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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

A

380- 475

21
Q

PaO2/PAO2 range

A

0.8-1.0

22
Q

SaO2 (sats)

A

97%

23
Q

SvO2

A

75%

24
Q

CaO2

A

20 vol%

25
Q

CvO2

A

15 vol%

26
Q

DO2

A

1000 mL/min

27
Q

VO2

A

250 mL/min

28
Q

High FiO2 at levels > ____ can result in _____ ________

A

60%;
oxygen toxicity

29
Q

Breathing a 100% O2 can lead to

A

absorption atelectasis and increased intrapulmonary shunting

30
Q

What are the acceptable limits for adults PaO2 and SpO2?

A

PaO2 of 60 mm Hg
SpO2 of 90%

31
Q

One approach that can increase the PaO2 involves increasing

A

Mean airway pressure (Paw)

32
Q

The Paw is the average pressure above

A

baseline during a total respiratory cycle (I+E)

33
Q

Paw is a major determinant of oxygenation in pts with

A

ARDS

34
Q

What does Paw do?

A

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
Q

Factors that increase Paw during PPV include: (5)

A
  • increasing PIP
  • increase total PEEP
  • I:E ratios
  • RR
  • inspiratory flow pattern
36
Q

The goal for PEEP and CPAP is to

A

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
Q

It is important to set an appropriate level PEEP that avoids _____________ while maintaining alveolar patency and preventing alveoli from collapsing

A

overdistention

38
Q

The goal of PEEP and CPAP therapy are: (4)

A
  • 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
Q

What does PEEP implies?

A

the pt is getting MV support and the baseline is above zero cm H20 (ETT,TT)

40
Q

CPAP is the pressure above the ambient

A

pressure maintained during spontaneous ventilation (non-invasive)

41
Q

What is Inverse Ratio Ventilation (IVR)

A
42
Q

There are 2 levels or ranges of PEEP that can be employed, what are they?

A
  • minimum or low PEEP (physiological PEEP)
  • therapeutic PEEP
43
Q

In most situations it is appropriate to use a minimum level of PEEP of

A

3-5 cm H20 to help preserve a pt’s normal FRC

44
Q

The reduction of FRC is due primarily to

A

abdominal contents moving upward and exerting pressure on the diaphragm

45
Q

Therapeutic PEEP is

A

5 cm H20 or greater

46
Q

Therapeutic PEEP is used in the treatment of (3)

A
  • refractory hypoxemia caused by intrapulmonary shunting
  • V/Q mismatching accompanied by decreased FRC
  • pulmonary compliance
47
Q

What are indications for PEEP (5)

A
  • 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
Q

Starting PEEP at 3 to 5 cm H20 and can be increased in increments of

A

3 to 5 cm H20

49
Q

Calculate pulmonary shunt

A

Qs= (Cc, O2- CaO2)/
Qt=(Cc, O2 - CvO2)

Topics of Respiratory Care (20 decks)

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