Question Answer
 1. A 16 year-old patient with a history of asthma has a chest radiograph that indicates bilateral
bibasilar pneumonia. The following results are obtained while the patient is spontaneously breathing room air.pH 7.42 RBC 5 mill/mm3
PaCO2 41 Hb 12 gm/dL
PaO2 57 Hct 40%
SaO2 89% WBC 3200/ mm3
HCO3 24 Temp 37o C
BE +0The respiratory therapist should recommend which of the following?
 Give supplemental oxygen
 2. A 60 year old patient presents to the ER with substernal chest pain. The physician has diagnosed the patient with an MI. Where on the ECG rhythm strip should you find evidence of this?  ST segment
 3. A 65 year old female has the following ABG results:

pH 7.25
PCO2 60
HCO3 25

Based on the given results what is the patient’s status?

Acute respiratory failure
 4. A 75 year old male has the following ABG results:

pH 7.24
PCO2 80
HCO3 32

Based on the given results what is the patient’s status?

 Acute on chronic respiratory failure
 5. Abnormal collection of fluid in the pleural space:  Pleural Effusion
 6. After 1500 ml of pleural fluid have been removed by thoracentesis, the RCP notices the patient has become dyspneic and tachycardic. To further evaluate the patient, the RCP should initially recommend:  a chest x-ray
 7. After coming on a patient with complete obstruction of an oral endotracheal tube, your efforts to relieve the obstruction by moving the patient’s head and neck and deflating the cuff both fail. What should be your next step?  Immediately extubate the patient
 8. After drawing a blood gas, how long should pressure be applied to the puncture site to avoid a hematoma?  Until bleeding stops
 9. After intubation, the exhaled CO2 detection device turns from purple to yellow, what should you do?  Continue to ambu the patient with 100%
 10. After oxygen therapy, the initial treatment of choice for Ventricular fibrillation is?  Defibrillation
 11. After repeated nasotracheal suctioning over 2 days, a patient with retained secretions develops minor bleeding through the nose. Which of the following actions would you recommend?  Stop the bleeding and use a nasopharyngeal airway for access.
 12. Air in the pleural space:  Pneumothorax
 13. Air in the sample affects ABG results in which of the following ways?  raises a low PaO2
 14. Air under pressure in the pleural space:  Tension pneumothorax
 15. All of the following are non-invasive techniques used to assess gas exchange except:  Arterial blood gas
 16. All of the following equipment is needed to properly perform an arterial blood gas ?
  1. alcohol pad
  2. needle capping device
  3. 25 gauge needle
  4. gloves
 17. All of the following indicate an inability to adequately protect the airway except:  wheezing
 18. The appearance of fluid from empyema has an opaque appearance and is called:  exudate fluid
 19. An arterial blood gas is drawn from a 52 year old patient who is in no apparent distress. The arterial blood gas results on room air are: pH 7.58, PCO2 38, PO2 91, and HCO3 24, Based on the following results you would:  question the results of the blood gas analysis
 20. Atrial depolarization occurs in what deflection?  p wave
 21. Based on the following, what is the ABG interpretation for pH= 7.08mmHg, PCO2= 39mm Hg, HCO3= 12 mEq/L?  uncompensated metabolic acidosis
 22. Based on the following, what is the ABG interpretation for pH= 7.25mmHg, PCO2= 70 mm Hg, HCO3= 36 mEq/L?  partially compensated respiratory acidosis
 23. Based on the following, what is the ABG interpretation for pH= 7.36 mmHg, PCO2= 18 mm Hg, HCO3= 13 mEq/L?  compensated metabolic acidosis
 24. Based on the following, what is the ABG interpretation for pH= 7.39 mmHg, PCO2= 42 mm Hg, HCO3= 24.1 mEq/L?  acid base status within normal limits
 25. Based on the following, what is the ABG interpretation for pH= 7.59mmHg, PCO2= 41 mm Hg, HCO3= 38 mEq/L?  uncompensated metabolic alkalosis
 26. Before beginning an intubation procedure, the practitioner should check and confirm the operation of which of the following?
  1. laryngoscope light source
  2. endotracheal tube cuff
  3. suction equipment
  4. cardiac defibrillator
 27. Before the suctioning of a patient, auscultation reveals coarse breath sounds during both inspiration and expiration. After suctioning, the coarseness disappears, but expiratory wheezing is heard over both lung fields. What is most likely the problem?  The patient has hyperactive airways and has developed bronchospasm.
 28. Blood Gas sampling can be drawn by which of the following mechanisms:
  1. indwelling catheter
  2. capillary sample
  3. puncture of radial artery
  4. umbilical artery line
 29.Blood in the pleural space:  Hemothorax
 30.Capillary sampling is primarily used for checking what ABG parameters:  Both PCO2 and PO2
 31. A chest tube is placed anteriorly between the second and third ribs. The tube is probably intended to treat:  pneumothorax
 32. Chest wall puncture for diagnostic or therapeutic purposes:  Thorancentesis
 33. A chronic hypercapnic patient is admitted to the ER. He is receiving 1 LPM O2 via nasal cannula. Arterial blood gas results are as follows: pH 7.36, PCO2 55, PO2 49, HCO3 32, saO2 83%. Based on the following, the RT should recommend which of the following?  Increase O2 to 2LPm
 34. Collateral circulation ensures that if there is damage to the radial artery during a blood gas draw, the hand will receive blood flow from which of the following arteries?  ulnar artery
 35. The collection of bile in the pleural space:  Cholothorax
 36. Compared with the nasal route, the advantages of oral intubation include all of the following except:  less retching and gagging
 37. Compensation for metabolic acidosis occurs through which of the following?  decrease in blood CO2 levels
 38. Complications of fiberoptic bronchoscopy include all of the following except:  hypocapnia
 39. Complications of tracheal suctioning include all of the following except:  hyperinflation
 40. During a thoracentesis, the biopsy needle should be advance until:  fluid can be withdrawn from the area of the pleural space
 41. During cardiopulmonary resuscitation, the ECG monitor displays asystole. Which of the following treatments would be initially indicated for this patient?  Epinephrine 1 mg IV
 42. During cardiopulmonary resuscitation, the respiratory care practitioner pauses and checks the ECG monitor for a cardiac rhythm. The monitor shows a normal sinus rhythm with a rate of 62 bpm. You are unable to palpate a pulse both carotid and femoral. You would recommend to:  Continue CPR
 43. During fiberoptic bronchoscopy, a patient receiving intravenous fentanyl exhibits signs of respiratory depression. Which of the following would you recommend?  Immediately administer naloxone (Narcan).
 44. During fiberoptic bronchoscopy, a patient’s SpO2 drops from 91% to 87%. Which of the following actions would be appropriate?
  1. Apply suction through the scope’s open channel.
  2. Give oxygen through the scope’s open channel
  3. Increase the cannula or mask oxygen flow.
 45.During recovery from resection of an aortic aneurysm, a 65 year old female patient suddenly develops severe substernal chest pain with grave dyspnea. The physician describes the bilateral breath sounds as basilar moist crepiant rales. The patient appears cool, pale, and diaphoretic. Which of the following should the respiratory therapist recommend as part of the initial assessment of this patient?  EKG
 46. During the transport of a patient to CT scan, the chest drainage system becomes cracked and non-functional. The RCP should recommend:  submerge the distal end of the drainage tube approximately 2-3 cm under water
 47. An electrical impulse terminates in what part of the heart?  Purkinje fibers
 48. For which of the following reasons is atropine often used during fiberoptic bronchoscopy?
  1. to dry the patient’s airway
  2. to decrease vagal responses
  3. to provide topical anesthesia
 49. A galvanic oxygen analyzer is being used in a check of the ventilator to measure the delivered FiO2. The set FiO2 is 40%, however the analyzer is reading 32%. Which of the following is the most likely cause of this discrepancy?  The analyzer needs to be calibrated
 50. How long does it take for a COPD patient to achieve a steady state after making an oxygen change?  30 minutes
 51. How often should patients be suctioned?  When physical findings support the need/ prn
 52. Ideally, the distal tip of a properly positioned endotracheal tube (in an adult man) should be positioned about how far above the carina?  2 to 5 cm
 53. If a patient has refractory hypoxemia, what happens to the PaO2 when oxygen is initiated?  PaO2 stays the same
 54. Immediately after insertion of a central line via the subclavian vein an intubated patient becomes dyspneic. The RCP should recommend which of the following diagnostic tests?  chest radiograph
 55. Immediately after insertion of an oral endotracheal tube on an adult, what should you do?
  1. Stabilize it with your right hand.
  2. Inflate the tube cuff.
  3. Provide ventilation or oxygenation.
 56. Impulses through an electrical node normally fires at a rate of how many beats per minute?  60-100 bpm
 57. Impulses through the bradycardic SA node fire at a rate of:  40-60 bpm
 58. In a three-bottle chest drainage system that has been functioning properly, bubbling has increased to continuous bubbling in the waterseal chamber. The most appropriate action to do now would be to:  clamp the chest tube and check for air leaks
 59. In a three chamber chest drainage system, excessive bubbling in the suction chamber indicates:  the wall suction is excessive
 60. In the absence of neck or facial injuries, what is the procedure of choice to establish a patent tracheal airway in an emergency?  orotracheal intubation
 61. In which of the following conditions should fiberoptic bronchoscopy be considered an absolute contraindication unless risk-benefit assessment warrants procedure?
  1. uncorrected bleeding disorders
  2. presence of lung abscess
  3. refractory hypoxemia
  4. unstable hemodynamic status
 62. Key points to consider in planning fiberoptic bronchoscopy include which of the following?
  1. equipment preparation
  2. premedication
  3. airway preparation
  4. monitoring
 63. A main component for treatment of Third Degree AV block is?  Use of a pacemaker
 64. The main purpose of an ABG is to:  analyze gas exchange between the lungs and blood
 65. A major complication associated with a thoracentesis procedure is:  pneumothorax
 66. Membrane covering the surface of the chest wall:  Parietal pleura
 67. Membrane that lines the lung surface:  visceral pleura
 68. The normal duration of a P-R interval is?  Less than 0.20 seconds
 69. The normal duration of a QRS complex is not to exceed?  0.12 seconds
 70. The normal pacemaker of the heart is the:  Sinoatrial node
 71. Other than oxygen if needed, treatment is generally not necessary in this type of rhythm:  First degree AV block
 72. A patient develops sub-Q emphysema following a MVA involving multiple rib fractures. What action should the RCP take in this situation?  Recommend a chest x-ray
 73. A patient exhibits persistent mild hypoxemia after a fiberoptic bronchoscopy procedure. Which of the following would you recommend?  Continue oxygen therapy and reassess in 4 hours.
 74. A patient exhibits persistent stridor after a fiberoptic bronchoscopy procedure. Which of the following would you recommend?  aerosol therapy with racemic epinephrine
 75. A patient is suspected of having a pleural effusion. Which radiographic position is most appropriate to confirm this diagnosis?  Lateral decubitus chest film
 76. A patient should perform a Valsalva maneuver after completely exhaling during chest tube removal. True or False?  True
 77. A patient with a tracheal airway exhibits severe respiratory distress. On quick examination, you notice the complete absence of breath sounds and no gas flowing through the airway. What is most likely the problem?  complete tube obstruction
 78. A patient with a tracheal airway exhibits signs of tube obstruction. Which of the following are possible causes of this obstruction?
  1. The tube cuff has herniated over the tip of the tube.
  2. The tube is obstructed by a mucus plug or secretions.
  3. The tube is kinked, or the patient is biting the tube.
  4. The tube orifice is impinging on the tracheal wall.
 79. A patient with chronic ventilatory failure enters the ER. The following ABG and vitals are obtained while he is breathing room air:

pH 7.42 respirations 24
PaCO2 68 pulse 108
PaO2 58 BP 142/84
HCO3 36 temp 37.5 Celsius
BS- expiratory wheezes bilaterally

The patient is alert and oriented yet complaining of shortness of breath. Which of the following is the correct acid-base interpretation of these results?

 compensated metabolic alkalosis with moderate hypoxemia
 80. A patient with symptomatic bradycardia should receive IV access for what type of medication?  Atropine
 81. The pH electrode of the blood gas analyzer that is used to measure acid/base balance in blood is:  Sanz electrode
 82. The physician has scheduled an elective thoracentesis on a conscious patient with a left pleural effusion. The RCP is preparing the patient. What position should the patient be placed in to facilitate the procedure?  sitting up and leaning forward
 83. A physician is concerned about the potential for tracheal damage due to tube movement in a patient who recently underwent tracheotomy and is now receiving 40% oxygen through a T-tube (Briggs adapter). Which of the following would be the best way to limit tube movement in this patient?  Switch from the T-tube to a tracheostomy collar.
 84. Pleural fluid rich with triglycerides from a ruptured thoracic duct:  Chylothorax
 85. The point at which the S-T segment joins the QRS is called?  J point
 86. The process of testing a new instrument to ensure accuracy and precision by testing samples of know value is called:  performance validation
 87. A pulse oximeter is being used to monitor a patient who was rescued from a fire. The SpO2 is 90%. The patient is unconscious and shows signs of respiratory distress. What additional test should the respiratory care practitioner recommend?  Co-oximetry
 88. Pus-filled pleural effusion:  Empyema
 89. A quick and easy way to ensure adequate collateral circulation to the hand can be done by what procedure?  Modified Allen’s Test
 90. The removable inner cannula commonly incorporated into modern tracheostomy tubes serves which of the following purposes?
  1. aid in routine tube cleaning and tracheostomy care
  2. prevent the tube from slipping into the trachea
  3. provide a patent airway should it become obstructed
 91. The __________ represents the time of transmission of electrical impulse from atrial depolarization to ventricle depolarization.  P-R interval
 92. A sample for arterial blood gas analysis was drawn from a patient receiving room air. Analysis reveals the following, pH 7.45, PCO2 35, PO2 155. Which of the following best explains the results?  An air bubble contaminated the sample
 93. Sampling distal to the segmental bronchi must be performed by doing which of the following?  Bronchoalveolar lavage
 94. Several attempts to insert a central venous catheter into the right subclavian vein of a patient who is being mechanically ventilated have been unsuccessful. Suddenly, the patient’s blood pressure drops, there is a significant increase in peak airway pressure, and breath sounds are absent over the right upper chest. Which of the following should the RCP do at this time?  recommend inserting a chest tube
 95. Soon after endotracheal tube extubation, an adult patient exhibits a high-pitched inspiratory noise, heard without a stethoscope. Which of the following actions would you recommend?  STAT racemic epinephrine aerosol treatment
 96. The spread of electrical impulse through the AV node, bundle of HIS, and the bundle branches occurs during the:  P-R segment
 97. The term Pulseless Electrical Activity refers to a condition where there is?  Electrical activity in the heart, no pulse
 98. Therapeutic indications for fiberoptic bronchoscopy include which of the following?
  1. inspect the airways
  2. retrieve foreign bodies
  3. remove secretions
  4. aid endotracheal intubation
 99. The therapist is obtaining a 12-lead ECG on a 72 year old female and notices artifact on the ECG paper. Upon inspection, the therapist discovers the V2 electrode has fallen off the chest. The proper position of this electrode is:  4th intercostal space, left side of the sternum.
 100. To maintain high positive end-expiratory pressure (PEEP) and high FIO2 when suctioning a mechanically ventilated patient, what would you recommend?  Use a closed-system multiuse suction catheter.
 101. To make oral intubation easier, how should the patient’s head and neck be positioned?  both the neck and head fully extended with neck supported by towel or (both are correct answers) neck flexed with head supported by towel and tilted back
 102. To minimize laryngeal swelling, a physician orders “continuous aerosol therapy” after the extubation of a patient. Which of the following specific approaches would you recommend?  cool mist therapy through a jet nebulizer and aerosol mask
 103. To prevent hypoxemia when suctioning a patient, the respiratory care practitioner should initially do which of the following?  Preoxygenate the patient with 100% oxygen.
 104. Total application time for endotracheal suction in adults should not exceed which of the following?  10 to 15 seconds
 105. The type of capnometer that is a in-line analysis between patient’s airway and ventilator circuit is called:  mainstream
 106. An unresponsive patient is admitted to the ER with the following arterial blood gas results on room air:

