How is the percentage of functional hemoglobin that is saturated with oxygen determined via pulse oximetry?A. The sum of the amount of red and infrared absorbed by the tissue determines the Sp02B. The ratio of the red and infrared light that reaches the photodiode signifies the Sp02C. The percentage of infrared light that reaches the photodetector reflects the Sp02D. The percentage of red light that lands on the photodiode represents the Sp02 (oxygen saturation as determined by pulse oximetry.B. The ratio of the red and infrared light that reaches the photodiode signifies the Sp02
The therapist has applied a bandage-type pulse oximetry probe too tightly to an infant’s finger. What problem can be expected to occur in this situation?A. The Sp02 will read erroneously low.B. The Sp02 will read erroneously high.C. The monitor displays a message indicating inadequate pulse.D The monitor displays fluctuating Sp02 values between being erroneously low and high.D The monitor displays fluctuating Sp02 values between being erroneously low and high.
As the therapist applies a pulse oximeter finger probe to a neonate who is receiving supplemental oxygen, she notices that the Sp0 reading is 100%. What should the therapist do in this situation?A. The therapist should reduce the fraction of inspired oxygen.B. The therapist should switch to using a capnometer.C. The therapist should obtain an arterial blood sample from this patient.D. The therapist should do nothing, because the reading is accurate.C. The therapist should obtain an arterial blood sample from this patient.
Why do transcutaneous oxygen tension (P0 and carbon dioxide tension (PCO values differ from Pa0 and PaCO measurements?A. Because metabolism in the tissue consumes oxygen and produces carbon dioxide at the site of the electrodeB. Because oxygen is consumed and carbon dioxide is produced in transit from the left ventricle to the electrode siteC. Because the skin is much more permeable to oxygen than carbon dioxideD. Because of the lag time between the cardiac output and the time the blood reaches the transcutaneous electrode siteA. Because metabolism in the tissue consumes oxygen and produces carbon dioxide at the site of the electrode
While attending to a neonatal patient in the neonatal intensive care unit (NICU), the therapist notices that a transcutaneous electrode is affixed to the upper chest of the neonate. What should the therapist do at this time?A. The therapist should relocate the electrode on the sternum as close as possible to the heart.B. The therapist needs to move the transcutaneous electrode to the infant’s right shoulder.C. The therapist should reposition the electrode on the neonate’s abdomen.D. The therapist should do nothing because the transcutaneous electrode is properly placed.D. The therapist should do nothing because the transcutaneous electrode is properly placed.
The therapist is assessing a mechanically ventilated infant and observes that the transcutaneous electrode temperature is set between 430 C and 44° C. What action does the therapist need to take at this time?A. The temperature range set is appropriate; therefore, no action is necessary.B. The temperature of the transcutaneous electrode needs to be reduced to 36° C toC. The therapist should increase the temperature range to 470 C to 48° C.38° C.D. The electrode needs to be repositioned and maintained at the same temperature.A. The temperature range set is appropriate; therefore, no action is necessary.
Which of the following factors is the main physiologic factor responsible for deriving accurate transcutaneous data?A. Ventilation—perfusion ratiosB. Peripheral perfusionC. Minute ventilationD. Heart rateB. Peripheral perfusion
Which of the following features or characteristics apply to mainstream capnography?I. The mainstream capnograph contains narrow tubing that can become occluded with mucus.II. Mainstream capnography generally employs infrared spectrometers.III. The mainstream capnograph does not add much weight to the breathing circuit.IV. The mainstream capnograph is placed at the proximal end of the endotracheal tube.A. I, III, and IV onlyB. I, II, and III onlyC. II and IV onlyD. I and II onlyC. II and IV only
1.A 12-hour-old infant is experiencing respiratory distress, and the neonatologist orders a heel stick to assess the infant’s oxygenation status. What action should the therapist take at this time?: recommend non invasive monitors like a pulse ox or transcutaneous oxygen monitors.2.An 18-month-old patient brought to the emergency department is exhibiting signs and symptoms consistent with an acute asthma episode, and is administered a ￼-agonist to which the patient does not respond favorably. Which conditions could be responsible for this patient’s problem?: Aspiration of a foreign object3.After increasing the level of CPAP delivered to an infant, the therapist notices that the neonate’s PaCO2 rises and the PaO2 falls. What may have caused this situation?: -periods of apnea – may need mechanical ventilation to regulate more.4.As the therapist applies a pulse oximeter finger probe to a neonate who is receiving supplementaloxygen, she notices that the SpO2 reading is 100%. What should the therapist do in this situation?: The therapist should obtain an arterial blood sample from this patient5.By what percentage does breath holding increase particle deposition in the lungs?: 10%
6.Calculate a patient’s total arterial oxygen content given the following data:• Arterial oxygen tension (PaO2), 100 mm Hg• Arterial carbon dioxide tension (PaCO2), 45 mm Hg• Arterial oxygen saturation (SaO2), 97.5%• Hemoglobin concentration ([Hb]), 15 g/dl• Cardiac output, 4.5 L/minute• Stroke volume, 55 ml/beat: 207.During volume-controlled ventilation, which of the following factors influences the peak inspiratory pressure?: Pulmonary Compliance8.The following capnogram was obtained from a newborn infant receiving mechanical ventilation. How should the therapist evaluate this capnogram?: Airway obstruction9.The following pressure-volume loop was obtained from a patient receiving mechanical ventilation in the pressure support mode. What type of problem does this ventilator graphic represent?: -Insufficient flow caused by insufficient driving pressure10.For which types of patients would using a dry powder inhaler (DPI) for medication delivery likely be contraindicated?: A 4 year old child, an 85 year old patient with COPD and a teenager with AMS11.How can a patient avoid the problem of terminating inhalation when a plume from a pressurized metered-dose inhaler (pMDI) impacts the oropharynx?: Use a valved holding chamber12.How is the percentage of functional hemoglobin that is saturated with oxygen determined via pulse oximetry?: The ratio of the red and infrared light that reaches the photodiode signifies the SpO2.13.How is the positive pressure level established in a bubble CPAP system?: submerging the distal end of expiratory limb straight into water at a measured depth (cmH20)14.How would tricuspid stenosis be expected to influence a patient’s CVP value?: INCREASED CVP15.In addition to applying direct pressure to the puncture site immediately after the arterial puncture procedure, what can the therapist do to minimize the risk of hematoma