Nur144 Exam 2:respiratory Disruptions

Front 1

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

Back 1

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

Front 2

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

Back 2

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 3

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 3

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 4

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 4

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 5

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

Back 5

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

Front 6

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 6

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 7

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

Back 7

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

Front 8

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

Back 8

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 9

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

Back 9

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

Front 10

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 10

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 11

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

Back 11

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

Front 12

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 12

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 13

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 13

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 14

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 14

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 15

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 15

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 16

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 16

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 17

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 17

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 18

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 18

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 19

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 19

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 20

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 20

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 21

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 21

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 22

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 22

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 23

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 23

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 24

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 24

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 25

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

Back 25

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

Front 26

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 26

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 27

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 27

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 28

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 28

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 29

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 29

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 30

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

Back 30

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

Front 31

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 31

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 32

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 32

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 33

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 33

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 34

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

Back 34

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

Front 35

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 35

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 36

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

Back 36

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 37

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

Back 37

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)
b. Non-small cell CA (80%)--Staged (TNM--tumor, node, metastasis)

Front 38

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 38

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 39

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 39

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 40

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 40

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 41

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 41

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 42

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 42

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 43

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 43

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 44

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

Back 44

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

Front 45

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

Back 45

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 46

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

Back 46

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

Front 47

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

Back 47

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

Front 48

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

Back 48

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 49

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

Back 49

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

Front 50

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

Back 50

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

Front 51

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 51

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 52

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

Back 52

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

Front 53

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

Back 53

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

Front 54

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

Back 54

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 55

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

Back 55

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

Front 56

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

Back 56

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 57

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 57

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 58

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 58

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 59

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 59

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 60

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

Back 60

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 61

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 61

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 62

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 62

FIX
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 63

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 63

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 64

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 64

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 65

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 65

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 66

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 66

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 67

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 67

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 68

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 68

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 69

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 69

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 70

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 70

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 71

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 71

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 72

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 72

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 73

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 73

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 74

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 74

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 75

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 75

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 76

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 76

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 77

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 77

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 78

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 78

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 79

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 79

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 80

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 80

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 81

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 81

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 82

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 82

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 83

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 83

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 84

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 84

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 85

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 85

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 86

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 86

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 87

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 87

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 88

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 88

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 89

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 89

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 90

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 90

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 91

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 91

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 92

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 92

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 93

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

Back 93

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 94

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 94

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 95

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 95

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 96

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 96

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 97

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 97

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 98

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 98

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 99

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

Back 99

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 100

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

Back 100

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

Front 101

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 101

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 102

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 102

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 103

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 103

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 104

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 104

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 105

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 105

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 106

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

Back 106

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

Front 107

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 107

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 108

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 108

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 109

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 109

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 110

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

Back 110

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

Front 111

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

Back 111

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

Front 112

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

Back 112

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 113

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 113

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 114

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 114

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 115

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

Back 115

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

Front 116

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

Back 116

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

Front 117

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

Back 117

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

Front 118

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

Back 118

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 119

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

Back 119

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

Front 120

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

Back 120

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

Front 121

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

Back 121

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

Front 122

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

Back 122

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

Front 123

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

Back 123

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

Front 124

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

Back 124

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

Front 125

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

Back 125

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

Front 126

