RCP 143 – Clinical Practice II Final Exam Flashcards

Arterial Blood Gases (ABGs)

• Acid-Base Status Interpretation:
    - Determine the primary status as either Respiratory or Metabolic.
    - Identify the state of Acidosis vs. Alkalosis.

• Compensation Identification:
    - Uncompensated: The pH is outside the normal range; one component ($PaCO_2$ or $HCO_3^-$) is abnormal while the other remains within normal limits.
    - Partial Compensation: The pH is outside the normal range; both $PaCO_2$ and $HCO_3^-$ are abnormal and moving in the same direction to balance one another.
    - Full Compensation: The pH has returned to the normal range ($7.35$ to $7.45$), but both $PaCO_2$ and $HCO_3^-$ remain abnormal.

• Oxygenation Evaluation:
    - Interpret the Partial Pressure of Oxygen ($PaO_2$) to assess the severity of hypoxemia or the adequacy of oxygenation.

• Clinical Application: Ability to apply ABG data to specific patient scenarios to determine necessary interventions.

Ventilation and Oxygenation Concepts

• Respiratory States:
    - Hypoventilation: Characterized by an increase in $PaCO_2$ (hypercapnia) and a corresponding decrease in pH (respiratory acidosis).
    - Hyperventilation: Characterized by a decrease in $PaCO_2$ (hypocapnia) and a corresponding increase in pH (respiratory alkalosis).

• Respiratory Volumetric Definitions:
    - Minute Ventilation ($\dot{V}_E$): The total volume of air inspired and expired per minute.
    - Alveolar Ventilation ($\dot{V}_A$): The volume of air reaching the gas-exchange surfaces (alveoli) per minute.
    - Dead Space ($V_D$): The portion of tidal volume that does not participate in gas exchange.

• Calculations and Formulas:
    - Minute Ventilation: $\dot{V}_E = V_T \times f$
    - Alveolar Ventilation: $\dot{V}_A = (V_T - V_D) \times f$
    - Rapid Shallow Breathing Index (RSBI): $RSBI = \frac{f}{V_T}$ (where $V_T$ is measured in liters).

• Weaning Parameters: Evaluation of Negative Inspiratory Force (NIF) and other metrics required to assess potential for extubation or weaning from mechanical support.

Oxygen Therapy and Delivery Devices

• System Classification:
    - Low-Flow Systems: Devices that do not meet the patient's full inspiratory flow needs (e.g., nasal cannula, simple mask).
    - High-Flow Systems: Devices designed to meet or exceed the patient's inspiratory flow demands, providing precise concentrations (e.g., Venturi mask, high-flow nasal cannula).

• Indications: Choosing appropriate O2 delivery systems based on patient clinical status and saturation goals.

• Troubleshooting: Identifying and resolving equipment malfunctions, such as leaks or flow obstructions.

• COPD Considerations: Managing oxygen therapy in COPD patients with an emphasis on preventing the suppression of the hypoxic drive or oxygen-induced hypercapnia.

Airway Management

• Airway Adjuncts: Proper selection and use of Oropharyngeal Airways (OPA) and Nasopharyngeal Airways (NPA).

• Intubation: Understanding the basic procedure, preparation, and necessary equipment (laryngoscopes, endotracheal tubes, stylets).

• Emergencies: Recognizing and managing acute airway crises.

• Complications:
    - Vagal Response: Monitoring for bradycardia and other autonomic responses during airway manipulation or suctioning.
    - Cuff Pressure: Managing ETT cuff pressures to ensure a seal while preventing tracheal wall ischemia or damage.

Mechanical Ventilation and IPPB

• Ventilator Parameters: Understanding triggering mechanisms, sensitivity settings, flow rates, and pressure limits.

• Compliance Assessment: Recognizing and differentiating changes in static and dynamic lung compliance and their impacts on pressures.

