Question Answer
What type of breathing pattern is periodic in nature, with a gradual increase in depth and respiratory rate followed by a tapering of rate and depth with periods of apnea is? BH Cheyne-Stokes
Name 4 indications of increased work of breathing. BH 1. tripod position 2. use of accessory muscles 3. pursed lip breathing 4. retractions
An increase in tactile fremitus indicates what? BH an increase in density of the underlying tissue
What can digital clubbing indicate? KW cardio pulmonary disease
What are you looking for when you inspect and palpate the abdomen? KW evidence of distention and tenderness
The patient with heart disease who has an S3 and S4 is said to have a __________________. KW gallop rythm
Most accurate method of measuring temperature? AF rectal
What pressure is measured at the time the ventricles are contracting? AF systolic
What is a normal ventilatory pattern? AF 1:2
What is a barrel chest? AF the anterior/posterior diameter is greater than normal
What type of appearance would you have with a kyphotic spine? AF humpback
What is a lateral curvature of the spine? AF scoliosis
The presence of air beneath the skin in the subcutaneous tissues is called? BH subcutaneous emphysema
What causes tracheal deviation toward the affected lung side? BH atelectasis fibrosis
What causes tracheal deviation away from the affected lung side? BH pleural effusion pneumothorax tension pneumothorax
Shortness of breath in the upright position is called? KW platypnea
Coughing up blood-streaked sputum is called _____________. KW hemoptysis
Vomiting blood is called _________________. KW hematemesis
What are the four steps in doing a physical exam on your patient? KW inspection palpation percussion asculation
Waht is the swelling of the lower extremities called? KW pedal edema
What is another name for a pigeon chest? AF pectus carinatum
What type of percussion sound would you hear in the presence of air trapping or air in a closed cavity? AF hyperresonance
What 4 things do you assess sputum for? AF color quantity viscosity smell
If your sputum is reddish brown, what does it indicate? AF blood in the sputum
If you cough up more than 300ml of blood streaked sputum in 24 hours, what does that indicate? AF massive hemoptysis
A flat percussion note is an indication of what? AF pleural effusion
Normal breath sounds heard in the lungs and are found in the peripheral lungs is called? BH vesicular breath sounds
This occurs when the two pleural layers rub together with more friction than normal? BH pleural rub
When a patient awakens only with difficulty and might be able to reply to a few answers is refferred to as _________________________. BH obtunded
An audible upper airway noise indicative of upper airway narrowing is called? BH stridor
What is another name for crackles? BH rales
Yellowish coloration of the skin, mucus membranes or conjunctiva of the eyes is called? BH jaundice
An elevated pulse rate over 100 bpm indicates? KW tachycardia
A significant decrease in pulse strength during spontanous inhalation is called? KW pulsus paradoux
When respiratory disease reduces arterial oxygen content, __________________ may be detected especially around the lips. KW cyanosis
To measure the SpO2, one should use a __________. KW pulse oximeter
What is the technique called when you ask the patient to say 99?KW vocal frmitus
Question Answer
How do you explain the therapy and goals to the patient and family use simple language, home care procedures
What is disinfection process of destroying vegetative pathogenic organisms
What is sterile lack of any life or living organisms
What is vegetative organisms growing organisms
What is pathogenic organisms disease producing
What is contaminated the introduction of disease causing microorganisms
What is static growth is inhibited
What is cidal microorganisms are killed
What is spore a resistant form of certain species of bacteria
Steam under pressure, steam autoclave 121 degrees at 15 psi for 15 minutes, not used on plastics or other heat sensitive items, must be wrapped in penetrable packaging, all air must be evacuated and steam must be allowed to penetrate all parts, heat sensitive tapes and bio indicators used
Pasteurization disinfection process using moderate temperatures to kill vegetative organisms, items washed then submersed in hot water bath for 30 minutes, dried then assembled and packaged
What is incineration treats contaminated disposable items and supplies
What is irradiation gamma rays are used to sterilize pre packaged equipment, these items should not be re-sterilized with ethylene oxide
Ethylene oxide sterilization sterilizes equipment by alkylation of enzymes, concentration of 800-1000mg/L, 50% relative humidity enhances the effectiveness of ETO, exposure time, aeration time, biological indicators that sterility has been met, NOT recommended for a bronchoscope
What are examples of ethylen oxide sterilization bird mark vii, electric incentive spirometry device, non disposable resuscitation bag removed from a HIV patient room
Alkaline gluteraldehyde or cidex disinfection or sterilization, ph is 7.5-8.5, bactericidal in 10 minutes, tuberculocidal in 10-20 minutes, sporicidal in 10 hours (sterilize), appropriate for plastics mouth pieces, tubing, aerosols, APPROPRIATE for BRONCHOSCOPE
Acid gluteraldehyde (Sonacide) disinfection and sterilization, ph 2.5-3.5, bactericidal in 10 minutes, tuberculocidal in 20 minutes, sporicidal in 1 hour, equipment must be rinsed, dried and packaged after exposure to sonacide, potent for 28 days
Alcohol ethyl and isopropyl alcohol are most effective in 70-90% solutions, alcohol wipes are not sporicidal although it is bactericidal and fungicidal
