Overview Flashcards
What is Hypoxic Hypoxia?
Deficiency in alveolar O2 exchange.
Reduced PO2 in the lungs (high altitude) or inadequate gas exchange.
What is Hypemic Hypoxia?
Reduction in the O2 carrying capacity in the blood due to hemorrhage, anemia, and certain drugs.
Lack of O2 carrying capacity to the tissue.
What is Histotoxic Hypoxia?
Occurs as a result of poisoning or metabolic disorders such as cyanide, ETOH, CO poisoning.
Inability of the cells to accept or use oxygen.
What is Stagnant Hypoxia?
Reduced cardiac output or pooling of blood such as heart failure, PE, or shock.
Reduced blood flow.
A PaCO2 greater than 45 mmHg indicates what?
Alveolar Hypoventilation.
A PaCO2 less than 35 indicates what?
Alveolar Hyperventilation.
Normal Range of Hemoglobin (Hgb)
12 to 18 g/dL.
Normal range for Red Blood Cells (RBC) for Male and Female.
Male: 4.3-5.7 cells/mcL
Female: 3.8-5.1 cells/mcL
Normal Range for White Blood Cells (WBC)
4,500-10,500 cells/mcL
What are the three types of Lymphocytes and where do they operate?
B cells, CD4+ helper T cells, and CD8+ cytotoxic T cells that operate in the lymphatic system.
Normal range for Sodium (Na)
135-145 mEq/L
Normal range for Potassium (K)
3.5-5 mEq/L
Normal range for Chloride (Cl)
85-105 mEq/L
Normal Range for Magnesium (Mg)
1.5-2.5 mEq/L
Normal range for Calcium (Ca)
8.5-10.5 mEq/L
Normal range for Phosphorus (P)
3-4.5 mEq/L
Normal range for Blood Urea Nitrogen (BUN)
6-23 mg/dL.
Normal range for Creatine (Cr)
0.6-1.4 mg/dL.
Normal range for Serum Osmolality
275-295 mOsm/kg H2O.
Normal range for Platelets (Plt)
150,000-440,000/ mcL.
What is the range for Prothrombin Time (PT)?
11-13 seconds.
What is the International normalized ratio (INR) for someone not on Warfarin?
0.8-1.1
What is the International normalized ratio (INR) for someone on Warfarin?
2.0-3.0.
Normal range for Activated partial thromboplastin time (aPTT)
21-35 seconds.
Normal range for Fibrinogen
200-400 mg/dL.
Normal range for D-dimer
Less than 250 mcq/mL.
Normal range for B-type natriuretic peptide (BNP)
Less than 100 pg/mL.
Normal range for Troponin-I
Less than 0.04 ng/mL.
What is the function of Sodium in the body?
Main electrolyte in the extracellular fluid that helps maintain fluid balance; assists in regulation of acid-base balance.
What is the function of Potassium in the body and how is it regulated?
Major cation intracellularly. Regulated mainly by kidneys. Essential for cardiac and CNS function by regulation muscle and nerve excitability.
What is Chloride and its function in the body? What does it assist with?
Chief anion of extracellular fluid necessary for potassium retention and transport of CO2; assists in formation of hydrochloric acid in the GI tract.
What is Calcium and its function with in the body?
Responsible for blood coagulation, muscle contraction, and nerve excitability.
What kind of relationship does Calcium have to Phosphorus?
A reciprocal relationship.
What is the function of Magnesium? What other electrolytes does a deficit of Magnesium seen with?
Affects cardiac and neuromuscular function.
Deficits are seen with Calcium and/or Potassium.
What is Phosphorus and what role does it play in the body?
Provides mineral strength to bone, integral component of DNA and RNA.
Plays a role in neuromuscular function and forming and storing of ATP.
What is BUN?
A byproduct from breakdown of blood, muscle, and protein in the body.
What is Creatinine?
A waste product of muscle metabolism.
What does Serum Osmolality measure? What partly controls it?
Amount of chemical dissolved in the serum.
Controlled partly by ADH.
What is the function of platelets, where is it formed, and how long does it live?
Normal blood clotting.
Bone marrow.
9-12 days.
What does Prothrombin Time measure?
The time it takes for the plasma of the blood to clot.
What does INR do?
Standardizes the results of Prothrombin Time (PT) no matter the method used to test it.
What does Activated partial thromboplastin time measure?
The activity of intrinsic and common pathways of coagulation.
What is Fibrinogen?
Protein in the plasma that aids in clot formation.
What does D-dimer reflect? What does it rule out?
Ongoing activation of the hemostatic and thrombolytic system.
Rules of PE,DVT, DIC.
What is BNP and what does it rule out?
Secreted by ventricles in response to excessive stretching.
Acute heart failure vs. COPD.
What is Troponin-I?
