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LJ/ Ketter TMC notes
TMC notes
| Question | Answer |
|---|---|
| TCM on Infants; How to avoid Skin Erythema | The transcutaneous electrode is heated to a temperature of about 44 deg C and can cause burning of the skin. It should be moved at least every 4 hours. It may be moved more frequently if reddening and/or erythema continues to be observed. |
| A Sputum culture & sensitivity will help: | to identify the specific organism and will more accurately identify the type of antimicrobial therapy that will most effectively kill the organism. *EVEN IF THE ORGANISM IS KNOWN BUT ANTIBIOTIC IS INEFFECTIVE |
| Baby Grunting= they're trying to give themself PEEP. They would benefit from what? | CPAP- administered by mask |
| A 6 MWT is primarily used to look at a patient's: | cardiac stamina during activity |
| NORMALLY PetCO2 is lower than PaCO2 but an even Lower PetCO2 combined with normal PaCO2 is suggestive of a : | Pulmonary embolus; hypovolemia |
| Normal PetCO2: Normal PaCO2: | PaCO2= 40 torr (40's) PetCO2= 30 torr (30's) or 3-5% |
| An increase in PetCO2 would indicate a decrease in: | ventilation (ventilatory failure; remember PetCO2 is exhaled carbon dioxide) |
| Following Intubation: a low PetCo2 indicates: | ETT is in the esophagus |
| During CPR the petCo2 should: | Increase |
| A 34 weeks-of-gestation newborn is being monitored transcutaneously for CO2 and PO2 levels. The respiratory therapist notices the PO2 reading suddenly rises to 140 mm Hg. Which of the following is most likely? | A value of 140 mm Hg is consistent with the PO2 value found in the ambient environment and therefore indicates the electrode has likely become dislodged from the skin. |
| The recommended dose for Atrovent (Ipratropium bromide): | 6-8 hours *therefore it cannot be added to an Albuterol Q4h; it must be added to EVERY OTHER doe. |
| To configure a fenestrated tracheostomy to for speaking: | the button must be removed, the inner cannula must also be removed, and the cuff should be deflated. This allows air to be deviated through a hole in the fenestrated tube and pass the vocal folds, allowing speech. |
| In preparing to cap a fenestrated tracheostomy tube on a patient who is scheduled for speech therapy, the respiratory therapist should remember to: | deflate the cuff and remove the inner cannula |
| While performing manual ventilation with a self-inflating resuscitator bag through a properly placed endotracheal tube, a respiratory therapist observes no chest rise. To troubleshoot the problem, the therapist should: | check for proper function of the air inlet valve. |
| VD/VT ratio formula: | (PaCO2 - PECO2)/PaCO2= VD/VT ratio |
| A respiratory therapist is preparing to intubate and place a patient on a mechanical ventilator. The patient will require humidity therapy in conjunction with ventilatory support. Which humidifier would you recommend? | Cascade or Wick-type humidifier |
| H-Tank ratio factor | 3.14 |
| Tank duration formula: | (PSI X tank factor)/ flow |
| E- Tank factor/ PSI | 0.28 PSI 2200 |
| ventilator circuits must be changed every | 7 days (IF GIVEN the option of "monthly, daily, when soiled, every 14 days" the answer IS "WHEN SOILED"; because all other options ARE NOT 7 days) |
| A patient with tuberculosis had a bronchoscopy procedure. To properly clean the bronchoscope, the equipment must be soaked in Cidex (Alkaline Gluteraldehyde) for a minimum of how many minutes? | 20 minutes |
| A chemical indicator tape inside a sterialized package does not actually indicate the presence or absence of viable spores. It does, however, indicate if | if the equipment has been through the sterilization process. |
| Which of the following are acceptable for home-care use for the cleaning of non-electric respiratory therapy equipment? | Acetic acid is another name for common household vinegar. (safe for at home) |
| guidelines for infection control procedures in the home do include the use of: | distilled water, boiling, and cleaning with vinegar (acetic acid). |
| A respiratory-compromised patient who is being discharged from a long-term care facility requires frequent oropharyngeal suctioning with a tonsil-tip suction device. Which of the following infection control cleaning procedures are recommended? | submerge the device in boiling water, reuse until integrity is lost |
| In order to properly disinfect a home-use nebulizer, the respiratory therapist should recommend | acetic acid |
