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Therapeutic II > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

what device is used when tongue or epiglottis fall back against posterior pharynx in unconscious patients

A

OPA (oropharyngeal airways)

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2
Q

A curved piece of plastic inserted over the tongue that creates an air passageway between the mouth and the posterior pharyngeal wall.

A

OPA (oropharyngeal airways)

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3
Q

which device is indicated for patient’s who do not have couch, gag or swallow reflex

A

OPA (oropharyngeal airway)

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4
Q

in what patient would an OPA (oropharyngeal airway) be contraidicated in

A

person who is conscious and has intact cough, gag, or swallow reflex

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5
Q

two types of OPA’s

A

guedel, and berman

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6
Q

could you see the use of an OPA in intubated patient’s, if so, why

A

yes in order to prevent them from biting the tube

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7
Q

how often should you perform mouth care with an OPA

A

every two hours

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8
Q

what to assess with OPA

A

oral mucosa and tongue

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9
Q

device inserted into the nostril to create air passage

A

NPA (nasopharyngeal airway)

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10
Q

what device would be used in patient’s with an intact but weak cough and gag reflex but require frequent suctioning and are unable to cough forcefully and clear secretions

A

NPA (nasopharyngeal airway)

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11
Q

before insertion of NPA what would you do

A

apply water based lubricant to NPA

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12
Q

NPA’s are contraindicated in what patients

A
  • anticoagulated
  • low platelet count
  • skull fracture or facial trauma
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13
Q

how often would you remove NPA and do assessment

A

at least every 8 hrs

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14
Q

what assessment do you do with both the OPA and NPA

A

check for breath and for lung sounds

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15
Q

if a persons cough is intact what is the most effective method for clearing the airway

A

cough and deep breathing

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16
Q

device that promotes deep breathing and good inspiratory effect

A

incentive spirometer

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17
Q

what does an incentive spirometer decrease the risk of in post op patients

A

development of atelectasis or pneumonia

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18
Q

provides baseline of best maximal expiration to evaluate airway diameter

A

peak flow measurement

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19
Q

nebulizer delivers meds over what duration usually

A

5-10 minutes

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20
Q

what should flow be for nebulizer and run on air or oxygen

A

air preferably at 6-8 liters

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21
Q

preferred method for inhaled medications

A

metered dose inhaler with spacer

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22
Q

if patient is on multiple inhaled meds what should be done first

A

bronchodilator and then any steroid

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23
Q

before administering inhalers what should be assessed

A

ascultate lungs, work of breathing, O2 sat, RR, HR, BP and color

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24
Q

technique that utilizes gravity to facilitate movement and expectoration of secretions and mucous from various lobes of lungs and airway

A

postural drainage

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25
Q

gentle rhythmic clapping parts of lungs to move and loosen mucus from bronchioles

A

cupping

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26
Q

what is PD & C

A

postural drainage and cupping

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27
Q

PD & C is commonly indicated for what patient;s

A

cystic fibrosis, spinal cord injury, pneumonia

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28
Q

PD & C is contraindicated in what patients

A

head injuries, COPD, history of cardiac disorders

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29
Q

patient who is unable to clear secretions and it is affecting respiratory function, may require

A

suctioning

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30
Q

device indicated for hypoxia, hypoventilation, resp. failure, resp. arrest

A

bag valve mask devices and ventilation (resuscitation breathing bags)

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31
Q

assessment for all drainage systems includes

A
  • amount of drainage
  • consistency
  • color
  • monitor temp
  • wound site
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32
Q

change of the consistency of drainage should change from what to what

A

blood, then serosanguinous, then serous

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33
Q

flexible, rubber, tube/drain that uses gravity to pull drainage out

A

penrose drain

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34
Q

drain that removes fluid by creating suction in a bulb

A

jackson pratt drain

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35
Q

when should JP drain be emptied

A

every 8 to 12 hours

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36
Q

when does the JP drain get removed

A

when fluid is less than 30 ml in 24 hrs

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37
Q

can patients go home with JP drain

A

yes, but drain gets removed at office

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38
Q

drain that also uses suction but is larger than JP drain

A

hemovac

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39
Q

device that as piece of foam with an open cell structure which is placed in the wound to remove blood and serous fluid

A

Vacuum-Assisted Closure Device (VAC)

40
Q

benefits of VAC therapy

A
    • entire surface is exposed to negative pressure effect
  • maintains contact with edges and prevents tissue necrosis
  • decreases risk of infection
  • enhances formulation of granulation tissue
  • increase blood flow to area
41
Q

when air collects in he pleural space it is called

A

pneomothorax

42
Q

signs pneumothorax

A

tachypnea, tachycardia, decreased or absent breath sounds

43
Q

symptoms of pneumothorax

A

pain that worsens with inspiration, dyspnea, couch, sudden stabbing pain on side of pneumo

