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If your not sure what answer should be entered, press the space bar and the next missing letter will be displayed. When you are all done, you should look back over all your answers and review the ones in red. These ones in red are the ones which you needed help on. Question: VD/VT Answer: ((PaCO2-PECO2)/PaCO2 )* 100, 20-40% Question: Air Equation(PAO2) Answer: (FIO2*7) – (PaCO2 +10) Question: A-a (A-aDO2) Answer: PAO2- PaO2, 25-65mmHg Question: Oxygen Content (CaO2) Answer: (Hb*1.34*SaO2) + (PaO2 * .003), 17-20% Question: Oxygen Content (CvO2) Answer: (Hb*1.34*SvO2) + (PvO2 * .003), 12-16% Question: Arterial-Venous content difference, C(a-v)O2 Answer: CaO2-CvO2, 4-5% Question: Equation , QS/QT Answer: ((A-aDO2)*.003 ) / ((A-aDO2)*.003+C(a-v)O2), 3- 5 % Question: Fick Equation for Cardiac (QT) Answer: VO2 / (C(a-v)O2 * 10) , 4-8 L/min Question: Index Answer: CO / BSA, 2.5 - 4 L/m/m2 Question: Types of X-rays : AP(Anterior to posterior) Answer: most common in hostpitals. Good for in-bed X-rays. Use when determining proper of an endotracheal tube. Question: Types of Chest X-rays : PA(Posterior to ) Answer: most done standing Question: of Chest X-rays : Lateral Answer: to visualize the lungs as a 3-dimensional body Question: Types of Chest X-rays : decubitus Answer: Helpful in detecting pleural effusions. Described as having a concave superior or interface. Question: Types of X-rays : Oblique Answer: Any diagonal or non-traditional angle. Increases 3-dimensionality of lung, in spotting internal issues such as masses, blebs, or lesions. Question: Neck X-rays : Neck Answer: a.Differentiate Croup (Subglottic inflammation/Laryngotracheobronchitis):1.Steeple Sign2.not Life-Threatening & epiglottitis(Supraglottic swelling): Thumb sign. Question: Neck X-rays : Airway placement and function Answer: 1. Use a A-P chest radiograph. 2. Determined by radio-opaque line on the ET tube. 3. End of line be 2cm above the carina (or 1 inch) Question: X-rays : Chest tube placement Answer: should be in the space Question: 1) Placement X-rays : Central venous catheter placement 2)Placement X-rays : artery catheter placementAnswer: 1)tip should rest in the right atrium or vena cava 2)distal end in the artery, not wedged(i.e. balloon not inflamed.) Question: X-rays : Nasogastric tube positioning Answer: be found in the stomach or small bowel Question: Chest X-ray description Answer: 1. Bilateral radiolucency 2. sharp costophrenic angles 3. Hemi-diaphragms dome , right higher than left 4. Trachea is midline Question: Radiological Description : shift from midline-Associated Problem Answer: Pneumothroax, hemotorax, atelectasis Question: Radiological Description : Obliterated costophrenic -Associated Problem Answer: pleural Question: Radiological : Flattened diaphragm-Associated Problem Answer: COPD, air trapping Question: Radiological Description : Radiolucent-Associated Answer: Question: Radiological Description : infiltrates-Associated Problem Answer: edema Question: Description : Wedge - shaped infiltrates-Associated Problem Answer: Pulmonary Question: Radiological Description : Air -Associated Problem Answer: Question: Radiological Description : or Batwing Pattern-Associated Problem Answer: edema Question: Radiological Description : Plate like or infiltrates-Associated Problem Answer: Atelectasis Question: Radiological Description : Ground glass or Honeycomb - Associated Problem Answer: ARDS/IRDS Question: Radiological Description : pattern Answer: ARDS/IRDS Question: Description : Concave superior interfaceAnswer: effusion Question: Diagnostic Radiology : V/Q Answer: 1.Perfusion- abnormal when blood flow around the alveoli is hindered.2. Ventilation-abnormal/missing gas flow in areas of the . Xenon gas is used to monitor gas flow. - V/Q is associated w/ pulmonary emboli. Question: Diagnostic Radiology : Computed CT / CAT Answer: Used to visualize 1.lung masses,lesions,or nodules 2. scanning metals are not to be used directly. Question: Diagnostic Radiology : Magnetic Resonance (MRI) Answer: 1. Useful in detecting masses, lesions or nodules without use of radioactive materials. 