Respiratory Management Day 1

Questions and Answers

What characterizes chronic respiratory failure?

Rapid development of hypoxemia and hypercapnia

Absence of acute symptoms (correct)

Severe confusion and lethargy during evaluation

Immediate resolution after acute episodes

Which of the following is NOT a cause of failure to ventilate?

Obstruction

Neurological impairment

Shunting (correct)

Abdominal compression

What does a pH level below 7.35 indicate?

Normal acid-base balance

Respiratory alkalosis

Metabolic alkalosis

Metabolic acidosis (correct)

In assessing acute respiratory failure, which early symptoms are commonly observed?

Restlessness and fatigue Signup and view all the answers

Which arterial blood gas measurement indicates a normal range for PAO2?

80-100 mmHg Signup and view all the answers

What is the appropriate treatment for restoring gas exchange in acute respiratory failure?

Intubation/Mechanical ventilation Signup and view all the answers

What does metabolic alkalosis indicate regarding bicarbonate levels?

Bicarbonate levels are above 26. Signup and view all the answers

What is a common result of chronic respiratory failure due to conditions like COPD?

Gradual hypoxemia and hypercapnia Signup and view all the answers

What is the primary purpose of ventilation in the respiratory system?

Movement of air in and out of the lungs Signup and view all the answers

Which type of trauma involves injuries like sternal fractures or flail chest?

Blunt trauma Signup and view all the answers

What critical value of PaO2 indicates hypoxemia?

60 mmHg Signup and view all the answers

What is the characteristic pH level and PCO2 measurement for respiratory alkalosis?

pH over 7.45 with PCO2 below 35 Signup and view all the answers

What is the primary function of the upper respiratory tract?

Filters impurities and warms the air Signup and view all the answers

What is a common clinical manifestation of pulmonary embolism?

Dyspnea Signup and view all the answers

Which of the following represents a commonly recognized cause of respiratory acidosis?

Hypoventilation syndrome Signup and view all the answers

What is the mortality rate commonly associated with ARDS?

40% Signup and view all the answers

In the case of pulmonary embolism, what does an increase in pulmonary vascular resistance typically lead to?

Increased right ventricular work Signup and view all the answers

Which medication is preferred by providers due to its faster reversal and decreased chance of delirium?

Precedex (Dexmedetomidine) Signup and view all the answers

Which step is NOT part of the six steps for blood gas interpretation?

Match PCO2 to the HCO3 Signup and view all the answers

Which of the following assessments is considered the best test for pulmonary embolism if time and condition allow?

Pulmonary angiogram Signup and view all the answers

What is a potential side effect of Propofol (Diprivan)?

Hypotension and bradycardia Signup and view all the answers

In the acute exudative phase of ARDS, what significant change occurs?

Proteinaceous flooding that nullifies surfactant Signup and view all the answers

Which of the following IV medications is commonly used for seizure control?

Ativan (Lorazapam) Signup and view all the answers

Which of the following is NOT a management strategy for acute respiratory failure?

Anticoagulation therapy Signup and view all the answers

Which of the following treatments is NOT typically utilized in ARDS management?

Continuous positive airway pressure (CPAP) Signup and view all the answers

What two conditions may coexist in a patient with acidotic status?

Metabolic and respiratory acidosis Signup and view all the answers

What is the primary goal of medical management for pulmonary embolism?

Prevent future emboli from forming Signup and view all the answers

What is a common complication of intubating the right lung mistakenly?

Decreased gas exchange Signup and view all the answers

What is monitored using the Train of Four during paralysis?

Neuromuscular response Signup and view all the answers

What must be assessed alongside ABGs and vital signs in respiratory assessments?

Respiratory status Signup and view all the answers

What is an essential preventive measure against Deep Vein Thrombosis (DVT)?

Avoid venous stasis Signup and view all the answers

What must be documented every hour for patients receiving paralytics?

Response to sedation levels Signup and view all the answers

What characterizes the pulmonary condition known as ARDS?

A sudden and progressive pulmonary edema Signup and view all the answers

Which factor is NOT commonly associated with the development of ARDS?

Chronic bronchitis Signup and view all the answers

What is a primary pathophysiological change occurring in ARDS?

Severe ventilation-perfusion mismatch Signup and view all the answers

Which clinical manifestation is characteristic of ARDS?

Rapid onset dyspnea within 72 hours of an event Signup and view all the answers

When using paralytics, what is essential for patient safety?

Patients must be on a ventilator Signup and view all the answers

What is a potential outcome of the proliferative phase of ARDS?

