Problem 5: Identifying atrial gas deficiency and Cor Pulmonale management Flashcards Preview

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Flashcards in Problem 5: Identifying atrial gas deficiency and Cor Pulmonale management Deck (12)
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1
Q

Why are patients admitted to high dependency units? HDU

A

HDUs are wards for people who need more intensive observation, treatment and nursing care than is possible in a general ward but slightly less than that given in intensive care. The ratio of nurses to patients may be slightly lower than in intensive care but higher than in most general wards.

2
Q

What are the ABGs and describe parameters measured?

A

Atrial Blood Gases
Important routine investigation to monitor the acid-base balance of patients; helping to make diagnosis, indicate severity of a condition and help to assess treatment.

Information provided:

  • oxygenation
  • adequacy of ventilation
  • acid-base levels

The following indices should be looked at in the following order (see local laboratory for reference ranges):

Blood pH - high indicates alkalosis, low indicates acidosis and normal indicates either normal, mixed defect or a compensated defect.
PaCO2 level - is it a respiratory problem? If not, look at the bicarbonate level. High PaCO2 with an acidosis indicates a respiratory problem. If the PaCO2 is normal or low it indicates compensation.
Bicarbonate - if the bicarbonate fits with the pH it suggests a primary metabolic problem. If not, it indicates compensatory changes.
Look for any compensation - eg, low PaCO2 in severe metabolic acidosis.
Anion gap in metabolic acidosis - see below under ‘Other useful information from arterial blood gases’.
O2 level - is hypoxaemia present?

3
Q

Why does a pharmacist need to know about ABGs

A

The following indices should be looked at in the following order (see local laboratory for reference ranges):

Blood pH - high indicates alkalosis, low indicates acidosis and normal indicates either normal, mixed defect or a compensated defect.
PaCO2 level - is it a respiratory problem? If not, look at the bicarbonate level. High PaCO2 with an acidosis indicates a respiratory problem. If the PaCO2 is normal or low it indicates compensation.
Bicarbonate - if the bicarbonate fits with the pH it suggests a primary metabolic problem. If not, it indicates compensatory changes.
Look for any compensation - eg, low PaCO2 in severe metabolic acidosis.
Anion gap in metabolic acidosis - see below under ‘Other useful information from arterial blood gases’.
O2 level - is hypoxaemia present?

4
Q

What is respiratory failure?

A

Respiratory failure occurs when disease of the heart or lungs leads to failure to maintain adequate blood oxygen levels (hypoxia) or increased blood carbon dioxide levels (hypercapnia)

  1. Hypoxaemic respiratory failure is characterised by an arterial oxygen tension (PaO2) of <8 kPa (60 mm Hg) with normal or low arterial carbon dioxide tension (PaCO2).
  2. Hypercapnic respiratory failure is the presence of a PaCO2 >6 kPa (45 mm Hg) and PaO2 <8 kPa.
5
Q

What are the different types of respiratory failure?

A

Type I and Type II
Type I : Hypoxemic respiratory failure (type I) is characterized by an arterial oxygen tension (PaO2) lower than 60 mm Hg with a normal or low arterial carbon dioxide tension (PaCO2). This is the most common form of respiratory failure, and it can be associated with virtually all acute diseases of the lung
Common in COPD

Type II: Hypercapnic respiratory failure (type II) is characterized by a PaCO2 higher than 50 mm Hg. Common in COPD

6
Q

How is respiratory failure treated?

A

Hypoxaemia

Ensure adequate oxygen delivery to tissues, generally achieved with a PaO2 of 60 mm Hg or an arterial oxygen saturation (SaO2) of greater than 90%.
Assisted venitaliton
used to increase PaO2 and to lower PaCO2.

Hypercapnia and respiratory acidosis

Correct the underlying cause and/or provide assisted ventilation.

7
Q

When is long term oxygen therapy recommended in COPD patients?

A

Long-term home oxygen therapy improved survival in a selected group of COPD patients with severe hypoxaemia (arterial PaO2 less than 55 mm Hg (8.0 kPa)).

8
Q

Explain how oxygen is prescribed and administered for patients with COPD?

A

For most COPD patients, you should be aiming for an SaO2 of 88-92%, (compared with 94-98% for most acutely ill patients NOT at risk of hypercapnic respiratory failure). Mark the target saturation clearly on the drug chart.
The aim of (controlled) oxygen therapy is to raise the PaO2 without worsening the acidosis. Therefore, give oxygen at no more than 28% (via venturi mask, 4 L/minute) or no more than 2 L/minute (via nasal prongs) and aim for oxygen saturation 88-92% for patients with a history of COPD until arterial blood gases (ABGs) have been checked.

9
Q

Describe the considerations needed to be made when initiating patients on long term oxygen therapy

A

People receiving LTOT should breathe supplemental oxygen for at least 15 hours a day. If they smoke, warn them about the risk of fire and explosion.

10
Q

How long should a patient be on LTOT for per day?

A

There is strong evidence of survival benefit of long-term oxygen therapy (LTOT) in patients with COPD and severe chronic hypoxaemia when used for at least 15 hours daily.

11
Q

Explain the risks associated with home oxygen therapy

A

If they smoke, warn them about the risk of fire and explosion.

Skin Irritation and Nasal Dryness. Because oxygen therapy has a drying effect on the nasal passages, it is not uncommon for skin irritation, skin breakdown and nasal dryness to occur when using it. …
Fire Hazard. …
Oxygen Toxicity. …
Suppression of Breathing.

12
Q

PJ - what a pharmacist should know about ABGs

A

The ideal pH of extracellular fluid is 7.35–7.45. Maintaining this pH requires a delicate balance between carbon dioxide (which dissociates in the blood to form carbonic acid and, therefore, hydrogen ions) and bicarbonate (produced primarily by the kidneys).

If there is a disturbance in pH the body can adjust the respiration or the amount of bicarbonate and hydrogen ions excreted by the kidneys. Detecting and acid-base imbalances is done by checking the pH of the blood and the amount of carbon dioxide and bicarbonate in the blood. This is known as checking a patient’s “arterial blood gases”.