Quiz 2 Study Guide Flashcards
1) Knowledge of what is categorized as a restrictive vs. an obstructive lung disorder
○ Restrictive- volume of air or gas is (increased/reduced); an abnormal (increase/reduction) in pulmonary ventilation caused by restrictive expansion of the chest wall or lungs
○ Obstructive- flow of air on (inhale/exhale) is impeded
reduced; reduction; exhale
2) Signs and Symptoms of obstructive and restrictive lung disorders
○ Obstructive disease signs and symptoms-
■ (Tachypnea/Dyspnea) one exertion, (increased/shortness) of breath, (decreased/increased) anxiety level, cognitive impairment from hypoxia, secretion production and cough, complains of poor strength in legs, physical exam consists of prolonged (inspiratory/expiratory) phase, observe tripod position, chest x-ray changes, adventitious lung sounds, poor endurance.
○ Restrictive disease signs and symptoms-
■ (Dyspnea/Tachypnea) - to maintain minute ventilation
■ Hypoxemia - V/P mismatch
■ (Increased/Decreased) breath sounds
■ (Increased/Decreased)lung volumes and capacities
■ (Increased/Decreased)diffusing capacity of lung for CO
■ Cor pulmonale
■ Three symptoms: the above are allegedly considered “signs”
● Dyspnea (SOB) - during exercise progress to at rest
● Dry cough - dry, irritating non-productive
● wasting/emanciation as disease progresses
Dyspnea; shortness; increased; expiratory; Tachypnea; decreased; decreased; decreased;
Trends
● PaCO2 (Partial pressure of carbon dioxide)
○ Amount of carbon dioxide dissolved in arterial blood
○ Normal = - mmHg
○ Greater than _ mmhg = acidosis
○ Lower than _ mmhg= alkalosis
35-45; 45; 35
pH ○ Measurement of acidity or alkalinity based on hydrogen ○ Normal is _-_ ○ Higher than _ = alkalosis ○ Lower than _ = acidosis
7.35-7.45; 7.45; 7.35
PaO2
○ Partial pressure of oxygen in arterial blood
○ Normal = _ mmHg
90
HCO3- ○ Amount of bicarbonate in the bloodstream ○ Normal = _-_ mEq/liter ○ Greater than _ = alkalosis ○ Less than _ = acidosis
22-26; 26; 22;
○ Respiratory alkalosis - occurs when high levels of carbon dioxide disrupt the bloods pH balance. Often occurs in individuals who have uncontrolled, rapid breathing.
■ pH is (less/greater) than 7.45 with PaCO2 (less/greater) than 33 mmHg
■ Causes hyperventilation (breathing out a lot of CO2)–breathing too much and too fast when nervous/anxious
■ Signs and symptoms:
● Neurological: light-headedness, numbness & tingling, confusion, inability to concentrate, blurred vision
● Cardiovascular: dysrhythmias, palpitations, diaphoresis
● Other: dry mouth, tetanic spasms of the arms and legs
greater; less;
○ Respiratory acidosis - this occurs when the lungs cannot remove all of the carbon dioxide the body produces; it causes the blood to become more acidic.
■ pH is (higher/lower) than what we consider normal - (less/more) than 7.35. Higher pressure of CO2 (higher CO2, lower pH) - PaCO2 (less/greater) than 45mmhg
■ Hypoventilation can cause this. Anything that doesn’t allow patient to blow off CO2
■ Signs and symptoms:
● Pulmonary: dyspnea, respiratory distress, shallow respirations
● Neurological: headache, restlessness, confusion
● Cardiovascular: tachycardia, dysrhythmia
■ Treatment:
● Try to decrease the hypoventilation–let them breathe→ increase ventilation
● Correct causes such as pneumothorax, pain, CNS depression related to meds
● Ventilation may be required until cause resolved
lower; less; greater
Metabolic alkalosis - A condition in which the bodies pH increases, becoming more basic.
■ Bicarbonate level (lesser/greater) than 26mEQ/L with a pH (less/greater) than 7.45
■ Caused by an (excess/loss) of base or (excess/loss) of acid
■ Excess base can be from ingestion of antacids, excess use of bicarbonate, use of lactate in dialysis
■ Loss of acid: vomiting, gastric suction, hypochloremia, excess use of diuretics, high levels of aldosterone
■ Signs and symptoms:
● Pulmonary - respiratory depression
● Neurological - dizziness, lethargy, disorientation, seizures, coma
● Muskuloskeletal - weakness, muscle twitching, muscle cramps, tetanty
● GI - nausea, vomiting
■ Treatment:
● Difficult to treat
● Drugs can stimulate bicarbonate excretion through the kidneys
● IV of acids
● Metabolic alkalosis in a patient who is hospitalized usually iatrogenic (meaning its happen due to some treatment for another problem happening while they’re in the hospital)
greater; greater; excess; loss
○ Metabolic acidosis - A condition in which too much acid accumulates in the body. Causes of metabolic acidosis can include buildup of body toxins, kidney failure, and ingestion of certain drugs or toxins, such as methanol or large doses of aspirin. It can be a rare complication of diabetes. Symptoms include nausea, vomiting, fast breathing, and lethargy. Treatment depends on the cause. Sodium bicarbonate can reduce the acidity of blood.
■ Defined as a bicarbonate level of (less/more) than 22 mEq/L (normal 22-26) with a pH (less/more) 7.35
■ Caused by either a deficit of base in the blood or excess of acids other than Co2 (Lack of base and too much acid)
■ Causes decreased levels of base: diarrhea, intestinal fistulas
■ Causes of increased acids: renal failure, diabetic ketoacidosis, anaerobic metabolism, starvation, salicylate intoxication
■ Signs and symptoms:
● Neurological - headache, confusion, restlessness, lethargy, stupor or coma
● Cardiovascular - dysrhythmias, warm, flushed skin
● Pulmonary - kussmaul’s respirations?
● GI - nausea and vomiting
■ Treatment:
● Sodium bicarbonate
● Renal failure is a bicarbonate-responsiveness acidosis
● Use of sodium bicarbonate routinely can cause metabolic alkalosis with hypernatremia (thirst, confusion, muscle twitching, seizures, coma, and death)
less; less;
○ pH → is a measurement of the acidity or alkalinity of the blood → acid base balance tells you nothing about oxygenation
■ pH is inversely proportional to the number of hydrogen ions (H+)
■ The more H+ present, the lower the pH will be
■ Fewer H+, the higher the pH will be
■ The scale from 1 (very acidic) to 14 (very alkalotic)
■ A pH of 7 is neither acidic or alkalotic (it is neutral)
● The normal blood pH range is 7.35-7.45
● It is maintained in a tight range of control
● pH lower than 7.35 is acidic (too much CO2, too little HCO3)
● Body system functions have changes when in acidic state
○ Decrease in the force of cardiac contractions
○ Decrease in vascular response to catecholamines
○ Diminished response to the effects/actions of certain medications
○ Respiratory acidosis → pt is not blowing off enough CO2
○ Metabolic acidosis → can be due to lack of a base in the blood or too much acids (often CO2)
● Blood pH above 7.45 alkalotic (too little CO2, too much HCO3)
○ Body system functions have changes when alkalotic
■ Interferes with tissue oxygenation
■ Interferes with normal neurological function
■ Interferes with normal muscular functioning
○ Respiratory alkalosis → may be due to hyperventilation where they are blowing off too much CO2 ( can cause pt to pass out)
● Significant pH changes above 7.8 or below 6.8 → can be deadly
○ Interferes with cellular functioning and can lead to death
■ Balance of pH is managed b/tw respiratory and renal systems
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