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RTH 132 Hannah > Needs > Flashcards

Needs Flashcards

1
Q

What are the physiologic objectives of CMV?

A
  • To support or manipulate pulmonary gas exchange
  • Reduce WOB
  • Increase lung volume
  • Minimize cardiac impairment
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2
Q

What are the clinical objectives for CMV?

A
  • Reverse acute respiratory acidosis
  • Reverse hypoxemia
  • Relieve respiratory distress
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3
Q

What are the sudden signs of distress?

A
  • Cyanotic
  • Anxious
  • Pale
  • Eyes wide open
  • Diaphoretic
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4
Q

What are the physical signs of distress?

A
  • Patient complains of not getting enough air
  • Abnormal breath sounds
  • Intercostal spaces may appear indented during active inspiration
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5
Q

How would you recognize ARF?

A
  • LOC
  • Cyanosis, pale, diaphoretic
  • Vital signs assessed
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6
Q

Who needs CMV?

A
  • Apnea
  • Acute respiratory failure (type I and II)
  • Impeding respiratory failure
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7
Q

What can cause apnea?

A
  • CA
  • Overdose
  • Severe hypoxia
  • Head trauma
  • High cervical spine injury
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8
Q

What is acute respiratory failure?

A

Any condition when respiratory activity is inadequate to maintain O2 uptake and CO2 clearance

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9
Q

What is a typical ABG for acute respiratory failure?

A

pH50torr

PaO2<60torr

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10
Q

What are the two types of acute respiratory failure?

A
  • Hypoxic respiratory failure (type 1)

- Hypercapnia respiratory failure (type 2)

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11
Q

What is another name for hypercapnia respiratory failure (type 2)?

A

Hypoxic lung failure

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12
Q

What is hypercapnia respiratory failure (type 2)?

A
  • Problem with respiratory muscles
  • Caused by diseases that increase WOB
  • Primary defect is ventilation
  • Severe low V/Q
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13
Q

What are the causes of hypercapnia respiratory failure (type 2)?

A
  • CNS (decreased or increased drive)
  • Neuromuscular disorders
  • Disorders that increase WOB
  • Drugs that increase WOB
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14
Q

____ is characterized by a ____ in alveolar ventilation and an ____ in PaCO2

A

ARF type 2; reduction; increase

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15
Q

What are the 6 things that contribute to a CNS decrease drive in ARF type 2?

A
  • Depressant drugs
  • Acid/base abnormals
  • Sleep disorders
  • Head trauma
  • Hypothyroidism
  • Inappropriate oxygen
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16
Q

What are the 3 things that contribute to a CNS increase drive in ARF type 2?

A
  • Metabolic acidosis
  • Increased metabolic rate
  • Anxiety associated with dyspnea
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17
Q

What neuromuscular disorders cause ARF type 2?

A
  • Hypoglycemia
  • Impaired muscle function
  • Motor nerve damage
  • Paralytic drugs
  • Drugs that affect neurotransmission
  • MG and GB
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18
Q

Normally, WOB take ___ of total oxygen consumption

A

1%-4%

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19
Q

What can cause an increased WOB in ARF type 2?

A
  • Decreased lung expansion, thoracic excursion and diaphragm excursion
  • Increased deadspace diseases, RAW, metabolic rate
  • Acute lung injury
  • Congenital heart disease
  • Shock
  • Drugs
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20
Q

What could cause decreased lung expansion?

A

Pleural effusion

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21
Q

What could cause decreased thoracic excursion?

A

Chest surgery

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22
Q

What could cause decreased diaphragm excursion?

A

Obesity

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23
Q

What could cause an increase in deadspace diseases?

A

Emphysema

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24
Q

What could cause an increase in RAW?

A

COPD

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25
Q

What is an example of an acute lung injury?

A

ARDS

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26
Q

What could cause congenital heart disease?

A

Decreased CMO

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27
Q

What could cause shock?

A

Blood loss

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28
Q

What could cause an increase in metabolic rate?

A

Fever

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29
Q

What drugs could cause an increased WOB in ARF type 2?

A
  • Narcotics (pulmonary edema)

- Insulin (bronchospasm)

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30
Q

What is ARF type 1?

A

Primary problem is oxgenation. Hypoxemic respiratory failure (severe refractory hypoxemia)

31
Q

What are 2 ways you could try to treat ARF type 1?

A
  • Oxygen

- PEEP/CPAP

32
Q

What does a typical ABG for ARF type 1 look like?

A
  • PaO2 is low
  • PaCO2 is normal to low
  • PaO2/FiO2<200
33
Q

What are 5 things that cause ARF type 1?

A
  • Decreased inspired Oxygen
  • Diffusion Impairment
  • Perfusion/Diffusion impairment
  • Shunt
  • Ventilation/Perfusion mismatch
34
Q

True or false: Ventilation/perfusion mismatch responds to oxygen

A

True

35
Q

What is the clinical presention of V/Q mismatch?

A
  • Dyspnea
  • Accessory muscles
  • Tachycardia
  • Tachypnea
36
Q

What is diffusion impairment in ARF type 1?

