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

Ch. 5 Special Respiratory Care Procedures Flashcards

1
Q

Which of the following are complications associated with bronchoscopy?

  1. Pulmonary hemorrhage
  2. Pneumothorax
  3. Hypoxemia
A

1, 2, and 3

The placing of a bronchoscope into a patient’s airway has several complications, including pulmonary hemorrhage, pneumothorax, hypoxemia, laryngospasm (nonintubated patient), bronchospasm, cardiac arrhythmia, and hypotension.

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2
Q

While assisting with a bronchoscopy you note that the physician is having difficulty entering the trachea this may be the result of which of the following?

A. Pneumothorax
B. Tracheomalacia
C. Laryngospasm
D. pulmonary hemorrhage

A

Laryngospasm

As the physician attempts to advance the bronchoscope tube through the vocal cords in nonintubated patients, the irritation of the tube on the cords can result in laryngospasm, making it difficult to enter the trachea. Do not be fooled on the exam. This is not a concern if the patient is intubated because the bronchoscope tube passes through the ET tube without coming into contact with the vocal cords.

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3
Q

After a bronchoscopy the respiratory therapist notes that is taking more ventilator pressure to ventilate the patient’s lungs than before the procedure. This could be caused by which of the following?

  1. Bronchospasm
  2. Pneumothorax
  3. Hypoxemia
  4. Pulmonary hemorrhage
A

1, 2 and 4

After a bronchoscopy, complications that may have occurred as a result of the procedure that would result in higher ventilator pressures than before the procedure are bronchospasm or pulmonary hemorrhage, which increase airway resistance, and a pneumothorax resulting in decreased lung compliance.

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4
Q

To aid in the evacuation of air from the plural space a chest tube should be inserted at what level?

A. Supraclavicular space
B. Second intercostal space anteriorly at the midclavicular level
C. Sixth intercostal space anteriorly
D. Eight intercostal space anteriorly

A

Second intercostal space anteriorly at the midclavicular level

Because air tends to gravitate upward in the thorax, placing the chest tube in the second intercostal space is indicated. To drain fluid from the pleural space, which tends to gravitate downward, insert the chest tube lower, generally in the sixth or seventh intercostal space.

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5
Q

The RT notices on a patient’s chest tube drainage system that there is fluctuating of the water level in the water seal chamber with each patient breath, and that air bubbles are seen only in the suction control chamber, which has a suction pressure of -20 CMH2O. The most appropriate action is which of the following?

A. clamp the chest tube and check for leaks
B. insert a chest tube farther until bubbling stops in the vacuum chamber
C. Withdraw the chest tube until bubbling starts in the water seal chamber
D. recommend a chest x-ray to determine whether the pneumothorax has resolved

A

Clamp the chest tube and check for leaks

It is normal for the water level in the water-seal chamber to fluctuate as the patient inhales and exhales. Bubbling that occurs only in the suction control chamber under 220 cm H2O pressure—and not in the water-seal chamber—indicates that the pneumothorax is resolving. Intermittent, excessive, or persistent bubbling occurring in the water-seal chamber may be an indication of a leak in the system or that air is still being removed from the pleural space.

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6
Q

Which of the following diagnostic procedures should be recommended to diagnose a peripheral pulmonary lesion?

A. Computed tomography (CT) chest scan
B. Electromagnetic navigational bronchoscopy (ENB)
C. Fiberoptic bronchoscopy
D. Chest xray

A

Electromagnetic navigational bronchoscopy (ENB)

ENB is a much more precise diagnostic procedure to aid in the diagnosis of peripheral pulmonary lesions.

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7
Q

Which of the following medication should be administered before a bronchoscopy to dry out the airway making for better visualization

A. Atropine
B. Lidocaine
C. Lasix
D. Pulmozyme

A

Atropine

Atropine has drying effects to the airway and should be administered before a bronchoscopy. It will also help counteract bradycardia that can often occur as the tube strikes the carina, causing vagal stimulation.

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8
Q

Which of the following should be monitored during a bronchoscopy?

  1. Pulse ox
  2. Capnography
  3. RR
  4. ECG
A

1, 3 and 4

All of these except capnography are routinely moni- tored during a bronchoscopy to monitor the patient for any side effects from the procedure.

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9
Q

Which of the following drugs is commonly used to provide conscious sedation during a bronchoscopy?

A. Midazolam (Versed)
B. Meperdine (Demerol)
C. Morphine sulfate
D. Vecuronium (Norcuron)

A

Midazolam (Versed)

Versed provides for conscious sedation, while meperidine (Demerol) and morphine are narcotic analgesics used for pain management. Vecuronium (Norcuron) is a neuromuscular blocking agent often used to paralyze combative ventilator patients.

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10
Q

During a fibrotic bronchoscopy, the patient’s airway begins to bleed after tissue biopsy. Which of the following should be instilled down the bronchoscope to help stop the bleeding?

A. Cold saline
B. Xylocaine
C. Hypertonic saline
D. Isoproterenol

A

Cold saline

Cold saline, epinephrine, or racemic epinephrine all cause vasoconstriction, which will help relieve bleeding during a bronchoscopy.

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11
Q

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

A

KNOW

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12
Q

Because bronchoscopy is uncomfortable a mild sedative should be administered to the patient 1 to 2 hours before the procedure. What 2 medication’s can be used for this procedure?

