1
Deposition and particle size
- 2-5 microns for airway deposition (bronchodilators+steroids) - 1-2 microns for parenchymal deposition (antibiotics)
CO2 transporter by 6 different mechanisms:
- 3 mechanisms in the plasma - 3 mechanisms in the RBCs
What materials are used to construct cylinders?
- 3AA- heat-treated high-strength steel - 3AL- seamless aluminum alloy (can be stamped or spun into shape)
How often are cylinders tested?
- 3AL- 5 years - 3AA- 10 years
Normal forced expiratory flow rate 25%-75%
- 4.5 L/sec (270 L/min) for men - 3.5 L/sec (210 L/min) for women
BODY HUMIDITY ***
- 47 mmHg - 44 mg/L @ 37*C
SVN (small volume nebulizer)
- 50 mL reservoir tube helps increase aerosol deposition - average MMAD 1-5 microns - only 10% medication gets delivered to patient - must be in upright position - VERY INEFFICIENT
Average forced expiratory flow 200-1200
- 8 L/sec (480 L/min) men - 5.5 L/sec (330 L/min) women
Common abnormalities (anatomic shunt)
- CHF (ventricular septal defect) - intrapulmonary fistula (chest trauma damaging both pulmonary arteries and veins) - vascular lung tumors
Carbon Monoxide
- CO binds to Hb 210 times more quickly than O2 - prevents O2 from binding to Hb - curve shifts to the left
Evaluating lung ability to diffuse gases
- CO is used: this test is called Diffusion Capacity of CO test (D LCO) - measures amount of CO that moves across alveolar- capillary membrane into the blood at a given time
pH scale affected by
- CO2 - HCO3
2 Types Station Outlets
- DISS - Quick connect
Monoplace chamber
- O2 compresses chamber - breathing 100% O2 - only one person can be treated
Describe air entrainment masks
- O2 flows though the nozzle and entrains room air with it thru the entrainment port - O2 concentration depends on the O2 flow rate thru the jet nozzle, size of the jet nozzle, and size of the entrainment ports - works on bernoulli and venturi principles
Lactic acidosis
- O2 is inadequate to meet the tissue needs - alternate biochemical reactions are activated that do not utilize O2 - lactic acid= end product of process
List six factors that can affect the performance of a SVN.
1) nebulizer design 2) gas pressure 3) gas density 4) temperature 5) humidity 6) medication characteristics
Name 4 types of heating devices that can be used to increase the humidity output of an active humidifier.
1) simple HME's 2) heat and moisture exchanging filters 3) hygroscopic condenser humidifiers 4) hygroscopic condensers w/filters
Name two types of commercially available threshold resistors that are used to administer CPAP.
1) underwater seals 2) weighted ball receptors
(4) Main types of Hypoxia
1. hypoxic- RAW 2. anemia- Hb 3. circulatory- blood flow 4. histotoxic- poison (CO)
Cylinder factor: M
1.56
70:30 He:02 ratio
1.6x liter flow correction factor
If you use an O2 flowmeter to determine heliox flow, the actual flow is ____ x higher than your reading if using 80/20 mixture
1.8
80:20 He:02 ratio
1.8x liter flow correction factor
How many Pin combinations are there for the P.I.S.S. System
10
How many sites should be auscultated when listening to breath sounds?
10
A physician orders 40% O2 through an air-entrainment Neb for a patient with a minute volume of 12 LPM. What is the minimum neb input flow required to ensure the prescribed FIO2?
10 LPM
Board Exam question: A doctor orders 40% O2 via air entrainment nebulizer for a patient with a minute volume of 12 LPM. What is the minimum nebulizer input flow required to meet the patient's inspiratory demand?
10 Lpm
Bulk liquid oxygen supplies should not be closer than ____ to public sidewalks?
10 feet
What is the recommended dosage of continuous nebulization of albuterol?
10 mg/hr
How much above its filling pressure should a cylinder be able to hold?
10%
The breath hold improves aerosol deposition by approximately how much percentage?
10%
You are planning to transport a patient via ambu bag at 10 LPM to another acute care facility. The transport time is approximately 1 hour and 30 minutes. How many full E tanks (2000 psi) would you need to take with you?
2
PISS oxygen pin location
2 and 5
You start a COPD patient on a nasal cannula at 2 L/min. What is the maximum time that should pass before assessing this patients PaO2 or SaO2?
2 hrs
Multiple stage pressure reducing valve
2 or more single stages in a series - each stage reduces pressure a little more - each stage has its own pop-off or pressure relief valve (count number of pop-offs to know how many stages there are)
at what pressure will the pressure pop-off activate on a bubble bottle?
2 psi
What is therapeutic dose of NO?
2-80 ppm
Board Exam question: A patient is receiving from an "E" cylinder at 4 L/min through a nasal cannula. The cylinder pressure is 1900 psig. How long will the cylinder run until it is empty?
2.2 hr
Cylinder factor: G
2.41
Tank Factor for G Cylinders
2.41
cylinder factor: G
2.41
Total flow of an air entrained device
20 __ __ 100 __ Find the Ratio, add ratios then multiply added ratio to O2 input, (answer in l/m)
During hyperbaric O2 therapy at 3 ATA, what is the approximate half life of carbon monoxide in the blood?
20 minutes
Normal CaO2
20 vol%
Normal CcO2
20 vol%
Helium is most effective for therapeutic use when mixed with which of the following oxygen concentrations?
20%
Carbon monoxide has ____ times greater affinity to Hb than that of O2
210
boiling point of water
212 F, 100 C, 373 K
Size of E Cylinder
22 cu ft
Match the lab value with it's normal value=Total CO2
22-29 mEq/L
What is the PSI of a full Cylinder?
2200 PSI
What is the approximate duration of flow for 12 lbs of liquid oxygen running at 3 LPM?
23 hrs
What is the minimum criterion for how often an O2 delivery system should be checked according to the clinical practice guidelines from the AARC?
24 hrs
Size of H Cylinder
244 cu ft
Normal diffusion capacity of CO
25 ml/min/mmHg
A patient's new pressure is 30 cmH2O for this pressure he receives a volume of 800 ml. What is his compliance?
26.6 ml/cmH2O
Normal P50
27 mmHg
simple, wick, membrane, continuious positive airway pressure
3 types of passive humidifiers are ____ reservoir, ___ unit, and ____ devices? They are used for non invasive nasal ____ ____ ___ ___ ___or bilevel ventilation;
If tolerated, a specified postural drainage position should be maintained for at least how long?
3-15 minutes
Cylinder factor: H/K
3.14
Tank Factor for H Cylinders
3.14
What cylinder factor is used to calculate duration of flow for an H cylinder filled with air?
3.14
cylinder factor: H & K
3.14
What temperature is required to maintain a neutral thermal environment (NTE) in an Oxy-Hood for infants weighing 2500 g or more?
30 Degrees Celcius
recommendation if you are using passive humidification on invasive mechanical ventilation
30 mg H20/L
Which of the following measurements represent the presence of copious mucus production? a. 5 ml per day b. 30 ml per day c. 10 ml/day d. 20 ml/day
30 ml per
Normal PaCO2
30mmHg
Average IRV
3100 ml
freezing point of water
32 F, 0 C, 273 K
A 45 year old patient with congestive heart failure is receiving O2 through a 40% air entrainment mask. With an O2 output of 8 LPM, calculate total flow.
32 LPM
According to AARC Clinical Practice Guidelines, what is the percentage of volume goal must a patient achieve in order to prevent and treat atelectasis with incentive spirometer?
33%
A 45-year-old patient with congestive heart failure is receiving O2 through a 35% air-entrainment mask. With an O2 input of 6 L/min, what is the total output gas flow?
34 L/min
A 45-year-old patient with CHF is receiving O2 through a 35% air-entrainment mask with an O2 input of 6 LPM what is the total output gas flow?
34 LPM
The temperature of gas delivered to a patient's airway by a servo-controlled heated humidifier should be maintained at what temperatures?
35 *C
Normal PaCO2
35-45 mmHg
3 types of cylinders
3AA- produced from heat treated high strength steel 3A- made of carbon steel 3AL- constructed of specially prescribed seamless aluminum alloys
Which of the following would require humidification of oxygen gas via bubble humidifier?
4 LPM nasal cannula
Bubble humidifiers are of limited effectiveness at flows below which of the following flow rates?
4 Lpm
temperature, surface area, time, thermal
4 things that affect the efficiency of bubble humidifiers (all humidifiers) are ____, ___ ___, ____ of contact, and ____ mass;
How full should an SVN be?
4-5 mL (depends on residual/dead volume)
The normal red blood cell count is:
4-6 mill/cubic mm
Normal PvO2
40
A 27 year old patient is receiving O2 via nasal cannula at 5 LPM. What is the approximate FiO2 the patient is receiving?
40%
A 27-year-old woman received from the emergency department is on a nasal cannula at 5 L/min. Approximately what FIO2 is this patient receiving?
40%
A patient is receiving nasal O2 at 5 LPM. His respiratory rate is normal and consistent. What is the approximate FIO2 he is receiving?
40%
O2 concentrators that use semi-permeable membranes usually can provide what percentage of O2 at flows of 1 to 10 L/min?
40%
What is the upper limit of O2 concentrations available through tents?
40-50%
Absolute humidity of alveolar gas
44 mg/ml (100% humidified at body temperature)
what is the common pin for O2?
5 (but it can be 2-5)
What is the minimum flow setting for a simple mask applied to an adult?
5 L/min
What is the minimum flow setting for a simple mask being worn by an adult?
5 Lpm
A physician places a patient in respiratory failure on 100% O2. To avoid the hazards of O2 toxicity, you would recommend that every effort be made to reduce this FIO2 to less than 50% within what time frame?
5 days
physiologic, airways, mucociliary, body temps, hypothermia, bronchospasm
5 indications of using warm humidified gas are to maintain normal ______ conditions in the ____, normal function of _____ transport system raise ___ __, prevent intraoperative _____, and reduce ____ in asthmatics.
Normal C(a-v)O2
5 vol%
For patients receiving IS, what is the minimum number of sustained maximal inspirations per hour would you recommend?
5-10
How frequently are cylinders tested?
5-10 Years
In performing a sustained maximal inspiration during incentive spirometry, the patient should be instructed to do a breath hold of how long after each inhalation?
5-10 seconds
At what psi do all cylinders provide gas at?
50 psi
Large piston air compressors used in bulk systems typically can provide working pressures of:
50 psi
The pressure of O2 or air in a bulk supply O2 system must be reduced to a working pressure of:
50 psi
What is the maximum FIO2 expected to be delivered by most air entrainment masks?
50%
What is the maximum FIO2 expected to be delivered by most air-entrainment Masks?
50%
PO2 27= ____% saturation
50% (P50 no shift to curve)
O2 in storage must be retrievable to use at _____
50-55 PSI
To Verify tank, ensure PSI isn't below _____
500 PSI
Average Vt
500 ml
What is the relative humidity when the absolute humidity is 10 mg/L of water and the capacity is 18 mg/L of water?
55%
Normally, when using a 50psi flowmeter to power a SVN, what should the flow be set at?
6-10 Lpm
A venti-mask that delivers 1 liter of air for each liter of oxygen delivers ____ O2:
60
A true high flow O2 delivery system should provide at least what flow?
60 L/min
What is the minimum peak flow rate that must be generated to successfully use a dry powder inhaler?
60 Lpm
PO2 30= ____% saturation
60%
What is the approximate FiO2 that can be delivered with a partial rebreather mask?
60-65%
What is clinically acceptable for SvO2
65%
Which of the following flows is the minimum setting for a infant receiving oxygen by an oxyhood?
7 Lpm
Normal pH
7.35-7.45 <7.35= acidic >7.45= alkalosis
A well-fitted non rebreathing mask, adjusted so that the patient's inhalation does not deflate the bag (flows between 6 & 10 L/min), should provide inspired O2 concentrations in what range?
70 - 85%
Normal SvO2
75%
PO2 40= ____% saturation
75% (normal mixed venous)
Barometric pressure @ sea level
760 mmHg
A patient is wearing a Venturi mask oxygen device delivering 30%. The flowmeter is set at 9 LPM. What is the approximate total flow of the device?
79 Lpm
What liter flow to use for SVN?
8 LPM
To minimize the risk of ROP, the American Academy of Pediatrics recommends keeping PaO2 below what level?
80 mm Hg
To minimize the risk of retinopathy of prematurity (ROP) the American academy of pediatrics recommends keeping the PaO2 below what level?
80 mmHg
Normal PAO2
80-100
What is the normal range for PaO2? (include unit of measurement
80-100mmHg
Why do all hospitals now utilize liquid oxygen and not banks of cylinders?
860 time expansion
PO2 60= ____% saturation
90%
You design an air-entrainment system that mixes air with 02 at a fixed ratio of 1:7 (1 L Air to 7 L O2). About what O2 will this device provide?
90%
You design an air-entrainment system that mixes air with O2 at a fixed ratio of 1:7 (1 L air to 7 L O2). About what O2 will this device provide?
90%
What is the level of SpO2 typically associated with discontinuation of O2 therapy?
92%
Normal PaO2 of 100 mmHg has a Hb saturation of..
97%
PO2 100= ____% saturation
97% (normal arterial)
What level of purity does Oxygen have to be at?
99%
Drop off point of PO2
<60mmHg= big change in amount of O2 bound to Hb
PaO2 hypoxemia
<80
What does a rightward shift cause?
<pH >PCO2 >temperature >PPG
How RR affects PaCO2
> RR = < PaCO2 < RR = > PaCO2
Acute ventilatory failure
> pH < PaCO2 N HCO3 (24-48 hours, HCO3 decreases)
What does a leftward shift cause?
> pH <PCO2 <temperature <PPG HbF present COHb present
PaO2 hyperoxemia
>100
Normal P/F
>350 acceptable (<200= poor oxygenation)
Diffusion of pulmonary gases in the lungs
- a gas molecule must diffuse through the alveolar capillary membrane - the membrane consists of 9 levels - thickness of these levels is between 0.36 and 2.5 microns - normal circumstances the diffusion of O2 and CO2 is not impacted
Buffer systems
- ability of an acid-base mixture to resist large changes in pH - most important: H2CO3/NaHCO3 (carbonic acid/sodium bicarbonate)
Increase in VO2
- exercise - seizures - shivering - hyperthermia
Humidity characteristics
- exerts a partial pressure (PH20) - sometimes refered to as molecular water - can't see it, but you can feel it - can't transmit bacteria but it can grow it
Causes of capillary shunt-like effect
- hypoventilation - uneven distribution of ventilation (bronchospasm or excess mucous) - alveolar-capillary diffusion defect (not enough time for O2 equilibration) * O2 will treat these conditions
Decrease PAO2 (hypoxemia)
- hypoventilation (COPD, drug overdose, neuromuscular disease/conditions such as myasthenia gravis) - high altitudes - breathing gas mixture less than 21% O2
Cyanosis
- hypoxemia is severe - blue-gray discoloration seen in mucous membranes - decrease in HB at least 5g%
Chronic alveolar hyperventilation
- if patient on ventilator being hyperventilated >24-48 hrs - kidneys will attempt to compensate by excreting excess HCO3 - pH increases, PaCO2 decreases, HCO3 decreases (partial or complete)
Adjustable flow restrictors
- if you increase the drive pressure across a fixed resistance you will increase the flow - you can change the size of the opening by selecting the value you want - must use correct gas source (home devices=20 psi, hospital devices=50 psi)
Decreases O2ER
- increase CO - skeletal muscle relaxation - peripheral shunting - certain poisons - hypothermia - increase Hb - increase arterial O2
Dead space ventilation
- increase VD/VT= much of VE is wasted in ventilating non-perfused alveoli (must work hard to maintain VA) - clinically we use capnometers to analyze CO2 (put at net of ETT to check for CO2 from esophagus)
Factors decreasing C(a-v)O2
- increase in CO - skeletal muscle relaxation - peripheral shunting (sepsis, trauma) - certain poisons (cyanide prevents cellular metabolism) - hypothermia
P50 decrease (leftward shift)
- increase pH (decrease PCO2) - decrease temperature - decreased in 2-3 DPG - affinity for O2 increases
O2 toxicity
- increased radicals - turns type II cells into type I cells (decreases surfactant - less diffusion
Important things to remember- humidity therapy
- maintain adequate water supply - keep water at the appropriate level - ensure tight fittings of temperature probes, attachments, and the closing of device - use a water trap to capture condensation
Ventilation
- mass movement of gas in and out of lungs - carries O2 from atm to alveoli - carries CO2 from alveoli to atm
Condensation
- occurs when temperature decreases and gas can't hold as much moisture falls out of suspension - water pools at lowest point in tubing - can be hazardous to patient so use a water trap (if not using heated wire technology, NEED to use water trap)
HMEs best for:
- short term ventilation - patients with limited secretions - patients with normal body temperature
Continuous Supply System
A mechanism that delivers a gas or an aerosol throughout the ventilatory cycle.
Wood's Metal
A metal alloy commonly used in fusible plugs.
Fractional Distillation
A method of reducing air to its component gases using pressure and temperature changes
Decrease in VO2
- skeletal muscle relaxation - peripheral shunting - certain poisons - hypothermia
High flow set-ups
- some use humidifier and a blender to deliver high flows at a specific oxygen concentration - much quieter - supplies heated air if hypothermia is an issue
High flow nebulizers
- specific high flow nebs made to give high flows at high FiO2s - not entrainment device - requires two gas flows/sources - flows from 40-110 LPM depending on FiO2 - has a 38 mm fitting so device can attach to sterile water bottles - use primary gas to drive the nebulizer and add gas to nebulizer to increase flow to >40 LPM
Liquid Oxygen storage
- stationary unit that you refill the "portable" unit from (12-60 L) - smaller unit is used when you go "out" (0.5-1.2L) - only deliver 20 psi (so it cannot power equipment)
Principles of N20
- supports combustion, NF - thermal decomposition of ammonium nitrate
Concentrators
- take atmospheric air and produce enriched O2 - used in home or SNFs to deliver O2 - uses molecular sieves to separate O2 from the other gases in atmosphere (N2 removed via sodium aluminum silicate pellets) - flows <6L~93%O2 - outlet pressure 5-10 psi - 10L~50% O2
Thorpe tube
- tapered, hollow tube - gas flows thru unit and pushes the ball higher - the ball will raise to the point where the forward pressure keeps it up despite gravity trying to push it down
BANs (breath actuated nebulizers)
- the NEW "it" - nebulize only on inspiration - eliminates waste - increases delivered dose- 3x greater than other news - cost more but decrease treatment time and number of treatments needed
Passive Humidification- HME (heat and moisture exchange)
- theory behind how this works: exhaled gas contains 100% RH at 37*C - a device collects the exhaled moisture from the patient and when the patient takes another breath, the dry gas picks up moisture from the device
Alternating Supply System
- two banks of cylinders (primary- A, secondary- B) - each bank contains 1 day supply of oxygen - once bank is empty, it switches to other bank - you can remove empty cylinders and replace them with new full ones
Continuos Supply System
- two oxygen sources (primary and reserve) - NFPA states reserve should contain 1 day supply of oxygen - can be liquid/liquid (hospitals) or liquid/cylinders (nursing homes)
Heated wire circuit
- used in conjunction with a humidifier - used to decrease rainout/ condensation with humidifier - if not using this technology, then should use a water trap
Arterial-venous O2 content difference
- useful information in patients cardiopulmonary status - 5 ml of O2 are extracted from each 100 ml of blood for tissue metabolism
Piston air compressor
- uses action of motor-driven piston to compress atmospheric air - sealed with teflon or carbon ring - used to power vents
Jet nebulizer/large volume jet nebulizers
- uses bernoulli principle to produce aerosol - gas exits a restriction (drawn up capillary tube, fluid shattered into small particles) - if there is a baffle, decreased and more uniform particle size
Diaphragm air compressor
- uses flexible diaphragm attached to piston to compress gas - powers SVNs
A physician orders O2 for a patient with documented chronic hypercapnia and hypoxemia (PaO2=47 mmHg). What is the most appropriate action in this case?
Administer O2 to achieve a PaO2 between 50-60 mmHg
Normal Hb levels
Adult male: 14-15 g/100ml or g/dl Adult female: 12-15 g/dl Infant: 14-20 g/dl
fractional distillation
Bulk O2 is produced by _____ ______.
Who regulates the pressure relief valves on cylinders?
Bureau of Explosives
Clogging of an isolette incubator air inlet filter will result in which of the following? A. Excessive heat buildup B. Increased convection cooling C. Increased O2 concentrations D. Automatic sounding of an alarm
C. Increased O2 concentrations
A physician wants a stable FIO2 of 0.5 for a newborn infant with severe hypoxemia. Which of the following systems would you select? A. An infant nasal cannula B. An isolette C. O2 hood with blender & heated humidifier D. Nasal Catheter
C. O2 hood with blender & heated humidifier
What conditions/diseases will increase or lengthen transit time (gas diffusion time)?
