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respiratory therapy > FINAL 2025 > Flashcards

FINAL 2025 Flashcards

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1
Q

what are the conditions associated with increased resonance

A

COPD and pneumothorax

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2
Q

etiology of COPD

A
  1. smoking- 80-90% COPD related deaths
  2. environmental/occupational exposures
  3. genetic- alpha 1 antitrypsin deficiency
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3
Q

how to calculate pack years

A

years smoking X number of packs a day= pack years

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4
Q

causes of tracheal deviation away from affected area (push)

A

seen in pneumothorax and pleural effusion patients

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5
Q

causes of tracheal deviation towards affected area(pull)

A

seen in atelectasis and fibrosis patients

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6
Q

PaCO2 in phases of asthma attack

A
  1. early asthmatic response- hypocapnia (low CO2)
  2. late asthma response- normal PaCO2 indicates more severe obstruction
  3. hypercapnia seen with impending respiratory failure
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7
Q

what are normal percussion notes?

A

resonant are normal percussion notes, they are clear low pitches and hollow quality like the sound of tapping on a drum

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8
Q

what are the abnormal percussion notes and there causes

A

hyperresonant- louder and lower pitched heard in the presence of excessive air seen in pts with COPD, pneumothorax, large pulmonary cavity(tympanic)
Hyporesonant- dull sounds associated with increased density seen in pts with pneumonia, atelectasis, and pleural effusion, lung mass/tumor (flat)

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9
Q

what are the oxygen status on O2 (corrected vs uncorrected)

A

> 100mmhg= overcorrected hypoxemia
<100= corrected hypoxemia
<60mmhg= uncorrected hypoxemia

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10
Q

what are the xray findings in COPD

A
  1. hyperinflation
  2. flattened diaphragm
  3. elongated (vertical) heart
  4. Bullae (blebs)
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11
Q

hypoxemia classifications

A

60-79mmHg=mild hypoxemia
40-59mmHg=moderate hypoxemia
<40mmHg= severe hypoxemia

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12
Q

what do retractions indicate?

A

retractions are inward sinking on or around the chest wall that indicate increased WOB
(intercostal, subcostal, and substernal/suprasternal effected)

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13
Q

what is the treatment for a acute asthma attack

A

*Oxygen to relieve hypoxemia (goal >92%)
Fast acting Bronchodilators (beta adrenergic)
SVN
*Continuous bronchodilator therapy
*IV/PO corticosteroids (high doses ASAP due to prolonged onset of action)
*Monitor peak flow (PEFR) before/after bronchodilators
*IV ketamine (promotes bronchodilation)
*IV magnesium sulfate (has bronchodilating properties)
*Heliox
*NIPPV
*Mechanical ventilation

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14
Q

what is the relationship of minute ventilation and PaCO2

A

VA (alveolar ventilation) and CO2 are inversely proportional
*Increased VA = decreased PaCO2, increases PH
*Decreased VA = increased PaCO2, decreases PH

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15
Q

CXR terms associated with pleural effusion

A

1.Blunting of the costophrenic angles
2.Meniscus sign (fluid tracking up the chest wall)
3.Partially obscured diaphragm
4.Tracheal deviation away

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16
Q

CXR terms related to interstitial lung disease

A

1.Diffuse opacities
2.Nodular opacities
3.Reticular opacities
4.Reticulonodular opacities
5.Honeycombing

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17
Q

definition of a silhouette sign

A

When examining the lung fields of a normal CXR, the silhouettes of the heart borders, the ascending and descending aorta, the aortic knob and the hemidiaphragms should be clear. Obliteration of any of these silhouettes by consolidated lung tissue is known as the silhouette sign.