| Poor hand washing Vs Disconnecting pt from circuit. | The most common nosocomial infection source is from poor hand washing. Although frequent disconnection of a ventilator circuit will also increase incidence of infection, poor hand washing is by far more common. |
| A galvanic oxygen analyzer will read erroneously under two conditions: | he probe or the fuel cell is depleted or the analyzer requires calibration. |
| Which of the following conditions could cause a galvanic fuel cell analyzer to read erroneously high? | -when exposed to high ambient pressures, such as seen in a hyperbaric chamber. -When installed in a humidified ventilator circuit (moisture will cause erroneous readings) |
| A 65 kg spinal cord injured patient develops atelectasis. His inspiratory capacity is 30% of his predicted value. What bronchial hygiene therapy would be most appropriate initially? | IPPB |
| Indications for IPPB (intermittent positive pressure breathing): | -correct atelectasis -decrease pulmon. edema -decrease WOB -distribute aerosols more evenly -improve & promote the cough mechanism |
| A healthy adult female can exhale what portion of her forced vital capacity in the first second? | 70% (FEV1/FVC ratio) |
| Which of the following patients would most likely benefit from pressure support ventilation? | A patient on SIMV with a mandatory rate of 12/min and total rate of 24/min. |
| Which of the following information may be obtained from a FVC maneuver during bedside pulmonary function testing? | FEV1 & FRC |
| A patient who complains of dyspnea is noted to have a dry, non-productive cough. On physical examination, breath sounds are diminished on the right, tactile fremitus is decreased and there is dullness to percussion over the right lower lobe. | Pleural Effusion |
| A patient’s breathing pattern irregularly increases and decreases and is interspersed with periods of apnea up to 1 minute. | Elevated intracranial pressure Cheyenne stokes (60 sec of apnea is key) |
| AHI: mild, moderate, severe: | normal: <5 mild: 5-15 moderate: 16-30 severe: >30 |
| While monitoring a newborn utilizing a transcutaneous monitor, the respiratory therapist notices a change in PtcO2 from 60 to 142 torr and simultaneously the PtcCO2 changes from 37 to 2 torr. What is the most likely explanation for these changes? | Air leak |
| Air Entrainment Factors for FiO2 of 28%, 40%, 60%: | 28:11 40:4 60:2 O2 flow X factor = Total flow ex: 5L/min , FiO2 28% air entrainment = ____ Flow? 5 L/min X 11 = 55 L/min Total Flow |
| Sleep apnea can be defined as repeated episodes of complete cessation of airflow for | ≥ 10 sec |
| A patient in the ICU receiving mechanical ventilation underwent fiberoptic bronchoscopy following the procedure, the respiratory therapist notes that the peak inspiratory pressure on the ventilator has increased. Potential causes for this include | - Pneumo - Pulmonary hemorrhage - Bronchospasm/ Larygospasm NOT hypoxemia |
| How to detect Auto PEEP on vented pt? | initiate an expiratory hold just prior to the next ventilator-delivered breath. |
| What is the primary advantage of volume-controlled ventilation as compared to pressure-controlled ventilation? | VC provides a constant minute ventilation. |
| Bronchial breath sounds heard over the lung periphery indicate | Lung consolidation - considered normal if heard over trachea or bronchi -lung periphery = lung consolidation |
| The respiratory therapist is asked to administer 2.5 mg of albuterol to a patient via small volume nebulizer. The medication is available in a 0.5% solution. What volume of albuterol should be administered? | 0.50 mL |
| Airway Pressure Release Ventilation (APRV) | -similar to CPAP -occasionally releases PEEP (to allow lungs to rest) - Uses a lower PIP (resulting in lower mean airway pressure, improves oxygenation with lower mRaw) -Good for patients with high PIP and not oxygenating |
| While performing diagnostic chest percussion, the respiratory therapist notes decreased resonance to percussion. Which of the following are potential causes of this finding? | -Pleural Effusion -PNA -Atelectasis -NOT pneumothorax as this would show and INCREASED resonance; resonance means AIR |
| Following thoracotomy, a patient on volume-control ventilation has a chest tube in the left pleural space. While inspecting the chest drainage system, the respiratory therapist notes bubbling in the water seal chamber during the inspiratory phase. | -a persistent bronchopleural fistula - WATER SHOULD BE OBSERVED IN THIS CHAMBER BUT NOT CONTINUOUSLY; THIS MEANS LEAK. -SPONT. BREATHING PT: EXHALATION BUBBLE -PPV: INHALE BUBBLE |