CHF, increase in RAW, COPD (decrease in PaO2)
Oxygen extraction ratio (O2ER)=
CaO2-CvO2/CaO2 (.25)
(Flow in liters X 4) + 20=FiO2
Calc % FiO2 when flow is known
(FiO2%-20)/4=flow in liters
Calc flow in liters when FiO2 % is given
Pstatic fluid = ρgh where ρ = m/V = fluid density g = acceleration of gravity (9.8) h = depth of fluid
Calculation for the pressure exerted by a liquid is ____.
Qs/Qt=
CcO2-CaO2 / CcO2-CvO2 x 100
A gas cylinder color coded yellow should contain which of the following gases?
Air
Air:O2 ratios >35%
Air = 100-FiO2 ---- -------- O2 = FiO2-20
Air:O2 ratios <35%
Air = 100-FiO2 ---- -------- O2 = FiO2-21
A physician has requested delivery of a stable, low O2 concentration to an alert patient. Which of the following devices would be best suited for the patient?
Air Entrainment Mask
Low flow O2 delivery systems contain all of the following devices except: a. Nasal Cannula b. Partial Rebreather c. Air Entrainment mask d. Simple Mask
Air Entrainment mask
A physician requests you provide a patient with exactly 45% O2 at a flow of 60 LPM. Lacking a blender you must manually mix air and O2 to achieve the desired mixture at the prescribed flow. Which of the following air and O2 flow would you select?
Air LPM (42) O2 LPM (18)
Which of the following factors determine the actual O2 provided by an air-entrainment system?
Air-to-O2 ratio of the device Resistance downstream from the jet
Board Exam question: A physician has ordered a controlled FiO2 concentration of a patient with a tracheostomy tube. Which would be the appropriate device for the patient?
Air/O2 Blending system with T-piece
What is the term for the impedance to ventilation caused by the movement of gas through the conducting system of the lungs?
Airway Resistance
What type of patient would benefit most from mechanical insufflation-exsufflation?
Amyotrophic Lateral Sclerosis
The loss of muscle tone that commonly occurs in paralysis patients that hinders the ability to cough is called:
Atrophy
DISS
Diameter index safety system - designed by CGA - uses non-interchangeable threaded fittings - <200 psi
Duration of Supply Equation
Duration of supply (min)= (lbs/2.5lbs/L)x860 ----------- Liter flow (LPM)
Which of the following is FALSE regarding IPPB?
During inspiration, pressure of the alveoli decreases
Barrel Chest is an increase in AP diameter commonly seen in which of the following types of patients?
Chronic obstructive Pulmonary disease
Low flow- what would happen if RR increases?
FiO2 decrease (more diluted with room air)
Low flow- what would happen if Vt increases?
FiO2 decrease (more diluted with room air)
6 l/m 60%, 7 l/m 70%, 8 l/m 80%, 9 l/m 80+%, 10 l/m 80+%
FiO2 for a NBR (non-rebreather) mask?
Low flow- what would happen if RR decreases?
FiO2 increase (less diluted with room air)
Low flow- what would happen if Vt decreases?
FiO2 increase (less diluted with room air)
What FiO2 changes occur when the air entraiment port is fixed and the jet orifice increases in size?
FiO2 increases
The air entrainment ports of a Venturi mask are partially obstructed by patient's bedding. Which of the following can you expect to change in total FiO2 delivered?
FiO2 will increase
A physician orders 2 L/min O2 through a simple mask to a 33-year-old postoperative woman with moderate hypoxemia breathing room air (PaO2 = 52 mm Hg). What would be the correct action at this time?
Flow of 5 L/min to wash out CO2
FiO2=
Flow of O2 (1) + flow of RA (.2) -------------------------- total flow
What is used to control flow to the patient?
Flowmeter
coanda effect
Fluidic circuitry is based on what principle?
What is the propellant used in the manufacturing of today's MDI?
Hydrofluoroalkane
A patient has been brought to your ER. He has been seriously injured in an auto accident. He is in severe shock. The MD tells you to put him on some O2. You should select which of the following devices?
Non-rebreather mask
Which device is used for smoke inhalation?
Non-rebreather mask at 15 LPM
What vaccination does OSHA require hospital employers to provide?
Hepatitis B
The patient is inhaling. What receptor would make him stop inhalation to begin exhalation?
Hering-Breuer
A physician orders a 70% He and 30% O2 mixture to reduce the work of breathing in a patient having an acute asthma attack. Which of the following devices would be appropriate in this case?
Nonrebreather
Board Exam Question: A 52 year old man enters the emergency room complaining of severe chest pain and exhibits signs of central cyanosis. Which of the following is the appropriate initial device for O2 delivery?
Nonrebreather at 10 LPM
Match the lab value with it's normal value=Sodium
Normal Lab value=135-145 mEq/L
Match the lab value with it's normal value=Potassium
Normal Lab value=3.5-5.0 mEq/L
Match the lab value with it's normal value=White Blood Cell
Normal Lab value=4,500-11,500/cu mm
Match the lab value with it's normal value=Hematocrit
Normal Lab value=40-50%
Match the lab value with it's normal value=Serum Glucose
Normal Lab value=70-110mg/dL
Match the lab value with it's normal value=Chloride
Normal Lab value=98-106 mEq/L
Match the lab value with it's normal value= Sweat Chloride
Normal Lab value=<60 mEq/L
What type of breath would you instruct patient to perform while taking a SVN treatment?
Normal tidal breathing
Which of the following is the most common type of DISS safety system?
Ohio Diamond Quick connect system
What is the minimum backup an acute care facility must have for oxygen supply?
One times daily usage
Color Code of Cyclopropane
Orange
Simple unheated bubble humidifiers are commonly used to humidify gases with what type of systems?
Oronasal oxygen delivery
Where does gas mixing take place in low flow gas mixing?
Oropharynx
The term defined as difficulty breathing except in the upright position is called:
Orthopnea
Which of the following are desirable outcomes of IPPB? I. Improved vital capacity II. Enhanced cough III. Improved breath Sounds IV. Increased secretion clearance
I, II, III, and IV
Which of the following should be charted after completing a postural drainage treatment? I. amount and consistency of sputum produced II. patient tolerance of procedure III. position(s) used (including time) IV. any adverse effects observed
I, II, III, and IV
In setting up a postural drainage treatment schedule for a postoperative patient, which of the following information would you try to obtain from the patient's nurse? I. patient's medication schedule II. patient's meal schedule III. location of surgical incision
I, II, and III
In which of the following conditions would you initially seek to provide the highest FiO2 possible? I. CO poisoning II. Cyanide poisoning III. Severe shock or trauma
I, II, and III
What happens as the pressure or flow delivered through a small volume nebulizer increases? I. Treatment time becomes shorter II. Particle size becomes smaller III. Aerosol output increases
I, II, and III
Which of the following conditions alter normal mucociliary clearance? a. I, II, and III b. I and II only c. I and III only d. II and III only
I, II, and III
Which of the following conditions are potential indications for incentive spirometry? I. a restrictive disorder such as quadriplegia II. post operative COPD patient III. diagnosis of pulmonary atelectasis
I, II, and III
Which of the following devices are approved for storage of medical oxygen? I. high pressure cylinders II. Large bulk reservoirs III. Cryogenic containers
I, II, and III
Which of the following is/are necessary for normal airway clearance? I. patent airway II. functional mucociliary escalator III. effective cough
I, II, and III
Which of the following patient categories are at high risk for developing atelectasis? I. those who are heavily sedated II. those with abdominal or thoracic incisions III. those with neuromuscular disorders
I, II, and III
A chronic obstructive pulmonary disease patient cannot develop an effective cough. Which of the following would you recommend to help this patient generate a more effective cough? I. enhancing expiratory flow by bending forward II. using short, expiratory bursts or the "huffing" method III. using only moderate (as opposed to full) inspiration IV. having the patient "tense" the neck muscles while coughing
I, II, and III only
What are some types of passover humidifiers? I. simple reservoir II. membrane III. wick IV. bubble humidifier
I, II, and III only
A normal cough reflex includes which of the following phases? I. irritation II. inspiration III. decompression IV. expulsion
I, II, and IV only
In which of the following clinical situations would you recommend hyperbaric O2 therapy? I. CO poisoning II. Respiratory or Cardiac arrest III.Decompression sickness IV.Cyanide poisoning
I, III and IV only
Which of the following clinical findings indicate the development of atelectasis? I. opacified areas on the chest X-ray II. inspiratory and expiratory wheezing III. tachypnea IV. inspiratory crackles
I, III, and IV only
What characteristics of sputum should be inspected after aerosol therapy sputum induction? I. color II. volume III. odor IV. consistency
I,II,III, and IV
Inspiratory capacity
IC: volume of air that can be inhaled after a normal exhalation (Vt+IRV)
Ideal gas law
PV=nRT P: pressure V: volume T: temperature (Kelvin) nR: both are constants
Anemia hypoxia
PaO2 (PAO2) is normal but the O2 carrying capacity is inadequate due to: - Hb decrease - Hb inability to carry O2 (CO poisoning, methemoglobinemia)
Moderate Hypoxemia
PaO2 45-59 mmHg
Mild hypoxemia
PaO2 60-79 mmHg
Severe hypoxemia
PaO2 <45 mmHg
According to Dalton's law, what happens to PaO2 and PAO2 with increasing pressures?
PaO2 and PAO2 increases
Circulatory hypoxia
PaO2 that reaches the tissue cells maybe normal, but the amount of blood is inadequate to meet the needs of the tissues
am't O2 dissolved in plasma=
PaO2 x sol. coefficient
P/F equation
PaO2/FiO2
In clinical practice, which of the following should be done to identify the contents of a gas cylinder? I. Inspect the cylinder threads II. Inspect the color of the tank III. Read the cylinder label IV. Analyze the gas
II and III only
Incentive spirometry can generally be classified as which of the following types: I. pressure oriented II. volume oriented III. flow oriented
II and III only
What is the fire risk for medical oxygen? I. Flammable II. Nonflammable III. Supports combustion IV. no fire risk
II and III only
Physician orders bland water aerosol administration to a patient with an intact upper airway. Which of the following airway appliances could you use to meet this goal? I. tracheostomy collar II. face tent III. Venturi mask IV. aerosol mask
II and IV only
Which of the following would be correct instructions for a patient being taught the proper use of a DPI? I. Place mouthpeice 4 cm from mouth II. Exhale slowly to FRC III. Inhale slowly IV. Repeat until dose is completed
II and IV only
To ensure delivery of the proper drug dosage with a MDI, which of the following must be done before used? I. The cannister valve stem must be cleaned with a pin. II. The cannister should be warmed III. The cannister should be shakened well IV. The cannister should be primed
II, III, and IV only
Which of the following are clinical indications for the use of CPAP? I. first line treatment of atelectasis II. Cardiogenic pulmonary edema III. Obstructive sleep apnea IV. Severe hypoxemia
II, III, and IV only
Inspiratory reserve volume
IRV: maximum volume of air that can be inhaled after a normal tidal volume inhalation
pressure compensated
If the ball in a Thorpe tank rises quickly and then falls it is considered to be ____ _____
non pressure compensated
If the ball in a Thorpe tube doesn't jump when plugged into to wall, what does that mean? On the contrary, if the float in the tube jumps & then falls to zero, the flowmeter is pressure compensated, this occurs b/c the source gas must pass thru the indicator tube b/f it reaches the needle valve, remember pressure compensated the needle is distal or downstream from Thorpe tube (PD) Pressure compensated, Distal.
Carbon dioxide is ____ soluble than Oxygen
MORE O2: 0.0244 ml/mmHg/ml H20 CO2: 0.592 ml/mmHg/ml H20
Which of the following agencies should be contacted so that the piping system of O2 and air is correctly installed?
NFPA
What must you monitor when giving NO?
NO2, NO3, and methomoglobin levels
You must deliver the highest possible FIO2 to a 67-year-old man with pulmonary edema breathing at a rate of 35/min. Which of the following O2 delivery systems would be most ap-propriate?
Non breathing mask at 12-15 L/min
When Transporting Cylinders Always______
Ensure cap is on, regulators off, and secure with strap and chain on cart. NEVER ROLL or place in Traffic Area
When attaching regulator, make sure to use a ____ Wrench
Non-Spark
An ambu bag is used to provide oxygen during cardiac arrest.
True
Bradycardia is termed as a heart rate less than 60 beats per minute.
True
Nasal flaring and retractions are common bedside assessments that indicate respiratory distress in infants.
True
Purse-lip breathing prevents airway collapse in patients with obstructive lung disease.
True
Temperature and FiO2 must be monitored when using an oxyhood for an infant.
True
The sweat chloride test evaluates for cystic fibrosis.
True
CALCULATED Inspiratory flow equation (Vi)
Vt (L) ---- x 60 sec/min Ti (sec) Ti=inspiratory time
Minute ventilation equation
Vt x RR
IC=
Vt+IRV (inspiratory capacity)
VC=
Vt+IRV+ERV (vital capacity)
TLC
Vt+IRV+ERV+RV (total lung capacity)
Tidal volume
Vt: volume of air that normally moves in and out of the lungs in 1 quiet breath
Charles Law
V1/T1=V2/T2 (if P remains constant)
Vital capacity
VC: maximum volume of air that can be exhaled after a maximal inspiration (IRV+Vt+ERV)
PaCO2=
VCO2/VA if VCO2 remains constant, the PaCO2 will decrease as VA increases, and PaCO2 will increase as VA decreases
Delivery systems that provide only a portion of a patient's inspired gas are referred to as what?
Variable Performance Systems
Dalton's, temperature, displaces, other gases
Water vapor does NOT follow ____ law because such pressure primarily depends on ______; water vapor ___ the partial pressure of __ __.
To accurately determine the amount of oxygen remaining in a liquid filled cylinder, what would you do?
Weigh the contents of the cylinder
dry cracked skin around nose & lips, twisting of tubing, discomfort from tubing around ears; allows higher degree of mobility/freedom (allows the patient to continue to talk, eat and drink while receiving the therapy)
What are disadvantages of a Nasal Cannula? What are advantages?
keep the flowmeter upright (gravity)
What are limiting factors for a pressure compensated flow meter?
nasal bleeding and drying of nasal mucosa;
What are risks of giving O2 greater than 50%?
know where the O2 shutoff valve is located and how to shut it off; RACE (rescue, alert, contain, evacuate)
What are steps to take in case of a fire?
small volume nebulizer
What bland aerosol device is used for intebated patients with stridor (swelling of the throat) ?
small volume nebulizer
What bland aerosol device is used for patients with upper airway edema?
large volume nebulizer
What bland aerosol generator is used to administer anesthesia for upper airway bronchoscopy?
bourdon regulator, mask, E cylinder
What device is an difficult pt transport situation when O2 flow is expected to be altered? always remember that with a bourdon gauge the flow registered on the gauge may not be accurate because it does not compensate if obstruction or resistance is present. if obstruction is present, the flow registered on the flowmeter is higher than the actual flow, its erroneously high.
complied with requirements; retest in 10 years;
What does a plus sign beside of the date on a tank mean? What does an asterisk mean?
Patients tidal volume and respiratory rate; whether breathing thru nose or mouth;
What influences FiO2 delivered to a patient using a NC?
PaO2=(Pb-PH20)Fi02-(PaC02*1.25), when FiO2 is >than 60%
What is the Alveoloar air equation? When do leave off the last part of the equation (*1.25) ?
2 to 80 parts per million (ppm)
What is the therapeutic does for Nitric Oxide (NO) ?
Coanda Effect
What principle does fluidic circuity involve?
intermittent postitive pressure breather (IPPB), Good fitting non rebreather mask attached to a reservoir bag, with flow high enough to prevent collapse of bag.
What type of O2 device is used to administer Heliox treatment to intebated patient? to non-intebated patient?
The narrowing or constriction of a bronchial airway will produce which of the following lung sounds?
Wheeze
All of the following are contraindication for heat-moisture exchanger except:
When a patient is suffering for increase body temperature
increase the flow, modification of an aerosol mask by adding 6" pieces of tubing to the ports
When you see the aerosol disappear on a large volume nebulizer, what do you need to do? how is it done?
Color Code of Air
Yellow, or Black with 2 green bands, or White and black
Bourdon Gauge
a flowmeter device that is always used in combination with an adjustable pressure-reducing valve. The Bourdon gauge is thus a fixed-orifice, variable-pressure flowmeter device.
Absolute Humidity
actual content/weight of water present in a given volume of gas content
% predicted=
actual/predicted x 100
Contraindications for positive airway pressure therapies include all of the following except: a. intracranial pressure exceeding 20 mm Hg b. recent facial, oral, or skull surgery or trauma c. untreated pulmonary barotrauma d. acute hyperventilation
acute hyperventilation
Evaporation
adding more heat causes the liquid water molecules to move more vigorously and escape into the gaseous state.
FiO2 level and flow rate of nasal cannula
adults 0.24 to 0.44 and 1 to 6 L/min neonates 0.35 to 0.7 and 0.25 to 2 L/min
Which of the following devices is most commonly used to deliver continuous aerosol with oxygen to a patient with a Trach?
Pneumatic Jet Nebulizer
The application of gravity to achieve specific clinical objectives in respiratory care best describes which of the following? a. Coughing techniques b. Postural Drainage therapy c. Hyperinflation therapy d. Purse-lip breathing exercise
Postural Drainage therapy
PSIG
Pounds per Square Inch Gauge
ROP is a potentially serious management problem mainly in the car of whom?
Premature or low birth weight infants
Total O2 delivery (DO2)=
QTx(CaO2x10) QT= total cardiac output (L/min) Factor 10= needed to convert CaO2 to ml O2/L blood
DOT
agency that oversees compressed gases for storage & transport?
Board Exam Question: Which of the following devices should be selected to administer nebulized bronchodilator therapy in the home?
air compressor
To minimize a patient's infection risk between drug treatments with a SVN, what should you do?
Rinse the SVN with sterile water, air dry
Labeling on mixed gas cylinders
Shoulder- minor gas Body- major gas
larger, distribute
Some advantages of piped bulk oxygen systems (compared to portable) is that they have a _____ gas capacity, and the ability to ______ gas throughout entire building.
American Standard Safety System (ASSS)
Specifications adopted in the US and Canada for threaded high pressure connections between compressed gas cylinders and their attachments
The test used to identify the bacteria present in sputum is called:
Sputum Culture
sputum color with the indication =Brown
Sputum= Old blood/Tar
sputum color with the indication =Bright red
Sputum=Active bleeding
sputum color with the indication =Yellow
Sputum=Presence of WBC, infection
sputum color with the indication =Mucoid
Sputum=White/gray, as seen in patients with chronic bronchitis
sputum color with the indication =Clear
Sputum=normal
sputum color with the indication =Pink/frothy
Sputum=pulmonary edema
After administering a 30-minute continuous aerosol treatment to an elderly patient with chronic bronchitis, you note increased wheezing and a general increase in the intensity of breath sounds. Which of the following has probably occurred?
airflow has impoved
What typically occurs first when monitoring the earliest physiologic response to breathing 100% O2?
Substernal Chest Pain
Which of the following patient groups would IPPB not be indicated? a. patients with diagnosed atelectasis who are not responsive to traditional therapies b. patients who have the inability to follow demands c. all obese patients who have undergone abdominal surgery d. neurologically impaired postoperative patient
all obese patients who have undergone abdominal surgery
Which of the following cylinders have a yoke connector and a valve stem? a. E tank b. AA tank c. D tank d. all of the above
all of the above
Which of the following disease/disorders can cause asymmetrical chest movement? a. atelectasis b. pneumothorax c. mainstem intubation d. all of the above
all of the above
When Attaching regulator, clean valve with a________
Stiff Brush
During chest physical therapy, a patient has an episode of hemoptysis. Which of the following actions would be appropriate at this time? a. Put the patient in a sitting position and have him or her cough strenuously b. Place the patient in a head-down position and call the nurse c. Immediately perform nasotracheal suctioning of the patient d. Stop therapy, sit the patient up, give O2, and contact the physician.
Stop therapy, sit the patient up, give O2, and contact the physician
Total lung capacity
TLC: maximum amount of air that the lungs can accommodate (IC+FRC)
All of the following are typical of high-frequency external chest wall compression therapy except: a. 30-minute therapy sessions b. oscillations at 5 to 25 Hz c. one to six sessions per day d. long inspiratory oscillations
long inspiratory oscillations
Hypochloremia
low Cl (when Cl decreases, HCO3 increases)
Heliox
low density gas for severe acute asthma..to get medication around obstuctions..70/30 or 80/20
2 classification of oxygen therapy systems
low flow and high flow
Low flow gas mixing
low flow device provides O2, mouth and nose provide RA (they mix and give the patient a certain FiO2)
According to Boyle's law, what happens to lung volume with increasing pressures?
lung volume decreases
Internal respiration
lungs -> atm.
