Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
95 Cards in this Set
- Front
- Back
- 3rd side (hint)
|
Definition of circadian rhythm
|
Natural timing system, or "internal clock."
|
2.6
|
|
|
Cardiac function decline in aging
|
With aging cardiac function declines largely related to atherosclerosis, calcium build up, forming paque in coronary arteries. Also increase chance of aneurysm. More than 60% of 65 or older haver atherosclerotic disease.
|
9.11
|
|
|
Physical changes that occur after 25
|
The disks in the spine begin to settle, and height can sometimes shrink. Fatty tissue increase, as well as your weight. Muscle strength decrease. Reflexes slow, which can lead to accidents even causing death.
|
9.10
|
|
|
Definition of age parameters for infancy
|
Neonates birth to 1 month
Infants 1 month to 1 yr Toddlers 1yr to 3yr Preschoolers 3yr to 6yr School-age 6yr to 12yr Adolescents 12yr to 18yr |
9
|
|
|
Airway changes in older adults
|
The size of the airway increases and the surface are of the alveoli decreases.
|
9.12
|
|
|
Fontanelle development in the infant
|
These three or four bones of the skull eventually bind together and form suture joints within 18 months of birth.
|
9.4
|
|
|
Causes of subdural hematomas in older adults
|
Bleeding emptying into the void cause by the shrinkage of the brain.
|
9.12
|
|
|
Psychosocial factors for 35+ person
|
They realize the are approaching the halfway point of human life expectancy. Many at this point experience their children leaving causing "empty nest" syndrome. Finances may worsen as they look towards retirement.
|
9.10
|
|
|
Definition of belly breathing and where it is most common
|
Breathing with movement of the abdomen. You see it in infants often.
The rib cages of infants are less rigid than those of older humans, and the ribs sit horizontally. This explains the diaphragmatic breathing ("bell breathing") in infants. |
9.4
|
|
|
Acquired immunity in the first year of life
|
While in the womb, infants collect antibodies from the maternal blood. For the first year of life, the infant maintains some of the mother's immunities, so he or she has naturally acquired passive immunities. Infants can also receive antibodies via breastfeeding.
|
9.4
|
|
|
Primary communication of the infant
|
crying
|
9.6
|
|
|
Peer effects on school aged children
|
Conventional reasoning, they look for approval from their peers and society.
Start to try and "fit in" with peers. |
9.9
|
|
|
Respiratory in younger vs older
|
When a younger pt inhales, the airway maintains its shape, allowing air to enter. As the smooth muscles of the lower airway weaken with age, strong inhalation can make the walls of the airway collapse inward and cause inspiratory wheezing. The collapsing airway results in low flow rates, because less air can move through the smaller airways, and air trapping, because air does not completely exit the alveoli (incomplete expiration).
|
9.12
|
|
|
Changes is school aged child
|
Most children grow about 4 lb (2kg) and 2 and half inches (6cm) each yr. Also get their permanent teeth in this period.
|
9.8
|
|
|
Definition of mid life crisis
|
A person who makes a dramatic gesture in a bid to reclaim their youth.
|
9.10-11
|
|
|
Renal function changes in the older adult
|
Kidneys function decline about 50% from the age of 20 yrs and 90yrs.
|
9.12
|
|
|
Pupil and ocular changes is older adults
|
Pupillary reaction and ocular movements become more restricted with age. The pupils are generally smaller in older pts, and the opacity of the eye's lens diminish visual acuity and makes pupils sluggish to light. Lens become thicker making it harder to focus, peripheral vision become narrower, and greater sensitivity to glare.
|
9.13
|
|
|
Physical changes in the infant vs. the toddler
|
The heart rate and respiratory rate are slower than the corresponding vital signs in infants, where the systolic blood pressure is higher.
|
9.7
|
|
|
Growth spurts in boys vs. girls
|
As a whole boys experience this stage of development later in life than girls do. When this period of growth has finished, however, boys are generally taller and stronger than girls.
|
9.9
|
|
|
Closing of ductus arteriosus after birth
|
Prior to birth, fetal circulation occurs through the placenta which is connected to the ductus venosus and ductus arteriosus. Just after birth, the ductus venous constricts and closes.
|
9.3
|
|
|
Digital capnometry parameters
|
When it falls below 30 mm Hg it should alert you of a possible problem.
|
11.60
|
|
|
Structures of the upper airway
|
Consist of all anatomic airway structures above the level of the vocal cords. Its major functions are to warm, filter, and humidify air as it enter the body through the nose and mouth.
|
11.6
|
|
|
Emergent airway considerations in the burn patient
|
Use humidified oxygen for passive breathing pts.
