Care Of Client With Pulmonary Conditions Flashcards
1
Q
Examples of artificial or advanced airways
A
Endotracheal (ET) tube and Trach
2
Q
External chest wall manipulation, broadly classified as airway clearance therapy (ACT), that loosens and removes secretions from patients’ airways
A
Chest Physiotherapy (CPT)
3
Q
Examples of chest physiotherapy (CPT)
A
Percussion, vibration, postural drainage (PD) therapy, and acapella device
4
Q
What do acapella devices measure?
A
Expiration pressure
5
Q
How to use incentive spirometer
A
Set goal for patient, instruct patient to take deep breath in and “aim for the smiley face”
6
Q
Purpose of incentive spirometer
A
Preventing build-up of fluid and bacteria that can cause pneumonia
7
Q
High frequency chest wall oscillators are commonly used in
A
Patients with cystic fibrosis
8
Q
Managing secretions nursing care
A
Turn/repostion q1-2h, early ambulation and out-of-bed activities, cough and deep breathe, CPT (percussion, vibration, postural drainage)
9
Q
Oral care for patients with pulmonary conditions
A
Sponge tooth cleaner or soft-bristle toothbrush moistened in water; avoid glycerin swabs or mouthwash containing alcohol
10
Q
Emergency airway that maintains airway patency by displacing the tongue forward and toward the oral cavity floor
A
Oropharyngeal airway (OPA)
11
Q
How to determine correct OPA size
A
Hold flange parallel to the front teeth and the end of the OPA should reach he angle of the jaw
12
Q
Airway used for unconscious patient? Airway used for conscious patient?
A
OPA; nasal trumpet
13
Q
Inserting an OPA
A
Insert upside down or sideways, then flip it
14
Q
What should be done if a patient with an OPA continually coughs and gags when it is inserted?
A
Remove OPA and turn patient to side; nasal trumpet may be a better option
15
Q
What kind of technique should be used for oral suctioning?
A
Clean
16
Q
Describe nasotracheal suctioning
A
Use sterile technique; one sterile hand (dominant) and one clean hand; no more than 3 passes and for no more than 10 seconds each; suction on WITHDRAW; use sterile saline to clear suction
17
Q
How much room should the nurse leave between the start and end of suction catheter?
A
About a fist
18
Q
Suctioning unexpected outcomes
A
Decrease in cardiopulmonary status as evidenced by decreased SpO2, increased EtCO2, tachypnea, increased work of breathing, and cardiac dysrhythmias
19
Q
Interventions to address unexpected outcomes related to suctioning
A
Limit length of suctioning, more frequent suction with shorter duration, supplemental oxygen, supply oxygen between suctioning passes, notify health care provider
20
Q
Prior to suctioning, the nurse should
A
Hyperoxygenate the client; set ventilator to 100% oxygen
21
Q
Signs that a patient needs oxygen
A
Low pulse ox, rapid and hard respirations, confusion/agitation, cyanosis, changes in HR and rhythm and BP
22
Q
Oxygen safety considerations
A
Fall risk, skin breakdown (on top of nose, behind ears)
23
Q
Nasal cannula flow
A
2-6 L (can add humidification at 4 L)
24
Q
Simple face mask flow
A
6-10 L
25
Nonrebreather face mask flow
10-15 L
26
Nonrebreather mask nursing consideration
Do not place on patient unless the bag is filled some (risk for suffocation); this device is more emergent, for patients that are no doing well
27
Benefit of Venturi mask
Allows for administration of a very specific amount of oxygen (% instead of L)
28
Benefit of high-flow nasal cannula
Gives high amount of oxygen and patient can still talk, eat, and move around
29
How can the nurse tell the type and size of a trach tube
By looking at the trach plate
30
T or F: nurse can change a tracheostomy tube
False: nurses can only change the inner cannula
31
Changing/cleaning an inner cannula
Sterile procedure; only touch the outer portion (knob); use sterile water/saline and brush to clean inner then outer cannula
32
What supplies should be kept at the HOB for patients with tracheostomy tubes?
