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AHN 572 > Pulmonary II > Flashcards

Pulmonary II Flashcards

1
Q

When HCO3 is low due to loss you will see…

A

increase in chloride ions

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2
Q

All the positive charges in your body and all the negative charges in your body have to..

A

remain equal

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3
Q

Normal Anion gap is…

A

12

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4
Q

Normal Bicarb is….

A

24

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5
Q

Normal pH is…

A

7.4

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6
Q

Normal pCO2 is

A

40

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7
Q

What makes up the majority of the anion gap…

A

Albumin

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8
Q

Albumin of 4 makes up the anion gap of…

A

12

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9
Q

Predicted anion gap should be…

A

Albumin x 3

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10
Q

Acute respiratory acidosis

A

Bicarb has not had a chance to increase

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11
Q

Chronic respiratory acidosis

A

Bicarb has had a chance to increase

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12
Q

Indications for intubation

A 
Airway support (altered mental status, secretions, airway anatomy)
Pulmonary disease (ARDS, pulmonary edema, failed NIV)
Circulatory causes (cardiopulmonary arrest, shock)
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13
Q

Two types of positive pressure ventilation

A

Volume controlled ventilation

Pressure controlled ventilation

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14
Q

Trigger of MV

A

Trigger initiates inspiration
Pressure, flow, or time
Usually Flow

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15
Q

Cycle of MV

A

Cycle terminates inspiration

Pressure, volume, flow or time

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16
Q

Limit of MV

A

Maximum level that can be reached and sustained during inspiration
Can be pressure, volume or flow

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17
Q

Ventilator breath phases

A 
Trigger (when to deliver)
Control variables (how to deliver)
Cycle phase (how much to deliver-terminate)
Expiratory phase
18
Q

Conditions that affect compliance

A

ARDS, Pulmonary edema, pneumothorax, atelectasis

19
Q

Complications of Volume ventilation

A

Barotrauma
uneven gas distribution
may induce ARDs

20
Q

Pressure ventilation advantages

A

Improved gas distribution
improved alveolar filling
reduced barotrauma
improved comfort

21
Q

Winter’s formula ratios

A

Metabolic acidosis- 1 bicarb/1CO2
Metabolic alkalosis- 2 bicarb/ 1 pCO2
Acute respiratory acidosis- 1 bicarb/10pCO2
Chronic respiratory acidosis- 1BIcarb/3pCO2
Acute respiratory alkalosis- 1Bicarb/5pCO2
Chronic respiratory alkalosis- 1Bicarb/2pCO2

22
Q

Anion gap metabolic acidoses

A 
Methanol
Uremia
DKA-all sorts of ketones
Paraldehyde
Isoniazid
Lactic acidosis
Ethylene glycol, ethanol
Salicylates
23
Q

Non anion gap metabolic acidosis

A

Diarrhea
Renal tubular acidosis
Carbonic anhydrase inhibitors- medications

Addisons disease- the only one of the three that causes hyperkalemia

24
Q

Metabolic alkalosis

A

Vomiting- chloride responsive

Cushings disease- nonchloride responsive

25
Q

Acute respiratory acidosis

A

COPD exacerbation

Drug overdose

26
Q

Chronic respiratory acidosis

A

COPD

27
Q

Acute respiratory alkalosis

A

Asthma exacerbation

hyperventilation anxiety

28
Q

Chronic respiratory alkalosis

A

Pregnancy

29
Q

High peak pressures with low plateau pressures

A

Mucus plug
bronchospasm
ET tube blockage
Biting

30
Q

High peak pressures

High plateau pressures

A 
ARDS
Pulmonary edema
Pneumothorax
ET tube migration to a single bronchus
Effusion
31
Q

CMV ventilation

A

Controlled mandatory ventilation
delivers a preset number of breaths per minute of a predetermined tidal volume
additional breaths cannot be initiated by the patient

32
Q

AC ventilation

A

Set RR and TV
Every breath is supported by the ventilator
A back up rate is sent and the patient may choose any rate above that rate

33
Q

AC advantages

A

Controlled ventilation with breath support
Increased ventilatory support on demand
May help critically ill patients who need constant TV or near full support

34
Q

AC disadvantages

A

Excessive patient work
May be poorly tolerated
May lead to respiratory alkalosis
May worsen air trapping in COPD

35
Q

IMV ventilation

A

Intermittent mandatory ventilation
Combines a present number of ventilator breaths of a preset tidal volume with the capability of intermittent patient initiated breaths
Spontaneous breaths above the set rate will be whatever TV the patient can generate

36
Q

IMV advantages

A

Patient can perform a variable amount of work with a preset level of mandatory ventilation

37
Q

IMV disadvantages

A

Risk of dyssynchrony between patient effort and machine delivered volume

38
Q

SIMV ventilation

A

Synchronized mandatory intermittent ventilation
Will sense if the patient is trying to initiate a breath and will deliver the mandatory breath in synchrony with the patients effort

39
Q

PSV ventilation

A

Pressure support ventilation

Amount of positive pressure is pre set, each breath must be initiated by the patient

40
Q

Applications for PSV

A

used to improve patient tolerance and decreased work in spontaneous breathing
Used as sole ventilatory mode for patients under consideration for weaning or during the stabilization period

41
Q

PSV disadvantages

A

Tidal volume not controlled: may be poorly tolerated in patients with high airway resistance. requires very careful monitoring in unstable patients

AHN 572 (2 decks)

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