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Resp 2200 > Final Exam > Flashcards

Final Exam Flashcards

1
Q

For patients with a normal breathing rate and depth of breathing, each liter per minute of nasal oxygen increases the FiO2 about 4%

A

Nasal cannula at 2 lpm

  • 2 x 4% =8%
  • 21% + 8% = 29%
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2
Q

Low flow systems

A

Supplemental

  • increase MV — decrease FiO2
  • decrease MV— increase FiO2

1-6 LPM

  • variable FiO2
  • nasal cannula
  • nasal catheter
  • transtracheal catheter
  • increase MV — decrease FiO2
  • decrease MV— increase FiO2
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3
Q

High flow systems

A

Meets or exceeds needs.

precise FiO2 with any breathing pattern

24%-50% 60 lpm oxygen delivery

-fixed FiO2

  • air-entrainment device
  • Venturi mask

-precise FiO2 with any breathing pattern.

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4
Q

Reservoir (low flow )

Non rebreathing mask

A

55-70% (100%) oxygen

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5
Q

What is FiO2 in low flow devices affected by?

A
  • tidal volume
  • respiratory rate
  • flow meter setting
  • inspiratory flow
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6
Q

High flow systems will

A
  • Meet or exceed patients inspiratory flow
  • should be able to provide at least 60 lpm of total flow
  • FiO2 is indirectly proportional to total flow.
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7
Q

Airway appliance (high flow) types

A
  • aerosol mask- intact airway
  • face tent- intact airway
  • T-tube- ET tube or trach tube in place
  • tracheostomy mask- trach rube in place

All used with large-bore tubing to minimize flow resistance and prevent occlusion by condensate.

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8
Q

How often should oxygen setups be checked?

A

Every 24 hours.

Every effort should be made to start reducing the FiO2 to lower the levels by this 24 hour period when possible

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9
Q

When should you reassess, after initially setting up oxygen?

A

Within 2 hours to determine if you are meeting the goals of oxygen therapy

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10
Q

Hazards of oxygen therapy

A
  • depression of ventilation
  • absorption atelectasis )
  • retinopathy of prematurity (ROP)
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11
Q

Cheyne -Stokes

A

Gradual increase followed by gradual decrease in rate and depth of breath with periods of apnea up to 60 seconds (usually 10-30 seconds)

  • seen in patients with CNS disease (cerebral disorders, meningitis, drug overdose )
  • CHF
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12
Q

Biots

A

Deep breathing with periods of 10-30 seconds of apnea

Seen in patients with increased intercranial pressure

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13
Q

Kussmauls

A

Increased respiratory rate (usu over 20 bpm) and depth but irregular rhythm

Seen in patients with metabolic acidosis, dieabetic ketoacidosis, renal failure.

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14
Q

Contraindications of incentive spirometry

A
  • unconscious patient
  • patients unable to operate
  • VC (vital capacity )< 10 ml/kg
  • IC < 1/3 Predicted normal
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15
Q

Hazards of incentive spirometry

A

Hyperventilation and respiratory alkalosis (dizziness and numbness)

  • discomfort
  • pulmonary barotrauma
  • hypoxemia
  • exacerbation of bronchospasm
  • fatigue
  • ineffective unless closely supervised or performed as ordered
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16
Q

Autogenous infection

A

A source of infection contracted from the persons own endogenous flora

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17
Q

Indications for nasopharyngeal airway

A
  • frequent nasotracheal suctioning, to prevent nasal trauma
  • maintain a patent airway in semi-conscious patient.
  • patients who have had a recent facial surgery to maintain patent airway
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18
Q

Disinfection

A

A process that reduces or completely eliminates all pathogenic microorganisms except spores by direct exposure to chemical or physical agents.

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19
Q

Sanitation

A

Make clean by removing dirt, filth, or unwanted substances from

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20
Q

Sterilization

A

The complete destruction of all microorganisms, including spores

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21
Q

Chemotherapy

A

The application of a chemical agent that has specific toxic effects upon disease-producing organisms within a living animal

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22
Q

Immunization

A

Protection of susceptible individuals from communicable diseases by administration of a living modified agent, a suspension of killed organisms, or an inactivated toxins

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23
Q

Pressure compensated

Thorpe Tube

A

Prevents changes in downstream resistance or back pressure

- flow control needle valve is placed after (distal to) flow tube.