To ensure a stable FiO2 under varying patient demand, what must an O2 delivery system do?
maintain flows at least equal to patient's inspiratory demand
Fusible plug pressure relief valve
metal alloy that melts at certain temperatures
10-20% shunt equation value
mild intrapulmonary shunting
Goal of humidity therapy
minimize or eliminate HD while patient is breathing a dry medical gas (provide 100% RH @ body temp= eliminate HD)
ESTIMATED Inspiratory flow equation (Vi)
minute volume (in LPM) x 3
Heliox
mixture of helium and oxygen
torr =
mmHg
When Hb is 75% saturated with O2, there is ___ CO2 for any PCO2
more (Haldane effect)
examples of low flow oxygen therapy devices
nasal cannulas and catheters, transtracheal catheters, simple oxygen mask, partial rebreathing reservoir mask, and nonrebreathing reservoir masks
difference between atomizer and nebulizer
nebulizer has baffle, atomizer has no baffle
what is an open humidity system?
need to open it to refill it
Which of the following are appropriate initial settings in IPPB therapy of a new patient? a. sensitivity -2 cmH2O, pressure 20-25 cmH2O, high flow b. sensitivity -3 to -4 cmH2O, pressure 5-10 cmH2O, moderate flow c. sensitivity -1 to -2 cmH2O, pressure 10-15 cmH2O, moderate flow d. sensitivity -8 cmH2O, pressure 15cmH2O, moderate flow
sensitivity -1 to -2 cmH2O, pressure 10-15 cmH2O, moderate flow
Oxygen concentrator
separates air with molecular sieves and semi permeable membrane (for home care and SNF patients)
<10% shunt equation value
normal lung status
Which of the following devices would would be the first choice for eliminating leaks with IPPB therapy? a. flanged mouthpiece b. nose clips c. form fitting mask d. oral airway
nose clips
What is the term for infection acquired in the hospital?
nosocomial
Cryogenic
of or relating to very low temperatures
Flow Restrictors
operate on same principle as Bourdon flowmeters. two types: fixed-orifice and adjustable
What is the movement of small volumes of air back and forth in the respiratory tract at high frequencies (12 to 25 Hz) called?
oscillation
The mass of aerosol particles produced by a nebulizer in a given unit time best describes which quality of the aerosol?
output
A gas cylinder that is color coded green should contain which of the following gases?
oxygen
Example of supports combustion
oxygen
Which gas do you use to treat hypoxemia in a patient with chronic obstructive pulmonary disease?
oxygen
Which of the following methods of oxygen production is commonly used in home care oxygen equipment?
physical seperation
What is used to produce aerosol particles in an ultrasonic nebulizer?
piezoelectric crystal
Ideally, when should patients be oriented to incentive spirometry?
preoperatively, before undergoing surgical procedure
Restrictive
problem breathing IN
Obstructive
problem breathing OUT
Spirometry
process of measuring lung volumes of air moving in and out of the lungs
Graham's Law
rate of diffusion of a gas through a liquid is: - directly proportional to solubility of gas - inversely proportional to square root of gram-molecular weight of the gas
Relative Humidity
ratio of content to capacity (what you have vs. what you could have)
What is the mass of aerosol that reaches the lungs
respirable mass
Which of the following methods would you recommend for bronchial hygiene therapy for a patient with asthma/mucus plugging? a. Positive expiratory pressure device b. percussion and postural drainage c. acapella d. all of the above
all of the above
Primary objectives for turning include all of the following except to: a. promote lung expansion b. prevent retentions of secretions c. reduce risk of aspiration d. improve oxygenation
promote lung expansion
Which of the following is NOT a hazard or complication of postural drainage therapy? a. cardiac arrhythmias b. increased intracranial pressure c. acute hypotension d. pulmonary barotraumas
pulmonary barotraumas
PFT
pulmonary fraction test
Partial pressure of O2 (alveoli an atm.)
alveoli: 100 mmHg atm.: 159 mmHg
Thorpe Tube
always attached to a 50-psig source, either a preset pressure-reducing valve or a bedside station outlet. Used to measure true flow. Come in two basic designs: pressure compensated and pressure uncompensated.
Volume %
amount of O2 in ml that is in 100ml of blood (also equals ml/dl)
Solubility coefficient of a liquid
amount of gas that is dissolved by 1 ml of a given liquid @ standard pressure (760 mmHg) and specified temp
what is dead space volume?
amount that can't be nebulized
Renal failure
an accumulation of H ions can cause metabolic acidosis
Strong acid
an acid that dissociates completely into H ions and anion
Weak acid
an acid that dissociates only partially into ions
Diffusion of O2 and CO2 will continue until...
an equilibrium is reached (0.25 sec)
sputum induction, humidification
an ultrasonic nebulizer will aid in ___ ___ and room _____;
An abnormally low red blood cell count is indicative of what condition?
anemia
All of the following can provoke a cough except? a. anesthesia b. foreing body in airway c. infection d. smoke
anesthesia
The clinical use for nitrous oxide is which of the following?
anesthesia gas
Use of N20
anesthetic (CNS depressant)
Regulator
any of various controls or devices for regulating or controlling fluid flow, pressure, temperature, etc.
Cessation of breathing is called:
apnea
Directing a cool O2 mixture to an infant can cause which of the following?
apnea
sputum induction
appropriate use of ultrasonic nebulizer aids in _____ ______
External respiration
atm. -> lungs
Primary safety concerns in the application of hyperbaric O2 therapy include which all of the following except? a. Sudden decompression b. Electrical Fires c. CO2 accumulation d. Pneumothorax
c. CO2 accumulation
Physiologic effects of hyperbaric O2 therapy include all of the following except: a. Bubble reduction b. Neovascularization c. Systemic vasodilation d. Hyperoxygenation
c. Systemic vasodilation
A patient who exhibits a wasted appearance and weak muscles can be best described as
cachexia
Diffusion impairment (hypoxemia)
certain respiratory diseases/conditions with decreased time for O2 equilibrium across the A/C membrane (pulmonary fibrosis, pneumonia, pulmonary edema)
Electrolytes
charged ions that conduct a current in a solution
ROP
retinopathy of prematurity (premies PO2 is too high, developing of optic nerve is compromised)
You set up a nasal cannula with a humidifier. The flow is set at 5 LPM. Upon entering the room for a nebulizer treatment, you notice the pop-off alarm is sounding. What should be your initial action to correct the problem?
check for kinks in the tubing
Board Exam question: A patient is recieving oxygen via simple mask at 6 LPM from a Bourdon gauge flowmeter. When the respiratory therapist repositions the patient, the patient becomes cyanotic. The flowmeter reveals a flow of 6 LPM. The practitioner's most appropriate initial action is to:
check the tubing to the oxygen mask for kinks
All of the following conditions impair secretion clearance by affecting the cough reflex except: a. muscular dystrophy b. amyotrophic lateral sclerosis c. chronic bronchitis d. cerebal palsy
chronic bronchitis
infection, environmental, inadequate, hydration, noise
common problems with bland aerosol delivery systems involve ____ control, ____ safety, ____ mist production, over ______ and ___;
hyperresponsivness, bronchoconstriction
continuous bland aerosols can be hazardous when administered to patients with a history of ______ and _________
The AARC Clinical Practice Guideline for IPPB states that this form of therapy is a viable lung expansion technique for patients with reduced lung function. Which of the following findings from a patient suggest that IPPB is warranted? 1) FVC = 50% predicted 2) FEV1=70% predicted 3) MVV<50% predicted 4)VC=15 ml/kg a) 1 only b) 4 only c) 2 and 3 only d) 1 and 3 only
d) 1 and 3 only FVC = 50% predicted MVV<50% predicted
Which of the following are contraindications to the administration of IPPB? 1. active hemoptysis 2. nausea 3. intracranial pressure >15 mm hg 4. recent esophageal surgery a) 1 and 3 only b) 2 and 3 only c) 1,2, and 3 only d) 1,2,3, and 4
d) 1,2,3, and 4 1. active hemoptysis 2. nausea 3. intracranial pressure >15 mm hg 4. recent esophageal surgery
goal of medicated aerosol therapy
deliver a therapeutic dose of medication to the desired site of action
bland aerosol
deliver hypotonic, hypertonic, isotonic saline, sterile water
PaCO2
determined by the quantity of CO2 produced by the body per minute (VCO2) relative to the alveolar ventilation (VA)
Histotoxic hypoxia
develops in any condition that impairs the ability of tissues to utilize O2 (CO poisoning)
Spirometer
device used to measure lung volumes
oxygen concentrators
devices that produce enriched oxygen from atmospheric air
MMAD measures
diameter that divides the range of particles in half (half are larger and half are smaller, particles are measured in microns)
Correct instruction in the technique of incentive spirometry should include which of the following?
diaphragmatic breathing at slow to moderate flows
Examples of high flow devices
entrainment masks, hi flow devices (humidifiers), entrainment nebs, oxyhoods, high flow NC
Which of the following types of white blood cells are increased during allergic reactions and during an asthma attack?
eosinophils
All of the following are hazards of positive airway pressure therapies except: a. decreased venous return b. epistaxis c. pulmonary barotrauma d. increased intracranial pressure
epistaxis
Avogadro's Law
equal volume of gas at the same pressure and temperature contain the same number of molecules
What are the blood cells that carry hemoglobin and oxygen?
erythrocytes
0, 100
evaporation begins between ___ and ___ degrees celcius;
Exothermic change (energy given up)>loses energy to the surrounding.
ex: Condensation (gas to liquid or solid) Freezing (liquid to solid)
Endothermic change (energy added) think of the sun beaming on ice.
ex: sublimation (solid to gas) >dry ice Melting (fusion) solid to liquid>ice melting Evaporative (vaporization) liquid to gas>water boiling
What condition will decrease or shorten gas diffusion time?
exercise
Hemoglobin F
fetal (Hb F)
Which of the following breath sounds will be heard in the presence of fluid in the alveoli?
fine rales
Is high flow a fixed or variable performance device?
fixed
Which of the following is true with Bourdon gauges when there is downstream resistance?
flow output decreases
Low flow
flow rate < patient's inspiratory demands
increase dose delivered to lower respiratory tract and reduce oropharyngeal impaction
for what reason is an MDI held 4 cm away from the mouth during actuation?
Barometric pressure
force of the earth's surface created by the atmosphere gases
FVC
forced vital capacity (exhalation is performed as rapidly as possible)
D=(2200psi-500)*3.14/flow, D=(2200psi-500)*.28/flow *convert to hours & mins
formula for Duration of full H or K tank to medical standard? E tank?
D=344*liquid weight/flow *convert to hours & mins
formula for duration of liquid oxygen?
Hb*1.34*SaO2
formula to calculate the amount of hemoglobin bound to oxygen
PaO2*0.003
formula to calculate the amount of oxygen dissolved in specific # amount of blood (mL) when PaO2 (% mmHg) is given
(psi * tank factor) / flow (liters)
formula to calculate the duration of gas in a tank; Don't forget to convert to hours and minutes
(344 * weight (lbs) of gas only in tank)/flow(liters)
formula to calculate the duration of liquid in a tank; Don't forget to convert to hours and minutes
How is CO2 purified?
fractional distillation
How is oxygen commercially produced?
fractional distillation until 99% pure
FiO2
fractional inspired oxygen concentration (amount of O2- decimal or percent)
Rupture Disks
frangible disks, is a thin, metal disk that ruptures or buckles when the pressure inside the cylinder exceeds a certain predetermined limit.
Vibrations felt on the chest is termed:
fremitus
Which of the following setting adjusts aerosol particle size in an ultrasonic nebulizer?
frequency
Cylinder color: oxygen
green
What is the proper procedure for manual percussion therapy?
hands cupped, thumbs in, percussing in a circular motion over affected areas
A physician orders postural drainage for a patient with pneumonia in the right middle lobe. When doing postural drainage, which of the following positions would you recommend for this patient?
head down, on left side, half rotated to the right
If a patient's chest radiograph shows infiltrates in the posterior basal segments of the lower lobes, what postural drainage position would you recommend?
head down, patient prone with a pillow under abdomen
Passive humidification
heat + moisture exchange (ex: HME)
Which type of humidifier "traps" the patient's body heat and expired water vapor to raise the humidity of inspired gas?
heat-moisture exchanger
Active humidification
heated humidifier (ex: cascade)
Which gas do you use to reduce the work of breathing in a patient with airway obstruction?
heliox
A gas cylinder that is color coded brown should contain which of the following gases?
helium
Which of the following gases in conjunction with oxygen aids in management in severe airway obstructions?
helium
none, two
how many flaps on a PRB (partial rebreather)? NRB (non-rebreather)?
there are 2 or more pressure relief valves
how to quickly determine if pressure reduction valve is multistage?
Which of the following is considered the primary source of infection in the health care setting?
humans
recommendation for humidification for patients on invasive mechanical ventilation
humidification for ALL invasive
The percussion note that makes a booming sound heard with emphysema and pneumothorax is called:
hyper-resonance
Elevated blood pressure is termed:
hypertension
** A postoperative patient using incentive spirometry complains of dizziness and numbness around the mouth after therapy sessions. What is the most likely cause of these symptoms? a. gastric distention b. hyperventilation c. pulmonary barotrauma d. respiratory acidosis
hyperventilation
Response to temperature changes in the body is regulated by which of the following:
hypothalamus
Cyanosis is caused by which of the following abnormalities?
hypoxia
Which of the following is not usually a complication associated with IPPB? a. air-trapping b. hypoxia c. decreased venous return d. gastric distention
hypoxia
ISO standars for HMEs
ideally 70% efficiency and provides at least 30 mg/L
Chronic ventilatory failure
if patient hypo ventilates for long period of time kidneys will start to compensate for decreased pH by retaining HCO3 (partial or complete)
Chronic metabolic acidosis
immediate response is to increase RR- causes CO2 to decrease and pH to increase
Kidney's role maintaining pH and HCO3
important in balancing during long periods of hypoventilation and hyperventilation (24-48 hours) (long term)
Lung's role maintaining PCO2, pH, HCO3 levels
important in maintaining levels on a moment to moment basis (short term)
Postural drainage should be considered in all of the following situations except: a. in all patients with chronic obstructive pulmonary disease b. in patients who expectorate more than 25 ml of sputum per day c. in the presence of atelectasis caused by mucus plugging d. in patients with cystic fibrosis and bronchiectasis
in all patients with chronic obstructive pulmonary disease
When using water traps to help minimize the problems caused by condensation in heated humidifier ventilator cicuit, where would you place the traps?
in both the expiratory and inspiratory limbs, at low points in the circuit.
What is the purpose of a zone valve?
in order to shut off certain areas
All of the following are considered bronchial hygiene therapies except: a. percussion and postural drainage b. incentive spirometry c. intrapulmonary percussive ventilation d. High frequency chest wall oscillation
incentive spirometry
Factors increasing SvO2
increase O2 loading into the lungs (increase in Hb, PaO2, pH, decrease in PaCO2
Partial airway obstruction can result in all of the following except: a. increased work of breathing b. air-trapping and overdistention c. increased expiratory flows d. ventilation/perfusion imbalances
increased expiratory flows
Level of CO2 increases, HCO3..
increases
Leftward shift of oxyhemoglobin dissociation curve
increases the affinity for Hb to O2 molecules (O2 is less available to tissues)
What type of breathing would you instruct a patient to perform when teaching the use of a dry powder inhaler?
inhale deeply and forcefully
iNO
inhaled nitric oxide
Bernoulli principle
injector-term for a venturi device-re: increase in orifice size
When Hb is 97% saturated with O2 there is ___ CO2 content for any PCO2
less
what happens to humidity as liter flow increases?
less humidity (as flow increases, RH decreases)
level and type of humidification is recommended for invasive mechanical ventilation
level- 33-44 mg/L 34-41*C 100% RH (measured @ wye)
level and type of humidification is recommended for invasive mechanical ventilation
level- 33-44 mg/L 34-41*C 100% RH (measured @ wye)
>30% shunt equation value
life threatening
Cylinder color: nitrous oxide
light blue
O2 is ____/____ than CO2
lighter/faster
Duration of a liquid oxygen supply
liter or liquid O2-2.5lbs liquid weight/2.5= number of liters of liquid oxygen liters of liquid * 860=liters of gas duration of supply = gas supply remaining(L) / flow (L/min
A Thorpe tube measures flow in:
liters per minute
V/Q mismatch (hypoxemia)
shunt-like effect PaO2 and CaO2 decrease
Zone Valves
shut off valves placed in different areas of the hospital and are to be shut off in case of fire
Hemoglobin S
sickle cell (much less soluble than adult Hb; it changes its shape from bi-concave to a curved shape. They break easily and clump which eliminates the ability of Hb to transport O2- patients become anemic)
The aerosol ouput (in mg/L) of an ultrasonic nebulizer depends mainly on which of the following?
signal amplitude
Which of the following devices is a low flow device that can deliver 40-55%
simple mask
components of multistage regulators
simply two or more single stage regulators
2 types of regulators
single stage and multistage
What is the ideal patient position for directed coughing? a. sitting with one shoulder rotated inward, the head and spine slightly flexed b. supine, with knees slightly flexed and feet braced c. prone, with the head and spine slightly flexed d. supine, with forearms relaxed and feet supported
sitting with one shoulder rotated inward, the head and spine slightly flexed
What type of breathing technique would you instruct your patient to perform when teaching a metered dose inhaler?
slow and deep inhalations
best breathing pattern to increase aerosol penetration?
slow breath, hold for 4-10 seconds (increased peripheral deposition) - mouth piece better than mask - particles 0.5-1 micron stable and exhaled
SVC
slow vital capacity (slow, long exhale)
Pin Index Safety System
small cylinder outlet connections, AA-E.
Pin-Index safety system(PISS)
small cylinders, pin system oxygen 2:5, Air 1:5
Board Exam Question: A physician has ordered the antiviral agent ribavirin to be administered to an infant with bronchiolitis and RSV. Which of the following devices would you recommend in this situation?
small-particle aerosol generator
Why must pipes be labeled every 20 feet?
so you know what you should/shouldn't be cutting into when you open up ceiling
sublimation
solid molecules completely bypass the liquid state and change to gas
Definition of aerosol
solid or liquid particles suspended in a gas (you can see a mist produced AND it can transmit bacteria) (referred to as particulate water)
gas
state of matter that is above its critical temperature
bernouli's principle
states that as velocity of a gas increases, the pressure on the lateral wall decreases
When performing a nebulizer treatment, you notice the patient heart rates had increased by 25 beats per minute. What should you do next?
stop the treatment
Potential energy
stored energy, or the energy that an object possess because of its position
Subglottic swelling caused from post extubation trauma may require would produce which of the breath sounds?
stridor
Alkalosis/Basic pH
substance accepts H ions, decreasing H concentration to solution causing pH to increase (<H2CO3)
Acidic pH
substance donates H ions, increased H concentration of solution causing pH to decrease (>H2CO3)
Buffer
substance that neutralizes both acids and bases without causing a change in original pH
Successful application of incentive spirometry depends on:
the effectiveness of patient teaching
laminar flow
the fluid flows in descrete cylindrical layers, or streamlines
viscosity
the force opposing deformation of a fluid
RH=measured humidity CONTENT/water CAPACITYx100
the formula to calculate relative humidity is _______;
what happens if heated wire circuit is warmer than the humidifier outfit?
the gas will not be fully saturated and humidity deficit can occur
vapor
the gaseous form of any substance that can exist as a liquied or a solid at ordinary pressures and taemperatures
combined gas law, P1*V1/T1=P2*V2/T2
the law that explains: behavior of gases when any or all variables change simultaneously; What is the formula?
Boyle's Law, P1xV1-P2xV2
the law that states: the volume that a gas occupies, when it is maintained at a constant temperature, is inversely proportional to the absolute pressure exerted upon it. What is the formula?
charles Law, V1/T1=V2/T2
the law that states: when a gas is held at a constant pressure, volume and temperature are directly proportional; What is the formula?
Gay Lussak's, p1/t1=p2/t2
the law that states: when gas is held at a constant volume, the temperature and the pressure are directly proporational. What is the formula?
poisoullie's law
the law that states: when you decrease the radius of a tube by 1/2, the the resistance increases by 16x;
air entrainment, areosol, humidifiers
the most common applications of Bernouli's Principle in respiratory care are ___ ___ masks, ___ generators, and _______;
turbulent flow
the movement of fluid molecules becomes chaotic and the orderly pattern of concentric layers seen with laminar flow is lost
pressure compensated flow meters
the needle valve controlling gas flow out of the flowmeter is located distal to the Thorpe tube
*Pulmonary shunt (true)
the portion of the cardiac output that enters the left side of the heart without exchanging gases with alveolar gases (true shut)
What is the Venturi Principle?
the pressure that has dropped as the fluid flows through a constriction in the tube can be restored to the pre constriction pressure if a gradual dilation occurs in the tube distal to the constriction
condensation
the process in which gas turns back to liquid is called ______
The percentage of O2 delivery provided by molecular sieve O2 concentrators depends on what factors?
the rate of gas flow and the age of the sieve beds
Fick's Law (directly proportional)
the rate of gas transfer across a sheet of tissue is DIRECTLY proportional: - to the surface area of the tissue - diffusion constants (Henry, Graham's Law) - difference in partial pressures of gas between 2 sides of the tissue
Fick's Law (inversely proportional)
the rate of gas transfer across a sheet of tissue is inversely proportional: - to the thickness of the tissue (can slow the gas transfer if too thick)
<2000
the reynolds number for Laminar flow is ____.
3000
the reynolds number for transient (transitional) flow is ____.
>4000
the reynolds number for turbulent flow is ____.
