PCCN REVIEW - PULMONARY EXAM QUESTIONS
AND ANSWERS
Your patient had an exacerbation of COPD.
xc ̣ The rapid response team was alled and is urr
xc xc xc xc xc xc xc xc xc xc xc xc xc xc
ently intubating the patient and preparing him f ̣or transf ̣er to ICU. When the f ̣amily visits, the
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
y are shocked to see the people working with the patient. No one had told them the patient h
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
ad deteriorated and required intubation. Af ̣ter the patient is intubated and is being wheeled
xc xc xc xc xc xc xc xc xc xc xc xc xc xc
past them, f ̣amily members try to ommunicate verbally with the patient, but he does not res
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
pond except to gesture. The nurse should tell the f ̣amily members:
xc xc xc xc xc xc xc xc xc xc
-They must leave the area because they are exciting the patient.
xc xc xc xc xc xc xc xc xc xc
-The tube used f ̣or breathing prevents the patient f ̣rom speaking
xc xc xc xc xc xc xc xc xc
-They must speak with the doctor, who will explain why the patient annot speak-
xc xc xc xc xc xc xc xc xc xc xc xc xc
The patient is very ill and may die. - ans-
xc xc xc xc xc xc xc xc xc
The tube used f ̣or breathing prevents the patient f ̣rom speaking
xc xc xc xc xc xc xc xc xc
This is a ase where ommunication is learly the problem. The f ̣amily should have been inf ̣
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
ormed by someone that the patient needed assistance with breathing and that they should
xc xc xc xc xc xc xc xc xc xc xc xc xc xc
expect a transf ̣er. It should also have been mentioned how the patient might look in the ICU.
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc x
In addition, it ould have been ommunicated about the patient's inability to speak.
c xc xc xc xc xc xc xc xc xc xc xc xc
The other answers are all non-
xc xc xc xc xc
theraputic responses. The f ̣amily is learly distressed, so a simple explaination in best.
xc xc xc xc xc xc xc xc xc xc xc xc
Ben was just transf ̣erred to the PCU. He had been in ICU f ̣or 2 weeks. Ben was intubated f ̣or
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc x
a time because of his
c xc ̣ ARDs. On arrival to your unit, you note that he is tachycardic and restl
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
ess. Ben states, "I an't be here now. What if something
xc ̣ like this happens to me again?" The
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
nurse's best response would be:
xc xc xc xc xc
-The nurses in our unit an take are of you
xc ̣ xc xc xc xc xc xc xc xc
-We are not very f ̣ar away at the nurses' station-
xc xc xc xc xc xc xc xc xc
Your insurance will not over another day there-
xc xc xc xc xc xc xc
You sound oncerned about leaving the ICU - ans-
xc xc xc xc xc xc xc xc
You sound oncerned about leaving the ICU
xc xc xc xc xc xc
Theraputic ommunication occurs when the patient's f ̣eelings are validated. This response
xc xc xc xc xc xc xc xc xc xc xc
allows f ̣or the patient to express the oncerns he has about the transf ̣er. The other answers
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
are losed and judgmental and do not allow f ̣or any expression of f̣ ̣eeling f ̣rom the patient.
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
Ben was just transf ̣erred to the PCU. He had been in ICU f ̣or 2 weeks. Ben was intubated f ̣or
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc x
a time because of his
c xc ̣ ARDs. On arrival to your unit, you note that he is tachycardic and restl
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
ess. A set of blood
̣ gases drawn just prior to his transf ̣er show:
xc xc xc xc xc xc xc xc xc xc xc xc
,pH 7.52, PaCO2 31, HCO3 22, PaO2 87.
xc xc xc xc xc xc xc
These results would indicate: xc xc xc
-Respiratory acidosis xc
-Respiratory alkalosis xc
-Metabloic acidosis xc
-Metabolic alkalosis - ans-Respiratory alkalosis xc xc xc xc
Ben was quite anxious and tachycardic. His RR probably was increased because of both
xc xc ̣ xc xc xc xc xc xc xc xc xc xc xc xc
a nxiety and his ondition. xc xc xc xc
He would blow of ̣f CO2.
xc ̣ xc xc xc xc
His pH is below normal, so it is uncompensated.
