final

Question 1

ABG normal values
 pH
 PaCO2
 HCO3
 SaO2
 BE

Answer 1

1. pH = 7.35- 7.45
2. PaCO2 = 35-45mmHg
3. HCO3 = 22-28
4. SaO2 = > 95%
5. BE = +/- 2 m Eq/L

Question 2

PaO2
newborn
adult < 60
adult > 60

Answer 2

1. newborn = 40-70 mmHg
2. adult < 60 80-100 mmHg
3. adult > 60 = subtract 1mm / year

Question 3

acid/ base balance
volatile vs. non-volatie acids (2)
bicarbonate
other buffer system in body (and %)

Answer 3

1. volatile acids - g->l
   nonvolatile acids cant change => must be excreted
2. lungs regulate volatile and kidneys regulate non-volatile
3. bicarbonate is major base (regulated by kidney)
4. hemoglobin accounts for 85% of non-bicarbonate buffering action

Question 4

acidemia
acidosis
alkemia
alkalosis

Answer 4

1. acidemia = pH < 7.35, caused by acidosis

4. alkemia = pH > 7.45, alkalosis is the process causing alkelima (high HCO3, low CO2)

Question 5

primary acid/ base disorder-

determination if problem is respiratory or renal (and nemonic)

Answer 5

ROME

1. respiratory - opposite = pH and CO2 maintain inverse relationship
2. metabolism - equal = pH and CO2 do not have an inverse relationship

Question 6

alveolar ventilation classification
hyperventilation
adequate
ventilatory failure

Answer 6

1. alveolar hyperventilation = < 30 mmHg PCO2 (breathing too much CO2 out)
2. adequate ventilation = 35-45mm Hg
3. ventilatory failure = hypoventilation = > 50 mmHg

Question 7

assessment of ventilatory status
is primary problem is respiratory
4 steps
how to classify your results

Answer 7

calculating “expected pH”
1. determine absolute diff btwn reported PCO2 and normal (use 40)
2. divide by 100
3. IF REPORTED # is >40-
subtract half this value from 7.40
4. IF REPORTED # is < 40- add entire value to 40

acute = reported pH is same or further from normal than expected pH
chronic = reported pH is closer to normal than expected pH

Question 8

assessment of ventilatory status

if primary problem is metabolic (3)

Answer 8

1. uncompensated
   pH is outside normal range
   CO2 w/i normal range (lungs haven’t kicked in yet to compensate)
2. partially compensated
   both pH and CO2 are outside normal range (lungs kicked in)
3. compensated
   pH w/i normal range
   CO2 outside normal range

Question 9

supplemental oxygen delivery devices

nasal cannula- estimated FIO2

Answer 9

FIO2 = fraction of inspired air that is O2
1L/min = 0.24
2L/min =0.28
3L/min = 0.32
4L/min = 0.36
5L/min = 0.40
6L/min = 0.44

Question 10

what % of ambient air is O2?

Answer 10

21%

Question 11

at what FIO2 do we humidify air

Answer 11

> 30%, otherwise secretions will thicken

Question 12

ventilator alarms
 high pressure (and what you do)
 low pressure/ disconnection
 FiO2
 Apnea
 Volume

Answer 12

1. high pressure- patient should be checked for secretions of potential obstructions (may be proximal mucous plug)
   action- suctioning or using manual resuscitator bag
2. low pressure/ disconnection- leak or pt became disconnected
3. FiO2 - not delivering correct FiO2
4. Apnea- no breath is appreciated * medical emergency*
5. volume - pt is not maintaing adequate minute vol; may be b/c patient is fatiguing