Clinical Simulation Exam 329 Questions with Verified Answers
COPD - CORRECT ANSWER Preventable and treatable disease state characterized by air flow
... [Show More] limitation that is not fully reversible.
Emphysema - CORRECT ANSWER Presence of permanent enlargement of the air spaces distal to the terminal bronchioles, accompanied by destruction of their walls and without obvious fibroisis
Chronic bronchitis - CORRECT ANSWER Chronic productive cough for three months in each of two successive years in a pt for whom other causes of the productive cough have been excluded
Etiology of COPD - CORRECT ANSWER - tobacco smoke
-genetic predisposition
- indoor and outdoor pollution
Pt Assessment of Emphysema Pt (Primary assessment) - CORRECT ANSWER AKA pink puffer or Type A COPD
Body build = thin, underweight
Past medical history = Tobacco use
Cough = Less common, muciod secretions
Appearance of chest = Barrel chest, increased A-P diameter (Hoover's Sign)
Respiratory Pattern = Dyspnea, pursed-lip breathing, accessory muscle use, especially during exacerbations
Color= Often reddish
Clubbing = Late stage
Diagnostic Chest Percussion = Hyperresonant/ Tympanic note
Breath Sounds = Diminished, prolonged expiration
Body build of Type A COPD (pink puffer) Emphysema - CORRECT ANSWER Thin, underweight
Past medical history for emphysema pts - CORRECT ANSWER Tobacco use
Cough (Emphysema) - CORRECT ANSWER Less common, muciod secretions
Appearance of the chest (Emphysema) - CORRECT ANSWER Barrel chest, increased A-P diameter
Respiratory pattern ( Emphysema) - CORRECT ANSWER Dyspnea, pursed lip breathing, accessory muscle use, especially during exacerbations
Color (Emphysema) - CORRECT ANSWER Often reddish
Clubbing (Emphysema) - CORRECT ANSWER Late stage
Diagnostic Chet Percussion (Emphysema) - CORRECT ANSWER Hyperresonant/tympanic note
Breath sounds ( Emphysema) - CORRECT ANSWER Diminished, prolonged expiration
Patient Assessment (Primary) Chronic Bronchitis - CORRECT ANSWER AKA Blue bloater Type B COPD
Body build = Stocky, overweight
Past Medical History = Tobacco use
Cough = Productive, copious amounts, purulent secretions
Chest Appearance = Ocassionally barrel chest
Color = Cyanotic
Clubbing = Common
Diagnostic Chest Percussion = normal
Breath Sounds = Rhonchi, crackles , wheezing
Body build (Chronic Bronchitis) - CORRECT ANSWER Stocky, overweight
Past Medical History (Chronic Bronchitis) - CORRECT ANSWER Tobacco use
Cough (Chronic Bronchitis ) - CORRECT ANSWER Productive, copious amounts of purulent secretions
Chest Appearance (Chronic Bronchitis) - CORRECT ANSWER Occasionally barrel chest
Respiratory Pattern (Chronic Bronchitis ) - CORRECT ANSWER Use of accessory muscles less common
Clubbing ( Chronic Bronchitis ) - CORRECT ANSWER Common
Diagnostic Chest Percussion ( Chronic Bronchitis) - CORRECT ANSWER Normal
Breath Sounds (Chronic Bronchitis ) - CORRECT ANSWER Rhonchi, crackles, wheezing
Secondary Assessment Emphysema pt - CORRECT ANSWER Chest X-ray = translucent (dark) lung fields, depressed or flattened diaphragms, long and narrow heart, increased retrosternal air spaces, possibly hypertrophy or right ventricle
ABG = Mild to moderate stages: Acute alveolar hyperventilation with hypoxemia Severe Stages: Chronic ventilatory failure with hypoxemia
Pulmonary Function = Decreased flowrates (FEV1 , FEF 25-75%, FEF 200-1200, FEV1/FVC, and PEFR) Decreased DLCO
CBC = Increased RBC/Hb/Hct in late stages
Sputum = Normal
Chest X-ray (Emphysema ) - CORRECT ANSWER Translucent (dark) lung fields, depressed or flattened diaphragms, long and narrow heart, increased retrosternal air space, possibly hypertrophy or right ventricle
ABG (emphysema) - CORRECT ANSWER Mild to moderate stages: Acute alveolar hyperventilation with hypoxemia Severe stage: Chronic ventilatory failure with hypoxemia
