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Hemo Exam 2

What is the proper positioning for a conscious and mobile patient during a thoracentesis? Patient sits upright on side of bed, feet supported, and arms are on bedside table
What is the positioning for a patient that is unable to sit up during a thoracentesis? Patient should lay with affected side up
Define Bullae Large, thin walled dark area surrounded by normal lung tissue
Define Bleb Superficial air cyst protruding into pleura
What is the Posterior-Anterior X-ray technique (PA)? Patient is upright, front of chest on film, shoulders forward, deep breath in and hold - shows least cardiac distortion
What is the Anterior-Posterior X-ray technique (AP)? Portable CXR (for vented patients in bed), patient is sitting up or lying supine, film behind back - can magnify organs due to closeness
What is the Lateral X-ray technique? Upright with left side against film (always left), arms raised above head, deep breath in and hold - allows you to see behind heart and diaphragm
What is the Lateral Decubitus X-ray technique? Determines extent of pleural effusion or pneumothorax after seen on AP or PA, patient lies on either side in "lateral recumbent" position - pillow under head, arms raised over head, knees bent
How is the patient positioned for a pleural effusion when taking a lateral decubitus x ray? Fluid side down for pleural effusion - fluid spreads up
How is the patient positioned for a pneumothorax when taking a lateral decubitus x ray? Air side up for pneumothorax
What is the Apical Lordotic X-ray technique? Best view for seeing RML and tops of lungs (apices), used to detect location of tumors, obstruction, collapse - patient leans back at 30-45 degree angle or patient is upright and xray beam is angled up at 30-45 degree angle
Where is a chest tube placed to remove air? Midclavicular in 2nd, 3rd, or 4th intercostal space
Where is a chest tube placed to remove fluid? 5th or 6th intercostal space, midaxillary line
Where is the chest tube placed when both air and fluid are present? Need 2 tubes; superior to wound site in anterior chest and inferior to wound site in posterior wall
Define Hyper-aerated lungs Hyperlucent (black) appearance; depressed diaphragms
What causes hyper-aerated lungs? Air trapping, emphysema, COPD, severe asthma
Define Under-aerated lungs Hazy or less radiolucent; "white out" = big reduction in lung volumes
What causes under-aerated lungs? Atelectasis- collapsed beyond obstruction, hypoventilation, pneumothorax
How does accumulated fluid appear on a chest x ray? "Fluffy" infiltrates, cloudy or white, can be diffuse (all over) or localized (one spot)
What causes accumulated fluid? Pulmonary edema, interstitial edema, pneumonia
Define Reticular Net appearance (fluid - CHF or RDS)
Define Reticulogranular Combo of reticular and granular (CHF or RDS)
Define Honeycomb (aka reticulonodular) Bands of dense fibrous tissue with air between them (cloudy), seen with pulmonary fibrosis, interstitial edema, or RDS
Define Air Bronchograms Small tubular densities - leave small and medial bronchioles intact and air-filled, outline of air-containing bronchi; seen in pneumonia and atelectasis
Define Kerley B Lines Thin lines caused by fluid in interstitium; seen in interstitial edema
How does a pleural effusion appear on a CXR? Fluid in the pleural space, increased density (blunting) at costophrenic angle
How does a pneumothorax appear on CXR? Air in pleural space, tracheal shift away, increased radiolucency (black) - CANNOT see vascular markings
How does pneumonia appear on CXR? Inflammation of alveolar space (usually from bacteria) causes increased fluid (white) and air bronchograms
How does pulmonary edema appear on CXR? Swelling and/or fluid in alveoli and interstitial space; "fluffy" infiltrates or butterfly pattern, enlarged heart, increased density (white) - especially around hilar region
How does atelectasis appear on CXR? Collapsed lung tissue, tracheal shift towards, increased density (white) near atelectasis, elevated diaphragm on affected side, air bronchograms, foreign body apiration - atelectasis beyond obstruction
How does emphysema appear on CXR? Hyper-inflation, flattened diaphragm, spread out ribs, lots of black, presence of blebs or bullae
Define Bleb Superficial air cyst protruding into pleura
Define Bullae Large, thin walled dark area surrounded by normal lung tissue
