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Patient Evaluation > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

Before getting an ABG on a pt what steps should one take

A

Review chart for physician’s orders
Check on pt’s condition

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2
Q

What does the Modified Allen’s test show

A

Clotting ability and collateral circulation

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3
Q

Define Arteriotomy

A

Sample obtained by insertion of needle into a major artery

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4
Q

Name some sites where one can obtain an ABG

A

Radial
Dorsalis pedis
Bronchial
Femoral

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5
Q

What is the difference between arterial and venous

A

Arterial - provides more info regarding oxygenation and acid-base balance
Provides info on lung function and the adequacy of CO2 removal

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6
Q

How long should you apply pressure for after ABG

A

Until it stops bleeding

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7
Q

Define thrombosis

A

Formation of an abnormal clot within the vessel which can lead to cessation of blood flow

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8
Q

Define Hemorrhage

A

Pt’s on anticoagulation medications or low platelet count

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9
Q

Define hematoma

A

Leakage of blood into the tissues

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10
Q

Which population are at a higher risk of getting hematoma’s and why

A

Elderly
due to lack of sufficient elastic tissues to seal the puncture sites

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11
Q

Described as secondary reflex to pain

A

Arteriospasm

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12
Q

Reflects the lung’s ability to transfer O2 from the inspired gas into the circulating blood

A

PaO2

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13
Q

PaO2 depends on

A

O2 concentration
Barometric P
Lung function
Age
Prescence of disease

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14
Q

Normal range for PaO2 on RA

A

80-100 mmHg

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15
Q

What is the formula used to calculate PAO2(alveolar air equation)

A

PAO2= FiO2(pB-pH2O)-(PaCO2* 1.25) or
paCO2 / 0.8

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16
Q

Defined as below normal regardless of FiO2, less than 80 mmHg

A

Hypoxemia

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17
Q

Define hypoxia

A

inadequate oxygenation of the tissues

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18
Q

Classification of hypoxemia:(less than 60 years of age)
40-59 mmHg

A

Moderate

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19
Q

Classification of hypoxemia:(less than 60 years of age)
< 40 mmHg

A

Severe

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20
Q

Classification of hypoxemia:(less than 60 years of age)
60-79 mmHg

A

Mild

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21
Q

if PaO2 is <60 mmHg at any age it is defined as

A

hypoxemia

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22
Q

If paO2 is < 40 mmHg at any age it is defined as

A

Severe

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23
Q

Name some causes of hypoxemia

A

V/Q mismatch
Hypoventilation
Pulmonary shunting
Diffusion defect
Breathing in gas with a low FiO2

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24
Q

Described as abnormalities in the lung structure that slow diffusion of O2 thru ACM, resulting in hypoxemia

A

Diffusion defect

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25
Q

Diffusion defect respond well to O2 therapy(true or false)

A

True

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26
Q

What is the normal alveolar-arterial O2 difference (PA-aO2 /A -aDO2)

A

10-15 mmHg on RA

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27
Q

How can you estimate the patient’s A.a

A

0.3 * pt. age in years

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28
Q

When does V/Q mismatch happen

A

occurs when inhaled gas does not match with lung perfusion

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29
Q

It is the most common cause of hypoxemia in cases of respiratory disease

A

V/Q mismatch

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30
Q

Define deadspace ventilation

A

Ventilation in excess of perfusion

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31
Q

Define shunt

A

Perfusion without ventilation or in excess of ventilation

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32
Q

Whats the normal for V/Q

A

0.8

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33
Q

If V/Q is greater than 0.8 it is considered

A

Deadspace

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34
Q

If V/Q is less than 0.8 it is considered to be

A

Shunting

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35
Q

Perfusion in excess of ventilation is caused from

A

Atelectasis

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36
Q

Ventilation in excess of perfusion is caused from

A

Pulmonary emboli

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37
Q

Define venous admixture

A

Deoxygenated venous mixing with oxygenated arterial in turn reducing paO2

38
Q

Define O2 saturation

A

Amount of O2 Hb carries in a given volume of blood

39
Q

What does O2 saturation depend on

A

Hb concentration

40
Q

If a patient was in a fire accident which device would obtain a true saO2

A

Co-oximeter

40
Q

True or false
PaO2 is a calculated value

A

False
SaO2 is a calculated value

41
Q

What is the normal anatomic shunt (in %)

A

3%

42
Q

What is the normal Hb with O2

A

97%

43
Q

Relationship between the paO2 and saO2 can be demonstrated by the

A

Oxyhemoglobin curve

44
Q

Where is 2,3 DPG found in

A

Erythrocytes

45
Q

What’s the purpose of 2,3 DPG

A

Aids in reducing the affinity of O2 and releasing it to the cells

46
Q

What causes an increase in 2,3 DPG level(right shift)

