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CVP > Midterm Study Tips > Flashcards

Midterm Study Tips Flashcards

1
Q

O2 Transport Chain

A 
Inspired O2 and quality of ambient air
airways
lungs and chest wall
diffusion
perfusion
myocardial function
peripheral circulation
tissue extraction and use of O2
return of desat blood and CO2 to the lungs
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2
Q

O2 Transport: Airways

A

become smaller and branch out

lined with smooth mm, cilia, mucus

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3
Q

O2 transport: lungs and chest wall

A

contraction of diaphragm creates (-) intrapleural pressure to inflate the lungs and bring air in

need good compliance

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4
Q

O2 transport: diffusion

A

O2 from alveoli -> pulm capillaries

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5
Q

O2 transport: perfusion

A

gravity dependent

V/Q ratio ideally is 0.8

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6
Q

O2 transport: myocardial function

A

need a coordinated conduction system, strong forceful contraction

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7
Q

O2 transport: peripheral circulation

A

neural stimulation of arteriole smooth mms contract or relax and let more/less blood through

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8
Q

O2 transport: tissue extraction and use of O2

A

rate of O2 extraction by cells depends on the O2 demand of those cells

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9
Q

O2 transport: return

A

CO2 eliminated by diffusion into alveoli

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10
Q

Practice Pattern A

A

Primary Prevention/Risk Reduction for Cardio/Pulm Disorders

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11
Q

Practice Pattern B

A

Impaired aerobic capacity/endurance associated with deconditioning

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12
Q

Practice Pattern C

A

Impaired ventilation, resp/gas exchange, and aerobic capacity/endurance associated with Airway Clearance Dysfunction

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13
Q

Practice Pattern D

A

Impaired ventilation, resp/gas exchange, and aerobic capacity/endurance associated with Cardiovascular pump dysfunction or failure

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14
Q

Practice Pattern E

A

Impaired ventilation, resp/gas exchange, and aerobic capacity/endurance associated with Ventilatory pump dysfunction or failure

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15
Q

Practice Pattern F

A

Impaired ventilation, resp/gas exchange, and aerobic capacity/endurance associated with Respiratory Failure

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16
Q

Practice Pattern G

A

Impaired ventilation, resp/gas exchange, and aerobic capacity/endurance associated with Respiratory failure in the neonate

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17
Q

Practice Pattern H

A

Impaired circulation and anthropometric dimensions associated with lymphatic system disorders

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18
Q

preload

A

amount of blood that fills ventricles in diastole

decreased = decreased CO

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19
Q

afterload

A

amount of BP (resistance) heart has to push against to eject blood out
(Increased = decreased CO)

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20
Q

Signs and Sx of Unstable patient

A 
hypotension
acute altered mental status
signs of shock
ischemic chest discomfort
acute heart failure
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21
Q

4 pieces to the complicated patient

A

dysrythmia
heart failure
thrombosis
damage to heart structure

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22
Q

3rd spacing

A

the space where fluids build up in the interstitum of the lungs

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23
Q

hydrostatic pressure (water)

A

higher in capillaries and tends to PUSH fluid OUT into the interstitum

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24
Q

oncotic pressure

A

high in the capillaries and PULLS fluid IN to the capillaries
oncotic > hydrostatic - net flow of fluid IN
if hydrostatic is high enough (CHF) it will push fluid out

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25
Q

Shunt

A

alveolus not ventilated but normal flow through the capillary

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26
Q

dead space

A

alveolus is normally ventilated but no blood flow through the capillary

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27
Q

silent

A

alveolus is unventilated and capillary no perfusion

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28
Q

conducting divisions

A

1-16 of bronch*

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29
Q

respiratory divisions

A

> 16

more SA however narrower lumen therefore easier to clog

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30
Q

Risk Factors for Atelectasis

A 
smoking hx
DOE, PND, CHF, orthopnea, dependent edema, angina
PaO2  60mmHg, PaCO2 > 50 mmHg
bed rest for 36+ hours
FIM <3-4
abdominal and or cardio thoracic surgery/traume
impaired cognitive status
low tidal volumes/breaths
retained secretions
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31
Q

