Exam 2 Flashcards
Normal pH
Acidic 7.35 - 7.45 Alkalotic
Normal PaCO2
Alkalotic 35 - 45 Acidic mmHg
Normal PaO2
80 - 100 mmHg
Normal HCO3
Acidic 22 - 26 Alkalotic mmHg
Hypoxemic
PaO2 less than 60 mmHg (SpO2 <90%)
Hypercapnic
PaCO2 greater than 50 mmHg
Duke Activity Status Index (DASI)
Estimates VO2 max up to 34 ml/kg/min or 9.8 METS
1-4 Light home activities.
5-9 Cilmb a flight of stairs, run a short distance.
>10 Strenuous Activity.
Respiratory Reserve Ratio
pO2/FiO2 476 = normal person >300 = sufficient respiratory reserve for mobility <300 = ask senior PT, much caution. <200 = Poor <100 = Very Poor
Abdominal Paradoxical Breathing
Chest out, abdominal in
Minimal Aerobic Capacity to Remain Functionally Independent
Males 18 ml/kg/min or 5.14 METs
Females: 15 ml/kg/min or 4.3 METs
Normal FEV1, FVC and FEV1/FVC
greater than or equal to 80%.
Point Change on the SPPB to be minimally clinically difference.
1-2 point change.
Risk of hospitalization and/or Death SPPB 0-4 score
Five fold increase risk
Risk of hospitalization and/or Death SPPB 5-7 score
2.6 fold increased risk
A one point increase in SPPB?
Gives a 14% reduction in risk.
Global Initiative for COPD Stage 1
FEV1/FVC = <0.70 FEV = greater than or equal to 80% of predicted Smokers Cough Little or no SOB No clinical Signs of COPD FEV1 greater than 80%
Add reduction of risk factors, add short acting bronchodialtor
Global Initiative for COPD Stage 2
FEV1 < 80% of Predicted
Shortness of Breath
Some clinical signs of COPD
Sputum producing cough
Add regular treatment with one or more long-acting bronchodialators and add pulmonary rehab
Global Initiative for COPD Stage 3
SOB on mild exertion
FEV1 < 50% of predicted.
Add inhaled glucocorticosteroids if repeated exacerbations.
Global Initiative for COPD Stage 4
SOB on mild exertion
Right heart failure
cyaosis
FEV1 < 30% of predicted.
These people will need long term O2 if in chronic respiratory failure. Consider Surgical Treatments
BODE Index Definition
A multidimensional index developed to assess an individuals risk of death from COPD.
- Weight
- Airway Obstruction (FEV1)
- Dysnpea (Medical Research Council Dyspnea Score)
- Exercise Capacity (6 min walk test)
BODE Index Scores
0-2 = 80% survival 3-4 = 67% Survival 5-6 = 57% survival 7-10 = 18% survival
O2 reccommended for Patients with PaO2 or SpO2 of?
PaO2 < 60 mmHg
SpO2< 90%
PaO2 is titrated between what?
PaO2 60-65 mmHg
SpO2 90-93%
Sufficient Cardiovascular Reserve
Resting HR < 50% of their age predicted max heart rate
Blood pressure <20% variability recently (meaning an increase or decrease in BP of 20% or more representing hemodynamic instability.
ECG normal
Other major cardiac conditions excluded.
Sufficient Respiratory Reserve
PaO2/FiO2 Ratio > 300
SpO2 > 90% and <4% recent decrease in SpO2
Respiratory Pattern Satisfactory
Mechanical ventilation to be maintained during Tx
MRC Sum Score
Assesses for critical illness weakness. Similar to MMT but no +/- UE: Wrist extension, elbow flexion, shoulder abduction LE: DF, Knee extension, Hip flexion. Total Range 0-60
MRC Score diagnosis for critical illness weakness?
<48/60
Hemodynamic Stability with Body Positioning and Changes
Heart Rate20-30 from resting my be appropriate.
BP no greater than a 10-20 mmHg drop (go with 10)
Diastolic should remain the same or increase 10.
Neoadjuvant and Adjuvant Chemo Effect on Cardiopulmonary System
Cardiotoxicity (Cardiomyopathy) Pulmonary Toxicity Fatigue Weakness Risk of Infection Decreased Aerobic Activity
Lung Metastasis and Ressection of Lung Tissue
Lung Damage Decreased ventilation/perfusion Decreased FRC Increased WOB SOB Inflammation Cough Fatigue
Premorbid History of Asthma
Inflammation Brochoconstriction Increased Mucous Difficulty Breathing Increased WOB SOB Coughing Wheezing.
Pediatric Objective Examination
Communication: Affect/cognition/language and learning style.
Consistent with age/ development
Family Centered
Culturally Sensitive
