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Cardiopulmonary > Final Exam > Flashcards

Final Exam Flashcards

1
Q

How much O2 in atmosphere?

A

21% O2

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2
Q

Nasal Cannula

A

-24-44% o2
-1-6L

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3
Q

Reservoir Cannula

A

-conserve o2, stored in reservoir
-100% o2 in each breath
-retains exhhaled air

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4
Q

High Flow Cannula

A

-1-15L w/ humidification
-24-75% o2
-not harsh on nose

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5
Q

Simple O2 Mask

A

-6-10L
-30-70%
-6L minimum to brevent rebreathing

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6
Q

Face Tent

A

-for mouth breathers or facial trauma
-8-15L
-21-40%

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7
Q

Aerosol Mask

A

-liquid medicatitons into mist
-must be able to see mist
-8-15L
-21-60%

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8
Q

Venturi Mask

A

-rroom air mixed with specific concentration
-color coded

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9
Q

Nonrebreathing Mask

A

-highest 02
-75-100%
-8-15L
-bag must be 1/3-1/2 full
-might be close to intubation

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10
Q

Tracheostomy Mask

A

-straight into tracheostomy tube
-35-60%
-10-15L

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11
Q

High Flow humidification Systems

A

-up to 60L
-up to 100% o2
-humidified and warmed air

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12
Q

Mechanical Ventilation

A

-meet physiological needs of pulmonary system

  1. Rrespiratory failure
  2. Protection of airway and lung
  3. Relief of upper airway obstruction
  4. Improvement of ulmonary toilet (unable to clear airways)
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13
Q

Paradoxical Breathing

A

-diaphragm fatigued from working hard
-must be inubated

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14
Q

Ventilator Settings to Know

A

-mode of ventilation
-FiO2: o2 concentration being administered (>60 concern)
-PEEP

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15
Q

Ventilator Patient Data to Know

A

-Minute ventilation
-respiratory rate

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16
Q

PEEP

A

-Positive End Expiratory Pressure
-resisdual pressure in alveoli after exhalation
-pressure required to inflate alveoli and prevent collapse

Low PEEP 3-5: normal
Moderate PEEP 5-15: treat refractory hypoxemia
High PEEP >15: severe lung injury
-put pressure on IVC and decreased CO

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17
Q

Mode of Ventilation

A

-how breath is delivered

  1. Assist-Control
  2. SIMV and Pressure Support
  3. Pressure Support
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18
Q

Assist-Control

A

-non weaning: breathing for patient
-rate and tidal volume pre-set
-patient can trigger breaths with pre-set tidal volume

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19
Q

SIMV

A

-synchronized intermittent Mandatory Ventilation
-Weaning mode: starting to take them off
-rate and tidal volume pre-set
-patient can trigger breaths with pressure support instead of pre-set tidal volume

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20
Q

Pressure Support Ventilation

A

-weaning mode: 0-30cmH20 (10 normal)
-applies to spontaneous breaths
-tidal volume not pre-set
-NOT air, only pressure

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21
Q

CPAP

A

-constant positive pressure applied in airways
-noninvasive ventilation

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22
Q

BIPAP

A

-Bi-level pulmonary airway pressure
-noninvasive ventilation

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23
Q

Hypoxia

A

O2 concentration of tissues

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24
Q

Hypoxemia

A

O2 concentration of blood

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25
Q

Right Shift in O2 Concentration

A

-reduced affinity for for O2, higher po2 will result in lower hemoglobin concentrations

-high temp, high acidity

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26
Q

Left Shift in O2 concentration

A

-increased affinity for O2, lower po2 will result in higher hemoglobin concentrations

-low temp, basic environment

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27
Q

Ventilation to Perfusion Ratio (V/Q)

A

-blood flow to alveoli must match ventilation or =hypoxemia
-changes with posture
-Norm: 0.8

Reduced: decreased ventilation to perfusion, blood shunted to other parts of the lung, vasoconstriction at arterioles to reduce BV, corrected with O2

Increased: increased ventilation to perfusion, vasodilation to increase BV, dead space

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28
Q

Arteriole Vasoconstriction

A

-alpha receptors
Shunt blood to muscles, from skin and mesenteric

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29
Q

Arteriole Vasodilation

A

-induced by increased vessel stretch
-induced by low O2 or high H+, CO2, metabolites

Beta Receptors
-increased blood flow to Skeletal muscle
-increase ventilation and alveolar perfusion

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30
Q

Most common cause of pulmonary congestion

A

-heart failure
-mostly right side affected

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31
Q

Pulmonary Embolism

A

-lung infarction due to decreased BV
-increased pulmonary hypertension
-increases load to right side of heart
-presence of ascities, bilateral LE edema and jugular vein distension
-increases V/Q ratio

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32
Q

Pulmonary Hypertension

A

-risk for cardiac disease
->20mmHg
-increased R ventricle work (Swangan’s Catheter)

