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Midterm Study Tips Flashcards

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1
Q

O2 Transport Chain

A 
Inspired O2 and quality of ambient air
airways
lungs and chest wall
diffusion
perfusion
myocardial function
peripheral circulation
tissue extraction and use of O2
return of desat blood and CO2 to the lungs
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2
Q

O2 Transport: Airways

A

become smaller and branch out

lined with smooth mm, cilia, mucus

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3
Q

O2 transport: lungs and chest wall

A

contraction of diaphragm creates (-) intrapleural pressure to inflate the lungs and bring air in

need good compliance

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4
Q

O2 transport: diffusion

A

O2 from alveoli -> pulm capillaries

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5
Q

O2 transport: perfusion

A

gravity dependent

V/Q ratio ideally is 0.8

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6
Q

O2 transport: myocardial function

A

need a coordinated conduction system, strong forceful contraction

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7
Q

O2 transport: peripheral circulation

A

neural stimulation of arteriole smooth mms contract or relax and let more/less blood through

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8
Q

O2 transport: tissue extraction and use of O2

A

rate of O2 extraction by cells depends on the O2 demand of those cells

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9
Q

O2 transport: return

A

CO2 eliminated by diffusion into alveoli

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10
Q

Practice Pattern A

A

Primary Prevention/Risk Reduction for Cardio/Pulm Disorders

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11
Q

Practice Pattern B

A

Impaired aerobic capacity/endurance associated with deconditioning

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12
Q

Practice Pattern C

A

Impaired ventilation, resp/gas exchange, and aerobic capacity/endurance associated with Airway Clearance Dysfunction

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13
Q

Practice Pattern D

A

Impaired ventilation, resp/gas exchange, and aerobic capacity/endurance associated with Cardiovascular pump dysfunction or failure

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14
Q

Practice Pattern E

A

Impaired ventilation, resp/gas exchange, and aerobic capacity/endurance associated with Ventilatory pump dysfunction or failure

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15
Q

Practice Pattern F

A

Impaired ventilation, resp/gas exchange, and aerobic capacity/endurance associated with Respiratory Failure

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16
Q

Practice Pattern G

A

Impaired ventilation, resp/gas exchange, and aerobic capacity/endurance associated with Respiratory failure in the neonate

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17
Q

Practice Pattern H

A

Impaired circulation and anthropometric dimensions associated with lymphatic system disorders

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18
Q

preload

A

amount of blood that fills ventricles in diastole

decreased = decreased CO

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19
Q

afterload

A

amount of BP (resistance) heart has to push against to eject blood out
(Increased = decreased CO)

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20
Q

Signs and Sx of Unstable patient

A 
hypotension
acute altered mental status
signs of shock
ischemic chest discomfort
acute heart failure
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21
Q

4 pieces to the complicated patient

A

dysrythmia
heart failure
thrombosis
damage to heart structure

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22
Q

3rd spacing

A

the space where fluids build up in the interstitum of the lungs

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23
Q

hydrostatic pressure (water)

A

higher in capillaries and tends to PUSH fluid OUT into the interstitum

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24
Q

oncotic pressure

A

high in the capillaries and PULLS fluid IN to the capillaries
oncotic > hydrostatic - net flow of fluid IN
if hydrostatic is high enough (CHF) it will push fluid out

