Final Study Guide Flashcards by Bianca Barillas

How to determine level of hypoxemia

Mild~79-60
Moderate~59-40
Severe~<40

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What is the preferable site for ABG

Radial artery

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What is the modified Allen’s test for

Tests for functional collateral circulation

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3 indications for an ABG

Assess pt response to therapy or diagnostic tests
Monitor severity and progression of disease
Evaluate ventilation, acid base balance, oxygen status and o2 capacity of blood

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Indications for incentive Spirometry vs IPPB

IS: Atelectasis, upper abdominal surgery and restrictive lung defect
IPPB: Improve lung expansion, unsuccessful therapies for atelectasis and deliver aerosol medications

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What causes leaks in IPPB therapy

Leak or sensitivity

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What’s the purpose of adjusting sensitivity in IPPB

Help deliver breaths

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What causes a large negative swing in IPPB

Incorrect sensitivity, not sensitive enough

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What devices can decrease air trapping in patients with asthma and COPD

PEP and PAP

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What’s the physiological impact of retained secretions

Labored breathing, fever, increased inspiratory and expiratory crackles

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What are some bronchial hygiene therapies

Cough, postural drainage, compression devices, intra pulmonary percussive ventilation and PEP/PAP

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What is necessary for normal airway clearance

Patent airway, functional mucociliary escalator and effective cough

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What are the phases of cough reflex

Irritation, inspiration, compression and expulsion

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What happens during compression phase of a cough

Trachea and chest tightens as well as the diaphragm

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What phase of cough is impaired in a patient with neuromuscular disease or tracheostomy

Inspiratory

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How is the mucociliary escalator impaired in intubated pt

ETT or trach tube, tracheobronchial suction, inadequate humidification, increased Fio2, meds and pulmonary disease

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What diseases impair mucociliary transport

Cystic fibrosis, ciliary dyskinetic syndrome and bronchiectasis

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What impairs mucociliary transport in intubated pt

ETT and cuff site

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What are signs and symptoms of retained secretions

Labored breathing, fever and increased crackles on inspiration and expiration

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What is mucus plug and what can result from it

It’s mucus that leads to partial and full obstruction and can cause atelectasis, impaired shunting and hypoxemia

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What are some positions for postural drainage

Right middle lobe and left upper lobe

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What are some areas to avoid during chest percussion

Surgery sites, bony prominences and fractured ribs

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Which diseases are associated with increased sputum production

Chronic bronchitis, cystic fibrosis and bronchiectasis

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Define aerosol

Suspension of solid or liquid particles in gas

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What are some particle deposition at

Mouth and nose (5-50) Oropharyngeal( 5-10) Respiratory tract( 2-5) Terminal airway ( 1-3)

What is FRC

Functional residual capacity

What is the best way to determine a pt understands instructions

Teach back method

What are adverse effects of a bronchodilator

Tachycardia HR>20, tremors, headache and increased BP

What device requires a spacer

MDI

What are limitations to an SVN

Pt must sit up for meds to nebulize

What are limitations with DPI

Pt must generate inspiratory flow of 40-60 L/min and hold like a hamburger to prevent dry powder from falling out

What is an adverse effect when administering treatment

Tachycardia

What are clinical indications for cool aerosol

Reduce upper airway inflammation

What do bubble humidifiers produce at flows greater than 6 lpm

Whistle noise

What primary and natural conditions inhaled gas to be humidified

The nose

What’s the difference between active and passive humidifiers

Active: bubble, aerosol, passover( offer heated humidifier) -wick and membrane Passive: HME( traps body heat)

Purpose of a reservoir

Store and deliver high concentration of o2

What is the limitation of reservoir devices if not set to the minimum flow

Bag will collapse

Flow range for nasal cannula

1/4-6 lpm

Flow range for nonrebreather

10- flush

Flow range for oxymask

1-15 lpm

Flow range for simple mask

5-10 lpm

Fio2 delivery range of AEM

24-60%

What are limitations to AEM

No bubble humidifier and cannot cover ports

What happens when ports on AEM are occluded

Room air decreases and Fio2 increases

What is retinopathy of prematurity ROP

Premature infants and new borns have defective eyes due to high PaO2

When is o2 toxicity and absorption atelectasis is a concern

High Fio2 greater than 50% for over 24 hrs

What is hypoxic drive

Blunted central chemoreceptors due to chronic increased co2

What can cause co2 retention on a simple mask

Simple mas doesn’t have one way valves

Rule of 4 with NC

24-44%

What are the factors for E and H tank

E- 0.28 H- 3.14

When is HBO2 indicated

Air embolism and carbon monoxide poisoning

How to select suction catheter based on ETT size

(ETT size) x 1.5

What’s done pre and post airway suction

Oxygenate with nonrebreather

What minimizes mucosal damage during tracheal suctioning

Rotate catheter and limit suction pressure

Contraindications for nasotracheal suctioning

Nasal bleeding, occluded nasal passages, acute facial injury, coagulopathy, trach surgery, MI and bronchospasm

