Chapter 5 Flashcards
Special resp. care procedures
List 5 indications for bronchoscopy?
- Removal of foreign bodies
- Removal of mucous plugs
- Atelectasis that affects a lobe or entire
lung - Pulmonary hemorrhage
- When tracheal intubation is difficult as a
result of upper airway trauma, obesity,
tumors, or spinal deformity.
List 8 complications of bronchoscopy
- Hypoxemia
- Laryngospasm
- Brochospasm
- Arrythmias
- Hemorrhage
- Respiratory depression
- Hypotension
- Pneumothorax
Name 1 medication that is used to achieve
conscious sedation before surgery?
Versed
What is the purpose of administering atropine
before a bronchoscopy?
To dry out the airway to aid in visualization
during the procedure.
How should the bronchoscope be cleaned after
the procedure?
Sterilized in Cidex for 3-10 hours
What is the purpose of inserting a chest tube?
To drain substances that accumulate in the
pleural space.
If the water in the water seal bottle is not
fluctuating, what should be suspected?
Obstruction of the tube
If a chest tube becomes obstructed what may
occur?
Tension pneumothorax
If an air leak from a chest tube is suspected,
what should be done first?
Chest tube should be clamped to identify the
source of the leak.
How much negative pressure is generally
required to help evacuate fluid from the pleural
space?
-20 cmH2O
Which of the following diagnostic techniques is
utilized to obtain biopsies for peripheral lung
lesions.
Electromagnetic navigational bronchoscopy
(ENB)
Which of the diagnostic technique is often used
to detect a DVT?
Ultrasound
What size needle is used to perform a
thoracentesis?
25-27 (for lidocaine)
16-20 (for procedure)
What is another medication used for a
conscious sedation?
Valium
Lidocaine can be used as what 2 things?
Lubricant & anesthetic
What are some complications of bronchoscopy?
- Hypoxemia
- Laryngospasm
- Arrhythmias
- Hemorrhage
- Respiratory depression
- Hypotension
- Pneumothorax
What are the responsibilities of the therapist
before bronchoscopy?
- Prepare patient and explain procedure
- Administer aerosolized local anesthetic to
patients upper airway - Conduct patient monitoring throughout
procedure - Collect sputum sample and tissue samples
that the physician has obtained and
prepare them for laboratory analysis - Clean the bronchoscope properly after the
procedure
ENB can successfully diagnose of
peripheral lesions
75-77%
A pneumothorax is a complication in
approximately of patients?
3.5%
EBUS is a technique that is much more accurate
for the diagnosis of ?
Lung tumors (approximately 98%)
Complications of EBUS include?
pneumothorax
pneumomediastinum
bacteremia
What is BAL?
Approximately 100mL of normal saline through
the bronchscope’s suction channel to the
affected area.
The tip of the bronchoscope is positioned into a
and the saline instilled in five
separate times.
Fourth generation bronchus; 20mL increments
BAL is contradicted in?
Hypoxemic patients
patients with reduced pulmonary function
patients with cardiovascular disease
patients with serious electrolyte abnormalities
To help evacuate air (pneumothorax) from the
pleural space, the chest tube is usually inserted
where?
Second, third, or fourth intercostal space
To remove fluid the tube is placed where?
sixth or seventh intercostal space
what is the one bottle set up?
The bottle is both a water seal container and a
collection container.
What is the two bottle system?
The bottle closest to the patient collects the
drainage, while the second bottle provides the
water seal.
What is a three bottle system?
A suction source may be attached to the vent of
the third bottle to maintain a desire, constant
pressure
What is the most common chest tube drainage
system?
The three chambered system
What is tidaling?
The water level in the water seal bottle fluctuates
with changes in pleural pressure that occur with
normal breathing.
What can obstruct a chest tube?
Blood clots or kinks
Occasional excessive or persistent bubbling in
the water seal bottle indicates what?
Air leaks in the system or patient
The absence of bubbling indicates what?
What is this a sign of?
No air being removed from the plural space
Patient improvement
Clamping of the tube must be done with caution
in patients with plural air leaks because what
can occur?
Tension pneumothorax
What are some complications of a
thoracentesis?
bleeding
Infection
Pneumothorax
Pulmonary edema (caused by removing fluid
too quickly?
CT scan is used to detect what?
Bony abnormalities
Soft tissue abnormalities
Pleural abnormalities
Parenchymal lung disease
Pulmonary embolism
Aortic dissection
MRI is used to detect what?
soft tissue abnormality
Bone marrow pathology
Plerual disease
Diaphragmatic disease
Mediastinal abnormalities
Congenital heart disease
What are some disadvantages of MRI?
- Motion artifact caused by respiratory and
cardiac motion that can obscure images - Contraindicated in patients with
pacemakers - Because of the strength of the MRI
magnets, most ventilators cannot be used
near an MRI
