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Intro to Respiratory Medicine > Cardiopulmonary Diagnostics - 121 Exam 1 > Flashcards

Cardiopulmonary Diagnostics - 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
Q

What chemistry Values are calculated (7)?

A
  1. Hgb
  2. Oxyhemoglobin
  3. Dyshemoglobin
  4. Hematocrit
  5. Bicarbonate
  6. O2 Content
  7. Base Excess
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26
Q

Possible ABG Complications (12)

A
  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
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27
Q

3 indications for an ABG

A
  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
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28
Q

What Chemistries cause Cardiac Arrythmias (3)

A

Troponin 1
BNP (Brain Natriuretic Peptide)
Potassium (K)

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29
Q

What chemistries are related to Renal Function (3)

A

BUN (Blood Urea Nitrogen)
Creatinine (Cr)
Lactate

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30
Q

What is Ca and it’s normal range

A

Calcium
8.5-10.2 mg/dl

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31
Q

What is a Cation vs Anion

A

Cation is positively charged ions and Anions are negatively charged ions

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32
Q

What is Na?
What is Na’s normal Values?

A

Sodium
136-145

33
Q

What causes High/Low Na

A

Hypernatremia= Dehydration

Low= Excessive vomiting/Diarrhea

34
Q

What is Cl?
What is Cl’s values

A

Chloride
98-107

35
Q

What causes High/Low Cl?

A

Hyperchloremia= Kidney Failure, Diabetes, Diarrhea, Vomiting

Hypochloremia= Prolonged vomiting and diarrhea

36
Q

What is the Anion Gap, It’s normal values and how do we determine the Anion Gap?

A

Tells us there are excessive unmeasured anions and identifies metabolic acidosis.

Normals: 8-14 meq/l

Na-CO2-Cl= Anion Gap

37
Q

What is Total CO2 normal values (in vein)

A

Serum Carbon Dioxide

Normals: 22-32

38
Q

What are WBC’s and their normal values?

A

White Blood Cells
4k-11k

39
Q

What causes High/Low WBCs

A

High= Leukocytosis- Infection
Low= Leukopenia- overwhelming infection of immunocompromised

40
Q

What is Hct and what are the Normals?

A

Hematocrit
45% of formed elements specifically RBCs

41
Q

What is Hgb and what is it’s normals

A

Hemoglobin
12.5-15.5 g/dl

42
Q

What causes High/Low Hgb

A

High=Polycythemia- too many RBCs. Makes blood thicker making it harder for heart to pump
Low= Anemia- low O2 carrying capacity

43
Q

What is BNP and it’s normals

A

Brain Natriuretic Peptide
<100

44
Q

What does BNP come from and what happens?

A

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
Q

What is Glucose and it’s normals

A

Sugar
70-139

46
Q

What causes High/Low Glucose

A

High=Hyperglycemia- Diabetes or Sepsis
Low=Hypoglycemia- Digestive issues, too much insulin or inadequate intake of carbs

47
Q

What is Cr and it’s Normals

A

Creatinine= Waste product related to Muscle activity
.7-1.3

48
Q

What causes High/Low Creatinine

A

High= Kidney’s are not functioning properly

Low= Low muscle mass

49
Q

What is BUN and it’s normals

A

Blood Urea Nitrogen
8-23

50
Q

What is Easy Cap and where does it attach.

A

Determines the presence of CO2, attaches at the artificial airway

51
Q

When is the Easy Cap sometimes used

A

During intubation

52
Q

What do the Easy Cap colors represent

A

Purple= Problem
Tan= Think
Yellow= Yes!!!

53
Q

What do the waveforms look like with the presence of Muscle relaxants

A

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
Q

What does a possible obstruction waveform look like. What do we need to Think of with an obstruction waveform?

A

Normal RR, Normal Height, Normal Length with a wonky shark fin

THINK BRONCHOSPASM

55
Q

What are the 4 waveform phases?

A
  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
Q

Name or Explain the parts of a normal ETCO2 waveform

A

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
Q

Mainstream Vs Sidestream ETCO2 monitoring

A

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
Q

How close to PaCO2 values are ETCO2 values and why is there a difference?

A

3-5 mmHg less than PaCO2

Some CO2 is dropped off in blood and alveolar, the remaining CO2 is breathed out as ETCO2

59
Q

Does ETCO2 measure Oxygenation or Ventilation?

A

Ventilation. It tells us the status of our breathing (too fast, too slow, too much, too little)

60
Q

What is required for Insurance to cover O2 therapy?

A

A severe lung disease such as COPD, Cystic Fibrosis, Bronchiectasis, Widespread pulmonary neoplasm, Hypoxia

61
Q

How does a pulse ox work? What affects a pulse ox validity?

A

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
Q

Hypoxemia vs Hypoxia and the normal values

A

Hypoxemia= Low O2 in the blood

Hypoxia= Low O2 in the tissues

Norm= 80-100
Mild= 60-79
Moderate= 40-59
Severe= <40

63
Q

What is the Levey Jennigs Plots used for?

What are the differences between trends and shifts

What are lab limits set to?

A

Used to track quality performance

Trend= Consistent pattern in values

Shift/Drift= Sudden change in Values

Lab limits are +/- 2 Standard Deviations

64
Q

What is Precision vs. Accuracy

A

Precision= How close measured values are to each other

Accuracy= How close measured values are to the true value

65
Q

What values are measured by ABG

66
Q

What is the PH, CO2, O2 electrodes called

A

PH= Sanz
CO2= Stowe-Severinghaus
O2= Clark

67
Q

Understanding the ABG Tic-Tac-Toe

A

PH 7.35-7.45
PCO2 (Respiratory) 45-35
HCO3 (Metabolic) 22-26

ACID<————–>Base

68
Q

ABG: When all 3 values are in either the Acidic column or the Base column what compensation is that?

69
Q

ABG: When either the PCO2 or the HCO3 are in the Normal Column what compensation is that?

A

Uncompensated

70
Q

ABG: When PCO2 and HCO3 are in opposite columns what compensation is that?

A

Partially compensated

71
Q

ABG: When PH is in the Normal column, what compensation is that?

A

Full Compensated

72
Q

What are the Levels of Hypoxemia at Room Air (21%)

What are the levels of Hypoxemia NOT at Room Air

A

Normal= 80-100
Mild= 60-79
Moderate= 40-59
Severe= <40

Less than 80= Uncorrected
80-100= Corrected
100+= Over corrected

73
Q

What can Void an ABG Test?

A

Air Bubbles
Improper anticoagulant and amount
Improper Blood sample (vein instead of artery)
Clots in Sample

74
Q

What is the time-length of an ABG

A

15 minutes and 60 if Iced

75
Q

Reasons we would NOT do an ABG

A
  • 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
Q

How do you do an Allens Test

A
  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
Q

Where is the most desired ABG site and why?

A

Radial Artery
Close to the surface, collateral circulation, Easy to palpate and stabilize, not near any large veins

78
Q

What are the 5 acceptable ABG sites

A
  1. Radial
  2. Brachial
  3. Femoral
  4. Posterior Tibial
  5. Dorsalis Pedis
79
Q

What test measures the ability to Clot

A

PT or PTT
prothrombin time

Intro to Respiratory Medicine (6 decks)

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