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CRT/RRT (NBRC) FULL REVIEW EXAM STUDY GUIDE GRADED A 2024, Exams of Nursing

University of Wales Nursing

CRT/RRT (NBRC) FULL REVIEW EXAM STUDY GUIDE GRADED A 2024/CRT/RRT (NBRC) FULL REVIEW EXAM STUDY GUIDE GRADED A 2024/CRT/RRT (NBRC) FULL REVIEW EXAM STUDY GUIDE GRADED A 2024/CRT/RRT (NBRC) FULL REVIEW EXAM STUDY GUIDE GRADED A 2024/CRT/RRT (NBRC) FULL REVIEW EXAM STUDY GUIDE GRADED A 2024

Typology: Exams

2023/2024

Available from 04/10/2024

zachbrown 🇺🇸

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CRT/RRT (NBRC) FULL REVIEW EXAM

STUDY GUIDE GRADED A 2024

Ascites - accumulation of fluid in the abdomen caused by LIVER FAILURE

Venous distention - -occurs with CHF

-seen with obstructive patients (seen in exhalation phase)

Capillary refill - -indication of peripheral circulation

-Normal < 3 seconds

Jaundice skin color - -increase in bilirubin.

-mostly in face and trunk

Bradypnea (oligopnea) - -decreased respiratory rate (<12bpm) variable depth and

irregular rhythm

Hyperpnea - -increased rate, depth, with regular rhythm

Cheyne-Stokes - -gradually increasing then decreasing rate and depth in a cycle lasting

from 30 - 180 secs, with apnea up to 60 secs

-increased ICP, meningitis, overdose

Biots - -increased rate and depth with irregular periods of apnea

-CNS problem, head/brain injury

Kussmaul's - -increased rate, depth, irregular rhythm, breathing sounds labored

-Raspy voice

Apneustic - prolonged gasping inspiration followed by extremely short, insufficient

expiration

-respiratory center problems, trauma, tumor

cachectic - muscle atrophy/loss of muscle tone

retractions - -chest moves inward during inspiratory efforts instead of outward

-blocked airway in adults = INTUBATE

-RDS in infants

Character of cough - -dry, non-productive cough may indicate tumor in the lungs or

asthma

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Download CRT/RRT (NBRC) FULL REVIEW EXAM STUDY GUIDE GRADED A 2024 and more Exams Nursing in PDF only on Docsity!

CRT/RRT (NBRC) FULL REVIEW EXAM

STUDY GUIDE GRADED A 2024

Ascites - accumulation of fluid in the abdomen caused by LIVER FAILURE Venous distention - - occurs with CHF

seen with obstructive patients (seen in exhalation phase) Capillary refill - - indication of peripheral circulation
Normal < 3 seconds Jaundice skin color - - increase in bilirubin.
mostly in face and trunk Bradypnea (oligopnea) - - decreased respiratory rate (<12bpm) variable depth and irregular rhythm Hyperpnea - - increased rate, depth, with regular rhythm Cheyne-Stokes - - gradually increasing then decreasing rate and depth in a cycle lasting from 30 - 180 secs, with apnea up to 60 secs
increased ICP, meningitis, overdose Biots - - increased rate and depth with irregular periods of apnea
CNS problem, head/brain injury Kussmaul's - - increased rate, depth, irregular rhythm, breathing sounds labored
Raspy voice Apneustic - prolonged gasping inspiration followed by extremely short, insufficient expiration
respiratory center problems, trauma, tumor cachectic - muscle atrophy/loss of muscle tone retractions - - chest moves inward during inspiratory efforts instead of outward
blocked airway in adults = INTUBATE
RDS in infants Character of cough - - dry, non-productive cough may indicate tumor in the lungs or asthma