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33
Q

Respiratory Cycle

A

Inspiration: 1/3, faster and louder

Expiration: 2/3, slower and softer

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34
Q

Vesicular Breath Sounds

A

-most of lung area
-inspiratory longer than expiatory
-soft

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35
Q

Brocho-Vesicular Breath Sounds

A

-near midline around upper spine and sternum
-inspiratory equal expiatory

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36
Q

Bronchial Breath Sounds

A

-above manubrium
-loud
-inspiratory shorter than expiatory

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37
Q

Chest Tubes

A

-placed to suction air or fluid
-avoid pulling out, dont tip over, treat as drainage tube
-encourage upright positions, ambulation and deep breathing

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38
Q

Anesthesia

A

-restrictive
-depresses breathing and diaphram contractions (intubation)
-decreases TLC, FRC, RV, lung compliance
-can cause collapse, shunting, atelectasis
-consider time under and O2 given during procedure
-airway obstructions from tubes/fluids

FRC
-causes alveolar collapse in supine

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39
Q

PT Intervention Goal

A

-prevent bedrest issues
-weightbearing activites
-ADLs
-pulmonary toilet/normal breathing
-o2
-family support

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40
Q

Incentive Spirometry

A

-ball rises as patient inspires
-helps inflate the lungs

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41
Q

Positive Expiratory Decives: Acapella

A

-vibratory PEP therapy
-exhale through device and vibrations looses secretions
-10x followed by huffs and a cough

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42
Q

Inspiratory Muscle Training

A

-use if pt can diaphragmatically breath w/o accessory muscles
-90-90-90 positioon, nose clippped, back supported
-lower pressures= weakness

Maximal Inspiratory Pressure:
-expire fully then maximal inspire
-can be used with sniff pressure

Maximal Expiratory: inspire fully then perfoorm maximal expiratory

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43
Q

IMP Endurance

A

-15-20% MIP
-30min/day

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44
Q

IMP Strength

A

-50-60% MIP
-train to failure 25-35 breaths

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45
Q

High Frequency Chest Wall Oscillation

A

-vibration of chest wall to remove secretions

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46
Q

Bed Rest Effects

A

Cardio:
-increased resting HR, risk of DVT
-decreased max HR, Vo2max

Respiratory:
-decreased vital capacity, inpaire toilet, increase V/Q mismatch

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47
Q

Abnormal Response to Exercise

A

-HR increase 20-30 or drop below resting
-SBP increase 20-30 or drop by 10
-Spo2 drop
-High RR, accessory muscles

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48
Q

Coronary Artery Bypass Graft

A

-CABG
-open heart surgery
-place another vessel from one spot to bypass blockage (radial arteries, saphenous veins, mammary arteries)

On pump: extensive, machine pumps for heart

Off pumo: minimally invase

Check:
-hemoglobin, hemocrit, xrays, nurses and drs, temporary pacemakers

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49
Q

Sternal Precautions

A

-limit movement for 6-8 weeks
-gentle coughing
-move “in the tube”: keep arms to the side
-infection control/incision

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50
Q

Intra Aortic Balloon Pump

A

-severe heart failure; shock
-restore CO and perfusion
-inserted in femoral (bedrest) and axillary (might be allowed to exercise) to ascending aorta
-balloon inflates and deflates to increase CO by 40%

Complications: dissectiono, perforation, ischemia, emboli

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51
Q

Mechanical Circulatory Support Steps

A

Bridge to recovery: allow organ to regain function

Bridge to Decision: determine if transplant candidate

Bridge to transplant: keep paitents alive before transplant

Destination Therapy: prolong survival and quality of life

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52
Q

Fried Frailty Phenotype

A

-weight loos, low PA, slow gait, exhaustion, weakness

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53
Q

Impella Device

A

-cathater based ventricular assist device (hook)
-increased blood flow from LV to aorta 2.2-6.2 L/min

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54
Q

ECMO

A

-Veno-Arterial Ecmo: supports heart and lungs

-Veno-venous Ecmo: supports lungs

-cannot be turned off by PT

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55
Q

LVAD

A

-Left ventricular assist device
-pump blood from LV to aorta
-has outer controller
-3-10L/m (drop in flow could be pump failure)
-Speed usually fixed (abnormal condition)
-10 Watts
-Pump Index (higher is better LV function

Complications:
-bleeding, infection, MAP

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56
Q

Heart Transplant

A

Indications:
-CHF, Cardiomyopathy, low prognosis

Post op:
-infections, low response to activity, sternal precautions

Denervated heart:
-no ischemic pain
-higher RHR >90
-slower HR changes
-orthostatic HTN

