# Shared Flashcard Set

## Details

RES120 Study Guide 2nd ver
final exam study guide
103
Health Care
10/17/2008

Term
 Which medical gases support combustion
Definition
 "Helium, Oxygen, Air, Nitrous oxide, Nitric oxide, Heliox (He/O2), CO2, "
Term
 Which gases are nonflammable
Definition
 "nitrogen (N), Helium (He), Carbon dioxide, O2, Air, NO, Heliox (He/O2), CO2"
Term
 How is water content removed from medical air
Definition
 cooling/condensation
Term
 What is DOTC and ICC folowed by on the shoulder of a compressed gas cylinder
Definition
 (Interstate commerce commission) followed by cylinder classification such as 3A or 3AA and normal filling pressure in pounds per square inch
Term
 What is below DOT and ICC on the shoulder of a compressed gas cylinder
Definition
 "letter size of the cylinder (E, G, etc)"
Term
 WHat is on the third line below DOT and ICC on the shoulder of a compressed gas cylinder
Definition
 mark of ownership followed by stamp or mark identifying inspecting authority
Term
 WHat is on the opposite side of a compressed gas cylinder
Definition
 an abbreviation indicating the method of cylinder manufacture and information regarding the original safety test and dates of all subsequent tests
Term
 "What does the notation ""EE"" followed by a # indicate on the shoulder of a compressed gas cylinder"
Definition
 the elastic expansion of the cylinder in cubic centimeters under test conditions
Term
 What does an asterik next to the test date on the shoulder of a compressed gas cylinder indicate
Definition
 DOT approval for 10-year testing
Term
 what does a plus sign next to the test date on the shoulder of a compressed gas cylinder indicate
Definition
 the cylinder is approved for filling to 10% above its service pressure
Term
 What is something about compressed gas cylinders regarding coding
Definition
 it's color coded and labeled
Term
 How is duration of flow calculated from an H cylinder of oxygen
Definition
 duration of flow (min) = 3.14 (factor for H cylinder) * pressure/flow. Note that the factors for: G cylinder is 2.41; E is 0.28 and D is 0.16
Term
 What is ASSS
Definition
 standards for threaded high-pressure connections between large compressed gas cylinders and their attachments
Term
 What are the large compressed gas cylinders
Definition
 F - H/K
Term
 PISS
Definition
 Pin indexing applies to valve outlets of small cylinders up to and including E.
Term
 What type of connection is used for PISS
Definition
 "yoke type where the upper yoke fits over the lower valve stem. Two pins, projecting from the inner surface of the yoke connector, mate with two pinholes bored into the valve stem. Proper pin position aligns the small receiving nipple of the hyoke with the recessed cylinder valve outlet"
Term
 DISS
Definition
 "ASS and PISS provide standards for high pressure connections between cylinders and equipment, the DISS was established to prevent accidental interchange of low pressure (less than 200 psig) medical gas connectors. "
Term
 Where are DISS connections typically found
Definition
 "at the outlets of pressure-reducing valves attached to cylinders, at the station outlets of central piping systems and at the inlets of blenders, flowmeters, ventilators, and other pneumatic equipment"
Term
 WHat does the DISS system consist of
Definition
 "externally threaded body and a mated nipple w/ a nut. as the two parts are joined, the shoulders of the nipple and the bores of the body mate and the union is held tgether by a hand-tightened hex nut. indexing is achieved by varying the dimensions of the borings and shoulders"
Term
 "An intubated mechanically ventilated patient is using an HME and starts to develop thick, tenacious secretions. what action should be taken?"
Definition
 heated humidifier
Term
 WHat happens when a bourdon gauge encounters back-pressure resistence
Definition
 (bourdon gauge is a flowmeter device that is used in combination with an adjustable pressure-reducing valve). The pressure difference across the orifice and actual output flow decrease. the bourdon gauge flow reading depends on upstream pressure which stays constant. the gauge reading would be falsely higher than the actual delivered flow because it measures upstream pressure. the gauge registers flow even when the outlet is completely blocked
Term
 Why is oxygen monitored closedly with COPD patients
Definition
 "COPD patients with chronic hypercapnia ventilate less. Patients hypoventilate when given oxygen because of suppression of the hypoxic drive. Normal response to PCO2 is blunted. The primary stimulus to breathe being lack of O2 as sensed by peripheral chemoreceptors. The increase in O2 levels supresses chemoreceptors, depresses ventilatory drive, and elveates PCO2. High blood oxygen levels may disrupt the normal V/Q balance and cuse an increase in dead space to Vt ratio and an increase in PaCo2"
Term
 What action would you take when removing a flowmeter from the wall outlet and there is a sudden massive gas leak
Definition
 "try to reinsert and pull back out again due to a valve not properly closing. If this doesn't work, leave in the wall until it can be fixed"
Term
 What are the advantages of a SVN vs MDI
Definition
 "less patient coordination required, high doses possible, no CFC release"
Term
 what are some disadvantages of MDI vs SVN
Definition
 "Pt coordination required, Pt activation required, high percentage of pharyneal deposition, risk of abuse, difficult to deliver high doses, not all meds are available, most units still use ozone-depleting CFCs."
