Exam 1 Thursday

8/8/2019 Exam 1 Thursday

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EXAM 1 THURSDAY

1. What is the function of the nose?a. To filter, warm and humidify inspired air

2. What is the composition of the mucosa?a. 95% water, 5% glycoprotein, carbs, lipids, DNA, debris

3. What are the two distinct layers of the mucosa?a. Gel and sol

4. Which cells produce mucus?a. Submucosal cellsb. Goblet cells

5. How much mucus is produced daily?

a. 100 ml/day

6. What is the purpose of the cilia?a. To propel mucus to the pharynx

7. How fast is mucus propelled upward?a. 2 cm per minute

8. What moves the mucus past the larynx?a. A cough

9. what are the factors that impair the mucociliary transport system?a. Dehydrationb. Cigarette smokingc. High FiO2d. General anestheticse. Parasymaptholytics (atropine)f. Impaired cough

10. What is used to induce a sputum collection?a. An aerosolized sterile water or hypertonic 3-10% NaCl treatment

for 15-30 minutes. May be heated or unheated.

11. How does a hypertonic saline solution cause bronchorrhea?a. Sodium concentration is greater than the amount in the mucosab. Fluid moves toward the higher sodium concentrationc. Net movement of fluid goes from mucosa to the airway

12. How do you obtain a sputum sample through catheteraspiration?


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a. Specimen is obtained through suction catheter either through anartificial airway or through the oro or nasotracheal tube.

b. Using the sterile technique, place Lukens sputum trap betweenthe suction catheter and the suction tubing.

c. Hyperoxygenate with 100% oxygen for 1 minute (can just bump

up the flowmeter)d. Do not contaminate the suction catheter tip and do not dilute thesample with too much saline

e. Let patient rest between suction passes, and repeat until enoughsputum is obtained.

13. Why do a sputum aspiration via bronchoscopy?a. Sample is aspirated deep from the lungsb. A sample from the affected area can directly be culturedc. There is less chance of contamination from upper airway

14. Under gross observation, what is considered a small amount?Moderate? Large?a. Small = < cup/dayb. Moderage = cup/dayc. Large = >1/4 cup per day

15. Describe the sputum colors.a. Clear

i. Normalb. Mucoid

i. White/grey is chronic bronchitis

c. Yellowi. Pus and infection. Indicates large number of WBC

d. Greeni. Infection or old retained secretions (gram negative bacteria)

(bronchiectasis)e. Brown

i. Old bloodf. Rust

i. Pneumococcal pneumoniag. Black or grey

i. Inhaled coal dust or smoke inhalation

h. Redi. Fresh blood (tumor, TB, bleeding) or Klebsiella pneumonia

16. Describe sputum consistency.a. Wateryb. Thickc. Thind. Solid/plugs


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e. Tenacious

17. Describe sputum odor.a. Foul

i. Anaerobic infection

b. Sweeti. Bacterial or pseudomonas

18. What is a gram stain test?a. A special staining process to colorize bacteria into one of two

groups.

19. What does a gram positive stain test indicate?a. It stains violet and is most commonly associated with bronchitis

and pneumonias and are treated with penicillin related drugs orsulfa drugs

20. What does a gram negative stain test indicate?a. It stains pink and is usually treated with broad spectrum

antibiotics or antibiotics which bacteria is sensitive to.

21. What cannot be identified by simple staining?a. Viruses

22. What is a sputum culture?a. An attempt to grow organisms found in the sputum

23. Why is sputum susceptibility (sensitivity) testing done?a. Sensitivity is the act of exposing the cultured organisms to a

variety of antimicrobial drugsb. The goal is to find which drugs kill the bacteria

24. What is an acid fast stain?a. It is done to diagnose mycobacterium tuberculosis

25. What is a normal WBC count?a. 5,000 to 10,000 mm3

26. What is a normal segmented neutrophil count?a. 60%. Increases with bacterial infections

27. What is a normal lymphocyte count?a. 30%

28. What is a normal monocyte count?


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a. 3%. Increases is associated with TB

