Midterm 202/203 Flashcards

Question

Criteria for ECMO

Answer 1

For patients with extreme hypoxemic respiratory failure/ARDS with compromised gas exchange

Answer 2

- 50%-80% mortality rate - PaO2/FIO2 less than 150 on FIO2 greater than 0.9 - Murray score of 2-3

Answer 3

1. Right internal jugular vein 2. Femoral vessels 3. Subclavian vessels 4. Axillary vessels

Answer 4

= Provides support for ONLY Respiratory Failure - Supports oxygenation and CO2 removal and requires an adequate cardiac function - Acts as a third lung - TYPICALLY PREFERRED - Right atrium to right atrium

Answer 5

= Provides support for BOTH Cardiac & Respiratory support - Provides oxygenation, CO2 removal and also adequate perfusion - Typically used for kids and NICU

Answer 6

1. Visual 2. Aline for frequent ABG’s to ensure adequate gas exchange 3. Measure pressures/resistance to flow 4. Cannula placement

Answer 7

Parasympathetic of nervous system

Answer 8

characterized by abnormal levels of nitrogen-containing compounds, such as urea or creatinine

Answer 9

elevated urea nitrogen levels

Answer 10

Cardiopulmonary= hypertension, pericarditis with fever, chest pain, pulmonary edema, and Kussmaul respirations

Answer 11

abnormally high

Answer 12

poor patient outcome

Answer 13

- Head elevation - Decrease in CSF volume - Severe arterial hypotension - hyperventilation/hypocapnia

Answer 14

- Increased volume of brain (edema or tumor) or blood (hemorrhage/hematoma) - Restrictive venous outflow (CVP) - Right heart failure/cor pulmonale - High intrathoracic pressure (PEEP/recruitment maneuvers) - Severe arterial hypertension - hypoventilation/hypercapnia - Hypoxia - Intubation - suctioning/cough - High PEEP - High MAP

Answer 15

= variation of the spontaneous mode of ventilation that augments (change/support) a patient's spontaneous effort with positive pressure - patient spontaneously breathing - Low spontaneous tidal volume - High spontaneous frequency - Increased WOB - facilitate weaning in a difficult-to-wean patient

Answer 16

= ventilator delivers the preset tidal volume at a set time interval (time-triggered frequency) (controls patients tidal volume, respiratory, minute ventilation) - if patient ¨fights¨ the ventilator in the initial stages of mechanical ventilatory support - tetanus or other seizure activity - complete rest for the patient for 24 hour period - patient with a crush chest injury

Answer 17

= patient spontaneously breathes while giving mandatory breathes when needed (rate set) - ventilatory support - patient provides part of minute ventilation - Mainly for patients out of surgery

Answer 18

= patient spontaneously breathing while time triggered by present frequency (rate set) - severe ARDS (need high PIP)

Answer 19

= mandatory mechanical breaths may be patient-triggered by the patient's spontaneous inspiratory efforts (assist) or time-triggered by a present frequency (control) - provide full ventilatory support - stable respiratory drive - Set tidal volume in volume control

Answer 20

= mandatory pressure-controlled breathes are time-triggered by a preset frequency (pressure plateau created) - severe ARDS (need high PIP)

Answer 21

= provides volume-controlled breaths with the lowest pressure possible by altering the flow and inspiratory time - achieve volume support while keeping the PIP at a lowest level possible - Lowers flow to decrease resistant and decrease pressure

Answer 22

= causes an increase of mandatory frequency when the patients spontaneously breathing level becomes inadequate (safe minute ventilation) - Additional function of SIMV mode - prevent hypercapnia - preventing hypoventilation - preventing respiratory acidosis

Answer 23

= provides pressure support based on changes with the patient's breathing effort over time - No target flow, volume, or pressure during mechanical ventilation - Can over inflated lungs

Answer 24

combines two different dual mode volume-targeted breath types

Answer 25

= inverse ratio, pressure controlled, intermittent mandatory ventilation with unrestricted spontaneous breathing - Delivered Vt determined by pressure gradient between Phigh (PINSP) and Plow (PEEP) - No respiratory rate since patient is breathing on their own - For severe ARDS (decreased lung compliance)

Answer 26

= minimize development of lung injury while providing mechanical ventilation - Delivers extremely small volumes at high frequency

Answer 27

= increase the end-expiratory or baseline airway pressure that reinflates collapsed alveoli and supports and maintains alveolar inflation during exhalation - NOT A STAND ALONE MODE

Answer 28

- Intrapulmonary shunting - Refractory hypoxemia → not responding to method - Decreased FRC - Decreased lung compliance - Auto-PEEP (patient not getting rid of gas in system) not responding to adjustments of vent systems

Answer 29

- Decreased venous return → decreased CO and hypotension - Barotrauma → PEEP greater than 10cmH2O lead to alveoli rupture - Increase ICP - High PEEP effects- INCREASED PAP, INCREASE CVP, DECREASE PCWP

