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Test 3 > Chp 38 Oxygenation and Tissue Perfusion Study Guide > Flashcards

Chp 38 Oxygenation and Tissue Perfusion Study Guide Flashcards

1
Q

collapse of lung tissue in the still part of the lung

A

atelectasis

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2
Q

an inflammation of the larger airways, increased production of mucus, and chronic cough

A

chronic bronchitis

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3
Q

en enlargement of small air sacs in the distant end of terminal bronchioles

A

emphysema

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4
Q

a reaction of airways to stimulation by irritant, allergens, pollutants or cold air thought constriction and spasms

A

asthma

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5
Q

an infection in the lungs

A

pneumonia

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6
Q

the normal heart rate is _______ beats per minute

A

60-100

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7
Q

identify cardiovascular alterations that can influence oxygenation

A

Oxygenation can be inclined by atherosclerosis, arterial spasm or malformation blood clots, dysrhythmias, valvular issues, failure, and trauma

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8
Q

what is the cause of emphysema

A

caused by smoking, pollution, or family history

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9
Q

what is the cause of pneumonia

A

caused by infectious agent or aspiration

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10
Q

what is the cause of atelectasis

A

caused by decreased diaphragmatic movement and hypoventilation

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11
Q

how do scoliosis and kyphosis affect respiration

A

they are curvatures of the spine that limit thoracic movement and result in hypoventilation, retention of carbon dioxide, and reduced oxygenation

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12
Q

Identify at least fie assessment question that the nurse should ask the patient in regards to cardiopulmonary function

A

the nurse should ask about chest pain shortness of breath, dyspnea, weight gain/loss, dizziness blood clots, weakness/fatigue, persistent cough, and a history of smoking or cardiopulmonary disease

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13
Q

For the physical assessment , which areas will the nurse focus on to determine the patent’s oxygenation status

A

obtain vital signs auscultate heart and lung sounds evaluation peripheral pulses, and observe for changes in the skin (hairless, shiny extremities) or structure (barrel-chest) that would indicate alterations

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14
Q

cyanosis

A

bluish discoloration of the skin r/t deoxygenation of hemoglobin

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15
Q

define hemoptysis

A

blood in the sputum

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16
Q

define hypercapnia

A

an abnormal high level of carbon dioxide in the blood

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17
Q

define arrhythmia

A

abnormal rhythms of the heart

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18
Q

define necrosis

A

tissue death

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19
Q

define hypoxemia

A

low level of oxygen in the blood

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20
Q

For the patient with emphysema the results of forced vital capacity (FVC), forced expiratory volume (FEV1), and forced expiratory flow (FEF are expected to be ______ than normal

A

lower/less

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21
Q

the results of the residual volume (RV) and functional residual capacity (FRC) for a patient with emphysema is expected to be ________ than normal

A

higher/more than normal

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22
Q

For the patient with heart failure hemoglobin levels may be? Potassium levels may be?

A

Decreased (dilution fro excess fluid)

Decreased (hypokalemia related to diuretics)

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23
Q

What abnormalities can be found with a chest radiograph

A

abnormal findings on a chest radiograph are rib fractures, tumors, pneumothorax, pneumonia, pleural effusion, pericardial effusion, enlarged heart, and atelectasis

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24
Q

What concerns does the nurse have for the patient undergoing a cardia catheterization

A

the patient will have contrast dye injected, which could result in an allergic reaction. The nurse also has to monitor for bleeding and circulation to the extremity used for access

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25
Q

Identify at least three nursing diagnoses r/t oxygenation

A

Impaired Gas Exchanged r/t destruction of alveolar walls AEB Sp02 of 90% and patient complaints of inability to breath
Ineffective Airway Clearance r/t low oxygen levels and need for more oxygen with activity, AEB complaints of fatigue with activity , slow gait, and dropping O2 saturation levels with activity
Ineffective Breathing Pattern r/t ineffective movement of air into an out of the lungs, AEB difficulty breathing with activity and at least, use of pursed lip breathing

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26
Q

Goals out comes statements for oxygenation

A

Patient will maintain SpO2 at 92% or greater by the end of the shift
Patients lungs will be clear to auscultation within 24 hours
Patient will report decreased fatigue during hospitalization
Etc

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27
Q

What measures can the nurse implement to promote a patient’s oxygenation

A

posting in semi or high Fowler position, providing oxygen, maintaining airway clearance, instructing the patient in respiratory exercises (deep breathing, laughing, incentive spirometer use), providing adequate hydration, and administering medication to improve cardiovascular and pulmonary function

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28
Q

Oxygen saturation should be at least

A

90% or higher

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29
Q

What is required when oxygen is going to be sued by a patient at home

A

order from PCP, be instructed in the proper use and storage of the oxygen, have signs for No Smoking and determination of the type of deliver devise and tubing

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30
Q

For the Quality and Safety Education for Nurses competency of Teamwork and Collaboration, what other health team members will most likely be involved in the care of a patient with an oxygenation deficit

A

nurses, respiratory therapist, PCP, speech therapist (aspiration risk), and physical therapist (increase activity tolerance)

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31
Q

The patient is admitted to the hospital with an exacerbation of his emphysema. The patient’s wife asks why the oxygen level is “not turned up high enough” to help her husband breathe better. The nurse response by explaining to the patient’s spouse?

