Brad\'s Final Part 4.txt

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  1. During preoperative evaluation of a patient's lung function, findings of a reduction in forced expiratory volume in 1 second to FVC ratio (FEV1/FVC%) to less than 50% of normal or an FVC of less than 20 ml/kg because of nonreversible obstructive or restrictive disease indicate that the patient may be at high risk for developing
    pulmonary complications in the postoperative period
  2. Factors that influence the degree of decrease in VC during the postoperative period and the incidence of postoperative pulmonary complications include
    surgical site, smoking history, age, nutritional status, obesity, pain, type of anethesia, and type of narcotics used for pain control
  3. The most importa factor that reduces VC is?
    incision site
  4. A VC of __________is usually needed for effective deep brathing and coughing.
    10-15 ml/kg
  5. A VC less than ______ are usually associated with impending respiratory failure.
  6. A VC greater than _______ usually indicate adequate ventilatory reserve and the possibility of discontinuing CMV and extubation.
  7. is also measured to follow the responsiveness of the patient to various respiratory therapies such as incentive spirometry or intermittent positive-pressure breathing (IPPB)
  8. Serial, not individual, measurements of weaning indices (RSBI, VC, and VT) are most likely to predict
    success or failure
  9. is the volume of gas remaining in the lungs at the end of a normal passive exhalation. It is rarely measured in the ICU.
    Functional residual capacity (FRC)
  10. It is composed of a combination of residual volume (RV) and expiratory reserve volume (ERV)
  11. FRC is about __ ml/kg of ideal body weight, or approximately _________ of total lung capacity (TLC).
    40 35-40%
  12. When alveolar volume falls, as with atelectasis, FRC is _______ and there are regional changes in alveolar pressure-volume curves.
  13. The application of ______ prevents alveolar collapse and may reduce the extent of acute lung injury.
  14. Theraputic modalities, such as PEEP or CPAP in crease?
  15. The primary reason that you would treat FRC with PEEP and CPAP is?
    atelectasis and refractory hypoxemia
  16. You monitor this to help determine the need for mechanical vent., help determine the site and thereby the cause of impedance to mech. vent., help estimate the amount of positive pressure being transmitted to the heart and major vessels, help assess the PT's respiratory muscle strength.
    Airway pressure
  17. is the maximum pressure attained during the inspiratory phase of mechanical ventilation. It reflects the amount of force needed to overcome opposition to airflow into the lungs.
    Peak inspiratory pressure (PIP)
  18. Causes include resistance generated by the ventilator circuit, the artificial airway (ET tube), and the patient's airways and elastic recoil of the thoracic cage and the lungs
    Opposition of flow
  19. If the PIP increases while the plateau pressure (explained later) is unchanged, an increase in ___ is probably occurring
  20. Causes include bronchospasm, airway secretions, and mucous plugging
    Increased Raw
  21. Mechanical ventilation is usually indicated in patients with neuromuscular disease (Guillain-Barr� or myasthenia gravis) when serial measurements of VC decrease to less than ____ ml/kg or ___ L, and PImax has lessened to ____ cm H2O or less.
    10, 1, -20
  22. If mechanically ventilated patients do not complete exhalation before inspiration begins, they will develop
    auto�positive end-expiratory pressure (PEEP)
  23. is defined as the difference between total�PEEP (obtained by expiratory hold maneuver) and the set�PEEP on the ventilator.
  24. If _____ is detected, measurement of total�PEEP should be attempted. It is not always possible to make accurate measurements of total�PEEP because the patient must not inhale or exhale during the expiratory hold maneuver and the circuit cannot have any leaks
  25. When auto�PEEP is caused by dynamic airway compression, the patient may be unable to trigger
    ventilator breaths
  26. will increase if the amount of set�PEEP exceeds the resulting auto�PEEP
  27. The most effective method to reduce auto�PEEP during conventional ventilation is through the reduction of
  28. is defined as volume change per unit of pressure change, or the amount of lung volume achieved per unit of pressure.
  29. Two forms of compliance are commonly reported:
    effective dynamic compliance and static compliance.