Answer 30

ASV use the otis equation to calculate the optimal (best) frequency that corresponds with lowest WOB

Answer 31

applies independent positive pressure pressures (PAP) to both inspiration and expiration

Answer 32

1. Help prevent Intubation for end-stage COPD patients 2. Supporting patients with chronic ventilatory failure 3. Patients with Restrictive diseases, Neuromuscular diseases, and NOCturnal Hypoventilation

Answer 33

1. Respiratory acidosis 2. Tachypnea 3. Respiratory distress with dyspnea 4. Use of accessory muscles 5. Abdominal paradox

Answer 34

= Applied only in Inspiration - think Ventilation (VT) (Improves Ventilation & Hypoxemia)

Answer 35

= Continuously applied during Inspiration and Exhalation - think Oxygenation (SpO2) (Improves FRC & Shunting)

Answer 36

1. Decrease intubation rate 2. Decrease pneumonia rate 3. Increase survival rate

Answer 37

provides information on patients ventilation (PaCO2), oxygenation (PaO2), and acid-base (pH) status

Answer 38

= A chronic, inflammatory, obstructive, non-contagious airway disease with varying levels of severity, characterized by exacerbations of wheezing and coughing Anatomic Alterations of the Lungs - Smooth muscle constriction of bronchial airways (bronchospasm) - Excessive production of thick, whitish bronchial secretions - Mucous plugging - Hyperinflation of alveoli (air trapping) - Bronchial wall inflammation leading to fibrosis (in severe cases, caused by remodeling) Patient Assessment-History and Physical exam - SOB-pursed-lip breathing, chest tightness - Appearance of the chest –increased A-P diameter during an attack - Respiratory Pattern- Accessory muscle usage, retractions (more so in kids) Diagnostic Chest Percussion – hyperresonant/tympanic note BS - Diffuse wheezing, bilateral wheezing, diminished breath sounds, prolonged expiration Physical Appearance – diaphoresis Vitals – tachycardia, tachypnea - Decreased blood pressure during inspiration - Increased blood pressure during expiration Chest X-ray –During an attack increased A-P diameter, translucent lung fields, depressed or flattened diaphragm ABG – Initially acute respiratory alkalosis with hypoxemia then acute respiratory acidosis

Answer 39

PFT –Spirometry shows reduced flowrates during an attack - Post-bronchodilator: if asthma return to normal - Significant response if FEV1 increases at least 12% and 200ml (Peak Flow Meter) - Bronchial Provocation test –FEV1 decreases significantly when methacholine is given

Answer 40

- Inhalers with bronchodilators or steroids to help people with lung disease like COPD. - high heart rate - high BP - high RR - leaning forward position to breathe - pursed lips - decreased tactile fremitus - bilateral diminished with scattered expiratory wheezing, basilar rhonchi - possible edema

Answer 41

Class 1= conscious sedation, soft palate, fauces, uvula, anterior and posterior tonsillar pillars Class 2= conscious sedation, soft palate, fauces, and uvula Class 3= seek anesthesia consultation, soft palate, and base of uvula Class 4= seek anesthesia consultation, soft palate only

Answer 42

size 7.5 to 8 typical male size and 7.0 to 7.5 for adult females

Answer 43

= aka Diprivan used for sedation - Intravenous use - GABA-activated chloride ion channel

Answer 44

= sedation and induction = decreases cerebral metabolic rate, cerebral blood flow, and intracranial pressure - Etomidate binds at a distinct binding site associated with a Cl- ionopore at the GABAA receptor, increasing the duration of time for which the Cl- ionopore is open

Answer 45

artificial airway that is passed through the mouth or nose and advanced into the trachea

Answer 46

designed to relieve obstruction in the unconscious patient caused by the tongue and other soft tissue Adult female- 80mm/3 Adult male- 90mm/4 Large adult- 100mm/5

Answer 47

relieve obstructions in the conscious or semiconscious patient caused by the tongue esophageal obturator airway. Can be used to facilitate ventilation or removal of secretions Adult female- 6 (24-Fr) Adult male- 6 (28-Fr) Large adult- 8-9 (32-36 Fr)

Answer 48

= infection of the lung parenchyma that is related to any or multiple events that the patient undergoes during mechanical ventilation that happens after 48 hours - proper handwashing techniques - closed suction systems - continuous feed humidification systems - change of ventilator circuit only when visibly soiled - elevated head of 30-45 degrees

Answer 49

= the movement of gas in and out of the lungs → moves oxygen to enter the body and carbon dioxide to be removed - Focuses on the PaCo2

Answer 50

= amount of oxygen available for metabolic functions; affected by ventilation, diffusion, and perfusion - Focuses on the PaO2

Answer 51

F → 45 + 2.3 x (inches over 5’) M→ 50 + 2.3 x (inches over 5’) THEN → answer x 8 = tidal volume

Answer 52

- low pH (more acidotic)= curves right - increase in body temp = curves right - PCO2 increase = curves right - 2,3 BPG increase = curves right

