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66 Cards in this Set
- Front
- Back
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A surgical incision into the trachea for the purpose of establishing an airway:
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-Tracheotomy
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The stoma (opening) that results from the tracheotomy:
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-Tracheostomy
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Describe 4 indications for a tracheostomy:
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1.) Bypass an upper airway obstruction
2.) Facilitate removal of secretions 3.) Permit long-term mechanical ventilation 4.) Permit oral intake and speech in the pt who requires long-term mechanical ventilation |
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Describe the advantages for a patient with a tracheostomy:
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1.) Less risk of long-term damage to the airway
2.) Comfort may be increased 3.) Patient can eat 4.) Mobility may be increased due to increased security |
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Care of a patient with a tracheostomy involves:
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-suctioning the airway to remove secretions
-cleaning around the stoma -changing tracheostomy ties |
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A tracheostomy tube with an inflated cuff is used when?
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-If the patient is at risk of aspiration
OR -If the patient needs mechanical ventilation |
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Cuff inflation should not exceed_____.
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-20 mm Hg or 25 cm H2O
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What precautions are taken during a tube replacement?
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1.) A replacement tube of equal or smaller size is kept at bedside, readily available for emergency reinsertion
2.) Tracheostomy tapes are not changed for at least 24 hours after the insertion procedure 3.) The first tube change is performed by a physician usually no sooner than 7 days after the tracheostomy |
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After the first tube change, how often should a trach tube be changed?
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-Approx once a month
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Describe the steps (in order) of changing to a fenestrated tube (to allow speech):
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1.) the inner cannula is removed
2.) the cuff is deflated 3.) the decannulation cap is placed in the tube |
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Air in the pleural space resulting in either partial or complete collapse of the lung:
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-pneumothorax
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This type of pneumothorax has no associated external wounds; caused by rupture of small blebs on the visceral pleural space, these ruptures can be caused by injury to the lungs from broken ribs or COPD:
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-Closed pneumothorax
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This type of pneumothorax occurs when air enters the pleural space through an opening in the chest wall; also known as sucking chest wound:
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-Open pneumothorax
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A pneumothorax with rapid accumulation of air in the pleural space, causing severely high intrapleural pressures with resultant tension on the heart and great vessels; may result from either an open or a closed pneumothorax:
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-Tension pneumothorax
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Describe what occurs during a tension pneumothorax:
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-Intrathoracic pressure increases, the lung collapses, and the mediastinum shifts toward the unaffected side, which is subsequently compressed; CO is altered
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True or False:
Tension pneumothorax is a medical emergency |
-True
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The accumulation of blood in the intrapleural space:
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-Hemothorax
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Lymphatic fluid in the pleural space due to a leak in the thoracic duct:
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-Chylothorax
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Describe s&s of a pneumothorax:
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-Tachycardia
-Respiratory distress including shallow, rapid respirations -O2 Stats lowered -Chest pain -Failure to cough -Increased secretions -No breath sounds over the affected area -Mediastinal displacement can occur with a tracheal shift (during tension pneumothorax) |
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This condition results from multiple rib fractures, causing an unstable chest wall; diagnosis is made on the basis of fractures of two or more ribs, in two or more separate locations, causing an unstable segment:
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-Flail Chest
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What is the signature physical sign when a person is experiencing flail chest?
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-During inspiration, the affected portion is sucked in, and during expiration it bulges out
-This prevents adequate ventilation of the lung in the injured area and increases the work of breathing |
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What is the purpose of chest tubes and pleural drainage?
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-To remove air and fluid from the pleural space and to restore normal intrapleural pressure so that the lungs can reexpand
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A purulent pleural fluid, which may be associated with lung abcesses or pneumonia:
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-Empyema
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During a chest tube insertion, if air is to be removed, the catheter is place anteriorly through the ___intercostal space to remove air.
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-second
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During a chest tube insertion, if fluid is to be drained, the tube is place posteriorly through the ___ or ____ intercostal space to drain fluid and blood.
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-Eighth or Ninth
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What does the first compartment or collection chamber, of a pleural drainage system do?
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-Receives fluid and air from the chest cavity
-Fluid stays in this compartment while air vents to the second compartment |
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What does the second compartment or water-seal chamber, of a pleural drainage system do?
