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Lindsey Jones 1B
Lindsey Jones 1B- Patient Data
| Question | Answer |
|---|---|
| VD/VT | ((PaCO2-PECO2)/PaCO2 )* 100, Range 20-40% |
| Alveolar Air Equation(PAO2) | (FIO2*7) – (PaCO2 +10) |
| A-a Gradient (A-aDO2) | PAO2- PaO2, RANGE 25-65mmHg |
| Arterial Oxygen Content (CaO2) | (Hb*1.34*SaO2) + (PaO2 * .003), range 17-20% |
| Venous Oxygen Content (CvO2) | (Hb*1.34*SvO2) + (PvO2 * .003), range 12-16% |
| Arterial-Venous Oxygen content difference, C(a-v)O2 | CaO2-CvO2, Range 4-5% |
| Shunt Equation , QS/QT | ((A-aDO2)*.003 ) / ((A-aDO2)*.003+C(a-v)O2), Range 3- 5 % |
| Fick Equation for Cardiac Output (QT) | VO2 / (C(a-v)O2 * 10) , range 4-8 L/min |
| Cardiac Index | CO / BSA, RANGE 2.5 - 4 L/m/m2 |
| Types of Chest X-rays : AP(Anterior to posterior) | most common in hostpitals. Good for in-bed X-rays. Use when determining proper position of an endotracheal tube. |
| Types of Chest X-rays : PA(Posterior to Anterior) | most often done standing |
| Types of Chest X-rays : Lateral | Helps to visualize the lungs as a 3-dimensional body |
| Types of Chest X-rays : Lateral decubitus | Helpful in detecting pleural effusions. Described as having a concave superior border or interface. |
| Types of Chest X-rays : Oblique | Any diagonal or non-traditional angle. Increases 3-dimensionality of lung, helpful in spotting internal issues such as masses, blebs, or lesions. |
| Neck X-rays : Lateral Neck | a.Differentiate Croup (Subglottic inflammation/Laryngotracheobronchitis):1.Steeple Sign2.not Life-Threatening & Acute epiglottitis(Supraglottic swelling): Thumb sign. |
| Neck X-rays : Artificial Airway placement and function | 1. Use a A-P chest radiograph. 2. Determined by radio-opaque line on the ET tube. 3. End of line should be 2cm above the carina (or 1 inch) |
| Placement X-rays : Chest tube placement | should be in the pleural space |
| 1) Placement X-rays : Central venous catheter placement 2)Placement X-rays : Pulmonary artery catheter placement | 1)tip should rest in the right atrium or vena cava 2)distal end in the pulmonary artery, not wedged(i.e. balloon not inflamed.) |
| Placement X-rays : Nasogastric tube positioning | should be found in the stomach or small bowel |
| Normal Chest X-ray description | 1. Bilateral radiolucency 2. sharp costophrenic angles 3. Hemi-diaphragms dome shaped, right higher than left 4. Trachea is midline |
| Radiological Description : Trachea shift from midline-Associated Problem | Pneumothroax, hemotorax, significant atelectasis |
| Radiological Description : Obliterated costophrenic angles-Associated Problem | pleural effusion |
| Radiological Description : Flattened diaphragm-Associated Problem | COPD, significant air trapping |
| Radiological Description : Radiolucent-Associated Problem | Normal |
| Radiological Description : Fluffy infiltrates-Associated Problem | Pulmornary edema |
| Radiological Description : Wedge - shaped infiltrates-Associated Problem | Pulmonary embolus |
| Radiological Description : Air bronchogram-Associated Problem | Pneumonia |
| Radiological Description : Butterfly or Batwing Pattern-Associated Problem | Pulmonary edema |
| Radiological Description : Plate like or patchy infiltrates-Associated Problem | Atelectasis |
| Radiological Description : Ground glass or Honeycomb pattern- Associated Problem | ARDS/IRDS |
| Radiological Description : Reticulongranular pattern | ARDS/IRDS |
| Radiological Description : Concave superior interface | pleural effusion |
| Diagnostic Radiology : V/Q studies | 1.Perfusion- abnormal when blood flow around the alveoli is hindered.2. Ventilation-abnormal/missing gas flow in areas of the lungs. Xenon gas is used to monitor gas flow. - V/Q is associated w/ pulmonary emboli. |