productive cough may indicate infection evidence of difficult airway - - short receding mandible (chin)
enlarged tongue (macroglossia)
bull neck
limited neck range-of-motion pulsus paradoxus - - pulse/blood pressure varies with respiration. may indicate severe air trapping (status asthmaticus or cardiac tamponade) tactile fremitus - - vibrations felt by hand on chest wall
vocal fremitus: voice vibrations on the chest wall
pleural rub fremitus: grating sensation due to roughened pleural spaces
Rhonchial fremitus(palpable rhonchi): secretions in airways Crepitus - - bubbles of air under skin that can be palpated and indicates subcutaneous emphysema Resonant percussion - - hollow sound
normal lungs Flat percussion - - heard over sternum, muscles, or areas of atelectasis Dull percussion - - heard over fluid-filled organs such as heart or liver (thudding)
pleural effusion or pneumonia Tympanic percussion - - heard over air-filled stomach.
drum-like sound and when heard over lung = increased volume Hyperresonant - - found where pneumothorax or emphysema is present.
booming sound vesicular breath sounds - normal sounds in lungs bronchial breath sounds - - normal sounds over airways.
breath sounds over lungs indicate LUNG CONSOLIDATION Egophony - - patient instructed to say E and sounds like A.
lung consolidation Bronchophony / whisphered pectoriloquy - - increased intensity or transmission of the spoken voice and indicate CONSOLIDATION or PNEUMONIA
increase in spoken voice = consolidation
decrease in spoken voice = obstructon, pneumo, emphysema Rales - - crackles

Bruits - - sounds made in an artery or vein when blood flow becomes turbulent or flows at an abnormal speed.

usually heard via stethoscope over the identified vessel (carotid artery) Blood pressure - - systolic and diastolic pressures
sphygmomanometer to measure cuff pressures
↑BP = cardiac stress = hypoxemia
↓BP = poor perfusion = hypovolemia, CHF Costophrenic Angle - - angle made by the outer curve of the diaphragm and the chest wall
obliterated by pleural effusions and pneumonia Diaphragm - - dome shaped normally
flattened with COPD
hemidiaphragms may shift downward with pneumothorax
right hemidiaphragm is level of 6th anterior rib and slightly higher than the left
right lung: 55% and appear larger than left lung Lateral decubitus CXR - - patient lying on affected side
detecting small pleural effusions End expiratory film - - taken when patient is at end-exhalation
detecting small pneumothorax/foreign body aspiration (FBA) Position of ET/Tracheostomy tube - - tip should be positioned below the vocal chords and no closer than 2 cm or 1 inch above the carina.
approx same level of the aortic knob/arch
observation and auscultation will quickly determine adequate ventilation before CXR is taken
cuff should not extend over the end of the ET or tracheostomy tube Pacemaker, catheters, Etc. - - pacemaker should be positioned in the right ventricle
PAC should appear in right lower lung field
central venous catheters are placed in the right or left subclavian or jugular vein and should rest in the vena cava or right atrium
chest tubes should be located in the pleural space surrounding the lung
NG tubes should be in stomach 2-5 cm below the diaphragm Croup (laryngotracheobronchitis) - - viral disorder
narrowing subglottic swelling
steeple/picket fence/pencil sign
gradual onset
infants
Mist tent, O2, Racemic epi, corticosteroids
barking cough

Epiglottitis - - bacterial infection

supraglottic swelling with an enlraged and flattened epiglottis and swollen aryepiglottic folds
Thumb sign
Rapid onset
pediatrics
provide airway and antibiotics Computerized Tomography (CT scan) - - X-ray through a specific plane and appear as slices of organs/body parts
diagnosis of bronchiectasis
spiral CT scan w/ contrast dye for PE Magnetic Resonance Imaging (MRI) - - 2D view without use of radiation
used for determining thoracic aneurysms, congenital abnormalities of the aorta and major thoracic vessels esp. the hilar area
able to locate precise position of tumors V/Q scan - Ventilation scan
- Radioisotope (xenon) gas is inhaled
- and obstruction to airflow will allow little gas to enter Perfusion scan
- albumin, tagged with radioactive iodine is injected into a peripheral vein and lodges in the pulmonary capillaries
- scanned over chest and shows distribution and volume of perfusion Ventilation with no perfusion = PE (deadspace disease) Barium swallow (esophagram) - - for diagnosing of abnormalities in the hypopharynx, esophagus, or stomach
ingested and traced through the hypopharynx and into the esophagus via fluoroscope and xray at the end
suspected esophageal malignancy, dysphagia, congenital defect in hypopharync, esophagus, gastric reflux, esophageal varices. Positron Emission Tomography (PET scan) - - for determining cancer, brain disorders and heart disease
injected with radioactive substance bronchography (bronchogram) - - injection of radio-opaque contrast into tracheobronchial tree
study of OBSTRUCTING LESIONS (tumors) and BRONCHIECTASIS
better administration of postural drainage

