# T2 - Blueprint (Josh) Flashcards

1
Q

V/Q Ratio:

Avg ventilation is —

Avg perfusion is —

Which means, normal V/Q Ratio is —

A

V = 4 L/min

Q = 5 L/min

V/Q = 4/5 = 0.8 (more perfusion than ventilation)

2
Q

What would cause a V/Q less than 0.8?

A

less O2 going into the the blood in lungs

• Shunting
3
Q

What would cause a V/Q more than 0.8?

A

less blood getting into the alveoli than normal

• PE
• Cardiogenic shock
4
Q

What level of shunting is abnormal?

What level of shunting is life-threatening?

A

greater than 10%

greater than 30%

5
Q

What is the horizontal axis of the Oxyhemoglobin curve?

Vertical axis?

A

PaO2 (oxygen unbound and able to get to tissue)

SaO2 (oxygen bound to Hgb)

6
Q

When the Oxyhemoglobin Curve shifts right, what does this mean?

A

Hgb gets rid of O2 more readily

• Hypercapnia
• Acidosis
• Rise in 2,3 DPG
• Fever
7
Q

When the Oxyhemoglobin Curve shifts left, what does this mean?

A

Hgb holds on to the O2 so it doesn’t perfuse to tissue

• Alkalosis
• Low CO2
• Low temp (CoLd)
• Low 2,3 DPG
• Increased Carb. Monoxide
8
Q

What are two ways to estimate shunting?

A

PaO2/FiO2 Measurement (normal is 286)

9
Q

What does a wide A-a gradient (greater than 20 mmHg) mean?

A

more O2 in alveoli than in arterial blood

indicating there is a lot of shunting going on

10
Q

With V/Q Mismatch, the A-a gradient is —

With Alveolar Hypoventilation, the A-a gradient is —

A

wide (because the O2 in alveoli isn’t perfusing well)

normal (because the Alveoli aren’t getting O2)

11
Q

Is this a health lung?

PaO2 = 95

FiO2 = 50%

A

95 divided by 0.5 = 190

not a healthy lung function

too much shunting

normal should be 286

12
Q

ABGs:

Normal PaO2

Normal PaCO2

A

PaO2 = 80-100 mmHg

PaCO2 = 35-45 mmHg

13
Q

ABGs:

Normal Bicarb

A

21-28 mEq/L

• rises when acidic to buffer
14
Q

ABGs:

Normal SaO2

A

95-100

15
Q

What is a normal PETCO2?

A

20-40 mmHg

• Partial Pressure of End Tidal CO2

***Measures amount of expired CO2 in exhaled air

16
Q

What conditions raise PETCO2?

A

anything that reflects inadequate gas exchange or an increase in cellular metabolism (both of which increase production of CO2)

• Hypoventilation
• Bronchial intubation
• Partial airway obstruction
• COPD
• Fever
• Increased CO and BP
17
Q

What conditions lower PETOC2?

A

anything that reflects poor pulmonary ventilation

• PE
• Apnea
• Hypothermia
• Sedation
• Sleep
• Cooling
• Reduced CO and BP
18
Q

Bronchoscopy:

NPO how long?

A

8 hrs prior

***assess gag reflex before allowing to drink

19
Q

Bronchoscopy:

A

mild fever around 24 hours is not uncommon

20
Q

Thoracentesis:

How much can be withdrawn daily?

A

1000mL

21
Q

Thoracentesis:

Why do we need them to deep breath post procedure?

A

help expand the lungs

22
Q

BNC:

Rates?

FiO2?

A

1-6 L/min

24-44%

23
Q

Rates?

A

min of 5 L/min

***monitor for aspiration

***no humidity

24
Q

Partial Rebreather:

Rates?

FiO2?

A

6-11 L/min

60-75%

***1/3 Vt with each breath

25
Q

Nonrebreather:

Rates?

FiO2?

A

12-15 L/min

greater than 90%

26
Q

Rates?

FiO2?

A

never less than 8 L/min

28-100%

27
Q

What do we nee do with FiO2 amounts greater than 50%?

A

high flow setup

28
Q

Rates?

FiO2?

A

never less than 8 L/min

28-100%

29
Q

What is the most accurate way to deliver O2?

A

***ideal for CO2 retainers

30
Q

How do you determine correct placement of ETT?

