RRT Clin Sims | 398 Questions and Answers with complete solution

Pneumonia: - - Collection and/or consolidation of sputum as a result of a bacterial or viral agent entering the lung on inhalation. - Presents with fever, dyspnea, chills, cyanosis, rhonchi and rales - CXR: scattered infiltrates - CBC: Increased WBC if bacterial, decrease WBC if viral - Interventions: O2 therapy first, suctioning and other bronchial hygiene efforts. - Antibiotics: Penicillin for gram positive organisms, Gentamycin, or other 'mycin antibiotics for gram negative organisms. Information gathering: Emphysema - - Abnormal condition of the alveoli resulting destruction and loss of elasticity. - Can present with cyanosis, barrel chest, accessory muscle use, digital clubbing, dyspnea, and wheezing breath sounds - Due to significant hx of smoking and/or occupational exposure to smoke or asbestos, other pulm. irritant - CXR: ↑ A-P diameter, flattened diaphragms, hyperlucency, diminished pulmonary vascular markings. - CBC: polycythemia, increased WBC due to possible infection. - ABGs: Compensated respiratory acidosis (high PaCO2, normal pH), moderate to severe hypoxemia. - Sputum culture: often positive for bacteria. - PFT: flows are ↓ especially middle sized airways (FEF 25-75%) Fev1 & Fev1/FVC%, reduced DLCO (less than 20). Descision Making: Empysema - - Tx: Oxygen therapy—low FIO2 (0.24 to 0.28) or 1 to 2 lpm nasal cannula. Oxygen conserving devices such as liquid oxygen or trans-tracheal oxygen. Bronchodilators medication via MDI or aerosol nebulizers, antibiotics for infection, smoking cessation products (nicotine replacement therapy). - Home care education on devices and equipment cleaning - Rehabilitation efforts (specifics not usually required)Information Gathering: Chronic Bronchitis - - Condition where the patient has a productive cough 25% of the year for at least two consecutive years. - Presents with productive cough, purulent sputum production, dyspnea, and frequent infections - Due to exposure to pulmonary irritants and like hx of smoking - CXR: may show hyperlucency, diminished pulmonary markings. - CBC: possibly ↑ WBC due to possible infection. - ABGs: very slight respiratory acidosis and hypoxemia - PFT: flows are ↓ especially middle sized airways (FEF 25-75%) FEV1, Normal DLCO Decision Making: Chronic Bronchitis - - Tx: Anything that promotes good pulmonary hygiene such as chest physiotherapy, hydration therapy when sputum is thick. Fluid therapy if dehydrated, oxygen therapy for hypoxemia, aerosolized bronchodilator therapy, - Antibiotic: Tetracycline may be preferable Decision Making: Bronchiectasis - - Anything that promotes good pulmonary hygiene such as CPT, hydration therapy when sputum is thick. - Fluid therapy if dehydrated. - Oxygen therapy for hypoxemia - Aerosolized bronchodilator therapy. - May have to consider surgical intervention on some highly affected segments Information Gathering: Bronchiectasis - - Abnormal condition where the bronchi secrete large volumes of pus during abnormal dilation - Presents with productive cough, often with blood, digital clubbing of the nail beds, significant hx of infections (recurrent), and dyspnea - CXR: generally normal. Used in dx: Air bronchogram. Characterized by a "winter tree pattern". - Sputum culture: gram negative bacteria Information Gathering: Sleep apnea (Central or Obstructive) - - Cessation of breathing during sleep.Is usually obstructive in nature but sometimes can be central or a combina