EXAM 1 Flashcards
Cardiovascular, Pulmonary, ABGs
What are the 3 normal breath sounds?
vesicular; bronchovesicular; bronchial
What do PFTs (pulmonary function tests) measure?
lung volume & airflow
What does deep breathing promote and what does it assist in doing?
It promotes air movement through the pores; assists in moving mucus out of the bronchioles
Alveoli total volume?
2500 mL
Where are the vocal cords located?
larynx
What is the larynx also known as?
the voice box
What is the opening between the vocal cords called?
glottis
Air passes through the __________ and into the __________. (intubation marker)
glottis; trachea
The lower respiratory tract consists of what structures?
trachea, bronchi, bronchioles, alveolar ducts, alveoli
What procedure involves inserting a needle through the chest wall, usually under CT guidance?
TTNA (Percutaneous Needle Aspiration)
Why is a chest x-ray ordered after a TTNA (Percutaneous Needle Aspiration)?
a risk for pneumothorax
Where are gases exchanged? (where the alveoli come in contact with pulmonary capillaries)
alveolar- capillary membrane
When excess fluid fills the interstitial space & alveoli what is reduced?
gas exchange
What condition happens when excess fluid fills the interstitial space and alveoli reducing gas exchange?
pulmonary edema
What are sputum samples examined for?
culture and sensitivity; to identify an infecting organism or to confirm a diagnosis
What important observations should be made of sputum?
color, volume, viscosity, presence or absence of blood
Why are skin tests performed?
allergic reactions or exposure to fungi or TB
What are the results of a PFT used for?
diagnosis of pulmonary disease; monitor disease progression; evaluate disability; evaluate response to bronchodilators
What is the exercise test used for and what is being monitored?
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)
What is monitored during a modified test (desaturation test)?
only SpO2
What is the 6 min walk test used for? What is monitored and measured?
-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.
What are chest x-rays for and what are the most common views?
used to screen, diagnose, & evaluate changes in respiratory system; anterior-posterior (AP) & lateral
A procedure performed for diagnosis of suspicious lesions too difficult to assess (mediastinum, hilum, pleural) by conventional x-ray studies.
Computed Tomography (CT)
What are some common types of Computed Tomography?
helical or spiral CT (contrast media usually used); high-resolution CT scan (contrast media is not used)
Which type of Computed Tomography (CT scan) is used to diagnose a PE?
Spiral/ Helical CT
What medication should be stopped prior to a CT with contrast and withheld for 48hrs after the procedure?
Metformin
What should be assessed and documented during an assessment of the posterior chest?
any spinal curvature
What should the patient be educated on regarding a procedure with contrast?
it is Nephrotoxic; should be flushed out- increase PO or IV fluids to flush out of system
Spinal curvatures that affect breathing
Kyphosis, Scoliosis, Kyphoscoliosis
Normal tracheal positioning
midline (if there is a deviation to the left or the right it is abnormal)
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?
MRI (Magnetic Resonance Imaging)
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.
Ventilation- Perfusion scan (V/Q)
Ventilation without perfusion suggests what?
a PE (Pulmonary Embolus/ blood clot)
What is the vibration in the chest while talking called?
fremitus
A procedure in which the bronchi are visualized through a fiberoptic tube?
Bronchoscopy
What is a bronchoscopy used for?
for diagnostic purposes- to obtain biopsy specimens & assess changes resulting from treatment; as treatment to remove mucus plugs or foreign bodies
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.
VATS (Video- Assisted Thoracic Surgery)
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.
Open Lung Biopsy
When doing a respiratory assessment, inquire about the use of which medication class that has a side effect of a cough?
ACE inhibitors (Angiotensin- converting enzyme)
When you are assessing the characteristics of an abnormal breath sound, what should you note?
location, pitch (high or low), duration of the sound
All the lower airway structures are located inside the lungs except for what structures?
the right and left main-stem bronchi
The small flap located behind the tongue that closes over the larynx during swallowing is called what?
epiglottis
What does the epiglottis prevent from happening?
solids and liquids from entering the lungs (aspiration)
How should you document adventitious sounds?
