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MED SURG 2 > EXAM 1 > Flashcards

EXAM 1 Flashcards

Cardiovascular, Pulmonary, ABGs

1
Q

What are the 3 normal breath sounds?

A

vesicular; bronchovesicular; bronchial

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2
Q

What do PFTs (pulmonary function tests) measure?

A

lung volume & airflow

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3
Q

What does deep breathing promote and what does it assist in doing?

A

It promotes air movement through the pores; assists in moving mucus out of the bronchioles

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4
Q

Alveoli total volume?

A

2500 mL

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5
Q

Where are the vocal cords located?

A

larynx

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6
Q

What is the larynx also known as?

A

the voice box

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7
Q

What is the opening between the vocal cords called?

A

glottis

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8
Q

Air passes through the __________ and into the __________. (intubation marker)

A

glottis; trachea

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9
Q

The lower respiratory tract consists of what structures?

A

trachea, bronchi, bronchioles, alveolar ducts, alveoli

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10
Q

What procedure involves inserting a needle through the chest wall, usually under CT guidance?

A

TTNA (Percutaneous Needle Aspiration)

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11
Q

Why is a chest x-ray ordered after a TTNA (Percutaneous Needle Aspiration)?

A

a risk for pneumothorax

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12
Q

Where are gases exchanged? (where the alveoli come in contact with pulmonary capillaries)

A

alveolar- capillary membrane

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13
Q

When excess fluid fills the interstitial space & alveoli what is reduced?

A

gas exchange

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14
Q

What condition happens when excess fluid fills the interstitial space and alveoli reducing gas exchange?

A

pulmonary edema

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15
Q

What are sputum samples examined for?

A

culture and sensitivity; to identify an infecting organism or to confirm a diagnosis

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16
Q

What important observations should be made of sputum?

A

color, volume, viscosity, presence or absence of blood

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17
Q

Why are skin tests performed?

A

allergic reactions or exposure to fungi or TB

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18
Q

What are the results of a PFT used for?

A

diagnosis of pulmonary disease; monitor disease progression; evaluate disability; evaluate response to bronchodilators

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19
Q

What is the exercise test used for and what is being monitored?

A

determine if o2 should be used at home & determine exercise capacity; monitor expired oxygen, carbon dioxide, resp. rate, heart rate & heart rhythm (all while walking on a treadmill)

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20
Q

What is monitored during a modified test (desaturation test)?

A

only SpO2

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21
Q

What is the 6 min walk test used for? What is monitored and measured?

A

-used to measure functional capacity & response to treatment in patients with heart or lung disease.
-A pulse ox is usually used to monitor the patient during the walk.
-The distance walked is measured and used to monitor the progression of disease or improvement after rehab.

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22
Q

What are chest x-rays for and what are the most common views?

A

used to screen, diagnose, & evaluate changes in respiratory system; anterior-posterior (AP) & lateral

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23
Q

A procedure performed for diagnosis of suspicious lesions too difficult to assess (mediastinum, hilum, pleural) by conventional x-ray studies.

A

Computed Tomography (CT)

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24
Q

What are some common types of Computed Tomography?

A

helical or spiral CT (contrast media usually used); high-resolution CT scan (contrast media is not used)

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25
Q

Which type of Computed Tomography (CT scan) is used to diagnose a PE?

A

Spiral/ Helical CT

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26
Q

What medication should be stopped prior to a CT with contrast and withheld for 48hrs after the procedure?

A

Metformin

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27
Q

What should be assessed and documented during an assessment of the posterior chest?

A

any spinal curvature

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28
Q

What should the patient be educated on regarding a procedure with contrast?

A

it is Nephrotoxic; should be flushed out- increase PO or IV fluids to flush out of system

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29
Q

Spinal curvatures that affect breathing

A

Kyphosis, Scoliosis, Kyphoscoliosis

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30
Q

Normal tracheal positioning

A

midline (if there is a deviation to the left or the right it is abnormal)

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31
Q

What procedure is used for in-depth diagnosis of lesions too difficult to assess by CT scan (lung apex) and for differentiating vascular from non-vascular structures?

A

MRI (Magnetic Resonance Imaging)

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32
Q

What scan is used to assess ventilation & perfusion of the lungs?
*IV radioisotope is given to assess perfusion- if radioactivity is diminished or absent this suggests a lack of perfusion or airflow.

A

Ventilation- Perfusion scan (V/Q)

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33
Q

Ventilation without perfusion suggests what?