Pulmonary Function (Emphysema ) - CORRECT ANSWER Decreased flowrates, Decreased DLCO
CBC (Emphysema) - CORRECT ANSWER Increased RBC/Hct/Hb in late stages
Sputum (Emphysema) - CORRECT ANSWER Normal
Secondary Assessment Chronic Bronchitis - CORRECT ANSWER AKA Type B Blue Bloater
Chest X-ray = translucent (dark) lung fields, depressed or flattened diaphragms, possibly hypertrophy of right ventricle
ABG = Mild to moderate stages: Acute alveolar hyperventilation with hypoxemia
Severe stage: Chronic ventilatory failure with hypoxemia
Pulmonary Function = Decreased flowrates, DLCO normal
CBC = increased RBC/Hb/Hct in early and late stages
Sputum = Often shows ; Streptococcus pneumoniae, Haemophilus influenza, Moraxella catarrhalis
Chest X-ray (Chronic Bronchitis) - CORRECT ANSWER Translucent lung fields, depressed or flattened diaphragms, possibly hypertrophy of the right ventricle
ABG ( Chronic Bronchitis) - CORRECT ANSWER Mild to moderate stages: Acute alveolar hyperventilation with hypoxemia
Severe stage: Chronic ventilatory failure with hypoxemia
Pulmonary Function ( Chronic Bronchitis ) - CORRECT ANSWER Decreased flowrates, normal DLCO
CBC (Chronic Bronchitis) - CORRECT ANSWER Increased RBC/Hb/Hct in early and late stages
Sputum (Chronic Bronchitis ) - CORRECT ANSWER Often shows: Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis
Treatment for COPD - CORRECT ANSWER 1. Low flow o2 therapy
Nasal cannula 1-2 L/min or 24-28% air entrainment mask
Consider o2 conservation devices for home use
2. Bronchodilators (SABA, LABA, and anticholinergic)
3. Inhaled corticosteroids
4. Antibiotics if indicated by sputum culture
5. Bronchial hygiene as indicted
6. Referral to smoking cessation program, including nicotine replacement therapy
7. Consider NPPV for acute exacerbations of ventilatory failure
8. Refer pt family to pulmonary rehab ed programs which should include
-Nutritional management
- Avoiding infections
-Exercise program
- Methods to aid in secretion clearance
-Home O2 and aerosol therapy
-Appropriate use of medications
9. Annual flu vaccine
Bronchiectasis (definition ) - CORRECT ANSWER Chronic dilation and distortion one of one or more bronchi as a result of excessive inflammation and destruction of the bronchial walls, blood vessels, elastic tissue and smooth muscle. Results in impaired mucocilary clearance causing accumulation of copious amounts of bronchial secretions
-one or both lungs may be involved
-Commonly limited to lobe or segment
- Frequently found in lower lobes
-Can create an obstructive or restrictive pattern or a combination of both
Patient Assessment (Primary) for Bronchiectasis pt - CORRECT ANSWER Past Medical History = Recurrent pulmonary infections, Cystic Fibrosis, if Kartageners Syndrome
Shortness of Breath = Present, possibly pursed lip breathing
Cough = Productive with purulent foul smelling sputum, hemoptysis and 3 layer sputum, may be blood streaked
Appearance of chest = Barrel chest, increased A-P diameter
Respiratory Pattern = Accessory muscle usage
Color = Cyanotic
Appearance of the nail beds = clubbing
Diagnostic Chest Percussion = Hyperresonant/tympanic note
Breath Sounds = Wheezing, diminished breath sounds
Past Medical History ( Bronchiectasis) - CORRECT ANSWER Recurrent pulmonary infections, Cystic Fibrosis, or Kartageners Syndrome
Shortness of Breath (Bronchiectasis ) - CORRECT ANSWER Present, possibly pursed lip breathing
Cough ( Bronchiectasis ) - CORRECT ANSWER Productive with purulent foul smelling sputum, hemoptysis and 3 layer sputum, may be blood streaked
Appearance of chest (Bronchiectasis ) - CORRECT ANSWER Barrel chest, increased A-P diameter
Respiratory Pattern ( Bronchiectasis ) - CORRECT ANSWER Accessory muscle usage
Color ( Bronchiectasis ) - CORRECT ANSWER Cyanotic
Appearance if the Nail Beds (Bronchiectasis ) - CORRECT ANSWER Clubbing
