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461-Foundations > ATI - Chapter 53 > Flashcards

ATI - Chapter 53 Flashcards

1
Q

Oxygen helps maintain adequate _____ for clients who have many acute and chronic respiratory problems (hypoxemia, cystic ribrosis, asthma). or are at risk for developing hypoxia.

A

cellular oxygenation

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2
Q

Maintaining a patient ____ is a nursing priority. It involves mobilizing secretions, suctioning the airway, and managing artificial airways (endotracheal tubes, tracheostomy tubes) to promote adquate gas exhange and lung expansion.

A

airway

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3
Q

A ___ is a device with a sensor probe that attaches securely to the fingertip, to =, birdge of nose, earlobe, or froehead with a clip or band.

A

pulse oximeter

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4
Q

A pulse oximeter measure pulse saturation (______) via a wave of infrared light that measures light absorption by oxygenated and deoxygenated hemoglboin in arterial blood.

A

SpO2

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5
Q

SpO2 reliably reflects the precent of saturation of ______ (sSaO2) when the SaO2 is greater than ____%

A

hemoglobin

70%

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6
Q

Oxygen is tasteless and colorless gas that accounts for 21% of ____.

A

atmospheric air

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7
Q

Oxygen flow rates vary to maintain an SpO2 of _____% to ___% using the lowest amount of oxygen to achieve the goal without risking complications.

A

95 - 100%

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8
Q

The fraction of inspired oxygen (FIO2) is the percentage of oxygen the client ____.

A

receives

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9
Q

Noninvasive measurment of the oxygen saturation of the blood for monitoring respiratory status when assessment finding inlcude any of the following.

A 
increased work of breathing
wheezing
coughing
cyanosis
changes in respiratory rate or rhythm
adventitious breath sounds
restlessness, irritability, confusion
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10
Q

Interventions for readings less than 90% (indicating hypoxemia)

A

confirm probe placement

confirm that the oxygen delivery system is functioning and that the lcient is receiving the prescribed oxygen levels

place the client in semi-fowler’s or fowler’s position to promote chest expansion and to maximize ventilation

Encrougae deep breathing

Remain with the client and provide emotional support to decrease anxiety

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11
Q

The SpO2 expected reference range

A

95 -100

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12
Q

The SpO2 accepted levels reference range

A

91-100

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13
Q

Some illness states can allow for ____ to ____. Readings less than 90% reflect hypoxemia.

A

85-89

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14
Q

SpO2 values can be slightly lower for older adult clients and client who have ___.

A

dark skin

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15
Q

Additional reasons for low SpO2 levels include hypothermia, por peripheral blood flow, too much light (sun, infrared lamps), low hemoglobin levels, ______, movement, edema and nail polish.

A

jaundice

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16
Q

Oxygen is a thrapeutic gas that treats _____(low levels of arterial oxygen). Administering and adjusting it requires a prescription.

A

hypoxemia

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17
Q

Manifestations of early hypoxemia

A 
tachypnea
tachycardia
restlessness, anxiety, confusion
pale skin, mucous membranes
elevated bp
use of accessory muscles, nsala flaring, tracheal tugging, adventitious lung sounds
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18
Q

Manifestations of late hypoxemia

A 
stupor
cyonotic skin, mucous membranes
bradypnea
bradycardia
hypotension
cardiac dysrhythmias
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19
Q

Monitor respiratory rate and pattern, level of consciousness, SpO2, and _____ when giving oxygen therapy.

A

arterial blood gas

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20
Q

Provide oxygen therapy at the ___ liter flow that will correct hypoxemia.

A

lowest

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21
Q

Maske sure the mask creates a secure seal over the ______.

A

nose and mouth

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22
Q

Assess/monitor hypoxemia and hypercarbia (elevated levels of CO2); restlessness, hypertension and _____.

A

headache

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23
Q

Ausculate the lungs for breath sounds and adventitious sounds, such as _____.

A

crackles and wheezes

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24
Q

Assess/Monitor ______- status with pulse oximetery and arterial blood gases (ABGs)

A

oxygenation

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25
Q

When on oxygen therapy promote good ____.

A

oral hygiene

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26
Q

Encourage turning, coughing, deep breathing, and the use of incentive spirometry and _____.

A

suctioning

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27
Q

When on oxygen therapy promote rest and ____.

A

decrease environmental stimuli

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28
Q

When on oxygen therapy provide ____ support.

A

emotional

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29
Q

When on oxygen therapy assess nutritoinal status and provide ______.

A

supplements as needed

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30
Q

When on oxygen therapy assess skin integrity. Provide moisture and _____.

A

pressure relief devices

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31
Q

When on oxygen therapy assess and _____ response to therapy.

