alteration in ventilation

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Author:
nurse&dad
ID:
110111
Filename:
alteration in ventilation
Updated:
2011-10-20 10:10:22
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respiratory
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interventions
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  1. What is respiration?
    Supplies the cells with oxygen and removes carbon dioxide
  2. What is ventilation?
    • Mechanical movement of air to and from the atmosphere and the alveoli
    • It is the actual work of breathing
    • The amount of work that must be performed to overcome the elastic and resistive properties of the lungs
  3. Important aspects to assess in a respiratory system history
    • Smoking hx
    • Childhood illnesses-asthma, pneumonia, communicable diseases, hay fever, allergies, eczema, frequent colds, croup, cystic fibrosis
    • Adult illnesses-pneumonia, sinusitis, tuberculosis, HIV/AIDS, emphysema, sarcoidosis, diabetes, hypertension, heart disease
    • Vaccinations-influenza, pneumoccocal (pneumovax), BCG
    • Surgeries of respiratory system
    • Hospitalizations
    • Date of last diagnostic test-chest x-ray, PFT, tuberculin test
    • Recent weight loss
    • Night sweats
    • Sleep disturbances
    • Lungs disease
    • Family hx
    • Recent travel
    • Occupation
    • Hobbies
  4. ABG measure
    • pH: 7.35-7.45
    • PaO2: 80-100
    • PaCO2: 35-45
    • HCO3: 22-26
    • SaO2: 95-100
  5. Blood pH levels
    • acidosis: < 7.35
    • alkalosis: > 7.45
  6. Early S/S of hypoxemia
    • Tachypnea
    • Tachycardia
    • Restlessness
    • Pallor of skin & mucous membranes
    • Elevated blood pressure
    • Symptoms of respiratory distress-use of accessory muscles, nasal flaring, tracheal tugging, adventitous lung sounds
  7. Late S/S of hypoxemia
    • Confusion and stupor
    • Cyanosis of skin and mucous membranes
    • Bradypnea
    • Bradycardia
    • Hypotension
    • Cardiac dysrhythmias
  8. What is pulmonary toileting?
    • TCDB
    • IS
  9. What is CPAP?
    Continuous Positive Airway Pressure
  10. What is BiPAP?
    Bilevel Positive Airway Pressure
  11. What is PEEP?
    Positive End-Expiratory Pressure
  12. Nasal cannula
    • Provide 24-40% FiO2 (fraction of inspired oxygen)
    • Flow rate 1-6 L/min
    • Long term O2 therapy
  13. Simple face mask
    • For increased flow rates
    • Provide 40-60% FiO2
    • Flow rate 5-8 L/min
    • Minimum flow rate is 5 L/min to ensure flushing of CO2 from mask
  14. Non-rebreather mask
    • High concentrations
    • Provide 80-95% FiO2
    • Flow rate 10-15 L/min
    • For clients in respiratory distress who may require intubation
  15. S/S respiratory depression
    • Decreased respiratory rate
    • Decreased LOC
  16. Venturi mask
    • Venti mask
    • Deliver most accurate O2 concentration
  17. Bronchoscopy
    Permits visualization of larynx, trachea, bronchi
  18. Therapeutic indications for bronchoscopy
    • Control of bronchial bleeding
    • Removal of aspirated foreign bodies
    • Removal of mucous plugs
    • Endobronchial brachytherapy
    • Laser treatment of neoplastic obstruction
  19. Important lab values
    • pH: 7.35-7.45
    • PaO2: 80-100 mmHg
    • PaCO2: 35-45 mmHg
    • HCO3: 22-26 mEq/L
    • BUN: 8-22 mg/dL
    • APTT: 20-35 sec, anticougualtion therapy; 1.5-2.5 times normal
    • PT: 10-13 sec, anticoagulation therapy; 1.5-2.0 times normal
    • INR: 2.0-3.0
    • HCT: male 40-54%, female 36-46%
    • Hgb: male 13.5-17g/dL, female 12-15g/dL
    • Platelet: 150,000-400,000/mm3
    • WBC: 4,500-11,000 cells/mm3
  20. PCO2
    • Indicator of respiratory buffering
    • < 35 mmHg indicates alkalosis
    • > 45 mmHg indicates acidosis
    • ex:
    • pH<7.35+PCO2>45=respiratory acidosis
    • pH>7.45+PCO2<35=respiratory alkalosis
  21. HCO3
    • Indicator of metabolic buffering
    • <22mEq/L indicates acidosis
    • >26mEq/L indicates alkalosis
    • ex:
    • pH<7.35+HCO3<22=metabolic acidosis
    • pH>7.45+HCO3>36=metabolic alkalosis
  22. Respiratory acidosis
    • pH 7.2 = acidosis
    • PCO2 50 = acidosis
    • HCO3 24 = normal
  23. Respiratory alkalosis
    pH

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