RRT Clin sims Exam 437 Questions with Verified Answers,100% CORRECT

RRT Clin sims Exam 437 Questions with Verified Answers Emphysema - CORRECT ANSWER Weakening and enpermanent enlargement of the air spaces distal to the terminal bronchioles Etiology of Emphysema - CORRECT ANSWER Ci ...

RRT Clin sims Exam 437 Questions with Verified Answers Emphysema - CORRECT ANSWER Weakening and enpermanent enlargement of the air spaces distal to the terminal bronchioles Etiology of Emphysema - CORRECT ANSWER Cigarette smoking >80% of all cases Genetic predisposition Occupational exposure Atmospheric pollutants Primary Assessment of Emphysema - CORRECT ANSWER Past medical history Shortness of breath Cough Appearance of the chest Respiratory Pattern Color Appearance of the nail beds Diagnostic chest percussion Breath sounds Secondary Assessment of Emphysema - CORRECT ANSWER CXR Arterial Blood Gas Pulmonary Function CBC Sputum Appearance of CXR in patient with Emphysema - CORRECT ANSWER Hyper lucent lung fields Depressed or flattened diaphragm Narrow heart Increased retro sternal air space (lateral film) Arterial Blood Gas findings in patient with Emphysema - CORRECT ANSWER Mild to moderate Emphysema Acute alveolar hyperventilation with hypoxemia Severe Emphysema Chronic ventilatory failure with hypoxemia Pulmonary Function Findings in patient with Emphysema - CORRECT ANSWER Decreased flow rates and Decreased DLco CBC findings in a patient with Emphysema - CORRECT ANSWER Increased RBC, Hb, HCT Sputum findings in a patient with Emphysema - CORRECT ANSWER May indicate bacterial infection Treatment/Management of Emphysema - CORRECT ANSWER Low Flow (FiO2) oxygen therapy 1-2 L/min (.24-.28) Antibiotics as indicated by sputum culture Pulmonary Rehab and Home Care Aerosolized medications Consider NPPV for acute exacerbation of ventilatory failure Annual Flu injection Smoking cessation Pulmonary Hygiene Chronic Bronchitis - CORRECT ANSWER Daily productive cough for at least 3 consecutive month each year for 2 years in a row Etiology of Chronic Bronchitis - CORRECT ANSWER Cigarette smoking Pollution Infection GERD Primary Assessment of Chronic Bronchitis - CORRECT ANSWER Past medical history Shortness of Breath Cough Appearance of the Chest Respiratory Pattern Color Appearance of Nail beds Diagnostic Chest Percussion Breath Sounds Secondary Assessment of Chronic Bronchitis - CORRECT ANSWER CXR Arterial Blood Gas Pulmonary Function CBC Sputum Electrolytes CXR findings in a patient with Chronic Bronchitis - CORRECT ANSWER Hyper lucent lung fields Depressed or flattened diaphragm Enlarged or elongated heart Arterial Blood gas in a patient with mild to moderate Chronic Bronchitis - CORRECT ANSWER Acute alveolar hyperventilation with hypoxemia ABG in a patient with severe Chronic Bronchitis - CORRECT ANSWER Chronic ventilatory failure with hypoxemia Pulmonary Function test in a patient with Chronic Bronchitis - CORRECT ANSWER Decreased flow rates CBC in a patient with Chronic Bronchitis - CORRECT ANSWER Increased Hb and HCT Sputum findings in a patient with Chronic Bronchitis - CORRECT ANSWER May indicate infection Electrolyte findings in a patient with Chronic Bronchitis - CORRECT ANSWER Increased HCO3 (chronic ventilatory failure) Treatment and Management of a patient with Chronic Bronchitis - CORRECT ANSWER Pulmonary Hygiene therapy Antibiotics for infection Oxygen for hypoxemia Aerosolized mediations Consider NPPV for acute exacerbations Smoking cessation Reduce risk factors What aerosolized medications should be considered for Chronic Bronchitis - CORRECT ANSWER Short acting Beta 2 agonists Anticholinergics Long acting Beta 2 agonists Inhaled corticosteroids Bronchiectasis - CORRECT ANSWER Chronic dilation and distortion of one or more bronchi as a result of excessive inflammation and destruction of bronchial walls, blood vessels, elastic tissue and smooth muscle. Can create an obstructive or restrictive pattern Etiology of Bronchiectasis - CORRECT ANSWER Not always clear Can be either acquired or congenital Primary assessment of Bronchiectasis - CORRECT ANSWER Past medical history Shortness of breath Cough- productive with purulent foul smelling sputum, hemoptysis and 3 layer sputum Appearance of chest Respiratory pattern Color Appearance of nail beds Diagnostic chest percussion Breath sounds Secondary Assessment of Bronchiectasis - CORRECT ANSWER CXR ABG Pulmonary Function CBC Sputum Special Diagnostic tests CXR findings in Bronchiectasis - CORRECT ANSWER Hyperlucent lung fields Depressed or flattened diaphragm Enlarged or elongated heart ABG of mild to moderate Bronchiectasis - CORRECT ANSWER Acute alveolar hyperventilation with hypoxemia ABG of severe Bronchiectasis - CORRECT ANSWER Chronic ventilatory failure with hypoxemia Pulmonary findings in Bronchiectasis - CORRECT ANSWER Decreased flow rate CBC findings in Bronchiectasis - CORRECT ANSWER Increase RBC, Hb, HCT Sputum findings in Bronchiectasis - CORRECT ANSWER May indicate infection Special Diagnostic findings in Bronchiectasis - CORRECT ANSWER CT scan or bronchogram indicates a tree in winter pattern Treatment and management of Bronchiectasis - CORRECT ANSWER Pulmonary hygiene Antibiotics for infection Aerosolized medications Surgical resection of involved segments if necessary Oxygen for hypoxemia What aerosolized medications can be used for Bronchiectasis - CORRECT ANSWER Short acting Beta 2 agonists Anticholinergics Inhaled corticosteroids Sleep Apnea - CORRECT ANSWER Cessation of breathing for a period of 10 seconds or longer. Sleep apnea is diagnosed in patins who have more that 5 episodes of apnea per hour during sleep over a 6 hour peroid Central Sleep Apnea - CORRECT ANSWER Caused by failure of the respiratory center of the brain to send signals to the respiratory muscles Obstructive Sleep Apnea - CORRECT ANSWER Caused by anatomic obstruction of the upper airway in the presence of continued ventilatory effort Mixed Sleep Apnea - CORRECT ANSWER Combination of both central and obstructive. Usually begins as central apnea followed by onset of ventilatory effort without airflow Primary Assessment of Sleep Apnea - CORRECT ANSWER Past medical history- daytime sleepiness, insomnia at night, loud snoring with periods of apnea, morning headaches, hypothyroidism Physical Appearance- Obese, short stocky neck, large tongue Secondary Assessment of Sleep Apnea - CORRECT ANSWER CXR ABG Pulmonary Function Special Tests CXR of Sleep Apnea - CORRECT ANSWER May be normal or demonstrate right and/or left sided heart failure ABG of Sleep Apnea - CORRECT ANSWER Chronic ventilatory failure with hypoxemia (severe sleep apnea) Pulmonary Function of Sleep Apnea - CORRECT ANSWER Decreased volumes With obstructive sleep apnea a saw tooth pattern is seen on maximal inspiratory and expiratory flow volume loops Special tests for Sleep Apnea - CORRECT ANSWER Sleep study (polysomnography) If both flow and respiratory effort decrease then desaturation is caused by Central Apnea If nasal flow decrease with an increase in respiratory effort then desaturation is caused by obstructive sleep apnea Treatment and management of Central Sleep Apnea - CORRECT ANSWER Drug therapy Phrenic nerve pacer Nocturnal ventilation What drugs are used to manage Central Sleep Apnea - CORRECT ANSWER REM inhibitors (Vivactil) Carbonic anhydrase inhibitors (Diamox) Respiratory Stimulants (Aminophylline, caffeine) Treatment and management of Obstructive Sleep Apnea - CORRECT ANSWER Weight loss Sleep posture (lateral or upright) Oxygen therapy for hypoxemia NIPPV Nasal CPAP BiPAP Oral surgery Tracheostomy Oral appliances Neck Collar Asthma - CORRECT ANSWER A chronic, inflammatory, obstructive, non contagious airway disease with varying levels of severity and characterized by exacerbation's. A reversible condition characterized by increased responsiveness of the small airways to stimuli Etiology of Asthma - CORRECT ANSWER External or environmental agents Infections Exercise Cold air exposure Chemical exposure GERD Sleep Emotional stress PMS Primary assessment of Asthma - CORRECT ANSWER Past medical history --allergies, episodes of cough & wheezing Shortness of breath --pursed-lip breathing, chest tightness Cough --increased & productive with presence of eosenophils --Charcot-Leyden ceystals --Kirschman spirals --increased IgE levels Appearance of the chest --increased A-P diameter during episode Respiratory Pattern --accessory muscle usage, tachypnea Color --cynotic Diagnostic Chest percussion --hyperresonant/tmpanic note Breath sounds --diffuse wheezing, diminished b/s Physical appearance --Diaphoresis, Anxous, speak short phrases Vital Signs --Tachycardia, Pulsus paradoxing during severe episode Secondary assessment of Asthma - CORRECT ANSWER