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24
Q

Uncompensated

Thorpe Tube

A
  • calibrated in lpm at atmospheric pressure.

- gas from 50-psig source flows into meter at rate controlled by needle valve located BEFORE flow tube

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25
Q

Suction device issues

A

Leak at suction trap or vacuum line. The suction may not be turned on leak in line

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26
Q

What controls Body temperature

A

The hypothalamus regulates heat loss by initiation peripheral vasodilation and sweating.

The respiratory system also helps remove excess heat through ventilation by warming the inspired air .

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27
Q

Chest auscultation

Coarse crackles

A
  • airflow moves secretions of fluid in airways

- usually clears when patient coughs or upper airway is suctioned.

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28
Q

Fine crackles

A
  • sudden opening of small airways in lung deep breathing

- heard w/ pulmonary fibrosis and atelectasis

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29
Q

Bronchial breath sounds

A
  • abnormal if heard over peripheral lung regions

- replacing normal vesicular sounds when lung tissue density increases

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30
Q

Diminished breath sounds

A
  • occur when sound intensity at site of generation (larger airways) is reduced due to shallow or slow breathing, or
  • when sound transmission through lung or chest wall is decreased (COPD, asthma)
31
Q

What are wheezes

A

Consistent with airway obstruction

  • monophonic wheezing indicates one airway is affected
  • polyphonic wheezing indicates many airways are involved
32
Q

Bland aerosol therapy

Indications

A
  • presence of upper airway edema—cool, bland aerosol
  • laryngotracheobronchitis
  • subglottic edema
  • post extubation edema
  • postoperative management of the upper airway
  • presence of a bypassed upper airway
  • need for sputum specimens or mobilization of secretions
33
Q

Humidity Vs. aerosol

A

Hazards
Indication
Contraindications for each

34
Q

Oxygen high FiO2 needs

In emergencies in which hypoxia is suspected what should patients be given?

A

The highest FiO2 possible- ideally 100%.

Can be achieved with a true high-flow or a closed reservoir system.

35
Q

Precautions and hazards of supplemental oxygen

A

-depressed ventilation
(Occurs in COPD patients with chronic hypercapnia )
- retinopathy of prematurity
(Excessive blood o2 levels cause retinal vasoconstriction and necrosis)

  • absorption atelectasis
    (Can occur with FiO2 above .50 , patients breathing small tidal volumes at greatest risk)
36
Q

Coudé

A

Facilitates left mainstream suctioning

37
Q

Suctioning procedure

A

Step 1 : assess patient for indications of suctioning
Step 2 : assemble equipment. Check suction pressures. Get appropriately sized suction catheter .
Step 3 : HYPEROXYGENATE and hyperinflate for at least 30 seconds
Step 4 : insert catheter
Step 5 : advance catheter until patient coughs or until you meet resistance. Pull catheter back slightly
Step 6: apply suction intermittently while withdrawing the catheter from air. Keep suction time less than 15 seconds.
Step 7.: reoxygenate and hyperinflate/ reassess (auscultation )

38
Q

Fever related respiratory issues

A

Low grade fever usually accompanies common upper respiratory tract infections

High grade fever occurs with viral influenza infection
Fever that occurs with a cough suggests a respiratory tract infection.

Patients with significant fever have an increased metabolic rate that increases both o2 consumption and carbon dioxide production and may cause tachypnea. Dangerous for patients with severe chronic cardiopulmonary disease because increased ventilatory demand may induce acute respiratory failure.

