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NURS 470 > Essential Concepts in Oxygenation > Flashcards

Essential Concepts in Oxygenation Flashcards

1
Q

What is the process of O2 leaving the alveoli to combine with Hgb or dissolve in blood to be carried to the left side of the heart?

A

perfusion

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2
Q

What does ventilation depend on (5)?

A

conducting airways, ventilatory muscles, thorax, elasticity of the lungs, and nervous system/regulators

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3
Q

Where are the sensors (chemoreceptors) responsible for ventilation located?

A

medulla (central) and aortic arch (peripheral)

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4
Q

What are the chemoreceptors in the medulla sensitive to?

A

H+ ions (increase in H+ ions increases ventilation)

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5
Q

What are the chemoreceptors in the aortic arch sensitive to?

A

PaO2 and PaCO2… (decrease in PaO2 increases ventilation, increase in PaCO2 or H+ will increase ventilation)

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6
Q

What is the PaCO2 level for respiratory distress?

A

greater than or equal to 50

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7
Q

What is the PaO2 for a patient in respiratory distress?

A

less than or equal to 60

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8
Q

What is the Ph of someone to be considered in respiratory distress?

A

less than or equal to 7.3

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9
Q

What is the environmental percentage O2 in the air?

A

21%

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10
Q

What is the type of alveoli that account for 90% of total alveolar surface within the lungs?

A

type I alveolar epithelial cells

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11
Q

Which type of alveoli produce, store, and secrete pulmonary surfactant?

A

type II alveolar epithelial cells

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12
Q

What happens in the type I alveoli cells are injured?

A

they become inflamed

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13
Q

What does surfactant do in the lungs?

A

lowers the surface tension of the lungs, increases pulmonary compliance, and ease the WOB

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14
Q

What happens if there is a disruption of synthesis/storage of surfactat?

A

collapse of alveoli which impairs the pulmonary gas exchange

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15
Q

What type of molecule is surfactant?

A

phospholipid

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16
Q

Which cells play a phagocytic role in alveoli?

A

monocytes

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17
Q

What is released when microorganisms are being killed by macrophages in the alveoli?

A

h2o2 (peroxide)

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18
Q

What are the 3 factors that affect gas exchange?

A

pressure gradient, surface area, thickness

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19
Q

What is the pressure gradient a measure of?

A

PAO2:PaO2

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20
Q

How much does the A-a gradient increase for every 10% increase in FiO2?

A

5 to 7 mmHg

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21
Q

What is the proper intervention for increasing the PAO2: PaO2 gradient?

A

oxygen supplementation

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22
Q

What is the A to a gradient also known as?

A

driving pressure

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23
Q

What are 4 interventions that increase the surface area in the lungs?

A

incentive spirometer, TCDB (turning, coughing, and deep breathing), sighs/yawns, positive end expiratory pressure

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24
Q

What is the main cause of decreased surface area in the lungs?

A

fluid in the lungs

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25
Q

The thicker the alveolar capillary membrane, the ______ the rate of diffusion

A

slower

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26
Q

What are conditions that increase alveolar capillary membrane thickness?

A

ARDS, Pulmonary edema, Pulmonary Fibrosis, and Heart Failure

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27
Q

More than 97% of all oxygen is transported in this form

A

oxyhemoglobin

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28
Q

What is oxygen saturation measured as?

A

SaO2 and SpO2

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29
Q

What percentage of oxygen is transported in the dissolved blood?

A

3%

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30
Q

How is PaO2 measured?

A

ABG

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31
Q

What is the normal pH?

A

7.35-7.45

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32
Q

What is the normal PaCO2?

A

35-45

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33
Q

What is the normal PaO2?

A

80-100

34
Q

What is the normal SaO2?

A

95-100%

35
Q

What is the normal HCO3-?

A

21-28

36
Q

What are 5 common causes of respiratory acidosis?

A

COPD, pneumonia, atelectasis, neuromuscular disease, post-op recovery, narcotics

37
Q

What are 5 common reasons for metabolic acidosis?

A

diabetic acidosis, starvation, impending shock, ASA OD, diarrhea

38
Q

What are 6 common causes of respiratory alkalosis?

A

hysteria, fear, anxiety, head injury, pain, fever, ventilator

39
Q

What are 4 common causes of metabolic alkalosis?

A

diuretics, prolonged NG suction without electrolyte replacement, excessive vomiting, overuse of antacids

40
Q

What causes respiratory alkalosis?

A

low PCO2 due to hyperventilation (excess amount of CO2 exhaled)

41
Q

What causes respiratory acidosis?

A

excessive retention of CO2 due to hypoventilation, leading to a decrease in pH below 7.35

42
Q

Why does diarrhea cause metabolic acidosis?

