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TMC: Study Guide
| Question | Answer |
|---|---|
| What are the four life functions? | Ventilation, Oxygenation, Circulation. Perfusion |
| How can you measure ventilation? | Frequency, Tidal Volume, Chest movement, Breath sounds, paCO2, ETCO2 |
| How can you measure oxygenation? | Heart rate, color, sensorium, PaO2, SpO2 |
| How can you measure circulation? | heart rate & strength, cardiac output |
| Things you CAN SEE on a patient: | Appearance, Edema, Dig. Clubbing, Venous Distention, Cap. Refill, Diaphoresis, Skin Color, Movement of Chest/ Diaphragm, Breathing Patterns, Apnea, Muscle Activity/ Condition, Retractions/ Nasal Flaring, Character of Cough, Evidence of Difficult a/w |
| Edema [+1 through +3] caused by: | CHF & Renal Failure |
| Digital Clubbing caused by: | Chronic Hypoxemia |
| Venous Distention caused by: | CHF or during exhalation with Obstructive lung disease |
| Capillary Refill should return within: ______ seconds | 3 seconds |
| What can cause Diaphoresis? | Heart Failure, Fever/Infection, Anxiety/Nervousness, Tuberculosis |
| Diaphoresis + Heart Failure recommend: | diuretics, positive inotropic agents |
| Diaphoresis + fever/ Infection recommend: | Antibiotics |
| Diaphoresis + Anxiety/ Nervousness recommend: | Sedatives |
| Diaphoresis + Tuberculosis/ night sweats recommend: | Antitubercular drugs |
| Skin Color & Cause: ASHEN/ PALLOR | anemia, acute blood loss, vasoconstriction |
| Skin Color & Cause: JAUNDICE | liver- increase of bilirubin |
| Skin Color & Cause: ERYTHEMA | transcutaneous: capillary congestion, inflammation, or infection |
| Skin Color & Cause: CYANOSIS | hypoxemia |
| UNEQUAL chest/diaphragm movement: | post lung resection, post pneumonectomy, atelectasis, pneumothorax, flail chest, improper endotracheal insertion |
| Breathing Pattern: EUPNEA | normal: 12-20 bpm |
| Breathing Pattern: TACHYPNEA | Increased: above 20 bpm (think Hypoxia, Fever, Pain, CNS) |
| Breathing Pattern: BRADYPNEA | Decreased: below 12 bpm (think Sleep, Drugs, Alcohol, Metabolic Disorders) |
| Breathing Pattern: CHEYNE-STOKES | INCREASING then DECREASING frequency & depth with periods of Apnea (think Increased ICP, Brainstem Injury, Drug OD) |
| Breathing Pattern: BIOT's | Increased frequency & depth with IRREGULAR periods of Apnea (think CNS issue) |
| Breathing Pattern: KUSSMAUL'S | Increased Depth, Frequency, Irregular Rhythm, LABORED. GET ABG! (think metabolic acidosis, renal failure, diabetic ketoacidosis (DKA)) |
| Apneustic Breathing: | prolonged gasping inspiration followed by extremely short, insufficient expiration (think respiratory center issue, trauma, or tumor) |
| Things that you can FEEL on patient: | Pulsem Tracheal Deviation, Tactile Fremitus, Tenderness, Crepitus, Chest motion Symmetry |
| Normal Pulse: | 60- 100 bpm |
| Tachycardia= >100 bpm think/ recommend: | hypoxemia, anxiety, stress; recommend O2 |
| bradycardia= <60 bpm think/recommend: | heart failure, shock, code/emergency; recommend Atropine |
| a "20 bpm" change during therapy signifies: | Adverse Reaction; STOP treatment |
| Atelectasis, Fibrosis, Pneumonectomy, & Diaphragmatic paralysis can cause TRACHEAL DEVIATION to be PULLED to____ side. | Abnormal |
| Pleural Effusion, tension Pneumothorax, Tumor, or Mediastinal Mass can cause TRACHEAL DEVIATION to be PUSHED to ____side. | Normal |
| Percussion: RESONANT | normal |
| Percussion: FLAT | NOT air |
| Percussion: DULL | NOT air |
| Percussion: TYMPANIC | MUCH air |
| Percussion: HYPERRESONANT | MUCH air |
| Coarse crackles: | big/large airways |
| Medium crackles: | middle/mid airways: recommend Flutter or postural drainage |
| Fine crackles: | Alveoli: recommend O2, PPV, inotropic agents, diuretics |
| Wheeze: | bronchospasm: recommend Bronchodilator |
| Stridor = _____ airway obstruction recommend: | upper airway obstruction, recommend racemic epi, cool mist (suction) |
| Pleural Friction Rub: | visceral or parietal rub; recommend steroids or antibiotics |
| Heart Sounds S3 & S4 (neonates) think _____ recommend _____: | Think Heart Murmur; Recommend Echo |
| Hypertension (High BP) indicates: | Cardiac Stress |
| Hypotension (Low BP) indicates: | Poor Perfusion |