| Diagnostic Radiology : Computed Tomography CT / CAT | Used to visualize 1.lung masses,lesions,or nodules 2. during scanning metals are not to be used directly. |
| Diagnostic Radiology : Magnetic Resonance Imaging (MRI) | 1. Useful in detecting masses, lesions or nodules without use of radioactive materials. 2.Must use fluidic ventilator with no metal parts. No oxygen tank in the area (only non-ferrous items) |
| Diagnostic Radiology : Bronchogram | 1. Primary diagnostic tool for Bronchiectasis. 2. helps to direct postural drainage and percussion efforts. 3. this procedure can lead to respiratory deterioration and distress. |
| Diagnostic Radiology : Barium Swallow | 1. Radiographic assessment 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. |
| K+ Potassium | Major: Intracellular Cation. Important for acid-base balance. Normal: 3.5-4.5 mEq/L range HYPERkalemia-(Metabolic ACIDOSIS) Hypokalemia-(Metabolic Alkalosis) |
| Na+ Sodium Major: | Major:Extracellular Cation. Normal: 135-145 mEq/L range HYPERnatremia Hyponatremia |
| Cl- Chloride | Major: Extracellular Anion. Normal: 80-100 mEq/L range HYPERchloremia: (Metabolic ACIDOSIS ) Hypochloremia: (Metabolic alkalosis) |
| HCO3- Bicarbonate | Changes in Total CO2 content reflect changes in blood base. Normal: 22-26 mEq/L range HIGH HCO3- (Metabolic ALKALOSIS) Low HCO3- (Metablolic acidosis) |
| Creatinine and BUN (Blood Urea Nitrogen) | 1. Both indicates kidney function. 2. Ceratine is more accurate than BUN. 3.Acceptable range- 8-25 mg/dl. 4. Acceptable range- 0.7-1.3 mg/dl. |
| Coagulation Studies : Platelet count | 1. Required for blood clotting. 2. Acceptable value - 150,000-400,000 units/mm3 |
| Coagulation Studies : PT (Prothrombin time) | PT Done when patient receiving Warfarin (coumadin). Normal Value (23-32) |
| Coagulation Studies : APTT(Activated partial thomblastin time) | APTT done when pt. taking Heparin therapy. PTT Normal Value (12-15 secs.) |
| Complete Blood Count(CBC) : Hb | 1. Carries 1.34mL/gm O2 2. Acceptable range-12-16 gm/dl. |
| Complete Blood Count(CBC) : RBC | 1. cells that carry Hb. 2.Acceptable range-4-6 mill/cu mm. |
| Complete Blood Count(CBC) : WBC | 1.Range 5000-10000/cu mm.(higher indicates infection-txt. antibiotics)2. Types:Neutrophils A)Bands4%-increased w/bacterial infection. B)Segs60%-decreases w/bacterial infection.C)Esinophills2%-causes asthma yellow sputum. D)Monocytes-elevation causes TB. |
| Transcutaneous PO2 and PCO2 monitoring | 1. used on infants 2. electrode placed on skin & should be moved every 4 hrs. or causes burns on the skin 3. only accurate if perfusion is happening - correlates with the blood gas values. |
| Urine: Urinalysis | 1. Helpful in checking urinary tract infections. 2. Useful when suspecting diabetes (check ketones in blood). |
| Sputum:Gram stain | Determine if organism is gram positive/gram negative. |
| Sputum:Culture | Identifies the actual organism. |
| Sputum: Sensitivity | Identifies the organism-killing antibiotics. |
| Sputum: Acid fast stain | Used to detect the organism associated w/ TB (mycobacterium TB) |
| Sputum: clear | normal |
| Sputum: White or mucoid | chronic bronchitis |
| Sputum: Yellow | presence of WBC, bacterial infection. |
| Sputum: Green | stagnant sputum- Bronchiectasis, pseudomonas. |
| Sputum: Red | Hemoptysis - bleeding, TB. |
| Sputum: Brown | old blood. |
| Sputum: Pink frothy | Pulmonary edema. |
| Ventilation : Definition | It is the act of moving air in&out of lung space. Most imp. vital function is vetilation. Ie. Ventilation must happen before oxygenation. If that never happens, oxygenation,circulation&perfusion will not occur. |
| Ventilation : Physical signs of ventilation | 1. Chest movement 2. RR & depth 3. Vt 4. Breath Sounds |
| Ventilation : Physical signs of ventilatory distress | 1. Intercostal & Sternal retractions - associated with upper airway obstruction 2. Accessory muscle use. |
