms (cough, changes, sputum, loose/dry, color, odor, blood), pain (what relieves it)
3. Medications--prescription and over the counter 169.254.115.213

Back 1

Respiratory
I. Assessment
A. Subjective Data
1. Past Health History--smoking, asthma, occupation, recent illnesses, previous hospitalizations, allergies, COPD, pneumonia, bronchitis, TB, weight loss (early lung cancer, TB, and COPD), sleep apnea, recent travel, flu vaccination
2. Symptoms--SOB (when, etc.), # of pillows for sleep, DOE (how far can they walk), associated symptoms (cough, changes, sputum, loose/dry, color, odor, blood), pain (what relieves it)
3. Medications--prescription and over the counter

Front 2

Respiratory
I. Assessment
A. Subjective Data
1. Past Health History--smoking, asthma, occupation, recent illnesses, ________, _________, _________, ________, bronchitis, TB, weight loss (early lung cancer, TB, and COPD), sleep apnea, recent travel, flu vaccination
2. Symptoms--SOB (when, etc.), # of pillows for sleep, DOE (how far can they walk), associated symptoms (cough, changes, sputum, loose/dry, color, odor, blood), pain (what relieves it)
3. Medications--prescription and over the counter

Back 2

Respiratory
I. Assessment
A. Subjective Data
1. Past Health History--smoking, asthma, occupation, recent illnesses, previous hospitalizations, allergies, COPD, pneumonia, bronchitis, TB, weight loss (early lung cancer, TB, and COPD), sleep apnea, recent travel, flu vaccination
2. Symptoms--SOB (when, etc.), # of pillows for sleep, DOE (how far can they walk), associated symptoms (cough, changes, sputum, loose/dry, color, odor, blood), pain (what relieves it)
3. Medications--prescription and over the counter

Front 3

Respiratory
I. Assessment
A. Subjective Data
1. Past Health History--smoking, asthma, occupation, recent illnesses, previous hospitalizations, allergies, COPD, pneumonia, _____, ______, _______ (early lung cancer, TB, and COPD), _______, recent travel, flu vaccination
2. Symptoms--SOB (when, etc.), # of pillows for sleep, DOE (how far can they walk), associated symptoms (cough, changes, sputum, loose/dry, color, odor, blood), pain (what relieves it)
3. Medications--prescription and over the counter

Back 3

Respiratory
I. Assessment
A. Subjective Data
1. Past Health History--smoking, asthma, occupation, recent illnesses, previous hospitalizations, allergies, COPD, pneumonia, bronchitis, TB, weight loss (early lung cancer, TB, and COPD), sleep apnea, recent travel, flu vaccination
2. Symptoms--SOB (when, etc.), # of pillows for sleep, DOE (how far can they walk), associated symptoms (cough, changes, sputum, loose/dry, color, odor, blood), pain (what relieves it)
3. Medications--prescription and over the counter

Front 4

Respiratory
I. Assessment
A. Subjective Data
1. Past Health History--smoking, asthma, occupation, recent illnesses, previous hospitalizations, allergies, COPD, pneumonia, bronchitis, TB, weight loss (early lung cancer, TB, and COPD), sleep apnea, ____,________
2. Symptoms--SOB (when, etc.), # of pillows for sleep, DOE (how far can they walk), associated symptoms (cough, changes, sputum, loose/dry, color, odor, blood), pain (what relieves it)
3. Medications--prescription and over the counter

Back 4

Respiratory
I. Assessment
A. Subjective Data
1. Past Health History--smoking, asthma, occupation, recent illnesses, previous hospitalizations, allergies, COPD, pneumonia, bronchitis, TB, weight loss (early lung cancer, TB, and COPD), sleep apnea, recent travel, flu vaccination
2. Symptoms--SOB (when, etc.), # of pillows for sleep, DOE (how far can they walk), associated symptoms (cough, changes, sputum, loose/dry, color, odor, blood), pain (what relieves it)
3. Medications--prescription and over the counter

Front 5

Respiratory
I. Assessment
A. Subjective Data
1. Past Health History--smoking, asthma, occupation, recent illnesses, previous hospitalizations, allergies, COPD, pneumonia, bronchitis, TB, weight loss (early lung cancer, TB, and COPD), sleep apnea, recent travel, flu vaccination
2. Symptoms--SOB (when, etc.), # of _______ for sleep, _____ (how far can they walk), associated symptoms (____, ______, sputum, loose/dry, color, odor, blood), pain (what relieves it)
3. Medications--prescription and over the counter

Back 5

Respiratory
I. Assessment
A. Subjective Data
1. Past Health History--smoking, asthma, occupation, recent illnesses, previous hospitalizations, allergies, COPD, pneumonia, bronchitis, TB, weight loss (early lung cancer, TB, and COPD), sleep apnea, recent travel, flu vaccination
2. Symptoms--SOB (when, etc.), # of pillows for sleep, DOE (how far can they walk), associated symptoms (cough, changes, sputum, loose/dry, color, odor, blood), pain (what relieves it)
3. Medications--prescription and over the counter

Front 6

Respiratory
I. Assessment
A. Subjective Data
1. Past Health History--smoking, asthma, occupation, recent illnesses, previous hospitalizations, allergies, COPD, pneumonia, bronchitis, TB, weight loss (early lung cancer, TB, and COPD), sleep apnea, recent travel, flu vaccination
2. Symptoms--SOB (when, etc.), # of pillows for sleep, DOE (how far can they walk), associated symptoms (cough, changes, _____, ______, ______, ______, blood), pain (what relieves it)
3. Medications--prescription and over the counter

Back 6

Respiratory
I. Assessment
A. Subjective Data
1. Past Health History--smoking, asthma, occupation, recent illnesses, previous hospitalizations, allergies, COPD, pneumonia, bronchitis, TB, weight loss (early lung cancer, TB, and COPD), sleep apnea, recent travel, flu vaccination
2. Symptoms--SOB (when, etc.), # of pillows for sleep, DOE (how far can they walk), associated symptoms (cough, changes, sputum, loose/dry, color, odor, blood), pain (what relieves it)
3. Medications--prescription and over the counter

Front 7

Respiratory
I. Assessment
A. Subjective Data
1. Past Health History--smoking, asthma, occupation, recent illnesses, previous hospitalizations, allergies, COPD, pneumonia, bronchitis, TB, weight loss (early lung cancer, TB, and COPD), sleep apnea, recent travel, flu vaccination
2. Symptoms--SOB (when, etc.), # of pillows for sleep, DOE (how far can they walk), associated symptoms (cough, changes, sputum, loose/dry, color, odor, ______), ______ (what relieves it)
3. Medications--prescription and over the counter

Back 7

Respiratory
I. Assessment
A. Subjective Data
1. Past Health History--smoking, asthma, occupation, recent illnesses, previous hospitalizations, allergies, COPD, pneumonia, bronchitis, TB, weight loss (early lung cancer, TB, and COPD), sleep apnea, recent travel, flu vaccination
2. Symptoms--SOB (when, etc.), # of pillows for sleep, DOE (how far can they walk), associated symptoms (cough, changes, sputum, loose/dry, color, odor, blood), pain (what relieves it)
3. Medications--prescription and over the counter

Front 8

Respiratory
I. Assessment
A. Subjective Data
1. Past Health History--smoking, asthma, occupation, recent illnesses, previous hospitalizations, allergies, COPD, pneumonia, bronchitis, TB, weight loss (early lung cancer, TB, and COPD), sleep apnea, recent travel, flu vaccination
2. Symptoms--SOB (when, etc.), # of pillows for sleep, DOE (how far can they walk), associated symptoms (cough, changes, sputum, loose/dry, color, odor, blood), pain (what relieves it)
3. Medications--________ and _______

Back 8

Respiratory
I. Assessment
A. Subjective Data
1. Past Health History--smoking, asthma, occupation, recent illnesses, previous hospitalizations, allergies, COPD, pneumonia, bronchitis, TB, weight loss (early lung cancer, TB, and COPD), sleep apnea, recent travel, flu vaccination
2. Symptoms--SOB (when, etc.), # of pillows for sleep, DOE (how far can they walk), associated symptoms (cough, changes, sputum, loose/dry, color, odor, blood), pain (what relieves it)
3. Medications--prescription and over the counter

Front 9

Respiratory
I. Assessment
B. Objective Data
1. Inspection
a. Signs of respiratory distress--_____, _______, ----------, ----------, ↑HR, accessory muscle use, pursed lip breathing, tracheal deviation
b. Shape and symmetry of chest--bilaterally unequal, anterior-posterior diameter (ex. COPD-barrel), kyphosis, scoliosis, pectis exctavatum
c. Ventilatory patterns--kussmals, chayne-stokes, rate, depth, etc.
d. Evidence of clubbing--chronic hypoxia from COPD, lung cancer, and CF

Back 9

Respiratory
I. Assessment
B. Objective Data
1. Inspection
a. Signs of respiratory distress--cyanosis, diff breathing, anxiety, diaphoretic, ↑HR, accessory muscle use, pursed lip breathing, tracheal deviation
b. Shape and symmetry of chest--bilaterally unequal, anterior-posterior diameter (ex. COPD-barrel), kyphosis, scoliosis, pectis exctavatum
c. Ventilatory patterns--kussmals, chayne-stokes, rate, depth, etc.
d. Evidence of clubbing--chronic hypoxia from COPD, lung cancer, and CF

Front 10

Respiratory
I. Assessment
B. Objective Data
1. Inspection
a. Signs of respiratory distress--cyanosis, diff breathing, anxiety, diaphoretic, ↑-----, -------------, -----------, ---------
b. Shape and symmetry of chest--bilaterally unequal, anterior-posterior diameter (ex. COPD-barrel), kyphosis, scoliosis, pectis exctavatum
c. Ventilatory patterns--kussmals, chayne-stokes, rate, depth, etc.
d. Evidence of clubbing--chronic hypoxia from COPD, lung cancer, and CF

Back 10

Respiratory
I. Assessment
B. Objective Data
1. Inspection
a. Signs of respiratory distress--cyanosis, diff breathing, anxiety, diaphoretic, ↑HR, accessory muscle use, pursed lip breathing, tracheal deviation
b. Shape and symmetry of chest--bilaterally unequal, anterior-posterior diameter (ex. COPD-barrel), kyphosis, scoliosis, pectis exctavatum
c. Ventilatory patterns--kussmals, chayne-stokes, rate, depth, etc.
d. Evidence of clubbing--chronic hypoxia from COPD, lung cancer, and CF

Front 11

Respiratory
I. Assessment
B. Objective Data
1. Inspection
a. Signs of respiratory distress--cyanosis, diff breathing, anxiety, diaphoretic, ↑HR, accessory muscle use, pursed lip breathing, tracheal deviation
b. Shape and symmetry of chest: --------, ------------------ (ex. COPD-barrel), ------------, scoliosis, pectis exctavatum
c. Ventilatory patterns--kussmals, chayne-stokes, rate, depth, etc.
d. Evidence of clubbing--chronic hypoxia from COPD, lung cancer, and CF

Back 11

Respiratory
I. Assessment
B. Objective Data
1. Inspection
a. Signs of respiratory distress--cyanosis, diff breathing, anxiety, diaphoretic, ↑HR, accessory muscle use, pursed lip breathing, tracheal deviation
b. Shape and symmetry of chest--bilaterally unequal, anterior-posterior diameter (ex. COPD-barrel), kyphosis, scoliosis, pectis exctavatum
c. Ventilatory patterns--kussmals, chayne-stokes, rate, depth, etc.
d. Evidence of clubbing--chronic hypoxia from COPD, lung cancer, and CF

Front 12

Respiratory
I. Assessment
B. Objective Data
1. Inspection
a. Signs of respiratory distress--cyanosis, diff breathing, anxiety, diaphoretic, ↑HR, accessory muscle use, pursed lip breathing, tracheal deviation
b. Shape and symmetry of chest--bilaterally unequal, anterior-posterior diameter (ex. COPD-barrel), kyphosis, ----------, ----------------
c. Ventilatory patterns--kussmals, chayne-stokes, rate, depth, etc.
d. Evidence of clubbing--chronic hypoxia from COPD, lung cancer, and CF

Back 12

Respiratory
I. Assessment
B. Objective Data
1. Inspection
a. Signs of respiratory distress--cyanosis, diff breathing, anxiety, diaphoretic, ↑HR, accessory muscle use, pursed lip breathing, tracheal deviation
b. Shape and symmetry of chest--bilaterally unequal, anterior-posterior diameter (ex. COPD-barrel), kyphosis, scoliosis, pectis exctavatum
c. Ventilatory patterns--kussmals, chayne-stokes, rate, depth, etc.
d. Evidence of clubbing--chronic hypoxia from COPD, lung cancer, and CF

Front 13

Respiratory
I. Assessment
B. Objective Data
1. Inspection
a. Signs of respiratory distress--cyanosis, diff breathing, anxiety, diaphoretic, ↑HR, accessory muscle use, pursed lip breathing, tracheal deviation
b. Shape and symmetry of chest--bilaterally unequal, anterior-posterior diameter (ex. COPD-barrel), kyphosis, scoliosis, pectis exctavatum
c. Ventilatory patterns: ------------, ----------, --------, ---------, etc.
d. Evidence of clubbing--chronic hypoxia from COPD, lung cancer, and CF

Back 13

Respiratory
I. Assessment
B. Objective Data
1. Inspection
a. Signs of respiratory distress--cyanosis, diff breathing, anxiety, diaphoretic, ↑HR, accessory muscle use, pursed lip breathing, tracheal deviation
b. Shape and symmetry of chest--bilaterally unequal, anterior-posterior diameter (ex. COPD-barrel), kyphosis, scoliosis, pectis exctavatum
c. Ventilatory patterns--kussmals, chayne-stokes, rate, depth, etc.
d. Evidence of clubbing--chronic hypoxia from COPD, lung cancer, and CF

Front 14

Respiratory
I. Assessment
B. Objective Data
1. Inspection
a. Signs of respiratory distress--cyanosis, diff breathing, anxiety, diaphoretic, ↑HR, accessory muscle use, pursed lip breathing, tracheal deviation
b. Shape and symmetry of chest--bilaterally unequal, anterior-posterior diameter (ex. COPD-barrel), kyphosis, scoliosis, pectis exctavatum
c. Ventilatory patterns--kussmals, chayne-stokes, rate, depth, etc.
d. Evidence of clubbing: --------------- from --------, ---------, and -----

Back 14

Respiratory
I. Assessment
B. Objective Data
1. Inspection
a. Signs of respiratory distress--cyanosis, diff breathing, anxiety, diaphoretic, ↑HR, accessory muscle use, pursed lip breathing, tracheal deviation
b. Shape and symmetry of chest--bilaterally unequal, anterior-posterior diameter (ex. COPD-barrel), kyphosis, scoliosis, pectis exctavatum
c. Ventilatory patterns--kussmals, chayne-stokes, rate, depth, etc.
d. Evidence of clubbing--chronic hypoxia from COPD, lung cancer, and CF

Front 15

Respiratory
I. Assessment
B. Objective Data
2. Palpitation
a. Assess trachea is -------, tracheal deviation indicated---------
b. Assess thoracic excursion/chest expansion--normally equal bilaterally
i. Decreased bilaterally for emphysema
ii. Decreased on effected side for pleural effusion and pneumothorax

Back 15

Respiratory
I. Assessment
B. Objective Data
2. Palpitation
a. Assess trachea is midline--tracheal deviation indicated tension pneumothorax
b. Assess thoracic excursion/chest expansion--normally equal bilaterally
i. Decreased bilaterally for emphysema
ii. Decreased on effected side for pleural effusion and pneumothorax

Front 16

Respiratory
I. Assessment
B. Objective Data
2. Palpitation
a. Assess trachea is midline--tracheal deviation indicated tension pneumothorax
b. Assess ---------/chest expansion--normally equal ---------
i. Decreased bilaterally for emphysema
ii. Decreased on effected side for pleural effusion and pneumothorax

Back 16

Respiratory
I. Assessment
B. Objective Data
2. Palpitation
a. Assess trachea is midline--tracheal deviation indicated tension pneumothorax
b. Assess thoracic excursion/chest expansion--normally equal bilaterally
i. Decreased bilaterally for emphysema
ii. Decreased on effected side for pleural effusion and pneumothorax

Front 17

Respiratory
I. Assessment
B. Objective Data
2. Palpitation
a. Assess trachea is midline--tracheal deviation indicated tension pneumothorax
b. Assess thoracic excursion/chest expansion--normally equal bilaterally
i. Decreased --------- for ---------
ii. Decreased on effected side for pleural effusion and pneumothorax

Back 17

Respiratory
I. Assessment
B. Objective Data
2. Palpitation
a. Assess trachea is midline--tracheal deviation indicated tension pneumothorax
b. Assess thoracic excursion/chest expansion--normally equal bilaterally
i. Decreased bilaterally for emphysema
ii. Decreased on effected side for pleural effusion and pneumothorax

Front 18

Respiratory
I. Assessment
B. Objective Data
2. Palpitation
a. Assess trachea is midline--tracheal deviation indicated tension pneumothorax
b. Assess thoracic excursion/chest expansion--normally equal bilaterally
i. Decreased bilaterally for emphysema
ii. Decreased on effected side for --------- and ---------

Back 18

Respiratory
I. Assessment
B. Objective Data
2. Palpitation
a. Assess trachea is midline--tracheal deviation indicated tension pneumothorax
b. Assess thoracic excursion/chest expansion--normally equal bilaterally
i. Decreased bilaterally for emphysema
ii. Decreased on effected side for pleural effusion and pneumothorax

Front 19

Respiratory
I. Assessment
B. Objective Data
2. Palpitation
c. -----------: vibration of chest wall produced by vocalization (“Say 99” feel upper back)
i. Decreased if lung is further away (pleural effusion, emphysema)
ii. Increased if pneumonia, tumors, and fibrosis
iii. Nothing felt if pneumothorax or severe atelectasis

Back 19

Respiratory
I. Assessment
B. Objective Data
2. Palpitation
c. Fremitis--vibration of chest wall produced by vocalization (“Say 99” feel upper back)
i. Decreased if lung is further away (pleural effusion, emphysema)
ii. Increased if pneumonia, tumors, and fibrosis
iii. Nothing felt if pneumothorax or severe atelectasis

Front 20

Respiratory
I. Assessment
B. Objective Data
2. Palpitation
c. Fremitis--vibration of chest wall produced by vocalization (“Say ----” feel upper back)
i. Decreased if lung is ---------- (------------,------------)
ii. Increased if pneumonia, tumors, and fibrosis
iii. Nothing felt if pneumothorax or severe atelectasis

Back 20

Respiratory
I. Assessment
B. Objective Data
2. Palpitation
c. Fremitis--vibration of chest wall produced by vocalization (“Say 99” feel upper back)
i. Decreased if lung is further away (pleural effusion, emphysema)
ii. Increased if pneumonia, tumors, and fibrosis
iii. Nothing felt if pneumothorax or severe atelectasis

Front 21

Respiratory
I. Assessment
B. Objective Data
2. Palpitation
c. Fremitis--vibration of chest wall produced by vocalization (“Say 99” feel upper back)
i. Decreased if lung is further away (pleural effusion, emphysema)
ii. Increased if -------, -----------, and --------------
iii. Nothing felt if pneumothorax or severe atelectasis

Back 21

Respiratory
I. Assessment
B. Objective Data
2. Palpitation
c. Fremitis--vibration of chest wall produced by vocalization (“Say 99” feel upper back)
i. Decreased if lung is further away (pleural effusion, emphysema)
ii. Increased if pneumonia, tumors, and fibrosis
iii. Nothing felt if pneumothorax or severe atelectasis

Front 22

Respiratory
I. Assessment
B. Objective Data
2. Palpitation
c. Fremitis--vibration of chest wall produced by vocalization (“Say 99” feel upper back)
i. Decreased if lung is further away (pleural effusion, emphysema)
ii. Increased if pneumonia, tumors, and fibrosis
iii. Nothing felt if ---------- or -----------

Back 22

Respiratory
I. Assessment
B. Objective Data
2. Palpitation
c. Fremitis--vibration of chest wall produced by vocalization (“Say 99” feel upper back)
i. Decreased if lung is further away (pleural effusion, emphysema)
ii. Increased if pneumonia, tumors, and fibrosis
iii. Nothing felt if pneumothorax or severe atelectasis

Front 23

Respiratory
I. Assessment
B. Objective Data
2. Palpitation
d. ---------- (subcutaneous emphysema): crackling, crinkling, or grating feeling/sound under skin, around lungs, or in joints caused by escape of air (like bubble wrap)
i. Common causes: chest tube leak, mechanical ventilation

Back 23

Respiratory
I. Assessment
B. Objective Data
2. Palpitation
d. Crepitus (subcutaneous emphysema)--crackling, crinkling, or grating feeling/sound under skin, around lungs, or in joints caused by escape of air (like bubble wrap)
i. Common causes: chest tube leak, mechanical ventilation

Front 24

Respiratory
I. Assessment
B. Objective Data
2. Palpitation
d. Crepitus (subcutaneous emphysema): ---------, -----------, or ------------------, around lungs, or in joints caused by escape of air (like bubble wrap)
i. Common causes: chest tube leak, mechanical ventilation

Back 24

Respiratory
I. Assessment
B. Objective Data
2. Palpitation
d. Crepitus (subcutaneous emphysema)--crackling, crinkling, or grating feeling/sound under skin, around lungs, or in joints caused by escape of air (like bubble wrap)
i. Common causes: chest tube leak, mechanical ventilation

Front 25

Respiratory
I. Assessment
B. Objective Data
2. Palpitation
d. Crepitus (subcutaneous emphysema)--crackling, crinkling, or grating feeling/sound under skin, ---------, or in---------- caused by escape of air (like bubble wrap)
i. Common causes: chest tube leak, mechanical ventilation

Back 25

Respiratory
I. Assessment
B. Objective Data
2. Palpitation
d. Crepitus (subcutaneous emphysema)--crackling, crinkling, or grating feeling/sound under skin, around lungs, or in joints caused by escape of air (like bubble wrap)
i. Common causes: chest tube leak, mechanical ventilation

Front 26

Respiratory
I. Assessment
B. Objective Data
2. Palpitation
d. Crepitus (subcutaneous emphysema)--crackling, crinkling, or grating feeling/sound under skin, around lungs, or in joints caused by escape of air (like bubble wrap)
i. Common causes: ------------, ------------

Back 26

Respiratory
I. Assessment
B. Objective Data
2. Palpitation
d. Crepitus (subcutaneous emphysema)--crackling, crinkling, or grating feeling/sound under skin, around lungs, or in joints caused by escape of air (like bubble wrap)
i. Common causes: chest tube leak, mechanical ventilation

Front 27

Respiratory
I. Assessment
B. Objective Data
3. Percussion--assessment of --------- or ----------- of the lungs
a. Resonance--air filled lung (normal)
b. Hyperresonance--loud, lower pitched sound from increased air volume (ex. COPD)
c. Tympany--drum like (ex. gastric air bubble)
d. Dullness--consolidation in lung (ex. heart, top of liver, or pneumonia, hemothorax)
e. Flat--soft, high pitched sound from large fluid mass (ex. thigh)

Back 27

Respiratory
I. Assessment
B. Objective Data
3. Percussion--assessment of density or aeration of the lungs
a. Resonance--air filled lung (normal)
b. Hyperresonance--loud, lower pitched sound from increased air volume (ex. COPD)
c. Tympany--drum like (ex. gastric air bubble)
d. Dullness--consolidation in lung (ex. heart, top of liver, or pneumonia, hemothorax)
e. Flat--soft, high pitched sound from large fluid mass (ex. thigh)

Front 28

Respiratory
I. Assessment
B. Objective Data
3. Percussion--assessment of density or aeration of the lungs
a. Resonance: ---------- (normal)
b. Hyperresonance: -----, lower pitched sound from --------------- (ex. COPD)
c. Tympany--drum like (ex. gastric air bubble)
d. Dullness--consolidation in lung (ex. heart, top of liver, or pneumonia, hemothorax)
e. Flat--soft, high pitched sound from large fluid mass (ex. thigh)

Back 28

Respiratory
I. Assessment
B. Objective Data
3. Percussion--assessment of density or aeration of the lungs
a. Resonance--air filled lung (normal)
b. Hyperresonance--loud, lower pitched sound from increased air volume (ex. COPD)
c. Tympany--drum like (ex. gastric air bubble)
d. Dullness--consolidation in lung (ex. heart, top of liver, or pneumonia, hemothorax)
e. Flat--soft, high pitched sound from large fluid mass (ex. thigh)

Front 29

Respiratory
I. Assessment
B. Objective Data
3. Percussion--assessment of density or aeration of the lungs
a. Resonance--air filled lung (normal)
b. Hyperresonance--loud, lower pitched sound from increased air volume (ex. COPD)
c. ----------: drum like (ex. gastric air bubble)
d. Dullness--consolidation in ----------- (ex. heart, top of ---------, or pneumonia, ----------)
e. Flat--soft, high pitched sound from large fluid mass (ex. thigh)

Back 29

Respiratory
I. Assessment
B. Objective Data
3. Percussion--assessment of density or aeration of the lungs
a. Resonance--air filled lung (normal)
b. Hyperresonance--loud, lower pitched sound from increased air volume (ex. COPD)
c. Tympany--drum like (ex. gastric air bubble)
d. Dullness--consolidation in lung (ex. heart, top of liver, or pneumonia, hemothorax)
e. Flat--soft, high pitched sound from large fluid mass (ex. thigh)

Front 30

Respiratory
I. Assessment
B. Objective Data
3. Percussion--assessment of density or aeration of the lungs
a. Resonance--air filled lung (normal)
b. Hyperresonance--loud, lower pitched sound from increased air volume (ex. COPD)
c. Tympany--drum like (ex. gastric air bubble)
d. Dullness--consolidation in lung (ex. heart, top of liver, or pneumonia, hemothorax)
e. Flat--soft, high pitched sound from --------------- (ex. thigh)

Back 30

Respiratory
I. Assessment
B. Objective Data
3. Percussion--assessment of density or aeration of the lungs
a. Resonance--air filled lung (normal)
b. Hyperresonance--loud, lower pitched sound from increased air volume (ex. COPD)
c. Tympany--drum like (ex. gastric air bubble)
d. Dullness--consolidation in lung (ex. heart, top of liver, or pneumonia, hemothorax)
e. Flat--soft, high pitched sound from large fluid mass (ex. thigh)

Front 31

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for ---------- and --------- sounds

Back 31

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sounds
a. Adventitious Sounds
i. Fine crackles--short lasting, high pitched at end of inspiration

Front 32

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sounds
a. Adventitious Sounds
i. Fine crackles--short lasting, ---------- at --------------

Back 32

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sounds
a. Adventitious Sounds
i. Fine crackles--short lasting, high pitched at end of inspiration

Front 33

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sounds
• Due to ---------- snapping open or movement of ---------- through a lot of ----------
• Post-op atelectasis, pulmonary edema
ii. Course crackles--low pitched on inspiration and expiration that is not eliminated by cough (will not go away until disease process ends/gets better)
• Due to air passing through airway intermittently occluded with mucus
• Pulmonary edema, pneumonia, CHF
• Do fluid assessment, I/Os, and O2Sat

Back 33

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sounds
• Due to alveoli snapping open or movement of air through a lot of liquid
• Post-op atelectasis, pulmonary edema
ii. Course crackles--low pitched on inspiration and expiration that is not eliminated by cough (will not go away until disease process ends/gets better)
• Due to air passing through airway intermittently occluded with mucus
• Pulmonary edema, pneumonia, CHF
• Do fluid assessment, I/Os, and O2Sat

Front 34

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sounds
• Due to alveoli snapping open or movement of air through a lot of liquid
• Post-op -----------, pulmonary--------
ii. Course crackles--low pitched on inspiration and expiration that is not eliminated by cough (will not go away until disease process ends/gets better)
• Due to air passing through airway intermittently occluded with mucus
• Pulmonary edema, pneumonia, CHF
• Do fluid assessment, I/Os, and O2Sat

Back 34

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sounds
• Due to alveoli snapping open or movement of air through a lot of liquid
• Post-op atelectasis, pulmonary edema
ii. Course crackles--low pitched on inspiration and expiration that is not eliminated by cough (will not go away until disease process ends/gets better)
• Due to air passing through airway intermittently occluded with mucus
• Pulmonary edema, pneumonia, CHF
• Do fluid assessment, I/Os, and O2Sat

Front 35

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sounds
• Due to alveoli snapping open or movement of air through a lot of liquid
• Post-op atelectasis, pulmonary edema
ii. Course crackles--low pitched on --------- and ----------- that is not eliminated by---------- (will not go away until disease process ends/gets better)
• Due to air passing through airway intermittently occluded with mucus
• Pulmonary edema, pneumonia, CHF
• Do fluid assessment, I/Os, and O2Sat

Back 35

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sounds
• Due to alveoli snapping open or movement of air through a lot of liquid
• Post-op atelectasis, pulmonary edema
ii. Course crackles--low pitched on inspiration and expiration that is not eliminated by cough (will not go away until disease process ends/gets better)
• Due to air passing through airway intermittently occluded with mucus
• Pulmonary edema, pneumonia, CHF
• Do fluid assessment, I/Os, and O2Sat

Front 36

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sounds
• Due to alveoli snapping open or movement of air through a lot of liquid
• Post-op atelectasis, pulmonary edema
ii. Course crackles--low pitched on inspiration and expiration that is not eliminated by cough (will not go away until disease process ends/gets better)
• Due to air passing through --------- intermittently occluded with---------
• Pulmonary ------, pneumonia, CHF
• Do fluid assessment, I/Os, and O2Sat

Back 36

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sounds
• Due to alveoli snapping open or movement of air through a lot of liquid
• Post-op atelectasis, pulmonary edema
ii. Course crackles--low pitched on inspiration and expiration that is not eliminated by cough (will not go away until disease process ends/gets better)
• Due to air passing through airway intermittently occluded with mucus
• Pulmonary edema, pneumonia, CHF
• Do fluid assessment, I/Os, and O2Sat

Front 37

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sounds
• Due to alveoli snapping open or movement of air through a lot of liquid
• Post-op atelectasis, pulmonary edema
ii. Course crackles--low pitched on inspiration and expiration that is not eliminated by cough (will not go away until disease process ends/gets better)
• Due to air passing through airway intermittently occluded with mucus
• Pulmonary edema, pneumonia, CHF
• Do -------- assessment, ------, and -------

Back 37

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sounds
• Due to alveoli snapping open or movement of air through a lot of liquid
• Post-op atelectasis, pulmonary edema
ii. Course crackles--low pitched on inspiration and expiration that is not eliminated by cough (will not go away until disease process ends/gets better)
• Due to air passing through airway intermittently occluded with mucus
• Pulmonary edema, pneumonia, CHF
• Do fluid assessment, I/Os, and O2Sat

Front 38

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
iii. Rhonchi--harsh/----------, from large airway obstruction by --------
• Pneumonia
• Can be cleared--have pt cough or suction if vented and listen for changes
iv. Wheezes--mostly on inspiration (can also be expiration)
• Asthma

Back 38

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
iii. Rhonchi--harsh/course rattling, from large airway obstruction by mucus
• Pneumonia
• Can be cleared--have pt cough or suction if vented and listen for changes
iv. Wheezes--mostly on inspiration (can also be expiration)
• Asthma

Front 39

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
iii. Rhonchi--harsh/course rattling, from large airway obstruction by mucus
• Pneumonia
• Can be cleared--have pt ------- or --------- if vented and listen for ----------
iv. Wheezes--mostly on inspiration (can also be expiration)
• Asthma

Back 39

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
iii. Rhonchi--harsh/course rattling, from large airway obstruction by mucus
• Pneumonia
• Can be cleared--have pt cough or suction if vented and listen for changes
iv. Wheezes--mostly on inspiration (can also be expiration)
• Asthma

Front 40

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
• If stops w/out intervention could be diminished due to ------------ (bad)
v. --------------: grating/leather rubbing sound stops when pt holds breath

Back 40

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
• If stops w/out intervention could be diminished due to tightness (bad)
v. Pleural friction rub--grating/leather rubbing sound stops when pt holds breath

Front 41

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
• If stops w/out intervention could be diminished due to tightness (bad)
v. Pleural friction rub--grating/leather rubbing sound stops when pt -----------

Back 41

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
• If stops w/out intervention could be diminished due to tightness (bad)
v. Pleural friction rub--grating/leather rubbing sound stops when pt holds breath

Front 42

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
• Diff from ----------- rub (continuous rub while holding breath)
b. Normal--: ------------ breath sounds throughout (Moving down, sounds high to low pitch)
i. Bronchial--heard over trachea; “wind through tube” (louder and higher pitch)
ii. Bronchovesicular--heard over main bronchi (medium pitch)
iii. Vesicular--heard over lobes (softer and lower pitched)
iv. Patients can open mouth to breath deeper

Back 42

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
• Diff from pericardial rub (continuous rub while holding breath)
b. Normal--vesicular breath sounds throughout (Moving down, sounds high to low pitch)
i. Bronchial--heard over trachea; “wind through tube” (louder and higher pitch)
ii. Bronchovesicular--heard over main bronchi (medium pitch)
iii. Vesicular--heard over lobes (softer and lower pitched)
iv. Patients can open mouth to breath deeper

Front 43

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
• Diff from pericardial rub (continuous rub while holding breath)
b. Normal--vesicular breath sounds throughout (Moving down, sounds high to low pitch)
i. Bronchial--heard over -----------; “wind through ---------” (louder and higher pitch)
ii. Bronchovesicular--heard over main bronchi (medium pitch)
iii. Vesicular--heard over lobes (softer and lower pitched)
iv. Patients can open mouth to breath deeper

Back 43

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
• Diff from pericardial rub (continuous rub while holding breath)
b. Normal--vesicular breath sounds throughout (Moving down, sounds high to low pitch)
i. Bronchial--heard over trachea; “wind through tube” (louder and higher pitch)
ii. Bronchovesicular--heard over main bronchi (medium pitch)
iii. Vesicular--heard over lobes (softer and lower pitched)
iv. Patients can open mouth to breath deeper

Front 44

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
• Diff from pericardial rub (continuous rub while holding breath)
b. Normal--vesicular breath sounds throughout (Moving down, sounds high to low pitch)
i. Bronchial--heard over trachea; “wind through tube” (louder and higher pitch)
ii. Bronchovesicular--heard over ---------- (medium pitch)
iii. Vesicular--heard over -------- (softer and ------- pitched)
iv. Patients can open mouth to breath deeper

Back 44

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
• Diff from pericardial rub (continuous rub while holding breath)
b. Normal--vesicular breath sounds throughout (Moving down, sounds high to low pitch)
i. Bronchial--heard over trachea; “wind through tube” (louder and higher pitch)
ii. Bronchovesicular--heard over main bronchi (medium pitch)
iii. Vesicular--heard over lobes (softer and lower pitched)
iv. Patients can open mouth to breath deeper

Front 45

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
• Diff from pericardial rub (continuous rub while holding breath)
b. Normal--vesicular breath sounds throughout (Moving down, sounds high to low pitch)
i. Bronchial--heard over trachea; “wind through tube” (louder and higher pitch)
ii. Bronchovesicular--heard over main bronchi (medium pitch)
iii. Vesicular--heard over lobes (softer and lower pitched)
iv. Patients can open ------- to breath deeper

Back 45

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
• Diff from pericardial rub (continuous rub while holding breath)
b. Normal--vesicular breath sounds throughout (Moving down, sounds high to low pitch)
i. Bronchial--heard over trachea; “wind through tube” (louder and higher pitch)
ii. Bronchovesicular--heard over main bronchi (medium pitch)
iii. Vesicular--heard over lobes (softer and lower pitched)
iv. Patients can open mouth to breath deeper

Front 46

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
• Diff from pericardial rub (continuous rub while holding breath)
c. Abnormal--sound other than what is supposed to be there (diff from --------)
d. Voice Sounds--can indicate need for ---------
i. Whispered Pectoriloquy--the way words come across as the whisper “1, 2, 3”

Back 46

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
• Diff from pericardial rub (continuous rub while holding breath)
c. Abnormal--sound other than what is supposed to be there (diff from adventitious)
d. Voice Sounds--can indicate need for CXR
i. Whispered Pectoriloquy--the way words come across as the whisper “1, 2, 3”

Front 47

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
• Diff from pericardial rub (continuous rub while holding breath)
c. Abnormal--sound other than what is supposed to be there (diff from adventitious)
d. Voice Sounds--can indicate need for CXR
i. -----------------: the way words come across as the whisper “1, 2, 3”

Back 47

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
• Diff from pericardial rub (continuous rub while holding breath)
c. Abnormal--sound other than what is supposed to be there (diff from adventitious)
d. Voice Sounds--can indicate need for CXR
i. Whispered Pectoriloquy--the way words come across as the whisper “1, 2, 3”

Front 48

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
• Normal to hear it muffled when listening to ----------------
• Abnormal to hear it clearly (---------,-----------)
ii. Bronchophony--say “99” in louder tone (should sound muffled)
iii. Egophony--say “E” abnormal if it sounds like “A” (should sound muffled)

Back 48

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
• Normal to hear it muffled when listening to posterior chest wall
• Abnormal to hear it clearly (pneumonia, atelectasis)
ii. Bronchophony--say “99” in louder tone (should sound muffled)
iii. Egophony--say “E” abnormal if it sounds like “A” (should sound muffled)

Front 49

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
• Normal to hear it muffled when listening to posterior chest wall
• Abnormal to hear it clearly (pneumonia, atelectasis)
ii. -------------: say “99” in louder tone (should sound muffled)
iii. ------------: say “E” abnormal if it sounds like “A” (should sound muffled)

Back 49

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
• Normal to hear it muffled when listening to posterior chest wall
• Abnormal to hear it clearly (pneumonia, atelectasis)
ii. Bronchophony--say “99” in louder tone (should sound muffled)
iii. Egophony--say “E” abnormal if it sounds like “A” (should sound muffled)

Front 50

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
• Normal to hear it muffled when listening to posterior chest wall
• Abnormal to hear it clearly (pneumonia, atelectasis)
ii. Bronchophony--say “-----” in louder tone (should sound muffled)
iii. Egophony--say “-----” abnormal if it sounds like “------” (should sound muffled)

Back 50

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
• Normal to hear it muffled when listening to posterior chest wall
• Abnormal to hear it clearly (pneumonia, atelectasis)
ii. Bronchophony--say “99” in louder tone (should sound muffled)
iii. Egophony--say “E” abnormal if it sounds like “A” (should sound muffled)

Front 51

Respiratory
II. Artificial Airways
A. ------------- Airway--used to keep tongue from occluding airway in unconscious pts (protection)
1. Techniques of Insertion
a. Clear mouth of secretions and maintain head position
b. Measure from corner of mouth to tragus
2. Precautions--cannot use with oral trauma or if patient has gag reflex

Back 51

Respiratory
II. Artificial Airways
A. Oropharyngeal Airway--used to keep tongue from occluding airway in unconscious pts (protection)
1. Techniques of Insertion
a. Clear mouth of secretions and maintain head position
b. Measure from corner of mouth to tragus
2. Precautions--cannot use with oral trauma or if patient has gag reflex

Front 52

Respiratory
II. Artificial Airways
A. Oropharyngeal Airway--used to keep tongue from occluding airway in unconscious pts (protection)
1. Techniques of Insertion
a. Clear mouth of ------ and maintain -------
b. Measure from corner of mouth to ------
2. Precautions--cannot use with oral trauma or if patient has gag reflex

Back 52

Respiratory
II. Artificial Airways
A. Oropharyngeal Airway--used to keep tongue from occluding airway in unconscious pts (protection)
1. Techniques of Insertion
a. Clear mouth of secretions and maintain head position
b. Measure from corner of mouth to tragus
2. Precautions--cannot use with oral trauma or if patient has gag reflex

Front 53

Respiratory
II. Artificial Airways
A. Oropharyngeal Airway--used to keep tongue from occluding airway in unconscious pts (protection)
1. Techniques of Insertion
a. Clear mouth of secretions and maintain head position
b. Measure from corner of mouth to tragus
2. Precautions--cannot use with -------- or if patient has -------

Back 53

Respiratory
II. Artificial Airways
A. Oropharyngeal Airway--used to keep tongue from occluding airway in unconscious pts (protection)
1. Techniques of Insertion
a. Clear mouth of secretions and maintain head position
b. Measure from corner of mouth to tragus
2. Precautions--cannot use with oral trauma or if patient has gag reflex

Front 54

Respiratory
II. Artificial Airways
B. ----------------- airway--provides patent airway without stimulating gag reflex (needs lubrication)
1. Precautions--cannot be used for facial trauma (basal skull fracture)

Back 54

Respiratory
II. Artificial Airways
B. Nasopharyngeal Airway--provides patent airway without stimulating gag reflex (needs lubrication)
1. Precautions--cannot be used for facial trauma (basal skull fracture)

Front 55

Respiratory
II. Artificial Airways
B. Nasopharyngeal Airway--provides patent airway without stimulating -------- (needs lubrication)
1. Precautions--cannot be used for ----------- (basal skull fracture)

Back 55

Respiratory
II. Artificial Airways
B. Nasopharyngeal Airway--provides patent airway without stimulating gag reflex (needs lubrication)
1. Precautions--cannot be used for facial trauma (basal skull fracture)

Front 56

Respiratory
II. Artificial Airways
C. ------------- Intubation--can be placed for 2 weeks, than tracheotomy or extubation
1. Oral--larger tube therefore less air resistance (preferred form)
a. Disadvantage--pt can bit tube (need to use a bite block)

Back 56

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
1. Oral--larger tube therefore less air resistance (preferred form)
a. Disadvantage--pt can bit tube (need to use a bite block)

Front 57

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for ------ weeks, than tracheotomy or ------------
1. Oral--larger tube therefore less air resistance (preferred form)
a. Disadvantage--pt can bit tube (need to use a bite block)

Back 57

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
1. Oral--larger tube therefore less air resistance (preferred form)
a. Disadvantage--pt can bit tube (need to use a bite block)

Front 58

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
1. Oral--larger tube therefore less ------------- (preferred form)
a. Disadvantage--pt can ---------- (need to use a ---------- block)

Back 58

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
1. Oral--larger tube therefore less air resistance (preferred form)
a. Disadvantage--pt can bit tube (need to use a bite block)

Front 59

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
2. Nasal--used if ------------ prevents moving neck for --------- intubation (more comfortable)
a. Disadvantages--hard to suction (smaller tube diameter)
b. Contraindicated in pts with facial trauma

Back 59

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
2. Nasal--used if spinal cord injury prevents moving neck for oral intubation (more comfortable)
a. Disadvantages--hard to suction (smaller tube diameter)
b. Contraindicated in pts with facial trauma

Front 60

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
2. Nasal--used if spinal cord injury prevents moving neck for oral intubation (more comfortable)
a. Disadvantages--hard to -------- (smaller tube --------)
b. Contraindicated in pts with --------- trauma

Back 60

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
2. Nasal--used if spinal cord injury prevents moving neck for oral intubation (more comfortable)
a. Disadvantages--hard to suction (smaller tube diameter)
b. Contraindicated in pts with facial trauma

Front 61

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
3. Indications
a. Inadequate -------------- (↓arterial --------, etc.) that is not corrected by supplemental O2
i. Causes--barbiturate overdose, anesthesia, etc.

Back 61

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
3. Indications
a. Inadequate oxygenation (↓arterial PO2, etc.) that is not corrected by supplemental O2
i. Causes--barbiturate overdose, anesthesia, etc.

Front 62

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
3. Indications
a. Inadequate oxygenation (↓arterial PO2, etc.) that is not corrected by supplemental -----------
i. Causes--: -------------, ------------, etc.

Back 62

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
3. Indications
a. Inadequate oxygenation (↓arterial PO2, etc.) that is not corrected by supplemental O2
i. Causes--barbiturate overdose, anesthesia, etc.

Front 63

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
3. Indications
b. Inadequate ---------- (increased arterial ----------)--can’t move gas inside
i. PCO2 >50 or pH <7.25
**Get ABG after to see if corrected

Back 63

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
3. Indications
b. Inadequate ventilation (increased arterial PCO2)--can’t move gas inside
i. PCO2 >50 or pH <7.25
**Get ABG after to see if corrected

Front 64

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
3. Indications
b. Inadequate ventilation (increased arterial PCO2)--can’t move gas inside
i. PCO2 >-------- or pH <--------------
**Get ------------ after to see if corrected

Back 64

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
3. Indications
b. Inadequate ventilation (increased arterial PCO2)--can’t move gas inside
i. PCO2 >50 or pH <7.25
**Get ABG after to see if corrected

Front 65

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
4. Procedure--need ----------- and --------- at bed side

Back 65

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
4. Procedure--need suction and O2 at bed side

Front 66

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
4. Procedure--need suction and O2 at bed side
a. Patient education
i. Won’t be able to --------- (reassure needs will be met)
ii. Assure that pt will be able to----------- better

Back 66

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
4. Procedure--need suction and O2 at bed side
a. Patient education
i. Won’t be able to talk (reassure needs will be met)
ii. Assure that pt will be able to breathe better

Front 67

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
4. Procedure--need suction and O2 at bed side
b. Preparation for intubation--: -----------, ----------, -------, and sedation -------- (Versed)
i. Assess for hypoxia (arrhythmias) and vomiting

Back 67

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
4. Procedure--need suction and O2 at bed side
b. Preparation for intubation--supplies, ambu bag, code cart, and sedation meds (Versed)
i. Assess for hypoxia (arrhythmias) and vomiting

Front 68

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
4. Procedure--need suction and O2 at bed side
b. Preparation for intubation--supplies, ambu bag, code cart, and sedation meds (Versed)
i. Assess for ------- (arrhythmias) and ----------

Back 68

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
4. Procedure--need suction and O2 at bed side
b. Preparation for intubation--supplies, ambu bag, code cart, and sedation meds (Versed)
i. Assess for hypoxia (arrhythmias) and vomiting

Front 69

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
4. Procedure--need suction and O2 at bed side
c. Hold breath to remember --------- of attempt (no more than ---------- to 1min)

Back 69

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
4. Procedure--need suction and O2 at bed side
c. Hold breath to remember length of attempt (no more than 30sec-1min)

Front 70

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
4. Procedure--need suction and O2 at bed side
d. Checking placement--tape tube at ------ and record --------
i. Check tidal CO2 monitor (color or number change)
ii. Listen for breath sounds
iii. Visualize chest expansion

Back 70

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
4. Procedure--need suction and O2 at bed side
d. Checking placement--tape tube at lip and record line mark
i. Check tidal CO2 monitor (color or number change)
ii. Listen for breath sounds
iii. Visualize chest expansion

Front 71

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
4. Procedure--need suction and O2 at bed side
d. Checking placement--tape tube at lip and record line mark
i. Check tidal -------- monitor (color or number change)
ii. Listen for --------
iii. Visualize ----------

Back 71

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
4. Procedure--need suction and O2 at bed side
d. Checking placement--tape tube at lip and record line mark
i. Check tidal CO2 monitor (color or number change)
ii. Listen for breath sounds
iii. Visualize chest expansion

Front 72

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
4. Procedure--need suction and O2 at bed side
5. Post Intubation Assessment
a. Assess end tidal ---------
b. Assess for -----------, equal breath sounds, and ----------
c. Auscultation of gastric area (to determine if esophageal intubation instead of tracheal)
d. Nurse, RT, or anesthetist stabilizes tube

Back 72

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
4. Procedure--need suction and O2 at bed side
5. Post Intubation Assessment
a. Assess end tidal CO2
b. Assess for bilateral, equal breath sounds, and chest expansion
c. Auscultation of gastric area (to determine if esophageal intubation instead of tracheal)
d. Nurse, RT, or anesthetist stabilizes tube

Front 73

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
4. Procedure--need suction and O2 at bed side
5. Post Intubation Assessment
a. Assess end tidal CO2
b. Assess for bilateral, equal breath sounds, and chest expansion
c. Auscultation of ----------- (to determine if esophageal intubation instead of ----------)
d. Nurse, RT, or anesthetist stabilizes --------

Back 73

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
4. Procedure--need suction and O2 at bed side
5. Post Intubation Assessment
a. Assess end tidal CO2
b. Assess for bilateral, equal breath sounds, and chest expansion
c. Auscultation of gastric area (to determine if esophageal intubation instead of tracheal)
d. Nurse, RT, or anesthetist stabilizes tube

Front 74

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
4. Procedure--need suction and O2 at bed side
5. Post Intubation Assessment
e. Oral ETT positioned ------ or ------- side of mouth and changed q24hrs (safer with 2 people)
i. Suction before deflating balloon so secretions do not flow into lungs
f. Oral airway may need bite block to prevent pt from biting tube
g. Stat CXR verifies correct placement (if it needs to move, deflate and reinflate balloon)
i. Should be 2 finger breadths above carina

Back 74

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
4. Procedure--need suction and O2 at bed side
5. Post Intubation Assessment
e. Oral ETT positioned lf or rt side of mouth and changed q24hrs (safer with 2 people)
i. Suction before deflating balloon so secretions do not flow into lungs
f. Oral airway may need bite block to prevent pt from biting tube
g. Stat CXR verifies correct placement (if it needs to move, deflate and reinflate balloon)
i. Should be 2 finger breadths above carina

Front 75

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
4. Procedure--need suction and O2 at bed side
5. Post Intubation Assessment
e. Oral ETT positioned lf or rt side of mouth and changed --------hrs (safer with 2 people)
i. Suction before deflating ------------ so secretions do not flow into lungs
f. Oral airway may need bite block to prevent pt from biting tube
g. Stat CXR verifies correct placement (if it needs to move, deflate and reinflate balloon)
i. Should be 2 finger breadths above carina

Back 75

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
5. Post Intubation Assessment
e. Oral ETT positioned lf or rt side of mouth and changed q24hrs (safer with 2 people)
i. Suction before deflating balloon so secretions do not flow into lungs
f. Oral airway may need bite block to prevent pt from biting tube
g. Stat CXR verifies correct placement (if it needs to move, deflate and reinflate balloon)
i. Should be 2 finger breadths above carina

Front 76

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
5. Post Intubation Assessment
e. Oral ETT positioned lf or rt side of mouth and changed q24hrs (safer with 2 people)
i. Suction before deflating balloon so secretions do not flow into lungs
f. Oral airway may need ---------- to prevent pt from biting tube
g. Stat ----------- verifies correct placement (if it needs to move, deflate and reinflate balloon)
i. Should be 2 finger breadths above carina

Back 76

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
5. Post Intubation Assessment
e. Oral ETT positioned lf or rt side of mouth and changed q24hrs (safer with 2 people)
i. Suction before deflating balloon so secretions do not flow into lungs
f. Oral airway may need bite block to prevent pt from biting tube
g. Stat CXR verifies correct placement (if it needs to move, deflate and reinflate balloon)
i. Should be 2 finger breadths above carina

Front 77

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
5. Post Intubation Assessment
e. Oral ETT positioned lf or rt side of mouth and changed q24hrs (safer with 2 people)
i. Suction before deflating balloon so secretions do not flow into lungs
f. Oral airway may need bite block to prevent pt from biting tube
g. Stat CXR verifies correct placement (if it needs to move, deflate and ------------ balloon)
i. Should be ------------ breadths above carina

Back 77

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
5. Post Intubation Assessment
e. Oral ETT positioned lf or rt side of mouth and changed q24hrs (safer with 2 people)
i. Suction before deflating balloon so secretions do not flow into lungs
f. Oral airway may need bite block to prevent pt from biting tube
g. Stat CXR verifies correct placement (if it needs to move, deflate and reinflate balloon)
i. Should be 2 finger breadths above carina

Front 78

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
a. Maintaining correct --------- placement (------- shift)
b. Monitoring proper cuff inflation (20-25mmHg q8hr)--should not be 100% occlusive

Back 78

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
a. Maintaining correct tube placement (q shift)
b. Monitoring proper cuff inflation (20-25mmHg q8hr)--should not be 100% occlusive

Front 79

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
a. Maintaining correct tube placement (q shift)

Back 79

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
a. Maintaining correct tube placement (q shift)
b. Monitoring proper cuff inflation (20-25mmHg q8hr)--should not be 100% occlusive

Front 80

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
a. Maintaining correct tube placement (q shift)
b. Monitoring proper cuff inflation (-------to ----------mmHg q-------hr)--should not be 100% occlusive

Back 80

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
a. Maintaining correct tube placement (q shift)
b. Monitoring proper cuff inflation (20-25mmHg q8hr)--should not be 100% occlusive

Front 81

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
a. Maintaining correct tube placement (q shift)
b. Monitoring proper cuff inflation (20-25mmHg q8hr)--should not be ----------% occlusive

Back 81

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
a. Maintaining correct tube placement (q shift)
b. Monitoring proper cuff inflation (20-25mmHg q8hr)--should not be 100% occlusive

Front 82

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
b. Monitoring proper -------- inflation (20-25mmHg q8hr)--should not be 100% occlusive

i. If <--------mmHg leak
ii. If >----------mmHg damage to tissue
iii. If able to talk air through vocal cords balloon deflated then ----------

Back 82

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
b. Monitoring proper -------- inflation (20-25mmHg q8hr)--should not be 100% occlusive

i. If <20mmHg leak
ii. If >20mmHg damage to tissue
iii. If able to talk air through vocal cords balloon deflated reinflate

Front 83

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
c. Monitor ---------- and ----------
i. End tidal CO2 monitor--indicates correct placement
ii. ABGs--SAO2 measures tissue oxygenation and gives info on CO
iii. Peak inspiratory pressure--if increased suction

Back 83

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
c. Monitor oxygenation and ventilation
i. End tidal CO2 monitor--indicates correct placement
ii. ABGs--SAO2 measures tissue oxygenation and gives info on CO
iii. Peak inspiratory pressure--if increased suction

Front 84

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
c. Monitor oxygenation and ventilation
i. End tidal CO2 monitor--indicates ------------
ii. ABGs: ------------ measures tissue oxygenation and gives info on CO
iii. Peak ---------- pressure--if increased suction

Back 84

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
c. Monitor oxygenation and ventilation
i. End tidal CO2 monitor--indicates correct placement
ii. ABGs--SAO2 measures tissue oxygenation and gives info on CO
iii. Peak inspiratory pressure--if increased suction

Front 85

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
c. Monitor oxygenation and ventilation
i. End tidal CO2 monitor--indicates correct placement
ii. ABGs--SAO2 measures tissue oxygenation and gives info on CO
iii. Peak inspiratory pressure--if increased -----------

Back 85

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
c. Monitor oxygenation and ventilation
i. End tidal CO2 monitor--indicates correct placement
ii. ABGs--SAO2 measures tissue oxygenation and gives info on CO
iii. Peak inspiratory pressure--if increased suction

Front 86

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
d. Provide --------- and maintaining skin ------: tube positioning and oral care
e. Comfort and communication--talk to pt/use meds (Versed, Propofol) to relieve anxiety
i. When pt starts to wake up watch for pt pulling tube out and assess for mental status (takes time to get used to tube often pts kept sedated for a while)

Back 86

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
d. Provide oral care and maintaining skin integrity--: tube positioning and oral care
e. Comfort and communication--talk to pt/use meds (Versed, Propofol) to relieve anxiety
i. When pt starts to wake up watch for pt pulling tube out and assess for mental status (takes time to get used to tube often pts kept sedated for a while)

Front 87

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
d. Provide oral care and maintaining skin integrity--: tube positioning and oral care
e. Comfort and communication--talk to pt/use meds (---------, ----------) to relieve anxiety
i. When pt starts to wake up watch for pt pulling ----------- and assess for ---------- (takes time to get used to tube often pts kept sedated for a while)

Back 87

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
d. Provide oral care and maintaining skin integrity--: tube positioning and oral care
e. Comfort and communication--talk to pt/use meds (Versed, Propofol) to relieve anxiety
i. When pt starts to wake up watch for pt pulling tube out and assess for mental status (takes time to get used to tube often pts kept sedated for a while)

Front 88

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
f. Assess for complications: --------, ----------, decreased ------, etc.
g. Maintain tube patency--suction as needed

Back 88

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
f. Assess for complications--ALOC, arrhythmias, decreased O2, etc.
g. Maintain tube patency--suction as needed

Front 89

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
f. Assess for complications--ALOC, arrhythmias, decreased O2, etc.
g. Maintain tube --------: --suction as needed

Back 89

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
f. Assess for complications--ALOC, arrhythmias, decreased O2, etc.
g. Maintain tube patency--suction as needed

Front 90

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
h. Pt needs --------- assessment within ------hrs of intubation

Back 90

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
h. Pt needs nutritional assessment within 72hrs of intubation

Front 91

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
7. Potential Complications
a. Suctioning--suction for <--------sec and watch for ------------
i. Hypoxemia--preoxygenate (suctioning will drop O2Sats)
ii. Bronchospasm--give pt break in between
iii. Arrhythmias--stop if bradycardia (vaso-vagal response)--have atropine near by
iv. HTN/hypotension

Back 91

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
7. Potential Complications
a. Suctioning--suction for <10sec and watch for arrhythmias
i. Hypoxemia--preoxygenate (suctioning will drop O2Sats)
ii. Bronchospasm--give pt break in between
iii. Arrhythmias--stop if bradycardia (vaso-vagal response)--have atropine near by
iv. HTN/hypotension

Front 92

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
7. Potential Complications
a. Suctioning--suction for <10sec and watch for arrhythmias
i. --------------: preoxygenate (suctioning will drop O2Sats)
ii. B------------: give pt break in between
iii. A-----------: stop if bradycardia (vaso-vagal response)--have atropine near by
iv. HTN/-------------

Back 92

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
7. Potential Complications
a. Suctioning--suction for <10sec and watch for arrhythmias
i. Hypoxemia--preoxygenate (suctioning will drop O2Sats)
ii. Bronchospasm--give pt break in between
iii. Arrhythmias--stop if bradycardia (vaso-vagal response)--have atropine near by
iv. HTN/hypotension

Front 93

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
7. Potential Complications
a. Suctioning--suction for <10sec and watch for arrhythmias
i. Hypoxemia--preoxygenate (suctioning will drop O2Sats)
ii. Bronchospasm--give pt --------- in between
iii. Arrhythmias--stop if ------------- (vaso-vagal response)--have atropine near by
iv. HTN/hypotension

Back 93

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
7. Potential Complications
a. Suctioning--suction for <10sec and watch for arrhythmias
i. Hypoxemia--preoxygenate (suctioning will drop O2Sats)
ii. Bronchospasm--give pt break in between
iii. Arrhythmias--stop if bradycardia (vaso-vagal response)--have atropine near by
iv. HTN/hypotension

Front 94

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
7. Potential Complications
a. Suctioning--suction for <10sec and watch for arrhythmias
v. ---------: can be too much suction (should be <120mmHg)
vi. I------------
vii. Increase in ------------ pressure (in head trauma pts)--use minimal suctioning

Back 94

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
7. Potential Complications
a. Suctioning--suction for <10sec and watch for arrhythmias
v. Pulmonary bleeding--can be too much suction (should be <120mmHg)
vi. Infections
vii. Increase in intracranial pressure (in head trauma pts)--use minimal suctioning

Front 95

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
7. Potential Complications
a. Suctioning--suction for <10sec and watch for arrhythmias
v. Pulmonary bleeding--can be too much suction (should be <---------mmHg)
vi. Infections
vii. Increase in intracranial pressure (in --------- trauma pts)--use minimal suctioning

Back 95

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
7. Potential Complications
a. Suctioning--suction for <10sec and watch for arrhythmias
v. Pulmonary bleeding--can be too much suction (should be <120mmHg)
vi. Infections
vii. Increase in intracranial pressure (in head trauma pts)--use minimal suctioning

Front 96

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
7. Potential Complications
b. Self-extubation--most pts --------- or ----------- for prevention (explain need to family)
c. Aspiration--keep HOB >30° (likely tube fed--always check placement)

Back 96

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
7. Potential Complications
b. Self-extubation--most pts restrained or sedated for prevention (explain need to family)
c. Aspiration--keep HOB >30° (likely tube fed--always check placement)

Front 97

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
7. Potential Complications
b. Self-extubation--most pts restrained or sedated for prevention (explain need to family)
c. Aspiration--keep HOB >------° (likely tube fed--always check ----------)

Back 97

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
7. Potential Complications
b. Self-extubation--most pts restrained or sedated for prevention (explain need to family)
c. Aspiration--keep HOB >30° (likely tube fed--always check placement)

Front 98

Respiratory
II. Artificial Airways
D. ---------: stoma that results from a surgical incision (in OR or at bedside) into the trachea

Back 98

Respiratory
II. Artificial Airways
D. Tracheostomy--stoma that results from a surgical incision (in OR or at bedside) into the trachea

Front 99

Respiratory
II. Artificial Airways
D. Tracheostomy--stoma that results from a surgical incision (in OR or at bedside) into the trachea
1. Indications
a. Bypass an ----------- obstruction
b. Facilitate removal of -----------
c. Permit long-term -------------- ventilation--after two weeks with ET tube
i. Easier to ween from trach than from ET tube
d. Permits oral ----------

Back 99

Respiratory
II. Artificial Airways
D. Tracheostomy--stoma that results from a surgical incision (in OR or at bedside) into the trachea
1. Indications
a. Bypass an upper airway obstruction
b. Facilitate removal of secretions
c. Permit long-term mechanical ventilation--after two weeks with ET tube
i. Easier to ween from trach than from ET tube
d. Permits oral intake and speech

Front 100

Respiratory
II. Artificial Airways
D. Tracheostomy--stoma that results from a surgical incision (in OR or at bedside) into the trachea
1. Indications
a. Bypass an upper airway obstruction
b. Facilitate removal of secretions
c. Permit long-term mechanical ventilation--after -------- weeks with--------tube
i. Easier to ween from --------- than from ET tube

Back 100

Respiratory
II. Artificial Airways
D. Tracheostomy--stoma that results from a surgical incision (in OR or at bedside) into the trachea
1. Indications
a. Bypass an upper airway obstruction
b. Facilitate removal of secretions
c. Permit long-term mechanical ventilation--after two weeks with ET tube
i. Easier to ween from trach than from ET tube
d. Permits oral intake and speech

Front 101

Respiratory
II. Artificial Airways
D. Tracheostomy--stoma that results from a surgical incision (in OR or at bedside) into the trachea
2. Care
a. Suctioning for ----------
b. ----------- care
c. Changing --------- ties
d. Inner cannula care (always have opterator at bed side to get it back in-then remove)

Back 101

Respiratory
II. Artificial Airways
D. Tracheostomy--stoma that results from a surgical incision (in OR or at bedside) into the trachea
2. Care
a. Suctioning for secretions
b. Stoma care
c. Changing tracheostomy ties
d. Inner cannula care (always have opterator at bed side to get it back in-then remove)

Front 102

Respiratory
II. Artificial Airways
D. Tracheostomy--stoma that results from a surgical incision (in OR or at bedside) into the trachea
2. Care
a. Suctioning for secretions
b. Stoma care
c. Changing tracheostomy ties
d. Inner -------- care (always have ------------ at bed side to get it back in-then remove)

Back 102

Respiratory
II. Artificial Airways
D. Tracheostomy--stoma that results from a surgical incision (in OR or at bedside) into the trachea
2. Care
a. Suctioning for secretions
b. Stoma care
c. Changing tracheostomy ties
d. Inner cannula care (always have opterator at bed side to get it back in-then remove)

Front 103

Respiratory
III. Mechanical Ventilation
A. Goals
1. Improve ------------
2. Improve -------------
3. Decrease work of ----------- (decreases oxygen consumption)
4. Permit sedation
5. Airway protection

Back 103

Respiratory
III. Mechanical Ventilation
A. Goals
1. Improve oxygenation
2. Improve ventilation
3. Decrease work of breathing (decreases oxygen consumption)
4. Permit sedation
5. Airway protection

Front 104

Respiratory
III. Mechanical Ventilation
A. Goals
1. Improve oxygenation
2. Improve ventilation
3. Decrease work of breathing (decreases oxygen consumption)
4. Permit ----------
5. Airway -------

Back 104

Respiratory
III. Mechanical Ventilation
A. Goals
1. Improve oxygenation
2. Improve ventilation
3. Decrease work of breathing (decreases oxygen consumption)
4. Permit sedation
5. Airway protection

Front 105

Respiratory
III. Mechanical Ventilation
B. Negative Pressure Ventilation--noninvasive --------- encase chest/body and provide intermittent negative pressure (ex. --------- wrap)

Back 105

Respiratory
III. Mechanical Ventilation
B. Negative Pressure Ventilation--noninvasive chambers encase chest/body and provide intermittent negative pressure (ex. Pulmo-wrap)

Front 106

Respiratory
III. Mechanical Ventilation
B. Negative Pressure Ventilation--noninvasive chambers encase chest/body and provide intermittent negative pressure (ex. Pulmo-wrap)
1. Patient must be able to cough up own ---------- and have adequate lung ------------
2. Indications--neuromuscular and ---------- disorders; severe COPD

Back 106

Respiratory
III. Mechanical Ventilation
B. Negative Pressure Ventilation--noninvasive chambers encase chest/body and provide intermittent negative pressure (ex. Pulmo-wrap)
1. Patient must be able to cough up own secretions and have adequate lung elasticity
2. Indications--neuromuscular and spinal disorders; severe COPD

Front 107

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
1. ---------- Ventilation--predetermined tidal volume w/ varied pressure (most common)
a. Opposite of -------------- (passive exhalation)

Back 107

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
1. Volume Ventilation--predetermined tidal volume w/ varied pressure (most common)
a. Opposite of normal volume (passive exhailation)

Front 108

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
2. ------------ Ventilation--peak inspiratory pressure is predetermined w/ variable tidal volume
a. Prevents adding too much -----------

Back 108

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
2. Pressure Ventilation--peak inspiratory pressure is predetermined w/ variable tidal volume
a. Prevents adding too much volume

Front 109

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
3. Monitoring
a. V---------- settings--program settings
b. P-------: own rate, etc.
c. A-----: customized based on needed parameters

Back 109

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
3. Monitoring
a. Ventilator settings--program settings
b. Patient data--own rate, etc.
c. Alarms--customized based on needed parameters

Front 110

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
4. Settings
a. Rate--number of ------------ ventilations

Back 110

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
4. Settings
a. Rate--number of delivered ventilations

Front 111

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
4. Settings
b. Tidal Volume (VT)--volume of------ delivered; generally weight based (___-____mL/kg)

Back 111

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
4. Settings
b. Tidal Volume (VT)--volume of gas delivered; generally weight based (5-15mL/kg)

Front 112

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
4. Settings
c. FIO2--fraction of ------------- delivered (adjust for PAO2 to be at least >------)
i. Room air is 21%

Back 112

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
4. Settings
c. FIO2--fraction of inspired oxygen delivered (adjust for PAO2 to be at least >60)
i. Room air is 21%

Front 113

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
4. Settings
c. FIO2--fraction of inspired oxygen delivered (adjust for PAO2 to be at least >60)
i. Room air is ------%

Back 113

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
4. Settings
c. FIO2--fraction of inspired oxygen delivered (adjust for PAO2 to be at least >60)
i. Room air is 21%

Front 114

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
4. Settings
d. Flow Rate--speed ------ is delivered

Back 114

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
4. Settings
d. Flow Rate--speed VT is delivered

Front 115

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
4. Settings
e. I:E ratio--duration of--------- to ---------- (normal is 1:2)

Back 115

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
4. Settings
e. I:E ratio--duration of inspiration to expiration (normal is 1:2)

Front 116

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
4. Settings
e. I:E ratio--duration of inspiration to expiration (normal is ------:--------)

Back 116

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
4. Settings
e. I:E ratio--duration of inspiration to expiration (normal is 1:2)

Front 117

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
4. Settings
f. Sensitivity (---------- pressure)--effort pt must generate to initiate -------- breath
i. Higher sensitivity less work pt does
ii. Lower sensitivity increase in pt’s muscular use to initiate breath

Back 117

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
4. Settings
f. Sensitivity (trigger pressure)--effort pt must generate to initiate ventilator breath
i. Higher sensitivity less work pt does
ii. Lower sensitivity increase in pt’s muscular use to initiate breath

Front 118

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
4. Settings
f. Sensitivity (trigger pressure)--effort pt must generate to initiate ventilator breath
i. ----------- sensitivity less work pt does
ii. ---------- sensitivity increase in pt’s muscular use to initiate breath

Back 118

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
4. Settings
f. Sensitivity (trigger pressure)--effort pt must generate to initiate ventilator breath
i. Higher sensitivity less work pt does
ii. Lower sensitivity increase in pt’s muscular use to initiate breath

Front 119

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
4. Settings
g. Pressure Limit--regulates -------- pressure ventilator can generate to deliver ---------

Back 119

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
4. Settings
g. Pressure Limit--regulates maximal pressure ventilator can generate to deliver VT

Front 120

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
5. Modes--based on ---------- status and dependent on resp. drive and ---------

Back 120

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
5. Modes--based on ventilatory status and dependent on resp. drive and ABGs

Front 121

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
5. Modes--based on ventilatory status and dependent on resp. drive and ABGs
a. Controlled ----------- Ventilation (CMV)--not used often
i. Ventilator ----------

Back 121

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
5. Modes--based on ventilatory status and dependent on resp. drive and ABGs
a. Controlled Mandatory Ventilation (CMV)--not used often
i. Ventilator parameters

Front 122

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
• Set rate
• Set tidal --------- or pressure
ii. Indication--pt with no -------- (spinal cord, anesthesia, neuromuscular disease)

Back 122

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
• Set rate
• Set tidal volume or pressure
ii. Indication--pt with no drive (spinal cord, anesthesia, neuromuscular disease)

Front 123

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
• If pt has drive, ventilator can’t sense pt ----------- need sedation
b. Assist-Control ------------ Ventilation (AC)
i. Ventilator parameters

Back 123

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
• If pt has drive, ventilator can’t sense pt fight ventilator need sedation
b. Assist-Control Mechanical Ventilation (AC)
i. Ventilator parameters

Front 124

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
• Preset ------- volume/pressure--vent delivers breaths at preset --------- volume in response to pt’s own inspiratory drive (senses pt inspiration)

Back 124

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
• Preset tidal volume/pressure--vent delivers breaths at preset tidal volume in response to pt’s own inspiratory drive (senses pt inspiration)

Front 125

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
• Preset rate--minimal setting (if pt does not ------------ a breath, vent will breathe so that pt receives the ------------- rate)

Back 125

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
• Preset tidal volume/pressure--vent delivers breaths at preset tidal volume in response to pt’s own inspiratory drive (senses pt inspiration)

Front 126

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
ii. Potential disadvantages
• Hyperventilation if pt is anxious (resp --------------)
• Hypoventilation if monitor is set too ---------- (must monitor rate saturations)

Back 126

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
ii. Potential disadvantages
• Hyperventilation if pt is anxious (resp alkalosis)
• Hypoventilation if monitor is set too low (must monitor rate saturations)

Front 127

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
ii. Potential disadvantages
• Hypoventilation if monitor is set too low (must monitor rate saturations)
c. Synchronized ------------ ------------ Ventilation (SIMV)--most common

Back 127

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
ii. Potential disadvantages
• Hypoventilation if monitor is set too low (must monitor rate saturations)
c. Synchronized Intermittent Mandatory Ventilation (SIMV)--most common
i. Ventilator parameters

Front 128

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
c. Synchronized Intermittent Mandatory Ventilation (SIMV)--most common
i. Ventilator parameters
• Preset---------- volume/pressure
• Preset ---------

Back 128

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
c. Synchronized Intermittent Mandatory Ventilation (SIMV)--most common
i. Ventilator parameters
• Preset tidal volume/pressure
• Preset rate

Front 129

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
c. Synchronized Intermittent Mandatory Ventilation (SIMV)--most common
i. Ventilator parameters
• Pt can initiate ------------ breathing (in between vent breaths) with own tidal volume, but vent delivers full tidal volume for preset ---------- rate
ii. Used for -------: --preset gradually lowered (better synchrony-pt no fight vent)

Back 129

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
c. Synchronized Intermittent Mandatory Ventilation (SIMV)--most common
i. Ventilator parameters
• Preset tidal volume/pressure
• Preset rate

Front 130

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
c. Synchronized Intermittent Mandatory Ventilation (SIMV)--most common
i. Ventilator parameters
• Can lead to --------- fatigue

Back 130

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
c. Synchronized Intermittent Mandatory Ventilation (SIMV)--most common
i. Ventilator parameters
• Can lead to muscle fatigue

Front 131

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
d. Pressure ----------- Ventilation (PSV)--enhanced mode (can be used with SIMV)

Back 131

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
d. Pressure support Ventilation (PSV)--enhanced mode (can be used with SIMV)

Front 132

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
d. Pressure Support Ventilation (PSV)--enhanced mode (can be used with SIMV)
i. Positive pressure is applied to airway only during ------------ and is used in conjunction with pts spontaneous respirations

Back 132

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
d. Pressure Support Ventilation (PSV)--enhanced mode (can be used with SIMV)
i. Positive pressure is applied to airway only during inspiration and is used in conjunction with pts spontaneous respirations

Front 133

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
d. Pressure Support Ventilation (PSV)--enhanced mode (can be used with SIMV)
ii. Pt must be able to----------- breath (only for spontaneous breathers)

Back 133

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
d. Pressure Support Ventilation (PSV)--enhanced mode (can be used with SIMV)
ii. Pt must be able to initiate breath (only for spontaneous breathers)

Front 134

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
d. Pressure Support Ventilation (PSV)--enhanced mode (can be used with SIMV)
iii. Pt completely controls inspiratory ----------, tidal volume, and RR

Back 134

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
d. Pressure Support Ventilation (PSV)--enhanced mode (can be used with SIMV)
iii. Pt completely controls inspiratory length, tidal volume, and RR

Front 135

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
d. Pressure Support Ventilation (PSV)--enhanced mode (can be used with SIMV
iv. Decreases pt work during ----------- (decreases effort)

Back 135

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
d. Pressure Support Ventilation (PSV)--enhanced mode (can be used with SIMV
iv. Decreases pt work during weaning (decreases effort)

Front 136

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
d. Pressure Support Ventilation (PSV)--enhanced mode (can be used with SIMV
v. Advantages--↑ pt comfort and ↓-------- consumption (↓work) and ↑ ----------

Back 136

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
d. Pressure Support Ventilation (PSV)--enhanced mode (can be used with SIMV
v. Advantages--↑ pt comfort and ↓O2 consumption (↓work) and ↑ endurance

Front 137

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
e. Pressure Controlled ------ ------- Ventilation (PC-IRV)

Back 137

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
e. Pressure Controlled Inverse Ratio Ventilation (PC-IRV)

Front 138

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
e. Pressure Controlled Inverse Ratio Ventilation (PC-IRV)
i. Prolonged (+)pressure applied↑--------------- time expands collapsed -----------

Back 138

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
e. Pressure Controlled Inverse Ratio Ventilation (PC-IRV)
i. Prolonged (+)pressure applied↑inspiratory time expands collapsed alveoli

Front 139

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
e. Pressure Controlled Inverse Ratio Ventilation (PC-IRV)
ii. Unnatural (causes anxiety paralyze/sedate) -------------- (2:1 4:1)

Back 139

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
e. Pressure Controlled Inverse Ratio Ventilation (PC-IRV)
ii. Unnatural (causes anxiety paralyze/sedate) nonphysiologic (2:1 4:1)

Front 140

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
e. Pressure Controlled Inverse Ratio Ventilation (PC-IRV)
ii. Unnatural (causes anxiety paralyze/sedate) nonphysiologic (-----:1 ------:1)

Back 140

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
e. Pressure Controlled Inverse Ratio Ventilation (PC-IRV)
ii. Unnatural (causes anxiety paralyze/sedate) nonphysiologic (2:1 4:1)

Front 141

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
e. Pressure Controlled Inverse Ratio Ventilation (PC-IRV)
iii. Used for pt still hypoxic after other measures (------ and --------)

Back 141

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
e. Pressure Controlled Inverse Ratio Ventilation (PC-IRV)
iii. Used for pt still hypoxic after other measures (ARDS and neonates)

Front 142

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive _____-______ Pressure (PEEP)

Back 142

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)

Front 143

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
a. (+) pressure exerted during -------- allows for better saturation with ↓------

Back 143

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
a. (+) pressure exerted during expiration allows for better saturation with ↓FiO2

Front 144

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
a. (+) pressure exerted during expiration allows for better saturation with ↓FiO2
i. Airway P is ------ at expiration end w/ atmospheric P (PEEP prevents this)

Back 144

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
a. (+) pressure exerted during expiration allows for better saturation with ↓FiO2
i. Airway P is 0 at expiration end w/ atmospheric P (PEEP prevents this)

Front 145

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
a. (+) pressure exerted during expiration allows for better saturation with ↓FiO2
ii. Prevents ---------- and alveolar collapse

Back 145

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
a. (+) pressure exerted during expiration allows for better saturation with ↓FiO2
ii. Prevents atelectasis and alveolar collapse

Front 146

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
b. ↑functional -------- capacity (FRC-volume at end of normal cresp) ↑oxygenation

Back 146

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
b. ↑functional residual capacity (FRC-volume at end of normal cresp) ↑oxygenation

Front 147

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
b. ↑functional residual capacity (______-volume at end of normal cresp) ↑________

Back 147

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
b. ↑functional residual capacity (FRC-volume at end of normal cresp) ↑oxygenation

Front 148

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
c. Uses--severe hypoxia that does not improve w/ FiO2 between ____-____%

Back 148

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
c. Uses--severe hypoxia that does not improve w/ FiO2 between 50-70%

Front 149

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
c. Uses--severe hypoxia that does not improve w/ FiO2 between 50-70%
i. For hypoxia could breath faster, deeper, use PEEP or ↑____ (risk O2 toxicity)

Back 149

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
c. Uses--severe hypoxia that does not improve w/ FiO2 between 50-70%
i. For hypoxia could breath faster, deeper, use PEEP or ↑FiO2 (risk O2 toxicity)

Front 150

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
d. Indications
i. Acute lung injury and -------
ii. Cardiogenic ---------- edema

Back 150

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
d. Indications
i. Acute lung injury and ARDS
ii. Cardiogenic pulmonary edema

Front 151

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
d. Indications
iii. Atelectasis associated with severe ---------
iv. Diffuse pneumonia requiring --------- ventilation

Back 151

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
d. Indications
iii. Atelectasis associated with severe hypoxemia
iv. Diffuse pneumonia requiring mechanical ventilation

Front 152

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
e. Contraindications
i. Pneumothorax w/out --------- catheter (would worsen pneumo)

Back 152

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
e. Contraindications
i. Pneumothorax w/out pleural catheter (would worsen pneumo)

Front 153

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
e. Contraindications
ii. Increased --------- pressure

Back 153

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
e. Contraindications
ii. Increased intracranial pressure

Front 154

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
e. Contraindications
iii. Hypovolemia--↑---------- pressure ↓------- return ↓BP

Back 154

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
e. Contraindications
iii. Hypovolemia--↑intrathoracic pressure ↓venous return ↓BP

Front 155

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
e. Contraindications
iv. Low ------- output

Back 155

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
e. Contraindications
iv. Low cardiac output

Front 156

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
f. -------------- considerations--decreases venous return and CO

Back 156

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
f. Hemodynamic considerations--decreases venous return and CO

Front 157

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
g. Normal setting:____-____cm H2O

Back 157

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
f. Hemodynamic considerations--decreases venous return and CO

Front 158

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
2. Continuous ----------- ----------- Pressure (CPAP)

Back 158

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
2. Continuous Positive Airway Pressure (CPAP)

Front 159

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
2. Continuous Positive Airway Pressure (CPAP)
a. Continuous (+) pressure during entire ------- cycle--prevents airway P from reaching ----------

Back 159

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
2. Continuous Positive Airway Pressure (CPAP)
a. Continuous (+) pressure during entire resp. cycle--prevents airway P from reaching 0

Front 160

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
2. Continuous Positive Airway Pressure (CPAP)
b. No breaths by vent--must be ----------- breather (rate determined by pt own ----------)

Back 160

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
2. Continuous Positive Airway Pressure (CPAP)
b. No breaths by vent--must be spontaneous breather (rate determined by pt own RR)

Front 161

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
2. Continuous Positive Airway Pressure (CPAP)
b. No breaths by vent--must be spontaneous breather (rate determined by pt own RR)
i. Pt is doing all the work--increases -----------

Back 161

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
2. Continuous Positive Airway Pressure (CPAP)
b. No breaths by vent--must be spontaneous breather (rate determined by pt own RR)
i. Pt is doing all the work--increases WOB

Front 162

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
2. Continuous Positive Airway Pressure (CPAP)
c. Commonly used for ------------- and primarily in the weaning process (do CPAP trials)

Back 162

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
2. Continuous Positive Airway Pressure (CPAP)
c. Commonly used for sleep apnea and primarily in the weaning process (do CPAP trials)

Front 163

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
3. High ---------- Ventilation

Back 163

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
3. High Frequency Ventilation

Front 164

Respiratory
III. Mechanical Ventilation
E. Complications
1. Cardiovascular
a. Decreased venous return--from increased ------------ pressure

Back 164

Respiratory
III. Mechanical Ventilation
E. Complications
1. Cardiovascular
a. Decreased venous return--from increased intrathoracic pressure

Front 165

Respiratory
III. Mechanical Ventilation
E. Complications
1. Cardiovascular
b. Decreased ________--preload
c. Decreased _______ output

Back 165

Respiratory
III. Mechanical Ventilation
E. Complications
1. Cardiovascular
b. Decreased LVEDV--preload
c. Decreased cardiac output

Front 166

Respiratory
III. Mechanical Ventilation
E. Complications
1. Cardiovascular
d. Hypotension
**Further impairment with --------

Back 166

Respiratory
III. Mechanical Ventilation
E. Complications
1. Cardiovascular
d. Hypotension
**Further impairment with PEEP

Front 167

Respiratory
III. Mechanical Ventilation
E. Complications
2. Pulmonary--_____% of vented pts have some lung damage

Back 167

Respiratory
III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage

Front 168

Respiratory
III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
a. ___________--damage to lungs by excessive pressure

Back 168

Respiratory
III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
a. Barotrauma--damage to lungs by excessive pressure

Front 169

Respiratory
III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
a. Barotrauma--damage to lungs by excessive pressure
i. Lungs can be over extended and rupture w/ high ----------- pressure

Back 169

Respiratory
III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
a. Barotrauma--damage to lungs by excessive pressure
i. Lungs can be over extended and rupture w/ high peak inspiratory pressure

Front 170

Respiratory
III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
a. Barotrauma--damage to lungs by excessive pressure
ii. Can cause pneumothorax, subcutaneous ------------, and -------------

Back 170

Respiratory
III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
a. Barotrauma--damage to lungs by excessive pressure
ii. Can cause pneumothorax, subcutaneous emphysema, and pneumomediastinum

Front 171

Respiratory
III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
a. Barotrauma--damage to lungs by excessive pressure
iii. Risk to pt w/----------- lungs (ex. COPD)

Back 171

Respiratory
III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
a. Barotrauma--damage to lungs by excessive pressure
iii. Risk to pt w/ compliant lungs (ex. COPD)

Front 172

Respiratory
III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
b. Volu-trauma--injury from ↑-------- volume on pt with -------------/stiff lungs (ARDS)

Back 172

Respiratory
III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
b. Volu-trauma--injury from ↑tidal volume on pt with noncompliant/stiff lungs (ARDS)

Front 173

Respiratory
III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
c. Alveolar _________--excessive lung secretions, leaking cuff, etc.