Answer 53

- high pH = curves left - decrease in body temp = curves left - PCO2 decrease = shift left - Fetal hemoglobin = shifts left - Carbon monoxide hemoglobin = shifts left

Answer 54

= volume of gas moves in and out of the lungs without taking part in gas exchange - ARDS - 150mL for anatomic dead space (conducting airways)

Answer 55

= occurs when carbon monoxide builds up in the blood - Carboxyhemoglobin reduces the hemoglobin O2 saturation - CO causes a leftward shift in the oxyhemoglobin curve - Measure with Co-oximetry

Answer 56

→ ADMINTRATE 100% OXYGEN - Considered hyperbaric oxygen therapy (HBOT)

Answer 57

Methacholine Challenge

Answer 58

CO2 Retainer

Answer 59

Specific FiO2

Answer 60

One-way valve

Answer 61

VapoTherm or Optiflow (Fisher & Paykel) (NOT HFNC up to 15L)

Answer 62

NPPV = NIV = BiPAP

Answer 63

the spread of microorganisms by direct or indirect contact with the patient or the patient’s environment, including contaminated equipment

Answer 64

the spread of microorganisms in the air via large droplets (larger than 5 um)

Answer 65

the spread of microorganisms in the air via small droplet nuclei (5um or smaller)

Answer 66

= home use primarily as backup system in cae the concentrator fails or these is a power outage - can be used for infants who require very little flow, or if flows higher than concentrator capabilities are required

Answer 67

used in hospital setting in areas that lack piped wall gas and during patient ambulation or transport

Answer 68

Duration of flow= [gauge pressure (psi) x cylinder factor] ፥ flow (L/min) → ፥60 PSI= 2200 E tank → 0.28 H tank → 3.14

Answer 69

efficient way to store supplemental oxygen

Answer 70

holds between 45 and 100 pounds of LOX

Answer 71

LOX weight in pounds to volume of gaseous O2 in liters

Answer 72

vaporizes into 860L of gaseous O2

Answer 73

equals approximately 344 L of gaseous O2

Answer 74

→ total available gaseous O2 ፥ prescribed flow (L/min) - portable LOX systems are used in conjunction with a stationary base unit - typical portable unit holds about 1L of LOX and weighs less than 6 pounds

Answer 75

- cylinders can last longer with O2-conserving device - O2-conserving devices minimize O2 waste that occurs during exhalation with standard nasal cannula - can reduce 50-75%, doubling or tripling duration of flow from bulk sources

Answer 76

= store O2 in a small reservoir during exhalation and release it during inhalation - bulky appearance not well tolerated by patients

Answer 77

= these systems trigger a valve that delivers O2 only during inspiration - flow must be individually adjusted to achieve desired SpO2 - if fails →patient must switch to continuous O2 source at 2-3 times the conserving device flow

Answer 78

the patient has control over his or her upper airway function, can manage secretions, and is cooperative and motivated

Answer 79

- to avoid intubation of patients in hypercapnic respiratory failure (COPD) - to avoid reintubation of patients after extubation - to treat patients with acute cardiogenic pulmonary edema - to treat patients with sleep apnea (CSA) - to support patients with chronic hypoventilation syndromes - to alleviate breathlessness and fatigue in terminally ill patients

Answer 80

- Local skin damage from the mask - Mild stomach bloating - Dry mouth - Leaking from the mask, causing less pressure to be delivered - Eye irritation - Trouble clearing phlegm - Sinus pain or sinus congestion - Anxiety or claustrophobia preventing you from keeping mask on and cooperating with ventilator

Answer 81

Tv → aiming for 6-8 mL/kg Pressure limit → IPAP= 10-15 Rate → backup rate at least 8 Trigger/sensitivity → 1-2cm H2O below baseline or 1-3L/min below baseline flow Flow, I:E ratio → in 20-30% range FiO2 → 40% Flow waveform → no spiking PEEP → EPAP= 5

Answer 82

To INCREASE pH or DECREASE PaCO2 → INCREASE IPAP or INCREASE PEEP TO DECREASE pH or INCREASE PaCO2 → DECREASE IPAP or DECREASE PEEP

Answer 83

- condensation can trigger breaths without pt effort; proper tubing replacement can help avoid occlusion of side stream sampling systems - with heated humidifiers or any nebulizer - use large-bore corrugated tubing with water trap/drain to avoid blockage by condensation - HME or heated wires can eliminate condensation → a little is acceptable - prevent accidental drainage into pt airway

Answer 84

electrically powered device that physically separates the O2 in RA from nitrogen (N2)

Answer 85

sodium-aluminum silicate pellets to absorb nitrogen, CO2, and water vapor and produce about 90-95% O2 at flows up to 10L/min

Answer 86

1-6L for adults with 22-45% FIO2

Answer 87

LPM x 4 + 20

Answer 88

- Blood clot (CVT or pulmonary embolism) - Heart failure - Pulmonary edema - Infection → pneumonia - scarring of lungs → pulmonary fibrosis - Asthma - COPD - Drug overdose

