PCCN Pulmonary

Question 1

Oxyhemaglobin: shift to right

Answer 1

ACIDOTIC

result from:
↓pH

↑pCO2
↑temp
↑2,3 DPG

Hgb picks up O2 less easily at lungs, MORE OXYGEN RELEASED TO TISSUES

Question 2

Oxyhemaglobin: shift to left

Answer 2

ALKALOTIC

result from:
↑pH

↓pCO2
↓temp
↓2,3 DPG

Hgb picks up O2 less easily at lungs

Question 3

Partial non-rebreather mask

Answer 3

acute respiratory failure
15L/min 60-90% of O2
anticipate BiPAP or intubation

Question 4

NC flow rate

Answer 4

highest is 44 FiO2%
1L-24
2L-28
3L-32
4L-36
5L-40
6L-44

Question 5

What does ABG assess?

Answer 5

Acid-base balance (ventilation)

Oxygenation

Question 6

Respiratory

Acidosis vs Alkalosis

Answer 6

Respiratory acidosis: retaining CO2 (over sedation)
pH < 7.35
PaCO2 > 45

Respiratory alkalosis: ↑RR, blow off CO2 (hypoxia)
pH > 7.45
PaCO2 < 35

Question 7

Metabolic

Acidosis vs Alkalosis

Answer 7

Metabolic acidosis: DKA
pH < 7.35
HCO3 < 22 mEq

Metabolic alkalosis: diuretic therapy
pH > 7.45
HCO3 > 26 mEq

Question 8

How do you know if compensation is occuring?

Answer 8

When the pH is normal but PaCO2 and HCO3 are abnormal, compensation is occuring

The primary imbalance will correlate with the pH

Question 9

ARDS: adult respiratory distress syndrome

Answer 9

acute onset
P/F ratio = PaO2 / FiO2
>400 normal
=<300 mild ARDS (acute lung injury)
<200 ARDS

Question 10

Positioning for pneumonectomy (total lung) and lobectomy (partial resection)

Answer 10

pneumonectomy: incisional side down to promote incisional splinting, allows improved ventilation, and prevents fluid from draining in the unaffected lung
partial: operative side up to promote improved perfusion to the unaffected lung

Question 11

What stimulates the COPD pt to breathe?

Answer 11

a low serum O2 level b/c their CO2 drive is blunted

Question 12

Position for pt with unilateral PNA?

Answer 12

side-lying on unaffected side, optimizes perfusion to healthy lung