N244 Respiratory Exam 2025

NUR244 N244 Respiratory Exam 2025 What measures oxygenation in the body? - Correct Answer- chemoreceptors Sa O260 CO2 70 What is lung compliance? - Correct Answer- measure the elasticityy of the lungs and thorax What is airway resistance? - Correct Answer-opposition of gas flow in the airways. Mainly due to the diameter of the airways. ***small changes in diameter produce large changes in resistance. The amount of carbon dioxide in plasma dictates the? - Correct Answer-acidity of blood What does shunt mean? - Correct Answer-it means the amount of blood circulating through the lungs that does not participate in gas exchange. Normal shunt is To estimate a patients shunt how do we calculate? - Correct Answer-take the patient Pa O2 and divide by FiO2. What is hypoxia? - Correct Answer-decrease tissue profussion. What is hypoxemia? - Correct Answer-decreased in arterial blood transportation Think RAT for hypoxia? - Correct Answer-*restlessness *agitation, anxiety *tachycardia, tachypnea What is acute respiratory failure characterized by? - Correct Answer-PH 7.35 PCO250 PaO260 Risk factors for ARF are? - Correct Answer-*increased age *comorbidities *sepsis/shock Imparired ventilation =impaired gas exchange=V/Q ventalation perfusion mismatch=obstruction obstruction - Correct Answer--- ARF type one is? - Correct Answer-intrapulmonary problem NUR244 NUR244 Normal carbon dioxide Lower airways and alvoli ARF type two is? - Correct Answer-extrapulmonary pleura *brain *spinal cord *upper airway Signs of hypoxemia are? - Correct Answer-restlessness agitation confusion Signs of hypercapnia are? - Correct Answer-*HA *blurred vision *confusion *seizures Signs of renal involvement will be? - Correct Answer-*decreased urine output and edema Signs of GI involvement will be? - Correct Answer-*decreased bowel sounds *anorexia *n/v Signs of skin will be? - Correct Answer-*pallor *cyanosis **Early signs and symptoms of ARF are? - Correct Answer-*****restlessness ****agitaion Late signs will be? - Correct Answer-confusion cyanosis Remember the first ABG's will be? - Correct Answer-Alkalotic /ph7.45 with a PaO2 80,due to the compensatory mechanism and then they will get acidotic. What arterial blood gas would the nurse most commonly note with respiratory insufficiency? - Correct Answer-PH within normal limits/patient compensatory through increased heart rate. (respiratory insufficiency is a state in which an acceptable level of gas exchange is maintained only through cardiopulmonary compensatory mechanism. Chronic pulmonary problems have a slow onset and often are progressive in nature.The body has time to compensate for the deficiency therefore maintaining a adequate level of oxygenation until late-stage disease. NUR244 NUR244 What arterial blood gas ph results would be most suspicious of acute respiratory failure? - Correct Answer-PH lower than normal Failure to oxygenate refer to which primary problem? - Correct Answer-Hyoxemia The primary problems associated with failure to ventilate is which condition? - Correct Answer-*Alveolar hypoventilation Many of the common clinical manifestations typically noted in ventilate are primary the result of - Correct Answer-vasodilation What s the result of increased metabolic demand? - Correct Answer-increased oxygen consumption High acutity patients often walk a fine line between respiratory insufficiency and respiratory failure and their ability to compensate is? - Correct Answer-decreased. Edcompensation results from any stressor such as acute infection and if severe enough will push patient beyond compensatory measures which will cause respiratory muscle fatigue and respiratory failure. Without recognition of the early symptoms these patient will decompensate quickly.***** Signs and symptoms that indicate impending respiratory failure are? - Correct Answer *tachypnea *tachycardia *increase use of respiratory muscles *nasal flaring *abnormal chest wall movements *labored breathing *orthopnic *decreased SpO2 *disphoretic *air hungry/tri-podding **anxious Order an ABG Remember PH can remain normal for quite a while even though the patients is experiencing hypoxemia and showing s/s. The ph will be normal but the PaO2 will be decreased and the HC03 will be - Correct Answer-normal to low. So watch patients carefully they will compensate and then crump. ARF acute will have what ABG's? - Correct Answer-ph7.30 *PaCO250 *PaO260 NUR244 NUR244 MODS is? - Correct Answer-Multiple Organ Damage If the respiratory failure is coupled with decreased cardiac output the pt is particular risk for hypo perfusion, hypoxic organ shock complication such as those see in MODS, including ARDS. The presence of hypercapnia with its accompanying respiratory acidosis and vasodilation states adds more burden on the body because cellular function rapidly become impaired in acidotic states. In addition the generalized vasodilator effects can increase ICP and decrease CO and system vascular resistance. - Correct Answer-__ What is V/Q? - Correct Answer-this is assess the efficiency and adequacy of ventilation and profusion. Respiratory failure is a complex process and this how it works? - Correct Answer *usually the patient has a disease process such as pneumonia and they the V/Q ratio become abdomal and decreasing PaO2. So the pt start breathing faster, aniexty, tachycardia but this requires more