Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
CRT Prep/Exam
CRT Practice Exam/ KNS
| Question | Answer |
|---|---|
| Normal range for Pulmonary Capillary Wedge Pressure in an ADULT? | 4-12 torr |
| Which Techniques measure Total Lung Capacity (TLC)? 1.Helium Dilution 2.Body Plethysmograph 3.Single Breath Nitrogen Elimination | 1.Helium Dilution: Measures: TLC, RV, FRC 2. Body Plethysmograph: Measures, TLC, FRC, RV, VTG - (VTG thorasic gas volume=same as FRC) Single Breath Nitrogen Elimination - is best for FRC |
| What spirometer will give the most accurate measurement of VOLUME and FLOW | Collins water-sealed spirometer |
| Most Significant problem associated with the use of a bronchoscope? | Hemoptysis |
| List Facts about Spacers and Holding Chambers? | 1. Improves the efficacy of MDI 2. used for drug delivery by MDI to intubated and MV-patients 3.if pt exhales immediately following activation of the inhaler, they will clear the meds from the device and waste dose 4. trouble cordinating MDI |
| The tip of the Macintosh Laryngoscope Blade should be placed in? | 1. Vallecula - 2. Fact: For Adult Intubation, indirectly raises epiglottis. |
| The Straight/Miller blade should be placed? | Directly under the epiglottis Fact: Preferred for infant intubation |
| A HME (heat mosture exchanger) is used during? | 1. Short term MV 2. Transport |
| What drugs can be administered VIA endotracheal tube? | 1. Narcon - Narcotic overdose 2. Atropine - Bradyucardia 3. Valium/Versed - Sedative 4. Epinephrine - Asystole 5. Lidocaine - PVC |
| What drug increases cardiac output and decrease pulmonary vascular resistance? | B-53 Digitalis Fact: increase strength of contraction |
| What Drug lowers BP and decreases right ventricular pre-load? | Nipride: Sodium Nitroprusside (Direct Vasodilator) |
| 5 Drugs that lower BP | 1. Methyldopa (Aldomet) 2. Propranolol (Inderal) 3.Metoprolol (Lopressor) 4. Diazoxide (Hyperstat IV) 5.Sodium Nitroprusside (Nipride) |
| Aminoglycosides Drugs used for serious gram-negative infections? | 1.Tobramycin (Nebcin) 2. Amikicin (Amikin) 3.Gentamicin (Garamycin) Fact: Gram Neg - Give a mycin drug |
| Vancomycin | Indicated for life threatening gram-positive cocci. Most potent antibiotic available for infections caused by Methacillin -Resistant Staphylococcus aureus (MRSA) |
| Narcon (Nalaxone) | Treats Narcotic Overdose (Narcotic Blocker) |
| Drug that reduces ICP, in patients with intracranial swelling | Mannitol (Osmitrol) Acetazolamide (Diamox) |
| Used to sedate a patient with head trauma | Phenobarbital - Seditive |
| BIPAP Ventilation | Breaths are time controlled Two levels of CPAP are applied (IPAP) and (EPAP) Breaths are FLOW Triggered Used for Non-invasive ventilation |
| What controls are available on a Negative Pressure Ventilator (chest Cuirass) | 1. Inspiratory Time - Ventilation (adjusting the length of inspiration (time cycled) controls Ventilaion 2. Negative Pressure: controls amount of Suction |
| Formula For Static Lung Compliance | FLOW OF GAS Raw Exhaled Volume (tidal Volume) TV / (Plateau pressure - PEEP) |
| Formula For Dynamic Compliance | NO AIR FLOWING (Most accurate measurement of LUNG COMPLIANCE) Exhaled Volume (Tidal Volume) TV / (Peak Inspiratory Pressure (PIP) - PEEP) |
| Which Artery is palpated when deciding to initiate chest compressions on an adult patient? | Carotid- for 10 seconds |
| TB (Mycobacterium Tuberculosis) is spread by? | Inhalation of Droplets |
| Distribution of Ventilation in the lungs is measureed by? 1. Phase 3 of the SBN2 Elimination test 2. N2 Wash out time 3. Ventilation Lung Scan | ALL OF THEM - See PAGE 3 (D-37) |
| PD20% Measurement | Airway Hyper-reactivity (narrowing of airway from some-type of trigger) |
| Ascites | Fluid build up inside abdomen caused by liver failure |
| Where will tissue edema show up 1st in a patient that develops ascites and shortness of breath | abdomen |
| Infraction is diagnosed by Significant | Q waves |
| MI (Myocardial infarction) often occurs in? | the left Ventricle |
| MI (Muocardial Infarction) axis shifts to the | Right (RAD) right axis deviation |
| Most heart attacks occur on the | LEFT SIDE OF HEART |
| Increased Vascular Markings | Fluid Overload (CHF) |
| Absent Vascular Markings | Lungs have been pushed away, you have a pneumothorax |
| Depressed S-T segment and Inverted T waves | MI (Myocardial Ischemia) |
| Ischemia is indicated by? | Depressed or Inverted T waves |
| Inverted T-wave can also be caused by | digitalis toxicity and hypokalemia |
| Bronchsospasm | bilateral inspiratory and expiratory wheezing. Need a bronchodilator (A-18) |
| Pleural Effusion would look like on an X-Ray? | Flattened Diaphragm,widened intercostal spaces and blunting of the costophrenic angles |
| Describe Pleural Effusion. | Fluid in the pleural space |
| Pleural Effusion Assessment. | Dyspnea, chest pain,decreased breath sounds and dry non-prod cough. Mediastinal shift to unaffected area(away from affected area). Lateral decubitus X-ray - Obliteration of the costophrenic angle, unilateral basilar infiltrate with meniscus formation. |
| obliteration(Blunting) | Fluid in chest will not see angles = Blunting SEE (I-28) |
| Pneumothorax (Left) | Right-shift of the mediastinum, Hyperlucency of the left chest with absent vascular markings |
| Hyperluceny | Extra Air |
| Absent vascular Markings | Pneumothorax Lungs have been pushed away |
| Increase Vascular Markings | Fluid Overload (CHF) |
| No light can be seen on infants left chest. | left hemidiaphragm is herniated- (Transillumination) |
| Transillumination | Recommend when a pneumothorax is suspected A Bright fiberoptic light is placed against the infants chest in a darkened room. Normally a lighted halo is seen around the point of contact Pneumothorax or pneumomediastinum causes entire hemithorax to light up |