How often should you suction

Whenever it’s needed

What’s the proper pressure range for adult NTS

100-120

What supplies are needed to suction

Sterile gloves, saline solution, yaunker and suction catheter

What does IPAP control

Ventilation

What’s does EPAP control

Oxygenation

What is mallampati

How visible is the airways to intubate 1/2 good ,3/4 bad

What type of equipment is used to view the airway during intubation

Laryngoscope

Proper ETT size for male vs female

Male 7.5-8.5 Female 6.5-8.0

What’s the purpose of a stylet during intubation

Shapes the tube and makes it more rigid for easier insertion

What is the purpose of a pilot balloon on a tracheostomy tube or an endotracheal tube

Ensures maximum o2 is being delivered

What is the purpose of the tracheostomy tube obturator

Guides tube into airway protecting from damage and ensuring proper placement

What is the maximum time devoted to an intubation attempt

30 seconds

What does a capnogram of near zero likely indicate after an intubation attempt with a patient that has adequate cardiac perfusion

ETT is inserted into the esophagus

What is preferred aerosol treatment for stridor post extubation

Corticosteroids and race epi

What is the preferred o2 therapy for stridor post extubation

Cool aersol

What o2 delivery device adapter can limit tracheostomy tube movement

Trach collar

What is the depth of insertion of ETT on cxr above carina

2-6 cm

What does a passy Muir valve improve

Improves speech, smell, taste, swallow and secretion management

During mechanical ventilation when should a tracheostomy be considered

Prolonged mech vent 7-10 days, secretion management, upper airway obstruction and unable to intubate

What can be auscultated after extubation with upper airway damage and how to treat is

Stridor treated with steroids

What are come clinical complications of a cuff

Reduce airway, decrease taste, smell, sensation and voice, decrease PEEP and compromise cough and swallow

When to transition to tracheostomy tube

7-10 days of intubation, and unsuccessful intubation

Which tracheostomy tube is made of steel

Jackson

When should orophrayngeal airway be used

When pt is unconscious

What’s the difference between a guedel and berman OPA

Guedel- single catheter with hollow center Berman- two parallel side channels and it’s not compatible with suction

Indications for oropharyngeal airway

Restore airway patency, adequate ventilation and prevent tongue/ nose obstruction

HIPPA stands for

Health insurance portability and accountability act

Who needs to comply with the privacy rule

Everyone

What is protected health information

Name, DOB, address and medical history

PHI stands for

Protected health information

What is required for RT to work under

A competent medical supervision like M.D

What would you expect the patient to present as in a rapid response situation

Respiratory distress or health crisis that could lead to respiratory or cardiac failure

What are the typical departments and care provided in an acute care facility

ER, ICU and short term hospital csre

What is HMO

Health maintenance organization that delivers Medicare benefits

When a pt needs long term care where are they transferred

Skilled nursing facility SNF

What is cultural competence

Recognize and respond appropriately to key cultural features

Calculate heliox using factors 80/20 and 70/30

Flow X factors 80/20=1.8 70/30=1.6

Calculate tank duration

Factor x PSI / flow = A/6= B x 6 = C B( hour) C (minutes) E=.28 H= 3.14

Calculate CaO2

(Hb x 1.34 x SaO2) + ( 0.003 x PaO2)

Calculate minute ventilation (VE)

Tidal volume x respiratory rate

Calculate suction catheter

(ETT) x 1.5

Calculate Air/O2 ratio

100-A/A-21= B/C (divide c to both numerator and denominator) = D/E add D to E = F x flow = answer

Calculate PaO2

Fio2(deci) x (760-47)- co2 /.8

Is eastern medicine okay for pts to supplement western care

Yes

What is the purpose of cultural competence

To make pt feel more safe and comfortable

What does nitric oxide do

Improve blood flow to lungs

Standard precautions and proper infection control

Wash and sanitize hands for 30 sec, gloves gown and mask

Final Study Guide Flashcards

(103 cards)