Soaps and detergents used as cleaners, surfactants that will reduce surface tension
What are gram negative organisms cause pneumonia and respiratory tract infection, rod shaped, not spore producing, grow in water and found in gi tract normal flora spread by poor hand washing
What are the gram negative organisms called pseudomonas aeruginosa (most common, green sputum) haemophilus influenza, serratia marcescens, escherichia coli, proteus, klebsiella
What are the gram positive cocci pneumonia, respiratory tract infections, staphylococcus, streptococcus, diplococcus, pneumococcus
What are acid fast bacilli mycobacterium tuberculosis
What are pathogenic fungi candida, candidiasis, histoplasma capsulatum, histoplasmosis, coccidiodes immitis, coccidiomyosis
What are viruses respiratory infections, flu like symptoms and viral pneumonia, adenovirus, influenza, cytomegalovirus, respiratory syncytial virus
Droplet nuclei dispensed via the cough or sneeze
What precautions are used with AIDS pts standard, gloves
What precautions are used with respiratory isolation airborne transmission masks and gloves, measles, rubella, mumps, pertussis, meningoccal meningitis and suspected tuberculosis patients
What precautions are used with strict complete isolation gloves, masks and gowns, staph aureus and group patients with streptococcus pneumonia
What precautions are used with protective or reverse isolation strict isolation, burn, transplant, or cancer patients and immunosuppressed individuals
What precautions are used with enteric and skin isolation gowns are used, gloves necessary when having direct contact with infected blood or fecal material, hepatitis
What type of precautions are used with wound and skin isolation gloves are worn, mask and gown optional
Wright respirometers and other equipment used with multiple patients should have one way valves or personal sampling chambers to prevent cross contamination
Change nebulizer and aerosol tubing every 24 hours
Use a different small volume nebulizer for each patient
When do you double bag equipment to be gas sterilized aids and hepatitis patients
What are the 3 procedures used to sample respiratory equipment to determine the source of the nosocomial infection swab rubbed on equipment at one location used to inocculate a dish of growth medium and incubated
With aerosol impaction a sample of particle output is obtained from aerosol producing equipment like nebulizer, maintain asepsis, incubation
With liquid broths used to obtain a sample inside the tubing the broth then dispensed into a sterile container and incubated
Describe purse lip breathing semi fowlers relaxed, inhale through nostrils, slowly with lips closed, instruct patient to pucker at end inhalation, exhalation should be passive relaxed
Why do we use purse lip breathing increase tidal volume, decrease rr, decrease alveolar collapse, prolong slow exhalation, emphysema
Describe diaphragmatic breathing muscle relaxation shoulders and chest, conditioning abdominal lower chest muscles, combined with pursed lip technique, abdomen rises on inspiration
Why do we use diaphragmatic breathing improve ventilation, reduce oxygen cost of breathing
What is huff coughing coughing with an open glottis, effective in copd and head trauma to prevent increased intracranial pressure
What criteria is used to determine if a patient will benefit from oxygen in the home po2 less than 55 torr on toom air, exercise limitation that is responsive to o2 therapy, ear or finger oximetry at rest excercise and sleep, polycythemia or cor pulmonale
Oxygen concentrators used at a higher level than 1-2 L/min can cause concentrations to fall
If molecular sieve beds are not working analyze the fio2 and check circuit breaker fuse
What is the terminology used to describe a copd patient chronic ventilatory failure patient, chronic hypercapnic patient, increased compliance patient, a loss of elastic recoil patient and co2 retainer
What is the assessment for CBABE expiratory wheeze, barrel chest, clubbing and cyanosis, percussion notes resonant or hyperresonant, hyperlucency hyperinflation increased ap diameter on chest xray, compensated respiratory acidosos with hypoxemia and hypercapnea, decreased fev1
What is the treatment for CBABE aerosol therapy low flow o2, bronchodilators, expectorants, coricosteroids, diuretics, rehab therapy purse lip breathing, proper nutrition, monitor fluid intake, or if copd in full arrest at er then resuscitate with 100% o2
What is croup viral, gradual onset upper respiratory infection less than 3 years old occurs in winter
What are the signs of croup fever, drooling and retraction, toxic appearance
What is the admission criteria for croup stridor at rest
What is the treatment for croup cool mist tent, dexamethasone (steroid)racemic epinephrine aerosol
What do the xrays look like for croup subglottic edema, steeple or pencil sign
What is hemophilus influenza sudden bacterial upper respiratory infection, occurs age 3-7
What is the admission criteria for hemophilus influenza drooling, extended neck, suspicion of epiglottitis
What is the treatment of hemophilus influenza intubation, IV antibiotics(Ampicilin)
What do the xrays look like for hemophilis influenza supraglottic edema, thumb or thumb print sign, obliterated vallecula
What is mycobacterium disease tuberculosis asid fast rod shaped bacteria spread by inhalation
What is the assessment of tuberculosis night sweats or nocturnal diahoresis, weight loss and weakness, dry cough with or without hemoptysis and pleural pain, 2 positive test sputum culture and tb test, xrays will show consolidation fibrosis and cavity formation
