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Adult Health I > T2: Pulmonary System (2) > Flashcards

T2: Pulmonary System (2) Flashcards

1
Q

When does shunting occur?

A

when a portion of the VENOUS blood does not participate in gas exchange

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2
Q

Examples of conditions that may cause anatomic shunting:

A
  • AVMs
  • ARDS
  • atelectasis
  • pneumonia
  • pulmonary edema
  • pulmonary embolus
  • vascular lung tumors
  • intracardiac R to L shunt
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3
Q

Does increased FiO2 help when shunting occurs?

A

No

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4
Q

Does PCO2 change or stay the same when shunting occurs? Why?

A

stays the same

B/c compensation with increased RR

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5
Q

Venous blood that flows through the lungs w/o being oxygenated due to nonfunctioning alveoli:

A

intrapulmonary shunting

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6
Q

Intrapulmonary shunting:
____% is abnormal
____% is life-threatening

A

greater than 10% = abnormal

greater than 30% = life-threatening

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7
Q

What 2 methods can be used to measure shunting?

A
  • Direct measurement

- Estimation

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8
Q

How do we directly measure shunting?

A
  • Give 100% O2 for 15 min

- measure CaO2 and CvO2

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9
Q

CaO2 means ____.

CvO2 means ____.

A 
CaO2 = O2 content of arterial blood
CvO2 = O2 content of venous blood
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10
Q

CaO2 - CvO2 normal is ____ ml/dl.

A

5 ml/dl

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11
Q

How do we estimate shunting?

A
  • PaO2 / PAO2 ratio
  • Alveolar-arterial gradient
  • PaO2 / FiO2 ratio
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12
Q

What is the A-a gradient?

A

The alveolar (PAO2) to arterial (PaO2) pressure difference

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13
Q

PAO2 means ____ pressure

PaO2 means ____ pressure

A 
PAO2 = alveolar O2 pressure
PaO2 = arterial O2 pressure
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14
Q

Why is the A-a gradient always positive?

A

You always have more O2 in the lungs than in the body tissue

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15
Q

What is a normal A-a gradient?

A

10-20 mmHg

increases within this range as the pt ages

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16
Q

What does A-a gradient show?

A

How efficiently the lung is managing pulmonary capillary O2 and alveolar O2

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17
Q

If the A-a gradient is large, this indicates a dysfunction in the ___.

A

lung

(it’s not picking up the O2 like it should

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18
Q

Issues that can lead to large A-a gradient:

A
  • V/Q mismatching
  • shunting
  • diffusion abnormalities
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19
Q

What is the formula to find PAO2?

A

PAO2 = FiO2 (PB - PH2O) - PaCO2 / RQ

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20
Q

Abbreviation for fraction of inspired oxygen:

A

FiO2

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21
Q

Abbreviation for barometric pressure. What is normal?

A

PB

760 mmHg

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22
Q

Abbreviation for pressure of water vapor. What is normal?

A

PH2O

47 mmHg

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23
Q

Abbreviation for respiratory quotient. What is normal?

A

RQ

0.8

24
Q

PaO2 / FiO2 normal value:

A

greater than 286

the lower the number, the worse the lung function

25
Q

HYPOXEMIA caused by what 3 physiological problems:

A
  • low inspire O2 tension
  • alveolar hypoventilation
  • V/Q mismatch
26
Q

High _____ can cause LOW inspired O2 tension.

A

altitudes

27
Q

Alveolar hypoventilation can be caused by disorders of the _____ center and _____ of the respiratory system.

A

respiratory

muscles

28
Q

A-a gradient is NORMAL with _____ _____.

A-a gradient is INCREASED with _____ _____.

A 
Normal = alveolar hypoventilation
Increased = V/Q mismatch
29
Q

What 5 things are checked by lab test regarding the pulmonary system?

A

1) Blood
2) Sputum
3) Chest
4) Ventilation and perfusion
5) Pulse oximetry

30
Q

What BLOOD test is performed?

