314 Oxygenation Flashcards
Normal changes in the respiratory system for aging adults are?
Rigid chest wall
Decreased lung capacity
Normal o2 sat 93-94%
Right sided heart failure presenting in JVD, ascites, hepatosplenimegaly, ankle edema can be associated with what respiratory disease
Chronic bronchitis
Prolonged exhalation, barrel shaped chest, chronic hypercapnia, and shallow respirations can be associated with what respiratory disease
Emphysema
What diagnostic tests are used for Copd
Spirometry (pulmonary function testing)
What is the role of the nurse with COPD
Education of medication management, self management, smoking cessation, o2 management.
What is the greatest risk factor for obstructive sleep apnea?
Obesity
What lab test or diagnostic studies are done for obstructive sleep apnea
Polysomnographic test
Complications of obstructive sleep apnea
Systemic hypertension
Cardiac arrhythmias
Heart failure
Stroke
What is the nursing role with obstructive sleep apnea regarding environmental factors?
Effective sleep environment
What is the nursing role with obstructive sleep apnea regarding safety considerations
Medications that cause sleepiness
What is the nursing role with obstructive sleep apnea regarding client education
Compliance with CPAP!
Avoid risk factors: smoking, alcohol, sedatives
What occurs when a substance enters the venous circulation and forms a blockage in the pulmonary vasculature?
Pulmonary embolism
Medical emergency
Person can breathe but blood can not oxygenate
DVT prevention is key to prevent what
Pulmonary embolism
Major risk factors for pulmonary embolism
Immobility.
Tobacco
Oral contraception
Pregnancy
Cancer
Trauma/ surgery
Advanced age
What diagnostics are used for pulmonary embolism
ABG analysis
D-dimer
Chest X-ray (rule out other condition)
Pulmonary angiography (1st choice and expensive)
VQ scan (2nd choice)
- compares ventilation and perfusion
What are treatments for pulmonary embolisms
Heparin drip
Thrombolytic therapy
Embolectomy
Vena cava filter placement
What is a pneumothorax
Lung collapse
Primary spontaneous pneumothorax usually occurs in what type of clients
Males between 20-30 with no underlying conditions
What procedure can increase the risk of a pneumothorax
Thorancentesis
A client with asymmetrical lung expansion, decreased breath sounds or absent breath sounds, and respiratory discomfort is presenting symptoms of what?
Pneumothorax
Manifestations of pneumothorax plus tachycardia
Hypotension
Tracheal deviation
Cyanosis
Would most likely have what
Tension pneumothorax
Blood in the pleural space associated with trauma is what
Hemothorax
What is flail chest
And what does it lead to
Inability to expand chest adequately with inhalation and contract upon exhalation on one side due to multiple rib fractures.
Leads to hypo ventilation with atelectasis.
Role of nurse with pneumothorax
Prepare client for chest tube insertion
Fear due to breathing difficulties and pain.
What conditions indicate chest tubes
Pneumothorax
Hemothorax
Pleural effusion
Pulmonary empyema
Post op chest drainage (open heart)
When a chest tube is being removed what is nurses role
Assist provider
Administer pain meds prior
Instruct patient to bear down (valsalva maneuver)
Cover site with petroleum gauze after
Obtain chest X-rays
Continue to monitor
What umbrella term includes acute respiratory failure and acute respiratory distress syndrome
Respiratory failure
Why are elderly patient more vulnerable to rapid respiratory decline
They have decreased lung elasticity.
Acute respiratory failure (ARF) is a state where a patient is unable to adequately ventilate and is caused how
Mechanical abnormality
Oxygenation failure (pneumonia)
Lung disorders
Can respiratory failure be seen on ABGs?
Yes.
As respiratory acidosis
Acute respiratory distress syndrome (ARDS) is caused by what
Sepsis, aspiration, pneumonia
What condition causes life threatening hypoxemia resulting from edema in the alveoli and loss of elasticity in the lungs
ARDS
What is VQ mismatch
Ventilation / perfusion not working how they should.
2 types
Dead space- ventilation with no perfusion
Intrapulmonary shunting- perfusion with no ventilation
Patient positioning for ARDS is how
Prone
Most common lower respiratory tract infection in children under 2
Bronchiolitis
Bronchiolitis is mainly viral from what infections
RSV
Influenza
Adenovirus
Increased risk for Bronchiolitis are patients who…
Preterm infants
Lung disease
Congenital heart disease
Immunodeficiency
Young. (Less than 3mo)
If a baby has Bronchiolitis what important education is needed for parents
Don’t kiss baby
Hand hygiene
Role of nurse in Bronchiolitis
Encourage hydration
Suction upper airway
Monitor for signs of respiratory failure
Supplement oxygen for less than 90%
PPE
Support family
What types of pneumonia are there
Bacterial
Viral
Aspiration
Who is more at risk for increased incidence of pneumonia
Older adults
Chronic lung disease
Lab testing diagnostics for pneumonia
Chest xray
Influenza presents how. (FACTS)
Fever
Aches
Chills
Tiredness
Sudden onset
What assessment tools are used with asthma patients
Vs
Lung sounds
Peak flow
ABG
Peak flow less than 50% of your normal is a signal of what
Airways narrowing. Medical alert!
Status asthmaticus treatment
Ventilatory support required!
Medical emergency
Pulses paradoxus can be a symptom of what non cardiac event
Status asthmaticus
What is the difference between pediatric and older adults when considering water in the human body
Pediatric have higher %
Older adults have lower %
The intravascular fluid, trans cellular fluid and interstitial fluid are components of what
Extracellular fluid
Crystalloids or colloids. Which is larger?
Colloids. Exert oncotic pressure.
What’s the difference between hypertonic dehydration and hypotonic dehydration
Hypotonic= more Na loss= fluid shifting from ECF to ICF.
Hypertonic = more h2o loss than Na = higher Na level= fluid shifting from iCF to ECF
Vital signs of dehydration
Hypo or hyperthermia
Tachycardia & weak pulse
Hypotension
Tachypnea
Lab values for dehydration
Hemo concentration
Increased urine specific gravity
How often do you monitor weight during fluid replacement with dehydration
Every 8 hr
What’s the difference between fluid overload and hypervolemia?
Fluid overload = hemodilution
Hypervolemia= no hemodilution
Fluid overload signs and symptoms
(Don’t have to name them all…)
HTN
Tachycardia -bounding pulse
Tachypnea
Vision changes
Altered LoC
Liver enlargement
Dyspnea
Crackles
Edema
JVD
Increased motility
Positioning for fluid volume excess
Semi Fowler or Fowler. Reposition frequently for skin maintenance
How often do you weigh for fluid overload
Daily
Fluid volume overload complications
Heart failure
Water intoxication
Pulmonary edema
Pulmonary edema interventions
High fowlers
Supplement O2, cpap/bipap, mechanical vent
Morphine, nitrates, diuretics (must assess BP first!!)
A patient present with frothy pink tinged sputum, tachycardia, anxiety, JVD, crackles and Dyspnea at rest. What is suspected
Pulmonary edema