Continuation to the fibrotic phase with ventilator dependence Signup and view all the answers

What condition is strongly associated with pulmonary embolism, particularly following surgery?

Venous stasis Signup and view all the answers

Which nursing management action is critical for a patient in acute respiratory failure (ARF)?

Assist with intubation if necessary Signup and view all the answers

Which management strategy is recommended for improving oxygenation in ARDS patients?

Reduction of tidal volumes Signup and view all the answers

What is a common sign seen on a chest x-ray for patients with ARDS?

Bilateral infiltrates Signup and view all the answers

Study Notes

Management of Respiratory Disorders

Understand anatomy and physiology of respiratory system for effective management of disorders.
Assess respiratory function using diagnostic tools: PFT, pulse oximetry, chest X-ray, CT scan, ABGs, biopsy, bloodwork, EKG.
Auscultate lung fields both anteriorly and posteriorly; evaluate work of breathing through visual inspection.

Sedation and Pain Management in ICU

Propofol (Diprivan): Fast-acting sedative, potential for hypotension and bradycardia; undergo hourly monitoring during usage.
Precedex (Dexmedetomidine): Preferred for quicker reversal and lower delirium risk, also can cause bradycardia and hypotension.
Benzodiazepines:
- Valium (Diazepam): Used in alcohol detoxification, may cause oversedation.
- Ativan (Lorazepam): Controls seizures, can lead to respiratory depression.
- Midazolam (Versed): Short-acting with similar risks.

Use of Paralytics

Commonly includes Norcuron, Pavulon, Nimbex.
Essential for patients on ventilators, requires continuous IV sedation.

Lung Anatomy

Upper respiratory tract filters and warms incoming air.
Lower respiratory tract comprises three lobes on the right, two on the left.
Visceral pleura covers lungs, parietal pleura lines the pleural cavity.

Gas Exchange and Oxygen Transport

Respiration: Involves gas exchange between atmosphere and blood; includes cellular exchange of O2 and CO2.
Ventilation: Movement of air in/out of lungs; consists of active inspiration and passive expiration.

Chest Trauma

Types: Blunt trauma (rib fractures, pulmonary contusion) and penetrating trauma (gunshot/stab wounds).
Management focuses on airway, oxygen needs, fluid volume restoration, and drainage of pleural fluid/blood.

Pulmonary Embolism (PE)

Obstruction in pulmonary artery from thrombus, primarily originating from DVT.
Risk factors: trauma, surgery, pregnancy, heart failure, age >50, immobility, atrial fibrillation.
Clinical manifestations include dyspnea, tachypnea, chest pain, and hemoptysis.

Assessment and Diagnosis of PE

Utilize CXR, ECG, pulse oximetry, ABGs, V/Q scan, pulmonary angiogram, and CT scan.
Treatment involves managing existing PE with thrombolytics (TPA) and preventing future occurrences through anticoagulation.

Acute Respiratory Failure (ARF)

Defined as a rapid decline in gas exchange; characterized by pH < 7.35, PaO2 < 60 mmHg, PaCO2 > 50 mmHg.
Differentiate between acute and chronic respiratory failure based on symptom onset and history.

Causes of Respiratory Failure

Failures include inability to oxygenate (diffusion abnormalities), maintain airways (obstruction), or ventilate effectively (shunting, chest injury).

Clinical Signs of ARF

Early signs: restlessness, tachycardia, hypertension; progression to lethargy, cyanosis, respiratory arrest.
Management includes correcting underlying causes, intubation, mechanical ventilation, and ICU care.

Blood Gas Interpretation

Normal ranges: pH (7.35-7.45), PCO2 (35-45), PAO2 (80-100), bicarbonate (22-26).
Metabolic and respiratory acid-base abnormalities can occur; assessing for compensation is crucial.

Acute Respiratory Distress Syndrome (ARDS)

Sudden onset lung injury resulting in severe pulmonary edema, hypoxemia, and bilateral infiltrates on CXR.
Stages: acute exudative phase with protein flooding and decreased gas exchange, followed by a proliferative phase.

Management of ARDS

Focus on intubation, mechanical ventilation with PEEP, vasopressor support, and nutritional care.
Clinical research supports prone positioning for improved oxygenation.

Prevention of Venous Thromboembolism

Key measures include early mobilization, leg exercises, anti-embolic stockings, and anticoagulation therapy to avoid DVT/VTE.

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Description

This quiz focuses on the management of patients with chest and lower respiratory disorders. It covers the anatomy and physiology of the respiratory system, assessment techniques for acutely or critically ill patients, and various diagnostic evaluations such as pulmonary function tests and imaging studies.