Pharmacology:

What is the transfer of a drug from its site of administration to the blood stream?

Pharmacology:

Absorption will depend on the r_____ and e_______ of the route of administation.

Pharmacology:

The i____ route delivers complete absorption; other routes may result in only p_____ absorption.

Pharmacology:

D_______ states or certain f______ may also affect absorption.

Pharmacology:

Other factors affecting absorption include type of t_____ from the GI tract, p__, b______ f______ to absorption site, total s_____ a_____, and amount of c____ t_____ with absorption surface.

Pharmacology:

What is the fraction of the administered drug that reaches the systemic circulation and therefore the targer organ or system?

Pharmacology:

Bioavailability is determined by comparing p____ levels of a drug after a particular route of administration and with plasma drug levels achieved after I__ i_____.

Pharmacology:

Factors affecting bioavailability include f____-p____ h______ metabolism, s____ of the drug, chemical i_____, and the nature of the drug f_______.

Pharmacology:

What is the property wherein two drugs with identical active ingredients (as a brand-name drug and its generic equivalent) or two different dosage forms (as tablet and oral suspension) of the same drug possess similar bioavailability and produce the same effect at the site of physiological activity?

Pharmacology:

What is a drug that has essentially the same effect in the treatment of a disease or condition as one or more other drugs?

Pharmacology:

A drug that is a therapeutic equivalent may or may not be c________ equivalent, b_________, or g__________ equivalent.

Pharmacology:

What is the process by which a drug reversibly leaves the blood stream and enters the interstitium and/or cells of the tissues?

Pharmacology:

Distribution is affected by b___ f___, c____ permeability, and binding of drugs to p______.

Pharmacology:

Once a drug enters the body, it is distributed to the p____, e____ f_____, total b______ w_____, and other sites like f___ reserves.

Pharmacology:

What plasma proteins do drugs bind to?

Pharmacology:

True or False-

Drugs that are bound to plasma proteins can still be active.

False-

bound drugs are pharmacologically inactive; only the free, unbound drug can act on target sites in the tissues and elicit a biological response

Pharmacology:

True or False-

The ability/quantity of a drug molecule able to bind to one or more albumin molecule will vary by drug.

Pharmacology:

True or False-

Each drug has an equal opportunity to bind to albumin molecules.

False-

There is competition between drugs for binding to albumin molecules

Pharmacology:

What is a specialized target macromolecule that is present on the surface of a cell that binds a drug and mediates its pharmacologic actions?

Pharmacology:

What are 3 types of drug receptors?

1. competitive

2. noncompetitive

3. partial agonist

Pharmacology:

What is another term for metabolism?

Pharmacology:

The l____ is the major site for drug metabolism, which is called the 1st-pass effect. However, some drugs undergo metabolism in other tissues, such as the l_____, s______, and i_____.

Pharmacology:

True or False-

All drugs are administered in their active form and the therapeutic effect is then activated during distribution.

False-

Some drugs are administered in their inactive form and the therapeutic effect is then activated during metabolism

Pharmacology:

Drugs are most often e____ by biotransformation and/or e_____ into the urine or bile.

Pharmacology:

What is the ratio of the dose that produces toxicity to the dose that produces a clinically desired or effective response in a population of individuals?

Pharmacology:

True or False-

It is better to have a drug with a narrow therapeutic index because that means that the drug is more effective and works more quickly than others.

False-

A drug is determined to generally be safer if the therapeutic index is larger; the more narrow the therapeutic index, the more caution must be used with the drug

Pharmacology:

What is the most common route of elimination?

Pharmacology:

Other sites of elimination include: b____, i_____, l_____, b_____ m______, and/or d_____. 

Pharmacology:

How might medications be dosed in pts. with decr. renal function?

Pharmacology:

What is the amount of time that it takes for 50% of the drug to be metabolized or eliminated?

Pharmacology:

Factors affecting t 1/2 include: decr. renal b___ f___; the introduction of a s_____ drug; decr. e______ ratio; and decr. m_____.

Oxygenation & Assessment of Resp. System:

What are the components of the upper resp. tract?

Oxygenation & Assessment of Resp. System:

What are the components of the lower resp. tract?

Oxygenation & Assessment of Resp. System:

What is the point at which the 2 mainstem bronchi emerge from the trachea?

Oxygenation & Assessment of Resp. System:

True or False-

The left bronchus is slightly wider, shorter, and more vertical than the right bronchus.

False-

The right bronchus is slightly wider, shorter, and more vertical than the right bronchus

Oxygenation & Assessment of Resp. System:

What are the 2 main potential problems associated with the R bronchus being wider, shorter, and more vertical than the L bronchus?

1. accidental intubation when an endotracheal tube is passed

2. aspiration is more likely to occur on the R side when a foreign object enters the throat

Oxygenation & Assessment of Resp. System:

What are the accessory muscles used for breathing (which you don't really want a pt. to be using!)?

Oxygenation & Assessment of Resp. System:

With aging, a pt.'s a_____ surface area decr., d____ capacity decr., elastic r____ decr., bronchioles and alveolar ducts d____, and the ability to c____ decr.

Oxygenation & Assessment of Resp. System:

With aging, a pt.'s lung r____ volume incr., v____ capacity decr., efficiency of e_____ decr., and e____ decr.

Oxygenation & Assessment of Resp. System:

With aging, muscles of the p____ and l_____ atrophy, v____ c____ become slack, laryngeal muscles lose e_____, and airways lose c______.

Oxygenation & Assessment of Resp. System:

With aging, pulmonary v____ r_____ incr., pulmonary capillary b____ v______ decr., and the risk of h____ incr.

Oxygenation & Assessment of Resp. System:

With aging, a pt. may experience exercise i_____, which is the body's response to hypoxia and h______.

Oxygenation & Assessment of Resp. System:

With aging, resp. muscle s____, especially the diaphragm and the i_______ muscles, decr.

Oxygenation & Assessment of Resp. System:

With aging, effectiveness of c___ decr., I_____ A decr., and alveolar m______ are altered, leaving the pt. more susceptible to i______.

Oxygenation & Assessment of Resp. System:

With aging, the a_____ diameter incr., the thorax becomes s____, progressive k_______ occurs, chest wall c_____ decr., m____ may decr., and o____ is possible.

Oxygenation & Assessment of Resp. System:

What are the 3 organs/tissues working with the resp. system that are responsible for meeting the needs of oxygenation and tissue perfusion?

1. lungs

2. heart

3. blood vessels/RBCs

Oxygenation & Assessment of Resp. System:

What is the role of the lungs in the oxygenation and tissue perfusion of the body?

Oxygenation & Assessment of Resp. System:

What is the role of the heart and the blood vessels/RBCs in the oxygenation and tissue perfusion of the body?

Oxygenation & Assessment of Resp. System:

When completing a pt. hx for a resp. issue, what are some important pieces of information that an RN should obtain?

Oxygenation & Assessment of Resp. System:

Where are the frontal sinuses?

Oxygenation & Assessment of Resp. System:

Where are the ethmoid sinuses?

