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2010-05-31 04:26:34

Board study questions
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  1. What type of cell secretes surfactant?
    Type 2
  2. What are the 4 critical life functions?
    Ventilation: air in and out

    Oxygenation: o2 into blood

    Circulation: moving blood through body

    Perfusion: getting blood and o2 into tissue
  3. What is water vapor pressure?
    47 torr regardless of the inspired humidity.

    Absolute humidity: 100% humidified is 44mg/L. When in the presence of gas, it behaves accoring to gas law
  4. What is the Aa gradient?
    P(A-a)O2: PAlveolar o2 (100)- Parterial o2 (80) = 20.

    Normal AC membrane o2 < 20

    if its high, that means decrease in diffusion rate due to poor AC membrane fxn due to enlargement
  5. What is FRC?
    Volume present in lung @ end of normal expiration b4 start of inspiration
  6. What is in atmosphere aka barometric pressure?
    78% N2, 21% O2, .95% Argon, .05% C02. At sea level its 760 mmHg or 1 atm.
  7. What is the Alveolar air equation?
    • Approximate Alveolar partial pressure of o2.
    • PAo2=[(Pb-PH20)× fio2] - PaC02 × 1.25
  8. What is normal CO and what is the formula?
    • 3.5 - 8 Lpm.
    • CO=SV × CR
  9. What is the anatomical dead space?
    1 mL/Lb or 2.2mL/kg
  10. What is the formula for true alveolar VE?
    [VT- Vd] × breathes per minute
  11. Normal breathing at rest: what happens to the diaphragm and what is the intrapleural pressure?
    Diaphragm drops 1.5 cm and intrapleural prrssure is 3-6 cwp or 2-4 mmHg
  12. When there is no air movement @ end expiration, what does that tell us about pressures?
  13. CaO2 calculation. Short cut...
    • Look @ SaO2, PaO2, Hb, if they are normal, pick normal and move on. Short cut to calculate:
    • CaO2=Hb x 1.34
  14. Shortcut to calculate alveolar air equation
    (7 x fio2 as a whole#) - (PaC02 + 10)
  15. How do u calculate pulse pressure?
    Systolic - diastolic. Normal: 40 mmHg
  16. How do u calculate map?
    (2 x diastolic) + systolic ) ÷ 3. Normal is 120/80
  17. What 3 factors control bp?
    Heart, blood, vessel
  18. Normal QT (cardiac output)
    4-8 L/m
  19. Normal CI (cardiac index)
    2-4 L/min/m2
  20. PAP
    Lungs (25/8)
  21. PAP norm?
  22. PWP
    Left heart (4-12mmHg)
  23. PWP norm?
    4-12 mmHg
  24. CVP
    Right heart (2-6 mmHg or 4-12 cwp)
  25. CVP norm?
    2-6 mmHg or 4-12 cwp
  26. Normal CaO2?
    17-20 vol% ml/dL
  27. A-a gradient range for V/Q mismatch
    66 -300 mmHg. Tx with o2
  28. A-a gradient range for shunting
    >300 mmHg. Tx with o2, peep or cpap
  29. Normal A-a gradient
    25-65 mmhg on 100% fio2
  30. Cystic fibrosis
    No chloride channel. Causes thick mucus accumulation.
  31. Obtunded
    Drowsy state, may have decreased cough or gag reflex
  32. Assess ADL to determine 6 things
    • -Nursing home admission
    • -need for home health care providers
    • -living arrangements
    • -use of hospital services
    • -insurance coverage
    • -mortality
  33. Living will
    Describes tx pt would want if he became terminally ill (<6 months to live)
  34. Eupnea
    Normal RR, depth, and rhythm
  35. Semi-comatose
    Responds only 2 painful stimuli
  36. What are the 6 criterias for ADL?
    • -eating
    • -dressing
    • -walking/transferring
    • -bathing
    • -urine and bowel incontinence
    • -toilet use
  37. What do you want to review in a pt. chart?
    • 1. Admission Notes
    • 2. S/Sx
    • 3. Occupational hx (maybe they were a cole miner?)
    • 4. Allergies/Rxns?
    • 5. Prior surgery,illness, or injury
    • 6. V/S (pulse,rr,bp,temp)
    • 7. Physical exam of chest (percussion,auscultation, inspection, palpation)
    • 8. Smoking hx
  38. How do you measure ventilation?
    RR, VT, chest movement, BS, PaCO2
  39. How do you monitor oxygenation?
    Heart rate, color (if cyanotic, waited too long), sensorium, PaO2
  40. How do you monitor Circulation?
    • Pulse/heart rate and strength, cardiac output
    • -Strong and bounding: hypoxic, need O2
    • -Weak and thready: Heart failure=> circulation is at risk
  41. How do you monitor Perfusion?
    Blood pressure, sensorium, temperature (cold and clammy), urine output, hemodynamics
  42. Respiratory care orders must include...
    • 1. Type of tx
    • 2. Frequency
    • 3. Med dose and dilution
    • 4. Physician signature
  43. Normal urine output?
    • 40 ml/hr (Minimum)
    • => if <40, then we should be concerned with perfusion problems. Poor perfusion of kidneys=poor urine output
  44. How do we know if intake exceeds output?
    • 1. weight gain
    • 2. electrolyte imbalance
    • 3. increased hemodynamic pressures
    • 4. decreased lung compliance
  45. Changes in CVP pressures indicate what?
    fluid balance
  46. Decreased CVP <2 mmHg indicates...
  47. Incresed CVP >6 mmHg indicates...
  48. Somnolent, lethargic, sleepy
    think COPD O2 overdose or sleep apnea
  49. Stuperous, confused
    responds inappropriately, think drug overdose, intoxication
  50. 4 reasons why pt may be uncooperative
    • 1. Language difficulties
    • 2. Influence of medications
    • 3. Hearing loss
    • 4. Fear, apprehension, depression, etc
  51. Emotional State...
    1. Anxiety,nervousness: watching every movement, asthmatic, rt distress, hypoxemia

