Respiratory Theory I Final

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Normal PaO2 range is within____to____mmHg?

80-100mmHg

Give 2 clinical signs of hypoxemia.

Hypertension, Tachycardia.

T/F. One of the body's first responces to hypoxemia is to increase the rate and depth of respirations?

True.

T/F. Administration of supplemental O2 will increase the partial pressure of O2 in the alveoli?

True

T/F. Administraton of supplemental O2 may serve to exacerbate the hypoxemia and increase the body's stimulus to increase cardiac output?

False.

You are selecting an O2 delivery device for a patient with COPD. His arterial blood gas results indicate he is a chronic CO2 retainer requiring very precise FIO2. Which device would you choose for this patient?

A Venturi Mask.

T/F. Administration of supplemental O2 will increase the partial pressure of O2 in the alveoli?

True.

T/F. Large volume aerosol generators allow for adjustment of air entrainment that determines the delivered FIO2?

True.

To qualify as a true High Flow O2 Device a system should privide at least_____LPM?

60 LPM

A nasal cannula at 1 LPM delivers what % of O2 delivered?

.24

A nasal cannula at 2 LPM delivers what % of O2 delivered?

.28

A nasal cannula at 3 LPM delivers what % of O2 delivered?

.32

A nasal cannula at 4 LPM delivers what % of O2 delivered?

.36

A nasal cannula at 5 LPM delivers what % of O2 delivered?

.40

A nasal cannula at 6 LPM delivers what % of O2 delivered?

.44

A simple mask at 7 LPM delivers what % of O2 delivered?

.40

A simple mask at 8 LPM delivers what % of O2 delivered?

.45

A simple mask at 9 LPM delivers what % of O2 delivered?

.50

A simple mask at 10 LPM delivers what % of O2 delivered?

.55

You should never run a simple mask on less than 6 LPM because of what reason?

CO2 buildup in the mask.

What 2 conditions affect the performance of a simple mask?

Minute volume and Tidal Volume.

A nasal cannula is considered a____flow device?

Low.

A simple mask is considered a____flow device?

Low.

A partial rebreather mask is also known as what?

Reservoir system.

A Nonrebreather has ____________ that prevent the rebreathing of exhaled gas?

One way valves.

A nonrebreather is also known as what type of device?

Reservoir system.

What FIO2 can a Partial rebreather deliver to the patient?

35-60%

What FIO2 can a Nonrebreather deliver to the patient?

70-90%

What is the air/O2 ratio for 100%

0:1

What is the air/O2 ratio for 70%

0.6:1

What is the air/O2 ratio for 40%

3:1

What is the air/O2 ratio for 35%

5:1

What is the air/O2 ratio for 30%

8:1

What is the air/O2 ratio for 28%

10:1

What is the air/O2 ratio for 24%

25:1

_____________Provide constant concentrations of O2 by meeting or exceeding patients flow requirements?

High Flow Systems.

Give the most popular device used in Respiratory Care that is considered a High Flow Device.

Venturi Mask.

What High Flow system generates particulate water for deposition in the respiratory tract?

Air Entrainment Nebulizer.

What is the purpose for using a croup tent?

To provide a cool mist and O2 enrichment.

What is the FIO2 High range for a Croup Tent?

40-50%

Where should you analyze the O2 level in a croup tent?

at patients face

What provides a controlled O2 environment for an infant?

Oxyhood.

What must be carefully controlled when using an Oxyhood with an infant?

Temperature.

What device uses Servo-Controlled temperature?

Incubator

What must be monitored on an infant inside an incubator?

PaO2

Infants under 1 month of age exposed to high O2 levels are in danger of what condition?

Retinopathy.

What device delivers O2 at pressures greater than 1 atmosphere?

Hyperbaric chamber.

What device would be indicated for decompression sickness?

HBO therapy

What device would be indicated for air or gas embolism?

HBO therapy

Give 3 HBO complications.

Fire O2 toxicity, Barotrauma.

What gas therapy activates cGMP causing smooth muscle relaxation?

Nitric Oxide.

When withdrawing Nitric oxide therapy, what should you do to prevent the "rebound effect"?