May require intubation or more advance airway. Watch for nasty goo in ET tube. |
|
|
|
Additional processes to open the airway and view the vocal cords
|
?
|
|
|
|
What pulse oximetry measure
|
Measures the percentage of hemoglobin in the arterial blood that is saturated.
|
11.18
|
|
|
S/S of the need for tracheal suctioning
|
gurgling ?
|
|
|
|
Definition of hypoxemia
|
Decrease in arterial oxygen level.
|
11.16
|
|
|
Definition and location of laryngopharnyx
|
The lowest portion of the pharynx; it opens into the larynx anteriorly and the esophagus posteriorly.
|
11.6
|
|
|
Characteristic of biot respirations
|
Irregular pattern, rate, and depth with intermittent periods of apnea; results from increased intracranial pressure.
|
11.18
|
|
|
The average depths fo ET placement
|
The average depth for adult patients is 21 to 25 cm.
|
11.61
|
|
|
Digital tube placement procedures
|
1. BSI
2. Preoxygenate patient for 2 to 3 minutes 3. Check, prepare, and assemble equipment. 4. Bend ET tube by placing a slight curve at its distal end like a hockey stick. 5. Place patient's head in a neutral position. 6. If possible place bite block. 7. Insert your left middle and index fingers into the patient's mouth and shift the pt's tongue forward as you advance your fingers toward the pt's larynx. 8. Palpate and lift the epiglottis with your left middle finger. 9. Advance the tube with your Rt hand and guide it in between the vocal cords with your index finger. 10. Remove the stylet from the ET tube. 11. Inflate the distal cuffof the ET tube and DETACH syringe. 12. Check placement and secure tube. |
11.71
|
|
|
Disadvantages of endotracheal intubation
|
Requires special equipment, bypasses physiologic function of the upper airway (warming, filtering, and humidifying.
|
11.52
|
|
|
Definition of surfactant
|
Proteinaceous substance that lines alveoli and decrease surface tension on the alveolar wall and keeps them expanded.
|
11.9
|
|
|
The use of oxygen in myocardial infarction pt
|
?
|
|
|
|
Definition and occurence of atelectasis
|
If the amount of pulmonary suractant is decreased or alveoli are not inflated, the collapse.
|
11.9
|
|
|
Neuronal control of breathing
|
Can be trace the medulla. The involuntary control of breathing originates in the brain stem--specifically the pons and medulla.
|
11.12
|
|
|
ET tube size for average adult
|
The average female size is 7 to 8 mm
The average male size is 7.5 to 8.5 mm |
11.53
|
|
|
Components and process of hypoxic drive
|
The "back system" or secondary control of breathing. Usually breathing is based off of the PaCO2 and pH of CSF, the chemoreceptors in the carotid bodies and aortic arch also respond to decrease levels of oxygen in the plasma PaO2, sending a message to the respiratory center to increase the rate and depth of breathing. Usually only seen in end stage COPD pt's.
|
11.12
|
|
|
Considerations for a blocked tracheostomy tube
|
Suction and limit to only 10 seconds to keep from causing laryngospasm.
|
11.103
|
|
|
Reasons for increase compliance with the BVM
|
Proper use
Improper use includes not opening airway, poor mask for face seal, and gastric distention. |
11.43
|
|
|
Reasons for a false high pulse ox reading
|
It can not tell the difference between hemoglobin saturated with oxygen or carbon monoxide. CO poisoning causes false highs.
|
11.19
|
|
|
Head postition for the orotracheal intubated pt
|
sniff position
|
11.65
|
|
|
Location of external jugular vein
|
sides of the neck
|
|
|
|
Definition and location of the valeculla
|
An anatomic space, or "pocket," located between the base of the tongue and the epiglottis. An important landmark for endotracheal intubation.
|
11.8
|
|
|
Respiratory rate for adults at rest
|
12 to 20 per minute
|
9.4
|
|
|
S/S of orthopnea
|
The inability to breathe easily unless one is sitting up straight or standing erect.
