RESP 101 Exam #2, RESP 101 Exam #2

What is the typical flow range for adults using a nasal catheter or transtracheal catheter? less than 2LPM 1-6LPM >6 LPM 1-10LPM

1-6 LPM

What is the normal flow range for adults using a nasal cannula? less than 2LPM 1-6LPM 4-6LPM 1-10LPM

1-6LPM

What are the three phases of the course of drug action?

1-drug administration phase 2-pharmacokinetic phase 3-pharmacodynamic phase

List three ways to determine the need for oxygen therapy

1. ABG/SpO2 reading 2. existing chronic cardiopulmonary conditons 3. other disease processes

A patient is receiving 02 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? 1.7 hr 47min 2.2 hr 3.6 hr

2.2 hr

What is the FiO2 range for a nasal cannula using between 1-6LPM? 20-40% 24-44% 22-60% 20-50%

24-44%

Secretions tend to become thicker if the inspired air has which of the following characteristics? 48 mg H20 per liter of gas A water vapor pressure of 47 mm Hg A relative humidity of 100% at body temperature 32 mg H20 per liter of gas

32 mg H20 per liter of gas

What is the approximate FiO2 for a nasal cannula operated at 3 LPM? 32% 21% 40% 50%

32%

The physician has ordered 02 to be set up on a patient who has a spontaneous tidal volume of 500 ml and an inspiratory time of 1 second. Which of the following 02 delivery devices will deliver a flow that meets or exceeds this patient's inspiratory flow? Simple mask at 10 l/min 60% aerosol mask at 12 l/min 35% air entrainment mask at 6 l/min Non-rebreathing mask at 15 l/min

35% air entrainment mask at 6 l/min

What is the FiO2 range for a simple mask? 35-45% 35-40% 22-35% 35-50%

35-50%

A heated humidifier is delivering 100% body humidity to a patient's airway. What volume of water is being delivered? 47 mg/L 44 mg/L 37 mg/L 24 mg/L

44 mg/L

A patient is using a 30% air entrainment mask at an O2 flow of 5 l/min. What is the total flow delivered to the patient? 54 l/min 60 l/min 45 l/min 36 l/min

45 l/min

What is the relative humidity when the absolute humidity is 11 mg/L and the humidity level capacity is 24 mg/L: 17.2% 21.6% 26.4% 45.8%

45.8%

What is the flow range for adults using a simple mask? 5-10 LPM 1-6LPM <5 LPM 1-10 LPM

5-10LPM

What is the ideal aerosol therapy flow rate?

6-8Lpm

What do we assume to be the average adult peak inspiratory flow during tidal ventilation? 40LPM 60LPM 100LPM none of the above

60 LPM

What % of FiO2 exists when the flow rate of medical air and of oxygen are equal?

61% Ex: 3 Lpm air; 3 Lpm O2 FiO2= (3 x .21) + (3x 1.0) / 6

Identify the approximate saturation levels for the arterial oxygen tensions listed: 40 mmHg 50 mmHg 60 mmHg 100 mmHg

70 SaO2 80 SaO2 90 SaO2 100 SaO2

1 ATA (atmosphere) equals ___ at sea level 700 mm Hg 760 mm Hg 713 mm Hg can't be determined from the information given

760 mm Hg

A heat and moisture exchanger has an efficiency rating of 80%. What does this mean? 20% returns to the patient on inspiration 80% returns to the patient on inspiration The inspired temperature is 80% of the expired temperature The device provides 80% relative humidity at body temperature

80% returns to the patient on inspiration

What does 100% relative humidity mean?

@ a given temperature; it cannot hold any more water (vapor) ex: the relative humidity @ 20 F is a lot less than at higher temperatures

hyperbaric chamber

A chamber, usually a small room, pressurized to more than atmospheric pressure.

Perfusion in the extremities may best be determined by which of the following methods? Palpating a brachial pulse. Obtaining ABG studies and determining Pa02 level. Assessing the patient's Sp02. Assessing capillary refill.

Assessing capillary refill.

An immunocompromised patient is to be placed on oxygen with a humidity/aerosol device. Which of the following devices is most likely to deliver contaminated water to the patient? Heated wick humidifier Heated jet nebulizer Heated cascade humidifier Bubble humidifier

Heated jet nebulizer

The respiratory therapist is asked to recommend a humidifier that will be able to provide the highest water vapor content to the patient's airway. Which of the following humidifiers should the therapist select? Passover Bubble Heat moisture exchanger Heated wick

Heated wick

While palpating the chest, the respiratory therapist determines that there are decreased vibrations over the right lower lobe. This may be the result of which of the following?I. PneumothoraxII. Pleural effusionIII. Pneumonia II only II and III only I and II only I only

I and II only

While making 02 rounds, you discover the 6-inch reservoir tubing on a 60% T-piece set-up has fallen off. What may result from this situation?I. The FiO2 could decrease.II. The total flow to the patient could increase.III. More room air entrainment could occur. II only I only I and III only II and III only

I and III only

Which of the following are indications for cool, bland aerosol therapy?I. A cough must be induced for sputum collection.II. Mobilization of secretions must be improved.III. Postextubation inflammation of the upper airway must be treated. II and III only I only I, II, and III I and III only

I, II, and III

Yes/No COPD patients who are CO2 retainers should have all O2 therapy withheld to prevent hypoventilation/CO2 narcosis.

