flash cards
(254 cards)
1
Q
What are the four critical life functions?
A
Ventilation, Oxygenation, Circulation, Perfustion
2
Q
Which of the 4 life functions is first priority?
A
Ventilation
3
Q
What assessments would determine how well a pt is ventilating?
A
RR, Vt, Chest Movement, Breath Sounds, PaCO2 etc.
4
Q
How would the therapist determine if there was a problem with oxygenation?
A
HR, Color, Sensorium, PaO2 etc.
5
Q
What info would help the RT determine if a pt’s circulation is adequate?
A
Pulse/HR and strength, Cardiac Output
6
Q
What changes would indicate that a patient may not have adequated perfusion?
A
BP, Sensorium, Temperature, Urine Output, Hemodynamics.
7
Q
Explain the difference between signs and symptoms and list examples of each:
A
Signs - Objective information, those things that you can see or measure (color, pulse, edema, BP, etc.
9
Q
List the 8 things that are important to examine when reviewing a patient’s chart:
A
Admission Notes
17
Q
Define an advance directive:
A
Set of instructions documenting what treatment a patient would want if he was unable to make medical decisions.
18
Q
List and describe the 3 types of advance directives:
A
- DNR - accepted in all 50 states
21
Q
A properly written order should include what for factors?
A
- Type of tx
25
Q
What is the normal value for urine output?
A
40 mL/Hr or approx 1L/day
26
Q
What findings might indicate a patients fluid intake has exceeded his urine output?
A
- Weight gain
30
Q
Changes in what reading can indicate hypovolemia?
A
Decreased CVP (CVP of < 2 mm Hg)
31
Q
Define Semi comatose:
A
Responds only to painful stimuli.
32
Q
Define Lethargy/Somnolence:
A
Sleep
33
Q
Define Obtunded:
A
Drowsy state
34
Q
When assessing a patient’s orientation to time, place and person, what are some of the factors that could affect the patient’s ability to cooperate?
A
Language difficulty
38
Q
Define “Activities of Daily Living” ADL:
A
The basics of everyday life.
39
Q
List the six criteria that “Activities of Daily Living” are based upon:
A
Bathing
45
Q
Describe what a “KATz ADL” score of 1 indicates:
A
0 = Pt unable to perform or needs assistance performing activity.
47
Q
Measuring subjective symptoms, define the following terms:
A
Orthopnea - Difficulty breathing except in an upright position (CHF, Heart problem)
54
Q
Peripheral Edema:
A
Presence of excessive fluid in the tissue known as pitting edema - occurs primarily in arms and ankles - caused by CHF and renal failure. Rated +1 and up… the higher the number, the greater the swelling.
55
Q
Ascites
A
Accumulation of fluid in the abdomen; generally caused by liver failure.
56
Clubbing of fingers
Caused by chronic hypoxia. Presence of this is suggestive of pulmonary disease.
57
Venous distension
Occurs with CHF; Seen in patients with obstructive lung disease. Seen during exhalation because of the obstructive component.
58
Capillary refill
Indication of peripheral circulation; Blanching of one hand and watching the blood return (Modified Allen's Test)
59
Diaphoresis
State of profuse/heavy sweating; Heart failure; fever; infection; anxiety; nervousness; Tuberculosis (night sweats)
60
Ashen/pallor
Decrease in color due to anemia or acute blood loss. Can be caused by vasoconstriction too.
61
Erythema
Redness of the skin - May be due to capillary congestion, inflammation or infection.
62
Cyanosis
Blue or blue-gray(dusky) discoloration of skin and mucous membranes. Caused by hypoxia from increase amount of reduced hemoglobin (5g of reduced hemoglobin).
63
Kyphosis
Convex curvature of the spine (rounded leaning forward)
64
Scoliosis
Lateral curvature of the spine
65
Barrel chest
Result of air trapping in the lungs for a long period of time
66
What are the normal muscles of ventilation?
Diaphragm, external intercostals
67
What are the accessory muscles of ventilation?
Intercostal, scalene, sternocleidomastoid, pectoralis major and abdominal
68
What causes hypertrophy of the accessory muscles?
Occurs with COPD
69
Signs of respiratory distress in infants:
Flaring of nostrils and intercostal retractions.
70
What is the normal range for a patient's heart rate?
60-100 BPM
71
What term would be used to describe a heart rate of 120 bpm? What would this indicate?
Tachycardia. Indication of hypoxemia, anxiety or stress.