xc xc xc xc xc xc xc xc
The HCO3 is low, indicating alkalosis
xc xc xc xc xc
The interpretation would be:
xc xc xc
Uncompensated Respiratory Alkolosis
xc xc xc
Ben was just transf ̣erred to the PCU. He had been in ICU f ̣or 2 weeks. Ben was intubated f ̣or
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc x
a time because of his
c xc ̣ ARDs. On arrival to your unit, you note that he is tachycardic and restl
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
ess. Ben is f ̣inally released f ̣rom the hospital. He plans to visit his f ̣amily in Denver. Part of th
xc xc xc ̣ xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
e patient teaching f ̣or Ben should include inf ̣ormation on the ef ̣f ̣ects of high
xc xc ̣ altitude on his ab xc xc xc xc xc xc xc xc xc xc xc xc xc xc
ility to oxygenate ef ̣f ̣ectively. Which of the
xc xc ̣ f ̣ollowing hanges would be expected on his bloo xc xc xc xc xc xc xc xc xc xc xc xc
d gas results?
xc xc
-The pH would decrease xc xc xc
-No ef ̣f ̣ect xc
-The O2 saturation would decreasexc xc xc xc
-The PaO2 would increase - ans-The O2 saturation would decrease
xc xc xc xc xc xc xc xc xc
At higher altitudes, there is decreased atmospheric pressure to f ̣orce oxygen into the lungs.
xc xc xc xc xc xc xc xc xc xc xc xc xc x
To ompensate f ̣or the lower pressure, the person must breathe f ̣aster. The percentage of ̣
c xc xc xc xc xc xc xc xc xc xc xc xc xc xc
oxygen remains the same, but the partial pressure of the
̣xc oxygen decreases. Aterial PaO2 d xc xc xc xc xc xc xc xc xc xc xc xc xc
ecreases, as does O2 saturation. The rapid breathing will result in hyperventillation, raising
xc xc xc xc xc xc xc xc xc xc xc xc xc
the pH and lowering the PaCO2 level.
xc xc xc xc xc xc
SaO2 values account f ̣or what % of O2
̣ arreid within the bloodstream?
xc xc xc xc xc xc xc xc xc xc xc
-2-3%
-10-24%
-97-98%
-100% - ans-97-98% xc xc
The % of total
̣ oxygen arried within the bloodstream attributed to the SaO2 is 97-98%.
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
,SaO2 is the arterial saturation of hemoglobin.
̣ xc The % orresponds to the % of hemoglobin
xc ̣ xc o xc xc xc xc xc xc xc xc xc xc xc xc
n the red blood ells that arries O2. Typically this % is documented as normal when within
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
93-99%. xc
PaO2 is the % of O2
̣ within the bloodstream that is f ̣ree or dissolved in the plasma. This valu
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
e is documented in mmHg and is onsidered normal when within the range of 80-
xc xc ̣ xc xc xc xc xc xc xc xc xc xc xc xc
100 mmHg. xc
Hypoxemia is best def ̣ined as: xc xc xc xc
-A decrease in O2 at the ellular level
xc xc xc xc xc xc xc
-A decrease in O2 levels in arterial blood
xc xc xc xc xc xc xc
-A decrease in O2 levels in venous blood
xc xc xc xc xc xc xc
-A decrease in O2 levels f ̣rom the brain - ans-A decrease in O2 levels in arterial blood
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
Hypoxemia is a decrease in O2 levels in arterial blood or PaO2 < 80 mmHg. xc xc xc xc xc xc xc xc xc xc xc xc xc xc
Hypoxia is def ̣ined as a decreased oxygen level at the ellular level.
