Critical Care Part 2 Flashcards
Pulmonary system is no longer able to perform its normal functions is __________
Respiratory Failure
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
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
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
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
Primary damage to lung causing ARDS
pneumonia
inhalation injury
near drowning
secondary damage to lung tissue that causes ARDS
SIRS
sepsis
Ventilator delivers preset breaths in coordination with the respiratory effort of the patient
Assist-Control Ventilation (A/C)
Combination of machine & spontaneous breaths
Synchronous Intermittent Mandatory Ventilation (SIMV)
Applies a set positive pressure to a spontaneous inspiratory effort
Pressure Support Ventilation (PSV)
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
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
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
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
Surgical opening made in the trachea to assist breathing is a _________. The specific opening is the ________
Tracheostomies
stoma
Reasons tracheostomies are needed
Bypass an obstruction
Frequent pulmonary suctioning required
Deliver O2 to the lungs for individuals unable to breathe
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
what is ECMO stand for
extracorporeal Membrane Oxygenation
Ecmo is used for ?
Therapy used for patients whose heart &/or lungs are so damaged that they cannot oxygenate the blood
ECMO is an extracorporeal technique of providing both ______ and _____ support
cardiac and respiratory
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
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 ?
- is pH WNL, acidic, or basic
- is PaCO2 acidic or alkalosis
- is HCO3 acidic or alkaline
- Determine if the cause of the imbalance is respiratory or metabolic
- 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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