No

what is the aim of aerosol therapy? What is the benefit?

-deliver a therapeutic dose of the selected agent to the desired site of action -higher local drug concentration in lung -lower systemic side effects

DPI

-dry powder inhaler -help prevent attacks but do not help during an attack -the releases powder medicine into your mouth -has to be kept dry

list aerosol modalities

-face tent -aerosol mask -trach mask -t tube (t piece)

breath enhanced jet nebulizer

-has an exhalation valve; mouth piece

High flow vs low flow devices

-high flow devices are assuming it is meeting all of the patients ventilatory/inspiratory needs -low flow devices are given assuming it is assisting with or not meeting ALL of the pt's ventilatory/inspiratory needs

Things to consider when selecting the best device for a patient:

-how hypoxemia are they? -level of SpO2 -facial trauma? -is humidity needed? -emergency? -artificial airway pts? -patient comfort

Things to keep in mind/review when choosing the best device for a patient:

-how hypoxemic is the pt? -facial trauma? -is humidity or aerosol needed? -is the patient emergent or nonemergent? -does the pt have an artificial airway? -patient comfort

breath actuated nebulizer

-medication is only administered by patient actually breathing -does not run continuously -lid comes off, medicine goes in, twist to hold it -hooks up -breathing in activates the aerosol -doesn't waste medication

MDI

-metered dose inhaler -portable drug delivery system -uses for asthma; COPD -meter counts doses on inhaler -needs primed when first being opened/used -propellant inhaler -pts require alertness/coordination to use -color coded based on the medication in them

list oxygen modalities (per lecture; so far)

-nasal cannula -oxygen mask (simple mask) -nonrebreather -venturi -resorvoire cannula -nasal catheter -trasntracheal catheter

tidal volume

-normal breathing/breaths -peak inspiratory flow is unique to each person but 'standard' is 60LPM

List disadvantages of inhaled aerosols

-number of variables affecting the delivered dose -lack of adequate knowledge of device performance -use among patents and caregivers

aerosol

-particles of water/medication suspended in air -pressurized/spray/propellant medication -solids/liquids suspended in air -can usually be seen

Respiguard II

-pieces: reservoir tubing, filter, mouth piece, expiratory valve, medication, various filters -used to nebulize pentamidine only -pentamidine is toxic on expiration -pt must be alone during treatment -pentamidine is a very strong antibiotic to treat serious infections -HIV/AIDS pts, transplant pts, other pts with weakened immune systems -used in negative pressure rooms

You are called to the emergency department to assess a 52 year old college professor. ECG monitoring reveals sinus tachycardia. The pt was complaining of chest pain but subsided with administration of nitroglycerine. RR=20, SpO2=92% on room air. What should you conclude about the assessment of the patient and what should you recommend?

-possible conclusion: pt could be experiencing an heart attack -recommendation: nasal cannula to ease the burden on pt's heart

You are called to the emergency department to assess a 67 y/o pt with a known history of COPD with hypercarbia. SpO2 is 83% on room air. What is your recommendation?

-pt appears to be a CO2 retainer -mild hypoxemia based on SpO2 -venturi mask for precise O2 delivery (28%)

slow mist inhaler (MDI)

-respimat -cartridge turns, push button, mist releases slowly

V/Q mismatch results in ...

-shunt (no ventilation; with perfusion) -deadspace (ventilation; no perfusion) -V/Q mismatch→hypoxemia→hypoxia

disadvantages of inhaled aerosols

-the number of variables affecting the delivered dose -lack of adequate knowledge of device performance -use among patients and caregivers

Why must oxygen masks be set at least 5LPM?

-to be able to flush out CO2 -some facilities have different guidelines (7LPM)

Racemic epinephrine

-ultra short acting bronchodilator -used to reduce airway swelling after extubation -used to clear airway obstruction in croup -can control bleeding during surgery

peak flow meter

-used for asthma and COPD patients to monitor airways and how they are doing

Briggs Adapter

-used when giving a nebulizer treatment to trach patients -trach patients need the piece to receive humidity and the breathing treatment

Given a particular drug is available in 5mg/ml of solution, how many cc's would you administer to a patient if the written order is to administer 2.5mg?

