Exam 2, Chapter 28 (Week 4): Supporting Ventilation Flashcards

1
Q

Chest Physiotherapy is an important way to help patients with what kind of condition?

A

Chronic lung Disease

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2
Q

What would be the goal of Chest Physiotherapy for the treatment of a chronic lung disease?

A

The goal would be to keep their lungs clear, and loosen secretions.

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3
Q

Which method of Chest Physiotherapy involves the changing of positions to allow gravity to loosen secretions?

a.) Breathing Retraining
b.) Chest percussion
c.) Chest Vibration
d.) Postural drainage
e.) Cor Pulmonale

A

d.) Postural drainage is the changing of positions to allow gravity to loosen secretions

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4
Q

What is postural drainage?

Can you give an example?

A

Postural drainage is changing positions to allow gravity to assist in loosening secretions.

An example could be:
A patient with complaints of coughing and mucus buildup has been lying on their back all day. Because of this, all their mucus has been settling in the back/bottom of their lungs. So, you move them onto their left side to allow the mucus to move, and potentially be coughed out.

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5
Q

Cupping your hands together and lightly striking the chest wall is what type of Chest Physiotherapy?

A

Chest Percussions/Vibrations

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6
Q

True or False:
During Chest Percussions/Vibrations, you cup your hands together and firmly strike the chest wall to loosen secretions.

A

False

You LIGHTLY strike the chest wall to loosen secretions.

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7
Q

Where on the chest wall do you begin percussion/vibrations and which direction do you go?

A

You start at the base, and gradually move up towards the top of the sternum.

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8
Q

The nurse’s role should be to assess a patient’s what prior to chest physiotherapy?

A

Assess the patient’s lung status.

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9
Q

Which of the following does Postural Drainage work best on:

a.) Atelectasis
b.) Cystic Fibrosis
c.) COPD
d.) Pneumonia
e.) All of the above
f.) None of the above

A

e.) All of the above

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10
Q

What are the 4 respiratory diseases that postural drainage works best on?

A

-Atelectasis
-Cystic Fibrosis
-COPD
-Pneumonia

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11
Q

How long would you keep a patient in a single postural drainage position? (On average)

A

5 minutes

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12
Q

Which would be the best time to schedule a postural drainage?

a.) 1 hour before meals
b.) 3 hours after meals
c.) Every 4 hours
d.) All of the above
e.) A & B only
f.) B & C only

A

e.) A & B only

1 hour before a meal, or 3 hours after a meal.

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13
Q

What is the goal of Chest physiotherapy?

A

To keep the airway clear and to loosen secretions.

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14
Q

Screening the patient for lung effectiveness, giving chest physiotherapy treatment, and assessing the effectiveness of the Chest Physiotherapy after it is given are the roles of what health care professional?

A

The nurse

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15
Q

The chest physiotherapy method of “Breathing Retraining” involves the nurse teaching the patient what 2 breathing methods?

A

Pursed lip breathing, and diaphragmatic breathing.

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16
Q

A patient coughs up sputum into an emesis basin after utilizing pursed lip breathing techniques, alongside postural drainage. What would be the nurses next move for patient care after the sputum has been cleared?

a.) Document the characteristics of the sputum.
b.) Continue postural drainage for another 15-20 minutes.
c.) Offer Mucolytics to further loosen residual sputum.
d.) Clean the emesis basin and place the call light near the patient.

A

a.) Document the Sputum characteristics asap

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17
Q

In Spirometry, do you exhale or inhale?

How often should a patient use spirometry in a day?

A

Inhale and hold for 6 seconds.

Use a spirometer 10 times a day every 1-2 hours.

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18
Q

Hypoxia vs Hypoxemia
what’s the difference?

A

Hypoxia is a lack of oxygen to the tissues.

Hypoxemia is a lack of oxygen to blood cells.

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19
Q

What part of the brain senses a rise in CO2 levels, and triggers an increase in respiration to receive more O2?

A

The Medulla

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20
Q

COPD patients are often called “CO2 retainers” because they often suffer from Hypercarbia. What is Hypercarbia?

A

High Co2 levels

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21
Q

Gradually, the medulla of a patient with COPD becomes damaged and malfunctioning because of the consistent CO2 retention. What does this mean for the patients drive to breath?

How does this relate to Oxygen Therapy?

A

The drive to breath is gone and the body can only sense its need for O2 from its blood arterial levels. The body can’t rely on the medulla, and so it has to get the drive to breath from an outside source.

O2 therapy is used to replace the patient’s malfunctioning medulla. The O2 saturation levels are kept on the lower side, between 90-95% sat. Only when the Arterial O2 levels drop does the body force the drive to breath. So, if the Arterial O2 levels are kept on the lower side (90-95%), the drive to breath will remain working.

