Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
260 Cards in this Set
- Front
- Back
|
Purpose of PFT
|
-evaluate cause of pulmonary symptoms
-evaluate abnormalities seen on the CXR and/or CT scan -follow course of disease adn response to tx -evaluate perioperative risk for pulmonary complications -rule out pulmonary pathology in people with high risk for pulmonary dysfunction -evaluate disability |
|
|
PFT normal values vary with:
|
-age
-height -gender -race |
|
|
Height
|
the most important factor predicting lung volumes
- the taller the person, the larger the values |
|
|
Weight
|
important when BMI > or = to 30 = restrictive
|
|
|
Gender
|
males have larger lungs
|
|
|
Race
|
African Americans, Asians, East Indians have 12% smaller lung volumes
|
|
|
Spirometer
|
routine flows and volume
|
|
|
Body plethysmograph
|
TLC and airway resistance studies
|
|
|
Diffusion system
|
lung diffusion
|
|
|
Gas analysis
|
carbon dioxide, carbon monoxide, helium, nitrogen, and oxygen
|
|
|
Multifunction device
|
measures lung volumes, flow rates, diffusing capacity, and response to bronchial provocation
|
|
|
Tidal Volume
|
volume during quiet breathing
adults: 350-600ml stiff lungs: sm. vol. @ high rate Obstruction: norm vol. @ slower rate |
|
|
Minute volume
|
rate x volume
4 to 8L/min |
|
|
Vital capacity
|
maximal volume exhaled
-measured after deepest breath possible -slow vital capacity -forced vital capacity |
|
|
Phases
|
maximal inspiratory effort
initial expiratory blast forceful emptying of lungs <20ml/kg: risk of complications |
|
|
Total lung capacity
|
SVC + RV
normal % predicted is 80% to 120% increased in obstructive diseases due to air trapping obtained by body plethysmography, open circuit nitrogen washout, closed circuit helium dilution, XR planimetry |
|
|
Body plethysmography
|
Boyle's Law
-pressure and voluem of a gas vary inversely if temperature is constant -V1 = V2 x P2/P1 -accurate but body box is expensive -limited to facilities with high volume PFT |
|
|
Open circuit nitrogen washout
|
oxygen 100% for 7 minutes or until nitrogen is washed out of patient's lungs
-estimation of intrathoracic gas volume *79% of exhaled lung vol is Nitrogen * V1 x N1 = V2 x N2 -if air trapping is present this technique will underestimate total intrathoracic volume |
|
|
Closed system helum dilution
|
helium is inert and not significantly absorbed form lungs by blood
-helium is diluted in proportion to size of lung volume being measured -equilibrium takes 7 min -CO2 has to be removed from system -FRC = (initial He - final He) x V x BTPS |
|
|
Residual volume
|
gas left after exhalation
obtained from TLC studies TLC - SVC or FRC - ERV increased in air trapping |
|
|
Expiratory reserve volume
|
maximal gas exhaled from resting status
|
|
|
Functional residual capacity
|
gas left after full exhalation at resting status
|
|
|
FEV1
|
-max vol exhaled during 1st second of expiration
-it is a forced maneuver -varies with age, gender, race, and height -the % predicted is 80% to 100% -reduced in obstructive and restrictive lung disease |
|
|
FEV3
|
-3sec point of the expiratory curve
-not as reproducible as FEV1 -reported as % of the FVC (normal approx 95%) |
|
|
FEF 25%-75%
|
average flow rate during middle half of expiratory curve
-norm 65% to 100% -more sensitive to airway obstruction than FEV1 |
|
|
Peak expiratory flow
|
-max flow rate achieved during FVC maneuver
-effort dependent -peak flowmeters are inexpensive Asthma action plans - green zone: 80% to 100% of personal best -yellow zone: 50% to 80% -red zone: <50% = urgent physician intevention |
|
|
Maximual voluntary ventilation
|
patient breathes as rapidly and deeply as possible for 12 to 15 seconds
-extrapolated to obtain MMV in 1 min MMV reflects: -status of resp. muscles -compliance of thorax lung complex -airway resistance patient motivation and ability to move air important in the preoperative patient |
|
|
Amount of change required to qualify as improvement after bronchodilator
|
FVC >10%
FEV1 > 200ml or >15% FEF 25%-75% >20% to 30% |
|
|
Diffusion capacity
|
determinants of gas exchange
-surface area of membrane -thickness of membrane -hemoglobin and blood flow in capillaries -matching of ventilation and perfusion |
|
|
Cal DLCO
|
[VA x 60/ (Pbar - 47) x t] x [ln x (PACOi/ PACOt)]
|
|
|
DLCO - SB norm
|
80% to 120% predicted
|
|
|
Airway resistance
|
greater on expiration than on inspiration
-increases with asthma, bronchitis, emphysema -uses the plethysmograph -normal 80% to 120% predicted |
|
|
Esophageal balloon
|
proximal end connected to pressure transducer
-serial pressure readings at various volumes |
|
|
Static compliance
|
decreased in atelectasis, pneumonia, pulmonary fibrosis
|
|
|
Cal. total CL
|
CL thorax + CL lung
|
|
|
Nitrogen washout
|
-to determine distribution of ventilation
-pt breathes 100% oxygen -nitrogen analyzer measures diminishing N2 concentration from lungs -well ventilated units empty first -uneven pattern common in obstructive lung disease |
|
|
Closing volume
|
special form of nitrogen washout to diagnose obstruction in small airways
-pt inhales single breath of 100% O2, then slowly exhales while N2 is monitored |
|
|
what are the 4 phases of CV
|
phase I (dead space)
phase II (dead space + alv gas) phase III (alveolar gas) phase IV (abrupt increase in N2) |
|
|
Respiratory Quotient
|
ratio of CO2 produced to O2 consumed
-assess food group metabolized for energy -norm: 0.8 to 0.85 If RQ < 0.7 fats are the sole source of energy If RQ is 1, carbohydrates are the main source -glucose produces more CO2 than if fed with fat and protein |
|
|
Stress ECG
|
detection of coronary artery disease
|
|
|
Ventilatory capacity
|
ability of lungs to respond to exercise
|
|
|
Blood gases
|
problems not apparent at rest
|
|
|
Exercise bronchial provocation
|
drop of exp. flows 20% postexercise; asthma
|
|
|
Anaerobic threshold
|
where oxygen need exceeds availability
-athletes in training and patients with heart disease for individualized exercise program |
|
|
Maximal oxygen uptake
|
level of exercise that causes maximum oxygen consumption
|
|
|
Bronchoprovocation testing
|
diagnosis of occult asthma
provoking agents - inhaled histamine or methacholine -exercise -cold air a 20% decrease in FEV1 indicates hyperreactive airways |
|
|
Other applications of PFT
|
smoking censsation
surgery sleep apnea environmental lung disease |
|
|
Obstructive
|
expiratory flow < 80% predicted
TLC>80% predicted (air trapping) obstruction changes flow vol loop Fixed: flattened expiratory and inspiratory limbs of FVL |
|
|
Restrictive
|
lung volume < 80% predicted
|
|
|
If FVC
|
> 80% predicted = no restrictive
<80% predicted = look at TLC |
|
|
If TLC
|
>80% predicted = no restrictive
<80% predicted = restrictive |
|
|
FEV1 and FEF 25%-75%
|
FEV1 normal and FEF 25%-75% < 65% predicted = mild obstructive disease
|
|
|
Response to bronchodilator
|
if FVC, FEV1, FEF 25%-75% improve = response
|
|
|
FVL
|
scooping of expiratory limb = obstructive
flattening inspiratory and expiratory limbs = fixed or variable large airway obstruction |
|
|
DL
|
>80% prediced is normal
|
|
|
Pattern Recognition Asthma
|
low FEV1 and FEF 25%-75%: normal TLC; normal DL; response to bronchodilator
|
|
|
Pattern Recognition Emphysema
|
low FEV1 and FEF 25%-75%; normal TLC; low DL; no response to bronchodilator
|
|
|
Pattern Recognition Pulmonary Fibrosis
|
low FVC; low FEV1 but normal FEV1/FVC; small TLC, low DL; no response to bronchodilator
|
|
|
Hematology
|
two major categories of tests are part of the hematology evaluation
1. the complete blood count 2. tests of the blood clotting ability of the pt's blood |
|
|
Complete Blood Count
|
-this test determines the number of circulating red and white blood cells
-in addition, the test determines the number and type of white blood cells present in the circulating blood -red blood cells are also evaluated for their size and amount of hemoglobin present |
