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RCP 250 > Week 1 > Flashcards

Week 1 Flashcards

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1
Q

Gas absorption atelectasis occurs?

A

when mucus plugs block ventilation to selected regions of the lungs ; gas distal to obstruction is absorbed by passing blood through the pulmonary capillaries which leads to partial collapse

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2
Q

Compression atelectasis is caused by

A

caused by persistent breathing with small tidal volumes and/or certain types of restrictive chest-wall disorder (common in post-op)

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3
Q

Lobar atelectasis occurs when

A

when ventilation is compromised in the larger airways (or bronchus)

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4
Q

Factors associated with causing atelectasis(8)

A

obesity, neuromuscular disorders, heavy sedation, surgery near diaphragm, bed rest, poor cough, history of lung disease and restrictive chest-wall abnormalities

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5
Q

what is atelectasis?

A

alveolar collapse (lung collapse)

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6
Q

clinical signs of atelectasis? (8)

A

history of recent major surgery, tachypnea, fine late-inspiratory crackles, bronchial or diminished breath sounds, tachycardia and increased density & signs of volume loss on chest radiograph

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7
Q

options for hyperinflation / lung expansion therapy(6)

A

Early mobilization
IS - incentive spirometry
DB & C - deep breathing and cough technique
PEP - positive expiratory pressure
IPPB - intermittent positive pressure breathing
CPAP - continuous positive pressure breathing

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8
Q

what are the different types of hyperinflartion therapy? (4)

A

IS - incentive spirometry
PEP - positive expiratory pressure
IPPB - intermittent positive pressure breathing
CPAP - continuous positive pressure breathing

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9
Q

Administration of I. S ?

A

need for incentive spirometry is determined by careful patient assesment
HIGH RISK patient

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10
Q

Hazards for I.S ? (3)

A

hyperventilation
discomfort
fatigue

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11
Q

How long should patient sustain their maximal inspiratory effort for?

A

5 to 10 seconds

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12
Q

I. S contraindications (3)

A

patient cannot be instructed
lac k of patient cooperation
patient is unable to take a deep breath
- V < 10 ml/kg

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13
Q

potential outcomes of incentive spirometry? (6)

A

decrease or elimination of atelectasis
improved breath sounds
normal or improved chest x ray
increased oxygen saturation
increased vital capacity
improved inspiratory muscle performance and cough

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14
Q

Goal of IPPB?

A

to assist in deep breathing and/or stimulate a cough

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15
Q

what does IPPB stand for?

A

intermittent positive pressure breathing

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16
Q

indications for IPPB

A

patient with atelectasis and not responsive to other modalities such as IS
patient at high risk for atelectasis who cannot perform IS
Inability to clear secretions
Need to delivery aerosol medication(but does not improve aerosol deposition)

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17
Q

pressure (Vt 12-15ml/kg = ?

A

controls tidal volume

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18
Q

inspiratory flow =?

A

controls inspiratory time

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19
Q

sensitivity = ?

A

triggers the end of the inspiratory breath

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20
Q

contraindications of IPPB (9)

A

tension pneumothorax, ICP > 15 mmHg, hemodynamic instability, active hemoptysis, tracheoesophageal fistula, recent esophageal surgery, radiographic evidence of blebs, recent racial/oral/ or skull surgery and nausea

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21
Q

Hazards and complications of IPPB (5)

A

Hyperventilation and respiratory alkalosis
discomfort secondary to inadequate pain control, pulmonary barotrauma, exacerbation of bronchospasm and fatigue

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22
Q

signs of pulmonary barotrauma

A

tension pneumothroax
-sudden sharp pain in chest
-tachypnea
-tachycardia
-central cyanosis

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23
Q

administration of IPPB

A

preliminary planning
therapeutic outcomes set
evaluate alternatives
baseline assesment of patient

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24
Q

implementation of IPPB

A

equipment preparation
patient orientation
patient positioning
adjusting parameters(flow and pressure)

