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CCRN > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Factors that shift Oxyhemoglobin dissociation curve

A

PCO2, pH, 2,3 Diphosphoglycerate(DPG), body temp

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2
Q

Reasons for pleural friction rub

A

Pleurisy, pulmonary infarction

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3
Q

PO2 60 = sao2 of ?

A

90…on a NORMAL dissociation curve

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4
Q

Factors that shift oxyhemoglobin curve to right

A

Acidosis, hyperthermia, increased 2,3 DPG, increased H+, increased pCO2

Decreased affinity for O2

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5
Q

Factors that shift oxyhemoglobin curve to left

A

Hypothermia, alkalosis, decreased 2,3 DPG, decreased H+, CO, decreased CO2

Increased affinity for O2

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6
Q

Dalton Law of Partial Pressures

A

Partial pressures cannot add up to more than atmospheric pressure. ie if 760mmHg max and pCO2 is high there is less room for pO2 and it must be decreased

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7
Q

A:a gradient

A

Reflection of the process of diffusion across the alveolar-capillary membrane. Calculated by subtracting PaO2(arterial) fromPAO2(alveolar)

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8
Q

CaO2

A

Total number of oxygen in arterial blood both bound and unbound to Hgb

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9
Q

Hypoventilation

A

PaCO2 >45. RR alone does not make up ventilation. RR plus TV

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10
Q

Expected SaO2 level for PaO2 of 40(normal curve)

A

75%

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11
Q

KussMaul breathing

A

Deep frequent breathing
Most commonly seen d/t DKA

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12
Q

Normal VO2I (oxygen consumption index)

A

150ml/min/m2

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13
Q

Dynamic compliance

A

Compliance of lung when air is moving
Static compliance plus airway resistance.
Ex: bronchospasm or mucous plug would decrease dynamic compliance

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14
Q

Salmeterol

A

Long acting bronchodilator contraindicated in acute asthma attack d/t delayed onset

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15
Q

IRV

A

Inverse ratio ventilation
Ie 2:1 instead of 1:2 etc
Need sedation and or paralytics to tolerate
Causes auto peep and can increase incidence of barotrauma as a result

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16
Q

Static compliance

A
  • Pressure it takes to overcome static resistance to ventilation
  • Evaluates compliance of lung and chest wall specifically during period of no air flow like during inspiratory pause
    Ex pneumothorax, ARDS, atelectasis would decrease static compliance
    Flail chest would increase it
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17
Q

Why mechanical ventilation makes patients prone to volume overload?

A
  • Water gained by cascade humidifier
  • stimulation of ADH caused by PEEP
  • simulation of RAAS d/t decreased in CO after initiated mechancial ventilation
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18
Q

DO2

A

Oxygen delivery
Normal is 1000ml/min2

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19
Q

State when compensation is least likely

A

Resp alkalosis

Many pts with COPD have compensation for their resp acidosis

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20
Q

Leading cause ARDS

A

Shock

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21
Q

Hyper-resonance to percussion

A

Indicates pneumothorax

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22
Q

Reasons for crackles

A

Pulm edema and atelectasis

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23
Q

Difference between laryngectomy tube and trach tube

A

No cuff
Food can only go into stomach with laryngectomy tube unless fistula forms

24
Q

Normal VO2I

A

150ml/min/m2

25
Q

ARF definition

A

PaO2 50-60
PCO2 >50
And pH <7.3 in COPD d/t chronic CO2 levels

26
Q

Three purposes of PEEP

A
  • increase driving pressure o2
  • decrease surface tension and WOB
  • decrease shunting. By reopening collapsed alveoli
27
Q

Rhonchi

A

Mucous or fluid in airway

28
Q

Vent factors in being able to cough

A

Negative Inspirator pressure and vital capacity

29
Q

Connection b/w resp alkalosis and tetany

A

Hyperventilation increases binding between Ca and albumin decreased ionized calcium. This causes tetany(tingling around mouth and fingertips) Correction is to reduce minute ventilation NOT give Ca

30
Q

Most definitive study for PE

A

Pulmonary arteriography

31
Q

Adverse effects specific to inhaled corticosteroids

A

Hoarseness and candidiasis

32
Q

Movement of oxygen across alveolar capillary membrane

A

External respiration

33
Q

Movement of air into and out of lungs

A

Ventilation

34
Q

Use of oxygen by mitochondria to produce adenosine triphosphate(ATP)

A

Internal respiration or cellular respiaration

35
Q

Delivery of blood to tissues

A

Perfusion

36
Q

2 major causes of alveolar collapse in ARDS

A

Lack of surfactant and pulm edema

37
Q

Auto PEEP

A

synonymous with IRV
Can increase PVR, risk of barotrauma and hypercapnia
Will not lead to hypoxia

38
Q

Respiratory/intrapulmonary shunt

A
  • More perfusion than ventilation
  • Ex ARDS pneumonia atelectasis
  • PEEP can be used to decrease shunting by reopening alveoli
  • Also caused by increase in perfusion not just decrease in ventilation
  • ie nitroprusside
39
Q

Alveolar dead space

A

More ventilation than perfusion
Ex PE, shock

40
Q

Early signs of oxygen toxicity

A

Substernal chest pain/distress, parasthesias in extremities, GI symptoms N/V fatigue mailaise, dyspnea, restlessness

41
Q

Late signs oxygen toxicity

A

Hypercapnia, cyanosis, decreasing compliance, increased A:a gradient, pulmonary edema

42
Q

Lab that should be monitored on nitric

A

Methoglobin levels

  • Normal level 1-2%, harmful 10%, obtunded >50%
  • Nitrates and nitrites can cause methoglobinemia which changes hgb to a form that can’t carry O2.
  • Treatment is methylene blue
  • causes decrease in sao2 despite normal po2
43
Q

VO2

A

Sao2 minus svo2
Consumption of o2 by tissues

44
Q

Normal water seal fluctuation on vent

A

Water down on inspiration and up on expiration

45
Q

Findings in atelectasis

A

Crackles, fever, hypoxemia

Dullness on percussion indicates PNA NOT atelectasis

46
Q

Sign of impending crisis in pneumothorax

A

Tracheal shift away from affect side and JVD

47
Q

Cromolyn sodium

A

Inhaled to prevent degranulation of epithelial mast cells that cause release of histamine. It’s prophylactic and won’t help with acute asthma attack

48
Q

Ipratropium bromide

A

Bronchodilator used to reduce risk of bronchospasm in pts with COPD primarily

49
Q

Metaproterenol

A

Bronchodilator used for asthma and bronchospasm

50
Q

Heimlich valve

A

Discharge home with chest tube so no need for water seal

51
Q

ARDS diagnostic criteria

A

P/F <200

52
Q

Xanthine

A

Treats bronchospasm but not first line for asthma cause it takes longer to work

53
Q

Altering ph of stomach with H2 blockers can cause what?

A

PNA!
Any ph >4 puts you at risk for PNA

54
Q

Effect of MTP on oxyhgb curve

A

Shift left and less release of oxygen to tissue d/t decreased 2,3 dpg in transfused blood…and maybe hypothermia

55
Q

Needed to calculate static compliance

A

Plateau pressure
Reflects pressure in the lungs

56
Q

Used to calculate dynamic compliance

A

Peak inspiratory pressure

57
Q

Goal of vent support for status asthmaticus

A

Decrease air trapping
Don’t have massive tidal volumes
Prolong expiration…can be done with low RR
decrease PEEP and risk of autopeep by avoiding IRV modes

CCRN (9 decks)

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