RES220 Flashcards

Health Care
Terms Definitions
SOAPIER acronym
Subjective, Objective, Assessment, Plan, Implementation Evaluation, Revision
what do all gases exert
pressure
Liquid
"mutual attraction but much weaker than solids, molecules move about freely which explains why they take shape of container and are capable of flow, liquids are similar to solids in that they are dense and cannot easily be compressed"
What is IPPB
application of insiratory positive pressure to a spontaneously breathing patient as an intermittent or short-term therapeutic modality. They usually last 15-20 minutes and may be given for a variety of reasons.
Identify treatment modalities beneficial in the management of the GBS patient
plasmapharesis, infusion of immunoglobulin (ig-used by the immune system to identify and neutralize foreign objects, such as bacteria and viruses), corticosteroids; respiratory care treatment protocols (oxygen therapy, bronchopulmonary hygiene, hyperinflation, mechanical ventilation, ) physical therapy and rehabilitation
Patient assessment components
medical history, physical assessment, diagnostic tests, symptom assessment, musculoskeletal and exercise assessment, pain assessment, adl, nutritional, educational, psychosocial,
preload
"Preload is the stretch on the ventricular muscle fibers before contraction. Preload is created by the end-diastolic volume. In 1914, Starling found that up to a critical limit, the force of a muscle contraction was directly related to the initial length of the muscle prior to contraction. His theory has come to be known as Starling's law of the heart. Simply stated, the greater the stretch on the resting ventricle, the greater the strength of contraction within physiologic limits. When the physiologic limits are exceeded, greater stretching of the muscles does not result in an increased force of contraction."
What do high atmospheric pressures exert in the atmosphere
the PIO2
What is absolute zero on the Fahrenheit scale
-460
what are the contraindications for CPAP
"hemodynamically unstable; hypoventilation ( machine does not ensure ventilation); nausea, facial deformities, untreated pneumothorax, elevated intracranial pressure"
Define “pneumoconiosis”
general term used to describe diseases of the lungs that are caused by the chronic inhalatin of inorganic dusts and particulate matter, usually of occupational or environmental origin (coal dust, asbestos, silica)
SOAPIER acronym - I
Implementation - actual administration of the specific therapy plan
Recognize the type of sputum associated withbronchiectasis
foul smelling sputum
Documentation of evaluations would include what information
symptoms, previous hospitalizations, medications, smoking history, allergies, and the ability to perform daily activities
treat sinus bradycardia that does not respond to atropine
pacemaker therapy
"What helps explain viscosity, capillary action and surface tension"
"although melting weakens intermolecular bonding forces, liquid molecules still attract one another adn the persistence of these cohesive forces among liquid molecules explain the physical properties of viscosity, capillary action and surface tension"
what is the pressure needed to maintain equilibrium between the liquid and gas phases of a substance
critical pressure
Molecular water obeys the same physical principles as other gases and therefore exerts a pressure called what
water vapor pressure
Chronic airway inflammation and infection can lead to bronchiectasis which is a common finding in which two things
CF and ciliary dyskinetic sydromes
What are examples of impairments affecting the Inspiration phase of the cough reflex
"pain, neuromuscular dysfunction, pulmonary restriction, abdominal restriction"
Treatment protocols for the management ofpostoperative atelectasis.
Oxygen therapy protocols, bronchopulmonary hygiene therapy protocols, hyperinflation therapy protocol, mechanical ventilation protocol
SOAPIER acronym - S
Subjective - information about the patient's feelings, concerns, or sensations presented by the patient. only the patient can provide subjective information
Disorders associated with increased A-a Gradient (P(A-a)O2)
Oxygen diffusion disorders (chronic interstitial lung disease), decreased ventilation/perfusion ratios disorders (COPD, atelectasis, consolidation), right-to-left intracardiac shunting (patent ventricular septum), and age.
