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Clinical Instruction (Kass) > Homework > Flashcards

Homework Flashcards

1
Q

After a patient performed an FVC, the therapist performed a validity
check, and noticed that the back extrapolated volume was 175 mLs.
What should the therapist do?

A

Invalidate the test

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2
Q

At the start of a PFT the therapist turns on the PFT machine, but the
machine will not actually turn on. What actions should the therapist
take?

A

The device lacks electrical power.
Confirm device:
Is plugged in
Wire connections are good
Check/replace batteries.

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3
Q

Then the portable spirometer turns on but does not complete or fails
the power-on self-test. What actions should the therapist take?

A

failure of boot/start-up program or central processing unit
failure.
Record error message.
Turn device off, wait 20 seconds, turn device on.
Replace device

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4
Q

During the 3 L volume calibration the portable spirometer reads 3.12
L? What actions should the therapist take?

A

(3090 L is the acceptable high for calibration)
Check temp/press of altitude input
Check/fix flow sensor assembly
Check flow sensor for obstructions

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5
Q

At the start of the PFT the therapist notices that volume accumulated
before the exhalation. What should the therapist do?

A

Have patient hold the sensor steady at the beginning of the test, or set
it on the table

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6
Q

What should the therapist do if the flow measures appear to be
reversed in the PFT results?

A

The flow sensor for the inlet and outlet pressure tubing is
reversed.
Check/correct and confirm proper tubing placement

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7
Q

The spirometer did not sense the beginning of exhalation, what should the therapist do?

A

Check the sensor for damage and the sensor pressure tubing assembly and connections. Confirm correct tubing connections and/or replace
sensor.

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8
Q

The therapist suspects a low volume reading on a PFT what should be
done?

A

Recalibrate the PFT machine
Check the temperature
Pressure, or altitude inputs
Check the flow sensor for damage, reassemble/replace, check for leaks
in the tubing
Use nose clips
Ensure lip seal

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9
Q

if the therapist suspects high or low percent normal computations for
a PFT what should be done?

A

Check patient data entry (age, height, gender)
Reenter correct patient data

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10
Q

A patient has a PFT. The first FVC is 4.32 L. The second FVC is
4.6 L. What should the therapist do?

A

The therapist should do up to 8 tests until the patient tires or the 2
largest values are between 0.150 L

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11
Q

What does a peak flow device measure?

A

Flow (obstruction)

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12
Q

What type of patient most commonly utilizes a peak flow device?

A

Asthma patients

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13
Q

How are normal values established for peak flow devices?

A

The patient uses the peak flow meter 1 to 2 times/day.
Establishes their own normal

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14
Q

What is the green zone?

A

80% to 100 % of patient’s normal.
Patient is doing well

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15
Q

What is the yellow zone?

A

50 to 80% of patient’s normal.
May need to increase medications, call DR.

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16
Q

What is the red zone?

A

Less than 50% of patient’s normal.
Go to the hospital!

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17
Q

Define forced vital capacity (FVC).

A

Volume of air exhaled after a maximum inhalation.

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18
Q

What does the FVC measure?

A

Capacity or volume.

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19
Q

What does a low forced vital capacity mean?

A

Patient is restricted

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20
Q

Explain why the FVC is important when determining obstruction

A

If the FVC is low the patient may not look obstructed.
If the FVC is high the patient may look obstructed, but is not
obstructed. The FVC and the FEV1 need to be compared

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21
Q

define functional residual capacity (FRC

A

The volume of gas remaining in the lungs at the end of a resting
exhalation.

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22
Q

Define residual volume (RV

A

The volume of gas remaining after at the end of a resting
exhalation

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23
Q

Define forced expiratory volume (FEV1):

A

Volume of air exhaled in the first second of exhalation

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24
Q

What does the FEV1 measure?

A

Flow L/sec

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25
Q

What does a low FEV1 mean?

A

large amount of Obstruction. Patients cannot move air out of the
lungs, which makes it hard to get air into the lungs.