Partial pressure of atm. gases within circulatory system
the sum of partial pressures are reduced due to the decrease in PO2 in venous blood
Dalton's law of partial pressure
the sum of the partial pressure of a gas mixture equals the total pressure of the system.
Melting Point
the temperature at which a solid converts to a liquid substance
boiling point
the temperature at wich a liquid is changed to a solid state
boiling point
the temperature in which a liquid turns into a gaseous state is its ____ _____.
Boyle's Law
the volume a gas occupies when it is maintained at a constant temperature is inversely proportional to the absolute pressure exerted on it V=1/P
Patients can control a flutter valve's pressure by changing what?
their expiratory flow
most important characteristic of high flow devices
they can deliver fixed FiO2 levels regardless of the patients breathing pattern
Rupture disk pressure relief valve
thin disk that ruptures when internal pressure is elevated
Properly performed chest vibration is applied at what point?
throughout expiration
Board Exam question: Which of the following devices would be most indicated in the treatment of a patient with large amounts of thick secretions?
ultrasonic nebulizer
Advantages of the dry powder inhaler delivery system include any of the following except: A: easy to use B: no propellants required C: no-hand breath coordination D: unaffected by humidity
unaffected by humidity
Where do particles in the 5-10 micron range deposit?
upper airway
Invasive mechanical ventilation
upper airway bypassed- use of artificial airways (ETT and tracheostomy tube)
Noninvasive ventilation
upper airways not bypassed (BiPAP, CPAP, NiPPV- non invasive positive pressure ventilation)
Diaphragm Compressors
use a flexible diaphragm attached toa piston to compress gas
quick connect adapters
use a plunger that is held forward by a spring to prevent gas from leaving the outlet.
Rotary Compressors
use a rotating vane to compress air from an intake valve
Rotary compressors
use a rotating vane to compress air from an intake valve
Piston Compressor
use the action of a motor-driven piston to compress atmospheric air
Oxyhemoglobin
used for Hb that IS bound to O2
Deoxyhemoglobin
used for Hb that is NOT bound to O2
Duration of flow
used for determining how long the gas will "run" in a cylinder- based on size of cylinder and pressure in cylinder
What is heliox used for?
used in PFT lab to treat severe airway obstruction
Reducing Valve
used to adjust pressure when compressed gas is used as the drive mechanism
Duration of Supply
used to determine how long liquid oxygen will last (1L of liquid=2.5 pounds)
oxygen concentrators
used to provide enriched oxygen mixtures for oxygen therapy in the home. examples molecular sieves and semipermeable membranes
Active high flow humidity devices
used when supplying all the inspiratory gas especially for intubated or trached patients (33-44 mg H20/L @ 34-41*C at wye piece, RH=100%) can only attach large bore tubing
diameter index safety system (DISS)
uses noninterchangeable, threaded fittings to connect gas-powered devices to station outlets
Quick-connect
uses plunger that is held forward by a spring to prevent gas from leaving the outlet (insertion of appropriate adapter pushes the plunger backward, allowing gas to flow into the striker and into the equipment attached to the adapter)
Diaphragm Valves
usually found on smaller cylinders
American Standard Indexing
valve outlet connections for large cylinders, H-K.
Is low flow a fixed or variable performance device?
variable (room air added)
O2 and CO2 diffusion
venous blood enters the alveolar-capillary system - O2 pressure gradient= 60 mmHg (40->100) -CO2 pressure gradient= 6 mmHg (46->40)
Flow
volume of gas delivered (speed in LPM)
charles' law
volume of gas varies with changes in temerpature
Gay-Lussac law
volume of has is held constant the gas pressure rises as the absolute temperature of the gas increases
Water vapor pressure
water in a gaseous form is called water vapor or molecular water (behaves according to the gas laws and exerts partial pressure)
All of the following are used to calculate a patient's goal with incentive spirometer except? a. weight b. height c. age d. sex
weight
green, brown, gray, yellow, red, orange
what color is an oxygen tank? helium (He) tank? carbon dioxide (CO2) tank ? air tank? ethylene tank? cyclopropane tank?
frequent vent circuit change-outs
what contributes to the decreas in vent associated pneumonia (VAP)?
jet neb, large volume neb, ultrasonic neb
what device is used to administer continuous bland cool mist aerosol?
5-6 l/min 40%, 6-7 l/min 50%, 7-8 l/min 60%
what is FiO2 of a simple mask?
humidification
what is recommended if patient on nasal cannula reports dry nose/throat?
6 l/m 60%, 7 l/m 70%, 8 l/m 80%, 9 l/m 80+%, 10 l/m 80+%
what is the FiO2 of PRB (partial rebreather?
positioned away from bystanders
what is the best position for cylinder valve when cracking a tank?
heated humidifier, HME,
what is the correct humidity & aerosol therapy for pt uncuffed with thick/bloody secretions? intebated cuffed w/no secretions ?
heliox
what is the treatment for severe airway obstruction?
HME (heat and moisture exchanger) - bubble
what type of humidifier used during invasive mechanical ventilation?
Hypocapnia
when PaCO2 <35 mmHg
Hypercapnia
when PaCO2 > 45 mmHg
Thorpe Tube Flowmeters: 2 types (non-pressure compensated & pressure compensated) needle valve placement determines whether the device is back pressure compensated.
when delivering O2 from bedside, what outlet device is used?
When is hemoglobin 100% saturated?
when it holds 4 O2 molecules
Capillary shunt-like effect
when pulmonary capillary perfusion is in excess of ventilation
indication for using warm humidified gas
when the airways are exposed to relatively cold dry air, ciliary motility is reduced and airways become more irritable; the producition of mucus increases, and pulmonary secretions become thick and inspissated;
condensation (rain out), saturated, humidity deficit
when the humidifier is warmer than the circuit, __ __ occurs; when the circuit is warmer than the humidifier output, the inspired gas will not be fully ____ and a ___ ___ can be created. (pg 104)
60
when the relative humidity of inspired gas is greather than ___ % of BTPS conditions, no injury is believe to occur in normal lungs;
In a hospital, where should the main alarm be for an O2 system?
under continuous surveillance
How much O2 can each g% of Hb carry?
1.34 ml
N20 combustion characteristics
NF
NO combustion characteristics
NF
Air combustion characteristics
NF/SC
O2 combustion characteristics
NF/SC
What is the oxygen carrying capacity of hemoglobin?
1.34 ml/gm
60:40 He:02 ratio
1.4x liter flow correction factor
Residual volume
RV: amount of air remanding in the lungs after a maximal exhalation
CcO2=
(Hbx1.34)+(PAO2x0.003)
(Total O2 content) CaO2=
(Hbx1.34xSaO2)+(PaO2x0.003)
CvO2=
(Hbx1.34xSvO2)+(PvO2x0.003)
Cylinder Time Calculation
(PSI-500)x Tank Factor _________________= Minutes of tank Flow rate or MV
% O2 content=
(Pb-PH20)(FiO2)-PaCO2(1.25) use PaCO2 of 40 mmHg
PAO2=
(Pb-PH20)FiO2-(PaCO2x1.25)
Which of the following are clinical findings that indicate the development of atelectasis?
(Something) areas on chest x-ray film Tachypnea Diminished or bronchial
Estimating the duration of a medical gas cylinder supply
(cylinder pressure(psi)*Cylinder factor)/Flow rate of gas (L/min)=duration of flow in minutes
% change=
(post-pre)/pre x 100
Calculating total flow
(ratio added)x liter flow=total flow (ratio added)x=estimated insp flow (Vex3) insp demand (Vt/i time)x60
Normal PEFR
- 10 L/sec (600 L/min) men - 7.5 L/sec (450 L/min) women
American Standard Indexing
- H-K - large cylinders indexed by thread type, thread size, L/R hand threading, internal/external threading, and nipple seat design - used for large cylinders - life support gases are right hand and externally threaded
Polycythemia
- Increase level of RBC - pulmonary disorders produce chronic hypoxemia - hormone erythropoietin responds by stimulating the bone marrow to increase RBC production - adaptive mechanism designed to increase the O2 carrying capacity of blood
Piping System
- NFPA regulates construction, instillation, and testing - labeled every 20 feet with the contents - must be able to maintain 50 psi - has pressure release valves (50% higher than working pressure)
Uses of nitric oxide
- acute pulmonary hypertension in adult - PPHN (persistent pulmonary hypertension of newborn) - hypoxic respiratory failure in term/near term infants (back to fetal circulation)
patient interfaces
- aerosol mask (H+A) - face tent (H+A) - trach mask (H+A) - t-piece/briggs adapter (H+A) - mouthpiece (aerosol only)
Decrease in forced expiratory flow 200-1200
- age - obstructive disease - restrictive disease (due to low VC)
Decrease in forced expiratory flow rate 25%-75%
- age - obstructive patient - restrictive patient (due to low VC)
Oxygen Hoods (tut huts)
- allows infant to receive care without affecting FiO2 - can pre blend O2 and add humidity and deliver it to patient - flow is 5-10 LPM to flush CO2 (avg 7 LPM)
HME booster
- allows you to combine the simplicity of an HME and the extra power of active humidification - water is fed to heater thru a gravity feed solution bag - with 500 mL Vt 36-39 mgH20/L - with 1000 mL Vt 34-36 mgH20/L - dead space added in between HME and patient with all the extra tubing
Tissue hypoxia
- amount of O2 available for cellular metabolism is inadequate - when hypoxia exists lactic acid is produced which decreases Ph in the blood
Carbon dioxide in blood
- arterial blood enters systemic capillaries with PO2 of 100 mmHg and PCO2 of 40 mmHg - at tissue bed, O2 is consumed and CO2 is a by product of aerobic metabolism - blood must carry the CO2 produced away and to the lungs for elimination so CO2 does not build up in the tissues - maintain average PCO2 of 45 mmHg
Bourdon flowmeter
- as drive pressure increases, flow from the flowmeter outlet is increased - make sure gauge says LPM - this is not back pressure compensated, so as resistances occurs, indicated flow > actual flow
Examples of obstructive lung disease
- asthma - emphysema - chronic bronchitis - foreign body - croup - trachealitis - tumors - epiglotitis
Examples of restrictive lung disease
- atelectasis - fibrosis - pneumonia - massive obesity - pleural effusion - myasthenia gravis - diaphragmatic paralysis
Capillary shunt causes
- atelectasis - pneumonia - alveolar fluid accumulation (CHF or pulmonary edema)
Conditions which may cause problems with diffusion
- atelectasis - pulm. fibrosis - emphysema - pulm. edema - pneumonia
AeronebGo
- average particle size: 3.1 microns MMAD - medication cup- max 6 mL - 2 oz. - 3 AA disposable batteries
Alveolar hyperventilation
- best indexed by PaCO2 - PaCO2 <35 indicates the patient has ventilation in excess of the CO2 elimination needs of the body - PaCO2 >45 indicates the patient's ventilation is inadequate to meet the needs of the CO2 elimination needs of the body
Circulatory consistes of
- blood - heart (pump) - vascular system
Ketoacidosis
- blood insulin is low with diabetes, serum glucose cannot enter the tissues for metabolism - activates alternative metabolic process (ketone production)
What is CO2 used for?
- calibrate ABG machines - calibrate transcutaneous monitors - calibrate capnographs (measures exhaled CO2) - fire extinguisher
Liquid Oxygen
- can deliver O2 in bulk - regulated by NFPA (National Fire Protection Association) and American Society for Mechanical Engineers - pressure relief valves used in bulk systems regulated by Bureau of Explosives
Aeroneb Pro X
- can use with a ventilator or with a mp for spontaneously breathing patients - vibrating mesh
NebuTech HDN
- can use with mp or mask - mask- move the green valve from top to side port - uses 8 L of flow
HCO3 in plasma
- combines with Na (splitting NaCl) - NaHCO3 is transported to the lungs through venous blood - once HCO3 moves out of RBC the Cl then moves into the cell causing a neutrality (chloride shift)
Wick humidifier (concha system)
- contains ambient paper or sponge that draws water from a reservoir by capillary action - may contain a heated wire circuit - provides 100% RH at various temps
Direct-acting cylinder valve
- contains two fiber washers and teflon packing to prevent gas leakage around threads - can withstand high pressures (>1500 lbs/square inch (psi)
2 types Central Supply System
- continuous (liquid system) - alternating (gas system)
How is oxygen stored
- cryogenic storage tanks (liquid) - cylinders (gas)
Increases O2ER
- decrease CO - periods of increase O2 consumption (exercise, seizures, shivering, hyperthermia, anemia, decrease arterial O2)
Factors increasing C(a-v)O2
- decrease in CO - periods of increased O2 consumption (exercise, seizures, shivering, hypervolemia)
Hypokalemia
- depletion of K - several days of IV therapy with inadequate replacement of K - diuretic therapy - diarrhea
when HMEs are wet
- devices' resistance increases - WOB may increase
Acute alveolar hyperventilation
- due to pain, anxiety, secretions, fever, blood loss, inflammation, bronchospams - PaCO2 decreases, allowing more O2 molecules to leave pulmonary blood flow - pH increases, PaCO2 decreases - normal bicarb= acute
Venous admixture
- end result of pulmonary shunting - mixing of shunted blood - blood mixture evaluated downstream (radial artery) to determine patients ABG (arterial blood gas)
Incubator
- environmental delivery system - keeps baby warm, but can also deliver O2 - flag down= port open 40% O2 - flag up= port closed >40% O2 - monitor PO2 to prevent ROP
passover- fisher & paykel
- gas flow is directed over heated water - may contain a heated wire circuit - provides 100% RH at various temps - need water collection bag @ lowest point in tubing
Predicted PFT values based on:
- gender - age - race - height - normal body weight
BENs (breath enhanced nebulizers)
- generate aerosol continuously - increases delivered dose over simple medication news - decreases aerosol waste
VIAspire personal oxygen system
- gives patients ability to create daily supply of liquid O2 - analyzes patients' breath rate and automatically adjusts the O2 dose- encouraging better saturation, activity, and independence - can be used with any OSD (oxygen sensing device) concentrator
Pulse regulators
- has bourdon pressure reducing valve and flow restrictor - conserves O2 in 5:1 ratio
Fetal Hb
- has greater affinity for O2 and shifts curve to the left - enhances the transfer of O2 from mothers blood to fetal blood - infant has fetal Hb from birth- approx. 1 year - major difference in fetal Hb and adult Hb is related to 2-3 DPG - fetal Hb cannot bind to 2, 3 DPG, having a greater affinity for O2
Thickness of A/C membrane
- intra-alveolar liquid lining - alveolar epithelial cell - basement membrane with epithelial cell - loose connective tissue (interstitial space) - basement membrane with capillary endothelium - capillary endothelium - blood plasma - blood cell membrane - intracellular erythrocyte fluid
Methemoglobin (met Hb)
- iron in ferric state (F+++) rather than the ferrous state (F++) - Hb cannot function and cannot combine with O2; O2 is not delivered to the tissues - normal met Hb level <1% and is measured by a coximeter
Air Compressors
- large units provide 50 psi pressure with flows that can power a ventilator - small compressors can not produce 50 psi gas so they are only used to power SVN (small volume nebulizers)
What could be the problem when you hear gas escaping after attaching a regulator to a cylinder?
- leak due to loose connections - damaged plastic washer - left regulator on
Carbon Dioxide dissociation curve
- loading and unloading of CO2 in the blood - more direct relationship between partial pressure of CO2 (PCO2) and the amount of CO2 (CO2 content) in the blood - SaO2 and SvO2 affect the curve
Pulmonary mechanics
- looks at gas flow rates to access integrity of airways - FVC: max volume of gas that can be exhaled as forcefully as possible after a max inspiration
Properties of helium
- low density - must be 95% pure - nonflammable and does not support combustion - must combine with oxygen to support life - prepared commercially from natural wells
Humidity therapy
- low flow device- pt inspires O2 and RA and gets humidity from RA - use humidity to make patient comfortable (flows > 4 LPM) - high flow device- supply all inspiratory needs of patient therefore must provide humidity
Membrane- vapotherm precision flow
- molecular water passes into gas stream without direct contact between the two - flow range of 1-40 LPM by external source (air, O2 flowmeters, or blender) - delivers 95-100% RH - delivers up to 55 mg of water per liter of inspired air - temperature range 33-43*C - utilizes special shortened nasal cannula or may be used with other devices (i.e. transtracheal catheter, CPAP)
LVN (large volume nebulizer)
- most used for bland aerosol therapy - can entrain room air with specific FiO2s - delivers 26-35 mg H20/L - must make sure to have water trap in line, if not, patient may drown - FiO2 can increase with water in line because room air is not being entrained (back pressure)
Back pressure compensated flowmeters
- needle valve is distal to the thorpe tube therefore pressure in the thorpe tube is 50 psi - flowmeter reads accurately in the face of back pressure (if in upright position)
How can you tell if thorpe tube is compensated?
- needle valve is distal to thorpe tube - ball jumps when first given pressure - read label
ComfortFlo and ConcahTherm humidification system
- neonate thru adults - 1-40 LPM - adjustable airway temperature
Describe Oxy Mask
- only O2 therapy device to deliver FiO2 of 24-90% - high flow - zero probability of CO2 rebreathing - allows open communication with patient - designed for nose and mouth breathers - reduces probability of aspiration - cost effective (reduces PVC waste/gas consumption/manpower, achieves higher FiO2 on lower flow rates)
New Life InTENsity 10
- outlet pressure 20 psi - 2-9 LPM 92% +/-3 - 10 LPM 90% +/-3 - can be used on 2 patients at once (home, long term, hospice, assisted living)
ABG
- pH - PaCO2 - PaO2 - HCO3 - SaO2
O2ER= 25%
- patients Hb returning to the alveoli is 75% saturated with O2 and 25% is metabolized at the tissues - during the course of 1 minute 250 ml of blood is metabolized by tissues and 750 ml of O2 is returned to the lungs (1000 ml/min)
How can O2 be either perfused or diffused limited?
- perfusion limited: decrease in cardiac output or decrease in Hb - diffusion limited: if carbon monoxide is present (CO binds to Hb quicker than O2)
What is NO used to treat?
- persistent pulmonary hypertension of the newborn - hypoxic respiratory failure in term and near term newborns - congenital cardiac defects
3 Types air compressors
- piston - diaphragm - rotary
SVN use with MAV and NiPPV
- place 18" from patient airway - only nebulize on inspiration - best if use same oxygen concentration as patient is getting so use deliver port on machine designed for SVN use
How is a cylinder hydrostatically tested?
- placed in water - exposed to 5/3 of its working pressure - if it holds pressure, it passes (marked with date, the tester's initials and a +)
Pin Index Safety System (PISS)
- placement of small pins into a post valve - AA-E
Kinetic energy
energy an object posses when it is in motion
Absolute humidity characteristics
- recorded as a g/m3 or mg/L - sometimes referred to as content - as content increases, temperature increases
P50
- reference point Hb 1/2 saturated with O2 - usual PO2 is 27 mmHg @ P50 - changes as curve shifts to right/left
Capnography
- refers to the PCO2 changes of exhaled tidal volumes graphically displayed as a waveform - the waveform is called capnogram
Hypoxic hypoxia (hypoxemia)
- refers to the condition where PaO2 and CaO2 are abnormally low - this form of hypoxia can develop from pulmonary shunting
Multiplace chamber
- room air compresses chamber - breathing 100% O2 - more than one person can be treated
Explain process of fractional distillation
- room air is drawn in and removed of impurities - cooled to near freezing to remove water vapor - compressed to 200 atm so temperature increases - cooled to room temperature with nitrogen coils - liquid gas mixture produced from cooling - liquid air is put through distilling column and warmed to room temperature so other gases boil off - liquid oxygen obtained by maintaining temperature of gas mixture just below boiling point of oxygen - process repeated until mixture is 99% pure - transferred to cold converters for storage and later transported
3 types pressure relief valves
- rupture disk (frangible disk) - fusible plug - spring loaded
Why is O2 conservation so important?
- saves money - increases time patients can be "out and about" using smaller O2 delivery devices
Advantages vibrating mesh technology
- uses no compressed air - generates negligible heat - works with drugs in solution or suspension - adds no additional flow into a ventilator circuit - creases a fine particle, low-velocity aerosol with precisely sized particles - leaves virtually no residual (no dead space vol.)
