Review For Crt

Front 1

Ventilation

Back 1

Breathing air in and out of the lungs

Front 2

Oxygenation

Back 2

Getting Oxygen into the blood

Front 3

Circulation

Back 3

Moving the blood through the body

Front 4

Perfusion

Back 4

Getting Blood and Oxygen into the tissues

Front 5

Ventilation

Back 5

Respiratory Rate, Tidal Volume, Chest Movement Breath Sounds, PaCO2

Front 6

Oxygenation

Back 6

Heart Rate, Color, Sensorium, PaO2

Front 7

Circulation

Back 7

Pulse Heart Rate and Strength. Cardiac Output

Front 8

Perfussion

Back 8

Blood Pressure, Sensorium temperature, Urine Output hemodynamics

Front 9

When you have an emergency what comes first?

Back 9

1st is Ventilation (establish an open airway and breathe 2nd. Oxygenation (Increase FIO2) 3rd is Circulation (Chest compressions defibrillate, give heart drugs Most Common problem is Oxygenation

Front 10

What is on a Patient Evaluation?

Back 10

l) Admission Notes include: Admitting diagnosis History of Present Illness (chief complaint) and past medical history2) Signs and Symptoms things you can see Color, Pulse Edema, Blood Pressure Symptoms Patient must tell you: dyspnea, pain neasea muscle weakness Occupation or Employment History Allergies, Prior Surgeries Illness or Injury Vital Signs, RR, Pulse, BP, Temp Physical Exam of Chest inspection, palpation, purcussion and auscultation

Front 11

What is smoking history?

Back 11

Patients number of pkg per day times number of years smoked

Front 12

What is an Advance Directive?

Back 12

DNR: Do Not Resuscitate

Front 13

What is On the Respiratory Care Orders?

Back 13

Type of treatment, frequency, medication dosage and dilution Physican Signature

Front 14

What goes on a Patients Progress Notes and Lab Reports

Back 14

Respirator Notes Date, times Reactions Nursing Notes check patient status boats Reports ABG Pulmonary Function testing Image Reports Xrays Ct, MRI, PET

Front 15

What are the basic lab Assessments?

Back 15

CBC, electrolytes, urine analysis, pleural fluid Intake and Output: Normal l liter a day Sensible water loss-urine, vomiting Insensible water loss Lungs and Skin If intake exceeds output could cause: Weight gain, electrolyte imbalance Increased homodynamic pressures... Decreased Lung Compliance

Front 16

What do you check for bedside interview?

Back 16

Determine Level of Consciousness Alert and responsive is Norma) Lethargic somnolent sleepy could be COPD Overdose or Sleep Apnea stuporous confused, respond inappropriate could be Drug Overdose, Intoxication Semi Comatose responds only-to painful Stimuli Coma does not respond to painful stimuli Obtunded drowsy state may have decreased cough or gag Check Orientation to time and place and person Assess emotional State Check activities of daily living: Eating, dressing, walking, bathing

Front 17

What are some subjective symptoms?

Back 17

Orthopnea difficulty breathing upright CHF General Malaise: electrolyte imbalance Dyspnea Grade I normal dys pnea occurs. after unusual exertion Grade II breathless after going up hills or stairs Grade 111 dyspnea while walking abnormal speed Grade IV dyspnea slowly walking short distances Grade V dyspnea at rest, shaving dressing

Front 18

What is pain and some signs?

Back 18

Reaction of specific nervous tissue, BP up and HR also

Front 19

Whet are some symptoms of Nose and throat?

Back 19

Excessive nasal secretions Itching and burning of nose and throat Dysphagia difficulty swallowing and hoarseness

Front 20

What does the Respiratory Care Plan consist of?

Back 20

Case Management Plan Therapy protocols Disease management Patient and family educational needs

Front 21

What is a patents physical environment?

Back 21

Ramps, doorways. stairs

Front 22

What are open ended questions?

Back 22

Questions that ask a Patient to describe they provide more detail.

Front 23

How do you assess a patnent's learning need?

Back 23

Knowing possible barriers Language Age Education Emotional barriers

Front 24

Assessment by Inspection What Can you see?

Back 24

General Appearance age height, weight sex, nourishment Peripheral Edema Caused by CHF and Renal Failure Clubbing of fingers Chronic hypoxemia Venous distention CHF Seen during exhalation COPD Capillary refill indication of peripheral circulation noninvasive and quick Diaphoresis heavy sweating Heart failure Fever infection TB night-sweats Cachectic Muscle Wasting

Front 25

What do you look at for skin Color?

Back 25

Normal is pink,tan,brown, black Abnormal is a decrease in color anemia or blood loss Vasoconstriction will cause a change by reducing blood flow Jaundice Increase in bilirubin 17 blood tissue face and trunk Erythema Redness of skin capillary congestion and inflammation Cyanosis blue or blue gray Hypoxia from increased amount of reduced hemoglobin.

Front 26

What are the chest Configurations?

Back 26

Normal is normal A-P diameter Kyphosis is hunch back or convex spine curve Scoliosis is lateral curvature of-the Spine Kyphoscoliosis combination hunchback and lateral curvature Barrel chest result of chronic air trapping C0PD increased AP diameter

Front 27

What is the normal movement of the Chest?

Back 27

Symmetrical Both sides of chest move at same Time Abdomen moves out due to diaphram dropping chest moves outward and upward

Front 28

What is Asymmetrical ?

Back 28

Asymmetrical is an unequal movement of chest Underlying pathology could include Chronic lung disease Atelectasis Pneumotorax Flail Chest Paradoxical Intubated patient with endotacheal tube in one lung

Front 29

What are some breathing patterns?

Back 29

Eupnea Normal RR depth and rhythm Tachyphnea Increased RR > 20 Bpm Fever, Hypoxia, Pain, CNS problem Bradypnea Oliaopnea Decreased RR < 8bpm variable depth and Rhythm Apnea is cessation of breathing Cheyne-Stokes Increased and Decreased Rate and Depth with periods of Apnea Caused by increased intracranial pressure meningitis, drug overdose

Front 30

What is accessory muscle activity?

Back 30

Muscles used to increase ventilation during times of stress are Diaphragm-intercostals scalene, sternocleidomastoid and abdominal

Front 31

What is muscle Condition?

Back 31

Muscle wasting atrophy is loss of muscle tone and occurs in paralysis Increase in muscle size hypertrophy occurs in C0PD patients

Front 32

What are retractions?

Back 32

Intercostals and or sternal retractions occur when the chest moves inward during inspiratory efforts instead of outward This is due to a obstructed airway A sign of respiratory distress in infants

Front 33

What is nasal flaring?

Back 33

Flaring of the nostrils during inspiration. A sign of respiratory distress in infants Expiratory grunting and retractions occur in newborns to prevent atelectasis

Front 34

What is the character of a cough?

Back 34

Strong, moderate or weak. Productive or non productive Frequent or infrequent, tight or moist A dry or nonproductive cough may indicate a tumor in the lungs. A productive cough may indicate an infection.

Front 35

What is the pulse?

Back 35

Normal 60-100 bpm Tachycardia >100 bpm indicates hypoxemia anxiety, stress Bradycardia <60bpm indicates heart failure shock code emergency

Front 36

When is heart rate a cause for concern?

Back 36

Increased heart rate > 2Obpm is an adverse reaction, stop therapy, notify nurse and doctor Any change in rhythm is indication for further monitoring

Front 37

What is paradoxical pulses pulse paradoxus?

Back 37

Pulse blood pressure varies with respirations May indicate severe airtrapping as m status asthmatics tension pneumothorax

Front 38

What is tracheal deviatlon?

Back 38

Pulled to Abnormal side? Pulmonary Atelectasis Pulmonary Fibrosis Pnemonectomydiaphragmatic paralysis

Front 39

Whet is percussion ?

Back 39

Percussion is done by placing the middle finger between two ribs and tapping the middle fingers first joint with the middle fingertip of your opposite hand Resonance Normal filled air filled lungs\ This gives a hollow sound. Flatness heard over Sternum muscle on area of atelectasis Dullness heard over a loud filled organs such as heart or liver pleural effusion or pneumonia will give this thudding sound Tympany heard over air filled stomach) This is a dreamlike sound and when heard over the lungs indicates increased volume Hyperresonance found in areas of the lung where pnemothorax or emphysemas are present this is a booming sound

Front 40

What are breath sounds?

Back 40

Normal breath sounds vesicular Bronchial breath Sounds normal sounds heard over tracheal on bronchi Over the lung would indicate lung Consolidation

Front 41

Abnormal Breath Sounds

Back 41

Rates crackles secretion fluid

Front 42

Coarse rales rhonchi Large Airways Secretions

Back 42

Patient needs suctioning

Front 43

Medium Rales

Back 43

Middle airways secretions Patient needs chest physical therapy

Front 44

Fine Rales mass crepitate rates

Back 44

Abrader fluid Patient has cHF pulmonary edema Patient needs IPPB heart drugs diuretics and oxygen

Front 45

What is wheeze due to?

Back 45

Broncho spasm, patient needs bronchodilator Unilatenatal Wheeze indicative of a foreign body obstruction, Mucus plug

Front 46

What is stndor?

Back 46

Due to upper airway obstruction Supraglottic swelling epiglottis Subglottic swelling croup post extubation Foreign body aspiration solids or fluids

Front 47

What is Pleural Friction Rub?

Back 47

Coarse grating or crunching sound visceral and parietal pleura rubbing together

Front 48

What are normal Heart Sounds)

Back 48

SI and S2

Front 49

What are abnormal heart sounds?

Back 49

S3 and S4 heart sounds You need an Echocardiogram

Front 50

What is normal blood pressure?

Back 50

120180 mmHg using a sphygmomanometer Increased Blood Pressure indicates cardiac stress-hypoxemia Decreased blood pressure indicates poor perfusions shock<

Front 51

What is the position of the endothachial tube?

Back 51

Below the vocal cords and no closer than 2 cm or I inch above the carina

Front 52

What are some of the anatomical landmarks?

Back 52

Trachea seen as a dark area midline Costophrenic angles, Angle made by the outer curve of diaphragm and the chest wall Angles are obliterated by Pleural Effusions Diaphragm Dome Shaped normally Flattened with COPD Vascular Markings are Blood Vessels lymphatics,lung tissue

Front 53

What are the positions and projections on the chest x-ray?

Back 53

AP projection-anterior, posterior
Lateral decubitus position-Patient lying on affected side-valuable for detecting small pleural effusion

Front 54

What is normal chest x-ray?

Back 54

Both hemidiaphragms are frounded (dome-shaped) The right hemidiaphragm is slightly higher than the left, liver pushes it up. The right hemidiaphragm is at the level of the sixth anterior rib.

Front 55

What are the position of tubes and catheters?

Back 55

Chest tubes should be located in the pleural spaace surrounding the lung. Nasogastric tubes and feeding tubes should be positioned in the stomach and small bowel below the diaphragm. Central Venous catheters are placed in the right or left subclavian or jugular vein and should rest in the vena cava or right atrium of the heart.

Front 56

What is a valuable diagnostic tool for an upper airway obstruction in children ? Croup and Epiglottitus

Back 56

Lateral neck x-ray

Front 57

What is the classic x-ray sign for croup(larynotrachebronchitis)

Back 57

Viral disorder , the xray will reveal tracheal narrowing in a classic pattern called steeple sign, pencil point , picket fence all meaning pointing

Front 58

What is Epiglottitis and what x-ray sign helps identify it?

Back 58

Epiglottitis is a potentially life-threatening inflammaaton of the supraglottic airway caused by a bacterial infection. A lateral neck x-ray shows supaglottic narrowing showing a thumb sign.

Front 59

What is Radiolucent?

Back 59

Dark pattern, air seen on X-ray normal for lungs

Front 60

What is Radiodense?

Back 60

White pattern, solid , fluid normal for bones, organs.

Front 61

What is an Infilttrate?

Back 61

Any ill-defined radiodensity as in Atelectasis.

Front 62

What is Consolidation?

Back 62

Solid white area, such as Pneumonia(inside)
Pleural effusion (outside)

Front 63

What is hyperlucency?

Back 63

Extra pulmonary air as seen in COPD, asthma attack, pneumothorax.

Front 64

What are Vascular markings?

Back 64

Lymphatics, vessels,lung tissue
Increased with CHF
Absent with Pneunmothorax

Front 65

What is Diffuse meaning on X-ray?

Back 65

Spread throughout as in Atelectasis /Pneumonia

Front 66

What is Opaque meaning on X-ray?

Back 66

Fluid , solid as in consolidation

Front 67

What is Bilateral and what is unilateral?

Back 67

Bilateral means on both sides
Unilateral means on one side

Front 68

What are Fluffy infiltrates?
What are Butterfly/Batwing pattern?

Back 68

Diffuse whiteness and infiltrate in shape of butterfly as seen with Pulmonary Edema

Front 69

What are patchy infiltrates and platelike infiltrates?

Back 69

Scattered densities and thin-layered densities as seen in Atelectasis

Front 70

What is Ground Glass Appearance and Honeycomb Pattern?

Back 70

Reticulogranular and Reticulonodular as seen in ARDS/IRDS

Front 71

What is an Air Bronchogram?

Back 71

Pneumonia

Front 72

What are peripheral-wedge-shaped Infiltrate?

Back 72

Pulmonary Embolus

Front 73

What are Concave superior inerface/border?
What are Basilar infiltrates with meniscus?

Back 73

Pleural effusion

Front 74

What is Bronchography?(bronchograms)

Back 74

Injection of radio-opaque contrast that outlines the airways it allows study of obstruction lesions(tumors) and bronchiectasis.

Front 75

What is a V/Q scan?

Back 75

Two scans ventilation and perfusion if the results indicate a normal ventilation scan but abnormal perfusion scan= Pulmonary Emboli

Front 76

What type of equipment do you need for a MRI?

Back 76

Manual resuscitation equipment should have detachable non-rebreathing valves made of non-ferrous(non-metallic) materials.

Front 77

What is an Electroencephalography? (EEG)

Back 77

Electrical activity of the brain. Indications for brain tumors, injuries, retardation, epilepsy, seizuries, sleep disorders.

Front 78

What is normal ICP?(intracranial pressure)

Back 78

5-10 mm Hg

Front 79

When should ICP be treated?

Back 79

If ICP> 20 mmHg
Patient should be hyperventilated until PaCo2 is 25-30 mmHg

Front 80

What is Ultrasonography of the Heart? Echocardiogram (ECG)

Back 80

Non invasive method for monitoring cardiac performance.
More S1 or S2

Front 81

What is the normal RBC? red blood cell count

Back 81

Normal value
4-6 mill/cu mm

Front 82

What is normal Hemoglobin? Hb

Back 82

Normal value
12-16 gm/dl

Front 83

What is normal hematocrit?Hct

Back 83

Normal value
40-50%

Front 84

What is normal White blood cell ? WBC

Back 84

Normal WBC
5,000 to 10,000 per cu mm

Front 85

What is leukocytosis?

Back 85

Increased WBC over 10,000 is bacterial infection

Front 86

What is leukpenia?

Back 86

Decreased WBC count under 5,000 mean viral infection

Front 87

What are Electrolytes and their clinical application of imblance?

Back 87

K+, Na+, Cl-, HCO3-(CO2 content) are elements required by the body for normal metabolism.
Electroyle imbalance cause muscle weakness, soreness, nausea, mental changes such as lethargy, dizziness and drowsiness - general maliase

Front 88

What is the normal value for K+ Potassium?

Back 88

Normal = 3.5 - 4.5 range Important for acid-base balance
CO2 +

Front 89

What is Hypokalemia?

Back 89

Low K+ low potassium, metabolic alkalosis, excessive excretion , renal loss, vomiting
Flattened T waves on EKG

Front 90

What is Hyperkalemia?

Back 90

High K+ potassium , kidney failure, metabolic acidous
Spiked T wave on EKG

Front 91

What is the normal value for Na+ sodium?

Back 91

Normal Na+ Sodium is 140mEq/L (135-145 range)
CO2+

Front 92

What is hyponatremia?