CXR ABG Pulmonary Function Sputum CXR findings in Asthma - CORRECT ANSWER During acute episode: flattened diaphragms, hyperinflation and some infiltrates (may develop pneumothroax) ABG findings in Asthma - CORRECT ANSWER Acute alveolar hyperventilation with hypoxemia, hypercarbia may occur in status asthmaticus Pulmonary Function findings in Asthma - CORRECT ANSWER Decreased flow rates, normal DLco, pre and post bronchodilator improvement- at least 12% and 200 mL increase in FEV1 Sputum findings in Asthma - CORRECT ANSWER May indicate infection Treatment and management of Asthma - CORRECT ANSWER Environmental control Oxygen therapy Bronchopulmonary hygiene Aerosolized medications Asthma action plan based on peak flow monitoring Rescue medications used for Asthma - CORRECT ANSWER Short Acting Beta2 agonists Anticholinergics Controller medication used for Asthma - CORRECT ANSWER Long acting Beta2 agonists Inhaled corticosteroids Mast cell stabilizers (for prevention) Systemic medications used for Asthma - CORRECT ANSWER Corticosteroids Leukotriene modifiers Xanthines Immunomodulators Emergency room treatment for acute episodes of Asthma - CORRECT ANSWER Oxygen therapy Aerosol therapy with SABA and anticholinergic (consider continuous aerosol therapy) Steroids (IV or oral) Close monitoring Intubation and mechanical ventilation if respiratory arrest occurs Consider adjunct therapies: Heliox, magnesium sulfate, subcutaneous epinephrine Rib fractures, Flail Chest, Chest Trauma - CORRECT ANSWER Involves any type of trauma to the chest wall Etiology of Rib fractures, Flail Chest, Chest Trauma - CORRECT ANSWER Industrial accidents Vehicle accidents Falls Violence Surgery Primary assessment of Rib fractures, Flail Chest, Chest Trauma - CORRECT ANSWER Past medical history --history of injury Shortness of breath Cough --possibly hemoptysis Appearance of chest --brusing over area involved Respiratory Pattern --paradoxical chest movement - fail chest. shallow rapid respirations, severe chest pain Color --cynotic Diagnostic Chest Percussion Breath sounds --diminished breath sounds over affected area Vitals --elevated heart rate & BP Secondary assessment of Rib fractures, Flail Chest, Chest Trauma - CORRECT ANSWER CXR ABG Pulmonary Function CXR findings in Rib fractures, Flail Chest, Chest Trauma - CORRECT ANSWER Increased opacity from lung compression, rib fractures ABG findings in Rib fractures, Flail Chest, Chest Trauma - CORRECT ANSWER Acute alveolar hyperventilation with hypoxemia Pulmonary Function findings in Rib fractures, Flail Chest, Chest Trauma - CORRECT ANSWER Decreased volumes and capacities Treatment and management of Rib fractures, Flail Chest, Chest Trauma - CORRECT ANSWER Oxygen therapy for hypoxemia Analgesics Routine bronchial hygiene Hyperinflation therapy (IS, IPPB, deep breathing and coughing) Prevention of pneumonia Closely monitor for acute ventilatory failure Treatment and management of severe Rib fractures, Flail Chest, Chest Trauma - CORRECT ANSWER Stabilization of chest wall Volume control ventilation for 5 to 10 days PEEP Pneumothorax - CORRECT ANSWER Gas or free air accumulated in the pleural space Etiology of Pneumothorax - CORRECT ANSWER Traumatic- obvious injury Spontaneous- no obvious injury Primary Assessment of Pneumothorax - CORRECT ANSWER Past medical history Shortness of breath Appearance of the chest Respiratory pattern color Diagnostic chest percussion Breath sounds Physical appearance Vital signs Secondary Assessment of Pneumothorax - CORRECT ANSWER CXR ABG CXR findings of Pneumothorax - CORRECT ANSWER Hyperlucency with absence of vascular markings on the affected side, tracheal shift to the unaffected side, depressed diaphragm, lung collapse ABG findings of Pneumothorax - CORRECT ANSWER Acute alveolar hyperventilation with hypoxemia Treatment and management of Pneumothorax - CORRECT ANSWER Oxygen for hypoxemia Hyperinflation therapy (IS, IPPB) after chest tube insertion Mechanical ventilation with PEEP for acute ventilatory failure Treatment and management of small Pneumothorax - CORRECT ANSWER Less than 20% of lung collapse may only require bed rest and limited physical activity. Absorption usually occurs within 30 days Treatment of management of large Pneumothorax - CORRECT ANSWER Greater than 20% of lung collapse should be evacuated by chest tube Needle aspiration of the chest if necessary if patient is unstable: bradycardia, hypotension, cyanosis Hemothorax - CORRECT ANSWER Blood accumulated in the pleural space Etiology of Hemothorax - CORRECT ANSWER Traumatic- obvious injury Primary assessment of Hemothorax - CORRECT ANSWER Past medical history Shortness of breath Cough Appearance of the chest Respiratory pattern Color Diagnostic chest percussion Breath sounds Secondary assessment of Hemothorax - CORRECT ANSWER CXR ABG CBC CXR findings in Hemothorax - CORRECT ANSWER Increased radio density, tracheal shift away from the affected side ABG findings in Hemothorax - CORRECT ANSWER Acute alveolar hyperventilation with hypoxemia CBC findings in Hemothorax - CORRECT ANSWER Reduced RBC, Hb, HCT Treatment and management of Hemothorax - CORRECT ANSWER Thoracentesis or chest tube to drain fluid Oxygen for hypoxemia Hyperinflation therapy (IS,IPPB) after chest tube insertion Mechanical ventilation with PEEP for acute ventilatory failure Thoracic Surgery - CORRECT ANSWER Any surgical procedure performed on structures within the thoracic cavity Etiology of Thoracic Surgery - CORRECT ANSWER Lung repairs or resections Tracheal / mediastinal repairs or resections Pneumonectomy or lobectomy Cardiac surgery: valve replacements, bypass grafts Primary Assessment of Thoracic Surgery - CORRECT ANSWER Past medical history Shortness of breath Cough Appearance of the nail beds Diagnostic chest percussion Breath sounds Secondary assessment of Thoracic Surgery - CORRECT ANSWER Routinely performed pre operative basic laboratory testing CXR Pulmonary function Treatment and management of Thoracic Surgery Pre operative - CORRECT ANSWER Hyperinflation therapy, IS, IPPB Treatment and management of Thoracic Surgery Post op - CORRECT ANSWER Hyperinflation therapy Prevention of infection Monitor chest drainage systems Observe for post op complications Post op complications associated with Thoracic Surgery - CORRECT ANSWER Subcutaneous emphysema Increased pressures on mechanical ventilation Decreased static lung compliance Hypovolemic shock- decreased hemodynamic values Head trauma or surgery - CORRECT ANSWER Any injury or surgical procedure performed on the skull and or brain Etiology of Head trauma or surgery - CORRECT ANSWER Traumatic brain injury Tumors Aneurysms Cerebrovascular accidents Seizures Primary assessment of Head trauma or surgery - CORRECT ANSWER Past medical history --tumors, headaches, cranial bleeds, trauma, seizures, hemiparalysis, slurred speach Respiratory pattern --irregular rhythm, cheyne-stokes breathing Level of consciousness --altered level of conciousness Pupillary response --abnormal Secondary assessment of Head trauma or surgery - CORRECT ANSWER Special tests: CT, MRI,PET scans Intracranial Pressure Monitoring: Normal values are 5 to 10 mmHg Treatment and management of Head trauma or surgery - CORRECT ANSWER Oxygen therapy- maintain PaO2 level near 100 torr Mechanical ventilation Mechanical ventilation for Head trauma or surgery - CORRECT ANSWER Maintain PaCO2 level between 25 to 30 torr to reduce ICP Minimiza airway resistance by utilizing low PEEP and peak inspiratory pressures Set low pressure and exhaled volume alarms appropriately Medications used to treat Head trauma or surgery - CORRECT ANSWER Barbiturates for sedation Mannitol to decrease ICP Dilantin for seizures Neck and Spinal Injury/Surgery - CORRECT ANSWER Any injury or surgical procedure performed on the neck and or around the spine Etiology of Neck and Spinal Injury/Surgery - CORRECT ANSWER Traumatic injury Tumors Spine deformities Primary assessment of Neck and Spinal Injury/Surgery - CORRECT ANSWER Past medical history --fall, accidents, tumors Appearance of the neck/spine --bruses over affected area Respiratory Pattern --maybe be apneic with severe damageto spine Level of consciousness --altered Secondary assessment of Neck and Spinal Injury/Surgery - CORRECT ANSWER CT MRI Treatment and management of Neck and Spinal Injury/Surgery - CORRECT ANSWER Oxygen therapy to treat or prevent hypoxemia Maintain patent airway Support ventilation, oxygenation, circulation and perfusion as indicated by bedside assessment and laboratory testing Abdominal Surgery/Pre & Post Op patients - CORRECT ANSWER Any surgical procedure performed on structures within the abdominal cavity Etiology of Abdominal Surgery/Pre & Post Op patients - CORRECT ANSWER Gall