What effects do changes in body temperature have on metabolism and the cardiopulmonary system?
increase or decrease in the metabolic rate
vasodilation or vasoconstriction
an increase in the demand for the cardiopulmonary system
An increase in the body temperature...
increases the metabolic rate and this action leads to an increase in oxygen consumption and an increase in carbon dioxide production at the cellular level
A decrease in the body temperature...
and reduces the metabolic rate and the cardiopulmonary demand.
What changes in vital signs or other clinical manifestations might you identify in a febrile patient?
increase in body temp
increase in blood pressure
increase in respiratory rate
What does a dull chest percussion note indicate?
areas of pleural thickening
What does a hyperresonant chest percussion note indicate?
areas of trapped gas
What is the clinical significance of bilateral dependent pitting edema?
What is the clinical significance of distended neck veins?
severe flail chest
the major veins of the chest that return blood to the right side of the heart may be compressed
What is the function of the carotid sinus and aortic baroreceptors?
To activate reflexes that cause decrease heart rate and ventilator rate in response to increased systemic blood pressure and increase heart and ventilator rate in response to decrease systemic blood pressure.
What is a common post-op pulmonary complication that might stimulate the deflation reflex and or the Hering-Breuer reflex? What type of respiratory pattern would this patient demonstrate?
Name 4 clinical conditions that might stimulate the J receptors. What is the resulting respiratory pattern?
pulmonary capillary congestion
edema of the alveolar walls
respiratory pattern is rapid, shallow breathing.
What breathing pattern is demonstrated by the patient with decreased lung compliance?
Increase in rate and a decrease in tidal volume
What breathing pattern is demonstrated by the patient with increased airway resistance?
Decrease in rate and an increase in volume
What determines the breathing pattern adopted by the patient?
Minimum work requirements rather than gas exchange efficiency.
What happens to the V/Q ratio with shunting?
Name 2 causes of capillary shunts!
Alveolar collapse or atelectasis
Alveolar fluid accumulation
Alveolar consolidation or pneumonia.
Does an absolute shunt respond to oxygen therapy? Why or why not?
Does not respond to oxygen therapy because alveolar oxygen does not come in contact with the shunted blood.
How do the peripheral chemoreceptors respond to hypoxemia?
By sending a signal to the respiratory centers of the medulla by way of the glossopharyngeal nerve from the carotid bodies and by way of the vagus nerve from the aortic bodies
What do the central chemoreceptors respond to and what breathing pattern results?
To an increase concentration of H+ in the CSF
Causes and increase in the ventilator rate.
What are the advantages of pursed –lip breathing?
It offsets early airway collapse and air trapping during exhalation and has been shown to slow the patient’s ventilator rate and generate a ventilatory pattern that is more effective in gas mixing.
Pleuritic chest pain!
Described as a sudden, sharp, or stabbing pain
The pain generates normally intensified during deep inspiration and coughing and diminished during breath holding or splinting.
Nonpleuritic chest pain!
Usually described as a constant pain that is located centrally. The pain also may radiate.
List the qualities by which a therapist should evaluate and monitor sputum!
List the qualities by which a therapist should evaluate and monitor a cough!
If the cough is strong or weak, in other words can the patient mobilize secretions. A productive cough should be evaluated in terms of its frequency, pitch, and loudness.
What is the most common cause of acute alveolar hyperventilation?
How is acute ventilatory failure defined?
A condition in which the lungs are unable to meet the metabolic demands of the body in terms of CO2 homeostasis
How acute ventilatory failure different from chronic ventilatory failure?
pH will be within the normal range
How does acute hypoxemia lead to acute metabolic acidosis?
Oxygenation is inadequate to meet tissue metabolism
Describe a patient who is experiencing oxygen-induced hypoventilation!
hard to arouse
With slow and shallow breathing.
What are the 2 ways in which oxygen is transported by the blood?
As dissolved oxygen in the blood plasma
bound to the hemoglobin
Write the formula used to calculate Oxygen content of arterial blood.
(Hb x 1.34 x SaO2) + (PaO2 x 0.003)
Write the formula for the ideal alveolar gas equation (PAO2).
