1what structures are in the upper respiratory system
nose and mouth
2what structures are in the lower resp system
larynx, trachea, bronchi, alveoli
3What system works with the lungs to achieve gas exchange
the vascular system
4What cells make up alveoli
epithelial and type 2 cells
5What is the purpose of type 2 cells in alveoli
to secrete surfactant and stop their collapse
6what is the purpose of epithelial cells in a alveoli
allow expansion and contraction
7how much air from breathing makes it to alveoli
350mL out of 500mL
8what part of the brain controls ventilation
Medulla and Pons
9Respiratory drive responds to what
CO2 and Oxygen
10What makes up the process of respiration
Ventilation, Diffusion, Perfusion/transportation
11Normal V:Q measurement
4:5 or 0.8
12What does VQ measure
Ventilation of alveoli(V) and perfusion of pulmonary vessels(Q)
13What are the 3 VQ mismatches
Dead space, Shunting, Silent unit
14Dead space has what VQ
high ventilation and low perfusion... expect PE or perfusion impairment
15Shunting has what VQ
low ventilation and high perfusion... expect airway obstruction (pneumonia and atelectasis)
16Silent unit has what VQ
low ventilation and low perfusion... expect ARDs and pneumothorax
17what is paO2
Oxygen in plasma
18what is saO2
Oxygen in Hgb
19What is the oxyhemoglobin dissacossiation curve
When paO2 is less than 60 there is suddenly a large drop in saO2
20what is the pathological reasoning for the oxyhemoglobin dissacossiation curve
hemoglobins affinity for oxygen can change
21When hemoglobins affinity for ox is low then cells absorb it which leads to...
fever and acidemia
22When Hgb has a high affinity it leads to ...
low temp, carbon monoxide poisoning, high altitude sickness
23hypoxia early s/s
pallor, cool, dry and tachycardia, HTN, and anxiety, restlessness
24hypoxia late s/s
blue, sweaty and bradycardia, low BP and coma, loss of LOC
25general hypoxia s/s
dyspnea, TACHYPNEA, dyssrythmias, chest pain
26PF ratio measures what
PaO2/ FiO2 or gas exchange defect
27What PF ratio means severe ARDs
less than 100
28what PF ratio means Mild ARDs
200-300
29100-200 PF ratio means what
moderate ARDS
30what does ARF lead to
ARDs
31ARDs number one cause
sepsis
32patho of ARDs
inflammatory mediators release neutrophils, macrophages, and platelets which release humoral mediators that damage alveolar membranes
33non medicinal treatment of ARDS
intubation, HOB above 30, fluids, nutrition, prone position
34prone position benefits
shifts perfusion to anterior bases and removes weight of abd and heart
35medical treatment of ARDs
corticosteroids, sedation, paralytics
36intubation indications
altered LOC, bad airway, ineffective gas exchange, CO2 greater than 50, and O2 less than 50
37what is BNP
brain natriuretic peptide
38what does BNP measure
chronic increased heart workload and possibly heart failure
39What does PE lead to
brochoconstriction, impaired gas exchange, and decreased surfactant
40PE complications
pulmonary HTN, right sided HF, Afib
41triad of PE precipitators
venous stasis, hypercoagulability, endothelial damage
42Venous Stasis RF of PE
Afib, low CO2, Immobility
43hypercoagulability RF of PE
pregnancy, HRT, chemo, birth control, factor V
44endothelial damage RF for PE
smoking, HTN, surgery, PICC
45What are considered the picture perfect three s/s of PE
dyspnea, bloody sputum, pleuritic pain
46dx of pe in dvt
Homans sign, ultrasonography
47gold standard for dx of pe
PULMONARY ANGIOGRAM (and d dimer)
48Tx for existing PE
TpA, IVC filter, Catheter embolectomy
49prevention measures for dvt/pe
heparin, SCDs, stockings, ambulation
50what test does heparin affect
PTT will be 1.5 or 2 x control
51antidote of heparin how do you treat
protamine sulfate
52complication of heparin
bleeding or heparin induced thrombocytopenia
53what is heparin induced thrombocytopenia
antibodies activate platelets
54how to treat heparin induced thrombocytopenia
STOP heparin, give ARGOTRAVAN and antidote
55COPD def
chronic injury of airway that results in narrowing due to scarring, airway spaces enlarge due to destruction of alveolar walls and connective tissue, mucus increases due to enlarged gland and damaged cilia
56Can COPD cause pulmonary HTN
yes, vessels thicken which can lower gas exchange
57What are the two "types" of COPD
Chronic Bronchitis and Emphysema
58How do you diagnose chronic bronchitis
consecutive cough for three months
59Are infections a cause or result of chronic bronchitis
result
60What is elastin
compound in respiratory system that allows alveoli to constrict
61patho of emphysema
macrophages destroy elastin causing overinflation of alveoli and destruction of walls
62what are the s/s of emphysema
- cyanosis
- pink hue
- pursed lip breathing
- hyperesonance with percussion
- cough
- thin
- edema
- barrel chest
- long expiration
63COPD S/S
- dusky
- cyanotic
- barrel chest
- cough
- edema/clubbing
- JVD
- deep breathing
- large heart
64What is the number one cause of COPD
smoking
65how do we monitor oxygen effectiveness in COPD Pt
titrate slowly, monitor ABG, watch resp drive, Venturi mask is best
66What lifestyle changes can help COPD Pt
oxygen, pursed lip breathing, smoking cessation!!, vaccines, diet
67MED for COPD
Beta2 agonist (both short and long acting), anticholinergics, methylxanthines
68short acting Beta 2 agonists
albuterol and terutaline
69long acting Beta 2 Agonists
salmeterol and formoterol
70side effects of beta 2 agonists
tremors and anxiety
BRONCHOSPASM, dyspnea
tachycardia, dysrhythmias
HTN, hypokalemia
71examples of methylxathines
theophylline and aminphylline
72Nurse Imp of theophylline and aminphylline
Monitor therapeutic drug levels
73anticholinergic examples
end in -bromide
74SE of anticholinergics
dry mouth, bronchocnstriction, bitter taste
75Nurse imp of anticholinergics
good for patients with tachycardia, avoid contact with eyes