Answer 89

aka T-piece;patient is only breathing on oxygen - an instrument used in weaning of a patient from ventilator during spontaneous breath trials

Answer 90

=most common plotting format used for statical Q/C plots individual values for control media over multiple measurements and compares these values with mean and standard deviation (+-2) of data

Answer 91

- shake canister - wait less than 1 minute between puffs - have patient hold breath for 10 seconds to allow MAXIMUM DRUG DEPOSITION

Answer 92

- correct patients technique - higher inspiratory flows are needed (greater than 60L/min) - breath hold not required

Answer 93

= provide humidification (and O2) for a bypassed upper airway and reduce inflammation for patients with upper airway edema - large volumes with high output of aerosol - interface include t-piece

Answer 94

= delivers aerosolized medications - input gas flow 6-8L/min for optimal particle size

Answer 95

= small is to deliver inhaled medications while large is to help thin secretions or for sputum induction - high volume and high density

Answer 96

= deliver inhaled medications - agitation created by vibrations creates aerosol droplets - preferred with mechanically ventilated patients

Answer 97

= A contagious chronic bacterial infection that primarily affects the lungs - fever - night sweats - cough - weight loss TB pathogen, Mycobacterium tuberculosis—a rod-shaped bacterium with a waxy capsule Anatomic: - Alveolar consolidation - Alveolar-capillary destruction - Caseous tubercles or granulomas - Cavity formation - Fibrosis and secondary calcification of the lung parenchyma - Distortion and dilation of the bronchi - Increased bronchial airway secretions Diagnosis: - Mantoux tuberculin skin test - Acid-fast bacilli (AFB) sputum cultures - The QuantiFERON-TB Gold (QFT-G) test - The rapid Xpert MTB/RI assay CXR →may show infiltrates or cavities, interstitial markings bilaterally, increased opacities, calcifications, fibrosis

Answer 98

- Pharmacologic agents - Consists of 2 to 4 drugs for 6 to 9 months - Isoniazid (INH) and rifampin (Rifadin) are first-line agents prescribed for the entire 9 months - Isoniazid is considered to be the most effective first-line antituberculosis agent - Rifampin is bactericidal and is most commonly used with isoniazid - When the TB is resistant to one or more of these agents, at least three or more antibiotics must be added to the treatment regimen and the duration should be extended - Oxygen therapy protocol - Airway clearance therapy protocol - Mechanical ventilation protocol - Infectious control measures protocols

Answer 99

Tidal Volume (L) / Inspiratory Time (s) x 60

Answer 100

→ 4-12L/min →24-50% for unstable COPD - provide stable FIO2 to provide total flow of at least 40 L/min

Answer 101

→ 10-15L/min → 28-100% - for patients with artificial airways requiring low to moderate FIO2 - post-extubation or post upper airway surgery

Answer 102

= involves the collection, measurement, and reporting of selected lab tests at or near the site of the patient care - ABG

Answer 103

= should be set at 100mL lower than expired mechanical tidal volume - alarm triggered if patient does not exhale an adequate tidal volume

Answer 104

= should be set at 10-15cmH2O below the observed PIP - alarm triggered if PIP is less than alarm setting

Answer 105

= should be set 10-15cmH2O above observed PIP - alarm triggered when PIP is equal or higher than the high pressure limit

Answer 106

= should be set 15-20 seconds time delay - triggered in circuit disconnection, ET suctioning

Answer 107

= should be set at 10/min over the observed frequency - triggering is a sign of respiratory distress

Answer 108

should be set 5-10% over and under analyzed FIO2

Answer 109

- check probe position - warm probe site - fingernail polish Check heart rate manually to see if sensor is working

Answer 110

= to obtain VC and other volumes as well as flows to help determine the presence and the severity. of obstructive and restrictive disease processes - 2 largest FVC and FEV1 measurements must be within 200mL or % of each other

Answer 111

patient hesitated → greater than 5% FVC or 150mL

Answer 112

= calculates how much gas patient can move in a minute - patient deeps breaths and rapid for 12-15 seconds

Answer 113

= to measure amount of CO that crosses the alveolar-capillary membrane in units of mL per minute per unit of pressure - 25-30% - helps quantify the diffusing capacity of lungs - single inhalation of gas that includes small amount of CO and He with 10 second breath hold

Answer 114

1. inject 3L of room air into the spirometry 2. occlude the breathing circuit at the patient interface 3. use manufacturer recommended method to pressurize the system to 3cmH2O 4. observe for any change in volume over 1 minute 5. ATS volume accuracy standard for diagnostic spirometers is +3 or +50mL

Answer 115

= simple disposable indicator devices to help patients perform slow, deep breaths accompanied by a breath-hold (sustained maximal inspiration) - patient must be able to cooperate and general a INSPIRATORY capacity that is at least ⅓ of predicted values