energy thus increasing body metabolic rate. More oxygen is consumed by the tissues and more carbon dioxide is produced from end stage metabolism. The overall eff is increase carbon dioxide and decreased oxygen. A state of respiratory distress is a PH7.30, PaCO250 and a PaO2 60. What is ARDS? - Correct Answer-A severe, often fatal inflammatory disease of the lung characterized by the sudden onset of pulmonary edema and respiratory failure usually in the setting of other acute medical conditions, co-morbidities, resulting from local (pneumonia) or distant (trauma) injury. Big thing with ARDS is in causes a? - Correct Answer-severe inflammatory response which involves the lungs leading to lung injury. *decreased surfactant causes increased alveolar surface tension resulting in atelectasis which is alveolar collapse. Big things that can cause ARDS are: - Correct Answer-*gastric aspiration *septic shock/sepsis***** *multiple blood transfusions *near drowning *DIC *pancreatitis Defining if the patient has ARDs is by comparing? - Correct Answer-PaOx to FiOs of 200mmHg or less**** ALI 300mgHg Differeniate ARDS from HF by? - Correct Answer-*PAWP 18 for ARDS, 18 for HF *Bronchoalveloar lavage fluid will be rich in protein and inflammatory cells with ARDS *BNP 100pg/ml indicates ARDS, A high BNP indicates heart failure *Chest -x-ray Pulmonary infiltrates throughout the lungs NUR244 NUR244 ARDs facts: - Correct Answer-*comes on approx. 48-72 hours after precipitating event (sepsis is a big one) *respiratory rate increases *hypoxemia *dyspnea The increased breathing results in respiratory alkalosis in abgs. *as it progresses *cyanosis *accessory muscles engage *cough with sputum develops *heart rate increases *crackles *Blood gases turn toward acidosis and its refractory to oxygen. Due to shunt from alveolar collapse and become dysfunctionable. The nursing goal for ARDS is? - Correct Answer-*maintaining hemodynamic and oxygenation until the syndrome resolves. *ventilation with PEEP (that is inspiratory and expiratory pressure *patient postion strategies *drug therapy. According to ARDS consensus criteria, a diagnosis of ARDS requires a P/F ration of less than? - Correct Answer-200 What condition is the most common indirect predisposing disorder of ARDS? - Correct Answer-*sepsis*********************** The pulmonary edema associated with ARDS is cause by which condition? - Correct Answer-injured alveolar-capillary membrane Ther term permissive hypercapnia refers to which therapeutic strategy? - Correct Answer-Reducing peak airway pressure by allowing some increase in PaCO2. What will we see on ARDS? - Correct Answer-*lung infiltrates from leaking capillaries/fluid filled lungs *oxygen PaO2/FiO2200 *no elevated pulmonary pressure Risk for ARDS goes up when patient has more risk factors. Ex: one risk factor increases the risk of ARD's by - Correct Answer-*25% *two increases 42% *3 increases 85% If the patient survives the recovery process will take? - Correct Answer-6-12 months NUR244 NUR244 *may develop pulmonary fibrosis and eventually die from lung infection and on autopsy the lungs are: congested , heavy and wet. Respiratory insufficiencies requires compensation for other systems , as it reflects a chronic state of stress so you would see increase in? - Correct Answer-*blood pressure *heart rate A pt is a severe auto accident has developed ARD's. The nurse explained the concept of non hydrostatic pulmonary edema to the pats family;. Which statement by the family indicates an understanding? - Correct Answer-Her disease has injured the membranes in her lungs so that fluid is leaking into her lungs from tiny blood vessels. A patient is admitted with possible ARD's and has a bronchoalveolar lavage (BAL) fluid sample collection from the patients lungs What will the nurse expect the samples to contain if ARDS is the correct dx? - Correct Answer-*protein and inflammatory cells What is tidal volume? - Correct Answer-the amount moving in and out of lung with each breath What is FiO2? - Correct Answer-fraction of inspired oxygen *room air is 21% *vent can deliver up to 100% What is PEEP? - Correct Answer-positive end expiratory pressure Complications of PEEP include? - Correct Answer-******decreased preload *****increased after load *increased ICP *barotrauma Nursing dx for ARF/ARDS? - Correct Answer-*Impaired gas exchange r/t mismatch or intrapulmonary shunting or alveolar hypoventilation *ineffective breathing pattern *Impaired spontaneous ventilation When alarms on vent are ringing and your in doubt? - Correct Answer-Disconnect pt from the vent and bag them. Pt is on vent and acute deterioration occurs. Remember DOPE? - Correct Answer-D is for displaced ET tube or teach O is for obstruction (kinked tube or mucous plug) P is for pneumothorax E is for equipment failure Prevent complications of ARDS with vented patients - Correct Answer-*avoid high PEEP or tidal volume NUR244 NUR244 *stress ulcers *use medication for reducing acid *renal failure *keep blood pressure up/fluid hydration *avoid VAP /ventilator assisted pneumonia *avoid ventilator dependence -tracheostomy Ventilator Acquire Pneumonia BUNDLE IS? - Correct Answer-***Hand hygiene *oral care/chlorhexidine "a must" *HOB elevated 30 degrees *daily sedation vacation *daily assessment "readiness to extubate" *Peptic ulcer prophylaxis *venous thrombosis emboli prophylaxis