Back 92

Low Na+ low sodium
fluid loss from diuretics, vomiting, diarrhea, fluid gain from: CHF,IV therapy

Front 93

What is hypernatremia?

Back 93

High Na+ high sodium
Dehydration

Front 94

What is the normal value for Cl- Chloride?

Back 94

Normal values for Cl- Chloride 90 mEq/L (80-100 range)
Pa-

Front 95

What is hypochloremia?

Back 95

Low Cl- chloride
metabolic alkalosis

Front 96

What is hyperchloremia?

Back 96

High Cl- chloride
metabolic acidosis

Front 97

What is normal HCO3?
Bicarbonate (total CO2 content)

Back 97

Normal HCO3 24mEq/L
22-26 range

Front 98

What do you look at in Sputum analysis?

Back 98

Amount of sputum teaspoons, tablespoon.
Consistency-thin,thick, tenacious
Color

Front 99

What does the color of sputum tell you?

Back 99

Clear-normal
Mucoid-White/gray, chronic brochitis
Yellow presence of WBCs bacterial infection
Green- stagnant sputum, gram negative bacteria (Bronchiectasis, pseudomonas)
Brown/dark- old blood
Bright red - hemoptysis(bleeding tumor, TB)
Pink frothy- pulmonary edema

Front 100

What does the sputum culture tell you?

Back 100

Identify the bacteria present and what antibiotics will kill the bacteria

Front 101

What is the difference between the Gram and Acid fast stain?

Back 101

Gram stain identifies whether it is gram positive or negative this is a fast test less than 1 hour.
Acid fast stain indicates tuberculosis takes longer to get result

Front 102

What is an Oscilloscope?

Back 102

Oscilloscope is a moniter that is at the head of the bed that provides the visual image of the ECG

Front 103

What is the Electrocardiograph?

Back 103

It is the printed version of recording the electrical activity of the heart.
Always Look at Lead II

Front 104

What is a Holter Monitor?

Back 104

Portable version of an electrocardiograph that is worn under clothes for 24-48 hours continually

Front 105

What is an Electrode?

Back 105

Electrode is a sticker placed on the skin to conduct electric current

Front 106

What is a lead?

Back 106

A positive and negative electrode that allows electrical current to flow.

Front 107

How many leads and electrodes are there in a 12 lead?

Back 107

There are 12 leads and 10 stickers (electrodes)

Front 108

What lead do you moniter?

Back 108

Moniter Lead II
Left leg positive, Right Arm Negative

Front 109

What is distintive about the AVR lead?

Back 109

AVR is the only limb lead that produces an upside down (neg) pattern

Front 110

What leads give dimension of right heart and where are they placed ?

Back 110

V1 - 4th intercostal space on right side of sterum
V2 - 4th intercostal space on left side of sterum

Front 111

What leads give dimension of Ventricular septum and where are they placed?

Back 111

V3- between V2 and V4 on left side
V4 - 5 th intercostal space, left mid clavicular line

Front 112

What leads give dimension of left heart and where are they placed?

Back 112

V5- between V4 and V6 on the left side
V6-5th intercostal space, left mid-axillary ling

Front 113

What is normal heart rate?

Back 113

60-100 bpm

Front 114

What is bradycardia?

Back 114

<60bpm

Front 115

What is tachycardia?

Back 115

>100bpm

Front 116

What is flutter?

Back 116

>200bpm

Front 117

What is fibrillation?

Back 117

Too fast to count

Front 118

How do you measure heart rate on a strip?

Back 118

You measure the distance between the two R waves and divide 300 by it.
If the two R waves are between 3 and 5 large blocks the the rate is normal 60-100
If the two R waves are closer than 3 large blocks then the rate is greater than 100-tachycardia
If the two R waves are wider than 5 large blocks than the rate is less than 60 - bradycardia

Front 119

How do you treat Sinus Rhythm?

Back 119

Normal rate, no skips, or extra beats, treat other symptoms

Front 120

How do you treat Sinus Tachycardia?

Back 120

Sinus rhythm > 100
Treat with Oxygen

Front 121

How do you treat Sinus bradycardia?

Back 121

Sinus rhythm <60
Treat with Atropine, Oxygen

Front 122

How do you treat PVC's?

Back 122

Premature ventricular contractions (PVC)
Absent of P wave
Treat with Oxygen, Lidocaine, Suctioning

Front 123

How do you treat V tach?

Back 123

Ventricular tachycardia
Ventricular rhythm with rate>100
Treat with Defibrillate (If No Pulse)
Lidocaine and Cardiovert (If Pulse Present)
Oxygen

Front 124

How do you treat V-fib?

Back 124

Ventricular fibrillation, completely irregular ventricular rhythm
Treat-Defibrillate

Front 125

How do you treat Multifocal PVC's?

Back 125

Premature ventricular contractions
No P wave , Large QRS
Treat with Oxygen, Lidocaine (this reduces the irritibility of heart)

Front 126

How do you treat Asystole?

Back 126

Confirm in 2 leads first, then Epinephrine, Atropine , 100% Oxygen and CPR

Front 127

What does the axis of an ECG measure?

Back 127

Axis measures the direction of all the electricity through the heart during contraction

Front 128

What do you assess for a perinatal history?

Back 128

Mother's History: History of pregnancy, age, smoking and substance abuse, nutrition, infecton , previous pregnancies/outcomes. Hypertension, toxemia diabetes ( diabetes prone to have problems with premature babies)

Front 129

What is the gestation Age of infant?

Back 129

Time since the estimated date of conception.
Term-38 to 42 weeks
Preterm(premature) less than 38 wks
Post- more than 42 wks

Front 130

What are the five factors for evaluating infant and when are they done?

Back 130

APGAR routinely done at 1 and 5 minutes
A isAppearance (Color) Good is 2 completely pink Bad is 1 Body pink , extremities blue, Real Bad is 0 blue all over, pale
Pulse Good(2) is >100 minute
Bad(1) is <100 minute
Real Bad (0) is absent no pulse
Grimace(Reflex irritability) Good(2) cough or sneeze
Bad(1) grimace
Real Bad(0) No response
Activity Good(2) Active motion
Bad(1) some flexion of extremities
Real Bad (0) Limp No movement
Respiratory effort Good(2) Regular, strong cry
Bad(1) slow, irregular weak cry
Real bad(0) Absent no cry

Front 131

What action do you take based on APGAR score?

Back 131

0-3 RESUSCITATE
4-6 SUPPORT stimulate, warm , administer O2
7-10 MONITOR routine care

Front 132

What is a transillumination?

Back 132

Bright fiberoptic light placed against the infant's chest in a darkened room
Normally a lighted halo is seen around the point of contact
A Pneumothorax or pneumomediastinum will cause the entire hemithorax to light up

Front 133

What are the vital signs of an infant?

Back 133

Normal pulse rate 110-160bpm
Respirations normal 30-60breaths per minute(higher in preterm babies)
Blood Pressure Normal term Infant 60/40mmHg
Preterm 50/30 mmHg
Birth Weight Normal Term>3000gm 3kg
28wks 1000gm

Front 134

What are some signs of Respiratory Distress in Infants?

Back 134

Cyanosis bluish all over
Acrocyanosis is bluish extremities not true cyanosis
Retractions intercostal sucostal substernal or supraclavicular retractions
Nasal Flaring dilation of nasal openings (breathing through nose)
Capillary refill How long it takes for normal color to return -longer than 3 seconds may indicate a decreased cardiac output

Front 135

What are some methods of measuring gestional age?

Back 135

Dubowitz Method and New Ballard Score

Front 136

What are pre and post ductal blood gas studies and what do they mean/

Back 136

If the pre-ductal (right radial artery Pao2 is 15 mmHg highter than the post-ductal (umbilical artery) PaO2 , then the patient has a paten ductus arteriosus with a right to left shunt. Needs a Echocardiogram

Front 137

What are the normal Blood glucose levels in infants?

Back 137

Hypoglycemia
Term infants >30 mg/dL
Preterm > 20 mg/dL

Front 138

What is L/S ratio and what does it mean?

Back 138

Lecithin/sphingomyelin , a ratio
of 2:1 or highter is good. It measures lung maturity.
A ratio less than 2:1 indicates high risk of hyaline membrane disease (HMD) or Infant respiratory distress syndrome (IDS) approaches zero

Front 139

What is PG?

Back 139

Most reliable indicator of pulmonary maturity even with diabetes. Phosphatidylglycerol

Front 140

What is capnography and what is the normal range?

Back 140

Measuring exhaled carbon dioxide content using infrared absorption. ETCO2 normal value is 3-5%

Front 141

What does an increase in Capnograph (PECO2 or PetCO2% ) indicate?

Back 141

An increase indicates a decrease in ventilation (ventilatory failure)
Increase Tidal Volume

Front 142

What does an decrease in the capnograph indicate?

Back 142

Decrease indicates an increase in ventilation or decreased perfusion (deadspace disease: pulmonary embolism, hypovolemia

Front 143

What does low PetCO2 reading immediately following intubation indicate?

Back 143

ET tube is in the esophagus
If patient already on ventilator and you get low or 0 reading then reconnect patient to ventilator

Front 144

What does the PetCO2 do during CPR?

Back 144

The PetCO2 should increase during CPR

Front 145

What are the examples of color change for PCO2?

Back 145

Purple=poor
Yellow=normal
False readings may occur in patients who have been without CPR for a period of time

Front 146

What is a non-invasive method of monitoring oxygen saturation?

Back 146

Pulse oximetry measures SaO2 or SpO2 and pulse

Front 147

What effects accuracy of pulse ox?

Back 147

Perfusion, shock and hypotension, conditions that interfere with the light transmission, fingernail polish bright ambient lights, erytherma (redness of skin due to capillary dialation)

Front 148

What will make a pulse ox measure higher?

Back 148

Carbon Monoxide poisoning

Front 149

What accurately measures COHb?

Back 149

Co-oximeter/hemoximeter
Used to diagnose carbon monoxide poisoning.>20% COHb

Front 150

What is normal COHb reading and abnormal?

Back 150

Normal COHb is 1-3%
COHB for smokers 5-10%
Heavy Smokers 10-15%

Front 151

What is an invasive and non-continuous measurement of O2Hb?

Back 151

ABG but is this is calculated and the Co-oximetry are directly measured

Front 152

What are transcutaneous PO2 and PCO2 measurement?

Back 152

Continuous non-invasive measurement by electrodes placed on the skin instead of ABG

Front 153

What improves Transcutaneous PO2 and PCO2 measurment?

Back 153

Heating the skin to 43-45C improves the capillary blood flow (perfusion) and enhances gas movement through the skin.

Front 154

How long should electrode site be changed for transcutaneous measurement?

Back 154

Every four hours. If redness or blistering every 3 hrs.

Front 155

What is hemodynamics?

Back 155

Hemodynamics is monitoring the blood pressures . circulation and perfusion

Front 156

What is the physiology of blood pressures?

Back 156

Without sufficient blood pressure the tissue will not receive the oxygen and nutrients it needs to survive.(perfussion)
High blood pressure causes strain on the heart and willeventually cause heart failure.
There are three factors that control blood pressures: Heart, Blood and Vessels

Front 157

How do changes in the heart affect blood pressure?

Back 157

Increase in the heart rate / strenght will increase the blood pressure
Decrease in the heart rate/ strength will decrease the blood pressure-contractility

Front 158

How does the blood affect the blood pressured?

Back 158

Excessive fluids increase pressures so give diuretics
Loss of fluids decrease pressures so give fluid

Front 159

How does the condition of the vessels change blood pressures/

Back 159

Vessel constriction increase pressures so give sodium nitro(Nipride)
Vessel dilation decrease pressures give dopamine

Front 160

How do you calculate mean arterial pressures (MAP)?

Back 160

MAP= 1 x systolic + 2 x diastolic / 3
Normal value is 120/80mmHg
Normal = 90mmHg

Front 161

What is the normal blood pressure?

Back 161

120/80 or 90mmHg

Front 162

What is the normal value for Central Venous Pressure ?

Back 162

2-6 mmHg
4-12 cmH2O
Mean right atrial pressure.
If low also give fluids and drugs

Front 163

What is the Pulmonary Artery Pressure (PAP)?

Back 163

25/8mmHg or 14mmHg

Front 164

What is the Wedge Pressure (PWP)?

Back 164

4-12mmHg
Estimates left ventricle filling
(preload)
Equal to left atrial pressure

Front 165

What is the flow of blood through the body?

Back 165

Left ventricle through the aortic valve into the systemic arterial system to the capillary then the systemic veins back to right heart through right atria through the tricuspid valve to right ventricle through the pulmonic valve into the pulmonary artery through the lungs then to the pulmonary veins into the left atria through the mitral valve into the left ventricle again.

Front 166

When will CVP be increased/

Back 166

Right Heart Failure, Cor pulmonale (tricusid valve) The CVP will be up

Front 167

When will PAP be increased?

Back 167

Lung disorders, Pulmonary embolism, Pulmonary hypertension, Air Embolism , Hypoxcemia

Front 168

When will PCWP be increased?

Back 168

Left heart failure Mitral valve stenosis CHF/pulmonary edema High PEEP effects

Front 169

What happens with Hypervolemia (fluid overload)?

Back 169

Every value is up

Front 170

What happens with Hypovolemia (fluid decreased)?

Back 170

Every value is down

Front 171

What is pulse pressure and the normal?

Back 171

The difference between the systolic and diastolic pressure
The normal value is 40 mmHg

Front 172

What is Cardiac Output equation?

Back 172

Fick equation =
QT=VO2/Ca-v)o2 (10)
QT= heart rate x stroke volume
Normal Value 4-8L/min

Front 173

How do you calculate Cardiac Index (Cl)?

Back 173

Cardiac Index is the cardiac output (QT) divided by the body surface area (BSA) in meters squared(m2)
Cl= QT/BSA
normal is 2.5-4L /min/m2
half of QT normal

Front 174

What is the Systemic Vascular Resistance( SVR)?
<20 mmHg/L/min or 1600Dynes/sec/cm-5

Back 174

The pressure gradient across the systemic circulation divided by the cardiac output
SVR=MAP-CVP/Cardiac output x 80 for dynes/sec/cm-5

Front 175

How may SVR change?

Back 175

SVR is increased with systemic hypertension and or vasoconstriction(especially due to Alpha Type drugs) SVR may change with changes in cardiac output or index if other values remain constant

Front 176

What is Pulmonary Vascular Resistance(PVR)?
Normal <2.5mmHg/L/min or 200Dynes/sec/cm-5

Back 176

The pressure gradient across the pulmonary circulation divided by the cardiac output.
PVR=(MPAP-PCWP) / Cardiac Output x 80

Front 177

How is Pulmonary Vascular Resistance increased?

Back 177

PVR is increased with hypoxia, pulmonary hypertension and lung disease

Front 178

What is the formula for calculating resistance?

Back 178

R= Change in Pressure /Flow

Front 179

What are the three sights for obtaining an arterial blood gas?

Back 179

Radial, Brachial, Femoral

Front 180

What should Not be used to monitor oxgen therapy and why?

Back 180

Capillary gases should not be used as PO2 values do not correlate very well with actual arterial blood.

Front 181

What artery is the first choice to draw a ABG and why?

Back 181

Radial artery is first choice because of accessibility and collateral blood flow.

Front 182

What test is used to assess collateral blood flow?

Back 182

Modified Allen's Test and you release the ulnar artery to test for collateral blood flow.

Front 183

What does Blood Gas Analyzers Measure?

Back 183

PCO2 (severinghaus electrode)
PO2(Clark electrode)
PH(Sanz electrode)
All other values are calculated

Front 184

What is point of care testing?

Back 184

Monitoring done at the bedside

Front 185

What is the Alveolar Air Equation? PAO2

Back 185

PAO2 calculates the partial pressure of oxygen in the alveoli.
PAO2= (7 x FIO2)-(PaCO2 + 10)

Front 186

What is the A-aDO2 or the
A-a gradient?

Back 186

A-a gradient measures the difference between alveolar and arterial PO2.
Best done after patient has been on 100% oxygen for 20 minutes.

