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Special Procedures 1
Special Procedures Review
| Question | Answer |
|---|---|
| How is a tissue sample during this Percutaneous LUNG BIOPSY procedure? | refers to obtaining a tissue sample through a small puncture in the chest wall as opposed to obtaining the sample through a surgical opening or from the airways during bronchoscopy. |
| Why would the physician perform this Percutaneous LUNG BIOPSY procedure? | local anesthetics are administered |
| In what position should the PT be placed for this Percutaneous LUNG BIOPSY procedure? | Semi Fowler's or decubitus position with the healthy lung dependent. |
| List the potenial hazzards of Percutaneous LUNG BIOPSY? | Infection Pneumothrax Bleeding |
| What is the most common disorder that requires a thoracentesis? | PLEURAL EFFUSION |
| How can the presence of a pleural effusion be established? | Physical Exam- revals flatness to percussion and diminished breath sounds and tracheal shift away from site. X-RAY- Lateral decubitus film shows concave upper border or a continual line from the diaphragm to apices. Ultrasound techniques |
| Briefly Describe the THORACENTESIS procedure? | PT sitting up leaning forward, 3-10 ml of a 2% lidocaine is used,25 gauge neddle used, A longer neddle/anesthetize the thickness of chest wall, neddle is inserted the 7th 0r 8th intercostal space, neddle inserted to flud level reached,100-300ml/50syringe |
| How would a TRANSUDATE FLUID appear? | clear/has a light straw color fluid also called serous fluid |
| What type of disorder is associated with TRANSUDATE FLUID? | CONGESTIVE HEART FAILURE |
| What is EMPYSEMA? | a chronic, irreversible disease of the lungs characterized by abnormal enlargement of air spaces in the lungs accompanied by destruction of the tissue lining the walls of the air spaces. |
| What type of fluid is associated with EMPYSEMA? | has an opaque appearance and is called EXUDATE FLUID |
| EXUDATE FLUID is indicated by what pH level? | pH less than 7.30 |
| PURULENT FLUID is defined as: | Pus filled exudate |
| MUCOPURULENT FLUID contains both ___ and ____? | mucus and pus extudate |
| Infection would produce what color fluid? | yellow or milky excudate fluid |
| What are three types of SLEEP APNEA disorders? | CENTRAL APNEA due to loss of ventilation effort OBSTRUCTIVE APNEA due to blockage of the upper airway Mixed APNEAa combination of the Central and Obstructive types |
| How will the following present during the sleep study CENTRAL PROBLEM? | if nasal flow DECREASES AND RESPIRATORY EFFORT DECREASES then desaturation is a result of CENTRAL problem |
| How will the following present during the sleep study OBSTRUCTIVE PROBLEM? | if nasal flow DECREASES but RESPIRATORY EFFORT CONTINUES then desaturation is a result of OBSTRUCTIVE problem |
| INDUCTIVE PLETHYSMOGRAPHY is performed to monitor? | chest motion during sleep stuides |
| Treatment for CENTRAL SLEEP APNEA would include? | weight loss, surgery,respiratory stimulants,Tracheostomy, Nasal/mask CPAP and/or NIPPV therapy |
| Treatment for OBSTRUCTIVE SLEEP APNEA would include? | weight loss, surgery,respiratory stimulants,Tracheostomy, Nasal/mask CPAP and/or NIPPV therapy |
| List the two common conditions requiring chest tube insertion? | Pneumothrax Hemothorax |
| Describe the location of the chest tube if the tube is to drain AIR from the pleural space? | it is placed in the anterior chest (second intercostal space in the midclavicular line) |
| Describe the location of the chest tube if the tube is to drain FLUID from the pleural space? | it is placed in the fourth or fifth intercostal space in the midaxillary line) |
| How is suction regulated in a three-bottle suction drainage system? | the amount of negative pressure being applied above the water seal |
| Explain how PULMONARY EDEMA may result following insertion of a chest tube? | may result if there is a malfuction that creates |
| What does continuous bubbling in the water seal bottle indicate? | it can be assumed that 10cm of negative pressure is being maintained by the suction contral bottle and applied to the drainage system |
| What action should be tacken if the water seal bottle breaks? | submerge chest tube in a glass of water, if PT is receiving mechanical ventilation then leave the tube open to atmospheric air until a new system can be set up |
| Describe the compartments contained in a disaposable drainage unit? | consists of three parts resembles the three bottle system |
| How much water should be in a water seal chamber? | Approximately 1 to 2cm of water |
| Describe the movement of water in the water seal chamber during spontaneous ventilation. | the water rises toward the PT side of the chamber during inspiration and returns to the other side on expiration. Normal movement of water is 2 t0 6 cm. The movement is accentuated during greater inspiratory and expiratory effort |
| How does the movement of water in the water seal chamber differ during POSITIVE PRESSURE ventilation. | the movement of water is reversed due to positive pressure within the thorax and the pleural cavity |
| How does the disposible drainage unit differ when there is no suction applied to the control system? | there will be no bubbling in the suction control chamber; the unit will resemble a two-bottle gravity drainage unit |
| Voloume lost through the peripherial airways and chest tube is calculated by? | Delivered Tidal Volume (800ml) --- Exhaled tidal volume (600ml) = lost tidal volume(200ml) |
| How long should the chest tube be clamed brfore removing it? | 24 hours before removing the tube |
| What action should be taken if the PT showes signs of respiratory distress while the chest tube is clamped place? | unclamp tube for respiratory distress or the x-ray indicates a pneumothorax or pleural effusion |
| How should the PT be instructed to breath just before removing the chest tube? | PT takes a deep breath,exhales and performs a Valsalva Maneuver |
| What should be done if a 5% pneumothrax is shown to be present? | <10% pneumothrax may not require traetment unless PT shws significant distress |
| What should be done if a 25% pneumothrax is shown to be present? | >20% pneumothrax requires a chest tube |
| Describe the purpose of an exercise tolerance test? | exam used to evaluate the ability of the heart and lungs to provide oxygen and remove carbon dioxide from the bloodstream |
| List 4 indications for an excercise tolerance test? | complaint of dyspnea on exertion Determine Ventilatory limitations to work Determine Cardiac limitations to work Determine Maximum workload |
| List the formula to calculate the PTs maximum heart rate? | 220- Age in years |
| List the equipment necessary to perform an Exercise TOLERANCE test? | treadmill or riding a cycle ergometer (bike) |
| Describe the purpose of a BRONCHALVEOLAR LAVAGE? | is for the diagnosis and treatment of alveolar filling disorder |
| What piece of equipment is used when performing a BRONCHALVEOLAR LAVAGE of an entire Lung? | a CARLENS TUBE (double lumen tube) is inserted to ventilate lung while other is filled saline and a complete lavage is done |
| Apnea monitoring is recommended for what type of infants? | for an infant who may be at risk for periods of significant apnea (>20sec) |
| Describe the indication of apnea monitoring for infants who are at risk for SIDS? | One or more Apperent Life Threating Episodes. the infant has apnea,cyanosis,choking,or lifelessness that require stimulation or CPR, Sibling of a SIDS baby, Preterm infant, Snoring in infant |
| List the criteria for discontinuing an Apnea monitor. | 2 months free of event, No monitor alarms on apnea settings of >20 sec and heart rate at <60/min |
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