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Principles and Practices of Resp II > Final > Flashcards

Final Flashcards

1
Q

Bronchial hygiene outcomes

A
  1. Increase aeration
  2. To clear and thin sputum
  3. CXR- Residue of consolidation (white now)
  4. Improved SpO2 with less O2
  5. ABG normalized
  6. Vitals and labs- Trend toward norm or resolve
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2
Q

Hydrated sputum=

A

thin and clear

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3
Q

Flutter Valve- PEP device

A
  • Gravity Dependent (must remain upright, have pt sitting up)
  • Start with flutter horizontal with floor (Up-increases frequency, down- decreases)
  • Creates PEP and Oscillation
  • Oscillation Frequencies are b/w 2-32hz
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4
Q

Hz

A

measurements of cycles in seconds, know: 0-30 hz

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5
Q

EzPAP

A

-Positive airway pressure is created with flow/ 50psi gas source
-Parts:
A: ambient air inlet
B: Gas inlet port
C: Pressure monitoring port with cap (cap if not monitoring)
-Can use with a mask (create a seal)
-Able to deliver a neb tx
-EzPAP flow setting is norm 5-7lpm
-Therapeutic PAP pressures are 10-20cmH2O
NO BREATH HOLD-CONTINUOUS PRESSURE

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6
Q

Acapella

A
  • Can be used in any position, with mask
  • Can deliver a neb treatment
  • Produces PEP with oscillation (breath hold)
  • Active exhalation for 1:3 or 1:4 ratio
  • Oscillation frequencies produced 0-30Hz

-Adjustable: increasing the frequency (+) increases the PEP pressure which can be measured with pressure manometer

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7
Q

TheraPEP

A
  • Exhaling actively but not foreful
  • Therapeutic pressures 10-20cmH20 are indicated between lines
  • Resistance can be increased or decreased
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8
Q

Metaneb

A
  • Can use on vent
  • CHFO: continuous high frequency oscillation
  • CPEP: continuous positive exp pressure
  • Blue ring= changes resistance
  • Black ring= used when delivering therapy through vent (covers resistance holes)
  • Requires special circuit and adaptors
  • Therapy can be delivered through: mouthpiece, mask, trach, and in line with vent circuit
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9
Q

Fitting the vest

A

a. Full vest- Top of the hipbone snug without being restricted
b. Wrap!!- fasten to pt during deep inspiration , snug without restriction, disposable
c. Chest vest- inhale deeply and secure flaps to the front under the arm

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10
Q

Generic settings of vest

A

-10-30 min treatments
-Frequency- 10-14Hz
-Pressure: 1-4 for the front vest/ 5-6 for the full vest
DONT NEED TO DO POSTURAL DRAINAGE

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11
Q

How does HFCWO work

A

Changes intrapulmonary pressures

-Oscillates air through the lungs/ mucus moves secretion out on exhalation

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12
Q

Cough Assist

A
  • Delivers a positive pressure to assist with a deep breath (produces an effective cough)
  • Insp pressures: 25-32cmH2O for 1 to 2 seconds followed by
  • Expiratory Vacuum Pressure: -30 to -40 cmH2O for 1 to 2 seconds (this cycle mimics a cough by pulling the air out of the airways)
  • Perform 5 cycle breaths followed by normal breathing for 30 seconds, repeat until secretions are cleared
  • It is also known as insufflation (inspiration)/ Exsufflation (expiration)
  • Can be used with trach tube, mouthpiece, or mask
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13
Q

Postural Drainage

A
  • Each position is held for 5-10 minutes
  • Total treatment time 20-30 minutes up to an hour
  • Head down positions should exceed 25 degrees below horizontal
  • Must have adequate hydration for secretion mobility
  • Avoid strenuous coughing
  • Usually performed with percussion and vibration
  • Return pt to original resting position
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14
Q

During an intubation attempt, what two landmarks should you see as you advance the laryngoscope

A

Arytenoid cartilage, Epiglottis

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15
Q

Term intubation

A

passing of a tube into a body apature (vocal cords)

