Special Procedures Word Scramble

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Special Procedures

Section D

Question	Answer
What are the diagnostic reasons for a bronchoscopy	suspected foreign-body, suspected malignancy, bronchial washings, hemoptysis, persistent problems
Therapeutic reasons for a bronchoscopy	foreign-body obstruction, secretion removal, bronchial lavage, stenosis, atelectasis
when is intubation via bronchoscopy recommended?	with suspected neck fracture
Describe the typical bronchoscopy procedure	topical anesthetic (lidocaine) administered. scope inserted and airway is visualized, oxygen provided. diagnostic and/or therapeutic procedure performed
what further precautions should be taken for patients on mechanical ventilation during a bronchoscopy?	topical anesthetic should be administered down ET tube prior to insertion and increase FiO2 to 1.0
what is the most common complication with bronchoscopy?	mild epistaxis (nasal bleeding)
list three steps to be taken to control major bleeding during bronchoscopy	instill epinephrine, compress the site with scope, insert a fogarty catheter
what is the most common disorder that requires a thoracentesis?	pleural effusion
how can the presence of a pleural effusion be established?	x-ray, physical examination, ultrasound techniques
Describe to procedure for a thoracentesis	patient sites up and leans forward. anesthetize skin then chest wall. needle inserted through inner costal space at maximum dullness. inserted until fluid established
How would a transudate fluid appear?	clear with a light straw color
what type of disorder is a trasudate fluid associated with?	CHF
What is empyema? what type of fluid is it associated with?	opaque appearance--exudate fluid
describe a cardioversion	administering low volt current to heart tissue in attempt to convert cardiac dysrhythmia to normal sinus
when is cardioversion indicated?	atrial fibrillation, atrial flutter and ventricular tachycardia with pulse
what should be done if fibrillation occurs during cardioversion?	check pulse, turn off synchronizing switch, increase the watt-seconds and immediately defibrillate
what sedative would you recommend giving prior to cardioversion?	Midazolam (versed)
Briefly describe defibrillation	used during emergency cardiac dysrhythmia
what are the 3 indications for defibrillation?	pulseless ventricular tachycardia, ventricular flutter, ventricular fibrillation
at what power setting should the first defibrillation attempt be made?	200-300 joules
What are the 3 types of sleep apnea disorders?	Central: due to loss of ventilation effort; Obstructive: due to blockage of upper airway; Mixed: combination of central and obstruction
how is nasal flow and respiratory effort affected in a central problem?	nasal flow decreases and respiratory effort decreases
how is nasal flow and respiratory effort affected in a occlusive or obstructive problem?	nasal flow decreases and respiratory effort increases
describe inductive plethysmograph	series of elastic bands that are placed around chest to measure chest movement (respiratory effort) and breathing frequency
what is inductive plethysmograph used for?	sleep studies to monitor chest motion
List 2 common conditions requiring chest tube insertion?	pneumothorax and pleural effusion
describe the location of the chest tube if the tube is to drain air from the pleural space	anterior chest (second interspace in the midclavicular line)
describe the location of the chest tube if the tube is to drain fluid from the pleural space	between the fourth and fifth interspace in the midaxillary line
Describe the function of a one-bottle water-seal chest drainage system by gravity.	primarily used in emergencies. fluid is drained by gravity
what problem may occur with a rising drainage in a one-bottle gravity system?	significant fluid drainage will raise the original water level creating greater resistance for air to escape
when would it be recommended to use a two-bottle system over a one-bottle system?	when a large amount of fluid need to be drained
what would a disappearance of fluctuations in the water-seal bottle mean?	no pneumothorax or obstruction or kink in tube
how is suction regulated in a three-bottle suction drainage system?	through the suction control bottle (third bottle)
how can pulmonary edema occur with a three-bottle water-seal system?	if there is a malfunction that creates a sudden re-expansion of the lung
what does continuous bubbling in the middle bottle of a three-bottle indicate?	air leak
what action should be taken if the water seal breaks in a three-bottle system?	submerge chest tube in a glass of water. if patient is on a vent, then lease the tube open to atmospheric air until a new system can be set up
how long should the chest tube be clamped before removing it?	24 hours
what action should be taken if the patient shows signs of respiratory distress while the chest tubes are clamped	unclasp the tubes
how should the patient be instructed to breathe just before removing the chest tubes?	patient takes a deep breath, exhales and performs a valsalva maneuver
what should be done if 5% pneumothorax is shown to be present?	nothing unless patient shows significant distress (<10%)
what should be done if a 25% pneumothorax is show to be present?	Chest tube
What should be done about an unusually large volume of drainage collected in a collection bottle?	check the patient for problems associated with massive blood loss; pulse, blood pressure, shock look. >100 mL/hour
water seal bottle: the original fluid level has increased in the combined collection/water-seal drainage bottle. Drainage is reduced. what should be done?	replace bottle this proper water level or use a drainage system with a separate collection bottle and water-seal bottle

Created by: grumpeme on 2008-07-15