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Cardiopulmonary > Pulmonary Lab > Flashcards

Pulmonary Lab Flashcards

1
Q

Values for Pulse Rate

A

Normal = 60 – 100 bpm
> 100 bpm =Tachycardia
> < 60 bpm=Bradycardia

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2
Q

Pulse Rhythms

A
  • Regular = evenly spaced beats, may vary with respiration
  • Regularly Irregular = regular pattern overall with skipped beats (need to measure for 60 sec)
  • Irregularly Irregular = chaotic, no real pattern, very difficult to measure rate (need to measure for 60 sec)
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3
Q

How long do you need to take pulse for?

A

Adult: 15 seconds x 4, 30 sec x 2, 60 sec x 1
Children: Count for 60 seconds

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4
Q

Grading System for Pulse Quality

A
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5
Q

What are the 6 different pulses?

A
  • Radial
  • Femoral
  • Posterior Tibialis
  • Doralis Pedis
  • Abdominal Aorta
  • Femoral
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6
Q

Abdominal Aorta Palpation Steps

A
  • Pt. is supine, knees flexed to 90 degrees; examiner stands on the right
  • Assess for size, location and pulsation of the aorta
  • Place the palms of both have on abdomen with index fingers pointing up toward the head
  • Press down firmly to locate pulsating aorta
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7
Q

Values of abdominal aorta

A
  • Normal: 2.5 cm
  • Abnormal: 3-4 cm, suggests aortic aneurysm; refer
  • Width is more significant than pulsation
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8
Q

Abnormal Pulse Patterns

A

Pulsus Alterans
* Palpation: Weak beats alternating with strong beats; regular rhythm
* Probable Cause: Left Ventricular Failure

Pulsus Bigeminus
* Two beats ocurring in rapid sucession, followes by a pause during which no pulse is felt; irregular rhythm; premature beat
* Probably Cause: Cardiac Arrythmias

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9
Q

Why do we auscultate for Bruits

A
  • Late middle aged or older are at risk
  • Sign of srterial narrowing and risk of stroke
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10
Q

Ascultation for Bruits

A
  • Patient is seated or supine with head turned slightly away from examiner.
  • Place the BELL of the stethoscope over each carotid artery. You may use the diaphragm if the patient’s neck is highly contoured.
  • Ask the patient to stop breathing momentarily.
  • Listen for a blowing or rushing sound–a bruit suggesting turbulence. Do not be confused by heart sounds or murmurs transmitted from the chest.
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11
Q

Auscultation Steps for Aorta, Renal and Iliac Arteries

A
  • Patient is supine with knees flexed or supported by pillows for relaxation. Examiner stands on right side of patient.
  • Place the diaphragm of your stethoscope lightly on the abdomen starting in the upper right quadrant and work clockwise.
  • Bruits = loud blowing sound due to arterial atherosclerosis and represent turbulent blood flow.
  • Listen for bruits over the renal arteries, iliac arteries, and aorta. Renal bruits may be found in patients with hypertension.
  • Listen for bowel sounds. Are they normal or absent?
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12
Q

ABI via Doppler

A
  • Have subject lie supine ~ 10-15 minutes
  • Place cuff around arm above elbow
  • Apply gel to probe
  • Hold Doppler at 45 degree angle; and place over brachial artery (radial)
  • Inflate cuff until doppler sound disappears
  • Deflate the cuff until sound returns
  • Document this systolic pressure (brachial)
  • Place cuff around leg just above malleolus
  • Hold Doppler at 45° angle; and place over dorsalis pedis or post tibial artery
  • Inflate cuff until doppler sound disappears
  • Deflate the cuff until sound returns
  • Document this systolic pressure (ankle)
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13
Q

ABI Values: N vs Ab

A

N: 1.0 - 1.4
Ab: .41-.90
Severe: less than 0.4 (Critical Limb Ischemia)

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14
Q

How would you identify an arterial stenosis with ABI?

A

A reduction in pressure occurs distal to the lesion

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15
Q

ABI examines PAD but also ____ and ____

A
  • detecting stenosis
  • differentiating true cladification from psudocladification
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16
Q

How would you palpate doralis pedis a.?

