RSPT 251

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RSPT 251
2013-02-26 20:15:25
Test one

Test one
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  1. What effects do changes in body temperature have on metabolism and the cardiopulmonary system?
    • increase or decrease in the metabolic rate
    • vasodilation or vasoconstriction 
    • an increase in the demand for the cardiopulmonary system
  2. An increase in the body temperature...
    • causes vasodilation
    • increases the metabolic rate and this action leads to an increase in oxygen consumption and an increase in carbon dioxide production at the cellular level
  3. A decrease in the body temperature...
    • causes vasoconstriction
    • and reduces the metabolic rate and the cardiopulmonary demand.
  4. What changes in vital signs or other clinical manifestations might you identify in a febrile patient?
    • increase in body temp
    • increase in blood pressure
    • increase in respiratory rate
  5. What does a dull chest percussion note indicate?
    • Increase density
    • areas of pleural thickening
    • pleural effusion
    • atelectasis
    • consolidation
  6. What does a hyperresonant chest percussion note indicate?
    • areas of trapped gas
    • Lung hyperinflation
    • pneumothorax
  7. What is the clinical significance of bilateral dependent pitting edema?
    • CHF
    • cor pulmonale
    • hepatic cirrhosis
  8. What is the clinical significance of distended neck veins? 
    • cor pulmonale
    • severe flail chest
    • pneumothorax
    • pleural effusion
    • the major veins of the chest that return blood to the right side of the heart may be compressed
  9. What is the function of the carotid sinus and aortic baroreceptors?
    To activate reflexes that cause decrease heart rate and ventilator rate in response to increased systemic blood pressure and increase heart and ventilator rate in response to decrease systemic blood pressure.
  10. What is a common post-op pulmonary complication that might stimulate the deflation reflex and or the Hering-Breuer reflex?  What type of respiratory pattern would this patient demonstrate?
    • Atelectasis
    • hyperventilation
  11. Name 4 clinical conditions that might stimulate the J receptors. What is the resulting respiratory pattern?
    • pulmonary capillary congestion
    • capillary hypertension
    • lung deflation
    • edema of the alveolar walls
    • respiratory pattern is rapid, shallow breathing.
  12. What breathing pattern is demonstrated by the patient with decreased lung compliance?
    Increase in rate and a decrease in tidal volume
  13. What breathing pattern is demonstrated by the patient with increased airway resistance?
    Decrease in rate and an increase in volume
  14. What determines the breathing pattern adopted by the patient?
    Minimum work requirements rather than gas exchange efficiency.
  15. What happens to the V/Q ratio with shunting?
  16. Name 2 causes of capillary shunts!
    • Alveolar collapse or atelectasis
    • Alveolar fluid accumulation
    • Alveolar consolidation or pneumonia.
  17. Does an absolute shunt respond to oxygen therapy?  Why or why not?
    Does not respond to oxygen therapy because alveolar oxygen does not come in contact with the shunted blood.
  18. How do the peripheral chemoreceptors respond to hypoxemia?
    By sending a signal to the respiratory centers of the medulla by way of the glossopharyngeal nerve from the carotid bodies and by way of the vagus nerve from the aortic bodies
  19. What do the central chemoreceptors respond to and what breathing pattern results?
    • To an increase concentration of H+ in the CSF
    • Causes and increase in the ventilator rate.
  20. What are the advantages of pursed –lip breathing?
    It offsets early airway collapse and air trapping during exhalation and has been shown to slow the patient’s ventilator rate and generate a ventilatory pattern that is more effective in gas mixing. 
  21. Pleuritic chest pain!
    • Described as a sudden, sharp, or stabbing pain
    • The pain generates normally intensified during deep inspiration and coughing and diminished during breath holding or splinting.
  22. Nonpleuritic chest pain!
    Usually described as a constant pain that is located centrally. The pain also may radiate.
  23. List the qualities by which a therapist should evaluate and monitor sputum!
    • Amount
    • Consistency
    • Odor
    • Color
  24. List the qualities by which a therapist should evaluate and monitor a cough!
    If the cough is strong or weak, in other words can the patient mobilize secretions. A productive cough should be evaluated in terms of its frequency, pitch, and loudness.