xc xc xc xc xc xc xc xc xc xc xc
Decreased O2 levels within veins ref ̣er to PaO2 < 50mmHg xc xc xc xc xc xc xc xc xc
Decreased O2 levels within the brain ref ̣er to ScVO2 < 20 xc xc xc xc xc xc xc xc xc xc
Your patient has been diagnosed with pulmonary HTN. Which of the
xc ̣ f ̣ollowing ompensato
xc xc xc xc xc xc xc xc xc xc xc
ry mechanisms would be expected if the
xc ̣ patient suf ̣f ̣ered f ̣rom hronic hypoxia? xc xc xc xc xc xc xc xc xc xc
-Polycythemia
-Hypoplasia of the
̣ pulmonary vasculature xc xc xc xc
-Thinning of blood
̣ vessels in the lungs xc xc xc xc xc xc
-Cor pulmonale - ans-Polycythemia
xc xc xc
Ef ̣f ̣ects of acute
̣ hypoxia are reversible. xc xc xc xc xc
Chronic hypoxia auses permanent hanges in the lungs and pulmonary vasculature (hype
xc xc xc xc xc xc xc xc xc xc xc
rplasia and hypertrophy). This will ause thickening of the
xc ̣ blood vessels and will narrow the
xc xc xc xc xc xc xc xc xc xc xc xc xc xc
lumen. xc
Polycythemia develops and the blood viscosity increases. The increased number of ells ̣ w xc xc xc xc xc xc xc xc xc xc xc xc
ill be available to arry O2 but the increased viscosity will increase pressure in the pulmonar
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
y vasculature and f ̣orce the right ventricle to pump harder to maintain the CO level. The right
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
venticle will hypertrophy and eventually weaken, and the patient will develop right heart f ̣ail
xc xc xc xc xc xc xc xc xc xc xc xc xc xc
ure (cor pulmonale).
xc xc
Type II alveolar ells produce: xc xc xc xc
-Macrocytes
-Phagocytes
-Surf ̣actant
-CO2 - ans-Surf ̣actant xc xc
Surf ̣actant is a lipoprotein that f ̣unctions by increasing surf ̣ace tension of alveoli
xc ̣ and allow al
xc xc xc xc xc xc xc xc xc xc xc xc xc
veoli to expand and ontract. Some residual pressure should be present in the alveoli at the
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
, end of respiration
̣ to keep the alveoli open (physiologic PEEP). If surf
xc xc ̣ ̣actant production is im xc xc xc xc xc xc xc xc xc xc xc xc
paired, the alveoli's ability to exchange O2 is ompromised.
xc xc xc xc xc xc xc xc
Type I ells line the outside of the
̣xc alveoli.
xc xc xc xc xc xc xc
If you
̣xc hear f ̣aint breath sounds on the lef ̣t side of the
xc ̣ hest and normal sounds on the right si
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
de immediately af ̣ter your patient is intubated, most likely:
xc xc xc xc xc xc xc xc
-The patient has a tumor xc xc xc xc
-The doctor has intubated the esophagus
xc xc xc xc xc
-The ET is at the arina xc xc xc xc xc
-The right mainstem has been intubated - ans-The right mainstem has been intubated
xc xc xc xc xc xc xc xc xc xc xc xc
The right mainstem bronchus is somewhat wider and has less of an
xc ̣ angle of ̣f the
xc ̣ mainstem xc xc xc xc xc xc xc xc xc xc xc xc xc xc
bronchus, so it is much more readily intubated. xc xc xc xc xc xc xc
John is a 32 year old engineer that has been on hemodialysis f ̣or 3 years. He missed his last
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc x
2 treatments. He is lethargic, lacks stamina, and is very edematous. His ABGs show: pH 7.
c xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
30, PaCO2 32, HCO3 17, PaO2, 90.
xc xc xc xc xc xc
John's results indicate: xc xc
-Metabolic alkalosis xc
-Respiratory acidosis xc
-Metabolic acidosis xc
-Respiratory alkalosis - ans-Metabolic acidosis xc xc xc xc
More specif ̣ically, this ABG indicates an
xc xc xc xc xc xc
Uncompensated Metabolic Acidosis. xc xc xc
The pH is low, as is the PaCO2.
xc xc xc xc xc xc xc
You ask a f ̣ellow nurse to arry a newly drawn ABG specimen to the lab. She does not plave
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
the sample on ice. What ef ̣f ̣ect will the lack of icing
xc ̣ have on the sample: xc xc xc xc xc xc xc xc xc xc xc xc xc
-None
-It will invalidate the sample
xc xc xc xc
-The pH will rise xc xc xc
-The PaCO2 will rise - ans-It will invalidate the sample
xc xc xc xc xc xc xc xc xc
The PaCO2 will rise approximately 3-10 mmHg per hour.
xc xc xc xc xc xc xc xc
The PaO2 and the pH will decrease.
xc xc xc xc xc xc
Your patient must have an ABG. The respiratory therapist says he is out of prepared
xc ̣ syrin xc xc xc xc xc xc xc xc xc xc xc xc xc xc
g
es, so he obtains a syringe into which he places heparin. What ef ̣f ̣ect will too much heparin
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
have on the sample, if any?