-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
What are the 5 defense mechanisms of the respiratory system?
filtration of air, mucociliary clearance system, cough reflex, reflex bronchoconstriction, alveolar macrophages
What do the 5 defense mechanisms of the respiratory system protect the lungs from?
inhaled particles, microorganisms, & toxic gases
What filters inspired air?
Nasal hairs
About how many mLs of mucus is continually secreted daily?
100
Mucus forms a mucus blanket that contains what from the lung areas?
particles and debris
What beats rhythmically in the large airways (about 1000x/ min)?
cilia
What does the rhythmic beat of the cilia move toward the mouth?
mucus
Does the cilia beat faster or slower the further down you go into the lung areas?
slower
What should be documented if a patient uses oxygen?
flow rate (FlO2) in liters/ min, number of hours used per day, effectiveness of the therapy
When alveoli are collapsed and airless it is referred to as what?
atelectasis
What nursing care should be followed for a post-surgical patient to prevent atelectasis?
change the patient’s position often & have them deep breath
What are some risk factors for atelectasis?
post-surgery, restricted breathing from pain (ex, broken rib), acute respiratory distress syndrome (ARDS)
What do alveolar secrete and why do they need it?
surfactant; to keep from collapsing
What reduces the amount of pressure needed to inflate the alveoli and without it may lead to a collapse (atelectasis)?
surfactant
Which of the main-stem bronchi is shorter, wider, and straighter, and where aspiration is more likely to happen?
the right main-stem bronchi
Most large particles do not reach the alveoli but are removed where?
nasopharynx or bronchi
What is accomplished by the mucociliary clearance system?
the movement of mucus
What term is used to indicate the interrelationship between the secretion of mucus and the ciliary activity?
mucociliary clearance system
What do chemoreceptors respond to?
a change in the PaCO2 and pH (changes in hydrogen ion concentration)
Where in the brain are central chemoreceptors located?
medulla
An increase in H+ concentration
acidosis
A decrease in H+ concentration
alkalosis
During a respiratory assessment, determine if a patient has been hospitalized for a respiratory problem and document what information?
dates, therapy, surgeries, current status of the problem
Loud, high-pitched normal breath sound that resembles air blowing through a hollow pipe (heard next to the trachea).
bronchial sounds
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.
bronchovesicular sounds
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.
vesicular sounds
Rhonchi is now referred to as what?
wheezes
What are the 5 adventitious breath sounds?
fine crackles, coarse crackles, wheezes, stridor and pleural friction rub
Where does air enter into the respiratory tract?
through the nose
How many lobes is the right lung divided into? What are they called?
3; upper, middle, lower
How many lobes is the left lung divided into? What are they called?
2; upper, lower
What organ is located on the left side/ left lung area?
the heart
What percentage of oxygenating does the right lung do?
60- 65%
The overall direction of air movement is from _______ concentration to the _______ concentration. (diffusion)
higher; lower
_______ moves from alveolar gas (atomspheric air) into the arterial blood and _________ from the arterial blood into the alveolar gas (atomspheric air).
Oxygen; Carbon Dioxide
Diffusion continues until ______ is reached.
equilibrium
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)
fine crackles
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
coarse crackles
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.
wheezes
Where are the peripheral chemoreceptors located?
carotid bodies and aortic arch
What do peripheral chemoreceptors respond to?
a decrease in PaO2 & pH & an increase in PaCO2.
Peripheral chemoreceptors cause stimulation where?
the respiratory center
Each person, normally, does what after every 5-6 breaths?
takes a slightly larger breath- termed a sigh
A continuous musical or crowing sound of constant pitch.