A

End-tidal CO2 detector

Auscultate x 5

Inspect chest expansion

CXR to determine depth (3-4 cm above carina)

31
Q

With ETT, what pressure should cuff be?

A

14-20 mmHg

32
Q

When suctioning ETT, what should we NEVER use?

A

saline

33
Q

ETT Extubation Process

A

Hyperoxygenate first

Suction ET and Oral cavity

Rapidly deflate cuff

Remove at PEAK INSPIRATION

Instruct client to cough

Monitor q 5 mins

34
Q

Trach:

How can we prevent aspiration of food?

A

elevate HOB at least 30 ins after eating

35
Q

Trach:

How often should we turn client?

A

q 1-2 hrs and support out of bed activities and early ambulation

36
Q

Trach:

What kind of swabs and mouthwash?

A

those without ETOH

Chlohexidine

37
Q

Mechanical Ventilation:

What are the Modes we talked about?

A

AC (Assist Control)

PRVC

Synchronized Intermittent Mandatory Ventilation (SIMV)

BiPAP

CPAP

38
Q

Mechanical Ventilation:

What are the Setting we talked about?

A

Tidal Volume (Vt)

Mniute Ventilation

I:E Ratio

Rate

FiO2

PIP (Peak Inspiratory Pressure)

CPAP

PEEP (Positive End Expiratory Pressure)

Pressure Support

39
Q

Mechanical Ventilation:

How is Minute Ventilation calculated?

A

MV = RR x Vt

RR = 12 and Vt = 600

Then, MV = 12 x 0.6 = 7.2 L/min

40
Q

Mechanical Ventilation:

What is normal I:E ratio and what would we set it at for COPD?

A

normal is 1:2

set at 1:4 for COPD to prevent breath stacking

41
Q

Mechanical Ventilation:

Which setting provides positive pressure at end of expiration?

Which setting provides positive pressure at beginning of inspiration?

A

PEEP

Pressure Support

42
Q

Mechanical Ventilation

Which setting augments the patients own Vt?

A

Pressure Support

***assists movement of air through tubing in order to augment the client’s Vt

43
Q

Mechanical Ventilation:

— is the amount of pressure it takes for ventilator to deliver Vt or breath.

Number changes from breath to breath

A

PIP

**if increases, look for kink, biting, or mucous plug

44
Q

Describe the Cardiovascular Compromise that being on a Vent can cause?

A

Increases intrathoracis pressure, which leads to

decreased venous return, which leads to

decreased CO and BP, which leads to

tachycardia, hepatic dysfunction, renal dysfunction and impairment of cerebral venous return (ICP)

45
Q

VAP:

What are some things we can do to prevent VAP?

A

HOB elevated 30-45 degrees

ETT w/ dorsal lumen to allow continuous suction above cuff

Oral care

Handwashing

46
Q

What are included in ventilator bundles?

A

VAP precautions

DVT precautions

Gastric Reflux precautions

Sedation vacations

47
Q

What would CSF lead look like with a nose bleed?

A

positive glucose test

***halo on filter paper

48
Q

What should we teach regarding a Rhinoplasty?

A

Avoid forceful coughing/straining

Do not sneeze with mouth closed

Avoid ASA and NSAIDs

Humidifier to prevent dry mucosa

49
Q

If they have neck trauma, what kind of intubation would we use?

A

nasal intubation so we don’t have to bend neck

50
Q

Client presents with persistent unilateral ear pain and unexplained oral bleeding?

A

Facial, Oral, or Neck Cancer

51
Q

Asthma affects the —, not the —

A

airways

alveoli

52
Q

Asthma:

What is criteria for Mild Intermittent?

A

s/s less than twice a week

53
Q

Asthma:

What is criteria for Mild Persistent?

A

s/s more than twice a week, but not daily

54
Q

Asthma:

What is criteria for Moderate Persistent?

A

s/s daily with exacerbations twice a week

55
Q

Asthma:

What is criteria for Severe Persistent?

A

s/s occur continually with frequent exacerbations

56
Q

What Pulmonary Function Test can diagnose the severity of Asthma symptoms?

A

Forced Vital Capacity (FVC)

Forced Expiratory Volume in First Second (FEV1)

Peak Expiratory Flow Rate (PEFR)

57
Q

Ashtma:

What decrease in FEV1 is expected with Asthma?

A

15-20%

58
Q

Asthma:

With bronchodilators, what change can we expect in FEV1?

