Lab Equipment Test

The nurse calls you to tell you that there is a fresh trach pateint coming from the OR to your floor. Doc ordered Trach care and O2 therapy for sats > 95%. Please set up your patient on a NEW start trach collar and the CHART all pertinent patient assessment information regarding the patient, the trach, and all vitals & interventions performed by RT and recommendations. PT FOUND on ROOM AIR

from the wall start with a flow meter, nebulizer with sterile water, with large bore tubing connected and a trach collar.

John Doe M 65 y/o in rm 1. is a fresh trach patient. looking at his trach there is some irritation, redness, and swelling with drainage coming from his stoma. RN and MD was notified of the site. He is currently wearing a shiley XLT proximal sz 8 cuffed (deflated) with a DIC in placed. He is currently sating 81% on RA, HR of 79bpm, RR of 17 and Temp is slightly increased and i recommended an antipyretic PRN.

For the trach collor set up it is given to deliver humidfication to the trach since we are by passing the upper airway you want to give humidification because you dont want the airway to dry out. You also want to give oxygent to increase his oxygen since he is sating 81% and we want to have his sats > 95%. Also suctioning and trach care should be performed PRN with ascultation + hyperoxygenations before and afterwards to make sure that the care given has helped the patient sats improve

Describe the standard HIGH FLOW TRACH COLLAR set up from the wall

Flow meter, nebulizer, sterile water, large bore tubing, trach collar

List necessary supplies you would need to stock in the room and/ or require for trach care

obturator

2 extra trachs that consists of one a size down and one cuffed

extra split gauze

inner cannulas

ambu bag

sterile water

trach ties

hydrogen peroxide

Please List the items indicated by the acronym BOSSY

B- bag

O- obturator

S- Supplies

S- Suction

Y- Yaunker/ Y connector for the wall

What does A&A stand for?

Albuterol and atrovent

What are the doses for A&A?

2.5mg in .5cc

.5mg in 2.5cc

What device is this single dose typically delivered in (one package each of A&A)

SVN

What is the normal lpm range of SVN?

8-10lpm

how many CC’s does a SVN hold?

3-5cc’s

How long sould a SVN last?

10mins

What is the side effects of mucomyst?

bronchospasm

which secondary medications should mucomyst be given with?

bronchodilator such as albuterol and levalbuterol

what is the adult therapeutic range for mucomyst?

600-1000mg

whar is the percent strength of mucomyst?

10% and 20%

If I give 3 cc of 20% Mucomyst, how many mg's is the patient going to receive?

200mgx3ml= 600mg

If I give 6 cc of 10% Mucomyst, how many mg's is the patient going to receive?

100x6= 600mg

What does incentive spirometer treat?

microatelectasis

what does IS prevent?

atelectasis

What is the "paper" called in an IS that you look at to determine your goal

nomogram

What are the demographics to look at on a nomogram?

age, gender, height

How would you instruct a patient to use an IS?

exhale, take a slpw deep breath in while keeping the float inside the middle, hold for 10 seconds then exhale

how ofen would you use an IS?

10x per hour while awake

If the patient cannot achieve at least a certain range of cc/kg of IBW then we should consider another device: what is the range we are looking for? (How many cc/kg of IBW or how many times normal VT)

at least 2-3x VT

at least 10-15cc/kg IBW

which patient usually use a peak expiratory flow meter

asthma

how would you instruct the patient to use a peak flow meter?

Tight seal around the mouthpiece and take a fast forceful exhale

What% of predicted would we consider admission to the hospital or keeping the patient admitted?

<50%

What would be your recommended treatment (medication and dose) and recommended device to deliver (Lpm, total cc, tx duration)?

How much improvement are you looking for post intervention to deem the intervention effective

A&A 10mg of albuterol and 1mg of atrovent in an LVN with 25-30cc’s 5-6 lpm for an hour

20% improvement

Your patient had a predicted of 500 with an actual of 175: what is the % predicted?

175/500=x/100= 35%

A patient with 35% predicted on a PEF what are some further recommendations?

systemic steroids

What is the tank factor for H tank?

3.14

what is the tank factor for E cyl?

.28

What is the calculation to determine a patients normal PaCO2?

HCO3/ .6

What is the calculation to determine desired or targeted VT?

(PaCO2)(VT)= CO2(VT)

What is the calculation to “fix” oxygenation?

PaO2/ FIO2 = PaO2’ / FiO2’

What is another way to fix oxygenation?

PEEP

When would you use the secondary oxygenation tool?

If the patient has refractory hypoxemia/ Fio2 is at 60%

You are called to the PACU (Post-Anesthesia Care Unit/recovery room) asses to initiate 02 therapy on a post op patient who is desaturating and is also experiencing nausea and vomiting. When you arrive, the nurse has attempted to place the patient on a 3L NC, however sats remain in in the 80's. she states that the patient is mouth breathing and asks if you can place the patient on a 3L Simple mask?

Which device would you initiate for this patient based on the above information?

Face tent

Why would you recommend a face tent for this patient?

it will let the patient be able to vomit if needed without anything blocking (a vomit reservoir)

Is a face tent considered a high flow or low flow device?

high flow

What liter flow should you run a face tent on?

check the device

Duration of the cool mist intervention?

until stridor improves

what FiO₂ range is a face tent capable of delivering?

check the device correlate the FiO2 with the liter flow

how do you set up a face tent

from the fall, flow meter, nebulizer with sterile water, large bore tubing, face tent

In what situations should a flutter valve be recommended?

when the patient has difficulty breaking up their secretions

how should you instruct the patient to use a flutter valve

tight seal around the mouthpiece, exhale till you hear a flutter and repeat 10x an hour every hour

liter range for nasal cannula

1-6lpm

Fio2 range for nasal cannula

24-44%

is a nasal cannula low flow or high flow?

low flow

to add humidity you would add a what to the patient set up?

bubbler

When a patient is wearing an NC this device is set at what liter flow or more to humidify?

3 lpm

what is the liter flow for a simple mask?

5-10lpm

at is the FiO2 range for a simple mask?

40-60%

is a simple mask a high flow or low flow device?

low flow

how could you tell that a mask is a non rebreather?

the one way valve

what is the liter flow for a nonrebrether?

10-15lpm with the bag 2/3 full and the end of inhalation

what is the FiO2 range for a non rebreather?

80-100%

is a nonrebreather a high flow or low flow device?

low flow

Can you titrate the O2 down on a non-rebreather while still utilizing the device?

yes just remove the oneway valve

you should set and chart the following three parameters of a heathed high flow?

Flow

FiO2

Temp

How do you. know that a mask is a partial rebreather?

its missing the one way valve

what is the liter flow range for NRB or PRBdevice?

10-15lpm with bag 2/3 full at end of inhalation

what is the FiO2 range for a partial rebreather mask?

60-80%

You have a patient presenting to the ED with mild stridor, what are your recommendations for this patient? What is the device, LPM and duration of the intervention

cool mist with an aerosol mask and putting the liter flow on whatever is on the device

List all of the equipment you would need to gather for an aresol mask and the order it should be set up in starting at the wall

flow meter, nebulizer with steril water, large bore tubing, areosol mask

You have initiated your suggested intervention however now the patient is presenting with moderate stridor. What are your new recommendations for this patient?

Racemic epinrphrine 2.25% 11.25mg/.05cc

List everything you will need to initiate this intervention. Device and/or medication (dosage), LPM, mL, and duration of the intervention

T piece, separate flow meter O2 tubing with aerosol mask set up. racemic Epi 11.25mg/ 0.5cc with normal saline 3-5cc’s in a SVN for 10 minutes

What should you do immediately upon entering the room?

foam and glove

introduction

2 pt identifier

HR normal range

60-100bpm

RR normal range

12-20 bpm

BP normal range

120/80

Temp normal range

98.6ºF or 37ºC

SpO2 normal range

Greather than or equal to 94%

COPD: 88-92%

This should be administered to the patient with the addition of a what for optimal particle deposition?

a Spacer

with a new inhaler you must _________ prior to use

Prior to each subsequent uses the therapist or patient should do what before using?

Prime

shake the device

how would you instruct a patient to use a MDI

attach the spacer, exhale, make a tight seal around the mouthpiece, actuate the inhaler, take a slow deep breath in, hold for 5-10 seconds then exhale

How would you instruct a patient to use a DPI

Exhale, make a tight seal around the mouthpiece, take a fast deep breath in, hold for 5-10 seconds, then exhale

hat should you instruct a patient to do after using a DPI?

Rinse their mouth to prevent oral thrush

How many cc’s/ ml does a SVN hold?

3-5cc

you should run a SVN at what flow rate

8-10lpm

how would you instruct a patient to use a SVN with a mouthpiece?

Tight seal around the mouth piece, breather normally while taking deep breaths occasionally

how long should SVN run?

about 10 minutes

How will you know that a SVN is done?

when it spits and sputters

What is the FiO2 range of a venti mask?

24-50%

What Liter flow should this device be run at/How do you determine LPM to set when initiating this type of O2 therpay?

Look at the adapter to determine desired FiO2

Sodium

135-145

Chloride

95-105

Potassium

3.5-5.0

Calcium

4.5-5.4

In what instances would you suggest ordering electrolytes?

Muscle weakness, tachycardia, or abnormal EKG

proper compression to breath ratio

30:2

With an advance airay what is the compression range?

100-120

1 breath every ____ seconds

6 seconds

Epi dose

1mg

how often to give epi?

every 3-5mins

What is the max dose for epi

ulimited

Amnio first dose?

300mg

2nd dose of amnio

150mg

propor compression depth

2in

List of shockable rhythms

Vfib and Vtach

Non shochable rhythms

PEA and asystole