  25. What is the most common cause of acute alveolar hyperventilation?
  26. How is acute ventilatory failure defined? 
    A condition in which the lungs are unable to meet the metabolic demands of the body in terms of CO2 homeostasis
  27. How acute ventilatory failure different from chronic ventilatory failure?
    pH will be within the normal range
  28. How does acute hypoxemia lead to acute metabolic acidosis?
    Oxygenation is inadequate to meet tissue metabolism
  29. Describe a patient who is experiencing oxygen-induced hypoventilation!
    • sleepy
    • lethargic
    • hard to arouse
    • With slow and shallow breathing.
  30. What are the 2 ways in which oxygen is transported by the blood?
    • As dissolved oxygen in the blood plasma
    • bound to the hemoglobin
  31. Write the formula used to calculate Oxygen content of arterial blood.
    (Hb x 1.34 x SaO2) + (PaO2 x 0.003)
  32. Write the formula for the ideal alveolar gas equation (PAO2).
    FiO2(PB – PH2O) – PaCO2 (1.25)
  33. What is the normal P(A-a)O2 range at room air?
    ranges  from 7 to 15 mm Hg and it should not exceed 30 mm Hg.
  34. In what conditions is the P(A-a)O2 value increased?
    • Oxygen diffusion disorders
    • Decreased ventilation-perfusion ratio disorders
    • Right to left intracardiac shunting
    • Age
  35. What is normal oxygen consumption?
    250 mL of oxygen per minute.
  36. How is the respiratory quotient defined?
    The ratio of the volume of carbon dioxide released to the volume of oxygen consumed by a body tissue in a given period.
  37. What is the formula used to calculate oxygen delivery.  Under what circumstances does this value decrease?
    • QT x (CaO2 x 10) 
    • decrease in blood oxygen saturation
    • decrease in hemoglobin concentration
    • decrease cardiac output.
  38. What is the normal Oxygen extraction ratio?  
    about 25%
  39. When is the normal oxygen extraction ration increased?
    • decreased cardiac output
    • periods of increased oxygen consumption
    • anemia
    • decreased arterial oxygenation.
  40. When is the normal oxygen extraction ration decreased?
    • Increased cardiac output
    • skeletal muscle relaxation
    • peripheral shunting
    • certain poisons
    • hypothermia
    • increased hemoglobin
    • increased arterial oxygenation.
  41. What is the normal SvO2?
    about 75%
  42. What is a normal degree of pulmonary shunting? 
    below 10%.
  43. When does the degree of shunting become significant?
    greater than 20%
  44. Hypoxemia
    An abnormally low arterial oxygen tension (PaO2) and is frequency associated with hypoxia.
  45. Hypoxia
    An inadequate level of tissue oxygenation
  46. What are some symptoms of hypoxia?
    • Tachycardia
    • hypertension
    • peripheral vasoconstriction
    • dizziness
    • mental confusion.
  47. What are the 3 major mechanisms involved in producing cor pulmonale in chronic pulmonary disease?
    • The increased viscosity of the blood associated with polycythemia
    • The increased pulmonary vascular resistance caused by hypoxic vasoconstriction
    • The obliteration of the pulmonary capillary bed, particular in emphysema.
  48. Hypoxic hypoxia
    Inadequate oxygen at the tissue cells caused by low arterial oxygen tension. (PaO2)
  49. Anemic hypoxia
    PaO2 is normal, but the oxygen-carrying capacity of the hemoglobin is inadequate.
  50. Circulatory hypoxia
    Blood flow to the tissues cells is inadequate; therefore oxygen is not adequate to meet tissue needs.
  51. Histotoxic hypoxia
    Impaired ability of the tissue cells to metabolize oxygen
  52. Define sinus arrhythmia?  Treatment?
    • The heart rate varies by more than 10% from beat to beat
    • No treatment is needed
  53. Of the atrial arrhythmias, which is most serious?  Why?
    • Atrial fibrillation
    • May reduce the cardiac output by 20% because of a loss of atrial filling
  54. Of the ventricular arrhythmias, which is most serious?  Why?
    • Ventricular fibrillation
    • There is no cardiac output or blood pressure and without treatment the patient will die within minutes
