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Pediatric CCRN > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

Normal pH levels

A

A: 7.35-7.45
V: 7.32-7.42

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2
Q

Normal PaO2

A

A: 80-100
V: 28-48

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3
Q

Normal PaCO2

A

A: 35-45
V: 38-52

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4
Q

Normal HCO3

A

A: 22-26
V: 19-25

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5
Q

Normal SaO2

A

A: 90-100
V: 50-70

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6
Q

Acidosis

A

Low pH
High CO2
Low Bicarb

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7
Q

Alkalosis

A

High pH
Low CO2
High Bicarb

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8
Q

Respiratory Alkalosis

A

-Hyperventilating, blowing off CO2
-caused by pain, ARDS, Excessive ventilator rate

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9
Q

Respiratory Alkalosis

A
  • Hypoventilating, retaining CO2
    -late respiratory failure
    -caused by oversedation, COPD, severe obesity
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10
Q

Metabolic Acidosis

A

Caused by:
-DKA
-AKI
-Sepsis
-Lactic acidosis
-Low electrolytes

Calculate anion gap: 11-12

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11
Q

Metabolic Alkalosis

A

Caused by:
-loss of acid
-vomiting/emesis
-NG suctioning
-loss of stomach acid

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12
Q

Measuring ventilation/perfusion CO2 levels

A

-Ventilation: End tidal of 35-45
-Perfusion: PaCO2: 35-45

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13
Q

When is capnography used?

A

-Ventilation (during sedation or continuous)
-Perfusion (during CPR to measure quality of CPR, low CO = low etCO2)
-Head injuries
-PCA/sedation agents

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14
Q

Hypoventilation

A

Increased end tidal CO2

Too low of RR or tidal volume

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15
Q

Hyperventilation

A

Decreased end tidal CO2

Too high of RR or tidal volume

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16
Q

V/Q Ratio

A

-Ventilation/Perfusion
-PaCO2 - etCO2
-Should be less than 5

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17
Q

V/Q Mismatch

A

-Low etCO2 but high PaCO2
-Causes: pulmonary embolism, pneumonia, ARDS, high PEEP, ETT in main stem, mucus plug, low CO

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18
Q

Oxygen causes pulmonary _____ and vasco____

A

dilation, vasoconstriction

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19
Q

Adventitious Breath Sounds

A
  • Crackles: fluid
    -Wheezes: narrowed airways
    -Rhonchi: secretions in large airways, PNA
    -Stridor: harsh sounds, obstructed larynx or trachea, give nebulized epi
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20
Q

Signs of Acute Respiratory Failure

A

-Acute: increased WOB, use of accessory muscles, increased RR, respiratory alkalosis
-Late: Hypercapnia/high PaCO2, respiratory acidosis

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21
Q

3 main reasons for hypoxemia

A

-Hypoventilation: OSA, low Mg
-V/Q mismatch: PE, PNA, ARDS
-Poor perfusion: decreased CO, severe anemia

22
Q

Causes of asthma

A

-Bronchial constriction
-Airway hyperreactivity
-Inflammation

23
Q

Treatment for asthma

A
  • Beta agonist: bronchodilators
    -Corticosteroids
    -Hydration is key!
    -Treat hypercapnia with mechanical ventilation or BiPAP
    -Give mg to produce bronchodilation
    -consider heliox
    -No O2
    -No CXR unless suspected PNA
    -No ABG
    -No abx
24
Q

Bronchodilators

Onset:
Duration:
Side effects

A

Onset: <5min
Duration: 2-5hrs
Side effects: tachycardia, tremors, hyperglycemia, low K,Mg, Phos

25
Q

Corticosteroid use for asthma

A

-reduces airway inflammation
-prevents relapse
-give for less than 7 days
-give IV or PO

26
Q

Status Asthmaticus

A

-Medical emergency
-exposure to allergy or trigger
-continuous bronchospasm and restriction
-Results in hypoxia, hypercapnia, respiratory failure

27
Q

Phases of Status Asthmaticus

A

Early bronchospasm
-inflammation
-bronchospasm
-increased capillary permeability
-increased mucus secretion

Late inflammatory
-mucus plugging
-increased airway resistance
-airway obstruction
-lung hyperinflation
-V/Q mismatch
-increased RR