Back 173

Respiratory
III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
c. Alveolar Hypoventilation--excessive lung secretions, leaking cuff, etc.

Front 174

Respiratory
III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
d. Alveolar _________--pt anxious ↑tidal volumes

Back 174

Respiratory
III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
d. Alveolar Hyperventilation--pt anxious ↑tidal volumes

Front 175

Respiratory
III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
e. Ventilator-assisted pneumonia--ET tube bypasses ------------ defenses

Back 175

III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
e. Ventilator-assisted pneumonia--ET tube bypasses normal upper airway defenses

Front 176

III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
e. Ventilator-assisted pneumonia--ET tube bypasses normal upper airway defenses
i. Critical care pt at risk because of -------- and poor -------- status

Back 176

III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
e. Ventilator-assisted pneumonia--ET tube bypasses normal upper airway defenses
i. Critical care pt at risk because of immobility and poor nutritional status

Front 177

III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
e. Ventilator-assisted pneumonia--ET tube bypasses normal upper airway defenses
ii. Sputum cultures often grow ----------- (pseudomonas, serratia, klebsiella)

Back 177

III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
e. Ventilator-assisted pneumonia--ET tube bypasses normal upper airway defenses
ii. Sputum cultures often grow gram(-)bacteria (pseudomonas, serratia, klebsiella)

Front 178

III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
e. Ventilator-assisted pneumonia--ET tube bypasses normal upper airway defenses
ii. Sputum cultures often grow gram(-)bacteria (pseudomonas, ---------, ----------)

Back 178

III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
e. Ventilator-assisted pneumonia--ET tube bypasses normal upper airway defenses
ii. Sputum cultures often grow gram(-)bacteria (pseudomonas, serratia, klebsiella)

Front 179

III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
e. Ventilator-assisted pneumonia--ET tube bypasses normal upper airway defenses
iii. Decrease risk by using strict ------------ technique while suctioning (hand washing, drain condensation from tubes, etc.)

Back 179

III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
e. Ventilator-assisted pneumonia--ET tube bypasses normal upper airway defenses
iii. Decrease risk by using strict aseptic technique while suctioning (hand washing, drain condensation from tubes, etc.)

Front 180

III. Mechanical Ventilation
E. Complications
3. Gastrointestinal
a. Risk of stress ulcers and ----------- bleeding

Back 180

III. Mechanical Ventilation
E. Complications
3. Gastrointestinal
a. Risk of stress ulcers and GI bleeding

Front 181

III. Mechanical Ventilation
E. Complications
3. Gastrointestinal
b. Nursing Implication--______receptor blockers or PPIs and monitor pH of gastric aspirate

Back 181

III. Mechanical Ventilation
E. Complications
3. Gastrointestinal
b. Nursing Implication--H2-receptor blockers or PPIs and monitor pH of gastric aspirate

Front 182

III. Mechanical Ventilation
E. Complications
3. Gastrointestinal
b. Nursing Implication--H2-receptor blockers or ----------- and monitor pH of gastric ----------

Back 182

III. Mechanical Ventilation
E. Complications
3. Gastrointestinal
b. Nursing Implication--H2-receptor blockers or PPIs and monitor pH of gastric aspirate

Front 183

III. Mechanical Ventilation
E. Complications
4. Neurologic
a. Potential for increase in intracranial pressure from ↓ _______ return (keep HOB ____-45°)

Back 183

III. Mechanical Ventilation
E. Complications
4. Neurologic
a. Potential for increase in intracranial pressure from ↓ venous return (keep HOB 30-45°)

Front 184

III. Mechanical Ventilation
E. Complications
5. Fluid_________--fluid overload potential (↓CO↓kidney flow↑ReninNa/H2O retention)

Back 184

III. Mechanical Ventilation
E. Complications
5. Fluid Imbalance--fluid overload potential (↓CO↓kidney flow↑ReninNa/H2O retention)

Front 185

III. Mechanical Ventilation
E. Complications
5. Fluid Imbalance--fluid overload potential (↓---------↓-----------↑ReninNa/H2O retention)

Back 185

III. Mechanical Ventilation
E. Complications
5. Fluid Imbalance--fluid overload potential (↓CO↓kidney flow↑ReninNa/H2O retention)

Front 186

III. Mechanical Ventilation
E. Complications
5. Fluid Imbalance--fluid overload potential (↓CO↓kidney flow↑-------------/H2O retention)

Back 186

III. Mechanical Ventilation
E. Complications
5. Fluid Imbalance--fluid overload potential (↓CO↓kidney flow↑ReninNa/H2O retention)

Front 187

III. Mechanical Ventilation
E. Complications
6. Musculoskeletal Problems--due to --------

Back 187

III. Mechanical Ventilation
E. Complications
6. Musculoskeletal Problems--due to immobility

Front 188

III. Mechanical Ventilation
E. Complications
7. Psychosocial Effects--assess for causes of ----------- and meeting basic needs

Back 188

III. Mechanical Ventilation
E. Complications
7. Psychosocial Effects--assess for causes of anxiety and meeting basic needs

Front 189

Respiratory Disruptions
I. Laryngeal Polyps
A. Etiology and Pathophysiology--more common in men, ----------, talkers/yellers, ----------, and -----------

Back 189

Respiratory Disruptions
I. Laryngeal Polyps
A. Etiology and Pathophysiology--more common in men, singers, talkers/yellers, smokers, and GERD

Front 190

Respiratory Disruptions
I. Laryngeal Polyps
B. Clinical Manifestations
1. _______--not going to go away
2. Continuously ________ (breathy, harsh, and low in quality)

Back 190

Respiratory Disruptions
I. Laryngeal Polyps
B. Clinical Manifestations
1. Cough--not going to go away
2. Continuously change voice (breathy, harsh, and low in quality)

Front 191

Respiratory Disruptions
I. Laryngeal Polyps
C. Medical Management
1. Rest vocal cords and maybe a course of ---------
2. If long enough ------------ (rare) and surgically removed (could become malignant)

Back 191

Respiratory Disruptions
I. Laryngeal Polyps
C. Medical Management
1. Rest vocal cords and maybe a course of steroids
2. If long enough biopsied (rare) and surgically removed (could become malignant)

Front 192

Respiratory Disruptions
I. Laryngeal Polyps
C. Medical Management
1. Rest vocal cords and maybe a course of steroids
2. If long enough biopsied (rare) and surgically removed (could become malignant)
i. Potential for voice quality to ---------- after surgery

Back 192

Respiratory Disruptions
I. Laryngeal Polyps
C. Medical Management
1. Rest vocal cords and maybe a course of steroids
2. If long enough biopsied (rare) and surgically removed (could become malignant)
i. Potential for voice quality to not be same after surgery

Front 193

Respiratory Disruptions
II. Laryngeal Cancer
A. Etiology and Pathophysiology--squamous cell -----------

Back 193

Respiratory Disruptions
II. Laryngeal Cancer
A. Etiology and Pathophysiology--squamous cell carcinomas

Front 194

Respiratory Disruptions
II. Laryngeal Cancer
A. Etiology and Pathophysiology--squamous cell carcinomas
1. Found in smokers and ------------ users (can be prevented)
2. Prevalence--_____% of head and neck cancers in pts >_______yrs

Back 194

Respiratory Disruptions
II. Laryngeal Cancer
A. Etiology and Pathophysiology--squamous cell carcinomas
1. Found in smokers and ETOH users (can be prevented)
2. Prevalence--90% of head and neck cancers in pts >50yrs

Front 195

Respiratory Disruptions
II. Laryngeal Cancer
B. Clinical Manifestations--hoarseness, persistent -----------, change in --------- quality

Back 195

Respiratory Disruptions
II. Laryngeal Cancer
B. Clinical Manifestations--hoarseness, persistent sore throat, change in voice quality

Front 196

Respiratory Disruptions
II. Laryngeal Cancer
B. Clinical Manifestations--hoarseness, persistent sore throat, change in voice quality
1. Eventually pain and difficulty ---------------- (late presentation)

Back 196

Respiratory Disruptions
II. Laryngeal Cancer
B. Clinical Manifestations--hoarseness, persistent sore throat, change in voice quality
1. Eventually pain and difficulty swallowing (late presentation)

Front 197

Respiratory Disruptions
II. Laryngeal Cancer
C. Diagnostic Studies--visualize -----------, biopsies, ------------- (determine spread)

Back 197

Respiratory Disruptions
II. Laryngeal Cancer
C. Diagnostic Studies--visualize cancer, biopsies, CT/MRI (determine spread)

Front 198

Respiratory Disruptions
II. Laryngeal Cancer
C. Diagnostic Studies--visualize cancer, biopsies, CT/MRI (determine spread)
1. If diagnosed early--good cure rate (after partial/total -------------, laser treatment/---------)

Back 198

Respiratory Disruptions
II. Laryngeal Cancer
C. Diagnostic Studies--visualize cancer, biopsies, CT/MRI (determine spread)
1. If diagnosed early--good cure rate (after partial/total laryngectomy, laser treatment/chemo)

Front 199

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
1. _____________--partial/complete surgical removal of larynx usually from cancer (disfiguring)

Back 199

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring)

Front 200

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring)
a. Often try other ----------- first
b. Partial when ---------- limited to 1 spot (may be able to speak, but quality will be different)

Back 200

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring)
a. Often try other methods first
b. Partial when CA limited to 1 spot (may be able to speak, but quality will be different)

Front 201

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring)
c. Total--radical surgery creating permanent airway through---------- (no speech)

Back 201

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring)
c. Total--radical surgery creating permanent airway through trachea (no speech)

Front 202

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring)
d. Nursing Management
i. Pre-___________

Back 202

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring)
d. Nursing Management
i. Pre-Laryngectomy

Front 203

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring)
d. Nursing Management
i. Pre-Laryngectomy
• Assessment of ----------
• Pre-op ---------

Back 203

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring)
d. Nursing Management
i. Pre-Laryngectomy
• Assessment of knowledge
• Pre-op teaching

Front 204

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring)
d. Nursing Management
i. Pre-Laryngectomy
• Expected goals for -------

Back 204

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring)
d. Nursing Management
i. Pre-Laryngectomy
• Expected goals for pts

Front 205

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring)
d. Nursing Management
i. Pre-Laryngectomy
• Post-op expectations (J-Ps/---------/suction/pain/---------/---------)

Back 205

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring)
d. Nursing Management
i. Pre-Laryngectomy
• Post-op expectations (J-Ps/ventilation/suction/pain/catheters/feeding tube)

Front 206

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring)
d. Nursing Management
ii. Post-Laryngectomy
• Maintain patient airway (administer ------------, clean --------- tubes TID)

Back 206

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring)
d. Nursing Management
ii. Post-Laryngectomy
• Maintain patient airway (administer humidified air, clean trach tubes TID)

Front 207

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring)
d. Nursing Management
ii. Post-Laryngectomy
• Prevention of infection (dressing changes q---------h, ------- hygiene)

Back 207

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring)
d. Nursing Management
ii. Post-Laryngectomy
• Prevention of infection (dressing changes q8h, oral hygiene)

Front 208

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring)
d. Nursing Management
ii. Post-Laryngectomy
• ---------- control
• Maintain adequate nutritional support --NG tube for -------- days

Back 208

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring)
d. Nursing Management
ii. Post-Laryngectomy
• Pain control
• Maintain adequate nutritional support --NG tube for 7 days

Front 209

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring)
d. Nursing Management
ii. Post-Laryngectomy
• Effective comm.--__________ speech to make sounds/artificial voice box

Back 209

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring)
d. Nursing Management
ii. Post-Laryngectomy
• Effective comm.--esophageal speech to make sounds/artificial voice box

Front 210

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring)
d. Nursing Management
iii. Home Care--teaching so that they can manage themselves at home
• S----------
• Daily cleaning of -----------

Back 210

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring)
d. Nursing Management
iii. Home Care--teaching so that they can manage themselves at home
• Suctioning
• Daily cleaning of trach

Front 211

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring)
d. Nursing Management
iii. Home Care--teaching so that they can manage themselves at home
• ________________--steam filled shower, moistened cover over stoma (prevent tracheal bronchitis)
• Use of _________ covers--to protect during shower, etc.

Back 211

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring)
d. Nursing Management
iii. Home Care--teaching so that they can manage themselves at home
• Humidification--steam filled shower, moistened cover over stoma (prevent tracheal bronchitis)
• Use of stoma covers--to protect during shower, etc.

Front 212

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring)
d. Nursing Management
iii. Home Care--teaching so that they can manage themselves at home
• Changing --------- ties or Velcro-type holders
• ------------: should have ID band stating that they are neck breathers

Back 212

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring)
d. Nursing Management
iii. Home Care--teaching so that they can manage themselves at home
• Changing twill ties or Velcro-type holders
• Resuscitation--should have ID band stating that they are neck breathers

Front 213

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
2. Radial Neck Dissection--remove as much cancer as possible and ↓risk of ---------- spread

Back 213

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
2. Radial Neck Dissection--remove as much cancer as possible and ↓risk of lymphatic spread

Front 214

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
2. Radial Neck Dissection--remove as much cancer as possible and ↓risk of lymphatic spread
a. Removal of all --------- nodes and --------- channels

Back 214

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
2. Radial Neck Dissection--remove as much cancer as possible and ↓risk of lymphatic spread
a. Removal of all lymph nodes and lymphatic channels

Front 215

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
2. Radial Neck Dissection--remove as much cancer as possible and ↓risk of lymphatic spread
b. May involve -------- muscle, internal jugular vein, ------------ gland, part of thyroid/parathyroid, --------- accessory nerve (controls speech/swallowing) removal

Back 215

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
2. Radial Neck Dissection--remove as much cancer as possible and ↓risk of lymphatic spread
b. May involve sternocleidomastoid muscle, internal jugular vein, submxillary gland, part of thyroid/parathyroid, spinal accessory nerve (controls speech/swallowing) removal

Front 216

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
2. Radial Neck Dissection--remove as much cancer as possible and ↓risk of lymphatic spread
c. Usually involves ------- side of neck, but can have -------- (very disfiguring and long recovery)

Back 216

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
2. Radial Neck Dissection--remove as much cancer as possible and ↓risk of lymphatic spread
c. Usually involves 1 side of neck, but can have 2 (very disfiguring and long recovery)

Front 217

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
2. Radial Neck Dissection--remove as much cancer as possible and ↓risk of lymphatic spread
d. Operation should not be preformed if it has spread further (surgery won’t ----------)

Back 217

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
2. Radial Neck Dissection--remove as much cancer as possible and ↓risk of lymphatic spread
d. Operation should not be preformed if it has spread further (surgery won’t contain)

Front 218

Respiratory Disruptions
III. Lung Cancer
A. Epidemiology--leading cause of ------------- related death in men and women (survival rate --------%)

Back 218

Respiratory Disruptions
III. Lung Cancer
A. Epidemiology--leading cause of CA related death in men and women (survival rate 15%)

Front 219

Respiratory Disruptions
III. Lung Cancer
B. Etiology-->________yrs w/ long smoking hx (also 2nd hand) is most sig. risk factor (80-______% of lung CA)

Back 219

Respiratory Disruptions
III. Lung Cancer
B. Etiology-->50yrs w/ long smoking hx (also 2nd hand) is most sig. risk factor (80-90% of lung CA)

Front 220

Respiratory Disruptions
III. Lung Cancer
B. Etiology-->50yrs w/ long smoking hx (also 2nd hand) is most sig. risk factor (80-90% of lung CA)
1. Total exposure to ------------- (asbestos, --------, ---------, radiation)

Back 220

Respiratory Disruptions
III. Lung Cancer
B. Etiology-->50yrs w/ long smoking hx (also 2nd hand) is most sig. risk factor (80-90% of lung CA)
1. Total exposure to carcinogens (asbestos, Ni, Fe, radiation)
2. If stop smoking for 10yrs decrease risk by 30-50%

Front 221

Respiratory Disruptions
III. Lung Cancer
B. Etiology-->50yrs w/ long smoking hx (also 2nd hand) is most sig. risk factor (80-90% of lung CA)
2. If stop smoking for _________yrs decrease risk by 30-_____%

Back 221

Respiratory Disruptions
III. Lung Cancer
B. Etiology-->50yrs w/ long smoking hx (also 2nd hand) is most sig. risk factor (80-90% of lung CA)
2. If stop smoking for 10yrs decrease risk by 30-50%

Front 222

Respiratory Disruptions
III. Lung Cancer
C. Pathophysiology
1. Occurs primarily in ------------- or beyond and have preference for upper lobes

Back 222

Respiratory Disruptions
III. Lung Cancer
C. Pathophysiology
1. Occurs primarily in segmental bronchi or beyond and have preference for upper lobes

Front 223

Respiratory Disruptions
III. Lung Cancer
C. Pathophysiology
1. Occurs primarily in segmental bronchi or beyond and have preference for upper lobes
a. ---------% originate from ---------- and are very slow growing (8-10yrs to show on XR)

Back 223

Respiratory Disruptions
III. Lung Cancer
C. Pathophysiology
1. Occurs primarily in segmental bronchi or beyond and have preference for upper lobes
a. 90% originate from epithelium and are very slow growing (8-10yrs to show on XR)

Front 224

Respiratory Disruptions
III. Lung Cancer
C. Pathophysiology
2. Primary Lung Cancers
a. ____________ (20%)--caused by smoking (most malignant w/ poor prognosis-_______m)

Back 224

Respiratory Disruptions
III. Lung Cancer
C. Pathophysiology
2. Primary Lung Cancers
a. Small cell CA (20%)--caused by smoking (most malignant w/ poor prognosis-16m)

Front 225

Respiratory Disruptions
III. Lung Cancer
C. Pathophysiology
2. Primary Lung Cancers
b. ____________ (80%)--Staged (TNM--_______, node, metastasis)

Back 225

Respiratory Disruptions
III. Lung Cancer
C. Pathophysiology
2. Primary Lung Cancers
a. Small cell CA (20%)--caused by smoking (most malignant w/ poor prognosis-16m)

Front 226

Respiratory Disruptions
III. Lung Cancer
C. Pathophysiology
2. Primary Lung Cancers
a. Small cell CA (20%)--caused by smoking (most malignant w/ poor prognosis-16m)
i. _____________--most common (more common in women)

Back 226

Respiratory Disruptions
III. Lung Cancer
C. Pathophysiology
2. Primary Lung Cancers
a. Small cell CA (20%)--caused by smoking (most malignant w/ poor prognosis-16m)
i. Adnocarcinoma--most common (more common in women)

Front 227

Respiratory Disruptions
III. Lung Cancer
C. Pathophysiology
2. Primary Lung Cancers
a. Small cell CA (20%)--caused by smoking (most malignant w/ poor prognosis-16m)
i. Adnocarcinoma--most common (more common in women)
• Not related to ----------
• Nonclinical manifestations until it -----------

Back 227

Respiratory Disruptions
III. Lung Cancer
C. Pathophysiology
2. Primary Lung Cancers
a. Small cell CA (20%)--caused by smoking (most malignant w/ poor prognosis-16m)
i. Adnocarcinoma--most common (more common in women)
• Not related to smoking
• Nonclinical manifestations until it metastasizes

Front 228

Respiratory Disruptions
III. Lung Cancer
C. Pathophysiology
2. Primary Lung Cancers
a. Small cell CA (20%)--caused by smoking (most malignant w/ poor prognosis-16m)
i. Adnocarcinoma--most common (more common in women)
• Not related to smoking
• Nonclinical manifestations until it metastasizes
• Does not respond well to -----------

Back 228

Respiratory Disruptions
III. Lung Cancer
C. Pathophysiology
2. Primary Lung Cancers
a. Small cell CA (20%)--caused by smoking (most malignant w/ poor prognosis-16m)
i. Adnocarcinoma--most common (more common in women)
• Not related to smoking
• Nonclinical manifestations until it metastasizes
• Does not respond well to chemo/treatment

Front 229

Respiratory Disruptions
III. Lung Cancer
C. Pathophysiology
2. Primary Lung Cancers
a. Small cell CA (20%)--caused by smoking (most malignant w/ poor prognosis-16m)
ii. ________ cell--30-_____% of CAs (associated with smoking)

Back 229

Respiratory Disruptions
III. Lung Cancer
C. Pathophysiology
2. Primary Lung Cancers
a. Small cell CA (20%)--caused by smoking (most malignant w/ poor prognosis-16m)
ii. Squamous cell--30-35% of CAs (associated with smoking)

Front 230

Respiratory Disruptions
III. Lung Cancer
C. Pathophysiology
2. Primary Lung Cancers
a. Small cell CA (20%)--caused by smoking (most malignant w/ poor prognosis-16m)
iii. Large cell--correlated with ---------

Back 230

Respiratory Disruptions
III. Lung Cancer
C. Pathophysiology
2. Primary Lung Cancers
a. Small cell CA (20%)--caused by smoking (most malignant w/ poor prognosis-16m)
iii. Large cell--correlated with smoking

Front 231

Respiratory Disruptions
III. Lung Cancer
D. Clinical Manifestations--late in disease, especially with -----------
1. -------------- (most common-74% of pts)--can cause chest pain from sore muscles
2. --------------: not always

Back 231

Respiratory Disruptions
III. Lung Cancer
D. Clinical Manifestations--late in disease, especially with adnocarcinoma
1. Persistent cough (most common-74% of pts)--can cause chest pain from sore muscles
2. Hemoptysis--not always

Front 232

Respiratory Disruptions
III. Lung Cancer
D. Clinical Manifestations--late in disease, especially with adnocarcinoma
3. D----------
4. H-----------

Back 232

Respiratory Disruptions
III. Lung Cancer
D. Clinical Manifestations--late in disease, especially with adnocarcinoma
3. Dyspnea
4. Hoarsness,

Front 233

Respiratory Disruptions
III. Lung Cancer
D. Clinical Manifestations--late in disease, especially with adnocarcinoma
5. -------------- or stridor and recurrent pneumonia or ------------

Back 233

Respiratory Disruptions
III. Lung Cancer
D. Clinical Manifestations--late in disease, especially with adnocarcinoma
5. Wheezing or stridor and recurrent pneumonia or bronchitis
6. Difficulty swallowing anorexia/weight loss/fatigue (late manifestation)

Front 234

Respiratory Disruptions
III. Lung Cancer
D. Clinical Manifestations--late in disease, especially with adnocarcinoma
6. Difficulty ------------, -------------/weight loss/fatigue (late manifestation)

Back 234

Respiratory Disruptions
III. Lung Cancer
D. Clinical Manifestations--late in disease, especially with adnocarcinoma
6. Difficulty swallowing anorexia/weight loss/fatigue (late manifestation)

Front 235

Respiratory Disruptions
III. Lung Cancer
D. Clinical Manifestations--late in disease, especially with adnocarcinoma
7. Pleural ---------, pericardial ------------- (if mediasternum), cardiac -----------

Back 235

Respiratory Disruptions
III. Lung Cancer
D. Clinical Manifestations--late in disease, especially with adnocarcinoma
7. Pleural effusion, pericardial effusion (if mediasternum), cardiac tamponade

Front 236

Respiratory Disruptions
III. Lung Cancer
D. Clinical Manifestations--late in disease, especially with adnocarcinoma
8. Superior ------------- syndrome--swelling in ---------, neck, and face

Back 236

Respiratory Disruptions
III. Lung Cancer
D. Clinical Manifestations--late in disease, especially with adnocarcinoma
8. Superior vena cava syndrome--swelling in arms, neck, and face

Front 237

Respiratory Disruptions
III. Lung Cancer
D. Clinical Manifestations--late in disease, especially with adnocarcinoma
9. Swollen lymph nodes--swell with -----------

Back 237

Respiratory Disruptions
III. Lung Cancer
D. Clinical Manifestations--late in disease, especially with adnocarcinoma
9. Swollen lymph nodes--swell with metastasis

Front 238

Respiratory Disruptions
III. Lung Cancer
E. Diagnosis
1. History and ---------
2. CXR--detect -------, pleural effusions, and -------- (1-2sonometers)

Back 238

Respiratory Disruptions
III. Lung Cancer
E. Diagnosis
1. History and physical
2. CXR--detect metastasis, pleural effusions, and tumors (1-2sonometers)

Front 239

Respiratory Disruptions
III. Lung Cancer
E. Diagnosis
2. CXR--detect metastasis, pleural effusions, and tumors (1-2sonometers)
a. Routing CXRs often lead to --------- of lung ----------

Back 239

Respiratory Disruptions
III. Lung Cancer
E. Diagnosis
2. CXR--detect metastasis, pleural effusions, and tumors (1-2sonometers)
a. Routing CXRs often lead to Dx of lung CA

Front 240

Respiratory Disruptions
III. Lung Cancer
E. Diagnosis
3. ________--single most effective noninvasive test to determine CA and metastasis

Back 240

Respiratory Disruptions
III. Lung Cancer
E. Diagnosis
3. CT--single most effective noninvasive test to determine CA and metastasis

Front 241

Respiratory Disruptions
III. Lung Cancer
E. Diagnosis
4. Biopsy--definitive --------- (must have ----------- cells)

Back 241

Respiratory Disruptions
III. Lung Cancer
E. Diagnosis
4. Biopsy--definitive Dx (must have malignant cells)

Front 242

Respiratory Disruptions
III. Lung Cancer
E. Diagnosis
4. Biopsy--definitive Dx (must have malignant cells)
a. From morning ---------- sample, bronchoscopy, needle ----------, tap pleural ---------

Back 242

Respiratory Disruptions
III. Lung Cancer
E. Diagnosis
4. Biopsy--definitive Dx (must have malignant cells)
a. From morning sputum sample, bronchoscopy, needle biopsy, tap pleural effusion

Front 243

Respiratory Disruptions
III. Lung Cancer
E. Diagnosis
4. Biopsy--definitive Dx (must have malignant cells)
b. Brain and ---------- most common metastasis sites

Back 243

Respiratory Disruptions
III. Lung Cancer
E. Diagnosis
4. Biopsy--definitive Dx (must have malignant cells)
b. Brain and bone most common metastasis sites

Front 244

Respiratory Disruptions
III. Lung Cancer
F. Treatment--based on staging (early ----------- is not helpful)
1. Surgery--only hope (------------ more likely to be resected)

Back 244

Respiratory Disruptions
III. Lung Cancer
F. Treatment--based on staging (early detection is not helpful)
1. Surgery--only hope (squamous cells more likely to be resected)

Front 245

Respiratory Disruptions
III. Lung Cancer
F. Treatment--based on staging (early detection is not helpful)
1. Surgery--only hope (squamous cells more likely to be resected)
a. ----------- (part of lung) vs. ------------ (whole lung)

Back 245

Respiratory Disruptions
III. Lung Cancer
F. Treatment--based on staging (early detection is not helpful)
1. Surgery--only hope (squamous cells more likely to be resected)
a. Lobectomy (part of lung) vs. pneumonectomy (whole lung)

Front 246

Respiratory Disruptions
III. Lung Cancer
F. Treatment--based on staging (early detection is not helpful)
1. Surgery--only hope (squamous cells more likely to be resected)
b. Many times not possible if already -----------

Back 246

Respiratory Disruptions
III. Lung Cancer
F. Treatment--based on staging (early detection is not helpful)
1. Surgery--only hope (squamous cells more likely to be resected)
b. Many times not possible if already metastasized

Front 247

Respiratory Disruptions
III. Lung Cancer
F. Treatment--based on staging (early detection is not helpful)
2. Radiation--when used with surgery and -------- (not beneficial for --------- cell)
a. Sometimes just for --------- measures

Back 247

Respiratory Disruptions
III. Lung Cancer
F. Treatment--based on staging (early detection is not helpful)
2. Radiation--when used with surgery and chemo (not beneficial for small cell)
a. Sometimes just for palliative measures

Front 248

Respiratory Disruptions
III. Lung Cancer
F. Treatment--based on staging (early detection is not helpful)
3. Chemotherapy--standard treatment for advanced ---------- CA

Back 248

Respiratory Disruptions
III. Lung Cancer
F. Treatment--based on staging (early detection is not helpful)
3. Chemotherapy--standard treatment for advanced non-small cell CA

Front 249

Respiratory Disruptions
III. Lung Cancer
G. Nursing Management
1. Assess level of ----------- related to disease
2. Provide pre-op/post-op procedure and ------------- teaching
3. Assess --------- system

Back 249

Respiratory Disruptions
III. Lung Cancer
G. Nursing Management
1. Assess level of knowledge related to disease
2. Provide pre-op/post-op procedure and intervention teaching
3. Assess support system

Front 250

Respiratory Disruptions
III. Lung Cancer
G. Nursing Management
4. Assess pain and provide --------- measures
5. Assess ------------ status (pts easily lose wt)
6. Be able to provide------------ in the community

Back 250

Respiratory Disruptions
III. Lung Cancer
G. Nursing Management
1. Assess level of knowledge related to disease
2. Provide pre-op/post-op procedure and intervention teaching
3. Assess support system

Front 251

Respiratory Disruptions
IV. Traumatic Injuries of the Chest and Thorax
A. Blunt--body is struck by a blunt object (ex. MVAs chest wall in contact with steering wheel)
1. --------------- trauma--impact of parts of the body against other objects

Back 251

Respiratory Disruptions
IV. Traumatic Injuries of the Chest and Thorax
A. Blunt--body is struck by a blunt object (ex. MVAs chest wall in contact with steering wheel)
1. Countrecoup trauma--impact of parts of the body against other objects

Front 252

Respiratory Disruptions
IV. Traumatic Injuries of the Chest and Thorax
A. Blunt--body is struck by a blunt object (ex. MVAs chest wall in contact with steering wheel)
2. Pulmonary ---------, vessel ------------- (great vessel tears), cardiac tamponade, crush ----------

Back 252

Respiratory Disruptions
IV. Traumatic Injuries of the Chest and Thorax
A. Blunt--body is struck by a blunt object (ex. MVAs chest wall in contact with steering wheel)
2. Pulmonary contusions, vessel ruptures (great vessel tears), cardiac tamponade, crush injuries

Front 253

Respiratory Disruptions
IV. Traumatic Injuries of the Chest and Thorax
B. ___________--foreign body impales or passes through body tissues
C. _____________--air/fluid in pleural space (have a tendency to reoccur)

Back 253

Respiratory Disruptions
IV. Traumatic Injuries of the Chest and Thorax
B. Penetrating--foreign body impales or passes through body tissues
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)

Front 254

Respiratory Disruptions
IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
• If >_____% of lung resp. distress, if <________% they can still function (may need chest tube)

Back 254

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
• If >40% of lung resp. distress, if <25% they can still function (may need chest tube)

Front 255

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
1. Closed--caused by -------- rupture on lung
a. Characteristics--no associated open ---------, no underlying disease

Back 255

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
1. Closed--caused by bleb rupture on lung
a. Characteristics--no associated open wound, no underlying disease

Front 256

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
1. Closed--caused by bleb rupture on lung
a. Characteristics--no associated open wound, no underlying disease
i. -------------- pneumothorax--no clear cause (tall, thin, 20-_____yr men who smoke)

Back 256

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
1. Closed--caused by bleb rupture on lung
a. Characteristics--no associated open wound, no underlying disease
i. Sponaneous pneumothorax--no clear cause (tall, thin, 20-40yr men who smoke)

Front 257

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
1. Closed--caused by bleb rupture on lung
a. Characteristics--no associated open wound, no underlying disease
ii. Injury from ----------- ventilation (PEEP)
iii. Injury from broken --------

Back 257

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
1. Closed--caused by bleb rupture on lung
a. Characteristics--no associated open wound, no underlying disease
ii. Injury from mechanical ventilation (PEEP)
iii. Injury from broken ribs

Front 258

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
1. Closed--caused by bleb rupture on lung
a. Characteristics--no associated open wound, no underlying disease
iv. S/P ------------- insertion--always follow w/ ----------- to check for pneumo

Back 258

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
1. Closed--caused by bleb rupture on lung
a. Characteristics--no associated open wound, no underlying disease
iv. S/P subclavian catheter insertion--always follow w/ CXR to check for pneumo

Front 259

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
2. Open--air enters pleural space from opening in chest wall and gets trapped (“sucking wound”)
a. Causes--stab/--------- wound; s/p ----------

Back 259

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
2. Open--air enters pleural space from opening in chest wall and gets trapped (“sucking wound”)
a. Causes--stab/gunshot wound; s/p thoracotomy

Front 260

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
2. Open--air enters pleural space from opening in chest wall and gets trapped (“sucking wound”)
b. Manifestations--SOB, ----------------/hyperresonance on affected side, see ------------

Back 260

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
2. Open--air enters pleural space from opening in chest wall and gets trapped (“sucking wound”)
b. Manifestations--SOB, shallow breaths/hyperresonance on affected side, see bubbling

Front 261

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
2. Open--air enters pleural space from opening in chest wall and gets trapped (“sucking wound”)
c. Management--cover w/ ---------- dressing and taped on ------------ sides (creates 1 way valve)

Back 261

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
2. Open--air enters pleural space from opening in chest wall and gets trapped (“sucking wound”)
c. Management--cover w/ vented dressing and taped on 3 sides (creates 1 way valve)

Front 262

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
2. Open--air enters pleural space from opening in chest wall and gets trapped (“sucking wound”)
c. Management--cover w/ vented dressing and taped on 3 sides (creates 1 way valve)
i. If taped on all ----------- sides pneumo gets bigger tension -----------

Back 262

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
2. Open--air enters pleural space from opening in chest wall and gets trapped (“sucking wound”)
c. Management--cover w/ vented dressing and taped on 3 sides (creates 1 way valve)
i. If taped on all 4 sides pneumo gets bigger tension pneumo

Front 263

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
2. Open--air enters pleural space from opening in chest wall and gets trapped (“sucking wound”)
c. Management--cover w/ vented dressing and taped on 3 sides (creates 1 way valve)
ii. Give ----------- until ---------- placement

Back 263

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
2. Open--air enters pleural space from opening in chest wall and gets trapped (“sucking wound”)
c. Management--cover w/ vented dressing and taped on 3 sides (creates 1 way valve)
ii. Give oxygen until chest tube placement

Front 264

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
3. Tension--pneumothorax w/ rapid ------------- of air in pleural space causing severely high ---------------- pressures w/ resultant tension on heart and great vessels (life threatening)

Back 264

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
3. Tension--pneumothorax w/ rapid accumulation of air in pleural space causing severely high intrapleural pressures w/ resultant tension on heart and great vessels (life threatening)

Front 265

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
3. Tension--pneumothorax w/ rapid accumulation of air in pleural space causing severely high intrapleural pressures w/ resultant tension on heart and great vessels (life threatening)
a. Clinical Manifestations (can occur due to blunt or ----------- object)

Back 265

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
3. Tension--pneumothorax w/ rapid accumulation of air in pleural space causing severely high intrapleural pressures w/ resultant tension on heart and great vessels (life threatening)
a. Clinical Manifestations (can occur due to blunt or penetrating object)

Front 266

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
3. Tension--pneumothorax w/ rapid accumulation of air in pleural space causing severely high intrapleural pressures w/ resultant tension on heart and great vessels (life threatening)
a. Clinical Manifestations (can occur due to blunt or penetrating object)
i. Triad of symptoms--resp ----------, look ------------ (↓BP), no breath sounds

Back 266

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
3. Tension--pneumothorax w/ rapid accumulation of air in pleural space causing severely high intrapleural pressures w/ resultant tension on heart and great vessels (life threatening)
a. Clinical Manifestations (can occur due to blunt or penetrating object)
i. Triad of symptoms--resp distress, look shocky (↓BP), no breath sounds

Front 267

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
3. Tension--pneumothorax w/ rapid accumulation of air in pleural space causing severely high intrapleural pressures w/ resultant tension on heart and great vessels (life threatening)
a. Clinical Manifestations (can occur due to blunt or penetrating object)
ii. Interferes with ----------- shock ↓BP hypoxic ↓---------, etc.

Back 267

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
3. Tension--pneumothorax w/ rapid accumulation of air in pleural space causing severely high intrapleural pressures w/ resultant tension on heart and great vessels (life threatening)
a. Clinical Manifestations (can occur due to blunt or penetrating object)
ii. Interferes with venous return shock ↓BP hypoxic ↓CO, etc.

Front 268

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
3. Tension--pneumothorax w/ rapid accumulation of air in pleural space causing severely high intrapleural pressures w/ resultant tension on heart and great vessels (life threatening)
a. Clinical Manifestations (can occur due to blunt or penetrating object)
iii. Complete collapse -------------- shift (tracheal -----------)

Back 268

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
3. Tension--pneumothorax w/ rapid accumulation of air in pleural space causing severely high intrapleural pressures w/ resultant tension on heart and great vessels (life threatening)
a. Clinical Manifestations (can occur due to blunt or penetrating object)
iii. Complete collapse mediastinal shift (tracheal deviation)

Front 269

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
3. Tension--pneumothorax w/ rapid accumulation of air in pleural space causing severely high intrapleural pressures w/ resultant tension on heart and great vessels (life threatening)
b. Diagnosis--on clinical grounds (do NOT need ----------)

Back 269

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
3. Tension--pneumothorax w/ rapid accumulation of air in pleural space causing severely high intrapleural pressures w/ resultant tension on heart and great vessels (life threatening)
b. Diagnosis--on clinical grounds (do NOT need CXR)

Front 270

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
3. Tension--pneumothorax w/ rapid accumulation of air in pleural space causing severely high intrapleural pressures w/ resultant tension on heart and great vessels (life threatening)
b. Diagnosis--on clinical grounds (do NOT need CXR)
c. Treatment--large gauge needle --------------- (if air comes out pt will need chest tube)

Back 270

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
3. Tension--pneumothorax w/ rapid accumulation of air in pleural space causing severely high intrapleural pressures w/ resultant tension on heart and great vessels (life threatening)
b. Diagnosis--on clinical grounds (do NOT need CXR)
c. Treatment--large gauge needle decompression (if air comes out pt will need chest tube)

Front 271

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
4. __________--blood accumulates in intrapleural space (blood and air-hemopneumothroax)

Back 271

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
4. Hemothorax--blood accumulates in intrapleural space (blood and air-hemopneumothroax)

Front 272

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
4. Hemothorax--blood accumulates in intrapleural space (blood and air-hemopneumothroax)
a. Causes--massive bleeding from major chest ---------- or ----------- vessel rupture

Back 272

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
4. Hemothorax--blood accumulates in intrapleural space (blood and air-hemopneumothroax)
a. Causes--massive bleeding from major chest vessel or intercostal vessel rupture

Front 273

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
4. Hemothorax--blood accumulates in intrapleural space (blood and air-hemopneumothroax)
a. Causes--massive bleeding from major chest vessel or intercostal vessel rupture
i. Can accumulate up to -----------L of blood from blunt or ------------ trauma

Back 273

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
4. Hemothorax--blood accumulates in intrapleural space (blood and air-hemopneumothroax)
a. Causes--massive bleeding from major chest vessel or intercostal vessel rupture
i. Can accumulate up to 1L of blood from blunt or penetrating trauma

Front 274

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
4. Hemothorax--blood accumulates in intrapleural space (blood and air-hemopneumothroax)
a. Causes--massive bleeding from major chest vessel or intercostal vessel rupture
ii. Pulmonary ------------, -------------- therapy, TB, etc.

Back 274

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
4. Hemothorax--blood accumulates in intrapleural space (blood and air-hemopneumothroax)
a. Causes--massive bleeding from major chest vessel or intercostal vessel rupture
ii. Pulmonary embolus, coagulation therapy, TB, etc.

Front 275

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
4. Hemothorax--blood accumulates in intrapleural space (blood and air-hemopneumothroax).
b. Clinical Manifestations--dull ------------, shock (from ↓---------)

Back 275

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
4. Hemothorax--blood accumulates in intrapleural space (blood and air-hemopneumothroax).
b. Clinical Manifestations--dull percussion, shock (from ↓blood)

Front 276

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
4. Hemothorax--blood accumulates in intrapleural space (blood and air-hemopneumothroax).
c. Treatment--CXR, ↑------------, chest tube, ----------------- devices (diverts blood back into pt)

Back 276

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
4. Hemothorax--blood accumulates in intrapleural space (blood and air-hemopneumothroax).
c. Treatment--CXR, ↑HR, chest tube, autotransfusion devices (diverts blood back into pt)

Front 277

IV. Traumatic Injuries of the Chest and Thorax
D. Fractured Ribs--blunt/penetrating injuries (most common from trauma)
1 Clinical Manifestations--pain, --------------, bruising, tenderness, some ------------ bleeding, hurts to take --------------- (increased risk for atalectasis), splinting ----------- side

Back 277

IV. Traumatic Injuries of the Chest and Thorax
D. Fractured Ribs--blunt/penetrating injuries (most common from trauma)
1 Clinical Manifestations--pain, swelling, bruising, tenderness, some internal bleeding, hurts to take deep breath (increased risk for atalectasis), splinting affected side

Front 278

IV. Traumatic Injuries of the Chest and Thorax
D. Fractured Ribs--blunt/penetrating injuries (most common from trauma)
2. Diagnosis--________
3. Treatment--↓pain (more apt to take deep breaths) w/ ASA, _________, _______

Back 278

IV. Traumatic Injuries of the Chest and Thorax
D. Fractured Ribs--blunt/penetrating injuries (most common from trauma)
2. Diagnosis--CXR
3. Treatment--↓pain (more apt to take deep breaths) w/ ASA, NSAIDS, narcotics

Front 279

IV. Traumatic Injuries of the Chest and Thorax
D. Fractured Ribs--blunt/penetrating injuries (most common from trauma)
2. Diagnosis--CXR
3. Treatment--↓pain (more apt to take deep breaths) w/ ASA, NSAIDS, narcotics
a. -------------- if in resp distress (possible pneumothorax)

Back 279

IV. Traumatic Injuries of the Chest and Thorax
D. Fractured Ribs--blunt/penetrating injuries (most common from trauma)
2. Diagnosis--CXR
3. Treatment--↓pain (more apt to take deep breaths) w/ ASA, NSAIDS, narcotics
a. Intubation if in resp distress (possible pneumothorax)

Front 280

IV. Traumatic Injuries of the Chest and Thorax
D. Fractured Ribs--blunt/penetrating injuries (most common from trauma)
2. Diagnosis--CXR
3. Treatment--↓pain (more apt to take deep breaths) w/ ASA, NSAIDS, narcotics
b. -------------- chest tubes if fractures and intubation

Back 280

IV. Traumatic Injuries of the Chest and Thorax
D. Fractured Ribs--blunt/penetrating injuries (most common from trauma)
2. Diagnosis--CXR
3. Treatment--↓pain (more apt to take deep breaths) w/ ASA, NSAIDS, narcotics
b. Prophylactic chest tubes if fractures and intubation

Front 281

IV. Traumatic Injuries of the Chest and Thorax
E. Flail Chest--from multiple -------------- fractures causing instability of chest wall

Back 281

IV. Traumatic Injuries of the Chest and Thorax
E. Flail Chest--from multiple rib fractures causing instability of chest wall
1. Clinical Manifestations--crepitis, paradoxical chest movement, ↑RR, shallow breaths, ↑HR

Front 282

IV. Traumatic Injuries of the Chest and Thorax
E. Flail Chest--from multiple rib fractures causing instability of chest wall
1. Clinical Manifestations--crepitis, ---------- chest movement, ↑---------, shallow breaths, ↑---------

Back 282

IV. Traumatic Injuries of the Chest and Thorax
E. Flail Chest--from multiple rib fractures causing instability of chest wall
1. Clinical Manifestations--crepitis, paradoxical chest movement, ↑RR, shallow breaths, ↑HR

Front 283

IV. Traumatic Injuries of the Chest and Thorax
E. Flail Chest--from multiple rib fractures causing instability of chest wall
1. Clinical Manifestations--crepitis, paradoxical chest movement, ↑RR, shallow breaths, ↑HR
a. Breathe in ------------- pressure sucks chest wall in (opposite when breathing out)

Back 283

IV. Traumatic Injuries of the Chest and Thorax
E. Flail Chest--from multiple rib fractures causing instability of chest wall
1. Clinical Manifestations--crepitis, paradoxical chest movement, ↑RR, shallow breaths, ↑HR
a. Breathe in negative pressure sucks chest wall in (opposite when breathing out)

Front 284

IV. Traumatic Injuries of the Chest and Thorax
E. Flail Chest--from multiple rib fractures causing instability of chest wall
1. Clinical Manifestations--crepitis, paradoxical chest movement, ↑RR, shallow breaths, ↑HR
b. Often have ------------- contusion and/or -------------

Back 284

IV. Traumatic Injuries of the Chest and Thorax
E. Flail Chest--from multiple rib fractures causing instability of chest wall
1. Clinical Manifestations--crepitis, paradoxical chest movement, ↑RR, shallow breaths, ↑HR
b. Often have pulmonary contusion and/or pneumothorax

Front 285

IV. Traumatic Injuries of the Chest and Thorax
E. Flail Chest--from multiple rib fractures causing instability of chest wall
2. Diagnosis--fractures on -------- (visual diagnosis)

Back 285

IV. Traumatic Injuries of the Chest and Thorax
E. Flail Chest--from multiple rib fractures causing instability of chest wall
2. Diagnosis--fractures on CXR (visual diagnosis)

Front 286

IV. Traumatic Injuries of the Chest and Thorax
E. Flail Chest--from multiple rib fractures causing instability of chest wall
3. Treatment--stabilize-----------, ----------- (put on ventilator for flail chest)

Back 286

IV. Traumatic Injuries of the Chest and Thorax
E. Flail Chest--from multiple rib fractures causing instability of chest wall
3. Treatment--stabilize chest wall, oxygenate (put on ventilator for flail chest)

Front 287

V. Pleural Drainage System
A. Purpose--evacuate ----------/air/pus/fluid from ------------- and reestablish ----------- pressure in intrapleural space so lungs can reexpand

Back 287

V. Pleural Drainage System
A. Purpose--evacuate blood/air/pus/fluid from thoracic cavity and reestablish negative pressure in intrapleural space so lungs can reexpand

Front 288

V. Pleural Drainage System
B. Chambers
1. Collection chamber--collects ---------- that drains into chest tub through -------ft connecting tube

Back 288

V. Pleural Drainage System
B. Chambers
1. Collection chamber--collects fluid that drains into chest tub through 6ft connecting tube

Front 289

V. Pleural Drainage System
B. Chambers
1. Collection chamber--collects fluid that drains into chest tub through 6ft connecting tube
a. Holds up to ------------mL

Back 289

V. Pleural Drainage System
B. Chambers
1. Collection chamber--collects fluid that drains into chest tub through 6ft connecting tube
a. Holds up to 2000mL

Front 290

V. Pleural Drainage System
B. Chambers
2. Water-Seal Chamber--______cm water act as 1-way valve (air drains from______, but not back to pt)

Back 290

V. Pleural Drainage System
B. Chambers
2. Water-Seal Chamber--2cm water act as 1-way valve (air drains from chest, but not back to pt)

Front 291

V. Pleural Drainage System
B. Chambers
2. Water-Seal Chamber--2cm water act as 1-way valve (air drains from chest, but not back to pt)
a. B----------
b. T---------: fluctuations on inspiration and expiration (when pt is off suction)

Back 291

V. Pleural Drainage System
B. Chambers
2. Water-Seal Chamber--2cm water act as 1-way valve (air drains from chest, but not back to pt)
a. Bubbling
b. Tidaling--fluctuations on inspiration and expiration (when pt is off suction)

Front 292

V. Pleural Drainage System
B. Chambers
2. Water-Seal Chamber--2cm water act as 1-way valve (air drains from chest, but not back to pt)
b. Tidaling--fluctuations on inspiration and expiration (when pt is off suction)
i. Deep breath in with -------------- breathing water moves up

Back 292

V. Pleural Drainage System
B. Chambers
2. Water-Seal Chamber--2cm water act as 1-way valve (air drains from chest, but not back to pt)
b. Tidaling--fluctuations on inspiration and expiration (when pt is off suction)
i. Deep breath in with normal breathing water moves up

Front 293

V. Pleural Drainage System
B. Chambers
2. Water-Seal Chamber--2cm water act as 1-way valve (air drains from chest, but not back to pt)
b. Tidaling--fluctuations on inspiration and expiration (when pt is off suction)
ii. Deep breath on -------------- water moves down
iii. No ----------: full lung expansion

Back 293

V. Pleural Drainage System
B. Chambers
2. Water-Seal Chamber--2cm water act as 1-way valve (air drains from chest, but not back to pt)
b. Tidaling--fluctuations on inspiration and expiration (when pt is off suction)
ii. Deep breath on vent water moves down
iii. No tidaling--full lung expansion

Front 294

V. Pleural Drainage System
B. Chambers
3. ------------- Chamber--applies controlled suction to chest drainage system

Back 294

V. Pleural Drainage System
B. Chambers
3. Suction Control Chamber--applies controlled suction to chest drainage system

Front 295

V. Pleural Drainage System
B. Chambers
3. Suction Control Chamber--applies controlled suction to chest drainage system
a. To regulate suction, connect ------------- line tubing to wall suction and set at ordered level

Back 295

V. Pleural Drainage System
B. Chambers
3. Suction Control Chamber--applies controlled suction to chest drainage system
a. To regulate suction, connect vacuum line tubing to wall suction and set at ordered level

Front 296

V. Pleural Drainage System
B. Chambers
3. Suction Control Chamber--applies controlled suction to chest drainage system
b. Suction order must be written by ---------- (usually ----------sonometers in suction chamber)

Back 296

V. Pleural Drainage System
B. Chambers
3. Suction Control Chamber--applies controlled suction to chest drainage system
b. Suction order must be written by physician (usually 20sonometers in suction chamber)

Front 297

V. Pleural Drainage System
C. Nursing Management
1. Keep tubing coiled loosely below ------------ level and do not let pt lie on it
2. Check ------------ and tape them

Back 297

V. Pleural Drainage System
C. Nursing Management
1. Keep tubing coiled loosely below chest level and do not let pt lie on it
2. Check connections and tape them

Front 298

V. Pleural Drainage System
C. Nursing Management
3. Mark -------------- levels--time depends on drainage (check q5-_______min post-surgery)

Back 298

V. Pleural Drainage System
C. Nursing Management
3. Mark drainage levels--time depends on drainage (check q5-10min post-surgery)

Front 299

V. Pleural Drainage System
C. Nursing Management
4. Assess ---------- level in water seal chamber q-------h (suction regulated by water amount in chamber)

Back 299

V. Pleural Drainage System
C. Nursing Management
4. Assess water level in water seal chamber q8h (suction regulated by water amount in chamber)

Front 300

V. Pleural Drainage System
C. Nursing Management
5. Observe for ----------- bubbling in water seal chamber and ------------- (tidaling)

Back 300

V. Pleural Drainage System
C. Nursing Management
5. Observe for air bubbling in water seal chamber and fluctuations (tidaling)
6. Never elevate drainage system to level of pts chest

Front 301

V. Pleural Drainage System
C. Nursing Management
6. Never ------------ drainage system to level of pts chest
7. Never ---------- tubes--except for changing drainage system

Back 301

V. Pleural Drainage System
C. Nursing Management
6. Never elevate drainage system to level of pts chest
7. Never clamp tubes--except for changing drainage system

Front 302

V. Pleural Drainage System
C. Nursing Management
8. If continuous ---------- in water seal chamber, assess for air leak (assess appropriateness)
a. Use ------------ to find leak’s location

Back 302

V. Pleural Drainage System
C. Nursing Management
8. If continuous bubbling in water seal chamber, assess for air leak (assess appropriateness)
a. Use clamp to find leak’s location

Front 303

V. Pleural Drainage System
C. Nursing Management
9. Daily ---------- to determine if totally reinflated (before taking out try ----------- suction and assess)

Back 303

V. Pleural Drainage System
C. Nursing Management
9. Daily CXR to determine if totally reinflated (before taking out try gravity suction and assess)

Front 304

V. Pleural Drainage System
C. Nursing Management
10. Premedicate w/ chest tube ----------- (morphine)--take deep breath in and ------------, pull

Back 304

V. Pleural Drainage System
C. Nursing Management
10. Premedicate w/ chest tube removal (morphine)--take deep breath in and blow out pull

Front 305

VI. Acute Respiratory Failure
A. Clinical Manifestations
1. Change in ------------ status (early sign)
2. Dyspnea,-----------, mild ---------

Back 305

VI. Acute Respiratory Failure
A. Clinical Manifestations
1. Change in mental status (early sign)
2. Dyspnea, tachypnea, mild HTN

Front 306

VI. Acute Respiratory Failure
A. Clinical Manifestations
2. Dyspnea, tachypnea, mild HTN
a. ----------- breathing slowed w/ no -------------, unable to ----------- (bad) intubate

Back 306

VI. Acute Respiratory Failure
A. Clinical Manifestations
2. Dyspnea, tachypnea, mild HTN
a. Fast breathing slowed w/ no intervention unable to compensate (bad) intubate

Front 307

VI. Acute Respiratory Failure
A. Clinical Manifestations
3. Skin cool, clammy, and ----------
4. ---------: if PaO2 <45 (late sign)

Back 307

VI. Acute Respiratory Failure
A. Clinical Manifestations
3. Skin cool, clammy, and diaphoretic
4. Cyanosis--if PaO2 <45 (late sign)

Front 308

VI. Acute Respiratory Failure
A. Clinical Manifestations
4. Cyanosis--if PaO2 <---------- (late sign)

Back 308

VI. Acute Respiratory Failure
A. Clinical Manifestations
4. Cyanosis--if PaO2 <45 (late sign)

Front 309

VI. Acute Respiratory Failure
A. Clinical Manifestations
5. Assess pt for comfort position breathing (ab breathing, ---------- lip, --------- muscles, high --------)

Back 309

VI. Acute Respiratory Failure
A. Clinical Manifestations
5. Assess pt for comfort position breathing (ab breathing, pursed lip, IC muscles, high fowlers)

Front 310

VI. Acute Respiratory Failure
A. Clinical Manifestations
6. --------- breath sounds and ------------- upon percussion

Back 310

VI. Acute Respiratory Failure
A. Clinical Manifestations
6. Adventitious breath sounds and hyperresonance upon percussion

Front 311

VI. Acute Respiratory Failure
A. Clinical Manifestations
7. Prolonged expiration (I:E ratio)--1:-------, 1:---------

Back 311

VI. Acute Respiratory Failure
A. Clinical Manifestations
7. Prolonged expiration (I:E ratio)--1:3, 1:4

Front 312

VI. Acute Respiratory Failure
B. Diagnosis
1. ------------- assessment
2. Lab values--ABGs (checks both --------- and -----------)

Back 312

VI. Acute Respiratory Failure
B. Diagnosis
1. Physical assessment
2. Lab values--ABGs (checks both oxygenation and ventilation)

Front 313

VI. Acute Respiratory Failure
B. Diagnosis
3. -------: diagnosis and see changes
4. Mixed venous blood gases--amount of -------- delivered to tissues

Back 313

VI. Acute Respiratory Failure
B. Diagnosis
3. CXR--diagnosis and see changes
4. Mixed venous blood gases--amount of O2 delivered to tissues

Front 314

VI. Acute Respiratory Failure
B. Diagnosis
4. Mixed venous blood gases--amount of O2 delivered to tissues
a. ----------- (venous 38-42) and ---------- (venous 60-80%) from pulmonary artery catheter

Back 314

VI. Acute Respiratory Failure
B. Diagnosis
4. Mixed venous blood gases--amount of O2 delivered to tissues
a. PVO2 (venous 38-42) and SVO2 (venous 60-80%) from pulmonary artery catheter

Front 315

VI. Acute Respiratory Failure
B. Diagnosis
4. Mixed venous blood gases--amount of O2 delivered to tissues
a. PVO2 (venous _____-42) and SVO2 (venous ____-80%) from pulmonary artery catheter

Back 315

VI. Acute Respiratory Failure
B. Diagnosis
4. Mixed venous blood gases--amount of O2 delivered to tissues
a. PVO2 (venous 38-42) and SVO2 (venous 60-80%) from pulmonary artery catheter

Front 316

VI. Acute Respiratory Failure
B. Diagnosis
4. Mixed venous blood gases--amount of O2 delivered to tissues
b. ------------ measure tissue consumption

Back 316

VI. Acute Respiratory Failure
B. Diagnosis
4. Mixed venous blood gases--amount of O2 delivered to tissues
b. SWANs measure tissue consumption

Front 317

VI. Acute Respiratory Failure
B. Diagnosis
5. Pulse oximetry (---------2)--if poor (<---------%) get ABG **want >---------%

Back 317

VI. Acute Respiratory Failure
B. Diagnosis
5. Pulse oximetry (SpO2)--if poor (<95%) get ABG **want >90%

Front 318

VI. Acute Respiratory Failure
B. Diagnosis
6. V/Q lung scan--acute ------------- embolus

Back 318

VI. Acute Respiratory Failure
B. Diagnosis
6. V/Q lung scan--acute pulmonary embolus

Front 319

VI. Acute Respiratory Failure
B. Diagnosis
7. Pulmonary ---------: rule out pulmonary embolism

Back 319

VI. Acute Respiratory Failure
B. Diagnosis
7. Pulmonary angiography--rule out pulmonary embolism

Front 320

VI. Acute Respiratory Failure
B. Diagnosis
8. Possible insertion of ---------- to monitor
9. ---------- status ↑ or ↓

Back 320

VI. Acute Respiratory Failure
B. Diagnosis
8. Possible insertion of PA catheter to monitor
9. Fluid status ↑ or ↓

Front 321

VI. Acute Respiratory Failure
C. Categories **------------- and -----------: physiologic mechanism for hypoxemia (1-4)

Back 321

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)

Front 322

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure--alteration in ---------- transport between alveoli and-------------- capillary bed (gas exchange) resulting in ----------2 <60mmHg w/ FiO2 >60% due to problems with lungs (ex. pneumonia, pulmonary edema, pulmonary emboli, CHF, shock)

Back 322

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure--alteration in O2 transport between alveoli and pulmonary capillary bed (gas exchange) resulting in PaO2 <60mmHg w/ FiO2 >60% due to problems with lungs (ex. pneumonia, pulmonary edema, pulmonary emboli, CHF, shock)

Front 323

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure--alteration in O2 transport between alveoli and pulmonary capillary bed (gas exchange) resulting in
PaO2 <-----------mmHg w/ --------------2 >60% due to problems with lungs (ex. pneumonia, pulmonary edema, pulmonary emboli, CHF, shock)

Back 323

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure--alteration in O2 transport between alveoli and pulmonary capillary bed (gas exchange) resulting in PaO2 <60mmHg w/ FiO2 >60% due to problems with lungs (ex. pneumonia, pulmonary edema, pulmonary emboli, CHF, shock)

Front 324

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure--alteration in O2 transport between alveoli and pulmonary capillary bed (gas exchange) resulting in PaO2 <60mmHg w/ FiO2 >60% due to problems with lungs (ex. ------------, pulmonary -----------, pulmonary ------------, CHF, ---------)

Back 324

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure--alteration in O2 transport between alveoli and pulmonary capillary bed (gas exchange) resulting in PaO2 <60mmHg w/ FiO2 >60% due to problems with lungs (ex. pneumonia, pulmonary edema, pulmonary emboli, CHF, shock)

Front 325

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
a. -------------- Mismatch--alteration in ratio of ventilation to perfusion (should have 4-5L/min blood to alveoli and 4/5L of gas into lungs 1:1)

Back 325

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
a. Ventilation-Perfusion Mismatch--alteration in ratio of ventilation to perfusion (should have 4-5L/min blood to alveoli and 4/5L of gas into lungs 1:1)

Front 326

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
a. Ventilation-Perfusion Mismatch--alteration in ratio of ventilation to perfusion (should have 4-________L/min blood to alveoli and 4/_______L of gas into lungs 1:____)

Back 326

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
a. Ventilation-Perfusion Mismatch--alteration in ratio of ventilation to perfusion (should have 4-5L/min blood to alveoli and 4/5L of gas into lungs 1:1)

Front 327

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
a. Ventilation-Perfusion Mismatch--alteration in ratio of ventilation to perfusion (should have 4-5L/min blood to alveoli and 4/5L of gas into lungs 1:1)
i. ↑secretions in --------------- (COPD, --------------, asthma)-↓ventilation w/ same blood

Back 327

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
a. Ventilation-Perfusion Mismatch--alteration in ratio of ventilation to perfusion (should have 4-5L/min blood to alveoli and 4/5L of gas into lungs 1:1)
i. ↑secretions in airway (COPD, pneumonia, asthma)-↓ventilation w/ same blood

Front 328

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
a. Ventilation-Perfusion Mismatch--alteration in ratio of ventilation to perfusion (should have 4-5L/min blood to alveoli and 4/5L of gas into lungs 1:1)
ii. Conditions resulting in ---------------- collapse (---------: not taking in enough air)

Back 328

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
a. Ventilation-Perfusion Mismatch--alteration in ratio of ventilation to perfusion (should have 4-5L/min blood to alveoli and 4/5L of gas into lungs 1:1)
ii. Conditions resulting in alveolar collapse (atelectasis--not taking in enough air)

Front 329

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
a. Ventilation-Perfusion Mismatch--alteration in ratio of ventilation to perfusion (should have 4-5L/min blood to alveoli and 4/5L of gas into lungs 1:1)
iii. ↓-------------- flow (pulmonary ----------: blood can’t get to area ↓perfusion)

Back 329

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
a. Ventilation-Perfusion Mismatch--alteration in ratio of ventilation to perfusion (should have 4-5L/min blood to alveoli and 4/5L of gas into lungs 1:1)
iii. ↓blood flow (pulmonary embolism--blood can’t get to area ↓perfusion)

Front 330

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
b. _________-blood exits heart w/o gas exchange (severe hypoxia extreme VQ mismatch)

Back 330

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
b. Shunt-blood exits heart w/o gas exchange (severe hypoxia extreme VQ mismatch)

Front 331

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
b. Shunt-blood exits heart w/o gas exchange (severe hypoxia extreme --------- mismatch)

Back 331

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
b. Shunt-blood exits heart w/o gas exchange (severe hypoxia extreme VQ mismatch)

Front 332

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
b. Shunt-blood exits heart w/o gas exchange (severe hypoxia extreme VQ mismatch)
i. ----------: bypasses lungs through ventricular septal defect (↓oxygenation)

Back 332

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
b. Shunt-blood exits heart w/o gas exchange (severe hypoxia extreme VQ mismatch)
i. Anatomic--bypasses lungs through ventricular septal defect (↓oxygenation)

Front 333

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
b. Shunt-blood exits heart w/o gas exchange (severe hypoxia extreme VQ mismatch)
ii. --------------: flow through pulmonary capillaries w/out gas exchange

Back 333

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
b. Shunt-blood exits heart w/o gas exchange (severe hypoxia extreme VQ mismatch)
i. Anatomic--bypasses lungs through ventricular septal defect (↓oxygenation)

Front 334

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
b. Shunt-blood exits heart w/o gas exchange (severe hypoxia extreme VQ mismatch)
i. Anatomic--bypasses lungs through ventricular septal defect (↓oxygenation)
• ARDS, ------------, pulmonary -----------

Back 334

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
b. Shunt-blood exits heart w/o gas exchange (severe hypoxia extreme VQ mismatch)
i. Anatomic--bypasses lungs through ventricular septal defect (↓oxygenation)
• ARDS, pneumonia, pulmonary edema

Front 335

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
c. ---------------: gas exchange across alveolar-capillary membrane is compromised by process that thickens/destroys membranes (not permeable)

Back 335

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
c. Diffusion Impairment--gas exchange across alveolar-capillary membrane is compromised by process that thickens/destroys membranes (not permeable)

Front 336

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
c. Diffusion Impairment--
i. Takes longer for ---------- to exchange
ii. Pts are ok when at rest, but have no --------- tolerance

Back 336

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
c. Diffusion Impairment--
i. Takes longer for gas to exchange
ii. Pts are ok when at rest, but have no exercise tolerance

Front 337

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
c. Diffusion Impairment--
iii. _________--thickening of membrane with fibrosis and scarring (main problem)

Back 337

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
c. Diffusion Impairment--
iii. ARDS--thickening of membrane with fibrosis and scarring (main problem)

Front 338

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
d. ----------------: generalized ↓ ventilation resulting in ↑PaCO2 and ↓PaO2 (not enough air into lungs)

Back 338

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
d. Alveolar Hypoventilation--generalized ↓ ventilation resulting in ↑PaCO2 and ↓PaO2 (not enough air into lungs)

Front 339

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
d. Alveolar Hypoventilation--generalized ↓ ventilation resulting in ↑-----------2 and ↓-----------2 (not enough air into lungs)

Back 339

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
d. Alveolar Hypoventilation--generalized ↓ ventilation resulting in ↑PaCO2 and ↓PaO2 (not enough air into lungs)

Front 340

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
d. Alveolar Hypoventilation--generalized ↓ ventilation resulting in ↑PaCO2 and ↓PaO2 (not enough air into lungs)
i. Can cause ---------

Back 340

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
d. Alveolar Hypoventilation--generalized ↓ ventilation resulting in ↑PaCO2 and ↓PaO2 (not enough air into lungs)
i. Can cause hypoxia

Front 341

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
d. Alveolar Hypoventilation--generalized ↓ ventilation resulting in ↑PaCO2 and ↓PaO2 (not enough air into lungs)
ii. Restrictive ------------ disease (asthma), chest wall ------------, neuromuscular disease (------------ brae)

Back 341

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
d. Alveolar Hypoventilation--generalized ↓ ventilation resulting in ↑PaCO2 and ↓PaO2 (not enough air into lungs)
ii. Restrictive lung disease (asthma), chest wall dysfunction, neuromuscular disease (Gyron brae)

Front 342

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
2. ---------------: CO2 transport alteration from ventilatory factor (good lungs, but air can’t get in/out hypercapnia main problem, but will have hypoxia too)

Back 342

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
2. Hypercapnic Respiratory Failure--CO2 transport alteration from ventilatory factor (good lungs, but air can’t get in/out hypercapnia main problem, but will have hypoxia too)

Front 343

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
2. Hypercapnic Respiratory Failure--CO2 transport alteration from ventilatory factor (good lungs, but air can’t get in/out, ---------- main problem, but will have ---------- too)

Back 343

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
2. Hypercapnic Respiratory Failure--CO2 transport alteration from ventilatory factor (good lungs, but air can’t get in/out hypercapnia main problem, but will have hypoxia too)

Front 344

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
2. Hypercapnic Respiratory Failure--
a. Abnormalities of the---------- and --------: CF, asthma, emphazema

Back 344

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
2. Hypercapnic Respiratory Failure--
a. Abnormalities of the airways and alveoli--CF, asthma, emphazema

Front 345

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
2. Hypercapnic Respiratory Failure--
b. Abnormalities of the ------: narcotic overdose, brain stem infarct

Back 345

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
2. Hypercapnic Respiratory Failure--
b. Abnormalities of the CNS--narcotic overdose, brain stem infarct

Front 346

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
2. Hypercapnic Respiratory Failure--
c. Abnormalities of the ---------: flail chest, morbidly obese, rib fractures

Back 346

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
2. Hypercapnic Respiratory Failure--
c. Abnormalities of the chest wall--flail chest, morbidly obese, rib fractures

Front 347

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
2. Hypercapnic Respiratory Failure--
d. Neuromuscular Conditions--MS, -------------, -----------

Back 347

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
2. Hypercapnic Respiratory Failure--
d. Neuromuscular Conditions--MS, muscular dystrophy, dyron-brae

Front 348

VI. Acute Respiratory Failure
D. Tissue ------------ Needs--major threat of underlying resp. failure (------------ or -----------) is inability to meet oxygen demands of tissues

Back 348

VI. Acute Respiratory Failure
D. Tissue Oxygen Needs--major threat of underlying resp. failure (hypoxic or hypercapnia) is inability to meet oxygen demands of tissues

Front 349

VI. Acute Respiratory Failure
D. Tissue Oxygen Needs-
1. Inadequate tissue ------------ delivery--valvular disease, -------------, CHF (pump problem)

Back 349

VI. Acute Respiratory Failure
D. Tissue Oxygen Needs-
1. Inadequate tissue O2 delivery--valvular disease, anemia, CHF (pump problem)

Front 350

VI. Acute Respiratory Failure
D. Tissue Oxygen Needs-
2. Inadequate usage, ---------- shock (tissues don’t know what to do w/ it or not using appropriately)

Back 350

VI. Acute Respiratory Failure
D. Tissue Oxygen Needs-
2. Inadequate usage-septic shock (tissues don’t know what to do w/ it or not using appropriately)

Front 351

VI. Acute Respiratory Failure
E. Arterial Blood Gases (ABGs)
1. Normal
a. pH: 7.35-_______
b. PaO2: 80-_______mmHg

Back 351

VI. Acute Respiratory Failure
E. Arterial Blood Gases (ABGs)
1. Normal
a. pH: 7.35-7.45
b. PaO2: 80-100mmHg

Front 352

VI. Acute Respiratory Failure
E. Arterial Blood Gases (ABGs)
1. Normal
c. PaCO2: 35-______mmHg
d. SaO2: 95-______%

Back 352

VI. Acute Respiratory Failure
E. Arterial Blood Gases (ABGs)
1. Normal
c. PaCO2: 35-45mmHg
d. SaO2: 95-100%

Front 353

VI. Acute Respiratory Failure
E. Arterial Blood Gases (ABGs)
1. Normal
e. HCO3: 22-_______mEq/L
f. Base Excess/Deficit: +/______

Back 353

VI. Acute Respiratory Failure
E. Arterial Blood Gases (ABGs)
1. Normal
e. HCO3: 22-26mEq/L
f. Base Excess/Deficit: +/-2

Front 354

VI. Acute Respiratory Failure
E. Arterial Blood Gases (ABGs)
1. Normal
f. Base Excess/Deficit: +/-2
i. Amount of buffering ---------- in blood (from all buffer systems: --------- greatest)

Back 354

VI. Acute Respiratory Failure
E. Arterial Blood Gases (ABGs)
1. Normal
f. Base Excess/Deficit: +/-2
i. Amount of buffering anions in blood (from all buffer systems-bicarb greatest)

Front 355

VI. Acute Respiratory Failure
E. Arterial Blood Gases (ABGs)
1. Normal
f. Base Excess/Deficit: +/-2
ii. Describes amount of --------- needed to bring blood back to normal pH
iii. Excess--metabolic ------------ or compensation

Back 355

VI. Acute Respiratory Failure
E. Arterial Blood Gases (ABGs)
1. Normal
f. Base Excess/Deficit: +/-2
ii. Describes amount of acid/base needed to bring blood back to normal pH
iii. Excess--metabolic alkalosis or compensation

Front 356

VI. Acute Respiratory Failure
E. Arterial Blood Gases (ABGs)
2. Analysis
a. What is primary disturbance--acidosis/-----------?
b. What is primary cause--respiratory/----------?

Back 356

VI. Acute Respiratory Failure
E. Arterial Blood Gases (ABGs)
2. Analysis
a. What is primary disturbance--acidosis/alkalosis?
b. What is primary cause--respiratory/metabolic?