Oxygenation & Assessment of Resp. System:

Where are the maxillary sinuses?

Oxygenation & Assessment of Resp. System:

Where are the sphenoid sinuses?

Oxygenation & Assessment of Resp. System:

What does a typical assessment of the pharynx, trachea, and larynx include?

Oxygenation & Assessment of Resp. System:

What does a typical assessment of the lungs and thorax include?

Inspect thorax with patient sitting up, observe chest for symmetry, work from the apex downward and from side-to-side, observe resp. rate/rhythm/depth of inspiration, examine AP diameter w/ lateral diameter, palpate —distance between ribs, palpate to assess respiratory movement, symmetry, palpate for crepitus, observe diaphragmatic excursion (norm = 3-5 cm), and auscultate for adventitious breath sounds

Oxygenation & Assessment of Resp. System:

When auscultating the lungs, why should you listen to 4 points on the right side but 5 points on the left side?

Oxygenation & Assessment of Resp. System:

Of the following types, which type of sputum is the most concerning for an RN, which should be addressed immediately?

a. thin, clear sputum

b. thick, green-yellow sputum

c. thick yellow-brown sputum

d. pink, frothy sputum

Answer: d

'd' is quite common with pulmonary edema and should be addressed immediately

Oxygenation & Assessment of Resp. System:

What is the term used for blood in the sputum?

Oxygenation & Assessment of Resp. System:

Rust-colored, foul-smelling sputum is often associated with which condition?

a. pulmonary edema

b. pneumococcal pneumonia

c. chronic bronchitis or lung cancer

d. TB/pulmonary infarction/bronchial adenoma

Answer: b

Oxygenation & Assessment of Resp. System:

Hemoptysis is most often associated with which condition?

a. pulmonary edema

b. pneumococcal pneumonia

c. chronic bronchitis or lung cancer

d. TB/pulmonary infarction/bronchial adenoma

Oxygenation & Assessment of Resp. System:

Grossly bloody sputum is often associated with which condition?

a. pulmonary edema

b. pneumococcal pneumonia

c. chronic bronchitis or lung cancer

d. TB/pulmonary infarction/bronchial adenoma

Oxygenation & Assessment of Resp. System:

How much sputum production in one day would be considered WNL?

Oxygenation & Assessment of Resp. System:

C____, s_____ and m_____ membrane changes, and p____ may indicate immediate oxygenation problems.

Oxygenation & Assessment of Resp. System:

What can be indicators of both immediate and long-term oxygenation problems?

Oxygenation & Assessment of Resp. System:

C____, w____ loss, unevenly developed m_____, and "b____ chest" indicate long-term oxygenation problems.

Oxygenation & Assessment of Resp. System:

A normal range for RBCs for females is __.2-__.4 million/mm³ and __.7-__.1 for males.

4.2-5.4 for females

4.7-6.1 for males

Oxygenation & Assessment of Resp. System:

A normal range for Hgb for females is 1__-1__ mg/dL and 1__-1__ for males.

12-16 mg/dL for females

14-18 mg/dL for males

Oxygenation & Assessment of Resp. System:

A normal range for Ht for females is __7-__7% and __2-__2% for males.

37-47% for females

42-52% for males

Oxygenation & Assessment of Resp. System:

A normal range for WBCs is __,000-__,000/mm³.

Oxygenation & Assessment of Resp. System:

Polycythemia may result from C___ or high a_____; while decr. levels of RBCs may indicate a_____, h_____, or h_____.

Oxygenation & Assessment of Resp. System:

True or False-

High and low levels of Hgb and Ht can indicate the same conditions as polycythemia and decr. levels of RBCs.

Oxygenation & Assessment of Resp. System:

Leukocytosis may indicate acute i___ or i____, p_____, m_____, t_____, or e_____; while leukopenia may indicate an overwhelming i____, an a_____ disorder, or evidence of i_____ therapy.

infection; inflammation; pneumonia; meningitis; tonsilitis; emphysema;

infection; autoimmune; immunosuppressant

Oxygenation & Assessment of Resp. System:

In a differential WBC count, a normal range for neutrophils is __5-__0% of total WBCs.  

Oxygenation & Assessment of Resp. System:

In a differential WBC count, a normal range for eosinophils is __-__% of total WBCs.  

Oxygenation & Assessment of Resp. System:

In a differential WBC count, a normal range for basophils is __-__% of total WBCs.  

Oxygenation & Assessment of Resp. System:

In a differential WBC count, a normal range for lymphocytes is __0-__0% of total WBCs.  

Oxygenation & Assessment of Resp. System:

In a differential WBC count, a normal range for monocytes is __-__% of total WBCs.  

Oxygenation & Assessment of Resp. System:

Neutrophils, eosinophils, basophils, lymphocytes, or monocytes?-

Elevation = possible acute bacterial pneumonia, COPD, or inflammatory conditions; Decr. = possible viral dz (influenza)

Oxygenation & Assessment of Resp. System:

Neutrophils, eosinophils, basophils, lymphocytes, or monocytes?-

Elevation = possible viral infection, pertussis, infectious mononucleosis, and active TB; Decr. = may be seen during corticosteroid therapy

Oxygenation & Assessment of Resp. System:

Neutrophils, eosinophils, basophils, lymphocytes, or monocytes?-

Elevation = possible viral infection, pertussis, infectious mononucleosis; Decr. = may be seen during corticosteroid therapy

Oxygenation & Assessment of Resp. System:

Neutrophils, eosinophils, basophils, lymphocytes, or monocytes?-

Elevation = possible inflammation seen in chronic sinusitis and hypersensitivity reactions; Decr. = may be seen in an acute infection

Oxygenation & Assessment of Resp. System:

Neutrophils, eosinophils, basophils, lymphocytes, or monocytes?-

Elevation = possible COPD, asthma, or allergies; Decr. = may indicate pyogenic infections (infections producing pus)

Oxygenation & Assessment of Resp. System:

In ABGs, a normal range for Pao₂ is __0-__00 mmHg and may be ____ in older adults.

Oxygenation & Assessment of Resp. System:

In ABGs, a normal range for Paco₂ is __5-__5 mmHg.

Oxygenation & Assessment of Resp. System:

In ABGs, a normal range for pH is 7.__-7.__ until the age of 60; 7.__-7.__ for 60-90 year olds; and 7.__-7.__ for >90 yrs old.

7.35-7.45 for =/< 60 yrs old

7.31-7.42 for 60-90 yrs old

7.26-7.43 for > 90 yrs old

Oxygenation & Assessment of Resp. System:

In ABGs, a normal range for HCO₃ is 2__-2__ mEq/L.

Oxygenation & Assessment of Resp. System:

In ABGs, a normal range for Spo₂ is 9__-__00% and may be ____ in older adults.

