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NPS Kettering Workbook > Diagnostic Testing > Flashcards

Diagnostic Testing Flashcards

1
Q

Full formula for PAO2

A

(PB-PH2O)FiO2 - PaCO2/0.8

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2
Q

PAO2 shortcut

A

(FiO2x7) - (PaCO2+10)

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3
Q

Clinical shunt shortcut

A

5% baseline, add 5% per 100 torr of A-a gradient

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4
Q

Four pulmonary disorders that could increase shunt

A

Atelectasis, pneumonia, pulmonary edema, ARDS

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5
Q

Oxygenation index formula

A

(PawxFiO2 / PaO2) x 100

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6
Q

Acceptable range of accuracy for 3L syringe

A

+/- 3.5%, 2.895-3.105

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7
Q

What device is used to calibrate an instrument which measures flow

A

Rotameter

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8
Q

At what age can a child perform basic spirometry?

A

5 and up

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9
Q

What is the single most important spirometry test and how long must the procedure be sustained for a while who is less than ten? Older than 10?

A

FVC/FEV1
3 seconds
6 seconds

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10
Q

What is the best test to evaluate volume? What type of disorder does it evaluate?

A

Vital capacity, restrictive

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11
Q

What is the best test to evaluate flow rates? What type of disorder does it evaluate?

A

FEV1, obstructive

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12
Q

Why is a pre and post bronchodilator study done? How much change in the FEV1 is considered significant?

A

Evaluate reversibility, 12%

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13
Q

3 obstructive and 2 restrictive diseases found in children

A

Obstructive: asthma, CF, bronchitis
Restrictive: pulmonary fibrosis, skeletal deformities

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14
Q

When determining a child’s personal best peak flow measurement, when should they record their peak flow?

A

Record peak flow BID, for 2-3 weeks, during a period when asthma is under control. Then pick single highest measurement.

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15
Q

How many times should the peak flow maneuver be performed in one sitting?

A

3x

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16
Q

What value should be recorded after a child performs peak flow maneuvers

A

Highest of the three numbers

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17
Q

What negates a positive bronchial provocation test?

A

20% decrease in FEV1

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18
Q

What value for MIP indicates respiratory muscle weakness?

A

<20

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19
Q

What value for MEP indicates inability to clear airway secretions?

A

<40

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20
Q

What two parameters are measured by pulse ox?

A

Spo2 and HR

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21
Q

Normal range SpO2 for newborns?

A

90-95%

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22
Q

Normal range SpO2 for children?

A

93-97%

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23
Q

What factors effect accuracy of pulse ox?

A

Perfusion, nail polish, hypotension, erythema

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24
Q

Primary co-oximeter indication

A

Detect COHb

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25
Q

Normal range for COHb

A

1-3%

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26
Q

What value of COHb indicates carbon monoxide poisoning?

A

> 20%

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27
Q

What parameter is measured by cerebral oximetry?

A

Tissue oxygenation

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28
Q

Where are the sensors placed to monitor cerebral tissue oxygenation?

A

Forehead

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29
Q

Where in the patient circuit should capnograpy sensor be placed?

A

Proximal to ETT

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30
Q

What is the effect of moisture or secretions on ETCO2 sensor?

A

False low readings

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31
Q

What is indicated by an increase in the capnograph reading?

A

Decrease in ventilation

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32
Q

What is indicated by a decrease in capnograph reading?

A

Increase in ventilation, and a decrease in perfusion (dead space, PE, etc)

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33
Q

What is the significance of continuous low readings following intubation?

A

Tube in esophagus

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34
Q

What do transcutaneous monitors measure?

A

PO2 and PCO2

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35
Q

What two advantages do transcutaneous monitors have over ABGs?

A

Non-invasive, continuous

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36
Q

Why is the skin around heated? And to what temp?

A

Improves capillary blood flow (perfusion), 41-44C

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37
Q

What conditions would diminish the accuracy of the transcutaneous monitor?

A

Skin thickness, anemia, shock, burns, vascular disease, cardiac defects

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38
Q

Where is the transcutaneous electrode placed?

A

Flat areas with good perfusion (chest, abdomen, thighs, back), no bony areas, large vessels, or extremities

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39
Q

How often should the transcutaneous electrode site be changed?