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26
Q

List possible ways to fix missed triggering

A

increase sensitivity
Increase PEEP if there is auto-PEEP

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27
Q

List 3 possible ways to fix air trapping

A

Increase PEEP
Decrease respiratory rate
Decrease inspiratory time

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28
Q

List possible ways to fix a rise or slope problem

A
  1. Decrease inspiratory time
  2. Increase the rise time
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29
Q

List possible ways to fix a prolonged inspiratory phase problem:

A
  1. Decrease the inspiratory time
  2. Change the cycle time
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30
Q

List possible ways to fix “Beaking”

A
  1. Decrease PEEP
  2. Decrease PIP
  3. Decrease tidal volume
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31
Q

A therapist enters a patient room, and the ventilator is emitting a low
volume and a low-pressure alarm. What actions should the therapist
take?

A

Check ETT placement
Check for disconnections and/or loose connections in ventilator tubing

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32
Q

A therapist enters a patient room, and the ventilator is emitting a low
volume and a high-pressure alarm. What actions should the therapist
take?

A

Check to see if the patient needs suctioning
Water in the ventilator tubing
Check for a decrease in patient compliance (change to a pressure
mode)

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33
Q

A therapist enters a patient room, the ventilator is emitting a low
volume and a low minute volume alarm on a spontaneous mode.
What actions should the therapist take?

A

Assess the patient for distress
Check minute ventilation and respiratory rate
Check ETT placement
Check for disconnections and/or loose connections in ventilator tubing
If patient is distressed, change to a more supportive mode

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34
Q

A therapist enters a patient room, the ventilator is emitting a high-
respiratory rate and a high minute ventilation alarm on a spontaneous
mode. What actions should the therapist take?

A

Assess the patient for distress
Check minute ventilation and respiratory rate
If patient is distressed, change to a more supportive mode.

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35
Q

The ventilator heater is alarming. What actions should the therapist
take

A

Check the water level in the humidifier (add sterile water if needed)
Check the temperature reading
Check the temperature probe
Check for water in the ventilator tubing

36
Q

A patient on a ventilator is on a heated Passover humidifier. There
is water bubbling in the circuit tubing. What actions could a
therapist take?

A

Empty the water from the tubing
Turn the heater down if above 35 degrees C

37
Q

The humidifier pop-off sounds on the bubble bottle. What actions
could a therapist take?

A

remove from the patient’s nose
Find the obstruction in the cannula

38
Q

A patient on a ventilator is on a heat and moisture exchanger
(HME). The positive inspiratory pressure (PIP) is increased. What
actions could a therapist take?

A

Change the HME

39
Q

A patient on a ventilator is on a heated Passover humidifier. The
airway temperature is too low. What actions could a therapist take?

A

Refill reservoir
Cover the temperature probe
Reset thermostat to 34 to 41 degrees C

40
Q

A patient on a ventilator is on a heat and moisture exchanger (HME).
The patient has profuse or viscous secretions. What action could a
therapist take?

A

Change to a heated, humidified system

41
Q

List 4 factors of low flow devices which that increase the FiO2

A

Flow
Reservoir
No leak from device
Valves

42
Q

What patients’ breathing patterns (inspiratory flow, tidal volume,
respiratory rate, minute ventilation) decrease the FiO2 in low flow
devices?

A

Increased inspiratory flow
Increased tidal volume
Increased rate
Increased minute ventilation

43
Q

A patient states that there is no flow from the nasal cannula. What
actions could a therapist take?

A

check flowmeter
Check for leaks
Check humidifier tubing
Check prong direction

44
Q

A therapist is called to a room with a high-pitched whistle sound
from the bubble bottle. What actions could a therapist take?

A

Check for obstructions in the tubing
Check the flow from the flowmeter
Check the patient’s nares

45
Q

A patient complains of soreness over ears or lips. What actions
could a therapist could take?

A

loosen straps
Use skin protecting pads
Change the device

46
Q

patient constantly removes their oxygen mask. What actions
could a therapist take?

A

Restrain/sedate patient
Alternative device

47
Q

The therapist is checking a patient on a non-rebreather mask. The
reservoir bag collapses when the patient inhales. What should the
therapist do?

