Respiratory Ventilation Quiz

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Questions and Answers

What does a respiratory rate of 28 bpm indicate?

Respiratory alkalosis (correct)

Oxygenation improvement

Respiratory acidosis

Hypoventilation

Which ventilation method is characterized by an inverse ratio of inspiration to expiration?

SIMV

APRV (correct)

PC ventilation

AC ventilation

What is a primary goal of APRV?

Encourage spontaneous breathing

Improve oxygenation (correct)

Prevent respiratory alkalosis

Reduce muscle atrophy

What distinguishes SIMV from AC ventilation?

SIMV allows patients to initiate their own breaths Signup and view all the answers

Which complication can result from APRV due to its method of ventilation?

Hypercapnia Signup and view all the answers

What is the most common risk factor for developing a pulmonary embolism?

Prolonged immobility Signup and view all the answers

Which of the following symptoms is NOT typically associated with pulmonary embolism?

Hyperthermia Signup and view all the answers

Which diagnostic test is considered the most definitive for diagnosing pulmonary embolism?

Pulmonary angio Signup and view all the answers

What is a common complication associated with Assist Control (AC) ventilation mode?

Barotrauma Signup and view all the answers

Which of the following treatments would be most appropriate to reduce the risk of bleeding in a patient with pulmonary embolism?

Inferior vena cava filter Signup and view all the answers

What immediate action should be taken for ongoing verification after intubation?

Mark the ET tube position Signup and view all the answers

What should be monitored in a patient receiving assisted ventilation to prevent respiratory alkalosis?

Sedation levels Signup and view all the answers

Which of the following is a significant nursing consideration when managing a patient with pulmonary embolism?

Monitor for hypotension Signup and view all the answers

What is the primary purpose of the cuff in a tracheostomy tube?

Completely seals the airway to prevent aspiration Signup and view all the answers

Which of the following symptoms indicates airway obstruction?

Nasal flaring Signup and view all the answers

What is the appropriate initial intervention for a patient showing signs of airway obstruction?

Perform the Heimlich maneuver Signup and view all the answers

What does a fully inflated pilot balloon indicate about the tracheostomy cuff?

The cuff is properly inflated Signup and view all the answers

What should be done if a tracheostomy tube becomes dislodged?

Use the obturator to replace the tube Signup and view all the answers

When performing tracheostomy care, which step is essential during insertion?

Ensure the existing IV is patent Signup and view all the answers

Which monitoring tool is essential for confirming tracheostomy tube placement?

End tidal CO2 monitoring Signup and view all the answers

What is a potential complication of a fully inflated cuff in a tracheostomy tube?

Patient becoming non-verbal Signup and view all the answers

What is a primary characteristic of hypovolemic shock?

Loss of circulating blood volume Signup and view all the answers

Which of the following treatments is most important for managing anaphylactic shock?

Epinephrine administration Signup and view all the answers

Which condition is associated with cardiogenic shock?

Myocardial infarction (MI) Signup and view all the answers

What is a common manifestation of neurogenic shock?

Bradycardia Signup and view all the answers

Which medication is primarily used to raise blood pressure in obstructive shock?

Vasoactive medications Signup and view all the answers

What is indicated by a decreased cardiac output in the context of shock?

Impaired heart function Signup and view all the answers

In which type of shock does severe vasodilation occur, leading to hypotension?

Distributive shock Signup and view all the answers

What immediate action should be taken for a tension pneumothorax?

Chest tube insertion Signup and view all the answers

Which of the following is a complication of sepsis?

DIC (Disseminated Intravascular Coagulation) Signup and view all the answers

What is the purpose of using inotropic medications in cardiogenic shock?

To enhance heart contractility Signup and view all the answers

Which condition is characterized by a normal pH level but abnormal PaCO2 and HCO3 levels?

Fully compensated Signup and view all the answers

What is the primary cause of respiratory alkalosis?

Hyperventilation Signup and view all the answers

What is a significant manifestation of metabolic acidosis?

Warm, flushed skin Signup and view all the answers

Which symptom is NOT typically associated with hyperglycemia in diabetes mellitus?

Cool, clammy skin Signup and view all the answers

What is the primary treatment intervention for diabetic ketoacidosis (DKA)?

IV fluids and insulin therapy Signup and view all the answers

In cases of adrenal insufficiency, what is the most effective treatment?

Steroid therapy Signup and view all the answers

Which understanding is incorrect regarding the differences between DKA and HHS?