Front 357

VI. Acute Respiratory Failure
E. Arterial Blood Gases (ABGs)
2. Analysis
c. Is there -------------?

Back 357

VI. Acute Respiratory Failure
E. Arterial Blood Gases (ABGs)
2. Analysis
c. Is there compensation?

Front 358

VI. Acute Respiratory Failure
F. Respiratory Therapy
1. Oxygen therapy--goal PaO2 >--------- and SaO2 >----------

Back 358

VI. Acute Respiratory Failure
F. Respiratory Therapy
1. Oxygen therapy--goal PaO2 >60 and SaO2 >90

Front 359

VI. Acute Respiratory Failure
F. Respiratory Therapy
1. Oxygen therapy
a. Risk of oxygen ------------ (strive for oxygenation w/ minimum ---------2)

Back 359

VI. Acute Respiratory Failure
F. Respiratory Therapy
1. Oxygen therapy
a. Risk of oxygen toxicity (strive for oxygenation w/ minimum FiO2)

Front 360

VI. Acute Respiratory Failure
F. Respiratory Therapy
1. Oxygen therapy
b. ---------- mismatch may respond well to ↑O2 (2-4L via nasal cannula)

Back 360

VI. Acute Respiratory Failure
F. Respiratory Therapy
1. Oxygen therapy
b. VQ mismatch may respond well to ↑O2 (2-4L via nasal cannula)

Front 361

VI. Acute Respiratory Failure
F. Respiratory Therapy
1. Oxygen therapy
b. VQ mismatch may respond well to ↑O2 (2-_______L via nasal cannula)

Back 361

VI. Acute Respiratory Failure
F. Respiratory Therapy
1. Oxygen therapy
b. VQ mismatch may respond well to ↑O2 (2-4L via nasal cannula)

Front 362

VI. Acute Respiratory Failure
F. Respiratory Therapy
1. Oxygen therapy
c. Shunt will likely need--------- or -----------

Back 362

VI. Acute Respiratory Failure
F. Respiratory Therapy
1. Oxygen therapy
c. Shunt will likely need facemask or intubation

Front 363

VI. Acute Respiratory Failure
F. Respiratory Therapy
2. Mobilization of secretions
a. Coughing and positioning--good lung ----------, postural -----------

Back 363

VI. Acute Respiratory Failure
F. Respiratory Therapy
2. Mobilization of secretions
a. Coughing and positioning--good lung down, postural drainage
b. Hydration and humidification--fluids help thin secretions out

Front 364

VI. Acute Respiratory Failure
F. Respiratory Therapy
2. Mobilization of secretions
b. ------------ and ------------: fluids help thin secretions out

Back 364

VI. Acute Respiratory Failure
F. Respiratory Therapy
2. Mobilization of secretions
b. Hydration and humidification--fluids help thin secretions out

Front 365

VI. Acute Respiratory Failure
F. Respiratory Therapy
2. Mobilization of secretions
c. Chest ---------- therapy
d. Airway -----------

Back 365

VI. Acute Respiratory Failure
F. Respiratory Therapy
2. Mobilization of secretions
c. Chest physical therapy
d. Airway suctioning

Front 366

VI. Acute Respiratory Failure
F. Respiratory Therapy
3. -------------- ventilation

Back 366

VI. Acute Respiratory Failure
F. Respiratory Therapy
3. Positive pressure ventilation

Front 367

VI. Acute Respiratory Failure
G. Pharmacologic Therapy--Goals
1. Relief of bronchospasm: ------------ or -------- (severe)

Back 367

VI. Acute Respiratory Failure
G. Pharmacologic Therapy--Goals
1. Relief of bronchospasm--Albuterol or Anophelin (severe)

Front 368

VI. Acute Respiratory Failure
G. Pharmacologic Therapy--Goals
2. Airway inflammation reduction (-----------, asthma)--: ------------ (quick acting, IV if acute)

Back 368

VI. Acute Respiratory Failure
G. Pharmacologic Therapy--Goals
2. Airway inflammation reduction (COPD, asthma)--Corticosteroids (quick acting, IV if acute)

Front 369

VI. Acute Respiratory Failure
G. Pharmacologic Therapy--Goals
3. Reduction of pulmonary congestions--: ----------- (Lasix), ------------ (↑contractility for A-fib)

Back 369

VI. Acute Respiratory Failure
G. Pharmacologic Therapy--Goals
3. Reduction of pulmonary congestions--diuretics (Lasix), Digoxin (↑contractility for A-fib)

Front 370

VI. Acute Respiratory Failure
G. Pharmacologic Therapy--Goals
4. Treatment of pulmonary infection--IV -----------, frequent ----------- samples

Back 370

VI. Acute Respiratory Failure
G. Pharmacologic Therapy--Goals
4. Treatment of pulmonary infection--IV antibiotics, frequent sputum samples

Front 371

VI. Acute Respiratory Failure
G. Pharmacologic Therapy--Goals
5. Reduction of severe anxiety--↑--------- and ---------2 consumption (Propofol, Atavan, ----------)

Back 371

VI. Acute Respiratory Failure
G. Pharmacologic Therapy--Goals
5. Reduction of severe anxiety--↑RR and O2 consumption (Propofol, Atavan, Versed)

Front 372

VI. Acute Respiratory Failure
H. Supportive Care Interventions
1. Treat ----------- cause (need ---------- at cellular level)--primary goal

Back 372

VI. Acute Respiratory Failure
H. Supportive Care Interventions
1. Treat underlying cause (need O2 at cellular level)--primary goal

Front 373

VI. Acute Respiratory Failure
H. Supportive Care Interventions
2. Maintain adequate cardiac output--BP indicates cardiac function (check MAP >---------- and ---------2)

Back 373

VI. Acute Respiratory Failure
H. Supportive Care Interventions
2. Maintain adequate cardiac output--BP indicates cardiac function (check MAP >60 and SVO2)

Front 374

VI. Acute Respiratory Failure
H. Supportive Care Interventions
3. Maintain adequate----------- concentration (ex. if anemic give blood)

Back 374

VI. Acute Respiratory Failure
H. Supportive Care Interventions
3. Maintain adequate hemoglobin concentration (ex. if anemic give blood)

Front 375

VI. Acute Respiratory Failure
H. Supportive Care Interventions
4. Nutritional Therapy--avoid ↑------------ (metabolizes into CO2); --------------- (↑protein ↓CHO)

Back 375

VI. Acute Respiratory Failure
H. Supportive Care Interventions
4. Nutritional Therapy--avoid ↑CHO (metabolizes into CO2); pulmonary diet (↑protein ↓CHO)

Front 376

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--sudden and progressive form of ------------ where alveolar capillary membrane becomes ----------- and more permeable to ------------- fluid

Back 376

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--sudden and progressive form of ARF where alveolar capillary membrane becomes damaged and more permeable to intravascular fluid

Front 377

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
1. ARF can become---------- (----------% mortality)

Back 377

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
1. ARF can become ARDs (40% mortality)

Front 378

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
2. Etiology--predisposing factors stimulate inflammatory/immune response (cause unknown)
a. Aspiration of -------- contents
b. Viral/bacterial ---------

Back 378

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
2. Etiology--predisposing factors stimulate inflammatory/immune response (cause unknown)
a. Aspiration of gastric contents
b. Viral/bacterial pneumonia

Front 379

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
2. Etiology--predisposing factors stimulate inflammatory/immune response (cause unknown)
c.------------ (esp. gram (-) infection)--most common cause w/ greatest mortality (70-90%)

Back 379

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
2. Etiology--predisposing factors stimulate inflammatory/immune response (cause unknown)
c. Sepsis (esp. gram (-) infection)--most common cause w/ greatest mortality (70-90%)

Front 380

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
2. Etiology--predisposing factors stimulate inflammatory/immune response (cause unknown)
c. Sepsis (esp. gram (-) infection)--most common cause w/ greatest mortality (70-_____%)

Back 380

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
2. Etiology--predisposing factors stimulate inflammatory/immune response (cause unknown)
c. Sepsis (esp. gram (-) infection)--most common cause w/ greatest mortality (70-90%)

Front 381

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
2. Etiology--predisposing factors stimulate inflammatory/immune response (cause unknown)
d. Severe massive ----------
e. Multiple ---------- transfusions
f. ----------------- bypass

Back 381

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
2. Etiology--predisposing factors stimulate inflammatory/immune response (cause unknown)
d. Severe massive trauma
e. Multiple blood transfusions
f. Cardiopulmonary bypass

Front 382

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
2. Etiology--predisposing factors stimulate inflammatory/immune response (cause unknown)
g. Consequence of multiple ------------- dysfunction syndrome (MODS)

Back 382

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
2. Etiology--predisposing factors stimulate inflammatory/immune response (cause unknown)
g. Consequence of multiple organ dysfunction syndrome (MODS)

Front 383

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
3. Pathophysiology
a. Injury (Exudative Phase)--1-_______days after insult/injury (usually within ______hrs)

Back 383

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
3. Pathophysiology
a. Injury (Exudative Phase)--1-7days after insult/injury (usually within 24hrs)

Front 384

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
3. Pathophysiology
a. Injury (Exudative Phase)-
i. Injury inflammatory mediators ↑ cap ------------, interstitial edema, ----------- edema, ---------------- shunting (fluid filled alveoli exchange gas) V/Q mismatch ↓gas exchange refractory hypoxemia

Back 384

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
3. Pathophysiology
a. Injury (Exudative Phase)-
i. Injury inflammatory mediators ↑ cap permeability interstitial edema alveolar edema intrapulmonary shunting (fluid filled alveoli exchange gas) V/Q mismatch ↓gas exchange refractory hypoxemia

Front 385

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
3. Pathophysiology
a. Injury (Exudative Phase)-
i. Injury inflammatory mediators ↑ cap permeability interstitial edema alveolar edema intrapulmonary shunting (fluid filled alveoli exchange gas) ------------- mismatch, ↓----------- exchange, refractory ------------

Back 385

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
3. Pathophysiology
a. Injury (Exudative Phase)-
i. Injury inflammatory mediators ↑ cap permeability interstitial edema alveolar edema intrapulmonary shunting (fluid filled alveoli exchange gas) V/Q mismatch ↓gas exchange refractory hypoxemia

Front 386

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
3. Pathophysiology
a. Injury (Exudative Phase)-
ii. ------------- 1 2 (produce surfactant) cell damage, ↓------------, ↓----------- compliance and recall widespread atelectasis ↓lung compliance

Back 386

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
3. Pathophysiology
a. Injury (Exudative Phase)-
ii. Alveolar 1 2 (produce surfactant) cell damage ↓surfactant ↓alveolar compliance and recall widespread atelectasis ↓lung compliance

Front 387

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
3. Pathophysiology
a. Injury (Exudative Phase)-
ii. Alveolar 1 2 (produce surfactant) cell damage ↓surfactant ↓alveolar compliance and recall, widespread -------------, ↓lung ------------

Back 387

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
3. Pathophysiology
a. Injury (Exudative Phase)-
ii. Alveolar 1 2 (produce surfactant) cell damage ↓surfactant ↓alveolar compliance and recall widespread atelectasis ↓lung compliance

Front 388

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
3. Pathophysiology
a. Injury (Exudative Phase)-
iii. ----------- membrane lines alveoli fibrosis, ↓--------- exchange ↓ --------------- (stiff lung-need high pressure to get air into)

Back 388

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
3. Pathophysiology
a. Injury (Exudative Phase)-
iii. Hyaline membrane lines alveoli fibrosis ↓gas exchange ↓ compliance (stiff lung-need high pressure to get air into)

Front 389

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
3. Pathophysiology
b. ---------------(Proliferative Phase)--1-2weeks after initial injury

Back 389

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
3. Pathophysiology
b. Reparative (Proliferative Phase)--1-2weeks after initial injury

Front 390

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
3. Pathophysiology
b. Reparative (Proliferative Phase)--1-2weeks after initial injury
i. Inflammatory response dense, ---------- tissue ↑pulmonary ------------ resistance, pulmonary ------------, ↓lung compliance hypoxia

Back 390

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
3. Pathophysiology
b. Reparative (Proliferative Phase)--1-2weeks after initial injury
i. Inflammatory response dense, fibrous tissue ↑pulmonary vascular resistance, pulmonary HTN, ↓lung compliance hypoxia

Front 391

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
3. Pathophysiology
b. Reparative (Proliferative Phase)--1-2weeks after initial injury
ii. If phase ends ------------ resolve
iii. If phase persists widespread -----------

Back 391

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
3. Pathophysiology
b. Reparative (Proliferative Phase)--1-2weeks after initial injury
ii. If phase ends lesions resolve
iii. If phase persists widespread fibrosis

Front 392

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
3. Pathophysiology
c. ----------- (Chronic/Late Phase)--2-3 weeks after initial injury (irreversible changes)

Back 392

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
3. Pathophysiology
c. Fibrotic (Chronic/Late Phase)--2-3 weeks after initial injury (irreversible changes)

Front 393

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
3. Pathophysiology
c. Fibrotic (Chronic/Late Phase)--2-3 weeks after initial injury (irreversible changes)
i. Lung remodeled by sparsely ------------ and ------------ tissues (diffuse scarring and fibrosis) ↓lung compliance (stiff lung) and ↓ gas exchange surface area hypoxia and pulmonary HTN

Back 393

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
3. Pathophysiology
c. Fibrotic (Chronic/Late Phase)--2-3 weeks after initial injury (irreversible changes)
i. Lung remodeled by sparsely collagenous and fibrous tissues (diffuse scarring and fibrosis) ↓lung compliance (stiff lung) and ↓ gas exchange surface area hypoxia and pulmonary HTN

Front 394

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
3. Pathophysiology
c. Fibrotic (Chronic/Late Phase)--2-3 weeks after initial injury (irreversible changes)
i. Lung remodeled by sparsely collagenous and fibrous tissues (diffuse scarring and fibrosis) ↓---------- (stiff lung) and ↓ --------- exchange surface area hypoxia and pulmonary ---------

Back 394

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
3. Pathophysiology
c. Fibrotic (Chronic/Late Phase)--2-3 weeks after initial injury (irreversible changes)
i. Lung remodeled by sparsely collagenous and fibrous tissues (diffuse scarring and fibrosis) ↓lung compliance (stiff lung) and ↓ gas exchange surface area hypoxia and pulmonary HTN

Front 395

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
3. Pathophysiology
c. Fibrotic (Chronic/Late Phase)--2-3 weeks after initial injury (irreversible changes)
ii. Survival rate poor and will need long term------------- ventilation

Back 395

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
3. Pathophysiology
c. Fibrotic (Chronic/Late Phase)--2-3 weeks after initial injury (irreversible changes)
ii. Survival rate poor and will need long term mechanical ventilation

Front 396

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
4. Clinical Manifestations
a. ↑---------- (work of breathing), tachypnea
b. T-----------

Back 396

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
4. Clinical Manifestations
a. ↑WOB (work of breathing), tachypnea
b. Tachycardia

Front 397

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
4. Clinical Manifestations
c. ----------, pallor, ------------
d. ↓----------

Back 397

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
4. Clinical Manifestations
c. Cyanosis, pallor, diaphoresis
d. ↓Mentation

Front 398

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
4. Clinical Manifestations
e. Diffuse ----------- and rhonchi
f. CXR--“------------”

Back 398

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
4. Clinical Manifestations
e. Diffuse crackles and rhonchi
f. CXR--“white out”

Front 399

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
4. Clinical Manifestations
g. ABGs--resp -------------- (initially) decompensates to combined met and resp ------------

Back 399

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
4. Clinical Manifestations
g. ABGs--resp alkalosis (initially) decompensates to combined met and resp acidosis

Front 400

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
4. Clinical Manifestations
h. Elevated---------- with normal ---------: --key finding

Back 400

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
4. Clinical Manifestations
h. Elevated PAP with normal PAWP--key finding

Front 401

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
4. Clinical Manifestations
h. Elevated PAP with normal PAWP--key finding
i. Can’t ----------- w/ ↑------------ b/c could be something else (heart prob fluid overload)

Back 401

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
4. Clinical Manifestations
h. Elevated PAP with normal PAWP--key finding
i. Can’t Dx w/ ↑PAWP b/c could be something else (heart prob fluid overload)

Front 402

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
4. Clinical Manifestations
h. Elevated PAP with normal PAWP--key finding
ii. If fluid overloaded ↑-------------- (backing up of fluids causing too much preload) give diuretics, ---------2 improves not ARDS

Back 402

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
4. Clinical Manifestations
h. Elevated PAP with normal PAWP--key finding
i. Can’t Dx w/ ↑PAWP b/c could be something else (heart prob fluid overload)

Front 403

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
5. Diagnosis Criteria
a. --------------: --do not respond to ↑FiO2

Back 403

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
5. Diagnosis Criteria
a. Refractory hypoxia--do not respond to ↑FiO2

Front 404

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
5. Diagnosis Criteria
b. CXR with new bilateral -----------/--------------- infiltrates (“white out”)

Back 404

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
5. Diagnosis Criteria
b. CXR with new bilateral interstitial/alveolar infiltrates (“white out”)

Front 405

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
5. Diagnosis Criteria
c. PAWP of --------------mmHg or less and no evidence of heart failure
d. Must have predisposing condition for ARDS within -----------hrs (need trigger)

Back 405

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
5. Diagnosis Criteria
c. PAWP of 18mmHg or less and no evidence of heart failure
d. Must have predisposing condition for ARDS within 48hrs (need trigger)

Front 406

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
6. Treatment
a. Prevention of further ----------
b. Maintain adequate -----------: --mechanical ventilation (5-6mL/kg w/ lowest FiO2)

Back 406

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
6. Treatment
a. Prevention of further injury
b. Maintain adequate oxygenation--mechanical ventilation (5-6mL/kg w/ lowest FiO2)

Front 407

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
6. Treatment
b. Maintain adequate oxygenation--mechanical ventilation (5-_________mL/kg w/ lowest ______2)

Back 407

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
6. Treatment
b. Maintain adequate oxygenation--mechanical ventilation (5-6mL/kg w/ lowest FiO2)

Front 408

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
6. Treatment
b. Maintain adequate oxygenation-
i.-------------- Ventilatory--high frequency (100-_________breath/min)

Back 408

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
6. Treatment
b. Maintain adequate oxygenation-
i. Jet Ventilatory--high frequency (100-300breath/min)

Front 409

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
6. Treatment
b. Maintain adequate oxygenation-
ii.---------------- ratio--sedate and paralyze
iii. --------------- strategies

Back 409

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
6. Treatment
b. Maintain adequate oxygenation-
ii. Inverse ratio--sedate and paralyze
iii. Positioning strategies

Front 410

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
6. Treatment
c. Optimize oxygen delivery--keep PaO2 >----------- and SaO2 >-----------

Back 410

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
6. Treatment
c. Optimize oxygen delivery--keep PaO2 >60 and SaO2 >90

Front 411

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
7. Management
a. Mechanical -----------
b. -------------- strategies

Back 411

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
7. Management
a. Mechanical ventilation
b. Positioning strategies

Front 412

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
7. Management
b. Positioning strategies
i. Lateral ------------
ii. ------------ position (-----------)--lungs down

Back 412

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
7. Management
b. Positioning strategies
i. Lateral decubitus
ii. Prone position (proning)--lungs down

Front 413

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
7. Management
b. Positioning strategies
ii. Prone position (proning)--lungs down
• ↓----------------, improves perfusion and ventilation, reduces lung constriction

Back 413

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
7. Management
b. Positioning strategies
ii. Prone position (proning)--lungs down
• ↓atelectasis, improves perfusion and ventilation, reduces lung constriction

Front 414

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
7. Management
c. Drug Therapy--no good drug
i. _________--antifungal
ii. ________--controversial
iii. ________ oxide--dilate pulmonary vasculature

Back 414

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
7. Management
c. Drug Therapy--no good drug
i. Ketoconadol--antifungal
ii. Steroids--controversial
iii. Nitrous oxide--dilate pulmonary vasculature

Front 415

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
8. Complications
a. Noscomial ---------
b. --------: --can cause and also lead to
c. Pulmonary -------

Back 415

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
8. Complications
a. Noscomial pneumonia
b. Sepsis--can cause and also lead to
c. Pulmonary emboli

Front 416

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
8. Complications
d. Pulmonary ---------
f. Stress ------------ and hemorrhage
g. Acute --------- failure

Back 416

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
8. Complications
d. Pulmonary fibrosis
f. Stress ulceration and hemorrhage
g. Acute renal failure

Front 417

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
8. Complications
h. A----------
i. Decreased -------

Back 417

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
8. Complications
h. Arrhythmias
i. Decreased CO

Front 418

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
8. Complications
j. DIC (disseminated------------ coagulation-often in sepsis)/T--------------

Back 418

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
8. Complications
j. DIC (disseminated intravascular coagulation-often in sepsis)/Thrombocytopenia

Front 419

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
8. Complications
k. MODS (multiple ------------ dysfunction syndrome)

Back 419

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
8. Complications
k. MODS (multiple organ dysfunction syndrome)

Front 420

Burns
I. Skin’s Function--all care for burns in reflective of skin’s purpose (largest body organ)
A. Protection (impairment leads to ------------)

Back 420

Burns
I. Skin’s Function--all care for burns in reflective of skin’s purpose (largest body organ)
A. Protection (impairment leads to infection)

Front 421

Burns
I. Skin’s Function--all care for burns in reflective of skin’s purpose (largest body organ)
B. Temperature Regulation (impairment leads to inability to maintain ------------)

Back 421

Burns
I. Skin’s Function--all care for burns in reflective of skin’s purpose (largest body organ)
B. Temperature Regulation (impairment leads to inability to maintain body temp)

Front 422

Burns
I. Skin’s Function--all care for burns in reflective of skin’s purpose (largest body organ)
C. Keep body fluids in (impairment leads to inability to maintain ---------)

Back 422

Burns
I. Skin’s Function--all care for burns in reflective of skin’s purpose (largest body organ)
C. Keep body fluids in (impairment leads to inability to maintain fluid balance)

Front 423

Burns
II. Types--most injuries take place at ---------- (need prevention); highest fatalities in ----------- and elderly

Back 423

Burns
II. Types--most injuries take place at home (need prevention); highest fatalities in children and elderly

Front 424

Burns
II. Types--
A. Thermal--flame, -------------, ------------, steam, and contact with ----------- objects (most common)
1. Major causes of fire in home--smoking, cooking, space heaters, and chemicals

Back 424

Burns
II. Types--
A. Thermal--flame, flash/explosion, scald, steam, and contact with hot objects (most common)
1. Major causes of fire in home--smoking, cooking, space heaters, and chemicals

Front 425

Burns
II. Types--
A. Thermal--flame, flash/explosion, scald, steam, and contact with hot objects (most common)
1. Major causes of fire in home--smoking, -------------, ---------------, and chemicals

Back 425

Burns
II. Types--
A. Thermal--flame, flash/explosion, scald, steam, and contact with hot objects (most common)
1. Major causes of fire in home--smoking, cooking, space heaters, and chemicals

Front 426

Burns
II. Types--
B. Chemical--result of ------------ injury and destruction from ------------- substances (most commonly acids)

Back 426

Burns
II. Types--
B. Chemical--result of tissue injury and destruction from necrotizing substances (most commonly acids)

Front 427

Burns
II. Types--
B. Chemical--result of tissue injury and destruction from necrotizing substances (most commonly acids)
1. Causative agents: things with -----------, paint removers, drain cleaners (acids and ------------)

Back 427

Burns
II. Types--
B. Chemical--result of tissue injury and destruction from necrotizing substances (most commonly acids)
1. Causative agents: things with lye, paint removers, drain cleaners (acids and alkaloids)

Front 428

Burns
II. Types--
B. Chemical--result of tissue injury and destruction from necrotizing substances (most commonly acids)
2. Can cause respiratory problems and ----------- manifestations (usually smaller extent)

Back 428

Burns
II. Types--
B. Chemical--result of tissue injury and destruction from necrotizing substances (most commonly acids)
2. Can cause respiratory problems and systemic manifestations (usually smaller extent)

Front 429

Burns
II. Types--
B. Chemical--result of tissue injury and destruction from necrotizing substances (most commonly acids)
3. Looks ----------- pink and slightly wet (can continuously burn for -----------hrs after chemicals removed)

Back 429

Burns
II. Types--
B. Chemical--result of tissue injury and destruction from necrotizing substances (most commonly acids)
3. Looks cherry pink and slightly wet (can continuously burn for 72hrs after chemicals removed)

Front 430

Burns
II. Types--
B. Chemical--result of tissue injury and destruction from necrotizing substances (most commonly acids)
4. Tissue damage based on concentration, --------------, time on skin, and extent of ------------

Back 430

Burns
II. Types--
B. Chemical--result of tissue injury and destruction from necrotizing substances (most commonly acids)
4. Tissue damage based on concentration, quantity, time on skin, and extent of penetration

Front 431

Burns
II. Types--
B. Chemical--result of tissue injury and destruction from necrotizing substances (most commonly acids)
5. Treatment
a. Remove ------------ of burn (brush off powder or remove clothing/jewelry, etc.)
b. Wash for ---------min with--------- water or until not complaining of pain
c. Wrap area in sterile dressing

Back 431

Burns
II. Types--
B. Chemical--result of tissue injury and destruction from necrotizing substances (most commonly acids)
5. Treatment
a. Remove cause of burn (brush off powder or remove clothing/jewelry, etc.)
b. Wash for min 20min with cold water or until not complaining of pain
c. Wrap area in sterile dressing

Front 432

Burns
II. Types--
B. Chemical--result of tissue injury and destruction from necrotizing substances (most commonly acids)
5. Treatment
c. Wrap area in ---------- dressing

Back 432

Burns
II. Types--
B. Chemical--result of tissue injury and destruction from necrotizing substances (most commonly acids)
5. Treatment
c. Wrap area in sterile dressing

Front 433

Burns
II. Types--
C. Smoke and Inhalation
1. Types
a. Inhalation injury ↑ ---------- (inhale hot air/steam/smoke ------------- obstruction)

Back 433

Burns
II. Types--
C. Smoke and Inhalation
1. Types
a. Inhalation injury ↑ glottis (inhale hot air/steam/smokeedemaairway obstruction)

Front 434

Burns
II. Types--
C. Smoke and Inhalation
1. Types
b. Inhalation injury ↓---------- (inhale hot air , ------------ swelling can’t exchange gases)

Back 434

Burns
II. Types--
C. Smoke and Inhalation
1. Types
b. Inhalation injury ↓ glottis (inhale hot airalveolar swellingcan’t exchange gases)

Front 435

Burns
II. Types--
C. Smoke and Inhalation
1. Types
b. Inhalation injury ↓ glottis (inhale hot airalveolar swellingcan’t exchange gases)
i. Chemically produced (depends on -------------- exposed)

Back 435

Burns
II. Types--
C. Smoke and Inhalation
1. Types
b. Inhalation injury ↓ glottis (inhale hot airalveolar swellingcan’t exchange gases)
i. Chemically produced (depends on amount of time exposed)

Front 436

Burns
II. Types--
C. Smoke and Inhalation
1. Types
b. Inhalation injury ↓ glottis (inhale hot airalveolar swellingcan’t exchange gases)
ii. Symptoms usually present ____-______hrs after and can cause ARDS

Back 436

Burns
II. Types--
C. Smoke and Inhalation
1. Types
b. Inhalation injury ↓ glottis (inhale hot airalveolar swellingcan’t exchange gases)
ii. Symptoms usually present 12-24hrs after and can cause ARDS

Front 437

Burns
II. Types--
C. Smoke and Inhalation
1. Types
b. Inhalation injury ↓ glottis (inhale hot airalveolar swellingcan’t exchange gases)
iii. Check for coughing up soot, diff -----------, forced voice, singed ------------, facial burns, and fume---------- (if fire was in enclosed space)

Back 437

Burns
II. Types--
C. Smoke and Inhalation
1. Types
b. Inhalation injury ↓ glottis (inhale hot airalveolar swellingcan’t exchange gases)
iii. Check for coughing up soot, diff swallowing, forced voice, singed nose hairs, facial burns, and fume inhalation (if fire was in enclosed space)

Front 438

Burns
II. Types--
C. Smoke and Inhalation
1. Types
c. CO Poisoning--CO displaces -------- on Hg w/ ---------x affinity hypoxia death

Back 438

Burns
II. Types--
C. Smoke and Inhalation
1. Types
c. CO Poisoning--CO displaces O2 on Hg w/ 250x affinity hypoxia death

Front 439

Burns
II. Types--
C. Smoke and Inhalation
1. Types
c. CO Poisoning--CO displaces O2 on ------- w/ 250x affinity ----------- death

Back 439

Burns
II. Types--
C. Smoke and Inhalation
1. Types
c. CO Poisoning--CO displaces O2 on Hg w/ 250x affinity hypoxia death

Front 440

Burns
II. Types--
C. Smoke and Inhalation
1. Types
c. CO Poisoning--CO displaces O2 on Hg w/ 250x affinity hypoxia death
i. Manifestations: HA, N/V, -----------, confusion, ----------- damage, ---------

Back 440

Burns
II. Types--
C. Smoke and Inhalation
1. Types
c. CO Poisoning--CO displaces O2 on Hg w/ 250x affinity hypoxia death
i. Manifestations: HA, N/V, fatigue, confusion, brain damage, death

Front 441

Burns
II. Types--
C. Smoke and Inhalation
1. Types
c. CO Poisoning--CO displaces O2 on Hg w/ 250x affinity hypoxia death
ii. Fatigue lay down to sleep, -------- in sleep

Back 441

Burns
II. Types--
C. Smoke and Inhalation
1. Types
c. CO Poisoning--CO displaces O2 on Hg w/ 250x affinity hypoxia death
i. Manifestations: HA, N/V, fatigue, confusion, brain damage, death

Front 442

Burns
II. Types--
C. Smoke and Inhalation
1. Types
c. CO Poisoning--CO displaces O2 on Hg w/ 250x affinity hypoxia death
iii. Caused by inappropriate burnings of wood, ----------, grilling -----------, etc.

Back 442

Burns
II. Types--
C. Smoke and Inhalation
1. Types
c. CO Poisoning--CO displaces O2 on Hg w/ 250x affinity hypoxia death
iii. Caused by inappropriate burnings of wood, kerosene, grilling inside, etc.

Front 443

Burns
II. Types--
C. Smoke and Inhalation
1. Types
c. CO Poisoning--CO displaces O2 on Hg w/ 250x affinity hypoxia death
iv. Treatment--100% ---------- w/ NR mask in high --------- (may need to intubate)

Back 443

Burns
II. Types--
C. Smoke and Inhalation
1. Types
c. CO Poisoning--CO displaces O2 on Hg w/ 250x affinity hypoxia death
iv. Treatment--100% O2 w/ NR mask in high fowlers (may need to intubate)

Front 444

Burns
II. Types--
C. Smoke and Inhalation
1. Types
c. CO Poisoning--CO displaces O2 on Hg w/ 250x affinity hypoxia death
iv. Treatment--100% O2 w/ ---------- mask in high fowlers (may need to -----------)

Back 444

Burns
II. Types--
C. Smoke and Inhalation
1. Types
c. CO Poisoning--CO displaces O2 on Hg w/ 250x affinity hypoxia death
iv. Treatment--100% O2 w/ NR mask in high fowlers (may need to intubate)

Front 445

Burns
II. Types--
C. Smoke and Inhalation
2. Treatment
a. Administration of ----------- air

Back 445

Burns
II. Types--
C. Smoke and Inhalation
2. Treatment
a. Administration of humidified air

Front 446

Burns
II. Types--
C. Smoke and Inhalation
2. Treatment
b. Position in high -----------

Back 446

Burns
II. Types--
C. Smoke and Inhalation
2. Treatment
b. Position in high fowler’s

Front 447

Burns
II. Types--
C. Smoke and Inhalation
2. Treatment
c. Cough and -------- breath q----------hr

Back 447

Burns
II. Types--
C. Smoke and Inhalation
2. Treatment
c. Cough and deep breath q1hr

Front 448

Burns
II. Types--
C. Smoke and Inhalation
2. Treatment
d. Use of --------------

Back 448

Burns
II. Types--
C. Smoke and Inhalation
2. Treatment
d. Use of bronchodilators

Front 449

Burns
II. Types--
C. Smoke and Inhalation
2. Treatment
e. Suction --------

Back 449

Burns
II. Types--
C. Smoke and Inhalation
2. Treatment
e. Suction prn

Front 450

Burns
II. Types--
C. Smoke and Inhalation
2. Treatment
f. Continuous ------------- of resp. status/prep for ----------- (swelling is greatest danger)

Back 450

Burns
II. Types--
C. Smoke and Inhalation
2. Treatment
f. Continuous monitoring of resp. status/prep for intubation (swelling is greatest danger)

Front 451

Burns
II. Types--
C. Smoke and Inhalation
2. Treatment
g. Indications for immediate intubation
i. Full thickness burns to ----------
ii. Circumferential---------- burns
iii. Acute ---------- distress

Back 451

Burns
II. Types--
C. Smoke and Inhalation
2. Treatment
g. Indications for immediate intubation
i. Full thickness burns to face
ii. Circumferential neck burns
iii. Acute respiratory distress

Front 452

Burns
II. Types--
C. Smoke and Inhalation
2. Treatment
g. Indications for immediate intubation
iv. Respiratory ------------- or altered mental status
v. --------------- edema and inflammation noted on bronchoscopy

Back 452

Burns
II. Types--
C. Smoke and Inhalation
2. Treatment
g. Indications for immediate intubation
iv. Respiratory depression or altered mental status
v. Supraglottic edema and inflammation noted on bronchoscopy

Front 453

Burns
II. Types--
D. Electrical--coagulation ---------- caused by intense heat from electrical current (less common, ____-9%)

Back 453

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)

Front 454

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
1. Severity--burn will not look that bad (most destruction is within ---------)

Back 454

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
1. Severity--burn will not look that bad (most destruction is within body)

Front 455

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
1. Severity--burn will not look that bad (most destruction is within body)
a. Amount of voltage
i. <------------V (low)--energy can’t enter body unless opening exists (not hospitalized)

Back 455

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
1. Severity--burn will not look that bad (most destruction is within body)
a. Amount of voltage
i. <1000V (low)--energy can’t enter body unless opening exists (not hospitalized)

Front 456

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
1. Severity--burn will not look that bad (most destruction is within body)
a. Amount of voltage
i. <1000V (low)--energy can’t enter body unless ------------ exists (not hospitalized)

Back 456

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
1. Severity--burn will not look that bad (most destruction is within body)
a. Amount of voltage
i. <1000V (low)--energy can’t enter body unless opening exists (not hospitalized)

Front 457

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
1. Severity--burn will not look that bad (most destruction is within body)
a. Amount of voltage
ii. >------------V (high)--entry exit wound (damp/sweaty areas-hands, feet, axillaries)

Back 457

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
1. Severity--burn will not look that bad (most destruction is within body)
a. Amount of voltage
ii. >1000V (high)--entry exit wound (-------------- areas-hands, feet, axillaries)

Front 458

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
1. Severity--burn will not look that bad (most destruction is within body
b. Tissue resistance--fat and ----------- more resistant (most damage done to ----------- vessels)

Back 458

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
1. Severity--burn will not look that bad (most destruction is within body
b. Tissue resistance--fat and bone more resistant (most damage done to nerves vessels)

Front 459

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
1. Severity--burn will not look that bad (most destruction is within body
c. Current pathways--goes through---------- resistant path (were ----------- organs in the way?)

Back 459

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
1. Severity--burn will not look that bad (most destruction is within body
c. Current pathways--goes through least resistant path (were vital organs in the way?)

Front 460

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
1. Severity--burn will not look that bad (most destruction is within body
c. Current pathways--goes through least resistant path (were vital organs in the way?)
i. Hand to hand goes through ------------ (burns across hands --------x great for arrhythmias)

Back 460

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
1. Severity--burn will not look that bad (most destruction is within body
c. Current pathways--goes through least resistant path (were vital organs in the way?)
i. Hand to hand goes through heart (burns across hands 3x great for arrhythmias)

Front 461

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
1. Severity--burn will not look that bad (most destruction is within body
d. ------------- area in contact with current--look at skin carefully

Back 461

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
1. Severity--burn will not look that bad (most destruction is within body
d. Surface area in contact with current--look at skin carefully

Front 462

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
1. Severity--burn will not look that bad (most destruction is within body
e. -------------- current flow was sustained

Back 462

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
1. Severity--burn will not look that bad (most destruction is within body
e. Length of time current flow was sustained

Front 463

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
2. Complications--can occur during and after burn
a. Risk for cardiac arrest/arrhythmias (massive --------------cardiac standstill/----------)

Back 463

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
2. Complications--can occur during and after burn
a. Risk for cardiac arrest/arrhythmias (massive depolarization-cardiac standstill/asystole)

Front 464

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
2. Complications--can occur during and after burn
b. Acid-base imbalance--metabolic ----------- as cells rupture

Back 464

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
2. Complications--can occur during and after burn
b. Acid-base imbalance--metabolic acidosis as cells rupture

Front 465

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
2. Complications--can occur during and after burn
c. Kidney failure--massive -------------

Back 465

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
2. Complications--can occur during and after burn
c. Kidney failure--massive myoglobinuria

Front 466

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
2. Complications--can occur during and after burn
i. Big proteins from ------------- tissues block renal ----------, renal failure

Back 466

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
2. Complications--can occur during and after burn
i. Big proteins from damaged tissues block renal tubules renal failure

Front 467

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
2. Complications--can occur during and after burn
d. Injury to CNS--coma, ----------, epilepsy, -----------------, spinal injury (falls)

Back 467

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
2. Complications--can occur during and after burn
d. Injury to CNS--coma, aphasia, epilepsy, peripheral neuropathy, spinal injury (falls)

Front 468

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
2. Complications--can occur during and after burn
d. Injury to CNS--________, aphasia, _________, peripheral neuropathy, _______ injury (falls)

Back 468

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
2. Complications--can occur during and after burn
d. Injury to CNS--coma, aphasia, epilepsy, peripheral neuropathy, spinal injury (falls)

Front 469

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
2. Complications--can occur during and after burn
e. ------------- injury--muscle spasms due to current causing bones to break, trauma

Back 469

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
2. Complications--can occur during and after burn
e. Musculoskeletal injury--muscle spasms due to current causing bones to break, trauma

Front 470

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
2. Complications--can occur during and after burn
f. ----------- shock

Back 470

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
2. Complications--can occur during and after burn
f. Hypovolemic shock

Front 471

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
3. Treatment--LR with urine output at _____-______mL/hr (all electrical burns go to burn ________)

Back 471

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
3. Treatment--LR with urine output at 75-100mL/hr (all electrical burns go to burn center)

Front 472

Burns
II. Types--
E. Cold Thermal--frostbite
1. Pathophysiology--ice crystals in --------- and cells ↓-------- flow and destry cell membrane

Back 472

Burns
II. Types--
E. Cold Thermal--frostbite
1. Pathophysiology--ice crystals in tissue and cells ↓blood flow and destry cell membrane

Front 473

Burns
II. Types--
E. Cold Thermal--frostbite
2. Depth--result of ----------- temperature, length of-----------, and type/condition of clothing

Back 473

Burns
II. Types--
E. Cold Thermal--frostbite
2. Depth--result of ambient temperature, length of exposure, and type/condition of clothing

Front 474

Burns
II. Types--
E. Cold Thermal--frostbite
2. Depth--result of ambient temperature, length of exposure, and type/condition of clothing
a. Superficial--skin, ---------- tissue (ears, cheeks, ---------, toes)

Back 474

Burns
II. Types--
E. Cold Thermal--frostbite
2. Depth--result of ambient temperature, length of exposure, and type/condition of clothing
a. Superficial--skin, SQ tissue (ears, cheeks, fingers, toes)

Front 475

Burns
II. Types--
E. Cold Thermal--frostbite
2. Depth--result of ambient temperature, length of exposure, and type/condition of clothing
a. Superficial--skin, SQ tissue (ears, cheeks, fingers, toes)
i. Treatment--immerse in bath water at ______-______° blisters will form after

Back 475

Burns
II. Types--
E. Cold Thermal--frostbite
2. Depth--result of ambient temperature, length of exposure, and type/condition of clothing
a. Superficial--skin, SQ tissue (ears, cheeks, fingers, toes)
i. Treatment--immerse in bath water at 102-108° blisters will form after

Front 476

Burns
II. Types--
E. Cold Thermal--frostbite
2. Depth--result of ambient temperature, length of exposure, and type/condition of clothing
ii. Re-warming is very painful (pain can continue for-------- to --------- after injury)

Back 476

Burns
II. Types--
E. Cold Thermal--frostbite
2. Depth--result of ambient temperature, length of exposure, and type/condition of clothing
ii. Re-warming is very painful (pain can continue for weeks to years after injury)

Front 477

Burns
II. Types--
E. Cold Thermal--frostbite
2. Depth--result of ambient temperature, length of exposure, and type/condition of clothing
b. Deep--muscles, ---------, tendons (skin mottled ---------)

Back 477

Burns
II. Types--
E. Cold Thermal--frostbite
2. Depth--result of ambient temperature, length of exposure, and type/condition of clothing
b. Deep--muscles, bones, tendons (skin mottled gangrene)

Front 478

Burns
II. Types--
E. Cold Thermal--frostbite
2. Depth--result of ambient temperature, length of exposure, and type/condition of clothing
b. Deep--muscles, bones, tendons (skin mottled gangrene)
i. Treatment--usually requires -------------

Back 478

Burns
II. Types--
E. Cold Thermal--frostbite
2. Depth--result of ambient temperature, length of exposure, and type/condition of clothing
b. Deep--muscles, bones, tendons (skin mottled gangrene)
i. Treatment--usually requires amputation

Front 479

Burns
III. Severity
A. Depth--know ----------- of skin

Back 479

Burns
III. Severity
A. Depth--know layers of skin

Front 480

Burns
III. Severity
A. Depth--know layers of skin
1. Superficial --------- Thickness (1st degree)

Back 480

Burns
III. Severity
A. Depth--know layers of skin
1. Superficial Partial Thickness (1st degree)

Front 481

Burns
III. Severity
A. Depth--know layers of skin
1. Superficial Partial Thickness (1st degree)
a. Involves mainly ------------- and uppermost part of dermis

Back 481

Burns
III. Severity
A. Depth--know layers of skin
1. Superficial Partial Thickness (1st degree)
a. Involves mainly epidermis and uppermost part of dermis

Front 482

Burns
III. Severity
A. Depth--know layers of skin
1. Superficial Partial Thickness (1st degree)
b. Manifestations--redness, --------, blanches under pressure, mild swelling w/ ------------

Back 482

Burns
III. Severity
A. Depth--know layers of skin
1. Superficial Partial Thickness (1st degree)
b. Manifestations--redness, --------, blanches under pressure, mild swelling w/ ------------

Front 483

Burns
III. Severity
A. Depth--know layers of skin
1. Superficial Partial Thickness (1st degree)
c. Heals in about-------- days (may peel after ---------hrs)

Back 483

Burns
III. Severity
A. Depth--know layers of skin
1. Superficial Partial Thickness (1st degree)
c. Heals in about 7 days (may peel after 24hrs)

Front 484

Burns
III. Severity
A. Depth--know layers of skin
2. --------- Partial Thickness (2nd degree)

Back 484

Burns
III. Severity
A. Depth--know layers of skin
2. Deep Partial Thickness (2nd degree)

Front 485

Burns
III. Severity
A. Depth--know layers of skin
2. Deep Partial Thickness (2nd degree)
a. Damage through epidermis into ------------

Back 485

Burns
III. Severity
A. Depth--know layers of skin
2. Deep Partial Thickness (2nd degree)
a. Damage through epidermis into dermis

Front 486

Burns
III. Severity
A. Depth--know layers of skin
2. Deep Partial Thickness (2nd degree)
b. Manifestations--salmon pink/cherry red w/ red, shiny/wet --------------, blanches under pressure,------------, mild-moderate ---------

Back 486

Burns
III. Severity
A. Depth--know layers of skin
2. Deep Partial Thickness (2nd degree)
b. Manifestations--salmon pink/cherry red w/ red, shiny/wet fluid-filled vesicles, blanches under pressure, severe pain, mild-moderate edema

Front 487

Burns
III. Severity
A. Depth--know layers of skin
2. Deep Partial Thickness (2nd degree)
b. Manifestations--salmon pink/------------, shiny/wet fluid-filled vesicles, ---------- under pressure, severe pain, mild-moderate edema

Back 487

Burns
III. Severity
A. Depth--know layers of skin
2. Deep Partial Thickness (2nd degree)
b. Manifestations--salmon pink/cherry red w/ red, shiny/wet fluid-filled vesicles, blanches under pressure, severe pain, mild-moderate edema

Front 488

Burns
III. Severity
A. Depth--know layers of skin
2. Deep Partial Thickness (2nd degree)
c. Heals in ____-______days

Back 488

Burns
III. Severity
A. Depth--know layers of skin
2. Deep Partial Thickness (2nd degree)
c. Heals in 7-21days

Front 489

Burns
III. Severity
A. Depth--know layers of skin
3. --------- Thickness (3rd degree)

Back 489

Burns
III. Severity
A. Depth--know layers of skin
3. Full Thickness (3rd degree)

Front 490

Burns
III. Severity
A. Depth--know layers of skin
3. Full Thickness (3rd degree)
a. Destruction of epidermis -------------- (can be into fat, muscle, and bone)

Back 490

Burns
III. Severity
A. Depth--know layers of skin
3. Full Thickness (3rd degree)
a. Destruction of epidermis through dermis (can be into fat, muscle, and bone)

Front 491

Burns
III. Severity
A. Depth--know layers of skin
3. Full Thickness (3rd degree)
c. Manifestations--dry, ----------, ------------, charred black, insensitive to -----------

Back 491

Burns
III. Severity
A. Depth--know layers of skin
3. Full Thickness (3rd degree)
c. Manifestations--dry, leathery, waxy white, charred black, insensitive to pain/pressure

Front 492

Burns
III. Severity
A. Depth--know layers of skin
3. Full Thickness (3rd degree)
d. Will require skin ---------

Back 492

Burns
III. Severity
A. Depth--know layers of skin
3. Full Thickness (3rd degree)
d. Will require skin grafting

Front 493

Burns
III. Severity
B. Extent--need to know in order to calculate needed fluid replacement
1. Rule of ---------(faster)

Back 493

Burns
III. Severity
B. Extent--need to know in order to calculate needed fluid replacement
1. Rule of 9s (faster)

Front 494

Burns
III. Severity
B. Extent--need to know in order to calculate needed fluid replacement
1. Rule of 9s (faster)
a. Head/neck--_____%
b. Arms--_____%
c. Anterior trunk--_____%

Back 494

Burns
III. Severity
B. Extent--need to know in order to calculate needed fluid replacement
1. Rule of 9s (faster)
a. Head/neck--9%
b. Arms--9%
c. Anterior trunk--18%

Front 495

Burns
III. Severity
B. Extent--need to know in order to calculate needed fluid replacement
1. Rule of 9s (faster)
d. Posterior trunk--______%
e. Legs--____%
f. Perineum--_____%

Back 495

Burns
III. Severity
B. Extent--need to know in order to calculate needed fluid replacement
1. Rule of 9s (faster)
d. Posterior trunk--18%
e. Legs--18%
f. Perineum--1%

Front 496

Burns
III. Severity
B. Extent--need to know in order to calculate needed fluid replacement
2. --------------- Chart (more detailed and more accurate)
**Cut off age--need to be >6yrs

Back 496

Burns
III. Severity
B. Extent--need to know in order to calculate needed fluid replacement
2. Lund-Browder Chart (more detailed and more accurate)
**Cut off age--need to be >6yrs

Front 497

Burns
III. Severity
B. Extent--need to know in order to calculate needed fluid replacement
2. Lund-Browder Chart (more detailed and more accurate)
**Cut off age--need to be >______yrs

Back 497

Burns
III. Severity
B. Extent--need to know in order to calculate needed fluid replacement
2. Lund-Browder Chart (more detailed and more accurate)
**Cut off age--need to be >6yrs

Front 498

Burns
III. Severity
C. Location
1. Face,------------, and circumferential chest--severe b/ increase possibility of --------- compromise

Back 498

Burns
III. Severity
C. Location
1. Face, neck, and circumferential chest--severe b/ increase possibility of resp. compromise

Front 499

Burns
III. Severity
C. Location
2. Hands, feet, ---------, eyes, and -------: difficult to treat (high movement ↑ ----------)

Back 499

Burns
III. Severity
C. Location
2. Hands, feet, joints, eyes, and perineum--difficult to treat (high movement ↑ complications)

Front 500

Burns
III. Severity
C. Location
3. Ears, nose--susceptible to infection b/c -------------- to cartilage

Back 500

Burns
III. Severity
C. Location
3. Ears, nose--susceptible to infection b/c poor blood supply to cartilage

Front 501

Burns
III. Severity
C. Location
4. Circumferential extremities--risk of ------------- syndrome (↓blood supply to distal region)

Back 501

Burns
III. Severity
C. Location
4. Circumferential extremities--risk of compartment syndrome (↓blood supply to distal region)

Front 502

Burns
III. Severity
D. Patient Risk Factors
1. Age--<_______yrs (not full development of immune system) and >_______yrs

Back 502

Burns
III. Severity
D. Patient Risk Factors
1. Age--<2yrs (not full development of immune system) and >60yrs

Front 503

Burns
III. Severity
D. Patient Risk Factors
2. Pre-existing cardiovascular, -----------, or --------- disease--can be worsened

Back 503

Burns
III. Severity
D. Patient Risk Factors
2. Pre-existing cardiovascular, respiratory, or renal disease--can be worsened

Front 504

Burns
III. Severity
D. Patient Risk Factors
3. ------------ or PVD--↓healing and ↑infection

Back 504

Burns
III. Severity
D. Patient Risk Factors
3. Diabetes or PVD--↓healing and ↑infection

Front 505

Burns
III. Severity
D. Patient Risk Factors
4. Debilitating states--chronic ---------, history of ---------, malnutrition

Back 505

Burns
III. Severity
D. Patient Risk Factors
4. Debilitating states--chronic disease, history of ETOH, malnutrition

Front 506

Burns
III. Severity
D. Patient Risk Factors
5. Concurrent injuries--often ------------- injuries (need to know circumstances of injury)

Back 506

Burns
III. Severity
D. Patient Risk Factors
5. Concurrent injuries--often traumatic injuries (need to know circumstances of injury)

Front 507

Burns
IV. Burn Center Referral Criteria (check book)
A. Partial thickness burns >_________% of total body surface area (TBSA)
B. All ------------- burns
C. Electrical and ---------- burns

Back 507

Burns
IV. Burn Center Referral Criteria (check book)
A. Partial thickness burns >10% of total body surface area (TBSA)
B. All full thickness burns
C. Electrical and chemical burns

Front 508

Burns
IV. Burn Center Referral Criteria (check book)
D. --------------- injury
E. All burns involving injury to --------, eyes, face, ---------, feet, -----------, and joints

Back 508

Burns
IV. Burn Center Referral Criteria (check book)
D. Inhalation injury
E. All burns involving injury to ears, eyes, face, hands, feet, perineum, and joints

Front 509

Burns
V. Treatment
A. ------------- process--mostly prehospital

Back 509

Burns
V. Treatment
A. Stop burning process--mostly prehospital

Front 510

Burns
V. Treatment
A. Stop burning process--mostly prehospital
1. Removal of ---------- and jewelry (especially w/ --------- burns)

Back 510

Burns
V. Treatment
A. Stop burning process--mostly prehospital
1. Removal of clothing and jewelry (especially w/ chemical burns)
2. Cut around areas where clothing is stuck to skin

Front 511

Burns
V. Treatment
A. Stop burning process--mostly prehospital
2. Cut around areas where clothing is -------- to skin

Back 511

Burns
V. Treatment
A. Stop burning process--mostly prehospital
2. Cut around areas where clothing is stuck to skin

Front 512

Burns
V. Treatment
A. Stop burning process--mostly prehospital
3. Brush -------------- off skin followed by lavage w/ water for at least -------min (for chemical)

Back 512

Burns
V. Treatment
A. Stop burning process--mostly prehospital
3. Brush solid particles off skin followed by lavage w/ water for at least 20min (for chemical)

Front 513

Burns
V. Treatment
A. Stop burning process--mostly prehospital
4. Cover and ---------- dressing or clean sheet to prevent -------- loss (for thermal)

Back 513

Burns
V. Treatment
A. Stop burning process--mostly prehospital
4. Cover and dry dressing or clean sheet to prevent heat loss (for thermal)

Front 514

Burns
V. Treatment
B. Assess ABCs--burns to airway can cause swelling that blocks flow of air into lungs
1. A--keep ---------- patent

Back 514

Burns
V. Treatment
B. Assess ABCs--burns to airway can cause swelling that blocks flow of air into lungs
1. A--keep airway patent

Front 515

Burns
V. Treatment
B. Assess ABCs--burns to airway can cause swelling that blocks flow of air into lungs
2. B--assess ------- and -------

Back 515

Burns
V. Treatment
B. Assess ABCs--burns to airway can cause swelling that blocks flow of air into lungs
2. B--assess RR and O2Sat

Front 516

Burns
V. Treatment
B. Assess ABCs--burns to airway can cause swelling that blocks flow of air into lungs
3. C--assess --------- and look for ------------ burns

Back 516

Burns
V. Treatment
B. Assess ABCs--burns to airway can cause swelling that blocks flow of air into lungs
3. C--assess pulses and look for circumferential burns

Front 517

Burns
V. Treatment
C. Assess for __________--circumstances of injury

Back 517

Burns
V. Treatment
C. Assess for other injuries--circumstances of injury

Front 518

Burns
V. Treatment
C. Assess for other injuries--circumstances of injury
1. -------------- burns--concurrent w/ spinal injuries due to falls

Back 518

Burns
V. Treatment
C. Assess for other injuries--circumstances of injury
1. High voltage burns--concurrent w/ spinal injuries due to falls

Front 519

Burns
VI. Phases
A. --------------- Phase--period of time required to resolve immediate problems (usually 24-48hrs)

Back 519

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)

Front 520

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
1. ------------------- formation and continues until mobilization and diuresis begins

Back 520

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
1. Initial fluid loss and edema formation and continues until mobilization and diuresis begins

Front 521

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >____%)

Back 521

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)

Front 522

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
a. ---------- and ------------ shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days)

Back 522

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
a. Fluid and electrolyte shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days)

Front 523

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
a. Fluid and electrolyte shifts (------------- greatest risk)--leads to formation of edema (as early as -------min and can last 7-10days)

Back 523

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
a. Fluid and electrolyte shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days)

Front 524

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
a. Fluid and electrolyte shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days)
i. Larger burns ↑---------- shift (↑----------- volume loss insensible skin loss)

Back 524

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
a. Fluid and electrolyte shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days)
i. Larger burns ↑fluid shift (↑intravascular volume loss insensible skin loss)

Front 525

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
a. Fluid and electrolyte shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days)
ii. ____________--Na moves into the interstitial spaces

Back 525

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
a. Fluid and electrolyte shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days)
ii. Hyponatremia--Na moves into the interstitial spaces

Front 526

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
a. Fluid and electrolyte shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days)
iii. ----------------: released from injured cells and hemolysed RBCs vasculature

Back 526

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
a. Fluid and electrolyte shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days)
iii. Hyperkalemia-released from injured cells and hemolysed RBCs vasculature

Front 527

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
a. Fluid and electrolyte shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days)
iv. ---------------- (↑Hct)--blood is more viscous

Back 527

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
a. Fluid and electrolyte shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days)
iv. Hemoconcentration (↑Hct)--blood is more viscous

Front 528

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
a. Fluid and electrolyte shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days)
v. -------------- (↓albumin)--↑permeability fluid from intravascular to interstitial space ↓colloidal vascular pressure 2nd and 3rd spacing

Back 528

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
a. Fluid and electrolyte shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days)
v. Hypotproteinemia (↓albumin)--↑permeability fluid from intravascular to interstitial space ↓colloidal vascular pressure 2nd and 3rd spacing

Front 529

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
a. Fluid and electrolyte shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days)
v. Hypotproteinemia (↓-------------)--↑permeability fluid from ------------- to interstitial space ↓---------- vascular pressure 2nd and 3rd spacing

Back 529

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
a. Fluid and electrolyte shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days)
v. Hypotproteinemia (↓albumin)--↑permeability fluid from intravascular to interstitial space ↓colloidal vascular pressure 2nd and 3rd spacing

Front 530

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
a. Fluid and electrolyte shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days)
vi. At end of stage--restored ------------ (still creates problems)

Back 530

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
a. Fluid and electrolyte shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days)
vi. At end of stage--restored capillary permeability (still creates problems)

Front 531

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
• Proteins can’t return to -------------

Back 531

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
• Proteins can’t return to vascular space

Front 532

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
• ----------- can move back into vascular space

Back 532

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
• Fluids can move back into vascular space

Front 533

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
• Assess for ↓------- (as --------- moves back into cell and pt. diureses hypokalemia)

Back 533

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
• Assess for ↓K (as K moves back into cell and pt. diureses hypokalemia)

Front 534

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
• Assess for ↓K (as K moves back into cell and pt. diureses hypokalemia)
b. Immunologic--widespread impairment causing susceptibility to ---------

Back 534

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
• Assess for ↓K (as K moves back into cell and pt. diureses hypokalemia)
b. Immunologic--widespread impairment causing susceptibility to infection

Front 535

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
b. Immunologic--widespread impairment causing susceptibility to infection
i. ↑Release------------ ---------------- markers ↑permeability (severe w/ >---------%)

Back 535

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
b. Immunologic--widespread impairment causing susceptibility to infection
i. ↑Release cytokines inflammatory markers ↑permeability (severe w/ >30%)

Front 536

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
b. Immunologic--widespread impairment causing susceptibility to infection
ii. ------------ suppression and ↓circulating WBCs

Back 536

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
b. Immunologic--widespread impairment causing susceptibility to infection
ii. Bone marrow suppression and ↓circulating WBCs

Front 537

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
c. Cardiovascular--volume depletion ↑-------------- ↑SVR ↓---------

Back 537

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
c. Cardiovascular--volume depletion ↑cardiac workload ↑SVR ↓CO

Front 538

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
c. Cardiovascular--volume depletion ↑cardiac workload ↑SVR ↓CO
i. Release of tumor necrosis factor --------------- depression (↓contractility)

Back 538

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
c. Cardiovascular--volume depletion ↑cardiac workload ↑SVR ↓CO
i. Release of tumor necrosis factor myocardial depression (↓contractility)

Front 539

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
c. Cardiovascular--volume depletion ↑cardiac workload ↑SVR ↓CO
ii. ↓BP ↓-----------

Back 539

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
c. Cardiovascular--volume depletion ↑cardiac workload ↑SVR ↓CO
ii. ↓BP ↓organ perfusion

Front 540

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
d. Respiratory--_____________; ARDS (__________ is a risk factor)

Back 540

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
d. Respiratory--brochoconstriction; ARDS (trauma is a risk factor)

Front 541

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
e. Metabolic--basic metabolic rate ↑-------x need ↑------------ (aggressive w/ caloric intake)

Back 541

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
e. Metabolic--basic metabolic rate ↑3x need ↑nutrition (aggressive w/ caloric intake)

Front 542

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
3. Clinical Manifestations
a. -------------- shock--↓BP, ↑HR

Back 542

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
3. Clinical Manifestations
a. Hypovolemic shock--↓BP, ↑HR

Front 543

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
3. Clinical Manifestations
b. ____________--fluid overload need fluids b/c all fluid is not where it needs to be

Back 543

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
3. Clinical Manifestations
b. Edematous--fluid overload need fluids b/c all fluid is not where it needs to be

Front 544

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
3. Clinical Manifestations
c. Pain--__________ and ___________ burns

Back 544

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
3. Clinical Manifestations
c. Pain--superficial and partial thickness burns

Front 545

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
3. Clinical Manifestations
d. Shivering--heat loss (can lead to -----------) ↑---------- requirements

Back 545

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
3. Clinical Manifestations
d. Shivering--heat loss (can lead to hypothermia) ↑energy requirements

Front 546

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
3. Clinical Manifestations
e. ______________-- massive trauma response and occurs from K shifts (must assess gut)

Back 546

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
3. Clinical Manifestations
e. Adynamic ilius-- massive trauma response and occurs from K shifts (must assess gut)

Front 547

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
a. Cardiovascular
i._____________--electrolyte shifts (especially electrical burns through heart)

Back 547

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
a. Cardiovascular
i. Dysrhythmias--electrolyte shifts (especially electrical burns through heart)

Front 548

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
a. Cardiovascular
ii. ______________ shock--can become irreversible shock end organ failure

Back 548

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
a. Cardiovascular
ii. Hypovolemic shock--can become irreversible shock end organ failure

Front 549

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
a. Cardiovascular
iii. Impaired --------------- circulation--especially w/ circumferential burns (compartment syndrome need escoratomy-burns or fashiotomy-nonburns)

Back 549

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
a. Cardiovascular
iii. Impaired peripheral circulation--especially w/ circumferential burns (compartment syndrome need escoratomy-burns or fashiotomy-nonburns)

Front 550

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
a. Cardiovascular
iii. Impaired peripheral circulation--especially w/ circumferential burns (compartment syndrome need --------------- or --------------)

Back 550

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
a. Cardiovascular
iii. Impaired peripheral circulation--especially w/ circumferential burns (compartment syndrome need escoratomy-burns or fashiotomy-nonburns)

Front 551

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
b. Respiratory (can occur ---------- days after initial injury)--inflammatory ------------ release

Back 551

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
b. Respiratory (can occur 2 days after initial injury)--inflammatory marker release

Front 552

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
b. Respiratory (can occur 2 days after initial injury)--inflammatory marker release
i. Upper respiratory tract injury--___________ airway

Back 552

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
b. Respiratory (can occur 2 days after initial injury)--inflammatory marker release
i. Upper respiratory tract injury--swelling/blocking airway

Front 553

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
• Pneumonia risk
ii. Inhalation injury--___________ and ↓______ diffusion

Back 553

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
• Pneumonia risk
ii. Inhalation injury--interstitial edema and ↓gas diffusion

Front 554

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
• Inflammatory marker release ↑--------------- permeability, ↑------------, ↑PVR, and ↑-------------- constriction

Back 554

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
• Inflammatory marker release ↑capillary permeability, ↑SVR, ↑PVR, and ↑peripheral constriction

Front 555

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
c. Urinary--Acute -------------- Necrosis (most common complication in this phase)

Back 555

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
c. Urinary--Acute Tubular Necrosis (most common complication in this phase)

Front 556

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
c. Urinary--Acute Tubular Necrosis (most common complication in this phase)
i. Can result from --------------- shock

Back 556

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
c. Urinary--Acute Tubular Necrosis (most common complication in this phase)
i. Can result from hypovolemic shock

Front 557

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
c. Urinary--Acute Tubular Necrosis (most common complication in this phase)
ii. Electrical burns ↑------------- and ------------- release block renal tubules

Back 557

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
c. Urinary--Acute Tubular Necrosis (most common complication in this phase)
ii. Electrical burns ↑Myoglobin and hemoglobin release block renal tubules

Front 558

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
c. Urinary--Acute Tubular Necrosis (most common complication in this phase)
iii. Treatment--__________ and diuretics, flush ___________ out

Back 558

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
c. Urinary--Acute Tubular Necrosis (most common complication in this phase)
iii. Treatment--fluids and diuretics flush myoglobin out

Front 559

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
a. Airway Management
i. Assessment of ---------- and ------------

Back 559

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
a. Airway Management
i. Assessment of ventilation and oxygenation

Front 560

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
a. Airway Management
ii. Early ------------ and ventilatory management within 1-______hrs (ABGs)

Back 560

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
a. Airway Management
ii. Early intubation and ventilatory management within 1-2hrs (ABGs)

Front 561

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
a. Airway Management
iii. B__________

Back 561

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
a. Airway Management
iii. Bronchoscopy

Front 562

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
a. Airway Management
iv. Inhalation injury: humidified ----------% O2, ↑-----------, CDB, chest PT, -------------

Back 562

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
a. Airway Management
iv. Inhalation injury: humidified 100% O2, ↑Fowlers, CDB, chest PT, suction

Front 563

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
a. Airway Management
v. CO poisoning: ------------% O2

Back 563

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
a. Airway Management
v. CO poisoning: ------------% O2 100% O2

Front 564

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
b. Fluid therapy
i. Establish IV access--2 ------------- IVs and maybe central line

Back 564

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
b. Fluid therapy
i. Establish IV access--2 large bore IVs and maybe central line

Front 565

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
b. Fluid therapy
ii. Consider therapy for burns >------------% TBSA

Back 565

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
b. Fluid therapy
ii. Consider therapy for burns >15% TBSA

Front 566

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
b. Fluid therapy
iii. 1st -----------hrs colloids generally not given (leak out w/ ↑------------- cost more)

Back 566

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
b. Fluid therapy
iii. 1st 12hrs colloids generally not given (leak out w/ ↑permeability cost more)

Front 567

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
• Usually give ---------- instead

Back 567

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
• Usually give LR instead

Front 568

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
• b. Fluid therapy
iv. --------------- Formula: 4mL/kg/%TBSA = total fluid replacement in 24hrs

Back 568

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
• b. Fluid therapy
iv. Parkland Burn Formula: 4mL/kg/%TBSA = total fluid replacement in 24hrs

Front 569

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
• b. Fluid therapy
iv. Parkland Burn Formula: ---------mL/kg/%TBSA = total ---------- replacement in 24hrs

Back 569

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
• b. Fluid therapy
iv. Parkland Burn Formula: 4mL/kg/%TBSA = total fluid replacement in 24hrs

Front 570

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
• b. Fluid therapy
• ½ given in first -----------hrs from time of burn

Back 570

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
• b. Fluid therapy
• ½ given in first 8hrs from time of burn

Front 571

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
• b. Fluid therapy
• ½ given over next -----------hrs

Back 571

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
• b. Fluid therapy
• ½ given over next 16hrs

Front 572

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
• b. Fluid therapy
v. Monitory response to ------------ therapy

Back 572

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
• b. Fluid therapy
v. Monitory response to fluid therapy

Front 573

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
• b. Fluid therapy
• Urine output should be ______-50mL/hr (if electrical _____-100mL/hr)

Back 573

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
• b. Fluid therapy
• Urine output should be 30-50mL/hr (if electrical 75-100mL/hr)

Front 574

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
• b. Fluid therapy
• BP >____
• HR <_____

Back 574

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
• b. Fluid therapy
• BP >90
• HR <120

Front 575

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after --------- and IV ------- replacement (low priority) PAINFUL

Back 575

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL

Front 576

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL
i. Cleaning and debridement--remove -------- ------------skin (should not see blood)

Back 576

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL
i. Cleaning and debridement--remove escar necrotic skin (should not see blood)

Front 577

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL
ii. Hydrotherapy--immersed in ------------/NA water bath or showered no longer than ______-30min/day to flush off loose necrotic skin

Back 577

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL
ii. Hydrotherapy--immersed in isotonic/NA water bath or showered no longer than 20-30min/day to flush off loose necrotic skin

Front 578

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL
• Can cause --------------- (not sterile water)

Back 578

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL
• Can cause cross contamination (not sterile water)

Front 579

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL
• May cause too much ------------ shift (pulls Na out)
• For chemical burns flush w/ water no hotter than -----------°

Back 579

• May cause too much electrolyte shift (pulls Na out)
• For chemical burns flush w/ water no hotter than 104°

Front 580

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL
iii. Open Method--exposing and ------------ wound w/ thin layer of topical -----------

Back 580

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL
iii. Open Method--exposing and covering wound w/ thin layer of topical antibiotic

Front 581

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL
iv. Closed Method--multiple dressing changes q-----------hrs (acticote can stay ---------- days)

Back 581

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL
iv. Closed Method--multiple dressing changes q8hrs (acticote can stay 3 days)

Front 582

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL
v. Prevention of ____________--primary goal (some__________ from pts own flora)

Back 582

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL
v. Prevention of infection--primary goal (some infections from pts own flora)

Front 583

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL
• Always gowned,-------------, and masked (strict visitor handwashing/gowning)
• Remove dirty bandages ------------ sterile gloves, but put on ---------- sterile gloves

Back 583

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL
• Always gowned, gloved, and masked (strict visitor handwashing/gowning)
• Remove dirty bandages w/out sterile gloves, but put on w/ sterile gloves

Front 584

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL
• Clean ------------ infected wounds first (clean to dirty)
• Antibiotics (------------, NaNO3, ---------------)--topical penetrates; can develop resistance (requires changing antibiotics)

Back 584

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL
• Clean less infected wounds first (clean to dirty)
• Antibiotics (Silvidine, NaNO3, Sulfamyoline)--topical penetrates; can develop resistance (requires changing antibiotics)

Front 585

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL
vi. Adequate pain control--IV -------------- before dressing changes (oral meds difficult w/ slow gut)

Back 585

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL
vi. Adequate pain control--IV morphine before dressing changes (oral meds difficult w/ slow gut)

Front 586

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL
vii. Avoid hypothermia--room >-------------° and wound changes under ------------

Back 586

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL
vii. Avoid hypothermia--room >85° and wound changes under heat lamp

Front 587

Burns
VI. Phases
B. Acute Phase--occurs until wound is ------------ or completely covered by ------------- (weeks to months)

Back 587

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)

Front 588

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
1. Pathophysiology--extracellular ------------ mobilization into ---------------- space pt diureses begins

Back 588

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
1. Pathophysiology--extracellular fluid mobilization into intravascular space pt diureses begins

Front 589

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
1. Pathophysiology--extracellular fluid mobilization into intravascular space pt diureses begins
a. ---------------- (necrotic tissue) separates and begins to slough off formation of -------------- tissue (for partial thickness buns)

Back 589

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
1. Pathophysiology--extracellular fluid mobilization into intravascular space pt diureses begins
a. Escar (necrotic tissue) separates and begins to slough off formation of granulation tissue (for partial thickness buns)

Front 590

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
1. Pathophysiology--extracellular fluid mobilization into intravascular space pt diureses begins
b. Full thickness burns must be covered by ----------
c. Return of ----------- sounds

Back 590

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
1. Pathophysiology--extracellular fluid mobilization into intravascular space pt diureses begins
b. Full thickness burns must be covered by skin grafts
c. Return of bowel sounds

Front 591

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
a. Alterations in Electrolytes--potential for all sorts of shifting (know -------- and -------- values)

Back 591

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
a. Alterations in Electrolytes--potential for all sorts of shifting (know K and Na values)

Front 592

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
a. Alterations in Electrolytes--potential for all sorts of shifting (know K and Na values)
i. Hyponatremia--excess-------------, ---------- suctioning, diarrhea, excess ----------- replacement, excess dieresis

Back 592

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
a. Alterations in Electrolytes--potential for all sorts of shifting (know K and Na values)
i. Hyponatremia--excess hydrotherapy, NG suctioning, diarrhea, excess fluid replacement, excess dieresis

Front 593

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
a. Alterations in Electrolytes--potential for all sorts of shifting (know K and Na values)
• Muscle cramps, fatigue, weakness, HA, ------------ (think O2, --------, or ↑---------)

Back 593

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
a. Alterations in Electrolytes--potential for all sorts of shifting (know K and Na values)
• Muscle cramps, fatigue, weakness, HA, confusion (think O2, Na, or ↑HR)

Front 594

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
a. Alterations in Electrolytes--potential for all sorts of shifting (know K and Na values)
ii. Hypernatremia--too much--------------- solution or not enough ----------- (dehydrated)

Back 594

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
a. Alterations in Electrolytes--potential for all sorts of shifting (know K and Na values)
ii. Hypernatremia--too much hypertonic solution or not enough fluid (dehydrated)

Front 595

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
a. Alterations in Electrolytes--potential for all sorts of shifting (know K and Na values)
• Thirsty, dried --------------, -------------, seizures

Back 595

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
a. Alterations in Electrolytes--potential for all sorts of shifting (know K and Na values)
• Thirsty, dried furrowed tongue, confusion, seizures

Front 596

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
a. Alterations in Electrolytes--potential for all sorts of shifting (know K and Na values)
iii. Hyperkalemia--Tissue -------------- (electrical burns ATN -------------- can’t filter out K)
• Dysrhythmias, muscle weakness

Back 596

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
a. Alterations in Electrolytes--potential for all sorts of shifting (know K and Na values)
iii. Hyperkalemia--Tissue destruction (electrical burns ATN kidney damage can’t filter out K)
• Dysrhythmias, muscle weakness

Front 597

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
a. Alterations in Electrolytes--potential for all sorts of shifting (know K and Na values)
iii. Hyperkalemia--Tissue destruction (electrical burns ATN kidney damage can’t filter out ----------)
• ------------, muscle weakness

Back 597

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
a. Alterations in Electrolytes--potential for all sorts of shifting (know K and Na values)
iii. Hyperkalemia--Tissue destruction (electrical burns ATN kidney damage can’t filter out K)
• Dysrhythmias, muscle weakness

Front 598

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
a. Alterations in Electrolytes--potential for all sorts of shifting (know K and Na values)
iv. Hypokalemia--excess hydrotherapy, -------------, ------------ suction, wound -----------
• Dysrhythmias

Back 598

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
a. Alterations in Electrolytes--potential for all sorts of shifting (know K and Na values)
iv. Hypokalemia--excess hydrotherapy, vomiting, GI suction, wound drainage
• Dysrhythmias

Front 599

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
b. Infections--often gram (-) -------------- (leading death cause in hospitalized burn pts)

Back 599

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
b. Infections--often gram (-) pseudomonas (leading death cause in hospitalized burn pts)

Front 600

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
b. Infections--often gram (-) pseudomonas (leading death cause in hospitalized burn pts)
i. Risk factors: >---------% full thickness burns, children, ------------, preexisting disease

Back 600

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
b. Infections--often gram (-) pseudomonas (leading death cause in hospitalized burn pts)
i. Risk factors: >30% full thickness burns, children, elderly, preexisting disease

Front 601

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
b. Infections--often gram (-) pseudomonas (leading death cause in hospitalized burn pts)
ii. ↑---------, ↑HR, ↑---------, ↓BP, ↓--------- output, mild confusion, ---------, ↓appetite, WBCs 10-20,000 (pt becomes immunosuppressed) can spread to blood (sepsis)

Back 601

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
b. Infections--often gram (-) pseudomonas (leading death cause in hospitalized burn pts)
ii. ↑temp, ↑HR, ↑RR, ↓BP, ↓urine output, mild confusion, chills, ↓appetite, WBCs 10-20,000 (pt becomes immunosuppressed) can spread to blood (sepsis)

Front 602

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
b. Infections--often gram (-) pseudomonas (leading death cause in hospitalized burn pts)
ii. ↑temp, ↑----------, ↑RR, ↓BP, ↓urine output, ----------- confusion, chills, ↓-------------, WBCs 10-20,000 (pt becomes immunosuppressed) can spread to blood (-----------)

Back 602

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
b. Infections--often gram (-) pseudomonas (leading death cause in hospitalized burn pts)
ii. ↑temp, ↑HR, ↑RR, ↓BP, ↓urine output, mild confusion, chills, ↓appetite, WBCs 10-20,000 (pt becomes immunosuppressed) can spread to blood (sepsis)

Front 603

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
b. Infections--often gram (-) pseudomonas (leading death cause in hospitalized burn pts)
ii. ↑temp, ↑HR, ↑RR, ↓BP, ↓urine output, mild confusion, chills, ↓appetite, WBCs 10-_________ (pt becomes immunosuppressed) can spread to blood (sepsis)

Back 603

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
b. Infections--often gram (-) pseudomonas (leading death cause in hospitalized burn pts)
ii. ↑temp, ↑HR, ↑RR, ↓BP, ↓urine output, mild confusion, chills, ↓appetite, WBCs 10-20,000 (pt becomes immunosuppressed) can spread to blood (sepsis)

Front 604

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
b. Infections--often gram (-) pseudomonas (leading death cause in hospitalized burn pts)
iii. Burn can worsen--2nd degree can convert to ----------- degree

Back 604

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
b. Infections--often gram (-) pseudomonas (leading death cause in hospitalized burn pts)
iii. Burn can worsen--2nd degree can convert to 3rd degree

Front 605

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
b. Infections--often gram (-) pseudomonas (leading death cause in hospitalized burn pts)
iv. Treatment--remove -------------- tissue early and wound ------------ as soon as possible

Back 605

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
b. Infections--often gram (-) pseudomonas (leading death cause in hospitalized burn pts)
iv. Treatment--remove necrotic tissue early and wound closure as soon as possible

Front 606

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
b. Infections--often gram (-) pseudomonas (leading death cause in hospitalized burn pts)
iv. Treatment--remove necrotic tissue early and wound closure as soon as possible
• IV antibiotics not given unless pt is truly ------------- (can create resistance)
• ------------ everything if sepsis is suspected

Back 606

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
b. Infections--often gram (-) pseudomonas (leading death cause in hospitalized burn pts)
iv. Treatment--remove necrotic tissue early and wound closure as soon as possible
• IV antibiotics not given unless pt is truly septic (can create resistance)
• Culture everything if sepsis is suspected

Front 607

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
c. Neurologic--extreme disorientation
i. ---------------- if no underlying cause of confusion (---------------’s Syndrome)

Back 607

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
c. Neurologic--extreme disorientation
i. ICU psychosis if no underlying cause of confusion (Sundowner’s Syndrome)

Front 608

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
d. Musculoskeletal--prevention of --------------- (frequent ----------, make pt/family aware)

Back 608

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
d. Musculoskeletal--prevention of contractions (frequent ROB, make pt/family aware)

Front 609

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
e. G__________
i. IV antibiotics and -------------- can cause diarrhea

Back 609

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
e. Gastrointestinal
i. IV antibiotics and tube feedings can cause diarrhea

Front 610

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
e. Gastrointestinal
ii. Too much ----------- + ------------ ↓motility constipation

Back 610

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
e. Gastrointestinal
ii. Too much narcotics + bed rest ↓motility constipation

Front 611

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
e. Gastrointestinal
iii. High risk for _________--↓blood flow to ________ track (_________’s ulcer-burn specific)

Back 611

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
e. Gastrointestinal
iii. High risk for ulcers--↓blood flow to GI track (Curling’s ulcer-burn specific)

Front 612

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
e. Gastrointestinal
• Tx w/ ___________, -__________-blocker (Zantac, etc.)

Back 612

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
e. Gastrointestinal
• Tx w/ antacid, H2-blocker (Zantac, etc.)

Front 613

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
f. ___________--risk for ↑blood sugar (check frequently-often need ________ coverage)

Back 613

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
f. Endocrine--risk for ↑blood sugar (check frequently-often need insulin coverage)

Front 614

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
3. Skin Grafting
a. Biological Dressings--temp wound closure prevents ------------- -------------- protects ------------- tissue until autogafting is possible (will be rejected due to diff DNA)

Back 614

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
3. Skin Grafting
a. Biological Dressings--temp wound closure prevents infection fluid loss protects granulation tissue until autogafting is possible (will be rejected due to diff DNA)

Front 615

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
3. Skin Grafting
a. Biological Dressings--temp wound closure prevents infection fluid loss protects granulation tissue until autogafting is possible (will be rejected due to diff DNA)
• Used until ----------------- established (48hrs) and up to several weeks

Back 615

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
3. Skin Grafting
a. Biological Dressings--temp wound closure prevents infection fluid loss protects granulation tissue until autogafting is possible (will be rejected due to diff DNA)
• Used until revascularization established (48hrs) and up to several weeks

Front 616

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
3. Skin Grafting
a. Biological Dressings--temp wound closure prevents infection fluid loss protects granulation tissue until autogafting is possible (will be rejected due to diff DNA)
i. Homografts (--------------)--skin from --------- (skin bank-fresh or frozen)

Back 616

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
3. Skin Grafting
a. Biological Dressings--temp wound closure prevents infection fluid loss protects granulation tissue until autogafting is possible (will be rejected due to diff DNA)
i. Homografts (Allografts)--skin from humans (skin bank-fresh or frozen)

Front 617

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
3. Skin Grafting
a. Biological Dressings--temp wound closure prevents infection fluid loss protects granulation tissue until autogafting is possible (will be rejected due to diff DNA)
ii. Heterografts (-----------)--from ------------- (mostly pigs)

Back 617

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
3. Skin Grafting
a. Biological Dressings--temp wound closure prevents infection fluid loss protects granulation tissue until autogafting is possible (will be rejected due to diff DNA)
ii. Heterografts (xenografts)--from animals (mostly pigs)

Front 618

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
3. Skin Grafting
b. Synthetic Dressings (------------)--dermalayer becomes permanent part of ------------ (absorbed) and top later removed in ~______weeks when autograft is placed (less costly)

Back 618

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
3. Skin Grafting
b. Synthetic Dressings (Integra)--dermalayer becomes permanent part of wound (absorbed) and top later removed in ~2weeks when autograft is placed (less costly)

Front 619

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
3. Skin Grafting
c. Autograft--unburned skin removed w/ ------------ (donor site take _______-15days to heal)

Back 619

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
3. Skin Grafting
c. Autograft--unburned skin removed w/ dermatome (donor site take 10-15days to heal)

Front 620

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
3. Skin Grafting
c. Autograft--unburned skin removed w/ dermatome (donor site take 10-15days to heal)
i. Donor sites
ii. Cultured ---------------- autografts--pt w/out enough own skin (>----------% body need)

Back 620

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
3. Skin Grafting
c. Autograft--unburned skin removed w/ dermatome (donor site take 10-15days to heal)
i. Donor sites
ii. Cultured epithelial autografts--pt w/out enough own skin (>50% body need)

Front 621

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
3. Skin Grafting
c. Autograft--unburned skin removed w/ dermatome (donor site take 10-15days to heal)
• Remove skin sample and culture in medium w/ ------------- growth factor
• Takes _________-4 weeks for skin to grow (use __________ graft during this time)

Back 621

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
3. Skin Grafting
c. Autograft--unburned skin removed w/ dermatome (donor site take 10-15days to heal)
• Remove skin sample and culture in medium w/ epidermal growth factor
• Takes 3-4 weeks for skin to grow (use temporary graft during this time)

Front 622

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
4. Nursing Management
a. Wound Management/Care
i. Cleanse and ----------- to prevent bacterial growth
ii. Minimize further destruction of ----------- skin
iii. Promote wound ----------------/successful skin grafting

Back 622

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
4. Nursing Management
a. Wound Management/Care
i. Cleanse and debride to prevent bacterial growth
ii. Minimize further destruction of viable skin
iii. Promote wound reepithelialization/successful skin grafting

Front 623

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
4. Nursing Management
b. Pain management--PCA (document effectiveness and assess for changes)
i. ----------------- methods esp. useful in burn (distractions, visualization, etc.)

Back 623

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
4. Nursing Management
b. Pain management--PCA (document effectiveness and assess for changes)
i. Nonpharmacologic methods esp. useful in burn (distractions, visualization, etc.)