Risk Factors for pneumonia

A 
smoking, alcoholism, obesity
underlying disease
trauma
prior viral illness
altered consciousness
immunosuppression
surgery
invasive procedures (mech vent)
Meds -
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32
Q

compliance

A

ease of which lungs are inflated during inspiration

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33
Q

Decreased compliance due to…

A

lung fibrosis, alveolar edema, dec surfactant, rib injury, intercostal mm tightness/fibrosis
Inc WOB

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34
Q

Heart Failure Signs and Sx

A

BNP >100
chest x-ray - cardiomegaly
ST elevation or depression on EKG

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35
Q

NYHA Class I/ Class A Heart Failure

A

cardiac dz; no limits with daily activity

unrestricted physical activity

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36
Q

NYHA Class II/ Class B Heart Failure

A

Cardiac dz; comfortable at rest, ordinary activity causes fatigue, palpation, angina, SOB
no severe or competitive sports

37
Q

NYHA Class III/ Class C Heart Failure

A

marked limits of physical activity, still comfortable at rest
moderate restrictions on ordinary activity and no strenuous efforts

38
Q

NYHA Class IV/ Class D heart failure

A

symptoms at rest - activity causes discomfort
Ordinary activity restricted
Class E - complete rest

39
Q

Zone of Apposition

A

part of the diaphragm that lines up against the inside of the lower rib cage. D/t line of pull brings rib cage up and out with inspiration
If diaphragm is flat ZofA will be less and therefore less lung expansion

40
Q

MIP - Maximum inspiratory pressure

A

negative value

max inspiration after a max expiration

41
Q

MEP - max expiratory pressure

A

max expiration after max inspiration (Positive value)

42
Q

Arterial Blood Gas Levels (ABGs)

A

Hyperventilation - alkalosis pH >7.45
Hypoventilation - Acidosis pH < 7.35
hypercapnia pCO2 >45 mmHg

43
Q

Ventilation and gravity

A

ventilation inc from apex to bass regardless of position. Lower alveoli are more compliant

44
Q

Perfusion and gravity

A

changes with position. More perfusion in the dependent areas of the lungs

45
Q

V/Q ratio and gravity

A

decreases as you move from apex to base

46
Q

Chest Xray Basics

A 
PA and later views
Look at all 4 corners
Heart size and contour (1/2 width of chest)
L/R pulmonary arteries and main bronchi
trachea
compare lung 1/3s
domes of hemi-diaphragms
costophrenic angles 
gastric air bubbles
post ribs are horizontally aligned, ant ribs angled inferiorly
47
Q

pneumo-peritoneum

A

air gets between diaphragm and live-stomach, looks paper thin on xray

48
Q

Auscultation

A

S1 - closure of mitral and tricuspid valves. Beginning of systole
S2 - closure aortic and pulmonic valves. Beginning of diastole
S3 - ventricular gallop - low pitched sound caused by rapid filling of ventricules - compliant ventricle walls or in high out put conditions
S4 - soft, low pitched sound via vibration of atrial contraction, caused by hypertroph of ventricles

49
Q

Contraindication to activity

A 
CHF (overt)
MI or extension of MI
2nd or 3rd degree heart block
HTN resting BP or hypo
>10-15 PVCs per minute at rest
severe aortic stenosis
unstable angina with recent changes in sx
dissecting aortic aneurysm
uncontrolled metabolic diseasse
psychosis or other unstable psych condition
50
Q

Diuretics

A

Bumex

51
Q

Positive Ionotropes

A

milrinone

52
Q

Sedativess

A

Popofol

53
Q

Beta 2 agonists for Bronchodilation

A

albuterol

54
Q

anticholinergics for bronchodilation

A

Spiriva

55
Q

inhaled corticosteroids

A

azmacort

56
Q

negative chronotopes/beta blockade

A

metropolol - beta blocker for angina and HTN

causes slowed heart rate

57
Q

PSV

A

patient controls frequency, tidal vol, inspiratory volume. When initiated, triggers preset inspiratory support until min pressure reached
high patient compliance

58
Q

CMV

A

controlled mandatory ventilation

patient does 0 work; no spontaneous breathing

59
Q

AC

A

assist control or “partial support” - patient receives set volume, frequency and flow rate however pt can trigger machine on their own
no spontaneous breathing?

