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Pulmonary Diagnostic Tests and Procedures
Chapter 10 Test 3
94
Medical
Graduate
04/06/2012

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Term
A predominant diagnostic test to determine anatomic abnormalities and pathological processes within the chest.
Definition
Chest Radiographs
Term
Radiograph is referred to as ___
Definition
Roentgenogram
Term
Name the 5 principle objects that are seen in chest radiographs
Definition
Air
Fat
Water
Bone
Tissue
Term
What color is air on a radiograph?
Definition
Dark
Term
What color is bone on a radiograph?
Definition
White
Term
A standard chest radiograph is taken in what two views?
Definition
Posteroanterior (PA)
Left Lateral
Term
Besides PA and left lateral, what are 4 other views that may be done via chest radiograph?
Definition
Decubitus
Lordotic
Oblique
AP at bedside
Term
With chest radiographs, positioning for AP views in supine or semirecumbent often results in poor ___ __
Definition
Inspiratory Effort
Term
When examining a chest radiograph, what type of approach should be used?
Definition
Systematic
Term
When looking at bones and soft tissues on a chest radiograph what all can you look at?
Definition
-Size, shape, and symmetry of bony thorax
-Determine if pt is rotated
-Summation effect
Term
What is the summation effect?
Definition
Soft tissues (skin, fat, muscle) tend to blend together
Term
Two hemidiaphragms should appear how on a chest radiograph?
Definition
Smooth and rounded
Term
The size of the mediastinum varies, the trachea is seen via shadow, and you can see the heart and great vessels on what?
Definition
Chest radiograph
Term
This is formed by the root of the lungs and includes the pulmonary blood vessels, bronchi, and group of lymph nodes
Definition
Hila
Term
Knowledge of __ and __ anatomy is crucial to assessment of lung fields
Definition
lobar and segmental
Term
What is the silhouette sign?
Definition
Present when normal line of demarcation between two structures is partially or completely obliterated
Term
How can you spot specific lung lesions on a chest radiograph?
Definition
Abnormal density areas
Term
Can you spot acute vs. chronic changes on a chest radiograph?
Definition
Yes
Term
This type of radiography is known as digital chest radiography and it involves a narrow beam of x-rays moving across fields of examination.
Definition
CT (Computed Tomography)
Term
This defines successive adjacent columns of tissue.
Definition
CT
Term
CT is primarily used for diagnosis of what?
Definition
Tumors vs. calcifications or nodules
Term
The gold standard for diagnosis of emboli?
Definition
Pulmonary Arteriography
Term
This test can read emboli as complete obstruction, intraluminal filling defects, or decrease in flow rate.
Definition
Pulmonary Arteriography
Term
Which is more popular? CT or Pulmonary Arteriography?
Definition
CT
Term
What are some disadvantages to pulmonary arteriography?
Definition
Invasive, increased morbidity/mortality, associated with complications, time consuming, expensive
Term
This test is more detailed and expensive than CT. It involves the interaction of stimulated hydrogen nuclei and strong magnetic field.
Definition
MRI
Term
This test is primarily indicated for evaluation of chest wall processes. May be indicated in individuals with an abnormal chest radiographs that shows a nodule or mass.
Definition
MRI
Term
What type of gas is used to measure regional distribution of ventilation in the lungs
Definition
Xenon
Term
This is where the pt inhales the gas and holds breath while ventilation scans are made over the lung field.
Definition
Ventilation and Perfusion Scans
Term
This is used to measure regional distribution of pulmonary blood flow in the lugns, patient is injected intravenously with radioactive iodine, then serial perfusion scans are made
Definition
Ventilation/Perfusion Scans
Term
V/Q scans are indicated to rule out what?
Definition
Pulmonary Emboli
Term
This permits the study of normal and variant anatomy and gross pathological changes int he bronchial wall and lumen.
Definition
Bronchography
Term
Fiberoptic bronchoscopy has decreased the need for what?
Definition
Contrast bronchography
Term
This test permits direct visualization of previously inaccessible areas of the bronchial tree. Indicated to assess for infection
Definition
Fiberoptic bonchoscopy
Term
Samples can be taken to see infection or cancer if necessary. May be used to clear viscous secretions. Provides information about integrity of airways, function of respiratory musculature, condition of lung tissues.
Definition
Fiberoptic Bronchoscopy
Term
This measurement tool tests lung volume and capacity by graphic tracing of breathing.
Definition
Spirogram
Term
An airtight chamber in which the patient sits in
Definition
Body Plethysmograph
Term
What is the equation for total lung capacity?
Definition
Vital Capacity + Residual Volume = TLC
Term
This value is increased in patients with emphysema
Definition
Residual Volume
Term
Name 8 Tests of Gas Flow Rates
Definition
1. Measure of airflow rates during forced breathing maneuvers
2. Provide info on actual function of lungs, degree of impairment, general location
3. FVC (forced vital capacity)
4. FEV1 (foced expiratory volume in 1 sec) - expressed in liters or as %
5. Forced midexpiratory flow (uncommon)
6. Forced expiratory flow, 200-1200
7. Maximum voluntary ventilation (MVV)
8. Peak expiratory flow (PEF)
Term
Name 5 tests of diffusion
Definition
1. Diffusing capacity of lung (DL) or diffusing capacity of lung for carbon monoxide (DLCO)
2. Amount of gas entering the pulmonary blood flow per unit of time
3. Relative to difference between partial pressures of gas in alveoli and pulmonary blood
4. Measure of integrity of function of the lung unit
5. Abnormal values attributed to 3 key factors (anemia, increased diffusion distance across alveolar capillary membrane, and decreased exchange area for oxygenation to happen)
Term
Name 3 additional tests of gas exchange
Definition
Tidal volume
Minute Ventilation (inspiration/expiration)
CO2 Output
Term
A method of graphically representing the events that occur during forced inspiration and expiration
Definition
Flow-Volume Loop
Term
Results of basic pulmonary function tests are presented in columns of __, __, __ of predicted values.
