Chapter 19

Question 1

What is the difference between invasive and non invasive analyzing and monitoring?

Answer 1

NONinvasive gathers data externally
Invasive requires insertion of sensor or collection device into body

Question 2

What are the sites for arterial puncture and the preferred site?

Answer 2

Radial, femolar, brachial and ulnar arteries. Radial Artery is preferred method

Question 3

What are the indications for blood gas sampling?

Answer 3

Sudden unexplained dyspnea, Cyanosis, Abnormal breath sounds, Severe unexplained tachypnea, Changes in ventilator settings, CPR, Acute hypotension, Acute deterioration in neurologic function

Question 4

What are the known complications and precautions for ABG?

Answer 4

Hemorrhage, Air or clotted blood emboli, Trauma to vessel, patient or sampler contamination, vasovagal response, hematoma and pain

Question 5

What are the supplies needed for ABG

Answer 5

Gloves, Safety goggles, Pre-heparinized blood gas kit system, short bevel 20-22 gauge needle w clear hub, label, isopropyl alcohol, sterile gauze, ice slush and needle capping device

Question 6

Should you do an ABG if there are abnormal Allen test results?

Answer 6

No, that means there is no collateral circulation in the arteries

Question 7

What can you associated PaCO2 with? What is the normal range?

Answer 7

Lungs. 35-45 mmHG

Question 8

What do you associated bicarbonate (HCO3-)? What is the normal range?

Answer 8

Associate it with kidneys. 22-36 mEq/L

Question 9

What levels are checking for acid base status?

Answer 9

pH,CO2 and HCO3-

Question 10

What is the normal PaO2?

Answer 10

80-100 mmHg

Question 11

What does PaO2 mean?

Answer 11

Checking of oxygenation status

Question 12

What is the range for Mild Hypoxemia?

Answer 12

60-79 mmHg

Question 13

What is the range for Moderate Hypoxemia?

Answer 13

40-59 mmHg

Question 14

What is the range for severe hypoxemia?

Answer 14

< 40 mmHg

Question 15

Can hyperventilation cause changes in ABG results while doing the procedure? What is the time to return to steady states for healthy lungs ? What about lungs that aren’t healthy? IE lung disease?

Answer 15

yes it will change the values. Healthy lungs take 5 minutes or so
Lungs with dieases may take up to 30 min

Question 16

What are some preanalytical errors with arterial blood?

Answer 16

Air in sample, Excess anticoagulant, venous admixture, and metabolic effects

Question 17

What happens when there is air in the ABG sample?

Answer 17

pH INCREASES
PCO2 Decreases toward 0 mm HG
PO2 increase/decrease towards 150 mmHg (room air)

Question 18

What happens when there is excess anticoagulant in ABG samples?

Answer 18

pH DECREASES, PCO2 decreases towards 0 mmHg
PO2 increases/decreases toward 150 mmHg

Question 19

What happens to ABG sample when venous admixture occurrs?

Answer 19

pH decreases
PCO2 increases
PO2 decreases

Question 20

What metabolic effects are seen with ABG samples?
\

Answer 20

pH decreases, PCO2 increases, PO2 decreases

Question 21

What is the amount of blood required for arterial blood sampling?

Answer 21

0.5 to 1 mL

Question 22

What is the recommended time for analysis?

Answer 22

15 minutes

Question 23

What is the advantage of point of care testing?

Answer 23

Reduces turnaround time, which improve care and lowers costs, used for blood chemistry and hematology parameters

Question 24

Define the purpose of transcutaneous monitoring and gases monitored? Is it invasive or noninvasive?

Answer 24

It is noninvasive. It is used to continuously monitor adequacy of arterial oxygenation or ventilation
Real time responses to diagnostic and therapeutic interventions as evidenced by PtCO2 or PtcCO2 values

Question 25

What are the common sites for Transcutaneous monitoring?

Answer 25

Abdomen, Chest and lower back

Question 26

What are the indications/contraindications or hazards for TM?

Answer 26

Indications: need to monitor continuously the adequacy of arterial oxygenation or ventilation, or real time responses to diagnostic/therapeutic Contraindications: N/A, adhesive allergies, poor skin integrity alt devices should be considered. Hazards: false neg/false pos results and tissue injury from heat may occur at measuring site

Question 27

define capillary blood gases (CBG)

Answer 27

can accurately reflect and provide clinically useful estimates of arterial pH and PCO2 levels

Question 28

What are the indications for CBG's

Answer 28

ABG is indicated but unavailable Noninvasive readings are abnormal A change in pt status is detected by history or physical assessment Monitoring the severity and progression of a documented disease process is desirable

Question 29

What are complications/hazards for CBG's

Answer 29

Not to be done on anyone younger than 24 hours, contamination and infection of the patient, burns, hematoma, bruising, scarring, bleeding

Question 30

What is pulse oximetry? is it invasive or noninvasive?

Answer 30

NONinvasive procedure performed at bedside that provides estimates of SaO2. (SpO2 > 95% on room air is normal)

Question 31

What is HbCO and what problems does it cause when monitoring pulse oximetry?

Answer 31

Carboxyhemoglobin. Can read normal SpO2 levels even if there is zero O2 and carbon monoxide poisoning is occurring

Question 32

What other oximetry can be used if carbon monoxide is suspected?

Answer 32

Hemoximetry (cooximetry) Lab analytical procedure requiring invasive sampling of Arterial blood. Provides values for abnormal hemoglobin

Question 33

What is capnometry?

Answer 33

The measurement of Co2 in respiratory gases

Question 34

What is mainstream sampling in capnometry?

Answer 34

Placing an analysis chamber in patients breathing circuit

Question 35

What is the sidestream technique in capnometry?

Answer 35

Pumps small volume of gas from circuit into nearby analyzer

Question 36

What are the phases of a capnograph

Answer 36

Phase 1: shows PCo2 of zero at start of expiratory breath Phase 2: the PCO2 level rises sharply Phase 3: The level plateaus as alveolar gas is exhaled Phase 4: End Tidal PCO2 (PETCO2) is used to estimate dead space ventilation and normally averages 3-5 mm Hg less than PaCO2