medterms.com |
medterms.com
|
|
|
Effects of non-humidified oxygen
|
Will rapidly dry the pt's mucous membranes.
|
11.39
|
|
|
Ventilation rates in adults
|
Apneic with a pulse:10 to 12 breaths/min
-With or without advance airway in place Apneic and pulseless:8 to 10 breaths/min -After advanced airway has been inserted. |
11.41
|
|
|
Causes of laryngeal spasm and edema
|
foreign material in airway
trauma and irritation to airway. |
|
|
|
Complications of anemia
|
Decrease in RBC, as well as hemoglobin, what carries oxygen throughout the body. So the oxygen does not have enough transport to do its job. We can not fix this in the field, they need blood.
|
11.14
|
|
|
Effects on forceful inhalation on the vocal cords
|
During forceful inhalation, the vocal cords open widely to provide minimum resistance to air flow.
|
11.8
|
|
|
Sequence steps managing an airway
|
Head Tilt-Chin Lift with no trauma
Jaw-Thrust with trauma |
11.20-21
|
|
|
Effects of properly performed cricoid pressure (Sellick's)
|
Alleviated gastric distention and helps to prevent passive regurgitation with aspiration during positive-pressure ventilation.
|
11.47
|
|
|
Amount of air left in the physiologic dead space
|
In the adult, about 30% of the normal tidal volume remains in the upper airway or dead space which is ~150mL. Dead space is any portion of the airway where air lingers, and does not participate in gas exchange.
|
11.10
|
|
|
Steps prior to placing a commercial ET tube restraint
|
Never take your hand off the ET tube before it has been secured with the tape or a commercial device.
|
11.61
|
|
|
The DOPE pneumonic
|
Troubleshooting acute deterioration in intubated child
DOPE Displacement Obstruction Pneumothorax Equipment failure |
11.82
|
|
|
Airway management and tongue considerations
|
Move tongue out of the way with proper head placement and airway adjunts
|
|
|
|
Considerations when placing the stylette in the ET tube
|
Should be lubricated with water soluble gel to faciliate removal and form a gentle "hockey stick curve. The end of the stylet should rest at least half inch back from the end of the ET tube.
|
11.54
|
|
|
Process of soft tip suction catheter
|
Must be lubricated when suction nasopharynx and down ET tube.
Always MEASURE. |
11.30-31
|
|
|
Functions of the lower airway
|
Exchange oxygen and carbon dioxide.
|
11.9
|
|
|
Advantages of the three person BVM`
|
Provides better ventilation than with only 2 or 1 rescuers.
|
11.43
|
|
|
Uses of gastric tube
|
Remove contents of stomach, removing air and liquid, decreasing the pressure on the diaphragm and virtually eliminates the risk of regurgitation and aspiration.
|
11.48
|
|
|
Cautions concerning intubation and the cricothyroid membrane
|
Possible laceration of EJ vein causing massive bleeding or puncture to highly vascular thyroid gland.
|
11.99
|
|
|
S/S of inadvertent extubation
|
capnography declines
no cx rise no lung sounds etc |
|
|
|
Process for two person ventilation
|
One holds seal the other squeezes bag and watch for chest rise.
|
11.43
|
|
|
Angle of insertion for needle cricoidthyrotomy
|
45 degree angle toward the feet
|
11.103
|
|
|
Definition of endotracheal intubation
|
Passing an endotracheal ET tube through the glottic opening and sealing the tube with cuff inflated against the tracheal wall.
|
11.51-52
|
|
|
Breathing patterns that do and do not suggest brain injury
|
?
|
|
|
|
Positive pressure vs negative pressure ventilation
|
Negative ventilation is normal ventilation by the patient when air flow from the higher pressure outside the body, to area of low pressure the lungs. Positive pressure is the method of assisting ventilation.
|
Glossary
|
|
|
Characteristics of asymmetric chest wall movement
|
When ones side of the chest moves less than the other, indicates that airflow into one lung is decreased.
|
11.16
|
|
|
Definition of tidal volume
|
A measure of the depth of breathing, is the volume of air that is inhaled or exhaled during a single respiratory cycle.
|
11.10
|
|
|
Definition of ventilation
|
The process of moving air into and out of the lungs.
