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NURS 428: Evolution > Ventilation > Flashcards

Ventilation Flashcards

Exam 3

1
Q

Anatomy:

What are the lungs protected by?

A

Lungs protected by thoracic cage

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2
Q

Anatomy:

What are the lungs attached to?

A

Attached at pulmonary ligament in mediastinum

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3
Q

Anatomy:

Right lung has how many lobes? Left?

A

Right lung—three lobes

Left lung—two lobes

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4
Q

Anatomy:

Mediastinum contains the following:

A

Heart, blood vessels, lymph nodes, thymus gland, nerve fibers, esophagus

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5
Q

Slide 4

A
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6
Q

Movement of Air Into and Out of the Lungs

How does gases move?

A

Movement of gases is always from an area of higher pressure to one of lower pressure

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7
Q

Movement of Air Into and Out of the Lungs:

What are the types of pressure?

A

Airway pressure

Intrapleural pressure

Intra-alveolar pressure

Transpulmonary pressure

Intrathoracic pressure

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8
Q

Mechanics of Ventilation

Breathing in:

A

When breathe in, diaphragm goes down.

Lung expands- because it gets filled with air.

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9
Q

Work of Breathing

In normal breathing, what occurs during inspiration and expiration?

A

In normal breathing muscle contract occurs during inspiration only (expiration is passive, caused by elastic recoil of lung)

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10
Q

Work of Breathing

Inspiration divided into three categories:

A

Must overcome compliance or elastic work

Must overcome tissue resistance work

Must overcome airway resistance work

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11
Q

Assessment of Ventilation

Minute ventilation =

A

volume of air inhaled and exhaled/min

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12
Q

Assessment of Ventilation

Dead space ventilation: Two types?

A

Anatomical
Physiologic

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13
Q

Assessment of Ventilation

Alveolar ventilation

A

Minute ventilation- dead space

Inversely proportional to PaCO2.

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14
Q

Assessment of Ventilation

Alveolar ventilation is inversely proportional to what?

A

Inversely proportional to PaCO2

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15
Q

Assessment of Ventilation

Lung compliance:

A

Ability of the lungs to expand and deflate.

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16
Q

Assessment of Ventilation

Two types of Dead Space Ventilation:

Anatomical: What is it?

A

Anatomical dead space or the air in the conducting airways (about 150 to 200 mL) does not participate in gas exchange but increases with intubation.

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17
Q

Assessment of Ventilation

Two types of Dead Space Ventilation:

Anatomical: What may cause this?

A

Anatomic dead space depends on body posture and disease states.

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18
Q

Assessment of Ventilation

Two types of Dead Space Ventilation:

Physiologic: What may cause this?

A

Physiologic dead space occurs when ventilation is normal but perfusion to the alveoli is reduced or absent.

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19
Q

Assessment of Ventilation

Two types of Dead Space Ventilation:

Physiologic: What causes Physiologic dead space?

A

This can occur with certain disease states, such as reduced cardiac output or pulmonary embolism.

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20
Q

Principles of Gas Exchange

A

Diffusion

Four factors affect alveolar capillary gas exchange

Perfusion

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21
Q

Principles of Gas Exchange

Four factors affect alveolar capillary gas exchange

A
  1. Surface wall area
  2. Thickness of alveolar capillary membrane
  3. Partial pressure of gas
  4. Solubility of gas
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22
Q

Principles of Gas Exchange

Perfusion

A

Flow of blood through pulmonary capillaries

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23
Q

Principles of Gas Exchange

Diffusion

A

Traveling from high concentration to low concentration.

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24
Q

Principles of Gas Exchange

Thickness of alveolar capillary membrane

A

Thickness of alveolar–capillary membrane:

Thicker it is the harder it is for gas exchange to occur.

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25
Q

Ventilation to Perfusion

What is the ratio?

A

The ventilation-perfusion ratio is the ratio between the amount of air getting to the alveoli (the alveolar ventilation, V, inml/min) and the amount of blood being sent to the lungs (the cardiac output or Q - also in ml/min).

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26
Q

Patient Assessment: Respiratory System

History: What two broad groups to collect?

A

Chief complaint

Smoking history

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27
Q

Patient Assessment: Respiratory System

History:

Chief complaint: What could it be?

