Functional Level Assessment PDF

Functional level assesment presented by : DR.Eman Rashad lecturer at Horus University in Egypt PHD, M.sc, CMP,CMTP,CSMT,KCMT,CLT  Functional level Assessment LUNG VOLUME ARTERIAL BLOOD PULSE AND CAPACITIES. GASES. OXIMETERY. Functional level Ass...

Functional level assesment presented by : DR.Eman Rashad lecturer at Horus University in Egypt PHD, M.sc, CMP,CMTP,CSMT,KCMT,CLT  Functional level Assessment LUNG VOLUME ARTERIAL BLOOD PULSE AND CAPACITIES. GASES. OXIMETERY. Functional level Assessment ❖Lung volume and capacities. ❖Arterial blood gases. ❖Pulse oximetery. Pulmonary function testS  Pulmonary function tests ❑noninvasive tests that show how well the lungs are working. The tests measure lung volume, capacity. This information can help your healthcare provider diagnose and decide the treatment of certain lung  A. Lung volume and capacities: Lung volumes and capacities are related to person’s age , weight , sex and body position and are altered by disease Two or more lung volumes , when combined are described as a capacity. A basic understanding of these measurements and what the values reflect is useful for a therapist treating patients with pulmonary dysfunction. A. Lung volume and capacities: (con.) Respiratory volumes –static TV: The amount of air that moves in and out of the lungs during inspiration and expiration with quiet breathing , it is about 500 ml. inspiratory reserve volume (IRV ):The air inspired with maximal inspiratory effort( by forced inspiration) in excess of the tidal volume, it is about 3000 ml. The expiratory reserve volume (ERV): is the additional air that can be forcibly exhaled after the expiration of a normal tidal volume it is about 1000 ml. residual volume (RV): is the volume of air remaining in the lungs after maximal exhalation , it is about 1500 ml. The inspiratory capacity (IC): is the maximal amount of air that can be inspired after resting expiration (IRV + TV), it is about 3500 ml. The functional residual capacity (FRC): represents the volume of air remaining in the lungs after quite expiration (ERV + RV), it is about 2500 ml. The vital capacity (VC) is the maximum volume exhaled after maximum inhalation (IRV + TV + ERV), it is about 4500 ml. The total lung capacity (TLC), about 6 L, is the maximum amount of air that can fill the lungs (IRV + TV + ERV + RV), it is about 6000 ml. spirometry NEVER measures : RV FRC TLC RV : increases in emphysema decreases in collapse Spirometer measurements of lung function: dynamic lung volumes: Forced vital capacity (FVC) the amount of air a person can forcefully expired (as fast as possible) after maximum inspiration Forced expiratory volume (FEV1), the amount of air a person can blow out of their lungs in the first one second  Obstructive lung diseases When the airways are narrowed (obstructed), the amount of air you can blow out quickly in one second (FEV1) is less than would be expected, obstructive lung diseases cause the lungs to take in too much air and take too long to empty. Since your FEV1, in this case, is low, the ratio of FEV1/FVC will be lower than average.  Restrictive lung diseases A restrictive pattern will be indicated by a low FVC, but a normal ratio of FEV1 to FVC (meaning both numbers are proportionately decreased).  Obstructive Restrictive FVC FEV1 FEV1 / FVC 80% Normal or 80% VC TLC FRC  Arterial blood gases Arterial blood gases test (ABG's) is a blood test which is used to give an indication of ventilation, gas exchange and acid-base status and the sample is taken from an arterial blood supply and analyzed in an ABG analyzer. The line in is usually inserted in the radial artery located at the wrist but can also be used in the femoral artery in the groin. Is to assess patient type1 (hypoxemia) pao2 ↓ with normal or low co2 or type 2 (hypercapnia) respitatory failure paco2 ↑  ABG Definitions PH: The measure of acidity or alkalinity of the blood  PH= - Log H⁺ so it is inversely proportional to the number of hydrogen ions in the blood. PaC02: Partial pressure of Carbon dioxide in the arterial blood, the acidic element of the balance  Acidic component  Indicator of respiratory function  Changes are rapidly to be compensated HCO3-: Bicarbonate ion concentration in the blood, the basic element of the balance Basic/Alkaline component Indicator of metabolic function Compensation is slower BE: Base Excess = quantity of strong acid or base that is required to restore pH to normal Pa02: Partial pressure of oxygen in the arterial blood. is a measurement of oxygen pressure in arterial blood. It reflects how well oxygen is able to move from the lungs to the blood, and it is often altered by severe illnesses It also reflects the amount of oxygen gas dissolved in the blood. It primarily measures the effectiveness of the lungs in pulling oxygen into the blood stream from the atmosphere. Elevated pO2 levels are associated with: Increased oxygen levels in the inhaled air Normal range is 80 -100 mmHg , low levels reveals the requirement for supplemental oxygen. A low PaO2 indicates abnormal oxygenation of blood and a person is known as having hypoxemia. (Note that a low PaO2 is not required for the person to have hypoxia as in cases of Ischemia, a lack of oxygen in tissues or organs as opposed to arterial blood.) At a PaO2 of less than 60 mm Hg, supplemental oxygen should be administered.  pO2 in venous blood is lower than arterial blood due to oxygen extraction by peripheral tissues. Hyperoxia or Oxygen toxicity is lung damage that happens from breathing in too much extra (supplemental) oxygen. It‘s also called oxygen poisoning. It can cause coughing and trouble breathing , reduce neurotransmission and suppress neural sensitivity to sensory stimulus and In severe cases it can even cause death.  