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57
Q

Lung Transplant

A

Single:
-Thoracotomy
Double:
-clamshell

Complications:
-pneumothorax, plural effusion, hypoventilation, phrenic n injury

Denervated Lungs:
-decreased cough reflex, ciliary mmt
-Increased infection risk, edema, mucous

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58
Q

Chest Wall Excursion Skills

A

-Direct Technique
-Tape Measure

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59
Q

Chest Wall Examination SKills

A

-Bronchohony
-Egophony
-Whispered Pectoriloquy
-Mediate Percussion
-Diaphragmic Excursion

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60
Q

Trachial Deviation

A

-determine if trachea is in midline position

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61
Q

Lower Lateral Costal Breathing

A

Explain: I’m going to show you how to focus on your ribs movements as you breathe to make sure you get enough air in, i will be palcing my hand on the sides of your lower ribs

-position Pt < palpate lower ribs < instruc Pt to “breathe into my hands”

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62
Q

Abnormal Breathing

A
  • inward motion of abdomen during inhalation
    -upper chest moves excessively
    -excessive use of accessory muscles
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63
Q

Diaphragmatic Breathing

A

-ease breathing in a controlled manner
-in all positions

Explain: I’m going to teach you a breathing technique tha focuses on using your diaphragm so you can do less work to breathe

Position patient upright < palpate diaphram and place Pt hand on it and upper chestt < instruct them to breath in through the nose and slowly through their mouth < encourage them to feel it more in their belly than chest

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64
Q

Segmental Breathing

A

Explain: I’m going to teach hhow to focus on expanding different parts of your belly and chest as you breathe so we can decrease the amount of work your body has to do
-i will be palcing my hand on your chest and belly

-place hand in diaphragm scoop < instruct to breathe into hand < place other hand low on sternum < instruct to breathe into hand < place first hand into upper sternum < instruct to breath into hand

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65
Q

Scoop Diahragmatic Breathing

A

-allows Pt to feel the breathing in their diaphragm as they do it by following the scoop motion, self cues
-“i will be palcing my hand on the front of your stomach”

-position patient up right < palpate breathing pattern < scoop diaphragm instruct to “breathe into hand” < scoop upward during exhalation < after some breaths place Pts hand there

-CHANGE POSITION IF NEEDED

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66
Q

Sniffing Breathing Technique

A

-Pt with weak diaphragm or controlled doesn’t work
-sit patient up with bent knees

Intruct:
-3 small sniffs, let it out slowly
-2 small sniffs, let out slowly
-1 long sniff, let out slowly

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67
Q

Pursed Lip Breathing

A

-used with emphysema Pt
-slows down exhalation and maintains pressure in airways
-makes it easier for next breath

Relax mouth < inhale < purse lips and exhale slowly

DONT USE IF ACUTELY SOB

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68
Q

Basic Ventilatory Strategies for Inhalation

A

-trunk extension
-shoulder flexion, abduction, ER
-against gravity

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69
Q

Basic Ventilatory Strategies for Exhalation

A

-trunk flexion
-shoulder extension, adduction, IR
-into gravity

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70
Q

Posture Strategies for Ventilation

A

-Butterfly technique (w/ rotation)
-Modified PNF Bilateral UE (flx/ext)
-Lateral Costal Expapnsion
-Diaphragmatic Cues
-Segmental Breathing

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71
Q

Thoracic Mobility Exercises to Enhance Inspiration

A

Explain: I’m going to teach you an exercise to help you expand your ribcage to take larger breaths

Butterfly:
Patient sitting < hands behind your head in a slouched position < bring elbows out as you inhale deeply < exhale normally through mouth as you come back to start

Home exercise:
Patient sitting < hands down by feet in a slouched position < bring arms and chest up as you inhale deeply < exhale normally through mouth as you come back to start

-to expand one side abduct ipsi arm and SB to contra

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72
Q

Thoracic Mobility Exercises to Enhance Expiration

A

Explain: I’m going to teach you an exercise to help you close your posture to take release breaths out

Butterfly:
Patient sitting < hands behind your head in a slouched position during inhale normally through the nose < bring elbows down by your ears as you exhale with PURSED LIPS < inhale normally through nose as you come back to start

Home exercise:
Patient sitting < inhale trough nose normally < hands down by feet in a slouched position as you exhale through PURSED LIPS < inhale normally through nose as you come back to start

-to expand one side abduct ipsi arm and SB to ipsi too force out air

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73
Q

Postural Drainage

A

Prone (head down): superior lobes, posterior basal

Sidelying (head down a little): lateral lobes

Supine: anterior lobes, middle lobe

Forward Lean: posterior and superior lobes2

74
Q

Percussion

A

Explain: To loosen and remove secretions i’m going to do some cupping and precussion, Show on leg

Position to help gravity drain into larger areas < cup hands and percusses for 15-30s < reasses vitals < repeat 3x < add vibration on exhale < reasses vitals

