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178 Cards in this Set
- Front
- Back
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what stage do you get to know your patient by briefing of their health status and a synopsis of their oral output
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Interviewing stage
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If you accelerate the rate of combustion the oxygen concentration does what?
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it accelerates the rate of combustion
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What does POMR stand for
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PROBLEM ORIENTATED MEDICAL RECORD
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What is the normal value for BUN
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7-28 mg/dl
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What is the normal range of CO2
what happens if its too low or too high |
Normal 21-32 mmol/L
too high Respiratory acidosis too low Metabolic alkalosis |
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If you have bronchitis for 3 consecutive months for 2 years you have what
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Chronic bronchitis
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What does Veracity mean
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to tell the truth, its a vital element in establishing trust
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If C (compliance) is constant in the equation P=V/C what does that mean about pressure and volume?
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Higher pressure would lead to a larger volume
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If P is constant in the equation if Q=P/R what does this mean about resistance and flow
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the higher the resistance would lead to lower the flow
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what was the epidemic in the 1930's that lead to the use of negative pressure ventilators?
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poliomyelitis
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oxygen demand valves of WWII combat aviators & high altitude hypoxia contributed to the development and practical application of what
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IPPB
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What is the Index Medicus
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a mag that just accepted respiratory care
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What the the primary duty of the first inhalation therapist?
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to support oxygen therapy
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Who developed the iron lung in the 1950's?
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Drinker and Emerson
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What was the name for the first professional organization for the field of respiratory care?
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Inhalator Therapy association
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Diagnostic related group , health maintenance organization and preferred provider organization these are example of what type of care?
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Managed Care
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Daily clinical review, working with insurance companies disease prevention and patient education, are examples of what kind task of whom?
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Case Manager
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What did Dr Levine do?
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He organized the 1st training program for inhalation therapist
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process of prescribing, diagnostic, or treatment services when not indicated?
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Misallocation
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The full body iron lung led to the development of what?
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The Emerson respirator
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What type of insurances bill of RUG categories?
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Medicare and managed care
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What law states that in PFT's the lung volume recorded at room temp are converted to volume at body temp.
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Charles
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refuse to conceal illegal, unethical or incompetent acts of others?
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role fidelity
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CO2 diffuses in blood 19X faster than O2 why?
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CO2 has a higher diffusion coefficient
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As the temp increase the viscosity of a gas becomes higher & the viscosity of a liquid becomes_____?
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lower
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Airway resistance is _____ related to the pressure gradient and ______ related to the flow?
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directly
inversely |
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Thermodilution is a technique based on who's principle?
what does it measure? |
Fick's principle
cardiac output |
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Thrope tubes are always attached to what kind of source?
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50 psi
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What is hypoxic hypoxia?
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Oxygen has trouble getting through the capillary membrane.
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What is the ratio if oxygen at 60%
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1:1
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What is the FiO2 for a nasal cannula and catheter?
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25-45 %
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Who establishes the standards for the construction and operation of medical gas piping systems?
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NFPA
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who establishes the standards for the larger cylinders
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ASSS
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What does PISS stand for
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Pin Index Safety System
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What gauge shows a higher flow rate that what is actually being delivered?
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Bourdon Guage
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(+) stamped on a cylinder means what
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that the tank can be filled 10% in excess of its listed service pressure
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In a compensated throurpe the flow meter needle is ______ to the flow indicator.
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distal
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How soon can atelectasis can set up in as little as______
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1 hour
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What are goals established for Post-Op?
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Alveolar collapse, pneumonia, and incision pain
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What is an example of pre-op and post-op training?
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Incentive Spirometry
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What is the most common cause of post-op atelectasis?
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splinting of breathing secondary to incisional pain
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if you sigh 6-10 times per hour, it inhibits replacements of what?
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surfactant in alveoli
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intercommunicating channels b/t terminal bronchioles & the alveloi that are about 30 mm in size and appear to remain open
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canals of Lambert
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why due open lungs tend to collapse
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due to the recoil of the lung
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What does HASH stand for?
