Question Answer
True or False- The presence of atelectasis is an indication for directed cough. JM True
The inability of reluctance of a patient to change body positions is an indication of which bronchiopulmonary hygiene therapy? JM postural drainage
Name 3 chronic conditions that indicate the need for BPH therapy. JM Cystic Fibrosis, Bronchiectasis, & Chronic Bronchitis
What is the main indication for any BPH therapy? JM difficulty clearing secretions
Name 2 absolute contraindications for postural drainage. JM head/neck injury & active hemorrhage with hemodynamic instability
Would a person who is dehydrated with a poor cough be indicated for BPH therapy? JM Yes
Which BPH therapy could be indicated as part of a routine in patients with CF, bronchiectasis, chronic bronchitis, & spinal injury? JM directed cough
True or False Obtaining a sputum specimen for diagnostic analysis is not an indication of directed cough. Jm false
Name 2 contraindications for PEP. JM ear infection & active hemoptysis
Contraindications for BPH therapy include which of the following: A- recent meals B- hiccups C- depression D- vomiting JM A & D
Burns, wounds, & skin grafts are all contraindications of which BPH therapy? JM percussion/vibration
True or False Poor oxygenation associated with unilateral lung disease would be an indication for BPH therapy. JM True
Question Answer
Boiling point of Oxygen? -183C or -297F @ 1ATM
1 cubic foot of liquid O2 = ? 860 cubic feet of gaseous O2
1 cubic foot of gaseous O2 = ? 28.3L of gas
What is the cylinder volume ofE?G?H?K? E = 22 CU. FT.G = 187 CU. FT.H = 244 CU. FT.K = 275 CU. FT.
What are the colors and uses of medical gases?O2?CO2?He?N2?N2O?He/O2? O2 = Green – TherapyCO2 = Gray – LabHe = Brown – LabN2 = Black – LabN2O = Blue – AnesthesiaHe/O2 = Brown/Green – Therapy
Organizations NFPA? Regulates storage and handling as well as central supply gas and piping systems
Organizations DOT? Regulates cylinder construction, testing and transport
Organizations CGA? Sets all saftely standards ASSS, PISS, DISS
Organizations FDA? Set medical gas purity standards
PISS (Pin Index Safety System) Yoke regulators of smaller cylinders E-AA
DISS (Diameter Index Safety System) Threaded male body to female inlet port, used in central piping and flowmeter outlets
ASSS (American Standard Safety System) Threaded outlet from the stem of large cylinders G,H,K to hex nut of regulator
Thorpe Tubes COMPENSATED, needle distal to float, float will jump upon insertion, read accurately with back pressure
Duraton of Flow Calculation PSIG times the Factor all divided by Flow
Cylinder Factor of E? G? H? E = .28, G = 2.41. H = 3.14
1 LB of liquid O2 converts to how many L gaseous O2? 344L
What are Oxygen concentrators? Electrically powered units that use mloecular sieves containing Zeolite to absorb N2, H2O, and CO2 from air. At ,6L/M, 92-97% delivered
Alveolar Equation PAO2 = FIO2(PB-H2O) – PaCO2/.8If FIO2>.60 eliminate /.8Quick and dirty – 7 x FIO2 – CO2
O2 – Hypoventilation Noted in COPD w/elevated PaCO2 and HCO3, develop hypoxic drive via peripheral chemoreceptors, as PaO2 above 60 mmHg, dive is diminished leading to hypoventilation
Absorption Atelectasis High FIO2> . 50 = Nitrogen washout of alveolar gas. With bronchial obstruction alveolar collapse(atelectasis) may occur as O2 is absorbed in the blood
Oxygen Toxicity Caused by elevated PIO2 = damage to lung tissue, increased free radical, edema and fibrosis
ROP – Retinoparthy of Prematurity Noted in babies, High PaO2> 80mmHg (American Academy of Pediatrics), leads to scarring and blindness