A

Palpate between the first and second toes mid foot

17
Q

When should a ABI-Walk test be performed?

A

When resting ABI is between .91 and 1.2 with Sx

18
Q

A positive ABI walk test would be:

A
  • SBP drop of 20% in the ankle or more
    OR
  • Drop of ABI by .2 or more
19
Q

When looking at limbs, what should you be on the lookout for?

A
  • Cyanosis: Lips, Finger tips (thick)
  • Loss of hair (lower extremities - vascular disease)
20
Q

Pitting Edema Scale

A
21
Q

Anthropometric Water Displacement Test

A
  • Select correct sized container
  • Filled to line
  • Instruct patient to slowly lower limb into the water
  • Collect displaced water and document
22
Q

What does the Capillary Nail Refill test?

A

Monitors tissue perfusion and dehydrations

23
Q

How to perform a capillary refill test?

A
  • Pressure applied to nail bed until it turns (blanched; ~5 sec)
  • Remove pressure and record time for the pink color to return to the nail
  • Perform at distal finger or distal great toe
24
Q

Capillary Nail Refill Test

A

Normal:
* Less than 3 seconds

Abnormal:
* 3 seconds or more at distal finger
* 5 seconds or more at distal great toe (diabetic patients)

25
Q

What are some things that can cause poor capillary refill?

A
  • Low body temperature
  • Vasoconstriction due to nicotine, peripheral edema, or anemia
26
Q

How to perform the Rubor Dependency Test

A
  • Place subject supine and assess color of feet (plantar)
  • Elevate leg to 45-60 seconds for 1 minute
  • Have timing device with them or have asked for one prior to starting test
  • Assess color of foot - plantar aspect
  • Return leg to bed and time how long for color return
27
Q

Rubor Dependency Test Values:

A

N: Color returns in 15 - 20 seconds (color is pink or light red)
Ab: Takes greater than 25-30 seconds (if color returns may be bright red)

28
Q

How would you perform a skin turgor test?

A
  • Grasp skin between two fingers to create a tent (hand, forearm or abdomen)
  • Hold skin for a few seconds and release
  • Indicate if decreased skin turgor (skin remains tented and returns slowly; indicates moderate to severe dehydration)
  • Can do on the back of the hand, lower arm, or abdomen
29
Q

What does Oxygen Saturation measure? Where do you perform it?

A
  • Percentage of hemoglobin staturated
  • Finger, ear or toe
30
Q

How do you determine the actual O2 content?

A
  • Measure the PaO2
  • Corresponds with O2 stat percentages
31
Q

Normal and Abnormal % and PaO2 level

A

Normal:
* 95% or higher

Abnormal:
* Lower than 90% may be caused by lung disease/problems, cigarette smoking, or blood bessel problems
* Hypoxia when below 92%

Values:
* 95% O2 Sat = 80 mm Hg PaO2
* 90% O2 Sat = 60 mm Hg PaO2
* Medicare will only pay when PsO2 60 mm Hg = 88% O2 stat

32
Q

What percentages of O2 is in a nasal cannula? How does this relate to exercise?

A

Percentage
* 1 L O2 = 24%
* 2 L O2 = 28%
* 3 L O2 = 32%
* 4 L O2 = 36%

  • Pts on 2 L of O2 may be able to exercise without it.
  • Some pts only way to get increase in functional activity is by increasing the O2. Example: Emphysema patients.
33
Q

If patients don’t have access to supplemental oxygen what should be provide them with?

A

Breathing efficency and breathing patterns

34
Q

Carbon monoxide has an affinity for hemoglobin of ____ higher than O2

A

25x

35
Q

Most and Least reliable temperature taking methods

A

Most reliable: Rectum
Least reliable: Axillary

36
Q

Wells Clinical Decision Rule for DVT Values

A
  • -2 to 0: Low probability of DVT - 3%
  • 1 to 2: Moderate probability of DVT - 17%
  • 3 or more: High probability of DVT - 75%
  • Medical consultation is advised in the presence of low probability
  • Medical referral is required with moderate or high score.
37
Q

Clinical Decision Rule for PE

A

Probability
<2 – low
2-6 – Intermediate
>6 - High

Cardiopulmonary (21 decks)

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