formation in a patient who requires frequent radial arterial punctures?: alternating puncture sites decreases the risk of hematoma formation16.An infant demonstrates the following capnogram while being mechanically ventilated. How should the therapist interpret this?: The patient may have developed a pneumothorax17.A Maquet Servo 300A ventilator has been set in such a manner that the resulting inspiratory flow exceeds the maximal flow for the selected patient range setting. What type of alarm will be activated?: …18.The NICU RT supervisor is observing a therapist obtaining an ABG from an infant’s radial artery, and notices that the therapist has the bevel of the needle pointed upward, entering the patient’s skin at a 45-degree angle, and in a direction against the arterial flow. What should the supervisor do at this time?: allow the therapist to continue – this is correct technique19.On the basis of clinical evidence, which medications appears to best relieve reversible airflow obstruction occurring in patients with chronic obstructive pulmonary disease (COPD)?: Ipratropium Bromide20.On the basis of the following flow-time scalar, which of the following conditions has developed?: Auto PEEP21.On the basis of the following pressure-volume loop, what ventilator setting change should the therapist make?: -Increase the inspiratory flow22.On the basis of the following waveform, in which anatomic locations is the distal tip of the pulmonary artery catheter located?: Right Ventricle23.On the basis of the following waveform, in which anatomic locations is the distal tip of the pulmonary artery catheter located?: Pulmonary Capillary Wedge24.On the basis of the following waveform, in which anatomic locations is the distal tip of the pulmonary artery catheter located?: Pulmonary Artery25.On the Maquet SERVO-i, what is the result of increasing the “inspiratory cycle off” settings?: Enables expiration to occur at an earlier point in the peak flow requirements.26.Over the last 90 minutes, the therapist has obtained three arterial blood samples from an arterial line inserted in a neonate receiving mechanical ventilation and being monitored by capnometry. The PaCO2 values were as follows: (1) 47 mm Hg, (2) 46 mm Hg, and (3) 47 mm Hg. How should the therapist evaluate the following capnogram?: -Reduced pulmonary blood flow caused by overdistension of the lungs27.A patient has a systolic blood pressure of 100 mm Hg and a diastolic pressure of 75 mm Hg. What is this patient’s mean arterial pressure?: 83.328.A patient is about to be switched from a conventional mode of ventilation to inverse ratio ventilation. What should the therapist recommend for this patient before instituting this mode?: That the patient be sedated and paralyzed29.A pediatric patient with an inspiratory flow of 20 L/minute enters the emergency department wheezing and short of breath. Which devices would be most efficacious for delivering a bronchodilator?: SVN30.The physician asks the therapist to recommend a long-acting ￼-agonist for a patient. Which of the following medications should the therapist recommend?: Formoterol31.The physician in the emergency department is attending to a 12-year-old child who has an exacerbation of asthma. The physician asks the therapist to recommend a medication that has a synergistic effect with ￼-agonists during asthma exacerbations. Which medications should the therapist recommend?: Ipratropium Bromide32.Pirbuterol is known by which of the following brand names?: MaxAir33.Pneumatic nebulizers operate according to which of the following physical tenets?: Bernoulli Principle34.The therapist has applied a bandage-type pulse oximetry probe too tightly to an infant’s finger. What problem can be expected to occur in this situation?: The monitor displays a message indicating inadequate pulse35.The therapist is about to mechanically ventilate a neonate with a ventilator that delivers the volume guarantee mode. Which of the ventilator settings does the therapist need to set for this mode?: Vt, I Time, Inspiratory Flow36.The therapist is assessing a mechanically ventilated infant and observes that the transcutaneous electrode temperature is set between 43º C and 44º C. What action does the therapist need to take at this time?: The temperature range set is appropriate; therefore, no action is necessary
37.The therapist is conducting a ventilator check for a neonate and makes the following notations on the ventilator flow sheet:PEEP: 5PIP: 25Mand. Rate: 15FiO2: 0.35On the basis of these observations, what should the therapist recommend for this neonate?: -Wean from mechanical ventilation38.The therapist is initiating mechanical ventilation for a 12-year-old patient who has status asthmaticus. Which modes of ventilation is most appropriate for this patient at this time?: Time or patient triggered pressure control ventilation39.The therapist receives an order to administer a bronchodilator in-line to an infant receiving mechanical ventilation. The order also indicates that the nebulizer must not significantly increase the patient’s delivered tidal volume. Which aerosol delivery devices should the therapist select?: Vibrating mesh neb, pMDI and Ultrasonic neb
40.The therapist would like to achieve an arterial oxygen tension (PaO2) of 85 mm Hg in an infant who has a PaO2 of 75 mm Hg with a stable arterial carbon dioxide tension (PaCO2) and stable lung conditions. This patient has the following ventilator settings:RR 25Vt 150mlInsp Flow 60L/minFiO2 0.60Determine FIO2 that needs to be set on the O2 blender required to achieve a PaO2 of 85mmHg: 0.6841.Twenty-four hours ago, a hospitalized pediatric patient was prescribed theophylline. The patient’s first dose at that time was 5.0 mg/kg. The patient has an oral dose of 2.5 mg/kg in hand and asks the therapist if the dose is correct. What should the therapist do at this time?: Give patient medication – this is the correct dosage42.What event or activity is represented by the wavy lines appearing on the following capnogram?: Cardiac Oscillations43.What FIO2 should a patient receive when CPAP is initiated?: -same FiO2 pt was on before initiation of CPAP44.What is the average range of normal circulating blood volume in a neonate?: 85-90mL/kg45.What is the potential problem associated with the use of methylprednisolone in neonates?: Gasping Syndrome46.What is the purpose of the optional open lung tool on the SERVO-i ventilator?: To assist in determining the inflating and deflating pressure in the lungs.47.What is the set flow in an Infant Flow CPAP system based on?: -the flow of gas through the solenoid valve48.What percentage of the nominal dose would remain in the nebulizer if the nebulizer had a residual volume of 1 ml and a fill volume of 2 ml?: 50%49.What settings require that the patient breath spontaneously?: PS and CPAP50.When airway pressure release ventilation is used, what physiologic process occurs as the higher pressure is released and the lower is achieved?: Exhalation of Carbon Dioxide51.Where can a therapist obtain an arterial blood sample from a neonate for acid-base and blood gas analysis?: dorsalis pedis, posterior tibial, femoral, brachial, ulnar, radial ,axillary, temporal52.Where in the CPAP delivery system should the