Respiratory 2

Front 1

Hypercapnic RF results from an imbalance between?

Back 1

Ventilatory supply and Ventilatory Demand

Front 2

Define Ventilatory Supply

Back 2

The MAXIMUM ventillation (gas flow in and out of lungs) that someone can sustain without developing resp muscle fatigue

When ventilatory demand EXCEEDS vent supply (needing a lot more ventilation to keep Co2 within normal limits)

Front 3

Define Ventilatory Demand

Back 3

The amount of VENTILATION (gas) that is needed to keep PaC02 within normal limits

Front 4

Normally, ventillatory ____ exceeds demand

Back 4

SUPPLY (people can handle a lot of gas without getting muscle fatigue) Therefore people can exercise great and not have to worry about a huge increase in PaC02

(But not people with COPD, other problems)

Front 5

Hypercapnia reflects ____ lung dysfunction

Back 5

Substantial

Front 6

Hypercapnic RF is sometimes called?

Back 6

Ventilatory Failure (Primary problem: Respiratory system INABILITY to remove sufficient C02 to maintain NORMAL PaC02.

Front 7

Hypercapnic RF can ALSO be labeled as?

Back 7

Acute vs. Chronic

Front 8

MANY different diseases can cause a limitation in ventilatory supply. The diseases can be grouped into 4 categories. Name them

Back 8

1) Abormalities of Airways +Alveoli

2) Abnormalities of CNS

3) Abnormalities of Chest Wall

4) Neuromuscular Conditions

Front 9

People that have airway/alveoli abnormalities are at HIGH risk for Hypercapnic Respiratory Failure because, such conditions result in airflow OBSTRUCTION and air trapping. List some of the conditions (3)

Back 9

1. Asthma

2. CPOD

3. Cystic Fibrosis

Front 10

Ultimately, Respiratory muscle fatigue and ventilatory failure occur d/t?

Back 10

Additional WORK needed to inspire adequate tidal volumes against such increased airway resistance/air trapped within alveoli

Front 11

A variety of CNS problems may SUPRESS the drive to? Name an example

Back 11

Breathe ; Overdose of a respiratory depressant drug (opiods, benzodiazepines)

CNS DEPRESSANTS.

Front 12

CNS depressants DECREASE C02 reactivity in?

Back 12

Brainstem. (this allows arterial Co2 levels to rise)

Front 13

Other examples of CNS situations that can cause hypercapnic RF include? (3)

Back 13

Brainstem infarction, severe head injury (mess with the respiratory center in medulla)

+High level spinal cord injuries

People at risk because the medulla doesn't ALTER the respiratory rate based on a change in PaC02.

Front 14

Metabolic or structural brain injury resulting in DECREASED or LOSS of consciousness, may interfere with the patient's ability to manage ___ or adequately protect his/her airway

Back 14

Secretions

Front 15

Chest wall abnormalities. Several conditions can PREVENT normal movement of the chest wall and LIMIT lung ___

Back 15

Expansion (Causing PaC02 to build up)

They also limit diaphragmatic movement, therefore gas exchange

Front 16

List examples of such chest wall abormalities (3)

Back 16

1) Flail Chest: Fractures prevent rib cage from expanding d/tpain, mechanical restriction, and muscle spasm

2) Kyphoscoliosis: Change in spinal configuration COMPRESSES the lungs and prevents normal expansion of chest wall

3) Obesity: Weight of chest/abdominal contents may limit expansion

Front 17

Various types of NEUROMUSCULAR conditions/diseases may result in respiratory muscle weakness or PARALYSIS. List examples of those that are unable to maintain adequate PaC02 levels

Back 17

Muscular Dystrophy, Multiple Sclerosis, Myasthenia Gravis

Front 18

Why are they at risk?

Back 18

Respiratory muscles are weakened or paralyzed d/t result of UNDERLYING neuromuscular condition

(Muscle wasting, peripheral nerve damage, prolonged effects of neuromuscular blocking agents, etc)

Front 19

Neuromuscular disorders may be acquired as a consequence of exposure to?

Back 19

Toxins (they can interefere with NERVE supply to muscle and lung ventilation)

Front 20

RF occurs because what things may not be functioning normally?

Back 20

1) Medulla

2) Chest wall

3) Peripheral Nerves tissue

4) Respiratory Muscles

5) Damage to lung

Front 21

May be UNABLE to INSPIRE a TIDAL VOLUME, sufficient enough to remove ___ from lungs

Back 21

C02

Front 22

Remember that even though Pa02 and PaC02 determine the defintion of RF, the major cause of RF is the lungs inability to meet?

Back 22

Lungs can't meet the 02 needs of the tissues

(inadequate 02 delivery to tissues, or tissues may not even be able to use the 02 delivered to them) May also occur due to overall stress response and dramatic increases in tissue 02 consumption (if happening too fast)

Front 23

Tissue 02 delivery is determined by what 2 main things?

Back 23

Cardiac Output + Amount of 02 carried in hemoglobin

Front 24

RF can put the patient at GREATER risk, if they have heart problems or anemia. t/f?

