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Brian's Practice Course > Special Procedures - Flash Cards > Flashcards

Special Procedures - Flash Cards

1
Q

Which bronchoscope is typically used to remove FBA’s, and is used commonly as a distractor on the exam?

A

Rigid bronchoscope

*page D-5

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2
Q

While performing a bronchoscopy, what drug would you use to address serious bleeding?

A

Epinephrine

*page D-7

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3
Q

During a bronchoscopy, the patient experiences a sudden drop in heart rate. What does this indicate?

A

A vagal response

*page D-8

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4
Q

You are drawing an ABG sample from a patient on anticoagulant therapy. Should you apply pressure to the site? For how long?

A

Yes, apply pressure to the site. There is no correct amount of time to apply pressure. You apply it for as long as necessary.

  • page D-11
  • audio lecture 00:11:50 in Special Procedures
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5
Q

ABG machines are always at 37C on the exam. If a patient has a higher body temperature than the machine, what effect will it have on PaO2, PaCO2, and pH?

Conversely, what will happen to the gas if the patient is hypothermic and under 37C in body temperature?

A

If the patient’s temp is higher than the machine, PaCO2 and PaO2 will also be higher, and pH will move in the opposite direction.

If the patient’s temp is lower than the machine, PaCO2 and PaO2 will also be lower, and pH will move in the opposite direction.

  • page D-12
  • audio lecture 00:14:40 in Special Procedures
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6
Q

What gauge needle is used for most radial ABG’s? (not important)

A

20-22 gauge

*page D-12

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7
Q

Is PaO2 reliable when taken from a capillary blood gas?

A

No.

*page D-13

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8
Q

An FiO2 of 50% would produce a PAO2 (Alveolar) of what?

A

300

*page D-16

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9
Q

True or False:

A-a gradient should always be < Fio2 to be considered normal on the exam. For this reason, anything > 100 is abnormal.

A

True

*page D-16 (bottom of page)

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10
Q

What formula is the best measurement of oxygen “delivered” to the tissues?

A

Arterial oxygen content (CaO2)

Keyword “delivered”. Look for it on the exam.

*page D-17

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11
Q

True or False:

Cardiac output is associated with your calculated venous values (CvO2, SvO2)

If venous values are decreased, it indicates a drop in cardiac output.

A

True.

  • page D-17
  • audio lecture 00:47:00 in Special Procedures
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12
Q

True or False:

The difference between CaO2 - CvO2 will increase if venous values or cardiac output decrease.

A

True.

  • page D-17
  • audio lecture 00:48:00 in Special Procedures
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13
Q

Possible exam question:

A patient is suspected of having a pulmonary embolism. Which of the following calculations whould you recommend?

A

Deadspace to tidal volume ratio (Vd/Vt)

PaCO2 - PeCO2
_____________
PaCO2

Always associate deadspace with a pulmonary embolism, and recommend Vd/VT.

  • page D-21
  • audio lecture 01:02:00 in Special Procedures
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14
Q

Match the PaO2 value and FiO2 to the interpretation:

Choices:

Acceptable
Hypoxemia (poor ventilation or VQ mismatch)
Hypoxemia (shunt or refractory)
Hyperoxemia

  1. PaO2 80-100 on 21 - 100% FiO2, this is ___
  2. PaO2 < 80 on 21 - 59% FiO2, this is ___
  3. PaO2 < 80 on 60% FiO2 or greater, this is ___
  4. PaO2 > 100 on 21 - 100% FiO2, this is ___
A
  1. PaO2 80-100 on 21 - 100% FiO2 = Acceptable
  2. PaO2 < 80 on 21 - 59% FiO2 = Hypoxemia (poor ventilation or VQ mismatch) you increase Fio2
  3. PaO2 < 80 on 60% FiO2 or greater, = Hypoxemia (shunt or refractory) you start or increase CPAP or PEEP
  4. PaO2 > 100 on 21 - 100% FiO2 = Hyperoxemia, you decrease FiO2 first to under 60%, then decrease CPAP or PEEP.
    * page D-23
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15
Q

An ABG looks good, but the patient looks and feels bad. Which should you trust?

A

The patient

*page D-27

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16
Q

A patient is in respiratory distress due to inhaling smoke from an automobile fire, but their ABG results look normal. What do you suspect? How do you treat this patient?

A

CO poisoning. Give 100% O2 or hyperbaric O2 therapy.

CO poisoning is common with pt’s who inhale smoke, were in a fire, or attempted suicide by inhaling car exhaust fumes.

*page D-27

17
Q

A patient is in respiratory distress due to MVA trauma and you see PVC’s on the monitor. Your ABG results look normal. What do you suspect?

A

Anemia. You can only treat anemia by restoring Hb with a blood transfusion.

Anemia is common in pt’s who are post-op or trauma victims.

*page D-27

18
Q

You draw an ABG on a patient, and the results are normal. You return to the room a few minutes later and all of a sudden the patient is experiencing severe respiratory distress. What do you suspect?

A

Pulmonary embolism.

If you see “all of a sudden” on the exam, suspect PE.

*page D-27

19
Q

Common exam question:

There is a sudden fall in your patient’s pulse oximetry reading, but no change in the patient’s condition. What do you suspect is the problem? What should you do?

A

The probe is malfunctioning. Reattach or change it if necessary.

*page D-31

20
Q

At what percentage of COHb is carbon monoxide poisoning present?

A

> 20% COHb is considered carbon monoxide poisoning.

*page D-32

21
Q

True or False:

Co-oximetry and hemoximetry are used to diagnose CO poisoning, and are considered invasive

A

True

*page D-32

22
Q

Once capnography is set up, what should you do to correlate values with PaCO2?

What should you do if there is a sudden change in PETCO2?

A

Once capnography is set up, what should you do to correlate values with PaCO2? Draw an ABG.

What should you do if there is a sudden change in PETCO2? Draw an ABG.

*page D-34

23
Q

Possible exam question:

You have a patient on ETCO2 monitoring. the ETCO2 is low ( < 30) and the patient is tachypneic, but your ABG drawn 5 minutes ago is normal. What do you suspect?

A

Suspect increased deadspace, and a pulmonary embolism.

*page D-35 (graph)

24
Q

Possible exam question:

What 2 things should you always recommend in a smoking cessation program?

A

Group counseling/support

Nicotine replacement therapy

*page D-37

25
Q

You have a patient who is participating in a smoking cessation program. You suspect the patient is not being truthful about quitting. What are 3 ways that you can test the patient’s compliance with the program?

A

COHb levels in the blood (co-oximetry/hemoximetry)

Exhaled CO levels (FeCO)

Cotinine levels in urine/blood

*page D-37

26
Q

True or False:

Patient education/knowledge is a very important first step in managing asthma because it will help the patient to identify and avoid triggers.

A

True

*page D-41

27
Q

True or False:

Pulmonary rehabilitation is not intended to normalize PFT, ABG, etc.

A

True

It is unrealistic to try to normalize a chronic disease.

*page D-42

28
Q

True or False:

One of the most important long term benefits/goals of pulmonary rehabilitation is a decrease in a patient’s frequency of hospitalization.

A

True.

*page D-42

Brian's Practice Course (32 decks)

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