Pulmonary Lab

Question 1

Values for Pulse Rate

Answer 1

Normal = 60 – 100 bpm
> 100 bpm =Tachycardia
> < 60 bpm=Bradycardia

Question 2

Pulse Rhythms

Answer 2

• Regular = evenly spaced beats, may vary with respiration
• Regularly Irregular = regular pattern overall with skipped beats (need to measure for 60 sec)
• Irregularly Irregular = chaotic, no real pattern, very difficult to measure rate (need to measure for 60 sec)

Question 3

How long do you need to take pulse for?

Answer 3

Adult: 15 seconds x 4, 30 sec x 2, 60 sec x 1
Children: Count for 60 seconds

Question 4

Grading System for Pulse Quality

Answer 4

Question 5

What are the 6 different pulses?

Answer 5

• Radial
• Femoral
• Posterior Tibialis
• Doralis Pedis
• Abdominal Aorta
• Femoral

Question 6

Abdominal Aorta Palpation Steps

Answer 6

• Pt. is supine, knees flexed to 90 degrees; examiner stands on the right
• Assess for size, location and pulsation of the aorta
• Place the palms of both have on abdomen with index fingers pointing up toward the head
• Press down firmly to locate pulsating aorta

Question 7

Values of abdominal aorta

Answer 7

• Normal: 2.5 cm
• Abnormal: 3-4 cm, suggests aortic aneurysm; refer
• Width is more significant than pulsation

Question 8

Abnormal Pulse Patterns

Answer 8

Pulsus Alterans
* Palpation: Weak beats alternating with strong beats; regular rhythm
* Probable Cause: Left Ventricular Failure

Pulsus Bigeminus
* Two beats ocurring in rapid sucession, followes by a pause during which no pulse is felt; irregular rhythm; premature beat
* Probably Cause: Cardiac Arrythmias

Question 9

Why do we auscultate for Bruits

Answer 9

• Late middle aged or older are at risk
• Sign of srterial narrowing and risk of stroke

Question 10

Ascultation for Bruits

Answer 10

• Patient is seated or supine with head turned slightly away from examiner.
• Place the BELL of the stethoscope over each carotid artery. You may use the diaphragm if the patient’s neck is highly contoured.
• Ask the patient to stop breathing momentarily.
• Listen for a blowing or rushing sound–a bruit suggesting turbulence. Do not be confused by heart sounds or murmurs transmitted from the chest.

Question 11

Auscultation Steps for Aorta, Renal and Iliac Arteries

Answer 11

• Patient is supine with knees flexed or supported by pillows for relaxation. Examiner stands on right side of patient.
• Place the diaphragm of your stethoscope lightly on the abdomen starting in the upper right quadrant and work clockwise.
• Bruits = loud blowing sound due to arterial atherosclerosis and represent turbulent blood flow.
• Listen for bruits over the renal arteries, iliac arteries, and aorta. Renal bruits may be found in patients with hypertension.
• Listen for bowel sounds. Are they normal or absent?

Question 12

ABI via Doppler

Answer 12

• Have subject lie supine ~ 10-15 minutes
• Place cuff around arm above elbow
• Apply gel to probe
• Hold Doppler at 45 degree angle; and place over brachial artery (radial)
• Inflate cuff until doppler sound disappears
• Deflate the cuff until sound returns
• Document this systolic pressure (brachial)
• Place cuff around leg just above malleolus
• Hold Doppler at 45° angle; and place over dorsalis pedis or post tibial artery
• Inflate cuff until doppler sound disappears
• Deflate the cuff until sound returns
• Document this systolic pressure (ankle)

Question 13

ABI Values: N vs Ab

Answer 13

N: 1.0 - 1.4
Ab: .41-.90
Severe: less than 0.4 (Critical Limb Ischemia)

Question 14

How would you identify an arterial stenosis with ABI?

Answer 14

A reduction in pressure occurs distal to the lesion

Question 15

ABI examines PAD but also ____ and ____

Answer 15

• detecting stenosis
• differentiating true cladification from psudocladification

Question 16

How would you palpate doralis pedis a.?

Answer 16

Palpate between the first and second toes mid foot

Question 17

When should a ABI-Walk test be performed?