Diagnostic Chest Percussion ( Bronchiectasis ) - CORRECT ANSWER Hyperresonant/tympanic note
Breath Sounds ( Bronchiectasis ) - CORRECT ANSWER Wheezing, diminished breath sounds
Patient Assessment ( Secondary) Bronchiectasis - CORRECT ANSWER Chest X-ray = hyperlucent lung fields, depressed or flattened diaphragm, enlarged or elongated heart
ABG= mild to moderate : Acute alveolar hyperventilation with hypoxemia Severe: Chronic ventilatory failure with hypoxemia
Pulmonary Function = Deceased flowrates
CBC = increased RBC/Hb/Hct
Sputum = May indicate infection
Special Diagnostic Tests = CT scan - Increased bronchial wall opacity. Characteristic appearance of end on signet ring opacity
chest X-ray (Bronchiectasis ) - CORRECT ANSWER Hyperlucent lung fields, depressed or flattened diaphragm, enlarged or elongated heart
ABG ( Bronchiectasis ) - CORRECT ANSWER Mild to moderate : acute alveolar hyperventilation with hypoxemia
Severe : Chronic ventilatory failure with hypoxemia
Pulmonary Function ( Bronchiectasis ) - CORRECT ANSWER Decreased flowrates
CBC ( Bronchiectasis ) - CORRECT ANSWER Increased RBC/Hb/Hct
Sputum (Bronchiectasis ) - CORRECT ANSWER May indicate infection
Special Diagnostic Tests ( Bronchiectasis ) - CORRECT ANSWER CT scan - Increased bronchial wall opacity. Characteristic appearance of end on signet ring opacity
Treatment for Bronchiectasis - CORRECT ANSWER 1. Bronchopulmonary hygiene
2. Lung expansion therapy
3. antibiotics for infection
4. Expectorants
5. Aerosolized medications
-Sympathomimetic agents
-Parasympatholytic agents
6. Surgical resection of involved segments if necessary
7. Oxygen for hypoxemia
8. Mechanical ventilation for reversible acute ventilatory failure
9. Childhood vaccines, yearly flu vaccines
10. Avoid triggers:
- Upper respiratory infections
-Smoking
-Polluted environments
Chest Trauma definition - CORRECT ANSWER Any type of trauma to the chest wall
Flail Chest definition - CORRECT ANSWER The result of double fractures of at least three or more adjacent ribs, causing the thoracic cage to become unstable (flail)
Etiology of Chest trauma or flail chest - CORRECT ANSWER -industrial accidents
-vehicle accidents
-falls
-Violence
-Blast injury
Pt assessment (Primary) Chest Trauma/Flail Chest - CORRECT ANSWER Past Medical History = History of injury
Cough = Possibly hemoptysis
Appearance of Chest = Bruising over area involved
Respiratory Pattern = Paradoxical chest movement - flail chest. Shallow rapid respirations, severe chest pain
Color = Cyanotic
Breath Sounds = Diminished over the affected area
Vital Signs = Elevated heart rate and blood pressure
Past Medical History ( Chest Trauma) - CORRECT ANSWER History of injury
Cough ( Chest Trauma) - CORRECT ANSWER Possibly hemoptysis
Appearance of chest ( Chest Trauma ) - CORRECT ANSWER Paradoxical chest movement - flail chest Shallow rapid respirations, severe chest pain
Color ( Chest Trauma ) - CORRECT ANSWER Cyanotic
Breath Sounds (Chest Trauma) - CORRECT ANSWER Diminished Sounds over the affected area
Vital Signs (Chest trauma) - CORRECT ANSWER Elevated heart rate and blood pressure
Pt assessment (secondary) chest trauma/flail chest - CORRECT ANSWER Chest X-ray = increased opacity from lung compression, rib fractures
ABG = Acute alveolar hyperventilation with hypoxemia
Pulmonary Function = Decreased volumes and capacities
Chest X-ray (chest trauma ) - CORRECT ANSWER Increased opacity from lung compression, rib fractures
ABG= Acute alveolar hyperventilation with hypoxemia - CORRECT ANSWER Pulmonary Function = decreased volumes and capacities
Treatment for chest trauma/flail chest - CORRECT ANSWER - O2 therapy for hypoxemia
-Analgesics
- Hyperinflation therapy
-Mechanical Ventilation with PEEP or severe cases
-Severe cases may require surgical stabilization of the chest wall
-Brochoplumonary hygiene
-Prevention of PNA
