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Respiratory Care Seminar‼️ > Ch. 5: Special Respiratory Care Procedures > Flashcards

Ch. 5: Special Respiratory Care Procedures Flashcards

1
Q

What does this describe?

A technique for assessing and examining the bronchi by means of a bronchoscope, which is used for diagnostic and therapeutic purposes.

A

Bronchoscopy

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2
Q

What type of brochoscope is this?

Consists of a collection of thin, threadlike glass strands with a light source projected to its distal end for visualization.

A

Fiberoptic bronchoscope

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3
Q

How do you prepare for a fiberoptic bronchoscopy?

A

Mild sedative 1-2 hours before procedure. This level of sedation is called conscious sedation.

Diazepam (Valium) and Midazolam (Versed) commonly used.

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4
Q

During a fiberoptic bronchoscopy, the airway must be dry to help with visualization. What would help with this?

A

Atropine 1-2 hours before procedure

Atropine will also help with vagal tone (reduced risk of bradycardia and hypotension)

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5
Q

Fiberoptic Bronchoscopy

The tube can be inserted orally, nasally, or through an ET tube. The bronchoscopic tube should be lubricated with a water-soluble jelly for easier nasal insertion. What is often used as a lubricant and an anesthetic?

A

2% Lidocaine (Xylocaine)

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6
Q

The dose of lidocaine should be limited to ____________ in adults to help avoid methemoglobinemia.

a blood disorder where an abnormal amount of methemoglobin is produced

A

5-7 mg/kg

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7
Q

What are a few indications for bronchoscopy?

A
  • Removal of foreign bodies
  • Removal of mucus plugs and thickk secretions
  • Atelectasis that affects lobe or entire lung
  • Pulmonary hemorrhage
  • Suspected tumors
  • Sputum culture
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8
Q

How would you fix/prevent the following complication of bronchoscopy?

Hypoxemia

A
  • Monitor saturation during procedure
  • Increase O2 percentage during procedure
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9
Q

How would you fix the following complication of bronchoscopy?

Laryngospasm

Makes advancing the tube more difficult

A

Bronchodilator should be readily available

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10
Q

How would you fix the following complication of bronchoscopy?

Bronchospasm

Results from irritation of the airway

A

Bronchodilator should be readily available

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11
Q

How would you fix the following complication of bronchoscopy?

Arrhythmias

Results from vagal stimulation

A

Monitor ECG and remove bronchoscope until cardiac status is stabilized

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12
Q

How would you fix the following complication of bronchoscopy?

Hemorrhage

May occur during insertion or after biopsy

A

Direct instillation of epinephrine, racemic epinephrine or cold saline will help stop the bleeding

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13
Q

How would you fix the following complication of bronchoscopy?

Respiratory depression

Results from sedatives given before procedure

A
  • Monitor respiratory status closely
  • Flumazenil, reversal agent for Versed, should be given
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14
Q

The Center of Disease Control and Prevention recommends that bronchoscopes be sterilized by immersoin in glutaraldehyde (Cidex) for ______ hours.

A

3-10 hours

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15
Q

What type of specialized bronchoscopy is this?

A diagnostic tool that combines conventional bronchoscopy with virtual bronchoscopy and allows for bronchoscopic instruments to reach peripheral lung areas that traditional fiberoptic bronchoscopes cannot reach.

A

Electromagnetic navigational bronchoscopy (ENB)

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16
Q

What type of specialized bronchoscopy is this?

A bronchoscope with an ultrasound attached to the distal end. A video camera allows visualization for guidance of a needle to sample tissue from the mediastinum and peripheral lung areas where traditional bronchoscopy cannot reach.

A

Endobronchial Ultrasound (EBUS)

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17
Q

What type of specialized bronchoscopy is this?

______ can successfully diagnose 75-77% of peripheral lung lesions where traditional fiberoptic bronchoscopy biopsies are unsucsessful.

