Week 6 NRS 222-- Respiratory (CF & ARDS) Flashcards


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1

CF is the result of the dysfunction of what system

Exocrine

(mucous producing)

2

What is the physiological root of CF?

abnormal transport of sodium and chloride across epithelium

3

What do the thick mucous secretions associated with CF obstruct?

Small passageways of effected organs

4

As of 2016, what is the median life expectancy for CF pts?

Mid 40s

5

What age group of CF pts might receive a lung transplant?

12+

6

Which race most commonly carries the CF genes?

Caucasian

7

In cases in which CF presents immediately, what is often the first symptom?

meconium ileus

(tenacious/first stool is thick and dry)

8

In CF, the respiratory system is often effected. What symptoms might be seen?

wheezing and dry cough

posttussive emesis

dyspnea

paroxysmal cough

9

In CF, the respiratory system is often effected. What physical changes might be seen?

-barrel chest

-clubbing

-cyanosis

-bronchiectasis from repeated infections (seen on imaging)

10

In CF, the respiratory system is often effected. What complications are most common?

hemoptysis

pneumothorax

11

What does CF's impact on the pancreas cause?

Pancreatic enzyme deficiency due to small duct blockage

12

What are the 4 Fs of CF?

relating to stool:

-frothy

-foul smelling

-fat containing

-float

13

What causes the stool changes often seen in CF?

loss of pancreatic enzymes

14

How does CF effect appetite?

high appetite early on, loss of appetite as disease progresses

15

What is difficult to break down in CF cases involving pancreatic involvement?

FAT

-Vit ADEK

16

What happens to nutritional status as CF and pancreatic involvement progresses?

-weight loss/failure to thrive

-protruding abdomen w/ thin extremities

-anemia

-evidence of loss of ADEK

17

As CF leads to pancreatic fibrosis, what secondary illnesses can occur?

-DM

-glucose intolerance

-pancreatitis

18

What is the most noticeable evidence of sweat gland dysfunction in CF pts?

salty tasting skin

easily dehydrated

19

What are some possible GI symptoms which may be seen in CF pts other than ileus and pancreatic enzyme deficiency?

-rectal prolapse

-transient or chronic esophageal reflux

20

At what age is a CF pt most likely to experience rectal prolapse?

6 and under

21

Why does CF have the potential to cause liver issues?

blockages leading to biliary cirrhosis or gallbladder dysfunction

22

What can happen to the nares of CF pts?

polyps

sinusitis

23

What leads to the misdiagnosis of CF?

This is also the reason it is sometimes called the "great imitator".

Symptoms that are related to failure to thrive and chronic respiratory infection present similarly to several other childhood ailments

24

What is the technical name for the "sweat test"?

pilocarpine iontophoresis

25

When is pilocarpine iontophoresis (sweat test) done?

between 2 and 4 weeks of age

26

What chloride level taken by pilocarpine iontophoresis is considered diagnostic?

60 mmol/L

27

What can be done to screen for CF early on aside from pilocarpine iontophoresis?

IRT (immunoreactive trypsinogen test)

CFTR (genetic testing)

28

What might be seen on imaging in the lungs of a CF pt?

patchy atelectasis

chronic obstructive emphysema

29

Can CF be tested for prenatally?

Yes, through chorionic villi and amniotic fluid DNA analysis

30

What is the best positioning for a CF pt with poor airway clearance?

Upright, sitting, without slouching

31

When should nebulization be administered for a CF pt?

1 hr before or 2 hours after meals

32

Why can CF chest physiotherapy interfere with nutrition?

the resulting coughing may lead to vomiting

33

How often should CF chest physiotherapy be performed?

2-4 times per day

34

What is the benefit of CF chest physiotherapy in the morning?

loosening up mucous that collects overnight

35

What is the benefit of CF chest physiotherapy before bed?

Loosening up secretions that may provide a medium for bacterial growth

36

After chest physiotherapy, how long should postural drainage last?

20-40 minutes

37

What is a PEP device?

Oscillating positive expiratory pressure device

(ie Flutter)

38

How long should a CF pt use a PEP device?

5-15 minutes

39

What is a HFCWO?

High frequency chest wall oscillation device AKA "The Vest"

(the life jacket thing for loosening secretions via pressure)

40

Why is hydration SO IMPORTANT for CF pts?

Fluids help thin and loosen secretions

41

What is dornase alfa?

pulmozyme

an enzyme medication that thins mucous

42

When should a nurse report a CF pt's o2 sat?

92% or lower

43

What is the best positioning for a CF pt with poor oxygenation?

high fowlers or leaning forward

44

Why must o2 administration be carefully monitored in CF pts with chronic hypercapnia?

they are at risk of Co2 narcosis---> respiratory failure

45

Because CF often leads to weight loss, what should the patient and/or parents be told to do at home?

daily weights

46

Nutritionally, what can be given to help promote proper absorption and digestion?

administering pancreatic enzymes

47

When pancreatic enzymes must be administered to a child with CF who cannot swallow capsules, what should be used?

