CCRN Pulmonary

Question 1

What is Carbon Dioxide Narcosis?

Answer 1

Results from too much O2 –> increase PaCO2 –>resp acidosis, organ failure and death

Idea of Hgb CO2 dissociation curve and hypoxic drive theory

Question 2

How would you avoid Carbon Dioxide Narcosis?

Answer 2

Commonly occurs with overadmin of O2 w/COPD pt. Aim for 88-92% O2 sat. Admin max 4Lnc. 21%FiO2

Question 3

Vent: What does increased PEEP help with?

Answer 3

Can help stabilize alveolar lung volume and improve O2. Use of PEEP during expiration can keep alveoli open and prevent early closure during exhalation.

Can help increase FCR functional residual capacity, which is decreased in PNA.

Question 4

Vent: What are risks with using PEEP settings?

Answer 4

• Increase in intra-thoracic pressure, which can decrease CO by decreasing preload.
• May decrease cerebral blood flow
• Increase chance of barotrauma d/t higher mean, and peak airway pressures during ventilation.

Question 5

What are signs and symptoms of O2 toxicity?

Answer 5

O2 toxicity primarily affects CNS and pulm system.

S.S: nausea, anxiety, visual changes, numbness, muscular twitching and grand mal seizures.Fatigue, non productive cough.

Question 6

How should you manage and prevent O2 toxicity?

Answer 6

Monitor O2 admin and ABG levels. Once PaO2 retuns to acceptable levels (>60mmHg) can decrease O2 delivery.

Question 7

What is the gold standard for pulmonary artery HTN dx?

Answer 7

R heart cardiac catheterization w/vasodilator testing.

Question 8

What are vent weaning parameters for FiO2, RR, minute Ventilation?

Answer 8

FiO2: <0.5
RR <30 breathes
Minute Ventilation <10L

Question 9

Vent weaning parameters for vital capacity, negative inspiratory pressure, PaO2/FiO2 ratio?

Answer 9

Vital Capacity: >10ml/kg, ideally 15ml/Kg
Negative inspiratory pressure: 25-30 cm H2O
PaO2/FiO2 ratio >200

Question 10

What kind of disease if pulmonary HTN?

Answer 10

Progressive life threatening disorder of pulmonary circulation that causes high pulmonary artery pressures >25mmHg leading from right side of the heart to lungs –>R ventricular failure.

Question 11

What is the peak flow measurement used for?

Answer 11

It’s the best assessment tool to determine the severity of asthma. It measures the max speed of expiration and indicates how well air is flowing in and out of hte lungs.
Measurement <100L/min indicates severe bronchoconstriction.

Question 12

Clinical features of O2 toxicity could be broken down in three phases, what are they?

Answer 12

1. Tracheobronchitis, decreased tracheal mucosal blood flow. Follows 1-4 days of high O2 levels.
2. Atelectasis after 12 days, vital capactiy decreases d/t poor lung expansion. ARDs pic develops.
3. Pulmonary interstitial fibrosis.