Term
 "How is total flow from an air entrainment calculated. EX. 50% O2, 15L/min"
Definition
 liters air/liters )2 = (100-%02)/(%02-21) ex. ansser is 41L/min
Term
 What are the clincial signs/indications of hypoxemia (abnormal deficiency of oxygen in arterial blood)
Definition
 "PaO2<60 mmHg or Sao2 <90% on room air; PaOc of SaO2 below desirable range for clinical situation; also, tachypnea - tachycardia - cyanosis, distressed overall appearance."
Term
 What is retinopathy of preamturity
Definition
 abnormal eye condition occurs in some premature or low-birth weight infants who receive supplemental oxygen. An excessive blood oxygen level causes retinal vasoconstriction which leads to necrosis of blood vessels.
Term
 "with retinopathy of prematurity, what happens in response to necrosis of blood vessels"
Definition
 new vessels form and increase in number. Hemmorhage of these delicate new vessels causes scarring behind the retina.
Term
 "in retinopathy of prematurity, what does scarring behind the retina often lead to"
Definition
 detachment and blindness.
Term
 Who does ROP affect most often
Definition
 "neonates up to approx. one month of age, by which time the retinal arteries have sufficienty matured"
Term
 What is Bernoulli's principle
Definition
 fluid's lateral pressure varies inversely with velocity
Term
 What is dalton's law
Definition
 total gas pressure = sum of partial pressures
Term
 Graham's Law
Definition
 rate of diffusion of a gas is inversely proportional to the square root of its gram molecular weight
Term
 Henry's Law
Definition
 solubility of a gas in liquid is proportion to its pressure if temp is constant and the gas does not react with the liquid
Term
 What is HBO therapy
Definition
 Hyperbaric oxygen therapy and is the therapeutic use of oxygen at pressures greater than 1 atm. Pressures during HBO therapy usually are expressed in multiples of atmopheric pressure absolute (ATA)
Term
 What does one ATA equal?
Definition
 "760 mmHg, 101.32 kPa"
Term
 What pressures are more HBO therapy conducted at
Definition
 between 2 and 3 ATA
Term
 What are the physiologic effects of HBO therapy
Definition
 "bubble reduction (boyle's law), hyperoxygenation of blood and tissue (henry's law), vasoconstriction, enhanced host immune function, neovascularizatoiin"
Term
 What acute conditions benefit from HBO therapy
Definition
 "decompression sickness, air or gas embolism, carbon monoxide and cyanide poisoning, acute traumatic ischemi, crush injuries and limb suturing, clostridial gangrene, necrotizing soft tissue infection, ischemic skin graft or flap"
Term
 What are some chronic conditions that benefit from HBO therapy
Definition
 "diabetic wounds of lower extrmeties and other non-healing wounds, refractory osteomyelitis, actinomyosis (chronic systemic abscesses), Radiation necrosis (as an adjunct to conventional treatment)"
Term
 Nitric oxide is used primarily for what purpose?
Definition
 To treat neonates with hypoxic respiratory failure with associated pulmonary hypertension.
Term
 "what are some potential, but currently not used uses for inhaled NO"
Definition
 "ARDS, persistent pulmonary hypertension of the newborn, pulmonary hypertension follwing cardiac surgery, cardiac transplantation, acute pulmonary embolism, COPD, congental diaphragmatic hernia, sickle cell disease, testing pulmonary vascular responsiveness"
Term
 WHat is a USN
Definition
 Ultrasonic nebulizer
Term
 what kind of method is used to create aerosol in a USN
Definition
 piezoelectric crystal
Term
 USN - how does the crystal transducer create aerosol
Definition
 "converts radio waves into high-frequency mechanical vibrations(sound). these virbrations are transmitted t aliquid surface wher ethe intense mechanical energy creates a cavitation in the liquid, forming a standing wave or geyser which sheds aerosol droplets. vibrational energy is transmitted either indirectly through a water-filled couplant reservoir or directly to a solution chamber. Gas entering the chamber inlet picks up the aerosol particles and exits through the chamber outlet"
Term
 What do the properties of the ultrasonic signal in a USN signal determine
Definition
 the characteristics of the aerosol generated by these nebulizers.
