1
Q
What are the special diagnostic procedures related to in the examination?
A
Questions related to setting up equipment, instructing the patient, performing procedures, and evaluating results
These procedures are essential for accurate diagnostic testing.
2
Q
What is arterial blood gas collection used for?
A
- Evaluation of ventilation (PaCO₂)
- Evaluation of oxygenation (PaO₂)
- Assessment of acid-base status (pH)
It helps determine the need for therapeutic interventions or diagnostic evaluations.
3
Q
What are the indications for arterial blood gas sampling?
A
- Evaluate adequacy of ventilation
- Assess need for therapeutic intervention
- Monitor severity and progression of disease
These indications guide the decision to perform an arterial blood gas analysis.
4
Q
Name the three primary sites for obtaining an arterial blood gas.
A
- Radial
- Brachial
- Femoral
The radial artery is preferred due to accessibility and collateral blood flow.
5
Q
Which artery is the first choice for arterial blood gas sampling?
A
Radial artery
It is chosen for its accessibility and good collateral circulation.
6
Q
What is the second choice site for arterial blood gas sampling?
A
Brachial artery
It is an appropriate alternative when the radial artery is not accessible.
7
Q
What is the last choice site for arterial blood gas sampling?
A
Femoral artery
This site is used only when other sites are not viable.
8
Q
What is the purpose of the Modified Allen’s Test?
A
To assess collateral circulation in the hand prior to drawing a radial ABG
This test ensures that there is adequate blood flow before performing the procedure.
9
Q
What does a positive Modified Allen’s Test confirm?
A
Collateral blood flow is present
The hand should pink up within 2 seconds after releasing the ulnar artery.
10
Q
In a Modified Allen’s Test, if the color does not return within _______ seconds, what should you do?
A
Use another site
Color should return within 5 seconds.
11
Q
True or false: You should attempt radial or brachial arterial punctures on patients with an indwelling dialysis shunt.
A
FALSE
Do not attempt arterial punctures on these patients.
12
Q
List some sampling hazards and problems.
A
- Disruption of blood flow - hematoma
- Clotting of sample
- Bleeding - hold pressure on site for a minimum of 5 min
- Vessel spasm
- Tissue trauma - muscles, bone, nerves
- Anticoagulant therapy - apply pressure to site longer
- Air bubbles
These issues can affect the quality of blood samples.
13
Q
What happens to Paco2 and PaO2 levels when air bubbles are present in the sample?
A
- Paco2 decreases toward 0 torr
- PaO2 increases toward 150 torr
Air bubbles can significantly alter blood gas measurements.
14
Q
What is the effect of improper cooling on Paco2, PaO2, and pH?
A
- Paco2 increases
- PaO2 decreases
- pH decreases
Samples should be iced to maintain accurate values.
15
Q
What is the effect of excess heparin on Paco2, PaO2, and pH?
A
- Paco2 decreases toward 0 torr
- PaO2 increases toward 150 torr
- pH decreases toward 7.0
Excess heparin can skew blood gas results.
16
Q
What happens to Paco2, PaO2, and pH with flush solution dilution?
A
- Paco2 decreases
- PaO2 increases
- pH decreases
Flush solutions can dilute blood samples and affect results.
17
Q
What should you do before analyzing a blood sample?
A
Mix the blood sample
Proper mixing is essential for accurate analysis.
18
Q
What is the pH of lithium liquid heparin?
A
7.0
Lithium liquid heparin is acidic, but powdered lithium heparin does not alter ABG values.
19
Q
Name some other anticoagulants that can decrease pH.
A
- Sodium EDTA
- Acetylsalicylic acid
- Sodium citrate
These anticoagulants can affect blood gas measurements.
20
Q
What is the purpose of Arterial Blood Gas Collection?
A
- Evaluation of ventilation (PaCO2)
- Evaluation of oxygenation (PaO2)
- Assessment of acid-base status (pH)
- Assess need for therapeutic intervention
- Monitor disease progression
These evaluations help determine the patient’s respiratory and metabolic status.
21
Q
What are the three primary sites for obtaining an arterial blood gas?
A
- Radial
- Brachial
- Femoral
The radial artery is preferred due to accessibility and collateral blood flow.
22
Q
Which artery is the first choice for arterial blood gas sampling in most patients?
A
Radial
The radial artery is chosen unless blood pressure is low, in which case the femoral artery may be used.
23
Q
What is the Modified Allen’s Test used for?
A
To assess collateral circulation in the hand
This test is performed prior to drawing a radial arterial blood gas.
24
Q
True or false: The femoral artery is the first choice for arterial blood gas sampling.
A
FALSE
The femoral artery is the last choice for arterial blood gas sampling.
25
What are the indications for performing an **arterial puncture**?
* Evaluate ventilation (PaCO2)
* Evaluate oxygenation (PaO2)
* Assess acid-base status (pH)
* Monitor disease progression
## Footnote
These indications guide the need for therapeutic interventions or diagnostic evaluations.
26
What does a **positive Modified Allen's Test** confirm?
Collateral blood flow is present
## Footnote
The hand should pink up within 2 seconds after releasing the ulnar artery.
27
If the color does not return within **5 seconds** after a Modified Allen's Test, what should be done?
Use another site
## Footnote
This indicates a potential issue with collateral circulation.
28
What should not be attempted on patients with an **indwelling dialysis shunt**?
Radial or brachial arterial punctures
## Footnote
This is to prevent complications related to the shunt.
29
List some **sampling hazards and problems**.