| A pt is brought to the ED after taking a handful of pills. The patient is obtunded but is making regular, sonorous respiratory efforts. Auscultation reveals coarse rhonchi bilaterally. Which of the following should be done FIRST to assess this patient? | ABG NOT GCS |
| A tracheostomy tube has just been inserted percutaneously into a patient with a C3 fracture. How much air should the respiratory therapist initially inject into the cuff? | Enough to achieve a pressure of 25-35 cm H2O. Normal cuff pressure = 25-35 cmH2O or 20-25 mmHg |
| All of the following conditions can be treated with hyperbaric oxygen (HBO) therapy: | CO poisoning, decompression sickness (bends) , anaerobic infections (gas gangrene), tissue transplants/grafts NOT Pulmon HTN |
| HBO pressures (hyperbaric chamber): | most therapy is conducted at pressures between 2-3 ATA -typical chamber can provide pressure between 2-6 ATA @ 100% FiO2 |
| Which of the following factors are determinants of cardiac output? | SV & HR |
| The following ABG results are reported for a patient in the ED on room air: pH 7.20; PaCO2 24 torr; PaO2 95 torr; HCO3 10 mEq/L; SaO2 95%; BE -15 mEq/L. The respiratory therapist should recommend | administering sodium bicarbonate. |
| The physician asks the respiratory therapist to select ventilator parameters that will deliver the lowest peak inspiratory pressure possible. Which of the following inspiratory flow patterns will enable the therapist to fulfill the physician’s request? | Decelerating |
| Square wave: | normal flow pattern for Volume controlled breath |
| Sine wave: | normal flow pattern for Spontaneous breath |
| Decelerating wave: | normal flow pattern for Pressure control or Pressure Support breath |
| An intubated patient receiving 30% FiO2 has a SpO2 80% & ETCO2 of 40 torr. After administration of 50% O2 for 30 min, theRT t notes that the SpO2 rises to 98% and the ETCO2 remains stable at 40 torr. The major cause of hypoxemia in this patient is: | ventilation/perfusion mismatch. |
| Hemodynamics of ARDS patient usually has a NORMAL | PCWP |
| COPD is characterized by | increase in a/W resistance |
| Most useful way to detect presence of Pleural Effusion | Lateral Decubitus chest radiograph |
| reasons why tidal volume may drop or not reaching set volume | - tracheal position - breath sounds - chest drainage system |
| PEEP is required for PaO2 & FiO2 of what: | PaO2 <50-60 FiO2 >40-50 |
| normal A-aDO2 | 25-65 |
| ABG: air bubbles | Key: pH INCREASED |
| A 60 year-old male is admitted to the ED with chest pain. The CBC and electrolytes are normal. Troponin level is 0.4 ng/mL. The physician should report to the patient that he is suffering from | Myocardial Infarction |
| A young healthy adult with complaints of intermittent wheezing is seen in the pulmonary clinic. A pre/post bronchodilator spirometry reveals a normal study with no reversibility. Which of the following should the respiratory therapist recommend? | Bronchial Provocation |
| A tracheostomy tube has just been inserted percutaneously into a patient with a C3 fracture. How much air should the respiratory therapist initially inject into the cuff? | Enough to achieve a pressure of 25-35 cm H2O. |
| Pulmonary Hypertension CANNOT be treated with Hyperbaric oxygen but these conditions CAN: | CO poisoning, decompression sickness (bends), anaerobic infections (gas gangrene), tissue transplants/grafts |
| ABG: improper cooling (sample not iced) | Key: PaCO2 will INCREASE |
| ABG: TOO much liquid heparin: | Key: pH DECREASES toward 7.0 |
| Stroke volume & Heart Rate are determinants of: | Cardiac Output |
| Vibratory/Oscillatory PEP is a good Bronchial Hygiene Therapy for these types of patients: | cystic fibrosis patients & pneumonia ; examples of these devices are FLUTTER, ACAPELLA, QUAKE |
| PEP therapy: the expiratory flow resistor prevents end-expiratory pressures from falling to ______ | Zero; * expiratory pressures should range from 10-20 @ mid exhalation * used for 15-20 min intervals, 3-4 times a day |
| Fowler's, Semi Fowler's, or Reverse Trendelenburg best for: | Hypoxic pts, Obese pt's w/ Dyspnea, Post-Op abdominal surgery, & pt's w/ Pulmonary Edema |
| Lateral Fowlers position: | very Obese patient w/ air hunger |
| Trendelenburg position: | for pt's w/ very low blood pressure OR an obese pt w/ an order for bronchial hygiene therapy |