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18
Q

what are the factors that play a role in the development of atelectasis

A

inadequate lung expansion
weak or impaired cough

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19
Q

what is the definition of CaO2

A

arterial oxygen content

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20
Q

how to calculate CaO2

A

1.34ml/g X Hb g/dl X SaO2) + (0.003 ml/dl X PaO2)

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21
Q

what is the indicator for adequate ventilation

A

clinically, PaCO2 is the best index of adequacy of alveolar minute ventilation (35-45mmHg)

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22
Q

what are the surgeries with the greatest risk for developing atelectasis

A

upper abdominal or thoracic surgery

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23
Q

treatment for cystic fibrosis

A

*Oxygen therapy: used to treat hypoxemia
*Airway clearance: used to assist in mobilization of secretions,
pep therapy, vest therapy, percussion and postural drainage
*Lung expansion: IS, CPAP, IPV
Aerosolized medications:
*SABA- albuterol
*LABA: salmeterol or formoterol
*SAMA: ipratropium bromide
*LAMA: tiotropium

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24
Q

what are all the routes for developing PNA

A

*Droplet: transmitted through small, aerosolized droplets that are produced via cough, sneeze, or talking. Droplets can land on surfaces contaminating them.
*CAP: community acquired pneumonia
*HAP: hospital acquired pneumonia, 48 hours after hospital admission
*HCAP: healthcare acquired pneumonia: care home facility
*VAP: ventilator associated pneumonia (secondary)
*Aspiration pneumonia: most common in right lung, aspiration of oropharyngeal secretions or gastric fluids into the lower airways
*Pneumocystis jiroveci pneumonia: fungal pneumonia seen in immunocompromised patients (HIV/AIDS) antimicrobial would be given