Front 624

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
4. Nursing Management
c. PT and OT--prevents ------------- (get pt family involved)

Back 624

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
4. Nursing Management
c. PT and OT--prevents contractures (get pt family involved)

Front 625

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
4. Nursing Management
d. Nutritional therapy--hypermetabolic ---------------- state worsens w/ anxiety/pain
i. Need nutrition consultation (need food w/in -----------hrs)

Back 625

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
4. Nursing Management
d. Nutritional therapy--hypermetabolic hypercatabolic state worsens w/ anxiety/pain
i. Need nutrition consultation (need food w/in 72hrs)

Front 626

Burns
VI. Phases
C. Rehabilitation Phase--wounds are healed/grafts are in place
1. Scar control--prevent hypertrophic scaring due to ↑------------ deposit
a. Apply pressure garments (-----------hr/day for 1-2yrs until complete healing) to scar and ---------------- to prevent collagen deposit and keep scar fat

Back 626

Burns
VI. Phases
C. Rehabilitation Phase--wounds are healed/grafts are in place
1. Scar control--prevent hypertrophic scaring due to ↑collagen deposit
a. Apply pressure garments (23hr/day for 1-2yrs until complete healing) to scar and massage to prevent collagen deposit and keep scar fat

Front 627

Burns
VI. Phases
C. Rehabilitation Phase--wounds are healed/grafts are in place
1. Scar control--prevent hypertrophic scaring due to ↑collagen deposit
b. Keep out of sun for ----------yr (to prevent ---------------)

Back 627

Burns
VI. Phases
C. Rehabilitation Phase--wounds are healed/grafts are in place
1. Scar control--prevent hypertrophic scaring due to ↑collagen deposit
b. Keep out of sun for 1yr (to prevent hyperpigmentation)

Front 628

Burns
VI. Phases
C. Rehabilitation Phase--wounds are healed/grafts are in place
2. Prevent ___________--need PT, splinting, exercise/positioning
a. Occur due to tendons shortening and CT replaced by scar tissue limits mobility

Back 628

Burns
VI. Phases
C. Rehabilitation Phase--wounds are healed/grafts are in place
2. Prevent contractures--need PT, splinting, exercise/positioning
a. Occur due to tendons shortening and CT replaced by scar tissue limits mobility

Front 629

Burns
VI. Phases
C. Rehabilitation Phase--wounds are healed/grafts are in place
2. Prevent contractures--need PT, splinting, exercise/positioning
a. Occur due to tendons--------------- and CT replaced by ------------ limits mobility

Back 629

Burns
VI. Phases
C. Rehabilitation Phase--wounds are healed/grafts are in place
2. Prevent contractures--need PT, splinting, exercise/positioning
a. Occur due to tendons shortening and CT replaced by scar tissue limits mobility

Front 630

Burns
VII. Psychosocial Care--very important
A. Physical and ------------- scars (array of emotions)
B. Team effort--support from nurses, -------------, PT, OT, ------------ workers

Back 630

Burns
VII. Psychosocial Care--very important
A. Physical and emotional scars (array of emotions)
B. Team effort--support from nurses, physicians, PT, OT, social workers

Front 631

Burns
VII. Psychosocial Care--very important
C. Family and patient ------------ groups
D. Psychiatric treatment--__________

Back 631

Burns
VII. Psychosocial Care--very important
C. Family and patient support groups
D. Psychiatric treatment--depression

Front 632

Burns
VII. Psychosocial Care--very important
E. Nursing diagnosis--disturbed body image related to --------------- secondary to burn
1. Goal--pt sets realistic goals regarding ------------ lifestyle
2. Goal--acceptance of ----------- body image

Back 632

Burns
VII. Psychosocial Care--very important
E. Nursing diagnosis--disturbed body image related to disfigurement secondary to burn
1. Goal--pt sets realistic goals regarding future lifestyle
2. Goal--acceptance of altered body image

Front 633

Shock
I. Definition--syndrome characterized by ↓--------- perfusion and impaired --------------- (imbalance btw supply and demand for O2 and nutrients)

Back 633

Shock
I. Definition--syndrome characterized by ↓tissue perfusion and impaired cellular metabolism (imbalance btw supply and demand for O2 and nutrients)

Front 634

Shock
II. Low Blood Flow Shock
A. Cardiogenic--systolic/diastolic myocardium dysfunction compromised CO cell hypoperfusion
1. Types (mortality rates 50-______%)
a. Systolic--heart can’t pump blood _________ (L ventricle problem)
b. Diastolic--heart can’t relax and get enough preload (cardiac tamppnade)

Back 634

Shock
II. Low Blood Flow Shock
A. Cardiogenic--systolic/diastolic myocardium dysfunction compromised CO cell hypoperfusion
1. Types (mortality rates 50-80%)
a. Systolic--heart can’t pump blood forward (L ventricle problem)

Front 635

Shock
II. Low Blood Flow Shock
A. Cardiogenic--systolic/diastolic myocardium dysfunction compromised CO cell hypoperfusion
1. Types (mortality rates 50-80%)
a. Systolic--heart can’t pump blood forward (L ventricle problem)
b. Diastolic--heart can’t relax and get enough ---------- (cardiac -----------)
**Can have occurance w/ ---------- ventricle if it is severe enough

Back 635

Shock
II. Low Blood Flow Shock
A. Cardiogenic--systolic/diastolic myocardium dysfunction compromised CO cell hypoperfusion
1. Types (mortality rates 50-80%)
a. Systolic--heart can’t pump blood forward (L ventricle problem)
b. Diastolic--heart can’t relax and get enough preload (cardiac tamppnade)
**Can have occurance w/ R ventricle if it is severe enough

Front 636

Shock
II. Low Blood Flow Shock
A. Cardiogenic-
2. Causes
a. MI--dysrhythmias and ------------- muscles rupture (5-______% pts develop shock w/in 48hrs)
b. Cardiomyopathy--viral --------- failure

Back 636

Shock
II. Low Blood Flow Shock
A. Cardiogenic-
2. Causes
a. MI--dysrhythmias and papillary muscles rupture (5-10% pts develop shock w/in 48hrs)
b. Cardiomyopathy--viral heart failure

Front 637

Shock
II. Low Blood Flow Shock
A. Cardiogenic-
2. Causes
c. ----------- (L ventricular dysfunction) or ------------ (R ventricular dysfunction) HTN
d. Blunt -------------- injury--briusing of heart

Back 637

Shock
II. Low Blood Flow Shock
A. Cardiogenic-
2. Causes
c. Systemic (L ventricular dysfunction) or Pulmonary (R ventricular dysfunction) HTN
d. Blunt cardiac injury--briusing of heart

Front 638

Shock
II. Low Blood Flow Shock
A. Cardiogenic-
2. Causes
e. Myocardial ------------ from sepsis--inflammatory markers release (TNF) ↓--------, ↓--------

Back 638

Shock
II. Low Blood Flow Shock
2. Causes
e. Myocardial depression from sepsis--inflammatory markers release (TNF) ↓SV, ↓CO

Front 639

Shock
II. Low Blood Flow Shock
A. Cardiogenic-
3. Clinical Manifestations--similar to ----------- failure

Back 639

Shock
II. Low Blood Flow Shock
3. Clinical Manifestations--similar to acute heart failure

Front 640

Shock
II. Low Blood Flow Shock
A. Cardiogenic-
3. Clinical Manifestations--similar to acute heart failure
a. ↑----------, ↓---------- w. narrowed pulse pressure

Back 640

Shock
II. Low Blood Flow Shock
3. Clinical Manifestations--similar to acute heart failure
a. ↑HR, ↓BP w. narrowed pulse pressure
b. Tachypneic w/ crackles on auscultation

Front 641

Shock
II. Low Blood Flow Shock
A. Cardiogenic-
3. Clinical Manifestations--similar to acute heart failure
b. -------------- w/ crackles on auscultation

Back 641

Shock
II. Low Blood Flow Shock
3. Clinical Manifestations--similar to acute heart failure
b. Tachypneic w/ crackles on auscultation

Front 642

Shock
II. Low Blood Flow Shock
A. Cardiogenic-
3. Clinical Manifestations--similar to acute heart failure
c. Signs of peripheral ------------- (cyanosis, -----------, ↓cap refill)

Back 642

Shock
II. Low Blood Flow Shock
3. Clinical Manifestations--similar to acute heart failure
c. Signs of peripheral hypoperfusion (cyanosis, pallor, ↓cap refill)

Front 643

Shock
II. Low Blood Flow Shock
A. Cardiogenic-
3. Clinical Manifestations--similar to acute heart failure
d. Hemodynamic findings (↑----------, ↑PVR, ↓-------, ↑-------: due to body clamping down)

Back 643

Shock
II. Low Blood Flow Shock
3. Clinical Manifestations--similar to acute heart failure
d. Hemodynamic findings (↑PAWP, ↑PVR, ↓CO, ↑SVR-due to body clamping down)

Front 644

Shock
II. Low Blood Flow Shock
A. Cardiogenic-
3. Clinical Manifestations--similar to acute heart failure
e. ↓------- output (↓-------- perfusion)

Back 644

Shock
II. Low Blood Flow Shock
3. Clinical Manifestations--similar to acute heart failure
e. ↓Urine output (↓renal perfusion)

Front 645

Shock
II. Low Blood Flow Shock
A. Cardiogenic-
3. Clinical Manifestations--similar to acute heart failure
f. ---------- and water retention (renin-_________-aldosterone activation)

Back 645

Shock
II. Low Blood Flow Shock
3. Clinical Manifestations--similar to acute heart failure
f. Na and water retention (renin-angiotensin-aldosterone activation)

Front 646

Shock
II. Low Blood Flow Shock
A. Cardiogenic-
3. Clinical Manifestations--similar to acute heart failure
g. Confusion and ----------

Back 646

Shock
II. Low Blood Flow Shock
3. Clinical Manifestations--similar to acute heart failure
g. Confusion and anxiety

Front 647

Shock
II. Low Blood Flow Shock
A. Cardiogenic-
3. Diagnostic Studies
a. Cardiac _________
b. E_______

Back 647

Shock
II. Low Blood Flow Shock
3. Diagnostic Studies
a. Cardiac enzymes
b. EKG

Front 648

Shock
II. Low Blood Flow Shock
A. Cardiogenic-
3. Diagnostic Studies
c. C______
d. _________--valular dysfunction and EF

Back 648

Shock
II. Low Blood Flow Shock
3. Diagnostic Studies
c. CXR
d. ECHO--valular dysfunction and EF

Front 649

Shock
II. Low Blood Flow Shock
A. Cardiogenic-
3. Diagnostic Studies
e. Insertion of _________--monitor fluid status
f. Emergent __________

Back 649

Shock
II. Low Blood Flow Shock
A. Cardiogenic-
3. Diagnostic Studies
e. Insertion of PA catheter--monitor fluid status
f. Emergent catheterization

Front 650

Shock
II. Low Blood Flow Shock
B. ____________--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.

Back 650

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.

Front 651

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss ------------- to rapid blood loss (internal or external) low blood flow ↓---------- return ↓tissue ------------/impaired cell met.

Back 651

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.

Front 652

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
1. -------------- loss--true loss of fluid from vascular space (hemorrhage, vomiting, diarrhea)

Back 652

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
1. Absolute loss--true loss of fluid from vascular space (hemorrhage, vomiting, diarrhea)

Front 653

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
1. Absolute loss--true loss of fluid from vascular space (-----------, vomiting, ----------)

Back 653

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
1. Absolute loss--true loss of fluid from vascular space (hemorrhage, vomiting, diarrhea)

Front 654

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
2. Relative loss--fluid there but moved elsewhere from ↑---------- in burn/sepsis (---------- spacing)

Back 654

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
2. Relative loss--fluid there but moved elsewhere from ↑cap perm. in burn/sepsis (2nd spacing)

Front 655

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
3. Ability to compensate (if <---------% loss body is able to compensate w/out ---------- symptoms)

Back 655

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
3. Ability to compensate (if <15% loss body is able to compensate w/out outward symptoms)

Front 656

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
3. Ability to compensate (if <15% loss body is able to compensate w/out outward symptoms)
a. 15-______%--sympathetic venous system response
b. >_____% loss--volume must be replaced with blood

Back 656

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
3. Ability to compensate (if <15% loss body is able to compensate w/out outward symptoms)
a. 15-30%--sympathetic venous system response
b. >30% loss--volume must be replaced with blood

Front 657

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
3. Ability to compensate (if <15% loss body is able to compensate w/out outward symptoms)
a. 15-30%--sympathetic ------------ system response
b. >30% loss--volume must be replaced with -----------

Back 657

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
3. Ability to compensate (if <15% loss body is able to compensate w/out outward symptoms)
a. 15-30%--sympathetic venous system response
b. >30% loss--volume must be replaced with blood

Front 658

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
3. Ability to compensate (if <15% loss body is able to compensate w/out outward symptoms)
c. >_____% loss--irreversible damage to tissues

Back 658

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
3. Ability to compensate (if <15% loss body is able to compensate w/out outward symptoms)
c. >40% loss--irreversible damage to tissues

Front 659

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
3. Ability to compensate (if <15% loss body is able to compensate w/out outward symptoms)
c. >40% loss--irreversible damage to --------

Back 659

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
3. Ability to compensate (if <15% loss body is able to compensate w/out outward symptoms)
c. >40% loss--irreversible damage to tissues

Front 660

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
3. Causes
a. _______--external penetrating
b. Severe ______ bleeding--2nd main cause

Back 660

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
3. Causes
a. Trauma--external penetrating
b. Severe GI bleeding--2nd main cause

Front 661

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
3. Causes
c. ----------- pregnancy
d. ------------ fracture

Back 661

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
3. Causes
c. Ectopic pregnancy
d. Pelvic fracture

Front 662

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
3. Causes
d. Pelvic fracture
e. ---------- obstruction--fluid in colon
f. Ascites due to --------- dysfunction

Back 662

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
3. Causes
d. Pelvic fracture
e. Colon obstruction--fluid in colon
f. Ascites due to liver dysfunction

Front 663

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
4. Clinical Manifestations--result of ------------- mechanisms (can support BP if <---------% loss)

Back 663

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
4. Clinical Manifestations--result of compensatory mechanisms (can support BP if <30% loss)

Front 664

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
4. Clinical Manifestations--result of compensatory mechanisms (can support BP if <30% loss)
a. Initial symptoms--_________
i. ↑______ (careful b/c some meds keep HR lower than expected--blunting effect)

Back 664

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
4. Clinical Manifestations--result of compensatory mechanisms (can support BP if <30% loss)
a. Initial symptoms--compensating
i. ↑HR (careful b/c some meds keep HR lower than expected--blunting effect)

Front 665

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
4. Clinical Manifestations--result of compensatory mechanisms (can support BP if <30% loss)
a. Initial symptoms--compensating
ii. ↑--------
iii. ↑------- (not a pump problem)

Back 665

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
4. Clinical Manifestations--result of compensatory mechanisms (can support BP if <30% loss)
a. Initial symptoms--compensating
ii. ↑RR
iii. ↑CO (not a pump problem)

Front 666

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
4. Clinical Manifestations--result of compensatory mechanisms (can support BP if <30% loss)
a. Initial symptoms--compensating
iv. ↓-------- (due to ↑HR) and ↓----------

Back 666

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
4. Clinical Manifestations--result of compensatory mechanisms (can support BP if <30% loss)
a. Initial symptoms--compensating
iv. ↓SV (due to ↑HR) and ↓PCWP

Front 667

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
4. Clinical Manifestations--result of compensatory mechanisms (can support BP if <30% loss)
b. Later symptoms--as compensatory mechanisms fail
i. ↓---------
ii, ↓-------- output
iii. Skin --------, cool, clammy

Back 667

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
4. Clinical Manifestations--result of compensatory mechanisms (can support BP if <30% loss)
b. Later symptoms--as compensatory mechanisms fail
i. ↓CO
ii, ↓urine output
iii. Skin pale, cool, clammy

Front 668

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
5. Diagnostic Studies
a. Hg/______--initially normal (get ________) ↓ after give fluids (reflection of actual values)

Back 668

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
5. Diagnostic Studies
a. Hg/Ht--initially normal (get baseline) ↓ after give fluids (reflection of actual values)

Front 669

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
5. Diagnostic Studies
a. Hg/Ht--initially normal (get baseline) ↓ after give ------------ (reflection of ----------- values)

Back 669

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
5. Diagnostic Studies
a. Hg/Ht--initially normal (get baseline) ↓ after give fluids (reflection of actual values)

Front 670

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
5. Diagnostic Studies
b. Urine--↓--------- output (↓------------ perfusion), ↑specific ---------- (renin-aldosterone release)

Back 670

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
5. Diagnostic Studies
b. Urine--↓urine output (↓kidney perfusion), ↑specific gravity (renin-aldosterone release)

Front 671

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
5. Diagnostic Studies
c. Elevated lactic acid levels--acidotic due to ----------- metabolism in tissue from ↓--------

Back 671

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
5. Diagnostic Studies
c. Elevated lactic acid levels--acidotic due to anaerobic metabolism in tissue from ↓O2

Front 672

Shock
III. Misdistribution of Blood Flow Shock
A. ____________--hemodynamic phenomenon that occurs after spinal cord injury at or above T5 resulting in massive vasodilation w/out compensation (onset can occur in 30min and last up to 6 weeks)

Back 672

Shock
III. Misdistribution of Blood Flow Shock
A. Neurogenic--hemodynamic phenomenon that occurs after spinal cord injury at or above T5 resulting in massive vasodilation w/out compensation (onset can occur in 30min and last up to 6 weeks)

Front 673

Shock
III. Misdistribution of Blood Flow Shock
A. Neurogenic--hemodynamic phenomenon that occurs after ------------- injury at or above --------- resulting in massive vasodilation w/out compensation (onset can occur in --------min and last up to 6 weeks)

Back 673

Shock
III. Misdistribution of Blood Flow Shock
A. Neurogenic--hemodynamic phenomenon that occurs after spinal cord injury at or above T5 resulting in massive vasodilation w/out compensation (onset can occur in 30min and last up to 6 weeks)

Front 674

Shock
III. Misdistribution of Blood Flow Shock
A. Neurogenic--
1. Causes--loss of ----------- vasoconstrictor tone pooling of blood in vessels

Back 674

Shock
III. Misdistribution of Blood Flow Shock
A. Neurogenic--
1. Causes--loss of SNS vasoconstrictor tone pooling of blood in vessels

Front 675

Shock
III. Misdistribution of Blood Flow Shock
A. Neurogenic--
1. Causes--loss of SNS vasoconstrictor tone pooling of blood in vessels
a. ----------- injury
b. ----------- anesthesia
c. Drugs: --------------

Back 675

Shock
III. Misdistribution of Blood Flow Shock
A. Neurogenic--
1. Causes--loss of SNS vasoconstrictor tone pooling of blood in vessels
a. Spinal cord injury
b. Spinal anesthesia
c. Drugs--benzodiazepines

Front 676

Shock
III. Misdistribution of Blood Flow Shock
A. Neurogenic--
2. Clinical Manifestations
a. H_________
b. ↓________ (no compensation) ↓_____ (PNS takes over b/c no SNS stimulation)

Back 676

Shock
III. Misdistribution of Blood Flow Shock
A. Neurogenic--
2. Clinical Manifestations
a. Hypotension
b. ↓HR (no compensation) ↓CO (PNS takes over b/c no SNS stimulation)

Front 677

Shock
III. Misdistribution of Blood Flow Shock
A. Neurogenic--
2. Clinical Manifestations
c. ---------------- (take on room’s temp) due to hypothalamic dysfunction (can’t regulate)

Back 677

Shock
III. Misdistribution of Blood Flow Shock
A. Neurogenic--
2. Clinical Manifestations
c. Poikilpthermia (take on room’s temp) due to hypothalamic dysfunction (can’t regulate)

Front 678

Shock
III. Misdistribution of Blood Flow Shock
A. Neurogenic--
2. Clinical Manifestations
c. Poikilpthermia (take on room’s temp) due to hypothalamic dysfunction (can’t regulate)
i. Massive ----------- (often cold)

Back 678

i. Massive dilation (often cold)

Front 679

Shock
III. Misdistribution of Blood Flow Shock
B. Septic--presence of sepsis w/ ----------- despite fluid resuscitation w/ presence of tissue ---------- abnormalities (mortality rates 28-50%)

Back 679

Shock
III. Misdistribution of Blood Flow Shock
B. Septic--presence of sepsis w/ hypotension despite fluid resuscitation w/ presence of tissue perfusion abnormalities (mortality rates 28-50%)

Front 680

Shock
III. Misdistribution of Blood Flow Shock
B. Septic--presence of sepsis w/ hypotension despite fluid resuscitation w/ presence of tissue perfusion abnormalities (mortality rates 28-____%)

Back 680

Shock
III. Misdistribution of Blood Flow Shock
B. Septic--presence of sepsis w/ hypotension despite fluid resuscitation w/ presence of tissue perfusion abnormalities (mortality rates 28-50%)

Front 681

Shock
III. Misdistribution of Blood Flow Shock
B. Septic--presence of sepsis w/ hypotension despite fluid resuscitation w/ presence of tissue perfusion abnormalities (mortality rates 28-50%)
1. Sepsis--systemic inflammatory response to a documented/suspected --------

Back 681

Shock
III. Misdistribution of Blood Flow Shock
B. Septic--presence of sepsis w/ hypotension despite fluid resuscitation w/ presence of tissue perfusion abnormalities (mortality rates 28-50%)
1. Sepsis--systemic inflammatory response to a documented/suspected infection

Front 682

Shock
III. Misdistribution of Blood Flow Shock
2. Pathophysiology--caused mostly --------- (-) bacteria (higher ---------- rates)

Back 682

Shock
III. Misdistribution of Blood Flow Shock
2. Pathophysiology--caused mostly gram (-) bacteria (higher mortality rates)

Front 683

Shock
III. Misdistribution of Blood Flow Shock
2. Pathophysiology--
a. Release of --------- inflammatory response ↑cap ------------ and vasodilation

Back 683

Shock
III. Misdistribution of Blood Flow Shock
2. Pathophysiology--
a. Release of endotoxins inflammatory response ↑cap permeability and vasodilation

Front 684

Shock
III. Misdistribution of Blood Flow Shock
2. Pathophysiology--
b. Microthrombi ------------- intravascular ------------- (DIC)

Back 684

Shock
III. Misdistribution of Blood Flow Shock
2. Pathophysiology--
b. Microthrombi disseminated intravascular coagulation (DIC)

Front 685

Shock
III. Misdistribution of Blood Flow Shock
2. Pathophysiology--
c. Pts are in---------------- state (like burns)

Back 685

Shock
III. Misdistribution of Blood Flow Shock
2. Pathophysiology--
c. Pts are in hypermetabolic state (like burns)

Front 686

Shock
III. Misdistribution of Blood Flow Shock
3. Clinical Manifestations--systemic response (everything just starts to ----------)

Back 686

Shock
III. Misdistribution of Blood Flow Shock
3. Clinical Manifestations--systemic response (everything just starts to shut down)

Front 687

Shock
III. Misdistribution of Blood Flow Shock
a. Alteration in --------- status (early)

Back 687

Shock
III. Misdistribution of Blood Flow Shock
a. Alteration in mental status (early)

Front 688

Shock
III. Misdistribution of Blood Flow Shock
b. Skin warm and flushed--due to --------------- (early)

Back 688

Shock
III. Misdistribution of Blood Flow Shock
b. Skin warm and flushed--due to vasodilation (early)

Front 689

Shock
III. Misdistribution of Blood Flow Shock
d. Significant ↑_______--overcompensation (early)

Back 689

Shock
III. Misdistribution of Blood Flow Shock
d. Significant ↑CO--overcompensation (early)

Front 690

Shock
III. Misdistribution of Blood Flow Shock
e. ↑_______2--tissues not properly utilizing available O2 seen w/ pulmonary catheter (early)

Back 690

Shock
III. Misdistribution of Blood Flow Shock
e. ↑SvO2--tissues not properly utilizing available O2 seen w/ pulmonary catheter (early)

Front 691

Shock
III. Misdistribution of Blood Flow Shock
e. ↑SvO2--tissues not properly utilizing available --------2 seen w/ ---------- catheter (early)

Back 691

Shock
III. Misdistribution of Blood Flow Shock
e. ↑SvO2--tissues not properly utilizing available O2 seen w/ pulmonary catheter (early)

Front 692

Shock
III. Misdistribution of Blood Flow Shock
f. ↓_____--dilation

Back 692

Shock
III. Misdistribution of Blood Flow Shock
f. ↓SVR--dilation

Front 693

Shock
III. Misdistribution of Blood Flow Shock
g. H_________
h. GI bleeding/_________ ileus

Back 693

Shock
III. Misdistribution of Blood Flow Shock
g. Hypotension
h. GI bleeding/paralytic ileus

Front 694

Shock
III. Misdistribution of Blood Flow Shock
i. Hypoxemia w/ resp failure/ARDS (_____% will go on to resp failure and ______% to ARDS)

Back 694

Shock
III. Misdistribution of Blood Flow Shock
i. Hypoxemia w/ resp failure/ARDS (85% will go on to resp failure and 40% to ARDS)

Front 695

Shock
III. Misdistribution of Blood Flow Shock
i. ---------- w/ resp failure/ARDS (85% will go on to resp failure and 40% to ARDS)

Back 695

Shock
III. Misdistribution of Blood Flow Shock
j. ↓------- (late) ↓---------- output; skin cool (clamping down) and mottled (very late)

Front 696

Shock
III. Misdistribution of Blood Flow Shock
C. Anaphylactic--acute, life-threatening - (allergic) reaction to sensitizing substance resulting in massive ------------, release of vasoactive -------------, and ↑-------------- permeability

Back 696

III. Misdistribution of Blood Flow Shock
C. Anaphylactic--acute, life-threatening hypersensitivity (allergic) reaction to sensitizing substance resulting in massive vasodilation, release of vasoactive mediators, and ↑capillary permeability

Front 697

Shock
III. Misdistribution of Blood Flow Shock
C. Anaphylactic
1. Causes--Drug (also IV drug infusions), ------------, vaccine, --------, or insect ---------

Back 697

III. Misdistribution of Blood Flow Shock
C. Anaphylactic
1. Causes--Drug (also IV drug infusions), chemical, vaccine, food, or insect venom

Front 698

Shock
III. Misdistribution of Blood Flow Shock
C. Anaphylactic
2. Clinical Manifestations--sudden onset
a. Hypotension, ----------

Back 698

III. Misdistribution of Blood Flow Shock
C. Anaphylactic
2. Clinical Manifestations--sudden onset
a. Hypotension, chest pain

Front 699

Shock
III. Misdistribution of Blood Flow Shock
C. Anaphylactic
2. Clinical Manifestations--sudden onset
b. Swelling of ------- and --------

Back 699

III. Misdistribution of Blood Flow Shock
C. Anaphylactic
2. Clinical Manifestations--sudden onset
b. Swelling of lips and tongue

Front 700

Shock
III. Misdistribution of Blood Flow Shock
C. Anaphylactic
2. Clinical Manifestations--sudden onset
c. Wheezing and stridor due to ------------ edema and --------------- resp distress

Back 700

III. Misdistribution of Blood Flow Shock
C. Anaphylactic
2. Clinical Manifestations--sudden onset
c. Wheezing and stridor due to laryngeal edema and bronchoconstriction resp distress

Front 701

Shock
III. Misdistribution of Blood Flow Shock
C. Anaphylactic
2. Clinical Manifestations--sudden onset
d. Skin--flushing, ----------, --------

Back 701

III. Misdistribution of Blood Flow Shock
C. Anaphylactic
2. Clinical Manifestations--sudden onset
d. Skin--flushing, pruritus, uticaria

Front 702

Shock
III. Misdistribution of Blood Flow Shock
C. Anaphylactic
2. Clinical Manifestations--sudden onset
e. A________
f. Edema from fluid leaking into _______

Back 702

III. Misdistribution of Blood Flow Shock
C. Anaphylactic
2. Clinical Manifestations--sudden onset
e. Angioedema
f. Edema from fluid leaking into interstitial space

Front 703

Shock
III. Misdistribution of Blood Flow Shock
C. Anaphylactic
3. Patient education--find cause of -----------, carry -------- pen, and wear --------- bracelet

Back 703

III. Misdistribution of Blood Flow Shock
C. Anaphylactic
3. Patient education--find cause of allergy, carry epi pen, and wear med alert bracelet

Front 704

Shock
IV. Stages
A. Initial Stage--body responding at cellular level by utilizing ---------- metabolism (no outward signs)

Back 704

Shock
IV. Stages
A. Initial Stage--body responding at cellular level by utilizing anaerobic metabolism (no outward signs)

Front 705

Shock
IV. Stages
B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain ---------

Back 705

Shock
IV. Stages
B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis

Front 706

Shock
IV. Stages
B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis
1. If recovery occurs at this stage little ---------- done

Back 706

Shock
IV. Stages
B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis
1. If recovery occurs at this stage little damage done

Front 707

Shock
IV. Stages
B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis
2. Clinical Manifestations--reflect body’s response to imbalance in -----------2 supply and demand (chemo and baroreceptros sense ↓--------- and attempt to raise it)

Back 707

Shock
IV. Stages
B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis
2. Clinical Manifestations--reflect body’s response to imbalance in O2 supply and demand (chemo and baroreceptros sense ↓BP and attempt to raise it)

Front 708

Shock
IV. Stages
B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis
2. Clinical Manifestations--reflect body’s response to imbalance in O2 supply and demand (chemo and baroreceptros sense ↓BP and attempt to raise it)
a. Neurogenic--subtle -----------, agitation, mild -------

Back 708

Shock
IV. Stages
B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis
2. Clinical Manifestations--reflect body’s response to imbalance in O2 supply and demand (chemo and baroreceptros sense ↓BP and attempt to raise it)
a. Neurogenic--subtle restlessness, agitation, mild ALOC

Front 709

Shock
IV. Stages
B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis
2. Clinical Manifestations--reflect body’s response to imbalance in O2 supply and demand (chemo and baroreceptros sense ↓BP and attempt to raise it
b. Cardiovascular--selective ------------ (norepinephrine) ↑-------- and contractility; ß-adrenergic stimulation dilate coronary arteries

Back 709

Shock
IV. Stages
B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis
2. Clinical Manifestations--reflect body’s response to imbalance in O2 supply and demand (chemo and baroreceptros sense ↓BP and attempt to raise it
b. Cardiovascular--selective vasoconstriction (norepinephrine) ↑HR and contractility; ß-adrenergic stimulation dilate coronary arteries

Front 710

Shock
IV. Stages
B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis
2. Clinical Manifestations--reflect body’s response to imbalance in O2 supply and demand (chemo and baroreceptros sense ↓BP and attempt to raise it
b. Cardiovascular--selective vasoconstriction (norepinephrine) ↑HR and contractility; ß----------- stimulation dilate ----------- arteries

Back 710

Shock
IV. Stages
B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis
2. Clinical Manifestations--reflect body’s response to imbalance in O2 supply and demand (chemo and baroreceptros sense ↓BP and attempt to raise it
b. Cardiovascular--selective vasoconstriction (norepinephrine) ↑HR and contractility; ß-adrenergic stimulation dilate coronary arteries

Front 711

Shock
IV. Stages
B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis
2. Clinical Manifestations--reflect body’s response to imbalance in O2 supply and demand (chemo and baroreceptros sense ↓BP and attempt to raise it
c. Respiratory--↑------------ dead space (some areas not leading to gas exchange) ------ mismatch ↑--------- and depth

Back 711

Shock
IV. Stages
B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis
2. Clinical Manifestations--reflect body’s response to imbalance in O2 supply and demand (chemo and baroreceptros sense ↓BP and attempt to raise it
c. Respiratory--↑physiological dead space (some areas not leading to gas exchange) VQ mismatch ↑RR and depth

Front 712

Shock
IV. Stages
B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis
2. Clinical Manifestations--reflect body’s response to imbalance in O2 supply and demand (chemo and baroreceptros sense ↓BP and attempt to raise it
d. GI--constriction ---------------- bowel sounds, ---------

Back 712

Shock
IV. Stages
B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis
2. Clinical Manifestations--reflect body’s response to imbalance in O2 supply and demand (chemo and baroreceptros sense ↓BP and attempt to raise it
d. GI--constriction hypoactive bowel sounds, ileus

Front 713

Shock
IV. Stages
B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis
2. Clinical Manifestations--reflect body’s response to imbalance in O2 supply and demand (chemo and baroreceptros sense ↓BP and attempt to raise it
e. Renal--vasoconstriction ↓------------ release of renin ↑---------

Back 713

Shock
IV. Stages
B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis
2. Clinical Manifestations--reflect body’s response to imbalance in O2 supply and demand (chemo and baroreceptros sense ↓BP and attempt to raise it
e. Renal--vasoconstriction ↓blood flow release of renin ↑aldosterone

Front 714

Shock
IV. Stages
B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis
2. Clinical Manifestations--reflect body’s response to imbalance in O2 supply and demand (chemo and baroreceptros sense ↓BP and attempt to raise it
e. Renal--vasoconstriction ↓blood flow release of renin ↑aldosterone
i. Renin --------------- 1 2 (most potent vasoconstrictor in body) Aldosterone (retains -------)

Back 714

Shock
IV. Stages
B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis
2. Clinical Manifestations--reflect body’s response to imbalance in O2 supply and demand (chemo and baroreceptros sense ↓BP and attempt to raise it
e. Renal--vasoconstriction ↓blood flow release of renin ↑aldosterone
i. Renin Angiotensin 1 2 (most potent vasoconstrictor in body) Aldosterone (retains Na)

Front 715

Shock
IV. Stages
B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis
2. Clinical Manifestations--reflect body’s response to imbalance in O2 supply and demand (chemo and baroreceptros sense ↓BP and attempt to raise i
f. Temperature--not -------- finding
g. Skin--pale, ---------- (septic will be warm)

Back 715

Shock
IV. Stages
B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis
2. Clinical Manifestations--reflect body’s response to imbalance in O2 supply and demand (chemo and baroreceptros sense ↓BP and attempt to raise i
f. Temperature--not early finding
g. Skin--pale, cool (septic will be warm)

Front 716

Shock
IV. Stages
B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis
2. Clinical Manifestations--reflect body’s response to imbalance in O2 supply and demand (chemo and baroreceptros sense ↓BP and attempt to raise
h. Labs--↓-----------2 and ------------ (due to ↑resp state)

Back 716

Shock
IV. Stages
B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis
2. Clinical Manifestations--reflect body’s response to imbalance in O2 supply and demand (chemo and baroreceptros sense ↓BP and attempt to raise
h. Labs--↓PaO2 and alkalosis (due to ↑resp state)

Front 717

Shock
IV. Stages
C. Progressive Stage--↓--------------- altered cap perm (begins as comp mechanisms fail)

Back 717

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail)

Front 718

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail)
1. Must be presence of ------------ cause

Back 718

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail)
1. Must be presence of precipitating cause

Front 719

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail)
2. Massive ---------- stimulation (compensatory mechanisms not working)

Back 719

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail)
2. Massive SNS stimulation (compensatory mechanisms not working)

Front 720

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
a. Neurologic--↓-------------- pressure ↓------------- blood flow listless, agitated, ↓ responsiveness to stimuli

Back 720

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
a. Neurologic--↓cerebral perfusion pressure ↓cerebral blood flow listless, agitated, ↓ responsiveness to stimuli

Front 721

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
a. Neurologic--↓cerebral perfusion pressure ↓cerebral blood flow listless, ------------, ↓ -------------- to stimuli

Back 721

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
a. Neurologic--↓cerebral perfusion pressure ↓cerebral blood flow listless, agitated, ↓ responsiveness to stimuli

Front 722

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
b. Respiratory--pulmonary arterioles constriction (to ↑--------) ↑------------ ↓---------- blood flow worsening VQ mismatch ↑cap perm interstitial edema alveolar edema ↓gas exchange tachypnea, crackles, ↓compliance

Back 722

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
b. Respiratory--pulmonary arterioles constriction (to ↑BP) ↑PAP ↓pulm blood flow worsening VQ mismatch ↑cap perm interstitial edema alveolar edema ↓gas exchange tachypnea, crackles, ↓compliance

Front 723

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
b. Respiratory--pulmonary arterioles constriction (to ↑BP) ↑PAP ↓pulm blood flow worsening ---------- mismatch ↑cap perm, -------------, -------- edema ↓gas exchange tachypnea, crackles, ↓compliance

Back 723

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
b. Respiratory--pulmonary arterioles constriction (to ↑BP) ↑PAP ↓pulm blood flow worsening VQ mismatch ↑cap perm interstitial edema alveolar edema ↓gas exchange tachypnea, crackles, ↓compliance

Front 724

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
b. Respiratory--pulmonary arterioles constriction (to ↑BP) ↑PAP ↓pulm blood flow worsening VQ mismatch ↑cap perm interstitial edema alveolar edema ↓gas exchange -----------, ----------, ↓----------

Back 724

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
b. Respiratory--pulmonary arterioles constriction (to ↑BP) ↑PAP ↓pulm blood flow worsening VQ mismatch ↑cap perm interstitial edema alveolar edema ↓gas exchange tachypnea, crackles, ↓compliance

Front 725

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
c. Cardiogenic--↑cap perm ↓-------------- and ↓---------------, progressive tissue --------- ß-adrenergic receptor stimulation CO begins to fail (heart can’t keep up) ↑HR ↓BP ↓peripheral perfusion (MAP) ↓coronary perfusion arrhythmias ischemia potential MI (can be nonatherosclerotic)

Back 725

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
c. Cardiogenic--↑cap perm ↓circulating volume and ↓myocardial function progressive tissue hypoxia ß-adrenergic receptor stimulation CO begins to fail (heart can’t keep up) ↑HR ↓BP ↓peripheral perfusion (MAP) ↓coronary perfusion arrhythmias ischemia potential MI (can be nonatherosclerotic)

Front 726

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
c. Cardiogenic--↑cap perm ↓circulating volume and ↓myocardial function progressive tissue hypoxia ß-adrenergic ------------- stimulation, ------- begins to fail (heart can’t keep up) ↑-------- ↓BP ↓peripheral perfusion (MAP) ↓coronary perfusion arrhythmias ischemia potential MI (can be nonatherosclerotic)

Back 726

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
c. Cardiogenic--↑cap perm ↓circulating volume and ↓myocardial function progressive tissue hypoxia ß-adrenergic receptor stimulation CO begins to fail (heart can’t keep up) ↑HR ↓BP ↓peripheral perfusion (MAP) ↓coronary perfusion arrhythmias ischemia potential MI (can be nonatherosclerotic)

Front 727

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
c. Cardiogenic--↑cap perm ↓circulating volume and ↓myocardial function progressive tissue hypoxia ß-adrenergic receptor stimulation CO begins to fail (heart can’t keep up) ↑HR ↓-------- ↓------------- (MAP) ↓--------- perfusion arrhythmias ischemia potential MI (can be nonatherosclerotic)

Back 727

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
c. Cardiogenic--↑cap perm ↓circulating volume and ↓myocardial function progressive tissue hypoxia ß-adrenergic receptor stimulation CO begins to fail (heart can’t keep up) ↑HR ↓BP ↓peripheral perfusion (MAP) ↓coronary perfusion arrhythmias ischemia potential MI (can be nonatherosclerotic)

Front 728

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
c. Cardiogenic--↑cap perm ↓circulating volume and ↓myocardial function progressive tissue hypoxia ß-adrenergic receptor stimulation CO begins to fail (heart can’t keep up) ↑HR ↓BP ↓peripheral perfusion (MAP) ↓coronary perfusion --------------- ischemia potential ---------- (can be nonatherosclerotic)

Back 728

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
c. Cardiogenic--↑cap perm ↓circulating volume and ↓myocardial function progressive tissue hypoxia ß-adrenergic receptor stimulation CO begins to fail (heart can’t keep up) ↑HR ↓BP ↓peripheral perfusion (MAP) ↓coronary perfusion arrhythmias ischemia potential MI (can be nonatherosclerotic)

Front 729

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
c. Cardiogenic--
i. --------- cannot be maintained (unlike compensatory stage)

Back 729

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
c. Cardiogenic--
i. CO cannot be maintained (unlike compensatory stage)

Front 730

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
d. Renal--↓perfusion to ---------- ↓--------- output ↑------- fxn tests (BUN/CR) ATN ARF ↓ability to excrete acids and absorb bicarb metabolic acidosis

Back 730

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
d. Renal--↓perfusion to kidney ↓urine output ↑renal fxn tests (BUN/CR) ATN ARF ↓ability to excrete acids and absorb bicarb metabolic acidosis

Front 731

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
d. Renal--↓perfusion to kidney ↓urine output ↑renal fxn tests (BUN/CR) ------, -------, ↓ability to excrete ------- and absorb bicarb metabolic acidosis

Back 731

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
d. Renal--↓perfusion to kidney ↓urine output ↑renal fxn tests (BUN/CR) ATN ARF ↓ability to excrete acids and absorb bicarb metabolic acidosis

Front 732

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
d. Renal--↓perfusion to kidney ↓urine output ↑renal fxn tests (BUN/CR) ATN ARF ↓ability to excrete acids and absorb -----, metabolic -------

Back 732

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
d. Renal--↓perfusion to kidney ↓urine output ↑renal fxn tests (BUN/CR) ATN ARF ↓ability to excrete acids and absorb bicarb metabolic acidosis

Front 733

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
e. GI--extended ↓-------------- 2° to vasoconstriction, mucosal ----------, ↓-------- absorption and ulcers/GI bleeding ↑risk of bacteria to blood (sepsis)

Back 733

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
e. GI--extended ↓tissue perfusion 2° to vasoconstriction mucosal barrier ischemia ↓nutrient absorption and ulcers/GI bleeding ↑risk of bacteria to blood (sepsis)

Front 734

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
e. GI--extended ↓tissue perfusion 2° to vasoconstriction mucosal barrier ischemia ↓nutrient absorption and ulcers/------- bleeding ↑risk of -------- to blood (sepsis)

Back 734

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
e. GI--extended ↓tissue perfusion 2° to vasoconstriction mucosal barrier ischemia ↓nutrient absorption and ulcers/GI bleeding ↑risk of bacteria to blood (sepsis)

Front 735

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
f. Hepatic--↓----------- to liver ↓ability to ------------- drugs and waste products ↑-------3 lactate accumulation of bilirubin ↑LFTs (ALT, AST, GGT)

Back 735

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
f. Hepatic--↓perfusion to liver ↓ability to metabolize drugs and waste products ↑NH3 lactate accumulation of bilirubin ↑LFTs (ALT, AST, GGT)

Front 736

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
f. Hepatic--↓perfusion to liver ↓ability to metabolize drugs and waste products ↑NH3 lactate accumulation of ---------- ↑---------s (ALT, AST, GGT)

Back 736

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
f. Hepatic--↓perfusion to liver ↓ability to metabolize drugs and waste products ↑NH3 lactate accumulation of bilirubin ↑LFTs (ALT, AST, GGT)

Front 737

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
f. Hepatic--↓perfusion to liver ↓ability to metabolize drugs and waste products ↑NH3 lactate accumulation of bilirubin ↑LFTs (ALT, ------, ------)

Back 737

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
f. Hepatic--↓perfusion to liver ↓ability to metabolize drugs and waste products ↑NH3 lactate accumulation of bilirubin ↑LFTs (ALT, AST, GGT)

Front 738

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
g. Hematologic--platelets and clotting factor consumption ----------, ↑--------, ↑PTT, ↓-------- DIC risk widespread bleeding (GI, lungs, puncture sites)

Back 738

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
g. Hematologic--platelets and clotting factor consumption thrombocytopenia, ↑PT, ↑PTT, ↓fibrinogen DIC risk widespread bleeding (GI, lungs, puncture sites)

Front 739

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
g. Hematologic--platelets and clotting factor consumption thrombocytopenia, ↑PT, ↑-------, ↓fibrinogen ---------- risk widespread bleeding (GI, -------, puncture sites)

Back 739

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
g. Hematologic--platelets and clotting factor consumption thrombocytopenia, ↑PT, ↑PTT, ↓fibrinogen DIC risk widespread bleeding (GI, lungs, puncture sites)

Front 740

Shock
IV. Stages
D. Refractory Stage--high likelihood of ------- (can sometimes be reversed)

Back 740

Shock
IV. Stages
D. Refractory Stage--high likelihood of death (can sometimes be reversed)

Front 741

Shock
IV. Stages
D. Refractory Stage--high likelihood of death (can sometimes be reversed)
1. ↓---------- ↓------ anaerobic metabolism ↑-------- acid ↑cap perm interstitial fluid transfer worsens ↓intravascular volume ↓BP worsens myocardial depression worsens ↑HR ischemia further ↓CO ↓ cerebral flow cerebral ischemia

Back 741

Shock
IV. Stages
D. Refractory Stage--high likelihood of death (can sometimes be reversed)
1. ↓Perfusion ↓CO anaerobic metabolism ↑lactic acid ↑cap perm interstitial fluid transfer worsens ↓intravascular volume ↓BP worsens myocardial depression worsens ↑HR ischemia further ↓CO ↓ cerebral flow cerebral ischemia

Front 742

Shock
IV. Stages
D. Refractory Stage--high likelihood of death (can sometimes be reversed)
1. ↓Perfusion ↓CO anaerobic ----------- ↑lactic acid ↑cap perm interstitial ------------ worsens ↓---------- volume ↓BP worsens myocardial depression worsens ↑HR ischemia further ↓CO ↓ cerebral flow cerebral ischemia

Back 742

Shock
IV. Stages
D. Refractory Stage--high likelihood of death (can sometimes be reversed)
1. ↓Perfusion ↓CO anaerobic metabolism ↑lactic acid ↑cap perm interstitial fluid transfer worsens ↓intravascular volume ↓BP worsens myocardial depression worsens ↑HR ischemia further ↓CO ↓ cerebral flow cerebral ischemia

Front 743

Shock
IV. Stages
D. Refractory Stage--high likelihood of death (can sometimes be reversed)
1. ↓Perfusion ↓CO anaerobic metabolism ↑lactic acid ↑cap perm interstitial fluid transfer worsens ↓intravascular volume ↓--------- worsens myocardial ----------- worsens ↑---------- ischemia further ↓CO ↓ cerebral flow cerebral ischemia

Back 743

Shock
IV. Stages
D. Refractory Stage--high likelihood of death (can sometimes be reversed)
1. ↓Perfusion ↓CO anaerobic metabolism ↑lactic acid ↑cap perm interstitial fluid transfer worsens ↓intravascular volume ↓BP worsens myocardial depression worsens ↑HR ischemia further ↓CO ↓ cerebral flow cerebral ischemia

Front 744

Shock
IV. Stages
D. Refractory Stage--high likelihood of death (can sometimes be reversed)
1. ↓Perfusion ↓CO anaerobic metabolism ↑lactic acid ↑cap perm interstitial fluid transfer worsens ↓intravascular volume ↓BP worsens myocardial depression worsens ↑HR ischemia further ↓----------- ↓ ------------ flow cerebral --------

Back 744

Shock
IV. Stages
D. Refractory Stage--high likelihood of death (can sometimes be reversed)
1. ↓Perfusion ↓CO anaerobic metabolism ↑lactic acid ↑cap perm interstitial fluid transfer worsens ↓intravascular volume ↓BP worsens myocardial depression worsens ↑HR ischemia further ↓CO ↓ cerebral flow cerebral ischemia

Front 745

Shock
IV. Stages
D. Refractory Stage--high likelihood of death (can sometimes be reversed)
2. Pathophysiology--recovery is -------- (pt will code quickly)

Back 745

Shock
IV. Stages
D. Refractory Stage--high likelihood of death (can sometimes be reversed)
2. Pathophysiology--recovery is unlikely (pt will code quickly)

Front 746

Shock
IV. Stages
D. Refractory Stage--high likelihood of death (can sometimes be reversed)
2. Pathophysiology--recovery is unlikely (pt will code quickly)
a. Neurologic--unresponsive, pupils ------------ and dilated, --------- (loss of reflexes)

Back 746

Shock
IV. Stages
D. Refractory Stage--high likelihood of death (can sometimes be reversed)
2. Pathophysiology--recovery is unlikely (pt will code quickly)
a. Neurologic--unresponsive, pupils nonreactive and dilated, areflexia (loss of reflexes)

Front 747

Shock
IV. Stages
D. Refractory Stage--high likelihood of death (can sometimes be reversed)
2. Pathophysiology--recovery is unlikely (pt will code quickly)
b. Respiratory--severe refractory ----------- (despite intubation ↑---------2) and resp failure

Back 747

Shock
IV. Stages
D. Refractory Stage--high likelihood of death (can sometimes be reversed)
2. Pathophysiology--recovery is unlikely (pt will code quickly)
b. Respiratory--severe refractory hypoxemia (despite intubation ↑FiO2) and resp failure

Front 748

Shock
IV. Stages
D. Refractory Stage--high likelihood of death (can sometimes be reversed)
2. Pathophysiology--recovery is unlikely (pt will code quickly)
c. Cardiogenic--profound ------------ (can’t get it back up), ↓----------, bradycardia

Back 748

Shock
IV. Stages
D. Refractory Stage--high likelihood of death (can sometimes be reversed)
2. Pathophysiology--recovery is unlikely (pt will code quickly)
c. Cardiogenic--profound hypotension (can’t get it back up), ↓CO, bradycardia

Front 749

Shock
IV. Stages
D. Refractory Stage--high likelihood of death (can sometimes be reversed)
2. Pathophysiology--recovery is unlikely (pt will code quickly)
i. ---------- can only compensate for so long then if begins to drop

Back 749

Shock
IV. Stages
D. Refractory Stage--high likelihood of death (can sometimes be reversed)
2. Pathophysiology--recovery is unlikely (pt will code quickly)
i. HR can only compensate for so long then if begins to drop

Front 750

Shock
IV. Stages
D. Refractory Stage--high likelihood of death (can sometimes be reversed)
2. Pathophysiology--recovery is unlikely (pt will code quickly)
d. Renal--anuria; need ------------ or they will die (everything is shut down)

Back 750

Shock
IV. Stages
D. Refractory Stage--high likelihood of death (can sometimes be reversed)
2. Pathophysiology--recovery is unlikely (pt will code quickly)
d. Renal--anuria; need dialysis or they will die (everything is shut down)

Front 751

Shock
IV. Stages
D. Refractory Stage--high likelihood of death (can sometimes be reversed)
2. Pathophysiology--recovery is unlikely (pt will code quickly)
e. GI--_________

Back 751

Shock
IV. Stages
D. Refractory Stage--high likelihood of death (can sometimes be reversed)
2. Pathophysiology--recovery is unlikely (pt will code quickly)
e. GI--ischemic gut

Front 752

Shock
IV. Stages
D. Refractory Stage--high likelihood of death (can sometimes be reversed)
2. Pathophysiology--recovery is unlikely (pt will code quickly)
f. Hepatic--accumulation of ----------- products (including ↑---------3 and lactate)

Back 752

Shock
IV. Stages
D. Refractory Stage--high likelihood of death (can sometimes be reversed)
2. Pathophysiology--recovery is unlikely (pt will code quickly)
f. Hepatic--accumulation of waste products (including ↑NH3 and lactate)

Front 753

Shock
IV. Stages
D. Refractory Stage--high likelihood of death (can sometimes be reversed)
2. Pathophysiology--recovery is unlikely (pt will code quickly)
g. Skin--mottled and ----------

Back 753

Shock
IV. Stages
D. Refractory Stage--high likelihood of death (can sometimes be reversed)
2. Pathophysiology--recovery is unlikely (pt will code quickly)
g. Skin--mottled and cyanotic

Front 754

Shock
IV. Stages
D. Refractory Stage--high likelihood of death (can sometimes be reversed)
3. Residual Deficits (if live through stage)
a. Gangrene and amputations from -----------
b. Kidney and ----------- problems (possibly need transplants)

Back 754

Shock
IV. Stages
D. Refractory Stage--high likelihood of death (can sometimes be reversed)
3. Residual Deficits (if live through stage)
a. Gangrene and amputations from vasoconstriction

Front 755

Shock
V. Diagnostic Studies--no single ---------- test

Back 755

Shock
V. Diagnostic Studies--no single diagnostic test

Front 756

Shock
V. Diagnostic Studies--no single diagnostic test
A. ↑----------- levels and base deficit--from ↓--------- perfusion and anaerobic metabolism

Back 756

Shock
V. Diagnostic Studies--no single diagnostic test
A. ↑lactate levels and base deficit--from ↓tissue perfusion and anaerobic metabolism

Front 757

Shock
V. Diagnostic Studies--no single diagnostic test
B. EKG--if ------------- shock

Back 757

Shock
V. Diagnostic Studies--no single diagnostic test
B. EKG--if cardiogenic shock

Front 758

Shock
V. Diagnostic Studies--no single diagnostic test
C. C______
D. ____________ monitoring

Back 758

Shock
V. Diagnostic Studies--no single diagnostic test
C. CXR
D. Hemodynamic monitoring

Front 759

Shock
V. Diagnostic Studies--no single diagnostic test
E. Continuous--------- oximeter
F. ----------2

Back 759

Shock
V. Diagnostic Studies--no single diagnostic test
E. Continuous pulse oximeter
F. SVO2

Front 760

Shock
V. Diagnostic Studies--no single diagnostic test
G. Labs
1. Electrolytes--↑-------- (↑-----------), early ↓-------- (↑aldoseterone), later ↑K (cells die ↓kidney fxn)

Back 760

Shock
V. Diagnostic Studies--no single diagnostic test
G. Labs
1. Electrolytes--↑Na (↑aldosterone), early ↓K (↑aldoseterone), later ↑K (cells die ↓kidney fxn)

Front 761

Shock
V. Diagnostic Studies--no single diagnostic test
G. Labs
1. Electrolytes--↑Na (↑aldosterone), early ↓K (↑------------), later ↑K (cells die ↓---------- fxn)

Back 761

Shock
V. Diagnostic Studies--no single diagnostic test
G. Labs
1. Electrolytes--↑Na (↑aldosterone), early ↓K (↑aldoseterone), later ↑K (cells die ↓kidney fxn)

Front 762

Shock
V. Diagnostic Studies--no single diagnostic test
G. Labs
2. Blood--↓-------/Hg after volume replacement (if ---------)

Back 762

Shock
V. Diagnostic Studies--no single diagnostic test
G. Labs
2. Blood--↓Ht/Hg after volume replacement (if hemorrhagic)

Front 763

Shock
V. Diagnostic Studies--no single diagnostic test
G. Labs
3. ABGs--late metabolic ----------- (anaerobic ----------)

Back 763

Shock
V. Diagnostic Studies--no single diagnostic test
G. Labs
3. ABGs--late metabolic acidosis (anaerobic metabolism)

Front 764

Shock
V. Diagnostic Studies--no single diagnostic test
G. Labs
4. Renal function tests--↑----------/Cr

Back 764

Shock
V. Diagnostic Studies--no single diagnostic test
G. Labs
4. Renal function tests--↑BUN/Cr

Front 765

Shock
V. Diagnostic Studies--no single diagnostic test
G. Labs
5. LFTs--increased (only in -------------- stages)

Back 765

Shock
V. Diagnostic Studies--no single diagnostic test
G. Labs
5. LFTs--increased (only in progressive stages)

Front 766

Shock
V. Diagnostic Studies--no single diagnostic test
G. Labs
5. LFTs--_________ (only in progressive stages)

Back 766

Shock
V. Diagnostic Studies--no single diagnostic test
G. Labs
5. LFTs--increased (only in progressive stages)

Front 767

Shock
V. Diagnostic Studies--no single diagnostic test
G. Labs
6. Cardiac ---------

Back 767

Shock
V. Diagnostic Studies--no single diagnostic test
G. Labs
6. Cardiac enzymes

Front 768

Shock
V. Diagnostic Studies--no single diagnostic test
G. Labs
7. DIC panel--↓----------, ↓-----------, ↑PT/PTT

Back 768

Shock
V. Diagnostic Studies--no single diagnostic test
G. Labs
7. DIC panel--↓fibrinogen, ↓platelets, ↑PT/PTT

Front 769

Shock
V. Diagnostic Studies--no single diagnostic test
G. Labs
8. Glucose
a. Early--SNS stimulation, liver releases ------------ and stress response releases ----------- to maintain glucose levelsshock continues↓cells responsive to insulin↑glucose

Back 769

Shock
V. Diagnostic Studies--no single diagnostic test
G. Labs
8. Glucose
a. Early--SNS stimulationliver releases glycogen and stress response releases cortisol to maintain glucose levelsshock continues↓cells responsive to insulin↑glucose

Front 770

Shock
V. Diagnostic Studies--no single diagnostic test
G. Labs
8. Glucose
a. Early--SNS stimulationliver releases glycogen and stress response releases cortisol to maintain glucose levelsshock continues↓--------- responsive to insulin↑----------

Back 770

Shock
V. Diagnostic Studies--no single diagnostic test
G. Labs
8. Glucose
a. Early--SNS stimulationliver releases glycogen and stress response releases cortisol to maintain glucose levelsshock continues↓cells responsive to insulin↑glucose

Front 771

Shock
V. Diagnostic Studies--no single diagnostic test
G. Labs
8. Glucose
b. Late--depleted ---------- stores and no --------- from kidney ↓glucose

Back 771

Shock
V. Diagnostic Studies--no single diagnostic test
G. Labs
8. Glucose
b. Late--depleted glycogen stores and no cortisol from kidney ↓glucose

Front 772

Shock
VI. Management
A. Oxygenation and Ventilation--goal is to ↑O2 ----------- and ↓ O2 ---------

Back 772

Shock
VI. Management
A. Oxygenation and Ventilation--goal is to ↑O2 supply and ↓ O2 demand

Front 773

Shock
VI. Management
A. Oxygenation and Ventilation--goal is to ↑O2 supply and ↓ O2 demand
1. Optimize O2 delivery--NR mask, ----------, ↑---------2

Back 773

Shock
VI. Management
A. Oxygenation and Ventilation--goal is to ↑O2 supply and ↓ O2 demand
1. Optimize O2 delivery--NR mask, intubation, ↑FiO2

Front 774

Shock
VI. Management
A. Oxygenation and Ventilation--goal is to ↑O2 supply and ↓ O2 demand
2. Ensure pt has patent -----------
3. Provide ---------- O2

Back 774

Shock
VI. Management
A. Oxygenation and Ventilation--goal is to ↑O2 supply and ↓ O2 demand
2. Ensure pt has patent airway
3. Provide supplemental O2

Front 775

Shock
VI. Management
A. Oxygenation and Ventilation--goal is to ↑O2 supply and ↓ O2 demand
4. Optimize cardiac output--drug therapy (------------, debutamine, -----------)

Back 775

Shock
VI. Management
A. Oxygenation and Ventilation--goal is to ↑O2 supply and ↓ O2 demand
4. Optimize cardiac output--drug therapy (epinephrine, debutamine, levofed)

Front 776

Shock
VI. Management
A. Oxygenation and Ventilation--goal is to ↑O2 supply and ↓ O2 demand
4. Optimize cardiac output--drug therapy (epinephrine, debutamine, ---------)

Back 776

Shock
VI. Management
A. Oxygenation and Ventilation--goal is to ↑O2 supply and ↓ O2 demand
4. Optimize cardiac output--drug therapy (epinephrine, debutamine, levofed)

Front 777

Shock
VI. Management
A. Oxygenation and Ventilation--goal is to ↑O2 supply and ↓ O2 demand
5. Assess labs including ----------/Ht, ---------2

Back 777

Shock
VI. Management
A. Oxygenation and Ventilation--goal is to ↑O2 supply and ↓ O2 demand
5. Assess labs including Hg/Ht, SaO2

Front 778

Shock
VI. Management
A. Oxygenation and Ventilation--goal is to ↑O2 supply and ↓ O2 demand
6. Hemodynamic monitoring to assess ---------2 (assesses ----------- at level of tissues)

Back 778

Shock
VI. Management
A. Oxygenation and Ventilation--goal is to ↑O2 supply and ↓ O2 demand
6. Hemodynamic monitoring to assess SVO2 (assesses oxygenation at level of tissues)

Front 779

Shock
VI. Management
B. Fluid therapy--not ------------- (good volume w/ bad pump) or ---------- (good volume w/ vasodil.)

Back 779

Shock
VI. Management
B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.)

Front 780

Shock
VI. Management
B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.)
1. Establish ----------- access (14 to -------G)

Back 780

Shock
VI. Management
B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.)
1. Establish IV access (14-16G)

Front 781

Shock
VI. Management
B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.)
2. Hemodynamic monitoring to assess --------- status

Back 781

Shock
VI. Management
B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.)
2. Hemodynamic monitoring to assess fluid status

Front 782

Shock
VI. Management
B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.)
3. Fluid choice--think about what has been -------

Back 782

Shock
VI. Management
B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.)
3. Fluid choice--think about what has been lost

Front 783

Shock
VI. Management
B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.)
3. Fluid choice--think about what has been lost
a. RBCs--give w/ ----------- b/c RBCs do not have ------------ factors (1-2U FFP for 5U RBCs)

Back 783

Shock
VI. Management
B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.)
3. Fluid choice--think about what has been lost
a. RBCs--give w/ FFP b/c RBCs do not have clotting factors (1-2U FFP for 5U RBCs)

Front 784

Shock
VI. Management
B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.)
3. Fluid choice--think about what has been lost
a. RBCs--give w/ FFP b/c RBCs do not have clotting factors (1-______U FFP for 5_______ RBCs)

Back 784

Shock
VI. Management
B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.)
3. Fluid choice--think about what has been lost
a. RBCs--give w/ FFP b/c RBCs do not have clotting factors (1-2U FFP for 5U RBCs)

Front 785

Shock
VI. Management
B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.)
3. Fluid choice--think about what has been lost
a. Crystalloid (NS, LR)--2/3rd diffuse into ------------ space (require more -----------)

Back 785

Shock
VI. Management
B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.)
3. Fluid choice--think about what has been lost
a. Crystalloid (NS, LR)--2/3rd diffuse into interstitial space (require more volume)

Front 786

Shock
VI. Management
B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.)
3. Fluid choice--think about what has been lost
a. Crystalloid (---------, -----------)--2/3rd diffuse into interstitial space (require more volume)

Back 786

Shock
VI. Management
B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.)
3. Fluid choice--think about what has been lost
a. Crystalloid (NS, LR)--2/3rd diffuse into interstitial space (require more volume)

Front 787

Shock
VI. Management
B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.)
3. Fluid choice--think about what has been lost
b. Colloid (----------, -----------)--large therefore fluids stay in vascular space better

Back 787

Shock
VI. Management
B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.)
3. Fluid choice--think about what has been lost
b. Colloid (Albumin, Hespain)--large therefore fluids stay in vascular space better

Front 788

Shock
VI. Management
B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.)
3. Fluid choice--think about what has been lost
b. Colloid (Albumin, Hespain)--large therefore fluids stay in --------- space better

Back 788

Shock
VI. Management
B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.)
3. Fluid choice--think about what has been lost
b. Colloid (Albumin, Hespain)--large therefore fluids stay in vascular space better

Front 789

Shock
VI. Management
B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.)
3. Fluid choice--think about what has been lost
b. Colloid (Albumin, Hespain)--large therefore fluids stay in vascular space better
a. Can be given in concentrated space (esp. w/ ↑------------)--careful w/ -----------

Back 789

Shock
VI. Management
B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.)
3. Fluid choice--think about what has been lost
b. Colloid (Albumin, Hespain)--large therefore fluids stay in vascular space better
a. Can be given in concentrated space (esp. w/ ↑permeability)--careful w/ CHF

Front 790

Shock
VI. Management
B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.)
3. Fluid choice--think about what has been lost
b. Colloid (Albumin, Hespain)--large therefore fluids stay in vascular space better
b. More ---------

Back 790

Shock
VI. Management
B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.)
3. Fluid choice--think about what has been lost
b. Colloid (Albumin, Hespain)--large therefore fluids stay in vascular space better
b. More costly

Front 791

Shock
VI. Management
B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.)
3. Fluid choice--think about what has been lost
c. Avoid in first 24-_______hrs w/ burn pts

Back 791

Shock
VI. Management
B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.)
3. Fluid choice--think about what has been lost
c. Avoid in first 24-48hrs w/ burn pts

Front 792

Shock
VI. Management
B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.)
4. Monitor for ------------ (try to get warm fluids)

Back 792

Shock
VI. Management
B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.)
4. Monitor for hypothermia (try to get warm fluids)

Front 793

Shock
VI. Management
C. Drug Therapy--goal is to correct decreased ----------

Back 793

Shock
VI. Management
C. Drug Therapy--goal is to correct decreased tissue perfusion

Front 794

Shock
VI. Management
C. Drug Therapy--goal is to correct decreased tissue perfusion
1. Utilized if ------------- replacement does not work

Back 794

Shock
VI. Management
C. Drug Therapy--goal is to correct decreased tissue perfusion
1. Utilized if volume replacement does not work

Front 795

Shock
VI. Management
C. Drug Therapy--goal is to correct decreased tissue perfusion
1. Utilized if volume replacement does not work
a. Good response is seen w/ --------- output of 30-50mL/hr (0.5mL/kg/hr for critical care)

Back 795

Shock
VI. Management
C. Drug Therapy--goal is to correct decreased tissue perfusion
1. Utilized if volume replacement does not work
a. Good response is seen w/ urine output of 30-50mL/hr (0.5mL/kg/hr for critical care)

Front 796

Shock
VI. Management
C. Drug Therapy--goal is to correct decreased tissue perfusion
1. Utilized if volume replacement does not work
a. Good response is seen w/ urine output of 30-______mL/hr (_______mL/kg/hr for critical care)

Back 796

Shock
VI. Management
C. Drug Therapy--goal is to correct decreased tissue perfusion
1. Utilized if volume replacement does not work
a. Good response is seen w/ urine output of 30-50mL/hr (0.5mL/kg/hr for critical care)

Front 797

Shock
VI. Management
C. Drug Therapy--goal is to correct decreased tissue perfusion
2. Types
a. -------------- drugs
b. Vasopressors--cause vasoconstriction

Back 797

Shock
VI. Management
C. Drug Therapy--goal is to correct decreased tissue perfusion
2. Types
a. Sympathomimetic drugs
b. Vasopressors--cause vasoconstriction

Front 798

Shock
VI. Management
C. Drug Therapy--goal is to correct decreased tissue perfusion
2. Types
a. Sympathomimetic drugs
b. Vasopressors--cause ------------

Back 798

Shock
VI. Management
C. Drug Therapy--goal is to correct decreased tissue perfusion
2. Types
a. Sympathomimetic drugs
b. Vasopressors--cause vasoconstriction

Front 799

Shock
VI. Management
C. Drug Therapy--goal is to correct decreased tissue perfusion
2. Types
a. Sympathomimetic drugs
b. Vasopressors--cause vasoconstriction
i. Dobutamine (---------)

Back 799

Shock
VI. Management
C. Drug Therapy--goal is to correct decreased tissue perfusion
2. Types
a. Sympathomimetic drugs
b. Vasopressors--cause vasoconstriction
i. Dobutamine (Dobutrex)

Front 800

Shock
VI. Management
C. Drug Therapy--goal is to correct decreased tissue perfusion
2. Types
a. Sympathomimetic drugs
b. Vasopressors--cause vasoconstriction
ii. D________
iii. E________

Back 800

Shock
VI. Management
C. Drug Therapy--goal is to correct decreased tissue perfusion
2. Types
a. Sympathomimetic drugs
b. Vasopressors--cause vasoconstriction
ii. Dopamine
iii. Epinephrine

Front 801

Shock
VI. Management
C. Drug Therapy--goal is to correct decreased tissue perfusion
2. Types
a. Sympathomimetic drugs
b. Vasopressors--cause vasoconstriction
iv. ---------- (Levophed)
v. _________

Back 801

Shock
VI. Management
C. Drug Therapy--goal is to correct decreased tissue perfusion
2. Types
a. Sympathomimetic drugs
b. Vasopressors--cause vasoconstriction
iv. Norepinephrine (Levophed)
v. Neo-Synephrine

Front 802

Shock
VI. Management
C. Drug Therapy--goal is to correct decreased tissue perfusion
3. ----------Effects--balancing act

Back 802

Shock
VI. Management
C. Drug Therapy--goal is to correct decreased tissue perfusion
3. Detrimental Effects--balancing act

Front 803

Shock
VII. Specific Interventions
A. Cardiogenic--restore blood flow to ----------- by restoring balance between --------2 supply and demand

Back 803

Shock
VII. Specific Interventions
A. Cardiogenic--restore blood flow to myocardium by restoring balance between O2 supply and demand

Front 804

Shock
VII. Specific Interventions
A. Cardiogenic--
1. Hemodynamic goal--decrease ----------- of heart
2. --------- therapy

Back 804

Shock
VII. Specific Interventions
A. Cardiogenic--
1. Hemodynamic goal--decrease workload of heart
2. Drug therapy

Front 805

Shock
VII. Specific Interventions
A. Cardiogenic--
2. Drug therapy
a. ------------ therapy
b. Decrease ---------

Back 805

Shock
VII. Specific Interventions
A. Cardiogenic--
2. Drug therapy
a. Thrombolytic therapy
b. Decrease preload

Front 806

Shock
VII. Specific Interventions
A. Cardiogenic--
2. Drug therapy
i. Nitrates
ii. M_______
iii. D_______

Back 806

Shock
VII. Specific Interventions
A. Cardiogenic--
2. Drug therapy
i. Nitrates
ii. Morphine
iii. Diuretics

Front 807

Shock
VII. Specific Interventions
A. Cardiogenic--
2. Drug therapy
c. Reduce __________--be careful with reducing afterload ↓_________

Back 807

Shock
VII. Specific Interventions
A. Cardiogenic--
2. Drug therapy
c. Reduce afterload--be careful with reducing afterload ↓BP

Front 808

Shock
VII. Specific Interventions
A. Cardiogenic--
2. Drug therapy
i. Inotropic drugs (------------, ------------ Epinephrine)

Back 808

Shock
VII. Specific Interventions
A. Cardiogenic--
2. Drug therapy
i. Inotropic drugs (Dobutamine, Dopamine Epinephrine)

Front 809

Shock
VII. Specific Interventions
A. Cardiogenic--
2. Drug therapy
i. Inotropic drugs (Dobutamine, Dopamine Epinephrine)
ii. N---------

Back 809

Shock
VII. Specific Interventions
A. Cardiogenic--
2. Drug therapy
i. Inotropic drugs (Dobutamine, Dopamine Epinephrine)
ii. Nipride

Front 810

Shock
VII. Specific Interventions
A. Cardiogenic--
2. Drug therapy
d. ß-blockers, ---------: ↓--------- to allow for ↑ filling time

Back 810

Shock
VII. Specific Interventions
A. Cardiogenic--
2. Drug therapy
i. Inotropic drugs (Dobutamine, Dopamine Epinephrine)
ii. Nipride

Front 811

Shock
VII. Specific Interventions
A. Cardiogenic--
3. Correct ---------

Back 811

Shock
VII. Specific Interventions
A. Cardiogenic--
3. Correct arrhythmias

Front 812

Shock
VII. Specific Interventions
A. Cardiogenic--
4. Stents, emergency ----------
5. ------------ assist devices (only in critical care)

Back 812

Shock
VII. Specific Interventions
A. Cardiogenic--
4. Stents, emergency revascularization
5. Circulatory assist devices (only in critical care)

Front 813

Shock
VII. Specific Interventions
A. Cardiogenic--
5. Circulatory assist devices (only in critical care)
a. IABP--↓----------- and ↑---------- blood flow

Back 813

Shock
VII. Specific Interventions
A. Cardiogenic--
5. Circulatory assist devices (only in critical care)
a. IABP--↓afterload and ↑coronary blood flow

Front 814

Shock
VII. Specific Interventions
A. Cardiogenic--
5. Circulatory assist devices (only in critical care)
b. VAD--outside pump ------------ blood (likely need ----------)

Back 814

Shock
VII. Specific Interventions
A. Cardiogenic--
5. Circulatory assist devices (only in critical care)
b. VAD--outside pump diverts blood (likely need transplant)

Front 815

Shock
VII. Specific Interventions
B. Hypovolemic--restore ------------- volume and stop fluid loss restore ----------

Back 815

Shock
VII. Specific Interventions
B. Hypovolemic--restore circulating volume and stop fluid loss restore perfusion

Front 816

Shock
VII. Specific Interventions
B. Hypovolemic--restore circulating volume and stop fluid loss restore perfusion
1. Optimize ----------
2. ---------- cause

Back 816

Shock
VII. Specific Interventions
B. Hypovolemic--restore circulating volume and stop fluid loss restore perfusion
1. Optimize oxygenation
2. Correct cause

Front 817

Shock
VII. Specific Interventions
B. Hypovolemic--restore circulating volume and stop fluid loss restore perfusion
3. Volume replacement--warm to prevent ---------

Back 817

Shock
VII. Specific Interventions
B. Hypovolemic--restore circulating volume and stop fluid loss restore perfusion
3. Volume replacement--warm to prevent hypothermia
a. Fresh frozen plasma (FFP)

Front 818

Shock
VII. Specific Interventions
B. Hypovolemic--restore circulating volume and stop fluid loss restore perfusion
3. Volume replacement--warm to prevent hypothermia
a. Fresh ---------- ----------- (FFP)

Back 818

Shock
VII. Specific Interventions
B. Hypovolemic--restore circulating volume and stop fluid loss restore perfusion
3. Volume replacement--warm to prevent hypothermia
a. Fresh frozen plasma (FFP)

Front 819

Shock
VII. Specific Interventions
B. Hypovolemic--restore circulating volume and stop fluid loss restore perfusion
4. Monitor response to --------------- (↑PAWP and central venous pressures from 0 12)

Back 819

Shock
VII. Specific Interventions
B. Hypovolemic--restore circulating volume and stop fluid loss restore perfusion
4. Monitor response to fluid replacement (↑PAWP and central venous pressures from 0 12)

Front 820

Shock
VII. Specific Interventions
B. Hypovolemic--restore circulating volume and stop fluid loss restore perfusion
4. Monitor response to fluid replacement (↑------------ and central venous pressures from 0 to -------)

Back 820

Shock
VII. Specific Interventions
B. Hypovolemic--restore circulating volume and stop fluid loss restore perfusion
4. Monitor response to fluid replacement (↑PAWP and central venous pressures from 0 12)

Front 821

Shock
VII. Specific Interventions
C. Septic--: --------- O2 supply and ------------ O2 demand

Back 821

Shock
VII. Specific Interventions
C. Septic--optimize O2 supply and decrease O2 demand

Front 822

Shock
VII. Specific Interventions
C. Septic--optimize O2 supply and decrease O2 demand
1. Large amounts of fluid replacement (6-______L crystalloids or 2-______L colloids)

Back 822

Shock
VII. Specific Interventions
C. Septic--optimize O2 supply and decrease O2 demand
1. Large amounts of fluid replacement (6-10L crystalloids or 2-4L colloids)

Front 823

Shock
VII. Specific Interventions
C. Septic--optimize O2 supply and decrease O2 demand
1. Large amounts of fluid replacement (6-10L --------- or 2-4L ----------)

Back 823

Shock
VII. Specific Interventions
C. Septic--optimize O2 supply and decrease O2 demand
1. Large amounts of fluid replacement (6-10L crystalloids or 2-4L colloids)

Front 824

Shock
VII. Specific Interventions
C. Septic--optimize O2 supply and decrease O2 demand
1. Large amounts of fluid replacement (6-10L crystalloids or 2-4L colloids)
a. Endotoxins ↑----------- lose lots of fluids to -------- space

Back 824

Shock
VII. Specific Interventions
C. Septic--optimize O2 supply and decrease O2 demand
1. Large amounts of fluid replacement (6-10L crystalloids or 2-4L colloids)
a. Endotoxins ↑cap perm lose lots of fluids to interstitial space

Front 825

Shock
VII. Specific Interventions
C. Septic--optimize O2 supply and decrease O2 demand
2. Optimize ----------

Back 825

Shock
VII. Specific Interventions
C. Septic--optimize O2 supply and decrease O2 demand
2. Optimize CO

Front 826

Shock
VII. Specific Interventions
C. Septic--optimize O2 supply and decrease O2 demand
2. Optimize CO
a. V---------
b. Vasopressors to ↑----------
c. I-----------

Back 826

Shock
VII. Specific Interventions
C. Septic--optimize O2 supply and decrease O2 demand
2. Optimize CO
a. Volume
b. Vasopressors to ↑BP
c. Inotropes

Front 827

Shock
VII. Specific Interventions
C. Septic--optimize O2 supply and decrease O2 demand
3. Correct -----------
4. Antibiotics (------------ before beginning)

Back 827

Shock
VII. Specific Interventions
C. Septic--optimize O2 supply and decrease O2 demand
3. Correct acidosis
4. Antibiotics (cultures before beginning)

Front 828

Shock
VII. Specific Interventions
D. Neurogenic
1. Use ----------- precautions

Back 828

Shock
VII. Specific Interventions
D. Neurogenic
1. Use spinal precautions

Front 829

Shock
VII. Specific Interventions
D. Neurogenic
2. Treatment of ↓BP w/ --------- and --------- therapy

Back 829

Shock
VII. Specific Interventions
D. Neurogenic
2. Treatment of ↓BP w/ fluids and drug therapy
a. Dopamine--↑BP and is (+) cornotrope (↑HR)

Front 830

Shock
VII. Specific Interventions
D. Neurogenic
2. Treatment of ↓BP w/ fluids and drug therapy
a. Dopamine--↑------- and is (+) --------- (↑HR)

Back 830

Shock
VII. Specific Interventions
D. Neurogenic
2. Treatment of ↓BP w/ fluids and drug therapy
a. Dopamine--↑BP and is (+) cornotrope (↑HR)

Front 831

Shock
VII. Specific Interventions
D. Neurogenic
2. Treatment of ↓BP w/ fluids and drug therapy
b. E---------

Back 831

Shock
VII. Specific Interventions
D. Neurogenic
2. Treatment of ↓BP w/ fluids and drug therapy
b. Epinephrine

Front 832

Shock
VII. Specific Interventions
D. Neurogenic
3. Monitor for ---------

Back 832

Shock
VII. Specific Interventions
D. Neurogenic
3. Monitor for hypothermia

Front 833

Shock
VII. Specific Intervention
E. Anaphylactic--can generally be ------------ if treated promptly

Back 833

Shock
VII. Specific Intervention
E. Anaphylactic--can generally be reverse if treated promptly

Front 834

Shock
VII. Specific Intervention
E. Anaphylactic--can generally be reverse if treated promptly
1. Prevention--avoidance of known ---------

Back 834

Shock
VII. Specific Intervention
E. Anaphylactic--can generally be reverse if treated promptly
1. Prevention--avoidance of known allergen
2. Treatment

Front 835

Shock
VII. Specific Intervention
E. Anaphylactic--can generally be reverse if treated promptly
2. Treatment
a. Maintain patient ----------

Back 835

Shock
VII. Specific Intervention
E. Anaphylactic--can generally be reverse if treated promptly
2. Treatment
a. Maintain patient airway
b. Drugs

Front 836

Shock
VII. Specific Intervention
E. Anaphylactic--can generally be reverse if treated promptly
2. Treatment
b. Drugs
i. --------------- (drug of choice)--peripheral vasoconstriction and bronchodilation

Back 836

Shock
VII. Specific Intervention
E. Anaphylactic--can generally be reverse if treated promptly
2. Treatment
b. Drugs
i. Epinephrine (drug of choice)--peripheral vasoconstriction and bronchodilation

Front 837

Shock
VII. Specific Intervention
E. Anaphylactic--can generally be reverse if treated promptly
2. Treatment
b. Drugs
i. Epinephrine (drug of choice)--peripheral ------------ and ------------

Back 837

Shock
VII. Specific Intervention
E. Anaphylactic--can generally be reverse if treated promptly
2. Treatment
b. Drugs
i. Epinephrine (drug of choice)--peripheral vasoconstriction and bronchodilation

Front 838

Shock
VII. Specific Intervention
E. Anaphylactic--can generally be reverse if treated promptly
2. Treatment
b. Drugs
i. Epinephrine (drug of choice)--peripheral vasoconstriction and bronchodilation
ii. Benadryl--blocks release of ---------
iii. IV steroids--↓------------ response

Back 838

Shock
VII. Specific Intervention
E. Anaphylactic--can generally be reverse if treated promptly
2. Treatment
b. Drugs
i. Epinephrine (drug of choice)--peripheral vasoconstriction and bronchodilation
ii. Benadryl--blocks release of histamine
iii. IV steroids--↓allergic response

Front 839

Shock
VII. Specific Intervention
E. Anaphylactic--can generally be reverse if treated promptly
2. Treatment
c. Aggressive --------- replacement (colloids) to combat ----------

Back 839

Shock
VII. Specific Intervention
E. Anaphylactic--can generally be reverse if treated promptly
2. Treatment
c. Aggressive fluid replacement (colloids) to combat hypotension

Front 840

Shock
VIII. Nursing Management
A. Goals
1. Assurance of adequate -------- perfusion
2. Restoration of normal ----------

Back 840

Shock
VIII. Nursing Management
A. Goals
1. Assurance of adequate tissue perfusion
2. Restoration of normal BP

Front 841

Shock
VIII. Nursing Management
A. Goals
3. Return/Recovery of -------- function
4. Avoidance of complications from prolonged states of -----------

Back 841

Shock
VIII. Nursing Management
A. Goals
3. Return/Recovery of organ function
4. Avoidance of complications from prolonged states of hypoperfusion

Front 842

Shock
VIII. Nursing Management
B. Acute Interventions
1. ------------ status
2. ---------- status
3. ----------- status

Back 842

Shock
VIII. Nursing Management
B. Acute Interventions
1. Neurologic status
2. Cardiovascular status
3. Respiratory status

Front 843

Shock
VIII. Nursing Management
B. Acute Interventions
4.-------- status
5. G---------
6. Skin and ----------

Back 843

Shock
VIII. Nursing Management
B. Acute Interventions
4. Renal status
5. GI
6. Skin and temperature

Front 844

Shock
VIII. Nursing Management
B. Acute Interventions
7. Emotional --------- or comfort

Back 844

Shock
VIII. Nursing Management
B. Acute Interventions
7. Emotional support or comfort

Front 845

Shock
VIII. Nursing Management
C. Health Promotion Strategies
1. Prevention--identify patients at -------
2. Interventions aimed at decreasing --------- demand

Back 845

Shock
VIII. Nursing Management
C. Health Promotion Strategies
1. Prevention--identify patients at risk
2. Interventions aimed at decreasing O2 demand

Front 846

Shock
VIII. Nursing Management
C. Health Promotion Strategies
3. Monitoring of ------------ balance to prevent hypovolemic shock
4. Prevention of -------------

Back 846

Shock
VIII. Nursing Management
C. Health Promotion Strategies
3. Monitoring of fluid balance to prevent hypovolemic shock
4. Prevention of infection

Front 847

Respiratory
I. Assessment
A. Subjective Data
1. Past Health History--______, ________, _________, ________, previous hospitalizations, allergies, COPD, pneumonia, bronchitis, TB, weight loss (early lung cancer, TB, and COPD), sleep apnea, recent travel, flu vaccination
2. Symptoms--SOB (when, etc.), # of pillows for sleep, DOE (how far can they walk), associated symptoms (cough, changes, sputum, loose/dry, color, odor, blood), pain (what relieves it)
3. Medications--prescription and over the counter 169.254.115.213

Back 847

Respiratory
I. Assessment
A. Subjective Data
1. Past Health History--smoking, asthma, occupation, recent illnesses, previous hospitalizations, allergies, COPD, pneumonia, bronchitis, TB, weight loss (early lung cancer, TB, and COPD), sleep apnea, recent travel, flu vaccination
2. Symptoms--SOB (when, etc.), # of pillows for sleep, DOE (how far can they walk), associated symptoms (cough, changes, sputum, loose/dry, color, odor, blood), pain (what relieves it)
3. Medications--prescription and over the counter

Front 848

Respiratory
I. Assessment
A. Subjective Data
1. Past Health History--smoking, asthma, occupation, recent illnesses, ________, _________, _________, ________, bronchitis, TB, weight loss (early lung cancer, TB, and COPD), sleep apnea, recent travel, flu vaccination
2. Symptoms--SOB (when, etc.), # of pillows for sleep, DOE (how far can they walk), associated symptoms (cough, changes, sputum, loose/dry, color, odor, blood), pain (what relieves it)
3. Medications--prescription and over the counter

Back 848

Respiratory
I. Assessment
A. Subjective Data
1. Past Health History--smoking, asthma, occupation, recent illnesses, previous hospitalizations, allergies, COPD, pneumonia, bronchitis, TB, weight loss (early lung cancer, TB, and COPD), sleep apnea, recent travel, flu vaccination
2. Symptoms--SOB (when, etc.), # of pillows for sleep, DOE (how far can they walk), associated symptoms (cough, changes, sputum, loose/dry, color, odor, blood), pain (what relieves it)
3. Medications--prescription and over the counter