pH 7.03
PaCO2 56
PaO2 79
HCO3 14
SaO2 93%

You would interpret the blood gas as follows:

 Uncomensated respiratory and metabolic acidosis with mild hypoxemia.
 107. Ventricle repolarization occurs in what part of a contraction?  ST segment and t wave
 108. Ventricular Rate can be determined by counting the:  R waves
 109. What general condition requires airway management?
  1. airway compromise
  2. respiratory failure
  3. need to protect the airway
 110. What intubation tube would you select for a patient who has just undergone a thoracotomy and requires independent lung ventilation?  Carlen’s tube
 111. What is the approximate normal PO2 for a 72 year old female?  68 mmHg
 112. What is the average depth of proper nasal endotracheal tube insertion in adult patient?  28 cm from the naris
 113. What is the average distance from the tip of a properly positioned oral endotracheal tube to the lipline of an adult patient?  20 to 24 cm
 114. What is the maximum amount of time you should allow to expire before icing a blood gas sample?  15 minutes
 115. What is the maximum recommended value for tracheal tube cuff pressures?  25 cmH2O
 116. What is the maximum time a blood gas sample maintains accuracy after placing the sample on ice?  60 minutes
 117. What is the measurement of CO2 in expired respiratory gases called?  Capnometry
 118. What is the most common complication of suctioning?  Hypoxemia
 119. What is the normal arterial blood CO2 range?  35-45 mmHg
 120. What is the normal arterial blood pH range?  7.35 to 7.45
 121. What is the normal range of negative pressure to use when suctioning an adult patient?  -100 to -120 mm Hg
 122. What is the normal range of negative pressure to use when suctioning children?  -80 to -100 mm Hg
 123. What is the primary indication for tracheal suctioning?  retention of secretions
 124. What is the primary indication for tracheostomy?  when a patient has a long-term need for an artificial airway
 125. What is the primary purpose of a cuff on an artificial tracheal airway?  seal off and protect the lower airway
 126. What is the purpose of an endotracheal tube stylet?  adds rigidity and shape to ease insertion
 127. What is the purpose of a tracheostomy tube obturator?  minimize trauma to the tracheal mucosal during insertion
 128. What is the purpose of the additional side port (Murphy eye) on most modern endotracheal tubes?  ensure gas flow if the main port is blocked
 129. What is the purpose of the pilot balloon on an endotracheal or a tracheostomy tube?  monitor cuff status and pressure
 130. What is the standard size for endotracheal or tracheostomy tube adapters?  15 mm external diameter
 131. What should be the maximum time devoted to any intubation attempt?  30 seconds
 132. What size endotracheal tube would you select to intubate an adult female?  8 mm
 133. What size endotracheal tube would you select to intubate a neonate weighing 1500 g?  2.5 to 3.0 mm
 134. When checking for proper placement of an endotracheal tube in an adult patient on chest radiograph, it is noted that the distal tip of the tube is 2 cm above the carina. Which of the following actions would you recommend?  Withdraw the tube by 2 cm (using tube markings as a guide)
 135. When checking for proper placement of an endotracheal tube or a tracheostomy tube on a chest radiograph, how far above the carina should the distal tip of the tube be positioned?  5 cm
 136. When monitoring PETCO2 from a capnometer, an increase in the capnograph would be indicative of:  decrease in ventilation
 137. When palpating a trauma victim’s chest the RCP observes that a portion of the chest rises during expiration and falls during inspiration. Which of the following is the most likely cause?  Flail chest
 138. When placing a chest tube for drainage of a pleural effusion, which of the following sites is correct for tube insertion?  midaxillary in the 5th intercostal space
 139. When reviewing a patient’s lab data you notice the following: pH 7.50 mmHg, PCO2 25 mmHg, HCO3 24 mEq/L. Based on the given data, what is your conclusion of the patients status?  The patient is hyperventilating
 140. When using a bulb-type esophageal detection device (EDD) during an intubation attempt, how do you know that the endotracheal tube is in the esophagus?  The bulb fails to reexpand upon release
 141. When would the RCP be most concerned about good arterialization of blood gas site?  When doing a capillary heel stick
 142. Which of the following bedside methods can absolutely confirm proper endotracheal tube position in the trachea?  fiberoptic bronchoscopy
 143. Which of the following can help to minimize the likelihood of mucosal trauma during suctioning?
  1. Use as large a catheter as possible.
  2. Rotate the catheter while withdrawing.
  3. Use as rigid a catheter as possible.
  4. Limit the amount of negative pressure.
 144. Which of the following clinical findings would you expect in a compensated respiratory acidosis?
  1. elevated HCO3
  2. pH < 7.35
  3. CO2 elevation
  4. pH 7.35-7.45
 145. Which of the following conditions require emergency tracheal intubation?
  1. upper airway or laryngeal edema
  2. loss of protective reflexes
  3. cardiopulmonary arrest
  4. traumatic upper airway obstruction
 146. Which of the following correctly describes the minimal leak technique procedure used to prevent tracheal necrosis?  fully inflate cuff then withdraw air until a slight leak is heard while auscultation the neck
 147. Which of the following describes the correct procedure for a Modified Allen’s test?  Compress both the radial and ulnar arteries, then release the ulnar artery.
 148. Which of the following drugs can be used to prevent bleeding during fiberoptic bronchoscopy?
  1. epinephrine
  2. atropine
  3. cocaine
 149. Which of the following equipment is NOT needed to perform nasotracheal suctioning?  laryngoscope with MacIntosh and Miller blades
 150. Which of the following equipment would you gather before assisting in extubation of a patient?
  1. suctioning apparatus
  2. oxygen or aerosol therapy equipment
  3. manual resuscitator and mask
  4. nebulizer with racemic epinephrine
  5. intubation tray
 151. Which of the following features incorporated into most modern endotracheal tubes assist in verifying proper tube placement?
  1. length markings on the curved body of the tube
  2. imbedded radiopaque indicator near the tube tip
  3. additional side port (Murphy eye) near the tube tip
 152. Which of the following indicates the presence of a pneumothorax on a chest x-ray?  a dark area with no lung markings
 153. Which of the following is a correct procedure to ensure accurate results of an analyzer?  (all the above) analyze O2 at closest to patient’s mouth, calibrate analyzer to 100%O2, calibrate analyzer to 21% O2
 154. Which of the following is/are complications associated with an Arterial Blood Gas puncture?
  1. embolus
  2. vasovagal response
  3. arteriospasm
  4. hematoma
 155. Which of the following is/are indications for an arterial blood gas?
  1. cyanosis
  2. mild use of accessory muscles
  3. CPR
  4. Unexplained dyspnea
 156. Which of the following is a type of oxygen analyzer utilizes the polarographic electrochemical property?  Clark
 157. Which of the following is the site of choice for an arterial blood gas?  radial artery
 158. Which of the following methods should be used to clean the bronchoscope?  Use alkaline glutaraldehyde
 159. Which of the following statements are FALSE about methods used to displace the epiglottis during oral intubation?  Levering the laryngoscope against the teeth can aid displacement.
 160. Which of the following statements are true concerning capillary blood gas sampling versus arterial blood gas analysis?  Capillary PO2 will be lower than the arterial PO2.
 161. Which of the following types of artificial airways are inserted through the larynx?
  1. pharyngeal airways
  2. tracheostomy tubes
  3. nasotracheal tubes
  4. orotracheal tubes
 162. While checking a crash cart for intubation equipment, you find the following: suction equipment, oxygen apparatus, two laryngoscopes and assorted blades, five tubes, Magill forceps, tape, lubricating gel, and local anesthetic. What is missing?
  1. obturator
  2. syringe(s)
  3. resuscitator bag or mask
  4. tube stylet
 163. While checking a Miller and a MacIntosh blade on an intubation tray during an emergency intubation, you find that the Miller blade “lights” but the MacIntosh blade does not. What should you do now?  Check and tighten the bulb in the MacIntosh blade.
 164. While suctioning a patient, you observe an abrupt change in the electrocardiogram wave form being displayed on the cardiac monitor. Which of the following actions would be most appropriate?  Stop suctioning and immediately administer oxygen.
 165. Why is the radial artery the preferred site for arterial blood sampling?
  1. It is near the surface and easy to palpate and stabilize.
  2. The ulnar artery normally provides good collateral circulation.
  3. The radial artery is not near any large veins.
 166. With atrial flutter and atrial fibrillation, the key consideration is to treat the?  atrial rate
 167. You are about to suction a 10-year-old patient who has a 6-mm (internal diameter) endotracheal tube in place. What is the maximum size of catheter that you would use in this case?  10 Fr
 168.You are about to suction a female patient who has an 8-mm (internal diameter) endotracheal tube in place. What is the maximum size of catheter you would use in this case?  14 Fr
 169.You are assisting a physician in the emergency care of a patient with a maxillofacial injury who will require short-term ventilatory support. Which of the following airway approaches would you recommend?  Intubate via the nasal route.