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25
Shunt
alveolus not ventilated but normal flow through the capillary
26
dead space
alveolus is normally ventilated but no blood flow through the capillary
27
silent
alveolus is unventilated and capillary no perfusion
28
conducting divisions
1-16 of bronch*
29
respiratory divisions
>16 | more SA however narrower lumen therefore easier to clog
30
Risk Factors for Atelectasis
``` smoking hx DOE, PND, CHF, orthopnea, dependent edema, angina PaO2 60mmHg, PaCO2 > 50 mmHg bed rest for 36+ hours FIM <3-4 abdominal and or cardio thoracic surgery/traume impaired cognitive status low tidal volumes/breaths retained secretions ```
31
Risk Factors for pneumonia
``` smoking, alcoholism, obesity underlying disease trauma prior viral illness altered consciousness immunosuppression surgery invasive procedures (mech vent) Meds - ```
32
compliance
ease of which lungs are inflated during inspiration
33
Decreased compliance due to...
lung fibrosis, alveolar edema, dec surfactant, rib injury, intercostal mm tightness/fibrosis Inc WOB
34
Heart Failure Signs and Sx
BNP >100 chest x-ray - cardiomegaly ST elevation or depression on EKG
35
NYHA Class I/ Class A Heart Failure
cardiac dz; no limits with daily activity | unrestricted physical activity
36
NYHA Class II/ Class B Heart Failure
Cardiac dz; comfortable at rest, ordinary activity causes fatigue, palpation, angina, SOB no severe or competitive sports
37
NYHA Class III/ Class C Heart Failure
marked limits of physical activity, still comfortable at rest moderate restrictions on ordinary activity and no strenuous efforts
38
NYHA Class IV/ Class D heart failure
symptoms at rest - activity causes discomfort Ordinary activity restricted Class E - complete rest
39
Zone of Apposition
part of the diaphragm that lines up against the inside of the lower rib cage. D/t line of pull brings rib cage up and out with inspiration If diaphragm is flat ZofA will be less and therefore less lung expansion
40
MIP - Maximum inspiratory pressure
negative value | max inspiration after a max expiration
41
MEP - max expiratory pressure
max expiration after max inspiration (Positive value)
42
Arterial Blood Gas Levels (ABGs)
Hyperventilation - alkalosis pH >7.45 Hypoventilation - Acidosis pH < 7.35 hypercapnia pCO2 >45 mmHg
43
Ventilation and gravity
ventilation inc from apex to bass regardless of position. Lower alveoli are more compliant
44
Perfusion and gravity
changes with position. More perfusion in the dependent areas of the lungs
45
V/Q ratio and gravity
decreases as you move from apex to base
46
Chest Xray Basics
``` PA and later views Look at all 4 corners Heart size and contour (1/2 width of chest) L/R pulmonary arteries and main bronchi trachea compare lung 1/3s domes of hemi-diaphragms costophrenic angles gastric air bubbles post ribs are horizontally aligned, ant ribs angled inferiorly ```
47
pneumo-peritoneum
air gets between diaphragm and live-stomach, looks paper thin on xray
48
Auscultation
S1 - closure of mitral and tricuspid valves. Beginning of systole S2 - closure aortic and pulmonic valves. Beginning of diastole S3 - ventricular gallop - low pitched sound caused by rapid filling of ventricules - compliant ventricle walls or in high out put conditions S4 - soft, low pitched sound via vibration of atrial contraction, caused by hypertroph of ventricles
49
Contraindication to activity
``` CHF (overt) MI or extension of MI 2nd or 3rd degree heart block HTN resting BP or hypo >10-15 PVCs per minute at rest severe aortic stenosis unstable angina with recent changes in sx dissecting aortic aneurysm uncontrolled metabolic diseasse psychosis or other unstable psych condition ```
50
Diuretics
Bumex
51
Positive Ionotropes
milrinone
52
Sedativess
Popofol
53
Beta 2 agonists for Bronchodilation
albuterol
54
anticholinergics for bronchodilation
Spiriva
55
inhaled corticosteroids
azmacort
56
negative chronotopes/beta blockade
metropolol - beta blocker for angina and HTN | causes slowed heart rate
57
PSV
patient controls frequency, tidal vol, inspiratory volume. When initiated, triggers preset inspiratory support until min pressure reached high patient compliance
