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therapeutic procedures Flashcards

1
Q

Patient position to enhance oxygenation

Prone

A

ARDS

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2
Q

Patient position to enhance oxygenation

Fowler’s position

A

CHF
(30-35 degrees)

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3
Q

Patient position to enhance oxygenation

Lateral Fowler’s

A

obese patient

with air hunger

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4
Q

Patient position to enhance oxygenation

unilateral lung disease

A

good lung down

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5
Q

Inspiratory muscle training (IMT)

Ventilatory muscle training benefits patients by

A

increaseing their muscle strength and endurance, decreasing dyspnea and need for medication and hospital visits

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6
Q

Inspiratory muscle training (IMT)

progressive resistance

A

over time, greater resistance is imposed on the inspiratory muscles. to increase muscle strength and endurance

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7
Q

incentive spirometry

POST-opeative goal should be ____of the Pre- operative insp. capasity

A

one-half

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8
Q

incentive spirometry

if pt is unable to achieve targeted volume ….

A

check connection and pt mouth seal before reducing volume target

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9
Q

contraindications for IPPB

A
  1. unskilled practitioners and users
  2. hypotension
  3. untreated pnuemo
  4. elevated IC pressure
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10
Q

IS should be performed ___ while the pt is awake for approximately ___ breaths

A
  1. hourly
  2. 10 breaths
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11
Q

Indications for IPPB

A
  1. prevent/ correct atelectasis
  2. Prevent/ decrease pulmonary edema
  3. decrease wob (assesory muscle use, pt it COPD)
  4. distribute aerosols more evenly
  5. improve and promote the cough mechanism
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12
Q

Hazards of IPPB

Impening venous return - results in

A

decreased Cardica output ,
and incrased intracranial pressure

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13
Q

classification: Bird Mark

A
  • Pnumatically powered
  • Pressure cycled
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14
Q

How do we change the volume on a Bird Mark (IPPB)

A

change the pressure setting

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15
Q

if IPPB sensitivity is set too much it will

A

self cycle

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16
Q

Turning the knob higher on IPPB will cause

A

a greater flow ( decrease inspt time)

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17
Q

IPPB

increase pressure will____volume

A

increase

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18
Q

Bird Mark IPPB

decreasing the flow will

A

increase the volume

(increases inspiratory time)

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19
Q

Bird Mark IPPB

increasing flow will

A

increase turbulence and decrease volume

decrease inspiratory time

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20
Q

IPPB

fail to cycle off

cause

A

Leak
1. mouthpiece / mouth seal
2. cuff leak
3. fenestrated trach tube open
4. loose equpment connection

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21
Q

IPPB

If pressure does not rise normally (neddle reads low or neg)
it means…

troubleshoot?

A

there’s insufficient flow

troubleshoot: raise the flow

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22
Q

consider bronchial hygiene therapy for pt with

A
  • Cystic Fibrosis
  • Bronchiectasis
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23
Q

Position

Fowlers, Semi-fowlers or reverse trendelenburg

is best for

A
  • hypoxic pt,
  • obese pt with dyspena,
  • post-op abdominal surgery pt ,
  • pt with pulmonary edema
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24
Q

Body position

position for pt with low blood pressure or and obese pt with an order for bronchial hygiene therapy

A

trendelenburge

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25
Q

Body position
*Flat *

A

upper lobes

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26
Q

Body position
*down 15 degrees *

A

middle lobes

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27
Q

Body position
*down 30 degrees *

A

lower lobes

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28
Q

cough control techniques

small breath and cough, larger breath and cough, then deep breath and hard cough

this technique is called

A

Serial cough

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29
Q

cough control technique

coughing with an open glottis

this technique is called

A

Huff coughing

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30
Q

cough control technique

more effective in pts with COPD or head trauma to prevent increased IC pressures

A

Huff cough

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31
Q

Postive expiratory pressure therapy

PEP definition

A

application of expiratory positve airway pressure using a one-way insp. valve and one-way exp. flow resistor

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32
Q

PEP therapy

the exp. flow resistor prevents

A

end-expiratory pressure from falling to zero

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33
Q

PEP therapy

expiratory pressure
range

A

10-20 cmH2O at mid-exhalation

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34
Q

PEP tharapy is an

A

alterantaive airway clearance technique

hlep improve secretion expectoration, improve airway maintenance

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35
Q

instruction for PEP therapy

A

inspire a longer than normal Vt and exhale actively but nor forcefully (exhalation is 2-3 times longer than inspiration)

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36
Q

High Frequency Chest wall Compression devices are for what kind of pt ?

