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midterm 2
| Question | Answer |
|---|---|
| a centruy after laplace described the relationship of transuraface pressure and surface tension of gas-fluid interface in a sphere what did neergaard discover about the retractile force of the lung? | that it was dependaent on the surface tension in the alveoli |
| how is surface tension created? | by the attraction of water molecules to one another at the liquid gas interface |
| ehat does the laplace law postulate about the alveoli in the lung? | that alveoli would collapse as they got smaller |
| which physiological consequqnces would develop if the liquid gas interface were without surfactant? | every breath would require more pressure to expand lung w inspiration and all the alveoli would collapse during exhalation |
| what physiological conditions result from the presence of normal amounts of pulmonary surfactant in the lung? | uniform gas distribution during inspiration and functional residual capacity is maintained |
| what structure is responsible for producing pulmonary surfactant? | type II pmeumocytes |
| what components comprise pulmonary surfactant? | dipalmitoyl phosphatidylcholine, phosphatidylinositol, and phospholipids |
| what following proteins are known to comprise human pulomary surfactant? | SP-B, Sp-C, Sp-D |
| What is the role of SP-d in human pulmonary surfactant? | suppresses proinflammatory responses, enhances killing of microbes, enhances phagocytosis |
| what relationship id correct rearding to the composition of amniotic fluid as it relates to determining fetal lung maturity? | PG and lecithin increase while sphingomyelin decreases during gestation |
| what is the most commone form of surfactant abnormality? | inactivation by proteins |
| full term infants with RDS, surfactant nonresponders and infancts who can't be extubated in the first weeks of life because of a respiratory condition should be evaluated for? | alpha antitrypsin deficiency, SPB deficiency |
| what cardiovascular conditions can cause surfactant inactivation? | pulmonary hemorrhage and hemorrhagic edema |
| what pathophysiologic conditions are components of meconium aspiration? | surfactant inactivation and chemical pneumonitis |
| How is pna in a neo believed to adversely affect surfactant? | by bacteria directly attacking type II pneumo and by microorganisms releasing substances altering surfactant components |
| which proteins are found to be deficient in the sputum of pts with asthma? | SP-A |
| what are the physiologic benegits of surfactant? | prevents capillary leakage of fluid into alveoli, optimizes surface area for gas exchange and protects epithelium of lung |
| what causes upper airway obstruction and may require an artifical airway? | laryngotracheobronchitis, epiglottitis, subglottic stenosis |
| on the bases of illustration of neo et indetify murpheys eye | b hole at the distal end of the tube |
| therapist about to perform ett on a 2 yo infant what size tube? | 4.5mm ID |
| why are some ped ETT available without cuffs? | because in some infants ETT creats a seal against cricoid cartulage |
| where in the upper airway if an infant should the laryngoscope blade be placed to expose the glottis during ett? | epiglottis directly lifted with tip of laryngoscope blade |
| which statement describes the LMA? | potential for aspiration greater than with tranlaryngeal intubation as well as LMA good alternative as an emergency airway when ppv needed |
| whats the purpose of placing small towel under occiput of 4 yo? | to align oral cavity, pharynx, and larynx |
| when should sellicks maneuver be performed? | when pt is at risk for regurgitating or aspirating during intubation |
| how should therapist determine depth of insertion of ETT in infant during intubation | at pt where single heavy black line just moves beyond the glottis |
| what anatomical difference between larynx of an infant to an adult makes intubation of the infant more difficult? | larynx of infant is more cephalad and anterior |
| what conditions are considered disadvantages of nasotracheal intubation in neonates? | postextubation atelectasis among very low birth weight infants, pressure necrosis of nares |
| what forms of et will neonate w pierre robin syndrome likely undergo? | anterior commissure intubation |
| 5 yo child brought to er in severe respiratory distress w diagnosis of epiglottis, what measures must be performed to secure childs airway? | child needs to be transported to OR intubated |
| a child is orally intubated because of laryngotracheal stenosis has an air leak at 25 cm h2o what action does therapist take now? | therapist must insert an oral ETT large enough to stop leak |
| Which following areas of an infant's upper airway are most prone to develop edema as a result of ett? | subglottic area |
| what equipment is essential for performing extubation? | stylet, yaunkerm opa |
