150 ch 2, 3, 11 & near drowning ppt

based on study guide, book, and ppt. (Term: question, Definition: answer)

What are the signs and symptoms of inadequate oxygenation for the respiratory system? (6)

• tachypnea

• dyspnea on exertion

• dyspnea at rest

• accessory muscle use

• intercostal retractions

• takes a breath between each word or sentence

What are the signs and symptoms of inadequate oxygenation for the cardiovascular system? (6)

• tachycardia

• mild hypertension

• arrhythmias

• hypotension

• cyanosis

• skin is cool or clammy

(inspection) What are the possible causes and significance of splinting?

thoracic or abdominal incision pain,

chest trauma, pleurisy

(inspection) What are the possible causes and significance of an increased AP diameter?

COPD, asthma, CF,

lung hyperinflation,

advanced age

(inspection) What is the possible cause and significance of Kussmaul respiration?

Metabolic acidosis:

↑ in rate aids body in ↑ CO2 excretion

(inspection) What are the possible causes and significance of cyanosis?

• + cyanosis is a nonspecific, ____ indicator

↓ oxygen transfer in lungs, ↓ cardiac output.

unreliable

(inspection) What are possible causes and significance of distended neck veins?

cor pulmonale, flail chest, pneumothorax

(auscultation) What are possible causes and significance of fine crackles?

loss of lung volume (atelectasis)

interstitial fibrosis (asbestosis)

intersitial edema (early pulm edema)

alveolar filling (pneumonia)

early phase of CHF

(auscultation) What are the possible causes and significance of coarse crackles?

COPD, CF, CHF, bronchiectasis, pulmonary edema, pneumonia with severe congestion, COPD

(auscultation) What are the possible causes and significance of wheezing?

bronchospasm (caused by asthma), airway obstruction (caused by mucosal edema, inflammation, foreign body, tumor), COPD

In an anatomic shunt, the nonoxygenated blood _____ the ventilated alveoli, and mixes downstream with the oxygenated blood.

bypasses

In a capillary shunt, the nonoxygenated blood passes ______ alveoli and mixes downstream with the oxygenated blood.

nonventilated

What causes capillary shunting? (2)

Collapsed alveoli (atelectasis)

Consolidated or fluid-filled alveoli (pneumonia)

Anatomic and capillary shunts are considered _____ shunts

absolute, or true

A relative shunt is caused by an airway _____, an alveolar-capillary _____ defect, or a combination of both

obstruction, diffusion

Pleuritic chest pain is sharp chest pain that intensifies during _____ and ____, and diminishes during breath holding or splinting.

inspiration, coughing

Pleuritic chest pain is a characteristic feature of the following respiratory diseases: (8)

• pneumonia

• pleural effusion

• pneumothorax

• pulmonary infarction

• lung cancer

• pneumoconiosis

• fungal diseases

• tuberculosis

What is the difference in diagnostic value between peripheral and central cyanosis? Where should you check for central cyanosis?

Peripheral may or may not indicate true hypoxemia, while central indicates true hypoxemia/cyanosis.

Central should be checked at the tongue, lips, and gums

Sputum color/characteristics - brown/dark

Indications and conditions?

Old blood

Sputum color/characteristics - bright red (hemoptysis)

Indications and conditions?

Fresh blood (bleeding tumor, tuberculosis)

Sputum color/characteristics - clear and translucent

Indications and conditions?

Normal

Sputum color/characteristics - Copious

Indications and conditions?

Large amount

Sputum color/characteristics - Frank hemoptysis

Indications and conditions?

Massive amount of blood

Sputum color/characteristics - Green

Indications and conditions?

Stagnant sputum or gram-negative bacteria

Sputum color/characteristics - Green and foul smelling

Indications and conditions?

Pseudomonas or anaerobic infection

Sputum color/characteristics - Mucoid (white/grey)

Indications and conditions?

Asthma, chronic bronchitis

Sputum color/characteristics - Pink, frothy

Indications and conditions?

Pulmonary edema

Sputum color/characteristics - Tenacious

Indications and conditions?

Secretions that are sticky or adhesive or otherwise tend to hold together

Sputum color/characteristics - Viscous

Indications and conditions?

thick, sticky, or glutinous

Sputum color/characteristics - Yellow or opaque

Indications and conditions?

Presence of white blood cells, bacterial infection

What are the common factors that stimulate the cough/irritant receptors? (7)

• Inflammation

• Infectious agents

• Excessive secretions

• Noxious gases (e.g., cigarette smoke, chemical inhalation)

• Very hot or very cold air

• A mass of any sort obstructing the airway or compressing the lungs

• Mechanical stimulation (e.g., endotracheal suctioning, compression of the airways)

Classify the following abnormal breathing patterns of the airways as: A (acute), C (chronic), and/or O (obstructive)

• Laryngospasm -

• Bronchospasm -

• Excessive secretions -

• Tumors -

• Foreign body -

• Laryngospasm - O, A

• Bronchospasm - O, A

• Excessive secretions - O, A, or C

• Tumors - O, C

• Foreign body - O, A

Why is lactate monitoring via frequent blood gases important for a near drowning patient?

Lactate clearance is a significant outcome marker.

It’s a positive sign if there is 50% clearance of lactate within the first 6 hours.

What are the anatomic alterations seen in near drowning? (9)

• Surfactant deficiency due to washout

• Laryngospasm

• Bronchospasm

• Alveolar consolidation

• Atelectasis

• Diffuse, frothy, white secretions

• Aspiration pneumonitis (dependent upon type of fluid victim submerged in)

• Non-cardiogenic pulmonary edema

• Pneumonia

What screening tests are done in severe cases of near drowning? (7)

• Glasgow Coma Scale

• Neurological exam for reflex response and response to noxious stimuli

• EEG

• CT scan

• Ice water caloric testing

• Intracranial pressure monitoring

• Apnea test

What is the purpose of the screening tests done in severe cases of near drowning?

to determine the level of anoxic insult

Wet drowning occurs when the victim aspirates fluid into the lungs.

Dry drowning refers to the victim who experiences _____ and glottic closure during the submersion. No fluid is aspirated into the lungs.

laryngospasm

Which is more prevalent with cases at 85-90% : wet drowning or dry drowning?

Wet drowning

Diagnosis of near drowning is generally not in question - most diagnoses are made via ____ offered by eye witness.

history

The first question in screening a near drowning patient is whether or not the victim has required ___

CPR

The level of oxygen deprivation may be determined by sampling blood gases for what? (3)

pH, base deficit, and lactate levels

The most severe cases are those who require CPR or are status post CPR. With these patients, the most critical role in managemetn is the prompt correction of ____ and ____.

hypoxemia, acidosis

The Orlowski Score (1 pt each)

• Age: 3 yrs or older

• Submersion time: >5 mins

• CPR: no CPR for the first 10 mins after rescure

• Comatose on admission

• Arterial pH: <7.10

What does a score of 2 or less state?

What does a score of 3 or more state?

2 or less: 90% chance of complete recovery

3 or more: 5% chance of survival

Reperfusion injury occurs when tissue damage is caused when blood supply is returned to a previously ____ area. It can cause further damage to the tissue

ischemic