An extra trach kit and obturator (used in emergency situations to maintain patency should the trach be misplaced)
33
Attachment that delivers desired FIO2 to clients with tracheostomy, laryngectomy, and ET tubes
T-piece
34
__________ should appear on exhalation side of T-piece
Aerosol
35
Preoperative interventions for tracheostomy
NPO, hold anticoagulants, stop TF as ordered, clean site with chlorhexidine, witness informed consent
36
Postoperative interventions tracheostomy
Monitor for bleeding
37
Tracheostomy can be inserted at _________ or in the ___
Bedside; OR
38
Tracheostomy complications
Tube obstruction, tube dislodgement/accidental decannulation, pneumothorax, subcutaneous emphysema, bleeding, infection
39
Preventing tracheostomy complications
Prevent tissue injury by keeping area clean and dry, ensure air warming and humidification, suction as needed
40
Tracheostomy complications characterized by air-trapping in the subcutaneous area; feels and sounds like rice-crispy
Subcutaneous emphysema
41
Supporting the psychosocial needs and self-esteem of patients with tracheostomy
Aknowledge frustration, allow sufficient time for communication, use normal tone of voice, address changes in self-image, provide social contact, nutritional needs
42
Alternate forms of communication in patients with tracheostomy
Writing tablet, picture board w/ letters, flashcards, hand signals, smart phones, yes/no questions, mark central call light to indicate patient cannot speak, collaborate with SLP
43
Swallowing can be difficult for the patient with a tracheostomy. Educate the patient to keep the HOB elevated for at least ___ min after eating
30
44
Trach weaning
Gradual decrease in tube size until ultimate removal of tube; deflate cud when patient can manage secretions and does not need assisted ventilation; change from cuffed to uncuffed tube; capping, tracheostomy button
45
Example of non-invasive ventilation
Bipap
46
Bipap safety considerations
High risk for aspiration (DO NOT restrain these patients; patient may need to be NPO or have an NGT)
47
Bipap assessment
Mentation, skin, mucus membranes
48
Ventilation that uses positive pressure to keep alveoli open and improve gas exchange
Noninvasive positive-pressure ventilation (CPAP, volume-limited or flow-limited, BiPAP)
49
Ventilation that provides continuous positive airway pressure and is the most effective treatment for sleep apnea because the positive pressure acts as a splint to keep upper airway and trachea open during sleep
CPAP
50
Ventilation the provides bilevel (inspiratory and expiratory) positive airway pressure
BiPAP
51
Describe how a BiPAP works
Indicated for patients who need help ventilating; Machine cycles to provide a set positive inspiratory pressure when inspiration takes place and a lower set end-pressure during expiration
52
Interventions for prevention of ventilator assisted pneumonia
Proper hand hygiene, elevate HOB (unless contraindicated), oral hygiene w/ chlorhexidine, peptic ulcer and VTE prophylaxis, provide daily disruption of sedation, early mobilization, initiate enteric feedings earlier, provide subglottic secretion drainage
53
Flexible, plastic tubes placed in the mouth or through the nose and advanced down into the trachea
Endotracheal tubes
54
Endotracheal tubes indications
Short-term for mechanical ventilation, relieving upper airway obstruction, protecting against aspiration, and clearing secretions
55
ET routine care
Maintain correct position of tube, monitor cuff pressures, prevent complications
56
Unexpected outcomes related to ET tubes
Accidental extubation, cuff leaks
57
Interventions for accidental ET tube extubation
Remain w/ patient while calling for help, notify health care provider, ventilate with bag-valve mask as needed, assess: airway patency, spontaneous breathing, vital signs, prepare for reintubation
58
What health care professionals can intubate?
CRNA, anesthesiologist, ER/Critical Care Physician, pulmonologist (intensivist)
59
Who should the nurse always call as a right-hand man for intubation?
Respiratory Therapist (RT)
60
Supplies needed for intubation
Glidescope, med kit (whatever sedative/paralytic doc wants), orders in place, OG, lube, tape, meds, ambu bag
61
Intubation should not be attempted longer than _____ without oxygenating the patient
30 sec
62
Intubation nursing interventions
Monitor VS, color change, chest rise, breath sounds, assist with stabilizing tube, CXR to ensure placement
63
When intubating, sedatives and paralytics are administered? Which is administered first?
Sedative first, followed by paralytic
64
Interventions for and prevention of ventilator alarms and equipment malfunctions
Ensure alarms are appropriately set and respond to alarms promptly. Prevent malfunctions by regularly checking equipment and performing maintenance
65
What does a low tidal volume alarm indicate?
Low exhaled volume d/t disconnection, cuff leak, and/or tube displacement
66
What does a high peak pressure alarm indicate?
Excessive secretions, biting the tube, kinks in tubing, coughing, pulm edema, bronchospasm or pneumothorax
67
Mnemonic for complications of mechanical ventilation
DOPE: displacement, obstruction, pneumothorax, equipment failure
68
How does positive pressure ventilation (PPV) work?