A

Dyspnea
Chest pain
Sputum production
Cough

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28
Q

Patient Assessment: Respiratory System

History:

Smoking history: What could be collected?

A

Amount
For how long

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29
Q

Patient Assessment: Respiratory System

Physical Examination: What are you inspecting?

A

Head, neck, fingers, and chest

Accessory muscles, sternal retractions, nasal flaring, asymmetrical chest movements, open-mouth breathing, and gasping breaths

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30
Q

Patient Assessment: Respiratory System

Respiratory rate

A

Tachypnea: rate > 20

Bradypnea: rate < 10

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31
Q

Patient Assessment: Respiratory System

Respiratory rate: What should you assess about it?

A

Assess rate and depth and altered patterns

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32
Q

Patient Assessment: Respiratory System

A patient was admitted for respiratory distress. They have a productive cough. The sputum is yellowish-gree. Which of the following is the most likely cause?

A. Bacterial infection

B. Tb

C. Pulmonary infarction

D. Viral infection

A

A. Bacterial infection

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33
Q

Patient Assessment: Respiratory System

What would sputum that has large blood clots indicate?

A

Pulmonary infarction

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34
Q

Patient Assessment: Respiratory System

What would sputum that is rust colored indicate?

A

Tb

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35
Q

Patient Assessment: Respiratory System

What would sputum that has streaks of blood indicate?

A

Viral infection

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36
Q

Patient Assessment: Respiratory System

What can effect breathing?

A

Kyphosis or hunchback: can also affect breathing
Barrel chest can also affect breathing.

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37
Q

Patient Assessment: Respiratory System

Abnormal Breathing Patterns

A

Cheyne-Stokes

Biot’s:

Kussmaul’s:

Apneustic:

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38
Q

Patient Assessment: Respiratory System

Abnormal Breathing Patterns: Cheyne-Stokes

A

Cyclical with apneic periods

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39
Q

Patient Assessment: Respiratory System

Abnormal Breathing Patterns: Biot’s:

A

Cluster breathing

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40
Q

Patient Assessment: Respiratory System

Abnormal Breathing Patterns: Kussmaul’s:

A

deep, regular, and rapid

look at pictures!

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41
Q

Patient Assessment: Respiratory System

Abnormal Breathing Patterns: Apneustic

A

gasping inspirations

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42
Q

Patient Assessment: Respiratory System

Palpation: What should you evaluate?

A

Tactile fremitus

Subcutaneous emphysema (air leak)

Thoracic expansion during respiration

Trachea alignment

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43
Q

Patient Assessment: Respiratory System

Percussion: What should you evaluate?

A

Resonance:

Dullness:

Flatness:

Hyperresonance:

Tympany:

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44
Q

Patient Assessment: Respiratory System

Percussion: Resonance- what is it?

A

normal lung sound

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45
Q

Patient Assessment: Respiratory System

Percussion: Dullness- what is it?

A

denser than normal tissue

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46
Q

Patient Assessment: Respiratory System

Percussion: Flatness- what is it?

A

Air is absent

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47
Q

Patient Assessment: Respiratory System

Percussion: Hyperresonance- what is it?

A

increased amount of air

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48
Q

Patient Assessment: Respiratory System

Percussion: Tympany- what is it?

A

air-filled area

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49
Q

Patient Assessment: Respiratory System

Auscultation: What is it?

A

Assess breath sounds, presence of adventitious lung sounds (extra lung sounds), voice sounds

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50
Q

Patient Assessment: Respiratory System

Auscultation: What kind of approach do you take?

A

Quiet environment

Systematic approach

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51
Q

Patient Assessment: Respiratory System

Breath Sounds: What does it include?

A

Normal

Adventitious sounds

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52
Q

Patient Assessment: Respiratory System

Breath Sounds: What are normal breath sounds?

A

Bronchial

Bronchovesicular

Vesicular

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53
Q

Patient Assessment: Respiratory System

Breath Sounds: What are adventitious breath sounds?

A

Crackles

Rhonchi

Wheezes

Pleural friction rub

Stridor

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54
Q

Patient Assessment: Respiratory System

Arterial Blood Gases: What measurements are included?

A

Oxygen measurement

Ventilation measurement

Measure pH

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55
Q

Patient Assessment: Respiratory System

Arterial Blood Gases: What measurements are for oxygen?