Question Answer
High blood pressure or head trauma would be a ______ of placing a pt in a head down position. Contraindication
What rules should always be followed when giving CPT? Never just after meals, watch pt’s face, furthest bed railing up
Prone position w/ foot of bed elevated drains what segments/lobes? Posterior basal & lower
Percussive Therapy is best described as: Cupped hands trapping air as hand strikes pt’s chest
Splinting is: Support of incision during coughing to ease pain
Postural draining typically indicated with: Pneumonia
Hazards of postural drainage: Increased intracranial pressure, transient hypoxemia, & acute airway obstruction
How many segments in the R & L lungs? 10 & 8
Supine position, pillow under knees, w/ foot of bed slightly elevated drains what segment/lobe? Anterior basal, lower
Pt laying 1/4 turn from prone w/ a pillow between legs, draining which segment/lobe? Lateral, lower
Prone w/ a pillow under pt’s stomach & foot of bed elevated, draining which segment/lobe? Posterior basal, lower
CPT does not treat: Plural abscess
Race Epi (what,dose) Bronchodilator(rescue drug),0.25-0.5ml
Mucomyst (what,dose) Mucolytic, reduce mucus volume & viscocity, 10% recomm. but 20% also avail., give w/ bronchodilator, stinks, don’t give to nauseated pts, short-term use
Atrovent(ipratropium bromide) (what, dose) Anticholinergic, prevent constriction in larger intermediate airways, SVN: 0.5mg w/ 2-3ml saline, MDI: 18ug/puff – 2 puffs QID
Combivent(ipratropium bromide & albuterol sulfate) (what, dose) Anticholinergic(larger airways) & sympathomimetic(smaller/lower airways), MDI: 18ug ipratropium 90ug albuterol, not for pts w/ soy or peanut allergies
Advair(fluticasone & salmeterol) (what, dose) Corticosteroid & sympathomimetic, DPI Discus or MDI: 100/250/500ug fluticasone 50ug salmeterol/puff (1 BID)
Xopenex(levalbuterol) (what, dose) Sympathomimetic, smaller/lower airways SVN: 0.63/1.25mg w/ 3ml saline, MDI: 45ug/puff
Pulmozyme(dornase alpha) (what, dose) Proteolytic, thin infectious mucus, 2.5mg ampoule
Spiriva(tiotropium bromide) (what, dose) Anticholinergic, larger airways, DPI: 18ug/capsule (QD)
Asepsis Free from infection
Aseptic technique Methods used to prevent contamination
Colonization Presence & growth of microbes in a host
Disinfection Complete destruction of vegetative microorganisms – not spores
Gram-negative Bacteria that DO NOT retain their basic stain after alcohol wash
Gram-positive Bacteria that DO retain their basic stain after alcohol wash
Nosocomial infection Hospital acquired infection
Pathogenic Disease producing
Pseudomonis aeruginosa Gram negative bacilli known for rapid appearance in water reservoirs (ex: nebs)
Sterilization Process that results in the absence of living microorganisms – includes spores
Sterile To be absent of living microorganisms – includes spores
Ziehl-Neelsen stain(AFB) Acid-fast stain used to identify acid-fast organisms
Dry Heat method Sterilize, 160-180C, 2hrs, only glass & metals
Ethylene Oxide (ETO) method Sterilize, 50-56C, 30-60% humidity, 3-4hrs, items must be dry, kills by alkylation, mix w/ 10-15% CO2 otherwise explosive, don’t ETO PVC, aerate plastics up to 12hrs.
Glutaraldehyde method Alk form 10mins disinfection – 10hrs for sterilization, Acid form 20mins disinfection – if heated to 60C will sterilize in 1 hr, denatures proteins, very irritating
Quaternary method Disinfectant, bactericidal activity is limited
Gamma Radiation method Sterilize, very effective, expensive, requires extensive facility & equipment
Ultraviolet method Limited use, kills most – not all – bacteria
Betadine(iodophor) Disinfectant, less irritating than iodine though less bactericidal
Isopropyl alcohol Disinfectant
Output Sampling surveillance Test in-use or cleaned equip, colony counts, quantitative, amounts & types compared to ambient air, excessive = positive
Rinse Sampling surveillance Monitor effectiveness of process method, sloshed in sterile broth, broth incubated, quantitative, sensitive to growth
Swab Sampling surveillance Monitor in-use equip, sterile swab on single location, swab inoculate auger plate or broth for incubation, qualitative *most common method
Glutaraldehyde requires what to be activated? NaHCO3
Steam autoclaving used what level of pressure? 15psi
Autoclave & glutaraldehyde are effective against? Tuberculosis organisms
Autoclave & ETO are effective in killing? Spores
What older bronchodilator has more cardiovascular effects? Metaprel (metaproterenol or alupent)
Hypoventilation can be caused by? High FiO2 delivered to CO2 retainer
What happens to FiO2 if resistance builds up in a venturi device? Increases
IPPB breathing issues Breathing pattern unnatural, pt should relax & allow vent to fill lungs, exhalation passive
IPPB sensitivity Set auto-trigger, then slowly decrease until pt able to trigger easily
IPPB hazards/complications Hypocapnea, hyperventilation, decreased CO, increased ICP, pneumothorax
After reviewing the physician’s order & the CXR, what next would best help determine where CPT should be concentrated? Ausculate & percuss
CPT/PD contraindications Cardiovascular instability, undrained empyema, lung abscess, hemoptysis
High Flow devices Air Entrainment Mask (venti mask)
Low Flow devices Nasal cannula, simple O2 mask, partial re-breathing mask, non-rebreather
Suction pressure should not exceed 120 when end of suction tube occluded
Autoclave Sterilization, 15psi @ 121C for 15 min, very effective, limited use on certain materials due to high heat

1. Study CPT positions and what area of the lung is being drained

2. Normal humidity levels: *Under normal conditions with air- 43.9 (44) mg/L absolute humidity *Look at Ch. 6 in Egan’s

3. Hazards of Oxygen therapy: *O2 toxicity *Absorption Atelectasis *O2 induced hypoventilation *ROP(Retinopathy of prematurity)

4. Indication of helium therapy: *Treat obstructive disorders *Decrease respiratory rate *The level of dyspnea *The need for intubation and mechanical ventilation in patients with reversible obstructive disorders *Asthma *COPD *Croup **Always mix with at least 20% O2

5. Signs of right heart failure: *Increased venous distention *Distention of the external jugular vein *Shortness of breath *Peripheral edema *Fast heart rate

6. Abnormal breathing patterns: *Eupnea- normal breathing *Hypopnea- shallow breathing, RR slower *Bradypnea-slow breathing, RR <12 *Tachypnea- rapid breathing, RR >20 *Kussmaul’s- rapid, large breaths, increased tidal volume *Cheyne-Stokes-waxing and waning tidal volumes *Biot’s- unpredictably variable, periods of apnea between breaths *Apnea- cessation of breathing at the end of exhalation

7. Signs of Inadequate humidity-thickness of secretions or drying of the mucous membrane

8. Assessment of orientation- Orientation to time, place, person, and emotional state

9. Causes of tachycardia: *pulse rate exceeds 100 beats/min *exercise *fear *anxiety *low blood pressure *anemia *fever *reduced arterial blood O2 levels *certain medications

10. Abnormal and normal blood pressure terminology: *Normal BP 120/80 mmHg *Hypotension-systolic BP of less than 80 mmHg *Hypertension-systolic BP of 140 mmHg or greater or a diastolic BP of 90 mmHg or greater or both

11. Signs of respiratory distress: *tachypnea *refraction *grunting *nasal flaring *cyanosis *decreased breath sounds

12. Spinal deformities: *Kyphosis- exaggerated AP curvature of the upper portion of the spine *Lordosis-exaggerated AP curvature of the lower portion of the spine *Scoliosis- either a right or left lateral curvature of the spine *Kyphoscoliosis- either a right or left lateral curvature combined with an AP curvature of the spine

13. CPR- Chapter 11 in Comprehensive Respiratory Therapist Exam Review book P. 321

14. Breath sounds- administer therapy based on breath sounds (wheezing, rales, rhonchi, stridor (mild and severe stridor) *Look in chapter 5 in Patient Assessment book

15. Diseases characterized by chronic cough: *COPD *asthma *allergic rhinitis *GERD

16. Two Assessment questions concerning breath sounds, chest expansion, and vocal fremitus

17. Test to diagnose active TB *TB skin test *chest radiograph *sputum culture *blood test

18. Obtaining a pulse rate (technique) *The radial artery is the most common site for evaluation of the pulse. The patient’s arm and wrist should be relaxed, with the hand at or below heart level. The pads of the examiner’s index and middle fingers are placed lightly over the patient’s pulse point and then compress until the max pulse is felt. The rhythm and strength of pulse are evaluated, the pulse rate is evaluated, and then the pulse rate is counted. When the pulse is regular, the rate should be counted for 15 seconds and then multiplied by 4 or counted for 30 seconds and multiplied by 2. Pulse can also be felt at carotid, femoral, and brachial

19. Troubleshooting venturi setups: *The performance of all air entrainment devices is affected by downstream resistance. The result can be inaccurate FIO2 that makes delivery of a low O2 concentration with air-entrainment nebulizer

20. Troubleshooting IPPB therapy: *Large negative pressure swings early in inspiration indicate incorrect sensitivity or trigger setting, the RT should increase the sensitivity or alter the trigger level *If system pressure decreases after inspiration begins, the problem is too low a flow. The RT should increase the flow *If there is a leak around the mask, a flanged mouthpiece may be needed. *Also, refer to handout titled “IPPB Parameters”

21. Hazards of O2 on COPD patients: *The patient could hyperventilate and knock out their hypoxic drive

22. Ultrasonic (description and when to use): *A USN is an electrically powered device that uses a piezoelectric crystal to generate aerosol. This crystal transducer converts radio waves into high-frequency mechanical vibrations. These vibrations are transmitted to a liquid surface, where the intense mechanical energy creates a cavitation in the liquid, forming a standing wave, or “geyser” which sheds aerosol droplets. The frequency determines the aerosol particle size and the signal amplitude determines the amount of aerosol produced. Small volume USNs have been used to administer undiluted bronchodilators to patients with severe bronchospasm. USNs are used to mobilize secretions.

23. Humidity devices- select appropriate devices for equipment, when to change from HME to heated humidifiers

24. Indications and goals for IPPB therapy: *Goals: -To reduce air trapping in patients with emphysema, bronchitis, and asthma -To prevent or reverse atelectasis -To help mobilize secretion in patients older than 5 years who have CF, chronic bronchitis, bronchiectasis,and bronchiolitis -To maximize the delivery of aerosolized medication; such as bronchodilators *Indications: -Increased work of breathing -hypoventilation -inadequate cough -increased airway resistance -atelectasis -pulmonary edema

25. Therapy to prevent atelectasis (conscious and unconscious patient) *deep breathing/directed cough *Incentive spirometry *CPAP *PEP *IPPB

26. Objectives of oxygen therapy *Correct documented or suspected acute hypoxemia *decrease symptoms associated with chronic hypoxemia *decrease the workload hypoxemia imposes on the cardiopulmonary system

27. Choose appropriate oxygen therapy for patients (high or low flow systems based on patient characteristics and symptoms

28. Disadvantages of simple oxygen mask *Uncomfortable *must be removed for eating *prevents radiant heat loss *blocks vomitus in unconscious patients

29. Hazards of ultrasonic therapy *Bronchospasm and to assess bronchial hyperactivity

30. Hazards and side effects of IPPB therapy -pneumothorax -barotrauma -increased airway resistance from a bronchoplastic reaction to the positive pressure or an adverse reaction to a medication -hyperoxia when 100%O2 is delivered to the patient -secretions may become impacted when the inhaled gas is not humidified adequately -nosocomial infection -decreased venous return -increased ventilation-to-perfusion mismatch -This may worsen hypoxemia, hyperventilation, and psychologic dependence. -This may be seen in the long-term care of patients who do not want to switch to another method of taking inhaled medications, hypocarbia, hemoptysis, gastric distention, air trapping, auto-PEEP, or over-distended alveoli.

