RESPIRATORY Flashcards
Control center for respiration is located in the ____and the _______.
pons
medulla
What is Minute Volume and how do you calculate it?
Minute volume (amount of effective ventilation)
ventilatory rate x tidal volume
Normal is 5-8 L per minute
What is RESTRICTIVE LUNG DISEASE (all relate to alveoli)
inhibition of the inflation of the alveoli due to restriction
could be like a neuromuscular disease where lungs are stiff/noncompliant so you can’t even breathe in
it can be a traumatic injury where the lung is restricted by something else (PE)
It could be genetic deformity
It could be scarring from a severe infection
What is OBSTRUCTIVE LUNG DISEASE (all relate to alveoli)
Alveoli expand, but deflate slowly or not at all
Increased overall lung volume, however new air cannot come in because of trapping from inflammation
Examples include: asthma, COPD
What is COMPROMISE OF DIFFUSION (all relate to alveoli)
Fluid in the Alveoli Inhibits O2-CO2 exchange
Can be caused by:
Infections (pneumonia)
Drowning
Edema
Adult Respiratory Distress Syndrome (ARDS)
COMMON LABORATORY EXPECTATIONS for people with respiratory issues
Chem panel: potassium, sodium, those sorts of things. You may see an issue there. You may not.
CBC: WBCs, anemia, a low H&H?
Abgs: carbon dioxide levels, pH
How do you verify ET tube placement
End-tidal carbon dioxide levels
Chest x-ray (can see radiopaque strip on end of ET tube)
Color change indicators (changes colors when exposed to CO2 levels) helps indc not in the stomach
Assess for breath sounds bilaterally, symmetrical chest movement, air emerging from ET tube
What are some things you need to do for your patient with an ET tube in?
Chart how far the ET tube is in (22 at teeth, 23cm at lips)
ensure pilot balloon is inflated
chart vent settings
prevent pt movement w/ wrist restraints while sedated
Q4 oral care to prevent pneumonia
What is tidal volume?
the volume that the ventilator gifts to the patient with each breath that it gives
What is tidal volume rate?
is how many breaths per minute
What is FIO2?
that’s how much oxygen they’re getting.
What is PEEP?
positive and expiatory pressure
extra boost that is given at the end of the expiatory cycle by the machine, measured in millimeters of mercury. So it’s given in order to keep the alveoli from collapsing because we want to prevent atelectasis
affect cardiac output and that can affect their intrathoracic pressure. So they can become very dependent on that peep. And then if you take it off, suddenly they can go into cardiovascular collapse.
What is the difference between Bi-PAP and CPAP?
Bi-PAP—preset pressure delivered during inspiration and expiration
CPAP—preset constant pressure delivered
What is the difference between Assist Control and Synchronized intermittent mandatory ventilation (SIMV)
Assist Control—Preset rate and tidal volume, allows patient to breathe over vent but delivers preset volume
Synchronized intermittent mandatory ventilation (SIMV)—Preset rate and volume, but for breaths initiated by patient volume is dependent on patient
What causes a the high pressure alarm to go off on the vent. How do you fix it?
High pressure is going to happen when there’s some sort of obstruction the line. It can happen when they’re coughing, biting the tube, have stiff lungs (ARDS), or thick secretions.
If that happens, you can suction them. Also make sure that the ET tube is above the carina because sometimes the ET tube is sitting on the carina and causing irritation/cough.
What causes a the low pressure alarm to go off on the vent. How do you fix it?
Low pressure occurs when there’s a leak in the cuff or in the circuit, apnea (no breath triggering machine for 20 seconds, happens when trying to get pt off the vent)
How do you take a patient off of mechanical ventilation?
Turn off sedation and let pt wake up
Check Glasgow Coma Scale (GCS) Score
Put them on BIPAP or CPAP until pt proves they can spontaneously breath
COMPLETE WITHIN AN HOUR OF STOPPING SEDATION Look at ABGs, if they look normal, they extubate If not, they sedate again
Hyperoxygenate pt by giving 100% FIO2, suction all secretions
tell pt to cough at peak of inspiration, then remove it
monitor every 5 minutes (resp pattern/look for resp distress)
Why is it important to ALWAYS keep the ET tube sealed and circuit intact?
decreases the exposure to pathogens, easy to get life threatening pneumonia when intubated
quickly disconnecting them can cause them to go into cardiovascular collapse
How often do you asses you patient after they come off the vent
monitor every 5 minutes (resp pattern/look for resp distress)
What is the different between barotrauma and volutrauma?