Answer 116

→ patient cant cooperate or generate IC greater than 33% predicted - not inhaling fast - not blowing into device

Answer 117

ETT or trach ID size x 2 → choose next smallest catheter size

Answer 118

= -100 to -150mmHg - negative pressure

Answer 119

remove air or fluid from the pleural space via tube properly positioned inside the chest cavity

Answer 120

prevent air from returning to the pleural space

Answer 121

for adjusting the negative pressure applied to the chest tube

Answer 122

for gathering fluid aspirated through the chest tube

Answer 123

= initially contains 100mL sterile water - long tube submerged in exactly 2cm of water (water seal)

Answer 124

chamber 1 collects all pleural fluids. chamber 2 remains constant and the work of spontaneous breathing is unaffected

Answer 125

chamber 1 collection chamber of pleural fluid. chamber 2 water seal chamber with 2cm of water and acts as water seal. chamber 3 suction chamber regulates amount of suction in the three-chamber system

Answer 126

pinch the chest tube near its insertion point into the patient

Answer 127

= for emergencies, short term therapy requiring high FIO2, or for heliox therapy - minimum 10L/min to prevent bag collapse - 60-80% FIO 2

Answer 128

= helium with oxygen that can help decrease the work of breathing, especially in patients with large airway obstruction or severe asthma - 1.8 for 80/20%*** - 1.6 for 70/30% - 1.4 for 60/40%

Answer 129

short self test

Answer 130

= used on intensive care ventilation 1. inspiratory limb that delivers fresh gas from ventilator to patient 2. a standard 15-mm patient connector/swivel adapter 3. expiratory limb that directs expired gas to the ventilator expiratory valve or PEEP/CPAP valve

Answer 131

used in home care of transport ventilators

Answer 132

noninvasive ventilators

Answer 133

= used to aid secretion clearance, help prevent or treat atelectasis, and reduce air trapping in asthma and COPD - generate 6-25cmH2O pressure during exhalation - allow unrestricted inspiration

Answer 134

patient exhales against a threshold resistor with an expiratory valve oscillating at 10-30Hz

Answer 135

= monitors employ a sensor with miniaturized PO2 and PCO2 electrodes like those in lab ABG analyzers along with heating element - heating elemental “arterialized” the blood by dilating the underlying capillary bed and increased its blood flow - oxygen and CO2 diffuse from capillaries through the skin and into the sensor’s contact gel, where their pressure are measured by electrode

Answer 136

- elevate head of bed 30-45% - implementing sedation vacations and SBTs - providing peptic ulcer disease prophylaxis - providing oral care with chlorhexidine - using subglottic ETTs that remove secretion above ETT cuff - in-line or closed-suction catheter to avoid breaking the circuit

Answer 137

1. measure CO2% 2. confirm three levels of measurement 3. adding a high-precision gas with 10% CO2 (PCO2=76mmHG) - tap the syringe to fix air bubbles

Answer 138

a medical device that measures gas pressure and gas flow rate for respiratory equipment

Answer 139

A dead weight tester can be used to calibrate a Bourdon tube pressure gauge by adding weights to a platform that puts a known force on a piston

Answer 140

a medical instrument that measures the flow rate of gases, such as oxygen

Answer 141

- Turn the selector ring until the arrow is above the green "continuous flow" - Turn the white flow control knob until the red ball is at the same height as the indication line on the Thorpe tube - Turn the selector ring to the right until the arrow is above the desired therapy level

Answer 142

used to assess rhythm disturbances, determine the heart’s electrical axis, and identify the site and extent of myocardial damage

Answer 143

- verify ECG snaps and connectors are clean and corrosion free - verify lead electrodes are connected properly to patient - electrode gel is not dry - check ECG main cable - confirm patient is motionless - verify device’s setting

Answer 144

left or right atrial hypertrophy (enlarged muscle)

Answer 145

greater than 0.45 seconds, MI

Answer 146

less than 0.30 seconds, electrolyte imbalance, digoxin

Answer 147

less than 0.60 seconds, tachycardia

Answer 148

greater than 1.00 second, bradycardia

Answer 149

non-ST elevation, MI/infarction (NSTEMI)

Answer 150

ST elevation, MI/infarction (STEMI)

Answer 151

hyperkalemia

Answer 152

MI, hyperventilation, pulmonary embolism

Answer 153

- vinegar - soap and water

Answer 154

the destruction of all forms of microbial life, including bacteria, viruses, spores, and fungi

Answer 155

liquid chemical solution can be achieved in 20 minutes at room temperature, but true sterilization requires full 10 hours

Answer 156

- blunting of costophrenic angle - partial to complete opacification of affected half of thorax

Answer 157

regions of darkness around the lungs

Answer 158

cannot be shown in CXR directly if they do not have fluid in them

Answer 159

- substances denser than air, pus, edema, blood, surfactant, protein, or cells - loungers in the lung parenchyma - small patchy opacities scattered in the lungs

