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LindseyJones Rapid Reference > PATIENT INFORMATION > Flashcards

PATIENT INFORMATION Flashcards

1
Q

Arterial Blood Gases

A
  • pH - 7.35 - 7.45
  • PaCO2 - 35 - 45 mmHg
  • PaO2 - 80 - 100 mmHg
  • HCO3 - 22 - 26 mEq/L
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2
Q

Ventilation Parameters

A
  • VT (spont) - > 5 mL/kg
  • VC - 10 mL/kg
  • MIP - > -20 cm H2O
  • MEP - > +40 cm H2O
  • RSBI - < 106
  • Resp rate - 8-20/min
  • VD/VT ratio - 20-40% (off vent); < 60% (on vent)
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3
Q

Oxygenation Parameters

A
  • SpO2 - >94%
  • A-aDO2 25-65 mmHg
  • CaO2 - 17-20 vol%
  • CvO2 - 14-16 vol%
  • C(a-v)O2 - 4-5 vol%
  • P/F ratio - > 380
  • Qs/Qt (shunt) - 3 - 5%
  • PetCO2 - 25-35 mmHg
  • PetCO2% - 2 - 5%
  • PAO2 - 100 mmHg (room air)
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4
Q

Vitals

A
  • Pulse - 60 - 100 bpm
  • BP - 120-80 mmHg
  • Temp (oral) - 37ºC
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5
Q

Pulmonary Function

A
  • Fev1 - > 80% of predicted
  • Fev1 /FVC% - 70% or greater
  • DLCO - 20 - 25 mL/CO/min/mmHg
  • SVC - > 80% of predicted
  • FVC - > 80% of predicted
  • RAW - 0.6 - 2.4 cmH2O/L/sec
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6
Q

Hemodynamics

A
  • C.O. - 4 - 8 L/min
  • C.I. - 2 - 4 L/min/m2
  • CVP - 2 - 6 mmHg
  • mPAP - 14 mmHg or 25/8 mmHg
  • PCWP - 7 - 9 mmHg
  • SVR - 1440 dynes
  • PVR - 160 - 200 dynes
  • MAP - 93 mmHg
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7
Q

Electrolytes

A
  • K+ - 3.5 - 4.5 mEq/L
  • Na+ - 135 - 145 mEq/L
  • Cl- - 80 - 100 mEq/L
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8
Q

Other Laboratory Values

A
  • Creatinine - 0.7 - 1.3 mg/dL
  • BUN - 8 - 25 mg/dL
  • WBC - 4,000 - 12,000 cu mm
  • Hb - 12 - 16 gm/dL
  • RBC - 4 - 6 mill/cu mm
  • HCT - 45%
  • PT - 23 - 32 seconds
  • APTT - 12 - 15 seconds
  • Platelet cnt - 150,000 - 400,000 units
  • Theophylline - 10 - 20 ug/L
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9
Q

Neurological

A

ICP - 5 - 10 mmHg

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10
Q

Arterial Blood Gases

A
  • pH - 7.35 - 7.45
  • PaCO2 - 35 - 45 mmHg
  • PaO2 - 60 - 80 mmHg
  • HCO3 - 22 - 26 mEq/L
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11
Q

Ventilation Parameters

A
  • Resp rate - 30 - 60/min
  • Apnea - up to 10 seconds
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12
Q

Oxygenation Parameters

A

SpO2 - > 90%

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13
Q

Vitals

A
  • Pulse - 110 - 160 bpm
  • Temp - 36 - 37ºC
  • BP - 60/40 mmHg (term), 55/35 mmHg (preterm)
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14
Q

APGAR Assessment

A

1 & 5 minute - 7 - 10

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15
Q

Maturity

A
  • Birth weight - 3000 grams or more
  • Gestation - 38-42 weeks
  • L/S ratio - 2:1
  • New Ballard - 40
  • Silverman - 0 - 1
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16
Q

Other Laboratory Values

A
  • WBC - 4500 - 10000 cu mm
  • Hb - 17 - 22 gm/dL
  • Glucose - 35 mg/dL (term), 30 mg/dL (preterm)
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17
Q

“Adventitious”

A

abnormal

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18
Q

“Vesicular”

