Pulmonary Assessment (ABG/CXR)

Question 1

Most O2 in the blood is bound to Hgb ~ ___%

Answer 1

97%

Question 2

Mild hypoxemia = PaO2 ___-___ mmHg

Answer 2

60-79 mmHg

Question 3

Moderate hypoxemia = PaO2 ___-___ mmHg

Answer 3

40-59 mmHg

Question 4

Severe hypoxemia = PaO2 < ___ mmHg

Answer 4

40 mmHg

Question 5

pH can be calculated by the _________ __________ equation

Answer 5

Henderson Hassleback equation

Question 6

Kidneys reabsorb ______ and eliminate ___

Answer 6

HCO3
H+

Question 7

PaCO2 < 35 mmHg = respiratory ________

Answer 7

alkalosis

Question 8

PaCO2 > 45 mmHg = respiratory ________

Answer 8

acidosis

Question 9

Rapidly change PaCO2 by adjusting _______ _________

Answer 9

minute ventilation

Question 10

Most frequent cause of airway obstruction?

Answer 10

Tongue

Question 11

HCO3 > 26 mmHg = metabolic _________

Answer 11

alkalosis

Question 12

HCO3 < 22 mmHg = metabolic _________

Answer 12

acidosis

Question 13

Causes of ________ HCO3: vomiting, diuretic administration

Answer 13

Increased

Question 14

Causes of ________ HCO3: hypoperfusion, ketoacidosis, renal failure

Answer 14

Decreased

Question 15

_________ __________ is characterized by hyperbicarbonatemia (>27 mEq/L) and usually by an alkalemic pH (>7.45)

Answer 15

Metabolic alkalosis

Question 16

Factors that generate metabolic alkalosis include vomiting and ________ administration

Answer 16

diuretic

Question 17

Metabolic alkalosis is associated with ____-kalemia, ionized ____-calcemia, secondary ventricular arrhythmias, increased ______ toxicity, and compensatory _____-ventilation (hypercarbia), although compensation rarely results in PaCO2 above ___ mmHg

Answer 17

hypokalemia

hypocalcemia

digoxin

hypoventilation

55 mmHg

Question 18

Etiologic therapy for metabolic alkalosis consists of measures such as expansion of ________ ________ and/or the slow administration of __________

Answer 18

intravascular volume

potassium

Question 19

Nonetiologic therapy for metabolic alkalosis includes administration of __________ (a carbonic anhydrase inhibitor that causes renal bicarbonate wasting), and _______

Answer 19

acetazolamide

dialysis

Question 20

Sufficient reductions in pH may reduce myocardial _________, increase ________ vascular resistance, and decrease _______ vascular resistance

Answer 20

contractility

pulmonary

systemic

Question 21

________ should rarely be used to treat acidemia induced by metabolic acidosis

Answer 21

NaHCO3

Question 22

In contrast to NaHCO3, _______ effectively reduces [H+], does not increase plasma [Na+], does not generate CO2 as a byproduct of buffering, and does not decrease plasma [K+]16; however, there is no generally accepted indication for ______

Answer 22

THAM (buffer tris-hydroxymethyl aminomethane)

THAM

Question 23

Results from an increase in minute alveolar ventilation (VA) that is greater than that required to excrete metabolic CO2 production

Answer 23

Respiratory alkalosis

Question 24

_________ ________ ________ is tightly regulated and responds rapidly to changes in PaCO2

Answer 24

Cerebral blood flow (CBF)

Question 25

List 3 acute conditions that respiratory alkalosis can produce

Answer 25

-hypokalemia -hypocalcemia -cardiac dysrhythmias -bronchoconstriction -hypotension -digoxin toxicity

Question 26

How do we typically tx respiratory alkalosis?

Answer 26

Treat underlying cause

Question 27

Occurs because of a decrease in alveolar ventilation and an increase in production of carbon dioxide.

Answer 27

Respiratory acidosis

Question 28

With acute respiratory acidosis, do we have HCO3- retention?