Answer 160

- dependent opacities with lateral upward sloping - looks more like fluid in lungs rather than blurry opacities such as hemothorax

Answer 161

bubbles on the skin that produce a crackling sensation seen in subcutaneous emphysema - conjunction with pneumothorax

Answer 162

< (less than) 80% predicted and FEV1/FVC ratio < 70%

Answer 163

Normal FEV1% (FEV1/FVC x 100) - 70% or more for most patients

Answer 164

% change= post – pre ፥ pre x 100

Answer 165

- dizzy - lightheaded - tired - cough

Answer 166

Able to assess and confirm patient’s overall cardiopulmonary status EET-> 5-10 above carina

Answer 167

areas of increased whiteness → high-density objects (bone)

Answer 168

areas of darkness → low-density mattern (air)

Answer 169

areas of darkness → low-density mattern (air)

Answer 170

patient’s sensation of uncomfortable breathing when lying down → find relief when sitting or standing up

Answer 171

Modified borg scale → 0 representing non sensation of SOB/10 representing maximum sensation of SOB Graded cardiopulmonary exercise test → 6 minute walk test (6MWT) → 0=none, 4=severe

Answer 172

- tachypnea - thoracic-abdominal dyssynchrony or paradox (see-saw motion) -x use of accessory muscles

Answer 173

a mathematical formula used to determine the percentage of blood that bypasses the normal gas exchange process in the lungs

Answer 174

Shunt equation→ Qs= CcO2 - CaO2 —-------------------- Qr= CcO2 - CvO2 1.PAO2= (PB- PH2O) FIO2 - PaCO2 (1.25) 2.CcO2= (Hb x 1.34) + (PAO2 x 0.003) 3.CaO2= (Hb x 1.34 x SaO2) + (PaO2 x 0.003) 4.CVO2= (Hb x 1.34 x SVO2) + (PVO2 x 0.003)

Answer 175

→ RV= FRC – ERV, TLC= FRC + IC - helium dilution and nitrogen washout methods both measure actual FRC - Body plethysmography measures total Thoracic Gas Volume (TGV)

Answer 176

“trapped” gas that is not in communication with the airways

Answer 177

= assessed by measuring the transfer of carbon monoxide (CO) from the lungs into the pulmonary capillaries - single-breath test is the most common procedure

Answer 178

- monitor airway tone of patients with asthma over time - assess changes in airway tone in response to bronchodilator therapy (FEV spirometry) - a post-bronchodilator improvement of 12% or more is considered significant

Answer 179

- screen for lung dysfunction suggested by history and physical indicators or other abnormal diagnostic tests - asses changes in lung function in response to treatment - assess the risk for surgical procedures known to affect lung function - monitor disease progression

Answer 180

- confirm the need for bronchodilator therapy - individualize the patient’s medication dose - determine patient status during acute and long-term drug therapy - determine if a change in dose, frequency, or medication is needed

Answer 181

- quantify the severity and prognosis associated with lung disease - follow up on bedside spirometry results are not definitive (restrictive) - assess the potential pulmonary effects of environmental or occupational exposures - assess the degree of pulmonary impairment for rehabilitation or disability claims

Answer 182

- follow course of interstitial lung diseases (pulmonary fibrosis and pneumoconiosis) - follow course of emphysema and cystic fibrosis - differentiate among chronic bronchitis, emphysema, and asthma in obstructive patients - quantify degree of pulmonary impairment disability - evaluate cardiovascular disorders

Answer 183

- assess the presence/severity of airway hyperreactivity - evaluate occupational asthma - determine relative risk of developing asthma - assess response to therapeutic interventions

Answer 184

used to assess neonates at 1 and 5 minutes after birth A= appearance (color) P= pulse (heart rate) G= grimace (reflex irritability) A= activity (muscle tone) R= respirations (respiratory effort) →m 0= absent, 1= slow, irregular, gasping, 2= crying, vigorous breathing

Answer 185

Normal APGAR score= 7-10 Intensive support for APGAR= 4-6 APGAR score 0-3 → resuscitation

Answer 186

Low pH, Elevated PaCO2, Normal HCO3

Answer 187

Low pH, Low HCO3, Normal PaCO2

Answer 188

High pH, low PaCo2, normal HCO3

Answer 189

High pH, normal PaCO2, high HCO3

Answer 190

Slightly low pH, Elevated PaCO2, Slightly elevated HCO3

Answer 191

Slightly low pH, Low HCO3, Slightly low PaCO2

Answer 192

slightly high pH, low PaCO2, normal or slightly low HCO3

Answer 193

slightly elevated pH, slightly elevated PaCO2, high HCO3

Answer 194

1. neurological injury 2. Sedation and analgesics (opioid) 3. Severe hypoxemia or hypercapnia

Answer 195

Mild impairment= 13-15 Moderate impairment= 9-12 Severe impairment (coma)= 8 and less → INTUBATE

