Crit Care Pulmonary

Front 1

Ventilation

Back 1

movement of air in and out; how well we inspire O2 and expire CO2

Front 2

Respiration (Perfusion)

Back 2

transport of O2 and CO2 between the alveoli and pulmonary capillaries; occurs via diffusion

Front 3

Alveolar Capillary Membrane

Back 3

method by which O2 is transported to alveoli and CO2 is exhaled from lungs

Front 4

Compensation

Back 4

when portion of lung injured other alveoli will help out to make up for injury

Front 5

Ventilation Chemoreceptors

Back 5

activated by the SNS; Increase or decrease in chemoreceptors based on CO2 levels

Front 6

Negative Pressure

Back 6

how we breath

Front 7

Positive Pressure

Back 7

ventilator forces air and pressure into lungs; very uncomfortable/unnatural; reason why pts need sedation and pain meds so they can relax and let ventilator do job

Front 8

WOB

Back 8

compliance, recoil, resistance

Front 9

Compliance

Back 9

stretchability; "air in" how well do lungs let O2 in. EX. Pulmonary Fibrosis

Front 10

Recoil

Back 10

stretchability; "air out" how well does lung go back to original state and get CO2 out. EX. COPD

Front 11

Resistance

Back 11

size of airway. EX. ET Tube increases resistance; Asthma

Front 12

V/Q Mismatch

Back 12

dead space; shunt; silent

Front 13

Dead space

Back 13

V>Q; pulmonary embolis. Adequate ventilation but not perfusion

Front 14

Shunt

Back 14

V<Q; atelectasis; pneumonia; fluid. Perfusion works but ventilation is compromised "lungs full"

Front 15

Silent

Back 15

V = Q; both inadequate. ARDS "stiff, wet, lungs"

Front 16

PaO2

Back 16

partial pressure of oxygen, direct measurement. normal 80-100

Front 17

SaO2

Back 17

amount of oxygen bound to hemoglobin, indirect measurement. normal 92-99%

Front 18

Affinity

Back 18

capacity of hemoglobin to bind with O2

Front 19

High:

Back 19

HGB combines readily with O2 at the alveolar-capillary membrane. Does not release O2 at tissues. pH- alkalosis or > 7.45

Front 20

Low:

Back 20

HGB doesn't bind readily with O2 at the alveolar-capillary membrane (partial binding). Releases more O2 at tissues. pH- acidosis 7.26-7.34

Front 21

Low-Low:

Back 21

No binding of HGB and O2 at alveolar-capillary membrane. No O2 released at tissues. pH- <7.25 (profound shock states- respiratory failure)

Front 22

Shift to the Left:

Back 22

increased affinity of HGB for O2; less released at tissues. aLkalosis, Low temp, Low CO2 (hyperventilation)

Front 23

Shift to the Right:

Back 23

decreased affinity for HGB for O2; more released to tissues. Reduced pH, Rise in temp, Rise in CO2 (COPD exacerbation, impending respiratory arrest)

Front 24

Geriatric Considerations: Increased Function

Back 24

V/Q mismatch
AP diameter
Residual Volume
(COPD)

Front 25

Geriatric Considerations: Decreased Function

Back 25

COugh and laryngeal reflexes
mucociliary escalator
alveoli
respiratory muscle strength

Front 26

When older adults develop respiratory failure, they often manifest non-specific symptoms of hypoxemia such as....

Back 26

agitation
confusion
disorientation
lethargy
dypsnea
chest pain

Front 27

PaO2

Back 27

80-100 worried < 60

Front 28

SaO2

Back 28

92-99%

Front 29

pH

Back 29

7.35-7.45

Front 30

PaCO2

Back 30

35-45

Front 31

HCO3

Back 31

22-26

Front 32

Respiratory Acidosis

Back 32

PaCO2 > 45
pH <7.35

Front 33

Metabolic Acidosis

Back 33

HCO3 < 22
pH < 7.35

Front 34

Respiratory Alkalosis

Back 34

PaCO2 < 35
pH > 7.45

Front 35

Metabolic Alkalosis

Back 35

HCO3 > 26
pH > 7.45

Front 36

Type I Hypoxemic Respiratory Failure

Back 36

due to disruption in O2 transport.
Decreased SaO2
Decreased PaO2
Increased Respirations
r/t pneumonia, ARDS, pulmonary edema, atelectasis, aspiration

Front 37

Type II Hypercapneic Hyposemic Respiratory Failure

Back 37

due to disruption in O2 transport and ventilation.
Increased CO2
Decreased SaO2
Decreased PaO2
Decreased pH
Respirations can increase or decrease
r/t COPD, neuro issues, muscular failure

Front 38

Nasopharyngeal Airway

Back 38

neonate-adult size. Measure nose to ear for size. Need an order to suction. Comes out q 8 to be cleaned. Weak muscles, no gag reflex

Front 39

Oropharyngeal Airway

Back 39

neonate-adult size. Measure corner of lip to ear. Protects tongue from falling over airway. Not good gag. Need order

Front 40

Nasal Cannula

Back 40

...

Front 41

Non-rebreather Mask

Back 41

resevoir bag. needs to be filled before putting on pt

Front 42

venturi mask

Back 42

delivers 40-100% oxygen

Front 43

Aquanox

Back 43

high flow humidified air >15 L through nasal cannula

Front 44

Non-invasive intubation

Back 44

supports ventilation without insertion of artificial airway. CPAP and BIPAP

Front 45

CPAP

Back 45

one pressure setting delivered during inspiration and expiration. (5-15). Recruits or opens alveoli. Prevents atelectasis on expiration. Reduces preload and afterload. Increased FRC

Front 46

BIPAP

Back 46

used prior to mechanically ventillating. two pressure levels for inspiration and expiration. IPAP/EPAP (5/15). Decreases WOB. More effective than CPAP

Front 47

Indications for NIV

Back 47

exacerbation of COPD
Cardiopulmonary edema
Respiratory failure in pt with DO NOT INTUBATE order

Front 48

CI for NIV

Back 48

respiratory arrest- pt cannot protect airway - ventilate
Appropriate interface unavailable- mask does not fit
Hemodynamic instability- intubate and more aggressive tx
ACute MI- due to c/o and BP
Agitated/Uncooperative- pulling mask off
Cannot maintain airway or has copious secretions
Recent airway or GI surgery