Management Flashcards

airway obstruction
Terms Definitions
Mild Hypoxia
91-94%
Hypoxia
Oxygen deficiency
Insufflate
To blow into
Atelectasis
collapse of alveoli
Infant Tt size
3.5
Severe Hypoxia
85% or lower
_______________ respirations are rapid, deep respiration due to diabetic ketoacidosis.
Kussmaul's
high pressure cuffs are...volume
low
Intubation Devices
Endotracheal Tube (ETT)Esophageal ConbiTube (ETC)Pharyngo-tracheal Lumen Ariway (PtL)Laryngeal Mask Airway (LMAEsophageal Gastric Tube (EGTA)Esophageal Obturator Airway (EOA)
Lumen
the tunnel through a tube
Sighing
Slow, deep, involuntary inspiration followed by a prolonged expiration
Narrowest part of adult airway
glottis
Nasal Cannula
Liter Flow 2-6
Concentration: Low
O2 Percentge:: 25-40 National : 24-44
the..nerves provide sensory fibers from the trigeminal nerve to the superior and inferior surfaces of the hard and soft palate
palatine
lma contraindications
morbid obesity
risk of aspiration
hiatial hernia
delayed gastric emptying, diabetics
glottic obstruction
limited mouth opening less than 1.5 mm
increased airway resistance
poor pulmonary compliance
intestinal obtruction
loud, lower-pitched sound on percussion heard over hyperinflated lungs, such as COPD/asthma
hyperresonance
Magill Forceps
scissor-style clamps with circular tips
ET Intubation Complications
Equipment malfunctionteeth breakage and soft tissue lacerationhypoxiaesophageal intubationendobronchial intubationtension pneumothorax
Snoring
results from partial obstruction of the upper airway by the tongue
Most nasopharyngeal airways are designed to be placed in which nostril?
Right nostril
Sneezing
Sudden, forceful exhalation from the nose
Anoxia
The absence or near-absence or oxygen
Agonal Respirations
Shallow, slow infrequent breathing, indicating brain anoxia
Dyspnea
An abnormality of breathing rate, pattern, or effort
Lower Airway
Bronchi, alveoli, lung parenchyma, pleura
When possible, suction should be limited to _____ seconds.
15
Nervous system control of breathing comes from the
medulla
bilateral palsy of the superior laryngeal nerve cause
hoarsness
the...nerve provides sensation to the airway below the epiglottis
vagus
Stop suctioning the artificial airway if the HR decreases by ___ BPM or if it increases by ____ BPM, or if oxygen saturation drops below ___ %
20

40

90
What is the total lung capacity?
6.0L
Needle Cricothyrotomy
surgical airway technique that inserts a 14 gauge needle into a trachea and the cricothyroid membrane
Compliance
the stiffness or flexibility of the lung tissue
Paradoxical Breathing
assymetrical chest wall movement that lessens res
Rhonchi
a course, rattling noise heard on inspiration, associated with inflammation, mucus, or fluid in the bronchioles
Barotrauma
injury caused by pressure within an enclosed space
An insufficiency of oxygen in the body's tissues.
Hypoxia
Therapy regulater
Pressure regulator used for delivering oxygen to patients
Tension Pneumothorax
Is marked by progressively worsening compliance (more difficulty in ventilation), diminished unilateral breath sounds, hypoxia with hypotension, and destended neck veins
Endotracheal intubation equipment
Laryngoscope (handle, blade), ETT, 10-mL syringe, Stylet, BVM, Suction device, Magill forceps, Tape or tube-holding device
Stoma
Opening in the anterior neck that connects the trachea with ambient air
Pulse Oximetry
A measurement of hemoglobin oxygen saturation in the peripheral tissues
Respiratory rate X tidal volume =
Minute volume
Agonal or apneustic respirations
Shallow, infrequent, irregular respirations.
Coughing
forceful exhalation of a large volume of air from the lungs. It serves as a protective mechanism to expell foreign matter from the lungs.
The most common cause of airway obstruction is the __________.
tongue.
Should BVM's used an an emergency setting be equipped with a pop off valve?
No
The primary muscle of ventilation is the
diaphragm
the cricorthyroid membrane covers the crycothyroid space of about
9 mm
airways problems are less recurent in ..bilateral recurrent laryngeal nerve loss
chronic
A stoma resultingfrom a tracheotomy is called a:
tracheostomy
How often should you change the disposable inner cannula?
q24h
What are the four medications that can go down the ETT tube
LidocaneEpinephrineAtropineNaloxalone
What happens with you poke the ETT tube or laryngascope on the back of the throat
Bradacardia
Contraindications of the Combi Tube
Esopheal VarasisPediatric PatientsGag ReflexIngestion of caustic substance
What breathing device is the EMT's best way of administering oxygen?
Nonrebreather mask
Kussmaul's Respirations
Deep, slow or rapid, gasping breathing commonly found in diabetic ketoacidosis
Non-deplorizing agents
Block the uptake of acetylcholine and do not allow stimulation of the muscle
End-Tidal CO2
Is the measurement of the CO2 concentration a the end of expiration
Rapid-sequence induction
Classic rapid sequence induction is an anesthetic procedure whereby patients rapidly receive induction of general anesthesia, followed by indotracheal intubation
Which mainstem bronchus is straighter, and more likely to be inadvertently intubated.
Right mainstem bronchus
Mouth to mouth or mouth to mask delivers _____% oxygen.
16-17%
sniffing position requires alignment of the three axes
oral pharyngeal and tracheal
bilateral vagal denervation produces
flaccid, midpositioned vocal cords similar to those seen after administration of succinocholine
high pressure cuffs are associated with
more ischemic damage
What do wheezes indicate?