Rotary air compressor
- uses rotating vane to compress air from an intake valve - used as internal component to some ventilators
Diaphragm cylinder valve
- uses threaded stem in place of packing found on direct-acting valves - stem is separated from valve seat and spring by two diaphragms (one steel, one copper)
Bulk Air Supply
- uses two compressors that can operate together or independently - each compressor should be able to deliver 100% of average peak demand - NFPA regulates this - usually piston or rotary - have features of high flow and provides 50 psi gas
Oxygen consumption (VO2)
- usually related to body surface area because the amount of O2 extracted by peripheral cells varies with patients height and weight (VO2/BSA normal= 125-165 ml O2/m2)
Advantages of diaphragm cylinder valve
- valve seat doesn't turn, so it is resistant to scoring - no stem leakage can occur - the stem can be opened with parietal oration rather than with two turns o the wheel (as in direct-acting) - preferable when pressures are relatively low (<1500 psi) - ideal for situations in which no gas leaks can be allowed (flammable anesthetics)
Micro Air
- vibrating mesh technology - uses 2 AA batteries - provides 40 treatments - home device (instead of small air compressor)
Nitric Oxide (NO)
- will support combustion - will combine with O2 to form brown fumes of nitrogen dioxide (NO2) - if combined with water it will become corrosive by forming nitrous and nitric acid
Boiling point of oxygen
-183*C/-297.3*F
Base excess/deficit
-2, -1, 0, 1, 2 (normal) ex: if BE= -5, HCO3 <22 if BE= 4, HCO3 >26
Flat portion of curve
-O2 uptake in the lungs occur in this PO2 range (60-100 mmHg) -PO2 changes but with only little changes from 90-97% in & Hb saturation
P50 increase (rightward shift)
-decreases Ph: unloading of O2 @ cellular level (increase PCO2) - increase temperature: release of O2 as blood flows through muscle capillaries - increase 2-3 DPG: prolonged hypoxia or cyanotic heart disease is significant, anemia - affinity of Hb to O2 is decreased - exercising muscles: enhancing unloading of O2 (helpful)
Dissolved O2 in plasma (PO2)
-driving force moving O2 into the RBC and forming HbO2 - PO2 is used clinically because PaO2 reflects oxygenation problems sooner than SaO2
Physical Separation
-methods based on differences in physical properties and used to separate mixtures into the components present (mix components to form original material)
Prefusion-Limited Gas Flow
-the transfer of gas the alveolar wall is the function of the amount of blood that flows past the alveoli -the movement of gas across alveolar wall is the function of integrity of alveolar capillary membrane
Normal solubility of O2 in plasma
0.003 vol% for every torr of PaO2
The average compliance of the lungs and chest all combined is:
0.1 L/cmH2O
Tank Factor for D Cylinders
0.16
cylinder factor: D
0.16
Normal lung compliance is:
0.20 L/cmH2O
Cylinder factor: E
0.28
Tank Factor for E Cylinders
0.28
What cylinder factor is used to calculate duration of flow for an E cylinder filled with oxygen?
0.28
cylinder factor: E
0.28
Normal arterial blood PO2 of 100 mmHg contains..
0.3 ml of O2
average dead volume SVN
0.5-2.2 mL
Total transit time for blood to move through the alveolar-capillary system
0.75 sec (perfusion= blood going through the system)
PISS air pin location
1 and 5
You set up an Oxy-Hood with an FIO2 of 0.5 for a newborn infant. What is the maximum time that should pass before assessing this patients PaO2 or SaO2?
1 hour
The gauge on an E cylinder of O2 reads 800 psi. About how long will the cylinder contents last at a flow of 3LPM?
1 hour 15 minutes
How long should you instruct a patient to wait between puffs while using an MDI?
1 minute
E cylinders of carbon dioxide are colored:
gray
IS is indicated for patients who are predisposed to develop atelectasis. List four medical conditions for which IS is indicated.
1) upper abdominal surgery 2) thoracic surgery 3) presence of restrictive lung defect associated with quadriplegia or a dysfunctional diaphragm 4) to prevent atelectasis in patients with COPD who are scheduled for surgery
2 forms O2 is carried
1. Dissolved in blood plasma 2. chemically bound to Hb
EIGHT possible disadvantages of all masks?
1. FiO2 varies significantly 2. CO2 rebreathing occurs if flow rate is not high enough to flush it out 3. confining 4. not well tolerated 5. must remove to eat/drink/talk/etc 6. skin irritation 7. pressure sores 8. reservoir for vomitus
(4) results long standing HD
1. airway drying 2. retention of secretions 3. airway plugging (secretion blocking) 4. increased chance of infection
(5) Common causes metabolic acidosis
1. hypokalemia 2. hypochloremia 3. gastric suctioning or vomiting (loss of hydrochloric acid, increase pH) 4. excessive administration of corticosteroids 5. excessive administration of NaHCO3
SIX Indications (O2 in home)
1. Long-term oxygen therapy (LTOT) in the home or alternate site health care facility is normally indicated for the treatment of hypoxemia. LTOT has been shown to significantly improve survival in hypoxemic patients with COPD. LTOT has been shown to reduce hospitalizations and lengths of stay. 2. Laboratory indications: Documented hypoxemia in adults, children, and infants older than 28 days as evidenced by [1] PaO2 ≤ 55 mm Hg or SaO2 ≤ 88% in subjects breathing room air or [2] PaO2 of 56-59 mm Hg or SaO2 or SpO2 ≤ 89% in association with specific clinical conditions (eg, cor pulmonale, congestive heart failure, or erythrocythemia with hematocrit > 56). 3. Some patients may not demonstrate a need for oxygen therapy at rest (normoxic) but will be hypoxemic during ambulation, sleep, or exercise. Oxygen therapy is indicated during these specific activities when the SaO2 is demonstrated to fall to ≤ 88%.8 4. Oxygen therapy may be prescribed by the attending physician for indications outside of those noted above or in cases were strong evidence may be lacking (eg, cluster headaches) on the order and discretion of the attending physician. 5. Patients who are approaching the end of life frequently exhibit dyspnea with or without hypoxemia. Dyspnea in the absence of hypoxemia can be treated with techniques and drugs other than oxygen. Oxygen may be tried in these patients at 1-3 liters per minute, to obtain subjective relief of dyspnea. 6. All oxygen must be prescribed and dispensed in accordance with federal, state, and local laws and regulations.
Precautions (O2 in home)
1. There is a potential in some spontaneously breathing hypoxemic patients with hypercapnia and chronic obstructive pulmonary disease that oxygen administration may lead to an increase in PaCO2. 2. Undesirable results or events may result from noncompliance with physicians' orders or inadequate instruction in home oxygen therapy. 3. Complications may result from use of nasal cannulae or transtracheal catheters. 4. Fire hazard is increased in the presence of increased oxygen concentrations. 5. Bacterial contamination associated with certain nebulizers and humidification systems is a possible hazard. 6. Possible physical hazards can be posed by unsecured cylinders, ungrounded equipment, or mishandling of liquid oxygen. Power or equipment malfunction and/or failure can lead to an interruption in oxygen supply.
FIVE reasons to use heliox therapy?
1. asthma with acute respiratory failure 2. post extubation stridor 3. adjunctive therapy to refractory croup 4. ventilator support for chronic bronchitis and emphysema with severe airway obstruction 5. delivery anesthesia to patient with small ETT
(3) O2 decreases when decrease in:
1. blood oxygenation 2. Hb concentration 3. cardiac output (blood loss)
What are three possible configurations for regulators?
1. bourdon/bourdon 2. bourdon/thorpe 3. bourdon/flow
(3) pH maintained by
1. buffer systems of blood and tissue 2. respiratory system's ability to regulate elimination of CO2 3. renal system's ability to regulate the excretion of H ions and reabsorption of HCO3 ions
What 2 things must you check if your patient is going to be on a pulse dose device?
1. check sats 2. make sure they can trigger the device
(3) reasons why not using a water trap may be a problem?
1. condensation can decrease/obstruct gas flow to patient 2. condensation may change FiO2 delivered to patient 3. condensation may be aspirated by patient
Contraindications of hyperbaric chamber
1. congenital spherocytosis 2. high fevers 3. hypercaphia (>60 mmHg) 4. obstructive airway disease 5. optic neuritis 6. pneumothorax 7. seizure disorders 8. sinusitis 9. upper respiratory infections 10. viral infections
TEN diseases/conditions for using hyperbaric O2
1. decompression sickness 2. CO poisoning 3. skin grafts 4. cyanide poisoning 5. air embolism (deep sea diving) 6. refractory anaerobic infections 7. thermal burns 8. bone inflammation (refractory osteomyelitis) 9. gas gangrene 10. wound healing
THREE Clinical applications of Fick's Law
1. decrease in alveolar SA (decrease ability of O2 to enter pulmonary capillary blood) 2. decrease alveolar O2 pressure (high altitudes) reduces diffusion of O2 into pulmonary capillary blood 3. alveolar thickness (increase in tissue thickness- Pulm. fibrosis/pulm. edema- reduces movement of O2 across alveolar capillary membrane)
(3) advantages medicated aerosol
1. deliver where it needs to work 2. decrease systemic side effects 3. rapid absorption and onset of action *non invasive
3 mechanisms in the plasma
1. dissolved CO2 (5% of total CO2 released) 2. bicarbonate (5% of total CO2 released) 3. carbamino compound which is bound to protein (1% of total CO2 released)
3 mechanisms in the RBC
1. dissolved CO2 intracellular of the RBC (5% of total CO2 released) 2. bicarbonate (63% of total CO2 released) 3. carbamino-Hb is bound to Hb (21% of total CO2 released)
What three things can act as a baffle
1. fluid surface 2. sides of container 3. device in the gas stream
Contraindications for HME use
1. frank bloody or thick, copious secretions 2. patients with expired Vt
Things affecting aerosol deposition
1. gravity/ sedimentation (larger, less stable easier deposited) 2. intertial impaction (happens with high inspiratory flows >30 LPM) 3. aging (aerosols grow and shrink and fall out of suspension over time) 4. diffusion (have low mass)
(3) uses of bland aerosol therapy
1. humidify dry medical gases 2. sputum induction 3. decrease airway edema (use for croup and post-extubation in stridor) *using something other than sterile water can help them cough up secretions for sputum sample
(7) hazards of bland aerosol therapy
1. inadequate mist production 2. bronchospams 3. cross-contamination 4. fluid overload (over hydration) 5. swelling of secretions or airway obstruction due to swollen mucus 6. airway thermal injury (if heated unit is used) 7. environmental safety
Indications for PFT
1. indicate the type of disease (obstructive/restrictive) 2. evaluate course of the disease 3. check the effectiveness of treatment 4. quantify a disability 5. identify post-operative risk 6. diagnosis or assess the severity of restrictive lung disease (reduced TLC) 7. differentiate between obstructive and restrictive lung disease
What do the components of liquid O2 bulk storage include?
1. inner and outer steel shells, separated by vacuum 2. Safety System that vents O2 if warming occurs 3. Vaporizer system that converts liquid O2 to gas 4. Pressure-reducing valve to lower pressure to 50 PSIG
uses for HME
1. intubated patients 2. trached patients on or off mechanical ventilation 3. stoma patients
(3) Common causes of metabolic acidosis
1. lactic acidosis 2. ketoacidosis 3. renal failure
FOUR problems with NC?
1. nasopharynx irritation 2. twisting of tubing 3. skin irritation and pressure sores (face+ears; oxyears= cushioning) 4. dislodging
(5) engineering controls that may reduce exhaled aerosols
1. place pt. in environmental chamber with HEDA filter 2. exhalation filters 3. place in negative pressure room (six air exchanges/hour) 4. wear PPE 5. use BAN nebulizers (only get on inspiration)
What are two devices incorporated into a regulator?
1. pressure reducing valve 2. flow meter
Three goals of O2 therapy
1. prevent/treat hypoxemia 2. decrease WOB 3. decrease work of heart
(6) hazards medicated aerosols
1. reaction to medication (systemic+pulmonary) 2. infection (clean+disinfect) 3. bronchospams 4. drug concentration changes 5. eye irritation (especially with anticholinergic) 6. exposure to 2nd hand aerosols
(3) Factors that impact alveolar venitlation
1. respiratory rate 2. tidal volume 3. dead space ventilation
(2) Causes circulatory hypoxia
1. stagnet hypoxia 2. arterial-venous shunting
(4) factors that will increase the effectiveness of a humidifier
1. temperature 2. surface area 3. time of contact 4. thermal mass
Three types flowmeters
1. thorpe tubes 2. bourdon 3. flow resrictors
(2) examples: high flow active humidifiers
1. wick type humidifier 2. passover humidifier
what amount of flow does a bubble humidifier deliver at flows <5 LPM?
10-20 mg/L 20% RH @BTPS
what amount of humidity do HMEs provide
10-31 mg/L water @ 30*C
Tachycardia is defined as a heart rate greater than:
100 bpm
PAO2=? at normobaric conditions
100 mmHg
A post-operative pt is on a 5 Lpm nasal cannula. A physician has written an order for a blood gas. After the gas has been analyzed the results are as follow: pH7.40 PCO 40mmHg HCO3 34mEq/l PaO2 50mmHg What FiO2 and device would you need to change the pt to in order to correct the ABG to normal?
100% nonrebreather
Normal DO2
1000 ml O2/L blood
Board Exam question: The respiratory therapist is setting up a portable liquid oxygen system for a patient with chronic lung condition who attends church each week. The patient is using a 2 L/min nasal cannula, and the portable oxygen container holds 4 lb. of oxygen. The therapist should explain to the patient that the oxygen supply will last for approximately what length of time?
11.5 h
Which of the following blood pressure measurements would be considered normal?
115/75
Which of the following respiratory rates would be considered normal?
12 breaths per minute
The normal hemoglobin count is:
12-16 g/dL
Average ERV
1200 ml
Average RV
1200 ml
Size of D Cylinder
13 cu ft
You are given a 80% He: 20% O2 mixture to an asthmatic patient through a non-rebreathing mask with a compensated Thorpe tube O2 flowmeter set at 8 LPM. What is the actual flow being delivered to the patient?
14 LPM
You are giving a 80% he and 20% O2 mixture to an asthmatic patient with a compensated Thorpe tube set at 8 LPM. What is the actual flow being delivered to the patient?
14 LPM
What is the minimum recommended time for handwashing in the health care environment?
15 seconds
Normal CvO2
15 vol%
At what temp do small cylinders have a fusible plug that melts to prevent bursting?
150-170 Degrees F
At approximately what pressure would a cylinder be 3/4 full?
1500 psi
What does 2 atmospheric pressure absolute (ATA) equal in mmHg?
1520 mmHg
A patient has a tumor occluding half of his airway; his resistance to flow is increased ____ times.
16
The gauge of an H cylinder reads 2000 psi. About how long would the cylinder contents last at a flow of 6 LPM?
17 hours 30 minutes
Size of G Cylinder
187 cu ft
What is the air:oxygen ratio for a patient receiving 60% air entrainment nebulizer?
1:1
Estimated FiO2s for 1L-6L for NC?
1L- 24% 2L- 28% 3L- 32 4L- 36% 5L- 40% 6L- 44%
hypoxia
@ tissue level (if you have hypoxia, you definitely have hypoxemia)
Which of the following factors should be used in properly selecting an O2 delivery device? A. Knowledge of general performance of device B. If the safety valve is present C. Individual capabilities of the equipment D. All of the Above
A & C Knowledge of the general performance of device Individual capabilities of the equipment
Semipermeable Membranes
A biologic or synthetic membrane that permits the passage of certain molecules.
Spring-Loaded Devices
A device that functions based on its ability to overcome the tension imposed by a spring.
Oxygen Concentrators
A device that increases the oxygen content of inspired gas by enriching or concentrating the oxygen in the air.
Check Valves
A device usually consisting of a one way valve that prevents back or retrograde gas flow.
Thorpe Tube Flow meter
A flow meter in which the gas stream suspends a steel ball in a tapered tube. As the ball obstructs a greater proportion of the cross section of the tapered tube, flow is reduced.
Piston Compressors
A gas source in which a volume of gas is reduced in volume and pressurized by a piston.
Alternating Supply System
A gas supply system that has two supplies of compressed gas (primary and secondary). The secondary system is used when the primary system fails.
Diameter Index Safety System (DISS)
A safety system for compressed gas fittings. The Diss is used in respiratory care when equipment is connected to a low pressure gas source (<or=200 psi).
Molecular Sieves
A term used to describe components of a type of oxygen concentrator that filters air and chemically removes nitrogen and some trace gases from the air.
Fusible Plugs
A type of pressure relief mechanism made of metal alloy that melts when the temperature of the gas in the tank exceeds a predetermined temperature. Fusible plugs operate on the principle that as the pressure in the tank increases, which causes the plug to melt. The melting of the plug releases excess pressure
American Standards Association Indexing (ASA)
A type of safety system for high pressure gas connections. American Standard for high noninterchangeable to prevent the interchange of regulator equipment among gases. American Standard Indexing has separate system for large and small cylinders.
Flowmeter
A valve that indicates the flow of oxygen in liters per minute.
Which of the following are advantages of the nasal cannula as a low flow O2 delivery system? A. Easy to use B. Disposable C. Low Cost D. Fixed flow
A, B, C Easy to use, disposable, low cost
Which of the following signs and symptoms are associated with the presence of hypoxemia? A. Tachypnea B. Tachycardia C. Cyanosis D. Bradycardia
A, B, C Tachypnea, Tachycardia, Cyanosis
A patient receiving 3 L/min O2 through a nasal cannula has a measured SpO2 of 93% and no clinical signs of hypoxemia. At this point, what should you recommend? A. Decreasing the flow to 2 L/min and rechecking the SpO2 B. Maintaining the therapy as is and rechecking the SpO2 on the next shift C. Increasing the flow to 4 L/min & rechecking the SpO2 D. Discontinuing the O2 therapy
A. Decreasing the flow to 2 L/min and rechecking the SpO2
An infant requires both a precise high FIO2 and maintenance of a neutral thermal environment. Which of the following systems can best achieve these goals? I. Oxy-Hood or warmed O2 blending system without incubator II. Heated incubator with automatic O2 controlling system III. Heated incubator with Oxy-Hood blending system A. I and II B. II and III C. I and III D. I, II, and III
A. I and II Oxy-Hood or warmed O2 blending system without incubator or heated incubator with automatic O2 controlling system
In which of the following clinical situations would you recommend hyperbaric oxygen (HBO) therapy, if available? I. Carbon monoxide poisoning II. Respiratory or cardiac arrest III. Severe trauma IV. Cyanide poisoning A. I and IV B. II and III C. I, II, III, and IV D. I, II, and IV only
A. I and IV
Which of the following is false about absorption atelectasis? A. It only occurs when breathing supplemental O2 B. Its risk is increased in patients at low tidal volumes C. Its risk is decreased through sign mechanism D. It results in an increase in physiologic shunt fraction
A. It only occurs when breathing Supplemental O2
American Standard Connection
ASC
Oxygen therapy is least to be of benefit in hypoxia that is due to:
Abnormalities in tissue utilization
Which of the following factors will decrease the FIO2 delivered by a low-flow O2 System? A. Short inspiratory time B. Fast rate of breathing C. Lower O2 output D. Large minute ventilation
All are factors
Which of the following methods can assess therapeutic effective of aerosolized bronchodilator medication? A. peak flow meter B. spirometer C. breath sounds D. all the above
All the above
Gas Supply Systems
Alternating (cylinder manifold), Cylinder (reserve supply), bulk Bulk
An acute blood loss would cause ______ hypoxia.
Anemic
Nitrous Oxide
Anesthetic Gas, Colorless, slightly sweet, does not support life, supports combustion. must be delivered with at least 20% oxygen. has a depressant effect on CNS
Dalton's Law
Atmosphere consists of several kinds of gases. It is essential to understand how they react when mixed together. In a mixture of gases, the total pressure is equal to the sum of the partial pressures of each separate gas.
A physician orders 40% O2 through an air-entrainment nebulizer for a patient with a minute volume of 12 L/min. What is the minimum nebulizer input flow required to ensure the pre-scribed FIO2? A. 8 L/min B. 10 L/min C. 12 L/min D. 14 L/min
B. 10 L/min
Which of the following would indicate adequate oxygenation for adult patients with chronic lung disease and an accompanying acute-on-chronic hypoxemia? I. SaO2 of 90% or higher II. PaO2 of 50 mm Hg to 60 mm Hg III SaO2 of 85% to 90% A. I and II B. II and III C. I and III D. I, II, and III
B. II and III
Which of the following is false about the simple O2 mask? A. The FIO2 is variable B. It can easily deliver high FIO2 values than .6 to .7 C. The correct flow for simple masks is 5-10 L/min D. The FIO2 range is 35-50%
B. It can easily deliver high FIO2 values
HD=
BH-ambient
What is the principle of which mist tents work to produce an aerosol
Babbington principle
Uncompensated Thorpe
Back Pressure will indicate a flow lower than delivered flow (older and not accurate)
You can determine that a nasal O2 catheter is properly positioned when its tip is where?
Behind & Above the Uvula
ROP may result in what condition?
Blindness
Retinopathy of prematurity that results from oxygen toxicity may result in which of the following?
Blindness
Always used with an adjustable pressure reducing device
Bourdon Gauge
Describe pendant cannula
holds about 40 ml bolus of 100% O2
A patient receiving 35% O2 through an air-entrainment mask set at 6 L/min input flow becomes tachypneic. Simultaneously, you notice that the SpO2 has fallen from 91% to 87%. Which of the following actions would be most appropriate in this situation? A. Continue monitoring patient, no action at this time as this is a safe range B. Increase the output flow to 8 L/min C. Increase the devices input flow to 10 L/min D. Increase the O2 to 100%
C Increase the devices input flow to 10 L/min
What is the level of SpO2 typically associated with discontinuation of O2 therapy? A. 88% B. 90% C. 92% D. 94%
C. 92%
Low flow O2 delivery systems used in respiratory care include all of the following except: A. Nasal O2 Cannula B. Nasal O2 Catheter C. Air entrainment Mask D. Transtracheal Catheter
C. Air Entrainment Mask
Which of the following is FALSE about air-entrainment systems? A. FIO2 is fixed B. FIO2 range is 24-50% C. FIO2 values are directly proportional to total flow D. Flow varies & should provide output flow below 60 L/min
C. FIO2 values are directly proportional to total flow
Which of the following statements is false about low-flow O2 delivery systems? A. All low flow devices provide variable O2 contractions B. Provided O2 is diluted with air patients flow usually exceeds that from low flow device C. The greater the patients inspiratory flow the greater the FIO2 D. The greater the patients inspiratory flow the more air that is breathed.