31. Identification of medical gas cylinder contents -Oxygen: green -Air: yellow -Helium: brown -CO2: gray -Ethylene: red -Cyclopropane: orange -Nitrous oxide: blue -Nitrogen- black -CO2/O2: gray/green -Helium/O2: brown/green -Nitrogen/O2: black/green

32. Bourdon device- indications for use -As with a flow restrictor, gravity does not affect a Bourdon gauge. The bourdon gauge is the best choice when a flowmeter cannot be maintained in an upright position. This situation is common when a patient is being transported with a portable O2 source.

33. Troubleshooting bourdon device when exposed to back pressure -If downstream pressure is increased, the gauge reading is falsely higher than the actual delivered flow. A user who needs accurate flow when using a device that creates high resistance, should not select a Bourdon gauge. A compensated Thorpe tube should be used instead.

34. SMI techniques (how to instruct patients) -The RT should set an initial goal that is attainable to the patient yet requires moderate effort. Patient should breathe out completely until there is no more air. The patient should be instructed to inspire slowly and deeply to maximize the distribution of ventilation (correct technique calls for diaphragmatic breathing at slow to moderate inspiratory flows). The RT instructs the patient to sustain his or her maximal inspiratory effort for 5 to 10 seconds (breath hold). A normal exhalation should follow the breath hold and the patient should be given the opportunity to rest as long as needed before the next SMI maneuver. 10 reps are performed at a time.

35. Determine effectiveness of SMI therapy (Sustained maximal improvement or incentive spirometry) -absence of or improvement in signs of atelectasis -decreased RR -resolution of fever -normal pulse rate -absence of crackles or presence of or improvement in previously absent or diminished breath sounds -normal chest radiograph
-improved PaO2 and decreased alveolar-arterial O2 tension gradient -increased VC and peak expiratory flows -return of FRC or VC to preoperative values, in absence of lung resection -improved inspiratory muscle performance (attainment of preoperative flow and volume levels, increased FRC)

36. Complications and side effects of mask CPAP

37. Criteria for effective CPAP -Improvement in breath sounds, improvement of vital signs, resolution of abnormal radiograph findings, and restoration of normal oxygen all would indicate that the therapy has achieved its goals. -Patients must be able to maintain adequate excretion of CO2 on their own if the therapy is to be successful. Tight seal must be maintained to keep pressure levels above atmospheric levels.

38. CPT- when to modify positions *Trendelenburg is contraindicated in: -ICP > 20 -uncontrolled hypertension -distended abdomen -esophageal surgery -recent gross hemoptysis -risk of aspiration *Reverse Trendelenburg: -Hypotensive or receiving vasoactive medicine *Do not perform CPT on: -head and neck injury -active hemorrhage -ICP >20 -recent spinal surgery -emphysema -bronchopleural fistula -pulmonary edema from CHF -large pleural effusions -fractured ribs -surgical wounds

39. CPT- percussion and vibration techniques -Both involve CPT- percussion and vibration techniques -Both involve application of mechanical energy to the chest wall by the use of either hands or various electrical or pneumatic devices. Percussion should help loosen secretions from the tracheobronchial tree, making them easier to remove by coughing or suctioning. Vibration should aid movement of secretions toward the central airways during exhalation.

40. Therapy to prevent inspissated secretions -good hydration -good coughing -suctioning -PEP -CPT -turning immobile patients

41. Definition of a regulator -combination of a reducing valve and flowmeter (ex: Bourdon gauge)

42. Troubleshooting cannulas and flowmeters when obstructed or when leaks are present -Obstruction: check for tube kinking or replace nasal cannula as needed -Leak: check that tubing is connected to flowmeter and flowmeter is turned on and connected to wall outlet properly. Check to verify no cracks/dysfunction in flowmeter

43. Troubleshooting a FiO2 analyzer to measure O2 percent (Galvanic or polarographic analyzer) -Reading will be wrong if patient has poor circulation at site of reading (hypothermic, hypotensive, or receiving vasoconstricting medicine) -weak pulse -motion artifact affects reading -artificial or painted nails *Polarographic- battery operated *Problems: Replace battery and try again. If doesn’t help, replace sensor. If still not working, replace with another analyzer

44. Select an O2 analyzer for continuous monitoring -transcutaneous monitor (Clark electrode)

45. Troubleshooting a non-rebreathing mask -Most common problem is a leak around the mask -Reservoir bag collapses on inspiration = flow not set high enough

46. IPPB controls (pressure, sensitivity, and flow *Sensitivity: how easily it triggers on -Normal = -1 to -2 (increase = more sensitive) *Flow: inspiratory time -decreased flow = longer I-time -Increased flow = shorter I-time *Ideally the flow should result in steady rise in the pressure up to the preset max pressure. (Reduce flow if pressure rises too quickly) Increase flow if the pressure wavers high and lower; this indicates the patient is breathing in faster than the gas is being delivered. *Anxious Patients may initially need a fast flow *Pressure: how forceful a breath a patient gets (may need higher pressure with noncompliant lung. Ex: atelectasis)

47. Indications of CPT -to mobilize retained secretions -atelectasis known or is believed to be caused by mucus plug -patient diagnosed with CF -bronchiectasis -a cavitating lung disease

48. Troubleshooting flowmeters *Pressure uncompensated: read lower flow than actually delivered when faced with back pressure *Bourdon gauge: read higher than actually delivered when faced with back pressure *Pressure compensated: accurately indicates flow despite back pressure (Thorpe) *Choose a pressure compensated flowmeter in all situations except during patient transport (Bourdon) *Do not use any flowmeter that does not give an accurate reading

49. Troubleshooting aerosol nebulizer systems when FiO2s are different from settings

50. Aerosol drug therapy- optimal particle size for alveolar and upper airway deposition -Alveolar: 1 to 3 microns -Upper airway: 5 to 10 microns

51. Differentiate between high and low flow O2 delivery devices and know examples of each. -Low flow: FiO2 is variable. Example: reservoir, simple mask, partial rebreather, non-rebreather, nasal cannula -High flow: provides full inspiratory flow demand, FiO2 stable Examples: AEM (Venturi), high flow nasal cannula, air entrainment neb, blending system

52. One question about sterilization/disinfection method *Sterilization: disassemble, use hot water to wash equipment in detergent solution, place in acetic acid (white vinegar) for 60 min, rinse with hot water following soak *Disinfection: steam autoclave (15 min), dry heat, Ethylene oxide gas, Glutaraidehyide solutions

53. Airway care and suctioning: -selection of airway to prevent obstruction of tongue for conscious patient: a nasopharyngeal airway -selection of airway for mechanical vent: endotracheal tube, can use oropharyngeal in intubated patients as bite block to prevent biting ETT or nasopharyngeal for frequent suctioning -disposable device used to confirm proper tube placement after an intubation: ET CO2 detector (capnometer) -cause of bradycardia during suctioning procedure: Vagus or Vagal nerve stimulation -Selection of device needed to obtain sputum sample: Lukens trap