72
What term would be used to describe a pulse of 47 bpm? What would this indicate?
Bradycardia. Indication of heart failure or shock.
73
What does pardoxical pulse/pulsus paradoxus indicate?
Pulse/blood pressure varies with respiration. May indicate severe air trapping.
74
What is tactile fremitus
Vibrations felt by hand on the chest wall
75
What is meant by crepitus and what condition is it associated with?
Bubbles of air under the skin that can be palpated and indicates the presence of subcutaneous emphysema.
76
Resonant
Normal air filled lung. Gives hollow sound.
77
Flat
Heard over the sternum, muscle or areas of atelectasis.
78
Dull
Heard over fluid-filled organs such as the heart or liver. Pleural effusion or pneumonia will give this thudding sound.
79
Tympanic
Heard over air-filled stomach. This is a drum like sound and when heard over the lungs indicates increased volume.
80
Hyperresonant
found in areas of the lung where pneumothorax or emphysema is present. This is a booming sound.
81
What is the difference between vesicular and adventitious sounds?
Vesicular is normal, adventitious is abnormal
82
What is egophony and what would it indicate?
Patient instructed to say "E" but it sounds like "A". This would indicate consolodation in the lung like pneumonia.
83
What breath sounds would be expected in a patient with pneumonia?
Dull
84
Describe S1 heard sound and when it would occur in the cardiac cycle
Created by the normal closure of the mitral and tricuspid valves at the beginning of ventricular contraction.
85
Describe S2 heard sound and when it would occur in the cardiac cycle
Normal and occurs when systole ends. The ventricles relax and the pulmonic and aortic valves close.
86
Describe what the abnormal S3 sound indicates:
May suggest CHF; Low pitched and may be difficult to discriminate from S4
87
Describe what the abnormal S4 sound indicates:
Indicative of a cardiac abnormality such as myocardial infarction or cardiomegaly.
88
Describe what a murmur may indicate:
Caused by turbulent blood flow. May be caused by heart valve defects or congenital heart abnormalities and should be investigated.
89
Describe Bruits:
Sound made in an artery or vein when blood flow becomes turbulent or flows in an abnormal speed.
90
What effect could cardiac stress have on blood pressure?
Hyoxemia
91
What effect would hypoperfusion have aon BP?
Hypovolemia, CHF
92
Describe the normal appearance of the hemidiaphragm on a chest x-ray.
Both are rounded (dome shaped); right is slightly higher than the left; right is at the level of the 6th anterior rib.
93
Describe the normal appearance of the trachea on a chest x-ray.
Midline, bilateral radiolucency, with sharp costophrenic angles.
94
Describe the normal appearance of the clavicles on a normal chest x-ray.
Head of clavicles should be level.
95
List some possible causes for loss of airway latency:
Foreign body obstruction; Edema as seen with croup, epiglottitis or allergic reactions, tracheal spasms, internal or external compression, trauma leading to airleak.
96
What condition causes obliteration of the costophrenic angles?
Pleural effusion
97
In what pathology is the diaphragm flattened?
COPD
98
Describe lateral postion when used for x-ray:
Projection from either the right or left side.
99
Describe lateral decubitus position when used for x-ray:
Patient lying on the affected side. Valuable for detecting small pleural effusions.
100
Where should the tip of the endotracheal tube be positioned when viewed on a chest x-ray.
Below the vocal chords approx 2 cm or 1 inch above the carina. Approx the same height as the aortic notch.
101
What is the quickest way to to determine adequate ventilation following endotracheal intubation?
Auscultation
102
Where should the chest tube be located when positioned properly?
In the pleural space surrounding the lung.
103
Where should the nasogastric and feeding tube be located when positioned properly?
2-5 cm below the diaphragm.
104
Where should the pulmonary artery catheter be located when positioned properly?
In the right lower lung field.
105
Where should the pacemaker be located when positioned properly?
Should normally be positioned in the right ventricle (SA node...).
106
Where should the central venous catheter be located when positioned properly?
Right or left subclavian or jugular vein and should rest in the vena cava or right atrium of the heart.
107
What diagnostic test is appropriate for determining an upper airway obstruction in a child (croup and epiglottitis)?
Lateral neck x-ray.