.5 cc

The term used to describe a condition in which a patient has difficulty breathing while in a supine position is which of the following? Kussmaul respirations Paroxysmal nocturnal dyspnea Hypoventilation Orthopnea

Orthopnea

Which of the following documented evidence indicates hypoxemia? PaO2 less than 60 mm Hg acute care situations which hypoxemia is suspected new trauma patient in ER SaO2 less than 90% in patient breathing room air

PaO2 less than 60mmHg SaO2 less than 90% in patient breathing room air

Indicate when you would place a patient on O2?

PaO2= <60 mmHg SpO2= <90%

As air enters the body, it is changed from ___ to __ ? Ambient Temp Pressure Dry to Body Temp Pressure Saturated Std Temp Pressure Saturated to Body Temp Pressure Saturated St Temp Pressure Dry to Body Temp Pressure Dry Standard Temp Pressure Dry to Body Temp Pressure Saturated

Standard Temp Pressure Dry (STPD) to Body Temp Pressure Saturated (BTPS)

T/F all water/condensation in tubing must be considered as infectious waste

TRUE

The respiratory therapist notes a respiratory rate of 36/ min in an adult patient's chart. The patient's breathing pattern is best described by which of the following? Hyperventilation Hypoventilation Dyspnea Tachypnea

Tachypnea

T/F Heat and Moisture Exchangers heat and humidify gas on inspiration using reclaimed heat and moisture from exhaled air

True

T/F Hypoxemia causes pulmonary vasoconstriction and pulmonary hypertension

True

Your patient is on nasal cannula at 3LPM and complaining of dry and bloody nose. What is your recommendation? D/C the oxygen attach HME to cannula Call supervisor and MD for recommendation add bubble humidifier

add bubble humidifier

You are finishing your equipment rounds and notice your patient's aerosol tubing has a significant amount of water in it. What is your response?

add drain bag and check corrugated tubing positon

Identify the main uses for this type of inhaled respiratory medication: Anticholinergic Bronchodilators:

address mucus before its made

what is a possible hazard of aerosol drug therapy?

adverse reaction to medications (allergies)

Oxymizer

aka mustache/nasal reservoir cannula low flow device

As a result of anti-cholinergic medications, patients may experience ... dry cough dry mouth reduced bronchospasm all of the above

all of the above

Identify the phases of drug action: drug administration phase pharmacodynamic phase pharmacokinetic phase all of the above

all of the above

Identify vital signs monitored and recorded in patients receiving respiratory care medications pulse, respiratory rate/pattern, retractions, accessory muscles patient report of condition/subjective reaction to treatment breath sounds on auscultation, general patient appearance all of the above

all of the above

Oxygen toxicity can cause: low V/Q ratio physiologic shunting hypoxia all of the above

all of the above

Respiratory medications can promote ... short term bronchial smooth muscle relaxation long term bronchial smooth muscle relaxation back door bronchial smooth muscle relaxation all of the above

all of the above

Which of the following disorders indicates a need for O2 therapy? postoperative recuperation period patients with carbon monoxide poisoning acute myocardial infraction all of the above

all of the above

Which of the following is a common aerosol delivery device for respiratory medications? Metered dose inhaler (MDI) dry powder inhaler (DPI) small volume nebulizer (SVN) all of the above

all of the above

Which of the following is a key element when starting a medication treatment? make sure patient understands why you are there distribute patient education materials determine if patient has had previous negative reaction to the drug ordered all of the above

all of the above

Which of the following is a mode of action in respiratory medications? alpha 1 (heart) vasoconstriction- Beta 1: increased heart rate and force Beta 2- bronchodilation and increased mucociliary action all of the above

all of the above

Which of the following is a purpose of respiratory care medications anti microbial anti bacterial anti asthmatic all of the above

all of the above

Which of the following is a side of respiratory medications? tremor shakiness increased heart rate and contractility all of the above

all of the above

Indications for humidification include which of the following? humidifying dry gases to overcome humidity deficit managing hypothermia preventing/treating bronchospasm caused by cold/dry air all options are correct

all options are correct

Types of humidifiers? bubble humidifier passover/wick heat moisture exchangers/HMEFs and membrane devices all options are correct

all options are correct

Which is a sign and symptom of inadequate airway humidification? Atelectasis & dry, nonproductive cough (NPC) increased WOB and sub-sternal pain thick, dehydrated secretions all options are correct

all options are correct

Which is considered an advantage of an HME to the patient? inexpensive and simple to use filters impurities away from the patient can provide high levels of humidity all options are correct

all options are correct

Which of the following patients would be considered to have a bypassed upper airway? A patient with a tracheostomy that doesn't need supplemental oxygen A patient with an endotracheal tube receiving mechanical ventilation A patient with a tracheostomy that is receiving mechanical ventilation all options are correct

all options are correct

Identify the main uses for this type of inhaled respiratory medication: non steroidal agents

anti asthmatic (preventative)