pressure-relief/pop-off valve be situated?: -as close to the patient’s airway as possible.53.Where on the following normal capnogram is the end-tidal carbon dioxide (PetCO2) represented?: D54.Which adverse effects are likely to be experienced by patients who use nonselective ￼-adrenergic agonists?: Tremor, vasodilation, tachycardia, headache, nervousness, dizziness, palpitations, cough, nausea, vomiting, throat irritations.55.Which anatomic structures has been shown to break down because of the use of nasal masks associated with IF-CPAP?: nasal septum56.Which arterial blood values reflects ventilatory failure?: -decreasing pH below 7.25, CO2 greater than 60, FiO2 requirement exceeding 0.6 to 0.7 with PaO2 less than 50 to 60 mm Hg.57.Which arteries are considered the optimal puncture site for obtaining arterial blood samples from neonatal and pediatric patients?: radial artery58.Which arteries are involved when the modified Allen’s test is performed, using a foot as the potential arterial puncture site?: dorsalis pedis and posterior tibial arteries59.Which characteristics of an aerosol influence(s) its ability to penetrate a mucous barrier?: Solubility of the aerosol particles, change of the aerosol particles, size of the particles60.Which complications are associated with the insertion of a pulmonary artery catheter?: Bleeding, pneumothorax, tricuspid/pulmonic valve damage, RA or RV perforation, and arrythmias.61.Which complications of CPAP can develop when an infant experiences inadvertent positive end-expiratory pressure (PEEP) from gas trapping resulting from tachypnea?: Pneumothorax62.Which conditional variables can most easily become the baseline variable?: pressure is the easiest63.Which conditions are contraindications for nasal CPAP?: -upper airway abnormalities, untreated congenital diaphragmatic hernia, neuromuscular disorders, CNS depression meds, central or frequent apneas.64.Which conditions can cause methemoglobinemia?: Nitric containing molecules in medications and therapeutic gases65.Which considerations is most important when using a large-volume nebulizer to provide oxygen and humidification to an infant in an incubator?: Preventing a high noise level from developing66.Which CPAP systems delivers a more consistent pressure, lowers work of breathing (WOB), is less sensitive to leaks, and is more effective at alveolar recruitment compared with other forms of CPAP?: IF-CPAP67.Which effects are related to activation of β-adrenergic receptor sites?: Activation of adenyl cyclase, which increase the production of cAMP. This increase results in bronchial smooth muscle relaxation and skeletal muscle stimulation. Inhibits the release of inflammatory mediators through stabilization of the mast cell membrane.68.Which effects constitute adverse reactions to recombinant human deoxyribonuclease I (rhDNase)?: Voice alteration, pharyngitis, laryngitis, rash and chest pain.69.Which factors increase the rate of inertial impaction of particles greater than 2 µm in diameter?: Bifurcations and Obstructed Airways70.Which factors influences the gas volume compressed in the ventilator circuit?: -Water level in the humidifier71.Which factors influence the central venous pressure (CVP) measurement?: mechanical ventilation and hypervolemia, interference of RV ability to pump blood = higher CVP, hypovolemia = lower CVP72.Which factors would adversely affect the correlation between arterial puncture measurements and those from a capillary sample?: capillary PO2 is lower than the PO2 in arterial draws73.Which features are often components of CPAP systems incorporated within infant ventilators?: -apnea backup rate, leak compensation capabilities, highly responsive demand flow system.74.Which features or characteristics apply to mainstream capnography?: Mainstream capnography generally employs infrared spectrometers and the mainstream capnograph is placed at the proximal end of the ET tube.75.Which form of CPAP is associated with a “thoracic wiggle”?: -bubble nasal CPAP76.Which functions are served by spacer and holding chambers in conjunction with pMDIs?: Reduction in oropharyngeal deposition of drug, elimination of the cold Freon effect, and improvement in lower respiratory tract deposition77.Which mechanism is the primary mechanism for deposition of particles with a diameter of 5 µm or greater?: Inertial Impaction78.Which medications is most suited for the treatment of postextubation edema?: Racemic Epinephrine79.Which medications is the only drug that inhibits 5-lipoxygenase?: Zieleuton (Zyflo)80.Which medications works to maintain the integrity of the mast cell?: Cromolyn Sodium81.Which methods is/are acceptable for delivering a drug via a pMDI to an intubated neonate receiving mechanical ventilation? Chose the best answer.: In-line with the ventilator and through a resuscitation bag82.Which modes of ventilation attempt to maintain a minimal target tidal volume with a constant pressure by manipulating the inspiratory flow?: PRVC83.Which motor and linkage mechanisms are used in ventilator compressors?: -Pistons and cylinders, diaphrams, bellows and rotating vanes84.Which of the following factors is the main physiologic factor responsible for deriving accurate transcutaneous data?: Peripheral perfusion85.Which outcomes are advantages of CPAP over mechanical ventilation in infants?: -fewer nosocomial vent related infections, lower incidence of intraventricular hemmorhage, fewer incidents of retinopathy of the newborn.86.Which physiologic effects are generally associated with the use of CPAP for the treatment of respiratory distress syndrome (RDS)?: -stabilized chest wall, increased FRC87.Which pulmonary artery catheter waveforms represents the catheter’s normal location?: Pulmonary Artery Waveform88.Which responses are considered adverse effects of inhaled corticosteroids?: Oropharyngeal candidiasis, dysphonia, cough, dry throat, increased wheezing89.Which statements accurately describe levalbuterol?: …90.Which statements characterize a ventilator’s control scheme as closed loop?: -Output variable ismeasured and compared with reference. Input is modified as needed.91.Which statements describes the pressure-limited ventilation (PLV) mode available on the Dräger Medical Evita 4 ventilator?: can be used to modify mandatory breaths in the CMV, SIMV, and MMV modes92.Which statements refers to the Puritan Bennett 840 ventilator when it is set to deliver a flow-triggered breath?: The ventilator deliver a base gas flow through the patient circuit during the expiratory phase of all breaths. The base flow is equal to the flow set as the trigger sensitivity plus 1.5L/min. As the patient breaths from the base flow, the vent detects a difference in the inspiratory and expiratory flow measurements. Flow triggering occurs when this flow differential equals the value set as the trigger sensitivity. (0.1-20L/min)93.Which terms best describe(s) the activity of aerosol particles less than 3 µm in diameter throughout the distal airways?: Brownian Movement94.Which terms describes the rate of increase in airway pressure from baseline at the onset of inspiration?: Pressure Rise Breath95.Which terms is used to describe the variable responsible for initiating inspiration?: Trigger (pressure, flow or