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H- HYPOXIC low O2 across capillary
A- ANEMIC low iron S- STAGNANT circulatory H- HISTOXIC low O2 in tissues |
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swelling of a vessel is known as what?
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aneurysm
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what is the incidence of atelectasis following abdominal or thoracic procedures
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40% +
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What is pleural effusion
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fluid in the pleural
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What is some of the clinical appearances of atelectasis?
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shift of the mediastinal structures toward the affected side
elevation of the diaphragm decrease in PAO2 decrease in BS Increase in WOB |
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What are some tx options for atelectasis?
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foreign body o r remove tumor
pneumo chest tubes or needle aspiration aerosol therapy then remove get air around to reexpand alveoli. |
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Atelectasis can only be corrected by making alveolar pressure greater than ___________ pressure
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transpulmonary
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What does IS stand for and what does it do?
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Incentive Spirometry---- spontaneous generated deep breathing
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What does PAP stand for
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Positive Airway Pressure
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high alveolar inflating pressure exerted over a period of time can be achieved
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Ideal Maneuver
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What are some post-op complications?
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Atelectasis
pleural effusion Infections Pneumonias |
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_______ & _______ are a result if the introduction of bacteria from the oro and naso pharynx into the lower airway due to intubation
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infections and pneumonia
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region behind each terminal bronchiole forms a functional structure known as what?
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acinus
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What is the first thing in a diagnosis and pt?
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Why and what you are treating
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what do you need to be aware of with Dr's orders?
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type of tx,frequency, medication, dosage, and diluent.
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You need a ____ to work on a pt.
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Order
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Why is it important to get the history and physical of a pt.?
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Allerges, lung disease, smoking, cough and sputum production.
Physical-- breath sounds, CXR( chest x-ray |
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what would vital signs be?
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HR.RR.BP., temp graphic sheet grid with all criteria.
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What is on lab work?
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Cultures, sensitivies, and blood work.
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What do you want to look for in RT. notes
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how previous treatment was, how well it was taken and tolerated.
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POMR/SOAP?
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problem orientated medical record.
subjective- how pt. feels Objective- data and vitals assesment- of pt, progress. Plan- Dr. is working or doing |
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POMR
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Goes through each medical case. ID's each problem pt. has & work on it. Insert Resp. Ass & flow chart
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Physical Assessment Monitoring?
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RT's most likely to notice change, sound observations, monitor while on therapy if pt. is haveing reactions to tx. or meds.
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4 area's of assessment?
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Observation, inspection, & physical assessment. Vital signs
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HR
RATE RYTHM |
rate, rythym, and volume
brady<60-120>tachy reg or irregular volume |
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<90-140>
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hypotension<>hypertension
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Euphea
Platynea srtnopnea |
normal breathing
abnormal condition. diffuculity breathing in standing postition breathing easier in an upright position. |
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what is an normal RR?
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10-20, Brpm
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<12-18>
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Bradypnea<>tachypnea
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what are the four places to take a temp
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Axillary, rectal(lol), ear, Oral(lol).
**Axillary2degrees less than core** **Oral 1 degree less than core** |
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Assess Thoracic config>
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normal anterior and posterior diameter less then transverse diameter.
***A-P diameter does increase with age and copd*** |
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what are some abnormalities that would affect thoracic config?
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Kyphosis, scoliosis, kyphoscoliosis(hump & or curve of spine) pectus carinatum (bird chest)
Excavatum (caved in chest) |
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Abnormal Breathing Patterns?
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Prolonged inspiration, increased rate, increased depth, shallow decrease depth.
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Bedside assessment?
