abnormal breathing pattern seen as a sinking inward motion of the abdomen with each inspiratory effortAbdominal paradox
inward movement of the lower lateral margins of the chest wall with each inspiratory effort owing to a low, flat diaphragm as seen in emphysemaHoover sign
deep and labored breathing pattern often associated with severe metabolic acidosis, particularly diabetic ketoacidosisKussmaul respirations
difficult breathing in the standing position, which is relieved in the lying or recumbent positionPlatypnea
alternating strong and weak beatsPulsus alternans
abnormal decrease in pulse pressure with each inspiratory effortPulsus paradoxus
general term referring to the relative state of a patient’s consciousness or alertnessSensorium
cycles of respiration that are increasingly deeper then shallower with possible periods of apneaCeyne-stokes
prolonged inspiratory phasesApneustic breathing
the difference between the systolic and diastolic pressure readingsPulse Pressure
Large cylinders and attachmentsAmerican Standard Safety System (ASSS)
Controls both pressure and flowRegulator
Low pressure gas connectorsDiameter-index safety system (DISS)
Constant pressure flowmeter device. Measures true flow.Thorpe tube
Small CylindersPin-Index Safety system (PISS)
Used in combination with adjustable reducing valve. Ideal for patient transports.Bourbon Gauge
Reduce gas pressure to useable levelReducing Valve
Regulating agencyDOT
Fractional distillationOxygen production
Can manage severe cases of airway obstructionHelium
Low flow O2 delivery systems used in respiratory care include all of the following except: A. Nasal Cannula B. Nasal Catheter C. Air entrainment mask D. Transtracheal catheterC. Air entrainment mask
You enter the room of a patient who is receiving nasal O2 through a bubble humidifier at 5 L/min. You immediately notice that the humidifier pressure relief is popping off. Which of the following actions would be most appropriate in this situation?Look for crimped or twisted delivery tubing
A physician orders 2 L/min O2 through a simple mask to a 33 year old postoperative women with moderate hypoxemia breathing room air (PaO2 = 52 mmHg). What would be the correct action at this time?Recommend a flow of at least 5 L/min to wash out carbon dioxide
A true high flow O2 delivery system should provide at least what flow?60 L/min
An O2 delivery device takes separate pressurized air and O2 sources as input, then mixes these gases through a precision valve. What does this describe?O2 blending system
What best defines an aerosol?suspension of liquid or solid particles in a gas
Which of the following factors affect pulmonary deposition of an aerosol? I. size of particles II. shape and motion of the particles III. physical characteristics of the airwaysI, II, III
Which of the following techniques will increase aerosol deposition by sedimentation in the lungs10 second breath hold
Where do most aerosol particles that are less than 3 micrometers deposit?Alveoli
What is the primary hazard of aerosol drug therapy?drug reactions
All of the following drugs or drug categories have been associated with increased airway resistance and bronchospasm during aerosol administration except: A. Albuterol B. Steroids C. Antibiotics D. AcetylcysteineA. Albuterol
Drug aerosol delivery systems include all of the following except: A. DPIs B. Spinning disc nebulizer C. MDIs D. Small volume jet nebulizersB. Spinning disc nebulizer
Before inspiration and actuation of a metered-dose inhaler, the patient should exhale to which of the following?functional residual capacity
To ensure delivery of the proper drug dosage w/ a MDI, which of the following must be done be4 its use?I. The canister valve stem should be cleaned with a pin. II. The can should be warmed to hand or body temp. III. The can should be vigorously shaken.II and III
Which of the following groups of patients are most likely to have difficulty using a simple metered-dose inhaler for aerosol drug therapy? I. patients in acute distress II. infants and young children III. elderly personsI, II, and III
Which of the following devices depends on the patient’s inspiratory effort to dispense the dose?dry power inhaler
During aerosol delivery using a SVN set at 8 L/min, a pt asks that the head of the bed be lowered to a semi-Fowler’s position. After doing so, u observe a sig drop in SVN aerosol output,despite there being 3 ml of soln left.How do you correct the problem?Reposition the patient so that the SVN is more upright.