2.Must use ventilator with no metal parts. No oxygen tank in the area (only non-ferrous items) Question: Diagnostic Radiology : Answer: 1. Primary diagnostic tool for Bronchiectasis. 2. helps to direct postural drainage and percussion . 3. this procedure can lead to respiratory deterioration and distress. Question: Radiology : Barium SwallowAnswer: 1. Radiographic of esophagus while the pt. swallows food mixed with radiopaque paste. 2. Used to determine risk for aspiration by visualizing any food entering tracheal& protection of tracheal opening during swallowing. Question: K+ Answer: Major: Intracellular Cation. Important for acid-base . Normal: 3.5-4.5 mEq/L range HYPERkalemia-(Metabolic ACIDOSIS) Hypokalemia-(Metabolic Alkalosis) Question: Na+ Major: Answer: Major:Extracellular Cation. Normal: 135-145 mEq/L range HYPERnatremia Question: Cl- Answer: Major: Extracellular Anion. Normal: 80-100 mEq/L range HYPERchloremia: (Metabolic ) Hypochloremia: (Metabolic alkalosis) Question: HCO3- Answer: Changes in CO2 content reflect changes in blood base. Normal: 22-26 mEq/L range HIGH HCO3- (Metabolic ALKALOSIS) Low HCO3- (Metablolic acidosis) Question: Creatinine and BUN (Blood Urea ) Answer: 1. Both indicates kidney function. 2. Ceratine is more accurate than BUN. 3.Acceptable range- 8-25 mg/dl. 4. range- 0.7-1.3 mg/dl. Question: Studies : Platelet countAnswer: 1. for blood clotting. 2. Acceptable value - 150,000-400,000 units/mm3 Question: Studies : PT (Prothrombin time) Answer: PT Done when patient receiving Warfarin (coumadin). Normal (23-32) Question: Coagulation Studies : APTT(Activated thomblastin time) Answer: APTT done when pt. Heparin therapy. PTT Normal Value (12-15 secs.) Question: Blood Count(CBC) : Hb Answer: 1. Carries 1.34mL/gm O2 2. Acceptable -12-16 gm/dl. Question: Blood Count(CBC) : RBC Answer: 1. cells that carry Hb. 2.Acceptable -4-6 mill/cu mm. Question: Complete Count(CBC) : WBC Answer: 1.Range 5000-10000/cu mm.(higher indicates infection-txt. antibiotics)2. Types:Neutrophils A)Bands4%-increased w/bacterial . B)Segs60%-decreases w/bacterial infection.C)Esinophills2%-causes asthma yellow sputum. D)Monocytes-elevation causes TB. Question: Transcutaneous PO2 and PCO2 Answer: 1. used on infants 2. electrode placed on skin & should be moved every 4 hrs. or burns on the skin 3. only accurate if perfusion is happening - correlates with the blood gas values. Question: Urine: Answer: 1. in checking urinary tract infections. 2. Useful when suspecting diabetes (check ketones in blood). Question: :Gram stain Answer: Determine if is gram positive/gram negative. Question: :Culture Answer: Identifies the organism. Question: Sputum: Answer: Identifies the organism-killing . Question: Sputum: Acid fast Answer: Used to the organism associated w/ TB (mycobacterium TB) Question: : clear Answer: normal Question: Sputum: White or Answer: bronchitis Question: : Yellow Answer: presence of WBC, bacterial . Question: : Green Answer: stagnant sputum- Bronchiectasis, . Question: : Red Answer: - bleeding, TB. Question: : Brown Answer: old . Question: Sputum: Pink Answer: Pulmonary . Question: : DefinitionAnswer: It is the act of moving air in&out of lung space. Most imp. vital function is vetilation. Ie. Ventilation must before oxygenation. If that never happens, oxygenation,circulation&perfusion will not occur. Question: Ventilation : Physical signs of Answer: 1. Chest movement 2. RR & 3. Vt 4. Breath Sounds Question: : Physical signs of ventilatory distress Answer: 1. Intercostal & Sternal retractions - associated with airway obstruction 2. Accessory muscle use. Question: Ventilation : lab signs of Answer: level Question: Oxygenation : Answer: Oxygenation probs. r imp. than circulation&perfusion. consider those 1st. consider CPR. If an object is blocking airway, dont start chest compression eventhough pt.'ve lost HR.U continue to object for ventilation becoz 1st priority is ventilation. Question: Oxygenation : Physical of oxygenation Answer: 1. Color 2. HR(Tachycardia is poor oxygenation) 3. Mental (confused, stuporous) 4. Sensorium Question: : Lab signs of oxygenation Answer: 1. saturation 2. PaO2(blood gas) Question: Circulation: Answer: 1. Pulse rate 2. Pulse 3. Cardia output 4. Stroke volume Question: Perfusion : Answer: 1. BP 2. Sensorium 3. Output (best indicator of perfusion) Question: study of and perfusion is also called Answer: Hemodynamics Question: Visual Inspection : General Answer: 1. Height and weight. 