Tcu Abt Adult Ii Acute Resp Failure & Copd

Front 1

What is the major function of the respiratory system?

Back 1

gas exchange
02 and CO2

Front 2

Inadequate exchange of O2 and CO2 can be termed as ____.

Back 2

Respiratory failure

Front 3

Inadequate transfer of O2 is called __________.

Back 3

Hypoxemia

Front 4

Increased levels of CO2 is called ____________.

Back 4

Hypercapnia

Front 5

True or False
Respiratory failure is a disease.

Back 5

False.
It is a condition that occurs as a result of one or more diseases involving the lungs or other body systems.

Front 6

What is hypoxemic respiratory failure?

Back 6

PaO2 of 60 or less when pt is receiving 60% or greater inspired O2.

Front 7

What is hypercapnic respiratory failure?

Back 7

PaCO2 above normal in combination with acidemia.
1. PaCO2 is higher than norm.
2. there is no compensation
3. pH is at a lvl where further decrease may lead to severe acid base imbalance

Front 8

What is V/Q?

Back 8

Ventilation/perfusion ratio
(relationship of ventilation to perfusion in the lungs)

Front 9

What are some types of common causes of Hypoxemic Resp failure?
(think things that would get less gas exchange)

Back 9

Pneumonia, ARDS, toxic inhalation, Massive pulmonary embolism

Front 10

What are this that can lead to hypercapnic resp failure?

Back 10

Asthma, COPD, Cystic fibrosis

Front 11

What are the 2 most common causes of hypoxemic respiratory failure?

Back 11

V/Q mismatch and shunt

Front 12

What is V/Q?

Back 12

The assumption that the volume of blood perfusing the lungs each minute is approx equal to the amount of fres gas that reaches the alveoli each minute.

Front 13

Where in the lung is the V/Q ratio greater than 1?

Back 13

Upper lungs.
There is more ventilation than perfusion. (think air rises)

Front 14

Where in the lungs is the V/Q ratio less than 1?

Back 14

The lower lungs. There is more perfussion than ventilation. (heavy liquids sink)

Front 15

What kinds of things effect V/Q and can cause a V/Q mismatch?

Back 15

increased secretions (ex: COPD, asthma)
Pain (interferes with ches/abd wall expansion)
Embolus (limits blood flow. no effect on airflow)

Front 16

_____ occurs when blood exits the heart without having participated in gas exchange.

Back 16

Shunt

Front 17

What are the two types of shunts?

Back 17

anatomic and intrapulmonary

Front 18

Why will O2 therapy not be effective if shunt is the problem?

Back 18

blood passes from the right to the left side of the heart without passing through the lungs (anatomic) or the alveoli are filled with fluid which prevents gas exchange (intrapulmonary)

Front 19

Which patient is often more critical, a V/Q mismatch or a shunt?

Back 19

Shunt. They are usually more hypoxemic and may need ventilation and high FiO2.

Front 20

______ ________ occurs when gas exchange is across teh alveolar-capillary membrane is compromised by a process that thickes or destroys the membrane.

Back 20

Diffusion limitation.

Front 21

Why does diffision limitation have more effect during exercise?

Back 21

The person's blood is pumping faster and therefore RBCs are in the lungs for a shorter time and limit the diffusion of O2 across the alveolar-capillary membranes.

Front 22

What is ventilatory supply?

Back 22

The maximum ventilation that the patient can sustain without developing respiratory muscle fatigue.

Front 23

What is ventilatory demand?

Back 23

the amount of ventilation needed to keep the PaCO2 within normal limits.

Front 24

Which is higher, ventilatory demand or ventilatory supply?

Back 24

supply exceeds demand

Front 25

When vent demand exceeds vent supply, what happens?

Back 25

hypercapnia

Front 26

What are the four main categories that can cause a drop in ventilation supply?

Back 26

1. abnormalities of teh airways and alveoli
2. abnormailites of the CNS
3. abnormalities of the chest wall
4. nuromuscular conditions

Front 27

What part of the brain will respond to CO2 levels and alter the respiratory rate?

Back 27

Medulla

Front 28

What are some implications related to respiratory distress that pts with kyphoscoliosis face?

Back 28

The change in spinal configuration compresses the lungs and prevents normal expansion of the chest wall. Therefore you might see Hypercapnic Respiratory Failure

Front 29

A patient with myasthenia gravis or Guillan-Barre has normal lungs. Why would they become hypercapnic?