-the smallest amount of carb based food (protein breaks down the enzymes)

-do not mix with milk/formula (causes curdling)

48

How might a nurse assess the efficacy of digestion in a CF pt?

-looking at stools -- steatorrhea/frothiness/malodourous/floating is not reassuring

49

What is the recommended diet for a CF pt?

HIGH calorie/protein

up to 150% fat

50

Why is hyponatremia SUCH a concern with CF?

Content of sodium in sweat is 2-5x normal

51

Because reflux is common in CF, what should be done to prevent symptoms?

-stay upright for 1-2 hrs after eating

-Give GER/GERD meds at appropriate times

52

Which bronchodilator side effects are more common in children?

-CNS stimulation

-hyperactivity

-insomnia

-nervousness

53

How is pulmozyme taken?

aerosolized from a specific type of nebulizer which includes a compressor

54

What are the side effects of pulmozyme?

--Drying out--

-hoarseness

-pharyngitis/laryngitis

-conjunctivitis

--Other--

-chest pain

-rash

55

What may happen if other meds or diluents are mixed with pulmozyme?

deactivation of the enzymes

56

Who is pulmozyme approved for?

5 yrs+

(2-4 yrs in special circumstances)

57

What is a TOBI podhaler?

inhaled tobomycin for pseudomonas infection via specialized nebulizer

58

What are the most common side effects from TOBI podhaler?

-SOB

-hoarseness/sore throat/pharyngitis

-cough

-fever

-hemoptysis

59

How must a TOBI inhaler be stored?

refrigerator away from light

60

What CF med cannot be taken with Pulmozyme for fear of creating a precipitate?

TOBI

61

Put these in order:

TOBI

mucolytic

bronchodilator

chest physiotherapy

bronchodilator

mucolytic

chest physiotherapy

TOBI

62

Why is it best to administer TOBI after other treatments for airway clearance?

The antibiotic works better in clearer lungs

63

What are the two biggest concerns with the use of aminoglycosides (like TOBI)?

ototoxicity

nephrotoxicity

64

How should the administration of pancreatic enzymes be times?

within 30 minutes of eating

65

What might occur is pancreatic enzyme tabs are chewed?

mucosal irritation

stomatitis

66

If a CF pt taking pancreatic enzymes experiences constipation or less than 3 BMs/day, what needs to take place?

Medication adjustment

67

How should the dosage of pancreatic enzymes be changed for CF pts taking h2 inhibitors or gastric acid pump inhibitors?

they enhance, so they should be decreased

68

How long would one expect a CF pt to be on antibiotics?

at least 10 days, possibly weeks

69

How can the lack of absorption of fat soluble vitamins be managed in CF?

by switching to water soluble versions

70

Why are NSAIDS used for CF pts?

they appear to slow pulmonary decline and prevent hospitalizations in 7-16 yrs old pts

71

What two components of CF need to be the most thoroughly taught to pts and parents?

-GI

-Respiratory

72

When is extra dietary salt especially important to CF pts?

-heat

-diarrhea/vomiting

-fever

73

What qualifies as acute respiratory failure?

PaO2 of <60 mmHg at rest on room air

74

What is the most common precursor to acute respiratory failure?

respiratory acidosis (PaC02 50 mmhg+/ pH <7.35)

75

What are the four components to acute respiratory failure?

alveolar hypoventilation

vent-perfusion mismatch

diffusion disturbances

Right-to-left shunt

76

What is the normal vent-perfusion ratio?

0.8-1

alveolar ventilation of 4L/min- pulm vascular blood flow of 5L/min

77

What is a diffusion disturbance?

anything that physically interferes with exchange across alveolar-cap membrane

78

What does right-to-left shunt refer to in respiratory failure?

poorly oxygenated blood gets pumped from the right side of the heart to the left

--occurs due to fluid in alveoli or atelectasis--

79

Which of the four components of respiratory failure is not improved with supplemental oxygenation?

Right to left shunt

80

What is the diagnostic test for ARDS/ARF?

ABG

81

What is refractory hypoxemia?

when there is enough inspired o2, but it is not getting into the blood

82

What is ARDS?

noncardiac pulmonary edema and refractory hypoxemia

83

What is the mortality rate for ARDS?

25-45%

84

What does ARDS cause physiologically?

extensive lung tissue inflammation and small vessel injury---leading to organ malfunction

85

ARDS onset is ___________

-48rapid

w/i 90 mins of inflammatory insult

w/i 24 hrs of initial injury

86

What is the most common cause of ARDS?

sepsis

multiple organ dysfunction

87

Who is more likely to die from ARDS?

men

african americans

88

Which cause of ARDS has the poorest prognosis?

sepsis

89

Aside from the initial insult, what leads to the destruction seen in ARDS?

the body's inflammatory chemicals damaging the capillary membrane

90

In ARDS, why is surfactant lost?

capillary membrane destruction leads to dilution

91

Which disease leads to the formation of hyaline membranes, CF or ARDS?

