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General Nursing > Arterial Blood Gases & Chest tubes > Flashcards

Arterial Blood Gases & Chest tubes Flashcards

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1
Q

What is the normal range for pH?

A

7.35-7.45

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2
Q

What is the normal range for PaCo2?

A

35-45

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3
Q

What is the normal range for PaHCO3?

A

22-28

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4
Q

What is the normal range for PaO2?

A

80-100

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5
Q

What is the normal range for base excess?

A

-2 to +2

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6
Q

What is the normal range for SaO2?

A

> 95%

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7
Q

What is the normal acid-to-base ratio?

A

1:20

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8
Q

What is the normal a/A gradient?

A

5-10 mmHg

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9
Q

What is the normal PF ratio?

A

normal >300

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10
Q

What is the normal arterial/total O2 content?

A

20

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11
Q

Describe how to perform the Allen test and why it is used.

A

Have the patient clench their fist tightly. Locate and occlude the radial and ulnar arteries. While occluding, have the patient release their fist and observe for blanching. Release the ulnar artery. The test is positive if redness returns in 5-15 seconds. This means the radial artery can be used for arterial blood gas sampling. The Allen test is performed first to make sure that the artery can be used for blood sampling, and that there is another artery to perfuse the hand if something goes wrong.

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12
Q

Describe why we would use pulse oximetry or capnography.

A

Pulse oximetry measures the O2 saturation of Hgb in the blood. Capnography measures the end tidal CO2. Pulse oximetry correlates with PaCO2 and helps measure hypoxia. Capnography is more accurate and is often used to measure respiratory depression (ie: opioid use) and the metabolism/efficiency of breathing.

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13
Q

What are the pH’s that result in death?

A

6.8 and 8.0

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14
Q

What are common causes of respiratory depression? BBOAAA

A

Brain injury
Blood transfusion reaction
Obstructive respiratory disease
post-op Anesthesia
neurologic Analgesics (opioids, sedatives)
respiratory acidosis, metabolic alkalosis

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15
Q

What are the risk factors of respiratory depression?

A

Opioid and PCA use
morbid obesity
age

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16
Q

What are the signs and symptoms of respiratory depression?

A

RR<12
shallow respirations
low O2 saturation/hypoxia
low CO2 on capnography
cyanosis
elevated HR
hard to arouse, drowsiness

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17
Q

What are the nursing interventions for respiratory depression?

A

administer Narcan if necessary. Several doses may be needed as Narcan has a short half-life.
administer oxygen

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18
Q

What are common signs and symptoms of acidosis?

A

hyperkalemia: confusion, muscle spasms, coma, respiratory distress, ECG changes (tall T-waves, wide QRS, long PR interval)
vasodilation: low BP, high HR, headache

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19
Q

What are some common causes of respiratory acidosis?

A

D drugs (opioids, sedatives, antianxiety, etc)
E edema (pul edema, pul effusion, pul HTN)
P pneumonia
R CNS damage
E emboli (or other lung obstruction)
S spasms (neuromuscular impairment)
S sac damage (lung dz: atelectasis, COPD, asthma)

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20
Q

What are common signs and symptoms of respiratory acidosis?

A

N: CNS depression, confusion, HA
C: low BP, high HR, dysrhythmia
R: hypoventilation
S: diaphoresis, flushing

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21
Q

Explain the physiology of respiratory acidosis.

A

Something causes the patient to hypoventilation. During hypoventilation, CO2 is not being excreted and builds up in the body, increasing the acid content of the blood. Excess acid causes vasodilation, which causes many of the symptoms seen in respiratory acidosis. The body compensates by stimulating the kidneys to secrete acid through the urine and to produce more HCO3 in order to increase the pH of the blood.

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21
Q

A patient is post-opt from knee surgery. The patient has been receiving Morphine 4 mg IV every 2 hours. You notice the patient is exhibiting a respiratory rate of 8 and is extremely drowsy. Which of the following conditions is the patient at risk for?
A. Respiratory acidosis
B. Respiratory alkalosis
C. Hypokalemia
D. Metabolic acidosis

What are the interventions you will take in this situation?

A

A. Respiratory acidosis.
The patient is experiencing respiratory depression and hypoventilation, which will increase the PaCO2 and decrease the pH.