HHS always contains high levels of ketones Signup and view all the answers

What strategy is utilized to treat respiratory acidosis?

Increase respiratory rate Signup and view all the answers

In Syndrome of Inadequate Antidiuretic Hormone Secretion (SIADH), which of the following is a hallmark manifestation?

Fluid retention Signup and view all the answers

What is a common complication of untreated diabetes mellitus type II?

Prolonged wound healing Signup and view all the answers

Which of the following is NOT a recommended intervention for a patient with respiratory alkalosis?

Encouraging hyperventilation Signup and view all the answers

Which intervention would best help manage hypoglycemia?

Give 15g of simple carbohydrates Signup and view all the answers

What is the expected consequence of metabolic alkalosis on potassium levels?

Hypokalemia Signup and view all the answers

Study Notes

Airway Management

A patent airway, adequate ventilation, and adequate perfusion are essential for survival
Oropharyngeal airway (OPA) and nasopharyngeal airway (NPA) are emergency airway devices, endotracheal airway (ETA) with intubation is preferred
Signs and symptoms of airway obstruction include stridor, choking, wheezing, nasal flaring, restlessness, and loss of consciousness
Interventions for airway obstruction include Heimlich maneuver, repositioning the head, intubation, tracheostomy, and cricothyroidotomy

Tracheostomy Tube

Provides long-term airway assistance
Components include cuff, pilot balloon, and obturator
Cuff seals the airway and is inflated using the pilot balloon which prevents aspiration
A flat pilot balloon indicates a deflated cuff, which may lead to trach dislodgement
The obturator is used to guide the tube back into place if dislodged
Always keep the obturator at the bedside

Tracheostomy Care

Insertion requires a respiratory therapist, vital sign and SpO2 monitoring, patent IV, sedation, supine positioning, bedside suction, and emergency equipment
Post-operative care includes confirming placement with a chest X-ray, end-tidal CO2 monitoring, removing the obturator, ensuring balloon and cuff inflation, securing the trach with suture, and monitoring vital signs, SpO2, and ventilator settings

Pulmonary Embolism

A clot occlusion in a pulmonary vessel
Causes an inflammatory response, leading to increased right ventricle workload and potential pulmonary hypertension
Risk factors include immobility, recent surgery, history of DVT, malignancy, obesity, oral contraceptives, smoking, prolonged travel, heart failure, pregnancy, and clotting disorders
Signs and symptoms include chest pain, hemoptysis, hypoxia, tachypnea, use of accessory muscles, respiratory alkalosis, anxiety, tachycardia, hypotension, cough, wheezing, crackles, fever, syncope, confusion, and accentuation of pulmonic heart sounds
Diagnostics include elevated BNP, PT/INR, and aPTT, spiral CT with pulmonary angiography, echocardiography, D-dimer, troponin, chest X-ray, ECG, and V/Q scan
Treatments options include oxygen, rest and activity balance, inferior vena cava filter placement, pulmonary embolectomy, fibrinolytic therapy, heparin, and enoxaparin
Concerns associated with PE treatment include risk of bleeding and obstructive shock

Ventilation

Endotracheal tube insertion is performed by a CRNA, anesthesiologist, nurse practitioner, physician assistant, or physician for mechanical ventilation
Indications for ventilation include hypoxia, hypercapnia, trauma, and edema
Nursing considerations for ventilation include positioning, pre-oxygenation, sedation, and paralytics
Verification of ET tube placement requires chest X-ray, CO2 detection, bilateral chest rise, lung and abdominal auscultation, and improvement in oxygenation parameters
Intubation attempt should be no longer than 30 seconds
Continued ET tube verification is essential by marking the tube to teeth/lips

