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Diagnostic Final

spc

QuestionAnswer
What should PFT results be reported in? BTPS, the American thoracic society requires this
In a pt with severe obstructive lung disease, which would be higher the FVC ot SVC? The SVC, they can get more air out in a longer amount of time
A decreased FEV1 could be seen in? restriction, obstruction, combined, and poor pt effort
Indirect spirometry methods? gas dilution(open or closed), body plethysmography
If air is trapped in the lungs(emphysema) gas dilution techniques will? not work, can only measure volumes in communication with the conduction airways, you would have to use body plethysmography for accurate FRC
FEF 25%-75%? medium to small airways, later in expiratory maneuver, normal is 4-5 l/sec,<80% pt on way to developing airway disease
FEF 200-1200? larger airways, earlier in expiratory maneuver, normal is 6-8 /sec. decreased with obstruction
Your pt's FEF 25% 75% is below predicted, what does this indicate? early stages of obstructive or restrictive disease
MEP is used for? strength test for abdominal muscles and accessory expiratory muscles. if decreased pt may not be able to cough, normal is 80-100
MIP/NIF is used for? strength test of the diaphragm, intercostals, and inspiratory accessory muscles. (most negative pressure generated with inspiratory effort)
If pt has an abnormal MIP what does this indicate? weakened inspiratory muscles, neuromuscular disease, chest/spine abnormalities
What is a normal MIP? <-60 (-61,-62,-63, etc...)
Normal % predicted TLC 80%-120%, < restricted, > obstructed
Normal % predicted FRC 35-135, < restricted, > obstructed
FEV1(actual)/FVC(actual) < 80% = obstructed
FVC(actual) < 80% predicted = restricted
Your subject's spirometry results shows a VC, FRC, RV, and TLC less than predicted. This indicates... restricted, all values decreased
A patient has an increased TLC, RV,FRC and has a reduced peak flow. What does this suggest? obstruction
Body plethysmography? measures FRC, most accurate because it can measure trapped air. (better than gas dilution methods)
Pt has a reduced VC, reduced FEV1/FVC, increased RV, FRC, and TLC, This indicates? obstruction
What is the most commonly used device to monitor asthmatics? peak flow meter, a decreased peak flow indicates obstruction
VT? volume inhaled and exhaled in a normal breath
IRV? volume forcibly inhaled past normal vt
ERV? volume forcibly exhaled past normal vt
RV? volume left in the lungs after max expiration (increased with obstruction)
IC? max volume inhaled after normal exhale, ( VT+IRV)
FVC? volume exhaled after max inhale (can be decreased in obstruction because pt cant get air out, SVC will be higher) VT+IRV+ERV
TLC? air in the lungs after max inhale (increased with obstruction due to air trapping) sum of all lung volumes IRV+VT+ERV+RV
FRC? air in lungs after normal expiration (increased in obstruction due to air trapping)
The borg scale measures? perceived dyspnea
Exhaled nitric oxide levels are used for (FeNO)? determining extent of airway inflammation, asthma severity and success of treatment, higher the FeNO the more inflammation
What are the two methods of determining dead space? Fowler method and Bohr method
The fowler method is? nitrogen washout, can be either single or multiple breathes, pt breathes 100% OXYGEN for 7 mins and then the amount of nitrogen is measured
The bohr method uses what equation? PaC02-PeC02/PaC02 PaC02- ABG, PeC02- Douglas bag and end tidal C02
DLCO measurements are based on? the idea that the difference between the CO inhaled and exhaled is the amount that has diffused into the bloodstream
If an FRC measured in a body box is higher than an FRC measured from a gas dilution method, this means? there is an obstruction, the body box can measure air trapped in the airways
Why is soda lime used in a rebreathing circuit? used to absorb the exhaled carbon dioxide, prevent C02 re breathing
Short & Fat Loops indicate- Tall & skinny loops indicate- Obstruction Restriction
Scoop in the loop of expiratory side? obstruction, early is larger airways, later in smaller airways (exhale larger airways first)
