Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Intro to Respiratory Medicine > 112 Exam 2 > Flashcards

112 Exam 2 Flashcards

1
Q

3 Indications for Suctioning

A
  1. Secretion Retention
  2. Inability to clear secretions
  3. Audible evidence of secretions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

(5) Assessment of need for suctioning

A
  1. Lung Sounds
  2. Tactile Fremitus
  3. Ineffective cough
  4. Change in Vital Signs
  5. Change in ABG or SPO2
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the Suctioning Procedure (Pre, During, Post)

A

Pre:
Assemble equipment, Sterile Environment, Proper ET tube, Preoxygenate with nasal cannula or mask at 6 LPM for minimum of 30 seconds.

During:
Lube Catheter, check suction is working, insert in nasal passageway bevel facing toward septum to lower pharynx, Pt in Sniffing position. Do not suction on the way in, only on the way out. Suction maximum 10-15 seconds. Remove ET Suction and clear with sterile water.

Post:
Reoxygenate Pt minimum of 1 minute. Reassess vital signs, lung sounds, Pt Color, SPO2, check for Trauma, increase ICP (on monitor) and cough effectiveness. If sputum sounds still heard, re-suction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the proper sizes for ET Suction tubing (Adult, Peds, Infant)

A

Adult: 12-18 Fr
Peds: 8-10 Fr
Infant: 5-8 Fr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

11 Hazards/Complications of suctioning and how to avoid them

A
  1. Hypoxia/Hypoxemia - Oxygenate
  2. Tissue/Trauma - Gentle insertion
  3. Bradycardia - Oxygenate
  4. Cardiac Dysrhythmias - Oxygenate
  5. Hypo/Hypertension - Oxygenate
  6. Cardiac Arrest
  7. Nasal Bleeding
  8. Bronchoconstriction or spasm
  9. Atelectasis - oxygenate
  10. Respiratory Arrest
  11. Increased ICP - Provide numbing agent to reduce/eliminate cough reflex
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

7 Contraindications of suctioning

A
  1. Epiglottitis
  2. Laryngospasms
  3. Irritated Airway
  4. Upper Resp. infection
  5. Occluded nasal passage
  6. Acute Head/Neck/Face injury
  7. Coagulopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

4 Contraindications of Pulmonary Rehab

A
  1. Cardiovascular instability requiring monitoring
  2. Malignant neoplasm of Resp. System
  3. Severe arthritis
  4. Neuromuscular abnormalities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

3 Team members of Pulmonary Rehab Team

A
  1. Psychological
  2. Nutritional
  3. Vocational
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

4 Qualifications for Pulmonary Rehab

A
  1. Symptomatic Moderate COPD
  2. Both obstructive & restrictive defects
  3. Chronic mucociliary clearance issues
  4. Exercise limitations due to severe dyspnea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

2 Goals of pulmonary Rehab

A
  1. Maximize Pt Functional Ability
  2. Minimize disease impact on Pt, family and community
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

4 indications for intubation

A
  1. Inability to oxygenate
  2. Inability to ventilate
  3. Unable to protect their airway (such as drug overdose)
  4. inability to maintain patent airway (such as a tumor)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

1 Contraindication for intubation

A

When Pt. clearly expresses and documents the desire to not be resuscitated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

5 Hazards/Complications of intubation with examples

A
  1. Failure to establish or locate airway or intubation into esophagus
  2. Damage to larynx, airway, tongue, teeth etc.,
  3. Bronchospasms or Laryngospasms
  4. Increase/Decreased HR/BP, bleeding, ulcerations
  5. ET Tube issues, kinking/biting, sizing, cuff/pilot balloon issues, occlusions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

2 Predictors of a difficult airway

A
  1. Mallampati= Class III or IV (Visual of airway is reduced to almost nothing)
  2. Thyromental Distance= measured from upper edge of thyroid cartilage to chin with head fully extended. Should be more than 6 cm or 3-4 Finger widths
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What equipment is needed for intubation (11 items)

A
  1. O2 flowmeter
  2. MRB & Mask
  3. Blade and Handle (Mac vs miller)
  4. ET Tube (3 sizes)
  5. 10 mL syringe
  6. Stylet or bougie
  7. Lube
  8. Tape or ET holder
  9. Suctioning supplies
  10. Cuff Pressure manometer
  11. PPE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

8 Steps to intubate

A
  1. Sniffing Position
  2. Preoxygenate. Suction as needed
  3. Insert Laryngoscope/blade
  4. Visualize glottis
  5. Displace glottis
  6. Insert tube 2-4 cm past vocal cords
  7. Confirm correct placement by listening and hearing equal/bilateral lung sounds. CXR 3-6 cm above carina
  8. Stabilize tube with tape or holder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Labeling the 6 parts of an ET Tube

A

From Bottom to Top of tube

  1. Bevel
  2. Murphy’s eye
  3. Cuff
  4. Radiopaque Line (seen on Xray)
  5. Cuff filling tube
  6. Cuff pilot balloon
18
Q

Labeling the Larynx

A

From Top to bottom

Tongue–Vallecula–Epiglottis–Glottis–Vocal Cords–Arytenoid Cartilage

19
Q

When and why and How to use a bougie

A

When/Why= Difficult Airway, ET tube change out

How= Place the bougie in the vocal cords all the way to the carina, slide ET tube over bougie until inside vocal cords then pull bougie out and secure ET Tube.

