RRT Study Guide (NBRC) 2023 100% with correct questions and answers

Four vital functions Ventilation Oxygenation Circulation Perfusion Signs Objective information Color, pulse, edema Symptoms Subjective information Dyspnea, pain, nausea Visual examination 1st step in assessment General appearance, sensorum, chest movement, posture, skin color Bedside examination 2nd step in assessment Breath sounds, vital signs, chest auscultation, chest percussion, past medical history, cap refill Lab examination 3rd step in assessment ABG, CBC, CXR, Lytes Special examination 4th step in assessment Urinalysis, gram stain, MIP, VC Edema Excessive fluid in the tissue Occurs primarily in arms and ankles Lasix Clubbing Thumb, first finger, and toes affected JVD Occurs with CHF Cap refill Color should return within 3 seconds Obtunded Drowsy state may decreased cough or gag reflex ADL Activities of daily living Orthopnea Difficulty breathing except in the upright position CHF Fick equation Calculates cardiac output (Qt) Qt normal: 4-8 L/min Dysphagia Difficulty swallowing Diaphoresis TB/nightsweats Skin color Normal: Race specific Decrease in color (ashen, pallor): Anemia, blood loss Jaundice: Increase bilirubin levels Erythema: Redness of the skin (Hypercarbia) Cyanosis: Hypoxia Cardiac index: Normal 2.5-4.0 for patients of all ages Pectus carinatum Anterior protrusion of the sternum Pectus excavatum Depression of the sternum Kyphosis Convex of the spine (lean forward) Kyphoscoliosis A combination of kyphosis and scoliosis Reduced lung volumes Asymetrical Unequal Eupnea Normal respiratory rate, depth, and rythm 12-20 breaths/min Cheyne Stokes Gradually increase then decreasing rate and depth in a cycle lasting from 30-180 seconds Biots respiration Increase RR and depth with irregular periods of apnea Kussmaul's Increased RR (>20 breaths/min), increased depth, irregular rhythm, breathing sounds labored Diabetic ketoacidosis Evidence of difficult airway Short receding mandible Enlarged tongue (macroglossia) Ascites Accumulation of fluid in the abdomen Caused by liver failure Normal urine output 40 mL/hr (approximately 1 Liter/day) Normal Body temp 37˚ C (98.6˚ F) Normal PR 60-100 A change of more than 20 bpm is an adverse reaction (call nurse) Normal RR 12-18 Normal BP 120/80 HTN > 140/90 Kussmaul's sign Deep and rapid breathing pattern occur in patients with diabetic ketoacidosis Hoover's sign Contraction of the flat diaphragm that draws in costal margins Respiratory alterans Diaphragm and rib cage are alternatively expanding Bronchial breath sounds Occurs when lung density occurs and breath sounds are heard in the peripheral lung Diminished breath sounds When sound intensity is reduced Wheezes and stridor Narrowed airways Crackles Secretions CBC lab RBC: WBC: Leukocytosis Excessive WBC Leukopnea Deficient WBC Electrolyte lab (BCP): Normal BGL: 70-99 K+: Na+: Cl-: Prothrombin time and partial thromboplastin time Tests functionality of coagulation from two separate pathways clots are formed Gram stain + or negative; cocci or rods; Streptococcus Common type of bacteria associated with pneumonia Sputum culture Matures sputum culture, then tests sensitivity to antibiotic therapy Acid-fast testing Used after a gram stain to detect TB Decreased FEV1/FVC Obstructive disease Decreased FVC Restrictive disease Normal ABG values pH: 7.35-7.45 PCO2: 35-45 PO2: 60-80 Bicarb: 22-26 BE: 2-6 Radiograph Low density tissue (radiolucent) - Lung tissue High density tissue (radiopaque) - Bone Computed tomography (CT) Can visualize great deatail by cross-section MRI Useful in evaluation of chest pathology Advantage in vascular structure imaging Vt The volume of air which moves in and out of the lungs Removes CO2 and replenishes O2 Elasticity Physical tendency for an object to return to an initial