Term
| What is pulmonary diffusion? |
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Definition
| movement of gasses for a grater to lesser concentration through a simple membrane (alveoli, capillaries) |
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Term
Match the term to the definition
Resperation, Ventalation, Compliense
A. the air movement into and out of the pulmonary airway
B.The exchange of gas across the capillary membrane
C.The ease of lung inflation |
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Definition
A. Ventalation
B. Resperation
C. Compliense |
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Term
Pulmonary Diffusion has a gradient (A/a)
What does this mean? |
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Definition
Alveoli/arterial
this is to say that it is a ratio of available air to RBC's to carry the oxygen |
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Term
| what factors can affect diffusion? |
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Definition
Partial pressure of gases
Gradient: A-a gradient and a/A ratio
Surface area
Membrane thickness
Length of exposure |
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Term
during inhalation, what is the position of the diaphragm?
( contracted or relaxed) |
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Definition
contracted
The diaphragm is relaxed on exhalation |
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Term
| ventilation and perfusion are not equal in the body they are mismatched how is this represented and what is the ratio? |
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Definition
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Term
| With inadequate perfusion or dead space ventilation how would you expect the V/Q to change? |
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Definition
> .8
because the ventilation stays the same (4) but the perfusion is decreased (goes form 5 to 4.5)
now the ratio is 4/4.5 =.89
or 4/4 = 1 |
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Term
| if the patient had inadequate ventilation (shunting) how wouldyou expect the V/Q to change? |
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Definition
if norm is 4/5 or 0.8
then as ventalation decreases the top number is lowered
3/5 = 0.6
(< 0.8) |
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Term
| the patient V/Q scan comes back as 1.2, are they having a problem with ventilation or perfusion? |
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Definition
perfusion
because is it greater than 0.8 |
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Term
| the patient V/Q scan comes back as 0.4, are they having a problem with ventilation or perfusion? |
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Definition
ventilation
because it is less than 0.8 |
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Term
| what types of conditions can cause inadequate perfusion |
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Definition
| pulmonary embolus or decreased cardiac output |
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Term
| what types of conditions can cause inadequate ventilation? |
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Definition
| pneumonia, COPD, asthma, ARDS ect. |
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Term
| what is a Venous Admixtures? |
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Definition
| Mixing of re-oxygenated and unoxygenated blood. It usually has to do with a hole somewhere where it doesn’t belong so between the atrium or the ventricle there is usually some sort of septal defect |
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Term
match the term to definition:
Pa02 , Sa02
A. oxygen saturation of arterial blood
B. The fraction of inspired air
C. partial pressure of 02 in arterial blood
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Definition
A. Sa02
B. FiO2 *bonus points if you knew this
C. PaO2 |
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Term
| what happens when you have a condition that affects both ventilation and perfusion? |
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Definition
| it may not show up on a V/Q scan. This is called a silent unit. |
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Term
| what are two examples of a silent unit? |
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Definition
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Term
| in what type of pulmonary diseases does the lungs have decreased compliance? |
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Definition
| restrictive pulmonary diseases |
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Term
in what type of pulmonary diseases does the lungs have increased compliance?
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Definition
| obstructive pulmonary disease |
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Term
| What is a pulmonary embolism (PE)? |
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Definition
| a collection of particulate matter (solids, liquids, or air) that enters venous circulation and lodges in the pulmonary vessels. |
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Term
many patients die of a PE within 1 hour of the onset of symptoms or before the diagnosis has even been suspected.
T/F? |
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Definition
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Term
| What will the PE lead to? |
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Definition
Decreased systemic oxygenation
Pulmonary tissue hypoxia→ tissue damage |
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Term
| What are the Risk Factors for a PE |
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Definition
Immobilization
Surgery
Obesity
Hypercoagulability
Smoking
Pregnancy
Estrogen Therapy (i.e birth control)
Trauma, certain diseases, central lines
Advancing age
History of embolus |
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Term
what are the respiratory Manifestations/Symptoms of a PE
|
|
Definition
dyspnea
tachypnea
pleuretic chest pain
hemoptysis- expectoration (coughing up) of blood
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Term
| what are the cardiac Manifestations/Symptoms of a PE |
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Definition
tachycardia
syncope
cyanosis
S3, S4 possible |
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Term
Manifestations/Symptoms of a PE
Miscellaneous |
|
Definition
low grade fever
petechiea
nausea, vomiting, malaise |
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|
Term
|
Definition
CXR
V/Q scan
CT contrast (pulmonary angiogram) |
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Term
| What is the nurses first intervention for a pt with a PE? |
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Definition
| 1. Oxygen therapy-maintain airway |
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Term
| a nurse admits a pt to the ER with a PE. The nurse gives Oxygen therapy and has maintain airway. What should the nurse do next? |
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Definition
| Monitoring-pulse ox and draw labs- ABG’s, INR, PTT and PT |
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Term
| a nurse admits a pt to the ER with a PE. The nurse gives Oxygen therapy and has maintain airway, drawn labs. What should the nurse do next? |
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Definition
Prepair to give Anticoagulation thrombolytic therapy
(Alteplase recombinant, Activase ) |
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Term
| After a pt has recived the anti- thrombolytics, what is the next type of theripys the pt may recive? |
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Definition