Respiratory Acidosis Respiratory acidosis is caused by inadequate alveolar ventilation (hypoventilation) leading to the retention of carbon dioxide. Decreased pH Increased PaCO2 Causes CNS depression related to head injury CNS depression related medications such as narcotics, sedatives or anesthesia Hypoventilation due to pain, chest wall injury or abdominal distension Impaired respiratory muscle function related to spinal cord injury, neuromuscular diseases or neuromuscular blocking drugs Symptoms Headache, Anxiety, Blurred vision, Restlessness, Drowsiness, Tremors, Delirium, Coma  Metabolic Acidosis loss of HCO3.It occurs when the body produces excess quantities of acid or the kidneys are not removing sufficient acid from the body. Decreased pH Decreased HCO3 Causes Renal disease, Liver disease, Lactic acidosis, Prolonged lack of oxygen( tissue hypoxia), Medications, Dehydration, Diarrhea, starvation and diabetic ketoacidosis Symptoms Rapid breathing, Confusion, Tachycardia and arrhythmia  Respiratory Alkalosis Respiratory alkalosis is caused by over excretion of carbon dioxide (hyperventilation) resulting in more CO2 than normal being exhaled Increased pH Decreased PaCO2 Causes: Psychological responses such as anxiety or fear Increased metabolic demands such as fever, pregnancy, sepsis, thyrotoxicosis Symptoms Diziness, Peripheral paraesthesia, Confusion Dry mouth, Bloating  Metabolic Alkalosis a direct result of increased bicarbonate concentrations. Increased pH Increased HCO3 Causes: Excess of base (excess use of antacids, excess use of bicarbonate) Excess loss of acids that can occur from excessive Vomitting, diuretic therapy, gastric suction or high levels of aldosterone Symptoms Weakness, Polyuria, Cardiac arrhythmias Key concepts: The only 2 ways an acidotic state can exist is from either too much pco2 or too little HCO3 The only 2 ways an alkalotic state can exist is from either too little PCO2 or too much HCO3 Problem (1) An arterial blood gas test was performed and revealed: pH 7.25, PCO2 60, PO2 65, HCO3 – 25. interprete Solution: The patient has a low pH (acidemia) The PCO2 is high (respiratory acidosis) and the bicarbonate is normal. Interpretation: respiratory acidosis (acute) Problem (2) An arterial blood gas was performed and revealed: pH 7.32, PCO2 57, PO2 70, HCO3 – 32 solution The patient has a low pH (acidemia) The PCO2 is high ( respiratory acidosis) the bicarbonate is high ( metabolic alkalosis). The low pH in combination with the high PCO2 tells us that the respiratory acidosis is the primary process and The metabolic alkalosis is the compensatory process. interpretation: respiratory acidosis partialy compensated by metabolic alkalosis Problem (3) an arterial blood gas revealed: pH 7.43, PCO2 49, PO2 68, HCO3 - 34.. Solution: The patient has a normal pH (full compensation) The PCO2 is high ( respiratory acidosis) the bicarbonate is high (metabolic alkalosis). As the pH is within normal so we apply its normal value as (7.4), any value more than it is considered as alkalosis and if less it will be considered as acidosis So PH 7.43 will be considered alkalosis The high pH and the high bicarbonate tell us that the metabolic alkalosis is the primary process and The respiratory acidosis is the compensatory process interpretation: metabolic alkalosis with full compensated by respiratory acidosis Problem (4) an arterial blood gas revealed: pH 7.32, PCO2 49, PO2 68, HCO3 - 13. Solution: The patient has ph less than 7.35 so acidosis The PCO2 is high ( respiratory acidosis) the bicarbonate is low ( metabolic acidosis). interpretation: MIXED respiratory and metabolic acidosis  Pulse oximeter It measures Oxygen saturation level (Spo2) is the fraction of oxygen-saturated hemoglobin relative to total hemoglobin (unsaturated + saturated) in the blood. Normal arterial blood oxygen saturation levels in humans are 95–100 percent. If the level is below 90 percent, it is considered low and called hypoxemia Arterial blood oxygen levels below 80 percent may compromise organ function, such as the brain and heart, and should be promptly addressed. Continued low oxygen levels may lead to respiratory or cardiac arrest. Oxygen therapy may be used to assist in raising blood oxygen levels. At low partial pressures of oxygen, most hemoglobin is deoxygenated  Pulse Oximetry a noninvasive method for monitoring a person's oxygen saturation (SO2). Though its reading of peripheral oxygen saturation (SpO2) is not always identical to the more desirable reading of arterial oxygen saturation (SaO2) from arterial blood gas.  analysisThe pulse oximetry is clipped onto a patient’s finger , and specific wavelengths of light are passed through the finger. Oxygenated and deoxygenated hemoglobin have different patterns of light absorption and measurement of the pulsatile absorption of light by arteriolar blood passing through the finger allows quantifying the two forms of hemoglobin Advantages of Pulse Oximetry comparable to arterial blood gases Although direct measurement of arterial blood gases provides the best method for assessing gas exchange , it requires collection of blood by arterial puncture. As already noted , sampling of arterial blood is uncomfortable for patients , and a small but finite risk is associated with arterial puncture.  Disadvantages of pulse oximetry I. The oximeter measures O2 saturation rather than PO2. II. No information is provided about CO2 elimination and acid-base status. III.The results typically are inaccurate in the presence of an abnormal hemoglobin such as carboxy hemoglobin , as seen in carbon monoxide poisoning. Thanks ☺