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45 Cards in this Set

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What values are measured in an ABG report?
pH
PaCO2
PaO2
SaO2
HCO3-
Base excess/deficit
Normal pH?
7.35 to 7.45
Normal PaCO2?
35 - 45 mmHg
Normal PaO2?
80-100 mmHg

(usual goal is to maintain
PaO2 between 60-100mmHg)
Normal SaO2?
greater than 94%

(normal saturation is 94% or
greater, but anything
greater than 90% is usually
adequate)
Normal HCO3-?
22-26 mEq/L
Normal base excess/deficit?
-2 to +2

(-2 refers to an acidic base and +2 refers to an alkaline base)
Define hyperventilation?
a state of ventilation in excess of that required to eliminate the normal venous carbon dioxide produced by cellular metabolism...measures the ventilation of the ALVEOLI, not the person's respirations
What part of brain controls respiratory center?
medulla oblongata
What helps the lungs push and pull air in and out?
diaphragm
intercostal muscles
accessory muscles including
scalenes, sternocleido-
mastoid, pectoralis minor,
erector spinae
What can cause hyperventilation?
anxiety
infections
drugs
acid-base imbalance
hypoxia associated with PE
or shock
fever
salicylate (aspirin)
amphetamines
diabetic ketoacidosis
Define hypoventilation?
occurs when alveolar ventilation is inadequate to meet the body's oxygen demand or to eliminate sufficient carbon dioxide.
As alveolar ventilation decreases, PaCO2 is elevated..measures ALVEOLI ventilation, not person's respiration
What can cause hypoventilation?
severe atelectasis
inappropriate administration
of excessive oxygen in
clients with COPD
Define atelectasis?
collapse of the alveoli that prevents normal respiratory exchange of oxygen and carbon dioxide...as alveoli collapse, less of lung can be ventilated and hypoventilation occurs
Why does inappropriate administration of excessive oxygen result in hypoventilation in COPD patients?

1 to 3 L/min...this may result in?

respiratory arrest
Because the patient has adapted to a high carbon dioxide level, and carbon dioxide-sensitive chemoreceptors are essentially not functioning.
The stimulus to breathe is a decreased PaO2.
If excessive oxygen is administered, the oxygen requirement is satisfied and stimulus to breathe is negated.

What concentration of oxygen prevents the PaO2 from falling and obliterating stimulus to breathe?

hypoventilation...and the excessive retention of carbon dioxide may lead to?
What is the best index of alveolar ventilation?
PaCO2 is the best index of alveolar ventilation
Define tachypnea?
abnormally rapid respiration...not synonymous with hyperventilation because breaths can be rapid, but shallow...so there's not enough oxygen going in and and may not be blowing enough carbon dioxide off...so with tachypnea, there could be hypoxia
Define hypoxemia?
?
What is PaO2?
pressure exerted by O2 dissolved in plasma of arterial blood
What is SaO2?
amount of hemoglobin combined with oxygen compared to the total amount of hemoglobin
What is CaO2 (oxygen content)?
actual quantity of O2 in each 100 ml of blood, expressed in ml...

this value includes both the amount dissolved in the plasma and carried on the Hgb, but an acceptable clinical shortcut is to calculate only the amount carried on the Hgb
What does the oxyhemoglobin dissociation curve show?
as the oxygen level in the arterial blood goes up, the saturated oxygen level goes up...when the saturated oxygen level gets up to 100, the arterial oxygen level is higher than the range we want to keep it between...so over-oxygenation occurs if there's 100% SaO2)
If hemoglobin is down, and SaO2 is high, is oxygenation considered high or low?
oxygenation is low resulting in hypoxemia
What does NRB stand for?