used to monitor asthma patient's response to anti-inflammatory (corticosteroid) treatment
decrease in FENO suggests a decrease in airway inflammation Sputum colors - Clear = normal Mucoid = white/gray, chronic bronchitis Yellow = presence of WBC, bacterial infection Green = stagnant sputum, gram neg bacteria (Bronchiectasis, pseudomonas Brown/dark = old blood Bright red = hemoptysis (bleeding tumor, TB) Pink frothy = pulmonary edema Sputum tests - sputum culture = identify bacteria present (days) Sensitivity = identify what antibiotics will kill bacteria Gram Stain = whether Gram positive or negative (5mins) Acid Fast Stain = identify mycobacterium tuberculosis can be done on blood, urine, and pleural samples. collect samples prior to mouthcare, meals, and treatments Oscilloscope - - provides a continous visual image of the electrical activity of the heart on a screen
displays rapid changes in voltage as a moving line on a phosphorescent screen Four Critical Life Functions - - Ventilation
Oxygenation
Circulation
Perfusion Signs - - Objective information
things that can be seen or measured Symptoms - - subjective information
things that the patient must tell you Respiratory care orders - - type of treatment
frequency
medication dosage and dilution
physician signature CALL MD IF MISSING CVP abnormalities - - decreased CVP = hypovolemia
increased CVP = hypervolemia

Katz ADL - - Activities of Daily Living: Bathing, eating, dressing, toilet, transferring, urine and bowel continence

patient is unable to perform or needs assistance = score of ZERO
patient needs no direction or assistance = score of ONE
6 = independent
4 = impairment
2 = severe impairment General malaise - - run down feeling, nausea, weakness, fatigue, headache
ELECTROLYTE IMBALANCE Diagnosis of Pulmonary Embolism (PE) - - Pulmonary Angiography
V/Q Scan
Spiral CT Scan Chest ECG electrodes - - V1 = 4th intercostal space on right side of sternum
V2 = 4th intercostal space on left side of sternum
V3 = between V2 and V4 on left side
V4 = 5th intercostal space, left mid-clavicular line
V5 = between V4 and V6 on left side
V6 = 5th intercostal space, left mid-axillary line Estimating heart rate on ECG - - two R waves between 3-5 large boxes = normal
two R waves closer and 3 large boxes = tachycardia
two R waves wider than 5 large boxes = bradycardia Sinus Bradycardia - Rate less than 60 Treat with Oxygen/Atropine Multifocal PVC - Premature Ventricular Contraction (PVCs) - Ventricular Tachycardia (V-Tach) - Ventricular Fibrillation (V-Fib) - Asystole - 1st Degree AV Block - 2nd Degree AV Block - 3rd Degree AV Block -

Swan-Ganz Catheter - - When the balloon is inflated, the catheter will WEDGE and the back pressure from the pulmonary capillary will be measured

measuring PAP = balloon deflated
double spike (dicrotic notch) is normal for PAP
Pressure Dampening = obstructed catheter (blood clot, bubble, kink)
if a blood clot occurs: ASPIRATE-FLUSH-ROTATE catheter Oropharyngeal Airway - - UNCONSCIOUS PATIENT
supports base of tongue
Bite block
facilitate oral suctioning
should be left unsecured
gagging: remove-suction-oxygen Nasopharygeal Airway - - CONSCIOUS PATIENT
supports base of tongue
facilitate deep tracheal suctioning
decrease trauma during NT suctioning
increased airway resistance (USE LARGEST SIZE)
inserted anatomically shaped with lubricant NARCAN - - Narcan - Narcotic overdose
Atropine - Bradycardia
Valium/Versed - Sedation
Epinephrine - Asystole
Lidocaine - PVC
X2 normal IV dose + 10 mL saline Cuff Pressures - - 20 mmHg / 25 CM H
5 - lymphatic - edema
10 - vein - edema
20 - artery - necrosis
Low pressure, high volume, high compliance, floppy cuff is preferred Cricoid Pressure - - Sellick maneuver
indicated if larynx is in an anterior location Assessment of Tube Position - - Inspect for bilateral chest expansion
Ausculate for bilateral breath sounds
Capnography or CO2 detectors
Chest X-ray 2cm or 1 inch above carina or at aortic knob/notch Laryngoscope - - mac: into vallecula, indirectly raises epiglottis
miller: directly under and lifts the epiglottis (infants)