| how do arched and angled trach tubes compare to each other? | angled tube is longer |
| what are most common causes pf death in a trach dependant child? | accidental decannulation and mucous plugging |
| what typr of x-ray view is obtained when xray plate is between pt's back and bed w x-ray tube in front of pt's chest? | anteriorposterior view |
| lateral decub view is front x-ray projection wherby side down can be evaluated for presence of ____ and side up may better define _____ | a pleural effusion, pneumothorax |
| what xray would be best suited for eval of fractured ribs in peds pt? | oblique view |
| how will well expanded air filled lungs appear on an x-ray? | black |
| therapist is viewing x-ray of peds pt recently awoke form anesthesia after upper abd surgery. Right hemidiaphragm is elevated w atelectasis seen as long thich horizontal line w/in right lower lobe. what term describes this atelectasis? | plate |
| peds pt w pna has infiltrate in lower half of right lung. Right heart border is obliterated. which lobes of right lung is infiltrate located? | right middle lobe |
| what structures on an x-ray projects to the left causing a prominent bulge of superior mediastinum and mild indentation on trachea? | aortic arch |
| AP x-ray neo examined and structure projecting away from mediastinum toward the right upper lung. structure looks like a sail w sharp inferior margin and lateral margins w wavy contours. what structure are you seeing? | thymus |
| minor fissure on r side of lung seperates which of folloing lobes? | middle from upper lobe |
| x-ray 18m/ boy trachea is truncated and right lung is collapsed. what situations or conditions may have caused this situation? | mucous plug in the right mainstem bronchus |
| therapist is viewing frontal chest x-ray of neonate has just been ett. therapist notices tip of ett located between thoracic inlet and carina what to do? | nothing ett good placement |
| what xray view provides best perspective for ascertaining position of ett in pt esophogus? | lateral view |
| therapist viewing frontal and lateral nech x-rays of 12mth notices steeple sign subglottic narrowing below vocal chords and an overdistended hypopharynx. what condition is this? | laryngotracheobronchitis |
| lateral view of neck x-ray 18 mth enlarged epiglottis, aryepiglottic folds are thickened and hypopharynx is overdistended what condition is this? | epiglottitis |
| 42 week infnat sga. x-ray reveals coards patch opacities secondary to atelectasis from bronchial obstruction alternating w areas of hyperinflation. what clinical disorder? | meconium aspiration syndrome |
| which term refers to abnormally low levels of o2 in the tissues | hypoxia |
| where does fetal oxyhemoglobin dissociation curve reside in comparison w normal adult diss curve? | fetal oxyhemoglobin lies to the left of the adult curve |
| therapist eval neo o2 PaO2 40, SpO2 80, what to do? | add FiO2 to raise SpO2 to 90% |
| which problems occur as result of abs atelectasis? | increased intrapulmonary shunting and decreased alveolar volumes |
| what tyoes of neo and pped O2 delivery are applied clinically? | low flow, high flow, fixed and variable performance |
| what O2 delivery devices be most suitable for an infant being treated for chanal atresia? | O2 hood |
| how should nasal cannula be secured in an active infant? | secure cannula to face and tighten cannula behind head. |
| when weaning infant receiving O2 from nasal cannula attched to low flowmeter set at 100% what range is recomended? | 0.1-0.2 L/min |
| whats the concern when admin O2 to sedated infant wearing a nasal cannula? | too high an FiO2 can be given |
| what ranges of O2 flow need to be set when admin O2 to an infant via simple mask? | 6-10L/min |
| therapist noices reservoir bad on partial rebreathing mask being worn by peds pt collapses during inspiration what to do? | increase O2 flow |
| what gas delivery devices are most suitable for admin of heliox? | nonrebreathing mask |
| whats the purpose of attaching 22mm humidification collar to an air entrainment mask despite adding no humidification to delived gas? | safeguard against bedlinings obstructing air entrainment port |
| how will excess condensate present in aerosol tubing affect delivered FIo2 | increase FiO2 |
| for which of following conditions is a high flow nasal cannula indicated? | apnea of prematurity |
| which features characterize a self inflating neo resus bag? | max Vt 200-300ml, one way valved preventing rebreathing of exhaled gas, reservoir to achieve high O2 concentrations, pressure relief valve preventing excess pressure |
| noe w min vent of 2L/min about to be bvm w non self inflating resu bad what flow should be set? | 4-6 L/min |
| what are advantages of non-self inflating resus system? | amt of PEEP can be set, 100% fio2, inspiratory pressure can be regulated |
| what percentage does breath holding increase particle deposition in the lungs? | 10% |