| Ventilation : lab signs of ventilation | PaCO2 level |
| Oxygenation : Definition | 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 remove object for ventilation becoz 1st priority is ventilation. |
| Oxygenation : Physical signs of oxygenation | 1. Color 2. HR(Tachycardia is poor oxygenation) 3. Mental Status(confused, stuporous) 4. Sensorium |
| Oxygenation : Lab signs of oxygenation | 1. Oxygen saturation 2. PaO2(blood gas) |
| Circulation: signs | 1. Pulse rate 2. Pulse strength 3. Cardia output 4. Stroke volume |
| Perfusion : signs | 1. BP 2. Sensorium 3. Urine Output (best indicator of perfusion) |
| study of circulation and perfusion is also called | Hemodynamics |
| Visual Inspection : General Appearance | 1. Height and weight. 2. age and sex. 3. body frame, nutrition. 4. Cachetic - wasted in appearance, poor skin tugor. |
| Visual Inspection : Color- Cyanosis | Hypoxemia. |
| Visual Inspection : Color - ashen/pallor | anemia, shock (vasodilation). |
| Visual Inspection : Color- jaundice | excessive bilirubin. |
| Visual Inspection : Color - erythema | redness, infection and inflammation. |
| Visual Inspection : Color -normal, good color | good oxygentaion. |
| Visual Inspection : chest configuration and condition- increased A-P diameter (barrel-chest) | seen in pt. with COPD or chronic air-trapping such as cystic fibrosis. |
| Visual Inspection : chest configuration and condition - scoliosis, kyphosis, kyphoscoliosis | curvature of the spine. Kyposis is hunchback. Scoliosis curvature. PFT will show restrictive component. |
| Visual Inspection : respiratory rate and pattern- Eupnea | normal breathing pattern. |
| Visual Inspection : respiratory rate and pattern: Tachypnea | RR over >20 bpm |
| Visual Inspection : respiratory rate and pattern: Bradypnea | RR less <8 also know as Oligopnea. |
| Visual Inspection : respiratory rate and pattern: Hperpnea | Increased RR,depth and regular rhythm. Associated w/ metabolic disorders. |
| Visual Inspection : respiratory rate and pattern: Apnea | cessation of breathing. |
| Visual Inspection : respiratory rate and pattern: Kussmaul breathing | Increased RR,depth and irregular rhythm. Associated w/diabetic ketoacidosis/ metabolic acidosis. |
| Visual Inspection : respiratory rate and pattern: Biots breathing | Increased RR,depth and unpredicatable periods of apnea. Associated with CNS disorders. |
| Visual Inspection : respiratory rate and pattern: cheyne-stokes | Increase and then decreasing RR and rhythm. Each cycle takes upto 3minutes to complete and apnea lasts up to 60 secs. Associated w/ingestional errors (drug overdose) and elavated Intracranial pressure (ICP) problems (Head trauma etc.) |
| Visual Inspection : Acessory muscle use - normal muscles | 1. External intercostals 2. Diaphragm |
| Visual Inspection : Acessory muscle use - associated with ventilatory difficulty | 1. Intercostals 2. scalene. 3. Sternocleidomastoid 4. Oblique, rectus abdomial muscles. |
| Visual Inspection : Nasal flaring | Relates to ventilatory difficulty in the newborn. |
| Visual Inspection : Presence and nature of a cough | 1. strenght of cough effort. 2. frequency. 3. Productive or not:> a. Blood(hemoptysis)-TB. B. Dry or non-productive- Lung cancer/foreign body. Yellow sputum-infection. |
| Visual Inspection: Chest movement-symmetry of movement - Asymmetrical | 1. COPD. 2. Flail chest(broken ribs. 3. Pneumothorax. 4. ET tube advanced too far into one lung. 5. Significant atelectasis. |
| Visual Inspection: Chest movement-symmetry of movement - Normal Pattern | 1. Thorax moves out on inspiration. 2. Abdomen moves out on inspiration. |
| Visual Inspection: Digital clubbing | 1. Increased angle of the nail bed. 2. Associated w/ chronic hypoxemia (COPD). |
