AH Nursing Resp Questions

Question 1

NIPPV

Answer 1

(noninvasive positive pressure ventilation) - BiPAP, CPAP; noninvasive but giving + pressure in to airways

Question 2

Which condition will increase the body’s need for more oxygen? (select all that apply)
A. Hypothyroid
B. Infection in blood
C. Diabetes Mellitus
D. Temperature of 101 F
E. Hbg of 8.7 g/dL

Answer 2

Answer: B, D, E
Hyper - increasing metabolic rate but no hypothyroidism
Infection - increases metabolic needs of body
DM - well controlled
Temp - infec
Hbg - decreased O2 carrying capacity
Factors affecting oxygenation: decreased O2 carrying capacity, Increased metabolic needs; decreased inspired O2/decrease in ventiation; air breathing has less O2 or have some sort defect or pneumothorax that affecting ventilation of lung also affects oxygenation

Question 3

Which parameters does the nurse monitor to ensure that a patient’s response to oxygen therapy is adequate? (select all that apply)
A. Level of consciousness
B. Respiratory pattern
C. Oxygen flow rate
D. Pulse oximetry
E. Adequate humidification of O2

Answer 3

Answer: A, B, D
Oxygen flow rate - flow rate and want make sure correct; not tell if pat responding adequately but pat may need more/less
Do want adequate humidification of O2 but does not tell how pat responding

Question 4

How else can we evaluate oxygen therapy?

Answer 4

Arterial blood gases (ABG)
Oxygen saturation (SpO2)
Capnography

Question 5

Arterial blood gases (ABG) (How else can we evaluate oxygen therapy?)

Answer 5

Most accurate
Invasive
Obtain by arterial blood draw
Very helpful
Invasive and painful unless have good RT and do really well; very accurate because tell us pH, HCO3, PO2 (oxygenation), PCO2; PCO2 and HCO3 and tells us the acid base balance - not only tells how well oxygenated are but how breathing; CO2 tell if hypoventilating; ABG tell if hypoventilating because acid base balance will get off

Question 6

Oxygen saturation (SpO2) (How else can we evaluate oxygen therapy?)

Answer 6

Non invasive
Easy to obtain
Use pulse oximetry to measure
Used all time
Very good and useful tool
Certain limitations - poor perfusion can use other sites; can do continuous/periodic

Question 7

Capnography (How else can we evaluate oxygen therapy?)

Answer 7

Non invasive
Measures exhaled CO2

Question 8

When a patient is requiring oxygen therapy what is most important for the nurse to know?
A. Patients require 1-10 L/min by nasal cannula for oxygen to be effective
B. Oxygen induced hypoventilation is the priority when the pCO2 levels are unknown
C. Why the patient is receiving oxygen, expected outcomes and complications
D. The highest FiO2 possible for the particular device being used

Answer 8

Answer: C
Oxygen induced hypoventilation is the priority when the pCO2 levels are unknown - no such thing as O2 induced hypoventilation; people can hyperventilating and drive to breathe and hypoxic vasoconstriction - really for pats with chronic lung disease (happens is body compensates for damaged part lung and constricts blood vessels to that area of lung and if give too much O2 lose that hypoxic vasoconstriction)
The highest FiO2 possible for the particular device being used - use lowest FiO2 necessary to meet needs for pat
O2 does come with comps - is a med and needs be with prescribed

Question 9

What are considered hazards of oxygen therapy? (select all that apply)
A. Increased combustion
B. Oxygen narcosis
C. Oxygen toxicity
D. Absorption atelectasis
E. Oxygen induced hypoventilation

Answer 9

Not start a fire but can Perpetuate a fire - feeds a fire
Oxygen toxicity - can happen; happens more frequently when longer on O2 and higher flow rate
Absorption atelectasis - increase FiO2 (% O2 in air breathing) increase O2 increasing FiO2 for pats and if do that and have higher O2 and get less other gases and N helps keep alveoli open; when have too igh O2 decrease N and could be at increased risk of atelectasis
Oxygen induced hypoventilation - can happen but lot more patho behind it

Question 10

Review O2 delivery devices:

Answer 10

Face tent
Make sure check all skin, no wounds, make sure humidified and connected

Question 11

Face tent (Review O2 delivery devices:)

Answer 11

Often times only used when have sinus/upper airway surgery; open at the top and often used for humidification

Question 12

What nursing interventions should be included when a patient is receiving oxygen?

