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Acute Care Module 3 > Pulm Procedures > Flashcards

Pulm Procedures Flashcards

1
Q

what are the four cytologic and hematologic tests for pulm

A

blood work, nasal swab, saliva, and sputum to identify pathogens

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2
Q

why use a cxr for lung patients

A

identify normal structures, identify lung fields, identify abnormalities

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3
Q

what are three abnormally white lung fields

A

pneumonia, atelectasis, and pleural effusion

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4
Q

what are two abnormally black lung fields

A

pneumothorax and COPD

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5
Q

what is a normal V/Q ratio

A

0.8

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6
Q

why use a V/Q scan

A

to rule OUT PE and other acute causes of dec O2 and gas exchange

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7
Q

why is pulmonary angiography used? (3)

A

dx PE, dx AVM, and to dissolve a PE with thrombolytic agents

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8
Q

what would you use to dx an acute PE: V/Q scan or pulm angiography?

A

pulm angiography

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9
Q

what does flexible bronchoscopy do

A

direct visualization of the bronchial tree and dx/intervention to remove secretions and aspirated contents

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10
Q

what is thoracentesis and pleural biopsy

A

inserting a needle into the pleural space to remove fluid or biopsy

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11
Q

what is a PT implication for thoracentesis and pleural biopsy patients

A

postpone until post procedure cxr has ruled OUT pneumothorax

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12
Q

what is oximetry

A

indirect assessment of oxyhemoglobin saturation (PO2)

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13
Q

what does PFT determine

A
  1. lung volumes and capacity
  2. gas flow rates
  3. gas diffusion
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14
Q

how does PFT classify pulmonary diseases

A
  1. obstructive
  2. restrictive
  3. combined
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15
Q

What is tidal volume

A

amount of air inspired or exhaled during normal quiet breathing

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16
Q

what is IRV

A

additional volume of air that can be taken in above normal Vt

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17
Q

what is ERV

A

additional volume of air that can be forced about above normal Vt

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18
Q

what is RV

A

residual volume of air still in the lung after forceful exhalation

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19
Q

what is IC

A

inspiratory capacity of air that can be inhaled AFTER A TIDAL exhalation

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20
Q

what is FRC

A

functional residual capacity of air remaining in the lungs AFTER A TIDAL exhalation

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21
Q

what is VC

A

vital capacity - max volume of forceful exhale to max inhale

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22
Q

what is TLC

A

max volume that the lungs can be expanded

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23
Q

what is MV

A

minute ventilation - amount of air that is moved into or out of the lungs per minute

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24
Q

for the following scenarios, what happens to RR

  1. exertion
  2. hypoxia
  3. hypercapnia
  4. acidosis
  5. CNS depression
A
  1. normal increase
  2. abnormal increase
  3. abnormal increase
  4. abnormal increase
  5. abnormal decrease
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25
Q

Minute ventilation (Ve) is a product of ____ and ____

A

Vt and RR

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26
Q

what are the two results of hypoventilation

A

hypercapnia and respiratory acidosis

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27
Q

what are the two results of hyperventilation

A

ventilation hypocapnia and respiratory alkalosis

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28
Q

what is the difference between anatomic dead space (Vd) and alveolar dead space

A

Vd - airways that do not participate in gas exchange

alveolar - alveoli that recieve too little blood supply and thus do not participate in gas exchange

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29
Q

how does FVC change in patients with obstructive disease

A

decreases

30
Q

What is FEV1, what is normal, what is severe obstruction

A

forced expiratory volume in 1 second - normal is around 3 but severe obstruction is < 1.0

31
Q

______ CO2 and _____ bicarbonate will make conditions more acidic

A

increase and dec

32
Q

______ CO2 and _____ bicarbonate will make conditions more basic

A

decreased and increased

33
Q

CO2 is regulated through which system

A

pulm system

34
Q

Bicarb is regulated though which system

A

renal system

35
Q

what is normal PO2

A

80-100

36
Q

what is normal PCO2

A

35-45

37
Q

what is normal pH

A

7.35-7.45

38
Q

what is normal SaO2

A

97-100

39
Q

what is normal HCO3

A

22-28

40
Q

how long does it take for respiratory compensation to occur for primary metabolic disorder