Normally, when using a 50-psi flowmeter to drive a small-volume jet nebulizer, to what should you set the flow?6 to 10 L/min
To minimize a patient’s infection risk between drug treatments with a small-volume jet nebulizer (SVN), what would you do?Rinse the SVN with sterile water; air dry.
A physician has ordered the antiviral agent ribavirin (Virazole) to be administered by aerosol to an infant with bronchiolitis. Which of the following devices would you recommend in this situation?small-particle aerosol generator (SPAG)
Persistent breathing at small tidal volumes can result in which of the following?compression atelectasis
Which of the following patient categories are at high risk for developing atelectasis? I. those who are heavily sedated II. those with abdominal or thoracic pain III. those with neuromuscular disordersI, II, and III
What is the major contributing factor in the development of postoperative atelectasis?repetitive, shallow breathing
Which of the following clinical findings indicate the development of atelectasis? I. opacified areas on the chest x-ray film II. inspiratory and expiratory wheezing III. tachypnea IV. diminished or bronchial breath soundsI, III, and IV
How do all modes of lung expansion therapy aid lung expansion?increasing the transpulmonary pressure gradient
How can the transpulmonary pressure gradient be increased? I. increasing alveolar pressure II. decreasing pleural pressure III. decreasing transthoracic pressureI and II
Lung expansion methods that increase the transpulmonary pressure gradients by increasing alveolar pressure include which of the following? I. Incentive spirometry (IS) II. PEEP therapy III. IPPB therapy IV. expiratory positive airway pressure (EPAP)II, III, and IV
Which of the following modes of lung expansion therapy is physiologically most normal?incentive spirometry
An alert and cooperative 28 yr old woman w/ no prior history of lung disease underwent cesarean section 16 hours earlier. Her x-ray film currently is clear. Which of the following approaches to preventing atelectasis would you recommend for this patient?incentive spirometry
Which of the following situations is a contraindication for incentive spirometry? I. a patient whose vital capacity is less than 10 ml/kg II. a patient who cannot cooperate or follow instructions III. an unconscious patientI, II, and III
Which of the following is not a potential hazard or complication of incentive spirometry?decreased cardiac output
A postoperative patient using incentive spirometry complains of dizziness and numbness around the mouth after therapy sessions. What is the most likely cause of these symptoms?hyperventilation
Which of the outcomes would indicate improvement in a pt previously diagnosed with atelectasis who has been receiving IS? I. improved PaO2 II. decreased respiratory rate III. improved chest radiograph IV. decreased FVC V. tachycardiaI, II, and III
Ideally, when should high-risk surgical patients be oriented to incentive spirometry?preoperatively, before undergoing the surgical procedure
In teaching a patient to perform the sustained maximal inspiration maneuver during incentive spirometry, what would you say?“Exhale normally, then inhale as deeply as you can, then hold your breath for 5 to 10 seconds.”
The short-term application of inspiratory positive pressure to a spontaneously breathing patient best defines which of the following?intermittent positive-pressure breathing
Intermittent positive-pressure breathing is associated with a passive exhalation.True
Which of the following patient groups should be considered for lung expansion therapy using intermittent positive-pressure breathing (IPPB)?I. patients with clinically diagnosed atelectasis who are not responsive to other therapies II. patients at high risk for atelectasis who cannot cooperate with other methods
What is the optimal breathing pattern for intermittent positive-pressure breathing (IPPB) treatment of atelectasis?slow, deep breaths held at end-inspiration
Which of the following is an absolute contraindication for using intermittent positive-pressure breathing?tension pneumothorax
In order to eliminate leaks in an alert patient receiving intermittent positive-pressure breathing therapy, which of the following adjuncts would you first try?nose clips
During administration of a continuous positive airway pressure flow mask to a patient with atelectasis, you find it difficult to maintain the prescribed airway pressure. Which of the following is the most common explanation?system or mask leaks
Which of the following is/are necessary for normal airway clearance? I. patent airway II. functional mucociliary escalator III. effective coughI, II, III
All of the following drug categories can impair mucociliary clearance in intubated patients except:bronchodilators
All of the following are goals of airway clearance therapy except:Reverse the underlying disease process.
