Exam 2 RCA

Normal ABG levels

pH 7.35 – 7.45

PaO2 80-100 mmHg

HCO3 22 – 25 mmol/L

SaO2 > 95%

SvO2 65-75%

B.E. + or – 2 mmol/L

Uncompensated Respiratory Acidosis

pH 7.25

PaCO2 65

HCO3 26

PaO2 58

BE +2

Partially compensated respiratory acidosis

pH 7.33

PaCO2 65

HCO3 28

PaO2 58

BE +4

Compensated respiratory acidosis

pH 7.36

PaCO2 65

HCO3 30

PaO2 58

BE +6

Uncompensated Respiratory Alkalosis

pH 7.57

PaCO2 24

HCO3 23

PaO2 88

BE +1

Partially compensated respiratory alkalosis

pH 7.49

PaCO2 24

HCO3 20

PaO2 88

BE -3

Compensated respiratory alkalosis

pH 7.44

PaCO2 24

HCO3 18

PaO2 88

BE -5

Uncompensated Metabolic Acidosis

pH 7.29

PaCO2 40

HCO3 16

PaO2 74

BE -5

Partially compensated metabolic acidosis

pH 7.31

PaCO2 34

HCO3 16

PaO2 80

BE -5

Compensated metabolic acidosis

pH 7.35

PaCO2 30

HCO3 16

PaO2 83

BE -5

Uncompensated Metabolic Alkalosis

pH 7.52

PaCO2 39

HCO3 29

PaO2 92

BE +4

Partially compensated metabolic alkalosis

pH 7.49

PaCO2 46

HCO3 29

PaO2 85

BE +4

Compensated metabolic alkalosis

pH 7.45

PaCO2 49

HCO3 29

PaO2 80

BE +4

What lobe of the lung is this?

Left Upper Lobe

What lobe of the lung is this?

Left Lower Lobe

What lobe of the lung is this?

Right Upper Lobe

What lobe of the lung is this?

Right Lower Lobe

What lobe of the lung is this?

Right Middle Lobe

Where is the most appropriate place to check for a pulse during a code?

Carotid artery on the neck

What is the normal pulse range and what are the terms for high and low pulse?

60 to 100 beats per minute

Tachycardia greater than 100: anxiety, hypoxemia, exercise, fever, anemia

Bradycardia under than 60: diseased heart, athletes, medication side effect

Apnea

Absence of spontaneous ventilation

Eupena

Normal rate and depth of breathing

Bradycardia

Less than normal rate of breathing

Tachycardia

Rapid rate of breathing

Hypopnea

Decreased depth of breathing

Hyperpnea

Increased depth of breathing with or without an increased rate

Sighing respiration

Normal rate and depth of breathing with periodic deep and audible breaths

Intermittent breathing

Irregular breathing with periods of apnea

Terminology for clinical labs: Erythrocytes, Leukocytes, Thrombocytes

Erythrocytes: Red blood cells

Leukocytes: White blood cells

Thrombocytes: platelets

Terminology for clinical labs: CBC, PT, APTT

CBC: Complete blood count

PT: prothrombin time

APTT: Activated partial thromboplastin time

Terminology for clinical labs: Neutropenia, Anemia, Polycythemia, Coagulation

Neutropenia: a decrease in the neutrophils

Anemia: decrease in the RBCs

Polycythemia: An abnormal increase in the number of circulating RBCs

Coagulation: ability of blood to clot

Terminology for clinical labs: Hemostasis

Ability to prevent hemorrhage, form a blood clot, keep blood flowing in circulation

Terminology for clinical labs: Expectorated Sputum

Preferred method goal is to collect fresh, uncontaminated secretions from tracheobronchial tree. If sputum is needed to look for AFB, THREE samples are needed. Early AM specimens are the best time to obtain. Need 3-5 mL (about 1 teaspoon).

Terminology for clinical labs: Induced sputum

If patient is unable to cough anything up, a sputum induction may be ordered. Hypertonic saline is used via SVN. It is irritating to the airways and may help stimulate a cough.

Terminology for clinical labs: BAL: Bronchoalveolar lavage

Performed via a bronchoscopy by injecting a large volume of fluid into the lungs and then collecting it (sucking it back out) after it mixes with the cells in the lung helps to diagnose interstitial lung disease and the organism causing penumonia

What WBC types and levels of each indicate

Neutrophils: * 50-70% of our WBC most numerous type- our soldiers called into battle to fight infection

Eosinophils: 1-3% of our WBC (accumulate in allergic reactions)

Basophils: 0-1% of our WBC- may also accumulate in allergic reactions

Lymphocytes: 20-40* of WBC- useful in the fight against viral, fungal and TB infections

Monocytes: 2-11% of WBC

What are clinical lab studies for bleeding/coagulation

APTT - Activated Partial Thromboplastin time (APTT)

PT - Prothrombin Time

TCT - Thrombin clotting time

What are the lab studies that evaluate kidney function

BUN: 7 to 20 mg/dL

Creatinine: 0.7- 1.3 mg/dL

GFR: glomerular filtration rate- calculation used to measure kidney function and indicate stage of renal disease.

Urinalysis:

-Urea is a waste product that the kidneys eliminate

-Many kidney diseases result in decreased filtration and increased retention of urea

-BUN will be elevated in other conditions- esp. heart failure

What are CK- MB, troponin, and BNP?