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22
Q

Oxygen Toxicity is a complication that can occur from Oxygen Therapy. What are some signs of Oxygen Toxicity?

A

-Restlessness
-Fatigue
-Pain
-Infection

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23
Q

Warmth and moisture are a breeding ground for bacteria. Because of this, infection is a great risk in patients on O2 therapy, especially if the instruments they are using are not cleaned thoroughly. What is the most common, colonized infection found in patients using O2 therapy?

A

Pseudomonas Aeruginosa

or

Pseudomonas

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24
Q

True or False:

Consistent use of Antibiotics is the only way to eliminate pseudomonas.

A

False

Pseudomonas only be treated for symptoms and pain, but once you have it, it will never go away.

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25
Q

There is nitrogen in the air we breathe, and this helps maintain a patent airway in the alveoli. But consistent high levels of O2 from oxygen therapy can dilute the nitrogen levels that we breath. This diluting of Nitrogen levels can lead to what O2 therapy complication in the alveoli?

A

Atelectasis: Alveolar collapse

Specifically, the complication of Oxygen therapy known as “Absorbtion Atelectasis.”

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26
Q

What does “Flow Rate” mean, in terms of a mathematic equation? (How would Flow Rate be written out as a math formula?)

A

L/Min

Flow Rate means: Liters per minute.

27
Q

What is the average Flow Rate for Nasal Cannula?

What is the highest it should go?

What patients typically use Nasal Cannula?

A

Average is 2-4L/min.

Highest is 6L/min.

Patients using Nasal Cannula are typically post-operative, or patients with COPD.

28
Q

True or False:
Nasal Cannula is supplemental O2 treatment.

A

True

Nasal Cannula is supplemental O2.

29
Q

What makes an O2 administration method ‘Low Flow?”

A

-The patient is breathing partial oxygen (from tank or system in the walls)

-The patient is breathing partial room air

30
Q

What is the Flow Rate for a Simple Face Mask?

A

6-12L/min

31
Q

If a patient has an order to titrate them (adjust dosage) and stay above 92% O2, but their Nasal Cannula only goes up to 92% O2 because of their 6L/min max flow rate. What is the next tool above Nasal Cannula for O2 administration?

A

Simple face mask

32
Q

A partial-rebreather and a non-rebreather have the exact same flow rate. What is it?

A

10-15L/min

33
Q

Match the flow rate with the O2 administrations: Nasal Cannula, Simple face mask. Partial-rebreather, non-rebreather.

-2-4L/min
-10-15L/min
-6L/min max
-6-12L/min

A

2-4L/min is Nasal cannula

10-15L/min is partial and non-rebreather

6L/min max is nasal cannula

6-12L/min is Simple face mask

34
Q

Partial and non-rebreather face masks not only share similar flow rates, but also similar designs. Both use a plastic bag reservoir attached to hold oxygen. The difference between them is in their exhalation methods.

What is the difference between the two in terms of their exhalation design?

A

Partial-rebreather has several exhalation ports on the side of the mask.

Non-rebreather has a “one-way flutter valve.”
This makes it so that CO2 can leave the valve and enter the room, but not come back in.

35
Q

Which face mask uses exhalation ports, and which uses a one-way flutter valve?

-Partial-rebreather
-Non-rebreather

A

-Partial rebreather uses exhalation ports

-Non-rebreather uses the one-way flutter valve.

36
Q

How is High-Flow O2 administration different than Low-Flow?

A

In High Flow the O2 that is breathed in is provided strictly from the source (O2 tank, wall mount, Venturi-mask, etc.) with no room air mixed in with it.

37
Q

What type of High-Flow O2 administration is the most reliable and most precise form of O2 administration?

a.) Venturi mask
b.) High-flow Nasal Cannula
c.) Trach collar O2
d.) T-tube

A

A Venturi mask is the most reliable and most precise form of O2 administration?

38
Q

Unlike other methods of O2 administration, a venturi mask is not measured in Flow Rate. How is a Venturi mask measured?

A

Venturi masks are measured by the percentage of oxygen that is delivered.

39
Q

What method of O2 administration uses either a dial or colored adaptors to measure out O2 percentages?

A

Venturi masks oxygen percentages are controlled via a dial or measured out in colored adaptors.

40
Q

With tracheostomy patients needing O2 administration, a T-tube or Trach collar would be applied. What other O2 administration tools can be attached to a trach collar/t-tube as well?

A

A Venturi mask can be attached

Humidifier tubes can be attached as well

41
Q

The last high-flow O2 administration device is the High-Flow Nasal Cannula. What is the Flow Rate for a high flow nasal cannula?