Front 187

What can be evaluated by the A-a gradient (A-aDO2)?

Back 187

Therapy to improve distribution of ventilation can be evaluated(IPPB, IS )

Front 188

What are the values of the A-a gradient?

Back 188

Normal 25-65 mmHg on 100%
V/Q mismatch 66-300mmHg
Shunting >300mm Hg

Front 189

What is CaO2 and it's normal?

Back 189

CaO2 is the best measurement of oxygen delivered to the tissues, or best index of oxygen transport Oxygen in RBC + Oxygen in Plasma
Normal is 17-20 vol %(mL/dL)

Front 190

What is the CaO2 formula?

Back 190

CaO2= (Hb x 1.34 x SaO2)
If SaO2 above 90% then don't use it

Front 191

What is CvO2 and it's normal?

Back 191

CvO2 is total amout of oxygen carried in the mixed venous blood.
Normal is 12-16vol%
Blood is drawn from Pulmonary Artery by swan-ganz catheter

Front 192

What is the C(a-v) O2?

Back 192

C(a-v)O2 is the arterial minus the venous oxygen content It measures oxygen consumption of the tissues
CaO2-CvO2
Normal 4-5vol%
Short Cut Take SaO2-SvO2 x 2 and put in decimal

Front 193

What happens when QT cardiac output decreases?

Back 193

CvO2 and SvO2 decreases and C(a-v)O2 increases

Front 194

What is the PaO2/FIO2 ratio and what are the normals and what is it used for?

Back 194

PaO2/FIO2 measures the efficiency of oxygen transfer across the lung and used in deternimation of ALI or ARDS
Normal is 380 mmHg or >
Less than 300mmHg is ALI
Less than 200mmHg is ARDS

Front 195

What does C(a-v)O2 equal?

Back 195

C(a-v)O2 = (SaO2- SvO2) x 0.2

Front 196

What is the QS/QT?

Back 196

The portion of the cardiac output that is shunted
Normal value is 3-5%
(PAO2-PaO2( first number from A-a + 1 ) x 5

Front 197

What is the relationship of PaO2 to SaO2?

Back 197

SaO2 =PaO2 + 30

Front 198

What is VD /VT?

Back 198

Dead space to Tidal Volume ratio Ventilation without Perfussion
VD/VT=
PaCO2-PECO2/PaCO2

Front 199

How do you calculate VD?

Back 199

VD/VT x VT= VD

Front 200

How do you determine a desired VE?

Back 200

(VE (known) x PaCO2 (known) /Desired PaCO2

Front 201

How do you determine a Desired FIO2?

Back 201

PaO2(desired) x FIO2(known) /PaO2 (known)

Front 202

How do you determine a desired rate?

Back 202

Current rate x PaCO2(known) / Desired PaCO2

Front 203

What are the normal blood gas ranges?

Back 203

PCO2 35-45 torr
PO2 80 - 100 torr
pH 7.35 - 7.45
HCO3 22 - 26 mEq/L
SO2 95-100% Venus 70-75%

Front 204

What are the blood gas interpretations?

Back 204

CO2 to Ventilation
35-45torr normal
Above 45 Patient Not Ventilating Ventilate Pt or Increase Tidal Volume or Rate
Below 35 Pt Is Ventilating too much Add Deadspace if PO2 acceptable
Abnormal PCO2 with normal pH Pt COPD don't change ventilation

Front 205

What are the normal oxygen values and responses/

Back 205

PaO2 FIO2 Interpretation
80 -100 on ,21 Normal
<80 on .21-.59 Hypoxemia due to Poor ventilation High PCO2 INcrease ventilation
V-Qmismatch normal PCO2 Increase FIO2 up to 0.60
Below 80 on .60+ Shunting, Venus Admixture Start CPAPif Pt breathing on own
Start PEEP if Pt on ventilator
Above 100 (hyperoxemia) if on .22-1.0 Over Oxygenation Decrease the FIO2 first if at or above .60 Once FIO2 is<60 then reduce PEEP/CPAP and decrease ventilation if lowPCO2

Front 206

What are the exceptions to the rule for ABG interpertations?

Back 206

TYPE 1 ABG looks good / Pt looks and feels bad / CO poisoning /100% oxygen treatment /Anemia Low Hb , pt maybe hypoxic PVC's , tachycardia, distress, CBC low/ give oxygen until transfusion is complete / Pulmonary Embolus (increased dead space)Sudden increased rate and depth of breathing/Anticoagulat therapy support ventilation.
COPD type 2 also could have given too high an oxygen flow

Front 207

What are some types of Spirometers?

Back 207

Water -seal Collins measures volume and time and are most accurate. Pneumotachometers measure flow like the Turbine Wright respirometer, Pressure differential Fleish and can continuously measure VE.
Peak flow meters can measure at the bedside they have a resistor and moveable indicator, resistance is provided by utilizing a narrow orifice

Front 208

What is the plethysmograph?

Back 208

It's the body box , it measures airway resistance difference in pressure between the mouth and the alveoli and it will more accurately measure FRC in COPD patients

Front 209

What are some recording devices?

Back 209

Kymograph is a rotating drum which maneuver is recorded on graph paper it plots volume (y-axis) against time (x-axis)
The X-Y recorder plots volume(x-axis) against flow(y-axis) Advantage over kymograph is it allows for recording of flow-volume loops

Front 210

How is equipment tested for accuracy?

Back 210

Volume calibration and leak tests by using a large volume syringe , normally 3.0 liters. If a leak occurs recalibrate.

Front 211

What is a gas analyzer?

Back 211

Galvanic fuel cell that produces a current measures partial pressure , displays FIO2 as percent. Accuracy can be affected by water on the sensor, high system pressures and changes in altitude, if unable to calibrate , change fuel cell.

Front 212

What is a polarographic?

Back 212

Similar to a galvanic fuel cell except it has a battery . If unable to calibrate change the battery and check electrolyte level. Trouble shooting recalibrate analyzer and recheck equipment

Front 213

What is the VC, SVC?

Back 213

Vital Capacity pt takes maximal inspiration followed by a maximal exhalation without force.
The SVC will provide the important Volumes used to measure Restrictive Disease

Front 214

What are the volumes and capacities measured in pulmonary diagnostic testing?

Back 214

VT tidal volume normal breathing
IRV inspiratory reserve volume
ERV expiratory reserve volume
IC inspiratory capacity (IRV+VT)
VC Vital capacity (IRV+VT+ERV

Front 215

What is the best indicator of Restrictive lung disease?

Back 215

Decreased Vital Capacity

Front 216

What is FVC forced vital capacity?

Back 216

The volume that can be expired as forcefully and as rapidly as possible after a maximum inspiration. It provides important flow rates to measure obstructive disease

Front 217

What is the best indicator of Obstructive disease?

Back 217

Decreased FEV1/FVC
If the FEV1 is decreased but the FER1/FVC ratio is normal then the patient is restrictive only.
Most individuals can exhale all of their air in about 2 seconds

Front 218

What is the forced expiratory flow 200-1200?

Back 218

FEF200-1200 is average flow during the first 1000ml after 200ml expired decreased values are associated with large airway obstruction. (begining of breathe)

Front 219

What is forced expiratory flow 25-75?

Back 219

FEF25-75 decreased values are associated with small airway obstruction. (middle of breathe)

Front 220

What is PEFR?

Back 220

Peak expiratory flow rate effort dependant sometimes used to evaluate asthmatic patients , pre and post bronchodilation.

Front 221

What is MVV?

Back 221

Maximum voluntary ventilation the largest volume and rate that can be breathed per minute by voluntary effort.12-15 seconds. Measures the muscular mechanics of breathing preOp patients.

Front 222

What is pre and post bronchodilator PFT testing?

Back 222

Used to measure the reversibility of an obstructive pattern . increase of 12% or 200mL in the FEV1 post test is considered significant

Front 223

How do you measure FRC?

Back 223

FRC (RV,TLC) is measured by either the He dilution (closed method) or N2 wash out (Open method)

Front 224

What are flow volume loops?

Back 224

Displays the volumes and flow rates of the FVC. Flow rates are measured on the vertical axis. Expiratory flows are above the base line. Inspiration is below the line.Volume is measured directly on the horizontal axis. Restrictive is a skinny and tall loop . Obstructive is short and wide loop

Front 225

What is the evaluation of pulmonary function tests?

Back 225

Values predicted on age, height, and sex
80-100% of predicted=normal
60-79%of predicted=mild disorder
40-59% of predicted=moderate
<40% of predicted=severe

Front 226

How can PFT tell the difference between Obstructive and Restrictive disease?

Back 226

Restrictive only decreased Volumes, VC or FVC
Obstructive only decreased flows, FEV1, FEV1/FVC
Both obstructive and restrictive decreased flows and decreased volumes

Front 227

What is a bronchoscopy?

Back 227

A procedure that allows the therapist to visualize the trachea and bronchi.

Front 228

What are the types of bronchoscopy and what is the difference in use?

Back 228

There is a flexable bronchoscopy used for diagnostic reasons and a ridgid bronchoscopy used for therapeutic reasons in the OR for foreign-body obstruction atelectasis.
Also used for intubation in patients with a suspected neck fracture use a flexable fiberoptic bronchoscopy

Front 229

What is the first procedure before inserting the bronchoscopy?

Back 229

Topical anesthetic is administered to control the gag/cough reflex and prevent laryngospasm. Lidocaine , cetacaine, novacaine.
Patients receiving continuous ventilation need a special adaper Bodaii for introduction of the scope and Increase FIO2 and Increase high pressure alarm setting. Be sure to reset after procedure.

Front 230

What is partial obstruction?

Back 230

Inspiratory stridor, cough/gurgling or unilateral wheeze

Front 231

What is complete obstruction/

Back 231

Marked inspiratory efforts without air movement inability to speak
Marked, sternal, intercostal and epigastric retractions. Marked distress and marked attempts to ventilate

Front 232

What is the cause of upper airway obstruction?

Back 232

Tongue/soft tissue obstruction most common

Front 233

What are the methods of establishing a patent airway and the contraindications?

Back 233

Head-tilt / Chin -lift Opens airway and pulls tongue back
Contraindications: fractured neck
Jaw Thrust / Modified Jaw Thrust Allows for establishing a patent airway in patients with suspected neck fractures

Front 234

When do you preform a Abdominal thrust?

Back 234

When complete airway obstruction is indicated. Contraindications; Obese victims, Advanced pregnancy, Infants

Front 235

When do you preform a chest thrust?

Back 235

Used instead of abdominal thrust on obsese victims, infants and pregnant women

Front 236

When do you use a oral pharynegal airway?

Back 236

Unconscious patient Patient has bite block as in seizure facilitate oral suctioning
Complications: Airway to be left uncecured.

Front 237

When do you use a nasal pharygneal airway?

Back 237

On a conscious patient to facilitate deep tracheal suctioning and decrease nasal trauma
Complications; Trauma to mucosa -lubricate water soluble

Front 238

What is the size determination and insertion techniques of oral and nasal techniques?

Back 238

Size of oral -Lenght should be equal to distance formangle of jaw to just past corner of mouth. Insert upside down and twist into position.
Nasal- Length of airway is from tip of earlobe to center of nostrils. Inserted the way it is anatomicallly shaped with water soluble lubricant.

Front 239

What is the purpose of oral and nasal intubation?

Back 239

Patent airway
Access for suctioning
Means for mechanical ventilation
Protect airway (aspiration, obstruction)
Direct instillation of medication.

Front 240

What is NAVEL?

Back 240

Narcan-Narcotic Overdose
Atropine-Bradycardia
Valium-Versed-Sedative
Epinephrine_Asystole
Lidocaine-PVC's

Front 241

What are some complications of intubation?

Back 241

Infection, fever,secretions
Cuff pressures, Larynogospasm most serious
Right mainstem intubation>25cm marking deep
VAP Ventilator acquired pneumonia

Front 242

What is cuff pressure related to?

Back 242

Cull pressure is directly related to capillary pressures. It should be equal to or less than 20 torr or mmHg or 25cmH2O
>5mmHg is the lymphatic vessel resulting in edema
>10mmHg is vein resulting in edema
> 20mmHg is the artery resulting in necrosis

Front 243

What is the procedure for ventilation?

Back 243

Position patients head in sniffing position. Adequately hyperoxygenate(resuscitation bag with FIO2 100% for 2 minutes) Hold laryngoscope in left hand, ET tube in right hand Insert b lade down reght side of mouth Advance blade, lift epiglottis, visualize cords (curve blade tip into vallecula, straight blade tip under epiglottis) have suction available Insert tube, inflate cuff, assess tube position, ventilate, and oxygenate

Front 244

How do you assess the position of the tube?

Back 244

Look for bilateral chest expansion during inspiration
Auscultation, breath sounds should be heard on both sides
Capnography or CO2 dectectors
Chest x-ray - tip of tube should be 2 cm or 1 inch above carina or at the aortic notch

Front 245

What do you preform for tube maintenance?

Back 245

Suctioning maintain patency
Humidification prevent dehydration of tissue (100% Humidity @ 37 C best way to prevent obstruction
Cuff pressure minimal leak
minimal occluding volume
use high volume/low pressure cuff (equal to or < 20 mm Hg pressure

Front 246

What equipment do you use for intubation?

Back 246

Laryngoscope, Handle , Always held in left hand, holds batteries for light,
Blades, Curved MacIntosh fits into vallecula, indirectly raises epiglottis
Straight Miller blade fits directly under epiglottis (preferred for infants)

Front 247

What do you check for troubleshooting upon intubation?

Back 247

If light does not work
tighten bulb
check handle attachment
change blades
check batteries

Front 248

What are the blade and endotracheal tube sizes used/

Back 248

Blade sizes: Adult Size 3
Pediatric Size 2
Term Infant Size 1
Pre-term Size 0
Tube Sizes
Full term Infant 3 -3.5
Adult males 8 - 9mm
Adult females 7-8 mm
Adult (wt in kg ? 10 = approximate size

Front 249

When do you use Magill forceps?

Back 249

Only to aid nasal intubation

Front 250

What are the tube markings and cuff types used in intubation?

Back 250

Oral intubation-21-25cm mark
Nasal Intubation 26-29cm mark
Cuff types: Low pressure, high volume, high compliance , floppy cuff
Cuff pressure should not exceed 20mmHg or 25cmH2O

Front 251

What is the MOV and MLT?

Back 251

Minimal occluding volume -stop inflating at no leak via trach or endotracheal tube
Minimal leak technique slowly inject air during inspiration until leak stops then small amount of air is removed to allow a sling leak during inspriation

Front 252

What is a DLT?

Back 252

Double lumen endotracheal tube /Carlen's tube : A tube with two independent lumens of different lengths; the longer lumen is inserted into either right or left mainstem and shorten end into trachea above the carina to independent lung ventilation (two ventilators) Unilateral lung disease, used in surgery during a pneumonectomy , lobectomy, esophageal resecton and aortic aneurysm
To provide airway protection in preventing blood or secretions from entering the unaffected lung

Front 253

What is a LMA?

Back 253

Laryngeal Mask Airway used fmost frequently during anesthesia Inflatable mask positioned directly over the opening into the trachea (hypopharynx) Indicated for short term intubation or facial or nasal injuries. Or and Emergency Dept , EMTs

Front 254

When would an endotracheal tube be inserted into the trachea?

Back 254

If patient was eating or had a heart attack and no time.

Front 255

What is the proper extubation technique?

Back 255

Suction the airway below then above the cuff
Deflate the cuff
have patient inspire deeply
Pull the tube out at peak inspiration to prevent vocal cord damage
Have patient cough to clear any remaining secretions, speak
Administer oxygen and humidity if as indicated
Observe for any complications:
Laryngeal edema - strider
Respiratory obstruction

Front 256

What do you do for complications and management of extubation?

Back 256

Severe respiratory distress and/or Marked inspiratory stridor--REINTUBATE the patient
Moderate distress/stridor-Oxygen, cool mist aerosol and racemic epinephrine to reduce swelling
Mild distress/stridor /Sore throat--Provide humidity, oxygen and/or racemic epinephrine as necessary

Front 257

What are the indications and advantages of Tracheostomy?

