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CCRN > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

Central control: brain stem

A

Senses pH, decreased pH > ventilation is stimulated > increased RR

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2
Q

Peripheral control: PaO2 sensors in aortic arch

A

Senses PaO2 > decrease in PaO2 (hypoxemia) > ventilation is stimulated > increased RR

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3
Q

How to know if ventilating normally?

A

PaCO2! NOT PaO2

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4
Q

Minute ventilation

A

Tidal volume x RR

Normal is approx. 4L/minute

Increased minute vent = increased WORK OF BREATHING

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5
Q

Primary muscle of ventilation

A

Diaphragm!

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6
Q

Anatomic dead space

A

Doesn’t participate in gas exchange

Dead space is approx. 2ml/kg of Vt

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7
Q

Alveolar dead space

A

Pathologic, non-perfused alveoli (PE)

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8
Q

Physiologic dead space

A

Anatomic + alveolar dead space

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9
Q

Perfusion def

A

Movement of blood past alveoli

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10
Q

Normal ventilation/perfusion ratio

A

4L ventilation/min
5L perfusion/min

Ideal lung unit = 0.8 VQ ratio

Can be decreased by PE or low CO

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11
Q

How to position R lung PNA

A

GOOD LUNG DOWN

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12
Q

Treatment of VQ mismatch

A

Give O2, treat cause

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13
Q

Lung shunt such as ARDS

A

An extreme VQ mismatch, even on 100% O2 will not correct hypoxemia

Treatment: give 100% O2, PEEP

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14
Q

Shunt def

A

Movement of blood from R side of heart to L without oxygenation

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15
Q

Normal physiologic shunt

A

Thebesian veins of the heart empty into L atrium

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16
Q

Anatomic shunt

A

VSD or ASD

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17
Q

Pathologic shunt

A

ARDS! Blood goes through without being oxygenated resulting in refractory hypoxemia

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18
Q

PEEP

A

Prevents expiratory pressure from returning to zero, by keeping exp. pressure positive it

  • decreases surface tension of alveoli
  • increases alveolar recruitment
  • increases driving pressure, extends time of gas transfer and allows decrease in FiO2
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19
Q

Left shift of oxyhemo dissociation curve

A

Alkalosis
Low PaCO2
Hypothermia
Low 2,3-DPG

SaO2 high but O2 stuck to hgb > BAD

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20
Q

Right shift of oxyhemo dissociation curve

A

Acidosis (high H+)
High PaCO2
Fever
High 2,3-DPG

Good for tissues, SaO2 low but O2 easily released

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21
Q

What is 2,3-DPG?

A

Organic phosphate in RBCs that alters affinity of hgb for oxygen

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22
Q

Decreased 2,3-DPG

A

Multiple blood transfusions
Hypophosphatemia
Hypothyroidism

Less O2 available to tissues

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23
Q

Increased 2,3-DPG

A

Chronic hypoxemia
Anemia
Hyperthyroidism

More O2 available to tissues

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24
Q

Carboxyhemoglobin levels & symptoms

A 
0-5 is normal
<15% often in smokers
15-40 headache, some confusion
40-60 loss of consciousness, Cheyne-Stokes
50-70 mortality >50
25
Q

Treatment of CO poisoning

A

100% FiO2 until symptoms resolve and level is <10%

Hyperbaric chamber

26
Q

Static compliance def

A

Measurement of elastic properties of lung
TV/plateau pressure

Increase is PP will decrease compliance

27
Q

Dynamic compliance def

A

Measurement of elastic properties of airways

TV/peak inspiratory pressure

Increase in PIP will decrease compliance

28
Q

Status asthmaticus

A 
Static compliance (lungs) normal 
Dynamic compliance would be low
29
Q

ARDS

A

Static compliance would be low

Dynamic would also be low

30
Q

Anion gap

A

Normal 5-15

Helpful in determining cause and response to treatment of metabolic acidosis

31
Q

Problems with increased anion gap

A 
Ketoacidosis
Uremia
Salicylate intoxication 
Methanol 
Alcoholic ketosis
Unmeasured osmoles
Lactic acidosis
32
Q