108
Describe Croup:
Laryngotracheobronchitis - a viral disorder common in infants and young children. the x-ray of the neck will reveal tracheal narrowing with subglottic swelling in a classic pattern called:
110
Describe Epiglottitis:
A potentially life-threatening inflammation of the supraglottic airway caused by a bacterial infection. A lateral neck x-ray shows supraglottic narrowing with an enlarged and flattened epiglottis and swollen aryepiglottic folds. Seen as a thumb sign.
111
Radiolucent description and diagnosis:
Dark pattern (Air);
113
Radiodense/opacity
White pattern (Solid, Fluid);
115
Infiltrate
Any ill-difined radio density;
117
Consolidation
Solid white area;
119
Hyperlucency
Extra pulmonary air;
121
Vascular markings
Lymphatics, vessels, lung tissue;
123
Diffuse
Spread throughout;
125
Opaque
Fluid, solid;
127
Fluffy infiltrates
Diffuse whiteness;
129
Butterfly/Batwing pattern
Infiltrate in shape of butterfly/bat wing;
131
Patchy infiltrates
Scattered densities;
133
Patelike infiltrates
Thin-layered densities;
135
Ground glass appearance
Reticulogranular;
137
Honeycomb pattern
Reticulondodular;
139
Diffuse bilateral radiopacity
ARDS
140
Air Bronchogram
Pneumonia
141
Peripheral wedge-shaped infiltrate
Pulmonary embolus
142
Concave superior interface/border
Pleural effusion
143
Basilar infiltrates with meniscus
Pleural effusion
144
Describe a CT scan:
An x-ray through a specific plane of the body part to be examined. Images appear as narrow slices of the organ or body part.
145
What pathologies would a CT be indicated?
Bronchiectasis
146
What special type of CT scan is indicated to diagnose a pulmonary embolus?
Ct scan with conrtrast dye.
147
What is the advantage of using MRI over a conventional x-ray?
No x-rays are used.
148
What type of ventilators are used with MRI and why?
Fluidic (non-electric, gas powered)
149
Describe how ventilation/perfusion scan test is performed:
Ventilation -
153
What is indicated by normal ventilation and abnormal perfusion?
Pulmonary emboli.
154
What are indications for a barium swallow test?
Suspected esophageal malignancy.
159
What is the main indication for bronchography?
Bronchiectasis
160
List two hazards of a bronchography:
Allergic reaction and impairment of ventilation
161
A PET (positron emission topography) scan would be useful to help diagnose what conditions?
Cancer, brain disorders and heart disease.
162
An EEG is indicated to assess activit of the?
Brain
163
Pulmonary (arteriogram) Angiogram test is indicated to diagnose what pathology?
Pulmonary embolism.
164
Briefly describe what echocardiograpy would be indicated and what can be measured with two different types of procedures:
Indications are valvular disease or dysfunciton; mycocardial disease, abnormalities of cardiac blood flow; Cardiac abnormalites in infant (ASD, VSD, PDA); Abnormal hear sounds.
166
What is the normal rance for ICP?
5-110 mmHg
167
Treatment is recommended when ICP increases above what level?
>20 mmHg
168
Define cerebral perfusion pressure
The pressure gradient that determines cerebral perfusion
169
What is the formula to calculate CPP?
MAP - ICP
170
What is the normal value for CPP?
70-90 mmHg
172
CVP - Normal values; related to...
2-6 mmHg; Right heart fx
173
PAP - Normal values; related to...
25/8 Mean 14 Range 9-18 mmHg; Lungs
174
PCWP - Normal values; related to...