| Visual Inspection: Venous distension | 1. Veins of the neck protrude during breathing. 2. Associated w/CHF and COPD. |
| Visual Inspection: Diaphoresis(Heavy sweating) | 1. CHF. 2. Myocardial Infarction (described as cold and clammy skin) 3. Febrile conditions. 4. Night sweats (pt. w/TB.) |
| Visual Inspection: Peripheral edema | 1. Found in extremities esp. in the lower legs. 2. Associated w/CHF and any fluid-shift disease. |
| Bedside Assessment :Adventious(abnormal) Breath Sounds-Wheeze | 1. It is caused by Bronchoconstriction. 2. Bilateral wheeze is treated w/ a bronchodilator. 3. Unilateral wheeze could be caused by a foreign body obstructiob or a bronchial mass as seen w/ lung cancer and treat w/ bronchoscope. |
| Bedside Assessment :Adventious(abnormal) Breath Sounds-Rhonchi(coarse rales) | 1. secretions in the large airways. 2. Often remedied by suctioning. |
| Bedside Assessment :Adventious(abnormal) Breath Sounds-Rales(crackles) | 1. Secretions in the middle-sized airways. 2.Treated w/ CPT including postural drainage. 3. Fine crackles/rales indicates atelectasis- treat w/ hyperinflation therapy. |
| Bedside Assessment :Adventious(abnormal) Breath Sounds-stridor | 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 foreign body-perform bronchoscopy. Croup and epiglottis occurs. |
| Bedside Assessment :Adventious(abnormal) Breath Sounds-diminished(decreased breath sounds) | 1. Indicates decresed air movement in the area. 2. Egophony- associated w/consolidation of secretions such as Pneumonia. 3. Bronchophony-Indicates consolidation. Whispered pectoriloquy is similar. |
| Bedside Assessment :Adventious(abnormal) Breath Sounds-friction rub | 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 pleurisy. |
| Bedside Assessment : Breath Sounds-Vesicular | Normal breath sounds indicate normal lungs. |
| Bedside Assessment : Breath Sounds-define Percussion | Done by tapping the knuckles while placed over the thorax. |
| Bedside Assessment : Breath Sounds-tones Percussion-resonant | normal lungs. |
| Bedside Assessment : Breath Sounds-tones Percussion-Hyperresonant | found in cases w/significant air-trapping, such as COPD and with Pneumothorx. |
| Bedside Assessment : Breath Sounds-tones Percussion-Dull | When done over areas of infiltrates such as seen with Pneumonia. |
| Bedside Assessment : Breath Sounds-tones Percussion-Flat | When done over bones or consolidated lung tissue (not fluid) such as seen with atelectasis. |
| Bedside Assessment : Breath Sounds-Pulse-Acceptable range | 60-100 bpm |
| Bedside Assessment : Breath Sounds-Pulse-Tachycardia | >100 bpm associated w/ Hypoxemia - pt. need more O2. |
| Bedside Assessment : Breath Sounds-Pulse-Bradycardia | <60 bpm associated w/shock, Heart failure, seizure etc. |
| Bedside Assessment : Breath Sounds-Pulse-Pulses Paradoxus | BP rise and fall during Inspiratory and expiratory efforts. associated w/ significant air-trapping such as in severe asthma/ status asthmaticus cases. |
| Bedside Assessment : Breath Sounds-Ventilation-Tidal Volume(VT) | Should be @least 5ml/kg otherwise pt. needs ventilatory assistance. |
| Bedside Assessment : Breath Sounds-Ventilation-Vital Capacity(VC) | Should be @least 10ml/kg otherwise pt. needs ventilatory assistance. |
| Bedside Assessment : Breath Sounds-Ventilation-Maximum Inspiratory pressure(MIP/MIF/NIP/NIF) | Should be @least -20 cmH20 |
| Bedside Assessment : Breath Sounds-Tracheal Palpation-Deviation toward the problem | 1. Pulmonary fibrosis. 2. atelectasis. 3. lobectomy. 4. pneumothorax. |
| Bedside Assessment : Breath Sounds-Tracheal Palpation-Deviation away the problem | 1. Tension pneumothorax/hemothorax. 2. Pleural effusion (very large). |
| Bedside Assessment : Breath Sounds-Blood Pressure-Acceptable range | Normal - 120/80 mmHg. |