A

a PE (Pulmonary Embolus/ blood clot)

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34
Q

What is the vibration in the chest while talking called?

A

fremitus

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35
Q

A procedure in which the bronchi are visualized through a fiberoptic tube?

A

Bronchoscopy

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36
Q

What is a bronchoscopy used for?

A

for diagnostic purposes- to obtain biopsy specimens & assess changes resulting from treatment; as treatment to remove mucus plugs or foreign bodies

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37
Q

A procedure where a rigid scope with a lens is passed through a trocar placed in the pleura via 1 or 2 small incisions in the intercostal muscles.
-The procedure of choice when appropriate as it is much less invasive than an open lung biopsy.
-A physician views the lesions on a monitor directly via the lens & biopsy specimens are taken.
-A chest tube is kept in place until the lungs expand.
-Lesions in the pleura or peripheral lung can be biopsied.

A

VATS (Video- Assisted Thoracic Surgery)

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38
Q

An invasive procedure used when a pulmonary disease cannot be diagnosed by other less invasive procedures.
-The patient is anesthetized, the chest is opened with a thoracotomy incision, and a biopsy specimen is obtained.
-A chest tube is expected after the procedure to remove air or fluid.

A

Open Lung Biopsy

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39
Q

When doing a respiratory assessment, inquire about the use of which medication class that has a side effect of a cough?

A

ACE inhibitors (Angiotensin- converting enzyme)

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40
Q

When you are assessing the characteristics of an abnormal breath sound, what should you note?

A

location, pitch (high or low), duration of the sound

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41
Q

All the lower airway structures are located inside the lungs except for what structures?

A

the right and left main-stem bronchi

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42
Q

The small flap located behind the tongue that closes over the larynx during swallowing is called what?

A

epiglottis

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43
Q

What does the epiglottis prevent from happening?

A

solids and liquids from entering the lungs (aspiration)

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44
Q

How should you document adventitious sounds?

A

-divide the anterior and posterior lungs into 3rds (upper, middle, lower) and note the pitch, duration and location

ex: crackles posterior right lower lung field

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45
Q

What are the 5 defense mechanisms of the respiratory system?

A

filtration of air, mucociliary clearance system, cough reflex, reflex bronchoconstriction, alveolar macrophages

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46
Q

What do the 5 defense mechanisms of the respiratory system protect the lungs from?

A

inhaled particles, microorganisms, & toxic gases

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47
Q

What filters inspired air?

A

Nasal hairs

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48
Q

About how many mLs of mucus is continually secreted daily?

A

100

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49
Q

Mucus forms a mucus blanket that contains what from the lung areas?

A

particles and debris

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50
Q

What beats rhythmically in the large airways (about 1000x/ min)?

A

cilia

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51
Q

What does the rhythmic beat of the cilia move toward the mouth?

A

mucus

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52
Q

Does the cilia beat faster or slower the further down you go into the lung areas?

A

slower

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53
Q

What should be documented if a patient uses oxygen?

A

flow rate (FlO2) in liters/ min, number of hours used per day, effectiveness of the therapy

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54
Q

When alveoli are collapsed and airless it is referred to as what?

A

atelectasis

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55
Q

What nursing care should be followed for a post-surgical patient to prevent atelectasis?

A

change the patient’s position often & have them deep breath

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56
Q

What are some risk factors for atelectasis?

A

post-surgery, restricted breathing from pain (ex, broken rib), acute respiratory distress syndrome (ARDS)

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57
Q

What do alveolar secrete and why do they need it?

A

surfactant; to keep from collapsing

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58
Q

What reduces the amount of pressure needed to inflate the alveoli and without it may lead to a collapse (atelectasis)?

A

surfactant

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59
Q

Which of the main-stem bronchi is shorter, wider, and straighter, and where aspiration is more likely to happen?

A

the right main-stem bronchi

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60
Q

Most large particles do not reach the alveoli but are removed where?

A

nasopharynx or bronchi

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61
Q

What is accomplished by the mucociliary clearance system?

A

the movement of mucus

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62
Q

What term is used to indicate the interrelationship between the secretion of mucus and the ciliary activity?

A

mucociliary clearance system

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63
Q

What do chemoreceptors respond to?

A

a change in the PaCO2 and pH (changes in hydrogen ion concentration)

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64
Q

Where in the brain are central chemoreceptors located?

A

medulla

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65
Q

An increase in H+ concentration

A

acidosis

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66
Q

A decrease in H+ concentration

A

alkalosis

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67
Q

During a respiratory assessment, determine if a patient has been hospitalized for a respiratory problem and document what information?

A

dates, therapy, surgeries, current status of the problem

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68
Q

Loud, high-pitched normal breath sound that resembles air blowing through a hollow pipe (heard next to the trachea).

A

bronchial sounds

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69
Q

A breath sound with medium pitch and intensity that can be heard anteriorly over the main-stem bronchi on either side of the sternum and posteriorly between the scapulae.

A

bronchovesicular sounds

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70
Q

A normal breath sound that is relatively a soft, low-pitched, gentle, rustling sound that is heard over all the lung areas except the major bronchi.

A

vesicular sounds

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71
Q

Rhonchi is now referred to as what?

A

wheezes

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72
Q

What are the 5 adventitious breath sounds?

A

fine crackles, coarse crackles, wheezes, stridor and pleural friction rub

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73
Q

Where does air enter into the respiratory tract?

A

through the nose

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74
Q

How many lobes is the right lung divided into? What are they called?

A

3; upper, middle, lower

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75
Q

How many lobes is the left lung divided into? What are they called?

A

2; upper, lower

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76
Q

What organ is located on the left side/ left lung area?

A

the heart

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77
Q

What percentage of oxygenating does the right lung do?

A

60- 65%

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78
Q

The overall direction of air movement is from _______ concentration to the _______ concentration. (diffusion)

A

higher; lower

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79
Q

_______ moves from alveolar gas (atomspheric air) into the arterial blood and _________ from the arterial blood into the alveolar gas (atomspheric air).

A

Oxygen; Carbon Dioxide

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80
Q

Diffusion continues until ______ is reached.

A

equilibrium

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81
Q

A series of short-duration, discontinuous, high-pitched sounds that are heard just before the end of inspiration.
(similar sound to that made by rolling hair between fingers just behind the ear)

A

fine crackles

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82
Q

A series of long-duration, discontinuous, low-pitched sounds caused by air passing through the airway intermittently occluded by mucus, unstable bronchial wall or fold of mucosa.
-Evident on inspiration and at times, expiration.
-Similar sound- blowing through a straw under water; they increase in bubbling quality with more fluid

A

coarse crackles

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83
Q

Continuous high-pitched squeaking or musical sounds caused by rapid vibration of bronchial walls.
-First evident on expiration but possibly evident on inspiration as obstruction of the airway increases.
-Possibly audible without a stethoscope.

A

wheezes

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84
Q

Where are the peripheral chemoreceptors located?

A

carotid bodies and aortic arch

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85
Q

What do peripheral chemoreceptors respond to?

A

a decrease in PaO2 & pH & an increase in PaCO2.

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86
Q

Peripheral chemoreceptors cause stimulation where?

A

the respiratory center

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87
Q

Each person, normally, does what after every 5-6 breaths?

A

takes a slightly larger breath- termed a sigh

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88
Q

A continuous musical or crowing sound of constant pitch.
-result of partial obstruction of larynx or trachea
bad
-usually using accessory muscles

A

stridor

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88
Q

What does a sigh/ slightly larger breath do to the alveoli and what does it promote?

A

stretches the alveoli and promotes surfactant secretion

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89
Q

A cough is only effective in removing secretions where?

A

in the large or main airways

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90
Q

A defense mechanism to the inhalation of large amounts of irritating substances (dust, aerosols) is called what?
-the bronchi constrict to prevent the entry of the irritants.

A

reflex bronchoconstriction

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91
Q

The trachea is also called what?

A

wind pipe

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92
Q

What keep the trachea open but allow the adjacent esophagus to expand for swallowing?

A

u-shaped cartilages

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93
Q

A cylindrical tube about 5 in. long and 1 in. in diameter.

A

trachea

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94
Q

What may an asthmatic (someone with hyper-reactive airways) experience after inhalation of triggers such as cold air, perfume, or other strong odors?

A

bronchoconstriction

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95
Q

What kind of cells are not found below the level of the respiratory bronchioles?

A

ciliated cells

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96
Q

What is the primary defense mechanism at the alveolar level?

A

alveolar macrophages

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97
Q

What rapidly phagocytizes inhaled foreign particles such as bacteria?

A

alveolar macrophages

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98
Q

Debris that is moved to the level of the bronchioles is removed from the lungs by what?

A

cilia or the lymphatic system

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99
Q

What does the bronchial circulation do?

A

provides O2 to bronchi & pulmonary tissue

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100
Q

Where does bronchial circulation start?

A

the bronchial arteries

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101
Q

Where do bronchial arteries arise from?

A

the thoracic aorta

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102
Q

Deoxygenated blood returns from the bronchial circulation through which vein into the superior vena cava?

A

azygos vein

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103
Q

What protects the lungs and the heart from injury and is called the thoracic cage?

A

the ribs

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104
Q

What is the space in the middle of the thoracic cavity?

A

mediastinum

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105
Q

What major organs of the chest are housed in the mediastinum?

A

heart, aorta, esophagus

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106
Q

What physically separates the right from the left lung into 2 separate compartments?

A

mediastinum

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107
Q

What are the 2 types of pleura and where is each located?

A

parietal line- chest cavity; visceral line- the lungs

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108
Q

Which pleura does not have any sensory pain fibers or nerve endings?

A

visceral pleura

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109
Q

Which pleura has sensory pain fibers so irritation and inflammation cause pain?

A

parietal pleura

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110
Q

What is the major muscle of respiration that pulls air into the lungs when it contracts?

A

diaphragm

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111
Q

What does the contraction of the diaphragm decrease?

A

intrathoracic pressure

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112
Q

The tendency for the lungs to return to their original size is called what?

A

elastic recoil

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113
Q

When intrathoracic pressure rises what does it cause the air in the lungs to do?

A

move out

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114
Q

The ease of expansion of the lungs

A

Compliance

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115
Q

The expansion of the lungs

A

Elasticity

116
Q

When compliance is decreased, the lungs are more __________ to inflate.

A

difficult

117
Q

Any impediment to airflow during inspiration and expiration

A

resistance

118
Q

How is resistance primarily affected?

A

changes in the diameter of the airways

119
Q

Changes in either compliance &/ or resistance have the ability to seriously affect both _________ and ___________ of the patient.

A

oxygenation; ventilation

120
Q

The process of obtaining oxygen from the atmosphere & supplying it to the organs and tissues of the body.

A

oxygenation

121
Q

By what 3 ways are the lungs’ ability to adequately oxygenate arterial blood assessed?

A

clinical assessment of the patient, partial pressure of oxygen in arterial blood (PaO2) ABGs (oxygen dissolved in plasma 34-45 mmHg), oxygen saturation (SpO2) Pulse Ox (95-100%)

122
Q

How does oxygen and carbon dioxide move back and forth across the alveolar-capillary membrane?

A

diffusion

123
Q

What is a protective reflex action that clears the airway by a high-pressure, high-velocity flow of air?

A

the cough

124
Q

What is the backup to the mucociliary clearance system especially when that system is overwhelmed or ineffective?

A

the cough

125
Q

rapid, deep breathing

A

Kussmaul

126
Q

What is responsible for the sense of smell and where are they located?

A

olfactory nerve endings; in the roof of the nose

127
Q

Air moves through the ________ then to the laryngopharynx then to the epiglottis then to the _________ before moving to the trachea.

A

oropharynx; larynx

128
Q

Inspect the turbinates for __________.

A

polyps

129
Q

Assess any discharge for ________ & ________.

A

color and consistency

130
Q

Inspect the interior of the mouth for _______, lesions, _______, gum retraction, bleeding & poor __________.

A

color; masses; dentition

131
Q

Inspect the tongue for _________ and the presence of __________.

A

symmetry; lesions

132
Q

Where can a bronchoscopy be performed?

A

-outpatient procedure room
-surgical suite
-at the bedside in the intensive care unit or med surg unit

133
Q

Where can the bronchoscope be inserted?

A

through the nose, mouth, or ET tube

134
Q

An abnormal pattern of respiration characterized by alternating periods of apnea & deep, rapid breathing.

A

Cheyne-Stokes

135
Q

irregular breathing w/ apnea every 4 to 5 cycles

A

Biot’s

136
Q

What color of skin provides clues to respiratory status- such as hypoxemia?

A

cyanosis- blue/ purple

137
Q

How do you best observe cyanosis (hypoxemia) in a dark-skinned patient?

A

in the conjunctivae, lips, palms and under the tongue

138
Q

Evidence of long-standing hypoxemia

A

clubbing of the nails/ fingers

139
Q

An increase in the angle between the base of the nail & the fingernail to 180 degrees or move usually accompanied by an increase in the depth, bulk & sponginess of the end of the fingers is called what?

A

clubbing

140
Q

How would you observe the pharynx?

A

By pressing a tongue blade against the middle of the back of the tongue

141
Q

The pharynx should be ________ & ________, with no evidence of exudate, ulcerations, swelling or postnasal drip. Note the ________, __________, & any enlargement of the tonsils.

A

smooth; moist; color; symmetry

142
Q

Stimulate the _____ ______ by placing a tongue blade along the side of the pharynx behind the tonsil.

A

gag reflex

143
Q

A creaky or grating sound from roughened, inflamed pleural surfaces rubbing together.
-evident during inspiration, expiration, or both, and no change with coughing
-often uncomfortable, especially on deep inspiration

A

pleural friction rub

144
Q

Peripheral
-longer catheter usually placed in upper arm for difficult or longer term access (~1 to 4wks)

A

midlines

145
Q

Complications from vascular access devices are avoidable with _______ care and _______.

A

proper; maintenance

146
Q

What occurs when the medication is a vesicant?

A

extravasation

147
Q

What are common signs of infiltration &/ or extravasation?

A

inflammation, tightness of the skin, pain around the IV site

148
Q

Types of PIVs (peripheral IVs)

A

Midlines, short peripheral catheter, arterial line

149
Q

Peripheral IV catheters do not cross what?

A

the axillary

150
Q

Governing bodies of the VAD

A

*CDC
-NHSN National Healthcare Safety Network (monitors HAIs)
*CMS (financial; determines reimb. to hospitals)
*INS Infusion Nurse Society (advisory group creates evidence-based standards for Infusion Therapy; recommendations for all aspects of vascular access care from insertion to removal)

151
Q

What should be used on unused ports? What kind of protection from bacterial buildup does these provide?

A

disinfecting caps; passive disinfection

152
Q

What does a disinfecting cap keep between needleless connectors and the outside world?

A

physical barrier

153
Q

What should always happen before using a port?

A

scrub the hub

154
Q

What does the VA team do at the hospital?

A

-daily audits of all central lines, midlines, and arterial lines
-insertion of ultrasound-guided central lines, midlines, arterial lines, and difficult peripheral lines.
-research of best practices & work with committees to implement EBP.
-education & in-services with hospital staff on the IV line care

155
Q

Central Line
-used for dialysis

A

Permacaths

156
Q

Rales are now referred to as what?

A

crackles

157
Q

Central Line Access
-usually surgically placed, for long-term use
- more permanent option; stable

A

Tunneled catheter (Hickman, Groshong)

158
Q

Complications: VAD

A

-CLABSI; CRBSI; blood clots; occlusions; infiltrations; extravasation; phlebitis

159
Q

What is a CRBSI?

A

Catheter-Related Blood Stream Infections

160
Q

What is a CLABSI?

A

Central Line Acquired Blood Stream Infections

161
Q

All vascular devices carry the ______ _______ of complications regardless of line type.

A

same risk

162
Q

Every ______ with a VAD has the potential to _______ a problem.

A

interaction; cause

163
Q

Ultrasound guidance is recommended by whom for VAD placement.

A

INS

164
Q

Ultrasound guidance improves ______
_______.

A

insertion success

165
Q

What does ultrasound guidance reduce the number of?

A

IV insertion attempts

166
Q

What does ultrasound guidance of IV insertions decrease?

A

complications

167
Q

Ultrasound guidance provides a real-time visualization and assessment of what?

A

the intended vessel and surrounding tissue

168
Q

Needleless Connector
-displaced fluid is pushed out the tip of the catheter

A

positive

169
Q

Needleless connectors are defined by ________ ________ when disconnecting a syringe.

A

fluid displacement

170
Q

What are the 3 types of needleless connectors?

A

positive; negative; neutral

171
Q

Flush each unused lumen with _____mL NS daily & after each used using what method?

A

10; push pause method

172
Q

After a blood draw, flush with ___ mL NS daily using what kind of method?

A

20; push pause method

173
Q

When checking IV for patency, always use ____mL or large barrel syringe.

A

10

174
Q

What is the proper flushing sequence dependent on?

A

the type of needleless connector your facility uses

175
Q

What should you use to scrub the port before injections?

A

a CHG &/or 70% alcohol prep or device

176
Q

How many seconds should you scrub the hub for? How many seconds do you allow for drying?

A

15; 5

177
Q

What complications can occur when fluid leaks out of the vein into the surrounding soft tissue?

A

infiltration, extravasation

178
Q

Improper flushing techniques can allow ______ to get into the catheter and ______ inside the cathlon.

