Oxygenation And Ventilation Flashcards
What questions should we ask when assessing oxygenation?
- Risk factors: Familial - genetic/more members of the family
- Fatigue
- Pain (jaw, chest, left arm).
- Breathing pattern (dyspnea, orthopnea, wheezing)
- Cough
- Respiratory infections
- Medication use
Exposure to what substances are linked to respiratory disease?
- Smog
- Cotton
- Dust
- Silicon
- Mold
- Cockroaches
- Secondhand smoke
- Asbestos
How would you describe the pain originating in the heart?
- Substernal and typically radiates to the left arm and jaw in men.
- Some women (some men) have epigastric pain, complaints of indigestion, nausea, or vomiting, or a choking feeling and dyspnea.
When a patient doesn’t feel good and doesn’t look good what is the first intervention that you should do?
Take their vitals.
Describe pericardial pain resulting from an inflammation of the pericardial sac.
It is usually non-radiating and often occurs with inspiration or when lying supine.
How would you describe pleuritic chest pain?
Peripheral and usually radiates to the scapula regions. Inspiratory maneuvers such as coughing, yawning, & sighing aggravates pleuritic chest pain. An inflammation or infection in the plural space usually causes pleuritic chest pain. Patient often describe it as knife like or Sharp, and it increases in intensity with inspiration.
How would you describe musculoskeletal pain?
Musculoskeletal pain is often present following exercise, rib trauma, and prolonged coughing episodes. Respiratory movements aggravate the pain and are easily confused with pleuritic chest pain.
What is dyspnea?
A subjective feeling of breathlessness as reported by the patient, or it can be observable labored breathing with shortness of breath.
What are symptoms of dyspnea?
Exaggerated respiratory effort, use of the accessory muscles of respiration, nasal flaring, and marked increases in the rate and depth of respirations.
What is dyspnea that occurs when a patient is sleeping?
Paroxysmal nocturnal dyspnea (PND)
What is wheezing?
A high-pitched musical sound caused by high velocity movement of air through a narrow airway. It is present and asthma, acute bronchitis, or pneumonia.
What is a productive cough
One that produces sputum that is Swallowed or expectorated.
What is hemoptysis?
Bloody sputum.
Dead space ventilation
Ventilation where not all inspired air reaches the alveoli and 150 mL is stopped in the airway leading to the alveoli.
What is the fraction of inspired oxygen?
The concentration of oxygen in our in hailed air, which is referred to as FIO2.
What may cause a pulse oximeter to not work?
Nail polish or poor circulation.
On inspiration what does the chest wall do?
It moves out.
On expiration what does the chest wall do?
It moves inward (sinks in).
Expiration is what kind of process?
Passive process.
Inspiration is what kind of process?
An active process.
Inspiration is an active process that causes the brain to do what?
Send impulses down the phrenic nerve to initiate diaphragm contraction.
When assessing a patient respirations, what should we keep in mind?
- The patient’s baseline
- Influence of any disease or illness
- Relationship with respiration in cardiac function
- Influences of any therapies on their respiration status
What is hyperventilation?
It is a state in which there is an increased amount of air entering the lungs.
What is hypoventilation?
It is breathing at an abnormally slow rate, resulting in an increased amount of carbon dioxide in the blood.
What is Cheyne-Stokes respiration?
A regular pattern of irregular breathing rate (often before patients die).
A 12-year-old female patient is having an asthma attack after participating in some strenuous activity during recess at school. She’s taken several doses of her own bronchodilator with a little relief. Your partner immediately and minister’s oxygen. Providing supplemental oxygen will increase the amount of oxygen molecules carried by what?
Carried by the hemoglobin in her body, helping oxygenate critical organs like the brain.
What causes hyperventilation?
Anxiety
Infections
Drugs
What are the signs and symptoms of hypoventilation?
Mental status changes dysrhythmias
potential cardiac arrest
Treatment for hypoventilation
Improved oxygenation
restore ventilation
treat underlying cause
received the acid-base balance
What causes hypoxia?
Impaired oxygenation
Poor tissue perfusion
Decreased diffusion of oxygen and alveoli to blood
The inability of tissues to extract oxygen from the blood
What is hypoxemia?
Low level of arterial oxygen in the blood.
What are the signs and symptoms of hypoxemia?
Restlessness
Inability to concentrate
Dizziness
Increased pulse rate
What is the treatment for hypoxemia?
Administer oxygen entry underlining cause
What is chest wall movement asymmetry?