| Equipment Least Appropriate For a victim of a House Fire? | Pulse Oximeter - will read higher saturation if carbon monoxide poisoning is present |
| Transcutaneous oxygen monitor | heat setting set between 44 and 45 C, change electrode every 4 hrs, calibrate on room air with a zeroing solution, place over flat areas of skin, move around to prevent erythema (redness or blistering of skin) |
| erythema | Redness or blistering of skin |
| VD/VT | Deadspace to tidal volume ratio Normal Value:20-40% up to 60& vent pts See(D-15) |
| An increase in VD/VT Ratio above 40% | Indicates Increasing Dead Space: Pulmonary Embolus (PE)- a deadspace producing disease |
| Pt PAO2 is determined to be 650mmHg, this would indicate the patient has? | Pneumonia |
| P (A-a) O2 is 410torr or 410 mmHg, the gradient is | increased >300mmHg = Shunting - this pt is shunting |
| A-aDO2: The A-a Gradient | Normal Value =25-65mm Hg on 100% V/Q mismatch = 66-300 mm Hg Shunting = >300 mmHg |
| A-aDO2: The A-a Gradient Formula | A-aDO2=PAO2 -PAO2 See (D-11) |
| CaO2: Arterial Oxygen Content | CaO2= (Hb X 1.34 X SaO2) + (PaO2 X.003) Oxygen in RBC Oxygen in Plasma Normal Value: 17 -20% |
| CvO2: Mixed Venous Oxygen Content | CvO2= (Hb X 1.34 X SvO2)+ (PvO2 X .003) Normal Value = 14% (12-16 Vol%) |
| QT: Cardiac Output | QT= VO2 / C(a-v)O2 (10) Normal Value= 4-8L/min (D-13) |
| C(a-v)O2: arterial venus oxygen content difference | C(a-v)O2= CaO2 -CvO2 Norma Value =4-5% Used in Fick Equation to calc Cardiac Output or Oxygen Consumption |
| Used to monitor airflow improvement following each Beta2 agonist treatment taken at home | Peak Flow Meters Measure Peak Expiratory Flowrate (PEFR) at bedside |
| Used to Calculate Inspiratory Capacity | TLC - FRC See (D-34) |
| Kyphosis | Convex curvature of the spine (lean forward) Can't get air out |
| Scolliosis | lateral curvature of the spine (lean side to side) |
| Kyphoscoliosis | Combination of both Scolliosis and Kyphosis and causes a severe restrictive impairment |
| What method should be used to determine a patients height who has severe Kyphosoliosis | Calculate using their armspan |
| Flow Volume Loops: Skinny Tall Loop | Restrictive Can't get air in |
| Flow Volume Loops: Short and Wide Loop | Obstructive Can't get air out |
| Obstructive Disease: Decreased Flow | Cystic Fibrosis Bronchitis Asthma Bronchiectasis Emphysema |
| Restrictive Disease: Decreased Volume | Inflammatory diseases, Cardiac disease Neurological/neuromuscular Pleural disease, Thoracic deformities Post surgical patients Fibrotic disease |
| Restrictive Only | Decreased Volumes VC or FVC |
| Obstructive Only | Decreased Flows FEV1, FEV1/FVC |
| Both Obstructive & Restrictive | Decreased Flows & Volumes |
| What happens when the FIO2 setting is changed from 40% to 60% on a large volume nebulizer? | The Density of the aerosol will increase |
| Catheter Size | ID size/2 X 3 = |
| What device would be most helpful in removing large amounts of thick purulent secretions in a Chronic Bronchitis patient? | mechanical percussor ultrasonic nebulizer |
| A Heated Nebulizer has insufficient aerosol flow being delivered to pt can be caused by | water collecting in the tubing low nebulizer water level |
| Cuff pressures are not to exceed (20mmHg or 25 cmH20) to allow | circulation to the tracheal mucosa |
| A cuff pressure greater than 20 mmHg or 25 cmH2O can Cause | 1. arterial occlusion 2. tracheal necrosis if maintained |
| An X-ray shows ET-Tube in correct position, yet with manually ventilating with a nasotracheal tube, there is still no chest movement, minimal breath sounds and air escaping from the mouth as the bag is squeezed, what is a likely cause? | the cuff ruptured during intubation |
| When Evaluating a patient for Extubation when deflating cuff | Breath sounds are heard around the tube on auscultation |
| Bed Flat , pt in prone position with pillows under hips, which segments are being treated | superior segment of the lower lobes See (B23-B24) |
| Prone | Patient lying Face Down |
| Supine | Patient lying on spine (best for post -craniotomy patients |
| Fowlers, Semi Fowlers or Reverse Trendelenburg | Best for hypoxic pateints, obese pts with dyspnea, post op abdominal pts, and pts with pulmonary edema |
| Trendelenburg | For patients with very low blood pressure |
| Lateral Fowlers | Very Obese patients with air hunger |
| Lateral Flats | best position to prevent aspiration |
| If patient aspirates | First suction and then place in opposite position for postural drainage |
| If patient has unilateral consolidation | Place the affected lung up to allow it to drain and to increase perfusion to the unaffected lung |
| Difficulty establishing an IV Route to administer emergency medications | Instill the medications through the patients endotracheal tube- (Direct instilation of Meds) |
| An increase in static lung compliance, while using a pressure cycled ventilator will | increase the volume See (C-9) |
| Pressure cycled Ventilator being used for continuous ventilation fails to cycle into inspiration can be caused by | 1. Failure of apnea control 2. Expiratory line disconnected |
| Bird Mark 7 Vent Does not cycle into Expiration. This can be caused by | 1. Disconnected expiratory valve 2. leak in the patient tubing 3. ruptured endotracheal tube cuff |
| What is the Ideal Breathing Pattern for a patient receiving Incentive Spirometry | 1. Slow Deep Inspriations (from resting exhalation) 2. Inspiratory Hold/pause (1-3 sec) 3. Exhalation is slow, passive and relaxed 4. strong cough effort |
