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Intro to Respiratory Medicine > 121 Exam 1 > Flashcards

121 Exam 1 Flashcards

Week 1-4

1
Q

What does the “Rebreathing CO2” waveform look like and what are the likely causes

A

Normal height and length with a baseline not at zero.

Causes: Faulty expiratory valve, inadequate inspiratory flow, insufficient expiratory flow

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2
Q

What does the “Increase in ETCO2” waveform look like and what are the likely causes

A

Normal height increasing overtime, normal length.

Causes: Decreased RR, Decreased Tidal Volume, Increased metabolic rate, Rapid Rise in Body Temp

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3
Q

What does the “Low Perfusion” waveform look like

A

Shortened height, normal length

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4
Q

What does the “DKA” wave form look like

A

Fast RR, elevated Height

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5
Q

What does “COPD” wave form look like

A

Shark Fin but taller

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6
Q

What does “Asthma” waveform look like

A

Shark Fin

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7
Q

What does “Hyperventilation” waveform look like

A

Fast RR, shortened height and normal length

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8
Q

What does “Hypoventilation” waveform look like

A

Slow RR, tall height and
normal length

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9
Q

What is Plethysmography

A

Changes in Volume- specifically Blood Volume. Shown as a waveform

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10
Q

What is “PI”

A

Perfusion Index: Pulse strength in a value form. (.02%-20%. Anything under .4% considered inaccurate)

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11
Q

What are the 4 types of Hypoxia and what causes each?

A
  1. Hypoxic Hypoxia= Low O2 at the tissue due to low O2 in the arteries
  2. Anemic Hypoxia= Inadequate O2 carrying ability of Hgb. (Carboxyhemoglobin or Methemoglobin)
  3. Circulatory Hypoxia= Blood flow is inadequate. Low cardiac output, Shunting
  4. Histotoxic Hypoxia= Cells cannot use O2. Cyanide poisoning
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12
Q

Why do we have Metabolic Alkalosis

A

Bicarbonate Excess (greater than 24 meq/L)

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13
Q

What are some causes of Metabolic Alkalosis

A

Excessive vomiting,
Excessive use of alkaline drugs
Certain Diuretics
Endocrine disorders
Heavy ingestion of antacids
Severe Dehydration

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14
Q

Why do we have Metabolic Acidosis

A

Bicarbonate Deficit (less than 22 (meq/L)

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15
Q

What are the causes of Metabolic Acidosis

A

Diarrhea or renal function inadequate
lactic acid or Ketone buildup
Failure of kidneys to excrete Hydrogen Ions

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16
Q

Why do we have Respiratory Alkalosis

A

Alveolar Hyperventilation (Low CO2)

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17
Q

What are some causes of Respiratory Alkalosis

A

High Altitude O2 deficit
Pulmonary disease or CHF
Anxiety
Fever, Anemia
Asprin OD
Hypoxia
Cirrhosis
Gram Neg Sepsis
Pain
Brain Inflammation

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18
Q

Why do we have Respiratory Acidosis

A

Alveolar Hypoventilation (High CO2)

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19
Q

What are some causes of Respiratory Acidosis

A

ARDS
Pulmonary Edema
Pneumothorax
COPD
Drug OD
Generalized Anesthesia
Head Trauma
Neurological Disorders

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20
Q

What does Alkalosis cause within the body and what are some side effects

A

Over excitability of CNS and PNS (Speeds up brain)

Numbness
Lightheadedness
Nervousness
Muscle Spasms
Tetany
Loss of consciousness
Death

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21
Q

What does Acidosis cause within the body and what are some side effects

A

Depression of CNS (slows brain down)

Generalized weakness
Disorientation
Coma
Death

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22
Q

How does the body compensate for too much Acid or too much Base (3 ways)

A
  1. Buffer System: uses or releases H+ (hydrogen ions)
  2. Respiratory: Changes CO2 Levels
  3. Renal: can get rid of H+ or Bicarbonate
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23
Q

How long does each compensation system take (3 systems)

A
  1. Buffer- instantaneously
  2. Respiratory- Min to hours
  3. Renal- Hours to days
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24
Q

What are the 3 phases of analysis and what happens in each phase?

