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SECURE TMC TIPS
| Question | Answer |
|---|---|
| If you hear a low pressure alarm, what do you look for? | Leak |
| On an Arterial BP waveform on on Inspiration the systolic BP is 120 and expiration is 135; this is described as: | Pulsus Paradoxus |
| If the HR during an SBT is increasing than you should what? | Return to previous settings |
| Use a ______ for blood samples to establish an _______ shunt. | (central) catheter; intrapulmonary |
| What is the main goal for a patient who has CF? | Mucous mobilization is the goal |
| 5 indications to give fluid: | nausea, vomiting, tachycardia, bradypnea, hypotensive |
| If your baby has Q3H eating orders & there are Q4H CPT orders; when would you give the treatment? | give 1 Hr after feedings |
| There is a sudden loss of consciousness in your patient; what is the RT's main goal? and how would you do it? | Secure a/W patency, head tilt/ chin lift |
| If your Pt has SpO2 82% w/ increased WOB and the family wants CMV but they are DNR/DNI: what would you recommend? | NPPV |
| When monitoring ETCO2 and there is a fall of 10 in over 24H; what is a reason why? | Increased RR * Increased RR = decrease ETCO2 and vice versa |
| Central Sleep Apnea Tx: | BiPAP |
| Narcotic induced hyperventilation reversal (DRUG) ______: | Narcan |
| If your patient is mechanically ventilated / intubated and is Anxious, and biting on tube what DRUG would you recommend? | Propofol |
| A pt with chronic bronchitis is congested and presents with a non-productive cough; what would you add to their tx? | Add PEP therapy |
| ECG lead "V4" placed? | left mid clavicular line |
| NRB reservoir bag collapses on inspiration what do you do? | Increase Flow |
| Threshold resistor to exhalation valve: | Replace flow resistor |
| If you have an asthmatic pt on a vent and they are given a bronchodilator. How would you know if it is effective? | you will see a decrease in PIP's |
| while suctioning in-line and your patient becomes tachycardic; what should you always do prior to suctioning? | Increase FiO2 |
| What type of IV is used for Levophed? | Central venous (CVP catheter) |
| normal CUFF pressure: | 20-25 mmHg 25-35 cmH2O |
| ETT depth: Oral/Lips: Nares: | Oral/Lips: 21-25 cmH2O Nares: 26-29 cmH2O |
| If you notice that you are frequently suctioning a patient who is on a ventilator what can you add? | add closed circuit sxn catheter |
| Unequal breath sounds are clinical findings of: | Pneumo |
| SXN pressure for an adult? | 120; (-120) |
| If your pt is receiving a 70/30 helix mixture, without SOB & tachycardic: what do you recommend? | titrating to 80/20 mixture * this is less O2 |
| Loss of O2 can sound which alarms to go off_____ & the ventilator will alarm for: | O2 zone alarm; Low O2 alarm |
| This score ____ determines the neonates gestational age: | Ballard |
| "I can't breathe when I Lay down" is what kind of dyspnea? | Orthopnea |
| Smoke Inhalation. Give ______: | 100% O2 -NRB |
| You need to change the trach tube; you must first: | deflate the cuff |
| Disadvantage of portable liquid oxygen system: | EXPENSIVE; runs out quickly?? |
| Uses for Lidocaine during bronchoscopy: | anesthetic; give if pt coughs during procedure |
| In an unpressurized aircraft with an intubated patient; what is critical to monitor during transport? | a patients PULSE OXIMETER; SpO2 |
| for an Intubated patient who presents with trachea midline, decreased expansion of the left chest, and left BS diminished: what should you FIRST assess? | ETT position |
| a hypothermic trach pt needs ______ % of humidification which is relative to ______ degrees. | 100%; 37 |
| Describe the NORMAL function of a Chest Tube drainage system: if there is an increase in PIP this indicates: | H2O levels fluctuate with breathing; obstruction |
| how to properly use a DPI: | inhale forcefully, exhale normally. EC |
| how to properly use a MDI: | slow deep breath, exhale normal, WAIT 1 minute in between |
| VOCP: importance from most to least: | Ventilation, Oxygenation, Circulation, Perfusion |
| V-Fib with No pulse: | Defib |
| This diagnostic test of the chest can identify a pnuemo: | diagnostic chest percussion |
| Resonance = air; hyperresonance =_____ | increased amount of air |
| A patient is Young, and presents w/ an acute onset of Left chest pain, SOB with Equal BS, tachycardia, and Desaturation. This would indicate: | Pulmonary Embolism |
| why is an ABG best at the radial artery? | collateral blood flow present |
| HFOV initial frequency for a neonate: | 10 Hertz |
| A CXR would confirm the placement of a ________ catheter placement. | Subclavian |
| Your patient is unresponsive to verbal stimuli but passes the SBT; what do you do next? | EXTUBATE * NBRC WILL EXTUBATE THE PATIENT; THEY COULD BE RESPONSIVE TO SXNING BUT NOT VERBAL & THAT'S OKAY FOR NBRC!!! |
| Frequency of quality control for blood gas analyzer: | CLIA standards (8 hours) |