Radiographic findings associated with alveolarconsolidation related to penumonia
increased density (from consolidation and atelectasis), air bronchograms, pleural effusions
Submaximal exercise and evaluating O2 needs
submaximal, steady-state exercise testing can be performed to assess supplemental oxygen requirements for ADLs. conducted at a work rate that approximates those encountered during normal living conditions. a submaximal exercise test may also be conducted with patients with severe pulmonary hypertension or congestive heart failure, for whom maximal stess testing is containdicated
what is temperature's effect on solubility a result of
changes in kinetic activity
What is the temperature at which condensation begins
the dew point
How would resorption atelectasis caused by malpositioned ET tube be treated
the ET tube would be re-positioned
What are some hazards and complications associated with postural drainage therapy (AARC)
"hypoxemia, increased ICP, Acute hypotension during procedure, Pulmonary hemorrhage, pain or injury to muscles, ribs or spine, vomiting and aspiration, bronchospasm, arrhythmias"
what are contraindications for trendelenburg position during postural drainage therapy
hemoptysis; icp > 20 mmhg; hypertension; distended abdomen; pt needing to avoid increased ICP (aneurysms); uncontrolled airway at risk for aspiration; esophageal surgery
what are PAP adjuncts
"used to help mobilize secretions and treat atelectasis. as adjuncts for airway clearance, these methods are never used alone but always comgined with directed cough or other airway clearance techniques"
"When assessing for the need for bronchial hygiene therapy, what two areas should be reviewed"
medical record; patient observation/interview
Refractory hypoxemia associated with ARDS
hypoxemia caused by capillary shunting often is refractory to oxygen therapy
Wheal size in a positive TB test
10 mm or greater
Major structural / pathologic changes inpulmonary edema.
interstitial edema including fluid engorgement of the perivascular and peribronchial spaces and the alveolar wall interstitium; alveolar flooding; increased surface tension of pulmonary surfactant; alveolar shrinkage and atelectasis; frothy white (or pink) secretions throughout the tracheolbronchial tree
Goal of plasmapheresis in treating chronicinterstitial lung disease.
directly removes the anti-GBM antibodies from the circulation - tx is directed at reducing the circulating anti-GBM antibodies that attack the patient's glomerular basement membrane
Patient selection criteria. (What about smokers?)
conditions for exclusion - unstable cardiac disease, orthopedic problems, unstable medical problems, pulmonary hypertension, lack of desire/interest. some allow smokers, cessation is encouraged and smoking is discouraged. possibly included if a quit date is given, some include smoking interventions.
Letter C in A-B-C-D
Circulation - check and start chest compressions if no pulse is found
how does radiant heat transfer
It transfers without direct contact and occurs even when in a vacuum such as the sun heating the earth
Why does vaporization require more energy than melting
melting weakens attractive forces between molecules but vaporization eliminates them. elimination of these forces converts essentially all of a substances' internal energy into kinetic energy
what are the contraindications for IPPB
"the only absolute is tension pneumothorax and carefully evaluate the following: ICP>15 mmhg; hemodynamic instability; recent facial oral or skull surgery; tracheoesophageal fistula; recent esophageal surgery; active hemoptysis; nausea; air swallowing; active, untreated tuberculosis; radiographic evidence of bleb; singultus (hiccups)"
How can the PL (transpulmonary) gradient be increased
by either decreasing the surrounding Ppl (pleural pressure) or increasing the Palv (alveolar pressure)
"Identify the condition where ""proning"" is most commonly applied"
patients with ALI (acute lung injury) - it has been shown to improve oxygenation in patients with ALI without negative effects on hemodynamics
what are other conditions that can lead to bronchiectasis
"chronic obstructive lung diseases, foreign body aspiration and obliterative bronchiolitis"
What are the hazards associated with PAP therapy
"pulmonary barotrauma; increased ICP; cardiovascular compromise (myocardial ischemia, decreased venous return); skin breakdown and discomfort from mask; air swallowing, vomiting, and aspiration; claustrophobia; increaseed work of breathing that may lead to hyupoventilation and hypercapnea"
"WHat are some added benefits, beside drainage of secretions, to postural drainage therapy"
improved distribution of ventilation and an improvement in ventilation and perfusion
What type of patients are susceptible to passive atelectasis
"debilitated patients who remain motionless in bed, most commonly in dependent lung segments and lobes. Post op patients who do not actively engatge in deep breathing or sighing due to pain or depressive effects analgesics have on teh respiratory center in the brain"
Describe the chest radiograph for the patient suffering from asbestosis
small round opacities scattered throughout the lung, irregularly shaped opacities, irregular cardiac and diaphragmatic borders, pleural plaques, honeycomb appearance
The most common cause of pleuraleffusion (2) The major causes of anexudative effusion
Congestive heart failure is probably the most common cause of pleural effusion. Exudate is usually caused by inflammation, infection, or malignancy