-result of partial obstruction of larynx or trachea
bad
-usually using accessory muscles
stridor
What does a sigh/ slightly larger breath do to the alveoli and what does it promote?
stretches the alveoli and promotes surfactant secretion
A cough is only effective in removing secretions where?
in the large or main airways
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.
reflex bronchoconstriction
The trachea is also called what?
wind pipe
What keep the trachea open but allow the adjacent esophagus to expand for swallowing?
u-shaped cartilages
A cylindrical tube about 5 in. long and 1 in. in diameter.
trachea
What may an asthmatic (someone with hyper-reactive airways) experience after inhalation of triggers such as cold air, perfume, or other strong odors?
bronchoconstriction
What kind of cells are not found below the level of the respiratory bronchioles?
ciliated cells
What is the primary defense mechanism at the alveolar level?
alveolar macrophages
What rapidly phagocytizes inhaled foreign particles such as bacteria?
alveolar macrophages
Debris that is moved to the level of the bronchioles is removed from the lungs by what?
cilia or the lymphatic system
What does the bronchial circulation do?
provides O2 to bronchi & pulmonary tissue
Where does bronchial circulation start?
the bronchial arteries
Where do bronchial arteries arise from?
the thoracic aorta
Deoxygenated blood returns from the bronchial circulation through which vein into the superior vena cava?
azygos vein
What protects the lungs and the heart from injury and is called the thoracic cage?
the ribs
What is the space in the middle of the thoracic cavity?
mediastinum
What major organs of the chest are housed in the mediastinum?
heart, aorta, esophagus
What physically separates the right from the left lung into 2 separate compartments?
mediastinum
What are the 2 types of pleura and where is each located?
parietal line- chest cavity; visceral line- the lungs
Which pleura does not have any sensory pain fibers or nerve endings?
visceral pleura
Which pleura has sensory pain fibers so irritation and inflammation cause pain?
parietal pleura
What is the major muscle of respiration that pulls air into the lungs when it contracts?
diaphragm
What does the contraction of the diaphragm decrease?
intrathoracic pressure
The tendency for the lungs to return to their original size is called what?
elastic recoil
When intrathoracic pressure rises what does it cause the air in the lungs to do?
move out
The ease of expansion of the lungs
Compliance
The expansion of the lungs
Elasticity
When compliance is decreased, the lungs are more __________ to inflate.
difficult
Any impediment to airflow during inspiration and expiration
resistance
How is resistance primarily affected?
changes in the diameter of the airways
Changes in either compliance &/ or resistance have the ability to seriously affect both _________ and ___________ of the patient.
oxygenation; ventilation
The process of obtaining oxygen from the atmosphere & supplying it to the organs and tissues of the body.
oxygenation
By what 3 ways are the lungs’ ability to adequately oxygenate arterial blood assessed?
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%)
How does oxygen and carbon dioxide move back and forth across the alveolar-capillary membrane?
diffusion
What is a protective reflex action that clears the airway by a high-pressure, high-velocity flow of air?
the cough
What is the backup to the mucociliary clearance system especially when that system is overwhelmed or ineffective?
the cough
rapid, deep breathing
Kussmaul
What is responsible for the sense of smell and where are they located?
olfactory nerve endings; in the roof of the nose
Air moves through the ________ then to the laryngopharynx then to the epiglottis then to the _________ before moving to the trachea.
oropharynx; larynx
Inspect the turbinates for __________.
polyps
Assess any discharge for ________ & ________.
color and consistency
Inspect the interior of the mouth for _______, lesions, _______, gum retraction, bleeding & poor __________.
color; masses; dentition
Inspect the tongue for _________ and the presence of __________.
symmetry; lesions
Where can a bronchoscopy be performed?
-outpatient procedure room
-surgical suite
-at the bedside in the intensive care unit or med surg unit
Where can the bronchoscope be inserted?
through the nose, mouth, or ET tube
An abnormal pattern of respiration characterized by alternating periods of apnea & deep, rapid breathing.
Cheyne-Stokes
irregular breathing w/ apnea every 4 to 5 cycles
Biot’s
What color of skin provides clues to respiratory status- such as hypoxemia?
cyanosis- blue/ purple
How do you best observe cyanosis (hypoxemia) in a dark-skinned patient?
in the conjunctivae, lips, palms and under the tongue
Evidence of long-standing hypoxemia
clubbing of the nails/ fingers
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?
clubbing
How would you observe the pharynx?