Front 849

Respiratory
I. Assessment
A. Subjective Data
1. Past Health History--smoking, asthma, occupation, recent illnesses, previous hospitalizations, allergies, COPD, pneumonia, _____, ______, _______ (early lung cancer, TB, and COPD), _______, recent travel, flu vaccination
2. Symptoms--SOB (when, etc.), # of pillows for sleep, DOE (how far can they walk), associated symptoms (cough, changes, sputum, loose/dry, color, odor, blood), pain (what relieves it)
3. Medications--prescription and over the counter

Back 849

Respiratory
I. Assessment
A. Subjective Data
1. Past Health History--smoking, asthma, occupation, recent illnesses, previous hospitalizations, allergies, COPD, pneumonia, bronchitis, TB, weight loss (early lung cancer, TB, and COPD), sleep apnea, recent travel, flu vaccination
2. Symptoms--SOB (when, etc.), # of pillows for sleep, DOE (how far can they walk), associated symptoms (cough, changes, sputum, loose/dry, color, odor, blood), pain (what relieves it)
3. Medications--prescription and over the counter

Front 850

Respiratory
I. Assessment
A. Subjective Data
1. Past Health History--smoking, asthma, occupation, recent illnesses, previous hospitalizations, allergies, COPD, pneumonia, bronchitis, TB, weight loss (early lung cancer, TB, and COPD), sleep apnea, ____,________
2. Symptoms--SOB (when, etc.), # of pillows for sleep, DOE (how far can they walk), associated symptoms (cough, changes, sputum, loose/dry, color, odor, blood), pain (what relieves it)
3. Medications--prescription and over the counter

Back 850

Respiratory
I. Assessment
A. Subjective Data
1. Past Health History--smoking, asthma, occupation, recent illnesses, previous hospitalizations, allergies, COPD, pneumonia, bronchitis, TB, weight loss (early lung cancer, TB, and COPD), sleep apnea, recent travel, flu vaccination
2. Symptoms--SOB (when, etc.), # of pillows for sleep, DOE (how far can they walk), associated symptoms (cough, changes, sputum, loose/dry, color, odor, blood), pain (what relieves it)
3. Medications--prescription and over the counter

Front 851

Respiratory
I. Assessment
A. Subjective Data
1. Past Health History--smoking, asthma, occupation, recent illnesses, previous hospitalizations, allergies, COPD, pneumonia, bronchitis, TB, weight loss (early lung cancer, TB, and COPD), sleep apnea, recent travel, flu vaccination
2. Symptoms--SOB (when, etc.), # of _______ for sleep, _____ (how far can they walk), associated symptoms (____, ______, sputum, loose/dry, color, odor, blood), pain (what relieves it)
3. Medications--prescription and over the counter

Back 851

Respiratory
I. Assessment
A. Subjective Data
1. Past Health History--smoking, asthma, occupation, recent illnesses, previous hospitalizations, allergies, COPD, pneumonia, bronchitis, TB, weight loss (early lung cancer, TB, and COPD), sleep apnea, recent travel, flu vaccination
2. Symptoms--SOB (when, etc.), # of pillows for sleep, DOE (how far can they walk), associated symptoms (cough, changes, sputum, loose/dry, color, odor, blood), pain (what relieves it)
3. Medications--prescription and over the counter

Front 852

Respiratory
I. Assessment
A. Subjective Data
1. Past Health History--smoking, asthma, occupation, recent illnesses, previous hospitalizations, allergies, COPD, pneumonia, bronchitis, TB, weight loss (early lung cancer, TB, and COPD), sleep apnea, recent travel, flu vaccination
2. Symptoms--SOB (when, etc.), # of pillows for sleep, DOE (how far can they walk), associated symptoms (cough, changes, _____, ______, ______, ______, blood), pain (what relieves it)
3. Medications--prescription and over the counter

Back 852

Respiratory
I. Assessment
A. Subjective Data
1. Past Health History--smoking, asthma, occupation, recent illnesses, previous hospitalizations, allergies, COPD, pneumonia, bronchitis, TB, weight loss (early lung cancer, TB, and COPD), sleep apnea, recent travel, flu vaccination
2. Symptoms--SOB (when, etc.), # of pillows for sleep, DOE (how far can they walk), associated symptoms (cough, changes, sputum, loose/dry, color, odor, blood), pain (what relieves it)
3. Medications--prescription and over the counter

Front 853

Respiratory
I. Assessment
A. Subjective Data
1. Past Health History--smoking, asthma, occupation, recent illnesses, previous hospitalizations, allergies, COPD, pneumonia, bronchitis, TB, weight loss (early lung cancer, TB, and COPD), sleep apnea, recent travel, flu vaccination
2. Symptoms--SOB (when, etc.), # of pillows for sleep, DOE (how far can they walk), associated symptoms (cough, changes, sputum, loose/dry, color, odor, ______), ______ (what relieves it)
3. Medications--prescription and over the counter

Back 853

Respiratory
I. Assessment
A. Subjective Data
1. Past Health History--smoking, asthma, occupation, recent illnesses, previous hospitalizations, allergies, COPD, pneumonia, bronchitis, TB, weight loss (early lung cancer, TB, and COPD), sleep apnea, recent travel, flu vaccination
2. Symptoms--SOB (when, etc.), # of pillows for sleep, DOE (how far can they walk), associated symptoms (cough, changes, sputum, loose/dry, color, odor, blood), pain (what relieves it)
3. Medications--prescription and over the counter

Front 854

Respiratory
I. Assessment
A. Subjective Data
1. Past Health History--smoking, asthma, occupation, recent illnesses, previous hospitalizations, allergies, COPD, pneumonia, bronchitis, TB, weight loss (early lung cancer, TB, and COPD), sleep apnea, recent travel, flu vaccination
2. Symptoms--SOB (when, etc.), # of pillows for sleep, DOE (how far can they walk), associated symptoms (cough, changes, sputum, loose/dry, color, odor, blood), pain (what relieves it)
3. Medications--________ and _______

Back 854

Respiratory
I. Assessment
A. Subjective Data
1. Past Health History--smoking, asthma, occupation, recent illnesses, previous hospitalizations, allergies, COPD, pneumonia, bronchitis, TB, weight loss (early lung cancer, TB, and COPD), sleep apnea, recent travel, flu vaccination
2. Symptoms--SOB (when, etc.), # of pillows for sleep, DOE (how far can they walk), associated symptoms (cough, changes, sputum, loose/dry, color, odor, blood), pain (what relieves it)
3. Medications--prescription and over the counter

Front 855

Respiratory
I. Assessment
B. Objective Data
1. Inspection
a. Signs of respiratory distress--_____, _______, ----------, ----------, ↑HR, accessory muscle use, pursed lip breathing, tracheal deviation
b. Shape and symmetry of chest--bilaterally unequal, anterior-posterior diameter (ex. COPD-barrel), kyphosis, scoliosis, pectis exctavatum
c. Ventilatory patterns--kussmals, chayne-stokes, rate, depth, etc.
d. Evidence of clubbing--chronic hypoxia from COPD, lung cancer, and CF

Back 855

Respiratory
I. Assessment
B. Objective Data
1. Inspection
a. Signs of respiratory distress--cyanosis, diff breathing, anxiety, diaphoretic, ↑HR, accessory muscle use, pursed lip breathing, tracheal deviation
b. Shape and symmetry of chest--bilaterally unequal, anterior-posterior diameter (ex. COPD-barrel), kyphosis, scoliosis, pectis exctavatum
c. Ventilatory patterns--kussmals, chayne-stokes, rate, depth, etc.
d. Evidence of clubbing--chronic hypoxia from COPD, lung cancer, and CF

Front 856

Respiratory
I. Assessment
B. Objective Data
1. Inspection
a. Signs of respiratory distress--cyanosis, diff breathing, anxiety, diaphoretic, ↑-----, -------------, -----------, ---------
b. Shape and symmetry of chest--bilaterally unequal, anterior-posterior diameter (ex. COPD-barrel), kyphosis, scoliosis, pectis exctavatum
c. Ventilatory patterns--kussmals, chayne-stokes, rate, depth, etc.
d. Evidence of clubbing--chronic hypoxia from COPD, lung cancer, and CF

Back 856

Respiratory
I. Assessment
B. Objective Data
1. Inspection
a. Signs of respiratory distress--cyanosis, diff breathing, anxiety, diaphoretic, ↑HR, accessory muscle use, pursed lip breathing, tracheal deviation
b. Shape and symmetry of chest--bilaterally unequal, anterior-posterior diameter (ex. COPD-barrel), kyphosis, scoliosis, pectis exctavatum
c. Ventilatory patterns--kussmals, chayne-stokes, rate, depth, etc.
d. Evidence of clubbing--chronic hypoxia from COPD, lung cancer, and CF

Front 857

Respiratory
I. Assessment
B. Objective Data
1. Inspection
a. Signs of respiratory distress--cyanosis, diff breathing, anxiety, diaphoretic, ↑HR, accessory muscle use, pursed lip breathing, tracheal deviation
b. Shape and symmetry of chest: --------, ------------------ (ex. COPD-barrel), ------------, scoliosis, pectis exctavatum
c. Ventilatory patterns--kussmals, chayne-stokes, rate, depth, etc.
d. Evidence of clubbing--chronic hypoxia from COPD, lung cancer, and CF

Back 857

Respiratory
I. Assessment
B. Objective Data
1. Inspection
a. Signs of respiratory distress--cyanosis, diff breathing, anxiety, diaphoretic, ↑HR, accessory muscle use, pursed lip breathing, tracheal deviation
b. Shape and symmetry of chest--bilaterally unequal, anterior-posterior diameter (ex. COPD-barrel), kyphosis, scoliosis, pectis exctavatum
c. Ventilatory patterns--kussmals, chayne-stokes, rate, depth, etc.
d. Evidence of clubbing--chronic hypoxia from COPD, lung cancer, and CF

Front 858

Respiratory
I. Assessment
B. Objective Data
1. Inspection
a. Signs of respiratory distress--cyanosis, diff breathing, anxiety, diaphoretic, ↑HR, accessory muscle use, pursed lip breathing, tracheal deviation
b. Shape and symmetry of chest--bilaterally unequal, anterior-posterior diameter (ex. COPD-barrel), kyphosis, ----------, ----------------
c. Ventilatory patterns--kussmals, chayne-stokes, rate, depth, etc.
d. Evidence of clubbing--chronic hypoxia from COPD, lung cancer, and CF

Back 858

Respiratory
I. Assessment
B. Objective Data
1. Inspection
a. Signs of respiratory distress--cyanosis, diff breathing, anxiety, diaphoretic, ↑HR, accessory muscle use, pursed lip breathing, tracheal deviation
b. Shape and symmetry of chest--bilaterally unequal, anterior-posterior diameter (ex. COPD-barrel), kyphosis, scoliosis, pectis exctavatum
c. Ventilatory patterns--kussmals, chayne-stokes, rate, depth, etc.
d. Evidence of clubbing--chronic hypoxia from COPD, lung cancer, and CF

Front 859

Respiratory
I. Assessment
B. Objective Data
1. Inspection
a. Signs of respiratory distress--cyanosis, diff breathing, anxiety, diaphoretic, ↑HR, accessory muscle use, pursed lip breathing, tracheal deviation
b. Shape and symmetry of chest--bilaterally unequal, anterior-posterior diameter (ex. COPD-barrel), kyphosis, scoliosis, pectis exctavatum
c. Ventilatory patterns: ------------, ----------, --------, ---------, etc.
d. Evidence of clubbing--chronic hypoxia from COPD, lung cancer, and CF

Back 859

Respiratory
I. Assessment
B. Objective Data
1. Inspection
a. Signs of respiratory distress--cyanosis, diff breathing, anxiety, diaphoretic, ↑HR, accessory muscle use, pursed lip breathing, tracheal deviation
b. Shape and symmetry of chest--bilaterally unequal, anterior-posterior diameter (ex. COPD-barrel), kyphosis, scoliosis, pectis exctavatum
c. Ventilatory patterns--kussmals, chayne-stokes, rate, depth, etc.
d. Evidence of clubbing--chronic hypoxia from COPD, lung cancer, and CF

Front 860

Respiratory
I. Assessment
B. Objective Data
1. Inspection
a. Signs of respiratory distress--cyanosis, diff breathing, anxiety, diaphoretic, ↑HR, accessory muscle use, pursed lip breathing, tracheal deviation
b. Shape and symmetry of chest--bilaterally unequal, anterior-posterior diameter (ex. COPD-barrel), kyphosis, scoliosis, pectis exctavatum
c. Ventilatory patterns--kussmals, chayne-stokes, rate, depth, etc.
d. Evidence of clubbing: --------------- from --------, ---------, and -----

Back 860

Respiratory
I. Assessment
B. Objective Data
1. Inspection
a. Signs of respiratory distress--cyanosis, diff breathing, anxiety, diaphoretic, ↑HR, accessory muscle use, pursed lip breathing, tracheal deviation
b. Shape and symmetry of chest--bilaterally unequal, anterior-posterior diameter (ex. COPD-barrel), kyphosis, scoliosis, pectis exctavatum
c. Ventilatory patterns--kussmals, chayne-stokes, rate, depth, etc.
d. Evidence of clubbing--chronic hypoxia from COPD, lung cancer, and CF

Front 861

Respiratory
I. Assessment
B. Objective Data
2. Palpitation
a. Assess trachea is -------, tracheal deviation indicated---------
b. Assess thoracic excursion/chest expansion--normally equal bilaterally
i. Decreased bilaterally for emphysema
ii. Decreased on effected side for pleural effusion and pneumothorax

Back 861

Respiratory
I. Assessment
B. Objective Data
2. Palpitation
a. Assess trachea is midline--tracheal deviation indicated tension pneumothorax
b. Assess thoracic excursion/chest expansion--normally equal bilaterally
i. Decreased bilaterally for emphysema
ii. Decreased on effected side for pleural effusion and pneumothorax

Front 862

Respiratory
I. Assessment
B. Objective Data
2. Palpitation
a. Assess trachea is midline--tracheal deviation indicated tension pneumothorax
b. Assess ---------/chest expansion--normally equal ---------
i. Decreased bilaterally for emphysema
ii. Decreased on effected side for pleural effusion and pneumothorax

Back 862

Respiratory
I. Assessment
B. Objective Data
2. Palpitation
a. Assess trachea is midline--tracheal deviation indicated tension pneumothorax
b. Assess thoracic excursion/chest expansion--normally equal bilaterally
i. Decreased bilaterally for emphysema
ii. Decreased on effected side for pleural effusion and pneumothorax

Front 863

Respiratory
I. Assessment
B. Objective Data
2. Palpitation
a. Assess trachea is midline--tracheal deviation indicated tension pneumothorax
b. Assess thoracic excursion/chest expansion--normally equal bilaterally
i. Decreased --------- for ---------
ii. Decreased on effected side for pleural effusion and pneumothorax

Back 863

Respiratory
I. Assessment
B. Objective Data
2. Palpitation
a. Assess trachea is midline--tracheal deviation indicated tension pneumothorax
b. Assess thoracic excursion/chest expansion--normally equal bilaterally
i. Decreased bilaterally for emphysema
ii. Decreased on effected side for pleural effusion and pneumothorax

Front 864

Respiratory
I. Assessment
B. Objective Data
2. Palpitation
a. Assess trachea is midline--tracheal deviation indicated tension pneumothorax
b. Assess thoracic excursion/chest expansion--normally equal bilaterally
i. Decreased bilaterally for emphysema
ii. Decreased on effected side for --------- and ---------

Back 864

Respiratory
I. Assessment
B. Objective Data
2. Palpitation
a. Assess trachea is midline--tracheal deviation indicated tension pneumothorax
b. Assess thoracic excursion/chest expansion--normally equal bilaterally
i. Decreased bilaterally for emphysema
ii. Decreased on effected side for pleural effusion and pneumothorax

Front 865

Respiratory
I. Assessment
B. Objective Data
2. Palpitation
c. -----------: vibration of chest wall produced by vocalization (“Say 99” feel upper back)
i. Decreased if lung is further away (pleural effusion, emphysema)
ii. Increased if pneumonia, tumors, and fibrosis
iii. Nothing felt if pneumothorax or severe atelectasis

Back 865

Respiratory
I. Assessment
B. Objective Data
2. Palpitation
c. Fremitis--vibration of chest wall produced by vocalization (“Say 99” feel upper back)
i. Decreased if lung is further away (pleural effusion, emphysema)
ii. Increased if pneumonia, tumors, and fibrosis
iii. Nothing felt if pneumothorax or severe atelectasis

Front 866

Respiratory
I. Assessment
B. Objective Data
2. Palpitation
c. Fremitis--vibration of chest wall produced by vocalization (“Say ----” feel upper back)
i. Decreased if lung is ---------- (------------,------------)
ii. Increased if pneumonia, tumors, and fibrosis
iii. Nothing felt if pneumothorax or severe atelectasis

Back 866

Respiratory
I. Assessment
B. Objective Data
2. Palpitation
c. Fremitis--vibration of chest wall produced by vocalization (“Say 99” feel upper back)
i. Decreased if lung is further away (pleural effusion, emphysema)
ii. Increased if pneumonia, tumors, and fibrosis
iii. Nothing felt if pneumothorax or severe atelectasis

Front 867

Respiratory
I. Assessment
B. Objective Data
2. Palpitation
c. Fremitis--vibration of chest wall produced by vocalization (“Say 99” feel upper back)
i. Decreased if lung is further away (pleural effusion, emphysema)
ii. Increased if -------, -----------, and --------------
iii. Nothing felt if pneumothorax or severe atelectasis

Back 867

Respiratory
I. Assessment
B. Objective Data
2. Palpitation
c. Fremitis--vibration of chest wall produced by vocalization (“Say 99” feel upper back)
i. Decreased if lung is further away (pleural effusion, emphysema)
ii. Increased if pneumonia, tumors, and fibrosis
iii. Nothing felt if pneumothorax or severe atelectasis

Front 868

Respiratory
I. Assessment
B. Objective Data
2. Palpitation
c. Fremitis--vibration of chest wall produced by vocalization (“Say 99” feel upper back)
i. Decreased if lung is further away (pleural effusion, emphysema)
ii. Increased if pneumonia, tumors, and fibrosis
iii. Nothing felt if ---------- or -----------

Back 868

Respiratory
I. Assessment
B. Objective Data
2. Palpitation
c. Fremitis--vibration of chest wall produced by vocalization (“Say 99” feel upper back)
i. Decreased if lung is further away (pleural effusion, emphysema)
ii. Increased if pneumonia, tumors, and fibrosis
iii. Nothing felt if pneumothorax or severe atelectasis

Front 869

Respiratory
I. Assessment
B. Objective Data
2. Palpitation
d. ---------- (subcutaneous emphysema): crackling, crinkling, or grating feeling/sound under skin, around lungs, or in joints caused by escape of air (like bubble wrap)
i. Common causes: chest tube leak, mechanical ventilation

Back 869

Respiratory
I. Assessment
B. Objective Data
2. Palpitation
d. Crepitus (subcutaneous emphysema)--crackling, crinkling, or grating feeling/sound under skin, around lungs, or in joints caused by escape of air (like bubble wrap)
i. Common causes: chest tube leak, mechanical ventilation

Front 870

Respiratory
I. Assessment
B. Objective Data
2. Palpitation
d. Crepitus (subcutaneous emphysema): ---------, -----------, or ------------------, around lungs, or in joints caused by escape of air (like bubble wrap)
i. Common causes: chest tube leak, mechanical ventilation

Back 870

Respiratory
I. Assessment
B. Objective Data
2. Palpitation
d. Crepitus (subcutaneous emphysema)--crackling, crinkling, or grating feeling/sound under skin, around lungs, or in joints caused by escape of air (like bubble wrap)
i. Common causes: chest tube leak, mechanical ventilation

Front 871

Respiratory
I. Assessment
B. Objective Data
2. Palpitation
d. Crepitus (subcutaneous emphysema)--crackling, crinkling, or grating feeling/sound under skin, ---------, or in---------- caused by escape of air (like bubble wrap)
i. Common causes: chest tube leak, mechanical ventilation

Back 871

Respiratory
I. Assessment
B. Objective Data
2. Palpitation
d. Crepitus (subcutaneous emphysema)--crackling, crinkling, or grating feeling/sound under skin, around lungs, or in joints caused by escape of air (like bubble wrap)
i. Common causes: chest tube leak, mechanical ventilation

Front 872

Respiratory
I. Assessment
B. Objective Data
2. Palpitation
d. Crepitus (subcutaneous emphysema)--crackling, crinkling, or grating feeling/sound under skin, around lungs, or in joints caused by escape of air (like bubble wrap)
i. Common causes: ------------, ------------

Back 872

Respiratory
I. Assessment
B. Objective Data
2. Palpitation
d. Crepitus (subcutaneous emphysema)--crackling, crinkling, or grating feeling/sound under skin, around lungs, or in joints caused by escape of air (like bubble wrap)
i. Common causes: chest tube leak, mechanical ventilation

Front 873

Respiratory
I. Assessment
B. Objective Data
3. Percussion--assessment of --------- or ----------- of the lungs
a. Resonance--air filled lung (normal)
b. Hyperresonance--loud, lower pitched sound from increased air volume (ex. COPD)
c. Tympany--drum like (ex. gastric air bubble)
d. Dullness--consolidation in lung (ex. heart, top of liver, or pneumonia, hemothorax)
e. Flat--soft, high pitched sound from large fluid mass (ex. thigh)

Back 873

Respiratory
I. Assessment
B. Objective Data
3. Percussion--assessment of density or aeration of the lungs
a. Resonance--air filled lung (normal)
b. Hyperresonance--loud, lower pitched sound from increased air volume (ex. COPD)
c. Tympany--drum like (ex. gastric air bubble)
d. Dullness--consolidation in lung (ex. heart, top of liver, or pneumonia, hemothorax)
e. Flat--soft, high pitched sound from large fluid mass (ex. thigh)

Front 874

Respiratory
I. Assessment
B. Objective Data
3. Percussion--assessment of density or aeration of the lungs
a. Resonance: ---------- (normal)
b. Hyperresonance: -----, lower pitched sound from --------------- (ex. COPD)
c. Tympany--drum like (ex. gastric air bubble)
d. Dullness--consolidation in lung (ex. heart, top of liver, or pneumonia, hemothorax)
e. Flat--soft, high pitched sound from large fluid mass (ex. thigh)

Back 874

Respiratory
I. Assessment
B. Objective Data
3. Percussion--assessment of density or aeration of the lungs
a. Resonance--air filled lung (normal)
b. Hyperresonance--loud, lower pitched sound from increased air volume (ex. COPD)
c. Tympany--drum like (ex. gastric air bubble)
d. Dullness--consolidation in lung (ex. heart, top of liver, or pneumonia, hemothorax)
e. Flat--soft, high pitched sound from large fluid mass (ex. thigh)

Front 875

Respiratory
I. Assessment
B. Objective Data
3. Percussion--assessment of density or aeration of the lungs
a. Resonance--air filled lung (normal)
b. Hyperresonance--loud, lower pitched sound from increased air volume (ex. COPD)
c. ----------: drum like (ex. gastric air bubble)
d. Dullness--consolidation in ----------- (ex. heart, top of ---------, or pneumonia, ----------)
e. Flat--soft, high pitched sound from large fluid mass (ex. thigh)

Back 875

Respiratory
I. Assessment
B. Objective Data
3. Percussion--assessment of density or aeration of the lungs
a. Resonance--air filled lung (normal)
b. Hyperresonance--loud, lower pitched sound from increased air volume (ex. COPD)
c. Tympany--drum like (ex. gastric air bubble)
d. Dullness--consolidation in lung (ex. heart, top of liver, or pneumonia, hemothorax)
e. Flat--soft, high pitched sound from large fluid mass (ex. thigh)

Front 876

Respiratory
I. Assessment
B. Objective Data
3. Percussion--assessment of density or aeration of the lungs
a. Resonance--air filled lung (normal)
b. Hyperresonance--loud, lower pitched sound from increased air volume (ex. COPD)
c. Tympany--drum like (ex. gastric air bubble)
d. Dullness--consolidation in lung (ex. heart, top of liver, or pneumonia, hemothorax)
e. Flat--soft, high pitched sound from --------------- (ex. thigh)

Back 876

Respiratory
I. Assessment
B. Objective Data
3. Percussion--assessment of density or aeration of the lungs
a. Resonance--air filled lung (normal)
b. Hyperresonance--loud, lower pitched sound from increased air volume (ex. COPD)
c. Tympany--drum like (ex. gastric air bubble)
d. Dullness--consolidation in lung (ex. heart, top of liver, or pneumonia, hemothorax)
e. Flat--soft, high pitched sound from large fluid mass (ex. thigh)

Front 877

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for ---------- and --------- sounds

Back 877

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sounds
a. Adventitious Sounds
i. Fine crackles--short lasting, high pitched at end of inspiration

Front 878

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sounds
a. Adventitious Sounds
i. Fine crackles--short lasting, ---------- at --------------

Back 878

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sounds
a. Adventitious Sounds
i. Fine crackles--short lasting, high pitched at end of inspiration

Front 879

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sounds
• Due to ---------- snapping open or movement of ---------- through a lot of ----------
• Post-op atelectasis, pulmonary edema
ii. Course crackles--low pitched on inspiration and expiration that is not eliminated by cough (will not go away until disease process ends/gets better)
• Due to air passing through airway intermittently occluded with mucus
• Pulmonary edema, pneumonia, CHF
• Do fluid assessment, I/Os, and O2Sat

Back 879

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sounds
• Due to alveoli snapping open or movement of air through a lot of liquid
• Post-op atelectasis, pulmonary edema
ii. Course crackles--low pitched on inspiration and expiration that is not eliminated by cough (will not go away until disease process ends/gets better)
• Due to air passing through airway intermittently occluded with mucus
• Pulmonary edema, pneumonia, CHF
• Do fluid assessment, I/Os, and O2Sat

Front 880

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sounds
• Due to alveoli snapping open or movement of air through a lot of liquid
• Post-op -----------, pulmonary--------
ii. Course crackles--low pitched on inspiration and expiration that is not eliminated by cough (will not go away until disease process ends/gets better)
• Due to air passing through airway intermittently occluded with mucus
• Pulmonary edema, pneumonia, CHF
• Do fluid assessment, I/Os, and O2Sat

Back 880

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sounds
• Due to alveoli snapping open or movement of air through a lot of liquid
• Post-op atelectasis, pulmonary edema
ii. Course crackles--low pitched on inspiration and expiration that is not eliminated by cough (will not go away until disease process ends/gets better)
• Due to air passing through airway intermittently occluded with mucus
• Pulmonary edema, pneumonia, CHF
• Do fluid assessment, I/Os, and O2Sat

Front 881

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sounds
• Due to alveoli snapping open or movement of air through a lot of liquid
• Post-op atelectasis, pulmonary edema
ii. Course crackles--low pitched on --------- and ----------- that is not eliminated by---------- (will not go away until disease process ends/gets better)
• Due to air passing through airway intermittently occluded with mucus
• Pulmonary edema, pneumonia, CHF
• Do fluid assessment, I/Os, and O2Sat

Back 881

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sounds
• Due to alveoli snapping open or movement of air through a lot of liquid
• Post-op atelectasis, pulmonary edema
ii. Course crackles--low pitched on inspiration and expiration that is not eliminated by cough (will not go away until disease process ends/gets better)
• Due to air passing through airway intermittently occluded with mucus
• Pulmonary edema, pneumonia, CHF
• Do fluid assessment, I/Os, and O2Sat

Front 882

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sounds
• Due to alveoli snapping open or movement of air through a lot of liquid
• Post-op atelectasis, pulmonary edema
ii. Course crackles--low pitched on inspiration and expiration that is not eliminated by cough (will not go away until disease process ends/gets better)
• Due to air passing through --------- intermittently occluded with---------
• Pulmonary ------, pneumonia, CHF
• Do fluid assessment, I/Os, and O2Sat

Back 882

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sounds
• Due to alveoli snapping open or movement of air through a lot of liquid
• Post-op atelectasis, pulmonary edema
ii. Course crackles--low pitched on inspiration and expiration that is not eliminated by cough (will not go away until disease process ends/gets better)
• Due to air passing through airway intermittently occluded with mucus
• Pulmonary edema, pneumonia, CHF
• Do fluid assessment, I/Os, and O2Sat

Front 883

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sounds
• Due to alveoli snapping open or movement of air through a lot of liquid
• Post-op atelectasis, pulmonary edema
ii. Course crackles--low pitched on inspiration and expiration that is not eliminated by cough (will not go away until disease process ends/gets better)
• Due to air passing through airway intermittently occluded with mucus
• Pulmonary edema, pneumonia, CHF
• Do -------- assessment, ------, and -------

Back 883

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sounds
• Due to alveoli snapping open or movement of air through a lot of liquid
• Post-op atelectasis, pulmonary edema
ii. Course crackles--low pitched on inspiration and expiration that is not eliminated by cough (will not go away until disease process ends/gets better)
• Due to air passing through airway intermittently occluded with mucus
• Pulmonary edema, pneumonia, CHF
• Do fluid assessment, I/Os, and O2Sat

Front 884

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
iii. Rhonchi--harsh/----------, from large airway obstruction by --------
• Pneumonia
• Can be cleared--have pt cough or suction if vented and listen for changes
iv. Wheezes--mostly on inspiration (can also be expiration)
• Asthma

Back 884

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
iii. Rhonchi--harsh/course rattling, from large airway obstruction by mucus
• Pneumonia
• Can be cleared--have pt cough or suction if vented and listen for changes
iv. Wheezes--mostly on inspiration (can also be expiration)
• Asthma

Front 885

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
iii. Rhonchi--harsh/course rattling, from large airway obstruction by mucus
• Pneumonia
• Can be cleared--have pt ------- or --------- if vented and listen for ----------
iv. Wheezes--mostly on inspiration (can also be expiration)
• Asthma

Back 885

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
iii. Rhonchi--harsh/course rattling, from large airway obstruction by mucus
• Pneumonia
• Can be cleared--have pt cough or suction if vented and listen for changes
iv. Wheezes--mostly on inspiration (can also be expiration)
• Asthma

Front 886

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
• If stops w/out intervention could be diminished due to ------------ (bad)
v. --------------: grating/leather rubbing sound stops when pt holds breath

Back 886

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
• If stops w/out intervention could be diminished due to tightness (bad)
v. Pleural friction rub--grating/leather rubbing sound stops when pt holds breath

Front 887

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
• If stops w/out intervention could be diminished due to tightness (bad)
v. Pleural friction rub--grating/leather rubbing sound stops when pt -----------

Back 887

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
• If stops w/out intervention could be diminished due to tightness (bad)
v. Pleural friction rub--grating/leather rubbing sound stops when pt holds breath

Front 888

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
• Diff from ----------- rub (continuous rub while holding breath)
b. Normal--: ------------ breath sounds throughout (Moving down, sounds high to low pitch)
i. Bronchial--heard over trachea; “wind through tube” (louder and higher pitch)
ii. Bronchovesicular--heard over main bronchi (medium pitch)
iii. Vesicular--heard over lobes (softer and lower pitched)
iv. Patients can open mouth to breath deeper

Back 888

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
• Diff from pericardial rub (continuous rub while holding breath)
b. Normal--vesicular breath sounds throughout (Moving down, sounds high to low pitch)
i. Bronchial--heard over trachea; “wind through tube” (louder and higher pitch)
ii. Bronchovesicular--heard over main bronchi (medium pitch)
iii. Vesicular--heard over lobes (softer and lower pitched)
iv. Patients can open mouth to breath deeper

Front 889

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
• Diff from pericardial rub (continuous rub while holding breath)
b. Normal--vesicular breath sounds throughout (Moving down, sounds high to low pitch)
i. Bronchial--heard over -----------; “wind through ---------” (louder and higher pitch)
ii. Bronchovesicular--heard over main bronchi (medium pitch)
iii. Vesicular--heard over lobes (softer and lower pitched)
iv. Patients can open mouth to breath deeper

Back 889

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
• Diff from pericardial rub (continuous rub while holding breath)
b. Normal--vesicular breath sounds throughout (Moving down, sounds high to low pitch)
i. Bronchial--heard over trachea; “wind through tube” (louder and higher pitch)
ii. Bronchovesicular--heard over main bronchi (medium pitch)
iii. Vesicular--heard over lobes (softer and lower pitched)
iv. Patients can open mouth to breath deeper

Front 890

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
• Diff from pericardial rub (continuous rub while holding breath)
b. Normal--vesicular breath sounds throughout (Moving down, sounds high to low pitch)
i. Bronchial--heard over trachea; “wind through tube” (louder and higher pitch)
ii. Bronchovesicular--heard over ---------- (medium pitch)
iii. Vesicular--heard over -------- (softer and ------- pitched)
iv. Patients can open mouth to breath deeper

Back 890

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
• Diff from pericardial rub (continuous rub while holding breath)
b. Normal--vesicular breath sounds throughout (Moving down, sounds high to low pitch)
i. Bronchial--heard over trachea; “wind through tube” (louder and higher pitch)
ii. Bronchovesicular--heard over main bronchi (medium pitch)
iii. Vesicular--heard over lobes (softer and lower pitched)
iv. Patients can open mouth to breath deeper

Front 891

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
• Diff from pericardial rub (continuous rub while holding breath)
b. Normal--vesicular breath sounds throughout (Moving down, sounds high to low pitch)
i. Bronchial--heard over trachea; “wind through tube” (louder and higher pitch)
ii. Bronchovesicular--heard over main bronchi (medium pitch)
iii. Vesicular--heard over lobes (softer and lower pitched)
iv. Patients can open ------- to breath deeper

Back 891

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
• Diff from pericardial rub (continuous rub while holding breath)
b. Normal--vesicular breath sounds throughout (Moving down, sounds high to low pitch)
i. Bronchial--heard over trachea; “wind through tube” (louder and higher pitch)
ii. Bronchovesicular--heard over main bronchi (medium pitch)
iii. Vesicular--heard over lobes (softer and lower pitched)
iv. Patients can open mouth to breath deeper

Front 892

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
• Diff from pericardial rub (continuous rub while holding breath)
c. Abnormal--sound other than what is supposed to be there (diff from --------)
d. Voice Sounds--can indicate need for ---------
i. Whispered Pectoriloquy--the way words come across as the whisper “1, 2, 3”

Back 892

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
• Diff from pericardial rub (continuous rub while holding breath)
c. Abnormal--sound other than what is supposed to be there (diff from adventitious)
d. Voice Sounds--can indicate need for CXR
i. Whispered Pectoriloquy--the way words come across as the whisper “1, 2, 3”

Front 893

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
• Diff from pericardial rub (continuous rub while holding breath)
c. Abnormal--sound other than what is supposed to be there (diff from adventitious)
d. Voice Sounds--can indicate need for CXR
i. -----------------: the way words come across as the whisper “1, 2, 3”

Back 893

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
• Diff from pericardial rub (continuous rub while holding breath)
c. Abnormal--sound other than what is supposed to be there (diff from adventitious)
d. Voice Sounds--can indicate need for CXR
i. Whispered Pectoriloquy--the way words come across as the whisper “1, 2, 3”

Front 894

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
• Normal to hear it muffled when listening to ----------------
• Abnormal to hear it clearly (---------,-----------)
ii. Bronchophony--say “99” in louder tone (should sound muffled)
iii. Egophony--say “E” abnormal if it sounds like “A” (should sound muffled)

Back 894

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
• Normal to hear it muffled when listening to posterior chest wall
• Abnormal to hear it clearly (pneumonia, atelectasis)
ii. Bronchophony--say “99” in louder tone (should sound muffled)
iii. Egophony--say “E” abnormal if it sounds like “A” (should sound muffled)

Front 895

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
• Normal to hear it muffled when listening to posterior chest wall
• Abnormal to hear it clearly (pneumonia, atelectasis)
ii. -------------: say “99” in louder tone (should sound muffled)
iii. ------------: say “E” abnormal if it sounds like “A” (should sound muffled)

Back 895

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
• Normal to hear it muffled when listening to posterior chest wall
• Abnormal to hear it clearly (pneumonia, atelectasis)
ii. Bronchophony--say “99” in louder tone (should sound muffled)
iii. Egophony--say “E” abnormal if it sounds like “A” (should sound muffled)

Front 896

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
• Normal to hear it muffled when listening to posterior chest wall
• Abnormal to hear it clearly (pneumonia, atelectasis)
ii. Bronchophony--say “-----” in louder tone (should sound muffled)
iii. Egophony--say “-----” abnormal if it sounds like “------” (should sound muffled)

Back 896

Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
• Normal to hear it muffled when listening to posterior chest wall
• Abnormal to hear it clearly (pneumonia, atelectasis)
ii. Bronchophony--say “99” in louder tone (should sound muffled)
iii. Egophony--say “E” abnormal if it sounds like “A” (should sound muffled)

Front 897

Respiratory
II. Artificial Airways
A. ------------- Airway--used to keep tongue from occluding airway in unconscious pts (protection)
1. Techniques of Insertion
a. Clear mouth of secretions and maintain head position
b. Measure from corner of mouth to tragus
2. Precautions--cannot use with oral trauma or if patient has gag reflex

Back 897

Respiratory
II. Artificial Airways
A. Oropharyngeal Airway--used to keep tongue from occluding airway in unconscious pts (protection)
1. Techniques of Insertion
a. Clear mouth of secretions and maintain head position
b. Measure from corner of mouth to tragus
2. Precautions--cannot use with oral trauma or if patient has gag reflex

Front 898

Respiratory
II. Artificial Airways
A. Oropharyngeal Airway--used to keep tongue from occluding airway in unconscious pts (protection)
1. Techniques of Insertion
a. Clear mouth of ------ and maintain -------
b. Measure from corner of mouth to ------
2. Precautions--cannot use with oral trauma or if patient has gag reflex

Back 898

Respiratory
II. Artificial Airways
A. Oropharyngeal Airway--used to keep tongue from occluding airway in unconscious pts (protection)
1. Techniques of Insertion
a. Clear mouth of secretions and maintain head position
b. Measure from corner of mouth to tragus
2. Precautions--cannot use with oral trauma or if patient has gag reflex

Front 899

Respiratory
II. Artificial Airways
A. Oropharyngeal Airway--used to keep tongue from occluding airway in unconscious pts (protection)
1. Techniques of Insertion
a. Clear mouth of secretions and maintain head position
b. Measure from corner of mouth to tragus
2. Precautions--cannot use with -------- or if patient has -------

Back 899

Respiratory
II. Artificial Airways
A. Oropharyngeal Airway--used to keep tongue from occluding airway in unconscious pts (protection)
1. Techniques of Insertion
a. Clear mouth of secretions and maintain head position
b. Measure from corner of mouth to tragus
2. Precautions--cannot use with oral trauma or if patient has gag reflex

Front 900

Respiratory
II. Artificial Airways
B. ----------------- airway--provides patent airway without stimulating gag reflex (needs lubrication)
1. Precautions--cannot be used for facial trauma (basal skull fracture)

Back 900

Respiratory
II. Artificial Airways
B. Nasopharyngeal Airway--provides patent airway without stimulating gag reflex (needs lubrication)
1. Precautions--cannot be used for facial trauma (basal skull fracture)

Front 901

Respiratory
II. Artificial Airways
B. Nasopharyngeal Airway--provides patent airway without stimulating -------- (needs lubrication)
1. Precautions--cannot be used for ----------- (basal skull fracture)

Back 901

Respiratory
II. Artificial Airways
B. Nasopharyngeal Airway--provides patent airway without stimulating gag reflex (needs lubrication)
1. Precautions--cannot be used for facial trauma (basal skull fracture)

Front 902

Respiratory
II. Artificial Airways
C. ------------- Intubation--can be placed for 2 weeks, than tracheotomy or extubation
1. Oral--larger tube therefore less air resistance (preferred form)
a. Disadvantage--pt can bit tube (need to use a bite block)

Back 902

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
1. Oral--larger tube therefore less air resistance (preferred form)
a. Disadvantage--pt can bit tube (need to use a bite block)

Front 903

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for ------ weeks, than tracheotomy or ------------
1. Oral--larger tube therefore less air resistance (preferred form)
a. Disadvantage--pt can bit tube (need to use a bite block)

Back 903

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
1. Oral--larger tube therefore less air resistance (preferred form)
a. Disadvantage--pt can bit tube (need to use a bite block)

Front 904

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
1. Oral--larger tube therefore less ------------- (preferred form)
a. Disadvantage--pt can ---------- (need to use a ---------- block)

Back 904

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
1. Oral--larger tube therefore less air resistance (preferred form)
a. Disadvantage--pt can bit tube (need to use a bite block)

Front 905

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
2. Nasal--used if ------------ prevents moving neck for --------- intubation (more comfortable)
a. Disadvantages--hard to suction (smaller tube diameter)
b. Contraindicated in pts with facial trauma

Back 905

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
2. Nasal--used if spinal cord injury prevents moving neck for oral intubation (more comfortable)
a. Disadvantages--hard to suction (smaller tube diameter)
b. Contraindicated in pts with facial trauma

Front 906

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
2. Nasal--used if spinal cord injury prevents moving neck for oral intubation (more comfortable)
a. Disadvantages--hard to -------- (smaller tube --------)
b. Contraindicated in pts with --------- trauma

Back 906

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
2. Nasal--used if spinal cord injury prevents moving neck for oral intubation (more comfortable)
a. Disadvantages--hard to suction (smaller tube diameter)
b. Contraindicated in pts with facial trauma

Front 907

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
3. Indications
a. Inadequate -------------- (↓arterial --------, etc.) that is not corrected by supplemental O2
i. Causes--barbiturate overdose, anesthesia, etc.

Back 907

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
3. Indications
a. Inadequate oxygenation (↓arterial PO2, etc.) that is not corrected by supplemental O2
i. Causes--barbiturate overdose, anesthesia, etc.

Front 908

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
3. Indications
a. Inadequate oxygenation (↓arterial PO2, etc.) that is not corrected by supplemental -----------
i. Causes--: -------------, ------------, etc.

Back 908

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
3. Indications
a. Inadequate oxygenation (↓arterial PO2, etc.) that is not corrected by supplemental O2
i. Causes--barbiturate overdose, anesthesia, etc.

Front 909

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
3. Indications
b. Inadequate ---------- (increased arterial ----------)--can’t move gas inside
i. PCO2 >50 or pH <7.25
**Get ABG after to see if corrected

Back 909

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
3. Indications
b. Inadequate ventilation (increased arterial PCO2)--can’t move gas inside
i. PCO2 >50 or pH <7.25
**Get ABG after to see if corrected

Front 910

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
3. Indications
b. Inadequate ventilation (increased arterial PCO2)--can’t move gas inside
i. PCO2 >-------- or pH <--------------
**Get ------------ after to see if corrected

Back 910

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
3. Indications
b. Inadequate ventilation (increased arterial PCO2)--can’t move gas inside
i. PCO2 >50 or pH <7.25
**Get ABG after to see if corrected

Front 911

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
4. Procedure--need ----------- and --------- at bed side

Back 911

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
4. Procedure--need suction and O2 at bed side

Front 912

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
4. Procedure--need suction and O2 at bed side
a. Patient education
i. Won’t be able to --------- (reassure needs will be met)
ii. Assure that pt will be able to----------- better

Back 912

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
4. Procedure--need suction and O2 at bed side
a. Patient education
i. Won’t be able to talk (reassure needs will be met)
ii. Assure that pt will be able to breathe better

Front 913

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
4. Procedure--need suction and O2 at bed side
b. Preparation for intubation--: -----------, ----------, -------, and sedation -------- (Versed)
i. Assess for hypoxia (arrhythmias) and vomiting

Back 913

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
4. Procedure--need suction and O2 at bed side
b. Preparation for intubation--supplies, ambu bag, code cart, and sedation meds (Versed)
i. Assess for hypoxia (arrhythmias) and vomiting

Front 914

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
4. Procedure--need suction and O2 at bed side
b. Preparation for intubation--supplies, ambu bag, code cart, and sedation meds (Versed)
i. Assess for ------- (arrhythmias) and ----------

Back 914

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
4. Procedure--need suction and O2 at bed side
b. Preparation for intubation--supplies, ambu bag, code cart, and sedation meds (Versed)
i. Assess for hypoxia (arrhythmias) and vomiting

Front 915

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
4. Procedure--need suction and O2 at bed side
c. Hold breath to remember --------- of attempt (no more than ---------- to 1min)

Back 915

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
4. Procedure--need suction and O2 at bed side
c. Hold breath to remember length of attempt (no more than 30sec-1min)

Front 916

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
4. Procedure--need suction and O2 at bed side
d. Checking placement--tape tube at ------ and record --------
i. Check tidal CO2 monitor (color or number change)
ii. Listen for breath sounds
iii. Visualize chest expansion

Back 916

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
4. Procedure--need suction and O2 at bed side
d. Checking placement--tape tube at lip and record line mark
i. Check tidal CO2 monitor (color or number change)
ii. Listen for breath sounds
iii. Visualize chest expansion

Front 917

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
4. Procedure--need suction and O2 at bed side
d. Checking placement--tape tube at lip and record line mark
i. Check tidal -------- monitor (color or number change)
ii. Listen for --------
iii. Visualize ----------

Back 917

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
4. Procedure--need suction and O2 at bed side
d. Checking placement--tape tube at lip and record line mark
i. Check tidal CO2 monitor (color or number change)
ii. Listen for breath sounds
iii. Visualize chest expansion

Front 918

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
4. Procedure--need suction and O2 at bed side
5. Post Intubation Assessment
a. Assess end tidal ---------
b. Assess for -----------, equal breath sounds, and ----------
c. Auscultation of gastric area (to determine if esophageal intubation instead of tracheal)
d. Nurse, RT, or anesthetist stabilizes tube

Back 918

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
4. Procedure--need suction and O2 at bed side
5. Post Intubation Assessment
a. Assess end tidal CO2
b. Assess for bilateral, equal breath sounds, and chest expansion
c. Auscultation of gastric area (to determine if esophageal intubation instead of tracheal)
d. Nurse, RT, or anesthetist stabilizes tube

Front 919

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
4. Procedure--need suction and O2 at bed side
5. Post Intubation Assessment
a. Assess end tidal CO2
b. Assess for bilateral, equal breath sounds, and chest expansion
c. Auscultation of ----------- (to determine if esophageal intubation instead of ----------)
d. Nurse, RT, or anesthetist stabilizes --------

Back 919

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
4. Procedure--need suction and O2 at bed side
5. Post Intubation Assessment
a. Assess end tidal CO2
b. Assess for bilateral, equal breath sounds, and chest expansion
c. Auscultation of gastric area (to determine if esophageal intubation instead of tracheal)
d. Nurse, RT, or anesthetist stabilizes tube

Front 920

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
4. Procedure--need suction and O2 at bed side
5. Post Intubation Assessment
e. Oral ETT positioned ------ or ------- side of mouth and changed q24hrs (safer with 2 people)
i. Suction before deflating balloon so secretions do not flow into lungs
f. Oral airway may need bite block to prevent pt from biting tube
g. Stat CXR verifies correct placement (if it needs to move, deflate and reinflate balloon)
i. Should be 2 finger breadths above carina

Back 920

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
4. Procedure--need suction and O2 at bed side
5. Post Intubation Assessment
e. Oral ETT positioned lf or rt side of mouth and changed q24hrs (safer with 2 people)
i. Suction before deflating balloon so secretions do not flow into lungs
f. Oral airway may need bite block to prevent pt from biting tube
g. Stat CXR verifies correct placement (if it needs to move, deflate and reinflate balloon)
i. Should be 2 finger breadths above carina

Front 921

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
4. Procedure--need suction and O2 at bed side
5. Post Intubation Assessment
e. Oral ETT positioned lf or rt side of mouth and changed --------hrs (safer with 2 people)
i. Suction before deflating ------------ so secretions do not flow into lungs
f. Oral airway may need bite block to prevent pt from biting tube
g. Stat CXR verifies correct placement (if it needs to move, deflate and reinflate balloon)
i. Should be 2 finger breadths above carina

Back 921

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
5. Post Intubation Assessment
e. Oral ETT positioned lf or rt side of mouth and changed q24hrs (safer with 2 people)
i. Suction before deflating balloon so secretions do not flow into lungs
f. Oral airway may need bite block to prevent pt from biting tube
g. Stat CXR verifies correct placement (if it needs to move, deflate and reinflate balloon)
i. Should be 2 finger breadths above carina

Front 922

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
5. Post Intubation Assessment
e. Oral ETT positioned lf or rt side of mouth and changed q24hrs (safer with 2 people)
i. Suction before deflating balloon so secretions do not flow into lungs
f. Oral airway may need ---------- to prevent pt from biting tube
g. Stat ----------- verifies correct placement (if it needs to move, deflate and reinflate balloon)
i. Should be 2 finger breadths above carina

Back 922

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
5. Post Intubation Assessment
e. Oral ETT positioned lf or rt side of mouth and changed q24hrs (safer with 2 people)
i. Suction before deflating balloon so secretions do not flow into lungs
f. Oral airway may need bite block to prevent pt from biting tube
g. Stat CXR verifies correct placement (if it needs to move, deflate and reinflate balloon)
i. Should be 2 finger breadths above carina

Front 923

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
5. Post Intubation Assessment
e. Oral ETT positioned lf or rt side of mouth and changed q24hrs (safer with 2 people)
i. Suction before deflating balloon so secretions do not flow into lungs
f. Oral airway may need bite block to prevent pt from biting tube
g. Stat CXR verifies correct placement (if it needs to move, deflate and ------------ balloon)
i. Should be ------------ breadths above carina

Back 923

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
5. Post Intubation Assessment
e. Oral ETT positioned lf or rt side of mouth and changed q24hrs (safer with 2 people)
i. Suction before deflating balloon so secretions do not flow into lungs
f. Oral airway may need bite block to prevent pt from biting tube
g. Stat CXR verifies correct placement (if it needs to move, deflate and reinflate balloon)
i. Should be 2 finger breadths above carina

Front 924

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
a. Maintaining correct --------- placement (------- shift)
b. Monitoring proper cuff inflation (20-25mmHg q8hr)--should not be 100% occlusive

Back 924

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
a. Maintaining correct tube placement (q shift)
b. Monitoring proper cuff inflation (20-25mmHg q8hr)--should not be 100% occlusive

Front 925

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
a. Maintaining correct tube placement (q shift)

Back 925

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
a. Maintaining correct tube placement (q shift)
b. Monitoring proper cuff inflation (20-25mmHg q8hr)--should not be 100% occlusive

Front 926

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
a. Maintaining correct tube placement (q shift)
b. Monitoring proper cuff inflation (-------to ----------mmHg q-------hr)--should not be 100% occlusive

Back 926

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
a. Maintaining correct tube placement (q shift)
b. Monitoring proper cuff inflation (20-25mmHg q8hr)--should not be 100% occlusive

Front 927

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
a. Maintaining correct tube placement (q shift)
b. Monitoring proper cuff inflation (20-25mmHg q8hr)--should not be ----------% occlusive

Back 927

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
a. Maintaining correct tube placement (q shift)
b. Monitoring proper cuff inflation (20-25mmHg q8hr)--should not be 100% occlusive

Front 928

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
b. Monitoring proper -------- inflation (20-25mmHg q8hr)--should not be 100% occlusive

i. If <--------mmHg leak
ii. If >----------mmHg damage to tissue
iii. If able to talk air through vocal cords balloon deflated then ----------

Back 928

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
b. Monitoring proper -------- inflation (20-25mmHg q8hr)--should not be 100% occlusive

i. If <20mmHg leak
ii. If >20mmHg damage to tissue
iii. If able to talk air through vocal cords balloon deflated reinflate

Front 929

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
c. Monitor ---------- and ----------
i. End tidal CO2 monitor--indicates correct placement
ii. ABGs--SAO2 measures tissue oxygenation and gives info on CO
iii. Peak inspiratory pressure--if increased suction

Back 929

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
c. Monitor oxygenation and ventilation
i. End tidal CO2 monitor--indicates correct placement
ii. ABGs--SAO2 measures tissue oxygenation and gives info on CO
iii. Peak inspiratory pressure--if increased suction

Front 930

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
c. Monitor oxygenation and ventilation
i. End tidal CO2 monitor--indicates ------------
ii. ABGs: ------------ measures tissue oxygenation and gives info on CO
iii. Peak ---------- pressure--if increased suction

Back 930

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
c. Monitor oxygenation and ventilation
i. End tidal CO2 monitor--indicates correct placement
ii. ABGs--SAO2 measures tissue oxygenation and gives info on CO
iii. Peak inspiratory pressure--if increased suction

Front 931

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
c. Monitor oxygenation and ventilation
i. End tidal CO2 monitor--indicates correct placement
ii. ABGs--SAO2 measures tissue oxygenation and gives info on CO
iii. Peak inspiratory pressure--if increased -----------

Back 931

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
c. Monitor oxygenation and ventilation
i. End tidal CO2 monitor--indicates correct placement
ii. ABGs--SAO2 measures tissue oxygenation and gives info on CO
iii. Peak inspiratory pressure--if increased suction

Front 932

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
d. Provide --------- and maintaining skin ------: tube positioning and oral care
e. Comfort and communication--talk to pt/use meds (Versed, Propofol) to relieve anxiety
i. When pt starts to wake up watch for pt pulling tube out and assess for mental status (takes time to get used to tube often pts kept sedated for a while)

Back 932

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
d. Provide oral care and maintaining skin integrity--: tube positioning and oral care
e. Comfort and communication--talk to pt/use meds (Versed, Propofol) to relieve anxiety
i. When pt starts to wake up watch for pt pulling tube out and assess for mental status (takes time to get used to tube often pts kept sedated for a while)

Front 933

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
d. Provide oral care and maintaining skin integrity--: tube positioning and oral care
e. Comfort and communication--talk to pt/use meds (---------, ----------) to relieve anxiety
i. When pt starts to wake up watch for pt pulling ----------- and assess for ---------- (takes time to get used to tube often pts kept sedated for a while)

Back 933

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
d. Provide oral care and maintaining skin integrity--: tube positioning and oral care
e. Comfort and communication--talk to pt/use meds (Versed, Propofol) to relieve anxiety
i. When pt starts to wake up watch for pt pulling tube out and assess for mental status (takes time to get used to tube often pts kept sedated for a while)

Front 934

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
f. Assess for complications: --------, ----------, decreased ------, etc.
g. Maintain tube patency--suction as needed

Back 934

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
f. Assess for complications--ALOC, arrhythmias, decreased O2, etc.
g. Maintain tube patency--suction as needed

Front 935

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
f. Assess for complications--ALOC, arrhythmias, decreased O2, etc.
g. Maintain tube --------: --suction as needed

Back 935

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
f. Assess for complications--ALOC, arrhythmias, decreased O2, etc.
g. Maintain tube patency--suction as needed

Front 936

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
h. Pt needs --------- assessment within ------hrs of intubation

Back 936

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
h. Pt needs nutritional assessment within 72hrs of intubation

Front 937

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
7. Potential Complications
a. Suctioning--suction for <--------sec and watch for ------------
i. Hypoxemia--preoxygenate (suctioning will drop O2Sats)
ii. Bronchospasm--give pt break in between
iii. Arrhythmias--stop if bradycardia (vaso-vagal response)--have atropine near by
iv. HTN/hypotension

Back 937

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
7. Potential Complications
a. Suctioning--suction for <10sec and watch for arrhythmias
i. Hypoxemia--preoxygenate (suctioning will drop O2Sats)
ii. Bronchospasm--give pt break in between
iii. Arrhythmias--stop if bradycardia (vaso-vagal response)--have atropine near by
iv. HTN/hypotension

Front 938

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
7. Potential Complications
a. Suctioning--suction for <10sec and watch for arrhythmias
i. --------------: preoxygenate (suctioning will drop O2Sats)
ii. B------------: give pt break in between
iii. A-----------: stop if bradycardia (vaso-vagal response)--have atropine near by
iv. HTN/-------------

Back 938

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
7. Potential Complications
a. Suctioning--suction for <10sec and watch for arrhythmias
i. Hypoxemia--preoxygenate (suctioning will drop O2Sats)
ii. Bronchospasm--give pt break in between
iii. Arrhythmias--stop if bradycardia (vaso-vagal response)--have atropine near by
iv. HTN/hypotension

Front 939

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
7. Potential Complications
a. Suctioning--suction for <10sec and watch for arrhythmias
i. Hypoxemia--preoxygenate (suctioning will drop O2Sats)
ii. Bronchospasm--give pt --------- in between
iii. Arrhythmias--stop if ------------- (vaso-vagal response)--have atropine near by
iv. HTN/hypotension

Back 939

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
7. Potential Complications
a. Suctioning--suction for <10sec and watch for arrhythmias
i. Hypoxemia--preoxygenate (suctioning will drop O2Sats)
ii. Bronchospasm--give pt break in between
iii. Arrhythmias--stop if bradycardia (vaso-vagal response)--have atropine near by
iv. HTN/hypotension

Front 940

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
7. Potential Complications
a. Suctioning--suction for <10sec and watch for arrhythmias
v. ---------: can be too much suction (should be <120mmHg)
vi. I------------
vii. Increase in ------------ pressure (in head trauma pts)--use minimal suctioning

Back 940

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
7. Potential Complications
a. Suctioning--suction for <10sec and watch for arrhythmias
v. Pulmonary bleeding--can be too much suction (should be <120mmHg)
vi. Infections
vii. Increase in intracranial pressure (in head trauma pts)--use minimal suctioning

Front 941

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
7. Potential Complications
a. Suctioning--suction for <10sec and watch for arrhythmias
v. Pulmonary bleeding--can be too much suction (should be <---------mmHg)
vi. Infections
vii. Increase in intracranial pressure (in --------- trauma pts)--use minimal suctioning

Back 941

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
7. Potential Complications
a. Suctioning--suction for <10sec and watch for arrhythmias
v. Pulmonary bleeding--can be too much suction (should be <120mmHg)
vi. Infections
vii. Increase in intracranial pressure (in head trauma pts)--use minimal suctioning

Front 942

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
7. Potential Complications
b. Self-extubation--most pts --------- or ----------- for prevention (explain need to family)
c. Aspiration--keep HOB >30° (likely tube fed--always check placement)

Back 942

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
7. Potential Complications
b. Self-extubation--most pts restrained or sedated for prevention (explain need to family)
c. Aspiration--keep HOB >30° (likely tube fed--always check placement)

Front 943

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
7. Potential Complications
b. Self-extubation--most pts restrained or sedated for prevention (explain need to family)
c. Aspiration--keep HOB >------° (likely tube fed--always check ----------)

Back 943

Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
7. Potential Complications
b. Self-extubation--most pts restrained or sedated for prevention (explain need to family)
c. Aspiration--keep HOB >30° (likely tube fed--always check placement)

Front 944

Respiratory
II. Artificial Airways
D. ---------: stoma that results from a surgical incision (in OR or at bedside) into the trachea

Back 944

Respiratory
II. Artificial Airways
D. Tracheostomy--stoma that results from a surgical incision (in OR or at bedside) into the trachea

Front 945

Respiratory
II. Artificial Airways
D. Tracheostomy--stoma that results from a surgical incision (in OR or at bedside) into the trachea
1. Indications
a. Bypass an ----------- obstruction
b. Facilitate removal of -----------
c. Permit long-term -------------- ventilation--after two weeks with ET tube
i. Easier to ween from trach than from ET tube
d. Permits oral ----------

Back 945

Respiratory
II. Artificial Airways
D. Tracheostomy--stoma that results from a surgical incision (in OR or at bedside) into the trachea
1. Indications
a. Bypass an upper airway obstruction
b. Facilitate removal of secretions
c. Permit long-term mechanical ventilation--after two weeks with ET tube
i. Easier to ween from trach than from ET tube
d. Permits oral intake and speech

Front 946

Respiratory
II. Artificial Airways
D. Tracheostomy--stoma that results from a surgical incision (in OR or at bedside) into the trachea
1. Indications
a. Bypass an upper airway obstruction
b. Facilitate removal of secretions
c. Permit long-term mechanical ventilation--after -------- weeks with--------tube
i. Easier to ween from --------- than from ET tube

Back 946

Respiratory
II. Artificial Airways
D. Tracheostomy--stoma that results from a surgical incision (in OR or at bedside) into the trachea
1. Indications
a. Bypass an upper airway obstruction
b. Facilitate removal of secretions
c. Permit long-term mechanical ventilation--after two weeks with ET tube
i. Easier to ween from trach than from ET tube
d. Permits oral intake and speech

Front 947

Respiratory
II. Artificial Airways
D. Tracheostomy--stoma that results from a surgical incision (in OR or at bedside) into the trachea
2. Care
a. Suctioning for ----------
b. ----------- care
c. Changing --------- ties
d. Inner cannula care (always have opterator at bed side to get it back in-then remove)

Back 947

Respiratory
II. Artificial Airways
D. Tracheostomy--stoma that results from a surgical incision (in OR or at bedside) into the trachea
2. Care
a. Suctioning for secretions
b. Stoma care
c. Changing tracheostomy ties
d. Inner cannula care (always have opterator at bed side to get it back in-then remove)

Front 948

Respiratory
II. Artificial Airways
D. Tracheostomy--stoma that results from a surgical incision (in OR or at bedside) into the trachea
2. Care
a. Suctioning for secretions
b. Stoma care
c. Changing tracheostomy ties
d. Inner -------- care (always have ------------ at bed side to get it back in-then remove)

Back 948

Respiratory
II. Artificial Airways
D. Tracheostomy--stoma that results from a surgical incision (in OR or at bedside) into the trachea
2. Care
a. Suctioning for secretions
b. Stoma care
c. Changing tracheostomy ties
d. Inner cannula care (always have opterator at bed side to get it back in-then remove)

Front 949

Respiratory
III. Mechanical Ventilation
A. Goals
1. Improve ------------
2. Improve -------------
3. Decrease work of ----------- (decreases oxygen consumption)
4. Permit sedation
5. Airway protection

Back 949

Respiratory
III. Mechanical Ventilation
A. Goals
1. Improve oxygenation
2. Improve ventilation
3. Decrease work of breathing (decreases oxygen consumption)
4. Permit sedation
5. Airway protection

Front 950

Respiratory
III. Mechanical Ventilation
A. Goals
1. Improve oxygenation
2. Improve ventilation
3. Decrease work of breathing (decreases oxygen consumption)
4. Permit ----------
5. Airway -------

Back 950

Respiratory
III. Mechanical Ventilation
A. Goals
1. Improve oxygenation
2. Improve ventilation
3. Decrease work of breathing (decreases oxygen consumption)
4. Permit sedation
5. Airway protection

Front 951

Respiratory
III. Mechanical Ventilation
B. Negative Pressure Ventilation--noninvasive --------- encase chest/body and provide intermittent negative pressure (ex. --------- wrap)

Back 951

Respiratory
III. Mechanical Ventilation
B. Negative Pressure Ventilation--noninvasive chambers encase chest/body and provide intermittent negative pressure (ex. Pulmo-wrap)

Front 952

Respiratory
III. Mechanical Ventilation
B. Negative Pressure Ventilation--noninvasive chambers encase chest/body and provide intermittent negative pressure (ex. Pulmo-wrap)
1. Patient must be able to cough up own ---------- and have adequate lung ------------
2. Indications--neuromuscular and ---------- disorders; severe COPD

Back 952

Respiratory
III. Mechanical Ventilation
B. Negative Pressure Ventilation--noninvasive chambers encase chest/body and provide intermittent negative pressure (ex. Pulmo-wrap)
1. Patient must be able to cough up own secretions and have adequate lung elasticity
2. Indications--neuromuscular and spinal disorders; severe COPD

Front 953

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
1. ---------- Ventilation--predetermined tidal volume w/ varied pressure (most common)
a. Opposite of -------------- (passive exhalation)

Back 953

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
1. Volume Ventilation--predetermined tidal volume w/ varied pressure (most common)
a. Opposite of normal volume (passive exhailation)

Front 954

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
2. ------------ Ventilation--peak inspiratory pressure is predetermined w/ variable tidal volume
a. Prevents adding too much -----------

Back 954

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
2. Pressure Ventilation--peak inspiratory pressure is predetermined w/ variable tidal volume
a. Prevents adding too much volume

Front 955

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
3. Monitoring
a. V---------- settings--program settings
b. P-------: own rate, etc.
c. A-----: customized based on needed parameters

Back 955

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
3. Monitoring
a. Ventilator settings--program settings
b. Patient data--own rate, etc.
c. Alarms--customized based on needed parameters

Front 956

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
4. Settings
a. Rate--number of ------------ ventilations

Back 956

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
4. Settings
a. Rate--number of delivered ventilations

Front 957

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
4. Settings
b. Tidal Volume (VT)--volume of------ delivered; generally weight based (___-____mL/kg)

Back 957

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
4. Settings
b. Tidal Volume (VT)--volume of gas delivered; generally weight based (5-15mL/kg)

Front 958

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
4. Settings
c. FIO2--fraction of ------------- delivered (adjust for PAO2 to be at least >------)
i. Room air is 21%

Back 958

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
4. Settings
c. FIO2--fraction of inspired oxygen delivered (adjust for PAO2 to be at least >60)
i. Room air is 21%

Front 959

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
4. Settings
c. FIO2--fraction of inspired oxygen delivered (adjust for PAO2 to be at least >60)
i. Room air is ------%

Back 959

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
4. Settings
c. FIO2--fraction of inspired oxygen delivered (adjust for PAO2 to be at least >60)
i. Room air is 21%

Front 960

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
4. Settings
d. Flow Rate--speed ------ is delivered

Back 960

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
4. Settings
d. Flow Rate--speed VT is delivered

Front 961

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
4. Settings
e. I:E ratio--duration of--------- to ---------- (normal is 1:2)

Back 961

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
4. Settings
e. I:E ratio--duration of inspiration to expiration (normal is 1:2)

Front 962

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
4. Settings
e. I:E ratio--duration of inspiration to expiration (normal is ------:--------)

Back 962

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
4. Settings
e. I:E ratio--duration of inspiration to expiration (normal is 1:2)

Front 963

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
4. Settings
f. Sensitivity (---------- pressure)--effort pt must generate to initiate -------- breath
i. Higher sensitivity less work pt does
ii. Lower sensitivity increase in pt’s muscular use to initiate breath

Back 963

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
4. Settings
f. Sensitivity (trigger pressure)--effort pt must generate to initiate ventilator breath
i. Higher sensitivity less work pt does
ii. Lower sensitivity increase in pt’s muscular use to initiate breath

Front 964

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
4. Settings
f. Sensitivity (trigger pressure)--effort pt must generate to initiate ventilator breath
i. ----------- sensitivity less work pt does
ii. ---------- sensitivity increase in pt’s muscular use to initiate breath

Back 964

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
4. Settings
f. Sensitivity (trigger pressure)--effort pt must generate to initiate ventilator breath
i. Higher sensitivity less work pt does
ii. Lower sensitivity increase in pt’s muscular use to initiate breath

Front 965

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
4. Settings
g. Pressure Limit--regulates -------- pressure ventilator can generate to deliver ---------

Back 965

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
4. Settings
g. Pressure Limit--regulates maximal pressure ventilator can generate to deliver VT

Front 966

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
5. Modes--based on ---------- status and dependent on resp. drive and ---------

Back 966

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
5. Modes--based on ventilatory status and dependent on resp. drive and ABGs

Front 967

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
5. Modes--based on ventilatory status and dependent on resp. drive and ABGs
a. Controlled ----------- Ventilation (CMV)--not used often
i. Ventilator ----------

Back 967

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
5. Modes--based on ventilatory status and dependent on resp. drive and ABGs
a. Controlled Mandatory Ventilation (CMV)--not used often
i. Ventilator parameters

Front 968

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
• Set rate
• Set tidal --------- or pressure
ii. Indication--pt with no -------- (spinal cord, anesthesia, neuromuscular disease)

Back 968

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
• Set rate
• Set tidal volume or pressure
ii. Indication--pt with no drive (spinal cord, anesthesia, neuromuscular disease)

Front 969

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
• If pt has drive, ventilator can’t sense pt ----------- need sedation
b. Assist-Control ------------ Ventilation (AC)
i. Ventilator parameters

Back 969

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
• If pt has drive, ventilator can’t sense pt fight ventilator need sedation
b. Assist-Control Mechanical Ventilation (AC)
i. Ventilator parameters

Front 970

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
• Preset ------- volume/pressure--vent delivers breaths at preset --------- volume in response to pt’s own inspiratory drive (senses pt inspiration)

Back 970

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
• Preset tidal volume/pressure--vent delivers breaths at preset tidal volume in response to pt’s own inspiratory drive (senses pt inspiration)

Front 971

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
• Preset rate--minimal setting (if pt does not ------------ a breath, vent will breathe so that pt receives the ------------- rate)

Back 971

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
• Preset tidal volume/pressure--vent delivers breaths at preset tidal volume in response to pt’s own inspiratory drive (senses pt inspiration)

Front 972

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
ii. Potential disadvantages
• Hyperventilation if pt is anxious (resp --------------)
• Hypoventilation if monitor is set too ---------- (must monitor rate saturations)

Back 972

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
ii. Potential disadvantages
• Hyperventilation if pt is anxious (resp alkalosis)
• Hypoventilation if monitor is set too low (must monitor rate saturations)

Front 973

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
ii. Potential disadvantages
• Hypoventilation if monitor is set too low (must monitor rate saturations)
c. Synchronized ------------ ------------ Ventilation (SIMV)--most common

Back 973

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
ii. Potential disadvantages
• Hypoventilation if monitor is set too low (must monitor rate saturations)
c. Synchronized Intermittent Mandatory Ventilation (SIMV)--most common
i. Ventilator parameters

Front 974

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
c. Synchronized Intermittent Mandatory Ventilation (SIMV)--most common
i. Ventilator parameters
• Preset---------- volume/pressure
• Preset ---------

Back 974

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
c. Synchronized Intermittent Mandatory Ventilation (SIMV)--most common
i. Ventilator parameters
• Preset tidal volume/pressure
• Preset rate

Front 975

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
c. Synchronized Intermittent Mandatory Ventilation (SIMV)--most common
i. Ventilator parameters
• Pt can initiate ------------ breathing (in between vent breaths) with own tidal volume, but vent delivers full tidal volume for preset ---------- rate
ii. Used for -------: --preset gradually lowered (better synchrony-pt no fight vent)

Back 975

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
c. Synchronized Intermittent Mandatory Ventilation (SIMV)--most common
i. Ventilator parameters
• Preset tidal volume/pressure
• Preset rate

Front 976

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
c. Synchronized Intermittent Mandatory Ventilation (SIMV)--most common
i. Ventilator parameters
• Can lead to --------- fatigue

Back 976

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
c. Synchronized Intermittent Mandatory Ventilation (SIMV)--most common
i. Ventilator parameters
• Can lead to muscle fatigue

Front 977

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
d. Pressure ----------- Ventilation (PSV)--enhanced mode (can be used with SIMV)

Back 977

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
d. Pressure support Ventilation (PSV)--enhanced mode (can be used with SIMV)

Front 978

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
d. Pressure Support Ventilation (PSV)--enhanced mode (can be used with SIMV)
i. Positive pressure is applied to airway only during ------------ and is used in conjunction with pts spontaneous respirations

Back 978

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
d. Pressure Support Ventilation (PSV)--enhanced mode (can be used with SIMV)
i. Positive pressure is applied to airway only during inspiration and is used in conjunction with pts spontaneous respirations

Front 979

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
d. Pressure Support Ventilation (PSV)--enhanced mode (can be used with SIMV)
ii. Pt must be able to----------- breath (only for spontaneous breathers)

Back 979

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
d. Pressure Support Ventilation (PSV)--enhanced mode (can be used with SIMV)
ii. Pt must be able to initiate breath (only for spontaneous breathers)

Front 980

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
d. Pressure Support Ventilation (PSV)--enhanced mode (can be used with SIMV)
iii. Pt completely controls inspiratory ----------, tidal volume, and RR

Back 980

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
d. Pressure Support Ventilation (PSV)--enhanced mode (can be used with SIMV)
iii. Pt completely controls inspiratory length, tidal volume, and RR

Front 981

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
d. Pressure Support Ventilation (PSV)--enhanced mode (can be used with SIMV
iv. Decreases pt work during ----------- (decreases effort)

Back 981

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
d. Pressure Support Ventilation (PSV)--enhanced mode (can be used with SIMV
iv. Decreases pt work during weaning (decreases effort)

Front 982

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
d. Pressure Support Ventilation (PSV)--enhanced mode (can be used with SIMV
v. Advantages--↑ pt comfort and ↓-------- consumption (↓work) and ↑ ----------

Back 982

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
d. Pressure Support Ventilation (PSV)--enhanced mode (can be used with SIMV
v. Advantages--↑ pt comfort and ↓O2 consumption (↓work) and ↑ endurance

Front 983

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
e. Pressure Controlled ------ ------- Ventilation (PC-IRV)

Back 983

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
e. Pressure Controlled Inverse Ratio Ventilation (PC-IRV)

Front 984

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
e. Pressure Controlled Inverse Ratio Ventilation (PC-IRV)
i. Prolonged (+)pressure applied↑--------------- time expands collapsed -----------

Back 984

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
e. Pressure Controlled Inverse Ratio Ventilation (PC-IRV)
i. Prolonged (+)pressure applied↑inspiratory time expands collapsed alveoli

Front 985

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
e. Pressure Controlled Inverse Ratio Ventilation (PC-IRV)
ii. Unnatural (causes anxiety paralyze/sedate) -------------- (2:1 4:1)

Back 985

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
e. Pressure Controlled Inverse Ratio Ventilation (PC-IRV)
ii. Unnatural (causes anxiety paralyze/sedate) nonphysiologic (2:1 4:1)

Front 986

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
e. Pressure Controlled Inverse Ratio Ventilation (PC-IRV)
ii. Unnatural (causes anxiety paralyze/sedate) nonphysiologic (-----:1 ------:1)

Back 986

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
e. Pressure Controlled Inverse Ratio Ventilation (PC-IRV)
ii. Unnatural (causes anxiety paralyze/sedate) nonphysiologic (2:1 4:1)

Front 987

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
e. Pressure Controlled Inverse Ratio Ventilation (PC-IRV)
iii. Used for pt still hypoxic after other measures (------ and --------)

Back 987

Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
e. Pressure Controlled Inverse Ratio Ventilation (PC-IRV)
iii. Used for pt still hypoxic after other measures (ARDS and neonates)

Front 988

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive _____-______ Pressure (PEEP)

Back 988

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)

Front 989

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
a. (+) pressure exerted during -------- allows for better saturation with ↓------

Back 989

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
a. (+) pressure exerted during expiration allows for better saturation with ↓FiO2

Front 990

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
a. (+) pressure exerted during expiration allows for better saturation with ↓FiO2
i. Airway P is ------ at expiration end w/ atmospheric P (PEEP prevents this)

Back 990

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
a. (+) pressure exerted during expiration allows for better saturation with ↓FiO2
i. Airway P is 0 at expiration end w/ atmospheric P (PEEP prevents this)

Front 991

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
a. (+) pressure exerted during expiration allows for better saturation with ↓FiO2
ii. Prevents ---------- and alveolar collapse

Back 991

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
a. (+) pressure exerted during expiration allows for better saturation with ↓FiO2
ii. Prevents atelectasis and alveolar collapse

Front 992

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
b. ↑functional -------- capacity (FRC-volume at end of normal cresp) ↑oxygenation

Back 992

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
b. ↑functional residual capacity (FRC-volume at end of normal cresp) ↑oxygenation

Front 993

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
b. ↑functional residual capacity (______-volume at end of normal cresp) ↑________

Back 993

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
b. ↑functional residual capacity (FRC-volume at end of normal cresp) ↑oxygenation

Front 994

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
c. Uses--severe hypoxia that does not improve w/ FiO2 between ____-____%

Back 994

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
c. Uses--severe hypoxia that does not improve w/ FiO2 between 50-70%

Front 995

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
c. Uses--severe hypoxia that does not improve w/ FiO2 between 50-70%
i. For hypoxia could breath faster, deeper, use PEEP or ↑____ (risk O2 toxicity)

Back 995

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
c. Uses--severe hypoxia that does not improve w/ FiO2 between 50-70%
i. For hypoxia could breath faster, deeper, use PEEP or ↑FiO2 (risk O2 toxicity)

Front 996

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
d. Indications
i. Acute lung injury and -------
ii. Cardiogenic ---------- edema

Back 996

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
d. Indications
i. Acute lung injury and ARDS
ii. Cardiogenic pulmonary edema

Front 997

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
d. Indications
iii. Atelectasis associated with severe ---------
iv. Diffuse pneumonia requiring --------- ventilation

Back 997

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
d. Indications
iii. Atelectasis associated with severe hypoxemia
iv. Diffuse pneumonia requiring mechanical ventilation

Front 998

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
e. Contraindications
i. Pneumothorax w/out --------- catheter (would worsen pneumo)

Back 998

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
e. Contraindications
i. Pneumothorax w/out pleural catheter (would worsen pneumo)

Front 999

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
e. Contraindications
ii. Increased --------- pressure

Back 999

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
e. Contraindications
ii. Increased intracranial pressure

Front 1000

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
e. Contraindications
iii. Hypovolemia--↑---------- pressure ↓------- return ↓BP

Back 1000

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
e. Contraindications
iii. Hypovolemia--↑intrathoracic pressure ↓venous return ↓BP

Front 1001

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
e. Contraindications
iv. Low ------- output

Back 1001

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
e. Contraindications
iv. Low cardiac output

Front 1002

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
f. -------------- considerations--decreases venous return and CO

Back 1002

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
f. Hemodynamic considerations--decreases venous return and CO

Front 1003

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
g. Normal setting:____-____cm H2O

Back 1003

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
f. Hemodynamic considerations--decreases venous return and CO

Front 1004

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
2. Continuous ----------- ----------- Pressure (CPAP)

Back 1004

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
2. Continuous Positive Airway Pressure (CPAP)

Front 1005

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
2. Continuous Positive Airway Pressure (CPAP)
a. Continuous (+) pressure during entire ------- cycle--prevents airway P from reaching ----------

Back 1005

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
2. Continuous Positive Airway Pressure (CPAP)
a. Continuous (+) pressure during entire resp. cycle--prevents airway P from reaching 0

Front 1006

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
2. Continuous Positive Airway Pressure (CPAP)
b. No breaths by vent--must be ----------- breather (rate determined by pt own ----------)

Back 1006

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
2. Continuous Positive Airway Pressure (CPAP)
b. No breaths by vent--must be spontaneous breather (rate determined by pt own RR)

Front 1007

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
2. Continuous Positive Airway Pressure (CPAP)
b. No breaths by vent--must be spontaneous breather (rate determined by pt own RR)
i. Pt is doing all the work--increases -----------

Back 1007

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
2. Continuous Positive Airway Pressure (CPAP)
b. No breaths by vent--must be spontaneous breather (rate determined by pt own RR)
i. Pt is doing all the work--increases WOB

Front 1008

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
2. Continuous Positive Airway Pressure (CPAP)
c. Commonly used for ------------- and primarily in the weaning process (do CPAP trials)

Back 1008

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
2. Continuous Positive Airway Pressure (CPAP)
c. Commonly used for sleep apnea and primarily in the weaning process (do CPAP trials)

Front 1009

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
3. High ---------- Ventilation

Back 1009

Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
3. High Frequency Ventilation

Front 1010

Respiratory
III. Mechanical Ventilation
E. Complications
1. Cardiovascular
a. Decreased venous return--from increased ------------ pressure

Back 1010

Respiratory
III. Mechanical Ventilation
E. Complications
1. Cardiovascular
a. Decreased venous return--from increased intrathoracic pressure

Front 1011

Respiratory
III. Mechanical Ventilation
E. Complications
1. Cardiovascular
b. Decreased ________--preload
c. Decreased _______ output

Back 1011

Respiratory
III. Mechanical Ventilation
E. Complications
1. Cardiovascular
b. Decreased LVEDV--preload
c. Decreased cardiac output

Front 1012

Respiratory
III. Mechanical Ventilation
E. Complications
1. Cardiovascular
d. Hypotension
**Further impairment with --------

Back 1012

Respiratory
III. Mechanical Ventilation
E. Complications
1. Cardiovascular
d. Hypotension
**Further impairment with PEEP

Front 1013

Respiratory
III. Mechanical Ventilation
E. Complications
2. Pulmonary--_____% of vented pts have some lung damage

Back 1013

Respiratory
III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage

Front 1014

Respiratory
III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
a. ___________--damage to lungs by excessive pressure

Back 1014

Respiratory
III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
a. Barotrauma--damage to lungs by excessive pressure

Front 1015

Respiratory
III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
a. Barotrauma--damage to lungs by excessive pressure
i. Lungs can be over extended and rupture w/ high ----------- pressure

Back 1015

Respiratory
III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
a. Barotrauma--damage to lungs by excessive pressure
i. Lungs can be over extended and rupture w/ high peak inspiratory pressure

Front 1016

Respiratory
III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
a. Barotrauma--damage to lungs by excessive pressure
ii. Can cause pneumothorax, subcutaneous ------------, and -------------

Back 1016

Respiratory
III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
a. Barotrauma--damage to lungs by excessive pressure
ii. Can cause pneumothorax, subcutaneous emphysema, and pneumomediastinum

Front 1017

Respiratory
III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
a. Barotrauma--damage to lungs by excessive pressure
iii. Risk to pt w/----------- lungs (ex. COPD)

Back 1017

Respiratory
III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
a. Barotrauma--damage to lungs by excessive pressure
iii. Risk to pt w/ compliant lungs (ex. COPD)

Front 1018

Respiratory
III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
b. Volu-trauma--injury from ↑-------- volume on pt with -------------/stiff lungs (ARDS)

Back 1018

Respiratory
III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
b. Volu-trauma--injury from ↑tidal volume on pt with noncompliant/stiff lungs (ARDS)

Front 1019

Respiratory
III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
c. Alveolar _________--excessive lung secretions, leaking cuff, etc.