Back 257

Preferred method for long-term ventilation
When upper airway obstruction prevents intubation/child epigloltisis
Patient is able to eat and speak with takling trach tubes

Front 258

When should the cuff be deflated on a trach tube?

Back 258

The cuff should be kept deflated unless the patient is eating or on positive pressure ventilation and the tube should not be changed more than once a week .

Front 259

When do you replace a trach tube?

Back 259

When the tube is obstructed and unable to pass a suction catheter, then you must pull tube out, ventilate and insert new tube. If the tube is too small , change to larger tube .5 size larger as you will have too high cuff pressure >20mm Hg . Also change if punctured cuff , unable to seal trach

Front 260

What types of trach tubes are there?

Back 260

Standard trach tubes may have an inner cannula for easy cleaning, Often have an oberator to reduce trama during insertion.
Fenestrated tubes has opening in outer cannula above the cuff for weaning and temporary mechanical ventilation with inner cannula and can be used for phonation you must deflate cuff for this
Tracheal Button used to maintain stoma, for multiple intubations.

Front 261

What other types of trach tubes are there?

Back 261

Jackson trach tube , silver or metal comes with inner cannula , no cuff, not for resuscitation (you need cuff )
Lamen-Wilkinson Foam/Bivona Cuff Foam filled cuff in which air is evacuated prior to insertion, Pilot is open to the atmosphere and foam expands to seal treachea(has no pilot balloon) Do not inflate the cuff with a syringe

Front 262

What tracheal speaking devices are there?

Back 262

One way valve that attaches to tracheostomy tube. Cuff should be deflated

Front 263

What is a laryngectomy and larngectomy tube?

Back 263

Surgical removal of the patient's larynx, patient will breathe through a laryngectomy tube initially , patient cannot be orally or nasally intubated it has no cuff, Laryngectomy tube will be removed after 3-6 weeks then patient will have a permanent stoma . Laryngectomy tubes are designed to maintain a patent airway after a laryngectomy has been performed

Front 264

What is postural drainage and percussion(vibration) done for?

Back 264

Purpose is for improve mobilzation of secretions , prevent accumulation of secretions and improve ventilation, the indications is accumulated or retained secretions ineffective cough examples are bronchiectasis, CF lots of secretions.

Front 265

What are the body positions for postural drainage?

Back 265

Bed is flat-Upper lobes
Head of bed down 15 degrees Middle lobes
Head of bed down 30 degrees Lower Lobes
If patient aspirates while in a particular body position,first suction and then place in opposite position for drainage
If patient has unilateral consolidation affected side up to drain and increase perfusion to unaffected lung

Front 266

For how long do you percuss for and what do you do for sensitive patients?

Back 266

Percuss for 5 minutes in every position and use mechanical percussors or percussion cups for sensitive patients

Front 267

How and when do you perform vibration?

Back 267

After every segment you put hand over hand compress and vibrate with exhalation to move secretions to larger airways

Front 268

What are some alternative airway clearance techniques?

Back 268

Positive Expiratory (PEP) Therapy The expiratory flow resistor prevents end-expiratory pressures from falling to zero
Flutter Valve Devices Combines positive expiratory pressure therapy with high-frequency oscillations at the airway. (PEP)

Front 269

What is Autogenic Drainage?

Back 269

Breathing exercises utilized to improve mucus clearance, primarily in patients with cystic fibrosis and bronchiectasis. Patients are insturcted to breathe at low lung volumes to loosen secretions from the small airways. Patients then increase their volume by breathing in the normal tidal volume range , but exhaling at low range , during last stage patient breathes at high lung volumes

Front 270

What are external percussive devices?

Back 270

High frequency chest wall compression devices , oscillatory , vests

Front 271

What is intrapulmonary percussive ventilation?

Back 271

IPV is for bronchial clearance is a combination of high frewuency pulse delivery of a sub tidal volume and a dense aerosol , delivering more aerosol to the distal airways and coughing helps facilitate removal of retained secretions

Front 272

Why would you modify chest physical therapy?

Back 272

Consideration for pediatrics and neonates, size of thorax , fear and positioning , goal 5 minutes but must listen to patient. Presence of chest tubes, fractures and treatments (IPPB, IS, bronchdialator) must be scheduled and coordinated with CPT

Front 273

How do you evaluate if CPT is working?

Back 273

Assessment of bronchial hygiene is preformed by
Ascultation /improved BS
Inspection/color, chest expansion
Chest x-ray improved pattern

Front 274

When would you discontinue bronchial hygiene?

Back 274

When you have clear breath sounds and xray , Ambulating Well, Strong cough , Afebrile 24 hrs, Hazards occur (dizziness, SOB, cyanosis

Front 275

What is the purpose, indications and hazards of suctioning?

Back 275

Purpose patent airway,specimen collection, stimullate cough
Indications accumulated secretions
Obstructed airway, depressedf cough , inability to swallow
Hazards Trauma to mucosa (most common) Lubricate catheter(nasal-tracheal suctioning) use gentle technique
Contamination use aseptic technique
Hypoxemia leading to trachcardia, arrhythmias (most severe)
Bradycardia from vagal nerve stimulation

Front 276

What is the procedure of suctioning?

Back 276

100% O2 pre and post suctioning is required. Oxygenation should be for at least 1-2 minutes.

Front 277

What is some of the equipment used in suctioning?

Back 277

Vacuum regulators Used to adjust vacuum pressure
Adjust with tubing occluded and a built in shut off device in the collection bottle prevents aspirated secretions from entering the regulator and vacuum system when bottle is full

Front 278

What are the suction pressures for patients?

Back 278

Adult 100- 120 mm Hg
Child 80 - 100 mm Hg
Infant 60 - 80 mm Hg

Front 279

What type of suction catheters and specimen collectors?

Back 279

Coude tip catheter is angled to help suction the left main stem bronchus
A closed system suction catheter the Ballard (inline suction) allows the patient to receive ventilation and oxygenation during suctioning. Indicated for patients with high oxygen and or PEEP

Front 280

What and how are the sizes of catheters determined?

Back 280

The ideal catheter length is 20 -22 inches.
Catheter size is listed in French Units
The external diamenter of the suction catheter should be no greater than 1/2 the Inside diameter (ID) of endo or trach tube
Catheter Size = ID size x 3 / 2

Front 281

What is an oral suction device?

Back 281

Yankauer , tonsil suction device , used to suction the mouth and throat, using aseptic technique

Front 282

What is a suction trap?

Back 282

Lukens trap , used to collect a sputum specimen

Front 283

How do you modify suctioning?

Back 283

Change size and type of catheter If having difficulty removing secretion , verify the appropriate catheter size for patients endotracheal tube
Change to a Coude catheter is used to suction the left mainstem bronchus
Change to a closed system suction(Ballard) catheter.
Alter negative pressure/ suctioning should be stopped if hazards occur reduce level of vacuum or do in less time, increase negative pressure to remove thick tenacious secretions. Instill to dilute secretions 5-10cc normal saline or Mucomyst (Acetylcysteine) Alter duration of suctioning no longer than 15 seconds If cardiac arrhythmias Stop and decrease time in airway

Front 284

What do you do to troubleshoot suctioning?

Back 284

Check catheter for patency
Assure vacuum system is working
Change or empty a full collection bottle
Check all connections

Front 285

What are the hazards of aerosol therapy (continuous nebulization)?

Back 285

Bronchospasm treat with bronchodilator
Secretion swelling and airway obstrution treat with suctioning
Fluid overload ( CHF, renal failure and especially infants) treat by monitoring intake and ooutput and weight
Cross contamination(especially large volume, heated aerosol devices) heated humifier to treat

Front 286

How do you check a bubble humidifier alarm?

Back 286

Occluding or pinching the connecting tubing and listening for the whistling alarm
If no alarm occurs there is a leak
If alarm sounds without occlusion oxygen flow is excessively high or obstruction or kinking of tubing

Front 287

What is a heat moisture exchanger/

Back 287

An artificial nose humidifier, must be removed during aerosol therapy and some may not be as effective as Heated Humidifiers and may increase or thicken secretions, if this occurs change to a heated humidifier
Ideal use is for patient transport and short term ventilation

Front 288

What is the preferred heat humidifier?

Back 288

The Wick is preferred , it can deliver 100 % body humidity (44mg/L) It has a low risk of cross contamination (nosocomial infection) because no particles are being produced.

Front 289

What is a heated wire circuits?

Back 289

Used in conjunction with ventilator humidification systems to minimize circuit condensation.
Condensation (rainout) is minimized

Front 290

What are some Aerosol Devices/

Back 290

Pneumatic nebulizers-gas
Jet nebulizers gas also hand held small volume nebulizer (SVN) are used to nebulize small doses of medications A 1-3 second breath hold is important to enhance medication delivery

Front 291

What are Large volume nebulizers used for/

Back 291

LVN are used to deliver bland aerosols to the upper airway to decrease the chances of edema or humidity deficit
For thick secretions a heating element can be added.
Heated jet nebulizers have a much higher output of water vapor and aerosolized solution than non-heated nebulizers

Front 292

How do flow and FIO2 interact in a LVN?

Back 292

As the FIO2 is decreased on the nebulizers , air entrainment is increased , the density of the mist decreases and the total flow or output of the mist increases

Front 293

How do you trobleshoot a LVN?

Back 293

Not enough mist: often due to clogged capillary tube , insufficient flow , a decrease in the temperature or insufficien water level
Changes in FIO2: Any increase in resistance (such as water collecting in the tubing) will cause less air to be entrained causing the FIO2 to increase
The best way to verify adequate aerosol flow is to observe the aersol comming out the end of the tubing during inspiration. (turn up flow or add another neb) Flow >50% add two Nebs

Front 294

What is a SPAG?

Back 294

Small particle aerosol generator nebulizer specifically designed to deliver Ribavirin (anti viral) for treating RSV (bronchiolitis) used with a scavenger evacuation system

Front 295

What is a electric nebulizer?

Back 295

Ultrasonic nebulizer has the highest output range of aqueous solution without heating

Front 296

What is a DPI?

Back 296

Dry powder inhaler medications are in powder form and do not require a propellant
Inhale through the DPI with more force than when using an MDI

Front 297

What is a MDI?

Back 297

Metered dose inhaler shake canister first. Patient inhales slowly while squeezing cartridge. Hold breath briefly to allow distribution. Patient must be able to understand and cooperate
Spacers improves the efficacy of MDI and can be used to overcome coordination difficulties

Front 298

What is the Drug Calculation?

Back 298

Drug % x 10 = #mg/mL
#mg/mL x dosage ordered =number of mg of drug

Front 299

What is Clark's Rule?

Back 299

Clark's Rule=
wt(lb) x normal adult dose/ 150

Front 300

What are Sympathomimetics Drugs?

Back 300

Front door Bronchodilators
Alpha, beta1 and beta2 adrenergic recptor agonist

Front 301

What are Parasympatholytics drugs?

Back 301

Back Door Bronchodilator
Anticholinergics drugs act by blocking cholinergic parasympathetic receptors

Front 302

What are Xanthine drugs?

Back 302

Side door bronchodilators
This inhibitor indirectly increases the amount of cAMP within the smooth muscle this increased amount of cAMP causes bronchodilation

Front 303

What are wetting agents?

Back 303

Substances to liquefy secretions and as diluent for medications.

Front 304

Name some wetting agents

Back 304

Water given orally is the best mucolytic
Saline solution .45% hypotonic saline
0.9 Saline normal saline same as body tissue
1.8 - 15% hypertonic saline , commonly used to induce sputum specimens, and also cause bronchospasm or secretion obstruction

Front 305

What is an asthmatic prophylactic agents?

Back 305

Inhibit histamine release
Cromolyn Sodium (Intal) donot give during asthma attack only in prevention of bronchospasm
Nedocromil(Tilade) donot give during acute asthma attack

Front 306

What are corticosteroids?

Back 306

Anti inflammatory,immunosuppressive agent Status asthmaticus and asthmatic bronchitis
(end in one)
Predisone
Methyleprednisolone(Solu-Medrol)
Dexamethasone(Decadron)
Beclamethasone(Vanceril/Beclovent)
Triamcinolone(Asmacort)
Funisolide(Aerobid)
Fluticasone(Flovent)
Pulmicort(budesonide)
to prevent thrush rinse with water

Front 307

What are decongestants?

Back 307

Alpha effect which causes vasoconstriction and reduces blood flood and mucosal edema
Racemic Epinephrine(vaponephrine)

Front 308

What are Leukotriene modifiers?

Back 308

Non steroid drugs that have been approved for use in cases of mild to moderate asthma
Montelukast(Singulair)

Front 309

What are anti inflammatory /long acting brochodilator combinations?

Back 309

Combination of fluticasone(anti inflammatory) and salmeterol(long acting bronchodilator)--Advair Indicated for asthma

Front 310

What are some beta bronchodilators?

Back 310

Albuterol-0.5mL normal 2.5mg/Side effect Tremors
Metaproterenol(Alupent or Metaprel) dosage 0.3mL q4
Terbutaline(Brethine or Bricanyl) 0.5mL
Bitolterol(Tornalate) 1.25QID
Pirbuterol(maxair)0.2mg/puffQ4-6hr
Saimeterol(Serevent)21ug/puffBID
Formelterol

Front 311

What are some of the side effects of beta adrenergic bronchodilators?

Back 311

Tachycardia
Palpitations
Hypertension/hypotension
Headache
Tremors
Paradoxical hypoxemia
Nausea vomiting

Front 312

What are some anticholinergic bronchodialators?

Back 312

Atropine Sulfate
Ipratropium Bromide (Atrovent)
Tiotropium(Spiriva)

Front 313

What are some Adrenergic/Anticholinergic bronchodilators?

Back 313

Combination of beta adrenergic and anticholinergic agents.
Ipratropium Bromide and Albuterol(Combivent, DuoNeb)

Front 314

What are some Xanthine drugs?

Back 314

Theophylline (Aminophylline)
Theophylline(Theo-Dur)
Oxytriphylline(Choledyl)
Caffine also

Front 315

What are the safe blood levels of theophylline and signs of toxicity?

Back 315

Therapeutic blood levels of theophylline are 10-20/ug/mL
Blood levels are important to monitor in asthmatic patients
Signs of toxicity are
tremors nausea and vomiting
nervousness
tachycardia and other arrhymias

Front 316

What is given for mucus plugs, CF?

Back 316

Acetylcysteine(mucomyst) dissolves disulfide bonds used for liquefaction of thick tenacious secretions
Always give bronchodilator first

Front 317

What is a mucolytic agent other than mucomyst?

Back 317

Dornase Alpha(pulmozyme)
digests extracellular DNA
treat viscous secretions CF

Front 318

What are Cardiac Glycosides and what are they used for?

Back 318

Increases the strength of contraction
Treatment of CHF
Digitalis(Crystodigin)
Digoxin (Lanoxin)

Front 319

What are anti-arrhythmic agents?

Back 319

Used for arrhythmias-
Atrial arrhymias Quinidine, Propranolol (Inderal)
Ventricular arrhythmias Lidocaine control of PVC's, pulseless ventricular tachycardia, or ventricular fibrillation

Front 320

What is Amiodarone used for?

Back 320

Treatment of pulseless ventricular tachycardia and ventricular fibrillation that has not responded to defibrillation

Front 321

What do you treat bradycardia with?

Back 321

Atropine, Epinephrine

Front 322

What do you treat angia with?

Back 322

Nitroglycerin (vasodilation)
Isordil
Relief of pain (angina pectoris) is almost immediate

Front 323

What are the vasodilator drugs and what do they treat?

Back 323

Vasodilator drugs used to decrease BP. (Nitro)
Diuretics-Thiazides
Chlorthiaside(Diuril)
Hydrochlorothiazide(Hydrodiuril)
Sympatholytics are Methyldopa (aldomet)blocks sympathetic neurotransmission
Propranolol(Inderal) bloks over reactive sympathetic neurons
Metoprolol(Lopressor) B1 blockade(slow down the rate)

Front 324

What are direct vasodilators?