By pressing a tongue blade against the middle of the back of the tongue
The pharynx should be ________ & ________, with no evidence of exudate, ulcerations, swelling or postnasal drip. Note the ________, __________, & any enlargement of the tonsils.
smooth; moist; color; symmetry
Stimulate the _____ ______ by placing a tongue blade along the side of the pharynx behind the tonsil.
gag reflex
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
pleural friction rub
Peripheral
-longer catheter usually placed in upper arm for difficult or longer term access (~1 to 4wks)
midlines
Complications from vascular access devices are avoidable with _______ care and _______.
proper; maintenance
What occurs when the medication is a vesicant?
extravasation
What are common signs of infiltration &/ or extravasation?
inflammation, tightness of the skin, pain around the IV site
Types of PIVs (peripheral IVs)
Midlines, short peripheral catheter, arterial line
Peripheral IV catheters do not cross what?
the axillary
Governing bodies of the VAD
*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)
What should be used on unused ports? What kind of protection from bacterial buildup does these provide?
disinfecting caps; passive disinfection
What does a disinfecting cap keep between needleless connectors and the outside world?
physical barrier
What should always happen before using a port?
scrub the hub
What does the VA team do at the hospital?
-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
Central Line
-used for dialysis
Permacaths
Rales are now referred to as what?
crackles
Central Line Access
-usually surgically placed, for long-term use
- more permanent option; stable
Tunneled catheter (Hickman, Groshong)
Complications: VAD
-CLABSI; CRBSI; blood clots; occlusions; infiltrations; extravasation; phlebitis
What is a CRBSI?
Catheter-Related Blood Stream Infections
What is a CLABSI?
Central Line Acquired Blood Stream Infections
All vascular devices carry the ______ _______ of complications regardless of line type.
same risk
Every ______ with a VAD has the potential to _______ a problem.
interaction; cause
Ultrasound guidance is recommended by whom for VAD placement.
INS
Ultrasound guidance improves ______
_______.
insertion success
What does ultrasound guidance reduce the number of?
IV insertion attempts
What does ultrasound guidance of IV insertions decrease?
complications
Ultrasound guidance provides a real-time visualization and assessment of what?
the intended vessel and surrounding tissue
Needleless Connector
-displaced fluid is pushed out the tip of the catheter
positive
Needleless connectors are defined by ________ ________ when disconnecting a syringe.
fluid displacement
What are the 3 types of needleless connectors?
positive; negative; neutral
Flush each unused lumen with _____mL NS daily & after each used using what method?
10; push pause method
After a blood draw, flush with ___ mL NS daily using what kind of method?
20; push pause method
When checking IV for patency, always use ____mL or large barrel syringe.
10
What is the proper flushing sequence dependent on?
the type of needleless connector your facility uses
What should you use to scrub the port before injections?
a CHG &/or 70% alcohol prep or device
How many seconds should you scrub the hub for? How many seconds do you allow for drying?
15; 5
What complications can occur when fluid leaks out of the vein into the surrounding soft tissue?
infiltration, extravasation
Improper flushing techniques can allow ______ to get into the catheter and ______ inside the cathlon.
blood; clot
Improper flushing or med administration can cause what to happen?
stagnant meds to clog the catheter
An occlusion can be __________ in nature if the IV is kinked at or beneath the skin.
mechanical
The loss of the ability to infuse fluids of meds in a previously working catheter.
occlusion
signs and symptoms of a superficial venous thrombophlebitis
-hard cord-like feeling along a vein
-soreness over this area; redness and warmth over the vein
-swelling in the area
-limb pain
What are some conditions that increase the risk for blood clots?
cancer; pregnancy
A swollen or inflamed vein due to a blood clot from a peripheral IV.
thrombophlebitis
To decrease risk of blood clots when using PICCs or midlines…. what must be measured prior to insertion?