Term
 what does the frequenchy of the USN signal determine
Definition
 determines aerosol particle size which is inversely proportional to signal frequency
Term
 WHat does signal amplitude of USN signal determine
Definition
 "ignal aplitude directly affects the amount of aerosol produced. the greater the amplitude the greater the volume of aerosol output. Unlike frequency, signal amplitude may be adjusted by the clinician"
Term
 What is the treatment for laryngitis or croup
Definition
 cool mist nebulizer - mist tent
Term
 what are the indications for the use of humidity therapy
Definition
 "primary: humidifying dry medical gases, overcoming the humidity deficit created when the upper airway is bypassed. Secondary: managing hypothermia, treating bronchospasm caused by cold air"
Term
 WHat is SPAG
Definition
 "special-purpose large-volume nebulizer. used especially for the administration of ribavirinto infants with respiratory synctial virus infection. it incorporates a drying chamber with its own flow control to produce a stable aerosol. it reduces medical gas source from teh normal 50 pounds per square inch gauge (psig) line pressure to as low as 26 psig with an adjustable regulator. used to treat infants with RSV, respiratory synctial virus treated ribaririn"
Term
 what does one cubic foot of liquid oxygen equal
Definition
 860 cubic feet of gas
Term
 WHat devices are capable of delivering 100% relative humidity at BTPS
Definition
 heated humidifiers
Term
 Which oxygen delivery device most likely to be tolerated by children
Definition
 Oxygen enclosure such as oxygen tent
Term
 What is the main problem with oxygen tents
Definition
 large swings in oxygen concentration due to frequen opening and closing of the canopy
Term
 What is the best method of administration of controlled oxygen therapy to infants
Definition
 oxygen hood
Term
 How is oxygen delivered to an oxygen hood
Definition
 it is delivered to the hood through either a heated air entrainment nebulizer or a blending system iwth a heated humidifier. a minimum flow of 7 L/min should be set to prevent accumulation of CO2.
Term
 WHat flow would need to be used to maintain stable high oxygen concentration in an oxygen hood
Definition
 flow of 10 - 15 L/min
Term
 WHat may cause stress on neonatal patients with regard to an oxygen hood
Definition
 flows greater than 10-15 L/min due to harmful noise levels
Term
 What must be precisely maintained in an oxygen hood for an infant
Definition
 the temperature of gases provided to an infant in an oxygen hood should be precisely set to maintain a neutral thermal environment (NTE). The NTE varies with weight and age.
Term
 WHat are incubators
Definition
 plexiglas enclosures that combine servo-controlled convection heating with supplemental oxygen
Term
 WHat is the best way to control oxygen delivery to infants in an incubator
Definition
 with an oxyhood
Term
 "With an infant in an incubator using an oxyhood, where must hte oxygen concentration and gas temperature be assessed"
Definition
 within the oxyhood and not the incubator
Term
 What devices would most likely cause over hydration when used on a continuous basis
Definition
 large volume jet nebulizers and USNs
Term
 what is bland aerosol
Definition
 liquid particles suspended in a gas
Term
 what is the most common device used to generate bland aerosols
Definition
 large-volume jet nebulizers
Term
 how are large-volume jet nebulizers powered
Definition
 pneumatically powered attaching directly to a flowmeter and compressed gas source
Term
 How are liquid particle aerosols generated in large-volume jet nebulizers
Definition
 "by passing a gas at a high velocity through a small jet orifice. The resulting low pressure at the jet draws fluid from the reservoir up to the top of a siphon tube, where it is sheared off and shattered into liquid particles. The large, unstable particles fall out of suspension or impact on the internal surfaces of the device, including the fluid surface (baffling)"
Term
 "With a large-volume jet nebulizer, how would heat be added"
Definition
 "as with humidifiers, if heat is required, a hot-plate, wrap-around, yolk collar, or immersion element can be added."