A

normal

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19
Q

Wheezing (Bilateral)

A

bronchoconstriction - treat with bronchodilator

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20
Q

Wheezing (Unilateral)

A

foreign body aspiration

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21
Q

Rhonchi

A

secretions in the large airway - treat by suctioning or cough instruction

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22
Q

Rales (crackles) (medium)

A

secretions in middle sized airways - treat with CPT, PEP therapy, (anything to mobilize secretions)

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23
Q

Rales (crackles) (fine)

A

atelectasis - hyperinflation therapy

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24
Q

Rales (crackles) (fine moist)

A

fluid overload, pulmonary edema, CHF

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25
Stridor
upper air inflammation
26
Stridor (mild)
treat with cool mist
27
Stridor (moderate)
racemic epinephrine
28
Stridor (marked or severe)
intubate or send to surgery for tracheostomy
29
Deviation TOWARD the problem
pulmonary fibrosis, atelectasis, lobectomy
30
Deviation AWAY from the problem
pneumothorax, pleural effusion, tension pneumothorax
31
Types of X-rays
* AP - for non-ambulatory pts * PA - for ambulatory pts only (preferred perspective) * Lateral - facilitates 3D view * Lateral decubitus - detect pleural effusions * Lateral neck - used to detect inflammation above or below the epiglottis
32
Normal Placements
* ET tube - 2 - 5 cm above carina level with aortic knob level with 4th rib or T4 * Central venous catheter - in right atrium or vena cava * Pulmonary artery catheter - tip in right lower lung field
33
Other Radiological Procedures
* V/Q scan - detect pulmonary emboli * MRI - no metal, used for 3D visualization
34
Tracheal shift from midline
* pneumothorax * hemothorax * significant atelectasis
35
Obliterated costophrenic angles
* pleural effusion
36
Flattened diaphragm
* COPD * significant air trapping
37
Fluffy infiltrates
* pulmonary edema
38
Wedge-shaped infiltrates
* pulmonary embolism
39
Butterfly or bat wing pattern
* pulmonary edema
40
Plate-like or patchy infiltrates
* ARDS or atelectasis
41
Scattered patchy infiltrates
* ARDS
42
Ground glass or honeycomb pattern
* ARDS or IRDS
43
Reticulogranular or granular pattern
* ARDS or IRDS
44
Concave superior border or interface
* pleural effusion
45
Consolidation or haziness
* pneumonia
46
Radiological Exam Quality and Technique
* spaces between vertebrae are supposed to be visible distinct * apices (apexes) are supposed to be level - if not patient may be rotated, x-ray should be repeated * overexposure causes lung dark areas to become darker * underexposure causes whiter lung fields
47
Diaphoresis and Fluid Retention
* CHF and fluid overload * Myocardial infarction - "cold" and "clammy" to the touch * Tuberculosis - night sweats * Febrile conditions * Pitting Peripheral Edema (rated +1, +2, +3) indicates fluid overload - diuretics needed
48
Medical Records
* Diagnosis, chief complaint * Signs - (objective information) - data that can be observed by the caregiver. ie, color, chest configuration, etc * Symptoms - (subjective information) - data that must be reported by the patient. ie, pain, dyspnea \*baby or comatose pt cannot report symptoms * Occupation exposure - pulmonary irritants * Smoking history * Pack years - avg pks per day x years
49
Interview Technique
* Pictograms for children or intubated pts * Pain - rate 1- 10 * Ask open-ended questions
