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Midterm - RCT125

Stark State Clinical Midterm - Huston

QuestionAnswer
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