volume)96.Which terms is used to describe the variable that is responsible for terminating inspiration?: Cycle (pressure, flow or volume)97.Which terms is used to describe the variable that reaches a preset value before the end of inspiration?: Limit (pressure, flow or volume)98.Which therapeutic interventions would be appropriate for a neonate with a respiratory rate of 65 breaths/minute while displaying paradoxical chest wall movement with suprasternal and substernal retractions, grunting, nasal flaring, and cyanosis, along with the following blood gas data: pH 7.30; arterial partial pressure of carbon dioxide (PaCO2), 50 mm Hg; arterial partial pressure of oxygen (PaO2), 60 mm Hg?: CPAP99.Which valves function as output control valves?: -Inspiratory flow valves and exhalation valves100.Which variables is the control variable when both the volume and pressure waveforms vary considerably when the patient’s lung compliance and airway resistance change?: Time101.Which ventilator settings are preset during time-cycled, pressure-limited ventilation?: I Time, RR, I:E Ratio102.While attending to a neonatal patient in the neonatal intensive care unit (NICU), the therapist notices that a transcutaneous electrode is affixed to the upper chest of the neonate. What should the therapist do at this time?: The therapist should do nothing because the transcutaneous electrode is properly placed.103.While checking the ventilator of a pediatric patient, the therapist observes the following volume-time scalar:: -Increase both inspiratory flow and pressure setting.104.While nebulizing albuterol to a patient via a small-volume nebulizer, the therapist hears a sputtering sound originating from the nebulizer. How should the therapist respond to this situation?: Terminate the treatment at this time105.While working at the bedside of a small child who has myasthenia gravis, the therapist notices a new medication order prescribing glycopyrrolate (40 mc/kg four times a day)￼ for the control of secretions. What should the therapist do at this time?: Inform the nurse that this is contraindicated for patients with myasthenia gravis.106.While working in the NICU with a mechanically ventilated newborn who is being monitored for PetCO2, the therapist observes the following capnogram. What interpretation should the therapist make?: The patient is rebreathing his own exhaled gas107.Why are pass-over humidifiers preferred over pneumatic nebulizer humidifiers?: Pass overs transmit fewer pathogens than pneumatic nebs.108.Why do transcutaneous oxygen tension (PO2) and carbon dioxide tension (PCO2) values differ from PaO2 and PaCO2 measurements?: Because metabolism in the tissue consumes oxygen and produces carbon dioxide at the site of the electrode109.Why should pMDIs containing steroids be used with a valved holding chamber?: To reduce the risk of oral yeast infections110.With an umbilical artery catheter (UAC) in the “low position,” which of the following blood vessels are avoided?: UAC is placed between the renal artery and aortic intersection, and avoids the large tributaries supplied by those vessels to minimize trauma of the vital organs.111.With the Dräger Medical Evita 4 ventilator, how will the inspiratory pressure waveform appear for a pressure-controlled mandatory breath when the pressure rise time is set at 0?: Rectangle
1.1. How is the percentage of functional hemoglobin that is saturated with oxygen determined via pulse oximetry?A. The percentage of red light that lands on the photodiode represents the SpO2 (oxygen saturation as determined by pulse oximetry).B. The percentage of infrared light that reaches the photodetector reflects the SpO2.C. The ratio of the red and infrared light that reaches the photodiode signifies the SpO2.D. The sum of the amount of red and infrared absorbed by the tissue determines the SpO2.: ANS: CFeedbackA. Incorrect response: See explanation C.B. Incorrect response: See explanation C.C. Correct response: A pulse oximeter sensor has two light-emitting diodes (LEDs) that function as light sources and one photodiode that acts as a light receiver. One LED emits red light, and the other diode emits infrared light. As the light from the diodes passes through the blood and tissue, some of the light from both the red and infrared diodes is absorbed. The photodiode then measures the amount of light that passes through the body without being absorbed. By knowing the amount of light that is entering the body and the amount of light leaving the body, the amount of light absorbed is easily determined. This absorption of both the red and infrared light is used to determine the percentage of functional hemoglobin that is saturated with oxygen.D. Incorrect response: See explanation C.OBJ: Recall
2.2. The therapist has applied a bandage-type pulse oximetry probe too tightly to an infant’s finger. What problem can be expected to occur in this situation?A. The SpO2 will read erroneously low.B. The SpO2 will read erroneously high.C. The monitor displays a message indicating inadequate pulse.D. The monitor displays fluctuating SpO2 values between being erroneously low and high.: ANS: CFeedbackA. Incorrect response: See explanation C.B. Incorrect response: See explanation C.C. Correct response: Application of the sensor is crucial to the quality of readings from the pulse oximeter. The sensor should be placed over a vascular area with the diodes and the photodiode directly opposite each other and in good contact with the skin. The sensors should be placed firmly to avoid falling off or motion artifact, but care should be taken to avoid overtightening and compromising the circulation. An artifact that obscures the pulse triggers the “loss of pulse” alarm on the monitor.D. Incorrect response: See explanation C.OBJ: Recall
3.3. As the therapist applies a pulse oximeter finger probe to a neonate who is receiving supplemental oxygen, she notices that the SpO2 reading is 100%. What should the therapist do in this situation?A. The therapist should do nothing, because the reading is accurate.B. The therapist should obtain an arterial blood sample from this patient.C. The therapist should switch to using a capnometer.D. The therapist should reduce the fraction of inspired oxygen.: ANS: BFeedbackA. Incorrect response: See explanation B.B. Correct response: Even when properly functioning, the pulse oximeter does not provide good information regarding hyperoxia in the neonatal patient. If the oximeter is reading an SaO2 (arterial oxygen saturation) of 100%, the arterial oxygen tension (PaO2) could be between 90 and 250 mm Hg. In such a situation, the therapist needs to obtain an arterial blood sample to determine the actual PaO2 of the patient. The risk in this situation is in not recognizing a dangerously high PaO2, which, if permitted to persist, can cause retinopathy of prematurity.C. Incorrect response: See explanation B.D. Incorrect response: See explanation B.OBJ: Application
