Snap, Crackle, Pop
You have a patient lying at a 45-degree angle and notice a protrusion in their neck. Because you're a smart RT, you know that jugular vein distention (JVD) greater than 3–4 cm is abnormal. Give one possible cause of JVD.
What is right heart failure?
(Also acceptable: What is constrictive pericarditis? / pleural effusion / obstructed vena cava, etc.)
A patient with moderate asthma symptoms is prescribed a non-rescue inhaled beta-agonist with rapid onset. Which drug was most likely chosen?
What is metaproterenol?
(Note: While Albuterol is a more common SABA, metaproterenol has a rapid onset and is less commonly used today.)
This is the functional zone of the lung where alveoli are present and gas exchange occurs. It begins after the terminal bronchioles.
What is the respiratory zone?
What does the use of large-bore tubing usually indicate in a respiratory therapy setup?
What is a high-flow oxygen device?
Calculate Estimated Vdana, and VDPhys.
Volume in the conducted airways of a 5’10 woman, her ABG reports PaCO2 = 37 and her PECO2= 30.
105 + 5(10)= 155 lbs -> 155 mL VDana
(37-30)/37= 0.19= 19% VDPhys
TWO IN ONE
This term refers to a dramatic increase in the anteroposterior (AP) diameter of the chest, often seen in COPD patients.
This condition occurs when multiple adjacent ribs are fractured in multiple places, leading to chest wall instability.
What is barrel chest? What is flail chest?
What is the dosage recommended by NAEPP EPR 2 for continuous nebulization of adrenergic agents?
10-15 mg/hr
What describes the pressure in the small airways and alveoli during a breath hold?
AND
What term describes how easily the lungs expand when there's no airflow
Pplat and Cstat. Plateau pressure and Static lung compliance both occur when there is no airflow.
Your patient is on a high-flow device set at 40% FiO₂ and 15 L/min. What type of device are they on, and what is the approximate total flow delivered?
What is a Venturi mask (AEM) delivering approximately 60–75 L/min total flow?
(Assuming 3:1 ratio for 40%: 15 L/min × 4 = 60 L/min)
What is dark red, current jelly colored sputum associated with?
Klebsiella pneumonia
While palpating a patient’s chest as they repeat “99,” you feel a marked decrease in tactile fremitus. Given this physical finding, name one pulmonary condition that could cause this.
What is a pneumothorax?
(Other acceptable: emphysema, pleural effusion)
A 45-year-old patient with moderate persistent asthma complains of occasional shortness of breath and wheezing. The physician decides to start a maintenance medication to improve lung function and reduce symptoms between exacerbations.
Suggest one medication that can be used to treat the indication.
LABA: Salmeterol, Formoterol, Arformoterol, Indacaterol, Olodaterol. (SOFIA)
A patient with interstitial lung disease shows impaired oxygen diffusion. According to this physiologic law, the thickened alveolar membrane decreases oxygen transfer. What law explains this?
What is Fick's Law?
You are using a fixed oxygen device on a patient. You notice the oxygen flow rate is set below the manufacturer's recommended minimum for the selected FiO₂. What is the clinical consequence of delivering too low a flow to this device?
total flow may not meet the patient's inspiratory demand → variable FiO₂ and potential rebreathing of CO₂.
On auscultation of a 56-year-old patient, you note fine crackles towards the bases of the lungs. What does this finding potentially indicate?
Pulmonary edema or interstitial lung disease.
A 10-year-old asthma patient arrives in severe respiratory distress. You notice labored breathing, nasal flaring, but no wheezing is heard on auscultation. What is this finding called, and what does it indicate?
What is a silent chest, indicating life-threatening airway obstruction?
You are treating a 12-year-old patient with acute asthma. The physician orders a beta-2 agonist to be administered QID via inhalation. Describe the name, route, dose, and frequency of the drug.
What is Proventil (Albuterol), 90 mcg per actuation, 2 puffs via MDI every 6 hours (QID)?
Match these clinical scenarios to the correct abnormal breathing pattern:
A head trauma patient shows irregular breathing with periods of apnea.
A CHF patient shows a crescendo-decrescendo pattern with apnea.
A DKA patient is breathing deeply and rapidly.
What are Biot’s breathing, Cheyne-Stokes respiration, and Kussmaul breathing?
You have a patient wanting to convert to a portable oxygen delivery via LOX. It weighs 3lbs, and he runs his oxygen at 4 L/min. How long would his container last if he were to run it till empty? In hours and minutes.
4 hr 18 min: 3lbs(860)/ 2.5= x/60
On auscultation of a patient, you note coarse and loud sounds in the bronchial airways, and breezy, high-pitched sounds in the vesicular region. What could be a potential finding with these auscultations, with no other tests?
Normal Breath sounds.
During your chest exam, you percuss dullness over the right lower lobe and hyperresonance on the left. Name at least three different percussion tones and what clinical condition each may indicate. (dull, hyperresonance, and flat)
Dull – consolidation or pleural effusion
Hyperresonant – pneumothorax or hyperinflation
Flat- Normal
A 4-year-old boy has been given multiple aerosolized albuterol treatments over the last several days. You enter the room and his father tells you that every time a therapist administers a treatment, a few minutes later the saturation falls. You explain to the father:
This is because of increased perfusion to poorly ventilated areas. A fall in arterial oxygen pressure PaO2, has been noted with beta agonist administration during bronchospasm and is probably due to an increase in perfusion to poorly ventilated areas of the lungs.
While managing a mechanically ventilated patient, you measure a plateau pressure of 25 cmH₂O, a PEEP of 5 cmH₂O, and a tidal volume of 500 mL. Using this information, calculate the patient's static compliance. Explain the relationship between lower cstat and pressure.
25 mL/cwp. A lower Cstat leads to increased pressures.
Cstat= VT/ (Pplat- PEEP)
You are placing a patient on an AEM, and the physician has ordered a Venturi mask with a L flow of 6 L/min with a desired FiO2 of 28%. How do you know which air entrainment port to pick?
What is the Total Flow at the face of the patient?
If you increase flow above the minimum, FiO₂ _______ but total flow increases.
Choose the 28% (blue) Venturi adapter and ensure the flow rate meets or exceeds the minimum required per the manufacturer's chart. 66L/min total flow. Stays the same.
Patient H has right lower lobe pneumonia, and Patient M has COPD. Explain the primary difference in the type of pulmonary gas exchange abnormality expected in each patient.
Patient H is likely experiencing a right-to-left pulmonary shunt due to alveolar consolidation impairing ventilation, while Patient M typically has a ventilation-perfusion (V/Q) mismatch caused by uneven airflow and perfusion in the lungs.