Back 29

The muscles are comprimised and therefore they can't adequately breathe/blow of CO2.

Front 30

Is cyanosis an reliable indicator of hypoxemia? Why or why not?

Back 30

No. It is a late sign of resp failure and does not occur until hypoxemia is severe.

Front 31

If hypoxemia is severe, the cells will shift from _____ metabolism to ____metabolism.

Back 31

aerobic to anaerobic

Front 32

What are the consequences of anaerobic metabolism?

Back 32

Use of more fuel and the production of lactic acid. Lactic acid is hard to get rid of and requires more bicarb. If bicarb levels are low, the body can easily be thrown into metabolic acidosis and result in cell death

Front 33

How is the heart going to react to decreased levels of O2?

Back 33

The hear will increase in rate and cardiac output. (move more through faster to get more o2)

Front 34

What is the normal inspiratory to expiratory ratio? What does it mean?

Back 34

1:2
expiration is twice as long as inspiration

Front 35

POX is a good measure of lung ventilation.
True or False

Back 35

False. It monitors oxygenation status but tells nothing about the lung ventilation.

Front 36

Note about planning for pt in acute respiratory failure . . .

Back 36

you want to get things to normal for the Patient. Not necessarily the population normals.

Front 37

True or False
The best way to treat intralumonary shunt is with O2.

Back 37

False - they are not going to respond because the blood isn't going through the exchange process. These people will probably need PPV. Positive Pressure Ventilation.

Front 38

What level does O2 become toxic?

Back 38

60%

Front 39

What are some ways to mobilize secretions?

Back 39

suctioning, coughing, hydration and humidification, and CPT

Front 40

What is augmented coughing?

Back 40

place both hands on the abd below the xiphoid process. at the end of deep inspiration , move hands forcefully downward. helps increase expiratory flow.

Front 41

What are some reasons why drug therapy would be indicated for the acute respiratory failure.

Back 41

1. relief of bronchospasm(short acting bronchodilator)
2. reduction of airway inflammation(solu-medrol) and pulmonary congestion (Lasix)
3. tx of pulmonary infection (Vanc or Rocephin)
4. reduction of severe anxiety and restlessness (Ativan, Diprivan)

Front 42

If a person has a MAP greater than 60 and systolic greater than 90 and is experiencing a change in LOC, what can you conclude?

Back 42

The change may be attributed to levels of O2 and CO2, not lack of cerebral perfussion.

Front 43

ARDS stands for what?

Back 43

Acute Respiratory Distress Syndrome

Front 44

ARDS has a ____ onset.

Back 44

sudden

Front 45

What is ARDS? What happens in the lungs?

Back 45

The alveoli fill with fluid and result in severe dyspnea

Front 46

What is the most common cause of ARDS?

Back 46

sepsis

Front 47

What is the first phase of ARDS? describe it.

Back 47

Injury or exudative phase.
1-7 days after injury/insult; neutrophils adhere to lung tissue and damage the vascular edothelium which makes it more permeable; fluid then shifts in; then intrapulmonary shunt develops because the fluid blocks the blood from passing and becoming oxygenated.

Front 48

What is teh second phase of ARDS? Describe it.

Back 48

Reparative/Proliferative Phase.
Lung tissue is trying to heal and dense fibrous tissue forms. Lung compliance decreases. If this phase stops, then lesions will resolve. If not, then they can become fibrotic.

Front 49

What is the last phase of ARDS? Describe it.

Back 49

Fibrotic Phase. lung is completely remodeled by collagenous and fibrous tissues. surface area for gas exchange is significantly reduced.

Front 50

Rupture of overdistended alveoli during mechanical ventilation is known as _____.

Back 50

Barotrauma

Front 51

What is volu-pressure trauma.

Back 51

occurs when large tidal volumes are used to ventilate non-compliant lungs

Front 52

What are the most common forms of manifestation of a PE?

Back 52

anxiety and sudden onset of dyspnea, tachypnea, or tachycardia.

Front 53

Warfarin levels are titrated based on what?

Back 53

INR

Front 54

Heparin levels are titrated based on what?

Back 54

aPTT

Front 55

Activase does what?

Back 55

It is a fibrinolytic agent. Acts to dissolve clots. Warfarin/Heparin are inhibitors.