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JM Respiratory Lag
Respiratory lag pg 1-7
| Question | Answer |
|---|---|
| How is O2 transported? Monitored? | 3% dissolved (PO2) and 97% bound to Hgb (O2 sats, pulse oximetry). |
| How is CO2 transported? | 70% (bicarbonate ion form: H2Co3- (carbonic acid) (dissociates into bicarb); 20 % (deoxygenated Hgb carbaminohemoglobin); 10% )dissolved PCO2 on an ABG |
| What factors affect the work of breathing? | Airway resistance (airway radius, rate or speed of gas flow) and elastic forces (compliance). |
| Discuss local clinical manifestations of respiratory dysfunction. | Cough (lasting longer then 2-3 wks may indicate pulmonary disease; excessive nasal secretions; expectoration of sputum; pain (pleuritic intercostals, generalized);dyspnea. |
| What type of main may be experienced with resp dysfunction? | pleuritic, intercostal, generalized |
| Describe clinical manifestations of respiratory dysfunction dyspnea. | Rapid, audible, labored breathing; accessory muscles; dilated nostrils (flaring); tachycardia;anxious expression; gasping; cyanosis. |
| Define ventilation/perfusion (V/Q) mismatch. | Areas of the lung participating in ventilation that will not be perfused because of the decreased blood flow to lungs (d/t increased dead space) |
| Give examples of conditions with dead space. | Emphysema & pulmonary embolism: because of loss of cap bed no blood flow |
| What is dead space? | areas where ventilation is present w/o perfusion: no gas exchange can occur |
| Give examples of conditions with shunting. | pneumonia, atelectasis, ARDS bit mp ventilation. |
| What is shunting? | Blood flow but no ventilation |
| Discuss systemic manifestations of respiratory dysfunction. | Hypoxemia/hypoxia. Hypoxemia is decreases PaO2 and Hypoxia is inadequate tissue oxygenation. |
| What are some causes of hypoxemia/hypoxia? | Ventilation/perfusion mismatching is MOST COMMON cause; high altitude; inadequate O2 in inspired air; anemia; abnormal types of hgb; circulatory impairment (hypotension, low CO…) |
| What is the MOST reliable indicator of hypoxemia? | ABGs |
| What are the early signs of hypoxia? | tachycardia, dilated pupils(sympathetic n.s. response)tachypnea, irritability; unexplained apprehension |
| What might rapid shallow breaths suggest? | the tidal vol may be inadequate to remove co2 from the lungs. |
| What may a severe morning HA indicate? | that hypercapnia may have occurred during the night, increasing cerebral blood flow by vasodilation and causing a morning HA |
| What are later signs of hypoxia? | combativeness;retraction;cyanosis,hypotension; HA, decreased loc |
| See pg 1804 for hypotension with hypoxia | |
| Why is it important to give LOW FLOW o2 TO copd PTS? | With long-standing CO2 retention & resultant acidosis, hypoxemia will stimulate peripheral chemoreceptors. |
| Discuss role of hypoxemia and acidosis. | Anaerobic metabolism, lactic acidosis buildup |
| What is hypercapnia/hypercarbia? | Increased amounts of CO2 in ARTERIAL BLOOD. |
| What are causes of hypercapnia/hypercarbia? | Inadequate alveolar ventilation-think about it!! Alveoli not working properly!respdepression,pneumonia,pulmonary edema, obstructive lung disease. |
| What are s/s of hypercapnia/hypercarbia? | Increased CO2 leads to increased H+ ion concentration: tachycardia, HTN,dizzy,HA, mental cloudiness, LOC if severe. |
| See pg 1804 | |
| What is respiratory failure? | Oxygenation &/or ventilatory failure;inability to supply body with O2 (O2 failure) & rid it of CO2 (ventilatory failure) |
| Define ventilatory failure affects. | it is the inability to get rid of the co2 |
| Oxygenation failure? | inability to SUPPLY o2 |
| What blood gases define respiratory failure? | PaO2=< 50 mm Hg or Paco2 =>50 mm Hg and pH =< 7.25 |
| How is respiratory failure classified? | acute or chronic |
| What are some causes of ventilatory failure? | alveolar hypoventilation: upper airway obst, depress/ medulla,drug OD, anesthesia, head trauma, cva;impaired nerve impulse(resp.center to resp musc);mech abnormalities;smokers (copd) |
| What mechanical abnormalities my cause ventilator failure? | Abnormalities of chest wall or lung pleural effusion,pneumothorax, hemothorax,flair chest; |
| What are some conditions of impaired transmission of nerve impulses from respiratory center to the muscles of respiration? | lesion @ cervical level of spinal cord, d/o of nerves or neuromuscular junction (polio, Guillain-Barre’, myasthenia gravis) |
| Discuss causes of oxygenation failure. | V/Q mismatch: pneumonia, ARDS, atelectasis, severe pulmonary edema, pulmonary embolism |
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