• Intermittent Positive Pressure Breathing (IPPB):
    - Functional understanding of the IPPB unit.
    - Troubleshooting common clinical issues during treatment (e.g., failure to cycle, leaks).

Humidity and Aerosol Therapy

• Purpose: Providing moisture to the respiratory tract to maintain the mucociliary escalator and prevent secretion thickening.

• Equipment: Identifying and using different device types (e.g., bubble humidifiers, heated humidifiers, Passover humidifiers).

• Aerosol Principles: Understanding deposition, particle size ($1$ to $5\,\mu m$ for lower airway), and delivery mechanics.

• Infection Control: Applying rigorous hygiene and maintenance standards to avoid contamination of therapy delivery systems.

Secretion Management and Airway Clearance

• Techniques:
    - Chest Physiotherapy (CPT): Percussion and vibration.
    - Postural Drainage: Utilizing gravity-assisted positions to mobilize secretions.
    - Incentive Spirometry (IS): Improving lung expansion to prevent atelectasis.
    - Positive Expiratory Pressure (PEP): Using resistance to maintain airway patency and facilitate clearance.

• Sign Identification: Recognizing signs of respiratory infection, such as changes in sputum color, consistency, or volume.

Patient Assessment and Clinical Signs

• Breathing Patterns: Identifying abnormalities such as tachypnea, bradypnea, Kussmaul, or Cheyne-Stokes respiration.

• Physical Findings: Utilizing inspection, palpation, percussion, and auscultation at the bedside.

• Orientation and LOC: Assessing Level of Consciousness and neurological orientation (Person, Place, Time).

• Laboratory Values: Interpreting non-ABG lab data critical for respiratory care management.

Emergency and Critical Care Scenarios

• Specific Emergencies:
    - Managing airways in cases of drug overdose (potential respiratory depression).
    - Managing airways in trauma scenarios (potential spinal or facial injuries).

• Hypoxemia: Rapid recognition of clinical signs and immediate corrective actions.

• Equipment Failure: Responding to ventilator or oxygen system malfunctions in high-stakes environments.

Safety, Troubleshooting, and Equipment Maintenance

• Oxygen Cylinder Duration Calculation: $\text{Duration (min)} = \frac{\text{Pressure (psig)} \times \text{Cylinder Factor}}{\text{Flow (L/min)}}$

• Quality Control: Identifying leaks and mechanical malfunctions in various respiratory therapy equipment.

• Documentation: Applying correct techniques for medical recording, including the proper method for correcting errors (e.g., single line through the error and initialing).

Pharmacology

• Drug Classifications:
    - Bronchodilators: Specifically Beta-agonists for relaxation of airway smooth muscle.
    - Anticholinergics: Often used for larger airway bronchodilation.
    - Mucolytics: Agents used to thin and facilitate the removal of thick secretions.

• Usage: Knowing the indications and basic clinical application of each respiratory drug class.

Clinical Judgment and Prioritization

• Decision Making: Selecting the most appropriate first-line intervention in a clinical scenario.

• Urgency: Recognizing which clinical findings require immediate action vs. monitoring.

• Bedside Thinking: Integrating all physiological and equipment data to make safe and effective patient-care decisions.

• Type I Surfactant:
  • Acts as a high-resistance (HR) vasodilator, helping to regulate pulmonary blood flow.
  • Comprises flattened epithelial cells that provide structural support to the alveoli but do not produce surfactant.
• Type II Surfactant:
  • Contains surfactant proteins and is responsible for the production and secretion of pulmonary surfactant.
  • Functions include decreasing surface tension in the alveoli, preventing collapse during exhalation, and aiding in the repair of damaged alveolar epithelium.
• Type III Macrophages:
  • Not focused on gas exchange or surfactant production but may exhibit vasoconstrictive properties, regulating pulmonary blood flow in response to local conditions.
  • Involved in the immune response by phagocytizing pathogens, secreting cytokines, and facilitating the clearance of debris in the lungs.