A

ABGs

31
Q

What SPUTUM characteristics are observed?

A

Pathogens
abnormal cells
color, amount, consistency

32
Q

What CHEST tests are performed?

A

CXR
Digital chest radiography
CT

33
Q

What VENTILATION and PERFUSION test is performed?

A

V/Q scan

34
Q

What noninvasive PULSE OXIMETRY test is performed?

A

SpO2

35
Q

What areas do we ask about in a respiratory history assessment?

A

(Remember: SCAS HOG)

  • Smoking history
  • Childhood diseases
  • Adult diseases
  • Surgeries
  • Hospitalizations
  • Occupation/leisure activity
  • Geographic area or travel
36
Q

Pulmonary Function Test:

What does it look for?

A

Evaluates lung:

  • VOLUME and CAPACITIES
  • FLOW RATES
  • DIFFUSION CAPACITY
  • GAS EXCHANGE
  • AIRWAY RESISTANCE
  • DISTRIBUTION OF VENTILATION
37
Q

Pulmonary Function Test:

No smoking for _____ hrs prior to test.

A

6 - 8 hrs

38
Q

Pulmonary Function Test:

How many hours must bronchodilator drugs be held before test?

A

4 - 6 hrs

39
Q

Capnometry and Capnography:

What does it measure?

A

Measures amount of CO2 present in EXHALED air

Remember you exhale to blow the “cap” off someone’s head

40
Q

Capnometry:

What is the normal pressure of PETCO2?

A

between 20 and 40 mmHg

41
Q

What is a capnometry device often used for?

A

Check for correct positioning of an ET tube

42
Q

What 4 things can increase or decrease PETCO2?

A

Ventilation
Metabolism
Circulation
Error

43
Q

What does exercise testing evaluate?

A

A 6 or 12 min walk test to see how short of breath, how far you can walk during that time

44
Q

What do skin tests evaluate?

A
  • allergens

- infectious diseases

45
Q

What 3 things can be done during a bronchoscopy?

A
  • visualize
  • biopsy
  • aspirate material
46
Q

How many hours must a pt be NPO before a bronchoscopy? Why?

A

8 hrs

risk of aspiration

47
Q

After a bronchoscopy, what must you assess for before allowing pt to drink?

A

Return of cough and gag reflex

48
Q

What are 3 common complications with a bronchoscopy?

A

(Remember LAP)

  • Laryngospasm
  • Aspiration
  • Pneumothorax
49
Q

What is a THORACENTESIS?

A

aspiration of pleural FLUID or AIR from pleural space

50
Q

What do we tell the pt a thoracentesis will feel like?

A

Stinging sensation and pressure; pt will feel better after excess fluid is pulled off lungs

51
Q

What must the pt do during a thoracentesis?

A

Sit absolutely motionless in the correct position

52
Q

What amount is typically the limit to aspirate in a thoracentesis? Why?

A

1000 mL

too much can cause complications from fluid shift

53
Q

What 5 complications can be seen after a thoracentesis?

A

1) mediastinal shift
2) pneumothorax
3) bleeding
4) infection
5) subcutaneous emphysema
(**pneumothorax can cause the mediastinal shift)

54
Q

What is subcutaneous emphysema? Is it dangerous?

A

trapped air under the skin that sounds like crackels (“Rice Crispies”)
Not dangerous, but the reason that caused it can be!

55
Q

What does a lung biopsy look for?

A

obtains tissue for

  • histologic analysis
  • culture
  • cytologic exam
56
Q

Does a lung biopsy need to be performed in the OR?

A

No, can be done at the bedside

57
Q

Follow-up care for lung biopsy:

A
  • Assess VITALS, BREATH SOUNDS at least q4h for 24 hrs
  • Assess for respiratory DISTRESS
  • Report REDUCED/ABSENT breath sounds immediately
  • Monitor for HEMOPTYSIS

Adult Health I (10 decks)

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