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Competency/ Midterms
First semester competency and midterm for RCP 120 and 150
| Term | Definition |
|---|---|
| What can affect the results of a pulse oximeter reading? | Motion, sensor misalignment, dysfunctional hemoglobin, low perfusion, ambient light, vascular dyes, nail polish, fake nails |
| What does the SPO2 represent? | O2 saturation of a capillary bed |
| DISS | Used on thrope tubes and ventilator circuits |
| ASSS | Regulators that are used on large tanks (sizes F - H/K) |
| PISS | Regulators that are used on small tanks (up to E) |
| What gas does the color green represent? | Oxygen |
| What gas does the color gray represent? | Carbon |
| What gas does the color yellow represent? | Air |
| What gas does the color brown represent? | Helium |
| What gas does the color black represent? | Nitric oxide |
| What gas does the color blue represent? | Nitrous oxide |
| How are gas tanks stored? | On a tank rack or chained to the wall, away from heat sources, flammable gasses away from combustible gasses, full and empty tanks separated, signs posted not to smoke. |
| How are gas tanks transported? | Use a cylinder cart, make sure there is a protective cylinder cap in place, don't allow the tanks to strike one another, avoid dropping, dragging, or rolling the cylinders, and make sure they are correctly labeled |
| Why do we crack a tank before attaching the regulator? | To assure the cylinder valves are free from dust |
| Nasal Cannula | 1-6 L/min 22-44 FiO2 |
| Non-Rebreather Mask | 10-15 L/min 60-100 FiO2 |
| Partial Rebreather Mask | 6-10 L/min 60-65 FiO2 |
| Simple Mask | 6-10 L/min 40-60 FiO2 |
| Oximizer | 1-10L/min 24-60FiO2 |
| Oxymask | 1- flush L/min 24-90FiO2 |
| Aerosol trach mask | Depends on the FiO2 delivered and the flow requirements of the patient 21-40FiO2 |
| Venturi Mask | Depends on the FiO2 delivered and the flow requirements of the patient 24-55FiO2 |
| Aerosol t-piece | Depends on the FiO2 delivered and the flow requirements of the patient 21-100FiO2 |
| Aerosol face tent | Depends on the FiO2 delivered and the flow requirements of the patient 21-40FiO2 |
| Aerosol face mask | Depends on the FiO2 delivered and the flow requirements of the patient 21-100FiO2 |
| What is the difference with the non-rebreather and partial rebreather? | The flaps on the ports block air-entrainment on the non-rebreather which increases the FiO2 |
| What are the special characteristics of the Venturi mask? | Gives an exact or dialed in FiO2. Considered a high flow device |
| What is the oxymizer used for? | Used to conserve oxygen in home health patients |
| What is the trach mask, collar, and t-piece? | Administers aerosolized O2 or cool mist for humidification of artificial airway. |
| What is the aerosol face mask and face tent used for? | Administers aerosolized O2 or cool mist following extubation or for airway edema |
| When do we replace a HME? | When it is occluded or has large amounts of secretions |
| What type of device would you use on a burn patient and hypothermic patient and why? | Heated humidifier. Assists with controlling body temperature and restoring heat and also assists with thick sticky secretions |
| Why is it important to keep water in your heated humidifer? | Without the water in the humidifier you would have no humidity and no condensation. Lack of humidity can cause mucus plugging and dry airway. |
| What are the indications for humidity therapy? | Administration of dry medical gases at flows greater than 4 L/min. Overcoming humidity deficit created when upper airway is bypassed. Managing hypothermia. Treating bronchospasm with cold air, house fires, thick, tenacious secretions |
| What are the indications for Aerosol therapy? | Humidify the respiratory tract when patient has an artificial airway, Relieve an edematous airway, Sputum induction, thin secretions tat are thick and tenacious |
| Why is it important to keep water in your bland aerosol set up? | There will be no cool mist without the water. Dry air can then cause mucus plugging |