Interventions:
- stop IV infusion
- administer oxygen
- provide respiratory assistance (deep breathing, ventilator)

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22
Q

A patient attempted to commit suicide by ingesting a bottle of Aspirin. Which of the following conditions is this patient at risk for?
A. Hyperkalemia
B. Hypercalcemia
C. Respiratory alkalosis
D. Respiratory acidosis

What are the interventions you will take in this situation?

A

C. Respiratory alkalosis
Aspirin toxicity can cause hyperventilation, fever, hypokalemia.

Interventions:
- administer IV NaHCO3
- slow down breathing (deep breathing, paper bag, ventilator)
- administer K+ if needed

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23
Q

Respiratory alkalosis can affect other electrolyte levels in the body. Which of the following electrolyte levels can also be affected in this condition?
A. Calcium and sodium levels
B. Potassium and sodium levels
C. Calcium and potassium levels
D. Potassium and phosphate levels

A

C. Calcium and Potassium levels
Respiratory alkalosis causes low CO2 levels in the blood. As a result, H+ will move out of the cells, and K+ and Ca++ will move into the cells to maintain ion balance. This causes hypokalemia and hypocalcemia.

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24
Q

A patient is experiencing respiratory alkalosis. What is the most classic sign and symptom of this condition?
A. Bradypnea
B. Tachypnea
C. Bradycardia
D. None of the options are correct

A

B. Tachypnea

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25
Q

A patient has the following blood gases: PaCO2 25, pH 7.50, HCO3 19. Which of the following could NOT be the cause of this condition?
A. Anxiety attack
B. Chronic obstructive pulmonary disease (COPD)
C. Fever
D. Aspirin toxicity
Is the condition chronic? Compensated?

A

B. COPD
PaCO2 25, pH 7.50, HCO3 19
PaCO2 = alkalosis
pH = alkalosis
HCO3 = acidic
The patient is experiencing chronic partially compensated respiratory alkalosis. COPD causes respiratory acidosis.

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26
Q

A patient on mechanical ventilation has the following blood gases: PaCO2 29, pH 7.56, HCO3 23. Which of the following conditions is the patient experiencing?
A. Respiratory alkalosis not compensated
B. Respiratory alkalosis partially compensated
C. Respiratory alkalosis fully compensated
D. Respiratory acidosis partially compensated
Is the condition chronic?

A

A. Respiratory Alkalosis not compensated
PaCO2 29, pH 7.56, HCO3 23
PaCO2 = alkalosis
pH = alkalosis
HCO3 = normal
The patient is experiencing acute respiratory alkalosis. It is not compensated b/c the pH is still high and HCO3 is wnl.

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27
Q

A patient is experiencing respiratory acidosis due to brain trauma. Which of the following lab values correlates with this acid imbalance?
A. Potassium level of 6.0
B. Potassium level of 2.5
C. Potassium level of 5.0
D. Potassium level of 3.5

A

A. Potassium level of 6.0
Respiratory acidosis can cause hyperkalemia. The normal range of K is 3.5-5.0.

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28
Q

Which patient is experiencing partially compensated respiratory acidosis?
A. PaCO2 30, pH 7.35, HCO3 26
B. PaCO2 53, pH 7.23, HCO3 28
C. PaCO2 45, pH 7.49, HCO3 21
D. PaCO2 50, pH 7.30, HCO3 23
Is the condition chronic?

A

B. PaCO2 53, pH 7.23, HCO3 28
PaCO2 = acidic
pH = acidic
HCO3 = normal to high
The patient is experiencing respiratory acidosis. It is partially compensated because the HCO3 is slightly high.
It is mildly acute or just starting to become chronic because the HCO3 is starting to rise.

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29
Q

Which of the following is not a cause of respiratory acidosis?
A. Pulmonary emboli
B. Asthma
C. Chronic obstructive pulmonary disease (COPD)
D. Hyperventilation

A

D. Hyperventilation
Hyperventilation causes respiratory alkalosis. Hypoventilation causes respiratory acidosis.

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30
Q

A patient with COPD has the following blood gases: PCO2 59, pH 7.26, HCO3 42. Which of the following conditions is presenting?
A. Respiratory alkalosis
B. Respiratory acidosis
C. Metabolic alkalosis
D. Metabolic acidosis
Is the condition chronic? Compensated?

A

B. Respiratory acidosis
PCO2 59, pH 7.26, HCO3 42
PaCO2 = acidic
pH = acidic
HCO3 = high
The patient is experiencing chronic respiratory acidosis with partial compensation.