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16
Q

What size blades is/ are used to intubate an adult pt

A

3 and 4

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17
Q

What are two different laryngoscope blades and how are they used to visualize the vocal cords

A
  • Miller: Directly lifts the epiglottis in order to visualize the vocal cords
  • Macintosh: inserted into the vallecula, which is the space between the epiglottis and the tongue, indirectly lifts epiglottis
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18
Q

When is placing an artificial airway (intubation) contraindicated

A

Pt is DNI

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19
Q

What is the norm range for cuff pressure? what are you trying to prevent

A

20-30cmH2O- minimize aspiration, avoid cutting off blood supply

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20
Q

Can you intubate with a LMA (laryngeal mask airway)

A

no, its above the glottis (not passing through apature)

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21
Q

How much time do you have when attempting to intubate a pt

A

30 seconds

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22
Q

What are the different techniques used to monitor cuff pressure? how are they performed

A
  • Min. Leak technique-check during inspiration
  • MOP/MOV
  • Cuff manometer
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23
Q

What initial FiO2 do we choose on the vent.

A

Whatever patient was on before, safe 60%< and add pressure to improve O2 from there

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24
Q

Vt Range

A

6-8ml/kg

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25
Q

How do we provide humidity and heat to an intubated pt

A

HME-Passive

Heated wire circuit

26
Q

VAP protocol; what can we influence?

A

Keep head elevated 30-45%, Perfrom subglottic suctioning, Keep cuff pressure adequate (20-30cmH2O), methylene blue dye test, Make sure appropriate size tube

27
Q

IBW

A

50+2.3 (PtH x 60)

28
Q

Common vent wean settings

A

Decrease vent: decrease VT, and RR.

-Go from setting volumes and rates to observ- giving O2 support

PEEP +5 , PS 5, FiO2 <50%

29
Q

Spontaneous awake trial (SAT) and spontaneous breathing trial (SBT)

A

SAT- removing sedation
SBT- Readiness to wean, removing/ reducing vent support
do for 2 min- looks good? check pt and do for 2 more hours

30
Q

What is a cuff leak test

A

test airway edema

  • Deflate cuff, few seconds
  • Hear air moving through upper airway (nothing? not able to substain airway)
31
Q

NIF/ VC/ RSBI

A

NIF- diaphragm strength, more neg than -20 (breath/cough)
VC- 1 L for adults or 10ml/kilo (take deep breath=cough)
RSBI- Rapid shallow breathing index < 105

32
Q

What is stridor and how is it treated?

A

Racemic epi or cool aerosol

  • distress
  • 0.5 and 2.5 ml norm saline
33
Q

How to treat resp acidosis

A

Increase ventilation and decrease FiO2

34
Q

Blood gas machine/ analyzer directly measures 3 values, what are they

A

pH
PaCO2
PaO2

35
Q

What part of the blood gas machine will directly measure CoHgb, SaO2, and methemoglobin

A

Co-Oximetry

36
Q

When performing an Allen’s test, why do you release only the ulnar artery

A

Show there is collatural circulation between ulnar and radial artery

37
Q

Suction settings for adults, pediatric, and infants

A

suction for 15 seconds
adult: 120-150
Ped: 100-120
infant: 80-100

38
Q

List two absolute contraindications specific to nasotracheal suctioning

A

Epiglotitis and croup

39
Q

mini-BAL suctioning procedure

A

Collecting sputum sample in intubated pt

“bronchial alveolar lavage”

40
Q

What type of airway can be used on an unconscious pt

A

Oral/ nasopharyngeal

41
Q

What type of airway is mostly used to facilitate suctioning

A

nasal

42
Q

When should you use oral suction, what is the other name for oral suction

A

Removing secretions from pharynx in order to visualize vocal cords during intubation - yankauer

43
Q

How can you collect sputum while suctioning a pt

A

luken trap

44
Q

how do you measure a nasal trumpet? how do you choose correct diameter? how are they labeled for measurement