tighten bulb, check handle attachment, change blade, check batteries Stylet - - recessed 1 cm above tip of ET tube Laryngoscope Blade Sizes - Adult: 3 Pediatric: 2 Term infant: 1 Pre-term infant: 0 ET Tube Size - pre-term: 2.5 - 3 Full term: 3.0 - 3. Adult: wt in kg / 10 Adult male: 8 - 9 Adult female: 7 - 8 Tube Markings - Oral Intubation: 21-25 cm mark at patient's lips Nasal intubation 26-29 cm mark at patient's nares Double-Lumen ET tube - - Endobronchial/Carlen's tube
can ventilate one lung separately
two cuffs: distal cuff is high pressure, low volume for mainstem bronchus tube
during pneumonectomies, lobectomies
for bronchopleural fistulas etc Esophageal Tracheal Combitube - - for emergency airway management
if placed in trachea, distal balloon will seal trachea(ET tube) and clear #2 is used for ventilation
if placed in esophagus, distal balloon will occlude esophagus
ventilation will be provided through blue #2 longer tube Laryngeal Mask Airway (LMA) - - positioned directly over trachea (hypopharynx)
standard ET tube can be inserted directly through LMA into the trachea
short term ventilation Hi-Lo Evac Tubes - - for Continuous Aspiration of Subglottic Secretions (CASS)
continuous suction via separate pilot tube @ 20 mmHg
reduce VAP Extubation - - inspire deeply
remove tube at PEAK INSPIRATION to prevent vocal cord damage MARKED distress/stridor = reintubate moderate stridor = O2-Cool Mist-Racemic epinephrine mild stridor = humidity, O2, Racemic epinephrine Tracheostomy - - for long term ventilation

unilateral consolidation - - place the affected lung up to allow it to drain and to increase perfusion to the unaffected lung

BAD LUNG UP, GOOD LUNG DOWN Postural Drainage Position - Left upper and right middle lobe: 15 degrees and 12- 14 inches up Lower lobes: 30 degrees and 18 inches up Chest Percussion - - used in combination with postural drainage not for PE, pleural effusion, tuberculosis and untreated pneumothorax Positive Expiratory Pressure (PEP) Therapy - - applying positive pressure using a one- way inspiratory valve and a one-way expiratory resistor
expiratory pressure from 10 - 20 cmH20 at mid-exhalation
used for 15-20 mins 3-4x/day
improve secretion expectoration, reduce RV (decrease hyperinflation) and improve airway maintenance (CF, pneumonia)
discontinue if sinusitis, epistaxis or ear infection occurs
inspire larger than normal VT and exhale actively but NOT forcefully. exhalation 2-3x longer than inspiration Autogenic Drainage - - primarily for CF and bronchiectasis
breathe at low lung volumes to loosen secretions from the small airways
helps to accumulate secretions in the middle airways
during the last stage the patient breathes at high lung volumes Intrapulmonary Percussive Ventilation - - Combination of high frequency pulse delivery (100-250 cycles/min of a sub-tidal colume and a dense aerosol
percussive effect of gas delivery improves ventilation past obstructions in the airway thereby delivering more aerosol to the distal airways.
Dense aerosol delivery promotes bronchial hygiene, reduces edema, and relieves bronchospasm with the appropriate medications
starting source pressure is 30 psi Discontinuing bronchial hygiene - - clear breath sounds and x-ray
ambulating well
strong cough
afebrile for 24 hours
hazards occur (dizziness, SOB, cyanosis, etc.) iatrogenic hypoxemia - induced by a physician's words or therapy (used especially of a complication resulting from treatment) can be caused by suctioning

