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Adult Health I > T2: Pulmonary System (2) > Flashcards

T2: Pulmonary System (2) Flashcards

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1
Q

When does shunting occur?

A

when a portion of the VENOUS blood does not participate in gas exchange

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2
Q

Examples of conditions that may cause anatomic shunting:

A
  • AVMs
  • ARDS
  • atelectasis
  • pneumonia
  • pulmonary edema
  • pulmonary embolus
  • vascular lung tumors
  • intracardiac R to L shunt
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3
Q

Does increased FiO2 help when shunting occurs?

A

No

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4
Q

Does PCO2 change or stay the same when shunting occurs? Why?

A

stays the same

B/c compensation with increased RR

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5
Q

Venous blood that flows through the lungs w/o being oxygenated due to nonfunctioning alveoli:

A

intrapulmonary shunting

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6
Q

Intrapulmonary shunting:
____% is abnormal
____% is life-threatening

A

greater than 10% = abnormal

greater than 30% = life-threatening

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7
Q

What 2 methods can be used to measure shunting?

A
  • Direct measurement

- Estimation

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8
Q

How do we directly measure shunting?

A
  • Give 100% O2 for 15 min

- measure CaO2 and CvO2

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9
Q

CaO2 means ____.

CvO2 means ____.

A 
CaO2 = O2 content of arterial blood
CvO2 = O2 content of venous blood
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10
Q

CaO2 - CvO2 normal is ____ ml/dl.

A

5 ml/dl

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11
Q

How do we estimate shunting?

A
  • PaO2 / PAO2 ratio
  • Alveolar-arterial gradient
  • PaO2 / FiO2 ratio
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12
Q

What is the A-a gradient?

A

The alveolar (PAO2) to arterial (PaO2) pressure difference

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13
Q

PAO2 means ____ pressure

PaO2 means ____ pressure

A 
PAO2 = alveolar O2 pressure
PaO2 = arterial O2 pressure
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14
Q

Why is the A-a gradient always positive?

A

You always have more O2 in the lungs than in the body tissue

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15
Q

What is a normal A-a gradient?

A

10-20 mmHg

increases within this range as the pt ages

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16
Q

What does A-a gradient show?

A

How efficiently the lung is managing pulmonary capillary O2 and alveolar O2

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17
Q

If the A-a gradient is large, this indicates a dysfunction in the ___.

A

lung

(it’s not picking up the O2 like it should

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18
Q

Issues that can lead to large A-a gradient:

A
  • V/Q mismatching
  • shunting
  • diffusion abnormalities
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19
Q

What is the formula to find PAO2?

A

PAO2 = FiO2 (PB - PH2O) - PaCO2 / RQ

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20
Q

Abbreviation for fraction of inspired oxygen:

A

FiO2

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21
Q

Abbreviation for barometric pressure. What is normal?

A

PB

760 mmHg

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22
Q

Abbreviation for pressure of water vapor. What is normal?

A

PH2O

47 mmHg

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23
Q

Abbreviation for respiratory quotient. What is normal?

24
Q

PaO2 / FiO2 normal value:

Study These Flashcards
A

greater than 286

the lower the number, the worse the lung function

25
HYPOXEMIA caused by what 3 physiological problems:
- low inspire O2 tension - alveolar hypoventilation - V/Q mismatch
26
High _____ can cause LOW inspired O2 tension.
altitudes
27
Alveolar hypoventilation can be caused by disorders of the _____ center and _____ of the respiratory system.
respiratory | muscles
28
A-a gradient is NORMAL with _____ _____. | A-a gradient is INCREASED with _____ _____.
``` Normal = alveolar hypoventilation Increased = V/Q mismatch ```
29
What 5 things are checked by lab test regarding the pulmonary system?
1) Blood 2) Sputum 3) Chest 4) Ventilation and perfusion 5) Pulse oximetry
30
What BLOOD test is performed?
ABGs
31
What SPUTUM characteristics are observed?
Pathogens abnormal cells color, amount, consistency
32
What CHEST tests are performed?
CXR Digital chest radiography CT
33
What VENTILATION and PERFUSION test is performed?
V/Q scan
34
What noninvasive PULSE OXIMETRY test is performed?
SpO2
35
What areas do we ask about in a respiratory history assessment?
(Remember: SCAS HOG) - Smoking history - Childhood diseases - Adult diseases - Surgeries - Hospitalizations - Occupation/leisure activity - Geographic area or travel
36
Pulmonary Function Test: | What does it look for?
Evaluates lung: - VOLUME and CAPACITIES - FLOW RATES - DIFFUSION CAPACITY - GAS EXCHANGE - AIRWAY RESISTANCE - DISTRIBUTION OF VENTILATION
37
Pulmonary Function Test: | No smoking for _____ hrs prior to test.
6 - 8 hrs
38
Pulmonary Function Test: | How many hours must bronchodilator drugs be held before test?
4 - 6 hrs
39
Capnometry and Capnography: | What does it measure?
Measures amount of CO2 present in EXHALED air | Remember you exhale to blow the "cap" off someone's head
40
Capnometry: | What is the normal pressure of PETCO2?
between 20 and 40 mmHg
41
What is a capnometry device often used for?
Check for correct positioning of an ET tube
42
What 4 things can increase or decrease PETCO2?
Ventilation Metabolism Circulation Error
43
What does exercise testing evaluate?
A 6 or 12 min walk test to see how short of breath, how far you can walk during that time
44
What do skin tests evaluate?
- allergens | - infectious diseases
45
What 3 things can be done during a bronchoscopy?
- visualize - biopsy - aspirate material
46
How many hours must a pt be NPO before a bronchoscopy? Why?
8 hrs | risk of aspiration
47
After a bronchoscopy, what must you assess for before allowing pt to drink?
Return of cough and gag reflex
48
What are 3 common complications with a bronchoscopy?
(Remember LAP) - Laryngospasm - Aspiration - Pneumothorax
49
What is a THORACENTESIS?
aspiration of pleural FLUID or AIR from pleural space
50
What do we tell the pt a thoracentesis will feel like?
Stinging sensation and pressure; pt will feel better after excess fluid is pulled off lungs
51
What must the pt do during a thoracentesis?
Sit absolutely motionless in the correct position
52
What amount is typically the limit to aspirate in a thoracentesis? Why?
1000 mL | too much can cause complications from fluid shift
53
What 5 complications can be seen after a thoracentesis?
1) mediastinal shift 2) pneumothorax 3) bleeding 4) infection 5) subcutaneous emphysema (**pneumothorax can cause the mediastinal shift)
54
What is subcutaneous emphysema? Is it dangerous?
trapped air under the skin that sounds like crackels ("Rice Crispies") Not dangerous, but the reason that caused it can be!
55
What does a lung biopsy look for?
obtains tissue for - histologic analysis - culture - cytologic exam
56
Does a lung biopsy need to be performed in the OR?
No, can be done at the bedside
57
Follow-up care for lung biopsy:
- Assess VITALS, BREATH SOUNDS at least q4h for 24 hrs - Assess for respiratory DISTRESS - Report REDUCED/ABSENT breath sounds immediately - Monitor for HEMOPTYSIS

Adult Health I (10 decks)

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