Goals of O2 Therapy 1. Treat Hypoxemia 2. Reduce WOB 3. Reduce myocardial workload as PVR is decreased
Indications for O2 Therapy 1. Documented Hypoxemia = PaO2 < 60mmHg and SaO2 < 90% 2. Suspected Hypoxemia from acute M/I and severe trauma
Clinical Manifestations of Hypoxemia Tachycardia, tachypnea, cyanosis, restlessness, confusion, pulmonary hypertention
Responsive Hypoxia Increase in PaO2 with FIO2 due to V/Q mismatch, use low or high flow O2 device
Refractory Hypoxemia PaO2 demonstrates minimum response with increase FIO2 due to shunting, use PEEP or CPAP to maintain constant airway pressure
Low Flow Systems – Under 15L/M Will not meet pt peak inspitory needs, nasal cannualas – 2-4L, transtracheal O2 cateter, Simple mask – 6-10L, Partial and Non-rebreather masks 12-15L
Air/O2 ratio 100-%(L air)/%-20*, *use 21 if FIO2< .40
Calculate Total Flow Flow x AIR/O2 = total flow
 What is Reservoir Tubing used for? Maintain FIO2, and increase L flow by adding tubing
Question Answer
What is Oxidation? Electron loss
Where does Oxidation occur? Anode
What is reduction? Electron gain
Where does reduction occur? Cathode
Where are Polargraphic analyzers used? Blood gas machines, TcO2(transcutaneous)monitors(Clark electrode), vent circuits, and O2 analyzers
What are the components of a P/G analyzer? Silver anode, Platinum cathode, and KCl solution
What are the components of a GFC (Galvanic fuel cell)? Lead anode, Gold cathode, hydroxyl solution(KOH, or CsOH)
What are the clinical applications of electrochemical analyzers? Use Polargraphic for quick (<30 secs) response time, and GFC for slower (up to 60 secs)
What are theraputic applications of Helium? Lower density gas will decrese turbulence and WOB. Stridor(post extubation), Croup, Foreign body aspiration, and Upper airway masses
What are the diffusion qualites of Heliox? Diffuse faster
What are special conciderations of Heliox? 1. Deliver w/”closed” system -NRB mask, ET tube, NO HOODS 2. Aerosols get better depostion
Flow meter factors for He/Ox? 80/20 mix = Flow x 1.8, 70/30 mix = Flow x 1.6
What are the 2 pricipals of Pulse Oximetry? Spectrophotometry – light absortion = Spectrum, Photoplethysmograpghy – light transmission = Pulse Rate
Red/Infrared ratios? Low ratio = High Sat (1/2 = SpO2 93%), High ratio = Low Sat (2/1 = SpO2 55%)
What are the technical limitations of Pulse Ox? False highs. HbCO (Firemen)carboxy hemoglobin, MHb reads R/IR 1.0 85%SpO2 Both don’t allow Hb to release O2, Nail Polish, Flourescent Lights(babies)
What are the Hyperinflation Pressures? IS, IPPB, and PEP
What is IS? Incentive Spirometry, (-) pleural and aveolar pressure
What is IPPB? Intermittent Positive Pressure Breathing, (+) Inspiration(I) alveolar and pleural pressure
What is PEP? Positive Expiratory Pressure, (+) E alveolar and pleural pressure
What are the Cardiovascular effects of hyperinflation? 1. Decrease venous return, 2. Dercease C.O., 3. Increase PVR, 4. Increase ICP(IntaCranial Pressure)
What is the Clinical application of Hyperinflation? Primary is Tx of atelectasis
What are the target populations for hyperinflation? Neuromuscular disease pts, Post-Op/Surgery
Define IS? Sustained Max Inspiraton via device for >3 secs, 5-10 breaths Q 1-2 hrs
Indications for IS? Atelectasis, Vital Capacity(VC) > 10-15 ml/kg
Contraindication of IS? Uncoroperative pts, VC < 10-15 ml/kg
Hazards of IS? Dizzy, Tired, Hypoxemia if on Mask already
Monitor for IS? Improved breathing sounds, Chest X-ray, Breath hold, V/Flow setting