Identify the minimum elements of assessment of a patient receiving respiratory care medications ask the MD what they think ask the family what they think assess vital signs before and after the treatment all of the above

assess vital signs before and after the treatment

antagonists

blocking agents

BTPS

body temp pressure saturated

You are caring for a patient who is on the med-surg floor who is being treated with supplemental O2 via 5L/min nasal cannula. The patient is complaining of a dry, stuffy nose. What are your recommendations?

bubble humidifier or bland aersol

What happens if you use a simple mask with a flow of less than 5LPM? nothing buildup of CO2 CO2 rebreathing Hypoxia

buildup of CO2 CO2 rebreathing

How does O2 therapy correct hypoxemia? by increasing pressure above 1 ATA decreasing CO2 in the blood by increasing alveolar and blood levels of O2 recruiting alveoli and preventing atelectasis

by increasing alveolar and blood levels of O2

bubble humidifier

can come in disposable water packs or refillable containers to provide humidity to NC or aerosol masks.

beta 1 receptor stimulation

causes increased heart rate and heart contractility

alpha-receptor stimulation

causes vasoconstriction and vasopressor effect

Troubleshoot: no flow felt from nasal cannula NC

check tubing, possible occlusion, patient is laying on it

Identify the main uses for this type of inhaled respiratory medication: Mucus-controlling agents

control/manage mucus production

atomizer

converts a liquid into a droplet

What is the effect of failing to provide supplemental heat/moisture to patients with a bypassed upper airway? no effect at all, the body is adaptable a runny nose fluid overload, particularly in patient with CHF damage to the respiratory tract

damage to the respiratory tract

What is the primary purpose of Respiratory Care Pharmacology? delivery of aerosols for treatment and diagnosis of pulmonary diseases improve outcomes for COPD patients improve outcomes for asthmatic patients all of the above

delivery of aerosols for treatment and diagnosis of pulmonary diseases

Which of the following is a potential complication of hyperbaric oxygen therapy? gas embolism somnolence worsening of chronic wounds orange discoloration of dermis

gas embolism

inhalers

generate aerosolized medication from liquids or dry powders for a single inhalation

Which of the following is not an advantage of respiratory care medications? quick action direct action fewer side effects guarantee of return to previous lung function

guarantee of return to previous lung function

CO2 narcosis

happens due to not breathing makes you sleepy; CO2 levels are too high in the body

You are called to the emergency department to care for a patient who fell into a lake while ice fishing. His core body temperature is 30C. What are your recommendations?

heated bland aerosol administration

HME

heated moisture exhanger acts as artificial nose to mechanically ventilated patients

Hazards and complications of bland aerosol therapy include all of the following except: bronchospasm infection overhydration hemoconcentration

hemoconcentration

What type of device is an air entrainment mask? low flow high flow high flow as long as it meets pts inspiratory needs aerosol

high flow as long as it meets pts inspiratory needs

Relative Humidity- how is it calculated?

how much water there is / how much water you could have at a given temperature

What device adds molecular water to gas? nebulizer humidifier atomizer agitator

humidifier

What is a hygrometer used to measure? barometric pressure humidity blood pressure all of these

humidity

In which cardiac condition is oxygen therapy especially important?

myocardial infarction-eases the amount of work the heart has to do

If a patient is on a venturi mask (28%) what device should be used during meal times?

nasal cannula @ 2LPM

If a patient is on 28% venturi mask, what device should be use at meal times?

nasal cannula at 2L/min

Which O2 modalities can be administered with humidity?

nasal cannula, aerosol mask; trach mask

Where should the temperature probe be placed when using a heated humidifier? near the patients airway closest point to the heater doesn't matter can't be determined by the information provided

near the patient's airway

Your patient required 80 LPM to maintain a stable FiO2. Is a 50% AEM at 6 LPM high flow? yes no depends on blender setting can't be determined from information given

no

A patient with carbon monoxide (CO) poisoning can best be treated with which of the following therapies? Nasal canula at 6 l/min Simple mask at 10 l/min CPAP at 60%

non-rebreathing mask

what is tidal volume?

normal breaths/breathing

Which of the following indicates that gas delivered with a heated-wire system is fully saturated in the airway? observing no visible condensate anywhere in the tubing observing a few condensate at or near the patient's airway confirming an airway temperature between 32-35 C observing condensate over the full length of the tubing

observing a few condensate at or near the patient's airway

List indications for bland aerosol administration

obstructed airways- CROUP, Trach patients to induce sputum production its with inflamed airways/post-endotrach pts

At sea level gas at BTPS has a water vapor pressure: of 47 mm Hg and contains 43.9 mg/L of 43.9 mm Hg and contains 47 mg/L of 21% and and RH of 70% of 50% RH

of 47 mm Hg and contains 43.9 mg/L

Venturi mask

offers precise FiO2 delivery entrains room air

Identify the main uses for this type of inhaled respiratory medication: pulmonary vasodilators

open up vessels in the lungs

nasal cannula

oxygen modality with two 'prongs' that rest in the nose. low flow device flow rate 1-6LPM FiO2-24-44%