| A pressure cycled vent will not cycle off at endinspiration. What is the most likely cause? | The cuff has ruptured |
| Increase Volume= | Increase IT(inspiratroy time) Increase Pressure Decrease Flow |
| Decrease Volume | Decreased IT Increase turbulence Increase Flow |
| To increase or decrease minute volume, what controls would help accomplish this? | Ve =(Vt X f) tidal volume Rate |
| A decreased urine output from 35 to 10 ml/hr can be caused by | an increase in Peak Pressure |
| Weaning See E-30 | A-a DO2 <300 mmHg Qs/Qt <20% VD/VT <60% Pulse and blood pressure Normal Verify that underlying disease process has been reversed |
| Optimal PEEP | Lowest amount necessary to provide good oxygenation (PaO2) without any side effects |
| PE Pulmonary embolus | When all of a sudden Pick PE |
| Assess Respiratory Muscle Strength | MIP and VC |
| Min Volume Ve | Ve = (Vt X f) |
| To Decrease Barotraum | Use Flow Cycle/Pressure Limited Ventilation |
| To Reduce High PCO2 you could increase | 1. TV 2 Rate 3 alveolar ventilation |
| A change in Airway resistance would reflect a change in | Dynamic compliance Raw see (E-14) |
| What can cause the High pressure alarm to sound on a volume cycled vent | Decrease in lung compliance increase in airway resistance bronchospasm |
| When Placed on PEEP, the 1st parameter to measure is | COMPLIANCE |
| Increase flow | Decrease I-time Increase E-time |
| Increase Flow | I-Time would Decrease I:E ratio would change E-time would Increase |
| If lung compliance is increasing then | PIP (peak pressure) is decreasing |
| If lung compliance in decreasing then | PIP (Peak Pressure) is increasing |
| Patients with Chronic CO2 retention must have adequate inspiratory flow to prevent | Air trapping |
| When Administering 1 rescuer CPR to an adult victim and another therapist enters the room to help, the therapist doing chest compressions should | Start chest compressions at a rate of 100 compressions per minute- High Quality CPR See (F-9) |
| If a Resuscitation Bag fills rapidly and COLLAPSES EASILY on minimal pressure, check... | inlet valve: Could be missing, Replace bag quickly |
| On a Resuscitation Bag, if bag becomes difficult to compress and patient compliance is normal the patient valve could be.. | stuck open or closed-Obstruction somewhere |
| What are the oxygen concentrations and Liter Flow used with a Resuscitation bag | 100% (95-100%) @ 15L/min |
| During Resuscitation efforts, the therapist notes increasing difficulty in manually ventilating an intubated patient. Possible explanations for this situation include? | Decreasing compliance outlet valve is sticking |
| During manual ventilation via endotracheal tube, there is increased resistance during manual ventilation with decreased chest movement and diminished breath sounds on the left. The 1st response is? | Check the position of the endotracheal tube- poss Right Mainstem Intubation |
| Trachea deviated to opposite side, hyperresonant percussion note and decreased breath sounds on the affected side | Pneumothorax Recommend insertion of chest tube |
| Trachea deviated to opposite side, dull percussion note and decreased breath sounds on the affected side | Hemothorax Recommend insertion of chest tube |
| Cannot pass suction catheter Decreased breath sounds | Endotracheal tube Obstruction Remove tube and use alternative form of ventilation (Bag-valve mask unit) |
| Trachea deviated to the left, hyperresonant percussion note on the right, dull percussion note on the left. Increased chest movement on the right, decreased on the left. | Right Mainstem Intubation: Withdraw endotracheal tube slightly, listen for improved breath sounds, and observe for bilateral chest movement |
| Polysomnography | Sleep Apnea Studies SEE (G-6) |
| Central sleep apnea | Apnea due to loss of ventilation effort Brains Fault |
| Obstructive sleep apnea | Apnea due to blockage of the upper airway Something blocking airway while sleeping |
| Mixed sleep apnea | A combination of the Central and Obstructive types |
| Total Flow | Flow Meter Setting X Factor [Air + O2] See (H-18) |
| Air Entrainment Mask(Venturi Mask) | Delivers precise FIO2 Concentrations Ideal for pts with COPD, irregular tidal volumes and breathing patterns |
| with an Air Entrainment Mask/ (Venturi Mask), The FIO2... | remains the same with increases or decreases in the flow through the oxygen inlet. |
| To increase O2 Concentration when using a Air Entrainment Mask (Venturi Mask) | Must increase size of Inlet port |
| Air Entrainment Mask (Venturi Mask) will _____deliver _______ FIO2 | Not Deliver 100% FIO2 |
| Non-rebreather mask | High Flow Device Used in an Emergency Delivered FIO2: 21 -100% |
| Used to deliver 100% O2 in an Emergency | Non-rebreather Mask |
| Device BEST suited for administration of oxygen to a patient with acute pulmonary edema? | Non-rebreather Mask |
| acute | Emergency |
| Used to deliver 100% O2 in an emergency (pneumothorax, CO Poisoning, CHF, Burns, Acute Pulmonary Edema etc) and for mixed gas therapy (He/O2 mixtures, CO2/O2 mixtures) | Non-rebreather Mask |
| Has 3 one way valves | Non-rebreather Mask |
| one way valve | controls direction of gas going in and out |
| An Advantage to using a non-rebreather Mask | We have full control of O2, we put at 100% they get 100%, we put at 50% they get 50% |
| What Oxygen Administration Device is used with a blender when FIO2 is above 100% | Non-rebreather Mask |
| A COPD patient with tachypnea, and dyspnea. What device should a therapist recommend when the physician orders oxygen therapy at 40% FIO2? | Venturi Mask (Air Entrainment Mask)- (High FLOW) Precise FIO2 Ideal for COPD Patinets |
| What Oxygen device should be initialy used for a patient with a stable respiratory rate (RR) and tidal volume (TV)? | Nasal Cannula - Low Flow Device |
