Fluid/Electrolyte & Respiratory Exam Study Guide

Question 1

What are ways to monitor someone who has a loss of Extracellular fluid? (ECF)

Answer 1

• ECF is the most important fluid in regulation of fluid balance, so would monitor fluid intake ,and make sure that they are excreting the same amount as their intake (normal fluid volume=euvolemic)

Question 2

What foods are high in acidity/alkaline?

Answer 2

• Food that is high in acidity:
  
  • Vinegar (2-3.5)
  • Lemon juice 2.3
  • Wine 3.5
• Food that is high in alkaline
  
  • Milk of magnesia 10.5
  • Baking soda 10.5

Question 3

Arterial blood gasses -Determination signs/symptoms

Answer 3

• Respiratory Alkalosis PH INCREASES,, CO2 DECREASES
  
  • (Low blood respiratory acid) can occur as a result of hyperventilation or excess aspirin taken in
• Respiratory Acidosis PH DECREASES, CO2 INCREASES
  
  • Occurs when breathing is inadequate and respiratory acid builds up. Common in Emphysema,.
• Metabolic Alkalosis PH INCREASES, HCO3- INCREASES
  
  • Occurs when bicarbonate ion concentration increases, causing an elevation in blood PH.
  • This can occur in excessive vomiting, dehydration, and endocrine disorder.
• Metabolic Acidosis PH DECREASES, HCO3- DECREASES
  
  • Normal metabolism is impaired, causing a decrease in bicarbonate and a buildup in lactic acid.
  • This causes diarrhea, ketosis, and kidney disorders

Question 4

What is Respiratory acidosis and alkalosis? What ABG value determines Acidosis or Alkalosis?

Answer 4

• Respiratory Alkalosis
• PH INCREASES,, CO2 DECREASES
  • (Low blood respiratory acid) can occur as a result of hyperventilation or
  • excess aspirin taken in
• PH >7.45, CO2 <35, HCO3 >26
• Respiratory Acidosis
• PH DECREASES, CO2 INCREASES
  
  • Occurs when breathing is inadequate and respiratory acid builds up.
  • Common in Emphysema,
• PH <7.35, CO2 >45, HCO3 <22

Question 5

What is Metabolic acidosis/alkalosis and what lab values will let us know that our patient is in metabolic alkalosis?

Answer 5

Metabolic Alkalosis

• Occurs when bicarbonate ion concentration increases, causing an elevation in blood PH.
• This can occur in excessive vomiting, dehydration, and endocrine disorder.
• PH INCREASES, HCO3- INCREASES

Metabolic Acidosis

• Normal metabolism is impaired, causing a decrease in bicarbonate and a buildup in lactic acid.
• This causes diarrhea, ketosis, and kidney disorders
• PH DECREASES, HCO3-DECREASES

Question 6

Elderly clients are at a higher risk for fluid and electrolyte imbalances. How would we explain aging factors for fluid/electrolyte imbalance to the family members.

Answer 6

• Encourage the client to increase intake of food and fluids.
• Encourage the client to exercise and have a balanced diet.
• Monitor the client’s sodium intake and blood pressure.
• Encourage intake of foods containing
potassium.
• Administer medications as ordered.

Question 7

What are Pulmonary respirations?

Answer 7

The exchange of oxygen (O 2 ) for carbon dioxide (CO 2 ) within the alveoli of the lungs (by diffusion—passive transport) is called external respiration ( pulmonary respiration ) because it is involved with the external environment

Question 8

What are the functions of the Upper and lower airways?

Answer 8

• Upper
  
  • Pathway for air to enter and exit the lungs where the exchange of gasses take place
• Lower
  
  • Pull in air from the upper respiratory system, absorb the oxygen, and release carbon dioxide in exchange

Question 9

What does the nasal passage do? What does cilia do?

Answer 9

• It is divided into two sections called nasal passages.
• Air moves through these passages during breathing.
• The nasal passages filter and warm the air, and make it moist before it goes into the lungs
• Cilia move microbes and debris up and out of the airways

Question 10

What precautions do we need to take to take care of a patient that has active TB.

Answer 10

• Airborne Precautions
• (Chest X-Ray and PPE including N95 Or PAPR )

Question 11

What are the limits in seconds that you should be suctioning someone?

Answer 11

• 10 Seconds and 3 times in to the trachea

Question 12

What are the causes for respiratory alkalosis?