A

PaO2 and SaO2

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56
Q

Patient Assessment: Respiratory System

Arterial Blood Gases: What measurements are for ventilation?

A

PaCO2

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57
Q

Patient Assessment: Respiratory System

Arterial Blood Gases: pH measures for what?

A

Acids

Base

58
Q

Patient Assessment: Respiratory System

Arterial Blood Gases: What are the three possible results?

A

Respiratory acidosis

Respiratory alkalosis

Metabolic acidosis

Metabolic alkalosis

59
Q

Patient Assessment: Respiratory System

Arterial Blood Gases: Respiratory acidosis- What is it?

A

PaCO2 greater than 45 mm Hg and pH less than 7.35

60
Q

Patient Assessment: Respiratory System

Arterial Blood Gases: Respiratory alkalosis- What is it?

A

PaCO2 less than 35 mm Hg and pH greater than 7.45

61
Q

Patient Assessment: Respiratory System

Arterial Blood Gases: Metabolic acidosis- What is it?

A

HCO3 less than 22 mEq/L and pH less than 7.35

62
Q

Patient Assessment: Respiratory System

Arterial Blood Gases: Metabolic alkalosis- What is it?

A

HCO3 greater than 26 mEq/L and pH greater than 7.45

63
Q

Patient Assessment: Respiratory System

Arterial Blood Gases:
What is the normal PaO2 level? What is a normal SaO2?

A

The normal PaO2 is 80 to 100 mm Hg at sea level

The normal SaO2 ranges between 93% and 97%.

64
Q

Patient Assessment: Respiratory System

Arterial Blood Gases:
What is normal PaCO2, HCO3 and pH?

A

pH: 7.35 to 7.45

PaCO2: 35 to 45 mm Hg

HCO3: 22 to 26 mEq/L

65
Q

Patient Assessment: Respiratory System

ABG Interpretation

Steps of evaluation include:

A

Determine pH-acidosis or alkalosis

CO2 abnormalities

HCO3 abnormalities

Determine compensation

66
Q

Patient Assessment: Respiratory System

Compensation #1:

What kind of response to metabolic-based pH imbalances?

A

Respiratory response metabolic-based pH imbalances

67
Q

Patient Assessment: Respiratory System

Compensation #1:

Respiratory response metabolic-based pH imbalances: Metabolic acidosis

A

Increase respiratory rate and depth

68
Q

Patient Assessment: Respiratory System

Compensation #1:

Respiratory response metabolic-based pH imbalances: Metabolic alkalosis

A

Decrease respiratory rate and depth

69
Q

Patient Assessment: Respiratory System

Compensation #1:

What is the response to respiratory-based pH imbalances?

A

Renal system response to respiratory-based pH imbalances

70
Q

Patient Assessment: Respiratory System

Compensation #1:

Renal system response to respiratory-based pH imbalances: Respiratory acidosis

A

Increase hydrogen secretion and bicarbonate reabsorption

71
Q

Patient Assessment: Respiratory System

Compensation #1:

Renal system response to respiratory-based pH imbalances: Respiratory alkalosis?

A

Decrease hydrogen secretion and bicarbonate reabsorption

72
Q

Respiratory Diagnostic Studies

What is included?

A

Chest radiograph (CXR)

Ventilation–perfusion scan (VQ scan)

Pulmonary angiography

Bronchoscopy

Thoracentesis

Sputum culture

Pulmonary function tests

73
Q

Patient Management: Respiratory System

Bronchial Hygiene Therapy (BHT): What is the goal of it?

A

Goal to improve ventilation and diffusion

74
Q

Patient Management: Respiratory System

Bronchial Hygiene Therapy (BHT): Goal to improve ventilation and diffusion -How?

A

Mobilize and remove secretions.

Improve gas exchange.

75
Q

Patient Management: Respiratory System

Bronchial Hygiene Therapy (BHT): Who is it used on?

A

Hospitalized patients at risk for pulmonary dysfunction

Pneumonia, atelectasis, inability to cough and deep breath, COPD, cystic fibrosis, pulmonary fibrosis, quadriplegia, etc.

76
Q

Patient Management: Respiratory System

Bronchial Hygiene Therapy (BHT):

What are the positions?

A

A. Face lying

B. Lying on the left side

C. Back lying

D. Sitting upright or semireclining

D. Lying on the right side

77
Q

Patient Management: Respiratory System

Bronchial Hygiene Therapy (BHT):

Positions: Face lying- What is the position and what is the purpose?