Indications for IPPB? Atelectasis, Delivery of aerosol meds, VC < 10-15 ml/kg, good breath sound
Contraindicatons of IPPB? Untreated tension pneumothorax
Monitoring of IPPB? Tidal Volume > 1/3 predicted IC(Inspiratory Capacity)
Calculate Vt for IPPB? 1/3 predicted IC x 50ml/KgPatient weighs 80 Kg, Vt = 1/3 (80×50), 4000/3 = 1333ml
Indications for PEP? Atelectasis, SECRETIONS, VC > 10-15 ml/Kg
What are HFCC devices? High Frequency Closed Circuit. Oscillatory from 5-25Hz
One Hz = how many cycles per minute? 60
What are the advantages of HFO (High Freq Oscillatory)? Portable and cheap
What are the HFO devices? Intrapulmonary Percussive Vents(IPV), used for Txs with aerosol, 6-14Hz
What is an MIE(Mechanical Insuffulaton Exsufflation) device? Artificial Cough Machines, Peak Cough < 270 L/M,
What pts use MIE devices? With Neuromuscular problems
Monitor for MIE? Sputum (V and quantities), Improved breath sounds, and chest x-rays
What are ACBT(Airway Clearance Breathing Techniques)? HUFF and AD(Autogenic Drainage)
HUFF Cough? Blow tissue/cotton ball. Active cycle of breathing
AD(Autogenic Drainage)? series of steps include, “unstick”=low lung V, “collect”=Vt, and “evacuate”=high lung Volumes.
Question Answer
What are the 3 evaporation factors? Temperature, Atmospheric Pressure, Surface Area
Calculate Relative Humidity Content(what you measure)/ Max capacity x 100
Maximum Absolute Humidity 44mg/L
Humidity Deficit 44mg/L – what you measure
What size aerosol particles target the upper airways like the larynx, pharynx? 5-20 microns
What size aerosol particles target the lower airways from the trachea to terminal bronchioles? 2-5 microns
What size aerosol particles target the parenchyma know as the gas exchange area? 1-3 microns
What is inertial impaction? Particles >5 microns stay on at bends. Think of the pic of the particles at the bend in the tube.
What factors increase inertial impaction? Turbulent flow, Airway branching, Hi Inspiratory flow > 30L/M
What is Graviational Sedimentation? particles between 1-5 microns. Time increases G.S. with a 10 sec breath hold deposition increases up to 10%
What patient factors affect G.S.? Ventilation Pattern. Hi Insp. Flow, Slow Rate, Large Tidal V, Mouth breathing
Inadequate Humidification results in? Impaired ciliary activity, Impaired mucus flow, Retained Secretions, Infections, Pneumonia
What are the goals of Humidification? Humidify Inspired Gas(Jet Neb), Deliver Meds(MDI), Improve Bronchial Hygiene(Ultrasonic) which thins secretions and promotes cough and expectoration
What are the Hazards of Humidification? Bronchospasm with mucolytic and proteolytic aerosols(Asthmatics)
ANSI Standards for Humidification Devices Minimum level of A.H. to aviod mucosal damage to upper airway is 10mg/L for spontaneous breathing. Pts w/bypassed airways(ET tube, trach tube)minimum 30mg/L
Bubble Humidifier Low Flow Device – Think bubbler in fish tank. Cannula to partial and non rebreather. Output 15-20mg/L
Passover Humidifier used in Vent circuits, Uses Wick or hydrophobic membrane(Membrane). Output 35-50mg/L. Lots of secretions
HME = Heat Moisture Exchanger Pennies. Captures pt exhaled gas and uses it to warm and humidify next inspiration. Uses hydrophobic condenser. Output 20-30mg/L
Nebulization Baffles or plates to decrease particle MMAD
Categories of Nebs Pneumatic(powered by gas) include Jet,SVN, LVN, MDI, DPI. Electric- ultrasonic
What’s the primary goal of Jet Neb? AKA Air entrainment neb Humidify Inspired Gas
What’s the primary goal of SVN? Deliver Meds
What’s the number one factor affecting SVNs? Baffles.