̣ xc xc xc xc xc
AND ANSWERS
Your patient had an exacerbation of COPD.
xc ̣ The rapid response team was alled and is urr
xc xc xc xc xc xc xc xc xc xc xc xc xc xc
ently intubating the patient and preparing him f ̣or transf ̣er to ICU. When the f ̣amily visits, the
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
y are shocked to see the people working with the patient. No one had told them the patient h
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
ad deteriorated and required intubation. Af ̣ter the patient is intubated and is being wheeled
xc xc xc xc xc xc xc xc xc xc xc xc xc xc
past them, f ̣amily members try to ommunicate verbally with the patient, but he does not res
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
pond except to gesture. The nurse should tell the f ̣amily members:
xc xc xc xc xc xc xc xc xc xc
-They must leave the area because they are exciting the patient.
xc xc xc xc xc xc xc xc xc xc
-The tube used f ̣or breathing prevents the patient f ̣rom speaking
xc xc xc xc xc xc xc xc xc
-They must speak with the doctor, who will explain why the patient annot speak-
xc xc xc xc xc xc xc xc xc xc xc xc xc
The patient is very ill and may die. - ans-
xc xc xc xc xc xc xc xc xc
The tube used f ̣or breathing prevents the patient f ̣rom speaking
xc xc xc xc xc xc xc xc xc
This is a ase where ommunication is learly the problem. The f ̣amily should have been inf ̣
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
ormed by someone that the patient needed assistance with breathing and that they should
xc xc xc xc xc xc xc xc xc xc xc xc xc xc
expect a transf ̣er. It should also have been mentioned how the patient might look in the ICU.
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc x
In addition, it ould have been ommunicated about the patient's inability to speak.
c xc xc xc xc xc xc xc xc xc xc xc xc
The other answers are all non-
xc xc xc xc xc
theraputic responses. The f ̣amily is learly distressed, so a simple explaination in best.
xc xc xc xc xc xc xc xc xc xc xc xc
Ben was just transf ̣erred to the PCU. He had been in ICU f ̣or 2 weeks. Ben was intubated f ̣or
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc x
a time because of his
c xc ̣ ARDs. On arrival to your unit, you note that he is tachycardic and restl
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
ess. Ben states, "I an't be here now. What if something
xc ̣ like this happens to me again?" The
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
nurse's best response would be:
xc xc xc xc xc
-The nurses in our unit an take are of you
xc ̣ xc xc xc xc xc xc xc xc
-We are not very f ̣ar away at the nurses' station-
xc xc xc xc xc xc xc xc xc
Your insurance will not over another day there-
xc xc xc xc xc xc xc
You sound oncerned about leaving the ICU - ans-
xc xc xc xc xc xc xc xc
You sound oncerned about leaving the ICU
xc xc xc xc xc xc
Theraputic ommunication occurs when the patient's f ̣eelings are validated. This response
xc xc xc xc xc xc xc xc xc xc xc
allows f ̣or the patient to express the oncerns he has about the transf ̣er. The other answers
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
are losed and judgmental and do not allow f ̣or any expression of f̣ ̣eeling f ̣rom the patient.
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
Ben was just transf ̣erred to the PCU. He had been in ICU f ̣or 2 weeks. Ben was intubated f ̣or
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc x
a time because of his
c xc ̣ ARDs. On arrival to your unit, you note that he is tachycardic and restl
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
ess. A set of blood
̣ gases drawn just prior to his transf ̣er show:
xc xc xc xc xc xc xc xc xc xc xc xc
,pH 7.52, PaCO2 31, HCO3 22, PaO2 87.
xc xc xc xc xc xc xc
These results would indicate: xc xc xc
-Respiratory acidosis xc
-Respiratory alkalosis xc
-Metabloic acidosis xc
-Metabolic alkalosis - ans-Respiratory alkalosis xc xc xc xc
Ben was quite anxious and tachycardic. His RR probably was increased because of both
xc xc ̣ xc xc xc xc xc xc xc xc xc xc xc xc
a nxiety and his ondition. xc xc xc xc
He would blow of ̣f CO2.
xc ̣ xc xc xc xc
His pH is below normal, so it is uncompensated.