state after deformation (Hooke's law) Vital capcity Preformed with a respirometer Normal: 70 ml/kg Muscle weakness: 10-15 ml/kg Maximum inspiratory pressure (MIP) Maximum output of the inspiration muscle Normal 10 Vent: Tidal volume 6-10 ml/kg IBW IBW calculation Normal VT: 6-10 ml/kg Height: 5' 11" 50+(11x2)= 50+22= 72 72x6= 432 72x10= 720 VT range = 432-700 Vent: Rate 12-18 bpm Vent: Trigger sensitivity 1-2 L/min Vent: Inspiratory time 0.8 Vent: I:E ratio 1:2 Compliance Reciprocal of elastance ∆volume/∆pressure Elacticity Distensibility of the lungs and thorax ∆pressure/∆volume Resistance Airflow and tissue resistance ∆pressure/∆flow WOB Respiratory muscles work for normal passive breathing Pulse oximetry Measures arterial blood oxyhemoglobin saturation levels VD/VT Provides an index of wasted ventilation Capnography normals Used during general anesthesia and mechanical ventilation PaCO2 = 40 torr PetCO2 = 30 torr EtCO2 = 3-5% Increase in PeCO2 or PetCO2% would indicate what? Decrease in ventilation (ventilatory failure) Decrease in PeCO2 or PetCO2% would indicate what? Increase in ventilation Decreased perfusion (pulmonary embolism, hypovelemia) True or False: During CPR the PetCO2% should decrease F Co-oximeter/hemoximeter Normal COHb: 0-1% COHb for smokers: 2-12% CO poisoning: >20% More accurately measures COHb and O2Hb Trancutaneous PO2 and PCO2 measurement Temp of 32-43 C improves capillary blood flow (perfusion) Electrode site should be changed every 4 hrs. If erythema occurs electrode should be moved Calibration is done on room air (PaO2 = 150 torr, PaCO2 = 0 torr) and with a zeroing solution Air leaks will increase the TcPO2 to read higher than the PaO2 There are 3 factors that control blood pressure Heart, blood, Vessels Heart: BP Pump that creates the BP, changes in the PR and contractility will affect the BP Decrease in contractility will decrease BP Heart: BP drugs Chronotropic drugs (Atropine) increase HR B-blockers or B-antagonsits (atenolol, propranolol, Labetalol) Blood: Bp drugs Excessive fluid (increase pressure): treat with diuretics (lasix) Decreased fluid (decrease pressure): treat with fluids or blood products Vessel: BP Drugs Vasodialators (nitroprusside, hydralazine, milrinone) ACR inhibitors (Lisinopril, Perindopril, Captopril, Enalapril, Ramipril) Erythema Redness or blistering of the skin ECG When electrical impulse moves toward the positive electrode an upward deflection is made on the paper Movement away from the positive electrode produces a downward deflection 12 leads used: 6 limb leads, 6 chest leads (10 electrodes) V1, V2 4th intercostal Right atrium V3 Between V2 and V4 Ventricular septum V4 5th intercostal space Ventricular septum V5 Between V4 and V6 Left ventricle V6 5th intercostal space, left mid-axillary line Normal HR 60-100 If the R-waves are between 3 and 5 boxes, then the rate is normal CVP-right atrial pressure Swan ganz catheter Normal 2-6 mmHg QRS complex ECG: Tachycardia Oxygen ECG: 1st degree heart block Long PQ interval ECG: Bradycardia Oxygen, Atropine ECG: 2nd degree heart block (Mobitz type 1) PQ gets longer and longer until QRS is dropped ECG: 2nd degree heart block (Mobitz type 2) Random P waves ECG: 3rd degree heart block P and QRS waves are completely disjointed and random ECG: Atrial flutter Sawtooth ECG: Atrial fibrillation P wave quivers randomly ECG: Premature ventricular contractions Oxygen, Lidocaine, Amiodarone ECG: Ventricular tacycardia Pulse present: Cardiovert Pulse absent: Defibrilate, CPR Epinephrine, Amiodarone Pulmonary artery pressure 25/8 mmhg at rest, 14 mean 30 mmhg during exercise is a sign of HTN Wedge pressure ... ECG: Ventricualr fibrillation Completely irregular Defibrillate, CPR Epinephrine, Amiodarone Asystole Confirm in 2 leads first CPR, Epinephrine Multifocal PVC