Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Older Adults Pt 2 > 6.1 Respiratory Part 1 > Flashcards

6.1 Respiratory Part 1 Flashcards

1
Q

Respiratory ABC’s

A

A - Airway
B - Breathing
C - Circulation

Cannot have B without A, and cannot have C without B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Oxygen Therapy

A
  • Mainstay of initial treatment
  • Advanced airways used as a last resort
  • Medications used to reduce infection/inflammation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Work of Breathing

A
  • The amount of oxygen/energy consumption needed by respiratory muscles to produce enough ventilation/respiration to meet metabolic demands of the body
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Assessment

A
  • Accessory Muscles to Breathe (Retractions)
  • Skin color
  • Nasal Flaring
  • Pursed Lip Breathing
  • Symmetrical Chest Expansion
  • Ability to communicate in full sentences
    VITALS
  • Pulse oximetry
  • Breath sounds
  • Full vitals
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Room Oxygen

A
  • Room air is 21% oxygen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Oxygen Therapy

A
  • Administration of supplemental oxygen greater than 21%
  • Decreases work of breathing
  • Reduces myocardial stress
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Hypoxemia

A
  • Decrease in arterial oxygen in the blood
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Hypoxia

A
  • Decrease in oxygen supply to the tissue

- Can be caused by problems outside the respiratory system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Causes of Hypoxemia

A
  • Sepsis
  • Fever
  • Anemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Low Oxygen Delivery Systems

A
  • Nasal Canula
  • Simple Mask
  • Partial Re-breather
  • Non Re-breather
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

High Flow Oxygen

A
  • High flow nasal canula
  • Venturi Mask
  • Noninvasive Positive Pressure Vent (NPPV)
  • BIPAP
  • CPAP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Nasal Canula

A

1 - 6 Liters per Minute
- Max 4 L/min with humidifier

  • Maintain oxygen at >92% except for patients with COPD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Fio2 (Nasal Canula)

A
  • Fraction of Inspired Oxygen and Gas Mixture
Room Air = 21% Fio2
Additional 4% for each liter of oxygen delivered
1 L/min = 24%
2 L/min = 28%
3 L/min = 32%
4 L/min = 36%
5 L/min = 40%
6 L/min = 44%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Nursing TIP (Nasal Canula)

A
  • Constantly assessing and re-evaluating patient
  • Data is gathered for oxygen via ABG’s, Pulse Oximeters, and Capnography (measures amount of exhaled carbon dioxide) - Usually around 35-45 mmHg
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Simple Mask

A
  • Oxygen varies from 40-60%
  • Minimum flowrate is 40% = 5 L/min
  • 55-60% = 8 L/min
  • Delivered temporarily after surgery while recovering or if there is rapid change in patients oxygenation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Nursing TIP (Simple Mask)

A
  • Assess for signs of respiratory distress

Use of accessory muscles, nasal flaring, prolonged capillary refill >3 seconds, reports of dyspnea or SOB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Partial Re-breather

A
  • 60-75% Fio2 = 6-11 L/min
  • Used for patients with extremely low levels of oxygen
  • Mask with reservoir bag
  • Make sure bag is always inflated
  • Educate patient on making sure to not kink the bag
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

NURSING TIP (Partial Re-breather)

A
  • Medical history will tell you what you need to look out for in patients
  • A-fib can cause blood clots which may cause hypoxemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Non Re-breather

A
  • 10-15 L/min
  • Mask with reservoir bag and exhalation ports to prevent room air from entering
  • Highest oxygen to be delivered from low oxygen delivery systems
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

NURSING TIP (Non Re-breather)

A
  • Oxygen greater than 50% for 24-48 hours can cause injury to the lungs
  • Can cause crackles upon auscultation, cough and dyspnea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

High Flow Nasal Canula

A
  • 30-60 L/min with combination of heat and humidity
  • Decreases mucous membrane damage and better tolerated
  • Used for a lot of COVID patients
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Nursing TIP (High Flow Nasal Canula)

