Advanced Patient Care Flashcards
What is the formula for alveolar minute
ventilation?
(Vt-Vd) X F
What is the formula for dead space?
PaCO2-PeC02/PaCO2
What is normal dead space?
20-40%
What is normal dead space for a diseased
patient?
40-60%
What is normal dead space for ventilated
patient?
> 60%
Why is puffs of aerosol a concern?
Because FiO2 will increase
Condensation will cause a of airflow?
resistance
What is the solution to condensation in the
tubing?
Drain the tube
Increase the flow
What is the formula for static compliance?
Vt/Pplat-PEEP
Why is static compliance important?
Because it tells us if the lungs are expanding
enough
Lack of expansion (movement) of lungs
indicates what?
Worsening of disease
As pressure increases what decreases?
What does this mean?
Compliance
Patient is getting worse
Pressure and compliance are ?
opposite
What is the alveolar air equation?
(PB - PH20) X FiO2 -(1.25xPaCO2) -
Why is the alveolar air equation important?
Helps to figure out the A-a gradient; which tells
us the amount of air in the alveoli and arteries.
What is the best view for a pleural effusion?
Lateral decubitus
What are some causes of hypercarbia?
Over-sedation
Head trauma
COPD
What is a cause of hypocarbia?
Narcotic drug overdose
Radiolucent CXR
Dark air pattern
Normal lungs
Radiodense/opacity
White fluids/solids
pneumonia, pleural effusion, bones
Infiltrates
White scattered patchy
Inflammatory processes atelectasis
Consolidation
Well defined solid appearing (light)
pneumonia
Hyperlucency
Excessive dark air
Emphysema, asthma, subcutaneous
emphysema
Vascular Markings
indicate the vessels of the lungs that are usually
less prominent or not visible as they have air
within them.
Diffusion
Widely spread or scattered
Opaque
White fluids/solids
pneumonia, pleural effusion, bones
Bilateral
Movement/sounds on both sides
Unilateral
Movement/sounds on one side
What is ARDS/IRDS?
A group of symptoms causing acute,
catastrophic respiratory failure, resulting from
pulmonary injury.
For the lung conditions to be considered ARDS,
what are the three criteria that must be met?
- Infiltrates on chest x-ray film confirm that
fluid is leaking into the interstitial spaces - Normal heart function as evidenced by
normal PWCP - P/F ratio < 200
What are the characteristics of ARDS on a CXR?
Interstitial edema
Alveolar edema (fluffy infiltrate, ground
glass appearance)
What is the treatment for ARDS?
FiO2 of 50-60%
CPAP
PEEP (mechanical ventilation)
Tidal volume 4-6 mL/kg of IBW
High peak pressures
Alveolar pressure < 30cmH20
permissive hypercapnia (stop when pH is
7.20)
What is atelectasis?
Partial or complete lung collapse of alveoli. It
may involve small or localized areas of the lung,
a lobe, or the entire lung.
What are the characteristics of atelectais on a
CXR?
Increased density (white)
Elevated diaphragm
Displaced interlobar fissures
Mediastinal shift
Altered bronchial and carinal angles
What is the treatment for atelectasis?
I.S.
IPPB
Adequate pulmonary hydration to prevent
mucous plugs and mobilize secretions
02 as needed up to 50-60%
Initiation of CPAP and PEEP
What is pleural effusion?
Excessive fluid in the pleural space
What are the characteristics of pleural effusion
on an CXR?
Blunting of costophrenic angles
Homogeneous density in dependent part
of the hemithorax
What is the treatment for a pleural effusion?
Thoracentesis
Chest tube drainage (for large pleural
effusions)
Supplemental 02
What is pneumonia?
Acute inflammation of lung parenchyma
(alveoli)
What are the characteristics of pneumonia on a
CXR?
Consolidation
Air bronchogram
What is the treatment of pneumonia?
Antibiotics
Supplemental 02
Bronchial hygiene therapy
Adequate hydration
Adequate nutrition
Tracheal suctioning (if there is poor
removal of secretions because of
ineffective coughing)
What is a pneumothorax?
Air in the pleural space
What are the characteristics of pneumothorax
on a CXR?
Hyperlucency
What is the treatment of a pneumothorax?
Needle aspiration immediately in tension
pneumothorax
Placement of chest tube
Supplemental 02 as needed (monitor
Sp02 and ABG levels)
What is pulmonary edema?
An excessive amount of fluid in the lung tissues
or alveoli.
Caused by an increase in pulmonary capillary
pressure resulting from increase left-sided heart
pressure.
What are the characteristics of pulmonary
edema on a CXR?
Increased vascular markings
Interstitial edema
Enlarged heart shadow
Bat wing appearance
Kerley B lines
What is the treatment of pulmonary edema?
02 administration (percentage based on
PaCO2
CPAP/NPPV
Ventilatory support with PEEP (if condition
results in acute respiratory failure)
Shallow suctioning to maintain a patent
airway
Morphine
Diuretics such as furosemide
Cardiac glycosides
What is pulmonary embolism?
Obstruction of the pulmonary artery or one of its
branches by blood clot.
Embolus is a clot that travels to the bloodstream
from a vessel of origin to lodge in a smaller
vessel, obstructing blood flow.
What are the characteristics of PE on a CXR?
May be normal
Decreased lung volume
Linear densities of atelectasis
Pleural effusion
Elevated hemidiaphragm caused by
atelctasis
What is the treatment for a PE?
a. Prevention
1. Elastic stockings
2. Leg elevation
3. Ambulation
4. Small doses of heparin (an anticoagulant)
given intravenously for hospitalized
patients
b. Anticoagulation (antithrombus) therapy
1. Heparin
2. Warfarin sodium (Coumadin) (oral
medication)
3. Streptokinase or urokinase in cases of
massive embolus
C. Supplemental 02
d. If hypotension is present
1. Vasopressors
2. Fluids
What is TB?
a granulomatous bacterial infection, chronic in
nature, affecting the lungs and other organs of
the body.
What are the characteristics of TB on a CXR?
Enlarged lymph nodes in the hilar region
(lymphadenopathy)
Pleural effusion
Cavitation
Ghon complex (lung lesion and lymph
node involvement)
Fibrosis
Infiltrates