A

Nose to tragus + 2cm

-Largest diameter that will slide with ease

45
Q

How do you measure an oral airway? what type of pt is this appropriate for

A

Even with pts mouth to the corner of the jaw

-Unconscious patients

46
Q

PEEP valve

A

positive exp pressure placed on exhalaton port on bag valve

  • improves oxygenation by improving pressures in the lungs
  • Absolutely have on when placed on positive pressure on a vent requires a PEEP of 10 on vent
47
Q

VAP protocol- consistent cares

A
  • Elevate head of bed
  • Daily sedation vacation
  • Daily assessment of readiness for extubation
  • Peptic ulcer disease prophylaxis
  • Deep vein thrombosis(thinners)
  • oral care
48
Q

Initial vent settings

A
  • IBW: tidal volume
  • RR: normal
  • Minute ventilation
  • PEEP
  • LPM converted to %
  • I:E ratio
49
Q

Vent settings findings

A 
IBW: 50+2.3(PtH-60)
FiO2: Lpm x 4 = # + 21= %
RR:
PEEP: +5
Vt: (x6-x8 of FiO2)
50
Q

LMA- Laryngeal Mask Airway

A

Above glottis

  • Insirted into the oropharynx, the tip resting at the upper esophageal sphincter
  • used predominantly in surgery
  • Airway is covered in ACLS, an alternative to standart ETT intubation
  • Placed blindly
  • Dont protect from aspiration
51
Q

Two major limitations of LMA

A
  1. Pt must be unconscious
  2. If vent pressures are higher than 20cmH2O then there is a risk of gastric distention
    - Do not protect against aspiration
52
Q

Combitube

A

Blind intubation: landing in either esophagus or trachea

  • 2 lumens: stomach, passively vent lungs
  • Two cuffs: seal oropharynx, esophagus or trachea
53
Q

Special ET tubes

A

Mallinckrodt Hi-Lo Evac ET tube
-Suction lumen above the cuff-continuous suction of 20-30cmH2O
Wire Reinforced ET tube
-Prevent kinking

Carlens Tube

  • Intubate left mainstem
  • hook that is designed to catch the carina

Robertshaw Tube
-Selective for either right or left main stem

Double Lumen

  • For independent lung ventilation
  • Stiffer and bulkier
  • Must be rotated into specific bronchi
  • Ensured placement with bronchoscope
  • Increased resistance because of smaller lumen with each tube

High Frequency Jet ventilation

  • Port that allows injection of high flow
  • port for monitoring pressures
54
Q

Intubation- RSI- Medications

A 
Rapid sequence intubation
Sedative drugs
-Propofol: white , fast acting
-Ketamine
-Etomidate

Paralytic drugs
-Succinylcholine: fast acting
-Rocuronium
(they have no neurological assessment)

55
Q

Cricoid pressure

A
  • Close esophagus off so gastric cant leak into airway (oropharynx)
  • Bring anterior airway into view
  • Apply until tube is in place
56
Q

Laryngoscope blade sizes

A 
00- preemie
0- preemie
1- infant
2- child
3- adult
4-adult
57
Q

ETT sizes

A

infant: 2.5-4.0 mmID (same diameter as pinky)
6mo-3 years: 3.0-5.0mm
5-12 years: 4.5-7.0 mm
16- adult: 6.5-9.0 mm

58
Q

Tube placement- oral intubation

A

Males: between 21-23 cm
Females: between 19-21
Placement 3-5 cm above carina

59
Q

Bedside assessment for correct tube placement

A
  • Listen to bilateral breath sounds: bases first
  • Observe for bilateral chest rise (no rise=rt mainstem)
  • Note tube length- condensation
  • Colorimetry
  • Listen over stomach right away
  • Capnometry(co2 detector)
  • Light wand-stylet(glow in trachea)
  • Fiberoptic laryngoscope/bronchoscope
  • Esophageal detection device (bulb)
  • Order chest xray
60
Q

Thomas tube holder

A

temp hold

-no access to mouth= poor oral care

61
Q

Nasotracheal intubation

A

-Performed blindly or direct visualization
-insertion depth at nare
28cm-hub males
26cm- hub females
-Risk of sinitus

62
Q

Micro aspiration

A

patient aspirating without no one being aware of it

Principles and Practices of Resp II (5 decks)

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