A

4-12 hours, otherwise erythema develops

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40
Q

Describe how a transcutaneous monitor is calibrated

A

With room air and a zeroing solution

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41
Q

Describe how a transcutaneous monitor can be used to detect the presence of a R to L shunt

A

Pre- and post ductal, reads at least 15 higher on pre

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42
Q

POC test time

A

90 seconds

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43
Q

3 methods to obtain ABG

A

Umbilical arterial line
Arterialized capillary sample
Peripheral artery puncture

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44
Q

When placing an umbilical artery Lin, what size catheter should be used for a newborn <1500g? >1500g?

A

3.5Fr, 5Fr

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45
Q

Briefly describe how to draw a sample from an umbilical artery line

A

Insert catheter into the umbilical artery at the cut end of the umbilical cord

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46
Q

Why should the heel not be squeezed when obtaining a capillary blood sample?

A

It will alter results and damage heel

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47
Q

What value from the capillary sample will not correlate well with actual arterial blood gas values?

A

PO2

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48
Q

What needle size should be used for a peripheral artery puncture?

A

25 gauge

49
Q

For what period of time should the puncture site be compressed following the procedure

A

5 minutes

50
Q

What is the important concern when performing peripheral artery puncture?

A

Stimulation of child effecting result

51
Q

What sample size should be obtained from an umbilical or peripheral artery?

A

1.25-2mL

52
Q

Newborn ABG ranges

A

PH: 7.25-7.35
CO2: 45-55
PaO2: 50-70

53
Q

Infant ABG ranges

A

PH: 7.34-7.46
CO2: 30-45
PaO2: 85-100

54
Q

What is different about a premature infants ABG?

A

Higher CO2, lower pH (50-55, 7.33)

55
Q

What two values from an ABG will assess the oxygenation status of a pt?

A

PaO2 and FiO2

56
Q

What three possible problems could cause hypoxemia?

A

Poor ventilation
V/Q mismatch
Shunting

57
Q

V/Q mismatch responds to what tx?

A

Oxygen

58
Q

Pneuomogram

A

12-24 hr continuous recording of respiratory movement, HR, SpO2, and nasal air flow

59
Q

Polysomnogram

A

Monitors sleep stages via EEG, respiration, ECG rhythm, muscle activity, gas exchange, and snoring data

60
Q

When would periods of apnea be considered abnormal?

A

Longer than 20 seconds for infants, longer than 10 seconds in children

61
Q

Three types of apnea

A

Central, obstructive, combined

62
Q

Which type of apnea is common in older children?

A

Obstructive

63
Q

Describe how to diagnose obstructive sleep apnea

A

Nasal air flow stops but chest motion continues or increases

64
Q

What is the correct interpretation of an apnea-hypopnea index of 26?

A

Moderate (16-30)

65
Q

What is the correct interpretation of a respiratory disturbance index of 16 for a 15 y/o?

A

Moderate (15-30)

66
Q

RBI of 8 in <12 y/o?

A

Moderate (5-10)

67
Q

List five ways apnea can be treated

A

CPAP/BiPAP
Weight loss
Trach
Tonsillectomy/adenoidectomy
Drugs: caffeine, resp stimulant, theophylline

68
Q

What factors would indicate that an infant is at risk for SIDS?

A

SIDS sibling
One or more apparent life threatening episodes (ALTE)
Preterm infant with significant apnea episodes
Snoring in infants

69
Q

What are indications for apnea monitoring?

A

Infants who may be at risk for significant apnea (>20sec) or bradycardia (<80bpm)

70
Q

Under what condition is it safe to d/c apnea monitoring?

A

2 mos free of events
No monitor alarms on apnea settings >20 seconds and bradycardia <60
After asymptomatic period when infant received DPT immunization and experienced nasopharyngitis without recurrence of symptoms
Follow up pneumogram is Normal

71
Q

Send baby home with apnea monitor after parents learn

A

CPR

72
Q

What two life functions are monitored with hemodynamics?

A

Circulation and perfusion

73
Q

At what age can a PAC be placed in a child?

A

8-9 y/o

74
Q

What is the primary cause of bradycardia in an infant?

A

Hypoxemia

75
Q

What is the primary cause of tachycardia in children?

A

Hypoxemia

76
Q

How can the quality of the cardiac monitor tracing be improved?

A

Clean skin with alcohol prior to placement

77
Q

How is blood pressure best measured?

