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Questions and Answers
What is the primary purpose of percussion in chest physiotherapy?
What is the primary purpose of percussion in chest physiotherapy?
Which of the following oxygen delivery systems is most appropriate for a patient requiring the highest concentration of oxygen?
Which of the following oxygen delivery systems is most appropriate for a patient requiring the highest concentration of oxygen?
What is the primary consideration when using oxygen flow rates above 3 LPM?
What is the primary consideration when using oxygen flow rates above 3 LPM?
What is the recommended starting flow rate for a nasal cannula?
What is the recommended starting flow rate for a nasal cannula?
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In which situation is tracheal suctioning indicated?
In which situation is tracheal suctioning indicated?
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Which of the following statements regarding the Venturi mask is true?
Which of the following statements regarding the Venturi mask is true?
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What is the most appropriate action to take when weaning a patient off oxygen?
What is the most appropriate action to take when weaning a patient off oxygen?
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What is a key characteristic of the High Flow Nasal Cannula?
What is a key characteristic of the High Flow Nasal Cannula?
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What is the maximum suction depth for tracheostomy care?
What is the maximum suction depth for tracheostomy care?
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How long should suctioning last for adults during a single pass?
How long should suctioning last for adults during a single pass?
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What should be done before and between suctioning passes?
What should be done before and between suctioning passes?
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What is the initial treatment for asystole?
What is the initial treatment for asystole?
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Which of the following is NOT a complication associated with tracheostomy suctioning?
Which of the following is NOT a complication associated with tracheostomy suctioning?
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Which device is designed to help with bradycardia and tachycardia?
Which device is designed to help with bradycardia and tachycardia?
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What is a common symptom of Congestive Heart Failure (CHF)?
What is a common symptom of Congestive Heart Failure (CHF)?
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What is the purpose of a stress test?
What is the purpose of a stress test?
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Which symptom is associated with a myocardial infarction (MI)?
Which symptom is associated with a myocardial infarction (MI)?
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What lifestyle factor is NOT linked to heart disease risk?
What lifestyle factor is NOT linked to heart disease risk?
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Which procedure involves using a balloon to compress a blockage in the coronary arteries?
Which procedure involves using a balloon to compress a blockage in the coronary arteries?
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Which of the following symptoms would most likely indicate a stroke?
Which of the following symptoms would most likely indicate a stroke?
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What is a contraindication when using an Automated External Defibrillator (AED)?
What is a contraindication when using an Automated External Defibrillator (AED)?
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What should be monitored at the insertion site after a cardiac intervention?
What should be monitored at the insertion site after a cardiac intervention?
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What do DNR and DNI stand for in life-sustaining orders?
What do DNR and DNI stand for in life-sustaining orders?
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Which type of vascular access device is typically used for long-term antibiotic therapy?
Which type of vascular access device is typically used for long-term antibiotic therapy?
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What is the primary function of antihypertensive medications?
What is the primary function of antihypertensive medications?
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Which of the following medications is primarily used to prevent and resolve blood clots?
Which of the following medications is primarily used to prevent and resolve blood clots?
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In EKG lead placement, which color is associated with the Right Arm?
In EKG lead placement, which color is associated with the Right Arm?
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What characterizes Ventricular Fibrillation (V-Fib) and its treatment approach?
What characterizes Ventricular Fibrillation (V-Fib) and its treatment approach?
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Which of the following describes Normal Sinus Rhythm (NSR)?
Which of the following describes Normal Sinus Rhythm (NSR)?
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What is the primary concern with Pulseless Electrical Activity (PEA)?
What is the primary concern with Pulseless Electrical Activity (PEA)?
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What is the primary role of cardiac glycosides in patient care?
What is the primary role of cardiac glycosides in patient care?
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What does V-Tach indicate in terms of heart rhythm and necessary intervention?
What does V-Tach indicate in terms of heart rhythm and necessary intervention?
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What is a key difference between a Hickman Central Line and a Groshong?
What is a key difference between a Hickman Central Line and a Groshong?
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Which of the following diets would be appropriate for a patient recovering from surgery on their first postoperative day?
Which of the following diets would be appropriate for a patient recovering from surgery on their first postoperative day?