| Nasal Canula See (H-6) | LOW FLOW Device Delivers FIO2 24-45% Flow: 1-6 L/min |
| Simple Mask | Low Flow Device Delivered FIO2 40-55% Flow 6-10 L/min Flow must be at least 6L/min to flush out exhaled CO2 |
| What is the Problem with a Low Flow Simple Mask? | The patient inhales in Mask BUT Also Exhales in Mask (mask accumulates O2 BUT CO2 as well) |
| What is the Minimum Flow Rate for a Simple Mask and Why? | 6L/min to Flush out CO2 |
| Partial Rebreather | Low Flow Device Delivers FIO2 60-65% Flow: 6-10L/min NO one way flap valves |
| Yellow ZONE Peak Flow | 50-80% |
| Duration of Flow | Gauage Pressure (psi) X Tank Factor/ Liter Flow |
| E Cylinder Tank Factor See(H-14) | .28 L/psi Rounded: (.3) |
| H Cylinder Tank Factor See (H-14) | 3.14 L/psi Rounded: (3.0) |
| dyspnea | shortness of breath or difficulty in breathing |
| Tachypnea | Increased Respiratory Rate (over 20 breaths per minute) |
| Pulmonary Edema | Fluid in the lungs |
| Pneumonia | Infectious Disease Infectious bacteria or virus enters the lung via inhalation or aspiration |
| A patient with pneumonia and on on a Ventri Mask at 40% FIO2. During Transport, a patient becomes agitated and has a heart rate of 120bpm, what is a likely cause? | Oxygen tank is empty |
| What should be used to clean used flowmeters removed from patients rooms? | wipe with alcohol (70%) |
| Before leaving the patient's room, equipment should be wiped down with | 70% alcohol |
| A steady increase in distance of a 6 minute walk test each week would indicate? | improvement in exercise ability |
| What is the most appropriate infection control procedure to use for patients with HIV? | Standard Precautions: 1.Hand washing 2.gloves 3.masks, eye protection, face shields gown 4.occupational health and blood borne pathogens 5. patient placement |
| Patent Ductus Arteriosus | congenital disorder in the heart where in a neonates ductus arterious fails to close after birth, creating a right to left shunt |
| TcPO2 (Transcutaneous Monitoring)can also be used to evaluate | Patent ductus Arteriosus |
| If Right to left shunt occurs across the Ductus Arteriosus the PO2 level obtained from a preductual site (right arm ect..) will | exceed the PO2 level obtained from a post ductal site (umbilical artery or a lower extremity Vessel. |
| If the pre-ductal (right radial artery) PaO2 is 15 torr higher than the post ductal (umbilical Artery) PaO2, then the patient has a | Patent ductus arteriosus with a right to left shunt |
| What test should be recommended to determine cause of a shunt in a neonate? | echocardiogram |
| To rule out a patent ductus arteriosus | compare the upper right upper chest TcPO2 to the abdominal TcPO2 |
| Strider? | Due to upper Airway Obstruction: 1. Supraglottic swelling (epiglottis) 2. Subglottic swelling (croup, post extubation) 3. Foreign body aspiration (solids or fluids) |
| Treatment of Strider? | 1. Topical decongestant (racemic epinephrine) for swelling and edema 2. Intubate for severe swelling 3. SXN and or bronchoscoopy for secretions and foreign body aspiration 4. cool mist areosol |
| Respirometer measures | Flow and Actual Volume |
| Determines Oxygen level is stable patients | Pulse Oximeter |
| Minute Ventilation | Ve = (VT X f) |
| When weaning Minute Ventilaion (Ve) needs to be______. | < (less than) or = to 10 L/min |
| To reduce the chance of transmitting an infection from patient to patient, the therapist should wipe stethoscope with | Alcohol between patients |
| To Administer bronchodilator therapy with albuterol, to reduce cross contamination, use a | MDI- metered dose inhaler UNIT DOSE Medication |
| To prevent nosocomial infections (cross contamination) Utilize _____ Medications whenever possible. | Unit Dose (MDI)metered dose inhaler |
| When receiving a diuretic such as Lasix, the patient will need what type of electrolyte replacement? | K+ and Cl |
| Remember K+ goes where ever | Cl goes May need to recommend KCL |
| APGAR SCORE 0-3 | Resuscitate |
| APGAR SCORE 4-6 | support- stimulate, warm, administer O2 |
| APGAR SCORE 7-10 | MONITOR- routine care - celebrate normal baby |
| If unable to calibrate a Polaragraphic oxygen analyzer | 1. Change the battery 2. check electrolyte level (refill if low) |
| Emphysema | weakening and permanent enlargement of the air spaces distal to the terminal bronchioles |
| A Patient with end-stage Emphysema is not responding to questions and pulse is 20 bpm, what should the therapist do? | Patient has end stage Emphysema and is bradying down, CHECK FOR DNR STATUS. |
| Chrontic Bronchitis | Characterized by daily productive cough for at least 3 consecutive months each year for 2 years in a row |
| Helps to remove secretions from airways in patients with Bronchitis | PEP Therapy: Positive Expiratory Pressure (Vibratory/Oscillatory(PEP) Devices Examples:Flutter, Acapella, Quake |
| To Normalize high PaCO2 | 1st: Decrease or Remove Deadspace 2nd: Increase the Tidal Volume (TV) 3rd: Increase the Respiratory Rate (RR) If 80kg-TV is at or near 800 then leave it alone and change the Rate instead. If 80kg TV is 400 then increase TV |
| To Normalize Low PaCO2 | 1st: Increase Deadspace 2nd: Decrease Respiratory Rate (RR) 3rd: Decrease Tidal Volume (TV) Target PaCO2 for Closed head injury patients should be 25-30torr (may want to hyperventilate pt. If CO2 is at 28 then don't do anything:maintain current setting |
| To Increase Low PaO2 | 1st:Increase FIO2 by 5-10%(up to 60%) 2nd:Increase PEEP/(CPAP)levels by 2-5cmH2O(or add PEEP CPAP)until: 1)acceptable oxygenation is achieved,or 2)unacceptable side-effects occur(decreased compliance and cardiac function, barotrauma,increased C(a-v)O2) |
