establishing needs Flashcards
The primary purpose of ventilation
Homeostasis
Mechanical ventilation is indicated when a person cannot achieve an appropriate level of _____ to maintain adequate gas exchange ____-____ balance
ventilation; acid-base
Maintain adequate oxygen delivery (CaO2 × Cardiac output)
Alveolar oxygenation
Physiological Objectives of Mechanical Ventilation
Support or manipulate pulmonary gas exchange:
Increase lung volume
Reduce the work of breathing
signs of respiratory distress are the result of the person experiencing a “panic attack.
Respiratory distress in this type of patient can usually be relieved simply by calming the person and questioning him or her about the distress
defined as the inability to maintain Pao2, Paco2, and pH at acceptable levels
ARF
A patient with ARF may experience the following clinical symptoms.
I) PaO2 below the predicted normal range for the patient’s age under ambient (atmospheric) conditions
II) Bicarb within ranges of 25-30
III) Paco2 greater than 50 mm Hg and rising
IV) a falling pH of 7.25 and lower.
I, III, IV
Two forms of ARF
hypoxemic respiratory failure
and hypercapnic respiratory failure
Type II ARF
Hypercapneic Respiratory Failure
Type I ARF
Hypoxic Respiratory Failure
(Lung failure accompanied by hypoxemia)
Hypoxic Lung Failure) (Ventilatory Failure
Hypercapneic Respiratory Failure (type II)
(Pump failure accompanied by hypercapnia) (Hypoxic Respiratory Failure)
Hypoxic Respiratory Failure (type I)
Hypoxic Respiratory Failure (type I) result from the following.
I) severe ventilation/perfusion (V/Q) mismatching. II) diffusion defects, III) right-to-left shunting, IV) alveolar hyperventilation V) aging VI) inadequate inspired oxygen
I, II, III, V, VI
IV is wrong because it’s Alveolar HYPOventilation
acute life-threatening or vital organ–threatening tissue hypoxia
acute hypoxemic respiratory failure
Hypoxemic respiratory failure can be treated with oxygen or in combination
with ?
positive end-expiratory pressure (PEEP) or continuous positive airway pressure (CPAP)
The ventilatory pump consists of
the respiratory muscles
thoracic cage
nerves that are controlled by respiratory centers in the brainstem
Three types of disorders can lead to pump failure
Central nervous system disorders
•Neuromuscular disorders
•Disorders that increase the work of breathing (WOB)
T/F Tachycardia and tachypnea are specific ways to indicate a paitients needs and help the clinician in deciding when to intubate and ventilate a patient
FALSE
Tachycardia and tachypnea are nonspecific and mostly subjective signs that may provide only limited help in deciding when to intubate and ventilate a patient
Any condition when respiratory activity is inadequate to maintain O2 uptake and CO2 clearance. Sudden
ACUTE RESP. FAILURE
(Lung failure accompanied by hypoxemia)
Hypoxic Lung Failure) (Ventilatory Failure
Hypercapneic Respiratory Failure (Type II)
Hypercapneic Respiratory Failure (Type II)
PaO2 =
Low (only because it is displaced by carbon dioxide
Hypercapneic Respiratory Failure (Type II)
PaCO2 =
high
Hypercapneic Respiratory Failure (Type II)
a/A ratio
Normal
Hypercapneic Respiratory Failure (Type II)
A-a gradient
Normal
What’s the equation for PAO2
(760-47)xFio2 - (PaCo2 x 1.25)
Hypercapneic Respiratory Failure (Type II)
What should the treatment be?
Rx: Mechanical ventilation, oxygen
Hypercapneic Respiratory Failure (Type II)
Causes
\_\_\_\_\_\_ \_\_\_\_\_\_\_ Problem with respiratory muscles, diseases that increase the WOB. Primary defect is ventilation. Severe \_\_\_ \_\_\_\_, R-L shunt, Diffusion defect, \_\_\_\_\_, VD
Pump failure.
low V/Q
aging
Hypercapneic Respiratory Failure (Type II)
Causes
Pump failure. Problem with\_\_\_\_\_\_ \_\_\_\_\_\_\_ diseases that \_\_\_\_ WOB. Primary defect is ventilation. Severe low V/Q , \_\_\_\_\_ \_\_\_\_\_, Diffusion defect, aging, VD
respiratory muscles,
increase
R-L shunt
Hypercapneic Respiratory Failure (Type II)
Causes
Pump failure. Problem with respiratory muscles, diseases that increase the WOB. Primary defect is ventilation. Severe low V/Q , R-L shunt, \_\_\_\_\_ \_\_\_\_, aging, \_\_
Diffusion defect
VD
Primary defect is ventilation
Hypercapneic Respiratory Failure (Type II)
CNS – Depressed Drive
Depressant Drugs Head Trauma Sleep Disorders Acid/Base Abnormals Inappropriate Oxygen Therapy Hypothyroidism
What are some of the Acid/Base abnormals for Type II ARF
Metabolic Alkalosis
Respiratory Acidosis
Increased Metabolic Rate
Hypercapneic Respiratory Failure (Type II)
CNS-Increased Drive
Increased metabolic rate
Metabolic Acidosis
Anxiety associated with dyspnea
Normally WOB % to% of total oxygen consumption. Can go as high __% to __%.
1 - 4%
35- 40%
Normally WOB 1% to 4% of total oxygen consumption. Can go as high 35% to 40%.
This category includes increased ______ of COPD and increased Raw in____.
deadspace
asthma
Normal pH
7.35-7.45
abnormal pH ARF
<7.25
abnormal PaCO2 ARF
<50, pt not a co2 retainer
ARF
VD/VT ratio normal
0.3-0.4
ARF
VD/VT abnormal
VD/VT >.60
VD/VT not usually done watch for
increasing MV with no change in CO2
ARF
Abnormal VT
<5 ml/kg
ARF
Normal VC
65-75 ml/kg
PaO2
abnormal
PaO2 < 70 O2
PaO2 <50 RA