What are the 2 types of LVNs? SPAG and Heart/Hope
SPAG Neb = Small Particle Aerosol Generator Deliver Ribavirin for RSV
Heart/Hope Neb = High output Extended Aerosol Respiratory Therapy Continuous Bronchodilator delivery
MDI Deliver Med
MDI Factors Patient Technique. Use spacers and holding chambers and use flow triggered MDI to reduce oropharyngeal depostion
DPI Breath accuated to Deliver Meds
DPI Factors High Inspiratory Flow – >40 L/M therefore not on infants or pts w/SOB. High Humidity causes Clumping of MEd
What is the primary goal of Ultrasonic? Thin and Mobilize secretions. Outputs as much as 500mg/L. Saturates the airways
Drug Dilution Ex. 1:200. 1gram/200ml H2O = 1000mg/200ml = 5mg/ml
Percent Solution divide mg/ml/10 for % solution or % solution x 10= mg/ml
Autonomic NS Sympathetic – neurotransmitter is norepinephrine. Receptors termed adrenergic. Parasympathetic – transmitter is Acetylcholine and receptor termed cholinergic
Adrenergic Drugs that stim receptors sensitive to norepinephrine
Cholinergic Drugs that stim receptors sensitive to acetylcholine
Anitcholinergic Drugs that block receptors sensitive to acetylcholine
Cholinergic Effects(Parasympathetic) Decrease Heart Rate, Bronchoconstriction, Vasodilation in Pulmonary Bl. Vessels
Alpha Stimulation Pulmonary BL. V. = vasoconstrition
Beta 1 Stim Heart rate increase and contraction
Beta 2 Stim Bronchodilation and vasodilation
Adrenergic Action (Sympathetic) Alpha drugs vasoconstrict to increase BP or decrease mucusal edema. B1 increase HR and Inotropic. B2 = brocho and vaso dilation
Anticholinergic Action (Blocks Para) Bronchodilation, Increase HR, Dry secretions
Catecholamines Racemic Epinephrine is the only one still used. Hits all receptors. Is the quickest.
Noncatecholamines – Quick Onset/Short Duration Alupent- Neb/MDI/Tab
Noncatecholamines – Slower onset(15 min)/Longer Duration Albuterol, Levalbuterol, Formoterol, Salmeterol
Noncatecholamines – Quick Onset(5 min)/Long Duration(8-12 hours) Maxair, Brovana, Tornalate
Adrenergic Side Effects Tachycardia, Tremor, Headache, Insomnia, Nervousness
Anticholinergic Drugs Atrovent, Spirvia
Anticholinergic Side Effects Increase HR, Increase BP, Decrease Secretions
What Mediator Antagonist are Mast Cell Stabilizers? Intal, Tilade
What Mediator Antagonist are Leukotriene Blockers? Accolate, Zyflo, Singulair(most popular)
What do mast cells contain? Histamine and inflammatory mediators
Stim of Leukotriene receptor cause what? Bronchoconstriction, Mucus Secretions, and Release of Inflammatory Cells
What are Glucocorticosteroids used for? Maintenance of Asthma
Steroids Agents Prednisone(Tab), Pulmicort(MDI,DPI)
Steroid Side Effects Thrush, Weak Bones, Immunosuppresion(more pulmonary infection), Peptic Ulcers, Muscle Wasting, Hair, Moon Face, Fat Deposits
What is the device of choice for Wetting Agents? Ultrasonic
Saline Solutions – Use Ultrasonic Neb(USN) Iso(.9%) = Thin secretions, Hypo(<.9%) = Thin, Hyper(>.9%) Sputum induction
What is the only Mucolytic agent? Mucomyst. Disrupts the disulfide bonds in mucus
Mucolytic Side Effects Bronchospasm in Astmatics, Nausea, Smell, Rhinorrhea
Proteolytic Agents Pulmozyme w/special neb. Used in Cystic Fibrosis pts. Digests DNA in purulent solutions
Proteolytic Side Effects Pharyngitis, Laryngitis, Conjuctivitis(Pink Eye)
Question Answer
What is the function of the respiratory system Facilitate the uptake of oxygen,elimination of carbon dioxide and maintain pH of blood.
