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NURS 123 > MIDTERM 1 > Flashcards

MIDTERM 1 Flashcards

1
Q

Arterial blood gas

A

Primary method for evaluating oxygenation/ventilation and acid-base status (respiratory and metabolic abnormalities). Provides snapshot of that moment in time and good trend information. includes PaO2, PaCO2, HCO3, pH

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2
Q

Clinical indications for drawing ABG

A

Change in LOC
New dyspnea
Falling BP
Drop in CO2 in chemistry

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3
Q

PaO2 formula for “lower limit” in older adult

A

80 - (years over 60)

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4
Q

PaO2 requiring intubation

A

< 50

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5
Q

Oxygen titration

A

5-10% every hour

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6
Q

Too much oxygen causes…

A

alveolar damage

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7
Q

Oxygen delivery choice for SEVERE respiratory acidosis

A

BIPAP or intubation

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8
Q

Oxygen delivery choice for mild-moderate respiratory acidosis

A

encourage deep breathing

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9
Q

Intervention for respiratory alkalosis

A

slow down breathing

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10
Q

PaO2 definition

A

pressure of oxygen dissolved in plasma

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11
Q

pH definition

A

concentration of H+ in plasma

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12
Q

PaCO2 definition

A

pressure of CO2 (as a GAS) dissolved in plasma

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13
Q

Base excess

A

amount of ACID required to restore a LITER of blood to normal pH at a PaCO2 at 40 mmHg

High (positive) base excess in METABOLIC ALKALOSIS

Low (negative) base excess in METABOLIC ACIDOSIS

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14
Q

Classic symptoms of alkalosis

A

agitation, anxiety, change in LOC

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15
Q

Classic symptoms of acidosis

A

lethargic, change in LOC

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16
Q

Causes, manifestations, and interventions: Respiratory Acidosis

A

Low pH
High PaCO2

Cause: hypoventilation

Due to: opioids, head injury (CNS impairment), lung obstruction/disease, chest wall dysfunction (e.g. flail chest)

Early S/S: fatigue, flushed skin, irritability

Late S/S: lethargy, confusion, and somnolence

Tx: increased respiratory rate and depth, naloxone, mobility, repositioning

O2: BIPAP, intibation if unable to breath off themselves

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17
Q

Causes, manifestations, and interventions: Respiratory Alkalosis

A

High pH
Low PaCO2

Cause: hyperventilation

Due to: arterial hypoxemia, inc. metabolic or HEPATIC failure, mechanical ventilation

Manifestations: anxiety, CNS and peripheral NS irritability

Tx: anxiety medications (if it’s the cause), sloooow breathing

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18
Q

Causes, manifestations, and interventions: Metabolic Acidosis

A

Low pH
Low HCO3

Loss of base or gain of acid

Causes: diarrhea (secretes HCO3), fistulas, loss of BILE or PANCREATIC juice

More causes: ketoacidosis, lactic acidosis, drugs, TPN, renal failure (less H+ is secreted out the body)

Manifestations: CNS depression, weakness, confusion –> delirium, stupor, respiratory depression, Kussmaul respirations

Tx: treat the underlying problem, replace HCO3 and monitor K+

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19
Q

Causes, manifestations, and interventions: Metabolic Alkalosis

A

High pH
High HCO3

Cause: gain of base or loss of acid

Due to: diuretics, antacids, GI vomit/suctioning

Manifestations: CNS or PNS irritability (numbness, tingling), cramps, tetany, disorientation –> late symptom is lethargy

Tx: monitor chemistry and remove source

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20
Q

Uncompensated

A

Abnormal pH, abnormal and normal PaCO2 or HCO3

21
Q

Partially compensated

A

Abnormal everything

22
Q

Compensated

A

Normal pH, abnormal HCO3 and PaCO2

23
Q

Respirations are monitored in the CNS by the

A

medulla oblongata

24
Q

Why would someone with anxiety who is breathing rapidly want to breath into .a bag?

A

Anxiety –> rapid breathing –> loss of CO2 –> Respiratory alkalosis

Breathing into a bag = rebreathing CO2

25
Q

Where would you find TOTAL CO2 content?

A

Chemistry labs

26
Q

Normal serum CO2 levels

A

22-24

27
Q

Explain the buffer system of the kidneys in relation to CO2 and HCO3

A

CO2 serum level reflects buffering status of kidneys

  • Lower serum CO2 = HCO3 being used to buffer acids
  • Kidneys PULL the CO2 in serum to create HCO3
  • If CO2 drops in chemistry, indication that you should get an ABG
  • Low serum CO2 reflects metabolic acidosis (HCO3 is created and RELEASES H+ into the BLOOD!)