FiO2(PB – PH2O) – PaCO2 (1.25)
What is the normal P(A-a)O2 range at room air?
ranges from 7 to 15 mm Hg and it should not exceed 30 mm Hg.
In what conditions is the P(A-a)O2 value increased?
Oxygen diffusion disorders
Decreased ventilation-perfusion ratio disorders
Right to left intracardiac shunting
What is normal oxygen consumption?
250 mL of oxygen per minute.
How is the respiratory quotient defined?
The ratio of the volume of carbon dioxide released to the volume of oxygen consumed by a body tissue in a given period.
What is the formula used to calculate oxygen delivery. Under what circumstances does this value decrease?
QT x (CaO2 x 10)
decrease in blood oxygen saturation
decrease in hemoglobin concentration
decrease cardiac output.
What is the normal Oxygen extraction ratio?
When is the normal oxygen extraction ration increased?
decreased cardiac output
periods of increased oxygen consumption
decreased arterial oxygenation.
When is the normal oxygen extraction ration decreased?
Increased cardiac output
skeletal muscle relaxation
increased arterial oxygenation.
What is the normal SvO2?
What is a normal degree of pulmonary shunting?
When does the degree of shunting become significant?
greater than 20%
An abnormally low arterial oxygen tension (PaO2) and is frequency associated with hypoxia.
An inadequate level of tissue oxygenation
What are some symptoms of hypoxia?
What are the 3 major mechanisms involved in producing cor pulmonale in chronic pulmonary disease?
The increased viscosity of the blood associated with polycythemia
The increased pulmonary vascular resistance caused by hypoxic vasoconstriction
The obliteration of the pulmonary capillary bed, particular in emphysema.
Inadequate oxygen at the tissue cells caused by low arterial oxygen tension. (PaO2)
PaO2 is normal, but the oxygen-carrying capacity of the hemoglobin is inadequate.
Blood flow to the tissues cells is inadequate; therefore oxygen is not adequate to meet tissue needs.
Impaired ability of the tissue cells to metabolize oxygen
Define sinus arrhythmia? Treatment?
The heart rate varies by more than 10% from beat to beat
No treatment is needed
Of the atrial arrhythmias, which is most serious? Why?
May reduce the cardiac output by 20% because of a loss of atrial filling
Of the ventricular arrhythmias, which is most serious? Why?
There is no cardiac output or blood pressure and without treatment the patient will die within minutes
How does the cardiovascular system compensate for hypoxemia? At what HR does this response decline?
Increase heart rate, pulse, and blood pressure,
When the heart rate increases beyond 150 to 175 bpm
What is the most commonly used method of invasive hemodynamic monitoring?
What occurs to the following hemodynamic indices in patients with cor pulmonale?
What occurs to the following hemodynamic indices in a patient with a pneumothorax?
What are the disadvantages of an AP chest radiograph?
The heart is magnified and the radiograph has less resolution and more distortion and also extraneous shadows are often present
What are the standard two views of the chest radiograph performed in the radiology department?
When is a lateral decubitus chest radiograph useful?
In the diagnosis of a suspected or known fluid accumulation in the pleural space (Pleural effusion)
Describe an over-exposed chest radiograph!
The heart and lungs become more radiolucent (darker) with greater exposure of the radiograph.
A chest radiograph that has been overexposed is said to be “heavily penetrated” or burned out”
Describe an under-exposed chest radiograph!
The heart and lung on an underexposed radiograph may appear denser and whiter.
The lungs may appear to have infiltrates, and there may be little or no visibility of the thoracic vertebrae.
List the anatomic structures that should be noted when inspecting the mediastinum on a CXR.
superior vena cava
Describe in detail the right heart bulges seen on the normal PA CXR.
Two bulges should be seen on the right border of the heart
The upper bulge is the superior vena cava
The lower bulge is the right atrium
Describe in detail the left heart bulges seen on the normal PA CXR.
Three bulges are normally seen on the left side of the heart.
The superior bulge is the aorta
The middle bulge is the main pulmonary artery
The inferior bulge is the left ventricle
What might cause enlargement of the hilar region?
