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Study Guide Chp 1-5
Test Thursday 1/11/18
| Question | Answer |
|---|---|
| Patient Related Factors | 1) Preexisting, age, risk factors 2)Rapidity of onset 3) Type, stage, severity 4) Presence/absence of coexisting complications or drugs |
| Technical Factors | 1) Improper setup/maintenance 2) Poor/inconsistent technique 3) Defects in monitor/cables 4) malposition or occlusion of catheter tip 5) artifacts 6) pt-related factors |
| Appropriateness of Monitor and Labs | If pt looks "bad" despite "good" numbers, pt physiologic status is bad. Pt can also look "good" and have "bad" numbers due to acute problem. |
| Reliability of Monitor Alarm systems | Depends on limits set by caregivers & whether alarms are activated and functioning |
| Pressures are equal / no airflow | end expiration |
| Pressure in alveoli fall below atmospheric pressure / airflow In | Inspiration |
| Pressure in alveoli rise above atmospheric pressure/ airflow out | Expiration |
| Negative intrathoracic pressure brings in / positive pressure sends out | spontaneous breathing |
| Positive Pressure sends air in | Mechanical breathing |
| Increased PaCO2 will increase Rate & depth of breathing Decreased PaCO2 will decrease rate & depth of breathing | CNS Control of Breathing |
| Hypoxemia causes an increased rate & depth of breathing | PNS Control of Breathing |
| Other Factors that affect Mechanics of Ventilation | 1) Stretch receptors and sensory nerves in lungs effect ventilation 2) Muscle and joint movement, pain, strong emotions, fever & sepsis |
| Abnormalities in Ventilatory Control | Hypoxic ventilatory drive may become primary stimulus, esp in pts with COPD |
| CNS Disorders -- vascular | A stroke may cause damage to brainstem & cause chronic resp depression ie: cerebral vascular disease |
| CNS Disorders -- Brain | Acute increases in intracranial pressures cause alterations in rate & pattern of breathing ie: brain injury |
| Distribution | Delivery of fresh air from upper airway to alveoli |
| Upper airways | Nose, pharynx, and larynx |
| Lower airways | trachea, bronchi, bronchioles, and terminal bronchioles |
| Alveoli | Tiny air sacs |
| Anatomic Dead Space | Air that doesn't reach the alveoli |
| Alveolar Dead Space | Ventilation without perfusion |
| Physiologic Dead Space | total of anatomic and Alveolar dead space |
| Factors that interfere with Adequate gas distribution and WOB | 1) Decreased lung compliance (stiff) 2) Increased lung compliance (flabby) 3) Decreased chest wall compliance (rigid) 4) Increased RAW 5) Artificial airways |
| Diffusion | Transfer of O2 and CO2 between alveoli, plasma, and tissue |
| Factors that determine rate of gaseous diffusion | 1) Diffusion coefficient 2)Membrane surface area 3) Membrane thickness 4) Diffusion of resp gases in lungs & tissue level |
| Perfusion and Transport | Means by which venous blood is brought to the AC membrane for oxygenation, CO2 removal, sustenance of lung tissue, & dlvy to left side of heart for transport to body cells |
| Increased PVR (pulmonary vascular resistance) | Pulmonary arterial pressures & ventricular systolic work increases |
| Decreased PVR (pulmonary vascular resistance) | Right ventricular systolic work & O2 demand decreases |
| Pulmonary Vasoactive Agents | A. Vasoconstrictors = 1) Epinephrine & 2) Norepinephrine B. Vasodilators = 1) Isoproterenol 2) Diltiazem |
| PVR means | Pulmonary Vascular Resistance |
| Causes of V/Q Mismatch | 1) Shunting (absolute & relative) 2) Hypoventilation 3) Alveolar Dead Space 4) Silent Units |
| Silent Units | No ventilation or perfusion |
| How the body compensates for V/Q mismatches | 1) Poorly ventilated alveoli tend to be under perfused 2) Poorly perfused alveoli tend to be under ventilated |
| Two ways Oxygenated blood is transported to body tissue | 1) Dissolved in plasma or 2) bound to Hb |
| Factors that affect the affinity of Hb to O2 | PO2, Body Temperature, Quantity of 2,3 DPG, ph & PCO2 |
