Critical Care Part 2 Flashcards by Sydney Perry

Pulmonary system is no longer able to perform its normal functions is __________

Respiratory Failure

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Patient in Respiratory failure requires ___________ and may involve mechanical ventilation

Respiratory failure can result from ______ or as a result of acute insult to the lungs

supplemental O2
chronic diseases

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Pulmonary Disorders
Neuromuscular Disorders
Neurologic injury
Cardiovascular Disorders
Respiratory infection
Inhalation of toxic gases
Drug overdose
SIRS/sepsis
Multiple Organ Dysfunction Syndrome (MODS)

causes of respiratory failure

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Acute Respiratory Distress Syndrome (ARDS) is ____ onset, life-threatening respiratory failure caused by ______

characterized by severe _______, pulmonary ______, and decreased _________

results in __________

Acute
diffuse alveolar injury

hypoxemia
edema
lung compliance

respiratory failure

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Acute Respiratory Distress Syndrome (ARDS) starts with ___________ in the lungs=>
___________=>
increased ____________=>
____________________=>
decreased _______________________

Tissue damage
inflammation
capillary permeability
fluid build up in the alveoli
transfer of O2 to the bloodstream

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Primary damage to lung causing ARDS

pneumonia
inhalation injury
near drowning

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secondary damage to lung tissue that causes ARDS

SIRS
sepsis

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Ventilator delivers preset breaths in coordination with the respiratory effort of the patient

Assist-Control Ventilation (A/C)

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Combination of machine & spontaneous breaths

Synchronous Intermittent Mandatory Ventilation (SIMV)

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Applies a set positive pressure to a spontaneous inspiratory effort

Pressure Support Ventilation (PSV)

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Impact of Malnutrition on Respiratory Function in the lung

Decreased respiratory _____, _____, and _____
Reductions in _______
Decreased __________
Decreased _______=> decreased lung compliance
______________=> pulmonary edema

muscle mass, strength, & endurance
vital capacity
ventilatory drive
surfactant
Hypoalbuminemia

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Impact of Malnutrition on Respiratory Function on whole body

Decreased ____________
Diminished ______________ of blood

Low serum levels of _______________ compromise respiratory muscle function at the cellular level

Prolonged __________

immune function
oxygen carrying capacity
Phos, Ca, Mg, & K+
intubation

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MNT FOR RESPIRATORY FAILURE

Energy is ____ kcal/kg of ____
provide adequate but not excessive kcal to facilitate _______

Protein is ______ g/kg

Fluid needs are __________

25
EDW
weaning

1.5-2.0

individualized

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If Mechanical ventilation (orally intubated)=> give __________

If pulmonary edema, use a _____________

Specialty high-fat/low-CHO EN formulas designed to reduce CO2 production are NOT recommended for ICU patients with acute respiratory failure

Monitor _____, _____, ______, ______, _____

enteral nutrition

1.5-2.0 kcal/ml EN formula that restricts fluid

Phos, Mg, K+, serum glucose, ABG’s

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Surgical opening made in the trachea to assist breathing is a _________. The specific opening is the ________

Tracheostomies
stoma

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Reasons tracheostomies are needed

Bypass an obstruction

Frequent pulmonary suctioning required

Deliver O2 to the lungs for individuals unable to breathe

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Patients with tracheostomies may be at increased risk for _______&_________

Prolonged oral intubation can damage the ________ and cause atrophy of the _________ leading to _________

dysphagia & aspiration

vocal cords
laryngeal muscles
aspiration

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what is ECMO stand for

extracorporeal Membrane Oxygenation

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Ecmo is used for ?

Therapy used for patients whose heart &/or lungs are so damaged that they cannot oxygenate the blood

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ECMO is an extracorporeal technique of providing both ______ and _____ support

cardiac and respiratory

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ECMO is a continuous process where blood is

1) drained from ______ via a ______

2) pushed by an external pump through a _____________ that ___________

3) returned to the circulation through _________

a central vein
cannula

“membrane oxygenator”
removes CO2 and adds O2

another cannula

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what are the types of ECMO

Veno-arterial (VA) ECMO

Veno-venous (VV) ECMO

Veno-arterial (VA) ECMO

Primarily used for __________
the _______ bypassed

cardiac failure
♡ and lungs

Veno-venous (VV) ECMO

used for patients with _____________
bypasses _________
Can provide sufficiency oxygenation for several ______ and allows ____ to heal

respiratory failure to improve gas exchange
lungs but ♡ preserved function
weeks
lungs

___________ not used for ECMO

indirect calorimetry

MNT for Patients on ECMO Assess for ___________ Monitor for ______ deficiency, losses of ___ and ____

cardiac cachexia thiamin K+ Mg

MNT for Patients on ECMO ENERGY ??? PRO ???