Problems with normal anion gap

A 
Saline infusion
TPN
Diarrhea
Ammonium chloride 
Acute renal failure
33
Q

Acute resp failure type 1: hypoxemic

A

PNA, ARDS, atelectasis, pulm edema, PE, interstitial fibrosis, asthma

34
Q

Acute resp failure type 2: hypercapneic

A

CNS depression due to drugs, increased ICP, COPD, flail chest, ALS, Guillian Barre, MS, spinal injury

35
Q

Acute resp failure type 3: combo

A

ARDS, asthma, COPD

36
Q

S/S of hypoxemic resp failure

A

Tachynpea, accessory muscle use, tachycardia at first then brady, cyanosis, anxiety, agitation

37
Q

S/S of hypercapneic resp failure

A

Shallow breathing, bradypnea, progressive decreased LOCA

38
Q

Treatment of resp failure

A

Maintain airway and improve ventilation, optimize oxygenation, circulation and CO, identity etiology

39
Q

CPAP

A

Indicated for patients with hypoxemic resp failure who have increased work of breathing (cardiogenic pulm edema)

40
Q

BiPAP

A

Indicated for patients with hypoxemic or hypercapneic resp failure

41
Q

Advantages of noninvasive ventilation

A

Buys time, reduces work of breathing, decreases preload and afterload, improves oxygenation, prevents intubation

42
Q

Contraindications for NIV

A

Unstable or life threatening arrhythmia, secretions, high risk aspiration, impaired mentation, pneumothorax, life threatening refractory hypoxemia

43
Q

Signs of acute exacerbation of COPD

A

Worsening dyspnea, increase sputum volume and thickness, hypercapnia and hypoxemia

44
Q

Management of COPD exacerbation

A

Titration FiO2 to PaO2 >60 without overcorrecting
Bronchodilator therapy - short acting beta agonist and anticholenergic
Steroids
Antibiotics for PNA
NIV

45
Q

Status asthmaticus def

A

Airway hyper-reactivity that produces severe airway narrowing that is refractory to aggressive bronchodilator therapy

46
Q

S/S of status asthmaticus

A

Dyspnea, tachypnea, cough, accessory muscle use, wheezing > decreased breath sounds, VQ mismatch, tachycardia, pulsus paradoxus, decreased LOC, elevated WBC, hx of intubations

47
Q

Management of status asthmaticus

A

Measure presenting peak flow rate
50-70 admit, <50 ICU
Bronchodilator, anticholenergic, steroids, pulse ox, hydration, avoid secretions, intubation (resp acidosis, severe hypoxemia, silent chest, change in LOC)

48
Q

Vent management of status asthmaticus

A

Use low rate to increase exhalation time, low TV to prevent auto PEEP, increase I/E ratio

49
Q

Types of PE

A

Venous - DVT
Fat - long bone, pelvis
Air - surgery, IVs

50
Q

S/S of PE

A

Dyspnea, tachycardia, CP, anxiety, cough, petechaie (fat), low grade fever, resp alkalosis

Severe: hypoxemia, hypotension, EKG changes, PEA

51
Q

Treatment of PE

A

Adequate oxygenation, fluids, anticoagulant, fibrinolytic therapy, maintain CO

52
Q

Pulm HTN def

A

MEAN pulm artery pressure greater than 25 at rest and PAOP less than 16 at rest with secondary R HF

53
Q

S/S of pulm HTN

A

Exertional dyspnea, lethargy, fatigue, progression to RV failure, CP and syncope, abdominal pain, ortners syndrome, systolic murmur, RV hypertrophy, JVD distention, ascites, pleural effusion

54
Q

Tx of pulm HTN

A

Diuretics, oxygen, anticoagulant, digoxin, exercise training

Lastly transplant

55
Q

S/S of PNA

A

Chills, fever, tachycardia, confusion, productive cough, dehydration

56
Q

Tx of PNA

A

Optimize ventilation and oxygenation, positioning GOOD LUNG DOWN, NIV or intubation, bronch, mobilize, identify organism, antibiotics

57
Q

Etiology of aspiration

A

AMS, drug use, depressed cough/gag, feeding tubes, positioning, artificial airway, gastric distention, hx of dysphagia, increased secretions

58
Q

S/S of aspiration

A

Resp distress, tachycardia, hypoxemia, crackles, secretions, hypotension

CCRN (2 decks)

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