Pneumothorax definition - CORRECT ANSWER Gar or free air accumulated in the pleural space
Pt assessment (Primary) pneumothorax - CORRECT ANSWER Past medical history = severe chest pain
Appearance of the chest = Tracheal and/or mediastinal shift away from the affected side, increased volume on the affected side, bruising over the effected side
Color = cyanotic
Diagnostic Chest Percussion = Hyperresonant /tympanic note
-Breath sounds = Diminished or absent on affected side
-vital signs = Small pneumo: Tachycardia, hypertension
large pneumo: Bradycardia, hypotension
Past medical history ( Pneumothorax) - CORRECT ANSWER Severe chest pain
Appearance of Chest (Pneumothorax) - CORRECT ANSWER Tracheal and/or mediastinal shift away from affected side, increased volume on affected side, bruising over the affected area
Respiratory Pattern ( Pneumothorax) - CORRECT ANSWER Tachypnea, reduced movement on affected side
Color ( pneumothorax) - CORRECT ANSWER Cyanotic
Diagnostic Chest Percussion (pneumothorax) - CORRECT ANSWER Hyperresonant / tympanic note
Breath Sounds ( Pneumothorax) - CORRECT ANSWER Diminished or absent on affected side
Vital signs (Pneumothorax ) - CORRECT ANSWER Small pneumothorax: Tachycardia, hypertension
Large pneumothorax: Bradycardia, hypotension
Pt assessment (Secondary) Pneumothorax - CORRECT ANSWER Chest X-ray = hyperlucency with absence of vascular markings on the affected side, tracheal shift to the unaffected side, depressed diaphragm, lung collapse
Treatment for pneumothorax - CORRECT ANSWER -Small pneumo may only reaffirm bed rest and limited physical activity. Absorption usually occurs within 30 days.
-Large pneumo should be evacuated by chest tube
-Needle aspiration of the chest necessary if patient is unstable (bradycardia, hypotension, cyanosis, etc)
-Oxygen for hypoxemia
-Hyperinflation therapy after chest tube insertion
-Mechanical ventilation with PEEP for acute ventilatory failure
Hemothorax definition - CORRECT ANSWER Blood accumulated in the plural space
Etiology of a hemothorax - CORRECT ANSWER traumatic - obvious injury
Pt assessment (Primary) Hemothoarx - CORRECT ANSWER Past Medical History = Severe chest pain
Vital Signs = Elevated heart rate and blood pressure
Cough = Productive cough (hemoptysis)
Appearance of the chest = Tracheal and/or mediastinal shift away from the affected side,bruising over the affected area
Respiratory Pattern = Tachypnea, Dyspnea depending on severity
Color= Cyanotic
Diagnostic Chest Percussion = Flat/full percussion note, decreased tactile and vocal free iTunes
Breath sounds = Diminished or absent of the affected side, possibly pleural friction rub
Pt assessment (Secondary) Hemothorax - CORRECT ANSWER Chest X-ray = increased radio density, tracheal shift away from affected side
ABG= Acute alveolar hyperventilation with hypoxemia
CBC= Reduced RBC/Hb/Hct
Treatment for Hemothorax - CORRECT ANSWER -Thoracentesis or chest tube to drain blood
-Oxygen for hypoxemia
-Hyperinflation therapy after chest tube insertion
-Mechanical Ventilation with PEEP for acute ventilatory failure
Thermal Injuries definition - CORRECT ANSWER The inhalation of smoke and hot gases often accompanied by body surface burns
-May lead to complete airway obstruction. Should be suspected in the presence of any type of fire
Etiology of thermal injury - CORRECT ANSWER -Fire victims
-Firefighters
-Inhalation of car exhaust
Pt assessment (Primary) thermal injury - CORRECT ANSWER Past medical history = Fireman or pts pulled from a burning building, pts found sitting in garage with car running, trash fires
Shortness of breath = May be present
Cough = Excessive thick, black, sooty secretions
Respiratory Pattern = Tachypnea
Color = Cyanosis, Cherry Red (suspect CO poisoning )
Level of consciousness = Alert, may be confused, unresponsive