CVR (catheter-vein ratio)
To decrease risk of blood clots when using PICCs or midlines… they should not be placed in what kind of limbs?
flaccid; contractured
To decrease risk of blood clots when using PICCs or midlines…. what should you do prior to administrating medications?
review for appropriateness/ per catheter type
Assess IV site for what during bedside report & each time you administer medication?
redness, pain, swelling, drainage, any complications
Be sure to properly note any problems or potential problems such as ________ or _________ issues and __________ those to the next shift.
bleeding; dressing; report
Bad IVs will never _________ themselves.
fix
What kind of dressings should be used on VADs?
transparent semipermeable with proper securement
What should not be placed under IV dressing?
anything that is not sterile (such as tape)
Dressing changes should occur every ______ days or when loose or soiled (according to facility policy).
7
Daily cleansing of the patient with what will decrease the bioburden on the patient’s skin and decrease what?
CHG wipes; risk for infection
Patient gowns and sheets should be changed how often?
daily
What is the highest touched area in a patient’s room?
their bed
Central access
-surgically implanted, for intermittent access
Mediports
Central Access
-not for emergencies, easier to dress and clean, comfortable for long-term use
PICCs
Accepted but Unacceptable- Helms et al
-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
hospital-caused
iatrogenic
What equipment is used for central line insertion and maintenance?
drapes, PPE, secured anchored dressing, CHG/ alcohol sterilization devices, ultrasound guidance device
In what year was a government initiative started to prevent CLABSIs?
2008
What did research show was the cause of most CLABSI/central line infections?
poor insertion techniques and poor maintenance
What are some types of Central Lines?
-centrally inserted catheters, PICCs, Mediports, Tunneled catheter (Hickman, Groshong), Permacaths
Central access catheter tips lie where?
in the superior or inferior vena cava
All vascular devices enter the blood stream and are what?
invasive
For testing purposes, the IV belongs to whom?
the RN
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.
PICCS & midlines;
Beyond the scope of practice- you should know what as they will guide your practice within the framework of your scope?
facilities’ policies
All tubing should be what when hung?
dated, timed and initialed
What should dictate how often tubing should be changed?
your facilities’ policies
Bags of fluid and meds should be changed every _______ (unless otherwise specified).
24hrs
All accessories such as filters, stopcocks should be changed with each what?
new administration sets
Centrally inserted catheter insertion sites
-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.
Peripheral line
-used for hemodynamic monitoring or frequent blood draws
arterial lines
Line selections: peripheral or central access
*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?
What 2 centrally inserted access devices have an increased risk for catheter-related blood clots?
PICCs and Midlines
Needleless Connector
-fluid is pulled into the catheter
negative
Needleless Connector
-there is NO fluid displacement
neutral
What health effects do ultrasounds have?
no known negative effects
Line selection- peripheral access device
*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.
Line selection- midlines
*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)
Line selection- Central Lines
*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
What are CLABSIs and CRBSIs caused by, as they are not just something a patient gets?
poor nursing care
What is the mortality rate of CLABSIs and CRBSIs?
extremely high
In what year was there 24,179 hospital-related blood stream infections?
-51% were in where?
-35% were from what?
2017; ICUs; PIVs
What is the most common cause of blood stream infections?
IV catheters
Betadine can be used in the event of what?
a CHG allergy (for skin disinfecting)
CHG- best to use on what surface? Scrub in what shape?
the patient’s skin; hashtag
Alcohol- best cleaner for what surface? Can be used on what if CHG allergy exists?
devices; the patient’s skin
Is caused by contamination of the IV system during catheter insertion or manipulation, or by poor skin antisepsis.
bacterial phlebitis
What kind of care is required for central lines and peripheral lines?
the same
All lines have the same potential to what a patient?
harm
What can harm the patient as a result of IV attempts?
unsuccessful repeated insertions/ attempts
Occurs where the movement of a foreign object (cannula) within a vein causes friction and subsequent venous inflammation.
mechanical phlebitis
What are 3 types of phlebitis?
chemical, mechanical, bacterial
If unnoticed or untreated, IV infiltration can result in what?
compartment syndrome; skin necrosis; permanent nerve damage; amputations
Injuries (from insertion attempts) create _______ and ________ to vessels and tissue that can last for the rest of the patient’s life.
scars; damage
Every subsequent hospital admission or (IV insertion) attempt will _________ the previous ________.
compound; damage
The trachea bifurcates into the right and left mainstem bronchi at a point called what?
carina
What area of the trachea is highly sensitive and stimulating this area during suctioning causes vigorous coughing?
carina
As the lungs inflate, what activates the inspiratory center to inhibit further lung expansion?
pulmonary stretch receptors
Stimulation of the what causes rapid respiration (________) that is seen in pulmonary edema?
