question

CPT/IPPB/IS A. Know indications and contraindications for postural drainage.

answer

indications - mobilize secretions (mucokinesis), dehydration, acute pulmonary disease, prophylaxis contraindications - empyema, flail chest, wounds, spinal injury, pneumothorax, head injury or surgery, unstable cardiac status, unstable COPD, obesity, pregnant, and recent meal or tube feeding.

question

CPT/IPPB/IS B. Know positions to drain following: 1. Apicals of upper lobes 2. Posterior basal 3. Anterior and posterior segments of lower lobes

answer

1. Fowler's 2. Prone Trendelenburg 3. Prone

question

CPT/IPPB/IS C. Know peak flow range of the Bird Mark 7 in the airmix mode and when it is not in the airmix mode.

answer

0-50 L/Min. (non air mix pushed in). 0-80 L/Min. (air mix pulled out).

question

CPT/IPPB/IS D. Know how to classify the PR1.

answer

pneumatically powered, pressure limited, flow cycled, single circuit, positive pressure, assist or control (usually assist).

question

CPT/IPPB/IS E. Know what the concentrations of oxygen are on the PR1 in the airmix mode and what position the knob is in for the airmix mode.

answer

100 percent pull out (pulled out 100 fio2) push in is airmix (push in 40-60 fio2).

question

CPT/IPPB/IS F. Know what the apnea timer on the Bird Mark 7 controls.

answer

inspiratory hold that improves gas distribution. has most influence on expiatory time.

question

CPT/IPPB/IS G. Know what parameter is effected with a change in pressure during an IPPB treatment.

answer

volume delivered (will increase or decrease with the pressure) and inspiratory time.

question

CPT/IPPB/IS H. Know the primary indication for incentive spirometry.

answer

to treat and/or prevent atelectasis.

question

CPT/IPPB/IS I. Know indications and contraindications for IPPB.

answer

indications - deliver medication, deliver adequate vital capacity, improve I:E ratio, Improve cough (mobilize secretions), alter the V/Q (ventilation-profusion), and improve or prevent atelectasis, and decrease PaCO2. contraindications - untreated tension pneumothorax, active TB, O2 induced hypo ventilation, may increase air trapping, may increase ICP, may decrease cardiac pressure, may cause tachypnea, could create pneumothorax, may cause hymoptass (coughing blood), may cause hypotension.

question

ABG Puncture/Interpretation A. Know what type of patient might have the following results: pH 7.37 PaCO2 60 PaO2 60 HCO3 35. What is the correct recommendation for this and what causes this.

answer

the ABG is fully compensated respiratory acidosis, the patient has COPD, do nothing this is normal for this patient.

question

ABG Puncture/Interpretation B. Know how to identify lab errors.

answer

if sample is left room air for over an hour, or has air bubbles, and excessive heparin.

question

ABG Puncture/Interpretation C. Know what happens when you fail to ice your sample.

answer

if not been iced within 10 minutes, it will lower the PaO2, raise the PaCO2, and the Ph will be lower than it really is.

question

ABG Puncture/Interpretation D. Know what happens when an air bubble is left in your sample.

answer

could increase the PaO2 and decrease CO2.

question

ABG Puncture/Interpretation G. Know what the following electrodes measure: 1. Clark 2. Sanz 3. Severinghaus

answer

1. clark - O2 2. sanz - Ph 3. Severinghaus - CO2

question

ABG Puncture/Interpretation H. Know what 5 things to do after you have drawn your ABG sample to complete the procedure.

answer

hold pressure for 5 minutes or greater, expel air and cap it, mix sample, and ice it.

question

ABG Puncture/Interpretation I. Know the proper sequence for determining the site of an ABG puncture.

answer

radial then brachial then femoral

question

ABG Puncture/Interpretation J. Know the types of hypoxia

answer

1. hypoxic hypoxia 2. hypemic hypoxia 3. stagnant hypoxia 4. histoxic hypoxia

question

ABG Puncture/Interpretation K. Know what happens to make the Oxyhemoglobin dissociation curve shift left or right.

answer

left - H+ decreases (Ph increases), PCO2 decreases, temperature decreases, and 2-3 DPG decreases right - H+ increases (Ph decreases), PCO2 increases, temperature increases, and 2-3 DPG increases.