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25
what to check prior to ABG draw
*Patient name/dob *Order *Allens test *Dominant hand *Check meds/ Blood thinners
26
what are the nebulizer ABX for cystic fribrosis patients
*Tobramycin (tobi): typically given to pts with pseudomonas infection *Azithromycin- anti-inflammatory, that can help improve lung function *Ibuprofen- helps reduce progression of disease *Corticosteroids only given when having asthmatic exacerbation
27
what is the gold standard diagnosis of CF and its associated values
*Sweat chloride test is considered the gold standard for CF diagnosis; it measures the amount of sodium and chloride in patients sweat *less than or equal to 29mmol/L= unlikely CF *30-59 mmol/L possible CF *greater than or equal to 60 mmol/L diagnostic for CF
28
what causes a oxyhemoglobin dissociation curve to do a left shift
Left shift: 1.Increased PH, decrease PaCO2 2.Decreased T (fever), decreased 2-3 DPG 3.Increased Hb O2 bond 4.Decreased tissue release
29
what causes a oxyhemoglobin dissociation curve to do a right shift
1.Decreased PH, Increased PaCO2 2.Increased T (fever), increased 2-3 DPG 3.Decreased Hb O2 bond 4.Increased tissue release
30
what is the most common bacteria to cause PNA
streptoccocus pneumoniae
31
how to calculate PaO2
PaO2= FiO2 X (PB- PH20) – (PaCO2 X 1.25)
32
what is the treatment for PNA
1. Fluid and nutritional therapy 2. Oxygen (address hypoxemia) 3. Bronchodilators if wheezing is occurring 4. Antipyretics/analgesics (for fever and pain) 5. Lung expansion therapy 6. Airway clearance therapy 7. Suctioning 8. NIPPV or mechanical ventilation 9. Antibiotics: *Streptococcus pneumoniae- azithromycin *Pseudomonas aeruginosa- cefepime (cephalosporin) *Haemophilus influenzae- ceftriaxone
33
what are the CXR terms associated with CHF
PBIFCK 1.Pulmonary edema 2.Batwing/butterfly pattern 3. Increased vascular markings 4.Fluffy opacities 5.Cardiomegaly 6.Kerley B lines
34
what are the cardio biommarkers and what do they tell us?
*B-type Naturietic peptide (BNP): secreted by the ventricles, levels increase as CHF symptoms worsen. <100 pg/ml- no CHF >500 pg/ml- indicates CHF *Troponin I: protein found primarily in cardiac muscle, when heart muscle is injured troponin is released into the blood stream. Normal value: <0.04 ng/mL
35
what is the normal range for potassium and the effect albuterol has on it
*K+ normal range: 3.5-5 mEq/L *As a temporary fix albuterol will be given in high doses (typically 10-20mg) to bring down levels of potassium by moving them from the blood into cells.
36
what are the complications of left heart failure
*When the left ventricular fails, it leads to lower CO and pulmonary congestion *Pulmonary venous congestion leads to increased interstitial and pleural fluid retention *Causes issues with systemic circulation, causes fluid back up in the lungs/ chest cavity, and causes dyspnea/SOB
37
renal function labs
*Testing Sodium (Na+) levels- major extracellular cation (+) that is controlled by kidney function Correct range= 135-145 mEq/L *Blood urea nitrogen (BUN)- 7-20 mg/dl most common tool for the assessment of kidney function, increased levels due to decreased kidney filtration *Creatinine levels- 0.6-1.2 mg/dl value rises in renal disease *Potassium (K+) 3.5-5 mEq/L Decreases indicates renal failure
38
how to diagnose myasthenia gravis
*chronic autoimmune disorder resulting from. Circulating antibodies which block/alter/destroy acetylcholine receptors (muscle contraction) *muscle weakness/paralysis is episodic and from head to feet *immunologic studies (antibody tests) *eye drooping/double vision *positive tensilon test- anticholinesterase inhibitor (improves muscle strength if the medication works it indicates MG)
39
general treatment for NMD
1.lung expansion/mucus clearances (no IS) 2. ventilatory support 3.Nutrition (protein calorie malnutrition increases risk for infection) 4.antibiotic therapy (with development of pneumonia) 5. anticoagulant and pneumatic compression sock therapy to prevent blood clots and pulmonary emboli 6. serial measurement of MIP, VC, RR
40
role of CPAP for heart failure pts
*improves decreased Cl *decreases left and right ventricular preload *enhance gas exchange (recruit collapsed alveoli) *DON’T use when patient is hypercapnic
41
respiratory pattern seen in HF
Cheyne stokes respiration- gradual increase of breathing (faster and deeper) following periods of apnea, cycle repeats
42
what are the isolation procedures for TB
*single patient use, negative pressure room *N95 mask *PAPR
43
platelet count normal ranges and names
*Also known as thrombocytes *Normal range: 150,000- 400,000/mcL *Thrombocytosis- increased platelets (blood clotting) *Thrombocytopenia- decreased platelets (increased bleeding no blood clotting)
44
effects of NMD on respiratory system
*Atelectasis *Impaired cough *Mucus plugging *Sleep disordered breathing *Hypoventilation *Stiffening rib cage *Aspiration *Pneumonia *Respiratory failure *Death
45
diagnostic testing for TB
1. Chest XRAY *Ghon nodules (encapsulated region) *Enlarged lymph nodes in the hilar region *Cavitation *Fibrosis(calcification) 2. AFB sputum culture and smear Used to test for acid-fast bacteria Early AM collection of expectorated secretions best for lab eval 3. QuantiFERON-TB gold test Blood test used to test for mycobacterium tuberculosis 4. PPD (MANTOUX testing) Intradermal injection with small amount of purified protein derivative <5mm-neg 5-9- suspicious retest >10- positive, past or active infection