Volutrauma: injury occurs when there is an increased stretch in the lung
Barotrauma: injury occurs due to pressure
both damage the alveoli, which then decrease the individuals their capacity for gas exchange further
What are complications that arise from increased intrathoracic pressure r/t the positive pressure being forced in from the vent
hypotension, fluid restriction, retention, parasympathetic stimulation (increase gut motility, increased salivation, slowed HR)
collapse the aorta and reduce the pressure that’s going out to the system (hypotension). body will think that there’s actually lower volume going out so it will retain fluid, causing hypovolemia and hyperkalemia
what is a chest tube
a catheter that’s placed in between the ribs, into the thorax and into that intrapleural space. Placed in-between the visceral and the parietal pleura.
Helps re-expand the lung by either evening out the air pressure because the atmospheric pressure has gotten off or by removing fluid that started to accumulate there in the case of a hemothorax.
Ultimately re-expands the lung and that is what helps to improve the condition
What are the 3 chambers of a CT drainage system
There’s a drainage collection chamber, a water-sealed chamber, and a suction chamber
How do you measure output from a CT
measuring it hourly usually for the first 24 and then usually once a shift (every 8 hours) after that
How can you tell air is being expelled from the CT
if you have a pneumothorax and allows air to come through this tube, come through the water sealed chamber, and then come out through this water. The water acts as a seal so that it can’t go back into the lungs.
There’s always 2 cm of sterile water in the water sealed chamber
this chamber SHOULD NEVER CONTINUOUSLY BUBBLE
you may see tidaling (water level moving up and down with inspiration and expiration)
Where will you see continuous bubbling in the chest tube
The suction chamber when suction is on. For drainage systems with wet suction option only.
Where would the CT be placed in the chest cavity for air vs blood/fluid?
Air: Upper chest cavity, up front
Fluid/blood: side placement near base of lung
What is tidaling
water seal chamber water level moving up and down 2-4cm with inspiration and expiration
Will decrease as lung fully re-expands
What things do you have to do for patients with chest tubes in
Q4 vital signs, check water seal
Assess respiratory status, CT site, crepitus
When should you notify the provider regarding CT drain output
greater than 70ml/hr
What do you always need to keep at the bedside of a pt with a chest tube in. Why?
hemostats, sterile water, and occlusive dressings
for when the water seal is continuously bubbling and you need to find where the leak in the tubing is by methodically clamping the tube until the bubbling stops
When can you strip a chest tube?
FOR CARDIAC TUBES ONLY
not for when the tube is in the lungs
What do you do if the CT collection system gets disconnected from the CT?
Pu the CT into a bottle o sterile water to water seal it
What if the CT gets accidentally ripped out of the patient?
immediately apply an occlusive dressing
How can you help manage a patient’s discomfort during a CT removal
Tell them to bear down and exhale to help keep the pressure where it needs to be and avoid air from coming in through the wound.
As soon as its out out an air-tight petroleum gauze over it.
What is an open pneumothorax
occurs when there is a breach in the chest wall that allows air to enter the pleural space from the outside. It can occur due to a penetrating injury, such as a stab or gunshot wound.
A “sucking” sound may be heard during inhalation.
Can lead to a significant decrease in intrathoracic pressure, impairing lung expansion and ventilation.
Requires immediate medical attention, often necessitating chest tube placement and potentially surgical intervention
What is a closed pneumothorax
This occurs when air enters the pleural space but without an external wound. Causes can include spontaneous pneumothorax (often in tall, young males), trauma (such as rib fractures), or complications from medical procedures (like central line insertion).
No external wound or air entry from the outside.
The pleural space pressure increases, which can lead to lung collapse.
Often managed with observation or chest tube insertion, depending on the size and symptoms.
What is the difference between a Primary vs. Secondary Pneumothorax
Primary Pneumothorax: occurs without any underlying lung disease. It often affects young, tall males and can occur spontaneously.
Secondary Pneumothorax: occurs in patients with underlying lung disease, such as chronic obstructive pulmonary disease (COPD), cystic fibrosis, or pneumonia.
What is the difference between a Stable vs. Unstable Pneumothorax (Compensated vs. Decompensated)
Stable:
Vital signs: High heart rate (HR) and respiratory rate (RR) may be present as the body compensates for reduced lung capacity, but the patient remains alert and responsive.
Oxygen saturation may be slightly reduced but typically above 90%.
Requires monitoring and possibly intervention, such as chest tube placement if symptoms worsen.
Unstable:
Vital signs: Low heart rate (bradycardia) and low respiratory rate (hypoventilation) may be evident due to severe respiratory distress or hypoxia.
Signs of hypoxia may include confusion, cyanosis, or altered mental status.
Immediate intervention is required, including possible emergency chest tube placement, intubation, or surgical intervention.
What is a Tension pneumothorax
-air enters the pleural space and cannot leave, shifting the organs and compressing organs (from penetrating trauma)
What lab findings indicate a pulmonary embolism?