C. The greater the patients inspiratory flow the greater the FIO2
celsius to kelvin
C=k-273
Graham's and Henry's Law
CO2 diffuses about 20 times faster than O2
Compare CO2 and O2 dissociation curves
CO2- linear O2- s curve
Non-Flamable Gasses
Carbon Dioxide
High oxygen concentrations given over a long period of time will:
Cause intrinsic cellular damage to the alveolar epithelium
How is compliance computed?
Change in volume/change in pressure
Volume Pressure Constant
Charles law
** When checking a patient's IPPB breathing circuit prior to use, you notice the device will not cycle off, even when you occlude the mouthpiece. What would be the most appropriate action at this time?
Check the circuit for leaks
What type of test gives a measurement of all important cellular components that make up the blood?
Complete Blood Count
Board Exam question: A patient with acute exacerbation of asthma is not responding to the standard dose and frequency of aerosolized bronchodilator and is now receiving small volume nebulizer every 30 minutes. Which of the following would you recommend to the patient's physician at this time?
Consider continuous nebulization of the drug
At rest tissues consume and produce how much O2 and CO2?
Consumes 250 ml of O2 and produce 200 ml of CO2 each minute
cm H2Ox 0.7355=mmHg, 29.42 mmHg
Conversion of cm to mmHg = ______; EXAMPLE: If peak pressur on ventilator reads 40cm, the equivilent in mmHg is _____ mmHg;
Which of the following respiratory therapy modalities would aid in clearing rhonchi?
Cough
When attaching regulator, make sure to ____ the Cylinder
Crack (open)
Flammable Gases
Cyclopropane
heat treated steel tank; aluminum tank; type of tank & service pressure; DOT specs, manfucturers mark, owners mark, serial number
Cylinder markings: What does 3AA mean? 3Al? what are the 2 DOT specs listed on tank? 4 things on left side of tank?
Specific clinical objectives of O2 therapy include which of the following? A. Correct documented or suspected acute hypoxemia B. Decrease symptoms associated with hypoxemia C. Decrease the workload hypoxemia imposes on cardiopulmonary systems D. All of the above
D. All of the Above
When determining the need for O2 therapy, the RT should assess which of the following? A. Neurological Status B. Pulmonary Status C. Cardiac Status D. All of the Above
D. All of the Above
Which of the following would indicate a need for O2 therapy for an adult or child? A. The use of lab measurements to diagnose hypoxemia B. A patients need for O2 based on specific clinical problem or condition C. Manifestations of tachypnea, tachycardia, cyanosis, & distressed overall appearance. D. All of the Above
D. All of the Above
Which of the following are components of a typical O2 blender? A. Precision metering device or mixture control B. Audible dual pressure (low) alarm system C. Pressure regulating & equalizing valve D. All of the above
D. All of the above
You note that the air intake ports surrounding the jet of a 35% air-entrainment mask are partially obstructed by the patient's bedding. Which of the following would you expect? A. Decreases the devices output flow B. Increases the % of O2 delivered by device C. Change in FIO2 received by the patient D. All of the above
D. All of the above
What is/are the primary organ system affected by O2 toxicity? A. Lungs B. CNS C. Kidneys D. Both A & B
D. Both A & B Lungs & CNS
Disadvantages of standard O2 masks include all of the following except: A. Being difficult to apply B. Patient discomfort C. Increasing risk of aspiration D. FIO2 will not vary with air leakage
D. FIO2 will not vary with air leakage
What are some key patient considerations in selecting O2 therapy equipment? I. type of airway (natural or artificial) II. Severity and cause of the hypoxemia III. Age group (infant, child, adult) IV. Stability of the minute ventilation A. II and IV B. I, II, and III C. III and IV D. I, II, III, and IV
D. I, II, III, and IV
Benefits of properly applied O2 therapy in patients with chronic hypoxemia include all of the following except: A. Reversal of pulmonary vasoconstriction B. Relief of pulmonary hypertension C. Decreased right ventricular workload D. Improved pulmonary diffusing capacity
D. Improved pulmonary diffusing capacity
Low Pressure Connections use what kind of safety sysem?
D.I.S.S. Diameter index safety system
Who regulates cylinders?
DOT
What are Cylinders tested for?
Damage, Moisture, and foreign odors
If you increase orifice size on the jet of a nebulizer the entrain gas or fluid would:
Decrease
When delivering a positive pressure, a decrease in lung compliance will result in what change in lung volume?
Decrease in lung volumes
A patient breathing 100% O2 for 24 hrs or longer would most likely exhibit what?
Decreased Vital Capacity
Goals of O2 therapy include?
Decreased Work of Breathing Treatment of Hypoxia Decreased Intracranial Pressure
A fibrotic lung would exhibit which of the following characteristic?
Decreased lung compliance
All of the following are factors that contribute to beneficial effect of CPAP except: a. Recruitment of alveoli b. Decrease work of breathing c. Improves distribution of ventilation d. Decreases transpulmonary pressure gradient
Decreases transpulmonary pressure gradient
A venti-mask set at 24% O2 has the flowmeter running at 4 LPM. Which of the following would increase the O2 concentration?
Decreasing the air entrainment port size Increasing the oxygen-orifice diameter
A patient receiving 3 LPM O2 through a nasal cannula has a measure SpO2 of 93% and no clinical signs of hypopnea. At this point what should you recommend?
Decreasing the flow to 2 LPM and rechecking the SpO2
DHHS
Department of Health and Human Services (department of federal government that oversees health care delivery in the US)
Who regulates the transportation of O2
Department of Transportation (DOT)
DOT
Department of transportation (provides regulations for the manufacture, storage, and transport of compressed gases)
What is a Quick Connect system?
Designed to fit directly into the wall, specific to each gas.
What do you do if the label and color on a cylinder don't match?
Don't use it
All of the following occur(s) during the compression phase of a cough except? a. Expiratory muscle contraction b. Closing of the glottis c. Drop in alveolar pressures d. Rise in pleural pressure
Drop in alveolar pressures
Which of the following is not considered a clinical sign of a disorder?
Dyspnea
Only use _______ with connections of 200 or more PSIG
E Cylinders
The most commonly used oxygen tank for patient transportation in the acute care setting is:
E tank
If you were to go on a local transport that required you to place a cylinder on the side, which of the following would be the the device of choice?
E tank with a Bourdon gauge
Volume Pressure Conversion factors
E-0.28 G-2.39 H or K-3.14
Which of the following alternatives may increase the FIO2 capabilities of air-entrainment nebulizers? A. Add open reservoir to expiratory side of t-tube B. Connect two or more nebulizers C. Use a commercial dual flow system D. None of the above E. All of the Above
E. All of the Above
In giving O2 to an infant through a hood, which of the following is/are correct? A. A neutral & thermal environment should be kept B. Gases should be directed away from infants face C. High input flow greater than 10-15 should be avoided D. Both A & B E. All of the above
E. All of the above
Which of the following factors determine the actual O2 provided by an air entrainment system? A. The nebulizer used B. Air to O2 ratio of device C. Resistance downstream from the Jet D. Both A & B E. Both B & C F. All of the Above
E. Both B & C Air to O2 ratio of device Resistance downstream from the Jet
(air flow x 21) + (O2 flow x 100) / total flow
percent oxygen
The FRC is made up of which of the following?
ERV (Expiratory Reserve Volume) RV (Residual Volume)
FRC=
ERV+RV (functional residual capacity)
Expiratory reserve volume
ERV: maximum volume of air that can be exhaled after a normal tidal volume exhalation
What is the most common complication of hyperbaric oxygen therapy?
Ear or Sinus trauma
Which of the indicates consolidation where an E sounds like an A?
Egophony
To ensure the prescribed FIO2 for a patient receiving 65% O2, you apply a closed reservoir delivery system with a one-way expiratory valve. What other component must be included in this system to ensure a fail-safe operation?
Emergency Inlet Valve
I have a patient who had gastric bypass surgery three days ago. She is on a 3 LPM nasal cannula has a weak cough and you have noticed that her breath sounds reveal fine crackles in the bases. As this patient's respiratory therapist what would you suggest as the best therapy for this patient?
Encourage deep breathing and coughing to clear lungs because your lungs are warm and moist and you are at a high risk of getting an infection Inform patient on proper use of incentive spirometer Inform doctor that this patient appears to be getting atelectasis and suggest a CRX and IPPB therapy
Flammable Gases
Ethylene
In teaching a patient to perform a sustained maximal inspiration maneuver during IS, what would you say to the patient?
Exhale normally, then inhale as deeply as you can, then hold your breath 5-10 seconds
CO combustion characteristics
F
To confirm proper operation of an O2 blending system, what should you do? A. Test low pressure alarms & bypass systems B. Analyze FIO2 @ .21 & 1.00 & prescribed level C. Confirm air & FIO2 inlet pressure D. Read the label for mixing instructions E. All of the above F. A, B, & C
F. A, B, C
Directing a cool O2 mixture to an infant in an Oxy-Hood can result in which of the following? A. Increased O2 Consumption B. Increased convective heat loss C. Possible choking or aspiration D. Apnea E. All of the above F. A, B, D G. A, B, C
F. A, B, D Increased O2 Consumption Increased convective heat loss Apnea
Who sets the standards for medical gases?
FDA
Which of the following is false about air entrainment systems?
FIO2 values are directly proportional to their total flow
Functional residual capacity
FRC: volume of air remaining in the lungs after a normal exhalation (ERV+RV)
A serum glucose of 65 mg/dL is indicative of hyperglycemia.
False
Abnormal breath sounds are termed as vesicular breath sounds.
False
Acid fast stain is used to test for Pseudomonas aeruginosa.
False
Heliox is used to treat hypoxemic respiratory failure in infants when traditional therapies are unsuccessful.
False
T or F: Nasal anatomy & breathing patterns do not affect the performance of reservoir cannulas?
False; Nasal anatomy & breathing patterns doe affect the performance of reservoir cannulas
FDA
Food and Drug Administration (agency of DHHS that sets purity standards for medical gases)
When are Low Pressure connections used?
For Cylinders of 200 PSIG or less.
decompression sickness, air embolism, CO2 poisoning, smoke inhalation, anaerobic infections, skin grafts, and refractory osteomyleitis;
For what are patients treated via hyperbaric oxygen (7 things)?
total flow=addition of air:O2 ratio (e.g. sum of 1 : 3.2 = 4.2) & divide by flow (L/min) given in problem
Formula for calculating total flow of air entrainment device?
What is the most common and least expensive method for commercial production of medical oxygen?
Fractional distillation of air
Which gas do you use as a refrigerant?
Frozen CO2 (dry ice)
Which type of relief valve is most commonly used in the valve system of E cylinders?
Fusible plug
What are the most commonly used cylinder sizes in the hospital?
G and H (E is used for transportation within hospital)
Color is used only as a guide. Codes are not used internationally, Contents must be identified with inspection label.
Gas Cylinder
What is the most common device used to generate bland aerosols?
Large-volume jet nebulizer
Adult Flow Meter
Larger flow increments
Which of the following dyspnea grades would a patient have if they were short of breath at rest?
Grade V
Color Code of O2 and Helium
Green and Brown
Color Code of O2 and CO2 mix
Green and Grey
Which of the following cylinders have a threaded valve outlet?
H tank
Henderson-Hasselbalch equation
H2CO3/NaHCO3
Bulk of CO2 is transported from tissues to lungs as..
HCO3
Major portion of dissolved CO2 enters the RBC and is converted to..
HCO3
example: one type of high flow passive humidifier
HME
if you patient is receiving a lung protective strategy (small Vt), what type of humification is not recommended?
HMEs
what should not be used as a preventative strategy for VAP?
HMEs
Residual volume/TLC ratio
percentage of TLC occupied by the RV
Non-Flamable Gasses
Helium
Gasses That Support Combustion
Helium/O2
1.8*flow rate; 1.6*flow rate
Helium/Oxygen flow rate conversion; 80He/20O2? 70/30?
Which of the following is used by the USN to produce aerosol droplets?
High-frequency vibrations
tidal volume (TV) x respiratory rate (RR)
How do you calculate minute respiration?
Absolute contraindications for postural drainage include which of the following? I. Unstable head and neck injury II. active hemorrhage with hemodynamic instability III. Pain from surgery
I and II only
In theory, how does positive expiratory pressure (PEP) help to move secretions into the larger airways? a. II and III only b. I and II only c. I, II, and III d. I and III only
I and II only
Why are zone valves into a hospital piping system? I. to terminate oxygen flow in case of fire II. to allow selective maintenance without shutting the entire system down III. To allow variable pressure reduction throughout the system
I and II only
A physician orders bland water aerosol administration to a patient with a tracheostomy. Which of the following airway devices could you use to meet this goal? I. tracheostomy mask II. face tent III. T-piece (Brigg's adapter) IV. aerosol mask
I and III only
Which of the following are considered therapeutic medical gases? I. Oxygen II. Nitrogen III. Heliox IV. Nitrous oxide
I and III only
Which of the following would indicate a need for O2 therapy? I. SaO2 < 90% II. PaCO2 > 45 mmHg III. PaO2 < 60 mmHg
I and III only
Which of the following are specific clinical objectives of oxygen therapy? I. Decrease symptoms caused by chronic hypoxemia II. Decrease the workload hypoxemia poses on the cardiac and pulmonary systems III.Correct document arterial hypoxemia
I, II and III
Which of the following patients might you recommend bland aerosol therapy administration? I. patient with upper airway swelling (edema) II. patient with a bypassed upper airway III. patient who must provide a sputum specimen
I, II and III
Which of the following methods can be used to minimize harmful effects of environmental exposure to ribavirin or pentamidine aerosols? I. use an isolation booth or tent with HEPA filtered exhaust II. have health care professional wear a HEPA filtered mask. III. Use negative pressure room with adequate air exchange
I, II and III only
Which of the following are systems for aerosol drug delivery? I. dry powder inhalers II. metered dose inhalers III. small volume nebulizers IV. bubble humidifier
I, II and IV only
What are some problems common to mist tents? I. heat retention II. CO2 buildup III. hypothermia
I, II only
To monitor a patient for possibility of reactive bronchospasm during aerosol drug therapy, what should you do? I. Measure pre and post peak flow II. Auscultation for abnormal breath sounds III Carefully observe the patient's response IV. Communicate with the patient during treatment
I, II, III and IV
Flammable
If conditions are right, a flame will begin spontaneously
1.34
In 100mL of blood, 1g of hemoglobin when fully saturated with oxygen can carry ___ mL of Oxygen
membrane
In a ___ humidifier, (type of passive), the water is separated from the gas stream by a hydrophobic membrane;
wick, wick, capillary
In a ____ humidifier, gas passes over or through water-saturated material; the ___, which is a cylinder of absorbent material, is placed upright with the gravity-dependent end in a water reservoir and surrounded by a heating element; ____ action continually draws up water from the reservoir and keeps it saturated; as dry gas enters the chamber, the gas flows around it, quickly picking up heat & moisture , leaving the chamber fully saturated with water vapor; No bubbling occurs, therefor no aerosol is produced;
compressed air, oxygen, pressures, compressed air, oxygen
In a blender, ____ ___ and ____ from a high pressure source enter a chamber where the _____ of the ___ ___ and the _____ are equalized;
hydrophobic
In a membrane humidifier, the water is separated from the gas stream by a _____ membrane;
heat, energy, cooling
In evaporation ___ and ___ are removed from the air surrounding a liquid, thus _____ the air.
location O2 shutoff valves and known how to shut off; rescue patients near fire, alert personnel, contain fire and shut doors, evacuate
In the event of a hosptial fire, what is the first priority? What is the meaning of RACE?
Which of the following lung expansion modalities mimic normal physiological breathing? a. Continuous Positive Airway Pressure b. Incentive Spirometry c. Positive End Expiratory Pressure d. Intermittent Positive Pressure Breathing
Incentive Spirometry
Lung expansion methods that increase the transpulmonary pressure gradients by decreasing pleural pressure includes which of the following? a. Incentive spirometry b. Positive Expiratory Pressure therapy c. Intermittent Positive Pressure Breathing d. Continuous Positive Airway Pressure therapy
Incentive spirometry
When assessing a pt's response to bronchodilator therapy, notice a decrease in wheezing accompanied by an overall decrease in the intensity of breath sounds. Which of the following is most likely.
Increase in bronchial constriction.
A patient receiving 35% O2 through an air-entrainment mask set at 6 L/min input flow becomes tachypnea. Simultaneously you notice that the SpO2 has fallen from 91% to 87%. Which of the following actions would be most appropriate in this situation?
Increase the devices input flow to 10 L/min
You connect an air entrainment nebulizer to an ET tube of a COPD patient. When the patient inhale the mist disappears from the reservoir tubing. Which of the following would you do next?
Increase the flow
Board Exam Question: A patient receiving 40% O2 through an air entrainment nebulizer mask set at 6LPM input flow becomes tachypneic. Simultaneously, you notice the patient's SpO2 has fallen from 91% to 87%. Which of the following actions would be most appropriate at this time?
Increase the flow to 10 LPM
You enter a patient's room and the patient is wearing a nonrebreather. You notice the bag collapses when the patient inhales. What is the appropriate action to take?
Increase the flow to the bag
A patient is receiving O2 through a nonrebreathing mask set at 8 L/min. You notice that the mask's reservoir bag collapses completely before the end of each inspiration. Which of the following actions is appropriate in this case?
Increase the liter flow
While reviewing the chart of a patient receiving postural drainage therapy, you notice that the patient tends to undergo mild desaturation during therapy (a drop in SpO2 from 93% to 89%). Which of the following would you recommend to manage this problem? a. Increase the patient's FIO2 during therapy b. Discontinue the postural drainage therapy entirely c. Discontinue the percussion and vibration only d. Decrease the frequency of treatments
Increase the patient's FIO2 during therapy
Inhalation of dry gases can do which of the following?
Increase viscosity of secretions Impair muco-cilliary motility Increase airway irritability
When lung compliance decreases the patient commonly has a/an:
Increased Respiratory Rate Decreased Tidal Volume
Board Exam question:::While preparing to analyze the O2 concentration on a pt's aerosol mask, you notice there is water in the aerosol tubing. What effect does this have on the operation of the device?
Increases the FiO2
Which of the following settings will increase lung volume delivered to a patient on the IPPB?
Increasing the pressure
How do all modalities of hyperinflation therapy aid in lung expansion?
Increasing the transpulmonary pressure gradient
A patient with chronic hypercapnia placed on an FIO2 of 0.6 starts hypoventilating. What is the probable cause of this phenomenon?
Induced Hypoventilation
A patient about to receive postural drainage and percussion is attached to an electrocardiograph (ECG) monitor and is receiving both intravenous (IV) solutions and O2 (through a nasal cannula). Which of the following actions would be appropriate for this patient?
Inspect and adjust the equipment to ensure function during therapy
Total lung capacity is made up of:
Inspiratory Capacity Expiratory Reserve Volume Residual Volume
What is the effect of surface tension forces in the air-filled lung?
It increases the elastic recoil of the lung (promoting collapse) It makes the lung harder to inflate than if it were filled with fluid.
Which of the following statements about alveolar pressure during quiet breathing is true?
It is negative during inspiration and positive during expiration
Which of the following is FALSE about heated humidifier condensate?
It poses minimal infection risk
source, flowmeter, nebulizer, large bore tubing, drain bag, mask, analyzer, heating, thermometer
Items needed to put together continuous areosol include; ___, ____, ____, ___ ___ __, ___ ___, ___ or tent collar, O2 ____, ___ device and _____.
kelvin to celsius
K=C+273
What is the primary indicator of the cylinder contents?
Label
Which of the following is the most common source of patient infections?
Large Volume Nebulizers
Which of the following is an indication of the use of helium-O2 mixtures?
Large-airway obstruction
Which of the following breath sounds would most likely indicate atelectasis?
Late inspiratory crackles
A galvanic fuel cell uses a ____ and a ____ to measure FIO2.
Lead anode Gold cathode
Color Code of Nitrous Oxide
Light Blue
Which type of centrally located gas supply systems is most common in an acute care facility ?
Liquid bulk O2 system
What are the types of O2 Storage
Liquid, solid, gas
NFPA Governs _______
Location of System Where No smoking signs are Requires emergency cut off valves on each floor.
You enter the room of a patient who is receiving nasal O2 through a bubble humidifier at 5 L/min. You immediately notice that the humidifier pressure relief is popping off. Which of the following actions would be most appropriate in this situation?