What type of study is indicated when the patient has a history of wheezing, is a known asthmatic, has a cough of unknown etiology, or to see if bronchodilater therapy will benefit pt? pre and post bronchodilater study, an increase in FEV1 > 12% indicates positive response, used to determine if obstructive disease is reversibe
Normal resting value for DLCO? 25mlCO/min/mmhg
Predicted DLCO values? 80-120% normal 60-80% mild defect 40-60% moderate defect 20-40% severe <20% very severe
What pulmonary problems can cause a decreased DLCO? emphysema, cystic fibrosis, pulm resection, pulm/fat emboli, anemia, interstitial lung disease(asbestosis, sarcoidosis, fibrosis, pneumonitis) pulm hypertension/edema
What can cause an increased DLCO? supine position, increased pulm blood flow, exercise, pulm hemorrhage, polycythemia with increased Hb(chronic lung disease can cause polycythemia), left heart failure, left to right cardiac shunt, high altitudes that increase Hb, asthma will be normal or
Pulmonary disease will affect DLCO results? any disease that decreases AC membrane surface area will decrease DLCO, anything that increases blood flow to the AC membrane will increase DLCO (exercise or disease) asthma will be normal or increased DLCO
Which parameters does a blood gas analyzer measure & which does it calculate? Measures: pH, PO2, PCO2 Calculates: HCO3, base excess, hemoglobin saturation
What does a co-oximeter measure? Directly mesures TOTAL Hemoglobin(hb), Oxyhemoglobin(HbO2), Methhemoglobin(MetHb), Carboxyhemoglobin(COHB), and carbon monoxide also calculate 02 percent but does not directly measure it
Analyzer electrodes that measure? Clark electrode measures P02, severinghaus measures C02, sanz measures PH
How do air bubbles in an ABG sample effect the CO2 & O2 of the sample? Will lower C02 (because partial pressure is 0.023 in air we breathe), if blood P02 is low it will falsely raise it, if blood P02 is high it will falsely lower it, also depends on how large air bubble is
What are ventilation scans used for? assessing the effects of bronchiectasis and bullous lung disorders
What are perfusion scans used for? shows distribution of pulmonary blood flow, will show clots
V/Q scans are used for? They will show both of what ventilation and perfusion scans show. Normally used to find clots (pulm emboli) especially with positive D-Dimer
V/Q scans require the injection of? iodine tagged colloids into the bloodstream
The gas used for single breath and rebreathing DLCO test are? 0.3% CO, 10% He, 02 , and N2 (room air) Single breath DLCO requires difficult breathing maneuver and is very effort dependent
What gas mix does the steady state DLCO test use? pt maintains normal VT breathing, 0.1% CO, remaining is room air
What is the most important part of a quality assurance program? record keeping
What is included in a quality assurance program? record keeping, calibration verification, quality control, proficiency testing, and performance validation
What is the largest and most common blood gas lab accreditation in pinellas county? CAP
RV is a volume, PEFR is a flow, and MIP is a ? pressure
What is the advantage of using the DLCO rebreathing technique? The results are less affected by V/Q abnormalities or by changes in the pt’s lung volumes during the test
You just bronched a patient and used lidocaine, 2 hours later the nurse calls because pt is SOB, her sP02 is 100%, you should? get an ABG and run it through a Co Oximeter, lidocaine causes methemoglobin, and a co oximeter measures all Hb, oxyhb, carboxyhb, methb
Agencies that accredit blood gas labs: College of American Pathologists, Joint Commission for Healthcare Accreditation(JCAHO) , agency for healthcare administration, american thoracic society (ATS)
What is remedial action? process of applying appropriate measures to correct errors with blood gas machines
What are Levey-Jennings plots used for? They provide a visual indicator of the performance of the ABG machine. One can determine whether a QC sample that is out of range is a random error, part of a trend, or systemic error (bias) that is trending out of range
Remedial action consists of? staff training and retraining, more frequent preventative maintenance, closer staff supervision. The punishment must fit the crime though!
The term mets directly relates to? 02 uptake, it is a multiple of resting 02 consumption.