All of the following are considered airway clearance therapies except:incentive spirometry
The application of gravity to achieve specific clinical objectives in respiratory care best describes which of the following?postural drainage therapy
Properly performed chest vibration is applied at what point?throughout expiration
Soon after you initiate postural drainage in a Trendelenburg position, the patient develops a vigorous and productive cough. Which of the following actions would be appropriate at this time?Move the patient to the sitting position until the cough subsides.
All of the following would indicate a successful outcome for postural drainage therapy except:decreased sputum production
What is the point in the respiratory track where inspired gas reaches body temperature, ambient pressure, saturated (BTPS) conditions?isothermic saturation boundary
What is the primary goal of humidity therapy?maintain normal physiologic conditions
Indications for warming inspired gases include all of the following except:reducing upper airway inflammation or swelling
Inhalation of dry gases can do which of the following? I. increase viscosity of secretions II. impair mucociliary motility III. increase airway irritabilityI, II, and II
What device adds molecular water to gas?humidifier
Factors affecting a humidifier’s performance include all of the following except:outlet size
What is the most important factor determining a humidifier’s performance?temperature
The greater the temperature of the gas, the:more water vapor it can hold
What is the simplest way to increase the humidity output of a humidifier?Increase the temperature of either the water or the gas
Which of the following types of humidifiers are used in clinical practice? I. heat-moisture exchanger II. passover humidifier III. bubble humidifierI, II, and III
Simple unheated bubble humidifiers are commonly used to humidify gases with what type of systems?nasal oxygen delivery
What is the goal of using an unheated bubble humidifier with nasal oxygen delivery systems?Raise the humidity of the gas to ambient levels.
The relief valve on a bubble humidifier serves which of the following functions? I. It indicates when flow has been interrupted. II. It protects the device from pressure damage. III. It warns you when the water level is low.I and II
To protect against obstructed or kinked tubing, simple bubble humidifiers incorporate which of the following?pressure relief valve
When checking an oxygen delivery system that incorporates a bubble humidifier running at 6 L/min, you occlude the delivery tubing, and the humidifier pressure relief immediately pops off. What does this indicate?normal, leak-free system
A design that increases surface area and enhances evaporation by incorporating an absorbent material partially submerged in a water reservoir that is surrounded by a heating element best describes what type of humidifier?wick
Which type of humidifier “traps” the patient’s body heat and expired water vapor to raise the humidity of inspired gas?heat-moisture exchanger
Hazards and complications of bland aerosol therapy include all of the following except:hemoconcentration
What is the most common device used to generate bland aerosols?large-volume jet nebulizer
Which of the following nebulizers uses a piezoelectric transducer to generate liquid particle aerosols?ultrasonic nebulizer
All of the following sites are used for arterial blood sampling by percutaneous needle puncture except:carotid
Indications for arterial blood sampling by percutaneous needle puncture include all of the following except the need to:assess the adequacy of tissue oxygenation
Why is the radial artery the preferred site for arterial blood sampling? I. It is near the surface&easy to palpate and stabilize. II. The ulnar artery normally provides good collateral circulation. III. The radial artery is not near any large veins.I, II, and III
All of the following are grounds for finding an alternative site for arterial puncture except:anticoagulation therapy
Precautions and/or possible complications of arterial puncture include which of the following? I. arteriospasm II. embolization III. infection IV. hemorrhageI, II, III, and IV
Which of the following describes the correct procedure for an Allen test?Compress both the radial and ulnar arteries, then release the ulnar artery.