CONTRAINDICATIONS:
-hemmorage, emoblism, new babies with respiratory issues, subcutaneous emphysema, pneumothorax, bone issues, osteoporosis

-COPD: can cause spasms, pursed lip exhalation, more secretions

75
Q

Vibration

A

-used on chest wall during exhalation
-can be used when percussion not tollerated

CONTRAINDICATIONS:
-hemmorage, emoblism, new babies with respiratory issues, subcutaneous emphysema, pneumothorax, bone issues, osteoporosis

-COPD: can cause spasms, pursed lip exhalation, more secretions

76
Q

Special Considerations for Airway Clearance with COPD

A

Percussion can cause spasms, pursed lip exhalation, more secretions
-avoid forced exhalation
-head down might not be tolerated

77
Q

Coughing

A

Explain: I’m going to teach you how to prepare and to cough to best clear the lungs of secretions

Position: upright with towel <Teach Thoracic Expansion < hold on inspiration < Recruit abdominals by tightening muscles like preparing for a punch < hunch over and cough into napkin

CONTAINDICATIONS:
-surgical incisions, aortic aneryism, hemmorage, wounds, tolerance

78
Q

Huffing

A

Explain: I’m going to teach you another technique when coughing isn’t working. It is more of a forced breath like fogging up your glasses

Sit patient upright with towel < segmental thoracic expansion < hold on inspiration < recruit abs < open mouth on an “O” and huff while flexing trunk

-good for noneffective coughs, COPD less forced exhale

79
Q

Active Cycle Breathing Technique

A

Explain: We will combine deep breathing, huffing, and coughing

Relaxed diaphragmatic breathing < gradually breathing deeper (note crackles early are large airways and late are small airways) < Add thoracic expansion < inspire and hold 3s < relaxed exhalation in sigh < 1-2 huffs < if felt in upper airways cough gently < relax breathing

80
Q

Autogenic Breathing

A

-self drainage to control mucus

Explain: Self drainage to control mucus

-breathe normally, breath diaphragmatically for 3-4 breaths, exhale completely, inhale maximally, let me know when you feel secretions

Level 1: Unsticking of mucus
-avoid coughing < exhale completely < inhale a small breath and hold 1-3s < repeated until crackles are heard

Level 2: Collecting the mucus
- avoid coughing < slighly larger breath < hold for 1-3s < slight exhale < repeat until crackles heard at the end of exhale < continue for 2-3 more breaths

Level 3: Evacuating mucus
-slow deep breath < hold 1-3s < exhale forcefully in a < spit out secretion < if not, do 2-3 large huffs

81
Q

Patient Paced Diaphragmatic Breathing (Emphysema)

A

-allows for ambulation, prevents dypnea, helps with management of dypnea

Explain: I’m going to teach you how to breathe properly during different activities to conserve your energy while we move.
-you will inhale normally and exhale through pursed lips

Supine < Palpate diaphragm and tell to breathe into hand < exhale and PURSE LIPS during transitional mmt (roll to sit) < put on gait belt < show relief position if needed (bend over and breathe into belly) < reminder to pace themselves < walk and guard

82
Q

Diaphragmatic Breathing (Obstructive/Emphysema))

A

-ease breathing in a controlled manner
-in all positions

Explain: I’m going to teach you a breathing technique tha focuses on using your diaphragm so you can do less work to breathe

Position patient upright < palpate diaphram and place Pt hand on it and upper chest < instruct them to breath in through the nose REGULARLY and slowly through their mouth with PURSED LIPS < encourage them to feel it more in their belly than chest

83
Q

Emphysema

A

-COPD
-Obstructive
-red skin, skinny, pursed lips
-working hard to exhale air, can still oxygenate
-hypercompliant lung balloons alveoli trapping air

-O2 desaturation during exercise

Panacinar: alveoli only, genetic
Centrilobular: bronchioles only, progression of bronchitis

84
Q

Chronic Bronchitis

A

-COPD
-obstructive
-inflamation of bronchioles obstructing/narrowing airway and increasing mucous/cough
-“blue bloater”

S/S:
-Cor pulmonale, jugular vein distension, edema, decreased FEV1

85
Q

Segmental Thoracic Expansion

A

-place hand in diaphragm under constal angle < instruct to breathe into hand < place other hand low on sides of ribs < instruct to breathe into hand < place first hand into upper ribs; apical (not sternum) < instruct to breath into hand

CONTRAINDICATIONS:
-pneumothorax, hemmorage

86
Q

Tracheal Tickling Technique

A

-if effective cough cannot be produced

-apply digital pressure to trachea, right above sternal notch, move side to side

87
Q

Tongue out Technique

A

-if effective cough cannot be produced

-deep breath and stick toungue out before cough

88
Q

Chest Wall Excursion: Direct Technique

A

Explain: I’m to place my hands on your shoulders, chest and mid back to see how it expands on each side
-Breathe normally, looking for symmetrical movement
-inhale maximally

