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Cardio pulm exam 2 > Tests & Lab Values > Flashcards

Tests & Lab Values Flashcards

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1
Q

SpO2/SaO2:

A

norms = 95-100%

Below 88-90% usually requires supplemental O2

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2
Q

PaO2:

A

norms = 75-100 mmHg

> 100 mmHg = hyperoxygenation

<80 mmHg = hypoxygenation

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3
Q

PaCO2:

A

norms = 35-45 mmHg

> 45 mmHg = COPD, hypoventilation

<35 mmHg = hyperventilation, pregnancy, PE & anxiety

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4
Q

Blood pH:

A

norms = 7.35-7.45

<7.35 = acidic; respiratory acidosis = hypoventilation or metabolic acidosis: CO2 retainer

> 7.45 = basic; respiratory alkalosis= hyperventilation or metabolic alkalosis: vomiting, diuretics; low CO2

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5
Q

Type of coagulation tests =

A

prothrombin time (PT) = evaluates ability to clot

International Normalized Ratio (INR) = ensures that results from PT tests are the same from one lab to another

Partial thromboplastin time (PTT) = determines if blood-thinning therapy is effective

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6
Q

Prothrombin Time (PT):

A

norms = 11-15 sec

> 15 sec = clotting deficiency, hemorrhagic ds, cirrhosis, medication (warfarin)

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7
Q

Partial Thromboplastin Time (PTT):

A

norms = 25-40 sec

> 40 sec = see above

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8
Q

International Normalized Ratio(INR):

A

norms = 0.9-1.1

Look for signs of bleeding

Use compensatory strategies to reduce risk of falls or injury

Patients with DVT, PE, mechanical valve, AF = on anticoagulation therapy will have target INF 2-3; higher if genetic clotting condition INF 3.5

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9
Q

C-reactive protein (CRP):

A

norm = <10 mg/L

> 10 mg/L = platelet disorder, increase risk of atherosclerosis

> 100 mg/L = associated with inflammation & infection

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10
Q

White Blood Cells (WBC):

A

norms = 4,300-10,800 cells/mm3

Indicative of immune system status

> 10,800 = infection, inflammation, cancer, corticosterioids

<4,300 = aplastic anemia, folate deficiency; increased risk of infection

Wear mask when working with immunosuppressed patients

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11
Q

Red Blood Cells (RBC):

A

Male: 4.6-6.2 106/uL
Female: 4.2-5.9 106/uL

Increased levels = polycythemia; fatigue with activity

Decreased levels = anemia; Fatigue with activity

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12
Q

Hematocrit (Hct):

A

% by volume of RBC in whole blood

Male: 45-52%

Female: 37-48%

Increased levels = polycythemia, dehydration, shock

Decreased levels = severe anemia, acute hemorrhage

Decreased exercise tolerance, increased fatigue, and tachycardia

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13
Q

Hemoglobin (Hgb):

A

oxygen carrying protein

Male: 13-18 g/dL

Female: 12-16 g/dL

Increased levels = polycythemia, dehydration, shock

Decreased levels = anemia, hemorrhage, cancer, sickle cell disease

Decreased exercise tolerance, increased fatigue, and tachycardia

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14
Q

Platelet Count:

A

150,000-450,000 cells/mm3

Increased = chronic leukemia

Decreased = acute leukemia, anemia

Look for active signs of bleeding hematuria, petechiae

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15
Q

Platelet count and exercise guidelines:

A

<20,000: AROM, ADLs only

20,000-30,000: light exercise only

30,000-50,000: moderate exercise

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16
Q

Heart rate norms:

A

infants = 120 bpm

adults = 60-100bmp

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17
Q

BP norms:

A

infants = 75/50 mmHg

adults = <120/80 mmHg

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18
Q

RR norms:

A

infants = 40 br/min

adults = 12-20 br/min

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19
Q

PaO2 (ABG) norms:

A

infants = 75-80 mmHg

adults = 75-100 mmHg

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20
Q

PaCO2 (ABG) norms:

A

infants = 34-54 mmHg

adults = 34-45 mmHg

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21
Q

pH (ABG) norms:

A

infants = 7.26-7.41

adults = 7.35-7.45

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22
Q

Tidal volume norms =

A

infants = 20mL

adults = 500mL

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23
Q

Temperature norms =

A

infants = 97.9F

adults = 98.6 F (37C)

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24
Q

What is respiration?

