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312 FINAL Flashcards

Final Exam for RT 312

1
Q

List the indications for Oxygen therapy

A
  1. Correct documented or suspected acute HYPOXEMIA
  2. Decrease the symptoms associated with CHRONIC HYPOXEMIA
  3. Decrease the workload hypoxemia imposes on the cardiopulmonary system
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2
Q

Describe how to monitor Oxygen therapy.

A

Check Vitals (temp, HR, RR, BP), Perform ABG, Pulse-Ox meter, Use Oxygen analyzers for delivery devices.

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3
Q

Indications for IS.

A

Primary indication is to treat existing atelectasis or prevent development of atelectasis

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4
Q

Complications of IS.

A
  • Ineffective unless closely supervised or performed as ordered
  • Inappropriate as sole treatment for major lung collapse or consolidation
  • Hyperventilation and respiratory alkalosis
  • Barotrauma
  • Discomfort secondary to inadequate pain control
  • Hypoxia secondary to interruption of prescribed oxygen therapy if face mask or shield is being used
  • Exacerbation of bronchospasm
  • Fatigue
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5
Q

How to set goals for IS.

A

From chart that comes with the IS, goals are set according to gender, age, height

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6
Q

Contraindications for IS.

A
  • Pt cannot be instructed or supervised to assure appropiate use of device
  • Pt cooperation is absent or is unable to understand or demonstrate proper use of device, unconscious patients
  • Pts unable to deep breathe effectively
  • Presence of an open tracheal stoma is not a contraindication but requires an adaptation
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7
Q

Define CPAP.

A

Continuous Positive Airway Pressure

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8
Q

Define PEP.

A

Positive Expiratory Pressure

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9
Q

Define HFCWO.

A

High-Frequency Chest Wall Oscillation

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10
Q

Define Intermittent Positive Pressure Breathing (IPPB)

A

Technique used to provide short-term intermittent mechanical ventilation for the purpose of augmenting lung expansion, delivering aerosol, or assisting ventilation

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11
Q

Define Incentive Spirometer (IS)

A

Uses Negative pressure to enhance lung expansion via a spontaneous and sustained decrease in pleural pressure

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12
Q

Define SMI

A

Sustained Maximal Inspiration, another name for IS and a component of bronchial hygiene therapy

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13
Q

Name the complications/hazards of IPPB.

A
  • Increased airway resistance
  • Barotrauma, pneumothorax
  • Nosocomial infection
  • Hypocarbia
  • Hemoptysis
  • Hyperoxia-when O2 is the gas source
  • Air swallowing
  • Gastric distention
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14
Q

Name the indications for IPPB.

A
  • The need to improve lung expansion
  • Presence of clinically important atelectasis when other forms of therapy have been unsucessful, or patient cannot cooperate
  • Need to deliver aerosol medication
  • Inability to clear secretions because of pathology that severly limits the ability to ventilate or cough effectively and failure to respond to other modes of treatment
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15
Q

Calculate Total Flow.

A

(Air+Oxygen) X (Liter Flow)

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16
Q

Calculate Inspiratory Flow Demand.

A

(Minute Volume) X (I:E)
or
(Tidal Volume X Respiratory Rate) X (I:E)

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17
Q

Define Low-flow devices.

A

Variable performance devices may prrovide less gas than the patient is breathing in and causes the FiO2 to vary

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18
Q

Define High-flow devices.

A

Fixed performance devices that meets or exceeds the patient’s inspiratory flow demands

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19
Q

Name the Cylinder Factors for D, E, G, and H/J Cylinders

A 
D= 0.16
E= 0.28
G= 2.41
H/J= 3.14
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20
Q

Explain how to troubleshoot an oxygen analyzer.

A

Preventive maintenance-replace parts that may deteriorate and cause inaccurate readings

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21
Q

Explain how the HME works.

A

This captures exhald heat and moisture and uses it to heat and humidify the next inspiration

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22
Q

Calculate Heliox mixtures.

A

80/20-Factor (1.8)
70/30-Factor (1.6)

Helium being delivered=(Liter flow) X (Factor)

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23
Q

How to deliver Heliox mixtures.

