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Midterm - RCT125
Stark State Clinical Midterm - Huston
| Question | Answer |
|---|---|
| What defines a "Low Flow System"? | Oxygen administering devices that do not meet ALL of the patients inspiratory needs. |
| What defines a "High Flow System"? | Oxygen administering devices that provide for ALL of the patients inspiratory needs. |
| Examples of low flow systems? | Nasal catheter, Nasal cannula, Simple oxygen mask, Partial rebreathing mask |
| Examples of high flow systems? | Nonrebreathing mask, Air entrainment mask (Venturi mask), Aerosol mask, Face tent, Tracheostomy collar, T-tube |
| Increase in either tidal volume or RR does what to the O2% the patient receives from a low flow system? | Decreases the O2% due to more 21% room air being inhaled. |
| Decrease in tidal volume or RR does what to the O2% received from a low flow system? | Increases the O2% due to more 100% O2 being inhaled. |
| What are the factors that effect O2% being delivered by a low flow system | Flowmeter setting, Patients breathing pattern (RR, Tv, Inspiratoy flowrate), Anatomical reservoir, Equipment reservoir |
| Criteria for low flow systems? | Tv : 300mL - 700mL, RR : <25 Breaths per min, Breathing pattern is regular and consistent |
| Venturi mask: INDICATIONS? | Pts requiring low concentrations of O2(Chronic CO2 retention, COPD, chronic alveolar hypoventilation), When exact O2 concentrations are needed, Pts with changing breathing patterns |
| Venturi mask: LIMITATIONS? | Pulmonary asperation, Pressure necrosis, must be removed to eat, uncomfortable, must be on tight to ensure O2%, air entrainment must remain in tact. |
| Ratio for 24%? | 1:25 |
| Ratio for 28%? | 1:10 |
| Ratio for 31%? | 1:7 |
| Ratio for 35%? | 1:5 |
| Ratio for 40%? | 1:3 |
| Ratio for 60%? | 1:1 |
| Ratio for 70%? | 1:0.6 |
| Ratio for 100%? | 1:0 |
| Formula for total flow? | Flowmeter setting X sum of parts in ratio |
| Peak inspiratory flowrate =? (formula) | MV x 3 |
| Minute volume =? (formula) | RR x Vt |
| Factors affecting the O2% delivered from an Air-entrainment mask (Venturi mask) | Size of the jet orifice, size of the entrainment port, amount of downstream resistance. |
| An increase in the size of the jet orifice causes? (VENTURI MASK, LVN) | Decreases the amt of room air entrained, increases the amt of 100% O2 in the mask, provides less total flow, causes higher O2 concentrations. |
| A decrease in the size of the jet orifice causes? (VENTURI MASK, LVN) | Increases the amt of RA entrained, decreases the amt of 100% O2 in the mask, provides higher total flow, lower O2 concentration. |
| Cylinder factor for an E tank? | 0.28 L/PSI |
| Cylinder factor for an H tank? | 3.14 L/PSI |
| Formula to determine cylinder factor? | (capacity X 28.3) / presssure in a full cyl |
| Formula to determine tank duration? | (pressure X factor) / flowrate |
| What are the disadvantages of an uncompensated flowmeter? | when exposed to back pressure it indicates the incorrect flowrate delivered to the patient (lower than delivered) |
| Where is the needle valve located on an uncompensated flowmeter? | proximal to the thorpe tube |
| Goals of oxygen therapy? | decrease the work of breathing, decrease the work of the heart, treatment of hypoxemia |
| What is the difference between Hypoxia and Hypoxemia? | Hypoxemia is decreased levels of oxygen in the BLOOD, Hypoxia is decreased levels of oxygen in the TISSUE |
| Formula to determine Air/O2 dilution ratio? | A:100-O2 concentration, B:O2 concentration-21, A/B |
| Indications for NASAL CANNULA? | patients with chronic CO2 retention (COPD), chronic alveolar hypoventilation, need low concentrations of O2, stable respiratory rate and tidal volume |
| Limitations of NASAL CANNULA? | unstable (easily dislodged), not suitable for pts with varying inspiratory needs, inadequate O2 delivery in Mucosal Edema, Deviated septum, excessive mucous drainage, nasal polyps, flowrates above 6lpm do not increase O2%, doesn't provide exact O2% |
| Indications for SIMPLE O2 MASK? | delivery of medium concentrations of O2, post operative patient, temporary therapy while waiting for definate plans |
