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Principles 1 > Respiratory Monitoring > Flashcards

Respiratory Monitoring Flashcards

1
Q

What two things does airway management include?

A

the ability to oxygenate AND ventilate a patient

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2
Q

How is CO2 made in the body?

A

cellular respiration

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3
Q

What vital sign is the indicator of the CO2 response curve?

A

respiratory rate

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4
Q

tidal volume x respiratory rate

A

minute ventilation

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5
Q

-Heavy weight chest piece placed on skin or
esophageal temperature probe used
-Custom fitted ear piece connects the tubing to
either the chest piece or esophageal probe

A

esophageal stethoscope

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6
Q

What things can an esophageal stethoscope detect?

A 
Confirms ventilation by breath sounds
Can detect abnormal breath sounds 
   -stridor 
   -wheezing
Detects abnormal heart sounds
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7
Q

esophageal stethoscope contraindicated with?

A

esophageal varices

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8
Q

What can esophageal stethoscope NOT detect?

A

diffusion abnormalities

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9
Q

esophageal stethoscope placement?

A 
Place at 4th 
intercostal 
space and 
left sternal 
border
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10
Q

clinical condition: apnea, vent or circuit disconnect, accidental extubation
stethoscope finding?

A

absence of breath sounds

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11
Q

clinical condition: air embolism

stethoscope finding?

A

sudden appearance of new murmur (mill wheel murmur)

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12
Q

clinical condition: bronchospasm/aspiration

stethoscope finding?

A

wheezing

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13
Q

clinical condition: CHF

stethoscope finding?

A

S3 gallop rhythm, rales

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14
Q

clinical condition: arrhythmias/cardiac arrest

stethoscope finding?

A

irregular heart sounds

absence of heart sounds

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15
Q

what tidal volumes do you want to achieve?

A

tidal volumes between 6-8 ml/kg (ideal body weight)

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16
Q

5 ways to monitor Tidal Volume

A
  1. adequate amount tidal volume 6-8
  2. do not exceed PiP> 35-40
  3. bilateral chest rise and fall
  4. control of ETCO2
  5. bellows moving
    [PiP = peak inspiratory pressure]
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17
Q

The weight of the bellows gives about how much intrinsic PEEP?

A

2-3 cmH2O

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18
Q

6 things on an abg

A 
PaO2
PaCO2
pH
oxyhgb sat
base excess 
bicarb
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19
Q

what two numbers on abg are for oxygenation assessment?

A

PaO2

oxyhgb sat

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20
Q

what number on abg is for the assessment of ventilation?

A

PaCO2

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21
Q

What numbers are for acid-base?

A

pH
bicarb
base excess

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22
Q

Decreased blood oxygen levels
resulting from decreased delivery of oxygen from
atmosphere to the blood

A

Hypoxemia [PaCO2]

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23
Q

Decreased delivery of oxygen to the

tissues.

A

Hypoxia

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24
Q

5 reasons we have hypoxia

A
  1. hypoxemia 90%
  2. anemic hypoxia 10%
  3. circulatory hypoxia 5%
  4. affinity hypoxia
  5. histiocystic hypoxia
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25
Q

5 things that cause hypoxemia?

A
  1. ↓ blood oxygen tension ↓ PaO2
  2. Low inspired oxygen (FiO2)
  3. Hypoventilation
  4. V/Q mismatch – shunt
  5. Diffusion limitations
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26
Q

not enough Hgb

A

Anemic hypoxia

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27
Q

not enough cardiac output

A

Circulatory hypoxia

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28
Q

decrease release of O2 ( ↓temp, increased pH, carbon monoxide poisoning

A

Affinity hypoxia:

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29
Q

cell won’t accept the

delivery of the O2, (cyanide poisoning)

A

Histiocystic hypoxia

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30
Q

what is cyanosis?

A
  • -Skin is blue, ashy or dark purple

- -PaO2 is low causing deoxygenated hgb

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31
Q

what results in greater cyanosis?

A

higher hgb levels

[testosterone supplementation]

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32
Q

these pts have little to no cyanosis

A

Anemic patients

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33
Q

PO2 of 40, 50, 60 equals:

A

sat of 70, 80, 90

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34
Q

PO2 of 50 =

A

paO2 of 26

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35
Q

Average oxygen consumption at rest is

A

2-4 ml O2/kg/minute

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36
Q

Fi02-Fe02 x Vm /weight in kg

A

VO2

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37
Q

FiO2 x Vm /weight in kg

A

DO2 (lungs)

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38
Q

will increasing FiO2 have any affect on DO2 if sat is 100%?

A

No, you need more hgb to increase O2 at that point

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39
Q

what 2 factors have greatest effect on 02 consumption and delivery?

A

hgb level and CO

40
Q

what is the limiting factor in delivery of O2 to tissues?

A

cardiovascular system

41
Q

what does the alveolar gas equation calculate?

A

alveolar partial pressure of O2 (PAO2)

fio2 x 6

42
Q

PaO2 can be determined by

A

fio2 x 5

43
Q

Pa-AO2 gradient is ≤ 10 mmHg with

A

FiO2 .21

44
Q

Pa-AO2 gradient is ≤ 50 mmHg with

A

FiO2 1.0

45
Q

CaO2 (mls/dL) x CO(mls/min)/kg/100

A

DO2

46
Q

what will you see with hypoventilation?

A

decreases 02 and increased CO2

47
Q

5 things that result from hypoxia?

A
  1. Hypoventilation
  2. Low partial pressure of oxygen in lung(PAO2)
  3. Low partial pressure of oxygen in arterial blood
    (PaO2)
  4. Low arterial oxygen saturation (SaO2)
  5. Low oxygen content (CaO2)
48
Q

what is cpr intended for?

