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TMC: Study Guide

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
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) *
Created by: tumi6472
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