    2. Depressed: quiet or denial

    3. Anger, combative, or irritable: electrolyte imbalance

    4. Euphoria: drug overdose

    5. Panic: hypoxia, tension pneumothorax, status asthmaticus

  52. Katz ADL scoring
    0: pt unable to perform or need assistance in performing ADL

    1: pt needs NO direction or assistance in performing ADL
  53. Interpretation of Katz scoring
    6: pt is independent and has full functional capability

    4: pt has moderate impairment and needs some assistance

    <2: pt requires assistance when performing any activity
  54. Orthopnea
    difficulty breathing except when in upright position

    CHF, heart problem
  55. General Malaise
    run down feeling, nausea, weakness, fatigue, headache

    Electrolyte imbalance
  56. Grades for dyspnea

    • 1. dyspnea occuring after unusual exertion
    • 2. breathless after going up hills or stairs
    • 3. dyspnea while walking at normal speed
    • 4. dyspnea slowly walking short distances
    • 5. dyspnea at rest, shaving, dressing, etc
  57. 8 characteristics to identify symptoms of pain (all are important)
    • 1. location
    • 2. quality (what kind is it)
    • 3. severity ( on a scale of 1-10)
    • 4. aggravating factors
    • 5. relieving factors
    • 6. hx (when did it start and how did it progress)
    • 7. context (under what circumstances did it occur)
    • 8. accompanying symptoms
  58. symptoms of nose and throat
    excessive nasal seretions from irritants, pollutants, allergies

    itching, buring sensation of nose and thoat

    dysphagia and hoarsness
  59. Definition of assessing pt learning needs
    influencing pt behaviou and producing changes in knowledge, attitudes, and skills necessary to maintain and improve health
  60. learning topics
    health status

    disease management

    use of medication and equipment

    nutrition (eating more or less)

    community resources

    rehabilitation techniques
  61. Pt/ Family history
    History of present illness: current medical/physical problems

