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Respiratory Therapy (Study Folder) > Lab 104 Homework Question > Flashcards

Lab 104 Homework Question Flashcards

1
Q

List 15 Items needed for endotracheal intubation

A
  1. Oxygen flow meter and tubing
  2. Suction apparatus
  3. Flexible sterile suction catheter
  4. Sterile gloves
  5. Yankaver
  6. Manual resuscitation bag and mask
  7. CO2 detector
  8. Laryngoscope (2) with assorted blades
  9. Endotracheal tubes (3 sizes)
  10. Tongue depressor
  11. Stylet
  12. Stethoscope
  13. 10- or 12-mL Syringe
  14. Tape or endotrachael tube holder
  15. Water soluble lubricating gel
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2
Q

List 5 bedside methods to assess endotracheal tube position/placements

A
  1. Auscultation of chest and abdomen
  2. Observation of chest movement
  3. light wand
  4. Capnometry
  5. Colorimetry
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3
Q

What is the tube size that a woman and man are intubated with

A

Woman: 7 or 7.5 tube
Men: 8 or 8.5 tube

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4
Q

What hand do you hold the laryngoscope with

A

Left hand

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5
Q

What is the most common size laryngoscope used for adults

A

A No. 3 curved Macintosh or straight Miller Laryngoscope blade

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6
Q

How long should one be allowed to attempt to intubate

A

No more than 30 seconds should be devoted to any intubation attempt

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7
Q

Explain the difference between the Miller and Macintosh blades and how they displace the epiglottis

A

Macintosh Blade is curved. The epiglottis is displaced indirectly by advancing the tip of the blade into the vallecula (at the base of the tongue), and the laryngoscope is lifted up and forward.

Miller Blade is straight. The epiglottis is displaced directly by advancing the tip of the blade over its posterior surface and the laryngoscope is lifted up and forward.

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8
Q

In general, initially where should the ETT be secured at for men at the teeth and woman at the teeth

A

Men: 21-23 cm
Woman: 19-21 cm

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9
Q

The tip of the ETT should be approximately (what) above the carina

A

3-5 cm above

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10
Q

To prevent tracheal mucosal injury, it is recommended to inflate the cuff to

A

20-30 cmH2O

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11
Q

What equation do we use to estimate the proper suction catheter size per Egan

A

Multiply tube’s inner diameter by 2. Then use the next smallest size catheter. Example: 6mm ETT 2x6=12 the next smallest tube is 10. I would use a 10F suction catheter

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12
Q

List 4 indications for use of closed suction technique

A
  1. Positive End Expiratory Pressure (PEEP) >= 10 cmH2O
  2. Mean Airway Pressure (MAP) >= 20 cmH2O
  3. Inspiratory Time >= 1.5 sec
  4. FiO2 >= 0.60
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13
Q

How can you prevent hypoxemia while inline suctioning (2)

A
  1. Minimized by preoxygenating Pt.
  2. Minimized by using closed suction technique
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14
Q

How can you prevent atelectasis during inline suctioning (4)

A
  1. Limit amount of negative suction pressure used
  2. Keep duration of suctioning less than 15 seconds
  3. Use appropriate size catheter
  4. Avoid disconnection from vent by using closed suction technique
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15
Q

What suction pressure would you use for an adult per Egan and per Instructor

A

Egan: 120-150 mmHg
Instructors: 100-120 mmHg

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16
Q

According to Egan, how long should you wait after changes in ventilatory support have been applied before taking a blood gas sample

A

Healthy Lungs: 5 minutes
COPD: 30 minutes

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17
Q

A patient is ready to be extubated when? List 4 things

A
  1. The ability to maintain adequate oxygenation and ventilation w/out mechanical support
  2. The ability of the patient to protect the airway by presence of a gag reflex
  3. The ability to manage secretions based on cough strength
  4. The patency of the upper airway
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18
Q

List 4 items needed for extubation

A
  1. Two suction kits with correct size sterile suction catheters and gloves
  2. Tonsil-lar suction tip (Yankauer)
  3. Manual resuscitation bag with mask (AMBU)
  4. 10-mL or 12-mL syringe
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19
Q

List 3 things that must be performed before the ETT is removed

A
  1. Oxygenate the patient before and well after suctioning
  2. Suction ETT and Pharynx above the cuff
  3. Deflate the cuff completely
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20
Q

When should the ETT be removed? when the vocal cords are?