A

Increase the flow

48
Q

A patient on a simple mask develops erythema over their face.
What actions could a therapist take?

A

Reposition straps
Use protective pads
Provide skin care
Change devices

49
Q

A patient’s SaO2 is 88% on a 28% venturi mask. What should the
therapist do? List new settings and total out put of the device.

A

Check the oximeter.
Check if oxygen is on the patient
Check oxygen tubing
Check the flowmeter
Increase FiO2 to 31%

50
Q

A patient has an SpO2 of 94%, and complains of dryness on a 50%
venturi mask. What actions could a therapist take?

A

Could change the patient to a 50% cool large volume jet nebulizer.

51
Q

A patient has an SaO2 of 87% on a 30% large volume jet nebulizer.
What actions a therapist could take?

A

Check the oximeter.
Check if oxygen is on the patient
Check oxygen tubing
Check the flowmeter
Could change the patient to a 35% cool large volume jet nebulizer

52
Q

The therapist does not see mist from a 40% cool jet nebulizer with a
flow of 8 L/min. What should the therapist do?

A

increase the flow until mist appears

53
Q

A therapist is administering a vibrating mesh aerosol treatment
using AC power. The device does not mist. What 4 actions
concerning AC power should a therapist take?

A

Check that device is plugged in
Check that the plug works
Check the cable
Replace if mesh plate is clogged

54
Q

patient complains their small volume jet nebulizer treatment does
not mist the way it did originally. What 5 problems should the
respiratory therapist check.

A

Check the baffle placement
Check to make sure the jet orifice is not clogged
Check that the flow is not too low
Check the med cup isn’t loose or cross-threaded
Check the volume of medication
Check the nebulizer position

55
Q

There is medication left over in the vibrating mesh unit after the
treatment is finished. What actions should a therapist take?

A

Check the batteries to make sure they are not low
Check the mesh plate to make sure it isn’t clogged

56
Q

A patient complains that although they take their Symbicort MDI
every morning and evening they do not feel any relief from their
asthma. What problems should the respiratory therapist check?

A

is the patient priming when new?
Is the Patient shaking the MDI before use
Spacer use?
Check patient technique
Check amount of medication in the MDI

57
Q

A patient complains that their asthma is worse although they take
Advair every morning and evening. What problems should the
respiratory therapist check.

A

Check the patient’s technique
Is the patient’s inspiratory flow greater than 30 L/min.
How much medication is left?
Is there grinding or loose powder?

58
Q

A stable patient needs short-term low FiO2 supplemental oxygen. What is the appropriate oxygen delivery device?

A

nasal cannula
simple mask
venturi mask

59
Q

An adult that needs humidity and a high FiO2. What is the appropriate oxygen delivery device?

A

2 Large volume jet nebulizers
A Humidified NRM

60
Q

A post operative patient with a tracheostomy who needs moderate
FiO2. What is an appropriate oxygen delivery device?

A

A Large Volume Jet Nebulizer

61
Q

A patient needs high FiO2 with chest pain. What is the appropriate oxygen delivery device?

A

A High Flow Nasal Cannula
An Oxymask
A NRM

62
Q

A claustrophobic patient with moderate FiO2 needs. What is the appropriate oxygen delivery device?

A

A Face Tent Large Volume Jet Nebulizer
An Oxymask

63
Q

An unstable COPD patient with low FiO2 needs. What is the appropriate oxygen delivery device?

A

A venturi mask

64
Q

A male patient with a chest tube does not have fluctuations in the
water level while breathing. The drainage system is obstructed. What
actions should the therapist consider?

A

Check the collection chamber for kinks or dependent loops
“Milk” the tubing connected to the chest tube toward the collection
chamber
Check the patient for signs of a pneumothorax
Notify the physician if not fixable

65
Q

There is no bubbling at all in the suction control chamber of a female
patient with a chest tube. What actions should the therapist consider?

A

Check suction control regulator to make sure it is on.
Check suction chamber for leaks/obstructions/kinks
Check atmospheric vent to make sure it is open.

66
Q

There is continuous bubbling in the water seal chamber of a female
patient with a chest tube. What actions should the therapist consider?