bladder Colon Uterine Appendix Primary assessment of Abdominal Surgery/Pre & Post Op patients - CORRECT ANSWER Past medical history Respiratory pattern Secondary assessment of Abdominal Surgery/Pre & Post Op patients - CORRECT ANSWER Routinely perform pre op basic laboratory testing Pre op pulmonary function testing (basic spirometry testing) Treatment and management of Abdominal Surgery/Pre & Post Op patients - CORRECT ANSWER Pre op: Hyperinflation therapy (IS,IPPB) Post op: Hyperinflation therapy (IS,IPPB) Prevention of infection Analgesics as needed Mechanical ventilation if needed What are possible post op complications associated with Abdominal Surgery - CORRECT ANSWER Increased pressure on the vent Decreased static lung compliance Hypovolemic shock(decreased hemodynamic values) Laryngectomy - CORRECT ANSWER Surgical removal of the larynx With only vocal cord involvement, the temporary stoma is closed within days after removal of the cords. With more radical involvement, the entire larynx may be removed along with the epiglottis and thyroid cartilage. IN the case the stoma becomes permanent Following Laryngectomy - CORRECT ANSWER There is nor longer a connection between the upper and lower airways, and the patient has a permanent atoms. The patient can not be orally or nasally intubated. If mechanical ventilation is required. insert an endotracheal tube into the laryngectomy opening Etiology of Laryngectomy - CORRECT ANSWER Carcinoma of the upper airway Trauma Primary assessment of Laryngectomy - CORRECT ANSWER Past medical history: upper airway carcinoma Secondary assessment of Laryngectomy - CORRECT ANSWER Routinely perform basic laboratory testing Treatment and management of Laryngectomy - CORRECT ANSWER Use meticulous suctioning technique Cool aerosol will help keep secretions thin in the early post op period Laryngectomy tube is removed after 3 to 6 weeks, at that time the stoma is considered stable and permanent Monitor basic laboratory tests ARDS - CORRECT ANSWER An illness or injury that affects the lung compliance that includes a multitude of etiologic factors Etiology of ARDS - CORRECT ANSWER Aspiration Trauma Drug overdose Fluid overload Inhalation of toxins and irritants Shock Primary assessment of ARDS - CORRECT ANSWER Past medical history Shortness of breath Cough Respiratory pattern Color Diagnostic chest percussion Breath sounds Secondary assessment of ARDS - CORRECT ANSWER CXR ABG Pulmonary function Sputum Special tests CXR findings of ARDS - CORRECT ANSWER Diffuse alveolar infiltrates with a honeycomb or ground glass appearance, radiopacity ABG findings in ARDS - CORRECT ANSWER Refractory hypoxemia Acute alveolar hyperventilation with hypoxemia Pulmonary function findings in ARDS - CORRECT ANSWER Decreased volumes and capacities Sputum findings in ARDS - CORRECT ANSWER May indicate infection Special tests performed in ARDS - CORRECT ANSWER Hemodynamic monitoring reveals elevated PAP Treatment and management of ARDS - CORRECT ANSWER Treat underlying cause Oxygen therapy up the 60%, then add CPAP/PEEP Titrates oxygen to below 60%, then reduce CPAP/PEEP with patient improves Hyperinflation therapy (IS,IPPB) for atelectasis Consider mechanical ventilation Alternative modes of mechanical ventilation - CORRECT ANSWER PCV IRV APRV PRVC HFV ARDSnet protocol - CORRECT ANSWER Reduce tidal volume to 6 ML/kg Maintain plateau pressure <30 cmH2O Recruitment maneuvers For patients with any neurologic/neuromuscular disease watch for ventilatory failure by monitoring - CORRECT ANSWER Tidal volume 5 mL/kg IBW if less than consider vent Vital capacity less than 1000mL MIP -20 or more negative Myasthenia Gravis - CORRECT ANSWER Chronic disorder of the neuromuscular junction that interferes with chemical transmission of acetylcholine Descending paralysis: remember mind to ground Etiology of Myasthenia Gravis - CORRECT ANSWER Related to circulating antibodies of the autoimmune system Clinical manifestation are provoked by - CORRECT ANSWER Emotional upset Physical stress Exposure to extreme temperature changes Pregnancy Febrile illness Primary assessment of Myasthenia Gravis - CORRECT ANSWER Past medical history Physical appearance (don't pick pupillary response) Respiratory pattern Breath sounds Physical appearance of Myasthenia Gravis - CORRECT ANSWER General weakness that improves with rest Drooping eyelids (ptosis) Double vision (diplopia) Difficulty swallowing (dysphagia) Past medical history of Myasthenia Gravis - CORRECT ANSWER Gradual onset of weakness, may have previous admissions for Myasthenia Gravis Secondary assessment of Myasthenia Gravis - CORRECT ANSWER Special tests Spontaneous ventilatory parameters ABG Pulmonary function Special tests for Myasthenia Gravis - CORRECT ANSWER Edrophonium: Tensilon challenge Electomyography Spontaneous ventilatory parameters - CORRECT ANSWER Decreasing tidal volume, vital capacity, MIP ABG for Myasthenia Gravis - CORRECT ANSWER Acute ventilatory failure with hypoxemia Watch for ventilatory failure PaCO2 >45 torr Pulmonary function of Myasthenia Gravis - CORRECT ANSWER Reduced volumes If Vt, VC, MIP and weakness improve with Tensilon - CORRECT ANSWER Indicates more of this type of drug needs to be given Maintenance drug therapy including: Prostigmine (Neostigming) Pyridostigmine (Mestinon, Regonol) Amount dictated by Tensilon If Vt, VC, MIP and weakness worsens with Tensilon - CORRECT ANSWER Referred to as a Cholinergic Crisis, indicating too mush of this type of drug has been given Administer Atropine to reverse Tensilon Atropine will relieve symptoms of a cholinergic crisis Treatment and management of Myasthenia Gravis - CORRECT ANSWER Bedrest restriction Soft diet to reduce symptoms Oxygen therapy for hypoxemia Hyperinflation therapy Pulmonary hygiene Other treatment modalities for Myasthenia Gravis - CORRECT ANSWER Corticosteroids for severe cases Adrenocorticotropic hormone Thymectomy Plasmapheresis Guillain-Barre Syndrome - CORRECT ANSWER Rare disorder of the peripheral nervous system. Most likely an immune disorder that causes inflammation and deterioration of the patients peripheral nervous system Guillain-Barre Syndrome an ascending paralysis - CORRECT ANSWER Remember moves to the ground to the brain Etiology of Guillain-Barre Syndrome - CORRECT ANSWER Precise cause is unknown Onset frequently occurs after a febrile illness 1 to 4 weeks Primary assessment of Guillain-Barre Syndrome - CORRECT ANSWER Past medical history Physical appearance Respiratory pattern Breath sounds Past medical history of Guillain-Barre Syndrome - CORRECT ANSWER Febrile illness, often viral in nature, decreased WBC Secondary assessment of Guillain-Barre Syndrome - CORRECT ANSWER Spontaneous ventilatory parameters ABG Pulmonary function Special tests Spontaneous ventilatory parameters of Guillain-Barre Syndrome - CORRECT ANSWER Decreasing Vt,VC,MIP ABG of Guillain-Barre Syndrome - CORRECT ANSWER Acute ventilatory failure with hypoxemia, watch for ventilatory failure PaCO2 >45 torr Pulmonary function of Guillain-Barre Syndrome - CORRECT ANSWER Reduced volumes Special tests for Guillain-Barre Syndrome - CORRECT ANSWER Lumbar puncture- high protein level in CSF, abnormal electromyograph Treatment and management of Guillain-Barre Syndrome - CORRECT ANSWER Directed at stabilization of vital signs and supportive care Initially patients should be managed in the ICU Oxygen therapy for hypoxemia Hyperinflation therapy (IS,IPPB) Pulmonary hygiene Plasmapheresis-severe cases only Other treatment modalities for Guillain-Barre Syndrome - CORRECT ANSWER Anti coagulation therapy Physical therapy Corticosteroids Watch for pulmonary embolism Drug overdose - CORRECT ANSWER The intentional misuse or accidental overuse of medication that exceeds the recommended medical dose Etiology of Drug overdose - CORRECT ANSWER History is often the most significant finding Mental illness such as depression and addiction Primary assessment in Drug overdose - CORRECT ANSWER Past medical history Respiratory pattern Physical appearance Secondary assessment in Drug overdose - CORRECT ANSWER Monitor results of basic laboratory testing Treatment and management of Drug overdose - CORRECT ANSWER Placement of an artificial airway is the first priority Mechanical ventilation for ventilatory failure Naloxone (Narcan) can be used to reverse a narcotic overdose Stroke/CVA/Transient Ischemic Attack (TIA) - CORRECT ANSWER Area of the brain loses blood supply as a result of a vascular occlusion Etiology of Stroke/CVA/Transient Ischemic Attack (TIA) - CORRECT ANSWER Cerebral thrombi or emboli (Most common) Atherosclerosis Hypertension Primary assessment of Stroke/CVA/Transient Ischemic Attack (TIA) - CORRECT ANSWER Past medical history Respiratory