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Flashcards in Final Deck (88):
1

What are the indications for chest pt?

-evidence or suggestion of retained secretions in the presence of an artificial airway
-inability or reluctance of patient to change body position
-evidence or suggestion of difficulty with secretion clearance
-difficulty clearing secretions, with expectorated sputum production greater than 25-30 ml/day
-diagnosis of diseases such as CF, bronchiectasis, or cavitating lung disease

2

What are the hazards of chest pt?

-hypoxemia
-increased ICP
-bronchospasm
-vomiting/aspiration
-acute hypotension during procedure
-pulmonary hemorrhage

3

What position would you place the patient in for percussion of the anterior segment of the upper lobes?

bed flat. patient supine with pillow under knees for comfort

4

What position would you place the patient in for percussion of the superior and inferior segments of the lingula?

foot of bed 20 degree angle as tolerated. patient partially on right side (1/4 turn) with pillow behind back and shoulders

5

What position would you place the patient in for percussion of the anterior basal segment of the lower lobes?

foot of bed 30 degree angle. patient on right side (1/2 turn)

6

What position would you place the patient in for percussion of the lateral basal segment of the lower lobe?

foot of bed 30 degree angle. patient partially on right side (3/4 turn)

7

What position would you place the patient in for percussion of the superior segment of the lower lobes?

bed flat. patient prone

8

What position would you place the patient in for percussion of the posterior basal segment of the lower lobes?

foot of bed 30 degree angle

9

What position would you place the patient in for percussion of the lateral and medial segments of the right lower lobe?

foot of bed 20 degrees. patient on left side (1/4 turn) with pillow under back and shoulders

10

How many compressions to how many breaths do you do?

30:2

11

When bagging, how often do you give a person a breath?

1 breath every 5 seconds

12

What are the critical responsibilities of airway maintenance?

-securing the tube and maintaining its proper placement
-providing for patient communication
-ensuring adequate humidification
-minimizing possibility of infection
-aiding in secretion clearance
-providing appropriate cuff care
-troubleshooting airway related problems

13

What are the indications for IPPB?

-atelectasis
-increased WOB
-hypoventilation
-increased RAW

14

What are the hazards of IPPB?

-increased RAW
-airtrapping
-bronchospasm
-pneumothorax
-hyperventilation

15

What are the physiologic effects of IPPB?

-increase MAP
-increase VT
-decrease WOB
-secretion control

16

What should you look at when troubleshooting for IPPB?

-sensitivity
-pressure
-flow
-air flow mix
-circuit

17

What is an uncompensated flowmeter?

it won't change when it's moved or occluded

18

What is a compensated flowmeter?

the ball will drop when it is occluded

19

What is an example of an uncompensated flowmeter?

bourdon gage

20

What is an example of a compensated flowmeter?

thorpe tube

21

What is relative humidity?

the amount of water vapor in a gas when not fully saturated

22

What is the equation for calculating relative humidity?

[(content or absolute humidity) / saturated capacity] x 100

23

What is absolute humidity?

the amount of water extracted from air

24

What is the equation for calculating absolute humidity?

relative humidity x capacity

25

What is body humidity?

the ratio of its actual water vapor content to the water vapor content in saturated gas at body temp (37C)

26

What is the equation for calculating body humidity?

(absolute humidity / 44mg/L) x 100

27

What is a humidity deficit?

the amount of water vapor the body must add to the inspired gas to achieve saturation at body temp (37C)

28

What does the interview part of patient assessment aid in?

-establishes patient rapport between the clinician and the patient
-obtains essential diagnostic information
-helps monitor changes in the patient's symptoms and response to therapy

29

Where is the introduction of the interview done?

social space (4-12 feet from patient)

30

Where does the interview begin?

personal space (2-4 feet from patient)

31

What do you look for during the physical assessment?

-general appearance
-LOC
-vital signs (RR, BP, HR, BS)
-body temp
-cyanosis
-dyspnea
-edema
-hemoptysis
-cough and sputum production

32

What is eupnea?

normal, relaxed breathing

33

What is hypernea?

increased depth of breathing

34

What is orthopnea?

shortness of breath when lying flat

35

What is platypnea?

shortness of breath when sitting up

36

What is dyspnea?

shortness of breath

37

What is paradoxical nocturnal dyspnea?

severe shortness of breath and coughing that generally occurs at night

38

What is biot's breathing?

abnormal pattern of breathing that includes quick, shallow inspirations followed by regular or irregular patterns of apnea

39

What is cheyne stokes breathing?

deep, fast breathing followed by irregular periods of apnea

40

What is kussmal's breathing?

deep and labored breathing, and is a form of hyperventilation and occurs with metabolic acidosis

41

What is PISS?

pins that prevent misconnection

42

What is DISS?

screw type safety system found on flowmeters and gas outlets

43

What are the indications of IS?