A

Strenuous exercises(enhances unloading of O2)
Anemia
Hypoxemia associated with COPD

47
Q

What causes a left shift(decrease) in 2,3 DPG level

A

Septic shock(bacterial infection in lung)
Stored blood( eg. for transfusion)
Fetal blood

48
Q

True or false
The oxyhemoglobin curve has a linear relationship

A

False
It has no linear relationship

49
Q

Are there minimal or significant changes in saO2 when the paO2 changes above 80mmHg

A

Minimal changes in saO2

50
Q

Are there minimal or significant changes in saO2 when the paO2 changes below 80mmHg

A

Significant changes in saO2

51
Q

When the curve shifts to the left what happens

A

There is easier binding of O2 to hgb.
Higher SaO2 for a given PaO2

52
Q

When the curve shifts to the right. What happens

A

Decreased O2 affinity for Hgb.
Lower saO2 for a given PaO2

53
Q

Whats the affinity for CO to bind to Hgb

A

240 X

54
Q

When CO binds to Hgb, shift curve to which side

A

To the left

55
Q

True or false
A pt can be hypoxic even with a normal PO2

A

True

56
Q

Fetal curve shifted to the ——facilitates uptake of O2 by placenta at very low pO2(27 mmHg)

A

Fetal curve to the Left

57
Q

It is the measurement of PO2 at 50% Hb saturation

A

P-50

58
Q

What is the normal value for P-50

A

27 mmHg

59
Q

What is the most sensitive indicator of a curve

A

P-50

60
Q

What other factors can lead the P-50 to shift

A

PH,
Temp
PCO2

61
Q

When there is low P-50 and the graph shifts to the ——-there is a ———-affinity

A

Left shift
High affinity

62
Q

When there is high P-50 and the graph shifts to the ——-there is a ———-affinity

A

Right shift
Low affinity

63
Q

What is the normal CaO2 value

A

16-20 Ml/dl

64
Q

Consists of ——and ——–dissolved in the plasma

A

O2 bound Hgb
O2 physically

65
Q

True or False; CaO2 significantly influence tissue oxygenation

A

True

66
Q

What is the greatest factor effect content in CaO2

A

hgb

67
Q

Formula for CaO2

A

1.34 * Hb * SaO2 ( ml/ dl)

68
Q

If hgb is not normal is the pt still considered

A

Hypoxic

69
Q

Normal PVO2 value

A

35 - 45 mmHg

70
Q

What is considered a good representation of tissue oxygenation

A

PVO2

71
Q

A true sample of the tissue oxygenation is obtained from

A

Pulmonary artery

72
Q

O2 delivery is a function of

A

Cardiac output and CaO2

73
Q

Why is PVO2 a good indicator for hypoxia

A

Because it is a reflection of the interaction of the pulmonary and CV system

74
Q

What does venous provides information on

A

The balance of O2 supply and demand

75
Q

If CO is low with constant O2 extraction

A

Low PVO2 below normal

76
Q

If CO is high with constant O2 extarction

A

High PVO2

77
Q

What is the normal (C(a-v)O2)

A

3.5 -5.0 vol%

78
Q

What is (C(a-v)O2) used as an indicator for

A

Cardiac output

79
Q

What (C(a-v)O2) provide an estimation of

A

Tissue perfusion (CO) and Oxygenation

80
Q

Formula for QT
HINT: QT is CO

A

VO2( Consumption of O2 ) / C(a-v) O2

81
Q

Increased C(a-v) O2 (8 vol%) =

A

Reduced QT, ( constant VO2)

82
Q

Decreased C(a-v) O2(3 vol%)

A

Increase QT (Constant VO2)

83
Q

What is the formula for CaO2

A

1.34 *Hb *saO2 + 0.003 * paO2

84
Q

What is the formula for svO2

A

1.34 * Hb * svO2 + 0.003 * pvO2

85
Q

What are the units for both SaO2 & SVO2

A

Vol %

86
Q

Normal Carboxyhemoglobin(

A

< 3%

87
Q

What device gets an accurate reading of the hgb(O2) in the blood if a pt. has been in a fire incident ( HbCO)

A

Co-oximeter

88
Q

If CO is inhaled it shifts the curve to which side of the graph and why

A

Left
causing tissue hypoxia due to the decreased unloading of O2 to tissues

89
Q

What are the 2 problems with HbCO

A

Inhibits the carrying capacity of O2 &
Prevents unloading of O2 at the tissues

90
Q
A

Patient Evaluation (4 decks)

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