A

blood; clot

179
Q

Improper flushing or med administration can cause what to happen?

A

stagnant meds to clog the catheter

180
Q

An occlusion can be __________ in nature if the IV is kinked at or beneath the skin.

A

mechanical

181
Q

The loss of the ability to infuse fluids of meds in a previously working catheter.

A

occlusion

182
Q

signs and symptoms of a superficial venous thrombophlebitis

A

-hard cord-like feeling along a vein
-soreness over this area; redness and warmth over the vein
-swelling in the area
-limb pain

183
Q

What are some conditions that increase the risk for blood clots?

A

cancer; pregnancy

184
Q

A swollen or inflamed vein due to a blood clot from a peripheral IV.

A

thrombophlebitis

185
Q
A
186
Q

To decrease risk of blood clots when using PICCs or midlines…. what must be measured prior to insertion?

A

CVR (catheter-vein ratio)

187
Q

To decrease risk of blood clots when using PICCs or midlines… they should not be placed in what kind of limbs?

A

flaccid; contractured

188
Q

To decrease risk of blood clots when using PICCs or midlines…. what should you do prior to administrating medications?

A

review for appropriateness/ per catheter type

189
Q

Assess IV site for what during bedside report & each time you administer medication?

A

redness, pain, swelling, drainage, any complications

189
Q

Be sure to properly note any problems or potential problems such as ________ or _________ issues and __________ those to the next shift.

A

bleeding; dressing; report

190
Q

Bad IVs will never _________ themselves.

A

fix

191
Q

What kind of dressings should be used on VADs?

A

transparent semipermeable with proper securement

192
Q

What should not be placed under IV dressing?

A

anything that is not sterile (such as tape)

193
Q

Dressing changes should occur every ______ days or when loose or soiled (according to facility policy).

A

7

194
Q

Daily cleansing of the patient with what will decrease the bioburden on the patient’s skin and decrease what?

A

CHG wipes; risk for infection

195
Q

Patient gowns and sheets should be changed how often?

A

daily

196
Q

What is the highest touched area in a patient’s room?

A

their bed

197
Q

Central access
-surgically implanted, for intermittent access

A

Mediports

198
Q

Central Access
-not for emergencies, easier to dress and clean, comfortable for long-term use

A

PICCs

199
Q

Accepted but Unacceptable- Helms et al

A

-discusses the complications of PIVs & that they are the same as central lines
-highlights the increased failure rate of PIVs up to 90% by some studies

200
Q

hospital-caused

A

iatrogenic

201
Q

What equipment is used for central line insertion and maintenance?

A

drapes, PPE, secured anchored dressing, CHG/ alcohol sterilization devices, ultrasound guidance device

202
Q

In what year was a government initiative started to prevent CLABSIs?

A

2008

203
Q

What did research show was the cause of most CLABSI/central line infections?

A

poor insertion techniques and poor maintenance

204
Q

What are some types of Central Lines?

A

-centrally inserted catheters, PICCs, Mediports, Tunneled catheter (Hickman, Groshong), Permacaths

205
Q

Central access catheter tips lie where?

A

in the superior or inferior vena cava

206
Q

All vascular devices enter the blood stream and are what?

A

invasive

207
Q

For testing purposes, the IV belongs to whom?

A

the RN

208
Q

Ky limits LPNs in broad scopes, such as they cannot insert or remove what?
They also cannot administer some types of medications under certain circumstances.

A

PICCS & midlines;

209
Q

Beyond the scope of practice- you should know what as they will guide your practice within the framework of your scope?

A

facilities’ policies

210
Q

All tubing should be what when hung?

A

dated, timed and initialed

211
Q

What should dictate how often tubing should be changed?

A

your facilities’ policies

212
Q

Bags of fluid and meds should be changed every _______ (unless otherwise specified).

A

24hrs

213
Q

All accessories such as filters, stopcocks should be changed with each what?

A

new administration sets

214
Q

Centrally inserted catheter insertion sites

A

-jugular- preferred by anesthesia, often difficult to keep clean and dressed
-subclavian- lowest risk for infection, higher risk for pneumothorax, difficult to use
-femoral- highest infection risk, usually easiest to access in emergencies.

215
Q

Peripheral line
-used for hemodynamic monitoring or frequent blood draws

A

arterial lines

216
Q

Line selections: peripheral or central access

A

*prescribed intravenous medicine therapy
-are meds irritants or vesicants?
-is pt on multiple incompatible meds?
*Length of time pt will be receiving meds
-Long-term? Short-term?
-Continuous? Intermittent?