A

Must always be mixed with Oxygen. Must be delivered in tightly closed system (nonrebreathing mask, ET tube or Tracheostomy tube)

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24
Q

Name the Indications of an HME.

A

Humidification of inspired gas during mechanical ventilation is mandatory when a tracheostomy or endotracheal tube is present

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25
Q

Name the Contraindications of an HME.

A

For patient with:

  • Thick, copious secretions
  • An expired tidal volume 10 L/min

-Better suited for short-term use greater than or equal to 96 hours

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26
Q

What does a Pulse Oximeter measure?

A

Estimate of arterial blood oxyhemoglobin saturation levels

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27
Q

What interferes with normal operations of Pulse Oximeters?

A

Motion artifact, abnormal hemoglobins, intravascular dyes, low perfusion rates, skin pigmentation, nail polish, etc.

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28
Q

Explain how to determine if the pressure is set correctly when using IPV.

A

ADD

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29
Q

Explain how to troubleshoot IPPB (Machine won’t trigger on)

A

If machine will not trigger on:
-Check sensitivity control

If manometer needle is not moving:

  • Check for large leak
  • Check gas supply for 50 psig
  • Check to see if breathing valve is sticking
  • Check to see if patient is breathing through mouth
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30
Q

Calculate Tank Times.

A

Until Empty: (2200) X (Tank factor) / (Liter Flow)

or

Until Changed: (X-500) X (Tank Factor) / (Liter Flow)

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31
Q

Indications for CPT

A
  • Lung conditions that cause increased difficulty in mobilizing pulmonary secretions
  • Acute respiratory failure with retained pulmonary secretions
  • Acute atelectasis
  • Ventilation and Perfusion abnormalities from retained secretions
  • COPD patients with inefficient breathing patterns
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32
Q

Name the primary hazard of Aerosol Therapy.

A

-Adverse reaction to drug being delivered

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33
Q

Diameter-Indexed Safety Systems (DISS)

A 
Found on all connections for low pressures (<200 psi)
–Examples:
Outlets of regulators
Flowmeters
Oxygen concentrators
High pressure hoses
Wall outlet of central piping system
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34
Q

American Standard Safety System (ASSS)

A

Used with large-sized cylinders

Have different variations of threaded outlets indexed by:
•Thread type
•Thread size
•Right or left handed threading
•External or internal threading
•Nipple seat design
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35
Q

Explain Pin-Idexed Safet Systems (PISS)

A

This safety system is used with E cylinders and smaller

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36
Q

Pin positions for oxygen are?

A

2 & 5

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37
Q

Pin positions for AIR are?

A

1 & 5

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38
Q

Name the inital settings for IPPB therapy and breathing pattern.

A
  • Sensitivity or trigger level between +/- 2

- System pressure between 10-15 cm H2O

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39
Q

Sensitivity Setting on IPPB Controls.

A

Control how hard to cycle machine on.

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40
Q

Name the correct procedure for Chest Physical Therapy (CPT) with positions, techniques and hand position.

A

Techniques:

  • Postural Drainage
  • Chest Percussion
  • Chest Vibration
  • Cough techniques
  • Breathing exercises
  • Turning
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41
Q

What is PEP used for?

A

It is a bronchial hygiene therapy used in the management of airway secretions and postoperative atelectasis

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42
Q

Name the contraindications for Postural Drainage.

A
  • Head and neck injury until stabilized

- Active hemorrhage with hemodynamic instability

43
Q

Indications for Postural Drainage.

A

Limited largely to patients diagnosed with cystic fibrosis, bronchiectasis, or cavitating lung disease and to adult patients who produce at least 25-30 mL of secretions and have difficulty clearing their secretions

44
Q

Contraindications for Chest Percussion Therapy.

A
  • Head and neck injury until stabilized

- Active hemorrhage with hemodynamic instability

45
Q

How does the Flutter valve work, and what does is utilize?

A

This works when the patient actively exhales into the mouthpiece, the ball creates positive expiratory pressure. The PEP helps loosen up secretions so the patient can cough them up.

46
Q

Define Pursed-Lip Breathing.

A

Have patient exhale through pursed lips, helps COPD patients empty lungs more completely

47
Q

Define Diaphragmatic Breathing.