| If PaO2 is elevated, Hb has a(n) ____________ affinity for O2 | Increased |
| If PaO2 is low, Hb has a (n) ____________ affinity for O2 | Decreased |
| Hypercarbia | High CO2 |
| Hypocarbia | Low CO2 |
| Acidemia and hypercarbia do what to Hb affinity for O2? | Decrease |
| Alkalemia and hypocarbia do what to Hb affinity for O2? | Increase |
| Monitors are only _____________ to patient evaluation | adjuncts |
| _____________ conditions for accurate physical assessment | Optimize |
| Assessment ________________ and specific assessment ____________ are to be determined by the pts known or suspected problems | Frequency -- with which assessment needs to be done Techniques -- those that are key and those that aren't |
| ______________ of certain assessment findings are patient dependent | Characteristics |
| General considerations under physical assessment | Transcultural considerations |
| Evaluation of symptoms of pulmonary disease | Cough, Dyspnea, and chest pain |
| Signs of pulmonary disease | 1) pt mentation 2) abnormalities in RR 3) abnormal breathing patterns 4) characteristics of breathing 5)Entirely thoracic breathing 6) Entirely abdominal breathing 7) Abnormal resp cycles 8) Stridor |
| Abnormalities in Respiratory Rate | 1) Tachypnea & 2) Bradypnea |
| Abnormalities in Characteristics of Breathing | 1) asymmetry of movement between both sides of chest 2) asymmetry of movement between chest & abdomen |
| Entirely thoracic breathing | Indicates that diaphragmatic movement is restricted |
| Entirely abdominal breathing | Indicates paralysis of intercostal muscles |
| Abnormalities relative to phases of respiratory cycle | 1) Labored inspiration (retractions & nasal flaring) 2) Labored expiration (using accessory muscles, prolonged, purse lip breathing, or grunting) |
| Other signs of Pulmonary Disease | 1) Cyanosis 2) pitting & edema 3) Subcutaneous emphysema 4) Pt posture 5) Pleural friction rub |
| Types of Cyanosis | 1) Central 2) Peripheral 3) Mixed 4) Differential |
| Central Cyanosis | Around the core, lips & tongue |
| Peripheral Cyanosis | Extremities and fingers; hypothermia |
| Mixed Cyanosis | Combination of central and peripheral cyanosis. |
| Differential Cyanosis | Coloration of lower but not upper part of head. |
| Specific Techniques of physical assessment | A. Tracheal position; 1)Tension pneumothorax, 2)atelectasis, 3)percussion B. 1)Resonance, 2)Hyperresonance, 3)Tympany, 4)Dullness C. Auscultation |
| Structures of Heart Wall | Pericardium, Myocardium, Endocardium |
| Cardiac Chambers | 1) Atria; upper right and left 2) Ventricles; lower right and left |
| Cardiac Valves | 1) Semilunar -- aortic & pulmonary 2) Atrioventricular -- Mitral & Tricuspid |
| Preload -- determines CO | Amount of stretch on myocardial muscle fibers at end diastole; determined by volume of blood in ventricles at that time |
| Afterload -- determines CO | Sum of forces against which the ventricular muscle fibers must shorten to eject blood into arterial circulation. |
| Left Ventricular Afterload | Imposed by aortic diastolic pressure and SVR |
| Right Ventricular Afterload | Imposed by pulmonary artery diastolic pressure and SVR |
| SVR | Systemic Vascular Resistance |
| Contractility -- determines CO | Force and velocity of myocardial fiber shortening independent of preload & afterload. Inotropic stimuli will increase or decrease strength of contraction. |
| Muscular Synergy - determines CO | Pattern of ventricular contractile dynamics. |
| Coronary Circulation | Supplies blood in the sinus node, AV node, and initial portion of Bundle of HIS |
| Left Main Coronary Artery (2) | 1) LAD (Left Anterior Descending branch) 2) Circumflex branch |
| Physical factors that determine coronary blood flow | 1) Coronary perfusion pressure 2) coronary vascular resistance |
| Factors that may globally or locally decrease coronary blood flow | 1) physical obstruction/narrowing of lumen 2) decrease in aortic diastolic pressure or significant increase in right atrial pressure |