What is a CT scan? Computer aided tomography; takes x ray images in slices, shows presence of pulmonary emboli
What is an MRI? Magnetic Resonance Imaging; uses magnets and radio waves to get cross sectional images, wave bounce off tissues and return image
What is a Fluroscopy? Dynamic (moving) picture on screen; used for bronchoscopy with biopsy, feeding tube placement, swallow studies, difficult PICC line insertion
What is Angiography? Dye injected through PAC, PICC, CVP to view pulmonary tree; detects obstruction in coronary arteries and pulmonary emboli
What is Bronchography? Radiopaque dye is inhaled or instilled through ETT, view tracheobronchial tree, detects tumors or obstructions
What is a V/Q scan? Ventilation/Perfusion Scan; used to detect pulmonary emboli
What is the ventilation part of the V/Q scan? Patient breathes radioactive gas; gamma camera looks at areas of ventilation; dark areas = good ventilation / white areas = absence of ventilation
What is the perfusion part of the V/Q scan? Radiate albumin injected into IV; flow of gas is then scanned; no flow = emboli
How many bulges are on the right side of the heart? 2
What do the bulges on the right side of the heart represent? SVC and RA
How many bulges are on the left side of the heart? 3
What do the bulges on the left side of the heart represent? Aortic knob, main PA, LV
How big should the heart be in comparison to the thorax? Should be 50% or less then width of thorax at diaphragm level
Where should the diaphragm be seen on CXR? Should be visible at base of the lungs, right side is 1 -2 cm higher due to liver
During a deep breath, how far does the diaphragm descend? Descends to 6th anterior rib and 10th posterior rib
Define Costophrenic Angle Anatomic junction of diaphragm and lung pleura
What does flattened costophrenic angles indicate? Pleural effusion
What does elevated costophrenic angles indicate? Increased abdominal pressure or atelectasis
What does hyperlucency indicate on a CXR? Air
What does radiopaque (white) indicate on a CXR? Fluid or atelectasis
What does honeycomb indicate on a CXR? Fibrosis
What does blunted costophrenic angles indicate on CXR? Pleural effusion
What does elevated diaphragms indicate on CXR? Atelectasis
What does flattened diaphragms indicate on CXR? Hyperinflation, air trapping
What does ground glass indicate on CXR? RDS
What does reticulo (anything) indicate on CXR? RDS or fibrosis
What does consolidation indicate on CXR? Pneumonia or atelectasis
What does no vascular markings indicate on CXR? Pneumothorax
What does diffused vascular markings indicate on CXR? Fluid overload (pulmonary edema, CHF)
What do spread ribs indicate on a CXR? COPD
What does fluffy or hilar infiltrates indicate on CXR? Pulmonary Edema
What does a butterfly pattern indicate on CXR? Pulmonary Edema
What does a tracheal shift away indicate? Pneumothorax or pleural effusion
What does a tracheal shift towards indicate? Atelectasis
What do air bronchograms indicate on CXR? Pneumonia or atelectasis
What do Kerley B Lines indicate on CXR? Interstitial edema
What does Retrosternal air indicate on CXR? Pneumothorax or COPD
What does a wedge shape indicate on CXR? Pulmonary embolism
What does a meniscus indicate on CXR? Pleural effusion
What does a concave appearance indicate on CXR? Pleural effusion
What does a plater-like appearance indicate on CXR? Atelectasis
What does a coin lesion indicate on CXR? Cancer
What does a cavity indicate on CXR? TB or abscess
What is the treatment of a pneumothorax? Chest tube or thoracentesis
What are the causes of pulmonary edema? Swelling and/or fluid in alveoli or interstitial space
What are possible complications of IABP during insertion? Aortic dissection, dislodging of plaque, inability to pass catheter, obstruction of femoral blood flow
What are possible complications of IABP during pumping? Bleeding, decreased leg circulation, thrombosis (immobile), perforated aorta, blood embolism, gas emboli (balloon rupture), inability to wean, cardiac compromise (timing off)
What are possible complications of IABP during removal? Bleeding, emboli, dislodging of plaque
What are possible post removal complications of IABP? Relapse of condition, hematoma, bleeding
What are absolute contraindications for IABP? Aortic valve insufficiency, aortic dissection, chronic end-stage heart disease (not on transplant list), other end stage terminal disease, severe arteriosclerosis (preventing insertion)
