Ch. 10 Specialized Test Regimen Flashcards
Who are some candidates for exercise testing?
• Normal PFT but has SOB on exertion
• Other tests (such as metacholine and histamine challenge) were normal but pt is symptomatic
• Evaluating therapy is know EIA
Exercise challenge:
Do not repeat test for at least _____ hrs.
4
Exercise testing:
Be prepared to reverse ________.
Bronchospasm
What do you need for pre-test prep?
• history and physical
• EKG
• No bronchodilator prior to test
• FEV1 should be no less than 65% of predicted
• no vigorous exercise for 4 hours prior
• no respiratory infection 3-6 weeks prior
Testing:
Workload should be _________of max heart rate for _______.
80-90%; 4-6mins
Testing:
_______ or _______can be used
Treadmill or cycle
Testing:
_______ of low intensity workload (observe pt for changes)
1-2mins
What do you monitor during and after testing?
• BP
• HR
• SpO2
• EKG
During and after test:
FEV1 has to be ______ & _______ and within ______ of each other.
Repeatable; acceptable; 5%
Positive exercise challenge test:
Dec of _____ FEV1 is consistent with airway hyperactivity?
10-15%
Positive exercise testing:
In healthy pt exercise will _____ FEV1?
Increase
Eucapnic Voluntary Hypoventilation:
______ is added to prevent hyperventilation. We are creating CO2 _____.
CO2; narcosis
Performing test:
Baseline spirometry is performed with ______?
MVV
Performing test:
Mixture of air is passed over a heat exchanger or cooling coil to chill air to ______ to _______ degrees Celsius.
-10 to -20
Performing test:
Ensure patient has had no ______ prior to testing. We are trying to _______ ________.
Bronchodilator; invoke bronchospasm
Cold air method:
CO2 is added to prevent _______ and maintain ______.
Hyperventilation; pH
Cold air method:
Pt must ventilate at _______ of MVV for _______.
60-85%; 4-6min
Results:
In a healthy pt EVH will usually cause ______ not bronchospasm.
Bronchodilation
Results:
You will know it has reactive airway if there is a _____ decrease in FEV1.
10%
Results:
After last spirometry is performed results should be reversed with ______?
Bronchodilator
Enabled notices oxide (ENO):
Measures _______ in the lungs.
Inflammation
Enabled notices oxide (ENO):
Specifically _________ inflammation typical with ______& ________ pts
Eosinophilic; asthma; COPD
Enabled notices oxide (ENO):
Smoking causes a ______ ENO?
Decreased
What should pt not do before test?
• no smoking for 1hr
• no eating or drinking few hrs before
• perform before all other tests
• record pt meds and current health status
remember ICS decreases inflammation
How to measure ENO?
• online sample exhaled gas continuously at the mouth (most common)
• offline measures collected gas in a sampling device
How does online measuring work for ENO?
• Pt inhales through a nitric oxide scrubber
• exhale to RV
• inspires to 2-3 sec to TLC
• Gas is exhaled and samples continuously to prevent nasal irritation
• No contamination
• No nose clip needed
Online measuring ENO:
Exhalation is against ______ exhaled gas should be at ________ ?
+5cmH2O; 0.05L/sec
Online measuring ENO:
Must measure long enough to give a plateau. What at the plateau for children?
• 12 yrs and older > 6sec
• Under 12 years > 4sec
Online measuring ENO:
Must have at least _____ acceptable and replicable test within ______ of each other then average them.
2;20%
Offline measuring ENO:
• sample is collected in balloon
• analysis will take place within 12 hrs
• pt inhales into TLC through NO scrubber or from reservoir of NO free gas
• pt exhales RV into sampling device where resistance is added
Nasal nitric oxide (NO)
• Air is aspirated into one side of the nose and out of the other
• Against 10cmH2O resistance
• Plateau achieved in 20-30 sec
• Nasal values are typically higher than exhaled values (epithelial cells)
• Sample is taken value and flow are recorded
If levels are elevated above the norm think suspect _______ or ________
Eosinophilic inflammation of airways; alveolitis
What are the normal FENO levels for adults and children?
Adults: 10-35ppb
Children: 5-25ppb
The numbers are good for monitoring _______?
Therapy