Answer 12

Ensure humidification
Assess for skin breakdown
Assess mucous membranes for dryness and bleeding - anybody with a nasal cannula should have humidification regardless L/min because very drying and no harm to have humidification on pat
Assess for patency of tubing
Educate patients regarding oxygen safety

Question 13

Assess for skin breakdown (What nursing interventions should be included when a patient is receiving oxygen?)

Answer 13

Use padding if needed

Question 14

Tracheostomy tubes

Answer 14

Many types and sizes of tubes:
Are variations of tracheostomy
Goes in the airway and in their airway and certain partsw outside that will have to manage
Parts: face plate
Chronically long period time - tract gets really well and good tract; putting it in and not know what doing and jab against side and that is painful but if know what doing then usually not painful and easily with min discomfort; suction - depends on who doing it and how long had it
Clean technique at home if pat doing it and sterile at hospital
Obturator -
This is their airway cannot breath without it
Ideally with trach has extra trach in correct size at bedside; nurses can put it in if comes out
Check placement - CXR after new placement or had to put back in; put in and leave obturator in and have cough and if pops out then in airway but not best prac
Timeframe one comes out - pat specific; may need get in right away or can wait

Question 15

Many types and sizes of tubes: (Tracheostomy tubes)

Answer 15

Single lumen and dual lumen
Cuffed and uncuffed
Reusable and disposable
Fenestrated and unfenestrated

Question 16

Single lumen and dual lumen (Many types and sizes of tubes: (Tracheostomy tubes)

Answer 16

Almost all now is double lumen: means that has inner cannula that can come in and out; adv to having inner cannula that can come in and out is that if becomes full secretions - can take it out and keeps cleaner; when have single lumen - take trach out, put new one in, clean it and keep clean until have to replace it again - seen in trachs had for long time
Metal trachs - single lumen that have to be changed out

Question 17

Cuffed and uncuffed (Many types and sizes of tubes: (Tracheostomy tubes)

Answer 17

In-patient setting often are cuffed; inflate by putting air in pilor balloon; does not keep it in place; cuff - prevents air leaking in and out past the trach; being ventilated or want only breath out trach want block out air coming from nose and mouth - cannot talk when have trach with cuff up because not air past vocal cords and only air in trach and cuff is blocking air movement
Safety - cuff inflated and not on vent and want talk so get cap and cap it and happens is not able to breath; cuff inflated so no air moving in and out through airway/nose and blocking off trach which is where trach needs to go; caps completely close it off; if pat weaning of trach and using speaking valve (one-way valve) - always make sure cuff deflated, allow air come in and no air out why speaking valve - breath in and out through nose, and mouth and trach, but when exhale only through nose and mouth past vocal cords so then can talk; can use speaking valves through ventilators as well

Question 18

Reusable and disposable (Many types and sizes of tubes: (Tracheostomy tubes)

Answer 18

Most disposable - are reusable - take whole trach in and out to clean it

Question 19

Fenestrated and unfenestrated (Many types and sizes of tubes: (Tracheostomy tubes)

Answer 19

Fenestrated - holes above cuff (most time not have cuff) Allows little bit of air leaking so gives little bit breathing past nose and mouth
On vent not helpful

Question 20

Obturator -(Tracheostomy tubes)

Answer 20

Pats trach came out; could put back in without this esp if had good tract but if put this in this is hard and rounded and very firm so easier to get in; replacing a trach always have this because better as goes down; often taped to wall because diff sizes and diameters and want correct size when need replace
Cannot breath while have this in

Question 21

A patient is receiving preoperative teaching for a partial laryngectomy and will have a tracheostomy. How does the nurse define a tracheostomy to the patient?
A. Opening in the trachea that enables breathing
B. Temporary procedure that will be reversed later
C. Technique using positive pressure to improve gas exchange
D. Procedure that holds the airway open

Answer 21

Answer: A

Question 22

A patient returns from the operating room after a tracheostomy placement. While assessing the patient which observations by the nurse warrant immediate notification to the provider?
A. Patient is alert but unable to speak
B. Small amount of bleeding present at incision
C. Skin is puffy at the neck area with a crackling sensation
D. Respirations are audible and noisy with increased respiratory rate

Answer 22

Answer: C
C - Skin is puffy at the neck area with a crackling sensation - subQ emphysema; air trapped in subQ tissue; happens with chest tubes and trachs; putting invasive tube and knick airway and could have air leaking into subQ tissue; not emergency but need monitor because could indicate not placed correctly; keep eye on it and make sure not worse with tubes and trachs; immediately after placement notify provider; crackles - indicates pneumothorax; not emergency but need keep an eye on and let provider and doc
D - increased RR because concerning; can hear breathing easier when have trach because hear secretions more

