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CCRN - My Flashcards > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

Anatomy of the Pulmonary System

A

-Primary muscle of ventilation: Diaphragm
-Right Lung: 3 Lobes
-Left Lung: 2 lobes

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2
Q

What is the normal ventilation rate (Liters)

A

4L per minute

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3
Q

What is anotomic dead space? What is normal?

A

-Volume of space that does not participate in gas exchange
-Normal is 2mL/kg of tidal volume

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4
Q

Normal Ventilation/Perfusion Ratio

A

5L perfusion/min (Q)

-Ideal lung unit = 0.8 ratio

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5
Q

What is the Lab Diagnostic that Indicates Ventilation

A

-PaCO2 is the clinical indicator for ventilation NOT PaO2

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6
Q

What is dead space ventilation? What body parts experience dead space ventilation?

A
  • Areas of the pulmonary system with no gas exchange
    -Nose, mouth, trachea, bronchi
    -The only place where gas is exchanged is the alveolar sacs
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7
Q

Pulmonary Embolism: Signs and Symptoms + Causes

Massive = >50% Occlusion
Submassive = < 50% Occlusion

A

-Refractory hypoxemia, tachypnea, dyspnea, chest pain
-Can be caused by blood, air, fat, or amniotic fluid
-Puts strain on the right ventricle as it tries to pump the same amount of blood through a obstructed circulatory system
-Leads to RIGHT ventricular heart failure

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8
Q

Leading cause of Pulmonary Embolism

A
  • 80% to 90% result from DVT
  • VTE and Fat Embolism
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9
Q

Treatment of Pulmonary Embolism

A

-Fluids!
-Coumadin on the first day of treatment
-Heparin drip and injections
-Fibronolytic Therapy
-Inotropes (maintain cardiac output)

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10
Q

Oxyhemoglobin Dissociation Curve

A

LEFT SHIFT: Causes HgB to “hold on” to more O2
-pH move UP
-BAD for tissues (SaO2 is high but tissues don’t receive O2)

RIGHT SHIFT: Causes HgB to “release” O2 more readily
-pH moves DOWN
-GOOD for tissues (SaO2 is low but tissues receive O2 readily)

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11
Q

Carbon Monoxide Poisoning (CO)

A

-CO attaches to HgB and does not allow the RBC to carry O2 or CO2

-CO has a higher affinity for Hgb than O2 and CO2

-Treatment: 100% oxygenation (Hyperbaric) until Carboxyhemoglobin level is <10%

-Finger probe cannot differentiate between CO and O2 so do not rely on finger probe SATs

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12
Q

Acid Base - How does hydrogen effect pH

A

-There is an inverse relationship between H+ and pH

  • The more H+ the lower the pH (acidic)
    -The less H+ the higher the pH (alkolotic)
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13
Q

Methods of pH correction. Metabolic and Respiratory

A

-Respiratory System (Lungs) corrects pH rapidly (within minutes to hours)

-Metabolic system (kidneys) corrects pH slowly (within hours to DAYS)

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14
Q

Anion Gap. What is it? What is normal? What makes an anion gap worse?

A

-A measurement of acid base balance in the blood typically used to identify cases of metabolic acidosis

-Normal range is 5-15

-Worsening factors: DKA, Salicylate intoxication, alcohol ketosis, lactic acidosis

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15
Q

Lung Compliance. Static and Dynamic

A

-How well the lungs accept the positive pressure ventilation from CPAP/BiPAP/Ventilator. Are the lungs elastic or stiff

-Static: Measures the elasticity of the tissues of the LUNG (Pneumonia, ARDS)

-Dynamic: Measures the elasticity of the tissues in the AIRWAY (Asthma)

-Increase in plateau pressure OR increase in peak inspiratory pressure will DECREASE lung compliance

-Static Problems (lung) have a decrease in BOTH static and dynamic compliance
-Dynamic problems (airway) have a decrease of ONLY the dynamic compliance and the static compliance remains NORMAL

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16
Q

How does lung compliance effect a patients?

A

-Decreased lung compliance will increase the patients work of breathing

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17
Q

Treatment for Respiratory Failure

A

-Position patient upright, bronchodilators, suction, ventilate, avoid O2 toxicity
-Correct hypotension and cardiac arrhythmias

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18
Q

CPAP

A

Continuous Positive Airway Pressure

-FiO2 + 1 pressure setting (PEEP)

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19
Q

BiPAP

A

Bilevel Positive Airway Pressure

-FiO2 + 2 pressure settings (IPAP and EPAP)
-Useful for hypoxemic or hypercarbic respiratory failure- expected to make a fast recovery

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20
Q

Invasive Mechanical Ventilation

A

-Placement of an endotracheal tube
-X-ray confirmation ETT is 3-5cm above the carina
-Poor positioning typically occurs in to the right lung 2/2 short mainstem bronchus and low angle of right lung

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21
Q

Mechanical Ventilation - Set Volume OR Set Pressure

A

-A ventilator can provide a Set breath volume OR a set breath pressure NOT BOTH

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22
Q

Assist Control Mode (AC)