58
CMV
controlled mandatory ventilation | patient does 0 work; no spontaneous breathing
59
AC
assist control or "partial support" - patient receives set volume, frequency and flow rate however pt can trigger machine on their own no spontaneous breathing?
60
IMV
intermittent mandatory ventilation | set to give number of breaths per min. Patient can breathe on own in between - no coordination b/n machine and patient
61
SIMV
synchronized mandatory ventilation - synchronizes machine delivered breaths with pts spontaneous breaths if no insp. effort machine will begin
62
PEEP
positive end expiratory pressure - keeps pressure positive so it never goes to zero to keep the alveoli from closing
63
CPAP
contunuous positive airway pressure - alveoli kept open constantly to take some work off skeletal mm done with spontaneous breathing patient
64
Delirium
acute, fluctuating change in mental status, with inattention and altered level of consciousness
65
RASS
Level of consciouness scale +4 combative - violent +3 very agitated - removes tubes +2 agitated - nonpurposeful mvmt, fights vent +1 restless - non aggressive 0 alert and calm -1 drowsy - eye opens to voice -2 light sedation - awake to voice <10 s -3 moderate sedation - mvmt to voice no eyes -4 deep sedation - no response to voice, only to tactile -5 - unarousable
66
CAM - ICU
confusion assessment method 1. acute change or fluctuating course of mental status AND 2. inattention + 3. altered level of consciousness Or 4. disorganized thinking =delirium (+)
67
triad factors of asthma
mucus production - blocks airways inflammation - can damage airways bronchospasm - increases resistance to flow
68
RDS
rapid breathing air hunger low O2 sat in blood
69
SBTs
spontaneous breathing trials | avoid prolonged mechanical ventilation
70
SATs
spontaneous awakening trials - interrupted sedation to avoid acute brain injury from delirium
71
poor air quality causes
inflammation, destroys lung tissue, weakens lung defenses
72
LFT
liver function test dysfunction of liver can be life threatening - metabolizes carbs and proteins and detoxifies blood test: amylase, alkaline, phosphotase, bilirubin
73
BUN/Cr
kidney function. 10-20:1 is normal | <10:1 = renal damage
74
D-dimer
molecule present in blood after clot has been degraded by fibrinolysis - indicative of thrombus
75
Cardiac markers
troponin and CPX - elevated = infarct | CBC - if decreases = diminished O2 transport
76
FRC
functional residual capacity amount of air left in lungs at end or NORMAL respiration. FRC = residual vol + expir. reserve volume higher is better greater in standing than sitting
77
FEV1
forces expiratory volume in 1 second - amount of air vol forcibly exhaled from lungs in 1 sec Lung issues FEV1 is < 1L
78
FEV1/FVC %
anything <70% = airway problems
79
RV
volume of air in lungs after forced expiration | closure of airways (atlectasis) causes inc RV
80
TLC
total lung capacity vol after forced inspiration dec compliance = dec TLC
81
FVC
amt of air can fully get out o flungs | dx with obstructive/restrictive dz
82
DLCO
diffusion capacity of the lung for CO2 O2 passes from alveoli into blood low - less O2 into blood and less CO2 out
83
MVV
maximal voluntary ventilation time takes for VMP to dec to 1/2 its peak ventilation, when breathing in and out as much and as fast as possible measure of VMP power/fatigue
84
PC-20 Methacholine
dx airway hyperresponsiveness measure amount of methacholine (bronchoconstrictor) have to give the person for there to be a 20% change in FEV1 >16 mg/mL dose is normal, 1-4 mg/mL is mild hyperresponsiveness, <1 severe
85
DVT Signs and Sx
swelling, pain/tenderness, inc warmth and redness
86
PE Signs and Sx
sudden onset tachypnea, radiating chest pain, anxiety
87
MAP
(1/3 SBP) + (2/3 DBP) <60 mmHg blood isnt getting to internal organs enough = cell death normal 65-90 mmHg
88
CVP
central venous pressure monitoring - direct measure of BP in right atrium and vena cava good for assessing right ventricular function and systemic fluid status INC with Heart Failure

CVP (2 decks)

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