Back 1019

Respiratory
III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
c. Alveolar Hypoventilation--excessive lung secretions, leaking cuff, etc.

Front 1020

Respiratory
III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
d. Alveolar _________--pt anxious ↑tidal volumes

Back 1020

Respiratory
III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
d. Alveolar Hyperventilation--pt anxious ↑tidal volumes

Front 1021

Respiratory
III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
e. Ventilator-assisted pneumonia--ET tube bypasses ------------ defenses

Back 1021

III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
e. Ventilator-assisted pneumonia--ET tube bypasses normal upper airway defenses

Front 1022

III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
e. Ventilator-assisted pneumonia--ET tube bypasses normal upper airway defenses
i. Critical care pt at risk because of -------- and poor -------- status

Back 1022

III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
e. Ventilator-assisted pneumonia--ET tube bypasses normal upper airway defenses
i. Critical care pt at risk because of immobility and poor nutritional status

Front 1023

III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
e. Ventilator-assisted pneumonia--ET tube bypasses normal upper airway defenses
ii. Sputum cultures often grow ----------- (pseudomonas, serratia, klebsiella)

Back 1023

III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
e. Ventilator-assisted pneumonia--ET tube bypasses normal upper airway defenses
ii. Sputum cultures often grow gram(-)bacteria (pseudomonas, serratia, klebsiella)

Front 1024

III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
e. Ventilator-assisted pneumonia--ET tube bypasses normal upper airway defenses
ii. Sputum cultures often grow gram(-)bacteria (pseudomonas, ---------, ----------)

Back 1024

III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
e. Ventilator-assisted pneumonia--ET tube bypasses normal upper airway defenses
ii. Sputum cultures often grow gram(-)bacteria (pseudomonas, serratia, klebsiella)

Front 1025

III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
e. Ventilator-assisted pneumonia--ET tube bypasses normal upper airway defenses
iii. Decrease risk by using strict ------------ technique while suctioning (hand washing, drain condensation from tubes, etc.)

Back 1025

III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
e. Ventilator-assisted pneumonia--ET tube bypasses normal upper airway defenses
iii. Decrease risk by using strict aseptic technique while suctioning (hand washing, drain condensation from tubes, etc.)

Front 1026

III. Mechanical Ventilation
E. Complications
3. Gastrointestinal
a. Risk of stress ulcers and ----------- bleeding

Back 1026

III. Mechanical Ventilation
E. Complications
3. Gastrointestinal
a. Risk of stress ulcers and GI bleeding

Front 1027

III. Mechanical Ventilation
E. Complications
3. Gastrointestinal
b. Nursing Implication--______receptor blockers or PPIs and monitor pH of gastric aspirate

Back 1027

III. Mechanical Ventilation
E. Complications
3. Gastrointestinal
b. Nursing Implication--H2-receptor blockers or PPIs and monitor pH of gastric aspirate

Front 1028

III. Mechanical Ventilation
E. Complications
3. Gastrointestinal
b. Nursing Implication--H2-receptor blockers or ----------- and monitor pH of gastric ----------

Back 1028

III. Mechanical Ventilation
E. Complications
3. Gastrointestinal
b. Nursing Implication--H2-receptor blockers or PPIs and monitor pH of gastric aspirate

Front 1029

III. Mechanical Ventilation
E. Complications
4. Neurologic
a. Potential for increase in intracranial pressure from ↓ _______ return (keep HOB ____-45°)

Back 1029

III. Mechanical Ventilation
E. Complications
4. Neurologic
a. Potential for increase in intracranial pressure from ↓ venous return (keep HOB 30-45°)

Front 1030

III. Mechanical Ventilation
E. Complications
5. Fluid_________--fluid overload potential (↓CO↓kidney flow↑ReninNa/H2O retention)

Back 1030

III. Mechanical Ventilation
E. Complications
5. Fluid Imbalance--fluid overload potential (↓CO↓kidney flow↑ReninNa/H2O retention)

Front 1031

III. Mechanical Ventilation
E. Complications
5. Fluid Imbalance--fluid overload potential (↓---------↓-----------↑ReninNa/H2O retention)

Back 1031

III. Mechanical Ventilation
E. Complications
5. Fluid Imbalance--fluid overload potential (↓CO↓kidney flow↑ReninNa/H2O retention)

Front 1032

III. Mechanical Ventilation
E. Complications
5. Fluid Imbalance--fluid overload potential (↓CO↓kidney flow↑-------------/H2O retention)

Back 1032

III. Mechanical Ventilation
E. Complications
5. Fluid Imbalance--fluid overload potential (↓CO↓kidney flow↑ReninNa/H2O retention)

Front 1033

III. Mechanical Ventilation
E. Complications
6. Musculoskeletal Problems--due to --------

Back 1033

III. Mechanical Ventilation
E. Complications
6. Musculoskeletal Problems--due to immobility

Front 1034

III. Mechanical Ventilation
E. Complications
7. Psychosocial Effects--assess for causes of ----------- and meeting basic needs

Back 1034

III. Mechanical Ventilation
E. Complications
7. Psychosocial Effects--assess for causes of anxiety and meeting basic needs

Front 1035

Respiratory Disruptions
I. Laryngeal Polyps
A. Etiology and Pathophysiology--more common in men, ----------, talkers/yellers, ----------, and -----------

Back 1035

Respiratory Disruptions
I. Laryngeal Polyps
A. Etiology and Pathophysiology--more common in men, singers, talkers/yellers, smokers, and GERD

Front 1036

Respiratory Disruptions
I. Laryngeal Polyps
B. Clinical Manifestations
1. _______--not going to go away
2. Continuously ________ (breathy, harsh, and low in quality)

Back 1036

Respiratory Disruptions
I. Laryngeal Polyps
B. Clinical Manifestations
1. Cough--not going to go away
2. Continuously change voice (breathy, harsh, and low in quality)

Front 1037

Respiratory Disruptions
I. Laryngeal Polyps
C. Medical Management
1. Rest vocal cords and maybe a course of ---------
2. If long enough ------------ (rare) and surgically removed (could become malignant)

Back 1037

Respiratory Disruptions
I. Laryngeal Polyps
C. Medical Management
1. Rest vocal cords and maybe a course of steroids
2. If long enough biopsied (rare) and surgically removed (could become malignant)

Front 1038

Respiratory Disruptions
I. Laryngeal Polyps
C. Medical Management
1. Rest vocal cords and maybe a course of steroids
2. If long enough biopsied (rare) and surgically removed (could become malignant)
i. Potential for voice quality to ---------- after surgery

Back 1038

Respiratory Disruptions
I. Laryngeal Polyps
C. Medical Management
1. Rest vocal cords and maybe a course of steroids
2. If long enough biopsied (rare) and surgically removed (could become malignant)
i. Potential for voice quality to not be same after surgery

Front 1039

Respiratory Disruptions
II. Laryngeal Cancer
A. Etiology and Pathophysiology--squamous cell -----------

Back 1039

Respiratory Disruptions
II. Laryngeal Cancer
A. Etiology and Pathophysiology--squamous cell carcinomas

Front 1040

Respiratory Disruptions
II. Laryngeal Cancer
A. Etiology and Pathophysiology--squamous cell carcinomas
1. Found in smokers and ------------ users (can be prevented)
2. Prevalence--_____% of head and neck cancers in pts >_______yrs

Back 1040

Respiratory Disruptions
II. Laryngeal Cancer
A. Etiology and Pathophysiology--squamous cell carcinomas
1. Found in smokers and ETOH users (can be prevented)
2. Prevalence--90% of head and neck cancers in pts >50yrs

Front 1041

Respiratory Disruptions
II. Laryngeal Cancer
B. Clinical Manifestations--hoarseness, persistent -----------, change in --------- quality

Back 1041

Respiratory Disruptions
II. Laryngeal Cancer
B. Clinical Manifestations--hoarseness, persistent sore throat, change in voice quality

Front 1042

Respiratory Disruptions
II. Laryngeal Cancer
B. Clinical Manifestations--hoarseness, persistent sore throat, change in voice quality
1. Eventually pain and difficulty ---------------- (late presentation)

Back 1042

Respiratory Disruptions
II. Laryngeal Cancer
B. Clinical Manifestations--hoarseness, persistent sore throat, change in voice quality
1. Eventually pain and difficulty swallowing (late presentation)

Front 1043

Respiratory Disruptions
II. Laryngeal Cancer
C. Diagnostic Studies--visualize -----------, biopsies, ------------- (determine spread)

Back 1043

Respiratory Disruptions
II. Laryngeal Cancer
C. Diagnostic Studies--visualize cancer, biopsies, CT/MRI (determine spread)

Front 1044

Respiratory Disruptions
II. Laryngeal Cancer
C. Diagnostic Studies--visualize cancer, biopsies, CT/MRI (determine spread)
1. If diagnosed early--good cure rate (after partial/total -------------, laser treatment/---------)

Back 1044

Respiratory Disruptions
II. Laryngeal Cancer
C. Diagnostic Studies--visualize cancer, biopsies, CT/MRI (determine spread)
1. If diagnosed early--good cure rate (after partial/total laryngectomy, laser treatment/chemo)

Front 1045

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
1. _____________--partial/complete surgical removal of larynx usually from cancer (disfiguring)

Back 1045

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring)

Front 1046

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring)
a. Often try other ----------- first
b. Partial when ---------- limited to 1 spot (may be able to speak, but quality will be different)

Back 1046

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring)
a. Often try other methods first
b. Partial when CA limited to 1 spot (may be able to speak, but quality will be different)

Front 1047

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring)
c. Total--radical surgery creating permanent airway through---------- (no speech)

Back 1047

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring)
c. Total--radical surgery creating permanent airway through trachea (no speech)

Front 1048

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring)
d. Nursing Management
i. Pre-___________

Back 1048

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring)
d. Nursing Management
i. Pre-Laryngectomy

Front 1049

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring)
d. Nursing Management
i. Pre-Laryngectomy
• Assessment of ----------
• Pre-op ---------

Back 1049

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring)
d. Nursing Management
i. Pre-Laryngectomy
• Assessment of knowledge
• Pre-op teaching

Front 1050

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring)
d. Nursing Management
i. Pre-Laryngectomy
• Expected goals for -------

Back 1050

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring)
d. Nursing Management
i. Pre-Laryngectomy
• Expected goals for pts

Front 1051

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring)
d. Nursing Management
i. Pre-Laryngectomy
• Post-op expectations (J-Ps/---------/suction/pain/---------/---------)

Back 1051

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring)
d. Nursing Management
i. Pre-Laryngectomy
• Post-op expectations (J-Ps/ventilation/suction/pain/catheters/feeding tube)

Front 1052

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring)
d. Nursing Management
ii. Post-Laryngectomy
• Maintain patient airway (administer ------------, clean --------- tubes TID)

Back 1052

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring)
d. Nursing Management
ii. Post-Laryngectomy
• Maintain patient airway (administer humidified air, clean trach tubes TID)

Front 1053

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring)
d. Nursing Management
ii. Post-Laryngectomy
• Prevention of infection (dressing changes q---------h, ------- hygiene)

Back 1053

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring)
d. Nursing Management
ii. Post-Laryngectomy
• Prevention of infection (dressing changes q8h, oral hygiene)

Front 1054

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring)
d. Nursing Management
ii. Post-Laryngectomy
• ---------- control
• Maintain adequate nutritional support --NG tube for -------- days

Back 1054

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring)
d. Nursing Management
ii. Post-Laryngectomy
• Pain control
• Maintain adequate nutritional support --NG tube for 7 days

Front 1055

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring)
d. Nursing Management
ii. Post-Laryngectomy
• Effective comm.--__________ speech to make sounds/artificial voice box

Back 1055

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring)
d. Nursing Management
ii. Post-Laryngectomy
• Effective comm.--esophageal speech to make sounds/artificial voice box

Front 1056

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring)
d. Nursing Management
iii. Home Care--teaching so that they can manage themselves at home
• S----------
• Daily cleaning of -----------

Back 1056

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring)
d. Nursing Management
iii. Home Care--teaching so that they can manage themselves at home
• Suctioning
• Daily cleaning of trach

Front 1057

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring)
d. Nursing Management
iii. Home Care--teaching so that they can manage themselves at home
• ________________--steam filled shower, moistened cover over stoma (prevent tracheal bronchitis)
• Use of _________ covers--to protect during shower, etc.

Back 1057

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring)
d. Nursing Management
iii. Home Care--teaching so that they can manage themselves at home
• Humidification--steam filled shower, moistened cover over stoma (prevent tracheal bronchitis)
• Use of stoma covers--to protect during shower, etc.

Front 1058

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring)
d. Nursing Management
iii. Home Care--teaching so that they can manage themselves at home
• Changing --------- ties or Velcro-type holders
• ------------: should have ID band stating that they are neck breathers

Back 1058

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring)
d. Nursing Management
iii. Home Care--teaching so that they can manage themselves at home
• Changing twill ties or Velcro-type holders
• Resuscitation--should have ID band stating that they are neck breathers

Front 1059

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
2. Radial Neck Dissection--remove as much cancer as possible and ↓risk of ---------- spread

Back 1059

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
2. Radial Neck Dissection--remove as much cancer as possible and ↓risk of lymphatic spread

Front 1060

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
2. Radial Neck Dissection--remove as much cancer as possible and ↓risk of lymphatic spread
a. Removal of all --------- nodes and --------- channels

Back 1060

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
2. Radial Neck Dissection--remove as much cancer as possible and ↓risk of lymphatic spread
a. Removal of all lymph nodes and lymphatic channels

Front 1061

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
2. Radial Neck Dissection--remove as much cancer as possible and ↓risk of lymphatic spread
b. May involve -------- muscle, internal jugular vein, ------------ gland, part of thyroid/parathyroid, --------- accessory nerve (controls speech/swallowing) removal

Back 1061

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
2. Radial Neck Dissection--remove as much cancer as possible and ↓risk of lymphatic spread
b. May involve sternocleidomastoid muscle, internal jugular vein, submxillary gland, part of thyroid/parathyroid, spinal accessory nerve (controls speech/swallowing) removal

Front 1062

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
2. Radial Neck Dissection--remove as much cancer as possible and ↓risk of lymphatic spread
c. Usually involves ------- side of neck, but can have -------- (very disfiguring and long recovery)

Back 1062

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
2. Radial Neck Dissection--remove as much cancer as possible and ↓risk of lymphatic spread
c. Usually involves 1 side of neck, but can have 2 (very disfiguring and long recovery)

Front 1063

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
2. Radial Neck Dissection--remove as much cancer as possible and ↓risk of lymphatic spread
d. Operation should not be preformed if it has spread further (surgery won’t ----------)

Back 1063

Respiratory Disruptions
II. Laryngeal Cancer
D. Medical Management
2. Radial Neck Dissection--remove as much cancer as possible and ↓risk of lymphatic spread
d. Operation should not be preformed if it has spread further (surgery won’t contain)

Front 1064

Respiratory Disruptions
III. Lung Cancer
A. Epidemiology--leading cause of ------------- related death in men and women (survival rate --------%)

Back 1064

Respiratory Disruptions
III. Lung Cancer
A. Epidemiology--leading cause of CA related death in men and women (survival rate 15%)

Front 1065

Respiratory Disruptions
III. Lung Cancer
B. Etiology-->________yrs w/ long smoking hx (also 2nd hand) is most sig. risk factor (80-______% of lung CA)

Back 1065

Respiratory Disruptions
III. Lung Cancer
B. Etiology-->50yrs w/ long smoking hx (also 2nd hand) is most sig. risk factor (80-90% of lung CA)

Front 1066

Respiratory Disruptions
III. Lung Cancer
B. Etiology-->50yrs w/ long smoking hx (also 2nd hand) is most sig. risk factor (80-90% of lung CA)
1. Total exposure to ------------- (asbestos, --------, ---------, radiation)

Back 1066

Respiratory Disruptions
III. Lung Cancer
B. Etiology-->50yrs w/ long smoking hx (also 2nd hand) is most sig. risk factor (80-90% of lung CA)
1. Total exposure to carcinogens (asbestos, Ni, Fe, radiation)
2. If stop smoking for 10yrs decrease risk by 30-50%

Front 1067

Respiratory Disruptions
III. Lung Cancer
B. Etiology-->50yrs w/ long smoking hx (also 2nd hand) is most sig. risk factor (80-90% of lung CA)
2. If stop smoking for _________yrs decrease risk by 30-_____%

Back 1067

Respiratory Disruptions
III. Lung Cancer
B. Etiology-->50yrs w/ long smoking hx (also 2nd hand) is most sig. risk factor (80-90% of lung CA)
2. If stop smoking for 10yrs decrease risk by 30-50%

Front 1068

Respiratory Disruptions
III. Lung Cancer
C. Pathophysiology
1. Occurs primarily in ------------- or beyond and have preference for upper lobes

Back 1068

Respiratory Disruptions
III. Lung Cancer
C. Pathophysiology
1. Occurs primarily in segmental bronchi or beyond and have preference for upper lobes

Front 1069

Respiratory Disruptions
III. Lung Cancer
C. Pathophysiology
1. Occurs primarily in segmental bronchi or beyond and have preference for upper lobes
a. ---------% originate from ---------- and are very slow growing (8-10yrs to show on XR)

Back 1069

Respiratory Disruptions
III. Lung Cancer
C. Pathophysiology
1. Occurs primarily in segmental bronchi or beyond and have preference for upper lobes
a. 90% originate from epithelium and are very slow growing (8-10yrs to show on XR)

Front 1070

Respiratory Disruptions
III. Lung Cancer
C. Pathophysiology
2. Primary Lung Cancers
a. ____________ (20%)--caused by smoking (most malignant w/ poor prognosis-_______m)

Back 1070

Respiratory Disruptions
III. Lung Cancer
C. Pathophysiology
2. Primary Lung Cancers
a. Small cell CA (20%)--caused by smoking (most malignant w/ poor prognosis-16m)

Front 1071

Respiratory Disruptions
III. Lung Cancer
C. Pathophysiology
2. Primary Lung Cancers
b. ____________ (80%)--Staged (TNM--_______, node, metastasis)

Back 1071

Respiratory Disruptions
III. Lung Cancer
C. Pathophysiology
2. Primary Lung Cancers
a. Small cell CA (20%)--caused by smoking (most malignant w/ poor prognosis-16m)

Front 1072

Respiratory Disruptions
III. Lung Cancer
C. Pathophysiology
2. Primary Lung Cancers
a. Small cell CA (20%)--caused by smoking (most malignant w/ poor prognosis-16m)
i. _____________--most common (more common in women)

Back 1072

Respiratory Disruptions
III. Lung Cancer
C. Pathophysiology
2. Primary Lung Cancers
a. Small cell CA (20%)--caused by smoking (most malignant w/ poor prognosis-16m)
i. Adnocarcinoma--most common (more common in women)

Front 1073

Respiratory Disruptions
III. Lung Cancer
C. Pathophysiology
2. Primary Lung Cancers
a. Small cell CA (20%)--caused by smoking (most malignant w/ poor prognosis-16m)
i. Adnocarcinoma--most common (more common in women)
• Not related to ----------
• Nonclinical manifestations until it -----------

Back 1073

Respiratory Disruptions
III. Lung Cancer
C. Pathophysiology
2. Primary Lung Cancers
a. Small cell CA (20%)--caused by smoking (most malignant w/ poor prognosis-16m)
i. Adnocarcinoma--most common (more common in women)
• Not related to smoking
• Nonclinical manifestations until it metastasizes

Front 1074

Respiratory Disruptions
III. Lung Cancer
C. Pathophysiology
2. Primary Lung Cancers
a. Small cell CA (20%)--caused by smoking (most malignant w/ poor prognosis-16m)
i. Adnocarcinoma--most common (more common in women)
• Not related to smoking
• Nonclinical manifestations until it metastasizes
• Does not respond well to -----------

Back 1074

Respiratory Disruptions
III. Lung Cancer
C. Pathophysiology
2. Primary Lung Cancers
a. Small cell CA (20%)--caused by smoking (most malignant w/ poor prognosis-16m)
i. Adnocarcinoma--most common (more common in women)
• Not related to smoking
• Nonclinical manifestations until it metastasizes
• Does not respond well to chemo/treatment

Front 1075

Respiratory Disruptions
III. Lung Cancer
C. Pathophysiology
2. Primary Lung Cancers
a. Small cell CA (20%)--caused by smoking (most malignant w/ poor prognosis-16m)
ii. ________ cell--30-_____% of CAs (associated with smoking)

Back 1075

Respiratory Disruptions
III. Lung Cancer
C. Pathophysiology
2. Primary Lung Cancers
a. Small cell CA (20%)--caused by smoking (most malignant w/ poor prognosis-16m)
ii. Squamous cell--30-35% of CAs (associated with smoking)

Front 1076

Respiratory Disruptions
III. Lung Cancer
C. Pathophysiology
2. Primary Lung Cancers
a. Small cell CA (20%)--caused by smoking (most malignant w/ poor prognosis-16m)
iii. Large cell--correlated with ---------

Back 1076

Respiratory Disruptions
III. Lung Cancer
C. Pathophysiology
2. Primary Lung Cancers
a. Small cell CA (20%)--caused by smoking (most malignant w/ poor prognosis-16m)
iii. Large cell--correlated with smoking

Front 1077

Respiratory Disruptions
III. Lung Cancer
D. Clinical Manifestations--late in disease, especially with -----------
1. -------------- (most common-74% of pts)--can cause chest pain from sore muscles
2. --------------: not always

Back 1077

Respiratory Disruptions
III. Lung Cancer
D. Clinical Manifestations--late in disease, especially with adnocarcinoma
1. Persistent cough (most common-74% of pts)--can cause chest pain from sore muscles
2. Hemoptysis--not always

Front 1078

Respiratory Disruptions
III. Lung Cancer
D. Clinical Manifestations--late in disease, especially with adnocarcinoma
3. D----------
4. H-----------

Back 1078

Respiratory Disruptions
III. Lung Cancer
D. Clinical Manifestations--late in disease, especially with adnocarcinoma
3. Dyspnea
4. Hoarsness,

Front 1079

Respiratory Disruptions
III. Lung Cancer
D. Clinical Manifestations--late in disease, especially with adnocarcinoma
5. -------------- or stridor and recurrent pneumonia or ------------

Back 1079

Respiratory Disruptions
III. Lung Cancer
D. Clinical Manifestations--late in disease, especially with adnocarcinoma
5. Wheezing or stridor and recurrent pneumonia or bronchitis
6. Difficulty swallowing anorexia/weight loss/fatigue (late manifestation)

Front 1080

Respiratory Disruptions
III. Lung Cancer
D. Clinical Manifestations--late in disease, especially with adnocarcinoma
6. Difficulty ------------, -------------/weight loss/fatigue (late manifestation)

Back 1080

Respiratory Disruptions
III. Lung Cancer
D. Clinical Manifestations--late in disease, especially with adnocarcinoma
6. Difficulty swallowing anorexia/weight loss/fatigue (late manifestation)

Front 1081

Respiratory Disruptions
III. Lung Cancer
D. Clinical Manifestations--late in disease, especially with adnocarcinoma
7. Pleural ---------, pericardial ------------- (if mediasternum), cardiac -----------

Back 1081

Respiratory Disruptions
III. Lung Cancer
D. Clinical Manifestations--late in disease, especially with adnocarcinoma
7. Pleural effusion, pericardial effusion (if mediasternum), cardiac tamponade

Front 1082

Respiratory Disruptions
III. Lung Cancer
D. Clinical Manifestations--late in disease, especially with adnocarcinoma
8. Superior ------------- syndrome--swelling in ---------, neck, and face

Back 1082

Respiratory Disruptions
III. Lung Cancer
D. Clinical Manifestations--late in disease, especially with adnocarcinoma
8. Superior vena cava syndrome--swelling in arms, neck, and face

Front 1083

Respiratory Disruptions
III. Lung Cancer
D. Clinical Manifestations--late in disease, especially with adnocarcinoma
9. Swollen lymph nodes--swell with -----------

Back 1083

Respiratory Disruptions
III. Lung Cancer
D. Clinical Manifestations--late in disease, especially with adnocarcinoma
9. Swollen lymph nodes--swell with metastasis

Front 1084

Respiratory Disruptions
III. Lung Cancer
E. Diagnosis
1. History and ---------
2. CXR--detect -------, pleural effusions, and -------- (1-2sonometers)

Back 1084

Respiratory Disruptions
III. Lung Cancer
E. Diagnosis
1. History and physical
2. CXR--detect metastasis, pleural effusions, and tumors (1-2sonometers)

Front 1085

Respiratory Disruptions
III. Lung Cancer
E. Diagnosis
2. CXR--detect metastasis, pleural effusions, and tumors (1-2sonometers)
a. Routing CXRs often lead to --------- of lung ----------

Back 1085

Respiratory Disruptions
III. Lung Cancer
E. Diagnosis
2. CXR--detect metastasis, pleural effusions, and tumors (1-2sonometers)
a. Routing CXRs often lead to Dx of lung CA

Front 1086

Respiratory Disruptions
III. Lung Cancer
E. Diagnosis
3. ________--single most effective noninvasive test to determine CA and metastasis

Back 1086

Respiratory Disruptions
III. Lung Cancer
E. Diagnosis
3. CT--single most effective noninvasive test to determine CA and metastasis

Front 1087

Respiratory Disruptions
III. Lung Cancer
E. Diagnosis
4. Biopsy--definitive --------- (must have ----------- cells)

Back 1087

Respiratory Disruptions
III. Lung Cancer
E. Diagnosis
4. Biopsy--definitive Dx (must have malignant cells)

Front 1088

Respiratory Disruptions
III. Lung Cancer
E. Diagnosis
4. Biopsy--definitive Dx (must have malignant cells)
a. From morning ---------- sample, bronchoscopy, needle ----------, tap pleural ---------

Back 1088

Respiratory Disruptions
III. Lung Cancer
E. Diagnosis
4. Biopsy--definitive Dx (must have malignant cells)
a. From morning sputum sample, bronchoscopy, needle biopsy, tap pleural effusion

Front 1089

Respiratory Disruptions
III. Lung Cancer
E. Diagnosis
4. Biopsy--definitive Dx (must have malignant cells)
b. Brain and ---------- most common metastasis sites

Back 1089

Respiratory Disruptions
III. Lung Cancer
E. Diagnosis
4. Biopsy--definitive Dx (must have malignant cells)
b. Brain and bone most common metastasis sites

Front 1090

Respiratory Disruptions
III. Lung Cancer
F. Treatment--based on staging (early ----------- is not helpful)
1. Surgery--only hope (------------ more likely to be resected)

Back 1090

Respiratory Disruptions
III. Lung Cancer
F. Treatment--based on staging (early detection is not helpful)
1. Surgery--only hope (squamous cells more likely to be resected)

Front 1091

Respiratory Disruptions
III. Lung Cancer
F. Treatment--based on staging (early detection is not helpful)
1. Surgery--only hope (squamous cells more likely to be resected)
a. ----------- (part of lung) vs. ------------ (whole lung)

Back 1091

Respiratory Disruptions
III. Lung Cancer
F. Treatment--based on staging (early detection is not helpful)
1. Surgery--only hope (squamous cells more likely to be resected)
a. Lobectomy (part of lung) vs. pneumonectomy (whole lung)

Front 1092

Respiratory Disruptions
III. Lung Cancer
F. Treatment--based on staging (early detection is not helpful)
1. Surgery--only hope (squamous cells more likely to be resected)
b. Many times not possible if already -----------

Back 1092

Respiratory Disruptions
III. Lung Cancer
F. Treatment--based on staging (early detection is not helpful)
1. Surgery--only hope (squamous cells more likely to be resected)
b. Many times not possible if already metastasized

Front 1093

Respiratory Disruptions
III. Lung Cancer
F. Treatment--based on staging (early detection is not helpful)
2. Radiation--when used with surgery and -------- (not beneficial for --------- cell)
a. Sometimes just for --------- measures

Back 1093

Respiratory Disruptions
III. Lung Cancer
F. Treatment--based on staging (early detection is not helpful)
2. Radiation--when used with surgery and chemo (not beneficial for small cell)
a. Sometimes just for palliative measures

Front 1094

Respiratory Disruptions
III. Lung Cancer
F. Treatment--based on staging (early detection is not helpful)
3. Chemotherapy--standard treatment for advanced ---------- CA

Back 1094

Respiratory Disruptions
III. Lung Cancer
F. Treatment--based on staging (early detection is not helpful)
3. Chemotherapy--standard treatment for advanced non-small cell CA

Front 1095

Respiratory Disruptions
III. Lung Cancer
G. Nursing Management
1. Assess level of ----------- related to disease
2. Provide pre-op/post-op procedure and ------------- teaching
3. Assess --------- system

Back 1095

Respiratory Disruptions
III. Lung Cancer
G. Nursing Management
1. Assess level of knowledge related to disease
2. Provide pre-op/post-op procedure and intervention teaching
3. Assess support system

Front 1096

Respiratory Disruptions
III. Lung Cancer
G. Nursing Management
4. Assess pain and provide --------- measures
5. Assess ------------ status (pts easily lose wt)
6. Be able to provide------------ in the community

Back 1096

Respiratory Disruptions
III. Lung Cancer
G. Nursing Management
1. Assess level of knowledge related to disease
2. Provide pre-op/post-op procedure and intervention teaching
3. Assess support system

Front 1097

Respiratory Disruptions
IV. Traumatic Injuries of the Chest and Thorax
A. Blunt--body is struck by a blunt object (ex. MVAs chest wall in contact with steering wheel)
1. --------------- trauma--impact of parts of the body against other objects

Back 1097

Respiratory Disruptions
IV. Traumatic Injuries of the Chest and Thorax
A. Blunt--body is struck by a blunt object (ex. MVAs chest wall in contact with steering wheel)
1. Countrecoup trauma--impact of parts of the body against other objects

Front 1098

Respiratory Disruptions
IV. Traumatic Injuries of the Chest and Thorax
A. Blunt--body is struck by a blunt object (ex. MVAs chest wall in contact with steering wheel)
2. Pulmonary ---------, vessel ------------- (great vessel tears), cardiac tamponade, crush ----------

Back 1098

Respiratory Disruptions
IV. Traumatic Injuries of the Chest and Thorax
A. Blunt--body is struck by a blunt object (ex. MVAs chest wall in contact with steering wheel)
2. Pulmonary contusions, vessel ruptures (great vessel tears), cardiac tamponade, crush injuries

Front 1099

Respiratory Disruptions
IV. Traumatic Injuries of the Chest and Thorax
B. ___________--foreign body impales or passes through body tissues
C. _____________--air/fluid in pleural space (have a tendency to reoccur)

Back 1099

Respiratory Disruptions
IV. Traumatic Injuries of the Chest and Thorax
B. Penetrating--foreign body impales or passes through body tissues
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)

Front 1100

Respiratory Disruptions
IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
• If >_____% of lung resp. distress, if <________% they can still function (may need chest tube)

Back 1100

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
• If >40% of lung resp. distress, if <25% they can still function (may need chest tube)

Front 1101

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
1. Closed--caused by -------- rupture on lung
a. Characteristics--no associated open ---------, no underlying disease

Back 1101

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
1. Closed--caused by bleb rupture on lung
a. Characteristics--no associated open wound, no underlying disease

Front 1102

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
1. Closed--caused by bleb rupture on lung
a. Characteristics--no associated open wound, no underlying disease
i. -------------- pneumothorax--no clear cause (tall, thin, 20-_____yr men who smoke)

Back 1102

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
1. Closed--caused by bleb rupture on lung
a. Characteristics--no associated open wound, no underlying disease
i. Sponaneous pneumothorax--no clear cause (tall, thin, 20-40yr men who smoke)

Front 1103

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
1. Closed--caused by bleb rupture on lung
a. Characteristics--no associated open wound, no underlying disease
ii. Injury from ----------- ventilation (PEEP)
iii. Injury from broken --------

Back 1103

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
1. Closed--caused by bleb rupture on lung
a. Characteristics--no associated open wound, no underlying disease
ii. Injury from mechanical ventilation (PEEP)
iii. Injury from broken ribs

Front 1104

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
1. Closed--caused by bleb rupture on lung
a. Characteristics--no associated open wound, no underlying disease
iv. S/P ------------- insertion--always follow w/ ----------- to check for pneumo

Back 1104

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
1. Closed--caused by bleb rupture on lung
a. Characteristics--no associated open wound, no underlying disease
iv. S/P subclavian catheter insertion--always follow w/ CXR to check for pneumo

Front 1105

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
2. Open--air enters pleural space from opening in chest wall and gets trapped (“sucking wound”)
a. Causes--stab/--------- wound; s/p ----------

Back 1105

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
2. Open--air enters pleural space from opening in chest wall and gets trapped (“sucking wound”)
a. Causes--stab/gunshot wound; s/p thoracotomy

Front 1106

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
2. Open--air enters pleural space from opening in chest wall and gets trapped (“sucking wound”)
b. Manifestations--SOB, ----------------/hyperresonance on affected side, see ------------

Back 1106

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
2. Open--air enters pleural space from opening in chest wall and gets trapped (“sucking wound”)
b. Manifestations--SOB, shallow breaths/hyperresonance on affected side, see bubbling

Front 1107

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
2. Open--air enters pleural space from opening in chest wall and gets trapped (“sucking wound”)
c. Management--cover w/ ---------- dressing and taped on ------------ sides (creates 1 way valve)

Back 1107

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
2. Open--air enters pleural space from opening in chest wall and gets trapped (“sucking wound”)
c. Management--cover w/ vented dressing and taped on 3 sides (creates 1 way valve)

Front 1108

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
2. Open--air enters pleural space from opening in chest wall and gets trapped (“sucking wound”)
c. Management--cover w/ vented dressing and taped on 3 sides (creates 1 way valve)
i. If taped on all ----------- sides pneumo gets bigger tension -----------

Back 1108

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
2. Open--air enters pleural space from opening in chest wall and gets trapped (“sucking wound”)
c. Management--cover w/ vented dressing and taped on 3 sides (creates 1 way valve)
i. If taped on all 4 sides pneumo gets bigger tension pneumo

Front 1109

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
2. Open--air enters pleural space from opening in chest wall and gets trapped (“sucking wound”)
c. Management--cover w/ vented dressing and taped on 3 sides (creates 1 way valve)
ii. Give ----------- until ---------- placement

Back 1109

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
2. Open--air enters pleural space from opening in chest wall and gets trapped (“sucking wound”)
c. Management--cover w/ vented dressing and taped on 3 sides (creates 1 way valve)
ii. Give oxygen until chest tube placement

Front 1110

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
3. Tension--pneumothorax w/ rapid ------------- of air in pleural space causing severely high ---------------- pressures w/ resultant tension on heart and great vessels (life threatening)

Back 1110

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
3. Tension--pneumothorax w/ rapid accumulation of air in pleural space causing severely high intrapleural pressures w/ resultant tension on heart and great vessels (life threatening)

Front 1111

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
3. Tension--pneumothorax w/ rapid accumulation of air in pleural space causing severely high intrapleural pressures w/ resultant tension on heart and great vessels (life threatening)
a. Clinical Manifestations (can occur due to blunt or ----------- object)

Back 1111

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
3. Tension--pneumothorax w/ rapid accumulation of air in pleural space causing severely high intrapleural pressures w/ resultant tension on heart and great vessels (life threatening)
a. Clinical Manifestations (can occur due to blunt or penetrating object)

Front 1112

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
3. Tension--pneumothorax w/ rapid accumulation of air in pleural space causing severely high intrapleural pressures w/ resultant tension on heart and great vessels (life threatening)
a. Clinical Manifestations (can occur due to blunt or penetrating object)
i. Triad of symptoms--resp ----------, look ------------ (↓BP), no breath sounds

Back 1112

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
3. Tension--pneumothorax w/ rapid accumulation of air in pleural space causing severely high intrapleural pressures w/ resultant tension on heart and great vessels (life threatening)
a. Clinical Manifestations (can occur due to blunt or penetrating object)
i. Triad of symptoms--resp distress, look shocky (↓BP), no breath sounds

Front 1113

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
3. Tension--pneumothorax w/ rapid accumulation of air in pleural space causing severely high intrapleural pressures w/ resultant tension on heart and great vessels (life threatening)
a. Clinical Manifestations (can occur due to blunt or penetrating object)
ii. Interferes with ----------- shock ↓BP hypoxic ↓---------, etc.

Back 1113

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
3. Tension--pneumothorax w/ rapid accumulation of air in pleural space causing severely high intrapleural pressures w/ resultant tension on heart and great vessels (life threatening)
a. Clinical Manifestations (can occur due to blunt or penetrating object)
ii. Interferes with venous return shock ↓BP hypoxic ↓CO, etc.

Front 1114

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
3. Tension--pneumothorax w/ rapid accumulation of air in pleural space causing severely high intrapleural pressures w/ resultant tension on heart and great vessels (life threatening)
a. Clinical Manifestations (can occur due to blunt or penetrating object)
iii. Complete collapse -------------- shift (tracheal -----------)

Back 1114

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
3. Tension--pneumothorax w/ rapid accumulation of air in pleural space causing severely high intrapleural pressures w/ resultant tension on heart and great vessels (life threatening)
a. Clinical Manifestations (can occur due to blunt or penetrating object)
iii. Complete collapse mediastinal shift (tracheal deviation)

Front 1115

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
3. Tension--pneumothorax w/ rapid accumulation of air in pleural space causing severely high intrapleural pressures w/ resultant tension on heart and great vessels (life threatening)
b. Diagnosis--on clinical grounds (do NOT need ----------)

Back 1115

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
3. Tension--pneumothorax w/ rapid accumulation of air in pleural space causing severely high intrapleural pressures w/ resultant tension on heart and great vessels (life threatening)
b. Diagnosis--on clinical grounds (do NOT need CXR)

Front 1116

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
3. Tension--pneumothorax w/ rapid accumulation of air in pleural space causing severely high intrapleural pressures w/ resultant tension on heart and great vessels (life threatening)
b. Diagnosis--on clinical grounds (do NOT need CXR)
c. Treatment--large gauge needle --------------- (if air comes out pt will need chest tube)

Back 1116

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
3. Tension--pneumothorax w/ rapid accumulation of air in pleural space causing severely high intrapleural pressures w/ resultant tension on heart and great vessels (life threatening)
b. Diagnosis--on clinical grounds (do NOT need CXR)
c. Treatment--large gauge needle decompression (if air comes out pt will need chest tube)

Front 1117

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
4. __________--blood accumulates in intrapleural space (blood and air-hemopneumothroax)

Back 1117

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
4. Hemothorax--blood accumulates in intrapleural space (blood and air-hemopneumothroax)

Front 1118

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
4. Hemothorax--blood accumulates in intrapleural space (blood and air-hemopneumothroax)
a. Causes--massive bleeding from major chest ---------- or ----------- vessel rupture

Back 1118

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
4. Hemothorax--blood accumulates in intrapleural space (blood and air-hemopneumothroax)
a. Causes--massive bleeding from major chest vessel or intercostal vessel rupture

Front 1119

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
4. Hemothorax--blood accumulates in intrapleural space (blood and air-hemopneumothroax)
a. Causes--massive bleeding from major chest vessel or intercostal vessel rupture
i. Can accumulate up to -----------L of blood from blunt or ------------ trauma

Back 1119

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
4. Hemothorax--blood accumulates in intrapleural space (blood and air-hemopneumothroax)
a. Causes--massive bleeding from major chest vessel or intercostal vessel rupture
i. Can accumulate up to 1L of blood from blunt or penetrating trauma

Front 1120

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
4. Hemothorax--blood accumulates in intrapleural space (blood and air-hemopneumothroax)
a. Causes--massive bleeding from major chest vessel or intercostal vessel rupture
ii. Pulmonary ------------, -------------- therapy, TB, etc.

Back 1120

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
4. Hemothorax--blood accumulates in intrapleural space (blood and air-hemopneumothroax)
a. Causes--massive bleeding from major chest vessel or intercostal vessel rupture
ii. Pulmonary embolus, coagulation therapy, TB, etc.

Front 1121

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
4. Hemothorax--blood accumulates in intrapleural space (blood and air-hemopneumothroax).
b. Clinical Manifestations--dull ------------, shock (from ↓---------)

Back 1121

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
4. Hemothorax--blood accumulates in intrapleural space (blood and air-hemopneumothroax).
b. Clinical Manifestations--dull percussion, shock (from ↓blood)

Front 1122

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
4. Hemothorax--blood accumulates in intrapleural space (blood and air-hemopneumothroax).
c. Treatment--CXR, ↑------------, chest tube, ----------------- devices (diverts blood back into pt)

Back 1122

IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur)
4. Hemothorax--blood accumulates in intrapleural space (blood and air-hemopneumothroax).
c. Treatment--CXR, ↑HR, chest tube, autotransfusion devices (diverts blood back into pt)

Front 1123

IV. Traumatic Injuries of the Chest and Thorax
D. Fractured Ribs--blunt/penetrating injuries (most common from trauma)
1 Clinical Manifestations--pain, --------------, bruising, tenderness, some ------------ bleeding, hurts to take --------------- (increased risk for atalectasis), splinting ----------- side

Back 1123

IV. Traumatic Injuries of the Chest and Thorax
D. Fractured Ribs--blunt/penetrating injuries (most common from trauma)
1 Clinical Manifestations--pain, swelling, bruising, tenderness, some internal bleeding, hurts to take deep breath (increased risk for atalectasis), splinting affected side

Front 1124

IV. Traumatic Injuries of the Chest and Thorax
D. Fractured Ribs--blunt/penetrating injuries (most common from trauma)
2. Diagnosis--________
3. Treatment--↓pain (more apt to take deep breaths) w/ ASA, _________, _______

Back 1124

IV. Traumatic Injuries of the Chest and Thorax
D. Fractured Ribs--blunt/penetrating injuries (most common from trauma)
2. Diagnosis--CXR
3. Treatment--↓pain (more apt to take deep breaths) w/ ASA, NSAIDS, narcotics

Front 1125

IV. Traumatic Injuries of the Chest and Thorax
D. Fractured Ribs--blunt/penetrating injuries (most common from trauma)
2. Diagnosis--CXR
3. Treatment--↓pain (more apt to take deep breaths) w/ ASA, NSAIDS, narcotics
a. -------------- if in resp distress (possible pneumothorax)

Back 1125

IV. Traumatic Injuries of the Chest and Thorax
D. Fractured Ribs--blunt/penetrating injuries (most common from trauma)
2. Diagnosis--CXR
3. Treatment--↓pain (more apt to take deep breaths) w/ ASA, NSAIDS, narcotics
a. Intubation if in resp distress (possible pneumothorax)

Front 1126

IV. Traumatic Injuries of the Chest and Thorax
D. Fractured Ribs--blunt/penetrating injuries (most common from trauma)
2. Diagnosis--CXR
3. Treatment--↓pain (more apt to take deep breaths) w/ ASA, NSAIDS, narcotics
b. -------------- chest tubes if fractures and intubation

Back 1126

IV. Traumatic Injuries of the Chest and Thorax
D. Fractured Ribs--blunt/penetrating injuries (most common from trauma)
2. Diagnosis--CXR
3. Treatment--↓pain (more apt to take deep breaths) w/ ASA, NSAIDS, narcotics
b. Prophylactic chest tubes if fractures and intubation

Front 1127

IV. Traumatic Injuries of the Chest and Thorax
E. Flail Chest--from multiple -------------- fractures causing instability of chest wall

Back 1127

IV. Traumatic Injuries of the Chest and Thorax
E. Flail Chest--from multiple rib fractures causing instability of chest wall
1. Clinical Manifestations--crepitis, paradoxical chest movement, ↑RR, shallow breaths, ↑HR

Front 1128

IV. Traumatic Injuries of the Chest and Thorax
E. Flail Chest--from multiple rib fractures causing instability of chest wall
1. Clinical Manifestations--crepitis, ---------- chest movement, ↑---------, shallow breaths, ↑---------

Back 1128

IV. Traumatic Injuries of the Chest and Thorax
E. Flail Chest--from multiple rib fractures causing instability of chest wall
1. Clinical Manifestations--crepitis, paradoxical chest movement, ↑RR, shallow breaths, ↑HR

Front 1129

IV. Traumatic Injuries of the Chest and Thorax
E. Flail Chest--from multiple rib fractures causing instability of chest wall
1. Clinical Manifestations--crepitis, paradoxical chest movement, ↑RR, shallow breaths, ↑HR
a. Breathe in ------------- pressure sucks chest wall in (opposite when breathing out)

Back 1129

IV. Traumatic Injuries of the Chest and Thorax
E. Flail Chest--from multiple rib fractures causing instability of chest wall
1. Clinical Manifestations--crepitis, paradoxical chest movement, ↑RR, shallow breaths, ↑HR
a. Breathe in negative pressure sucks chest wall in (opposite when breathing out)

Front 1130

IV. Traumatic Injuries of the Chest and Thorax
E. Flail Chest--from multiple rib fractures causing instability of chest wall
1. Clinical Manifestations--crepitis, paradoxical chest movement, ↑RR, shallow breaths, ↑HR
b. Often have ------------- contusion and/or -------------

Back 1130

IV. Traumatic Injuries of the Chest and Thorax
E. Flail Chest--from multiple rib fractures causing instability of chest wall
1. Clinical Manifestations--crepitis, paradoxical chest movement, ↑RR, shallow breaths, ↑HR
b. Often have pulmonary contusion and/or pneumothorax

Front 1131

IV. Traumatic Injuries of the Chest and Thorax
E. Flail Chest--from multiple rib fractures causing instability of chest wall
2. Diagnosis--fractures on -------- (visual diagnosis)

Back 1131

IV. Traumatic Injuries of the Chest and Thorax
E. Flail Chest--from multiple rib fractures causing instability of chest wall
2. Diagnosis--fractures on CXR (visual diagnosis)

Front 1132

IV. Traumatic Injuries of the Chest and Thorax
E. Flail Chest--from multiple rib fractures causing instability of chest wall
3. Treatment--stabilize-----------, ----------- (put on ventilator for flail chest)

Back 1132

IV. Traumatic Injuries of the Chest and Thorax
E. Flail Chest--from multiple rib fractures causing instability of chest wall
3. Treatment--stabilize chest wall, oxygenate (put on ventilator for flail chest)

Front 1133

V. Pleural Drainage System
A. Purpose--evacuate ----------/air/pus/fluid from ------------- and reestablish ----------- pressure in intrapleural space so lungs can reexpand

Back 1133

V. Pleural Drainage System
A. Purpose--evacuate blood/air/pus/fluid from thoracic cavity and reestablish negative pressure in intrapleural space so lungs can reexpand

Front 1134

V. Pleural Drainage System
B. Chambers
1. Collection chamber--collects ---------- that drains into chest tub through -------ft connecting tube

Back 1134

V. Pleural Drainage System
B. Chambers
1. Collection chamber--collects fluid that drains into chest tub through 6ft connecting tube

Front 1135

V. Pleural Drainage System
B. Chambers
1. Collection chamber--collects fluid that drains into chest tub through 6ft connecting tube
a. Holds up to ------------mL

Back 1135

V. Pleural Drainage System
B. Chambers
1. Collection chamber--collects fluid that drains into chest tub through 6ft connecting tube
a. Holds up to 2000mL

Front 1136

V. Pleural Drainage System
B. Chambers
2. Water-Seal Chamber--______cm water act as 1-way valve (air drains from______, but not back to pt)

Back 1136

V. Pleural Drainage System
B. Chambers
2. Water-Seal Chamber--2cm water act as 1-way valve (air drains from chest, but not back to pt)

Front 1137

V. Pleural Drainage System
B. Chambers
2. Water-Seal Chamber--2cm water act as 1-way valve (air drains from chest, but not back to pt)
a. B----------
b. T---------: fluctuations on inspiration and expiration (when pt is off suction)

Back 1137

V. Pleural Drainage System
B. Chambers
2. Water-Seal Chamber--2cm water act as 1-way valve (air drains from chest, but not back to pt)
a. Bubbling
b. Tidaling--fluctuations on inspiration and expiration (when pt is off suction)

Front 1138

V. Pleural Drainage System
B. Chambers
2. Water-Seal Chamber--2cm water act as 1-way valve (air drains from chest, but not back to pt)
b. Tidaling--fluctuations on inspiration and expiration (when pt is off suction)
i. Deep breath in with -------------- breathing water moves up

Back 1138

V. Pleural Drainage System
B. Chambers
2. Water-Seal Chamber--2cm water act as 1-way valve (air drains from chest, but not back to pt)
b. Tidaling--fluctuations on inspiration and expiration (when pt is off suction)
i. Deep breath in with normal breathing water moves up

Front 1139

V. Pleural Drainage System
B. Chambers
2. Water-Seal Chamber--2cm water act as 1-way valve (air drains from chest, but not back to pt)
b. Tidaling--fluctuations on inspiration and expiration (when pt is off suction)
ii. Deep breath on -------------- water moves down
iii. No ----------: full lung expansion

Back 1139

V. Pleural Drainage System
B. Chambers
2. Water-Seal Chamber--2cm water act as 1-way valve (air drains from chest, but not back to pt)
b. Tidaling--fluctuations on inspiration and expiration (when pt is off suction)
ii. Deep breath on vent water moves down
iii. No tidaling--full lung expansion

Front 1140

V. Pleural Drainage System
B. Chambers
3. ------------- Chamber--applies controlled suction to chest drainage system

Back 1140

V. Pleural Drainage System
B. Chambers
3. Suction Control Chamber--applies controlled suction to chest drainage system

Front 1141

V. Pleural Drainage System
B. Chambers
3. Suction Control Chamber--applies controlled suction to chest drainage system
a. To regulate suction, connect ------------- line tubing to wall suction and set at ordered level

Back 1141

V. Pleural Drainage System
B. Chambers
3. Suction Control Chamber--applies controlled suction to chest drainage system
a. To regulate suction, connect vacuum line tubing to wall suction and set at ordered level

Front 1142

V. Pleural Drainage System
B. Chambers
3. Suction Control Chamber--applies controlled suction to chest drainage system
b. Suction order must be written by ---------- (usually ----------sonometers in suction chamber)

Back 1142

V. Pleural Drainage System
B. Chambers
3. Suction Control Chamber--applies controlled suction to chest drainage system
b. Suction order must be written by physician (usually 20sonometers in suction chamber)

Front 1143

V. Pleural Drainage System
C. Nursing Management
1. Keep tubing coiled loosely below ------------ level and do not let pt lie on it
2. Check ------------ and tape them

Back 1143

V. Pleural Drainage System
C. Nursing Management
1. Keep tubing coiled loosely below chest level and do not let pt lie on it
2. Check connections and tape them

Front 1144

V. Pleural Drainage System
C. Nursing Management
3. Mark -------------- levels--time depends on drainage (check q5-_______min post-surgery)

Back 1144

V. Pleural Drainage System
C. Nursing Management
3. Mark drainage levels--time depends on drainage (check q5-10min post-surgery)

Front 1145

V. Pleural Drainage System
C. Nursing Management
4. Assess ---------- level in water seal chamber q-------h (suction regulated by water amount in chamber)

Back 1145

V. Pleural Drainage System
C. Nursing Management
4. Assess water level in water seal chamber q8h (suction regulated by water amount in chamber)

Front 1146

V. Pleural Drainage System
C. Nursing Management
5. Observe for ----------- bubbling in water seal chamber and ------------- (tidaling)

Back 1146

V. Pleural Drainage System
C. Nursing Management
5. Observe for air bubbling in water seal chamber and fluctuations (tidaling)
6. Never elevate drainage system to level of pts chest

Front 1147

V. Pleural Drainage System
C. Nursing Management
6. Never ------------ drainage system to level of pts chest
7. Never ---------- tubes--except for changing drainage system

Back 1147

V. Pleural Drainage System
C. Nursing Management
6. Never elevate drainage system to level of pts chest
7. Never clamp tubes--except for changing drainage system

Front 1148

V. Pleural Drainage System
C. Nursing Management
8. If continuous ---------- in water seal chamber, assess for air leak (assess appropriateness)
a. Use ------------ to find leak’s location

Back 1148

V. Pleural Drainage System
C. Nursing Management
8. If continuous bubbling in water seal chamber, assess for air leak (assess appropriateness)
a. Use clamp to find leak’s location

Front 1149

V. Pleural Drainage System
C. Nursing Management
9. Daily ---------- to determine if totally reinflated (before taking out try ----------- suction and assess)

Back 1149

V. Pleural Drainage System
C. Nursing Management
9. Daily CXR to determine if totally reinflated (before taking out try gravity suction and assess)

Front 1150

V. Pleural Drainage System
C. Nursing Management
10. Premedicate w/ chest tube ----------- (morphine)--take deep breath in and ------------, pull

Back 1150

V. Pleural Drainage System
C. Nursing Management
10. Premedicate w/ chest tube removal (morphine)--take deep breath in and blow out pull

Front 1151

VI. Acute Respiratory Failure
A. Clinical Manifestations
1. Change in ------------ status (early sign)
2. Dyspnea,-----------, mild ---------

Back 1151

VI. Acute Respiratory Failure
A. Clinical Manifestations
1. Change in mental status (early sign)
2. Dyspnea, tachypnea, mild HTN

Front 1152

VI. Acute Respiratory Failure
A. Clinical Manifestations
2. Dyspnea, tachypnea, mild HTN
a. ----------- breathing slowed w/ no -------------, unable to ----------- (bad) intubate

Back 1152

VI. Acute Respiratory Failure
A. Clinical Manifestations
2. Dyspnea, tachypnea, mild HTN
a. Fast breathing slowed w/ no intervention unable to compensate (bad) intubate

Front 1153

VI. Acute Respiratory Failure
A. Clinical Manifestations
3. Skin cool, clammy, and ----------
4. ---------: if PaO2 <45 (late sign)

Back 1153

VI. Acute Respiratory Failure
A. Clinical Manifestations
3. Skin cool, clammy, and diaphoretic
4. Cyanosis--if PaO2 <45 (late sign)

Front 1154

VI. Acute Respiratory Failure
A. Clinical Manifestations
4. Cyanosis--if PaO2 <---------- (late sign)

Back 1154

VI. Acute Respiratory Failure
A. Clinical Manifestations
4. Cyanosis--if PaO2 <45 (late sign)

Front 1155

VI. Acute Respiratory Failure
A. Clinical Manifestations
5. Assess pt for comfort position breathing (ab breathing, ---------- lip, --------- muscles, high --------)

Back 1155

VI. Acute Respiratory Failure
A. Clinical Manifestations
5. Assess pt for comfort position breathing (ab breathing, pursed lip, IC muscles, high fowlers)

Front 1156

VI. Acute Respiratory Failure
A. Clinical Manifestations
6. --------- breath sounds and ------------- upon percussion

Back 1156

VI. Acute Respiratory Failure
A. Clinical Manifestations
6. Adventitious breath sounds and hyperresonance upon percussion

Front 1157

VI. Acute Respiratory Failure
A. Clinical Manifestations
7. Prolonged expiration (I:E ratio)--1:-------, 1:---------

Back 1157

VI. Acute Respiratory Failure
A. Clinical Manifestations
7. Prolonged expiration (I:E ratio)--1:3, 1:4

Front 1158

VI. Acute Respiratory Failure
B. Diagnosis
1. ------------- assessment
2. Lab values--ABGs (checks both --------- and -----------)

Back 1158

VI. Acute Respiratory Failure
B. Diagnosis
1. Physical assessment
2. Lab values--ABGs (checks both oxygenation and ventilation)

Front 1159

VI. Acute Respiratory Failure
B. Diagnosis
3. -------: diagnosis and see changes
4. Mixed venous blood gases--amount of -------- delivered to tissues

Back 1159

VI. Acute Respiratory Failure
B. Diagnosis
3. CXR--diagnosis and see changes
4. Mixed venous blood gases--amount of O2 delivered to tissues

Front 1160

VI. Acute Respiratory Failure
B. Diagnosis
4. Mixed venous blood gases--amount of O2 delivered to tissues
a. ----------- (venous 38-42) and ---------- (venous 60-80%) from pulmonary artery catheter

Back 1160

VI. Acute Respiratory Failure
B. Diagnosis
4. Mixed venous blood gases--amount of O2 delivered to tissues
a. PVO2 (venous 38-42) and SVO2 (venous 60-80%) from pulmonary artery catheter

Front 1161

VI. Acute Respiratory Failure
B. Diagnosis
4. Mixed venous blood gases--amount of O2 delivered to tissues
a. PVO2 (venous _____-42) and SVO2 (venous ____-80%) from pulmonary artery catheter

Back 1161

VI. Acute Respiratory Failure
B. Diagnosis
4. Mixed venous blood gases--amount of O2 delivered to tissues
a. PVO2 (venous 38-42) and SVO2 (venous 60-80%) from pulmonary artery catheter

Front 1162

VI. Acute Respiratory Failure
B. Diagnosis
4. Mixed venous blood gases--amount of O2 delivered to tissues
b. ------------ measure tissue consumption

Back 1162

VI. Acute Respiratory Failure
B. Diagnosis
4. Mixed venous blood gases--amount of O2 delivered to tissues
b. SWANs measure tissue consumption

Front 1163

VI. Acute Respiratory Failure
B. Diagnosis
5. Pulse oximetry (---------2)--if poor (<---------%) get ABG **want >---------%

Back 1163

VI. Acute Respiratory Failure
B. Diagnosis
5. Pulse oximetry (SpO2)--if poor (<95%) get ABG **want >90%

Front 1164

VI. Acute Respiratory Failure
B. Diagnosis
6. V/Q lung scan--acute ------------- embolus

Back 1164

VI. Acute Respiratory Failure
B. Diagnosis
6. V/Q lung scan--acute pulmonary embolus

Front 1165

VI. Acute Respiratory Failure
B. Diagnosis
7. Pulmonary ---------: rule out pulmonary embolism

Back 1165

VI. Acute Respiratory Failure
B. Diagnosis
7. Pulmonary angiography--rule out pulmonary embolism

Front 1166

VI. Acute Respiratory Failure
B. Diagnosis
8. Possible insertion of ---------- to monitor
9. ---------- status ↑ or ↓

Back 1166

VI. Acute Respiratory Failure
B. Diagnosis
8. Possible insertion of PA catheter to monitor
9. Fluid status ↑ or ↓

Front 1167

VI. Acute Respiratory Failure
C. Categories **------------- and -----------: physiologic mechanism for hypoxemia (1-4)

Back 1167

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)

Front 1168

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure--alteration in ---------- transport between alveoli and-------------- capillary bed (gas exchange) resulting in ----------2 <60mmHg w/ FiO2 >60% due to problems with lungs (ex. pneumonia, pulmonary edema, pulmonary emboli, CHF, shock)

Back 1168

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure--alteration in O2 transport between alveoli and pulmonary capillary bed (gas exchange) resulting in PaO2 <60mmHg w/ FiO2 >60% due to problems with lungs (ex. pneumonia, pulmonary edema, pulmonary emboli, CHF, shock)

Front 1169

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure--alteration in O2 transport between alveoli and pulmonary capillary bed (gas exchange) resulting in
PaO2 <-----------mmHg w/ --------------2 >60% due to problems with lungs (ex. pneumonia, pulmonary edema, pulmonary emboli, CHF, shock)

Back 1169

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure--alteration in O2 transport between alveoli and pulmonary capillary bed (gas exchange) resulting in PaO2 <60mmHg w/ FiO2 >60% due to problems with lungs (ex. pneumonia, pulmonary edema, pulmonary emboli, CHF, shock)

Front 1170

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure--alteration in O2 transport between alveoli and pulmonary capillary bed (gas exchange) resulting in PaO2 <60mmHg w/ FiO2 >60% due to problems with lungs (ex. ------------, pulmonary -----------, pulmonary ------------, CHF, ---------)

Back 1170

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure--alteration in O2 transport between alveoli and pulmonary capillary bed (gas exchange) resulting in PaO2 <60mmHg w/ FiO2 >60% due to problems with lungs (ex. pneumonia, pulmonary edema, pulmonary emboli, CHF, shock)

Front 1171

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
a. -------------- Mismatch--alteration in ratio of ventilation to perfusion (should have 4-5L/min blood to alveoli and 4/5L of gas into lungs 1:1)

Back 1171

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
a. Ventilation-Perfusion Mismatch--alteration in ratio of ventilation to perfusion (should have 4-5L/min blood to alveoli and 4/5L of gas into lungs 1:1)

Front 1172

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
a. Ventilation-Perfusion Mismatch--alteration in ratio of ventilation to perfusion (should have 4-________L/min blood to alveoli and 4/_______L of gas into lungs 1:____)

Back 1172

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
a. Ventilation-Perfusion Mismatch--alteration in ratio of ventilation to perfusion (should have 4-5L/min blood to alveoli and 4/5L of gas into lungs 1:1)

Front 1173

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
a. Ventilation-Perfusion Mismatch--alteration in ratio of ventilation to perfusion (should have 4-5L/min blood to alveoli and 4/5L of gas into lungs 1:1)
i. ↑secretions in --------------- (COPD, --------------, asthma)-↓ventilation w/ same blood

Back 1173

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
a. Ventilation-Perfusion Mismatch--alteration in ratio of ventilation to perfusion (should have 4-5L/min blood to alveoli and 4/5L of gas into lungs 1:1)
i. ↑secretions in airway (COPD, pneumonia, asthma)-↓ventilation w/ same blood

Front 1174

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
a. Ventilation-Perfusion Mismatch--alteration in ratio of ventilation to perfusion (should have 4-5L/min blood to alveoli and 4/5L of gas into lungs 1:1)
ii. Conditions resulting in ---------------- collapse (---------: not taking in enough air)

Back 1174

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
a. Ventilation-Perfusion Mismatch--alteration in ratio of ventilation to perfusion (should have 4-5L/min blood to alveoli and 4/5L of gas into lungs 1:1)
ii. Conditions resulting in alveolar collapse (atelectasis--not taking in enough air)

Front 1175

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
a. Ventilation-Perfusion Mismatch--alteration in ratio of ventilation to perfusion (should have 4-5L/min blood to alveoli and 4/5L of gas into lungs 1:1)
iii. ↓-------------- flow (pulmonary ----------: blood can’t get to area ↓perfusion)

Back 1175

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
a. Ventilation-Perfusion Mismatch--alteration in ratio of ventilation to perfusion (should have 4-5L/min blood to alveoli and 4/5L of gas into lungs 1:1)
iii. ↓blood flow (pulmonary embolism--blood can’t get to area ↓perfusion)

Front 1176

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
b. _________-blood exits heart w/o gas exchange (severe hypoxia extreme VQ mismatch)

Back 1176

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
b. Shunt-blood exits heart w/o gas exchange (severe hypoxia extreme VQ mismatch)

Front 1177

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
b. Shunt-blood exits heart w/o gas exchange (severe hypoxia extreme --------- mismatch)

Back 1177

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
b. Shunt-blood exits heart w/o gas exchange (severe hypoxia extreme VQ mismatch)

Front 1178

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
b. Shunt-blood exits heart w/o gas exchange (severe hypoxia extreme VQ mismatch)
i. ----------: bypasses lungs through ventricular septal defect (↓oxygenation)

Back 1178

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
b. Shunt-blood exits heart w/o gas exchange (severe hypoxia extreme VQ mismatch)
i. Anatomic--bypasses lungs through ventricular septal defect (↓oxygenation)

Front 1179

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
b. Shunt-blood exits heart w/o gas exchange (severe hypoxia extreme VQ mismatch)
ii. --------------: flow through pulmonary capillaries w/out gas exchange

Back 1179

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
b. Shunt-blood exits heart w/o gas exchange (severe hypoxia extreme VQ mismatch)
i. Anatomic--bypasses lungs through ventricular septal defect (↓oxygenation)

Front 1180

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
b. Shunt-blood exits heart w/o gas exchange (severe hypoxia extreme VQ mismatch)
i. Anatomic--bypasses lungs through ventricular septal defect (↓oxygenation)
• ARDS, ------------, pulmonary -----------

Back 1180

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
b. Shunt-blood exits heart w/o gas exchange (severe hypoxia extreme VQ mismatch)
i. Anatomic--bypasses lungs through ventricular septal defect (↓oxygenation)
• ARDS, pneumonia, pulmonary edema

Front 1181

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
c. ---------------: gas exchange across alveolar-capillary membrane is compromised by process that thickens/destroys membranes (not permeable)

Back 1181

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
c. Diffusion Impairment--gas exchange across alveolar-capillary membrane is compromised by process that thickens/destroys membranes (not permeable)

Front 1182

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
c. Diffusion Impairment--
i. Takes longer for ---------- to exchange
ii. Pts are ok when at rest, but have no --------- tolerance

Back 1182

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
c. Diffusion Impairment--
i. Takes longer for gas to exchange
ii. Pts are ok when at rest, but have no exercise tolerance

Front 1183

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
c. Diffusion Impairment--
iii. _________--thickening of membrane with fibrosis and scarring (main problem)

Back 1183

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
c. Diffusion Impairment--
iii. ARDS--thickening of membrane with fibrosis and scarring (main problem)

Front 1184

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
d. ----------------: generalized ↓ ventilation resulting in ↑PaCO2 and ↓PaO2 (not enough air into lungs)

Back 1184

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
d. Alveolar Hypoventilation--generalized ↓ ventilation resulting in ↑PaCO2 and ↓PaO2 (not enough air into lungs)

Front 1185

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
d. Alveolar Hypoventilation--generalized ↓ ventilation resulting in ↑-----------2 and ↓-----------2 (not enough air into lungs)

Back 1185

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
d. Alveolar Hypoventilation--generalized ↓ ventilation resulting in ↑PaCO2 and ↓PaO2 (not enough air into lungs)

Front 1186

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
d. Alveolar Hypoventilation--generalized ↓ ventilation resulting in ↑PaCO2 and ↓PaO2 (not enough air into lungs)
i. Can cause ---------

Back 1186

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
d. Alveolar Hypoventilation--generalized ↓ ventilation resulting in ↑PaCO2 and ↓PaO2 (not enough air into lungs)
i. Can cause hypoxia

Front 1187

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
d. Alveolar Hypoventilation--generalized ↓ ventilation resulting in ↑PaCO2 and ↓PaO2 (not enough air into lungs)
ii. Restrictive ------------ disease (asthma), chest wall ------------, neuromuscular disease (------------ brae)

Back 1187

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
1. Hypoxemic Respiratory Failure
d. Alveolar Hypoventilation--generalized ↓ ventilation resulting in ↑PaCO2 and ↓PaO2 (not enough air into lungs)
ii. Restrictive lung disease (asthma), chest wall dysfunction, neuromuscular disease (Gyron brae)

Front 1188

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
2. ---------------: CO2 transport alteration from ventilatory factor (good lungs, but air can’t get in/out hypercapnia main problem, but will have hypoxia too)

Back 1188

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
2. Hypercapnic Respiratory Failure--CO2 transport alteration from ventilatory factor (good lungs, but air can’t get in/out hypercapnia main problem, but will have hypoxia too)

Front 1189

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
2. Hypercapnic Respiratory Failure--CO2 transport alteration from ventilatory factor (good lungs, but air can’t get in/out, ---------- main problem, but will have ---------- too)

Back 1189

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
2. Hypercapnic Respiratory Failure--CO2 transport alteration from ventilatory factor (good lungs, but air can’t get in/out hypercapnia main problem, but will have hypoxia too)

Front 1190

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
2. Hypercapnic Respiratory Failure--
a. Abnormalities of the---------- and --------: CF, asthma, emphazema

Back 1190

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
2. Hypercapnic Respiratory Failure--
a. Abnormalities of the airways and alveoli--CF, asthma, emphazema

Front 1191

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
2. Hypercapnic Respiratory Failure--
b. Abnormalities of the ------: narcotic overdose, brain stem infarct

Back 1191

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
2. Hypercapnic Respiratory Failure--
b. Abnormalities of the CNS--narcotic overdose, brain stem infarct

Front 1192

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
2. Hypercapnic Respiratory Failure--
c. Abnormalities of the ---------: flail chest, morbidly obese, rib fractures

Back 1192

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
2. Hypercapnic Respiratory Failure--
c. Abnormalities of the chest wall--flail chest, morbidly obese, rib fractures

Front 1193

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
2. Hypercapnic Respiratory Failure--
d. Neuromuscular Conditions--MS, -------------, -----------

Back 1193

VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4)
2. Hypercapnic Respiratory Failure--
d. Neuromuscular Conditions--MS, muscular dystrophy, dyron-brae

Front 1194

VI. Acute Respiratory Failure
D. Tissue ------------ Needs--major threat of underlying resp. failure (------------ or -----------) is inability to meet oxygen demands of tissues

Back 1194

VI. Acute Respiratory Failure
D. Tissue Oxygen Needs--major threat of underlying resp. failure (hypoxic or hypercapnia) is inability to meet oxygen demands of tissues

Front 1195

VI. Acute Respiratory Failure
D. Tissue Oxygen Needs-
1. Inadequate tissue ------------ delivery--valvular disease, -------------, CHF (pump problem)

Back 1195

VI. Acute Respiratory Failure
D. Tissue Oxygen Needs-
1. Inadequate tissue O2 delivery--valvular disease, anemia, CHF (pump problem)

Front 1196

VI. Acute Respiratory Failure
D. Tissue Oxygen Needs-
2. Inadequate usage, ---------- shock (tissues don’t know what to do w/ it or not using appropriately)

Back 1196

VI. Acute Respiratory Failure
D. Tissue Oxygen Needs-
2. Inadequate usage-septic shock (tissues don’t know what to do w/ it or not using appropriately)

Front 1197

VI. Acute Respiratory Failure
E. Arterial Blood Gases (ABGs)
1. Normal
a. pH: 7.35-_______
b. PaO2: 80-_______mmHg

Back 1197

VI. Acute Respiratory Failure
E. Arterial Blood Gases (ABGs)
1. Normal
a. pH: 7.35-7.45
b. PaO2: 80-100mmHg

Front 1198

VI. Acute Respiratory Failure
E. Arterial Blood Gases (ABGs)
1. Normal
c. PaCO2: 35-______mmHg
d. SaO2: 95-______%

Back 1198

VI. Acute Respiratory Failure
E. Arterial Blood Gases (ABGs)
1. Normal
c. PaCO2: 35-45mmHg
d. SaO2: 95-100%

Front 1199

VI. Acute Respiratory Failure
E. Arterial Blood Gases (ABGs)
1. Normal
e. HCO3: 22-_______mEq/L
f. Base Excess/Deficit: +/______

Back 1199

VI. Acute Respiratory Failure
E. Arterial Blood Gases (ABGs)
1. Normal
e. HCO3: 22-26mEq/L
f. Base Excess/Deficit: +/-2

Front 1200

VI. Acute Respiratory Failure
E. Arterial Blood Gases (ABGs)
1. Normal
f. Base Excess/Deficit: +/-2
i. Amount of buffering ---------- in blood (from all buffer systems: --------- greatest)

Back 1200

VI. Acute Respiratory Failure
E. Arterial Blood Gases (ABGs)
1. Normal
f. Base Excess/Deficit: +/-2
i. Amount of buffering anions in blood (from all buffer systems-bicarb greatest)

Front 1201

VI. Acute Respiratory Failure
E. Arterial Blood Gases (ABGs)
1. Normal
f. Base Excess/Deficit: +/-2
ii. Describes amount of --------- needed to bring blood back to normal pH
iii. Excess--metabolic ------------ or compensation

Back 1201

VI. Acute Respiratory Failure
E. Arterial Blood Gases (ABGs)
1. Normal
f. Base Excess/Deficit: +/-2
ii. Describes amount of acid/base needed to bring blood back to normal pH
iii. Excess--metabolic alkalosis or compensation

Front 1202

VI. Acute Respiratory Failure
E. Arterial Blood Gases (ABGs)
2. Analysis
a. What is primary disturbance--acidosis/-----------?
b. What is primary cause--respiratory/----------?

Back 1202

VI. Acute Respiratory Failure
E. Arterial Blood Gases (ABGs)
2. Analysis
a. What is primary disturbance--acidosis/alkalosis?
b. What is primary cause--respiratory/metabolic?