* Disruption of blood flow - hematoma
* Clotting of sample
* Bleeding - hold pressure on site for a minimum of 5 min
* Vessel spasm
* Tissue trauma - muscles, bone, nerves
* Anticoagulant therapy - apply pressure to site longer
* Air bubbles
* Improper cooling
* Excess heparin
* Flush solution dilution
* Mixing the blood sample before analysis
## Footnote
These hazards can affect the quality and accuracy of blood samples.
30
What happens to **PaCO2** if air bubbles are present in the sample?
Decreases toward 0 torr
## Footnote
Air bubbles can alter the gas composition of the sample.
31
What happens to **PaO2** if air bubbles are present in the sample?
Increases toward 150 torr
## Footnote
This is due to the introduction of air into the sample.
32
What happens to **pH** if air bubbles are present in the sample?
Increases
## Footnote
The presence of air can lead to changes in pH levels.
33
What is the effect of **improper cooling** on PaCO2?
Increases
## Footnote
Samples not iced can lead to inaccurate gas measurements.
34
What is the effect of **improper cooling** on pH?
Decreases
## Footnote
Improper cooling can alter the pH of the sample.
35
What is the effect of **excess heparin** on PaCO2?
Decreases toward 0 torr
## Footnote
Excessive heparin can dilute the sample and affect gas levels.
36
What is the effect of **excess heparin** on PaO2?
Increases toward 150 torr
## Footnote
This can lead to misleading oxygen levels in the sample.
37
What is the effect of **excess heparin** on pH?
Decreases toward 7.0
## Footnote
High levels of heparin can acidify the sample.
38
What happens to **PaCO2** with flush solution dilution?
Decreases
## Footnote
Flush solutions can alter the gas concentrations in the sample.
39
What happens to **PaO2** with flush solution dilution?
Increases
## Footnote
This can lead to inaccurate oxygen readings.
40
What happens to **pH** with flush solution dilution?
Decreases
## Footnote
Flush solutions can affect the acidity of the sample.
41
What type of heparin is **acidic** with a pH of 7.0?
Lithium liquid heparin
## Footnote
This type of heparin can influence ABG values.
42
Which type of heparin does **not alter ABG values**?
Powdered lithium heparin
## Footnote
It is preferred for maintaining accurate blood gas measurements.
43
What can other anticoagulants like **sodium EDTA** and **sodium citrate** do to pH?
Decrease the pH
## Footnote
These anticoagulants can affect the acidity of the blood sample.
44
What should be done if the patient has an **abnormal temperature** during an exam?
* Corrections should be made
## Footnote
This is crucial for accurate blood gas analysis.
45
If the analyzer temperature (37 C) is lower than body temperature (patient has a fever), what happens to the measured values for **PaCO2** and **PaO2**?
* Lower than the actual results
## Footnote
Fever affects the accuracy of these measurements.
46
If the analyzer temperature is higher than body temperature (patient is hypothermic), what happens to the measured values for **PaCO2** and **PaO2**?
* Higher than the actual results
## Footnote
Hypothermia can lead to inaccurate readings.
47
What happens to the **pH** value if the analyzer temperature is lower than the patient's body temperature?
* Higher than the actual results
## Footnote
The pH behaves oppositely to PaCO2 and PaO2 in this scenario.
48
What happens to the **pH** value if the analyzer temperature is higher than the patient's body temperature?
* Lower than the actual results
## Footnote
This indicates the need for temperature corrections in blood gas analysis.
49
What is the effect on **PaO2** and **PaCO2** if QC was stored at 25°C and then changed to 20°C?
* Lower than actual
## Footnote
The pH will be higher than actual in this case.
50
What gauge needle is typically used for most **radial samples**?
* Short bevel 20 - 22 gauge needle
## Footnote
This size is standard for blood gas sampling.
51
How should blood gas samples be transported to the lab?
* In an ice/water solution at 0°C
## Footnote
Proper transport is essential for maintaining sample integrity.
52
Where is mixed venous blood drawn from in a **pulmonary artery catheter**?
* Distal lumen
## Footnote
This is known as a Swan-Ganz catheter.
53
What must be done to the site before performing a **heel stick** for blood gas analysis in infants?
* Arterialized by wrapping in a warm, wet cloth at 45°C for 5 - 7 minutes
## Footnote
This ensures accurate blood flow for sampling.
54
What should be done to the heel before puncturing for a **heel stick**?
* Cleansed with alcohol and punctured with a lancet
## Footnote
The puncture must be deep enough for free-flowing blood.
55
What is the correlation of results from capillary samples with arterial **pH** and **PCO2**?
* Consistent correlation
## Footnote
However, PO2 values do not correlate with actual arterial blood.
56
True or false: **Capillary gases** should be used to monitor oxygen therapy.
FALSE
## Footnote
Actual oxygen levels may differ from what is measured in capillary samples.
57
What type of syringe is used for collecting **arterial samples**?
Pre-heparinized syringe
## Footnote
Arterial samples are sealed from the atmosphere immediately for rapid analysis.
58
Name the three methods for collecting **arterial samples**.
* Percutaneous puncture of a peripheral artery
* From an indwelling catheter
* Capillary sampling (infants only)
## Footnote
These methods ensure accurate collection of arterial blood samples.
59
What type of **personal protective equipment** should be utilized during arterial puncture?
* Disposable gloves
* Goggles
* Face shield
## Footnote
Standard barrier protection devices are essential for safety.
60
What is included in a standard **arterial blood gas kit**?