A

-Always delivers a set tidal volume at a set respiratory rate

-The volume will also be provided for spontaneous breaths

-Risk for barotrauma if patient is hyperventilating spontaneously and peak pressures increase

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23
Q

Pressure Control Mode (PC/AC)

A

-Always delivers a set pressure at a set respiratory rate

-Referred to as “pressure above PEEP”

-Set pressure will be provided for spontaneous breaths as well

-No guaranteed tidal volume

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24
Q

Synchronized Intermittent Mandatory Ventilation (SIMV)

A

-Always delivers a set tidal volume at a set respiratory rate

-Spontaneous breaths are delivered when the airway pressure drops below the end-expiratory pressure

-Good setting to ween off the ventilator

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25
Q

Pressure Support Ventilation (PSV)

A

-The patient triggers every breath but the ventilator provides increased airway pressure (if needed) to reach an adequate tidal volume

26
Q

Tidal Volume Normal Ranges

A

-Based off of IDEAL BODY WEIGHT NOT CURRENT BODY WEIGHT

-General: 6-10mL/kg
-ARDS patients: 4-6mL/kg

27
Q

Obstructive Lung Diseases; COPD, Asthma, Bronchitis

A

-Disorders that trap air and gas within the lungs, making it difficult to get air OUT
-Wheezing
-Barrel chest

28
Q

Bronchitis

A

-Inflammatory response to an irritant in the lungs or airway
-Always considered an acute illness unless the patient has had bronchitis for greater than 3 months a year for the past 2 years or more

29
Q

COPD

A

-Starts as an inflammatory response to an irritant in the lungs or airway
-Smoking is the #1 cause
-May also be caused by Alpha-1 antitrypsin disease (genetic)
-Leads to air obstruction and air trapping from collapsed alveoli, decrease in surface area leading to less gas exchange

-A chronic COPD patient may have a High HCO3 due to complete compensation

-May lead to cor pulmonale (right ventricular enlargement) and elevated CVP

30
Q

COPD Treatment

A

-Treat cause of admission (what caused this exacerbation?)
-O2 administration - be careful because the more O2 given = the more CO2 retained
-Bronchodilator (SABA; Short acting beta agonist; albuterol)
-Clear secretions
-Hydration and humidified O2
-High calorie, low carbohydrate foods

31
Q

Status Asthmatics

A

-A hyper-reactive airway that causes sever narrowing
-Not relieved with meds
-Severe air trapping with no air movement at all
-Increase in intrathoracic pressures which decreases venous return to the heart and increases RV afterload

32
Q

Status Asthmatics Presentation/Treatment

A

-Cough, tachycardia, tachypnea, anxiety, (late) low LOC
-Flattened diaphragm on x-ray
-Pulsus Paradoxus > 15mmHg (severe is >18)

-On the Vent: Use low tidal volumes and increase expiration time to reduce the amount of air trapping
-Meds: Bronchodilators, anticholinergics, corticosteroids, hydration
-Avoid sedation

33
Q

Restrictive Lung Diseases; Acute Lung Injury; ARDS; Pneumonia, Pulmonary Fibrosis

A

-These diseases restrict the lungs from expanding during inhalation
-Lung compliance and lung volumes are decreased

34
Q

Acute Lung Injury

A

-The first step of the progress of ARDS
-Direct or indirect injury which causes a significant amount of inflammatory response leading to increased permeability causing edema -> ARDS

35
Q

Restrictive Lung Disease: What is ARDs: Acute Respiratory Distress Syndrome

A

-A condition 2/2 illness or injury that allows fluid to leak in to the lungs (opacities bilaterally on x-ray)
-Breathing becomes difficult and oxygen cannot get IN to the body

-Classified as Mild, Moderate, or Severe

36
Q

How to determine ARDs Severity (Mild, moderate, severe)

A

-PF Ratio! (PaO2/FiO2)
-FiO2 as a decimal (ie 45% = 0.45)

-Mild -The ratio is between 200 and 300 with PEEP or CPAP
-Moderate -The ratio is between 100-200 with PEEP >5
-Severe -The ratio is < 100 with PEEP >5

37
Q

ARDs Treatment

A

-Treat admission cause (exacerbation)
-Mechanical Ventialtion
-Infection Prevention
-Upright Patient Positioning or PRONE
No steroids for ARDS patients

38
Q

3 Stages of ARDS (based on timing not severity)

A

Exudative: 0-4 days
Proliferative: 3-10 days
Fibrotic: 7-14 days

39
Q

ARDs Diagnosis Requirements

A

-chest X-ray showing bilateral opacities
-Must be within 1 week of new or worsening symptoms
-Respiratory failure proven to not be 2/2 cardiac function or fluid overload

40
Q

Restrictive Lung Disease: Pulmonary Fibrosis

A

-An interstitial lung disease that causes scarring of the lungs. This reduces elasticity and decreases expansion of the lung. Reduction of gas exchange due to scar tissue

41
Q

Primary VS. Secondary Pulmonary Fibrosis

A

-Primary: Inherited or idiopathic

-Secondary: Radiation, medications, medical conditions

42
Q

Pulmonary Fibrosis Treatments

A

-Medications (bronchodilators, O2, anti-anxiety agents), oxygen, rehabilitation, supportive care