A

Patients who cannot use or tolerate other procedures

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37
Q

combination of high frequency pulse delivery of a sub-tidal volume and a dense aerosol

(100 -250 cycles/min)

A

intrapulmonary percussive ventilation

IPV

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38
Q

cought assit devices is also called

A

Insufflation/Exsufflation devices

Manual assited coughing (MAC)

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39
Q

indicated for patiens with neurologic problems or muscle weakness

A

Insufflation/Exsufflation devices

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40
Q

how does a cough assist device work

A

deliver deep inspiration by positive pressure, followed by 1-2 sec breath hold, then negative pressure exsufflation to create a cough

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41
Q

Goals of humidity therapy

A
  1. prevention of mucosal crusting
  2. compensate for a humidity defict
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42
Q

Proper humidity to maintain

A

44 mg/L at 37 °C
or 47 mmhg

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43
Q

humidifier

Used on low-flow oxygen delivery devices

A

bubble humidifier

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44
Q

Proper function of bubble humidifier should be checked by

A

occluding or pinching the connecting tubing and listening for the whistling sound

if no sound occurs, there is a leak

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45
Q

with bubble humidifiers, if whistling sound occurs without intentional occlusion then that means…

A

oxygen flow is excessively high
obstruction or kinking of tubing

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46
Q

other names for Heat moisture exchanger

A
  • hydroscopic condenser humidifier
  • artificial nose
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47
Q

HME is located

A

between the wye and the patient

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48
Q

Replace the HME if

A

airway pressure increases

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49
Q

Can deliver 100% body humidity

A

Wick humidifier

50
Q

Wick Humidifiers have low risk of cross contamination (nosocomial infection ) because

A

no particles are being produced

51
Q

Goals of Aerosol therapy

A
  1. relieve bronchospasm and mucosal edema
  2. to thin secretions
  3. to humidify
  4. administer drugs
52
Q

Medications that can be admistered by a hand held or small volume neb

A

short acting beta agonist
Anticholinergic agent
inhaled corticosteroids
Mucolytic agents
Antibiotics

53
Q

SVN vs. LVN

A

SVN - for small doses of medication
LVN - are utilized to deliver bland aerosols to upper airway to reduce chances of edema of humidity deficit

54
Q

TROUBLESHOOTING

LVN not misting enough due to clogged capillary tube

A

get new one

55
Q

Small particle aerosol generator (SPAG)

designed for?

A

designed to deliver Ribavrin (Virazole)
for treating RSV

56
Q

Can you use SPAG with another drug

A

no just Ribavrin

57
Q

Nebulizers

Recomended for thick tenacious secretions

A

Ultrasonic neb

58
Q

Ultrasonic neb

A

has the highest output range of all neb without heating

59
Q

Vribrating Mesh Neb

A

electrically powered neb which produces aerosols with small particles

60
Q

IS indication

A

prevention or treatment of atelectasis for pt who are able to spontanously take a breath

61
Q

Hazards of IPPB

Hyperventilation

patient will complain of …

A
  1. Dizziness
  2. tingling of fingers (excessive elimination of CO2)

instruct to breath slower

62
Q

Bird Mark 7 (IPPB) sensitivity setting

A

1.0-2.0 cmH2O

63
Q

What happends on the Bird Mark 7 (IPPB) if setting is set too sensitive

A

self cycling will occur

64
Q

On Bird Mark 7(IPPB) leaks in the circuit will prevent

A

normal cycling to exhalation

65
Q

Bird Mark 7 (IPPB)

Purpose of bronchial hygiene therapy

A

improve mobilization of secretions

66
Q

IPV

recommended starting pressure

A

30 psi

67
Q

IPV

the percussive effect of gas improves___past obstruction in the airway thereby delivering ___ aerosol to the ____

A
  • ventilation
  • more
  • distal airways
68
Q

What type of pathology would benefit from PEP therapy

A

Cystic Fibrosis
Pneumonia

69
Q

Discontinue PEP therapy if …

A

sinusitis, epistaxis or middle ear infection occurs

70
Q

Most humidifiers incroporate ___ set at approximately ___

A
  • pop-off valves
  • 2psig or 40 mmhg
71
Q

HME ideal use

A

patient transport and short term ventilation

72
Q

Two ways insufflation/exsufflation device is attached to pt

A
  • oralnasal interface
  • endotraacheal
  • tracheostomy tubes
73
Q

Hazards of aerosol therapy

A
  • Bronchospasm
  • secretion swelling and airway obstruction
  • Fuid overload
74
Q

how are SVN powered

A

by pressurized gas source

75
Q

Medications that can be deliverd by meter dose inhaler

A
  1. short acting beta agonis
  2. Long acting beta agosnis
  3. Anticholinergics
  4. Inhaled corticosteroids
  5. Mast cell stabilizers
76
Q

Spacer and Holding chambers

A

improves the efficacy of MDI by allowing. larger particles to attach to the walls of the device and decrease oral deposition

77
Q

provide only a portion of total inspired volume

A

low flow devices
(nasal canula, simple mask, partial-rebreather)

78
Q

Nasal Canula Flow

A

1-6 L/min

79
Q

How to estimate FiO2 for NC (low flow)