Suction Pressures - Adult: 100 - 120 mm Hg Child: 80 - 100 mm Hg Infant: 60 - 80 mm Hg Coude tip catheter - suction catheter angles to help suction the LEFT main stem bronchus Closed system/inline suction catheter (Ballard) - - allows patient to recieve ventilation and oxygenation during suctioning

for pt with high oxygen/PEEP requirements, pulmonary infections, frequent suctioning and hemodynamic instability Catheter sizes - - ideal length is 20 - 22 inches
external diameter of the suction catheter should be no greater than 1/2 the inside diameter of ET/trach tube Lukens trap/sterile suction trap - - collect sputum specimen
placed in an upright position between the suction catheter and the suction tubing
flush catheter with sterile water or isotonic saline
saline for cytology samples Change size and type of catheter if - - difficulty removing secretions (verify appropriate size for airway)
change to Coude Catheter for LEFT main stem bronchus
change to closed system if pt has an infection, PEEP, or frequent desaturation Altering negative pressure - - increase negative pressure to remove thick tenacious secretions
do not exceed appropriate pressures Instill irrigating solutions - - 5 - 10 mL of normal saline to dilute secretions too thick to aspirate
5 - 10 mL of 10% solution of Acetylcysteine (Mucomyst) can be used for thick tenacious secretions + bronchodilator Troubleshooting Suctioning procedure - - check catheter for patency
assure vacuum is working/appropriate pressure
change or empty a full collection bottle
check all connections Bubble humidiifier - - incorporates pressure pop-pff valves set at 2 psig/40 mm Hg
check by occluding or pinching the connection tubing and listen for whistling sound
if no sound = leak

LVN + blender - - set blender at desired FiO

Set LVN air entrainment @ 100% Scavenger systems - - removes medications not inhaled by the patient
commonly used when administering Pentamidine and Ribavirin Ultrasonic Nebulizers - - uses vibrational energy
highest output range
clean with acetic acid
for thick and tenacious secretions increasing mist in USN (troubleshooting) - - check for low fluid
increase amplitude (volume)
increase blower flow and check filter
check for water in tubing
DO NOT adjust frequency (factory)
not grounded Metered Dose Inhaler - - 1 to 2 inches off mouth
inhale slowly and press once
hold breath for 10 seconds
if quick relief, wait one minute in between puffs, no wait with other meds Modifying Therapy - - change type equipment (USN for thick secretions)
change dilution of medication
adjust temp of aerosol (jet nebulizer @ 37 C)
modify breathing patters (slow/inspiratory hold)
change aerosol output (tandem set up) Alpha Response - - Vasoconstriction
blood pressures Beta 1 Response - - increase rate (chronotropic) and strength of contraction (inotropic) of cardiac muscle
cardiac drugs Beta 2 response - - Bronchodilator If bronchospasm/wheezing persists - - increase to max dose first then increase frequency Methylxanthines - - side door bronchodilators
theophylline 10-20mg/mL
theophylline is also given to increase diaphragmatic contractility and stimulate CNS in infants with apnea of prematurity.
Serum levels are kept at 5 - 10 mcg/mL in neonates and children

Nystatin - - antifungal agent to treat thrush

rinse mouth with water after ICS treatment Acetylcysteine (Mucomyst) - - liquify thick tenacious secretions
ACETAMINOPHEN OVERDOSE
give bronchodilator prior to acetylcysteine
3 to 4 mL of 10 - 20% Hypotonic Saline - - 0.45% saline
liquefying secretions and humidifying the airway Hypertonic Saline - - 15% saline
induce sputum specimens, can irritate the airway and cause bronchospasm or secretion obstruction Leukotriene modifiers - - Non-steroid drugs for mild to moderate persistent asthma
Montelukast, Zafirlukast, Zileuton Cardiac Glycosides - - for CHF (increases CO; inotropic)
digitalis (crystodigin)
digoxin (Lanoxin) Lidocaine - - PVC
pulseless v-tach/v-fib procainamide - - Pronestyl
Ventricular ectopic beats, v-tach, and atrial arrythmias atrial arrhythmias - quinidine, propanolol(inderal) verapamil - - control ventricular rates in narrow complex SVT amiodarone - - pulseless VT and V-fib that has not responded to defibrillation Bradycardia - - atropine
epinephrine Angina - - Nitroglycerin
isordil Vasopressors - - alpha adrenergic
increases BP
norepinephrine (levophed) =cardiogenic shock
Dopamine and dobutamine