28
Q

Rescue Treatment for Status Asthmaticus

A

Try CPAP or BiPAP
-Continuous PEEP
-CPAP: PEEP only
-BiPAP: PIP and PEEP

Intubate for:
-cardiac arrest
-decreased LOC
-respiratory fatigue/gasping

29
Q

COPD

A

-emphysema and chronic bronchitis
-constant airway obstruction
-air trapping with chronic lung hyperinflation
-patient with hypoxic drive to breathe rather than hypercapnic drive

30
Q

Signs of COPD

A

-SOB
-Cough
-Barrel chest
-Prolonged exhalation
-diagnosed with pulmonary function test

31
Q

COPD Exacerbation Treatment

A

-Bronchodilators
-short course steroids
-antibiotics for URI
-oxygen therapy, try not to intubate
-Intubation: low RR, prolonged expiratory phase, lower TV, monitor for intrinsic PEEP

32
Q

Signs of PE

A

-tachypnea
-crackles
-tachycardia
-fever
-diaphoresis
-chest pain
-feeling of impending doom
-sudden R sided heart failure

Ventilation with NO perfusion

Diagnosed with CT angio

33
Q

Treatment for PE

A

-Anticoagulants: heparin, lovenox
-Fibrinolytic: TPA

34
Q

Pulmonary Hypertension

A

High pressure in pulmonary vascularature

Normal PA pressure: 25/10
PHTN: 130/80

Leads to R sided heart failure, RV dilation, systemic edema, JVD

35
Q

Treatment of Pulmonary Hypertension

A

Goal is to pulmonary dilate

Meds: Sildenafil, basentan, epoprostenol

Lung transplant

Keep patients calm to promote vasodilation and adequate pulmonary perfusion

36
Q

Bubbling in Chest Tube

A

-Normal for pneumo
-If not a pneumothorax then there’s a leak in the system
-if no leak, get cxr for chest tube placement

37
Q

Hemothorax

A

Blood in pleural space caused by trauma or thoracic surgery

Treated with lower CT

38
Q

Pneumothorax

A

Air in the plural space

Caused by trauma, too much PEEP, ruptured bleb

39
Q

Types of Pneumothorax

A

Closed
-air enters but can’t escape causing tension pneumo

Tension
-life threatening, accumulation of air that collapses the lung and puts pressure on the lungs/heart
-can lead to PEA arrest

Open
-penetrating injury
-Air can enter and exit

40
Q

Treatment for Pneumothorax

A

Get CXR, place CT

In an emergency, a needle decompression may be performed with a 14-16g needle

41
Q

Lung Contusions

A

Due to trauma, damage to parenchyma of lung, localized edema, or hemorrhage

42
Q

Signs of a lung contusion

A

Not immediate, usually 24-72hrs after
-tachypneic
-tachycardia
-hypoxemia
-crackles
-rib fractures

Diagnosed with CT scan

43
Q

Pressure Control

A

-Delivers breath until pre-set pressure is reached
-pre set rate
-TV varies breath to breath

44
Q

Pressure Support

A

-liberate from vent
-patient decides rare and flow
-assistance during inspiration but patient must initiate breath

45
Q

Volume Control

A

-Pre set tidal volume and RR
-I- time is fixed
-PIP and pressures change

46
Q

SIMV

A

Synchronized Intermittent Mandatory Ventilation

Allows patients to spontaneously breathe in between set ventilator breaths

47
Q

Propofol for Intubation

A

Anesthetic, Sedative, Amnesiac

-Causes respiratory and CV depression
- 5-50mcg/kg/min
- quick onset, half life of 4 min
-monitor for hypotension and decreased CO
Propofol infusion syndrome: acidosis, cardiomyopathy, muscle myopathy

48
Q

Precedex for Intubation

A

Alpha 2 Agonist
-awaken and sleep easily with no respiratory depression
-dose: 0.2-1.4mcg/kg/hr
-monitor for bradycardia, hypotension, and decreased CO/SVR

49
Q

Low Pressure Alarm

A

Leak or disconnect

Check connections on vent

50
Q

High Pressure Alarm

A

Secretions, water, or kink causing blockage of air into patient

Suction or unkink tube

51
Q

Low Minute Ventilation Alarm

A

Decreased inhalation of the amount of air per minute

Caused by hypoventilation, leak, or disconnect

Pediatric CCRN (8 decks)

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