You are asked to calibrate an O2 analyzer. Which of the following gases would you use for this procedure? I. 100% oxygen. II. 50% oxygen. III. 21% oxygen (room air).I and III
Which blood gas analyzer electrode uses a separate reference electrode?pH
To measure PCO2, blood gas analyzers use what electrode?Severinghaus
How is the accuracy of a blood gas analyzer determined?comparing the analyzer’s measurements to known values
What is indicated by rounding of the costophrenic angles seen on the posteroanterior or lateral chest film?pleural effusion
What chest x-ray view is best used to identify a pleural effusion?lateral decubitus
Which of the following values represents a normal serum potassium level?3.5 to 4.8 mEq/L
Which of the following tests is used to evaluate renal function?creatinine
What type of white blood cell increases in response to allergic reactions?eosinophils

A PaO2 below what value would be considered severe hypoxemia?40 mm Hg
Which of the following is FALSE regarding body fluids and electrolytes?Interstitial fluid contains substantially more protein than does plasma.
What term is used to describe a red blood cell (RBC) count that is below normal values? What term is used to describe a red blood cell (RBC) count that is below normal values?Anemia
What is a normal level for CaO2?18 to 20 ml/100 ml
In which of the following clinical settings would hyperkalemia be a significant problem?During weaning from mechanical ventilation
Your patient has an elevated aspartate aminotransferase (AST). What two organs are most likely diseased?heart and liver
What is the normal anion gap?8 to 16 mEq/L
What term is used to describe the increase in neutrophils due to recruitment of marginated cells back into the circulating blood?Pseudoneutrophilia
What term is used to describe a potassium concentration that is below normal in the blood serum?Hypokalemia
A physician requests that you obtain and set up an arterial line system for invasive monitoring of blood pressure. Which of the following equipment would you gather?I. Pressurized intravenous bagII. Continuous flush deviceIII. Arterial catheterIV. Pressure transducerV. Amplifier or monitor
Which of the following is an isotonic solution?0.90% NaCl
In which of the following solutions do the molecules of solute remain intact?Nonpolar covalent
During examination of a patient’s extremities, you press firmly for a brief period on a fingernail. You observe that it takes about 5 seconds for the color to return to the nail bed. This finding is most consistent with which of the following?Reduction in cardiac output or poor peripheral perfusion.
What breathing pattern is associated with diabetic ketoacidosis?Kussmaul breathing
What term is used to describe a sodium concentration that is below normal in the blood serum?Hyponatremia
What type of solution could have 1 gEq of solute per L of solution?Normal
Factors contributing to imprecision (random) errors during blood gas analysis include all of the following except.Contaminated buffers
Which of the following axis placements represents right-axis deviation?+120
What disease is associated with a barrel chest?Emphysema
Which of the following is TRUE of peripheral cyanosis?Sign of inadequate tissue perfusion.
What is the most common cause of jugular venous distention (JVD)?Right-sided heart failure
Which of the following is NOT one of the formed elements in the blood?Electrolytes
What is the technical term for secretions from the tracheobronchial tree that have not been contaminated by the mouth?Phlegm
All of the following sites are used for arterial blood sampling by percutaneous needle puncture except:Carotid
While palpating the chest of a patient who repeats the words “ninety-nine,” you note an area of increased tactile fremitus over the left lower lobe. Which of the following could explain this finding?Pneumonia
Which of the following statements is NOT true about type 1 and type 2 diabetes?Type 1 is most often due to increased caloric intake.
Factors contributing to bias (systematic) errors during blood gas analysis include all of the following except.Statistical probability
What does the presence of stridor indicate?Upper airway obstruction
Which of following is NOT a nonhydroxide base?Ammonium
Continuous SpO2 monitoring (versus a spot check) is indicated in all of the following situations except.O2 therapy
An increase in intensity and clarity of vocal resonance because of enhanced transmission of sound is referred to as which of the following?Bronchophony
How is the gram-equivalent (gEq) weight of a substance computed?Dividing its gram atomic weight by its valence.