Apixal:Palms at upper trap, thumbs meet at clavicles

Middle: palms below nipple line, thumb meet at middle

Posterior Lobe: behind Pt, palms under 10th rib

89
Q

Chest Wall Excursion: Tape Measure

A

Explain: I’m to meaure your chest and mid back to see how it expands on each side when breathing
-Breathe normally 1st
-inhale maximally 2nd round
-measure at 3 and average (8.5cm)

Upper: 4th costal cartilage
Middle: xiphoid process
Lower: 9th constal cartilage

90
Q

Bronchophony

A

Explain: I’m going to listen your lungs and see how equal the sounds are on both sides while you repeat certain sounds

-chest wall examination using stethoscope
-listen for increased (consolidation) or decreased sounds

-say “Blue moon” and listen to changes in each lobe

91
Q

Egophony

A

Explain: I’m going to listen your lungs and see how equal the sounds are on both sides while you repeat certain sounds

-chest wall examination using stethoscope
-listen for increased (consolidation) or decreased sounds

-say “eeeee” and check for shifting sounds to “aaaaa”

92
Q

Whispered Pectoriloquy

A

Explain: I’m going to listen your lungs and see how equal the sounds are on both sides while you repeat certain sounds

-chest wall examination using stethoscope from top to bottom and side to side
-listen for increased (consolidation) or decreased sounds

-Whisper “99” and check for differences

93
Q

Mediate Percussion

A

Explain: I’m going be tapping my fingers along your chest and back to see if the sounds change from side to side

-strike finger at intercostal spaces anterior and posterioly over each lobe

Expectations:
Resonant (low longer) sounds over the lungs; filled with air

Dull: (higher pitched and shorter) indicate more dense structures/fluid, consoldation

Hyper-resonant: very low pitched and long; decreased tissue (emphysema)

Flat: muscle

Tympanic: high pitched, hollow structures

94
Q

Diaphragmatic Excursion

A

Explain: I’m going to tap several parts of your back to listen to how your diaphragm is moving as you breathe
-inhale and hold your breath
-Exhale and hold your breath

-tap down back from T7 and listen to where the resonant sound stops both time
-measure disance (3-5cm norm)
-repeat on other side

95
Q

Restrictive Lung Diseases

A

-decreased in vital capacity
-lung compliance reduced and stiffness limits expansion
-lower ventilation

Ex: pneumonia, collapsed lung

96
Q

Diaphragmatic Breathing (Restrictive)

A

-ease breathing in a controlled manner
-in all positions

Explain: I’m going to teach you a breathing technique tha focuses on using your diaphragm so you can do less work to breathe

Position patient upright < palpate diaphram and place Pt hand on it and upper chest < instruct them to take a DEEP breath in through the nose and slowly through their mouth in a SIGH < encourage them to feel it more in their belly than chest

97
Q

Right Bronchial Tree

A

-more vertical/short, more chance of asperation pneumonia

98
Q

Diffusion

A

-Co2 diffuses 4x faster than O2
-co2 sensitive to changes in ventilation
-o2 sensitive to changes in ventilation and diffusion
-need blood flow, air, close to capillary wall, sufficient o2
-takes 1/2 time RBC is in capillary to diffuse

CO2:
-Co2 (capillary) 46 + C02 (alveloi) 40 = co2 goes into alveoli
-Co2 (capillary) 40 + C02 (tissue) 46 = co2 goes into vein

O2:
-O2 (capillary) 40 + O2 (alveloi) 100 = O2 goes into capillary
-O2 (capillary) 100 + O2 (tissue) 40 = O2 goes into tissue

99
Q

Hypercapnic

A

-increased Co2
-hypoventilation: increases Co2, lowers pH
>45 PaCo2

100
Q

Hypoxemia

A

-decreased blood o2
<80% PaO2

101
Q

Diaphragm

A

-right sits higher
-tends to go upward with surgery and obesity

102
Q

Hypercompliant Lung

A

-stretches excessively without returning to normal during exhalation
-increased FRC, PaCo2, airway resistance
-Decreased PaO2, intrathoracic pressure

-COPD, Obstructive

103
Q

Hypocompliant Lung

A

-does not expand or contrac correctly
-decreased VC and RV
-increased work and pressure
-restrictive, obesity, surgery

104
Q

Tidal Volume

A

-500ml
-amount of air moved in and out in each breath

105
Q

Inspiratory Reserve Volume

A

-3000ml
-max inspiration after normal inspiration

-decrease with restrictive

106
Q

Expiratory Reserve Volume

A

-1100ml
-max one can expire after normal exhale

107
Q

Residual Volume

A

-1200ml
-volume of air left in lungs after max exhale
-FRC-ERV=RV (cannot be measured)