2. age and sex. 3. body frame, nutrition. 4. - wasted in appearance, poor skin tugor. Question: Visual Inspection : - Cyanosis Answer: Hypoxemia. Question: Visual : Color - ashen/pallor Answer: anemia, (vasodilation). Question: Inspection : Color- jaundice Answer: excessive . Question: Inspection : Color - erythema Answer: , infection and inflammation. Question: Visual Inspection : Color -normal, good Answer: good . Question: Visual Inspection : chest configuration and condition- increased A-P (barrel-chest) Answer: seen in pt. with COPD or chronic air-trapping such as fibrosis. Question: Visual Inspection : chest configuration and condition - scoliosis, , kyphoscoliosis Answer: curvature of the spine. Kyposis is . Scoliosis curvature. PFT will show restrictive component. Question: Visual Inspection : respiratory rate and - Eupnea Answer: breathing pattern. Question: Visual Inspection : rate and pattern: Tachypnea Answer: RR over >20 bpm Question: Visual Inspection : respiratory rate and : Bradypnea Answer: RR less <8 also know as . Question: Visual Inspection : respiratory rate and pattern: Answer: Increased RR,depth and regular rhythm. Associated w/ disorders. Question: Visual Inspection : rate and pattern: Apnea Answer: cessation of . Question: Visual : respiratory rate and pattern: Kussmaul breathingAnswer: Increased RR,depth and irregular . Associated w/diabetic ketoacidosis/ metabolic acidosis. Question: Visual Inspection : respiratory rate and pattern: breathing Answer: Increased RR,depth and periods of apnea. Associated with CNS disorders. Question: Inspection : respiratory rate and pattern: cheyne-stokes Answer: Increase and then decreasing RR and rhythm. Each cycle takes upto 3minutes to complete and apnea lasts up to 60 secs. w/ingestional errors (drug overdose) and elavated Intracranial pressure (ICP) problems (Head trauma etc.) Question: Visual Inspection : Acessory muscle use - normal Answer: 1. External 2. Diaphragm Question: Visual Inspection : muscle use - associated with ventilatory difficulty Answer: 1. 2. scalene. 3. Sternocleidomastoid 4. Oblique, rectus abdomial muscles. Question: Visual Inspection : flaring Answer: Relates to difficulty in the newborn. Question: Visual Inspection : and nature of a cough Answer: 1. strenght of cough . 2. frequency. 3. Productive or not:> a. Blood(hemoptysis)-TB. B. Dry or non-productive- Lung cancer/foreign body. Yellow sputum-infection. Question: Visual Inspection: Chest movement-symmetry of movement - Answer: 1. COPD. 2. chest(broken ribs. 3. Pneumothorax. 4. ET tube advanced too far into one lung. 5. Significant atelectasis. Question: Visual : Chest movement-symmetry of movement - Normal Pattern Answer: 1. Thorax moves out on inspiration. 2. Abdomen moves out on . Question: Visual Inspection: Digital Answer: 1. Increased angle of the nail bed. 2. w/ chronic hypoxemia (COPD). Question: Visual Inspection: distension Answer: 1. of the neck protrude during breathing. 2. Associated w/CHF and COPD. Question: Visual Inspection: (Heavy sweating)Answer: 1. CHF. 2. Myocardial Infarction (described as cold and skin) 3. Febrile conditions. 4. Night sweats (pt. w/TB.) Question: Visual Inspection: edema Answer: 1. Found in extremities esp. in the lower legs. 2. Associated w/CHF and any -shift disease. Question: Assessment :Adventious(abnormal) Breath Sounds-Wheeze Answer: 1. It is caused by Bronchoconstriction. 2. Bilateral wheeze is treated w/ a . 