D-dimer—elevation can indicate release of fibrin degradation products and clot formation
PT/PTT/INR (check b4 anticoag tx)
ABG analysis
Respiratory alkalosis early
Respiratory acidosis late
What diagnostic tests indicate a pulmonary embolism?
If stable:
- V/Q scan-show circulation of air and blood in lungs; can detect PE (only if stable)
- Pulmonary angiography-gold standard but invasive and not quick
If unstable:
CT (specifically spiral CT)
Can do tests for DVT like echo or compression ultrasound on hemodynamically unstable individuals
How do you treat a PE
IV Heparin given during acute phase (Monitor PTT every 6 hours or more)
Then Fibrinolytic therapy (tPA) to dissolve blood clot
If meds don’t work/can’t use b/c bleeding…
Embolectomy – surgical removal of clot
Vena cava filter – prevent further emboli from reaching pulmonary vasculature
How do you manage a pt experiencing and acute PE
O2 therapy (Monitor O2 status)
high Fowler’s
Initiate/maintain IV access
Assess respiratory, cardiac, CNS status every 30 minutes
What is ARDS
ACUTE RESPIRATORY DISTRESS SYNDROME
exudate of inflamm process occludes alveoli/inhibits gas exchange
OR
inflamm can cause structure damage itself which also impairs gas exchange, eventually become fibrotic (stiffer/less compliant)
Who is at risk for ARDS
Old people
septic people/pneumonia
people with physical trauma (inhalation injr=ury/burns)
people that just got blood transfused Transfusion-related acute lung injury (TRALI))
people with pancreatitis
What labs indicate ARDS
ABGs: resp acidosis
CBC: high WBC if infection/low hct
Coagulation studies: inflam causes microthrombi
ESR/CRP: increased means increased inflammation in body
How do you treat ARDS
steroids for inflammation
sedation
pulmonary vasodilators (nitrous oxide/prostaglandins)
Anticoagulation
Diuretics
Bicarb if acidotic
T/F: You should be conservative with fluid therapy for ARDS pts
T
What vent setting is significant for a ARDS pt
Typically will need a high PEEP level due to lung stiffness
Also higher sedation level because of this
ARDS can lead to _____.
SIRS: systemic inflam response syndrome
what is the normal blood PH range
7.35-7.45
what is the normal blood CO2 range
35-45 mm Hg
what is the normal blood HCO3 range
22-26
What is the expected PH, CO2, and HCO3 for someone with respiratory acidosis
pH < 7.35
CO2 > 45 mm Hg
HCO3 = normal (22-26)
Increased CO2 causes…
cerebral vasodilation
tachypnea
Ventricular tachycardia
What is the expected PH, CO2, and HCO3 for someone with respiratory alkalosis
pH > 7.45
CO2 < 35 mm Hg
HCO3 22-26 or compensating
What causes respiratory acidosis
respiratory conditions that reduce alveolar-capillary diffusion of gases
What causes respiratory alkalosis
hyperventilation
Emphysema, Pneumonia, high altitude, shock, Sepsis (early)
What drug overdose INCREASES respiratory rate
Salicylate Toxicity (aspirin overdose)
Increase respiratory rate by stimulating the respiratory center in the CNS
Decreased CO2 causes…
Weakness, paresthesias, tetany (increased pH causes a decrease in Ca and K)
Tachycardia-possible dysrhythmias
What is the expected PH, CO2, and HCO3 for someone with metabolic acidosis
pH < 7.35
CO2 35-45 or compensating
HCO3 <22
What causes metabolic acidosis
Excess production H+ (causes a decrease of HCO3)
Diabetic ketoacidosis (DKA)
starvation
lactic acidosis
heavy exercise
diarrhea (GI loss of bicarbonate)
Inadequate elimination of H+ (increased H+) OR Inadequate elimination of H+ (increased H+) r/t renal failure
What is the difference in presentation between respiratory acidosis and metabolic acidosis
Resp: Pale or cyanotic skin
Meta: Warm, dry, pink skin
How do you treat metabolic acidosis
Hydration
Bicarb
Fix problem (if diabetes insulin, if diarrhea antidiarrhea drugs)
What is the expected PH, CO2, and HCO3 for someone with metabolic alkalosis
pH >7.45
CO2 35-45 or compensating
HCO3- > 26
What causes metabolic alkalosis
Base Excess (increased HCO3)
oral ingestion of bases (antacids)
IV administrations of bases (massive blood transfusions, TPN, sodium bicarbonate)
Acid Deficit (decreased H+)
Loss of gastric secretions (vomiting, NG suction)
K+ depletion
thiazide diuretics, laxative abuse, Cushing’s syndrome
Licorice intoxication
How do you treat metabolic alkalosis
Stop treatments that may have caused alkalosis such as too much iv infusion, suction, or diuretics
Give fluids
Give antiemetics if necessary
