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Adult Health I final > Exam 2 Pulmonary Part 1 > Flashcards

Exam 2 Pulmonary Part 1 Flashcards

1
Q

Steps of the Gas exchange process

A

Step 1: Ventilation
Step 2: Respiration
Step 3: Transport of Gases in the circulation

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2
Q

Ventilation definition/patho

A

The process of moving air between atmosphere & the lung alveoli and distributing air within the lungs to maintain appropriate concentrations of O2 and CO2 in the alveoli

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3
Q

Respiration definition/patho

A

The process by which alveolar air gases are moved across the alveolar-capillary membrane to the pulmonary capillary bed

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4
Q

Transport of Gases in the circulation definition/patho

A

Movement of oxygen and carbon dioxide to and from the tissue cells

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5
Q

Ventilation anatomy

A

-Lungs
(Lobes and mediastinum)

-Conducting airways
(Upper airways, Trachea, Bronchial tree)

  • Gas exchange airways
    (Bronchioles) and (Alveoli (Type I and II)
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6
Q

Ventilation/Perfusion (V/Q) normal ratio

A

0.8 (More pulmonary capillary perfusion than alveolar ventilation)

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7
Q

V/Q <0.8 means

A
  • A decrease in ventilation in relation to perfusion has occurred.
  • Similar to right to left shunt
  • More deoxygenated blood is returning to the left heart
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8
Q

V/Q >0.8

A
  • A decrease in perfusion in relation to ventilation

- pulmonary emboli, cardiogenic shock

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9
Q

Gas Transport mechanism

A
  • Dissolved in Plasma
    (PaO2 about 3%)
  • Bound to hemoglobin molecules
    (SaO2=oxygen saturation about 97%)

The total always equals 100%

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10
Q

A “Shift to the Right” on the Oxyhemoglobin Dissociation Curve means what?

A
  • Enhances oxygen delivery to the tissues
  • Hgb has less affinity for oxygen
  • Releases the O2 more Readily

“Think R in the words”

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11
Q

A “Shift to the RIght” on the Oxyhemoglobin Dissociation Curve etiology?

A
  • Reduced pH (acidosis)
  • hypeRcapneia (PCO2 increase)
  • feveR
  • IncRease levels of 2,3- diphosphglycerate (2,3-DPG)

“Think R in the words”

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12
Q

A “Shift to the Left” on the Oxyhemoglobin Dissociation Curve means what?

A
  • O2 not dissociated from Hemoglobing (Hgb) until tissue and capillary O2 are very low, decreasing O2 delivery to the tissues
  • Hemoglobin (HgB) has more affinity for oxygen
  • Hemoglobing (HgB) hoLds the O2 to itself

“Think L in the words”

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13
Q

A “Shift to the Left” on the Oxyhemoglobin Dissociation Curve etiology?

A
  • AlkaLosis (pH increase)
  • Low CO2
  • coLd
  • Low levels of 2,3-DPG
  • Increased Level of carbon monoxide poisoning

“Think L in the words”

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14
Q

Normal A-a Gradient?

A

Normal A-a gradient is 10-20 mm Hg, with the normal gradient increasing within this range as the patient ages

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15
Q

A-a Gradient specifics

A
  • Provides an index on the efficiency the lung is in equilibrating pulmonary capillary O2 & alveolar O2
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16
Q

PaO2/FiO2 normal value

A
  • Normal value is > 286

- Lower the number, the worse the lung function

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17
Q

Wide A-a gradient causes

A
  • Lung is the site of the dysfunction

ventilation-perfusion mismatching, shunting, diffusion abnormalities

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18
Q

What is Capnometry and Capnography?

A
  • Noninvasive
  • Measure amount of carbon dioxide present in exhaled air
    (Capnography is the sensing of exhaled CO2. Carbon dioxide is produced in the body as a by-product of metabolism and is eliminated by exhaling.)
  • By measuring exhaled CO2, many types of pulmonary assessments can be made.
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19
Q

What can cause the exhaled CO2 measured from the Capnometry and Capnography increase? Decrease?