question

ABG Puncture/Interpretation L. Know what value best reflects ventilation.

answer

PaCO2

question

ABG Puncture/Interpretation M. Know normal venous blood values.

answer

Ph-7.36, PvCO2-46, PvO2-40, HCO3-24

question

CPR/ECG's F. Know when PCV's are dangerous.

answer

premature ventricular contractions, occur in multiples, more than 6 times a minute, land on or near a T wave.

question

CPR/ECG's G. Know what the P, QRS complex, and T represent on an ECG.

answer

P - depolarization of the atria, QRS - ventricular depolarization, T - ventricular repolarization.

question

CPR/ECG's H. Know how to identify: 1. PVC's 2. Normal sinus rhythm 3. Sinus bradycardia 4. Ventricular tachycardia 5. sinus tachycardia

answer

1. wide QRS, lacking P Wave, T wave deflation (going down) 2. normal P, QRS, and T, rate is between 60 - 100 beats a minute. 3. normal but rate below 60. 4. abnormal QRS but normal in appearance and regular inrhythm, no P wave, treated as an emergency. If witnessed, can be fixed with a premortial thump. 5. normal tracing but heart rate is over 100 beats a minute.

question

Patient Assessment B. Know the normal values for the following: 1. Hgb 2. WBC 3. Hct 4. K

answer

1. 14-18 for male, 12-16 for female. 2. 5000-10,000 3. 40-50 in males. 37-47 in female. 4. 3.5-5 *if you give Hgb and want to get an approximate hematacrit multiple Hgb by 3.

question

Patient Assessment C. know how to convert Celsius to Fahrenheit.

answer

1. F=Cx1.8x32 2. C= (F-32)/1.8

question

Patient Assessment G. Know what normal breath sounds are called

answer

visicular, bronchial, bronchioviscular, and tracheal.

question

Artificial Airways/Suctioning A. know how to determine proper size of suctioning catheters.

answer

mm/2x3, IDx2 then next lowest number.

question

Sterilization/Microbiology C. Know what Mycobacterium tuberculosis is and how it is spread.

answer

TB, gram positive, acid fast bacillus, spread through droplet.

question

Respiratory Equations A. Know the alveolar air equation and how to use it.

answer

PAO2=FIO2 (PB-47) - 1.2 (PaCO2)

question

Respiratory Equations D. Know what CaO2 is and how to find it.

answer

it is the arterial oxygen content, the formula is CaO2 = 1.36xHgbxSaO2+(0.003xPaO2). (normal = 17-24 mL/dL)

question

Respiratory Equations E. Know what an A-a gradient is and how to determine it.

answer

Alveolar-arterial O2 tension difference PA-aO2=PAO2-PaO2

question

Respiratory Equations F. Know what compliance is and how to determine it

answer

volume change per unit in applied pressure C=change in volume divided by change in pressure

question

Respiratory Equations G. Know how many milliliters of oxygen per grams of Hgb.

answer

1.34 ml of oxygen

question

Respiratory Equations H. Know what the respiratory quotient is and how it is determined.

answer

is a dimensionless number used in calculations of basal metabolic rate when estimated from carbon dioxide production. RQ=CO2/O2.

question

Respiratory Equations I. know what carbon anhydrase is and what it does.

answer

as CO2 enters the bloodstream it mixes with H2O and converts into carbonic acid, this reaction is enhanced and found in red blood cells.

question

Respiratory Equations J. Know the Henderson-Hasselbach equation and what the numbers represent.

answer

pH = 6.1 + log HCO3 / H2CO3

question

Analyzers, Cylinders, Guages, and Flowmeters A. know liters in G, H, and E cylinders.

answer

G = 5,300 L H = 6,600 L E = 600 L

question

Analyzers, Cylinders, Guages, and Flowmeters B. Know cubic feet in a G, H, and E cylinder.

answer

G = 187.17 ft 3 H = 233.08 ft 3 E = 23.31 ft 3

question

Analyzers, Cylinders, Guages, and Flowmeters c. know what to do if gas escapes from the wall outlet after removing a flowmeter.