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vital cap -forced & slow
min. vol=VT/RR, peakflow/min MNI(f)P= max neg. inspiratory pressure |
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Apnea- No breathing
(sensation of breathing for 20 sec or greater) |
Cardiac arrest
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BIOT's- Irregular breathing with long periods of apnea
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Increased intracranial pressure
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Cheyne-Strokes
(Irregular type of breathing; increased & decreased in depth & rate with periods of apnea) |
Disease of central nervous sysytem, congestive heart failure
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Kussmaul's (deep & fast)
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Metabolic acidosis
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Paradoxical (breathing is seen as a fiail chest)
Portion of all chest wall moves in with inhalation and out with exhalation |
Chest trauma, diaphragm paralysis
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Asthmatic (prolonged exhalation)
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Obstruction to airflow out of lungs
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Restrictive
Obstructive |
Can't get in air
Can't get air out |
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****Patients with Restrictive Disorders?****
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**rapid and shallow***
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****Obstructive Disorders***
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*****prolonged expiration*****
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Thoracic Expansion ass. for chest wall symmetry?
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Anterior-place hands over anterolateral chest wall with thumbs extended along costal margin toward the xiphoid process.
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Thoracic Expansion ass. for chest wall Posterior?
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place hands over the posterolateral chest wall with the thumbs meeting approx @ 8th thoracic verterbral.
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Where can significance-bilateral reductions be seen?
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neuromuscular disease and C.O.P.D. pt's
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What does Anemic hypoxia require?
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Requires 5 gms of reduced hemoglobin
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central hypoxia, how can you determin it?
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mucosal membranes, & lips
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Cyanosis?
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due to a decrease in arterial saturation of cutaneous capillary blood.
**(central is worse) |
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Anemic & central hypoxia is caused how?
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Due to a failure to oxygenate blood in the lungs or a congenital heart disorder causing arterial desaturation.
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Peripheral digits?
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caused by a decrease is systemic blood flow (cardiac failure)
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Sensorium?
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awarness, comprehension
(hypoxia could be present=reduced cerebral blood flow) |
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Tracheal?
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alignment is in line
Atelectasis= shift toward trachea Pneumothorax= shift away from trachea |
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Palpitation?
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touching chest wall in effort to evalute underlying lung structure & function
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Palpitation?
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to evalute vocal fremituss, estimate thoracis expansion & assess skin & subcutaneous tissues of the chest.
Rule out suspected prob. suggested by H&p and physical examination. |
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What is vocal fremitus?
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vibrations created by vocal cords during phonation.
vib.transmitted down the trach.bronch. tree& through the alveoli to chest wall |
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Tactile Fremitus
(increase when there is something solid) |
decreased or absent found in obese or overly muscular patients.
(also in pt's with pneumothorax or pleural effusion) |
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Pulmonary osteoarythropathy?
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clubbing of the digits (fingers)
children C.F. pts's who have chf for a long period of time. |
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Ausculation?
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generation of sound. lungs are analogous to a pipe organ.
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How is tone determined?
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lenght and diameter of the airway
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what happens on inspiration?
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you get turbulent eddies due to the splitting of airflow
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What happens to the sound on expiration?
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is more laminar unless airways are constricted or mucus is present.
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What is a vesicular sound?
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have a soft low pitched quality heard during inspiration except where large airways are close to the surface
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What does Bronchovesicular sound like?
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louder higher pitched sound with equal in and out components.
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where are normal breath sounds usually located?
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typically in central airways, normal near hilum of lung. Bronchial similar to bronchovesicular but reduced in intensity and pitch
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What are adventitious breath sounds divided into too
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continuous and discontinuous
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what are the five sounds of adventitious breathing?
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Wheezes, Rhonchi, Crackles, Rales, and Strider.
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What are the four qualities the examiner should listen for?
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Pitch, Intensity, Didtinctive charareistics, and duration of inspiratory sound as compared to expiratory
(in should be shorter than out. |
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What are the goals of IPPB?
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improve and promote cough
improve distribution of ventilation deliver medications |
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How can IPPB make asthma worse?