A

to keep delivering oxygen to brain

49
Q

pulse ox is measured by Dual wavelengths of light by

A

660nm and 940 nm pass

through tissue and vascular beds via LED

50
Q

this results in SpO2 that is falsely high

A

COHgb

51
Q

MetHgb is similar to Hgb, how does the pulse ox differ?

A

If SaO2 > 85% then SpO2 will be

low, if SaO2 < 85% then SpO2 high

52
Q

what two things are pulse ox NOT affected by?

A

Fetal Hgb and Sickle Cell Anemia

53
Q

These two things result in falsely low SpO2

A

Improper fitting probe

SpO2 < 60%

54
Q

5 things that cause errors in pulse ox resulting in falsely low SpO2?

A
  • low Hgb concentration
  • Methylene blue
  • blue nail polish close to 660 nm
  • excessive motion
  • poor perfusion
55
Q

1 thing that causes falsely high SpO2?

A

ambient fluorescent light

56
Q

Measurement of CO2 during ventilatory cycle

A

capnography

57
Q

CO2 is measured by

A

infrared absorption.

58
Q

Airway gas is aspirated through tubing

to a measurement chamber

A

Sidestream

59
Q

CO2 is affected by

A

VO2
CO2 transport
Alveolar ventilation

60
Q

8 things that cause increased CO2 readings

A 
 Fever
 Physical activity
 Seizures
 Sepsis
 Hyperthyroidism
 Trauma and burns
 High carbohydrate diet
 Hypoventilation
61
Q

7 things that cause decreased CO2 readings

A 
 Hypotension
 Decreased cardiac output
 Right to left pulmonary shunt:
 Hypothyroidism
 Hypothermia
 Paralysis, motionless
 Hyperventilation
62
Q

Cardiac status and ventilator settings affect

A

elimination/evacuation of CO2, not production

63
Q

Patient metabolic status affects CO2 production. What does VO2 mirror?

A

CO2 level.

Percent change in VO2 can indicate what the EtCO2 will show.

64
Q

3 things that cause increased PetCO2

A

increased CO2 production and delivery to lungs
decreased alveolar ventilation
equipment malfunction

65
Q

3 things that cause decreased PetCO2

A

decreased CO2 production and delivery to lungs
increased alveolar ventilation
equipment malfunction

66
Q

Inaccurate low readings and waveforms are
common as contaminated exhaled gases are
mixed with ambient air

A

capnography in non-intubated patients

67
Q

Occurs during times without gas flow, such as
during an inspiratory pause or at the end of
inhalation.

A

static lung compliance

68
Q

static lung compliance is measured by

A

using plateau pressure

69
Q

end inhalation prior to exhalation

A

Plateau pressure:

70
Q

Plateau pressure is always lower than

A

Peak pressure

71
Q

Occurs during times of gas flow, during active inspiration, Measures lung compliance plus airway resistance

A

dynamic lung compliance

72
Q

dynamic lung compliance is measured by

A

Peak pressure

73
Q

what contributes to a decrease in dynamic compliance

A

Airway resistance

74
Q

Airway resistance measured using peak pressures can ____
from breath to breath while lung compliance mostly remains
_____

A

changed

unchanged

75
Q

highest circuit pressure
during inspiratory cycle
Indicator of dynamic compliance
when flow is occurring.

A

PIP

peak inspiratory pressure

76
Q

pressure during inspiratory pause,

no flow

A

Plateau pressure (Pplat)

77
Q

Normal FEV1 (Forced expiratory volume over one second)

A

at least 80% of vital capacity

78
Q

FEV1/FVC (Forced Expiratory Volume/Forced vital capacity) ratio normal

A

80%, declines with age

79
Q

Forced Expiratory flow (FEF 25%-75%) between 25% and 75% of exhaled breath normal is

A

4-5L/sec

80
Q

Least affected by patient effort (effort independent)

A

Forced Expiratory flow

81
Q

most objective measurement of airway resistance medium airways

A

Forced Expiratory flow

82
Q

Normal results are found in restrictive disease

A

Forced Expiratory flow

83
Q

Most sensitive indicator of small airway obstructive disease

A

Forced Expiratory flow

84
Q

Diffusion capacity (DL test) Can identify

A

shunt, VQ mismatch, fibrosis, emphysema

85
Q

what is diffusion capacity test?

A

Carbon monoxide inhaled then measured

 Measures gas ability to cross alveolar-capillary membrane

86
Q

how do restrictive lung volumes compare to normal values?

A

Reduced TLC, FRC, RV
Reduced FVC & FEV1
FEV1/FVC ratio preserved

87
Q

how do obstructive lung volumes compare to normal?

A

Enlarged TLC, RV, FRC

Reduced ERV

88
Q

Indicator of lung compliance (distensibility).

Yields information regarding leaks, lung over-inflation and obstruction

A

pressure volume loops

89
Q

Loops move based on

A

positive or negative pressure

90
Q

how do loops move during positive pressure vs spont respirations?

A

Counter-clockwise during positive pressure ventilation.

Clockwise direction during spontaneous respiration.

91
Q

Higher pressure moves loop

A

farther right.

92
Q

Slope = lung compliance. what do they indicate?

A

Flatter slope indicates decreased compliance

Steeper slope indicates increased compliance

93
Q

Restrictive Lung Disease flow volume loop characteristics

A

 Normal shape
 Lung volumes are smaller
 Flows are reduced

94
Q

obstructive lung disease flow characteristics

A

 Shape is caved in which indicates expiratory obstruction
 Lung volumes are larger
 Flows are reduced

95
Q

Obstructed flow will always yield a

A

flatter, less round

shape as air flow is impeded.

Principles 1 (12 decks)

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