CK-MB- specific for heart damage

Troponin- elevated in heart damage

BNP: (B-type natriuretic peptide) <100 pg/mL, can rule out CHF

how breathing patterns are associated with certain diareses

Bradypnea: Slow breathing (<10–12 breaths/min) often associated with medication-induced respiratory depression (e.g., narcotics) or increased intracranial pressure.

Tachypnea: Fast, shallow breathing (>20–24 breaths/min) associated with pneumonia, pulmonary edema, or anxiety.

Orthopnea: Difficulty breathing while lying flat; associated with congestive heart failure (CHF).

Normal levels of labs ex: glucose, potassium, WBC

Glucose: Normal fasting blood sugar levels range from 70 to 99 mg/dL

Potassium: 3.5 to 5.0 mEq/L

WBC: 4,500 and 11,000

What disorders where unilateral chest movement may occur

pneumothorax

pleural effusion

flail chest

pneumonia

diaphragm paralysis

What is chest expansion and what reduced expansion signifies

Assessing or improving the thoracic cavity's ability to expand during breathing, crucial for optimal lung function

Reduced expansion signifies a decrease in thoracic mobility and lung volume expansion during breathing, indicating underlying pulmonary, pleural, or thoracic musculoskeletal dysfunction.

Where do you used palpation percussion and expansion to diagnose a pneumonia.

the posterior, lateral, and anterior chest wall

What is subcutaneous emphysema

It's when air leaks from the lung into the subcutaneous tissue and fine beads of air make a crackling sound and popping sensation when palpated

Normal Breath Sounds: Vesicular or normal

Pitch: Low

Intensity: Soft

Location: Peripheral lung areas

Normal Breath Sounds: Bronchovesicular

Pitch: Moderate

Intensity: Moderate

Location: Around upper part of sternum, between scapulae

Normal Breath Sounds: Tracheal

Pitch: High

Intensity: Loud

Location: Over trachea

What is vocal fremitus and what does each finding mean

The vibrations created by the vocal cords during phonation

Consolidation/Pneumonia: Air in the alveoli is replaced with fluid, pus, or cells, allowing vibrations to pass through more easily

Lung Tumor/Mass: A solid mass can transmit vibrations more efficiently.

Lung Collapse (Atelectasis): Specifically when the main bronchus is still open.

Fibrosis: Dense tissue acts as a better conductor

What is a D-dimer used for

Is produced as a result of the breakdown of fibrin clots that form in the vasculature

Used often when pulmonary emboli are suspected

What is the significance of abnormal potassium: Hypokalemia

Decreased Potassium Intake

(Low-potassium diet and Alcoholism)

Increased Loss of Potassium

(Gastrointestinal loss, Rental disease, Diuretics)

Extacellular-to-Intracellular Shift of Potassium

(Alkalosis, Increased plasma insulin, Diuretics use)

What is the significance of abnormal potassium: Hyperkalemia

Increased Potassium Intake

(High-potassium diet, Oral potassium supplement, Transfusion of old blood)

Decreased Potassium Excretion

(Rental failure and Hypoalsosteronism)

Intracellular-to-Extracellular Shift of Potassium

(Acidosis, Crush injuries, Tissue hypoxia)

Pseudohyperkalemia

(Hemolysis and Leukocytosis)

What are the 4 components of the physical exam

Inspection

Palpation

Percussion

Auscultation

What is myosis?

Pupil constriction (pontine hemorrhage, narcotics)

JVD is

most common cause of Distended external jugular vein is right-sided heart failure

How can you tell restrictive spine chest

limited lung expansion leading to shortness of breath, chronic back pain, and reduced mobility in the rib cage

How can you tell sternum configurations

Pectus carinatum: Outward sternal protrusion anteriorly

Pectus excavatum: Depression of part or all of the sternum

What does skin turgor help us identify in assessment?

Tells us about hydration status

A good specimen of Sputum Examination will have

few epithelial cells and many leukocytes

A high number of epithelial cells indicate

oral contamination with saliva

What is the Glasgow Coma Scale

Most widely used instrument to quantify neurologic impairment

-Score given for several categories:

Motor response

Verbal response

Poorly suited for patients with impaired verbal response (e.g., aphasia, hearing loss, tracheal intubation)

Eye opening

Issues with the brain stem can affect

regulation of heart rate, blood pressure, and breathing (apneas, hyperventilation, etc)

Phrenic nerves that arise from

C3-C5

Damage to the spinal nerves or above can result

in diaphragmatic paralysis and paralysis of intercostal muscles

In patients with an intact brain stem, the eyes

will move laterally toward the affected ear

In patients with severe brain stem injury, the

gaze will remain at midline

Cheyne-Stokes respiration includes

Intracranial cause * (also hypoxemia, cardiac failure)

Hyperventilation

Apneustic breathing

Ataxic breathing (Biot’s)- severe brainstem issues

Normal ICP includes

10-15mmHg

Declaration of Brain Death includes

Irreversible condition occurring when all perceptible brain activity has seized

Caused by: massive stroke, brain injury, and prolonged cardiac arrest

Establishing brain death will be the grounds used to pronounce a patient dead (even if the heart is still beating) and turn off the ventilator and/or other life-saving measures

A physician and an RT are usually involved in

an “apnea test” which is part of the clinical exam

Looks for an increase in C02 while off

ventilator and the absence of spontaneous breathing

this means that pt. brain is not responding to c02 by breathing