| What type of patient would you want to be careful using bland aerosol on? | Severe asthma |
| What do you do when the aerosol decreases? | Increase the flow |
| What is the liter flow for bland aerosol set up? | 8-10 L |
| What should be monitored while on aerosol therapy? | Heart rate, Respiratory rate, SPO2, Breath sounds, amount of sterile water in LVN, patency of corrugated tubing, color of sputum |
| How is the patient instructed to breath during a small volume nebulizer therapy treatment? | Slow inspiratory breaths; 1-3 second breath hold to enhance medication delivery |
| What should be monitored pre and post treatment of a small volume neb, MDI, and DPI? | Heart rate, respiratory rate, SPO2, Breath sounds, Peak flow |
| How is the patient instructed to breathe during an MDI treatment? | Slow deep breath with 5-10 second breath hold |
| How is the patient instructed to breathe during a DPI treatment? | Inhale deeply and forcefully; do not breathe back into the device |
| Anterior | Front |
| Posterior | Back |
| Lateral | Side |
| Inferior | Below / Lower |
| Superior | Above / Higher |
| Distal | Further from the middle |
| Proximal | Closer to the middle |
| Eupnea | Normal rate and depth of respirations |
| Hyperpnea | (Hyperventilation) Deep, rapid, and labored breathing. Causes: Pain, anxiety, hypoxia, cardiac and respiratory disease |
| Hyponea | (Hypoventilation) Shallow and slow respirations Causes: Damage to brain stem, obstructive sleep apnea. (Can be normal for a well conditioned athlete) |
| Kussmauls | Uniform breathing with increased rate and depth. Causes: Diabetic ketoacidosis |
| Biots | Irregular breathing, short and deep consistent volumes w/ periods of 10-30 seconds of apnea. Causes: Increased ICP (Intercranial pressure) Meningitis |
| Cheyne Stokes | Deep, rapid breathing w/ periods of 10-30 second apnea. Increase and decrease in depth. Causes: Overdose, stroke, CHF, Head injury |
| Paradoxical | (Flail chest) Respirations observe to be abnormal, chest expands on expirations, moves inward on inspirations. Causes: Rib fracture, sternal fracture, and trauam |
| Orthopnea | Dyspnea while laying down. Causes: Heart failure, emphysema, CHF |
| Kyphosis | (Humpback) Concave curvature of the spine |
| Scoliosis | Lateral curvature of the thoracic spine, causing chest protusio |
| Lordosis | (Swayback) Backward curvature of the lumbar spine |
| Kyphoscoliosis | Combination of the concave and lateral curvature of the spine |
| Pectus Excavatum | (Funnel chest) Sternum is depressed inward |
| Pectus Carinatum | (Pigeon chest) Sternum is protruding forward |
| Digital Clubbing | The enlargement of distal fingers. Causes: Chronic hypoximia |
| Barrel chest | Increased A-P diameter of the chest |
| Tactile Fremitus | Vibration felt on the chest wall as the patient speaks. Vibrations are decreased over pleural effusions, fluid, pneumothorax, overly muscular or obese. Vibes increase over atelectasis, pneumonia, and lung masses |
| Subcutaneous Emphysema | Air leaked into the subcutaneous tissue. Feeling is like crackling under the skin (crepitus) After chest trauma or thoracic surgery |
| Tracheal Deviation | Trachea deviates to the left or right, way from normal position |
| Hyperresonance | Loud, low-pitched, long duration that is produced over areas that contain a greater proportion of air than tissue. Causes: air-filled stomach, emphysema (Air-trapping), pneumothorax |
| Resonance | A low pitched, long duration heard over normal tissue. Cause Normal tissue |
| Dullness | Medium intensity and pitch, short duration of an area w/a higher proportion w/tissue or air Causes: Atelectasis, Consolidation, Pleural effusion, pleural thickening, Pulmonary edema |
| Flatness | Low amplitude over tissue Causes: Massive pleural effusion, massive atelectasis, pneumectomy |
| Tympanic | Drum like sound (air) Causes: Tension Pneumothorax |
| List the causes for tracheal shift toward affected side | Massive atelectasis and Mass/tumor |
| List the causes for tracheal shift away from affected side | Tension Pneumothorax, Massive pleural effusion |