How can supplemental oxygen therapy cause atelectasis?

oxygen overload can cause nitrogen washout

What is the typical cause of activating the pressure pop off in most simple bubble humidifiers? the water is nearing empty there is a hole in the humidifier there is a hole in the cannula tubing there is an occlusion

there is an occlusion

list consequences of inadequate humidification of inspired gases

thickened secretions, secretions will not be mobile, slowed down ciliary action

inspissated

thickened, dry secretions

Identify the main uses for this type of inhaled respiratory medication: Inhaled Corticosteroids

to treat inflammation

List situations where humidification should ALWAYS be added

trach patients, mechanically ventilated patients

T/F blenders have a functional alarm that measure medical air and oxygen are both 50psi.

true

T/F hyperbaric oxygen in the therapeutic use of O2 at pressures greater than 1 ATA

true

T/F the purpose of respiratory medications is either to cause something good to happen or to prevent something bad

true

Racemic Epinephrine

ultra short acting bronchodilator -reduces airway swelling after extubation or in pt with croup or epiglottitis -to control airway bleeding during endoscopy

Where is heat and moisture exchange of inhaled air primarily performed? upper airway, primarily the mouth lower airway, primarily the alveoli lower airway, primarily the bronchi upper airway, primarily the nose

upper airway, primarily the nose

Troubleshoot: mask caused claustrophobia

use a face tent or nasal cannula

N-Acetyl-cysteine (NAC)

*mucamist -given by aerosol or direct tracheal instillation -given to reduce accumulation of airway mucus -may cause bronchospasm -NAC substitutes its own sulfyhfryl group for disulfide group in mucus, breaking down of bond-forming gel structure of mucus SIDE EFFECTS: -airway obstruction due to rapid liquification of secretions -odor -nausea

small volume nebulizer

-A respiratory device that holds liquid medicine that is turned into a fine mist. -if a pt is using a nasal cannula but needs a breathing treatment, cheater can attach to air which can attach small volume neb -wall gas → flowmeter (6-8LPM) → tubing→medication goes into reservoir (3mL of medication) → attach lid & tubing for treatment → pt's mouth goes on the slender piece

anticholingeric aerosol agents

-SVN, MDI, DPI (most common): cough, dry mouth -MDI (occasional): nervousness, irritation, dizziness, headache, palpitation, rash -SVN and DPI: pharyngitis, flu like symptoms, bronchitis, upper respiratory infections, nausea

advantages of inhaled aerosols:

-aerosol doses are generally smaller than systemic doses -onset of drug action is rapid -delivery is targeted to the organ requiring treatment -systemic side effects are fewer and less severe

List advantages of using inhaled aerosols

-aerosol doses are usually smaller than systemic doses -onset of drug action is rapid -delivery is targeted to the organ requiring treatment -systemic side effects are fewer and less severe than ingested medications

humidity

-amount of water vapor in the air -is temperature dependent -molecular water -max amount of water vapor @ body temp is 44mg volume of pressure or 47 mmHg volume of water

spacers

-chamber holds medicine in so that the patient can inhale medicine -has port at the mouthpiece in case you exhale, air escapes but medicine still stays in the chamber

Identify two main types of medication airway receipts in the lung

1. adrenergic (sympathetic NS), aims to speed things up 2. cholinergic (parasympathetic, NS), aims to slow things down

Identify three phases of drug action

1. drug administration phase 2. pharmocokinetic phase 3. pharmacodynamic phase

A patient receiving 38 mg H20 per liter of gas from a nebulizer has a humidity deficit of which of the following? 12 mg/L 6 mg/L 18 mg/L 9 mg/L

12 mg/L

Given the following data, what is the patient's total arterial O2 content?pH 7.41PaCO2 37PaO2 88HCO3 26SaO2 95%Hb 14 12 mL/dL 14 mL/dL 16 mL/dL 18 mL/dL

18 mL/dL

In order to minimize an increased airway resistance produced by high density aerosol inhalation, the respiratory therapist should recommend which of the following? Administer a bronchodilator along with the aerosol. Perform chest physiotherapy following the aerosol treatment. Use a heated nebulizer to deliver the aerosol. Instruct the patient to breathe through their nose.

Administer a bronchodilator along with the aerosol.

The respiratory therapist receives an order to set up a moderate level of 02 on a patient who arrives in the ED breathing at a rate of 35 breaths/min. Which of the following 02 delivery devices is most appropriate to use in this situation? Simple 02 mask at 10 l/min Non-rebreathing mask at 15 l/min Nasal cannula at 4 l/min Air-entrainment mask at 40% 02

Air-entrainment mask at 40% 02

A severe COPD patient arrives in the emergency department on a 2 l/min nasal cannula. Arterial blood gas results follow:pH 7.32PaCO2 67PaO2 62HCO3 38Which of the following is the most appropriate recommendation? Increase the liter flow to 4 l/min Place on non-rebreathing mask at 12 l/min Answer Maintain current O2 levels Institute NIPPV

Answer Maintain current O2 levels

Identify the main uses for this type of inhaled respiratory medication: Adrenergic Bronchdilators

B2 receptor activation-inhaled medicine that help open up the airways. They are used to treat asthma and chronic bronchitis

Which specific type of COPD patient will experience depression of ventilatory drive when breathing supplemental oxygen?

