Kettering (Special Procedures) Questions With Complete Solutions

Kettering (Special Procedures) Questions With Complete Solutions Describe how the respiratory therapist would administer oxygen to a patient receiving hyperbaric oxygen therapy - ANSWER -- It is administered by mask or through the chamber at 100% Describe the purpose of utilizing Helium/Oxygen therapy for patients who have increased work of breathing (WOB) - ANSWER -- Decreases the patient's WOB by delivering low density gas (most important property) that can easily maneuver around obstructions State the indications of Helium/Oxygen therapy - ANSWER -- Post extubation stridor - Severe asthma/status asthmaticus - Obstructive tumors - Foreign object aspiration - Partial vocal cord paralysis List the two He/O₂ mixtures that are available - ANSWER -- 80% He/20% O₂ (most used) - 70% He/30% O₂ What type of oxygen administration device is used to deliver Helium/Oxygen therapy? - ANSWER -- Non-rebreathing mask What would the actual flow rate be if a 70/30 heliox mixture is used with an oxygen flowmeter set at a rate of 8 L/min? - ANSWER -- Actual Flow= indicated flow × factor Factors: a) 80/20 mixture: 1.8 (or use 2) b) 70/30 mixture: 1.6 Ex: Actual Flow = indicated flow × factor Actual flow = 8 L/min × 1.6 Actual flow = 12.8 L/min Describe the physiologic effects of Inhaled Nitric Oxide (iNO) on the pulmonary system - ANSWER --Inhaled Nitric Oxide (iNO) acts as a potent pulmonary vasodilator, which improves pulmonary blood flow and PaO₂, but does not affect systemic blood pressure. List the 4 indications for inhaled nitric oxide therapy - ANSWER -- Primary pulmonary hypertension - Refractory hypoxemia related to increased pulmonary artery pressure (PAP) - Increased pulmonary vascular resistance (PVR) - Right heart failure/Cor Pulmonale State the standard initial dose for iNO therapy - ANSWER -- 20-40 ppm (parts per million) * Start at 40ppm if given 2 choices. Describe the side effects that can occur during iNO therapy - ANSWER -- Methemoglobin (MetHb) levels may increase - Nitrogen Dioxide (NO₂) levels may increase and are toxic to body levels 10 ppm - Rebound pulmonary hypertension- occurs when the iNO is discontinued too rapidly What should the therapist do to avoid a rebound effect when discontinuing iNO therapy? - ANSWER -- Titrate the iNO dose to 20 ppm, then 10 ppm to, 5 ppm, then discontinue Identify the device that is used to deliver iNO therapy to mechanically ventilated patient. - ANSWER -- injector module and sample line added to ventilator circuit distal to humidifier and 24 inches after inspiratory limb Describe a thoracentesis - ANSWER -- A diagnostic and/or therapeutic procedural in which a needle is inserted into the chest to remove fluid from the pleural space. The most common pleural disorder that requires a thoracentesis is a: - ANSWER -- Pleural effusion List the three methods that can be used to identify the presence of a pleural effusion - ANSWER -1. Physical examination reveals flat or dull percussion notes, diminished breath sounds and tracheal shifts away from the site. 2. X-ray findings- lateral decubitus film shows concave upper border or a continual line from the diaphragm to the apices. 3. Ultrasound techniques State the most common position for the patient during the thoracentesis procedure - ANSWER -- Have the patient sitting up and leaning forward Describe the appearance of a transudate. - ANSWER -- Usually clear and has a light straw color - Transudate (clear) fluid is also called serous fluid. What is the most common type of pathology associated with transudate fluid? - ANSWER -- This type of fluid would be associated with congestive heart failure Purulent fluid can be described as a - ANSWER -pus-filled exudate What two things does mucopurulent fluid contain - ANSWER -1. Mucus 2. Pus exudate