What are MET's? multiples of resting 02 consumption, one MET is the amount of 02 produced at rest. The body normally consumes 250ml/min 02 at rest, this 250 is 1 MET
Metabolism requires the consumption of 02 to produce ATP, because it requires 02 it is called? aerobic metabolism, C02 AND H20 are produced as waste products of this process. Normal resting metabolism is performed through processing carbs and lipids
What is anaerobic metabolism? energy is produced even though tissues do not have enough 02 to complete oxidative phosphorylation ( the key stage in aerobic metabolism)
There is a point during exercise where there is not enough 02 available to the muscles? the muscle reaches the anaerobic threshold and begins anaerobic metabolism, the greatest 02 consumption work level that can be achieved without producing lactic acid
The anerobic threshold? is less efficient, it produces less ATP for energy production, generally occurs at 50-70% of V02 max, results in an RQ >1
What are the normal RQ values? VC02 200ml/min, V02 250ml/min RQ= 0.8
What are the physiologic problems with anaerobic metabolism? lactic acid build up, lactic acidosis, increased C02 production, increased VE and increased work on the lungs ( to get rid of C02), delayed onset muscle soreness ( due to lactic acid)
Your ventilated patient is having problems maintaining a low enough CO2 level. You want a diet that is? high in fats/lipids/protien, low in carbs. Carbs=C02, will raise RQ
Fats, carbs, and proteins have what RQ's? fat 0.7, carbs 1, protein 0.8
How to perform the leak test? place pressurized scope in sterile water, look for bubbles. If the scope bubbles during a leak test, this means? there is a leak, cannot be used, poses an infection risk to patient, must be sent out for repair
Checking bronchoscope integrity? checking for damage to the optics or scope channels, If you see black dots when looking through the scope then the fiber optic bundles have been damaged and it should not be used
What two diseases are involved in an overlap syndrome? OSA and COPD, The combination of overlap syndrome leads too an increased incidence of complications
What are disadvantages of the MVV maneuver? hyperventilation and cardiac stress
What is the maximum voluntary ventilation? Maximum voluntary ventilation (MVV) is a measure of the maximum amount of air that can be inhaled and exhaled within one minute
A sleep study report is made on a ? hypnogram
What is the most commonly used method of calorimetry on vented patients? open circuit with breath by breath analysis
Lidocaine is used to prepare? the airway for bronchoscopy
A correlation study? compares one blood gas analyzer to another
A low Nif, Mip, or Mep indicates? neuromuscular disease
What axis is volume and flow on a flow volume loop? volume is horizontal, flow is vertical
What are advantages of a liquid 02 system? easy refilling, quiet, works with power outage
What is therapeutic bronchoscopy? treat or solve a medical issue....verifying et tube placement is also therapeutic, assist with intubation, laser reduction of obstruction from cancer, etc...
What is diagnostic bronchoscopy? used to establish the cause of a problem..bronchoalveolar lavage to collect sample, tissue samples, evaluate infections, etc..
What are some indications for bronchoscopy? Evaluate atelectasis, evaluate airway swelling, suspicious sputum cytology results, lung cancer staging, remove a mass or growth, investigate hemoptysis, unexplained cough, wheeze, or stridor, to place a stent
You would use bronchoscopy to visualize the tracheo bronchial tree to see sources of bleeding, locate and biopsy a tumor, remove objects from airway, collect fluid samples, see lung damage, insert a stent to hold airway open
Complications of bronchoscopy? hypoxemia, irregular heart rhythms, bleeding, pneumothorax, fever, nausea, vomiting, pneumonia, medication complication, airway edema, respiratory arrest, vocal cord injury, death
Post bronch recovery? pt must be monitored for several hours, 02 therapy should be maintained for up to 4 hours, oximetry should be checked, pt must remain NPO as long as airway is numbed, should watch for stridor (race epi)
If the patient is on a ventilator receiving a bronchoscopy, you should? increase the Fi02 to 100%, attach PORTEX adapter to tube to introduce scope, hard to bronch through a 7.0 or smaller tube
Aside from monitoring the patient, the RT may also be asked too? Insert oral airway so pt does not bite scope, adjust pt's 02, prepare scope (sterile, leak test, no damage) prepare meds and lavage's, insert and direct forceps and brushes, collect and label samples, record vitals and lavage types and amounts