A

document

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32
Q

When on oxygen therapy titrate oxygen to maintain the recommended ____.

A

oxygen saturation

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33
Q

When on oxygen therapy discountinue _____.

A

gradually

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34
Q

When on oxygen therapy monitor for respiratory ______ (decreased resp rate and level of consciouness)

A

depression

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35
Q

Low flow oxygen delivery systems deliver varying amounts of oxygen based on the ______ and the client’s breathing pattern.

A

delivery method

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36
Q

Low flow oxygen delivery through a ______ is tubing with two small prongs for insertion into the nares.

A

nasal cannula

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37
Q

Fraction of inspired oxygen (FIO2) via a nasal cannula ranges from 24% to 44% at a flow rate of ____.

A

1 to 6 L/min

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38
Q

A cannula is a safe, simple, and _____ method.

A

easy to apply

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39
Q

A cannula is comfortable and ____.

A

well tolerated

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40
Q

With a ____ a client is able to eat, talk, and ambulate.

A

cannula

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41
Q

The FIO2 varies with the flow rate, and rate and depth of the client’s breathing which is a disadvantage when using a ____.

A

cannula

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42
Q

Extended use of a cannula can lead to ___ and dry mucous membranes.

A

skin breakdown

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43
Q

A disadvantage to a ______ is that it is easily dislodged.

A

cannula

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44
Q

When using a nasal cannula make sure to assess the patency of the nares. Ensure that the prongs fit in the nares properly. Use _____ to prevent dry nares. Provide humidification for flow rates of _____ or greater.

A

water soluble gel

4L or greater

45
Q

A ______ covers the client’s nose and mouth.

A

simple face mask

46
Q

A simple face mask delivers an FIO2 of _____ to _____ at a flow rate of 5 to 8 L/min.

A

40 to 60%

47
Q

The minimum flow rate is _____ to ensure flushing of CO2 from the mask when using a simple face mask.

A

5 L/min

48
Q

Advantages to a simple face mask is that it is easy to apply and can be more comfortable than a ____.

A

nasal cannula

49
Q

The simple face mask is a simple _____.

A

delivery method

50
Q

The simple face mask provides _____ oxygen

A

humidified

51
Q

With a ______ flow rates less than 5L/min can result in rebreathing CO2.

A

simple face mask

52
Q

Clients who have anxiety or claustrophobia do not tolerate a _____ well.

A

simple face mask

53
Q

Eating, drinking, and ____ are imparied when using a simple face mask.

A

talking

54
Q

Moisture and pressure can ___ under the simple face mask and cause skin breakdown.

A

collect

55
Q

When using a simple face mask assess proper fit to ensure a secure seal over the nose and mouth. make sure the client wears a nasal cannula during meals. Use with caution for clients who have a high risk of _______ or airway obstruction.

A

aspiration

56
Q

When using a simple face mask monitor for ____.

A

skin breakdown.

57
Q

A _____ mask covers the clients nose and mouth.

A

partial rebreather

58
Q

A partial rebreather mask delivers an FiO2 of ___ to ____ at flow rates of 6 -10 L/min.

A

40 to 70%

59
Q

An advantage to a partial rebreather mask is that it has a reservoir bag attached with no valve, which allows the client to rebreathe up to ____ of exhaled air together with the room air.

A

1/3

60
Q

With a ____ mask complete deflation of the reservoir bag during inspiration causes CO2 buildup.

A

partial rebreather

61
Q

The FiO2 varies with the client’s _____ with a partial rebreather mask.

A

breathing pattern

62
Q

Clients who have ____ or claustrophobia do not tolerate the partial rebreather mask well.

A

anxiety

63
Q

With a partial rebreather mask eating, ____, and talking is impaired.

A

breathing

64
Q

With a _____ mask it is necessary to keep the reservoir bag from deflating by adjusting the oxygen flow rate to keep the reservoir bag 1/2 to 1/3 full on inspiration

A

partial rebreather

65
Q

With a _____ mask it is necessary to assess proper fit to ensure a secure seal over teh nose and mouth. Assess for skin breakdown beneath the edges of the mask and _____.

A

partial rebreather

bridge of the nose

66
Q

Make sure the client uses a _____ during meals with a partial rebreather.

A

nasal cannula

67
Q

A partial rebreather mask should be used with caution for patients who have a high risk of aspiration or ______.

A

airway obstruction

68
Q

A nonrebreather mask covers the clients _____.

A

nose and mouth.

69
Q

Fraction of inspired oxygen delivers ___ to ____ at flow rates of 10 - 15 L/min to keep the reservoir bag 2/3rds full during inspiration and expiration

A

60 to 100 %

70
Q

A ____ mask delivers the highest O2 concentration possible (except for intubation).