    Past medical history: previous medical problems, accidents, injuries, etc

    Family history: heart disease, diabetes, cystic fibrosis, etc

    Social history: smoking, substance abuse, etc
  62. General appearance
    age, height, weight, sex, nourishment, etc
  63. Peripheral Edema
    excessive fluid in the tissue aka Pitting edema (may cause sob)

    occurs mostly in arms and ankles, but ankles is usually best choice (think of gravity)

    caused by CHF.

    rated +1, +2, +3, etc. the higher the #, the greater the swelling
  64. Ascites
    accumulation of fluid in the abdomen

    ususally caused by Liver Failure

    Tx: NG Tube
  65. Clubbing of the fingers
    caused by Chronic hypoxemia. Presence is suggestive of pulmonary disease or congenital heart defect
  66. Venous distention
    occurs with CHF, also seen in pts with Obstructive lung disease

    JVD from chronic hypoxemia=>vasoconstriction=>heart failure
  67. Capillary refill
    indication of peripheral circulation.

    Pinching their finger to see if it fills back up again, if it doesn't then we need to be concerned with perfusion
  68. Define diaphoresis and list common causes.
    A state of heavy/perfuse sweating.

    • Heart failure
    • Fever, Infection
    • Anxiety, nervousness
    • TB (night sweats)
  69. Abnormal skin color (ashen, pallor) due to..
    anemia or acute blood loss. (vasoconstriction will cause color to change by reduction of blood flow). Tx with O2
  70. Increased bilirubin in blood and tissue causes
    Jaundice. It appears mostly in the face and trunk
  71. What is Erythema?
    redness of the skin. may be from capillary congestion, inflammation, or infection or a reaction or CO poisoning
  72. Cyanosis.
    blue or blue-grey dusky discoloration.

    Caused by hypoxia from increased amount of reduced hemoglobin (5g reduced hgb)
  73. Scoliosis
    Lateral curvature of the spine (side to side)
  74. Kyphoscoliosis.
    combination of both and causes severe restrictive impairment
  75. Kyphosis
    convex curvature of spine (lean forward, hunch back)
  76. Pectus Excavatum
    depression of part or all of the sternum
  77. Pectus Carinatum
    anterior protrusion of the sternum
  78. Unequal (asymmetrical) movement may indicate what underlying pathologies?
    • 1. Chronic lung disease
    • 2. Atelectasis
    • 3. Pneumothorax
    • 4. Flail chest-Paradoxical
    • 5. Intubated pt with ET in one lung (deflate cuff, pull out, reinsert)
  79. Normal Adult RR
    12-20 breaths/min
  80. Tachypnea
    Increased RR >20 breaths/min

    Causes: hypoxia, fever, pain, CNS problem
  81. Bradypnea (Oligopnea)
    decreased rr <12 per min variable depth and irregular rhythm.

    Causes: sleep (normal), drugs, alcohol, metabolic disorders
  82. Apnea
    cessation of breathing
  83. Hyperpnea
    increased rr, increased depth, regular rhythm

    Cause: Metabolic disorder/CNS disorders
  84. Cheyne-Stokes breathing
    gradually increasing then decreasing and depth in cycle lasting from 30- 180 seconds with periods of apnea lasting up to 60 seconds.

    Cause: increased ICP, meningitis, drug overdose
  85. Biots breathing
    increased RR and depth with irregular periods of apnea. Each breath is same depth.

    Cause: CNS problem
  86. Kussmaul's Breathing
    increased RR (usually over 20 breaths/min), increased depth, irregular rhythm, breathing sounds labored

    Cause: Metabolic acidosis, renal failure, DKA

    Tx of diabetes with insuline and HCO3 with documented blood gas only
  87. Normal Muscles of ventilation
    • 1. Diaphragm
    • 2. External intercostals
    • 3. Exhalation is normally passive
  88. Accessory muscles of ventilation
    • 1. Intercostal, scalene, sternocleidomastoid, pectoralis major
    • 2. Abdominal muscles (oblique, rectus abdominus, etc)
    • 3. Hypertrophy (increase in muscle size) of accessory muscle occurs with COPD
  89. Muscle Hypertrophy
    increase in muscle size
  90. Muscle Atrophy
    muscle wasting. loss ofmuscle tone, occurs with paralysis.