50
Values
* CVP * PAP * PCWP * C.O. or * C.I.
51
Purpose
* Identify one of 5 problem areas: * right heart * lungs * left heart * fluid overload or * dehydration
52
Interpretive Steps
1. Look at CVP, PAP, PCWP, CO in that order 2. Look for the pattern when values go from HIGH to low or HIGH to normal 3. The anatomy in between these two values is the problem area
53
Other Interpretations
* All values high = fluid overload (especially CVP and PCWP) * All values low = dehydration (especially CVP and PCWP) * Lung heart problems = CHF, mitral valve stenosis, etc * Right heart problems = cor pulmonale, right heart failure, etc * Pulmonary problems = pulmonary embolism, pulmonary hypertension, etc.
54
Patient is Obstructive if:
* FEV1/FVC% - \< 70% OR * FEV1 - \< 80% of predicted
55
Patient is Restrictive if:
* SVC - \< 80% of predicted OR * FVC - \< 80% of predicted
56
Diffusion Impairment present if
* DLCO \< 20 mL/CO/min/mmHg
57
Poor patient effort if
* FVC \> SVC * Trials are not within 5%
58
Best Test (trial) determination
* Best Effort = highest (Fev1 + FVC)
59
Tall, narrow flow-volume loop
* RESTRICTIVE pattern
60
Short, wide flow-volume loop
* OBSTRUCTIVE pattern
61
"Round" flow-volume loop
* Vocal cord cancer or paralysis
62
PVCs
* Stop procedure * Give oxygen
63
V-Tach
* Defibrillate * Compression if no pulse
64
3rd Degree Block
turn on external pacemaker
65
Rate \> 200
flutter
66
Rate - fast, uncountable
fibrillation
67
Pulseless V-Tach
* chest compressions * epinephrine
68
V-tach with pulse
defibrillate with synch OFF
69
Atrial arrythmia
cardiovert with synch ON
70
Asystole
compressions, DO NOT SHOCK
71
PVCs
* stop all therapies; ie, suctioning CPT * give oxygen
72
2nd Degree Block
* attach external pacemaker * DO NOT TURN ON unless it transitions into a 3rd degree block
73
Spiked T Waves
hyperkalemia
74
Flattened T waves
hypokalemia
75
Cardiac ischemia
inverted T waves (opposite of P waves)
76
Cardiac Injury (Heart Attack)
elevated S-T segment
77
Myocardial Infarction
* tissue death * pronounced Q waves
78
Chest pain
give 4 lpm NC to reduce work of the heart OR keep SpO2 of 94% or higher
79
PAO2
PAO2 = [(PAO2 = [(PB - PH2O) x FIO2 - (PaCO2 x 1.25) PB - PH2O) x FIO2 - (PaCO2 x 1.25)
80
A-aDO2
A-aDO2 = PAO2 - PaO2
81
CaO2
CaO2 = (Hb x 1.34 x SaO2) + (PaO2 x 0.003)
82
CvO2
CvO2 = (Hb x 1.34 x SvO2) + (PvO2 x 0.003)
83
C(a-v)O2
C(a-v)O2 = CaO2 - CvO2
84
PF ratio
PF ratio = PaO2/FiO2
85
Est SaO2
Est SaO2 = PaO2 + 30 (only if PaO2 40-60 torr)
86
QS/QT
QS/QT = [(A-aDO2) x 0.003]/[(A-aDO2) x 0.003] + C(a-v)O2
87
Vd/Vt
Vd/Vt = (PaCO2 - PeCO2)/PaCO2 x 100
88
Dyn Compliance
Dyn Compliance = Exhaled VT/(PIP - PEEP)
89
Static Compliance
Static Compliance = Exhaled VT/(Plateau - PEEP)
90
VA
VA = (Vt - Vd) x RR (Alveolar Min Ventilation)
91
Est Vd
Est Vd = 1 mL per lb of ideal body weight
92
QT
QT = VO2/[C(a-v)O2 x 10]
93
VO2
VO2 = C(a-v)O2 x C.O. (L) x 10
94
C.O.
C.O. = stroke volume x heart rate
95
C.I.
C.I. = C.O./BSA
96
MAP
MAP = [(1 x systolic) + (2 x diastolic)]/3
97
SVR
SVR = [(MAP - CVP)/C.O. (QT)] x 80
98
SVRI
SVRI = [(MAP - CVP)/C.I.] x 80
99
PVR
PVR = [(PAP - PCWP)/C.O. (QT)] x 80
100
How many milligrams in a drug
drug% x 10 in 1 mL of that drug
101
1 inch
2.54 cm
102
Kg
1. lbs/2 2. subtract 10% from remainder
103
Ideal Body Weight
* First 5 ft of height = 106 lbs * Add 7 lbs/inch for men * Add 6 lbs/inch for women * May have to subtract lbs if under 5 ft * Pt considered obese if 20-30 lbs overweight

LindseyJones Rapid Reference (1 decks)

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