Back 24

True

Front 25

Failure of 02 use most commonly occurs in?

Back 25

Septic Shock (While adequate oxygen may be delivered to the tissues, impaired o2 extraction or diffusion limitation is existing at the cellular level) This results in ABNORMALLY HIGH 02 returning in venous blood, because it is not used a the tissue level

Front 26

What else may interfere with 02 delivery to peripheral tissues?

Back 26

Acid-Base Alterations ( Ex: Alkalosis and Acidosis)

Front 27

Clinical Manifestations. RF may develop ____ (minutes or hours) or gradually (several days or longer)

Back 27

Suddenly

Front 28

A sudden DECREASE in Pa02 or RAPID increase in PaC02, implies a?

Back 28

Serious condition (Ex: Asthma patient with severe bronchospasm) Could result in rapid respiratory muscle fatigue, acidemia, and RF (C02 build up)

This happened rapidly, so dangerous

Front 29

A more GRADUAL change in Pa02 and Pac02 is better tolerated because?

Back 29

Compensation can occur (Ex: If patient with COPD developed a respiratory infection over several days, and their renal compensation kicked in to minimize change in arterial PH to prevent respiratory acidosis

Front 30

Manifestations of RF are r/t to the EXTENT of change in Pa02 or PaC02, how rapid the change happened (acute vs chronic), + patients ability to compensate for the change. T/F

Back 30

True :) Very Important

Front 31

When the patient's compensatory mechanisms FAIL, ____ occurs

Back 31

RF

Front 32

Because clinical manifestations vary, its important to watch for trends in? (3)

Back 32

1) ABG's

2) Pulse Oximetry

3) Assessment Findings

Front 33

Frequently, the FIRST indication of RF is a change in the persons?

Back 33

Mental Status (Not getting enough o2)

(Brain sensitive to variations in 02, C02, and acid-base balance)

Front 34

Mental status changes occur EARLY, even before the ___ results are obtained

Back 34

ABG

Front 35

What behaviors suggest INADEQUATE 02 delivery to the brain and should be FULLY investigated?

Back 35

1) Restlesness

2) Confusion

3) Agitation

4) Combative Behavior

Front 36

Manifestations may be PRIMARY OR SECONDARY. Explain the difference between the 2

Back 36

1) Primary: Arising from the Respiratory System

2) Secondary: Arising from body systems

Front 37

What are some examples of symptoms that indicate that the heart and lungs are trying to compensate for decreased 02 delivery.

Back 37

Tachycardia, Tachypnea, Mild Hypertension (to try and deliver more blood/oxygen to the brain. Respirations, trying to breathe in more air and get 02)

May develop due to stress/rise in catecholaime levels

Front 38

A SEVERE morning HA may suggest that ____ occured during the night. And why?

Back 38

Hypercapnia

(Hypercapnia causes CEREBRAL vasodilation, increasing cerebral blood flow, and a mild increase in ICP): produces the HA

Front 39

At night the respiratory rate is slower and the lungs of patients at risk for respiratory failure may remove less?

Back 39

PaC02

Front 40

Rapid shallow breaths suggest that tidal volume may be INADEQUATE to remove __ from lungs

Back 40

C02 (trying to remove excess c02)

Front 41

____ is an UNRELIABLE indicator of hypoexemia and is a LATE sign of respiratory failure because it doesn't even occur until hypoxemia is super severe =

Back 41

Pa02 of 45 mm Hg or less

Front 42

Consequences of Hypoexemia and Hypoxia. Hypoxemia occurs when the amount of 02 in ARTERIAL blood is less than?

Back 42

The NL value

Front 43

Normal Pa02 is?

Back 43

80-100 mm Hg

Front 44

Hypoxia occurs when the Pa02 falls SUFFICIENTLY to cause signs and symptoms of?

Back 44

Inadequate Oxygenation

Front 45

HYPOXEMIA can lead to HYPOXIA if not ___

Back 45

Corrected

Front 46

If hypoxia or hypoxemia is SEVERE, the cells can shift from?

Back 46

Aerobic to ANAEROBIC metabolism

Front 47

Anaerobic metabolism uses MORE fule+ produces ___ energy

Back 47

LESS

(Overall less sufficient than aerobic metabolism)

Front 48

What is the BYPRODUCT of anaerobic respiration?

Back 48

LACTIC ACID (which is even MORE difficult to remove from the body than C02, because it has to be BUFFERED with Sodium Bicarb)

Front 49

When the body doesn't have enough sodium bicarb to BUFFER that lactic acid produced by anaerobic metabolism, what can occur? (3)

Back 49

1) Metabolic ACIDOSIS

2) Tissue and Cellular Dysfunction

3) Cell Death may occur

Front 50

With anaerobic metabolism, what two elements can fall? (2)

Back 50

1) BP

2) CO

Front 51

When anaerobic metabolism is going on and can cause BP+ CO to drop, certain agents may be less effective in that acidotic enviornment. Name two examples of these agents that may be less effective?

Back 51

1) Vasoactive

2) Inotropic

Front 52

Hypoxia and metabolic acidosis have ADVERSE effects on?