pattern: cheyene-stokes Physical appearance: motor and speech loss Secondary assessment of Stroke/CVA/Transient Ischemic Attack (TIA) - CORRECT ANSWER Special tests: CT/MRI of the brain ICP monitoring: may be elevated normal 5 to 10 mmHg Treatment and management of Stroke/CVA/Transient Ischemic Attack (TIA) - CORRECT ANSWER Treatment should be initiated with 6 hours of symptoms of onset Drug therapy Mechanical ventilation for ventilatory failure or reduce ICP Drug therapy used with Stroke/CVA/Transient Ischemic Attack (TIA) - CORRECT ANSWER Anticoagulation therapy Vasodilators Thrombolytic therapy (for acute ischemic stroke) Poliomyelitis/Tetanus/Botulism/Muscular Dystrophy - CORRECT ANSWER Neuromuscular disorders that involve loft of voluntary muscle action Etiology of Poliomyelitis/Tetanus/Botulism/Muscular Dystrophy - CORRECT ANSWER Viral infection (Polio) Genetic disorder (Muscular dystrophy) Puncture wound (Tetanus/Botulism) Primary assessment of Poliomyelitis/Tetanus/Botulism/Muscular Dystrophy - CORRECT ANSWER Past medical history current medications Secondary assessment of Poliomyelitis/Tetanus/Botulism/Muscular Dystrophy - CORRECT ANSWER ABG Spontaneous ventilatory parameters Treatment and management of Poliomyelitis/Tetanus/Botulism/Muscular Dystrophy - CORRECT ANSWER Closely monitor Vt,VC,MIP Drug therapy: Paralyzing agents to relax max for intubation and ventilation in case of tetanus/botulism Chest pain - CORRECT ANSWER Unstable angina is a form of acute coronary syndrome that results in reversible myocardial ischemia and is a sign of impending failure Myocardial Infarction - CORRECT ANSWER When coronary blood flow is interrupted for an extended period of time causing irreversible damage to the heart muscle. Sudden cardiac death can occur in either pathology Etiology of Chest pain/Myocardial Infarction - CORRECT ANSWER Heart disease Hypertension Thrombus Primary assessment of Chest pain/Myocardial Infarction - CORRECT ANSWER Past medical history Shortness of breath Respiratory pattern Color Breath sounds Physical appearance Vital signs Secondary assessment of Chest pain/Myocardial Infarction - CORRECT ANSWER ABG Electrolytes Special tests Electrocardiogram ABG findings in Chest pain/Myocardial Infarction - CORRECT ANSWER Hypoxemia Electrolyte findings in Chest pain/Myocardial Infarction - CORRECT ANSWER Hyperkalemia or hypokalemia Special tests performed for Chest pain/Myocardial Infarction - CORRECT ANSWER Cardiac enzymes (CPK,LDH,SGOT) Troponin ECG findings in Chest pain/Myocardial Infarction - CORRECT ANSWER Arrhythmias with significant Q waves and S-T segment changes Treatment and management of Chest pain/Myocardial Infarction - CORRECT ANSWER Immediate oxygen therapy at 100% Closely monitor vital signs Drug therapy Drugs used to treat Chest pain/Myocardial Infarction - CORRECT ANSWER Atropine for bradycardia Defibrillate for pulseless V-Tach or fib Nitrates for chest pain Asprin, anti arrhythmic agents Congestive heart failure - CORRECT ANSWER Abnormal condition that reflects impaired cardiac pumping. Caused by myocardial infarction, ischemic heart disease, or cardiomyopathy Pulmonary Edema - CORRECT ANSWER Excessive movement of fluid from the pulmonary vascular system to the extravascular system and air spaces of the lungs (alveoli) Etiology of Congestive heart failure - CORRECT ANSWER MI Ischemic heart disease Cadriomyopathy Etiology of Cardiogenic Pulmonary Edema - CORRECT ANSWER Increased pulmonary capillary hydrostatic pressure, usually due to CHF Etiology of Non Cardiogenic Pulmonary Edema - CORRECT ANSWER Increased capillary permeability Primary assessment of Congestive heart failure/Pulmonary Edema - CORRECT ANSWER Past medical history Shortness of breath: Orthopnea Cough: Pink frothy secretions Respiratory pattern Color Diagnostic chest percussion Breath sounds: Crackles, rhonchi Physical appearance: Pedal edema, diaphoresis, anxious Vital signs Secondary assessment of Congestive heart failure/Pulmonary Edema - CORRECT ANSWER CXR ABG Pulmonary Function Sputum Electrolytes Hemodynamics CXR findings in Congestive heart failure/Pulmonary Edema - CORRECT ANSWER Fluffy opacities, butterfly or bat wing pattern ABG findings in Congestive heart failure/Pulmonary Edema - CORRECT ANSWER Respiratory alkalosis with hypoxemia Pulmonary function findings in Congestive heart failure/Pulmonary Edema - CORRECT ANSWER Reduced volumes and capacities Sputum findings in Congestive heart failure/Pulmonary Edema - CORRECT ANSWER Pink frothy secretions Electrolyte findings in Congestive heart failure/Pulmonary Edema - CORRECT ANSWER Decreased potassium and sodium Hemodynamic findings in Congestive heart failure/Pulmonary Edema - CORRECT ANSWER Increased PCWP, PAP Treatment and management of Congestive heart failure/Pulmonary Edema - CORRECT ANSWER Immediate oxygen therapy at 100% Monitor vitals and place patient in Fowlers position IPPB with 100% oxygen Drug therapy Mechanical ventilation with PEEP for ventilatory failure Drug therapy for Congestive heart failure/Pulmonary Edema - CORRECT ANSWER Diuretics- to promote fluid excretion Furosemide (Lasix) Bumex Aldactone Drug therapy for Congestive heart failure/Pulmonary Edema - CORRECT ANSWER Positive inotropic agents Digitalis Digoxin Dopamine Low dose amiodarone Drug therapy for Congestive heart failure/Pulmonary Edema - CORRECT ANSWER Analgesic/Sedative Morphine Drug therapy for Congestive heart failure/Pulmonary Edema - CORRECT ANSWER Afterload reduction agents Morphine Nitroglycerin Nitroprusside ACE inhibitors Drug therapy for Congestive heart failure/Pulmonary Edema - CORRECT ANSWER Electrolyte replacement Potassium Sodium Arrhythmias - CORRECT ANSWER Irregularities in the cardiac rhythm Etiology of Arrhythmias - CORRECT ANSWER Hypoxemia Ischemia Electrolyte imbalance Conduction dysorders Treatment and management of PVC - CORRECT ANSWER Treat with oxygen and consider possible causes Treatment and management of V-fib and pulseless V-tach - CORRECT ANSWER Defibrillate with 360 joules Treatment and management of Atrial flutter, fib and V-tach with a pulse - CORRECT ANSWER Not immediately life threatening Perform synchronized cardioversion starting at 50 to 100 joules Drug therapy for Arrhythmias - CORRECT ANSWER Anti Arrhythmic agents should be administered as indicated by ECG and bedside assessment Shock - CORRECT ANSWER Occurs when the cardiovascular system fails to adequately perfuse tissues that results in widespread impairment of cellular metabolism. A reduction in blood flow to the tissues that is inadequate to sustain life Etiology of Cardiogenic schock - CORRECT ANSWER heart failure Etiology of Neurogenic of Vasogenic shock - CORRECT ANSWER Alterations in vascular smooth muscle tone Etiology of anaphylactic shock - CORRECT ANSWER Hypersensitivity Etiology of septic shock - CORRECT ANSWER Infection Etiology of hypovolemic shock - CORRECT ANSWER Insufficient intravascular fluid volume Etiology of traumatic shock - CORRECT ANSWER Components of hypovolemic and septic shock Primary assessment of Shock - CORRECT ANSWER Past medical history Shortness of breath Respiratory pattern color Physical appearance Vital signs Secondary assessment of Shock - CORRECT ANSWER ABG: hypoxemia Hemodynamics: Decreased CVP,PAP,PCWP,Qt Urine output:Decreased Treatment and management of Shock - CORRECT ANSWER Mechanical ventilation for ventilatory failure Drug therapy Treat hypovolemia Drug therapy for Shock - CORRECT ANSWER Vasopresssors for vasogenic hypovolemia Digitalis, digoxin for heart failure Antibiotics for infection Treatment for hypovolemia - CORRECT ANSWER IV fluids Blood transfusion Cor Pulmonale - CORRECT ANSWER Consists of right ventricular enlargement (hypertrophy, dilation or both) and is secondary to pulmonary hypertension from disorders of the chest wall or lungs Etiology of Cor Pulmonale - CORRECT ANSWER Increased right ventricular workload as a result of pulmonary hypertension that results in hypertrophy of the right ventricle Primary assessment of a patient with Cor Pulmonale - CORRECT ANSWER Past medical history Shortness of breath Appearance of chest Physical appearance: distended neck veins, chest apin, peripheral edema Secondary assessment of a patient with Cor Pulmonale - CORRECT ANSWER Hemodynamics: Decreased Qt with exercise Electrocardiogram: Right ventricular hypertrophy Treatment and management of Cor Pulmonale - CORRECT ANSWER Oxygen therapy Treat underlying cause Decrease workload of the right ventricle by lowering PAP Drug therapy Drug therapy used to treat Cor Pulmonale - CORRECT ANSWER Digitalis Diuretics Pulmonary vasodilators (nitric oxide) Croup (Laryngotracheobronchitis) - CORRECT ANSWER Used to describe the inspiratory barking sound associated with