Respiratory Disorders

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  1. ABG
    • Asses oxygenation and acid base balance
    • used to measure PaCO2
    • regulated by lungs
    • Acid
  2. Respiratory conditions that effect PH
    Acidosis: hypoventilation, asthma, copd, embolism, CABG surgery, hypoxia, ventilatory management

    Alkalosis: hyperventilating, panic attacks, head injury possible, fever, salicylate poisoning impairs  cellular respiration.
  3. Metabolic conditions that effect PH
    • acidosis: ingestion of salicylates, ethylene glycol, uncontrolled DM, Starvation, Shock, Renal disease.
    • alkalosis: protracted vomiting, excessive antacids, excessive bicarb admin.
  4. PH
    7.35-7.45
  5. PaCO2 value=respiratory low value is basic, high value is acidic.
    • CO2+H2O=Acid
    • Normal value: 40
    • Acceptable 35-45
    • <35 is alkalosis
    • >45 acidosis
  6. HCO3=metabolic low value is acidic, high value is basic
    • Kidney regulation of PH indicated by Bicarbonate.
    • HCO3- main base for regulation of PH
    • METABOLIC CONTROL
    • Normal: 24
    • Acceptable: 22-26
    • <22:  acidosis
    • >26: alkalosis
  7. Chemical Buffers
    • Bicarb-carbonic acid buffer
    • Protein buffer: hemoglobin
    • phosphate buffer
    • ammonia
    • Resp rate will compensate sooner (12min or less) than metabolic (48-72h).
  8. Determining Origin of PH imbalance
    • PH
    • PaCO2 and HCO3
    • abnormal results indicate imbalance of respiratory or metabolic origin.
  9. PH Panic values=Death
    <6.8 or >7.8
  10. PH tic tac toe
    PaCO2: 35-45 H: acid, L: basic
    HCO3: 22-26 H: basic, L: acid
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  11. Diagnostic test results for pnemonia
    Radiology
    lab
    RT
    • CBC:  elevated wbc to 12,500. neutrophils 80%=bacterial 
    • Cx Xray:  infiltrates in lungs
    • sputum culture results-takes 24-48 hours
    • Blood culture: organism invaded the bloodstream? sepsis?
    • ABG: O2 status, respiratory compromise.
  12. Risk factors for pneumonia
    • Smoking 
    • COPD
    • obesity
    • rib fractures
    • immunosuppression 
    • malnutrition
  13. COPD Risk factors
    • Smoking
    • obesity 
    • immunosuppression
    • Sedientary
    • environmental factors
    • genetic predisposition
    • Malnutrition or poor diet
  14. COPD
    • Chronic bronchitis 
    • Emphysema
    • asthma
  15. RSV-respiratory syncytial virus-manifests-bronchiolitis
    • invades mucosal cells that line the small bronchi or bronchioles.
    • infected cells die and fuse with healthy cells creating large masses of syncytia.
    • Most individuals <2 years
  16. RR for Pediatrics
    • newborn 30-60
    • 1 year: 20-40
    • 3 year: 20-30
    • 6 year: 16-22
    • 10 year: 16-20
  17. Croup Causative organisms
    • Viruses: parainfluenza, adenovirus, RSV & measles 
    • Bacteria: staphylococcus, hemophilus influenzae
    • S/S stridor
  18. Influenza
    • Incubation: 18-72 hours
    • S/S: Headache, fever, malaise, arthralgia, vomiting, cough, rhinorrhea 
    • info: inflammation of nasal or mucous membranes, epithelial  necrosis leads to secondary infection-pneumonia.
  19. Tuberculosis
    • mycobacterium=waxy
    • Droplet precautions
    • altered immune system can allow inactive TB to progress in elderly or HIV/immunosuppression 
    • macrophages attack bacterium in alveoli walling them off in tubercules.
  20. Inactive vs active TB
    • Inactive: is latent-positive skin test, but no S&S and not contagious. risk for developing disease later in life.
    • Active: Chronic cough, hemoptysis, malaise or cachexia, night sweats.
  21. TB diagnosis? test?
    • smear for acid fast bacillus-dyes the waxy coating and Cx X-ray.
    • TB test: Mantoux-PPD
  22. TB Treatment Latent
    • INH & rifampin
    • pyrazinamide + ethambutol
    • Different drug combinations take longer
    • There is a 12 dose treatment for latent TB
  23. TB treatment active
    • infectious for first 2-3 weeks of treatment
    • takes 6-9months for treatment
    • can spread through blood to other organs.
  24. TB Vaccine
    Bacille Calmette-Guerin not used in the U.S and it's 85% effective
  25. PH: 7.48
    PaCO2: 38
    HCO3: 30
    uncomp. Met. Alkalosis
  26. PH: 7.33
    PaC02: 50
    HCO3: 22
    Uncompensated Respiratory acidosis
  27. PH: 7.38
    PaCO2: 48
    HCO3: 28
    Fully compensated respiratory acidosis
  28. PH: 7.47
    PaCO2: 30
    HCO3: 20
    Partially compensated respiratory alkalosis
  29. Large use of Alka-Seltzer leads to?
    Metabolic alkalosis
  30. Extreme dieting/starvation leads to?
    Metabolic acidosis
  31. COPD can lead to what type of PH imbalance?
    Respiratory acidosis
  32. Salicylate poisoning can lead to?
    Respiratory alkalosis and metabolic acidosis
  33. Venous
    • Used to measure plasma CO2; done as part of electrolyte panel
    • regulated by kidneys
    • present in main for of Bicarb
  34. Sputum culture results?
    • 24 hours for initial culture for gram positive or negative.
    • 48 hours to ID the pathogen. Strep/staph etc.
  35. ANA Key response?
    Treatment of human responses
  36. Lobar Pneumonia
    • pneumococcal 
    • Heavy sputum, pleuritic pain
  37. Bronchopneumonia
    • patchy consolidation
    • Variable sputum production, no pain
  38. Alveolar or interstitial pneumonia
    • usually viral
    • fever pattern varies
    • influenza A&B
    • RSV
    • Adenovirus
  39. Rapid Response Indicators
    if they decrease?
    • —RR < 8——
    • HR < 40——
    • SBP < 71-80
    • ——No longer responds to voice——
    • Temp < 35∘C
  40. Rapid Response indicators 
    if they increase?
    • —RR 21-29
    • ——HR 111-129——
    • SBP 200-220
    • ——New onset agitation   or confusion——
    • Temp > 38.55 ∘C
Author:
rmwartenberg
ID:
314315
Card Set:
Respiratory Disorders
Updated:
2016-01-31 00:22:17
Tags:
nursing
Folders:
NUR107
Description:
Nursing ABG
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