A

the higher levels of oxygen may create respiratory depression. In patients with emphysema who have high levels of carbon dioxide, low oxygen levels drive respiration. Higher amounts of oxygen will drop the respiratory status

32
Q

Safety consideration associated with nasal cannula

A

Correct application involves placing the prongs in the patient’s nares with the curved side at the top and the prongs pointing toward the back of the head; looping the tubing around the patient’s ears (gauze or special tubing covers may be used as a cushion where the tubing rests on the ear to prevent sores and protect the skin); and tucking the tubing under the patient;s chin and securing it with sliding adjustment piece. Encourage the patient to breathe through the nose. Do not administer oxygen through a nasal cannula at greater than 6L per minute. Consider humidification at all levels, especially at flow rates of 4L per minute and higher

33
Q

Safety considerations associated with simple face mask

A

If there is a bag reservoir, ensure it is filled before placing the mask on the patient. Always humidify oxygen delivered via mask. If the patient is able to eat, obtain an order for a nasal cannula during meals. Correct application involves the following: Pace the ask over the patient’s nose and mouth. Secure the mask around the back of the head with the adjustable strap, pulling evenly from both ends of the strap to secure it in place. If the straps are around the ears where thy may chafe, fusion the ears with gauze. Adjust the nosepiece by pinching it to provide for comfort and to ensure fit. There are several types of oxygen masks but no reservoir bag is used for a smile face mask

34
Q

Continuous positive airway pressure (CPAP) is used for?

A

treating obstructive sleep apnea and to prevent atelectasis

35
Q

Barriers to CPAP compliance include

A

dry nares, skin irritation claustrophobia, perception of an inability to breath and nose of the devise

36
Q

What is the difference between CPAP and biphasic positive airway pressure (BIPAP)

A

BiPAP provides two pressures - higher during inhalant and lower during exhalation, whereas CPAP maintains the same pressure throughout

37
Q

When would a bag-valve mask (BVM) or Ambu bag be used

A

to ventilate and oxygenation a patient who needs ventilatory support in an emergency situation

38
Q

Oropharyngeal Airway Size, Insertion, and Nursing care?

A

Size - 90mm
Insertion - Insert the airway while direction the curve of the airway at the rood of the mouth and then rotate the airway 180 degrees once it reached the back of the throat
Nursing care - Secure the airway in place with a hole or tape. Remove the airway every 4-8 hours. Provide oral care
https://www.youtube.com/watch?v=vgqOrmBskaw

39
Q

Nasopharyngeal Airway Size, Insertion, and Nursing Care

A

Size - 28 French
Insertion - Lubricate the airway before attempting insertion. The airway is inserted gently; if resistance is encountered, try the other nostril
Nursing care - Secure the airway in place with holder or tape. Remove the airway every 8-24 hours, and alternate nares. Provide oral and Nasal care

40
Q

What emergency equipment should be in the room of a patient with a tracheostomy

A

Abu Bag, endotracheal and oropharyngeal suction equipment, waterproof adhesive tape, an extra tracheostomy care kit, two extra inner cannulas (one the same size as worn by the patient, and one size smaller) with obturators, scissors, extra tracheostomy ties, oxygenation equipment

41
Q

Indicate interventions that can be used to promote cardiopulmonary function

A 
diets high in fiber and low fat
exercise 
medications
chest physiotherapy
anti embolism stockings
sequential compression devise
smoking cessation
immunizations 
chest tubes, tracheostomies, airways suctioning
42
Q

Identify at least three medications that are expected to be part of the treatment for pulmonary disease

A

bronchodilators, anticholinergic agents, corticosteroids, vaccines, antibiotics, mucolytic therapy, leukotriene modifiers

43
Q

Medication to be expected with cardiovascular disease

A

diuretics, angiotensin-converting enzyme inhibitors, angiotensin II receptor antagonists, beta blockers, calcium channel blockers, vasodilators, antiarrhythmics, anticoagulants

44
Q

The UAP is checking on the patient with a nasopharyngeal airway who has oxygen in place and requires frequent suctioning. What do you tell the UAP to report to you regarding the patient’s status

A

Changes in vital signs respiratory status, or level of conscienceless
Pain or discomfort noted by the patient
Skin breakdown
Excessive secretions
Difficulties encountered with any of the treatments

45
Q

The patient who needs nasotracheal suctioning has an excessive amount of secretions. How does the nurse ventilate this patient before suctioning

A

pre suctioning ventilation is done with a tracheostomy oxygenation mask set for 100% Fi02 for several respiratory cycles

46
Q

Suctioning through patient’s nares is contraindicated for the patient who has?