108
Q

Functional Residual Capacity

A

-volume of air in lungs after normal expiration
-RV + ERV
(cannot be measured)
-balances lung and chest wall forces

109
Q

Inspiratory Capacity

A

-max volume one can inspire
-TV+ IRV

-decrease with restrictive

110
Q

Vital Capacity

A

-max volume one can exchange in a respiratory cycle
-IRV+TV+ERV

-decrease with restrictive

111
Q

Total Lung Capacity

A

-air in lungs during full inflation
-IRV+TV+ERV+RV
-RV+VC=TLC
(cannot be measured)

-decrease with restrictive, increase obstructive

112
Q

FEV1

A

-forced expiratory volume in 1 sec
-80% of predicted/max
-based on age, gender, race, height

113
Q

FVC

A

-forced vital capacity
-how much can you force out and in

114
Q

FEV1/FVC

A

-percentage of vital capacity exhaled in 1 sec
->70% norm

115
Q

Dynamic Airways Resistance

A

-increases as lung volumes dec
-forced exhalation increases resistance

Obstructive: longer exhale, more air out
Restrictive: faster exhale, less air out

116
Q

Ventilation to Perfusion Ratio (V/Q)

A

-blood flow to alveoli must match ventilation or =hypoxemia
-changes with posture
-Norm: 0.8

Reduced: shunt, decreased ventilation to perfusion, blood shunted to other parts of the lung, vasoconstriction at arterioles to reduce BV, corrected with O2

Increased: dead space, increased ventilation to perfusion, vasodilation to increase BV, dead space

117
Q

Control of Respiration

A

-increased CO2 increases ventilation and breathing drive
-Decreased O2 weakly stimulates (<60)

118
Q

PaO2/Co2

A

-partial pressure of arterial O2 (80-100) /Co2 (35-45)

119
Q

SaO2

A

-o2 sat of arterial hemoglobin (>90%)

120
Q

HCO3-

A

Bicarbonate ion concentration (22-26)

121
Q

pH

A

-<7.4 acidic
->7.5 alkaline

7.35-7.45

122
Q

Hgb

A

-hemoglobin (12-16)

123
Q

Hypocapnia

A

-Hyperventilation: raises pH, reduces Co2
-PaCo2 <35

124
Q

Acid Base Regulation

A

-kidneys can extrete or retain HCO3 (slowly)

Increased Ecretion: low pH, metabolic acidosis
Decreased Extrcetion/Increased Retention: high pH, metabolic alkalosis

-respiratory
Hyperventilation: raises pH, reduces Co2, respiratory alkalosis
Hypoventilation: increases Co2, lowers pH, respiratory acidosis

125
Q

Respiratory Acidosis

A

-excess CO2, low pH

Causes:
-CNS depression
-ashyxia/hypoventilation

Compensation:
-high HCO3-

S/S:
-sweating, headache, tacycardia, restlessness

126
Q

Respiratory Alkalosis

A

-low CO2 (excretion), high pH

Causes:
-hyperventilation
-respiratory stimulation
-bacteria

Comensation:
-low HCO3-

S/S:
-rapid breathing, parasthesia, light headedness, twitching

127
Q

Metabolic Alkalosis

A

-HCO3- retention (acid loss), high pH

Causes:
-renal disease
-vomiting
-decreased K

Compensation:
-high CO2

S/s:
-shallow breathing, confusion, twitching, restlessness

128
Q

Metabolic Acidosis

A

-HCO3- loss (excretion), low pH

Causes:
-kidney disease
-hepatic disease
-endocrine disorders
-high K

Compensation:
-low CO2

S/s:
-rapid breathing (kuzmals), fatigue, fruity breath, headache

129
Q

Acid Base Values

A

-pH, PaCO2, HCO3

130
Q

Ventilation Values

A

-PaCO2

131
Q

Oxygenation Values

A

-PaO2, SaO2, Hbg

132
Q

Evaluate ABG Results

A
  1. pH
    -high= alkalosis
    -Low= acidosis
  2. CO2
    -high: resp acidosis (with low pH)
    -low: res alkalosis (with high pH)
  3. HCO3
    -high: metabolic alkalosis (with high pH)
    -low: metabolic acidosis (with low pH)
  4. Compensatory
133
Q

ABG Short Cut

A

Metabolic: look @ pH and HCO3- same (look at co2 for compensations-must be same)

Respiratory: look @ pH and CO2-different (look at HCO3 for compensations-must be same as CO2)

134
Q

Obstructive Disorders

A

-airway obstruction, reduce flow rates
-asthma, COPD, cystic fibrosis
-FEV1/FVC= <70%

135
Q

Restrictive Disorders

A

-reduction in vital capacity
-pulmonary or neuro

Acute:
-atelectasis, pneumothorax, pneumonias, respiratory distress syndrome, Pleural effusion, ascities, LVAD