* 5 mL preheparinized disposable syringe
* Needles: 20 - 25 gauge, 1 inch
* Rubber stopper or needle capping device
* Adhesive strip or tape
* Iodine and alcohol prep pads
* Sterile 2 X 2 gauze sponges
* Plastic bag or container for transport
* Puncture resistant container
* Lidocaine anesthetic (if ordered)
* Label for sample
* Sharps container
## Footnote
These items are necessary for proper arterial blood gas collection and transport.
61
What is the primary purpose of **venipuncture**?
To provide vascular access for continuous infusion or blood sampling
## Footnote
Venipuncture is crucial for laboratory analysis.
62
Where is the most appropriate vessel for **venipuncture** located?
Anticubital vein (anterior to the elbow)
## Footnote
This location is commonly used for blood sampling.
63
True or false: **Standard barrier protection devices** are not necessary during venipuncture.
FALSE
## Footnote
Personal protective equipment is essential for safety during venipuncture.
64
What are the components of **standard venipuncture equipment**?
* Tourniquet
* IV administration set and various sized IV catheters (22 - 25 gauge needles)
* Razor (if necessary for shaving site)
* Vacu-tube or 'winged-tipped' butterfly needle with flexible tubing and collection tubes
* Lidocaine anesthetic (2% solution) if ordered by physician
* Iodine and alcohol prep pads
* Sterile 2 X 2 gauze sponges
* Label for sample
* Sharps container
* Adhesive tape
* Sterile transparent dressing
* Arm board (if necessary)
* Puncture resistant container to hold sample
* Rubber stopper, needle capping device or syringe cap with safety mechanism
## Footnote
These items are essential for safely performing venipuncture procedures.
65
What is the formula for calculating **Base Excess (BE)** from pH and PaCO₂?
[H*] = 24 x PaCO₂ HCO₃
## Footnote
This formula helps in assessing the metabolic component of acid-base balance.
66
If PaCO₂ is normal (35 - 45 mmHg), what happens to HCO₃ when pH increases or decreases by 0.1?
HCO₃ increases or decreases by 4.0
## Footnote
This relationship helps in understanding the compensatory mechanisms in acid-base disorders.
67
What does **Arterial Oxygen Saturation (SaO₂)** represent?
The percentage of hemoglobin that is bound by oxygen
## Footnote
SaO₂ is crucial for assessing oxygen delivery to tissues.
68
How can actual **SaO₂** saturation be measured?
Using a hemoximeter or co-oximeter
## Footnote
These devices provide accurate measurements of oxygen saturation.
69
What can cause large differences between calculated and measured **SaO₂** values?
Elevated carbon monoxide (COHb) levels
## Footnote
COHb can falsely elevate SaO₂ readings, leading to misinterpretation.
70
How can **PaO₂** be estimated from **SaO₂**?
By subtracting 30 from the SaO₂ value
## Footnote
This estimation provides a quick reference for arterial oxygen pressure.
71
What are the normal ranges for **pH**, **PaCO₂**, and **HCO₃**?
* pH: 7.35 - 7.45
* PaCO₂: 35 - 45 mmHg
* HCO₃: 22 - 26 mEq/L
## Footnote
These ranges are critical for evaluating acid-base status.
72
What is the primary function of **hemoglobin** in the blood?
Carries the majority of oxygen transported in the blood
## Footnote
Hemoglobin is essential for oxygen transport to tissues.
73
What is the **normal value** range for hemoglobin?
12-16 g/100 mL
## Footnote
This range indicates healthy hemoglobin levels in adults.
74
What does **hematocrit** measure?
Percent of red blood cells in the blood volume
## Footnote
Hematocrit is a technique used to assess red blood cell concentration.
75
The hematocrit is normally _______ the hemoglobin value.
3 times
## Footnote
This relationship helps in estimating hematocrit based on hemoglobin levels.
76
If the hemoglobin (Hb) is **15 g**, what would the hematocrit (Hct) be?
45%
## Footnote
Calculation: 15 g Hb × 3 = 45% Hct.
77
What are the **normal values** for arterial blood gas parameters?
* PCO2: 35 - 45 torr
* PO2: 80 - 100 torr
* pH: 7.35 - 7.45
* SO2: 95 - 100%
* HCO3: 22 - 26 mEq/L
* BE: -2 - +2
* Hb: 12 - 16 g
## Footnote
These values are critical for assessing respiratory and metabolic functions.
78
What is the **definition** of life functions in the context of blood gas interpretation?
Processes that involve getting air (oxygen) from the outside, through the lungs, into the blood, and to the tissues
## Footnote
Understanding life functions is essential for interpreting blood gas values.
79
True or false: Blood gas analysis can identify problems with **ventilation** and **oxygenation**.
TRUE
## Footnote
Identifying these problems is crucial for immediate correction.
80
What are the components of **ventilation** assessment?
* Respiratory rate
* Tidal volume
* Chest movement
* Breath sounds
* Paco2
* ECo2
## Footnote
These components help evaluate the effectiveness of breathing.
81
What are the components of **oxygenation** assessment?
* Heart rate
* Color
* Sensorium
* Pao2
* SpO2
## Footnote
These components help evaluate the effectiveness of oxygen delivery to tissues.
82
What is the **normal venous** PCO2 value?
46 torr
## Footnote
This value is important for understanding venous blood gas status.
83
Fill in the blank: Any problems with ventilation and oxygenation must be corrected _______.
right away
## Footnote
Immediate correction is vital for patient safety.
84
What does a **PaCO2 value** of 35 - 45 torr indicate?
Normal Ventilation
## Footnote
This range reflects sufficient or adequate ventilation.
85
What does a **PaCO2 value** above 45 torr indicate?