Body buffering system: CO2 + H2O <> H2CO3 <> H+ + HCO3

28
Q

Relation between COPD and kidney issues in balancing pH

A

COPD pt used to high CO2, kidneys work overtime to balance pH with HCO3

People with both kidney issues and COPD will have hard time balancing

Someone on dialysis will have a harder time making HCO3

29
Q

Explain the affinity of O2 when pH is <7.35 and >7.45

A

Acidosis: affinity to O2 is lost and more O2 will unload to tissues

Alkalotic: affinity increases and cannot unload to tissues

reason why it is “better” to be acidodic than alkalotic

30
Q

Hypoxemia

A

Less O2 in blood

31
Q

Hypoxia

A

Less O2 to the tissues

looks at function and organ perfusion problems

32
Q

Oxygen extraction fraction (OEF)

A

the ratio of bloodoxygenthat a tissue takes from the blood flow to maintain function and morphological integrity. OEF reflects the efficiency ofoxygen utilization by the tissue and, therefore, is a hemodynamic measure in brain ischemia.

Normal: 25%

33
Q

Saturation Venous Oxygen (SvO2)

A

percentage of oxygen bound to hemoglobin in blood returning to the right side of the heart. This reflects the amount of oxygen “left over” after the tissues remove what they need.

Normal: 75%

Lower values indicate greater need for extraction (ex: infection, pain)

Higher values indicate inability to extract (ex: microclots, SEPSIS)

34
Q

Nursing responsibilities in worsening WOB/LOC

A

HOLY TRINITY OF LABS:
Hgb/Hct, CXR, ABG

Always start the assessment with the patient

35
Q

Normal range of base excess

A

-2 mEq to +2 mEq

36
Q

Nursing interventions for PaO2…
<80
<60
<50

A

<80- oxygenation
<60- call physician STAT
<50- physician evaluation for intubation

37
Q

IOM QSEN & quality dimensions in healthcare

A

Quality and Safety Education for Nurses

6 Dimensions: SQ PT IE
Safe
Quality improvement (fall precautions, med. rights...)
Patient centered
Teamwork
Informatice 
Evidence Based Practice
38
Q

Which nursing process helps more in acute care and why?

A

DIKW: Data Information Knowledge & Wisdom

Works better in the care of complex patients than ADOPIE
Look at nursing assessments, progress notes… take all of that data and turn it into information & act on it
Reevaluating = wisdom. What worked? What didn’t?

39
Q

Quality management activities: Measurement, Assessment, Improvement

A

Measurement (x pts develops CAUTI)
Assessment (reasons why those pts develop CAUTI)
Improvement (can we lower the rate of CAUTI?)

40
Q

3 resources of legal and ethical standards for nurses

A

nurse practice act (guides practice by state)

ANA code of ethics (accurate information & privacy)

Critical care standards (decision making skills, critical thinking)

41
Q

Define respiratory failure

A

Inability for the body to meet tissue O2 need or CO2 removal either by hypoxia or hypercapnia

42
Q

Name some causes for hypoxia-related respiratory failure

A 
PE
ARDS
Drowning
Pulmonary edema
Lung tumors

Things that prevent O2 from entering or normal gas exchange (ALVEOLAR/CAPILLARY MEMBRANE ISSUE)

43
Q

Name some causes for hypercapnia-related respiratory failure

A 
CNS depression
COPD
asthma 
CF
MS
muscular dystrophy
Guillain-barre

CNS/PNS depression leading to air trapping

44
Q

Lab data you would find in respiratory failure: how is it diagnosed?

A

Diagnosed by ABG

PaO2 <50 OR PaCO2 >50 on RA

Check pain, anxiety, CXR, H/H

45
Q

What lab data would you look at with a patient with COPD experiencing respiratory failure?

A

pH

46
Q

Ventilation/Perfusion

A

1:1 ratio
The vol of blood perfusing the lungs/min is 4-5 L and is approx. equal to the volume of gas that reaches the alveoli /min.

47
Q

High V/Q

A

blood flow issue (PE, hypovolemia)

48
Q

Low V/Q

A

Possible causes:

Alveoli issue collapsed, blocked, or filled with fluid (COPD, PNA, asthma) which leads to decreased gas entering the bloodstream

49
Q

Pore of Kohn

A

If a pore of Kohn in alveoli is blocked by mucus, encourage deep breathing/IS to recruit the blocked alveoli.

Pore of Kohn is a backup mechanism that can pop open and perfuse the alveoli next to them. Reason why IS is great for preventing complications

NURS 123 (1 decks)

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