    May be referred to cachectic
  91. Retractions
    intercostal and/or sternal retractions occur when the chest moves inward during inspiratory effors instead of outward

    Causes: blocked (obstructed) airway

    **Sign of RT distress in infants**
  92. Nasal Flaring
    Flaring of nostrils during inspiration.

    **A sign of RT distress in infants**

    Retraction, Nasal flaring, Grunting is them trying to produce cpap=> give cpap for support
  93. Evidence of Difficult Airway
    • 1. Look externally of evidence of face or neck pathology.
    • -Enlarged tongue (macroglossia) (recommend anasthesiologist to intubate)
    • -Bull Neck
    • -Limited range of motion of neck
    • -Short receding mandible
  94. Pulse (2nd life function)

    >100 indicates hpoxemia, anxiety, stress

    Tx with O2
  95. Bradycardia
    <60 indicates heart failure, shock, code/emergency (inc. o2 consumption in muscle)

    Atropine with O2
  96. what do you do if there is increased heart rate > 20 beats/min
    it's an ADVERSE REACTION, stop therapy, notify nurse and doctor
  97. Paradoxical pulse/ Pulsus paradoxus
    pulse/bp varies with respiration. May indicate severe air trapping (status asthmaticus or cardiac tamponade).
  98. Emphysema: define and dx
    alveoli distention resulting in rupture of elasticiy of the lung

    Bedside assessment

    • smoking hx
    • sob
    • Increased Hb/HCT
    • Barrel Chest, Increased AP diameter
    • Accessory muscle use
    • Cyanotic
    • Digital clubbing

    Secondary assessment

    • CXR: hyperlucency with diminished vascular markings and flattened diaphragm

    ABG: compensated RT acidosis with moderate to severe hypoxemia

    Pulmonary fxn: decreased DLco, decreased flows (FEF 25-75% and FEV1/FVC)
  99. Chronic Bronchitis: define and dx
    Productive cough for more than 3 months out of the year for 2 or more consecutive years

    Bedside Assessment

    • Smoking hx with chronic infxns
    • sob
    • Productive cough with Purulent Sputum

    Secondary Assessment

    • CXR: Essentially Normal or may exhibit and Emphysemic Pattern
    • ABG: Hypoxemia with Normal to slightly increased PCO2 Levels
    • Pulmonary fxn: Decreased flows (FEV1, FEF 25-75%), DLco Normal
  100. How do you tx Emphysema?
    • Low Flow (FiO2) O2 Therapy @ 1-2 L/min (.24-.28)
    • Antibiotics as indicated from sputum culture
    • Rehab and Home Care
    • Bronchodilators, MDI, Aerosol Nebulizers
    • Perhaps Trans-Tracheal oxygenation
    • Nicotine replacement therapy may help to quit smoking
  101. How do you tx Chronic bronchitis?
    • good bronchial hygiene (CPT)
    • Antibiotics for infxn
    • Bronchodilator therapy
    • O2 for hypoxemia
  102. Bronchiectasis: define and dx
    Abnormal dilation of bronchi secreting large amounts of purulent secretions

    Bedside assessment

    • Hx of recurrent gram negative infxn
    • Digital clubbing
    • Productive cough involving hemoptysis
    • 3 Layer Sputum

    Secondary Assessment

    • CXR: Normal
    • Bronchogram: BEST DIAGNOSTIC TEST Show "A Tree in Winter Pattern"
    • Pulmonary Fxn: Decreased Flows (FEV1) (obstruction)
  103. How do you TX Bronchiectasis?
    • Good bronchial hygiene (CPT)
    • Abs for infxn (senormyocin, tobermyocin)
    • Aerosol Therapy with Bronchodilators
    • Surgical resection of involved segments is an option
  104. He/O2 mixtures using an o2 flowmeter 70/30 mixture
    Actual flow is 1.6 times greater than the L/min on an o2 flowmeter with an 70/30 mixture
  105. Patient's maximum heart rate
    220 - age in years
  106. Volume lost through chest tubes
    Delivered Vt - exhaled Vt
  107. He/O2 mixtures using an o2 flowmeter
    Actual flow is 1.8 times greater than L/min on o2 flowmwter with an 80/20 mixture
  108. Air - o2 ratio for various o2
    (100-X) / X-20

