Question Answer
How is a tissue sample during this Percutaneous LUNG BIOPSY procedure? refers to obtaining a tissue sample through a small puncture in the chest wall as opposed to obtaining the sample through a surgical opening or from the airways during bronchoscopy.
Why would the physician perform this Percutaneous LUNG BIOPSY procedure? local anesthetics are administered
In what position should the PT be placed for this Percutaneous LUNG BIOPSY procedure? Semi Fowler’s or decubitus position with the healthy lung dependent.
List the potenial hazzards of Percutaneous LUNG BIOPSY? Infection Pneumothrax Bleeding
What is the most common disorder that requires a thoracentesis? PLEURAL EFFUSION
How can the presence of a pleural effusion be established? Physical Exam- revals flatness to percussion and diminished breath sounds and tracheal shift away from site. X-RAY- Lateral decubitus film shows concave upper border or a continual line from the diaphragm to apices. Ultrasound techniques
Briefly Describe the THORACENTESIS procedure? PT sitting up leaning forward, 3-10 ml of a 2% lidocaine is used,25 gauge neddle used, A longer neddle/anesthetize the thickness of chest wall, neddle is inserted the 7th 0r 8th intercostal space, neddle inserted to flud level reached,100-300ml/50syringe
How would a TRANSUDATE FLUID appear? clear/has a light straw color fluid also called serous fluid
What type of disorder is associated with TRANSUDATE FLUID? CONGESTIVE HEART FAILURE
What is EMPYSEMA? a chronic, irreversible disease of the lungs characterized by abnormal enlargement of air spaces in the lungs accompanied by destruction of the tissue lining the walls of the air spaces.
What type of fluid is associated with EMPYSEMA? has an opaque appearance and is called EXUDATE FLUID
EXUDATE FLUID is indicated by what pH level? pH less than 7.30
PURULENT FLUID is defined as: Pus filled exudate
MUCOPURULENT FLUID contains both ___ and ____? mucus and pus extudate
Infection would produce what color fluid? yellow or milky excudate fluid
What are three types of SLEEP APNEA disorders? CENTRAL APNEA due to loss of ventilation effort OBSTRUCTIVE APNEA due to blockage of the upper airway Mixed APNEAa combination of the Central and Obstructive types
How will the following present during the sleep study CENTRAL PROBLEM? if nasal flow DECREASES AND RESPIRATORY EFFORT DECREASES then desaturation is a result of CENTRAL problem
How will the following present during the sleep study OBSTRUCTIVE PROBLEM? if nasal flow DECREASES but RESPIRATORY EFFORT CONTINUES then desaturation is a result of OBSTRUCTIVE problem
INDUCTIVE PLETHYSMOGRAPHY is performed to monitor? chest motion during sleep stuides
Treatment for CENTRAL SLEEP APNEA would include? weight loss, surgery,respiratory stimulants,Tracheostomy, Nasal/mask CPAP and/or NIPPV therapy
Treatment for OBSTRUCTIVE SLEEP APNEA would include? weight loss, surgery,respiratory stimulants,Tracheostomy, Nasal/mask CPAP and/or NIPPV therapy
List the two common conditions requiring chest tube insertion? Pneumothrax Hemothorax
Describe the location of the chest tube if the tube is to drain AIR from the pleural space? it is placed in the anterior chest (second intercostal space in the midclavicular line)
Describe the location of the chest tube if the tube is to drain FLUID from the pleural space? it is placed in the fourth or fifth intercostal space in the midaxillary line)
How is suction regulated in a three-bottle suction drainage system? the amount of negative pressure being applied above the water seal
Explain how PULMONARY EDEMA may result following insertion of a chest tube? may result if there is a malfuction that creates
What does continuous bubbling in the water seal bottle indicate? it can be assumed that 10cm of negative pressure is being maintained by the suction contral bottle and applied to the drainage system
What action should be tacken if the water seal bottle breaks? submerge chest tube in a glass of water, if PT is receiving mechanical ventilation then leave the tube open to atmospheric air until a new system can be set up
Describe the compartments contained in a disaposable drainage unit? consists of three parts resembles the three bottle system
How much water should be in a water seal chamber? Approximately 1 to 2cm of water
Describe the movement of water in the water seal chamber during spontaneous ventilation. the water rises toward the PT side of the chamber during inspiration and returns to the other side on expiration. Normal movement of water is 2 t0 6 cm. The movement is accentuated during greater inspiratory and expiratory effort
How does the movement of water in the water seal chamber differ during POSITIVE PRESSURE ventilation. the movement of water is reversed due to positive pressure within the thorax and the pleural cavity
How does the disposible drainage unit differ when there is no suction applied to the control system? there will be no bubbling in the suction control chamber; the unit will resemble a two-bottle gravity drainage unit