Breath Sounds = Normal in early stages, may present with wheezing, crackles, or rhonchi, inspiratory stridor may indicate airway obstruction
Physical appearance = Anxious, surface burns, singed facial hair, clack soot marks, obvious pharyngeal swelling and edema, hoarseness , altered voice, dysphasia
Vital Signs = Increased HR , BP, QT, pulse oximetry not accurate if CO poisoning present
Past medical history - thermal injury - CORRECT ANSWER Fireman or pts pulled for a burning building, pts found sitting in garage with the car running, trash fires
Shortness in breath - thermal injuires - CORRECT ANSWER May be present
Cough - thermal injury - CORRECT ANSWER Excessive thick, black, sooty secretions
Respiratory Pattern - thermal injury - CORRECT ANSWER Tachypnea
Color - thermal injury - CORRECT ANSWER Cyanosis, cherry red = suspect CO poisoning
Level of Consciousness - thermal injury - CORRECT ANSWER Alert, may be confused, unresponsive
Breath Sounds - thermal injury - CORRECT ANSWER Normal in early stages, may present with wheezing, crackles, or rhonchi, inspiratory stridor may indicate airway obstruction
Physical Appearance - thermal injury - CORRECT ANSWER Anxious, surface burns, singed facial hair, black soot marks, obvious pharyngeal swelling, and edema, hoarseness, altered voice and dysphagia
Vital signs - thermal injury - CORRECT ANSWER Increased HR,BP, QT, Sp02 not accurate if CO poisoning is present
Secondary Pt Assessment - thermal injury - CORRECT ANSWER Chest X-ray = normal in early stages, pulmonary edema/ARDS late stages
ABG= Acute hyperventilation with hypoxemia
Pulmonary Function = Decreased volumes and flowrates and decreased DLCO
Special Tests = CoHb Levels measured by co-oximetry
Chest X-ray - thermal injury - CORRECT ANSWER Normal in early stages
Pulmonary edema/ARDS in late stages
ABG - thermal injury - CORRECT ANSWER Acute alveolar hyperventilation with hypoxemia
Pulmonary Function - thermal injury - CORRECT ANSWER Decreased volumes and flowrates, decreased DLCO
Special Tests - Thermal injury - CORRECT ANSWER COHb levels ensured by co-oximeter
Treatment for thermal injury - CORRECT ANSWER -Immediate assessment of the pts airway and respiratory and cardiovascular status
Elective intubation should be performed for the pts who have inhaled hot gases or demonstrate signs of impending upper airway obstruction (marked or severe distress/stridor)
-O2 therapy at 100%
-Hyperbaric O2 therapy for CO poisoning (if available)
-Evaluate depth and percent of burns
-Immediate insertion of an IV line
-Isolation room
-Monitor ABG, electrolytes, and fluid levels
-Monitor for signs of infection
-Bronchoscopyto clear airways of mucus plugs and evaluation of the upper airways
-Mechanical ventilation for ventilatory failure
-Pulmonary hygiene
-hyperinflation therapy
-Aerolsolized medications
1. Bronchodilators
2. Mucolytics
3. Anti-inflammatory agents
ARDS definition - CORRECT ANSWER An illness or injury to the lungs that results in reduced lung compliance and refactory hypoxemia
Etiology of ARDS - CORRECT ANSWER -Aspiration
-Trauma
-Drug overdose
-Fluid overload
-Inhalation of toxins and irritants
-shock
Primary pt assessment - ARDS - CORRECT ANSWER Past medical history = Aspiration , trauma, drug overdose, fluid overload, inhalation of toxins and irritants, shock
Cough = Non productive
Respiratory Pattern = Tachypnea, substernal and/or intercostal retractions
Color = Cyanotic
Diagnostic Chest Percussion = Flat/dull note
Breath Sounds = Bronchial, crackles
Vital Signs = Tachycardia, hypertension
Past Medical History - ARDS - CORRECT ANSWER Aspiration , trauma, drug overdose, fluid overload, inhalation of toxins and irritants, shock
Cough - ARDS - CORRECT ANSWER Non productive
Respiratory Pattern- ARDS - CORRECT ANSWER Tachypnea, substernal and/or intercostal retractions
Color - ARDS - CORRECT ANSWER Cyanotic
Diagnostic Chest Percussion - ARDS - CORRECT ANSWER Flat/dull notes
