Respiratory 2 Flashcards
ABG’s if respiratory acidosis
pH < 7.35, pCO2 > 45, HCO3> 26 if compensating
causes of respiratory acidosis
CNS depression from drugs
Respiratory arrest
Hypoventilation from pulmonary, cardiac or neuromuscular disease
signs of respiratory acidosis
Tachycardia, tachypnea early, then bradypnea, confusion, hypotension, lethargy, coma
ABG’s if respiratory alkalosis
pH > 7.45, pCO2< 35, HCO3 <22 if compensating
causes of respiratory alkalosis
Hyperventilation from anxiety, pain or vent settings
Respiratory stimulation by drugs, disease, fever
Gram-negative bacteremia
Pulmonary emboli
signs of respiratory alkalosis
Confusion, light-headedness, anxiety, palpitations, paresthesias
metablic alkalosis if…
vomiting/diarrhea/ GI fistulas
metabolic acidosis if…
DKA and renal failure
cannot excrete hydrogen ions (renal): acidodic
are not exchanging glucose, slows down NaK pump… hold on to acid (DKA): acidodic
how do you know if respiratory or metabolic problem??
If respiratory then pO2 is affected, not so in metabolic
how do you know if compensating or not
Compensated if pH is normal! Uncompensated if pH is not normal
describe emphysema
- Fibrous type lungs filled with CT (grown d/t emphysema)
- Decrease in lastase (lung become fibrotic)
- Process of making fibrous tissue: continuous inflammatory process (chronic)
causes of emphysema
- smoking, inhaled particles, vaping, black lung disease, smoke/smog
- cannot get CO2 out of lungs
describe COPD
- do not have good expansion (appears like a barrel chested, dead lung)
- x ray is too dark/black, should see some lighting
- AP diameter is too wide
what does pneumonia x ray look like
- big old junk
- bacteria in the lungs, full of protein: pulls more fluid into lungs
what does pulmonary edema x ray look like
- Whispy, fills up with fluid until lungs collapse
- not a lot of room for oxygenation
- air movement does not really occur/stuck
what is a VQ test
- measure their ventilation vs perfusion
- mismatch??
- detect PE, evaluate pulmonary function
describe the ventilation part of the VQ test
patient inhales a gas
see ventilation patterns
describe the perfusion (Q) part of the VQ test
contrast medium is injected and blood flow is visualized
what can interfere with a pulse ox reading
- Elevated bilirubin level may falsely lower readings
- IV lipids and dyes can interfere
- Excessive light, movement, ear pigment, hypothermia, hypotension and vasoconstriction
- Blue, green, black and brown nailpolish
what can falsely elevate a pulse ox reading
- Carboxyhemoglobin can falsely elevate readings
- anemic (d/t low RBC)
what is a normal SVO2
60-80%
what does a decreased SVO2 mean
decreased values, less than 60% may indicate increased oxygen usage by tissues or a decreased oxygen delivery
what does an increased SVO2 mean
SVO2 values greater than 80% may indicate tissue death in organs, as they do not pick up the oxygen
how is SVO2 measured
measured by a pulmonary artery catheter or a central line
*can also get off the ventilator
a low (ie/ 50%) SVO2 may indicated what
means something is overworking (ie/ GI tract) or septic (distributive shock problem) or NOT picking up oxygen that it needs to begin with (then PO2 will be low AS WELL)
what does SVO2 mean
how much oxygen is in our venous system?
should have dropped off oxygen by about 20%
delivering oxygen to organs
what is the ETCO2
is used to measure the CO2 concentration at the end of expiration
what is a normal ETCO2
normal if 30-40 (only about 2-5 different from CO2)
what does the end tidal CO2 monitor
Monitoring patency of the airway in apnea and airway obstruction
Monitor hyperventilation or hypercapnia with ventilator systems
what does a low ETCO2 mean (ie/ 10)
not breathing deeply enough to push off CO2
what are the Beta 2 agonists (bronchodilators)
Albuterol and Epi
what are the anticholinergics (bronchodilators)
Ipatropium and Tiotropium