Pick the correct statement as it relates to hemoglobin and acid-base buffering.Deoxygenated hemoglobin is a fairly strong base.
A patient with asthma would tend to exhibit which of the following?Prolonged exhalation
You are asked to provide continuous monitoring of the FIO2 provided by a humidified O2 delivery system using a galvanic cell analyzer. Where would you install the analyzer’s sensor?Proximal to the heated humidifier.
Precautions and/or possible complications of arterial puncture include which of the following?I. ArteriospasmII. EmbolizationIII. InfectionIV. Hemorrhage
What is the normal range for serum phosphate?1.2 to 2.3 mEq/L.
Which of the following changes in the characteristics of wheezing indicate improvement in airway obstruction following bronchodilator therapy?Lower pitch, shorter duration
What term best describes a loud, high-pitched continuous sound heard (often with the unaided ear) primarily over the larynx or trachea during inhalation in patients with upper airway obstruction?Stridor
What term is used to describe a white blood cell (WBC) count that is below normal values?Leukopenia
Positive ions are referred to as what?Cations
Clinical manifestations of hypocalcemia would NOT include which of the following?Depressed tendon reflexes
During auscultation of a patient’s chest, you hear coarse crackles throughout both inspiration and expiration. These sound clear when the patient coughs. Which of the following is the most likely cause of these adventitious sounds?Movement of excessive secretions in the airways.
While observing a patient’s breathing, you note that the depth and rate first increase, then decrease, followed by a period of apnea. Which of the following terms would you use in charting this observation?I. Central nervous system disorderII. Congestive heart failure
How long should you wait before drawing an ABG on a chronic obstructive pulmonary disease (COPD) patient whose FIO2 has just been changed?20 to 30 minutes
Which of the following describes an aspect of pH?Any solution with a pH of 7 is neutral.
In which of the following conditions might the intensity of the heart sounds be reduced?I. Heart failureII. Severe obesityIII. PneumothoraxIV. Pleural effusionV. Pulmonary hyperinflation
Your patient has an abnormal sensorium.Which of the following is most likely true?He is confused about where he is.
What is the relation between pure water and acid-base balance?The concentrations of both H+ and OH- ions are equal.
Which of the following symptoms is least often associated with hypoglycemia?Shortness of breath
Joseph BlackDiscovers carbon dioxide
Joseph PriestlyCredited with the discovery of oxygen
Thomas BeddoesUses oxygen to treat various disorders
AARCPromote profession & practice
NBRCTesting & credentialing organization
CoArcProgram accreditation organization
Service AreasGeneral Therapeutics, Critical Care, Emergency Care, Diagnostics, Pulmonary Rehabilitation
Boyle’s LawVolume of gas varies inversely with its pressure P1V1 = P2V2
Charles’ LawVolume of gas varies directly with changes in its temperature V1/T1 = V2/T2
Gay-Lussac’s LawPressure exerted by a gas varies directly with its absolute temperature P1/T1 = P2/T2
Combined Gas Law(P1xV1)/T1 = (P2xV2)/T2
Minute Ventilation calculationVE = VT x f
Alveolar Ventilation calculationVA = (VT – VD) x f
ShuntPerfusion without ventilation
DeadspaceVentilation without perfusion
Oxygen Content equation(1.34 x Hb x SaO2) + (PaO2 x 0.003)
ABG rangespH:7.35–7.45, PaCO2(Resp):35 – 45 mmHg, HCO3(BiCarb):22 – 26 mEq/L, Base Excess: -2 to +2
Cylinder VolumesE = 22cu.ft. / 623L G = 187cu.ft. / 5292L H = 244cu.ft. / 6905L K = 275cu.ft. / 7783L
Cylinder Duration equation(Tank Pressure x Tank Factor) / Flow
Tank FactorsE = .28, G = 2.41, H = 3.14
NFPARegulates storage & handling of cylinders, as well as central supply gas & piping systems.