Breath Sounds - ARDS - CORRECT ANSWER Bronchial, crackles
Vital Signs - ARDS - CORRECT ANSWER Tachycardia, hypertension
Secondary pt assessment - ARDS - CORRECT ANSWER Chest X-ray =diffuse alveolar infiltrates with a honeycomb or ground glass appearance, radiopacity
ABG = Refractory hypoxemia acute alveolar hyperventilation with hypoxemia
Pulmonary Function = Decreased volumes and capacities
Sputum. = May indicate infection
Special Tests = Hemodynamic monitoring reveals elevated PAP with normal PCWP
ABG - ARDS - CORRECT ANSWER Refractory hypoxemia acute alveolar hyperventilation with hypoxemia
Pulmonary Function - ARDS - CORRECT ANSWER Decreased volumes and capacities
Sputum - ARDS - CORRECT ANSWER May indicate infection
Special Tests - ARDS - CORRECT ANSWER Hemodynamic monitoring reveals elevated PAP with normal PCWP
Treatment for ARDS - CORRECT ANSWER -Treat underlying cause
-O2 therapy
1. Increase Fio2 as high as .60, then add CPAP/PEEP
2. When pt improves, titrate Fi02 to below .60 the reduce CPAP/PEEP
-Closely monitor hemodynamics
-Hyperinflation therapy for atelectasis
-Implement ARDSnet ventilator protocol
1. Reduce Vt to 6ml/kg
2. Maintain plateau pressure < 30 cm H20
3. Recruitment maneuvers
- Consider alternative modes of ventilation
1. Inverse Ratio Ventilation
2. Airway Pressure Release Ventilation
3. Pressure Regulated Volume Control
4. High Frequency Ventilation
5. Permissive hypercapnia
6. Pulmonary vasodilator
-Consider prone positioning to improve oxygenation
Neurologic/Neuromuscular Conditions - CORRECT ANSWER -Myasthenia Gravis
-Guilain-Barre Syndrome
-Drug Ovedose
-Stroke, Cerebral Infarction, Cerebrovascular Accident, Transient Ischemic Attack
-ALS
What to monitor to watch for ventilatory failure nuero pts? - CORRECT ANSWER Spontaneous Vt
VC
MIP
If values fall below acceptable level, institute mechanical ventilation
Myasthenia Gravis definition - CORRECT ANSWER Chronic disorder of the neuromuscular junction that interferes with chemical transmission of acetylcholine
A descending paralysis that moves from Mind to ground
Etiology of Myasthenia Gravis - CORRECT ANSWER Related to circulating antibodies of the autoimmune system.
Clincal manifestations are provoked by:
Emotional Stress
Physical stress
Exposure to extreme temp changes
Pregnancy
Febrile illness
Primary patient assessment for Myasthenia Gravis - CORRECT ANSWER Past medical history = Gradual onset of weakness, may have previous admissions of Myasthenia Gravis
Physical Appearance = General weakness that improves with rest, drooping eyelids (ptosis), double vision (diplopia), difficulty swallowing (dysphagia)
Respiratory Pattern = Shallow breathing
Breath Sounds = diminished
Past Medical history - Myasthenia Gravis - CORRECT ANSWER Gradual onset of weakness, may have previous admissions for Myasthenia Gravis
Physical Appearance - Myasthenia Gravis - CORRECT ANSWER General weakness that improves with rest, ptosis, diplopia, dysphagia
Respiratory Pattern - Myasthenia Gravis - CORRECT ANSWER Shallow Breathing
Breath Sounds - Myasthenia Gravis - CORRECT ANSWER Diminished
Secondary Assessment - Myasthenia Gravis - CORRECT ANSWER Special testing = Edrophonium (Tenslion) Challange, Electromyography, Blood test for Ach Receptor Antibodies, Ice Pack test
Spontaneous Ventilatory Parameters = Decreasing Vt, VC, MIP
ABG = Acute ventilatory failure with hypoxemia. What for vent failure (PaCo2 >45 torr)
Pulmonary Function = Reduced volumes
Special testing - Myasthenia Gravis - CORRECT ANSWER Edrophonim (Tenslion) Challange, Electromyography, Blood test for Ach Receptor Antibodies, Ice pack test
Spontaneous Vent Parameters - Myasthenia Gravis - CORRECT ANSWER Decreasing Vt, VC, MIP
ABG - Myasthenia Gravis - CORRECT ANSWER Acute vent failure with hypoxemia. Watch for vent failure PaCo2 of >45 torr.