60
Q

IMV

A

intermittent mandatory ventilation

set to give number of breaths per min. Patient can breathe on own in between - no coordination b/n machine and patient

61
Q

SIMV

A

synchronized mandatory ventilation - synchronizes machine delivered breaths with pts spontaneous breaths
if no insp. effort machine will begin

62
Q

PEEP

A

positive end expiratory pressure - keeps pressure positive so it never goes to zero to keep the alveoli from closing

63
Q

CPAP

A

contunuous positive airway pressure - alveoli kept open constantly to take some work off skeletal mm
done with spontaneous breathing patient

64
Q

Delirium

A

acute, fluctuating change in mental status, with inattention and altered level of consciousness

65
Q

RASS

A

Level of consciouness scale
+4 combative - violent
+3 very agitated - removes tubes
+2 agitated - nonpurposeful mvmt, fights vent
+1 restless - non aggressive
0 alert and calm
-1 drowsy - eye opens to voice
-2 light sedation - awake to voice <10 s
-3 moderate sedation - mvmt to voice no eyes
-4 deep sedation - no response to voice, only to tactile
-5 - unarousable

66
Q

CAM - ICU

A

confusion assessment method
1. acute change or fluctuating course of mental status AND
2. inattention + 3. altered level of consciousness
Or
4. disorganized thinking
=delirium (+)

67
Q

triad factors of asthma

A

mucus production - blocks airways
inflammation - can damage airways
bronchospasm - increases resistance to flow

68
Q

RDS

A

rapid breathing
air hunger
low O2 sat in blood

69
Q

SBTs

A

spontaneous breathing trials

avoid prolonged mechanical ventilation

70
Q

SATs

A

spontaneous awakening trials - interrupted sedation to avoid acute brain injury from delirium

71
Q

poor air quality causes

A

inflammation, destroys lung tissue, weakens lung defenses

72
Q

LFT

A

liver function test
dysfunction of liver can be life threatening - metabolizes carbs and proteins and detoxifies blood
test: amylase, alkaline, phosphotase, bilirubin

73
Q

BUN/Cr

A

kidney function. 10-20:1 is normal

<10:1 = renal damage

74
Q

D-dimer

A

molecule present in blood after clot has been degraded by fibrinolysis - indicative of thrombus

75
Q

Cardiac markers

A

troponin and CPX - elevated = infarct

CBC - if decreases = diminished O2 transport

76
Q

FRC

A

functional residual capacity
amount of air left in lungs at end or NORMAL respiration.
FRC = residual vol + expir. reserve volume
higher is better
greater in standing than sitting

77
Q

FEV1

A

forces expiratory volume in 1 second - amount of air vol forcibly exhaled from lungs in 1 sec
Lung issues FEV1 is < 1L

78
Q

FEV1/FVC %

A

anything <70% = airway problems

79
Q

RV

A

volume of air in lungs after forced expiration

closure of airways (atlectasis) causes inc RV

80
Q

TLC

A

total lung capacity
vol after forced inspiration
dec compliance = dec TLC

81
Q

FVC

A

amt of air can fully get out o flungs

dx with obstructive/restrictive dz

82
Q

DLCO

A

diffusion capacity of the lung for CO2
O2 passes from alveoli into blood
low - less O2 into blood and less CO2 out

83
Q

MVV

A

maximal voluntary ventilation
time takes for VMP to dec to 1/2 its peak ventilation, when breathing in and out as much and as fast as possible
measure of VMP power/fatigue

84
Q

PC-20 Methacholine

A

dx airway hyperresponsiveness
measure amount of methacholine (bronchoconstrictor) have to give the person for there to be a 20% change in FEV1
>16 mg/mL dose is normal, 1-4 mg/mL is mild hyperresponsiveness, <1 severe

85
Q

DVT Signs and Sx

A

swelling, pain/tenderness, inc warmth and redness

86
Q

PE Signs and Sx

A

sudden onset tachypnea, radiating chest pain, anxiety

87
Q

MAP

A

(1/3 SBP) + (2/3 DBP)
<60 mmHg blood isnt getting to internal organs enough = cell death
normal 65-90 mmHg

88
Q

CVP

A

central venous pressure monitoring - direct measure of BP in right atrium and vena cava
good for assessing right ventricular function and systemic fluid status
INC with Heart Failure

CVP (2 decks)

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