| Limitations for SIMPLE O2 MASK? | doesn't provide exact O2%, pulmonary aspiration, pressure necrosis, uncomfortable, must be removed to eat, not suitable for pts with varying inspiratory needs |
| Indications for PARTIAL REBREATHING MASK? | provide high concentrations of O2, Cardiac conditions (MI, after CPR), Trauma patients |
| Limitatiions of PARTIAL REBREATHING MASK? | doesn't provide exact O2%, pulmonary aspiration, pressure necrosis, must be removed to eat, uncomfortable, not suitable for pts with varying inspriatory needs |
| Indications for NONREBREATHING MASK? | Deliver high concentrations of O2 (carbon monoxide poisoning, pneumothorax, CHF, burns, trauma, MI, after CPR), deliver O2/He mixtures, deliver O2/CO2 mixtures |
| Limitations of NONREBREATHING MASK? | Must remain tight on pts face to provide O2% necessary, must be removed to eat, pressure necrosis, pulmonary aspiration, uncomfortable |
| Indications for VENTURI MASK? | Pts requiring low concentrations of oxygen (COPD, Chronic alvoelar hypoventilation), when exact O2 concentrations are needed, patients with changing breathing patterns |
| Limitations of VENTURI MASK? | pulmonary aspiration, pressure necrosis, must be removed to eat, uncomfortable, must be on tight to insure O2% delivery, air entrainment ports must remain in tact |
| Purpose of humidity? | supply moisture to inspired gases for comfort and prevention of damage to the tracheal mucosa, supply moisture that will match the moisture of the body at the point at which inspired gas enters the body |
| What is humidity? | Invisble moisture / Molecular water / WATER VAPOR / water in gaseous form |
| Indications for bubble diffusion humidifiers? | Nasal catheter, nasal cannula, simple O2 mask, venturi mask |
| Types of humidifiers? | Pass over, bubble diffusion, heated |
| Complications associated with improper humidification? | Impaired cilia activity, impaired mucous movement, inflammatory changes in the tracheal mucosa, necrosis of the tracheal epithelium, retention of secretions, atelectasis, pneumonia |
| Purpose of humidifiers? | increase AH, increase the capacity the gas has to hold moisture (when heated), increase the RH of the gas, increase the %BH, Minimize HD |
| Characteristics of PASS OVER humidifier? | Used with incubators, deliver %BH = 30%, not very efficient |
| Characteristics of BUBBLE DIFFUSION humidifiers? | Deliver %BH = 40% same as RA / RH = 100% at room temp, effective at 2-6lpm |
| Factors influencing the efficiency of humidifiers? | Time, surface area, temperature, gas flowrate |
| Types of heated humidifiers? | Cascade humidifier, Wick humidifier |
| Characteristics of CASCADE humidifier? | Gas passes beneath the surface of the water and up through a grid, efficient bubble humidifier, allows for heating of the water, used with mechanical ventilators, delivers 100% RH and 100% BH |
| Characteristics of WICK humidifier? | Deliver precise control of temp and humidity, provide no resistance to inspired gas flow, low risk of infection, deliver 100% RH (at body temp) and 100% BH |
| Wick humidifier features? | high temp alarm (40 degrees Celsius), low temp alarm (27 degrees Celsius), temp probe disconnect |
| Indications for heated humidifiers? | T-tube, tracheostomy collar, whenever the upper airway is bypassed |
| Complications of heated humidifiers? | Bacterial contamination, overhydration, underhydration, hyperthermia, tracheal burns |
| Factors affecting the delivered temp (heated humidifiers)? | Length of tubing, heater setting, room temp, flowrate of gas |
| Characteristics of PASSIVE humidifiers? | Rely on the exhange of heat and water vapor from the pts exhaled gasses for adding moisture, AKA - Artificial nose |
| Indications of PASSIVE humidifiers? | Short term use (24-48hrs), addition of moisture in pts with artificial airways, addition of moisture in mechanically ventilated pts, pts free of secretins and good fluid intake |
| Disadvantages of PASSIVE humidifiers? | Increased resistance to breathing, infection, requires pt with normal body temp, pt must be well hydrated and absent of secretions |