the partial airway obstruction that develops in Croup (Laryngotracheobronchitis) subglottic croup. A viral infection that involves the upper and lower respiratory tract that causes subglottic edema Etiology of Croup (Laryngotracheobronchitis) - CORRECT ANSWER Caused by Parainfluenza virus 1,2&3, transmitted by aerosol droplet Primary assessment of Croup (Laryngotracheobronchitis) - CORRECT ANSWER Past medical history cough Appearance of the chest Respiratory pattern Color Breath sounds Physical appearance Vital Signs Past medical history findings in Croup (Laryngotracheobronchitis) - CORRECT ANSWER Recent cold that developed gradually into a barking cough over 2 to 3 days, most common in the fall and winter Physical appearance found in Croup (Laryngotracheobronchitis) - CORRECT ANSWER 6 months to 6 years alert with some accessory muscle use Vital signs hound in Croup (Laryngotracheobronchitis) - CORRECT ANSWER Increased HR, BP, Qt, low grade temperature Cough found in Croup (Laryngotracheobronchitis) - CORRECT ANSWER Barking Hoarse voice Secondary assessment found in Croup (Laryngotracheobronchitis) - CORRECT ANSWER Lateral Neck ABG Lateral neck findings in Croup (Laryngotracheobronchitis) - CORRECT ANSWER Haziness in the subglottic area, below the glottis, steeple point, pencil point, picket fence, hour glass narrowing of the upper airway ABG findings associated with Croup (Laryngotracheobronchitis) - CORRECT ANSWER Acute alveolar hyperventilation with hypoxemia Treatment and management of mild cases of Croup (Laryngotracheobronchitis) - CORRECT ANSWER Supportive care Oxygen therapy Cool aerosol mist Drug therapy Drug therapy used for mild cases of Croup (Laryngotracheobronchitis) - CORRECT ANSWER Racemic epinephrine (micro-nefrin, Vaponephrnie) Corticosteroids- For patient who do not respond to cool aerosol and racemic epinephrine therapy Treatment and management of severe cases of Croup (Laryngotracheobronchitis) - CORRECT ANSWER Child with SEVERE respiratory distress and or MARKED inspiratory stridor Criteria for intubation for Croup (Laryngotracheobronchitis) - CORRECT ANSWER Lethargic Severe stridor at rest Diminished breath sounds Extreme accessory muscle usage Treatment and management of severe cases of Croup (Laryngotracheobronchitis) - CORRECT ANSWER Temperature control Adequate hydration and humidification of inspired air Transfer patient to ICU Sedate patient if necessary Place on T-piece or CPAP Criteria for extubation for Croup (Laryngotracheobronchitis) - CORRECT ANSWER Child condition is stable Air leak around the tube (swelling has gone down) Epiglottitis - CORRECT ANSWER Life threatening emergency caused by inflammation of the suprglottic region that includes the epiglottis, aryepiglottic folds, and false vocal cords that causes swelling just ABOVE the vocal cords Etiology of Epiglottitis - CORRECT ANSWER Bacterial infection cause by Haemophilus influenza B (gram negative) transmitted by aerosol droplets Primary assessment of Epiglottitis - CORRECT ANSWER Past medical history Cough Appearance of chest Respiratory pattern Color Breath sounds Physical appearance Vital signs Past medical history - CORRECT ANSWER SUDDEN onset within 6 to 8 hours Cough - CORRECT ANSWER muffled cough Physical appearance found in Epiglottitis - CORRECT ANSWER 2 to 6 years of age Lifeless Drooling Hoarseness Inspiratory stridor Dysphagia Tongue thrusts forward during inspiration Voice and cry muffled Jaw jutted forward Vital signs found in Epiglottitis - CORRECT ANSWER High fever, measured axillary or tympanic to avoid stimulating the child Increased heart rate, BP, Qt Secondary assessment of Epiglottitis - CORRECT ANSWER Lateral neck ABG CBC Lateral neck findings in Epiglottitis - CORRECT ANSWER Haziness in the supraglottic area, supraglottic swelling above the glottic Thumb sign ABG findings in Epiglottitis - CORRECT ANSWER Acute alveolar hyperventilation with hypoxemia CBC findings in Epiglottitis - CORRECT ANSWER Elevated WBC, bacterial infection Treatment and management of Epiglottitis - CORRECT ANSWER Immediate placement of an artificial airway Transfer to ICU Sedate patient if necessary Place on t-piece or CPAP Oxygen therapy Drug therapy: Antibiotics Criteria for extubation - CORRECT ANSWER Childs condition is stable Swelling in the airway has diminished Pediatric Poisoning/Toxic Substance Ingestion - CORRECT ANSWER accidental or intentional ingestion of a toxic substance. Pediatric poisoning is defined as occurring in patients under the age of 20 Etiology of accidental Pediatric Poisoning/Toxic Substance Ingestion - CORRECT ANSWER Commonly occurs in children less that 6 years of age and generally involves only one substance Etiology os intentional Pediatric Poisoning/Toxic Substance Ingestion - CORRECT ANSWER Commonly occurs in older children. Frequently involves multiple substances and a delay in seeking medical treatment Primary assessment of Pediatric Poisoning/Toxic Substance Ingestion - CORRECT ANSWER Past medical history Color Physical appearance Secondary assessment of Pediatric Poisoning/Toxic Substance Ingestion - CORRECT ANSWER CXR ABG Lytes Special tests Special tests for Pediatric Poisoning/Toxic Substance Ingestion - CORRECT ANSWER Information on the dose and type of poison ingested, renal and liver function tests, glucose level, anion gap calculation, call poison control Treatment and management for Pediatric Poisoning/Toxic Substance Ingestion - CORRECT ANSWER Stabilize cardiovascular and respiratory system Maintenance of an airway, intubate when aspiration is possible Monitoring Full resuscitation Venous access for drug administration Appropriate weight measurement Toxicology screening Treatment and management for Pediatric Poisoning/Toxic Substance Ingestion - CORRECT ANSWER Supportive care Decontamination Mechanical ventilation for ventilatory failure Antidotes as indicated (acetylcysteine for acetaminophen, Narcan for narcotics) Gastric lavage - CORRECT ANSWER Use for kerosine Activated charcoal - CORRECT ANSWER Single dose administration is the most commonly used gastrointestinal decontamination method. Cannot be used to absorb alcohols, hydrocarbons, organic solvents, caustic agents, iron, cyanide, heavy metals and potassium. Cant use for kerosine Cystic Fibrosis (Mucoviscidosis) - CORRECT ANSWER An inherited, genetic disorder involving the exocrine glands Etiology of Cystic Fibrosis (Mucoviscidosis) - CORRECT ANSWER Caused by the mutation in a pair of genes located on chromosome 7 Production of preteen called cystic fibrosis trans membrane regulator (CTFR) Results in thick vicious mucus accumulation in the lungs, blocks passageways of the pancreas, and prohibits enzymes from reaching the intestines that lead to inhibition of digestion of protein and fat which leads to deficiencies of vitamins A,D,E, and K Primary assessment in Cystic Fibrosis (Mucoviscidosis) - CORRECT ANSWER Past medical history Shortness of breath Cough Appearance of chest Respiratory pattern Color Appearance of the nail beds Diagnostic chest percussion Physical appearance Vital signs Physical appearance found in Cystic Fibrosis (Mucoviscidosis) - CORRECT ANSWER Small for age Malnutrition Poor body development Meconium ileum of newborn Peripheral edema Secondary assessment for Cystic Fibrosis (Mucoviscidosis) - CORRECT ANSWER CXR ABG Pulmonary function CBC Sputum Special tests CXR findings in Cystic Fibrosis (Mucoviscidosis) - CORRECT ANSWER Translucent (dark) lung fields Depressed or flattened diaphragm Right ventricular enlargement Areas of atelectasis and fibrosis ABG findings in Cystic Fibrosis (Mucoviscidosis) - CORRECT ANSWER Acute alveolar hyperventilation with hypoxemia Pulmonary function findings in Cystic Fibrosis (Mucoviscidosis) - CORRECT ANSWER Decreased flow rates CBC findings in Cystic Fibrosis (Mucoviscidosis) - CORRECT ANSWER Elevated Hb and HCT Sputum findings in Cystic Fibrosis (Mucoviscidosis) - CORRECT ANSWER Common for staphylococcus aureus Haemophilus influenza Pseudomonas Special tests - CORRECT ANSWER Sweat chloride test: Chloride level >60 mEq/L, CFTR gene analysis (2 confirmed mutation), Immunoreactive Trypsinogen test (IRT) Treatment and management of Cystic Fibrosis (Mucoviscidosis) - CORRECT ANSWER Airway clearance four times daily Oxygen therapy Aerosol therapy Inhaled Antibiotics Airway clearance for Cystic Fibrosis (Mucoviscidosis) - CORRECT ANSWER Chest percussion and postural drainage Exercise PEP therapy High frequency chest wall compression Forced expiration techniques Aerosol therapy used for Cystic Fibrosis (Mucoviscidosis) - CORRECT ANSWER Bronchodilator Mucolytics-Pulmozyme Anti inflammatory- Advair, Flovent, Pulmicort Hydration- hypertonic saline Inhaled antibiotics used for Cystic Fibrosis (Mucoviscidosis) - CORRECT ANSWER Tobramycin Colistin Amikacin Bronchiolitis - CORRECT ANSWER Acute infection of the lower respiratory tract, usually caused by RSV. Results in inflammation and obstruction of the small bronchi and bronchioles Etiology of Bronchiolitis - CORRECT ANSWER Acquired in 1 in 10 infants younger than 2 years of age. Outcome is generally good Primary assessment of Bronchiolitis - CORRECT ANSWER Past medical history Shortness of breath cough appearance of the chest Respiratory pattern Breath sounds Physical appearance Vital Signs Secondary assessment of Bronchiolitis - CORRECT ANSWER CXR: Hyperinflation with areas of consolidation ABG: Hypoxemia Special tests for Bronchiolitis - CORRECT ANSWER Diagnosis determined by isolating the virus or its antigens in the patients sputum, oropharyngeal, or nasopharyngeal secretions. Specimens obtained by nasopharyngeal aspiration, nasal swab, or nasal lavage Treatment and management for Bronchiolitis - CORRECT ANSWER Prophylaxis recommended for infants Drug therapy Most cases treated at home with humidification and oral decongestants Severe cases (Patients with apnea) are hospitalized and treatment is directed at relieving the airway obstruction and hypoxemia Drug therapy for Bronchiolitis - CORRECT ANSWER Antibodies against RSV Intravenous-RespiGam Intramuscular- Synagic Aerosol- Ribavirin give via SPAG Foreign Body Aspiration - CORRECT ANSWER Sudden onset of airway obstruction caused by aspiration of a foreign object Etiology of Foreign Body Aspiration - CORRECT ANSWER Highest incidence is among children between 6 months and 3 years of age from attempting to ingest a foreign object. A major cause of death in the home Primary assessment of Foreign Body Aspiration - CORRECT ANSWER Past medical history Shortness of breath Cough Respiratory pattern Color Breath sounds Physical appearance Secondary assessment of Foreign Body Aspiration - CORRECT ANSWER CXR: Inspiratory and expiratory films indicate air trapping, hyperinflation and unequal ventilation. Majority or items aspirated are radiolucent and can not be seen on a chest film Treatment and management of Foreign Body Aspiration - CORRECT ANSWER Bronchoscopy-Tigid Postural drainage and percussion Aerosol therapy and bronchodilators Delivery Room Care - CORRECT ANSWER Assessment ans stabilization of the neonate immediately following delivery Primary assessment for Delivery Room Care - CORRECT ANSWER Clear airway first with bulb syringe Dry infant and keep warm APGAR score- Performed at 1 minute and then again at 5 minutes Secondary assessment for Delivery Room Care - CORRECT ANSWER History- family, mother, pregnant, delivery Gestational age Weight General appearance- color, chest configuration Breath Sounds Action based on APGAR score of 0 to 3 - CORRECT ANSWER resuscitate CPR Action based on APGAR score of 4 to 6 - CORRECT ANSWER Support Stimulate, warm, administer oxygen, assist ventilation Action based on APGAR score of 7 to 10 - CORRECT ANSWER Monitor Routine care Apnea of Prematurity - CORRECT ANSWER Apnea caused by immature neurologic control of ventilation resulting in death Etiology of Apnea of Prematurity - CORRECT ANSWER Immature central nervous system Primary assessment for Apnea of Prematurity - CORRECT ANSWER Past medical history Respiratory pattern Color Vital Signs Special tests for Apnea of Prematurity - CORRECT ANSWER Polysomnogram Risk factos for Apnea of Prematurity - CORRECT ANSWER Prone positioning Maternal smoking Bottle feeding Treatment and management for Apnea of Prematurity - CORRECT ANSWER Oxygen therapy 30 to 50 % as indicated by oximetry Methylxanthines (caffeine) Teach parents CPR Send infant home with an apnea monitor Meconium Aspiration Syndrome - CORRECT ANSWER Condition in which a fetus aspirates a mix of fetal stool (meconium) and amniotic fluid during episodes of fetal hypoxemia Etiology of Meconium Aspiration Syndrome - CORRECT ANSWER Occurs in 8 to 10% of all births Occurs in full term or post term infants Cannot be prevented even with the best maternal care Primary assessment for Meconium Aspiration Syndrome - CORRECT ANSWER Past medical history Appearance of the Chest Respiratory pattern Color Physical appearance Heart Rate Secondary assessment for Meconium Aspiration Syndrome - CORRECT ANSWER CXR ABG CXR findings in Meconium Aspiration Syndrome - CORRECT ANSWER Irregular densities throughout the lungs with atelectasis and consolidation Treatment and management for Meconium Aspiration Syndrome - CORRECT ANSWER Suction the nasopharynx and oropharynx throughly when amniotic fluid stained Follow NRP guideline Stabilize infanta and transfer to ICU Vigorous, active and crying, pulse >100, strong RR, good muscle tone - CORRECT ANSWER Suction mouth and nose to clear pharynx Warm, dry, and observe Blow by oxygen as needed Infant is not vigorous, pulse <100, limp, depressed RR, poort tone, absent or gasping respirations - CORRECT ANSWER No positive pressure ventilation Visualize vocal cords with laryngoscope Intubated with a meconium aspirator and suction the trachea Repeat until airway is clear- even if pulse is low Intubate and provide airway Once patient is in ICU - CORRECT ANSWER Vigorous pulmonar hygiene Oxygen therapy Mechanical ventilation for ventilatory failure Drug therapy Antibiotics Steroids Congenital Heart Defects - CORRECT ANSWER Structural abnormality of the heart present at birth Etiology of Cyanotic Congenital Heart Defects - CORRECT ANSWER Right to left shunt (Hypoxemia) Tetralogy of Fallot Transposition of the Great Vessels Etiology of Acyanotic Congenital Heart Defects - CORRECT ANSWER Left to Right shunt (pulmonary congestion) Atrial septal defect Ventricular septal defect Patent ductus arteriosus Primary assessment for Congenital Heart Defects - CORRECT ANSWER Color Breath Sounds Physical appearance Secondary assessment for Congenital Heart Defects - CORRECT ANSWER CXR: Possibly and enlarged or abnormal shaped heart Egg shaped heart - CORRECT ANSWER Transposition of the Great vessels Boot shaped heart - CORRECT ANSWER Tetralogy of Fallot Most important test to ID cardiac defects - CORRECT ANSWER Echocardiogram Tetralogy of Fallot - CORRECT ANSWER Overriding aorta, pulmonary stenosis, ventricular septal defect, and right ventricular hypertrophy Transposition of the Great Vessels - CORRECT ANSWER Aorta is switched with pulmonary artery (aorta arises from the right ventricular and the pulmonary artery arises from the left ventricle) Patent Ductus Arteriosus - CORRECT ANSWER Failure of the ductus arterioles to close. Most often results in a left to right shunt (increased pulmonary bllod flow) However, if the pressure in the right ventricle is greater than the pressure in the left ventricle, blood will flow from right to left across the ductus (shunt effect) Coarctation of the Aorta - CORRECT ANSWER A constriction in the aorta. Demonstrates as hypertension in the upper extremities and hypotension in lower extremities Atrial Septal Defect (ASD) - CORRECT ANSWER Opening in the atrial septum Ventricular Septal Defect (VSD) - CORRECT ANSWER Opening in the ventricular septum Truncus Arteriosus - CORRECT ANSWER Combined pulmonary artery and aorta Pre and Post ductal blood gas studies - CORRECT ANSWER If the pre ductal (right radial artery) PO2 is >15 torr higher than the post ductal (umbilical artery) PO2, then the patient has a right to left shunt Evaluated using two trancutaneous monitors - CORRECT ANSWER Once places on the upper rift thorax (Pre ductal) and the other on the lower left thigh of left abdominal region (post ductal) Treatment and management for Congenital Heart Defects - CORRECT ANSWER Oxygen therapy- maintain PaO2 levels between 60 to 80 torr Mechanical ventilation for ventilatory failure Supportive care prior to surgery ro correct defect Infant Respiratory Distress Syndrome - CORRECT ANSWER Primarily associated with prematurity or high risk infants Etiology of IRDS - CORRECT ANSWER Caused by insufficient amount of pulmonary surfactant or depressed surfactant activity that leads to massive atelectasis and hypoxemia Primary assessment for Infant Respiratory Distress Syndrome - CORRECT ANSWER Past medical history Appearance of the chest Respiratory pattern Color Breath sounds Physical appearance Vital signs Past medical history for Infant Respiratory Distress Syndrome - CORRECT ANSWER Gestational age <38 weeks Low APGAR scores Onset present at birth or within a few hour after delivery L:S ration 2:1 Secondary assessment for Infant Respiratory Distress Syndrome - CORRECT ANSWER CXR ABG CXR findings for Infant Respiratory Distress Syndrome - CORRECT ANSWER Increased opacity Ground glass appearance Air bronchograms ABG findings for Infant Respiratory Distress Syndrome - CORRECT ANSWER Acute alveolar hyperventilation with hypoxemia Treatment and management for Infant Respiratory Distress Syndrome - CORRECT ANSWER Correct hypoxemia Maintain neutral thermal environment Surfactant replacement therapy Mechanical ventilation for ventilatory failure (time cycled ventilation) with PEEP How to correct hypoxemia for Infant Respiratory Distress Syndrome - CORRECT ANSWER Oxygen via oxyhood or nasal cannula CPAP 4 to 6 cmH2o Maintain PaO2 between 60 to 80 torr How to give surfactant therapy for Infant Respiratory Distress Syndrome - CORRECT ANSWER Administer immediately after birth (prophylactic) in neonates <35 weeks or once IRDS has bee diagnosed Instill directly into the trachea though 5 fr catheter placed into the ETT Solution is administered in 4 portions, one at a time Catheter is removed after each administration Infanta is manually ventilated for 30 seconds Observe for adverse reactions Change patient position to increase distribution Bronchopulmonary Dysplasia - CORRECT ANSWER Chronic lung disorder characterized by bronchiolar metaplasia and interstitial fibrosis. A chronic lung disease that developed in newborns as a consequence of treatment of IRDS with oxygen and positive pressure ventilation for primary lung disorder Etiology of Bronchopulmonary Dysplasia - CORRECT ANSWER Precise cause is unknown Common factors: Low gestational age and low birth weight Mechanical ventilation with high airway pressures High oxygen concentrations History of IRDS Primary assessment of Bronchopulmonary Dysplasia - CORRECT ANSWER Past medical history Appearance of the chest Respiratory pattern Color Breath sounds Physical appearance Vital signs Secondary assessment of Bronchopulmonary Dysplasia - CORRECT ANSWER CXR ABG CXR findings in Bronchopulmonary Dysplasia - CORRECT ANSWER Groung glass pattern Air bronchograms Small lung volumes Cardiomegaly Pleural effusion may be present Treatment and management for Bronchopulmonary Dysplasia - CORRECT ANSWER Oxygen therapy Hyperinflation therapy Pulmonary hygiene Mechanical ventilation Ventilation and oxygenation should be maintained at the lowest possible level Drug therapy Monitor fluid balance Surgical ligation of PDA for infants that are difficult to wean Supportive care Minimize mean airway pressure Extubation can be done at ventilator rates between 5 and 15 Transient Tachypnea of the Newborn/Type II RDS - CORRECT ANSWER Occurs within 24 to 48 hours after birth and produces symptoms similar to the early stage of IRDS Etiology of Transient Tachypnea of the Newborn/Type II RDS - CORRECT ANSWER Precise cause is unknown Believed to be caused by slow absorption of fetal lung fluid Commonly seen in near term or full term infants of normal size and gestational age Primary assessment of Transient Tachypnea of the Newborn/Type II RDS - CORRECT ANSWER Past medical history Cough Appearance of the chest Respiratory pattern Color Breath sounds Vital signs Past medical history found in Transient Tachypnea of the Newborn/Type II RDS - CORRECT ANSWER Good APGAR scores at birth and then develop respiratory distress in the next 12 hours Secondary assessment of Transient Tachypnea of the Newborn/Type II RDS - CORRECT ANSWER CXR ABG CXR findings in Transient Tachypnea of the Newborn/Type II RDS - CORRECT ANSWER Initially appears normal, sign of pulmonary congestion developed 12 hours after birth, patchy infiltrates, cardiomegaly and pleural effusion may be present Treatment and management for Transient Tachypnea of the Newborn/Type II RDS - CORRECT ANSWER Support care to relieve symptoms Oxygen therapy CPAP to offset pulmonary congestion and interstitial edema Pulmonary hygiene Mechanical ventilation Congenital Diaphragmatic Hernia - CORRECT ANSWER Occurs when the diaphragm does not completely form. Causes the abdominal contents to be in direct contact with the thoracic cavity Etiology of Congenital Diaphragmatic Hernia - CORRECT ANSWER Occurs in 1 out of 2500 live births Infants are usually mature More common in males 90% of causes occur on the left through the foramen of Bochdalek. Mortality rate is 50% within 6 hours after delivery of not treated properly Primary assessment of Congenital Diaphragmatic Hernia - CORRECT ANSWER Past medical history Appearance of the chest Respiratory pattern Color Breath sounds Physical appearance Vital signs Breath sounds found in Congenital Diaphragmatic Hernia - CORRECT ANSWER Absent on affected side, bowel sounds on the affected side Physical appearance found in Congenital Diaphragmatic Hernia - CORRECT ANSWER Scaphoid abdomen Barrel chest CXR findings in Congenital Diaphragmatic Hernia - CORRECT ANSWER Fluid and air filled loops of intestine in the chest Shift of the heart and mediastinum toward unaffected side Atelectasis and complete lung collapse Hypoplastic left lung Treatment and management of Congenital Diaphragmatic Hernia - CORRECT ANSWER Always an emergency Prompt surgical repair is crucial Insert an oral gastric tube to decrease gas in the bowel Immediate oxygen therapy Place infant on affected side Do not ventilate with a mask May require intubation and mechanical ventilation ECMO for severe cases Exposure/Accidental Hypothermia - CORRECT ANSWER Marked cooling of core temperature (below 35 degrees C or 95 degrees F) Etiology of Exposure/Accidental Hypothermia - CORRECT ANSWER Generally the result of sudden immersion in cold water or prolonged exposure to cold environments Primary assessment for Exposure/Accidental Hypothermia - CORRECT ANSWER Past medical history Physical appearance Vital signs Secondary assessment for Exposure/Accidental Hypothermia - CORRECT ANSWER ABG: Moderate to severe acidosis with hypoxemia If patients body temperature is less than 37C or 98.6 then the patients actual values will show - CORRECT ANSWER pH increased PCO2 Decreased PO2 Decreased Treatment and management for mild cases of Exposure/Accidental Hypothermia - CORRECT ANSWER Passive rewarming may be sufficient Warm, dry clothes Warm drinks Isometric exercises to increased heart production Check core temperature as soon as possible Treatment and management for moderate cases of Exposure/Accidental Hypothermia, core temp >30C - CORRECT ANSWER Active rewarming may be required Warm water baths Warm blankets Heating pads Warm oral fluids when patient is alert Treatment and management for severe cases of Exposure/Accidental Hypothermia core temp of <30C - CORRECT ANSWER Active rewarming required Administration of warm IV solutions, warm gastric lavage or peritoneal lavage, inhalation of warm gases Rewarming should proceed no faster than few degrees per hour to avoid complications Mechanical ventilation for ventilatory failure Infectious Disease/Pneumonia - CORRECT ANSWER Result of an inflammatory process that primarily affects the gas exchange area of the lung causing capillary fluid to pout into the alveoli. This termed effusion. If the infection becomes overwhelming it is termed consolidation Etiology of Infectious Disease/Pneumonia - CORRECT ANSWER Extremely common Causes include: bacteria, virus, fungi, TB, atelectasis and inhalation Primary assessment of Infectious Disease/Pneumonia - CORRECT ANSWER Past medical history Shortness of breath Cough Appearance of chest Respiratory pattern Color Diagnostic chest percussion Breath sounds Physical appearance Vital signs Secondary assessment of Infectious Disease/Pneumonia - CORRECT ANSWER CXR ABG Pulmonary function CBC Sputum Special tests CXR finding in Infectious Disease/Pneumonia - CORRECT ANSWER Increased density from consolidation and atelectasis Air bronchograms Pleural effusion Pulmonary function findings in Infectious Disease/Pneumonia - CORRECT ANSWER Decreased volumes and capacities CBC findings in Infectious Disease/Pneumonia - CORRECT ANSWER Increased WBC with bacterial infection Decreased WBC with viral infection Sputum findings in Infectious Disease/Pneumonia - CORRECT ANSWER Gram positive or gram negative organisms Special tests for Infectious Disease/Pneumonia - CORRECT ANSWER CT scan Acid fast stain for TB ELISA test for HIV Treatment and management for Infectious Disease/Pneumonia - CORRECT ANSWER Oxygen therapy Pulmonary hygiene therapy Hyperinflation therapy Mechanical ventilation for ventilatory failure VAP protocol for intubated patients Drug therapy: Antibiotics, Aerosolized antiviral agents Thoracentesis Thermal Injuries:Burns/Smoke inhalation/carbon Monoxide Poisoning - CORRECT ANSWER The inhalation of smoke and hot gases. May be accompanied by body surface burns. May lead to complete airway obstruction. Should be expected in the presence of any type of fire Etiology of Thermal Injuries:Burns/Smoke inhalation/carbon Monoxide Poisoning - CORRECT ANSWER Fire victims Firefighters Inhalation of