4-12 mmHg; Left heart fx
175
CO - Normal values
4-8 L/min
176
Usual cause high CVP
Fluid overload, diurese
177
When CVP low
Usually dehydration or vasodilation, give fluids or vasoconstrictors
178
Possible pathology increased CVP
Right heart failure, cor pulmonale, tricuspid valve stenosis
179
(xray)Central venous catheter placement
Tip should rest in right atrium or vena cava
180
(xray) Pulmonary artery catheter placement
Tip should be over the right lower lung field
181
Most common complication of PA catheter insertion
Arrythmias
182
How you will know you are in the pulmonary artery
Dicrotic notch
183
How to fix pressure dampening (dicrotic notch absent)
a. Check for air bubbles
188
Hb range
12-16 gm/dL
189
Vd/Vt - Formula; range
PaCO2-(PeCO2)/PaCO2; 20-40%, up to 60% if ventilated
190
High Vd/Vt usually relates to
Pulmonary embolus
191
Alveolar air equation (PAO2)
((Pb-PH2O)FIO2) - PaCO2/0.8
192
A-a Gradient - Formula; values
A-aDO2 = PAO2 - PaO2; Normal 25-65. 65-299 = V/Q mismatch, >300 = shunt
193
It is best to obtain the A-a gradient when
The patient is on 100% FIO2
194
Arterial Oxygen Content - Formula; values
CaO2 = (Hbx1.34xSaO2) + (PaO2x0.003);
196
Venous Oxygen Content - Formula; values
CvO2 = (Hbx1.34xSv02) + (PvO2x0.003);
198
Arterial-Venous Oxygen Content Difference - Values
C(a-v)O2; Normal 4-5 vol%; difference INCREASES when Qt is DECREASING
199
Best measurement of oxygen being delivered to the tissues
CaO2
200
The CvO2 should be drawn from
Pulmonary artery
201
P/F ratio - values
Normal >380 (PaO2 of 80/21%), <200 ARDS
202
Fick Equation
Qt = VO2/C(a-v)02x10
203
If a BP cuff and an arterial line display different values. Trust the
BP cuff
204
Neonate, acceptable PaO2
50-80 mmHg, all other values same
205
(xray) Obliterated costophrenic angles; concave superior surface; meniscus
Pleural effusion
206
(xray) Flattened diaphragm
Air trapping
207
(xray) Radiolucent
Normal
208
(xray) Fluffy infiltrates, butterfly/batwing pattern
Pulmonary edema
209
(xray) Air bronchogram
Pneumonia
210
(xray) Ground glass, honeycomb, reticulogranular
ARDS/IRDS
211
(xray) Thumb sign
Acute epiglottitis
212
(xray) Steeple sign
Croup
213
(xray) Airway placement
2-5 cm above carina; level w/ 4th rib/T-4, aortic knob
214
(xray) Chest tube placement
Should be in the neural space
215
Primary Dx tool for bronchiectasis
Bronchogram
216
Used to determine risk for aspiration
Barium swallow
217
Low K+ can cause
Metabolic alkalosis
218
Hypokalemia - cause; ECG
Excessive fluid loss (vomiting, dehydration); Flattened T-wave
219
Cl- follows
Na+
220
Eosinophils associated w/
Asthma, allergic reactions
221
Monocytes associated w/
TB
222
PT - use; values
Monitors Warfarin (Coumadin) Therapys, 12-15 sec
223
APTT - use; values
Monitors Heparin therapy; 24-32 sec
224
Acid Fast stain
Tuberculosis
225
Culture
Identifies organism
226
Sensitivity
Identifies which antibiotics kills organism
227
TcPO2/TcPCO2 electrodes should be moved
Q4H
228
TcPO2/TcPCO2 calibration
Room air and zeroing solution
229
Best indicator of perfusion
Urine output
230
Dry non-productive cough
Think cancer
231
Digital clubbing
Chronic hypoxemia (think COPD)
232
Neck vein distension
Associate with CHF and COPD
233
Night sweats
TB
234
Cold and clammy skin
Think myocardial infarction
235
Unilateral wheeze
Foreign body; broncoscopy
236
Rhonchi
Suction
237
Mild stridor
Cool mist, racemic epi
238
Moderate stridor
Racemic epi
239
Severe stridor
Intubate
240
Pulsus paradoxus
BP rises and falls during inspiratory and expiratory efforts. Severe air trapping. Status asthmaticus
241
Test when S3/S4 heart sounds are heard
Echocardiogram
242
S3/S4 associations
S3 CHF, S4 cardiomegally
243
(ECG) Best lead to assess left ventricle
Lead V5
244
(ECG) Best lead to determine overall electrical condition
Lead II
245
Tx sinus tach
Oxygen
246
Tx sinus brady
Oxygen and atropine
247
Tx PVCs
Oxygen if occasional, lidocaine if frequent
248
Tx asystole
Confirm in two chest leads, CPR, epi, atropine
249
Tx V-tach
Pulse - Lidocaine and cardioversion
251
Tx V-fib
Defibrillate
252
Tx 1st degree heart block
Atropine
253
Tx 2nd degree heart block
Atropine, pacing
254
Tx 3rd degree heart block