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31
Q

What are the indications for tracheal intubation?

A

Respiratory acidosis with PaCO2 >50 and worsening respiratory distress.

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32
Q

What are the interventions for respiratory acidosis caused by pneumonia (6)?

A
  • administer antibiotics
  • high fowler’s position
  • administer O2
  • breathing assistance if necessary & incentive spirometer
  • encourage coughing
  • administer IV fluids
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33
Q

What the common signs and symptoms of alkalosis?

A

Neuromuscular irritability: CNS irritation, numbness, tingling, weakness, muscle twitch, seizure, arrhythmia, carpopedal spasms

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34
Q

What are some common causes of respiratory alkalosis?

A

T temperature (fever) -> hyperventilation
A aspirin toxicity
C controlled ventilation error
H hyperventilation
Y hysteria (anxiety, fear, psych disorder)
P pain
N neurologic (CNS stimulation - cocaine)
E embolism/edema -> hyperventilation
A asthma

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35
Q

Explain the pathophysiology of respiratory alkalosis.

A

Hyperventilation causes excess excretion of CO2, which decreases the acid in the system. The body detects the decreased pH and stimulates the kidneys to decrease acid excretion and bicarbonate production. Hyperventilation can cause some of the symptoms of alkalosis, such as weakness, lightheadedness, vertigo, tinnitus, and tachycardia. Alkalosis can cause hypokalemia and hypocalcemia as H+ ion moves out of the cell to correct the drop in pH. K+ and Ca++ ions then move into the cell to preserve ion balance, taking the ions out of the blood. Hypokalemia and hypocalcemia cause the other symptoms of neuromuscular irritability, such as muscle spasms, carpopedal spasms, numbness, tingling, seizure, and arrhythmias.

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36
Q

What are some common signs and symptoms of respiratory alkalosis?

A

N: CNS irritability, seizure, fatigue, tinnitus, vertigo
C: low BP, high HR, ECG changes (U-wave, ST depression), arrhythmia
R: hyperventilation
S: muscle spasms, muscle twitch, paresthesia, Chvostek sign +
low K+/Ca++

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36
Q

What are some common signs and symptoms of respiratory alkalosis?

A

N: CNS irritability, fatigue, tinnitus, vertigo
C: low BP, high HR, ECG changes (U-wave, ST depression), arrhythmia
R: hyperventilation
S: muscle spasms, muscle twitch, paresthesia, Chvostek sign +
low K+/Ca++

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37
Q

Lab values: pH 7.46, paCo2 36, HCO3 32*

A

metabolic alkalosis, partially compensated

38
Q

Which of the following is NOT a cause of metabolic acidosis?
A. Aspirin toxicity
B. Ileostomy
C. Hyperaldosteronism
D. Carbonic anhydrase inhibitors

A

C. Hyperaldosteronism.
It causes metabolic alkalosis

39
Q

What are some common causes of metabolic acidosis?

A

A aspirin toxicity
C carbohydrate anabolic metabolism (lactic acidosis, sepsis)
I ingestion of acid, fats, proteins & insufficient kidneys
D diarrhea (loss of HCO3) and DKA
O ostomies (loss of HCO3)

40
Q

What are some common signs and symptoms of metabolic acidosis?

A

Neuro: CNS depression, seizure, confusion, headache
Cardio: low BP, high HR, hyperkalemia (long QRS, tall T, long PR), arrhythmia
Respiratory: hyperventilation, Kussmal respirations
S: diaphoresis, flushing
other: hyperkalemia, N/V

41
Q

Describe the pathophysiology of metabolic acidosis.

A

One of the causes of metabolic acidosis causes either an increase in acid or a decrease in bicarbonate, resulting in a decrease in blood pH. The body detects the drop in pH and compensates by hyperventilating in order to expel excess CO2. The kidneys also decrease bicarbonate excretion. Since pH is high, cells take in H+ ions to compensate, but secrete K+ ions in return, causing hyperkalemia. Hyperkalemia is responsible for symptoms such as arrhythmias, seizure, and ECG changes. The blood vessels also dilate, causing low BP, high HR, headache, confusion, diaphoresis, and flushing.