  30. represents the total impedance to gas flow into the lungs, and it is determined by dividing delivered or corrected VT by the peak airway pressure minus the end-expiratory pressure (EEP)
    Dynamic compliance
  31. incorporates both the flow-resistive characteristics of the airways and ventilator circuit and the elastic components of the lung and chest wall
    Dynamic compliance
  32. also respiratory system compliance, is the lung volume change per unit of pressure during a period of no gas reflection of the combination of chest wall and lung compliance. It is calculated clinically by dividing delivered VT by the plateau pressure minus EEP
    Static compliance
  33. Lung diseases such as pulmonary edema, pneumothorax, pneumonia, and ARDS increase lung recoil and the
    observed static compliance
  34. normal static compliance values in patients receiving mechanical ventilation range from
  35. Compliance values less than ________ are not usually associated with successful weaning attempts or PEEP withdrawal
    20-25 mL/cm H2O
  36. is the essential mechanism by which oxygen is carried from the lungs to the capillary bed.
    Oxygen transport
  37. Equally important is how oxygen is used by the tissues, a process known as
    oxygen consumption
  38. Means oxygen delivery
  39. In the critically ill patient, an increase in oxygen consumption or decrease in Do2 to the tissues must be compensated for by an increase in one or more of the reserve systems:
    Cardiac output and distribution, PaO2 and SaO2 values, and sufficient levels of functional hempglobin
  40. is defined as the total amount of oxygen carried in the blood and is the sum of oxygen bound chemically to hemoglobin (Hb) plus oxygen dissolved in plasma
    Oxygen content
  41. is important because it reflects the degree of saturation of Hb and the driving pressure of oxygen between systemic capillary blood and the tissues:
  42. what is the equation for Oxygen content?
    O2 content = (Hb � 1.34 � % Saturation) + (Pao2 � 0.003)
  43. Traditional respiratory care has focused on the physiologic mechanisms that result in inadequate oxygenation of the pulmonary capillary blood. These mechanisms include the following
    V/Q mismatch (most common), Diffusion block (rare), hypovetilation, and Shunt (extreme V/Q mismatch)
  44. is extremely dependent on cardiac output and systemic distribution of blood flow
  45. is not sensitive to moderate changes in oxygen tension (Po2) and usually does not increase until the Pao2 drops below 50 mm Hg. Is dependent on metabolic activity
    Cadiac Output
  46. Its another factor that effects Do2.graphically depicts the relationship between Pao2 and the oxygen content or Hb saturation. The clinical significance of the curve is that large changes in Pao2 may have little effect on the oxygen content or Hb saturation of arterial blood on the upper, flat portion of the curve (Pao2 >70 mm Hg), but dramatic changes occur in oxygen content or Hb saturation at the steep portion of the curve (Pao2 =40 to 70 mm Hg)
    oxyhemoglobin dissociation curve (ODC)
  47. Shifting the ODC curve to the right or left may profoundly affect oxygen availability to
  48. is measured by tonometry or calculated at a point where the oxygen's partial pressure has saturated 50% of the Hb (P-50)
    clinical position of the ODC
  49. a shift to the ______ of the ODC decreases the P-50. This indicates an increase in oxygen affinity or a tendency for the Hb not to release oxygen to the tissues
  50. A shift to the _____ of the ODC (increased P-50) indicates a reduction in oxygen-hemoglobin affinity, resulting in oxygen being released more readily to the tissues.
  51. an be caused by massive transfusion of acid-citrate-dextrose�stored blood, rapid correction of acidosis that has been present for hours or days, or severe hyperventilation resulting in respiratory alkalosis
    A left-shifted ODC
  52. The amount of blood pumped out of the left ventricle in a minute is known as
    cardiac output (CO)
  53. It is the product of heart rate (HR) and stroke volume (SV), which is the volume of blood ejected by the ventricle by a single heart beat
    Stroke volume (SV)
  54. Normal SV in adults?
  55. The average CO for men and women of all ages is approximately
    5 L/min at rest (normal range is 4 to 8 L/min)
  56. the normal CO for an individual varies with
    age, sex, body size, blood, viscosity, and the tissue demand for O2
  57. The normal heart is capable of pumping approximately
    10 to 13 L/min (2X if stimulated by SNS)
  58. The volume of blood returning to the right atrium is known as
    venous return
  59. often plays an important role in the assessment and treatment of critically ill patients. It is performed to evaluate intravascular fluid volume by measuring central venous pressure (CVP) and pulmonary artery wedge pressure (PAWP); cardiac function by measuring cardiac output (CO) and cardiac index (CI); and vascular function by measuring systemic vascular resistance (SVR) and pulmonary vascular resistance (PVR)
    Hemodynamic monitoring
  60. is needed because clinical assessment (e.g., evaluating jugular venous distention and heart sounds) alone may not accurately predict hemodynamics in some patients
    Invasive hemodynamic monitoring
  61. acquire and calculate physiologic data in real time and often transfer the data automatically to computers for trend analysis
    Bedside monitors
  62. Monitors do not always ________. Therapeutic decision making based on numbers alone is never appropriate and can be dangerous, even deadly.