DOTRegulates cylinder construction, testing, & transport.
CGASets all safety standards (ASSS, DISS, &PISS)
FDASets medical gas purity standards.
Liquid to Gas conversion1cu.ft. liquid O2 = 860cu.ft. gaseous O2
Cubic Feet to Liters conversion1cu.ft. gaseous O2 = 28.3L gaseous O2
Refractory HypoxemiaLow levels of O2 in blood that cannot be corrected with add’l O2. Use PEEP or CPAP.
Responsive HypoxemiaLow levels of O2 in blood that can be corrected w/ add’l O2 – Significant increase in PaO2 w/ increase in FiO2 due to V/Q mismatch or diffusion defect. Use low or high flow O2 device.
Manifestations of HypoxemiaTachycardia – high heart rate > 100bpm Tachypnea – high rate of breathing > 20L/m Restlessness / confusion (nasty, mean) Pulmonary Hypertension
Alveolar Air equationPAO2 = FiO2(760 – 47) – PaCO2 / 0.8 *If FiO2<60% don’t / by 0.8
AARC CPGs for HypoxemiaDocumented: PaO2 < 60mmHg SaO2 < 90% Suspected: Acute M/I Severe trauma
High Flow DevicesWill meet pt’s inspiratory flow needs, Air Entrainment Mask < .40, AE Nebs – high flow or < .40
Low Flow DevicesWill not meet pt’s inspiratory flow needs, Nasal / reservoir cannulas, transtracheal O2 catheter, simple, O2 mask, partial & non-rebreather masks, Total Flow Question
Polorgraphic Oxygen AnalyzerComponents: silver anode, platinum cathode, KCI electrolyte soltn, polypropylene or Teflon membrane battery. Quick response time: <30 sec.
Galvonic Fuel Cell Oxygen AnalyzerComponents: Lead anode, gold cathode, KOH(potassium hydroxide) or CsOH(cesium hydroxide) electrolyte solution Longer response time: up to 60 sec.
HeOx TherapyLow density gases will decrease turbulence and WOB, helps O2 move better into airways. Tx of: stridor croup, foreign body aspiration, upper airway masses
HeOx Gas DensitiesAir 1.29g/L & O2 1.43g/L *80/20 He/Ox – 0.43g/L = flow x 1.8 *70/30 He/Ox – 0.55g/L = flow x 1.6
SpectrophotometryRed & Infrared light absorption on finger or earlobe to calculate HbO2
PhotoplethysmographyLight transmission to determine pulse
Pulse Oximetry*Red light is absorbed by deoxyHb *Infrared is absorbed by oxyHb *Low R/IR, ½ = High SpO2, 98% *High R/IR, 2/1 = Low SpO2, 60%
Adrenergic medsSympathetic, Catecholamines & Non-Catecoholamines, Side effects: tachycardia, tremor, headache, insomnia, nervousness
CatecholaminesRapid onset < 10 min, Short duration < 3hrs Epinephrine: Alpha 1, Beta 1 & 2 Racemic Epinephrine: Neb, Alpha 1, Beta 1 & 2
Non-Catecholamines (4-6hr duration)*Onset 15 – 20min, Peak 30 min, Metaproterenol – Neb/MDI/Tab, Pirbuterol – MDI, Albuterol – Q4 @ 2.5mg, Neb/MDI/TB/DPI, Levalbuterol – Q6 @ 1.25mg
Non-Catecholamines (Up to 12hr duration)Formoterol – Onset 3 min, Peak 30 – 60, DPI, Salmeterol – Onset 15 – 20, MDI/DPI, Arformoterole Tartrate – Onset 15 min, Neb
AnticholinergicsOnset 15 min, duration 4 – 6 hrs, Ipratropium Bromide (Atrovent) – MDI/Neb, Q6 – 8, Tiotropoim Bromide (Spiriva) – DPI, QDay, *Side effects – increased heart rate & blood pressure, decreased secretions
Asthma Maintenance DrugsMast Cell Stabilizers & Leukotriene Receptor Agonists
Mast Cell StabilizersIntal & Tilade (Not avail. In US)
Leukotriene Receptor AgonistsAccolate, Zyflo, Singulair – all 3 are mtce drugs
Proteolytic AgentPulmozyme (dornase alpha) – neb, 0.1% solution, commonly used with CF pts, can’t be mixed. *Side effects: pharyngitis, laryngitis, conjunctivitis
Henry’s Gas LawDirectly proportional to partial pressure
Graham’s Gas LawInverseley proportional to the square root of the gases GMW
3 Major CartilagesEpiglottis, Thyroid, Crycoid
GlottisThe space between the vocal cords
Trachea16-20 C Shaped cartilages, bifurcates at the carina into the R & L mainstem bronchi
Bronchi orderMainstem, Lobar, Segmental, Sub-Segmental
BronchiolesThousands, terminal bronchioles are the last of the conducting airways.