| what mechanism is the primary mechanism for deposition of particles w a diameter of 5 micro g or greater? | inertial impaction |
| what factors increase the rate of inertial impaction of particles greater than 2 micro grams in diameter? | bifurcations and obstructed airways |
| what term best describes activity of aerosol particles less than 3 micrograms in diameter throughout distal airways? | diffusion and browning movement |
| what characteristic of an aerosol influences its ability to penetrate mucous barrier? | solubility of aerosol particles, charge, size of particles |
| pneumatic nebulizers operate according to whcih physical tenets? | bernoulli principle |
| what % of nominal dose would remain in nebulizer of nebulizer had a residual volume of 1ml and fill volume of 2ml | 50% |
| while nebulizing alb to pt via svn therapist hears sputtering sound originiating from neb how should respond? | terminate treatment |
| why pass over humidifiers preferred over pneumatic nebulizers? | pass over trasnmit fewer pathogens |
| which following considerations is most important when using large volume nebulizer to provide oxygen and humidification to an infant in an incubater? | preventing a high noise level from developing |
| how can pt avoid problem of terminating inhalation when a plume from oressurized mdi impacts the oropharynx? | use a valved holding chamber |
| ped pt w inspiratory flow 20l.min enters emergency department wheezing and sob what devices would be most effective? | svn |
| which functions are served by spacer and holding chambers in conjunction with pMDIs | reduction in oropharyngeal deposition of drug, elimination of cold freon effect, and improvement in lower respiratory tract deposition |
| why should pMDI containing steroids be used with a valved holding chambe? | reduce risk of thrush/ yeast infection |
| for which of following types of pts would DPI be contraindicated? | 4 yo, 85 yo w copd, altered loc teen |
| physician in er attending to a 12 yo exacerbation of asthma, physician asks therapist to recommend a med w synergistic effect w b2 agonist during asthma exacerbations | ipratropium bromide |
| 18 mth pt brought to er exhibiting s/s acute athma episode and administered as a B2 agonist to pt doesn't respond favorably what conditions could be responsible? | aspiration of foreign object |
| therapise receoves an order to admin bronchodilator in line to infant, must not significanlty increase pts delivered todal volume what deliver device to use? | vibrating mesh neb, ultrasonic, and pMDI |
| what methods are acceptable for delivering drug via pMDI to an intubated neonate receiving mechanical vent? | through resuc bag |
| chest physiotherapy procedure includes which of the following techniques? | postural drainage, percussion, coughing |
| when performing et suction on neonate why should therapise routinely avoid advancing the catheter tip beyond the distal tip? | prevent development of bronchial stenosis and granulation |
| what maneuver is characterized by having ot forcibly exhale from middle middle to low lung volume though an open glotts? | active cycle of breathing |
| during autogenic drainage at which of following levels does pt begin breathing? | expiratory reserve volume |
| by which of following mechanisms are high frequency chest compressions supported to mobilize tracheal secretions? | by generating high expiratory air velocities |
| what do postural drainage postitive expiratory pressure therapy autogenic drainage forced expiration techniques and high frequency chest compressions have in common? | they attempt to prevent dynamic airway collapse |
| what most commonly cited complication of chest physiotherapy? | hypoxemia |
| how chould pt receiving CPT while in an icu be monitored? | spo2, rr, pulse |
| what the most important variable used to assess efficacy of CPT? | amount of mucus ontained during and after treatment |
| whaich of the following pts is incentive spiromtery contraindicated? | uncooperative, physically dissabled, and very young |
| what components should be considered when preopertaively teching a child how to do is? | paretns involvment, reason, demonstration |
| during postop what should be volume goal dor is? | 75% if preop |
| what are some problems w admin ippb to peds? | coordinating deep breath, securing pt cooperation, asynchronouse breathing |
| when giving ippb tx to ped pt what determins level of pressure set by therapist? | achieving volume goal, observing minimal volume increase, seeing pt becomines intolerant of pressure increase |
| which assessments used to evaluate pt response to Ippb? | heart rate and respiratory rate |
| whaich aspects of IPPB treatmentneed to be documented in the pts chart after the treatment? | peak flow, sensitivity setting |
| which of following assesment used to eval ots response to IPPB? | heart rate and respiratory rate |
| which aspect ippb treatment need to be documents in pts chart after treatment? | peak flow, sensitivity setting |