54. Calculations: -calculate total flow from air-entrainment devices -air to oxygen ratio -cylinder duration -calculate lbs to kg -approximate FiO2 from liter flow when using a cannula -be able to use VC and IC values to determine IPPB or IS therapy for post-op patients

Question Answer
what are tracheal breath sounds? high pitched, loud intensity sounds heard over the trachea
what are bronchovescicular breath sounds? moderate pitch, moderate sound, heard around upper half of sternum and between the scapulae.
what are the vesicular breath sounds? low pitch, soft intensity and heard in the peripheral lung areas
what is stridor? loud, high pitched sound that can sometimes be heard w/o at stethoscope. it is a sign of obstruction and heard mostly on inspiration.
what are discontinuous breath sounds? breath sounds that are intermittent, crackling, or bubbling on short duration.
In a diagram of normal breath sounds, what does the thickness of the stroke represent? the intensity
in a diagram of normal breath sounds, what does the angle represent? the pitch
when one hears crackles, what is going on in the airways? excessive secretions or fluid in the airways OR collapse airways that are popping open during inspiration
in what disease processes can you hear polyphonic wheezing? anytime multiple airways are obstructed eg asthma, bronchitis and CHF
what is pleural friction rub? creaking or grating sound (sounds leathery) that occurs when the pleural surfaces become inflamed and the roughened edges rub together during breathing. usually localized to a certain site of the chest wall.
what is bronchophony? an increase in the intensity and clarity of vocal resonance produced by enhanced transmission of vocal vibrations.
what does bronchophony indicate? inc lung tissue density (eg consolidation in pneumonia)
what is the possible lung mechanism behind fine crackles? sudden opening of peripheral airways
when are fine crackles usually heard? late inspiratory
what disease processes are fine crackles associated with? atelectasis, fibrosis, pulmo edema
what is biot’s breathing like and what disease process does it indicate? irregular with periods of apnea. (increased ICP)
what is kussmaul breathing and what disease process does it indicate? deep and fast, like panting. (metabolic acidosis)
what is asthmatic breathing like and what disease process does it indicate? prolonged expiratory phase. (obstructive pulmonary disease)
what is cheyne’stokes breathing and what disease process does it indicate? shallow breathing increases depth and rate followed by a period of apnea. Regular. (CNS problem, CHF)
what is apneustic breathing and what disease process does it indicate? long inspiration, like a sigh. (brain stem injury)
what is paradoxical breathing and what does it indicate? chest wall collapses or moves in while abdomen moves out. associated with respiratory muscle fatigue.
what is apnea and what can cause it? no breathing. (Arrest, complete airway obstruction)
where is the PMI (point of max impulse-of heart)? mid-clavicular line 5th intercostals space
PMI shifts towards/away from lobal collapse? toward
PMI shifts towards/away from pneumothorax? away
what is a quiet SI or S2 sound indicative of? Hyperinflation, poor CO
what is ascites especially associated with? liver cancer, liver cirrohsis, and other cancers
hepatomegaly can be sign of what? right sided heart failure
what is clubbing associated with? Clubbing-chronic long standing hypoxemia, lung cancers, infiltrative/interstitial lung disease, CHD, liver disease, inflammatory bowel disease
what is pedal edema? swelling of lower extremities due to inc in the hydrostatic pressure of the venous system.
what disease process is pedal edema associated with? left and right heart failure.
what is blanching? skin that is white with spots of red
what does blanching of skin indicate? inadequate perfusion, possible lack of arterial blood flow
what is cellulitis? inflammation of soft tissue in the extremity
what disease process is cellulitis associated with? heart failure or obesity or lung disease
what are the four parts of the treatment plan and evaluation? oxygenation, ventilation, airway management and secretion management
what is massive hemoptysis? more than 300 ml in a 24 hour period
how long is a normal PR interval on an ECG? .12 to .20 seconds or 3-5 small boxes
what is going on in the heart during the P wave? Atrial Conduction
what is going on in the heart during the QRS complex? Ventricular Conduction
what is going on in the heart during the ST segment? Time between left ventricular depolarization and repolarization
what is going on in the heart during the T wave? Repolarization
on the ECG grid, what does the vertical axis mean? mV (volts)
on the ECG grid, what does the horizontal axis mean? seconds
on the ECG grid, what does one large vertical box mean? 5 mm or .5 mV
on the ECG grid, what does one large horizontal box mean? .2 sec (.04 per each small box)
what is the normal length of a QRS complex? less than 0.12 sec (3 small blocks)
what is the six second rule in counting heart rate on the ECG? Measure the number of R waves or beats in a six second period then multiply by 10
what is the block rule in counting heart rate on the ECG? Count the number of large (0.2 sec) blocks between R waves
what is the order of heart rate in counting the heart rate for block rule? 300 (1 block=.2), 150 (2 blocks), 100,75,60,50
what happens during supraventricular tachy? ectopic focus above the ventricles,HR around 150, electrical pulses from av node have gone a bit crazy, can deteriorate into v tach or v fib.
what would you give lidocaine for during an arrhythmia? to dec mycocardia irritability
what would you give nitroglycerine for during an arrhythmia? potent vasodilator
what are colloids? consist of large molecules that attract and hold water
what does tonicity mean? describes how much osmotic pressure is exerted by a solution
what is the tonicity of average body cell fluid? .9%, is isotonic to .9% NaCL solution
what does hypertonic mean? solution more than .9%
what does a CBC lab test mean? complete blood count test-provides detailed description of WBCs, RBCs and platelets
what is leukocytosis? elevation of the WBC count
what is leukopenia? WBC count below normal
what are common causes of leukopenia? bone marrow disease, chemo and radiation therapy for cancer
What is normal WBC count? 4500 to 11,500 mm3
what is the percentage of neutrophils in the WBC count? 40% to 75%
what is the absolute count of neutrophils? 1800 to 7500
what are the causes for an abnormality in neutrophil count? increases due to bacteria infection and trauma, reduced w bone marrow diseases
what is the percentage of eosinophils in the WBC count? 0 to 6%
what is the absolute count of eosinophils? 0 to 600
what are the causes for an abnormality in eosinophils count? increased w allergic reactions and parasitic infections
what is the percentage of basophils in the WBC count? 0 to 1%
what is the absolute count of basophils? 0 to 100
what are the causes for an abnormality in basophils count? increased w allergic reactions
what is the percentage of monocytes in the WBC count? 2% to 10%
what is the absolute count of monocytes? 90-1000
what are the causes for an abnormality in monocytes count? inc w invasion of foreign material
what is the percentage of lymphocytes in the WBC count? 20 to 45%
what is the absolute count of lymphocytes? 900 to 4500
what are the causes for an abnormality in lymphocytes count? inc w viral infections, reduced count w immunodeficiency probs
what is neutrophilia? elevation of the absolute value of neutrophils
what are immature neutrophils referred to as? bands (due to banded shape of nucleus)