A
  • Humidifiers are a source of infection

- Be sure to change out humidifiers as per hospital policy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Venturi Mask

A
  • High flow oxygen Fio2 24-50%
  • Each color valve can deliver a different flow of oxygen
    Blue - 24% Fio2 - 3 L/min
    Orange - 50% Fio2 - 15 L/min
  • Used for patients with “hypoxic drive”
  • Includes COPD patients
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Noninvasive Positive Pressure Vent (NPPV)

A
  • Also commonly used for patients with COPD, hypercarbia and acute asthma attack.
  • Allows alveoli to open and prevent intubation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

BiPAP-

A
  • Bilevel Positive Airway Pressure
  • 2 pressure settings allowing more air to get in and out
  • Used for atelectasis post surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

CPAP

A
  • Goal is to expand collapsed alveoli
  • Continuous positive airway pressure
  • Specific setting that remains throughout the night. Patients may have difficulty exhaling due to constant positive pressure
  • Common for OSA (Sleep Apnea)
  • Used for Atelectasis post surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Oxygen Toxicity

A
  • Lung damage from too much supplemental oxygen
  • Occurs when oxygen levels greater than 50% is administered for an extended period of time
    MANIFESTATIONS
  • Substernal discomfort
  • Dyspnea
  • Progressive respiratory difficulty
  • Fatigue
  • Malaise
  • Paresthesia
  • Restlessness
  • Alveolar Atelectasis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Oxygen Toxicity Management

A
  • PREVENTION IS THE BEST MANAGEMENT
  • Use lowest effective concentrations of oxygen
  • Use of CPAP to prevent/reverse atelectasis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Upper Airway Obstruction

A
  • Rapid assessment essential (inspection, palpation, auscultation)
  • Call code team
  • Airway is priority (emergency endotracheal intubation)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Endotracheal Intubation

A
  • Passing endotracheal tube (ETT) through mouth or nose into trachea
  • Provides patent airway
  • Allows for mechanical ventilation and removal of secretions
31
Q

After Intubation of Endotracheal Tube

A
  • Check symmetry of chest expansion
  • Auscultate chest sounds both anterior and posterior
  • Obtain capnography as indicated
  • X-ray to ensure proper tube placement
  • Check cuff pressure every 6-8 hours
  • Monitor for aspiration
  • Ensure high humidity (should be able to see mist in T-piece)
  • Administer O2 concentration as prescribed by provider
  • Secure tube with tape (cut ends if longer than 3 inches to prevent kinking)
  • Insert mouth device to prevent patient from biting the tube
  • Use sterile suctioning to prevent infection
  • Prevent atelectasis by repositioning patient every 2 hours
  • Provide suction and oral hygiene as needed
32
Q

Extubation (removal of ETT)

A
  • Explain procedure
  • Have self-inflating bag and mask ready incase ventilatory assistance is needed after extubation
  • Suction tracheobronchial tree, remove tape, deflate cuff
  • Give 100% oxygen for a few breaths and insert new sterile suction catheter inside
  • Have patient inhale, and at peak inspiration, remove the tube and suctioning airway as being pulled out.
33
Q

Post Extubation

A
  • High Fowler position give heated/humidified face mask oxygen
  • Monitor RR, chest excursion, stridor, color change, mental status
  • Monitor O2 Saturation (pulse ox)
  • Patient should be NPO (only ice chips)
  • Provide oral hygiene
  • Educate patient on deep breathing exercises
34
Q

Endotracheal Tube Complications

A

D - Displacement of ETT
O - Obstruction of tube/airways
P - Pneumothorax (air in pleural spaces)
E - Equipment Failure

35
Q

Tracheostomy

A
  • Used with complete airway obstructions that cannot be passed by ETT
  • May also be used for patients who have had a prolonged ETT
  • Opening of airway directly into trachea
  • Have extra trach tube and smaller size next to bed at all times
  • Always have suctioning equipment ready to maintain patency
  • Hyperoxygenation patients before suctioning
  • Patient should be in semi-fowler position
36
Q

