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N434 Exam 2 Flashcards

Terms in this set (38)

What are risk factors for obstructive sleep apnea?
- Obesity
- Smoking
- Large neck circumference
- Increased age
- Male
- Micrognathia, macroglossia, deviated septum, enlarged tonsils
What are manifestations of OSA?
- Insomnia, daytime sleepiness, narcolepsy
- Morning headache
- Mood changes
- Impotence/decreased sex drive
- Impaired memory, depression

Long-term = increased BP, dysrhythmias, edema, trauma, stroke
In OSA, how many apneic episodes are there per hour? How long does each last?
5 or more per hour

Each lasts 10-90 seconds
Differentiate between mild OSA & severe OSA.
Mild = 5-10 apneic episodes per hour

Severe = >15 apneic episodes per hour
What is the difference between CPAP & BiPAP
CPAP = same pressure given all night

BiPAP = TWO levels of pressure given
- Higher during inhalation
- Lower during exhalation
What are nursing considerations for CPAP & BiPAP?
- Must be able to breathe on own
- Tight seal
- Prevent infection (clean mask once a week)
- Must be able to cough secretions out on own
What are surgical managements for OSA?
Uvulopalatopharyngoplasty
- Resection of soft palate, uvula, & tonsillar pillars to open up airway

GAHM
- Move tongue forward & move hyoid bone forward

RFVTR
- Scar tissue so not as much is obstructing airway

Tracheostomy
What type of drive to breathe does a person usually have?
Hypercapnic (too much CO2 & need to get rid of it)
What is hypoxemic respiratory failure?
PaO2 <60
or
FiO2 >60%
What is hypercapnic respiratory failure?
PaCO2 > 45 with pH <7.35 (acidemia)
What is impaired in a shunt V/Q mismatch -- perfusion or ventilation?
VENTILATION impaired

Atelectasis & mucus --> no room for ventilation to occur
What What is impaired in a dead space V/Q mismatch -- perfusion or ventilation?
PERFUSION impaired

Pulmonary embolism --> nowhere for O2 to go because alveoli not being perfused
What is are early signs of respiratory failure?
- Increased RR
- Tripod position
- Pursed lip breathing
- Retractions
- Accessory muscle use
What are late signs of respiratory failure?
- Decreased RR
- Cyanosis
- Paradoxical breathing
- Dysrhythmias
- Hypotension
- Coma
What is acute respiratory distress syndrome?
Increased permeability of alveolar capillary membranes --> pulmonary edema
What is the leading cause of ARDS in adults?
Sepsis
What are the 3 phases of ARDS?
1. Exudative
2. Proliferative
3. Fibrotic
What occurs during the exudative phase of ARDS?
Damage to surfactant-producing cells --> less surfactant --> increased surface tension --> atelectasis --> stiff lungs --> refractory hypoxemia --> impaired VENTILATION
What occurs during the proliferative phase of ARDS?
Continued interstitial fibrosis --> thickened membranes & decreased diffusion --> shunting --> worsening hypoxemia
What happens during the fibrotic phase of ARDS?
Remodeled lung due to fibrosis & scarring --> decreased compliance --> decreased gas exchange --> pulmonary HTN
What are initial findings of ARDS?
- Minimal dyspnea
- Tachypnea
- Cough
- Restlessnes
- Respiratory alkalosis
What are later findings of ARDS?
- Increased resp distress
- Severe hypoxemia
- Hypercapnia
- Organ failure
- Respiratory acidosis
- Cyanosis
What is the sniffing position?
Positioning for intubation
- Supine
- Head tilted back
- Neck flexed
What should the nurse do for the patient before intubation procedure?
Hyper-oxygenate the patient with 100% O2 for 3-5 min
After intubation, what should the cuff be inflated to?
20-25 cm
What is the fastest way to check ET tube placement?
End tidal CO2 detector
What is tidal volume?
Amount of air inhaled with EVERY ventilator breath
What is PEEP?
Positive end expiratory pressure

--> pressure applied at end of expiration of ventilator breaths
What are the 3 types of volume controlled ventilator modes?
1. Assist control
- Vent doing EVERYTHING for patient (patient can't breathe on own or do anything)

2. SIMV
- Vent set a specific breaths/min
- If patient spontaneously breathes on own at level of set tidal volume, vent recognizes & won't give pre-set amount of breaths

3. Pressure support ventilation
- Like CPAP
What is the pressure controlled ventilation mode?
Can dictate what peak pressure is going to be

No tidal volume set --> patient MUST be breathing spontaneously
What level of the spinal cord is the phrenic nerve at?
C4
What level of the spinal cord is the sympathetic NS at?
T6
What is the ASIA Impairment Scale?
Grades degree of impairment and severity of spinal injury

A = complete, no sensory or motor fxn
B, C, D = incomplete
E = normal
What is the difference between spinal shock & neurogenic shock?
Spinal:
- Maintains BP & perfusion
- Don't need to intervene
- Lasts 24-72 hours
- Masks injury dysfunctions until swelling goes down

Neurogenic:
- Do NOT maintain BP & perfusion
- Hypotension, bradycardia
- Need to intervene!
What is autonomic dysreflexia?
Occurs from an injury at T6 or above in response to visceral stimulation (e.g. full bladder, bowels, tight clothes)

--> intact ANS below level of injury respond with reflex arteriole vasoconstrction (raises BP)
What are manifestations of autonomic dysreflexia?
QUICK ONSET
- Headache
- High BP
- Decreased HR
- Sweating
- Nasal congestion
What level of spinal injuries require a ventilator?
C1-C3
Do males remain fertile after a spinal injury? Do females?
Males = depends on level of injury for fertility & function

Females = DO remain fertile
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