Quiz 7 - Pulmonary Function Tests (PFT's) Flashcards Preview

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Flashcards in Quiz 7 - Pulmonary Function Tests (PFT's) Deck (44):
1

What are the ABG normal values?

pH = 7.4 Bicarb - 24 CO2 - 40 PO2 - 75-100 Base excess = -3 to 3

2

What pH is considered acidemic?

< 7.35

3

What pH is considered alkalotic?

> 7.45

4

How can you tell if the alteration in pH is respiratory?

CO2 will be the most affected in a resp problem

5

How can you tell is the pH alteration is metabolic?

HCO3 will be the most affected in a metabolic problem

6

An increase or decrease in PCO2 by _________mm Hg causes a a decrease or increase in pH by _______.

10mmHg and pH 0.08

7

What is the A-a gradient?

It is a measure of lung efficiency

8

What is the equation for PAO2?

 

How do you find the A-a gradient?

PAO2 = (PB * PH2O) (FIO2) - PaCO2/0.8)
PB = 760, PH2O = 47

 

To find A-a gradient, subtract PAO2 from PaO2 measured on ABG

9

What is a rough estimate of a NORMAL A-a gradient?

approximately your age/3

or less than 20mmHg difference

10

What would cause a widened A-a gradient?

pneumothorax, PE, shunt, VQ mismatch, diffusion problems

11

How would you treat an abnormal A-a gradient?

tx underlying cause - supplemental O2, adjust ventilation, tx atelectasis, add PEEP,

12

An increase or decrease in bicarb by _________mmoles will increase or decrease the pH by __________.

10 mmoles, pH 0.15

13

What is the equation for TOTAL BODY bicarb deficit?

base deficit x wt in kg x 0.4 = answer is in mEq/L

14

How much of the total body bicarb deficit would you replace?

half of the deficit

15

What is an acute cause of low pH and high PCO2?

hypoventilation with hypercarbia

16

What is a chronic cause of low pH and high PCO2? (resp acidosis)

COPD, Asthma

17

How long does it take the kidneys to help compensate the pH in acidosis?

1-2 days

18

________ ions are excreted by the kidneys and _________ is reabsorbed into blood to PARTIALLY correct the pH

hydrogen, HCO3

19

What can cause a HIGH pH and LOW PaCO2? (resp alkalosis)

Hyperventilation with hypocarbia

20

What are some causes of resp alkalosis?

Pregnancy, artificial ventilation, hypoxic resp, CNS dzs, encephalitis, anxiety, withdrawal, early septic shock

21

What are some causes of LOW pH and LOW HCO3? (met acidosis)

Lactic acidosis, Diarrhea, ASA ingestion, high protein intake, DKA,

22

What are some causes of HIGH pH and HIGH HCO3? (met alkalosis)

Loss of H+ from vomiting or excessive NG tube suctioning

23

What is the most important clinical tool in assessing the severity of airway disease?

FEV-1

24

What is FEV-1? What are the normal values?

After max inspiration, the volume of air that can be forcefully exhaled in 1 second Normal - 3-5 liters

25

How else can FEV-1 be reported?

Can also be reported as a percent of FVC. FEV-1/FVC

26

What is a normal FEV1/FVC?

> 75%

27

What is a moderate and extreme FEV1/FVC and what would it indicate?

Mod = 45-60% Extreme = < 35% Degree of risk of obstructive lung disease

28

what is FEF 25-75 and how is it different from FEV1?

Reflects collapse of small/peripheral airways and It is a sensitive indicator of early airway obstruction. It is different because it is effort independent

29

What is the nickname for Maximal Voluntary Ventilation (MVV) or Maximal Breathing Capacity (MBC)?

the "will to live" test - it is the maximal amount of air a pt can exhale in one minute at maximal effort (hyperventilation) tests motivation, mechanics, strength and endurance

30

What patient are at risk for post-op pulmonary complications?

-Hx of pulmonary disease -Thoracic/abdominal(upper) surgery -Obesity -Long-term smoker -Elderly patients (>70 yrs)

31

Why get a pulmonary functioning Test preoperative?

Have a better plan and predict pre-, inta-, and post-operative pulmonary care requirements.

32

What is the normal inspiration:expiratory (I:E)?

1:2

33

What is the inspiration:expiratory (I:E) of a COPD patient?

1:3

34

T/F: CO2 retainers: EtCO2 should be keep near the patient's baseline, a rapid correction will lead to metabolic alkalosis.

True

35

What class of drugs should be avoided during bronchospasm?

Histamine releasing drugs

36

What drugs release histamine?

-Pentothal (STP) -Morphine (MSO4) -Atracurium -Mivacurium -Neostigmine

37

The extubation criteria are:

- VSS, awake and alert, resp. rate<30

- ABG on FIO2 40% --> PaO2>70 and PaCO2<55

- MIF is more negative than -20cm H2O

- VC > 15cc/kg

38

Mechanic intubation criteria are:

RR>35, VC <10cc/Kg in child or 15cc/kg adult, MIF more neg. than -20cmH2O

39

Oxygenation intubation criteria are:

PaO2 < 70mmHg on FiO2 of 40%, A-a gradient > 350mmHg on 100% O2

40

Ventilation intubation criteria are:

PaCO2 > 55 (except in chronic hypercarbia), Vd/Vt > 0.6 (remember normal dead space is 30%)

41

Clinical intubation criteria are:

airway burn, chemical burn, epiglottis, mental status change, rapidly deteriorating pulmonary status, fatigue

42

An arterial blood gas must be measured within 15 minutes or ________ will occur.

glycolysis (The sample can be placed on ice for 1 to 2 hours)

43

What MAY heparin due to a small arterial blood gas sample?

Lower PCO2

44

What results would indicate high risk PFT's on FEV1 and FEV1/FVC?

FEV1 <2 liter/second