Answer 196

Pulseless electrical activity= nons-shockable situations - asystole - CPR only - switch resecurer position every 2 minutes

Answer 197

measures carbon dioxide concentration in expired gases

Answer 198

= measurement and graphical display of CO2 levels, usually the end-tidal PCO2 or PETCO2 - in healthy adults → PETCO provides estimate of arterial PCO2 2-5 torr less than ABG or 30-45 torr - INCREASE in PaCO2– PetCO2= increase in physiological dead space

Answer 199

- sudden increase in cardiac output (ROSC) - sudden release of a tourniquet - injection of sodium bicarbonate - tracheal intubation

Answer 200

- hypoventilation - increased metabolism/CO2 production (fever) - rapid rise in temperature (malignant hyperthermia)

Answer 201

- sudden hyperventilation - sudden drop in cardiac output/cardiac arrest - massive pulmonary/air embolism - circuit leak/disconnection - esophageal intubation - ETT/trach tube obstruction or dislodgement

Answer 202

- hyperventilation - decreased metabolism/CO2 production - decreased pulmonary perfusion - decrease in body temperature

Answer 203

= indicates low SaO2 associated with poor oxygenation of blood by the lungs - blueish tint of the mucous membranes of the lips and mouth - Normal Hb content → SaO2 drops below 80% (PaO2 45-50 torr)

Answer 204

= poor blood flow - appear in only extremities - can occur in normal SaO2 saturation

Answer 205

central and peripheral cyanosis present with cool extremities

Answer 206

= (C = ΔV / ΔP) - determine plateau pressure forming an inspiratory pause maneuver (while employing a square inspiratory flow pattern) during volume-targeted ventilation - should be kept below 30cmH2O

Answer 207

no air movement in the lungs → 60-100cc

Answer 208

measure of the total impedance to inflation during ventilation-control ventilation → air movement in the lungs → 35-45cc

Answer 209

1. the pressure needed to overcome the elastic recoil of the lungs and thorax (Vt/Crs) on mechanical ventilation 2. the pressure due to airway resistance (Raw x V1) on mechanical ventilation - to assess how easily the lungs can expand and contract

Answer 210

- restrictive - results of inflammatory process that primary affects gas exchange areas of the lungs - alveolar consolidation - inflammation of the alveoli - atelectasis (aspiration pneumonia) - abnormal sputum examination - C-reactive protein elevated (<100mg/L)

Answer 211

- pink puffers - decreased DLco - permanent enlargement of the air spaces distal to the terminal bronchioles, destruction of their walls and without fibrosis - air trapping and hyperinflation - excessive bronchial secretions - bronchospasms - distal airway and alveolar weakening - high white blood cell count

Answer 212

accumulation of fluid in pleural space - infected - lung compression - atelectasis - compression of great veins and decreased cardiac venous return

Answer 213

- hand disease that occurs when lung tissue becomes damaged and scarred - thickened, stiff tissue makes it difficult for lungs to work properly - presence of high titers of antinuclear or rheumatoid factor

Answer 214

Total amount of air that the lungs can accommodate - capacities are 2 or more

Answer 215

= maximum pressure generated against airway occlusion at or near residual volume (RV) after successive inspiratory efforts for 15-25 sec NIF normal value= -80 to -120cm H2O NIF critical value= 0 to –20 or -25

Answer 216

= a test that measures the ratio of lecithin to sphingomyelin in amniotic fluid to assess the maturity of a fetus's lungs Normal: A ratio of 2.0 to 2.5 indicates normal fetal lung development Immature: A ratio of 1.5 or less indicates immature fetal lung development Transitional: A ratio of 1.51 to 1.80 indicates transitional fetal lung development Mature: A ratio of over 1.80 indicates mature fetal lung development

Answer 217

= present around week 35 - Reduces muscular effort - Works in tandem with the change in size of the alveoli - Can be measured in amniotic fluid - Determined by lecithin-to-sphingomyelin ratio (L/S ratio)

Answer 218

= viral infection of the upper airway that occurs most commonly in children 6 months to 3 years old - caused by parainfluenza virus, adenovirus, respiratory syncytial virus (RSV), or influence A or B - inflammation and swelling or subglottic tissue (larynx, trachea, and large bronchi) - barking cough - cold-like symptoms that become severe - tachypnea - lethargy - hypotonia - cyanosis

Answer 219

- “Steeple sign” Married and tapering airway below larynx due to subglottic edema → tracheal dilation possibly present if the film was taken during expiration - may appear normal (little or no evidence of supraglottic involvement)

Answer 220

= bacterial infection of the upper airway that occurs mostly in children 2-8 years old - WAS caused by haemophilus influenzae - NOW caused by staphylococcus aureus and group A streptococcus-associated epiglottis - inflammation and swelling of epiglottis aryepiglottic folds, and arytenoids → can lead to airway obstruction and death in HOURS - high fever up to 104 degrees celsius - irritability, anxiety - BS decrease - orthopnea or forward leaning preference - drooling

