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Respiratory Flashcards

1
Q

Factors that shift Oxyhemoglobin dissociation curve

A

PCO2, pH, 2,3 Diphosphoglycerate(DPG), body temp

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2
Q

Reasons for pleural friction rub

A

Pleurisy, pulmonary infarction

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3
Q

PO2 60 = sao2 of ?

A

90…on a NORMAL dissociation curve

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4
Q

Factors that shift oxyhemoglobin curve to right

A

Acidosis, hyperthermia, increased 2,3 DPG, increased H+, increased pCO2

Decreased affinity for O2

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5
Q

Factors that shift oxyhemoglobin curve to left

A

Hypothermia, alkalosis, decreased 2,3 DPG, decreased H+, CO, decreased CO2

Increased affinity for O2

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6
Q

Dalton Law of Partial Pressures

A

Partial pressures cannot add up to more than atmospheric pressure. ie if 760mmHg max and pCO2 is high there is less room for pO2 and it must be decreased

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7
Q

A:a gradient

A

Reflection of the process of diffusion across the alveolar-capillary membrane. Calculated by subtracting PaO2(arterial) fromPAO2(alveolar)

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8
Q

CaO2

A

Total number of oxygen in arterial blood both bound and unbound to Hgb

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9
Q

Hypoventilation

A

PaCO2 >45. RR alone does not make up ventilation. RR plus TV

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10
Q

Expected SaO2 level for PaO2 of 40(normal curve)

A

75%

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11
Q

KussMaul breathing

A

Deep frequent breathing
Most commonly seen d/t DKA

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12
Q

Normal VO2I (oxygen consumption index)

A

150ml/min/m2

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13
Q

Dynamic compliance

A

Compliance of lung when air is moving
Static compliance plus airway resistance.
Ex: bronchospasm or mucous plug would decrease dynamic compliance

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14
Q

Salmeterol

A

Long acting bronchodilator contraindicated in acute asthma attack d/t delayed onset

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15
Q

IRV

A

Inverse ratio ventilation
Ie 2:1 instead of 1:2 etc
Need sedation and or paralytics to tolerate
Causes auto peep and can increase incidence of barotrauma as a result

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16
Q

Static compliance

A
  • Pressure it takes to overcome static resistance to ventilation
  • Evaluates compliance of lung and chest wall specifically during period of no air flow like during inspiratory pause
    Ex pneumothorax, ARDS, atelectasis would decrease static compliance
    Flail chest would increase it
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17
Q

Why mechanical ventilation makes patients prone to volume overload?

A
  • Water gained by cascade humidifier
  • stimulation of ADH caused by PEEP
  • simulation of RAAS d/t decreased in CO after initiated mechancial ventilation
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18
Q

DO2

A

Oxygen delivery
Normal is 1000ml/min2

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19
Q

State when compensation is least likely

A

Resp alkalosis

Many pts with COPD have compensation for their resp acidosis

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20
Q

Leading cause ARDS

A

Shock

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21
Q

Hyper-resonance to percussion

A

Indicates pneumothorax

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22
Q

Reasons for crackles

A

Pulm edema and atelectasis

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23
Q

Difference between laryngectomy tube and trach tube

A

No cuff
Food can only go into stomach with laryngectomy tube unless fistula forms

24
Q

Normal VO2I

A

150ml/min/m2

25
ARF definition
PaO2 50-60 PCO2 >50 And pH <7.3 in COPD d/t chronic CO2 levels
26
Three purposes of PEEP
- increase driving pressure o2 - decrease surface tension and WOB - decrease shunting. By reopening collapsed alveoli
27
Rhonchi
Mucous or fluid in airway
28
Vent factors in being able to cough
Negative Inspirator pressure and vital capacity
29
Connection b/w resp alkalosis and tetany
Hyperventilation increases binding between Ca and albumin decreased ionized calcium. This causes tetany(tingling around mouth and fingertips) Correction is to reduce minute ventilation NOT give Ca
30
Most definitive study for PE
Pulmonary arteriography
31
Adverse effects specific to inhaled corticosteroids
Hoarseness and candidiasis
32
Movement of oxygen across alveolar capillary membrane
External respiration
33
Movement of air into and out of lungs
Ventilation
34
Use of oxygen by mitochondria to produce adenosine triphosphate(ATP)
Internal respiration or cellular respiaration
35
Delivery of blood to tissues
Perfusion
36
2 major causes of alveolar collapse in ARDS
Lack of surfactant and pulm edema
37
Auto PEEP
synonymous with IRV Can increase PVR, risk of barotrauma and hypercapnia Will not lead to hypoxia
38
Respiratory/intrapulmonary shunt
- More perfusion than ventilation - Ex ARDS pneumonia atelectasis - PEEP can be used to decrease shunting by reopening alveoli - Also caused by increase in perfusion not just decrease in ventilation - ie nitroprusside
39
Alveolar dead space
More ventilation than perfusion Ex PE, shock
40
Early signs of oxygen toxicity
Substernal chest pain/distress, parasthesias in extremities, GI symptoms N/V fatigue mailaise, dyspnea, restlessness
41
Late signs oxygen toxicity
Hypercapnia, cyanosis, decreasing compliance, increased A:a gradient, pulmonary edema
42
Lab that should be monitored on nitric
Methoglobin levels - Normal level 1-2%, harmful 10%, obtunded >50% - Nitrates and nitrites can cause methoglobinemia which changes hgb to a form that can’t carry O2. - Treatment is methylene blue - causes decrease in sao2 despite normal po2
43
VO2
Sao2 minus svo2 Consumption of o2 by tissues
44
Normal water seal fluctuation on vent
Water down on inspiration and up on expiration
45
Findings in atelectasis
Crackles, fever, hypoxemia Dullness on percussion indicates PNA NOT atelectasis
46
Sign of impending crisis in pneumothorax
Tracheal shift away from affect side and JVD
47
Cromolyn sodium
Inhaled to prevent degranulation of epithelial mast cells that cause release of histamine. It’s prophylactic and won’t help with acute asthma attack
48
Ipratropium bromide
Bronchodilator used to reduce risk of bronchospasm in pts with COPD primarily
49
Metaproterenol
Bronchodilator used for asthma and bronchospasm
50
Heimlich valve
Discharge home with chest tube so no need for water seal
51
ARDS diagnostic criteria
P/F <200
52
Xanthine
Treats bronchospasm but not first line for asthma cause it takes longer to work
53
Altering ph of stomach with H2 blockers can cause what?
PNA! Any ph >4 puts you at risk for PNA
54
Effect of MTP on oxyhgb curve
Shift left and less release of oxygen to tissue d/t decreased 2,3 dpg in transfused blood…and maybe hypothermia
55
Needed to calculate static compliance
Plateau pressure Reflects pressure in the lungs
56
Used to calculate dynamic compliance
Peak inspiratory pressure
57
Goal of vent support for status asthmaticus
Decrease air trapping Don’t have massive tidal volumes Prolong expiration…can be done with low RR decrease PEEP and risk of autopeep by avoiding IRV modes

CCRN (9 decks)

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