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59 Cards in this Set
- Front
- Back
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Describe Chest Xray |
Xrays passed through the Pts chest and recorded on a special film/plate |
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Basics of reading an Xray |
Bones, fluids, fluid containing bodies (organs), tumors, infiltrate, FB are denser than the lungs and typically appear opaque Air should be black as the xray passes right through it - xrays with a lot of black in the chest could mean overexposure |
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Indications for Usage for Xray |
General screening tool pre-op General Physical Exams Specific Dx purpose |
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What information does a chest Xray provide? |
anatomic location and abnormalities of the heart, great vessels, lungs, soft tissues of the chest & mediastinum, and bones |
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Pulmonary uses for Chest Xray |
Abscess, ARDS, atelectasis, Bethel myopathy, bronchitis, CF, emphysema, fibrosis bullae, hemothorax, pneumothorax, malignancies of lung, pleural effusion, pneumonia, pulmonary edema, calcifications due to TB |
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Norms for Chest Xray |
normal anatomy & no pathologic changes evident |
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Professional Considerations for Chest Xray |
No consent required |
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Contraindications for Chest Xray |
Any contraindications to Valsalva Maneuver: MI, bradycardia (if present teach Pt to hold breath w/o bearing down) |
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CT Traditional Description |
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Usage for Traditional CT |
Congenital anomalies, localization of FB, assessment of airway integrity post trauma, assessment of pulmonary masses, abscesses, or follow up on abnormalities detected on chest Xray, staging of bronchogenic carcinoma, detection, localization, and characterization of lung dz, detection of mediastinal or diaphragmatic hernia, musculoskeletal or soft tissue trauma |
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High Resolution CT description |
HRCT improves on traditional CT technology by providing optimized spatial resolution of body stxs and better differentiation of normal from abnormal blood vessels |
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High Resolution CT Usage |
Procedure of choice for lung evaluations for chronic infiltrative lung dz, vascular eval |
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Professional Considerations for CT/HRCT |
Consent required IF using contrast |
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Norms CT/HRCT |
Negative. No tumor, malformations, or pathologic activity |
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Contraindications for CT/HRCT |
Pts who are unable to remain motionless while lying in a supine postion Contrast: previous allergy to shellfish, iodine, or radiographic dye, renal insufficiency |
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Bronchoscopy description |
Direct visual examination of the larynx, trachea, and bronchi with a rigid bronchoscope or a flexible fiberoptic bronchoscope |
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Bronchoscopy usage |
To examine the bronchi for abscesses, aspiration pneumonia, hemoptysis, unresolved pneumonias, strictures, tumors; removal of FB; obtain deep sputum samples, & biopsy specimens |
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Bronchoscopy Norms |
Normal larynx, trachea, bronchi |
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Professional Consideration for Bronchoscopy |
Patient consent IS required |
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Arterial Blood Gas Description |
Measures dissolved O2 and CO2 in the arterial blood, reveals the acid--base state, reveals how well O2 is being carried to the body |
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Arterial Blood Gas Norms |
pH: 7.35-7.45 PaO2: 80-100 mmHg PaCO2: 35-45 mmHg HCO3: 22-26 mEq/L O2 Sat: 96-100% |
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ABG: Acidosis vs Alkalosis |
Acidosis: pH <7.35 Alkalosis: pH >7.45 |
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ABG: Respiratory Acidosis vs Respiratory Alkalosis |
Respiratory Acidosis: pH <7.35 AND HCO3 >26 / PaCO2 >45 Respiratory Alkalosis: pH >7.45 AND HCO3 <22 / PaCO2 <35 |
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ABG: Metabolic Acidosis vs Metabolic Alkalosis |
Metabolic Acidosis: pH <7.35 AND HCO3 <22 / PaCO2 <35 Metabolic Alkalosis: pH >7.45 AND HCO3 >26 / PaCO2 >45 |
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Hypoxemia |
Lack or deficient oxygen in the blood - hypoxia refers to lack of O2 in tissues PaO2 <80 would be hypoxemic... PaO2 <40 would be severely hypoxemic and is "panic value" |
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Arterial Blood Gas Professional Considerations |
No consent required |
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Arterial Blood Gas Contraindications |
Pts with bleeding disorders or an anticoagulated state; Invasive arterial catheter is preferred for repeated sampling (vs arterial puncture) |
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Ventilation and Perfusion (V/Q) Scan description |
This is a nuc med proc w/3 types of scans: Perfusion - blood flow to the lungs is evaluated by IV injn MAA tagged with Tc99 Ventilation - determines patency of the airways and detexts abnrmlts in ventilation via inhaled Tc99-DTPA Inhalation - radioactive mist is inhaled to show the major airways |
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Ventilation and Perfusion (V/Q) Scan Usage |
Dx of pulmonary embolism or thrombosis; determination of % of lungs fxng normally; est regional pulmonary blood flow to assess vasculature; identify shunting; identify absent capillaries; Dx of asthma, atelectasis, bronchitis, COPD, inflammatory fibrosis, lung cancer, pneumonia |
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V & P (V/Q) Scan Professional Considerations |
Consent IS required |
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V & P (V/Q) Scan Norms |