A

Have patient place hand on abdomen and ask patient to breathe in, pushing hand away while inhaling

48
Q

Define Segmental Breathing.

A

Apply pressure to area of chest amd ask patient to breathe in and send air to the area where hand is placed.

49
Q

When should an MDI be ordered?

A

When the patient can coordinate breathing with actuation

50
Q

After attaching the regulator to the E cylinder, gas is heard leaking from the cylinder. What would cause this and what should you do to correct this?

A

Check to make sure that the flow meter is still on tight, or change to another flow meter.

51
Q

Explain how to determine the stages of a pressure reducing valve.

A

Single stage pressure reducing valves have one stage

Multiple stage pressure reducing valves have two or more stages

52
Q

Name the Therapeutic uses of oxygen therapy.

A

Hyperbaric Oxygen Therapy and Heliox therapy

53
Q

Name the physiological effects of nitric oxide.

A

When inhaled, it improves blood flow to ventilated alveoli. Results in reduction in intrapulmonary shunting, improvement in arterial oxygenation, and decrease in pulmonary vascular resistance.

54
Q

Department of Transportation (DOT)

A
  • Regulating agency

* Responsible for regulating compressed gas cylinder and their transportation

55
Q

What does the FDA regulate?

A

Purity of medical gases

56
Q

What does the NFPA regulate?

A
  • Only recommending agency, but standards are often written into state and local laws
  • Standards concern storage of medical gases, piping systems, and bulk oxygen systems
  • Compliance with standards may be required by JCAHO
57
Q

What does the ICC regulate?

A

The were formerly responsible for transportation regulations for medical gases

58
Q

Explain how to determine if flow meter is compensated.

A

If the needle valve is located distal to plunger float (ball)

59
Q

Explain how to determine if flow meter is uncompensated.

A

If the needle valve is located proximal to the plunger float (ball)

60
Q

What is the volume of sputum to qualify for CPT?

A

25-30 mL/day

61
Q

What device compensates for leaks when using IPPB?

A

Nose clip

62
Q

Explain how to perform vibration with PDT.

A

Ask patient to take deep inhale, then as they exhale press with a vibration movement into the targeted lobe of lung.

63
Q

Define Autogenic Drainage (AD)

A

Trained patients can use this method to mobilize secretions using diaphragmatic breathing and varying lung volumes in 3 phases

64
Q

Contraindications of CPT

A
  • Increased Intracranial Pressure (ICP) >20 mmHg
  • Unstabilized head or neck injury
  • Recent spinal surgery or acute spinal injury
  • Active hemoptysis
  • Empyema, large pleural effusion
  • Bronchopleural fistula
  • Aged, confused, or nervous patient who does not tolerate position changes
  • Pulmonary edema-CHF
  • Pulmonary embolism
  • Subcutaneous emphysema
  • Recent skin grafts, burns, open wounds
  • Suspected pulmonary TB
  • Lung contusion
  • Osteomyelitis of ribs and osteoporosis
  • Coagulopathy and complaint of chest wall pain
65
Q

Complications/Hazards of CPT

A
  • Hypoxemia
  • Rib fractures
  • Increased airway resistance
  • Increased ICP
  • Hemorrhage
  • Decreased Cardiac output
  • Aspiration
66
Q

Indications of Autogenic Drainage

A

ADD

67
Q

Contraindications of Autogenic Drainage

A

ADD

68
Q

Complications/Hazards of Autogenic Drainage

A

ADD

69
Q

Indications for HFCWO

A

ADD

70
Q

Contraindications of HFCWO

A

ADD

71
Q

Complications/Hazards of HFCWO

A

ADD

72
Q

Indications of PEP Therapy

A

Need for management of airway secretions and prevention of postoperative atelectasis

73
Q

Contraindications of PEP Therapy

A
  • Acute sinusitis
  • Middle ear infection
  • Epitaxis (nose bleed)
  • Recent facial, oral or skull injury or surgery
  • Active hemoptysis
  • Pt. unable to follow instructions
  • Pt. unable to exhale forcefully
74
Q

