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Adult Health I final > Exam 2 Pulmonary Part 1 > Flashcards

Exam 2 Pulmonary Part 1 Flashcards

1
Q

Steps of the Gas exchange process

A

Step 1: Ventilation
Step 2: Respiration
Step 3: Transport of Gases in the circulation

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2
Q

Ventilation definition/patho

A

The process of moving air between atmosphere & the lung alveoli and distributing air within the lungs to maintain appropriate concentrations of O2 and CO2 in the alveoli

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3
Q

Respiration definition/patho

A

The process by which alveolar air gases are moved across the alveolar-capillary membrane to the pulmonary capillary bed

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4
Q

Transport of Gases in the circulation definition/patho

A

Movement of oxygen and carbon dioxide to and from the tissue cells

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5
Q

Ventilation anatomy

A

-Lungs
(Lobes and mediastinum)

-Conducting airways
(Upper airways, Trachea, Bronchial tree)

  • Gas exchange airways
    (Bronchioles) and (Alveoli (Type I and II)
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6
Q

Ventilation/Perfusion (V/Q) normal ratio

A

0.8 (More pulmonary capillary perfusion than alveolar ventilation)

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7
Q

V/Q <0.8 means

A
  • A decrease in ventilation in relation to perfusion has occurred.
  • Similar to right to left shunt
  • More deoxygenated blood is returning to the left heart
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8
Q

V/Q >0.8

A
  • A decrease in perfusion in relation to ventilation

- pulmonary emboli, cardiogenic shock

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9
Q

Gas Transport mechanism

A
  • Dissolved in Plasma
    (PaO2 about 3%)
  • Bound to hemoglobin molecules
    (SaO2=oxygen saturation about 97%)

The total always equals 100%

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10
Q

A “Shift to the Right” on the Oxyhemoglobin Dissociation Curve means what?

A
  • Enhances oxygen delivery to the tissues
  • Hgb has less affinity for oxygen
  • Releases the O2 more Readily

“Think R in the words”

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11
Q

A “Shift to the RIght” on the Oxyhemoglobin Dissociation Curve etiology?

A
  • Reduced pH (acidosis)
  • hypeRcapneia (PCO2 increase)
  • feveR
  • IncRease levels of 2,3- diphosphglycerate (2,3-DPG)

“Think R in the words”

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12
Q

A “Shift to the Left” on the Oxyhemoglobin Dissociation Curve means what?

A
  • O2 not dissociated from Hemoglobing (Hgb) until tissue and capillary O2 are very low, decreasing O2 delivery to the tissues
  • Hemoglobin (HgB) has more affinity for oxygen
  • Hemoglobing (HgB) hoLds the O2 to itself

“Think L in the words”

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13
Q

A “Shift to the Left” on the Oxyhemoglobin Dissociation Curve etiology?

A
  • AlkaLosis (pH increase)
  • Low CO2
  • coLd
  • Low levels of 2,3-DPG
  • Increased Level of carbon monoxide poisoning

“Think L in the words”

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14
Q

Normal A-a Gradient?

A

Normal A-a gradient is 10-20 mm Hg, with the normal gradient increasing within this range as the patient ages

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15
Q

A-a Gradient specifics

A
  • Provides an index on the efficiency the lung is in equilibrating pulmonary capillary O2 & alveolar O2
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16
Q

PaO2/FiO2 normal value

A
  • Normal value is > 286

- Lower the number, the worse the lung function

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17
Q

Wide A-a gradient causes

A
  • Lung is the site of the dysfunction

ventilation-perfusion mismatching, shunting, diffusion abnormalities

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18
Q

What is Capnometry and Capnography?

A
  • Noninvasive
  • Measure amount of carbon dioxide present in exhaled air
    (Capnography is the sensing of exhaled CO2. Carbon dioxide is produced in the body as a by-product of metabolism and is eliminated by exhaling.)
  • By measuring exhaled CO2, many types of pulmonary assessments can be made.
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19
Q

What can cause the exhaled CO2 measured from the Capnometry and Capnography increase? Decrease?