A

Hips elevated 16-18 inches on pillows, making 30-45 degree angle

Purpose: to drain the posterior lower lobes

78
Q

Patient Management: Respiratory System

Bronchial Hygiene Therapy (BHT):

Positions: Lying on the left side- What is the position and what is the purpose?

A

Hips elevated 16-18 inches on pillows

Purpose: to drain the right lateral lower lung segments

79
Q

Patient Management: Respiratory System

Bronchial Hygiene Therapy (BHT):

Positions: Back Lying- What is the position and what is the purpose?

A

Hips elevated 16-18 inches on pillows

Purpose: to drain the anterior lower lung segments

80
Q

Patient Management: Respiratory System

Bronchial Hygiene Therapy (BHT):

Positions: Sitting upright for semireclining- What is the position and what is the purpose?

A

Purpose: to drain the upper lung field and allow more forceful coughing

81
Q

Patient Management: Respiratory System

Bronchial Hygiene Therapy (BHT):

Positions: Lying on the right side- What is the position and what is the purpose?

A

Hips elevated on pillows forming a 30-45 degree angle.

Purpose: to drain the left lower lobes

82
Q

Patient Management: Respiratory System

Treatment of Bronchospasm:

What is bronchospasm present in?

A

Present in asthma and COPD

83
Q

Patient Management: Respiratory System

Treatment of Bronchospasm:

What is pharmacological therapy aimed at?

A

Pharmacologic therapy aimed at reducing inflammation, treating acute symptoms, and maintaining short- and long-term therapy

84
Q

Patient Management: Respiratory System

Treatment of Bronchospasm:

Pharmacologic therapy aimed at reducing inflammation, treating acute symptoms, and maintaining short- and long-term therapy

What is included?

A

Anticholinergics

Methylxanthines

anti inflammatories (corticosteroids, leukotriene receptor antagonists)

abx

85
Q

Patient Management: Respiratory System

Treatment of Bronchospasm:

Pharmacologic therapy aimed at reducing inflammation, treating acute symptoms, and maintaining short- and long-term therapy

How is the treatment delivered?

A

Delivery by propellant inhalers using MDI and dry powder inhalers (DPIs)

86
Q

Patient Management: Respiratory System

Bronchodilator: What are the three categories of this?

A

B2-adrenergic agonists (albuterol)

Anticholinergic (ipatropium)

Methylxanthines (theophylline)

87
Q

Patient Management: Respiratory System

Bronchodilator: B2-adrenergic agonists (albuterol)

What does this med do?

A

Stimulation of receptors in lung bronchial smooth muscle and decrease release of mediators from mast cells and basophils

88
Q

Patient Management: Respiratory System

Bronchodilator: B2-adrenergic agonists (albuterol)

What is an example?

A

Salmeterol first long-acting (12-hours)

89
Q

Patient Management: Respiratory System

Bronchodilator: Anticholinergic (ipatropium)

What does it do?

A

Reduces intrinsic vagal tone to the airways

90
Q

Patient Management: Respiratory System

Bronchodilator: Methylxanthines (theophylline)

What does it do?

A

Anti-inflammatory activity (third- or fourth-line treatment)

91
Q

Patient Management: Respiratory System

Chest Tubes: What do they do?

A

Remove air, fluid, or blood from the pleural space

Restore negative pressure

Reexpand collapsed lung

Prevent reflux of drainage back into the chest

92
Q

Patient Management: Respiratory System

Assessment and Management—Chest Tubes

What should you maintain?

A

Maintain patency and function of chest tube system.

93
Q

Patient Management: Respiratory System

Assessment and Management—Chest Tubes

How do you prevent kinks?

A

Coil tubing loosely on bed to prevent kinks in dependent loops.

94
Q

Patient Management: Respiratory System

Assessment and Management—Chest Tubes

What should never be done with a chest tube?

A

Never raise above the chest.

95
Q

Patient Management: Respiratory System

Assessment and Management—Chest Tubes

What should be checked frequently?

A

Check drainage, suction, and water seal levels frequently.

96
Q

Patient Management: Respiratory System

Assessment and Management—Chest Tubes

What should you assess for?

A

Assess for air leaks.

97
Q

Patient Management: Respiratory System

Assessment and Management—Chest Tubes

How should you secure connections?

