NURS 640 UPDATED EXAMS SCRIPT ALL
QUESTIONS AND ANSWERS SURE A+
✔✔Metabolic Acidosis - ✔✔Lactic acidosis, ketoacidosis (diabetic, alcoholic, starvation),
toxins (methanol, salicylates) renal failure (acute or chronic)
✔✔Respiratory alkalosis - ✔✔§ hypoxia (decreased inspired oxygen, high altitude,
ventilation, hypotension, severe anemia)
§ CNS-mediated disorders (hyperventilation, anxiety, neurologic disease, CVA,
infection, trauma, tumor, drugs, heat, hepatic failure)
§ Pulmonary disease (interstitial lung disease, pneumonia, PE, pulmonary edema)
§ Mechanical overventilation
✔✔Metabolic alkalosis - ✔✔Excessive body bicarb content (renal alkalosis,
Gastrointestinal alkalosis)
✔✔Pulse oximetry - ✔✔Measures peripheral arterial oxygen saturation. AKA "the fifth
vital sign." In most patients peripheral oxygen saturation as measured by pulse oximetry
(SpO2) provides accurate information on tissue oxygenation, which allows the clinician
to assess and treat patients who are potentially hypoxemic. As a general principle,
clinicians should pay attention to trends on oxygenation and when treating patients with
supplemental oxygen for hypoxemia, clinicians should target levels that are desirable for
the specific etiology, while simultaneously avoiding oxygen toxicity. A target level of 88
,to 92 percent may be sufficient in a patient with an acute exacerbation of chronic
obstructive pulmonary disease (COPD) who is chronically hypercapnic.
✔✔Arterial blood gas interpretation normal values - ✔✔●pH - 7.35 to 7.45
●PaCO2 - 35 to 45 mmHg (4.7 to 6 kPa)
●HCO3 - 21 to 27 mEq/L
✔✔Respiratory acidosis - ✔✔a disturbance in acid-base balance usually due to alveolar
hypoventilation that can be acute or chronic. It is characterized by an increased PaCO2
>45 mmHg (hypercapnia) and a reduction in pH (pH <7.35).
✔✔Respiratory alkalosis - ✔✔usually due to alveolar hyperventilation which leads to a
decrease in PaCO2 (hypocapnia) and an increase in the pH. It can also be acute or
chronic. In acute respiratory alkalosis, the PaCO2 level is below the lower limit of
normal (<35 mmHg or 4.7 kPa) and the serum pH is appropriately alkalemic (>7.45).
✔✔Metabolic acidosis - ✔✔diagnosed when the serum pH is reduced and the serum
bicarbonate concentration is abnormally low (often defined as <22 meq/L, but the
threshold may vary across clinical laboratories).
✔✔Metabolic alkalosis - ✔✔is usually accompanied by hypokalemia, is defined as a
disorder that causes elevations in the serum bicarbonate concentration and arterial pH.
In a patient with an uncomplicated (simple) metabolic alkalosis, both parameters are
above normal. However, this may not be present in patients with mixed acid-base
disorders.
✔✔Venous blood sample - ✔✔o Ph 7.31-7.41
o PCo2 41-51
o HCO3 23-29
o PO2 30-40
o SO2 75
✔✔Vocal fold dysfunction syndrome - ✔✔paradoxical vocal fold adduction, acute and
chronic upper airway obstruction.
✔✔Disorders of the upper airways - ✔✔Acute obstruction include trauma to the larynx
or pharynx, foreign body aspiration, laryngospasm, laryngeal edema from thermal injury
or angioedema, infections (acute epiglottis, Ludwig angina, pharyngeal or
retropharyngeal abscess) and acute allergic laryngitis.
✔✔Chronic obstruction of the upper airway - ✔✔carcinoma of the pharynx or larynx,
laryngeal or subglottic stenosis, laryngeal granulomas or webs, or bilateral vocal fold
paralysis.
, Characteristic findings= inspiratory stridor, intercostal retractions on inspiration, palpable
inspiratory thrill over the larynx, and wheezing localized to the neck or trachea on
auscultation.