A

Difficulty with movement across alveolar capillary membrane due to pressure gradient

37
Q

What causes diffusion impairment in ARF type 1?

A
  • In exercise, blood flow increases, which limits time for exchange
  • Pulmonary vascular abnormalities
38
Q

What are some examples of pulmonary vascular abnormalities?

A
  • Pulmonary embolism
  • Anemia
  • Pulmonary hypertension
39
Q

What causes perfusion/diffusion impairment in ARF type 1?

A
  • Liver disease

- Cirrhosis

40
Q

True or false: perfusion/diffusion is rare and does respond to oxygen

A

True

41
Q

What is a shunt?

A

No ventilation to match perfusion

42
Q

What is a physiologic shunt in ARF type 1?

A

Alveoli collapse, filled with fluid or exudate

43
Q

True or false: a shunt responds to oxygen

A

False

44
Q

What is the clinical presentation of a shunt in ARF type 1?

A
  • CXR white out
  • Unilateral absence of BS may indicate collapse, mass or effusion
  • Bilateral/unilateral crackles due to alveolar filling process
  • Asymmetrical chest expansion
45
Q

What diseases could cause ARF type 1?

A
  • Pulmonary emboli
  • ARDS
  • Anat/phys shunt
  • Severe atelectasis
  • CO poisoing
46
Q

What is refractory hypoxemia also known as and what therapy is used to treat it?

A

Severe oxygenation deficit; PEEP therapy

47
Q

What is impending respiratory failure?

A
  • Patient has an extreme WOD
  • RR>35
  • Diaphoretic
  • Use of accessory muscles
48
Q

What is a typical ABG for a person with impending respiratory failure?

A
  • pH normal or increased
  • PaCO2 decreased (increased in late stage)
  • O2 normal or decreased
49
Q

What are 5 notable changes in a person with impending respiratory failure?

A
  • Paradoxical breathing
  • Retractions
  • Extreme fatigue
  • Vt greater % of VC
  • Worsening pulmonary or pleural infection
50
Q

What are the respiratory clinical findings for hypoxia?

A

Tachypnea for both mild/moderate and severe

51
Q

What are the cardiovascular clinical findings for hypoxia?

A

Tachycardia for both mild/moderate and severe

52
Q

What are the neurological clinical findings for hypoxia?

A
  • Disorientation (mild/moderate)

- Confusion (severe)

53
Q

What are the respiratory clinical findings for hypercapnia?

A

Tachypnea for both mild/moderate and severe

54
Q

What are the cardiovascular clinical findings for hypercapnia?

A

Tachycardia for both mild/moderate and severe

55
Q

What are the neurologic clinical findings for hypercapnia?

A
  • Drowsiness (mild/moderate)

- Hallucinations (severe)

56
Q

What are the clinical signs of hypercapnia?

A
  • Sweating

- Redness

57
Q

What are the best indicators for inadequate alveolar ventilation?

A
  • PaCO2

- pH

58
Q

What are the best indicators for inadequate lung expansion?

A
  • Rate
  • Vt
  • VC
59
Q

What are the best indicators for inadequate respiratory muscle strength?

A
  • MIP

- VC

60
Q

What are the best indicators for excessive WOB?

A
  • Rate

- VD/VT

61
Q

What is the best indicator for an unstable ventilatory drive?

A

Breathing pattern

62
Q

What is the best indicator for severe hypoxemia?

A

PaO2/FiO2

63
Q

What 5 things should you look at when assessing a patient?

A
  • LOC
  • Skin color
  • Signs of hypoxia or hypercapnia
  • Vital signs
  • WOB
64
Q

What is the cause of tachycardia if the heart rate decreases by 10 after several minutes on oxygen?

A

Hypoxia

65
Q

What is the cause of tachycardia if the heart rate does not decrease after several minutes on oxygen?

A

Shunting

66
Q

What therapy is recommended to treat CHF?

A
  • NPPV

- BiPAP mask

67
Q

What therapy is recommended to treat slowly reversible hypoxemic respiratory failure?

A
  • Intubate
  • High inspired FiO2
  • PEEP
  • Inverse ratio
  • PCV
68
Q

What therapy is recommended to treat acute alveolar hypoventilation?

A
  • A/C
  • SIMV with high back up rate
  • PSV with high pressure
69
Q

What therapy is recommended to treat chronic alveolar hypoventilation?

A
  • NPPV

- BiPAP

70
Q

What therapy is recommended to treat altered mental status?

A
  • Intubate
  • A/C
  • SIMV with adequate back up rate
71
Q

What therapy is recommended to treat acute respiratory muscle fatigue?

A
  • BiPAP
  • Intubate
  • A/C
  • SIMV with adequate back up rate
72
Q

What therapy is recommended to treat chronic respiratory muscle fatigue?

A

Night time BiPAP with A/C or SIMV with tracheostomy

73
Q

What are the contraindications for CMV?

A
  • Patient’s informed request
  • Untreated tension pneumothorax
  • Medical futility

RTH 132 Hannah (12 decks)

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