| Bedside Assessment : Breath Sounds-Blood Pressure- Decreased | Associated w/shock/ significant fluid loss and dehydration. |
| Bedside Assessment : Breath Sounds-Blood Pressure - Increased | Associated w/ anxiety, stress, cardiac problems and hypoxemia. |
| Bedside Assessment : Breath Sounds-Heart sounds | Normal- S1 and S2. Abnormal- S3 and S4 indicates cardiac dysfunction-ECG is indicated. |
| Patient History: Patient Medical Record - History & Physical | 1. Diagnosis 2. Chief complaint 3. objective information(signs) 4. subjective information(symptoms) |
| Patient History: Patient Medical Record - Occupational exposure | Exposure to pulmonary irritants |
| Patient History: Patient Medical Record - Smoking history | pack years = # of yrs. X # of pack/day smoked. 1. Cigars 2. Injuries 3. Current vital signs&medication 4. current repiratory care orders 5. Progress notes. |
| Patient History: Interview - Orientation | 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 error(drug overdose) 4.Social Support System 5.Proper ques. tech. |
| Patient History: Interview - Other areas to assess | 1. Home environment 2. Current care plan 3. pain location, quality and persistance 4. triggers to dyspnea 5. family medical history |
| ECG/EKG : recording equipment & supplies-Machine | Computer Manages polarity(+ve/-ve) of each electrode. Helps in tracing hearts electro physiology |
| ECG/EKG : recording equipment & supplies- define Electrodes & Leads | A lead may be an individual electrode or a a line of electricity between 2 electrodes. There are total of 12 electrodes. |
| ECG/EKG : recording equipment & supplies - 6 Chest leads | V1-intercostal space, 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. |
| ECG/EKG : recording equipment & supplies- 6 limb leads | LeadI- 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. |
| ECG/EKG : recording equipment & supplies- +ve Lead | All precordial leads are positive. |
| ECG/EKG : recording equipment & supplies- determine which lead is positive and Negative. | leads 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. |
| ECG/EKG : recording equipment & supplies-Interpretations- 5 Rate Definition | 1. Acceptable range (60-100bpm) 2. Bradycardia(<60) 3. Tachycardia(>100) 4. Flutter(>200) 5. Fibrillations(too fast; uncountable). |
| ECG/EKG : recording equipment & supplies- Rhythms- Sinus rhythm | Normal. All the bumps (PQRST)are there especially the P wave. |
| ECG/EKG : recording equipment & supplies- Rhythms- Sinus Tachycardia | >100. Treated w/O2. |
| ECG/EKG : recording equipment & supplies- Rhythms- Sinus Bradycardia | <60 Treated w/ O2 and Atropine. |
| ECG/EKG : recording equipment & supplies- Rhythms- Premature ventricular contraction(PVC) | wide QRS and depressed T- waves. Treated w/ O2 and Lidocaine. |
| ECG/EKG : recording equipment & supplies- Rhythms- Asystole | 1. confirm in 2 chest leads. 2. Do not defibrilliate. 3. Treated w/ chest compression, epinephrine and atropine |
| ECG/EKG : recording equipment & supplies- Rhythms-Ventricular Fibrillation(v-fib) | 1. treat w/ defibrillation @ 360 joules. |
| ECG/EKG : recording equipment & supplies- Rhythms- Ventricular tachycardia(V-tach) | treat w/ defibrillation if no pulse. Then treat w/defibrillation @ 360 joules. |
| ECG/EKG : recording equipment & supplies- Heart Blocks- 1st degree | 1. The distance between the beginning of the P-wave to the beginning of the QRS-complex (P-R interval) is greater>.20 secs. 2. Caused by ischemia/digitalis. 3. Treated w/ Atropine. |
| ECG/EKG : recording equipment & supplies- Heart Blocks- 2nd degree | 1. Normal P-wave. 2. Missing QRS-comples. 3. Irregular rhythm. Treated w/ Atropine and electrical pacemaker is made ready. |
