185 - Med Surg Exam 1 Flashcards
what are 4 types of oxygen devices?
Nasal cannula (1-6L)
Non-rebreather (10-15L, 100%O2)
Simple face mask (1-8L)
Venturi mask (1-10L)
AKA “oropharyngeal airway”
Inserted by tilting head back, opening mouth, and inserting airway
* Tip pointed toward the roof of mouth
Oral airway
Surgically created opening through the neck into the trachea
Causes:
- Resp. Failure
- Cancer (throat, thyroid, ect)
- Trauma (face, neck)
- Surgery
Tracheostomy tube
AKA “nasopharyngeal airway”
Soft rubber tube inserted through the nose and extended to the base of the tounge
Nasal Airway
Long tube inserted though the mouth or nose into the trachea
- Requires specialized training
Tubes are cuffed & have inflatable balloons that seal the trach preventing aspiration & facilitate mechanical ventilations
Endotracheal tubes
What are the 9 steps for suctioning traches?
- Sterile tech. & Face shield
- Lube on tubing
- Oxygenate patient before suction
- Open vent during cath. insertion
- Suction intermittently while rotating and moving cath back and forth while withdrawling
- Suction no longer than 10-15 seconds
- Rinse cath suctioning w/ NS
- Oxygenate patient after suction
- Document status before & after
What are the 10 steps for proper trach care?
- Standard precaution
- suction before removing old dressings
- Don sterile gloves
- Use sterile solution (NS) to clean the inner cannula
- Rinse and dry inner cannula. Reinsert into outer cannula
- Cleans stoma and surrounding skin
- Dont get solution into stoma
- Change tracheostemy ties
- Replace trach dressing w/ precut pad/ gauze
- Tie the ties at sides
What are 4 nursing responsibilities for a patient who has a trach?
- Keep airway clean
- Keep inner cannula clean
- Prevent impairment of surroundings
- Provide patient a means for communication
What are nursing interventions for a patient who has a trach?
Evaluate - Look for secretions & suction
Provide - Constant airway humidification/ oxygenation
Change/clean - All equipment q8h or PRN
Remove - Water condensed in equipment tubing
Provide - Mouth care (moisturize lips), communication board/ tablet, & safety
Device intended to mechanically control/ assist patients breathing by delivering predetermined % of O2 in breathing gas
Cause:
- Acute resp. failure who are unable to maintain adequate gas exchange in lungs
Ventilator
Delivers constant preset amount of oxygenated air into a patient
- Most common/used
Gives breath for certain amount of time
Volume cycled
Pushes air into lungs until a preset pressure is reached
Not widely used for continous mechanical vent
Delivers certain amount of pressure then cycles
Pressure cycled
Delivers oxygenated air during a preset length of time
- mostly used w/ infants & children
Gives breath for certain amount of time
Timed cycled
What are the 10 care essentials for patients on a vent?
- Review communication board
- Check vent settings (resp rate, tidal volume, peak (PIP))
- Suction appropriately
- Assess pain & sedation needs
- Prevent infection
- Prevent hemodynamic instability
- Manage airway
- Meet nutritional needs
- Wean off vent
- Education
What 6 interventions would you provide for a patient on a vent?
- Monitor settings to ensure they match
- Ensure high & low pressure alarms are set
- Have manual resuscitator & O2 avalible
- Don’t allow water to accumulate in tubing
- Monitor vitals & breath sounds, suction PRN
- Establish communication methods
Inserted from pleural space of lungs
Permits re-expansion of a collapsed lung in patients w/ hemo/pneumothorax, or plural effusion
Inserted at bedside or OR
- Places at 8th/9th intercostal space
Equipment:
- Collection chamber
- Water seal chamber
- Suction control chamber
Chest tube
Lung infection that occurs when a person is on a vent for a long period
- Bacteria enters through the tube entering the patients lungs
- Major complication
Incidences in US range from 2-16 episodes/1,000 vent days
Tx: IV antibiodics
Ventilater-Associated-Pneumonia
(VAP)
What are nursing interventions for a patient Dx with Ventilater-Associated-Pneumonia
(VAP)?
Keep HOB 30-45 degrees
Oral care to decrease bacterial growth
If intubated, provide sedation “vacations” & evaluate extubation readiness
- Reflected by vitals & ABGs
Peptic ulcer disease (PUD) prophylaxis
- Pepcid, protonix
DVT prophylaxis
- Lovenox, heparin
IV antibiodics
Bronchodilator
- Relaxes & dilates bronchial smooth muscles
Use: Asthma, emphasema, chronic bronchitis, ect (think lungs)
- Increases renal blood flow & anti-inflammatory
Side effects:
- Increase HR & BP
Interventions:
- vitals & safety
- Lung assessment
Theophylline
Benzodiazepine, anti-anxiety, muslce relaxant, anti-convulsant
- Short acting
Use: Sedative (given in pre-op)
- Amnesia effect, produces sleep
Side effects:
- Drowsiness
- Confusion
- Hypotension
- Hepatotoxicity
- Low HR
Interventions: Vitals
Antidote: Flumazenil (Romazicon)
Midazolam
Dissolves chemical bonds w/in mucus making it separate/ liquiefying/ reducing viscosity
- Given as nebulizer
Use: Pneumonia, emphysema, asthma, & bronchitis
Side effects:
- N/V
- Tachycardia
- Hypotension
- Rotten egg oder
- Bronchospams (adverse)
Interventions:
- Vitals
- monitor cough & bronchial secretions
- Record GI symptoms before/after therapy
Antidote for Tylenol OD - Given PO
Mucomyst (Acetyl Cysteine)
Inhibits interaction of acetylcholine at recepter site on bronchial smooth muscle, resulting in bronchodilation
Use: Asthma, long term Tx or reversible bronchospasms associated w/ COPD
Adverse:
- Mouth dryness
- Throat irritation
- Dizziness
- Nasal congestion
Serious effects:
- Tachycardia
- Urinary retention
- Exacerbation of symptoms
Interventions:
- Vitals
- monitor cough & bronchial secretions
- Record GI symptoms before/after therapy
Ipratropium (Atrovent)
Combination of anticholinergic bronchodilator & selective beta 2-adrenegic bronchodilators
Use: Treat/ prevent symptoms (wheezing/SOB) caused by ongoing lung disease (COPD, bronchitis, emphysema)
Side effect:
- headache
- Shaking, tremors
- Nervousness
- Dry mouth, stuffy nose
Interventions:
- Vitals
- monitor cough & bronchial secretions
- Record GI symptoms before/after therapy
Bromide/ Albuterol sulfate
(Duo-Neb)
Corticosteroid - PO
- Decreases inflammation
- Caution w/ Diabetes (increases BS)
Use: severe inflammation, MS, asthma, COPD, pulmonary fibrosis
Side effects:
- Weight gain
- Depression, mood changes
- Poor wound healing
- Decreased immunity
Patient teaching:
- DO NOT STOP ABRUPTLY
- Taper off as Dr. directed
Prednisone
Deficiency of Pituitary hormone (TSH - Secondary hypothyroidism)
Deficiency of TSH decreases secretion of thyroid hormones
S/s:
* Decreased metabolic rate
* Lethargy, forgetfullness, irritability
* Headache, constipation
* Decreased HR, dyspnea
* Swelling/edema, dry/thick skin
* Coarse hair
Tx:
* Hormone replacement therapy - most commonly Levothyroxine (Synthroid)
Hypothyroid