Diag/inter Acute - Week 3 - Lab Tests & Measures, PT Intervention

What is D-Dimer? and what would elevated levels indicate?

It is protein fragment that's made when a blood clot dissolves in your body. Elevated levels may suggest the presence of blood clots, which can be relevant in conditions such as pulmonary embolism.

What is BNP? and what would elevated levels indicate?

Brain Natriuretic Peptide. Elevated levels may indicate heart failure, which can contribute to respiratory symptoms.

What would elevated levels of troponin indicate?

Myocardial damage which can have implications for respiratory function

what is a pulmonary related reason that electrolytes (sodium, potassium, and chloride) may be elevated?

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

What is lactate dehydrogenase (LDH)? and what would elevated levels indicate?

Lactate dehydrogenase is an enzyme found in nearly all living cells. elevated levels may be associated with varous lung diseases including pneumonia and pulmonary fibrosis.

What is included in a measurement of arterial blood gases? (5)

-pH
-PaO2
-PaCO2
-bicarbonate
-oxygen saturation (saturation of hemoglobin)

What information is provided from arterial blood gas levels?

-Provides important information about the function of the lungs and how well the lungs are able to move O2 into the blood and remove CO2.

What is FiO2?

Fraction of inspired oxygen. It is the percentage of oxygen in the air, which is 21% or 0.21.
-use of supplemental O2 will increase FiO2

What is the standard order that arterial blood gasses are written?

pH-> PaCO2 -> PaO2 -> HCO3-
(For example: 7.4/40/97/24)

What is the adult mean range for PaCO2?

35-45 mmHg

What is the adult mean range for PaO2?

80-100 mmHg

What is the adult mean range for HCO3-?

22-26 mEq/L

What is the adult mean range for SaO2?

95-98%

What is acidemia and alkalemia?

Acidemia is elevated acidity of the blood (pH <7.35)
Alkalemia is decreased acidity of the blood (pH>7.45)

What is Eucapnia?

Normal level of CO2 in arterial blood

What is hypercapnia?

Elevated level of CO2 in arterial blod (>45 mmHg)

What is hypocapnia?

decreased level of CO2 in arterial blod (<35 mmHg)

What is hypoxemia?

low oxygen in the blood. PaO2 less than 80 mmHg

What is mild hypoxemia?

PaO2: 60-79 mmHg

What is moderate hypoxemia?

PaO2: 40-59 mmHg

What is severe hypoxemia?

PaO2 less than 40 mmHg

What is hypoxia?

Low level of O2 in the tissue despite adequate perfusion of the tissue.

What is respiratory alkalosis? (2)

A decrease in carbon dioxide levels due to increased excretion by the lungs.
-Increased pH
-Decreased PaCO2

What is the cause of respiratory alkalosis?

Alveolar hyperventilation

What are signs and symptoms of respiratory alkalosis? (5)

-Dizziness
-Syncope (fainting)
-Tingling
-numbness
-early tetany

How do the kidneys respond to respiratory alkalosis?

The kidneys respond to the decreeased CO2 by decreasing HCO3 (base) which decreasse pH to return to homeostasis.

What is respiratory acidosis? (2)

-Decreased pH
-Increased PaCO2

What causes respiratory acidosis?

Alveolar hypoventilation.

What are signs and symptoms of respiratory acidosis? (4/3)

Early:
-anxiety
-restlessness
-dyspnea
-headache

Late::
-Confusion
-Somnolence (drowsiness)
-coma

What is metabolic alkalosis? (2)

-Increased pH
-Increased HCO3-

What causes metabolic alkalosis? (5)

-Bicarbonate ingestion
-Vomiting
-Diuretics
-Steroids
-Adrenal disease

What are signs and symptoms of metabolic alkalosis? (3)

-weakness
-mental dullness
-possible early tetany

What is metabolic acidosis?

-decreased pH
-decreased HCO3-

What causes metabolic acidosis? (4)

-Diabetic
-Lactic
-uremic acidosis
-prolonged diarrhea

What are signs and symptoms of metabolic acidosis?

-Secondary hyperventilation (kussmaul breathing)
-nausea
-lethargy
-coma

What is kussmaul breathing

Deep rapid breathing pattern that occurs in response to extreme acidosis by blowing off CO2.

