Perform Procedures to Gather Clinical Information

What does capnography measure?
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Terms in this set (57)
What does capnography measure?
exhaled CO2
what does transcutaneous blood gas monitoring provide?
continuous noninvasive estimates of arterial PO2 and PCO2 via a sensor placed on the skin
why would you recommend overnight oximetry?
- help identify patients with sleep apnea hypopnea syndrome
- help assess SAHS patients responses to therapy for example CPAP
- help identify if serious desaturation occurs n COPD patients during sleep
what is the gold standard to diagnose sleep apnea hypopnea syndrome (SAHS)
laboratory polysomnography
You are assisting a nurse in ICU to measure a patient's central venous pressure (CVP) with a strain-gauge pressure transducer. You note that the pressure transducer is positioned well above the middle of the patient's lateral chest wall. What effect if any would this have on the CVP measurement?
it would underestimate the CVP
when measuring vascular pressures you should always ensure that the base of the fluid column or pressure transducer is
leveled at point of measurement.
A doctor suspects that a patient's asthma-like symptoms are due to airway hyperreactivity. She asks your advice on the best way to confirm this diagnosis. You would recommend:
bronchial provocation testing
what is bronchial provocation testing used for?
- to confirm or exclude a diagnosis of airway hyperreactivty.
-determine the risk of developing asthma.
valuate patients with occupational asthma
assess the response to therapeutic interventions
During the middle of a 6-minute walk test, a patient complains of chest pain, exhibits diaphoresis, and appears very pale. Which of the following actions should you immediately take?
administer O2 as needed
retake vital signs
sit the patent down
why should a 6MWT be immediately stopped
chest pain
intolerable dyspnea
leg cramps
staggering
diaphoresis
pale or asthen appearance
The proper starting point for FRC measurement via helium dilution or nitrogen washout is:end of normal resting exhalationWhen performing a modified Allen test on the left hand of a patient, you note that her palm, fingers, and thumb remain blanched for over 15 seconds after releasing pressure on the ulnar artery. You should:perform the Allen test on the right handWhich one of the following measures could be used to assess changes in exercise tolerance associated with participation in a pulmonary rehabilitation program?pre- and post- 6 minute walking distancewhat measures are useful in assessing changes in exercise tolerance-pre and post 6 or 12 min walking distance - pre and post pulmonary exercise stress test -review of patient home exercise logs - strength measurement -performance on specific exercisesWhat two bedside measurements require a conscious and cooperative patient?-maximum expiratory pressure -vital capacityThe best way to determine the proper CPAP level for an individual patient is to:assess the apnea- hypopnea index at different CPAP levels during a sleep studyFor continuous monitoring of an adult patient's oxygen saturation with a pulse oximeter, which of the following LOW alarm limits would be appropriate?92%-94%Indications for a diagnostic bronchoscopy include which of the following?obtaining sputum and tissue samples for laboratory analysiswhat are therapeutic indications for a bronchoscopyremoving a mucus plug and foreign bodies placing stentsSignificant overinflation of an endotracheal tube cuff may cause which of the following?mucosal ischemia higher than 30 cm H2Owhat can a low cuff pressure causeair leakage and silent aspiration below 20 cm H2OWhen performing spirometry on an adult patient, which of the following would indicate invalid/unacceptable test results?back extrapolated volume 300 mLwhat would be indications of a valid spirometry- back extrapolated volume < 150 mL - a time to peak expiratory flow < 120 m sec -forced expiratory time > 6.0 sec with the change in exhaled volume during the last 0.5 sec of the maneuver < 100 ml - all repeat FEV6 values are within 150 mLwhat are indications for ending a cardiopulmonary exercise evaluation?- ECG abnormalities - severe desaturation - angina - hypotensive response - a fall of > 20 torr n systolic pressure after the normal exercise rise - a fall n systolic BP below pre-exercise level -lightheadedness - request from patient to stopAn ambulatory care patient has a white blood cell count (WBC) of 20,000, along with increased sputum production. Which of the following tests would you recommend for this patient?sputum gram stain, culture and senstivityThe ER physician asks you to evaluate a trauma patient who was the victim of a house fire. In order to properly evaluate the cardiopulmonary status of this patient you should perform which of the following procedures?CO- oximetrywhat can Carbon monoxides high affinity for hemoglobin causehypoxemiaA patient has a peak expiratory flow rate (PEFR) of 5.2 L/sec before bronchodilator treatment and 6.3 L/sec after treatment. What percent change in PEFR occurred?21%What is the % change formula?