Patient Assessment

Question 1

Crackles

Answer 1

When air move through excessive fluid or secretions in the airways, when collapsed alveoli pop open during inspiration.
May clear when the patient coughs

Question 2

Wheeze

Answer 2

Musical sounds heard from the chest of the patient with intrathoracic airway obstruction, narrowed or compressed airway as air passes through at a high velocity.
Causes:
-Bronchospasm
-Mucosal edema
-Increased mucus production
-Foreign object obstruction

Question 3

Stridor

Answer 3

Heard over the larynx and trachea during inhalation when upper airway obstruction is present because the upper airway tends to narrow during significant inspiratory efforts.
-May be heard without the aid of a stethoscope
-Epiglottitis or Croup
-Inflammation after extubation

Question 4

Diminished

Answer 4

The intensity of sound created by turbulent flow through the bronchi is reduced with shallow or slow breathing patterns.
-Major sedation
-Obstructed airways (mucus plugs)
-Hyperinflated lung tissue (Emphysema)
-Obesity
-Pneumothorax
Fluid (Pleural effusion)

Question 5

Pleural Friction Rub

Answer 5

As creaking or grating sound that occurs when the inflamed pleural membranes (pleurisy) rub together.
Very rare but may be heard in patients with pneumonia, pulmonary fibrosis, pulmonary embolism or after thoracic surgery.

Question 6

Rhonchi

Answer 6

Low-pitched wheezes or snore-like sounds indicating an obstruction or an increased amount of secretions in the airways.
-Usually caused by Pneumonia, Cystic Fibrosis or COPD

Question 7

Inspection

Answer 7

-Note breathing patterns
-Cyanosis
-Skin turgor
-JVD

Question 8

Peripheral cyanosis

Answer 8

Bluish color to the extremities (fingers, toes, tip of nose, lips and ear lobes).
This is related to inadequate circulation, cold patient, anxious patient, venous obstruction.

Question 9

Central cyanosis

Answer 9

Central cyanosis results from a decreased concentration of oxygen in arterial blood and may be the result of advanced lung disease or CHF.

Question 10

Jugular venous distention

Answer 10

Highly suggestive of right heart failure in older patients. When inspecting the patient, be sure to make a neck vein assessment.

Question 11

Apnea

Answer 11

The complete absence of spontaneous ventilation.

Question 12

Eupnea

Answer 12

Normal, spontaneous breathing

Question 13

Biot’s breathing

Answer 13

Short episodes of rapid, uniformly deep inspirations followed by 10 to 30 seconds of apnea. Described in patients with meningitis.

Question 14

Hyperpnea

Answer 14

Increased depth and volume of breathing with or without an increased frequency.

Question 15

Hyperventilation

Answer 15

Increased alveolar ventilation causing an increase in the PaCo2 to increase.

Question 16

Hypoventilation

Answer 16

Decreased alveolar ventilation causing a decrease in the PaCo2.

Question 17

Cheyne-stokes breathing

Answer 17

10 to 30 seconds of apnea, followed by a gradual increase in the volume and frequency of breathing until another period of apnea occurs.
-Associated with cerebral disorders or CHF.

Question 18

Kussmaul’s breathing

Answer 18

Both an increased depth and and rate
-Commonly associated with diabetic ketoaciodosis (DKA)

Question 19

Orthopnea

Answer 19

A condition in which the patient becomes dyspneic when laying down.

Question 20

Agonal respirations

Answer 20

Gasping respirations is an abnormal brainstem reflex breathing pattern.
-Possible causes include cerebral ischemia or extreme hypoxia.

Question 21

Palpation

Answer 21

Touching the patient to evaluate for the presence of pathology.
Evaluation of:
Crepitus
Fremitus
Thoracic expansion

Question 22

Crepitus

Answer 22

Feels like crackling under the skin caused by subcutaneous emphysema. (Air underneath the dermal layers)

Question 23

A full O2 cylinder contains what psig of pressure?

Answer 23

2200 psig

Question 24

H cylinder holds what cu ft. of oxygen?

Answer 24

244 cu ft. (6900 L) of oxygen

Question 25

E cylinder holds what cu ft. of oxygen?

Answer 25

22 cu ft. (622 L) of oxygen

Question 26

Green cylinder

Answer 26

Oxygen

Question 27

Brown cylinder

Answer 27

Helium

Question 28

Gray cylinder

Answer 28

Carbon dioxide

Question 29

Light blue

Answer 29

Nitrous oxide

Question 30

Ethylene

Answer 30

Red

Question 31

Air

Answer 31

Yellow

Question 32

CO2/O2

Answer 32

Gray and green

Question 33

He/O2

Answer 33

Brown and green

Question 34

What are regulators used for?

Answer 34

Regulators are attached to the cylinder valve to regulate flow and reduce cylinder pressure to a working pressure.

Question 35

Indications for O2 therapy

Answer 35

1. Hypoxemia
2. Labored breathing or dyspnea
3. Increased myocardial work

Question 36

Signs and symptoms of hypoxemia

Answer 36

1. Tachycardia
2. Dyspnea
3. Cyanosis (unless anemia is present)
4. Impairment of special senses
5. Headache
6. Mental disturbance
7. Slight hyperventilation

Question 37

Complication of O2 therapy 1

Answer 37

Respiratory depression:
COPD patients who are chronically hypoxic are most affected.
Maintain the PaO2 between 50 and 65 for these patients.

Question 38

Complication of O2 therapy 2

Answer 38

Atelectasis:
High O2 can wash out Nitrogen in the lung and reduce the production of surfactant.
Maintain FIO2 below 60%

Question 39

Complication of O2 therapy 3

Answer 39

Oxygen toxicity:
High oxygen toxicity may lead to ARDS. Maintain FIO2 below 60%.

Question 40

Complication of O2 therapy 4

Answer 40

ROP
Caused by high PaO2 levels in infants. Maintain PaO2 levels below 80 in infants. Normal is 50 to 70.

Question 41

Exam Note 1

Answer 41

When giving a patient 60% or higher FIO2, who is ventilating adequately (normal PaCO2) but has hypoxemia, place them on CPAP unless excessive pressures are not safe. (ICP, hypotension or a low CO) In this case, increase the FIO2.

Question 42

Exam Note 2

Answer 42

If a question states that a patient has been exposed to CO poisoning, always select a device that delivers 100% oxygen by a non-rebreather, CPAP or ET tube flow-by

Question 43

The blood carries Hb in 2 ways:

Answer 43

1. Bound to hemoglobin
2. Dissolved in plasma
   -The sum of these 2 mechanisms equals the total arterial O2 content of blood which is the most effective method for determining the O2-carrying capacity of the blood.

Question 44

Transtracheal catheter

Answer 44

Inserted directly into the trachea through an incision between the 2nd and 3rd tracheal rings.
-Delivers 22% to 35% FIO2 at flow rates of 1/4 to 4 LPM

Question 45

Nasal cannula

Answer 45

Delivers 24% to 40% O2 at flow rates of 1/4 to 6 LPM (at about a 4% increase for every 1 LPM increase.