Respiratory Therapy - Lindsey Jones/Clinical Simulations 100% correct answers already graded A+
Information Gathering - Emphysema: (Abnormal condition of the alveoli resulting destruction and loss of elasticity.) - answer LEVEL I : Cyanosis, Barrel chest, increased A-P diameter, Accessory muscle use, Digital clubbing of the nail beds, Significant history of smoking and/or occupational exposure to smoke or other pulmonary irritant
LEVEL II : Dyspnea, Wheezing breath sounds
LEVEL III : Chest X-ray—flattened diaphragms, hyperlucency, diminished pulmonary vascular markings.
CBC—polycythemia, increased WBC due to possible infection.
ABGs—Compensated respiratory acidosis (high PaCO2, normal pH), moderate to severe hypoxemia.
Sputum culture—often positive for bacteria.
LEVEL IV : FT—flows are decreased especially middle sized airways (FEF 25-75%) Fev1 and Fev1/FVC%, reduced DLCO (less than 20).
Descision Making - Empysema:
(Abnormal condition of the alveoli resulting destruction and loss of elasticity.) - answer Oxygen therapy
—low FIO2 (0.24 to 0.28) or 1 to 2 lpm nasal cannula
Oxygen conserving devices such as liquid oxygen or trans-tracheal oxygen
Home care education on devices and equipment cleaning
Rehabilitation efforts (specifics not usually required)
Aids to help quit smoking such as nicotine replacement therapy
Bronchodilation medication via MDI or aerosol nebulizers
Antibiotics for infection
Smoking cessation products (nicotine replacement therapy). Information Gathering - Chronic Bronchitis
(Defined: Condition where the patient has a productive cough 25% of the year for at least two consecutive years.) - answer LEVEL I : Productive cough, purulent sputum production
Exposure to pulmonary irritants, like history of smoking
Frequent infections
LEVEL II : Dyspnea
LEVEL III : Chest X-ray—could be normal, or may show hyperlucency, diminished, pulmonary markings.
CBC—possibly increased WBC due to possible infection.
ABGs—could be normal or very slight respiratory acidosis and hypoxemia
LEVEL IV : PFT—flows are decreased especially middle sized airways (FEF 25-75%) FEV1, Normal DLCO
Decision Making - Chronic Bronchitis
(Defined: Condition where the patient has a productive cough 25% of the year for at least two consecutive years.) - answer Anything that promotes good pulmonary hygiene such as chest physiotherapy, hydration therapy when sputum is thick.
Fluid therapy if dehydrated.Oxygen therapy for hypoxemia
Aerosolized bronchodilator therapy, Antibiotic Tetracycline may be preferable
Information Gathering - Bronchiectasis
(Defined: Abnormal condition where the bronchi
secrete large volumes of pus during abnormal
dilation.) - answer LEVEL I : Productive cough, often with blood, digital clubbing of the nail beds, significant history if infections (recurrent)
LEVEL II : Dyspnea
LEVEL III : Chest X-ray—generally normal
Sputum culture—gram negative bacteria
LEVEL IV : Bronchogram is the primary test. Characterized by a "tree in winter pattern" Decision Making - Bronchiectasis
(Defined: Abnormal condition where the bronchi
secrete large volumes of pus during abnormal
dilation.) - answer Anything that promotes good pulmonary hygiene such as chest physiotherapy, hydration therapy when sputum is thick.
Fluid therapy if dehydrated.Oxygen therapy for hypoxemia
Aerosolized bronchodilator therapy. May have to consider surgical intervention on some highly affected segments
Information Gathering - OSA
(Defined: the cessation of breathing during sleep.
Is usually obstructive in nature but sometimes can be central or a combination of the two (mixed). - answer LEVEL I : Spouse or bed partner will complain of snoring and will often report witnessing periods of apnea that exceed 10 seconds. Excessive upper airway tissue, obesity, thick neck (greater than 16 inch collar size. Ability to fall asleep quickly
Sleepiness during daytime and while watching TV or in front of a computer
LEVEL II : Dyspnea, Frequent urination during sleeping hours
LEVEL III : ABGs—could be normal or very slight respiratory acidosis and hypoxemia
LEVEL IV : Polysomnography (sleep study) - determines if obstructive or central, If no nasal flow AND no chest movement—then CENTRAL sleep apnea. If no nasal flow WITH chest movement—then OBSTRUCTIVE sleep apnea
Decision Making - OSA
(Defined: the cessation of breathing during sleep.
Is usually obstructive in nature but sometimes can be central or a combination of the two (mixed). - answer If central, ventilatory stimulant medication may be used, If obstructive, nocturnal nasal or full-
face CPAP or BiPAP (NIPPV) is usually initially indicated with follow-up weight loss or upper airway tissue removal through surgery. Problem must be corrected immediately, so even if discharging, send devices home with
patient. In the absence of a titration study, initially ordered pressure should be 10 to 20 cmH20.
Information Gathering - Asthma
(Defined: Abnormal constriction of the bronchials
resulting in sputum productionand narrowed
airways. - answer LEVEL I : Accessory muscle use, Tachycardia
LEVEL II : Dyspnea, Wheezing, Congested cough, Wet, clammy skin
LEVEL III : ABGs—possible respiratory acidosis, could be hypoxic, Chest X-ray—hyperinflation, scattered infiltrates, flattened diaphragms. In allergic cases, may see elevated eosinophil count which can cause yellow sputum
LEVEL IV : PFT—Decreased flows in FEV1 but diffusion is normal as manifested by DLCO
Decision Making - Asthma
(Defined: Abnormal constriction of the bronchials
resulting in sputum productionand narrowed
airways. - answer Oxygen therapy for hypoxemia
Aerosolized bronchodilator therapy
Continuous bronchodilator therapy, Albuterol (7-10 mg/hr)
Xanthine medication given IV (Aminophylline, etc)
Promote pulmonary hygiene
Inhaled sterioids such as oral or IV prednisone
Information Gathering - Status Asthmaticus
(Defined: Asthma that will not respond to bronchodilation therapy,usually persists more