Non Invasive Positive-Pressure Ventilation (NIPPV)

A

CPAP/BiPAP

  • May eliminate need for ETT or tracheostomy
  • Used during respiratory arrest, serious dysrhythmias, cognitive impairment, head/facial trauma
37
Q

Nursing Process CPAP/BiPAP

A
38
Q

Systemic Assessment of All Body Systems

A
  • Vitals
  • Oxygen status
  • Secretions
  • Neurological Status
  • Coping/Emotional Needs
  • Comfort Level
  • Ability to communicate
39
Q

Equipment Assessment

A
  • Collaborate with Respiratory Therapist (RT)
  • Device Settings
  • Evaluation of Alarms
  • Check tubes, oxygen source, and seal of mask on patient
40
Q

Goals

A
  • Maintain patent airways and gas exchange
  • Absence of trauma/infection
  • Attain optimal mobility
  • Adjustment to non-verbal methods of communication
  • Successful coping measures
41
Q

Nursing Diagnosis

A
  • Impaired gas exchange
  • Ineffective airway clearance
  • Risk for trauma
  • Impaired physical mobility
  • Impaired verbal communication
  • Defensive coping
  • Powerlessness
  • Anxiety related to CPAP, BiPAP, Hypoxia
42
Q

Collaborative Problems

A
  • Requires working with RT
  • Alteration in cardiac function
  • Barotrauma from high pressure oxygen delivery (injury from air pressure)
  • Pulmonary infection
  • Sepsis
  • Delirium
43
Q

NURSING INTERVENTIONS

A
44
Q

Enhancing Gas Exchange

A
  • Good use of analgesics without suppressing respiratory drive
    (Especially important for surgical patients)
  • Frequent repositioning to diminish effects of immobility
  • Monitor fluid balance by assessing peripheral edema, I&O, daily weights
  • Administer medication to control primary disease
45
Q

Chest Physiotherapy (CPT)

A
  • Postural drainage (drainage of lung secretions via gravity)
  • Chest percussion/vibration
  • Breathing retraining
    GOALS
  • Remove secretions
  • Improve ventilation
  • Increase efficacy of respiratory muscles
46
Q

Chest Physiotherapy (CPT)

A
  • Uses gravity to remove bronchial secretions and then suctioning
  • High-frequency chest wall oscillation with a vest can be used instead of percussion and vibration
47
Q

Effective Airway Clearance

A
  • Assess lung sounds every 2-4 hours
  • Clear airways (suctioning)
  • CPT
  • Position changes
  • Promoting mobility
  • Provide humidification of airway
  • Administer medications
48
Q

Trauma and Infection

A
  • Tube care
  • Cuff management
  • Scrupulous oral care
  • Elevation of HOB
49
Q

Other Interventions

A
  • Range of motion and mobility
  • Communication methods
  • Stress reduction techniques
  • Promote coping for patient
  • Include family teachings
  • Monitor complications
50
Q

Thoracic Surgery

A
51
Q

Pre-Op Management

A
  • Verify assessment/diagnosis
  • Preform incentive spirometry education
  • Relieve anxiety
  • Witness/verify informed consent
  • Implement NPO
  • Administer antibiotics on call to OR
52
Q

Post-Op Management

A
  • Monitor VS/Cardio/Respiratory status
  • Utilize oxygen as needed
  • Position to protect airway
  • Promote mobility
  • Maintain fluid volume and nutrition
  • Monitor and maintain chest drainage systems
53
Q

Patient Education

A
  • Signs and symptoms to report
  • Use of home respiratory treatments
  • Importance of progressive activity
  • Instructions on shoulder exercises
54
Q

Upper Respiratory Infection (URI)

A
  • Most common reason for seeking healthcare
  • Rhinitis/Rhinosinusitis/Pharyngitis/Tonsilitis/Adenoiditis/Laryngitis
  • Early detection and interventions help avoid unnecessary complications
  • Education based on prevention and health promotion (influenza/pneumonia vaccine)
55
Q