CO2 retainers

HBO therapy is used to treat all of the following conditions except: air embolism chronic non healing wounds CO2 retention crush injuries

CO2 retention

Which of the following patients would benefit from a simple mask to treat hypoxia? surgical patient requiring oxygen COPD patient either mouth breathing or increased O2 demand pt requiring bronchoscopy and O2 stable ambulatory pt at home who requires long term O2

COPD pt either mouth breathing or increased O2 demand

Which of the following patients would benefit form an air entrainment mask to treat hypoxia? emergencies requiring short term oxygenation COPD patient failing nasal cannula due to mouth breathing COPD patient with suspected hypercarbia for precise low FiO2 stable ambulatory patient at home who requires long term FiO2

COPD pt with suspected hypercarbia for precise low FiO2

Calculate O2 content for a patient with an Hb of 10 g/dL, saturation of 97% and PaO2 of 100 mm Hg

CaO2= (.003 x 100) + (10 x 1.34 x .97) = 13.3

Calculate O2 content for a patient with am Hb of 15 g/dL, saturation of 97%, and PaO2 of 100 mmHg

CaO2= (.003 x 100) + (15 x 1.34 x .97) = 19.8

You are continuing your rounds when your patient complains of not feeling the flow from the nasal cannula set at 2 L/min. What is the appropriate response?

Check for occlusion/check tubing

Which does not effect the ability of a device to provide humidity to a patient? FiO2 surface area contact time temperature

FiO2

A patient enters the emergency department, and on initial examinat ion the respiratory therapist observes paradoxical chest movement. Which of the following should the therapist suspect? Flail chest Pleural effusion Pneumonia Pulmonary edema

Flail chest

You notice that very little mist is being produced by a nebulizer attached to an aerosol mask. Which of the following could be responsible for this?I. The liter flow is too high.II. The nebulizer jet is clogged with lintIII. The filter on the capillary tube is obstructed. II and III only I only I and III only II only

II and III only

After setting up a non-rebreathing mask on a patient at a flow of 10 l/min, the reservoir bag collapses before the patient finishes inspiring. The respiratory therapist should do which of the following? Remove the one-way valve from the exhalation port. Change to a simple 02 mask at a flow of 10 l/min. Increase the flow to 15 l/min.

Increase the flow to 15 l/min.

A patient coughs up yellow sputum after receiving a treatment. Which one of the following statements is true in regard to this sputum production? It contains white blood cells (WBCs). It is termed hemoptysis. It is a normal color for sputum.

It contains white blood cells (WBCs).

The following blood gas levels have been obtained from a patient using a 60% aerosol mask.pH 7.47PaCO2 31PO2 58mmWhat should the respiratory therapist recommend at this time? Intubate and place the patient on mechanical ventilation. Place the patient on a therapy modality we have not yet discussed in this class.. Increase the 02 to 70%. Change to a non-rebreathing mask.

Place the patient on a therapy modality we have not yet discussed in this class..

nebulizers

Produce finer aerosol particles from liquid-based formulations over greater periods of time using compressed gas or electricity

When gas delivered to a patient has an absolute humidity of 22 mg/L, and 44 mg/L is required for BTPS, what is the relative humidity of the gas and what is the humidity deficit?

RH- 50% HD-22 mg

You notice that the patient's secretions have become thicker and more difficult to suction since changing from a heated-wire ventilator circuit with a heater/humidifier to a not heated circuit and heat moisture exchanger. The respiratory therapist should recommend which of the following? Replace the heat moisture exchanger with a conventional heated humidifier. Replace with a new heat moisture exchanger. Increase inspiratory flow. Decrease the temperature to the heat moisture exchanger.

Replace the heat moisture exchanger with a conventional heated humidifier.

The respiratory therapist is assessing apatient with severe emphysema and observes pedal edema and jugular venous distention. The therapist should note in the patient's chart these signs are most likely the result of: Hypercapnia Systemic hypertension Pulmonary infection Right ventricular hypertrophy

Right ventricular hypertrophy

After connecting a nasal cannula to the humidifier outlet, you kink the tubing and hear a whistling noise coming from the humidifier. Which of the following most likely has caused this? The top of the humidifier is not screwed on tightly. The humidifier jar is cracked. The capillary tube in the humidifier is disconnected. The humidifier has no leaks.

The humidifier has no leaks.

FEV1 PEFR

forced expiratory volume in 1 second peak expiratory flow rate

You are doing equipment rounds when you hear a high pitched whistling sound coming from a patient's room. When you enter, you see the bubble humidifier and nasal cannula are attached to a flowmeter set to 12 L/min. What is the appropriate response?