| ECG/EKG : recording equipment & supplies- Heart Blocks- 3rd degree | 1. PR interval cannot be determined. 2. QRS is widened. 3. cannot identify waves consistently. 4. Pt. needs a pacemaker. |
| ECG/EKG : recording equipment & supplies- Define Axis | 1.It is the angle 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. |
| ECG/EKG : recording equipment & supplies- Axis- Hypertrophy | 1. It means size of the heart has increased. Therefore will require more electricity and slower conductivity. 2.Usually to the left is the axis deviation direction as seen in the CHF. |
| ECG/EKG : recording equipment & supplies- Axis -Infarction | It means that tissue is dead and electricity cannot flow through dead tissue. So axis deviates away from the infarct tissue. |
| ECG/EKG : recording equipment & supplies- 3 Myocardinal "I"s | 1. Myocardial Ischemia. 2. Myocardial Injury. 3. Myocardial Infarction. |
| ECG/EKG : recording equipment & supplies- Myocardinal Ischemia | 1. Lack of O2 to the cardiac Muscle. 2. T-wave is depressed and will show a -ve deflection. |
| ECG/EKG : recording equipment & supplies- Myocardinal Injury | 1. Damage of cardiac tissues -is in the dying stage. 2. S-T waves will be elevated or spiked from the baseline. |
| ECG/EKG : recording equipment & supplies- Myocardinal Infarction | 1. Dead tissue (old / fresh). 2. Will produce a permanent Q-wave (wide,ht.and depth) |
| PFT:Slow Vital Capacity(SVC) | 1. Maximum volume a patient can exhale after a maximal inhalation 2. It is to measure restrictive lung disease. |
| PFT:Forced Vital Capacity(FVC) | 1. Maximum volume a patient can forcefully exhale after a maximal 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% |
| PFT:Maximum Voluntary Ventilation(MVV) | 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 difficult to get adequate cooperation. |
| PFT:Flow-volume Loop(FVL) | 1.includes FVC 2. used to evaluate 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. |
| PFT:Lung Volumes(Nitrogen washout & Helium dilution) | 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 caliberated. He should read 0% caliberated to room air. |
| PFT:Gas Distribution(SBN2) | 1.It is to eliminate single breath nitrogen 2. consists 4 phases 3. done during exhalation. |
| PFT:Body Box (Plethysmography) | 1. measures FRC & total thoracic gas volume(TLC). 2. replaces He&N dilution methods 3. also measures RAW |
| PFT:Diffusion studies(DLCO/DCO) | 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 measures how well gases move across ACM. |
| PFT:Bronchial Provocation | 1. determines ability to provoke bronchoconstriction. |
| PFT:Pre & Post bronchodilator studies | 1. needed to determine effectiveness of bronchodilator medications & help determine dosage. 2. Helpful in determining reversibility of bronchoconstriction. |
| PFT:Ventilatory response to CO2 | Study shows change in ventilation as a response to increases CO2 while keeping PaO2 steady. |
| Obstructive Impairment | 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 obstructive too. |
| Restrictive Impairment | 1. FVC- If less than 80% then pt. is Restrictive. If greater then not restrictive. Look@ SVC first. If not available then check FVC. |
| Diffusion impaired Vs Normal Diffusion | 1. DLCO- if less than 80% of predicted (<20mlCO/min/mmHg) then pt. has diffuion impariment. |
| Categorizing Interpretation of Obstructie & Restrictive & Diffusion Impairment | 1.Normal-80%. 2. Mild-60-80%. 3. Moderate-40-60%. 4. Severe- <40% . |
| Best Test Determination of FEV1 & FVC | Best Test = Highest (FEV1 + FVC) |
| Spirometer | It is caliberated using a 3.0 L syringe |
| 5 Obstructive Diseases | C BABE-1.Cystic Fibrosis 2. Bronchiectasis 3. Asthma 4. Bronchitis 5. Emphysema |
| Which obstructive disease is commonly associated with poor DLCO? | Emphysema |
| Hemodynamics | . |
