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PCM III final exam > resp procedure > Flashcards

resp procedure Flashcards

1
Q

_______ can decrease peripheral circulation and cause a falsely lowered O2 saturation

A

hypothermia

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2
Q

fingernail polish cannot penetrate though it, what is the alternate site for O2 measurement?

A

ear lobe

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3
Q

which CXR view is typically done?

A

PA and lateral studies

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4
Q

which CXR view for bed bound patients?

A

AP view

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5
Q

when to order CXR

A
  1. suspecting disease of the lungs, mediastinum, heart, or chest wall
  2. suspecting systemic disease and suspicion of chest involvement
  3. monitor life-support devices to make sure it is inserted correctly
  4. pneumoperitoneum (gase in abdominal cavity)
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6
Q

on AP CXR view, which structure is falsely enlarged?

A

heart

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7
Q

ABG is used to determine

A
  1. pH of blood
  2. PaO2
  3. PaCO2
  4. HCO3
  5. O2 sat
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8
Q

most common sites to do ABG

A
  1. radial artery
  2. brachial arter
  3. femoral artery (used in ICU patients)
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9
Q

indications for ABG

A
  1. asses for hypoxia and severity
  2. evaluation of acid-base disorders
  3. assess need for home O2 use (chronic patients)
  4. measure CO-Hb levels in patients suffering from smoke inhalation or other exposures
  5. calculate arterial O2 saturation content
  6. blood sample in difficult draw patients (obese)
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10
Q

calculating arterial O2 saturation

A

ABG cannot differentiate between O2 and CO, so subtract O2 sat and CO-Hb to get actual O2 saturation

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11
Q

relative contraindications to ABG

A
  1. invasive procedure
  2. coagulopathy
  3. severe PAD with poor collaterals (Allen’s test)
  4. trauma or infection at draw site
  5. difficult to standarize d/t factors such as hyperventilation, breath holding, altitude, obesity
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12
Q

what degree should bevel be when inserting syringe for ABG?

A

45 degrees

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13
Q

equipments for ABG

A
  1. sterile gloves
  2. rolled towel to support wrist or elbow
  3. ice for transport to lab to slow down blood metabolism
  4. ABG kit
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14
Q

ET/NT tube intubate indications

A
  1. resp failure
  2. airway protection
  3. maintaince of airway
  4. help facilitate pulm tx and meds
  5. use pos pressure ventilation
  6. maintain adequate oxygenation
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15
Q

ET/NT tube intubation contraindications

A
  1. operator unskilled
  2. excessive trauma to face, neck, c-spine (relative)
  3. inability to extend the head and neck (ET)
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16
Q

risk when sedating conscious patients for ET intubation

A
  1. rapid IV admin of sedative can cause sudden drop of BP

2. fast acting mm relaxant might cause arrhythmias and post-op myalgias

17
Q

blades used for ET intubation and location of insertion

A
  1. curved blade - into the vallecula

2. straight blade - below epiglottis

18
Q

verification of ET tube placement

A
  1. look for symmetrical rise of the chest wall
  2. listen for equal breath sounds b/l and over the epigastrium
  3. Do CXR to confirm placement is correct
19
Q

chest tubes indication

A
  1. pneumothorax causing resp distress
  2. hemothorax
  3. large pleural effusions causing resp distress
  4. empyema
  5. post thoracotomy
20
Q

chest tubes contraindication

A
  1. small pneumothorax not causing resp distress
  2. pleura adherent to the chest wall
  3. coagulopathy (relative)
  4. previous chest tube in the same site
21
Q

patient position for doing chest tube

A

lateral decubitous position with affected side up

22
Q

where to place the chest tube and why

A

5th and 6th intercostal space in MAL because are below this will risk injury to diaphragm or liver

23
Q

appropriate size chest tube for pneumothorax and hemothorax

A

pneumothorax - 22-24 French straight

hemothorax - 32-36 French straight of right angled

24
Q

where to anesthetize for chest tube

A

top edge of rib to avoid neurovascular bundle

25
Q

where to direct the tube after chest tube insertion

A

pneumothorax - posteriorly and toward apex

fluid - posteriorly

26
Q

what do you place around the tube exit site for airtight seal after placing chest tube?

A

petroleum gauze

27
Q

how to confirm placement of chest tube

A

CXR

28
Q

indications for spirometry/PFT

A
  1. screening
  2. diagnostic
  3. evaluate efficacy of tx
  4. tracking the course of disease
  5. disability determinations
29
Q

spirometry limitations and contraindications

A
  1. results very patient dependent
  2. severe debilitation and excessive tiring
  3. severe or moderately severe respiratory distress
  4. patient not motivated or desired to take the test
  5. medications affecting the resp cycle or function of the chest mm
30
Q

V/Q scan indications

A
  1. evaluate for presence of blood clots or other abnormalities in V and Q
  2. evaluate COPD or pneumonia
  3. detect PE
31
Q

V/Q scan contraindications

A
  1. kidney failure

2. allergy to radioactive materials

32
Q

V/Q scan risk

A
  1. radiation exposure

2. renal toxicity

33
Q

how do we use the results of PFT

A
  1. good correlation between FEV1 and ADL/work status
  2. FEV1 correlates better with exercise capacity than ABG
  3. FEV1/FVC

PCM III final exam (7 decks)

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