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Clinical Instruction (Kass) > Homework > Flashcards

Homework Flashcards

1
Q

After a patient performed an FVC, the therapist performed a validity
check, and noticed that the back extrapolated volume was 175 mLs.
What should the therapist do?

A

Invalidate the test

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2
Q

At the start of a PFT the therapist turns on the PFT machine, but the
machine will not actually turn on. What actions should the therapist
take?

A

The device lacks electrical power.
Confirm device:
Is plugged in
Wire connections are good
Check/replace batteries.

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3
Q

Then the portable spirometer turns on but does not complete or fails
the power-on self-test. What actions should the therapist take?

A

failure of boot/start-up program or central processing unit
failure.
Record error message.
Turn device off, wait 20 seconds, turn device on.
Replace device

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4
Q

During the 3 L volume calibration the portable spirometer reads 3.12
L? What actions should the therapist take?

A

(3090 L is the acceptable high for calibration)
Check temp/press of altitude input
Check/fix flow sensor assembly
Check flow sensor for obstructions

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5
Q

At the start of the PFT the therapist notices that volume accumulated
before the exhalation. What should the therapist do?

A

Have patient hold the sensor steady at the beginning of the test, or set
it on the table

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6
Q

What should the therapist do if the flow measures appear to be
reversed in the PFT results?

A

The flow sensor for the inlet and outlet pressure tubing is
reversed.
Check/correct and confirm proper tubing placement

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7
Q

The spirometer did not sense the beginning of exhalation, what should the therapist do?

A

Check the sensor for damage and the sensor pressure tubing assembly and connections. Confirm correct tubing connections and/or replace
sensor.

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8
Q

The therapist suspects a low volume reading on a PFT what should be
done?

A

Recalibrate the PFT machine
Check the temperature
Pressure, or altitude inputs
Check the flow sensor for damage, reassemble/replace, check for leaks
in the tubing
Use nose clips
Ensure lip seal

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9
Q

if the therapist suspects high or low percent normal computations for
a PFT what should be done?

A

Check patient data entry (age, height, gender)
Reenter correct patient data

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10
Q

A patient has a PFT. The first FVC is 4.32 L. The second FVC is
4.6 L. What should the therapist do?

A

The therapist should do up to 8 tests until the patient tires or the 2
largest values are between 0.150 L

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11
Q

What does a peak flow device measure?

A

Flow (obstruction)

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12
Q

What type of patient most commonly utilizes a peak flow device?

A

Asthma patients

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13
Q

How are normal values established for peak flow devices?

A

The patient uses the peak flow meter 1 to 2 times/day.
Establishes their own normal

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14
Q

What is the green zone?

A

80% to 100 % of patient’s normal.
Patient is doing well

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15
Q

What is the yellow zone?

A

50 to 80% of patient’s normal.
May need to increase medications, call DR.

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16
Q

What is the red zone?

A

Less than 50% of patient’s normal.
Go to the hospital!

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17
Q

Define forced vital capacity (FVC).

A

Volume of air exhaled after a maximum inhalation.

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18
Q

What does the FVC measure?

A

Capacity or volume.

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19
Q

What does a low forced vital capacity mean?

A

Patient is restricted

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20
Q

Explain why the FVC is important when determining obstruction

A

If the FVC is low the patient may not look obstructed.
If the FVC is high the patient may look obstructed, but is not
obstructed. The FVC and the FEV1 need to be compared

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21
Q

define functional residual capacity (FRC

A

The volume of gas remaining in the lungs at the end of a resting
exhalation.

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22
Q

Define residual volume (RV

A

The volume of gas remaining after at the end of a resting
exhalation

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23
Q

Define forced expiratory volume (FEV1):

A

Volume of air exhaled in the first second of exhalation

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24
Q

What does the FEV1 measure?

