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RCP 120 Exam 3
| Term | Definition |
|---|---|
| What are the steps to active cycle breathing? | Pt should be relaxed and should do relaxed diaphragmatic breathing, Instruct Pt to take 3-4 active deep inspirations with passive relaxed exhalations instruct the patient to do 2-3 huffs starting at a low volume to a higher volume, May repeat 2-4 times |
| What is the minimum amount of sputum production needed to justify postural drainage therapy | <30 mL |
| What equipment is required for nasotracheal intubation? | Magill forceps and fiberoptic bronchoscopy |
| What induction agent tends to provide the best glottis visualization? | Propofol |
| Why do we give induction agents during rapid sequence intubation? | provide sedation, provide upper airway relaxation and amnestic response |
| What method should be used to secure the endotracheal tube? | Using tape or a special endotracheal tube holder |
| Proper size ET tubes for patients? | Men-8-8.5 Women-7-7.5 |
| Why are subglottic suction ET tubes used? | To be able to get the secretions that pool above the airway cuff, to reduce VAP |
| Indications and complications of oropharyngeal airways. | Provides a patent airway access for suctioning means for mechanical ventilation protects the airway direct instillation of medication Cant use if patient has a gag reflex regurgitation and aspiration teeth can be broken ventilated around but not through |
| How do we measure oropharyngeal and nasopharyngeal airways? | From mouth to jaw, from nose to meatus of ear |
| Mallampati class I | Soft palate, uvula, fauces, and pillars visible |
| What is the most common complication of suctioning? | Hypoxemia -should hyperoxygenate |
| Know all of the complications of endotracheal suctioning. | Atelectasis, hypoxemia, tissue trauma to the trachea, bronchoconstriction, bronchospasm, Infection, changes in ICP, hypertension, hypotension, cardiac dysrhythmias |
| What is the normal range of negative pressure for suctioning adults | 120-150 |
| What is the normal range of negative pressure for suctioning children? | 100-120 |
| What is the normal range of negative pressure for suctioning infants? | 80-100 |
| Understand how to determine what size suction catheter you should use on artificial airways. | (airway x3)/2 |
| What methods can help to reduce the likelihood of atelectasis due to tracheal suctioning? | Use the right size suction catheter and use the right suction pressure, And suction no more than 15 secs |
| What indications are observed on a patient with an inability to adequately protect the airway? | Respiratory failure due to inadequate oxygenation and/or ventilation, the need for airway protection due to obstruction, and inability to maintain a patent airway due to other patient factors (confused and the subsequent risk of aspiration) |
| What is the purpose of a cuff on an artificial tracheal airway? | seal off and protect lower airway |
| What is the purpose of the pilot balloon on an endotracheal or a tracheostomy tube? | To inflate the cuff, monitor the pressure of the cuff |
| The removable inner cannula commonly incorporated into modern tracheostomy tubes serves what purpose? | For cleaning with out having to remove the whole trach, so that if the patient has a fenestrated trach, they can breathe through the hole |
| In the absence of neck or facial injuries, what is the procedure of choice to establish a patent tracheal airway in an emergency? | orotracheal intubation |
| What items are required on intubation cart or crash cart for maintaining a patent airway? | Stylet, Co2 detector, nasopharyngeal airway, oropharyngeal airway, laryngoscope, batteries, blades, oxygen devices, suction, Endotracheal tubes of various sizes, A syringe, Bite block, lube, nasal cannula, sedative, tape device |
| Understand how to troubleshoot laryngoscopes | Check batteries, check bulb, check blade, check handle |
| What is the purpose of an endotracheal tube stylet? | Keeps the tube from being too flimsy/ helps bring the tube down |
| To make oral intubation easier, how should the patient’s head and neck be positioned? | Sniffing |
| What should be the maximum time devoted to any intubation attempt? | 30 seconds |
| Immediately after insertion of an oral endotracheal tube on an adult, what should you do? | Inflate the cuff and provide oxygenation |
| After an intubation attempt, an expired capnogram indicates a CO2 level near zero. What does this finding probably indicate? | Displacement/ in the esophagus |
| When using capnometry or colorimetry to differentiate esophageal from tracheal placement of an endotracheal tube, what conditions can result in a false-negative finding (i.e., no CO2 present even when the tube is in the trachea)? | Cardiac arrest |