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What must always be verified before using a Nasogastric Tube?
What must always be verified before using a Nasogastric Tube?
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What is a critical intervention when administering tube feeds via a nasogastric tube?
What is a critical intervention when administering tube feeds via a nasogastric tube?
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Which type of central venous access device is placed in the arm and tunnels through subcutaneous tissue?
Which type of central venous access device is placed in the arm and tunnels through subcutaneous tissue?
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What is the primary purpose of the blue pigtail in a Salem Sump tube?
What is the primary purpose of the blue pigtail in a Salem Sump tube?
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What should be done to assess the patency of a nasogastric tube?
What should be done to assess the patency of a nasogastric tube?
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What is the role of a Decron Sheath in a Hickman Central Line?
What is the role of a Decron Sheath in a Hickman Central Line?
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Study Notes
Chest Physiotherapy
- Percussion: mechanical waves created by clapping to remove secretions
- Postural drainage: positioning to drain secretions (head down for lower lobes)
- Vibration: loosens secretions (flutter valve, acapella, high frequency pulsator vest)
Oxygen Delivery Systems
- Maintain SpO2 >93%, PaO2 >60 mmHg
- Use the LOWEST concentration for the SHORTEST amount of time
- Anything higher than 3LPM must be humidified
- Fill the oxygen bag BEFORE placing on the patient’s face
Low-Flow Oxygen Delivery Systems
-
Nasal Cannula (NC): 1-6LPM (24-60% O2)
- Comfortable and convenient
-
Simple Face Mask: 5-10 LPM (40-60% O2)
- Covers mouth and nose
-
Partial Rebreather Face Mask: 10-15 LPM (30-60% O2)
- Patient needs to re-breathe 1/3 of their CO2 (hyperventilating, anxious, stab wound)
-
Non-Rebreather Mask (NRB): 10-15 LPM (55-90% O2)
- One way valve prevents the patient from re-breathing CO2 (hypoxia, acute respiratory distress - pure O2)
High-Flow Oxygen Delivery Systems
- Entire ventilatory demand of the patient is met (fixed-precise concentration of O2)
- Pre-mixes ratio of O2 to air before delivery to the patient
- Delivers gas at flow rates that exceed the patient’s inspiratory demand
-
High Flow Nasal Cannula: up to 60 LPM
- Placed by respiratory therapist (premature infants)
- Reduces dead space, heated and humidified
-
Venturi Mask: 24-60% O2
- Colored valves to control concentration
- Used in patients with low O2 that need humidification, COPD (limits the amount of O2 so the patient does not lose the stimulus to breathe)
-
Tracheostomy Collar: 28-98%
- High humidity
-
Oxygen Hood: >60%
- High humidity
Weaning off of Oxygen
- Done incrementally:
- Reduce slightly, monitor the patient for distress, SpO2, work of breathing, respiratory rate, and then lower again when stable
Tracheal Suctioning
- Removal of secretions through a tube placed in a surgical opening (stoma)
- Indications: audible upper airway noise/gurgling, adventitious breath sounds (crackles/rhonchi), cyanosis, decreased pulse ox/PaO2, hypoxia (restlessness/anxiety), increased work of breathing (WOB) (retractions, nasal flaring, tachypnea, shortness of breath)
-
Principles:
- Suction to the end of the tracheostomy and 1 cm beyond MAX
- Suction on the way OUT only
- Rotate the catheter in a circular motion as you suction
- DO NOT suction more than 10-15 seconds in adults, or 5-10 seconds in infants/children (airway is occluded, they are not being oxygenated during that time)
- Hyperoxygenate the patient before and between passes
- NO MORE than 3 passes in one session
- Always keep extra trachs (1 same size + 1 smaller), a Kelly clamp, trach insertion kit, suction, and an Ambu bag at bedside
- Complications: edema, obstruction (secretions or foreign body), hypoxia/bronchospasm, infection, hemorrhage, skin breakdown, expulsion of trach/decannulation
Cardiac System
- Heart Disease: vessels, valves, heart itself
- Cardiovascular Disease: organs, body
- Risk Factors for Heart Disease: age, sex, race, high cholesterol, diabetes, hypertension, family history
- Lifestyle Risk Factors for Heart Disease: poor diet, sedentary lifestyle, obesity, smoking, drug use, excessive alcohol, high stress/anger
Altered Cardiac System
- Can lead to heart disease
-
Congestive Heart Failure (CHF): insufficient pumping of the heart
- Symptoms: shortness of breath, fatigue, weakness, lower extremity edema, weight gain, tachycardia, dysrhythmias, persistent cough/wheeze
-
Arrhythmia: improper beating of the heart
- Symptoms: fluttering in chest, tachycardia/bradycardia, chest pain, shortness of breath, dizziness, fainting
-
Stroke: damage to the brain from an interruption of blood flow
- Symptoms: numbness, difficulty with balance, speech, and understanding, blurred vision, facial drooping, difficulty swallowing
-
Myocardial Infarction (MI): lack of blood flow to the heart
- Symptoms: chest pain, numbness/pain in left arm, jaw, or back pain
- Cardiac Arrest: heart suddenly stops, may occur without warning
-
Hypertension (HTN): force of blood against artery walls
- Symptoms: headache, fatigue, vision problems, chest pain, dyspnea, dysrhythmia
Cardiac Medications
- Cardiac Glycosides: increase cardiac contractility, decrease heart rate
- Antihypertensives: decrease blood pressure
- Vasopressors: increase blood pressure
- Antiarrhythmics: regulate heart rate
- Nitrates: relieve angina (chest pain)
- Antilipids: decrease cholesterol levels
- Diuretics: reduce fluid volume
- Anticoagulants: prevent/resolve blood clots
EKG Lead Placement
- Artifact = movement
-
5 Lead (Telemetry):
-
Clouds over Grass:
- RA (white)
- RL (green)
-
Smoke over Fire:
- LA (black)
- LL (red)
-
Chocolate is good for the heart:
- V1: 5th ICS, Right side
-
Clouds over Grass:
-
12 Lead: + RA, LA, RL, LL
- V1: 4th ICS, Right side
- V2: 4th ICS, Left side
- V3: between V2/V4, not on bone
- V4: 5th ICS, Midclavicular, Left side
- V5: between V4/V6, not on bone
- V6: 5th ICS, Midaxillary, Left side
Nursing Interventions
- EKG, telemetry
- Leg exercises, positioning
- TEDS/SCIDS
- Medications: anticoagulants, diuretics
- Assessment and education
Cardiac Rhythm Strips
- Normal Sinus Rhythm (NSR): 60-100 bpm
-
NSR Bradycardia: <60 bpm
- P: atrial depolarization
- QRS: ventricular depolarization
- ST: complete depolarization of ventricles
- T: ventricular repolarization
Cardiac Rhythms
-
Ventricular Tachycardia (V-Tach): foci in ventricles take over and beat too fast to count (sawtooth)
- Shockable
- Treatment: cardioversion, CPR, antiarrhythmic drugs
-
Ventricular Fibrillation (V-Fib): rapid, disorganized depolarization of ventricles, no palpable pulse
- Shockable
- Treatment: defibrillation & CPR, long-term implantable cardioverter-defibrillator (LT ICD)
- Ventricular Dysrhythmia: ectopic foci in the walls of ventricles, decreased cardiac output, ventricular rate is only 20-40 bpm (cannot sustain life)
- Premature Ventricular Contraction: one-off beat, not a rhythm (more in bradycardia)
-
Pulseless Electrical Activity (PEA): electricity works but no contraction, if no pulse, then no cardiac output → no tissue perfusion → death
- Treatment: start CPR, hope the heart starts contracting
-
Asystole: no electrical activity, immediate loss of O2 to brain/heart/tissues
- Treatment: CPR (hopefully get some rhythm back and then shock)
Cardiac Tests/Monitoring
- Duplex Ultrasound: how blood moves through arteries and veins (US + doppler)
- Stress Test: monitor and record heart activity during physical activity
- Echocardiogram: visualize how the heart is pumping and valves work through ultrasound (detects structural abnormalities)
- Holter Monitor: worn 1-3 days at home, records activity of the heart during activities of daily living
- Angiogram/Angiography: dye to look for blockage or narrowing
-
Percutaneous Transluminal Coronary Angioplasty (PTCA): catheter in arm/neck/groin
- Uses a balloon to inflate and compress blockage, sometimes a coronary artery stent is placed to hold the vessel open
-
Coronary Artery Stent: placed with a balloon catheter, locks open to hold the vessel open
- Monitor dysrhythmias and administer anticoagulants
-
Coronary Artery Bypass Graft (CABG): uses another vessel to bypass a damaged vessel
- LIMA (left internal mammary artery): best moved over, live vessel, no valves
- LAD (left anterior descending) artery: “widow maker”
- Greater saphenous vein: veins are not built to handle the pressure
-
Interventions:
- Monitor vital signs (watch for dysrhythmias)
- Monitor for bleeding at the insertion site
- Check peripheral pulses
- Immobilize limb for 6 hours (dye-kidney function) and maintain pressure dressing
- IF bleeding through dressing, DO NOT remove old, apply another on top
- Monitor I&O (urinate within 6 hours of procedure)
- Administer fluids
Cardiac Rhythm Devices
-
Pacemaker: augments or replaces the natural pacemaker of the heart
- Indications: bradycardia, tachycardia, damage to heart from MI, CHF
- DO NOT put AED pads directly over the pacemaker
-
Implantable Cardiac Defibrillator (ICD):
- Indications: treatment of V Tach and V Fib (feels like being kicked in the chest)
Life-Sustaining Orders
- DNR: do not resuscitate
- DNI: do not intubate
- MOLST: medical orders for life-sustaining treatment
Cardiovascular Access Device
- Peripheral IV (PIV): short term, placed at bedside by nurse in peripheral vein
-
Peripherally Inserted Central Catheter (PICC): long term, typically used for antibiotics, terminates at superior vena cava (SVC) or subclavian artery
- Placed at bedside by specialized nurse
- Checked by X-ray before use
-
Central Line (Central Venous Access Device (CVAD)):
- Internal Jugular confirm by X-ray
-
Triple Lumen: short term, multiple lumens that terminate in different places to administer non-compatible meds at the same time, placed in neck by provider at bedside
- Increased risk of pneumothorax or air embolism
-
Hickman Central Line: triple lumen, long term, placed in OR in SVC, Internal Jugular
- Tunnels through subcutaneous tissue from arm
- Decron Sheath: plug for tissue to grow around
- Groshong: double lumen, rare, used when the patient is allergic to heparin
-
Mediport: long term, placed in OR, terminated in SVC
- Self healing: Huber needle used to access
Enteral Nutrition
- Nutrition delivered via the GI system (includes nutrition through gastric tubes)
-
Diets:
- NPO: nothing per os/nothing by mouth
-
Clear Liquid: tea, soda (ginger ale), light-color Jell-O, clear broth
- Pre- and post-op and/or first day after being NPO
- Full Liquid: clear liquid/liquids at room temperature (ice cream and sherbet)
- Soft Diet: puree diet/mechanical soft
- As Tolerated: indicated by the patient
- Restrictive: cardiac, diabetic
Nasogastric Tube (NG Tube)
- MUST be checked by X-ray before use, MD order OK to use, future placement verification: insert air into tube and listen over stomach, aspirate pH
- During insertion, have the patient sip water to help advance the tube
- Infants with cleft lip/palate cannot suck, which can cause heart/lung problems because they are too tired
-
Interventions:
- HOB 30-45 degrees at all times
- Check placement
- Administer tube feeds
- Check residual (GRV) and replace
- Flush tube to maintain patency
- Assess (is it in place? Markings on the tube. Is the patient tolerating well?)
-
Salem Sump: two lumens/pigtail, short term, suction (should not be used for feeding)
- Blue pigtail helps suction from sticking to membranes and allows air exchange
- DO NOT tie a knot in pigtail, use a chucks if it is leaking
- Levin: one lumen
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Description
Test your knowledge on chest physiotherapy techniques and the various oxygen delivery systems. This quiz covers essential methods like percussion, postural drainage, and low-flow oxygen options to maintain patient wellbeing. Understand how to effectively manage oxygen levels and support respiratory function.