44
Q

when air enters pleural space but chest wall remains intact it is

A

closed pneumothorax

45
Q

air in pleural space but chest wall and pleural space are penetrated

A

open pneumothorax

46
Q

blood in pleural space is called

A

hemothorax

47
Q

causes of hemothorax

A
  • blood clotting disorder
  • pulmonary infarction
  • lung cancer
  • tear in blood vessel
48
Q

blood and air in the pleural space

A

hemopneumothorax

49
Q

what would require two chest tubes to be inserted

A

hemopneumothorax one at apex and one as base

50
Q

when air leaks from a tear in the lung into the pleural space

A

tension pneumothorax

51
Q

accumulation of lymphatic fluid in the pleural space

A

chylothorax

52
Q

purulent drainage or pus from infection accumulating in pleural space

A

empyema

53
Q

chest tube is needed when

A

negative pressure in pleural space is disrupted resulting in pulmonary compromise

54
Q

when chest tube is place to put fluids in pleural space to prevent pleural effusions

A

pleurodesis

55
Q

chest tubes placed high for what

A

air accumulation

56
Q

chest tubes placed low for what

A

fluid accumulation

57
Q

can the chest tube tubing every be clamped

A

no

58
Q

if what type of drainage exists you should notify the provider

A

purulent

59
Q

every assessment of chest tube should include

A

noting color and quantity of fluid, and amount of drainage

60
Q

what are the fluctuations in the fluid level in the chest drainage unit indicative of

A

tidaling

61
Q

when water level rises in the tube and remains above 2cm is indicates that what is present

A

negative pressure in the pleural space

62
Q

how often should vitals be taken when person has a chest tube

A

every 2 hrs

63
Q

assessment of pt on chest tube includes

A

vitals, assess breath sounds, heart sounds, and skin and color temp

64
Q

how often should drainage be recorded with chest tube

A

every 8 hrs

65
Q

what is evidence of a leak with a chest tube

A

continuous rapid bubbling in water seal chamber

66
Q

when does normal bubbling occur with chest tube

A

during expiration

67
Q

if chest tube falls out what should you do

A

cover site with vaseline gauze and notify provider asap

68
Q

indications for tracheostomy tube

A
  • severe reccurent upper airway obstruction
  • facial trauma
  • inability to remove airway secretions
  • head/neck surgery
    prolonged mechanical ventilation
69
Q

complications of trachs

A

bleeding, infection, erosion of mucosal lining, compromised breathing, plugged with mucous, esophogeal fistual, crepitus

70
Q

how often is trach care performed when first put in

A

q 8 hrs

71
Q

how often is trach care performed after trach site is healed

A

daily

72
Q

what is not done for the first 72 hrs after trach is placed

A

the tie change

73
Q

after 72 hrs how often do you change the trach ties

A

daily or prn

74
Q

which suctioning procedure is a clean technique

A

only oral suctioning

75
Q

when is suctioning indicated for a patient

A
  • when they ask for it
  • decreased LOC
  • inability to clear secretions due to ineffective, weak cough
  • persistant coughing (though strong) that doesn’t clear secretions
  • decreased O2 sat
  • increased work of breathing, RR
76
Q

how long should wait in between suctioning

A

1-2 minutes

77
Q

was is the max number of times you can suction

A

3 passes

78
Q

suction should be set at what range for adults

A

100-120 mm Hg

79
Q

suction should be set at what range for peds

A

60-80 mm Hg

80
Q

what is important to make sure before applying suction

A

most patients will need to be pre-oxygenated

81
Q

max duration of a suction pass

A

10 seconds

82
Q

hazards of suctioning include

A

hypoxia, vomiting, aspiration, cardiac dysrhythmias, hypotension

83
Q

a valve that is used for pt’s who have adequate laryngeal and articulatory function

A

passy-muir speaking valve

84
Q

how often is the pt history record in eRecord when pt is on PCA pump

A

every 4 hrs

85
Q

vital signs and assessment done how often when on PCA

A

q 30 min for first hr
q 1 hr for 3 hrs
q 4 hrs for duration of therapy

86
Q

if respiratory depression occurs when on PCa what should nurse do

A

discontinue infusions and prepare to admin narcan

87
Q

how to alleviate itching related to PCEA opioid admin

A

benadryl per orders

88
Q

warning signs of complications for PCEA opioids

A

dizziness, ringing in ears, metal taste, seizure, lathergy, numbness of tongue

89
Q

p wave represents what

A

atrial depolarization

90
Q

qrs complex represents

A

ventricular depolarization

91
Q

T wave represents

A

ventricular repolarization

92
Q

U wave represents

A

purkinje fiber repolarization

93
Q

first step in analyzing a ekg rhythm strip

A

regular or irregular rhythm

94
Q

how is rhythm on ekg determined

A

cadence between R to R intervals

95
Q

second step in analyzing ekg rhythm strip

A

calculate ventricular rate by counting number of QRS complexes in six seconds and multiply that by 10 for beats per minute

96
Q

third step in analyzing rhythm strip on ekg

A

p waves, do they look alike, or are they different, and their relationship to QRS complex

Therapeutic II (6 decks)

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