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107 Cards in this Set
- Front
- Back
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What is normal Vt?
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3.5-8.5 L
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Spontaneous breathing pressure is + or - ?
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Negative
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What is normal I:E ratio?
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1:2-3
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What is Diffusion?
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Mechanism by which molecules move from an area of high concentration to an area of lower concentration
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The oxyhemoglobin dissociation curve is best described as?
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The ability of hgb to bind with O2
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SaO2
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% of O2 sat in the arterial blood being delivered
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PaO2
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Partial Pressure of O2
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SvO2
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% of O2 returning to the heart (venous)
a reflection of the amount of O2 the tissues use |
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What might be the cause of low SvO2?
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Early sepsis
CHF Decreased CO |
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What might be the cause of HIGH SvO2?
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Late sepsis
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PaO2/FiO2 Ratio
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Quick estimate of hypoxemia
Normal: >300 <300 Acute Lung Injury <200 Always ARDS |
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Vt
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amount of air taken in and out of lungs
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Inspiratory Reserve Volume (IRV)
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extra amount lungs can take in after a big deep breath
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Expiratory Reserve Volume (ERV)
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Amount left in lungs after a huge expiration
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Residual Volume (RV)
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Amount left over after ERV
(whats trapped in the lungs) |
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PaO2/FiO2 Ratio
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Quick estimate of hypoxemia
Normal: >300 <300 Acute Lung Injury <200 Always ARDS |
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Vt
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amount of air taken in and out of lungs
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Inspiratory Reserve Volume (IRV)
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extra amount lungs can take in after a big deep breath
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Expiratory Reserve Volume (ERV)
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Amount left in lungs after a huge expiration
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Residual Volume (RV)
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Amount left over after ERV
(whats trapped in the lungs) |
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Where does gas exchange occur in the lungs?
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Bases
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What is the best indicator of balance between O2 transport and O2 consumption?
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SvO2
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What is the most impt determinant of O2 transport? (delivery)
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CO
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What is the respiratory system's 2 major functions?
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1.) Deliver O2 into the arterial blood
2.) Removal of CO2 from mixed venous blood |
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Acute Respiratory Failure (ARF)
-is defined as |
A change in resp gas exchange such that normal cellular fxn is jeaporadized.
PaO2 < 60 mm Hg PaCO2 > 50 mm Hg |
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What are the 3 main causes of ARF? (resp)
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1.) Alveolar Hypoventilation
2.) VQ Mismatching 3.) Intrapulmonary Shunting |
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In Alveolar Hypoventilation what happens? What will the CO2 be?
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The amount of O2 being brought to alveoli is insufficient to meet the metabolic needs of the body
CO2 will be HIGH |
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Causes of Alveolar Hypoventilation
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After surgery--pain
overdrugged neuro |
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What is VQ Mismatching?
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When ventilation & blood flow are mismatched in various regions of lung.
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What is the most common cause of hypoxemia?
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VQ Mismatching
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What are causes of HIGH VQ ratio?
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PE
Cardiogenic Shock |
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What are causes of LOW VQ ratio?
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Partially collapsed or partially filled with fluid alveoli
-atelactasis, PNA |
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What is intrapulmonary shunting?
--causes |
Extreme form of VQ mismatching
LOW VQ ratio Atelactasis, hemothorax, pneumothorax, ventricular septal defect |
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Clinical Presentations of ARF
(resp) |
Hypoxemia, restlessness, tachypnea, restless, dyspnea, tachycardia, confusion, diaphoresis, anxiety, hypercarbia, HTN,
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What is the 3rd most common cause of death in people admitted to hospital?
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PE
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What are 3 types of embolism?
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Fat, air, thrombolytic (dvt)
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What is the most common cause of PE?