ENERGY 25-30 kcal/kg EDW If BMI >30, 11-14 kcal/kg EDW PROTEIN 1.2-2.0 g/kg EDW If BMI>30, >2.0 g/kg IBW

MNT for Patients on ECMO Monitor for _________ ____ frequently used ________ formulas are recommended if at risk for hemodynamic instability Note: severe CHF can lead to hypotension Individuals who have a mean arterial pressure ____ mmHg are at risk for _______

fluid overload EN Fiber-free <50 subclinical gut ischemia

Arterial Blood Gases (ABGs) include what

Partial Pressure of Oxygen (PaO2) O2 saturation pH PaCO2 HCO3

Normal serum pH range: ________ Low pH = ____ concentration of H+, indicating _____ High pH = _____ concentration H+, indicating _______

7.35-7.45 high acidity low alkalinity

Partial Pressure of Carbon Dioxide (PaCO2) Normal Range: _____ mmHg High level => _______ CO2 by the lungs via _____ventilation => ___________ Low level => _______ CO2 via _____ventilation => _______________

35-45 retained hypo respiratory acidosis excess expelled hyper respiratory alkalosis

what is respiratory acidosis

blood too acidic bc respiratory problem

Bicarbonate (HCO3) Normal range: _____ mEq/L High level=>_______ Low level=>_______

21-28 alkalinity acidity

what are Buffer systems purpose? How do they work?

regulate acid-base can absorb excessive H+ or OH- (base)

Compensation: Lungs=>Compensate for changes in pH by increasing or decreasing __________=> elimination or retention of ____ Kidneys=>Compensate by changing _________ excretion and ________ reabsorption & formation

alveolar ventilation CO2 renal H+ ion bicarbonate

Metabolic Acidosis is when pH is ______ with decreased _____

<7.35 HCO3

Causes of metabolic acidosis: Increased production of ____ => from ______ and ______ Decreased _______ => from _________ Loss of _________=>

acids DKA lactic acidosis H+ excretion renal failure bicarbonate diarrhea

Clinical Manifestations of Metabolic Acidosis

Headache Lethargy Deep, rapid respirations (Kussmaul) ***** Anorexia N/V/D, abd. pain Severe=> dysrhythmias

Treatment of Metabolic Acidosis ________________ if severe ______________

Determine the cause of metabolic acidosis sodium bicarbonate administration

Metabolic Alkalosis pH ______ with increased ______ Usually caused by ______

>7.45 HCO3

Metabolic Alkalosis causes

Prolonged vomiting NG suctioning Diuretics Excessive bicarbonate intake

Clinical Manifestations of Metabolic Alkalosis

Weakness Muscle cramps Tetany Slow, shallow respirations Severe=> confusion, seizures, dysrhythmias

Treatment of Metabolic Alkalosis

Determine cause Hypochloremic alkalosis=> IV sodium chloride

Respiratory Acidosis ________ pH; increased ___________ Increased ____ retained=> increased production of ___________ Can be acute or chronic

Decreased PaCO2 (hypercapnia) CO2 carbonic acid

Causes of Respiratory Acidosis

COPD Sleep apnea Asthma ARDS Neuromuscular disorders leading to decreased respiratory muscle function Depression of the respiratory center (brain stem injury, oversedation) Overfeeding*****

Clinical Manifestations of Respiratory Acidosis

Lethargy Anxiety Sleepiness Confusion Muscle twitching & tremors Coma

Treatment of Respiratory Acidosis Acute=>_____________, _________ Chronic=> ______________ MNT=> avoid ___________; avoid ___________

restore adequate alveolar ventilation may require mechanical ventilation treat underlying diseases overfeeding excessive CHO administration

Respiratory Alkalosis _________ pH; ____________ _____ventilation leading to loss of ____

Increased decreased PaCO2 Hyperventilation CO2

Causes of Respiratory Alkalosis

Pulmonary disease CHF High altitudes Anxiety/panic Pain Sepsis Mechanical ventilation

Clinical Manifestations of Respiratory Alkalosis

Dizziness Confusion Paresthesia Convulsions Coma

Treatment of Respiratory Alkalosis

Determine & treat underlying cause Correct hypoxemia

What are the steps to interpreting ABG's ?

1. is pH WNL, acidic, or basic 2. is PaCO2 acidic or alkalosis 3. is HCO3 acidic or alkaline 4. Determine if the cause of the imbalance is respiratory or metabolic 5. What may be the cause of the acid-base imbalance? Is there any MNT to address the cause?

for step 4. Determine if the cause of the imbalance is respiratory or metabolic. HOW?

Check the PaCO2 & the HCO3 to see which one has the same acid-base status as the pH If PaCO2 follows the pH = respiratory If HCO3 follows the pH = metabolic

PRACTICE 54 yo male admitted to the ICU with cardiac arrest resulting in acute tubular necrosis (ATN) PMHx: CHF, CHD, HTN Current GI status: No N/V/D/C ABG values: pH 7.32; PaCO2: 34 mmHg (normal range: 35-45 mmHg); HCO3: 17 mEq/L (normal range 21-28 mEq/L)

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