Flush with O2.

What medical gas therapy is used to manage large airway obstruction?

Heliox.

What is the % amount for helium in heliox?

80% and 70%

What is the % amount for O2 in heliox?

20% and 30%

What is the correction factor for an 80/20 dose of heliox?

1.8

What is the correction factor for an 70/30 dose of heliox?

1.6

What device must be used when administering Heliox to a patient?

Nonrebreather.

Give 2 examples of an electrochemical analyzer?

Galvanic Fuel Cell and Polarographic.

What is the accuracy of Electrochemical analyzer?

+/- 2%

What analyzer uses oxygen mediated chemical reaction?

Galvanic Fuel Cell.

A Hudson analyzer is an__________

Galvanic Fuel Cell

An Ohmeda analyzer is an_________

Galvanic Fuel Cell

A Teledyne analyzer is an_________

Polarographic Analyzer

If you wanted to measure O2 concentration in the quickest way what analyzer would be the the best choice?

Teledyne.

What type of analyzer cannot be used near flammable gases?

Electrical analyzer

What are 2 examples of an electrical analyzer?

OEM and MIRA.

Before analyzing O2 with an analyzer at what % should you calabrate it?

21% and 100%

A device device that can detect concentration of O2 in any gas mixture is called?

Physical analyzer.

Give an example of a Physical Analyzer.

Beckman D-2

What is one disadvantage of the Physical Analyzer?

only accurate at sea level.

Define Hypoxemia

Dangerously low levels of arterial O2 to meet tissue demands.

What is the threshold PaO2 for Hypoxemia?

< 60mmHg

What is the threshold SaO2 for Hypoxemia?

< 90mmHg

What is the newborn threshold PaO2 for Hypoxemia?

< 50mmHg

What is the newborn threshold SaO2 for Hypoxemia?

< 88mmHg

In what acute cardiac condition is O2 therapy especially important?

Myocardial infarction

What effect does hypoxemia have on the pulmonary blood vessels? What are the long term consequences of this effect?

Pulmonary vasoconstriction. Right ventricular failure or Cor Pulmonale.

What are 3 basic ways to determine weather a patient needs O2?

1. Lab tests 2. specific clinical problem or condition 3. tachypnea, Cyanosis, distressed overall appearance.

O2 toxicity affects what two organ systems?

Lungs, CNS

The harm caused by O2 is influenced by what two factors?

PO2 and Exposure Time

What specific type of COPD patient is likely to experiance depression of ventilatory drive while breathing O2?

Patients with Chronic Hypercapnea

How can you reduce the risk of ROP?

Keep infant PO2 below 80mmHg

When should you attach the cannula to a bubble humidifier?

When flows are greater than 4 LPM

What is the maximum flow for newborns?

< 2 LPM

Why does the range of FIO2 delivered by nasal cannulas vary so much?

Because of mouth breathing, RR, Tidal volume, Inspiratory flow rates, minute ventilation.

How can you tell if a nonrebreathing mask has an adequate flow rate?

The bag does not fully deflate on inspiration.

Air entrainment devices are classified as high flow. For what settings is this usually true?

35% or less

How do you boost the total flow when using an AEM?

Increase the input flow.

What is the minimum flow set to for an Oxyhood?

7 LPM

What is the harmful consequence that occurs when the flow rate into the hood is too high?

May generate harmful noise levels.

What effect will cold air flowing into the hood have on a premature infant?

Increases O2 consumption and may cause apnea.

What is the best way to control O2 delivery to an infant inside an incubator?

O2 Hood.

What is the primary benefit of the infant incubator?

Helps maintain a neutral thermal environment.

What property of helium results in decreased WOB?

Low density.

What happens in the exudative phase (24-72 hrs)?

Changes in alveolar type II cells, Destruction of pulmonary/capillary endothelial cells and alveolar edema.

What happens in the Proliferative phase (> 72 hrs), late phase?

Hylaine membrane formation and hyperplasia of type II cells.

The more critically ill the patient__________

The greater the need for a stable high FIO2

A critically ill adult patient w/ moderate to severe hypoxemia needs___________

Either a reservoir system or a high flow system capable of 60% O2.