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DVT
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D Dimer
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nonspecific to PE
will never have a PE without HIGH D Dimer |
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The most definitive test for a PE is
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Pulmonary angiogram
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PE produce all the following physiologic changes but
-pulm HTN -aterial hypoxemia -LOW PCO2 -LV heart failure |
LV heart failure
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Tension Pneumothorax
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Medical Emergency
-Pressure builds and there can be a mediastinal shift |
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S/S of tension pneumo
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sob, asymmetrical chest expansion, hypoxemia, hypercapnia, crepitus, tracheal shift, decreased CO
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ARDS
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-Noncardiac pulmonary edema caused by increased alveolar capillary membrane permeability
-Result of inflammatory process -Flooding of the lungs |
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Primary cause of ARDS
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Injury begins at the lungs
--PNA, Pulm Contusion |
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Secondary Causes of ARDS
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Indirect injury from a process that began outside the lungs
--Pancreatitis, Trauma*, sepsis*, multiple blood transfusions |
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4 Key Criteria of ARDS
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1.) acute onset
2.) bilateral infiltrates 3.) hypoxemia 4.) lack of left atrial HTN |
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Pathophys of ARDS
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damage to alveolar capillary membrane causes increased permeability --fluid accumulation and edema in alveoli.
-fluid deactivates surfactant--alveoli collapses |
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How should you position an ARDS pt
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healthy lung down
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Dosing for Nitric Oxide
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1-80 ppm
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Nitric Oxide (NO) uses
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-redistributes pulm blood to areas where ventilation is more efficient
-potent selective pulm vasodilator -improves VQ mismatching |
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Causes of Resp Acidosis
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-head trauma
-neuro issues -COPD, PE, PNA, ARDS, CHF, -extreme obesity -mech ventilation |
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Causes for Resp Alkalosis
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-excess excretion of CO2
-Fever -Excessive Ventilation -Early resp conditions -Pain, Anxiety |
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Causes of Met Acidosis
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Used it-ASA poisoning, toxins, DKA, renal failure, shock, Diamox
Lost it-Diarrhea, drainage tubes below umbilicus |
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Anion Gap
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3-11 mEq/L (Na-(Cl + CO2) )
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Causes of Met Alkalosis
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Too little acid-drainage tubes above umbilicus, vomiting, diuretic tx
Too much bicarb-excessive intake |
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Base Excess
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Norm +2- -2
>2 met alkalosis <2 met acidosis |
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If lung tx pt has escalation of pressor need, what does this indicate?
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Should prompt investigations for Sepsis, bleeding, myocardial dysfunction, hyperinflation of native lung
--should be weaned off pressors in 1st 18 hours |
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What is the goal FiO2 for lung tx pts?
-what if it is higher than that? |
30-40%
if >40% prob graft failure |
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What are common early complications for Lung tx pts?
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Primary Graft Dysfunction
Pleural Space Infections Renal Failure GI Complications |
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Primary Graft Dysfunction for lung tx
-stats -tx |
10-25%; 30 day mortality 42%
-Fluids, diuresis, severe-ecmo |
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What med severely increases Prograf levels?
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Cardizem
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What are side effects of Prograf?
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Nephrotoxic
HTN high BS HL |
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Common Complications for CF pts
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pancreatic insufficiency,
male infertility, biliary cirrhosis |
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Meds that decrease viscosity of mucous
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pulmazime
hypertonic NaCl |
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Two Causes of Resp Failure
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1. Pump Failure
2. Lung Failure |
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Causes of pump failure--resp failure
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drug od, CVA, head trauma, myesthenia gravis, polio, guillain barre, ALS, spinal cord trauma/tumors, flail chest, kyphosis, burns, vocal cord paralysis, tracheal stenosis,
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Causes of Lung Failure--resp failure
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asthma, bornchitis, COPD, PE, ARDS, PNA, Alveolar Hemmorrhage, CHF, Valvular abnormalities, Dysfunctional hgb's
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How will pt most likely present with methehemoglobinemia?
-norm range for met Hb |
Blue, but still talking
-<2% |
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When using NMBA's, what are the nurses responsibilities?
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-MUST have concurrent administration of sedation/analgesia
-MUST be on a vent -MUST have back up rate on vent |
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Vecuronium
-loading dose -vent? -CV effects? -excreted where? |
-loading dose: 0.08-0.1mg/kg IVP over 30-60 sec
-Must be on a vent -Has the least CV effects -excreted thru liver & kidneys |
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Cistracurium
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-loading dose 0.1mg/kg IVP
-IV infusion 0.5-10 mcg/kg/min Onset 3-6 min low CV risk |
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Rules for checking TOF (Train of Four)
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Check Baseline
Check Q15min x 1 hour Check Qhour x 3 hours Then Q4 & PRN |
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O2 toxicity
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>50% for longer than 24 hours
often can be permanent damange |
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Low Flow O2
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Amount of O2 fluctuates w/ varying inspiration depths
-ie-NC, Simple face mask, partial non-rebreather, non-rebreather |
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High Flow O2
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Stable O2 levels independent of inspiration changes
-Venturi Mask -large volume aerosol systems |
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What delivery gives the most specific amount of O2?