Answer 28

No

Question 29

With chronic respiratory acidosis, do we have HCO3- retention?

Answer 29

Yes

Question 30

Tx of severe acute respiratory acidosis

Answer 30

Mechanical ventilation

Question 31

low pH, high PaCO2, high HCO3

Answer 31

Partially compensated Respiratory Acidosis

Question 32

normal pH, high PaCO2, high HCO3

Answer 32

Fully compensated Respiratory Acidosis

Question 33

low pH, low PaCO2, low HCO3

Answer 33

Partially compensated Metabolic Acidosis

Question 34

normal pH, low PaCo2, low HCO3

Answer 34

Fully compensated Metabolic Acidosis

Question 35

high pH, low PaCO2, low HCO3

Answer 35

Partially compensated Respiratory Alkalosis

Question 36

Acute respiratory acidosis: for 10mmHg increase in PaCO2, the HCO3 will increase ~ __-__ mEq/L

Answer 36

1-2 mEq/L

Question 37

Chronic respiratory acidosis: for 10mmHg increase in PaCO2, the HCO3 will increase ~ __ mEq/L

Answer 37

5 mEq/L

Question 38

Base excess is highly negative, usually ______ related

Answer 38

volume related

Question 39

For every ___ units of CO2 above normal, the pH should inversely change by 0.1

Answer 39

10 units

Question 40

What is the calculated pH with a PaCO2 of 65 mmHg? (use 7.4 as normal)

Answer 40

7.2

Question 41

If the measured pH is lower than expected, we can assume there are other acids bring the pH down, e.g. _____ _______

Answer 41

lactic acids

Question 42

If the measured pH is better than the calculated, _______ __________ is probably occurring

Answer 42

renal compensation

Question 43

Normal base excess range?

Answer 43

-3 to 3

Question 44

Normal anion gap range?

Answer 44

8 - 12

Question 45

(high, low or normal AG albumin / globulin ratio?) affected by increases in unmeasured ions (acidosis) or affect of toxins

Answer 45

High AG

Question 46

(high, low or normal AG?) HCO3- is lost externally

Answer 46

Low AG

Question 47

Name 3 causes of high AG acid/base imbalance

Answer 47

Uremia lactic acidosis ketoacidosis

Question 48

Name 3 causes of normal AG acid/base imbalance

Answer 48

Renal tubular acidosis diarrhea administration of carbonic acid inhibitors HCL administration ureteral diversions

Question 49

(partially or fully compensated system) Opposing system will be outside the normal range in the direction opposite the problem

Answer 49

partially compensated system

Question 50

(partially or fully compensated system) Metabolic and respiratory systems will both be outside of range

Answer 50

fully compensated system

Question 51

A normal or slightly low HCO3- in the presence of hypercapnia suggests a ________ metabolic _______

Answer 51

concomitant acidosis

Question 52

A normal or slightly elevated HCO3- in the presence of hypocapnia suggests a ________ metabolic ________

Answer 52

concomitant alkalosis

Question 53

Lung markings more prominent in _______ ________ and decreased in ____________

Answer 53

chronic bronchitis emphysema

Question 54

Antero-posterior diameter increased in _______

Answer 54

COPD

Question 55

Flattened diaphragm in ______

Answer 55

COPD

Question 56

Know how to read CXRs (refer to slide 30 on PP to see what we need to be able to identify)

Answer 56

Know it bro

Question 57

List the ABCDEF method of reading CXRs

Answer 57

A: airways: trachea, R & L main bronchus B: bones and soft tissue: ribs, clavicles, sternum, spine/vertebral bodies C: cardiac silhouette / mediastinum (cardiomegaly) D: diaphragm: R & L hemidiaphragm (curved) E: everything else or effusions and pleura and costophrenic angles, gastric bubble F: lung fields: fissures, lobes (R x 3, L x 2) Also, Lines, tubes, devices, surgeries (sternal wires)