Back 324

Diazoxide(Hyperstat IV)
Sodium Nitroprusside(Nipride)light sensitive
Nipride lowers blood pressure and decreases ventricular preload

Front 325

What are vasopressers and what do they do?

Back 325

Vasopressors are a adrenergic and raise blood pressure.
Dopamine used to maintain BP
Norepinephrine(Levophed ) used in cardiogenic shock

Front 326

What are some diuretics, what do they do and what effects do they have?

Back 326

Loop diuretics- furosemide(lasix)
Used for pulmonary edema, liver and kidney disease, CHF
Adverse effects:hyplkalemia, hypochloremia, metabolic alkalosis

Front 327

What do you use for drug over dose?

Back 327

Narcotic Antagonist: Naloxone(narcan) reverses narcotics.

Front 328

What is an antiviral agent?

Back 328

Used to treat respiratory syncytial virus (RSV)
Delivered via a smalll particle aerosol generator SPAG
Deliver Ribavirin(Virazole)

Front 329

What are some artificial surfactants and how used and delivered/

Back 329

Used to prevent and treat IRDS/HMD(hylan membrane disease)
Route of administration directly into trachea, immediately after birth or once RDS has been diagnosed
Survanta Infasurf, Curosurf

Front 330

What is used to treat Central sleep apnea

Back 330

Doxapram(Dopram)
Medroxyprogesterone(hormone)
Aminophylline/Theophylline, caffine used to treat Apnea of Prematurity

Front 331

What is nicotine therapy and some treatments?

Back 331

Used to help patients quit smoking
Nicotine gum(NIcorette)
Patch (Nicotrod, NicoDerm)
Nicotine nasal spray (Nocotrol NS)
Nicotine inhaler

Front 332

What are some antibiotics?

Back 332

Penicillin-effective especially for gram postive organasims all the coccus (strep, diplo etc)

Front 333

What are good for broad spectrum therapy?

Back 333

Carbenicillin, Amoxicillin, Ampicillin

Front 334

What are some penicillnase resistant drugs?

Back 334

Methacillin. oxacillin and nafcillin

Front 335

What is a broad spectrum drug?

Back 335

Cephalosporins :effective on gram+ and gram- and can be given to patients allergic to penicillin
Cephalothin(Keflin)
Cephaloridine(Loridine)
Cephalexin(Keflex)
Erythromycin and for mhycoplasm pneumoniae infections

Front 336

What are Aminoglycosides?

Back 336

Good for gram- E. Coli, Pseudomonas
the mycins
Streptomycin
Gentamycin
Tobramycin
Vacomycin

Front 337

What are the antituberculin drugs?

Back 337

Used to treat TB
Isoniazid(INH)
Rifampin
Streptomycin
Ethambutol
Combination therapy usuall will continue for 2 yrs (3 drug combination0
Chemoprophylaxis for TB - 1yr of Isoniazid (INH) if exposed and no alchol

Front 338

What is the ideal breathing pattern?

Back 338

Slow, deep inspriation(from resting exhalation)
Inspiratory pause/hold (1-3 seconds)

Front 339

What is IS and how is it preformed?

Back 339

Indications: Prevention of atelectasis ,treatment of atelectasis. Encourage patients to take a deep breath.
IS should be performed hourly for 10 breaths
Date, time and Volume (IC) should be charted
Increase or decrease volume goals based upon patient's performance. Half of pre op goal
Volume-oriented:Patient inspires until preset measured volume of gas in inhaled.
Flow-oriented Patient's inspiratory flow rate causes a ball or float to rise

Front 340

How do you troubleshoot IS?

Back 340

Patient's must be reminded to inhale not exhale into device
In flow spiromenter ,a slow inspiration may not generate sufficient flow to raise the float/ball :may need to switch to a volume type spirometer

Front 341

What are the indications of IPPB therapy?

Back 341

Prevent or correct atelectasis in patients unable to take a Deep Breath

Front 342

What are the hazards of IPPB therapy/

Back 342

Hyperventiation-dizziness, tingling of fingers (have pt slow down respirations)
Impeding venou return-results in decreased cardiac output
increased intracranial pressure (keep pressure low)

Front 343

What is pressure-cycled ventilators?

Back 343

IPPB therapy - Bird Mark 7
Pressure cyclec : inspiration ends if you don't reach preset pressure
Flow rate ; Increasing flow will increase the E-time
Decreasing flow will increase the I time

Front 344

What are appropriate ventilators for IPPB home therapy?

Back 344

Bennett AP-4 and AP-5 ventilators ,electrically powered

Front 345

What changes on IPPB will effect the FIO2/

Back 345

Increase pressure will increase FIO2
Decrease flow (increased inspiratory time) will increase the FIO2

Front 346

What changes on IPPB will change the volume?

Back 346

Increasing the pressure will increase the volume
Decreasing the flow will increase the volume (increased inspiratory time)
Increasing th flow will increase turbulence and decrease volume (decreased inspiratory time)

Front 347

What changes the effect on the I:E ratio on IPPB ?

Back 347

Increased pressure(increase tidal volume) will increase the inspiratory time
Increased flow will decrease expiratory time

Front 348

How do you troubleshoot IPPB?

Back 348

Loss of pressure means leak or not enough flow
Excessive pressure means Obstruction or too much flow
Failing to cycle into inspiration mean adjust sensitivity or tight seal around mouthpiece
Failing to cycle off means a Leak, mouthpiece/mask seal
Cuff leaking
Fenestrated trach tube open
Loose equipment connection
If pressure does not rise normally =not enough flow

Front 349

What are the indications for non-invasive positive pressure ventilation NPPV?

Back 349

To avoid intubation , in patient who is DNI
To facilitate long-term ventilation at home
Assist a patient in early respiratory failure/COPD
Contraindications -poorly fitting mask

Front 350

What is BiPAP ventilation?

Back 350

Non invasive
Provides two levels of CPAP
One during inspiration(IPAP)
One during expiration(EPAP)
IPAP (ventilation) should be greater than EPAP (oxygenation)
An I:E ratio of 1:2 is preferred
Contraindicated for patients with dysphagia (trouble swallowing)

Front 351

What is a negative pressure ventilators , extrathoracic?

Back 351

Negative pressure (suction) is applied to the outside of the chest.
This causes the chest to rise and expand(inspiration)
Ventilation is controlled by adjusting the length of inspiration andt the amount of suction (time cycled ventilation
Indicated for intermittent use , home care(central sleep apnea) and patients with neuromuscular strength

Front 352

What do you troubleshoot for in negative pressure ventilators?

Back 352

Chest cuirass is hissing and unable to reach pressure means check for leaks
Patient is breathing faster than the rate setting on the machine means increase the rate on the machine

Front 353

What are some of the negative effects of positive pressure ventilation?

Back 353

Decreased venuous return
Increased intrathoracic pressures
Increased intracranial pressures
Decreased cardiac output

Front 354

What are the types of positive pressure ventilation?

Back 354

volume cycled-pressure is applied until a preset volume is delivered, inspiration ends
Airway pressure will increase and decrease with changes in patient's compliance or airway resistance.
Pressure Cycled- ventilation is (VT) adjusted by increasing or decreasing the pressure limit Inspiration ends when preset pressure is reached. Although peak pressure will remain constant , the volume will change as lung compliance and or airway resistance change
This type of ventilator is best for intermittent therapyIPPB or continuous ventilation for patients with normal lungs (Bird Mark 7, Bennett PR-2) Inspiration ends when time is reached .
Also used for infant ventilation

Front 355

What type of ventilators are used for home/

Back 355

Examples of negative pressure-Cuirass or shell and Body Wrap or poncho
Positive vents Intermed Bear33
Life Care PLV 100 and 102
Aequitron LP 6 and LP10
Puritan Bennett companion 2801
A backup vent should be provided for any pt who requires ventilation the majority of the time

Front 356

What are the qualities of a transport ventilator?

Back 356

Should be portable and lightweight
Duration of flow must be considered when using an oxygen tank to power vent
If respiratory rate or tidal volume decreases on pneumatic transport vent-check the tank pressure-may be running out of gas

Front 357

When should you change a vent circuit and how?

Back 357

Every seven days and manual ventilation with a resuscitation bag will be necessary while the new circuit is attached and tested by another person

Front 358

What are the common alarms for a ventilator?

Back 358

High pressure limit (set 10-15 cmH2O above peak airway pressure)
Minimum exhaled volume(set 100mL below exhaled tidal volume)
Low pressure limit (set 10 cmH2O below peak airway pressure)

Front 359

What does a low pressure alarm on the ventilator mean?

Back 359

Consider :
Leak in the ventilator circuit
Insufficient flow
Endotracheal/tracheostomy tube cuff leak

Front 360

What does a high pressure alarm on the ventilator mean?

Back 360

Consider:
Equipment obstruction(ventilator circuit)
Patient obstruction (endotracheal tube, pneumothorax, increased airway resistance , secretions etc.)

Front 361

What does low exhaled volume alarm mean?

Back 361

Consider;
Equipment disconnect(ventilator circuit)
Low spontaneous tidal volume

Front 362

What are time cycled pressure limited ventilators?

Back 362

Inspiration begins and ends according to preset inspiratory time
Maintains preset pressure limit using pressure popoff (pressure relief valve)
Volume delivered demands close monitoring because it varies with EVERYTHING
Pressure limit, flowrate, inspiratory time, compliance, airway resistance patient effort during spontaneous breathing, CPAP or PEEP changes

Front 363

What are the dtime cycled pressure limited settings for infants?

Back 363

Mode-SIMV
Peak Inspiratory Pressure(PIP)- 20-30 cmH2)
Respiratory Rate 20-30 breaths
Inspiratory time- 0.5-0.6 seconds
Flow- 5-6 L/min
FIO2 40 -60% or set at same level prior to ventilation
PEEP 2-4 cmH20
Change in increments of 2 cm H2O and not above 8 cm H2O

Front 364

What are the three phases of mechanical ventilation?

Back 364

Phase 1 initiating mechanical ventilation (when, settings)
Phase 2 caring for the patient receiving mechanical ventilation(changes)
Phase 3 weaning a patient off mechanical ventilation (when, method, monitoring)

Front 365

What are the indications for continuous mechanical ventilation?

Back 365

Apnea(not breathing) observation
Acute ventilatory failure not breathing enougnh (one ABG)
Impending respiratory failure rising PaCO2 (serial ABGs) neuromuscular, VC, MIP
Oxygenation last reason for ventilator, used to reduce work of breathing(Oxygen, CPAP)

Front 366

What are the clinical data for mechanical ventilation?

Back 366

Patient Assessment
Arterial Blood Gases , PH 7.35-7.45.mmHg PCO2 35-45mmHg
PO2 80-100mmHg
Bedside pulmonary function
Tidal Volume(VT) >5mL/kg
Vital capacity(VC) >10mL/kg or 2 x Vt
Respiratory rate(f) 8-20 bpm
Minute ventilation(VE) <10L/min
Maximun inspiratory pressure(MIP) -20 cmH2O measures muscle strength (NIF)
Maximum expiratory pressure(MEP) 40cmH2O
Physiological assessment/calculations
A-a DO2(21%O2) 5-10mmHg
A-aDO2(100%O2)25-65mmHg Acceptable66-300mmHg
Qs/Qt(% shunting) <5% Acceptable <20%
VD/VT(%deadspace) 20-40% Acceptable<60%
Cst(static compliance)60-100mL/cmH2O Acceptable>25mLcmH2O
Qs/Qt(%)

Front 367

What is the set-up of a continuous ventilator?

Back 367

Mode, VT, RR,FIO2, and PEEP
Mode:Control, assist/control, IMV/SIMV
Tidal volume and Rate two most important controls and should be set first
Tidal volume(VT) set at 10mL/kg of ideal body weight Range 8-12 set at 10 mL/kg and go 100mL up and down to get range
Respiratory rate 8-12breaths
FIO2 and PEEP once the ventilation has been set (VT and f ) then the next life function oxygenation should be set, Oxygenation begins with FIO2 setting if no information about prior O2/ABGs or patient on room air(21%) then Oxygen at 40-60% and no PEEP therapy
Patient was on oxygen prior to ventilation then same FIO2 and or/PEEP
PEEP 0-10 cmH2O

Front 368

What measurements are taken with patient OFF the ventilator?

Back 368

Tidal Volume(using respirometer)
Respiratory Rate (f)
Vital capacity(VC)
Maximum inspiratory pressure(MIP)
Maximum expiratory pressure(MEP)

Front 369

What are measurements are taken with patient ON the ventilator?

Back 369

Exhaled tital volume(VT)= (VE /f)
Respiratory rate(f)
Minute ventilation(VE)=(VT x f)
Inspiratory flow (I:E ratio)
Alveolar ventilation VA=Tidal volume -weight x 10

Front 370

What is the formula for static compliance and what is the normal value?

Back 370

Stactic Compliance = Exhaled volume/Plateau pressure -PEEP
Normal is 60 - 100 cm H2O

Front 371

What are some of the reasons for increasing pressures on a ventilator?

Back 371

Increasing airway resistance(Raw) obstructive disease
Peak inspiratory pressure(PIP) increases
Plauteau pressure(Ppl) REMAINS SAME - compliance
Raw can be estimated;PIP-Plp
Common causes are secretions in airway
Bronchospasm
Treatment /suction and
bronchodilator
Decreasing lung compliance(CL) restrictive
Peak inspiratory pressure(PIP)
Increases
Plateau pressure (Ppl)Increases Complance down
Common causes:
atelectasis, pulmonary edema
ARDS, pneumonia
Treatment: Increase PEEP ,
treat underlying cause for decreased compliance

Front 372

What is the mean airway pressure(Paw) what controls affect it ?

Back 372

Paw is the average pressure transmitted to the airway from the beginning of one breath to the beginning of the next.
Controls that affect Paw
peak inspiratory pressure(PIP)
rate(f)
inspiratory time(IT)
PEEP most influence on Paw inspiratory and expiratory
Peak Flow
Tidal Volume
Inflation hold

Front 373

What are the typical mean airway pressure values(Paw)?

Back 373

Patients with normal compliance and resistance 5-10 cmH2O
Obstructive patients 10-20 cm H2O
ARDS patients 15-30cm H2O

Front 374

What does Control mode on ventilator indicated for?

Back 374

Head trauma/surgery patients, status asthmaticus, flail chest, does not allow patient to initiate breaths. Change it

Front 375

What is the assist/control mode?

Back 375

Ventilator gives Tidal volume everytime patient inhales
Patient may hyperventilate if in pain

Front 376

What is the SIMV mode usually used for?

Back 376

Spontaneously breathing patient
Ventilator provides a miniumum minute ventilation
Used with COPD patients to normalize ABGs
Used with tachypnea(>mo bpm) to avoid hypervention(pulmonary emboli)
Used for weaning patients
Used instead of assist/control to reduce barotrauma
Used with PEEP to reduce barotrauma

Front 377

What is pressure control ventilation used for (PCV)?

Back 377

Used when peak inspiratory pressures(PIP) are very high(>50 cm H2O
Recommended for patients requiring high FIO2's(>60%) and PEEP (>15 cm H2O)
High PIP(>50 cm H2O)
Low PaO2's and decreased compliance (ARDS)

Front 378

What do you do to normalize a high PaCO2?

Back 378

Increase the tidal volume(8-12mL/kg)
Increase the respiratory rate
Remove the deadspace

Front 379

What do you do to normalize a low PaCO2?

Back 379

Decrease the tidal volume Target PaCO2 for head injury should be 25-30mm Hg
Decrease respiratory rate

Front 380

What do you do to increase a low PaO2?

Back 380

First increase FIO2 by 5-10%(up to 60%)
Then Increase PEEP levels by 5cm H2O until: Acceptable oxygenation is achieved or unacceptable side-effects occure (decrease compliance, decrease cardiac output, barotrauma)

Front 381

What do you do to decrease a high PaO2?

Back 381

First decrease FIO2 to less than 60%
Then decrease PEEP

Front 382

What is High Frequency Ventilation and when do you use it?

