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S4 2539 > M2 Gas Exchange > Flashcards

M2 Gas Exchange Flashcards

1
Q

Anemia

A

Deficiency in the number of erythrocytes (RBCs)

Poor hemoglobin

Poor hematocrit

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2
Q

Hemoglobin

A

Part of RBC responsible for O2 transfer

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3
Q

Hematocrit

A

Volume of RBCs

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4
Q

Anemia is caused by

A

Blood loss

Impaired erythrocyte production

Increased erythrocyte destruction

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5
Q

Anemia and gas exchange

A

Low hemoglobin = low O2

Leads to tissue hypoxia

This is the cause of manifestations

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6
Q

Common anemia causes

A

Decreased RBC production

Blood loss

Increased RBC destruction

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7
Q

Decreased RBC production and stomach

A

Low Iron
Low Cobalamin (b12)
Low Folic acid

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8
Q

Decreased RBC production and kidneys

A

Low Erythropoietin

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9
Q

Decreased RBC production and Liver

A

Low Iron availability

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10
Q

Blood loss causes
GI
Trauma

A

GI
Bleeding duodenal ulcers
Colorectal cancer
Liver disease

Trauma
Acute Trauma
Ruptured aortic aneurysm

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11
Q

Increased RBC destruction causes

A

Hemolysis causes
SCD
Medication
Bad blood

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12
Q

Classification of anemia is done via

A

CBC
Reticulocyte count (% of RBCs in blood)
Peripheral smear

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13
Q

Morphology vs etiology of blood

A

Morphology - cellular characteristics
Etiology - MOA of condition

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14
Q

Normal hemoglobin

male
female

A

13-17
12-15

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15
Q

Mild anemia Hgb values

Symptoms

A

10-12

exertional dyspnea
fatigue

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16
Q

Moderate anemia Hgb values

Symptoms

A

6-10

Bounding pulse
Dyspnea
“Ringing in the ears”
Fatigue

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17
Q

Severe anemia Hgb values

A

Less than 6

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18
Q

Severe anemia Integumentary symptoms

A

Pallor
Jaundice
Icteric sclera
Pruritus
Smooth tongue

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19
Q

Severe anemia cardiovascular symptoms

A

low viscosity results in

HR increase
Stroke volume increase
Systolic murmurs

then angina and MI

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20
Q

Severe anemia pulmonary symptoms

A

tachypnea
dyspnea at rest
orthopnea (breath better upright)

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21
Q

Long term Anemia symptoms

A

HF
Cardiomegaly
Pulmonary congestion
Ascites
Peripheral edema

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22
Q

Anemia risk factors

A

GI surgery - gastrectomy, small bowel resection
Disease - Chron’s, celiac, diverticulitis
Alcoholism

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23
Q

Meds that can cause anemia

A

H2 histamine receptor blockers, decrease gastric acid secretion - famotidine (pepcid), cimetidine

Proton pump inhibitors, also decrease gastric acid secretion - omeprazole, pantoprazole (prazole!)

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24
Q

Pernicious or megaloblastic anemia

A

Vit b12 deficiency

Gastric mucosa dont produce intrinsic factor due to GI illness or low hydrochloric acid in body

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25
Q

Intrinsic factor

A

Made by parietal cells of gastric mucosa
Helps absorb B12

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26
Q

Treatment for pernicious anemia

A

Good nutrition

B12 therapy
Parenteral - cyanocobalamin or hydroxocobalamin
Intranasal - Nascobal
Oral high dose supplements

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27
Q

Oral B12 schedule

if left untreated

A

1000mcg/day for 2 weeks
Then 1 a week until Hgb is normal
Then monthly for life

Death in 1-3 years

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28
Q

Clinical manifestation of Pernicious anemia

A

Severe Pallor
Slight Jaundice
Smooth beefy tongue (glossitis)
Fatigue
Weight loss
Paresthesia (tingling) of hands/feet
Gait difficulty

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29
Q

Folic acid and anemia

A

Folic acid is needed for DNA synthesis
DNA synthesis leads to RBC formation and maturation

NO FA, NO DNA synth, NO RBC

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30
Q

Common causes of low Folic Acid

A

MOST COMMON
Poor nutrition
Chronic alcohol abuse

2ND most common
Malabsorption syndromes (Crohn’s celiac etc.)
Meds - methotrexate, anticonvulsants, some contraceptives

