Therapeutic Procedures Flashcards by Shawn McGurran

To enhance a patient’s oxygenation, what are the positions you would recommend for the following patient diagnosis or conditions?

ARDS-CHF-obesity-unilatleral lung disease

Prone

Fowlers

Lateral Fowlers

Good lung down

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What procedure benefits patients by increasing their muscle, strength and endurance, decreases dyspnea, the need for medication and hospital visits

Inspiratory muscle training or IMT

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You should instruct a patient to use an inspiratory muscle training device twice per day for 10 to 15 minutes per session, building up to 30 minutes. You want to increase the resistance until their results are what percentage of their measured MIP?

30%

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What is the therapeutic procedure you would recommend for the prevention of atelectasis

Sustained maximal inspiration (SMI)

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Compared to preoperative inspiratory capacity, what is the postoperative goal in incentive spirometry?

1/2

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What are the five indications for IPPB therapy?

Prevention, or correction, of atelectasis in a patient, unable to take a deep breath

Prevention or correction of pulmonary edema.

Decrease the work of breathing (accessory muscles in COPD)

Distribute aerosols more evenly

Improved and promote the cough mechanism

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What are contraindications for IPPB?

Hypotension

Elevated intracranial pressures

Untreated pneumothorax

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What are five hazards of IPPB?

Hyperventilation

Impede venous return

Gastric distention

Pneumothorax

Excessive oxygenation and increased air trapping in patients with COPD

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You should adjust the IPPB sensitivity setting to be in what range

1.0 to 2.0 cm of H2O

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Decreasing the flow in IPPB will have what impact on the volume

It will increase the volume as the flow becomes more laminar

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What is the three reasons to provide bronchial hygiene therapy?

Improve mobilization of secretions

Prevent accumulation of secretions

Improve ventilation

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What does ciliary dyskinesia mean and what would be a therapy you could recommend?

Dysfunction of normal movement of the cilia

Bronchial hygiene therapy

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What are the four hazards or contraindications to bronchial hygiene therapy?

Unstable cardiovascular system

Unstable pulmonary system

Unstable, postoperative status

untreated tuberculosis

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What position would you recommend in bronchial hygiene therapy for the following? Patient conditions: hypoxic patients, obese patients with dyspnea, postop, abdominal surgery, patients, and patients with pulmonary edema.

Reverse trendelenburg or semi-fowlers

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What position in bronchial hygiene therapy would you recommend for a patient with very low blood pressure or who are obese and don’t have dyspnea

Trendelenburg’s

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Why would you use lateral Fowlers in bronchial hygiene therapy?

Very obese patients with air hunger

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What is the best position to prevent aspiration in bronchial hygiene therapy?

Lateral flat

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What is the position of the bed during bronchial hygiene therapy in patients with lingular or middle lobe consolidation?

Incline 12 to 14 inches or 15%

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What incline and positions should the patient be for postural drainage of the upper lobes?

Flat
Apical-semi fowlers with bed flat
Anterior-supine with pillow under butt
Posterior-sitting but leaning forward

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How high should you raise the bed for postural drainage of the lower lobes?

18 to 20 inches or 30%

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Please describe the patient position with respect to the bed for drainage of the superior segment to the lower lobes

Head of bed flat and patient prone with a pillow under their midsection

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What are hazards and contraindications to chest percussion?

Metastatic conditions
Pulmonary emboli
Tuberculosis
untreated pneumothorax
Pleural effusion
Hemolysis/pulmonary hemorrhage
Rib, fractures
soft tissue trauma

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If a patient does not tolerate manual percussion, what should be considered?

Mechanical percussion or vibration devices

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Vibration techniques can be used instead of just percussion, but I have the following associated contradictions?

Rib fracture or trauma
soft tissue trauma

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What type of cough is it when the therapist applies pressure on a patient’s abdomen during exhalation

Quad cough

What is the type of coughing with an open glottis and who is it recommended for?

Huff cough More effective impatience with COPD or head trauma to prevent increased intracranial pressures

What are some cough control techniques a respiratory therapist could recommend

Position relax between efforts Volume building -multiple inhalations Multiple cough with single exhalation Serial coughs-incremental depth and force Splitting over incision site

During pep therapy, what should exploratory pressures range from at mid exhalation?

10-20 cm H2O

What are the potential benefits of pep therapy?

Improve secretion expectoration Reduce residual volume Improve airway maintenance with cystic fibrosis pneumonia

What are the hazards to pep therapy that would cause you to discontinue the treatment

Sinusitis Epitaxis Middle ear infection

Breathing exercise utilized to improve mucus clearance, primarily in patients with cystic fibrosis and bronchiectasis, where a patient takes small breaths, then middle volume breast and then large breaths mobilize creations in the corresponding airways

Autogenic drainage

External percussive devices are indicated for patients who cannot tolerate other procedures. What is the Hertz you would order the treatment for and how long?

5-25 Hz for 30 minutes (1-6 times a day)

What is interapulmonary percussive ventilation?

Combination of high frequency, pulse deliveries of 100 to 250 cycles:minute of a sub-tidal volume and an aerosol to improve ventilation past obstructions for a better aerosol delivery and cough effectiveness

What is the recommended starting source pressure for most patients during intrapulmonary percussive ventilation

30 psi

What are the two names for the device that delivers a deep inspiration by positive pressure, followed by a one to 2 second breath hold and then negative pressure exsufflation to create a cough?