| CXR DESCRIPTION & TREATMENT: Pulmonary Edema | Fluffy Infiltrates, Butterfly/ Batwing pattern -Diuretics, Digitalis, Digoxin |
| CXR DESCRIPTION & TREATMENT: Atelectasis | Patchy Infiltrates, Crowded Pulmonary Vessels, Crowded Air Bronchograms -Lung Expansion (SMI, IPPB, CPAP/PEEP) |
| CXR DESCRIPTION & TREATMENT: ARDS or IRDS | Ground Glass Appearance, Honeycomb pattern, Diffuse bilateral Radiopacity -Oxygen, Low Vt or PIP, CPAP/PEEP |
| CXR DESCRIPTION & TREATMENT: Pleural Effusion | Blunting/ obliteration of costophrenic angle, Basilar Infiltrates w/ Meniscus, Concave superior interface/ Border -Thoracentesis, Chest Tube, Antibiotics, Steroids |
| CXR DESCRIPTION & TREATMENT: Pneumonia | Air Bronchogram -Antibiotics |
| CXR DESCRIPTION & TREATMENT: Pulmonary Embolus | Peripheral wedge Shaped infiltrate -Heparin, Streptokinase |
| CXR DESCRIPTION & TREATMENT: Tuberculosis | Cavity formation (often in Upper lobes) -Antitubercular agents |
| Useful in detecting the PRESENCE of mediastinal, pleural & parenchymal masses, pulmonary nodules & lesions not visualized on CXR: Useful in diagnosis of Bronchiectasis: | CT |
| Spiral CT with dye useful for diagnosing: | pulmonary embolus |
| Useful for determining Thoracic aneurysms, congenital abnormalities of the aorta & major thoracic vessels, especially in the hilarity area: Determines precise position of tumors, soft tissue abnormalities, & involvement of surrounding structures: | MRI |
| Useful for detecting a pulmonary embolism [normal ventilation, abnormal perfusion] | V/Q Scan |
| In a V/Q scan: explain Ventilation & explain Perfusion= | ventilation- obstruction will prevent gas from filling the lungs perfusion- obstruction will prevent radioactive iodine from passing through circulation |
| a BARIUM SWALLOW assists in the diagnosis of: | abnormalities in the hypopharynx, esophagus, or stomach |
| Indications for a Barium Swallow test: | -Suspected esophageal malignancy -dysphagia -congenital defect in hypo pharynx, esophagus -gastric Reflux (GERD) -Esophageal varices |
| Useful to detect and diagnose diseases earlier than MRI or CT scans as well as response to treatment: Useful in determining presence of cancer, brain disorders, & heart disease: | Positron Emission Tomography (PET scan/ Imaging) |
| This identifies obstructing lesions and bronchiectasis in the tracheobronchial tree: | Bronchography (bronchograms) |
| Indications for this SPECIAL DIAGNOSTIC TEST: Brain tumors, traumatic brain injuries, loss of brain function, epilepsy/ seizures, evaluation of sleep disorders | electroencephalography (EEG) |
| Used to diagnose a Pulmonary Embolism when V/Q & or CT are inconclusive: | Pulmonary Angiography |
| Indications for this SPECIAL DIAGNOSTIC TEST: Valvular disease or dysfunction, Myocardial disease, Abnormalities of cardiac blood flow, cardiac abnormalities in the infant, abnormal heart sounds | Echocardiogram (Ultrasound) |
| Used to assess overall cardiac function including Left ventricular & ejection Fraction: | Echocardiogram |
| Intracranial Pressure [ICP] Monitoring: normal= | 5 - 10 mmHg |
| Recommended Treatment if ICP > 20 mmHg: | hyperventilation, Lower jugular venous pressure, sedation & analgesia, osmotic agents to remove fluid from brain (MANNITOL &/ or HYPERTONIC SALINE) |
| Cerebral Perfusion Pressure [CPP] normal: CPP = MAP- ICP | 70 to 90 mmHg |
| Exhaled Gas Analysis: Exhaled NITRIC OXIDE [FENO] Testing Monitors ____ Useful for monitoring ____ Significantly Decreases ____ Handheld Device ____. | • Monitors: patient’s response to anti-inflammatory [corticosteroid] treatment • Useful for monitoring: asthma, cystic fibrosis, or COPD • Decrease signifies decrease in: airway inflammation • Handheld device: [NIOX] |
| Exhaled CARBON MONOXIDE [FECO] Testing: used to monitor ABSTINENCE in smokers= Heavy _____ ppm, Moderate ____ ppm, Light ____ ppm, Non smokers ____ ppm. | Heavy: >20 ppm Moderate 11-20 ppm Light 7-10 ppm Non Smokers <7 NORMAL <3 ppm |
| CBC consists of: | Red Blood Cells, Hemoglobin, Hematocrit, White Blood Cells, Platelets |
| RBC value: | [5 mill/mm3] |
| Hemoglobin value: | [15 g/100 mL blood (g/dL)] |
| Hematocrit value: | [45%] |
| White Blood Cells value: | [5,000 to 10,000 per mm3] |
