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Principles and Practices of Resp II > Final > Flashcards

Final Flashcards

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1
Q

Bronchial hygiene outcomes

A
  1. Increase aeration
  2. To clear and thin sputum
  3. CXR- Residue of consolidation (white now)
  4. Improved SpO2 with less O2
  5. ABG normalized
  6. Vitals and labs- Trend toward norm or resolve
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2
Q

Hydrated sputum=

A

thin and clear

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3
Q

Flutter Valve- PEP device

A
  • Gravity Dependent (must remain upright, have pt sitting up)
  • Start with flutter horizontal with floor (Up-increases frequency, down- decreases)
  • Creates PEP and Oscillation
  • Oscillation Frequencies are b/w 2-32hz
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4
Q

Hz

A

measurements of cycles in seconds, know: 0-30 hz

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5
Q

EzPAP

A

-Positive airway pressure is created with flow/ 50psi gas source
-Parts:
A: ambient air inlet
B: Gas inlet port
C: Pressure monitoring port with cap (cap if not monitoring)
-Can use with a mask (create a seal)
-Able to deliver a neb tx
-EzPAP flow setting is norm 5-7lpm
-Therapeutic PAP pressures are 10-20cmH2O
NO BREATH HOLD-CONTINUOUS PRESSURE

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6
Q

Acapella

A
  • Can be used in any position, with mask
  • Can deliver a neb treatment
  • Produces PEP with oscillation (breath hold)
  • Active exhalation for 1:3 or 1:4 ratio
  • Oscillation frequencies produced 0-30Hz

-Adjustable: increasing the frequency (+) increases the PEP pressure which can be measured with pressure manometer

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7
Q

TheraPEP

A
  • Exhaling actively but not foreful
  • Therapeutic pressures 10-20cmH20 are indicated between lines
  • Resistance can be increased or decreased
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8
Q

Metaneb

A
  • Can use on vent
  • CHFO: continuous high frequency oscillation
  • CPEP: continuous positive exp pressure
  • Blue ring= changes resistance
  • Black ring= used when delivering therapy through vent (covers resistance holes)
  • Requires special circuit and adaptors
  • Therapy can be delivered through: mouthpiece, mask, trach, and in line with vent circuit
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9
Q

Fitting the vest

A

a. Full vest- Top of the hipbone snug without being restricted
b. Wrap!!- fasten to pt during deep inspiration , snug without restriction, disposable
c. Chest vest- inhale deeply and secure flaps to the front under the arm

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10
Q

Generic settings of vest

A

-10-30 min treatments
-Frequency- 10-14Hz
-Pressure: 1-4 for the front vest/ 5-6 for the full vest
DONT NEED TO DO POSTURAL DRAINAGE

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11
Q

How does HFCWO work

A

Changes intrapulmonary pressures

-Oscillates air through the lungs/ mucus moves secretion out on exhalation

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12
Q

Cough Assist

A
  • Delivers a positive pressure to assist with a deep breath (produces an effective cough)
  • Insp pressures: 25-32cmH2O for 1 to 2 seconds followed by
  • Expiratory Vacuum Pressure: -30 to -40 cmH2O for 1 to 2 seconds (this cycle mimics a cough by pulling the air out of the airways)
  • Perform 5 cycle breaths followed by normal breathing for 30 seconds, repeat until secretions are cleared
  • It is also known as insufflation (inspiration)/ Exsufflation (expiration)
  • Can be used with trach tube, mouthpiece, or mask
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13
Q

Postural Drainage

A
  • Each position is held for 5-10 minutes
  • Total treatment time 20-30 minutes up to an hour
  • Head down positions should exceed 25 degrees below horizontal
  • Must have adequate hydration for secretion mobility
  • Avoid strenuous coughing
  • Usually performed with percussion and vibration
  • Return pt to original resting position
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14
Q

During an intubation attempt, what two landmarks should you see as you advance the laryngoscope

A

Arytenoid cartilage, Epiglottis

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15
Q

Term intubation

A

passing of a tube into a body apature (vocal cords)

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16
Q

What size blades is/ are used to intubate an adult pt

A

3 and 4

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17
Q

What are two different laryngoscope blades and how are they used to visualize the vocal cords

A
  • Miller: Directly lifts the epiglottis in order to visualize the vocal cords
  • Macintosh: inserted into the vallecula, which is the space between the epiglottis and the tongue, indirectly lifts epiglottis
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18
Q

When is placing an artificial airway (intubation) contraindicated

A

Pt is DNI

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19
Q

What is the norm range for cuff pressure? what are you trying to prevent

A

20-30cmH2O- minimize aspiration, avoid cutting off blood supply

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20
Q

Can you intubate with a LMA (laryngeal mask airway)

A

no, its above the glottis (not passing through apature)

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21
Q

How much time do you have when attempting to intubate a pt

A

30 seconds

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22
Q

What are the different techniques used to monitor cuff pressure? how are they performed

A
  • Min. Leak technique-check during inspiration
  • MOP/MOV
  • Cuff manometer
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23
Q

What initial FiO2 do we choose on the vent.