A

Flow L/sec

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25
What does a low FEV1 mean?
large amount of Obstruction. Patients cannot move air out of the lungs, which makes it hard to get air into the lungs.
26
List possible ways to fix missed triggering
increase sensitivity Increase PEEP if there is auto-PEEP
27
List 3 possible ways to fix air trapping
Increase PEEP Decrease respiratory rate Decrease inspiratory time
28
List possible ways to fix a rise or slope problem
1. Decrease inspiratory time 2. Increase the rise time
29
List possible ways to fix a prolonged inspiratory phase problem:
1. Decrease the inspiratory time 2. Change the cycle time
30
List possible ways to fix “Beaking”
1. Decrease PEEP 2. Decrease PIP 3. Decrease tidal volume
31
A therapist enters a patient room, and the ventilator is emitting a low volume and a low-pressure alarm. What actions should the therapist take?
Check ETT placement Check for disconnections and/or loose connections in ventilator tubing
32
A therapist enters a patient room, and the ventilator is emitting a low volume and a high-pressure alarm. What actions should the therapist take?
Check to see if the patient needs suctioning Water in the ventilator tubing Check for a decrease in patient compliance (change to a pressure mode)
33
A therapist enters a patient room, the ventilator is emitting a low volume and a low minute volume alarm on a spontaneous mode. What actions should the therapist take?
Assess the patient for distress Check minute ventilation and respiratory rate Check ETT placement Check for disconnections and/or loose connections in ventilator tubing If patient is distressed, change to a more supportive mode
34
A therapist enters a patient room, the ventilator is emitting a high- respiratory rate and a high minute ventilation alarm on a spontaneous mode. What actions should the therapist take?
Assess the patient for distress Check minute ventilation and respiratory rate If patient is distressed, change to a more supportive mode.
35
The ventilator heater is alarming. What actions should the therapist take
Check the water level in the humidifier (add sterile water if needed) Check the temperature reading Check the temperature probe Check for water in the ventilator tubing
36
A patient on a ventilator is on a heated Passover humidifier. There is water bubbling in the circuit tubing. What actions could a therapist take?
Empty the water from the tubing Turn the heater down if above 35 degrees C
37
The humidifier pop-off sounds on the bubble bottle. What actions could a therapist take?
remove from the patient’s nose Find the obstruction in the cannula
38
A patient on a ventilator is on a heat and moisture exchanger (HME). The positive inspiratory pressure (PIP) is increased. What actions could a therapist take?
Change the HME
39
A patient on a ventilator is on a heated Passover humidifier. The airway temperature is too low. What actions could a therapist take?
Refill reservoir Cover the temperature probe Reset thermostat to 34 to 41 degrees C
40
A patient on a ventilator is on a heat and moisture exchanger (HME). The patient has profuse or viscous secretions. What action could a therapist take?
Change to a heated, humidified system
41
List 4 factors of low flow devices which that increase the FiO2
Flow Reservoir No leak from device Valves
42
What patients’ breathing patterns (inspiratory flow, tidal volume, respiratory rate, minute ventilation) decrease the FiO2 in low flow devices?
Increased inspiratory flow Increased tidal volume Increased rate Increased minute ventilation
43
A patient states that there is no flow from the nasal cannula. What actions could a therapist take?
check flowmeter Check for leaks Check humidifier tubing Check prong direction
44
A therapist is called to a room with a high-pitched whistle sound from the bubble bottle. What actions could a therapist take?
Check for obstructions in the tubing Check the flow from the flowmeter Check the patient’s nares
45
A patient complains of soreness over ears or lips. What actions could a therapist could take?
loosen straps Use skin protecting pads Change the device
46
patient constantly removes their oxygen mask. What actions could a therapist take?
Restrain/sedate patient Alternative device
47
The therapist is checking a patient on a non-rebreather mask. The reservoir bag collapses when the patient inhales. What should the therapist do?
Increase the flow
48
A patient on a simple mask develops erythema over their face. What actions could a therapist take?
Reposition straps Use protective pads Provide skin care Change devices
49
A patient’s SaO2 is 88% on a 28% venturi mask. What should the therapist do? List new settings and total out put of the device.
Check the oximeter. Check if oxygen is on the patient Check oxygen tubing Check the flowmeter Increase FiO2 to 31%
50
A patient has an SpO2 of 94%, and complains of dryness on a 50% venturi mask. What actions could a therapist take?
Could change the patient to a 50% cool large volume jet nebulizer.
51
A patient has an SaO2 of 87% on a 30% large volume jet nebulizer. What actions a therapist could take?
Check the oximeter. Check if oxygen is on the patient Check oxygen tubing Check the flowmeter Could change the patient to a 35% cool large volume jet nebulizer
52
The therapist does not see mist from a 40% cool jet nebulizer with a flow of 8 L/min. What should the therapist do?
increase the flow until mist appears
53
A therapist is administering a vibrating mesh aerosol treatment using AC power. The device does not mist. What 4 actions concerning AC power should a therapist take?
Check that device is plugged in Check that the plug works Check the cable Replace if mesh plate is clogged
54
patient complains their small volume jet nebulizer treatment does not mist the way it did originally. What 5 problems should the respiratory therapist check.
Check the baffle placement Check to make sure the jet orifice is not clogged Check that the flow is not too low Check the med cup isn’t loose or cross-threaded Check the volume of medication Check the nebulizer position
55
There is medication left over in the vibrating mesh unit after the treatment is finished. What actions should a therapist take?
Check the batteries to make sure they are not low Check the mesh plate to make sure it isn’t clogged
56
A patient complains that although they take their Symbicort MDI every morning and evening they do not feel any relief from their asthma. What problems should the respiratory therapist check?
