lab final Flashcards
What are the indications for SVN use
neonates and older
1. person unable to follow instructions
2. poor inspiratory capacity
3. incapable of inspiratory hold
4. rapid or unstable respiratory pattern
5. need to nebulize non stand drug solutions
Indications for DPI use
3-4 years or older
1. inadequate coordination for MDI use
2. need for more portable alternative to SVN
3. subjects capable of high inspiratory flow rates >60
4. need for accurate dose monitoring
5. drug available in DPI formulation
Indications for MDI
7 years or older
1. ability to follow instructions
2. ability to mechanically coordinate actuation and breathing
3. adequate inspiratory capacity >900 ml
4. capable of inspiratory hold
5. stable, calm respiratory pattern
how do spacers/ holding chambers work?
Increases the distance between the MDI and the pts mouth, allowing aging of particles. incorporates a one way valve to prevent drug loss in pts with poor hand-breath coordination.
What are regulators also called?
Pressure-reducing valves
What do regulators do?
They are used in gas supply systems and mechanical ventilators to maintain constant pressure. They are also used on cylinders to reduce gas pressure from 2200 psi to a working pressure of 50 psi
what is a single stage pressure reducing valve
High pressure chamber that is supplied with a safety relief valve preset to 200 psig
what is a multiple stage pressure reducing valve
the first stage is to reduce pressure to 200-700 psig
the second stage reduces pressure to 50 psig
Describe ASSS
The American standard safety system is used with large cylinders, and utilizes differing thread pitches, and internal and external threading to prevent accidental misconnections (wrench)
Describe PISS
Pin index safety system is used with small compressed tank systems, it utilizes a yoke collar with varying pi placements to prevent accidental misconnections
Describe DISS
diameter index safety system connections consist of an externally threaded body and a mated nipple with a nut that may be hand tightened, it used to prevent accidental interchange of low pressure <200
op- 50 max pressure- 200
What is a bourdon gauge
A bourdon gauge measures flow based off of pressure, it has a fixed orifice and is typically used during transport.
What are the three goals of oxygen therapy?
- treat hypoxemia
- decrease work of breathing
- decrease myocardial workload
What is a nasal cannula?
It is a low flow oxygen device that deliver flows 24-44% from 1-6 LPM there is a 4% increase per liter. more than 6lpm does not increase fio2 delivered to the patient. A humidifier need to be used at 4 or more lpm
What is a simple mask
low flow oxygen device that delivered 35-55% oxygen from 6-10 LPM. There is a 5% increase per liter. A humidifier can be used at any liter. Cannot do less than 6 lpm due to build up of exhaled CO2 in the mask
what is a nonrebreathing mask
low flow oxygen device that delivers 75-100% oxygen at flows of 8-15 lpm. Flow rates to the mask must be sufficient enough to keep reservoir bag 1/2-1/3 full at all times. This device is only used short term and should never be used with a humidifier
What are the 7 factors that increase FiO2 delivered to patients
- Higher O2 input
- mouth-closed breathing
- lower inspiratory flow
- lower tidal volume
- slow rate of breathing
- small minute volume
- long inspiratory time
What are the 7 factors that decreases total FiO2 delivered to patients
- lower O2 input
- mouth-open breathing
- higher inspiratory flow
- higher tidal volumes
- fast rate of breathing
- large minute volume
- short inspiratory time
What are the five indications for using an incentive spirometer?
- prevention and reversal of atelectasis
- facilitate cough reflex
- mobilize secretions
- surgery
- improve inspiratory muscle performance
What are the 6 potential outcomes of using an incentive spirometer?
- absence or improvement in signs of atelectasis
- improved PaO2
- presence or improvement in previously absent or diminished breath sounds
- increased vital capacity and peak expiratory flows
- attainment of prep flow and volume levels
- improved inspiratory muscle performance
What is the most common pressure that most hospitals equipment operates
50 psig
what color gas is oxygen
green
what color gas is carbon dioxide
gray
what color gas is nitrous oxide
blue
what color gas is cyclopropane
orange
what color gas is helium
brown
what color gas is nitrogen
black
what color gas is air
yellow
what color gas is helium/oxygen
brown and green
what color gas is carbon dioxide/oxygen
gray and green
what color gas is nitric oxide
teal and black
what is hypoxemia
relative deficiency of oxygen in the blood
what is hypoxia
oxygen deficiency at the tissue level
what is hypoxemia hypoxia
oxygen deficit at the tissues due to increase altitude, suffocation, drug overdose, neurological injury that results in hypoventilation, and lung disease.