| Define capillary refill and how to assess | Compressing the patients fingernail for a short time, then releasing it and assessing the amount of time it takes for blood flow to return. Normal is less than 3 seconds. Patients w/decreased cardiac output and poor digital perfusion have a longer time |
| Hypothermia | Low body temperature. Causes: Exposure, blood loss, excessive sweating, excessive heat loss, and burns |
| Hyperthermia | High body temperature Causes: Exposure, infection, decreased heat loss |
| Adult heart rate | 60-100 |
| Adult Respiratory rate | 12-20 |
| Adult Blood pressure | 90-140 / 60-90 |
| Child heart rate | 90-120 |
| Child respiratory rate | 20-40 |
| Child blood pressure | Around 90/60 |
| Infant heart rate | 110-160 |
| Infant respiratory rate | 20-40 |
| Infant blood pressure | Around 60/30 |
| Tachycardia | Fast (High) heart rate (anything over 100) Causes: Anxiety, pyrexia (fever), heart abnormality, hypoxemia, pain, blood loss |
| Bradycardia | Slow (low) heart rate (anything under 60) Causes: Medications, hypothermia, heart abnormality, septic (infection), vagal stimulation |
| Tachypnea | Fast breathing (Fast RR, higher than 20) Causes: Decreased lung compliancy, pneumonia, pulmonary edema, restrictive diseases |
| Bradypnea | Slow breathing (Slow RR, less than 12) Causes: Overdose, trauma, respiratory center depression (medication, stroke, or cns) |
| How would you identify the signs of labored breathing? | Cyanosis (blue/grey color to skin), accessory muscle use/ contractions/tripoding, nasal flaring, diaphoresis (excessive sweating), tachycardia and tachypnea |
| Name the sites used to assess a patient's pulse | Radial, brachial, carotid, femoral, dorsalis, apical |
| Systolic | Numerator of BP. Ventricular contraction |
| Diastolic | Denominator of BP. Ventricular relaxation. Measuring heart at rest |
| Hypertension | High BP. Can both or just one is high. Causes; Cardiovascular imbalance, stress, anxiety, fluid retention due to kidney failure, stimulant drugs |
| Hypotension | Low BP. Causes; Volume/blood loss, hemorrhaging, shock, positioning (trendelenburg) (Patient position), CNS depressant drug |
| Vesicular | Normal breath sounds |
| Bilateral | Sounds on both sides |
| Bronchial | Normal sounds heard over the trachea or bronchi These sounds heard over the lung periphery would indicate lung consolidation |
| Course crackles | A bubbling/crackling sound that can be heard during inspiration or expiration and produced by air flowing through airways containing secretions or fluid Fluid in lower airways that will not clear with coughing Causes: Pulmonary edema and Pleural effusion |
| Ronchi | A type of crackle caused by secretions within the large main stem that clear or improve with coughing. Give a low whistling/ low wheezing sound |
| Fine Crackles | Late inspiratory crackles that are heard over the lung periphery. Alveoli and smaller airway openings. Sounds like rice krispies Causes; Atelectasis |
| Wheezing | High pitched, musical quality heard on inspiration and/or expiration. Produced by air flowing though constricted airways Causes: Asthma and bronchitis |
| Stridor | High-pitched inspiratory sound heard in the upper airway Causes: Supraglottic swelling (epiglottitis), Subglottic swelling (croup or post extubation), foreign body aspiration |
| Pleural Friction Rub | A course, grating, raspy, or crunching sound heard over lung periphery. Caused by inflamed surface of the visceral and parietal pleura rubbing together. Has bee associated with pleurisy, TB, and lung cancer |
| Egphony | Patient says "E" and it sounds like "A". Caused by consolidation of the lung tissue (Pneumonia) |
| Bronchophony or Whispered Pectoriloquy | Increased intensity or transmission of voice. Caused by consolidation of the lung tissue (pneumonia) |
| Diminished | Softer, more difficult to hear. Need to compare one lung with the other. Caused by obstructed bronchi, pneumothorax, emphysema, COPD, Barrel Chest, Air Trapping |
Created by:
K.Moskowitz
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