Special RCP Procedures

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This is the pre and post test for chapter five from the Respiratory Care Exam Review Persing book.

The following are complications associated with bronchoscopy

Pulmonary hemorrhage
Pneumothorax
Hypoxemia

While assisting with a bronchoscopy, you note that the physician is having difficulty entering the trachea. This may be the result of the following

laryngospasm
(Not a concern if the pt is intubated because the bronchoscope passes through the ETT and does not come in contact with the vocal cords)

After a bronchoscopy, the RCP notes that it is taking more ventilator pressure to ventilate the pt lungs than before the procedure. This is caused by the following

Bronchospasm
Pneumothorax
Pulmonary hemorrhage

To aid in evacuation of air from the pleural space, a chest tube should be inserted at what level?

Second intercostal space anteriorly
Air tends to gravitat upward in the thorax placing the chest tube in the 2nd intercostal space is indicagted. To drain fluid from the pleural space, which tends to gravitate downward, insert the chest tube lower, generally the 7th or 8th intercostal space.

The RCP notices on pt chest tube drainage system that there is fluctuation of the water level in the water-seal chamber with each pt breath and air bubbles seen only in the suction control chamber which has a suction pressure of -15 cmH2O. The most appropriate action is the following

Recommend a chest radiograph to determine wheter the pneumothorax has resolved.
-It is normal for the water level in the water-seal chamber to fluctuate as the pt inhales and exhales. Bubbling that occurs only in the suction control chamber under -15 cmH2O pressure and not in the water-seal chamber indicates that the pneumothorax is resolving. Excessive or persistent bubbling occuring in the water-seal chamber may be an indication of a leak in the system or that air is still being removed from the pleural space.

The RCP observes that, during a pt breathing cycle, there is no fluctuation in the water-seal chamber of the pleural drainage system. The most appropriate action is the following

"Strip" or "milk" the chest tube to clear a possible obstruction.

List indications for bronchoscopy

Removal of foreign bodies
Removal of mucus plugs and thick secretions.
Atelectasis that affects a lobe or an entire lung.
Pulmonary hemorrahage.
When tracheal intubaiton is difficult as a result of upper airway trauma, obesity, tumors or spinal deformity.

List 8 complications of bronchoscopy

Hypoxemia
Laryngospasm
Arrhythmias
Hemorrhage
Respiratory depression
Hypotension
pneumothorax

Medication that is commonly used to achieve conscious sedation before bronchoscopy

diazepam (Valium)
midazolam (Versed)

What is the purpose of administering atropine before bronchoscope?

drying the airway

How should the bronchoscope be cleaned after the bronchoscopy?

Sterlized by immersion in gltaraldehyde (Cidex) for 3-10 hours

What is the purpose of inserting a chest tub?

To drain fluid or air from the pleural space so the lung may reexpand.

If the water in the water-seal bottle is not fluctuating, what should be suspected

obstruction of the tube

If a chest tube becomes obstructed, what may occure

tension pneumothorax

If an air leak from a chest tube is suspected, what should be done first?

The chest tube should be clamped first to identify the source of the leak

How much negative pressure is generally required to help evacuate fluid or air from the plueral space?

-15 cmH2O

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