  109. Total flow
    Factor X Liter flow
  110. Tank Factors: E cylinder, H cylinder
    E cylinder = .28% L/psi (0.3)

    H cylinder= 3.14 L/psi (3.0)
  111. Duration of flow (cylinder duration in minutes)
    Guage pressure (psi) x Tank factor / liter flow
  112. To approximate fiO2 with a nasal cannula
    20 + (4 x Liter flow) = approximate FiO2
  113. RSBI
    RR / VT (L)
  114. Calculating minimum flow rate
    Flowrate= (tidal volume x rate) x (I+E)
  115. Work of breathing
    Change in pressure x change in volume
  116. IBW formula for females
    105 lb + 5 lb/in over 5 ft
  117. Ibw formula males
    106 lb + 6 lb/in over 5 feet
  118. Airway resistance (raw) - (estimate)
    Raw = peak pressure - plateau pressure
  119. Static compliance
    Exhaled volume/ plateau - peep
  120. Dynamic compliance
    Exhaled vol / pip - peep
  121. Normal icp
    5-10 mmHg
  122. Diagnostic chest percussion, norm
  123. Norm bs
  124. Norm heart sounds
    S1 and s2
  125. Norm cerebral perfusion pressure
    70-90 mmHg
  126. Norm rbc
    4-6 mill/mm3
  127. Norm hemoglobin
    12-16 gm/100 ml blood
  128. Normal hct
  129. Norm wbc
    5000-10,000 per mm3
  130. Norm potassium (k+)
    4.0 mEq/L, range 3.5 -4.5 mEq/L
  131. Norm sodium (Na+)
    140 mEq/L, range 135-145 mEq/L
  132. Normal Chloride (Cl-)
    90 mEq/L, range 80-100 mEq/L
  133. Normal bicarbonate (HCO3-)
    24 mEq/L, range 22-26 mEq/L
  134. Norm Creatinine
    0.7 - 1.3 mg/dL
  135. Norm Blood Urea Nitrogen (BUN)
    8-25 mg/dL
  136. Norm Clotting time
    Up to 6 minutes
  137. Norm platelet count
  138. Activated partial thromboplastin time (APTT)
    24-32 seconds
  139. Norm Prothrombin (PT)
    12-15 seconds
  140. Norm Thrombin time
    7-12 seconds
  141. Norm term infant (gestational age)
    38-42 weeks
  142. Norm APGAR Score
  143. Normal infant temp
    36.5 degrees
  144. Norm heart rate (infant)
    110 - 160/min
  145. Norm RR (infant)
    30-60 breaths min
  146. Normal BP (infant)
    60/40 mmHg
  147. Normal birth weight (term infant)
  148. Norm Dubowitz score
  149. Normal axis
    Down and to the left

    Electrical impulse begins in upper right corner (sa, rt atria) and moves down and across the heart to the left
  150. Resonant percussion
    Normal air filled lung, gives hollow sound
  151. Flat percussing sound
    heard over the sternum, muscle, or areas of atelectasis

    **LOSS of Air**
  152. Dull percussing sound
    heard over fluid fille dorgans such as the heart or the liver.

    Pleural Effusion (tracheal deviation away) or PNA (tracheal deviation toward) will give this a thudding sounds.

    **loss of air**
  153. Tympanic percussion sound..
    heard over air filled stomach. This is a drum like sound and when heard over the lungs, indicates increased volume.

    **loss of Air**
  154. Hyperresonant percussion sound...
    found in areas of the lung where pneumothorax (absent bs with tracheal shift) or emphysema is present. this is a booming sound.

    **Extra Air**
  155. Bronchial breath sounds
    normal sounds over the trachea or bronchi.

    These sounds over the lung periphery would indicate lung consolidation.
  156. Egophony
    When the pt says "E" and it sounds like "A". This indicates Consolidation of the lung wiht PNA-like condition
  157. Adventitious breath sounds
    Abnormal breath sounds
  158. Rales (crackles) indicate..
  159. Coarse rales (rhonchi) indicates...
    Large airway secretions. Pt needs suctioning
  160. Medium rales indicate
    MIddle airway secretions, Pt needs CPT
  161. Fine rales (moist crepitant rales) indicate...
    fluid in the alveoli, can't suction in the alveoli. Pt needs IPPB, heart durgs, diuretics, and o2.

    Pt probably has CHF/Pulmonary Edema
  162. Wheezing indicates...
    airway narrowing due to bronchospasm. Pt needs bronchodilator
  163. Unilateral wheeze indicates ...
    foreign body obstruction, need bronchoscope to go down and find it to get it ous. Can't have asthma on just one side.
  164. Stridor indicates...
    • due to upper airway obstruction
    • a. supraglottic swelling (epiglottitis)
    • b. subglottic swelling (croup, post extubation)
    • c. Froeign body aspiration (solids or fluids)

    • Tx:
    • a. racemic epi for swelling and edema
    • b. suctioning and /or bronchoscopy for secretions and foreign body aspiration
    • c. intubation for severe swelling.
  165. Pleural friction rub...
    A coarse grating or crunching sound caused by inflamed surface of the visceral and parietal pleura rubbing 2gether.

    Associated with pleurisy, TB, PNA, pulm infarct, CA

    TX with abs (infxn) or steriods (inflammation)
  166. normal adult b/p
  167. Roentgenogram
    Radiogram, CXR
  168. 5 things to note on a normal cxr
    1. both hemidiaphragms dome shaped

    2. Right hemidiaphragm slightly higher due to liver

    3. Right hemidiaphragm @ the level of 6th anterior rib (if @ 7,8,9 Emphysemic)

    4. Trachea midline, bilateral radiolucency, sharp costrophrenic angles

    5. head of clavicles should be level, if not (scoliosis)
  169. CXR Landmarks:

  170. CXR Landmarks:

    Midline, will shift with pleural effusion or pneumothorax
  171. CXR Landmarks:

    AP diameter
    increased with COPD, barrle chest, hyperinflation
  172. CXR Landmarks:

    Costrophrenic angles
    obliterated with Pleural effusion (also dull percussion)
  173. CXR Landmarks:

    dome shaped normally, flattened with COPD. Left or Rt Pneumothorax may shift downward, appearing flattened on one side
  174. CXR Landmarks:

    Vascular markings
    engorged with CHF, absent with Pneumo or a collapsed lung
  175. CXR Landmarks:

    Heart shadow
    left ventricle normally seen, cardiomegaly seen with CHF
  176. CXR Landmarks:

    Soft tissue
    Tissue surrouding the echest and avove the neck area.

    Sub Q emphysema is when hyperlucency is seen in the surrounding tissue.
  177. CXR:

    Lateral position
    projection from either the right or left side
  178. CXR:

    Oblique view
    Slanting/diagonal view.

    Aid in localizing lesions behind bones or unusal places
  179. CXR:

    Lateral decubitis
    Pt lying on affected side

    Good for detecting small pleural effusions
  180. CXR:

    apical Lordotic
    projection from lung apices
  181. CXR:

    End expiratory film
    Taken when the pt is at end exhalation.

    Good for detecting small pneumothorax or if their is an obstruction
  182. CXR:

    ETT position
    2cm or 1 inch above the carina, level with aortic knob or aortic arch
  183. CXR:

    position of Ng tube
    2-5 cm below the diaphragm
  184. Radiolucent
    air, Normal
  185. Radiodense
    Solid, normal for bones and organs, heart shadow
  186. Infiltrate
  187. Consolidation
    solid, PNA/Pleural effusion
  188. Hyperlucency
    EXTRA air, COPD, asthma attack

    Unilateral:: pneumothorax
  189. Opaque
    fluid, consolidation
  190. Fluffy infiltrates, Butterfly/Batwing pattern
    Pulmonary Edema
  191. Patchy infiltrates, Platelike infiltrates
  192. Gound glass, homeycomb pattern, diffuse bilateral rediopacity
  193. Air Bronchogram

    Pna fills small airways with fluid, big airways are full of air so they stand out
  194. Peripheral wedge shaped infiltrate
    Pulmonary embolus
  195. Concave superior interface/border, basilar ifiltrates with meniscus
    pleural effusion
  196. A sprial CT with contrast dye is used to dx..
    Pulmonary embolus
  197. Resusitation Equipment for MRI should be...
    Non-Ferrous (non-metallic)
  198. In V/Q scan, if ventilation is normal but perfusion is abnormal, this indicates...
    Pulmonary emboli
  199. If pt has dysphagia, what kind of therapy would be inappropriate and may cause the pt to aspirate?
  200. Bronchography (bronchogram) is an injection of radio-opaque contrast medium into that tracheobronchial tree that is helpful for what disease process?
    Bronchiectasis, helps id location of involved areas that will allow better administration of postural drainage
  201. Indications for EEG
    Traumatic brain injuries


    Evaluation of sleep disorders
  202. Indications for Echocardiograpy
    Cardiac anomaliles in the infant (ASD, VSD, PDA, etc)

    Abnormal heart sounds
  203. Normal ICP
    5-10 mmHg
  204. treatment of ICP > 20mmHG
    hyperventilation until PaCO2 is 25-30 torr
  205. Shortcut for remembering RBC, Hgb, Hct
    Magic # is 3

    5 (norm rbc) x 3 = 15 (norm hgb) x 3 =45% (norm hct)
  206. Increased vs Decreased WBC
    Norm: 5000-10,000 per mm3

    Increased (leukocytosis):::bacterial infection

    Decreased (leukopenia)::: viral infection
  207. Hypokalemia occurs with
    Metabolic alkalosis, excessive excretion, renal lowss, flattened T wave on EKG
  208. Hyperkalemia indicates
    Metabolic Acidosis, Spiked T wave, Kidney Failure
  209. Hypernatremia
  210. Hyponatremia
    fluid loss from diuretics, vomiting, diarrhea
  211. Hypchloremia
    low chloride: metabolic alkalosis (it follows K+ so K+ is low too)
  212. Hyperchloremia
    high chloride (metabolic acidosis) (K+ is high)
  213. Bicarbonate (HCO3-) ::: total Co2 content
    co2 is carried in blood as HCO3, so total co2 contetn relfects changes in blood base

    • high co2=high HCo3=Metabolic alkalosis=low K+
    • low CO2=low HCo3=Metabolic acidosis=high K+
  214. Clear sputum
  215. Mucoid white/grey sputum
    chronic bronchitis
  216. Yellow sputum
    presence of WBC, bacterial infxn
  217. Green sputum
    gram neg. bacteria, bronchiectasis, pseudamonas
  218. Brown/dark sputum
    old blood
  219. bright red sputum
    hemoptysis (bleeding , tumor)
  220. pink, frothy sputum
    pumonary edema
  221. Which is considered a "Quick" assessment for sputum tests?

    a) Gram Stain

    b) Sputum culture & sensitivity
    a) Gram stain: it's quick and will tell you if its a gram neg or gram pos.

    If it doesn't as for "Quick Assessment" then you could pick Sputum culture and sensitivity to tell yuou the type of bacteria and what kind of abs will work. Sputum C&S takes time
  222. what is the difference between Neurtrophil bands and segs?
    Bands: immatures cells, 4% of wbc, INCREASED BACTERIAL INFXN

    Segs: mature cells, 60% of wbc, DECREASED BACTERIAL INFXN
  223. What pathology is associated with increased eosinophils?
    Athma, 2% of wbc, Increased with ALLERGIC rxn produce yellow sputum
  224. Pulmonary angiogram is used to dx what pathology?
    Pulmonary embolism
  225. Tx is recommended when ICP increases above what level?
    > 20 mmHg
  226. Define cerebral perfusion pressure (CPP)
    pressure gradient that measures cerebral perfusion
  227. What is the formula to calculate cerebral perfusion pressure (CPP)
  228. What is the normal value for CPP?
  229. What is exhaled nitric oxide (NIOX) testing used for?
    monitor asthma pt's response to antiinflammatory (corticosteroid) through monitoring pt level of nitric oxide in pt exhaled breath
  230. Decrease in FEno level suggests...
    decrease in airway inflammation
  231. What are the indications for a barium swallow test?