Patient NOT Ventilating
## Footnote
This indicates inadequate ventilation.
86
What does a **PaCO2 value** below 35 torr indicate?
Patient IS Ventilating but, ventilating too much
## Footnote
This suggests hyperventilation.
87
What should be done if a patient is NOT ventilating (PaCO2 > 45)?
* Don't change ventilation settings
* Don't put the patient on mechanical ventilation
* Initiate Ventilation, or
* Remove/Decrease mechanical deadspace, or
* Increase current ventilation
## Footnote
These responses aim to improve the patient's ventilation status.
88
What should be done if a patient is ventilating too much (PaCO2 < 35)?
* Don't put the patient on mechanical ventilation
* Decrease ventilation (if PaCO2 is high)
* Consider other causes of hyperventilation (hypoxemia, metabolic acidosis, etc.)
## Footnote
These actions help manage the patient's ventilation effectively.
89
What does an **abnormal PCO2** with normal pH indicate?
Don't change ventilation (patient with COPD)
## Footnote
This suggests a stable condition despite abnormal CO2 levels.
90
What does a **PaO2 value** of 80-100 torr indicate?
Acceptable Oxygenation
## Footnote
Maintain settings and check SaO2 & Hb.
91
What does a **PaO2 value** below 80 indicate?
Hypoxemia
## Footnote
This requires further investigation and intervention.
92
What are the causes of **hypoxemia** when PaO2 is below 80 and FiO2 is between 0.21 - 0.59?
* Poor Ventilation (high PaCO2)
* V/Q Mismatch (normal or low PaCO2)
## Footnote
These conditions can lead to inadequate oxygenation.
93
What should be done if hypoxemia is present with a PaO2 below 80?
* Increase ventilation
* Increase FiO2 up to 0.60
## Footnote
These measures aim to improve oxygenation.
94
What does a **PaO2 value** below 80 with FiO2 above 0.60 indicate?
Hypoxemia caused by:
* Shunting
* Refractory hypoxemia
* Venous admixture
## Footnote
These conditions indicate severe oxygenation issues.
95
What does a **PaO2 value** above 100 indicate?
Hyperoxemia
## Footnote
This condition may require intervention to reduce oxygen levels.
96
What should be done for a patient with **hyperoxemia**?
* Start or increase CPAP or PEEP
* Decrease FiO2, PEEP, or CPAP
## Footnote
These actions help manage excessive oxygen levels.
97
What are the **three steps** to acid-base interpretation?
* Acidosis vs. Alkalosis
* Compensated vs. Uncompensated (Chronic vs Acute)
* Respiratory vs. Metabolic
## Footnote
These steps help in diagnosing acid-base disorders based on pH levels.
98
What is the **acceptable pH range** for acid-base status?
7.35 - 7.45
## Footnote
pH levels outside this range indicate acidosis or alkalosis.
99
What does a pH **below 7.35** indicate?
Acidosis
## Footnote
This condition can be uncompensated, caused by increased CO2 or low HCO3.
100
What does a pH **above 7.45** indicate?
Alkalosis
## Footnote
This condition can be uncompensated, caused by increased HCO3 or low CO2.
101
When is a condition considered **Compensated**?
When the pH remains within the acceptable range (7.35 - 7.45)
## Footnote
This indicates a chronic condition.
102
When is a condition considered **Uncompensated**?
When the pH is outside the acceptable range
## Footnote
This indicates an acute condition.
103
What is the diagnosis for a pH of **<7.35**?
Uncompensated Acidosis
## Footnote
This indicates a serious acid-base imbalance.
104
What is the diagnosis for a pH of **>7.45**?
Uncompensated Alkalosis
## Footnote
This indicates a serious acid-base imbalance.
105
What characterizes **Respiratory Acidosis**?
Abnormal pH due to a change in PCO2
## Footnote
Example: High PCO2 due to hypoventilation.
106
What characterizes **Respiratory Alkalosis**?
Abnormal pH due to a change in PCO2
## Footnote
Example: Low PCO2 due to hyperventilation.
107
What is the diagnosis for a 56-year-old woman with a pH of **7.31** and high PCO2?
Uncompensated Respiratory Acidosis with hypoxemia
## Footnote
Treatment: Initiate mechanical ventilation.
108
What is the diagnosis for an 18-year-old patient with a pH of **7.54** and low PCO2?
Uncompensated Respiratory Alkalosis with hypoxemia
## Footnote
Treatment: Oxygen for hypoxemia.
109
What is the diagnosis when the **pH** is abnormal due to a change in **HCO3**?
Metabolic Acidosis or Alkalosis
## Footnote
This diagnosis is determined when the pH is abnormal because of changes in bicarbonate levels.
110
In the case of a 32-year-old patient with a **pH** of 7.28, what is the diagnosis?
Uncompensated Metabolic Acidosis (Diabetic Ketoacidosis)
## Footnote
Treatment includes sodium bicarbonate for acidosis and insulin to control diabetes.
111
What is the treatment for **Uncompensated Metabolic Acidosis**?
* Sodium bicarbonate for acidosis
* Insulin to control diabetes
## Footnote
This treatment is necessary for patients with diabetic ketoacidosis.
112
In the case of a 30-year-old man with a **pH** of 7.54, what is the diagnosis?
Uncompensated Metabolic Alkalosis (Loss of metabolic acids, dehydration, electrolyte imbalance)
## Footnote
The patient has been sick and vomiting for the past 2 days.
113
What is the treatment for **Uncompensated Metabolic Alkalosis**?