3. Unilateral wheeze could be caused by a foreign body obstructiob or a bronchial mass as seen w/ lung cancer and treat w/ bronchoscope. Question: Bedside Assessment :Adventious(abnormal) Sounds-Rhonchi(coarse rales) Answer: 1. secretions in the airways. 2. Often remedied by suctioning. Question: Assessment :Adventious(abnormal) Breath Sounds-Rales(crackles) Answer: 1. Secretions in the middle-sized airways. 2.Treated w/ CPT including postural drainage. 3. Fine crackles/rales indicates atelectasis- treat w/ hyperinflation . Question: Assessment :Adventious(abnormal) Breath Sounds-stridor Answer: 1. Upper airway obstruction. 2. Possible foreign body aspiration. 3. If mild- Treat w/cool mist and hydration. 4. If moderate-treat w/racemic epinephrine. 4. If severe-intubate the pt. 5. If body-perform bronchoscopy. Croup and epiglottis occurs. Question: Bedside Assessment :Adventious(abnormal) Breath Sounds-diminished(decreased sounds) Answer: 1. Indicates decresed air movement in the area. 2. Egophony- associated w/consolidation of secretions such as Pneumonia. 3. Bronchophony-Indicates consolidation. Whispered is similar. Question: Bedside Assessment :Adventious(abnormal) Breath -friction rub Answer: 1. Caused from absence of fluid in the pleural space. 2. Treat w/ steroids for inflammation and antibiotics for infection. 3. May be seen in TB, Pulmonary infarction and . Question: Assessment : Breath Sounds-Vesicular Answer: Normal breath indicate normal lungs. Question: Bedside Assessment : Breath -define Percussion Answer: Done by the knuckles while placed over the thorax. Question: Bedside Assessment : Breath -tones Percussion-resonant Answer: normal . Question: Assessment : Breath Sounds-tones Percussion-Hyperresonant Answer: found in w/significant air-trapping, such as COPD and with Pneumothorx. Question: Assessment : Breath Sounds-tones Percussion-Dull Answer: When done over of infiltrates such as seen with Pneumonia. Question: Bedside Assessment : Breath Sounds-tones -Flat Answer: When done over or consolidated lung tissue (not fluid) such as seen with atelectasis. Question: Bedside Assessment : Sounds-Pulse-Acceptable range Answer: 60-100 bpm Question: Assessment : Breath Sounds-Pulse-Tachycardia Answer: >100 bpm w/ Hypoxemia - pt. need more O2. Question: Bedside : Breath Sounds-Pulse-Bradycardia Answer: <60 bpm w/shock, Heart failure, seizure etc. Question: Bedside Assessment : Breath Sounds-Pulse-Pulses Answer: BP rise and fall during Inspiratory and expiratory efforts. associated w/ significant air-trapping such as in asthma/ status asthmaticus cases. Question: Bedside Assessment : Sounds-Ventilation-Tidal Volume(VT)Answer: Should be @least 5ml/kg otherwise pt. needs assistance. Question: Assessment : Breath Sounds-Ventilation-Vital Capacity(VC) Answer: Should be @least 10ml/kg otherwise pt. ventilatory assistance. Question: Bedside Assessment : Breath Sounds-Ventilation-Maximum Inspiratory (MIP/MIF/NIP/NIF) Answer: Should be @least -20 Question: Bedside Assessment : Breath Sounds-Tracheal -Deviation toward the problem Answer: 1. Pulmonary fibrosis. 2. . 3. lobectomy. 4. pneumothorax. Question: Bedside Assessment : Breath Sounds-Tracheal Palpation-Deviation away the Answer: 1. Tension pneumothorax/hemothorax. 2. Pleural effusion (very ). Question: Bedside Assessment : Sounds-Blood Pressure-Acceptable range Answer: - 120/80 mmHg. Question: Bedside : Breath Sounds-Blood Pressure- Decreased Answer: Associated w/shock/ significant fluid loss and . Question: Bedside Assessment : Breath -Blood Pressure - Increased Answer: Associated w/ , stress, cardiac problems and hypoxemia. Question: Bedside Assessment : Sounds-Heart sounds Answer: Normal- S1 and S2. Abnormal- S3 and S4 cardiac dysfunction-ECG is indicated. Question: Patient History: Medical Record - History & Physical Answer: 1. 2. Chief complaint 3. objective information(signs) 4. subjective information(symptoms) Question: Patient History: Patient Record - Occupational exposure Answer: to pulmonary irritants Question: Patient History: Patient Record - Smoking history Answer: pack years = # of yrs. X # of pack/day . 