A

increase of 12%

59
Q

Which corticosteroids should be taken with food?

A

Prednisone

60
Q

Patient education for Asthma client?

A

Drink plenty of fluids to promote hydration

Encourage reg exercise (may require pre-medication)

Use hot water in wash to eliminate dust mites in linens

61
Q

COPD is characterized by — and —-

A

bronchospasm

dyspnea

62
Q

Etiology of COPD

A

Cigs

AAT deficiency

Exposure to air pollution

63
Q

COPD:

— is an alveolar problem

— is an airway problem

A

Emphysema

Chronic Bronchitis

64
Q

What sweat chloride test is diagnostic for CF?

A

60-200

***Normal is 5-35 mEq/L

65
Q

How do you deal with exacerbations of CF?

A

Avoid mechanical vent

Supplemental O2

Heliox (50% helium; 50% O2)

Airway clearance techniques

Meds

66
Q

Chest Tube Drainage System:

Which chamber should we see continuous bubbling?

A

Chamber 3 (Suction)

***bubbling in chamber 2 is an air leak

67
Q

Chest Tube Drainage System:

Where should we keep the water line in Chamber 2?

A

2 cm

68
Q

Chest Tube Drainage System:

What level is common in Chamber 3?

A

-20cm H2O

69
Q

What amount of fluid intake for pneumonia to promote thinning of secretions?

A

2-3 L/day

70
Q

Pneumonia:

What should we remember about Cephalasporins and Penicillins?

A

take with food

**obtain sputum culture BEFORE antibiotic therapy

71
Q

Pneumonia:

What are adverse effects of glucocorticoids?

A

Hypokalemia

Immunusuppression

Fluid retention (weight gain)

Hyperglycemia

Poor wound healing

72
Q

Flu:

A

24 hr before symptoms until about 5 days after

73
Q

TB:

When is client no longer considered infectious?

A

after 3 negative sputum cultures

74
Q

TB Meds:

Isoniazid

A

Take on empty stomach

Avoid ETOH due to hepatotoxicity

75
Q

TB Meds:

Rifampin

A

Orange pee

Hepatotixic (jaundice0

Use a condom (interferes with oral contraceptives)

76
Q

TB Meds:

Pyranzinamide

A

Drink a glass of H2O with each dose and increase fluids throughout day

Avoid ETOH due to hepatotoxicity

77
Q

TB Meds:

Ethambutol

A

E for Eye (Vision issues)

No for children less than 13

78
Q

TB Meds:

Streptomycin Sulfate

A

Otoxic (report ringing in ears)

79
Q

ARF:

What is the hallmark sign of Type I?

A

hypoxemia (PaO2 less than 60)

***oxygenation problem

80
Q

ARF:

Diagnostic criteria for Type I?

Diagnostic criteria for Type II?

A

PaO2 less than 60

PCO2 greater than 45 and pH less than 7.35

81
Q

Treatment regimen for ARF?

A

Treat underlying cause

Assess ABGs

Correct Acidosis

Prevent complications

82
Q

Nursing care of ARF?

A

Unilateral – good lung down

Bilateral – HOB at east 30 degrees and turn frequently

83
Q

Early on with SARS, what would we see?

A

early: fever, headache, bodyache, cold symptoms

days 2-7: dry cough, SOB, hypoxia with cyanosis

84
Q

ARDS:

What is mild?

A

PaO2/FiO2 of 201-300 with CPAP of 5 cm or greater

85
Q

ARDS:

What is Moderate?

A

PaO2/FiO2 of 101-200 with CPAP of 5cm or greater

86
Q

ARDS:

What is Severe?

A

PaO2/FiO2 of 100 or less with CPAP of 5 cm or greater

87
Q

Difference between Pneumonia and ARDS?

A

pneumonia is at one site

ARDS is diffuse throughout whole lung

88
Q

What will CXR look like with ARDS?

A

white out

89
Q

What are the Phases of ARDS?

A

Exudate Phase

Fibroproliferative Phase

Resolution Phase

Chronic ARDS Phase

90
Q

ARDS:

What is the FiO2 goal?

A

SaO2 of 90% with FiO2 less than 65%

91
Q

ARDS:

What do you do with the I:E Ratio?

A

inverse it so that inspiration is longer than expiration

***requires a neuromuscular block

92
Q

Which lung disease will we use the crazy rolling bed?