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31
Q

Folic acid anemia treatment

A

Same as pernicious
replace orally

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32
Q

Aplastic anemia
(pancytopenia)

etiology

A

Decrease in all blood cells

Etiology - congenital, or acquired

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33
Q

Acquired aplastic anemia causes

A

toxins - insecticides, arsenic, radiation, gold
meds - antiseizure, antimetabolites, antimicrobials
infections - hepatitis parvovirus

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34
Q

Aplastic anemia clinical manifestation

A

Fatigue
Dyspnea
Neutropenia
Thrombocytopenia
Cognitive changes
Cardiovascular changes

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35
Q

Neutropenia can lead to

Thrombocytopenia can lead to

A

infection risk

bleeding - petechiae, ecchymosis (bruise), epistaxis (nose bleed)

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36
Q

Cardiovascular changes with aplastic anemia

A

Palpitation
Tachycardia
Murmurs

Angina HF MI

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37
Q

Palpitation vs murmur

A

Palpitation - strong irregular beat

murmur - irregular blood swooshing

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38
Q

Cognitive manifestation of aplastic anemia

A

Impaired thought
Irritability
Depression
HA

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39
Q

In aplastic anemia all lab values would be
bleeding times would be

A

Decreased - less cells
prolonged - less clotting factors

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40
Q

Values to check for Aplastic anemai

A

Hgb
WBC
Plt
Bleed time
Bone marrow
Aspiration

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41
Q

Treatment of Aplastic anemia

A

ID cause
Supportive care - BLOOD Transfusion
ATG
Cyclophosphamide (cyclosporine)

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42
Q

Bone marrow with aplastic anemia

A

Hypocellular = less production

Increased yellow marrow, fat content

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43
Q

ATG Antithymocyte globulin

A

Horse serum - polyconal antibodies against human T cells

gets rid of autoimmune cytotoxic T cells that target and destroy pts hematopoietic stem cells

also results in anaphylaxis and serum sickness

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44
Q

If Aplastic anemia pt is less than 55 treatment options

if more than 55 treatment options

A

Have human leukocyte antigen (HLA) match
HSCT (Hematopoietic stem cell transplant) can be used

High dose of corticosteroids may be used

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45
Q

HLA
HSCT

A

Human leukocyte antigen - protein, helps body differentiate between self and not self

Hematopoietic (immature cell) stem cell transplant

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46
Q

Hemolytic anemia 101

A

Caused by destruction of RBCs faster than production

Intrinsic and Acquired

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47
Q

Intrinsic hemolytic anemia

A

Hereditary defects in RBCs

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48
Q

Acquired hemolytic anemia

A

RBCs damaged by via secondary disease or injury

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49
Q

Hemolytic anemia results in excess rbc destruction which affects and enlarges what organs

A

SPLEEN mainly
and Liver

responsible for RBC destruction

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50
Q

With gradual anemic hypovolemia

treatment

A

H&H will not reflect for up to 48h due to body accommodation of blood loss

Blood transfusion
Fluid replacement with LACTADE RINGER LR (has the replacing components lost at hemorrhage)

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51
Q

3 Components of gas exchange

A

Ventilation
Transport
Perfusion

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52
Q

Ventilation

A

O2 and CO2 exchange at LUNGS

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53
Q

Transport

A

hemoglobin carrying o2 and co2 too and from body

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54
Q

Perfusion

A

Exchange of O2 and CO2 and capillaries

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55
Q

Anemia impacts what part of gas exchange

A

TRANSPORT
Low RBC = low hemoglobin

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56
Q

ARDS
Acute respiratory distress syndrome

A

Non-cardia pulmonary edema

Refractory hypoxemia
Severe acute resp failure

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57
Q

Refractory Hypoxemia

A

(Stubborn condition) of (Low 02 in blood)

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58
Q

Is ARDS a primary process

A

NO

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59
Q

ARDS results frm

A

Septic shock
Near drowning
O2 toxicity
Aspiration of foreign material into lungs
Multiple transfusion
Heart surgery