Question 23

Indications:
Comps

Answer 23

Tracheostomy

Question 24

Indications: (Tracheostomy)

Answer 24

Stenosis of airway - typ had surgery on airway or trach in past and scar tissue build up and cannot keep airway without trach
Obstruction of airway - emergency situation
Tracheomalacia - softening of cartilage of trachea to where cannot stay open by self
Laryngeal or neck trauma
Neck cancer - laryngeal cancer
Extended need for mechanical ventilation - on vent and know need be on vent for awhile and more comfy on trach then endotracheal and not need be sedated and can wean off vent because if too sedated cannot wean off

Question 25

Comps (Tracheostomy)

Answer 25

Dislodgement
Obstruction
Subcutaneous emphysema
Skin breakdown - place where bad breakdown where plate sits on necks on clavicle breakdown - lot secretions and moisture want keep dry and want put specialized dressings on that - never cut it because fibers get in airway; some really foamy and thick and cushion better and absorb fluid better
Infection - not protection of upper airway
Bleeding - not suctioning correctly; cause mucosal trauma to airway

Question 26

To prevent accidental decannulation of a tracheostomy tube, what does the nurse do?
A. Obtain an order for continuous upper extremity restraints
B. Secure the tube in place using ties or fabric fasteners
C. Allow some flexibility in motion of the tube while coughing
D. Instruct the patient to hold the tube with a tissue while coughing

Answer 26

Answer: B
How prevent trach from becoming dislodged
Secure it with ribbon tie when first put in or commercial/trach tie; that is what keeps in place; if take it off to replace or clean and pat coughs can cough trach out - doing care and removing it and pat worried could cough - have someone hold onto trach whole doing care because if cleaning around trach site trach can move and make them cough because irritates airway so ties are a must

Question 27

A patient has a recent tracheostomy. What necessary equipment does the nurse ensure is kept at the bedside? (select all that apply)
A. Ambu bag
B. Pair of wire cutters
C. Oxygen tubing
D. Suction equipment
E. Tracheostomy tube with obturator

Answer 27

Answer: A, C, D, E
Extra trach
Suction supplies, ambu bag - bag used to resuccisate pats if not breathing or if pat on ventilator and question settings pop off and manually breath until someone comes; sometimes not on ventilator hyperoxygenate before suction - rarely seen tho

Question 28

A patient currently has an artificial airway in place. Oxygen is administered directly from the wall source. Why would warmed and humidified oxygen be a more appropriate choice for this patient?
A. Prevent drying damage of mucous membranes
B. Promotes thick secretions which are easier to suction
C. Is more comfortable for the patient
D. Is less likely to cause oxygen toxicity

Answer 28

Answer: A
Trach not have air moistened/warmed as breathing; air not getting O2 anymore still humidified air because if it dries up - mucous plug forms and becomes obstructed and cannot breath and emergency because cannot get it out; even more imp that have humidification - promotes thin secretions; not thick

Question 29

What nursing interventions should be included when caring for a patient with a tracheostomy?

Answer 29

Stoma care
Humidification of airway
Suctioning
Ensure placement and patency
Monitor cuff pressures
Maintain extra trach and obturator at bedside
Frequent oral care
Aspiration precautions - Not that can eat/drink with trach - sits right in front esophagus and can be diff to swallow; higher risk and need swallowgram,etc before ate; often times have feeding tube; long-term pats can develop muscle strength to eat

Question 30

Stoma care (What nursing interventions should be included when caring for a patient with a tracheostomy?)

Answer 30

Prevents Infection and skin breakdown

Question 31

Humidification of airway (What nursing interventions should be included when caring for a patient with a tracheostomy?)

Answer 31

Prevents Dryness and obstruction with mucous blugging
Mucous out

Question 32

Suctioning (What nursing interventions should be included when caring for a patient with a tracheostomy?)

Answer 32

Get secretions out

Question 33

Ensure placement and patency (What nursing interventions should be included when caring for a patient with a tracheostomy?)

Answer 33

Imp for the trach

Question 34

Monitor cuff pressures (What nursing interventions should be included when caring for a patient with a tracheostomy?)

Answer 34

14-20 mmHg
Cuff inflated too much irritates airway/mucosa
Not too high or low not then have leaking air pass trach

Question 35

Maintain extra trach and obturator at bedside (What nursing interventions should be included when caring for a patient with a tracheostomy?)

