Pulmonary Lab Flashcards
Values for Pulse Rate
Normal = 60 – 100 bpm
> 100 bpm =Tachycardia
> < 60 bpm=Bradycardia
Pulse Rhythms
- 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)
How long do you need to take pulse for?
Adult: 15 seconds x 4, 30 sec x 2, 60 sec x 1
Children: Count for 60 seconds
Grading System for Pulse Quality
What are the 6 different pulses?
- Radial
- Femoral
- Posterior Tibialis
- Doralis Pedis
- Abdominal Aorta
- Femoral
Abdominal Aorta Palpation Steps
- 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
Values of abdominal aorta
- Normal: 2.5 cm
- Abnormal: 3-4 cm, suggests aortic aneurysm; refer
- Width is more significant than pulsation
Abnormal Pulse Patterns
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
Why do we auscultate for Bruits
- Late middle aged or older are at risk
- Sign of srterial narrowing and risk of stroke
Ascultation for Bruits
- 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.
Auscultation Steps for Aorta, Renal and Iliac Arteries
- 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?
ABI via Doppler
- 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)
ABI Values: N vs Ab
N: 1.0 - 1.4
Ab: .41-.90
Severe: less than 0.4 (Critical Limb Ischemia)
How would you identify an arterial stenosis with ABI?
A reduction in pressure occurs distal to the lesion
ABI examines PAD but also ____ and ____
- detecting stenosis
- differentiating true cladification from psudocladification
How would you palpate doralis pedis a.?
Palpate between the first and second toes mid foot
When should a ABI-Walk test be performed?
When resting ABI is between .91 and 1.2 with Sx
A positive ABI walk test would be:
- SBP drop of 20% in the ankle or more
OR - Drop of ABI by .2 or more
When looking at limbs, what should you be on the lookout for?
- Cyanosis: Lips, Finger tips (thick)
- Loss of hair (lower extremities - vascular disease)
Pitting Edema Scale
Anthropometric Water Displacement Test
- Select correct sized container
- Filled to line
- Instruct patient to slowly lower limb into the water
- Collect displaced water and document
What does the Capillary Nail Refill test?
Monitors tissue perfusion and dehydrations
How to perform a capillary refill test?
- 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
Capillary Nail Refill Test
Normal:
* Less than 3 seconds
Abnormal:
* 3 seconds or more at distal finger
* 5 seconds or more at distal great toe (diabetic patients)
What are some things that can cause poor capillary refill?
- Low body temperature
- Vasoconstriction due to nicotine, peripheral edema, or anemia
How to perform the Rubor Dependency Test
- 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
Rubor Dependency Test Values:
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)
How would you perform a skin turgor test?
- 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
What does Oxygen Saturation measure? Where do you perform it?
- Percentage of hemoglobin staturated
- Finger, ear or toe
How do you determine the actual O2 content?
- Measure the PaO2
- Corresponds with O2 stat percentages
Normal and Abnormal % and PaO2 level
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
What percentages of O2 is in a nasal cannula? How does this relate to exercise?
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.
If patients don’t have access to supplemental oxygen what should be provide them with?
Breathing efficency and breathing patterns
Carbon monoxide has an affinity for hemoglobin of ____ higher than O2
25x
Most and Least reliable temperature taking methods
Most reliable: Rectum
Least reliable: Axillary
Wells Clinical Decision Rule for DVT Values
- -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.
Clinical Decision Rule for PE
Probability
<2 – low
2-6 – Intermediate
>6 - High