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60
Q

fibrosis

A

tissue becoming damaged and scarred

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61
Q

ARDS lungs manifestations

A

Dyspnea
Tachypnea
Crackles
Rhonchi

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62
Q

ARDS muscle manifestations

A

Intercostal retraction
Use of accessory muscles

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63
Q

ARDS other manifestation

A

Altered mental status
Anxiety
Cyanosis

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64
Q

Diagnosing ARDS

A

ABGs
Decrease pO2
INITIALLY resp alkalosis, THEN resp acidosis

Chest xray
Whiteout

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65
Q

A/B of ARDS

A

First resp alkalosis
Then resp acidosis

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66
Q

Treatment of ARDS

A

Correct disorder

meds
Low dose steroids
LMWH

ventilatory
PEEP with low setting oxygen

Prone position

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67
Q

Position for ARDS

A

PRONE

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68
Q

PEEP

A

Positive end expiratory pressure

pushes air at end of exhale so alveoli don’t collapse

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69
Q

Nursing and ARDS

A

Ventilator and PEEP
Hemodynamic monitoring
Lung sounds
Daily weight

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70
Q

Ventilator and PEEP adverse effects

A

Will result in decrease in cardiac output

this will lower venous return resulting in ventilation issues

71
Q

First signs of PEEP/ventilator related cardiac issues

how to monitor

A

Urine output decrease
Decrease in level of consciousness

Do hemodynamic monitoring

72
Q

Weaning off of ventilator what to monitor for

A

Increase in BP HR or RR
Decrease in O2 sat
Dyspnea and Cyanosis
Diaphoresis and pallor

Anxiety LOC
Accessory muscle use

73
Q

Position for ventilator weaning
Reduce anxiety by
At night

A

High fowlers
Explaining process
Let pt rest

74
Q

To wean off, decrease vent supported breaths by

avoid what

A

2/min

respiratory depressants

75
Q

Care after extubating

A

KEEP intubation kit handy
Provide supplemental O2
Do pulmonary hygiene

76
Q

Incentive spirometer use

A

sit up
10 times an hour

77
Q

Vent alarm for
low pressure
low ventilation
low exhaled vol

Measured PIP less than set PIP

causes

A

Cuff leak
Circuit leak/disconnection
Endotracheal tube displacement

78
Q

PIP

A

Peak inspiratory pressure

79
Q

Vent alarm for
low pressure
low ventilation
low exhaled vol

Solutions

A

Check ett
check disconnetions
check cuff

ask pt if higher flow needed
check water traps

80
Q

Vent alarm
High pressure

measured PIP greater than set PIP

Causes

A

Secretions
water in tube
Kink of blockage of tube

Pneumothorax
Atelectasis
Bronchospasms

81
Q

Vent alarm
High pressure

measured PIP greater than set PIP

Solutions

A

Suction
Reposition pt
Insert bite block
Empty water traps

bronchodilators

82
Q

Vent alarm high tidal volume

Causes

A

PT trying to take MORE air in than what is set on ventilator

83
Q

Vent alarm high tidal volume

Solution

A

Increase tidal volume or flow rate

84
Q

Pulmonary embolism

A

Thrombus fragments, fragment occludes lung vasculature

85
Q

Types of thrombus

A

Clot
Fat
Air
Tumor

86
Q

DVTs can result in

A

Pulmonary embolisms

87
Q

Other causes of pulmonary embolisms

A

Right HF
A fib

Upper extremity thrombosis

Pelvic surgery or childbirth

88
Q

Superficial thrombophlebitis

A

Inflammation and clot due to vein trauma

due to IV cath

89
Q

DVT may dislodge due to

A

Mechanical forces
Don’t massage

spontaneously

90
Q

S/S of DVTs

A

Calf tenderness
Redness

+ Homan’s sign

91
Q

Homan’s sign

A

Firmly and abruptly dorsiflex (point toes up) the ankle

if deep calve pain = DVT

92
Q

Other Pulmonary Embolism (PE) risk factors

A

Immobilization
Surgery
Stroke
Malignancy
Hypertension

smoking
oral contraceptives

93
Q

PE triad

A

Chest pain
Dyspnea
Hemoptysis (spitting blood)

REPORT IMMEDIATELY

94
Q

Other PE indicators to report

airway
general

PaCO2 will be

A

Cough
friction rub
Tachypnea

Tachycardia
anxiety
fever
LOC change

LOW

95
Q

Other PE indicators to report

airway
general

PaCO2 will be

A

Cough
friction rub
Tachypnea
Tachycardia

anxiety
fever
LOC change

96
Q

Pulmonary infarction

A

Complication of PE
Death of lung tissue due to lack of blood flow

97
Q

Pulmonary hypertension

A

PE complication
Dilation and hypertrophy of the RT ventricle due to increased pressure in lung arteries