What are the relative contraindications for IABP? Aortic aneurysm, vascular aortic or aortofemoral grafts
What is the timing for IABP? Inflates at beginning of diastole, deflates during early systole, best timing (most support) is 1:1 or 1:2
What are the indications for IABP? CHF, Acute MI, unstable or pre-infarct angina, cardiac contusion, bridge to CABG or heart transplant, circulatory support post CABG, mechanical defects - mitral regurgitation, ventricular septal wall defects, ventricular aneurysm, aortic stenosis
What is the DC criteria for IABP? HR < 110, MAP > 70 with minimal drugs, PCWP < 18, no arrhythmias or CHF, clotting time (ACT) < 180 seconds, good peripheral perfusion (color, temp, pulses, mental status, urine output)
Where should the PAC be visible on a CXR? In right lower lung field
Where should the central line be visible on CXR? RA
What is the procedure for inserting a chest tube? Make incision at appropriate rib space (up for air, down for fluid), insert tube into pleural space, sew tube in place, attach to drainage system, ensure that drainage system is placed lower than the patient
What are the 3 bottles in a 3 bottle set up? 1 Collection bottle, 2 water seal, 3 suction control
What are potential causes for no bubbling in the suction bottle? Suction set too low or off, leak in suction system, control straw is blocked
How can no bubbling in the suction bottle be corrected? Increase suction, fix the leak, replace or reposition straw
What causes water to splash out of water seal bottle? Suction set too high, correct by turning suction down
What does it mean if there is no bubbling is seen in the water seal bottle? Pneumothorax resolved, no air coming out of pleural space
What should be done if the chest tube is pulled out? Cover hole in chest immediately, replace tube
What should be done if chest tube is disconnected from water seal? Put tube in container/cup of water immediately
What is the procedure for a thoracentesis? Patient sits upright on side of bed with feet supported and arms on bedside table (may lay on affected side if unable to sit up), mark area to be punctured, insert 18g needed in upper edge of ribs, once in and attach to suction or pull back plunger
Where should the needle be inserted to remove fluid via thoracentesis? 7th or 8th intercostal
Where should the needle be inserted to remove air via thoracentesis? 2nd or 3rd intercostal
How should the bed be positioned after a thoracentesis? Head of bed slightly elevated for several hours
What are the affects of positive pressure on chest tube drainage? Too much positive pressure can stop drainage, but aid in keeping the lung inflated during drainage
What is obstructive sleep apnea? Absence of breathing due to occlusion of the oropharyngeal airway with continued efforts to breathe - air flow stops, but breathing movements continue
What is central sleep apnea? Absence of breathing due to depression of the medulla with no continued effort to breathe; respiratory signals gets blocked...usually due to brain stem issue
What is Periodic Limb Movement Disorder (PLMD)? Rhythmic movement of legs and arms during sleep, more common in those over age 65
What is Somnambulism? Sleeping walking - walking around, performing tasks but still in sleep mode, more common in children; sleep eating - common in young woman, eating while sleep walking
What are Sleep Starts? Common, sudden violent jerks of the body when falling asleep; can be auditory - noise or visual - sensation of light
What is insomnia? Inability to fall asleep and/or stay asleep, usually caused by anxiety, depression, or alcohol use
What is Bruxism? Grinding of the teeth during sleep, can cause tooth and jaw damage
What is Narcolepsy? Falling asleep at inappropriate times, can be very dangerous if driving or operating machinery
What is measured in a sleep study? RR and pattern, brain wave activity, SpO2, HR and rhythm, limb movement, chest movement, BP, eye movement, chin movement
What does tracheal deviation away indicate? Pneumothorax
What does a tracheal deviation towards indicate? Atelectasis
Where should the gastric bubble be visible on CXR? Should be seen no more than 2 cm above top dome of diaphragm
What are the consequences of sleep apnea? Snoring, daytime fatigue, morning headaches, not feeling refreshed after sleep, hypertension, wake up gasping for air during night, frequent urination at night
Created by: ashconrad417