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by overstimulating the airways
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Wheezes-airflow thru abstructed airways caused by b-spasm, mucosal edema
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High pitched; most often during exhalation
(asthma CHF, bronchitis) |
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Stridor-rapid airflow thru obstruction. Airway caused by inflammation (partial obstruction)
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High-pitched; occures during inhalation
(Croup, epiglottitis, p-extubation |
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Crackles (rales) Inspiratory&Expiratory
Excessive airway secretions moving with airflow |
Coarse & often clear with cough
(Bronchitis & Respiratory infections) |
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Early inspiratory- sudden opening of proximal brochi
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Not affected by cough
(Bronchitis, emphysema, and asthma) |
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Late inspiratory- Sudden opening of peripheral airways
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Diffuse, fine; occur initially in the bases
(Atelectasis, Pneumonia, pulmonary edema, fibrosis |
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What are a few indications that IPPB is necessary
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acute and chronic hypo-ventilation
prophylactic and tx atelectasis facilitate or aid in clearance of secretions decrease WOB Deliver aerosol meds |
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What does PEEP stand for?
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positive end expiratory pressure
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What are some physiological effects of IPPB
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improving oxygenation
WOB decreases if taken correctly improve gas distribution mechanical bronshodilation change I:E Increase Vt |
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What is an extreme precaution of IPPB
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never use IPPB on an acute untreated pneumothorax or tension pneumothorax.
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What are some contraindications precautions of IPPB
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subcutanoeous or mediastinal emphysema
T-E fistula-gastric insuffaltion Bullons disease Possible pneumo |
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what is the purpose of cpt?
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Mobilize and assist, aid & improve, & eliminate bronchial secretions, ventilation to affected lung areas, and potential airway obstructions
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What are indications for cpt?
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Thick excessive, copious purulent secretions, ineffective cough & mucus plugs, and Acutely ill pt's with copious secretions.
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what is frank hemoptysis
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spitting of bright red blood
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what is blebs
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huge alveloi in lungs that let air in but can't let air out
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What are some side effects of IPPB
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hyperinflation
hyperventilation gastric insufflation excessive oxygenation pt anxiety about being able to take correctly increase in intracranial pressure |
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the IPPB equip compresses good area so gas is able to penetarte into _____ areas
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bad
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What do you need to check before using IPPB tx's
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HR, RR, BS
alow deep breaths with breath holding Check HR to see if meds have adverse affect tx 7-10 min when done encourage pt to cough |
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What does percussion do?
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creates a mechanical shock wave to break mucus loose.
(3-5 min intervals |
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What does vibration due?
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helps move mucus along airway.
(segmental drainage wait 20 min. per Sit in position for 20 min. ) |
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what are 3 main factors that cause FiO2 to increase
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drive line use 100% source gas
Ambient side builds [ ] Venturi effect When spring loaded gate closes it places back pressure against entrainment of R/A |
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What are some characteristics for Pneumatic clutching
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decreases flow in response to increase to increase in back pressure
When you decrease flow your decrease turbulence only works on air mix |
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what is the theory of aerosol tx's
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b adrenergic, anticholineric, anti-inflammatory or mucokinetic agents to the lower airway
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What is a contraindication of aerosol tx
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sensitivity to meds allergies
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what is a side effect of aerosol tx's
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medicine side effects
brochospams device malfunction or improper tech may result in under or over dosing |
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What are some indications that I. S. therapy is needed
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Post-op pulmonary, complications abdominal or thoracic procedure
Atelectasis Retained secretions Increased inspirtaory volumes re-expnasion of lobes using (-) pressure lobectomy |
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What is a side effects of I.S. therapy
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dizziness due to hyperventilation
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Explain good technique for IS Therapy
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establish pre-op goals and volumes
continually steady inspire to peaks hold for several seconds perform one every 6 min |
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What is the purpose of IS tx
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increases trans pulmonary pressure
re-expands atelectatic areas breath holding at max inflation allows for better gas distribution |
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What is the purpose of nasopharyngeal airways
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to provide a route for nasotracheal suctioning minimizing trauma to the nasal mucosa from the suction catheter
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Explain the technique for inserting a nasopharyngeal airway
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well lubricate with H2O soluble jelly insert following natural curve
secure with a large safety pin thru phalange should be rotated to other nare and changes every 8 -24 hrs |
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What is the purpose of the oropharyngeal airway?