Answer 221

- lateral side - little to no evidence of subglottis involvement - “thumb sign” due to prominent shadow caused by a swollen epiglottis

Answer 222

= low volumes (unable for lungs to hold air) - FVC, IRV, ERV, RV, TLV - neuromuscular disorders, obesity, pulmonary fibrosis

Answer 223

less than 80% is restrictive

Answer 224

decreased or normal

Answer 225

increased or normal

Answer 226

= low flows (blocking air getting in) - FEV1, FEV1% (FEV1/FVC), PEFR, FEF 25-75% - asthma, COPD

Answer 227

Decreased or normal (80%)

Answer 228

decreased (less than 8%)

Answer 229

decreased volume and flows - FVC, FEV1, FEV1% DECREASED - cystic fibrosis

Answer 230

central cyanosis (lips and mouth are blue) on room air - preductal SpO2 that does not quickly normalize - lack of fetal movement - low heart rate - no crying - PaO2 needs to maintain at 55-80 torr with SpO2 of 88-95%

Answer 231

occurs where fluid builds up in the pleural space

Answer 232

→ dry cough, difficulty breathing, fever, chest pain Chronic pleural effusion treatment: - antibiotics - thoracentesis - steroids anti inflammatory drugs - bronchodilators Pleurodesis= procedure offered if thoracentesis didn't work

Answer 233

→ fever, chest pain, chills, cough, hiccups, rapid breathing Acute pleural effusion treatment: - antibiotics - diuretics - steroid anti-inflammatory - bronchodilator

Answer 234

= minute ventilation required needs to be increased → increase ventilatory frequency 1. Decrease or remove dead space 2. Increase Tidal Volume 3. Increase Respiratory Rate

Answer 235

1. FIRST- decrease FIO2 to less than .60 2. THEN - decrease PEEP

Answer 236

1. Increase Dead Space 2. Decrease the Respiratory Rate 3. Decrease the Tidal Volume

Answer 237

1. FIRST - increase Fio2 by 5-10% (up to 60%) 2. THEN - Increase PEEP levels by 5cmH20 until: - acceptable oxygenation is achieved - unacceptable side-effects occur (decrease in compliance, decrease in cardiac function, barotrauma)

Answer 238

- A improper small size tube can cause leaks with an excessive cuff pressure that can obstruct blood flow (ischemia) → tissue ulceration and necrosis → tracheomalacia - A improper big size and low cuff pressure can cause mucosal damage and leakage-type aspiration can occur → VAP

Answer 239

70-105mmHG

Answer 240

4.0-8.0 L/min

Answer 241

a mast cell stabilizer that prevents the release of inflammatory mediators, such as histamine and leukotrienes, which cause allergic symptoms and bronchoconstriction - managment of asthma

Answer 242

60-130 mL/beat

Answer 243

measure FRC, so the ERV from an SVC maneuver is used to calculate RV and TLV

Answer 244

a compact device that is placed on a laboratory bench to measure oxygen saturation and hemoglobin concentration

Answer 245

Clip: A soft clip is placed on your nose to ensure you breathe through your mouth, not your nose Mouthpiece: A disposable mouthpiece is attached to the spirometer Chair: You sit upright in a chair during the test

Answer 246

Treatment not working; no response to it

Answer 247

Pneumothorax

Answer 248

Low intravascular volume then flow decrease then vessels

Answer 249

Telling alveoli go inflate/helping them inflate

Answer 250

“Universal precaution” - basic level of infection control precaution example: glove

Answer 251

1. Hair/foot coverings 2. Gown 3. Mask 4. Goggles or face shield 5. Gloves

Answer 252

1. Hair/foot covering 2. Goggles or face shield 3. Mask 4. Gloves 5. Gown

Answer 253

Whooping cough

Answer 254

Used Clark electrode aka polarographic type or galvanic fuel cell to measure PO2 - failure to reach 100% or 21% may indicate damaged probe or defective analyzer

Answer 255

%predicted = actual / predicted x 100

Answer 256

[(3.00 — Liters) / 3.00] x 100

Answer 257

2 largest volumes for both FVC and the FEV1 are within 0.150L/150mL of each other

Answer 258

1. Calibration error message 2. Flagged results

Answer 259

LMA (cuff pressure max 60cmH2O)

Answer 260

- CO2 build up - rebreathing - asphyxia - barotrauma

Answer 261

high pressures and low Vt

Answer 262

large leak

Answer 263

describes the relationship between blood pH, ([HCO3-]), and the partial pressure of carbon dioxide (PCO2), showing how the respiratory system influences blood pH by regulating the level of CO2 through breathing

Answer 264

Have to increase EPAP

Answer 265

Don’t have to increase IPAP

Answer 266

An estimate of anatomical dead space

Answer 267

Normal= 80-120 Mild= 65-80 Moderate= 50-65 Severe= less than 50

Answer 268

Body plethysmography = evaluate airway responsiveness to provocation - identify obstructive lung diseases