4.4. Why do transcutaneous oxygen tension (PO2) and carbon dioxide tension (PCO2) values differ from PaO2 and PaCO2 measurements?A. Because of the lag time between the cardiac output and the time the blood reaches the transcutaneous electrode siteB. Because the skin is much more permeable to oxygen than carbon dioxideC. Because oxygen is consumed and carbon dioxide is produced in transit from the left ventricle to the electrode siteD. Because metabolism in the tissue consumes oxygen and produces carbon dioxide at the site of the electrode: ANS: DFeedbackA. Incorrect response: See explanation D.B. Incorrect response: See explanation D.C. Incorrect response: See explanation D.D. Correct response: Transcutaneous measurements of PO2 and PCO2 are based on the fact that a heating element in the sensor elevates the temperature in the underlying tissue. Increasing the skin’s temperature increases the capillary blood flow to the tissues, making the skin more permeable to gas diffusion. Because metabolism in the tissues (through which the blood perfuses) consumes oxygen and produces carbon dioxide, transcutaneous values differ from arterial values. Usually, the PO2 is slightly lower than in the arteries, and the PCO2 is slightly higher when measured transcutaneously.OBJ: Application
5.5. While attending to a neonatal patient in the neonatal intensive care unit (NICU), the therapist notices that a transcutaneous electrode is affixed to the upper chest of the neonate. What should the therapist do at this time?A. The therapist should do nothing because the transcutaneous electrode is properly placed.B. The therapist should reposition the electrode on the neonate’s abdomen.C. The therapist needs to move the transcutaneous electrode to the infant’s right shoulder.D. The therapist should relocate the electrode on the sternum as close as possible to the heart.: ANS: AFeedbackA. Correct response: A critical consideration regarding transcutaneous monitoring is the application and site selection of the sensor. The site should be a highly vascular area such as the upper chest, abdomen, and thighs, or the lower back if the patient is supine. Bony areas over the spine should be avoided. Another consideration when selecting a site is that the right side of the upper chest will give preductal oxygenation values, whereas the left side of the chest and the lower parts of the body will give postductal values.B. Incorrect response: See explanation A.C. Incorrect response: See explanation A.D. Incorrect response: See explanation A.OBJ: Application
6.6. The therapist is assessing a mechanically ventilated infant and observes that the transcutaneous electrode temperature is set between 43º C and 44º C. What action does the therapist need to take at this time?A. The temperature range set is appropriate; therefore, no action is necessary.B. The therapist should increase the temperature range to 47º C to 48º C.C. The temperature of the transcutaneous electrode needs to be reduced to 36º C to 38º C.D. The electrode needs to be repositioned and maintained at the same temperature.: ANS: AFeedbackA. Correct response: Selecting a sensor temperature is important to proper operation. The temperature range is usually 43º C to 44º C. Thicker skin requires a higher temperature. The fact that the sensor is heated requires changing the site routinely to prevent thermal injuries. The frequency of the site changes ranges from 3 to 4 hours. Relocating the electrode can be done sooner, that is, 2 or 3 hours, if the skin at the site has a reaction or if the sensor is operated at higher temperatures.B. Incorrect response: See explanation A.C. Incorrect response: See explanation A.D. Incorrect response: See explanation A.OBJ: Application
7.7. Which of the following factors is the main physiologic factor responsible for deriving accurate transcutaneous data?A. Heart rateB. Minute ventilationC. Peripheral perfusionD. Ventilation-perfusion ratios: ANS: CFeedbackA. Incorrect response: See explanation C.B. Incorrect response: See explanation C.C. Correct response: The main physiologic factor relating to good correlation is good peripheral blood perfusion. The skin reacts to cold, shock, and certain drugs by contracting the superficial blood vessels and by opening the larger, deeper-lying arterioles to achieve a shunting effect. In the event of exposure to cold, capillary blood flow slows or stops to reduce the loss of body heat. Shock and certain cardiopulmonary medications will dilate the blood vessels, causing the blood pressure in the body to drop. In response to this drop in blood pressure, the body will shunt blood from the skin and toward major organs. If blood flow in the capillary bed is reduced, the capillary blood rapidly becomes more or less venous, with a considerably lower PO2 and higher PCO2. Therefore, in patients with impaired peripheral blood perfusion, large deviations may occur between central PO2/PCO2 and the transcutaneous values.D. Incorrect response: See explanation C.OBJ: Recall
8.8. Which of the following features or characteristics apply to mainstream capnography?I. The mainstream capnograph contains narrow tubing that can become occluded with mucus.II. Mainstream capnography generally employs infrared spectrometers.III. The mainstream capnograph does not add much weight to the breathing circuit.IV. The mainstream capnograph is placed at the proximal end of the endotracheal tube.A. I and II onlyB. II and IV onlyC. I, II, and III onlyD. I, III, and IV only: ANS: BFeedbackA. Incorrect response: See explanation B.B. Correct response: Exhaled gas can be analyzed according to two methods, that is, by mainstream or sidestream capnography. Aside from other features, they differ according to how exhaled gas reaches the sample chamber. A mainstream capnograph is used with ventilated patients, and is placed at the proximal end of the endotracheal tube. This setup can be seen in Figure 11-5 in the textbook. This method generally employs infrared spectrometry. Caution must be taken because these analyzers can be a heavy addition to an infant or pediatric circuit, causing kinking or disconnecting of the endotracheal tube. Sidestream analyzers continuously aspirate a sample of gas through a small tube and into the analyzer. This method is used primarily with mass spectrometry and some infrared analyzers. It is advantageous in that it does not add much weight to the breathing circuit. However, the narrow tubing can become occluded with mucus or water, causing inaccuracies.C. Incorrect response: See explanation B.D. Incorrect response: See explanation B.OBJ: Recall
9.9. Where on the following normal capnogram is the end-tidal carbon dioxide (PetCO2) represented?A. AB. BC. CD. D:ANS: DFeedbackA. Incorrect response: See explanation D.B. Incorrect response: See explanation D.C. Incorrect response: See explanation D.D. Correct response: A normal capnogram can be divided into four phases.Phase A-B is the inspiratory phase, during which the sensor detects no carbon dioxide because the gas exhaled at that time is atmospheric air from the anatomic dead space. Phase B-C is the initial expiratory phase, during which carbon dioxide tension rapidly increases as the alveoli begin to empty, and only remnants of dead space gas remain. Phase C-D is the completion of expiration as the alveoli empty (alveolar plateau) and shows a slight increase in carbon dioxide. Phase D-E is the beginning of inspiration as the waveform returns to zero because of the reentry into the lung of atmospheric air. Point D on the capnogram represents the end-tidal PCO2, or PetCO2.OBJ: Application