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it prevents the tongue from obstructing the upper airway
provides an airway provide route for suctioning can use as a bite block |
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What is a EOA
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Esophageal Obturator Airway
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What is an indication that EOA is necessary
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Respiratory or cardiorespiratory arrest
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What are some hazards with tracheal intubation
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stimualtes vommitin with possible aspirations
gastric insufflation hypoxia trauma to vocal cords |
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what type of airway has a feature of an esophageal gastric airway and an endotracheal tube
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double lumen
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What is a LMA
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laryngeal mask airway
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What are some indications for suctioning?
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retained for liquefied secretions
poor or liquefied cough |
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Sx is the application of _______ pressure to the airways through a collecting tube
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negative
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What is in the url?
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apical, anterior, posterior
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What is in the RMl?
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Lateral, & Medial
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RLL?
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Lateral basal, Anterior basal, Medial basal, posterior basal, superior basal
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LUL?
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apical posterior, anterior Lingual, superior, lingual inferior
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LLL?
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Anterior basal, Lateral basal, posterior basal, Superior basal
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What is the Trendelenburg position?
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laying flat on a 45 degree angle, ankles above head
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Reverse trendelenburgh?
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laying flat 45 degree angle head above ankles
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what is a side effect/complications of NT
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N-T bleeding
Laryngospams stimulate gastric reflexes tachycardia hyper or hypotension tachypnea SOB hypoxia Vagal induced bradycardia |
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When suctioning an adult patient what is the proper pressure
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80-120 mmhg
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When suctioning an child patient what is the proper pressure
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60-80 mmHg
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When suctioning an infant patient what is the proper pressure
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40-60 mmHg
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what should the cath size be ID or ET or trach tube
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1/3 to 1/2
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What are the three apps. used for pep therapy and flutter valve?
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continuous pap(cpap), expiratory pap(epap), and positive expiratory pressure (pep)
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What should the chart entries include?
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positions used, time in post., patient tolerance, effectiveness, and any uptoward effects observed
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vagal stimulation?
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Arrhyimias due to hypoxia or irritable myocardium-watch pattern change on ekg monitors.
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What is the rule of thumb pertaining to trachs?
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tube below the vocal cords at least 2-3cm's above the carina
(oral tubes 18-21cm) (nasal tubes 20-24cm) |
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What is a passy-muir valve?
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1-way flap, can inspire through valve put upon experation the air is trapped in. forcing the air to be expired up around the valve and through the nose and mouth
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What does a ruptured cuff require?
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decannulation and reinsertion
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purpose of a cuff?
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protect and seal, decreases array from upper airway, allows positive pressure ventilation.
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what happens when a cuff leaks?
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primary problem is when pt is being mechanically ventilated will cause a reduced delivery in tidal volume
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what are the six steps of extubation?
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assemble equip., suction, oxygenate pt., deflate cuff- sx pt again, remove tube and apply o2 and humidity
****5-6l of nasal canula******* |
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what is the rule of thumb when it comes to endotracheal tubes?
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oral-18-21cm & nasal 20-24 cm
***pediatric & noenates are not cuffed |
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when is a double lumen used?
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when focusing on one lung, pt is on two ventilators, and 2 openings within the same tube.
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What is the capillary pressure in healthy individuals?
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32mmHg= healthy
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what is the max cuff pressure?
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20cm/h2o
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What would be some common problems with endotracheal tubes?
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obstruction, breakdown of mucus can occur, and airway resistance increase= more work for pt. because taking away 1/3 to 1/2 of anatomical dead space.
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