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NUR1213_Exam 4

OXYGENATION: Oxygenation: ABGs, Pneumothorax, PE, Cystic Fibrosis, Occupational

QuestionAnswer
<B><U>ABG NORMAL VALUES:</U></B> <BR/> <center>pH=</center> <center>PaO2=</center> <center>PaCO2=</center> <center>HCO=Sa02=</center> pH= 7.35-7.45 <center>PaO2= 80-100mm</center> <center>HgPaCO2= 35-45mm</center> <center>HgHCO= 22-26 mEq/L</center> <center>Sa02= 93-100%</center>
Pneumothorax- partial or complete collapse of the lung d/t possitive pressure in the pleural space
Pulmonary Embolism- obstruction of the pulmonary artery or one of its branches by a thrombus that originates somewhere in the venous system or in the right side of the heart; <BR> embolus may be d/t blood clot, air bubbles, or fat droplets
Cystic Fibrosis (CF)- fatal autosomal recessive disease
Occupational Lung Disease: Pneumoconioses- nonneoplastic alteration of the lung resulting from inhalation of mineral or inorganic dust ("dusty lung")
Pleural Effusion- abnormal accumulation of fluid in the pleural space, is rarely primary disease process but it usually occurs 2ndary to other diseases
Plasma pH is an indicator of... hydrogen ion (H+)concentration
<a href="http://media.photobucket.com/image/nursing%20icon/Mackglee87/Icons/nursingstress.jpg?o=3" target="_blank"><img src="http://i256.photobucket.com/albums/hh181/Mackglee87/Icons/nursingstress.jpg"></a>
Metabolic Alkalosis clinical disturbance characterized by a high pH (decreased H+ concentration)& a high plasma bicarbonate concentration.<center>----------------------</center>can be produced by a gain of bicarb. or a loss of H+
Most Common Cause of Metabolic Alkalosis? vomitting or gastric suction with loss of hydrogen and chloride ions.
Acidosis excess H+ ions (increased PaCO2)<center>OR</center>decrease in PaO2 level<center>_<center> </center>Results in decrease of blood pH</center>
Alkalosis Increase in PaCO <center>OR</center>Decrease in H+ ions (decrease in PaCO2)<center>_</center>**Results in increased pH
ROME Respiratory <center>Opposite</center>Metabolic<center>Equal</center>
Respiratory Acidosis pH down - PaCO2 up <center>See-Saw</center>
Treatments for respiratory acidosis ventalation, ventalation, ventalation!!!<center>-</center>bronchodialators, mucalytics, cough & deep breathing, **succtioning, mechanical breathing (last measure)
Respiratory Alkalosis pH up - CO2 down
Treatment for respiratory alkalosis paper bag breathing (retain and re-breathe CO2)
Metabolic Acidosis pH down - HCO3 down
Metabolic Alkalosis pH up - HCO3 up
Note** Bicarb not used in metabolic
The lungs compensate for metabolic disturbances by.. ? changing CO2 excretion.
The kidneys compensate for respiratory disturbances by... ? altering HCO3 retention in H+ secretion.
Fatal pH levels? death occurs if serum pH is less than 6.8 or higher then 7.8
Causes of resp. acidosis? * decreased depth & rate breathing <center>* decreased gas exchange</center>*obstruction of air passages<center>_ - _ - _ - _</center>All lead to accumulation of CO2
Causes of acid base disorders *Diabetic Ketoacidosis<center>*Excessive use of OTC indigestion products (met. alk)</center>*Anxiety attack with hyperventalation<center>*Respiratory suppression d/t Morphine (resp. acidosos)</center>
Physiological responses to acidosis *Cardiac- bradycardia, vfib, hyperkalemia, vasoconstriction<center>*Respiratory- decreased SaO2, increased RR d/t compensation</center>*Neurological- seizures, loss of consciousness
Physiologial responses to alkolosis *Cardiac- Tachycardia, Hypokalemia, Coronary artery spasm, Vasodialation<center>*Neurological- decreased cerebral blood flow</center>*Endocrine- Hypocalcemia
Hypoxic drive- If the PaCO2 exceeds 60mmHg.. ? peripheral chemoreceptors are not stimulated
Hypoxic drive note.. Always give low O2 until you know the pt is not retaining CO2.<center>* Empyema pts commonly known to retain CO2</center>
Tension Pneumothorax rapid accumulation of air in the pleural space which causes increase in pressure-leads to lung collapse. <center> Medical Emergency b/c causes decrease cardiac output which can lead to shock</center>
Hemothorax blood in pleural space d/t trauma
Pleural effusion excessive serus fluid in pleural space. <center>Treatment = plueralcentesis</center>
Empyema Pus in pleural space d/t infection.<center>Treatment = antibiotic thearpy, hymlic valve (1 way valve for drainage of pus)
Treatment for pneumo/hemothorax? closed drainage chest tube
Treatment for Pleural Effusion? Thorancentesis- removal of fl by aspiration, 1500ml or less removed to prevent hypotension, fl sent to lab, poss. complication= pneumothorax
What are the clinical manifestations of a PE? *Dyspnea & Tachypnea (most common S&S)<center>*Anxiety</center>*Chest Pain<center>*Tachcardia (compensation mech. get more O2 to tiss)</center>*Cough<center>*Hemoptosis(bld sputum)</center>
Diagnostic tests for PE? *Ultrasound (typically 1st test)<center>*Plasma D-dimer (fibrin lvl if elevated indicates PE)</center>*Lung Scan/VQ Scan (ventilation/perfusion testing)<center>Pulmonary Angiogram (100% certainty)</center>
Anticoagulation therapy VS. Thrombolytic therapy *Anticoag- Does NOT disolve clots (decreases formation of new clots)<center>*Thrombolytic- DOES dissolve clots (used for massive PE)</center>
Normal PT level? 11-15 seconds
Cystic Fibrosis inherited multi-system disease. Involves lungs, pancreas, & sweat glands. usually DX in childhood.
Clinical Manifestations of CF *Chronic cough<center>*Fatigue</center>*Clubbing of nailbeds (S&S long term hypoxia)<center>*Stetorrhea</center>*Infertile Men/Decreased Fertility in women
Treatment for CF Bronchodilators & CPT
Created by: lprovoost
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