A

ARDS

93
Q

ARDS:

Why would you allow some hypercapnia?

A

reduces atelectrauma and baratrauma

94
Q

ARDS:

Which modes on Vent would be used?

A

AC (to give lungs a rest)

Pressure Control for worsening ARDS to reduce volutrauma)

95
Q

ARDS:

Why use the PEEP mode?

What complications can this cause?

A

recruits collapsed alveoli to decrease pulmonary shunting

can cause barotrauma b/c increased pressure can decrease venous return

96
Q

Diagnostic criteria for Type II DM?

A

A1c of 6.5% (normal is 4-6)

Fasting BS greater than 126

2 hr BS greater than 200

Casual BS greater than 200

97
Q

Describe the Somogyi Effect and how to prevent?

A

tendency of body to respond to hypoglycemia by rebounding with severe hyperglycemia

usually in sleep hours

prevent by taking midnight snack before bed

98
Q

To prevent kidney damage from DM, how much fluid should we encourage?

A

2-3 L/day

no sodas or ETOH excess

99
Q

Oral Glycemics:

What should we remember about Metformin?

A

Farts (GI effects)

• take with food
• never crush or chew

Lactic Acidosis

Hold 48 hrs before dye procedure

100
Q

Oral Glycemics:

What should we remember about Sulfoylureas (Glip, Glim, Glyb)?

A

Monitor for hypoglycemia

Take 30 mins before meals

Avoid ETOH (disulifram)

101
Q

Oral Glycemics:

Which class of medications can mask the tachycardia caused by hypoglycemia, a side effect of oral glycemics?

A

Beta Blockers

102
Q

Oral Glycemics:

Which med requires that you monitor the A1c every 3 months?

A

Repaglinide

103
Q

Oral Glycemics:

Take —- 15-30 mins before meals.

A

Repaglinide

104
Q

Oral Glycemics:

What do we do if we miss a dose with Repaglinide?

A

skip it

105
Q

Oral Glycemics:

Which one can make you gain weight (fluid) and effect Oral Contraceptives?

A

Pioglitazine

106
Q

Oral Glycemics:

Which one requires you to keep dextrose paste on hand in case you have a hypoglycemic episode?

A

Acarbose

Miglitol

107
Q

Oral Glycemics:

Which one do you take with the first bite of each meal?

A

Ararbose

Miglitol

108
Q

Oral Glycemics:

Which ones are subQ?

A

Exenatide (before morning/evening meals)

Pramlinitide (before major meals)

109
Q

Oral Glycemics:

Hold — if A1c is greater than 9%.

A

Pramlinitide (subq)

110
Q

How many carbs do you give with mild hypoglycemia (less than 60)?

Moderate hypo (less than 40)?

A

Mild = 10-15 g

Moderate = 15-30 g

111
Q

What can we give that is 15 g of carbs if they are facing mild hypoglycemia?

A

4 oz fruit juice or soft drink (not diet)

8 oz nonfat or 1% milk

3-4 glucose tablets

8-10 hard candies

1 T of honey, sugar, or corn syrup

112
Q

If they are unconcious and cannot take PO 15 g or carbs, what can we do?

A

25-50 mL of D50W IV push

…or…

Glucagon 1 mg IM or SQ

113
Q

Rehydration protocol for DKA?

A

First hr: 15-20 mL/kg/hr or NS (isotonic)

Then: 1/2 NS (hypotonic) at 4-14 mL/kg/hr

114
Q

Rehydration protocol for HHS?

A

1 L of NS until BP stable

then, 1/2 NS at 100-200 mL/hr

115
Q

HHS:

What level of osmolality will we see?

A

greater than 320 mOsm/kg

normal is 280

116
Q

Metabolic Syndrome:

What is the Abdominal Obesity criteria?

A

Men: greater than 40 in

Women: greater than 35 in

117
Q

Metabolic Syndrome:

What is the Hyperglycemia criteria?

A

Fasting BS of 100 or more

…or…

on treatment for elevated glucose

…or…

Abnormal A1c (5.5-6.0)

118
Q

Metabolic Syndrome:

What is the HTN criteria?

A

130/85 or greater

…or…

on treatment for HTN

119
Q

Metabolic Syndrome:

What is Hyperlipidemia criteria?

A

Triglycerides greater than 150

HDL greater than 40 in men or 50 in women