| Anatomy of Circulatory system | Right Atrium-->Tricupsid valve-->Right Ventricle -->Pulmonary Artery-->Lung Capillaries-->Pulmonary Vein-->Left atrium-->Bicuspid/mitral valve-->Left ventricle-->Systemic Vascular system(body&capillaries)….back to right atrium |
| Normal BP | 120/80 mmHg(mean-93 mmHg) |
| Mean Pressue Formula | Mean BP =((1 x systolic) + (2 x diastolic)) / 3 |
| 3 Mechanisms of BP | 1. Heart 2. Blood 3. Vessels |
| Normal Hemodynamic values(CVP,PAP,PCWP,CO,SV,EF,CI) :Means & Ranges | 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. Stroke Volume(SV):60-130mL 6. Ejection Fraction: 65-75% 7. Cardiac Index(CI):2.5-4.0m2 |
| Central Venous Pressure(CVP) | 1.measurement taken in Rt. Atrium immediately 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. |
| Central Venous Pressure(CVP)-Other Names | 1. Right Atrial Pressure 2. Right side preload 3. Right ventricular filling presure 4. Right ventricular end-diastolic pressure 5. ALL descriptions use the word RIGHT for CVP. |
| Pulmonary Artery Pressure(PAP) | 1. measurement taken with a transducer at the tip of a catheter placed in the pulmonary artery. 2. high with COPD patients. 3. best place to get a mixed-venous blood sample. 4. also know as Right Ventricular after load. |
| Pulmonary Capillary Wedge Pressure(PCWP) | 1. Measurement taken with ballon-tipped catheter inflated and wedged in the pulmonary artery. 2. Relates to the function of left heart. 3. diastolic portion of the PAP can be substituted when a PCWP is not possible. |
| Pulmonary Capillary Wedge Pressure(PCWP): Other Names | 1. Pulmonary venous drainage 2. Left artrial pressure 3. Left ventricular filling pressure 4. Left Preload 5. Left ventricular end-diastolic preload. |
| Cardiac Output(CO/QT) | 1.expressed as vol. than pressure. 2.also expressed 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 |
| Hemodynamic measurements are taken from various ports in a catheter that is inserted via | the Vena Cava thru the Right Artery & Right Ventricle ending in the pulmonary artery |
| Hemodynamic Calculations: Systemic Vascular Resistance(SVR), Formula & Normal | ((MAP-CVP)/QT) x 80, normal: 1600 dynes/sec/cm-5 |
| Hemodynamic Calculations:Pulmonary Vascular Resistance(PVR), Formula & Normal | ((Mean PAP-PCWP)/QT) x 80, normal: 200 dynes/sec/cm-5 |
| Echocardiogram: Adults | helps to visualize(ultrasonically) function of the heart (in M-mode) including ejection fraction and assess general function of the left ventricle |
| Echocardiogram:Infants | Helps to visualize cardiac-related anatomy- especially when suspecting congenital heart and abnormalities |
| Echocardiogram:Infants-Anatomical Abnormalities | 1. Transpostion of the Great Vessels 2. Tetralogy of Fallot 3. Atrial septal defect (ASD) & Ventricular septal defect (VSD) 4. Patent ductus arteriosis (PDA) 5. Coarctation of the aorta. |
| ECG Technology | 1. Ultrasonic procedure combined with a computer to compose two-dimensional and M-mode ECG 2. It is Non-invasive, safe, free of radiation. |
| ECG Indications | 1. to determine adequacy of blood flow & pump function. 2. Examine size & disease state of cardiac tissue. 3. Inspect cardiac valve function |
| Intracranial Pressure (ICP) Monitoring: Acceptable Range, define Increased ICP | 1. 5-10 mmHg. 2. Increased ICP means -a volume of cerebral fluid in the brain is under significant pressure - should be treated if ICP > 20 mmHg |
| Intracranial Pressure (ICP) Monitoring: Technology | 1. Requires access to the brain through a hole in the skull. A) Subarachnoid bolt - metal screw-like device inserted into the subdural space. B) Ventricular Catheter - placed in a surgical hole in the skull. |
| Intracranial Pressure (ICP) Monitoring: Treatment & Prevention | 1. Diamox(acetazolamide) - cerebral diuretic 2. Osmitrol (mannitol) - cereberal diuretic 3. Avoid frequent & vigorous suctioning 4. keep patient sedated to avoid coughing. |
