ATI Respiratory Flashcards
COPD intervention?
Provide a diet that is high in calories and protein.
(Resp tx should be scheduled before meals not after, have short activities followed by short rest periods in between. Don’t combine too many activities)
Prep for discharge following bronchoscopy, priority assessment?
Assess gag reflex- risk is aspiration, gag reflex needs to return.
(Percussing lung sounds, auscultating heart sounds, and palpating peripheral pulses are important but not priority)
Best position for emphysema to promote effective breathing?
High fowlers with arms supported on overbed table- allows for expansion of chest
Med during asthma attack?
Albuterol (Proventil)- short acting beta 2 adrenergic agonist- bronchodilates quickly
(Cromolyn sodium (intal) is an anti-inflammatory used for maintenance. Fluticasone and salmeterol (Advair) is a glucocorticoid and long acting beta 2 adrenergic agonist for maintenance. Prednisone is a steroid that may be used after a severe exacerbation for anti-inflammatory effects.)
Assessment used to evaluate the effectiveness of mechanical ventilation?
ABGs- provide important info regarding serum oxygen saturation and the acid bace balance of blood. Will show if ventilator is providing adequate oxygenation to maintain lung fx.
(BP & HR- circulatory status. Breath sounds- tube placement and adequacy of air exchange)
Pt with ARDS, what indicates work of breathing has worsened?
Increase in respiratory rate- indicates increased work of breathing and need for improved oxygen delivery.
Risk for pulmonary embolus?
Total hip arthroplasty- surgery, decreased mobility
TB taking rifampin, teaching?
Urine and other secretions will be orange.
Ppd test won’t improve, med should be taken on empty stomach once per day
Bacterial pneumonia assessment finding?
Temperature 38.8c (101.8f)- high temp
Resp will be fast, cough will be productive
What to do when obtaining an ABG?
Hold pressure at site for 5 minutes, obtain specimen in heparinized syringe, perform Allen test before, don’t insert air bubble before capping syringe, transport to lab immediately.
Respiratory acidosis:
pH 7.30, PO2 80 mmhg, PaCO2 55 mmhg, HCO3 22 meq/L.
What precautions for active TB?
Airborne
Droplet- rubella, Contact- scabies, mrsa
Singulair (montelukast) teaching?
Take every evening even when there are no symptoms. Used for prophylaxis of asthma exacerbation.
Chest tube problem?
Continuous bubbling in the water seal chamber- suggests an air leak
(drainage should fluctuate in tubing during inspiration, small dark red clots are normal)
Monitor pt on albuterol for what SE?
Tachycardia- most common side effect.
Candidiasis is a SE of inhaled glucocorticoids such as beclomethasone (QVAR
Pt with COPD, report what to provider?
Productive cough with green sputum- indicates infection.
Expected findings- o2sat 89, clubbing, pursed lip breathing
Post total laryngectomy for laryngeal cancer, priority assessment?
Airway patency- greatest risk is airway obstruction.
Gag reflex, o2sat, and breath sounds are important but not the most important
Post thoracentesis, priority assessment?
Decreased breath sounds- could be developing pneumo.
Hemoptysis, incision site pain, and temp 100 are important but not priority
Emphysema assessment finding to report?
Cyanotic lips- indicates pt is not efficiently oxygenating blood.
(Fatigue, crackles, and barrel chest are expected findings)
Pt on vent, low pressure alarm?
Artificial airway cuff leak- interferes with oxygenation and causes low pressure alarm.
(Excess secretion, kinks in tubing, and biting ET tube cause the high pressure alarm)
Indicator of tension pneumothorax following chest trauma?
Tracheal deviation to unaffected site
Procedure during ET suctioning?
Remove suction catheter using rotating motion- reduces risk of tissue trauma, suction with sterile technique, suction the nonsterile oropharyngeal cavity after the ET tube not before to prevent cross contamination, suction PRN not on a schedule.
Acute respiratory failure, what labs?
PaO2 58mmhg, decreased with ARF
Resp acidosis results, decreased ph, paco2 will rise, o2 sat will be decreased
Post chest tube insertion, what should be at bedside?
Pair of padded clamps in case tube becomes disconnected.
Don’t need extra drainage system, suture removal set, or nonadherant pads
Pulmonary embolism highest priority intervention?
Administer IV heparin at 1300 units/hr- will prevent further clot formation, pt is at risk for respiratory arrest r/t extension of clot.
(Cardiac monitor, quiet environment, and incentive spirometer are important but not priority)
Postoperative pt develops acute onset of severe chest pain that is worse with inspiration, anxious, tachypnic. What should nurse do?
