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High Acuity Hesi > Respiratory Disorders > Flashcards

Respiratory Disorders Flashcards

1
Q

What is ventilation?

A

Movement of air to AND from alveoli and atmosphere by airways due to result of changing thorax size

Breathing air in ↓’s intrapulmonary pressure

Breathing air out ↑’s intrapulmonary pressure

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2
Q

Describe the changes in PCO2 and pH associated with hypoventilation

A

Hypoventilation= less airflow in / out of the lungs –> (↑ pCO2) and ↑pH (respiratory acidosis)

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3
Q

Describe the changes in PCO2 and pH associated with hyperventilation

A

Increased airflow in / out of the lungs –> ( ↓ pCO2) and ↓ pH (Respiratory alkalosis)

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4
Q

Where is the respiratory center of the brian located?

A

Medulla

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5
Q

A spinal cord injury at which locations will cause a paralyzed diaphragm?

A
  • “C-3,4,5”= keeps the diaphragm alive”,
  • Spinal Cord Injury at C3 and above will cause paralysis of the diaphragm –>
    • Mechanical Ventilation required
    • Diaphragm = major insp. Muscle
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6
Q

What is the normal negative inspiratory force in a patient?

A

¢Normal Negative Insp Force (NIF) is > -100 cm H2O

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7
Q

At what negative inspiratory force level is intubation required?

A

¢A NIF of

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8
Q

Describe the changes in inspiration and expiration associated with a flail chest

A
  • Flail Segment unable to contribute to lung expansion.
  • On Inspiration: Chest supposed to expand, but flail section “sinks in”
  • On Expiration: Flail section “bulges outward”, poor exhalation
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9
Q

What is compliance?

A
  • Ability of lungs to expand
  • Influenced by changes in pressure and volume
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10
Q

Describe what happens with low compliance in the lungs

A
  • žLow compliance: “stiff lungs” = lungs with decreased ability to fill with air
  • Difficult to expand alveoli, lungs
  • Takes more pressure to increase lung volume (means more work for the pt.) –>
    • Results in: Increased work of Breathing, Dyspnea, Tachypnea
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11
Q

What are causes of a low compliance in the lungs?

A
  • Obesity (ex: Pickwikian Syndrome)
    • Increased intrapulmonary pressure –> increased effort to breathe
  • Decreased surfactant production (ex: ARDS)
    • Leads to alveolar collapse –> makes it harder to inflate alveoli with are –> ↓ compliance on the lungs
  • Restrictive lung disease:
    • —Pneumonia (lungs can’t fill up with air if there’s fluid in the alveoli)
    • —Pneumothorax (lungs can’t fill up with air since it’s collapsed, and there is an increase in positive pressure)
    • —Pulmonary edema (too much fluid in da lungs bruh)
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12
Q

Describe the two types of respiration

A
  1. External (External environment to Capillary-Alveolar interface)
  2. Internal (Capillary to Tissue, Cells)
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13
Q

What 4 factors affect the diffusion of air across the alveoli?

A
  1. Partial pressures of gases (pO2 and pCO2) and gradient
    • Ventilation
  2. Surface area (of alveoli)
    • Atelectasis, Tumors
  3. Thickness (of the alveoli)
    • Inflammation, Alveolar edema (ARDS), Fibrosis (Sarcoidosis)
  4. Length of exposure
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14
Q

Describe the changes that occur with a left shift in the oxyhemoglobin curve and what causes it.

A

Changes:

  • A Left Shift increases O2 attraction to Hgb
  • Conditions make Oxygen easier for Hemoglobin to pick up; but O2 will tend to stay on Hgb and does not release easily to tissues
  • Tissue hypoxia will occur

Causes:

  1. High pH
  2. Low temperature
  3. Low PaCO2
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15
Q

Describe the changes that occur with a right shift in the oxyhemoglobin curve and what causes it.

A

Changes:

  • A Right shift decreases O2 attraction to Hgb
  • Conditions cause O2 to have less attraction to Hgb; but O2 is readily released to tissues (there is less binding, so not as much O2 available as in normal states)
  • Tissue hypoxia will occur

Causes:

  1. Low pH
  2. High temperature
  3. High PaCo2
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16
Q

What is a Ventilation-perfusion match?

A
  • It is the relationship between how well an alveoli is ventilated and how well an alveolar capillary is perfused.
  • Ideally, a 1:1 V/Q ratio between alveolar airflow & blood flow would exist
    • “V” ventilation- air that reaches alveoli
    • “Q” perfusion- blood that reaches alveoli
    • “V” and “Q” are main determinants of blood O2 concentration
17
Q

Describe High V/Q ratios and what causes them

A

High V/Q ratios (poor perfusion) result from follow-ing conditions:

  • Decreased Cardiac Output
  • Pulmonary emboli
  • Pneumothorax
  • Destruction of pulmonary capillaries
18
Q

Describe low V/Q ratios and what causes them

A

Low V/Q ratios (poor ventilation) result from the following conditions:

  • Hypoventilation
  • Obstructive lung disease
  • Restrictive lung disease
  • Effects of V/Q:
    • Hypoxemia
    • Acidosis
    • Hypercapnia
19
Q

Describe what a pulmonary shunt is

A
  • Major cause of hypoxemia in HA pts.
  • Anatomic shunt - blood doesn’t come in contact with the alveoli because of trauma to blood vessels.
  • Capillary shunt - normal blood flow across dysfunctional alveoli r/t atelectasis, pulmonary edema
  • Absolute shunt - combo of both anatomic and capillary shunt
20
Q

How and when would you estimate an intrapulmonary shunt?