Pacemaker
255
Reasons for cardiac electrical current deviation
Hypertrophy, infarction
256
(ECG) Ischemia
Current lack of oxygen; Inverted T-wave (may also be caused by digitalis toxicity)
257
(ECG) Injury
Cardiac tissue in a state of dying; S-T elevation
258
(ECG) Infarction
Dead cardiac tissue; significant Q-wave
259
The SVC should always be
Greater than the FVC. If FVC is greater, PT effort is poor (i.e. wanting disability)
260
FVC loop - Round
Large fixed airway obstruction (such as vocal cord paralysis or cancer)
261
FRC measurement
Nitrogen washout or plethsymograph
262
Only obstructive Dz associated w/ poor DLco
Emphysema
263
Pre-Post BD reversibility considered significant if
There is a 12%/200mL or greater increase in flows
264
Selection of best test
Best FEV1 + FVC
265
Calibration syringe - Results close together but far from correct
Inaccurate but precise
266
ICP
5-10 mmHg; Tx suggested >20 mmHg; keep PT sedated
267
PaCO2 range for PT w/ increased ICPs
25-30
268
Drugs to Tx increased ICPs
Diamox, Osmitrol
269
APGAR 7-10
Provide routine care
270
APGAR 4-6
Support w/ O2, warmth, stimulation
271
APGAR 0-3
Code
272
Gestational age ranges
42 Postterm
273
Venturi mask, bed covers may
Accidentally occlude entrainment port and increase FIO2
274
Problem suspected w/ pulse-dose O2 delivery system
Switch to continuous mode
275
Oxygen concentrator (molecular sieve) can produce up to
6 lpm
276
CPAP problem w/ infants
If infant is crying, pressure is lost
277
100% body humidity
44 mg/L
278
Ultrasonic neb frequency
Can not be changed
279
Back pressure does this to FIO2
Increases
280
Common home vents
PLV 100, LP 6, LP 10, PB Companion, Intermed Bear
281
Oral ET tube should be
20-24 lips
282
Nasal ET tube should be
25-29 at nares
283
PetCO2 during code
Will first read low, then rise w/ adequate ventilation
284
Best equipment to continually measure flow
Fleisch pneumotachometer
285
Helium dilution uses this type of analyzer
Wheatstone bridge
286
Nitrogen washout equipment that measures nitrogen
Geissler tube ionizer
287
Polarographic analyzer reads low FIO2
Change batteries
288
Polarographic analyzer will not read
If batteries are good, replace electrolyte solution
289
Galvanic fuel cell troubleshoot
Change cell (don't change solution or battery, the cell IS the battery)
290
BVM collapses easily
Change bag, otherwise replace air-inlet valve
291
BVM difficult
Ensure patient valve is not stuck open, does PT have low lung compliance?
292
Facilitate suction of left main stem bronchus
Coude tip catheter
293
Suction catheter diameter should not exceed
1/2 diameter of ETT
294
Difficult suction troubleshoot
Suction pressure range -> Increase cath size -> Increase suction time
295
Change Cidex
Every 14 days
296
Cidex is tuberculocidal in
20 minutes
297
Post-Op IS goal
1/2 amount achieved pre-op
298
Initiation of MV - Rate; Vt
Rate 8-12, Vt 8-12 mL/kg
299
Dynamic compliance
Exhaled Vt/PIP-PEEP
300
Static compliance
Exhaled Vt/Pplat-PEEP; 25-100 mL/cmH20 acceptable
301
If PaO2 is low
Raise FIO2 5-10% until 60%, then add/raise PEEP by 5
302
If PaO2 is high
Lower FIO2 until <60%, then lower PEEP in increments of 5
303
Most important alarm in paralyzed PT
Low PEEP. If low PEEP alarm not available, then low volume or disconnect
304
Best position for gas distribution during MV
Semi-Fowler's
305
If patient is in distress from suctioning
Decrease suction time
306
Avoid PEP therapy during
Epistaxis, middle ear infections, sinus problems
307
Low exhaled Vt w/ chest tube
Adjust Vt to maintain ABG values
308
Excessive bubbling in suction control bottle
Too much suction pressure
309
Excessive bubbling in water seal chamber
Clamp tube proximal PT, if bubbling stops, problem is inside the PT
310
If glass bottle breaks
Submerge chest tube into water from any container
311
Heliox 80/20 correction factor
1.8
312
Heliox 70/30 correction factor
1.6
313
Cardioversion must be done on
The R-wave of ECG. Ensure synchronization is on
314
Bleeding during bronchoscopy
Instill epi, then apply pressure with bronchoscope
315
AHI > 30
Severe sleep apnea. Next step is titration study
316
Transport vent volumes fall
Check tank
