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59 Cards in this Set
- Front
- Back
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normal pH
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7.35-7.45
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paCO2
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35-45
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HCO3
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22-26
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paO2
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80-100
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saO2
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>95%
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respiratory acidosis
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pH less then 6.35
CO2 above 45 causes ARDS sever asthma PEs pneumothorax, drug OD rapid shallow respirations |
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A management issue for respiratory acidosis
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may possibly need intubation
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respiratory alkalosis
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pH above 7.45
CO2 below 35 causes hyperventilation anxiety PE fibrosis of the lungs, deep rapid breathing, |
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metabolic acidosis
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pH below 7.35
HCO3 below 22 DKA, hyperkalemia, drinking binge, aspirin OD kidney can't excrete acid, |
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metabolic alkalosis
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pH above 7.45
HCO3 above 26 NG suction on continuos OD on sodium bicarb NG drainage is full of hydrogen (same as vomiting) |
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kidneys excrete
and retain to compensate |
sodium
bicarb |
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3 types of PE
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-thromboemboli- calcium deposit in valves-chunk of plaque
-air emboli- -fat emboli- bone fracture fat released plugs up alveoli |
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What is a PE
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Pulmonary embolism is the sudden blockage of a major blood vessel (artery) in the lung, usually by a blood clot
thrombi travel through venous circulation until become wedged in branch of pulmonary circulation |
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What are most PEs caused from?
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DVTs
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causes of air emboli
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open heart surgery
scuba diving intravenous infusion central venous catheter insertion/removal pulmonary endothelium damaged |
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Causes of fat embolus
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long bone fracture
sickle cell crisis pancreatitus burns (deep break down bones release) |
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S&S of PE
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dyspnea
pleuritic chest pain cough LE edema SOB anxiety localized rales/crackles |
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Diagnosing PE
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CXR
CT -***main VQ scan ABGs |
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Treating PE
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oxygen
anticoag preventing reembolization (vena cava filter, supoortive measures, coumadin heparin) coumadin at home usually lasts 6 months |
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What is acute lung injury
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severe diffuse lung injury
inflammation of the lung leading to impaired gas exchange along with systemic release of cytokines |
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causes of ALI
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direct damage to alveolar membrane like aspiration of gastric content
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secondary causes of ali
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sepsis
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The most severe form of ALI is...
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ARDS (acute resp. distress syndrome)
PaO2/Fi02- <300 if ALI <200 for ARDS this is a diagnostic tool (fraction) |
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A nurse should look for signs of ARDS/ALI in a patient with...
COPD exac, acute MI, Pulm contusion, CHF |
pulm contusion
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ARF
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syndrome when the respiratory system fails at both of its functions- oxygenation and carb dioxide elimination
type 1- pao2 below 60 type 2- paco2 above 50 |
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extrapulmonary causes of ARF
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neuromuscular
CNS depression (drug overdose) ARDS asp. pneumonia sleep apnea chest trauma |
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intrapulmonary causes of ARF
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aspiration of foreign body
bronchitis asthma copd pneumonia PE CF ALI |
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PNA
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an infection in one or both lobes caused by bacteria, virus, or fungi
-organisms settle in air sacs of lung where they grow rapidly in number -this are becomes filled with fluid and pus as the body attempts to fight the infection |
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Diagnosing PNA
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CXR, sputum sample,
treatment: o2, abx |
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strep can cause
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otitus media, meningitus, acute sinusitis, osteomylitus
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pneumovax
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lifetime vaccine against strep, spectrum does every 5 years
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RSV
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resp syncytial virus
causes infection of the lungs and breathing passages no treatment kills RSV treat symptoms |
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what qualifies as hospital acquired PNA
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PNA that develops >48 hrs post admission
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when foreign materials enter the bronchial tree Usually oral or gastric contents it is...
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pulm. aspiration
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apnea
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cessation of airflow for more than 10 seconds
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What is ILD
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interstitial lung disease broad category for over 130 disorders that are characterized by inflammation/fibrosis of lungs
fibrosis/scarring causes stiff lungs |
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Normal pulmonary artery pressure
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12-16
people with PULM HTN have pressures above 25 at rest |
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WHen pulmonary hypertension and heart pressure measurement are desired which of the following is the best diagnostic test?
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R sided Heart cath
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inhaled prostacyclin
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ventavis
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sub q prostacyclin
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remodulin
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IV prostacyclin
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flolan POTENT VASODILATORS
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pt with acute asthma exacerbation, what is your first line of treatment?1
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nebulized beta antagonists
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short vs long acting beta antagonists
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short-albuterol
long-advair |
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Cor pulmonale
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failure of the right side of the heart brought on by high blood pressure in pulmonary arteries and right ventricle of the heart
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Causes of cor pulmonale
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COPD, ILD, primary and secondary pulm. HTN, OSA
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pneumothorax
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the accumulation of air in the pleural space either spontaneously or tramautically
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management of pneumothorax
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Chest tube placement, pain meds, sedatives and antibiotics
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pleural air chest tube
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2nd ICS medclavicular line
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fluid pleural chest tube
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4th 5th or 6th midaxillary line
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pneumonectomy
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removal of entire lung
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lobectomy
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resection of one or more lobes of the lung
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after lobectomy operative side should be placed..
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up or "good lung" down (or supine)
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after pneumonectomy a patient should be positioned with the operative side...
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down and the remaining lung up to promote incisional splinting
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open pneumothorax
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both chest wall and pleural spaces are penetrated
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closed pneumothorax
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chest wall is still intact but air can leak from lung into pleural cavity
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tension pneumothorax
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tear in lung causes air to leak into pleural space with no means of escape causing lung collapse
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intermittent bubbling in a chest tube compartment...
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indicates an air leak from pleural space
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constant bubbling in the water seal chamber of a chest tube indicates...
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a leak in the system. start from insertion site and clamp tubing down to system until leak is found. if not found, replacement might be considered
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indications to remove chest tube
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-improved resp status
-no bubbling during expiration in water chamber -symmetrical rise and fall of chest -improved CXR findings |