Insufflation/exsufflation device or Manually Assisted Coughing (MAC)

What are the reasons you would discontinue bronchial hygiene for complications or because therapy goals were met

Hazards occur-dizziness, SOB, cyanosis,etc Patient is ambulating well with clear breath sounds and x-ray has a strong cough and is afebrile for 24 hours

How would you check proper function of a bubble humidifier?

Including or pinching the connecting tubing and listening to the whistling sound as t he he pop off alarm is activated, at 2 psi or 40 mm Hg

What are goals of aerosol therapy?

Relieve bronchospasm and mucosal edema Thin secretions Humidification Deliver drugs

What are four hazards of aerosol therapy and how would you treat each?

Broncospasm-treat with bronchodilator Secretion, swelling, the airway-suction Fluid overlord with CHF, renal failure, and infants -monitor and output and weight Cross-contamination- antibiotics

What is important to remember when using a blender with a large volume nebulizer?

Set the blender at the desired FiO2 Close the air entrainment port on the LVN

What is a small particle aerosol generator or SPAG, unit used for?

To deliver Ribavirin (I.e. Virazole) for treating RSV

What type of nebulizer has the highest aerosol output and what is it used for?

Ultrasonic nebulizer Sputum inductions

What are the advantages to an vibrating mesh nebulizer (aerogen)

Very small particles Low residual volume No flow is added, if used with mechanical ventilation

What are two drugs delivered by meter dose inhaler, they’re not typically delivered by small volume nebulizer

Long acting beta agonist (salmeterol and formoterol) Mast cell stabilizer (cromolyn sodium, nedocromil sodium)

Why are dry powder inhalers, or DPI’s, easier to use the MDI’s?

Coronation and timing is not as important

What are the two types of drugs delivered by DPI?

Long acting, beta agonists Inhaled corticosteroids

What oxygen flow is necessary to flush out exhale CO2 in simple and partial rebreather masks

6-10 LPM

What is FO two delivery of a simple mass, partial, rebreather, mask, and nonrebreather mask

Simple mask = 40 to 55 Partial rebreather mask = 60 to 65 Non-mask = 21 to 100%

What are some indications for a nonrebreather mask?

Pneumothorax CO poisoning CHF Burns Mixed gas therapy

What is the flow range needed with an oxygen hood to prevent CO2 buildup and maintain FiO2?

7 to 14 L per minute

What are the associated risks with an oxygen hood?

Overheating can cause dehydration and apnea. Under heating can increase O2 consumption. can amplify sounds

What are hazards of an isolate or incubator?

Thermal burns Electrical shock Oxygen toxicity Fire Toxic inhalation Hearing damage

What is the purpose of a radiant warmer?

Provides a neutral thermal environment that will not negatively impact insensible water, loss and premature infants because of evaporation 2. ideal for unstable newborns who require constant care

What is the advantage of a bourdon gauge?

The position of the tank is not a factor

What is the formula for duration of cylinder flow?

Gauge pressure in psi X tank factor/liter flow Change to hours E cylinder= 0.3 H cylinder= 3.0

What is the total flow and oxygen percentage calculations and what are the ratios and factors for 28% and 40% oxygen?

Total Flow=Flowmeter setting X Factor 28%= Ratio of 10:1, factor of 11 40%=Ratio of 3:1, factor of 4

On a blender, the low pressure alarm would indicate inlet pressures below what level

Below 40 PSI

What is the accuracy or precision with an air-oxygen proportioning blender?

Plus or minus 3%

What are the two types of oxygen analyzers?

Galvanic fuel cell-electron flows result of the oxidation/reduction of O2 Polarographic-similar to galvanic fuel needs a battery to polarize the electrodes

What is the accuracy requirement for an oxygen analyzer and how would you troubleshoot if it’s not reading correctly?

+/- 2% Ensure there’s no water I’m sensor, pressure changes and recalibrate

What is the purpose of CPAP?

Improve oxygenation Support oxygenation at lower FiO2’s

Why would you recommend sputum induction?

Patient with suspected pneumonia who don’t have a productive cough

What are the steps to a sputum induction?

Collect specimen early in the morning Have patients remove dentures. Have patient rinse or gargle with water. Administer prescribed bland aerosol therapy Have patient, cough and specimen

What is an adverse reaction to sputum induction?

Wheezing due to Broncospasm

How do you screen a sputum sample to verify that came from the lower respiratory tract and is not saliva?

Count the number of squamous epithelial cells. It should be less than 25 squamous cells per low power microscope field

What are the five medication types that can be delivered by small volume nebulizer?

SABA-abuterol Anticholinergic-ipatroptium bromide Corticosteroids-budesonide Mucolytic-pulmozyme Antibiotic-tobramycin

How does an anticholinergic work

by blocking the action of acetylcholine on muscarinic receptors in the airway smooth muscles. This leads to bronchodilation, reducing bronchospasm and airway resistance, which helps improve airflow and ease of breathing

when utilizing an inspiratory muscle training device, the respiratory therapist will set the resistor at what level?

The lowest available resistance setting