Back 52

Vital organs, especially heart and CNS

Front 53

HTN occurs primarily due to?

Back 53

Increased stress/Cat response

Front 54

As Pa02 decreases and acidosis increases, the myocardium becomes DYSFUNCTIONAL and CO may?

Back 54

Decrease

Front 55

Along with all the other clinical manifestations, what other 2 symptoms may occur?

Back 55

Angina, Dysrhythmias

Front 56

Permanent brain damage can occur if hypoxia is SEVERE and prolonged T/F

Back 56

True

Front 57

Renal function may also be impaired, resulting in?

Back 57

Sodium Retention, Edema, Acute Tubular Necrosis, and uremia

Uremia:a raised level in the blood of urea and other nitrogenous waste compounds that are normally eliminated by the kidneys.

Front 58

GI system alterations include

Back 58

Tissue ischemia, increased perm of intestinal wall, + possible migration of bacteria from GI tract into circulation

Front 59

Patients in RF can have breathing that is either?

Back 59

1) RAPID and shallow- can lead to resp muscle fatigue

2) SLOWER respirations than normal

(Both patterns predispose the patient to insufficient C02 removal)

Front 60

A change from a RAPID to a SLOWER rate in a patient with acute respiratory distress (ex: asthma), suggests extreme progression of respiratory muscle fatigue and increased probability of?

Back 60

Respiratory Arrest

Front 61

The patient's position is an indication of the effort associated with?

Back 61

WOB (work of breathing) + effort used for muscle contraction during inhalation to accomplish lung ventilation

Front 62

What would indicate that the patient is in mild distress?

Back 62

If the patient is able to lie down

Front 63

What would indicate that the patient is in moderate distress?

Back 63

Able to lie down, but prefer to sit

Front 64

What would indicate that the patient is UNABLE to breathe unless sitting upright?

Back 64

SEVERE Distress.

Front 65

Define TRIPOD position- helps to decrease?

Back 65

Indicative of the client with CPOD, having to sit with arms propped on overhead table, or on knees.

Helps decrease WOB, since propping the arms increases ANTEROPOSTERIOR DIAMETER of chest and changes pressure in the thorax. (or for those with asthma)

Front 66

Patients may also use what type of breathing to help increase Sa02, due to the fact that it slows respirations, allows more time for exporation, and prevents the small bronchioles from collasping (helps air exchange)

Back 66

Pursed lip breathing

Front 67

Another assessment is- How many pillows does the patient need to breathe comfortably, when lying flat. What is this called?

Back 67

Orthopnea (ex: 1, 2, 3, or 4) , along with how far the patient can walk without having to stop for rest.

Front 68

The patients ability to speak indicates the severity of the?

Back 68

Dyspnea

Front 69

The Inspiratory (I) to Expiratory (E) (I:E) ratio may change, in patients with?

Back 69

Respiratory distress

Front 70

Normally, I:E ratio is?

Back 70

1:2 (expiration is TWICE as long as inspiration)

This could increase up to 1:4, which signifies airflow obstruction

(requiring more time is needed to empty lungs)

Front 71

May observe retraction:

Back 71

INWARD movement of the intercostal spaces or supraclavicular area and use of accessory muscles (sternocledio) during inspiration or expiration.

Front 72

Use of accessory muscles signifies _____ distress. Paradoxic breathing indicates ___ distress

Back 72

Moderate; Severe.

Front 73

Normally, the abdomen and chest move ioutward during inhalation, and inward during?

Back 73

Exhalation

Front 74

Paradoxic breathing results in? Results from?

Back 74

The abdomen and the chest moving in the OPPOSITE manner (outward during exhalation, and inward during inspiration)

Results from maximal use of accessory muscles of respiration. Patient may also be diaphoretic from WOB

Front 75

We need to perform breath sounds to assess the patients baseline breath sounds and note any changes from?

Back 75

Baseline

Front 76

Note and document the presence and location of any?

Back 76

Abnormal Breath Sounds

Front 77

Crackles- generally heard on?

Back 77

INSPIRATION (may indicate pulmonary edema)

Front 78

Rhonchi (generally heard on expiration), may indicate?

Back 78

additional lung secretions and may be symptomatic of pneumonia or COPD

Front 79

Absent or diminished breath sounds may indicate?

Back 79

Atelectasis, pleural effusion, or impaired inspiratory effort and hypoventilation.

Front 80

Bronchial breath sounds over the lung periphery often indicate?

Back 80

Lung consolidation from pneumonia

Front 81

A pleural friction rub may also be heard in the presence of pneumonia that involves the?

Back 81

Pleura

Front 82

Diagnostic studies. AFTER physical assessment, the most common dx studies to evaluate resp failure are?

Back 82

1) Chest X ray

2) ABG Analysis

Front 83

A chest x ray helps to determine the possible cause of?

Back 83

Respiratory Failure (Ex: Atelectasis, Pneumonia)

Front 84

ABGS determine the levels of?

Back 84

PaC02, Pa02, Bicarbonate, and PH