Answer 17

When resting ABI is between .91 and 1.2 with Sx

Question 18

A positive ABI walk test would be:

Answer 18

• SBP drop of 20% in the ankle or more
  OR
• Drop of ABI by .2 or more

Question 19

When looking at limbs, what should you be on the lookout for?

Answer 19

• Cyanosis: Lips, Finger tips (thick)
• Loss of hair (lower extremities - vascular disease)

Question 20

Pitting Edema Scale

Answer 20

Question 21

Anthropometric Water Displacement Test

Answer 21

• Select correct sized container
• Filled to line
• Instruct patient to slowly lower limb into the water
• Collect displaced water and document

Question 22

What does the Capillary Nail Refill test?

Answer 22

Monitors tissue perfusion and dehydrations

Question 23

How to perform a capillary refill test?

Answer 23

• Pressure applied to nail bed until it turns (blanched; ~5 sec)
• Remove pressure and record time for the pink color to return to the nail
• Perform at distal finger or distal great toe

Question 24

Capillary Nail Refill Test

Answer 24

Normal:
* Less than 3 seconds

Abnormal:
* 3 seconds or more at distal finger
* 5 seconds or more at distal great toe (diabetic patients)

Question 25

What are some things that can cause poor capillary refill?

Answer 25

* Low body temperature * Vasoconstriction due to nicotine, peripheral edema, or anemia

Question 26

How to perform the Rubor Dependency Test

Answer 26

* Place subject supine and assess color of feet (plantar) * Elevate leg to 45-60 seconds for 1 minute * Have timing device with them or have asked for one prior to starting test * Assess color of foot - plantar aspect * Return leg to bed and time how long for color return

Question 27

Rubor Dependency Test Values:

Answer 27

N: Color returns in 15 - 20 seconds (color is pink or light red) Ab: Takes greater than 25-30 seconds (if color returns may be bright red)

Question 28

How would you perform a skin turgor test?

Answer 28

* Grasp skin between two fingers to create a tent (hand, forearm or abdomen) * Hold skin for a few seconds and release * Indicate if decreased skin turgor (skin remains tented and returns slowly; indicates moderate to severe dehydration) * Can do on the back of the hand, lower arm, or abdomen

Question 29

What does Oxygen Saturation measure? Where do you perform it?

Answer 29

* Percentage of hemoglobin staturated * Finger, ear or toe

Question 30

How do you determine the actual O2 content?

Answer 30

* Measure the PaO2 * Corresponds with O2 stat percentages

Question 31

Normal and Abnormal % and PaO2 level

Answer 31

Normal: * 95% or higher Abnormal: * Lower than 90% may be caused by lung disease/problems, cigarette smoking, or blood bessel problems * Hypoxia when **below 92%** Values: * 95% O2 Sat = 80 mm Hg PaO2 * 90% O2 Sat = 60 mm Hg PaO2 * Medicare will only pay when PsO2 60 mm Hg = 88% O2 stat

Question 32

What percentages of O2 is in a nasal cannula? How does this relate to exercise?

Answer 32

Percentage * 1 L O2 = 24% * 2 L O2 = 28% * 3 L O2 = 32% * 4 L O2 = 36% * Pts on 2 L of O2 may be able to exercise without it. * Some pts only way to get increase in functional activity is by increasing the O2. Example: Emphysema patients.

Question 33

If patients don't have access to supplemental oxygen what should be provide them with?

Answer 33

Breathing efficency and breathing patterns

Question 34

Carbon monoxide has an affinity for hemoglobin of ____ higher than O2

Answer 34

25x

Question 35

Most and Least reliable temperature taking methods

Answer 35

Most reliable: Rectum Least reliable: Axillary

Question 36

Wells Clinical Decision Rule for DVT Values

Answer 36

* -2 to 0: Low probability of DVT - 3% * 1 to 2: Moderate probability of DVT - 17% * 3 or more: High probability of DVT - 75% * Medical **consultation** is **advised** in the presence of **low probability** * Medical **referral** is **required** with **moderate or high score**.

Question 37

Clinical Decision Rule for PE

Answer 37

Probability <2 – low 2-6 – Intermediate >6 - High