CardioPulm - Pulmonary System: Lab Tests, PT Tests and Measures, PT Intervention

arterial blood gases (ABGs)

evaluate acid-base status (pH), ventilation (PaCO2), and oxygenation of arterial blood (PaO2)

complete blood count (CBC)

performed to assess health, to diagnose and monitor a medical condition, and to monitory the effects of medical treatment

forced vital capacity (FVC)

measures the maximum amount of air a person can exhale forcefully after a full inhalation

forced expiratory volume in 1 second (FEV1)

measures the amount of air a person can forcefully exhale in one second

FEV1/FVC ratio

assesses the ratio of the volume exhaled in the first second to the total exhaled volume

pH

indicates the alkalinity or acidity of the blood

PaCO2 (partial pressure of CO2)

reflects the efficiency of CO2 exchange in the lungs

PaO2 (partial pressure of O2)

measures the oxygen level in the arterial blood

low levels of hemoglobin (Hb) and hematocrit (Hct) may indicate

anemia, which can affect oxygen-carrying capacity

elevated levels of WBC can suggest

infection or inflammation

what can elevated levels of C-reactive protein (CRP) indicate, and how does that apply to the pulmonary system?

inflammation, which can be associated with various pulmonary conditions

what can elevated levels of D-Dimer indicate, and how does that apply to the pulmonary system?

presence of blood clots, which can be relevant in conditions such as pulmonary embolism

what can elevated levels of Brain Natriuretic Peptide (BNP) indicate, and how does that apply to the pulmonary system?

may indicate heart failure, which can contribute to respiratory symptoms

what can elevated levels of troponin indicate, and how does that apply to the pulmonary system?

may suggest myocardial damage, which can have implications for respiratory function

what can elevated levels of lactate dehydrogenase (LDH) indicate, and how can it affect the pulmonary system?

may be associated with various lung diseases, including pneumonia and pulmonary fibrosis

what can abnormal levels of liver function tests (LFTs) indicate, and how does that apply to the pulmonary system?

abnormalities can be seen in conditions affecting the lkiver, which can impact respiratory function

what can imbalanced levels of electrolytes (sodium, potassium, chloride) indicate, and how does that apply to the pulmonary system?

imbalances may occur in certain respiratory conditions or as a side effect of medications

normal range for sodium

135-145 mEq/L

normal range for potassium

3.5-5.5 mEq/L

normal range for magnesium

1.5-2.5 mEq/L

normal range for calcium

4.5-5.2 mEq/L

normal range for chloride

95-105 mEq/L

normal range for phosphate

2.5-4.8 mg/dL

normal range for bicarbonate

22-26 mEq/L

what information does ABGs provide?

important info about the function of the lungs and how well the lungs are able to move O2 into the blood and remove CO2

how is ABG taken?

blood test drawn from arteries

key components measured in ABG test?

pH, PaO2, PaCO2, HCO3-, SaO2

ABG analysis indicates adequacy of

alveolar ventilation and oxygenation

how does ABG analysis ensure alveolar ventilation adequacy?

by determining pH, HCO3-, PaCO2

how does ABG analysis ensure alveolar oxygenation adequacy?

by determining the partial pressure of O2 in relation to the fraction of inspired oxygen

FiO2

fraction of inspired oxygen in the air

% of O2 in the air

21% (0.21)

use of what external prescription will increase FiO2?

use of supplemental O2

what ABG components provide information about how well the lugns are functioning to oxygenate blood?

PaO2 and SaO2

what ABG components provide information on how well the lungs are able to remove CO2?

PaCO2

what is the ABG component that keeps the blood from becoming too acidic or basic?

HCO3-

what changes in the body directly affect the balance of pH?

PaCO2

an imbalance of blood pH can impact and cause what?

can impact CNS and cause convulsions or coma

what order are ABGs written in?

1. pH 2. PaCO2 3. HCO3-

pH normal range

7.35-7.45

pH mean value (adult)

7.4

PaCO2 normal range

35-45 mmHg (@ sea level)

PaCO2 mean value (adult)

40 mmHg

PaO2 normal range

80-100 mmHg

PaO2 mean value (adult)

97 mmHg

HCO3- normal range

22-26 mEq/L

HCO3- mean value (adult)

24 mEq/L

SaO2 normal range

95-98%

acidemia

pH < 7.35, elevated acidity

alkalemia

pH >7.45, decreased acidity

eucapnia

normal CO2 in arterial blood

hypercapnia

PaCO2 >45 mmHg, elevated CO2 in arterial blood

hypocapnia

PaCO2 <35 mmHg, low level CO2 in arterial blood

hypoxemia

PaO2 <80 mmHg, low level O2 in arterial blood

mild hypoxemia

PaO2 60-79 mmHg

moderate hypoxemia

PaO2 40-59 mmHg

severe hypoxemia

PaO2 <40 mmHg

hypoxia

low level of O2 in the tissue despite adequate perfusion of the tissue

causes of respiratory alkalosis

alveolar hyperventilation

symptoms of respiratory alkalosis

dizziness, syncope, tingling, numbness, early tetany

causes of respiratory acidosis

alveolar hypoventilation

symptoms of early respiratory acidosis

anxiety, restlessness, dyspnea, headache

symptoms of late respiratory acidosis

confusion, somnolence, coma

causes of metabolic alkalosis

bicarbonate ingestion, vomiting, diuretics, steroids, adrenal disease

symptoms of metabolic alkalosis

weakness, mental dullness, possible early tetany

causes of metabolic acidosis

diabetic, lactic, uremic acidosis, prolonged diarrhea

symptoms of metabolic acidosis

secondary hyperventilation, nausea, lethargy, coma

compensated ABG definition

blood pH has normalized from initial abnormal state

uncompensated ABG definition

HCO3- is normal
PaCO2 is normal

partially compensated ABG definition

HCO3- outside normal
PaCO2 outside normal

fully compensated ABG definition

pH within normal range
HCO3- and PaCO2 outside normal

how do high levels of PaCO2 influence pH?

more acidic

how do high levels of HCO3- influence pH?

more basic

gram stain sputum study

immediate identification of bacteria category (gram-neg or gram-pos) and appearance (pairs, chains)

culture and sensitivity sputum study

identifies specific bacteria as well as organism's susceptibility to various antibiotics

cytology sputum study

reports presence of cancer cells in the sputum

purpose of pulmonary function tests

to evaluate lung volumes, capacities, and flow rates, diagnose disease, monitor progression, and determine benefits of medical management

pulse oximetry

estimates the percent of arterial oxygen saturation of hemoglobin by placing a sensor on the finger or earlobe. the sensor measures the different absorption of light by oxygenated and nonoxygenated hemoglobin

if SpO2 is <90% in acutely ill patients, how should you proceed?

activity should take place to consider adding or increasing supplemental O2

if SpO2 <85% in patients with chronic lung disease, how should you proceed?

activity should take place to consider adding or increasing supplemental O2

dyspnea scales

quantifies dyspnea

aerobic capacity and endurance measures

6 minute walk test, 2 minute walk test, 2 minute step test, 1 minute sit to stand

manual secretion removal techniques

postural drainage, percussion & vibration, direct assisted cough, huff cough, assisted cough, tracheal stimulation

independent secretion removal techniques

active cycle breathing, autogenic drainage, PEP devices, HFCWO (air oscillation vest)

breathing exercises

diaphragmatic breathing, reed of diaphragm, paced breathing and exhale with effort, pursed-lip breathing, segmental breathing, sustained maximal inspiration with incentive spirometer

activities for increasing functional abilities

inspiratory muscle training, energy conservation

paced breathing

a strategy to decrease the work of breathing and prevent dyspnea during activity. allows anyone who experiences SOB to become less fearful of activity and exercise

exhale with effort

a breathing strategy employed during activity to prevent a patient from holding their breath. breaks any activity into one or more breaths with inhalation during the resting or less active phase of the activity and exhalation during the movement or more active phase of the activity

energy conservation

the practice of finding ways to use less energy or to use energy more efficiently