| Types of WBC: | o Neutrophils [64%] bacterial infections o Lymphocytes [30%] o Monocytes [3%] tuberculosis o Eosinophils [2%] asthma/allergies o Basophils [1%] |
| Platelets value: | [150,000 to 400,000 per mm3] |
| A CHEMISTRY PANEL consists of: | Electrolytes: K, Na, Cl, HCO3 (CO2 content) |
| Potassium [K+] value: Low: High = | 4.0 mEq/L -Low: Metabolic Alkalosis, Excessive excretion, vomiting, flattened T-waves -High: Kidney failure, spiked T- waves [metabolic acidosis] |
| Sodium [Na+] value: Low: High = | 140 mEq/L |
| A respiratory therapist is assisting a physician with endotracheal intubation. Which of the following should be used INITIALLY to confirm tracheal intubation? | D. Colorimetric capnography assesses the presence of CO2 and provides confirmation of tracheal intubation when CO2 is detected. |
| Pulse oximetry is an assessment of oxygenation and does not provide | confirmation of tracheal intubation. |
| The cm mark of the endotracheal tube is an indicator of the depth of insertion, but does not | confirm placement of the endotracheal tube in the trachea |
| AGPAR score 0: | A (appearance): Pale or blue P (heart rate): absent G (reflex): no response A (muscle tone): limp R (respiratory rate): absent |
| APGAR score 1: | A (appearance): acrocyanosis "peripheral" P (heart rate): <100 G (reflex): grimace A (muscle tone): some flexion R (respiratory rate): slow, irregular |
| APGAR score 2: | A (appearance): completely pink P (heart rate): >100 G (reflex): cry, cough, sneeze A (muscle tone): active motion R (respiratory rate): good cry |
| APGAR taken at minute _____ & _____: | 1 & 5 |
| A 58-year-old female was diagnosed with bronchiectasis 3 years ago. She reports increased cough and difficulty clearing secretions for the past 4 weeks. A chest radiograph shows no significant changes. 1st recommendation?: | Airway Clearance therapy |
| The treatment of bronchiectasis includes techniques to____ and ____ viscid secretions. Postural drainage enhances ____ clearance. | loosen; mobilize; sputum |
| Bronchodilator alone will not aid in ____ removal: | secretion |
| Allergy testing is NOT a routine part of ____ induced ASTHMA: | exercise induced asthma |
| In which of the following circumstances will tracheal secretions tend to dry in an intubated patient?A. a water vapor pressure of 47 mm HgB.√ a relative humidity of 100% at 22° C (71.6° F) C. a dew point of 37° C (98.6°F)D. an absolute humidity of 44 mg/L | B.√ a relative humidity of 100% at 22° C (71.6° F) -The absolute humidity at this temperature is inadequate. |
| The absolute tracheal humidity must be greater than or equal to | 30 mg/L. (ex: an absolute humidity of 44 mg/L is acceptable ) |
| How could you decrease CO2 in PCV? | In PCV increasing the PIP (inspiratory pressure) will also increase the Tidal Volume & minute Ventilation (potentially causing a decrease in CO2) |
| In PCV: Increasing expiratory time will decrease: | tidal volume and minute ventilation, potentially causing an increase in PCO2 and a further decrease in pH. |
| Peak Flow cannot be set in _____ Ventilation: | Pressure Control-Ventilation |
| Which of the following medications should a respiratory therapist use to anesthetize a patient's airway prior to a flexible bronchoscopy procedure? | Lidocaine HCI: -Lidocaine HCl is a topical anesthetic and will reduce airway reflexes during the procedure. |
| A pulse oximeter can provide an accurate indication of a patient's oxyhemoglobin saturation in which of the following clinical conditions? | CHF, Polycythemia, Pulmonary HTN |
| a patient with carbon monoxide poisoning who is on a Pulse Ox will have ______ O2 sats. | Inaccurate: -Carbon monoxide poisoning will result in carboxyhemoglobin. Standard pulse oximetry is unable to distinguish oxyhemoglobin from carboxyhemoglobin, which will lead to a falsely elevated SpO2 reading. |
| Polycythemia is an elevation of: | Hemoglobin & Red Blood Count (SpO2/Pulse Ox not affected) |
| Transporting Pt receiving mechanical ventilation-> demand valve respirator: | Demand valve respirators require an additional high-pressure gas source and will not be helpful if gas runs out. |
| A decrease in arterial carbon dioxide will result in a ____ in end-tidal carbon dioxide. | decrease |