(high-pitched squeaking)
rapid vibration of bronchial walls

Indicates bronchospasm, airway obstruction, COPD
What is the normal value for vital capacity?
4.5L
what is absent tactile fremitus indicitave of?
pneumothorax and atelectasis
a continuum from discomfort during inspiration to intense, sharp pain at the end of inspiration.

pain is aggravated by deep breathing and coughing.

pain that is localized (vs diffuse)
pleuritic chest pain
Pneumothorax
The presence of gas or air in the plural cavity
How many liters of oxygen do M cylinders hold?
3,000 liters
Demand Valve Device
A ventilation device that is manually operated by a push button or lever
Pulsus Paradoxus
Drop in blood pressure of greater than 10 torr during inspiration
Jaw Thrust
Lift the jaw by grasping under the chin and behind the teeth, without tilting the head.
Biot's respirations
an irregular pattern of rate and depth of breathing with sudden episodes of apnea.
sensory supply to the upper airway is derived from
cranial nerves
Waht is the normal level for hematocrit?
40-54% males

38-47% females
The volume of air inhaled and exhated with each breath; only a small proportion of total capacity of lungs
tidal volume(VT)

(0.5L)
After this test you must do a chest xray to check for pneumo.
thoracentesis
What are the 2 manual maneuvers to open an airway
Head Tilt/Chin LiftJaw-Thrust
How many liters per minute do you set a NRB for?
15 LPM
Modified Jaw Thrust
Lift the jaw using fingers behind the mandibular angles; do not tilt head
Laryngeal Mask Airway
Is an airway with an inflatable distal end that masks the laryngeal opening
Hypoxic drive is caused by _________. In this condition, the patients stimullis to increase rate and depth of ventilations occurs when _________________.
COPD, O2 levels decrease
low pressure cuffs increase the
likely hood of a sore throat
area below the cords is innervated by the
recurrent laryngeal nerve
what is hyperresonance on percussion indicative of?
lung hyperinflation (COPD), lung collapse, air trapping (Asthma)
Maximum volume of air that can be exhaled after maximum inspiration, higher for men generally.
Vital capacity (4.5L)
What does Absent breath sounds indicate?
pleural effusion, mainstem bronchi obstruction, large atelectasis, pneumonectomy, lobectomy
What does tachypnea indicate?

(Rate >20 breaths/min; >25 breaths/min in elderly)
Magnitude of increase above normal rate reflects increased work of breathing. Due to fever, anxiety, hypoxemia, restrictive lung disease.
Nonrebreather mask
a mask that has one sided ports with a reservoir bag to hold oxygen ready to inhale
The curves laryngoscope blade is also called a _______________ blade.
McIntosh (Curved like the apple.)
treatment for laryngospasm includes...or...
cont pp airway pressure of small dose of rapidly acting muscle relaxant
stridor/respiratory distress is due to injury to
acute injury to the recurrent laryngeal nerve
what is an option for the cannont ventilat e or cannot intubate ventilation
percutatneous transtracheal jet ventilation
voluntary decrease in tidal volume to decrease pain on chest expansion.

