Pulmonary Diagnostic Procedures

Question 1

What are the 4 pulmonary diagnostic procedures?

Answer 1

1. Chest imaging: radiographs, CT
2. Bronchoscopy
3. Blood Gas Analysis
4. Ventilation/Perfusion Scan

Question 2

What is the predominant diagnostic test to determine anatomic abnormalities and pathological processes in the chest

Answer 2

Chest Radiographs- provides a static view of the anatomy of the chest
-air: dark
-bone: white

Question 3

Advantages to CT scan

Answer 3

-much more sensitive
-evaluates lungs, heart, mediastinum, pleura, chest, and abdomen
-localizes disease
-guidance of interventional procedures
-evaluates chest tube placement

Question 4

Disadvantages of CT scan

Answer 4

-risk of transporting patient out of ICU
-significantly increased radiation
-risk of intravenous contrast

Question 5

What test involves a narrow beam of x-rays moving across field of examination?

Answer 5

CT scan- primarily used for diagnosis of tumors vs calcifications or nodules

Question 6

What are you able to visualize on a chest x-ray?

Answer 6

-bones and soft tissue
-mediastinum and trachea
-hilum (roots of pulmonary blood vessels and bronchi)
-lung fields
-silhouette sign
-specific lung lesions (abnormal density)

Question 7

What is a bronchoscopy?

Answer 7

Flexible, fiber optic tube that is inserted through the mouth or nose for direct visualization of the airways
-it allows direct access of previously inaccessible areas within the tracheobronchial tree

Question 8

Indications for a bronchoscopy

Answer 8

-tissue biopsy
-secretion sampling and removal
-bronchial lavage for tissue identification

Question 9

Arterial blood gas analysis provides information of which levels in the blood?

Answer 9

-pH
-oxygen concentration
-carbon dioxide concentration
-bicarbonate

Question 10

Blood ph levels

Answer 10

-Normal: 7.35-7.45
-Acidosis: <7.35
-Alkalosis: >7.45

Question 11

Normal partial pressure of oxygen within arterial blood

Answer 11

The amount of oxygen that is bound of hemoglobin
-normal: 80-100 mmHg
-abnormal: < 80 mmHg

Question 12

What is SpO2?

Answer 12

Peripheral oxygen saturation that may be measured by a pulse ox
-normal: >95-90%

Question 13

Hypoxemia levels PaO2

Answer 13

-mild: 60-80 mmHg
-moderate: 40-60 mmHg
-severe: <40 mmHg

Question 14

What does the partial pressure of carbon dioxide tell us?

Answer 14

The adequacy of alveolar ventilation
-normal: 35-45 mmHg
-abnormal: < 35 mmHg (hyperventilating), > 45 mmHg (hypo-ventilating)

*for every 10 mmHg increase in PaCO2, the pH should fall 0.7 units

Question 15

Normal Bicarbonate (HCO3) levels

Answer 15

Normal: 22-26 mEq/L
-determines if the pt has an acid balance imbalance

Question 16

Which two ways can Acidosis occur?

Answer 16

1. low HCO3 produces metabolic acidosis
2. high PaCO2 produces respiratory acidosis

Question 17

Which two ways can Alkalosis occur?

Answer 17

1. high HCO3 produces metabolic alkalosis
2. low PaCO2 produces respiratory alkalosis

Question 18

What compensation occurs with Respiratory acidosis?

Answer 18

The kidneys retain bicarbonate in an effort to increase the pH

Question 19

What is the compensation that occurs with respiratory alkalosis?

Answer 19

the kidneys excrete more bicarbonate to try and decrease the pH

Question 20

What is the compensation that occurs with metabolic acidosis?

Answer 20

Decrease carbon dioxide levels by hyperventilating (blowing off the excess CO2 to being pH back to normal)

Question 21

What is the compensation that occurs with metabolic alkalosis?

Answer 21

Increase carbon dioxide by hypo-ventilation to bring pH back to normal

Question 22

T/F there is a normal inverse relationship between pH and CO2

Answer 22

True
-if the relationship is maintained: the problem is respiratory in nature
-if the relationship is not maintained: the problem is metabolic in nature

Question 23

How to determine the adequacy of alveolar ventilation?

Answer 23

Look at PaCO2!
<30 mmHg: alveolar hyperventilation
30-50 mmHg: adequate ventilation
>50 mmHg: ventilatory failure

Question 24

Patient X presents with:
 PH 7.14
 PaCO2 72 mmHg
 HCO3 23mEq/L
 What can you say about the acid base balance of this patient?
 Does the patient have respiratory or metabolic imbalance

Answer 24

pH: acidotic
PaCO2: very high

Respiratory Acidosis

Question 25

Patient S has the following ABG values:
 pH 7.0
 PaCO2 = 75 mmHg
 HCO3 = 22 mEq/L
 Does the patient have respiratory or metabolic imbalance

Answer 25

pH: acidotic
PaCO2: very high

Respiratory acidosis

Question 26

Patient PT has the following ABG values:
 pH 7.54
 PaCO2 = 30 mmHg
 HCO3 = 39 mEq/L
 Does the patient have respiratory or metabolic imbalance

Answer 26

pH: alkalotic
PaCO2: low

Respiratory Alkalosis? …. but why? lol

Question 27

What is a pulmonary ventilation/perfusion (V/Q) scan?

Answer 27

Uses inhaled and injected radioactive material to measure ventilation and perfusion in all areas of the lungs
-done by scanning the pts lungs while the person inhales radioactive gas
-2 tests that can be performed separately or together

Question 28

Results of a V/Q scan

Answer 28

-decreased uptake of radioisotope during a perfusion scan indicates a problem with blood flow
-decreases uptake of radioisotope during a ventilation scan may indicate reduced breathing and ventilation ability or airway obstruction