    tell the truth
  63. The attending physician may place (or request) an ___________ into a patient with significant hemodynamic instability or a patient who will require frequent arterial blood draws. Patients with severe hypotension (shock), severe hypertension, or unstable respiratory failure are likely candidates to have continuous arterial pressure monitoring
    arterial catherter
  64. Normal arterial pressure in the adult is approximately
    120/80 mm Hg
  65. Systolic pressures greater than 160 and diastolic pressures greater than 90 are considered
  66. A pressure below 90/60 mm Hg is known as
  67. is the product of flow and resistance.
  68. With hypovolemia from fluid or blood loss (most commonly, bleeding), During cardiac failure and shock (most commonly, heart attack), With vasodilation (most commonly, sepsis) do what to the arterial pressure?
  69. must be watched carefully during the administration of vasodilators such as sodium nitroprusside, which may reduce diastolic pressure more rapidly than systolic or mean pressure
    Diastolic pressure
  70. Diastolic pressure less than 50 mm Hg and mean pressure less than 60 mm Hg in an adult may result in
    compromised coronary perfusion
  71. Improvement in circulatory volume and function, Sympathetic stimulation (e.g., fear or medications), Vasoconstriction, Administration of vasopressors cause what to happen to the arterial pressure?
  72. is the difference between the systolic and diastolic pressure
    pulse pressure
  73. Normal pulse is _____ and is a reflection of SV by the left ventricle and arterial system compliance.
    30-40 mmHg
  74. A decreasing pulse pressure is a sign of low
  75. A pulse pressure <30 mm Hg indicates a low SV by
    the left ventricle
  76. If the pulse pressure increases with fluid therapy, the patient was probably
  77. is an average of pressures pushing blood through the systemic circulation; therefore it is the more important of the arterial pressures and an indicator of tissue perfusion
    Mean arterial pressure (MAP)
  78. Normal MAP is considered to be
    80 to 100 mm Hg
  79. Circulation to the vital organs (i.e., kidneys, coronary arteries, and brain) may be compromised when MAP falls below
    60 mm Hg
  80. is used in calculating derived hemodynamic variables such as SVR, left ventricular stroke work, and cardiac work
  81. resulting from embolism, thrombus, or arterial spasm is the major complication of direct arterial monitoring. It is evidenced by pallor distal to the insertion site and usually is accompanied by pain and paresthesias (numbness/tingling sensations)
  82. can proceed to tissue necrosis if the catheter is not repositioned or removed
  83. is prevented by irrigation with diluted heparinized solution in the catheter.
  84. is done in very small amounts because flushing the line of the catheter can result in retrograde flow and cerebral embolization.
  85. is possible if the line becomes disconnected or a stopcock is left open; therefore the tubing should be kept on top of the bed sheets, where it can be observed
  86. Blood flow through an 18-gauge catheter is sufficient to allow a
    500-ml blood loss per minute
  87. All invasive hemodynamic monitoring lines are a potential source of
    infection, bleeding, hematoma, embolus, thrombus, and impaired circulation
  88. this in any patient with invasive lines must trigger questions about the necessity of the lines and their role in an infectious process.
  89. can be used to obliterate tumors obstructing large airways
  90. is a major issue as lasers are more likely to ignite airway fires if the oxygen concentration is above 30%
  91. Other specialty catheters available for use through a bronchoscope include
    suture cutters, magnetic extractors, and injector catheters
  92. Laser treatment through a bronchoscope is usually reserved for patients in whom lung cancer has
    obstructed a large airway
  93. is a general term used to describe procedures that look into the body's tubes and cavities
  94. There are two basic categories of indications for flexible fiberoptic bronchoscopy:
    diagnostic and therapeutic
  95. The flexible fiberoptic bronchoscope is used most often for
    diagnostic purposes
  96. The most common indication for flexible bronchoscopy is to
    diagnose an abnormality seen on CXR
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Brad\'s Final Part 4.txt
2011-12-05 19:41:40
Final RESP132

Final RESP 132
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