| To Decrease High PaO2 | 1st: Decrease FIO2 to less than 60% 2nd: Decrease PEEP |
| Briggs adapter (T-piece) | Used to deliver oxygen to patients with ET or tracheostomy tube who is breathing spontaneously. A device used to connecting two inputs to one output or vice versa |
| Briggs adapter (T-piece) (Humidity) | When intubated you are by-passing upper airway - so NOT getting Humidity. Need to provide Humidity (moisture) |
| Briggs adapter (T-piece) is use to deliver______ and ______ at the same time. | O2 Aerosol |
| Recommend Flexible Bronchoscopy (Flexible fiberptic scope)for intubating in patients with | Suspected neck fracture |
| The RT has analyzed the FIO2 of a patient receiving 40% O2 Via an aerosol mask. The therapist notes that the analyzed FIO2 is 38%. The Therapist should? | Record the reading - its close |
| SIMV MODE allows the patient to breathe | spontaneously |
| SIMV MODE is used for patients with | COPD to normalize ABG |
| SIMV MODE is used for | weaning patients from the ventilator |
| During bronchoscopy, a tissue sample was obtained, the patient is no hemorrhaging(serious bleeding) from the biopsy site, the therapist should | instill epinephrine Compress the site with the scope Insert a fogarty catheter One or more of the above steps should be taken when serious occurs |
| Beta2 Adrenergic drug | Rescue/Quick Relief Medication (For Wheezing) Albuterol(Ventolin or Proventil), Levalbuterol(Xopenex), Terbutaline (Brethine or Brethaire) Pirbuterol (Maxair) |
| Patient becomes anxious and ventilating pressures increase, administer_________ | A sedative- to calm patient Alprazolam (Xanan) Diazepam (Valium) Midazolam (Versed) Lorazepam (Ativan) |
| What drug can be given to reverse the effects of a sedative? | Bensodiazepine antagonist flumazenil (Romazicon) |
| Nasopharyngeal Airway | Conscious Patient, Support base of tongue Facilitate deep tracheal suctioning used to decrease trauma during nasotracheal suctioning outside diameter of airway should be equal to inside diameter of patient's external nares. |
| Good to use in establishing a patent airway for a conscious patient who requires frequent suctioning | Nasopharyngeal Airway |
| Oropharyngeal Airway | Unconscious patient support base of tongue Bite block (with ET tube or seizure) Facilitate oral suctioning Length should be equal to distance from the angle of jaw to top of chin or from the angle of jaw to just past corner of mouth |
| Nasopharyngeal Airway Length? | Length of airway is from tip of earlobe to center nostrils. |
| How is an oropharyngeal airway inserted? | Oral- Inserted opposite its anatomic shape (upside down) to back of throat and then ratated into its correct position. |
| How is an Nasopharyngeal Airway inserted? | Nasal- Inserted the way it is anatomically shaped with water soluble lubricant |
| A HME (Heat moisture Exchanger is not intended for long term use. If the HME becomes clogged with secretions change to a | Wick Humidifier |
| HME (Heat Moisture Exchanger) | Device containing absorptive material that absorbs heat and moisture from the patients exhaled air and dissipates that absorbed heat and moisture back into the patients inspired air |
| HME (Heat Moisture Exchanger)is located int the ventilator circuit | between the wye and the patient (where deadspace is located) |
| HME (Heat moisture exchanger must be ________ during aerosol therapy | removed |
| Ideal use of HME is for | patient transport (short term) ventilation |
| HME may increase or thicken | secretions |
| After 24 hrs of use, a HME should be changed to _________ | a wick humidifier - heated (A HME is not as effective as heated humidifer and may increase or thicken secretions. |
| If a Briggs Adaptor is not misting... | Increase Flow, check fuction of capillary tube, add more reservoir tubing, set up a device to provide more flow (blender, tandem set up, change flowmeter....) |
| A patient is intubated with a size 8mmID cuffed trach tube. A the beginning of shift, cuff pressure was 20mmHg with PIP(peak inspiratory pressure) of 34cm H2O. 4hrs later the PIP is only reaching 14cmH20. The therapist should..... | Recheck the CUFF presure |
| Bradycardia | <60 indicates heart failure, shock, code/emergency weak and thready |
| Tachycardia | >100 beats/min indicates hypoxemia, anxiety, stress (hypoxic) |
| Pulse/heart rate | how fast the heart is beating per min Normal 60-100/minute Increased Heart Rate: >20 beats/min is an adverse reaction stop therapy, notify nurse and doctor |
| Skin Color | Normal: Pink, Tan, Brown, Black Abnormal: decreased in color (ashen, pallor) due to anemia or acute blood loss.(Vasoconstgriction will cause color change by reducing blood flow) |
| Jaudice | Increase in bilirubin in blood and tissue. This appears mostly in the face and trunk |
| Erythema | rednes of the skin. may be due to capillary congestion, inflammation or infection |
| Cyanosis (Cyanotic) | Blue or blue-gray (dusky) discoloration of skin and mucous membranes. Caused by hypoxia from increased amount of reduced hemoglobin (5g of reduced hemoglobin) |
| Myasthenia Gravis | Chronic disorder of teh neuromuscular junction that interferes with chemical transmission of acetylcholine A descending paralysis - Moves from Mind to the Ground Myasthenia Gravis Gradual onset of weakness, shallow breathing, diminished BS |
| Myasthenia Gravis Physical Appearance | General weakness that improves with rest, drooping eyelids (ptosis) double vision (diplopia) difficulty swallowing (dysphagia) |
| Dysphagia | Difficulty swallowing |
| Tensilon Test | To diagnose and monitor therapy in Myasthenia Gravis |