answer

re-insert the flowmeter and tell management.

question

Analyzers, Cylinders, Guages, and Flowmeters D. know what carbogen therapy is and equipment used.

answer

a mixture of 5%-10% carbon dioxide and 95%-90% oxygen used for inhalation therapy to produce vasodilation.

question

Analyzers, Cylinders, Guages, and Flowmeters e (1). know facts about P.I.S.S.

answer

Pin Index Safety System. part of the american standard safety system. these specifications apply only to the value outlets of small cylinders, up to and including size e, which use a yoke-type connection.

question

Analyzers, Cylinders, Guages, and Flowmeters e (2) know facts about D.I.S.S.

answer

diameter index safety system. specifications, established to prevent accidental interchange of law-pressure (<200 psig) medical gas connectors. used in respiratory care to connect equipment to a law-pressure gas source.

question

Analyzers, Cylinders, Guages, and Flowmeters e(3) know facts about A.S.S.S.

answer

american standard safety system, specifications adopted in the U.S. and canada for threaded high-pressure connections between compressed gas cylinders and their attachments.

question

Analyzers, Cylinders, Guages, and Flowmeters F. know facts about the bourdon gauge.

answer

always used with adjustable pressure-reducing value. uses fixed crifice. operates under variable pressures. gravity does not affect it (can be laid in its side and not affect results)

question

Analyzers, Cylinders, Guages, and Flowmeters G. know formula to figure duration of flow in G, H, and E Cylinders

answer

pressure (psig) x cylinder factor over flow (L/min) cylinder factors - G = 2.41 H = 3.14 E = .28

question

Analyzers, Cylinders, Guages, and Flowmeters H. Know critical temperature of oxygen and process for making liquid oxygen.

answer

-118.6 C (-181.48 F). chemical mixture is separated according to their different boiling points. vapors from a boiling solution are passed along a column. the temp of the column gradually decreases along its length. components with a higher boiling point condense on the column and return to the solution, components with a lower boiling point pass through the column and are collected.

question

Analyzers, Cylinders, Guages, and Flowmeters I. Know color for: air, oxygen, helium, cyclopropane, carbon dioxide, nitrogen, heliox, and nitrous oxide.

answer

air = yellow, oxygen = green, helium = brown, cyclopropane = orange, carbon dioxide = grey, nitrogen = black, heliox = brown/grey, nitrous oxide = black and brown

question

Analyzers, Cylinders, Guages, and Flowmeters J. Know what pink and blue crystals are used for in oxygen analyzers.

answer

pink - add moisture. blue - remove moisture.

question

Analyzers, Cylinders, Guages, and Flowmeters K. know difference between compensated and uncompensated flow meter.

answer

compensated - needle valve is distal to thorpe tube, back pressure has no effect and the ball "jumps" when attached to gas source. uncompensated - needle valve is proximal to tube, not compensated for back pressure, pressure downstream may cause flow to appear less than what it really is

question

Analyzers, Cylinders, Guages, and Flowmeters L. know how to classify oxygen analyzers. (4 ways)

answer

physical - uses paramagnetism principle to measure O2 concentration electric - uses electric current to measure O2 concentration chemical - uses different chemicals to measure O2 concentration electrochemical - most common. uses mix of electric and chemical to measure O2 concentration.

question

Anatomy A. know flow of blood through the heart.

answer

S/1 VC ---> RA --> TV---> RV ---->PV ----> PA ---> pulmonary circulation --> PV ---> LA ---> BV ---> LV ----> AV ---> Aorta ---> systemic circulation

question

Anatomy B. know what supplies collateral circulation to the head

answer

ulnar artery

question

Anatomy C. know what is contained in the mediastinum

answer

thymus gland, trachea, esophagus, heart, great vessels, lymph nodes

question

Anatomy D. Know 4 facts about alveolar air

answer

gas exchange happens in the alveoli. 47 torr, body temp, about 44 miligrams (weight)

question

Anatomy E. know what makes up the mucus blanket.

answer

95% water, 2 layers: sol and gel layer.

question

Anatomy F. Know segments of the lungs.