39
Q

Head and neck exam

Neck

A
  • JUGULAR VEIN DISTENTION IS SEEN IN PATIENTS WITH CHF AND COR PULMONALE
40
Q

Suctioning pressure

A 
Adults= -120 to -150 mm Hg 
Children= -100 to -120 mm Hg
Infants= -80 to -100 mm Hg
41
Q

Suctioning via artificial airway indications

A
  • course breath sounds
  • patients inability to generate effective cough
  • chest x-ray shows retained secretions
  • visible secretions in airway
  • suspected aspiration of upper airway secretions or gastric contents
  • the need to obtain a sputum sample
  • pulmonary atelectasis
42
Q

National board for respiratory care (NBRC)

A

Administers examinations leading to credentials in respiratory care.

  • RRT
  • CRT
  • CPFT
  • RPFT
  • RRT-NPS
43
Q

Cardiopulmonary symptoms

Dyspnea

A
  • subjective experience. Should not be inferred from observing patients breathing pattern
  • orthopnea : dyspnea in reclining position; associated with CHF
  • platypnea : dyspnea in upright position associated with ateriovenous malformation
  • degree of dyspnea is evaluated by asking about level of exertion at which it occurs
44
Q

Oxygen therapy monitoring

Monitoring patient

A

Clinical assessment: cardiac, pulmonary, and neurologic status

  • assessment of physiologic parameters (PaO2, SaO2, SpO2)
  • within 12 hours of initiation with FiO2 less than 0.40
  • within 8 hours with FiO2 of 0.40 or greater
  • within 72 hours in acute myocardial infarction
  • within 2 hours of any patient with principle diagnosis of COPD
  • Within 1 hour for the neonate.
  • appropriate 02 therapy use protocol is suggested as a method to decrease waste and to realize increased cost savings.
45
Q

Equipment needed for heated large volume nebulizer set up

A 
A. Oxygen flowmeter
B. Humidifier/nebulizer
C. Sterile water
D. Large-bore tubing or oxygen connecting tubing
E. Administration device
F. Heater (if required)
G. Drainage bag and T- piece
H. Thermometer
I. No smoking signs
46
Q

Hand washing

A

Wash hands for no less than 30 seconds

-3 minute scrub should be done upon arrival to the hospital and before going home.

  • before and after contact with patients
  • before handling sterile products and medications
  • between clean and dirty procedures on same patient
  • after removing gloves
  • after contact with lab specimens.
47
Q

Condensation

A

Always treat breathing circuit condensate as infectious waste.

  • use standard precautions, including wearing gloves and goggles.
  • always drain tubing away from patients airway into infectious waste container.
48
Q

Pleuritic Chest Pain

A

Located laterally or posteriorly - sharp in nature, and increases with deep breathing (pneumonia and pulmonary embolism)

49
Q

Nonpleuretic chest pain

A

Located in center of chest and may radiate to shoulder or arm- often caused by coronary artery disease and known as ANGINA in such cases (other causes, gastroesophageal reflux and esophageal spasm.)

50
Q

Clinical signs of atelectasis

A
  • history of recent major surgery
  • tachypnea
  • fine, late-inspiratory crackles
  • bronchial or diminished breath sounds
  • tachycardia
  • increased density (opacified areas) and signs of volume loss on chest radiograph
51
Q

Aerosol (mist) tents

A
  • used in infant and pediatric patients with upper airway edema
  • mist tents or aerosol hood
  • provides a cool, dense aerosol.
52
Q

Characteristics of therapeutic aerosols

Deposition influenced by:

A
  • inspiratory flow rate
  • flow pattern
  • respiratory rate
  • inhaled volume
  • I:E ratio
  • breath holding
53
Q

Incentive spirometry contraindications

A
  • Unconscious patients
  • patients unable to cooperate
  • VC < 10 ml/kg
  • IC < 1/3 predicted normal
54
Q

Incentive spirometry hazards

A
  • hyperventilation and respiratory alkalosis
  • discomfort
  • pulmonary barotrauma
  • hypoxemia
  • exacerbation of branchospasm
  • fatigue
  • ineffective unless closely supervised or performed as ordered
55
Q

Aerosol drug delivery systems

-ultrasonic nebulizers (USNs)

A

Uses piezoelectric crystal to produce aerosol.