| After intubation of a cardiac arrest victim, you observe a slow but steady rise in the expired CO2 levels as measured by a bedside capnometer. Which of the following best explains this observation? | Yes in the trachea, patient is experiencing return spontaneous of circulation |
| What are the serious complications associated with oral intubation? | Cardiac arrest, oral trauma, pharyngeal trauma, laryngeal/tracheal trauma, main bronchus intubation, pulmonary aspiration, esophagus intubation, hypoxemia, cardiac arrhythmias |
| Which of the following factors should be considered when deciding to change from an endotracheal tube to a tracheostomy tube? | Pt’s tolerance of ET tube, relative risks of continued intubation vs. tracheostomy, Pt’s severity of illness, length of time that the pt will need it, Pt’s ability to tolerate a surgical procedure |
| Soon after endotracheal tube extubation, an adult patient exhibits a high-pitched inspiratory noise, heard without a stethoscope. Which of the following actions would you recommend? | Racemic epi |
| What airway injuries are associated with tracheostomy tubes? | Bleeding, pneumothorax, air embolism, subcutaneous emphysema, infection, hemorrhage, obstruction, tracheoesophageal fistula, tracheal stenosis |
| On chest radiography, where is the distal portion of the endotracheal tube supposed to be located? | 2-6cm above the carina |
| What is the maximum recommended range for tracheal tube cuff pressures? | 20-30 |
| Repeated connecting and disconnecting of a cuff pressure manometer to the pilot tube of a cuffed tracheal airway will do which of the following? | Can cause the cuff to lose pressure |
| What are possible causes of this artificial airway obstruction? | Mucus plugging, kinking, biting, wedging to the wall of the trachea |
| How would you assess the upper airway function of a patient with a fenestrated tracheostomy tube? | Remove cannula, plug opening, deflate cuff |
| Therapeutic indications for fiberoptic bronchoscopy. | Difficult airways- classes III and IV, retrieve foreign bodies, inspect airways, obtain specimen or analysis, and aid in et intubation |
| Complications of fiberoptic bronchoscopy | Hypoxemia, Hemodynamic changes (CO, BP,HR) bronchospasm, infection |
| Key points to consider in planning fiberoptic bronchoscopy | Premed, Equipment prep, airway prep, monitoring, |
| To avoid the risk of aspiration after a fiberoptic bronchoscopy procedure, what would you recommend that the patient do? | Don’t eat or drink |
| What is the major contributing factor in the development of postoperative atelectasis? | Shallow breathing |
| Indications and method for Incentive Spirometry, CPAP, PEP therapy? | -Lung expansion PEP-help mobilize secretions and bronchodilators IS- prevent atelectasis, 10x per hour volume and flow goals and patient effort and motivation and maintenance of breath hold CPAP- apnea |
| What outcomes would indicate improvement in a patient previously diagnosed with atelectasis who has been receiving incentive spirometry? | Absence of atelectasis, improved chest x ray, improved breath sounds, decreased respiratory rate, improved PaO2 |
| What are the complications and hazards of IS, CPAP, PEP, Postural drainage, CPT? | IS- hyperventilation, , PEP-pulmonary injuries CPAP-barrow trauma, gastric distention Postural drainage and CPT- acute hypotension, cardiac arrhythmias and increased ICP |
| What should the RT monitor during IS, PEP Postural drainage, CPT? | Sputum color and amount, adverse reactions, vital signs, chest x-ray and afebrile for 24 hours |
| What are the desirable outcomes and contraindications for IPPB? | IPPB- improve oxygenation, increase a cough, clear secretions, breath sounds, reduces dyspnea, etc COPD addiction |
| A normal cough reflex includes what? | Irritation, Inspiration, Compression, Expulsion |
| What can provoke a cough? | Deep breathing |
| Goals for airway clearance? | Clear secretions, improve gas exchange, reduce work of breathing |
| Properly performed chest vibration is applied at what point? | During exhalation |
| What factors can hinder effective coughing? | Pain or fear of pain, systemic dehydration, neuromuscular disease, artificial airway |
| What is the difference in Lung Expansion and Airway Clearance? | Lung expansion helps to prevent atelectasis and airway clearance keeps the airway patent |
| When should postural drainage be terminated? | When there is a severe reaction |
| Mallampati class II | Soft palate, fauces, and uvula visible |
| Mallampati class III | Soft palate and base of uvula |
| Mallampati class IV | Hard palate |
Created by:
K.Moskowitz
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