Voloume lost through the peripherial airways and chest tube is calculated by? Delivered Tidal Volume (800ml) — Exhaled tidal volume (600ml) = lost tidal volume(200ml)
How long should the chest tube be clamed brfore removing it? 24 hours before removing the tube
What action should be taken if the PT showes signs of respiratory distress while the chest tube is clamped place? unclamp tube for respiratory distress or the x-ray indicates a pneumothorax or pleural effusion
How should the PT be instructed to breath just before removing the chest tube? PT takes a deep breath,exhales and performs a Valsalva Maneuver
What should be done if a 5% pneumothrax is shown to be present? <10% pneumothrax may not require traetment unless PT shws significant distress
What should be done if a 25% pneumothrax is shown to be present? >20% pneumothrax requires a chest tube
Describe the purpose of an exercise tolerance test? exam used to evaluate the ability of the heart and lungs to provide oxygen and remove carbon dioxide from the bloodstream
List 4 indications for an excercise tolerance test? complaint of dyspnea on exertion Determine Ventilatory limitations to work Determine Cardiac limitations to work Determine Maximum workload
List the formula to calculate the PTs maximum heart rate? 220- Age in years
List the equipment necessary to perform an Exercise TOLERANCE test? treadmill or riding a cycle ergometer (bike)
Describe the purpose of a BRONCHALVEOLAR LAVAGE? is for the diagnosis and treatment of alveolar filling disorder
What piece of equipment is used when performing a BRONCHALVEOLAR LAVAGE of an entire Lung? a CARLENS TUBE (double lumen tube) is inserted to ventilate lung while other is filled saline and a complete lavage is done
Apnea monitoring is recommended for what type of infants? for an infant who may be at risk for periods of significant apnea (>20sec)
Describe the indication of apnea monitoring for infants who are at risk for SIDS? One or more Apperent Life Threating Episodes. the infant has apnea,cyanosis,choking,or lifelessness that require stimulation or CPR, Sibling of a SIDS baby, Preterm infant, Snoring in infant
List the criteria for discontinuing an Apnea monitor. 2 months free of event, No monitor alarms on apnea settings of >20 sec and heart rate at <60/min
Question Answer
A lateral decubitus chest radiograph shows a border from the diaphragmatic area to the apices. This is most indicative of which of the following? Fluid in pleural cavity
During a Thoracentesis procedure serous fluid is drawn from the PT. The finding assists in the diagnosis of which disease process? Congestive Heart Failure
Which of the following is one of the primary indications for BPAP? Central Sleep Apnea
A PT diagnosed with occulsive sleep apnea will display what type of breathing pattern during an afternoon nap study? Nasal flow descrease, Respiratory effort increases and Sp02 descrease
A PT is intubated and transported to ED via ambulance PT involved in a motor cycle accident. Respiratory performs assessment and notices asymmetrical chest movement. Palpation is performed and is NEG for crepitus.Therapist should immediately Pull the endotracheal tube back slightly
PT TV 800ml, PT having difficulty maintaining. Bilateral chest tube inserted for plural effusions. ph 7.33 PaC02 51 Pa02 70 HC03 25 SIMV F 12/min, totalrate of 28/min,35% oxy What should be done Assess volume lost through chest drainage system
A 52 yr male pt is undergoing a sleep study with CPAP and Oxygen titration. 2LPM 02 is being bled into CPAP level of * cmH20 Sp02 reading fluctuate between 83-86% The respiratory therapist would interpret this information as Inadequate oxygenation support
During the past six months a PT has experienced recurrent infiltrates requiring hospiitalization for drainage. Which of the following should be recommend to help determine the cause of this problem? PERCUTANEOUS BIOPSY
A PT in the ICU is receiving continuous Mechanical Ventilator check. The respiratory therapist notices the lack of a water seal. Until a closed system can be reestablished, the therapist should Leave the chest tubes open to atmospheric air
After undergoing polysomnography testing a PT learns he experienced 3 to 4 apneic periods per hour lasting 8 seconds or less. The respiratory therapist is asked for her recommendation on treatment for this PT. Which of the following suggest? Nothing,this is not definitive for sleep apnea
Question Answer
What are the indications for electoencephalography (EEG)? brain tumors, traumatic brain injuries, retardation, loss of brain function, epolepsy/ seizures, evaluatoion of sleep disorders
What is the most definitive test for diagnosing a pulmonary embolism? pulmonary angiography
indication for pulmonary angiography? high clinical suspicion for pulmonary embolism, intermediare or indeterminate V/Q scan
what is a echocardiogram? ultrasonography of the heart
what are the indications for echocardiography? Valvular disease or dysfunction, myocardial disease, abnormalities of cardiac blood flow, cardiac anomalies in the infant, abnormal heart sounds