A

Increase

  • Think respiratory failure
  • Increased work in breathing (trouble breathing)

Decrease

  • Think perfusion, metabolic or psychological problem
  • pulmonary embolism
  • Diabetic ketoacidosis (DKA)
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20
Q

Endoscopy/bronchoscopy specifics

A
  • Flexible or rigid
  • Visualize, biopsy, aspirate material
  • Sedation required
  • NPO ~ 8 hrs prior
  • Assess for return of cough & gag reflex before allowing pt to drink
  • Complications
    (Laryngospasm, pneumothorax, aspiration)
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21
Q

What is Thoracentesis

A

Aspiration of pleural fluid or air from pleural space

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22
Q

Thoracentesis procedure

A
  • Stinging sensation and feeling of pressure
  • Correct position (leaned over a table)
  • Motionless patient
  • Slow aspiration of fluid
    (Limit to 1000 mL typically)
  • Follow-up assessment for complications
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23
Q

Thoracentesis complications

A
  • Mediastinal shift
  • Pneumothorax
  • Bleeding
  • Infection
  • Subcutaneous emphysema
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24
Q

What is a lung biopsy

A
  • Invasive
  • Obtain tissue for histologic analysis, culture, cytologic examination
  • May be performed in patient’s room
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25
Lung biopsy follow-up care
- Assess vital signs, breath sounds at least every 4 hours for 24 hours - Assess for respiratory distress - Report reduced/absent breath sounds immediately - Monitor for hemoptysis
26
Blood pH normal range
7.35-7.45 <7.35 is acidosis >7.45 is alkalosis
27
blood PaCO2 normal range
35-45 mm Hg
28
Blood PaO2 normal range
80-100 mm Hg
29
Blood HCO3 normal range
21-28 mEq/L
30
When is it Metabolic acidosis
pH <7.35 HCO3 <21 pH goes does and HCO3 goes down
31
When is it Metabolic alkalosis
pH >7.45 HCO3 >28 pH goes up and HCO3 goes up
32
When is it Respiratory acidosis
pH< 7.35 PaCO2 >45 pH goes down and PaCO2 goes up
33
When is it Respiratory alkalosis
pH> 7.45 PaCO2 <35 pH goes up and PaCO2 goes down
34
Low-Flow Oxygen Delivery Systems
- Nasal cannula (1-6 L) - Facemask: 1. Simple 2. Partial rebreather 3. Non-rebreather
35
Nasal cannula specifics
- Flow rates of 1-6 L/min - O2 concentration of 24%-44% (1-6 L/min) - Flow rate >6 L/min does not increase O2 because anatomical dead space is full - Assess patency of nostrils - Assess for changes in respiratory rate and depth
36
Simple facemask specifics
- Delivers O2 up to 40%-60% - Minimum of 5 L/min - Mask fits securely over nose and mouth - Monitor closely for risk of aspiration
37
Partial Rebreather mask
- Provides 60%-75% with flow rate of 6-11 L/min - One-third exhaled tidal volume with each breath - Adjust flow rate to keep reservoir bag inflated
38
Non-rebreather mask
- Highest O2 level - Can deliver FIO2 greater than 90% - Used for unstable patients that may require intubation - Ensure valves are patent and functional
39
High-flow oxygen delivery systems
- Venturi mask (COPD patients/precise) - Face tent - Aerosol mask - Tracheostomy collar - T-piece
40
Venturi mask specifics
- Adaptor located between bottom of mask and O2 sources - Delivers precise O2 concentration—best source for chronic lung disease - Switch to nasal cannula during mealtimes
41
T-Piece specifics
- Delivers desired FIO2 for tracheostomy, laryngectomy, ET tubes - Ensures humidifier creates enough mist - Mist should be seen during inspiration and expiration
42
Noninvasive Positive-Pressure Ventilation (NPPV)
- Uses positive pressure to keep alveoli open, improve gas exchange without airway intubation - BiPAP - CPAP
43
CPAP specifics
- Delivers set positive airway pressure throughout each cycle of inhalation and exhalation - Opens collapsed alveoli - Used for atelectasis after surgery or cardiac-induced pulmonary edema; sleep apnea
44
High flow nasal cannula specifics
- Optiflow - Flow rate up to 60 L/min - Heated, vaporized air - FiO2 up to 100%
45
Transtracheal Oxygen Delivery (TTO)