29. What is a normal eosinophil count?a. 2%. Increase associated with asthma

30. What is a normal basophile count?a. 1%

31. Name four problems associated with sputum samples.a. If sputum has a large number os squamous cells, it is probably

contaminated with too much salivab. Sputum must be examined while fresh and still warm or results

may be unreliablec. Contamination may occur from touching the sterile container

with fingers or mouthd. RCP contaminates catheter during suctioning

32. Describe the sputum production for the following diseases.a. Asthma

i. Usually scant amounts of white. During severe attacks withplugging, sputum is purulent indicating stasis or secondaryinfection.

b. Bronchiectasisi. Copious amounts of purulent and separates into 3 layers. Can

be blood tingedc. Cancer of the lung

i. Unusual to have mucus unless there is obstruction from the

tumor.d. Chronic bronchitis

i. Usually white (mucoid). Turns purulent during acuteexacerbation with superimposed infection

e. Cystic fibrosisi. Large amounts of thick, tenacious with mucus plugs. May be

green with stasis.f. Lung abscess

i. Sudden onset of copious amounts of foul-smelling purulentsputum when cavity drains

g. Pneumonia

i. Yellow or green. Klebsiella is red, pneumococcal is rusth. Pulmonary edema

i. Can have copious amounts of pink frothy secretions. Not truesputum.

i. Tuberculosisi. Production is common and may be associated with

hemoptysis or blood tinged


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33. What is the one disease that does not respond to nebtreatments?a. Pulmonary edema

34. What are the indications for use of aerosol therapy?

a. Humidification of bypassed upper airwaysb. Bronchial hygienec. Drug depositiond. Sputum inductione. Upper airway inflammation

35. What drugs can be delivered to the lower airways viamedicated aerosol therapy?a. Beta adrenergicb. Anticholinergicc. Anti inflammatory

d. Mucokinetic agentse. Antibiotics

36. How do you establish a need for a nebulizer?a. Breath soundsb. Peak flowc. Reversibility of the airway diseased. % FEV1e. the overall clinical picture

37. What are the hazards associated with aerosol therapy?

a. Airway obstruction from mucusb. Airway resistance from bronchospasmsc. Fluid overloadd. Cross contamination/infectione. Drug reactionf. Hazards to health care workersg. Drug reconcentrationh. Paroxysmal coughing or airway collapse

38. What are some of the drug limitations of aerosol therapy?a. Not many bronchodilators are available in DPI form. Most

available as MDI or aerosol.b. Mucolytics come in aerosol form onlyc. Antimicrobial drugs available in aerosol form only. Some are so

viscous they cant be effectively nebulizedd. Steroids available in MDI and DPI only.

39. How do you select the appropriate aerosol device?a. Determine how the drug is available (MDI, DPI, SVN)


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a. Give 4 hours CBT with 15 mg/h of albuterol in a neb whoseoutput is 25 ml/h.i. Determine how much albuterol you need.

(1)15 mg/h x 0.2 ml/mg = 3.0 ml/h albuterol(2)4 h x 3.0 ml/h = 12 ml/h albuterol

ii. determine how much total solution you need(1)25 ml/h x 4 h = 100 ml total solutioniii. subtract total solution from known albuterol amt to get

dilutent(1)100 ml 12 ml albuterol = 88 ml dilutent

49. How do you determine if a pediatric patient should be givenCBT?a. Evaluate the 7 indicators for pediatrics: PaO2, SpO2, cyanosis,

b/s, wheezing, accessory muscles, level of consciousnessb. Each indicator is given a score ranging from 0 to 2

c. If overall clinical score is less than 4 after 3Q20min albuteroltreatments, start CBT at 15 mg/hr.

50. What are the limitations to aerosol therapy?a. Appropriate airway clearance technique must follow therapyb. Patient cooperationc. Patients ability to cough & mobilize secretionsd. Drug is wasted as much as .5 to 2.0 ml remains in the cup

following treatmente. Some wont nebulize if tilted > 30 degreesf. Usually only 25% of the medication is inhaled and the remainder

is wasted into the room

51. Out of inhaled drug, how much is actually deposited?a. 10-20%

52. What happens if the flow in an aerosol therapy is too low ornot enough pressure?a. It produces particle sizes > than 5 microns which are out of the

therapeutic range.

53. Where is most of the drug deposited in a vent aerosol therapy

situation?a. In the ventilator circuit resulting in only 1.5 to 3% being

deposited in the lungs.