| According to CLIA standards, quality control must be performed for blood gas analyzers every ____ hours: | 8 hours: -Eight hours is the CLIA-approved time frame for quality control of blood gas analyzers. |
| While performing a patient-ventilator assessment, a respiratory therapist observes very little condensation in the heated wire circuit. The reservoir of the heated wick humidifier is full of water. The most likely explanation is that the: | patient circuit is operating normally. -the heated wire circuit is designed to maintain gas temperature to prevent condensation. |
| A lower than normal room temperature may result in an____in tubing condensation. | increase |
| Condensation is not significantly affected by _____ flow. | low |
| The minute ventilation _____ impact condensation in the circuit. | will not |
| Which of the following devices must be used to comply with airborne precautions? | N95 face mask: An N95 face mask will provide protection against airborne microorganisms. -Protection against inspiration of fine particles is not achieved by vinyl gloves, a barrier gown, or a full face shield. |
| Which of the following imaging techniques is preferred when identifying metastatic disease associated with non-small cell lung cancer? PET Scan, CXR, Ultrasound or Ventilation Scan | The metabolically active tissue of a malignant mass will be shown in a PET scan. |
| A Pt has been receiving mech ventilation through a tracheostomy tube for 16 days. The Pt begins to thrash about in the bed following withdrawal of a drug- induced coma. The Pt's trache tube has become dislodged. After sedation, what should RT do NEXT: | Reinsertion of the tracheostomy tube should be the first response of the therapist. -After 16 days, the tracheostomy tract should be well established, and the tube should be easily reinserted. -RESTORE PATENT AIRWAY |
| Dornase alfa (Pulmozyme), a mucolytic, is indicated for patients: | with cystic fibrosis that have increasing thick secretions. |
| Pentamidine isethionate (NebuPent) is for: | pneumocystis pneumonia in immunocompromised patients. |
| Iloprost (Ventavis) is for: | pulmonary arterial hypertension |
| Halcion can inhibit breathing; what is a drug that can REVERSE Halcion? | Romazicon (Flumazenil) is a drug that will reverse Halcion. |
| When patients have a history of myasthenia gravis and as a result of receiving Tensilon, the respiratory therapist must be on guard for an adverse reaction from the Tensilon. The medication that can reverse the effects of Tensilon is: | Atropine Sulfate |
| Epinephrine is a drug of choice to treat____ (cardiac rhythm). | Asystole |
| The medication _________ is a cerebral diuretic. This will lower the ICP. | Diamox (Acetazolamide) * Diuretic |
| Circuit Leaks in IPPB result in: | a failure to reach a preset pressure which then results in failure to cycle into exhalation |
| IPPB machines are pressure ventilators without volume measuring devices. How is exhaled volume determined with IPPB? | Directly measured at the exhalation valve outlet * Tidal volume must be measured externally at the exhalation port. |
| You really only need two things to CALCULATE "EtCO2": - | PO2 and end tidal CO2. End tidal CO2 comes from a device called a capnograph. |
| DETERMINING A PATIENTS "RAW": There is a procedure where RAW can be determined. In order to do that procedure all conditions must be standardized, including temp, pressure, & humidity to some degree. Only a ____ can provide this controlled environment. | BODY BOX |
| You can determine FRC in three different ways: | body box, nitrogen washout, helium dilution test |
| If someone has non-ventilated lung space, nitrogen washout and helium dilution are not helpful and may be inaccurate. What other type of equipment would then be useful? | PLETHYSMOGRAPH (body box) FRC determined by body box will be higher because it can access non-ventilated lung space and therefore is more accurate. |
| To determine the A-aDO2, the therapist will need which of the following? | Arterial O2 Tension (determined from ABG) and alveolar oxygen tension (PAO2) * |
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tumi6472
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