Acute Resp Syndrome, Trach, Vent

  1. Define these terms:
    Anatomical Dead Space
    • Anatomical Dead Space: total volume of the conducting airways from nose/mouth down to level of the terminal bronchioles (150mL on average). This space is filled with inspired air with each breath in.
    • Bronchoscopy: Procedure that looks inside the lungs with a small camera.
    • PEEP: Positive end-expiratory pressure - pressure in the lungs (alveolar) above atmospheric pressure (outside the body) that exists at the end of expiration
  2. Define terms:
    Pleural Effusion
    • Pleural effusion: excess fluid in or around the lungs
    • Pleurisy: layer of tissue surrounding the lungs become inflamed, with sharp pain that worsens during brearthing.
    • Pneumonectomy: surgical removal of a lung or part of a lung
  3. Define term:
    • Thoracotomy: surgical incision into the chest wall
    • Tracheostomy: surgically creating a hole into the trachea
  4. Match:
    1. Active part of breathing, and is stimulated by chemical receptors, differences in pressure, and mechanical movements
    2. Passive part of breathing, which depends on the elastic recoil of lung tissue to relax

    a. Inspiration
    b. Expiration
    • 1. a
    • 2. b
  5. What is the compliance formula?
    Elasticity of Lung Tissue + Elastic recoil of chest wall = compliance
  6. The lungs ability to oxygenate arterial blood is determined by what two things?
    What are their normal ranges?
    • 1. Partial pressure of oxygen (PaO2): represents amount of oxygen dissolved in plasma in mmHg
    •  - NR: 80-100mmHg
    • 2. Arterial oxygen saturation (SaO2): represents amount of oxygen bound to hemoglobin as a %.
    •  - NR: 95-100%
  7. What are the 5 labs being looked at with an ABG?
    List their normal ranges
    What is the story these lab values are ultimately telling?
    • pH: 7.35-7.45
    • PaO2: 80-100mmHg
    • SaO2: >95%
    • PaCO2: 35-45 mmHg
    • HCO3: 22-26 mEq/L
    • These values are used intermittently to assess the efficiency of gas transfer
  8. When monitoring ventilation for CO2 concentration, what are the normal ranges? 
    List some equipment that a CO2 sensor can be attached to during measurement.
    • NR: 35-45 mmHg
    • Sensor may be attached to: ETT, trach tube, or NC
  9. 1. Define FiO2
    2. What is the multiplication factor used to predict FiO2 to Minimal PaO2. (ex: what is expected PaO2 if the FiO2 is 30?)
    3. What does it mean if the minimal predicted PaO2 is less than expected?
    FiO2: clinical term with which we refer to fraction of inspired oxygen, or how much of the air we breath is actually Oxygen.

    The multiplier is 5: 30 FiO2 = 150 minimal expected PaO2

    If PaO2 is less than FiO2x5, the pt can be assumed hypoxemic at room air.
  10. List the defense mechanisms that protects the lungs from pathogens and toxins (5)
    • Filtration of air
    • Mucocillary clearance system (mucus and cilia to cough up the mucus)
    • Cough reflex
    • Reflex Bronchoconstriction
    • Alveolar Macrophages
  11. State the indication, regarding respiratory therapy, for these listed drugs:
    • Heparin: Pulmonary emboli prophylaxis
    • Midazolam: provides sedation of mechanically ventilated pts during anesthesia
    • Nitro: Reduces myocardial oxygen consumption
  12. State the indication, regarding respiratory therapy, for these listed drugs:
    • Famotidine: prevention of aspiration pneumonitis
    • Pantoprazole: helps heal esophagitis and ulcers, which can cause SOB
    • Ranitidine: similiar to pantoprazole
  13. State the indication, regarding respiratory therapy, for these listed drugs:
    • Induction of skeletal muscle paralysis for intubation after induction of anesthesia
    •  - facilitates compliance during mechanical ventilation
  14. ARDS
    What does it begin with?
    Acute Respiratory Distress Syndrome: Begins with PULMONARY EDEMA
  15. List clinical manifestations of Pulmonary Edema
    • Increased Resp/dyspnea
    • Anxious, agitated, confused
    • Cough, frothy pink sputum
    • Crackles, rales
    • Tachycardia
    • JVD
  16. During Pulmonary edema, what will these diagnostic findings show:
    • CXR: show increased interstitial markings
    • ABGs: show increasing hypoxia
    • BNP: elevated (measures level of protein when there's heart damage)
  17. Which med do you want to administer for Pulmonary Edema?
    Lasix: diuretic + vasodilator
  18. This acronym is characterized by sudden progressive pulmonary edema, and hypoxemia regardless of O2 therapy
    ARDS: Acute respiratory distress syndrome
  19. List clinical manifestations of ARDS
    • Severe dyspnea occuring 12-48 hours after insult
    • Arterial hypoxemia regardless of O2 therapy
    • Lungs are "stiff"
  20. The pathophysiologic changes in ARDS are divided into these three phases. Describe each

    1. Exudative
    2. Proliferative 
    3. Fibrotic
    • 1. Injury or exudative phase: occurs approx 1-7 days after initial direct lung injury, with blood and fluid preventing oxygenation. Alveolar cells are damaged, surfactant dysfunction occurs (decreasing alveolar surface tension and collapse), then atelectasis and hypoxemia results. 
    • 2. Reparative or Proliferative Phase: 1-2 weeks after injury, there will be an influx of WBCs and inflammatory responses. This phase is considered complete when the diseased lung is characterized by dense, fibrous tissue. Increased vascular resistance and pulmonary HTN may occur, lung compliance also dicreases, and hypoxemia worsens. 
    • 3. Fibrotic Phase: 2-3 weeks after lung injury, lung is completely remodeled by collagenous and fibrous tissues. Further decreased lung compliance, surface area for gas exchange is significantly reduced, and hypoxemia continues. pulmonary HTN results.
  21. What is the most common cause of ARDS?
    • Sepsis
    • Direct lung injury may also cause it or SIRS from a noninfectious etiology
  22. What is the goal of PaO2 or O2 sat with ARDS?

    List meds that could be used

    What are nutritional considerations?
    • PaO2>60mm Hg
    • O2 >90%

    • Meds:
    •  - Pulmonary vasodilators first
    •  - steroids second
    •  - in worst stages: Human recombinant antagonist, surfactant (pt. will be on ventilator)

    Nutritional: pts. will need nutritional support  if on ventilator (35-45kcal/kg per day)
  23. Considerations w/ suctioning?
    don't suction so much you take out surfactant
  24. List med management of ARF
    • O2/intubation
    • Morphine for dilation
    • Lasix for pulm. edema
    • Dobutamine
Card Set
Acute Resp Syndrome, Trach, Vent