43
Q

Restrictive Lung Disease: Pneumonia

A

-Caused by an infection that leads to alveolar consolidation within the lungs
-Causes fluid and pus to fill alveolar sacs
-May be hard to distinguish between pneumonia and bronchitis; chest x-ray confirms 1 vs. the other

-Bronchitis affects the upper airways while pneumonia affects the lower lungs

44
Q

Pneumonia Causes

A

-Pneumonia is most commonly caused by a bacterial, viral, or fungal infection
-May also be from aspiration or parasites

45
Q

Pneumonia Signs and Symptoms

A

-Dehydration, tachycardia, chest pain, fever, chills, malaise, productive cough, (elderly) confusion

46
Q

Pneumonia Treatment

A

-Chest X-Ray, sputum cultures, ABG
-Antibiotics, antivirals, antifungals (depending on sputum culture result)
-Antibiotic administration should begin within 4 hours of entering the hospital

-GOOD LUNG DOWN
-Early Mobilization
-Suctioning + subglotic suction prior to cuff deflation
-Routine oropharyngeal suctioning
-Give fluids; hydration
-Fever control
-Nutrition
-Oral hygiene
-HOB 30 degrees or higher

47
Q

Type of Pneumonia: Community, Hospital, Ventilator

A

-Community Acquired develops outside of the hospital
-Hospital Acquired develops 48 hours after admission
-Ventilator Acquired develops in a patient who has been on a vent. for 2 continuous days OR develops pneumonia 1 day after extubation

48
Q

Chest Trauma

A

-Identify the mechanism of injury and the location of the injury

-Chest/Chest Wall: Pulmonary contusion, pneumothorax, hemothorax, lacerations

-Chest: Cardiac rupture, cardiac tamponade, aortic dissection, hemorrhage

49
Q

Air Leak Syndrome: Pneumothorax

A

-Caused by a tear in the pleura of the lung. Can be caused by thoracic trauma, barotrauma, or iatrogenic (caused by medical intervention)

50
Q

Pneumothorax

A

-Begins as air leaking in to the lungs leading to an eventual lung collapse due to POSITIVE pressure gradient

-Healthy human has a negative pressure gradient allowing the lung to expand with the thorax on inhalation

51
Q

Pneumothorax Classifications; Simple, TENSION, Hemothorax, Pneumomediastinum

A

-Tension Pneumothorax Air is unable to exit; causing a mediastinal shift
-Tracheal deviation AWAY from the affected side
-Distended neck veins (JVD)
-Hypotension
Life threatening

52
Q

Pneumothorax Treatment

A

-Needle decompression and chest tube placement

-Chest tube insertion site for pneumothorax; HIGH
-Chest tube insetion site for hemothorax; LOW (think fluid would be at the bottom of the lung

53
Q

Chest Tube Specifications

A

-If an air embolism is suspected during insertion, place the patient in reverse Trendelenburg and on left side to trap air in the right ventricle

** < 200mL of output in a day; consider weaning **
** > 200mL of output for 2 or more consecutive hours may require intervention!!! **

-No dependent loops in chest tubing
-No milking or stripping the chest tube
-Keep collection chamber lower than the chest
-Suction control chamber determines the amount of suction NOT the wall suction source
-Clamp ONLY when changing the system or when you receive an order (camping cuts off negative pressure and the expanded lung may re-collapse
-Bubbling in the water seal is not normal (if it is continuous)
-Bubbling intermittently (tidaling) on inspiration is normal

54
Q

Shunt What is it? What should we do?!?

A

-A shunt is movement from the right side of the heart to the left without being oxygenated in the process (venous blood moves to the arterial side) (result is refractory hypoxemia)

-This causes an extreme V/Q mismatch

-Providing O2 will not correct the hypoxemia present

-Treatment - Administer oxygen AND PEEP

-PEEP keeps expiratory pressure POSITIVE
-Decreases surface tension of the alveoli, increases alveolar recruitment, increases time of gas exchange which allows you to decrease FiO2

55
Q
A
56
Q

Signs of hypoxemic respiratory failure

A

-Tachypnea, accessory muscle use, abnormal breath sounds
-Tachyarrhythmias (early)
-Bradyarrhythmias (late)
-Cyanosis (Central; lips, earlobes)
-Anxiety and agitation

57
Q

Hypercapnic respiratory failure

A

-Shallow breathing
-Bradypnea
-Normal OR abnormal breath sounds
-Progressive loss of consciousness

58
Q

Pulmonary Hypertension Definition

A

-Mean Pulmonary artery pressure > 25 at rest and and PAOP that is less than 16 at rest

-Normal Pulmonary artery pressure is
~ 20

  • Eventually leads to Right ventricular
59
Q

Treatment of Pulmonary Hypertension

A

-Diuretics, oxygen, anticoagulants, digoxin, exercise trainign

60
Q

Aspiration

A

-Oropharyngeal is most common
-Usually in right lung due to mainstem bronchus anatomy
-Can lead to ARDS, tachycardia, hypoxemia, hypotension due to fluid shifts

CCRN - My Flashcards (5 decks)

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