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Orals, 2011
Orals
| Question | Answer |
|---|---|
| What is the approximate FiO2's of the Nasal Cannula? | 24-40% |
| Is the Nasal Cannula High or Low Flow? | Low Flow |
| What are three things that effect FiO2? | Increase Tidal Volume = Decrease FiO2 Increase Inspiratory Flow = Decreasing FiO2 Increase RR = Decrease FiO2 |
| What is the Partial Rebreather's FiO2 range? | 40%-70% |
| What do you do if the Partial Rebreather bag is flat? | Increase flow to inflate bag 3/4ths full |
| Indications for oxygen? | Severe Trauma Acute MI Suspected Hypoxemia Documented Hypoxemia |
| Oxygen Toxicity | Pt is on >50% oxygen for >24 hours. Oxygen free radicals which are byproducts of cellular metabolism are released and cause cell damage. Pt will experience chest pain, decreased VC, decreased lung compliance, decreased DLCO and increased PAaO2. CXR Patchy |
| Absorption Atelectasis | Occurs when a patient is on >50% oxygen. Causes nitrogen to be removed from the alveolus which causes the atelectasis to occur. |
| ROP | Occurs when premature infant <28 days of age have a PaO2 of >80mmHg. This high oxygen level in the blood causes retinal vasoconstriction which leads to necrosis of the blood vessels. New vessels form and these too hemorrhage causing scarring... |
| Depression of Ventilation | Occurs when CO2 retainers have a PaO2 of >60mmHg and fall apnic. CO2 retainers breath on a hypoxic drive (peripheral chemoreceptors). When oxygen levels become too high they don't have the drive to breath. |
| Indications of oximeter | Monitor the arterial saturation Assess response to therapy |
| Hazards of pulse oximetry | Pressure sores from prolonged application Electrical shocks and burns |
| What affects the Accuracy of an Oximeter | Ambient light (High) Dark skin (High) Dark nail polish (High) Movement (High) Perfusion (High) Abnormal hemoglobins- CO (High) Anemia (Low) |
| What is an invasive way to assess oxygenation? | ABG |
| List indications for ABG | Evaluate PaCO2 and acid base of pH Assess response to therapy Monitor severity of disease Recent SOB |
| Hazards of ABG | Arteriospasm Hemorrhage Trauma Pain |
| Explain Allen's Test | Obstruct radial and ulnar sides, release ulnar. Side must pink up in 10 seconds to be positive |
| Verbalize indications for continuous bland cool aerosol | Laryngotracheal bronchitis Subglottic edema Post extubation |
| Verbalize indications for continuous heated bland aerosol | Bypassed upper airway Sputum specimen |
| Hazards of continuous aerosol therapy | Bronchospasm Infection Overhydration Patient discomfort Caregiver exposure to airborne contagions |
| Troubleshoot continuous aerosol | Puffing = water in tubing No mist = increase flow, check H2O, check capillary tube |
| Verbalize instructions for new pts doing Neb Treatments | Breath Normal Occasional slow deep breath in through the mouth Occasional inspiratory hold |
| Verbalize indications for SVN/MDI | Mobilize secretions Deliver meds to desired site Decrease WOB |
| Verbalize hazards of SVN therapy | Bronchospasm (Airway Reaction) Allergic reaction Infection Tachycardia Hyperventilation Drug Reconcentration |
| Verbalize instructions for new pts doing Neb Treatments | Breath Normal Occasional slow deep breath in through the mouth Occasional inspiratory hold |
| Trouble shoot pt who is lightheaded and dizzy during neb treatments | Slow down breathing??? |
| Verbalize hazards of SVN therapy | Bronchospasm (Airway Reaction) Allergic reaction Infection Tachycardia Hyperventilation Drug Reconcentration |
| Indications for IPPB | Improve lung expansion (VC < 10ml/kg, neuro, atelectasis) Short term NIV Deliver meds |
| Indications for IPPB | Improve lung expansion (VC < 10ml/kg, neuro, atelectasis) Short term NIV Deliver meds |
| Hazards for IPPB | Barotrauma Decreased CO Hypo/hyperventilation Decreased VR Gastric distention |
| Preliminary settings for IPPB treatment | 15-15-15 15-15-Moderate |
| Preliminary settings for IPPB treatment | 15-15-15 15-15-Moderate |