Front 1203

VI. Acute Respiratory Failure
E. Arterial Blood Gases (ABGs)
2. Analysis
c. Is there -------------?

Back 1203

VI. Acute Respiratory Failure
E. Arterial Blood Gases (ABGs)
2. Analysis
c. Is there compensation?

Front 1204

VI. Acute Respiratory Failure
F. Respiratory Therapy
1. Oxygen therapy--goal PaO2 >--------- and SaO2 >----------

Back 1204

VI. Acute Respiratory Failure
F. Respiratory Therapy
1. Oxygen therapy--goal PaO2 >60 and SaO2 >90

Front 1205

VI. Acute Respiratory Failure
F. Respiratory Therapy
1. Oxygen therapy
a. Risk of oxygen ------------ (strive for oxygenation w/ minimum ---------2)

Back 1205

VI. Acute Respiratory Failure
F. Respiratory Therapy
1. Oxygen therapy
a. Risk of oxygen toxicity (strive for oxygenation w/ minimum FiO2)

Front 1206

VI. Acute Respiratory Failure
F. Respiratory Therapy
1. Oxygen therapy
b. ---------- mismatch may respond well to ↑O2 (2-4L via nasal cannula)

Back 1206

VI. Acute Respiratory Failure
F. Respiratory Therapy
1. Oxygen therapy
b. VQ mismatch may respond well to ↑O2 (2-4L via nasal cannula)

Front 1207

VI. Acute Respiratory Failure
F. Respiratory Therapy
1. Oxygen therapy
b. VQ mismatch may respond well to ↑O2 (2-_______L via nasal cannula)

Back 1207

VI. Acute Respiratory Failure
F. Respiratory Therapy
1. Oxygen therapy
b. VQ mismatch may respond well to ↑O2 (2-4L via nasal cannula)

Front 1208

VI. Acute Respiratory Failure
F. Respiratory Therapy
1. Oxygen therapy
c. Shunt will likely need--------- or -----------

Back 1208

VI. Acute Respiratory Failure
F. Respiratory Therapy
1. Oxygen therapy
c. Shunt will likely need facemask or intubation

Front 1209

VI. Acute Respiratory Failure
F. Respiratory Therapy
2. Mobilization of secretions
a. Coughing and positioning--good lung ----------, postural -----------

Back 1209

VI. Acute Respiratory Failure
F. Respiratory Therapy
2. Mobilization of secretions
a. Coughing and positioning--good lung down, postural drainage
b. Hydration and humidification--fluids help thin secretions out

Front 1210

VI. Acute Respiratory Failure
F. Respiratory Therapy
2. Mobilization of secretions
b. ------------ and ------------: fluids help thin secretions out

Back 1210

VI. Acute Respiratory Failure
F. Respiratory Therapy
2. Mobilization of secretions
b. Hydration and humidification--fluids help thin secretions out

Front 1211

VI. Acute Respiratory Failure
F. Respiratory Therapy
2. Mobilization of secretions
c. Chest ---------- therapy
d. Airway -----------

Back 1211

VI. Acute Respiratory Failure
F. Respiratory Therapy
2. Mobilization of secretions
c. Chest physical therapy
d. Airway suctioning

Front 1212

VI. Acute Respiratory Failure
F. Respiratory Therapy
3. -------------- ventilation

Back 1212

VI. Acute Respiratory Failure
F. Respiratory Therapy
3. Positive pressure ventilation

Front 1213

VI. Acute Respiratory Failure
G. Pharmacologic Therapy--Goals
1. Relief of bronchospasm: ------------ or -------- (severe)

Back 1213

VI. Acute Respiratory Failure
G. Pharmacologic Therapy--Goals
1. Relief of bronchospasm--Albuterol or Anophelin (severe)

Front 1214

VI. Acute Respiratory Failure
G. Pharmacologic Therapy--Goals
2. Airway inflammation reduction (-----------, asthma)--: ------------ (quick acting, IV if acute)

Back 1214

VI. Acute Respiratory Failure
G. Pharmacologic Therapy--Goals
2. Airway inflammation reduction (COPD, asthma)--Corticosteroids (quick acting, IV if acute)

Front 1215

VI. Acute Respiratory Failure
G. Pharmacologic Therapy--Goals
3. Reduction of pulmonary congestions--: ----------- (Lasix), ------------ (↑contractility for A-fib)

Back 1215

VI. Acute Respiratory Failure
G. Pharmacologic Therapy--Goals
3. Reduction of pulmonary congestions--diuretics (Lasix), Digoxin (↑contractility for A-fib)

Front 1216

VI. Acute Respiratory Failure
G. Pharmacologic Therapy--Goals
4. Treatment of pulmonary infection--IV -----------, frequent ----------- samples

Back 1216

VI. Acute Respiratory Failure
G. Pharmacologic Therapy--Goals
4. Treatment of pulmonary infection--IV antibiotics, frequent sputum samples

Front 1217

VI. Acute Respiratory Failure
G. Pharmacologic Therapy--Goals
5. Reduction of severe anxiety--↑--------- and ---------2 consumption (Propofol, Atavan, ----------)

Back 1217

VI. Acute Respiratory Failure
G. Pharmacologic Therapy--Goals
5. Reduction of severe anxiety--↑RR and O2 consumption (Propofol, Atavan, Versed)

Front 1218

VI. Acute Respiratory Failure
H. Supportive Care Interventions
1. Treat ----------- cause (need ---------- at cellular level)--primary goal

Back 1218

VI. Acute Respiratory Failure
H. Supportive Care Interventions
1. Treat underlying cause (need O2 at cellular level)--primary goal

Front 1219

VI. Acute Respiratory Failure
H. Supportive Care Interventions
2. Maintain adequate cardiac output--BP indicates cardiac function (check MAP >---------- and ---------2)

Back 1219

VI. Acute Respiratory Failure
H. Supportive Care Interventions
2. Maintain adequate cardiac output--BP indicates cardiac function (check MAP >60 and SVO2)

Front 1220

VI. Acute Respiratory Failure
H. Supportive Care Interventions
3. Maintain adequate----------- concentration (ex. if anemic give blood)

Back 1220

VI. Acute Respiratory Failure
H. Supportive Care Interventions
3. Maintain adequate hemoglobin concentration (ex. if anemic give blood)

Front 1221

VI. Acute Respiratory Failure
H. Supportive Care Interventions
4. Nutritional Therapy--avoid ↑------------ (metabolizes into CO2); --------------- (↑protein ↓CHO)

Back 1221

VI. Acute Respiratory Failure
H. Supportive Care Interventions
4. Nutritional Therapy--avoid ↑CHO (metabolizes into CO2); pulmonary diet (↑protein ↓CHO)

Front 1222

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--sudden and progressive form of ------------ where alveolar capillary membrane becomes ----------- and more permeable to ------------- fluid

Back 1222

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--sudden and progressive form of ARF where alveolar capillary membrane becomes damaged and more permeable to intravascular fluid

Front 1223

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
1. ARF can become---------- (----------% mortality)

Back 1223

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
1. ARF can become ARDs (40% mortality)

Front 1224

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
2. Etiology--predisposing factors stimulate inflammatory/immune response (cause unknown)
a. Aspiration of -------- contents
b. Viral/bacterial ---------

Back 1224

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
2. Etiology--predisposing factors stimulate inflammatory/immune response (cause unknown)
a. Aspiration of gastric contents
b. Viral/bacterial pneumonia

Front 1225

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
2. Etiology--predisposing factors stimulate inflammatory/immune response (cause unknown)
c.------------ (esp. gram (-) infection)--most common cause w/ greatest mortality (70-90%)

Back 1225

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
2. Etiology--predisposing factors stimulate inflammatory/immune response (cause unknown)
c. Sepsis (esp. gram (-) infection)--most common cause w/ greatest mortality (70-90%)

Front 1226

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
2. Etiology--predisposing factors stimulate inflammatory/immune response (cause unknown)
c. Sepsis (esp. gram (-) infection)--most common cause w/ greatest mortality (70-_____%)

Back 1226

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
2. Etiology--predisposing factors stimulate inflammatory/immune response (cause unknown)
c. Sepsis (esp. gram (-) infection)--most common cause w/ greatest mortality (70-90%)

Front 1227

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
2. Etiology--predisposing factors stimulate inflammatory/immune response (cause unknown)
d. Severe massive ----------
e. Multiple ---------- transfusions
f. ----------------- bypass

Back 1227

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
2. Etiology--predisposing factors stimulate inflammatory/immune response (cause unknown)
d. Severe massive trauma
e. Multiple blood transfusions
f. Cardiopulmonary bypass

Front 1228

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
2. Etiology--predisposing factors stimulate inflammatory/immune response (cause unknown)
g. Consequence of multiple ------------- dysfunction syndrome (MODS)

Back 1228

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
2. Etiology--predisposing factors stimulate inflammatory/immune response (cause unknown)
g. Consequence of multiple organ dysfunction syndrome (MODS)

Front 1229

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
3. Pathophysiology
a. Injury (Exudative Phase)--1-_______days after insult/injury (usually within ______hrs)

Back 1229

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
3. Pathophysiology
a. Injury (Exudative Phase)--1-7days after insult/injury (usually within 24hrs)

Front 1230

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
3. Pathophysiology
a. Injury (Exudative Phase)-
i. Injury inflammatory mediators ↑ cap ------------, interstitial edema, ----------- edema, ---------------- shunting (fluid filled alveoli exchange gas) V/Q mismatch ↓gas exchange refractory hypoxemia

Back 1230

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
3. Pathophysiology
a. Injury (Exudative Phase)-
i. Injury inflammatory mediators ↑ cap permeability interstitial edema alveolar edema intrapulmonary shunting (fluid filled alveoli exchange gas) V/Q mismatch ↓gas exchange refractory hypoxemia

Front 1231

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
3. Pathophysiology
a. Injury (Exudative Phase)-
i. Injury inflammatory mediators ↑ cap permeability interstitial edema alveolar edema intrapulmonary shunting (fluid filled alveoli exchange gas) ------------- mismatch, ↓----------- exchange, refractory ------------

Back 1231

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
3. Pathophysiology
a. Injury (Exudative Phase)-
i. Injury inflammatory mediators ↑ cap permeability interstitial edema alveolar edema intrapulmonary shunting (fluid filled alveoli exchange gas) V/Q mismatch ↓gas exchange refractory hypoxemia

Front 1232

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
3. Pathophysiology
a. Injury (Exudative Phase)-
ii. ------------- 1 2 (produce surfactant) cell damage, ↓------------, ↓----------- compliance and recall widespread atelectasis ↓lung compliance

Back 1232

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
3. Pathophysiology
a. Injury (Exudative Phase)-
ii. Alveolar 1 2 (produce surfactant) cell damage ↓surfactant ↓alveolar compliance and recall widespread atelectasis ↓lung compliance

Front 1233

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
3. Pathophysiology
a. Injury (Exudative Phase)-
ii. Alveolar 1 2 (produce surfactant) cell damage ↓surfactant ↓alveolar compliance and recall, widespread -------------, ↓lung ------------

Back 1233

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
3. Pathophysiology
a. Injury (Exudative Phase)-
ii. Alveolar 1 2 (produce surfactant) cell damage ↓surfactant ↓alveolar compliance and recall widespread atelectasis ↓lung compliance

Front 1234

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
3. Pathophysiology
a. Injury (Exudative Phase)-
iii. ----------- membrane lines alveoli fibrosis, ↓--------- exchange ↓ --------------- (stiff lung-need high pressure to get air into)

Back 1234

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
3. Pathophysiology
a. Injury (Exudative Phase)-
iii. Hyaline membrane lines alveoli fibrosis ↓gas exchange ↓ compliance (stiff lung-need high pressure to get air into)

Front 1235

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
3. Pathophysiology
b. ---------------(Proliferative Phase)--1-2weeks after initial injury

Back 1235

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
3. Pathophysiology
b. Reparative (Proliferative Phase)--1-2weeks after initial injury

Front 1236

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
3. Pathophysiology
b. Reparative (Proliferative Phase)--1-2weeks after initial injury
i. Inflammatory response dense, ---------- tissue ↑pulmonary ------------ resistance, pulmonary ------------, ↓lung compliance hypoxia

Back 1236

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
3. Pathophysiology
b. Reparative (Proliferative Phase)--1-2weeks after initial injury
i. Inflammatory response dense, fibrous tissue ↑pulmonary vascular resistance, pulmonary HTN, ↓lung compliance hypoxia

Front 1237

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
3. Pathophysiology
b. Reparative (Proliferative Phase)--1-2weeks after initial injury
ii. If phase ends ------------ resolve
iii. If phase persists widespread -----------

Back 1237

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
3. Pathophysiology
b. Reparative (Proliferative Phase)--1-2weeks after initial injury
ii. If phase ends lesions resolve
iii. If phase persists widespread fibrosis

Front 1238

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
3. Pathophysiology
c. ----------- (Chronic/Late Phase)--2-3 weeks after initial injury (irreversible changes)

Back 1238

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
3. Pathophysiology
c. Fibrotic (Chronic/Late Phase)--2-3 weeks after initial injury (irreversible changes)

Front 1239

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
3. Pathophysiology
c. Fibrotic (Chronic/Late Phase)--2-3 weeks after initial injury (irreversible changes)
i. Lung remodeled by sparsely ------------ and ------------ tissues (diffuse scarring and fibrosis) ↓lung compliance (stiff lung) and ↓ gas exchange surface area hypoxia and pulmonary HTN

Back 1239

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
3. Pathophysiology
c. Fibrotic (Chronic/Late Phase)--2-3 weeks after initial injury (irreversible changes)
i. Lung remodeled by sparsely collagenous and fibrous tissues (diffuse scarring and fibrosis) ↓lung compliance (stiff lung) and ↓ gas exchange surface area hypoxia and pulmonary HTN

Front 1240

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
3. Pathophysiology
c. Fibrotic (Chronic/Late Phase)--2-3 weeks after initial injury (irreversible changes)
i. Lung remodeled by sparsely collagenous and fibrous tissues (diffuse scarring and fibrosis) ↓---------- (stiff lung) and ↓ --------- exchange surface area hypoxia and pulmonary ---------

Back 1240

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
3. Pathophysiology
c. Fibrotic (Chronic/Late Phase)--2-3 weeks after initial injury (irreversible changes)
i. Lung remodeled by sparsely collagenous and fibrous tissues (diffuse scarring and fibrosis) ↓lung compliance (stiff lung) and ↓ gas exchange surface area hypoxia and pulmonary HTN

Front 1241

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
3. Pathophysiology
c. Fibrotic (Chronic/Late Phase)--2-3 weeks after initial injury (irreversible changes)
ii. Survival rate poor and will need long term------------- ventilation

Back 1241

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
3. Pathophysiology
c. Fibrotic (Chronic/Late Phase)--2-3 weeks after initial injury (irreversible changes)
ii. Survival rate poor and will need long term mechanical ventilation

Front 1242

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
4. Clinical Manifestations
a. ↑---------- (work of breathing), tachypnea
b. T-----------

Back 1242

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
4. Clinical Manifestations
a. ↑WOB (work of breathing), tachypnea
b. Tachycardia

Front 1243

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
4. Clinical Manifestations
c. ----------, pallor, ------------
d. ↓----------

Back 1243

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
4. Clinical Manifestations
c. Cyanosis, pallor, diaphoresis
d. ↓Mentation

Front 1244

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
4. Clinical Manifestations
e. Diffuse ----------- and rhonchi
f. CXR--“------------”

Back 1244

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
4. Clinical Manifestations
e. Diffuse crackles and rhonchi
f. CXR--“white out”

Front 1245

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
4. Clinical Manifestations
g. ABGs--resp -------------- (initially) decompensates to combined met and resp ------------

Back 1245

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
4. Clinical Manifestations
g. ABGs--resp alkalosis (initially) decompensates to combined met and resp acidosis

Front 1246

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
4. Clinical Manifestations
h. Elevated---------- with normal ---------: --key finding

Back 1246

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
4. Clinical Manifestations
h. Elevated PAP with normal PAWP--key finding

Front 1247

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
4. Clinical Manifestations
h. Elevated PAP with normal PAWP--key finding
i. Can’t ----------- w/ ↑------------ b/c could be something else (heart prob fluid overload)

Back 1247

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
4. Clinical Manifestations
h. Elevated PAP with normal PAWP--key finding
i. Can’t Dx w/ ↑PAWP b/c could be something else (heart prob fluid overload)

Front 1248

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
4. Clinical Manifestations
h. Elevated PAP with normal PAWP--key finding
ii. If fluid overloaded ↑-------------- (backing up of fluids causing too much preload) give diuretics, ---------2 improves not ARDS

Back 1248

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
4. Clinical Manifestations
h. Elevated PAP with normal PAWP--key finding
i. Can’t Dx w/ ↑PAWP b/c could be something else (heart prob fluid overload)

Front 1249

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
5. Diagnosis Criteria
a. --------------: --do not respond to ↑FiO2

Back 1249

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
5. Diagnosis Criteria
a. Refractory hypoxia--do not respond to ↑FiO2

Front 1250

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
5. Diagnosis Criteria
b. CXR with new bilateral -----------/--------------- infiltrates (“white out”)

Back 1250

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
5. Diagnosis Criteria
b. CXR with new bilateral interstitial/alveolar infiltrates (“white out”)

Front 1251

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
5. Diagnosis Criteria
c. PAWP of --------------mmHg or less and no evidence of heart failure
d. Must have predisposing condition for ARDS within -----------hrs (need trigger)

Back 1251

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
5. Diagnosis Criteria
c. PAWP of 18mmHg or less and no evidence of heart failure
d. Must have predisposing condition for ARDS within 48hrs (need trigger)

Front 1252

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
6. Treatment
a. Prevention of further ----------
b. Maintain adequate -----------: --mechanical ventilation (5-6mL/kg w/ lowest FiO2)

Back 1252

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
6. Treatment
a. Prevention of further injury
b. Maintain adequate oxygenation--mechanical ventilation (5-6mL/kg w/ lowest FiO2)

Front 1253

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
6. Treatment
b. Maintain adequate oxygenation--mechanical ventilation (5-_________mL/kg w/ lowest ______2)

Back 1253

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
6. Treatment
b. Maintain adequate oxygenation--mechanical ventilation (5-6mL/kg w/ lowest FiO2)

Front 1254

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
6. Treatment
b. Maintain adequate oxygenation-
i.-------------- Ventilatory--high frequency (100-_________breath/min)

Back 1254

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
6. Treatment
b. Maintain adequate oxygenation-
i. Jet Ventilatory--high frequency (100-300breath/min)

Front 1255

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
6. Treatment
b. Maintain adequate oxygenation-
ii.---------------- ratio--sedate and paralyze
iii. --------------- strategies

Back 1255

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
6. Treatment
b. Maintain adequate oxygenation-
ii. Inverse ratio--sedate and paralyze
iii. Positioning strategies

Front 1256

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
6. Treatment
c. Optimize oxygen delivery--keep PaO2 >----------- and SaO2 >-----------

Back 1256

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
6. Treatment
c. Optimize oxygen delivery--keep PaO2 >60 and SaO2 >90

Front 1257

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
7. Management
a. Mechanical -----------
b. -------------- strategies

Back 1257

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
7. Management
a. Mechanical ventilation
b. Positioning strategies

Front 1258

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
7. Management
b. Positioning strategies
i. Lateral ------------
ii. ------------ position (-----------)--lungs down

Back 1258

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
7. Management
b. Positioning strategies
i. Lateral decubitus
ii. Prone position (proning)--lungs down

Front 1259

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
7. Management
b. Positioning strategies
ii. Prone position (proning)--lungs down
• ↓----------------, improves perfusion and ventilation, reduces lung constriction

Back 1259

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
7. Management
b. Positioning strategies
ii. Prone position (proning)--lungs down
• ↓atelectasis, improves perfusion and ventilation, reduces lung constriction

Front 1260

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
7. Management
c. Drug Therapy--no good drug
i. _________--antifungal
ii. ________--controversial
iii. ________ oxide--dilate pulmonary vasculature

Back 1260

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
7. Management
c. Drug Therapy--no good drug
i. Ketoconadol--antifungal
ii. Steroids--controversial
iii. Nitrous oxide--dilate pulmonary vasculature

Front 1261

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
8. Complications
a. Noscomial ---------
b. --------: --can cause and also lead to
c. Pulmonary -------

Back 1261

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
8. Complications
a. Noscomial pneumonia
b. Sepsis--can cause and also lead to
c. Pulmonary emboli

Front 1262

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
8. Complications
d. Pulmonary ---------
f. Stress ------------ and hemorrhage
g. Acute --------- failure

Back 1262

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
8. Complications
d. Pulmonary fibrosis
f. Stress ulceration and hemorrhage
g. Acute renal failure

Front 1263

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
8. Complications
h. A----------
i. Decreased -------

Back 1263

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
8. Complications
h. Arrhythmias
i. Decreased CO

Front 1264

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
8. Complications
j. DIC (disseminated------------ coagulation-often in sepsis)/T--------------

Back 1264

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
8. Complications
j. DIC (disseminated intravascular coagulation-often in sepsis)/Thrombocytopenia

Front 1265

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
8. Complications
k. MODS (multiple ------------ dysfunction syndrome)

Back 1265

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
8. Complications
k. MODS (multiple organ dysfunction syndrome)

Front 1266

Burns
I. Skin’s Function--all care for burns in reflective of skin’s purpose (largest body organ)
A. Protection (impairment leads to ------------)

Back 1266

Burns
I. Skin’s Function--all care for burns in reflective of skin’s purpose (largest body organ)
A. Protection (impairment leads to infection)

Front 1267

Burns
I. Skin’s Function--all care for burns in reflective of skin’s purpose (largest body organ)
B. Temperature Regulation (impairment leads to inability to maintain ------------)

Back 1267

Burns
I. Skin’s Function--all care for burns in reflective of skin’s purpose (largest body organ)
B. Temperature Regulation (impairment leads to inability to maintain body temp)

Front 1268

Burns
I. Skin’s Function--all care for burns in reflective of skin’s purpose (largest body organ)
C. Keep body fluids in (impairment leads to inability to maintain ---------)

Back 1268

Burns
I. Skin’s Function--all care for burns in reflective of skin’s purpose (largest body organ)
C. Keep body fluids in (impairment leads to inability to maintain fluid balance)

Front 1269

Burns
II. Types--most injuries take place at ---------- (need prevention); highest fatalities in ----------- and elderly

Back 1269

Burns
II. Types--most injuries take place at home (need prevention); highest fatalities in children and elderly

Front 1270

Burns
II. Types--
A. Thermal--flame, -------------, ------------, steam, and contact with ----------- objects (most common)
1. Major causes of fire in home--smoking, cooking, space heaters, and chemicals

Back 1270

Burns
II. Types--
A. Thermal--flame, flash/explosion, scald, steam, and contact with hot objects (most common)
1. Major causes of fire in home--smoking, cooking, space heaters, and chemicals

Front 1271

Burns
II. Types--
A. Thermal--flame, flash/explosion, scald, steam, and contact with hot objects (most common)
1. Major causes of fire in home--smoking, -------------, ---------------, and chemicals

Back 1271

Burns
II. Types--
A. Thermal--flame, flash/explosion, scald, steam, and contact with hot objects (most common)
1. Major causes of fire in home--smoking, cooking, space heaters, and chemicals

Front 1272

Burns
II. Types--
B. Chemical--result of ------------ injury and destruction from ------------- substances (most commonly acids)

Back 1272

Burns
II. Types--
B. Chemical--result of tissue injury and destruction from necrotizing substances (most commonly acids)

Front 1273

Burns
II. Types--
B. Chemical--result of tissue injury and destruction from necrotizing substances (most commonly acids)
1. Causative agents: things with -----------, paint removers, drain cleaners (acids and ------------)

Back 1273

Burns
II. Types--
B. Chemical--result of tissue injury and destruction from necrotizing substances (most commonly acids)
1. Causative agents: things with lye, paint removers, drain cleaners (acids and alkaloids)

Front 1274

Burns
II. Types--
B. Chemical--result of tissue injury and destruction from necrotizing substances (most commonly acids)
2. Can cause respiratory problems and ----------- manifestations (usually smaller extent)

Back 1274

Burns
II. Types--
B. Chemical--result of tissue injury and destruction from necrotizing substances (most commonly acids)
2. Can cause respiratory problems and systemic manifestations (usually smaller extent)

Front 1275

Burns
II. Types--
B. Chemical--result of tissue injury and destruction from necrotizing substances (most commonly acids)
3. Looks ----------- pink and slightly wet (can continuously burn for -----------hrs after chemicals removed)

Back 1275

Burns
II. Types--
B. Chemical--result of tissue injury and destruction from necrotizing substances (most commonly acids)
3. Looks cherry pink and slightly wet (can continuously burn for 72hrs after chemicals removed)

Front 1276

Burns
II. Types--
B. Chemical--result of tissue injury and destruction from necrotizing substances (most commonly acids)
4. Tissue damage based on concentration, --------------, time on skin, and extent of ------------

Back 1276

Burns
II. Types--
B. Chemical--result of tissue injury and destruction from necrotizing substances (most commonly acids)
4. Tissue damage based on concentration, quantity, time on skin, and extent of penetration

Front 1277

Burns
II. Types--
B. Chemical--result of tissue injury and destruction from necrotizing substances (most commonly acids)
5. Treatment
a. Remove ------------ of burn (brush off powder or remove clothing/jewelry, etc.)
b. Wash for ---------min with--------- water or until not complaining of pain
c. Wrap area in sterile dressing

Back 1277

Burns
II. Types--
B. Chemical--result of tissue injury and destruction from necrotizing substances (most commonly acids)
5. Treatment
a. Remove cause of burn (brush off powder or remove clothing/jewelry, etc.)
b. Wash for min 20min with cold water or until not complaining of pain
c. Wrap area in sterile dressing

Front 1278

Burns
II. Types--
B. Chemical--result of tissue injury and destruction from necrotizing substances (most commonly acids)
5. Treatment
c. Wrap area in ---------- dressing

Back 1278

Burns
II. Types--
B. Chemical--result of tissue injury and destruction from necrotizing substances (most commonly acids)
5. Treatment
c. Wrap area in sterile dressing

Front 1279

Burns
II. Types--
C. Smoke and Inhalation
1. Types
a. Inhalation injury ↑ ---------- (inhale hot air/steam/smoke ------------- obstruction)

Back 1279

Burns
II. Types--
C. Smoke and Inhalation
1. Types
a. Inhalation injury ↑ glottis (inhale hot air/steam/smokeedemaairway obstruction)

Front 1280

Burns
II. Types--
C. Smoke and Inhalation
1. Types
b. Inhalation injury ↓---------- (inhale hot air , ------------ swelling can’t exchange gases)

Back 1280

Burns
II. Types--
C. Smoke and Inhalation
1. Types
b. Inhalation injury ↓ glottis (inhale hot airalveolar swellingcan’t exchange gases)

Front 1281

Burns
II. Types--
C. Smoke and Inhalation
1. Types
b. Inhalation injury ↓ glottis (inhale hot airalveolar swellingcan’t exchange gases)
i. Chemically produced (depends on -------------- exposed)

Back 1281

Burns
II. Types--
C. Smoke and Inhalation
1. Types
b. Inhalation injury ↓ glottis (inhale hot airalveolar swellingcan’t exchange gases)
i. Chemically produced (depends on amount of time exposed)

Front 1282

Burns
II. Types--
C. Smoke and Inhalation
1. Types
b. Inhalation injury ↓ glottis (inhale hot airalveolar swellingcan’t exchange gases)
ii. Symptoms usually present ____-______hrs after and can cause ARDS

Back 1282

Burns
II. Types--
C. Smoke and Inhalation
1. Types
b. Inhalation injury ↓ glottis (inhale hot airalveolar swellingcan’t exchange gases)
ii. Symptoms usually present 12-24hrs after and can cause ARDS

Front 1283

Burns
II. Types--
C. Smoke and Inhalation
1. Types
b. Inhalation injury ↓ glottis (inhale hot airalveolar swellingcan’t exchange gases)
iii. Check for coughing up soot, diff -----------, forced voice, singed ------------, facial burns, and fume---------- (if fire was in enclosed space)

Back 1283

Burns
II. Types--
C. Smoke and Inhalation
1. Types
b. Inhalation injury ↓ glottis (inhale hot airalveolar swellingcan’t exchange gases)
iii. Check for coughing up soot, diff swallowing, forced voice, singed nose hairs, facial burns, and fume inhalation (if fire was in enclosed space)

Front 1284

Burns
II. Types--
C. Smoke and Inhalation
1. Types
c. CO Poisoning--CO displaces -------- on Hg w/ ---------x affinity hypoxia death

Back 1284

Burns
II. Types--
C. Smoke and Inhalation
1. Types
c. CO Poisoning--CO displaces O2 on Hg w/ 250x affinity hypoxia death

Front 1285

Burns
II. Types--
C. Smoke and Inhalation
1. Types
c. CO Poisoning--CO displaces O2 on ------- w/ 250x affinity ----------- death

Back 1285

Burns
II. Types--
C. Smoke and Inhalation
1. Types
c. CO Poisoning--CO displaces O2 on Hg w/ 250x affinity hypoxia death

Front 1286

Burns
II. Types--
C. Smoke and Inhalation
1. Types
c. CO Poisoning--CO displaces O2 on Hg w/ 250x affinity hypoxia death
i. Manifestations: HA, N/V, -----------, confusion, ----------- damage, ---------

Back 1286

Burns
II. Types--
C. Smoke and Inhalation
1. Types
c. CO Poisoning--CO displaces O2 on Hg w/ 250x affinity hypoxia death
i. Manifestations: HA, N/V, fatigue, confusion, brain damage, death

Front 1287

Burns
II. Types--
C. Smoke and Inhalation
1. Types
c. CO Poisoning--CO displaces O2 on Hg w/ 250x affinity hypoxia death
ii. Fatigue lay down to sleep, -------- in sleep

Back 1287

Burns
II. Types--
C. Smoke and Inhalation
1. Types
c. CO Poisoning--CO displaces O2 on Hg w/ 250x affinity hypoxia death
i. Manifestations: HA, N/V, fatigue, confusion, brain damage, death

Front 1288

Burns
II. Types--
C. Smoke and Inhalation
1. Types
c. CO Poisoning--CO displaces O2 on Hg w/ 250x affinity hypoxia death
iii. Caused by inappropriate burnings of wood, ----------, grilling -----------, etc.

Back 1288

Burns
II. Types--
C. Smoke and Inhalation
1. Types
c. CO Poisoning--CO displaces O2 on Hg w/ 250x affinity hypoxia death
iii. Caused by inappropriate burnings of wood, kerosene, grilling inside, etc.

Front 1289

Burns
II. Types--
C. Smoke and Inhalation
1. Types
c. CO Poisoning--CO displaces O2 on Hg w/ 250x affinity hypoxia death
iv. Treatment--100% ---------- w/ NR mask in high --------- (may need to intubate)

Back 1289

Burns
II. Types--
C. Smoke and Inhalation
1. Types
c. CO Poisoning--CO displaces O2 on Hg w/ 250x affinity hypoxia death
iv. Treatment--100% O2 w/ NR mask in high fowlers (may need to intubate)

Front 1290

Burns
II. Types--
C. Smoke and Inhalation
1. Types
c. CO Poisoning--CO displaces O2 on Hg w/ 250x affinity hypoxia death
iv. Treatment--100% O2 w/ ---------- mask in high fowlers (may need to -----------)

Back 1290

Burns
II. Types--
C. Smoke and Inhalation
1. Types
c. CO Poisoning--CO displaces O2 on Hg w/ 250x affinity hypoxia death
iv. Treatment--100% O2 w/ NR mask in high fowlers (may need to intubate)

Front 1291

Burns
II. Types--
C. Smoke and Inhalation
2. Treatment
a. Administration of ----------- air

Back 1291

Burns
II. Types--
C. Smoke and Inhalation
2. Treatment
a. Administration of humidified air

Front 1292

Burns
II. Types--
C. Smoke and Inhalation
2. Treatment
b. Position in high -----------

Back 1292

Burns
II. Types--
C. Smoke and Inhalation
2. Treatment
b. Position in high fowler’s

Front 1293

Burns
II. Types--
C. Smoke and Inhalation
2. Treatment
c. Cough and -------- breath q----------hr

Back 1293

Burns
II. Types--
C. Smoke and Inhalation
2. Treatment
c. Cough and deep breath q1hr

Front 1294

Burns
II. Types--
C. Smoke and Inhalation
2. Treatment
d. Use of --------------

Back 1294

Burns
II. Types--
C. Smoke and Inhalation
2. Treatment
d. Use of bronchodilators

Front 1295

Burns
II. Types--
C. Smoke and Inhalation
2. Treatment
e. Suction --------

Back 1295

Burns
II. Types--
C. Smoke and Inhalation
2. Treatment
e. Suction prn

Front 1296

Burns
II. Types--
C. Smoke and Inhalation
2. Treatment
f. Continuous ------------- of resp. status/prep for ----------- (swelling is greatest danger)

Back 1296

Burns
II. Types--
C. Smoke and Inhalation
2. Treatment
f. Continuous monitoring of resp. status/prep for intubation (swelling is greatest danger)

Front 1297

Burns
II. Types--
C. Smoke and Inhalation
2. Treatment
g. Indications for immediate intubation
i. Full thickness burns to ----------
ii. Circumferential---------- burns
iii. Acute ---------- distress

Back 1297

Burns
II. Types--
C. Smoke and Inhalation
2. Treatment
g. Indications for immediate intubation
i. Full thickness burns to face
ii. Circumferential neck burns
iii. Acute respiratory distress

Front 1298

Burns
II. Types--
C. Smoke and Inhalation
2. Treatment
g. Indications for immediate intubation
iv. Respiratory ------------- or altered mental status
v. --------------- edema and inflammation noted on bronchoscopy

Back 1298

Burns
II. Types--
C. Smoke and Inhalation
2. Treatment
g. Indications for immediate intubation
iv. Respiratory depression or altered mental status
v. Supraglottic edema and inflammation noted on bronchoscopy

Front 1299

Burns
II. Types--
D. Electrical--coagulation ---------- caused by intense heat from electrical current (less common, ____-9%)

Back 1299

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)

Front 1300

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
1. Severity--burn will not look that bad (most destruction is within ---------)

Back 1300

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
1. Severity--burn will not look that bad (most destruction is within body)

Front 1301

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
1. Severity--burn will not look that bad (most destruction is within body)
a. Amount of voltage
i. <------------V (low)--energy can’t enter body unless opening exists (not hospitalized)

Back 1301

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
1. Severity--burn will not look that bad (most destruction is within body)
a. Amount of voltage
i. <1000V (low)--energy can’t enter body unless opening exists (not hospitalized)

Front 1302

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
1. Severity--burn will not look that bad (most destruction is within body)
a. Amount of voltage
i. <1000V (low)--energy can’t enter body unless ------------ exists (not hospitalized)

Back 1302

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
1. Severity--burn will not look that bad (most destruction is within body)
a. Amount of voltage
i. <1000V (low)--energy can’t enter body unless opening exists (not hospitalized)

Front 1303

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
1. Severity--burn will not look that bad (most destruction is within body)
a. Amount of voltage
ii. >------------V (high)--entry exit wound (damp/sweaty areas-hands, feet, axillaries)

Back 1303

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
1. Severity--burn will not look that bad (most destruction is within body)
a. Amount of voltage
ii. >1000V (high)--entry exit wound (-------------- areas-hands, feet, axillaries)

Front 1304

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
1. Severity--burn will not look that bad (most destruction is within body
b. Tissue resistance--fat and ----------- more resistant (most damage done to ----------- vessels)

Back 1304

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
1. Severity--burn will not look that bad (most destruction is within body
b. Tissue resistance--fat and bone more resistant (most damage done to nerves vessels)

Front 1305

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
1. Severity--burn will not look that bad (most destruction is within body
c. Current pathways--goes through---------- resistant path (were ----------- organs in the way?)

Back 1305

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
1. Severity--burn will not look that bad (most destruction is within body
c. Current pathways--goes through least resistant path (were vital organs in the way?)

Front 1306

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
1. Severity--burn will not look that bad (most destruction is within body
c. Current pathways--goes through least resistant path (were vital organs in the way?)
i. Hand to hand goes through ------------ (burns across hands --------x great for arrhythmias)

Back 1306

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
1. Severity--burn will not look that bad (most destruction is within body
c. Current pathways--goes through least resistant path (were vital organs in the way?)
i. Hand to hand goes through heart (burns across hands 3x great for arrhythmias)

Front 1307

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
1. Severity--burn will not look that bad (most destruction is within body
d. ------------- area in contact with current--look at skin carefully

Back 1307

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
1. Severity--burn will not look that bad (most destruction is within body
d. Surface area in contact with current--look at skin carefully

Front 1308

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
1. Severity--burn will not look that bad (most destruction is within body
e. -------------- current flow was sustained

Back 1308

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
1. Severity--burn will not look that bad (most destruction is within body
e. Length of time current flow was sustained

Front 1309

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
2. Complications--can occur during and after burn
a. Risk for cardiac arrest/arrhythmias (massive --------------cardiac standstill/----------)

Back 1309

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
2. Complications--can occur during and after burn
a. Risk for cardiac arrest/arrhythmias (massive depolarization-cardiac standstill/asystole)

Front 1310

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
2. Complications--can occur during and after burn
b. Acid-base imbalance--metabolic ----------- as cells rupture

Back 1310

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
2. Complications--can occur during and after burn
b. Acid-base imbalance--metabolic acidosis as cells rupture

Front 1311

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
2. Complications--can occur during and after burn
c. Kidney failure--massive -------------

Back 1311

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
2. Complications--can occur during and after burn
c. Kidney failure--massive myoglobinuria

Front 1312

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
2. Complications--can occur during and after burn
i. Big proteins from ------------- tissues block renal ----------, renal failure

Back 1312

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
2. Complications--can occur during and after burn
i. Big proteins from damaged tissues block renal tubules renal failure

Front 1313

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
2. Complications--can occur during and after burn
d. Injury to CNS--coma, ----------, epilepsy, -----------------, spinal injury (falls)

Back 1313

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
2. Complications--can occur during and after burn
d. Injury to CNS--coma, aphasia, epilepsy, peripheral neuropathy, spinal injury (falls)

Front 1314

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
2. Complications--can occur during and after burn
d. Injury to CNS--________, aphasia, _________, peripheral neuropathy, _______ injury (falls)

Back 1314

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
2. Complications--can occur during and after burn
d. Injury to CNS--coma, aphasia, epilepsy, peripheral neuropathy, spinal injury (falls)

Front 1315

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
2. Complications--can occur during and after burn
e. ------------- injury--muscle spasms due to current causing bones to break, trauma

Back 1315

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
2. Complications--can occur during and after burn
e. Musculoskeletal injury--muscle spasms due to current causing bones to break, trauma

Front 1316

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
2. Complications--can occur during and after burn
f. ----------- shock

Back 1316

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
2. Complications--can occur during and after burn
f. Hypovolemic shock

Front 1317

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
3. Treatment--LR with urine output at _____-______mL/hr (all electrical burns go to burn ________)

Back 1317

Burns
II. Types--
D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%)
3. Treatment--LR with urine output at 75-100mL/hr (all electrical burns go to burn center)

Front 1318

Burns
II. Types--
E. Cold Thermal--frostbite
1. Pathophysiology--ice crystals in --------- and cells ↓-------- flow and destry cell membrane

Back 1318

Burns
II. Types--
E. Cold Thermal--frostbite
1. Pathophysiology--ice crystals in tissue and cells ↓blood flow and destry cell membrane

Front 1319

Burns
II. Types--
E. Cold Thermal--frostbite
2. Depth--result of ----------- temperature, length of-----------, and type/condition of clothing

Back 1319

Burns
II. Types--
E. Cold Thermal--frostbite
2. Depth--result of ambient temperature, length of exposure, and type/condition of clothing

Front 1320

Burns
II. Types--
E. Cold Thermal--frostbite
2. Depth--result of ambient temperature, length of exposure, and type/condition of clothing
a. Superficial--skin, ---------- tissue (ears, cheeks, ---------, toes)

Back 1320

Burns
II. Types--
E. Cold Thermal--frostbite
2. Depth--result of ambient temperature, length of exposure, and type/condition of clothing
a. Superficial--skin, SQ tissue (ears, cheeks, fingers, toes)

Front 1321

Burns
II. Types--
E. Cold Thermal--frostbite
2. Depth--result of ambient temperature, length of exposure, and type/condition of clothing
a. Superficial--skin, SQ tissue (ears, cheeks, fingers, toes)
i. Treatment--immerse in bath water at ______-______° blisters will form after

Back 1321

Burns
II. Types--
E. Cold Thermal--frostbite
2. Depth--result of ambient temperature, length of exposure, and type/condition of clothing
a. Superficial--skin, SQ tissue (ears, cheeks, fingers, toes)
i. Treatment--immerse in bath water at 102-108° blisters will form after

Front 1322

Burns
II. Types--
E. Cold Thermal--frostbite
2. Depth--result of ambient temperature, length of exposure, and type/condition of clothing
ii. Re-warming is very painful (pain can continue for-------- to --------- after injury)

Back 1322

Burns
II. Types--
E. Cold Thermal--frostbite
2. Depth--result of ambient temperature, length of exposure, and type/condition of clothing
ii. Re-warming is very painful (pain can continue for weeks to years after injury)

Front 1323

Burns
II. Types--
E. Cold Thermal--frostbite
2. Depth--result of ambient temperature, length of exposure, and type/condition of clothing
b. Deep--muscles, ---------, tendons (skin mottled ---------)

Back 1323

Burns
II. Types--
E. Cold Thermal--frostbite
2. Depth--result of ambient temperature, length of exposure, and type/condition of clothing
b. Deep--muscles, bones, tendons (skin mottled gangrene)

Front 1324

Burns
II. Types--
E. Cold Thermal--frostbite
2. Depth--result of ambient temperature, length of exposure, and type/condition of clothing
b. Deep--muscles, bones, tendons (skin mottled gangrene)
i. Treatment--usually requires -------------

Back 1324

Burns
II. Types--
E. Cold Thermal--frostbite
2. Depth--result of ambient temperature, length of exposure, and type/condition of clothing
b. Deep--muscles, bones, tendons (skin mottled gangrene)
i. Treatment--usually requires amputation

Front 1325

Burns
III. Severity
A. Depth--know ----------- of skin

Back 1325

Burns
III. Severity
A. Depth--know layers of skin

Front 1326

Burns
III. Severity
A. Depth--know layers of skin
1. Superficial --------- Thickness (1st degree)

Back 1326

Burns
III. Severity
A. Depth--know layers of skin
1. Superficial Partial Thickness (1st degree)

Front 1327

Burns
III. Severity
A. Depth--know layers of skin
1. Superficial Partial Thickness (1st degree)
a. Involves mainly ------------- and uppermost part of dermis

Back 1327

Burns
III. Severity
A. Depth--know layers of skin
1. Superficial Partial Thickness (1st degree)
a. Involves mainly epidermis and uppermost part of dermis

Front 1328

Burns
III. Severity
A. Depth--know layers of skin
1. Superficial Partial Thickness (1st degree)
b. Manifestations--redness, --------, blanches under pressure, mild swelling w/ ------------

Back 1328

Burns
III. Severity
A. Depth--know layers of skin
1. Superficial Partial Thickness (1st degree)
b. Manifestations--redness, --------, blanches under pressure, mild swelling w/ ------------

Front 1329

Burns
III. Severity
A. Depth--know layers of skin
1. Superficial Partial Thickness (1st degree)
c. Heals in about-------- days (may peel after ---------hrs)

Back 1329

Burns
III. Severity
A. Depth--know layers of skin
1. Superficial Partial Thickness (1st degree)
c. Heals in about 7 days (may peel after 24hrs)

Front 1330

Burns
III. Severity
A. Depth--know layers of skin
2. --------- Partial Thickness (2nd degree)

Back 1330

Burns
III. Severity
A. Depth--know layers of skin
2. Deep Partial Thickness (2nd degree)

Front 1331

Burns
III. Severity
A. Depth--know layers of skin
2. Deep Partial Thickness (2nd degree)
a. Damage through epidermis into ------------

Back 1331

Burns
III. Severity
A. Depth--know layers of skin
2. Deep Partial Thickness (2nd degree)
a. Damage through epidermis into dermis

Front 1332

Burns
III. Severity
A. Depth--know layers of skin
2. Deep Partial Thickness (2nd degree)
b. Manifestations--salmon pink/cherry red w/ red, shiny/wet --------------, blanches under pressure,------------, mild-moderate ---------

Back 1332

Burns
III. Severity
A. Depth--know layers of skin
2. Deep Partial Thickness (2nd degree)
b. Manifestations--salmon pink/cherry red w/ red, shiny/wet fluid-filled vesicles, blanches under pressure, severe pain, mild-moderate edema

Front 1333

Burns
III. Severity
A. Depth--know layers of skin
2. Deep Partial Thickness (2nd degree)
b. Manifestations--salmon pink/------------, shiny/wet fluid-filled vesicles, ---------- under pressure, severe pain, mild-moderate edema

Back 1333

Burns
III. Severity
A. Depth--know layers of skin
2. Deep Partial Thickness (2nd degree)
b. Manifestations--salmon pink/cherry red w/ red, shiny/wet fluid-filled vesicles, blanches under pressure, severe pain, mild-moderate edema

Front 1334

Burns
III. Severity
A. Depth--know layers of skin
2. Deep Partial Thickness (2nd degree)
c. Heals in ____-______days

Back 1334

Burns
III. Severity
A. Depth--know layers of skin
2. Deep Partial Thickness (2nd degree)
c. Heals in 7-21days

Front 1335

Burns
III. Severity
A. Depth--know layers of skin
3. --------- Thickness (3rd degree)

Back 1335

Burns
III. Severity
A. Depth--know layers of skin
3. Full Thickness (3rd degree)

Front 1336

Burns
III. Severity
A. Depth--know layers of skin
3. Full Thickness (3rd degree)
a. Destruction of epidermis -------------- (can be into fat, muscle, and bone)

Back 1336

Burns
III. Severity
A. Depth--know layers of skin
3. Full Thickness (3rd degree)
a. Destruction of epidermis through dermis (can be into fat, muscle, and bone)

Front 1337

Burns
III. Severity
A. Depth--know layers of skin
3. Full Thickness (3rd degree)
c. Manifestations--dry, ----------, ------------, charred black, insensitive to -----------

Back 1337

Burns
III. Severity
A. Depth--know layers of skin
3. Full Thickness (3rd degree)
c. Manifestations--dry, leathery, waxy white, charred black, insensitive to pain/pressure

Front 1338

Burns
III. Severity
A. Depth--know layers of skin
3. Full Thickness (3rd degree)
d. Will require skin ---------

Back 1338

Burns
III. Severity
A. Depth--know layers of skin
3. Full Thickness (3rd degree)
d. Will require skin grafting

Front 1339

Burns
III. Severity
B. Extent--need to know in order to calculate needed fluid replacement
1. Rule of ---------(faster)

Back 1339

Burns
III. Severity
B. Extent--need to know in order to calculate needed fluid replacement
1. Rule of 9s (faster)

Front 1340

Burns
III. Severity
B. Extent--need to know in order to calculate needed fluid replacement
1. Rule of 9s (faster)
a. Head/neck--_____%
b. Arms--_____%
c. Anterior trunk--_____%

Back 1340

Burns
III. Severity
B. Extent--need to know in order to calculate needed fluid replacement
1. Rule of 9s (faster)
a. Head/neck--9%
b. Arms--9%
c. Anterior trunk--18%

Front 1341

Burns
III. Severity
B. Extent--need to know in order to calculate needed fluid replacement
1. Rule of 9s (faster)
d. Posterior trunk--______%
e. Legs--____%
f. Perineum--_____%

Back 1341

Burns
III. Severity
B. Extent--need to know in order to calculate needed fluid replacement
1. Rule of 9s (faster)
d. Posterior trunk--18%
e. Legs--18%
f. Perineum--1%

Front 1342

Burns
III. Severity
B. Extent--need to know in order to calculate needed fluid replacement
2. --------------- Chart (more detailed and more accurate)
**Cut off age--need to be >6yrs

Back 1342

Burns
III. Severity
B. Extent--need to know in order to calculate needed fluid replacement
2. Lund-Browder Chart (more detailed and more accurate)
**Cut off age--need to be >6yrs

Front 1343

Burns
III. Severity
B. Extent--need to know in order to calculate needed fluid replacement
2. Lund-Browder Chart (more detailed and more accurate)
**Cut off age--need to be >______yrs

Back 1343

Burns
III. Severity
B. Extent--need to know in order to calculate needed fluid replacement
2. Lund-Browder Chart (more detailed and more accurate)
**Cut off age--need to be >6yrs

Front 1344

Burns
III. Severity
C. Location
1. Face,------------, and circumferential chest--severe b/ increase possibility of --------- compromise

Back 1344

Burns
III. Severity
C. Location
1. Face, neck, and circumferential chest--severe b/ increase possibility of resp. compromise

Front 1345

Burns
III. Severity
C. Location
2. Hands, feet, ---------, eyes, and -------: difficult to treat (high movement ↑ ----------)

Back 1345

Burns
III. Severity
C. Location
2. Hands, feet, joints, eyes, and perineum--difficult to treat (high movement ↑ complications)

Front 1346

Burns
III. Severity
C. Location
3. Ears, nose--susceptible to infection b/c -------------- to cartilage

Back 1346

Burns
III. Severity
C. Location
3. Ears, nose--susceptible to infection b/c poor blood supply to cartilage

Front 1347

Burns
III. Severity
C. Location
4. Circumferential extremities--risk of ------------- syndrome (↓blood supply to distal region)

Back 1347

Burns
III. Severity
C. Location
4. Circumferential extremities--risk of compartment syndrome (↓blood supply to distal region)

Front 1348

Burns
III. Severity
D. Patient Risk Factors
1. Age--<_______yrs (not full development of immune system) and >_______yrs

Back 1348

Burns
III. Severity
D. Patient Risk Factors
1. Age--<2yrs (not full development of immune system) and >60yrs

Front 1349

Burns
III. Severity
D. Patient Risk Factors
2. Pre-existing cardiovascular, -----------, or --------- disease--can be worsened

Back 1349

Burns
III. Severity
D. Patient Risk Factors
2. Pre-existing cardiovascular, respiratory, or renal disease--can be worsened

Front 1350

Burns
III. Severity
D. Patient Risk Factors
3. ------------ or PVD--↓healing and ↑infection

Back 1350

Burns
III. Severity
D. Patient Risk Factors
3. Diabetes or PVD--↓healing and ↑infection

Front 1351

Burns
III. Severity
D. Patient Risk Factors
4. Debilitating states--chronic ---------, history of ---------, malnutrition

Back 1351

Burns
III. Severity
D. Patient Risk Factors
4. Debilitating states--chronic disease, history of ETOH, malnutrition

Front 1352

Burns
III. Severity
D. Patient Risk Factors
5. Concurrent injuries--often ------------- injuries (need to know circumstances of injury)

Back 1352

Burns
III. Severity
D. Patient Risk Factors
5. Concurrent injuries--often traumatic injuries (need to know circumstances of injury)

Front 1353

Burns
IV. Burn Center Referral Criteria (check book)
A. Partial thickness burns >_________% of total body surface area (TBSA)
B. All ------------- burns
C. Electrical and ---------- burns

Back 1353

Burns
IV. Burn Center Referral Criteria (check book)
A. Partial thickness burns >10% of total body surface area (TBSA)
B. All full thickness burns
C. Electrical and chemical burns

Front 1354

Burns
IV. Burn Center Referral Criteria (check book)
D. --------------- injury
E. All burns involving injury to --------, eyes, face, ---------, feet, -----------, and joints

Back 1354

Burns
IV. Burn Center Referral Criteria (check book)
D. Inhalation injury
E. All burns involving injury to ears, eyes, face, hands, feet, perineum, and joints

Front 1355

Burns
V. Treatment
A. ------------- process--mostly prehospital

Back 1355

Burns
V. Treatment
A. Stop burning process--mostly prehospital

Front 1356

Burns
V. Treatment
A. Stop burning process--mostly prehospital
1. Removal of ---------- and jewelry (especially w/ --------- burns)

Back 1356

Burns
V. Treatment
A. Stop burning process--mostly prehospital
1. Removal of clothing and jewelry (especially w/ chemical burns)
2. Cut around areas where clothing is stuck to skin

Front 1357

Burns
V. Treatment
A. Stop burning process--mostly prehospital
2. Cut around areas where clothing is -------- to skin

Back 1357

Burns
V. Treatment
A. Stop burning process--mostly prehospital
2. Cut around areas where clothing is stuck to skin

Front 1358

Burns
V. Treatment
A. Stop burning process--mostly prehospital
3. Brush -------------- off skin followed by lavage w/ water for at least -------min (for chemical)

Back 1358

Burns
V. Treatment
A. Stop burning process--mostly prehospital
3. Brush solid particles off skin followed by lavage w/ water for at least 20min (for chemical)

Front 1359

Burns
V. Treatment
A. Stop burning process--mostly prehospital
4. Cover and ---------- dressing or clean sheet to prevent -------- loss (for thermal)

Back 1359

Burns
V. Treatment
A. Stop burning process--mostly prehospital
4. Cover and dry dressing or clean sheet to prevent heat loss (for thermal)

Front 1360

Burns
V. Treatment
B. Assess ABCs--burns to airway can cause swelling that blocks flow of air into lungs
1. A--keep ---------- patent

Back 1360

Burns
V. Treatment
B. Assess ABCs--burns to airway can cause swelling that blocks flow of air into lungs
1. A--keep airway patent

Front 1361

Burns
V. Treatment
B. Assess ABCs--burns to airway can cause swelling that blocks flow of air into lungs
2. B--assess ------- and -------

Back 1361

Burns
V. Treatment
B. Assess ABCs--burns to airway can cause swelling that blocks flow of air into lungs
2. B--assess RR and O2Sat

Front 1362

Burns
V. Treatment
B. Assess ABCs--burns to airway can cause swelling that blocks flow of air into lungs
3. C--assess --------- and look for ------------ burns

Back 1362

Burns
V. Treatment
B. Assess ABCs--burns to airway can cause swelling that blocks flow of air into lungs
3. C--assess pulses and look for circumferential burns

Front 1363

Burns
V. Treatment
C. Assess for __________--circumstances of injury

Back 1363

Burns
V. Treatment
C. Assess for other injuries--circumstances of injury

Front 1364

Burns
V. Treatment
C. Assess for other injuries--circumstances of injury
1. -------------- burns--concurrent w/ spinal injuries due to falls

Back 1364

Burns
V. Treatment
C. Assess for other injuries--circumstances of injury
1. High voltage burns--concurrent w/ spinal injuries due to falls

Front 1365

Burns
VI. Phases
A. --------------- Phase--period of time required to resolve immediate problems (usually 24-48hrs)

Back 1365

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)

Front 1366

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
1. ------------------- formation and continues until mobilization and diuresis begins

Back 1366

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
1. Initial fluid loss and edema formation and continues until mobilization and diuresis begins

Front 1367

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >____%)

Back 1367

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)

Front 1368

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
a. ---------- and ------------ shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days)

Back 1368

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
a. Fluid and electrolyte shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days)

Front 1369

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
a. Fluid and electrolyte shifts (------------- greatest risk)--leads to formation of edema (as early as -------min and can last 7-10days)

Back 1369

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
a. Fluid and electrolyte shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days)

Front 1370

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
a. Fluid and electrolyte shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days)
i. Larger burns ↑---------- shift (↑----------- volume loss insensible skin loss)

Back 1370

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
a. Fluid and electrolyte shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days)
i. Larger burns ↑fluid shift (↑intravascular volume loss insensible skin loss)

Front 1371

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
a. Fluid and electrolyte shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days)
ii. ____________--Na moves into the interstitial spaces

Back 1371

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
a. Fluid and electrolyte shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days)
ii. Hyponatremia--Na moves into the interstitial spaces

Front 1372

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
a. Fluid and electrolyte shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days)
iii. ----------------: released from injured cells and hemolysed RBCs vasculature

Back 1372

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
a. Fluid and electrolyte shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days)
iii. Hyperkalemia-released from injured cells and hemolysed RBCs vasculature

Front 1373

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
a. Fluid and electrolyte shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days)
iv. ---------------- (↑Hct)--blood is more viscous

Back 1373

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
a. Fluid and electrolyte shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days)
iv. Hemoconcentration (↑Hct)--blood is more viscous

Front 1374

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
a. Fluid and electrolyte shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days)
v. -------------- (↓albumin)--↑permeability fluid from intravascular to interstitial space ↓colloidal vascular pressure 2nd and 3rd spacing

Back 1374

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
a. Fluid and electrolyte shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days)
v. Hypotproteinemia (↓albumin)--↑permeability fluid from intravascular to interstitial space ↓colloidal vascular pressure 2nd and 3rd spacing

Front 1375

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
a. Fluid and electrolyte shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days)
v. Hypotproteinemia (↓-------------)--↑permeability fluid from ------------- to interstitial space ↓---------- vascular pressure 2nd and 3rd spacing

Back 1375

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
a. Fluid and electrolyte shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days)
v. Hypotproteinemia (↓albumin)--↑permeability fluid from intravascular to interstitial space ↓colloidal vascular pressure 2nd and 3rd spacing

Front 1376

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
a. Fluid and electrolyte shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days)
vi. At end of stage--restored ------------ (still creates problems)

Back 1376

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
a. Fluid and electrolyte shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days)
vi. At end of stage--restored capillary permeability (still creates problems)

Front 1377

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
• Proteins can’t return to -------------

Back 1377

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
• Proteins can’t return to vascular space

Front 1378

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
• ----------- can move back into vascular space

Back 1378

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
• Fluids can move back into vascular space

Front 1379

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
• Assess for ↓------- (as --------- moves back into cell and pt. diureses hypokalemia)

Back 1379

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
• Assess for ↓K (as K moves back into cell and pt. diureses hypokalemia)

Front 1380

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
• Assess for ↓K (as K moves back into cell and pt. diureses hypokalemia)
b. Immunologic--widespread impairment causing susceptibility to ---------

Back 1380

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
• Assess for ↓K (as K moves back into cell and pt. diureses hypokalemia)
b. Immunologic--widespread impairment causing susceptibility to infection

Front 1381

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
b. Immunologic--widespread impairment causing susceptibility to infection
i. ↑Release------------ ---------------- markers ↑permeability (severe w/ >---------%)

Back 1381

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
b. Immunologic--widespread impairment causing susceptibility to infection
i. ↑Release cytokines inflammatory markers ↑permeability (severe w/ >30%)

Front 1382

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
b. Immunologic--widespread impairment causing susceptibility to infection
ii. ------------ suppression and ↓circulating WBCs

Back 1382

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
b. Immunologic--widespread impairment causing susceptibility to infection
ii. Bone marrow suppression and ↓circulating WBCs

Front 1383

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
c. Cardiovascular--volume depletion ↑-------------- ↑SVR ↓---------

Back 1383

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
c. Cardiovascular--volume depletion ↑cardiac workload ↑SVR ↓CO

Front 1384

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
c. Cardiovascular--volume depletion ↑cardiac workload ↑SVR ↓CO
i. Release of tumor necrosis factor --------------- depression (↓contractility)

Back 1384

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
c. Cardiovascular--volume depletion ↑cardiac workload ↑SVR ↓CO
i. Release of tumor necrosis factor myocardial depression (↓contractility)

Front 1385

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
c. Cardiovascular--volume depletion ↑cardiac workload ↑SVR ↓CO
ii. ↓BP ↓-----------

Back 1385

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
c. Cardiovascular--volume depletion ↑cardiac workload ↑SVR ↓CO
ii. ↓BP ↓organ perfusion

Front 1386

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
d. Respiratory--_____________; ARDS (__________ is a risk factor)

Back 1386

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
d. Respiratory--brochoconstriction; ARDS (trauma is a risk factor)

Front 1387

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
e. Metabolic--basic metabolic rate ↑-------x need ↑------------ (aggressive w/ caloric intake)

Back 1387

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
e. Metabolic--basic metabolic rate ↑3x need ↑nutrition (aggressive w/ caloric intake)

Front 1388

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
3. Clinical Manifestations
a. -------------- shock--↓BP, ↑HR

Back 1388

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
3. Clinical Manifestations
a. Hypovolemic shock--↓BP, ↑HR

Front 1389

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
3. Clinical Manifestations
b. ____________--fluid overload need fluids b/c all fluid is not where it needs to be

Back 1389

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
3. Clinical Manifestations
b. Edematous--fluid overload need fluids b/c all fluid is not where it needs to be

Front 1390

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
3. Clinical Manifestations
c. Pain--__________ and ___________ burns

Back 1390

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
3. Clinical Manifestations
c. Pain--superficial and partial thickness burns

Front 1391

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
3. Clinical Manifestations
d. Shivering--heat loss (can lead to -----------) ↑---------- requirements

Back 1391

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
3. Clinical Manifestations
d. Shivering--heat loss (can lead to hypothermia) ↑energy requirements

Front 1392

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
3. Clinical Manifestations
e. ______________-- massive trauma response and occurs from K shifts (must assess gut)

Back 1392

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
3. Clinical Manifestations
e. Adynamic ilius-- massive trauma response and occurs from K shifts (must assess gut)

Front 1393

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
a. Cardiovascular
i._____________--electrolyte shifts (especially electrical burns through heart)

Back 1393

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
a. Cardiovascular
i. Dysrhythmias--electrolyte shifts (especially electrical burns through heart)

Front 1394

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
a. Cardiovascular
ii. ______________ shock--can become irreversible shock end organ failure

Back 1394

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
a. Cardiovascular
ii. Hypovolemic shock--can become irreversible shock end organ failure

Front 1395

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
a. Cardiovascular
iii. Impaired --------------- circulation--especially w/ circumferential burns (compartment syndrome need escoratomy-burns or fashiotomy-nonburns)

Back 1395

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
a. Cardiovascular
iii. Impaired peripheral circulation--especially w/ circumferential burns (compartment syndrome need escoratomy-burns or fashiotomy-nonburns)

Front 1396

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
a. Cardiovascular
iii. Impaired peripheral circulation--especially w/ circumferential burns (compartment syndrome need --------------- or --------------)

Back 1396

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
a. Cardiovascular
iii. Impaired peripheral circulation--especially w/ circumferential burns (compartment syndrome need escoratomy-burns or fashiotomy-nonburns)

Front 1397

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
b. Respiratory (can occur ---------- days after initial injury)--inflammatory ------------ release

Back 1397

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
b. Respiratory (can occur 2 days after initial injury)--inflammatory marker release

Front 1398

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
b. Respiratory (can occur 2 days after initial injury)--inflammatory marker release
i. Upper respiratory tract injury--___________ airway

Back 1398

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
b. Respiratory (can occur 2 days after initial injury)--inflammatory marker release
i. Upper respiratory tract injury--swelling/blocking airway

Front 1399

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
• Pneumonia risk
ii. Inhalation injury--___________ and ↓______ diffusion

Back 1399

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
• Pneumonia risk
ii. Inhalation injury--interstitial edema and ↓gas diffusion

Front 1400

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
• Inflammatory marker release ↑--------------- permeability, ↑------------, ↑PVR, and ↑-------------- constriction

Back 1400

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
• Inflammatory marker release ↑capillary permeability, ↑SVR, ↑PVR, and ↑peripheral constriction

Front 1401

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
c. Urinary--Acute -------------- Necrosis (most common complication in this phase)

Back 1401

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
c. Urinary--Acute Tubular Necrosis (most common complication in this phase)

Front 1402

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
c. Urinary--Acute Tubular Necrosis (most common complication in this phase)
i. Can result from --------------- shock

Back 1402

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
c. Urinary--Acute Tubular Necrosis (most common complication in this phase)
i. Can result from hypovolemic shock

Front 1403

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
c. Urinary--Acute Tubular Necrosis (most common complication in this phase)
ii. Electrical burns ↑------------- and ------------- release block renal tubules

Back 1403

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
c. Urinary--Acute Tubular Necrosis (most common complication in this phase)
ii. Electrical burns ↑Myoglobin and hemoglobin release block renal tubules

Front 1404

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
c. Urinary--Acute Tubular Necrosis (most common complication in this phase)
iii. Treatment--__________ and diuretics, flush ___________ out

Back 1404

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
c. Urinary--Acute Tubular Necrosis (most common complication in this phase)
iii. Treatment--fluids and diuretics flush myoglobin out

Front 1405

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
a. Airway Management
i. Assessment of ---------- and ------------

Back 1405

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
a. Airway Management
i. Assessment of ventilation and oxygenation

Front 1406

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
a. Airway Management
ii. Early ------------ and ventilatory management within 1-______hrs (ABGs)

Back 1406

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
a. Airway Management
ii. Early intubation and ventilatory management within 1-2hrs (ABGs)

Front 1407

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
a. Airway Management
iii. B__________

Back 1407

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
a. Airway Management
iii. Bronchoscopy

Front 1408

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
a. Airway Management
iv. Inhalation injury: humidified ----------% O2, ↑-----------, CDB, chest PT, -------------

Back 1408

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
a. Airway Management
iv. Inhalation injury: humidified 100% O2, ↑Fowlers, CDB, chest PT, suction

Front 1409

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
a. Airway Management
v. CO poisoning: ------------% O2

Back 1409

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
a. Airway Management
v. CO poisoning: ------------% O2 100% O2

Front 1410

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
b. Fluid therapy
i. Establish IV access--2 ------------- IVs and maybe central line

Back 1410

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
b. Fluid therapy
i. Establish IV access--2 large bore IVs and maybe central line

Front 1411

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
b. Fluid therapy
ii. Consider therapy for burns >------------% TBSA

Back 1411

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
b. Fluid therapy
ii. Consider therapy for burns >15% TBSA

Front 1412

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
b. Fluid therapy
iii. 1st -----------hrs colloids generally not given (leak out w/ ↑------------- cost more)

Back 1412

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
b. Fluid therapy
iii. 1st 12hrs colloids generally not given (leak out w/ ↑permeability cost more)

Front 1413

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
• Usually give ---------- instead

Back 1413

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
• Usually give LR instead

Front 1414

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
• b. Fluid therapy
iv. --------------- Formula: 4mL/kg/%TBSA = total fluid replacement in 24hrs

Back 1414

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
• b. Fluid therapy
iv. Parkland Burn Formula: 4mL/kg/%TBSA = total fluid replacement in 24hrs

Front 1415

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
• b. Fluid therapy
iv. Parkland Burn Formula: ---------mL/kg/%TBSA = total ---------- replacement in 24hrs

Back 1415

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
• b. Fluid therapy
iv. Parkland Burn Formula: 4mL/kg/%TBSA = total fluid replacement in 24hrs

Front 1416

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
• b. Fluid therapy
• ½ given in first -----------hrs from time of burn

Back 1416

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
• b. Fluid therapy
• ½ given in first 8hrs from time of burn

Front 1417

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
• b. Fluid therapy
• ½ given over next -----------hrs

Back 1417

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
• b. Fluid therapy
• ½ given over next 16hrs

Front 1418

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
• b. Fluid therapy
v. Monitory response to ------------ therapy

Back 1418

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
• b. Fluid therapy
v. Monitory response to fluid therapy

Front 1419

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
• b. Fluid therapy
• Urine output should be ______-50mL/hr (if electrical _____-100mL/hr)

Back 1419

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
• b. Fluid therapy
• Urine output should be 30-50mL/hr (if electrical 75-100mL/hr)

Front 1420

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
• b. Fluid therapy
• BP >____
• HR <_____

Back 1420

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
• b. Fluid therapy
• BP >90
• HR <120

Front 1421

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after --------- and IV ------- replacement (low priority) PAINFUL

Back 1421

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL

Front 1422

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL
i. Cleaning and debridement--remove -------- ------------skin (should not see blood)

Back 1422

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL
i. Cleaning and debridement--remove escar necrotic skin (should not see blood)

Front 1423

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL
ii. Hydrotherapy--immersed in ------------/NA water bath or showered no longer than ______-30min/day to flush off loose necrotic skin

Back 1423

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL
ii. Hydrotherapy--immersed in isotonic/NA water bath or showered no longer than 20-30min/day to flush off loose necrotic skin

Front 1424

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL
• Can cause --------------- (not sterile water)

Back 1424

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL
• Can cause cross contamination (not sterile water)

Front 1425

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL
• May cause too much ------------ shift (pulls Na out)
• For chemical burns flush w/ water no hotter than -----------°

Back 1425

• May cause too much electrolyte shift (pulls Na out)
• For chemical burns flush w/ water no hotter than 104°

Front 1426

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL
iii. Open Method--exposing and ------------ wound w/ thin layer of topical -----------

Back 1426

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL
iii. Open Method--exposing and covering wound w/ thin layer of topical antibiotic

Front 1427

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL
iv. Closed Method--multiple dressing changes q-----------hrs (acticote can stay ---------- days)

Back 1427

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL
iv. Closed Method--multiple dressing changes q8hrs (acticote can stay 3 days)

Front 1428

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL
v. Prevention of ____________--primary goal (some__________ from pts own flora)

Back 1428

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL
v. Prevention of infection--primary goal (some infections from pts own flora)

Front 1429

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL
• Always gowned,-------------, and masked (strict visitor handwashing/gowning)
• Remove dirty bandages ------------ sterile gloves, but put on ---------- sterile gloves

Back 1429

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL
• Always gowned, gloved, and masked (strict visitor handwashing/gowning)
• Remove dirty bandages w/out sterile gloves, but put on w/ sterile gloves

Front 1430

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL
• Clean ------------ infected wounds first (clean to dirty)
• Antibiotics (------------, NaNO3, ---------------)--topical penetrates; can develop resistance (requires changing antibiotics)

Back 1430

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL
• Clean less infected wounds first (clean to dirty)
• Antibiotics (Silvidine, NaNO3, Sulfamyoline)--topical penetrates; can develop resistance (requires changing antibiotics)

Front 1431

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL
vi. Adequate pain control--IV -------------- before dressing changes (oral meds difficult w/ slow gut)

Back 1431

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL
vi. Adequate pain control--IV morphine before dressing changes (oral meds difficult w/ slow gut)

Front 1432

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL
vii. Avoid hypothermia--room >-------------° and wound changes under ------------

Back 1432

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL
vii. Avoid hypothermia--room >85° and wound changes under heat lamp

Front 1433

Burns
VI. Phases
B. Acute Phase--occurs until wound is ------------ or completely covered by ------------- (weeks to months)

Back 1433

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)

Front 1434

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
1. Pathophysiology--extracellular ------------ mobilization into ---------------- space pt diureses begins

Back 1434

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
1. Pathophysiology--extracellular fluid mobilization into intravascular space pt diureses begins

Front 1435

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
1. Pathophysiology--extracellular fluid mobilization into intravascular space pt diureses begins
a. ---------------- (necrotic tissue) separates and begins to slough off formation of -------------- tissue (for partial thickness buns)

Back 1435

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
1. Pathophysiology--extracellular fluid mobilization into intravascular space pt diureses begins
a. Escar (necrotic tissue) separates and begins to slough off formation of granulation tissue (for partial thickness buns)

Front 1436

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
1. Pathophysiology--extracellular fluid mobilization into intravascular space pt diureses begins
b. Full thickness burns must be covered by ----------
c. Return of ----------- sounds

Back 1436

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
1. Pathophysiology--extracellular fluid mobilization into intravascular space pt diureses begins
b. Full thickness burns must be covered by skin grafts
c. Return of bowel sounds

Front 1437

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
a. Alterations in Electrolytes--potential for all sorts of shifting (know -------- and -------- values)

Back 1437

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
a. Alterations in Electrolytes--potential for all sorts of shifting (know K and Na values)

Front 1438

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
a. Alterations in Electrolytes--potential for all sorts of shifting (know K and Na values)
i. Hyponatremia--excess-------------, ---------- suctioning, diarrhea, excess ----------- replacement, excess dieresis

Back 1438

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
a. Alterations in Electrolytes--potential for all sorts of shifting (know K and Na values)
i. Hyponatremia--excess hydrotherapy, NG suctioning, diarrhea, excess fluid replacement, excess dieresis

Front 1439

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
a. Alterations in Electrolytes--potential for all sorts of shifting (know K and Na values)
• Muscle cramps, fatigue, weakness, HA, ------------ (think O2, --------, or ↑---------)

Back 1439

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
a. Alterations in Electrolytes--potential for all sorts of shifting (know K and Na values)
• Muscle cramps, fatigue, weakness, HA, confusion (think O2, Na, or ↑HR)

Front 1440

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
a. Alterations in Electrolytes--potential for all sorts of shifting (know K and Na values)
ii. Hypernatremia--too much--------------- solution or not enough ----------- (dehydrated)

Back 1440

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
a. Alterations in Electrolytes--potential for all sorts of shifting (know K and Na values)
ii. Hypernatremia--too much hypertonic solution or not enough fluid (dehydrated)

Front 1441

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
a. Alterations in Electrolytes--potential for all sorts of shifting (know K and Na values)
• Thirsty, dried --------------, -------------, seizures

Back 1441

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
a. Alterations in Electrolytes--potential for all sorts of shifting (know K and Na values)
• Thirsty, dried furrowed tongue, confusion, seizures

Front 1442

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
a. Alterations in Electrolytes--potential for all sorts of shifting (know K and Na values)
iii. Hyperkalemia--Tissue -------------- (electrical burns ATN -------------- can’t filter out K)
• Dysrhythmias, muscle weakness

Back 1442

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
a. Alterations in Electrolytes--potential for all sorts of shifting (know K and Na values)
iii. Hyperkalemia--Tissue destruction (electrical burns ATN kidney damage can’t filter out K)
• Dysrhythmias, muscle weakness

Front 1443

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
a. Alterations in Electrolytes--potential for all sorts of shifting (know K and Na values)
iii. Hyperkalemia--Tissue destruction (electrical burns ATN kidney damage can’t filter out ----------)
• ------------, muscle weakness

Back 1443

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
a. Alterations in Electrolytes--potential for all sorts of shifting (know K and Na values)
iii. Hyperkalemia--Tissue destruction (electrical burns ATN kidney damage can’t filter out K)
• Dysrhythmias, muscle weakness

Front 1444

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
a. Alterations in Electrolytes--potential for all sorts of shifting (know K and Na values)
iv. Hypokalemia--excess hydrotherapy, -------------, ------------ suction, wound -----------
• Dysrhythmias

Back 1444

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
a. Alterations in Electrolytes--potential for all sorts of shifting (know K and Na values)
iv. Hypokalemia--excess hydrotherapy, vomiting, GI suction, wound drainage
• Dysrhythmias

Front 1445

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
b. Infections--often gram (-) -------------- (leading death cause in hospitalized burn pts)

Back 1445

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
b. Infections--often gram (-) pseudomonas (leading death cause in hospitalized burn pts)

Front 1446

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
b. Infections--often gram (-) pseudomonas (leading death cause in hospitalized burn pts)
i. Risk factors: >---------% full thickness burns, children, ------------, preexisting disease

Back 1446

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
b. Infections--often gram (-) pseudomonas (leading death cause in hospitalized burn pts)
i. Risk factors: >30% full thickness burns, children, elderly, preexisting disease

Front 1447

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
b. Infections--often gram (-) pseudomonas (leading death cause in hospitalized burn pts)
ii. ↑---------, ↑HR, ↑---------, ↓BP, ↓--------- output, mild confusion, ---------, ↓appetite, WBCs 10-20,000 (pt becomes immunosuppressed) can spread to blood (sepsis)

Back 1447

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
b. Infections--often gram (-) pseudomonas (leading death cause in hospitalized burn pts)
ii. ↑temp, ↑HR, ↑RR, ↓BP, ↓urine output, mild confusion, chills, ↓appetite, WBCs 10-20,000 (pt becomes immunosuppressed) can spread to blood (sepsis)

Front 1448

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
b. Infections--often gram (-) pseudomonas (leading death cause in hospitalized burn pts)
ii. ↑temp, ↑----------, ↑RR, ↓BP, ↓urine output, ----------- confusion, chills, ↓-------------, WBCs 10-20,000 (pt becomes immunosuppressed) can spread to blood (-----------)

Back 1448

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
b. Infections--often gram (-) pseudomonas (leading death cause in hospitalized burn pts)
ii. ↑temp, ↑HR, ↑RR, ↓BP, ↓urine output, mild confusion, chills, ↓appetite, WBCs 10-20,000 (pt becomes immunosuppressed) can spread to blood (sepsis)

Front 1449

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
b. Infections--often gram (-) pseudomonas (leading death cause in hospitalized burn pts)
ii. ↑temp, ↑HR, ↑RR, ↓BP, ↓urine output, mild confusion, chills, ↓appetite, WBCs 10-_________ (pt becomes immunosuppressed) can spread to blood (sepsis)

Back 1449

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
b. Infections--often gram (-) pseudomonas (leading death cause in hospitalized burn pts)
ii. ↑temp, ↑HR, ↑RR, ↓BP, ↓urine output, mild confusion, chills, ↓appetite, WBCs 10-20,000 (pt becomes immunosuppressed) can spread to blood (sepsis)

Front 1450

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
b. Infections--often gram (-) pseudomonas (leading death cause in hospitalized burn pts)
iii. Burn can worsen--2nd degree can convert to ----------- degree

Back 1450

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
b. Infections--often gram (-) pseudomonas (leading death cause in hospitalized burn pts)
iii. Burn can worsen--2nd degree can convert to 3rd degree

Front 1451

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
b. Infections--often gram (-) pseudomonas (leading death cause in hospitalized burn pts)
iv. Treatment--remove -------------- tissue early and wound ------------ as soon as possible

Back 1451

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
b. Infections--often gram (-) pseudomonas (leading death cause in hospitalized burn pts)
iv. Treatment--remove necrotic tissue early and wound closure as soon as possible

Front 1452

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
b. Infections--often gram (-) pseudomonas (leading death cause in hospitalized burn pts)
iv. Treatment--remove necrotic tissue early and wound closure as soon as possible
• IV antibiotics not given unless pt is truly ------------- (can create resistance)
• ------------ everything if sepsis is suspected

Back 1452

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
b. Infections--often gram (-) pseudomonas (leading death cause in hospitalized burn pts)
iv. Treatment--remove necrotic tissue early and wound closure as soon as possible
• IV antibiotics not given unless pt is truly septic (can create resistance)
• Culture everything if sepsis is suspected

Front 1453

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
c. Neurologic--extreme disorientation
i. ---------------- if no underlying cause of confusion (---------------’s Syndrome)

Back 1453

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
c. Neurologic--extreme disorientation
i. ICU psychosis if no underlying cause of confusion (Sundowner’s Syndrome)

Front 1454

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
d. Musculoskeletal--prevention of --------------- (frequent ----------, make pt/family aware)

Back 1454

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
d. Musculoskeletal--prevention of contractions (frequent ROB, make pt/family aware)

Front 1455

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
e. G__________
i. IV antibiotics and -------------- can cause diarrhea

Back 1455

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
e. Gastrointestinal
i. IV antibiotics and tube feedings can cause diarrhea

Front 1456

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
e. Gastrointestinal
ii. Too much ----------- + ------------ ↓motility constipation

Back 1456

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
e. Gastrointestinal
ii. Too much narcotics + bed rest ↓motility constipation

Front 1457

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
e. Gastrointestinal
iii. High risk for _________--↓blood flow to ________ track (_________’s ulcer-burn specific)

Back 1457

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
e. Gastrointestinal
iii. High risk for ulcers--↓blood flow to GI track (Curling’s ulcer-burn specific)

Front 1458

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
e. Gastrointestinal
• Tx w/ ___________, -__________-blocker (Zantac, etc.)

Back 1458

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
e. Gastrointestinal
• Tx w/ antacid, H2-blocker (Zantac, etc.)

Front 1459

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
f. ___________--risk for ↑blood sugar (check frequently-often need ________ coverage)

Back 1459

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
f. Endocrine--risk for ↑blood sugar (check frequently-often need insulin coverage)

Front 1460

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
3. Skin Grafting
a. Biological Dressings--temp wound closure prevents ------------- -------------- protects ------------- tissue until autogafting is possible (will be rejected due to diff DNA)

Back 1460

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
3. Skin Grafting
a. Biological Dressings--temp wound closure prevents infection fluid loss protects granulation tissue until autogafting is possible (will be rejected due to diff DNA)

Front 1461

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
3. Skin Grafting
a. Biological Dressings--temp wound closure prevents infection fluid loss protects granulation tissue until autogafting is possible (will be rejected due to diff DNA)
• Used until ----------------- established (48hrs) and up to several weeks

Back 1461

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
3. Skin Grafting
a. Biological Dressings--temp wound closure prevents infection fluid loss protects granulation tissue until autogafting is possible (will be rejected due to diff DNA)
• Used until revascularization established (48hrs) and up to several weeks

Front 1462

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
3. Skin Grafting
a. Biological Dressings--temp wound closure prevents infection fluid loss protects granulation tissue until autogafting is possible (will be rejected due to diff DNA)
i. Homografts (--------------)--skin from --------- (skin bank-fresh or frozen)

Back 1462

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
3. Skin Grafting
a. Biological Dressings--temp wound closure prevents infection fluid loss protects granulation tissue until autogafting is possible (will be rejected due to diff DNA)
i. Homografts (Allografts)--skin from humans (skin bank-fresh or frozen)

Front 1463

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
3. Skin Grafting
a. Biological Dressings--temp wound closure prevents infection fluid loss protects granulation tissue until autogafting is possible (will be rejected due to diff DNA)
ii. Heterografts (-----------)--from ------------- (mostly pigs)

Back 1463

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
3. Skin Grafting
a. Biological Dressings--temp wound closure prevents infection fluid loss protects granulation tissue until autogafting is possible (will be rejected due to diff DNA)
ii. Heterografts (xenografts)--from animals (mostly pigs)

Front 1464

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
3. Skin Grafting
b. Synthetic Dressings (------------)--dermalayer becomes permanent part of ------------ (absorbed) and top later removed in ~______weeks when autograft is placed (less costly)

Back 1464

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
3. Skin Grafting
b. Synthetic Dressings (Integra)--dermalayer becomes permanent part of wound (absorbed) and top later removed in ~2weeks when autograft is placed (less costly)

Front 1465

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
3. Skin Grafting
c. Autograft--unburned skin removed w/ ------------ (donor site take _______-15days to heal)

Back 1465

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
3. Skin Grafting
c. Autograft--unburned skin removed w/ dermatome (donor site take 10-15days to heal)

Front 1466

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
3. Skin Grafting
c. Autograft--unburned skin removed w/ dermatome (donor site take 10-15days to heal)
i. Donor sites
ii. Cultured ---------------- autografts--pt w/out enough own skin (>----------% body need)

Back 1466

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
3. Skin Grafting
c. Autograft--unburned skin removed w/ dermatome (donor site take 10-15days to heal)
i. Donor sites
ii. Cultured epithelial autografts--pt w/out enough own skin (>50% body need)

Front 1467

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
3. Skin Grafting
c. Autograft--unburned skin removed w/ dermatome (donor site take 10-15days to heal)
• Remove skin sample and culture in medium w/ ------------- growth factor
• Takes _________-4 weeks for skin to grow (use __________ graft during this time)

Back 1467

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
3. Skin Grafting
c. Autograft--unburned skin removed w/ dermatome (donor site take 10-15days to heal)
• Remove skin sample and culture in medium w/ epidermal growth factor
• Takes 3-4 weeks for skin to grow (use temporary graft during this time)

Front 1468

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
4. Nursing Management
a. Wound Management/Care
i. Cleanse and ----------- to prevent bacterial growth
ii. Minimize further destruction of ----------- skin
iii. Promote wound ----------------/successful skin grafting

Back 1468

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
4. Nursing Management
a. Wound Management/Care
i. Cleanse and debride to prevent bacterial growth
ii. Minimize further destruction of viable skin
iii. Promote wound reepithelialization/successful skin grafting

Front 1469

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
4. Nursing Management
b. Pain management--PCA (document effectiveness and assess for changes)
i. ----------------- methods esp. useful in burn (distractions, visualization, etc.)

Back 1469

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
4. Nursing Management
b. Pain management--PCA (document effectiveness and assess for changes)
i. Nonpharmacologic methods esp. useful in burn (distractions, visualization, etc.)