what are mature neutrophils known as? segs
when both bands and segs are elevated in the CBC, what does this mean? body is fighting a more severe bacterial infection. severe infection causes the bone marrow to release both mature and immature neutrophils
what is neutropenia? reduced number of circulating neutrophils
what can anemia mean? RBC production is inadequate or excessive loss of blood has occured
what is thrombocytopenia? significant reduction in the platelet count
what hazards come with thrombocytopenia? pt will bruise easily and at risk for hemorrhage
What is the normal value for sodium? 137-147 mEq/L
what is the normal value for potassium? 3.5 to 4.8 mEq/L
what is the normal value for chloride? 98 to 105
what is the normal value for co2? 25-33
what is the normal value for BUN? 7-20
what is the normal value for cholesterol? 150-220 mg/l
what is the normal value for glucose? 70-105
What does the total co2 mean in terms of hco3? co2 reps the level of hco3 in venous blood
how does elevated hco3 mean for co2? means elevated co2
what does decreased hco3 mean for co2? means abnormally low total co2
what are the chloride levels in CF patients? they are elevated (more than 60-80) bc of their inability to reaborb it
how do you calculate the anion gap? adding hco3 and cl values together and subtracting them from Na
what does anion gap evaluate? the balance between anions and cations in the serum
what is the normal range of anion gap? 8-16 mEq/l
what does elevation of the anion gap suggest? a metabolic acidosis is present (esp if over 16)
what are the two most common tests to evaluate kidney function? BUN and creatinine
what will the BUN look like during renal disease? can be over 20 mg/dl
what are normal levels of creatinine? .7-1.3 mg/l
what is range for mild hypoxemia? 60-80 mmHg
what is range for moderate hypoxemia? 40- 60 mmHg
what is range for severe hypoxemia? 40 or less mmHg
for adequate oxygenation, there are five requirements: transfer of oxygen across the alveolarcapillary membrane,presence of hemoglobin to carry the O2,cardiac output to deliver O2 to the tissue bed,release of O2 from the hemoglobin molecule,ability of the cells to utilize O2.
what is the effect of Acidosis, fever, and increased concentrations of 2,3-diphosphoglycerate (2,3-DPG) on the oxy-hb dissociation curve? shifts it to the right-making oxygen more readily available for delivery to tissues.dec affinity
what is the effect of Alkalosis and decreased 2,3-DPG concentrations on oxy-hb dissociation curve? shifts to the left- increasing oxygen binding to Hgb and potentially reducing oxygen delivery to tissues. inc affinity
what are two examples of chemicals that inhibit the cells from using O2? Lactic acidosis and cyanide poisoning
Case study A 47 year old man is seen in the ED Results are : ph 7.47, PaCO2 33, HCO3 20, PaO2 122mmhg. Can this PaO2 be correct? Using Dalton’s Law and Alveolar air equation: (Pb-H2O) X FIO2 – (PaCO2 X RQ) (760- 47) X .21 – (33 X 1.25) 149.73 – 41.25= 108.48 Alveolar
Case study A 47 year old man is seen in the ED Results are : ph 7.47, PaCO2 33, HCO3 20, PaO2 122mmhg. Can this PaO2 be correct? 108.48 Alveolar 122 arterial Aging – about 3mm loss AC Membrane thickness- about 10 mm loss 122 – (3+10) = 109 arterial
what is a way to treat hyperkalemia? give albuterol up to 10 mg/hr
what is the impact of Primary Respiratory Disturbances-Acidosis on dead space? Increased dead space- ventilation where no gas exchange takes place.
Primary Respiratory Disturbances-Acidosis bad alveolar ventilation- the lung’s inability to excrete CO2,Increased production of CO2-Changes in metabolic rate like fever.,Increased dead space- ventilation where no gas exchange takes place
Primary Respiratory Disturbances- Alkalosis Hyperventilation- excessive alveolar production of CO2-Changes in metabolic rate like fever.,Increased dead space- ventilation where no gas exchange takes ventilation.
Hypoventilation is frequently seen with muscle weakness/ fatigue, CNS malfunction, and mechanical disadvantage.
Increased production of carbon dioxide is frequently seen in burn patients, septic conditions, fever, and malnutrition.
Increased dead space ventilation is frequently seen in rapid shallow breathing, anatomical. Disorders, which are characteristic of wasted ventilation like PE. Or V/Q imbalances.
Primary Metabolic Disturbances- Acidosis Loss of plasma HCO3.,Increase in nonvolitile acids. ,Evident by plasma HCO3 less than 22 Meq/l. Anion gap is useful in determining acidosis due to a or b.
Loss of plasma HCO3 is frequently seen in diarrhea, decreased renal tubular function renal disease, hyperalimentation nutrition. Normal anion gap.
Increased production of fixed acids is seen in conditions like diabetic ketosis, lactic acid, ingestion of acids aspirin, methanol, ethylene glycol. High anion gap.
Primary Metabolic Disturbance- Alkalosis Increased levels of plasma HCO3.,Loss of fixed acids.,Evident by plasma HCO3 greater than 26 Meq/l and pH greater than 7.45.,Be aware of compensatory mechanisms, especially in chronic hypoventilation situations
what are examples seen that lead to metabolic alkalosis? Bicarbonate replacement in cardiac arrest. Excessive gastric suctioning or vomiting. hypochloremia and hypokalemia. These are common side effects in the COPD patient taking meds for cor pulmonale, and CHF
what type of acid base imbalance is cardiac arrest? Combined respiratory and metabolic acidosis. Apnea results in anaerobic metabolism that results in an increase in fixed acids.
What happens to pH during a cardiac arrest? pH drops quickly below 7.35 with elevated PaCO2 and decreased HCO3.
How do you correct cardiac arrest? Correct with artificial ventilation and bicarbonate administration.
what is the frequency of Combined respiratory and metabolic alkalosis? it is very rare.
what is the apneic threshold? between 26 and 30 mmHg
Hypoxic hypoxia refers to the condition in which there is inadequate oxygen at the tissue cells caused by low arterial O2 tension
Anemic hypoxia -the oxygen tension in the arterial blood is normal but the O2 carrying capacity of the blood is inadequate.
Circulatory hypoxia (aka stagnant or hypoperfusion) arterial blood that reaches the tissue cells may have a normal O2 tension and content, but the amt of blood and therefore the amt of O2- is not adequate to meet tissue needs.
Histotoxic hypoxia develops in any condition that impairs the ability of tissue cells to utilize oxygen.
Question Answer
Indication of respiratory distress ↑ RR, ↑ BP, ↑ Pulse
Abnormal Airway Indicators Wheezing Bronchospasm. Treatment: Bronchodilator treatment
Abnormal Airway Indicators Inspiratory stridor Laryngeal edema. Treatment: cool mist
Abnormal Airway Indicators Rhonchi Secretions in large airways. Treatment: bronchial hygiene therapy
Abnormal Airway Indicators crackles Secretions in distal airways. Treatment: treat underlying condition e.g CHF
cough effectiveness indicators Strong cough good ability to mobilize secretUnheated bubble-typeions
cough effectiveness indicators poor ability to mobilize secretions. Treatment: bronchial hygiene treatment
abnormal secretions indicators amount > 30 ml/24 hrs excessive bronchial secretions. Treatment: bronchial hygiene therapy
white and translucent sputum normal sputum
yellow or opaque sputum acute airway infection
green sputum old, retained secretions and infections
frothy secretions pulmonary edema
major pathologic changes associated with chronic bronchitis chronic inflamation and swelling fo the wall of the peripheral airways. Excessive mucous production and accumulation. Partial or total mucous plugging of the airways. Smooth muscle constriction of bronchial airways (bronchospasm). Air trapping