A

Epistaxis
Coagulation disorder
reactive airway disease
an upper neck injury

47
Q

To clear the suction catheter and check that the suction is functioning, the nurse uses

A

sterile normal saline

48
Q

Identify the pressure to be set for suction of tracheostomy

A

80-12 mm Hg continuous

49
Q

Identify the pressure to be set for suction of Oropharyngeal

A

120-150 mm Hg continuous

50
Q

Identify the correct sequence for cleaning the tracheostomy once the sterile field and solutions are prepared

A

Apply Sterile gloves
Dip the cotton swab into the sterile normal saline solution
Gently clean the outer area of the tracheostomy from the stoma outward
Pat the outer area of the tracheostomy dry with sterile gauze
Clean the inner cannula, if non disposable

51
Q

For a patient with a chest tube, indicate what the nurse should do for positioning for a patient with a pneumothorax

A

Semifowler position is used for a pneumothorax

52
Q

For a patient with a chest tube, indicate what the nurse should do for bubbling in the water seal chamber

A

Notify the PCP

53
Q

For a patient with a chest tube, indicate what the nurse should do for drainage is collecting in the coiled tube

A

lift the tubing up to clear the drainage. Do not lift the system above chest level

54
Q

For a patient with a chest tube, indicate what the nurse should do for assessment of the draining system should be done at least every

A

4 hours

55
Q

The nurse is working on a respiratory care unit in the hospital. Upon entering the room of a patient with emphysema, it is noted that the patient is experience=ign respiratory distress. The nurse should?

A

provide oxygen at 2L/minute via nasal cannula

56
Q

An older patient has developed kyphosis and is at a greater risk for developing pneumonia primarily because the:

A

abnormal chest shape prevents efficient ventilatory movement

57
Q

The patient has experience a MI resulting in damage to the left ventricle. A possible complication the patient may experience is?

A

pulmonary congestion

58
Q

A patient has recently had a mitral valve replacement. To prevent excess serosanguinous fluid accumulation, the nurse anticipates that care will include

A

chest tube placement in the thoracic cavity

59
Q

Chest percussion is indicated for

A

cystic fibrosis

60
Q

The nurse is working on a pulmonary unit at the local hospital. The nurse is alert to one of the early signs of hypoxia in patients, which is

A

restlessness

61
Q

in teaching a patient about an upcoming diagnostic test, the nurse identifies that which one of the following uses an injection of contrast material

A

cardiac catheterization

62
Q

At a community health fair, the nurse informs the residents that the pneumococcal vaccine is recommended for patients

A

of any age who have chronic lung disease

63
Q

an appropriate technique for nasotracheal suctioning

A

applying intermittent suction for 10 - 15 seconds during catheter removal

64
Q

The patient’s a chest tube in place following thoracic surgery. In working with patient who has a chest tube, the nurse should

A

keep drainage devise upright

65
Q

The patient has supplemental oxygen in place and requires suctioning to remove excess secretions fro the airway. In order to promote maximum oxygenation, an appropriate action by the nurse is to

A

replace the oxygen and allow rest in between suctioning passes

66
Q

During transport, a chest tube pulls out from the pleural space. The nurse immediately

A

covers the site with an occlusive dressing

67
Q

patient admitted with right sided heart failure. during assessment nurse expects to find?

A

peripheral edema

68
Q

A flow rate of oxygen of 2L per minute is providing what percent of oxygen

A

28%

69
Q

Left-sided heart failure signs

A

praoxysmal nocturnal dyspnea, restlessness, confusion orthopnea, tachycardia, exertional dyspnea, fatigue, cyanosis, elevated pulmonary capillary wedge pressure, pulmonary congestion (cough, crackles, wheezes, blood tinged sputum, tachypnea)

70
Q

Right-sided heart failure signs

A

fatigue, peripheral venous pressure, ascites, enlarged liver and spleen, may be secondary to chronic pulmonary problems, distended jugular veins, anorexia and complaints of GI distress, weight gain dependent edema

71
Q

signs of emphysema

A

CO2 increase retention (pink), minimal cyanosis, purse lip breathing, dyspnea, hyper resonance on chest precision orthopneic, barrel chest, exertion dyspnea, prolonged expiratory time, speaks in short jerky sentences, anxious, use of accessory muscles to breathe, thin appearance

72
Q

myocardium receives blood from

A

coronary arteries

73
Q

Left sided heart failure assessment

A

This side usually happens first. How many pillows needed? Are you short of breath at night? (Think of drowning inside)

74
Q

Right sided heart failure assessment

A

weigh daily. Pills may help relieve water build up, but you have to monitor levels because potassium may leave with fluid when taking them.

75
Q

Lab tests from lecture mentioned

A

Pulmonary Functioning Test (PFT), CBC (hemoglobin, hematocrit (Hgb, Hct), WBC), BMP (renal, glucose, electrolytes), ABG should be 7.35-7.45

Test 3 (15 decks)

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