PleuraeParietal: membrane that lines the ribcage, diaphragm, & mediastinum. Visceral: membrane that surrounds the lungs.
DiaphragmMajor muscle of inspiration, R & L, innervated by phrenic nerve
Inspiratory Accessory MusclesNeck, shoulders
Expiratory Accessory MusclesStomach
PericardiumFibrous, Parietal, Visceral (from outer most to inner most)
Heart LayersEpi-, Myo-, Endo- (from outer most to inner most)
ApneaNot Breathing
DyspneaShort of Breath
EupneaNormal Breathing
HyperventilationBlowing off CO2 < 35
HypoventilationCO2 level > 45
OrthopneaAbility to breathe only while sitting up
HyperpneaTidal volume > 10L/m
HypopneaTidal volume < 5L/m
BradypneaRate < 10L/m
TachypneaRate > 20L/m
Causes of Respiratory ACIDOSISAnesthesia, sedatives, narcotics Poliomyelitis, Myasthenia Gravis, Guillain-Barre Syndrome Sever obesity, COPD
Causes of Respiratory ALKALOSISAnxiety, fever, stimulant drugs, pain, hypobarism(high altitude) Acute asthma, Pulmonary Vascular Disease
Causes of Metabolic ACIDOSISLoss of BiCarb, Diarrhea, renal tubular acidosis, chloride administration, Diabetic ketoacidosis, alcoholic ketoacidosis, lactic acidosis, Drug or chemical induced = salicylate intoxication
Causes of Metabolic ALKALOSISAdmin/Ingestion of BiCarb, hypochloremia, diuretic therapy, Severe vomiting, nasogastric suction, corticosteroids
HumidifiersBubble, Passover, HME
NebulizersPneumatic: Jet,SVN,LVN,DPI,MDI. Electric: Ultrasonic,Mesh
AutoclavingUses steam under pressure. Rubber & plastic are easily damaged. Thermal indicators – temperature exposure. Biological indicators – sterilization
Ionizing Radiationx-rays/gamma rays. Limited use due to high cost, & the creation of toxic bi-products, long exposure time 48-72hrs
DisinfectionDestroys the vegetative form of pathogens but NOT spores
Low Level DisinfectionWill not kill resistant microorganisms
Acetic AcidBasically vinegar & water, used in homes to clean SVNS & tubes
Quaternary ammonium compoundsUsed to clean ventilators
Intermediate Level DisinfectionKill all vegetative bacteria & fungi, but not certain viruses
Ethyl & Isopropyl AlcoholGood surface disinfectants
PhenolicsLimited use surface disinfectants
IodophorsUsed primarily as an antiseptic agent (skin/tissue application – think IODINE)
High Level DisinfectionKills ALL vegetative microorganisms
GlutaraldehydeTrue sterilizing agent – kills SPORES w/ 3hr exposure time. Most widely use HIGH LEVEL disinfectant in Respiratory. Used w/ ventilator tubing, bronchoscopes, airways, & resuscitation bags.