What are the four vital signs
body temperature (T); Pulse (P); Respiratory Rate (RR); Blood pressure (BP)
SOAPIER acronym - O
Objective - data the RT can meausure, factually describe, or obtain from other professional reports or test results
Pulmonary rehab teams should include what members
coordinator (possibly RT or RN), medical director, physical therapist, occupational therapists, social worker or psychologist, exercise physiologist, possibly nutritionist consult
action associated with the letter B
check for breathing and provide breathing if necessary
how are hyperbaric chambers used clinically
hyperbaric chambers are used together with oxygen to treat a variety of conditions including carbon monoxide poisoning and gangrene
What does water vapor pressure represent
the kinetic activity of water molecules in air
What are the contraindications for IS
"pt cannot be instructed or supervised to ensure appropriate use, pt cooperation is absent or unable to understand or demonstrate proper procedure; pts unable to deep breathe effectively (ie pts with VC less than 10 ml/kg or IC less than about 1/3 predicted); presence of open tracheal stoma is not a contraindication but requires adaptation of the spirometer"
what are the relative contraindications of postural drainage therapy
ICP > 20 mmhg; recent spinal injury; hemoptysis; empyema; bronchopleural fistula; pulmonary edema with CHF; aged/confused/anxious; pulmonary embolism; rib fracture; surgical/healing tissue/wounds; large pleural effusions
what can tracheobronchial clearance be enhanced by
bland aerosol therapy with an unheated jet nebulizer
What is the primary purpose of turning
"to promote lung expansion, improve oxygenation, and prevent retention of secretions; other benefits include a reduction in venostasis and prevention of skin ulcers"
What are the physical signs of atelactesis
"rapid shallow breathing due to decreased compliance, increased tactile fremitus over the effected area due to increase in density, dullness to percussion over the effected area due to the increase in density, fine/late inspiratory crackles or bronchial breath sounds and/or dereased breath sounds over the effected area; brochophony, egophony, or whispered pectoriloquy; tachycardia in the presence of hypoxemia; fever; hypoxemia and hypocapnia on the arterial blood gas and/or; desaturation on pulse oximetry"
The use of mask CPAP to treat pulmonary edema
improves decreased lung compliance, decreases the work of breathing, enhances gas exchange, and decreases vascular congestion in patients with pulmonary edema. prescribed for patients with pulmonary edema who have arterial blood gas values that reveal impending or acute ventilatory failure.
Identify the type of hypoxemia associated withcapillary shunting in “pneumoconiosis”
most commonly caused by th ealveolar thickening, fibrosis, and capillary shunting associated with the disorder
What in included in an exercise prescription
duration frequency, mode and intensity should be included
What are typical physical findings in emphysema patients?
increased AP diameter, barrel chest, cachexsia, decreased diaphragmatic excursion, use of accessory muscles with respiration, prolonged exhalation, pedal edema, possibly cor pulmonale
Characteristics of children with sleep-disordered breathing
"Snoring is a hallmark symptom of OSA in the child, as in the adult. Pediatric SDB patients can be of any age or gender and may be overweight or have failure to thrive. In the infant, specific and numerous anomalies are linked with sleep apnea, more so than in the typical adult patient, making evaluation of pediatric sleep apnea more complex. PSG features are also quite different in infants and children. Unfortunately, questionnaires cannot reliably predict OSA in the child. The SDB child may be either sleepy or hyperactive and have a variety of other problems, including developmental delay, poor school performance, aggressive behavior, and social withdrawal. Although rare, brain damage, seizures, and coma can result from asphyxial brain damage.45 Untreated OSA can have a negative influence on school performance and behavior. Gozal46 found that first-graders who had an unusually high prevalence of snoring and nocturnal gas exchange abnormalities were poor achievers until their SDB was treated. After treatment, their academic scores significantly improved."
What is Avogadro's Law
"states that 1 g atomic weight of any substance contains exactly the same number of atoms, molecules, or ions. "
Which types of substances have high thermal conductivity and which have lower ones?
"metals - transfer heat rapidly therefore if you touch metal like silver, copper, aluminum, iron, lead, etc. it feels cold because the object is ""taking"" your heat. vs. solids and liquids exhibit low thermal conductivity - air, wool cork board, fiberglass all have low thermal conductivity with ice, glass, concrete, water, hydrogen, helium, snow all in the middle"
what does dalton's law describe with regard to the total pressure in a gas mixture
the relationship among the partial pressure and the total pressure in a gas mixture
What is the purpose of a baseline assessment conducted prior to IPPB treatment
helps individualize the treatment and allows objective evaluation of the patient's subsequent response to therapy. together with the pt medical history it alerts the RT to possible problems or hazards associated with administering IPPB to a specific pt.