1. Cigars 2. Injuries 3. Current vital signs&medication 4. current repiratory care orders 5. Progress notes. Question: Patient History: - Orientation Answer: 1.Orientation-name,place,day,language 2.Resp. ability-Dsypnea present&Orthopnea 3.Emotional State a)angry-electrolyte imbalance b)panic-hypoxemia,asthma,pneumothorax c)Euphoria-ingestional (drug overdose) 4.Social Support System 5.Proper ques. tech. Question: Patient : Interview - Other areas to assess Answer: 1. Home environment 2. Current care plan 3. pain , quality and persistance 4. triggers to dyspnea 5. family medical history Question: ECG/EKG : equipment & supplies-MachineAnswer: Manages polarity(+ve/-ve) of each electrode. Helps in tracing hearts electro physiology Question: ECG/EKG : recording equipment & - define Electrodes & Leads Answer: A lead may be an individual electrode or a a line of between 2 electrodes. There are total of 12 electrodes. Question: ECG/EKG : recording equipment & supplies - 6 leads Answer: V1-intercostal , rt. Of sternum. V2-intercostal space just lft. Of sternum. V3- is b/w V2 &V4. V4- 5th-intercostal space in the lft. Of mid-clavicular line. V5- b/w V4 & V6. V6-intercostal space in the lft. Of mid-axillary line. Question: ECG/EKG : recording equipment & - 6 limb leads Answer: - Left arm to rt. Arm. LeadII-left leg to rt. Arm. LeadIIIleft leg to left arm. - AVR-rt. Arm. AVL-left arm. AVF-left leg. Question: ECG/EKG : equipment & supplies- +ve LeadAnswer: All leads are positive. Question: ECG/EKG : recording equipment & supplies- which lead is positive and Negative. Answer: involving 2 electrodes, one must be +ve & other -ve. GUIDELINES:1.(Looking @ pt.), electrode most right is +ve. 2. electrode most downward is +ve. 3. Of lead I,right arm -ve,left arm +ve. 4.Of lead II,right arm -ve,left leg +ve. Question: ECG/EKG : recording & supplies-Interpretations- 5 Rate DefinitionAnswer: 1. Acceptable range (60-100bpm) 2. Bradycardia(<60) 3. Tachycardia(>100) 4. (>200) 5. Fibrillations(too fast; uncountable). Question: ECG/EKG : equipment & supplies- Rhythms- Sinus rhythm Answer: . All the bumps (PQRST)are there especially the P wave. Question: ECG/EKG : equipment & supplies- Rhythms- Sinus Tachycardia Answer: >100. w/O2. Question: ECG/EKG : recording equipment & supplies- - Sinus Bradycardia Answer: <60 Treated w/ O2 and . Question: ECG/EKG : equipment & supplies- Rhythms- Premature ventricular contraction(PVC) Answer: wide QRS and T- waves. Treated w/ O2 and Lidocaine. Question: ECG/EKG : recording & supplies- Rhythms- AsystoleAnswer: 1. confirm in 2 chest leads. 2. Do not . 3. Treated w/ chest compression, epinephrine and atropine Question: ECG/EKG : equipment & supplies- Rhythms-Ventricular Fibrillation(v-fib) Answer: 1. treat w/ @ 360 joules. Question: ECG/EKG : equipment & supplies- Rhythms- Ventricular tachycardia(V-tach) Answer: treat w/ defibrillation if no . Then treat w/defibrillation @ 360 joules. Question: ECG/EKG : recording & supplies- Heart Blocks- 1st degree Answer: 1. The distance between the beginning of the P-wave to the beginning of the QRS-complex (P-R ) is greater>.20 secs. 2. Caused by ischemia/digitalis. 3. Treated w/ Atropine. Question: ECG/EKG : recording equipment & supplies- Blocks- 2nd degree Answer: 1. Normal P-wave. 2. Missing QRS-comples. 3. Irregular rhythm. Treated w/ and electrical pacemaker is made ready. Question: ECG/EKG : recording equipment & supplies- Heart Blocks- 3rd Answer: 1. PR interval cannot be determined. 2. QRS is . 3. cannot identify waves consistently. 4. Pt. needs a pacemaker. Question: ECG/EKG : equipment & supplies- Define Axis Answer: 1.It is the in which electricity flows to the heart. 2. It flows down and to the left. 2.It only deviates from the normal for 2 reasons: a. Hypertrophy and b. Infarction. Question: ECG/EKG : recording equipment & supplies- Axis- Answer: 1. It means size of the heart has increased. Therefore will require more electricity and conductivity. 