  55. How does the cardiovascular system compensate for hypoxemia?  At what HR does this response decline?
    • Increase heart rate, pulse, and blood pressure,
    • When the heart rate increases beyond 150 to 175 bpm
  56. What is the most commonly used method of invasive hemodynamic monitoring?
    Arterial cather
  57. What occurs to the following hemodynamic indices in patients with cor pulmonale?
    • CVP--- increases
    • PAP--- decreases
    • PCWP---decreases
  58. What occurs to the following hemodynamic indices in a patient with a pneumothorax?
    • CVP---increase
    • PCWP----decrease
    • CO----decrease
    • PVR----increase
    • SVR----decrease
  59. What are the disadvantages of an AP chest radiograph?
    The heart is magnified and the radiograph has less resolution and more distortion and also extraneous shadows are often present
  60. What are the standard two views of the chest radiograph performed in the radiology department?
    • PA projection
    • Lateral radiograph
  61. When is a lateral decubitus chest radiograph useful?
    In the diagnosis of a suspected or known fluid accumulation in the pleural space (Pleural effusion)
  62. Describe an over-exposed chest radiograph!
    • The heart and lungs become more radiolucent (darker) with greater exposure of the radiograph.
    • A chest radiograph that has been overexposed is said to be “heavily penetrated” or burned out”
  63. Describe an under-exposed chest radiograph!
    • The heart and lung on an underexposed radiograph may appear denser and whiter.
    • The lungs may appear to have infiltrates, and there may be little or no visibility of the thoracic vertebrae.
  64. List the anatomic structures that should be noted when inspecting the mediastinum on a CXR.
    • Trachea
    • carina
    • cardiac borders
    • aortic arch
    • superior vena cava
  65. Describe in detail the right heart bulges seen on the normal PA CXR.
    • Two bulges should be seen on the right border of the heart
    • The upper bulge is the superior vena cava
    • The lower bulge is the right atrium
  66. Describe in detail the left heart bulges seen on the normal PA CXR.
    • Three bulges are normally seen on the left side of the heart.
    • The superior bulge is the aorta
    • The middle bulge is the main pulmonary artery
    • The inferior bulge is the left ventricle
  67. What might cause enlargement of the hilar region?
    In infectious lung disorders such as histoplasmosis or tuberculosis the lymph nodes around the hilar region are often enlarged
  68. What are some causes of absence of lung markings on a chest radiograph?
    • Pneumothorax
    • recent pneumonectomy
    • COPD
    • may be the result of an overexposed radiograph.
  69. Why is the right diaphragm higher than the left?
    Because of the liver below it
  70. Why should the pleura be carefully inspected on the chest radiograph?
    • pleural thickening
    • presence of fluid (pleural effusion)
    • air (pneumothorax)
  71. What changes to the intercostal spaces are common in patients with COPD?
    Generally far apart because of alveoli hyperinflation
  72. How would a lung tumor appear on spiral CT of the chest?
    A dense tumor in the lungs would appear as a white object surrounded by dark lungs
  73. For what type of pulmonary lesions or abnormalities is the CT scan especially helpful?
    • Confirming the presence of a mediastinal mass
    • small pulmonary nodules
    • small lesions of the bronchi
    • pulmonary cavities
    • a small pneumothorax
    • pleural effusion
    • small tumors
  74. Why is the PET scan helpful in diagnosing pulmonary cancerous lesions?
    • Early detection
    • Its ability to evaluate the metabolic rate of certain tissue cells that may be cancerous.
    • In other words the PET scan is able to detect cancerous cells n the tissue of the body before changes develop in anatomic shape of the organ
  75. What are the benefits of a combined PET/CT scan?
    • Earlier diagnosis
    • accurate staging and localization
    • precise treatment and monitoring
  76. Why is pulmonary angiography performed?
    Useful in identifying pulmonary emboli or arteriovenous malformations.
  77. What are causes of abnormal ventilation scan?
    • Airway obstruction (mucus plug or bronchospasm)
    • loss of alveolar elasticity (emphysema)
    • alveolar consolidation
    • pulmonary edema
  78. List 2 reasons to perform fluoroscopy of the chest
    • In the assessment of abnormal diaphragmatic movement
    • For localization of lesion to be biopsied during fiberoptic bronchoscopy
  79. Sputum culture and sensitivity study
    This test is performed to diagnose bacterial infection, select an antibiotic, and evaluate the effectiveness of antibiotic therapy
  80. Sputum gram stain test
    Performed to classify bacteria into gram negative organism and gram positive organisms