| Passive IPPB treatment instructions | Relax, place mouthpiece between your teeth, inhale just to trigger on the machine, relax and let the machine fill your lungs. Once your lungs are full, hold your breath for 5sec. When the machine shuts off exhale normally. |
| Passive IPPB treatment instructions | Relax, place mouthpiece between your teeth, inhale just to trigger on the machine, relax and let the machine fill your lungs. Once your lungs are full, hold your breath for 5sec. When the machine shuts off exhale normally. |
| Troubleshooting an IPPB treatment | Sluggish needle (Increase flow) Inspiratory does not terminate (Check for leaks) |
| Indications for CPT | Mobilize secretions (>25ml/day) Remove soft foreign bodies Tx atelectasis caused from mucus plugging Improving V/Q by turning |
| Hazards for CPT | Hypoxemia Increased ICP Bronchospasm Pain or injury to the ribs, muscles Vomiting and aspiration |
| Hazards for CPT | Hypoxemia Increased ICP Bronchospasm Pain or injury to the ribs, muscles Vomiting and aspiration |
| pt hemorrhaging during CPT treatment, troubleshoot | stop stay stabalize - return to resting position, place on O2, keep airway clear, call physician |
| pt hemorrhaging during CPT treatment, troubleshoot | stop stay stabalize - return to resting position, place on O2, keep airway clear, call physician |
| Propor technique maintaining an airway in an unconscious patient | Head tilt, chin lift Jaw thrust (Spinal vic) |
| Troubleshoot an ambu when there is resistance but no chest rise | Reposition head, check pt valve, ausculate for pneumothorax, bronchospasm, or secretions. |
| Troubleshoot an amby when there is no resistance and chest does not rise | Check for leaks in the mask, o2 enlet |
| Suction pressures for adult, child and infant | 100-120cmH2O (Torr) 80-100cmH2O (Torr) 60-80cmH2O (Torr) |
| Indications for sectioning | Remove retained secretions Ineffective cough |
| Hazards of suctioning | Hypoxemia Mucosal tears Dysrhythmias Infections |
| Hazards for Mechanical Ventilation | Decrease CO Decrease VR Increased ICP Decreased urine output decreased liver and splanchnic perfusion decreaaed gastrointestinal function |
| Troubleshoot apnea vent alarms | Leaks Disconnects Apnea |
| Troubleshoot FiO2 vent alarms | Inappropriate alarm settings Inappropriate FiO2 settings Analyzer cell failure |
| Troubleshoot high pressure alarms on ventilator | Kinked tubing Water in circuit Herniated ETT cuff Bronchospasm Secretions Pneumonthorax Blocked exhalation manifold Mainstem Bronchial intubation |
| How do you perform Minute ventilation | Patient must relax and breath normally for one minute which you count their RR. |
| What is the equipment needed to find Minute volume | Wright Respirometer Ve/RR=Vt in LPM |
| In order to come off the vent, what must the patients minute volume be? | Between 5-10 |
| Explain how to find SVC | Have the patient take a deep breath in and exhale all their air out slowly |
| Explain instructions for MIP | Patient exhales, you plug the hole and then the patient takes a deep breath in. Procedure could take up to 20 seconds |
| Explain instructions for MEP | Patient inhales, you plug the hole and then the patient exhales. Procedure could take up to 20 seconds. |
| What is the piece of equipment should you use to find MIP and MEP? | Pressure Manometer |
| What pressure should the patient achieve on their MIP and MEP to be extubated? | MIP -20 cmH20 MEP 25cmH2O |
| Position for CPT on Anterior segments | Supine, flat |
| Position for CPT on R. Middle lobe | 12in raise, 1/4 turn to the left |
| Position for CPT to the Left Lingula | 12 in raise, 1/4 turn to the right |
| Position for CPT to the Anterior lower lobe | 18 in raise, supine, flat |
| Position for CPT to the Posterior segments | 18 in raise, prone, flat |
| Position for CPT to the superior segments | Prone, Flat |
| What is important to remember when dealing with the patients personal safty when performing CPT? | Always have the patient face me so I can see his/her face! |
Created by:
Kallyleelee
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