A

Electromagnetic navigational bronchoscopy (ENB)

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18
Q

When is bronchoalveolar lavage contraindicated?

A
  • Hypoxemic patients
  • Reduced pulmonary lung function
  • Severe cardiovascular disease
  • Serious electrolyte abnormalities
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19
Q

Bronchoalvelar lavage is the instillation of ____ mL of normal saline through the bronchoscope’s suction channel to the affected area.

A

100

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20
Q

Bronchalveolar Lavage

The tip of the scope is positioned into a ________________-generation bronchus and the saline instilled in 20-mL increments five seperate times.

A

fourth

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21
Q

Electromagnetic navigational bronchoscopy (ENB)

A pmeumothorax is a complication in approximately _______% patients.

A

3.5

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22
Q

Endobronchial Ultrasound (EBUS)

What are complications of Endobronchial Ultrasound (EBUS)? (3)

A
  • Pneumothorax
  • Pneumomediastinum
  • Bacteremia
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23
Q

Which bronchoscopic technique is more accurate for diagnosing lung tumors (apporoximately 98%) than positron-emission tomography or CT scans?

A

Endobronchial Ultrasound (EBUS)

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24
Q

A software program creates a 3-dimensional virtual bronchial tree that is aligned with the patient’s bronchial anatomy, which is obtained from a CT scan performed before ________. The locatable guide is then navigated to the point of the lesion where a biopsy can be obtained with a brush, forceps or needle.

A

Electromagnetic navigational bronchoscopy (ENB)

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25
Q

____________ are used to drain substances that accumulate in the pleural space.

A

Chest tubes

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26
Q

What is this called?

Air in the plerual space

A

Pneumothorax

27
Q

What is this called?

Blood in the pleural space

A

Hemothorax

28
Q

What is this called?

Lymph in the pleural space

A

Chylothorax

29
Q

What is this called?

Serous fluid in the pleural space

A

Pleural effusion

30
Q

What is this called?

Pus in the pleural space

A

Pyothorax or Empyema

31
Q

To help remove air from the pleural space, the chest tube is inserted into which intercostal space?

A

Second, third or fourth intercostal space

32
Q

To help remove fluid from the pleural space, the chest tube is inserted into which intercostal space?

A

Sixth or seventh intercostal space

33
Q

What is the most common chest tube drainage sytem?

A

A plastic three-chambered sysetem (Pleur-evac)

34
Q

The water level in the water-seal bottle fluctuates with changes in pleural pressure that occur with normal breathing. This is referred to as ____________.

A

Tidaling

35
Q

If no fluctuation is occuring in the water-seal bottle, what should be suspected?

A

Obstruction of the tube

36
Q

What should happen if an air leak is suspected in a chest tube?

A

Chest tube should be clamped to identify the source of the leak

37
Q

Obstructed chest tubes may result in a ____________.

A

Tension pneumothorax

38
Q

Just something to know.

Chest tubes are sutured in, and the insertion distance should be moniored daily to ensure that the tube is not migrating outward.

A

…

39
Q

Chest tube drainage systems

Explain a one-bottle system.

A

Fluid/air drains from pleural space through the chest tube and enters through a glass tube , which is submerged under water. This forms a seal that acts as a one-way valve to prevent air from entering the pleural cavity.

The one-bottle set up is both a water-seal container and a collection container.

40
Q

Chest tube drainage systems

Explain a two-bottle system.

A

A second bottle is added to collect air. The bottle closest to the patient collects drainage while the second bottle provides the water seal.

The purpose is to better control the amount of suction applied.

41
Q

Chest tube drainage systems

Explain a three-bottle system.

A

Third bottle may be added to determine the amount of subatmospheric pressure in the water-seal bottle. The amount of suction is determined by how far under the water the tube is

42
Q

Chest tubes may become obstructed as a result of blood clots or kinks in the tube itself. Obstructed chest tubes may result in a _________.