* Administer potassium chloride (KCl)
* Oxygen
## Footnote
This treatment addresses the loss of metabolic acids and electrolyte imbalance.
114
What occurs during **Partial compensation** in blood gases?
pH is out of normal range and both CO2 and HCO3 are changing in the same direction
## Footnote
This indicates a partially compensated state in the acid-base balance.
115
What is the diagnosis for a patient with a **pH** of 7.30 and **Paco2** of 60 torr?
Partially Compensated Respiratory Acidosis
## Footnote
The pH is acidotic, indicating a respiratory issue.
116
What is the diagnosis for a patient with a **pH** of 7.50 and **Paco2** of 50 torr?
Partially Compensated Metabolic Alkalosis
## Footnote
The pH is alkalotic, indicating a metabolic issue.
117
What is a **mixed respiratory and metabolic imbalance**?
Occurs when both CO₂ and HCO₃ contribute to the problem
## Footnote
Example: pH 7.54 (alkalotic), PCO₂ 31 torr (low), HCO₃ 29 mEq/L (high) indicates Respiratory and Metabolic Alkalosis.
118
What should the total pressure be between for a patient breathing 100% oxygen?
110 - 140 torr
## Footnote
This is important for assessing arterial blood gas (ABG) values.
119
What do lower values (< 110 torr) indicate in ABG results?
* V/Q mismatch
* Diffusion defect
* Shunting
* Venous blood
## Footnote
These conditions can affect the accuracy of ABG readings.
120
What do higher values (> 140 torr) in ABG results indicate?
* Supplemental oxygen in use
* Bubble in sample
* Technical error
## Footnote
These factors can lead to misleading ABG results.
121
How is **PaO₂** estimated?
FIO₂ X 5
## Footnote
For example, if FIO₂ is 1.0, then estimated PaO₂ = 1.0 x 5 = 500.
122
What should be considered if reported lab values do not match the patient's clinical condition?
* Was the sample obtained correctly?
* Was the sample processed promptly and correctly?
* Were the results reported verbally?
* Could the results represent venous blood?
## Footnote
These factors can lead to discrepancies in ABG results.
123
What are the two types of **special pathologies** in ABG results?
* Type #1: ABG looks good, patient looks & feels bad
* Type #2: ABG looks bad, patient looks & feels fine
## Footnote
These types indicate that ABG results may not always reflect the patient's clinical appearance.
124
What is a common cause of misleading normal ABG results in **CO poisoning**?
Saturation of Hb with carbon monoxide
## Footnote
SaO₂ is calculated, which can misrepresent the patient's condition.
125
Who should be suspected of **CO poisoning**?
* Firefighters
* People rescued from burning buildings
* People exposed to automobile exhaust
## Footnote
These individuals are at higher risk for CO exposure.
126
What is the normal range for **COHb** in patients who smoke?
5 - 10%
## Footnote
Normal COHb is typically 0 - 2%.
127
What is the treatment for **CO poisoning**?
* 100% oxygen
* Hyperbaric oxygen therapy
## Footnote
These treatments help to displace carbon monoxide from hemoglobin.
128
What is **anemia** characterized by?
Low hemoglobin content (Type #1)
## Footnote
Normal ABG can be misleading if PaO2 and SaO2 are normal. Watch for low Hb (< 12 g).
129
In which patients does **anemia** commonly occur?
* Post-op patients
* Trauma victims
## Footnote
Patient may be hypoxic (PVC, tachycardia, distress), but not cyanotic.
130
What is the treatment for **anemia**?
* Restore Hb level to normal
* Give oxygen to support patient until transfusion is completed
## Footnote
Treatment is crucial to manage hypoxia.
131
What condition is indicated by **increased deadspace**?
Pulmonary Embolus (Type #1)
## Footnote
Suspect pulmonary embolus in various patient scenarios.
132
List the risk factors for **pulmonary embolus**.
* Post-op patients
* Bedridden patients
* History of deep vein thrombosis (DVT)
* Woman in advanced stages of pregnancy
* Venous stasis
* Obesity
* Varicose veins
* Trauma
* Atrial fibrillation
## Footnote
These factors increase the likelihood of developing a pulmonary embolus.
133
What are the symptoms of a **pulmonary embolus**?
* Dyspnea
* Diaphoresis
* Tachypnea
* Chest pain all of a sudden
## Footnote
Patient may appear to be hyperventilating but is not.
134
What does the **diagnosis** of pulmonary embolus involve?
* History
* Bedside assessment
* ABG (V,N is increased)
## Footnote
Bedside assessment shows hyperpnea (increased rate and depth of ventilation).
135
What is the treatment for **pulmonary embolus**?
* Support ventilation and oxygenation
* Prevent further emboli with anticoagulant therapy (heparin, warfarin)
* Treat existing clots with thrombolytic agents (streptokinase, tPA)
## Footnote
Treatment aims to stabilize the patient and address the embolism.
136
What is **nitrite poisoning** caused by?
Accidental ingestion of fertilizer or other chemicals
## Footnote
It results in methemoglobinemia.
137
What does increased levels of **methemoglobin** interfere with?
Co-oximeter analysis of carboxyhemoglobin
## Footnote
Methemoglobin does not carry oxygen.
138
What does **COPD** show in ABG results?
Compensated (Chronic) respiratory acidosis with hypoxemia (low PaO2)
## Footnote
Typical ABG values include PaO2 58 torr, Paco2 62 torr, HCO3- 36 mEq/L.
139
What can oxygen-induced hypoventilation result in for a patient with **COPD**?