A
  1. Preanalytical: Before test is performed. Specimen handling, temp correction, calibration principles
  2. Analytical: During Testing. Specimen protocol, SOPs, Accept/Reject criteria, Quality Control
  3. Postanalytical: After test performed. Reporting Results. Critical Value Reporting, Quality Control analyzer performed, checking for errors.
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25
What chemistry Values are calculated (7)?
1. Hgb 2. Oxyhemoglobin 3. Dyshemoglobin 4. Hematocrit 5. Bicarbonate 6. O2 Content 7. Base Excess
26
Possible ABG Complications (12)
1. Artery spasms 2. Hematoma 3. Air or clotted emboli 4. Anaphylaxis 5. Pt or sample contamination 6. hemorrhage 7. Vessel trauma 8. Arterial occlusion 9. vasovagal response 10. Pain 11. handler infection 12. inappropriate Pt care
27
3 indications for an ABG
1. Evaluation of Pt's, Ventilation, acid base, oxygenation status and/or oxygen carrying capacity 2. Monitoring of disease severity and progression 3. Assessment of Pt response to therapeutic interventions or diagnostic tests
28
What Chemistries cause Cardiac Arrythmias (3)
Troponin 1 BNP (Brain Natriuretic Peptide) Potassium (K)
29
What chemistries are related to Renal Function (3)
BUN (Blood Urea Nitrogen) Creatinine (Cr) Lactate
30
What is Ca and it's normal range
Calcium 8.5-10.2 mg/dl
31
What is a Cation vs Anion
Cation is positively charged ions and Anions are negatively charged ions
32
What is Na? What is Na's normal Values?
Sodium 136-145
33
What causes High/Low Na
Hypernatremia= Dehydration Low= Excessive vomiting/Diarrhea
34
What is Cl? What is Cl's values
Chloride 98-107
35
What causes High/Low Cl?
Hyperchloremia= Kidney Failure, Diabetes, Diarrhea, Vomiting Hypochloremia= Prolonged vomiting and diarrhea
36
What is the Anion Gap, It's normal values and how do we determine the Anion Gap?
Tells us there are excessive unmeasured anions and identifies metabolic acidosis. Normals: 8-14 meq/l Na-CO2-Cl= Anion Gap
37
What is Total CO2 normal values (in vein)
Serum Carbon Dioxide Normals: 22-32
38
What are WBC's and their normal values?
White Blood Cells 4k-11k
39
What causes High/Low WBCs
High= Leukocytosis- Infection Low= Leukopenia- overwhelming infection of immunocompromised
40
What is Hct and what are the Normals?
Hematocrit 45% of formed elements specifically RBCs
41
What is Hgb and what is it's normals
Hemoglobin 12.5-15.5 g/dl
42
What causes High/Low Hgb
High=Polycythemia- too many RBCs. Makes blood thicker making it harder for heart to pump Low= Anemia- low O2 carrying capacity
43
What is BNP and it's normals
Brain Natriuretic Peptide <100
44
What does BNP come from and what happens?
Comes from Left Ventricle in Heart. BNP levels rise when there is damage to the Heart Tissue. It backs up fluid into the heart and ultimately into the lungs.
45
What is Glucose and it's normals
Sugar 70-139
46
What causes High/Low Glucose
High=Hyperglycemia- Diabetes or Sepsis Low=Hypoglycemia- Digestive issues, too much insulin or inadequate intake of carbs
47
What is Cr and it's Normals
Creatinine= Waste product related to Muscle activity .7-1.3
48
What causes High/Low Creatinine
High= Kidney's are not functioning properly Low= Low muscle mass
49
What is BUN and it's normals
Blood Urea Nitrogen 8-23
50
What is Easy Cap and where does it attach.
Determines the presence of CO2, attaches at the artificial airway
51
When is the Easy Cap sometimes used
During intubation
52
What do the Easy Cap colors represent
Purple= Problem Tan= Think Yellow= Yes!!!
53
What do the waveforms look like with the presence of Muscle relaxants
There will be a little divet or cleft area in the highest peak of the length. "Curare Cleft" The depth of the cleft is inversely proportional to the drug activity
54
What does a possible obstruction waveform look like. What do we need to Think of with an obstruction waveform?
Normal RR, Normal Height, Normal Length with a wonky shark fin THINK BRONCHOSPASM
55
What are the 4 waveform phases?