98
Q

Diagnostics for Pulmonary embolisms
visual

A

Ventilation/Perfusion lung scan
Pulmonary angiography
Chest xray
CT

99
Q

Diagnostics of pulmonary embolism
LAB
EKG

A

D-dimer (normal less than 250)
PaO2 LOW

ST segment and T wave changes

100
Q

D dimer

A

protein produced during blood clot dissolving

normal is LESS than 250

101
Q

Order for PE

A

Supplemental O2
EKG
Labs

IV Heparin, start coumadin

Bed rest

102
Q

Goal of PE interventions

meds

A

Lyse existing emboli
Prevent new ones

heparin
coumadin
thrombolytic therapy

103
Q

Thrombolytic therapy requirements

A

Remain on bedrest
Vitals Q2h

104
Q

When on Thrombolytic therapy monitor

A

PT/INR - warfarINR

PTT - Heparin

105
Q

Heparin

A

inhibits formation of other clots
WHICH COULD FORM IN PRESENCE OF EXISTING CLOT

106
Q

when to start Heparin therapy

A

DVT diagnosis
Before it can become PE

107
Q

Heparin therapy

A

Bolus 100u/kg

iv infusion till APTT normal is 20-30 sec

therapeutic APTT levels 1.5-2 times normal

108
Q

Therapeutic APTT levels

A

1.5-2 times normal

40-75 sec

109
Q

Heparin contraindications

A

S/S of bleeding

Hematuria
Blood in stool
Ecchymosis
Petechia
LOC

110
Q

Heparin Antidote

How to dose

A

Protamine sulfate

1mg per 100u

111
Q

To prevent DVTs in high risk clients can we give heparin Subcutaneously

A

YES

112
Q

Other drugs for PE

A

Lovenox - low dose heparin
Dextran - Plasma expander ?
Warfarin
Aspirin

113
Q

Starting pt on warfarin

A

10-15mg qd for 2 days

then 2.5 to 7.5 mg qd in EVENINGS

114
Q

Warfarin may need to be take for up to _ after DVT

A

6 months

115
Q

Monitoring Prothrombin/INR time with warfarin

A

PT/INR

normal pt is 12 seconds, therapeutic is 1.5-2 times normal so 18-25

INR is 2.0-3.0

116
Q

Bleeding assessment for warfarin

A

Same as heparin

117
Q

Antidote for warfarin

A

Vit K

118
Q

Anticoagulant VS thrombolytic

A

Anticoagulants warfarin heparin

Thrombolytic tPA tissue plasminogen activator

119
Q

Common tPAs

A

Streptokinase
Urokinase

120
Q

tPA moa

A

dissolves clots

121
Q

When on tPA interventions

A

Monitor for bleeding
Only essential invasive procedures
Needle gauge is ONLY 22 or 23

122
Q

How long to apply pressure when pt is on anticoagulants or thrombolytics

A

?

123
Q

How often do you check IV sites if pt on bleed precaution

A

q2h

124
Q

Bleed precaution and rectal tissue

A

NO rectal temps
NO enemas
lubricate suppositories well
Avoid constipation

125
Q

ADLs and bleed precaution

A

Use electric razor
Use soft bristle toothbrush
No nose blowing

126
Q

Psych complications of Pulmonary Embolisms

A

Anxiety
Sense of doom
Fear

127
Q

PE surgery

A

Pulmonary embolectomy
Inferior vena cava filter

128
Q

Post DVT, PE, and bleed precaution discharge teaching

A

Assess bleeding
No antihistamines?
Wear elastic stockings
No laxatives - bleed
No leg crossing - dvt

129
Q

Prevention of DVTs

A

Avoid prolonged sitting (planes, long car rides)
Increase fluids
Wear shoes at all times

130
Q

Can you stop bleed meds abruptly

A

NO

131
Q

if bleeding occurs, apply direct pressure for

extremity care

if unresolved

A

5 min

apply ice, elevate

Go to ER

132
Q

Notify DR. if on blood thinners and this occures

A

Excessive menstrual bleeding
Blood in urine/stool
Easy bruising

133
Q

Cystic Fibrosis 101

A

Defective chloride ion transport

mucus becomes viscous and dehydrated

obstruction of airway, GI, integument, reproductives

134
Q

Cystic fibrosis is autosomal

gender?

race

A

recessive

not a factor

yes

135
Q

Glands affected by Cystic Fibrosis

A

Exocrine

release secretions on to surface, interior or exterior

i.e. sweat, saliva, digestive juices.

136
Q

CF and resp complications

A

Chronic infections
Air trapping
Hypoxia

137
Q

Air trapping and CF

A

Hyperinflation
Atelectasis
Fibrosis
Destruction of lung tissue

138
Q

CF hypoxia
A/B?
vascular?

