Lab Midterm Practicum

What 2 Factors Determine the Actual FiO2 Delivered to the Patient?

1. Flow

2. Patient’s Minute Ventilation

What 2 Devices are the Best for COPD Patients?

1. Nasal Cannula (2 LPM)

2. Venturi Mask (28%)

Misty Neb

Breath Enhanced

Aero-Eclipse "‘Mushroom Cap’

Breath Actuated

IsoNeb or Respirgard II

Continuous Flow and Filtered Neb

Used for Pentamidine

Pentamidine

Used for the Treatment of Pneumocystis Jiroveci Pneumonia

Must Pretreat Patient with a Bronchodilator Before Treatment

Standard Acorn Neb

Continuous/Jet Neb

Pari Nebulizer

Breath Enhanced

Used for Tobi and Dornase Alfa

Brovana

Generic: Arformoterol

LABA

Dosage: 15 mcg/2 mL

Frequency: BID

Used for Asthma and COPD

Racemic Epinephrine

Alpha-1 Adrenergic

Dosage: 11.25 mg

Frequency: Every 3-4 Hours

Used for Stridor/Croup

DuoNeb

Generic: Ipratropium and Albuterol

SAMA and SABA

Frequency: QID

Dosage: 0.5mg/3mg

Indication: Asthma and COPD

What Must a Patient be Instructed to Do After Any Treatments?

Cough

What Technique Must be Used to Deliver a Neb treatment to an Infant?

Blow Buy

What Tests are Run to Confirm a Pneumonia Diagnosis?

1. Sputum Culture

2. CBC w/ Differential

3. Culture and Sensitivity

What are the Side Effects of Albuterol?

1. Tachycardia

2. Tremors

What is a Side Effect of Ipratropium?

Dried Out Secretions

Formula to Calculate Oxygen Content (CaO2)

(1.34 x Hb x SaO2) + (PaO2 × 0.003)

Polycythemia

High Hb Levels

Normal Range of Hemoglobin

12 - 16 mEq/L

What Conditions Can Cause Polycythemia?

1. Chronic Hypoxemia

2. Severe Emphysema or Bronchitis

3. Bronchiectasis

4. CF

5. Congenital Heart Defect

Atrovent

Generic: Ipratropium

Dose: 0.5 mg/vial

SAMA or Anticholinergic

Frequency: QID

Indication: Asthma and COPD

Nebulizer with Misty Neb

Estimated Inspiratory Flow

3 x VE

Formula for Total Flow

(Sum of Ratio) x Flow

Use “Magic Box”

N-Acetylcysteine

Brand: Mucomyst

Class: Mucolytic

Dose: 20% - 3-5 mL

Frequency: TID or QID

Indication: Thick Secretions

• Must Pretreat w/ Bronchodilator

What is the Target I:E (Inspiratory-to-Expiratory) Ratio for Most PEP Devices

1:3 or 1:4 cmH20

What Do you Do if the Patient is Breathing Above the 1:4 Ratio with a PEP Device?

Increase the Resistance

What Do you Do if the Patient is Breathing Below the 1:3 Ratio with a PEP Device?

Decrease the Resistance

What is the Target Expiratory Pressure During Most PEP Therapy?

10 to 20 cmH2O

What Interfaces can be Used with PEP Therapy?

1. Ambu Mask

2. Mouthpieces

3. Trach Interfaces

Which 2 PEP Device Cannot be Used In-Line with Nebulizers?

1. AerbiKa

2. Incentive Spirometry

What is the Normal Set Up for a Nebulizer?

1. Place on Room air (FiO2 = 21%)

2. Flow set to 6-8 LPM

Do Pediatric Patients Need a ‘Bubbler’/Humification When Receiving O2 via Nasal Cannula?

Yes

When Do Adult Patient Require a ‘Bubbler’ with a Nasal Cannula?

When the Flow is at or Above 4 LPM

FiO2 Range for Nasal Cannula

24 - 44%

Adult Flow Range for Nasal Cannula?

1 - 6 LPM

Infant Flow Range for Nasal Cannula

0.25 - 2 LPM

Children’s Flow Range for Nasal Cannula

up to 3 LPM

FiO2 Range for Simple Mask

35 - 50%

Flow Range for Simple Mask

5 - 10 LPM

Does a PRBM Mask have Any Valves?

No

What is the Minimum Flow Required for a PRBM to Prevent Rebreathing?