Oxygen, Lidocaine, Amiodarone APGAR Airway, pulse, grimace, appearance and response >7 normal ≤6 abnormal Ischemia Reduced blood flow to the tissue Inverted T-wave Injury is indicated with elevated ST segment Infarction with significant Q waves Perinatal history Pregnancy history, age, smoking and substance abuse, nutrition, infection, HTN/toxemia Gestational age 38-42 weeks = Term gestation Before 38 weeks = Preterm After 42 weeks = Postterm You are assessing the one minute APGAR score for a newborn. She is pink all over and has a pulse of 130. As you dry her off she begins to cry vigorously and kick her legs. Her APGAR score is? 10 A neonatal patient has a pink color, a pulse rate of 102, and a respiration rate of 27. She grimaces in response to stimuli, has limited muscle movement. This patient has an APGAR score of? 7 A newborn has a strong cry and is actively moving his blue extremities when stimulated. Vital signs are P140, R48. What is his APGAR score? 9 It has been 5 minutes since your patient delivered her baby. The infant is crying weakly and is curling his arms and legs. He is pink all over with a pulse of 90 and weak respirations. What is his APGAR score? 6 After assisting in the delivery of a newborn the infant is pale and limp, has a slow heartbeat but shows some respiratory effort. What APGAR score would you give this infant? 2 You just delivered a baby boy. His body is pink, but his hands and feet are blue. Vital signs are P110, R rapid and irregular. He has a weak cry when stimulated and resists attempts to straighten his legs. His APGAR score is? 7 A newly delivered infanthas a pink trunk and blue hands and feet, pulse rate of 60 and does not respond to your attempts to stimulate her. She also appears to be limp and taking slow, gasping breaths. What is her APGAR score? 3 One minute after birth, your newborn patient is actively crying in response to your bulb syringe. His body is pink, and he is moving his extremities which are blue. His heart rate is 110. What is the newborns APGAR score? 9 Starting at which number on the APGAR score should you need to start resuscitation efforts? 6 Transillumination When pneumothorax is suspected If + for pneumo a light halo will appear around the point of contact Infant normal HR 110-160 Infant normal temp 36.5 Diagnosing sleep apnea Polysomnogram (Sleep lab) L/S Ratio The amount of Lexithin and sphingomyelin found in the amniotic fluid > 2:1 = Mature lungs Term infant weight >3000g Pre-term weight 1000g (28 weeks) Dubowitz and Ballard method Gestational age 40 normal <40 pre-term >40 post-term Infant BGL >30 Capnography ... Sleep apnea positional therapy Head of bed elevated, supine position, or lying in lateral position Sleep apnea PPV CPAP Bilevel General appearance Age, height, weight, and nourishment Airway assessment: Percussion Normal lungs: low pitched sound, heard easily, (tympanic) Dampend: Decreased resonance (pneumonia, atelectasis, tumor) Yellow or green sputum Bacterial infection Brown sputum Smokers, blood tinged, serious lung infection Tactile fremitus Vibrations created by the vocal chords echoing through the chest wall "99" Subcutaneous emphysema Air leaks from the lung into the subcutaneous tissue Creates crackling sound and sensation Crepitus The sensation from palpating subcutaneous emphysema Bubbles of air under the skin Chest percussion: Resonant Normal lungs Chest percussion: Flat Atelectasis Chest percussion: Dull Fluid-filled Chest percussion: Tympanic or hyperresonant Pneumothorax Adventitious Abnormal breath sounds Pleural friction rub Coarse grating raspy or crushing sound TB, pneumonia, cancer Recommend steroids and antibiotics Crackles (fluid) Coarse: Suction or instruct to cough Medium: Bronchial hygiene Fine: Oxygen, PPV, Lasix Wheeze Unilateral: FBAO (bronchoscopy)