What does this indicate?
splinting

*Due to thoracic or abdominal incision, chest trauma, or pleurisy
Amount of air remaining in lungs after forced expiration; air available in lungs for gas exchange between breaths
residual volume (RV) (1.5L)
What is the order of ETT intubation
Place through the cordsListen to StomachInflate the cuffListen to the lungsSecure the tube
Contraindications of the Esophageal Gastric Tube Airway and the Esophageal Obturator Airway
*Age less than 16
*Height less than 5 feet or more than 6'7"
*Possible ingestion of caustic poisons
*History or esophageal disease or alcoholism
nerve injury to these nerves can occur w lmas
recurrent laryngeal, hypoglossal or lingual
blood supply to the larynx is derived from
branches of the thyroid arteries
what does a patient in the tripod position/who is unable to lie flat indicate?
(leaning forward with arms and elbows supported on overbead table).
indicates moderate to severe respiratory distress or hypoxemia in COPD, asthma, pulmonary edema.
Measurement of airflow rate in middle half of forced expiration; early indicator of disease of small airways
Forced midexpiratory flow rate (FEF 25-75%)

(normal for age<50: >/= 75% predicted)
What does cyanosis indicate?(Bluish color of skin best seen in lips and on palpebral conjunctiva)
reflects 5-6 g of hemoglobin not bound with oxygen due to decrease O2 transfer in lungs, dereased cardiac output. Is nonspecific, unrealiable indicator.
What is a Venturi mask
A high flow face mask that uses a Venturi system to deliver precise oxygen conecntrations regardless of the PT's rate and depth of breathing
Ways to verify the placement of the ETT in the trachea
*Visualize the tube passing through the cords*Presence of bilateral breath sounds*Absence of breath sounds over the epigastrium*Positive end-tidal CO2 change on an ETCO2 device*Use of an EDD device*Absence of vomitus in ETT*Absence of phonation, or vocal sounds,once tube in place
To choose the correct size oropharyngeal airway, you should measure from the patient's
front teeth to the angle of the jaw.
the cuff of the lma forms a low pressure seal against
the enterance to the larynx
What are nursing considerations for CT scans?
- contrast media given IV/orally
- BUN and creatinine done prior to contrast
- assess if patient is allergic to shellfist (iodine)
- hydrate pt. before and after so can excrete dye
How do you determine the proper size of an oropharyngeal airway?
Measure from the corner of the patients mouth to the tip of the earlobe.
Amount of air that can be quickly and forcefully exhaled after maximum inspiration
forced vital capacity (FVC)

(over 80% of predicted is normal)
What happens when oxygen does not have any humidification?
It dry's out the mucous membranes of the patients airway and lungs.
the choice of tube diameter is always a compromise between
maximizing flow w a large size and mnimizing ariway trauma with a small size
How to figure out pediatric ETT size
ETT size(mm) = (age in years + 16) / 4
Stabilize Schedule (Lean)
Level Schedule
Underutilize capacity
Establish freeze windows
Foundations Team
Participate in local communication
Problem analysis
Improvement of design and implementation
Competence
having capacity to function effectively as an individual and/or org within the context of cultural beliefs behaviors.
RFID Tags
Transponder which receives radio signals and in response sends out a radio signal
Antennae, small chip, and stores small amount of data
Programmed at manufacture or installation
Powered by the electromagnetic field generated by antennas
Benefits of Simulations
Relatively straightforward and generally easier to understand
It can answer "what-if" types of questions without actually changing or building a real system
Generally safer and cheaper to experiment than a real system
Culture
patterns of human behavior that include language, thoughts, comms, actions, cusoms, beliefs, values, ethnic or religious groups.
Materials Management (ERP)
Requisitions for suppliers checked against budget
Electronic data interchage with suppliers
Bar codes, RFID chips
Food services management
QuickMedx's Value Propostions
Rapit throughput rate
Minimal queue time
Low cost
One stop shopping
Let the customer do the initial triage
Sponsor (six sigma)
Requestor of project
Defines project goals, objectives, and scope
Removes barriers and aligns resources
Key communicator of project progress
Horn Effect
-If a person seems particularly deficient in a critical trait, then that person is automatically assumed to be deficient in many other traits