| vascular smooth muscle is largel dependent on which of the following intracellular ions? | ca |
| smooth muscle contractions begin w release of which of the following ions from the sarcopasmic reticulum? | ca |
| which substance prevents relase of ca from sarcoplasmic reticulum? | cGMP-dependant kinase |
| what is the primary physiologic activity of inhaled notric oxide? | pulmonary vasodilation |
| which of the following meds contribute to an increased right to left intrapulmonary shunting? | nitroprusside and prostacyclin |
| whats the product of reaction between o2 and nitric oxide? | no2 |
| early scavenger systems were designated to protect health care workers from which of the following gases? | no2 |
| whats the putpose of admin heliox to pts? | reduce wob |
| what type of flow pattern prevails in healthy person from glottis to 10th airway generation? | turbulent flow |
| how does heliox comair to air o2 as carrier gas? | more aerosol deposited w heliox |
| terapist is using o2 flowmeter to deliver 80:20 heliox to pt reading flowmeter is 10 lpm what is actually being received? | 18 lpm |
| what potential benefit of using heliox while mechanically vent pt w status asthmaticus | minimize air trapping |
| what aspects of mech vent are affected by use of heliox? | inspiratory gas flow and volume |
| what are some problems w heliox as soutce has during mech vent? | high thermal conductivity of helium rapidly cools wire flow anemometer stimulating high flow condition |
| which anomalies are features of hypoplastic left sided heart syndrome | aortic shunting and absent or small left ventricle |
| what are consequences of ratio of puml blood flow to systemic blood flow? significantly above 1.0? | decreased renal blood flow and metabolic acidosis |
| whats relationship between cold pink extremities and the QpQs ratio | qp qs prob too high |
| whats therapeutic goal of admin of fractional concentration of fio2 of 0.18 to an infant? | increase pulmonary vascular resistrance |
| whcih inhaled anesthetic gases have demonstrated possibility to treat status asthmaticus? | halothane, isoflurane, sevoflurane |
| ehaich inhaled anesthetics should therapise recomment to admin via face mask to conscious spont breathing ped pt asthma | halothane |
| xenotransplantation is the use of___organs in humans | animal |
| in 1980's what was the major indication for heart transplantation? | cardiomyopathy |
| whats predominant priblem leading to heart transplant in children younger than 1 year | congential cardiac lesions |
| whats predominant cause of early postop mortality associated w heart transplant | graft failure |
| what problems are associated w long term heart transplant pts? | cad, coronary vasculopathy |
| which cardiac problems is responsible for cast majority of neo cardiac transplant | hypoplastic left ventricular |
| what are some reasons for decline in heart lung transplant among infants? | difficulty of donor, avoiding cardiac rejectio, averting premature cad |
| which chronic lung disease is the most common indication for bilateral lung transplant? | cystic fibrosis |
| which condition is frequen cause of graft failure within 90 days after lung transplantation | ischemia reperfusion |
| which of following meds are used as antirejection agents? | cyclosporine, azathoiprine and mycophenolate mofetil |
| what conditions are considered complications of thoracic organ transplantation | resp fail, bronchiolitis obliterans, infection |
| 24 hrs after ped pt undergone lung transplan, therapist notices x-ray consitent w edema how is it best interpreted? | ischmie reperfusion injury |
| therapist notices ped pt w lung transplant 6 days abundant lower airway secretion w out fever, abundant thick mucous, | bronchorrhea |
| therapist notices following signs in ped pt who recently had heart transplant: decreased contractility, chf, tachy, malaise | pt in rejection |
| while working w recent lung transplant pt therapist observes: tachy, bibasilar inspiratory crackles, increased intertitial infiltrates on chest xray, o2 destat, poor spirometry | lung rejection |
| why does pulmonary infection rate for lung transplant appear to be higher than w other solid organ transplants? | because lung is in direct contact with the external environment |
| which of following microorganisms is associated w increased mortality among pts w cystic fibrosis? | burkholderia cepacia |
| months after receiving lung transplant a pt w cystic fibrosis exhibits foloowing signs and symptoms: increasing dyspnea, increasing cough w sputum, colonization pseudamonas | bronchiolitis obliterans |
| which of following meds are associated w decreased wbc caused by bone marrow suppression? | azathioprine mycophenolate mofetil |
| which forms of interaction tend to occur between resp pt who receives lung transplant | mech vent, pulm rehab, broncho pulm hygeine |
Created by:
janeth4035