Definition
Predicted
Observed
Percentage
Term
Predicted values of basic pulmonary function tests are based on what 5 aspects?
Definition
Age
Gender
Height
Weight
Race
Term
Pulmonary function tests can determine whether results are normal, obstructive, or restrictive. If obstructive, determine its __
Definition
Reversibility
Term
What other 2 things should be considered along with pulmonary function tests?
Definition
History
Examination
Term
How might poor results not actually mean poor pulmonary function?
Definition
Poor patient effort
Term
These are crucial to the assessment of problems related to acid-base balance, ventilation, and oxygenation
Definition
Blood Gas Analysis
Term
The typical blood gas analysis report contains what 6 things?
Definition
Arterial pH
Partial pressures of CO2
Partial pressure of O2
Oxygen saturation
Bicarbonate concentration
Base Excess
Term
PaCO2 directly reflects adequacy of __ ventilation
Definition
Alveolar
Term
What are the values for hyperventilation?
Definition
PaCO2 <40 mmHg
Term
What are the values for Hypoventilation?
Definition
PaCO2 > 40 mmHg
Term
What are the values for ventilatory failure?
Definition
PaCO2 > 50 mmHg
Term
If your pt has a CO2 retainer, why can you not give them too much O2?
Definition
Because they are used to a lot of CO2 driving their breathing. Too much O2 will make their breathing worse
Term
Also used to determine the nature and severity of the illness with accuracy, the relationship of arterial pH and arterial CO2 tension is assessed.
Definition
Alveolar Ventilation
Term
Lungs and kidneys regulate 2 types of acids what are they?
Definition
Volatile and Nonvolatile
Term
Calculates the carbonic acid to bicarbonate ion relationship
Definition
Henderson-Hasselbalch Equation
Term
Permits a quick identification of 4 (metabolic, acidic, alkalosis, acidosis) primary disorders based on pH and CO2
Definition
Henderson-Hasselbalch Equation
Term
What is the normal human blood pH?
Definition
7.4
Term
pH < 7.4 is ___
- Low HCO3 leads to metabolic acidosis
- High PaCO2 (alveolar hypoventilation, hypercapnia)
Definition
Acidemia
Term
Assessment of blood pH - Nature of magnitude of __ and __ disorders
Definition
Respiratory
Metabolic
Term
pH > 7.4 is ___
- High HCO3
- Low PaCO2 (alveolar hypoventilation, hypocapnia)
Definition
Alkalemia
Term
Reflects concentration of bicarbonate in body
Definition
Base Excess (BE)
Term
What are normal PaO2 values?
Definition
80-100 mmHg
Term
What values of PaO2 would mean hypoxemia?
Definition
<80 mmHg
Term
Assess ventilatory status and oxygenation and hypoxemic status
Definition
Arterial blood gases
Term
Name 3 S&S of PE
Definition
Diaphoresis
Chest Pain
Difficulty Breathing
Term
__ status of a pt is assessed by determining the extent to which the observed PaO2 is above or below normal range.
Definition
Oxygenation
Term
PaO2 = ___mmHg (mildly hypoxemic)
Definition
60-80
Term
PaO2 = ____mmHg - moderately hypoxemic
Definition
40-60
Term
PaO2 = ____mmHg - severly hypoxemic
Definition
Less than 40
Term
Arterial blood gases are __ dependent. In acute care they are used to assess current situations.
Definition
Time
Term
Why might ABGs be repeated?
Definition
If ventilator modes or support change
Term
Venous blood gases can provide status of __ and __
Definition
pH and PaCO2
Term
Measurement of oxyhemoglobin saturation
Definition
Oximetry
Term
A popular tool for quick and accurate measurements
Definition
Pulse oximeter
Term
Name 4 problems with pulse oximetry.
Definition
1. Raynaud's
2. Vasospasms in fingers
3. Quality of pulse oximeter
4. Really cold fingers
Term
What does an oximeter measure?
Definition
O2 Hb %
Term
__ tests aid in the assessment of cardiopulmonary dz
Definition
Hemotological
Term
Name 4 typical tests included under hemotological tests.
Definition
ABGs
Electrolyte analysis
Complete blood cell counts
Coagulation Studies
Term
Low hemoglobin, low RBC, or hematocrit
Definition
Anemia
Term
Increase in hemoglobin, RBC, or hematocrit
Definition
Polycythemia
Term
Increased WBC
Definition
Leukocytosis
Term
Decreased WBC
Definition
Leukopenia
Term
Hematological tests are used in the identification of __ __ organisms and in monitoring body's responses.
Definition
Disease-causing
Term
Used to identify specific microorganisms that may cause dz
Definition
Cytological tests
Term
With cytological and hematological tests, what do the results depend on?
Definition
isolation
Term
Specimens are most often obtained by what?
Definition
Expectoration-sputum
Term
Evaluation of blood's tendency to clot (4)
Definition
Bleeding Time
Platelet Count
Partial Thromboplastin Time (PTT)
Prothrombin Time (PT)
Term
Bleeding time measures rate of formation of platelet thrombus - normal time is up to __ minutes.
Definition
6
Term
PTT - Normal =
Definition
32-70 seconds
Term
PT - normal =
Definition
12-15 seconds
Term
What are the 6 steps to ABG analysis?
Definition
1. Is pH normal?
2. Is CO2 normal?
3. Is HCO3 normal?
4. Match CO2 or the HCO3 with the pH
5. Does the CO2 or the HCO3 go the opposite direction of the pH?
6. Are the pO2 and the O2 saturation normal?
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