URI in Older Adults

A
  • Serious consequences with concurrent medical problems
  • Influenza can exacerbate COPD
  • Nose structure with aging may restrict airflow and predispose for geriatric rhinitis (watery drainage)
  • Laryngitis is common in older adults
  • Antihistamines and decongestants should be used with caution in older adults due to potential interactions with other medications
56
Q

URI Complications

A
  • Airway obstruction
  • Hemorrhage
  • Sepsis
  • Meningitis (inflammation of membranes covering brain/spinal cord due to infection)
  • Nuchal Rigidity (neck stiffness)
  • Medicamentosa (nasal congestion from extended use of topical decongestants)
  • Trismus (inflammation of chewing muscle of jaw)
  • Dysphagia
  • Aphonia (damage to mouth causing loss of ability to speak)
57
Q

Health History

A 
O - Onset
L - Location
D - Duration
C - Characteristics
A - Aggravating Factors
R - Relieving Factors
T - Timing
S - Severity
  • Also ask about cough/sputum
  • Recent travel
  • Vaccine status
  • Signs and symptoms
  • Inspection of nose/neck/throat/lymph nodes
58
Q

Nursing Interventions

A
  • Elevate Head
  • Ice collar to reduce inflammation
  • Hot pack to reduce congestion
  • Analgesics/Antibiotics
  • Gargles for sore throat
  • Pharyngitis - Needs new toothbrush after 24-48 hours after starting antibiotics
  • Alternative communication
  • 2-3L of liquid a day
  • Soft bland diet
  • Rest
59
Q

Patient Education

A
  • Prevention (hand hygiene)
  • When to contact healthcare provider
  • Need to complete full antibiotic regime
  • Annual flu shot
  • Pneumococcal vaccine for 65+ and high risk patients (smokers, lung pathologies)
  • Discuss smoking cessations
60
Q

Pseudoephedrine (Sudafed)

A
  • Decongestant
  • Acts on adrenergic receptors to release norepinephrine. This leads to vasoconstriction which shrinks nasal mucosa membranes causing less congestion.

USES
- Nasal decongestion for cold, allergies, sinuses

CAUTION

  • Kidney/Liver abnormalities
  • Coronary Artery Disease (CAD)
  • HTN

SIDE EFFECTS

  • HTN
  • Nervousness
  • CNS Stimulation
  • Insomnia
  • Tremors
  • Urine Retention
  • Increased HR

MONITOR
- BP and HR

EDUCATION
- Monitor BP for HTN and only use as directed

61
Q

Dextromethorphan (Delsym)

A
  • Antitussives (non-opioid)
  • Depresses cough center in medulla oblongata (goes through first pass metabolism)

USES
- Dry, nonproductive cough

CAUTION

  • Atopic syndrome caused by histamine releases
  • Hallucinations if taken too much

SIDE EFFECTS

  • Drowsiness/Nausea
  • Rash
  • Difficulty Breathing

Monitor
- Drug interactions, mental status, St. John Wort interactions

Education
- 30 minutes before meals

62
Q

Codeine

A
  • Antitussives (opioid)
  • Suppresses cough and often mixed with antihistamines and expectorants

CAUTION

  • History of drug dependance
  • Respiratory pathologies
  • Seizure disorders
  • Hepatic Impairment
  • GI disorders
  • Increased intracranial pressure

SIDE EFFECTS

  • Respiratory depression
  • Constipation
  • Pruritis
  • Drug Dependance

MONITOR
- Respiratory Status

63
Q

Guaifenesin (Robitussin/Mucinex)

A
  • Reduces viscosity of secretions. (Increased volume decreased viscosity)
  • Helps expel more secretions when coughing