Tired, sleepy, lethargic, and then unresponsive
## Footnote
This can occur when a patient receives oxygen therapy at high FIO2.
140
What does a **shift to the left** in the Hb Dissociation Curve indicate?
Increased oxygen affinity
## Footnote
This means there will be a higher oxygen content for any given PO2.
141
What does a **shift to the right** in the Hb Dissociation Curve indicate?
Decreased oxygen affinity
## Footnote
This means there will be a lower oxygen content at any given PO2.
142
List the factors that cause a **shift to the left** in the Hb Dissociation Curve.
* Increased H+ (decreased pH)
* Decreased PCO2
* Decreased temperature
* Decreased 2-3 DPG
## Footnote
These factors increase the affinity of hemoglobin for oxygen.
143
List the factors that cause a **shift to the right** in the Hb Dissociation Curve.
* Decreased H+ (increased pH)
* Increased PCO2
* Increased temperature
* Increased 2-3 DPG
## Footnote
These factors decrease the affinity of hemoglobin for oxygen.
144
What is the relationship between **Hb saturation** and **PO2** in the context of the Hb Dissociation Curve?
As PO2 increases, Hb saturation increases
## Footnote
The curve illustrates how hemoglobin's oxygen binding changes with varying levels of oxygen pressure.
145
What does **paoz at 50%** equal?
27 NORMAL
## Footnote
This indicates a specific measurement related to oxygen saturation.
146
What are the possible **shifts** indicated in the text?
* Right shift
* Left shift
## Footnote
These shifts refer to changes in the oxygen dissociation curve.
147
What is the **torr** measurement for normal conditions?
27 torr
## Footnote
This value is used to assess the partial pressure of oxygen.
148
What does **decreased affinity** indicate?
Increased release of oxygen
## Footnote
This is related to the oxygen dissociation curve.
149
What does **increased affinity** indicate?
Decreased release of oxygen
## Footnote
This is also related to the oxygen dissociation curve.
150
To determine the patient's **O2 saturation**, which of the following is required?
1. pH
2. PaCO2
3. PaO2
1. Yes
2. Yes
3. Yes
## Footnote
These parameters are essential for assessing oxygen saturation.
151
What does **pulse oximetry** measure?
The ratio of oxygenated hemoglobin (O2 HB) to reduced hemoglobin (RHb) expressed as a percent
## Footnote
It is the most appropriate noninvasive technique for continuous monitoring of oxygen saturation (SpO2) and pulse.
152
What is the **normal range** for SpO2?
93 - 97%
## Footnote
Displayed saturation from pulse oximeter is accurate in patients with good perfusion and saturation of 70% or higher.
153
What is the **function** of the pulse oximeter probe?
Attaches to finger and transmits light pulses through the capillary beds
## Footnote
It is used for continuous monitoring of oxygen saturation and pulse.
154
What factors can affect the **accuracy** of pulse oximetry?
* Poor perfusion (shock, hypotension)
* Conditions that interfere with light transmission (erythema, bright ambient lights)
## Footnote
These factors can lead to inaccurate readings.
155
What should be done to **disinfect** the pulse oximeter probe?
Clean probe with alcohol swab
## Footnote
Do not submerge in any solution.
156
What is a potential issue if there is a sudden fall in **readings** without a change in the patient's condition?
Consider probe malfunction
## Footnote
The probe should be reattached or changed.
157
True or false: A pulse oximeter will read higher saturation if **carbon monoxide poisoning** is present.
TRUE
## Footnote
This can lead to misleading saturation readings.
158
What should a patient do to ensure accurate readings from a pulse oximeter?
Relax his hand completely
## Footnote
Motion can affect the accuracy of the reading.
159
What is the purpose of **overnight pulse oximetry**?
Assessment of oxygen saturation during an overnight period
## Footnote
It is used as a screening tool for identifying patients with sleep-related breathing disorders.
160
What equipment is needed for overnight pulse oximetry?
* High quality and portable
* Able to record oxyhemoglobin saturation and pulse
* Set to the shortest time interval for measurement
## Footnote
This ensures accurate monitoring during sleep.
161
What are the **indications** for using overnight pulse oximetry?
* Screening tool for sleep-related breathing disorders
* Assess response to treatment for obstructive sleep apnea
## Footnote
These indications help in diagnosing and managing sleep apnea.
162
What is the primary use of a **Co-oximeter/Hemoximeter**?
To diagnose carbon monoxide poisoning
## Footnote
It provides accurate measurements of carbon monoxide levels in the blood.
163
What is the normal **COb** level?
0-2%
## Footnote
This indicates a normal level of carbon monoxide in non-smokers.
164
What is the **COb** level for smokers?
5 - 10%
## Footnote
Smokers typically have elevated carbon monoxide levels due to inhalation of smoke.
165
Define **CO poisoning** in terms of COb levels.
COb > 20%
## Footnote
This level indicates significant exposure to carbon monoxide, often from smoke inhalation or auto emissions.
166
What is the best method to evaluate oxygenation in a patient with **CO poisoning**?
Co-oximetry
## Footnote
It provides direct measurements of carbon monoxide and oxygen levels.
167
How does the **principle of operation** of a co-oximeter compare to a pulse oximeter?
Uses a blood sample and additional wavelengths of light
## Footnote
Unlike pulse oximeters, which are non-invasive, co-oximeters require blood samples.
168
What is the most accurate method to measure **COb**, **O2**, **Hb**, and other non-functional hemoglobin?
Co-oximetry
## Footnote
It can detect conditions like MetHb, which appears a chocolate brown or rusty color.
169
What type of measurement does a co-oximeter provide?