A

Respiration: gas exchange across the alveolar-capillary and capillary-tissue interface

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25
What is respiration measured by?
Arterial Blood Gases (ABG)
26
What is O2 saturation?
SpO2 or SaO2
27
What is the Ventilation/Perfusion ratio (V/Q match)?
Norm 0.7 - 0.8 < 0.7 = poor ventilation > 0.8 = poor perfusion
28
What is diffusion?
movement of solutes from area of higher to area of lower concentration
29
What is ventilation?
(Ve) the physical act of moving gas, primarily oxygen (O2) and carbon dioxide (CO2), into and out of the lungs Ve= Tidal Volume (Vt) normal breathing at rest x Respiratory Rate (RR)
30
Ventilation Normal adult values (Ve, Vt, RR):
Ve: 6.0 –10.0 L/min at rest Vt: 400 –850 ml per breath or .40 - .85 L/breath RR: 12 – 20 breaths per minute (bpm)
31
What is FiO2?
Fraction of inspired oxygen The % of oxygen at each inspired breath
32
What is the FiO2of atmospheric room air?
21%
33
What is respiratory failure?
Etiology: Inadequate gas exchange by the pulmonary system initiated by critical drop in blood oxygen level (hypoxemia) and/or a rise in arterial carbon dioxide (hypercapnia) PaO2<60mmHg or PaCO2 >50mmHg
34
What is arterial blood gas (ABG)?
Blood sample taken from an artery = Invasive Analysis assesses a patient’s partial pressure of oxygen (PaO2) and carbon dioxide (PaCO2) Provides information about the patient’s oxygenation status and ventilation status Hyperventilation (low CO2) and hypoventilation (high CO2) affect blood gas = resulting in a change in pH status of the blood
35
Pulmonary Assessment: Arterial Blood Gases
Assessment of the lungs ability to oxygenate the blood and remove carbon dioxide assessment of problems related to acid-base balance, ventilation and oxygenation Measures the pH, and the levels of oxygen (O2) and carbon dioxide (CO2) from an artery The analysis of the partial pressure of gases within the arterial blood indicates the effectiveness of alveolar ventilation
36
CO2 levels =
High CO2 = acidic Low CO2 = alkaline
37
What is ABG: Partial Pressure?
dynamic that explains why oxygen moves from the alveoli (oxygenated blood) into the capillaries (deoxygenated blood) and why carbon dioxide moves from the blood into the alveoli Normal Dynamics: Partial pressure of oxygen is higher in the alveoli than the adjacent capillaries, it flows into the capillaries since the partial pressure of carbon dioxide is higher in the capillaries than the alveoli, it moves from the capillaries into the alveoli
38
Invasive Assessment of ABG =
1. The blood pH: norm 7.35-7.45 2. Partial Pressure of Carbon dioxide (PaCO2): Norm 35 – 45 mm Hg 3. Partial Pressure of Oxygen (PaO2): Norm 75 – 100 mm Hg 4. Amount of serum bicarbonate (HCO3): Norm 22 – 26 mmol/L
39
Non-Invasive Assessment of ABG =
Oxygen Saturation (SpO2): Norm 94 – 100%
40
Normal ABG values:
pH = 7.35-7.45 PaCO2 = 35-45 HCO3 = 22-26 PaO2 =80-100 SaO2 = 94-100
41
what does low pH lead to?
acidemia high PCO2 -= respiratory acidosis OR low HCO3 = metabolic acidosis
42
what does high pH lead to?
alkalemia low PCO2 -= respiratory alkalosis OR high HCO3 = metabolic alkalosis
43
Pulmonary Assessment: Respiratory Alkalosis vs Acidosis Order of values to look at:
pH first PaCO2 is the next value to be determined - Compare the PaCO2 direction of the change with the direction of the change in pH
44
what is the Inverse relationship between PaCO2 and pH:
PaC02 decreases (less than 35mmHg) & pH increases (>7.45) - Respiratory Alkalosis PaC02 increases (more than 45mmHg) & pH decreases (<7.35) - Respiratory Acidosis
45
Direct relationship between bicarbonate and pH: metabolic
increase bicarbonate, increase pH decrease bicarbonate, decrease pH Normal range is 22 to 26 millimoles per liter (mmol/L)
46
When the direct relationship is evident, the primary cause of the altered pH is of a ___ etiology
metabolic
47
What is Metabolic acidosis?
HCO3 <24 mmol/L pH = decrease PaCO2 = WNL HCO3 = decreae causes: Diabetic, diarrhea signs/symptoms: Nausea, lethargy, secondary hyperventilation, coma
48
What is Metabolic alkalosis?
HCO3 >24 mmol/L pH = increase PaCO2 = WNL HCO3 = increaes causes: HCO3 ingestion, vomiting, diuretics signs/symptoms: Weakness, mental dullness
49
What is respiratory alkalosis?
pH = increase PaCO2 = decrease HCO3 = WNL causes: hyperventilation signs/symptoms: dizziness, syncope
50
What is respiratory acidosis?
pH = decrease PaCO2 = increase HCO3 = WNL causes: hypoventilation signs/symptoms: Early: anxiety, restlessness, dyspnea, headache Late: confusion, somnolence, coma
51
What do you do to detect respiratory conditions:
First: examine pH value; if HIGH (above 7.45), ALKALOSIS is present THEN: examine CO2 LEVELS, If below 35 mmHg, RESPIRATORY ALKALOSIS present IF: pH was low (below 7.35) and CO2 levels are High (above 45 mm Hg), RESPIRATORY ACIDOSIS is present
52
What do you do to detect metabolic conditions:
FIRST: examine pH values------High pH (above 7.45) SECOND: examine CO2 levels (assumed to be normal) THIRD: examine bicarb levels-----high bicarbonate (above 24 mmol/L) Condition: METABOLIC ALKALOSIS
53
What is chronic respiratory acidosis?
pH <7.35 CO2 retention PaCO2 >45 mmHg HCO3 >28 mmol/L (compensating)
54
What are the possible causes of chronic respiratory acidosis?
hypoventilation due to pulmonary, cardiac, musculoskeletal, or neuromuscular disease CNS depression from medication = possibly slows RR and tidal volume
55
What is chronic respiratory alkalosis?
pH >7.45 Excess CO2 excretion PaCO2 <35 mmHg HCO3 <24 mmol/L (compensating)
56
What are the possible causes of chronic respiratory alkalosis?
hyperventilation due to anxiety, pain, or improper ventilator settings respiratory stimulation caused by drugs, disease, hypoxia, fever, or high room temperature
57
Metabolic acidosis findings:
pH <7.35 PaCO2 = 35mmHg HCO3 <24 mmol/L
58
Metabolic acidosis possible causes:
HCO3 depletion due to renal disease, diarrhea, or small-bowel fistulas hepatic disease results in excessive production of organic acids endocrine disorders = diabetes mellitus
59
Metabolic alkalosis findings:
pH >7.45 PaCO2 = 45mmHg HCO3 >28 mmol/L
60
Metabolic alkalosis possible causes:
Inadequate excretion of acids due to renal disease Loss of hydrochloric acid from prolonged vomiting or gastric suctioning Loss of potassium due to increased renal excretion Steroid overdose Excessive alkali ingestion
61
Respiratory Acidosis signs and symptoms =
hypercapnia (increased CO2) hypoventilation headache visual disturb confusion coma/drowsiness hyperalkemia
62
Metabolic Acidosis signs and symptoms =
bicarbonate deficit hyperventilation headache mental dullness deep respiration coma/stupor cardiac arrhythmias
63
What is alveolar hyperventilation?
leads to a PaCO2 less than normal ratio with bicarbonate increases = blood pH increases = respiratory alkalosis bicarbonate/CO2
64
What is alveolar hypoventilation?
leads to a PaCO2 greater than normal ratio with bicarbonate decreases = blood pH decreases = respiratory acidosis
65
What is it called when a patient’s PaCO2 is > 50mmHg ?
Ventilation Failure = alveoli unable to remove CO2
66
Pulmonary Assessment: ABG: PaO2
75 and 100 mm Hg at sea level = As altitudes increase, normal values decrease Air that we breath in is approximately 21% Oxygen Total pressure of all of the gases you breathe = oxygen, nitrogen, carbon dioxide
67
Oxygenation status is determined by PaO2 levels:
80 – 100 mmHg - normal between 60-80mmHg-mildly hypoxemic between 40-60mmHg- moderate hypoxemic under 40mmHg- severe hypoxemic
68
Hypoxemic Respiratory Failure: Type I
PaO2 <60 mmHg (decrease) Hypoventilation (PaCO2 increases) V/Q mismatch Diffusion limitation Pneumonia, COPD, atelectasis/lobar collapse, ARDS Intrapulmonary shunt = fluid filled alveoli that are perfused but not ventilated
69
What is the most common form of respiratory failure?
Hypoxemic Respiratory Failure: Type I
70
Hypercapnic Respiratory Failure: Type II
PaCO2 >50mmHg (increase) Hyperventilation to compensate for high CO2 Compensation = Renal response, takes days to weeks
71
What causes Hypercapnic Respiratory Failure: Type II ?
Respiratory Center (medulla) dysfunction = drug overdose, CVA, tumor Neuromuscular Disorders = SCI, Guillain-Barre, ALS, MD Chest Wall/Pleural Diseases = Kyphosis, scoliosis, pneumothorax, massive pleural effusion Upper Airway Obstruction = Tumor, foreign body, laryngeal edema
72
Respiratory Failure: Clinical Manifestations
Dyspnea –secondary to hypercapnia and hypoxemia Altered breathing pattern Cyanosis –poorly oxygenated hemoglobin Circulatory changes –tachycardia, hypertension, or hypotension Mental status changes –confusion, somnolence, convulsions, coma Adventitious or absent lung sounds
73
Treatment of Respiratory Failure
Hypoxemia can cause death Treat underlying cause = hypoxemia = hypoxia Medical Management = Pharmacologic PT Management = breathing strategies, strengthening, pacing Supplemental oxygen : amount primarily determined by PaO2 and/or PaCO2
74
When does tissue hypoxia occur?
Pa02 <38mmHg or Sa02< 70% Need to Increase to minimum levels of: Pa02>60mmHg and Sa02>87%02
75
What is SAO2?
measurement of oxygen saturation in arterial blood measured by blood gas analysis measured in peripheral blood taken from an artery through puncturing measures the oxygen saturation of both functional and non-functional hemoglobin important ot determine anemic conditions
76
What is SPO2?
oxygen saturation in the arterial blood measured as a pulse oximeter measured by the pulse oximetry noninvasive method - uses a transmissive pulse oximeter measures the oxygen saturation of only functional hemoglobin important in surgery and post-anesthetic care units, neonatal care and NICU, emergency care, noninvasive transcutaneous pacing

Cardio pulm exam 2 (8 decks)

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