SIDE EFFECTS
- Rash

MONITOR
- Discontinue if it does not help patient

EDUCATION
- Increase PO fluids to help further loosen mucus

64
Q

Obstructive Sleep Apnea

A
  • Disorder where upper airway gets partially or completely blocked in sleep
  • Seen more in obese patients and older patients
  • Results in apnea, hypoxia, and sleep disturbances
  • Hypoxic periods affect BP and HR
    MANIFESTATIONS
  • Insomnia, Snoring, Awake At Night, Intellectual deterioration, pulmonary hypertension, cor pulmonale (heart failure), enuresis (involuntary urination), polycythemia (blood cancer)
    DIAGNOSIS
  • Monitor sleep
    Treatment
  • CPAP, BiPAP, oxygen therapy, potential surgery
65
Q

Epitaxis

A
  • Hemorrhage from the nose in the anterior septum. May result in airway compromise and significant blood loss
    RISK FACTORS
  • Infection, drying mucosa, trauma, HTN, arteriosclerosis, aspirin use, nose-picking, tumor, thrombocytopenia, liver disease
    NURSING MANAGEMENT
  • ABC’s, Vitals, Cardiac monitoring and pulse ox, reduce anxiety, pinch soft portion of nose for 5-10 minutes
    INTERVENTIONS
  • Phenylephrine spray for vasoconstriction, cauterizing with silver nitrate, gauze packing, balloon-inflated catheter inserted into nasal cavity for 3-4 days, antibiotics
    TEACHING
  • Avoid nasal trauma, nose picking, forceful blowing, spicy foods, tobacco, exercise
  • humidify to prevent dryness, pinch nose to stop bleeding, if bleeding does not stop in 15 minutes seek medical attention
66
Q

Cancer of the Larynx

A
  • Most common in men, and patients over age 65
    RISKS
  • Gender, Age, Tobacco, Alcohol, African Americans, poor nutrition, Human Papillomavirus, Genetic syndromes, workplace exposures to wood dust, paint fumes, chemicals
    MANIFESTATIONS
  • Early signs include hoarseness, persistent cough, sore throat, raspy voice, lump in neck
  • Late signs include dysphagia, dyspnea, nasal obstruction, ulcerations, foul breath,
    DIAGNOSTIC
  • Biopsy, barium swallow test, endoscopy, CT, MRI, PET scan, tumor grade and stage
    MANAGEMENT
    Stage 1&2 - Radiation therapy, cordectomy, endoscopic laser excision, partial laryngectomy
    STAGE 3&4 - Radiation therapy, chemotherapy, chemoradiation, total laryngectomy
67
Q

Cancer of Larynx Nursing Process

A

Assessment - nutrition, bmi, albumin, glucose, electrolytes,
POST OP CARE
- reduce anxiety, maintain patent airways, control secretions, alternate communication, adequate nutrition, self esteem and self care
COMPLICATIONS
- Respiratory distress, hemorrhage, infection, wound breakdown, aspiration, tracheostomas stenosis

68
Q

Atelectasis

A
  • Collapse of alveoli.
  • Most often occurs in post-op setting
  • Increased work of breathing and hypoxemia
69
Q

Atelectasis manifestations

A 
- Dyspnea, cough, sputum production 
ACUTE 
- Tachycardia
- Tachypnea
- Pleural Pain
- Central cyanosis
70
Q

DIAGNOSIS ATELECTASIS

A
  • Crackles in lungs (resolved with deep breathing)
  • Chest X-ray
  • Pulse ox less than 90%
71
Q

Prevention of Atelectasis

A
  • Frequent turning
  • Mobilization
  • Incentive spirometry
  • Deep breathing
  • Secretion management
  • Metered dose inhaler and nebulizer
72
Q

Interventions Atelectasis

A
  • Improve ventilation
  • Remove secretions through first line defenses including
  • Incentive spirometry
  • Frequent turning
  • Early ambulation
  • Lung volume expansion maneuvars
73
Q

I-COUGH (Prevention of post-op pulmonary complications)

A

I - Incentive Spirometry (10 times an hour)
C - Cough/Deep Breathe
O - Oral Care (prevent germs)
U - Understanding Education
G - Get out of Bed (helps lungs/circulation)
H - Head of Bed Elevated (30-45 degrees)

Older Adults Pt 2 (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions