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Questions and Answers
What is the main function of goblet cells in the lung?
What characterizes the normal breath sounds?
What is the most recommended therapy for a post-operative patient after surgery?
What are two possible therapies for long-term cystic fibrosis patients at home?
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What is the recommended compression ratio for two rescuers when performing CPR on an infant?
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What is a common indication of oxygen therapy?
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Which ECG change could be observed if you hit the carina while suctioning an ETT?
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What is the significance of observing wheezing after bronchodilator therapy?
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What can occur due to excessive oxygen administration?
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What is one hazard of oxygen therapy?
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What is the purpose of a sweat test?
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What is the correct dosage for arformoterol tartrate?
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What does the Murphy's eye facilitate?
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Which of the following is an indicator for heliox therapy?
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What is the primary indication for inhaled nitric oxide (NO)?
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What type of problem do obstructive patients typically experience?
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What may cause a low-pressure alarm in a ventilator?
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Which of the following is a common cause of a high-pressure alarm?
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Which condition is NOT typically associated with high-pressure alarms?
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What is a potential complication of mechanical ventilation?
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What is commonly used for non-invasive ventilation?
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Which test indicates restrictive lung disease based on decreased lung volume?
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What is a primary indication for performing an ABG?
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What condition is indicated by decreased flow during pulmonary function testing?
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What does NIF stand for and what is its normal range?
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What condition is indicated by an ABG result of 7.59, 19, 25?
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In which patients is a peak flow meter typically used?
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What is the normal range for PCO2 in mm Hg?
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What does PEEP stand for and what is its purpose?
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What can cause an increase in the peak inspiratory pressure (PIP)?
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What does the RSBI represent and what is its normal value?
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What is a common complication associated with the use of Pulmicort?
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Study Notes
Incentive Spirometry
- Recommended post op therapy
Cystic Fibrosis
- Home therapies: Vest, O2 therapy, PEP, mucolytic
- Sweat test determines chloride levels in sweat
Oxygen Therapy
- Indications: Hypoxemia, Hypoxia, Cyanosis, Short term therapy (post op), Asthma, OSA, Use of accessory muscles
- Hazards: O2 toxicity, Slows breathing/heart rate, Oxidative stress, Absorption atelectasis, Fire hazards, Increased hypoxic drive for COPD patients
- Complications: Nausea, Dizziness, Muscle twitching, Vision loss, Loss of consciousness
PEEP - Peak End Expiratory Pressure
- Adverse Effects: Hypotension, Decreased venous return, Decreased cardiac output, Alveolar overinflation, Pulmonary Barotrauma
Murphy's Eye
- Allows lung ventilation when endotracheal tube bevel is occluded
- Prevents obstruction and continues ventilation
Signs of Oxygen Need
- Hypoxemia/Hypoxia
- Cyanosis
- Diaphoresis
- SOB
Large Volume Nebulizer
- Used for: Bland aerosol therapy, Post extubation stridor, Croup, Delivery of airway-moisturizing mist
Obstructive vs. Restrictive Lung Problems
- Obstructive: Flow problem, Restricted airflow, Breathing difficulties
- Restrictive: Volume problem, Decreased lung capacity, Reduced elasticity
Inhaled Nitric Oxide (NO)
- Indications: Pulmonary hypertension, Hypoxic respiratory failure
Ventilator Alarms
- Low Pressure Alarm: Patient disconnecting, Leaks in ventilator circuit, Airway leaks, Chest tube leaks, Disconnecting tubing