A

begins in seconds

41
Q

how long does it take for kidney compensation to occur for primary respiratory disorder

A

takes 12-24 hours

42
Q

what are the two causes of acidosis

A

low bicarb (metabolic acidosis) and high PCO2 (respiratory acidosis)

43
Q

what are the two causes of alkalosis

A

high bicarb (metabolic alkalosis) and low PCO2 (respiratory alkalosis)

44
Q

PCO2 is an indicator of ventilatory status… what are the values and names of high and low PCO2

A

PCO2 < 30 = alveolar hyperventilation

PCO2 > 50 = alveolar hypoventilation and ventilatory failure

45
Q

interpret the following values

PCO2 > 45 and pH <7.40

A

respiratory acidosis

46
Q

interpret the following values

PCO2 > 45 and pH > 7.40

A

respiratory CO2 retention to compensate for metabolic alkalosis

47
Q

interpret the following values

PCO2 < 35 and pH > 7.40

A

respiratory alkalosis

48
Q

interpret the following values

PCO2 < 35 and pH < 7.40

A

respiratory CO2 elimination to compensate for metabolic acidosis

49
Q

interpret the following values

HCO3 < 22 and pH < 7.40

A

metabolic acidosis

50
Q

interpret the following values

HCO3 < 22 and pH > 7.40

A

renal compensation for respiratory alkalosis

51
Q

interpret the following values

HCO3 > 26 and pH > 7.40

A

metabolic alkalosis

52
Q

interpret the following values

HCO3 > 26 and pH < 7.40

A

renal compensation for respiratory acidosis

53
Q

define mild hypoxemia

A

PO2 60-80 and SpO2 90-95%

54
Q

define moderate hypoxemia

A

PO2 40-60 and SpO2 60-90%

55
Q

define severe hypoxemia

A

PO2 < 40 and SpO2 < or = 60%

56
Q

how does FiO2 change per liter of NC delivery

A

1 L = 0.24, then each liter adds 0.04 up to 6 liters = 0.44

57
Q

what is the range of a simple face mask

A

5-10 L and 0.35 - 0.55 FiO2

58
Q

what is the range of a NRB

A

> 10 L and 0.6 - 0.8 FiO2

59
Q

in patients with a history of lung disease, a drop in O2 sat to less than ___% during activity indicates that the patient needs additional oxygen

A

90

60
Q

how does an invasive mechanical vent work?

A

artificial airway plus positive pressure to increase alveolar ventilation and reduce work of breathing

61
Q

vents control OXYGENATION PO2 >60 by manipulate which two values

A

FiO2 and PEEP

62
Q

what is PEEP

A

threshold-like resistance at the end of exhalation to prevent early closure of the distal airways and alveoli

63
Q

vents control VENTILATION pH and PCO2 by manipulating which two values

A

TV and RR

64
Q

what is a “mandatory” mode of ventilation

A

started, controlled, and ended by vent

65
Q

what is a “assisted” mode of ventilation

A

started by the patient, but controlled and ended by the vent

66
Q

what is a “spontaneous” mode of ventilation

A

started, controlled, and ended by the patient

67
Q

what is controlled mandatory ventilation (CMV)

A

every breath is mandatory and RR and TV are set to deliver a minimum minute ventilation

68
Q

what is a synchronized intermittent mandatory ventilation (SIMV)

A

the vent senses a pt’s breath and delivers a mandatory breath, but it provides a mandatory breath even if the patient does not provide inspiratory effort.

69
Q

what is CPAP

A

pt initiates and completes each breath with vent assistance via constant level of pressure both at inspiration and exhalation

70
Q

what is positive pressure support or positive support ventilation

A

mode that provides positive pressure at each inspiration to help keep the airways open

71
Q

what are two treatment implications for patients on vents

A
  1. consider PROM or AROM of the neck and shoulder on the same side as the vent
  2. transfers, standing, marching in place, and ambulation ARE encouraged
72
Q

what should you know about suctioning (mostly done by respiratory therapy)

A
  1. only clears the trachea and main bronchi
  2. limit to 15-20 second bouts cuz it can cause hypoxemia
  3. can cause atelectasis

Acute Care Module 3 (11 decks)

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