Chronic:
-BPD, pulmonary fibrosis, SLE, scleroderma, cancer, skeletal issues, neuromuscular issues

136
Q

GOLD COPD Scale

A

1-4
-Mild (FEV1 >80)
-Moderate (FEV1 50-80)
-Severe (FEV1 30-50)
-Very Severe (FEV1 <30)

or number x exacerbation history A-D

137
Q

Asthma

A

-Obstructive
-bronchospasm/increased thickness and airway narrowing due to increased irritants
Irritants: allergens and enviornment or exercise

138
Q

Brochiectasis

A

-obstructive
-dilation of bronchial walls due to scar tisue or stretched from coughing
-reain secretions

139
Q

Atelectasis

A

-most common restrictive
-partial collapse of alveoli

Microatelectasis: alveolar collapse
Obstructive Atelectasis: occluded bronochus

Causes:
-inadequate pressure, chest wall deformity

140
Q

Pneumonias

A

-restrictive
-bacterial, chemical, aspiration

Bronchial:
-infection
-little consolidation
-wet cough

Lobar:
-infection
-consolidation
-dry cough

141
Q

Acute Respiratory Distress Syndrome

A

-restrictive
-life threatening (multy system organ failure)
-damage to alveoli cells
-fluffy look on xray

Causes:
-injury
-pneumonia
-embolism

142
Q

SNS Increasing Medications

A

-good for pulmonary sys

143
Q

PNS Increasing Meds

A

-bad for pulmonary sys

144
Q

Bronchoconstriction

A

-smooth muscle contraction
-in most obstructive pathophysiology
-Normal: balance between SNS and PNS activity

145
Q

Pulmonary Med Categories

A

-bronchodilation
-mucociliary clearance
-alveolar ventilation
-control of breathing

146
Q

Sympathomimetic Agents

A

-mimic SNS, increase HR and BP

Cause:
-anaphylaxis and asthma

Action:
-activate Beta 2 adrenergic receptors to bronchodilate
-epinephrine for emergent situations

147
Q

Beta 2 Agonists

A

-bronchodilation

Short acting:
-3-5 mins for 4-6 hours
-rescue inhalers
S/e: cough, high HR, tremors

Selective Beta 2 Agonist (SABA):
-long or short time
-treat bronchospasms for COPD
-rol ending

Long Lasting Beta 2 (LABA):
-12+ hours
-used for maintenance and COPD sleep

148
Q

Epinephrine

A

-for emergencies to bronchodilate
-non selective

s/s: increase BP, dizziness, tremors, increase HR

149
Q

Decongestants

A

-stimulate alpha-adrenergic vasoconstriction of capillaries in nasal mucosa
-reduction of fluid

S/s: dizziness, HTN, nausea, cardio irregularities

150
Q

Parasympatholytic Agents

A

-mimic PNS, bronchodilation
-Vagus: PNS input to lungs
-Acetylcholine: nicotitnic and muscarinic receptors

151
Q

Muscarinic Antagonists

A

-for heart when bradycardic
-lung bronchodilation

Atropine (MC)
-reduces secretions
-used to paralyze respiriatory sys due to poisoning
-not for asthma

152
Q

Methylxanthines

A

-promote increases in cAMP by stoping the breakdown by phosphoodiesterase
-cAMP is precursor to epinephrine
-promote bronchodilation and vasodilation of peripheral arteriole
-enhance epi and stop prostaglandins
-improve contractility of diaphragm

s/s: fast HR, CNS effects, RR, chest pain, dizziness, increase in urine

153
Q

Corticosteriods

A

-indirectly bronchodilate via immune system
-reduces swelling in mucosa
-immuno supressant

s/s: edema, hyperglycemia, osteoporosis, infections, atrophy, hypokalemia, clots

154
Q

Delivery Methods

A

Meter Dosed Inhaler:
-specific amount of aerosol meds per short burst from device

Nebulizer:
-mist inhaled into lungs
-compressed air/o2

155
Q

Respiratory Stimulants

A

-inhance CNS activity in respiratory centers
-sympathomimetics and methylxanthines

Analeptics: increase activity, convulsions
Dopram: chemorecepters in carotid, medulla

156
Q

Respiratory Depressants

A

-sedatives, tranqs, narcotics
-avoid witth pulmonary diseases
-supresses ventilator drive
-controls abnormal breathing patterns, anxiety

157
Q

DVT Locations

A

Proximal: worse, closer to bigger vessels
-popliteal & sup femoral (MC), proximal veins

Distal: smaller vessels
-Calf DVT extends proximally 30%

158
Q

Proximal Deep Vein Thrombosis

A

-PDVT
-most dangerous lower extremity because it can move

159
Q

Role of PT in DVT

A

Prevention:
-mobility, screen risk, education, compression, know signs, recommend testing

Post-DVT:
compression, verify anticoagulants, mobility, consult with team, screen for fall risk