- High Pressure Alarm: Secretions/mucus buildup, Patient biting tube, Tube migration into right mainstem bronchus, Bronchospasm, Mucosal edema/secretions, Pneumothorax, Patient-ventilator asynchrony, Condensation in circuit, Kinks in inspiratory circuit, Valve issues
Massive Oxygen Leak
- Action: Put the flow meter back in
High Pressure Limit Causes
- Mucus plugging
- Kink in the tube
- Obstruction
Low Pressure Alarm Causes
- Leaks in ventilator circuit
- Chest tube leaks
- Disconnecting tube from ventilator circuit
- Rupture of endotracheal tube cuff
Ventilator Complications
- Pulmonary Barotrauma
- Lung injury
- Pneumonia
- Respiratory muscle weakness
- Secretion retention
- Hyperinflation
- Occlusion in tube due to secretions
Non-Invasive Ventilation
- Used for: COPD, Obesity, OSA, Acute/Chronic respiratory failure
PFT - Pulmonary Function Tests
- Decreased lung volume: Restrictive lung disease
- Decreased flow: Obstructive lung disease
ABG - Arterial Blood Gas
- Indications: Assess blood gas levels, Sign of respiratory distress, Assess mechanical vent settings, Assess non-invasive monitoring accuracy
L/S Ratio
- Used to determine surfactant levels
Racisater Safety Feature
- Pop off valve
ABG Air Bubble
- Decreases CO2 levels
2 Rescuer CPR for Infants
- Compression Ratio: 15:2
- Preferred Technique: Circle (2 hands)
Surfactant Cells
- Type 2 alveolar cells
Goblet Cells Function
- Secrete mucin to create protective mucus layer
Normal Breath Sounds
- Vesicular
Finger Clapping Sign
- Chronic hypoxia, COPD
Idiopathic
- Unknown cause
Epi Alternatives
- Amiodarone
- Racemic Epi
Clot Risk Rhythm
- Atrial Fibrillation (A-fib)
ABG - Radial vs. Brachial Artery
- Radial artery is more superficial, making pulse easier to detect
RSBI - Rapid Shallow Breathing Index
- Calculation: RR/VT
- Normal value: Less than 105
ET Tube Suctioning - Carina
- Can cause bradycardia due to vagus nerve stimulation
Wheezing Post-Bronchodilator
- Indicates air movement
Heliox 80:20
- Factor: 1:8
Heliox 70:30
- Factor: 1:6
Heliox Therapy Indications
- Decrease inflammation
- Post-extubation stridor
Xopenex Doses
- 0.31 mg
- 0.63 mg
- 1.25 mg
Heated Humidifier Temperature
- 37-39 degrees Celcius
Laryngeal Edema vs. Laryngeal Stenosis
- Laryngeal Edema: Fluid buildup and swelling in larynx tissues
- Laryngeal Stenosis: Scarring in larynx that limits normal opening
Brovana
- Name: Arformoterol tartrate
- Dose: 15 mcg (once daily)
- Category: Long-acting beta agonists (LABAs)
Tracheostomy Patient Speech
- Methods: Fenestrated trach, Speaking valve, Deflated cuff
Mucomyst Dose
- 10% and 20%
- Know individual doses for each percentage
NIF, MIP, RSBI
- NIF: Negative inspiratory pressure. Normal: -20 to -40
- MIP: Maximum inspiratory pressure
- RSBI: Rapid shallow breathing index. Normal: < 105
SBT Parameters
- NIF
- Vital capacity
- Heart Rate (HR)
- Respiratory Rate (RR)
ABG Interpretation 7.59 19 25
- Uncompensated respiratory alkalosis
Peak Flow Meter
- Used with: Asthma patients
Laryngeal Blades
- Miller (straight)
- MacIntosh (curved)
O2 Pulse Device with High CO2
- Reading: 100% O2
- Appearance: Pink
BiPAP Adjustment for Low O2 and CO2
- Adjust EPAP and FiO2
SpO2 vs PaO2
- SpO2: Peripheral oxygen saturation
- PaO2: Partial pressure of oxygen in arterial blood
CPAP Indications
- OSA
- Pulmonary edema
- CHF
- COPD
- Obesity
Bubbler/Nasal Cannula Wheezing
- Cause: Kink in the tube
Ventilator Waveform - Fast I Time
- Square waveform
PEEP - Peak End Expiratory Pressure
- Meaning: Positive pressure applied at the end of expiration
- Purpose: Improve oxygenation
SBT Failure Signs with T Piece
- Increased heart rate
- Increased work of breathing
- Low RR
Allen Test
- Purpose: Assess collateral blood flow to the hand
- Procedure: Apply pressure to radial and ulnar arteries, release ulnar pressure, observe blood return in 8-10 seconds
ET Tube End Piece (2 Holes)
- Murphy's eye
BiPAP Adjustment for High CO2
- Increase IPAP (to increase gradient between IPAP and EPAP)
- Backup RR
ETT Placement Confirmation
- Auscultation
- Chest rise
- Chest X-ray
Capnography Colors
- Yellow: ET tube in correct place
- Purple: Problem with ET tube placement
- Brown: Unknown ET tube placement
Rising PIP (Peak Inspiratory Pressure)
- Actions: Suctioning, Bronchodilator, Switch to pressure control
Incorrect Pulse Reading
- Actions: Change location, ABG, Manual check
FiO2 1L
- 24% (know the rule of four)
PCO2 Normal Range
- 35-45 mm Hg or Torr
Pulmicort Dosages
- Corticosteroid medication
- 0.5 mg
- 1 mg
Pulmicort Complications
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Description
This quiz covers essential topics in respiratory therapy, including postoperative care, treatments for cystic fibrosis, indications for oxygen therapy, and the use of PEEP. Test your knowledge on tools like incentive spirometry and large volume nebulizers, as well as the importance of recognizing signs of oxygen need.