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CCRN > Pulmonary > Flashcards

Pulmonary Flashcards

(58 cards)

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1
Q

Central control: brain stem

A

Senses pH, decreased pH > ventilation is stimulated > increased RR

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2
Q

Peripheral control: PaO2 sensors in aortic arch

A

Senses PaO2 > decrease in PaO2 (hypoxemia) > ventilation is stimulated > increased RR

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3
Q

How to know if ventilating normally?

A

PaCO2! NOT PaO2

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4
Q

Minute ventilation

A

Tidal volume x RR

Normal is approx. 4L/minute

Increased minute vent = increased WORK OF BREATHING

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5
Q

Primary muscle of ventilation

A

Diaphragm!

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6
Q

Anatomic dead space

A

Doesn’t participate in gas exchange

Dead space is approx. 2ml/kg of Vt

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7
Q

Alveolar dead space

A

Pathologic, non-perfused alveoli (PE)

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8
Q

Physiologic dead space

A

Anatomic + alveolar dead space

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9
Q

Perfusion def

A

Movement of blood past alveoli

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10
Q

Normal ventilation/perfusion ratio

A

4L ventilation/min
5L perfusion/min

Ideal lung unit = 0.8 VQ ratio

Can be decreased by PE or low CO

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11
Q

How to position R lung PNA

A

GOOD LUNG DOWN

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12
Q

Treatment of VQ mismatch

A

Give O2, treat cause

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13
Q

Lung shunt such as ARDS

A

An extreme VQ mismatch, even on 100% O2 will not correct hypoxemia

Treatment: give 100% O2, PEEP

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14
Q

Shunt def

A

Movement of blood from R side of heart to L without oxygenation

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15
Q

Normal physiologic shunt

A

Thebesian veins of the heart empty into L atrium

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16
Q

Anatomic shunt

A

VSD or ASD

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17
Q

Pathologic shunt

A

ARDS! Blood goes through without being oxygenated resulting in refractory hypoxemia

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18
Q

PEEP

A

Prevents expiratory pressure from returning to zero, by keeping exp. pressure positive it

  • decreases surface tension of alveoli
  • increases alveolar recruitment
  • increases driving pressure, extends time of gas transfer and allows decrease in FiO2
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19
Q

Left shift of oxyhemo dissociation curve

A

Alkalosis
Low PaCO2
Hypothermia
Low 2,3-DPG

SaO2 high but O2 stuck to hgb > BAD

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20
Q

Right shift of oxyhemo dissociation curve

A

Acidosis (high H+)
High PaCO2
Fever
High 2,3-DPG

Good for tissues, SaO2 low but O2 easily released

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21
Q

What is 2,3-DPG?