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Venturi Mask
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Calculating FiO2
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(NC in L x 4) + 20 = FiO2 %
or (FiO2 % -20) / 4 = NC in L |
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Oropharyngeal Airway
-when used? -how to measure? |
unconscious pt only
ear lobe to corner of mouth |
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Nasopharyngeal Airway
-when used? -how to measure? |
conscious pt
ear lobe to nose |
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What do you need for an intubation?
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intubation tray
rolled towel-for underneath shoulders ambu bag connected to 100% O2 meds pulse ox suction |
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Where is ETT inserted to?
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2-4cm above carina
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How do you confirm ETT placement?
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1.) yellow CO2 detector
2.) auscultate 3.) cxry |
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Cuff Pressure
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25-30 cm H2O
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Volume Control Vent Modes
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Breath delivered until preset volume reached
pressure required to administer breath varies, Vt stays constant |
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Pressure Control Vent Modes
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Vent delivers a breath until preset pressure is reached
Vt will vary, pressure stays constant |
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Vt Tidal Volume
-def -norm |
Volume of gas moved into or out of lung with each inhalation and exhalation
5-8 mL/kg |
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Compliance
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strechability of the lung
--any disease that stiffens, restricts, causes congestion, or is space occupying can decrease compliance |
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What is the indicator for barotrauma?
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PAP
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Peak Airway Pressure (PAP)
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Pressure required to deliver Vt
Levels >35cm H2O usually indicate high resisitance and risk for barotrauma should be <35 |
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What can cause increased PAP's?
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Mucus plugs, PE, Bronchospasm, pneumo, tamponade
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Assist Control Vent Mode
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-Preset rate & Vt
-Mechanical & Spontaneous breaths will receive SAME Vt -uses to "rest" pt -Volume mode |
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What happens if rate on assist control is too high?
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can cause resp alkalosis
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SIMV (Synchronized Int Mandatory Vent)
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-Preset rate and Vt
-Spontaneous breaths are at pts OWN Vt -2nd most commonly used -Volume Mode |
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Pressure Control Ventilation (PCV)
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-Preset pressure
-Delivers volume to a SET inspiratory P -requires sedation/paralytic -can inverse I:E ratio |
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What kind of pts is PCV (Pressure control ventilation) good for?
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-pts w/ increased risk of barotrauma
-pts w/ decreased compliance |
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What happens when I:E ratio is inversed?
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-can better ventilate pt
-keeps alveoli more open (because they are decreased/closed during expiration) |
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Pressure Support Ventilation (PSV)
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Pressure set to assist the inspiratory phase on spontaneous breaths ONLY
--its the inspiratory portion of BiPAP --never a mode on its own |
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When is Pressure Support Ventilation used?
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-SIMV (always)
-weaning modes -BiPAP -CPAP (always) |
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Positive End-Expiratory Pressure (PEEP)
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-Application of + pressure in airways at end expiration, keeping alveoli open during resp
-5-20cm H2O |
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Pressure Regulated Volume Control
(PRVC) -def -indications |
-P and V preset
-P is continuously regulated to assure Vt -indications: decreased compliance/ARDS |
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PCV differs from SIMV how?
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SIMV is volume regulated, PCV is pressure regulated
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What vent settings hasa preset Vt and preset rate, and if pt initiates breath, will receive presetn Vt?
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A/C
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What is a complication of mechanical ventilation & PEEP?
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Reduced CO
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If RR up, CO2______
If RR down, CO2______ if Vt up CO2______ if Vt down CO2______ |
down
up down up |
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If O2 up PaO2_______
if O2 down PaO2_______ |
up
down |
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Negative Inspiratory Force (NIF)
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-Weaning measure
-pt taken off vent, coached to inspire forcefully, best effort recorded -- -20cmH2O or less -more - the better |
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Vital Capacity
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V of gas exhaled after deepest poss inspiration
-needs to be > 10-15mL/kg of baseline |