2.Usually to the left is the axis deviation direction as seen in the CHF. Question: ECG/EKG : equipment & supplies- Axis -Infarction Answer: It means that is dead and electricity cannot flow through dead tissue. So axis deviates away from the infarct tissue. Question: ECG/EKG : recording equipment & supplies- 3 "I"s Answer: 1. Myocardial . 2. Myocardial Injury. 3. Myocardial Infarction. Question: ECG/EKG : recording & supplies- Myocardinal IschemiaAnswer: 1. Lack of O2 to the Muscle. 2. T-wave is depressed and will show a -ve deflection. Question: ECG/EKG : recording & supplies- Myocardinal InjuryAnswer: 1. Damage of cardiac tissues -is in the stage. 2. S-T waves will be elevated or spiked from the baseline. Question: ECG/EKG : recording equipment & supplies- Myocardinal Answer: 1. Dead (old / fresh). 2. Will produce a permanent Q-wave (wide,ht.and depth) Question: PFT:Slow Capacity(SVC)Answer: 1. Maximum volume a patient can exhale after a maximal 2. It is to measure restrictive lung disease. Question: PFT:Forced Capacity(FVC) Answer: 1. Maximum volume a patient can forcefully exhale after a inhalation & in least possible time 2.Important to measure FVC both volume & flow 3.FV1/FVC is a best indicator of obstruction 4.Range-normal-85% min. is 75%. Obstructive is present if <75% Question: PFT:Maximum Ventilation(MVV) Answer: 1. Relates to muscle endurance & general function. 2. it is the max. amount of gas that pt. moves in & out of the lungs in 12-15 secs. 3. but this is not a good test bcoz it is to get adequate cooperation. Question: PFT:Flow-volume Loop(FVL) Answer: 1.includes FVC 2. used to vocal cord dysfunction,paralysis&cancerous(Round loop)masses in upper airway. 3. shape of the loop:a)tall&skinny loop-restrictive b)short&fat loop obstructive c)Round loop- large fixed airway obstruction. Question: PFT:Lung Volumes(Nitrogen & Helium dilution) Answer: 1.PURPOSE to determine FRC&RV 2.procedure involves breathing 100% O2 while exhaled nitrogen is analyzed until depleted then a calculation is made to project lung volume.3.He&N analyzer must be . He should read 0% caliberated to room air. Question: PFT:Gas (SBN2) Answer: 1.It is to single breath nitrogen 2. consists 4 phases 3. done during exhalation. Question: PFT:Body Box (Plethysmography) Answer: 1. measures FRC & total thoracic gas volume(TLC). 2. replaces He&N dilution 3. also measures RAW Question: PFT:Diffusion (DLCO/DCO) Answer: 1. Normal DLCO=25 mL CO/min/mmHg(STPD) 2. Poor DLCO usually found in restrictive disease affecting alveolar capillary membrane(ACM) eg. ARDS. Emphysema is only obstructive disease with poor DLCO 3.DLCO how well gases move across ACM. Question: PFT:Bronchial Answer: 1. determines ability to provoke . Question: PFT:Pre & Post bronchodilator Answer: 1. needed to determine effectiveness of bronchodilator & help determine dosage. 2. Helpful in determining reversibility of bronchoconstriction. Question: PFT:Ventilatory to CO2 Answer: Study shows change in ventilation as a response to increases CO2 while keeping PaO2 . Question: Obstructive Answer: 1. FEV1/FVC - If less than 75% then pt. is Obstructive. If FV1/FVC is not available then check or FEV1 by itself and if FEV1- less than 80% then pt. is too. Question: Impairment Answer: 1. FVC- If less than 80% then pt. is Restrictive. If greater then not . Look@ SVC first. If not available then check FVC. Question: Diffusion impaired Vs Normal Answer: 1. DLCO- if less than 80% of predicted (<20mlCO/min/mmHg) then pt. has impariment. Question: Interpretation of Obstructie & Restrictive & Diffusion ImpairmentAnswer: 1.Normal-80%. 2. Mild-60-80%. 3. -40-60%. 