car exhaust Primary assessment of Thermal Injuries:Burns/Smoke inhalation/carbon Monoxide Poisoning - CORRECT ANSWER Past medical history Shortness of breath Cough Appearance of chest Respiratory pattern Color Level of consciousness Physical appearance Vital signs Secondary assessment of Thermal Injuries:Burns/Smoke inhalation/carbon Monoxide Poisoning - CORRECT ANSWER CXR ABG Pulmonary Function Special tests CXR findings in Thermal Injuries:Burns/Smoke inhalation/carbon Monoxide Poisoning - CORRECT ANSWER Normal in early stages, pulmonary edema/ARDS late stages Pulmonary function in Thermal Injuries:Burns/Smoke inhalation/carbon Monoxide Poisoning - CORRECT ANSWER Decreased volumes and lowrates Special tests in Thermal Injuries:Burns/Smoke inhalation/carbon Monoxide Poisoning - CORRECT ANSWER COHb levels measured by Co-oximeter Treatment and management for Thermal Injuries:Burns/Smoke inhalation/carbon Monoxide Poisoning - CORRECT ANSWER Immediate assessment of patients airway and respiratory and cardiovascular status Hyperbaric oxygen therapy Oxygen therapy at 100% Evaluate depth and percent of burns Isolation room Monitor ABG and lytes and fluid levels Monitor of signs of infection Bronchoscopy to clear airways of mucus plugs and evaluation of upper airways Mechanical ventilation of ventilatory failure Pulmonary hygiene Hyperinflation therapy Aerosolized medications Medications used for Thermal Injuries:Burns/Smoke inhalation/carbon Monoxide Poisoning - CORRECT ANSWER Sympathomimetic and parasympatholytic agents Mucolytics Anti inflammatory agents Near drowning - CORRECT ANSWER Situation in which a victim temporarily survives a liquid immersion. Glottis relaxes and allows water to flood the tracheal bronchial tree and alveoli Etiology of Near drowning - CORRECT ANSWER Accidental from lack of adult supervision or alcohol and risk taking behavior Primary assessment of Near drowning - CORRECT ANSWER Past medical history Cough Respiratory pattern Color Breath sounds Physical appearance Vital signs Secondary assessment of Near drowning - CORRECT ANSWER CXR ABG CXR findings in Near drowning - CORRECT ANSWER Initially can be normal Fluffy infiltrates Pulmonary edema Pneumothorax Pneumomediastinum Treatment and management of Near drowning first responder and transport to hospital - CORRECT ANSWER Remove victim from the water and remove clothing Follow BLS Oxygen therapy at 100% Cover with warm dry blankets Monitor vitals It victim had been submerged for <60 minutes, fixed dilated pupils do not necessarily indicate a poor prognosis Treatment and management of Near drowning at hospital - CORRECT ANSWER U=Intubation and mechanical ventilation with PEEP therapy for apneic victims or victims who can not maintain a PaO2 of 60 torr on an FiO2 of 50% or lower Inotropic agent Diuretics Chest tube insertion Warming of the victim Warming of the victim in hospital - CORRECT ANSWER IV administration of heated solutions Heated lavage of the gastric, intrathoracic, pericardial and peritoneal spaces, or the bladder and rectum Heated blankets Warm baths ECMO for severe cases In neck injury is suspected, intubated patient with - CORRECT ANSWER Flexible bronchoscope Diabetic/Renal failure - CORRECT ANSWER Decreased renal function Etiology of Diabetic/Renal failure - CORRECT ANSWER Inpaired renal blood flow secondary to diabetes mellitus or renal insufficiency Primary assessment of Diabetic/Renal failure - CORRECT ANSWER Past medical history Respiratory pattern Breath sounds Physical appearance Secondary assessment of Diabetic/Renal failure - CORRECT ANSWER ABG: Metabolic acidosis Urine output: Decreased <500 mL/day Blood glucose level: >160 mg Treatment and management of Diabetic patients - CORRECT ANSWER closely monitor glucose levels, ABG, watch for signs of respiratory failure Treatment and management of Renal Failure - CORRECT ANSWER Carefully monitor intake and output, electrolytes, watch for signs of CHF Pickwickian Syndrome/Morbid Obesity - CORRECT ANSWER A restrictive condition characterized by severe obesity, hypersomnolence, polycythemia, decreased response to CO2 Etiology of Pickwickian Syndrome/Morbid Obesity - CORRECT ANSWER Caused by obesity Primary assessment of Pickwickian Syndrome/Morbid Obesity - CORRECT ANSWER Past medical history Breath sounds Secondary assessment of Pickwickian Syndrome/Morbid Obesity - CORRECT ANSWER Perform basic laboratory tests PRN Treatment and management of Pickwickian Syndrome/Morbid Obesity - CORRECT ANSWER Monitor for sleep apnea, polysomnography if indicated Use IBW when initiating mechanical ventilation AIDS - CORRECT ANSWER Acquired dysfunction of the immune system Etiology of AIDS - CORRECT ANSWER Transmission by trans placental, route (newborns) or by semen or body fluids transmitted through sexual contact. Can also occur from blood transfusions, intravenous drug use or medical use of blood products Primary assessment of AIDS - CORRECT ANSWER Past medical history Color Physical appearance Vital signs Sign and Symptoms Secondary assessment of AIDS - CORRECT ANSWER Special tests: Positive HTLV III or HIV from an ELISA test Bronchoscopy: For tracheal washing or lung biopsy indicate pneumocystis carinii/Jirovecii (carinii) Treatment and management of AIDS - CORRECT ANSWER Do not order culture and sensitivity tests. pneumocystis carinii/Jirovecii (carinii) can not grow outside of the body Utilize standard/universal precautions pneumocystis carinii/Jirovecii (carinii) infection is treated prevented with - CORRECT ANSWER Pentamidine (NebuPent) aerosol therapy. Most commonly a monthly treatment Special consideration for aerosol therapy - CORRECT ANSWER One way exhalation valves and bacteria filters Closely monitor VS Masks worn by personnel giving therapy Administer therapy in Semi fowlers position Given in a special room or chamber to direct room ventilation to the outside Observe for bronchospasm TB in this population is - CORRECT ANSWER Endemic Positive acid fast stain in sputum confirms active TB Respiratory isolation INH, rifampin, ethambutol, streptomycin (18 to 24 months) Pulmonary Emboli - CORRECT ANSWER A blood clot or obstruction that becomes dislodged from somewhere else in the body and obstructs the pulmonary vasculature. Results in a deadspace condition, ventilation without perfusion Etiology of Pulmonary Emboli - CORRECT ANSWER Blood clots Fat/Air emboli Fractures Recent surgery Venous stasis Primary assessment of Pulmonary Emboli - CORRECT ANSWER Past medical history Shortness of breath Cough Respiratory pattern Color Breath sounds Physical appearance Vital signs Secondary assessment of Pulmonary Emboli - CORRECT ANSWER CXR ABG Hemodynamics Special tests Capnography Vd/Vt ratio CXR findings of Pulmonary Emboli - CORRECT ANSWER May be normal or wedge shaped infiltrate ABG findings in Pulmonary Emboli - CORRECT ANSWER Respiratory alkalosis with hypoxemia Sputum in Pulmonary Emboli - CORRECT ANSWER Blood tinged Hemodynamic in Pulmonary Emboli - CORRECT ANSWER Increased PAP Special tests in Pulmonary Emboli - CORRECT ANSWER Spiral CT scan V/Q scan D-dimer Capnography - CORRECT ANSWER Decreasing PaCO2 with normal PaCO2 Vd/Vt ration in Pulmonary Emboli - CORRECT ANSWER Increased Treatment and management of Pulmonary Emboli - CORRECT ANSWER Oxygen therapy at 100% to maintain PaO2 >80 torr Coagulation studies Drug therapy Active and passive exercises Early ambulation Anti embolism stockings Intermittent pneumatic compression devices Surgical options Drug therapy for Pulmonary Emboli - CORRECT ANSWER Low dose heparin, coumadin, dicumarol for anticoagulation Analgesics to relieve chest pain Digitalis, digoxin to maintain circulation Thombrolytic agents- urokinase, streptokinase Surgical option for Pulmonary Emboli - CORRECT ANSWER Embolectomy Vena cava interruption with sutures Greenfield filter in IVC Peripheral Vascular Disease - CORRECT ANSWER An abnormal condition causing partial or complete obstruction of blood flow to or from the arteries or veins outside the chest. Examples of PVD are arteriosclerosis and atherosclerosis, DVT Etiology of Peripheral Vascular Disease - CORRECT ANSWER Diabetes Hypertension Smoking Primary assessment of Peripheral Vascular Disease - CORRECT ANSWER Different kinds and degrees of OVD are characterized by a variety of signs and symptoms, such as numbness, pain, pallor, elevated blood pressure impaired arterial pulsation Treatment and management of Peripheral Vascular Disease - CORRECT ANSWER Treatment of severe cases met require amputation of gangrenous body parts Less severe peripheral vascular problems may be treated by elimination of contributing factors, especially cigarette smoking, and by the administration of various drugs, such as salicylates and anticoagulants