Back 382

Positive pressure ventilation with breathing rates in excess of 150 bpm and low tidal volumes(<5mL/kg) 1-3mL/kg
Used for ARDS, pulmonary interstitial emphysema and infants

Front 383

What are the primary controls used to adjust ventilation and control gas exchange?

Back 383

1) Rate control/frequency
2) Amplitude/drive pressure regulator(volume)
3) % inspiratory time (I:E ratio)

Front 384

What are the types of HFV?

Back 384

High Frequency Positive Pressure Ventilation HFPPV
Rate150-300 Hertz 2-5
High Frequency Jet Ventilation HFJV
Rate100-600 Hertz1.5-10
High Frequency Flow Interruper Ventilation HFFIV
Rate 120-1320 Hertz 2-22
High Frequency Oscillator Ventilation HFOV
Rate 60-3000 Hertz >50

Front 385

What do you adjust in Volume control to change the I:E ratio?

Back 385

Flow rate
Increasing the flow rate will increase the time for exhalation

Front 386

What do you adjust to change Inspiratory Plateau and why?

Back 386

The inflation hold, the purpose is to increase diffusion of gases (improve distribution) and to decrease microstelectasis formation.
Not to be used with head injury patients and hypotensive patients

Front 387

How should the patient be positioned for mechanical ventilation?

Back 387

Patient should initially be placed in a supine position.
If patient stable Low or semi Fowlers

Front 388

Why should you adjust pressure support?

Back 388

To help patient overcome the resistance of breathing thorough the ventilator circuit
Pressure support can be adjusted above the airway resistance , PIP , Plateau

Front 389

What is normal PEEP/CPAP and when is it theraputic?

Back 389

PEEP/CPAP normal is 2-10cm H2O is considered physiological
PEEP/CPAP therapy 10-30 cm H2O

Front 390

When is PEEP/CPAP improving patients status?

Back 390

PO2 increases
Static Compliance increases(corrected plateau pressures decrease)
Cardiac output/Cardiac Index stabel or increases
Hemodynamic pressures are stable(PAP, PWP0
Increased PVO2,SVO2, stable or decreased A-aDO2

Front 391

When is PEEP/CPAP too high?

Back 391

PO2 decreases
Static Compliance decreases(corrected plateau pressures increase)
Cardiac Output.cardiac index decreases
Hemodynamic pressures increase(PAP, PWP)
Decreased PVO2 , SVO2,stable or increased A-aDO2
For patient with head injuries, increase the FIO2 instead of increasing or adding PEEP
Hypotensive pts also

Front 392

What is the sign volume and rate set at and why?

Back 392

Usually in Assist Control
Used to decrease microatelectasis
Sign volume set at double the VT or less (1.5 2 times VT)
Rate set at 1-3 sighs every 4-15 minutes

Front 393

How do you calculate minimum flowrate?

Back 393

Flowrate= (Tidal volume x Rate) x (I + E)

Front 394

What does a spontaneous volume/pressure loop look like?

Back 394

Skinny Oval

Front 395

What does a assisted volume/pressure loop look like?

Back 395

Fish tail , with tail over pressure line

Front 396

What does a controlled volume/pressure loop look like?

Back 396

Football

Front 397

What does Poor compliance too low a PEEP look like on loop graph?

Back 397

Football is flat on bottom, starts at 0 and is flat till 10 or whatever
If PEEP is optimual football starts at 10 or whatever is optimual for that PEEP

Front 398

What does the loop look like on the volume/pressure in overdistension of the lung?

Back 398

Beak of duck
To improve reduce tidal volume in volume control
or change to pressure control and limit PIP

Front 399

What does the loop look like on the volume/pressure with low compliance?

Back 399

Lazy line, just above the pressure line slanting down
such as in ARDS, IRDS,pneumonia, pulmonary edema,)
Improve with PEEP therapy, surfactant therapy

Front 400

What does the loop look like on the flow/volume loop with high airway resistance (decreased flow)?

Back 400

Laying flat above and below 0 line
This can occur with bronchospasms, secretions and other forms of obstruction
Therapy: Bronchodilator therapy , suctioning

Front 401

What does the loop look like on the flow/volume loop with leak?

Back 401

The loop will be broken , not at 0 in both flow/volume and volume/pressure
Example of leaks: Cuff, curcuit,chest tube bubbles in water chamber 2

Front 402

How do you evaluate air trapping (auto PEEP ) problems ?

Back 402

Flow / time graph and expiratory flow does not return to th zero baseling before next breath starts. square pattern

Front 403

What are the ideal drug characteristics for patients receiveing mechanical ventilation?

Back 403

Potent respiratory depressant
Minimal cardiovascular effects
Euphoric effects (makes being conscious tolerable)
Analgesic effects(alleviate pain)
Easily reversible

Front 404

What are the pharmacological agents used for mechanically ventilated patients?

Back 404

Morphine sulfate is a narcotic analgesic and causes a decrease in respiratory rate and tidal volumes in high doses.
Valium/Versed /ativan /Conscious sedation procedure
Anti-anxiety , sedative, anticonvulsant, Acts on CNS for anxietry, relieves fear
Pavulon(Pancuronium Bromide)Non-depolarizing neuromuscular blocking agent
Causes total muscle relaxation
Takes 2-3 min , no cardiovascular effects. Reversed by anticholinesterase dreu Edrophonium Chloride(Tensilon)
Curare(d-Tubocurarine)Non-depolarizing neuromuscular blocking agent, causes muscle paralysis, Reversed by Neostigmine and Atropine(Neostigmine destroys acetylcholinesterase) Check for complete reversal by asking patient to move
Norcuron(Vecuronium bromide) Non-depolarizing neuromuscular blocking agent, more potent than Pancuronium Bromide, less likely to cause histamine release, onset 2.5 -3min, duration 25-40min
Anectine(succinylcholine chloride) Sucostoran, given primarily for intubation, Fast acting drug last 3-10minute

Front 405

What do you assess for weaning from vent?

Back 405

1) Verify that underlying disease process has been reversed
2) Aterial Blood Gases should show adequate ventilation and oxygenation(PCO2, PO2, pH)
Bedside pulmonary function:
VT>5mL/kg
VC>10mL/kg
f 8-20bpm
MIP/NIF >-20cm H2O
MEP>40cm H2O
RSBI<100 (RR/Vt(L) rapid shallow breathing index
Clinical measurements
A-aDO2<300mm Hg
Qs/Qt <20%
VD/VT<60%
Pulse and blood pressure normal

Front 406

What methods are used for weaning?

Back 406

Traditional method/Trial and error/T-piece trial. Patient is taken completely off the ventilator.
IMV/SIMV decreasing the ventilator rate and allowing the patient to breathe spontaneously. Pressure Support Ventilation(PSV) IPAP to support inspiration when the patient is having difficulty with weaning. PSV can be used with IMV/SIMV
Drugs that suppress ventilation should be stopped
The patient should be aware of what is happening

Front 407

What do you assess during weaning from vent?

Back 407

Heart and Lungs , if heart rate increases 20 beats or more from baseling, then stop weaning and resume mechanical ventilation.
If the heart rate increases less than 20 beats, continue weaning and observe closely, you may increase the FIO2 while off the ventilator
BP,RR, VT,VC should be checked every 20 minutes for any problems.
Sensorium: Patient should be alert and responsive . Any chance in mental status or level of consciousness would indicate the need to resume mechanical ventilation.
Other assessments: ABG should be drawn after 20 -30 minutes off the ventilator to assess ventilation and oxygenation
Summary of adverse conditions to Resume mechanical ventilation
Increase in HR by>20 bpm
Change in BP by 10-20 torr
Increased PaCO2 by >10 torr
RR increases by >10 or is >30 BPM

Front 408

What are the steps in basic life support (BLS)?

Back 408

1) Determine unresponsiveness- tap and shout
2) Call for help-do not leave paient
3) Establish airway- position patient, elevate chin(head tilt-chin lift or modified jaw thrust)
4) Check for breathing-watch for chest movement,listenand feel air flow(no more than 10 seconds)
5) Give two breaths-(if unable to ventilate , reposition head)
6) Check for pulse, carodid artery
7) If pulseless:begin chest compressions-chech hand postion
8)Provide 100% oxygen and draw arterial blood gas
9)Even with proper CPR (30:2) can only establish about 30% of the patient's original cardiac output

Front 409

What are the two most common complications of basic life support?

Back 409

Number One Complication of artificial respirations is Gastric distention.
Number One Complication of external cardiac compression is Rib fractures

Front 410

What are the differences in performing CPR on adult , child, infant and newborn?

Back 410

IN establishing airway the same for Infant under 1yr to Adult use the head tilt-chin lift or Modified jaw thrust
Except in the Newborn Birth to 1 month Just Head slightly Extended
Breathing Rate 8yrs to Adult:10-12breaths/min or every 5-6seconds
Child and Infant under 1 to 8yrs 12 -20 breaths/min
Newborn birth to 1 month 40 -60 breaths/min
Compressions 8yrs to Adult Use heel of bottom hand
Child 1 to 8yrs Use heel of 1 hand
Infant to 1 month Use 2 or 3 fingers
Birth to 1 month Use 2 fingers or thumbs
Position of hands or fingers Infants to Adult -Lower half of sternum
Newborn birth to 1 month Use Lower Third of Sternum
Depth 8yr to Adult 1 1/2 - 2inches
Child 1 to 8yrs 1 to 1 1/2inch
Infant under 1 yr 1/2 to 1 inch
Newborn birth to1 month 1/2 to 3/4 inch
Rate 100/min except for Newborn is 90/min
Compression to Ventilation Ratio 8yr - Adult 30:2 both one and two rescurer
Child Under 1 to 8 yrs 15:2 two rescurer
Newborn 3:1 both one and two rescuer
For Under 1 to 8yr call 911 after 1 min or 20 cycles
Newborn birth to 1 month Begin chest compressions if HR is < 60 despite 30 sec. of ventilation .Only newborn has pulse and you still start compressions

Front 411

What is Hypotension and how do you treat it?

Back 411

Characterized by low blood pressure, poor capillary refill,weak thready pules.
Treated with fluid challege, dopamine, dobutamine

Front 412

What is Bradycardia and how treated?

Back 412

Characterized by heart rate < 60 in an adult and heart rate<100 in an infant
Treated with atropine, dopamine and epinephrine for adult
Epinephrine and atropine for children
Also treated with external pacemaker

Front 413

What are Ventricular arrhythmias and how are they treated?

Back 413

PVC:treat with Oxygen and LIdocaine
Pulseless Ventricular Tachycardia treat with defibrillation at 360 joules
If defibrillation unsuccessful, start CPR and administer:Epinephrine, amiodarone or lidocaine
Ventricular fibrillation treat with Defibrillation at 360 joules, if defibrillation unsuccessful, start CPR and administer Epinephrine, amiodarone or lidocaine
Special considerations: if the patient has a metabolic acidosis(documented by ABG) administer sodium bicarbonate.

Front 414

What is asystole and how is it treated?

Back 414

No activity , straight line
1st Confirm in two leads
Treat with Epinephrine, Atropine, DO NOT DEFIBRILLATE
CPR, intubate , IV pacing

Front 415

What is cardioversion?

Back 415

Therapeutic procedure (non-emergency) involves low voltage (50-100Joules) current to heart to attempt to convert dysrythmia to normal sinus rhythm. The electric current is synchronized with patient's rhythm. (Shock to R wave)
Atrial fibrillation , atrial flutter and venticular tachycardia with pulse. If ventricular fibrillation occurs , check pulse first, then turn off synchronizing switch , increase to 200 joules and defibrillate
Madazolam(Versed) is a strong short acting sedative given prior to cardioversion

Front 416

What is dibrillation and when is it used?

Back 416

Similar to cardioversion ,except used when emergency (lethal) cardiac dysrhymias are present.
Pulseless Ventricular Tachycardia
Ventricular Flutter
Ventricular Fibrillation
Normally 360 Joules
Life threathing, unsynchronized

Front 417

What is the criteria for the ideal resuscition bag?

Back 417

Self -inflating
Good mask design, will fitting, shapeable and transparent
Reservoir to give 95-100% oxygen at 15 L/min with a quick attachment (not bulky)

Front 418

How do you troubleshoot a resuscitation bag?

Back 418

If bag fills rapidly and collapes easily on minimal pressure then check inlet valve.
If bag becomes difficult to compress with normal patient compliance , patient valve maybe stuck open or closed.
Too high flow may cause valves to jam. Use 15 L/min.
If these are not the problem use another form of ventilation

Front 419

What are the advantages of mouth to valve mask ventilation?

Back 419

Head tilt is applied , mask is placed on the face of patient, (an oropharyngeal airway maybe inserted if needed)
This eliminates direct contact with patient and eliminates exposure to exhaled air.
Easy to preform and supplemental oxygen can be administered

Front 420

What equipment is needed for patient transport?

Back 420

Intubation equipment
Portable oxygen
Resuscitation device
Transport vent if patient on vent
Pulse oximeter
Appropriate medications
portable ECG monitor
Stethoscope and spirometer, for tidal volume assessment

Front 421

What is Pulmonary Edema ?

Back 421

Congestive Heart Failure/Left ventricular failure and lung reaction. Excessive fluids accumulate in the lungs that affect ventilation and especially oxygenation

Front 422

What are the signs of Pulmonary Edema?

Back 422

Assessment:
Orthopnea,pitting edema, distended neck veins and increased respiratory distress.
Pink/frothy/watery secretions
Fine crepitant audible rales ore crackles

Front 423

What is the treatment of Pulmonary Edema/ Congestive Heart Failure(CHF)?

Back 423

Improve gas exchange-give 100% O2 via non-rebreather, IPPB wigh 100% o2 and ethanol, PEEP, CPAP if necessary.
Increase strength of heart contraction(Inotropy)- give digitalis
Decrease venous return-give lasix(diuretic) body position(Fowlers)

Front 424

What is Pulmonary Emboli?

Back 424

Deadspace disease(ventlation without perfusion) Caused by blood clots in the lungs and will affect oxygenation and circulation.

Front 425

What are some of the signs of Pulmonary Emboli?

Back 425

Assessment:
Sudden onset of dyspnea, tachypnea
Patient appears to be hyperventilating but is not (ABG's show normal PaCO2)
Anxious, chest pain
Wedge shaped x-ray
Ventilation/Perfusion (V/Q) scan-shows no perfusion with ventilation=deadspace disease

Front 426

What is the treatment of Pulmonary Emboli?

Back 426

Anticoagulation therapy(heparin and coumadin)
Oxygen therapy
Thrombolytic drugs/screens/surgery

Front 427

What is a Pneumothorax/

Back 427

Presence of gas in the pleural space that can seriously affect ventilation

Front 428

What are some of the signs of Pneumothorax?

Back 428

Assessment:
Sudden onset of dyspnea with decreased breath sounds and tracheal shift away from the affected side
Decreased vocal fremitus, percussion is hyperresonant or tympanic.
X-ray shows hyperlucency without vascular markings and a flattened diaphragm.

Front 429

What is the treatment for Pneumothoraxx?

Back 429

Give 100% O2 via non-rebreathing mask
Immediate chest tube/ thoracentesis, or relieve pressure with needle and tubing inserted into a glass of water

Front 430

What is CO poisoning?

Back 430

The inability of hemoglobin to bind with oxygen due to the binding of carbon monoxide. This can serously arrect oxgenation.

Front 431

What are the symptoms of CO poisoning?

Back 431

Assessment:
History of present illness will be important. (fireman, smoke filled room, burning building etc.)
Redness of skin
Breathing labored and deep (tachypnea, hyperpnea)
Tachycardia with normal ABGs
Increase COHb on co-oximeter>20%
Do not rely on pulse oximetry(SpO2)

Front 432

What is the treatment of CO poisoning?

Back 432

100% O2 via non-rebreathing mask, CPAP mask
Hyperbaric Oxygen

Front 433

What is Status Asthmaticus?

Back 433

Sustained asthma attack, unrespinsive to bronchodilator therapy. Will have marked affect on ventilation and oxygenation

Front 434

What are the symptoms of Status Asthmaticus?

Back 434

Assessment:
Diagnosis made by history
Retractions and pulsus paradoxus
ABG's indicating respiratory acidosis or respiratory failure(PCO2>45)

Front 435

What is the treatment of Status Asthmaticus?

Back 435

100%O2 therapy via a non-rebreathing mask
Subcutaneous epinephrine x 3
Mechanical ventilation-sedate,paralyze,control if necessary
Bronchodilator therapy and steriods

Front 436

What are some examples of trauma?

Back 436

Head,chest, neck,burns and near drowning

Front 437

How do you treat trauma?

Back 437

Always start with airway,breathing and circulation
Administer 100% O2
Administer drugs and/or fluids based upon bedside and laboratory assessment
Remainder of treatment is based upon careful patient assessment.

Front 438

What is a thoracentesis and the most common disorder that requires it?

Back 438

Diagnostic and/or therapeutic procedure in which a needle is inserted into the chest to remove air/fluid from the pleural space. Most commonly used for pleural effusion

Front 439

How is a thoracentesis preformed?

Back 439

Patient is sitting up and leaning forward, 3 to 10 mL of licocaine is used to anesthetize the skin with a 25 gauge needle. A larger and longer needle is then used to anesthetize the thickness of the chest wall. The needle is inserted until the fluid level is reached. This is established when fluid can be withdrawn. 100 to 300 of pleural fluid is aspirated for diagnostic purposes with a 50 mL syringe

Front 440

What does the pleural fluid appearance mean?

Back 440

A clear fluid that has a light straw color is called a transudate (serous fluid) and is associated with Congestive Heart Failure
A cloudy or opaque fluid (more cells) is empyema and is an exudate as is infections that produce yellow or milky exudate fluid.
Purulent or pus filled is an exudate also chyle containing lymphatic exudative fluid
Mucopurulent is an exudate containing mucus and pus
Bloody effusions (hemothorax, serasanguineous) may suggest malignancy of cancer
Loculated means very thick
Pleural fluid pH can be measured and a ph < 7.30 is considered significant (Exudate)

Front 441

What is a Polysomnography?

Back 441

Sleep Apnea Study

Front 442

What is sleep apnea and what are the 3 types?

Back 442

Sleep apnea is a condition in which the patient has apnea during sleep for periods of 10 seconds or longer.
There are 3 types:
Central:apnea due to loss of ventilation effort/chest stops moving
Obstructive;apnea due to blockage of the upper airway/chest still moves
Mixed:a combination of central and obstructive

Front 443

What does Polysomnography use to confirm the diagnosis and assess the severity of sleep apnea?

Back 443

Chest motion detectors to measure respiratory effort
Flow dectectors to measure nasal flow
Oximetry to measure oxygen desaturation(SpO2) during apneic periods
If nasal flow decreases and respiratory effort decreases(chest rise) then desaturation is a result of central problem
If nasal flow decreases but respiratory effort increases(chest rise) then desaturation is a result of an obstructive pattern.

Front 444

What are the treatments for Sleeep Apnea?

Back 444

Weight loss
Surgery
Respiratory stimulants for Central Apnea
Tracheostomy
Nasal mask CPAP and/or BiPAP therapy

Front 445

What conditions require a chest tube?

Back 445

Pneumothorax air enters the pleural space with little or no fluid If this air that enters the pleural space is not allowed to escape it will not only collapse the lung but also affect the mediastinum by pushing it away from the effected side. This is a tension pneumothorax
Hemothorax or pleural effusion is fluid that enters the pleural cavity with no air. Immediate action should be taken to insert a large bore needle to relieve the pressure. Then insert a chest tube and apply the most appropriate chest tube drainage system.

Front 446

Where is the chest tube placed?

Back 446

One , two or more chest tubes may be inserted into the pleural space. If the tube is to drain Air (A-anterior) from the pleural space it is placed in the anterior chest (second interspace in the midclavicular line)
If the tube is to drain Fluid from the pleural space 1st is placed between the fourth and fifth interspace in the midaxillary line(fluid under arm)

Front 447

How do water seal suction drainage systems work?

Back 447

One collection (bottle) system bottle should be lower than pt.
Three bottle collection system
1st bottle is collection bottle from patient (blood drained)
2nd bottle is Water seal bottle with 2cm of water in it if bubbles in this the 2nd bottle patient still has a leak
3rd bottle is the suction control bottle it has 20cm of water and has gentle bubbles when system is on

Front 448

What are the Low Flow Devices to deliver Oxygen ?

Back 448

1) Low flow - provide ONLY part of total inspired volume
a) Cannula: Delivered FIO2: 0.24 - 0.45 / Flow 1-6LPM
To approximate FIO2 : for every 1LPM increase FIO2 increases by 4%
Most appropriate initial oxygen device for COPD patients with stable respiratory rates and tidal volumes.
b) Oxygen Conservation Cannulas
Reservoir cannula- Designed to maintain FIO2 at lower level by using a reservoir. The flowrate may be reduced without affecting the FIO2
Used commonly in the homecare setting to reduce costs.
c)Transtracheal Oxygen Catheters(TTO2)
Amethod of delivering long-term low flow oxygen therapy directly into the airway by a surgically implanted catheter
If the patient becomes SOB or has increased WOB ith a TTO2 device the catheter could be obstructed with secretions and you would need to flush catheter.
d) Simple mask
Delivered FIO2 : 0.40- 0.55
Flow 6-10LPM
Flow MUST be greater than 5LPM to flush out exhaled CO2
e) Partial rebreather mask
Delivered FIO2 : 0.60 - 0.65
Flow 6-10LPM/ Has NO one-way flaps

Front 449

What is the rule for oxygen deliervy for COPD patients?

Back 449

COPD Patients
1 - 2 LPM = 24 to 28% FIO2
Theraputic 30 to 60% FIO2
Emergency Situation 100% FIO2

Front 450

What are the high flow devices to deliver oxygen?

Back 450

1) High Flow Devices provides patient's entire inspired volume(100%)
a) Non-rebreather mask
1) Delivered FIO2: 0.21 to 1.0
2) Used to deliver 100% O2 in an emergency (Pneumothoras, CO Poisoning, CHF,Burns,etc)
He/O2, CO2/O2 mixtures
3)Ideally has THREE one-way valves
4) Troubleshooting
a) Flow rates must be sufficient to keep the bag from collapsing. If bag collapes, increase the flow
b) If patient inhales and bag does not contract
1)Mask is not tight, seal mask
2) Nonrebreathing valve is stuck, replace mask
b)Air-Entrainment Mask/Venturimask
1) Precise FIO2 concetrations available (ideal for patients with COPD)
2)Ideal for patients with irregular tidal volumes, rates and breathing patterns
c)Brigg's adapter (T-piece)
1)Delivered FIO2 : 0.21-1.0 depends upon the aerosol source
2)Turn up flow, add tubing after the patient
d)Aerosol masks, trach collars(masks) and face tents
1)Delivered FIO2 : 0.21-1.0 depends upon the aerosol source and nebulizer output

Front 451

What is an Oxygen Hood?

Back 451

1)Clear plastic device of various sizes that completely encloses the head of the infant for the administration of oxygen and high humidity
2)Flow range 7-14L/min to prevent CO2 buildup and allow controllled FIO2 without sealing the infants neck around the hood.
3)Monitor temperature:
a) Overheating can cause dehydration and apnea
b) Underheating can increase O2 consumption
4)Monitor FIO2 -Preferred method is to analyze O2 continuously near the infant's face. Oxygen may "layer" with higher FIO2 in the lower layers

Front 452

What environmental control devices are there for oxygen delivery?

Back 452

1)Mist Tent, Oxygen Tent, Croupette
a)Indicated for patients requiring a controlled environment
b)Environmental factors controlled:
1) Oxygen concentration
2)Temperature(less than room temperature
3)Filtered gas
4)Humidity and aerosol delivery
c)Used mostly for neonatal and pediatric patients
d)Run flow at 12-15L/min to wash out CO2
FIO2 variable at 0.40-0.50 and hard to control
f) If FIO2 is fluctuating-make sure tent is tightly tucked in. Increase flow
2)Incubators (Isolette)
a)Indications
1)Filtered gas
2)Temperature control-will maintain a neutral thermal environment
Ideal for non-stressed newborns
3)Radiant warmers(Open incubator
a)Ideal for code emergency and for easy access.
b)Provides a neutral thermal environment but will not decrease insensible water loss in premature infants due to evaporation.
4)Troubleshooting
1) As eith most circuits, LOSS OF PRESSURE indicates
a)Leak
b) Insufficient flow
INCREASED PRESSURES indicates
a) Obstruction
b)Faulty exhalation/CPAP/PEEP valve
c)With excessive flow, a continuous venting of the pop-off valve will occur

Front 453

What is Hyperbaric Oxygen Therapy?

Back 453

1) Means of increasing the PO2 by increasing the barometric pressure
2) Diseases/disorders frequently treated by hyperbaric O2 therapy
a) CO poisoning
b) Tissue transplants/grafts
c) Anaerobic infections(gas gangrene)
d) Decompression sickness (bends)

Front 454

What is Helium/Oxygen Therapy (He/O2)?

Back 454

1)Purpose-decreases the patient's work of breathing by delivering low density gas(most important property) that can easily maneuver around obstructions. Used for patients with increased airway resistance, edema, foreign object obstruction, or partial vocal cord paralysis
2) Concentrations used:80%He/20%O2 or 70%He/30%O2 mixtures
3) Considerations
a)Therapy given with non-rebreather
b) Use 1.7 for both concentrations =1.7 x Liter /min

Front 455

What is Nitric Oxide Therapy?(NO)

Back 455

1)The physiologic effects of nitric oxide are due to its ability to relax smooth muscle. This improves blood flow to alveoli to improve ventilation/perfusion mismatch, decreases pulmonary vascular resistance, decreases pulmonary pressures and improves oxygenation
2)Indications for nitric oxide therapy include:
a) primary and chronic pulmonary hypertension
b) Pulmonary fibrosis
c) Pulmonary embolism
d) Respiratory distress syndrome(ARDS)
e) Congenital heart defects
f) Persistent pulmonary hypertension of the newborn
g) Chronic lung disease
h) Heart and lung transplant
i) Sepsis
j) Sickle cell disease
3)Effective dose is in the range of 2 - 20ppm (parts per million)
4) Recommended starting dose is 20ppm. Doses up to 40 ppm can be sdministered without major side effects
5) Nitric oxide is most commonly delivered via mechanical ventilation. (I-NO delivery system) but can be delivered through a nasal cannula to spontaneously breathing patients as well
6) I - NO-Vent is a machine that is attached to vent to deliver NO Therapy
7) When nitric oxide is exposed to oxygen it can forem nitrogen dioxide(NO2) Levels of nitrogen dioxide greater than 10 ppm can result in cellular damage, pulmonary edema and death
9) Other adverse effects include:
a)poor/and or paradoxical response
b) methmeglobimenia/ hemoglobin ability to carry oxygen
c) rebound hypoxemia and /or pulmonary hypertension
d) increased left ventricular filling pressure
e) platelet agglutination(cells clump together
10)Discontinuing therapy
a) Must be done carefully to prevent a rebound effect
b) The nitric oxide level dhould be decreased to the lowest possible dose, usually 5 ppm or less
c) The patient should be able to maintain a good oxygenation level on an FIO2 of 0.4 or less
d) Before withdrawing the nitric oxide always hyperoxygenate the patient

Front 456

What do you do to troubleshoot an oxygen cylinder?

Back 456

Troubleshooting:
a) If tank is leaking, check and tighten all connections, check outlet for debris and check/replace washer
b) If patient states that no flow is sended from the cannula, the patient should be insturcted first to verify the flow by inserting the cannula into a glass of water and checking for bubbles

Front 457

What is the Formula for finding the duration of flow for a tank?

Back 457

Formula of Duration (in min)
Tank factors
E cylinder= 0.3
H cylinder= 3.0
duration= tank psi x tank factor/ Liters running at

Front 458

What is a pulsed-dose oxygen delivery system?

Back 458

1) Used in place of a flowmeter with low flow oxygen devices(nasal cannula, reservoir cannula and transtracheal catheters) and connected to a 50 psi gas source
2) Device senses the start of inspiration and delivers oxygen only during inspiration

Front 459

What is an Air-Oxygen Proportioners (Blenders)?

Back 459

1) Purpose:
a) To control the mixing of air and oxygen to obtain a specific FIO2
2) Can be used with a non-rebreather mask to achieve a precise FIO2

Front 460

What is an Air Compressor?

Back 460

1) Used as an alternative means for providing air to patient without using an air cylinder
2) Can be used in a hospital, out-patient clinic or in the home setting
3) Can be used to power a hand-held nebulizer for a COPD patient in the home setting

Front 461

Why are Total Flow and Oxygen Percentage calculations used?

Back 461

These calculations are necessary when:
a) A patient's inspiratory peak flow exceeds the output of the delivery device. (normal peak flow is approximately 40-60 L/min
b) blenders are unavailable for achieving specific FIO2

Front 462

What are the air-oxygen entrainment ratios?

Back 462

Total Flow = Flowmeter setting x Factor
Factors are;
FIO2 28%Ratio10:1= 11Factor
FIO2 40% Ratio 3:1 = 4 Factor
FIO2 60%Ratio 1:1=2 Factor

Front 463

What is the terminology for disinfection and sterilization techniques?

Back 463

Terminology:
1) Disinfection-the process of destroying vegetative pathogenic organisms
2) Sterile-lack of any life organism
3) Vegetative organisms-growing microorganisms
4) Pathogenic organisms-disease producing.
5) Contaminated-the introduction of disease causing microorganisms.
6) Static-growth is inhibited
7) Cidal-microorganisms are killed.
8) Spore-a resistant form of certain species of bacteria.

Front 464

What is the first thing that should be done before the disinfection process?

Back 464

All equipment should be adequately cleaned by removing organic soil and disassembled prior to the disinfection process.

Front 465

What are the physical methods of disinfection and sterilization?

Back 465

1) Steam under pressure (steam autoclave)
a) Conditions for sterilization- 121C at 15psi for 15 min.
b) This method will not be used for plactics or other heat sensitive items.(rubber)
c) Items must be wrapped in penetrable packaging
d) All air must be evacuated and steam must be allowed to penetrate all parts of the load.
e) Heat sensitive tapes and/or biological indicators are used to assure that the conditions sterilization have been met.
2) Pasteurzation -disinfection processes using moderate temperatures to kill vegetative organisms.
a) Items are first washed then completely submersed in a hot water bath at 63-70C for 30minutes (plastics, rubber)
b) Items must be completely dried then assembled and packaged
3) Incineration-the best method of treating contaminated disposable items and supplies.
4) Irradiation-gamma rays are used to sterilze pre-packaged equipment
a) Items that have been gamma radiated should not be re-sterillzed with ethylene oxide.

Front 466

What are the chemical methods of disinfection and sterilization?

Back 466

1) Ethylene oxide sterilization (ETO) sterlizes equipment by alkylation of enzymes.
a) Factors influencing the ETO process:
1) Temperature of the chamber
2) Concentration of ETO: 800-1000 mg/L
3) 50% relative humidity enhances the effectiveness of ETO
4) Exposure time
5) Aeration time
6) Can't get water out
b) Biological indicators(Attest) are necessary to verify that the conditions for sterility have been met.
c) Examples:Bird Mark VII, Electric Incentive Spirometry device, and a non-disposable resuscitation bag removed from a HIV patient's room
d) Not recommended for sterilizing a bronchoscope

Front 467

What is Alkaline gluteraldehyde?

Back 467

Cidex - disinfection or sterilization process
a) The pH of Cidex is 7.5-8.5
b) Cidex is :
1) bactericidal in 10 minutes
2)tuberculocidal in 10-20 minutes
3) sporicidal in 10 hours(to sterilize)
c) Equipment must be rinsed, dried and packaged after each soaking
d) Cidex once activated will be fully potent for 14 days.
e) Appropriate method for resuable plastics(mouthpiece, tubing aerosols, etcl)
f) Appropriate method for a bronchoscope

Front 468

What is Acid guteraldehyde?

Back 468

Sonacide-disinfection/sterilization processl
a) Sonacide's pH is 2.5-3-5
Sonacide is :
1) bactericidal in 10 minutes
2) tuberculocidal in 20 minutes
3) sporicidal in 1 hour
c) Equipment must be rinsed, dried and packaged after exposure to Sonacide
d) Sonacide remains potent for 28 days

Front 469

What is the Alcohol disinfection process?

Back 469

Alcohol disinfection process:
a) Ethyl and isopropyl alcohol are most effective in 70 - 90% solutions
b) Alcohol wipes are not sporicidal although it is bactericidal and fungicidal

Front 470

Are soaps and detergents used as disinfects?

Back 470

Not antimicrobial agents but will be used as cleaners
a) Agents are surfactants that will reduce surface tension

Front 471

What are some common respiratory pathogens?

Back 471

Gram + Cocci-pneumonia , respiratory track infections
All the Cocci- Staphylococcus
Streptococcus, Diplococus, Pneumococcus
2) Gram Negative cause pneumonia and respitatory tract infections Grow in water and found in GI tract. Spread by poor hand washing .
a) Pseudomonas aeruginosa -produces green sputum (most common)
b) Haemophilus influenza
c) Serratria marcescens
d) Escherichia coli
e) Proteus
f) Klebsiella
3) Acid fast bacilli
a) Mycobacterium tuberculosis-TB
4) Pathogenic fungi
a) Candida- Candidiasis
b) Histoplasma capsulatum-Histoplasmosis
c) Coccidioides immitis-Coccidiomycosis
5) Viruses commonly cause respiratory infections, flu-like symptoms and viral pneumonia
a) Adenovirus
b)Influenza
c) Cytomegalovirus (CMV)
d) Respiratory Syncytial Virus (RSV)

Front 472

What are nosocomial infections?

Back 472

Dirct contact, airborne, droplet, and indirect transmission are common routes for infectious organisms to be transmitted. Hospital accwuir

Front 473

What is Acid guteraldehyde?

Back 473

Sonacide-disinfection/sterilization processl
a) Sonacide's pH is 2.5-3-5
Sonacide is :
1) bactericidal in 10 minutes
2) tuberculocidal in 20 minutes
3) sporicidal in 1 hour
c) Equipment must be rinsed, dried and packaged after exposure to Sonacide
d) Sonacide remains potent for 28 days

Front 474

What is the Alcohol disinfection process?

Back 474

Alcohol disinfection process:
a) Ethyl and isopropyl alcohol are most effective in 70 - 90% solutions
b) Alcohol wipes are not sporicidal although it is bactericidal and fungicidal

Front 475

Are soaps and detergents used as disinfects?

Back 475

Not antimicrobial agents but will be used as cleaners
a) Agents are surfactants that will reduce surface tension

Front 476

What are some common respiratory pathogens?

Back 476

Gram + Cocci-pneumonia , respiratory track infections
All the Cocci- Staphylococcus
Streptococcus, Diplococus, Pneumococcus
2) Gram Negative cause pneumonia and respitatory tract infections Grow in water and found in GI tract. Spread by poor hand washing .
a) Pseudomonas aeruginosa -produces green sputum (most common)
b) Haemophilus influenza
c) Serratria marcescens
d) Escherichia coli
e) Proteus
f) Klebsiella
3) Acid fast bacilli
a) Mycobacterium tuberculosis-TB
4) Pathogenic fungi
a) Candida- Candidiasis
b) Histoplasma capsulatum-Histoplasmosis
c) Coccidioides immitis-Coccidiomycosis
5) Viruses commonly cause respiratory infections, flu-like symptoms and viral pneumonia
a) Adenovirus
b)Influenza
c) Cytomegalovirus (CMV)
d) Respiratory Syncytial Virus (RSV)

Front 477

What are nosocomial infections?

Back 477

Dirct contact, airborne, droplet, and indirect transmission are common routes for infectious organisms to be transmitted. Hospital accquired

Front 478

What are isolation procedures and techniques?

Back 478

1) Once the organisms have been identified, attempts are made to isolate the microorganism and prevent its spread.
2) Type of isolation is dependent upon how organism is spread.
a) Universal/Secretion precautions
1) Gloves are worn by personnedl having contact with secretions. Mask and gowns are optional
2) Used eith acquired immunosuppressed deficiency syndrome(AIDS)
b) Respiratory Isolation-Airborne transmission
1) Patients must have private rooms and closed doors.
2) Masks and gloves are worn when working with the patient, gowns are not necessary.
3) Diseases requiring respiratory isolation: Measles,Rubella, Mumps, Pertussis, Meningitis and Suspected Tuberculosis patients.
4) Paatients should wear a mask when persons are in the room.
c) Strict/complete isolation
1) Gloves, masks and gowns must be worn by all personnel and visitors.
2) Staphylococcus aureus and group Patients with streptococcus pneumonia must by isolated by this method.
d) Protective(reverse) isolation procedures must be followed
1) Strict isolation procedures must be followed.
2) Used with burn, transplant, or cancer patients and immunosuppressed individuals.
e) Enteric/Blood isolation
1) Gowns are used, gloves necessary only when having direct contact with the patient and infected blood/fecal material
f) Wound and skin isolation
1) Gloves are worn by personnel having contact with infected areas.
2) Mask and gowns are optional.

Front 479

What does home care infection control consist of?

Back 479

1) Flu shots/immunizations
2) Clean equipment daily
a) Wash with mild detergent
b) Remove all soap by rinsing well with water
c) Soak in white distilled vinegar (acetic acid) solution for 20 min.--Pseudomonas
d) Rinse, drain, dry without wiping
e) Air dry on a clean towel

Front 480

What different types of home oxygen delivery systems are there and what are some of their safety measures?

Back 480

1) Cylinders
a) Indicated for patients who use small amouts of oxygen intermittently (Prn)
b) They can be stored indefinitely but Do Not store in the trunk of a car.
2) Liquid bulk oxygen systems
a) Last longer than cylinders, used often in the home
b) Non-electrical, portable units are easily filled for trips
3) Oxygen concentrators
a) Principle of operation:
1) Run on electricity and have limited portability
2) Utilize a molecular sieve that removes nitrogen and other gases from room air to concentrate the oxygen.
3) If molecular sieve beds are not working-analyze the FIO2, check circuit breaker/fuse
b) Safety:
a) Instruct patients to routinely check and change filters
2) A properly grounded electrical outlet is required.
3) A backup system (tank or liquid ) must be used in case of a power failure

Front 481

What Is Chronic Obstructive Disease?

Back 481

1) Description: characterized by dyspnea on exertion with significant hypercapnea
2) Terminology used commonly to describe a COPD patient -chronic ventilatory failure patient, chronic hypercapnic patient, increased compliance patient, a loss of elastic recoil patient and CO2 retainer.
C-BABE- Cystic Fibrosis , Chronic Bronchitis,Asthma, Bronchiectasis, Emphysema

Front 482

What are the assessments for COPD?

Back 482

Assessment COPD:
a) Expiratory wheeze, barrel chest, clubbing and cyanosis
b) Percussion notes-resonant or hyper-resonant
c) Hyperlucency, hyperinflaton, increased A-P diameter on chest X-ray
d) Compensated respiratory acidosis wht hypoxemia and hypercapnea
e) Pulmonary functions- decreased flows(FEV1)

Front 483

What is the treatment for COPD?

Back 483

a) Aerosol therapy-low flow O2
b) Medications-bronchodilators, (give with compressed air) expetorants, corticosteroids and diuretics
c) Rehab therapy (purse lip breathing), proper nutrition and monitor fluid intake
d) If a COPD pt. comes into ER in a full arrest-resuscitate with 100% O2

Front 484

What are two acute obstructive diseases?

Back 484

Croup and Epiglottitis

Front 485

What is the etiology , symptoms and treatment of Croup?

Back 485

Croup is caused by the Parainfluenza (85%) Viral , it is an Upper Respiratory Infection , usually strikes in the Winter children less than 3 years old, the Onset is Gradual and Admission Criteria is Stridor At Rest
Treatment and Drugs: Cool mist tent, Dexamethasone (Steroid) and Racemic Epinephrine Aerosol
Lateral Neck X-Rays revel :
Subglottic edema, Steeple or pencil sign

Front 486

What is the etiology, symptoms and treatment of Epiglottitis?

Back 486

Epiglottitis is caused by Hemophilus Influenza (Bacterial) There is no upper respiratory infection it is usually between 3-7 years old the onset is Sudden , there is fever ,drooling and retraction, and a toxic appearance
Admission Critera is Drooling Extended neck and a Suspicion of epiglottitis
Treatment and drugs are Intubation, IV Antibiotics (Ampicillin)
Lateral Neck X-Rays revel Supraglottic edema, Thumb or thumbprint sign and Obliterated vallecula

Front 487

What is a mycobacterium disease ?

Back 487

Tuberculosis - caused by acid-fast , rod-shaped bacteria, spread by inhalation

Front 488

What is the Assessment of Tuberculosis?

Back 488

Assessment:
a) Night sweats(nocturnal diaphoresis), weight loss and weakness
b) Dry couch with or without hemoptysis and pleural pain
c) Two positive test are required from-TB test, bacteriological studies, sputum culture
d) X-rays will show consolidation, fibrosis and cavity formation

Front 489

What is the treatment for Tuberculosis?

Back 489

a) Isolate-Respiratory isolation
b) Drugs-Isoniazid(INH) , ethambutol, streptomycin, rifampin

Front 490

What is an infectious disease?

Back 490

Pneumonia , infectious bacteria or virus enters the lung via inhalation or aspiration

Front 491

What are some assessments of Pneumonia?

Back 491

Assessments of Pneumonia:
a) Chills, fever, cough, purulent sputum, dyspnea, cyanosis, rales and rhonchi on auscultation
b) White blood cell count (WBC) increased in bacterial, decreased in viral
c) Scattered patchy opacity/ consolidation on x-ray

Front 492

What is the treatment of Pneumonia?

Back 492

Treatment of Pneumonia:
a) Oxygen therapy if needed (pulse oximetry , ABG)
b) Bronchial hygiene
c) Antibiotics-penicillin for gram positive infections(stap &streptococcus), streptomycin, gentamycin and tobramycin for gram negative infections(serratia, klebsiella, haemophilus, pseudomonas, E.coli, proteus)
d) Mechanical ventilation if PCO2>45mmHg and PaO2<60mmHg

Front 493

What is pleural effusion, assessment of and treatment for?

Back 493

1) Description: Fluid in the pleural space
2) Assessment:
a) Dyspnea, chest pain, decreased breath sounds and dry non-productive cough
b) Mediastinal shift to the unaffected area(away from the affected area)
c) Lateral decubitus x-ray- obliteration of the costophrenic angle, unilateral basilar infiltrate with meniscus formation
3) Treatment:
a) Thoracentesis/or chest tube drainage system
b) Antibiotics

Front 494

What is Acute Respiratory Distress Syndrome (ARDS)?

Back 494

(ARDS) is a series of reactions leading to inflammation, resulting in a decrease in lung compliance, shunting, hypoxemia

Front 495

What are the assessments of ARDS?

Back 495

Assessment for ARDS:
a) Respiratory distress with tachypnea and cyanosis
b) Refractory hypoxemia, increased A-a DO2 gradient and work of breathing
c) X-ray -shows diffuse alveolar infiltrates in honeycomb/ground glass pattern
d) Decreased FRC, shunting and respiratory failure

Front 496

What are the treatments for ARDS/

Back 496

Treatment for ARDS:
a) O2 therapy-adequate arterial oxygenation without high FIO2
b) CPAP/PEEP therapy- to increase FRC and to decrease work of breathing
c) Titrate PEEP and FIO2 such that the FIO2 can be reduced below .60 (decrease FIO2 first then PEEP
d) Use IMV/SIMV with PEEP
e) Consider pressure control ventilation

Front 497

Name two neuromuscular diseases?

Back 497

Myasthenia Gravis and Guillain Barre Syndrome

Front 498

What is the etilolgy , signs, symptoms , tests and treatment of Myasthenia Gravis?

Back 498

Etiology of Myasthenia Gravis is it is an Auto-immune response , No URI
Signs and Symptoms:
Onset is slow, fatigue improves with rest
Paralysis is descending(Mind to Ground)
Diagnostic tests are : postive tensilon test and monitoring of VCand MIP
Drugs and treatment is Neostigmine,Pyridostigmine
Intubation /mech vent -short term

Front 499

What is the etilogy ,signs, symptoms, tests and treatment of Guillain Barre Syndrome?

Back 499

Etilolgy of Guillain Barre Syndrome is a Delayed reaction to a viral infection
URI is present
Signs/Symptoms are Acute , sudden weakness
Paralysis is Ascending(Ground to Brain)
Diagnostic Tests are spinal tap revels protein in spinal fluid and you Monitor VC/MIP
Drugs/treatments are Steroids, Prophylactic Antibiotics
Mech vent/trach-long term
Plasmapheresis

Front 500

What is the treatment plan for Asthma?

Back 500

Zone Green Peak Flow(80-100%) Level 1
No symptoms of an asthma episode /Able to perform usual activities/No coughing, wheezing or chest tightness
Status is stable/Action plan is continue with medications in daily treatment plan /Use preventative (anti-inflammatory medicine(steroids)
Yellow Peak Flow (50-80%) Level 2
Increased need for inhaled quick relief medicine
Increased asthma symptoms upon awakening
Awakening at night with asthma symptoms
Status is increase in symptoms
Action plan is Preventative(anti-inflammatory) inhaler
ADD:
Quick relief(short-acting bronchodilator) inhaler (Albuterol)
Begin/increase treatment with oral steroids.
Call doctor
Return to Level 1 when symptoms improve
Red/Level 3 /Peak Flow (less than 50% Or No improvement after increasing treatment according to Zone 2 )
Very short of breath
Increased symptoms longer than 24 hours
Limited daily activities
Status : No improvement Or Increase in symptoms
Action: Quick relief(bronchodilator) inhaler
Begin /increase treatment with oral steroids
Call Doctor
Danger Signs: Status/ Difficulty walking and talking due to shortness of breath
Lips or fingernails are blue
Go To Hospital or Call 911
Call Doctor if:
Asthma symptoms worsen while taking oral steroids
Or
Inhaled bronchodilator treatments are not lasting 4 hours
Or
Peak flow drops despite following treatment plan

Front 501

What is the Cardiac Output equation?

Back 501

QT= heart rate x stroke volume

Front 502

What is pulse pressure?

Back 502

Pulse pressure=systolic-diastolic

Front 503

What is Stroke volume?

Back 503

Stroke volume=CO/Heart rate

Front 504

What is ejection fraction?

Back 504

Ejection fraction=Stroke volume/End Diastolic Volume

Front 505

What is QT?

Back 505

QT=VO2/C(a-v)O2 (10)

Front 506

What is VO2?

Back 506

Oxygen consumption=
VO2=QT x C(a-v)O2 x 10

Front 507

What is Alveolar ventilation equation?

Back 507

VA=(VT-VD)f
use ideal body weight for VD

Front 508

What are the Hemodynamic's Values?

Back 508

CVP is 2-6 mmHg or 4-12H2O
PAP is 25/8 is 13mmHg
PCWP is 4-12mmHg
MAP is 120/80 or 90mmHg
Cardiac Output is 4-8L/m
Cardiac Index is 2-4 L/m

Front 509

What is an easy way to remember pulmonary function?

Back 509

FVC is Restrictive <80%
FEV1 is Obstructive <80%

Front 510

What do you do to increase ventilation on a ventilator?

Back 510

To increase ventilation:
High Jet Frequency Increase Driving Pressure
Bi-Pap Increase IPAP
Osculation Increase Amplitude
Pressure Control Increase PIP
Volume Control Increase Tidal Volume

Front 511

What is the shortcut for Shunt Equation?

Back 511

Take the first number from the A-aDo2 add a 1 and x it by 5

Front 512

What is the number for normal Resistance?

Back 512

.6-2.4 cmh2o/l/min
PIP - Plateau
Plateau -PEEP if PEEP given