-presence of conditions predisposing to the development of pulmonary atelectasis (upper abdominal surgery, thoracic surgery, surgery in COPD patients)
-presence of pulmonary atelectasis
-presence of restrictive lung defect associated with quadriplegia or dysfunctional diaphragm

44

What are the hazards of IS?

-hyperventilation
-fatigue
-barotrauma
-hypoxia
-exacerbation of bronchospasm
-discomfort secondary to inadequate pain control

45

What are the physiologic effects of IS?

-absence or improvement in signs of atelectasis
-increased VC and peak expiratory flows
-increased FVC
-restoration of preoperative FRC or VC

46

What are some low flow devices?

-nasal cannula
-simple mask
-partial and non rebreathers

47

What is a nasal cannula?

-FiO2 24-40%
-up to 6L/min
-over 4L/min must use a humidifier

48

What is a simple mask?

-FiO2 35-50%
-5-10L/min

49

What is a partial rebreather?

-FiO2 40-70%
-minimum of 10L/min

50

What is a non-rebreather?

-FiO2 60-80%
-minimum of 10L/min
-bag must be full during inspiration to prevent from collapsing

51

What liter flow is run for a SVN?

6-8L/min

52

What is normal flow?

30L/min

53

What do low flow devices provide?

only a portion of a patient's inspiratory flow

54

What do high flow devices provide?

equal to or exceeds the patients inspiratory flow and FiO2 is stable/fixed

55

The bigger the jet nozzle, the ____ the FiO2

higher

56

What is the cylinder factor for an E cylinder?

0.28

57

What is the cylinder factor for a H/K cylinder?

3.14

58

How do you calculate the air to oxygen ratio?

(100-x) / (x-21)

59

How do you calculate total flow?

(air + o2) x flow

60

How do you calculate the duration of flow?

(pressure x cylinder fact) / flow

61

What is the formula for finding PAO2?

(Pb-47)xFiO2 - (PACO2x1.25)

62

What is the formula for the a/A ratio?

PaO2 / PAO2 (normal >60%)

63

What does O2 therapy do?

-decrease WOB, shortness of breath
-decreases HR and RR
-increase SpO2 and PaO2

64

What sound indicates a leak or that the tubing is obstructed?

whistling

65

What does condensation or kinking in the tubing do to flow and FiO2?

-decreases flow
-increases FiO2
-increases RAW

66

What is the alkalosis equation?

7.40+(40-CO2)*.01

67

What is the acidosis equation?

7.40-(CO2-40)*.006

68

If trending in opposite directions, what kind of problem is it?

metabolic

69

If trending in same direction, what kind of problem is it?

respiratory

70

When the pH, CO2 and HCO3 are all abnormal, what is it?

partially compensated

71

When the pH is abnormal and everything else is normal, what is it?

uncompensated

72

When only the pH is normal, what is it?

fully compensated

73

When the pH is calculated to be worse than expected, what does it mean?

combined metabolic and respiratory

74

What are the indications for USN?

-presence of upper airway edema
-subglottic edema
-postextubation edema
-postoperative management of upper airway
-presence of bypassed airway
-need for sputum specimen or mobilization of secretions

75

What are the hazards of USN?

-wheezing or bronchospasm
-infection
-patient discomfort
-edema of the airway wall
-overhydration
-bronchoconstriction

76

What are the physiologic effects of USN?

-improved vital signs
-improved O2 saturation
-decreased WOB
-decreased dyspnea

77

What are the clinical findings of mild asthma (stage 1)?

-PaO2 normal
-PaCO2 decreased
-pH increased

78

What are the clinical findings of moderate asthma (stage 2)?

-PaO2 decreased
-PaCO2 decreased
-pH increased

79

What are the clinical findings of severe asthma (stage 3)?

-PaO2 decreased
-PaCO2 normal
-pH normal

80

What are the clinical findings of very severe asthma (stage 4)?

-PaO2 decreased
-PaCO2 normal
-pH decreased

81

What are the clinical findings of COPD stage 1?

-FEV1/FVC <70%
-FEV1 80% predicted

82

What are the clinical findings of COPD stage 2?

-FEV1/FVC <70%
-FEV1 50-79% predicted

83

What are the clinical findings of COPD stage 3?

-FEV1/FVC <70%
-FEV1 30-49% predicted

84

What are the clinical findings of COPD stage 4?

-FEV1/FVC <30% predicted

85

What are the clinical findings of emphysema?

-FEV1 decreased
-FEV1/FVC decreased
-lung volumes increased
-residual volumes increased

86

What is cleaning?

removing of all foreign material (e.g., soil, organic material) from objects

87

What is disinfection?

a process that destroys vegetative forms of all pathogenic organisms on an inanimate object except bacterial spores

88

What is sterilization?

a process that destroys all microorganisms on the surface of an article or in a fluid. forms of sterilization include steam (autoclaving), flash and low temperature