A

Start 24%
add 4% for every 1 l/min

2 L/min= 28% , 3L/min=32%

80
Q

Simple mask
Delivered FiO2 :
Flow :

A

Delivered FiO2 : 0.40-0.55
Flow :6-10 L/min

81
Q

Simple Mask: Flow must be at least___ to flush out __

A
  • 6L/min
  • exhaled CO2
82
Q

Partial rebreather mask
Delivered FiO2 :
Flow :

A

Delivered FiO2 : 0.60-0.65
Flow :6-10 l/min

83
Q

difference between partial-rebreather and non-rebreather mask

A

Partial: has no flap valves
NON: has three one way valves

Partial is a low flow, Non is a high flow

84
Q

provide patient’s entire inspired volume

examples

A

high flow devices
(non-rebreather mask, air entrainment mask , High flow nasal canula, T-piece)

85
Q

Non-rebrether mask
Delivered FiO2 :
Flow :

A

Delivered FiO2 : 0.21-1.00
Flow : must be sufficient to keep the bag from collapsing

86
Q

oxygen administration devices

used to deliver 100% O2 in an emergency

A

non-rebreather mask

87
Q

oxygen administration devices

What emergency requires 100% O2

A

Pneumothorax,
CO poisoning
CHF
Burns

88
Q

Non-rebreather: if bag does not slightly contract:

A
  • mask is not tight
  • nonrebreathing valve is stuck
    REPLACE MASK
89
Q

Can a non-rebreather be used for mixed gas therapy

A

yes

90
Q

delivers percise FiO2 concentrations

A

Air entrainment mas (venturi mask)

ideal for COPD

91
Q

HIgh Flow devices

ideal for patients with irregular VT, rates and breathing patters

A

Venturi mask

92
Q

High Flow devices

Should see aerosol from reservoir tubing during inspiration

A

T-peice

93
Q

troubleshoot

T- piece : if aerosol disappears

A
  1. increase the flow
  2. add more reservoir tubing
  3. set up a device to provide more flow (blender)
94
Q

T-pece should utilize reservoir to

A

maintain proper FiO2

95
Q

when do you use a Face Tent

A

Facial injury
Surgical treatment (mandible)

96
Q

High Flow Nasal Cannula

decribe

A
  • a humidification system that can heat and humidify oxygen at flow rates up to 40 L/min
  • O2 can be deliver by nasal cannula
97
Q

Can deliver 100% body humidity

A

HFNC

98
Q

Oxygen Hood
Flow range

A

7-14 L/min

99
Q

Reason for Flow range of oxygen hood

A

to prevent CO2 buildup and maintain FiO2 without sealing the infant’s neck around the hood

100
Q

OXY HOOD

what is the effect on the patient if the inspired air is overheating

A

can cause dehydration and apnea

101
Q

OXY HOOD

what is the effect on the patient if the inspired air is underheating

A

can increase O2 consumption

102
Q

Duratin of Cylinder Flow:

Formula

A

(Gauge presure (psi) x tank factor) / liter flow

103
Q

Total Flow
equation

A

= O2 flow x Factor

104
Q

Can be used with a non-rebrether mask to achieve a precise FiO2

A

Air-oxygen blender

105
Q

Air - oxygen blender need ____psi

A

at least 40 psi

106
Q

air compressor

description

A

provides a compressed gas source without using an air cylinder

107
Q

Can be used to power a hand-held neb for a pt with COPD in the home setting

A

air compressor

108
Q

CPAP

Purpose

A
  1. improve oxygenation
  2. support oxygenation at lower FiO2
109
Q

Nasal CPAP is useful for what type of pt

A

Neonates since they are obligated nose breathers

110
Q

What happends to the CPAP if infant begins to cry

A

can loose CPAP

111
Q

CPAP is not _____, its for _______

A
  • ventilation
  • oxygenation
112
Q

CPAP, EPAP, PEEP are pressures that

A

are maintain during exhalation

113
Q

CPAP: loss of pressure indicates

A
  • leak
  • insufficient flow
114
Q

CPAP: incresed pressure indicates

A
  • obstruction
  • with excessive flow, a continuous venting of the pop-off valve will occur
115
Q

Sputum induction is indicated for patients with

A

suspected pneumonia who do not have a productive cough

116
Q

Procedure for Sputum induction

A
  1. collect speciment early in the morning
  2. have pt remove dentures
  3. have pt rinse or gargle with water
  4. administer aerosol therapy
  5. instruct pt to cough deeply and expectorate into the speciment container
117
Q

IPPV is

pressure or volume cycled?

A

Pressure cycle

118
Q

Reasons IPPV does not reach the preset pressure

A
  1. leak
  2. not enough flow
119
Q

Vibrating Mesh Neb

A

used to diliver small amoutn of medication

120
Q

Therapy for atelectasis

A

CPAP

RTT (12 decks)

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