10.10. While working in the NICU with a mechanically ventilated newborn who is being monitored for PetCO2, the therapist observes the following capnogram:http://o.quizlet.com/7gP6ZyJ7Z2UE62C9f1X1Lw_m.jpgWhat interpretation should the therapist make of this capnogram?A. This capnogram is normal.B. The patient is receiving about 10 cm H2O positive end-expiratory pressure.C. The patient is rebreathing his own exhaled gas.D. The neonate is being hyperventilated.:ANS: CFeedbackA. Incorrect response: See explanation C.B. Incorrect response: See explanation C.C. Correct response: Rebreathing is characterized by an elevation in the A-B phase of the capnogram with a corresponding increase in PetCO2.It indicates the rebreathing of the previously exhaled carbon dioxide. Rebreathing can be caused by using an insufficient expiratory time or an inadequate inspiratory flow.D. Incorrect response: See explanation C.OBJ: Application
11.11. The following capnogram was obtained from a newborn infant receiving mechanical ventilation.http://o.quizlet.com/X7.q4WOuzOkpfAS8MGPD9w_m.pngHow should the therapist evaluate this capnogram?A. Airway obstructionB. HypoventilationC. HyperventilationD. Increased dead space ventilation:ANS: AFeedbackA. Correct response: Obstruction to the expiratory flow of gas will be noted as a change in the slope of the B-C phase of the capnogram.The B-C phase may diminish without a plateau. Obstruction can be caused by a foreign body in the upper airway, increased secretions in the airways, the patient having bronchospasms, or partial obstruction of the ventilator circuit.B. Incorrect response: See explanation A.C. Incorrect response: See explanation A.D. Incorrect response: See explanation A.OBJ: Application
12.12. An infant demonstrates the following capnogram while being mechanically ventilated.How should the therapist interpret this capnogram?A. The patient has received a paralytic agent.B. A paralytic agent is indicated for this patient because of the spontaneous breathing efforts represented by the downward deflections.C. The patient may have developed a pneumothorax.D. A leak has developed in the patient-ventilator system.:ANS: CFeedbackA. Incorrect response: See explanation C.B. Incorrect response: See explanation C.C. Correct response: A stair-stepping of the D-E phase of the capnogram, caused by unequal and incomplete emptying of the lungs, and a failure to return to baseline may suggest a pneumothorax. The capnogram depicting the possible pneumothorax is presented here:D. Incorrect response: See explanation C.OBJ: Application13.13. What event or activity is represented by the wavy lines appearing on the following capnogram?A. Spontaneous breathing effortsB. Patient-ventilator dyssynchronyC. HypoventilationD. Cardiac oscillations:ANS: DFeedbackA. Incorrect response: See explanation D.B. Incorrect response: See explanation D.C. Incorrect response: See explanation D.D. Correct response:
Question Answer a centruy after laplace described the relationship of transuraface pressure and surface tension of gas-fluid interface in a sphere what did neergaard discover about the retractile force of the lung? that it was dependaent on the surface tension in the alveoli how is surface tension created? by the attraction of water molecules to one another at the liquid gas interface ehat does the laplace law postulate about the alveoli in the lung? that alveoli would collapse as they got smaller which physiological consequqnces would develop if the liquid gas interface were without surfactant? every breath would require more pressure to expand lung w inspiration and all the alveoli would collapse during exhalation what physiological conditions result from the presence of normal amounts of pulmonary surfactant in the lung? uniform gas distribution during inspiration and functional residual capacity is maintained what structure is responsible for producing pulmonary surfactant? type II pmeumocytes what components comprise pulmonary surfactant? dipalmitoyl phosphatidylcholine, phosphatidylinositol, and phospholipids what following proteins are known to comprise human pulomary surfactant? SP-B, Sp-C, Sp-D What is the role of SP-d in human pulmonary surfactant? suppresses proinflammatory responses, enhances killing of microbes, enhances phagocytosis what relationship id correct rearding to the composition of amniotic fluid as it relates to determining fetal lung maturity? PG and lecithin increase while sphingomyelin decreases during gestation what is the most commone form of surfactant abnormality? inactivation by proteins full term infants with RDS, surfactant nonresponders and infancts who can’t be extubated in the first weeks of life because of a respiratory condition should be evaluated for? alpha antitrypsin deficiency, SPB deficiency what cardiovascular conditions can cause surfactant inactivation? pulmonary hemorrhage and hemorrhagic edema what pathophysiologic conditions are components of meconium aspiration? surfactant inactivation and chemical pneumonitis How is pna in a neo believed to adversely affect surfactant? by bacteria directly attacking type II pneumo and by microorganisms releasing substances altering surfactant components which proteins are found to be deficient in the sputum of pts with asthma? SP-A what are the physiologic benegits of surfactant? prevents capillary leakage of fluid into alveoli, optimizes surface area for gas exchange and protects epithelium of lung what causes upper airway obstruction and may require an artifical airway? laryngotracheobronchitis, epiglottitis, subglottic stenosis on the bases of illustration of neo et indetify murpheys eye b hole at the distal end of the tube therapist about to perform ett on a 2 yo infant what size tube? 4.5mm ID why are some ped ETT available without cuffs? because in some infants ETT creats a seal against cricoid cartulage where in the upper airway if an infant should the laryngoscope blade be placed to expose the glottis during ett? epiglottis directly lifted with tip of laryngoscope blade which statement describes the LMA? potential for aspiration greater than with tranlaryngeal intubation as well as LMA good alternative as an emergency airway when ppv needed whats the purpose of placing small towel under occiput of 4 yo? to align oral cavity, pharynx, and larynx when should sellicks maneuver be performed? when pt is at risk for regurgitating or aspirating during intubation how should therapist determine depth of insertion of ETT in infant during intubation at pt where single heavy black line just moves beyond the glottis what anatomical difference between larynx of an infant to an adult makes intubation of the infant more difficult? larynx of infant is more cephalad and anterior what conditions are considered disadvantages of nasotracheal intubation in neonates? postextubation atelectasis among very low birth weight infants, pressure necrosis of nares what forms of et will neonate w pierre robin syndrome likely undergo? anterior commissure intubation 5 yo child brought to er in severe respiratory distress w diagnosis of epiglottis, what measures must be performed to secure childs airway? child needs to be transported to OR intubated a child is