Oxygenation & Assessment of Resp. System:

Elevations in Pao₂ may indicate possible excessive o____ administration; decr. may indicate possible C___, asthma, chronic b____, lung/bronchi c_____, cystic f_____, R___, anemia, or a______.

oxygen

COPD; bronchitis; cancer; fibrosis; RDS; atelectasis

Oxygenation & Assessment of Resp. System:

Elevations in Paco₂ may indicate possible C____, asthma, p_____, a_____ effects, or use of o____ (respiratory acidosis); decr. indicate h________/respiratory a_______.

COPD; pneumonia; anesthesia; opioids

hyperventilation; alkalosis

Oxygenation & Assessment of Resp. System:

Elevations in pH may indicate possible metabolic or respiratory a_______; decr. may indicate possible metabolic or respiratory a_________.

Oxygenation & Assessment of Resp. System:

Elevations in HCO₃ may indicate respiratory a_____ as compensation for primary metabolic _____; decr. indicate possible respiratory a_____ as compensation for primary metabolic a______.

acidosis; alkalosis

alkalosis; acidosis

Oxygenation & Assessment of Resp. System:

Decr. in Spo₂ may indicate possible impaired ability of H____ to release oxygen to tissues.

Oxygenation & Assessment of Resp. System:

Besides blood tests, what other laboratory tests can be run to dx resp. conditions?

Oxygenation & Assessment of Resp. System:

What is the purpose of a PFT?

 Oxygenation & Assessment of Resp. System:

What is the purpose of capnometry and capnography?

Oxygenation & Assessment of Resp. System:

What is a third noninvasive resp. test?

Oxygenation & Assessment of Resp. System:

What is the purpose of a bronchoscopy?

Oxygenation & Assessment of Resp. System:

What is the difference between a flexible bronchoscopy and a rigid bronchoscopy?

flexible- can be performed in the ICU with low-dose sedation; mostly used for airway evaluation

rigid- usually requires general anesthesia and performed in the OR; mostly used for cancer staging/removal of secretions

Oxygenation & Assessment of Resp. System:

What is the purpose of a thoracentesis?

Oxygenation & Assessment of Resp. System:

How is a thoracentesis performed?

Oxygenation & Assessment of Resp. System:

What is the pt. preparation for a PFT?

1. pt. should not smoke 6-8 hrs before test

2. bronchodilator Rx may be w/held for 4-6 hrs before test

3. explain that it's a non-invasive test

Oxygenation & Assessment of Resp. System:

What is the pt. preparation for a bronchoscopy?

1. explain that it is an invasive procedure

2. id pt. allergies

3. use 2 pt. identifiers before procedure

4. review lab tests for abnormalities

5. NPO for 4-8 hrs before procedure

6. premedicate w/ benzos and/or opioids

Oxygenation & Assessment of Resp. System:

What condition can result from the use of benzocaine as a topical anesthetic to numb the throat prior to a bronchoscopy?

Oxygenation & Assessment of Resp. System:

What is the normal methemoglobin level in the body and at what level can this condition become fatal?

Oxygenation & Assessment of Resp. System:

What is the priority nursing intervention for a pt. w/ methemoglobinemia?

supplemental oxygen

(if this does not work and their blood is characteristic chocolate-brown color, call the Rapid Response Team)

Oxygenation & Assessment of Resp. System:

What is the follow-up care after a bronchoscopy?

1. NPO until gag reflex has returned (often dimished due to anesthesia)

2. monitor V/S q15min for first 2 hrs

3. assess for complications (i.e. bleeding, infection, or hypoxemia)

4. assess for pneumothorax and methemoglobinemia

Oxygenation & Assessment of Resp. System:

What is the pt. preparation for a thoracentesis?

1. inform pt. it is an invasive procedure

2. tell them to expect a "stinging sensation" from the local anesthetic

3. tell them to expect a "feeling of pressure" from the insertion of the needle

4. stress importance of remaining completely still during procedure

5. ensure allergies, id, and informed consent has been obtained

Oxygenation & Assessment of Resp. System:

What is the follow-up care after a thoracentesis?

1. CXR to assess for pneumothorax and mediastinal shift (shift of thoracic structures to one side)

2. monitor V/S incl. ausculatation of breath sounds

3. check puncture dressing

4. assess for complications

5. urge pt. to breath deeply to promote expansion

Oxygenation & Assessment of Resp. System:

What is the purpose of a lung biopsy?

Oxygenation & Assessment of Resp. System:

Where is a lung biopsy performed?

Oxygenation & Assessment of Resp. System:

What is the pt preparation for a lung biopsy?

1. address anxiety about procedure (i.e. biopsy does not automatically = CA, which is the fear of many pts.)

2. Admin. analgesic or sedative PRN

3. pt. may feel "sting" of local anesthetic

4. pt. may feel "pressure" if needle is used

5. pt. will need to be sedated under general anesthesia if open lung biopsy is necessary

Oxygenation & Assessment of Resp. System:

What is the follow-up care after a lung biopsy?

1. assess V/S w/ auscultation of breath sounds q4h for first 24 hrs

2. assess for S/S of resp. distress

3. report dimished/absent breath sounds immediately

4. monitor for hemoptysis

Oxygenation & Assessment of Resp. System:

Which is not a clinical manifestation of resp. distress?

a. dyspnea

b. nasal flaring/use of accessory muscles

c. erythema

d. decr. endurance

e. pursed-lip/diaphragmatic breathing

Answer: c

w/ resp. distress, a pt. will usually present with pallor (palenss) and/or cyanosis (bluish-tint) of their skin and mucous membranes, not erythema (redness)

Oxygenation & Assessment of Resp. System:

What is the difference between hypoxemia and hypoxia?

hypoxemia- low levels of oxygen in the blood

hypoxia- decr. tissue oxygenation

Oxygenation & Assessment of Resp. System:

What is the priority tx for both hypoxemia and hypoxia?

Oxygenation & Assessment of Resp. System:

What is the goal of oxygen therapy to tx hypoxemia and hypoxia?

Oxygenation & Assessment of Resp. System:

The type of oxygen delivery system used for oxygen therapy depends on what 5 factors? 

—1. Oxygen concentration required/achieved

—2. Importance of accuracy and control of oxygen concentration

—3. Patient comfort

4. —Importance of humidity

—5. Patient mobility

Oxygenation & Assessment of Resp. System:

What type of oxygen delivery system does not provide enough flow to meet total oxygen and air volume and is delivered via —nasal cannula or facemask?

Oxygenation & Assessment of Resp. System:

Which low flow oxygen delivery system has flow rates of 1-6 L/min and O2 concentration of 24%-44% (1-6 L/min)?

Oxygenation & Assessment of Resp. System:

When using a nasal cannula, which 2 things should you be assessing for frequently?

1. patency of nostrils

2. changes in resp. rate and depth

Oxygenation & Assessment of Resp. System:

Which low flow oxygen delivery system delivers O2 up to 40%-60% as a minimum of 5 L/min through a mask that fits securely over the nose and mouth?

Oxygenation & Assessment of Resp. System:

When using a simple facemask, what is the most important thing to assess the pt. for?

Oxygenation & Assessment of Resp. System:

Which low flow oxygen delivery system

Oxygenation & Assessment of Resp. System:

Which low flow oxygen delivery system

Oxygenation & Assessment of Resp. System:

What is the most important thing to assess when using a non-rebreather mask?