Unequal expansion of lungs caused by a chest wall injury i.e. a collapsed lung.
What are retractions?
Visible sinking in soft tissues of the chest that lies between and around firmer tissue (e.g. cartilage and bony ribs).
What is paradoxical breathing?
Asynchronous breathing and chest contraction during inspiration and expansion during expiration.
What normally triggers the respiratory drive by changing levels?
Carbon dioxide CO2
What do you call the volume of air that is moved in and out of the chest in a normal breath cycle?
Tidal volume.
What causes peripheral cyanosis?
Vasoconstriction and diminished blood flow and hypoxemia.
What causes central cyanosis?
Hypoxemia and/or hypoxia which is the late sign.
What causes decreased skin turgor? (The state of turgidity and resulting rigidity of cells or tissues, typically due to the absorption of fluid).
Do you hydration which is the normal finding an older adults as a result of decreased skin elasticity.
What causes dependent edema?
Heart failure.
What causes clubbing a finger tips?
Chronic hypoxemia
What causes pursed- lip breathing?
Chronic lung disease; increased respiratory effort.
How can oxygen be transferred?
Ventilation and perfusion.
What will happen if a person has low red blood cells?
Shortness of breath.
What causes pallor of the mouth and lips?
Anemia
What causes distention of neck Veins?
Heart failure (typically right sided) and fluid overload.
What causes barrel chest?
COPD and maybe a normal finding an older adults.
What are kussmaul respirations?
Respiration usually greater than 35 breaths per minute. Breaths deep in nature which is associated with metabolic acidosis state such as diabetic ketoacidosis.
What is Cheyenne-Stokes respiration?
Periods of increasing depth of breathing followed by a period of apnea. It is seen in seriously ill patients typically with brain injury or drug associated respiratory distress. It may be seen in children and older adults during sleep.
What is Ataxic or Biot’s respiration?
Irregular respirations of varying depths with irregular periods of apnea. It has poor prognosis and usually associated with severe brain injury.
What is neutral oxygenation?
The rhythm in depth between inspiration and expiration, the central nervous system controls rate and depth and rhythm.
When a patient blows up too much CO2 do they become basic or acidic?
Basic
Where are crackles commonly found in the lungs?
Dependent lobes
What is the treatment for crackles in the lungs?
Medication
Where is rhonchi heard?
Primary over the trachea and bronchi.
What is rhonchi?
A sound caused by mucus in the large Airways
What are
Sounds caused by minor fluid accumulation.
What is an arterial blood gas?
And invasive procedure that sticks a needle in an artery to tell the medical profession the pH of the blood (this does not require consent).
What are the four different types of hypoxia?
Hypoxemic hypoxia
Hystotoxic hypoxia
Circulatory hypoperfusion stagnant hypoxia
Anemic hypoxia
What is hypoxemia hypoxia?
A patient is hypoxic because they are hypoxemia.
What is hystotoxic hypoxia?
Oxygen can’t attach to the hemoglobin.
How many times greater is affinity and carbon monoxide than an oxygen for hemoglobin?
200 times
How do you treat carbon monoxide poisoning?
100% non-rebreather initially and then a hyperbaric chamber.
At what point do severe toxic effects start for carbon monoxide poisoning?
When the levels get over 30%.
What are the symptoms of severe toxic effects of carbon monoxide poisoning?
Headache
Lethargic
Arrhythmias
At what level is carbon monoxide poisoning fatal?
When it reaches over 50%.
What is the half life of carbon monoxide at room air?
3 to 4 hours
What is the half-life of carbon monoxide on 100% non-rebreather?
40 to 60 minutes
What is the half life?
The amount of time it takes for a substance to cut it’s amount in half
What is the half-life of carbon monoxide in a hyperbaric chamber?
15 to 20 minutes
Does the pulse ox number have any value when the patient is suspected of having carbon monoxide poisoning?
No
How do you measure carbon monoxide on an ABG?
Co-ox or hemoximetry
What will the ABG look like in a carbon monoxide poisoning?
High PaO2 and low SAO2
What is a normal CO percentage in smokers?
4-5%
What is circulatory hypoperfusion stagnant hypoxia?
The patient can’t get blood to the tissue because the blood pressure is too low to get it there.
What causes anemic hypoxia?
Low red blood cell RBC
What is A- a gradient also known as?
Alveolar air equation
What does the A stand for it and A-a gradient?
Alveolar
What does the a stand for in A-a gradient?
Arterial PaO2 in the blood.