What are compensatory mechanisms for respiratory and metabolic acidosis and alkalosis?

•The compensatory mechanisms for respiratory acidosis/alkalosis involve changes in renal bicarbonate reabsorption/excretion.

•Those for metabolic acidosis/alkalosis involve changes in respiratory rate/depth to adjust CO2 levels.

What does the term compenated indicate about blood pH?

that blood pH has normalized from initial abnormal state.

What does uncompensated mean?

It means the pH is abnormal due to one of the two systems. It could be respiratory acidosis/alkalosis or metabolic acidosis/alkalosis. Whichever system is at fault, for an uncompensated situation, the opposite system will be normal. For example: with uncompensated respiratory acidosis, the pH and CO2 are abnormal, but the HCO3- remains within the normal range. There is no metabolic compensation.

What does partially compensated mean?

That pH, HCO3, and PaCO2 are all abnormal. In this case, the opposing system is abnormal because there is compensation. However, because the pH is still abnormal, it is only partially compensated.

If there is respiratory acidosis or alkalosis, how would you know if there is compensation?

If the metabolic system is compensating, than HCO3 would be outside of the normal range (renal compensation)

If there is metabolic acidosis or alkalosis, how would you know if there is compensation?

If the respiratory system is compensating, than PaCO2 would be outside of the range (retntion of CO2)

How do you know if the compensation is full or partial?

-If the pH is within the normal range, then there is a full compensation
-If the pH is outside of the normal range, then there is a partial compensation

What effect does increased CO2 and increased HCO3 have on blood pH?

Increased CO2 makes the blood more acidic
Increased HCO3 makes the blood more basic.

What are the 5 steps for ABG interpretation?

1) check pH (high basic, low = acidic)
2) check PaCO2 (high=acidic, low = basic)
3) check HCO3 (high = basic, low = acidic)
4) Match the pH label with PaCO2 or HCO3 and determine the system at fault.
5) Determine if the body is tring to compensate.

How do you know which system is at fault?

If the pH is abnormal and the PaCO2 is abnormal, the lungs are at fault (respiratory aklalosis or acidosis)

If the pH and the HCO3 ar abnormal, the kidneys are at fault (metabolic acidosis and alkalosis.

How do you determine if the body is trying to compensate for the imbalance?

If the opposing system is in normal range and the pH is abnormal, then it is uncompensated.

If the opposing system is abnormal, and the pH is abnormal, then it is partially compensated.

If the opposing system is abnormal, and the pH is normal, than it is fully compensated.

What do pulmonary function tests evaluate? (3)

-lung volumes
-capacities
-flow rate

What are PFTs used for? (3)

Used to diagnose disease, monitor progression, and determine benefits of medical management.

How accurate is a pulse oximeter reading of SpO2?

+ or - 4%

What SpO2 level, measured with pulse oximetry, would indicate that supplemental oxygen should be given to the patient, or increased if already on?

<90% in acutely ill patients or < 85< in patients with chronic lung disease.

What is dyspnea?

Dyspnea is an uncomfortable awareness of breathing that may result from decreased oxygenation, hypoventilation, hyperventilation, or increased work of breathing due to changes in respiratory mechanics or anxiety.

What is the 1 minute sit to stend test?

It is a test for quantifying exercise capacity. It involves an armless chair and the performance of as many sit-to-stand actions as possible in 1 min without using the upper limbs.

What is the 2 minute step test?

It is a quick and simple outcome measure that assesses aerobic endurance and functional fitness. The test involves counting the number of full steps completed in 2 minutes by the patient.. The patient raises each knee to point midway between patella and iliac crest (score is number of times right knee reaches target). Can use to track progress and/or compare to population norms.

What is the 2 minute walk test?

The 2MWT is an easy self-paced measurement of aerobic capacity and functional mobility that may help establish a baseline level of impairment in patients who may not be able to tolerate the longer 6MWT (e.g. due to cardiovascular or pulmonary conditions). It can also be used as a measure of endurance in older populations and persons with lower extremity amputations, cystic fibrosis, traumatic brain injury, and neurological disorders.

What are 6 different manual secretion removal techniques?

