Flashcards in Final Deck (88):
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
What are the hazards of chest pt?
-acute hypotension during procedure
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
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
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)
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)
What position would you place the patient in for percussion of the superior segment of the lower lobes?
bed flat. patient prone
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
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
How many compressions to how many breaths do you do?
When bagging, how often do you give a person a breath?
1 breath every 5 seconds
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
What are the indications for IPPB?
What are the hazards of IPPB?
What are the physiologic effects of IPPB?
What should you look at when troubleshooting for IPPB?
-air flow mix
What is an uncompensated flowmeter?
it won't change when it's moved or occluded
What is a compensated flowmeter?
the ball will drop when it is occluded
What is an example of an uncompensated flowmeter?
What is an example of a compensated flowmeter?
What is relative humidity?
the amount of water vapor in a gas when not fully saturated
What is the equation for calculating relative humidity?
[(content or absolute humidity) / saturated capacity] x 100
What is absolute humidity?
the amount of water extracted from air
What is the equation for calculating absolute humidity?
relative humidity x capacity
What is body humidity?
the ratio of its actual water vapor content to the water vapor content in saturated gas at body temp (37C)
What is the equation for calculating body humidity?
(absolute humidity / 44mg/L) x 100
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)
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
Where is the introduction of the interview done?
social space (4-12 feet from patient)
Where does the interview begin?
personal space (2-4 feet from patient)
What do you look for during the physical assessment?
-vital signs (RR, BP, HR, BS)
-cough and sputum production
What is eupnea?
normal, relaxed breathing
What is hypernea?
increased depth of breathing
What is orthopnea?
shortness of breath when lying flat
What is platypnea?
shortness of breath when sitting up
What is dyspnea?
shortness of breath
What is paradoxical nocturnal dyspnea?
severe shortness of breath and coughing that generally occurs at night
What is biot's breathing?
abnormal pattern of breathing that includes quick, shallow inspirations followed by regular or irregular patterns of apnea
What is cheyne stokes breathing?
deep, fast breathing followed by irregular periods of apnea
What is kussmal's breathing?
deep and labored breathing, and is a form of hyperventilation and occurs with metabolic acidosis
What is PISS?
pins that prevent misconnection
What is DISS?
screw type safety system found on flowmeters and gas outlets
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
What are the hazards of IS?
-exacerbation of bronchospasm
-discomfort secondary to inadequate pain control
What are the physiologic effects of IS?
-absence or improvement in signs of atelectasis
-increased VC and peak expiratory flows
-restoration of preoperative FRC or VC
What are some low flow devices?
-partial and non rebreathers
What is a nasal cannula?
-up to 6L/min
-over 4L/min must use a humidifier
What is a simple mask?
What is a partial rebreather?
-minimum of 10L/min
What is a non-rebreather?
-minimum of 10L/min
-bag must be full during inspiration to prevent from collapsing
What liter flow is run for a SVN?
What is normal flow?
What do low flow devices provide?
only a portion of a patient's inspiratory flow
What do high flow devices provide?
equal to or exceeds the patients inspiratory flow and FiO2 is stable/fixed
The bigger the jet nozzle, the ____ the FiO2
What is the cylinder factor for an E cylinder?
What is the cylinder factor for a H/K cylinder?
How do you calculate the air to oxygen ratio?
(100-x) / (x-21)
How do you calculate total flow?
(air + o2) x flow
How do you calculate the duration of flow?
(pressure x cylinder fact) / flow
What is the formula for finding PAO2?
(Pb-47)xFiO2 - (PACO2x1.25)
What is the formula for the a/A ratio?
PaO2 / PAO2 (normal >60%)
What does O2 therapy do?
-decrease WOB, shortness of breath
-decreases HR and RR
-increase SpO2 and PaO2
What sound indicates a leak or that the tubing is obstructed?
What does condensation or kinking in the tubing do to flow and FiO2?
What is the alkalosis equation?
What is the acidosis equation?
If trending in opposite directions, what kind of problem is it?
If trending in same direction, what kind of problem is it?
When the pH, CO2 and HCO3 are all abnormal, what is it?
When the pH is abnormal and everything else is normal, what is it?
When only the pH is normal, what is it?
When the pH is calculated to be worse than expected, what does it mean?
combined metabolic and respiratory
What are the indications for USN?
-presence of upper airway edema
-postoperative management of upper airway
-presence of bypassed airway
-need for sputum specimen or mobilization of secretions
What are the hazards of USN?
-wheezing or bronchospasm
-edema of the airway wall
What are the physiologic effects of USN?
-improved vital signs
-improved O2 saturation
What are the clinical findings of mild asthma (stage 1)?
What are the clinical findings of moderate asthma (stage 2)?
What are the clinical findings of severe asthma (stage 3)?
What are the clinical findings of very severe asthma (stage 4)?
What are the clinical findings of COPD stage 1?
-FEV1 80% predicted
What are the clinical findings of COPD stage 2?
-FEV1 50-79% predicted
What are the clinical findings of COPD stage 3?
-FEV1 30-49% predicted
What are the clinical findings of COPD stage 4?
-FEV1/FVC <30% predicted
What are the clinical findings of emphysema?
-lung volumes increased
-residual volumes increased
What is cleaning?
removing of all foreign material (e.g., soil, organic material) from objects
What is disinfection?
a process that destroys vegetative forms of all pathogenic organisms on an inanimate object except bacterial spores