    Esophageal varices

    Suspected esophageal malignancy
  232. A ballon tipped, flow directed catheter positioned in the pulmonary artery with the balloon inflated measures which pressure?
    (this multiple choice question has been scrambled)
  233. A balloon tipped, flow directed catheter is positioned in the pulmoary arter with the balloon deflated, which pressure is being measured by the proximal lumen?
    (this multiple choice question has been scrambled)
  234. Symptoms of Pleural Effusion
    Dullness to Percussion

    Decreased Tactile Fremitus

    Dry, Non productive cough

    Diminished Breath Sounds

  235. What is a Galvanic Cell used for?
    to monitor o2 concentration
  236. which is the best aerosolized bronchodilator fo ra pt with acute asthma exacerbation?

    A) Tiotropium (spiriva)
    B) Salmeterol (Serevent)
    C) Albuterol (proventil)
    D) Ipratrpium Bromide (Atrovent)
    C) Albuterol. A fast acting beta 2 agonist is the appropriate tx for acute bronchospasm
    (this multiple choice question has been scrambled)
  237. In VCV, which controls can be changed to adjust the I:E ratio?
    • Volume (affects i time)
    • Mandatory Rate(affects e time)
    • Inspiratory Flow (affects i time)
  238. Drug: Dornase alfa (Pumozyme)

    ususally used with what kind of pts? and what does it do?
    Cystic fibrosis

    It decreases the viscosity of sputum in CF pts to decreased exacerbations that req. hospitalization
  239. If pt has increased PaCo2 during weaning trial, this indicates...
    respiratory muscle fatigue with resulting hypercapnia
  240. MIP, VT, VC measures what exactly in weaning from mechanical ventilation?
    Muscle Strength
  241. Suction pressures for Infant, Child, Adult??
    Infant: -60 to 80mmHg

    Child: -80 to -100 mmHg

    Adult: -100 to -120 mmHg
  242. Drug: Pentamidine Isethionate (NebuPent)

    What is it and what side effect may be caused by it?
    Anti-Viral for tx of Viral PNA. Side effect: Bronchospasm
  243. Bilateral fluffy infiltrates in cxr indicative of...
    Pulmonary Edema from increased interstitial and alveolar fluid
  244. when calibrating a thermal conductivity helium analyzer, what should the analyzer read when calibrated in air?

    A) 0%
    B) 21%
    C) 79%
    D) 100%
    A) 0%. Air contains no helium; therefore, it should read 0
    (this multiple choice question has been scrambled)
  245. When in proper position, the tip of the CVP catheter should be where?
    in the lower portion of the superior vena cava
  246. the is the correction factor for heliox mixture 80/20 and 70/30?
    1.8 for 80/20 mix, 1.6 for 70/30 mix
  247. If a pt is on a beta blocker medication and requires bronchodilator therapy, which medication should the RT recommend in leu of Albuterol?
    Atrovent. Albuterol is a beta receptor stimulator and may show reduced efficacy int eh presence of beta blocking agents. Atroven uses a different mechanism for bronchodilation.
  248. Cuff pressures > 30 ktorr on the tracheal wall will cause obstruction of...
    Capillary Flow

    Venous Flow

    Lymphatic Flow
  249. What device is used to deliver Pentamidine (NebuPent)?
    A filtered exhalation nebulizer to prevent environmental contamination
  250. what is the appropriate location of a chest tube for a pt with a hemothorax?
    5th ics in mid axillary line is appropriate to drain fluids from the chest. Any higher and thorax may not adequately drain the fluid
  251. MIP measures?
    inspiratory muscle strength