exam 3 Flashcards by britt rank

Normal Values for

Oxygen saturation (SpO2 ) is

95-100%

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Normal Values for

Partial pressure of arterial oxygenation: (Pa02) is

60-100mm Hg

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Normal Values for

Arterial carbon dioxide tension (PaCO2) is

35-45 mm Hg

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4 Physiological factors affecting oxygen

Decreased oxygen-carrying capacity (anemia then subsequent hypoxemia)

Decreased inspired oxygen concentration (High Altitude)

Hypovolemia (trauma, surgery)

Increased metabolic rate (sepsis, illness)

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6 Conditions Affecting Chest Wall Movement:

Pregnancy

Obesity

Musculoskeletal abnormalities

Trauma

Neuromuscular disease

CNS alterations

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During early stages of hypoxia the blood pressure is _______ unless the condition is caused by shock. As the hypoxia worsens, the respiratory rate _____ as a result of respiratory muscle fatigue.

elevated

declines

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3 early Central Nervous System Signs and Symptoms of Hypoxia

apprehension

restlessness or irritability

confusion, poor concentration and lethargy

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3 late Central Nervous System Signs and Symptoms of Hypoxia

Combativeness
Coma
confusion

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2 early Respiratory Signs and Symptoms of Hypoxia

 Tachypnea

 Dyspnea on exertion (DOE)

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4 late Respiratory Signs and Symptoms of Hypoxia

 Dyspnea at rest
 Use of accessory muscles
 Retractions on inspiration
 Pause for breath between sentences, words

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3 early Cardiovascular Signs and Symptoms of Hypoxia

 Tachycardia
 Mild elevated BP
 Dysrhythmias

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3 late Cardiovascular Signs and Symptoms of Hypoxia

 Dysrhythmias
 Cyanosis
 Cool, clammy skin

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Determines ability of the lungs to efficiently exchange oxygen and carbon dioxide. differentiate pulmonary obstructive from restrictive disease

Pulmonary function studies (PFT)

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Specimen of plural fluid obtained for cytological examination
Results may indicate an infection or neoplastic disease

Thoracentesis

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Visual examination of the tracheobronchial tree through a narrow, flexible fiberoptic bronchoscope
Performed to obtain fluid, sputum, or biopsy samples; remove mucus plugs or foreign bodie

Bronchoscopy

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Nuclear scanning test used to identify abnormal masses by size and location

lung scan

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can be performed nasally, orally, or via artificial airways such as endotracheal tubes and tracheostomies

Suctioning

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Oral suctioning is performed with a ____ device.

Yankauer

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Goal is to achieve and maintain a maximal inspiration to improve pulmonary ventilation, loosen secretions, facilitates gas exchange and prevent alveolar collapse.

Incentive Spirometry

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Incentive Spirometry Correct use:

exhale normally then slowly and deeply inhale as much as possible, hold 3 seconds and exhale, repeat 10X every hour while awake

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Humidification is necessary for clients receiving O2 therapy >__L/min

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Keep O2 delivery systems ___ feet from open flames

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Oxygen Capability at 1-6L/min

Nasal Cannula

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Best option for patients with COPD as it delivers very low flow oxygen

Nasal Cannula

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Provide concentrations of O2 at 4-8L/m

Face Tent

Provides 5-10L of O2

Simple Face Mask

Minimum of 5L/min O2 required to prevent client from re-breathing exhaled carbon dioxide

Simple Face Mask

Provides 6-10 L of O2 per minute

Partial Non-rebreather with a reservoir bag

rebreathe first third of exhaled air in conjunction with O2. Patient is still taking in room air.