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 126

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 127

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 127

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 128

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

Back 128

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

Front 129

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

Back 129

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

Front 130

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

Back 130

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

Front 131

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

Back 131

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

Front 132

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

Back 132

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

Front 133

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

Back 133

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

Front 134

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 134

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 135

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 135

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 136

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 136

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 137

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 137

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 138

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 138

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 139

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 139

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 140

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 140

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 141

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 141

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 142

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 142

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 143

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 143

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 144

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 144

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 145

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 145

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 146

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 146

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 147

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 147

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 148

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 148

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 149

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 149

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 150

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 150

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 151

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 151

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 152

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 152

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 153

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 153

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 154

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 154

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 155

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 155

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 156

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 156

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 157

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 157

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 158

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 158

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 159

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

Back 159

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 160

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

Back 160

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 161

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

Back 161

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

Front 162

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 162

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 163

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

Back 163

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

Front 164

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

Back 164

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

Front 165

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

Back 165

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

Front 166

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 166

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 167

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 167

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 168

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

Back 168

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 169

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

Back 169

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

Front 170

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

Back 170

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

Front 171

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

Back 171

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

Front 172

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

Back 172

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

Front 173

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

Back 173

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

Front 174

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

Back 174

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

Front 175

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

Back 175

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 176

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

Back 176

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

Front 177

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

Back 177

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

Front 178

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

Back 178

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

Front 179

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

Back 179

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

Front 180

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

Back 180

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

Front 181

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

Back 181

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

Front 182

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

Back 182

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

Front 183

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

Back 183

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

Front 184

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

Back 184

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

Front 185

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

Back 185

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

Front 186

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

Back 186

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

Front 187

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

Back 187

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

Front 188

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 188

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 189

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

Back 189

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

Front 190

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 190

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 191

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 191

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 192

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 192

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 193

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 193

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 194

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 194

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 195

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 195

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 196

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 196

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 197

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 197

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 198

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 198

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 199

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 199

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 200

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 200

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 201

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

Back 201

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

Front 202

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 202

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 203

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 203

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 204

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 204

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 205

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 205

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 206

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 206

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 207

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 207

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 208

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

Back 208

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

Front 209

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

Back 209

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

Front 210

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

Back 210

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

Front 211

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

Back 211

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 212

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
4. Clinical Manifestations
h. Elevated---------- with normal ---------: --key finding

Back 212

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
4. Clinical Manifestations
h. Elevated PAP with normal PAWP--key finding

Front 213

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 213

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 214

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 214

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 215

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
5. Diagnosis Criteria
a. --------------: --do not respond to ↑FiO2

Back 215

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
5. Diagnosis Criteria
a. Refractory hypoxia--do not respond to ↑FiO2

Front 216

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
5. Diagnosis Criteria
b. CXR with new bilateral -----------/--------------- infiltrates (“white out”)

Back 216

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
5. Diagnosis Criteria
b. CXR with new bilateral interstitial/alveolar infiltrates (“white out”)

Front 217

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 217

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 218

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 218

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 219

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 219

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 220

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
6. Treatment
b. Maintain adequate oxygenation-
i.-------------- Ventilatory--high frequency (100-_________breath/min)

Back 220

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 221

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
6. Treatment
b. Maintain adequate oxygenation-
ii.---------------- ratio--sedate and paralyze
iii. --------------- strategies

Back 221

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 222

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
6. Treatment
c. Optimize oxygen delivery--keep PaO2 >----------- and SaO2 >-----------

Back 222

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
6. Treatment
c. Optimize oxygen delivery--keep PaO2 >60 and SaO2 >90

Front 223

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
7. Management
a. Mechanical -----------
b. -------------- strategies

Back 223

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
7. Management
a. Mechanical ventilation
b. Positioning strategies

Front 224

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
7. Management
b. Positioning strategies
i. Lateral ------------
ii. ------------ position (-----------)--lungs down

Back 224

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 225

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 225

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 226

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 226

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 227

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
8. Complications
a. Noscomial ---------
b. --------: --can cause and also lead to
c. Pulmonary -------

Back 227

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 228

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
8. Complications
d. Pulmonary ---------
f. Stress ------------ and hemorrhage
g. Acute --------- failure

Back 228

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 229

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
8. Complications
h. A----------
i. Decreased -------

Back 229

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
8. Complications
h. Arrhythmias
i. Decreased CO

Front 230

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
8. Complications
j. DIC (disseminated------------ coagulation-often in sepsis)/T--------------

Back 230

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
8. Complications
j. DIC (disseminated intravascular coagulation-often in sepsis)/Thrombocytopenia

Front 231

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
8. Complications
k. MODS (multiple ------------ dysfunction syndrome)

Back 231

VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--
8. Complications
k. MODS (multiple organ dysfunction syndrome)

Front 232

Burns
I. Skin’s Function--all care for burns in reflective of skin’s purpose (largest body organ)
A. Protection (impairment leads to ------------)

Back 232

Burns
I. Skin’s Function--all care for burns in reflective of skin’s purpose (largest body organ)
A. Protection (impairment leads to infection)