A

Maximally abducted

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21
Q

What needs to be assessed post extubation. List 4 items

A
  1. Auscultation is performed to check for good air movement and post extubation stridor.
  2. Patient’s vitals (HR, RR, BP, SPO2, BS)
  3. ABG Values
  4. Monitor for nose bleeds (After Nasotracheal Extubation)
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22
Q

List 3 common problems that occur after extubation

A
  1. Hoarseness
  2. Sore throat
  3. Cough
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23
Q

What are acceptable values for the following indices for discontinuing Vent Support?

  1. FiO2
  2. PEEP
  3. PaO2
  4. PaCO2
  5. PH
  6. Vt
  7. RSBI
  8. MIP
  9. PaO2/PAO2
  10. PaO2/FiO2
  11. P(A-a)O2
  12. Qs/Qt
  13. Static Compliance
  14. VC
A
  1. FiO2 <= 0.40 - 0.50
  2. PEEP <= 5 - 8 cmH2O
  3. PaO2 >= 60 cmH2O
  4. PaCO2 < 50 mmHg
  5. PH >= 7.35
  6. Vt > 5 mL/Kg
  7. RSBI < 105 BPM/L
  8. MIP < -20 to -30 cmH2O
  9. PaO2/PAO2 >= 0.35
  10. PaO2/FiO2 > 150 - 200
  11. P(A-a)O2 <350 mmHg
  12. Qs/Qt < 15% - 20%
  13. Static Compliance > 25 mL/cmH2O
  14. VC > 10 - 15 mL/Kg
24
Q

List atleast 10 factors that should be optimized before discontinuing vent support

A
  1. Anemia
  2. Pain
  3. Fear/Anxiety
  4. Depression
  5. Humidification
  6. Ventilation
  7. Oxygenation
  8. Respiratory Alkalosis
  9. Metabolic Alkalosis
  10. Metabolic Acidosis
25
Q

A gradual increase in PETCO2 could indicate what?

A
  1. Hypoventilation - Increase in CO2 production
26
Q

A sudden low PETCO2 could indicate what? List atleast 2 items

A
  1. Sudden decrease in Cardiac Output
  2. Massive Pulmonary Embolism
27
Q

List two common problems that cause false PETCO2 readings

A
  1. Contamination or obstruction of the sampling system or monitor by secretions or condensate
  2. No reading with cable disconnection or condensate in sensor or monitoring tubing
28
Q

What is the normal value for PETCO2 in healthy individuals

A

35 - 43 mmHg

29
Q

List 5 indications for obtaining an inpatient CXR

A
  1. Placement of ETT
  2. Placement of Pulmonary Artery Catheter
  3. Placement of Central Venous Pressure Catheter
  4. Sudden onset of dyspnea or chest pain
  5. Sudden decline in oxygenation
30
Q

How can you determine if someone is rotated or not on a CXR

A
  1. Looking at the clavicles of a patient. They should look the same length. If one looks longer than the other, the patient is rotated.
31
Q

How can one determine if there was a good inspiratory effort on a CXR

A
  1. The visualization of 6 anterior or 10 posterior ribs above the level of the diaphragm on a PA Chest view indicates a good inspiratory effort by the patient
32
Q

List 4 indications for Mechanical Ventilation (MV)

A
  1. Apnea or impending respiratory arrest
  2. Acute exacerbation of COPD w/dyspnea, tachypnea, acute respiratory acidosis, and acute cardiovascular instability
  3. Acute ventilatory insufficiency in cases of neuromuscular disease with acute respiratory acidosis
  4. ## Need for endotracheal intubation to maintain or protect the airway or manage secretions
  5. PH < 7.25
  6. PaCO2 > 55 mmHg and rising
  7. PaO2 < 70 mmHg (on O2 >= 0.6)
  8. VD/VT > 0.6
33
Q