Ex. Employee who is constantly "late" to work (perhaps due to other non-work responsibilities in the morning) is assumed to be negligent in their work-related duties, not committed to the company/project, and perhaps even lazy overall.
Measuring Capacity
Ti = average time between arrivals
Tp = average processing time of a job
c = number of parallel servers
Arrival rate (measures throughput rate)= 1/Ti
Service rate (measures capacity) = c/Tp
Ri < Rp - adequate capacity
Utilization rate = Tp/(c x Ti)
Unstructured Care Problem
Iterative - compromised of multiple cycles
Recursive - each step based on the outcomes of the former
Customized
Uncertain
Service Oriented Architecture
Loose coupling of services with operating systems
Allows different applications to exchange data with one another.
Systems package functionality as interoperable services
Push System
An item is realseased for production at a specified time with an associated due date (controls throughput > WIP)
Pull System
Explicitly limits the amount of work in the process (aka inventory/unfinished products) that can be in the system ( controls WIP > throughput)
Characteristics of Manufacturing
Labor costs - 10%
Manufacturing costs - 40%
Production not near customers
High degree of automation
Variation is reduced
"Product" Layout
 
Time -
Quality -
Inventory -
Scheduling -
Flexibility -
Demand changes -
Product mix -
New products -
"Patient focused" care
Service line production
However, lack of pooling makes large variation aka difficult
Time -Shorter lead times
Quality -Faster feedback
Inventory -Lower WIP
Scheduling -Well defined
Flexibility -Less flexible
Demand changes -Less easy to absorb
Product mix - Limited and fixed
New products - More difficult to introduce
System Capacity
Minimum capacity of any step or key resource for the process (aka the capacity of the bottleneck)
 
Capacity = (1/unit load) x batch size x availibility x number of resources
Clinical Decision Support Systems
Passive - present information culled from other systems about patient and medical science
Active - patient specific information from clinical databasem and rule-based inference engine; combines them to generate specific suggestions
Risks of QuickMedx
Cannot treat all diseases (what do they do if a patient comes in and needs immediate treatment?)
More volume, more risk
Little price elasticity
NP's becoming bored
Patient flow is unpredictable
Management team not proven for growth
Criticisms by physician groups over quality of care
Uninsured patients expected PCP type service and consuming service time
No significant barriers to entry
"Process" Layout
Time -
Quality -
Inventory -
Scheduling -
Flexibility -
Demand changes -
Product mix -
New products -
Departmentalized - all personnel of one type are grouped together
Time - longer lead time
Quality -slower feedback
Inventory -High WIP
Scheduling -Difficult
Flexibility - More flexible
Demand changes -Relatively easy to absorb
Product mix - can be large and variable
New products -can incoroporate new products easily
Hawthorne Effect
-Bias occurs when people know they are being watched.
Ex. If I know my boss is watching, I will work harder.
- Illumination study. Two groups, one increased lighting, one not. Both groups' productivity increased. Not the lighting that caused the increase in productivity but the attention received by the group.
Benefits of RFID Tags (over barcode)
Unique identifier
Read many at once
No line of sight required
Easy to conceal
Works well in harsh environment
Theory X and Theory Y
-X= employees are lazy and unintelligent. (authoritarian/tight control)
-Y= employees are creative and competent.(liberating/developmental)
-Theory X managers are no longer effective b/c they rely on employee's lower needs for motivation (safety and psych)
Total Quality Control (Lean)
Jidoka - fix problem right when it occurs
Enforce compliance: quality first, output second
Housekeeping: sort, straighten, sweep, standardize, self-discipline
Kaizen
Automatic inspection/100% inspection
Misktake-proof the process
Process Flow Time
The time that a unit spends in the system (usually we calculate the average). Short flow time = high level of operational excellence
Levers for Decreasing Theoretical Flow Time
Reduce the work content of activities on the critical path
Eliminate non-value adding subactivities (work smarter)
Increase the speed
Reduce number of repeat activities
Change patient mixup
Design for efficiency 
Move some of the work content off the critical path
4 Main Six Sigma Objectives at Academic Medical Hospital
Create a safer environment by reducing medical errors
Become a "best place to care" reduced turnover
Become a preferred place to care, gain market shares
Reduce variability and process waste
Queuing Approach by Vericourt and Jennings
In order to provide care in a timely fashion, hospitals set up a threshold time T, and any patients waiting after T is unacceptable (needy patients get priority)
 