A

Indwelling arterial catheter and pressure transducer

78
Q

What factors will increase blood pressure?

A

Stress, hypoxia, sepsis

79
Q

What factors will decrease blood pressure?

A

Shock, severe stress, severe sepsis

80
Q

Normal pressure in left ventricle

A

120/0

81
Q

Normal pressure in systemic arteries

A

90

82
Q

Normal pressure in systemic veins

A

10

83
Q

Normal pressure in right atrium

A

2-6

84
Q

Normal pressure in right ventricle

A

25/0

85
Q

Normal pressure in pulmonary arteries

A

25/8

86
Q

Mean pulmonary artery pressure

A

14

87
Q

Normal pressure in pulmonary veins

A

8-10

88
Q

Normal pressure in left atrium

A

2-6

89
Q

What does the CVP monitor and evaluate?

A

Fluid levels and function of right heart

90
Q

Where is the tip of the CVP catheter placed?

A

Superior vena cava

91
Q

Normal CVP value

A

2-6

92
Q

What does PAP refer to and what does it measure?

A

Pulmonary artery pressure, lung fuction

93
Q

Normal PAP value

A

25/8, mean 14

94
Q

What type of blood samples are obtained via the PAC?

A

Mixed venous blood samples (balloon must be deflated prior to sampling)

95
Q

Normal pulmonary capillary wedge pressure? (PCWP)

A

4-12

96
Q

How can PCWP be estimated if the catheter cannot be wedged?

A

PA diastolic pressure

97
Q

How does the PCWP change in a pt with cardiogenic pulmonary edema?

A

Elevated

98
Q

How does PCWP change in a pt with non-cardiogenic pulmonary edema? (ARDS)

A

Normal

99
Q

You see wedge you think

A

Left

100
Q

Identify location of the tip of the catheter at each section

A

Right atrium
Right ventricle
Pulmonary artery
Pulmonary capillary wedge

101
Q

What are the four ways to determine cardiac output

A

Fick equation
QT = HR x SV
Thermal dilution
CaO2 - CvO2

102
Q

Normal range for cardiac output (Qt)

A

4-8

103
Q

Normal value for SvO2

A

75%

104
Q

significance of a decrease in SvO2?

A

Decreased CO, decreased O2 delivery, increased O2 demand, impaired tissue oxygenation, shock

105
Q

Formula for calculating cardiac index

A

Cardiac output (Qt) divided by body surface area

106
Q

Normal range or cardiac index

A

2.5-5.0

107
Q

Right heart failure, cor pulmonale, tricuspid valve stenosis hemodynamics (CVP, PAP, PCWP, CO)

A

CVP increased
PAP N/decreased
PCWP N/decreased
CO N

108
Q

Lung disorders, PE, Pulmonary Han, air embolism hemodynamics (CVP, PAP, PCWP, CO)

A

CVP increased
PAP increased
PCWP N/decreased
CO N

109
Q

Left heart failure, mitral valve stenosis, CHF, high PEEP effects hemodynamics (CVP, PAP, PCWP, CO)

A

CVP N
PAP increased
PCWP increased
CO decreased

110
Q

Hypervolemia hemodynamics (CVP, PAP, PCWP, CO)

A

All increased

111
Q

Hypovolemia hemodynamics (CVP, PAP, PCWP, CO)

A

All decreased

112
Q

Systemic vascular resistance definition, NV, formula

A

Pressure gradient across the systemic circulation divided by cardiac output
<20 or 1600 dynes
(MAP-CVP) / QT

113
Q

SVR is increased in

A

Systemic hypertension and/or vasoconstriction

114
Q

SVR is decreased in

A

Increased CO/CI

115
Q

PVR definition, NV, formula

A

Pressure gradient across pulmonary circulation divided by CO
<2.5 or 200 dynes
(MPAP - PWP) / Qt

116
Q

PVR is increased with

A

Hypoxia, PHtn

117
Q

How to convert mmHg/L/Min to dynes

A

X 80

118
Q

Mixed venous oxygen content (CvO2) equation and NV

A

CvO2 = (Hb x 1.34 x SvO2) + (PvO2 x 0.003)
12-16vol%C

119
Q

CvO2 decreases when

A

CO decreases

NPS Kettering Workbook (8 decks)

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