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236 spring 14 > gary test 1 > Flashcards

gary test 1 Flashcards

1
Q

maximum inspiratory pressure normal/critical value

A
  • 100 - -30

- 20 - 0 (critical)

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2
Q

maximum expiratory pressure normal/critical value

A

100

less than 40

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3
Q

vc - normal/critical

A

65-75

less than 10-15

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4
Q

vt normal/critical

A

5-8

less than 5

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5
Q

fev1 normal/critical

A

50-60

less than 10

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6
Q

pefr normal/critical

A

150-600

75-100

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7
Q

when do you stop MIP test

A

distress, dysrhythmia, hemodynamic instability

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8
Q

what is mip

A

lowest pressure generated during a forceful inspiratory effort against an occluded airway

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9
Q

when is mip values most accurate

A

when it is measured from residual volume

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10
Q

what are the 3 electrodes

A

positive, negative, ground

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11
Q

what is the name of the recording equipment for ecgs

A

oscilloscope

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12
Q

what produces an electrical current of the heart muscles

A

contraction of heart muscles

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13
Q

how does the current travel through the heart

A

in a wave from base to apex

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14
Q

what is the natural direction of the wave of the current called

A

a vector

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15
Q

where does the vector travel to and from

A

atria to ventricle

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16
Q

what is the key electrode

A

positive electrode

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17
Q

if the current is heading towards the positive electrode what type of deflection is seen on the oscilloscope

A

upward deflection

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18
Q

if the current is heading away from the positive electrode what type of deflection is seen on the oscilloscope

A

downward deflection

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19
Q

what are leads

A

electrodes arranged in patterns

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20
Q

why are there more than one pattern

A

bc different patterns give different views of the hearts activities

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21
Q

what do different views add to diagnostically

A

the accuracy of diagnosing the heart disease

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22
Q

what are the 3 lead categories

A

limb leads, augmented leads, precordial leads

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23
Q

where do the limb leads go

A

lead 1 - right arm negative, left arm positive
lead 2 - right arm negative, left leg positive
lead 3 - left arm negative, left leg positive

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24
Q

what do all the limb leads to

A

einthoven triangle

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25
Q

how are augmented leads created

A

by making a single limb positive and all other limbs negative

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26
Q

why are augmented leads augmented

A

bc the weak electrical signal must be amplified

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27
Q

what do the augmented leads represent

A

vectors / views of the heart

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28
Q

where are AVR leads located

A

right arm positive

left arm/left leg negative

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29
Q

where are AVL leads located

A

right arm/left leg negative

left arm postiive

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30
Q

where are AVF leads located

A

right/left arm negative

left leg postive

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31
Q

how many views do precordial or chest leads have

A

6 extra views of the hearts electrical activity

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32
Q

do chest leads improve diagnostic accuracy

A

yes

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33
Q

what type of disease does it help pinpoint

A

myocardial infarction

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34
Q

what type of view of the heart do limb leads offer

A

vertical view

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35
Q

what type of view of the heart do chest leads offer

A

horizontal view

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36
Q

where do V1 leads go

A

4th intercostal space, on the right side of sternum

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37
Q

where do V2 leads go

A

4th intercostal space, left side of sternum

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38
Q

where is V4 lead go

A

5th intercostal space in midclavicular line

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39
Q

where does V3 lead go

A

in between v2/v4

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40
Q

where does v6 lead go

A

5th intercostal space in the midaxillary line

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41
Q

where does v5 lead go

A

in between v4/v6

42
Q

how do you avoid artifacts

A

careful patient preparation

43
Q

what if there is a 60hz electrical artifact

A

change electrical outlets

44
Q

what causes artifacts

A

friction of electrode wires with sheets and bed rails, loose connections, muscle movement

45
Q

what color is a ground lead

A

green

46
Q

what color is a negative lead

A

white

47
Q

what color is a positive lead

A

red or black

48
Q

what do electrical cells in the heart do

A

initiate and conduct impulses

49
Q

what do mechanical cells in the heart do

A

contract in response to electrical stimulation and provide pumping action

50
Q

what is the electrical impulse from

A

result of the cells chemically changing

51
Q

where does the chemical change of cells come from

A

sodium potassium pump at cellular level

52
Q

what makes the heart automatic

A

cellular ability to repeat impulse without an external signal

53
Q

what is the conducting system

A

conducting/electrical cells that are arranged in a specific path that control the flow of electrical implulses from the atria to the ventricles in a coordinated fashion

54
Q

what does the picture look like of resting or polarized state

A

the negative cells are in the cardiac cell with lots of dots in the middle, and positive cells are outside of wall