It's the highest oxygen level of low-flow systems
non-rebreather mask...what is known about the NRB mask as far as the oxygen content that it delivers?
If PaCO2 is normal, but on the low side (ex: 35), what might this indicate?
patient might have a little bit of hyperventilation
A 56yo patient is found sitting up in bed gasping for breath. His pulse is 124, respiratory rate is 48 and blood pressure is 138/88.
An NRB mask was applied and patient was transferred to ICU.
ABG's showed:
pH of 7.02
pCO2 of 35
PO2 of 445
Calc O2Sat of 100%
HCO3 of 13

What is wrong with this?
pH is low which is acidosis..
PaCO2 is normal, but on low
side which might indicate
a little bit of hyper-
ventilation
PaO2 is too high
O2Sat is overoxygenated
HCO3- is low

This is metabolic acidosis and what he needed was sodium bicarb IV...so even though we see a patient having problems breathing, it's not always due to an oxygenation problem, it could be a metabolic process as well.
Define croup?
a general term applied to a symmptom complex characterized by hoarseness, a resonant cough described as "barking" or "brassy", varying degrees of stridor, and varying degrees of respiratory distress resulting from sweling or obstructin in the region of the larynx
Why is croup dangerous in infants and small children?
they have a narrower diameter of airway and gets smaller with inflammation
Define croup syndrome?
can affect larynx, trachea, and bronchi...larynx is the focus because it affects voice and breathing
How is croup syndrome defined?
by anatomic area affected
ex: epiglottitis (or
supraglottitis)
(((SERIOUS))))
laryngitis
laryngotracheobronchitis
LTB
(((NOT AS SERIOUS)))
tracheitis (((SERIOUS)))
What are the viral and bacterial croup syndromes?
Viral:
spasmodic laryngitis
laryngotracheitis
laryngotracheobronchitis

Bacterial:
bacterial tracheitis
and epiglottis
Define acute epiglottis or acute supraglottis?
a serious obstructive inflammatory process that occurs predominantly in children 2 to 5 years of age, but can occur from infancy to adulthood...REQUIRES IMMEDIATE ATTENTION...Haemophilus influenzae responsible...LTB and epiglottis don't occur together
What are the clinical manifestatations of acute epiglottis?
abrupt onset
can rapidly progress to
severe respiratory distress
child goes to sleep without
symptoms, then awakens
later complaining of sore
throat and pain on
swallowing...has fever...
appears sicker...insists
on sitting upright and
leaning forward, with chin
thrust out, mouth open,
and tongue protruding
(tripod position)...
drooling of saliva common
because of difficulty or
pain on swallowing and
excessive secretions...
child is irritable and
extremely restless and
has an anxious, apprehen-
sive, and frightened
expression...voice is
thick and muffled, with a
froglike croaking sound
on inspiration, but not
hoarse...suprasternal and
substernal retractions may
be visible...doesn't
struggle to breathe, and
slow, quiet breathing
provides better air
exchange...sallow color of
mild hypoxia may progress
to frank cyanosis...throat
is red and inflamed, and a
distinctive large, cherry
red, edematous epiglottis
is visible on careful
throat inspection...THROAT
INSPECTION SHOULD BE
ATTEMPTED ONLY WHEN
IMMEDIATE INTUBATION CAN BE
PERFORMED IF NEEDED.
Nursing Alert!
Three clinical observations that have been found to be predictive of epiglottis are absence of spontaneous cough, presence of drooling, and agitation.
Presumptive diagnosis of epiglottis is an?
EMERGENCY!
Progressive obstruction of airway in epiglottis leads to?
hypoxia
hypercapnia (buildup of CO2
in the blood)
acidosis

this leads to:
decreased muscular tone
reduced level of conscious-
ness
a possible rather sudden
death
After child gets to clinical setting, don't examine throat with tongue depressor or take throat culture...instead?
get properly experienced personnel and make sure equipment is at hand to proceed with immediate intubation or tracheostomy in case complete obstruction occurs
It's preferred for child to be moved as little as possible and to remain on parent's lap during which procedure?
portable x-ray
If SEVERE respiratory distress is occurring, what procedure is done?
endotracheal intubation or tracheostomy

(should be performed in OR as intensive observation is necessary)
An epiglottal swelling usually responds to antibiotic therapy within how many hours?
24 hours and epiglottis is near normal by the third day and then extubate child
With bacterial epiglottis, antibiotics are given IV, followed by what?
oral administration to complete a 7- to 10-day course.
What other med is given besides antibiotics?
corticosteroids to reduce edema during early hours of treatment...usually given to intubated children 24 hours before extubation
How can epiglottis be prevented?
H. influenzae type B conjugate vaccine given at 2 months old
Acute care is the same as for LTB...monitor respiratory status with pulse
oximetry and blood gases and maintain IV infusion...go to Chapter 22 for IV infusion info
okay
Age-group affected for acute epiglottitis?
1-8 years