ATI Unit 3 Respiratory Flashcards
Pulmonary Functions Tests (PFTs)
these determine lung function and breathing difficulties
- if client is a smoker, instruct not to smoke 6-8 hours prior, if client uses inhalers, withhold 4-6 hours prior to testing
what does an ABG measure
pH: amount of free hydrogen ions in arterial blood
PaO2: partial pressure of oxygen
PaCO2: partial pressure of carbon dioxide
HCO3-: concentration of bicarbonate in arterial blood
SaO2: percentage of oxygen bound to Hgb as compared with total amount than can be carried
how can an ABG be obtained
through venipuncture or arterial line
Preprocedure for ABG arterial puncture
- obtain heparinized syringe
- perform Allent Test (occlude ulnar and radial arteries with balled fist then release one each)
- can be painful so let patient know what an ABG is
Intraprocedure
- perform an arterial puncture using aseptic technique acquiring into heparinized syringe
- put syringe into container with ice and water to maintain pH and oxygen pressure transport immediately to lab
- radial sampling in older clientscanbehardb/c of decreased peripheral vasculature
Postprocedure for arterial puncture
- hold pressure/gauze for 5 minutes, 20 if on anticoags
- assess for swelling, temperature, loss of pulse, pallor
- document
- notify provider of results
- admin O2 and change ventilator settings if needed
***note: arterial puncture often performed by respiratory therapist
Arterial Line Procedure
Pre: get two syringes, heparinized for sampling and standard for waste (verify line can be used)
Intra: collect waste and sampling and put on ice to transport to lab; flush line with flushing system
Post: assess the arterial waveform upon completion, document/notify, admin O2 and adjust ventilator settings
Complications of Arterial line/arterial venipuncture
1) hematoma
2) air embolism
what’s important before performing a bronchoscopy
that client maintained on NPO status usually 8-12 hours to reduce aspiration risk and when cough reflex is blocked by anesthesia
what does atropine do
reduces oral secretions
what position is a bronchoscopy performed in
sitting
patient after a bronchoscopy has a mild, short fever nd a small amount of blood-tinged sputum, what does the nurse suscpect
nothing this is normal
when is a client discharged from bronschoscopy
when cough reflex and resp effort are adequate
what can ease a sore throat
gargling salt water and throat lozenges
what are complications of bronchoscopy
- laryngospasm: laryngeal cords (vocal cords) contract and impede client’s ability to inhale
- pneumothorax (obtain follow up x-ray)
- AspirationL can occur if client chokes on oral or gastric secretions
reasons for thoracentesis
- transudates (heart failure, cirrhosis, nephritic syndrome)
- exudates (inflammatory, infection, neoplastic conditions)
- empyema
- pneumonia
- trauma or invasive surgery
assessment of effusion area
decreased breath sounds, dull percussion sounds, decreased chest wall expansion
how much can you remove during a thoracentesis
1L at a time to prevent cardiovascular collapse
Complications of a thoracentesis
- mediastinal shift
- pneumothorax (deviated trachea, pain on affected side worse on exhale, affected side doesn’t move in and out, increased HR, rapid shallow resp, cough
- bleeding
- infection: with needle puncture (thoracentsis is aseptic
what are the three chambers for chest tube drainage system
1st chamger: drainage collection
2nd chamber: water seal
3rd: suction control
water seal
add up to 2cm line allows air to exit but not enter with inhale (level must be maintained, lies on the ground)
- tidaling movement is expected in water seal, with normal inspirations the fluid level rises with inspiration and vice versa expiration (but for pos-pressure mechanical ventilation it’s the opposite)
- cessation of tidaling in water seal chamber signals lung reexpansion or obstruction
suction control chamger important fact
heigh of sterile fluid determines amount of suction (usually -20cm H2O), results in continuous bubbling in suctino chamber