Partial Non-rebreather with a reservoir bag

Provides 10L/min of O2

Non-rebreather Face Mask with reservoir bag

prevent room air and client’s exhaled air from entering the bag so only O2 in bag is inspired

Non-rebreather Face Mask with reservoir bag

4L=24-28% 8L=35-40% 12L=50-60%

Venturi Mask

Hydration ________ml/day Cough and deep breathe every___ hours while awake

1500-2000 1-2

6 (+1) Rights of Medication Administration

``` Right Patient Right Medication Right Amount (dose & volume) Right Route Right Time Right Documentation Right Reason Remember: PMART DR ```

7 things that must be on a medication order

``` patients full name date and time order is written medication name dosage route time and frequency of administration signature of health care provider ```

the expected or predicted physiological response of the medication

Therapeutic effect:

: predictable and often unavoidable secondary effect of the medication

Side Effect

: unintended, undesirable and unpredictable severe responses

Adverse effect

: a severe and potentially life threatening allergy requiring immediate medical attention

Anaphylactic reaction

: developed after prolonged intake or when a medication accumulates due to impaired metabolism or excretion

Toxic Effect

- Solid, liquid, sustained release - Sublingual (under tongue), buccal (side of cheek) - Inhalation (Aerosolized) are all considered what kind of medication form

oral

- Skin - Body Cavity - Irrigation are all considered what form of medicaion

topical

- Intravenous - IV, IO - Injections - IM, SubQ, ID are all considered what form of medication

Parenteral

with oral medication Food may _______ therapeutic effect.

decrease

are enteric-coated or extended release tabs or caps crushable

when Giving a medication through a feeding tube Never add directly to a ______

tube feeding

when Giving a medication through a feeding tube | Flush tube with _____ before medication, in between medications, and when done

water

. If GRV is ___ mL or less, return aspirated contents to stomach. If GRV is greater than ____ mL, hold medication

250

Nasal: For access to frontal and ______, tilt head back over edge of bed or pillow with head turned toward side to be treated

maxillary sinus

Eye: Avoid instilling any form of eye medications directly onto the _____

cornea

Ear: instill eardrops at ______ to prevent vertigo, dizziness, or nausea.

room temperature

: Injection into the dermis just under the epidermis

Intradermal (ID)

- typically are used for skin testing | - injection is 5 to 15 degrees

Intradermal (ID)

Injection into tissues just below the dermis of the skin

Subcutaneous:

Syringe (1 to 3 mL) and needle (25- to 27-gauge, 3/8- to 5/8-inch) when injecting, If you can grasp 2 inches insert at a 90-degree angle; (1 inch) of tissue, 45-degree

Subcutaneous:

: Injection into a muscle

Intramuscular (IM)

_______ are only given intramuscularly.

Immunizations

Syringe 2 to 3 mL 90-degree angle

Intramuscular (IM)

Injection into a vein 25 degree angle

Intravenous (IV):

Injection locations recommended for volumes greater than 2 mL

Ventrogluteal

Injection locations recommended for 2ml or less

Deltoid

Injection locations up to 3 ml

Vastus lateralis

- calibrated in sixteenths of a minim and hundredths of a milliliter and has a capacity of 1 mL

The tuberculin syringe

- Each milliliter of U-100 insulin contains 100 units of insulin.

Insulin syringes

Prevents medication from leaking back into the tissues Reduces pain and discomfort Good for elderly patients who have decreased muscle mass

Z-track Technique

Use abdomen, avoiding the 2” area around umbilicus Never massage

Heparin

Pre-filled syringe Do not expel air bubble prior to administration

lovenox

Insulin is classified by __________

rate of action

5 Environmental factors affecting nutrition

1. - Lack of access to full-service grocery stores 2. high cost of healthy food 3. widespread availability of less healthy foods in fast-food restaurants 4. widespread advertising of less healthy food 5. lack of access to safe places to play and exercise

to avoid aspirations - Have patient remain sitting upright for at least ____-_____ minutes after meal.