(tachypnea); juxtacapillary receptors
These receptors are stimulated by fluid entering what area of the lungs?
interstitial space
Causes of cyanosis
hypoxemia; decreased cardiac output
What are the 2 types of circulation in the lungs?
bronchial and pulmonary
The pulmonary circulation of the lungs provides what that participates in gas exchange?
blood
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?
the pulmonary artery; O2-CO2 exchange
What do the pulmonary veins return to the left atrium, which then delivers it to the left ventricle for systemic circulation?
oxygenated blood
Involves inspiration/ inhalation and expiration/ exhalation.
ventilation
What is the movement of air INTO the lungs called?
inspiration/ inhalation
What is the movement of air OUT of the lungs called?
expiration/ exhalation
In contrast to inspiration, expiration is what instead of forced?
passive
Where are mechanical receptors located?
lungs, upper airways, chest wall, diaphragm
What are some examples of physiologic factors that stimulate the mechanical receptors?
irritants, muscle stretching. alveolar wall distortion
Signals from stretch receptors aid in control of what?
respiration
The space between the pleura layers is called what?
intrapleural space
How much fluid is normally found in the intrapleural space?
20-25 mL
What are the 2 purposes of the fluid in the intrapleural space?
provides lubrication- allowing the pleural layers to slide over each other during breathing; increases cohesion between the pleural laters- helping with lung expansion
An accumulation of greater than 20-25 mL of fluid in the intrapleural space is called what?
pleural effusion
Why are ABGs measured?
to determine oxygenation status and acid-base balance
How can you obtain sputum samples?
expectoration, tracheal suction, bronchoscopy, sputum induction
ABG analysis includes what measurements?
PaO2, PaCO2, pH (acidity), HCO3- (bicarb), SaO2
What abbreviation is used to indicate the oxygen saturation of hemoglobin when pulse oximetry is used?
SpO2
What is the respiratory system divided into?
upper and lower respiratory tract
You should inspect the nose for what in an assessment?
patency, inflammation, deformities, symmetry, discharge
When inspecting the interior of the nose, the mucus membrane should be pink and moist, with no evidence of what ?
edema (bogginess), exudate or bleeding
When inspecting the nasal septum, you should look for what?
deviations, perforations and bleeding
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?
sputum induction
What is the primary purpose of the respiratory system?
gas exchange
What does gas exchange involve?
the delivery of O2 and the removal of CO2 between the atmosphere and the blood
The nasal cavity connects with what tubular passageway?
pharynx
What are the 3 parts that the pharynx is divided into?
nasopharynx, oropharynx, laryngopharynx
What is the function of the nose?
to protect the lower airway by warming and humidifying air and filtering small particles before air enters the lungs
A procedure that inserts a large-bore needle through the chest wall into the pleural space is called?
thoracentesis
The adult lung how many alveoli, each 0.3 mm in diameter?
+300 million
The alveoli are interconnected which allows for what between alveoli?
movement of air
What is associated with a response of the vein intima to certain chemicals infused into or placed within the vascular system?
chemical phlebitis
Why would a thoracentesis be done?
to obtain specimens for diagnostic evaluation; remove pleural fluid; or instill meds into the pleural space
What procedure is done to obtain tissue, cells, or secretions for evaluation (histology, dx of CA or infection)
a lung biopsy
Every insertion attempt is…….
an injury to the body.
Peripheral access
-short peripheral catheter
common regular IV
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
capnography
Peripheral IV: Info/ Background Info
*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%
Central IV: Info/ Background Info
*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
