Cardiovascular: Tests And Measures

Question 0

ABG Analysis: Step 2

Answer 0

Assess Ventilatory Status

PaCO2 = 35-45mmHg = Adequate ventilation
PaCO2 < 30mmHg = Alveolar Hyperventilation
PaCO2 > 50mmHg = Alveolar Hypoventilation

Question 1

ABG Analysis: Step 1

Answer 1

Assess Acid-Base Balance

pH < 7.4 = Acidosis
pH > 7.4 = Alkalosis

Question 2

ABG Analysis: Step 3

Answer 2

Assess PaCO2 in relation to pH
*Inverse Relationship: High PaCO2 + Low pH = Acidosis

PaCO2 > 45mmHg, pH < 7.4 = Respiratory Acidosis
PaCO2 > 45mmHg, pH > 7.4 = CO2 Retention compensation for metabolic alkalosis
PaCO2 < 35mmHg, pH > 7.4 = Respiratory Alkalosis
PaCO2 < 35mmHg, pH < 7.4 = CO2 Elimination compensation for metabolic acidosis

Question 3

ABG Analysis: Step 4

Answer 3

Assess HCO3- in relation to pH
*Linear Relationship: Low HCO3- + Low pH = Metabolic Acidosis

HCO3- 22-26mEq/L = Normal
HCO3- < 22mEq/L, pH < 7.4 = Metabolic Acidosis
HCO3- < 22mEq/L, pH > 7.4 = Renal compensation for respiratory alkalosis
HCO3- > 22mEq/L, pH > 7.4 = Metabolic Alkalosis
HCO3- > 22mEq/L, pH < 7.4 = Renal compensation for respiratory acidosis

Question 4

ABG Analysis: Step 5

Answer 4

Assess PaO2 and SaO2

Normal: PaO2 80-100mmHg, SaO2 > 95%
Mild Hypoxemia: PaO2 60-79mmHg, SaO2 90-95% (if no shift in oxyhemoglobin curve)
Moderate Hypoxemia: PaO2 40-59mmHg, SaO2 60-90% (if no shift in oxyhemoglobin curve)
Severe Hypoxemia: PaO2 < 40mmHg, SaO2 < 60% (if no shift in oxyhemoglobin curve)

Question 5

Hematocrit

Answer 5

% RBCs in total blood volume

Question 6

Serum Cholesterol

Answer 6

Total
<200 = Desirable
>240 = High
LDL
<100 = Optimal
130 = Borderline
160 = High
190 = Very High
HDL
<40 = Low
60 = High
Triglyceride
<150 = Desireable
200 = High
500 = Very High

Question 7

Invasive Hemodynamic Monitoring

Answer 7

IV Line: Pressure, volume, temperature
Swan-Ganz: Pulmonary artery wedge pressure, L atrial pressure
Thermodilution Catheter: CO
Cevtral Venous Pressure Line: Vena cava or R atrial pressure

Question 8

Dyspnea Scale

Answer 8

+1 Mild, Patient notices
+2 Mild, Observer notices
+3 Mod, Can continue
+4 Severe, Cannot continue

Question 9

Anginal Scale

Answer 9

1+ Light, Barely noticeable
2+ Moderate, Bothersome
3+ Severe, Very uncomfortable
4+ Most severe pain experienced

Question 10

Edema Scale

Answer 10

1+ Mild, Indentation 0-1/4in
2+ Mod, 15- sec, 1/4-1/2in
3+ Severe, 15-30 sec, 1/2-1in
4+ Very severe, 30+ sec, > 1in

Question 11

ABI Scale

Answer 11

LE/UE Pressures
1.0+ Normal
0.8-1.0 Mild PAD, Caution w compression
0.5-0.8 Mod PAD, Intermittent claudication, No compression
< 0.5 Severe CAD, Critical limb ischemia, + Rest for pain, No compression

Question 12

Rubor Of Dependency

Answer 12

Examine color changes of foot in elevation then dependency
(+) = Arterial insufficiency
Pallor in elevation, Rubor on dependency
Changes take > 30 sec

Question 13

Arterial Line

Answer 13

Inserted into artery
Measure blood pressure
Obtain blood samples

Question 14

Central Venous Pressure Catheter

Answer 14

In R atrium or superior vena cava

Measures R ventricular function, R atrial filling pressure, circulating blood volume

Question 15

Hickman (Indwelling R atrial catheter)

Answer 15

Inserted through cephalon or internal jugular vein
In superior vena cava and R atrium
Long term chemo, total parental nutrition, antibiotics

Question 16

Swan-Ganz (Pulmonary Artery Catheter)

Answer 16

Inserted in vein to pulmonary artery
Continuously measures pulmonary artery pressure, pulmonary capillary wedge pressure
Avoid excessive head, neck, extremity movement

Question 17

Chest Tube

Answer 17

In side of chest
Suctions air, fluid, or pus from intrathoracic space
Side Effects:
  Significant discomfort
  (-) Cough 
  (-) Deep breathing
  (-) Mobility

Question 18

Mechanical Ventilator

Answer 18

Produces controlled flow of gas into airways

Provides (+) pressure, causing lung inflation

Question 19

CBC: WBCs

Answer 19

4,300-10,800
Increased: Infection
Decreased: Anemia, B12/folate deficiency
Exercise:
  > 5,000 = Light exercise only
  < 5,000 = Fever, contraindicated
  < 1,000 = Use mask, std precautions

Question 20

CBC: RBCs

Answer 20

Male: 4.6-6.2x10^6/ul
Female: 4.2-5.9x10^6/L
Increased: Polycythemia
Decreased: Anemia

Question 21

CBC: ESR

Answer 21

Male: Up to 15 mm/hr
Female: Up to 20 mm/hr
Increased: Infection, inflammation, rheumatic, osteomyelitis
SLE, Hodgkin’s Disease

Question 22

CBC: Hct

Answer 22

Male: 45-52%
Female: 37-48%
Increased: Erythrocytosis, dehydration, shock
Decreased: Severe anemias, acute hemorrhage
Exercise:
> 25% but < normal = light exercise only
< 25% = contraindicated

Question 23

CBC: Hgb

Answer 23

Male: 13-18 g/dL
Female: 12-16 g/dL
Increased: Polycythemia, dehydration, shock
Decreased: Anemias, prolonged hemorrhage, RBC destruction
Exercise:
Low (8-10 g/dL) = Light exercise (fatigue, tachycardia)
< 8 g/dL = Contraindicated

Question 24

CBC: Platelets

Answer 24

150,000-450,000 cells/mm3 Increased: Chronic leukemia, hemoconcentration Decreased: Thrombocytopenia, acute leukemia, aplastic anemia, CA chemo Exercise: < 20,000 = AROM, ADLs only 20-30,000 = Light exercise only 30-50,000 = Moderate exercise

Question 25

PT

Answer 25

11-15 sec Increased: Factor X deficiency, hemorrhagic disease, cirrhosis, hepatitis drugs (warfarin) Increased 2.5x or more: PT contraindicated

Question 26

PTT

Answer 26

25-40 sec | Increased: Factor VIII, IX, and X deficiency

Question 27

INR

Answer 27

Ratio of PT to reference range 0.9-1.1 (ratio) INR < 2 = Desirable INR > 2 = Consult MD for bleeding risk INR > 3 = Hemarthrosis risk