|
11.13
|
|
|
Advantages of endotracheal intubation
|
Provides a secure airway, protects against aspiration, provides an alternate route to IV/IO for certain meds in last resort.
|
11.52
|
|
|
Pts who require nasopharyngeal airway
|
Pts who are breathing spontaneously, but require definitive airway management to prevent further deterioration of their condition. Conscious pts or pts with alter mental status and with intact gag reflex, who are in respiratory failure secondary to conditions such as COPD, asthma, or pulmonary edema are excellent candidates for nasotracheal intubation.
|
11.64
|
|
|
Definition of tracheostomy
|
A surgical opening into the trachea thus creating a stoma or hole.
|
11.103
|
|
|
Risk associated with extubation
|
Pt's inability to protect own airway.
On conscious pts it poses a high risk of laryngospasm, causing swelling making it harder to reintubate them. |
11.77
|
|
|
Risk associated with patient with a suppressed cough mechanism
|
Can't get the junk up
|
|
|
|
Definition of laryngoscopy
|
Examination of the larynx with a mirror (indirect laryngoscopy) or with a laryngoscope (direct laryngoscopy).
medterms.com |
medterms.com
|
|
|
What is the whistle tip suction cath used for?
|
Used for suction in the oropharynx, nasopharynx, or down the ET tube.
|
11.30
|
|
|
Steps prior to orotracheal intubation
|
BSI
Airway adjunt Preoxygenate pt Check equipment |
|
|
|
Advantages of multilumen airway
|
Effective and cannot be improperly placed, minimum c-spine movement, and no mask seal needed.
|
11.85
|
|
|
Definition of laryngospasm
|
Spasmodic closure of the vocal cords, which seals off the airway.
|
11.8
|
|
|
Factors that increase a persons respiratory rate
|
Increase in CO2 acidity of CSF tribbers chemoreceptors to increase the rate and depths of breaths.
Also back up receptors sense to low of oxygen and do the same. |
11.12
|
|
|
Complications of using an ET tube too large for the pt
|
Unable to extend beyond vocal cords without causing trauma.
|
|
|
|
Complications of airway obstruction secondary to sever allergic reaction
|
Swelling and constriction of the airway they need meds.
|
|
|
|
Contraindicaiton for nasotracheal intubation
|
Apneic pt, they should receive oral intubation. Head injury with possible midline fx (CSF drainage), deviated septums, nasal polyps, cocaine users.
|
11.62
|
|
|
Blade placement of orotracheal intubation
|
Insert to rt side of mouth and sweep tongue to the lt side, while moving blade into midline. Slowly advance blade back exert traction at 45 degree angle prevent prying back on teeth.
|
11.56-11.57
|
|
|
Definition of external respiration
|
External respiration or pulmonary respiration is the exchange of gases between the lungs and the blood cells in the pulmonary capillaries.
|
11.14
|
|
|
Use of EDD in ET tube confirmation
|
The esophageal detector device is deflate prior to attachment to ET tube and should easily move back to original structure confirming placement as it pulls air from the lungs.
|
11.60
|
|
|
Tx of poor lung compliance in the apneic pt
|
Readjust airway
Place advance airway May have gastric distension and need gastric tube place. |
|
|
|
Rt lung vs Lt Lung
|
Rt lung has 3 lobes
Lt has only 2 lobes due to room needed for heart. |
|
|
|
Curved vs. straight blade
|
The straight blade is design to extend beneath the epiglottis and lift it up, particularly useful in younger pts who have floppy epiglottis. In adults they pose the risk of damage to teeth cause by prying.
The tip of the curve blade is place in the vallecula lifting the epiglottis out of the way. The curve forms better for the adults. |
11.53-54
|
|
|
Sizing the nasogastric tube
|
Nose/mouth to ear to xiphoid process.
|
11.49
|
|
|
When negative pressure ventilation occurs
|
As the air pressure inside the chest falls below that of the higher pressure (out side the body) to the region of lower pressure (the lungs). When the pressures inside and outside are equal, inhalation stops. Oxygen and carbon dioxide then diffuse across the alveolar capillary membrane in the lungs.
|
11.13
|
|
|
Where involuntary control of breathing originates
|
The brain more specifically the medulla and pons of the brain stem.
|
11.12
|