Minimum Flow of 6 LPM

FiO2 Range for PRBM

40 - 70%

Flow Range for PRBM

8 - 15 LPM

For Both the PRBM and the NRBM, What Must the RT make Sure of Before Placing Mask on the Patient?

Make Sure Reservoir Bag is 2/3s Inflated

How Many One-Way Valves Does a NRBM Have?

2

How Does a One-Way Valve Work?

Only Allows Air to Flow in One Direction and Automatically Closes to Prevent Backflow

FiO2 Range for Open Oxygen Mask

24 - 90%

Flow Range for Open Oxygen Mask

1 - 15 LPM

What System Does a Open Oxygen Mask Use to Deliver Oxygen?

Pin and Diffuser System

Redistributes Flow of O2 and Creates a Mushroom Cloud of Concentrated O2

Why does an Open Oxygen Mask Have Large Openings?

To Allow for Flushing of CO2

Flow Range for Reservoir Nasal Cannula

1 - 12 LPM

What is Another Name for an Air-Entrainment Mask?

Venturi Mask

Types of High Flow Devices

1. Venturi Mask

2. Aerosol Face Mask

3. ATT or ATC

4. Aerosol Face Tent

What are the Advantages to Using a High Flow Device?

1. Can Deliver a Precise FiO2 at High Flow Rates

2. Is Able to Meet a Patient’s Inspiratory Flow Demand

3. Can be Used in Patients with a Highly Variable Respiratory Pattern

Characteristics of Low Flow Delivery Devices

1. Delivery Devices Include Reservoirs

2. Output Does Not Meet Patient’s Total Inspiratory Flow Demand

3. Cannot Guarantee a Precise FiO2

Types of Low Flow Delivery Devices

1. Nasal Cannula

2. Transtracheal catheter

3. Simple Mask

4. Partial Rebreathing Mask (PRBM)

5. Non-Rebreathing Mask (NRBM)

6. Open O2 Mask

FiO2 Range of Venturi Masks

24 - 50%

Flow Range of Venturi Mask

4 - 15 LPM

Based on Manufacturer Recommendation

FiO2 Range of Aerosol Face Mask

24 - 100%

Flow Range for Aerosol Face Mask

O2 Flow Setting Per Manufacturer Guideline

Used Large Volume Nebulizer

Large Volume Nebulizer

FiO2 Range for ATT/ATC

21 -100%

Use Air Flowmeter to Achieve 21%

FiO2 Range for Aerosol Face Tent

21 - 40%

Use Air Flowmeter to Achieve 21%

FiO2 Range for Aerosol T-Piece (ATP)

21 - 100%

Use Air Flowmeter to Achieve 21%

What Should Do Prior to Administering a New MDI?

Prime MDI

Shake and Spray 4 Times Before Use

Requirements of DPIs

1. Requires Patient Cooperation

2. Minimum Inspiratory Flow of > 40 - 60 LPM

Vacuum Pressure Required for Suction of Adult Patient

< 150 mmHg

Vacuum Pressure Required for Suction of Child Patient

< 120 mmHg

Vacuum Pressure Required for Suction of Infant Patient

-80 mmHg - (-100)

What Flow Should the Ambu Bag/ Resuscitation Bag be Set to Prior to Suctioning?

15 LPM

How to Calculate Catheter Size for Suctioning?

(Size of Trach on Box - 1) x 2

How Long Should You Preoxygenate a Patient Prior to Suctioning?

30 Seconds to 1 Minute

How Long Should Each Round of Suctioning Be?

No Longer than 15 Seconds

What Sats Should You Monitor When Suctioning to Monitor for Adverse Reactions?

1. VS

2. SpO2

3. ECG

Supplies Needed to Suction a Patient

1. Sterile Suction Catheter Kit

2. Resuscitation Bag

3. Luken’s Trap *If Sample is Needed

How Long Do You Need to Reoxygenate a Patient Inbetween Suctioning Rounds?

1 Minute

What Type of Trach Do You Need to Use For Use of a Speaking Valve?

Fenestrated

When Placing a Fenestrated Trach, What Test Should Be Performed to Check Placement or Obstruction?

1. Place Finger on Trach Opening and Feel for Resistance

Atelectasis

Pneumonia

Bilateral Pneumonia

Air Bronchograms

• Indicates:

  • Pneumonia

  • Pulmonary Hemorrhage

  • Pulmonary Edema

Honeycombing

Pulmonary Mass

Emphysema

Pneumothorax

Pneumothorax