Pumonary Function Myastenia Gravis - CORRECT ANSWER Reduced volumes
Edrophonium (Tensilon ) Challenge - CORRECT ANSWER Test to diagnose and monitor Myasthenia Gravis
If VC, Vt, MIP and weakness improves:
-Referred to as Myasthenic Crisis, indicating more of this type of drug needs to be given
If VC, Vt, MIP and weakness worsen:
-Referred to as a Cholinergic crisis, indicating too much of the drug has been given
Give atropine to relieve symptoms of cholinergic crisis
Treatment for Myasthenia Gravis - CORRECT ANSWER -Closely monitor Vt, VC, MIP
Incubate and institute mechanical ventilation when indicated
-Bedrest restriction and soft diet to reduce symptoms
-Oxygen therapy for hypoxemia
-Pulmonary hygiene
-Other treatment modalities:
Corticosteroids in severe cases
Thymectomy
Plasmapheresis
Guillain-Barré syndrome definition - CORRECT ANSWER Rare autoimmune disorder of the peripheral nervous system, Most likely an immune disorder that causes inflammation and deterioration of the pts peripheral nervous system
-Ground to brain
Etiology of Gillian-Barre Syndrome - CORRECT ANSWER Precise cause is unknown
Onset frequently occurs 1-4 weeks after a febrile illness caused by a mild respiratory or gastrointestinal viral or bacterial infection
Primary assessment for Guillian Barre Syndrome - CORRECT ANSWER Past medical history = Febrile illness, often viral in nature
Physical appearance = Acute weakness, especially in the legs
Respiratory Pattern = Shallow breathing
Breath Sounds = Dimished with crackles and rhonchi
Past medical history - Guillain-Barre Syndrome - CORRECT ANSWER Febrile illness, often viral in nature
Physical Appearance - Guillain-Barre Syndrome - CORRECT ANSWER Acute weakness, especially in the legs
Respiratory Pattern - Guillain-Barre - CORRECT ANSWER Shallow breathing
Breath Sounds - Guillain Barre - CORRECT ANSWER Diminished with crackles and rhonchi
Secondary Assessment - Guillain Barre Syndrome - CORRECT ANSWER Spontaneous ventilatory Parameters = Decreasing Vt, MIP, VC
ABG = Acute ventilatory failure with hypoxemia, watch for vent failure (PaCo2 >45 torr)
Pulmonary Function = Reduced volumes
Special Tests = Lumbar puncture - high protein level in CSF, electromyography, elevated IgM levels
Spontaneous vent parameters - Guillain Barre - CORRECT ANSWER Decreasing Vt, VC, and MIP
ABG - Guillain Barre - CORRECT ANSWER Acute vent failure with hypoxemia, watch for vent failure (PaCo2 >45 torr)
Pulmonary Function - Guillain Barre - CORRECT ANSWER Reduced volumes
Special Tests - Guillain Barre - CORRECT ANSWER Lumbar puncture
Abnormal electromyography
elevated IgM levels
Treatment for Guillain Barre - CORRECT ANSWER -Directed at stabilization of vital signs and supportive care
-Initially pts should be carefully monitored and manged in the ICU
-Closely monitor Vt, VC, MIP
Intubate and institute mechanical ventilation
when indicated
-O2 therapy for hypoxemia
-Hyperinflation therapy
-Pulmonary hygiene
-Plasmapheresis
-Other treatment modalities: Anti-coagulant therapy, physical therapy, corticorsteriods
Drug Overdose definition - 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 (depression, addiction)
Primary Assessment of drug overdose - CORRECT ANSWER Past medical History = Previous admissions for overdose, found by family, friends, ect
Respiratory pattern = slow, shallow respirations
Physical Appearance = Altered level of consciousness
Breath Sounds = Diminished throughout
Past medical history - drug overdose - CORRECT ANSWER previous admissions for overdose
Respiratory pattern - drug overdose - CORRECT ANSWER shallow, slow
Physical appearance - drug overdose - CORRECT ANSWER Altered level of consciousness
Breath Sounds - drug over dose - CORRECT ANSWER diminished throughout
Secondary assessment for drug overdose - CORRECT ANSWER drug toxicology
Monitor results of basic laboratory testing
Treatment for drug overdose - CORRECT ANSWER Placement of an artificial airway is the first priority
Mechanical ventilation for vent failure
Naloxone (Narcan) used to reverse narcotic overdose