Oxygenation & Assessment of Resp. System:

What are the hazards and complications of oxygen therapy?

Oxygenation & Assessment of Resp. System:

What oxygen delivery system can deliver 24-100% oxygen at 8-15 L/min?

Oxygenation & Assessment of Resp. System:

The high flow oxygen delivery system includes the v____ mask, face t____, a_____ mask, t_____ collar, and T-_____.

Oxygenation & Assessment of Resp. System:

What is the best high flow oxygen delivery system for chronic lung dz?

Oxygenation & Assessment of Resp. System:

Which high flow oxygen delivery system delivers desired FIO₂ for

Oxygenation & Assessment of Resp. System:

True or False-

With a T-piece, mist should only be seen during inspiration, not expiration.

Oxygenation & Assessment of Resp. System:

Which breathing treatment uses positive pressure to keep alveoli open in order to improve gas exchange w/out airway intubation?

noninvasive positive-pressure ventilation

(NPPV)

Oxygenation & Assessment of Resp. System:

What are the 2 types of NPPV?

BiPAP

CPAP

Oxygenation & Assessment of Resp. System:

What is a CPAP used for?

Oxygenation & Assessment of Resp. System:

What is a TTO and why do pts. prefer its use?

TTO = transtracheal oxygen delivery system-

avoids irritation that nasal prongs cause, is more comfortable, and has flow rates that are prescribed for rest and activity

Oxygenation & Assessment of Resp. System:

Oxygenation & Assessment of Resp. System:

True or False-

Like ileostomies and colostomies, tracheostomies can be temporary or permanent.

Oxygenation & Assessment of Resp. System:

Where in the pt.'s neck is the tracheostomy placed?

Oxygenation & Assessment of Resp. System:

The priority problems for pts. w/ tracheostomies include: reduced o_____, inadequate c_____, inadequate n______, potential for i_____, and damage to oral m_____.

Oxygenation & Assessment of Resp. System:

A major care issue of a pt. w/ a tracheostomy is what?

prevention of tissue damage-

so minimal leak and occlusive techniques should be used, the cuff pressure should be checked often, and malnutrition, hemodynamic instability, and hypoxia should be prevented/treated immediately

Oxygenation & Assessment of Resp. System:

What must happen to air delivered via tracheostomy tube? Why?

Oxygenation & Assessment of Resp. System:

Suctioning is n______ for a pt. w/ a tracheostomy but its complications include: h_____, mucosal t_____, i_____, v_____ stimulation resulting in bronchospasm, and c_____ d_____ from induced hypoxia.

Oxygenation & Assessment of Resp. System:

What are the 5 main causes of hypoxia in pts. with tracheostomies?

1. ineffective oxygenation before/during/after suctioning

2. use of catheter that is too large for artificial airway

3. prolonged suctioning time

4. excessive suction pressure

5. too frequent suctioning

Oxygenation & Assessment of Resp. System:

What is involved in the care of a conscious pt. with a tracheostomy?

Oxygenation & Assessment of Resp. System:

The HOB should be elevated for at least ____ minutes after eating for a pt. w/ a tracheostomy.

Oxygenation & Assessment of Resp. System:

Weaning from a tracheostomy tube will include:

Care of Pts. w/ Resp. Dysfunction:

What is the common preventable and treatable dz that is progressive and associated w/ an enhanced chronic inflammatory response in airways and the lung to noxious particles or gases?

Care of Pts. w/ Resp. Dysfunction:

What are the 2 subtypes of COPD?

1. emphysema

2. chronic bronchitis

Care of Pts. w/ Resp. Dysfunction:

What is the most important and modifiable risk factor for emphysema and chronic bronchitis development and exacerbation?

Care of Pts. w/ Resp. Dysfunction:

True or False-

Chronic bronchitis may have a genetic component.

True-

chronic bronchitis may be the result of Alpha-1 antitrypsin deficiency

Care of Pts. w/ Resp. Dysfunction:

True or False-

Only 5% of COPD pts. are non-smokers with no second-hand smoke exposure.

False-

20% of COPD pts. are non-smokers with no second-hand smoke exposure

Care of Pts. w/ Resp. Dysfunction:

Co-morbidities assoc. w/ COPD include: l____ CA; C___; o______; m______ syndrome; s____ m____ weakness; d_______; and c____ function.

Care of Pts. w/ Resp. Dysfunction:

What is the nickname for emphysema?

Care of Pts. w/ Resp. Dysfunction:

Emphysema is the p ermanent h_______ of the alveoli resulting in d______ of the alveolar and c______ walls.

Small bronchioles become o______ due to mucus, smooth muscle s____, i______ processes & collapse of b____ walls.

Care of Pts. w/ Resp. Dysfunction:

With emphysema, there is a repeated infectious process which leads to an incr. of n_____ and m_____, causing the release of p______ enzymes, which destroy a______ tissue, causing more i_______, e_______, and e________.

Care of Pts. w/ Resp. Dysfunction:

With emphysema, what else is destroyed and how does that affect gas exchange in the alveoli?

Care of Pts. w/ Resp. Dysfunction:

With emphysema, what can the development of blebs and bullae cause?

Care of Pts. w/ Resp. Dysfunction:

With emphysema, what can the loss of alveolar walls and capillaries (decr. gas exchange) cause?

Care of Pts. w/ Resp. Dysfunction:

True of False-

With emphysema, ABG abnormalities occur early in the dz process.

False-

ABG abnormalities occur late in the dz process; over time, renal compensation will also occur

Care of Pts. w/ Resp. Dysfunction:

What is defined as a productive cough for 3 months in each of 2 successive yrs in a pt. in whom other causes of the chronic cough have been R/O and is AKA the "blue bloater?"

Care of Pts. w/ Resp. Dysfunction:

What causes chronic bronchitis and what can exacerbate its S/S?

Care of Pts. w/ Resp. Dysfunction:

Early in chronic bronchitis, a pt.'s exam may be n_______ or show only p____ expiration or w______ upon forced exhalation.

Care of Pts. w/ Resp. Dysfunction:

As chronic bronchitis progresses, the pt. will present w/ d____ breath sounds, w_____, c______ at lung bases, d______ heart sounds, incr. r_____ to percussion, and b____-s____ chest.

Care of Pts. w/ Resp. Dysfunction:

With end-stage chronic bronchitis, the pt. will position to relieve d_____ (i.e. "tripoding"), use a______ m_____ to breathe, breathe thru p_____ lips, and will have neck vein d______. 

Care of Pts. w/ Resp. Dysfunction:

How is COPD dx?

Care of Pts. w/ Resp. Dysfunction:

forced vital capacity; forced expiratory volume; 1; residual volume;

total lung capacity

Care of Pts. w/ Resp. Dysfunction:

Which lung volume is most profoundly affected by COPD? How?

Care of Pts. w/ Resp. Dysfunction:

With lung volumes and COPD, when is a definitive dx made?