orally intubated because of laryngotracheal stenosis has an air leak at 25 cm h2o what action does therapist take now? therapist must insert an oral ETT large enough to stop leak Which following areas of an infant’s upper airway are most prone to develop edema as a result of ett? subglottic area what equipment is essential for performing extubation? stylet, yaunkerm opa how do arched and angled trach tubes compare to each other? angled tube is longer what are most common causes pf death in a trach dependant child? accidental decannulation and mucous plugging what typr of x-ray view is obtained when xray plate is between pt’s back and bed w x-ray tube in front of pt’s chest? anteriorposterior view lateral decub view is front x-ray projection wherby side down can be evaluated for presence of ____ and side up may better define _____ a pleural effusion, pneumothorax what xray would be best suited for eval of fractured ribs in peds pt? oblique view how will well expanded air filled lungs appear on an x-ray? black therapist is viewing x-ray of peds pt recently awoke form anesthesia after upper abd surgery. Right hemidiaphragm is elevated w atelectasis seen as long thich horizontal line w/in right lower lobe. what term describes this atelectasis? plate peds pt w pna has infiltrate in lower half of right lung. Right heart border is obliterated. which lobes of right lung is infiltrate located? right middle lobe what structures on an x-ray projects to the left causing a prominent bulge of superior mediastinum and mild indentation on trachea? aortic arch AP x-ray neo examined and structure projecting away from mediastinum toward the right upper lung. structure looks like a sail w sharp inferior margin and lateral margins w wavy contours. what structure are you seeing? thymus minor fissure on r side of lung seperates which of folloing lobes? middle from upper lobe x-ray 18m/ boy trachea is truncated and right lung is collapsed. what situations or conditions may have caused this situation? mucous plug in the right mainstem bronchus therapist is viewing frontal chest x-ray of neonate has just been ett. therapist notices tip of ett located between thoracic inlet and carina what to do? nothing ett good placement what xray view provides best perspective for ascertaining position of ett in pt esophogus? lateral view therapist viewing frontal and lateral nech x-rays of 12mth notices steeple sign subglottic narrowing below vocal chords and an overdistended hypopharynx. what condition is this? laryngotracheobronchitis lateral view of neck x-ray 18 mth enlarged epiglottis, aryepiglottic folds are thickened and hypopharynx is overdistended what condition is this? epiglottitis 42 week infnat sga. x-ray reveals coards patch opacities secondary to atelectasis from bronchial obstruction alternating w areas of hyperinflation. what clinical disorder? meconium aspiration syndrome which term refers to abnormally low levels of o2 in the tissues hypoxia where does fetal oxyhemoglobin dissociation curve reside in comparison w normal adult diss curve? fetal oxyhemoglobin lies to the left of the adult curve therapist eval neo o2 PaO2 40, SpO2 80, what to do? add FiO2 to raise SpO2 to 90% which problems occur as result of abs atelectasis? increased intrapulmonary shunting and decreased alveolar volumes what tyoes of neo and pped O2 delivery are applied clinically? low flow, high flow, fixed and variable performance what O2 delivery devices be most suitable for an infant being treated for chanal atresia? O2 hood how should nasal cannula be secured in an active infant? secure cannula to face and tighten cannula behind head. when weaning infant receiving O2 from nasal cannula attched to low flowmeter set at 100% what range is recomended? 0.1-0.2 L/min whats the concern when admin O2 to sedated infant wearing a nasal cannula? too high an FiO2 can be given what ranges of O2 flow need to be set when admin O2 to an infant via simple mask? 6-10L/min therapist noices reservoir bad on partial rebreathing mask being worn by peds pt collapses during inspiration what to do? increase O2 flow what gas delivery devices are most suitable for admin of heliox? nonrebreathing mask whats the purpose of attaching 22mm humidification collar to an air entrainment mask despite adding no humidification to delived gas? safeguard against bedlinings obstructing air entrainment port how will excess condensate present in aerosol tubing affect delivered FIo2 increase FiO2 for which of following conditions is a high flow nasal cannula indicated? apnea of prematurity which features characterize a self inflating neo resus bag? max Vt 200-300ml, one way valved preventing rebreathing of exhaled gas, reservoir to achieve high O2 concentrations, pressure relief valve preventing excess pressure noe w min vent of 2L/min about to be bvm w non self inflating resu bad what flow should be set? 4-6 L/min what are advantages of non-self inflating resus system? amt of PEEP can be set, 100% fio2, inspiratory pressure can be regulated what percentage does breath holding increase particle deposition in the lungs? 10% what mechanism is the primary mechanism for deposition of particles w a diameter of 5 micro g or greater? inertial impaction what factors increase the rate of inertial impaction of particles greater than 2 micro grams in diameter? bifurcations and obstructed airways what term best describes activity of aerosol particles less than 3 micrograms in diameter throughout distal airways? diffusion and browning movement what characteristic of an aerosol influences its ability to penetrate mucous barrier? solubility of aerosol particles, charge, size of particles pneumatic nebulizers operate according to whcih physical tenets? bernoulli principle what % of nominal dose would remain in nebulizer of nebulizer had a residual volume of 1ml and fill volume of 2ml 50% while nebulizing alb to pt via svn therapist hears sputtering sound originiating from neb how should respond? terminate treatment why pass over humidifiers preferred over pneumatic nebulizers? pass over trasnmit fewer pathogens which following considerations is most important when using large volume nebulizer to provide oxygen and humidification to an infant in an incubater? preventing a high noise level from developing how can pt avoid problem of terminating inhalation when a plume from oressurized mdi impacts the oropharynx? use a valved holding chamber ped pt w inspiratory flow 20l.min enters emergency department wheezing and sob what devices would be most effective? svn which functions are served by spacer and holding chambers in conjunction with pMDIs reduction in oropharyngeal deposition of drug, elimination of cold freon effect, and improvement in lower respiratory tract deposition why should pMDI containing steroids be used with a valved holding chambe? reduce risk of thrush/ yeast infection for which of following types of pts would DPI be contraindicated? 