| Lateral FLAT position: | best position to prevent aspiration |
| reports that the oxygen supply tubing will not stay attached to her transtracheal catheter, Pt attempted to flush catheter & clean it: what do you recommend? | switch to nasal cannula |
| A patient with copious amounts of secretions has required nasotracheal suctioning for the past 36 hours and has now developed mild epistaxis. Which of the following should the respiratory therapist recommend? | Insert a nasopharyngeal airway after bleeding has been controlled. |
| For Pt's with Asthma, recommend an initial Vt of _____ mL/kg: | 4 mL/kg |
| Bedside Vent Parameters: Vital Capacity= | Normal: 65-75 Acceptable: ≥ 10 mL/kg (2 x Vt) |
| Bedside Vent Parameters: MIP/NIF= | Normal: 80 Acceptable: 20 cmH2O |
| Bedside Vent Parameters: RR | Normal: 12-20 Acceptable: 8-20 / min |
| Bedside Vent Parameters: Spontaneous (Vt) | Normal: 5-8 Acceptable: ≥ 5 mL/kg |
| Bedside Vent Parameters: (Ve) minute ventilation | Normal: 5-6 Acceptable: < 10 L/min |
| Bedside Vent Parameters: MEP | Normal: 160 Acceptable: 40 cmH2O |
| Physiologic Assessment Calculations: Deadspace, VD/VT % | Normal: 20-40 Acceptable: ≤60 |
| Physiologic Assessment Calculations: Cst; Static Compliance (mL/cmH2O) | Normal: 60-100 Acceptable: .25 |
| Physiologic Assessment Calculations: A-a DO2 (21% O2) | Normal: 5-10 torr Acceptable: 10-15 torr |
| Physiologic Assessment Calculations: A-a DO2 (100% O2) | Normal: 25-65 torr Acceptable: 66-300 torr |
| Physiologic Assessment Calculations: Shunting; QS/QT % | Normal: ≤5 Acceptable: <20 |
| INITIAL VENT SETTINGS for Mechanical Ventilation: Vt- Pressure- RR- FiO2- PEEP- | Vt- 5 to 10 mL/kg Pressure- ≤35cmH2O RR-10-20 breaths/min FiO2- 40-60% PEEP- 2-6 cmH2O *Set @ same levels prior to ventilation |
| The respiratory therapist obtains a blood gas sample from the patient’s radial artery and applies pressure to the site for 10 minutes. After removing any excess air from the syringe, the next step for proper handling of the blood sample is: | Place syringe in an Ice bath *PaCO2 will INCREASE if NOT iced in time |
| After assisting with a bronch & biopsy on a vented, the RT notes the activation of a high pressure alarm. PIP has increased from 32 cm H2O before the procedure to 45 cm H2O after the procedure. Possible causes for the increased pressure include | bronchospasm, pneumothorax, pulmonary hemorrhage |
| BNP levels of HEART failure: Normal = <100 pg/mL MILD= MOD= SEVERE= | MILD= >300 MOD= >600 SEVERE= >900 "3-6-9" |
| A patient receiving PCV has acute hypoventilation with an ETCO2 of 70 torr. His vital signs include: heart rate 90/min, respiratory rate 18/min, SpO2 94%. Which of the following change(s) will address the situation? | -Increase the PRESSURE LIMIT -Increase the MANDATORY RATE |
| A patient receives oxygen via nasal cannula at 2 L/min and has the following ABG results: pH 7.37, PaCO2 42 torr, PaO2 80 torr, HCO3 38 mEq/L. The most likely explanation for these results is that | the numbers were not reported correctly. |
| The most serious complication associated with airway suctioning is | #73 ASK INSTRUCTOR Hypoxemia (mucosal trauma is MOST COMMON, HYPOXEMIA most severe) |
| The ability to distinguish central apnea from obstructive apnea during a sleep study requires the respiratory therapist to monitor: | -Nasal air flow -Chest Wall impedance |
| What solution would be most appropriate for disinfecting the surface of the pulse oximeter between patients? | Ethyl Alcohol |
| A capnograph used for continuous monitoring of a patients on mechanical ventilation should be recalibrated every _____ hours. | 8 hours |
| how to maintain patency of the stoma for secretion removal: | tracheostomy button |
| CVP | 2-6 mmHg |
| PCWP | 4-12 |
| PAP | 25/8 *mean 14 |
| MAP | 90's |
| CO | 4-8 |
| CI | 2-4 |
| the tip of the catheter used to measure the wedge pressure should be positioned in the _______. (Swanz Ganz, Balloon Tip catheter) | Pulmonary Artery |
| In order to confirm the accuracy of a pulse oximeter you should recommend : | ABG most common, hemoximetry |
| Which drugs should the RT recommend to lower a patients BP as well as decrease his ventricular afterload: | Sodium NITROPRUSSIDE (DIRECT VASODILATOR; "NIPRIDE") |
| MEAN ARTERIAL PRESSURE: formula | (2 x diastolic) + Systolic / 3 = MAP |
| A-aDO2= | (PAO2 - PaO2) |
| A-aDO2 values greater than 65 mm Hg but less than 300 mm Hg are consistent with: | V/Q mismatching |
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