How do you position a patient for postural drainage when the superior segment needs draining
"lying flat, pillow under stomach, pillow under legs"
What action should be taken if the patient experiences pulmonary hemorrhage during postural drainage therapy
"stop therapy, return patient to original resting position, call phusican immediately. Administer o2 and maintain an airway until physican responds"
"What action should be taken if the patient experiences pain or injury to muscles, ribs or spine during postural drainage therapy"
"stop therapy that appears directly associated with pain or problem, exercise care in moving patient, and consult physican"
How long are positions used in postural drainage held for
3-15 minutes and modified as the patient's condition and tolerance warrant
What is the treatment for passive atelectasis
"debilitated patients need to be moved periodically by rolling every two hours as an example. some hospitals have kinetic beds that continuously move the patients. post op pts must deep breathe. pts unable to voluntarily deep breathe may need IPPB and those who do, may benefit from IS"
Oxygen's effect on capillary shunt and shuntlike effect
with capillary shunt - refractory to oxygen therapy because the alveoli are unable to provide any 02/co2 exchange function. shuntlike effect - responds to O2 therapy because capillary perfusion is in excess of alveolar ventilation therefore increased O2 helps the situation!
Expert opinion re: education & psychosocial support sessions
grade c - less supported by evidence, but supported by expert opinion
diseases diagnosed by BAL procedure
BAL is useful in the diagnosis of some interstitial lung diseases (Table 16-1).12 This technique requires close cooperation between the bronchoscopist and the assistant in order to distend terminal bronchioles and alveolar spaces rapidly with pyrogen-free normal saline and then collect this cell-rich fluid without contamination or loss
Which two states of matter are considered fluids
liquids and gases because gases and liquids can both flow
What does condensation do with regard to temperature
"returns heat to and warms the surrounding environment, whereas vaporization of water cools teh adjacent air"
what is the major drawback of a venturi tube
any buildup of pressure downstream from the entrainment port decreases fluid entrainment
What are two applications of capillary action?
the basis for blood samples obtained by use of a capillary tube adn the absorbent wicks used in sme gas humidifiers
how does a pitot tube overcome the drawback of a venture tube
"rather than restoring fluid pressure, a pitot tube restores fluid velocity which lessens the effect of downstream pressure on fluid entrainment"
Describe the role of the thymus gland inmyasthenia gravis
Thymus gland is almost always abnormal and it is generally presumed that the antibodies arise within the thymus or in related tissue
What is the distance walking test and IMET
distance walking test is easier to perform, the results correlate well with functional status, ant they can identify the need for supplemental oxygen. IMET is incremental maximal exercise test; more complex but they stress the cardiopulmonary system maximally and better define the absolute limits on a patient
What are the two major types of internal energy
energy of position which is potential energy and energy of motion which is kinetic energy
What is the influence of pressure on vaporization
"if the surrounding air pressure is high, there will be more opposing air molecules and vaporization will decrease"
"with regard to fluid in a tube, where does frictional resistence to flow exist"
within the fluid itself (viscosity) and between the fluid and the tube wall
What shoule the clinician do after the postural drainage treatment is over
"restore the pt to the pre treatment position, and ensure his or her stability and comfort. Immediate post-treatment assessment includes repeat vital signs, confirmation of satisfactory arterial saturation, chest auscultation, and patient questioning regarding his ro her subjective response to the procedure"
What is the usual onset of GBS?
frequently occurs 1 to 4 weeks after a febrile episode such as upper respiratory or gastrointestinal illness. nerous viruses and some bacterial agents have been implicated as precursors to Guillain-Barre syndrome.
what is the coanda effect and what device uses this effect
used in most fluidic circuitry. when fluid flows through a small orifice with property contoured downstream surfaces a phenomenon called wall attachment occurs
What parts of the body should not be percussed
"avoid tender areas or sites of trauma or surgery, and never percuss directly over bony prominences such as te clavicles or vertebrae"
When to employ the use a chest tube to treat apneumothorax
When pneumothorax is larger than 20%, it should be evacuated. In less severe cases, air may simply be withdrawn from the pleural cavity by needle aspiration, In more serious cases, a chest tube attached to an underwater seal is inserted into the patient's pleural cavity
What is the formula for the first law of thermodynamics
"U=E+W U is internal energy of an object, E is the energy transferred to or from and W is the external work perfomed on the object"
what are the two ways a gas can be liquified
by cooling it to below its boiling point or cooling it to its critical temperature and then being compressed
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