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25
IPPB implementation when treating atelectasis
therapy should be volume-oriented *tidal volumes(VT) must be measured VT goals of 10-15 mL/kg of body weight pressure can be increased to reach VT goal if tolerated by patient
26
potential outcomes of intermittent positive airway pressure breathing therapy (6)
decrease or elimination of atelectasis improved breath sounds normal or improved chest x-ray increased oxygen saturation increased vital capacity improved inspiratory muscle performance and cough
27
IPPB bird series
mark 7 series pneumatically driven can be timed, pressure, or manually TRIGGERED pressure cycled can be used to provide short term ventilatory support primarily used for IPPB therapy
28
three current devices to PAP
PEP, flutter and CPAP
29
differences between PEP + Flutter and CPAP ?
PEP/Flutter create expiratory positive pressure, while CPAP maintains positive pressure during oinhalation and exhalation
30
Contraindications of positive airway pressure therapy (6)
hemodynamic instability patient with hypoventilation ICP > 15 mmHg Active hemoptysis Nausea hypoventilation
31
most common problem with PAP therapies is?
system leaks
32
patients must be monitored for? (continuous positive airway pressure CPAP)
hypoventilation and elevated PCO2
33
hazards/complications of continuous positive airway pressure (5)
barotrauma hypoventilation gastric distention vomiting and aspiration
34
selecting approach are (3)
Level of patient cooperation Amount of pulmonary secretions Patient's spontaneous vital capacity
35
3 elements that must be present for infection to spread
source of pathogens susceptible host route of transmission
36
host factors increasing chance of infection are
poorly controlled diabetes increased age chemotherapy placement of tubes and catheters
37
sources of infectious agents
humans are PRIMARY inanimate objects
38
individuals in hospital capable of being source include
workers visitors patients
39
infection acquired in hospital
nosocomial infection
40
most nosocomial pneumonias occur in patients having?
chest or abdominal surgery
41
patients with what histories have GREATEST risk for nosocomial pneumonia (4)
patients with history of COPD cigarette smoking obesity advanced age
42
patients with what are at HIGHER risk of acquiring nosocomial infections?
artificial airways or immuno-compromised
43
contact precautions
wash hands on entering and leaving room gloves gown
44
eliminating source of pathogens GENERAL
help to keep overall environment clean aim to reduce number of pathogens to safe level
45
eliminating source of pathogens SPECIALIZED
decontaminating equipment capable of spreading infection involving cleaning, disinfection and sterilization of equipment
46
Antiseptic
prevents
47
Bactericidal
kills bacteria
48
Bacteriostatic
inhibit the growth of bacteria
49
Sporicidal
destroys spores
50
Virucidal
destroys viruses
51
what do infection programs do?
programs identify and categorize HAIs and provide guidance to break chain of events
52
standard precautions apply to (4)
blood all bodily fluids non-intact skin mucous membranes
53
what does PPE stand for?
Personal Protective Equipment
54
standard PPE includes (4)
gloves ; must be sterile masks ; protect mucosal surfaces against splashes or sprays N-95 ; intended for diseases Gowns ; provide barrier protection and preventing contamination
55
respiratory hygiene/cough etiquette
education of patients and employees posted signs source control measures hand hygiene
56
airborne isolation
use of N-95 respirator room MUST be negative pressured
57
droplet precaution
prevent form of contact transmission that occurs when droplets are propelled short distances, such as influenza generated w/ coughing, sneezing suctioning, bronchoscopy and cough induction surgical mask MUST be worn
58
expanded precautions
protective environment specialized engineering approach to protect highly immumosurppressed patients used with allogeneic stem cell transplant patient
59
expanded precautions INCLUDE?
HEPA filtration of incoming air, directed room air flow, positive rom air pressure relative to corridor, well sealed rooms to prevent infiltration of outside air, ventilation to provide 12 or more air changes per hour
60
patient placement and transport
single occupancy room (ideal) cohorting: grouping patients w same infection limit transport of pains w. contagious diseases during transport, patient needs to wear appropriate barrier protection (masks, gowns, impervious dressgings) consistent w/ route and risk for transmission
61
disinfection and sterilization
1. cleaning in all equipment processing 2. involves removing dirt and organic material 3. failure to clean equipment properly can render all subsequent processing efforts ineffective 4. soaps and detergents need to be used 5. non-critical items, such as intravenous pumps, and ventilator surfaces must be thoroughly cleaned and disinfected before use of another patient
62
disinfection destroys vegetive form of all pathogens EXCEPT ?
bacterial spores
63
disinfection can involve either ?(2)
chemical or physical methods
64
most common physical disinfectant method?
pasteurization
65
chemical disinfection
equipment must be immersed in solution for a set period of time
66
what destroys all microorganisms?
sterilization
67
what can be achieved with physical and chemical approaches?
sterilization
68
___ sterilization is most common and easiest
steam sterilization
69
what is high pressure sterilization?
AUTOCLAVE 121C=249F for 10-15 minutes
70
what is low temp sterilization?
ethylene oxide glutaraldehyde
71
color and kind of gas is ethylene oxide?
colorless and toxic gas
72
glutaraldehyde
soricide : 6;45, 10 Hr, Acid G 1 hr
73
respiratory equipment that can spread pathogens (4)
nebulizers, ventilator circuits, bag valve masks devices, (bvms; manual resuscitators), suction equipment
74
oxygen therapy and pulmonary function equipment are also implicates as?
potential sources of nosocomial infections
75
are large volume nebulizers often problematic?
yes
76
small volume nebulizer can also produce?
bacterial aerosols
77
ventilators and circuits pose?
greater risk for infection
78
what filters help reduce endotracheal tube contamination
high efficiency particulate air/aerosol (HEPA)
79
3 major issues for equipment handling
cost quality reuse (raises significant safety concerns)

RCP 250 (2 decks)

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