Perfusion Scan: uniform uptake of Tc99 throughout lung vasculature, hot spots indicate good uptake and cold spots indicate poor uptake; Perf Scan is sensitive but not specific Ventilation Scan: = gas distrib throughout airways; abnrml dist = parenchymal dz Inhalation Scan: Low probability for Emboli |
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Pulse Oximetry Description |
The non-invasive, spectrophometric estimate of functional O2 saturation of hemoglobin, using a probe attached to the finger, toe, temporal area, bridge of nose. 3-wavelength reflectance is a motion-resistent form that increases consistency and accuracy |
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Pulse Oximetry Usage |
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Pulse Oximetry Norms |
Adult: 94-100% Newborn: 40-92% depending on lung development and altitude |
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Pulse Oximetry Professional Considerations |
No consent required |
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Pulmonary Angiogram Description |
Invasive roentgenographic, fluoroscopic procedure after ijxn of iodine radiopaque contrast mat'l via catheter in antecubital or femoral vein into pulmonary artery or one of its branches |
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Pulmonary Angiogram Usage |
Visualization of the size & shape of the pulmonary artery, its branches, & the vascular bed; meas of pressures w/in these stxs, cardiac output & pulmonary vasc resistance; assess pulmonary vascular perfusion defects; definitive test for pulm embolism; definitive test for lung torsion; eval pulmonary circulation in preop Pt w/ congenital heart dz/ eval obstxv sleep apnea |
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Pulmonary Angiogram Norms |
Radiopaque iodine contrast mat'l should circulate symmetrically and w/o interruption through the pulmonary circulatory system |
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Pulmonary Angiogram Professional Considerations |
Consent IS required |
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Thoracocentesis Description |
The removal of fluid or air fro the pleaural space by transthoracic aspiration. It is performed to:
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Thoracocentesis Usage |
Tx: relieves dyspnea becuase of pleural effusion or pneumothorax Dx: Eval underlying cause of pleural effusion abnormal accumulations of fluid in pleural space may be classified as transudate or exudate |
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Thoracocentesis Norms: |
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Thoracocentesis: Transudative Fluid |
Color: Clear Spec Grav: <1.016 pH: = serum level Protein: <3g/dL Fibrinongen: none or may be present Cells: Few lymphocytes Lactate: = to serum level Glucose: = to serum level Amylase: = to serum level |
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Thoracocentesis: Exudative Fluid |
Color: Cloudy, turbid Spec Grav: > 1.016 pH: < 7.3 Protein: > 3g/dL Fibrinogen: present Cells: Many/may have few RBCs or purulent Lactate: may be > Lactate Dehydrogenase/serum Glucose: may be < serum Amylase: may be > serum |
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Thoracocentesis Professional Consideration |
Consent IS required |
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Pulse Oximetry: Other Data |
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Describe Pulmonary Function Tests (PFTs) |
Several different tests used to evaluate lung mechanics, gas exchange, and acid-base disturbances through spirometry & ABGs |
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Describe Spirometry |
A part of PFTs that uses a spirometer, an instrument that measures lung capacity, volume, and flow rates and produces a graph that can be interpreted for patterns and abnormalities |
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Forced Expiratory Volume 1 (FEV1) |
A spirometry test that measures the amount of air forcefully exhaled in one second. Decreased FEV1 is indicative of an obstructive OR a restrictive process. <80% is obstructive & decreased or normal limit is restrictive |
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Forced Vital Capacity (FVC) |
A spirometry test that measures the amount of air forcefully & rapidly exhaled after a maximum inhalation. A decrease in FVC from 80% predicted indicates a restrictive pattern. |
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Peak Expiratory Flow Rate (PEFR) |
Uses a hand held peak flow meter to determine the peak flow rate during expiration. A decreased result (< 200 L/min) indicates severe obstruction (asthma) |
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FEV1/FVC Ratio |
The ratio of FEV1 to FVC expressed as a percentage. Important ratio for determining obstructive vs restrictive. Decreased ratio is indicative of obstructive process <70% in adults & < 85% in kids |
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Forced Expiratory Flow 25-75 (FEF 25-75) |
Average forced expiratory flow during mid-portion [25%-75%] of forced vital capacity; useful in patients with small airways (kids). Decreased % predicted <79% indicates obstructive pattern. |
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Mixed pattern (Obstructive & Restrictive) |
FEV1/FVC <70% (obstructive) AND FVC < 80% (restrictive) - so both values decreased indicates a mixed pattern |
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Total Lung Capacity (TLC) |
Total volume of lungs when maximally inflated. Increased is Obstructive & Decreased is Restrictive (confirms a restrictive Dx) |
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Norms for PFTs |
Observed values are reported as percentages of normal w/use of predictive equations calculated based on age, height, weight, sex, & race. |
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Usage for PFTs |
Diagnose and monitor the progress of pulmonary dysfunction; quantify the severity of known lung dz; evaluate the effectiveness of medications; determine whether a functional abnormality is obstructive or restrictive |
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Professional considerations for PFTs |
Consent is NOT required |
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Contraindications of PFTs |
Hemoptysis of unknown origin, pneumothorax, unstable cardiovascular status, recent cardiac event or pulmonary embolis, recent eye surgery, concurrent nausea or vomiting, recent thoracic/abdominal surgery, aneurysm (abdominal, thoracic, cerebral) |