Works opposite of normal dynamics of lungs (negative pressure) and pumps air into lungs
69
A lung infection that can occur when bacteria enter the lower respiratory tract through the endotracheal tube
Ventilator associated pneumonia (VAP)
70
Correct of VAP
Follow strict infection control measures, hand hygiene, ET tube care, oral hygiene, HOB 30-45 degrees to prevent aspiration
71
Complication of mechanical ventilation that refers to lung or airway injury due to excessive airway pressure that can lead to pneumothorax or air leakage into the surrounding tissues
Barotrauma
72
Correction of barotrauma
Adjust ventilator setting to limit peak inspiratory pressure and tidal volume
73
Damage to the lung tissue caused by mechanical ventilation that can lead to increased inflammation and impaired oxygenation
Ventilator-induced lung injury (VILI)
74
Correction of VILI
Lung-protective ventilation strategies such as low tidal volume and low plateau pressure; adjust ventilator settings to minimize overdistention and atelectrauma
75
Inadequate oxygenation (_________) and excessive carbon dioxide retention (__________) can occur if ventilator settings are not optimized
Hypoxemia; hypercapnia
76
Correction of hypoxemia and hypercapnia related to mechanical ventilation
Adjust FiO2 (fraction of inspired oxygen), PEEP (positive end-expiratory pressure), tidal volume, and RR to achieve oxygen saturation and end-tidal CO2 levels; frequent ABG analysis
77
A range of mechanical ventilation complications including ventilator associated conditions (VAC), infection related ventilator associated complications (IVAC), and possible VAP
Ventilator associated events (VAE)
78
Correction of ventilator associated events (VAE)
Follow strict infection control, monitor for signs of VAE, document changes in ventilator parameters (EARLY recognition and intervention are CRUCIAL!)
79
_____-sedation can lead to prolonged mechanical ventilation, while _____-sedation may result in patient agitation and increased work of breathing
Over; under
80
Correction of sedation and delirium related to mechanical ventilation
Use sedation protocols and daily sedation interruption to assess sedation needs, early mobilization, address pain and discomfort
81
Mechanical ventilation complication that occurs when the patient’s breathing does not match the ventilator settings, leading to discomfort and increased work of breathing
Ventilator asynchrony
82
Correction of ventilator asynchrony
Adjust ventilator settings to better match the patient’s respiratory efforts, consider using modes that allow or better synchronization like pressure support ventilation
83
Correction of malposition of ET tube or tracheostomy tube
Ensure proper placement and securement of airway tube; regular assessments and CXR can confirm correct positioning
84
Mechanical ventilation mode with preset rate and tidal volume by which the client initiates breath, but then the vent takes over
Assist control (AC)
85
Hyperventilation can result in what acid-base imbalance?
Respiratory alkalosis
86
Tidal volume is based on what two factors?
Height and gender
87
Pressure being fed to keep alveoli open
PEEP
88
Standard PEEP
5-15; the higher the PEEP, the sicker the patient
89
The amount of oxygen the patient is on
NFiO2; lowest is 21% (room air)
90
Preset rate and tidal volume for machine breaths by which the client initiates breath and volume depends on client effort, synched to reduce competition for breathing and can be used regular or for weaning
Synchronized Intermittent Mandatory Ventilation (SIMV)
91
Adverse effects of SIMV mode
Can increase work of breathing and cause fatigue
92
Things to give in report for a client on mechanical ventilation
Mode (usually ACVC), tidal volume (usually 4-6 mL/kg), PEEP (typically 5-10cm H2O), FiO2 (21-100%), and rate
93
What does VT stand for
Tidal volume
94
What does F RR stand for
Frequency of respirations
95
FiO2
Oxygen concentration
96
What does PS stand for
Pressure support
97
What does Ve stand for
Minute ventilation
98
What does PIP stand for
Peak inspiratory pressure
99
What does Pplat stand for
Plateau pressure
100
Vent complication that can occur when the patient is unable to breathe effectively without ventilatory support
Weaning failure
101
Correction of weaning failure
Evaluate patient readiness for weaning considering factors such as oxygenation, hemodynamics, and respiratory effort; use weaning protocols and techniques like spontaneous breathing trials to assess readiness
102
Chest tube indications
Draining air, fluid, blood
103
Chest tube safety considerations
Keep sterile occlusive dressings and sterile water at bedside at all times (if tube becomes dislodged, place in sterile water)
104
Chest tube nursing considerations
Only clamp if ordered, some bubbling w/ inspiration and expiration is normal but CONTINUOUS bubbling indicates air leak, chest tube should remain upright and below level of chest (WATCH CT VIDEO SLIDE 36)
105
What solutions should be used to clean the inner cannula of tracheostomy?
Half-strength hydrogen peroxide followed by sterile saline