More stable patients but are acutely ill w/ mild to moderate hypoxemia needs___________

A system of low to moderate O2 concentration can be used (nasal cannula or simple mask).

The less stable the patient's condition___________

The greater is the need for a high flow AEM.

A moderately hypoxemic patient w/ endotracheal tube in place, what device is most appropriate?

Either an Air entrainment nebulizer or O2 blender-humidifier system w/ T-tube Briggs Adapter.

What is the most popular Diffusion Humidifier used in Respiratory Care?

Bubble type.

What is the relative humidity % delivered by a bubble humidifier?

80%

What relative humidity % is delivered by a Wick Humidifier?

100%

A Wick Humidifier is also known as a __________?

type of passover humidifier.

What should a RT do first when treating a patient on a Cascade II when giving a SVN breathing treatment?

Shut off the Cascade II.

Why should you turn off a Cascade II when giving a SVN treatment?

Because the heating element will sense the change and compensate for it and get hotter.

Give an example of a Passover Humidifier.

Emerson "hot pot."

HME's are also known as_______?

Artificial nose.

What does an HME utilize to provide humidity to the patient?

Patient's exhaled gas.

What is the ideal Relative Humidity delivered by an HME?

70%

Candidates for Transtracheal O2 must have a PO2 of less than____ to qualify for the proceedure?

55mmHg

To qualify for TTO2 a patients PCO2 must be less than____ on supplemental O2?

45mmHg

What must a TTO2 patient do before cleaning a SCOOP 1 catheter?

Put on a nasal cannula.

A SCOOP 1 must be removed and cleaned periodically at least_________?

Once a week.

Name 2 gases that are flammable.

Cycloproprane, Ethylene

Name 6 medical gases that support combustion.

O2, N2O, Air, O2/N2, O2/CO2, He/O2

What medical gases that are nonflammable?

N2, CO2, He

What is in a Gray/Green cylinder?

CO2/O2

What is in a Brown cylinder?

Helium

What is in a Brown/Green cylinder?

He/O2

What is in a Yellow cylinder?

Air

What is in a Black cylinder?

Nitrogen

What is in a Orange cylinder?

Cycloproprane

What is in a Blue cylinder?

Nitrous Oxide

What is in a Grey cylinder?

CO2

What is in a Green cylinder?

O2

What is the working pressure of a wall outlet?

50 psi

Give 4 uses for the PISS system.

Indexing for small cylinders, Exact placement determined by pin locaton, Six hole pin combination, O2 is 2:5 configuration

Name the most economical way to produce oxygen.

Fractional Distillation

A cylinder with a 3A stamp indicates what about the construction of the tank?

Made of Carbon Steel

A cylinder with a 3AA stamp indicates what about the construction of the tank?

Produced from heat treated steel alloy

How much Oxygen can be stored in a Bulk Reservoir?

13,000 Cubic feet of gas

Give 2 uses for a DISS connection.

For low flow pressure connections, Used on threaded valve outlets.

In Celsius, kinetic activity stops at?

-273 degrees C

Absolute zero is what in Kelvin?

Zero degrees

K= degree of Celsius + ?

273

Convert 103 degrees F into C.

39 degrees C

Convert 40 degrees C into F.

104 derees F

Substances that go from a solid to a gas, bypassing the liquid state is called?

Sublimation

Molecules that break through liquid surface and convert ot a free gass below boiling point is called?

Evaporation

Define vapor pressure.

Pressure exerted by molecules hitting the surface of a liquid and escaping

One atmosphere equals how many PSI?

14.7 psi

One atmosphere equals how much in mmHg?

760

If a person were to decend 3 atmospheres underwater, how much pressure would it exert in Ft/H2O?

135.6 ft/H2O

One atmosphere equals how much pressure in ft/H2O?

33.9 ft/H2O

What type of barometer consists of a sealed evacuated metl box with a flexible spring that responds to external pressures?

Aneroid

What type of barometer indicates the downward force of Atmospheric pressure by the height of the column?

Mercury

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