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NRNP 6566 Week 6 and seven key concepts WIT COMPLETE ANSWERS
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EUNICENRNP 6566 Week 6 and seven key concepts WITH 100%
SURE ANSWERS
Terms in this set (119)
Diagnostic criteria and treatment for 1. Arterial blood gas analysis a. Acute respiratory alkalosis b. Variable degrees of
pulmonary embolism, hypoxemia
4. Ventilation/perfusion lung scan a. If read
as high probability for PE, treat with
anticoagulants b. If read as indeterminate
or low probability for PE and clinical
suspicion remains high, consider pulmonary
angiography
c. If the chest X-ray is abnormal, or if COPD
is present, lung scanning may lead to an
erroneous interpretation. Consider CTA.
5. Pulmonary angiography remains the
accepted gold standard for detecting the
presence of pulmonary emboli.
6. Venous Doppler studies of the lower
extremities may reveal the presence of
deep venous thrombosis, which requires
anticoagulation, in part obviating the need
for evaluation of PE.
Interpret arterial blood gases (ABG). METABOLIC ACIDOSIS ;Nonventilatory process that increases [H+]; pH < 7.35 1.
Differentiate alkalosis/ acidosis and Identified by a decrease in [HCO3 -] < 22 mEq/L Respiratory alkalosis (decreased
respiratory / metabolic pCO2) may be seen as compensating process
Normal AG metabolic acidosis < 12 mEq/L HCO3- loss, or H+ plus Cl− gain
Indicates primary
High AG metabolic acidosis AG > 15 mEq/L NaHCO3 therapy intravenous NaHCO3 infusion controversial Rarely indicated when
Management pH is 7.10 or greater
1/8
, stop or limit G.I. Carbonate losses.
Consider Methanol or ethylene glycol aspirin poisoning an alcoholic ketosis
High AG metabolic acidosis AG > 15 mEq/L
DKA intravenous normal Saline and insulin infusions
Management treatment
Lactic acid maintain tissue perfusion normal salinee is more effective than normal Na
plus bicarb
Discontinued diuretics
Infuse normal Saline at 100 to 150 an hour
Metabolic alkalosis increase of HCO3
Replace potassium if needed
exceeding 28 and respiratory acidosis may
Acetazolamide for volume expansion states or post mechanical ventilation
be a compensating process
If caused by excess aldosterone use sprinalactone or eplerenone
Hemodialysis low bicarb bath
Assist with ventilation
Nalaxone for opioid overdose
Respiratory acidosis carbon dioxide
FLumazenil for Benzo overdose
greater than 45
Avoid sedatives or excess oxygen therapy that can promote respiratory depression
Nocturnal continuous positive airway pressure
Respiratory alkalosis carbon dioxide less Treat the underlying causes
than 35 metabolic acidosis may be seen as Re-breathing to a paper bag or a disconnected oxygen mask for an acute process
a compensating process chronic generally nothing required
For hypoxemia when ventilation appears unlabored and sustainable 1. Supplemental
V/Q mismatching, when ventilation and oxygen via mask or nasal cannula
perfusion are not equally matched, such as For hypoxemia and hypercapnia in an alert patient with increased work of breathing
in the setting of atelectasis, airway 1. Consider escalation to positive pressure treatment modalities.
obstruction, pneumonia Humidified high-flow oxygen therapy: mask free noninvasive positive pressure
ventilation (i.e., Vapotherm, Opiflow)
Noninvasive continuous positive airway Primarily for those with hypoxemia alone (i.e., congestive heart failure exacerbation)
pressure (CPAP).
Noninvasive bilevel positive airway Primarily for those with hypoxemia and hypercapnia (i.e., COPD exacerbation)
pressure (BiPAP).
1. Elevation of head of bed and frequent position changes 2. Chest physiotherapy 3.
For Type 3 Respiratory Failure
Control of surgical site pain 4. Noninvasive positive pressure ventilation
For Type 4 Respiratory Failure 1. Intubation and mechanical ventilation
E. For hypoxemia or hypercapnia in a 1. Intubation and conventional mechanical ventilation 2. Nonconventional mechanical
somnolent/unresponsive patient or when ventilation (e.g., pressure control, airway pressure release ventilation [APRV] and
work of breathing is increased and high frequency oscillatory ventilation [HFOV])
ventilation is decreased
3. Ventilatory strategies: partial liquid ventilation (PLV) and extracorporeal membrane oxygenation (ECMO)
PAO2 − PaO2 4. Formula to calculate PAO2 PAO2 = [FIO2 x (Pb - PH2 O) - [PaCO2
Be able to calculate an Aa gradient. 0.8 (respiratory quotient)] FIO2 = Fraction of inspired oxygen: 21%-100% Pb =
Barometric pressure: 760 mmHg (at sea level) PH2O = Water vapor pressure:
47 mmHg PaO2 = [0.21 × (760 − 47)] − (40 0.8) PaO2 = 0.21 × 713 − 50 PaO2 = 100 mmHg
A-a gradient OR AaDO2 values Normal PaO2 = 60-100 mmHg The increased gradient indicates a higher oxygen
demand the typical gradient for a 40-year-old man is 14
a patient breathing hard to achieve normal oxygenation, a patient breathing normally
An elevated A-a gradient could indicate and attaining low oxygenation, or a patient breathing hard and still failing to achieve
normal oxygenation
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