217
Q

What 2 centrally inserted access devices have an increased risk for catheter-related blood clots?

A

PICCs and Midlines

218
Q

Needleless Connector
-fluid is pulled into the catheter

A

negative

219
Q

Needleless Connector
-there is NO fluid displacement

A

neutral

220
Q

What health effects do ultrasounds have?

A

no known negative effects

221
Q

Line selection- peripheral access device

A

*smallest gauge that can be used to give prescribed meds
*avoid the hand or areas of flexion
*no more than 2 attempts/ provider; no more than 4 attempts before seeking another method
*avoid the extra IV “just in case” mentality. It is an opportunity for a complication.

222
Q

Line selection- midlines

A

*peripheral lines that can stay in long- term
*if IV therapy +10 days but less than a month
*What to consider, if approp. line
-meds (characteristics, duration, frequency, compatibility with other meds
-pt hx (many of the same limitations as central lines)

223
Q

Line selection- Central Lines

A

*length of time pt will need therapy (days - lifelong)
*line maintenance responsibilities
-least amount of lumens to provide ordered meds should be used
*Pt hx
-CKD, mastectomy, paralyzed/ contractured limbs, blood clots
*Catheter to vein ratio (CVR)
- <45% of the vessel

224
Q

What are CLABSIs and CRBSIs caused by, as they are not just something a patient gets?

A

poor nursing care

225
Q

What is the mortality rate of CLABSIs and CRBSIs?

A

extremely high

226
Q

In what year was there 24,179 hospital-related blood stream infections?

-51% were in where?
-35% were from what?

A

2017; ICUs; PIVs

227
Q

What is the most common cause of blood stream infections?

A

IV catheters

228
Q

Betadine can be used in the event of what?

A

a CHG allergy (for skin disinfecting)

229
Q

CHG- best to use on what surface? Scrub in what shape?

A

the patient’s skin; hashtag

230
Q

Alcohol- best cleaner for what surface? Can be used on what if CHG allergy exists?

A

devices; the patient’s skin

231
Q

Is caused by contamination of the IV system during catheter insertion or manipulation, or by poor skin antisepsis.

A

bacterial phlebitis

232
Q

What kind of care is required for central lines and peripheral lines?

A

the same

233
Q

All lines have the same potential to what a patient?

A

harm

234
Q

What can harm the patient as a result of IV attempts?

A

unsuccessful repeated insertions/ attempts

235
Q

Occurs where the movement of a foreign object (cannula) within a vein causes friction and subsequent venous inflammation.

A

mechanical phlebitis

236
Q

What are 3 types of phlebitis?

A

chemical, mechanical, bacterial

237
Q

If unnoticed or untreated, IV infiltration can result in what?

A

compartment syndrome; skin necrosis; permanent nerve damage; amputations

238
Q

Injuries (from insertion attempts) create _______ and ________ to vessels and tissue that can last for the rest of the patient’s life.

A

scars; damage

239
Q

Every subsequent hospital admission or (IV insertion) attempt will _________ the previous ________.

A

compound; damage

240
Q

The trachea bifurcates into the right and left mainstem bronchi at a point called what?

A

carina

241
Q

What area of the trachea is highly sensitive and stimulating this area during suctioning causes vigorous coughing?

A

carina

242
Q

As the lungs inflate, what activates the inspiratory center to inhibit further lung expansion?

A

pulmonary stretch receptors

243
Q

Stimulation of the what causes rapid respiration (________) that is seen in pulmonary edema?

A

(tachypnea); juxtacapillary receptors

244
Q

These receptors are stimulated by fluid entering what area of the lungs?

A

interstitial space

245
Q

Causes of cyanosis

A

hypoxemia; decreased cardiac output

246
Q

What are the 2 types of circulation in the lungs?

A

bronchial and pulmonary

247
Q

The pulmonary circulation of the lungs provides what that participates in gas exchange?

A

blood

248
Q

What receives deoxygenated blood from the right ventricle of the heart and delivers it to the pulmonary capillaries that lie along side the alveoli?
What occurs at this point?

A

the pulmonary artery; O2-CO2 exchange

249
Q

What do the pulmonary veins return to the left atrium, which then delivers it to the left ventricle for systemic circulation?

A

oxygenated blood

250
Q

Involves inspiration/ inhalation and expiration/ exhalation.