| Recommendations to position your patient who has Right LL atelectasis to improve oxygenation: | Left Lateral decubitus (this is a POSITION) |
| Airplane Scenario! Patient will present with : | Pulmonary embolus *Change in barometric pressures causes change in intrathoracic pressure |
| Which humidifier is effective in achieving absolute humidity? | Heated Passover humidifier |
| A healthy Ejection Fraction: ____% (<50-_____%) | 60% (<50-75%) *less than this think cardiac issues |
| Apnea ALARM Time test set @ __ to __ seconds: | 20-30 seconds |
| For VAP protocol you recommend this type of lavage: | mini-BAL lavage |
| Flail chest would present with _______ movement of the left chest: | Asymmetric |
| For a COPD pt; what are some goals of pulmonary rehab? | improve exercise tolerance |
| After intubation the EtCO@ detector turns ________ and gives _____% EtCO2. | yellow; 5% EtCO2 |
| If your pt presents with severe bronchospasm you would give _______. | Albuterol |
| VD/VT formula= ______ - PeCo2/ _______ | PaCO2-PeCO2/PaCO2 |
| How would you diagnose Chronic Bronchitis: | monitor daily expectorated sputum |
| If your patient has muscle weakness and fails weaning you would run this LAB test: | electrolytes test |
| How would you clean a SVN (at home): | detergent |
| a 6MWT is based upon: | SpO2 (desats) |
| If you ADD mechanical deadspace what will change and will NOT change? | Ve will NOT change; PaCO2 will increase |
| A tube inserted falsely into the LUMEN can cause: | subcutaneous around neck/face POST TRACH |
| How would you instruct your patient to breath during a DPI tx? | rapid inspiration, blow maximal inspiration volume, end inspiration hold |
| you would need this medical personnel for a patient with a language barrier? | medical interpreter |
| A thoracentesis is recommended for _______. | Pleural effusion "air up; midclavicular, fluid down; midaxillary " |
| your patient is unconscious with a neck injury and you need to improve manual ventilation; you would recommend this a/W: | OPA; oropharyngeal airway insert |
| You would notice presence of Auto-Peep on this waveform: | Flow |
| you notice the sternocleidomastoid & anterior scalene muscles being used: this indicates: | increased WOB |
| Your patient has a trach and there is noticeable vibration through chest on inspiration & expiration. What should you do? | suction the patient |
| There is a decreased MAP and Increased urine output; this would indicate and increased cardiac ______ | CI cardiac index (ASKKKKKKK) |
| Devices for infant INO: | HFNC, HFOV, vent. |
| a CXR asymmetrically spaced around sternum= | rotated patient |
| If you increase the inspiratory flow, what will then decrease? | I-Time |
| A patient on PCV and the vent fails to cycle to expiration; this = | leak in circuit (circuit leak) |
| in a Flow inflating bag, the bag doesn't fill during exhalation= | total flow |
| you notice BUBBLES (in the chest tube) at the END of INSPIRATION; this indicates a _____ leak. | Pleural leak |
| Persistent Vomitting can cause ______. | Alkalosis |
| Use a PRESSURE MANOMETER with _____ patients. | Respiratory muscle strength/ neuro patients. |
| You would REPLACE ELECTROLODES and RECALIBRATE if the value of ABG analyzer control solution is __________. | out of range |
| This type of analyzer measures accuracy of air/oxygen blender: | Polygraphic Analyzer |
| A Bronch is most useful with a patient who has | LOBAR ATELECTASIS |
| Proper depth of insertion of NPA: | tip of earlobe to the tip of the nares |
| You notice asymmetrical chest wall movement and absent right BS. You would recommend: | Needle Decompression |
| If you notice that a ALLENS TEST ON RIGHT PALM STAYS PALE (failed test), where would you obtain the sample? | Try the LEFT PALM |
| Your Pt presents with Hemoptysis. A CT scan is done, Nodule found, what can assist with this Dx? | Bronchoscopy |
| A PT presents w/ fever, chills, SOB, cough, bronchial BS. What would their LL-AP-CXR show? | Increased density with air bronchograms (think Pneumonia) |
| To drain the APICAL segment/ UPPER lobes of both lungs . What position of drains would you recommend? | Semi-fowlers Drains * remember gravity fluid drains DOWN |
| If you are unable to SXN your trach patient. What do you do next? | Replace inner cannula |
| If there is NO blood flow on LEFT & SHUNT in RIGHT arm. Where else can you get the ABG from? | Dorsalis Pedis (foot) |
| ETT positioned tip: | 5 cm above the carina |
| MVV maneuver instruction: | breathe deep & rapidly for 12 seconds |
| Following ABG collections; wash your _______. | hands |
| An increase in alveolar deadspace would = _______ in PeTCO2 values. | Increase |
| Decreased PaCO2, Increased P(A-a)O2 during exercise testing= ______ limitations to _______. | pulmonary limitations to exercise |
| Post Trach tube insert/change could CAUSE: | subcutaneous around neck/face |
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tumi6472
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