Apply supplemental oxygen first.
Auscultating lungs, administering pain meds, and initiating heparin therapy are important but not priority
Lung cancer expected finding?
Blood tinged sputum- secondary to bleeding tumor
(Tactile fremitus is usually increased due to air spaces being replaced with tumor tissue or fluid, masses will sound dull or flat in percussion, no peripheral edema present)
Post tracheostomy discharge instructions?
Inspect stoma for irritation
Clean cannula with half strength peroxide and rinse with saline
Remove old twill tape once new is in place
Don’t such potion while inserting catheter only when withdrawing to prevent tracheal tissue trauma
Respiratory distress, how to provide highest level of oxygen via low flow system?
Nonrebreather mask- greater than 90% fio2, has reservoir bag from which the client obtains oxygen, one way valve to prevent exhaled air from entering reservoir bag, exhalation ports with flaps that prevent room air from entering the mask.
(Nasal cannula- 2-6L/min 28-44%o2. Simple face mask- o2 conc between 40-60%, has open exhalation ports that allow room air in and exhaled air out. Partial rebreather- o2 conc 60-75%, exhalation ports are open which allow room air in and exhaled air out.)
Don’t nasopharyngeal suction a patient who has?
Closed head injury and lethargic- nasopharyngeal suctioning can further increase ICP.
Indicators for suctioning:
dont suction routinely. If nurse identifies coarse crackles, ronchi, moist cough, hears or sees secretions in tube
crepitus
subcutaneous emphysema, coarse crackling sensation palpated over the skin surface, indicates air leak into the subcutaneous tissue often indicating a pneumothorax
Friction rub
scratching or squeeking sound that persists throughout the respiratory cycle and does not clear with coughing, may indicate pericarditis or pleurisy.
Crackles
sometimes called rales. wet popping sounds, created by air moving thorugh liquid or by collapsed alveoli snapping open on inspiration. crackles indicate fluid or mucous in small airways.
Tactile fremitus
vibration felt on palpation of the chest while the client repeats a syllable such as ninety nine. fremitus is increased over solid tissue or a tumor.
what to discuss with the pt about asthma
the pts perception of the disease process and what may have triggered the current attack. gives the nurse valuable information about the clients knowledge and misconceptions about asthma and potential environmental triggers.
Flail Chest
refers to the paradoxical movement of the chest wall of a client who has fractured two or more adjacent ribs in two or more places. results in a floating segment of the chest wall that moves inward on inspiration and outward on expiration.
Pleural Friction rub
sound that originates outside the airways and is associated with inflammation such as pleurisy
Inspiratory stridor
associated with narrowing of the middle airways, such as with croup
Pt at risk for ARDS
increased restlessness, apprehension, and anxiety after increasing oxygen concentration is a sign of progressive hypoxemia and ARDS
Pt with pneumonia
provide oral hygeine care after respiratory aerosol therapy treatments and before meals. oral hygiene removes the unpleasant or lingering taste from expected mucus, inhaled medications, and antibiotics. it helps improve the taste of food and stimulates the clients appetite.
Postop pneumonectomy
teach to splint incision when coughing, pt must cough to clear secretions from the remaining lung. also give pain meds to facilitate deep breathing and coughing
Pneumonectomy
removal of entire lung, there is no lung left to reexpand, eliminates need for upper chest tube which is placed to evacuate air from the pleural space, also lower chest tube is not needed as it is expected that fluid will gradually fill in the space left by the excised lung.
CM of pneumothorax
absence of breath sounds/ severely diminished on affected side
Pursed lip breathing
used by clients with emphysema when they experience dyspnea. Slows the clients pace of breathing, making each breath more effective. releases trapped air in the lungs and prolongs exhalation to slow the breathing rate. this improved breathing pattern moves carbon dioxide out of the lungs more efficiently.
Respiratory acidosis
decreased exhalation of carbon dioxide because of chronic lung disease lungs can’t recoil.
Chest physiotherapy (CPT)
mobilizes secretions in the airways. may give bronchodilators prior to CPT, encourage pt to breathe deeply and cough after CPT
Thoracentesis positioning
sitting while leaning over the bedside table. THroacentesis is for aspirating fluid or air from the pleural space. the upright position ensures that the diaphragm is most dependent and facilitates the removal of accumulated fluid, which tends to pool in the bases of the pleural space.
Chest tube system
Leak- bubbling in the water seal chamber
Tape all connections
Keep chest tube system below level of chest