Answer 35

Helps if have dislodgement

Question 36

A nurse is educating a client who will be going home with a tracheostomy. When discussing suctioning frequency, what should be included in the education?
A. The tracheostomy should be suctioned every 4 hours
B. The tracheostomy should be suctioned when secretions can not be cleared and physical symptoms are present
C. The tracheostomy should only be suctioned in an emergency
D. The tracheostomy should only be suctioned at times when the home health nurse is available.

Answer 36

Answer: B
Used be routinely suction pats (q4h); suctioning can cause trauma and decreased oxygenation to pats - lots comps; if not able cough those secretions up and appearing SOB and low O2 sats down or ask to suction then suction or if hear lot secretions then do it; not want do it regularly; sometimes cough up as much as can and go short way to do less trauma

Question 37

Hypoxia
Tissue (mucosal) trauma
Infection
Vagal stimulation and bronchospasm
Cardiac dysrhythmias (hypoxia)
Causes of Complications:

Answer 37

Comps of suctioning

Question 38

Hypoxia (Comps of suctioning)

Answer 38

Tube in airway and preventing O2 in and out airway

Question 39

Tissue (mucosal) trauma (Comps of suctioning)

Answer 39

Tube down in there

Question 40

Infection (Comps of suctioning)

Answer 40

Tube down there

Question 41

Vagal stimulation and bronchospasm (Comps of suctioning)

Answer 41

Can happen

Question 42

Cardiac dysrhythmias (hypoxia) (Comps of suctioning)

Answer 42

Secondary to hypoxia

Question 43

Causes of Complications: (Comps of suctioning)

Answer 43

Ineffective oxygenation before, during, after suctioning - hyperoxygenate before and after
Use of catheter that is too large for the artificial airway - use biggest catheter need to decrease obstruction of airway
Prolonged suctioning time - not suction for long periods time
Excessive suction pressure - not use lot pressure
Too frequent suctioning

Question 44

to prevent comps
1. Assess the need for suctioning (routine unnecessary suctioning causes mucosal damage, bleeding, and bronchospasm).
2. Wash hands. Don protective eyewear. Maintain Standard Precautions.
3. Explain to the patient that sensations such as shortness of breath and coughing are to be expected but that any discomfort will be very brief.
4. Check the suction source.
5. Set up a sterile field in hospital
6. Preoxygenate (hyperventilate) the patient with 100% oxygen for 3 ventilations prior to suction.
7. Quickly insert the suction catheter until resistance is met or until pat starts coughing. Do not apply suction during insertion. Meet resistance back up because might be up against mucosa and if were to apply suction there it could damage mucosal lining
8. Withdraw the catheter 1 to 2 cm, and begin to apply suction. Apply suction and use a twirling motion of the catheter during withdrawal. Never suction longer than 10 to 15 seconds. Do intermittent suction
9. Hyperoxygenate for 1 to 5 minutes or until the patient’s baseline heart rate and oxygen saturation are within normal limits.
Insert catheter until resistance or catheter - up against mucosa - could damage mucosal lining; back up
Hold breath - never suction longer than 10-15 because while suctioning not getting O2 so limit the amount of that
On vent can preoxygenate 100% and wait for 3 breaths; ambu bag do 3; if not just turn to 100 and take 3-4 deep breaths then suction
Only pass 3 times in each suction setting to limit amount of suctioning - preoxygenate in between before suction again but no more than 3 times each time suction - out window if decompensating and suction a lot

Answer 44

Suctioning

Question 45

A patient with a tracheostomy is unable to speak. He is not in acute distress, but is gesturing and trying to communicate with the nurse. Which nursing intervention is the best approach to the situation?
A. Rely on the family to interpret for the patient
B. Ask questions that can be answered with a yes or no
C. Obtain an immediate speech consult
D. Encourage the patient to rest rather than struggle with communication

Answer 45

Answer: B
Patients cannot talk while on trachs and can be frustrating - just ask yes and no questions if possible; cannot communicate needs - can write but sometimes so sick cannot; can mouth words; spell the word and tell one letter at a time; move mouth like talking and say slow down and say one word at a time because cannot read that fast; one most frustrating to not be able verbally communicate needs; have message boards and speech therapy can help with that - psychosocial needs

Question 46

Do heal on own
Do have trouble talking initially because leaking air in and out
Stoma will close on its own eventually;
How long had it depends on how long take to heal

Answer 46

Happens when take trach out