{(post -Pre) /pre} x 100% changeA patient breathing 100% O2 has a P(A-a)O2 of 400 torr. What is her approximate % shunt?20%when estimating the percent shunt for every 100 torr there isabout a 5% shuntWhich of the following would you recommend to help guide a physician in locating the appropriate needle insertion site for thoracentesis performed at the bedside?ultrasoundwhat can a ultrasound exam help diagnose- trauma to the diaphragm - heart - large thoracic vessels - fractures of the ribs and sternumAn exercise test can help determine the cause of which of the following?wheezing on exertionwhat can exercise testing help diagnose- coronary artery disease - differentiate between cardiac and pulmonary limitations to exercise capacity - exercise induced bronchospasm -extent of O2 desaturation during increased levels of activityWhich of the following is being measured if you instruct a patient to take a maximum deep breath and then exhale completely?vital capacityvital capacity is the sum ofIRV+ Vt+ ERVA 150-pound patient is breathing at a frequency of 20 breaths/minute, with a tidal volume of 550 mL. What is the estimated alveolar ventilation per minute?8.0 l/minalveola minute ventilation equationVE= f x (VT-VDS)Five minutes after elevating the pressure to 20 cm H2O during a CPAP titration study, a patient still exhibits obstructive respiratory events and some periods of central sleep apnea. What should be the next step in conducting this study?begin titrating with BiPAP up to a maximum IPAP-EPAP= 10 cm H20Due to her patient's minimal response to the standard prescription for an aerosolized bronchodilator, a doctor asks your advice on how best to adjust the dosage. You would recommend:pre-/post bronchodilator spirometrywhy is helium dilution functional residual capacity usedto quantify the degree of hyperinflation or differentiate obstructive from restrictive disorderswhy is peak expiratory flow rate monitoring usedassess asthma patients airway tone over timeYou detect an irregular pulse and pulse deficit in a patient by palpation and auscultation, and suspect atrial fibrillation as the cause. Which of the following tests would you recommend to confirm if atrial fibrillation is the problem?electrocardiogramAn electrocardiogram screens for- heart disease -rule out heart disease in surgical patients - evaluate patients with chest pain -follow progression of patients with CAD evaluate heart rhythm disordersTo measure the amount of auto-PEEP present in a patient receiving ventilatory support, you would:measure pressure during an end expiratory pauseA patient receiving volume-controlled SIMV develops subcutaneous emphysema around the tracheostomy site, neck, and chest. To obtain additional pertinent data, the most appropriate diagnostic procedure would be which of the following?chest x-rayA doctor asks you to provide serial measures of the respiratory muscle strength of a patient with a progressive acute neuromuscular disorder. Which of the following measures would you select to provide the needed information?forced vital capacityWhich of the following specialized imaging tests would be most useful in diagnosing a pulmonary emboli?ventilation perfusion scan (V/Q scan) orr CT angiogrraphyYou have just placed a COPD patient on SIMV at a rate of 8/min, a tidal volume of 700 mL, and an FIO2 of 0.45. In order to ensure proper equilibration between the alveolar and arterial gas tensions, how long should you wait before drawing an ABG?30 mnWhich of the following procedures can be performed on a comatose patient?maximum inspiratory pressureAfter setting up a 12-lead ECG on a patient and verifying that the leads are connected properly, you note a "noisy" and unstable signal. To resolve this problem you would:confirm that the patient is staying motionlesshow to troubleshoot during a 12 lead ECG- ECG lead snaps are clean and corrosion free - the lead electrodes are connected properly to the patient - the electrode gel s not dry - the main lead cable is undamagedThe primary indication for apnea monitoring is to:identify life threatening events in neonatesYou are monitoring a patient with myasthenia gravis and finds that the maximum inspiratory pressure (MIP/NIF) has changed from −35 cm H2O 4 hours ago to −10 cm H2O. Based on this change, you should recommend which of the following?obtain an arterial blood gas analysiswhat can a severe decrease in MIP/NIF causehypoventilation and respiratory acidosisWhich of the following alarm limits would be appropriate for setting on an apnea monitor being used on a neonate being discharge to the home setting?apnea limit 20 seconds: low/ high heart rate 80 to 220 bpm