Special Procedures

  1. What is a thoracentesis?
    Diagnostic or therapeutic procedure which a needle is inserted into the chest to remove air/fluid from the pleural space. 
  2. What disorder do you use a thoracentesis?
    Pleural effusion 
  3. What is position do you put a patient in during a thoracentesis? 
    Patient sitting up and leaning forward. 
  4. Where do you insert the needle?
    7th or 8th intercostal space at the site of maximal dullness.
  5. How much is aspirated after a thoracentesis?
    100 to 300 ml of pleural fluid with 50 mL syringe. 
  6. What color is transudate fluid and what disease is it associated with? 
    • Clear and has light straw color
    • Congestive heart failure
  7. Empyema/Pyothorax
    Opaque appearance and called exudate fluid 
  8. Pleural fluid with an infection is what color
    yellow or milky exduate fluid 
  9. Central sleep apnea
    apnea due to loss of ventilation effort
  10. Obstructie sleep apnea 
    blockage of upper airway 
  11. What is the history and presenation of sleep apnea disorders 
    • Daytime sleepiness and insomnia at night. 
    • Muscle twitching 
    • History of snoring and obesity 
  12. How do you confirm a patient has sleep apnea?
    observation in sleep lab (polysmnography) 
  13. What does the sleep study include?
    • Chest motion detectors to measure respiratory effort
    • Flow detectors to measure nasal flow
    • Oximetry measure oxygen desaturation
  14. If nasal flow decrease & respiratory effort decreases then desaturation results in 
    central problem 
  15. Treatment for sleep apnea
    • Weight loss
    • Surgery
    • Respiratory stimulants
    • Tracheostomy
    • Nasal/mask CPAP and or NIPPV therapy 
  16. What is the maximum CPAP Level
  17. What should be used first CPAP or Bi-Level
    CPAP first 
  18. Initiate BPAP
    • Patient cant tolerate high pressures on CPAP
    • Continued obstructive respiratory events when patient reaches CPAP presure 15 cmH2O
  19. Indications for NPPV (BPAP,BiPAP)
    • Increases patients tolerance of PAP thearpy
    • To treat central sleep apnea
  20. When is a chest tube required?
    • Pneumothorax
    • Hemothorax
  21. Pneumothorax
    • Air enters pleural space with little or no fluid.
    • If air cant escape lung mediastinum is affected pushing it away from affected side=tension pnumothorax.
  22. Hemothorax or pleural effusion
    • Fluid enters pleural cavity with no air. 
    • Insert large bore needle to relieve pressure. Insert chest tube 
  23. Chest tube placement draining air
    Placed in anterior chest (second intercostal space in midclavicular line)
  24. Chest tube placement drain Fluid
    Placed in 4th or 5th intercostal space in midaxillary line. 
  25. Removing chest tube
    • Tube clamped 24hrs before removing tube.
    • Observed for respiratory distress 
    • X-ray taken
    • Just before removing tubes patient takes deep breath, exhales & performs valsalva maneuver. 
Card Set
Special Procedures
Respiratory Therapy