20
Q

3 reasons why would we do a nasal intubation

A
  1. Access to the mouth not available
  2. Oral surgery or trauma
  3. When mouth cannot open due to:
    - TMJ
    - mandibular fixation
    - trauma
21
Q

6 Contraindications for nasal intubation

A
  1. Suspected basilar skull facture
  2. Nasal fracture
  3. Nasal polyps
  4. Epistaxis
  5. Coagulopathy
  6. Planned thrombolysis
22
Q

Advantages and Disadvantages of nasal intubation

A

Advantages:
- better tube stability
- better oral hygiene
- better tolerated in conscious and semi-conscious pt’s
- smaller tube size, less pressure on glottis

Disadvantages:
- Smaller/Longer tubes
- necrosis of nose/septum
- sinusitis
- otitis media
- epistaxis
- feeding is problematic

23
Q

3 Hazards/complications of nasal intubation

A
  1. Damage to nose/septum resulting in bleeding
  2. Trauma to naso/oro pharynx and larynx
  3. hypoxemia, hypercapnia, bradycardia, cardiac arrest
24
Q

When would we use a combitube

A

Difficult airways where we cannot see. Combitube allows guaranteed ventilation by forcing air to trachea even when intubated through esophogus

25
When would we use a double lumen tube
when the need to ventilate both lungs independently arises
26
2 indications of proper ET tube placement
1. 3-6 cm or 2-3 fingertips above the carina as seen on CXR 2. tube movement is in line with head/neck movement
27
4 ways for Pts to communicate while intubated and what should we as RT always do
1. Lip Reading 2. Paper/Pencil 3. Dry Erase 4. Letter/Picture board We should always talk to our pt no matter what even when unconscious
28
3 ways we assure adequate humidification and 3 reasons why
1. Gas Temp: AARC 34'-41' C (we set to 37'C) 2. Humidification device is pt dependent 3. inspired air is at least 30 mq/L water vapor Why: 1. Thickened secretions 2. decreased ciliary action 3. maintain as close to Body Temp Pressure Saturation (BTPS)
29
5 ways to prevent hospital acquired infections (HAIs)
1. Sterile suctioning 2. aseptically or sterile equipment 3. Hand hygiene 4. Decrease pharyngeal aspiration 5. Prevent retention secretions
30
What is VAP and what is the VAP/VAE RT's do
Ventilator acquired Pneumonia VAP/VAE is a checklist or 5 items we do daily
31
What are the 5 items we do on the VAP/VAE checklist daily
1. Head of bed at 30' 2. Daily sedative interruption and daily assessment of readiness to extubate 3. PUD paraphylaxis 4. DVT paraphylaxis 5. Daily oral care with chlorhexidine
32
Cuff pressures What is acceptable? When does it occur? What happens at <20cmH2O
acceptable= 20-30 cmH2O Damage at= 42 cmH2O <20 cmH2O= micro aspiration can occur
33
Troubleshooting emergencies in intubated pts and how to do a quick check for occlusions
1. Tube obstruction= - Kinking or biting - Cuff folded over tip - Tube stuck on trachea - mucus plugging 2. Clinical Signs= Partial - Decreased airflow/breath sounds Complete - Severe distress - no breath sounds/airflow to check= pass suction down through ET tube, if it cannot pass, there is occlusion
34
Cuff Leaks How to tell of a cuff leak (2 ways) Whats the biggest reason for cuff leak and how to correct
1. Small Leaks= - Decrease in pressure overtime - if pilot balloon issue, correct with blunt end needle and stopcock 2. Large Leaks= - rapid onset - attempt to deflate cuff and/or reintubate Biggest Reason= ET Tube movement up or down. Check cm location in notes at time of intubation and if different, move tube back into proper place by first deflating cuff
35
5 Indications for extubation
1. The need has resolved 2. Protective reflexes are intact (cough, gag) 3. Spontaneous vent is adequate 4. Airway patency is adequate 5. Pt can manage secretion without suction
36
2 Extubating hazards/complications What can happen if we extubate improperly
1. Hypoxemia - Atelectasis, upper resp obstruction, edema, aspirations, hypoventilation 2. Hypercapnia - Resp weakness, excessive WOB, Bronchospasms What can happen= Death can occur
37
7 steps to extubate
1. assemble/check equipment 2. inline suctioning and pharynx suctioning 3. oxygenate pt after suctioning 4. deflate cuff 5. Remove Tube (2 ways) - Large breath w/ MRB and remove tube - most common- deep breath and cough, while pt coughs, pull tube 6. oxygenate and humidify 7. Assess and Reassess
38
Common complications of extubating and treatment
Glottic edema & Stridor Tx= racemic epinephrine
39
Major but Rare complications of Extubating and treatment
Laryngospasms Tx= oxygenate and positive pressure
40
6 Rare complications of extubating
1. Laryngeal lesions 2. stenosis 3. vocal cord paralysis 4. ulcerations 5. tracheoesophageal fistula 6. tracheoinominate artery fistula (can be life threatening)

Intro to Respiratory Medicine (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions