Chapter38MedicalGasTherapyAnswerKey.doc

Mosby items and derived items 2009 by Mosby Inc an affiliate of Elsevier Inc Wilkins Egan s Fundamentals of Respiratory Care 9th Edition Chapter 38 Medical Gas Therapy Answer Key to Workbook for Egan s Fundamentals of Respiratory Care WORD WIZARD 1 cannula 2 reservoir 3 lassitude 4 diaphragmatic 5 retinopathy 6 hypoxemia 7 toxicity 8 infarction 9 dysplasia 10 pendant 11 concentration 12 entrainment 13 wye TANK JOCKEYS AND GAS PASSERS 14 Reference page 868 Hypoxemia is a decreased level of oxygen in the blood Acute means sudden Answer Key to Workbook for Egan s Fundamentals of Respiratory Care Mosby items and derived items 2009 by Mosby Inc an affiliate of Elsevier Inc 38 2 15 Reference page 869 1 PaO2 60 mm Hg 2 SaO2 90 16 Reference page 868 A COPD and interstitial disease O2 decreases dyspnea and cardiac workload B Chronic hypoxemia O2 improves mental function decreases pulmonary vascular resistance which decreases right ventricular workload 17 Reference page 868 A Increased ventilation faster rate and increased depth B Increased cardiac output faster heart rate increased stroke volume increased CO 18 Reference page 868 Myocardial infarction because the heart is stressed or damaged it is especially important to reduce workload 19 Reference page 868 Alveolar hypoxemia causes vasoconstriction of pulmonary vessels If prolonged this results in pulmonary hypertension increased work of the right heart and eventually cor pulmonale or right heart failure 20 Reference page 868 A laboratory evidence B patient s specific condition or problem C bedside assessment Answer Key to Workbook for Egan s Fundamentals of Respiratory Care Mosby items and derived items 2009 by Mosby Inc an affiliate of Elsevier Inc 38 3 21 Reference page 868 A carbon monoxide poisoning B cyanide poisoning C shock D trauma E acute myocardial infarction F postoperative patients 22 Reference page 870 SYSTEMMILD TO MODERATESEVERE TachypneaTachypneaA Respiratory DyspneaDyspnea TachycardiaTachycardia then bradycardia B Cardiovascular Mild hypertensionHypertension then hypotension RestlessnessSomnolenceC Neurologic DisorientationConfusion OXYGEN THERAPY RISKS Toxic Talk 23 Reference page 870 Answer Key to Workbook for Egan s Fundamentals of Respiratory Care Mosby items and derived items 2009 by Mosby Inc an affiliate of Elsevier Inc 38 4 A lungs B CNS 24 Reference page 870 A PO2 B exposure time 25 Reference pages 870 871 Tracheobronchitis and substernal chest pain develop during the first 12 hours Next vital capacity and lung compliance begin to decrease 12 to 30 hours A state similar to bronchopneumonia develops The alveoli and capillaries are damaged resulting in interstitial edema Type I cells are destroyed In the end stages hyaline membranes form then pulmonary fibrosis and hypertension develop 26 Reference page 871 Box 38 2 High FIO2 causes O2 toxicity which causes shunting which results in lower PO2 levels which require higher FIO2 levels for treatment 27 Reference page 871 Rule of Thumb Limit exposure to 100 oxygen to less than 24 hours whenever possible High FIO2 levels are acceptable if the concentration can be lowered to 70 within 2 days and 50 within 5 days 28 Reference page 871 never I Feel Depressed Answer Key to Workbook for Egan s Fundamentals of Respiratory Care Mosby items and derived items 2009 by Mosby Inc an affiliate of Elsevier Inc 38 5 29 Reference page 871 A small percentage of severe COPD patients with carbon dioxide retention tend to ventilate less when exposed to moderate to high levels of oxygen 30 Reference page 871 A Suppression of peripheral receptor drive to breathe increases CO2 B High oxygen levels may cause an increase in mismatch with an increased deadspace to tidal volume ratio and an increased CO2 31 Reference page 871 Never RLF or ROP It s All the Same to Me 32 Reference page 871 Oxygen causes retinal vasoconstriction and vascular necrosis New blood vessels form and cause hemorrhages and scarring which if severe leads to retinal detachment and blindness 33 Reference page 871 premature infants and neonates up to 1 month 34 Reference page 872 Maintain PO2 levels less than 80 mm Hg Minimize other factors such as acidosis Absorbing Information 35 Reference page 872 FIO2 levels above 0 50 cause atelectasis by washing nitrogen out of poorly ventilated units The oxygen diffuses into the blood and the alveoli collapse Answer Key to Workbook for Egan s Fundamentals of Respiratory Care Mosby items and derived items 2009 by Mosby Inc an affiliate of Elsevier Inc 38 6 36 Reference page 872 patients with low tidal volumes due to sedation surgical pain or CNS dysfunction Answer Key to Workbook for Egan s Fundamentals of Respiratory Care Mosby items and derived items 2009 by Mosby Inc an affiliate of Elsevier Inc 38 7 37 Reference page 872 Use the lowest FIO2 levels possible while maintaining adequate blood oxygen levels Identify at risk patients Use hyperinflation therapies to avoid or reverse the atelectasis OXYGEN DELIVERY SYSTEMS 38 Reference page 873 A 2 B 3 C 1 LOW FLOW 39 Reference page 873 well tolerated simple easy to use low cost disposable all ages 40 Reference page 873 when flows are greater than 4 L min also with infants and children 41 Reference page 873 2 L min 42 Reference page 874 lowers O2 use and cost Answer Key to Workbook for Egan s Fundamentals of Respiratory Care Mosby items and derived