1. Deadspace Ventilation= Begining of exhalation, No CO2 present 2. B-C= CO2 is present and increasing 3. C-D= Mostly CO2, D= End of Exhalation, highest amount of CO2. End Tidal CO2 4. Descending Phase. D-E. Inhalation begins. CO2 quickly drops to Zero.
56
Name or Explain the parts of a normal ETCO2 waveform
Height= Amount of CO2 Length= Exhalation time Baseline should be at Zero A-B= Baseline B-C= Expiratory Upstroke C-D= Expiratory plateau D= End Tidal Concentration D-E= Inspiration
57
Mainstream Vs Sidestream ETCO2 monitoring
Mainstream= Sensor at the airway. Fast Response. Short Lag Time (Real Time reading). No Sample Removal Side stream= No Sensor at airway. Can measure N20. Disposable. Can use with non-intubated patients. Uses Sample Flow.
58
How close to PaCO2 values are ETCO2 values and why is there a difference?
3-5 mmHg less than PaCO2 Some CO2 is dropped off in blood and alveolar, the remaining CO2 is breathed out as ETCO2
59
Does ETCO2 measure Oxygenation or Ventilation?
Ventilation. It tells us the status of our breathing (too fast, too slow, too much, too little)
60
What is required for Insurance to cover O2 therapy?
A severe lung disease such as COPD, Cystic Fibrosis, Bronchiectasis, Widespread pulmonary neoplasm, Hypoxia
61
How does a pulse ox work? What affects a pulse ox validity?
2 lights pass through the tissue. 1 is LED absorbed by deoxygenated Hb and 2 is infrared absorbed by oxygenated Hb. Medical Dyes, Dark/Fake nails, Ambient light including sunlight, Excessive motion, Low perfusion
62
Hypoxemia vs Hypoxia and the normal values
Hypoxemia= Low O2 in the blood Hypoxia= Low O2 in the tissues Norm= 80-100 Mild= 60-79 Moderate= 40-59 Severe= <40
63
What is the Levey Jennigs Plots used for? What are the differences between trends and shifts What are lab limits set to?
Used to track quality performance Trend= Consistent pattern in values Shift/Drift= Sudden change in Values Lab limits are +/- 2 Standard Deviations
64
What is Precision vs. Accuracy
Precision= How close measured values are to each other Accuracy= How close measured values are to the true value
65
What values are measured by ABG
PH PCO2 PO2
66
What is the PH, CO2, O2 electrodes called
PH= Sanz CO2= Stowe-Severinghaus O2= Clark
67
Understanding the ABG Tic-Tac-Toe
PH 7.35-7.45 PCO2 (Respiratory) 45-35 HCO3 (Metabolic) 22-26 ACID<-------------->Base
68
ABG: When all 3 values are in either the Acidic column or the Base column what compensation is that?
Mixed
69
ABG: When either the PCO2 or the HCO3 are in the Normal Column what compensation is that?
Uncompensated
70
ABG: When PCO2 and HCO3 are in opposite columns what compensation is that?
Partially compensated
71
ABG: When PH is in the Normal column, what compensation is that?
Full Compensated
72
What are the Levels of Hypoxemia at Room Air (21%) What are the levels of Hypoxemia NOT at Room Air
Normal= 80-100 Mild= 60-79 Moderate= 40-59 Severe= <40 Less than 80= Uncorrected 80-100= Corrected 100+= Over corrected
73
What can Void an ABG Test?
Air Bubbles Improper anticoagulant and amount Improper Blood sample (vein instead of artery) Clots in Sample
74
What is the time-length of an ABG
15 minutes and 60 if Iced
75
Reasons we would NOT do an ABG
- Negative Allens test - Skin Lesions, surgical shunts, evidence of infection or peripheral vascular disease in selected limb - Outside the hospital - Clotting issues - Medium to High Dose of coagulants
76
How do you do an Allens Test
1. Compress both ulnar and radial arteries 2. Ask Pt. to make a fist a few times 3. Release the ulnar artery and watch for the palm of the hand to pink up This shows sufficient blood flow to the hand
77
Where is the most desired ABG site and why?
Radial Artery Close to the surface, collateral circulation, Easy to palpate and stabilize, not near any large veins
78
What are the 5 acceptable ABG sites
1. Radial 2. Brachial 3. Femoral 4. Posterior Tibial 5. Dorsalis Pedis
79
What test measures the ability to Clot
PT or PTT prothrombin time

Intro to Respiratory Medicine (10 decks)

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