Modes of Ventilation

Mechanical ventilation modes include Assist Control (AC), Pressure Control (PC), Airway Pressure Release Ventilation (APRV), and Synchronized Intermittent Mandatory Ventilation (SIMV)
Assist Control (AC)
- Provides complete control of oxygenation parameters including tidal volume, FiO2, RR, and PEEP
- Most common ventilation setting
- Ventilator inflates the lungs with the ordered tidal volume on inspiration; patient exhales once tidal volume is reached
- Complications include barotrauma/pneumothorax and respiratory alkalosis
- Nursing Interventions include increasing sedation for respiratory alkalosis, adding paralytics, and ensuring peak pressure alarm is activated for barotrauma
Pressure Control (PC)
- Ventilator inflates lungs with the ordered pressure on inspiration; patient exhales once pressure is reached
- Complications include respiratory acidosis and hypoventilation
- Patients are heavily sedated and may be on paralytics
Airway Pressure Release Ventilation (APRV)
- Goal is to improve oxygenation and open alveoli, commonly used for ARDS patients
- Combines AC and PC ventilation principles
- Increases tidal volume, allowing for spontaneous breathing
- May or may not require sedation
- Uses inverse ratio ventilation where inspiration is extended and expiration is shortened
- Bilevel ventilation provides two different pressures: one for inspiration and a lower pressure for exhalation
- Complications include hypercapnia and respiratory acidosis
Synchronized Intermittent Mandatory Ventilation (SIMV)
- Delivers preset tidal volume with a preset number of breaths, allowing spontaneous breaths in between
- Encourages independent breathing and combats muscle atrophy
- SIMV takes over when the patient is unable to complete their breath, whereas AC continues to deliver preset settings
- Used for weaning from mechanical ventilation

Acid-Base Balance

Respiratory Acidosis
- Caused by inadequate breathing (hypoventilation) resulting in hypoxia
- Signs and symptoms include dyspnea, rapid shallow respirations, hyperkalemia, dysrhythmias, decreased BP, and disorientation
- Treatments include addressing the cause (hyperkalemia treatment) and increasing RR/improving ventilation
- Interventions include elevating head of bed (HOB), breathing exercises, incentive spirometry, oxygen therapy, and metabolic panel monitoring
Respiratory Alkalosis
- Caused by ineffective breathing (hyperventilation)
- Signs and Symptoms include increased RR and depth, increased HR, decreased or normal BP, hypokalemia, numbness/tingling of extremities, seizures, hyper reflexes, and muscle cramps
- Treatments include treating the cause (hypocalcemia and hypokalemia) and decreasing RR
- Interventions include using a brown paper bag to rebreathe CO2, IV fluids, breathing exercises, pain and anxiety management, sedation, and metabolic panel monitoring
Metabolic Acidosis
- Caused by excessive hydrogen ions (DKA, renal failure, dehydration, diarrhea)
- Manifestations include decreased BP, hyperkalemia, muscle twitching, warm flushed skin, N/V, decreased muscle tone and reflexes, and Kussmaul respirations
- Treatments include treating the cause (hyperkalemia treatment) and increasing RR
- Interventions include IV fluids and sodium bicarbonate for DKA, dialysis for renal failure, diphenoxylate/atropine for diarrhea, and antiemetics for vomiting
Metabolic Alkalosis
- Caused by loss of hydrogen ions (body fluids), due to vomiting, excessive gastric suction, and diuretics
- Signs and symptoms include restlessness followed by lethargy, dysrhythmias (tachycardia), compensatory hypoventilation, confusion, N/V/D, tremors, and hypokalemia
- Treatment/interventions include antiemetics, IV fluids and electrolyte replacements, dialysis for severe cases, and treatment of hypocalcemia and hypokalemia
Important Notes
- Acidosis leads to hyperkalemia
- Alkalosis leads to hypokalemia

Endocrine

Diabetes Mellitus Type 1 (DM I)
- Autoimmune disease requiring lifelong insulin therapy
- Signs and symptoms include the 3 Ps (polyuria, polydipsia, polyphagia), weight loss, weakness, and fatigue
Diabetes Mellitus Type 2 (DM II)
- Beta cells produce less insulin and body cells become insulin resistant
- Can be managed with diet, lifestyle changes, and weight loss
- Risk factors include family history, overweight, and advanced age
- Signs and symptoms include prolonged wound healing, visual problems, fatigue, and recurrent infections

Complications of Diabetes

Hypoglycemia
- Blood sugar less than 70 mg/dL
- Signs and symptoms include anxiety, sweating, hunger, confusion, blurred/double vision, shakiness, irritability, cool clammy skin
- Treatments include 15g of simple carbs (fruit juice or regular soft drink), recheck in 15 minutes, and 50% dextrose 20-50 mL IV push for immediate resolution
Diabetic Ketoacidosis (DKA)
- Blood glucose levels >300 to 600 mg/dL
- Presence of ketone bodies in blood and urine
- Monitor Cr, BUN, Hct, and BMP
- Metabolic acidosis, Kussmaul respirations, and fruity breath
- Manifestations include polyuria, polydipsia, blurred vision, weakness, headache, hypotension, weak/rapid pulse, and hyperkalemia
Hyperosmolar Hyperglycemic State (HHS)
- Blood glucose levels > 600
- Altered mental status (usually unresponsive)
- Associated with acute illness, uncontrolled diabetes, and glucocorticoid use
- Manifestations include serum osmolality >320, hypotension, tachycardia, variable neurological symptoms
- Management includes fluids, electrolyte correction, and insulin
DKA vs HHS
- DKA is faster onset than HHS.
- DKA: pH is acidic, HHS: pH is normal.
- DKA: Ketones are present, HHS: Ketones are absent or minimal.