items 2009 by Mosby Inc an affiliate of Elsevier Inc 38 8 43 Reference page 873 Many variables affect the FIO2 delivered by all low flow systems including mouth breathing respiratory rate tidal volume inspiratory flow rates minute ventilation etc 44 Reference page 877 Assess the actual response to the oxygen physical assessment and pulse oximetry or ABGs HR RR and BP go down with good oxygenation The patient reports less dyspnea 45 Reference page 874 A Advantages lower O2 usage and cost increased mobility less discomfort B Disadvantages unattractive cumbersome and affected by pattern poor compliance 46 Reference page 874 the home or ambulatory patients who need increased mobility RESERVOIR 47 Reference Table 38 3 page 874 MASKFIO2 RANGE ADVANTAGEDISADVANTAGE A Simple35 to 50 Cheap easyComfort vomitus B Partial rebreathing 35 to 60 Moderate FIO2See simple mask C Nonrebreathing 55 to 70 High FIO2Suffocation hazard Answer Key to Workbook for Egan s Fundamentals of Respiratory Care Mosby items and derived items 2009 by Mosby Inc an affiliate of Elsevier Inc 38 9 48 Reference page 880 valves particularly between the bag and the mask 49 Reference pages 880 881 The bag does not fully deflate on inspiration 50 Reference page 881 A Restrain patient B Find obstruction omit humidifier C Use another device D Increase flow E Correct leak fix replace mask as needed HIGH FLOW 51 Reference page 881 FACTORINCREASED SIZEDECREASED SIZE A Jet 1 FIO2 2 Flow Increased FIO2 Decreased flow Decreased FIO2 Increased total flow B Port 1 FIO2 2 Flow Decreased FIO2 Increased flow Increased FIO2 Decreased total flow Answer Key to Workbook for Egan s Fundamentals of Respiratory Care Mosby items and derived items 2009 by Mosby Inc an affiliate of Elsevier Inc 38 10 52 Reference page 883 A 0 1 B 1 1 C 3 1 D 5 1 E 8 1 F 25 1 53 Reference page 883 Venti mask or Venturi mask 54 Reference page 883 allows excess flow and patient exhalation to escape 55 Reference pages 883 885 little or no effect 56 Reference pages 883 884 35 or less 57 Reference page 885 increase the input flow 58 Reference page 885 The small jets limit the oxygen flow rates through the device Answer Key to Workbook for Egan s Fundamentals of Respiratory Care Mosby items and derived items 2009 by Mosby Inc an affiliate of Elsevier Inc 38 11 59 Reference page 884 PatientAerosol Delivery Device A Tracheostomy tubeT piece or tracheostomy collar B Endotracheal tubeT piece C Intact upper airwayFace tent aerosol mask 60 Reference page 885 Observe the mist on the expiratory side when the patient inhales Calculate the flow delivered by the device Measure the patient s minute ventilation and multiply by 3 Compare the two values 61 Reference pages 886 887 A Aerosol Gas injection nebulizer B Dry Downs flow generator 62 Reference pages 886 887 Downstream resistance increases the FIO2 and decreases total flow delivered MATHEMATICS 63 Reference page 882 Mini Clini A Step 1 Compute the ratio Formula Liters air 100 O2 Liters O2 O2 21 Calculation 100 60 60 21 40 1 1 39 B Step 2 Add the parts 1 1 2 C Step 3 Multiply the sum of the parts by the O2 flow rate 10 2 20 L min Answer Key to Workbook for Egan s Fundamentals of Respiratory Care Mosby items and derived items 2009 by Mosby Inc an affiliate of Elsevier Inc 38 12 BLENDERS 64 Reference page 888 A Confirm appropriate air and oxygen inlet pressure B Test alarms by disconnecting each gas source C Analyze at 100 21 and one other setting PUT THOSE KIDS IN A TENT 65 Reference page 888 Frequent opening and closing causes wide swings in the FIO2 66 Reference page 888 40 to 50 67 Reference page 888 It only covers the head and leaves the body free for nursing care 68 Reference pages 888 889 7 L min to prevent accumulation of CO2 69 Reference page 889 May generate harmful noise levels and cause addition stress for the infant 70 Reference page 889 Heat loss and cold stress which increase oxygen consumption and may cause apnea 71 Reference page 889 Oxygen hood Answer Key to Workbook for Egan s Fundamentals of Respiratory Care Mosby items and derived items 2009 by Mosby Inc an affiliate of Elsevier Inc 38 13 72 Reference page 889 Helps maintain a neutral thermal environment HYPERBARIC OXYGEN 73 Reference pages 892 893 CHAMBERO2 DELIVERYPATIENTSTAFF A MonoplaceCylinder is filled One onlyOutside B MultiplacePatient wears maskUp to 12Inside 74 Reference page 894 Box 38 6 AcuteChronic A Decompression sicknessEnhanced wound healing B Air or gas embolismRefractory osteomyelitis C Carbon monoxide poisoningRadiation necrosis 75 Reference page 894 Box 38 7 History of unconsciousness presence of neuropsychiatric abnormalities cardiac instability carboxyhemoglobin 25 in adults lower in kids and pregnant women OTHER GASES 76 Reference page 895 A Persistent pulmonary hypertension of the newborn Reference page 898 B Acute airway obstruction of various causes postextubation stridor in pediatric settings and croup Answer Key to Workbook for Egan s Fundamentals of Respiratory Care Mosby items and derived items 2009 by Mosby Inc an affiliate of Elsevier Inc 38 14 77 Reference page 898 Oxygen usually 80 helium 20 oxygen 78 Reference page 897 Its low density 79 Reference page 898 Nonrebreathing mask CASE STUDIES Case 1 80 Borderline saturation for a cardiac patient but meets minimum criteria Tachycardia may indicate cardiac dysfunction and definitely indicates increased cardiovascular work 81 De