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-Contains 2 cm of water acting as a one-way valve
-Incoming air enters from the collection chamber and bubbles up through the water preventing backflow of air into the patient from the system -Fluctuations, or "tidaling" will be seen that reflect the pressures in the pleural space (if seen, either the lungs have reexpanded or there is a kink or obstruction in the tubing) |
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What does the third compartment or suction control chamber, of a pleural drainage system do?
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-Applies controlled suction to the chest drainage system
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What are some common complications of chest tubes?
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-Chest tube malposition (routine monitoring is done by observing for tidaling in the water-seal chamber, listening for breath sounds, and measuring the amount of fluid drainage)
-Infection at the skin site (sterile technique is used) -Pneumonia -Should disuse |
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Explain what is generally done before, during, and after removal of a chest tube:
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-Generally suction is discontinued and the patient is placed on gravity drainage 24 hours before the tube is removed
-Premedicate the pt at least 15 min before tube is removed -Cut sutures -Apply sterile petroleum jelly gauze dressing -Have patient take deep breath, exhale, and bear down, and then remove the tube -Site is covered with an airtight dressing -CXR afterward |
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The process by which the fraction of inspired O2 (FIO2) is at 21% (room air) or greater and moved into and out of the lungs by a mechanical ventilator and is a means of supporting patients until they recover the ability to breathe independently:
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-Mechanical Ventilation
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What are some indications for mechanical ventilation?
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1.) Apnea or impending inability to breathe
2.) Acute respiratory failure (pH < or = 7.25 with a PaCO2 > or = 50 mm Hg) 3.) Severe hypoxia 4.) Respiratory muscle fatigue |
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This type of mechanical ventilation involves the use of chambers that encase the chest or body and surround it with intermittent subatmospheric or negative pressure (a.k.a. iron lung):
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-Negative Pressure Ventilation
**Intermittent negative pressure around the chest wall causes the chest to be pulled outward reducing intrathoracic pressure; expiration is passive and noninvasive |
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This type of mechanical ventilation is the primary method used with acutely ill patients; during inspiration the ventilator pushes air into the lungs under positive pressure:
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-Positive Pressure Ventilation (PPV)
**Unlike spontaneous ventilation, intrathoracic pressure is raised during lung inflation rather than lowered and expiration occurs passively |
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This form of PPV is with a predetermined tidal volume is delivered with each inspiration, and the amount of pressure needed to deliver the breath varies based on the compliance and resistance factors of the patient-ventilator system:
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-Volume Ventilation
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With this type of PPV, the peak inspiratory pressure is predetermined, and the tidal volume delivered to the patient varies based on the selected pressure and the compliance and resistance factors of the patient-ventilator system:
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-Pressure Ventilation
**Careful attention must be given to the tidal volume to prevent unplanned hyperventilation or hypoventilation |
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Manifested by a decrease in arterial O2 tension (PaO2) and saturation (SaO2):
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-Hypoxemia
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Manifested by an increase in arterial CO2 tension (PaCO2):
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-Hypercapnia
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Hypoxemic respiratory failure is also referred to as:
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-Oxygenation failure: inadequate O2 transfer between the alveoli and the pulmonary capillary bed
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Commonly defined as a PaO2 of 60 mm Hg or less when the patient is receiving an inspired O2 concentration of 60% or greater:
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-Hypoxemic Respiratory Failure
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Pneumonia, pulmonary edema, pulmonary emboli, and alveolar injury related to inhalation of toxic gases, as well as lung damage related to alveolar stress/ventilator-induced lung injury, are all disorders that interfere with what?
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-O2 transfer into the blood
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Hypercapnic respiratory failure is also referred to as:
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-Ventilatory failure: insufficient CO2 removal
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Commonly defined as a PaCO2 above normal (greater than 45 mm Hg) in combination with acidemia (arterial pH less than 7.35):
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-Hypercapnic respiratory failure
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Drug overdoses with CNS depressants, neuromuscular dz, and trauma or dz involving the spinal cord are all disorders that compromise what?
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-Lung ventilation and subsequent CO2 removal
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What are the 4 physiologic mechanisms that may cause hypoxemia and subsequent hypoxemic respiratory failure?