ARDS

92

What are some examples of direct insults resulting from ARDS?

aspiration

pulm infections

smoke or salt water inhalation

93

What are some examples of indirect insults resulting from ARDS?

sepsis

trauma

GI infections

multiple blood transfusion

OD

94

What is THE greatest risk factor for ARDS?

aspiration

95

What are some risk factors for ARDS other than aspiration?

-smoking

-immunocompromise

96

Which diagnostic resources are often normal in ARDS that one might not expect?

ABG

chest xray

97

What are the clinical manifestations of ARDS?

-agitation/confusion/lethargy

-dyspnea/tachypnea (duh)

-rales/rhonchi

98

If an ARDS xray is abnormal, what might you see?

-interstitial changes

-patchy infiltrates

99

WHy is nitric oxide used to treat ARDS?

reduces pulmonary shunting and improves oxygenation

100

How is the loss of surfactant replaced in ARDS?

surfactant therapy

101

When might corticosteroids be used in ARDS?

late in illness when fibrosis has started to occur

102

What is the mainstay or ARDS management?

endotracheal intubation

103

How does a negative pressure respirator work?

it pulls chest wall outward externally

104

Which type of vent is used most often for ards?

positive pressure (forces air in)

105

For most adults, what is the respiratory rate set to on a vent?

12-15 breaths

106

For adults, what volume is forced in with each vent breath?

500-750ml (to make up for tubing end space)

107

What happens if too much o2 is given via vent?

fibrosis

o2 toxicity

108

What is used for vent weaning when it was not used for an especially long time?

CPAP

T-piece

109

What is used for vent weaning when it was used for long enough to atrophy respiratory muscles?

SIMV

PSV

110

What sort of care is needed frequently for nasopharyngeal vent pts?

nasal and oral care

111

What may be done to prevent regurgitation/aspiration in a ventilated pt with ARDS?

jejunostomy

112

Why is low molecular weight heparin given to ARDS pts?

PE, DIC and thrombophlebitis are common complications

113

What must be considered in treating the rare pediatric ards pt?

-more compliant airways

-smaller lungs, smaller volume

-underdeveloped

-lower HCT and FRC

114

What cannot be used routinely in pediatric ARDS pts?

nitric oxide

exogenous surfactant

corticosteroids

prone positioning

Intubation

115

Pregnant women rarely develop ards, but when they do:

44% die

116

In the rare case of ards in a pregnant woman, what typically causes it?

sepsis (membrane, kidneys, uterus)

hemorrhage

flu

amniotic embolism

117

In a pregnant woman with ARDS, does delivery effect the outcome?

NO

118

Who is at the greatest risk of ARDS?

people over 40

119

Why are older adults more likely to die of ARDS?

-less likely to be given ICU bed

-more fragile organs

120

Nutritionally, what can help lung function?

omega 3 and 6

121

In assessing a potential ARDS pt on admission, what should be asked about?

illness and injury within the last 3-4 days

respiratory HX

surgeries

122

How often should the staff attempt to use the prone position on an ARS pt?

3-4x a day -- 30-60 minutes per

123

Aside from respiratory considerations, what organ system function should be enhanced during treatment of ards?

cardiac

(cardiac output)

124

During vent weaning, how often should vitals be assessed?

Q 15-30 minutes

125

Weaning should be D/C'd when?

during the night to provide rest

126

At what rate should SIMV RR be lowered during weaning?

2 breaths per minute

127

When is an NG airway contraindicated?

in bleeding risk

128

Why should an intubation kit be kept near an ARDS pt who has had their artificial airway removed?

laryngeal edema or spasm may occur after extubation

129

Most men with CF have a congenital lack of what?

vas deferens

130

How does pregnancy impact a CF pt?

exacerbates

131

What percentage of CF men are fertile?

2-3%

132

When can a pt be weaned from a SIMV to a T-piece or CPAP?

when they can tolerate setting of 4 breaths per minute

133

What is the primary use of a PSV?

weaning

134

When weaning from a PSV, when is extubation considered?

when the unit reaches 8-10 cm H2o/min

135

How is terminal weaning performed?

the same way as weaning, but in a hospice room, at home, or in a quiet hospital room, and possibly with sedation and/or analgesia

136

WHere does a nasopharyngeal airway terminate?

at the oropharynx

137

How often should a nasopharyngeal airway be swapped to the other nare?

Q 8 hrs to prevent mucosal necrosis

138

A new tracheostomy may need to be cleaned and suctioned how often?

Q1-2 hrs

139

Mechanical ventilation that messes with intrathoracic pressure, and therefore cardiac output, impedes which systems the most?

cardiac (CO)

renal (shitty RAAS--edema)

140

What is oliguria often the first sign of in an ARDS pt?

lowered CO