Looked for a crimped or twisted delivery tubing
A cooperative and alert postoperative patient taking food orally requires a small increment in FIO2, to be provided continuously. Precise FIO2 concentrations are not needed. Which of the following devices would best achieve this end?
Low Flow Nasal Cannula
Delivery systems that only provide a portion of the patient's inspiratory demands are referred to as what?
Low flow system
What size cylinder is commonly used in the home for back up?
M60
What is the preferred method for delivering aerosolized bronchodilators to intubated, mechanically ventilated pts
MDI
How do you determine the patient needs home oxygen?
Measurement of low PaO2
Duration of flow equation
Min of 02=cylinder pressure (psi)x cylinder factor (L/psi) ------------- flow rate (L/min)
Soon after you initiate postural drainage in a Trendelenburg position, the patient develops a vigorous and productive cough. Which of the following actions would be appropriate at this time?
Move the patient to the sitting position until the cough subsides
High Pressure regulator that reduces working pressure to 50 PSI in different Stages. 1st pop off is at 700 PSI, 2nd pop off at 200 PSI, last preset regulators (50 PSI)
Multi Stage high pressure gas regulator
He combustion characteristics
NF
Nitrous Oxide
N20 (laughing gas)
CO2 combustion characteristics
NF
What is the initial oxygen device of choice for a COPD patient?
Nasal Cannula
1-6 liters per minute and 24%-44% Fi02
Nasal Cannula (NC) FiO2 Flow?
1@ .24, 2%@ .28, 3% @ .32, 4% @ .36, 5%@ .40, 6%@ .44
Nasal Cannula (NC) liter flow in adults?
Who regulates Transportation and Storage of Medical Gases?
National Fire Protection Association (NFPA) and Compressed Gas Association
Who prescribes the color coding of cylinders?
National Formulary
Non-Flamable Gasses
Nitrogen
What are two major components of air?
Nitrogen and oxygen
What gases are in our atmosphere and in what percents?
Nitrogen- 78% Oxygen- 21% Argon- .9% CO2- .03%
Gasses That Support Combustion
Nitrous Oxide
Contraindications (O2 in home)
No absolute contraindications to oxygen therapy exist when indications are present
Gasses That Support Combustion
O2
What is the % saturation of Hb dependent on?
O2 (dissolved O2 in the plasma)
An O2 delivery device takes a separate pressurized air and O2 input source, then mixes the gases with a precision valve. Which of the following devices are described?
O2 blending system
An O2 delivery device takes separate pressurized air and O2 sources as input, then mixes these gases through a precision valve. What does this describe?
O2 blending system
An O2-delivery device takes separate pressurized air and O2 sources as input then mixes these gases through a precision valve. What does this describe?
O2 blending system
total flow
O2 flow x .79 / FiO2- .21
A patient with chronic hypercapnia on a FIO2 of .6 starts hypoventilating. What is the cause of this phenomenon?
O2-hypoventilation
Gasses That Support Combustion
O2/CO2
Gasses That Support Combustion
O2/Nitrogen
A patient with a transtrachel catheter is receiving O2 at 2 LPM. When you enter the room to check the patient's oxygenation status, you notice the patient is cyanotic and in moderate distress. What is the most likely problem with the device?
Obstruction from secretions
A patient with chronic hypercapnia placed on 60% O2 becomes lethargic and difficult to arouse. What is the probable cause of this response?
Oxygen induced hypoventilation
100-Fi02/FiO2-21, then divide bottom # into top to get air ratio, oxygen is always 1; add the total parts of ratio (ex: 1:3.2=4.2) and multiply it by the L/min given in problem to get total flow
Oxygen to air ratio calculation?
A physician wants a stable FiO2 of 50% for a newborn patient with moderate hypoxemia. Which of the following would you recommend?
Oxyhood with blender and a heated humidifier
High Pressure Connections use what?
P.I.S.S. Pin Index Safety System
Gay-Lussac's Law
P1/T1=P2/T2 (if V remains constant)
Boyles Law
P1xV1=P2xV2 (if T remains constant)
Alveolar O2/CO2
PAO2: 100 mmHg PACO2: 40 mmHg
A physician orders supplemental O2 for a patient through a nasal cannula at a flow of 12 L/min. When you ask what the goal is, the physician states that the patient should receive about 60% O2. Which of the following should you recommend?
Partial RB Mask O2 should be given through a partial rebreather mask set at 5 to 12 L/min
A nebulizer is a device that produces:
Particulate water
Persistent breathing at small volumes can result in which of the following?
Passive atelectasis
What is consistent with the radiographic appearance after prolonged exposure to O2?
Patchy Infiltrates
Which of the following is consistent with the radiographic appearance after prolonged exposure to O2?
Patchy infiltrates
You connect an intubated patient to an air-entrainment nebulizer system through a T-tube set at 60% with an input flow of 15 L/min. Toward the middle of inspiration, you observe that mist stops exiting from the open end of the T-tube. What does this indicate?
Patient is not receiving 60% O2
You connect an intubated patient to an air-entrainment nebulizer system through a t-tube set at 60% with an input flow of 15 LPM. Toward the middle of inspiration you observe that mist stops exiting from the open end of the t-tube what does this indicate?
Patient is not receiving 60% O2
Anterior protrusion of the sternum is called:
Pectus Carinatum
Which type of index safety system uses a yoke-type connection?
Pin Index Safety System
Which of the following may be a result of inadequate humidification in a patient whose upper airway has been bypassed?
Pneumonia Necrosis of cilia Atelectasis Retained secretions Inflammatory changes
Which of the following mechanisms do all medical gas cylinders use to avoid excessively high pressure buildup in the cylinder?
Pressure relief in the valve stem
How is airway resistance (Raw) computed? Change in:
Pressure/Flow
Cryogenic
Producing extremely low temperatures.
What is the problem with input flows greater than 10 to 15 L/min in an infant Oxy-Hood?
Production of harmful noise levels
To ensure a stabile FIO2 under varying patient demands, what must an O2 delivery system do?
Provide all the gas needed by the patient during inspiration
The term that refers to a pulse strength that varies with inspiration is:
Pulsus paradoxus
Venous O2/CO2
PvO2: 40 mmHg PvCO2: 46 mmHg
VO2=
QT(C(a-v)O2x10) = 250 ml O2/min
To clean the cylinder valve of foreign material, what should you do?
Quickly open and close the valve
Erthropoiesis
RBC production
What is the standard method in measuring the contents in a gas filled cylinder?
Read the pressure gauge
Thorpe Flow Meters
Reads from center of ball.
Compensated Thorpe
Reflects true flow, Compensates for back Pressure
What device is used to reduce the pressure and control the flow of a medical gas?
Regulator
What is the major contributing factor in the development in post-operative atelectasis?
Repetitive, shallow breathing
What is considered an advantage of the transtracheal catheter
Requires 40 - 60% less O2 flow than nasal cannula
hearing loss, overhydration,
Risks to infants using jet nebulizers include ____ ____ and ________;
FVC usually =
SVC within 5% or 200 ml
What would indicate a need for O2 therapy for a newborn infant? A. SaO2 less than 92% B. Capillary PO2 less than 40 mm Hg C. SaO2 less than 88% D. B & C E. A & B
SaO2 less than 88% Capillary PO2 less than 40 mm Hg Answer D
Which of the following would indicate a need for O2 therapy for an adult or child?
SaO2 less than 90% Pao2 less than 60 mmHg
SaO2 and PaO2 on steep curve
SaO2= 10-90% PaO2= 10-60 mmHg
Where must O2 be stored?
Safe, Central Storage area that is cool, dry and well ventilated. Never be subject to temps of 125 Degrees F. Full/Empty tanks must be labeled an in separate room
Pin Index Safety System (PISS)
Safeguard to eliminate cylinder interchanging and the possibility of accidentally placing the incorrect gas on a yoke designed to accommodate a different gas Consists of two pins projecting from yoke assembly Total of 6 pin positions, allow for 10 different combination Used on size E or smaller cylinders
What are piping systems made of?
Seamless K or L copper or standard weight brass pipe (needs to withstand pressure)
Which of the following body positions is ideal for IPPB therapy?
Semi-Fowlers
A 52-year-old man is admitted to the hospital emergency department with a primary complaint of severe radiating chest pain and signs of central cyanosis. The attending asks for your advice on selecting a device that provides a moderate FIO2 for this patient. Which of the following would you recommend?
Simple Mask O2 Mask @ 8 L/min
Which of the following devices would be contraindicated for a patient whose upper airway has been bypassed?
Simple bubble humidifier
High Pressure regulator that reduces working pressure to 50 PSI in one step. One pop-off valve is set at 200 PSI.
Single stage high pressure gas regulator
Pediatric Flow Meter
Smaller flow increments, flow in 1/2 to 1/4 increments
Hypokalemia is defined as a decrease in which of the following ions:
potassium
sputum color with the indication =Green
Stagnant Sputum, commonly seen in Pts with CF
Hypoxia in a patient suffering form congestive heart failure (CHF) is due to:
Stagnant blood flow
A patient has a desired goal of 2500 ml for incentive spirometry. While performing incentive spirometry, the patient achieves 725 ml X 10 breaths. What is your recommendation at this time?
Switch patient to IPPB therapy
A patient has been supported by a mechanical ventilator using a heat-moisture exchanger for the last 3 days. Suctioning reveals an increase in the amount and tenacity of secretions. Which of the following actions is indicated?
Switch the patient to a heated humifider
A patient who requires a fixed FiO2 is receiving a 70% FiO2 via air entrainment nebulizer. At 15 LPM O2 input flow, the device is unable to meet the inspiratory demand of the patient. What would be the next appropriate action?
Switch to a tandem set-up
minute respiration
TV x RR results in ___ ___.
The earliest sign of hypoxemia in the adult is:
Tachycardia
A rapid breathing pattern is called:
Tachypnea
Venti-masks are needed for patients who demonstrate:
Tachypnea
E, G, H, K
Tank factor calculation: ___ tank: 622 Liters / 2200 psi = 0.28 ___ tank: 5264 Liters / 2200 psi = 2.39 ____ or ____ tank: 6900 Liters / 2200 psi = 3.14
Cylinder Systems are controlled by who?
The Compressed Gas Association (CGA)
What happens during normal inspiration?
The Ppl decreases further below atmospheric The Transpulmonary pressure gradient widens Palv drops below that at the airway opening
Liquefaction
The conversion of a substance into its liquid form.
oxygen flowmeter, nebulizer, lge bore tubing, drain bag, mask (or tent or trach collar), oxygen analyzer, heating device & thermometer
The equipment necessary to set up continuous bland aerosol therapy consists of what 8 things?
Which of the following is true when there is downstream resistance with a compensated Thorpe Tube?
The float will not change and the actual flow is what the reading indicates
Which of the following statements is false about low flow oxygen devices?
The greater the patient's inspiratory flow, the higher the FiO2
You are asked to show an adult patient how to properly use a TriFlo incentive spiromenter. Although the patient appears to be following your instructions, she is unable to achieve the prescribed goal that you have established for her. Briefly describe several factors that could cause this problem.
The most common problem encountered involves a leak in the system caused by a crack in the device, defective tubing, or failure of the patient to maintain a tight seal around the mouth piece.
What is the key functional difference between a partial and nonrebreather mask?
The nonrebreather has a one way valve flap between the reservoir bag and the mask
With regard to surfactant and surface tension which of the following statements is correct?
The smaller the size of the alveolus, the greater the effect of surface tension
Air
Therapeutic Gas, Colorless, Odorless, Naturally occurring gas mixture that contains 20.95% O2 and 78.1% nitrogen, must be dry and free of oil or particles for medical use, supports life
Carbon Dioxide
Therapeutic Gas, Colorless, Odorless, does not support combustion or maintain animal life
Oxygen
Therapeutic Gas, Colorless, Tasteless, Odorless, Supports Combustion, not very soluble in water, supports life
Nitric Oxide
Therapeutic Gas, Colorless, non flammable, toxic gas that supports combustion with high concentrations it can cause methemoglobinemia, which causes tissue hypoxia.
Helium
Therapeutic Gas, Light Gas, Odorless, tasteless, and nonflammable, must always be mixed with 20% O2
You are asked to suggest a lung inflation therapy for a 55 year old man who is 72 inches tall and weighs 85 kg. He has just undergone a cholecystectomy, and his chest radiograph shows right middle lobe atelectasis. He has a 10 pack per year history of smoking cigarettes, and his preoperative pulmonary function studies showed that his vital capacity was 20 ml/kg. He is alert and cooperative but complains of some upper abdominal pain when taking a deep breath. What modality would you suggest?
This patient is a good candidate for incentive spirometry; he is alert and cooperative. Although he does experience some pain when he takes deep breaths, he should be able to take deep breaths (vital capacity>10 ml/kg)
Always attached with to 50 psig source
Thorpe Tube
three types of flow meters
Thorpe tub flowmeters, Bourdon flowmeters, and flow restrictors
If you have to deliver oxygen to a patient from a bedside outlet station, which of the following devices should you select?
Thorpe tube
Which of the following patient categories are at high risk for developing atelectasis?
Those who are heavily sedated Those with abdominal or thoracic pain Those with neuromuscular disorders
Large Cylinder valve outlets are indexed by____ and ____
Thread and Nipple Seat.
Why do you "crack" a cylinder?
To clear debris from the connector
aerosol, 6, ports, two, T-piece
To increase the aerosol output, an ____mask can be modified by adding ___ inch sections of tube to the ____. This provides a small reservoir when peak inspiratory flow exceeds gas flow delivered; Another way is to set up ___ aerosol devices in tandem & connecting them via a ____ to the mask. pg97
Which of the following are not goals of aerosol therapy?
To slow the muco-cilliary escalator
What are oxygen concentrators primarily used for?
To supply low flow oxygen in the home care setting
two oxygen conserving devices
Transtracheal oxygen catheters and pulse-demand oxygen delivery systems
Where are the minimum requirements listed for drugs?
United States Pharmacopeia (USP), or National Formulary (NF)
Pg=Pb*%g, N2=561.6 mmHg, O2=151.2 mmHg
Using a particular type of dry gas (i.e. N2, O2, etc.), and given the barometric pressure, what formula would I use to figure out the partial pressure of that particular gas? EXAMPLE; what is partial pressure of a) N2 (nitrogen) and b) O2 (oxygen) in an air sample at a barometric pressure of 720 mmHg when N comprises 78% and O comprises 21% of air?
Which of the following devices is the most appropriate oxygen device for a COPD patient?
Venturi Mask
Color Code of Oxygen
White or Green
Who regulates Gas purity requirements?
Who regulates Gas purity requirements? FDA (Food and Drug Administration)
Total flow equation
[(air ratio)+(O2 ratio)] x liter flow
water vapor, temperature
___ ___ pressure is used to measure kinetic activity of H2O vapor molecules? ___ measures the average kinetic energy of the molecules: KE=1/2*mass*velocity^2; At higher temps, the average velocity of the molecules is higher.
Humidified gases, hypthermic, hypothermia
___ ____ are used to raise the core temp of ______ patients, and to prevent intra-operative _____.
capillary action
____ ___ is the result of adhesion and surface tension. Adhesion of water to the walls of a vessel will cause an upward force on the liquid at the edges and result in a miniscus which turns upward;
transitional, tubes, branches, 2000, 4000
____ flow is a combination of turbulent and laminar; typically occurs at points where ____ divide into one or more ___; the reynolds number for this type of flow between ____ and ____;
turbulent, velocity, >4000
____ flow is chaotic; the _____ of liquid or gas molecules are sharply increasing; the reynolds number for this type flow is ______;
passover
____ humidifier directs gas over a liquid or a liquid saturated surface;
temperature, fibrous material, suction
_____ control, ____ ___, and ____ can all be used to correct the problem of condensation in the tubing within a vent circuit;
PISS (pin index safety system), ASSS, DISS (diameter index safety system), low, DISS, quick
_____ is the the indexing system for small cylinders; _______ is the system for large tanks (e.g H, K) based on thread types that joins a regulator and an H cylinder; The exit point of the regulator is a ___ connection designed for __ pressure connections; Station Outlets have a _____ connection (terminal point of a piping system) which are either ____ connect or threaded;
evaporation
______ occurs when liquid molecules near surface contain enough kinetic nergy to break free and enter a vaporous state (reduces volume & energy contained in liquid)
inspissated
_______ means being thickened, dried, or made less fluid by evaporation or absorption of liquid components;
Strong base
a base that dissociates completely
Weak base
a base that dissociates partially
Quick-Connect Adapters
a device that allows rapid connection and disconnection of compressed gas appliances to high-pressure gas delivery systems.
transitional flow
a mixture of laminar and turbulent flows
Manifold
a pipe that has several lateral outlets to or from other pipes. in medical gas storage, a collection of gas cylinders linked together for purposes of bulk storage, and usually including at least one reserve bank and other safety systems such as low pressure alarms
Fractional Distillation
a technique used to separate liquid mixture by manipulating their boiling points. primary commercial process used to produce oxygen.
Joule-Kelvin (Joule Thompson) Effect
a temperature change that occurs when a thermally insulated gas expands through a small hole into low pressure
What is the primary indication for lung inflation therapy? 1. to prevent atelectasis 2. to prevent hypoxemia 3. to reverse hypercapnia 4) to reduce pulmonary shunting a) 1 only b) 1 and 2 only c) 2 and 3 only d) 1,2,3, and 4
a) 1 only to prevent atelectasis
The active drug component of typical pMDI accounts for what percentage of the total content of the mixture in the device? a) less than 1% b) 10% c) 25 % d) 60%
a) less than 1%
Which of the following is a contraindication to use of an HME? a) minute volume greater than 10L/min b) minimal secretions c) small tidal volumes d) short-term mechanical ventilation
a) minute volume greater than 10 L/min
What is the problem of flows greater than 15 LPM in an Oxyhood?
a. Production of distressful noises
Flammable
able to catch fire easily
43.9, 37, 47
absolute humidity is (____mg/l) at body temp (____ degrees C) with water vapor pressure (PH20) being ____ mm Hg)
hygrometer
absolute humidity is measure with a ___;
recommendation for humidification for patients on noninvasive mechanical ventilation
active humidification (to improve adherence + comfort)
decreases, Bernouli's
as fluid flows thru a narrow passage, lateral wall pressure _____; This is ____ principle;
Bourdon Flowmeters
as the driving pressure is increased, the flow from the flowmeter outlet increases
What is the Bernoulli Principle?
as the forward velocity of a gas moving through a tube increases, the lateral wall pressure of the tube decreases
Indications for PFT (assess)
assess the effectiveness of the therapy: - bronchodilators, steroids - lung transplantations, resection, reduction - radiation or chemotherapy
The optimum range of aerosol particle sizes that are to be inspired for general deposition through the upper and lower airway is: a) o.1-1 um b) 1-5 um c) 3-10 um d) 5-15 um
b) 1-5 um
What types of percussive pressure does the Percussionaire IPV device deliver? a) 10 to 20 cm H20 b) 25 to 40 cm H20 c) 50 to 100 cm H20 d) >200 cm H20
b) 25 to 40 cm H20
Based on the AARC Clinical Practice Guideline, the temperature of medical gas delivered through an artificial airway should be: a)20-25 degrees Celsius b)31-35 degrees Celsius c)36-40 degrees Celsius d) over 45 degrees Celsius
b) 31-35 degrees Celsius
What is the recommended gas flow rate to operate an SVN? a) 1 L/min b) 6 to 8 L/min c) 10 L/min d) 15 L/ min
b) 6 to 8 L/min
If the temperature of a saturated gas decreases, which of the following occurs? a) condensation develops b) absolute humidity increases c) relative humidity increases d) water vapor pressure increase
b) absolute humidity increases
Mechanical insufflation-exsufflation therapy has been shown to be most effective in patients with: a) croup b) duchenne muscular dystrophy c) asthma d) Acute respiratory distress syndrome
b) duchenne muscular dystrophy
Which of the following parameters is used to set the therapeutic goal for a patient using a volume-displacement incentive spirometer? a) total lung capacity b) inspiratory capacity c) inspiratory reserve volume d) expiratory reserve volume
b) inspiratory capacity
What is the most important factor influencing aerosol deposition from an MDI? a) tidal volume b) inspiratory flow rate c) respiratory rate d) breath-hold
b) inspiratory flow rate
Which of the following results in increased aerosol deposition? a) large tidal volume b) slow inspiratory flow rate c) decrease in the expiratory peak flow d) short expiratory times
b) slow inspiratory flow rate
Which of the following creates aerosol particles in a small volume nebulizer?
baffle
Cylinder color: nitrogen
black
pulmonary shunt-like effect
blood that does exchange with alveolar gases but does not obtain a PO2 that equals that of a normal alveolus
Anatomic shunt
blood travels from right side of heart to left side without coming into contact with an alveolus for gas exchange
components of single stage regulators
body that is divided in half by a flexible metal diaphragm. the area above is high pressure chamber. the lower chamber has a spring attached to the lower sruface of the diaphragm and is exposed to ambient pressure.