42
Q

A patient is in metabolic alkalosis due to diuretic therapy. How do you expect the potassium level and bicarbonate level to be affected?
A. Increased potassium level and increased bicarb level
B. Decreased potassium level and decreased bicarb level
C. Increased potassium level and decreased bicarb level
D. Decreased potassium level and increase bicarb level

A

D. decreased potassium level and increased bicarb level.
Alkalosis indicates that there is a high bicarb level. Metabolic alkalosis has the complication of hypokalemia (increased excretion of K+ with H+).

43
Q

A patient has the following arterial blood gases: HCO3 38, pH 7.50, PaCO2 50. Which of the following signs may this patient exhibit as a compensatory mechanism?
A. Hyperventilation (tachypnea)
B. Hypoventilation (bradypnea)
C. Increased potassium level (hyperkalemia)
D. Constipation

A

B. Hypoventilation
pH: alkaline
PaCO2: alkaline
HCO3: alkaline
pH and HCO3 are the same, so we know it’s metabolic alkalosis. PaCO2 is high, indicating that there is bradypnea occurring as a compensatory mechanism.

44
Q

What the the treatment/management interventions for metabolic acidosis (4 underlying causes)?

A
  • monitor electrolytes, I&O, respirations
  • treat underlying cause
  • aspirin toxicity: administer NaHCO3
  • DKA: insulin therapy
  • renal insufficiency: dialysis
  • diarrhea: replacement fluids, electrolytes, administer NaHCO3
45
Q

What are some common causes of metabolic alkalosis?

A

A hyperaldosteronism
L loss of H+ - vomiting, suction
K loss of K+ - diuretics, steroids, Cushing’s disease
A citrates - Anticoagulants from blood transfusion/dialysis
I ingestion of HCO3 - drugs, antacids, food

46
Q

What are some common signs and symptoms of metabolic alkalosis?

A

Neuro: CNS irritability, seizure, confusion
Cardiac: low BP, high HR, hypokalemia, ECG change (U-wave, ST depression)
Respiratory: hypoventilation
Skin: numbness, muscle cramps
other: hypokalemia, N/V

46
Q

What are the treatment/management interventions for metabolic alkalosis (6)?

A
  • monitor electrolytes and I&O
  • treat underlying cause
  • vomiting - antiemetics
  • stop suction
  • diuretics - stop
  • administer K+ (KCL)
  • administer Diamax to excrete HCO3
47
Q

What is the goal of O2 therapy?

A

To achieve PaO2 near WDL (80-100).

48
Q

What factors affect gas exchange?

A
  • obstructive pulmonary disease: COPD, asthma
  • sac disorders: atelectasis, pneumothorax
  • wet lungs: pneumonia, pulmonary edema, pulmonary effusion, pulmonary HTN
49
Q

What are the two ways in which oxygen travels around the system?

A
  • dissolved in blood
  • bonded to Hgb
50
Q

What factors increase oxygen demand in the body?

A
  • fever, shivering
  • seizure
  • pain, anxiety
  • metabolic increases
  • work of breathing
  • exercise
51
Q

What determines oxygen delivery?

A

cardiac output

52
Q

What determines oxygen content?

A

hemoglobin

53
Q

What are normal hemoglobin levels?

A

men: 13.2-16.6
women: 11.6-15

54
Q

What are some interventions to increase the PF ratio?

A
  • incentive spirometer to open alveoli
  • proper positioning
55
Q

What are the complications of excess O2 therapy?

A
  • hypoventilation
  • absorption atelectasis
  • oxygen toxicity
56
Q

At what parameters does the risk for oxygen toxicity increase?

A

administration of >50% O2 for more than 24 hours

57
Q

What is the pathophysiology of oxygen toxicity?

A

Increased oxygen supply increases the amount of free radicals in the system, as there are not enough antioxidants. These free radicals damage lung/vascular capillaries, causing protein to flood into the endothelium. The capillaries get repaired, causing pulmonary fibrosis and scarring. This affects breathing and gas exchange efficiency, leading to substernal soreness, SOB, pleuritic pain, dry cough, sore throat, nasal congestion, eye and ear discomfort/fullness.

58
Q

What are the different methods of delivering oxygen and what % of oxygen can they deliver?

A
  • nasal cannula (1-5L of 24-48%)
  • face mask (5-10L of 40-60%)
  • face tent (10-15L of 40%)
  • nonrebreather (10-15L of 80-90%)
  • Venturi (2-15L of 24-60%)
59
Q

A nurse is preparing to care for a client following chest tube placement. Which of the following items should be available in the client’s room?
a. oxygen
b. sterile water
c. enclosed hemostat clamps
d. indwelling urinary catheter
e. occlusive dressing

A

a. oxygen
b. sterile water
c. enclosed hemostat clamps (for air leaks)
e. occlusive dressing

d. inappropriate

60
Q

A nurse caring for a client who has a chest tube and drainage system in place. The nurse observes that the chest tube was accidentally removed. Which of the following actions should the nurse take first?
a. obtain a chest x-ray
b. apply sterile gauze to the insertion site
c. place take around the insertion site
d. assess respiratory status

A

B. apply sterile gauze to the insertion site.

other interventions are appropriate but not first.
Proper procedure after accidental removal
- call for help
- cover opening with hand during inspiration
- cover 3 sides w/ sterile gauze
- obtain CXR for replacement or further eval

61
Q

A nurse is assessing a client who has a chest tube and drainage system in place. Which of the following are expected findings?
a. continuous bubbling in the water seal chamber
b. gentle constant bubbling in the suction control chamber
c. rise and fall in the level of water in the water seal chamber with inspiration and expiration.
d. exposed sutures w/o dressing
e. drainage system upright at chest level

A

b. gentle constant bubbling in the suction control chamber (indicates air leaving the chest)
c. rise and fall in the level of water in the water seal chamber with inspiration and expiration. (indicates normal pressure changes with respiration)

a. indicates air leak
d. should be covered with airtight dressings
e. needs to be lower than chest tube level

62
Q

A nurse is planning care for a client following the insertion of a chest tube and drainage system. Which of the following should be included in the plan of care?
a. encourage the patient to cough and take deep breaths
b. check for continuous bubbling in the suction control chamber
c. strip the drainage tubing every 4 hr
d. clamp the tube once a day
e. obtain a chest x-ray

A

a. encourage the patient to cough and take deep breaths (promotes oxygenation and re-expansion)
b. check for continuous bubbling in the suction control chamber (indicates air leaving the chest)
e. obtain a chest x-ray (checks appropriate chest tube placement)

c. never strip the drainage tubing
d. never clamp unless changing the tube, accidental removal, or checking for leaks

63
Q

A nurse is caring for a client who is experiencing respiratory distress. Which of the following early manifestations of hypoxemia should the nurse recognize?
a. confusion
b. pale skin
c. bradycardia
d. hypotension
e. elevated blood pressure

A

b. pale skin
e. elevated blood pressure

early manifestations: decreased RR, pale skin, low SaO2, elevated BP, elevated HR

late manifestations: confusion, lethargy, bradycardia, hypotension

64
Q

A nurse is caring for a client who is receiving mechanical ventilation via a ETT. which of the following actions should the nurse take?
a. apply restraint if self-extubation is attempted
b. monitor ventilator settings every 8 hours
c. document tube placement in cm at the angle of the jaw
d. asses breath sounds every 4 hours

A

d. assess breath sounds every 4 hours

a. not appropriate
b. monitor ventilation settings hourly
c. document placement at teeth or lips

65
Q

A nurse is caring for a client who has dyspnea and will receive oxygen continuously. Which of the following devices should the nurse use to deliver a precise amount of oxygen to the client?
a. nonrebreather
b. venturi
c. nasal cannula
d. simple face mask

A

b. venturi mask

the other three only deliver approximate amounts of oxygen

66
Q

What are the four kinds of artificial airways and their indications?

A

oropharyngeal - patient w/o gag reflex
nasopharyngeal
endotracheal tube - 2-3 wks
tracheostomy - long-term

67
Q

What are some complications of Yankauer tube suctioning?

A

bradycardia, gag-reflex activation, hypotension, tissue damage

68
Q

What are some complications of suctioning?

A

tachycardia
hypoxia
infection
vasovagal stimulation
aspiration

69
Q

What are some special considerations in suctioning for pediatrics, gerontology, and SNFs?

A

pediatrics: smaller suction and shorter suction. first with bulb, then catheter
gerontology: less cough and gag reflex, more sensitive mucosa
SNF: dysphagia and high risk of aspiration common

70
Q

A nurse is about to suction a patient. What actions should the nurse take before suctioning?
a. gather vital signs
b. administer oxygen
c. activate continuous suction
d. administer sterile saline
e. auscultate lungs

A

a. gather vital signs
b. administer oxygen
e. auscultate lungs

c. never suction with continuous suction
d. clean tube with sterile saline

71
Q

What settings do you set the wall suction at for adults, children, and infants?