Care of Pts. w/ Resp. Dysfunction:

What is an acute incr. in symptoms beyond the normal day-to-day variation?

Care of Pts. w/ Resp. Dysfunction:

Name a few things that exacerbate COPD.

Care of Pts. w/ Resp. Dysfunction:

How is a COPD exacerbation dx?

1. CXR- R/O CHF & pneumothorax

2. ABGs and pulse ox- differentiate between acidosis/alkalosis & metabolic/resp. etiology

3. Other labs (CBC, BNP, BMP) to R/O other causes

4. CT- R/O pulmonary embolism (rarely done unless suspected)

5. sputum cultures

Care of Pts. w/ Resp. Dysfunction:

The goals of COPD exacerbation tx include: identifying and treating the c_____ of exacerbation if possible; optimizing lung function with b______ and other meds; assuring adequate o______ and secretion c________; preventing the need for i________; preventing complications of i________; and addressing n_______ needs.

Care of Pts. w/ Resp. Dysfunction:

Beta-adrenergic agonist, Anticholinergic agents, Glucocorticoids, ATBs, or Methylxanthines?-

Not used anymore due to lack of efficacy and incr. of side effects; may see outpatient on oral theophylline, which will require regular bloodwork to check therapeutic levels.

Care of Pts. w/ Resp. Dysfunction:

What is the therapeutic range for theophylline?

Care of Pts. w/ Resp. Dysfunction:

Beta-adrenergic agonist, Anticholinergic agents, Glucocorticoids, ATBs, or Methylxanthines?-

Disrupts all known production pathways of inflammatory mediators; used for prevention.

Care of Pts. w/ Resp. Dysfunction:

Beta-adrenergic agonist, Anticholinergic agents, Glucocorticoids, ATBs, or Methylxanthines?-

Often start pt. on broad spectrum kind and then change kind as sputum cultures grow with sensitivity.

Care of Pts. w/ Resp. Dysfunction:

Beta-adrenergic agonist, Anticholinergic agents, Glucocorticoids, ATBs, or Methylxanthines?-

Examples are predisone, dexamethasone, methylpredisone, fluticasone, beclomethasone.

Care of Pts. w/ Resp. Dysfunction:

Beta-adrenergic agonist, Anticholinergic agents, Glucocorticoids, ATBs, or Methylxanthines?-

Relaxes the muscles surrounding the airways, helping decrease airway restriction; can be short- or long-acting; admin via nebulizer or MDI.

Care of Pts. w/ Resp. Dysfunction:

Beta-adrenergic agonist, Anticholinergic agents, Glucocorticoids, ATBs, or Methylxanthines?-

Short-acting form is ipratropium; long-acting form is tiotropium.

Care of Pts. w/ Resp. Dysfunction:

Beta-adrenergic agonist, Anticholinergic agents, Glucocorticoids, ATBs, or Methylxanthines?-

Acts like caffeine to cause bronchodilation by relaxing bronchiolar smooth muscles through inhibiting an enzyme that breaks down the intracellular trigger for relaxation; used to prevent asthma attack or stop one.

Care of Pts. w/ Resp. Dysfunction:

Beta-adrenergic agonist, Anticholinergic agents, Glucocorticoids, ATBs, or Methylxanthines?-

Causes bronchodilation by relaxing bronchiolar smooth muscle thru binding to and activating pulmonary beta₂ receptors.

Care of Pts. w/ Resp. Dysfunction:

Beta-adrenergic agonist, Anticholinergic agents, Glucocorticoids, ATBs, or Methylxanthines?-

Primary use is fast-acting "rescue" drug; admin via nebulizer or MDI.

Care of Pts. w/ Resp. Dysfunction:

Beta-adrenergic agonist, Anticholinergic agents, Glucocorticoids, ATBs, or Methylxanthines?-

Involves the parasympathetic nervous system and norepinephrine in bronchodilation; purpose is both "rescue" and prevention.

Care of Pts. w/ Resp. Dysfunction:

Beta-adrenergic agonist, Anticholinergic agents, Glucocorticoids, ATBs, or Methylxanthines?-

Short-acting (SABA) = albuterol and levalbuterol; long-acting (LABA) = salmeterol.

Care of Pts. w/ Resp. Dysfunction:

What resp. medication blocks the leukotriene receptors, preventing the inflammatory mediator from stimulating inflammation; purpose is prevention of attack?

Care of Pts. w/ Resp. Dysfunction:

True or False-

A pt. w/ COPD can NEVER have too much oxygen.

False-

COPD pts. are often chronically hypercapnic and have learned to live w/ that; too high/too much oxygen will cause them to lose their hypoxic drive, which is what is keeping them breathing

Care of Pts. w/ Resp. Dysfunction:

True or False-

The goal oxygen sat range for a COPD pt. is 90-94%.

Care of Pts. w/ Resp. Dysfunction:

What are some common side effects of beta-adrenergic agonists?

Care of Pts. w/ Resp. Dysfunction:

What some are common side effects of beta-adrenergic agonists?

Care of Pts. w/ Resp. Dysfunction:

What are some more serious side effects of beta-adrenergic agonists?

Care of Pts. w/ Resp. Dysfunction:

What are some common side effects of anticholinergic agents?

Care of Pts. w/ Resp. Dysfunction:

What are some more serious side effects of anticholinergic agents?

Care of Pts. w/ Resp. Dysfunction:

What are some common side effects of methylxanthines (theophylline)?

Care of Pts. w/ Resp. Dysfunction:

What are some more serious side effects of methylxanthines (theophylline)?

Care of Pts. w/ Resp. Dysfunction:

What are some common side effects of glucocorticoids?

Care of Pts. w/ Resp. Dysfunction:

What are some more serious side effects of glucocorticoids?

Care of Pts. w/ Resp. Dysfunction:

What are some common side effects of leukotriene antagonists (monteleukast)?

Care of Pts. w/ Resp. Dysfunction:

What are some more serious side effects of leukotriene antagonists (monteleukast)?

Care of Pts. w/ Resp. Dysfunction:

What are some nursing dx for COPD? (just be familiar w/ a few)

—Impaired Gas Exchange; Ineffective Breathing Pattern; Ineffective Airway Clearance; Imbalanced Nutrition; Anxiety; —Activity Intolerance

Also:  fatigue, knowledge deficit, sexual dysfunction, impaired spontaneous ventilation, disturbed sleep, disturbed thought processes, ineffective coping, & ineffective role performance

Care of Pts. w/ Resp. Dysfunction:

What is the priority nursing intervention for COPD pts.? 

Care of Pts. w/ Resp. Dysfunction:

What are some other nursing interventions for COPD pts.?

Care of Pts. w/ Resp. Dysfunction:

What is defined as a chronic inflammatory airway disorder assoc. w/ airway hyper-responsiveness that leads to episodes of wheezing, breathlessness, chest tightness, and coughing?

Care of Pts. w/ Resp. Dysfunction:

When are asthmatic episodes usually worse?

Care of Pts. w/ Resp. Dysfunction:

True or False-

Asthma attacks will always require a tx (medication) to resolve the airway obstruction. 