4. Severe- <40% . Question: Best Test Determination of FEV1 & Answer: Best Test = (FEV1 + FVC) Question: Spirometer Answer: It is caliberated using a 3.0 L Question: 5 Diseases Answer: C BABE-1.Cystic Fibrosis 2. Bronchiectasis 3. Asthma 4. Bronchitis 5. Question: Which disease is commonly associated with poor DLCO?Answer: Emphysema Question: Answer: . Question: Anatomy of Circulatory Answer: Right Atrium-->Tricupsid valve-->Right Ventricle -->Pulmonary Artery-->Lung Capillaries-->Pulmonary Vein-->Left -->Bicuspid/mitral valve-->Left ventricle-->Systemic Vascular system(body&capillaries)….back to right atrium Question: Normal Answer: 120/80 mmHg(mean-93 mmHg) Question: Mean Formula Answer: Mean BP =((1 x ) + (2 x diastolic)) / 3 Question: 3 of BP Answer: 1. Heart 2. 3. Vessels Question: Normal Hemodynamic values(CVP,PAP,PCWP,CO,SV,EF,CI) :Means & Answer: CVP:2-6 mmHg(mean 4-12 cmH2O) PAP:25/8mmHg(mean-14 mmHg) 3. PCWP:4-12 mmHg(normal 8 mmHg) 4. CO:4-8 L/min 5. Volume(SV):60-130mL 6. Ejection Fraction: 65-75% 7. Cardiac Index(CI):2.5-4.0m2 Question: Central Pressure(CVP) Answer: 1.measurement taken in Rt. Atrium before the atrium 2. when high it relates to fluid overload- diurese pt. 3.when low it relates to dehydration/vasodilation- give fluids/vasoconstricting drugs. 4. related to function the rt. heart in general. Question: Venous Pressure(CVP)-Other Names Answer: 1. Right Atrial Pressure 2. Right side 3. Right ventricular filling presure 4. Right ventricular end-diastolic pressure 5. ALL descriptions use the word RIGHT for CVP. Question: Artery Pressure(PAP) Answer: 1. measurement taken with a transducer at the tip of a catheter placed in the artery. 2. high with COPD patients. 3. best place to get a mixed-venous blood sample. 4. also know as Right Ventricular after load. Question: Pulmonary Capillary Wedge (PCWP) Answer: 1. Measurement taken with ballon-tipped catheter inflated and wedged in the pulmonary artery. 2. Relates to the of left heart. 3. diastolic portion of the PAP can be substituted when a PCWP is not possible. Question: Pulmonary Capillary Pressure(PCWP): Other Names Answer: 1. Pulmonary venous drainage 2. Left artrial pressure 3. Left ventricular filling pressure 4. Left Preload 5. Left ventricular end-diastolic . Question: Output(CO/QT) Answer: 1.expressed as vol. than pressure. 2.also by Cardiac index CI=QT/BSA 3.relates condition of Lft.ventricle 4.measured by a computer thru thermal dilution. 5.calculated by Fick eq.& SV*HR. if QT is decreased - treat w/cardiac medications-Digitalis Question: measurements are taken from various ports in a catheter that is inserted via Answer: the Vena Cava thru the Right Artery & Right Ventricle in the pulmonary artery Question: Hemodynamic : Systemic Vascular Resistance(SVR), Formula & NormalAnswer: ((MAP-CVP)/QT) x 80, : 1600 dynes/sec/cm-5 Question: Hemodynamic Calculations:Pulmonary Resistance(PVR), Formula & Normal Answer: ((Mean PAP-PCWP)/QT) x 80, normal: 200 /sec/cm-5 Question: Echocardiogram: Answer: helps to visualize(ultrasonically) function of the (in M-mode) including ejection fraction and assess general function of the left ventricle Question: :Infants Answer: Helps to visualize cardiac-related anatomy- when suspecting congenital heart and abnormalities Question: Echocardiogram:Infants-Anatomical Answer: 1. Transpostion of the Great Vessels 2. Tetralogy of Fallot 3. Atrial septal defect (ASD) & Ventricular septal (VSD) 4. Patent ductus arteriosis (PDA) 5. Coarctation of the aorta. Question: ECG Answer: 1. Ultrasonic procedure combined with a to compose two-dimensional and M-mode ECG 2. It is Non-invasive, safe, free of radiation. Question: ECG Answer: 1. to determine adequacy of blood flow & pump . 2. Examine size & disease state of cardiac tissue. 3. Inspect cardiac valve function Question: Intracranial (ICP) Monitoring: Acceptable Range, define Increased ICP Answer: 1. 