xc xc xc xc xc xc xc xc
The HCO3 is low, indicating alkalosis
xc xc xc xc xc
The interpretation would be:
xc xc xc
Uncompensated Respiratory Alkolosis
xc xc xc
Ben was just transf ̣erred to the PCU. He had been in ICU f ̣or 2 weeks. Ben was intubated f ̣or
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc x
a time because of his
c xc ̣ ARDs. On arrival to your unit, you note that he is tachycardic and restl
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
ess. Ben is f ̣inally released f ̣rom the hospital. He plans to visit his f ̣amily in Denver. Part of th
xc xc xc ̣ xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
e patient teaching f ̣or Ben should include inf ̣ormation on the ef ̣f ̣ects of high
xc xc ̣ altitude on his ab xc xc xc xc xc xc xc xc xc xc xc xc xc xc
ility to oxygenate ef ̣f ̣ectively. Which of the
xc xc ̣ f ̣ollowing hanges would be expected on his bloo xc xc xc xc xc xc xc xc xc xc xc xc
d gas results?
xc xc
-The pH would decrease xc xc xc
-No ef ̣f ̣ect xc
-The O2 saturation would decreasexc xc xc xc
-The PaO2 would increase - ans-The O2 saturation would decrease
xc xc xc xc xc xc xc xc xc
At higher altitudes, there is decreased atmospheric pressure to f ̣orce oxygen into the lungs.
xc xc xc xc xc xc xc xc xc xc xc xc xc x
To ompensate f ̣or the lower pressure, the person must breathe f ̣aster. The percentage of ̣
c xc xc xc xc xc xc xc xc xc xc xc xc xc xc
oxygen remains the same, but the partial pressure of the
̣xc oxygen decreases. Aterial PaO2 d xc xc xc xc xc xc xc xc xc xc xc xc xc
ecreases, as does O2 saturation. The rapid breathing will result in hyperventillation, raising
xc xc xc xc xc xc xc xc xc xc xc xc xc
the pH and lowering the PaCO2 level.
xc xc xc xc xc xc
SaO2 values account f ̣or what % of O2
̣ arreid within the bloodstream?
xc xc xc xc xc xc xc xc xc xc xc
-2-3%
-10-24%
-97-98%
-100% - ans-97-98% xc xc
The % of total
̣ oxygen arried within the bloodstream attributed to the SaO2 is 97-98%.
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
,SaO2 is the arterial saturation of hemoglobin.
̣ xc The % orresponds to the % of hemoglobin
xc ̣ xc o xc xc xc xc xc xc xc xc xc xc xc xc
n the red blood ells that arries O2. Typically this % is documented as normal when within
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
93-99%. xc
PaO2 is the % of O2
̣ within the bloodstream that is f ̣ree or dissolved in the plasma. This valu
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
e is documented in mmHg and is onsidered normal when within the range of 80-
xc xc ̣ xc xc xc xc xc xc xc xc xc xc xc xc
100 mmHg. xc
Hypoxemia is best def ̣ined as: xc xc xc xc
-A decrease in O2 at the ellular level
xc xc xc xc xc xc xc
-A decrease in O2 levels in arterial blood
xc xc xc xc xc xc xc
-A decrease in O2 levels in venous blood
xc xc xc xc xc xc xc
-A decrease in O2 levels f ̣rom the brain - ans-A decrease in O2 levels in arterial blood
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
Hypoxemia is a decrease in O2 levels in arterial blood or PaO2 < 80 mmHg. xc xc xc xc xc xc xc xc xc xc xc xc xc xc
Hypoxia is def ̣ined as a decreased oxygen level at the ellular level.