|
|
White blood cell count
|
-total number of white blood cells in a known volume of blood important to know
-also important to know distribution of white blood cell types: neutrophils, eosinophils, lymphocytes, basophils, monocytes -in healthy people, neutrophils and lymphocytes make up majority of WBC count |
|
|
The neutrophil
|
-normally makes up 40% to 70% of the total white blood cell count
-produced in the bone marrow, where it matures and waits to be called inot action -once neutrophil leaves the bone marrow it enters the circulating blood -next it marginates through the wall of the blood vessel and into the surrounding tissues -once the neutrophil marginates into the tissues, it usually participates in phagocytosis and dies (as in pneumonia) -then normal life span of any neutrophil is about 10 days |
|
|
Eosinophils
|
make up 0% to 6% of the WBCs
probably play a role in allergic reactions (asthmatics) |
|
|
Basophils
|
make up 0% to 1% of the WBCs normally
also may play a role in allergic reactions |
|
|
Lymphocytes
|
make up 20% to 45% of the circulating WBCs
useful in the fight against viral, fungal, and tuberculosis infections |
|
|
What are the two types of lymphocytes:
|
B cells and T cells
|
|
|
Monocytes
|
make up 2% to 10% of the circulating WBCs
the largest of the different WBCs in the lung the monocyte converts to a macrophage, then plays a key role in clearing the lung of inhaled dusts through phagocytosis |
|
|
Leukocytosis
|
an abnormal increase in the circulating white blood cells
|
|
|
Neutorphilia
|
if the increase in leukocytes is due to neutrophils
(drug epi and steroids) |
|
|
Leukopenia
|
an abnormal decrease in the circulating white blood cells
|
|
|
Neutropenia
|
a drop in WBC due to a decrease in neutrophils
|
|
|
Left shift
|
when bone marrow stimulated to release and produce additional neutrophils, immature version also released.
bands normally make up a very small percent of the circulating cells when bands increase significantly this is a sign that the body is under stress (severe infection) |
|
|
Eosinophilia
|
occurs with allergic reactions and parasitic infestations (increase asthma)
|
|
|
Basophilia
|
occurs with similar disorders that cause eosinophilia
(increase basophil) |
|
|
Lymphocytosis
|
occurs with viral infections especially mononucleosis
|
|
|
Monocytosis
|
seen in chronic infections such as tuberculosis
(preleukemia and malignancies) |
|
|
Lymphocytopenia
|
decrease in lymphocytes
is seen in trauma and acute infection. (HIV infection) |
|
|
Neutropenia
|
is a serious medical problem because it represents a reduced ability to fight infection.
caused by: bone marrow failure (chemotherapy or leukemia) or when the cells are destroyed rapidly in the tissues when severe infection is present. |
|
|
Red Blood Cells
|
produced in bone marrow
life span of 120days do not marginate into the tissues like WBCs. main component = hemoglobin Primary funct: carry O2 to the tissues with the help of hemoglobin |
|
|
Anemia
|
a low RBC count
(loss of blood) |
|
|
Microcytic
|
when RBCs are smaller than normal
|
|
|
Hpyochromic
|
when RBCs lack adequate hemoglobin
|
|
|
Microcytic anemia
|
caused by a diet deficient in iron (most common)
|
|
|
Polycythemia
|
an abnormal increase in the number of circulating RBCs
occurs when: bone marrow is overstimulated to produce RBCs in response to a secondary problem Caused: chronic hypoxia (COPD), living at high elevation, and some heart diseases |
|
|
Thrombocytes
|
blood platelets
they form clots normal count: 140,000 - 440,000/mm3 |
|
|
Thrombocytopenia
|
abnormally low platelet count
the lower the platelet count the more likely pt will have problems with bleeding. RTs should check pts platelet count before performing an arterial puncture |
|
|
When platelet count is less than 20,000 the pt is more likely to have?