A

Increase

  • Think respiratory failure
  • Increased work in breathing (trouble breathing)

Decrease

  • Think perfusion, metabolic or psychological problem
  • pulmonary embolism
  • Diabetic ketoacidosis (DKA)
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20
Q

Endoscopy/bronchoscopy specifics

A
  • Flexible or rigid
  • Visualize, biopsy, aspirate material
  • Sedation required
  • NPO ~ 8 hrs prior
  • Assess for return of cough & gag reflex before allowing pt to drink
  • Complications
    (Laryngospasm, pneumothorax, aspiration)
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21
Q

What is Thoracentesis

A

Aspiration of pleural fluid or air from pleural space

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22
Q

Thoracentesis procedure

A
  • Stinging sensation and feeling of pressure
  • Correct position (leaned over a table)
  • Motionless patient
  • Slow aspiration of fluid
    (Limit to 1000 mL typically)
  • Follow-up assessment for complications
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23
Q

Thoracentesis complications

A
  • Mediastinal shift
  • Pneumothorax
  • Bleeding
  • Infection
  • Subcutaneous emphysema
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24
Q

What is a lung biopsy

A
  • Invasive
  • Obtain tissue for histologic analysis, culture, cytologic examination
  • May be performed in patient’s room
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25
Q

Lung biopsy follow-up care

A
  • Assess vital signs, breath sounds at least every 4 hours for 24 hours
  • Assess for respiratory distress
  • Report reduced/absent breath sounds immediately
  • Monitor for hemoptysis
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26
Q

Blood pH normal range

A

7.35-7.45

<7.35 is acidosis
>7.45 is alkalosis

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27
Q

blood PaCO2 normal range

A

35-45 mm Hg

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28
Q

Blood PaO2 normal range

A

80-100 mm Hg

29
Q

Blood HCO3 normal range

A

21-28 mEq/L

30
Q

When is it Metabolic acidosis

A

pH <7.35
HCO3 <21

pH goes does and HCO3 goes down

31
Q

When is it Metabolic alkalosis

A

pH >7.45
HCO3 >28

pH goes up and HCO3 goes up

32
Q

When is it Respiratory acidosis

A

pH< 7.35
PaCO2 >45

pH goes down and PaCO2 goes up

33
Q

When is it Respiratory alkalosis

A

pH> 7.45
PaCO2 <35

pH goes up and PaCO2 goes down

34
Q

Low-Flow Oxygen Delivery Systems

A
  • Nasal cannula (1-6 L)
  • Facemask:
    1. Simple
    2. Partial rebreather
    3. Non-rebreather
35
Q

Nasal cannula specifics

A
  • Flow rates of 1-6 L/min
  • O2 concentration of 24%-44%
    (1-6 L/min)
  • Flow rate >6 L/min does not increase O2 because anatomical dead space is full
  • Assess patency of nostrils
  • Assess for changes in respiratory rate and depth
36
Q

Simple facemask specifics

A
  • Delivers O2 up to 40%-60%
  • Minimum of 5 L/min
  • Mask fits securely over nose and mouth
  • Monitor closely for risk of aspiration
37
Q

Partial Rebreather mask

A
  • Provides 60%-75% with flow rate of 6-11 L/min
  • One-third exhaled tidal volume with each breath
  • Adjust flow rate to keep reservoir bag inflated
38
Q

Non-rebreather mask

A
  • Highest O2 level
  • Can deliver FIO2 greater than 90%
  • Used for unstable patients that may require intubation
  • Ensure valves are patent and functional
39
Q

High-flow oxygen delivery systems

A
  • Venturi mask (COPD patients/precise)
  • Face tent
  • Aerosol mask
  • Tracheostomy collar
  • T-piece
40
Q

Venturi mask specifics

A
  • Adaptor located between bottom of mask and O2 sources
  • Delivers precise O2 concentration—best source for chronic lung disease
  • Switch to nasal cannula during mealtimes
41
Q

T-Piece specifics

A
  • Delivers desired FIO2 for tracheostomy, laryngectomy, ET tubes
  • Ensures humidifier creates enough mist
  • Mist should be seen during inspiration and expiration
42
Q

Noninvasive Positive-Pressure Ventilation (NPPV)

A
  • Uses positive pressure to keep alveoli open, improve gas exchange without airway intubation
  • BiPAP
  • CPAP
43
Q

CPAP specifics

A
  • Delivers set positive airway pressure throughout each cycle of inhalation and exhalation
  • Opens collapsed alveoli
  • Used for atelectasis after surgery or cardiac-induced pulmonary edema; sleep apnea
44
Q

High flow nasal cannula specifics

A
  • Optiflow
  • Flow rate up to 60 L/min
  • Heated, vaporized air
  • FiO2 up to 100%
45
Q

Transtracheal Oxygen Delivery (TTO)

A
  • Long-term delivery of O2 directly into lungs
  • Small flexible catheter is passed into trachea through small incision
  • Avoids irritation that nasal prongs cause; is more comfortable
  • Flow rates prescribed for rest, activity
46
Q