A

Tension pneumothorax

43
Q

Occasional, excessive or persistent bubbling in the water-seal bottle indicates ______.

A

Air leaks in the system or patient

THE GLASS TUBE MUST ALWAY BE SUBMERGED UNDER WATER.

44
Q

The absence of bubbling indicates that ______.

A

No air is being removed from the pleural space, which is a sign of patient improvement

45
Q

____ is required when changing drainage bottles but must be done with caution in patients with pleural air leaks because a tension pneumothorax may result.

A

Clamping of the tube

46
Q

CHEST TUBES

After the lung reexpands, the chest tube should remain in place for another ____.

A

1-2 days

After tube is removed, cover w/ sterile petroleum jelly to prevent air from entering the pleural space.

47
Q

What is a thoracentesis?

A

Withdraw of pleural fluid from the pleural space

48
Q

What is a pleurodesis?

A

Instilling sclerosing agents such as talc, bleomycin, doxycycline, povidone iodine or quinacrine into the pleural space resulting in inflammation causing the parietal and visceral layers to stick together, preventing air or fluids from entering the pleural space.

49
Q

List some complications of a thoracentesis. (4)

A
  • Bleeding
  • Infection
  • Pneumothorax
  • Pulmonary edema (caused by removing fluid too quickly)
50
Q

Which diagnostic imaging study is used to detect DVT?

A

Ultrasonography

51
Q

Which diagnostic imaging study is used guide the placement of arterial and central catheters?

A

Ultrasonography

52
Q

Thoracentesis indications

A
  • Identify cells in the fluid
  • Tissue samples from the lining of the chest wall to diagnose cancer
  • Relieve SOB or pain from large effusion
  • Remove air from pleural space
  • Instill medication directly to aid in treatment of cancer
53
Q

What is typically used to precisely locate the area of fluid, usually between the fifth and sixth rib?

A
  • Chest X-ray
  • CT scan
  • Ultrasonography
54
Q

Thoracentesis

This procedure is performed with the patient in what position?

A

Sitting position and leaning forward

55
Q

Thoracentesis

A local anesthetic such as lidocaine is injected used a 25-to 27-gauge needle. The MD then inserts what size needle to remove the fluid?

A

16-to 20-gauge needle or needle-catheter that is connected to a 3-way stopcock

56
Q

Diagonostic Imaging Studies

An image modality used to gain significant information about the thorax that conventional chest- radiograph cannot.

A

Computed Tomography (CT)

MRI is also useful in providing accurate details about the thorax.

57
Q

Diagonostic Imaging Studies

________ provides three-dimensional images of the thorax and is more accurate than V/Q scanning in the diagnosis of pulmonary embolism.

A

Computed Tomography (CT)

58
Q

What are some disadvantages of MRI?

A
  • Limited patient monitoring
  • Motion artifact caused by respiratory and cardiac motion can obscure images
  • Contraindicated in patients with pacemakers
  • Due to strength of MR magnets, most vents can’t be used near an MRI

Patient may need to be manually ventilated during procedure

59
Q

____ can distinguish between malignant and benign tumor and often detects tumors that are not easily recognized on CT.

A

PET scan

60
Q

A noninvasive method of obtaining data on cardiac performance.

A

Echocardiography

Sometimes referred to as transthoracic echocardioraphy.

61
Q

_______ is used to diagnose patent ductus arteriosus in neonates.

A

Echocardiography

62
Q

When a patient is being ventilated and they have a chest tube, light bubbling occurs during _________.

A

Inspiration

Know that light bubbling is okay

63
Q

Suspection of AIR LEAKS
If you still have bubbling when you clamp the chest tube, what should be done?

A

Whole system must be changed

64
Q

Suspection of AIR LEAKS
If you don’t have bubbling after you clamp the chest tube, what does this mean?

A

Check patient connection - Leak in the system or pulmonary air leak

Respiratory Care Seminar‼️ (19 decks)

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