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RTT > Pulmonary diagnostic testing > Flashcards

Pulmonary diagnostic testing Flashcards

1
Q

Three primary sites for obataining arterial blood gas

A

Radial
Brachial
Femoral

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2
Q

The Modified Allen’s test

A

used to assess the collateral circulation
Hand should pink up within 1-2 sec

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3
Q

ABG Hazards and Problems

air bubbles

effects on pH, PaCo2, PaO2

A
  • PaCO2 decreases toward 0
  • PaO2 increases or decreases toward 150 torr
  • pH increases
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4
Q

ABG Hazards and Problems

Improper cooling

effects on pH, PaCO2, PaO2

A
  • PaCO2 increases
  • PaO2 decreases
  • pH decreases
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5
Q

Capillary samples are used to obtain blood gas samples in

heel sticks

A

infants

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6
Q

capillary sample

PO2 values do/do not correlate well with ___

A
  • do not
  • arterial blood
    especially true when the arterial po2 is above 60torr
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7
Q

Capillary gases should not be used to monitor

A

oxygen therapy

Only pH and PCO2 correlate with arterial

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8
Q

Name harzards and problems of an arterial sample

A
  • Disruption of blood flow
  • clotting
  • Bleeding
  • Vessel spasm
  • Tissue trauma
  • Air bubbles
  • improper cooling
  • too much liquid heparin
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9
Q

Capillary blood samples correlate with arterial blood samples

A

pH and PCO2

not PO2

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10
Q

Umbilical arterial catheter tip placement

A

at L-3 which is above the bifurcation of the aorta but below the renal arteries

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11
Q

Unbilical artery PO2 may be used to regulate

A

FiO2

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12
Q

Advantages of umbilical artery catheter (UAC)

A
  1. allows continuous monitoring of blood pressure
  2. Arterial samples of ABG and other lab analysis
  3. Blood transfusion
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13
Q

Arterial line: If transducer is above the catheter, displayed pressure is

A

lower than actual

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14
Q

Arterial line: if transducre is below catheter, displayed pressure is

A

higher than actual

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15
Q

Blood Gas analyzers

Severinghaus electrode

A

PCO2 -
partial pressue of carbon dioxide in sample

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16
Q

Blood Gas analyzers

Clark electrode

A

PO2
Patrial pressure of oxygen in sample

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17
Q

Blood Gas analyzers

Sanz electrode

A

Acid base status

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18
Q

Blood Gas analyzers

Quality Control : when the blood gas machine is functioning correctly, the mesured control valies ..

A

will be close to the mean and withing +/- 2 standar deviations

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19
Q

Blood Gas analyzers

Westgard rules

A

a comon set of rules developed to differentiate between random errors and true out of control situations
* Called multiple-rule method

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20
Q

Blood Gas analyzers

Out of control situations

A
  • one control observation exceeds the mean +- 3 SD
  • Two consecutive control observations exceed the mean +2 SD or the mean -2SD
  • The difference between consecutive control runs exceed 4SD
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21
Q

Point of care testing

A

anytype of lab testing done at the bedside

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22
Q

List laboratory test that can be perfored by point of care testing

A
  • blood glucose
  • arterial blood gas
  • hematrocit
  • serum electrolytes
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23
Q

Intravenous infusionis used to administer ____, ____, and ____ continuously to the pt

A
  • medications
  • blood products
  • supplemental nutrition/ fluids
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24
Q

Venipuncture is performed to provide ____

A

vascular access for continuous infusion or for blood sampling for laboratory analysis

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25
Q

Alveolar Air equation

Definition

A

Calculates the partial pressure of oxygen (PO2) in the alveoli

PAO2

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26
Q

PAO2

equation

A

= (PB-Ph2o) FiO2 - (Paco2/0.8)

(747-47) Fio2 - Paco2/ 0.8

Fio2 is NOT in percent

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27
Q

A-a gradient

Definition

A

Measures the difference between alveolar and arterial PO2

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28
Q

A-aDO2

equation

A

PAO2 -PaO2

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29
Q

A-aDO2 normal value

A

25-65 torr on 100%

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30
Q

A-aDO2
66-300 torr

interpretation

A

V/Q mismatch

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31
Q

A-aDO2 : >300

interpretation

A

Shunting

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32
Q

A-a gradient of 190 torr

what would be a treatment ?