Invasive and non-continuous
## Footnote
It requires blood samples for analysis.
170
In the interpretation of results, what is the difference in oxygen saturation reported by a blood gas analyzer and a hemoximeter?
Blood gas analyzer saturation is calculated; hemoximeter saturation is measured
## Footnote
This highlights the accuracy of hemoximeter results in CO poisoning cases.
171
What treatment is indicated for a patient with **CO poisoning** and a COb of 25%?
Start oxygen therapy at 100% O2 with a non-rebreather mask
## Footnote
This is crucial for displacing carbon monoxide from hemoglobin.
172
Can a co-oximeter be used to verify the accuracy of **pulse oximeters**?
Yes
## Footnote
Co-oximeters provide a more accurate measurement of blood oxygenation.
173
What occurs when **Met Hb** is present in high concentrations?
It will not carry oxygen and will reduce O2 Hb levels
## Footnote
Methemoglobinemia can be caused by nitrite poisoning.
174
What factors do not change the accuracy of a **co-oximeter**?
* Changes in hemoglobin
* CO levels
* Heart rate
## Footnote
These factors are accounted for in the co-oximeter's design.
175
What may affect the accuracy of a **co-oximeter**?
Blood lipid levels
## Footnote
High fat levels in blood can interfere with measurements.
176
What should all Hb saturations add up to if the **co-oximeter** is functioning correctly?
100%
## Footnote
This indicates that the device is accurately measuring all forms of hemoglobin.
177
What is the definition of a **nosocomial infection**?
An infection acquired at least 72 hours after admission to a hospital or other health care facility
## Footnote
Nosocomial infections are a significant concern in healthcare settings.
178
Who are the **responsible parties** for nosocomial infections?
* Personnel
* Equipment
## Footnote
Personnel can transmit organisms through inadequate handwashing and nasal discharge.
179
What are **droplet nuclei**?
Dispersed via cough or sneeze
## Footnote
Always cover mouth during cough or sneeze to prevent transmission.
180
What type of equipment is particularly risky for transmitting infectious agents?
Water containing equipment, especially aerosol devices
## Footnote
These can transmit agents like *Pseudomonas aeruginosa* and *Serratia*.
181
What should containers and bottles be labeled with?
Date and time
## Footnote
They should be used within 24 hours of opening.
182
How should contaminated equipment from an isolation area be handled?
Double-bagged and labeled before returning to the cleaning area
## Footnote
This prevents contamination during transport.
183
What should items that are disinfected or sterilized be labeled with?
Date and method of processing
## Footnote
This ensures traceability and accountability in infection control.
184
What are the requirements for storage areas of equipment?
* Clean
* Dry
* Dust free
* Well ventilated
## Footnote
Proper storage conditions help maintain equipment sterility.
185
What must be inspected before using disposable equipment?
Package integrity
## Footnote
Ensures that the equipment is safe and uncontaminated.
186
What is the benefit of single patient use of equipment?
Reduces chances of cross-contamination and disease transmission
## Footnote
This practice enhances patient safety.
187
What should be routinely done to equipment in storage?
Cultured to assure its sterility/disinfection
## Footnote
Regular culturing helps detect any contamination issues.
188
How is documentation of sterilized equipment confirmed?
* Change in color of heat sensitive tape
* Heat sensitive chemical indicators
## Footnote
These indicators provide visual confirmation of sterilization.
189
What do biological indicators indicate?
Conditions have been met to assure sterilization
## Footnote
They are critical for validating sterilization processes.
190
What must manufacturers describe regarding their equipment?
* Acceptable methods for cleaning and disinfecting
* Recommended chemicals and concentrations
* Safety precautions for operators
## Footnote
Local requirements may supersede the manufacturer's recommendations.
191
What should be done with **disposable mouthpieces** or flow sensors after each patient use?
They should be discarded
## Footnote
This is crucial for preventing cross-contamination between patients.
192
Upon entering the testing area, patients should be given approved **hand sanitizer** or wipes. True or False?
TRUE
## Footnote
This practice helps maintain hygiene and reduce the risk of infection.
193
What should be done with **non-disposable mouthpieces** after each use?
They should be washed, disinfected, and dried
## Footnote
Proper cleaning is essential to ensure they are safe for the next patient.
194
How often should the **water** in the water-seal spirometer be changed?
Weekly
## Footnote
Regular maintenance is necessary to ensure accurate spirometry results.
195
What should be done with **equipment parts** handled by the patient after each use?
They should be wiped with alcohol
## Footnote
This helps to disinfect surfaces and reduce infection risk.
196
What type of **filters** should be used on all spirometers?
Disposable, inline filters
## Footnote
These filters help prevent cross-contamination during testing.
197
When scheduling patients with a possible or confirmed infection, when should they be scheduled?
* At the end of the day
* Reserving equipment for infected patients
* In the patient's own room with adequate ventilation
## Footnote
This minimizes the risk of spreading infection to other patients.
198
What are the **routes of transmission of infection** in the pulmonary function lab?
* Direct contact (mouthpieces, nose clips, handheld spirometers, arms of chairs)
* Indirect contact (aerosol droplets)
* Respiratory droplets
* Airborne droplet nuclei
## Footnote
Understanding these routes is critical for implementing effective infection control measures.
199
What are included in **Standard Precautions**?
* Hand washing or approved sanitizer
* Gloves
* Masks, eye protection, face shields
* Gowns
## Footnote
These precautions are essential to protect both patients and healthcare workers.
200
What should be done with **nose clips** after each use?