|
bleeding problems, especially with trauma such as surgery or arterial puntures.
|
|
|
When platelet count is less than 5,000 the pt is more likely to have?
|
at risk for serious spontaneous internal hemorrhage (brain hemorrhage)
|
|
|
The disorders most likely to result in decreased platelets are?
|
side effects of drugs such as heparin, bone marrow diseases, and idiopathic thrombocytopenia purpura, an autoimmune disorder in which antibodies are produced that destroy the person's own platlets.
|
|
|
Norms for Sodium
|
137-147mEq/L
|
|
|
Norms for Potassium
|
3.5-4.8mEq/L
|
|
|
Norms for Chloride
|
98-105mEq/L
|
|
|
Norms for Carbon Dioxide
|
25-33mEq/L
|
|
|
Norms for Blood urea nitrogen
|
7-20mg/dL
|
|
|
Norms for Creatinine
|
0.7-1.3mg/dL
|
|
|
Norms for total protein
|
6.3-7.9g/dL
|
|
|
Norms for Albumin
|
3.5-5.0g/dL
|
|
|
Norms for Cholesterol
|
150-220 mg/dL
|
|
|
Norms for Glucose
|
70-105 mg/dL
|
|
|
Decreased Potassium Intake
|
low potassium diet
alcoholism (causes of Hypokalemia) |
|
|
Increased Loss of Potassium
|
Gastrointestinal loss
Renal disease diuretics (causes of Hypokalemia) |
|
|
Extracellular to Intracellular shift of Potassium
|
alkalosis
increased plasma insulin diuretic use (causes of Hypokalemia) |
|
|
Increased Potassium Intake
|
high potassium diet
oral potassium supplement transfusion of old blood (causes of Hyperkalemia) |
|
|
Decreased Potassium Excretion
|
renal failure
hypoaldosteronism (causes of Hyperkalemia) |
|
|
Intracellurlar to Extracellular Shift of Potassium
|
acidosis
crush injuries tissue hypoxia (causes of Hyperkalemia) |
|
|
Pseudohyperkalemia
|
hemolysis
leukocytosis (causes of Hyperkalemia) |
|
|
Sodium
|
primary cation
norms 137-147mEq/L regulated by the kidneys |
|
|
Hypernatremia
|
occurs from loss of water
sweating, diarrhea |
|
|
The four electrolyte concentrations commonly measured are:
|
Na, K, Cl-, and total CO2
|
|
|
Potassium
|
primary intracellular cation
norms 3.5-4.8mEq/L vomiting, kidney diseases, diarrhea, nausea, abdominal distention, muscle weakness, abdominal muscle cramps. |
|
|
Hyperkalemia
|
tall peaked T waves, wide QRS complexes
|
|
|
Chloride
|
most common extracellular anion
norm 98-105mEq/L |
|
|
Hypochloremia
|
occurs with severe vomiting and chronic metabolie alkalosis
|
|
|
Hyperchloremia
|
occurs with certain kidney diseases and prolonged diarrhea
|
|
|
Norm anion gap
|
8-16mEq/L
|
|
|
Bicarb (total CO2)
|
plays a major role in acid base balance.
COPD pts who have chronic CO2 retention will have an elevated total of CO2 |
|
|
The two most common tests to check on renal function are?
|
BUN and Creatinine
neither test is sensitive to early kidney disease |
|
|
Normal BUN
|
7-20mg/dl
Heart failure = elevates BUN |
|
|
Normal Creatinine
|
0.7 to 1.3mg/dl
|
|
|
Anion Gap
|
missing anions that are not measured
|
|
|
High anion gap
|
metabolic acidosis is usually caused by lactic acid (as in sepsis), ketoacids (diabetic ketoacidosis), sulfates (renal failure), and poisons (aspirin overdose)
|
|
|
Enzymes
|
found in the body cells
when organs suffer damage, an enzyme will elevate in the the circulating blood In some cases, the type of enzyme found to be elevated along with the medical history can help diagnose the problem -AST elevates the acute hepatitis and following an acute myocardial infarciton |
|
|
Glucose
|
Norm fasting levels: 70-105mg/dl
needed to create energy |
|
|
Hyperglyceima
|
an elevated blood glucose
occurs from type II diabetes |
|
|
Hypoglycemia
|
reduced blood glucose
|
|
|
Microbiology
|
involves the isolation and identification of organisms causing disease in the body.
RT is often asked to obtain a sputum sample from the pt to identify the organism causing the pneumonia |
|
|
AST
|
aspartate aminotrasferase
|
|
|
SGOT
|
serum glutamic oxaloacetic transaminase
|
|
|
ALT
|
alanine aminotransferase
|
|
|
SGPT
|
serum glutamic pyruvic transaminase
|
|
|
Amylase and lipase
|
enzymes used primarily in assessing pancreatitis.
|
|
|
Amylase
|
in blood and urine is predominantly from the pancreas and salivary glands.
elevated in pancreatitis, diabetic detoacidosis, and diseases of the gallbladder, stomach, and small intestine. |
|
|
Serum lipase levels are elevated in:
|
acute pancreatitis
|
|
|
Sputum sample
|
a legitimate sample from lower airways is needed to identify the offending organism.
the sample is Gram stained and cultured |
|
|
Bronchoalveolar Lavage
|
performed during bronchoscopy by injecting a large volume of fluid into the lungs and then collecting it after it mixes with cells in the lung.
lung lavage diagnoses interstitial lung disease and identifies cause of pneumonia. BAL is contraindicated inthe pt who is unstable and hypoxic |
|
|
Gram Neg
|
stinks
|
|
|
transdate
|
low plearal
|
|
|
exidate
|
high plearal (cancer, pulmonary embolism trauma)
|
|
|
LDL
|
Bad cholesterol
|
|
|
HDL
|
Good cholesterol
|
|
|
Albumin
|
vol. replacement protein draw fluid from 3rd spacing,
decrease fluid overload |
|
|
Urine analysis:
|
appearance
gravity (concentration) pH protein (renal) glucose (diabetes /renal disease) ketones (starvation and diabetic) |
|
|
Bilirubin
|
occurs in the urine inthe conjugated form adn is seen when there is an obstruction to the outflow of bile from the liver.
|
|
|
Urobilinogen
|
appears in some liver diseases and hemolytic states
|
|
|
Nitrates
|
may indicated that significant numbers of bacteria are present
|
|
|
Average cholesterol
|
<160
|
|
|
Nutritional status has major influence on pt outcomes
|
provides energy for breathing and movement
food quality adn quantity affect oxygen needs and CO2 production Nutrients influence lung immune function |
|
|
Interdependence of Respiration and Nutrition
|
O2 and nutrients travel inthe blood to tissues
nutrient conversion to energy at cellular level requires O2 to support the process -aerobic metabolism required for life -breathing fuels the metabolic process -thus breathing is part of nutrition |
|
|
Metabolic rate determines
|
oxygen uptake (VO2) by measuring VO2 at rest, the basal metabolic rate (BMR) or resting energy expenditure (REE) can be calculated
|
|
|
Harris Benedict equation
|
basal energy expenditure (BEE) of healthy person at rest
-men: 66+(13.7xW)+(5xH)-(6.8xage) -women:655+(9.6xW)+(1.7xH)-(4.7xage) W= weight in kg H=height in cm |
|
|
True energy measurments are better
|
direct calorimetry
indirect calorimetry |
|
|
Direct calorimetry
|
special room measures heat produced by metabolism
metabolism genrates heat, measured in calories this is not practical clinically |
|
|
Indirect calorimetry
|
VO2 and VCO2 to determine energy consumption VO2 correlates directly with ATP produciton
-the higher the metabolic rate, the higher the VO2 this is now measured with a metabolic cart -portable -easy on vent pts -nose clips and mouth piece req for spont breathing pts |
|
|
Nutritional Depletion and Respiration
|
12 to 16hrs of insufficient carbohydrate intake will result in gluconeogenesis
-process of converting muscle and enzyme proteins into sugar -leads to functional tissue loss -in starvation: *muscle loss endurance and strength (including those of respiration) Noted by: decreased FVC, FEV1, and DLco -diminished immune function because antibodies are proteins |
|
|
Emphysema produces:
|
a catabolic state typically with weight loss even with normal caloric intake
-REE high in malnourished emphysemic pt -exacerbates symptoms of COPD *diminished respiratory muscle strength adn exercise tolerance *compromised immune function, thus increased pulmonary infections -increased intake of food can normalize weight *emphysemic pts are not comfortable eating large quantities of food |
|
|
Bronchodilators cause:
|
nausea
|
|
|
Nasal O2 interferes with:
|
smell and taste
|
|
|
Medications can interact to render:
|
nutrients less useful or inhibit some metabolic enzymes
|
|
|
Intubation complicates
|
eating process
|
|
|
Large meals interfere with
|
diaphragm movement
|
|
|
Anxiety, depression
|
often reduce appetite
|
|
|
Semistarved states can
|
decrease hypoxic drive
|
|
|
Critically ill pts require constant aid:
|
breathing: intubation, MV
feeding: NG tube or even total parenteral nutrition (TPN) matching energy adn nutritional needs with ventilatory needs can be challenging |
|
|
Metabolism
|
produces bodies energy
-transfers food to ATP-body's energy source *can occur by aerobic or anaerobic metabolism |
|
|
Aerobic pathway
|
oxygen is consumed
-very efficient yield of ATP -waste product is CO2, which is exhaled |
|
|
Anaerobic pathway occurs without oxygen
|
-very inefficient
-waste product is lactic acid; may result in lactic acidosis |
|
|
RQ
|
CO2 production/O2 consumption
|
|
|
Fat has RQ of
|
0.7
|
|
|
Protein has RQ of
|
0.85
|
|
|
Carbohydrate has RQ of
|
1
|
|
|
Burning of combination of the above produces a normal RQ of
|
0.8
that is 200ml CO2/250ml O2 |
|
|
What provides energy and are building blocks?
|
Carbs, proteins, and fats
|
|
|
Vitamins
|
facilitate metabolic pathway reactioins
|
|
|
Minerals
|
provide elemnets for molecules
|
|
|
Water
|
provides fluidity for blood flow and medium for various chemical reactions
|
|
|
Oxygen
|
without it everything stops
|
|
|
Carbohydrate (sugar)
|
should be largest amount of dietary intake
complex carbs in grains, vegi, fruits simple sugars present in the above foods but primarily found in refined processed foods pts with severe COPD may do better with a lower carbohydrate, higher fat diet due to reduced CO2 production |
|
|
Protein
|
should comprise 12% to 15% of intake
Recommended daily amount varies -0.8g/kg for healthy individual -1.2-1.5g/kg for average hospital pt -2-2.5g/kg for severe catabolic pts Nitrogen found only in protein amino acids -quick estimate of protein catabolism is made by multiplying blood urea nitrogen (BUN) by 6.25 |
|
|
Fat
|
carries fat soluble vitamins: A,D,E,K
-important for immunity, clotting, antioxidants, etc. Fats twice as calorie dense as other nutrients -thus efficient for increasing caloric intake for pts on fluid restrictions Higher fat content may decrease dyspnea for COPD pts |
|
|
Vitamins
|
fat soluble A,D,E,K
water soluble B group and C Co-factors in enzyme systems for various metabolic functions |
|
|
Minerals
|
used in chemical reactions and enzyem systems
iron key for role in O2 transport on hemoglobin |
|
|
Omega 3 useful anti-infalmmatory for
|
asthmatics
|
|
|
Nutritional administration route:
|
enteral or parenteral
|
|
|
Enteral is preferred as most natural
|
by mouth if possible (emphysema pt more freq small meals)
if intubated maybe by NG tube, PEG tube |
|
|
Parental (last resort)
|
if GI tract not functioning, pt may require TPN, which is IV infusion of all nutrients
|
|
|
Inspection findings
|
cachectic pts are bony with depressed intercostal spaces
accessory muscles are often readily visible poor cough secondary to muscle weakness viscous secretions may suggest dehydration |
|
|
Basilar coarse or fine crackles
|
may indicate fluid overload or loss of blood protein
|
|
|
Wheezing
|
secondary to food intolerance/allergy
|
|
|
Fine late inspiratory crackles
|
may indicate diminished surfactant secondary to malnutrition
|
|
|
S3
|
may indicate fluid overload and CHF
|
|
|
S4
|
may indicate severe anemia
|
|
|
PFT changes:
|
decreased FVC, FEV1, PEP, PIP
|
|
|
ABG changes:
|
hypercarbia with acidosis due to excessive nutrition or ventilatory failure
anemias decrease O2 carring capacity of hemoglobin and thus Ca)2 high fat intake may cause a low PaO2 pH alterations -secondary to foods that are alkalotic or acidotic -lactic acidosis due to low PaO2 |
|
|
What are the formed elements of the blood?
|
RBCs
WBCs Platelets |
|
|
Blood serum is plasma form which the clotting factors have been removed by liquid chromatography. (T/F)
|
True
|
|
|
In the presence of a significantly reduced RBC count, a normal oxygen-carrying capacity of the blood can be maintained. (T/F)
|
False
|
|
|
What is the normal range of WBCs?
|
4500-10,000/mm3
|
|
|
Which white cell type normally represents the largest percent int he differential?
|
Neutrophils
|
|
|
A tissue monocyte is called a macorphage (T/F0
|
True
|
|
|
What is the most common cause of anemia?
|
iron deficiency
|
|
|
Polycythermia
|
it can be caused by chronic hypoxemia.
it is defined as an increase in RBC, Hb, and hematocrit. it increases the O2 carrying capacity of the blood |
|
|
A left shifted white cell differential is evidenced by?
|
an increase in the number of bands (immature neutrophils)
|
|
|
What is the most common finding in patients with bacterial pneumonia?
|
neutrophilia
|
|
|
What is the most common finding in patients with an allergic reaction?
|
eosinophilia
|
|
|
Viral infections typically produce which of the following abnormalities?
|
lymphocytosis
|
|
|
Leukemia is defined as an uncontrolled increase in the number of WBCs. (T/F)
|
True
|
|
|
The sedimentation rate is a nonspecific test used to determine the general presence of disease. (T/F)
|
True
|
|
|
What test is used to assess the patient's blood clotting ability?
|
prothrombin time
|
|
|
Which electrolyte closely affects muscle function?
|
potassium
|
|
|
Which electrolyte is mainly responsible for extracellular water balance?
|
sodium
|
|
|
What is the normal range for the anion gap?
|
8-16 mEq/l
|
|
|
Anion gap is useful in assessing what type of situation?
|
cause of metabolic acidosis
|
|
|
An increase in the sweat electrolyte concentration is typical for what disease?
|
Cystic Fibrosis
|
|
|
What test is a measure of kidney function?
|
BUN
Creatinine |
|
|
What enzymes are elevated in a patient who has had a myocardial infarction?
|
AST
LDH CPK |
|
|
What is the therapeutic level for theophylline?
|
5-15 mg/mL
|
|
|
What decreases the clearance of theophylline?
|
CHF
|
|
|
What bacteriologic test is used to determine the effectiveness of antibiotics on a particular organism?
|
sensitivity
|
|
|
Bacteria that usually are present in a healthy person are called?
|
normal flora
|
|
|
A Ziehl-Neelsen stain is used to identify what type of organism?
|
Mycobacterium tuberculosis
|
|
|
What items are evaluated during a macroscopic (gross) sputum examination?
|
color
consistency volume |
|
|
What is the most common cause of bacterial pneumonia?
|
Strptococcus pneumonia
|
|
|
What finding is consistent with pleural infection?
|
opaque or turbid pleural fluid
|
|
|
What test performed during urinalysis could be helpful in diagnosing diabetes mellitus?
|
glucose
pH ketones |
|
|
Proteinuria usually is indicative of ?
|
kidney disease
|
|
|
What is responsible for producing primary lung carcinomas?
|
adenocarcinoma
|
|
|
What may cause a patient to have a negative reaction to a skin test?
|
does not have a disease
anergic |
|
|
PPD
|
is positive if the patient has previously had a BCG vaccination
|
|
|
In what situation is a PFT least useful?
|
evaluating the probablity of getting a pulmonary disease
|
|
|
The tracing obtained from a PFT is called a:
|
spirogram
|
|
|
What is the most important in predicting PFT measurements?
|
height
|
|
|
What piece of standard PFT equipment is used to determine total lung capacity and resistance of the airways?
|
body plethysmography
|
|
|
What is consistent with obstructive lung disease?
|
decreased expiratory flows
|
|
|
An anatomic obstruction located in the upper airway will affect which part of the spirometric tracing?
|
initial portion
|
|
|
Restricitve disease
|
it is characterized by reduced lung volumes on the PFT.
it can be caused by obesity expiratory flows generally are normal. |
|
|
Emphysema can produce both obstructive and restrictive defects in lung function
|
True
|
|
|
Total lung capacity is the sume of which of the following?
|
vital capacity and residual volume
|
|
|
What test is useful in determining the need for mechanical ventilation?
|
FVC
|
|
|
Residual volume is normally what value?
|
33% of VC
|
|
|
FRC
|
it is the sum of the RV & ERV
increased in obstructive disease reduced in restrictive disease |
|
|
Body plethysmography is based on what gas law?
|
Boyle's law
|
|
|
Open circuit nitrogen washout can be helpful in measuring what?
|
RV
TLC FRC |
|
|
What test is the best indicator of obstructive lung disease?
|
FEV1
|
|
|
What is the normal value for FEV1?
|
75% of VC
|
|
|
Prebronchodilator and postbronchodilator PFT
|
used to assess the reversibility of airway obstruction
|
|
|
DLco
|
it decreases with decreasing lung surface area
|
|
|
Bronchoprovocation testing
|
used to test of occult asthma
methacholine is commonly used as a bronchoprovocation agent histamine is commonly used as a bronchoprovocation agen dangerous |
|
|
What test is useful in determining coronary artery disease?
|
stress electrocardiograph
|
|
|
Basal energy expenditure
|
it requires a VO2 measurement in order to calculate
it gives an estimation of the patient's nutritional needs. if it is not met, use of body energy stores is required |
|
|
Measuring the patient's energy expenditure using oxygen consumption is referred to as?
|
indirect calorimetry
|
|
|
What is a pulmonary effect of starvation?
|
increased risk of pneumonia
|
|
|
What might hinder attempts at nutritional repletion in patients with respiratory disease?
|
the use of bronchodilators
|
|
|
What element must be stored in sufficient quantities to meet the metabolic demands of the diaphragm?
|
glycogen
|
|
|
What may be more difficult with a high carbohydrate diet?
|
weaning from the mechanical ventilation
|
|
|
What is nitrogen balance useful in determining?
|
the adequacy of protein intake
|
|
|
What is associated with a low protein diet?
|
immune compromise
|
|
|
High fat diet may:
|
increase risk of heart disease
decreased DLco increased CO2 production |
|
|
What mineral plays a very important role in oxygen transport?
|
iron
|
|
|
What might indicate poor nutritional status?
|
body weight less than ideal
neg. nitrogen balance neg. response to skin antigen testing |
|
|
What test is most useful for screening the pt for protein malnutrition?
|
thyroxin binding prealbumin
|