Trancheotomy

A

surgical incision into trachea for purpose of establishing an airway

47
Q

Trancheotomy nursing care

A
  • Prevention of tissue damage
  • Check cuff pressure often
  • Air must be humidified
  • Maintain proper temperature
  • Ensure adequate hydration
  • Assess the patient
  • Secure tracheostomy tubes in place
48
Q

Endotracheal tube: Intubation procedure

A
  • Correct placement
    Auscultate x5
    Auscultate epigastric area
    Abdomen, anterior & laterally on each side
  • Inspect chest expansion
  • End-Tidal CO2 Detector
  • CXR is used to validate the depth of the ETT
    3-4 cm above carina
    NOT too far down and into the right mainstem
49
Q

Endotracheal tube: nursing care

A
  • Check cuff pressure
  • Subjective:
    Monitor by touch
- Objective:
 Monitored every shift by RT
14 – 20 mmHg or 20-30cm H2O
Minimal air leak technique
Minimal occlusion volume technique
Too high – tracheal damage
Too low  - aspiration around cuff leak
  • Suction
50
Q

Modes of ventilation: AC (assist control) or CMV (continuous mandatory ventilation)

A
  • If pt initiates breath, machine delivers preset tidal volume for every breath
51
Q

Modes of ventilation: PRVC, (a variation of CMV)

A

Pressure-Regulated Volume Control

52
Q

Modes of ventilation: Combination of volume and pressure features

A
  • Delivers a preset tidal volume using the lowest possible airway pressure
  • Airway pressure will not exceed preset maximum pressure limit
  • Used in patients with airway resistance or decreased lung compliance such as ARDS
53
Q

Modes of ventilation: Bi-level positive airway pressure

A
  • Pre-set inspiratory pressure

- Expiratory pressure
Two levels
(a range for positive end-expiratory pressure (from PEEPHigh to PEEPLow).)

54
Q

Modes of ventilation: SIMV (Synchronous intermittent mandatory ventilation)

A
  • If pt initiates breath, machine allows pt to breath in own Tidal Volume
55
Q

Ventilator settings: Pressure support

A
  • A set amount of pressure delivered when patient initiates own breath. Assists movement of air through ventilator tubing in order to augment patient’s own tidal volume.
  • Works at the beginning of Inspiration
56
Q

Ventilator settings: PEEP (Positive end expiratory pressure)

A
  • Positive airway pressure applied at end of expiration. to keep alveoli open and facilitate oxygen transport.
  • Works at the end of Expiration
57
Q

Ventilator settings: Tidal Volume

A
  • Amount of air it takes to inflate the lungs with each breath.
  • Takes approximately 10-15 ml/kg.
58
Q

Ventilator settings: Minute ventilation

A
  • Amount of gas moved in or out of lungs per minute

- Normal is 5-8 liters/minute

59
Q

Ventilator settings: I: E ratio

A
  • Inspiration to expiration ratio
  • Normal to start at 1:2
  • Longer (1:4) in people with COPD to prevent “breath stacking”
60
Q

Ventilator settings: Peak Inspiratory Pressure

A
  • Amount of pressure it takes for ventilator to deliver tidal volume or breath.
61
Q

Ventilator settings: Percent of inspired O2 (Fi02)

A
  • Percent or fraction of oxygen delivered by the ventilator
62
Q

Complications of mechanical ventilation

A
  • Excessive pressure in the alveoli (barotrauma)
  • Excessive volume in the alveoli (volutrauma)
  • Shearing due to repeated opening and closing of the alveoli (atelectrauma)
  • Inflammatory immune response (biotrauma)

EX: pneumothorax, subcutaneous emphysema,

63
Q

Prevention of complications from mechanical ventilation

A
  • Plateau pressure kept < 32 cm H2O
  • PEEP should be used
  • Tidal Volume set at 6-10 ml/kg
64
Q

Troubleshooting alarms: Low pressure limit

A
  • Tubing disconnected
  • Circuit leak
  • Cuff deflated
65
Q

Troubleshooting alarms: Low exhaled VT

A
  • Leak in the system
  • Poor cuff inflation
  • Leak through chest tube
66
Q

Troubleshooting alarms: Temperature

A
  • Sensor malfunction

- Sensor picking up outside airflow

67
Q

Troubleshooting alarms: Apnea

A
  • Sedation
  • Neurologic
  • Metabolic
68
Q

Troubleshooting alarms: High respiratory rate

A
  • Not tolerating weaning
  • Neurogenic/ metabolic
  • Anxiety
  • Pain
69
Q

Troubleshooting alarms: Mechanical Ventilator failure

A
  • Check electrical outlet

- Needs replacement

Adult Health I final (16 decks)

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