54. What is the purpose of peak flow monitoring before and afterbronchodilator treatment?a. Establishes a baselineb. Documents improvements


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c. Documents a worsening as a result of therapyd. Should be done before and after therapy

55. What are the advantages of MDI therapy?a. Promotes self-care

b. Requires less time than aerosol therapyc. More portabled. Less equipmente. More medications are available

56. Describe the principles of MDIs.a. Pressurized cartridge with 150-300 dosesb. High vapor pressure creates smaller particle sizec. With each activation a metered amount of medicine is releasedd. Each activation is called a puff

57. What are the three components of an MDI?a. A micro ionized powder drugb. A propellant used to carry the drugc. Surfactant to keep the drug suspended

58. Name the two types of propellants.a. CFC chlorofluorocarbons. Harm the ozone and can cause some

reactions in patients. Banned as of 2008b. HFA hydrofluoroalkane. Do not have chlorine and are safe for

environment.

59. What criteria must be met to use an MDI?a. Patient must be able to cooperate and be able to perform a

breath holdb. If in severe distress they should receive aerosol treatmentc. Stable respiratory pattern and rated. Adequate VC (>30%)e. Medications only given in MDI form

60. What percentage of the population do not use MDIs correctly?a. 50-70%

61. When should an MDI treatment not be used?a. If there is a reaction to the propellant or to the cold aerosolb. Foreign body aspirationc. High loss of drug in mouthd. Inadequate VC (


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MDI?a. They have a high velocity gas which can cause the medication to

be deposited in the oropharynx

63. Using an MDI what is the ratio of drug deposition of mouth to

lungs?a. 80% in the oropharynx and 20% in the lungs

64. What can be done to decrease deposition in the mouth?a. Use a spacer or holding chamber

65. Name the benefits of using a spacer or holding chamber.a. Help reduce orophyarnx depositionb. Eliminate the need for hand-breath coordinatonc. Allows for more vaporization of the propellantd. Allows for evaporation of large particles to shrink to smaller,

more therapeutic sizee. Must be used with steroidsf. Used with pediatric patientsg. Used with patients who cannot coordinate their breath and

inhalation

66. Describe how a flow triggered MDI operates.a. Patient sets the lever on the top to the upright position.b. Medication is automatically released when the patient initiates

30 L/min of flow during an inspiratory effort

67. What is the only autohaler drug available?a. Pirbuterol (bronchodilator)

68. If more than one medication is prescribed, what is thesequence given?a. Bronchodilator 1st

b. Sereventc. Steroids

69. What are the criteria for a patient to perform self-therapy?a. Coordinate breath with activation of MDIb. Follow directions & perform breath hold

c. They have no adverse reactions

70. Describe a dry powder inhaler.a. Breath actuated metered-dosing systemb. Do not need propellantsc. Do not need hand-breath coordinationd. Do not need a breath hold


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71. How does a DPI work?a. Powder medication is aerosolized when patient inhales through

the device creating turbulent flow.

72. What are the limitations of a DPI?

a. Patients must generate flows of at least 40 to 60 lpm to producean aerosolb. Not used with children under 5 because they generally cannot

generate high enough peak inspiratory flows.c. Difficult for weak, compromised patients to generate adequate

inspiratory flow ratesd. Humidity can cause powder to clumpe. There are a limited number of drugs available in DPI

73. What three conditions indicate the use of an aerosol deliverydevice?

a. Acute exasperation of asthmab. Severe increased WOBc. Inability to breath hold or follow directions

74. What is a peak flow monitor?a. A pneumotachometer which measures flow

75. What does peak flow evaluate?a. The effectiveness of bronchodilator therapy by measuring the

peak expiratory flow rates (FVC).

76. How should PEFR be monitored in a hospital setting?a. For a stable patient assess PEFR initially before and after each

bronchodilator treatment. Then 2 x a day.

77. How should PEFR be monitored at home?a. PEFR should be done 3-4 times a day (preferably at the same

time) until a baseline is establishedb. After baseline is established perform the following:

i. COPD 2 x a dayii. Asthma 2 x a day and prn. Adjust for severity

78. Describe what the monitoring colors are for peak flows.a. Green

i. Means go. Asthma is in good control and values are between80-100% of personal best.

b. Yellowi. Means caution. Asthma is not in good control. Values are


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between 50-80%.c. Red

i. Means stop. Asthma Is in poor control. Values are less than50%. Contact a physician immediately or go to the local ER.

79. Describe the technique for performing peak flow.a. Instruct the patient to sit up (preferably stand)b. Have the patient take a deep, full breathc. Put mouth piece in mouth and exhale forcefully and fullyd. Repeat 3 timese. Record personal best

80. What is the name of a hospital acquired infection?a. Nosocomial infection

81. What percentage of hospital patients acquire infections?

a. 5 10%

82. What is the most common cause of nosocomial infections?a. Bacteria

83. What percentage of nosocomial infections are caused byrespiratory therapy equipment?a. 10 40%

84. Define highly virulent.a. Only a small number of organisms are needed to cause an

infection

85. Define virulence.a. Degree or ability to cause infection

86. Define bacteriostatic.a. Inhibits bacterial growth

87. Define bactericidal.a. Kills bacteria

88. Define aseptic.a. Free from microbes

89. Define disinfection.a. The process of destroying vegetative organisms

90. Define resident flora.a. Bacteria that live on the skin


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91. Define sanitize.a. To reduce the population of organisms to a safe level

92. Define surveillance.a. Identification of baseline information for infections and

identifying any alterations

93. Define transient flora.a. Found on hands and have high virulence acquired from colonized

or infected patients

94. Define aggressiveness in relation to bacteria.a. Ability to multiply and thrive.

95. Define toxigenicity.a. The ability to produce toxins

96. Define cleaning.a. The removal of foreign material

97. Define disinfection.a. The inactivation of pathogenic organisms.

98. Define sterilization.a. The complete destruction of all organisms

99. What conditions will influence antimicrobial action?

a. Type of product usedb. Length of exposurec. Barrier to exposured. Temperaturee. Strength

100. Describe bacteria.a. 0.5 5 microns in sizeb. unicellular and reproduce by binary fissionc. use organic chemicals from living or dead host for nutrition.

101. Describe three distinct bacterial shapes.a. Coccus

i. Spherical (diplococci pairs) (cluster-staphylococci)b. Bacillus

i. Rods (chains streptococci)c. Spiral

i. Corkscrew


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102. What is the most common organism spread by respiratoryequipment?a. Pseudomonas is the most common.

103. What are common infections spread by contact?

a. Staphylococcalb. Enteric bacteria

104. Describe fungi.a. Unicellular eucaryotesb. Reproduce by forming spores sexually or asexuallyc. Absorb organic material from soil, water, plants or animal hostsd. Antibiotics dont kille. Spores can stay alive for many years and are hard to kill

105. Describe viruses

a. Not cellularb. Submicroscopicc. Resistant to antibioticsd. Can withstand many forms of decontamination procedurese. Contain DNA or RNA

106. How can infections spread?a. Contact

i. Direct person-to-personii. Indirect passed by non-living objectiii. Droplet sneezing

b. Vehicle food, water, drugc. Airborne dustd. Vector insects or animal

107. What criteria is used to determine which disinfectant to use?a. The type of equipment to be cleanedb. The level of disinfection requiredc. Expense of the process

108. Describe incineration.a. Used to dispose extremely contagious/contaminated material of

no further useb. Used with highly virulent organisms

109. Describe dry heat sterilization.a. Uses a simple dry heat ovenb. Place object in over 1 2 hours at 180_C

110. What are the advantages of dry heat sterilization?


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a. Wont dull sharp instrumentsb. Good for glass and metal objects

111. What are the disadvantages of dry heat sterilization?a. Some organisms are resistant

b. Does not penetrate porous material

112. Describe pasteurization.a. Uses moist heat at temperatures below boiling to disinfectb. Coagulates cell proteinsc. Doesnt kill sporesd. Kills most vegetative bacteria, most viruses, and HIVe. Inexpensive and environmentally safef. 63_C for 30 minutes

113. What are the advantages of pasteurization?

a. Most equipment can tolerateb. No chemical residuec. Inexpensived. No harm to patients or personnel

114. What are the disadvantages of pasteurization?a. No electrical equipmentb. No HEPA filtersc. Does not sterilized. High rate of recontamination

115. Describe using boiling for disinfection.a. Low level disinfection processb. Kills vegetative forms but not sporesc. Doesnt assure sterilizationd. 100_C for 30 minutes

116. Describe the use of an autoclave for disinfection.a. Sterilizesb. Uses steam under pressurec. Is efficient, inexpensive and reliabled. Most respiratory equipment cant withstand

e. Standard use is 121_ C at 15 psig for 15 minutesf. Equipment must be cleaned first and wrapped in muslin, linen or

paper so that steam can penetrate.

117. What are the advantages of using an autoclave?a. Sterilizes (including liquids)

118. What are the disadvantages of using an autoclave?


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a. Can damage some equipmentb. Deteriorates rubbers and some plasticsc. Can dull metal instruments

119. Describe disinfection by ionizing radiation.

a. Sterilizesb. Not used often in hospitals due to costc. Uses x-rays and gamma rays which may produce toxic by-

productsd. Ultra violet light not used often because it doesnt penetrate

materials easily

120. Describe disinfection using Ethylene oxide (EtO).a. Sterilizesb. Colorless, toxic gas which is potent sterilizing agentc. Good for equipment that cant be autoclaved

d. Exposure hazards

121. What are the advantages of EtO disinfection?a. Effective sterilizerb. Most equipment can tolerate.

122. What are the disadvantages of EtO disinfection?a. Toxic, flammable and explosiveb. Aeration times required is 1 5 daysc. Expensived. Causes tissue & mucosa irritation

123. Name the equipment that can be disinfected using EtO.a. Sensitive equipment such as rubber and plasticsb. Equipment that cant be immersed (ventilators)c. Metals that require very little aeration time

124. What will a low level chemical disinfectant do?a. Kill most bacteria and some viruses and fungi, but not spores and

TB

125. Describe two types of low level chemical disinfectants.

a. 5% acetic acid white vinegari. used in home care. Good for pseudomonas

b. Quarternary ammonium compounds.i. Nontoxic chemical used in home care.ii. Weak sporicidal activityiii. Inactivated by soaps

126. Describe a medium level chemical disinfectant.


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a. Kill all vegetative bacteria and some viruses and spores.

127. Describe three types of medium level chemical disinfectants.a. Alcohols

i. 70% ethyl or 90% isopropyl

ii. can damage rubber or plastics and shellaciii. good for items that cant be immersediv. good for wiping surfaces: stethoscopes, medication vialsv. 1 min kills HIV, 5 min kills HbV

b. Phenolic i. Kills bacteria, fungus, TB. Kills some spores and viruses.ii. Remains active on surface and can be absorbed by plastics

and porous materialiii. Causes irritation to the skiniv. Causes hyperbilirubinemiav. Used as a surface disinfectant only

c. Idophorsi. Kills bacteria, viruses and TB.ii. Good antiseptic for skin

128. Describe a high level disinfectant.a. Kills all vegetative bacteria, fungi and viruses (not spores)b. Good for items that come in contact with mucus membranes and

for respiratory circuits.

129. Describe the types of high level disinfectants.

a. Glutaraldehyde (cidex)i. Alkaline pH level of 7.5 8.5ii. Stays active for 28 daysiii. Test strips should be usediv. Minimum exposure 20 minutesv. Vapor exposure can cause tissue inflammation, rhinitis and

asthma. Room must be well ventilatedvi. Equipment must be thoroughly rinsed

b. Hydrogen peroxidei. Wound antisepticii. 6% solution for 20 min is bactericidal, fungicidal and virucidal

iii. 6 hrs at 20_C will sterilize

iv. safe for rubber, plastic and stainless steel

v. corrodes copper, zinc and brass

c. Sodium hypoclorite (bleach)


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i. 1:10 solution used to clean blood spills

130. Name the standard universal precautions.

a. Wash hands immediately after removing gloves and betweenpatients

b. Wash hands after touching blood or body fluids even if wearinggloves

c. Wear gloves when working with blood or body fluids

d. Wear masks and eye protection during procedures that maygenerate splashes of blood or body fluids

e. Wear gowns during procedures that may generate splashes ofblood or body fluids

f. Never recap needles. Place sharps in appropriate containers

g. Use mouth pieces and/or resuscitation bags as an alternate tomouth-to-mouth resuscitation