| Fenestrated Tube | Has opening in outer cannula above cuff Used for weaning and temporary mechanical ventilation with inner cannula NOT for CODE or in EMERGENCIES |
| Fenestrateed Tube When plugging the tube | be sure to deflate the cuff, remove the inner cannula and then plug the tracheostomy tube: This allows the patient to breathe through the upper airway and speak. |
| When a Fenestrated tubes inner canula is removed and the tube plugged to facilitate speaking and breathing through upper airway, and the patient has difficulty swallowing, handling secretions and increased muscle weakness and weak cough, what do you do? | replace the inner cannula and support ventilation |
| Extubation Severe respiratory distress and/or Marked inspiratory stridor | REINTUBATE the patient |
| Extubation Moderate distress/stridor | Oxygen, cool mist aerosol to provide humidity and racemic ipinephrine to reduce swelling |
| Extubation Mild distress/stridor Sore throat | Provide humidity (cool mist aerosol), oxygen and/or racemic epinephrine as necessary |
| Severe and Marked | emergency |
| Stridor | Laryngeal edema |
| Card 1 When Extubating a patient | 1.SXN the airway below (clean) then above the cuff (dirty back of throat) 2. Deflate cuff 3. Have patient inspire deeply (deep breath in) 4. Remove the tube AT Peak Inspiration- to prevent vocal cord damage 5. Have pt cough to clear any secretions |
| Card 2 When Extubating a patient | 6. Administer oxygen and humidity if/as indicated 7. observe any complications 1) Laryngeal edema (stridor) 2) Respiratory Obstruction |
| Why remove tube at Peak Inspiration? | 1. lungs full of air stimulates cough 2. prevent vocal cord damage |
| A Volume Pressure loop is set a PEEP of 0cmH2O but there is no volume change until a pressure of 10cmH2O is reached (lower inflection point). This creates a flattened portion at the bottom of the curve between 0cmH2O and 10cmH2o. What do you do to fix it? | Increase the PEEP to 10cmH2O to normalize the shape of the curve (a foot ball shape) The Optimum PEEP is 10cmH2O. |
| Card 1 - setting optimum PIP, VT Describe the Volume/pressure loop Diagram Below (E-26) | 1.Note the volume/pressure loop on the left appears flat at the top of the curve. This is sometimes called a BEAK and indicates overdistension of the lung (upper inflection point) |
| Card 2 - setting optimum PIP, VT Describe the Volume/pressure loop Diagram Below | The improved volume/pressure loop on the right is achieved by either reducing the Tidal Volume or changing to Pressure Control Ventilation (PCV) and limiting the PIP |
| Card 1- Evaluating/treating lung compliance problems Describe the Volume/Pressure Loop Diagram Below | The Volume/Pressure loop on the left demonstrates low compliance (ARDS, IRDS, pneumonia, pulmonary edema ect....) Indication of shunting Patient would benefit from the application PEEP (positive end expiratory pressure) |
| Card 2- Evaluating/treating lung compliance problems Describe the Volume/Pressure Loop Diagram Below | The Volume/Pressure loop on the right shows the compliance improving with theraphy (PEEP therapy, surfactant therapy etc.) Increase PEEP- graph rotates upwards If Graph rotates downward again- too much PEEP |
| Card 1: Evaluating/treating airway resistance problems Describe the Flow/Volume Loop Diagram Below | The Flow/Volume loop on the left shows high airway resistance (decreased flow). This can occur with Bronchospasm, secreations, and other forms of obstruction. Looks flat = flows BAD =Airway Resistance NO FLOW = increase Raw |
| Card 2: Evaluating/treating airway resistance problems Describe the Flow/Volume Loop Diagram Below | The flow/volume loop on the right shows an increase in flow following therapy (Bronchodilator therapy, Suctioning etc.) Give Bronchodilator- flow volume loop should open up and get better flows |
| Card 1: Evaluating/Treating an Air Leak Problem Describe the Flow/Volume Loop Diagram Below | When a Leak is present in the ventilator system, all graphics measuring volume will show the expiratory volume to be less than the inspiratory volume. Both the flow/volume loop and volume pressure loop will be broken and not return to zero volume. |
| Card 2: Evaluating/Treating an Air Leak Problem Describe the Flow/Volume Loop Diagram Below | When the leak is corrected, the loop will return to a normal shape. |
| Card 1: Evaluating/Treating air trapping (auto PEEP) problems. | Air Trapping (auto PEEP) can be easily identified when the expiratory flow does not return to zero baseline before the next breath starts (shown on the first breath of the flow time scalar graphic. |
| Card 2: Evaluating/Treating air trapping (auto PEEP) problems. | When the expiratory time is extended (Inspiratory-time shortened, increase flowrate), complete exhalation can occur and the auto-PEEP is gone. |
| Tachypneia | Increased RR >20 breaths/min Cause: Hypoxia, fever, pain, CNS problem |
| Pneumonia | Reult of an inflammatory process that primarily affects the gas exchange area of the lung causing capillary fluid (serum) to pour into the alveoli. This is termed effusion. If the infection becomes overwhelming it is termed consolidation |
| What is the Primary Assessment for Pneumonia | Initially mimics a cold or flu, signs and symptoms may develop quickly SOB Cough: Productive, yellow/green Decreased chest expansion Tachypnea Cyanosis 7Breath sounds:Crackles, bronchial whispered pectoriloquy appearance Diaphoretic increased HR,B |
| Rhonchi | Coarse Rales (rhonchi) large airway secreations (upper) Patient needs suctioning |
| Rales (crackles) | secretion/fluid |
| Medium Rales | Middle airway secreations Patient needs chest physical therapy |
| Fine Rales | Moist crepitant rales- alveoli,fluid Patient has CHF/pulmonary edema Patient needs IPPB, heart drugs, diuretics and oxygen |
| Ultrasonic nebulizer | electgrical energy is changed to mechanical (vibrational)energy through the use of a transducer with a piezoelectric quality Highest output - gives plenty of moisture for thick secreations For thick tenacious secretions |
| After 5min of ultrasonic therapy for bronchial pneumonia, the patient complains of SOB. Upon auscultation the therapist notes severely diminished breath sounds and rhonchi. Pt is cyanotic, tachypneic, tachycardic and retracting. What do you do 1st.. | Suction the patient immediately |
| Describe Diffuse | Allover the place spread throughout atelectasis/pneumonia |
| Describe Infiltrate | Any ill-defined(I don't know) radiodensity (Looks funny) Atelectasis |
| An X-ray shows diffuse infiltrates in the lower lobes, auscultation reveals coarse rhonchi and rales bilaterally. Pt has a temp. What should be recommended to improve ventilation? | Pulmonary drainage and percussion |
| Name 2 drugs to help an asthma patient with bilateral wheezes in the ER. | Use Beta2 Adrenergic Bronchodilators 1. Metaproterenol (alupent) 2. Levalbuterol (xopenex) |
| Aminophylline (Theophylline) | Side Door Bronchodilator Case increase in CAMP within smooth muscle. The increased amount of cAMP the causes bronchodilation. Administered by intravenous, injection, by tablet |
| Levalbuteral (Xopenex) | Front Door Bronchodilator Beta2 Adrenergic Unit dose Rescue/Quick Relief Medications |
| Epinephrine | Flight or fight Blood vessels and air passage diameters |
| Racemic Epinephrine (Vaponephrine) | alpha effects which cause vasoconstriction and reduces blood flow and mucosal edema Used for upper airway conditions such as croup and post exgtubation swelling where mild/moderate stridor is present Dose: .25mL in 2.5 mL of saline |
| During an IPPB treatment, a patient slumps over in bed and does not cycle the machine. What should you do? | Assess the patients responsiveness check for exhaled air over the mouth and nose |
| Recommend modifications to reverse atelectasis with a patient on a volume cycled ventilator | Add Peep Add inspiratory Hold |
| Recruitment Maneuvers (E-23) | Sustained increase in pressure in lungs with the goal of opening as many collapsed lung units as possible sustained inflation CPAP of 30-40cmH2O for 40sec PEEP of 20cmH2O with PIP of 40 PCV with increased PEEP Increased PIP in increments of 5 Sigh B |
| Thoraotomy | An an incision into the pleural space of the chest |
| Flail Chest | A condition that occurs when enough ribs are broken (usually from a crushing injury) to compromise the rigidity of the chest wall. On inspiration, the chest wall moves inward instead of outward, and it does the opposite on expiration. |
| The lowest settings on the ventilator prior to extubation are | SIMV/IMV: 4 breaths per minute FIO2: 40% PEEP: 5 cmH2O - own physiological PEEP |
| Hemoglobin (Hb) | Carries oxygen (1.34 mL per gram Hb) Normal value = 12-16 gm/100 mL blood (g/dl) Low Hb= anemia (administer blood) High Hb= polycythemia |
| High Frequency Ventilation (E-18) | Fast Rate, tiny small volume [tiny breaths] Primary controls used to adjust ventilation and control gas exchange: 1. rate control/ frequency 2. Amplitude/Drive pressure regulator (volume) 3.%inspiratory time (I:E ratio) |
| Weaning: what does pressure support (PSV) help with... | Support inspiration when the patient is having difficulty with weaning. PSV can be used with IMV/SIMV |
| When weaning a patient from a ventilator, the therapist reduces the mandatory rate. The low exhaled volume and high rate alarms sound, what should be recommended | Add pressure support (this to support inspiration when a patient is having difficulty weaning) |
| The I:E Ratio alarm on a volume controlled vent is sounding. How should the therapist correct this situation? | Increase Peak Flow Fact: Expiratory time S/B Greater than I-time ↑Flow ↓I-time ↑E-time |
| I:Ratio (Flow Rate) is adjusted by adjusting_____. | Flow Rate |
| What is I:E ratio | I:E ratio is the amount of time for inspiration compared to the amount of time for exhalation Ex: 1:1 ratio - equal time for both 1:2 ratio - exhalation is twice as long as inspiration Expiratory time should be greater than inspiratory time(1:2 |
| I:E Ratio COPD Patients need more time to... | Exhale I:E ratio: (1:4) (1:5) |
| I:E Ratio Increasing the flow rate will increase the time to_______ | Increase the time for exhalation ↑Flow ↓I-time ↑E-time |
| An adult patient is recieving external cardiac compressions and manual ventilation. When cardiac compressions are momentarily discontinued the Patient Is Pulsesless and the ECG shows the pattern below. What is the appropiate action at this time? | defibrillate at 200 joules - Biphasic defibrillator or Defibrillate at 260 joules - monophasic defibrillator |
| Interpretation/Management of ECG Abnormalities Rate: HR (beats per min) | Normal= 60-100 Bradycardia= <60 Tachycardia = >100 Flutter = >200 Fibrillation= To fast to count |
| Ventricular Tachycardia V-Tach Ventricular rhythm with rate >100 What is the treatment? | Defibrillate (if no pulse) Lidocaine & Cardiovert (if pulse is present) |
| During an exercise tolerance test on a patient, the heart monitor shows an atrial rate of 202 and ventricular rate of 67. The immediate treatment for this situation is? | Perform cardioversion. Patient has a rate abnormality (Flutter >200) with a pulse |
| The 1st step in performing one rescurer CPR for an unwitnessed cardiopulmonary arrest in Adults and children (8 years and older). | Determine unresponsiveness - no breathing or only gasping. |
| When the therapist enters a patient's room, he notices that the patient appears to be sleeping and his EKG monitor line is flat. The therapist should? | Check for patient responsiveness 1st |
| The patients lungs are not being ventilated during ventilating with Mouth to Mask (Mouth to Valve) Ventilation. | Reposition the patients head |
| Chest Drainage System Continuous bubbling in the water-seal bottle indicates ... | a air leak in the system |
| Chest Drainage System The middle bottle is the water seal bottle, preventing air from entering the pleural cavity. Normally there is ________. | little or no bubbling in this bottle |
| Chest Drainage Systems If water seal breaks______ If patient is receiving mechanical ventilation then ________ | Submerge chest tube in a glass of water. Leave the tube open to atmospheric air until a new system can be set up |
| Chest Drainage System The Control Bottle regulates______ | the amount of negative pressure being applied above the water seal. |
| Chest Drainage System The water height in the suction control bottle will determine_____. | the amount of negative pressure |
| When Removing a chest tube, in order to assume normal intrapleural pressure the tube is clamped for___. | 24 hrs before removing the tube. |
| The chest tube is ________ for any signs of _______ or if the X-Ray indicates a __________. | 1. unclamped 2. Respiratory Distress 3. pneumothorax or pleural effusion |
| Just before removing the tubes the patient takes a deep breath, exhales and performs a _____. | Valsalva Maneuver |
| >20% pneumothorax will require a ____. | Chest tube |
| What Abnormal conditions require a chest tube? | Pneumothorax Hemothorax or pleural effusion |
| Pneumothorax | air enters the pleural space with little or no fluid |
| Tension pneumothorax | Air is not allowed to escape, it collapses the lung but also affect the mediastinum by pushing it way from the affected side |
| A patient is tachypnea, trachea deviated to the right, splinting, asyummetrical chest movement and decreased breath sounds on the Left side. The best treatment for this patient is? | Insert a chest tube. |
| Hemothorax or Pleural effusion [Blood] [Fluid] | Fluid that enters the pleural cavity Immediate action should be taken to insert a Large bore needle to relieve the pressure. Then insert a chest tube and apply the most appropriate chest tube drainage system. |
| If a chest tube is to drain AIR from the pleural space, it is placed in the_____? | Anterior chest (second intercostal space in teh midclavicular line) (higher in chest) |
| If the chest tube is to drain FLUID form the pleural space, it is placed _____? | In the 4th or 5th intercostal space in the midaxillary line. (little bit lower) |
| How long will a cylinder last? H cylinder @500psi, O2@ 1 L/min | H cylinder = 3.14 Round 3.0 Cylinder pressure X Cylinder Factor / Liter Flow 500 X 3.0/1 = 1500 1500/60sec =25 hrs |
| What Oxygen delivery device is good for a Patient with COPD and Pneumonia? | Air Entrainment Mask(Venturi Mask) |
| A Patient with COPD and pneumonia has the following arterial blood gas on room air. pH 7.39 PaCO2 48 PaO2 46 HCO3 28 What oxygen device should be recommended? | Air entrainment mask with FIO2 of 28% |
| The amount of oxygen actually combined with hemoglobin, expressed as a percentage of the oxygen capacity of that hemoglobin. | Oxyhemoglobin % |
| When O2 therapy is need for a patient with a tracheostomy tube, use_____. | T-piece or trach collar |
| A patient spontaneously breathing through a tracheostomy tube has an oxyhemoglobin level of 88% on room air. What piece of equipment should be used to deliver oxygen therapy to the patient? | Oxygen therapy (O2%) with a T-piece or trach collar |
| Noramal value for Capnography (ETCO2) | 3-5% |
| A Increase in PECO2 (capnography) level %. Such as 8% would indicate a | ↓ in ventilation (Ventilatory failure) Fix: by increasing ↑ minute ventilation See (A-46) |
| Spacer See (B-41) | 1.↑ TV 2.Used in Rehab programs 3.↑'s stability of aersol and results in deeper penetration of the particles |
| A Spacer can also be used for drug delivery by MDI to | intubated and mechanically ventilated patients |
| A spacer can be used to overcome | coordination difficulties |
| A spacer improves the efficacy of MDI by | allowing larger particles to attach to the walls of the device and decrease oral deposition |
| If a patient exhales immediately following activation of the inhaler, while using the spacer, they will_____ | Clear the medication from the devie and waste the dose |
| Febrile | Marked or caused by fever, feverish |
| If a patient is having difficulty achieving the set goal on a flow-oriented spirometer, tthen switch to a | volume-oriented spirometer |
| To prevent hypoxia during a circuit change, it is necessary while the new circuit is attached and tested by another person to | Manually Ventilate with a resuscitation bag (changing a circuit is a 2 person JOB)!! |
| Hypoxia | The body is not getting enough Oxygen |
| Given: spontanious breathing parameters VT (5mL/kg VC (15 mL/kg) MEP (-45cmH2O) Do you intubate patient? | NO! Parameters are Normal = VT ≥ 5mL/kg VC ≥ 10mL/kg MEP ≥ 40 cmH2O Facilitate deep breathing with incentive spirometry See(E-30) Weaning |
| Negative pressure ventilator, Ventilation is controlled by? | adjusting the length of inspiration (time cycle) (inspiratory time) and the amount of suction (negative pressure) |
| When using a Negative pressure ventilator with a vacuum setting of 20 cmH2O and the transcutaneous monitor records CO2 68 torr and O2 of 70 torr, what do you recommend 1st | The CO2 is 68 - Ventilation prob Fix ventilation 1st Ventilation is controlled by adjusting the length of inspiration (time cycle) (inspiratory time) and the amount of suction (negative pressure) |
Created by:
Max912