- Long-term delivery of O2 directly into lungs - Small flexible catheter is passed into trachea through small incision - Avoids irritation that nasal prongs cause; is more comfortable - Flow rates prescribed for rest, activity
46
Trancheotomy
surgical incision into trachea for purpose of establishing an airway
47
Trancheotomy nursing care
- Prevention of tissue damage - Check cuff pressure often - Air must be humidified - Maintain proper temperature - Ensure adequate hydration - Assess the patient - Secure tracheostomy tubes in place
48
Endotracheal tube: Intubation procedure
- Correct placement Auscultate x5 Auscultate epigastric area Abdomen, anterior & laterally on each side - Inspect chest expansion - End-Tidal CO2 Detector - CXR is used to validate the depth of the ETT 3-4 cm above carina NOT too far down and into the right mainstem
49
Endotracheal tube: nursing care
- Check cuff pressure - Subjective: Monitor by touch ``` - Objective: Monitored every shift by RT 14 – 20 mmHg or 20-30cm H2O Minimal air leak technique Minimal occlusion volume technique Too high – tracheal damage Too low - aspiration around cuff leak ``` - Suction
50
Modes of ventilation: AC (assist control) or CMV (continuous mandatory ventilation)
- If pt initiates breath, machine delivers preset tidal volume for every breath
51
Modes of ventilation: PRVC, (a variation of CMV)
Pressure-Regulated Volume Control
52
Modes of ventilation: Combination of volume and pressure features
- Delivers a preset tidal volume using the lowest possible airway pressure - Airway pressure will not exceed preset maximum pressure limit - Used in patients with airway resistance or decreased lung compliance such as ARDS
53
Modes of ventilation: Bi-level positive airway pressure
- Pre-set inspiratory pressure | - Expiratory pressure Two levels (a range for positive end-expiratory pressure (from PEEPHigh to PEEPLow).)
54
Modes of ventilation: SIMV (Synchronous intermittent mandatory ventilation)
- If pt initiates breath, machine allows pt to breath in own Tidal Volume
55
Ventilator settings: Pressure support
- A set amount of pressure delivered when patient initiates own breath. Assists movement of air through ventilator tubing in order to augment patient’s own tidal volume. * Works at the beginning of Inspiration
56
Ventilator settings: PEEP (Positive end expiratory pressure)
- Positive airway pressure applied at end of expiration. to keep alveoli open and facilitate oxygen transport. * Works at the end of Expiration
57
Ventilator settings: Tidal Volume
- Amount of air it takes to inflate the lungs with each breath. - Takes approximately 10-15 ml/kg.
58
Ventilator settings: Minute ventilation
- Amount of gas moved in or out of lungs per minute | - Normal is 5-8 liters/minute
59
Ventilator settings: I: E ratio
- Inspiration to expiration ratio - Normal to start at 1:2 - Longer (1:4) in people with COPD to prevent “breath stacking”
60
Ventilator settings: Peak Inspiratory Pressure
- Amount of pressure it takes for ventilator to deliver tidal volume or breath.
61
Ventilator settings: Percent of inspired O2 (Fi02)
- Percent or fraction of oxygen delivered by the ventilator
62
Complications of mechanical ventilation
- Excessive pressure in the alveoli (barotrauma) - Excessive volume in the alveoli (volutrauma) - Shearing due to repeated opening and closing of the alveoli (atelectrauma) - Inflammatory immune response (biotrauma) EX: pneumothorax, subcutaneous emphysema,
63
Prevention of complications from mechanical ventilation
- Plateau pressure kept < 32 cm H2O - PEEP should be used - Tidal Volume set at 6-10 ml/kg
64
Troubleshooting alarms: Low pressure limit
- Tubing disconnected - Circuit leak - Cuff deflated
65
Troubleshooting alarms: Low exhaled VT
- Leak in the system - Poor cuff inflation - Leak through chest tube
66
Troubleshooting alarms: Temperature
- Sensor malfunction | - Sensor picking up outside airflow
67
Troubleshooting alarms: Apnea
- Sedation - Neurologic - Metabolic
68
Troubleshooting alarms: High respiratory rate
- Not tolerating weaning - Neurogenic/ metabolic - Anxiety - Pain
69
Troubleshooting alarms: Mechanical Ventilator failure
- Check electrical outlet | - Needs replacement

Adult Health I final (16 decks)

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