List 5 hazards of Mechanical Ventilation (MV)

A
  1. Ventilator associated lung injuries (Barotrauma, Pneumothorax)
  2. Ventilator Associated Pneumonia (VAP)
  3. Oxygen Toxicity
  4. Auto PEEP = Air trapping
  5. Complications related to volume (Volutrauma, atelectrauma)
34
Q

While assessing your patient, what would indicate the need for MV for the following
1. ABG (PH, PaCO2, PaO2)
2. RR
3. VT
4. VC
5. VE
6. MIP
7. MEP
8. VD/VT
9. Qs/Qt
10. Cst
11. P(A-a)O2
12. P/F

A
  1. ABG (PH < 7.25, PaCO2 > 55 mmHg & rising, PaO2 < 70 mmHg on O2 >= 0.60)
  2. RR > 35 BPM
  3. VT < 5 mL/Kg
  4. VC < 10-15 mL/Kg
  5. VE > 10 LPM
  6. MIP -20 to -30 cmH2O
  7. MEP < 40 cmH2O
  8. VD/VT > 0.6
  9. Qs/Qt > 20%
  10. Cst < 25 mL/cmH2O
  11. P(A-a)O2 > 450 mmHg on 100 O2
  12. P/F < 200 mmHg
35
Q

What is IBW equation for male/female

A

MEN: IBW = (Height in (In) - 60)6 + 106/ 2.2 = Kg

WOMEN: IBW = (Height in (In) - 60)5 + 105/ 2.2 = Kg

36
Q

You have a 5’9” Male Pt. What VT range would you recommend?

A

Male 5’9” = 69”
IBW = (69-60)6 +106/2.2 = 73Kg

“Rule of thumb” Initial VT = 6-8 mL/Kg of IBW
VT = 6 x 73 = 440 mL
VT = 8 x 73 = 580 mL

VT recommended range is 440mL - 580mL

37
Q

What are the initial adult settings for MV
1. VT
2. PC
3. RR
4. FiO2
5. PEEP
6. I:E
7. Flow
8. Sensitivity

A
  1. VT = 6-8 mL/Kg
  2. PC = 10-15 cmH2O
  3. RR = 10-20 BPM
  4. FiO2 = 100% when Pt. is unknown (Wean ASAP)
  5. PEEP = 5 cmH2O
  6. I:E = <= 1:2
  7. Flow = 40-80 LPM
  8. Sensitivity = 1-2 LPM (flow) or -1 to -2 cmH2O (pressure)
38
Q

How to set the following alarms
1. High Pressure
2. Low Pressure
3. Low PEEP
4. Apnea
5. Low VT

A
  1. High Pressure = 10 cmH2O above PIP
  2. Low Pressure = 10 cmH2O below PIP
  3. Low PEEP = Don’t set to 0, 3-5 cmH2O below PEEP
  4. Apnea = 20 sec
  5. Low VT = 100 mL below set VT
39
Q

What are indications for PEEP? List 4

A
  1. Bilateral infiltrates on CXR
  2. Recurrent atelectasis with low FRC (functional residual capacity)
  3. Reduced lung compliance
  4. PaO2 < 60 mmHg on FiO2 > 0.5 (50%)
40
Q

Explain Mechanical Deadspace

A
  1. the amount of trapped air in circuit that a patient can rebreathe
  2. The amount of rebreathed volume in a ventilator circuit
  3. Dmech Increases CO2 in body
41
Q

Explain Anatomical Deadspace

A
  1. Airways and lung tissue that do not participate in gas exchange
  2. 1 mL/LB. The average person has about 150 mL of anatomical deadspace in their body
42
Q

Explain Alveolar Deadspace

A

Alveoli are ventilated, but not perfused by pulmonary capillary blood flow. (e.g. Pulmonary Embolism)