Adrenal Insufficiency

Addison's Disease
- Treated with steroid therapy
Cushing's Disease
- Treated with surgical removal of the adrenal gland
- Lifelong steroid therapy is required because the adrenal glands no longer produce cortisol

Pituitary Disorders

Diabetes Insipidus
- Hyposecretion of antidiuretic hormone (ADH)
- Manifestations include polydipsia, polyuria, and dehydration
- Treatment includes fluid replacement and desmopressin
- Monitor vital signs, neurologic status, cardiovascular status, electrolytes, I/O, weight, and urine specific gravity
Syndrome of Inadequate Antidiuretic Hormone Secretion (SIADH)
- Hypersecretion of antidiuretic hormone (ADH)
- Manifestations include fluid retention, edema, serum hypoosmolality, concentrated urine with normal/increased intravascular volume
- Diagnosis based on serum and urine osmolarity
- Treatment: treat underlying cause, fluid restriction (unless third spacing is present), furosemide, seizure and fall precautions, and laboratory monitoring

Shock

Stages of Shock: initial, compensatory, progressive, and refractory
Types of Shock
- Hypovolemic shock
- Cardiogenic shock
- Distributive shock
- Obstructive shock
Hypovolemic Shock
- Low circulating blood due to trauma or fluid loss
- Management includes labs (ABGs, H&H, metabolic panel, lactate), 100% O2 via non-rebreather, intubation, large bore IVs (18 gauge), central line, and fluid rehydration
Cardiogenic Shock
- Heart is unable to pump correctly due to MI, valvular dysfunction, or severe HF
- Manifestations include decreased cardiac output, decreased BP, narrow pulse pressure, and pulmonary congestion
- Treatment includes labs, oxygen, fluids, vasoactive medications, inotropes, diuretics, and morphine
- Limit activity and treat the underlying cause
Distributive Shock
- Severe vasodilation causing decreased BP and inadequate blood flow
- Subtypes: Sepsis, Anaphylaxis, Neurogenic Shock
Anaphylactic Shock
- Allergic response
- Management includes removing the trigger, 100% O2, IV fluids, epinephrine, corticosteroids, bronchodilators, and antihistamines
Neurogenic Shock
- Spinal cord injury above T5
- Severe hypotension and bradycardia due to vasodilation
- Management includes IV fluids, vasoactive drips, atropine, heparin/lovenox, and transcutaneous/transvenous pacing
Obstructive Shock
- Obstruction that prevents proper blood flow
- Subtypes: Tension pneumothorax, Cardiac tamponade, Severe valvular disease
- Management: neuro checks, intubation/ventilation, ABGs, vasoactive meds, anticoagulants, thrombolytics, tension pneumothorax treatment (chest tube), pericardiocentesis, suction thrombectomy, and valvular replacement

Vasoactive Medications

Dobutamine
- Positive inotropic effect, used for heart failure, not titratable
Dopamine
- Increases HR and BP, first-line treatment for shock
Epinephrine
- Increases HR and BP
- Continuous infusion is a last resort due to vasoconstrictive effects
- Use alongside dopamine if necessary
Norepinephrine
- Increases BP only
- Also known as Levophed
Phenylephrine
- Increases BP only
- Short-term use, also known as Neo or Neo-Synephrine

Sepsis

Sepsis 6: O2, blood cultures, antibiotics, fluids, lactate, and urine output
Complications of sepsis include disseminated intravascular coagulation (DIC) and multiple organ dysfunction syndrome (MODS)
Sepsis can arise from infection or systemic inflammatory response syndrome (SIRS)

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Description

Test your knowledge on respiratory rates and ventilation methods with this quiz. It covers key concepts like APRV, SIMV, and the implications of different ventilation strategies. Understand the nuances of respiratory support in clinical settings.