Acetylcsteine used for acetaminophen overdose
Stroke/Cerebral Infarction/Cerebrovascular Accident (CVA)/Transient Attack (TIA) definition - CORRECT ANSWER A portion of the brain loses blood supply as a result of a vascular occlusion or hemorrhage
Etiology - Stroke/Cerebral Infarction/Cerebrovascular Accident (CVA)/Transient Attack (TIA) definition - CORRECT ANSWER Cerebral thrombi or emboli
Atherosclerosis
Hypertension
Primary Pt Assessment - Stroke/Cerebral Infarction/Cerebrovascular Accident (CVA)/Transient Attack (TIA) definition - CORRECT ANSWER Past medical history = Cerebral thrombi or emboli
Atherosclerosis
Hypertension
Respiratory Pattern = Cheyne Stokes
Physical Appearance = Motor and speech loss
Secondary pt assessment - Stroke/Cerebral Infarction/Cerebrovascular Accident (CVA)/Transient Attack (TIA) definition - CORRECT ANSWER Monitor results of basic lab testing
Special Tests = CT/MRI of the brain, cerebral angiogram
Intracranial Pressure monitor = ICP may be elevated
Treatment of Stroke/Cerebral Infarction/Cerebrovascular Accident (CVA)/Transient Attack (TIA) definition - CORRECT ANSWER -Treatment should be initiated within 6 hrs of symptom onset
-Drug therapy : Anticouagulation therapy, Vasodilators, Thrombolytic therapy (for acute ischemic stroke)
-Mechanical ventilation for vent failure or to reduce ICP
Polio/ALS/Muscular Dystrophy - CORRECT ANSWER Neuromuscular disorder that involve loss of voluntary muscle action
Etiology -Polio/ALS/Muscular Dystrophy - CORRECT ANSWER Viral infection (Polio)
Genetic disorder (muscular dystrophy )
Puncture wound (Tetanus/Botulism)
Primary Assessment for Polio/ALS/Muscular Dystrophy - CORRECT ANSWER Past Medical History = History of present illness, previous admission for disease
Current medications = Drug therapy for specific disease
Secondary Assessment for Polio/ALS/Muscular Dystrophy - CORRECT ANSWER ABG = Watch for vent failure
Spontaneous vent parameters = Decreasing Vt, VC, MIP
Treatment for Polio/ALS/Muscular Dystrophy - CORRECT ANSWER -Closely monitor Vt, VC, MIP
Intubate and institute mechanical vent as
indicated
-Drug therapy : Paralyzing agents to relax jaw for intubation and ventilation in case of tetanus/botulism
Chest Pain/Myocardial Infarction - 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: Interruption of coronary blood flow for an extended period of time causing irreversible damage to the heart muscle
Sudden cardiac death can occur in either pathology
The history of the current event is often the most significant finding
Etiology - Chest Pain/Myocardial Infarction - CORRECT ANSWER Heart disease
Hypertension
Thrombus
Primary Pt Assessment for Chest Pain/Myocardial Infarction - CORRECT ANSWER Past medical history = Chest pain, family & social history, history of the present illness.
Shortness of Breath = May be present
Respiratory pattern = May be tachypneic
Color = Possible cyanosis
Breath Sounds = Crackles if ventricular failure is present
Physical Appearance = Diaphoretic, anxious, nauseous
Vital Signs = Elevated blood pressure, pulse
Secondary Assessment Chest Pain/Myocardial Infarction - CORRECT ANSWER ABG = Hypoxemia
Electrolytes = Hyperkalemia or hypokalemia
Electrocardiogram = Arrhythmias with S-T segment changes and significant Q waves
Special Tests = Cardiac enzymes
Treatment for Chest Pain/Myocardial Infarction - CORRECT ANSWER Immediate O2 therapy at 100%
Closely monitor vital signs, SpO2, ECG
Drug therapy : Asprin, Anti-arrhythmic agents (amniodarone, procainamide, atropine), nitrates for chest pain, maintain blood pressure with fluid or vasopressors (dopamine), defibrillate for pulseless ventricular tachy or fibrilation.
CHF/Pulmonary Edema - CORRECT ANSWER CHF: Abnoraml condition that reflects impaired cardiac pumping
Pulmonary edmea: Excessive movement of fluid from the pulmonary vascular system to the extravascular system and air spaces of the lungs
Etiology - CHF - CORRECT ANSWER myocardial infarction
ischemic heart disease
cardiomyopathy [Show Less]