43
Q

When would you recommend adding deadspace

A

To increase CO2. When you need to increase the patients PaCO2 levels

44
Q

When would you recommend removing deadspace

A

To decrease CO2. When you need to decrease the patients PaCO2 levels

45
Q

What is the difference between dynamic compliance and static compliance

A
  1. Dynamic Compliance: Considers the total impedance to volume change. (i.e., flow resistive, and elastic characteristics of the patient -vent interface
  2. Static Compliance: Is only influenced by the elastic characteristics of the lung -thorax unit
46
Q

How do you calculate dynamic and static compliance (Equations)

A
  1. Dynamic: Cd = Volume / PIP-PEEP =cmH2O
  2. Static: Cs = VT / Pplat-PEEP = cmH2O
47
Q

What is the normal values for Dynamic and Static Compliance

A
  1. Dynamic: 35 - 50 mL/cmH2O
  2. Static: 70 - 100 mL/cmH2O
48
Q

How do you calculate Raw? What is the normal value for an intubated and non-intubated patient

A
  1. Raw = PIP - Pplat / Flow (L/Sec)
  2. Normal Intubated Pt. = 0.6 to 2.4 cmH2O
  3. Normal Non-Intubated Pt. = Approximately 6 cmH2O
49
Q

When venting a head injury, where should you maintain the following parameters?
1. PaCO2
2. ICP
3. Flow

A
  1. PaCO2: 25 - 30 mmHg
  2. ICP: <= 10 mmHg
  3. Flow: > 60 L/Min
50
Q

While in VC (Volume Control) how does adjusting the following parameters change the I:E?
1. VT
2. Flow
3. RR

A
  1. VT: Increase VT = Increase I:E / Decrease VT = Decrease I:E
  2. Flow: Increase Flow = Decrease I:E / Decrease Flow = Increase I:E
  3. RR: Increase RR = Increase I:E / Decrease RR = Decrease I:E
51
Q

ABG (What vent setting would you change)
PH: 7.50
PaCO2: 27
PaO2: 89
HCO3: 24

A/C 10 mL/Kg, Rate 14, Total Rate 15, +5, 45%

A
  1. Patient is uncompensated Resp Alk with nml Oxygenation
  2. Pt. is over ventilating
  3. Decrease VT 9 mL/Kg
52
Q

ABG (What vent setting would you change)
PH: 7.30
PaCO2: 65
PaO2: 118
HCO3: 29

A/C 7 mL/Kg, Rate 14, Total Rate 20, +5, 60%

A
  1. Patient is partially compensated Resp Acid with hyperoxygenation
  2. Increase VT to 8 mL/Kg
53
Q

ABG (What vent setting would you change)
PH: 7.42
PaCO2: 36
PaO2: 127
HCO3: 25

A/C 650 mL, Rate 15, +10, 75%

A
  1. Patient is normal with hyperoxygenation
  2. Decrease FiO2 to 70%
54
Q

List 4 things that can reduce VAP’s

A
  1. Minimize sedation and interrupt it daily
  2. Assess readiness to extubate daily
  3. Perform spontaneous breathing trials with sedation turned off
  4. Facilitate early mobility
55
Q

Explain Auto PEEP

A
  1. Air trapped in lungs at the end of exhalation
  2. Pressure above atmospheric remaining in the alveoli at end-exhalation due to air trapping
56
Q

How can you prevent/treat auto PEEP? List 3 things

A
  1. Decrease Inspiratory Time (I-Time)
  2. Decrease VT
  3. Decrease Rate
  4. Decrease PEEP
  5. Bronchodilator
57
Q

How can you determine Optimal PEEP

A
  1. Best PEEP or Optimal PEEP is defined as the PEEP that maximizes O2 delivery. PEEP is increased in increments of 2 cmH2O until there is a decline in O2 delivery, at which point the Optimal PEEP has been exceeded. PEEP is adjusted down to previous level that represents the “Best PEEP”
  2. Look at CL (compliance). You want it to improve without compromising the Heart (blood pressure)
  3. When PVO2 decreases from normal (35-45 mmHg). When PVO2 decreases after an increase of PEEP this equals to much PEEP.

Respiratory Therapy (Study Folder) (30 decks)

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