Presents in cardiac muscle tissue and released in response to muscle damage in the heart (MI).
What is the Haldane effect?
Describes how oxygen concentrations determine hemoglobin’s affinity for CO2.
What is Bohr effect?
Describes how CO2 and Hydrogen affect the affinity of hemoglobin for oxygen.
With Oxyhemoglobin Dissociation curve, what does a right shift indicate? How does it affect the body?
A decrease affinity of oxygen and hemoglobin.
Raised unloading of oxygen, acid, temperature, 2,3-DPG, and PaO2.
With Oxyhemoglobin Dissociation Curve, what does a left shift indicate? What affect does it have on the body?
An increased affinity for oxygen in hemoglobin.
Low O2 release, acid, temperature, 2-3-DPG, and PaO2.
For every __ change in CO2, the pH will change __ in the __ direction.
10 mmHg.
0.08.
Opposite.
For every __ change in HCO3-, the pH will change by __ in the __ direction.
10 mEq.
0.15.
Same.
For every change in pH of __, the K+ will change by __ in the __ direction.
0.10.
0.6.
Opposite.
What is Tidal Volume (Vt)? What is the normal range for an adult ?
The normal volume of air inspired during each normal respiratory cycle.
6-8 mL of lean body mass or IBW.
What is the sum of respiratory rate set by the ventilator and any triggered breaths by the patient shown as on a ventilator? What does it reflect for a patient?
Frequency (f).
Patient’s work of breathing, PaCO2, and pH.
What is FiO2? What is the FiO2 of room air?
Fraction of inspired oxygen shown as a percentage from 21 (21%) to 1.0 (100%).
.21 or 21%.
What is plateau pressure and the abbreviation for it?
Amount of pressure placed against alveoli showing alveolar health.
Pplat.
What is Minute ventilation (VE)?
The volume of any gas or fluid moved per minute.
How is respiratory minute volume calculated? What is the average?
(Vt) • (RR)= VE.
Average is 4-8 L/min.
What is Exhaled tidal volume (Vte)? This should be within __ of the set __.
Measurement of the volume of air received by the patient.
+/- 50 mL of set Vt.
What is I:E ratio? Which is active and passive? What happens if the expiratory time is of insufficient duration?
Inspiratory and Expiratory Time.
Inspiratory is active. Expiratory is passive.
Gas becomes trapped in the alveoli at the end of expiration.
What is I-time and flow?
The basis of how quickly a breath is delivered.
What is flow?
Ratio of the amount of total volume delivered per minute based on Vt and I-time that relates to the Inspiratory phase of the I:E ratio.
What is PIP? What does it measure? PIP should be kept at what?
Peak inspiratory pressure that is used in volume controlled ventilation. The point of maximal airway pressure.
Measures the amount of pressure at the upper airway, ETT, vent circuit, and bronchial tree.
Less than 40 cmH2O.
What is Driving pressure? How do you get driving pressure?
Pressure that opens alveoli.
Pplat- PEEP.
What should the driving pressure be kept at or below? Why?
15 cmH2O.
To prevent lung injury or damage to the alveoli.
How can you keep Driving Pressure less than 15 cmH2O?
By keeping the Pplat less than 30 cmH2O
Decreasing Vt less than 6 mL/kg
Raising PEEP.
What is Pplat and what level should you keep it below?
The measurement of pressure at the alveolar level.
Less than 30 cmH2O.
What is the quickest way to increase oxygenation?
PEEP.
What is ARDS?
Acute Respiratoy Distress Syndrome. Diffuse alveolar damage and lung capillary injury.
What is the early vs. late stage of ARDS?
Early: influx of fluid into alveoli.
Late: Fibroproliferarion (scarring and overgrowth of connective tissue) occurs.
What is the pathophysiology of ARDS?
Inflammatory response where pro-inflammatory mediators destroy capillary and alveolar capillary membranes. Alveolar separates from the capillaries.
What is Assist Control (AC)? What are the indications for the mode?
Mode of volume control that delivers a preset Vt and RR.
Normal respiratory drive accompanied by conditions causing increased work or breathing and apneic patients.
What is Synchronized intermittent mandatory ventilation (SIMV)?
Mode of ventilation that gives a set number of breaths at a preset Vt, but allows the patient to spontaneously breath between mandatory breaths.
What is a risk for using SIMV mode?
Increased muscle fatigue.
What are the indications for using SIMV? What is SIMV often used with?
Weaning, increased comfort, and reduced chance of hyperventilation.
Pressure Support (PS).
What is Pressure Support (PS)?
Pressure applied at the end of vent circuit, used in SIMV to augment the patient’s spontaneous breathing which decreases effort and work load on the patient and assists in weaning process.
What is Pressure control ventilation (PC)?
Pressure mode that delivers each breath with a preset rate, Inspiratory pressure, and I:E ratio. Can be used with PS.