A

Secure connections with tape.

98
Q

Patient Management: Respiratory System

Assessment and Management—Chest Tubes

How should you position patient?

A

Position semi-Fowler’s; turn every 2 hours to enhance air and fluid evacuation.

99
Q

Patient Management: Respiratory System

Assessment and Management—Chest Tubes

What kind of bubbling is normal and abnormal?

A

You will see bubbling: it is pulling out air. But if bubbling is constant- that is bad because air is leaking from somewhere.

100
Q

Patient Management: Respiratory System

Chest tubes: Complications

Clamping of chest tubes is recommended in only two situations:

A
  1. To locate the source of an air leak if bubbling occurs in the water seal chamber (clamping is only momentary)
  2. To replace the chest tube drainage unit (clamping is only momentary)
101
Q

Patient Management: Respiratory System

Chest tubes: Complications

If chest tube is clamped, how long?

A

Momentarily

102
Q

Patient Management: Respiratory System

Chest tubes: Complications

If the tube must be clamped, what is used and why?

A

If the tube must be clamped, padded hemostats are used to avoid lacerating the vinyl chest tube.

103
Q

Patient Management: Respiratory System

Ventilatory Support: Why is it used?

A

Unable to maintain a patent airway

Inadequate gas exchange

Respiratory failure—the inability to maintain adequate respiration

104
Q

Patient Management: Respiratory System

Chest tubes: Complications

What must be done is patient is being transported?

A

Continuous monitoring while transporting the patient

105
Q

Patient Management: Respiratory System

Ventilatory Support: How is it measured?

A

Measured by arterial blood pH, PaCO2, and PaO2

106
Q

Patient Management: Respiratory System

Ventilatory Support: Hypoxemic respiratory failure

A

Hypoxemic respiratory failure
PaO2 < 60

107
Q

Patient Management: Respiratory System

Ventilatory Support: Hypoxemic hypercapnic failure

A

PaO2 < 60 and PaCO2 > 55

108
Q

Patient Management: Respiratory System

Mechanical Ventilation—Positive-Pressure

What are the types?

A

Volume ventilators

Pressure ventilator

High-frequency ventilator

109
Q

Patient Management: Respiratory System

Mechanical Ventilation—Positive-Pressure

Volume ventilators:

A

Preset volume delivered with each breath

110
Q

Patient Management: Respiratory System

Mechanical Ventilation—Positive-Pressure

Volume ventilators: How is pressure?

A

Preset pressure is sustained throughout inspiration.

111
Q

Patient Management: Respiratory System

Mechanical Ventilation—Positive-Pressure

Volume ventilators: How is rate, volume and inspiratory time?

A

Rate and inspiratory time are preset; volume varies.

112
Q

Patient Management: Respiratory System

Mechanical Ventilation—Positive-Pressure

High-frequency ventilator:

A

Small tidal volumes (1-3mL/kg) at frequencies > 100 breaths/minute

113
Q

Patient Management: Respiratory System

Ventilator Modes—Volume Modes

What are the two types?

A

Assist-control mode

Synchronized intermittent mandatory ventilation

114
Q

Patient Management: Respiratory System

Ventilator Modes—Volume Modes

Assist-control mode: How is rate and volume?

A

Rate and volume preset

115
Q

Patient Management: Respiratory System

Ventilator Modes—Volume Modes

Assist-control mode: How are spontaneous breaths?

A

Spontaneous breaths: full volume is delivered.

116
Q

Patient Management: Respiratory System

Ventilator Modes—Volume Modes

Synchronized intermittent mandatory ventilation: How is rate and volume?

A

Rate and volume are preset.

117
Q

Patient Management: Respiratory System

Ventilator Modes—Volume Modes

Synchronized intermittent mandatory ventilation: How are Spontaneous breaths?

A

Volume is determined by the patient’s effort.

118
Q

Patient Management: Respiratory System

Ventilator Modes—Pressure Modes

A

Pressure support ventilation (PSV) mode

Pressure-controlled ventilation (PCV) mode

119
Q

Patient Management: Respiratory System

Ventilator Modes—Pressure Modes

Pressure support ventilation (PSV) mode: What does it assist with?

A

Assists spontaneous breathing

120
Q

Patient Management: Respiratory System

Ventilator Modes—Pressure Modes

Pressure support ventilation (PSV) mode: What does it deliver?