A

High Flow Nasal Cannula max flow is 60L/min

42
Q

What O2 percentage/type can a High-Flow nasal cannula deliver?

A

Can deliver up to 100% heated and humidified oxygen.

43
Q

A patient with ALS, or in end-of-life care would most likely use which O2 administration tool?

a.) Nasal Cannula
b.) Venturi mask
c.) Trach collar
d.) High-Flow Nasal Cannula
e.) All of the above

A

d.) High-Flow Nasal Cannula would most likely be used in ALS patients and end-of-life care.

44
Q

Which of the high-flow methods of O2 administration delivers warm, humidified O2 directly?

A

High-Flow nasal cannula

45
Q

A cpap and a bi-pap are categorized under what O2 administration method? (In the name)

A

Positive-Airway Pressure

46
Q

Cpap and bi-pap are categorized under “Positive Airway Pressure”. With this information, what does cpap stand for?

What about bi-pap?

A

Continuous Positive Airway Pressure

Bi-Level Positive Airway Pressure

47
Q

A person who needs cpap needs a “continuous” positive airway pressure. This would mean that the cpap is coming from one direct pressure setting. With this knowledge, a person with a bi-pap needs what?

A

2 separate pressure settings.

48
Q

Finish these sentences:

For bi-pap, there are two separate pressure settings…

The 1st setting is so “x” that it forces air “x”

then, the 2nd pressure setting is “x”, so it allows the patient to “x”

A

The 1st pressure setting is so “high” that it forces air “in”

Then, the 2nd pressure setting is “low”, so it allows the patient to “exhale.”

In bi-pap, the pressure goes high, then the pressure drops low.

49
Q

Which of these options would be used on a patient whose lungs are not strong enough to forcibly exhale OVER the O2 coming in from a machine?

a.) cpap
b.) bi-pap
c.) Venturi mask
d.) High-Flow Nasal Cannula

A

b.) Bi-pap would be used on a patient with lungs that could not effectively exhale.

The two different pressure settings in a bi-pap allow for high O2 settings in the 1st pressure dose, then it drops to a lower O2 pressure to allow the patient to exhale more easily.

50
Q

What is the multi-use safety tool that is used not only to help insert a trach, but if a patient cough’s out their equipment, this can help guide back the outer cannula.

A

Obturator

51
Q

How can a cuff on the outer cannula of a trach damage the trachea if it is too tight?

A

It can cut off circulation and cause pressure at the trach site.

52
Q

IF a trach patient wants to eat or swallow, what therapy would be used to test for this ability?

A

Speech therapy

53
Q

What should the pressure of a Trach cuff be?

a.) 10-21mmHG
b.) 0.6-1.2 psi
c.) 15-22mmHG
d.) 6-12L/min
e.) 20-25 cmH2O

A

a.) 10-21mmHG is the proper pressure for a trach cuff

e.) 20-25 cmH2O is also the correct pressure level for a trach cuff, but its just the alternative measurement for 10-21mmHG.

54
Q

What are Trach patients at high risk for?

A

Aspirations

55
Q

Since Trach patients are at high risk for aspirations, what should the pressure of the trach cuff be when the patient is taking something by mouth?

A

“0” and-or “deflated.”

56
Q

How would you start an assessment for a patient’s trach care?

What next?

A

-Looking for lung sounds

-Next, look for hypoxia in surrounding tissues.

57
Q

What should you pay close attention to for trach care in a patient who has O2 administration devices attached?

A

What method of O2 delivery is being used and what percentage they are being given.

58
Q

When assessing the trach site for proper trach care, what three things should you be looking for?

A

-Secretions/drainage from the trach
It should be clean and dry.

-Assess the skin integrity around the site

-Check the cuff pressure

59
Q

What is one of the best aspiration precautions for trach patients that involves their bed?

A

Keep the HOB up

60
Q

What are 3 things that should always be kept by a trach patient’s bedside that assist in emergencies?

A

-Obturator
-Cannula
-Suctions

61
Q

What action should trach patients do when swallowing that makes swallowing food and meds easier?

A

Tuck their chin.

62
Q

The major advantage of a venturi mask is that it can:

A.) Deliver up to 80% O2
B.) Provide continuous 100% humidity
C.) Deliver a precise concentration of O2
D.) Be used while a patient eats and sleeps

A

C.) Venturi masks can deliver a precise concentration of O2

63
Q

True or False:
The primary oxygen administration
method for a patient with COPD is
a nasal cannula.

A

False

A Venturi mask is the primary O2 administration method for a COPD patient.

64
Q

True or False:
A patient should be encouraged
to use an incentive spirometer
approximately 10 breaths per hour
between treatments while awake

A

True