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Critical Care > Exam 2 Oxygen Indices & ICU Assessment > Flashcards

Exam 2 Oxygen Indices & ICU Assessment Flashcards

1
Q

what does P50 indicate

A

hemoglobin is 50% saturated with oxygen

normal P50 is 27 mmHg

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2
Q

how is P50 affected when curve shifts left

A 
increase Hb affinity for O2
increase pH
decrease CO2
decrease temperature
decrease 23DPG
P50 decrease
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3
Q

how is P50 affected when curve shifts right

A 
decrease Hb affinity for O2
decrease pH
increase CO2
increase temperature
increase 23DPG
P50 increase
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4
Q

what is the significance of utilization of monitoring systems in ICU

A

continuous assessment

measures values caregivers cant detect

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5
Q

what is the significance of P/F ratio

A

determine if dealing with ALI or ARDS

identify acute hypoxemic failure

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6
Q

what is the significance of

P(A-a)O2 difference

A

indicates gas exchange efficiency

help narrow the cause of hypoxemia

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7
Q

what is the significance of PaO2/PAO2 ratio

A

useful for gas exchange index with changing FiO2

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8
Q

what is the significance of

C(a-v)O2

A

how much oxygen is removed from blood in capillaries as it circulates into the body

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9
Q

what is the significance of O2 ER

A

assess the adequacy of systemic oxygen delivery

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10
Q

what can affect SpO2 readings

A 
motion artifact
environmental light
anemia
deeply pigmented skin
carboxyhemoglobin
methemoglobin
nail polish
blood-borne dyes (cyanide)
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11
Q

define anemia

A

lack of healthy RBC to carry oxygen to tissues

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12
Q

when is cyanosis noted on a patient

A

5g/dL desaturation of hemoglobin

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13
Q

what is the importance of assessing a patients baseline prior to diagnostic procedures

A

to compare and see how the patient is tolerating the procedure

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14
Q

how is a shunt determined using P(A-a)O2 and P/F ratio

A

for every 50 mmHg difference in A-a gradient, a 2% shunt is approximated

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15
Q

how is a ALI determined using P(A-a)O2 and P/F ratio

A

if the P/F ratio is < 300 its ALI, < 200 its ARDS

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16
Q

how is a V/Q mismatch determined using P(A-a)O2 and P/F ratio

A

an elevated A-a gradient indicated V/Q mismatch

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17
Q

how is a ARDS determined using P(A-a)O2 and P/F ratio

A

if the P/F ratio is < 200 its ARDS

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18
Q

what is Qs/Qt indication of

A

effectiveness of pulmonary oxygenation

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19
Q

what increased the Qs/Qt value

A 
atelectasis
pneumonia
ARDS
pulmonary edema
pulmonary vasodilation
inotropic agents
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20
Q

when does the body’s compensatory mechanism or increased C.O. get triggered

A

your body will shunt blood to vital organs if C.O. drops

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21
Q

what increases C(a-v)O2

2 things

A

low C.O.

increased VO2

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22
Q

what increases SvO2

3 things

A

decrease O2 ER
decrease VO2
decrease C(a-v)O2

23
Q

what increases PvO2

4 things

A

increase C.O.
increase Hb
increase SaO2
decrease VO2

24
Q

what increases VO2

5 things

A 
exercise
trauma
inflammation
sepsis
shivering
25
Q

what increases DO2

1 thing

A

septic shock

26
Q

what increases O2ER

3 things

A

low C.O.
increased VO2
decreased CaO2

27
Q

what decreases C(a-v)O2

4 things

A

septic shock
increased C.O.
anemia
left shift on curve

28
Q

what decreases SvO2

5 things

A 
suctioning
shivering
extubation
weaning
PPV
29
Q

what decreases PvO2

4 things

A

decrease C.O.
decrease Hb
decrease SaO2
increase VO2

30
Q

what decreases VO2

4 things

A

skeletal muscle relaxation (drug induced)
peripheral shunting (sepsid, trauma)
cyanide poisoning
hypothermia

31
Q

what decreases DO2

2 things

A

decreased C.O.

decreased CaO2

32
Q

what decreases O2ER

2 things

A

high C.O.

sepsis

33
Q

what are normal/(acceptable) values of C(a-v)O2

A

4 to 6 mL/100 mL blood or vol%

5 vol%, <7 ml/dL

34
Q

what are normal/(acceptable) values of SvO2

A

65 to 75%

minimal >60%, >65%

35
Q

what are normal/(acceptable) values of PvO2

A

38 to 42 mmHg

40 mmHg, >32 mmHg

36
Q

what are normal/(acceptable) values of VO2

A

100 to 140 mL/min

250 mL/min

37
Q

what are normal/(acceptable) values of DO2

A

550 to 650 mL/min

1000 mL/min

38
Q

what are normal/(acceptable) values of O2ER

A

75%

750 mL

39
Q

how do you calculate OI

A

FiO2 x (MAP/PaO2) x 100

40
Q

if on conventional ventilation what is the number to switch to HFV or iNO

A

> 25

41
Q

if on conventional ventilation what is the number to switch to ECMO

A

> 40

42
Q

what is a normal value of OI

A

< 25 (20)

43
Q

how do you calculate P(A-a)O2

A

PAO2 = [(Pb - PH2O) x FiO2] - (PaCO2 x 1.25)

PAO2 - Pao2

44
Q

how do you calculate estimated shunt

A

(CcO2 - CaO2) / (CcO2 - CvO2)

CcO2 = (Hb x 1.34) + (PaO2 x 0.003)

CaO2 = (SaO2 x Hb x 1.34) + (PaO2 x 0.003)

CvO2 = (SvO2 x Hb x 1.34) + (PvO2 x 0.003)

45
Q

how do you calculate CaO2

A

(Hb x 1.34 x SaO2)+(PaO2 x 0.003)

46
Q

how do you calculate C(a-v)O2

A

CaO2 = (Hb x 1.34 x SaO2) + (PaO2 x 0.003)

CvO2 = (Hb x 1.34 x SvO2) + (PvO2 x 0.003)

47
Q

how do you calculate VO2

A

C.O. x (CaO2 - CvO2) x 10

48
Q

how do you calculate DO2

A

C.O. x CaO2 x 10

CaO2 = (SaO2 x Hb x 1.34) + (PaO2 x 0.003)

49
Q

how do you calculate O2ER

A

[C(a-v)O2 / CaO2]

CaO2 = (SaO2 x Hb x 1.34) + (PaO2 x 0.003)

CvO2 = (SvO2 x Hb x 1.34) + (PvO2 x 0.003)

50
Q

how is ICP assessed in ICU patients

A

fluid filled system with external transducer

solid state system with miniature pressure transducers

51
Q

how is nutrition assessed in ICU patients

A

obtain history
perform physical exam
appraisal of muscle and organ function

52
Q

how is renal function assessed in ICU patients

A

assessing BUN
assessing creatinine
assessing urine volume

53
Q

how is neurological status assessed in ICU patients

A

obtain history
exam: mental status, pupillary response and eye movement, corneal and gag reflex, respiratory rate and pattern, ICP monitoring (10-15 normal), Glasgow coma scale

54
Q

how is hemodynamic stability assessed in ICU patients

A

ECG for arrhythmias

arterial blood pressure for integrity of cardiovascular tone

Critical Care (4 decks)

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