✔✔response to bronchodilator therapy, normal spirometry immediately after an attack, -
✔✔Dyspnea, wheezing that may be distinguished from asthma or exercise induced
asthma by the lack of
✔✔Disorders of the lower airways - ✔✔Tracheal obstruction= intrathoracic (below the
suprasternal notch) or extrathoracic.
✔✔Bronchial obstruction - ✔✔pulmonary secretions, aspiration, foreign bodies,
bronchomalcia, bronchogenic carcinoma, masses and tumors metastatic to the airways.
✔✔Intermittent or mild persistent asthma - ✔✔symptoms are worse at night. Circadian
variations in bronchomotor tone and bronchial reactivity reach their nadir between 3am
and 4am, increasing symptoms of bronchoconstriction
ymptoms=breathlessness while walking, talks in sentences, alertness may be agitated.
o Signs= increased respiratory rate, can lie down, usually does not use accessory
muscles, wheeze moderate, often only end expiratory. Pulse less than 100, pulsus
paradoxus absent less 10mmHg
o FEV1 > 70%, PaO2 on room air is normal, PcO2 <42mmHg SaO2on air >95%
✔✔Anaerobic pneumonia and lung absces - ✔✔History of or predisposition to
aspiration= larger amounts of mater include nocturnal asthma, chemical pneumonitis,
mechanical obstruction of airways by particulate matter, bronchiectasis, and
pleuroplumonary infection. Depressed levels of consciousness due to drug alcohol,
seizure, general anesthesia. (think of things that may cause aspiration)
o Indolent symptoms including fever, weight loss, and malaise
o Poor dentition
o Foul smelling purulent sputum
o Infiltrate in dependent lung zone, with single or multiple areas of cavitation or pleural
effusion
· S/S constitutional symptoms= fever, weight loss, malaise, cough with expectoration of
foul smelling purulent sputum. (nonproductive cough does not rule out)
✔✔Anaerobic pneumonia and lung absces - ✔✔· Lab findings
o Expectorated sputum is inappropriate because of the mouth flora contamination.
o Culture can be obtained only by transthoracic aspiration, thoracentesis, or
bronchoscopy with a protected brush.
· Imaging
o Lung abscess appears as a thick walled solitary cavity surrounded by consolidation.
An air fluid level is usually present.
· Treatment
QUESTIONS AND ANSWERS SURE A+
✔✔Metabolic Acidosis - ✔✔Lactic acidosis, ketoacidosis (diabetic, alcoholic, starvation),
toxins (methanol, salicylates) renal failure (acute or chronic)
✔✔Respiratory alkalosis - ✔✔§ hypoxia (decreased inspired oxygen, high altitude,
ventilation, hypotension, severe anemia)
§ CNS-mediated disorders (hyperventilation, anxiety, neurologic disease, CVA,
infection, trauma, tumor, drugs, heat, hepatic failure)
§ Pulmonary disease (interstitial lung disease, pneumonia, PE, pulmonary edema)
§ Mechanical overventilation
✔✔Metabolic alkalosis - ✔✔Excessive body bicarb content (renal alkalosis,
Gastrointestinal alkalosis)
✔✔Pulse oximetry - ✔✔Measures peripheral arterial oxygen saturation. AKA "the fifth
vital sign." In most patients peripheral oxygen saturation as measured by pulse oximetry
(SpO2) provides accurate information on tissue oxygenation, which allows the clinician
to assess and treat patients who are potentially hypoxemic. As a general principle,
clinicians should pay attention to trends on oxygenation and when treating patients with
supplemental oxygen for hypoxemia, clinicians should target levels that are desirable for
the specific etiology, while simultaneously avoiding oxygen toxicity. A target level of 88
,to 92 percent may be sufficient in a patient with an acute exacerbation of chronic
obstructive pulmonary disease (COPD) who is chronically hypercapnic.
✔✔Arterial blood gas interpretation normal values - ✔✔●pH - 7.35 to 7.45
●PaCO2 - 35 to 45 mmHg (4.7 to 6 kPa)
●HCO3 - 21 to 27 mEq/L
✔✔Respiratory acidosis - ✔✔a disturbance in acid-base balance usually due to alveolar
hypoventilation that can be acute or chronic. It is characterized by an increased PaCO2
>45 mmHg (hypercapnia) and a reduction in pH (pH <7.35).