False-

airway obstruction is spontaneously reversible and reversible w/ tx

Care of Pts. w/ Resp. Dysfunction:

With long-term asthma characterized by irreversible obstruction, it may be referred to as "o_____ a_____," which is a subtype of C_____.

Care of Pts. w/ Resp. Dysfunction:

True or False-

All asthmatics have COPD.

Care of Pts. w/ Resp. Dysfunction:

What is the main immunoglobulin and main cell type associated with asthma?

the main immunoglobulin = IgE

the main cell type = mast cells

Care of Pts. w/ Resp. Dysfunction:

More serious complications of asthma include: r____ fractures; p_____; a______; and p_______.

Care of Pts. w/ Resp. Dysfunction:

What is a severe, life-threatening form of asthma that is characterized by severe, prolonged asthma symptoms that are unresponsive to usual tx?

Care of Pts. w/ Resp. Dysfunction:

What are the goals of asthma tx?

1. control/prevent exacerbations (Rx, id/avoid irritants/precipitating factors)

2. improve air flow

3. relieve symptoms (rescue Rx, asthma action plan)

Care of Pts. w/ Resp. Dysfunction:

What is the ONLY injected medication for the tx/maintenance of chronic asthma?

Care of Pts. w/ Resp. Dysfunction:

How does Omalizumab administered and how does it work to tx chronic asthma?

Care of Pts. w/ Resp. Dysfunction:

What are some common side effects of Omalizumab?

Care of Pts. w/ Resp. Dysfunction:

What is the most serious side effect of Omalizumab?

Care of Pts. w/ Resp. Dysfunction:

What other Rx are used for tx/maintenance of chronic asthma S/S?

1. leukotriene modifiers (montelukast)

2. long-acting beta agonists (LABAs- salmeterol)

3. inhaled corticosteroids (fluticasone)

Care of Pts. w/ Resp. Dysfunction:

What are the Rx for "rescue" therapy for asthma?

1. short-acting beta agonists (SABAs- albuterol)

2. short-acting anticholinergics (ipratropium)

3. corticosteroids (Oral- prednisone, IV, IM)

4. Oxygen

5. methylxanthines (last ditch effort)

Care of Pts. w/ Resp. Dysfunction:

How do you use an inhaler w/ a spacer?

1. shake whole unit vigorously 3-4x

2. insert mouthpiece into mouth, over tongue and w/ lips sealed around it

3. breathe in medication slowly and deeply

4. hold breath for @ least 10 sec

5. wait @ least 1 min between puffs

6. clean @ least 1x/day

Care of Pts. w/ Resp. Dysfunction:

What is the preferred method of use for an inhaler w/out a spacer?

1. tilt head back slightly and breathe out fully

2. hold mouthpiece 1-2 inches away from mouth

3. breathe in medication slowly and deeply for 3-5 sec

4. hold breath for @ least 10 sec

5. wait @ least 1 min between puffs

6. clean @ least 1x/day

Care of Pts. w/ Resp. Dysfunction:

What is a bacterial infectious dz of the resp. system affecting the lungs that is spread via airborne droplet transmission?

Care of Pts. w/ Resp. Dysfunction:

What other areas of the body can be affected by TB?

Care of Pts. w/ Resp. Dysfunction:

TB can be spread through c____, s_____, and s_____ but is more commonly spread via r______ exposure of a close, frequent, and prolonged nature.

Care of Pts. w/ Resp. Dysfunction:

True or False-

The infecting bacterium, tubercle bacillus, can remain dormant for years, then reactivate and produce clinical TB.

True-

which is why repeated 2-step TB testing is required frequently for all health care personnel

Care of Pts. w/ Resp. Dysfunction:

Who is at highest risk for contracting TB?

Care of Pts. w/ Resp. Dysfunction:

What information should the RN obtain during an interview r/t TB hx?

1. ask about exposure

2. ask about country of origin or foreign travel

3. ask about results of previous TB tests

4. ask about BCG vaccine

Care of Pts. w/ Resp. Dysfunction:

What is the BCG vaccine and what does it do?

Care of Pts. w/ Resp. Dysfunction:

What should the RN know about a pt. who has received the BCG vaccine?

Care of Pts. w/ Resp. Dysfunction:

The stages of TB are: g______ inflammation; c_______ n______ in the center of the lesion; r_______/d_______/f_______; possible c________; and finally, it may s_______ thru the body.

Care of Pts. w/ Resp. Dysfunction:

The general S/S of TB include: unexplained wt. _____; _____ of appetite; night s______; f_____; f______; and c______.

Care of Pts. w/ Resp. Dysfunction:

What are the hallmark S/S of TB infection of the lungs?

Care of Pts. w/ Resp. Dysfunction:

How is TB tentatively dx?

1. sputum positive for acid-fast bacillus = need for further testing

2. CXR

3. 24-hr ELISA rapid blood test

4. TB skin test

Care of Pts. w/ Resp. Dysfunction:

How is TB definitively dx?

Care of Pts. w/ Resp. Dysfunction:

True or False-

A positive PPD (skin test) indicates active TB and contagiousness.

False-

A positive PPD does NOT indicate active TB and does NOT indicate contagiousness

Care of Pts. w/ Resp. Dysfunction:

True or False-

False positives never occur with PPD; the PPD test is 100% accurate.

False-

false positives can be assoc. w/ erroneous planting of PPD and incorrect reading of the test

Care of Pts. w/ Resp. Dysfunction:

What are some reasons for a false negative PPD result?

Care of Pts. w/ Resp. Dysfunction:

True or False-

A person w/ latent TB will have an abnormal CXR, postive PPD, postive sputum test, and will be exhibiting S/S of TB infection.

False-

A person w/ latent TB will have a normal CXR, a negative sputum test, and will not be exhibiting S/S of TB infection; this person WILL have a positive PPD, which may be the only indication of the infection!

Care of Pts. w/ Resp. Dysfunction:

True or False-

A person w/ latent TB should still be tx as if they have an active infection.

Care of Pts. w/ Resp. Dysfunction:

How long must TB be tx?

1. initial phase of 2 months

2. continuation phase of 4-7 months (extended by 28 wks if cavitation exists on CXR and/or sputum cultures are positive after 2 mos of tx)

Care of Pts. w/ Resp. Dysfunction:

How many drugs are approved by the FDA for tx of TB?

Care of Pts. w/ Resp. Dysfunction:

What are the 4 first-line anti-TB agents that form the core of tx regimens?

1. isoniazid (INH)

2. rifampin (RIF)

3. ethambutol (EMB)

4. pyraxinamide (PZA)

Care of Pts. w/ Resp. Dysfunction:

What is the major adverse effect of all anti-TB meds?

Care of Pts. w/ Resp. Dysfunction:

What can be an alarming side effect that is common w/ rifampin (RIF) use?

Care of Pts. w/ Resp. Dysfunction:

How is an active TB infection managed?