Physician groups in hospitals should decide what T is
 
Realize that compliance cannot be fully governed
 
Some hospitals turn away patients in order to keep their T level up
Heijunka
Production Smoothing.
Conscientiousness
Hardworking, organized, dependable
telecommuting theory
working from home
Stressor
A source of stress.
Mission
the organization’s reason for existence in society
Compensation
Pay, Benefits, Rewards and movivation
Ivory Tower Planning
getting ppl involved
budget
financial plan that sets forth management's expectations, and, on the basis of those expectations, allocates the use of specific resources throughout the firm
retrenchment strategy
changes operations to correct weaknesses
Value
The monitory amount associated with how well a job task, good, or service, meets users needs
Strategy
a comprehensive action plan that identifies long-term direction for an organization and guides resource utilization to accomplish organizational goals with sustainable competitive advantage
Fredrick Window Taylor
-Father of scientific management-engineer who believed that increasing worker productivity first began with improving management-insisted improvements be based on scientific researchpioneered time and motion studies
decision
choice made from among available alternatives
Corporation Charters
States give legal chartersusually choose Delaware because of its highly evolved law on corporations, and the fact that Delaware law is business-friendly.
informal leader?
not formally recongized, influences actions of others
What is the power gap?
Give examples
flow
______ is when skill level and difficulty of task rises at the same rate
risk
chance of loss, the degree of probability of loss, and the amount of possible loss
physiological needs
food, clothing, and shelter, which people try to satisfy before all others (most basic level)
manager
a person who supports and is responsible for the work of others. directly supervise, support, and help activate work efforts to achieve the performance goals of individuals, teams, or even an organization as a whole.
human capital
stock of skills and knowledge available for labor
Vroom-Jago Model
provides guidance in deciding the appropriate amount of participation for subordinates. Participation in decision making ranging from highly autocratic to highly democratic
People or companies that purchase goods or services from an organization.
O. Customers
ARBITRATION
Process where third party has high control over the final decision but low control over the resolution process (how the conflict gets decided)
expected creativity
discovering problems because you are expected to by the organization
performance appraisal
1) assessing an employer's performance2) providing him with feedback
Reg analysis
Reagan and Clinton both required federal regulatory agencies to write a REGULATORY IMPACT ANALYSIS for major new rules that had a predicted annual impact of more than $100 million.REIs have three components1.A statement of the need for the rule2.An examination of alternative approaches (other than the rule)3.An evaluation of the benefits and costs of the rule, and the alternatives
behavior patterns that go with the positions individuals occupy in an organization
roles
what are the 5 decisional roles?
-entrepeneur
-intrapeneur
-disturbance handler
-resource allocator
-negotiator
what are the 5 decisional roles?
-initiates/encourages change/creativity
-^^^^ in a big organization
-deal w/ issues demanding imm. attn.
-allocates resources
-internal arbitration role
cost-leadership
produce products or services at lower costs then competitors
scope
extent or range of view, outlook, application, operation, effectiveness, etc.:
negotiable instruments
forms of commercial paper (such as checks) that are transferable among businesses and individuals and represent a promises to pay a specified amount
Non-verbal Communication
All elements of communication that do not involve words
technical skill
the ability to use expertise to perform a task with proficiency accountants, engineers, market researchers, financial planners and systems analysts
shaping
when you have low self efficacy, this is used to build it, by receiving rewards successively for small progressions toward desired behavior
stories
story based in true events that is repeated frequently
REENGINEERING (reenginering)
overhaul of business process using IT, and results in a completely new method and technology to execute business processes
SITUATIONAL LEADERSHIP THEORY
Effective leaders vary their styles based on “readiness” of followers
Participating