A

Delivers preset pressure throughout the inspiratory phase

121
Q

Patient Management: Respiratory System

Ventilator Modes—Pressure Modes

Pressure support ventilation (PSV) mode: What does it decrease? What is it used for?

A

Decreases work of breathing, used for weaning

122
Q

Patient Management: Respiratory System

Ventilator Modes—Pressure Modes

Pressure-controlled ventilation (PCV) mode: What is it used for?

A

Used to control plateau pressures when compliance is decreased (ARDS)

123
Q

Patient Management: Respiratory System

Ventilator Modes—Pressure Modes

Pressure-controlled ventilation (PCV) mode: What is preset?

A

Preset pressure, rate, I:E ratio

124
Q

Patient Management: Respiratory System

Ventilator Modes—Pressure Modes

Pressure-controlled ventilation (PCV) mode: What is usually indicated for this?

A

Sedation or NMB is usually indicated.

125
Q

Patient Management: Respiratory System

Tracheostomy: What are indications for it?

A

Long-term mechanical ventilation

Frequent suctioning

Protecting the airway

Bypass an airway obstruction

Reduce WOB

126
Q

Patient Management: Respiratory System

Tracheostomy: Where is it preformed?

A

Performed in the operating room or bedside (percutaneous)

127
Q

Patient Management: Respiratory System

Tracheal Suctioning

Suction as indicated by assessment: like what?

A

Visible secretions

Coughing

Rhonchi

High PIP on ventilator

Ventilator alarm

128
Q

Patient Management: Respiratory System

Tracheal Suctioning

What are the types of suctioning?

A

Conventional versus closed suction

129
Q

Patient Management: Respiratory System

Tracheal Suctioning: What is the procedure to suction?

A

Hyperoxygenate throughout procedure

Avoid normal saline instillation

130
Q

Patient Management: Respiratory System

Tracheostomy Complications:

A

Ventilator-Associated Pneumonia (VAP)

Immobility

DVT/PE

131
Q

Patient Management: Respiratory System

Tracheostomy: Pharmacologic Therapy

A

Antibiotics, if indicated

Bronchodilators and mucolytics

IV corticosteroids

Nitric oxide

Sedation

Neuromuscular blocking agents

132
Q

Patient Management: Respiratory System

Sedation Assessment:

Why is sedation meds given?

A

Sedation medication is given to reduce anxiety; dose adjusted based on tools or scales

133
Q

Patient Management: Respiratory System

Sedation Assessment:

Sedation medication is given to reduce anxiety; dose adjusted based on tools or scales like?

A

Richmond Agitation-Sedation Scale (RASS)

Ramsey Sedation Scale (Ramsey)

Sedation-Agitation Scale (SAS)

134
Q

Patient Management: Respiratory System

Sedation Assessment:

What is important about using scales for assessment?

A

Inter-observer agreement in assessment using various scales is important

135
Q

Patient Management: Respiratory System

Sedation Assessment:

What tool is considered the gold standard?

A

No tool is considered the gold standard

136
Q

Patient Management: Respiratory System

Sedation Assessment:

What is the goal?

A

Goal is calm, easily arousable patient

137
Q

Patient Management: Respiratory System

Neuromuscular Blockade for mechanically ventilated patients

What is it used for?

A

used clinically to facilitate endotracheal intubation and to provide skeletal muscle relaxation during surgery.

Also used in conditions of high metabolic rate, i.e. ARDS.

138
Q

Patient Management: Respiratory System

Neuromuscular Blockade for mechanically ventilated patients

How does it work?

A

Compete with acetylcholine -> interfere with the transmission of nerve impulses -> resulting in skeletal muscle relaxation.

139
Q

Patient Management: Respiratory System

Neuromuscular Blockade for mechanically ventilated patients

How are they classified?

A

Based on their mechanism of action, neuromuscular blocking agents are classified as either depolarizing or non-depolarizing.

140
Q

Patient Management: Respiratory System

Neuromuscular Blockade for mechanically ventilated patients

Assessment and Management

A

Endotracheal tube care

Tube cuff pressure monitoring

Discharge planning and patient teaching

Nutritional support

Eye care

Oral care

Psychological care

Facilitating communication

Caring for the family

NURS 428: Evolution (17 decks)

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