xc xc xc xc xc xc xc xc xc xc xc
Decreased O2 levels within veins ref ̣er to PaO2 < 50mmHg xc xc xc xc xc xc xc xc xc
Decreased O2 levels within the brain ref ̣er to ScVO2 < 20 xc xc xc xc xc xc xc xc xc xc
Your patient has been diagnosed with pulmonary HTN. Which of the
xc ̣ f ̣ollowing ompensato
xc xc xc xc xc xc xc xc xc xc xc
ry mechanisms would be expected if the
xc ̣ patient suf ̣f ̣ered f ̣rom hronic hypoxia? xc xc xc xc xc xc xc xc xc xc
-Polycythemia
-Hypoplasia of the
̣ pulmonary vasculature xc xc xc xc
-Thinning of blood
̣ vessels in the lungs xc xc xc xc xc xc
-Cor pulmonale - ans-Polycythemia
xc xc xc
Ef ̣f ̣ects of acute
̣ hypoxia are reversible. xc xc xc xc xc
Chronic hypoxia auses permanent hanges in the lungs and pulmonary vasculature (hype
xc xc xc xc xc xc xc xc xc xc xc
rplasia and hypertrophy). This will ause thickening of the
xc ̣ blood vessels and will narrow the
xc xc xc xc xc xc xc xc xc xc xc xc xc xc
lumen. xc
Polycythemia develops and the blood viscosity increases. The increased number of ells ̣ w xc xc xc xc xc xc xc xc xc xc xc xc
ill be available to arry O2 but the increased viscosity will increase pressure in the pulmonar
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
y vasculature and f ̣orce the right ventricle to pump harder to maintain the CO level. The right
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
venticle will hypertrophy and eventually weaken, and the patient will develop right heart f ̣ail
xc xc xc xc xc xc xc xc xc xc xc xc xc xc
ure (cor pulmonale).
xc xc
Type II alveolar ells produce: xc xc xc xc
-Macrocytes
-Phagocytes
-Surf ̣actant
-CO2 - ans-Surf ̣actant xc xc
Surf ̣actant is a lipoprotein that f ̣unctions by increasing surf ̣ace tension of alveoli
xc ̣ and allow al
xc xc xc xc xc xc xc xc xc xc xc xc xc
veoli to expand and ontract. Some residual pressure should be present in the alveoli at the
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
, end of respiration
̣ to keep the alveoli open (physiologic PEEP). If surf
xc xc ̣ ̣actant production is im xc xc xc xc xc xc xc xc xc xc xc xc
paired, the alveoli's ability to exchange O2 is ompromised.
xc xc xc xc xc xc xc xc
Type I ells line the outside of the
̣xc alveoli.
xc xc xc xc xc xc xc
If you
̣xc hear f ̣aint breath sounds on the lef ̣t side of the
xc ̣ hest and normal sounds on the right si
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
de immediately af ̣ter your patient is intubated, most likely:
xc xc xc xc xc xc xc xc
-The patient has a tumor xc xc xc xc
-The doctor has intubated the esophagus
xc xc xc xc xc
-The ET is at the arina xc xc xc xc xc
-The right mainstem has been intubated - ans-The right mainstem has been intubated
xc xc xc xc xc xc xc xc xc xc xc xc
The right mainstem bronchus is somewhat wider and has less of an
xc ̣ angle of ̣f the
xc ̣ mainstem xc xc xc xc xc xc xc xc xc xc xc xc xc xc
bronchus, so it is much more readily intubated. xc xc xc xc xc xc xc
John is a 32 year old engineer that has been on hemodialysis f ̣or 3 years. He missed his last
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc x
2 treatments. He is lethargic, lacks stamina, and is very edematous. His ABGs show: pH 7.
c xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
30, PaCO2 32, HCO3 17, PaO2, 90.
xc xc xc xc xc xc
John's results indicate: xc xc
-Metabolic alkalosis xc
-Respiratory acidosis xc
-Metabolic acidosis xc
-Respiratory alkalosis - ans-Metabolic acidosis xc xc xc xc
More specif ̣ically, this ABG indicates an
xc xc xc xc xc xc
Uncompensated Metabolic Acidosis. xc xc xc
The pH is low, as is the PaCO2.
xc xc xc xc xc xc xc
You ask a f ̣ellow nurse to arry a newly drawn ABG specimen to the lab. She does not plave
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
the sample on ice. What ef ̣f ̣ect will the lack of icing
xc ̣ have on the sample: xc xc xc xc xc xc xc xc xc xc xc xc xc
-None
-It will invalidate the sample
xc xc xc xc
-The pH will rise xc xc xc
-The PaCO2 will rise - ans-It will invalidate the sample
xc xc xc xc xc xc xc xc xc
The PaCO2 will rise approximately 3-10 mmHg per hour.
xc xc xc xc xc xc xc xc
The PaO2 and the pH will decrease.
xc xc xc xc xc xc
Your patient must have an ABG. The respiratory therapist says he is out of prepared
xc ̣ syrin xc xc xc xc xc xc xc xc xc xc xc xc xc xc
g
es, so he obtains a syringe into which he places heparin. What ef ̣f ̣ect will too much heparin
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
have on the sample, if any?
̣ xc xc xc xc xc