What is the specific function of the upper respiratory tract Warm, humidify, cleanse inspired air
Dyspnea Difficult or labored breathing – short of breath.
Platypnea Difficulty breathing unless lying flat
Orthopnea Difficulty breathing unless individual is sitting or standing. Upright position to breath
Paroxysmal nocturnal dyspnea Sudden shortness of breath occurring several hours after individual lies down(heart is unable to pump circulatory volume i.e. caused by edematous tissue).
Cheyne-stokes breathing Slow, shallow breathing, which rapidly increases in depth and rate. Crescendo-decrescendo pattern is followed by apnea.
Biot respirations Symptomatic of elevated intracranial pressure and meningitis. Breathing pattern characterized by short bursts of uniform, deep respirations, followed by periods of apnea lasting 10 to 30 seconds.
OLD CART Onset, location, duration, character, associated manifestations, relieving factors, treatment.
ONSET when the problem started
Location where pain is situated, shortness of breath, or other symptoms
Duration Time: length of pain, shortness of breath, or other symptoms
Character Character, quantity and quality of pain, shortness of breath or other symptoms
Associated manifestations the setting in which the pain, shortness of breath, or other symptoms.
Treatment any medication or other remedies that relieve or exacerbate shortness of breath.
What are four techniques used in respiratory assessment Inspection, palpation, percussion, auscultation.
Inspection observe for use of accessory muscles in back, neck and abdomen. Use of these muscles implies increased work of breathing or diaphragm weakness.
Palpation Examiner uses hands to feel for body movement, lumps, masses, and skin characteristics. Palpation can be light or deep.
Percussion Examiner places finger firmly against a body part and strikes that finger with a fingertip from the other hand. Resulting sounds can suggest normal/abnormal sounds.
What are the characteristics of percussion Flat, dull, resonant, hyper-resonant,tympanic.
Auscultation Involves listening to the body sounds with a stethoscope place on bare skin.
What are the two main components of the stethoscope the diaphragm and the bell.
Name the tissue found in the anterior portion of the nasal cavity, oral cavity, orophyarynx and laryngopharynx. Stratified squamous epithelium
What tissue lines the posterior two-thirds of the nasal cavity and tracheobronchial tree. Pseudosratified columnar ciliated epithelium
What cells are found in the bronchioles Simple cuboidal epithelium
What cells are found in the alveoli and pulmoary capillaries that surround the alveoli Simple squamous epithelium
The upper airway consists of the… Nose, oral cavity, pharynx, larynx.
Name the lymphatic tissue of the oropharynx/nasopharynx Palatine tonsil, adenoid, lingual tonsil.
Define and describe nasal flaring Widening of the nostril during respiratory difficulty. Caused by increased airway resistance(asthma). Lungs that are stiffer -pneumonia.
Name the three bony protrusions on the lateral wall of the nasal canal the superior, middle and inferior nasal turbinates
What are the vibrissae The vibrissae function as a filter and are the tracheobronchial tree’s first line of defense.
What is the main function of the turbinates. The turbinates seperate inspired gas into several different airstreams increasing the contact area between inspired air and warm, moist surface of the nasal mucosa.