5-10 mmHg. 2. Increased ICP means -a volume of fluid in the brain is under significant pressure - should be treated if ICP > 20 mmHg Question: Intracranial Pressure (ICP) : Technology Answer: 1. Requires access to the brain through a hole in the . A) Subarachnoid bolt - metal screw-like device inserted into the subdural space. B) Ventricular Catheter - placed in a surgical hole in the skull. Question: Pressure (ICP) Monitoring: Treatment & Prevention Answer: 1. Diamox(acetazolamide) - cerebral diuretic 2. Osmitrol (mannitol) - cereberal diuretic 3. Avoid frequent & vigorous suctioning 4. keep sedated to avoid coughing. Question: Intracranial Pressure (ICP) : Causes of increased ICP Answer: 1. Head trauma ( subdural hematoma) 2. Tumors 3. Meningitis 4. Cerebral . Question: (EEG): Define Answer: Determines electrical of the brain Question: Electroencephalography(EEG): Answer: 1. sleep disorders 2. Evaluate for epilepsy 3. Determine degree of 4. Unexplain loss of brain function 5. head trauma. Question: Pulmonary Answer: 1.Useful in diagonising pulmonary embolism 2.definitive than V/Q Scan but expensive. 3.it involves injecting a solution thru a catheter into pulmonary artery. Pt. is monitored radiologically&areas of good, poor&absent blood flow are identified Question: Assessment of the upon Birth & Routine : APGAR Answer: 1. Appearance/color 2. 3. Grimace / Reflex Irritability 4. Activity - muscle movement & tone 5. Respiratory effort - presence of a cry. Question: of the Newborn upon Birth & Routine : APGAR Scoring Answer: 1. Done after 1 min.(neonatal survival) & 5min(Future neonatal brain damage). 2. Scores between 0 & 10 3. The higher the score the better: a)7-10 points - Routine care b)4-6: support with O2,warmth & general . 3. 0-3:CPR (heart/lungs or both). Question: Assessment of the upon Birth & Routine : Routine Assessment: Vital Signs-PulseAnswer: 1. Normal Pulse:110-160bpm. 2. >170-tachycardia-give O2 3. Pulse can be taken brachially or (not radially). 4. Any Cardiopulmonary challenge will cause will cause an increase in infant's heart rate (not an increase in contractility). Question: Assessment of the Newborn upon Birth & Routine : Routine Assessment: Signs- RR & Pattern Answer: 1.Range:30-60/min. 2. Apnea:10 secs. 3. Acceptable Apnea:lasting 10-20 4. if apnea > 20 secs, infant needs further investigation & apnea monitoring Question: Assessment of the Newborn upon Birth & Routine : Routine Assessment: Vital - BP Answer: 1. Normal : 60/40 mmHg. 2. Pre-term : 55/33 mmHg Question: Assessment of the upon Birth & Routine : Routine Assessment: Vital Signs - Temperature Answer: 1.Normal:36-37degree C. 2.Infants looses body temp. quickly& easily. 3.Servo-controlled radiant warmer/incubator should be used. 4.Servo control should be connected to a probe placed on the ' skin - low skin temp. alarm sound if probe comes off skin Question: Newborn Medical : Perinatal History Answer: 1. Maternal 2. Family History. Question: Newborn Medical History : Age Answer: 1. Term -38-42 weeks. 2. pre-term infant-<38 weeks. 3. post-term infant->42 weeks. Question: Newborn Medical : Birth Rate Answer: 1.Normal: 3000 . 2. Low birth wt. - risk of complications. 3. Minimal surviable age and week - 26-28 weeks annd round 100 grams. Question: Physical Assessment : Color Answer: Blue , pink body - called acrocyanosis. Question: Newborn Physical : RR Pattern Answer: sign of ventilatory distress 1)Retractions: a)Intercostal b)Subcostal c)Substernal d)Supraclavicular 2)Grunting:upon causes natural PEEP. 3) Nasal Flaring Question: Newborn Physical Assessment : Refill Answer: Increased refill times indicates problems with cardiac . Question: Newborn Lab : ABG Answer: Normal PaO2:50-80 mmHg. 2)done because infant's blood is scarce Question: Newborn Lab : ABG- How do you rule out a patent ductus arteriosis(PDA). Answer: If PaO2 from radial artery(pre-ductal) & umbilical artery(post-ductal) is greater>15mmHg then infant is +ve for PDA then send to surgery for correction. Question: Lab Assessment : Blood Glucose Answer: Range- greater>30mg/dL 2)for pre-term Range:greater>20mg/dL Question: Lab Assessment : Lenithin/Sphinogomyelin(L/S Ratio) Answer: 1) Normal- 2:1 2)relates to lung 3)if 1:1 is bad administer pulmonary surfactant. Question: Newborn Lab Assessment : Phosphatidyglycerol (PG ) Answer: accurate lung maturity even in the of diabetes. Question: Newborn Lab Assessment : Phosphatydlchloride (PC ) Answer: alternate indicator of lung . |
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