What is the formula for the A-a gradient?
PAO2 = [FI02( PB -47 )]-( PaC02×1.25)
What is a normal A-a gradient?
5-10 mmHg
What is the indication of a huge difference between the oxygen in the alveoli and oxygen in the blood?
It indicates a huge problem at the AC membrane. The patient should be put on a CPAP.
What do you do if the patient has a high level of oxygen and the alveoli and high level in the blood and is on a 100% non-rebreather?
Lower of the FIO2 to 60% then continue to lower to keep stats at or greater than 90%
Can the PaO2 to be greater than the PAO2?
No
Should an A-a gradient be high or low?
Low
What indicates a bad A-a gradient?
A high gradient with a high FIO2
What value should the P/F ratio be?
Greater than 300
What is a critical P/F value?
Less than 200 with a FIO2 greater than 60%.
What is mild hypoxemia?
91-95%
What is moderate hypoxemia?
86-90%
What is severe hypoxemia?
85% or lower
What are agonal respirations?
Shallow, slow, or in frequent breathing, and usually indicating brain and anoxia.
What hemoglobin Hb does SPO2 not distinguish but it reflects the amount of oxygen bound to hemoglobin?
Oxyhemoglobin Carboxyhemoglobin
Methemoglobin
In normal exhalation, the diaphragm and intercostal muscles relax to contract the chest, which creates a positive pressure. What is this type of process?
Passive
What does the pulse oximeter probe measure?
Pulsatile (arterial) Blood flow at two different wavelengths.
What two wavelengths does the SPO2 probe measure and what do they measure?
Oxyhemoglobin =660 nm
Reduced hemoglobin =940 nm
Which three patients should get a pulse oximetry?
Any hypoxemic patient
Patients who need a life monitors (critically ill or with Circulatory deficits)
Any patient under anesthesia
What are the limiting factors for interpreting SPO2?
Poor perfusion (hypotension, hypothermia, peripheral vasoconstriction)
Dark pigmentation
Motion
Accuracy (probe must be in place for at least 30 Sec, with good waveform/pulse form/HR)
Dyshemoglobinemias will falsely elevate SpO2
What are the normal values for ETCO2?
30-43 mmHg
How does a ETCO2 work?
Infrared light is passed through in title air to a photo detector. The detected light intensity is in inversely proportional to the concentration of CO2 in the sample.
What are the two designs for ETCO2 detectors and how do they differ?
Main-stream =optical chamber located in the circuit.
The other design is side-stream =sampling port is attached to a breathing circuit, and CO2 is desiccated and transported to the measurement chamber.
Desiccated- dried out, all moisture removed.
What for groups of patients are at risk of ventilatory failure?
Cardiac
Respiratory
NMJ
Neurologic patients
Which 4 categories of patient selection exist for ETCO2 monitoring?
Patient at risk of ventilatory failure, patients undergoing intermittent PPV, Anesthesia, pulmonary resuscitation patients
Which three disturbances may cause an increase in ET CO2?
Hypoventilation, increased metabolic rate (fever) and IPPV (increase cardiac output)
What is the indication of the rise and both baseline and ET CO2?
Rebreathing of CO2.
What is the indication of a sudden fall in ETCO2?
Airway leakage or ventilator malfunction and IPPV for cardiac arrest.
What are two common sampling errors during arterial blood gas collection and how do they affect results?
Exposure to room air or bubbles, PaO2 will approach 150 mmHg and PaCO2 will decrease (increases pH values). Excessive heparin will decrease pH, PaO2, and PaCO2.
What is the partial pressure of oxygen dependent upon?
The barometric pressure.
What do you call the potential space between the long and chest wall?
The plural space.
What are the four measurements of oxygen?
PaO2 (partial pressure of oxygen in arterial blood), alveolar-arterial O2 difference (A-a), 5 x FiO2, and partial pressure of oxygen: FiO2 (PaO2/FiO2)
What is PaO2 and what is the cut off value for hypoxemia?
Partial pressure of oxygen and arterial blood. Pa02 less than 85 to 90 mmHg = hypoxemia.
What is the A-a and what is the alveolar gas equation it follows?
A-a=difference in oxygen tension between the alveolus (A) and the artery (a). Mean alveolar PO2 (PAO2) = FIO2 (Barometric pressure - Water vapor) - (PaCO2/0.8).
What values the way follow for A-a?
Less than 10= normal for patient breathing room air and greater than 30=Abnormal for patient breathing room air.