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1.) V/Q mismatch (most common)
2.) Shunt (most common) 3.) Diffusion limitation 4.) Hypoventilation |
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Normal lung: the volume of blood perfusing the lungs each min (4-5 L) is approx equal to the amount of fresh gas that reaches the alveoli each min (4-5 L)
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-V/Q ratio of 1:1
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Increased secretion in the airways, bronchospasm, and atelectasis are all causes of which of the 4 physiologic mechanisms of hypoxemic repsiratory failure?
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-V/Q mismatch
-All of these conditions result in limited airflow (ventilation) to alveolu but have no effect on blood flow (perfusion) to the gas exchange units -Pulmonary embolus affects the perfusion portion |
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This type of physiologic mechanism of hypoxemic respiratory failure occurs when blood exits the heart without having participated in gas exchange:
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-Shunt
(2 types: anatomic and intrapulmonary) |
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This type of shunt occurs when blood passes through an anatomic channel in the heart and therefore does not pass through the lungs:
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-Anatomic shunt
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This type of shunt occurs when blood flow through the pulmonary capillaries without participating in gas exchange and is seen in conditions in which the alveolu fill with fluid
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-Intrapulmonary shunt
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This type of physiologic mechanism of hypoxemic respiratory failure occurs when gas exchange across the alveolar-capillary membrane is compromised by a process that thickens or destroys the membrane and is more likely to cause hypoxemia during excerise than at rest:
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-Diffusion limitation
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Severe emphysema or recurring pulmonary emboli, pulmonary fibrosis, interstitial lung dz, and ARDS are most likely to cause which of the 4 physiological mechanisms of hypoxemic resp failure?
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-Diffusion limitation
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This mechanism of hypoxemic resp failure is a generalized decrease in ventilation that results in an increase in the PaCO2 and a consequent decrease in PaO2:
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-Alveolar Hypoventilation
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The max ventilation (gas flow in and out of the lung) that the pt can sustain without developing resp muscle fatigue:
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-Ventilatory supply
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The amount of ventilation needed to keep the PaCO2 WNL:
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-Ventilatory demand
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Hypercapnic resp failure is sometimes called what:
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-Ventilatory failure: because the primary problem is the inability of the resp system to ventilate out sufficient CO2 to maintain a normal PaCO2
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What are the 4 categories that can cause a limitation in ventilatory supply (max gas flow in and out)?
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1.) Airways and Alveoli
2.) CNS 3.) Chest Wall 4.) Neuromuscular Conditions |
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Which category of ventilatory supply limitations does asthma, COPD, and CF belong?
a.) Airways & Alveoli b.) CNS c.) Chest Wall d.) Neuromuscular Conditions |
-A: underlying patho of these conditions results in airflow obstruction and air trapping
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An overdose of an opioid or other respiratory depressant drug and brainstem infarction/injury, all belong to which ventilatory supply limitation category?
a.) Chest Wall b.) Neuromuscular Conditions c.) CNS d.) Airways and Alveoli |
-C: decreased CO2 reactivity and respiratory rate in the brainstem
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Flail chest, rib fractures, morbid obesity, and scoliosis are all examples of which ventilatory supply limitation category?
a.) CNS b.) Neuromuscular c.) Airways and Alveoli d.) Chest Wall |
-D: prevents normal movement of the chest wall
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MS, muscular dystrophy, myasthenia, and Guillain-Barre syndrome are all examples of which ventilation supply limitation category?
a.) Neuromuscular Condition b.) Chest Wall c.) CNS d.) Airways and Alveoli |
-A: may result in resp muscle weakness or paralysis
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Occurs when the PaO2 falls sufficiently to cause signs and symptoms of inadequate oxygenation:
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-Hypoxia
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Occurs when the amount of O2 in arterial blood is less than the normal value:
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-Hypoxemia
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What type of metabolism do cells use when O2 is present?
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-Aerobic metabolism
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What type of metabolism do cells use when hypoxia or hypoxemia is severe?
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-Anaerobic metabolism (uses more fuel, produces less energy, and is less efficient)
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What is the waste product of anaerobic metabolism?
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-Lactic acid which is more difficult to remove from the body than CO2 because it has to be buffered with sodium bicarbonate
-When the body does not have enough amounts of sodium bicarbonate, metabolic acidosis results and cell death may occur |