The flow rate is set too high, must be 6 L/min maximum.

Which of the following is NOT a common problem with humidification systems? condensation in the tubing cross contamination ensuring proper conditioning of the inspired gas determining which device will generate the greatest revenue

determining which device will generate the greatest revenue

What qualifies a device as high flow or low flow? device meets or exceeds pt's peak inspiratory flow device meets or exceeds patient's FiO2 requirements device meets or exceeds patient's respiratory rate device meets or exceeds patient's depth of breathing

device meets or exceeds pt's peak inspiratory flow

List indications for providing bland aerosol to non-intubated patients

dried airways post extubations inflamed airways

Which of the following patients would benefit from a partial rebreather mask to treat hypoxia? emergencies requiring short term oxygen COPD patient failing nasal cannula due to mouth breathing patient requiring bronchoscopy and oxygen stable ambulatory pt at home who requires long term O2

emergencies requiring short term oxygenation

Which of the following patients would benefit from a nonrebreather mask to treat hypoxia? emergencies requiring short term oxygen COPD patient failing nasal cannula due to mouth breathing patient requiring bronchoscopy and oxygen stable ambulatory pt at home who requires long term O2

emergencies requiring short term oxygenation with high FiO2

Aerosol modalities

face tent, aerosol mask, trach mask/collar (and T piece if trach pt is on a ventilator)

turbulent flow

fast, deep breathing

Is FiO2 with air entrainment mask fixed or variable? fixed variable can't be determined from info given fixed as long as it meets the patient's inspiratory demands

fixed as long as it meets the pt's inspiratory demands

Troubleshoot: humidifier pop-off is activated

flow rate is too high

Troubleshoot: NRB bag is so inflated that it may pop

flow rate is too high, it must be turned down

Troubleshoot: NRB mask bag completely collapses on inspiration

flow rate is too low, must be turned up

What is the simplest way to increase the humidity output of a humidifier? increase the time the water and gas are in contact increase the surface area between the water and the gas decrease the water vapor pressure of the gas increase the temperature of the water or the gas

increase the temperature of the water or the gas

What patient action can DECREASE the FiO2 delivered to a patient via O2 delivery device? increase their depth of breathing decrease their depth of breathing decrease respiratory rate none of the above

increase their depth of breathing

Identify common methods of aerosol drug administration

inhalers, nebulizers, slow mist, DPI

to prevent O2 toxicity you should try, if possible, to limit exposure to 100% FiO2 to less than 12 hours less than 24 hours less than 48 hours less than 7 days

less than 24 hours

What is the flow range for infants using a nasal cannula? less than or equal to 2LPM 1-6LPM 1-10LPM 1/4-6LPM

less than or equal to 2LPM

bland aerosol

liquid particles suspended in gas, UNMEDICATED

medicated aersol

liquid particles suspended in gas; MEDICATED

What type of device is a nasal cannula? low flow high flow positive pressure aerosol

low flow

What type of device is a nasal catheter? low flow high flow positive pressure suction

low flow

What type of device is a reservoir cannula? low flow high flow bi-level positive pressure airway clearance device

low flow

What type of device is a simple mask? low flow high flow venturi aerosol

low flow

What type of device is a transtracheal catheter? low flow high flor

low flow

simple mask

mask fits over patients mouth and nose and tubing is small. low flow device 6-10 LPM FiO2 40-55%

Which describes the best process for choosing appropriate aerosol class of drug to treat a patient? MD preference overall disease process patient preference matching indications for the drug class to patient symptoms

matching indications for the drug class to patient symptoms

Hygrometer

measures humidity

How are aerosols used in a clinical setting

medicated aerosols are generated with atomizers, nebulizers and inhalers

What are antagonists?

medications that are blocking agents

What are agonists?

medications that are stimulating agents

Which of the following is NOT an objective way to determine if a patient needs O2 therapy? pt asks for oxygen because they feel they need it laboratory measures specific clinical condition that indicates need for oxygen clinical manifestation of tachypnea and tachycardia

patient asks for oxygen because they feel they need it

How do the lungs compensate when a patient is hypoxemic?

patient will take faster, more shallow breaths

List contraindications of using an HME

patients with a lot of secretions

Identify the main uses for this type of inhaled respiratory medication: anti-infective agents

prevent bacterial/viral infections

Which of the following is NOT a goal of O2 therapy? correct documented or suspected acute hypoxemia prevent oxygen toxicity decrease symptoms associated with chronic hypoxemia decrease the workload on the cardiopulmonary system

prevent oxygen toxicity

Which of the following patients would best benefit from a nasal catheter to treat their hypoxia? stable COPD pt with mild hypoxia unstable COPD pt with mild hypoxia patient requiring bronchoscopy and oxygen pt requiring hyperbaric oxygen

pt requiring bronchoscopy and oxygen

Indications for warming inspired gases include all of the following EXCEPT: treating a patient whose airways are reactive to cold providing to patients when the upper airway is bypassed treating a patient with hypothermia reducing upper airway inflammation or swelling

reducing upper airway inflammation or swelling

What is the term for the ratio of actual content of water present relative to capacity to hold water at the temperature actual humidity % relative humidity humidity deficit BTPD

relative humidity

What is the mode of action of beta agonist drugs? generate revenue for the facility relax smooth muscle prevent bad things from happening to the patient all of the above

relax smooth muscle

beta-2 receptor stimulation

relaxes bronchial smooth muscle, stimulates mucociliary activity, has some inhibitory action on inflammatory mediator release

tubing keeps popping off the transtracheal catheter, what should you do? call your supervisor ask the patient to decrease the size of their breaths remove tubing and check for an occlusion increase oxygen flow

remove tubing and check for an occlusion

High PaO2 can cause which of the following in infants? Bronchopulmonary dysplasia hypoxia retinopathy of prematurity (ROP) aka RLF cyanosis

retinopathy of prematurity (ROP) aka RLF

Pendant reservoir cannula

similar to oxymixer but reservoir sits in a pendant like necklace

laminar flow

slow, deep breaths

There is a high pitched noise coming from a humidifier as you enter a patient's room. What is causing the problem? there is a leak in the cannula/humidifier the flow is inadequate for the patient the patient is breathing too rapidly something is occluding the flow of the nasal cannula

something is occluding the flow of the nasal cannula

Which of the following patients would best benefit from a nasal cannula to treat their hypoxia? stable COPD patient with mild hypoxia unstable COPD patient with mild hypoxia stable patients with severe hypoxemia any patient with refractory hypoxemia

stable COPD patient with mild hypoxia

Which of the following patients would benefit from a reservoir cannula to treat hypoxia? surgical pt requiring oxygen unstable COPD pt with severe hypoxia pt requiring bronchoscopy and oxygen stable ambulatory pt at home who requires long term O2

stable ambulatory pt at home who requires long term O2

Which of the following patients would benefit from a transtracheal catheter to treat hypoxia post surgical pt requiring oxygen unstable COPD pt with mild hypoxia patent requiring bronchoscopy and oxygen stable ambulatory pt at home who requires long term O2

stable ambulatory pt at home who requires long term O2

agonists

stimulating agents

define acute hypoxemia

sudden low oxygen in the blood

List variables affecting the output of a humidifier and indicate which is most important:

surface area, how much water is in aquapack

List common acute clinical situations where oxygen therapy is provided:

surgical patients, myocardial infarction, CO poisoning, suspected hypoxemia, trauma patients, drug overdose patients, cyanide poisoning

Which of the following best defines an aerosol? suspension of liquid droplets in a gas molecular water dispersed throughout carrier gas suspension of particle matter in a gas suspension of liquid or solid particles in a gas

suspension of liquid or solid particles in a gas

hypoxic drive

the body mechanism that tells us to breathe when PaO2 is consistently below 60; activates if hyperbaric drive doesn't kick in; caused by pH increase

hyperbaric drive

the body mechanism that tells us to breathe, driven by increased CO2 in body

How does the heart compensate when your patient is hypoxemic?

the heart will beat faster

In a heated-humidifier circuit, where would you place the water traps? the highest point of the circuit rotated between the inspiratory and expiratory limbs each shift the lowest point in the circuit all options are correct

the lowest point in the circuit

What is the difference between a non rebreather and a rebreather mask? color of straps valves size of bag large bore v small bore tubing

valves

Which statement is TRUE? humidifiers can only be passive vapotherm is an example of a membrane humidifier device non heated devices provide the best humidification bubble humidifiers are also known as artificial nose

vapotherm is an example of a membrane humidifier device

Is FiO2 with reservoir cannula fixed or variable?

variable

Is FiO2 with simple mask fixed or variable?

variable

Is the FiO2 delivered with a nasal cannula considered fixed or variable?

variable

Is the delivered FiO2 with nasal catheter or transtracheal catheter fixed or variable?

variable

What is the flow range for adults using an air entrainment mask? 5-10LPM varies and usually indicated on the device min of 10 LPM 1-10LPM

varies and usually indicated on device

What is the effect of hypoxemia on pulmonary blood vessels?

vasoconstriction

You are called to the emergency department to assess a 67 y/o pt with a known history of COPD. ABG results indicate mild hypoxemia and pH/PaCO2 within normal limits. What is your recommendation?

venturi mask or nasal cannula

What flow range should be used for a nonrebreather mask? 5-10LM 1-6LPM whatever flow is necessary to keep the bag inflated 1-10LPM

whatever flow is necessary to keep the bag inflated

isothermal saturation boundary

where inhaled gases are fully absorbed in the body (the point of BTPS)