About 2-4% of people have some degree of OSA, severity can range from? minor sleep disturbances to desaturation, pulm htn, rt heart failure, excessive daytime sleepiness
The most common sleep disorder is sleep apnea, it is defined as? repeated episodes of complete cessation of airflow for 10 seconds or more
Obstructive sleep apnea is caused by? Central sleep apnea is caused by? -caused by airway closure (will snore) -a lack of ventilatory effort, pt has no airflow and no effort to breathe ( does not snore)
What is the primary cause of OSA? small/unstable pharyngeal airway due to soft tissue problems (obesity, tonsillar hypertrophy, skeletal factors like small chin)
The cause for CSA is unknown, it is commonly seen in people with? brain stem lesions, cardiovascular disorders, cerebrovascular disease, spinal cord lesions, elderly, thyroid disease, narcolepsy, cheyne stokes respirations
What kind of drugs may be given for a bronchoscopy? Lidocaine a topical anesthetic to numb pain/cough, bleeding controlled by vasoconstriction nasal sprays(nasoephrine) , sedative, Sterile water to lavage airways, Epinephrine for bleeding, Liquid cocaine, Acetylcystine to help break down thick secretions
Contraindications for bronchoscopy? No consent unless an emergency, no experienced bronchoscopist, lack of adequate facilities, inability to oxygenate patient, coagulopathy, refractory hypoxemia, unstable hemodynamic status
What are the components of a pulmonary rehab program? infection control and avoidance, nutrition, 02 therapy, smoking cessation, managing stress, recreation, leisure activities, exercise program, medical test and medication education
What are contraindications for a sleep study? psychotic, demented, febrile (fever), intoxicated, under heavy sedation
What does indirect calorimetry measure? . Indirect calorimetry is a technique that provides accurate estimates of energy expenditure from measures of carbon dioxide production and oxygen consumption during rest and steady-state exercise
Two types of calorimetry? direct calorimetry - amount of heat produced by a subject enclosed within a small chamber. indirect calorimetry -amount of heat produced by a subject by determination of the amount of oxygen consumed and the amount of carbon dioxide eliminated.
What are the primary forms of home respiratory care? 02 therapy, aerosal therapy, bronchial hygiene, CPAP/BIPAP, mechanical ventilation
What kind of 02 devices are used in the home? nasal cannulas, flow rate limited to 6 lpm for adults, 2 lpm for infants, should be humidified after 4 lpm. Trans tracheal 02 catheters or SCOOP
Trans tracheal 02 catheters or SCOOP benefits? not very common but provide same FIO2 at half the flow, and 2/3 the flow at exercise. They require greater supervision though and have greater risk for complication
RV and FRC measurements are made using indirect spirometry techniques ( cannot be done with direct because pt cant exhale these) . What are the techniques to measure this? One is gas dilution, via the open or closed circuit method, and the other is body plethysmography.
Fowler (single breath N2 washout) and bohr measure? deadspace, the fowler method they take the deepest breath possible of 100% oxygen, then exhales slowly and evenly into the mouthpiece of the pulmonary function testing (PFT) machine
How is the open circuit indirect spirometry done? multiple breath N2 washout, test measures the percentage of nitrogen in the alveolar gas after the subject has been breathing 100% oxygen for 7 minutes.
Closed circuit indirect spirometry is? helium dilution
During the DLCO single breath maneuver (DLCO-SB)? takes the deepest breath possible in of a special gas mixture. The subject then holds their breath for 10 seconds, then exhales back down to the RV level.
Tests that use carbon monoxide (CO) to measure ? a subject's diffusion are referred to as DLCO studies, single breath, steady state, and rebreathing
What are the three channels for a bronchoscope? light transmission, visualizing, and multipurpose (aspiration, 02, tissue sampling, etc..) multipurpose is the functional channel
Trained althletes may not reach their anearobic threshold until? 90% of their max V02
What two 02 devices are used in the home? nasal cannula and transtracheal 02 chatheter
The fi02 for at home nasal cannula is limited too? 24-40% and no more than 6lpm. Must be humidified after 4 lpm. Infants are limited to 2lpm and must always be humidified
What devices are used in the home to prevent 02 waste? resevoir/pendant cannulas, and pulse dose/ demand regulators
Created by: juialynn92