Final - 6 Oxygenation Flashcards
ARF =
PaO2 < _____
PaCO2 > _____
PaO2 < 50
PaCO2 > 50
Syndrome characterized by sudden, progressive pulmonary edema, increasing bilateral lung infiltrates on CXR, hypoxemia refractory to oxygen therapy, decreased lung compliance
acute respiratory distress syndrome (ARDS)
symptoms of ARDS
- severe dyspnea
- restlessness
- tachycardia
diagnostic test for early stages of ARDS
BPM (plasma brain natriuretic peptide)
works with cardiac ventricles and increases in response to volume expansion
BNP
BNP > 100 =
HF
BNP > 400 =
severe HF
T/F: if pt’ has HF and is going into ARDS, BNP is not helpful
True
PEEP
positive end expiratory pressure
- really scary to families
ARDS pt’s need _____ calories
extra
An initial symptom of a simple pneumothorax is a sudden onset of…
chest pain
The _____ mask is the most accurate way to deliver
oxygen and is primarily used for patients with _____. It provides appropriate levels, thus avoiding the risk of suppressing
the hypoxic drive.
Venturi
COPD
Oxygen concentrations of greater than _____ for extended periods of time (longer than 24 hours) can cause an overproduction of free radicals which can severely damage cells.
50%
_____ or _____ prevent or reverse atelectasis and allow lower oxygen percentages to be used.
PEEP or CPAP
Placement of a tube thorough the nose or mouth into the trachea. The oral route is preferred.
endotracheal intubation
Immediately after intubation check _____ of chest expansion and auscultate breath sounds
symmetry
The position of the endotracheal tube is verified by checking end-tidal carbon dioxide levels and confirmed with…
chest x-ray.
endotracheal intubation should be positioned…
above 2cm above carina
a disorder of the lower respiratory tract that occurs most commonly in young children and is caused by infection with seasonal viruses.
bronchiolitis
is the leading cause of acute illness and hospitalization of young children. Although the number of hospitalizations seems to have increased the Mortality rate is low.
viral bronchiolitis
most common type of viral bronchiolitis
RSV (Respiratory syncytial virus)
sputum test is usually done first; if it is negative or inconclusive then the viral PCR is done.
DFA (direct fluorescent antibody)
The DFA (does, does not) cover the H1N1
does not
study is the most accurate and costs more than DFA
Viral PCR (polymerase chain reaction)
When do you test with the DFA & Viral PCR
when the rapid RXV is negative, then DFA, then Viral PCR
to detect infectious organisms in lung secretions (sputum)
DFA
_____-tagged antibodies made in the laboratory will react with a specific antigen from the infectious agent if present in the sputum; _____ indicates a positive result
fluorescence
3 things tested with bronchiolitis scoring
- RR
- wheeze
- retractions
3 types retractions
- supraclavicular/subrasternal
- intracostal
- subcostal
One of the first things we do when the children are admitted is a base line _____ _____. It takes only seconds to do with a little practice.
bronchiolitis score
bronchiolitis score 0-1 =
normal
bronchiolitis score 4-6 =
moderate
bronchiolitis score 2-3
mild
bronchiolitis score 7-9
severe
T/F: medications are not as important as suction
T
the first and easiest way to suction
BBG (baby booger grabber)
Second way to suction
NP (nasal pharyngeal)
the highest you want to turn the suction to is _____ hg for peds patients
100
remember with suction you need protection…
gown, mask, googles, gloves
T/F: suction alone is better if it will work
T
the meds are effective if the score decreases _____-_____ minutes post-tx
15-30 minutes
Do not oral/PO feed if RR greater than or equal to _____ or bronchiolitis score >_____ or on a _____ _____ nasal cannular
- RR > 65
- bronchiolitis score > 6
- high flow nasal cannula
A 16-month old bronchiolitis patient with a baseline score of 5 is suctioned, and the post-suction score is 2. Following an albuterol trial, the RR = 42, subcostal & intercostal retractions are present and there are crackles bilaterally.What would you suggest for a plan of care?
Continue suctioning prn and discontinue albuterol treatments as the patient worsened post treatment.
You are asked to evaluate a 2 year old bronchiolitis patient who hasQ4 albuterol treatments ordered. The baseline score is 3 for increased RR & wheezing. After suctioning, the RR is 26 with no retractions or wheezing. What would you suggest for the plan of care?
Continue suctioning since there were no wheezes post-suction; discontinue albuterol treatments
A 20 month old bronchiolitis patient had a post suction score of 7 for RR 46, subcostal & intercostal retractions and inspiratory & expiratory wheezing. The post albuterol score was 6 for RR 45 (only change).Did the patient respond positively to the albuterol?
No—the drop in score was due to the drop in RR by one. Truly, this patient did not respond as breath sounds and work of breathing (retractions) did not change.
You are evaluating a 13 month old for treatment need. The patient has already been suctioned and has both albuterol & epinephrine trials ordered. You find a RR of 62, subcostal & intercostal retractions, head-bobbing, grunting & diminished breath sounds, but no wheezing. There is no family history to suggest atopy (The genetic tendency to develop the classic allergic diseases).
Which medication would you use first?
Epinephrine since the patient is not wheezing and there is no family history to suggest atopy. It also may work faster.
Volume of air inspired and expired with a normal breath
Tidal Volume
volume of air based on idea body wt
6 mL/kg
low tidal volumes can cause…
hypercapnic acidosis
hig tidal volumes cause…
lung injury or barotrauma
amt of O2 delivered to the pt
FIO2
Room air is _____-_____ compared to a nasal cannula…for every L the FIO2 is approximately 4% so, 1 L is about _____%
2L = \_\_\_\_\_% 4L = \_\_\_\_\_%
20-21%
1 L = 24%
2 L = 28%
4 L = 36%
used to ween from ventilator
PSV or CPAP
delivers air pressure at a single level. The air pressure cannot be altered.
CPAP
has two levels of airway pressure - high, when the patient inhales, and low when the patient exhales. The air pressure in the _____ can be altered.
BiPAP
All spontaneous breaths are volume support ventilation
PSV or CPAP
Provides preset pressure to augment the tidal volume of each spontaneous breath
PSV or CPAP
Use of mask or other device to maintain a seal and permit ventilation.
Noninvasive Positive–Pressure Ventilation
Every breath is ventilator-generated or patient triggered and will be augmented to the preset tidal volume or pressure limit
A/C
The patient receives full ventilator support for all spontaneous breaths
A/C
Rate and Tidal Volume are set
A/C
Provides full support to the preset tidal volume or pressure limit for only the ventilator programmed breath rate or frequency
SIMV
Any additional breaths will be from patient’s own efforts
SIMV
Patient may breathe above the set machine rate, during which the ventilator will not assist and tidal volume will be determined by patient
SIMV
Prevents alveoli collapse
PEEP
If you get it too high PEEP, it can _____ your cardiac output
decrease
