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Topics of Respiratory Care > Test 3 Ch.13 > Flashcards

Test 3 Ch.13 Flashcards

1
Q

Improving the ventilatory status of a pt can be accomplished by (3)

A
  • improving alveolar ventilation
  • reducing physiological dead space
  • reducing CO2 production
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2
Q

Improving oxygenation involves using various pt management such as (4)

A
  • supplemental O2
  • applying PEEP
  • CPAP
  • Patient positioning
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3
Q

Define Hypoxia

A

The reduction of oxygen in the TISSUES

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4
Q

Define Hypoxemia

A

The reduction of PaO2 in the blood
(i.e., PaO2< 80 mm Hg and SaO2 <95%)

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5
Q

Mild hypoxemia (3)

A
  • PaO2: <80 mm Hg
  • Range: 60-79 mm Hg
  • SaO2: 90-94%
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6
Q

Moderate hypoxemia (3)

A
  • PaO2: <60 mm Hg
  • Range: 40 -59 mm Hg
  • SaO2: 75-89%
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7
Q

Severe hypoxemia

A
  • PaO2: < 40 mm Hg
  • Range: <40 mm Hg
  • SaO2: <75%
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8
Q

What are the different types of Hypoxemia (4)

A
  • Hypoxemic hypoxia
  • Anemic hypoxia
  • Circulatory hypoxia
  • Histotoxic hypoxia
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9
Q

Define Hypoxemic hypoxia (3)

A
  • lower than normal PaO2
  • ascent to altitude
  • hypoventilation
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10
Q

Define Anemic hypoxia (3)

A
  • lower than normal red blood cell count (anemia)
  • abnormal Hb
  • Carbon monoxide poisoning
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11
Q

Define Circulatory Hypoxia (2)

A
  • reduced CO
  • decreased tissue perfusion
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12
Q

Define Histotoxic hypoxia

A

cyanide poisoning

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13
Q

Desired FiO2 equation

A

PaO2 (known)/FiO2 (known)= PaO2 (desired)/FiO2 (desired)
or
Desired FiO2= PaO2 (desired)x FiO2(known)/
PaO2 (known)

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14
Q

If a pt is not oxygenating well on 60% FiO2 what can you do to fix it?

A

Increase PEEP in increments of 3 to 5

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15
Q

If a pt is not oxygenating well on 40% FiO2, what can you do to fix it?

A

Increase FiO2 first until you 60%, after that increase PEEP

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16
Q

PaO2 range

A

80- 100 mm Hg

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17
Q

PvO2

A

40 mm Hg

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18
Q

PAO2 range

A

100- 673 mm Hg
FiO2 range: 0.21-1.0

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19
Q

A-a

A

5-10 mm Hg (FiO2= 0.21)
30- 60 mm Hg (FiO2=1.0)

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20
Q

P/F ratio range

21
Q

PaO2/PAO2 range

22
Q

SaO2 (sats)

23
Q

SvO2

24
Q

CaO2

25
CvO2
15 vol%
26
DO2
1000 mL/min
27
VO2
250 mL/min
28
High FiO2 at levels > ____ can result in _____ ________
60%; oxygen toxicity
29
Breathing a 100% O2 can lead to
absorption atelectasis and increased intrapulmonary shunting
30
What are the acceptable limits for adults PaO2 and SpO2?
PaO2 of 60 mm Hg SpO2 of 90%
31
One approach that can increase the PaO2 involves increasing
Mean airway pressure (Paw)
32
The Paw is the average pressure above
baseline during a total respiratory cycle (I+E)
33
Paw is a major determinant of oxygenation in pts with
ARDS
34
What does Paw do?
Opens up the alveoli, maintains them open, and allows for more time for gas exchange (the more time for gas exchange, the higher the PaO2 should become)
35
Factors that increase Paw during PPV include: (5)
- increasing PIP - increase total PEEP - I:E ratios - RR - inspiratory flow pattern
36
The goal for PEEP and CPAP is to
recruit the alveoli that have collapsed, the alveoli that are already open. We want to keep them open, and prevent them from collapsing on exhalation
37
It is important to set an appropriate level PEEP that avoids _____________ while maintaining alveolar patency and preventing alveoli from collapsing
overdistention
38
The goal of PEEP and CPAP therapy are: (4)
- Maintain a PaO2 60 mm Hg or greater and SpO2 90% or greater at an acceptable pH - Recruit alveoli and maintain them opened - Restore FRC - Enhance tissue oxygenation
39
What does PEEP implies?
the pt is getting MV support and the baseline is above zero cm H20 (ETT,TT)
40
CPAP is the pressure above the ambient
pressure maintained during **spontaneous** ventilation (non-invasive)
41
What is Inverse Ratio Ventilation (IVR)
42
There are 2 levels or ranges of PEEP that can be employed, what are they?
- minimum or low PEEP (physiological PEEP) - therapeutic PEEP
43
In most situations it is appropriate to use a minimum level of PEEP of
3-5 cm H20 to help preserve a pt's normal FRC
44
The reduction of FRC is due primarily to
abdominal contents moving upward and exerting pressure on the diaphragm
45
Therapeutic PEEP is
5 cm H20 or greater
46
Therapeutic PEEP is used in the treatment of (3)
- refractory hypoxemia caused by intrapulmonary shunting - V/Q mismatching accompanied by decreased FRC - pulmonary compliance
47
What are indications for PEEP (5)
- Bilateral infiltrates on CXR - Recurrent atelectasis w/ low FRC - Reduced lung compliance (CL) - PaO2 <60 mm Hg on FiO2 >0.5 - PaO2/FiO2 ratio <300 for ARDS Refractory hypoxemia: PaO2 increases <10 mm Hg w/ FiO2 increase of 0.2
48
Starting PEEP at 3 to 5 cm H20 and can be increased in increments of
3 to 5 cm H20
49
Calculate pulmonary shunt
Qs= (Cc, O2- CaO2)/ Qt=(Cc, O2 - CvO2)

Topics of Respiratory Care (20 decks)

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