IV therapy
Drug therapy-Heparin, Lovenox, Coumadin |
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Term
| what are the signs and symptoms of SARS |
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Definition
Fever, myalgia (severe), extreme weakness, HA, dry cough, N/V, dyspnea |
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Term
| when we can nurse suspect SARS to be the most likely cause of a patient's respiratory infection? |
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Definition
| when the patient or family member the patient has traveled Asia |
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Term
| what precautions need to be taken when the patient is suspected of having SARS? |
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Definition
PPE: glove, mask (N 95), gown
Place pt in neg. pressure room with isolation |
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Term
| if a patient is on a ventilator for an extended period of time what type of infection are they likely to contract? |
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Definition
| VAP- ventilator assisted pneumonia |
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Term
|
Definition
| an acute inflammation of the lungs parenchyma caused by an infectious agent that can lead to alveolar consolidation. |
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Term
| what steps can a nurse take to prevent VAP? |
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Definition
good oral hygiene Q2H
sedation vacation
elevated HOB
continuous aspiration of subglottic secretions
proper hand hygiene |
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Term
what is the most common pathogen associated with VAP
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|
Definition
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Term
| what percentage of patients are likely to get ventilator assisted pneumonia? |
|
Definition
| 20% if ventilated over 72 hours |
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Term
| what test should be ordered and reviewed ( if already obtained), if you suspect your patient to have VAP? |
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Definition
order/review recent chest x-ray
If results come back abnormal cultures may be obtained by endotracheal aspiration or bronchoalveolar lavage |
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Term
| What test can show repositoryproblems before a pt becomes symptomatic? |
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Definition
| Pulmonary Function Testing (PFT) |
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Term
| What is the Tidal volume of the Pulmonary Function Test |
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Definition
| amount of air inhaled and exhaled with each breath. |
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Term
| What is the normal range for the Tidal volume |
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Definition
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Term
| What is the Minute volume of the Pulmonary Function Test |
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Definition
| Tidal volume (TV) x RR or the amount of air that can be inhaled and exhaled from a person over one minute. |
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Term
| What is the Vital capacity of the Pulmonary Function Test |
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Definition
| amount of air that can be forcefully exhaled after a deep inspiration. |
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Term
| What is the Residual volume of the Pulmonary Function Test |
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Definition
| the amount of air left in the lungs after a full forced exhalation. |
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Term
| What is the Functional residual capacity of the Pulmonary Function Test |
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Definition
| amount of air left in the lungs after a normal expiration. |
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Term
| for what reasons may pulse oximetry have decreased reliability? |
|
Definition
Vasoconstriction
Vascular dyes
Abnormal hemoglobin
carbon monoxide |
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Term
| what is respiratory insufficiency |
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Definition
Gas exchange is acceptable only because of compensation. Ph is normal other ABGs maybe out of range |
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Term
| when does respiratory insufficiency become respiratory failure |
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Definition
when the pH changes out of normal Range
Failure develops quickly with any decrease in compensation. |
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Term
| what are the PaO2, CO2 and pH parameters for respiratory failure |
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Definition
Oxygenation failure = PaO2 < 60
Ventilation failure = CO2 >50 with a
pH < 7.30 |
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Term
| how is a PaO2 sample measured and what is its normal range? |
|
Definition
It is measured via arterial blood sample. A normal range is approximately 75-100 mm Hg.
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Term
| how is a SaO2 measured and what is its normal range |
|
Definition
measured by arterial blood sample or by continuous pulse oximetry.
A normal value is approximately 95-100%. |
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Term
if the patient presented with these signs and symptoms what diagnosis would you suspect?
Hypoxemia that persists even when 100% oxygen is given
Decreased pulmonary compliance
Dyspnea
Noncardiac-associated bilateral pulmonary edema
Dense pulmonary infiltrates on x-ray (ground-glass appearance) |
|
Definition
|
|
Term
What are the parameters of
PaO2 and FiO2 for ARDS? |
|
Definition
PaO2 < 50 with an FiO2 > 50%
or (PaO2/FiO2 <200)
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|
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Term
| what would you expect the A-a gradient and a/A ratio to be for patient with ARDS |
|
Definition
A-a gradient > 20%
a/A ratio < 60% |
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Term
| what steps should be taken to manage the patient with an air leak disorder? |
|
Definition
Administer oxygen therapy
Intubate patient as needed
Initiate mechanical ventilation as needed
Evacuate air from the pleural space- Percutaneous catheter attached to Heimlich valve ,Chest tube to water seal or suction
Assess for complications :Acute respiratory failure
Maintain the chest drainage system
Provide comfort and emotional support |
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Term
| what equipment should you have at the bedside of the patient with a chest tube? |
|
Definition
| A sterile occlusive dressing and a bottle of sterile water |
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Term
| in what instances would the nurse need to use the sterile occlusive dressing and/or a bottle of sterile water for a patient with a chest tube |
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Definition
If the chest tube system is interrupted, the tube should be placed in the bottle of water while the drainage system is reestablished.
A sterile occlusive dressing is applied to the chest wall if the chest tube is accidentally removed. |
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Term
What is used to determine the end-tidal partial pressure of Carbon Dioxide? |
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Definition
Capnometry
(not as useful if there is significant V/Q mismatch)
(used less grequently than Pulse Oximetry)
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