A

Check for leaks and correct them
Pinch the chest tube near insertion of patient, if bubbling stops the
leak is near the insertion site or in the patient.
If not check the collection system
1

67
Q

The therapist is checking a 45-year-old female morbidly obese
obstructive sleep apnea patient on CPAP. The pressure should
read 16 cm H2O but reads 10 cm H2O. List possible solutions to
correct this problem

A

Increase the flow
Fix circuit leak/disconnect
Mask leak

68
Q

The therapist is checking a 66-year-old male obstructive sleep
apnea patient on CPAP. The pressure should read 12 cm H2O
but reads 15 cm H2O. List possible problems/solutions for this
problem.

A

Decrease flow
Check expiratory limb for occlusions
Replace bacterial filter
Check the patient for a nasal/pharyngeal obstruction

69
Q

A male patient on NPPV with an oronasal (full face mask)
complains of claustrophobia. What should the therapist do?

A

Choose a clear mask with minimal bulk

70
Q

A female patient on NPPV with a nasal mask is leaking and
cannot keep her mouth closed. What should the therapist do?

A

A female patient on NPPV with a nasal mask is leaking and
cannot keep her mouth closed. What should the therapist do?

71
Q

A male patient on NPPV with a with nasal pillows has redness
and pressure sores in his external nares. What actions could the
therapist take?

A

Ensure a proper fit
Adjust the strap tension
Change mask type

72
Q

A female patient with an oral device is complaining of dry lips,
mouth, and throat after wearing her oral device all night. What
actions could the therapist take?

A

Provide humidification
Apply oral lubricants/saliva replacements

73
Q

A male Patient on NPPV with an oronasal mask is aspirating.
What should the therapist do?

A

make sure the patient can protect their airway
Use an NG tube

74
Q

A female patient on NPPV with a nasal mask has a pressure sore
on the bridge of her nose. What 4 actions could the therapist
take?

A

Reduce strap tension
Use a forehead spacer
Use nasal pillows
Use artificial skin or a nose pad

75
Q

When is a shiley trach tube usually used?

A

usually as the first tracheostomy tube inserted

76
Q

What is a TTS tube and when is it used?

A

Tight to shaft
used for weaning, allows a patient to placed on a ventilator or off vent support

77
Q

When is a bivona extra long trach tube used?

A

Used when a patient has a long neck or if there is tracheal damage
and a patient needs to have the cuff repositioned

78
Q

When is a proximal tracheostomy tube used?

A

used on patients with thick necks

79
Q

When is a distal trach tube used?

A

Used when a patient has a long neck or if there is tracheal damage
and a patient needs to have the cuff repositioned.

80
Q

When is a fenestrated trach tube used?

A

allows patients to talk

81
Q

When is a montgomery tube used?

A

the Montgomery T-tube is a device used as a
combined tracheal stent and an airway after laryngotracheal
surgery

82
Q

What is a speaking valve?

A

The speaking valve is a buttonlike piece of equipment that is
placed on the outer hub of the tracheostomy tube. The one-way
valve opens to let air in through the tracheostomy when the
patient inspires. The valve closes during expiration, causing the
air to follow the normal route of expiration and permitting
speech

83
Q

List contraindications for speaking valves

A

Dyspnea, thick secretions, copious secretions, unawake patient,
patient who can’t speak with a valve.

84
Q

when is a trach button used?

A

It is often the last step in your airway weaning program. It is
placed in the opening of the throat where your trach tube used
to be. It will help keep your airway open in the event that you
need help with mucous or have other breathing problems. The
trach button is made of plastic

85
Q

List early complications of artificial airways

A

One of the most common complications associated with
tracheostomy is bleeding. The incidence of major or minor bleeding
following tracheostomy is around 5.6%. This statistic refers to the
population of the United Kingdom. Other common complications
include tube obstruction, dislodgement, and stomal site infection.

86
Q

List late complications of artificial airways:

A

Long-term complications include granulation tissue formation,
laryngeal and/ or tracheal stenosis, tracheomalacia,
trachoesophageal fistula

Clinical Instruction (Kass) (13 decks)

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