Hydrogen peroxidePopular wound antiseptic, 6hr exposure time.
Sodium hypochlorite (bleach)Excellent surface disinfectant
Peracetic Acidw/ buffers is an excellent sporicidal agent
Ethylene OxideGood for heat sensitive equipment. Chemical indicators – ETO exposure. Bio indicators – sterilization
List the device and describe the technique that you would use to measure Peak expiratory flow rate, inspiratory capacity, slow vital capacity and negative inspiratory force.
Given a tidal volume and resp rate calc the minute volume
A healthy adult should have a peak expiratory flow rate in excess of
What would you predict for a vital capacity on a normal healthy person with no history of lung disease if VC=65-75 ml/IBW
What would you predict for a negative inspiratory force (NIF) or negative inspiratory pressure (NIP) in a person with no history of lung disease?
Describe the indications for a peak flow measurments
Describe the zones used in PEFR measurements discussed in class
Medical vacuum systemSeries of vacuum pumps, an air receiver, etc. where a neg.pressure is created so that suction maybe used in surgical or patient rooms
List 3 methods of o2 productionChemical method, fractional distillation, physical separation
Identify the most common method of commercial O2 productionFractional distillation
Identify reasons for an adjustable oxygen regulatorUsed to control both pressure and flow
Liquid gas cylinderGauge press. Is a measure of only the vapor press. Of gas in equilibrium w/liquid phase
Flow restrictors when exposed to a downstream resistance to flow?Can not change flow, cannot be set to incorrect
Liquid o2 resp. SystemMost cost efficient and convenient means of supplying oxygen to patients in hospital setting and those that would require continuous home o2
Gas filled cylinderDirectly proportional to the gas press. Ex. Press decrease 50% indicates a loss of 50% of the contained gas
True concerning O2 concentratorsAs flow rates increase delivered concentrations decrease
Which flow metering devices will indicate a flow higher than actual when exposed to a downstream resistance to flowBourdon gauge , flow restricted
List 3 categories of patients that are at high risk for developing atelectasisneuromuscular patients, heavily sedated patients, upper abdominal or thoracic surgery, spinal cord injusry, bed ridden patients and post-op
Indentify the major contributing factors in the development of postoperative atelectasissmoking, history of lung disease, ^ mucous prdxn, chronic bronchitis, inadequate nutritional intake
Identify indications for incentive spirometrytreatment of existing atelectasis and when conditions exist that make the development of atelectasis likely
Indentify which situations contraindicate ISpatient cannot be intructed,Vt less than 10ml/kg and IC less than 1/3 predicted
Describe the effects that may be seen in patients that experience of hyperventilationdizziness, drop in BP, pneumothorax, gastric distention
Describe IS devices and categorized two different typesused primarily as a preventative in a propholactic treatment; two types: volume oriented devices; measure and display amnt of air patient inhaled & flow oriented devices; display inspiratory flowrate and may attempt to estimate amnt of air inhaled
Describe flow-oriented IS devicesonly display inspiratory flowrate and may attempt to estimate the amnt of air inhaled.
Identify which parameters should be monitored in patients using ISdevice within reach of patient, periodic observation of patient compliance w/technique, new and increasing inspiratory volumes established each day
Choose the ideal time a high-risk surgical patient should be oriented to IS5-10 breaths per session every hour while awake
Describe the proper technique of breathing when teaching a patient to perform the sustained maximal inspiration (SMI) maneuverslow deep inhalation from FRC up to TLC, sustaining the inflation for a 5-10 sec. min of 3sec.
List critical steps involved in correct instruction in the technique of IS
Describe the ideal frequency a patient should performed an IS5-10 breaths every hour
Demo and identify methods to monitor patient’s response and progress
IC calculated for males20.72-(0.084xage)x(height in cm)
IC calculated for females16.34-(.075xage)x(height in cm)