A

nonrebreather

71
Q

A one way valve situated between the mask and resrvoir allows the client to inhale maximum O2 from the reservoir bag. The two exhalation ports have flaps covering them that prevent room air from entering the _____ mask,

A

nonrebreather

72
Q

The valve and flap on the mask must be intact and functional during each breath with a _____ mask.

A

nonrebreather

73
Q

A nonrebreather mask is poorly tolerated by clients who have anxiety or ____.

A

claustrophobia

74
Q

Eating, drinking, and ____ are impaired with a nonrebreather mask.

A

talking

75
Q

Nonrebreather masks should be used with caution for clients who have a high risk of ____ or airway obstrction.

A

aspiration

76
Q

Perform an ____ assessment on the valve and flap of a nonrebreather mask.

A

hourly

77
Q

Assess proper fit ensure seal over the nose and mouth. Assess for skin breakdown ____ of the mask and the bridge of the nose with a nonrebreather mask.

A

beneath the edges

78
Q

Low Flow oxygen delivery systems

A

nasal cannula
simple face mask
partial rebreather
nonrebreather

79
Q

A venturi mask is a ____ flow oxygen delivery system that covers the client’s noe and mouth.

A

high

80
Q

A venturi mask delivers an FiO2 of ___ to ___ flow rates of 4 to 12 L/min via different size adapters, which allows specific amounts of air to mix with oxygen.

A

24% to 60^

81
Q

A ___ mask delivers the most precise oxygen concentration.

A

venturi

82
Q

Humidification is not necessary with a ____ mask.

A

venturi

83
Q

A _____ mask is best for clients who have chronic lung disease.

A

venturi

84
Q

A disadvantage to a ___ mask it that it is expensive.

A

venturi

85
Q

A venturi mask impairs ____, drinking, and talking.

A

eating

86
Q

Assessment of a venturi mask needs to be frequent to ensure an ______ flow rate.

A

accurate

87
Q

Assess proper fit to ensure a secure seal over teh nose and mouth. Assess for skin breakdown beneath the edges of the mask particularly on the ____ when using a venturi mask.

A

nares

88
Q

Two types of aerosol masks

A

face tent

trachostomy collar

89
Q

A ____ fits loosely around the face and neck.

A

face tent

90
Q

A _____ is a small mask that covers the surgically created opening of the trachea.

A

tracheostomy collar

91
Q

An ____ mask delivers an FiO2 of ____ to ____ at flow rates of at least 10 L/min.

A

aersol (face tent or tracheostomy collar)

92
Q

An aerosol mask provides high ____ with oxygen delivery.

A

humidification

93
Q

An _____ mask is a good option for those that do not tolerate masks well.

A

aersol mask

face tent or tracheostomy collar

94
Q

_____ masks are useful for clients who have facial trauma, burns, and thick secretions.

A

aersol mask

95
Q

A drawback to an aersol mask is that the high humidification requires ____.

A

frequent monitoring

96
Q

Nurses need to empty ____ from the tubing often with aerosol masks.

A

condensation

97
Q

Nurses need to ensure adequate water in the ____ _canister with aersol masks.

A

humidification

98
Q

Nurses need to ensure that the ___ leaves from the vents during inspiration and expiration.

A

aerosol mist

99
Q

Make sure the tubing does not pull on the _____ with a tracheostomy collar.

A

tracheostomy

100
Q

______ can result from high concentrations of oxygen (typically greater than 50%), long durations of oxygen therapy (typically more than 24 to 48 hours) and the severity of lung disease.

A

oxygen toxicity

101
Q

Nonproductive cough, substernal pain, nasal stuffiness, nausea, vomiting, fatigue, headache, ____ and hypoventilation are manifestations of oxygen toxicity.

A

sore throat

102
Q

With oxygen toxcity use the lowest level of oxygen necessary to maintain an adequate ____.

A

SpO2

103
Q

Monitor _____ and notify the provider if SpO2 levels are outside the expected reference range to make sure oxygen toxicity.

A

ABGs

104
Q

To prevent oxygen toxicity decrease the FiO2 as teh client _____ improves.

A

SpO2

105
Q

Clients who have conditions that cause alveolar ________ can be sensitive to the administration of oxygen.

A

hypoventilation

106
Q

In oxygen-induced hypoventilation monitor respiratory rate and pattern, level of consciousness , and _____.

A

SpO2

107
Q

In oxygen-induced hypoventilation provide oxygen therapy at the lowest liter flow rate that manages ______.

A

hypoxemia

108
Q

In oxygen-induced hypoventilation monitor if the client tolerates it, use a ______ to deliver precise oxygen levels.

A

Venturi mask

461-Foundations (45 decks)

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