CPI Review SP25

tachycardia

greater than 100 bpm

bradycardia

less than 60 bpm

normal heart rate

60-100 bpm

Hypotension

systolic arterial pressure less than 90 mmhg, MAP less than 65mmHg, decrease in systolic pressure greater than 40mmHg from baseline

Hypertension

blood pressure consistently greater than 140/90 mmHg

Fluid Overload due to CHF

CVP greater than 6mmHg, PCWP greater than 18mmHg

Normal Blood Pressure

120/80

The types of lung diseases or conditions that can be associated with wheezing

Asthma, CHF (COPD), bronchitis, & emphysema

Cardiac Angina (pain)

pain in the chest, neck, back, or arms, lightheadedness, abnormal heartbeat, anxiety

Capillary refill

pressing firmly on the patient’s fingernail until the nail bed is blanched and then releasing the pressure

Peripheral Skin Temperature

causes extremities to be cool to touch

DISS

inlets of blenders, flowmeters, ventilators, and other pneumatic equipment

What safety system is this?

Diameter Index Safety System

PISS

Applies only to the valve outlets of small cylinders including size E

What safety system is this?

Pin Index Safety System

American Standard Safety System

standards for threaded high-pressure connections between large compressed gas cylinders (sizes through H/K)

What is this flowmeter called?

Bourdon Gauge

Fixed Orifice

operate under variable pressures as the pressure reducing valve adjust

What is G?

Gas Inlet Connector

What is A?

pressure indicator gear

Overall Goal of Oxygen Therapy

maintain adequate tissue oxygenation while minimizinf cardiopulmonary work

What kind of mask is this?

Air Entrainment Mask

Three Objectives of Oxygen Therapy

Correct documented or suspected acute hypoxemia, decrease symptoms associated with chronic hypoxemia, decrease the workload hypoxemia imposes on the cardiopulmonary system

When would you use a nasal cannula?

Patient in stable conditions who needs low FiO2

When would you use a nasal cannula?

home care patient who needs long-term therapy

When would you use a nasal cannula?

low to moderate FiO2 while eating

When would you use an air entrainment mask?

patients in unstable contion who needs precise low FiO2

When would you use a facemask?

emergencies, short-term therapy requiring moderate FiO2

When would you use a facemask?

mouth-breathing patients requiring moderate FiO2

Which oxygen device uses precise FiO2?

Air Entrainment Mask

Describe how to measure BP & determine the sound heard when ausculataing a BP.

Simple mechanical manometers

List the criteria (sputum) for diagnosis of chronic bronchitis.

mucoid — clear, thin, frothy

mucopurulent — (yellow, green, viscid, smelly thick — both mucoid & purulent [pus])

Describe the conditions that respond well to low-to-moderate O2 concentrations.

acute exacerbation of COPD, Emphysema, Chronic Bronchitis, Drug OD w/o aspiration, Neuromuscular disease, & Post-op patients w/ normal lungs

Determine which oxygen device is least affected by RR, VT, or ventilatory pattern.

any high flow device

• AEM (venturi mask)

• air-entrainment nebs

• HFNC

• AirVO2, Precision flow, Max Venturi.

Describe x-ray changes that are consistent with various disease states. For example what will cause an increase in A-P diameter on the chest.

Identify & explain the stages in a regulator & describe or identify a pressure relief valve & safety systems of a regulator.

Identify the early signs of hypoxia.

The initial symptoms of hypoxia may include shortness of breath, confusion, rapid heart rate, and cyanosis. These signs indicate inadequate oxygen delivery to tissues.

Describe how to choose an oxygen delivery device to deliver pre-mixed heliox

Clark’s oxygen analyzer

measure oxygen levels in liquids (%O2)

Galvanic’s oxygen analyzer

oxidation occurs in the anode & electrode where reduction occurs in the cathode (electrical energy)

Calculate & describe relative humidity of a gas.

(content / capacity) x 100

Calculate & describe absolute humidity of a gas.

(temperature) x (% saturation) or (mass of water vapor / volume of air)

Respiratory Acidosis / Alkalosis

Acidosis: pH < 7.35, PaCO2 > 45

Alkalosis: pH > 7.45, PaCO2 < 35

Metabolic Acidosis / Alkalosis

Acidosis: pH < 7.35, HCO3 < 22

Alkalosis: pH > 7.45, HCO3 > 26

Combined Acidosis / Alkalosis

Acidosis: pH < 7.35, HCO3 < 22, PaCO2 > 45

Alkalosis: pH > 7.45, HCO3 > 26, PaCO2 < 35

Hyperoxemia

Adults > 100

Newborn > 90

Mild hypoxemia

Adults 60 - 79

Newborn 50 - 59

Moderate hypoxemia

Adults 45 - 59

Newborn 40 - 49

Severe hypoxemia

Adults < 45 Newborn < 40

Troubleshoot a bubble-diffusion humidifier.

Troubleshoot a non-rebreather

increase the flow if the bag begins to deflate

Troubleshoot a partial rebreather mask

Troubleshoot a T-piece specifically when the mist disappears.

Explain the difference between a compensated and uncompensated flow meter (Thorpe tube)

A compensated flow meter’s density remains constant regardless of any backpressure after the needle valve, while an uncompensated flow meter’s accuracy is affected by changes in backpressure invalidating flow scale making readings less than the actual flow.

Determine the indication for using a bourdon gauge.

Determine what oxygen device to use for a COPD patient.

Describe the indications & functions of a bubble humidifier.

Explain all principles of aerosol particle generation.

Describe the indication, contraindication, hazards associated with the ultrasonic nebulizer.

Demonstrate & troubleshoot an ultrasonic nebulizer.

Explain & troubleshoot the use of a LVN to medicate & mobilize secretions.

Explain & troubleshoot the use of a SVN to medicate & mobilize secretions.

State the indications & contraindications of aerosol therapy.

Aerosol therapy hazards

Devices used for aerosol therapy

Calculate drug dilutions, e.g. translate 1:500 to mg/cc, understand % solutions, translate from medication dosage (2.5 mg albuterol in 3 ml diluent to 1:100 or other ratio)

1000g/ 500mL = 2mg

Calculate absolute humidity of a gas at 37 degrees and fully saturated with water vapor, and a gas that is 60% saturated with water vapor.

(Temperature) x (% Saturation)

37 × 0.60 = 22.2 mg/L

Calculate the humidity deficit given the absolute humidity.

BH (%)= (content [mg/L] / 43.8) x 100

Content (mg/L)= absolute humidity

Calculate cylinder duration for E and H cylinders.

H= 3.14 E= 0.28

Cylinder duration (min)= [(cylinder pressure (psig) x (conversion factor)] / flow (L/min)

• Full = 2200

• Half = 1100

• Take down to 500 = cylinder pressure - 500

Dilute a solution for example dilute 4 cc of an 8% mucomyst to a 4% solution. How ml of mucomyst would you need and how many ml of saline would you need?

• % strength (decimals)= [(dilute solute) x (% strength of solution)] / total amt (solution)

• Raul’s Way= x (0.08) = (4cc) (0.04) = 2ml

Recognize the body humidity a bubble humidifier will produce.

Identify the doses of all respiratory medications, the classification of the medications drug & explain how each classification of medication works.

IS indications

atelectasis, secretions, presence of conditions disposing to atelectasis, patients who can follow instructions & repeat demonstrations to the RT.

IS contraindications

untreated pneumothorax, elevated ICP, hemodynamic instability, patient inability to take a deep breath or cooperate, active hemoptysis

Goal for IS

patient must be achieving 1/3 of predicted volume (based on age, height, & gender)

• ONLY hyperinflation

Indication for a USN

Conditions or procedures that may be associated with development of micro-atelectasis

Identify the different type of oxygen flowmeters & explain when you would use them under various circumstances (such as horizontally placed E-cylinder)

Cold & heated aerosol delivery by mask indications

• Post extubation edema: Tx with cool air LVN

• Croup baby: Tx with cool air

• Post-op management of upper airway

• Upper airway edema

• Mobilizations of secretions

Cold & heated aerosol delivery by mask contraindications

• Untreated pneumothorax causing a stop in Tx

• Thick, copious or bloody secretions

• VE > 10 L/m

• Expired VT < 70% of delivered VT

• Body temp < 89.6 F (32 C)

• NO ABSOLUTE CONTRAINDICATIONS

Cold & heated aerosol delivery by mask hazards

• Nosocomial infections

• Elevated airway pressures

• Pooled condensation in patient circuit

• Hyperthermia

• Tubing meltdown

• Electrical shock

Recognize condensation in the corrugated tubing when setting up an aerosol device & what occurs in regards to the FiO2.

increase FiO2 decrease in total flow caused by back pressure

Describe the relationship between a patient’s hydration level and delivery of aerosol or ultrasonic nebulizer therapy.

Indications of all types of aerosol therapy.

induce cough, inflammation, infection, oxygen therapy w NC @ least 4 LPM

Contraindications of all types of aerosol therapy.

no relative or absolute contraindications

Hazards of all types of aerosol therapy.

bronchospasm, overhydration, aspiration of condensation, infection/contamination due to water especially with trach

IPPB Indications

presence of atelectasis or secretion retention, if 1/3 of IS is not reached or EzPAP/AccuPAP not successful, pneumonia, COPD, bronchiectasis

IPPB absolute contraindication

untreated tension pneumothorax

IPPB relative contraindications

ICP > 20, hemoptysis, Active TB, vomiting/nausea, hemodynamically instability, flail chest, spinal cord injury, facial trauma

Determine the role for each knob on the IPPB such as terminal flow, flowrate, pressure, sensitivity.

Determine hyperventilation with IPPB.

Troubleshoot the IPPB machine. For example a patient is not able to trigger the machine on, cycle the machine off, inspiratory time is very long.

Given a patient scenario and various volumes achieved by a patient using an IS, determine the effectiveness.

Evaluate the patient's lung expansion and inspiratory efforts to ascertain the effectiveness of the Incentive Spirometry (IS) based on achieved volumes.

IS indications

presence of atelectasis, restrictive lung diseases, pre/post abdominal/thoracic surgery, & neuromuscular patients

IS contraindications

untreated tension pneumothorax, unable to take instructions, obtunded/unconscious, uncoordinated, & cannot pull 1/3 of predicted value

IS hazards

hyperventilation & respiratory alkalosis, discomfort, pulmonary barotrauma, bronchospasm, & fatigue

Characteristics of IPPB

intermittent positive pressure breathing

• specialized form of NIV used in short treatment periods (ab. 15 mins) to achieve deep breath through positive pressure assisted breaths

Setting when using wall vacuum for suctioning adults & children

adults < 200 mmHg

children & infants < 120 mmHg

Indications of NT suctioning

to clear secretions, relieve airway obstruction, or obtain a specimen for diagnostic purposes

NT suctioning contraindications