A

adults: 120-150
children: 60-100
infants: 40-60

72
Q

A patient has a low VQ ratio. Describe what is happening.

A

A low VQ ratio indicates low ventilation, which suggests that there is a problem with the lungs. Common etiologies include COPD, atelectasis, pneumonia, or fibrosis.

73
Q

A patient has high VQ ratio. Describe what is happening

A

A high VQ ratio indicates that there is high ventilation. This suggests that there is a problem with perfusion in the circulatory system, such as occlusion, pulmonary edema, CHF, pulmonary hypertension, or cardiac arrest.

74
Q

Where would the provider insert the chest tube for a pneumothorax? Pleural effusion or hemothorax?

A

pneumothorax: 2/3 ICS
pleural effusion: 5/6 ICS
pericardial space: mediastinal

75
Q

Draw and label the parts of a chest tube drainage system

A

suction control - controls level of suction
bellows - inflate to triangle for optimum function
- wall suction >-80
- vacuum dial controls bellows
air leak monitor (5-1) - constant bubbling indicates leak
water seal (0-2) - regular gentle bubbling indicates adequate function
collection chamber (3) - collects fluid from lungs

76
Q

A nurse notices bubbling in the water seal chamber and oscillation. What steps should the nurse take next?
a. reposition the patient because the tubing is kinked
b. continue to monitor the drainage system
c. increase the suction to the drainage system until the bubbling stops
d. check the drainage system for an air leak

A

d. check the drainage system for an air leak

77
Q

You’re assessing a patient who is post-opt from a chest tube insertion. On assessment, you note there is 50 cc of serosanguinous fluid in the drainage chamber, fluctuation of water in the water seal chamber when the patient breathes in and out, and bubbling in the suction control chamber. Which of the following is the most appropriate nursing intervention?
A. Document your findings as normal.
B. Assess for an air leak due to bubbling noted in the suction chamber.
C. Notify the physician about the drainage.
D. Milk the tubing to ensure patency of the tubes.

A

A. Document your findings as normal.

b. continuous bubbling in the suction chamber is normal. Intermittent bubbling in the water seal chamber is normal w/ respirations, but continuous bubbling in the water seal chamber is not and indicates a leak.
c. postop serosanguinous fluid is normal.
d. do not milk the tubing

78
Q

How does the water in the water seal chamber oscillate with respiration?

A

During inspiration the water will increase, and decrease during expiration. It is the opposite with mechanical ventilation.

79
Q

How would you find the leak in a chest tube drainage system?

A

Intermittently and briefly clamp sections of the tube starting at the dressing until bubbling in the water seal chamber stops. Do not milk, strip, or clamp the tube. Seal the leak using tape to reinforce the tube.
No tidaling also indicates there is a leak or occlusion in the chest tube system.

80
Q

Which statement about chest-tube sizes is correct?
a. The larger the French size, the smaller the tube.
b. Common tube sizes for adults are 10 to 15 French.
c. Smaller tubes are used to drain blood; larger tubes to remove air.
d. Larger tubes are used to drain blood; smaller tubes to remove air

A

d. larger tubes are used to drain blood; smaller tubes remove air.

Adult common tube sizes are 24-40 French, and larger numbers indicate larger sizes.

81
Q

The first step in setting up an integrated chest drainage unit (CDU) is to:
a. fill the water-seal chamber to the level specified by the manufacturer.
b. fill the water-seal chamber to the 10-cm mark.
c. connect the drain to the vacuum and rapidly increase the pressure.
d. connect the drain to the vacuum and slowly increase the pressure.

A

a. fill the water-seal chamber to the level specified by the manufacturer.

  • Fill the suction chamber to -20cm with sterile water
  • connect the drain to the vacuum and slowly increase suction until bubbling in the suction-control chamber
  • connect chest tube to CDU
  • secure tube to patient with sutures
  • apply sterile gauze over tubing
  • x-ray to confirm proper tube position
82
Q

Which of the following is an advantage of a dry suction chest drainage system?
a. Lower levels of suction pressure
b. Variable bubbling, which indicates proper functioning
c. A steady bubbling sound, which indicates proper functioning
d. Higher levels of suction pressure

A

d. higher levels of suction

other advantages: easier set up, quieter (no bubbling), more constant pressure (no water)

83
Q

What teaching instructions should the nurse include when removing a chest tube?