| Ventricular Wall _____________ will proportionately affect myocardial work | Tension = determined by afterload and ventricular size |
| Myocardial ______________ will proportionately affect myocardial work | Contractility = determined by inotropic stimuli |
| ___________ rate will proportionately affect myocardial work | Heart |
| Normal systemic circulation pressure gradient | 90 mm Hg to drive systemic blood flow |
| Normal Pulmonary circulation pressure gradient | 8 mm Hg to drive pulmonary blood flow |
| Vascular System rate and volume of blood flow is determined by | 1) Inflow vs. outflow pressure difference (gradient) 2) The resistance to blood flow |
| Components of Vascular system | 1) Systemic Vessels 2) pressure by blood on arterial walls 3) blood pressure 4) Arterial Pressure 5) anything influencing systolic and diastolic pressures |
| 3 types of systemic vessels | Systemic arteries, systemic capillaries, systemic veins |
| 3 controllers of blood pressure | Arterial baroreceptors, chemoreceptors, strong emotional stimuli |
| 2 components of arterial pressure | 1) systolic pressure 2) diastolic pressure |
| Systolic pressure | The higher pressure that relates to contraction of ventricles and ejection of a bolus of blood into arterial system |
| Diastolic pressure | The lower pressure that relates to relaxation and runoff of blood through the vascular system |
| Factors influencing systolic and diastolic pressures | 1) Stroke volume 2) Vascular resistance 3)Heart rate 4) Intravascular volume |
| Symptoms of Cardiovascular disease | Chest pain, Dyspnea, Weakness, and fatigue |
| Signs of Cardiovascular disease | 1) Changes in mentation 2) Changes in skin color and temp 3) Cyanosis 4) Urine output |
| Specific Techniques of Physical Assessment | 1) Evaluate HR and rhythm (repeatability & regularity) 2) Evaluate arterial pressure (time doman & frequency) |
| O2 Consumption | `VO2 = `QT [C(a-v)O2 x 10] |
| Total O2 Delivery (amount of O2 transported to tissues) | DO2 = `QT x (CaO2 x 10) |
| O2 Content Arterial | CaO2 = (Hb x 1.34 x SaO2) + (PaO2 x .003) |
| O2 Content Mixed Venous | CvO2 = (Hb x 1.34 x SvO2) + (PvO2 x .003) |
| O2 Content Pulmonary Capillary | CcO2 = (Hb x 1.34) + (PAO2 x .003) |
| A-a gradient or Ideal Alveolar Air Equation | PAO2 = [PB - PH2O] FiO2 - PaCO2 (1.25) If all is normal PAO2 = (713 x FiO2) - (PaCO2 x 1.25) |
| Cardiac Output | CO = SV x HR |
| Blood pressure | BP = CO x SVR (Systemic Vascular Resistance) |
| Vascular Resistance | SVR = BP/CO |
| O2 Bound to Hb | 1.34 x Hb x SaO2 |
| Dissolved O2 | PaO2 x 0.003 |
| Arterial - Venous O2 Content Difference | C (a-v)O2 = CaO2 - CvO2 |
| O2 Extraction Ratio | O2ER = CaO2 - CvO2 / CaO2 |
| Shunt Equation | Qs/Qt = CcO2 - CaO2 / CcO2 - CvO2 |
| Semilunar Heart Valves | Aortic & Pulmonary Systole = open ; Diastole = closed |
| Atrioventricular Heart Valves | Mitral & Tricuspid Systole = closed ; Diastole = open |
| Vasoconstrictors (drugs) | Epinephrine and Norepinephrine |
| Vasodilators (drugs) | Isoproterenol and Diltiazem |
| Hypoxia (PVR) | Stimulates vasoconstriction and increases PVR |
| Acidemia (PVR) | Stimulates vasoconstriction and increases PVR |
| Atelectasis (PVR) | May increase PVR |
| Increased pulmonary blood flow (PVR) | decreases PVR (unless it's a great amt of blood flow) |
| Increased pulmonary venous & left atrial pressures | PVR response varies; depends on complications & underlying condition(s) |
| Vascular Obstruction | Massive blockage will increase PVR ie. PE/Tumor |
| Common Therapeutic Interventions for Hypothermia | Remove wet clothing, provide dry clothing, place pt in warm area, cover pt with warm blankets, apply warming pads, keep pts limbs close to body, cover pts head with a cap or towel, supply warm oral or iv fluids |
| Cyanosis is a result of | decreased V/Q ratio, pulmonary shunting, venous admixture, and hypoxemia |
Created by:
Beccaboop
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