Exam 2 Flashcards
How many people die due to medication errors each year?
7,000 - 9,000
How much time do Nurses spend administering meds?
40% of their time
Steps to take after a medication Error
- Assess
- Inform Dr.
- Incident Report
- Inform error to pt according to facility policy
Accuneb consists of
Sterile water and albuterol
(Bronchodilator)
Budesonide/pulmicort
(Corticosteroid).. what do you do different with this med?
Rinse after use for decay of teeth
Crackles and Rales
Moist or dry
On inspiration
Bubbly
Indicates pneumonia
Wheezing
-Expiration
-Whale sound
High pitch
-Indicates Asthma, Tumor, or obstruction
Ronchi
Inspiration & Expiration
Dinosaur
Can clear after cough
Strider
Pig sound
Inspiration & Expiration
Airway abstruction
Located in upper airway
Croup, medical emergency
How to Document breath sounds
Adventitious breath sounds auscultated on posterior RLL
Dyspnea
Painful breathing
Restlessness
Early signs of hypoxia
Tachycardia
High pulse
Tachypnea
Trying to get full breath
Oxygen saturation is emergent if
Emergent if 88% or lower
Use of accessory muscles means?
Harder moving air
Noisy breathing is an?
Obstruction of airway
Flaring of nostrils often happens in
Kids and with Asthma
Cyanosis
Blue skin due to decreased air
Position of patient having trouble breathing
Tripod
What do you do with pts w/SOB & inability to speak full sentences
Count words in between breaths
Important things with Respirations to document
Signs of distress
Rate, Rhythm, Depth
Lung field
Posterior vs Anterior
Sound?
Inspiration/Expiration or both?
Specimen Collection
Order needed
Who?
What? Sputum/swab/tube
When? Time if day
Where? Location and how to collect
Ventilation
Movement of air in and out of the lungs through the act of breathing
Respiration
Exchange of gases- oxygen and carbon dioxide in the lungs
Inhalation
Expansion of the chest cavity. Lungs creates negative pressure, causing air to be drawn in the nose or mouth
(part of ventilation)
Exhalation
When muscles relax. Chest & lungs return to normal size.
(part of ventillation)
Factors that affect Ventilation
Respiratory rate and depth
Airway resistance
Lung compliance (ease)
Lung elasticity (elastic recoil)
Hyperventilation (Too much CO2 removal)
Hypoventilation (CO2 isn’t eliminated good)
Diffusion
Exchange of gases O2 & CO2 between lungs & blood at the alveolar cellular membrane level
(part of Respiration)
. (in lungs)
Perfusion
Exchange of the gases O2 and CO2 between the blood and the rest if the body.
(part of respiration)
. (in the body tissue)
Target pulse ox everywhere
94-98%
Pulse ox for Colorado
90-95%
Pulse ox for chronic oxygen conditions
88-92%
What external factors influence oxygen?
Age
Environment
Lifestyle
Smoking
Medictions
Pain
Tachypnea
Fast breathing
RR+ 20+
Bradypnea
Slow Breathing
Less than 10 bpm
Apnea
Absence of breathing
Dyspnea
Trouble breathing, SOB
Orthopnea
Dyspnea that occurs when lying flat (they have to sleep proposed up in bed or chair)
Cheyne-Stokes
Gradual increase in-depth/rate of respirations…. Then
Gradual decrease in-depth/rate… then a period of apnea
Agonal Breathing
Lack of oxygen leads to gasping. Usually due to cardiac arrest or stroke. Not true breathing. Reflex where your brain isn’t getting oxygen and it needs it to survive. Sign person is near death.
Health History Assessment for Respiratory
-Environmental exposure
-Previous respiratory disease, problems, or infections
-Allergies
-Medications
-Family Hostory
Physical Exam Assessment for Respiration
-Inspect: clubbing, barrel chest, penetrating wounds
-Ausculate
-Breathing pattern/effort
-Cough and sputum
-Diagnostic studies
Vesicular breath sounds
Normal breath sounds
Adventitious breath sounds
Abnormal breath sounds on inspiration, expiration, or both
Crackles
Disruptive passing of air in small airways.
Popping sound
Sounds moist
Ronchi
Fluid/mucus in large airway
Continuous rumbling
Snoring/rattling
Cleared with cough
Wheeze
Airflow through narrowed or obstructed airway
Continuous high pitch whistling
Types of Adventitious breath sounds
Crackles, Rhonchi, wheeze, diminished, and absent
Ineffective airway clearance
Inability to maintain a clear airway
Ineffective breathing pattern
Inadequate ventilation
Gas exchange impairment
Diffusion if gasses across alveolar/capillary membrane impaired
Ineffective Spontaneous ventilation
Unable to maintain breathing adequate to support life
Atelectasis
Lung collapses, mucus accumulated, caused by anything that reduces ventilation
Hypoxia
Reduced level of tissue oxygenation-
Due to:
Poor diffusion
Hypoventilation
High altitude
Two signs of respiratory distress
Use of accessory muscle
Tracheal Tugging
Diarrhea
3 or more unformed stools in 24 hours
Healthcare associated infection from antibiotic overuse
C Diff- healthy flora is destroyed