  81. When would a cytology examination be performed on a sputum specimen?
    For the presence of abnormal cells that may indicate a malignant condition
  82. What illness is suspected when an AFB smear (acid fast bacilli) is ordered on a sputum specimen?
    Mycobacterium tuberculosis
  83. What are the indications for a therapeutic bronchoscopy?
    • Suctioning of excessive secretions or mucus plugs, especially when lung atelectasis is forming
    • The removal of foreign bodies or cancer obstructing the airways
    • Selective lavage
    • Management of life threatening hemoptysis
  84. What are the indications for a therapeutic thoracentesis?
    • To relieve shortness of breath or pain caused by a large pleural effusion
    • To remove air trapped between the lung and chest wall
    • To administer medication directly into the lung cavity to treat the cause of the fluid accumulation
    • To treat cancer
  85. What procedure is considered the standard of care for a patient with recurrent malignant pleural effusion?
    Chemical pleurodesis
  86. What are some causes of hypochromic microcytic anemia?
    • Chronic blood loss
    • iron deficiency
    • chronic infections
    • malignancies
  87. What cell type makes up the largest portion of the WBCs?
  88. What type of organisms do neutrophils target and how do they defend against them?
    They represent the primary defense against bacterial organisms through the process of phagocytosis. They ingest and destroy bacterial organisms and particulate mater
  89. List at least 4 conditions that are associated with thrombocytopenia? (Low platelet count)
    • Massive blood transfusion
    • pneumonia
    • cancer chemotherapy
    • infection
  90. What platelet count is associated with spontaneous bleeding?
    A platelet count of less than 20,000/mm
  91. What type of WBC deficiency is seen with HIV?
    T lymphocytes
  92. What are the symptoms of hypokalemia?
    • Metabolic alkalosis
    • Muscular weakness
    • Malaise
    • Cardiac arrhythmias
    • Hypotension
  93. What is the normal range for serum glucose?
    70 to 110 mg/dl
  94. Physical examination of patient with pulmonary edema!
    • Hypoxemia
    • Decreased lung compliance
    • Cheyne stokes respiration
    • Paroxymal nocturnal dyspnea
    • Orthopnea
    • Cyanosis
    • Pink and frothy sputum
    • Increased HR, RR, and BP
    • diaphoresis
    • fatigue
  95. Chest assessment finding associated with pulmonary edema!
    • Increased tactile and vocal fremitus
    • Crackles, rhonchi, and wheezing
  96. Radiologic finding in pulmonary edema!
    • Bilateral fluffy opacities
    • Dilated pulmonary arteries
    • Left ventricle hypertrophy
    • Kerly A and B lines
    • Bat's wing or butterfly pattern
    • Pleural effusion
  97. Hypokalemia, hyponatremia, and hypochloremia are often seen in patiens with...
    Left sided heart failure and may result from diuretic therapy or excessive fluid retention
  98. The causes of pulmonary edema into major categories!
    • Cardiogenic
    • Noncardiogenic
  99. The most common cause of cardiac pulmonary edema...
    Is left sided heart failure (CHF)
  100. Cardiac edema occurs when...
    The left ventricle is not able to pump out all of the blood that it receives from the lungs
  101. Increased pulmonary capillary hydrostatic pressure...
    Is the most common cause of pulmonary edema
  102. Causes of noncardiogenic pulmonary edema!
    • Increased capillary permeability
    • Lymphatic insufficiency
    • Decreased intrapleural pressure
    • Decreases oncotic pressure
    • Allergic reaction to drugs
    • Excessive sodium consumption
    • Drug overdose
    • Metal poisoning
    • Chronic alcohol ingestion
    • Aspiration
  103. Common causes of cardiogenic pulmonary edema!
    • Arrhythmias
    • Systemic hypertension
    • Congential heart defects
    • Excessive fluid administration
    • Left ventricular failure
    • Mitral or aortic valve disease
    • Myocardial infarction
    • Pulmonary embolus
    • Renal failure
  104. General management of pulmonary edema!
    • Antidysrhythmic agents
    • Positive inotropic agents (improved cardiac output)
    • Cardiac workload reduction (afterload reduction)
    • Vasodilators
    • Sodium and fluid retention therapy
    • Albumin and mannitol
  105. Respiratory care protocol for pulmonary edema!
    • Oxygen therapy protocol
    • Bronchopulmonary hygiene therapy protocol
    • Lung expansion therapy protocol
    • Aerosolized medication protocol
    • Alchohol
    • Decreasing hydrostatic pressure
  106. The sources of Pulmonary embolism!
    • Blood clots--- most common
    • Fat
    • Air
    • Amniotic fluid
    • Bone marrow
    • Tumor fragments
  107. Signs and symptoms commonly associated with pulmonary embolism!
    • Increased respiratory rate
    • Hypoxemia
    • Systemic hypotension
    • Chest pain
    • decreased cheast expansion
    • Peripheral edema and venous distention
    • Sudden shortness of breath
    • Tachycardia
    • Weak pulse
    • Lightheadness or fainting
    • Confusion
    • Anxiety
    • Excessive sweating
    • Cyanosis
    • Blood streaked sputum
    • Wheezing
    • Cool or clammy skin to touch
  108. Chest assessment finding in pulmonary embolism!
    • Crackles
    • Wheezes
    • Pleural friction rub
  109. Chest radiograph of pulmonary embolism!
    • Increased density
    • Hyperradiolucency distal to the embolus
    • dilation of the pulmonary arteries
    • Pulmonary edema
    • Cor pulmonale
    • Pleural efusion
  110. Management of Pulmonary embolism!
    • Oxygen
    • Fast acting anticoagulants, such as heparin or warfarin
    • Thrombolytic agents
  111. Risk factors for pulmonary embolism!
    • Venous stasis
    • Inactivity
    • CHF
    • Surgical procedures
    • Trauma
    • Obesity
    • Pregnancy
    • Smoking
    • Burns
  112. Diagnosis and screening for pulmonary embolism!
    • CT scan
    • V/Q scan
    • Pulmonary angiogram
    • D-Dimer blood test
  113. Vital signs in Atelectasis!
    • Increased heart rate
    • Increased cardiac output
    • Increased blood pressure
    • Increased ventilator rate
  114. Radiologic finding in Atelectasis!
    • Increased density
    • Increased opacity
    • Air bronchogram
  115. Chest assessment in Atelectasis!
    • Bronchial breath sounds
    • Crackles
    • Dull percussion note
  116. Vital signs in bronchospasm!
    • Increased heart rate
    • Increased cardiac output
    • Increased pressure
    • Increased ventilatory rate
    • Pursed lip breathing
  117. Radiologic Findings in Bronchospasm!
    • Trandlucent
    • Depressed diaphragm
    • Use of acessory muscles
    • Barrell Chest
  118. Cheast assessment in Bronchospasm!
    • Diminished breath sounds
    • Diminished heart sounds
    • Hyperresonant percussion note
    • Wheezing
  119. Vital signs in excessive bronchial secretions!
    • Increased heart rate
    • Increased cardiac output
    • Increased blood pressure
    • Increased ventilatory rate
    • Pursed lip breathing
  120. Radiologic findings in excessive bronchial secretions!
    • Translucent
    • Depressed diaphragm
    • Use of accessory muscles on inspiration
    • Pursed lip breathing
    • Barrell chest
  121. Chest assessment in excessive bronchial secretions!
    • Diminished breath sounds
    • Diminished heart sounds
    • Hyperresonant percussion note
    • Rhonchi and wheezing
  122. The essential base for a sucessful therapist drivin protocol program!
    • The anatomic alterations of the lungs caused by common respiratory disorders
    • The major pathophysiologic mechanisms activated throughout the respiratory and cardiac systems as a result of the anatomic alterations
    • The common clinical manifestations that develope as a result of the activated pathophysiologic mechanisms
    • The treatment modalities used to correct them
  123. Common treatment modalities for oxygen therapy protocol!
    • Nasal cannula
    • Oxygen mask
    • Venturi mask
    • Partial rebreathing mask
  124. Common treatment modalities for bronchopulmonary hygiene therapy protocol!
    • Inccreased bronchial hydration
    • Cought and deep breathing
    • CPT
    • Postural drainage
    • Percussion and vibration with postural drainage
    • Suctioning
    • Mucolytic therapy
    • Assist physician in bronchoscopy
  125. Common treatment modalities for lung expansion therapy protocol!
    • Cought and deep breathing
    • IS
    • IPPB
    • CPAP
    • PEEP
  126. Objective of oxygen therapy!
    • To treat hypoxemia
    • Decrease the work of breathing
    • Decrease myocardial work
  127. Heart rate
    300/ # of large boxes between R waves
  128. Atrial arrhythmias
    The normal P wave is absent
  129. Ventricular arrhythmias
    The QRS is wide and bizarre
  130. Deadspace ventilation!
    30% of tidal volume
  131. Predicted volume for vital capacity!
    65 ml/kg