A

Hypercapnia - resp acidosis

vasoconstriction - right side heart hypertrophy = CHF

139
Q

CF GI digestive enzymes that are blocked

A

Amylase (starch) Lipase (fat) Trypsin (protein)

secreted by PANCREAS

140
Q

Pancreas may also have CF problems with islets of langerhans which results in

A

T1 diabetes

141
Q

GI CF thick intestinal mucus can cause bowel

A

obstruction

intussusception (telescoping)

142
Q

CF GI inflammation results in

A

Crohn’s disease

143
Q

Bile is produce in the

thickened bile damages those organs

A

Liver
Gallbladder

144
Q

CF and skin

A

Increase in salt and chloride sweating

145
Q

CF and reproduction

A

Seminal vesicles obstruction in men

Thickened cervical mucous in women

146
Q

CF resp system S/S
Early
Late

A

Early
Wheezing
Dry cough
Frequent infection

Late
finger clubbing
barrel chest
nasal polyps

147
Q

CF GI S/S

A

Meconimu ileus - bowel obstruction

bulky foul fatty stool

failure to thrive

delayed development

T1 diabetes

148
Q

Test for CF
are related to S/S

A

Sweat test
Fecal fat test
Liver function
Fasted blood
Pulmonary function

149
Q

Pulmonary treatments with CF

A

Bronchodilators and Chest physio therapy

Mucolytic - help with viscosity

CFTR - cystic fibrosis transmembrane regulator

Antibiotics - infection

150
Q

CFTR and CF

A

increase chloride transport

151
Q

Digestive meds for CF

A

H2 (histamine) blockers, Proton pump inhibitors - reduces stomach acid

Pancreatic enzymes

Vitamins

Iron

Ursodiol

152
Q

vitamins and CF

A

Fat soluable ADEK
help with malabsorption

153
Q

Iron and CF

A

help with malabsorption

154
Q

Ursodiol and CF

A

Bile acid
helps prevent gallstone and liver disease

155
Q

Resp interventions for CF

A

CPT (chest therapy) - 1/2 times before meals

Nebulizer treatment - for airflow and mucus clearance

Exercise

Antibiotics

156
Q

Nutrition and CF

A

High calorie balanced diet
110-200% of recommended dietary calories

Moderate fat intake

pancratic enzymes
GERD meds
Vitamins
Sodium

157
Q

Infection prevention and CF

A

Limit exposure to people with resp infections
Adequate rest
Immunizations

158
Q

BiPAP
Bilevel positive airway pressure

CPAP
Continuous positive airway pressure

A

higher flow on inhalation

continuous flow

159
Q

FiO2
Fraction of inspired oxygen

A

Indicates amount of oxygen the ventilator delivers
Expressed as a percentage

21% room air
40% for support
100% for severe hypoxemia

160
Q

Tidal volume

A

Preset amount of oxygen and air delivered by ventilator

161
Q

PRVS
Pressure regulated volume control

A

This setting adjusts volume and pressure based on lung compliance

162
Q

AC
Assist control setting

A

Supports every breath
Used at night to help pt rest

risk for hyperventilation

163
Q

SIMV
Synchronized intermittent mandatory ventilation
setting

A

Not all breaths are assisted
PT has to start breathing on their own

164
Q

Pressure support setting with SIMV

A

small pressure to help on inspiration

165
Q

Ventilator complications

A

Infection
Atelectasis
Barotrauma
O2 toxicity

166
Q

Barotrauma

A

Alveolar rupture due to high pressure

167
Q

Ventilator bundle AKA
Ventilator associated pneumonia prevention

4 components

A

Head of bed at 30-45 degrees
Daily assessment for extubation
Peptic ulcer prophylaxis
DVT prophylaxis

168
Q

Other prevention

A

CLEANING the DEVICES

169
Q

Preventing atelectasis with Ventilation

A

Repositioning - to redistribute pressure
Pulmonary hygiene, CPT
PEEP

170
Q

With vents assess breath sounds how often

A

q4h

171
Q

Barotrauma and emphysema

A

Subcutaneous emphysema is an early warning sign

172
Q

Decreased breath and heart sounds with Ventilators could indicate

A

pneumothorax

173
Q

Oxygen toxicity vent S/S

A

decrease in LOC
weakness
N/V
hypoxemia
cyanosis

174
Q

To avoid Oxygen toxicity use

A

Lowers FiO2 setting to produce O2 sat of 90% at 60mmHg

S4 2539 (11 decks)

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