A

loss of HCO3-

43
Q

With a high temperature, does the oxyhaemoglobin dissociation curve shift to the right or left?

A

right

44
Q

With a low temperature, does the oxyhaemoglobin dissociation curve shift to the right or left?

A

left

45
Q

What is the normal alveolar ventilation?

A

4L/min

46
Q

What is the normal pulmonary capillary perfusion?

A

5L/min

47
Q

What is the normal V/Q ratio?

A

4:5 or .8

48
Q

What is a high V/Q ratio caused by?

A

ventilation exceeding perfusion

49
Q

What is a low V/Q ratio caused by?

A

poor ventilation

50
Q

What is the distribution of perfusion dependent on?

A

gravity

51
Q

Where is the V/Q ratio highest in the lungs? Lowest?

A

Apex, bases

52
Q

What is the maximum angle that you should elevate the HOB? Why?

A

45 degrees. It will cause decrease in blood flow to the lower extermities

53
Q

What are 3 factors that impair perfusion?

A

decreased Hgb, decreased Flow, and physiologic shunt

54
Q

What are issues that can cause decreased Hgb?

A

anemia, CO poisoning, cancer, GI bleeds

55
Q

What are issues that can cause decreased flow?

A

hemorrhage, PE, pulmonary vasoconstriction

56
Q

What happens with a physiologic shunt?

A

anatomic left to right cardiac shunt (septal defect, ductus arteriosus)

57
Q

What happens in a dead space V/Q mismatch?

A

alveoli are ventilated but not perfused

58
Q

When would alveolar dead space occur?

A

only with PE

59
Q

What are the two types of pulmonary absolute shunts?

A

pulmonary anatomic and intrapulmonary shunt combined

60
Q

What happens in an intrapulmonary shunt?

A

blood is shunting by the alveoli and not receiving oxygen because the alveoli are non-functional

61
Q

What happens with an anatomical shunt?

A

blood moves from the right side of the heart to the left side of the heart without ever coming into contact with the alveoli

62
Q

What percentage of blood normally has a pulmonary anatomic shunt?

A

2-5%

63
Q

What are common causes of the shunt-like effect in the lungs?

A

bronchospasm, hypoventilation, or pooling of secretions

64
Q

What happens in a patient that has an obstructive lung disease?

A

an abnormally high amount of air still lingers in the lungs

65
Q

What are 4 common reasons for obstructive lung disease?

A

COPD, Asthma, Bronchiectasis, and CF

66
Q

What does restrictive lung disease cause in the lungs?

A

stiffness in the lungs which keeps the lungs from fully expanding

67
Q

What is an inflammatory syndrome marked by disruption of alveolar-capillary membrane caused by an injury to the lung?

A

Acute Respiratory Distress Syndrome (ARDS)

68
Q

What are the 4 parts of the clinical definition of ARDS?

A

acute onset
Bilateral infiltrates on chest Xray
PAWP<18mmHg or no clinical evidence of left ventricular failure
Hypoxemia refractory to O2 Tx

69
Q

What is the PaO2/FiO2 that is considered Acute Lung Injury vs ARDS?

A

below 300 for acute lung injury
below 200 for ARDS

70
Q

What are 4 common causes of ARDS?

A

Aspiration of gastric contents or other substances
Viral or bacterial pneumonia
sepsis (especially gram-negative infections)
severe massive trauma

71
Q

6 of the most common s/s of ARDS

A

Air hunger
Labored/rapid breathing (dyspnea)
Low O2 levels in blood
Cough and fever
Low BP
Confusion
Extreme tiredness

72
Q

What are the 3 effects of releasing mediators with ARDS?

A

increased capillary permeability, change in small airway diameter, and injury to pulmonary vasculature

this leads to increased work of breathing and hypoxemia refractory to oxygen therapy

73
Q

What is the first thing that should be done when ARDS is present?

A

treat underlying cause

74
Q

Which fluids should be administered to a patient with ARDS?

A

normal saline and LR

75
Q

What medication is given in order to prevent clots in ARDS?

A

lovenox

76
Q

What kind of medications are given to patients with ARDS?

A

infection treatments, vasoactive medications, analgesia, anticoagulants, and PPIs

77
Q

What is the purpose of using ECMO for ARDS?

A

maintain oxygenation of the organs while resting the lung giving them time to heal

78
Q

What is the best position for an ARDS patient?

A

prone

79
Q

What is the mortality rate for ARDS?

A

40-60%

80
Q

How long does it take for pulmonary function to return back to normal after ARDS?

A

within 6-12 months

81
Q

5 NANDA diagnoses related to pulmonary disease

A

impaired gas exchange, ineffective airway clearance, ineffective breathing pattern, anxiety, pain (acute)

NURS 470 (33 decks)

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