What is the treatment for tuberculosis isoniazid INH, ethambutol, streptomycin, rifampin
What is pneumonia infectious bacteria or virus enters the lung via inhalation or aspiration
What is the assessment for pneumonia chills, fever, cough, purulent sputum, cyspnea, cyanosis, rales and rhonchi on auscultation, white blood cell count increased in bacterial and decreased in viral, scattered patchy opacity consolidation on xray
What is the treatment for pneumonia penicillin for gram positive infections such as staph and strept, streptomycin gentamycin and tobramycin for gramnegative infections such as serratia, klebsiella, haemophilus, pseudomonas, e coli, proteus
When do you mechanically ventilate a patient for pneumonia if pco2 > 45 mmhg and pao2 < 60 mmhg
What is pleural effusion fluid in the pleural space
What is the assessment for pleural effusion dyspnea, chest pain, decreased breath sounds and dry non productive cough, mediastinal shift to the unaffected area away from the affected area
What does that chest x ray show for pleural effusion lateral decubitus obliteration of the costophrenic angle, unilateral basilar infiltrate with meniscus formation
What is the treatment for pleural effusion Thoracentesis or chest tube drainage system, antibiotics
What is acute respiratory distress syndrome reactions leading to inflammation resulting in a decrease in lung compliance, shunting, hypoxemia
What is the assessment for acute respiratory syndrome ARDS tachypnea, cyanosis, refractory hypoxemia, increased A-a DO2 and work of breathing, x ray shows diffuse alveolar infiltrates in honeycomb ground glass pattern, decreased FRC, shunting and respiratory failure
What is the treatment for ARDS o2 therapy adequate arterial oxygenation without high fio2, cpap or peep therapy to increase frc and to decrease work of breathing titrate poop and fio2 so that fio2 can be reduced below .60, use imv/simv with peep, consider pressure control ventilation
What is myasthenia gravis auto immune response, slow fatigue improves with rest, paralysis mind to ground, positive tensilon test, monitor VC and MIP
What drugs are used to treat myasthenia gravis neostigmine, pyridostigmine, intubation/mech vent short term
What is guillain barre syndrome delayed reaction to viral infection, uri present, acute sudden weakness, ascending paralysis bround to brain
What test is used to determine guillain barre syndrome spinal tap protein in spinal fluid, monitor VC/MIP
What drugs are used to treat guillain barre syndrome steroids, prophylactic antibiotics, mechanical ventilation/trach long term plasmapheresis
What is asthma chronic inflammatory obstructive non contagious airway disease with varying levels of severity and characterized by exacerbations
Mild intermittent asthma patient has symptoms no more than 2 days a week and no more than 2 nights per month,worsening symptoms usually brief
What is the PEF or FEV1 for intermittent asthma >80%
PEF should not vary more than 20% during episodes and between morning and evening readings
What is the treatment for mild intermittent asthma when exacerbations occur recommend a course of systemic corticosteroids
What is mild persistent asthma patient has symptoms more than twice a week during the day but less than once a day and more than 2 nights a month
What is the PEF or FEV1 for mild persistent asthma >80% the PEF can vary between 20-30%
What is the treatment for mild persistent asthma low dose inhaled coricosteroids, may consider cromolyn sodium, leukotriene modifiers, nedocromil or sustained release theophylline
What is moderate persistent asthma symptoms daily and more than one night a week
What is the PEF or FEV1 for moderate persistent asthma PEF >30%,attacks can last for days and affect daily activities
What is the treatment for moderate persistent asthma low to medium dose inhaled corticosteroids, long acting inhaled beta 2 agonists, may consider increasing the inhaled coricosteroid within the medium dose range or use low dose inhaled corticosteroids with leukotriene modifier or theophylline
What is the treatment for moderate persisent asthma severe exacerbation increase the inhaled coricosteroids within the medium dose range, add long acting inhaled beta 2 agonists, consider increasing the inhaled corticosteroids within the medium dose range and adding either a leukotriene modifier or theophylline
What is severe persistent asthma continual daily symptoms with frequent exacerbations at night
What is the PEF or FEV1 for severe persistent asthma <60%, PEF can vary >30%
What is the treatment for severe persistent asthma high dose inhaled corticosteroids with long acting beta 2 agonists, add corticosteroid tablets or syrup, try to reduce the systemic corticosteroids as soon as possible and maintain with the inhaled corticosteroids

Question Answer
4 components of assessment observation, palpation, Percussion auscultation,
Tracheal shift may occur with a pneumothorax. With a right sided pneumothorax, what direction will the trachea go to ? To the opposite side. So it will go to the left (contralateral) side.
Distal enlargement of the phalanges of the hands and feet. Sometimes seen in cardiac, pulm, cancer, and other conditions. Digital clubbing
Sudden awakening during night. It is often associated with CHF. Paroxsysmal noct. dyspnea
Swelling of ankles especially in dependent position Pedal edema
Rt. Heart failure that is due to pulm disease Cor Pulmonale
Breath sounds heard frequently in CHF crackles
3 causes of crackles pulm edema, fibrosis, atelectasis
upper airway adventitious sound, heard esp on inspiration stridor