A
  • Use only if PaCO2 is stable
  • Calculated by the formula = PaO2 / FiO2
  • žNormal values= 350-450
  • žMinimal accepted value= 286
21
Q

What are normal HCO3 levels?

A

ž22-26

22
Q

What do changes in base excess indicate?

A

> +2 = metabolic alkalosis

23
Q

How would you manage a patient in metabolic acidosis?

A
  • Tx Cause: DKA, Renal Failure, Cardiac arrest, Shock, Diarrhea
  • Sodium Bicarbonate if pH is
  • If K+ level is
  • DKA: Insulin and fluids
  • Diarrhea: anti-diarrheals
  • Renal failure: Hemodialysis, CRRT
24
Q

How would you manage a patient in respiratory acidosis?

A
  • Tx Cause: Hypoventilation states, airway obstruction, neuromuscular disease
  • Support ventilation. May need to intubate and put on ventilator, Increase tidal volume and / or RR on vent
  • Bronchodilators,, Chest PT, Bronchoscopy with lavage
  • Encourage pursed lip breathing
25
Q

How would you manage a patient in metabolic alkalosis?

A
  • Tx Cause: Severe vomiting,
  • nasogastric suction, diuretics, corticosteroids, overventilation intestinal obstruction
  • Saline infusion may correct chloride deficit d/t gastric losses
  • KCL for pts with low K+ levels
26
Q

How would you manage a patient in respiratory alkalosis?

A
  • Tx Cause: Hyperventilation states, Anxiety, pain, fever,
  • O2 therapy if hypoxemia is problem
  • Provide reassurance, remain w/ pt
  • Encourage pt to breathe slowly
  • Sedation prn
  • Possibly rebreathe air into a paper bag
  • ON vent: decrease RR or tidal volume and add deadspace prn
27
Q

What are the respiratory signs of hypoxemia?

A
  • Dyspnea
  • Prolonged expiration (I:E= 1:3 or 1:4)
  • Intercostal retraction and other accessory muscles
  • Late signs:
    • —Paradoxical chest/abd movement
    • —Cyanosis
28
Q

What are non-specific signs of hypoxemia?

A
  • Agitation, Disorientation, Restlessness, Combativeness
  • Tachycardia, HTN
  • Skin cool, clammy
  • Fatigue
  • Unable to speak in complete sentences w/out pausing to breathe
  • Late signs:
    • —Dysrhythmias
    • —Hypotension
29
Q

What are the respiratory signs of hypercapnea?

A
  • Dyspnea
  • Decreased RR or increased RR with shallow volume
  • Decreased tidal volume
  • Decreased minute volume
  • Pursed lip breathing
  • Tripod position
30
Q

What are the non-specific signs of hypercapnea?

A
  • Morning Headache, Disorientation, Progressive somnolence
  • Dysrhythmias, HTN, Tachycardia, Bounding pulses
  • Muscle weakness, Decreased DTRs
  • Late signs:
    • —Coma
    • —Tremor, Seizures
31
Q

Describe type 1 respiratory failure

A
  • Imbalance of O2 supply and demand
  • Type I: Hypoxemia with failure of oxygenation
    • PaO2
    • —Recall O2 has a decreased affinity to Hgb at this levelà any further decreases will create rapid decrease in SaO2!
  • Examples: COPD, Pneumonia, ARDS, Restrictive Lung Disease
32
Q

Describe type2 respiratory failure

A
  • Hypoxemia and Hypercapnea
  • PaO2
  • PaCO2 > 50 mm Hg with a pH
  • Examples: COPD, Neuromuscular Disorders, Respiratory muscle fatigue
33
Q

What are Complications of Respiratory Failure?

A
  • Hypercapnia and acidosis impair cellular function
  • žVasodilatory effects can increase intracranial pressure and decrease cardiac output and vascular resistance
    • You get vasodilation with an increase in CO2
  • žConsidered more serious than oxygenation failure
34
Q

Describe the Pathogenesis of Respiratory Failure

A
  1. Initiated by disease process interferes directly or indirectly with normal lung function
  2. žAs pulmonary function deteriorates, patient develops V/Q ratio abnormalities and decreasing PaO2
  3. Body compensates for increase in O2 demands by increasing rate and depth of respirations
  4. PaO2 increases and PaCO2 decreases
  5. žMore energy is required: metabolic rate increases
  6. žMore oxygen is required by tissues; more CO2 is produced
  7. žEffect is an increase in arterial CO2 and decease in arterial O2
35
Q

What is Non-Invasive Ventilation?

A
  • Provides ventilatory support and avoids invasive artificial airway (ETT or trach)
  • Allows for possible oral intake
  • Uses oral or oronasal mask to deliver + Pressure
36
Q

What are the indications for non-invasive ventilation?

A

Indications:

  • Neuromuscular disease
  • Home settings for chronic Respiratory Failure (COPD, CHF)
  • Alternative to intubation in ED/ICU areas (Post-op, immunocompromised, to avoid reintu-bation, irreversible disease and pt does not want intubation)
  • Sleep apnea
37
Q

What are the different types of non-invasive ventilation?

A

Bilevel: also called “Bipap”

  • —Requires a ventilator
  • —Designed to prevent airleaks
  • —Inspiratory and Expiratory airway pressures
  • —Maintains minimum PEEP of 4 mmHg (EAP)

CPAP (continuous positive airway pressure)

  • —Provides continuous level of + airway pressure throughout breathing cycle
  • —Requires a device for flow delivery
  • —Useful for sleep apnea in home setting

NOTE: Positive pressure can lead to a decrease in cardiac output –> increased pressure on the heart –> makes it harder for the heart to push blood

High Acuity Hesi (7 decks)

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