✔✔Respiratory alkalosis - ✔✔usually due to alveolar hyperventilation which leads to a
decrease in PaCO2 (hypocapnia) and an increase in the pH. It can also be acute or
chronic. In acute respiratory alkalosis, the PaCO2 level is below the lower limit of
normal (<35 mmHg or 4.7 kPa) and the serum pH is appropriately alkalemic (>7.45).
✔✔Metabolic acidosis - ✔✔diagnosed when the serum pH is reduced and the serum
bicarbonate concentration is abnormally low (often defined as <22 meq/L, but the
threshold may vary across clinical laboratories).
✔✔Metabolic alkalosis - ✔✔is usually accompanied by hypokalemia, is defined as a
disorder that causes elevations in the serum bicarbonate concentration and arterial pH.
In a patient with an uncomplicated (simple) metabolic alkalosis, both parameters are
above normal. However, this may not be present in patients with mixed acid-base
disorders.
✔✔Venous blood sample - ✔✔o Ph 7.31-7.41
o PCo2 41-51
o HCO3 23-29
o PO2 30-40
o SO2 75
✔✔Vocal fold dysfunction syndrome - ✔✔paradoxical vocal fold adduction, acute and
chronic upper airway obstruction.
✔✔Disorders of the upper airways - ✔✔Acute obstruction include trauma to the larynx
or pharynx, foreign body aspiration, laryngospasm, laryngeal edema from thermal injury
or angioedema, infections (acute epiglottis, Ludwig angina, pharyngeal or
retropharyngeal abscess) and acute allergic laryngitis.
✔✔Chronic obstruction of the upper airway - ✔✔carcinoma of the pharynx or larynx,
laryngeal or subglottic stenosis, laryngeal granulomas or webs, or bilateral vocal fold
paralysis.
, Characteristic findings= inspiratory stridor, intercostal retractions on inspiration, palpable
inspiratory thrill over the larynx, and wheezing localized to the neck or trachea on
auscultation.
✔✔response to bronchodilator therapy, normal spirometry immediately after an attack, -
✔✔Dyspnea, wheezing that may be distinguished from asthma or exercise induced
asthma by the lack of
✔✔Disorders of the lower airways - ✔✔Tracheal obstruction= intrathoracic (below the
suprasternal notch) or extrathoracic.
✔✔Bronchial obstruction - ✔✔pulmonary secretions, aspiration, foreign bodies,
bronchomalcia, bronchogenic carcinoma, masses and tumors metastatic to the airways.
✔✔Intermittent or mild persistent asthma - ✔✔symptoms are worse at night. Circadian
variations in bronchomotor tone and bronchial reactivity reach their nadir between 3am
and 4am, increasing symptoms of bronchoconstriction
ymptoms=breathlessness while walking, talks in sentences, alertness may be agitated.
o Signs= increased respiratory rate, can lie down, usually does not use accessory
muscles, wheeze moderate, often only end expiratory. Pulse less than 100, pulsus
paradoxus absent less 10mmHg
o FEV1 > 70%, PaO2 on room air is normal, PcO2 <42mmHg SaO2on air >95%
✔✔Anaerobic pneumonia and lung absces - ✔✔History of or predisposition to
aspiration= larger amounts of mater include nocturnal asthma, chemical pneumonitis,
mechanical obstruction of airways by particulate matter, bronchiectasis, and
pleuroplumonary infection. Depressed levels of consciousness due to drug alcohol,
seizure, general anesthesia. (think of things that may cause aspiration)
o Indolent symptoms including fever, weight loss, and malaise
o Poor dentition
o Foul smelling purulent sputum
o Infiltrate in dependent lung zone, with single or multiple areas of cavitation or pleural
effusion
· S/S constitutional symptoms= fever, weight loss, malaise, cough with expectoration of
foul smelling purulent sputum. (nonproductive cough does not rule out)
✔✔Anaerobic pneumonia and lung absces - ✔✔· Lab findings
o Expectorated sputum is inappropriate because of the mouth flora contamination.
o Culture can be obtained only by transthoracic aspiration, thoracentesis, or
bronchoscopy with a protected brush.
· Imaging
o Lung abscess appears as a thick walled solitary cavity surrounded by consolidation.
An air fluid level is usually present.
· Treatment