| Hazards of OXYGEN THERAPY? | Oxygen induced hypoventilation, Retrolental fibroplasia (retinopathy of prematurity), Absorption atelectasis, Pulmonary oxygen toxicity |
| Normal PaO2 in a COPD patient? | 50 - 60 mmHg |
| Normal PaO2 in a newborn <28 days old? | 40 - 60 mmHg |
| Normal PaO2 in a normal patient? | 80 - 100 mmHg |
| Formula to calculate the desired FiO2? | (desired PaO2 X Actual FiO2) / Actual PaO2 |
| Guidelines for O2 administration? | Make use of the lowest possible FiO2, maintain PaO2 in the normal range for the patient, utilize 100% O2 for 24hrs or less, pts with history of lung disease are more likely to develop complications |
| Indications for O2 administration? | Documented hypoxemia, an acute care situation where hypoxemia is suspected, severe trauma, acute MI, short term therapy or surgical intervention |
| Contraindications for O2 administration? | No specific contraindications to oxygen therapy exist when indications are judged to be present. |
| Bleed in calculation formula? | (V1 X C1)+(V2 X C2) = (V3 X C3) WHEN V1 = Volume (flow) of gas from main gas source, C1 = Conc of main source gas, V2 = Volume (flow) of bleed-in gas, C2 = Conc of bleed-in gas, V3 = Total flow delivered to patient, C3 = Final oxygen conc |
| Five major routes for transmission of pathogens? | Contact, Droplet, Airborne, Vehicle, Vectorborne |
| Nosocomial means? | Hospital Aquired |
| Characteristics of a nosocomial infection? | not present or incubating at the time of or 3 days after admission, infections within 30 days of discharge or an invasive surgical procedure. |
| Disinfection? | asepsis of inanimate surfaces |
| Antisepsis? | asepsis of body surfaces |
| What is the most common route of nosocomial infection? | Contact, due to improper handwashing. |
| Two types of CONTACT? | Direct, indirect |
| Direct contact? | direct transfer of pathogenic organism from one person to another, STD's |
| Indirect contact? | contact between host and contaminated objects: EX - clothing, dressings, contaminated needles, nebulizers, humidifiers, suction cath, PFT equipment |
| Droplet? | pathogen reaches the cucous membranes of a host via an infected person who is coughing / sneezing / talking |
| How far can "droplets" travel? | up to 3 feet |
| Droplet examples? | Hemophilus influenza, neisseria meningitis, streptococcal, influenza, rubella, mumps |
| Airborne? | pathogen is spread via the air |
| Airborne aerosol examples? | Legionnaire's Disease, RSV |
| Airborne droplet nuclei? | Residues of evaporated water, suspended in air for long periods of time, EX: TB, Varicella, Measles |
| Airborne dust particles? | fungal infections |
| Vehicle route of transmission? | Contaminated water, food, soil, or drugs |
| Waterborne vehilce examples? | Shigellosis, Cholera |
| Foodborne vehicle examples? | Salmonellosis, hepatitis A, E.Coli |
| Vectorborne? | Infectious diseases transmitted by animals / insects |
| Vectorborne examples? | Lyme's disease, Malaria, West Nile Virus, Bubonic plaque |
| MRSA? | Methicillin Resistant Staphyloccus Aureus, resistant to most antibiotics, treat with Vanconycin |
| VRE? | Vancomycin Resistant Enterococcus, lack antibiotics to treat VRE |
| Disease that is continually present in a population, but does not affect a great number of people at any one time? | Endemic |
| Disease having an extensive outbreak affecting a large number of people for a short period of time? | Epidemic |
| World wide distribution of a disease affecting large numbers of people? | Pandemic |
| What can you do to reduce the risk of cross contamination? | Use disposable equipment, reduce the use of multiple dose vials, never exchange equipment between patients, follow a regular schedule for changing equipment |
| Change HIGH RISK equipment how often? | 24hrs |
| Change LOW RISK equipment how often? | 72hrs |
| The single most effective thing to do to fight infectious disease? | PROPER HANDWASHING |
| CPR breaths per minute for an adult using a manual recussitator? | 10 - 12 or one every 6 to 7.5 seconds |
| CPR compression rate for adults? | 100 per minute |
| Compression to ventilation ratio (adult)? | 30:2 |
Created by:
dbates
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