A

Whatever patient was on before, safe 60%< and add pressure to improve O2 from there

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24
Q

Vt Range

A

6-8ml/kg

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25
How do we provide humidity and heat to an intubated pt
HME-Passive | Heated wire circuit
26
VAP protocol; what can we influence?
Keep head elevated 30-45%, Perfrom subglottic suctioning, Keep cuff pressure adequate (20-30cmH2O), methylene blue dye test, Make sure appropriate size tube
27
IBW
50+2.3 (PtH x 60)
28
Common vent wean settings
Decrease vent: decrease VT, and RR. -Go from setting volumes and rates to observ- giving O2 support PEEP +5 , PS 5, FiO2 <50%
29
Spontaneous awake trial (SAT) and spontaneous breathing trial (SBT)
SAT- removing sedation SBT- Readiness to wean, removing/ reducing vent support do for 2 min- looks good? check pt and do for 2 more hours
30
What is a cuff leak test
test airway edema - Deflate cuff, few seconds - Hear air moving through upper airway (nothing? not able to substain airway)
31
NIF/ VC/ RSBI
NIF- diaphragm strength, more neg than -20 (breath/cough) VC- 1 L for adults or 10ml/kilo (take deep breath=cough) RSBI- Rapid shallow breathing index < 105
32
What is stridor and how is it treated?
Racemic epi or cool aerosol - distress - 0.5 and 2.5 ml norm saline
33
How to treat resp acidosis
Increase ventilation and decrease FiO2
34
Blood gas machine/ analyzer directly measures 3 values, what are they
pH PaCO2 PaO2
35
What part of the blood gas machine will directly measure CoHgb, SaO2, and methemoglobin
Co-Oximetry
36
When performing an Allen's test, why do you release only the ulnar artery
Show there is collatural circulation between ulnar and radial artery
37
Suction settings for adults, pediatric, and infants
suction for 15 seconds adult: 120-150 Ped: 100-120 infant: 80-100
38
List two absolute contraindications specific to nasotracheal suctioning
Epiglotitis and croup
39
mini-BAL suctioning procedure
Collecting sputum sample in intubated pt | "bronchial alveolar lavage"
40
What type of airway can be used on an unconscious pt
Oral/ nasopharyngeal
41
What type of airway is mostly used to facilitate suctioning
nasal
42
When should you use oral suction, what is the other name for oral suction
Removing secretions from pharynx in order to visualize vocal cords during intubation - yankauer
43
How can you collect sputum while suctioning a pt
luken trap
44
how do you measure a nasal trumpet? how do you choose correct diameter? how are they labeled for measurement
Nose to tragus + 2cm | -Largest diameter that will slide with ease
45
How do you measure an oral airway? what type of pt is this appropriate for
Even with pts mouth to the corner of the jaw | -Unconscious patients
46
PEEP valve
positive exp pressure placed on exhalaton port on bag valve - improves oxygenation by improving pressures in the lungs - Absolutely have on when placed on positive pressure on a vent requires a PEEP of 10 on vent
47
VAP protocol- consistent cares
- Elevate head of bed - Daily sedation vacation - Daily assessment of readiness for extubation - Peptic ulcer disease prophylaxis - Deep vein thrombosis(thinners) - oral care
48
Initial vent settings
- IBW: tidal volume - RR: normal - Minute ventilation - PEEP - LPM converted to % - I:E ratio
49
Vent settings findings
``` IBW: 50+2.3(PtH-60) FiO2: Lpm x 4 = # + 21= % RR: PEEP: +5 Vt: (x6-x8 of FiO2) ```
50
LMA- Laryngeal Mask Airway
Above glottis - Insirted into the oropharynx, the tip resting at the upper esophageal sphincter - used predominantly in surgery - Airway is covered in ACLS, an alternative to standart ETT intubation - Placed blindly - Dont protect from aspiration
51
Two major limitations of LMA
1. Pt must be unconscious 2. If vent pressures are higher than 20cmH2O then there is a risk of gastric distention - Do not protect against aspiration
52
Combitube
Blind intubation: landing in either esophagus or trachea - 2 lumens: stomach, passively vent lungs - Two cuffs: seal oropharynx, esophagus or trachea
53
Special ET tubes
Mallinckrodt Hi-Lo Evac ET tube -Suction lumen above the cuff-continuous suction of 20-30cmH2O Wire Reinforced ET tube -Prevent kinking Carlens Tube - Intubate left mainstem - hook that is designed to catch the carina Robertshaw Tube -Selective for either right or left main stem Double Lumen - For independent lung ventilation - Stiffer and bulkier - Must be rotated into specific bronchi - Ensured placement with bronchoscope - Increased resistance because of smaller lumen with each tube High Frequency Jet ventilation - Port that allows injection of high flow - port for monitoring pressures
54
Intubation- RSI- Medications
``` Rapid sequence intubation Sedative drugs -Propofol: white , fast acting -Ketamine -Etomidate ``` Paralytic drugs -Succinylcholine: fast acting -Rocuronium (they have no neurological assessment)
55
Cricoid pressure
- Close esophagus off so gastric cant leak into airway (oropharynx) - Bring anterior airway into view - Apply until tube is in place
56
Laryngoscope blade sizes
``` 00- preemie 0- preemie 1- infant 2- child 3- adult 4-adult ```
57
ETT sizes
infant: 2.5-4.0 mmID (same diameter as pinky) 6mo-3 years: 3.0-5.0mm 5-12 years: 4.5-7.0 mm 16- adult: 6.5-9.0 mm
58
Tube placement- oral intubation
Males: between 21-23 cm Females: between 19-21 Placement 3-5 cm above carina
59
Bedside assessment for correct tube placement
- Listen to bilateral breath sounds: bases first - Observe for bilateral chest rise (no rise=rt mainstem) - Note tube length- condensation - Colorimetry - Listen over stomach right away - Capnometry(co2 detector) - Light wand-stylet(glow in trachea) - Fiberoptic laryngoscope/bronchoscope - Esophageal detection device (bulb) - Order chest xray
60
Thomas tube holder
temp hold | -no access to mouth= poor oral care
61
Nasotracheal intubation
-Performed blindly or direct visualization -insertion depth at nare 28cm-hub males 26cm- hub females -Risk of sinitus
62
Micro aspiration
patient aspirating without no one being aware of it

Principles and Practices of Resp II (5 decks)

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