30 to 60

4 reasons for NG tube

1) Decompression 2) Enteral feeding 3) Compression 4) Lavage

nutrition | Used with patients who have functional GI tract

Enteral

nutrition Used with patients who have un functional GI tract

Parenteral

4 types of delivery systems for enteral feeding

* Nasogastric tube * Gastrostomy tube * PEG tube * Jejunostomy tube

with enteral feeding If residue volume is >____ml HOLD TUBE FEEDING

200

steps of diet progression

- clear liquid - full liquid - thickened/ pureed liquids (dysphagia) - mechanical soft - soft/low residue - high fiber - low sodium - low cholesterol - diabetic - gluten free - regular

4 Metabolic complications of parenteral nutrition

* Electrolyte imbalance * Hypercapnia * Hypoglycemia-Diaphoresis, shakiness, confusion, loss of consciousness * Hyperglycemia-

10 Complications of enteral feedings:

1. Pulmonary aspiration: - Regurgitation of formula, Feeding tube displaced, Deficient gag reflex, Delayed gastric emptying 2. Diarrhea: - Hyperosmolar formula or medications, antibiotic therapy, bacteria contamination, malabsorption 3. Constipation: - lack of fiber, lack of free water, inactivity 4. Tube occlusion: - pulverized medications given per tube, sedimentation of formula, reaction of incompatible medications or formula 5. Tube displacement: - coughing, vomiting, not taped securely 6. Cramping: - high osmolality of formula, rapid increase in rate/volume, lactose intolerance, intestinal obstruction, high fat formula used 7. Delayed gastric emptying: - diabetic gastroparesis, serious illness, inactivity 8. Serum electrolyte intolerance: - excess GI losses, dehydration, presence of disease 9. Fluid overload: - refeeding syndrome in malnutrition 10. Hyperosmolar dehydration: - hypertonic formula with insufficient free water

Clear fat-free broth, bouillon, coffee, tea, carbonated beverages, clear fruit juices, gelatin, fruit ices, popsicles

Clear Liquid

As for clear liquid, with addition of smooth-textured dairy products (e.g., ice cream), strained or blended cream soups, custards, refined cooked cereals, vegetable juice, pureed vegetables, all fruit juices, sherbets, puddings, frozen yogurt

Full Liquid

As for clear and full liquid, with addition of scrambled eggs; pureed meats, vegetables, and fruits; mashed potatoes and gravy

Dysphagia Stages, Thickened Liquids, Pureed

As for clear and full liquid and pureed, with addition of all cream soups, ground or finely diced meats, flaked fish, cottage cheese, cheese, rice, potatoes, pancakes, light breads, cooked vegetables, cooked or canned fruits, bananas, soups, peanut butter, eggs (not fried)

Mechanical Soft

Addition of low-fiber, easily digested foods such as pastas, casseroles, moist tender meats, and canned cooked fruits and vegetables; desserts, cakes, and cookies without nuts or coconut

Soft/Low Residue

Addition of fresh uncooked fruits, steamed vegetables, bran, oatmeal, and dried fruits

High Fiber

4-g (no added salt), 2-g, 1-g, or 500-mg sodium diets; vary from no-added-salt to severe sodium restriction (500-mg sodium diet), which requires selective food purchases

low sodium

300 mg/day l, in keeping with American Heart Association guidelines for serum lipid reduction

Low Cholesterol

Nutrition recommendations by the American Diabetes Association: focus on total energy, nutrient and food distribution; include a balanced intake of carbohydrates, fats, and proteins; varied caloric recommendations to accommodate patient's metabolic demands

Diabetic

Eliminates wheat, oats, rye, barley and their derivatives

Gluten Free

Oxygen Capability 24-48%

Nasal cannula

Provide 30-50% concentrations of O2

face tent

Provide 40-60% concentrations of O2

simple face mask

Provide 40-70% concentrations of O2

Partial Non-rebreather with a reservoir bag

Provide 60-80% concentrations of O2

Non-rebreather Face Mask with reservoir bag

Provides 24%-60% oxygen

Venturi Mask

exam 3 Flashcards

(94 cards)