131. What are the precautions in contact isolation.

a. Standard precautions plus:

i. Place patient in private room or cohort

ii. Wear gloves when entering the room

iii. Change gloves when contaminated

iv. Wear clean gown when entering the room

132. List some examples of contact isolation.

a. MRSA

b. VRE

c. Clostridium difficile


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d. RSV

e. Parainfluenza

f. Enteric infections

g. Lice, scabies

h. Conjunctivitis

i. Viral hemorrhagic fever

133. What are the precautions for airborne isolation?

a. Standard precautions plus:

i. Place patient in private, negative pressure room with 6 -12 airchanges/hour

ii. Wear a mask

134. List some examples of airborne diseases.

a. Measles

b. Varicella

c. TB

d. Smallpox

135. What are the precautions for droplet isolation?

a. Use standard precautions plus:

i. Place patient in private room or cohort with at least 3 feetseparation

ii. Wear a mask when 3 feet from patient

136. Give some examples of droplet isolation.


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a. H Flu

b. Meningococcal

c. Diphtheria

d. Pertussis

e. Mumps

f. Rubella

g. Parvovirus

h. Pneumonic plague

137. What are precautions for protective isolation?

a. Wear all barriers when in patient contact

b. If patient is immunosuppressed, barriers should be sterile.

138. Give some examples of protective isolation.

a. Heart/lung transplant

b. Bone marrow transplant

139. State the three types of terrorist threats.

a. Biological weapons agents which spread deadly disease

b. Chemical weapons

c. Radiological or nuclear agents

140. What are the 4 bioterrorism diseases identified by the CDC?

a. Anthrax

b. Botulism


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c. Smallpox

d. Plague

141. What symptoms would indicate it was an act of bioterrorism?

a. Large numbers of persons presenting with flu-like symptomswhich progress to respiratory failure

142. How can biological agents be spread?

a. By aerosols, food or water, or by victims themselves.

143. Define the three types of anthrax.

a. Inhalation: caused by breathing spores. Most lethal with amortality rate > 80%

b. Gastrointestinal: caused by ingesting spores. Can be lethal

c. Cutaneous: caused by spores entering sores or cuts. Least lethal.

144. How does inhalation anthrax present?

a. Fever, malaise, cough, dyspnea, diaphoresis, stridor, cyanosis,hypotension, hemorrhagic meningitis

145. How is anthrax seen on a CXR?

a. Mediastinal widening without infiltrates.

146. What is the treatment for inhalation anthrax?

a. Antibiotics rapidly. Doxycycline, ciprofloxacin, penicillin


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147. Define botulism.

a. A muscle-paralyzing disease caused by ingesting clostridiumbotulinum which produces a potent neurotoxin.

148. How is botulism diagnosed?

a. Serology, toxin assays, blood or stool cultures

149. What is the treatment for botulinum toxicity?

a. Antitoxin 1 vial and mechanical ventilation

150. How does botulism present?

a. Usually within 12-36 hours

b. Presents like myasthenis gravis or tetanus caused by cranialnerve damage

c. Symptoms include: a febrile symmetrical descending paralysis,ptosis, malaise, blurred vision, dizziness, disphonia, muscleweakness starting in the upper body and working down towards

legs.

d. May require mechanical ventilation if diaphragm becomesparalyzed

151. Define smallpox.

a. Caused by the variola virus.

b. Has been eradicated since 1978c. Very contagious via respiratory droplets or contaminated

articles.

d. Negative pressure isolation required with N-95 respirator mask


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152. How does smallpox present?

a. Fever, back pain, vomiting, malaise, headache, rigors, papules topustular vesicles on face and extremities.

153. What is the treatment for smallpox?

a. Immediate vaccination,

b. Aerosol cidofovir 0.5-.5 mg/kg and supportive care

154. Describe smallpox lesions.

a. Centrifugal

b. Appear at the same level of development

c. On palms and soles

d. Causes scarring

155. Define the plague.

a. Caused by bacteria Yersina pestis, a bacteria found in rodentsand fleas