| Intracranial Pressure (ICP) Monitoring: Causes of increased ICP | 1. Head trauma ( subdural hematoma) 2. Tumors 3. Meningitis 4. Cerebral edema. |
| Electroencephalography(EEG): Define | Determines electrical activity of the brain |
| Electroencephalography(EEG): Indications | 1. sleep disorders 2. Evaluate for epilepsy 3. Determine degree of retradation 4. Unexplain loss of brain function 5. head trauma. |
| Pulmonary Angiography | 1.Useful in diagonising pulmonary embolism 2.definitive than V/Q Scan but expensive. 3.it involves injecting a contrasting solution thru a catheter into pulmonary artery. Pt. is monitored radiologically&areas of good, poor&absent blood flow are identified |
| Assessment of the Newborn upon Birth & Routine : APGAR | 1. Appearance/color 2. Pulse 3. Grimace / Reflex Irritability 4. Activity - muscle movement & tone 5. Respiratory effort - presence of a cry. |
| Assessment of the Newborn upon Birth & Routine : APGAR Scoring | 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 simulation. 3. 0-3:CPR (heart/lungs or both). |
| Assessment of the Newborn upon Birth & Routine : Routine Assessment: Vital Signs-Pulse | 1. Normal Pulse:110-160bpm. 2. >170-tachycardia-give O2 3. Pulse can be taken brachially or femorally(not radially). 4. Any Cardiopulmonary challenge will cause will cause an increase in infant's heart rate (not an increase in contractility). |
| Assessment of the Newborn upon Birth & Routine : Routine Assessment: Vital Signs- RR & Pattern | 1.Range:30-60/min. 2. Normal Apnea:10 secs. 3. Acceptable Apnea:lasting 10-20 4. if apnea > 20 secs, infant needs further investigation & apnea monitoring |
| Assessment of the Newborn upon Birth & Routine : Routine Assessment: Vital Signs - BP | 1. Normal : 60/40 mmHg. 2. Pre-term infants: 55/33 mmHg |
| Assessment of the Newborn upon Birth & Routine : Routine Assessment: Vital Signs - Temperature | 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 infant' skin - low skin temp. alarm sound if probe comes off skin |
| Newborn Medical History : Perinatal History | 1. Maternal History 2. Family History. |
| Newborn Medical History : Gestational Age | 1. Term infant-38-42 weeks. 2. pre-term infant-<38 weeks. 3. post-term infant->42 weeks. |
| Newborn Medical History : Birth Rate | 1.Normal: 3000 grams. 2. Low birth wt. - risk of complications. 3. Minimal surviable age and week - 26-28 weeks annd round 100 grams. |
| Newborn Physical Assessment : Color | Blue extremities, pink body - called acrocyanosis. |
| Newborn Physical Assessment : RR Pattern | sign of ventilatory distress 1)Retractions: a)Intercostal b)Subcostal c)Substernal d)Supraclavicular 2)Grunting:upon exhalation causes natural PEEP. 3) Nasal Flaring |
| Newborn Physical Assessment : Capillary Refill | Increased refill times indicates problems with cardiac output. |
| Newborn Lab Assessment : ABG | Normal PaO2:50-80 mmHg. 2)done conservatively because infant's blood is scarce |
| Newborn Lab Assessment : ABG- How do you rule out a patent ductus arteriosis(PDA). | If PaO2 from right radial artery(pre-ductal) & umbilical artery(post-ductal) is greater>15mmHg then infant is +ve for PDA then send to surgery for correction. |
| Newborn Lab Assessment : Blood Glucose | Range- greater>30mg/dL 2)for pre-term infants Range:greater>20mg/dL |
| Newborn Lab Assessment : Lenithin/Sphinogomyelin(L/S Ratio) | 1) Normal- 2:1 2)relates to lung maturity 3)if 1:1 is bad administer pulmonary surfactant. |
| Newborn Lab Assessment : Phosphatidyglycerol (PG Level) | accurate lung maturity even in the presence of diabetes. |
| Newborn Lab Assessment : Phosphatydlchloride (PC Level) | alternate indicator of lung maturity. |
Created by:
johnfaar
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