They should be discarded or cleaned with alcohol
## Footnote
Proper handling of nose clips is important to prevent infection transmission.
201
What should be worn when handling all pieces of **equipment**?
Gloves
## Footnote
Wearing gloves is a basic infection control measure to protect both the patient and the healthcare provider.
202
What are the **Expanded Precautions** in patient care?
* Contact Precautions
* Droplet Precautions
* Airborne Infection isolation
* Protective Equipment
## Footnote
Personnel must wear NIOSH-approved respirator for Airborne Infection isolation.
203
What is the purpose of using **one-way valves** or personal sampling chambers?
To prevent cross infection
## Footnote
This applies to equipment like Wright Respirometers used with multiple patients.
204
When using medication bottles, what should be indicated on the bottle?
* Time
* Date
* Initials
## Footnote
This is important for tracking medication usage according to hospital policy.
205
What should be done with equipment from patients with **HIV/AIDS** and hepatitis before sterilization?
Double bag the equipment
## Footnote
This is a precautionary measure prior to gas sterilization.
206
Where should **disposable equipment** be discarded?
Inside the room
## Footnote
This helps contain any potential contamination.
207
What is the most effective way to avoid cross contamination when administering **aerosolized medications**?
Use a metered dose inhaler (MDI)
## Footnote
This method minimizes the risk of cross contamination of the drug.
208
What does **Biohazardous Waste** include?
* Laboratory waste (specimen cultures, research cultures)
* Human blood and contaminated articles
* Other body fluids (pleural fluid, cerebrospinal fluid)
## Footnote
This waste poses a risk to health and safety.
209
Define **Medical Waste**.
Bio-hazardous or sharps waste generated from diagnosing, treatment, or immunization
## Footnote
This includes waste from testing biologicals and home generated sharps waste.
210
What are the requirements for **Bio-hazardous and/or Medical Waste Disposal**?
* Use a biohazard bag inside a rigid container
* Do not use for normal trash or sharps items
* Place sharps in puncture-resistant containers
* Keep a lid on the waste container
* Mark bags with bio-hazardous waste or biohazard symbol
## Footnote
These measures ensure safe disposal and minimize risk.
211
What should be done with items that are double-bagged?
Place inside a leak proof container with a lid
## Footnote
This is crucial for containing biohazardous materials.
212
What are the two methods for administering **inhaled bronchodilators**?
* Small-volume nebulizer (SVN)
* Metered dose inhaler (MDI) with holding chamber/spacer
## Footnote
The MDI is normally preferred unless the patient has trouble coordinating their breathing.
213
When should the **small-volume nebulizer (SVN)** be used?
When the MDI is not appropriate
## Footnote
The SVN is an alternative method for delivering inhaled bronchodilators.
214
What is the **drug of choice** for bronchodilation and how long does it take to reach maximum effect?
Albuterol; takes up to 15 minutes
## Footnote
Albuterol is commonly used for quick relief in asthma management.
215
What should be done prior to administering the **metered dose inhaler (MDI)**?
* Shake the MDI
* Activate it to prime
* Confirm it is not empty
## Footnote
Proper preparation ensures effective delivery of the medication.
216
What is the recommended technique for using an **MDI**?
* Position close to mouth or use spacer
* Inhale slowly and deeply
* Activate MDI at the start of inhalation
* Hold breath for 5-10 seconds
* Exhale slowly
## Footnote
This technique maximizes drug delivery to the lungs.
217
What is the total dosage of **albuterol** for multiple doses?
360 mcg
## Footnote
Each dose is 90 mcg, and up to four doses can be administered.
218
What should always be done before making changes to a patient's **treatment plan**?
Have the patient demonstrate their technique
## Footnote
This ensures the patient is using the inhaler correctly.
219
What should be done if a patient sees a primary physician for **asthma**?
Send them to a pulmonologist
## Footnote
Specialized care may be necessary for effective asthma management.
220
What are common **triggers** for asthma that should be avoided?
* Tobacco smoke
* Food
* Dust
* Pollen
* Mold
* Dust mites
* Animal dander
* Chemicals
* Exercise
## Footnote
Identifying and avoiding triggers is crucial for asthma control.
221
What does an **asthma action plan** provide for the patient?
* Specific instructions for monitoring and managing asthma
* Actions to take during a developing problem or emergency
## Footnote
This plan helps patients respond effectively to asthma symptoms.
222
What should be measured daily to assess a patient's **asthma condition**?
Peak flow measurements
## Footnote
This provides a quick assessment of lung function.
223
What type of medication should be available for **quick relief** of asthma symptoms?
Short acting beta2 agonist (SABA), such as albuterol
## Footnote
SABA medications provide immediate relief during asthma attacks.
224
What type of medication should be used for **daily control** of asthma if needed?
Inhaled corticosteroid (ICS)
## Footnote
ICS medications help reduce inflammation and control asthma symptoms.
225
What additional medications can be added to maintain **asthma control**?
* Long acting beta2 agonists
* Leukotriene inhibitors
* Mast cell stabilizers
* Methyl xanthine drugs
## Footnote
These medications can be used as necessary to enhance asthma management.
226
What special arrangements should be made for patients who need to **travel**?
* Transportation to/from airport, train station, or ship harbor
* Oxygen therapy arrangements
* Medical services at the destination
## Footnote
Planning ahead ensures that medical needs are met during travel.
227
What inhaler types are more convenient for patients when **traveling**?
* Metered dose inhaler (MDI)
* Dry powder inhaler (DPI)
## Footnote
These inhalers do not require a compressed gas source, making them easier to use on the go.