what is stagnant (circulatory) hypoxia
oxygen deficit at the tissues due to shock and cardiac arrest
what is anemic hypoxia
oxygen deficit at the tissue due to anemia, blood loss, and carbon monoxide poisoning
what is histotoxic hypoxia
oxygen deficit at the tissues due to cyanide poisoning
What is a variable performance oxygen delivery device
It is a Low flow oxygen device, that gas flow of the apparatus is insufficient to meet all of an individuals inspiratory requirements. Room air is entrained to augment gas flow from the device
what is a fixed performance oxygen delivery device
High flow oxygen device, gas flow of the apparatus is sufficient to meet all of an individual inspiratory requirements. room air is not entrained
what are the four hazards of oxygen therapy
- oxygen toxicity
- retinopathy of prematurity
- oxygen-induced hypoventilation (COPD patients)
- Absorption atelectasis ( mucus plugging)
what does a large entrainment port do
it takes in more room air, and decreases total FiO2 delivered
what do small air entrainment ports do
it takes in less room air, increasing the total FiO2 delivered
what does a small jet orifice do
it lowers oxygen flows delivered through the device
what does a large jet orifice do
it raises oxygen flows through the device
what is the difference between asepsis and sterile
sterile is the complete absence of all forms of microorganisms while asepsis is the absence of disease producing microorganisms
where does aerosol deposition occur for >15 microns
completely removed above the larynx with mouth breathing
where does aerosol deposition occur for 10-15 microns.
completely removed above the larynx with nose breathing
where does aerosol deposition occur for 5-10 microns
enter the lower respiratory tract with mouth breathing
where does aerosol deposition occur for 1-5 microns
they deposit in the lung periphery
what is the optimal particle size
2-5 microns
what are the effects of low humidity on the airways
- long exposure to dry gases will cause heat/water loss changes to the epithelial layer
- ciliary activity is impaired when the BH% falls below 70%
- ciliary activity ceases when the BH% falls below 30%
what is the action of a baffle in a nebulizer
the number of baffles allow larger particles to impact (while small particles remain in suspension)
what are the 7 signs of humidity deficit
- dry, hacking, nonproductive cough
- inspissated secretions
- earache
4.sore throat
5.substernal pain - dryness of skin
- unstable control of bodily fluids
why are the standard precautions used
to reduce the risk of transmission of microorganisms from both recognized and unrecognized sources of infection in hospitals
what are the three factors that effect humidity output
- temperature
- surface area
- contact time
what are the three factors that influence particle size produced by jet nebulizer
- change in gas flow (increase=decrease in particle size)
- jet size= (increase= decrease in particle size)\
- number of baffles (the more the smaller the particles
what is the appropriate gas flow rate for powering a SVN
6-10 lpm
what are the 8 potential complications of aerosol therapy
- infection
- bronchial obstruction
- atelectasis (mucus plugging)
- overhydration
- electrolyte changes
- dyspnea
- drug concentration effect
- airway reactivity
korotkoff sounds
phase 1: systolic pressure
phase 5: silence marks the diastolic pressure
what is a heat/moisture exchanger also called
hygroscopic condensor humidifier
what is the specifics about a heat/moisture exchanger
passive humidifier that uses paper, wool, foam, treated with hygroscopic salt to increase thermal conductivity (increases temperature and RH%)
what is E cylinders safety and escape factor
escape- 0.28
safety- 500 psi
what is H-cylinders safety and escape factor
escape- 3.14
safety- 200 psi
what is the formula to calculate time remaining in a cylinder
(cylinder psig-safety factor) x escape factor divided by liters
indications for aerosol therapy (5)
- delivery of medications
- humidification of airways
- mobilize tracheobronchial secretions
- upper airway edema
- sputum induction
what are the three clinical situations in which humidity might be required
- administration of medical gases
- any artificial airway that bypasses the normal anatomical route for humidification
- treatment of thick secretions
what happens when an air entrainment device has an occlusion
the occlusion causes downstream resistance that builds up backpressure in the system. This will decrease the amount of air entrained and result in an increase in FiO2 delivered but will decrease the total flow delivered to the patient
what are the 3 functions of a spacer/holding chamber
- increase time and provide a holding volume to allow aging of aerosol particles
- reduction of oropharyngeal drug loss
- provision of a reservoir holding chamber to remove the need for coordination of actuation and inhalation by the user
what do you change to help a patient overcome work of breathing
you change the flow rates
what do you change to improve a patients oxygenation
you change the FiO2
if a patient is not capable of using a incentive spirometer what should you have them do
you have them do deep breath, cough exercises
if there is a picture of big single bubbles what device is this
a simple bubble humidifier
if there is a picture of lots of bubble what will this be
a diffuser
what does a salter or high flow nasal cannula typically run at
15 lpm
if patient cannot use a svn on there own what should you do
have them use Blow by for passive treatment, the aerosol will go through there nose
heat and moisture exchangers should only be used
short term
HEM
more saturation with water will cause resistance to increase, and coughing can occlude the device
everyone who comes into the hospital should get a blood gas done
false
what are the oxygen percentages for the Venturi mask
24-50%
what will a bourdon gauge show if the device is occluded
the bourdon gauge will not change but the patient will receive lower FiO2s
what is the equation for MAP
MAP= systolic + (diastolic x 2) divided by 3