A

Semi-fowler’s position
Valsalva maneuver: provider will remove tube at maximum inspiration
CXR will be taken several hours to f/u chest expansion
ongoing respiratory and vital signs assessment

84
Q
  1. If a chest tube becomes disconnected, the correct action is to:
    a. submerge the tube 3” to 5” (8 to 12 cm) below the surface of a 250-mL bottle of sterile saline solution.
    b. submerge the tube 1” to 2” (2 to 4 cm) below the surface of a 250-mL bottle of sterile water.
    c. remove the tube completely and place an occlusive dressing over the site.
    d. remove the tube completely and place a nonocclusive dressing over the site
A

b. submerge the tube 1” to 2” (2 to 4 cm) below the surface of a 250-mL bottle of sterile water.

85
Q

How do you calculate PF ratio?

A

PaO2/FiO2

86
Q

How do you calculate total oxygen content?

A

(Hgb)(1.34)(SatO2)

87
Q

How do you calculate PaCO2?

A

700(FiO2)-PaCo2

88
Q

A nurse is preparing to suction a client’s tracheostomy. Which of the following actions should the nurse take?
a. suction for 30 seconds with each pass
b. allow 2 min between suctioning to reoxygenate the lungs.
c. use a rotating motion when inserting the catheter from the tacheostomy
d. set the suction pressure to 180mmHg

A

b. allow 2 min between suctioning with each pass. (also encourage patient to cough and deep breathe)

a. suction for 10-20 seconds
c. use a rotating motion when withdrawing
d. suction pressure should be <120 mmHg for open suctioning and <160mmHg for closed system suctioning

89
Q

A nurse caring for a client who has cuffed ETT in place. Which of the following actions should the nurse take?
a. reposition ETT every 12 hr
b. provide oral care every 24 hr
c. apply the securing tape over the client’s ears
d. maintain a cuff pressure of 35 mmHg

A

a. reposition ETT every 12 hr

b. repositioning and oral care should be done every 12 hr
c. doing so will cause pressure injuries
d. cuff pressure should be 20-25 mmHg

90
Q

A nurse is caring for a client who has a tracheostomy tube with an inner cannula in place. Which of the following supplies should the nurse use to dry the inner cannula of the client’s tracheostomy?
a. paper towels
b. cotton tipped applicator
c. folded pipe cleaners
d. facial tissues

A

c. folded pipe cleaners will not leave residue

all other options can leave residue and cause aspiration

91
Q

A nurse is caring for a client who requires a chest tube. The provider asks for the suction pressure of the closed chest drainage system to be set at -40cm of water. Which of the following closed-chest drainage systems should the nurse prepare for this client?
a. Pneumostat
b. water-seal system
c. Heimlich valve
d. dry-suction control system

A

d. dry suction control system: used for higher pressures up to 40cm

a. pneumostat: portable and for small or partial pneumothorax. can collect fluid
b. water-seal system: for -20cm water.
c. Heimlich valve: mobile one-way valve for small or partial pneumothorax but cannot collect liquid

92
Q

A nurse is assessing a client 5 hr after the insertion of a chest tube that is attached to a water-seal drainage system. Which of the following observations bout the drainage should the nurse report to the provider?
a. 400mL drainage since insertion
b. a gush of liquid when repositioning the client
c. about 150mL/hr drainage over the past 2 hr
d. significant decrease in drainage over the past 3 hr

A

c. 150mL/hr drainage over the past 2 hr. (notify if drainage >70mL/hr)

a. normal is 100-300mL in first 3 hrs. 400mL in 5 hr is normal.
b. gush of liquid can be due to retained blood.
d. drainage begins to decrease 2 hr after insertion.

93
Q

A nurse is caring for a client who has a chest tube in place. Which of the following strategies should the nurse use to help promote comfort for the client?
a. have the client splint the affected side during coughing
b. perform passive range of motion exercises
c. place the client in a supine position w/ minimal elevation
d. encourage ambulation

A

a. have the client splint the affected side during coughing (prevents postop complications, drains pleural space, expands lungs, minimizes pain.)

b. can be painful. administer analgesics 30 min prior to attempting this
c. client should be upright (30 degree) to promote lung expansion
d. ambulation can be painful w/ chest tube. administer analgesics 30 min prior to attempting this

General Nursing (6 decks)

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