Front 1470

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
4. Nursing Management
c. PT and OT--prevents ------------- (get pt family involved)

Back 1470

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
4. Nursing Management
c. PT and OT--prevents contractures (get pt family involved)

Front 1471

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
4. Nursing Management
d. Nutritional therapy--hypermetabolic ---------------- state worsens w/ anxiety/pain
i. Need nutrition consultation (need food w/in -----------hrs)

Back 1471

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
4. Nursing Management
d. Nutritional therapy--hypermetabolic hypercatabolic state worsens w/ anxiety/pain
i. Need nutrition consultation (need food w/in 72hrs)

Front 1472

Burns
VI. Phases
C. Rehabilitation Phase--wounds are healed/grafts are in place
1. Scar control--prevent hypertrophic scaring due to ↑------------ deposit
a. Apply pressure garments (-----------hr/day for 1-2yrs until complete healing) to scar and ---------------- to prevent collagen deposit and keep scar fat

Back 1472

Burns
VI. Phases
C. Rehabilitation Phase--wounds are healed/grafts are in place
1. Scar control--prevent hypertrophic scaring due to ↑collagen deposit
a. Apply pressure garments (23hr/day for 1-2yrs until complete healing) to scar and massage to prevent collagen deposit and keep scar fat

Front 1473

Burns
VI. Phases
C. Rehabilitation Phase--wounds are healed/grafts are in place
1. Scar control--prevent hypertrophic scaring due to ↑collagen deposit
b. Keep out of sun for ----------yr (to prevent ---------------)

Back 1473

Burns
VI. Phases
C. Rehabilitation Phase--wounds are healed/grafts are in place
1. Scar control--prevent hypertrophic scaring due to ↑collagen deposit
b. Keep out of sun for 1yr (to prevent hyperpigmentation)

Front 1474

Burns
VI. Phases
C. Rehabilitation Phase--wounds are healed/grafts are in place
2. Prevent ___________--need PT, splinting, exercise/positioning
a. Occur due to tendons shortening and CT replaced by scar tissue limits mobility

Back 1474

Burns
VI. Phases
C. Rehabilitation Phase--wounds are healed/grafts are in place
2. Prevent contractures--need PT, splinting, exercise/positioning
a. Occur due to tendons shortening and CT replaced by scar tissue limits mobility

Front 1475

Burns
VI. Phases
C. Rehabilitation Phase--wounds are healed/grafts are in place
2. Prevent contractures--need PT, splinting, exercise/positioning
a. Occur due to tendons--------------- and CT replaced by ------------ limits mobility

Back 1475

Burns
VI. Phases
C. Rehabilitation Phase--wounds are healed/grafts are in place
2. Prevent contractures--need PT, splinting, exercise/positioning
a. Occur due to tendons shortening and CT replaced by scar tissue limits mobility

Front 1476

Burns
VII. Psychosocial Care--very important
A. Physical and ------------- scars (array of emotions)
B. Team effort--support from nurses, -------------, PT, OT, ------------ workers

Back 1476

Burns
VII. Psychosocial Care--very important
A. Physical and emotional scars (array of emotions)
B. Team effort--support from nurses, physicians, PT, OT, social workers

Front 1477

Burns
VII. Psychosocial Care--very important
C. Family and patient ------------ groups
D. Psychiatric treatment--__________

Back 1477

Burns
VII. Psychosocial Care--very important
C. Family and patient support groups
D. Psychiatric treatment--depression

Front 1478

Burns
VII. Psychosocial Care--very important
E. Nursing diagnosis--disturbed body image related to --------------- secondary to burn
1. Goal--pt sets realistic goals regarding ------------ lifestyle
2. Goal--acceptance of ----------- body image

Back 1478

Burns
VII. Psychosocial Care--very important
E. Nursing diagnosis--disturbed body image related to disfigurement secondary to burn
1. Goal--pt sets realistic goals regarding future lifestyle
2. Goal--acceptance of altered body image

Front 1479

Shock
I. Definition--syndrome characterized by ↓--------- perfusion and impaired --------------- (imbalance btw supply and demand for O2 and nutrients)

Back 1479

Shock
I. Definition--syndrome characterized by ↓tissue perfusion and impaired cellular metabolism (imbalance btw supply and demand for O2 and nutrients)

Front 1480

Shock
II. Low Blood Flow Shock
A. Cardiogenic--systolic/diastolic myocardium dysfunction compromised CO cell hypoperfusion
1. Types (mortality rates 50-______%)
a. Systolic--heart can’t pump blood _________ (L ventricle problem)
b. Diastolic--heart can’t relax and get enough preload (cardiac tamppnade)

Back 1480

Shock
II. Low Blood Flow Shock
A. Cardiogenic--systolic/diastolic myocardium dysfunction compromised CO cell hypoperfusion
1. Types (mortality rates 50-80%)
a. Systolic--heart can’t pump blood forward (L ventricle problem)

Front 1481

Shock
II. Low Blood Flow Shock
A. Cardiogenic--systolic/diastolic myocardium dysfunction compromised CO cell hypoperfusion
1. Types (mortality rates 50-80%)
a. Systolic--heart can’t pump blood forward (L ventricle problem)
b. Diastolic--heart can’t relax and get enough ---------- (cardiac -----------)
**Can have occurance w/ ---------- ventricle if it is severe enough

Back 1481

Shock
II. Low Blood Flow Shock
A. Cardiogenic--systolic/diastolic myocardium dysfunction compromised CO cell hypoperfusion
1. Types (mortality rates 50-80%)
a. Systolic--heart can’t pump blood forward (L ventricle problem)
b. Diastolic--heart can’t relax and get enough preload (cardiac tamppnade)
**Can have occurance w/ R ventricle if it is severe enough

Front 1482

Shock
II. Low Blood Flow Shock
A. Cardiogenic-
2. Causes
a. MI--dysrhythmias and ------------- muscles rupture (5-______% pts develop shock w/in 48hrs)
b. Cardiomyopathy--viral --------- failure

Back 1482

Shock
II. Low Blood Flow Shock
A. Cardiogenic-
2. Causes
a. MI--dysrhythmias and papillary muscles rupture (5-10% pts develop shock w/in 48hrs)
b. Cardiomyopathy--viral heart failure

Front 1483

Shock
II. Low Blood Flow Shock
A. Cardiogenic-
2. Causes
c. ----------- (L ventricular dysfunction) or ------------ (R ventricular dysfunction) HTN
d. Blunt -------------- injury--briusing of heart

Back 1483

Shock
II. Low Blood Flow Shock
A. Cardiogenic-
2. Causes
c. Systemic (L ventricular dysfunction) or Pulmonary (R ventricular dysfunction) HTN
d. Blunt cardiac injury--briusing of heart

Front 1484

Shock
II. Low Blood Flow Shock
A. Cardiogenic-
2. Causes
e. Myocardial ------------ from sepsis--inflammatory markers release (TNF) ↓--------, ↓--------

Back 1484

Shock
II. Low Blood Flow Shock
2. Causes
e. Myocardial depression from sepsis--inflammatory markers release (TNF) ↓SV, ↓CO

Front 1485

Shock
II. Low Blood Flow Shock
A. Cardiogenic-
3. Clinical Manifestations--similar to ----------- failure

Back 1485

Shock
II. Low Blood Flow Shock
3. Clinical Manifestations--similar to acute heart failure

Front 1486

Shock
II. Low Blood Flow Shock
A. Cardiogenic-
3. Clinical Manifestations--similar to acute heart failure
a. ↑----------, ↓---------- w. narrowed pulse pressure

Back 1486

Shock
II. Low Blood Flow Shock
3. Clinical Manifestations--similar to acute heart failure
a. ↑HR, ↓BP w. narrowed pulse pressure
b. Tachypneic w/ crackles on auscultation

Front 1487

Shock
II. Low Blood Flow Shock
A. Cardiogenic-
3. Clinical Manifestations--similar to acute heart failure
b. -------------- w/ crackles on auscultation

Back 1487

Shock
II. Low Blood Flow Shock
3. Clinical Manifestations--similar to acute heart failure
b. Tachypneic w/ crackles on auscultation

Front 1488

Shock
II. Low Blood Flow Shock
A. Cardiogenic-
3. Clinical Manifestations--similar to acute heart failure
c. Signs of peripheral ------------- (cyanosis, -----------, ↓cap refill)

Back 1488

Shock
II. Low Blood Flow Shock
3. Clinical Manifestations--similar to acute heart failure
c. Signs of peripheral hypoperfusion (cyanosis, pallor, ↓cap refill)

Front 1489

Shock
II. Low Blood Flow Shock
A. Cardiogenic-
3. Clinical Manifestations--similar to acute heart failure
d. Hemodynamic findings (↑----------, ↑PVR, ↓-------, ↑-------: due to body clamping down)

Back 1489

Shock
II. Low Blood Flow Shock
3. Clinical Manifestations--similar to acute heart failure
d. Hemodynamic findings (↑PAWP, ↑PVR, ↓CO, ↑SVR-due to body clamping down)

Front 1490

Shock
II. Low Blood Flow Shock
A. Cardiogenic-
3. Clinical Manifestations--similar to acute heart failure
e. ↓------- output (↓-------- perfusion)

Back 1490

Shock
II. Low Blood Flow Shock
3. Clinical Manifestations--similar to acute heart failure
e. ↓Urine output (↓renal perfusion)

Front 1491

Shock
II. Low Blood Flow Shock
A. Cardiogenic-
3. Clinical Manifestations--similar to acute heart failure
f. ---------- and water retention (renin-_________-aldosterone activation)

Back 1491

Shock
II. Low Blood Flow Shock
3. Clinical Manifestations--similar to acute heart failure
f. Na and water retention (renin-angiotensin-aldosterone activation)

Front 1492

Shock
II. Low Blood Flow Shock
A. Cardiogenic-
3. Clinical Manifestations--similar to acute heart failure
g. Confusion and ----------

Back 1492

Shock
II. Low Blood Flow Shock
3. Clinical Manifestations--similar to acute heart failure
g. Confusion and anxiety

Front 1493

Shock
II. Low Blood Flow Shock
A. Cardiogenic-
3. Diagnostic Studies
a. Cardiac _________
b. E_______

Back 1493

Shock
II. Low Blood Flow Shock
3. Diagnostic Studies
a. Cardiac enzymes
b. EKG

Front 1494

Shock
II. Low Blood Flow Shock
A. Cardiogenic-
3. Diagnostic Studies
c. C______
d. _________--valular dysfunction and EF

Back 1494

Shock
II. Low Blood Flow Shock
3. Diagnostic Studies
c. CXR
d. ECHO--valular dysfunction and EF

Front 1495

Shock
II. Low Blood Flow Shock
A. Cardiogenic-
3. Diagnostic Studies
e. Insertion of _________--monitor fluid status
f. Emergent __________

Back 1495

Shock
II. Low Blood Flow Shock
A. Cardiogenic-
3. Diagnostic Studies
e. Insertion of PA catheter--monitor fluid status
f. Emergent catheterization

Front 1496

Shock
II. Low Blood Flow Shock
B. ____________--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.

Back 1496

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.

Front 1497

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss ------------- to rapid blood loss (internal or external) low blood flow ↓---------- return ↓tissue ------------/impaired cell met.

Back 1497

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.

Front 1498

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
1. -------------- loss--true loss of fluid from vascular space (hemorrhage, vomiting, diarrhea)

Back 1498

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
1. Absolute loss--true loss of fluid from vascular space (hemorrhage, vomiting, diarrhea)

Front 1499

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
1. Absolute loss--true loss of fluid from vascular space (-----------, vomiting, ----------)

Back 1499

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
1. Absolute loss--true loss of fluid from vascular space (hemorrhage, vomiting, diarrhea)

Front 1500

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
2. Relative loss--fluid there but moved elsewhere from ↑---------- in burn/sepsis (---------- spacing)

Back 1500

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
2. Relative loss--fluid there but moved elsewhere from ↑cap perm. in burn/sepsis (2nd spacing)

Front 1501

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
3. Ability to compensate (if <---------% loss body is able to compensate w/out ---------- symptoms)

Back 1501

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
3. Ability to compensate (if <15% loss body is able to compensate w/out outward symptoms)

Front 1502

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
3. Ability to compensate (if <15% loss body is able to compensate w/out outward symptoms)
a. 15-______%--sympathetic venous system response
b. >_____% loss--volume must be replaced with blood

Back 1502

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
3. Ability to compensate (if <15% loss body is able to compensate w/out outward symptoms)
a. 15-30%--sympathetic venous system response
b. >30% loss--volume must be replaced with blood

Front 1503

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
3. Ability to compensate (if <15% loss body is able to compensate w/out outward symptoms)
a. 15-30%--sympathetic ------------ system response
b. >30% loss--volume must be replaced with -----------

Back 1503

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
3. Ability to compensate (if <15% loss body is able to compensate w/out outward symptoms)
a. 15-30%--sympathetic venous system response
b. >30% loss--volume must be replaced with blood

Front 1504

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
3. Ability to compensate (if <15% loss body is able to compensate w/out outward symptoms)
c. >_____% loss--irreversible damage to tissues

Back 1504

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
3. Ability to compensate (if <15% loss body is able to compensate w/out outward symptoms)
c. >40% loss--irreversible damage to tissues

Front 1505

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
3. Ability to compensate (if <15% loss body is able to compensate w/out outward symptoms)
c. >40% loss--irreversible damage to --------

Back 1505

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
3. Ability to compensate (if <15% loss body is able to compensate w/out outward symptoms)
c. >40% loss--irreversible damage to tissues

Front 1506

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
3. Causes
a. _______--external penetrating
b. Severe ______ bleeding--2nd main cause

Back 1506

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
3. Causes
a. Trauma--external penetrating
b. Severe GI bleeding--2nd main cause

Front 1507

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
3. Causes
c. ----------- pregnancy
d. ------------ fracture

Back 1507

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
3. Causes
c. Ectopic pregnancy
d. Pelvic fracture

Front 1508

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
3. Causes
d. Pelvic fracture
e. ---------- obstruction--fluid in colon
f. Ascites due to --------- dysfunction

Back 1508

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
3. Causes
d. Pelvic fracture
e. Colon obstruction--fluid in colon
f. Ascites due to liver dysfunction

Front 1509

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
4. Clinical Manifestations--result of ------------- mechanisms (can support BP if <---------% loss)

Back 1509

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
4. Clinical Manifestations--result of compensatory mechanisms (can support BP if <30% loss)

Front 1510

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
4. Clinical Manifestations--result of compensatory mechanisms (can support BP if <30% loss)
a. Initial symptoms--_________
i. ↑______ (careful b/c some meds keep HR lower than expected--blunting effect)

Back 1510

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
4. Clinical Manifestations--result of compensatory mechanisms (can support BP if <30% loss)
a. Initial symptoms--compensating
i. ↑HR (careful b/c some meds keep HR lower than expected--blunting effect)

Front 1511

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
4. Clinical Manifestations--result of compensatory mechanisms (can support BP if <30% loss)
a. Initial symptoms--compensating
ii. ↑--------
iii. ↑------- (not a pump problem)

Back 1511

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
4. Clinical Manifestations--result of compensatory mechanisms (can support BP if <30% loss)
a. Initial symptoms--compensating
ii. ↑RR
iii. ↑CO (not a pump problem)

Front 1512

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
4. Clinical Manifestations--result of compensatory mechanisms (can support BP if <30% loss)
a. Initial symptoms--compensating
iv. ↓-------- (due to ↑HR) and ↓----------

Back 1512

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
4. Clinical Manifestations--result of compensatory mechanisms (can support BP if <30% loss)
a. Initial symptoms--compensating
iv. ↓SV (due to ↑HR) and ↓PCWP

Front 1513

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
4. Clinical Manifestations--result of compensatory mechanisms (can support BP if <30% loss)
b. Later symptoms--as compensatory mechanisms fail
i. ↓---------
ii, ↓-------- output
iii. Skin --------, cool, clammy

Back 1513

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
4. Clinical Manifestations--result of compensatory mechanisms (can support BP if <30% loss)
b. Later symptoms--as compensatory mechanisms fail
i. ↓CO
ii, ↓urine output
iii. Skin pale, cool, clammy

Front 1514

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
5. Diagnostic Studies
a. Hg/______--initially normal (get ________) ↓ after give fluids (reflection of actual values)

Back 1514

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
5. Diagnostic Studies
a. Hg/Ht--initially normal (get baseline) ↓ after give fluids (reflection of actual values)

Front 1515

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
5. Diagnostic Studies
a. Hg/Ht--initially normal (get baseline) ↓ after give ------------ (reflection of ----------- values)

Back 1515

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
5. Diagnostic Studies
a. Hg/Ht--initially normal (get baseline) ↓ after give fluids (reflection of actual values)

Front 1516

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
5. Diagnostic Studies
b. Urine--↓--------- output (↓------------ perfusion), ↑specific ---------- (renin-aldosterone release)

Back 1516

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
5. Diagnostic Studies
b. Urine--↓urine output (↓kidney perfusion), ↑specific gravity (renin-aldosterone release)

Front 1517

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
5. Diagnostic Studies
c. Elevated lactic acid levels--acidotic due to ----------- metabolism in tissue from ↓--------

Back 1517

Shock
II. Low Blood Flow Shock
B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met.
5. Diagnostic Studies
c. Elevated lactic acid levels--acidotic due to anaerobic metabolism in tissue from ↓O2

Front 1518

Shock
III. Misdistribution of Blood Flow Shock
A. ____________--hemodynamic phenomenon that occurs after spinal cord injury at or above T5 resulting in massive vasodilation w/out compensation (onset can occur in 30min and last up to 6 weeks)

Back 1518

Shock
III. Misdistribution of Blood Flow Shock
A. Neurogenic--hemodynamic phenomenon that occurs after spinal cord injury at or above T5 resulting in massive vasodilation w/out compensation (onset can occur in 30min and last up to 6 weeks)

Front 1519

Shock
III. Misdistribution of Blood Flow Shock
A. Neurogenic--hemodynamic phenomenon that occurs after ------------- injury at or above --------- resulting in massive vasodilation w/out compensation (onset can occur in --------min and last up to 6 weeks)

Back 1519

Shock
III. Misdistribution of Blood Flow Shock
A. Neurogenic--hemodynamic phenomenon that occurs after spinal cord injury at or above T5 resulting in massive vasodilation w/out compensation (onset can occur in 30min and last up to 6 weeks)

Front 1520

Shock
III. Misdistribution of Blood Flow Shock
A. Neurogenic--
1. Causes--loss of ----------- vasoconstrictor tone pooling of blood in vessels

Back 1520

Shock
III. Misdistribution of Blood Flow Shock
A. Neurogenic--
1. Causes--loss of SNS vasoconstrictor tone pooling of blood in vessels

Front 1521

Shock
III. Misdistribution of Blood Flow Shock
A. Neurogenic--
1. Causes--loss of SNS vasoconstrictor tone pooling of blood in vessels
a. ----------- injury
b. ----------- anesthesia
c. Drugs: --------------

Back 1521

Shock
III. Misdistribution of Blood Flow Shock
A. Neurogenic--
1. Causes--loss of SNS vasoconstrictor tone pooling of blood in vessels
a. Spinal cord injury
b. Spinal anesthesia
c. Drugs--benzodiazepines

Front 1522

Shock
III. Misdistribution of Blood Flow Shock
A. Neurogenic--
2. Clinical Manifestations
a. H_________
b. ↓________ (no compensation) ↓_____ (PNS takes over b/c no SNS stimulation)

Back 1522

Shock
III. Misdistribution of Blood Flow Shock
A. Neurogenic--
2. Clinical Manifestations
a. Hypotension
b. ↓HR (no compensation) ↓CO (PNS takes over b/c no SNS stimulation)

Front 1523

Shock
III. Misdistribution of Blood Flow Shock
A. Neurogenic--
2. Clinical Manifestations
c. ---------------- (take on room’s temp) due to hypothalamic dysfunction (can’t regulate)

Back 1523

Shock
III. Misdistribution of Blood Flow Shock
A. Neurogenic--
2. Clinical Manifestations
c. Poikilpthermia (take on room’s temp) due to hypothalamic dysfunction (can’t regulate)

Front 1524

Shock
III. Misdistribution of Blood Flow Shock
A. Neurogenic--
2. Clinical Manifestations
c. Poikilpthermia (take on room’s temp) due to hypothalamic dysfunction (can’t regulate)
i. Massive ----------- (often cold)

Back 1524

i. Massive dilation (often cold)

Front 1525

Shock
III. Misdistribution of Blood Flow Shock
B. Septic--presence of sepsis w/ ----------- despite fluid resuscitation w/ presence of tissue ---------- abnormalities (mortality rates 28-50%)

Back 1525

Shock
III. Misdistribution of Blood Flow Shock
B. Septic--presence of sepsis w/ hypotension despite fluid resuscitation w/ presence of tissue perfusion abnormalities (mortality rates 28-50%)

Front 1526

Shock
III. Misdistribution of Blood Flow Shock
B. Septic--presence of sepsis w/ hypotension despite fluid resuscitation w/ presence of tissue perfusion abnormalities (mortality rates 28-____%)

Back 1526

Shock
III. Misdistribution of Blood Flow Shock
B. Septic--presence of sepsis w/ hypotension despite fluid resuscitation w/ presence of tissue perfusion abnormalities (mortality rates 28-50%)

Front 1527

Shock
III. Misdistribution of Blood Flow Shock
B. Septic--presence of sepsis w/ hypotension despite fluid resuscitation w/ presence of tissue perfusion abnormalities (mortality rates 28-50%)
1. Sepsis--systemic inflammatory response to a documented/suspected --------

Back 1527

Shock
III. Misdistribution of Blood Flow Shock
B. Septic--presence of sepsis w/ hypotension despite fluid resuscitation w/ presence of tissue perfusion abnormalities (mortality rates 28-50%)
1. Sepsis--systemic inflammatory response to a documented/suspected infection

Front 1528

Shock
III. Misdistribution of Blood Flow Shock
2. Pathophysiology--caused mostly --------- (-) bacteria (higher ---------- rates)

Back 1528

Shock
III. Misdistribution of Blood Flow Shock
2. Pathophysiology--caused mostly gram (-) bacteria (higher mortality rates)

Front 1529

Shock
III. Misdistribution of Blood Flow Shock
2. Pathophysiology--
a. Release of --------- inflammatory response ↑cap ------------ and vasodilation

Back 1529

Shock
III. Misdistribution of Blood Flow Shock
2. Pathophysiology--
a. Release of endotoxins inflammatory response ↑cap permeability and vasodilation

Front 1530

Shock
III. Misdistribution of Blood Flow Shock
2. Pathophysiology--
b. Microthrombi ------------- intravascular ------------- (DIC)

Back 1530

Shock
III. Misdistribution of Blood Flow Shock
2. Pathophysiology--
b. Microthrombi disseminated intravascular coagulation (DIC)

Front 1531

Shock
III. Misdistribution of Blood Flow Shock
2. Pathophysiology--
c. Pts are in---------------- state (like burns)

Back 1531

Shock
III. Misdistribution of Blood Flow Shock
2. Pathophysiology--
c. Pts are in hypermetabolic state (like burns)

Front 1532

Shock
III. Misdistribution of Blood Flow Shock
3. Clinical Manifestations--systemic response (everything just starts to ----------)

Back 1532

Shock
III. Misdistribution of Blood Flow Shock
3. Clinical Manifestations--systemic response (everything just starts to shut down)

Front 1533

Shock
III. Misdistribution of Blood Flow Shock
a. Alteration in --------- status (early)

Back 1533

Shock
III. Misdistribution of Blood Flow Shock
a. Alteration in mental status (early)

Front 1534

Shock
III. Misdistribution of Blood Flow Shock
b. Skin warm and flushed--due to --------------- (early)

Back 1534

Shock
III. Misdistribution of Blood Flow Shock
b. Skin warm and flushed--due to vasodilation (early)

Front 1535

Shock
III. Misdistribution of Blood Flow Shock
d. Significant ↑_______--overcompensation (early)

Back 1535

Shock
III. Misdistribution of Blood Flow Shock
d. Significant ↑CO--overcompensation (early)

Front 1536

Shock
III. Misdistribution of Blood Flow Shock
e. ↑_______2--tissues not properly utilizing available O2 seen w/ pulmonary catheter (early)

Back 1536

Shock
III. Misdistribution of Blood Flow Shock
e. ↑SvO2--tissues not properly utilizing available O2 seen w/ pulmonary catheter (early)

Front 1537

Shock
III. Misdistribution of Blood Flow Shock
e. ↑SvO2--tissues not properly utilizing available --------2 seen w/ ---------- catheter (early)

Back 1537

Shock
III. Misdistribution of Blood Flow Shock
e. ↑SvO2--tissues not properly utilizing available O2 seen w/ pulmonary catheter (early)

Front 1538

Shock
III. Misdistribution of Blood Flow Shock
f. ↓_____--dilation

Back 1538

Shock
III. Misdistribution of Blood Flow Shock
f. ↓SVR--dilation

Front 1539

Shock
III. Misdistribution of Blood Flow Shock
g. H_________
h. GI bleeding/_________ ileus

Back 1539

Shock
III. Misdistribution of Blood Flow Shock
g. Hypotension
h. GI bleeding/paralytic ileus

Front 1540

Shock
III. Misdistribution of Blood Flow Shock
i. Hypoxemia w/ resp failure/ARDS (_____% will go on to resp failure and ______% to ARDS)

Back 1540

Shock
III. Misdistribution of Blood Flow Shock
i. Hypoxemia w/ resp failure/ARDS (85% will go on to resp failure and 40% to ARDS)

Front 1541

Shock
III. Misdistribution of Blood Flow Shock
i. ---------- w/ resp failure/ARDS (85% will go on to resp failure and 40% to ARDS)

Back 1541

Shock
III. Misdistribution of Blood Flow Shock
j. ↓------- (late) ↓---------- output; skin cool (clamping down) and mottled (very late)

Front 1542

Shock
III. Misdistribution of Blood Flow Shock
C. Anaphylactic--acute, life-threatening - (allergic) reaction to sensitizing substance resulting in massive ------------, release of vasoactive -------------, and ↑-------------- permeability

Back 1542

III. Misdistribution of Blood Flow Shock
C. Anaphylactic--acute, life-threatening hypersensitivity (allergic) reaction to sensitizing substance resulting in massive vasodilation, release of vasoactive mediators, and ↑capillary permeability

Front 1543

Shock
III. Misdistribution of Blood Flow Shock
C. Anaphylactic
1. Causes--Drug (also IV drug infusions), ------------, vaccine, --------, or insect ---------

Back 1543

III. Misdistribution of Blood Flow Shock
C. Anaphylactic
1. Causes--Drug (also IV drug infusions), chemical, vaccine, food, or insect venom

Front 1544

Shock
III. Misdistribution of Blood Flow Shock
C. Anaphylactic
2. Clinical Manifestations--sudden onset
a. Hypotension, ----------

Back 1544

III. Misdistribution of Blood Flow Shock
C. Anaphylactic
2. Clinical Manifestations--sudden onset
a. Hypotension, chest pain

Front 1545

Shock
III. Misdistribution of Blood Flow Shock
C. Anaphylactic
2. Clinical Manifestations--sudden onset
b. Swelling of ------- and --------

Back 1545

III. Misdistribution of Blood Flow Shock
C. Anaphylactic
2. Clinical Manifestations--sudden onset
b. Swelling of lips and tongue

Front 1546

Shock
III. Misdistribution of Blood Flow Shock
C. Anaphylactic
2. Clinical Manifestations--sudden onset
c. Wheezing and stridor due to ------------ edema and --------------- resp distress

Back 1546

III. Misdistribution of Blood Flow Shock
C. Anaphylactic
2. Clinical Manifestations--sudden onset
c. Wheezing and stridor due to laryngeal edema and bronchoconstriction resp distress

Front 1547

Shock
III. Misdistribution of Blood Flow Shock
C. Anaphylactic
2. Clinical Manifestations--sudden onset
d. Skin--flushing, ----------, --------

Back 1547

III. Misdistribution of Blood Flow Shock
C. Anaphylactic
2. Clinical Manifestations--sudden onset
d. Skin--flushing, pruritus, uticaria

Front 1548

Shock
III. Misdistribution of Blood Flow Shock
C. Anaphylactic
2. Clinical Manifestations--sudden onset
e. A________
f. Edema from fluid leaking into _______

Back 1548

III. Misdistribution of Blood Flow Shock
C. Anaphylactic
2. Clinical Manifestations--sudden onset
e. Angioedema
f. Edema from fluid leaking into interstitial space

Front 1549

Shock
III. Misdistribution of Blood Flow Shock
C. Anaphylactic
3. Patient education--find cause of -----------, carry -------- pen, and wear --------- bracelet

Back 1549

III. Misdistribution of Blood Flow Shock
C. Anaphylactic
3. Patient education--find cause of allergy, carry epi pen, and wear med alert bracelet

Front 1550

Shock
IV. Stages
A. Initial Stage--body responding at cellular level by utilizing ---------- metabolism (no outward signs)

Back 1550

Shock
IV. Stages
A. Initial Stage--body responding at cellular level by utilizing anaerobic metabolism (no outward signs)

Front 1551

Shock
IV. Stages
B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain ---------

Back 1551

Shock
IV. Stages
B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis

Front 1552

Shock
IV. Stages
B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis
1. If recovery occurs at this stage little ---------- done

Back 1552

Shock
IV. Stages
B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis
1. If recovery occurs at this stage little damage done

Front 1553

Shock
IV. Stages
B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis
2. Clinical Manifestations--reflect body’s response to imbalance in -----------2 supply and demand (chemo and baroreceptros sense ↓--------- and attempt to raise it)

Back 1553

Shock
IV. Stages
B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis
2. Clinical Manifestations--reflect body’s response to imbalance in O2 supply and demand (chemo and baroreceptros sense ↓BP and attempt to raise it)

Front 1554

Shock
IV. Stages
B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis
2. Clinical Manifestations--reflect body’s response to imbalance in O2 supply and demand (chemo and baroreceptros sense ↓BP and attempt to raise it)
a. Neurogenic--subtle -----------, agitation, mild -------

Back 1554

Shock
IV. Stages
B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis
2. Clinical Manifestations--reflect body’s response to imbalance in O2 supply and demand (chemo and baroreceptros sense ↓BP and attempt to raise it)
a. Neurogenic--subtle restlessness, agitation, mild ALOC

Front 1555

Shock
IV. Stages
B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis
2. Clinical Manifestations--reflect body’s response to imbalance in O2 supply and demand (chemo and baroreceptros sense ↓BP and attempt to raise it
b. Cardiovascular--selective ------------ (norepinephrine) ↑-------- and contractility; ß-adrenergic stimulation dilate coronary arteries

Back 1555

Shock
IV. Stages
B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis
2. Clinical Manifestations--reflect body’s response to imbalance in O2 supply and demand (chemo and baroreceptros sense ↓BP and attempt to raise it
b. Cardiovascular--selective vasoconstriction (norepinephrine) ↑HR and contractility; ß-adrenergic stimulation dilate coronary arteries

Front 1556

Shock
IV. Stages
B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis
2. Clinical Manifestations--reflect body’s response to imbalance in O2 supply and demand (chemo and baroreceptros sense ↓BP and attempt to raise it
b. Cardiovascular--selective vasoconstriction (norepinephrine) ↑HR and contractility; ß----------- stimulation dilate ----------- arteries

Back 1556

Shock
IV. Stages
B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis
2. Clinical Manifestations--reflect body’s response to imbalance in O2 supply and demand (chemo and baroreceptros sense ↓BP and attempt to raise it
b. Cardiovascular--selective vasoconstriction (norepinephrine) ↑HR and contractility; ß-adrenergic stimulation dilate coronary arteries

Front 1557

Shock
IV. Stages
B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis
2. Clinical Manifestations--reflect body’s response to imbalance in O2 supply and demand (chemo and baroreceptros sense ↓BP and attempt to raise it
c. Respiratory--↑------------ dead space (some areas not leading to gas exchange) ------ mismatch ↑--------- and depth

Back 1557

Shock
IV. Stages
B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis
2. Clinical Manifestations--reflect body’s response to imbalance in O2 supply and demand (chemo and baroreceptros sense ↓BP and attempt to raise it
c. Respiratory--↑physiological dead space (some areas not leading to gas exchange) VQ mismatch ↑RR and depth

Front 1558

Shock
IV. Stages
B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis
2. Clinical Manifestations--reflect body’s response to imbalance in O2 supply and demand (chemo and baroreceptros sense ↓BP and attempt to raise it
d. GI--constriction ---------------- bowel sounds, ---------

Back 1558

Shock
IV. Stages
B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis
2. Clinical Manifestations--reflect body’s response to imbalance in O2 supply and demand (chemo and baroreceptros sense ↓BP and attempt to raise it
d. GI--constriction hypoactive bowel sounds, ileus

Front 1559

Shock
IV. Stages
B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis
2. Clinical Manifestations--reflect body’s response to imbalance in O2 supply and demand (chemo and baroreceptros sense ↓BP and attempt to raise it
e. Renal--vasoconstriction ↓------------ release of renin ↑---------

Back 1559

Shock
IV. Stages
B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis
2. Clinical Manifestations--reflect body’s response to imbalance in O2 supply and demand (chemo and baroreceptros sense ↓BP and attempt to raise it
e. Renal--vasoconstriction ↓blood flow release of renin ↑aldosterone

Front 1560

Shock
IV. Stages
B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis
2. Clinical Manifestations--reflect body’s response to imbalance in O2 supply and demand (chemo and baroreceptros sense ↓BP and attempt to raise it
e. Renal--vasoconstriction ↓blood flow release of renin ↑aldosterone
i. Renin --------------- 1 2 (most potent vasoconstrictor in body) Aldosterone (retains -------)

Back 1560

Shock
IV. Stages
B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis
2. Clinical Manifestations--reflect body’s response to imbalance in O2 supply and demand (chemo and baroreceptros sense ↓BP and attempt to raise it
e. Renal--vasoconstriction ↓blood flow release of renin ↑aldosterone
i. Renin Angiotensin 1 2 (most potent vasoconstrictor in body) Aldosterone (retains Na)

Front 1561

Shock
IV. Stages
B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis
2. Clinical Manifestations--reflect body’s response to imbalance in O2 supply and demand (chemo and baroreceptros sense ↓BP and attempt to raise i
f. Temperature--not -------- finding
g. Skin--pale, ---------- (septic will be warm)

Back 1561

Shock
IV. Stages
B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis
2. Clinical Manifestations--reflect body’s response to imbalance in O2 supply and demand (chemo and baroreceptros sense ↓BP and attempt to raise i
f. Temperature--not early finding
g. Skin--pale, cool (septic will be warm)

Front 1562

Shock
IV. Stages
B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis
2. Clinical Manifestations--reflect body’s response to imbalance in O2 supply and demand (chemo and baroreceptros sense ↓BP and attempt to raise
h. Labs--↓-----------2 and ------------ (due to ↑resp state)

Back 1562

Shock
IV. Stages
B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis
2. Clinical Manifestations--reflect body’s response to imbalance in O2 supply and demand (chemo and baroreceptros sense ↓BP and attempt to raise
h. Labs--↓PaO2 and alkalosis (due to ↑resp state)

Front 1563

Shock
IV. Stages
C. Progressive Stage--↓--------------- altered cap perm (begins as comp mechanisms fail)

Back 1563

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail)

Front 1564

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail)
1. Must be presence of ------------ cause

Back 1564

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail)
1. Must be presence of precipitating cause

Front 1565

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail)
2. Massive ---------- stimulation (compensatory mechanisms not working)

Back 1565

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail)
2. Massive SNS stimulation (compensatory mechanisms not working)

Front 1566

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
a. Neurologic--↓-------------- pressure ↓------------- blood flow listless, agitated, ↓ responsiveness to stimuli

Back 1566

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
a. Neurologic--↓cerebral perfusion pressure ↓cerebral blood flow listless, agitated, ↓ responsiveness to stimuli

Front 1567

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
a. Neurologic--↓cerebral perfusion pressure ↓cerebral blood flow listless, ------------, ↓ -------------- to stimuli

Back 1567

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
a. Neurologic--↓cerebral perfusion pressure ↓cerebral blood flow listless, agitated, ↓ responsiveness to stimuli

Front 1568

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
b. Respiratory--pulmonary arterioles constriction (to ↑--------) ↑------------ ↓---------- blood flow worsening VQ mismatch ↑cap perm interstitial edema alveolar edema ↓gas exchange tachypnea, crackles, ↓compliance

Back 1568

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
b. Respiratory--pulmonary arterioles constriction (to ↑BP) ↑PAP ↓pulm blood flow worsening VQ mismatch ↑cap perm interstitial edema alveolar edema ↓gas exchange tachypnea, crackles, ↓compliance

Front 1569

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
b. Respiratory--pulmonary arterioles constriction (to ↑BP) ↑PAP ↓pulm blood flow worsening ---------- mismatch ↑cap perm, -------------, -------- edema ↓gas exchange tachypnea, crackles, ↓compliance

Back 1569

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
b. Respiratory--pulmonary arterioles constriction (to ↑BP) ↑PAP ↓pulm blood flow worsening VQ mismatch ↑cap perm interstitial edema alveolar edema ↓gas exchange tachypnea, crackles, ↓compliance

Front 1570

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
b. Respiratory--pulmonary arterioles constriction (to ↑BP) ↑PAP ↓pulm blood flow worsening VQ mismatch ↑cap perm interstitial edema alveolar edema ↓gas exchange -----------, ----------, ↓----------

Back 1570

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
b. Respiratory--pulmonary arterioles constriction (to ↑BP) ↑PAP ↓pulm blood flow worsening VQ mismatch ↑cap perm interstitial edema alveolar edema ↓gas exchange tachypnea, crackles, ↓compliance

Front 1571

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
c. Cardiogenic--↑cap perm ↓-------------- and ↓---------------, progressive tissue --------- ß-adrenergic receptor stimulation CO begins to fail (heart can’t keep up) ↑HR ↓BP ↓peripheral perfusion (MAP) ↓coronary perfusion arrhythmias ischemia potential MI (can be nonatherosclerotic)

Back 1571

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
c. Cardiogenic--↑cap perm ↓circulating volume and ↓myocardial function progressive tissue hypoxia ß-adrenergic receptor stimulation CO begins to fail (heart can’t keep up) ↑HR ↓BP ↓peripheral perfusion (MAP) ↓coronary perfusion arrhythmias ischemia potential MI (can be nonatherosclerotic)

Front 1572

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
c. Cardiogenic--↑cap perm ↓circulating volume and ↓myocardial function progressive tissue hypoxia ß-adrenergic ------------- stimulation, ------- begins to fail (heart can’t keep up) ↑-------- ↓BP ↓peripheral perfusion (MAP) ↓coronary perfusion arrhythmias ischemia potential MI (can be nonatherosclerotic)

Back 1572

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
c. Cardiogenic--↑cap perm ↓circulating volume and ↓myocardial function progressive tissue hypoxia ß-adrenergic receptor stimulation CO begins to fail (heart can’t keep up) ↑HR ↓BP ↓peripheral perfusion (MAP) ↓coronary perfusion arrhythmias ischemia potential MI (can be nonatherosclerotic)

Front 1573

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
c. Cardiogenic--↑cap perm ↓circulating volume and ↓myocardial function progressive tissue hypoxia ß-adrenergic receptor stimulation CO begins to fail (heart can’t keep up) ↑HR ↓-------- ↓------------- (MAP) ↓--------- perfusion arrhythmias ischemia potential MI (can be nonatherosclerotic)

Back 1573

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
c. Cardiogenic--↑cap perm ↓circulating volume and ↓myocardial function progressive tissue hypoxia ß-adrenergic receptor stimulation CO begins to fail (heart can’t keep up) ↑HR ↓BP ↓peripheral perfusion (MAP) ↓coronary perfusion arrhythmias ischemia potential MI (can be nonatherosclerotic)

Front 1574

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
c. Cardiogenic--↑cap perm ↓circulating volume and ↓myocardial function progressive tissue hypoxia ß-adrenergic receptor stimulation CO begins to fail (heart can’t keep up) ↑HR ↓BP ↓peripheral perfusion (MAP) ↓coronary perfusion --------------- ischemia potential ---------- (can be nonatherosclerotic)

Back 1574

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
c. Cardiogenic--↑cap perm ↓circulating volume and ↓myocardial function progressive tissue hypoxia ß-adrenergic receptor stimulation CO begins to fail (heart can’t keep up) ↑HR ↓BP ↓peripheral perfusion (MAP) ↓coronary perfusion arrhythmias ischemia potential MI (can be nonatherosclerotic)

Front 1575

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
c. Cardiogenic--
i. --------- cannot be maintained (unlike compensatory stage)

Back 1575

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
c. Cardiogenic--
i. CO cannot be maintained (unlike compensatory stage)

Front 1576

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
d. Renal--↓perfusion to ---------- ↓--------- output ↑------- fxn tests (BUN/CR) ATN ARF ↓ability to excrete acids and absorb bicarb metabolic acidosis

Back 1576

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
d. Renal--↓perfusion to kidney ↓urine output ↑renal fxn tests (BUN/CR) ATN ARF ↓ability to excrete acids and absorb bicarb metabolic acidosis

Front 1577

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
d. Renal--↓perfusion to kidney ↓urine output ↑renal fxn tests (BUN/CR) ------, -------, ↓ability to excrete ------- and absorb bicarb metabolic acidosis

Back 1577

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
d. Renal--↓perfusion to kidney ↓urine output ↑renal fxn tests (BUN/CR) ATN ARF ↓ability to excrete acids and absorb bicarb metabolic acidosis

Front 1578

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
d. Renal--↓perfusion to kidney ↓urine output ↑renal fxn tests (BUN/CR) ATN ARF ↓ability to excrete acids and absorb -----, metabolic -------

Back 1578

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
d. Renal--↓perfusion to kidney ↓urine output ↑renal fxn tests (BUN/CR) ATN ARF ↓ability to excrete acids and absorb bicarb metabolic acidosis

Front 1579

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
e. GI--extended ↓-------------- 2° to vasoconstriction, mucosal ----------, ↓-------- absorption and ulcers/GI bleeding ↑risk of bacteria to blood (sepsis)

Back 1579

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
e. GI--extended ↓tissue perfusion 2° to vasoconstriction mucosal barrier ischemia ↓nutrient absorption and ulcers/GI bleeding ↑risk of bacteria to blood (sepsis)

Front 1580

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
e. GI--extended ↓tissue perfusion 2° to vasoconstriction mucosal barrier ischemia ↓nutrient absorption and ulcers/------- bleeding ↑risk of -------- to blood (sepsis)

Back 1580

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
e. GI--extended ↓tissue perfusion 2° to vasoconstriction mucosal barrier ischemia ↓nutrient absorption and ulcers/GI bleeding ↑risk of bacteria to blood (sepsis)

Front 1581

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
f. Hepatic--↓----------- to liver ↓ability to ------------- drugs and waste products ↑-------3 lactate accumulation of bilirubin ↑LFTs (ALT, AST, GGT)

Back 1581

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
f. Hepatic--↓perfusion to liver ↓ability to metabolize drugs and waste products ↑NH3 lactate accumulation of bilirubin ↑LFTs (ALT, AST, GGT)

Front 1582

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
f. Hepatic--↓perfusion to liver ↓ability to metabolize drugs and waste products ↑NH3 lactate accumulation of ---------- ↑---------s (ALT, AST, GGT)

Back 1582

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
f. Hepatic--↓perfusion to liver ↓ability to metabolize drugs and waste products ↑NH3 lactate accumulation of bilirubin ↑LFTs (ALT, AST, GGT)

Front 1583

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
f. Hepatic--↓perfusion to liver ↓ability to metabolize drugs and waste products ↑NH3 lactate accumulation of bilirubin ↑LFTs (ALT, ------, ------)

Back 1583

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
f. Hepatic--↓perfusion to liver ↓ability to metabolize drugs and waste products ↑NH3 lactate accumulation of bilirubin ↑LFTs (ALT, AST, GGT)

Front 1584

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
g. Hematologic--platelets and clotting factor consumption ----------, ↑--------, ↑PTT, ↓-------- DIC risk widespread bleeding (GI, lungs, puncture sites)

Back 1584

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
g. Hematologic--platelets and clotting factor consumption thrombocytopenia, ↑PT, ↑PTT, ↓fibrinogen DIC risk widespread bleeding (GI, lungs, puncture sites)

Front 1585

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
g. Hematologic--platelets and clotting factor consumption thrombocytopenia, ↑PT, ↑-------, ↓fibrinogen ---------- risk widespread bleeding (GI, -------, puncture sites)

Back 1585

Shock
IV. Stages
C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail))
3. Pathophysiology and Manifestations
g. Hematologic--platelets and clotting factor consumption thrombocytopenia, ↑PT, ↑PTT, ↓fibrinogen DIC risk widespread bleeding (GI, lungs, puncture sites)

Front 1586

Shock
IV. Stages
D. Refractory Stage--high likelihood of ------- (can sometimes be reversed)

Back 1586

Shock
IV. Stages
D. Refractory Stage--high likelihood of death (can sometimes be reversed)

Front 1587

Shock
IV. Stages
D. Refractory Stage--high likelihood of death (can sometimes be reversed)
1. ↓---------- ↓------ anaerobic metabolism ↑-------- acid ↑cap perm interstitial fluid transfer worsens ↓intravascular volume ↓BP worsens myocardial depression worsens ↑HR ischemia further ↓CO ↓ cerebral flow cerebral ischemia

Back 1587

Shock
IV. Stages
D. Refractory Stage--high likelihood of death (can sometimes be reversed)
1. ↓Perfusion ↓CO anaerobic metabolism ↑lactic acid ↑cap perm interstitial fluid transfer worsens ↓intravascular volume ↓BP worsens myocardial depression worsens ↑HR ischemia further ↓CO ↓ cerebral flow cerebral ischemia

Front 1588

Shock
IV. Stages
D. Refractory Stage--high likelihood of death (can sometimes be reversed)
1. ↓Perfusion ↓CO anaerobic ----------- ↑lactic acid ↑cap perm interstitial ------------ worsens ↓---------- volume ↓BP worsens myocardial depression worsens ↑HR ischemia further ↓CO ↓ cerebral flow cerebral ischemia

Back 1588

Shock
IV. Stages
D. Refractory Stage--high likelihood of death (can sometimes be reversed)
1. ↓Perfusion ↓CO anaerobic metabolism ↑lactic acid ↑cap perm interstitial fluid transfer worsens ↓intravascular volume ↓BP worsens myocardial depression worsens ↑HR ischemia further ↓CO ↓ cerebral flow cerebral ischemia

Front 1589

Shock
IV. Stages
D. Refractory Stage--high likelihood of death (can sometimes be reversed)
1. ↓Perfusion ↓CO anaerobic metabolism ↑lactic acid ↑cap perm interstitial fluid transfer worsens ↓intravascular volume ↓--------- worsens myocardial ----------- worsens ↑---------- ischemia further ↓CO ↓ cerebral flow cerebral ischemia

Back 1589

Shock
IV. Stages
D. Refractory Stage--high likelihood of death (can sometimes be reversed)
1. ↓Perfusion ↓CO anaerobic metabolism ↑lactic acid ↑cap perm interstitial fluid transfer worsens ↓intravascular volume ↓BP worsens myocardial depression worsens ↑HR ischemia further ↓CO ↓ cerebral flow cerebral ischemia

Front 1590

Shock
IV. Stages
D. Refractory Stage--high likelihood of death (can sometimes be reversed)
1. ↓Perfusion ↓CO anaerobic metabolism ↑lactic acid ↑cap perm interstitial fluid transfer worsens ↓intravascular volume ↓BP worsens myocardial depression worsens ↑HR ischemia further ↓----------- ↓ ------------ flow cerebral --------

Back 1590

Shock
IV. Stages
D. Refractory Stage--high likelihood of death (can sometimes be reversed)
1. ↓Perfusion ↓CO anaerobic metabolism ↑lactic acid ↑cap perm interstitial fluid transfer worsens ↓intravascular volume ↓BP worsens myocardial depression worsens ↑HR ischemia further ↓CO ↓ cerebral flow cerebral ischemia

Front 1591

Shock
IV. Stages
D. Refractory Stage--high likelihood of death (can sometimes be reversed)
2. Pathophysiology--recovery is -------- (pt will code quickly)

Back 1591

Shock
IV. Stages
D. Refractory Stage--high likelihood of death (can sometimes be reversed)
2. Pathophysiology--recovery is unlikely (pt will code quickly)

Front 1592

Shock
IV. Stages
D. Refractory Stage--high likelihood of death (can sometimes be reversed)
2. Pathophysiology--recovery is unlikely (pt will code quickly)
a. Neurologic--unresponsive, pupils ------------ and dilated, --------- (loss of reflexes)

Back 1592

Shock
IV. Stages
D. Refractory Stage--high likelihood of death (can sometimes be reversed)
2. Pathophysiology--recovery is unlikely (pt will code quickly)
a. Neurologic--unresponsive, pupils nonreactive and dilated, areflexia (loss of reflexes)

Front 1593

Shock
IV. Stages
D. Refractory Stage--high likelihood of death (can sometimes be reversed)
2. Pathophysiology--recovery is unlikely (pt will code quickly)
b. Respiratory--severe refractory ----------- (despite intubation ↑---------2) and resp failure

Back 1593

Shock
IV. Stages
D. Refractory Stage--high likelihood of death (can sometimes be reversed)
2. Pathophysiology--recovery is unlikely (pt will code quickly)
b. Respiratory--severe refractory hypoxemia (despite intubation ↑FiO2) and resp failure

Front 1594

Shock
IV. Stages
D. Refractory Stage--high likelihood of death (can sometimes be reversed)
2. Pathophysiology--recovery is unlikely (pt will code quickly)
c. Cardiogenic--profound ------------ (can’t get it back up), ↓----------, bradycardia

Back 1594

Shock
IV. Stages
D. Refractory Stage--high likelihood of death (can sometimes be reversed)
2. Pathophysiology--recovery is unlikely (pt will code quickly)
c. Cardiogenic--profound hypotension (can’t get it back up), ↓CO, bradycardia

Front 1595

Shock
IV. Stages
D. Refractory Stage--high likelihood of death (can sometimes be reversed)
2. Pathophysiology--recovery is unlikely (pt will code quickly)
i. ---------- can only compensate for so long then if begins to drop

Back 1595

Shock
IV. Stages
D. Refractory Stage--high likelihood of death (can sometimes be reversed)
2. Pathophysiology--recovery is unlikely (pt will code quickly)
i. HR can only compensate for so long then if begins to drop

Front 1596

Shock
IV. Stages
D. Refractory Stage--high likelihood of death (can sometimes be reversed)
2. Pathophysiology--recovery is unlikely (pt will code quickly)
d. Renal--anuria; need ------------ or they will die (everything is shut down)

Back 1596

Shock
IV. Stages
D. Refractory Stage--high likelihood of death (can sometimes be reversed)
2. Pathophysiology--recovery is unlikely (pt will code quickly)
d. Renal--anuria; need dialysis or they will die (everything is shut down)

Front 1597

Shock
IV. Stages
D. Refractory Stage--high likelihood of death (can sometimes be reversed)
2. Pathophysiology--recovery is unlikely (pt will code quickly)
e. GI--_________

Back 1597

Shock
IV. Stages
D. Refractory Stage--high likelihood of death (can sometimes be reversed)
2. Pathophysiology--recovery is unlikely (pt will code quickly)
e. GI--ischemic gut

Front 1598

Shock
IV. Stages
D. Refractory Stage--high likelihood of death (can sometimes be reversed)
2. Pathophysiology--recovery is unlikely (pt will code quickly)
f. Hepatic--accumulation of ----------- products (including ↑---------3 and lactate)

Back 1598

Shock
IV. Stages
D. Refractory Stage--high likelihood of death (can sometimes be reversed)
2. Pathophysiology--recovery is unlikely (pt will code quickly)
f. Hepatic--accumulation of waste products (including ↑NH3 and lactate)

Front 1599

Shock
IV. Stages
D. Refractory Stage--high likelihood of death (can sometimes be reversed)
2. Pathophysiology--recovery is unlikely (pt will code quickly)
g. Skin--mottled and ----------

Back 1599

Shock
IV. Stages
D. Refractory Stage--high likelihood of death (can sometimes be reversed)
2. Pathophysiology--recovery is unlikely (pt will code quickly)
g. Skin--mottled and cyanotic

Front 1600

Shock
IV. Stages
D. Refractory Stage--high likelihood of death (can sometimes be reversed)
3. Residual Deficits (if live through stage)
a. Gangrene and amputations from -----------
b. Kidney and ----------- problems (possibly need transplants)

Back 1600

Shock
IV. Stages
D. Refractory Stage--high likelihood of death (can sometimes be reversed)
3. Residual Deficits (if live through stage)
a. Gangrene and amputations from vasoconstriction

Front 1601

Shock
V. Diagnostic Studies--no single ---------- test

Back 1601

Shock
V. Diagnostic Studies--no single diagnostic test

Front 1602

Shock
V. Diagnostic Studies--no single diagnostic test
A. ↑----------- levels and base deficit--from ↓--------- perfusion and anaerobic metabolism

Back 1602

Shock
V. Diagnostic Studies--no single diagnostic test
A. ↑lactate levels and base deficit--from ↓tissue perfusion and anaerobic metabolism

Front 1603

Shock
V. Diagnostic Studies--no single diagnostic test
B. EKG--if ------------- shock

Back 1603

Shock
V. Diagnostic Studies--no single diagnostic test
B. EKG--if cardiogenic shock

Front 1604

Shock
V. Diagnostic Studies--no single diagnostic test
C. C______
D. ____________ monitoring

Back 1604

Shock
V. Diagnostic Studies--no single diagnostic test
C. CXR
D. Hemodynamic monitoring

Front 1605

Shock
V. Diagnostic Studies--no single diagnostic test
E. Continuous--------- oximeter
F. ----------2

Back 1605

Shock
V. Diagnostic Studies--no single diagnostic test
E. Continuous pulse oximeter
F. SVO2

Front 1606

Shock
V. Diagnostic Studies--no single diagnostic test
G. Labs
1. Electrolytes--↑-------- (↑-----------), early ↓-------- (↑aldoseterone), later ↑K (cells die ↓kidney fxn)

Back 1606

Shock
V. Diagnostic Studies--no single diagnostic test
G. Labs
1. Electrolytes--↑Na (↑aldosterone), early ↓K (↑aldoseterone), later ↑K (cells die ↓kidney fxn)

Front 1607

Shock
V. Diagnostic Studies--no single diagnostic test
G. Labs
1. Electrolytes--↑Na (↑aldosterone), early ↓K (↑------------), later ↑K (cells die ↓---------- fxn)

Back 1607

Shock
V. Diagnostic Studies--no single diagnostic test
G. Labs
1. Electrolytes--↑Na (↑aldosterone), early ↓K (↑aldoseterone), later ↑K (cells die ↓kidney fxn)

Front 1608

Shock
V. Diagnostic Studies--no single diagnostic test
G. Labs
2. Blood--↓-------/Hg after volume replacement (if ---------)

Back 1608

Shock
V. Diagnostic Studies--no single diagnostic test
G. Labs
2. Blood--↓Ht/Hg after volume replacement (if hemorrhagic)

Front 1609

Shock
V. Diagnostic Studies--no single diagnostic test
G. Labs
3. ABGs--late metabolic ----------- (anaerobic ----------)

Back 1609

Shock
V. Diagnostic Studies--no single diagnostic test
G. Labs
3. ABGs--late metabolic acidosis (anaerobic metabolism)

Front 1610

Shock
V. Diagnostic Studies--no single diagnostic test
G. Labs
4. Renal function tests--↑----------/Cr

Back 1610

Shock
V. Diagnostic Studies--no single diagnostic test
G. Labs
4. Renal function tests--↑BUN/Cr

Front 1611

Shock
V. Diagnostic Studies--no single diagnostic test
G. Labs
5. LFTs--increased (only in -------------- stages)

Back 1611

Shock
V. Diagnostic Studies--no single diagnostic test
G. Labs
5. LFTs--increased (only in progressive stages)

Front 1612

Shock
V. Diagnostic Studies--no single diagnostic test
G. Labs
5. LFTs--_________ (only in progressive stages)

Back 1612

Shock
V. Diagnostic Studies--no single diagnostic test
G. Labs
5. LFTs--increased (only in progressive stages)

Front 1613

Shock
V. Diagnostic Studies--no single diagnostic test
G. Labs
6. Cardiac ---------

Back 1613

Shock
V. Diagnostic Studies--no single diagnostic test
G. Labs
6. Cardiac enzymes

Front 1614

Shock
V. Diagnostic Studies--no single diagnostic test
G. Labs
7. DIC panel--↓----------, ↓-----------, ↑PT/PTT

Back 1614

Shock
V. Diagnostic Studies--no single diagnostic test
G. Labs
7. DIC panel--↓fibrinogen, ↓platelets, ↑PT/PTT

Front 1615

Shock
V. Diagnostic Studies--no single diagnostic test
G. Labs
8. Glucose
a. Early--SNS stimulation, liver releases ------------ and stress response releases ----------- to maintain glucose levelsshock continues↓cells responsive to insulin↑glucose

Back 1615

Shock
V. Diagnostic Studies--no single diagnostic test
G. Labs
8. Glucose
a. Early--SNS stimulationliver releases glycogen and stress response releases cortisol to maintain glucose levelsshock continues↓cells responsive to insulin↑glucose

Front 1616

Shock
V. Diagnostic Studies--no single diagnostic test
G. Labs
8. Glucose
a. Early--SNS stimulationliver releases glycogen and stress response releases cortisol to maintain glucose levelsshock continues↓--------- responsive to insulin↑----------

Back 1616

Shock
V. Diagnostic Studies--no single diagnostic test
G. Labs
8. Glucose
a. Early--SNS stimulationliver releases glycogen and stress response releases cortisol to maintain glucose levelsshock continues↓cells responsive to insulin↑glucose

Front 1617

Shock
V. Diagnostic Studies--no single diagnostic test
G. Labs
8. Glucose
b. Late--depleted ---------- stores and no --------- from kidney ↓glucose

Back 1617

Shock
V. Diagnostic Studies--no single diagnostic test
G. Labs
8. Glucose
b. Late--depleted glycogen stores and no cortisol from kidney ↓glucose

Front 1618

Shock
VI. Management
A. Oxygenation and Ventilation--goal is to ↑O2 ----------- and ↓ O2 ---------

Back 1618

Shock
VI. Management
A. Oxygenation and Ventilation--goal is to ↑O2 supply and ↓ O2 demand

Front 1619

Shock
VI. Management
A. Oxygenation and Ventilation--goal is to ↑O2 supply and ↓ O2 demand
1. Optimize O2 delivery--NR mask, ----------, ↑---------2

Back 1619

Shock
VI. Management
A. Oxygenation and Ventilation--goal is to ↑O2 supply and ↓ O2 demand
1. Optimize O2 delivery--NR mask, intubation, ↑FiO2

Front 1620

Shock
VI. Management
A. Oxygenation and Ventilation--goal is to ↑O2 supply and ↓ O2 demand
2. Ensure pt has patent -----------
3. Provide ---------- O2

Back 1620

Shock
VI. Management
A. Oxygenation and Ventilation--goal is to ↑O2 supply and ↓ O2 demand
2. Ensure pt has patent airway
3. Provide supplemental O2

Front 1621

Shock
VI. Management
A. Oxygenation and Ventilation--goal is to ↑O2 supply and ↓ O2 demand
4. Optimize cardiac output--drug therapy (------------, debutamine, -----------)

Back 1621

Shock
VI. Management
A. Oxygenation and Ventilation--goal is to ↑O2 supply and ↓ O2 demand
4. Optimize cardiac output--drug therapy (epinephrine, debutamine, levofed)

Front 1622

Shock
VI. Management
A. Oxygenation and Ventilation--goal is to ↑O2 supply and ↓ O2 demand
4. Optimize cardiac output--drug therapy (epinephrine, debutamine, ---------)

Back 1622

Shock
VI. Management
A. Oxygenation and Ventilation--goal is to ↑O2 supply and ↓ O2 demand
4. Optimize cardiac output--drug therapy (epinephrine, debutamine, levofed)

Front 1623

Shock
VI. Management
A. Oxygenation and Ventilation--goal is to ↑O2 supply and ↓ O2 demand
5. Assess labs including ----------/Ht, ---------2

Back 1623

Shock
VI. Management
A. Oxygenation and Ventilation--goal is to ↑O2 supply and ↓ O2 demand
5. Assess labs including Hg/Ht, SaO2

Front 1624

Shock
VI. Management
A. Oxygenation and Ventilation--goal is to ↑O2 supply and ↓ O2 demand
6. Hemodynamic monitoring to assess ---------2 (assesses ----------- at level of tissues)

Back 1624

Shock
VI. Management
A. Oxygenation and Ventilation--goal is to ↑O2 supply and ↓ O2 demand
6. Hemodynamic monitoring to assess SVO2 (assesses oxygenation at level of tissues)

Front 1625

Shock
VI. Management
B. Fluid therapy--not ------------- (good volume w/ bad pump) or ---------- (good volume w/ vasodil.)

Back 1625

Shock
VI. Management
B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.)

Front 1626

Shock
VI. Management
B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.)
1. Establish ----------- access (14 to -------G)

Back 1626

Shock
VI. Management
B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.)
1. Establish IV access (14-16G)

Front 1627

Shock
VI. Management
B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.)
2. Hemodynamic monitoring to assess --------- status

Back 1627

Shock
VI. Management
B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.)
2. Hemodynamic monitoring to assess fluid status

Front 1628

Shock
VI. Management
B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.)
3. Fluid choice--think about what has been -------

Back 1628

Shock
VI. Management
B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.)
3. Fluid choice--think about what has been lost

Front 1629

Shock
VI. Management
B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.)
3. Fluid choice--think about what has been lost
a. RBCs--give w/ ----------- b/c RBCs do not have ------------ factors (1-2U FFP for 5U RBCs)

Back 1629

Shock
VI. Management
B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.)
3. Fluid choice--think about what has been lost
a. RBCs--give w/ FFP b/c RBCs do not have clotting factors (1-2U FFP for 5U RBCs)

Front 1630

Shock
VI. Management
B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.)
3. Fluid choice--think about what has been lost
a. RBCs--give w/ FFP b/c RBCs do not have clotting factors (1-______U FFP for 5_______ RBCs)

Back 1630

Shock
VI. Management
B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.)
3. Fluid choice--think about what has been lost
a. RBCs--give w/ FFP b/c RBCs do not have clotting factors (1-2U FFP for 5U RBCs)

Front 1631

Shock
VI. Management
B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.)
3. Fluid choice--think about what has been lost
a. Crystalloid (NS, LR)--2/3rd diffuse into ------------ space (require more -----------)

Back 1631

Shock
VI. Management
B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.)
3. Fluid choice--think about what has been lost
a. Crystalloid (NS, LR)--2/3rd diffuse into interstitial space (require more volume)

Front 1632

Shock
VI. Management
B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.)
3. Fluid choice--think about what has been lost
a. Crystalloid (---------, -----------)--2/3rd diffuse into interstitial space (require more volume)

Back 1632

Shock
VI. Management
B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.)
3. Fluid choice--think about what has been lost
a. Crystalloid (NS, LR)--2/3rd diffuse into interstitial space (require more volume)

Front 1633

Shock
VI. Management
B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.)
3. Fluid choice--think about what has been lost
b. Colloid (----------, -----------)--large therefore fluids stay in vascular space better

Back 1633

Shock
VI. Management
B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.)
3. Fluid choice--think about what has been lost
b. Colloid (Albumin, Hespain)--large therefore fluids stay in vascular space better

Front 1634

Shock
VI. Management
B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.)
3. Fluid choice--think about what has been lost
b. Colloid (Albumin, Hespain)--large therefore fluids stay in --------- space better

Back 1634

Shock
VI. Management
B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.)
3. Fluid choice--think about what has been lost
b. Colloid (Albumin, Hespain)--large therefore fluids stay in vascular space better

Front 1635

Shock
VI. Management
B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.)
3. Fluid choice--think about what has been lost
b. Colloid (Albumin, Hespain)--large therefore fluids stay in vascular space better
a. Can be given in concentrated space (esp. w/ ↑------------)--careful w/ -----------

Back 1635

Shock
VI. Management
B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.)
3. Fluid choice--think about what has been lost
b. Colloid (Albumin, Hespain)--large therefore fluids stay in vascular space better
a. Can be given in concentrated space (esp. w/ ↑permeability)--careful w/ CHF

Front 1636

Shock
VI. Management
B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.)
3. Fluid choice--think about what has been lost
b. Colloid (Albumin, Hespain)--large therefore fluids stay in vascular space better
b. More ---------

Back 1636

Shock
VI. Management
B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.)
3. Fluid choice--think about what has been lost
b. Colloid (Albumin, Hespain)--large therefore fluids stay in vascular space better
b. More costly

Front 1637

Shock
VI. Management
B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.)
3. Fluid choice--think about what has been lost
c. Avoid in first 24-_______hrs w/ burn pts

Back 1637

Shock
VI. Management
B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.)
3. Fluid choice--think about what has been lost
c. Avoid in first 24-48hrs w/ burn pts

Front 1638

Shock
VI. Management
B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.)
4. Monitor for ------------ (try to get warm fluids)

Back 1638

Shock
VI. Management
B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.)
4. Monitor for hypothermia (try to get warm fluids)

Front 1639

Shock
VI. Management
C. Drug Therapy--goal is to correct decreased ----------

Back 1639

Shock
VI. Management
C. Drug Therapy--goal is to correct decreased tissue perfusion

Front 1640

Shock
VI. Management
C. Drug Therapy--goal is to correct decreased tissue perfusion
1. Utilized if ------------- replacement does not work

Back 1640

Shock
VI. Management
C. Drug Therapy--goal is to correct decreased tissue perfusion
1. Utilized if volume replacement does not work

Front 1641

Shock
VI. Management
C. Drug Therapy--goal is to correct decreased tissue perfusion
1. Utilized if volume replacement does not work
a. Good response is seen w/ --------- output of 30-50mL/hr (0.5mL/kg/hr for critical care)

Back 1641

Shock
VI. Management
C. Drug Therapy--goal is to correct decreased tissue perfusion
1. Utilized if volume replacement does not work
a. Good response is seen w/ urine output of 30-50mL/hr (0.5mL/kg/hr for critical care)

Front 1642

Shock
VI. Management
C. Drug Therapy--goal is to correct decreased tissue perfusion
1. Utilized if volume replacement does not work
a. Good response is seen w/ urine output of 30-______mL/hr (_______mL/kg/hr for critical care)

Back 1642

Shock
VI. Management
C. Drug Therapy--goal is to correct decreased tissue perfusion
1. Utilized if volume replacement does not work
a. Good response is seen w/ urine output of 30-50mL/hr (0.5mL/kg/hr for critical care)

Front 1643

Shock
VI. Management
C. Drug Therapy--goal is to correct decreased tissue perfusion
2. Types
a. -------------- drugs
b. Vasopressors--cause vasoconstriction

Back 1643

Shock
VI. Management
C. Drug Therapy--goal is to correct decreased tissue perfusion
2. Types
a. Sympathomimetic drugs
b. Vasopressors--cause vasoconstriction

Front 1644

Shock
VI. Management
C. Drug Therapy--goal is to correct decreased tissue perfusion
2. Types
a. Sympathomimetic drugs
b. Vasopressors--cause ------------

Back 1644

Shock
VI. Management
C. Drug Therapy--goal is to correct decreased tissue perfusion
2. Types
a. Sympathomimetic drugs
b. Vasopressors--cause vasoconstriction

Front 1645

Shock
VI. Management
C. Drug Therapy--goal is to correct decreased tissue perfusion
2. Types
a. Sympathomimetic drugs
b. Vasopressors--cause vasoconstriction
i. Dobutamine (---------)

Back 1645

Shock
VI. Management
C. Drug Therapy--goal is to correct decreased tissue perfusion
2. Types
a. Sympathomimetic drugs
b. Vasopressors--cause vasoconstriction
i. Dobutamine (Dobutrex)

Front 1646

Shock
VI. Management
C. Drug Therapy--goal is to correct decreased tissue perfusion
2. Types
a. Sympathomimetic drugs
b. Vasopressors--cause vasoconstriction
ii. D________
iii. E________

Back 1646

Shock
VI. Management
C. Drug Therapy--goal is to correct decreased tissue perfusion
2. Types
a. Sympathomimetic drugs
b. Vasopressors--cause vasoconstriction
ii. Dopamine
iii. Epinephrine

Front 1647

Shock
VI. Management
C. Drug Therapy--goal is to correct decreased tissue perfusion
2. Types
a. Sympathomimetic drugs
b. Vasopressors--cause vasoconstriction
iv. ---------- (Levophed)
v. _________

Back 1647

Shock
VI. Management
C. Drug Therapy--goal is to correct decreased tissue perfusion
2. Types
a. Sympathomimetic drugs
b. Vasopressors--cause vasoconstriction
iv. Norepinephrine (Levophed)
v. Neo-Synephrine

Front 1648

Shock
VI. Management
C. Drug Therapy--goal is to correct decreased tissue perfusion
3. ----------Effects--balancing act

Back 1648

Shock
VI. Management
C. Drug Therapy--goal is to correct decreased tissue perfusion
3. Detrimental Effects--balancing act

Front 1649

Shock
VII. Specific Interventions
A. Cardiogenic--restore blood flow to ----------- by restoring balance between --------2 supply and demand

Back 1649

Shock
VII. Specific Interventions
A. Cardiogenic--restore blood flow to myocardium by restoring balance between O2 supply and demand

Front 1650

Shock
VII. Specific Interventions
A. Cardiogenic--
1. Hemodynamic goal--decrease ----------- of heart
2. --------- therapy

Back 1650

Shock
VII. Specific Interventions
A. Cardiogenic--
1. Hemodynamic goal--decrease workload of heart
2. Drug therapy

Front 1651

Shock
VII. Specific Interventions
A. Cardiogenic--
2. Drug therapy
a. ------------ therapy
b. Decrease ---------

Back 1651

Shock
VII. Specific Interventions
A. Cardiogenic--
2. Drug therapy
a. Thrombolytic therapy
b. Decrease preload

Front 1652

Shock
VII. Specific Interventions
A. Cardiogenic--
2. Drug therapy
i. Nitrates
ii. M_______
iii. D_______

Back 1652

Shock
VII. Specific Interventions
A. Cardiogenic--
2. Drug therapy
i. Nitrates
ii. Morphine
iii. Diuretics

Front 1653

Shock
VII. Specific Interventions
A. Cardiogenic--
2. Drug therapy
c. Reduce __________--be careful with reducing afterload ↓_________

Back 1653

Shock
VII. Specific Interventions
A. Cardiogenic--
2. Drug therapy
c. Reduce afterload--be careful with reducing afterload ↓BP

Front 1654

Shock
VII. Specific Interventions
A. Cardiogenic--
2. Drug therapy
i. Inotropic drugs (------------, ------------ Epinephrine)

Back 1654

Shock
VII. Specific Interventions
A. Cardiogenic--
2. Drug therapy
i. Inotropic drugs (Dobutamine, Dopamine Epinephrine)

Front 1655

Shock
VII. Specific Interventions
A. Cardiogenic--
2. Drug therapy
i. Inotropic drugs (Dobutamine, Dopamine Epinephrine)
ii. N---------

Back 1655

Shock
VII. Specific Interventions
A. Cardiogenic--
2. Drug therapy
i. Inotropic drugs (Dobutamine, Dopamine Epinephrine)
ii. Nipride

Front 1656

Shock
VII. Specific Interventions
A. Cardiogenic--
2. Drug therapy
d. ß-blockers, ---------: ↓--------- to allow for ↑ filling time

Back 1656

Shock
VII. Specific Interventions
A. Cardiogenic--
2. Drug therapy
i. Inotropic drugs (Dobutamine, Dopamine Epinephrine)
ii. Nipride

Front 1657

Shock
VII. Specific Interventions
A. Cardiogenic--
3. Correct ---------

Back 1657

Shock
VII. Specific Interventions
A. Cardiogenic--
3. Correct arrhythmias

Front 1658

Shock
VII. Specific Interventions
A. Cardiogenic--
4. Stents, emergency ----------
5. ------------ assist devices (only in critical care)

Back 1658

Shock
VII. Specific Interventions
A. Cardiogenic--
4. Stents, emergency revascularization
5. Circulatory assist devices (only in critical care)

Front 1659

Shock
VII. Specific Interventions
A. Cardiogenic--
5. Circulatory assist devices (only in critical care)
a. IABP--↓----------- and ↑---------- blood flow

Back 1659

Shock
VII. Specific Interventions
A. Cardiogenic--
5. Circulatory assist devices (only in critical care)
a. IABP--↓afterload and ↑coronary blood flow

Front 1660

Shock
VII. Specific Interventions
A. Cardiogenic--
5. Circulatory assist devices (only in critical care)
b. VAD--outside pump ------------ blood (likely need ----------)

Back 1660

Shock
VII. Specific Interventions
A. Cardiogenic--
5. Circulatory assist devices (only in critical care)
b. VAD--outside pump diverts blood (likely need transplant)

Front 1661

Shock
VII. Specific Interventions
B. Hypovolemic--restore ------------- volume and stop fluid loss restore ----------

Back 1661

Shock
VII. Specific Interventions
B. Hypovolemic--restore circulating volume and stop fluid loss restore perfusion

Front 1662

Shock
VII. Specific Interventions
B. Hypovolemic--restore circulating volume and stop fluid loss restore perfusion
1. Optimize ----------
2. ---------- cause

Back 1662

Shock
VII. Specific Interventions
B. Hypovolemic--restore circulating volume and stop fluid loss restore perfusion
1. Optimize oxygenation
2. Correct cause

Front 1663

Shock
VII. Specific Interventions
B. Hypovolemic--restore circulating volume and stop fluid loss restore perfusion
3. Volume replacement--warm to prevent ---------

Back 1663

Shock
VII. Specific Interventions
B. Hypovolemic--restore circulating volume and stop fluid loss restore perfusion
3. Volume replacement--warm to prevent hypothermia
a. Fresh frozen plasma (FFP)

Front 1664

Shock
VII. Specific Interventions
B. Hypovolemic--restore circulating volume and stop fluid loss restore perfusion
3. Volume replacement--warm to prevent hypothermia
a. Fresh ---------- ----------- (FFP)

Back 1664

Shock
VII. Specific Interventions
B. Hypovolemic--restore circulating volume and stop fluid loss restore perfusion
3. Volume replacement--warm to prevent hypothermia
a. Fresh frozen plasma (FFP)

Front 1665

Shock
VII. Specific Interventions
B. Hypovolemic--restore circulating volume and stop fluid loss restore perfusion
4. Monitor response to --------------- (↑PAWP and central venous pressures from 0 12)

Back 1665

Shock
VII. Specific Interventions
B. Hypovolemic--restore circulating volume and stop fluid loss restore perfusion
4. Monitor response to fluid replacement (↑PAWP and central venous pressures from 0 12)

Front 1666

Shock
VII. Specific Interventions
B. Hypovolemic--restore circulating volume and stop fluid loss restore perfusion
4. Monitor response to fluid replacement (↑------------ and central venous pressures from 0 to -------)

Back 1666

Shock
VII. Specific Interventions
B. Hypovolemic--restore circulating volume and stop fluid loss restore perfusion
4. Monitor response to fluid replacement (↑PAWP and central venous pressures from 0 12)

Front 1667

Shock
VII. Specific Interventions
C. Septic--: --------- O2 supply and ------------ O2 demand

Back 1667

Shock
VII. Specific Interventions
C. Septic--optimize O2 supply and decrease O2 demand

Front 1668

Shock
VII. Specific Interventions
C. Septic--optimize O2 supply and decrease O2 demand
1. Large amounts of fluid replacement (6-______L crystalloids or 2-______L colloids)

Back 1668

Shock
VII. Specific Interventions
C. Septic--optimize O2 supply and decrease O2 demand
1. Large amounts of fluid replacement (6-10L crystalloids or 2-4L colloids)

Front 1669

Shock
VII. Specific Interventions
C. Septic--optimize O2 supply and decrease O2 demand
1. Large amounts of fluid replacement (6-10L --------- or 2-4L ----------)

Back 1669

Shock
VII. Specific Interventions
C. Septic--optimize O2 supply and decrease O2 demand
1. Large amounts of fluid replacement (6-10L crystalloids or 2-4L colloids)

Front 1670

Shock
VII. Specific Interventions
C. Septic--optimize O2 supply and decrease O2 demand
1. Large amounts of fluid replacement (6-10L crystalloids or 2-4L colloids)
a. Endotoxins ↑----------- lose lots of fluids to -------- space

Back 1670

Shock
VII. Specific Interventions
C. Septic--optimize O2 supply and decrease O2 demand
1. Large amounts of fluid replacement (6-10L crystalloids or 2-4L colloids)
a. Endotoxins ↑cap perm lose lots of fluids to interstitial space

Front 1671

Shock
VII. Specific Interventions
C. Septic--optimize O2 supply and decrease O2 demand
2. Optimize ----------

Back 1671

Shock
VII. Specific Interventions
C. Septic--optimize O2 supply and decrease O2 demand
2. Optimize CO

Front 1672

Shock
VII. Specific Interventions
C. Septic--optimize O2 supply and decrease O2 demand
2. Optimize CO
a. V---------
b. Vasopressors to ↑----------
c. I-----------

Back 1672

Shock
VII. Specific Interventions
C. Septic--optimize O2 supply and decrease O2 demand
2. Optimize CO
a. Volume
b. Vasopressors to ↑BP
c. Inotropes

Front 1673

Shock
VII. Specific Interventions
C. Septic--optimize O2 supply and decrease O2 demand
3. Correct -----------
4. Antibiotics (------------ before beginning)

Back 1673

Shock
VII. Specific Interventions
C. Septic--optimize O2 supply and decrease O2 demand
3. Correct acidosis
4. Antibiotics (cultures before beginning)

Front 1674

Shock
VII. Specific Interventions
D. Neurogenic
1. Use ----------- precautions

Back 1674

Shock
VII. Specific Interventions
D. Neurogenic
1. Use spinal precautions

Front 1675

Shock
VII. Specific Interventions
D. Neurogenic
2. Treatment of ↓BP w/ --------- and --------- therapy

Back 1675

Shock
VII. Specific Interventions
D. Neurogenic
2. Treatment of ↓BP w/ fluids and drug therapy
a. Dopamine--↑BP and is (+) cornotrope (↑HR)

Front 1676

Shock
VII. Specific Interventions
D. Neurogenic
2. Treatment of ↓BP w/ fluids and drug therapy
a. Dopamine--↑------- and is (+) --------- (↑HR)

Back 1676

Shock
VII. Specific Interventions
D. Neurogenic
2. Treatment of ↓BP w/ fluids and drug therapy
a. Dopamine--↑BP and is (+) cornotrope (↑HR)

Front 1677

Shock
VII. Specific Interventions
D. Neurogenic
2. Treatment of ↓BP w/ fluids and drug therapy
b. E---------

Back 1677

Shock
VII. Specific Interventions
D. Neurogenic
2. Treatment of ↓BP w/ fluids and drug therapy
b. Epinephrine

Front 1678

Shock
VII. Specific Interventions
D. Neurogenic
3. Monitor for ---------

Back 1678

Shock
VII. Specific Interventions
D. Neurogenic
3. Monitor for hypothermia

Front 1679

Shock
VII. Specific Intervention
E. Anaphylactic--can generally be ------------ if treated promptly

Back 1679

Shock
VII. Specific Intervention
E. Anaphylactic--can generally be reverse if treated promptly

Front 1680

Shock
VII. Specific Intervention
E. Anaphylactic--can generally be reverse if treated promptly
1. Prevention--avoidance of known ---------

Back 1680

Shock
VII. Specific Intervention
E. Anaphylactic--can generally be reverse if treated promptly
1. Prevention--avoidance of known allergen
2. Treatment

Front 1681

Shock
VII. Specific Intervention
E. Anaphylactic--can generally be reverse if treated promptly
2. Treatment
a. Maintain patient ----------

Back 1681

Shock
VII. Specific Intervention
E. Anaphylactic--can generally be reverse if treated promptly
2. Treatment
a. Maintain patient airway
b. Drugs

Front 1682

Shock
VII. Specific Intervention
E. Anaphylactic--can generally be reverse if treated promptly
2. Treatment
b. Drugs
i. --------------- (drug of choice)--peripheral vasoconstriction and bronchodilation

Back 1682

Shock
VII. Specific Intervention
E. Anaphylactic--can generally be reverse if treated promptly
2. Treatment
b. Drugs
i. Epinephrine (drug of choice)--peripheral vasoconstriction and bronchodilation

Front 1683

Shock
VII. Specific Intervention
E. Anaphylactic--can generally be reverse if treated promptly
2. Treatment
b. Drugs
i. Epinephrine (drug of choice)--peripheral ------------ and ------------

Back 1683

Shock
VII. Specific Intervention
E. Anaphylactic--can generally be reverse if treated promptly
2. Treatment
b. Drugs
i. Epinephrine (drug of choice)--peripheral vasoconstriction and bronchodilation

Front 1684

Shock
VII. Specific Intervention
E. Anaphylactic--can generally be reverse if treated promptly
2. Treatment
b. Drugs
i. Epinephrine (drug of choice)--peripheral vasoconstriction and bronchodilation
ii. Benadryl--blocks release of ---------
iii. IV steroids--↓------------ response

Back 1684

Shock
VII. Specific Intervention
E. Anaphylactic--can generally be reverse if treated promptly
2. Treatment
b. Drugs
i. Epinephrine (drug of choice)--peripheral vasoconstriction and bronchodilation
ii. Benadryl--blocks release of histamine
iii. IV steroids--↓allergic response

Front 1685

Shock
VII. Specific Intervention
E. Anaphylactic--can generally be reverse if treated promptly
2. Treatment
c. Aggressive --------- replacement (colloids) to combat ----------

Back 1685

Shock
VII. Specific Intervention
E. Anaphylactic--can generally be reverse if treated promptly
2. Treatment
c. Aggressive fluid replacement (colloids) to combat hypotension

Front 1686

Shock
VIII. Nursing Management
A. Goals
1. Assurance of adequate -------- perfusion
2. Restoration of normal ----------

Back 1686

Shock
VIII. Nursing Management
A. Goals
1. Assurance of adequate tissue perfusion
2. Restoration of normal BP

Front 1687

Shock
VIII. Nursing Management
A. Goals
3. Return/Recovery of -------- function
4. Avoidance of complications from prolonged states of -----------

Back 1687

Shock
VIII. Nursing Management
A. Goals
3. Return/Recovery of organ function
4. Avoidance of complications from prolonged states of hypoperfusion

Front 1688

Shock
VIII. Nursing Management
B. Acute Interventions
1. ------------ status
2. ---------- status
3. ----------- status

Back 1688

Shock
VIII. Nursing Management
B. Acute Interventions
1. Neurologic status
2. Cardiovascular status
3. Respiratory status

Front 1689

Shock
VIII. Nursing Management
B. Acute Interventions
4.-------- status
5. G---------
6. Skin and ----------

Back 1689

Shock
VIII. Nursing Management
B. Acute Interventions
4. Renal status
5. GI
6. Skin and temperature

Front 1690

Shock
VIII. Nursing Management
B. Acute Interventions
7. Emotional --------- or comfort

Back 1690

Shock
VIII. Nursing Management
B. Acute Interventions
7. Emotional support or comfort

Front 1691

Shock
VIII. Nursing Management
C. Health Promotion Strategies
1. Prevention--identify patients at -------
2. Interventions aimed at decreasing --------- demand

Back 1691

Shock
VIII. Nursing Management
C. Health Promotion Strategies
1. Prevention--identify patients at risk
2. Interventions aimed at decreasing O2 demand

Front 1692

Shock
VIII. Nursing Management
C. Health Promotion Strategies
3. Monitoring of ------------ balance to prevent hypovolemic shock
4. Prevention of -------------

Back 1692

Shock
VIII. Nursing Management
C. Health Promotion Strategies
3. Monitoring of fluid balance to prevent hypovolemic shock
4. Prevention of infection