Used when a follower is able to complete a task but may seem unwilling/insecure about doing do
high relationship, low task 
barriers to diversity
1) stereotypes and prejudices2) fears of reverse discrimination3) resistance to diversity programs4) unsupportive social atmosphere5) lack of support for family demands6) lack of support for career building steps
ORGANIZATIONAL STRUCTURE
THE FORMAL FRAMEWORK BY WHICH JOB TASKS ARE DIVIDED, GROUPED, & COORDINATED
Utilitarian Approach
proposes that actions and plans should be judged by their consequences. People should behave in a way that will produce the greatest benefit to society and produce the least harm or the lowest costs.
Is based on user's relationship with influential people?
Connection Power
Expectancy Theory
A theory about work motivation that focuses on how employees make choices among alternative behaviors and levels of effort.
Bernard Bass and Bruce Avolio created the
full range model
Leadership - Emotional Intelligence Competencies

Self-Awareness - Understanding ones moods, emotions, drives and their effect on others

Self-Management - Ability to control moods

Relationship Management - Ability to build networks, relationships, and rapport

Social Awareness - Ability to understand others
network structure
uses IT link with networks of outside suppliers and service contractors
Reason managers avoid making decisions
Lack of structure
Uncertainty and Risk
Conflict
The Japanese culture typically values _______; the U.S. culture typically values _________.
D. collectivism; individualism
COALITION
Group of people who pool their power & resources to gain greater influence via their numbers
disadvantages of matrix structure hybrid
1) confusion and conflict: disagreement and misunderstanding
set of assumptions of hoe to manage individuals who are motivated by lower order needs
Theory X
Rules for Active Listening
listen for message contentlisten for feelingsrespond to feelings- never tell someone they shouldn't feel a certain way.note all cues, verbal and nonverbalparaphrase and restate
corporate-level strategy
the mix of businesses within which an organization operates
3 types of casual attribtution
Fundamental -when one attributes the behavior of another to their characteristics rather than to situational factorsSelf Serving Bias - claims responsible for good but not bad3Self-fulfilling prophecy- when one’s expectations of themselves leads to such


o   Accord and satisfaction


-  When parties reach an agreement for payment in full on a contract 
Customer preference for a particular religion can qualify as a bonafide occupational qualification (BFOQ). True or False
False, customer preference never qualifies for BFOQ
STRUCTURAL APPROACHES TO CONFLICT MANAGEMENT
Emphasize superordinate goals that all in group can supportReduce differentiation between partiesImprove communication & understandingReduce task interdependenceIncrease resourcesClarify rules and proceduresThese work to minimize dysfunctional conflict
Fundamental attribution error
we have a tendency to overestimate the influence of internal factors and underestimate the external factors
System Used to Determine Payment in: INPATIENT REHABILITATION
(CMG)Case Mix Groups
Who were Lillian & Frank Gilbreth?
Follower's of Frederick W. Taylor
What does a patent holder have during the exclusive rights periods for patents


-        During the exclusive rights periods of 14 and 20 years, the patent holder has the sole rights for profits on sales
1) Size (structure of network)
+  useful source of info/help
- take time to build/maintain
Three key characteristics of transformation leaders
articulate a strategic vision for the corporationpresents a role for others to identify with and to followCommunicates high performance standards and also shows confidence in the followers' abilities to meet these standards.
Why do ppl not contribute to teams?
Presence of someone with expertise. The presentation of a compelling argument. Lacking confidence in one's ability to contribute. An unimportant or meaningless decision. A dysfunctional decision making climate.
In the open to buy budget, the inventory we need to purchase at cost to replace our expected sales is
the Unadjusted Purchase Budget (expected sales * %COGS)
A persons ethical behavior is affected by his or her
level of moral development, certain personality variables, and such situational factors at the job itself, the supervisor, and the organizational level.
what is meant by task identity
can identify their role ("thats what i do")
If, in the open to buy budget, you wanted to lower the purchase budget for the year by $24,000, how would you do this?
Calculate the worksheet like normal, except lower each month's adjusted purchase budget by $2,000, so that 2,000 multiplied by 12 spreads out the 24,000 over the entire year.
If your LPC score is high, what does that mean? What type of leader are you?
- You describe them positively because you have a high opinion of them; you are a relationship-oriented leader
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