Complications/Hazards of PEP Therapy

A

ADD

75
Q

Indications for IPV

A
  • In the treatment of COPD patients
  • To treat diffuse patchy atelectasis
  • Enhance mobilization and clearance of retained secretions
  • Deliver nebulized medications and wetting agents to distal airways
76
Q

Contraindications of IPV

A

ADD

77
Q

Complications/Hazards of IPV

A
  • Air swallowing
  • Barotrauma
  • Pt discomfort
  • Gastric distention
  • Nosocomial infection
  • Hyperventilation
  • Fatigue
  • Nausea
  • Hypoxemia/Hyperoxemia
  • Increased intrathoracic pressure, decreased venous return, decreased stroke volume
  • Decreased cardiac output
  • Increased ICP
78
Q

Indications for Flutter valve

A

ADD

79
Q

Contraindications of Flutter valve

A

ADD

80
Q

Complications/Hazards of Flutter valve

A

ADD

81
Q

Color code for tanks containing Oxygen (O2)

A

Green

82
Q

Color code for tanks containing Air

A

Yellow

83
Q

Color code for tanks containing Nitrogen–Oxygen

A

Black/Green

84
Q

Color code for tanks containing Carbon dioxide–Oxygen

A

Gray/Green

85
Q

Color code for tanks containing Cyclopropane

A

Orange

86
Q

Color code for tanks containing Ethylene

A

Red

87
Q

Color code for tanks containing Carbon dioxide (CO2)

A

Gray

88
Q

Color code for tanks containing Helium

A

Brown

89
Q

Color code for tanks containing Nitrogen

A

Black

90
Q

Color code for tanks containing Nitrous oxide

A

Blue

91
Q

Color code for tanks containing Helium–Oxygen

A

Brown/Green

92
Q

Explain oxyhood and flow rates.

A

Minimum flow rate of 7 L/min to prevent CO2 build up. 10-15 L/min may be needed to maintain stable FiO2. 15 is the max due to noise.

93
Q

Explain oxygen content available from oxygen tents.

A

Operates at 7-15 L/minute. Reservoir capacity is 2 L/min with 5 L/min output

94
Q

Nasal Cannula

A 
Provides 24-44% Oxygen
FiO2: 0.24-0.44
Flow:
1 L/min= 24%
2 L/min= 28%
3 L/min= 32%
4 L/min= 36%
5 L/min= 40%
6 L/min= 44%
95
Q

Simple Mask

A

Provides 35-50% Oxygen
FiO2: 0.35-0.5
Flow: 5-10 L/min

96
Q

Partial Rebreather

A

Provides 40-70% Oxygen
FiO2: 0.4-0.7
Flow: 6-10 L/min

97
Q

Non-Rebreather

A

Provides 60-80%
FiO2: 0.6-0.8
Flow: at least 10 L/min

98
Q

Venturi Mask (Air Entrainment Mask)

A

Provides 24%, 28%, 31%, 35%, 40% and 50% Oxygen

99
Q

Troubleshooting IPPB. (High negative pressure is registered when machine cycles on)

A
  • Inadequate flow may be causing starvation, increase flow rate
  • If the patient is actively inhaling, coach patient to passively allow machine to fill lungs
100
Q

Troubleshooting IPPB. (Machine won’t cycle off)

A

Check for system leaks (exhalation valve, lines, connections, nebulizer, pt. connection) Tighten all connections.

  • Coach pt to keep tight seal with lips or use lip seal
  • Check for sticking breathing valve
  • Check for adequate inspiratory flow rates
101
Q

Troubleshooting IPPB. (Machine auto-triggers on)

A

Check for following:

  • Too sensitive. Adjust sensitivity control to make it more difficult to initiate a breath
  • Rate control on. Make sure the expiratory timers are off.
102
Q

Troubleshooting IPPB. (No mist is coming out of nebulizer)

A

Check for following:

  • Gas flow to nebulizer
  • Adequate solution in nebulizer
  • Nebulizer positioned properly
  • Capillary tubes on
  • Nebulizer jets open
103
Q

Name ABG hazards with effects of an air bubble.

A

An air or clotted-blood emboli

104
Q

The SPAG machine is used to aerosolize what drug?

A

Ribivarin (Virazole)

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