Pt assess/ HFNC

Question 1

list and describe the types of normal breathing sounds
tracheal
bronchovesicular
vesicular

Answer 1

tracheal-ausculation of trachea
high, loud

bronchovesicular- ausculation of upper half of sternum
moderate, moderate

vesicular- ausculation over normal lung parenchgum
low, soft

Question 2

wheeze

Answer 2

high pitched, poly phonic or monophonic
-airflow through obstruction airways
-asthma, bronchitis, congestive heart failure

Question 3

stidor

Answer 3

high pitched monophonic sound
-airflow through obstructed upper airway
-laryngotracheobronchitis, epiglottitis, post-extubation swelling, laryngeal edema

Question 4

course crackle

Answer 4

crackling or bubbling sound or short
-airflow through airway secretions
-cleared by coughing or suction
-pneumonia, bronchitis

Question 5

fine crackles

Answer 5

recruitment of alveoli
-heard on inspirtation &depens on inspiratory effort
-atelectasis, fibrosis, pulmonary edema

Question 6

define patterns and possible causes: tachypnea

Answer 6

increased R.R
-exertion, fever, hypoxemia, metabolic acidosis, pulmonary edema, lung fibrosis, anxiety, pain

Question 7

define patterns and possible causes: bradypnea

Answer 7

decreased R.R
-traumatic brain injury, myocardial infraction,hypothermia, anesthetics, opiate narcotics, drug overdose

Question 8

define patterns and possible causes: apnea

Answer 8

no respirations
-respiratory arrest

Question 9

define patterns and possible causes: agonal

Answer 9

prolonged gasp
-cardiac arrest

Question 10

define patterns and possible causes: kussmauls

Answer 10

increased rate&depth
-metabolic acidosis, diabetic ketoacidosis, renal failure

Question 11

define patterns and possible causes: cheyne-stokes

Answer 11

R.R & Tidal volumeincrease in intensity then decrease into apnea for several seconds
-coma, brainstem injury, stroke, low cardiac output

Question 12

define patterns and possible causes: biots

Answer 12

choatic breathing w/irregularity in rate & tidal volume which become agonal
-damage to medulla by stroke or trauma

Question 13

what causes S1 heart sound

Answer 13

closing of mitral& tricuspid valves

Question 13

define patterns and possible causes: apneustic

Answer 13

prolonged inspiratory pauses at full inspiration that last 2-3 seconds
-damage to lower pons caused by basilary artery occlusion

Question 14

what cause S2 heart sounds

Answer 14

closing of pulmonary& aortic valves

Question 15

what causes heart murmurs

Answer 15

-backflow of blood through incompetent valves
-forward flow of blood through narrow valve
-rapid flow of blood through normal valve

Question 16

how do you assess for tracheal deviation

Answer 16

normal is middle
not aligned and shifted
place both thumbs on each side of the suprasternal notch gently

Question 17

if trachea is shifted toward the pathology what would you suspect

Answer 17

severe volume loss
*atelectasis
*pneumonectomy
*diaphragmatic paralysis

Question 18

if trachea is shifted away from the pathology, what would you suspect

Answer 18

increased volume & positive pressure in plural space
*massive pleural effusion
*tension pneumothorax
*neck or thyroid tumor
*large mediastinal mass

Question 19

what is the most common cause of an upper airway obstruction

Answer 19

tongue falling back against posterior wall of pharynx

edema, bleeding,secretions,foreign substances, laryngospasm

Question 20

what are the signs of complete upper airway obstructions

Answer 20

*inability to talk
*increased respiratory difficulty w/ no air movement
*cyanosis
*retractions
*use accessory muscles
*extreme panic
*unconscious

Question 20

what are the manual way to create airway patency and when do we use them

Answer 20

Head-tilt/Chin tilt- removes airway obstruction produced by tongue& epiglottis
*used when spinal trauma is not suspected

Jaw-thrust maneuver- removes airway obstruction produced by tongue&epiglottis
*used when spinal trauma is suspected

Question 21

what is the purpose of an oropharyngeal and a nasopharyngeal airway

Answer 21

to maintain an open airway by preventing the tongue from obstructing the airway

Question 22

Oropharyngeal airway (OPA)
how do you size it?

Answer 22

measure from corner of mouth to angle of jaw

Question 23

Oropharyngeal airway (OPA) how do you insert

Answer 23

insert the OPA into corner of mouth upside down, then turn into place by following natural curvature of mouth

Question 24

Oropharyngeal airway (OPA) what are the contraindications

Answer 24

conscious or semiconscious patients trauma to oral cavity, mandibular/maxillary areas of skull

Question 25

Nasopharyngeal airway (NPA) what are the contraindications

Answer 25

trauma to the nasal region, or foreign object present, facial trauma

Question 25

Nasopharyngeal airway (NPA) how to size it

Answer 25

measure from nostril tip to earlobe

Question 26

Nasopharyngeal airway (NPA) how to insert it

Answer 26

lubricate using water soluble gel, bevel faces septum

Question 27

High Flow Nasal Cannula (HFNC) can deliver flow up to how many L/min

Answer 27

60l/min, 70 l/min

Question 28

High Flow Nasal Cannula (HFNC) can deliver FiO2 to how much oxygen

Answer 28

up to 100% 21-100

Question 29

what three things does a high flow nasal cannula do for our patient

Answer 29

1.wash out CO2 from deadspace in the nasopharyngeal airways 2.flow exceed or meet the inspiratory needs of PT 3.increase functional residual capacity (FRC)

Question 30

what are the indications for High flow nasal cannula

Answer 30

*hypoxemic respiratory failure *hypercapnia *dyspnea

Question 31

when giving any kind of treatment, what do we assess the PT for

Answer 31

*pt interview-treatment received before, medication, home oxygen? *sensorium *physical assessment-color, WOB, PT position, chest abnormalities *vital signs-HR, RR, SPO2 *breath sounds&respiratory pattern *observe for treatment response-adverse reactions

Question 32

what indicates an adverse reaction when administering any treatment

Answer 32

more than 20 beats stop treatment!