A

give O2 therapy

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33
Q

A-a gradient of 350 torr

what would you recommend

A

give positive pressure therapy

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34
Q

P/F ration

definition

A

ratio of the partial pressure of arterial O2 to the inspired fractional concentration of oxygen

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35
Q

Used in determination of ALI or ARDS

A

P/F ratio

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36
Q

Measures the efficiency of oxygen transfer across the lung

A

P/F ratio

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37
Q

P/F ration : normal value

A

> 380 torr

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38
Q

P/F ration : < 300 signifies

A

ALI

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39
Q

P/F ration : < 200 signifies

A

ARDS

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40
Q

Arterial oxygen content

definition

A

best measurement of oxygen delivered to the tissues , or the bes index of oxygen transport

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41
Q

best measurement of oxygen delivered to the tissues , or the bes index of oxygen transport

A

Arterial oxygen content
(CaO2)

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42
Q

CaO2

equation

A

(Hb x 1.34 x SaO2) + (PaO2 x 0.003)

shortcut: Hb x 1.34 x SaO2 or Hb x 1.34

43
Q

Normal value for CaO2

arterial oxygen content

A

17-20 vol % (mL/dL)

44
Q

Mixed venous oxygen content

definition

A

total amount of oxygen carried in the mixed venous blood

equation like CaO2 but with venous

45
Q

CvO2 normal value

A

12-16 vol %

46
Q

arterial- venous oxygen content difference

definition

A

measures the oxygen consumption of the tissues

47
Q

C(a-v)O2

equation

A

CaO2 - CvO2

48
Q

C(a-v)O2 normal value

A

4-5 vol%

49
Q

CvO2 values will __ when C.O __

What about SvO2?

A
  • decrease
  • decreases
  • SvO2 values also decrease if C.O decreases

C.O decreases, CvO2 decreases

50
Q

The percentage of the hemoglobin that is bounde by oxygen

A

Arterial Oxygen Saturation
SaO2

51
Q

PaO2 value can be estimated by

A

subtracting 30 from the SaO2

52
Q

measure the amount of ventilation support required to provide the evel of oxygenation

A

Oxygen Index

53
Q

Oxygen Index equation

A

(Paw- Fio2 / PaO2 ) x 100

Fio2 is a decimal not a percent

54
Q

Normal OI

A

<10

55
Q

An increase in the pt venous oxygen content would indicate that

A

C.O increased

56
Q

Deadspace to tidal volume ratio

VD/VT

A

the percentage of the VT that does not participate in gas exchange

Ventilation without perfusion

57
Q

oxygen index

Recomend __ for newborns with __

A
  • ECMO for newborns withOI >40
58
Q

Normal VD/VT ration

deaspace

A

20-40%
(up to 60% with ventilator pt )

59
Q

Desired minute volume equation

A

current Ve x current PaCO2 = desired Ve x desired PaCO2

60
Q

PaO2 value
Below 80

interpretation

A

Hypoxemia
can be caused by
* Poor ventilation
* V/Q mismatch

61
Q

Hypoxemia
can be caused by

PaO2 below 80

A
  • Poor ventilation
  • V/Q mismatch
62
Q

Response for hypoxemia

A
  • increase ventilation
  • increase FiO2 up to 60%
  • add PEEP
63
Q

PaO2 bellow 80
with 60% + fio2

interpretation. What does the pt have?