A

Organic phosphate in RBCs that alters affinity of hgb for oxygen

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22
Q

Decreased 2,3-DPG

A

Multiple blood transfusions
Hypophosphatemia
Hypothyroidism

Less O2 available to tissues

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23
Q

Increased 2,3-DPG

A

Chronic hypoxemia
Anemia
Hyperthyroidism

More O2 available to tissues

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24
Q

Carboxyhemoglobin levels & symptoms

Study These Flashcards
A 
0-5 is normal
<15% often in smokers
15-40 headache, some confusion
40-60 loss of consciousness, Cheyne-Stokes
50-70 mortality >50
25
Treatment of CO poisoning
100% FiO2 until symptoms resolve and level is <10% | Hyperbaric chamber
26
Static compliance def
Measurement of elastic properties of lung TV/plateau pressure Increase is PP will decrease compliance
27
Dynamic compliance def
Measurement of elastic properties of airways TV/peak inspiratory pressure Increase in PIP will decrease compliance
28
Status asthmaticus
``` Static compliance (lungs) normal Dynamic compliance would be low ```
29
ARDS
Static compliance would be low | Dynamic would also be low
30
Anion gap
Normal 5-15 Helpful in determining cause and response to treatment of metabolic acidosis
31
Problems with increased anion gap
``` Ketoacidosis Uremia Salicylate intoxication Methanol Alcoholic ketosis Unmeasured osmoles Lactic acidosis ```
32
Problems with normal anion gap
``` Saline infusion TPN Diarrhea Ammonium chloride Acute renal failure ```
33
Acute resp failure type 1: hypoxemic
PNA, ARDS, atelectasis, pulm edema, PE, interstitial fibrosis, asthma
34
Acute resp failure type 2: hypercapneic
CNS depression due to drugs, increased ICP, COPD, flail chest, ALS, Guillian Barre, MS, spinal injury
35
Acute resp failure type 3: combo
ARDS, asthma, COPD
36
S/S of hypoxemic resp failure
Tachynpea, accessory muscle use, tachycardia at first then brady, cyanosis, anxiety, agitation
37
S/S of hypercapneic resp failure
Shallow breathing, bradypnea, progressive decreased LOCA
38
Treatment of resp failure
Maintain airway and improve ventilation, optimize oxygenation, circulation and CO, identity etiology
39
CPAP
Indicated for patients with hypoxemic resp failure who have increased work of breathing (cardiogenic pulm edema)
40
BiPAP
Indicated for patients with hypoxemic or hypercapneic resp failure
41
Advantages of noninvasive ventilation
Buys time, reduces work of breathing, decreases preload and afterload, improves oxygenation, prevents intubation
42
Contraindications for NIV
Unstable or life threatening arrhythmia, secretions, high risk aspiration, impaired mentation, pneumothorax, life threatening refractory hypoxemia
43
Signs of acute exacerbation of COPD
Worsening dyspnea, increase sputum volume and thickness, hypercapnia and hypoxemia
44
Management of COPD exacerbation
Titration FiO2 to PaO2 >60 without overcorrecting Bronchodilator therapy - short acting beta agonist and anticholenergic Steroids Antibiotics for PNA NIV
45
Status asthmaticus def
Airway hyper-reactivity that produces severe airway narrowing that is refractory to aggressive bronchodilator therapy
46
S/S of status asthmaticus
Dyspnea, tachypnea, cough, accessory muscle use, wheezing > decreased breath sounds, VQ mismatch, tachycardia, pulsus paradoxus, decreased LOC, elevated WBC, hx of intubations
47
Management of status asthmaticus
Measure presenting peak flow rate 50-70 admit, <50 ICU Bronchodilator, anticholenergic, steroids, pulse ox, hydration, avoid secretions, intubation (resp acidosis, severe hypoxemia, silent chest, change in LOC)
48
Vent management of status asthmaticus
Use low rate to increase exhalation time, low TV to prevent auto PEEP, increase I/E ratio
49
Types of PE
Venous - DVT Fat - long bone, pelvis Air - surgery, IVs
50
S/S of PE
Dyspnea, tachycardia, CP, anxiety, cough, petechaie (fat), low grade fever, resp alkalosis Severe: hypoxemia, hypotension, EKG changes, PEA
51
Treatment of PE
Adequate oxygenation, fluids, anticoagulant, fibrinolytic therapy, maintain CO
52
Pulm HTN def
MEAN pulm artery pressure greater than 25 at rest and PAOP less than 16 at rest with secondary R HF
53
S/S of pulm HTN
Exertional dyspnea, lethargy, fatigue, progression to RV failure, CP and syncope, abdominal pain, ortners syndrome, systolic murmur, RV hypertrophy, JVD distention, ascites, pleural effusion
54
Tx of pulm HTN
Diuretics, oxygen, anticoagulant, digoxin, exercise training Lastly transplant
55
S/S of PNA
Chills, fever, tachycardia, confusion, productive cough, dehydration
56
Tx of PNA
Optimize ventilation and oxygenation, positioning GOOD LUNG DOWN, NIV or intubation, bronch, mobilize, identify organism, antibiotics
57
Etiology of aspiration
AMS, drug use, depressed cough/gag, feeding tubes, positioning, artificial airway, gastric distention, hx of dysphagia, increased secretions
58
S/S of aspiration
Resp distress, tachycardia, hypoxemia, crackles, secretions, hypotension

CCRN (2 decks)

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