Otitis media Infection of mucous membranes of the pharynx that spreads through the pharyngotympanic tubes-young children have a shorter tube.
what is the average blood volume for a male 5 to 6 litres
what is the average blood volume for a female 4 to 5 litres
composition of whole blood Plasma 55% Formed elements 45%
Plasma is composed of ….. 91% water, 7% Protein(albumin-57%, globulins-38%, fibrinogen4%, prothrombin1%). Other solutes contain (ions, nutrients, waste products, gases, regulatory substances).
what is the function of blood 1: to transport oxygen to the tissue cells/ carbon dioxide to the lungs; 2: transport nutrients/waste products; 3: transport processed molecules(lactic acid to liver to convert to glucose).4:regulatory hormones.5:pH,osmosis. 6:Temp.7:Defence.8:form clots.
Average RBC count male 5.8 million per mm3
Average RBC count female 4.8 million per mm3
What is hematocrit The percentage of RBCs in relation to total blood volume.
average hematocrit for males and females Males – 45% Females 42 % Healthy newborn 45 to 60%
where are red blood cells produces red bone marrow in spongy bone of the cranium, bodies of vertebrae, ribs, sternum, proximal epiphyses of the humerus/femur. Two million per second
life span of RBC 120 days. Destroyed in spleen and liver
what is hemoglobin Major substance of RBC, occupies one-third of the cell’s volume/accounts for its red colour. Primary function is to transport 02 to the cell and transport carbon dioxide from the tissues to the lungs
what is the primary function of WBCs or leukocytes Protect against invading microorganisms (bacteria, viruses, parasites, toxins and tumor. Removal of dead cells/debris from body.
Name the different types of WBC’s Granulocytes(ben) – basophils, eosinophils, neutrophils. Agranulocytes(LW) – lymphocytes, monocytes.
WBCs Not confined to blood vessels – able to leave through process of diapedesis when needed for immune/inflammatory response – response to chemotaxis. Cells migrate out of blood through to tissue spaces toward damaged cells.
Ameboid movement The WBCs ability to form cytoplasmic extensions that are used to migrate through the tissue spaces toward the damaged cells.
Leukocytosis Overall increase in white cells
Leukopenia Overall decrease in white cells
Differential count of white blood cells Never Let Monkeys Eat Bananas Neutrophils 65% Lymphocytes 25% Monocytes 6% Eosinophils 3% Basophils 1 %
Neutrophils Polymorphoneuclear leukocytes active phagocytic cells. Contain lysosomes which are digestive enzymes that phagocytize invading bacteria
Eosinophils Numerous in tissue lining respiratory and digestive tracts. Destroy protozoa, parasitic worms and release ant inflammatory substances in antigen-antibody reactions. An elevated eosinophil count is commonly seen in asthmatic patients
Basophils Least numerous. Contain Histamine – inflammatory substance that cause vasodilation and atracts other WBCs to inflamed site. and Heparin – inhibits blood clotting. Basophils increase in number in both allergic and inflammatory reactions.
Agranulocytes – Lymphocytes Second most numerous.Found in the lymphoid tissue(nodes) role in immunity. T lymphocytes respond to virus infected cells and tumors. B lymphocytes give rise to plasma cells which produce immunoglobulins – inactivate invading antigens.
Agranulocytes – Monocytes Largest of the WBC. account for 4 to 8% of WBCs. In the tissue they differentiate into highly mobile MACROPHAGE – with a large appetite for bacteria, cell fragments, viral infected cells and dead cells.
Platelets or thrombocytes Smallest of the formed elements. 1:form platelet plugs that seal holes in blood vessels.2: form blood clots-larger tears in vessels. Contain Serotonin – which causes smooth-muscle constriction reducing blood flow.
Plasma Liquid part of blood. 55%total vol. Pale yellow.91% water. 7%(proteins and other solutes)