A

Shunt, refractory hypoxemia, venous admixture

64
Q

Shunt, refractory hypoxemia, venous admixture

RESPONCE

A

decrease Fio2, PEEP or CPAP

65
Q

When pH is inside aceptable range

its called

A

Compensated or Chronic

66
Q

When pH outside the acceptable range

its called

A

Non-compensated or Acute

67
Q

Higher PaO2 values (>140) would indicate

A

supplemental oxygen in use , bubble in sample or technical error

68
Q

Lower PaO2 values may indicate

A

V/Q mismatch, diffusion defect, shunting or venous blood

69
Q

Treatment for CO poisoning

A

100% oxygen and hyperberic oxygen therapy

70
Q

comfirm Pulmonary embolus with

A

V/Q scan, CT scan, pulmonary angiography

71
Q

Supect embolus in

pt with

A
  • post op pt
  • bedridden pt
  • history of deep vein thrombosis
  • women in advance stages of pregnancy
  • Venous stasis
  • obesity
  • Trauma
  • atrial fibrillation
72
Q

Loss of metabolic acids, dehydration, electrolyte imbalance (due to vomiting)

Treatment

A

Administer potassium chloride (KCl) and oxygen

73
Q

normal PaCO2 of a newborn

A

< 50 torr

74
Q

normal PaO2 of a newborn

A

> 60 torr

75
Q

Normal newborn pH

A

> 7.30

slightly acidotic

76
Q

ABG results do not match clinical appearance

Type 1
Type 2

A
  • type 1 - ABG loos good / pt looks and feels bad
  • type 2 ABG looks bad / pt loosk and feels fine
77
Q

Bedside assesment for Pulm. embolus shows

A

hyperpnea

increased rate and depth of ventilation

78
Q

treatment for pulmonary embolus

A
  1. prevent with aticoagulants (heparin)
  2. support ventilation and oxygenation
    treat existing clots with thrombolytic agens (streptokinase)
79
Q

Dissociation Curve

a shift to the left

A

increased affinity
* pH increases
* PCO2 decreases
* Temp decreases
* 2-3 DPG decreases

80
Q

Dissociation curve

shift to the right

A

decreased affinity
* pH decreases
* PCO2 increases
* Temp increases
* 2-3 DPG increases

81
Q

Spirometers measure

A

volume and flow rates

82
Q

Pneumotachometers (flow)

Turbine device

Wright respirometer

A

measures flow, may display volume

83
Q

Pneumotachometers (flow)

Pressure differential (Fleisch) pneumotachometer

A

measures flow
can be used to cotinuously measure minute ventilation (Ve)

84
Q

device used to measure and monitor PEFR for patients with asthma

A

Peak flow meter

85
Q

Pt exhales forcefully through a device which incorporates a resistor and a moveable indicator

A

Peak flow meter

86
Q

peak flow value

healthy adult

A

10 L/sec
or
600L/min

87
Q

Plethysmography

whats another name

A

Body box

88
Q

Plethysmography

Based on ___ law which states that pressure and volume ___ ___ if temperature is constant

A
  • Boyle’s Law
  • vary inversely
89
Q

Measure thoracic gas volume (TGV)

A

Body Box

Plethysmography

90
Q

Plethysmography measures __ which is the same as __

A
  • Thoracic Gas Volume (TGV)
  • FRC
91
Q

State the name of the standards that all PFT equipment must meet?

A

ATS - ERS

92
Q

Body box should be calibrated prior to procedure using:

A
  • mouth pressure transucer - water or mercury barometer
  • Box pressure tranducer - sine wave ratory pump
  • Flow transducer - rotameter
93
Q

Measures airway resistance wich is the difference in pressure between the mouth and alveoli

A

Body Box

Plethysmography

94
Q

PFT equipment

Volume calibration and leak test are performed by using a ..

A

large volume syringe or standard syringe volume of 3.0 Liters

95
Q

PFT equipment

daily calibration with a

A

3.0 L syringe

96
Q

Calibration and quality control

Acuracy range of daily calibration

A

+/- 3.5%
(2.895 L - 3.105 L)

97
Q

used to monitor and asses the readiness to wean in ventilator patients

A

MIP

98
Q

MIP: assess the degree of respiratory musce impairment in pts with ___ and ___

A

Guillain-Barré and Myasthenia Gravis

99
Q

Norma MIP

A

80 cmH20

negative number

100
Q

a MIP of <20 cmh20 indicates

A

isnpiratory muscle weakness

101
Q

Helpfull in evaluating a pt’s ability to maintain an airway and clear secretions (cough effectively)

A

MEP

102
Q

Normal MEP

A

160 cmh2o

103
Q

MEP < 40 cmh2o indicates

A

poor ability to clear airway secretions

RTT (9 decks)

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