Cylinder color: 80/20 O2/He
body- brown shoulder- green
Cylinder color: 70/30 O2/He
body- green shoulder- brown
Which of the following devices generates aerosol only during inspiration?
breath actuated nebulizer
Which of the following techniques will increase aerosol deposition and sedimentation in the lungs?
breath hold
The first treatment of choice for wheezes is which of the following?
bronchodilator
All of the following drug categories can impair mucociliary clearance in intubated patients except: a. general anesthetics b. bronchodilators c. opiates d. narcotics
bronchodilators
example: low flow active humidifier
bubble humidifier
How is NO prepared?
by oxidizing ammonia at high temperatures
If a patient has an artificial airway in place, what should be the minimum level of absolute humidity provided to the patient's airways? a) 10 mg/L b) 20 mg/L c) 30 mg/L d) 40 mg/L
c) 30 mg/L
According to the manufacturer, what is the flow of gas from a Vortran IPPB device connected directly to a 50-psig gas source? a) 10 L/min b) 25 L/min c) 40 L/min d) the flow varies as the amount of gas entrained by the patient changes
c) 40 L/min
A sample of room air gas contains 10 mg/L of humidity. What is the RH of gas if the room temperature is 77 degrees Fahrenheit? a) 10% b) 22% c) 43% d) 98 %
c) 43%
The vest is used to: a) provide positive pressure on exhalation b) keep infants' core temperature stable c) oscillate the chest wall to promote secretion clearance d) provide a biofeedback in the teaching of diaphragmatic breathing
c) oscillate the chest wall to promote secretion clearance
You can adjust the tidal volume delivered by a Bird Mark 7 ventilator by manipulating which of the following parameters? a) inspiratory time b) inspiratory flow c) peak inspiratory pressure d) trigger sensitivity
c) peak inspiratory pressure
adhesion, surface tension, adhesion, upward, meniscus
capillary action is the result of ____ and ___ ___. _____ of water to the walls of a vessel will cause an _____ force on the liquid at the edges and result in a ____ which turns upward.
Which gas is classified as a nonflammable gas that does not support combustion?
carbon dioxide
NO combined with O2
causes pulmonary vasodilation without systematic vasodilation (only local effect)
What is the first step in equipment processing for reuse on another patient?
cleaning the equipment
humidifiers, blood, surgical
clinical examples of capillary action are ____, a stick of ____, _____ dressings;
pressure conversions
cm h2o * 0.7335=mm Hg mm Hg/0.7355=cm h2o cm h2o*0.098=kPa kPa/0.098=cm h2o mm Hg*0.1333=kPa kPa/0.1333=mm Hg mm Hg/760=atm atm*14.7=lb/in2 (psi)
Nitrous Oxide, N2O
colorless gas at normal temps and atm pressures. nonflammable, will support combustion. light blue
Nitric Oxide, NO
colorless gas with slight metallic odor at room temp. nonflammable, and will support combustion. teal and black
Carbon Dioxide, CO2
colorless, odorless gas at normal atmospheric temperatures and pressures. nonflammable, does not support combustion or life. gray
Oxygen
colorless, odorless, and tasteless at normal temperatures and pressures. 20.9% of earths atmosphere. nonflammable, supports combustion. green or white
Three properties of oxygen
colorless, odorless, tasteless
Air
colorless,odorless gas mixture that contains varying amounts of water vapor. nonflammable, supports combustion. yellow or black and white
infection from surgery; hemoptosis and subcutaneous emphysema
complications of transtrachial catheter?
By what means is medical air produced for use in the hospital?
compression of atmospheric air
evaporation, heat, transferred, warming
condensation is the opposite of ______; ____ is removed from the liquid and ______ to the surrounding air, thus ____ it.
high flow 21-50% oxygen
connect to RA and inject oxygen
high flow 50-100% oxygen
connect to oxygen and inject RA
components of Thorpe tube
consist of tapered hollow tube engraved with a calibrated scale, a float, and a needle valve for controlling the flow rate of gas
continuous supply system
contains two sources of gas supply, one of which is reserve source
body humidity =
content mg/L / 44 mg/L X 100 content mmHg / 47 mmHg X 100
Chemically bound to hemoglobin
contributes to most of O2 transport (O2 is bound to Hb of the RBC)
Cylinder valves
control vices that seal the contents of a compressed cylinder until it is ready for use
Purpose of flowmeter
controls the indicated flow
760*.50, PaO2=(Pb-PH20)FiO2-(PaC02*1.25);
conversion of 50% oxygen to mmHG if outside of the body? If inside the body with inspirational saturation?
condensation
conversion of a substance from a gas to a liquid
max flow is 6 liters and % is (.24 -.44' % -.21) / 4 liters
convert % to NC if patient is not tolerating a mask? Also go backwards with the conversion % (this will be liter flow on NC)?
F=(9/5*C)+32
convert Celsius to Fahrenheit
C=5/9(F-32)
convert Fahrenheit to Celsius
K=C+273
convert celsius to Kelvin
F=(9/5*C)+32
convert celsius to fahrenheit
C=5/9(f-32)
convert fahrenhiet to celsius
C=K-273
convert kelvin to celsius
What is the primary problem with manually refilling heated humidifier reservoir?
cross-contamination and infection
Which of the following are potential problems that may arise in patients with a tracheostomy who are breathing nonhumidified oxygen at a rate of 6L/min? 1. atelectasis 2. destruction of the airway epithelium 3. inspissation of secretions 4. mucociliary dysfunction a. 1 and 3 only b. 2 and 4 only c. 1,2, and 3 only d. 1,2,3, and 4
d) 1,2,3, and 4 Atelectasis Destruction of the airway epithelium inspissation of secretions mucociliary dysfunction
Which of the following are considered positive outcomes to PEP therapy? 1. increased sputum production 2. increased respiratory rate 3. resolution of hypoxemia 4. Diminished breath sounds become adventitious sounds that can be auscultated over the larger airways. a) 1 only b) 1 and 3 only c) 2 and 3 only d) 1,3, and 4 only
d) 1,3, and 4 only 1. increased sputum production 3. resolution of hypoxemia 4. Diminished breath sounds become adventitious sounds that can be auscultated over the larger airways.
A gas at body temperature and ambient pressure (BTPS) contains: a) 10 mg/l of water vapor b) 30 mg/l of water vapor c) 33.9 mg/l of water vapor d) 43.9 mg/l of water vapor
d) 43.9 mg/l of water vapor
The function of the steel ball in the Flutter device is to: a) help prevent early airway closure b) provide high-frequency oscillation c) create a positive expiratory pressure d) all of the above
d) all of the above a) help prevent early airway closure b) provide high-frequency oscillation c) create a positive expiratory pressure
Which of the following is classified as a passive humidifier? a) bubble humidifier b) ultrasonic nebulizer c) wick humidifier d) heat and moisture exchanger
d) heat and moisture exchanger
All of the following treatments may be appropriate for fine rales except: a. oxygen b. diuretics c. IPPB d. suction
d. suction
Factors decreasing SvO2
decrease O2 loading into the lungs (decrease in Hb, PaO2, CO poisoning)
Patients with obstructive disease will have..
decrease in FEV t - SVC normal - FVC decrease due to airtrapping
Patients with restrictive disease will have..
decrease in FEV t due to low VC associated with cease (FEV t will also decrease with age)
Depth of penetration
decrease particle size and you increase where it deposits in lungs (MMAD <1 micron is exhaled) large particles- upper airway small particles (1-2) - alveoli level
When a patient exhales and the machine fails to cycle off, what adjustment needs to be made on the machine?
decrease sensitivity
Which of the following is NOT a potential hazard or complication of incentive spirometry? a. pulmonary barotrauma in emphysematic lungs b. decreased cardiac output c. respiratory alkalosis d. fatigue
decreased cardiac output
Barometric pressure _______ with an increase in altitude
decreases
Level of CO2 in blood decreases, level of HCO3..
decreases
Rightward shift of oxyhemoglobin dissociation curve
decreases the affinity for Hb to O2 molecules (O2 is more available to tissues)
**An alert and cooperative 28 year old patient with no history of lung disease underwent a cesarean section 16 hours earlier. Her X-ray film is clear. Which of the following approaches to preventing atelectasis would you recommend for this patient? a. CPAP b. PEP therapy c. deep breathing exercises d. IPPB
deep breathing exercises
Humidity Deficit
difference between actual water vapor content and body humidity (body-air=deficit)
Differences in the amino acid sequences create..
different types of human hemoglobin
What does NO do to the pulmonary vasculature?
dilates
two types of cylinder valves
direct-acting valves diaphragm valves
non flammable
does not burn easily
Which of the following depends on the pt's inspiratory effort to dispense the dose?
dry powder inhaler
Elements required by the body for metabolism are closely associated with kidney function are called:
electrolytes
Before inspiration and actuation of a metered dose inhaler, the patient should exhale to which of the following?
functional residual capacity
Examples of flammable things
gas, aerosol cans, turpentine
Spirogram
graphical representation of the lung volumes made by the spirometer
Cylinder color: carbon dioxide
gray
Indications for directed coughing include all of the following except to: a. enhance other bronchial hygiene therapies b. help patients with tuberculosis clear secretions c. help prevent postoperative pulmonary complications d. obtain sputum specimens for diagnostic analysis
help patients with tuberculosis clear secretions
What measurement is obtained by spinning whole blood in a centrifuge to get the ratio of red blood cells to total blood?
hematocrit
All of the following laboratory data are essential in assessing a patient's need for bronchial hygiene therapy except: a. chest radiograph b. pulmonary function tests c. hematology results d. ABG results/ oxygen saturation
hematology results
To deliver FiO2>60% what should you use?
high flow NC (heated humidified O2 at flows of 5-40LPM at an FiO2 >90%
are there any problems with an open humidity system?
higher risk of contamination, leaks, may change reservoir temperature, interrupts MAV (mechanical ventilation)
Describe mustache cannula
holds about 20 ml of 100% O2 so you get a bolus at the beginning of inspiration
O2 enriched gas, patient, warm, premature; temp, humidity, FiO2; servo mechanism, FiO2, entrainment, 40%
incubators provide large volumes of ___ ___ gas to atmosphere immediately surrounding ______; provides ____ environment for ____ infants; Has variable ___, ___, and _____; ,the temp and humidity controlled by ____ ______; _____ controlled by air _______ device which delivers FiO2 less than ___%
Bourdon gages
indicates pressure within cylinder (empty cylinder <500 psi) - as pressure increases, coil inside tries to straighten and this moves indicator up
What is the most common route of pathogen transmission in the hospital setting?
indirect contact transmission
Humidity
individual molecules in a vapor gaseous state
What is the primary mechanism for deposition of large particles (>5 microns) in the respiratory tract?
inertial impaction
A patient with a neuromuscular disorder causing generalized muscle weakness is having difficulty developing an effective cough. Which of the following cough phases are primarily affected in this patient? a. irritation b. inspiration c. compression d. expulsion
inspiration
The short term and multiple frequency application of inspiratory positive pressure to a spontaneously breathing patient best defines which of the following? a. sustained maximal inspiration b. intermittent positive pressure breathing c. continuous positive airway pressure d. positive end expiratory pressure
intermittent positive pressure breathing
The airway clearance technique that uses a pneumatic device to deliver compressed gas minibursts to the airway at rates above 100/min best describes which of the following? a. intrapulmonary percussive ventilation b. active cycle of breathing c. acapella d. High frequency chest wall oscillation e. intermittent positive pressure breathing
intrapulmonary percussive ventilation
Heme
iron compound that joins to the protein globin which is made of 4 polypeptides amino acid chains (alpha and beta)
A patient recovering from anesthesia after abdominal surgery is having difficulty developing an effective cough. Which of the following phases of the cough reflex would cause a weak, ineffective cough in this patient? a. irritation b. inspiration c. compression d. expulsion
irritation
How do you know a cylinder's maximum filling pressure is?
it is labeled (max. filling is 2200 psi)
Board Exam question: You are instructing a patient about the proper procedure for using an MDI. You would instruct the patient to activate the medication in the inhaler?
just after inspiration has begun
3 temperature scales
kelvin, celsius, fahrenheit
What type of flow can you deliver with heliox?
laminar (as opposed to turbulent)
Three patterns of flow
laminar, turbulent, transitional
A medical indication for the use of heliox mixtures may be necessary in the management of which of the following?
large airway obstruction
Indications for HMEs
mandatory when endotracheal or teach tube in place
MMAD definition
mass median aerodynamic diameter
Diffusion
mass movement of gas molecules from an area of high concentration to an area of low concentration
Body Humidity definition
maximum amount of water that can be held at body temperature
MEP
maximum expiratory pressure
MIP
maximum inspiratory pressure
FEV timed
maximum volume of gas that can be exhaled within a specific time - 0.5 sec= 60% total volume - 1 sec= 83% total volume - 2 sec= 94% total volume - 3 sec= 97% total volume
MVV
maximum voluntary ventilation
vapor pressure
measure of the force that molecules exert as they hit the surface of a liquid and escape into the gaseous phase
density
measure of the substances mass per unit volume under specific conditions of pressure and temperature
RH= %
measured humidity (content) _____________________________ water capacity x100
Passive diffusion
moves the gas molecules across the alveolar-capillary membrane
Diaphragm
muscle that controls inhalation and exhalation
advantages of closed humidity system
must manually open a valve to get water flowing but the fluid always remains attached to device - less chance of contamination - less chance for leaks - no interruption in MAV
two reservoir cannulas
mustache cannula and pendant cannula
diffusion
net movement of gas molecules, by virtue of their kinetic proerties, from an area of high concentration to an area of low concentration
Which of the following is not a potential contraindication for IPPB? a. hemoptysis b. recent esophageal surgery c. tension pneumothorax d. neuromuscular disorders
neuromuscular disorders
Which gas do you use to reduce pulmonary vasoconstriction, such as in PPHN?
nitric oxide
Which of the following gases can be used in treatment of hypoxemic respiratory failure of neonates when mechanical ventilation and traditional therapies are not successful?
nitric oxide
Helium, He
no color, odor, or taste. good conductor of heat, sound, and electricity. nonflammable, will not support combustion or life. brown
what is a closed humidity system?
no need to open it (must monitor to notice if fluid stops flowing in)
Carbon Dioxide properties
nonflammable and does not support combustion
Hemoglobin A
normal adult (Hb A)
When assessing the potential need for postoperative bronchial hygiene for a patient, all of the following factors are relevant except: a. patient's age and respiratory history b. nature and duration of current surgery c. number of prior surgical procedures d. type of anesthesia (e.g., local versus general)
number of prior surgical procedures
Blood
numerous specialized cells suspended in a liquid substance called plasma
what type of humidification is NOT recommended for invasive ventilation?
passive humidification
A physician orders postural drainage for a patient with post-overdose aspiration pneumonia in the anterior segments of the upper lobes. Which of the following positions would you recommend for this patient?
patient supine with a pillow under knees, bed flat
inhale, inspiratory flow rate
patients using DPI (dry powder inhaler) must have the ability to ___ with sufficient high _____ ___ ___
PERF
peak expiratory flow rate
PEFR
peak expiratory flow rate - maximum flow rate that can be achieved during a FVC maneuver - good for asthma patients, bad for emphysema patients
A tracheal deviation away from the pathology with hyper-resonant percussion note will indicate which of the following conditions?
pneumothorax
Which of the following airway clearance techniques would you recommend for a 15-month-old infant with cystic fibrosis?
postural drainage, percussion, and vibration
Preset/adjustable reducing valves
preset- delivers set pressure of 50 psi adjustable- can change pressure
critical pressure
pressue that must be applied to the substance at its critical temperature to maintain equilibrium between the liquied and gas phases
Partial pressure of atm. gases
pressure between external atmosphere and the alveoli is in equilibrium (3-6 cmH20 during inspiration or expiration)
To protect against obstructed or kinked tubing, simple bubble humidifiers incorporate which of the following?
pressure relief valve
venturi principle
pressure that has dropped as fluid flows thru a constriction, can be restored to a preconstriction state by gradual dialation, distal to the constriction;
duration of flow
pressure(psig) x cylinder factor / flow
Diameter-index safety system(DISS)
prevent accidental interchange of low-pressure (less than 200 psig) medical gas connectors (1) at the outlets of pressure-reducing valves attached to cylinders; (2) at the station outlets of central piping systems; and (3) at the inlets of blenders, flowmeters, ventilators, and other pneumatic equipment.
All of the following are goals of bronchial hygiene therapy except: a. prevent and treat atelectasis b. help mobilize retained secretions c. Improve pulmonary gas exchange d. Reduce work of breathing
prevent and treat atelectasis
Reducing valve
reduces high pressure to a working pressure of 50 psi
Single stage pressure reducing valve
reduces pressure in one stage (one pressure relief valve set at 200 psig)
Indications for warming inspired gases include all of the following except: a. treating a patient whose airways are reactive to cold b. providing humidification when the upper airway is bypassed c. treating a patient with a low body temperature d. reducing upper airway inflammation or swelling
reducing upper airway inflammation or swelling
20-30% shunt equation value
reflects significant pulmonary shunting
Safety system outlets
regulated by CGA (compressed gas association)
Downstream
relative reference to a point more distal from the source in a stream of flowing fluid
What are the primary uses of therapeutic gases?
relieve symptoms and improve the oxygenation of patients with hypoxemia
Spring loaded pressure relief valve
relieves excess pressure and then reseals with a decrease in pressure (usually found on large cylinders)
3 types of pressure relief mechanisms
rupture disks- metal disk ruptures when pressure exceeds certain limit fusible plugs- melts when the temp of the gas exceeds a temp spring-loaded devices- release excessive pressure and reseal.
freezing point
same temperature as the melting point
High flow
satisfies or exceeds oxygen needs of patient (can deliver fixed FiO2 despite patient's breathing pattern)
Why must pipes be seamless?
seams are weak- contents may leak and the pipes need to be able to contain the pressure
How is NO given?
supplied as compressed gas mixture with nitrogen (in aluminum allow cylinder to keep it stable)
Which of the following defines an aerosol?
suspension of liquid or solid particles in a gas
Pressure Swing Adsorption Method
technique used in some oxygen sieve concentrators to produce an enriched oxygen mixture.
All of the following parameters should be evaluated after IPPB therapy except: a. heart rate b. blood pressure c. breath sounds d. temperature
temperature
isothermic saturation boundary (ISB), 5 cm, carina
the ___ ____ ___ is the point where inhaled gas reaches saturation (100% relative humidity at body temp. (37 degree Celsius); This is typically ___ cm below the ____. (pg 90)
Henry's Law
the amount of gas dissolved in plasma at a given temperature is proportionate to partial pressure of O2
Henry's Law
the amount of gas that dissolves in a liquid @ a given temperature is proportional to a partial pressure of a gas (SOLUBILITY)
latent heat
the amount of heat that must be added to a substance to cause a complete change of state
Pa02=(Pb-PH20)*FiO2-(PaC02*1.25), 60
the aveolar air: oxygen tension equation is ______; disregard the ___ if % FiO2 is > than 60%)
critical point
the critical temperature and the critical pressure of a substance
What prevents cylinders with frangible disks from exploding when exposed to extremely high temperature?
the disk ruptures form the increased pressure, allowing gas to escape from the cylinder
crack
to clean a cylinder valve of debris you must ____ the tank.
oxidizing
to take away hydrogen, as by the action of oxygen; add oxygen or any nonmetal.
what is the goal of oxygen therapy
to treat or prevent hypoxemia
nasal cannula uses
to treat spontaneously breathing, hypoxemic pts in emergency departments and ccu, during exercise in cardio rehab, and for long term oxygen therapy in the home care setting.
Total O2 delivery
total amount of O2 delivered to the peripheral tissues
what happens to total flow and FiO2 if water is in tubing?
total flow decreases, FiO2 increases
what happens to total flow and aerosol density as you increase FiO2?
total flow decreases, aerosol density increases
O2 flow
total flow x (FiO2-21) / 79
Dissolved O2
transporting O2 dissolved in plasma is inadequate and accounts for a very small % of total O2 transport
nitric oxide
treatment used for pulmonary hypertension in a newborn?
Which of the following diseases is transmitted primarily by airborne transmission?
tuberculosis
alternating supply systems
two banks of cylinders, one primary and other is secondary.
Direct-acting Valves
type of cylinder valve for compressed medical gas cylinders. A device that provides volume or flow by direct action from a control knob or device, such as the valve connected to a water faucet. As the faucet is turned, the valve opens or closes.
Grahams law
when two gases are placed under the same temperature and pressure conditions, the rates of diffusion of the two gases are inversely proportional to the square root of their masses
back pressure
whistling of a humidifier is an indication of ____ ____ or a leak;
Hypoxic drive
why COPD patients breathe (sat <90%, PaO2 <60 mmHg)
A design that increases surface area and enhances evaporation by incorporating an absorbent material partially submerged in a water reservoir that is surrounded by a heating element best describes what type of humidifier?
wick
Supports Combustion
will make a flame burn once it's already started
How is NO stored?
with nitrogen in cylinders (more stable)
Chronic metabolic alkalosis
with respiratory compensation pH increases, HCO3 increases, PaCO2 increases
When are large cylinders designed to rupture to prevent bursting?
within 5% of PSI of Bursting
Cylinder color: air
yellow or black/green