55
Q

what does depolarization picture look like

A

positive cells are inside of wall, no dots, negative cells are outside of wall

56
Q

what is the dominant controller or pacemaker of the conduction system

A

sa node

57
Q

what does the pacemaker do

A

rhythmically repeats electrical impulses that travel down the conducting system

58
Q

what is the polarization state

A

ready state - sodium is outside cell potassium is inside cell

59
Q

what is the discharge state

A

depolarization state - sodium and potassium are uniting and switching spots

60
Q

what is Repolarization state

A

recovery state - potassium is outside of cell, and sodium is inside of cell

61
Q

what is the inherent rate of the sa node

A

60-100

62
Q

what is the inherent rate of the av junction

A

40-60

63
Q

what is the inherent rate of purkinje fibers

A

20-40

64
Q

what happens if the dominant pacemaker fails

A

the next one in line will take over av junction then purkinje fibers, and they will pace the heart at their inherent rate

65
Q

are all heart cells subject to the irritability mechanism

A

yes

66
Q

what is the irritability mechanism

A

clump of heart cells that can take over and become the pacemaker

67
Q

what does the parasympathetic system take influence over and decrease

A

decreases irritability, decreases heart rate, decreases force of contraction

68
Q

which system is the heart influenced by

A

autonomic nervous system

69
Q

what must happen before contraction of the heart

A

electrical stimulation

70
Q

can electrical activity occur w/o mechanical contraction

A

yes

71
Q

how do you study mechanical contraction

A

pulse, blood pressure, cardiac output

72
Q

how do you study electrical activity

A

ECG

73
Q

what does the sympathetic system do to the heart

A

directly influences every heart cell, the av node, sa node, and it increases irritability, increases rate, and increases force of contraction

74
Q

what does NIV encompasses both?

A

ventilation and cpap

75
Q

what is the pneumobelt

A

pts in wheelchairs like it and it pushes up and down on abdomen forcing exhalation and inhalation is passive

76
Q

what are the goal of ppv

A 
avoid intubation
improve mortality
decreases VAP
relieve symptoms
enhance gas exchange
improves patient/ventilator synchroniztion
patient comfort
decrease length of stay on vent/hospitilaztion
77
Q

what is the primary indication for niv

A

hypercapnic respiratory failure due to cold

its the first line therapy for acute exacerbation

78
Q

asthma and niv

A

some evidence of positive results use remains controversial

79
Q

acute cardiogenic pulmonary edema and niv

A

cPap == first line of defense

80
Q

if NIV is not working w/in 1-2 hours what should u do

A

intubate

81
Q

in community acquired pneumonia how does niv help

A

only helps copd patients who get it

82
Q

should u use NIV for weaning

A

only for cold/chf patients, all other patients who used NIV instead of reintubation got worse

83
Q

when can u use NIV for DNI patients

A

only if it makes them more comfortable or managing reversible disorder

84
Q

how does NIV help for nocturnal hypoventilaion

A

resting muscles, lowering co2, and improved compliance, frc, and deadspace

85
Q

is niv indicated for patients with restrictive thoracic diseases like kypho or polio

A

yes

86
Q

when is NIV used for copd patients at home

A

severe patients with at least one of the following: co2 greater than 55, or co2 less than 55 with nocturnal desating, and 2 hospital admissions for vent failure

87
Q

what is the first line of therapy for nocturnal hypoventilation

A

nasal cpap

88
Q

what types of diseases are associated with nocturnal hypoventilation

A

sleep apnea and lung parenchymal diseases

89
Q

when is nppv recommend for nocturnal hypoventilation

A

when cpap doesn’t work

90
Q

when does exclusion of NPPV occur

A

when ventilatory assistance has been established

91
Q

when is selection of NPPV happen

A

when signs and symptoms of resp, distress occur

92
Q

what are most common types of patient interfaces

A

nasal mask, full face mask, mouth piece

93
Q

what are the least common types of patient interfaces

A

total face mask, nasal pillows, helmet

94
Q

what is the interface of choice for patients in acute resp failure

A

full face mask

95
Q

are they designed to work with leaks

A

yes small leaks that they compensate for

96
Q

what are typical modes of NPPV

A

cpap, psv, p-a/c

97
Q

what do they do less of than icu vents

A

generate lower rates, pressures, and flows

98
Q

what happens with critical care vents used as a bipap

A

they can’t compensate for leaks, so u should use a full face mask to minimize leaks

99
Q

what aren’t vc modes recommended

A

lead to leaks and hypoventilation

100
Q

what are major complications of NPPV

A

aspiration, hypotenstion, pneumothorax

101
Q

causes of nppv failure

A 
mask related problems
flow related problems
large air leaks
patient/vent asynchrony
lack of improvement of ABGS
102
Q

what is success of NPPV closely linked with

A

RT to take time to give proper mask fitting, application, adjustment of settings, and patient education

236 spring 14 (13 decks)

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