A

diazepam (Valium)
misazolam (Versed)

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13
Q

The level of sedation should be just enough to allow the patient to follow commands yet still be comfortable. This is referred to as?

A

conscious sedation

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14
Q

The airway must be dry during the procedure to aid in visualization. This is achieved by administering _________ 1 to 2 hours before the procedure

A

Atropine

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15
Q

Atropine may also decrease

A

vagal tone, resulting in a decreased potential for bradycardia and hypotension

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16
Q

Often 2% _______________ (_____________) jelly is used both as a lubricant and as an anesthetic.

A

lidocaine (Xylocaine)

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17
Q

The dose of lidocaine should be limited to ___ to ___ mg/kg in adults to help avoid ________________________.

A

5 to 7
methemoglobinemia

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18
Q

What are some indications for a bronchoscopy?

A
  • Removal of foreign bodies
  • removal of mucous plugs and thick secretions
  • atelectasis that affects a low or entire lung
  • pulmonary hemorrhage
  • when tracheal intubation is difficult as a result of upper airway trauma, obesity, tumors, or spinal deformity
  • biopsy of suspected tumors
  • when sputum is needed for culture and sensitivity studies
19
Q

What are some complications of bronchoscopy?

A
  • Hypoxemia*
  • Laryngospasm *
  • Bronchospasm
  • Arrhythmias
  • Hemorrhage *
  • Respiratory depression
  • Hypotension
  • Pneumothorax *
20
Q

According to the CDC how should the bronchoscopes be sterilized and properly clean?

A

Immersion in glutaraldehyde (Cidex) for 3 to 10 hours

21
Q

Electromagnectic navigational bronchoscopy (ENB)

A

is a diagnostic tool that combines conventional bronchoscopy with virtual bronchoscopy and that allows bronchoscopic instruments to reach peripheral lung areas that traditional fibrotic bronchoscopes can’t reach

22
Q

ENB uses a software program that create a 3D virtual bronchial tree and that is aligned with the patient’s bronchial anatomy. Can successfully diagnose 75% to 77% of peripheral lesions were traditional fiberoptic bronchoscopy biopsies were unsuccessful

A

KNOW

23
Q

Endobronchial ultrasound (EBUS)

A

Is a bronchoscope with an ultrasound probe attached to the distal end. A video camera allows visualization for guidance of a needle to sample tissues from the mediastinum and peripheral lung areas which traditional bronchoscope can’t reach

24
Q

EBUS technique is much more Accurate for diagnosing…… then PET scan or CT chest scan

A

lung tumors (approximately 98%)

25
Q

Broncoalveolar lavage (BAL) is the

A

Installation of approximately 100 mL of normal saline through the bronchoscope section channel to the affected area. The tip of the scope is positioned into a fourth generation bronchus and the saline instilled in 20 – mL increments five separate times.

26
Q

What are chest tubes used for?

A

To drain substances that accumulate in the pleural space

27
Q

What are substances that may accumulate in the pleural space that require a chest tube? (5)

A

Air: pneumothorax
Blood: Hemothorax
Lymph: chylothorax
Serous fluid: pleural effusion
Pus: pyothorax or empyema

28
Q

To help evacuate air (pneumothorax) from the pleural space, the chest tube is inserted where? ( 3 places)

A

Mid-clavicular
second, third, fourth intercostal

29
Q

To remove fluids, the tube is placed lower, usually in the (2 places)

A

Mid-axillary
sixth or seventh intercostal space

30
Q

What is the most common chest tube drainage system used?

A

Three bottle chamber (Pleur-evac)

31
Q

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

A

tidaling

32
Q

If there’s no fluctuation occurring in the water seal bottle, what is suspected?

A

Obstruction of the tube

33
Q

Chest tubes may become obstructed as a result of what? (2)

A

Blood clots or kinks in the tube itself

34
Q

Obstructed chest tubes may result in a

A

Tension pneumothorax

35
Q

Occasional excessive or persistent bubbling in the water so bottle indicates what?

A

Air leaks in the system or patient

36
Q

The absence of bubbling indicates that no air is being removed from the pleural space, which is a sign of the patient’s improvement.

A

KNOW

37
Q

What should be done if an air leak is suspected?

A

The chest tube should be clamp to identify the source of the leak

38
Q

Define thoracentesis

A

A procedure to withdraw pleural fluid from the pleural space

39
Q

A thoracentesis may be perform as a diagnostic procedure to identify cells present in the fluid to help diagnose the cause of effusion or to obtain tissue samples from the lining of the chest to diagnose cancer.

A

KNOW

40
Q

Thoracentesis may also be done therapeutically to relieve shortness of breath or pain from a large effusion, to remove air from the pleural space, or even to instill medication directly to aid in the treatment of cancer.

A

KNOW

41
Q

A chest x-ray, CT scan, or ultrasonography typically is used to precisely locate the Area of the fluid, usually between the

A

fifth and sixth ribs

42
Q

To perform a thoracentesis a local anesthetic such as lidocaine is injecting using a

The physician that inserts a……. That is connected to a three-way stopcock which is attached to either a large syringe or a vacuum for collection bottle

A

small needle 25- to 27 gauge needle.

large needle 16- to 20 gauge needle or needle- catheter

43
Q

What are some complications of a thoracentesis? (4)

A
  • bleeding
  • infection
  • pneumothorax
  • pulmonary edema

Respiratory Care Seminar (19 decks)

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