1. respiratory isolation (i.e. Airborne Precautions- HEPA respirator masks, gowns, gloves)

2. contact investigation

3. direct observation therapy (watch pt. swallow all meds)

4. response to therapy evaluated via symptom resolution/improvement

5. well-balanced nutrition

6. TB drugs can cause nausea, so give @ bedtime

Care of Pts. w/ Resp. Dysfunction:

What are some nursing dx assoc. w/ TB? (just know a few)

Care of Pts. w/ Resp. Dysfunction:

What is excess fluid in the lungs resulting from inflammatory process as a result of an infectious organism (bacteria or viral) usually contracted via inhalation? 

Care of Pts. w/ Resp. Dysfunction:

What causes the inflammation in pneumonia?

Care of Pts. w/ Resp. Dysfunction:

What is a major nursing dx assoc. w/ pneumonia? Why?

Nursing dx: Impaired oxygenation

Why?: fluid collects in and around the alveoli, causing the alveolar walls to thicken, which results in decr. in efficient gas exchange 

Care of Pts. w/ Resp. Dysfunction:

The risk factors of pneumonia include: being an o____ adult; C____; i______; d_____; recent exposure to r____ or i_____ virus; use of drugs that cause decr. g____ a_____; intubation/t_____/NGT; and s______.

Care of Pts. w/ Resp. Dysfunction:

What are the generic S/S of pneumonia?

Care of Pts. w/ Resp. Dysfunction:

What are the more tell-tale S/S of pneumonia when present w/ the generic S/S?

Care of Pts. w/ Resp. Dysfunction:

A geriatric pt. may have an atypical presentation of pneumonia, exhibiting m_____ s_____ change and possibly be a______.

Care of Pts. w/ Resp. Dysfunction:

How is a definitive dx of pneumonia made?

Care of Pts. w/ Resp. Dysfunction:

True or False-

Regardless of cause of pneumonia, all pts. will be tx w/ ATBs.

False-

if the cause of the pneumonia is viral, no ATBs will be given b/c viral infections do not respond to ATBs

Care of Pts. w/ Resp. Dysfunction:

True or False-

ATB therapy for pneumonia will generally be broad-spectrum to begin w/, then tailored to specific organism once its identified.

True-

sputum cultures and other lab tests can help id the organism and dictate a more targeted ATB regimen

Care of Pts. w/ Resp. Dysfunction:

Symptom management of pneumonia includues: f_____; a_____; and b______.

Care of Pts. w/ Resp. Dysfunction:

Tx for pneumonia will also include: o_____; i_____ s______ to prevent pooling of fluid in airways; and encouragement of c____ and d_____ breathing.

Care of Pts. w/ Resp. Dysfunction:

Besides Impaired Oxygenation, what are some other nursing dx for pneumonia? (just be familiar w/ a few)

Care of Pts. w/ Resp. Dysfunction:

What is an inflammatory process in which connective tissue plugs form in the lower airways and in the tissues between alveoli, causing obliterated airways?

Care of Pts. w/ Resp. Dysfunction:

True or False-

BOOP is considered a true pneumonia and is assoc. w/ smoking and tobacco use.

False-

BOOP is not considered a true pneumonia and is not assoc. w/ smoking or tobacco use

Care of Pts. w/ Resp. Dysfunction:

What triggers BOOP?

Care of Pts. w/ Resp. Dysfunction:

The S/S of BOOP include: d_____; f_____; m____ cough; f__-l____ symptoms; and c____ heard upon auscultation.

Care of Pts. w/ Resp. Dysfunction:

S/S of BOOP may resolve s______ or r_____ progress; S/S usually _____ improve w/ standard ATB therapy.

Care of Pts. w/ Resp. Dysfunction:

True or False-

Dx of BOOP is easy and done via CXR.

False-

dx of BOOP is DIFFICULT due to non-specific S/S; definitive dx is done via BIOPSY W/ HISTOLOGICAL FINDINGS

Care of Pts. w/ Resp. Dysfunction:

The tx of BOOP that is most effective is c_____ therapy.

Care of Pts. w/ Resp. Dysfunction:

What is an acute viral dz that is highly contagious, occurs in adults of all ages, and is spread via droplet tranmission from person-to-person?

Care of Pts. w/ Resp. Dysfunction:

Transmission from person-to-person of influenza is most common in the first __-__ days of the illness.

Care of Pts. w/ Resp. Dysfunction:

May be able to dx influenza w/ p___-of-c____ testing (n____ swab or a____); lab testing exists, but takes __ wks, so influenza is most often dx & tx based on s______ and health t___ in the area.

Care of Pts. w/ Resp. Dysfunction:

What are the treatments for influenza?

Care of Pts. w/ Resp. Dysfunction:

What can, if admin. early, shorten the duration of fever/illness symptoms and possibly reduce the risk of complications assoc. w/ influenza?

Care of Pts. w/ Resp. Dysfunction:

How early into influenza infection should antivirals be admin. in order to be most effective?

Care of Pts. w/ Resp. Dysfunction:

True or False-

The CDC recommends the widespread/routine use of antivirals.

False-

The CDC does NOT recommend widespread/routine use of antiviral medications b/c they could incr. the possibilities of antiviral-resistant viruses emerging

Care of Pts. w/ Resp. Dysfunction:

What are the 2 FDA-approved antivirals for tx of influenza?

1. Oseltamivir

2. Zanamivir

Care of Pts. w/ Resp. Dysfunction:

What are some nursing dx for influenza?

(just be familiar w/ a few)

Care of Pts. w/ Resp. Dysfunction:

What is the most common pulmonary complication in hospitalized pts that mostly result from thrombi in deep veins of legs (DVT)?

Care of Pts. w/ Resp. Dysfunction:

Other causes of pulmonary embolism include: a_____ fibrilation; prolonged i______; o_____; and h_____ states. 

Care of Pts. w/ Resp. Dysfunction:

Other than deep veins of legs, pulmonary emboli can also develop in u____ e____ and p____ veins.

Care of Pts. w/ Resp. Dysfunction:

Complications of pulmonary emboli include: pulmonary i____ and pulmonary H___.

Care of Pts. w/ Resp. Dysfunction:

Clinical manisfestations of pulmonary emboli include: sudden d_____, t_____, & t_____; c_____; c_____ pain; h_____; c_____; f_____; and p_____ of chest & axillae.

Care of Pts. w/ Resp. Dysfunction:

More serious manifestations of pulmonary emboli include: accentuation of pulmonic heart sound S__; sudden change in m____ s_____; and s_____.

Care of Pts. w/ Resp. Dysfunction:

A m____ emboli may produce shock; a m_____ emobli may produce pleuritic chest pain; and a s____ emboli may go undetected.

Care of Pts. w/ Resp. Dysfunction:

How is pulmonary embolus dx when in chest? How is it dx when suspected in extremities?

chest- spiral CT scan

extremities- ultrasound

Care of Pts. w/ Resp. Dysfunction:

What are the goals of tx for pulmonary embolus?

1. incr. gas exchange

2. improved pulmonary perfusion

3. elimination of embolus

4. prevention of complications

5. oxygen therapy PRN

6. IV fluids for volume and to prevent shock

Care of Pts. w/ Resp. Dysfunction:

The tx of pulmonary embolus includes: a_____ drugs; b_____; n_______ for pain; t_____ agents; pulmonary e_____; or ____ vena cava interruption.

Care of Pts. w/ Resp. Dysfunction:

For a pulmonary embolus, when should thrombolytic agents be administered in order to be most effective? And what kind is most commonly admin?

Care of Pts. w/ Resp. Dysfunction:

What is the role of heparin and warfarin in tx of pulmonary embolus?

Care of Pts. w/ Resp. Dysfunction:

Which is administered 1st in tx of pulmonary emboli: heparin or warfarin?

Care of Pts. w/ Resp. Dysfunction:

What is a normal INR range compared to an INR range of a pt. taking warfarin?

normal- 1 to 2 sec

warfarin- 2 to 3 sec

Care of Pts. w/ Resp. Dysfunction:

What should the RN tell the pt. about warfarin and vitamin K?

Care of Pts. w/ Resp. Dysfunction:

What is the most important teaching point for a pt. on warfarin?

Acid-base & ABG Interpretation:

On the pH scale, __-__ is acidic, __ is neutral, and __-__ is alkalotic.

Acid-base & ABG Interpretation:

PH is i______ proportional to the amount of H+ in the blood, so the higher the H+, the ______ the pH and the lower the H+, the ______ the pH.

Acid-base & ABG Interpretation:

Normal blood pH is 7.__-7.__.

Acid-base & ABG Interpretation:

_______ state can only exist from either too much CO₂ or too little HCO₃. _______ state can only exist from too little CO₂ or too much HCO₃.

Acid-base & ABG Interpretation:

What are the body's 2 compensation mechanisms to maintain neutral pH?

1. resp. system- lungs

2. metabolic system- renal

Acid-base & ABG Interpretation:

As blood becomes more acidotic (____ pH), kidneys retain ____ and lungs attempt to expel ____ by increased respirations.

Acid-base & ABG Interpretation:

As blood becomes more alkalotic (____ pH), kidneys excrete ____ in the urine; respirations _____ change in an attempt to compensate.

Acid-base & ABG Interpretation:

What is defined as a pH of <7.35 w/ a Paco₂ >45 mmHg?

Acid-base & ABG Interpretation:

What causes resp. acidosis?

Acid-base & ABG Interpretation:

Resp. acidosis can be caused by any condition that causes ____ventilation, including: C____ depression from head injury/drugs, S____ impairing resp. muscle func., a_____, p______, p_______, pulm. e_____, massive pulm. e______, chest wall i______/d______, or abdom. d_______.

Acid-base & ABG Interpretation:

The S/S of resp acidosis are: _______ = dyspnea, resp. distress, shallow resp.; ________ = headache, restlessness, confusion; and _______ = tachycardia, dysrhythmias.

Acid-base & ABG Interpretation:

How do you manage resp. acidosis?

1. incr. ventilation to "blow off" excess H+ (supp. oxygen, mech. vent, etc)

2. correct underlying problem if possible (naloxone to reverse OD or effects of anesthesia, stabilize traumatic inj. or pulm. disorders)

Acid-base & ABG Interpretation:

True or False-

Oxygen alone will correct resp. acidosis.

False-

oxygen will help stabilize, but ultimately the underlying issue needs to be addressed for full recovery (if possible)

Acid-base & ABG Interpretation:

What is defined as a pH >7.45 w/ Paco₂ <35 mmHg?

Acid-base & ABG Interpretation:

What causes resp. alkalosis?

Acid-base & ABG Interpretation:

Any condition that causes Resp. alkalosis is caused by any condtion that causes _____ventilation including: psych resp. like f_____/a_____; p_____; incr. metabolic demands like f_____, s_____, p_____, t________; Rx like resp. s______, and C___ lesions.

Acid-base & ABG Interpretation:

The S/S of resp. alkalosis include: _______ = light-headedness, numbness/tingling, confusion, inability to concentrate, blurred vision; ______ = dysrhythmias, palpitations, diaphoresis; and ______ = xerostomia, tetanic spasms of arms/legs.

Acid-base & ABG Interpretation:

What is the tx of resp. alkalosis? If untx, what could happen?

Acid-base & ABG Interpretation:

What is defined as bicarb level <22 mEq/L with a pH of <7.35?

Acid-base & ABG Interpretation:

What causes metabolic acidosis?

Acid-base & ABG Interpretation:

Metabolic acidosis is caused by either a deficit in b_____ in the bloodstream or an excess of a_____ other than CO₂ including: r____ failure; D____; d_____/intest. f______; anaerobic m______; s______; or s______ intoxication.

Acid-base & ABG Interpretation:

The S/S of metabolic acidosis include: _____ = headache, confusion, restlessness, lethargy, stupor, coma; _____ = dysrhythmias, warm/flushed skin; ______ = Kussmaul's resp.; and ______ = N & V.

Acid-base & ABG Interpretation:

 What are Kussmaul's resp. and w/ which condition are they assoc.?

A type of labored or hyperventilation characterized by a consistently deep and

rapid respiratory pattern; assoc. w/ metabolic acidosis 

Acid-base & ABG Interpretation:

How do you tx metabolic acidosis?

Acid-base & ABG Interpretation:

What is one specific tx intervention for metabolic acidosis? What are the adverse effects of this tx?

Acid-base & ABG Interpretation:

What is defined as a bicarb level >26 mEq/L w/ a pH of >7.45?

Acid-base & ABG Interpretation:

What causes metabolic alkalosis?

Acid-base & ABG Interpretation:

Metabolic alkalosis is caused by an ______ of base or a ______of acid w/in the body including: excess use of a______; excess use of b___/l_____ in dialysis; produced v_____; gastric s______; h______; or excess admin of d_____.

Acid-base & ABG Interpretation:

Metabolic alkalosis S/S include: _____ = depression; _____ = dizziness, lethargy, disorientation, seizures, coma; ______ = weakness, muscle twitching/cramps, tetany; _____ = N & V; and high levels of a_______.

Acid-base & ABG Interpretation:

How is metabolic alkalosis tx?

Acid-base & ABG Interpretation:

pH, PO₂, SaO₂, pCO₂, HCO₃, or B.E.?-

Normal range is -2 to +2 mEq/L.

Acid-base & ABG Interpretation:

pH, PO₂, SaO₂, pCO₂, HCO₃, or B.E.?-

Normal range is 7.35-7.45.

Acid-base & ABG Interpretation:

pH, PO₂, SaO₂, pCO₂, HCO₃, or B.E.?-

Normal range is 22-26 mEq/L.

Acid-base & ABG Interpretation:

pH, PO₂, SaO₂, pCO₂, HCO₃, or B.E.?-

Normal range is 80-100 mmHg.

Acid-base & ABG Interpretation:

pH, PO₂, SaO₂, pCO₂, HCO₃, or B.E.?-

Normal range is 35-45 mmHg.