A

ventilation

251
Q

What is the movement of air INTO the lungs called?

A

inspiration/ inhalation

252
Q

What is the movement of air OUT of the lungs called?

A

expiration/ exhalation

253
Q

In contrast to inspiration, expiration is what instead of forced?

A

passive

254
Q

Where are mechanical receptors located?

A

lungs, upper airways, chest wall, diaphragm

255
Q

What are some examples of physiologic factors that stimulate the mechanical receptors?

A

irritants, muscle stretching. alveolar wall distortion

256
Q

Signals from stretch receptors aid in control of what?

A

respiration

257
Q

The space between the pleura layers is called what?

A

intrapleural space

258
Q

How much fluid is normally found in the intrapleural space?

A

20-25 mL

259
Q

What are the 2 purposes of the fluid in the intrapleural space?

A

provides lubrication- allowing the pleural layers to slide over each other during breathing; increases cohesion between the pleural laters- helping with lung expansion

260
Q

An accumulation of greater than 20-25 mL of fluid in the intrapleural space is called what?

A

pleural effusion

261
Q

Why are ABGs measured?

A

to determine oxygenation status and acid-base balance

262
Q

How can you obtain sputum samples?

A

expectoration, tracheal suction, bronchoscopy, sputum induction

263
Q

ABG analysis includes what measurements?

A

PaO2, PaCO2, pH (acidity), HCO3- (bicarb), SaO2

264
Q

What abbreviation is used to indicate the oxygen saturation of hemoglobin when pulse oximetry is used?

A

SpO2

265
Q

What is the respiratory system divided into?

A

upper and lower respiratory tract

266
Q

You should inspect the nose for what in an assessment?

A

patency, inflammation, deformities, symmetry, discharge

267
Q

When inspecting the interior of the nose, the mucus membrane should be pink and moist, with no evidence of what ?

A

edema (bogginess), exudate or bleeding

268
Q

When inspecting the nasal septum, you should look for what?

A

deviations, perforations and bleeding

269
Q

When a patient is unable to expectorate spontaneously, sputum may be collected by inhalation of irritating aerosol, usually hypertonic saline… what is this method called?

A

sputum induction

270
Q

What is the primary purpose of the respiratory system?

A

gas exchange

271
Q

What does gas exchange involve?

A

the delivery of O2 and the removal of CO2 between the atmosphere and the blood

272
Q

The nasal cavity connects with what tubular passageway?

A

pharynx

273
Q

What are the 3 parts that the pharynx is divided into?

A

nasopharynx, oropharynx, laryngopharynx

274
Q

What is the function of the nose?

A

to protect the lower airway by warming and humidifying air and filtering small particles before air enters the lungs

275
Q

A procedure that inserts a large-bore needle through the chest wall into the pleural space is called?

A

thoracentesis

276
Q

The adult lung how many alveoli, each 0.3 mm in diameter?

A

+300 million

277
Q

The alveoli are interconnected which allows for what between alveoli?

A

movement of air

278
Q

What is associated with a response of the vein intima to certain chemicals infused into or placed within the vascular system?

A

chemical phlebitis

279
Q

Why would a thoracentesis be done?

A

to obtain specimens for diagnostic evaluation; remove pleural fluid; or instill meds into the pleural space

280
Q

What procedure is done to obtain tissue, cells, or secretions for evaluation (histology, dx of CA or infection)

A

a lung biopsy

281
Q

Every insertion attempt is…….

A

an injury to the body.

282
Q

Peripheral access
-short peripheral catheter

A

common regular IV

283
Q

Sensor under the nose or attached to ET tube (measuring CO2 exhaled); sensor changes by color or number; during CODES it is used to determine if pt is receiving adequate chest compressions
-arterial CO2 - indirectly how well patient is oxygenated

A

capnography

284
Q

Peripheral IV: Info/ Background Info

A

*37 million est. hospital admissions/ yearly
*most pts rec. an IV during adm. stay
*> 350 million IV cathlons sold/ yearly
*10 cathlons/ patient
*studies- est. peripheral catheter failure at 50-90%

285
Q

Central IV: Info/ Background Info

A

*mostly used in the critical care setting, but becoming more common in acute care (PICCs)
*often used for long-term care- outpatient treatments or chemo
*placed using sterile technique (or should be)
*monitored by NHSH for incidence of infection
*>30,000 CLABSI or CRBSI in US/ yearly
-CLABSIs have a 60% mortality rate

286
Q
A

MED SURG 2 (12 decks)

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