-postural drainage
-percussion & vibration
-Directed assisted cough
-huff cough
-assisted cough
-tracheal stimulation

What are 4 different independent secretion removal techniques?

-Active cycle breathing
-Autogenic drainage
-positive expiratory pressure (PEP) devices
-High-frequency chest wall oscillation (HFCWO)

What are 6 different breathing exercises?

-diaphragmatic breathing
-Re-education of the diaphragm
-paced breathing and exhale with effort
-pursed lip breathing
-segmental breathing
-sustained maximal inspiration with incentive spirometer

What are two different activities for increaseing functional abilities?

Inspiratory muscle training and energy conservation

Who may benefit from repiratory muscle training?

Patients who have decreased inspiratory muscle strength and breathlessness despite receiving optimal medical therapy.

What is respiratory splinting?

Respiratory splinting involves supporting the surgical incision and surrounding tissues with a pillow while coughing. The goal is to reduce pain while encuraging lung expansion.

What is the purpose of sputum studies?

Find and diagnose bacteria or fungi that may be causing an infection in the lungs or airways

What is a gram stain sputum study?

-immediate identification of the category of bacteria (gram negative or positive)
-Appearance (pairs, chains)

What is culture and sensitivity in terms of sputum studies?

-Identifies the specific bacteria as well as the organisms ssceptibility to various antibiotics
-results available within a few days.

What is a cytology sputum study?

Reports the presence of cancer cells in the sputum.

What lab values would we look at for pulmonary pathologies? (10)

-ABGs (pH, PaCO2, PaO2, bicarbonate (HCO3), SaO2)
-CBC (hemoglobin, hematocrit, WBC, platelets)
-PFTs (FVC, FEV1, FEV1/FVC ratio)
-C-reactive protein
-D-Dimer
-Brain natriuretic peptide (BNP)
-Troponin
-Lactate dehydrogenase (LDH)
-Electrolytes (Na, K, Mg, Ca, Cl, PO4, HCO3)
-Liver Function Tests (LFTs)

What are ways of testing and monitoring patients with pulmonary pathologies? (8)

-Vital signs,
-pulse oximetry,
-dyspnea scales,
-RPE,
-6 minute walk test,
-2 minute walk test,
-2 minute step test,
-1 minute sit to stand test.

What are the different dyspnea scales? (3)

-There is the medical research council (MRC) breathlessness scale which has two different versions. One consists of 5 grades, the other of 6 grades. Both assess/measure the patient's perceived breathlessness during different activities with higher grades representing greater perceived dyspnea.

-There is also a visual smiley face dyspnea scale that ranges from 1 (no trouble at all) to 7 (very much trouble) that patients can point to.

-Lastly, there is the modified Borg dyspnea scale which ranges from 0 to 10. 0 represents no dyspnea, 10 represents maximal dyspnea.

What are the rate of perceived exertion scales?

There are two different RPE measures. The borg scale and the modified borg scale

-The borg scale ranges from 6 to 20 with low scores representing very very light levels of exertion and high scores representing very very hard levels of exertion.

-The modified borg scale is basically the same. However, the scale is shifted such that it ranges from 0 at rest to 10 which represents very very hard activity.

If a patient is in a car accident and breaks several ribs, she will report difficulty taking deep breaths due to rip pain. What is a potential consequence if the patient reuses to take deep breaths and is compensatinf one side?

Pneumonia

What is MIP and MEP?

Maximum inspiratory pressure and maximum expiratoy pressure

What is deep breathing with butterfly technique?

Patient sitting with hands on head. As they inhale, they look up, expand their chest, and pull their elbows back. As they exhale, the look down, round their shoulders, and bring their elbows together.

What is the lateral costal stretch with facilitation breathing technique?

Patient lies supine. PT blocks one side of the rib cage with one hand and uses the other under the shoulder blade to pull the patients upper body towards the PT to facilitate expansion on the opposite side of the chest. Can have pt breath in this position for 5 minutes or as long as they can tolerate.

What is the trunk rotation stretch breathing technique?

Patient lies supine on the bed with arms crossed across their chest. PT blocks one side of their chest with one hand and then uses the other to reach across and under the opposite scapula. The PT then rolls the patient toward the PT with inhale and then back down with exhale. Could alternatively just hold the patient in the rotated position and let them breath.