Antibiotics - - cillins = gram positive

myacins = gram negative
coccus = gram positive
everything else = gram negative
common side effect: diarrhea
Vancomycin = MRSA Antiviral agents - - Ribavirin = treat RSV
RSV Immune Globulin IV (RespiGam) = prevention of RSV
palivizumab (Synagis) = man-made antibody to RSV pentamidine - - treat Pneumocystis Jirovecii (carinii) infections (commonly with AIDS)
must use one way valve and bacteria filter to avoid spreading Vaccines - - against influenza and staphylococcus pneumoniae = Pneumovax for > 60 yrs
Children at risk for RSV should be immunize with RespiGam and Synagis Patient Positions - - Prone = ARDS
Fowler's = CHF
Lateral Fowler's = obese
good lung down for unilateral lung disease Sustained Maximal Inspiration (SMI) - - Prevention of atelectasis
Date, time, volume should be charted (not durations)
must be taught before surgery
auscultate BS before and after
Inhale! not exhale IPPB Indications - - Prevent or correct atelectasis in patients unable to take a deep breath
prevent/decrease pulmonary edema
decrease WOB
mechanical bronchodilation
distribute aerosols more evenly
Hazards include: hyperventilation (breathe slower), Impeding venous return, pneumothorax
contraindications: pulmonary hemorrhage, untreated pneumothorax Bird Mark 7 - - Pressure Cycled
increase flow = decrease i-time
Air mix off = 100% source gas, low flow rate because air not entrained, increase flow setting when air mix off
pressure limit controls volume

Bird Mark 7 changes that affect FiO2 - - increase pressure will increase FiO

decrease flow will increase FiO
Air mix off will give 100% FiO
use of nebulize will increase FiO2 on PR-II
Use of terminal flow on PR-2 will decrease FiO Bird Mark 7 control changes that affect volume - - increasing pressure will increase volume
decreasing flow will increase volume
increasing the flow will decrease volume Bird Mark 7 control changes that affect the I:E ratio - - increased pressure will increase i- time and change I:E
increased flow will decrease i-time
increased rate will decrease e-time IPPB Troubleshooting - - Loss of pressure = leak, low flow
Excessive pressure = obstruction, excessive flow
fail to cycle into inspiration = sensitivity, seal around mouthpiece
fail to cycle into expiration = leak (mouthpiece, cuff, trach tube, loose connection)
Pressure does not rise normally (needle reads low or negative) = insufficient flow Mask CPAP - - short term, temporary use
CO poisoning
pneumonia
post-op atelectasis, etc. Nasal CPAP - - neonates since they are obligate nose breathers
readjust nasal prongs if losing CPAP Troubleshooting CPAP - - loss of pressure = leak, insufficient flow
increased pressure = obstruction, excessive flow Non-Invasive PPV (NPPV) - - avoid intubation in patients with COPD, CHF, and pulmonary edema
long term ventilation at home
periodic support with NMD, restrictive chest wall, sleep apneas General Considerations of NPPV - - patient with uncomplicated obstructive sleep apnea started @ EPAP of 5-10 cmH2O
patient started on EPAP for hypoxemia at 6-8 cmH2O and increased as necessary
patients with NMD @ 10-15 cmH2O
low level of EPAP (5cmH2O) prevents small airway collapse on exhalation
oxygen must be titrated into the system to achieve desired FiO
IPAP always greater than EPAP
I:E of 1:2 preferred

CRT/RRT (NBRC) FULL REVIEW EXAM STUDY GUIDE GRADED A 2024, Exams of Nursing

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Download CRT/RRT (NBRC) FULL REVIEW EXAM STUDY GUIDE GRADED A 2024 and more Exams Nursing in PDF only on Docsity!

CRT/RRT (NBRC) FULL REVIEW EXAM

STUDY GUIDE GRADED A 2024