is the patient priming when new? Is the Patient shaking the MDI before use Spacer use? Check patient technique Check amount of medication in the MDI
57
A patient complains that their asthma is worse although they take Advair every morning and evening. What problems should the respiratory therapist check.
Check the patient’s technique Is the patient’s inspiratory flow greater than 30 L/min. How much medication is left? Is there grinding or loose powder?
58
A stable patient needs short-term low FiO2 supplemental oxygen. What is the appropriate oxygen delivery device?
nasal cannula simple mask venturi mask
59
An adult that needs humidity and a high FiO2. What is the appropriate oxygen delivery device?
2 Large volume jet nebulizers A Humidified NRM
60
A post operative patient with a tracheostomy who needs moderate FiO2. What is an appropriate oxygen delivery device?
A Large Volume Jet Nebulizer
61
A patient needs high FiO2 with chest pain. What is the appropriate oxygen delivery device?
A High Flow Nasal Cannula An Oxymask A NRM
62
A claustrophobic patient with moderate FiO2 needs. What is the appropriate oxygen delivery device?
A Face Tent Large Volume Jet Nebulizer An Oxymask
63
An unstable COPD patient with low FiO2 needs. What is the appropriate oxygen delivery device?
A venturi mask
64
A male patient with a chest tube does not have fluctuations in the water level while breathing. The drainage system is obstructed. What actions should the therapist consider?
Check the collection chamber for kinks or dependent loops “Milk” the tubing connected to the chest tube toward the collection chamber Check the patient for signs of a pneumothorax Notify the physician if not fixable
65
There is no bubbling at all in the suction control chamber of a female patient with a chest tube. What actions should the therapist consider?
Check suction control regulator to make sure it is on. Check suction chamber for leaks/obstructions/kinks Check atmospheric vent to make sure it is open.
66
There is continuous bubbling in the water seal chamber of a female patient with a chest tube. What actions should the therapist consider?
Check for leaks and correct them Pinch the chest tube near insertion of patient, if bubbling stops the leak is near the insertion site or in the patient. If not check the collection system 1
67
The therapist is checking a 45-year-old female morbidly obese obstructive sleep apnea patient on CPAP. The pressure should read 16 cm H2O but reads 10 cm H2O. List possible solutions to correct this problem
Increase the flow Fix circuit leak/disconnect Mask leak
68
The therapist is checking a 66-year-old male obstructive sleep apnea patient on CPAP. The pressure should read 12 cm H2O but reads 15 cm H2O. List possible problems/solutions for this problem.
Decrease flow Check expiratory limb for occlusions Replace bacterial filter Check the patient for a nasal/pharyngeal obstruction
69
A male patient on NPPV with an oronasal (full face mask) complains of claustrophobia. What should the therapist do?
Choose a clear mask with minimal bulk
70
A female patient on NPPV with a nasal mask is leaking and cannot keep her mouth closed. What should the therapist do?
A female patient on NPPV with a nasal mask is leaking and cannot keep her mouth closed. What should the therapist do?
71
A male patient on NPPV with a with nasal pillows has redness and pressure sores in his external nares. What actions could the therapist take?
Ensure a proper fit Adjust the strap tension Change mask type
72
A female patient with an oral device is complaining of dry lips, mouth, and throat after wearing her oral device all night. What actions could the therapist take?
Provide humidification Apply oral lubricants/saliva replacements
73
A male Patient on NPPV with an oronasal mask is aspirating. What should the therapist do?
make sure the patient can protect their airway Use an NG tube
74
A female patient on NPPV with a nasal mask has a pressure sore on the bridge of her nose. What 4 actions could the therapist take?
Reduce strap tension Use a forehead spacer Use nasal pillows Use artificial skin or a nose pad
75
When is a shiley trach tube usually used?
usually as the first tracheostomy tube inserted
76
What is a TTS tube and when is it used?
Tight to shaft used for weaning, allows a patient to placed on a ventilator or off vent support
77
When is a bivona extra long trach tube used?
Used when a patient has a long neck or if there is tracheal damage and a patient needs to have the cuff repositioned
78
When is a proximal tracheostomy tube used?
used on patients with thick necks
79
When is a distal trach tube used?
Used when a patient has a long neck or if there is tracheal damage and a patient needs to have the cuff repositioned.
80
When is a fenestrated trach tube used?
allows patients to talk
81
When is a montgomery tube used?
the Montgomery T-tube is a device used as a combined tracheal stent and an airway after laryngotracheal surgery
82
What is a speaking valve?
The speaking valve is a buttonlike piece of equipment that is placed on the outer hub of the tracheostomy tube. The one-way valve opens to let air in through the tracheostomy when the patient inspires. The valve closes during expiration, causing the air to follow the normal route of expiration and permitting speech
83
List contraindications for speaking valves
Dyspnea, thick secretions, copious secretions, unawake patient, patient who can’t speak with a valve.
84
when is a trach button used?
It is often the last step in your airway weaning program. It is placed in the opening of the throat where your trach tube used to be. It will help keep your airway open in the event that you need help with mucous or have other breathing problems. The trach button is made of plastic
85
List early complications of artificial airways
One of the most common complications associated with tracheostomy is bleeding. The incidence of major or minor bleeding following tracheostomy is around 5.6%. This statistic refers to the population of the United Kingdom. Other common complications include tube obstruction, dislodgement, and stomal site infection.
86
List late complications of artificial airways:
Long-term complications include granulation tissue formation, laryngeal and/ or tracheal stenosis, tracheomalacia, trachoesophageal fistula

Clinical Instruction (Kass) (13 decks)

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