160
Q

Test Risk of DVT

A

-Pauda Prediction Score
-Pt history and risk factors

161
Q

Test of Having DVT

A

-Wells DVT
-probablity of DVT
-Current symptoms

162
Q

Lab Test to Determine DVT

A

D-Dimer Test:
-reflects amount of degradation of a clot
-followed by ultra sound

PT Prothrombin Time:
-time it takes to clot, prothrombin to thrombin
->25 high risk for bleeding

PTT Partial Thromboplastin Time:
-22-32s
-heparin makes the value 2x higher

V/Q Scan:
-diagnose PE
-air is white and bad
-black is good and perfused

163
Q

Inferior Vena Cava Filter

A

-filter in IVC to catch blood cloths

164
Q

Exercise Considerations: Mild Lung Disease

A

-80 of predicted values but <70% of FEV1/FVC
-does well with exercise

s/s: SOB, cough

165
Q

Exercise Considerations: Moderate Lung Disease

A

<80 FEV1
-limited exercise tolerance
-consider meds being taken
-vitals

s/s:
-SOB with mild acivity, modify ADLs
-decreased respiiratory capacity

166
Q

Exercise Considerations: Severe Lung Disease

A

FEV1 <50
-limited walking
-need for O2, elevated CO2

167
Q

Exercise Considerations: Poor Oxygenation

A

-limits exercise capacity

s/s: SOB, decreased SaO2, secretions, cyanosis

Treat:
-postural drainage, huffing, coughing, percussion, O2, bronchodilators

168
Q

Exercise Considerations: Pump Dysfunction/Failure

A

Dysfunction
-weakness of diaphragm or fatigue
-reliance of accessory muscles and costal retraction
s/s: SOB, drop in O2
-Treat:
-breathing, positioning, supplementarry O2 (not too much or decrease in breathing drive), exercise training

Failure
-advancement of dysfunction
-further decline
-Mechanical dysfunction: obstruction of lungs, increased effort, accessory muscles (paradoxical breathing= hoover’s sign)
-Muscle Dysfunction: diaphragm ineffective
-Control Dysfunction: brainstem of breathing control

-Treat: leaning forward, urse liped

169
Q

Exercise Considerations: Pulmonary Hypertension

A

->20mmhg at rest and 30 during exercise
-40-50 stop exercise
-increased O2 demand, vasodilators, Ca blockers

s/s: hypoxia, dizziness, LOC

  1. PAH
  2. Left Heart Disease
  3. Lung Disease
  4. Chronic PE
  5. Insidious
170
Q

Exercise Considerations: Downward Spiral of Dyspnea Deconditioning

A

-Dyspnea during exercise
-less exercise: avoidance
-deconditioning: type 1 fibers then 2
-dysnea in early exercise…ADLs

171
Q

Exercise Considerations: Chronic Bronchitis

A

-hypersecretion of mucus
-low endurance, dyspnea, obesity, muscle fatigue

-reduced FEV1/FVC and FEV1

172
Q

Exercise Considerations: Emphysema

A

-decreased gas exchange
-hyperinflation
-low endurance
-accessory msucle use
-muscle wasting

-reduced FEV1/FVC and FEV1

173
Q

Exercise Considerations: Asthma

A

-wheezing, chest tightness, SOB
-low FEV1/FVC

174
Q

Predicted Percentage of Static Lung Volumes

A

<80% = Restricted Lung disease
>120%= obstructive lung disease

175
Q

Exercise tests for Muscle Strength

A

-if minute ventilation and max volume of inhalation are withing 70%= lungs were cause of end of exercise
-look for low dyspnea with high SpO2

176
Q

Dyspnea Scale

A

-1-5

177
Q

COPD Inspiratory Muscle Training

A

-<60% predicted
-diaphragmatic breathing
-facilitate expiration
-start at 30%

178
Q

Abnormal Breath Sounds

A

-bronchial sounds
-Decreased/diminished
-Absent

179
Q

Adventitious Sounds

A

-Crackles or rales: discontinuous sounds; airway obstruction or restrictive lung diseases

-wheezing: smaller airways, asthma

-stridor: crowing sound, uper airway obstruction

-Pleural rub: rubbing inflamed pleural surfaces agains lung

180
Q

Diagnosis of Sounds

A

Pleural Effusion: conta traacheal dev, decreased sounds, dull percussion (stuff)

Consolidation: increased fremitus and pectoriloquy, decreased breath sounds, dull percussion, bronchial sounds

Emphysema: decreased fremitus, hyper resonant percussion, decreased pectoriloquy, crackles

Tension Pneumonthorax:
-contra tracheal dev, hyper resonant percussion, decreased breath sounds

Mucus Plug w/ Collapse: ipsi tracheal dev, decreased everything, dull percussion

Cardiopulmonary (23 decks)

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