Term
 How are heated large-volume jet nebulizers different from humidifiers with regard to the control of delivery temperature
Definition
 "they rarely have servo-controlled systems to control delivery temperature. many systems do not even shut down when the reservoir empties, resulting in the delivery of hot, dry gas to the patient. failure of the element can also cause a loss of heating capacity without warning to the clinician"
Term
 How are pulse demand delivery devices advantageous
Definition
 it synchronizes O2 delivery with inspiration to conserve O2 (uses approx 60%) less
Term
 ANSI
Definition
 "(American National Standards Institute) The institute oversees the creation, promulgation and use of thousands of norms and guidelines that directly impact businesses in nearly every sector: from acoustical devices to construction equipment, from dairy and livestock production to energy distribution. They set the minimum level of humidty for intubated patients at 30 mg/L"
Term
 DOT
Definition
 "specs on gas cylinders, regs for safety testing"
Term
 NFPA and CGA
Definition
 National fire protection agency. Compressed Gas Agency. They set cylinder storage guidelines
Term
 what are the guidelines that apply to cylinder storage
Definition
 "store in racks or chain to wall; other than the wooden racks, store no other combustible material; store away from sources of heat; store flammagle gases separately from those that support combustion; keep protective cap in place; don't store compressors and cylinders together; contain and store cylinder supply systems with one hour fire resistive rating; segregate full and empty cylinders; warning sign regarding oxidizing gas and alert against smoking; cool, well-ventilated area; "
Term
 what are the guidelines that apply to cylinder transport
Definition
 "use cylinder carts with securing mechanism; keep cylinder caps in place; protect cylinders from striking other cylinders or objects; avoid dropping, dragging, etc; make sure appropriately labeled"
Term
 what are the guidelines for cylinder use
Definition
 secure to pt bedside that prevents cyl from falling; do not use flammable materials; never cover with any material; open cyl valve slightly to remove dust before attaching to regulator; never use cyl that need repair; do not alter markings/color; never place near heat; never secure to movable objects; make sure connection is appropriate (ASSS for H and G and PISS for E); post no smoking sign
Term
 what are the variable FIO2 low-flow O2 delivery systems used in RT
Definition
 "nasal cannula, nasal catheter, transtrachial catheter"
Term
 What are the fixed FIO2 low-flow O delivery systems employed in RT
Definition
 "AEM, AE neb, blending system, isolette, incubator"
Term
 what are the controls of an ultrasonic nebulizer
Definition
 amplitude - increase to increase output and flow - increase to decrease density
Term
 What would be provided to a pt receiving nasal O2 at 3 L/min complaining of nasal dryness and irritation
Definition
 add a bubbler ( not generally required for flows less than 3 L/min)
Term
 What features of an SVN affect its performance
Definition
 "baffles, fill volume, residual drying volume, position, continuous vs intermittent, reservoirs/extensions, vent/valves/gas entrainment, tolerance in manufacturing"
Term
 How do you minimize a patient's infection risk between drug treatments wiht an SVN
Definition
 rinse with sterile H2O and air dry
Term
 particle distributions produced by a typical MDI
Definition
 3-6 microns
Term
 what time period shoudl elapse between each puff of a single MDI treatment
Definition
 1 minute
Term
 Primary safety concerns in the application of hyperbaric oxygenation
Definition
 "most frequent is barotrauma: ear or sinus trauma or tympanic membrane rupture; alveolar overdistension and pneumo, gas embolism. oxygen toxicity: CNS reaction, pulm reaction; fire, sudden decomp, reversible vision changes, claustrophobia, decreased cardiac output"
Term
 what factor is used to compute the duration of flow for an E cylinder
Definition
 0.28
Term
 what factor is used to compute the duration of flow for an H cylinder
Definition
 3.14
Term
 what factor is used to compute the duration of flow for a D cylinder
Definition
 0.16
Term
 what does the plus sign on a cylinder mean
Definition
 approved for filling 10% over its service pressure
Term
 what is the humidity output of a simple unheated humidifier
Definition
 10-20%
Term
 "when monitoring a pt receiving O2 therapy, what needs to be assessed"
Definition
 "cardiac, pulm, and neuro stats"
Term
 what is the simplest way to increase the humidity output of a humidifier
Definition
 heat it
Term
 double the length of an oxygen tube would have what effect on resistance to flow
Definition
 double
Term
 what is the approximate half life of carboxyhemoglobin
Definition
 "room air: 5 hours, 100% fio2: 80 minutes; 3 ATA HBO: 23 min"
Term
 when is a continuous nebulizer appropriate treatment
Definition
 refractory bronchospasm
Term
 what are the characteristics of servo-controlled heated humidifier
Definition
 "adjusts heater power automatically, through feedback from thermistor placed at or near pt airway. provides automatic heater shutdown, includes temp safety alarms."
Term
 what is the key functional difference between disposable partial rebreathing and nonrebreathing O2 masks
Definition
 nonrebreathers have one-way insp and exp valves
Term
 How would you clean a cylinder valve outlet of foreign material
Definition
 crack it
Term
 what are the advantages of passover humidifiers
Definition
 "advantages over bubblers are: maintain sats at high flows, add little or no resistane to spntaneous breathing circuits, do not generate aerosols"
Term
 for what should sputum collected by aerosol therapy induction be inspected
Definition
 "for diagnosis of TB, pneumocystis carinii pneumonia, lung cancer"
Term
 compressed gas cylinders are manufactured from what mainly
Definition
 seamless steel
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