Exam 3 Part 5 RESP 132.txt

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MagusB81
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Exam 3 Part 5 RESP 132.txt
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2011-11-12 20:02:00
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Exam RESP 132
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Exam 3 Part 5
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  1. In about 40-40% of elderly patients, you may note an audible splintting of?
    the second heart sound(S2)
  2. This heart sound is indicative of ventricular disease in the elderly and can by auscultated in the same verticle line as S2, but about 2 inches lower at the fouth intecostal space. Can be the earliest markers of CHF.
    S3
  3. This sound can be heard best at the fifth intercostal space, midclavicular line, left side. is a sign of ventricular disease, as in the patient with CHF or recent MI
    S4
  4. Are swooshing sounds also described as sustained noised. most often the result of valvular heart disease and ca be caused by stenosis, regurgitation, or valvular incompetence.
    Heart murmurs
  5. A gain of more than ___ or more than _____ in a week may be fluid retention and could signal CHF.
    2 5
  6. A rapid onset of unilateral leg swelling and dependent edema suggest a diagnosis of?
    deep vein thrombosis
  7. is not always a reliable indicator or heart failure in the elderly.
    Peripheral edema
  8. Jugular venous distention is ver suggestive of?
    right heart failure
  9. During Auscultation of the elderly, _______, place the stethoscope on the patients skin, and listen for full I/E raito
    Start on the back
  10. Chest auscultation of an elderly patient can provide a quick and accurate assessment of his/her?
    Clinical condition
  11. Changes in closing volume and closing capacity affect?
    gas exchange.
  12. is the volume of gas in the lungs in excess of RV at end exhalation
    Closing volume.
  13. is simply closing volume added to RV. increases from about 30% of ttotal lung capacity at age 20 to about 50% of total lung capacity at age 70.
    Closing capacity
  14. PaO2 declines with?
    Age
  15. is repeated or continuous observations or measurements of the patient, his or her physiologic function, and the function of life support equipment, for the pupose of guiding management decisions, and interventions.
    Monitoring
  16. refers to the process of continuously evaluating the cardiopulmonary status of patients for the purpose of improving clinical outcomes.
    respiratory monitoring
  17. Changed in metabolism, lung mechanics, ventl efficiency, and equipment function will occur before changes are seen in the blood gases. So it is important to do what?
    monitor ventilatory parameters
  18. The ventilatory measurements that can be monitored at the bedside in the ICU include:
    Lung volumes/flows, airway pressures, fractional gas concentrations
  19. Norm. VT
    5-8 ml.kg IBW
  20. critical value for VT
    <4-5ml/kg or <300 ml
  21. Norm frequncey of breath
    12-24bpm
  22. crtical frequency of breath
    >30-35bpm
  23. Rapid shollow breathing index
    >105 w/o PS or CPAP
  24. dead space/VT ratio normal value
    0.25-0.40
  25. crtical value of deapspace/Vt ratio
    >.60
  26. Minute Vol. norm.
    5-6lpm
  27. crtical value for VE
    >10lpm
  28. Norm VC
    65-75ml/kg
  29. Crtical value of VC
    <10ml/kg
  30. Max. Inspiratory Pressure norm (Pimax)
    -80--100 cm H2O
  31. Critical value of Max Inspir. press. (Pimax)
    0-20 cm H2O
  32. is the p[rocess of moving gases between the atmosphere and the lung
    ventilation
  33. The four reasons why lung volumes are improtant to the clinician are:
    affect of gas exchange, rflect clinical status, indicate responce to therapy, and signal problem between patient and vent. interface.
  34. Intubated patients, patients being considered for or being weaned from mechanical vents, and patients with an abnormal breathing patter, and intubated patients should be monitored for what?
    Lung volumes
  35. Nonintubated patients: preoperative eval., adults w/ RR > 30bpm, w/ neuromuscular diseases, CNS depression, deteriorating blood gases, and patients recieveing noninvasive positive pressure vent. should be monitored for?
    lung volumes
  36. is defined as the volume of air inspired or passively exhaled in a normal respiratory cycle.
    Tidal Volume
  37. VT has two components:
    Alveolar volume VA and dead space volume VD
  38. portion of VT that effectively exchanges with alveolar-capillary blood
    VA
  39. the portion of VT that does not exchange with capillary blood
    VD
  40. VD is normal what percentage of VT
    25-40%
  41. The conductive airways and alveolar units that are ventilated but not perfused create the true or?
    physiological dead space.
  42. If VD increases to 60% the patient may need?
    Vent. Support
  43. how many sighs in an hour?
    6-10
  44. a VT less than 5ml/kg is?
    indication of resp. prob.
  45. Rapid and shollow breathing in a critically ill patient at rest may indicate?
    impending respiratory failure
  46. pneumonia, atelectasis, the postoperative period after chest and abdominal surgery, chest trauma, acute exacerbation of chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), pulmonary edema, acute restrictive diseases such as acute respiratory distress syndrome (ARDS), neuromuscular diseases, and CNS depression (especially of the respiratory centers) can cause?
    VT to be reduced
  47. may be seen with metabolic acidosis, sepsis, or severe neurologic injury.
    Larger than normal VT
  48. Patients receiving continuous mechanical ventilation (CMV) are routinely ventilated with VT of?
    10ml/kg
  49. The use of high-VT ventilation may predispose patients to _________, a lung injury that occurs from overdistention of the terminal respiratory units.
    Volutrauma
  50. often develops in nondependent lung regions and is a main reason why lung damage persists after recovery from severe protracted ARDS
    Volutrauma
  51. patients at risk for developing ARDS should be ventilated with mechanical VT of
    6-8 ml/kg
  52. A low measured VT can also be caused by �stacking� or _________, which is a problem seen with severe airway obstruction.
    dynamic hyperinflation
  53. The application of PEEP in combination with smaller VT maintains FRC and prevents the fall in?
    PaO2
  54. Montioring the VT of mechanically PT's is?
    crucial
  55. This creates higher peaks in airway pressure and barotrauma may result. TX w/ bronchodilators and decreasing VT may help resolve the problem
    stacking
  56. Setting the circuit to high pressure limit of 120cm H2O, Setting PEEP to 0 cm H2O, setting a VT of 100ml and dividing the resulting peak inspriatory pressure by 100 will determine what?
    the circuits compliance
  57. VT for mechanically ventilated PT's should be adjusted for clinical conditions. Some PT's, including those at risk for aor trapping and dynamic hyperinflation or ARDS, should be ventilated with a lower VT of?
    6-8 ml/kg
  58. When a PT is ready to be weaned from mech. vent, what should be attempted?
    Spontaneous breathing trial (SBT)
  59. The following criteria for SBT means what: 20% increase or decrease in BP or HR, SPO2 35bpm, change in mental status, accessory muscle use, or the onset of diaphoresis.
    Failure
  60. incorporates this spontaneous breathing rate change and measures the ratio of respiratory frequency (f) to VT. _______ = f (breaths/min)/VT (liters)
    Rapid-shallow breathing index (RSBI)
  61. RSBI values greater than 105 have been reported to be string prognostic indicators of?
    weaning failure
  62. Normal VE
    5-6lpm
  63. If a VE greater than 10lpm is needed for a mech. vent. PT to maintain normal PaCO2, weaning is?
    not possible. (less then it is okay)
  64. Normal VC for healthy people
    65-75ml/kg/IBW
  65. excellent measurment of vent. reserve in the cooperative PT. reflects the repiratory mescle strenth and volume capacity of the tung while the PT is performing a sustained maximal inpiratory or expiratory maneuver.
    VC
  66. VC can be measured two ways?
    FVC or SVC

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