56
Q

Hazards of oxygen therapy

A

Oxygen toxicity

Depression of ventilation

Absorption atelectasis

Retinopathy of prematurity (ROP)

57
Q

Characteristics of therapeutic aerosols
Deposition (continued)
Sedimentation

A

Sedimentation occurs when aerosol particles settle out of suspension and are deposited due to gravity

  • represents primary mechanism for deposition of small particles (1-5micometers)
  • holding breath after inhalation of aerosol increases sedimentation and distributions across lungs.
  • greater mass of a particle, the faster it settles
58
Q

Hazards of oxygen therapy time

A

0-12 hours= normal pulmonary function, tracheobronchitis, substernal chest pain
12-24 hours= decreasing vital capacity

25-30 hours= decreasing lung compliance, increasing P(A-a) O2 , Decreasing exercise PaO2.

30-72 hours= decreasing diffusion capacity

59
Q

Chest auscultation

Breath sounds

A

Tracheal breath sounds, heard over the trachea ; created by turbulent flow; loud with with expiratory component equal to or slightly longer that inspiratory component.

60
Q

Bronchovesicular breath sounds:

A

heard around sternum ; softer and slightly lower pitch.

61
Q

Vesicular breath sounds

A

Heard over lung parenchyma ; very soft and low-pitched

62
Q

To figure out flow:

A

1: use the magic box to get your ratio.
2: add your ratio together
3: multiply the sum of your ratio with the lpm of oxygen
4: this is your total flow

63
Q

Bubble humidifier

A

Pop-offs (2psi, 40 lpm) activate due to increased pressure; ie fro twisted or kinked tubing

64
Q

Chest palpation

Vocal and tactile fremitus is increased with

A

Pneumonia and atelectasis (consolidation)

65
Q

Vocal and tactile fremitus is reduced with

A

Emphysema, pneumothorax, and pleural effusion

66
Q

Bilateral reduction in chest expansion

A

Seen in neuromuscular disorders and COPD

67
Q

Unilateral reduction in chest expansion

A

Consistent with pneumonia or pneumothorax

68
Q

Air leaks into subcutaneous tissues, causes crepitus

A

Sign of subcutaneous emphysema

69
Q

Bland aerosol therapy contraindications

A
  • Bronchoconstriction

- history of airway hyperresponsiveness

70
Q

Bland aerosol therapy hazards

A
  • wheezing and bronchospasm
  • bronchoconstriction when artificial airway is used
  • infections
  • overhydration
  • patient discomfort
  • caregiver exposure to airborne contagions produced during coughing or sputum induction
  • edema of the airway wall
  • edema associated with decreased compliance and gas exchange and with increased airway resistance
  • sputum induction by hypertonic saline inhalation can cause bronchoconstriction in patients with chronic obstructive pulmonary disease, asthma, cystic fibrosis , or other pulmonary diseases.
71
Q

Bland aerosol therapy

Assessment outcomes

A

With administered water or hypotonic or isotonic saline, the desired outcome is one or more of the following:

  • decreased work of breathing
  • improved vital signs
  • decreased strider
  • decreased dyspnea
  • improved arterial blood gas values
  • improved o2 saturation, as indicated by pulse oximetry ]
  • with administration of hypertonic saline, the desired outcome is sputum sample adequate for analysis
72
Q

Oxygen FiO2 needs

A critically ill adult patient with moderate to severe hypoxemia needs

A

Either a reservoir or a high-flow system capable of at least 60% o2 .
The goal is a PaO2 greater than 60 mm Hg or oxyhemoglobin saturating greater than 90%

73
Q

The care of an adult patient in more stable condition but who are acutely ill with mild to moderate hopoxemia

A

A system capable of low to moderate o2 concentration can be used.

74
Q

Adult patients with chronic lung disease and accompanying acute-on-chronic hypoxemia present a special case, in the care of these patients, what is the goal?

A

To ensure adequate arterial oxygenation without depressing ventilation. This generally means an SaO2 of 85 % to 92% with PaO2 of 50 to 70 mm Hg.

This is achieved with either a low-flow nasal o2 or a low-concentration (24-28%) AEM. The less stable the patients condition, the higher the need for a high-flow AEM.

Resp 2200 (1 decks)

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