answer

RUL - apiral, posterior, anterior RML - lateral, medical RLL - superior, medinasal, Ant. Basal, lateral basal, post basal LVL - apporal, posterior Lingula - superior, inferior LLL - superior, ant. basal, lat. basal, post. basal

question

Anatomy G. know structure of alveoli

answer

grape-like clusters

question

Anatomy H. know valves for intraplueral and intrapulmonary pressures during inspiration and expiration

answer

intrapleural - insp. GmmHg. Exp -3 mmHg. Intrapulmonary - Insp - 3 mmHg. exp - +3 mmHg.

question

Anatomy I. know normal ventilation to perfusion

answer

0.8

question

Anatomy J. know 4 facts about surfactant

answer

detergent-like, phospholipid, down arrow surface tension, protect from alveoli collapse

question

Anatomy K. know about central and peripheral chemoreceptors. where located? what respond to? what happens when stimulated?

answer

central - near ventral medulla, respond to small variations in PCO2, regulates normal gas exchange. peripheral - located in carotid arteries. responds to heavy exercise. causes hyperventilation.

question

Anatomy L. know linings of the thorax.

answer

parietal plura, visceral plura, and mediastinal plura.

question

Anatomy M. know: ventilation, internal respiration, external respiration, and A-a gradient

answer

ventilation - molecular exchange of O2 and CO2 within body's tissue internal respiration - exchange of O2 and CO2 at tissue level external respiration - respiration process that involves gas exchange in the alveoli. A-a gradient - ratio of arterial O2 partial pressure (a) to alveolar O2 partial pressure (A) a measure of O2 transfer across the lungs.

question

Anatomy N. know what deadspace is and how to determine anatomic deadspace.

answer

respired gas volume that does not participate in gas exchange anatomical dead space is found by dividing tidal volume from dead-space (vd/vt)

question

anatomy O. know the muscles of normal ventilation, labored inspiration, and forced expiration

answer

normal - diaphragm, external and internal intercostals. labored - diaphragm, external and internal intercoastals, scalene, sternoclidoid, trapizavis, pectoral. forced - diaphragm, external and internal oblique.

question

anatomy P. know what hering-breuer reflex is

answer

sensory reflex in lungs that keep lungs from over/under inflating/deflating.

question

anatomy Q. know anatomical landmarks of upper air-way

answer

nose - nares, conchae (superior, middle, inferior), olfactory, nasopharynx. mouth - oral cavity, hard and soft palate, tongue, vellecula, orpharynx. throat - epiglottis, larynx, esophagus, trachea, laryngopharynx.

question

anatomy R. know structures of heart.

answer

epicardium, myocardium, endocardium, atria, ventricus, aortic valve, mitral valve, pulmonary valve. tricuspid valve.

question

anatomy S. know long segments most likely affected by aspiration in different anatomical positions.

answer

standing - right lower lobe and posterial basal. prone - anterior segments. supine - superior segments and right lower lobes.

question

medical gas, humidity, aerosol therapy a. know what gases make up the atmosphere and at what percent

answer

O2-21% Nitrogen - 78% CO2 - 0.04% trace gases like Augon - 0.9 %

question

medical gas, humidity, aerosol therapy b. how much more diffusible is CO2 than O2?

answer

CO2 is 20x more O2.

question

medical gas, humidity, aerosol therapy C. know Dalton's law and how to apply it.,

answer

total pressure of mixture of gases must equal sum of partial pressures of all component gases.

question

medical gas, humidity, aerosol therapy D. know how to express units in more than 1 way. (i.e. 760 torr= _____.)

answer

1 mmHg=1 torr 760 torr = 1 ATM 1 ATM = 76 cmHg 1 ATM = 29.92 in Hg 1 ATM = 10.332 m/H2O 1 ATM = 406.78 in/H2O 1 ATM = 1.033 kg/cm2 1 ATM = 33.899 ft of fresh H2O 1 ATM = 33 ft of sea H2O 1 ATM = 14.7 PSI 1 ATM = 101.325 kilopaxel

question

medical gas, humidity, aerosol therapy E. know what happens to partial pressures of gases in different elevations

answer

as you ascend partial pressure will rise and barometric pressure will drop.

question

medical gas, humidity, aerosol therapy f. know hazards of oxygen therapy.