4 yo, 85 yo w copd, altered loc teen physician in er attending to a 12 yo exacerbation of asthma, physician asks therapist to recommend a med w synergistic effect w b2 agonist during asthma exacerbations ipratropium bromide 18 mth pt brought to er exhibiting s/s acute athma episode and administered as a B2 agonist to pt doesn’t respond favorably what conditions could be responsible? aspiration of foreign object therapise receoves an order to admin bronchodilator in line to infant, must not significanlty increase pts delivered todal volume what deliver device to use? vibrating mesh neb, ultrasonic, and pMDI what methods are acceptable for delivering drug via pMDI to an intubated neonate receiving mechanical vent? through resuc bag chest physiotherapy procedure includes which of the following techniques? postural drainage, percussion, coughing when performing et suction on neonate why should therapise routinely avoid advancing the catheter tip beyond the distal tip? prevent development of bronchial stenosis and granulation what maneuver is characterized by having ot forcibly exhale from middle middle to low lung volume though an open glotts? active cycle of breathing during autogenic drainage at which of following levels does pt begin breathing? expiratory reserve volume by which of following mechanisms are high frequency chest compressions supported to mobilize tracheal secretions? by generating high expiratory air velocities what do postural drainage postitive expiratory pressure therapy autogenic drainage forced expiration techniques and high frequency chest compressions have in common? they attempt to prevent dynamic airway collapse what most commonly cited complication of chest physiotherapy? hypoxemia how chould pt receiving CPT while in an icu be monitored? spo2, rr, pulse what the most important variable used to assess efficacy of CPT? amount of mucus ontained during and after treatment whaich of the following pts is incentive spiromtery contraindicated? uncooperative, physically dissabled, and very young what components should be considered when preopertaively teching a child how to do is? paretns involvment, reason, demonstration during postop what should be volume goal dor is? 75% if preop what are some problems w admin ippb to peds? coordinating deep breath, securing pt cooperation, asynchronouse breathing when giving ippb tx to ped pt what determins level of pressure set by therapist? achieving volume goal, observing minimal volume increase, seeing pt becomines intolerant of pressure increase which assessments used to evaluate pt response to Ippb? heart rate and respiratory rate whaich aspects of IPPB treatmentneed to be documented in the pts chart after the treatment? peak flow, sensitivity setting which of following assesment used to eval ots response to IPPB? heart rate and respiratory rate which aspect ippb treatment need to be documents in pts chart after treatment? peak flow, sensitivity setting vascular smooth muscle is largel dependent on which of the following intracellular ions? ca smooth muscle contractions begin w release of which of the following ions from the sarcopasmic reticulum? ca which substance prevents relase of ca from sarcoplasmic reticulum? cGMP-dependant kinase what is the primary physiologic activity of inhaled notric oxide? pulmonary vasodilation which of the following meds contribute to an increased right to left intrapulmonary shunting? nitroprusside and prostacyclin whats the product of reaction between o2 and nitric oxide? no2 early scavenger systems were designated to protect health care workers from which of the following gases? no2 whats the putpose of admin heliox to pts? reduce wob what type of flow pattern prevails in healthy person from glottis to 10th airway generation? turbulent flow how does heliox comair to air o2 as carrier gas? more aerosol deposited w heliox terapist is using o2 flowmeter to deliver 80:20 heliox to pt reading flowmeter is 10 lpm what is actually being received? 18 lpm what potential benefit of using heliox while mechanically vent pt w status asthmaticus minimize air trapping what aspects of mech vent are affected by use of heliox? inspiratory gas flow and volume what are some problems w heliox as soutce has during mech vent? high thermal conductivity of helium rapidly cools wire flow anemometer stimulating high flow condition which anomalies are features of hypoplastic left sided heart syndrome aortic shunting and absent or small left ventricle what are consequences of ratio of puml blood flow to systemic blood flow? significantly above 1.0? decreased renal blood flow and metabolic acidosis whats relationship between cold pink extremities and the QpQs ratio qp qs prob too high whats therapeutic goal of admin of fractional concentration of fio2 of 0.18 to an infant? increase pulmonary vascular resistrance whcih inhaled anesthetic gases have demonstrated possibility to treat status asthmaticus? halothane, isoflurane, sevoflurane ehaich inhaled anesthetics should therapise recomment to admin via face mask to conscious spont breathing ped pt asthma halothane xenotransplantation is the use of___organs in humans animal in 1980’s what was the major indication for heart transplantation? cardiomyopathy whats predominant priblem leading to heart transplant in children younger than 1 year congential cardiac lesions whats predominant cause of early postop mortality associated w heart transplant graft failure what problems are associated w long term heart transplant pts? cad, coronary vasculopathy which cardiac problems is responsible for cast majority of neo cardiac transplant hypoplastic left ventricular what are some reasons for decline in heart lung transplant among infants? difficulty of donor, avoiding cardiac rejectio, averting premature cad which chronic lung disease is the most common indication for bilateral lung transplant? cystic fibrosis which condition is frequen cause of graft failure within 90 days after lung transplantation ischemia reperfusion which of following meds are used as antirejection agents? cyclosporine, azathoiprine and mycophenolate mofetil what conditions are considered complications of thoracic organ transplantation resp fail, bronchiolitis obliterans, infection 24 hrs after ped pt undergone lung transplan, therapist notices x-ray consitent w edema how is it best interpreted? ischmie reperfusion injury therapist notices ped pt w lung transplant 6 days abundant lower airway secretion w out fever, abundant thick mucous, bronchorrhea therapist notices following signs in ped pt who recently had heart transplant: decreased contractility, chf, tachy, malaise pt in rejection while working w recent lung transplant pt therapist observes: tachy, bibasilar inspiratory crackles, increased intertitial infiltrates on chest xray, o2 destat, poor spirometry lung rejection why does pulmonary infection rate for lung transplant appear to be higher than w other solid organ transplants? because lung is in direct contact with the external environment which of following microorganisms is associated w increased mortality among pts w cystic fibrosis? burkholderia cepacia months after receiving lung transplant a pt w cystic fibrosis exhibits foloowing signs and symptoms: increasing dyspnea, increasing cough w sputum, colonization pseudamonas bronchiolitis obliterans which of following meds are associated w decreased wbc caused by bone marrow suppression? azathioprine mycophenolate mofetil which forms of interaction tend to occur between resp pt who receives lung transplant mech vent, pulm rehab, broncho pulm hygeine