In infectious lung disorders such as histoplasmosis or tuberculosis the lymph nodes around the hilar region are often enlarged
What are some causes of absence of lung markings on a chest radiograph?
may be the result of an overexposed radiograph.
Why is the right diaphragm higher than the left?
Because of the liver below it
Why should the pleura be carefully inspected on the chest radiograph?
presence of fluid (pleural effusion)
What changes to the intercostal spaces are common in patients with COPD?
Generally far apart because of alveoli hyperinflation
How would a lung tumor appear on spiral CT of the chest?
A dense tumor in the lungs would appear as a white object surrounded by dark lungs
For what type of pulmonary lesions or abnormalities is the CT scan especially helpful?
Confirming the presence of a mediastinal mass
small pulmonary nodules
small lesions of the bronchi
a small pneumothorax
Why is the PET scan helpful in diagnosing pulmonary cancerous lesions?
Its ability to evaluate the metabolic rate of certain tissue cells that may be cancerous.
In other words the PET scan is able to detect cancerous cells n the tissue of the body before changes develop in anatomic shape of the organ
What are the benefits of a combined PET/CT scan?
accurate staging and localization
precise treatment and monitoring
Why is pulmonary angiography performed?
Useful in identifying pulmonary emboli or arteriovenous malformations.
What are causes of abnormal ventilation scan?
Airway obstruction (mucus plug or bronchospasm)
loss of alveolar elasticity (emphysema)
List 2 reasons to perform fluoroscopy of the chest
In the assessment of abnormal diaphragmatic movement
For localization of lesion to be biopsied during fiberoptic bronchoscopy
Sputum culture and sensitivity study
This test is performed to diagnose bacterial infection, select an antibiotic, and evaluate the effectiveness of antibiotic therapy
Sputum gram stain test
Performed to classify bacteria into gram negative organism and gram positive organisms
When would a cytology examination be performed on a sputum specimen?
For the presence of abnormal cells that may indicate a malignant condition
What illness is suspected when an AFB smear (acid fast bacilli) is ordered on a sputum specimen?
What are the indications for a therapeutic bronchoscopy?
Suctioning of excessive secretions or mucus plugs, especially when lung atelectasis is forming
The removal of foreign bodies or cancer obstructing the airways
Management of life threatening hemoptysis
What are the indications for a therapeutic thoracentesis?
To relieve shortness of breath or pain caused by a large pleural effusion
To remove air trapped between the lung and chest wall
To administer medication directly into the lung cavity to treat the cause of the fluid accumulation
To treat cancer
What procedure is considered the standard of care for a patient with recurrent malignant pleural effusion?
What are some causes of hypochromic microcytic anemia?
Chronic blood loss
What cell type makes up the largest portion of the WBCs?
What type of organisms do neutrophils target and how do they defend against them?
They represent the primary defense against bacterial organisms through the process of phagocytosis. They ingest and destroy bacterial organisms and particulate mater
List at least 4 conditions that are associated with thrombocytopenia? (Low platelet count)
Massive blood transfusion
What platelet count is associated with spontaneous bleeding?
A platelet count of less than 20,000/mm
What type of WBC deficiency is seen with HIV?
What are the symptoms of hypokalemia?
What is the normal range for serum glucose?
70 to 110 mg/dl
Physical examination of patient with pulmonary edema!
Decreased lung compliance
Cheyne stokes respiration
Paroxymal nocturnal dyspnea
Pink and frothy sputum
Increased HR, RR, and BP
Chest assessment finding associated with pulmonary edema!
Increased tactile and vocal fremitus
Crackles, rhonchi, and wheezing
Radiologic finding in pulmonary edema!
Bilateral fluffy opacities
Dilated pulmonary arteries
Left ventricle hypertrophy
Kerly A and B lines
Bat's wing or butterfly pattern
Hypokalemia, hyponatremia, and hypochloremia are often seen in patiens with...
Left sided heart failure and may result from diuretic therapy or excessive fluid retention
The causes of pulmonary edema into major categories!
The most common cause of cardiac pulmonary edema...
Is left sided heart failure (CHF)
Cardiac edema occurs when...
The left ventricle is not able to pump out all of the blood that it receives from the lungs