answer

O2 toxicity. COPD pts.

question

medical gas, humidity, aerosol therapy G. know what system of oxygen delivery is best for COPD patients

answer

low flow (nasal cannula) and high flow (venturi mask)

question

medical gas, humidity, aerosol therapy H. know acceptable concentrations for Heli-Ox therapy

answer

70 (helium) - 30 (O2) or 80-20

question

medical gas, humidity, aerosol therapy I. know what effects the output of a humidifier.

answer

temperature

question

medical gas, humidity, aerosol therapy K. know what the proper temperature is to assure adequate humidity from a cascade humidifier.

answer

37 C / 98.6 F

question

medical gas, humidity, aerosol therapy L. know ideal range for particle size deposition in alveoli.

answer

0.5-3 microns

question

medical gas, humidity, aerosol therapy m. know hazards of ultrasonic nebulizer.

answer

asthma, Pts, CHF pts, fluid overload

question

medical gas, humidity, aerosol therapy n. know Bernoulli's principle and how it is used in respiratory therapy.

answer

for an inviscid flow an increase in the speed of the fluid occurs simultaneously with a decrease in pressure in the fluids potential energy.

question

medical gas, humidity, aerosol therapy O. know following: 1. relative humidity, 2. absolute humidity. 3. humidity deficit.

answer

relative - (RH) amt. of moisture in the air compared with the max the air could contain at the same temp. absolute - actual mass or content of water in a measured volume of air. usually expressed in grams per cubic meter or pounds. HD - difference between actual water vapor pressure and saturation water vapor pressure at a particular temperature.

question

medical gas, humidity, aerosol therapy P. know what retrolental fibroplasis is and what it causes.

answer

abnormal proliferation of fibrous tissue immediately behind the lens of eye, causing blindness. affects premature babies who have been given excessive adminstration of O2.

question

medical gas, humidity, aerosol therapy Q. know how to troubleshoot an APN.

answer

aerosol particle nebulizer. check equipment, check for clinking, check premature obstructions, check flow rat.e

question

Pharmacology A. know common respiratory medication, generic and brand names

answer

isoproternol (isuprel) isoetharine (bronkosol) raceanic epinepherine (vaponeferin, micronefrin, asthmanefrin) epinefrine (adrenalin) albuteral sulfate/salbutamol (proventil, ventolin) terbutaline (brethine, brethaire)

question

pharmacology c. know adrenergic bronchodilator alpha, beta 1 and beta 2 responses.

answer

alpha - causes construction and vasopressors effect, in teh upper airway, it can provide decongestion beta 1 - causes increase myocardial conductivity and increase HR and contractile force. beta2 - causes relaxation of bronchial smooth muscles with some inhibition of inflammatory mediator release and stimulation of mucociliary clearance.

question

pharmacology d. know when to use following solutions: hypertonic, hypotonic, and isotonic.

answer

hypertonic - if pt needs immediate rise in blood pressure hypotonic - if pt is dehydrated isotonic - to maintain or slowly raise blood pressure

question

pharmacology e. hydrophilic

answer

having tendency to mix with, disolve in, or be wetted by H20.

question

pharmacology f. know what these drugs do: methylxanthine, cromolyn sodium, vaponefrin, salbutamol.

answer

methy-helps acutve asthma attacks/acute exasbation of COPD by relaxing airways, can strengthen the diaphragm to improve breathing and help get mucus out of lungs. cromolyn sodium - anti-inflammatory meds used to prevent asthma attacks. vaponefrin - regulates heart rate, blood vessels, air passage diameters, and metabolic shifts. salbutamol - treats bronchospasm and COPD.

question

pulmonary functions B. know what a vane respirometer is and what can effect its accuracy.

answer

measures tidal volume and minute volume from the number of revolutions of a vane rotated by the gas stream as the latter passes through ten slots in a cylindric stator ring to turn a flat two-bladed rotor.

question

pulmonary functions c. know what normal total lung compliance is

answer

6L.

question

pulmonary functions D. know what happens when lung compliance increases or decreases

answer

when increasing, can indicate old age or emphysema and decrease could indicate atelectasis, edema, fibrosis, phneumonia.

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