46
carbon monoxide poison treatment
*Active humidification (mucus plugging) *Bronchoscopy (remove foreign body/secretions) *Oxygen therapy- 100% to reduce half-life of CO *Hyperbaric oxygen therapy- reduces half-life of CO to 5 min *Fluids- parkland formula (4ml/kg of BW for each % of body surface burned) *Isotonic crystalloids- over 24 hr period *Pain control *Isolation room, wound coverings *Silvadene- cream based antibiotic to prevent infection
47
what are the complications or other disorders caused by inhalation injury
1.Secretion retention 2.Mucus plugging 3.Atelectasis 4.Bacterial colonization (PNA, staph, pseudomonas) 5.ARDS 6.Bronchiectasis 7.pulmonary embolism 8.multi organ disfunction 9.fibrosis
48
causes of burn injuries
*exposure to fire *superheated gases *scalding liquids *chemicals *electrical currents *most occur in residential fires
49
% change for FEV1 with bronchodilator
Considered significant if >12% increase in FEV1 or FVC= positive response Suggests reversible airway obstruction
50
what are the lung volumes
*Tidal Volume (Vt): ~ 500 mL *Inspiratory Reserve Volume (IRV): ~ 3100mL *Expiratory Reserve Volume (ERV): ~ 1200mL *Residual Volume (RV): ~ 1200 mL
51
what are the lung capacities
*Inspiratory Capacity (IC): VT + IRV *Functional Residual Capacity (FRC): ERV +RV *Vital Capacity (VC): VT + IRV + ERV *Total Lung Capacity (TLC): IRV + VT + ERV+RV
52
what do P waves represent
atrial depolarization
53
what does QRS complex represent
ventricular depolarization
54
conduction system
I.Sinoatrial node (SA node): *Considered the pacemaker of the heart *Starts the electrical signal (60-100bpm) *Causes atria to contract II.Electrical signals continue to AV node (40-60BPM) and Bundle of His. The bundle of His splits into right and left bundle branches which deliver the signal to both sides of the heart III.The bundle branches divide further down into Purkinje fibers(20-40BPM), which deliver the signal to the muscle fibers of the ventricles, which cause ventricular contraction
55
what is the rule of 300?
*Count the number of large boxes between two successive QRS complexes and divide the number by 300 *Ex: you count 3 large boxes between the two QRS complexes, so the heart rate would be about 100 BPM *300/3=100
56
what are the basic heart rhythms?
*Normal sinus- 60-100BPM *Sinus tachycardia >100BPM *Sinus bradycardia <60BPM
57
what does an obstructive PFT look like?
Decreased: *FEV1 *FEV1/FVC ratio (<70%) *PEFR Increased or normal: *RV *TLC *FRC
58
desired outcomes of PEP/PAP therapy
*Splints airways open *Collateral ventilation in the lung *Desired I:E ratio: 1:3 *Desired Pressure: 10-20 cm H2O
59
definition and location of bronchial breath sounds
*Loud, high pitch sound over the trachea/upper sternum/mainstem bronchi *If heard anywhere else, it is ABNORMAL (atelectasis, tumors, pneumonia)
60
charting breath sounds
anatomical location, phase, and distinctive characteristics
61
when to terminate suctioning procedure
*Terminate when airway has been cleared *with a maximum of 15 seconds while suctioning *hypoxia/hypoxemia *cardiac arrest/dysrhythmias *respiratory arrest *premature ventricular contraction (PVC) *increased ICP (intracranial pressure) *bronchospasm *infection *atelectasis *increased or decreased blood pressure changes
62
settings on HHFNC and what they are for
Provides flows of at least 15 LPM with FiO2 of 45-80% used with dry bubble humidifier creates PEEP and improves oxygenation
63
cuff pressure ranges
Maximum safe recommended cuff pressure range: 20 to 25 mmHg or 25 to 30 cmH2O
64
use of OPA/NPA
Both relieves obstruction of the upper airway by providing a passageway between the base of the tongue and the back of the pharynx. OPA: only indicated for use in unconscious patients (causes gagging vomiting) NPA: better tolerated in semi-conscious patients with an intact gag reflex
65
what is flow rate for a bag valve mask
Operate at 15 LPM (excess flow results in auto-PEEP)
66
NIPPV setting changes based on ABG values
IPAP- helps with ventilation and CO2 removal Increasing IPAP: *Increases Tidal volume and minute ventilation *Decreases PaCO2 Decreasing IPAP: *Decreases tidal volume and minute ventilation *Increases PaCO2 EPAP- improves oxygenation by increasing FRC increasing EPAP: *Increases FRC and PaO2 *Decreases tidal volume Decreasing EPAP: *Decreases FRC and PaO2 *Increases tidal volume
67
how to calculate Vt
*Vt= Ve/RR *Men: 50+2.3 X (height in inches – 60) *Women: 45.5=2.3 X (height in inches – 60)
68
how to calculate L to mL
L to mL L X 1000= mL Ex: 2L X 1000= 2000ml
69
what are the trach tubes with speaking valves?
*Passy-Muir valves *Pitt speaking trach tube
70
practice magic box/look over volume flow loops
see to study guide
71
diagnostic tests for Guillian Barre
monitor VC and MIP, support ventilation, lumbar puncture
72
normal BS heard in the lung periphery are called?
vesicular
73
what describes a series resister
pressure increases as expiratory flow increases
74
BS that has a raspy grating sound at end of inspiration in right middle lobe is called what?
pleural friction rub
75
two organisms other than bacteria that can cause PNA
virus or fungus
76
the best indicator of O2 transported to the tissues
CaO2

respiratory therapy (8 decks)

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