Answer 12

• (Low blood respiratory acid) can occur as a result of hyperventilation or excess aspirin taken in

Question 13

What is the role of surfactant in the respiratory system?

Answer 13

• Surfactant acts to break up surface tension in the pulmonary (lung) fluids.
• This reduces friction and preserves the elasticity of lung tissue, thus preventing collapse of the alveoli ( atelectasis ) between breaths.

Question 14

What is the purpose of a deep breathing exercise?

Answer 14

• Slows down heart rate
• Allows body to take in more oxygen
• Improves digestion
• Increases energy
• Lowers blood pressure
• Expand the Lungs

Question 15

What controls respirations in the brain and what are their functions?

Answer 15

• The medulla’s respiratory center automatically controls the depth and rate of respirations without requiring conscious thought
• The cerebral cortex allows some voluntary control over breathing when talking, singing, eating, or changing the rate of breathing.

Question 16

What are terms in regards to respiratory rate?

Answer 16

• Brady-
  
  • Low
• Tachy
  
  • High
• Dyspnea
  
  • Difficulty breathing is called
• Orthopnea
  
  • Dyspnea relieved by sitting up
• Hypopnea ( bradypnea)
• Shallow breathing
• Hyperpnea (Tachypnea)
  
  • Fast breathing
• Eupnea
  
  • Normal breathing

Question 17

What role does the medulla have in the respiratory system?

Answer 17

• The medulla’s respiratory center automatically controls the depth and rate of respirations without requiring conscious thought.
• The pons works with the medulla to produce a normal breathing rhythm.

Question 18

What does the blood do in the respiration process?

Answer 18

• After oxygen is brought into the body, it attaches to hemoglobin for transport to tissues and cells.
• The exchange of O 2 for CO 2 within the cells is called tissue respiration , internal respiration , or cellular respiration ( cell breathing ).
• An increase in CO 2 levels stimulates respiration. CO 2 and water are the waste products of respiration.
• Some water is excreted as waste; some is recycled for use in the body.

Question 19

What is internal and external respiration?

Answer 19

• External respiration
  
  • (exchange of oxygen for carbon dioxide within the
    alveoli of the lungs)
• Internal or Cellular Respiration
  
  • (exchange of oxygen for carbon dioxide within
    the cells).

Question 20

How would I position a person with COPD (Low oxygenation)

Answer 20

High-fowler Position

Question 21

What are major stimulus for breathing in a healthy person?

Answer 21

Changes in oxygen levels in the blood

Question 22

Where is the voice box (Vocal cords) located? What Structures are needed for speech?

Answer 22

• Larynx(voice box): Boxlike structure made of cartilages held together by ligaments.
• Air passes over vocal cords to produce sound

Question 23

How would you document someone who is having difficulty breathing?

Answer 23

Dyspnea

Question 24

Which side would you likely develop pneumonia and why?

Answer 24

Because the right bronchus is straighter down and wider than the left, it is more susceptible to aspiration of fluids or foreign objects.

Question 25

Bronchotomy: What are you looking for and when can you start fluids?

Answer 25

• Invasive procedure in which a bronchoscope is advanced through the pharynx into the trachea and bronchi.
• Purpose is to:
  
  • Observe lung tissue
  • Obtain a biopsy or bronchial washing
  • Removing mucus plugs or foreign bodies
  • To determine the extent of a tumor or mass.
• Before the test, the person’s throat is anesthetized and medicated.
  
  • Fluids are withheld for 6-8 hours before a bronchoscopy.
  • Give oral care just before the procedure.
• After the test:
  
  • Clients are not allowed to have anything by mouth until their gag reflex comes back due to the anesthesiologist numbing the throat.
  • Once the gag reflux comes back (2 hrs) we can offer the client clear liquids.
  • The client needs to be in a side lying position to help facilitate drainage and prevent aspiration.

Question 26

What are some nursing interventions for Elderly client with decreased respiratory function?

Answer 26

• Encourage changing position
• Encourage no smoking
• Supplemental oxygen
• Encourage coughing
• Encourage fluid intake
• Encourage exercise
• Elevate head of bed

Question 27

What are the postural drainage guidelines?

Answer 27

• Wash hands/ wear gloves
• Improve drainage by striking the clients between the shoulder blades with cupped hands (pummeling) or by causing vibrations,
• Have tissue ready for the client
• Perform before the client eats.
• Give patients oral hygiene following the procedure
• Person is placed head downward position due to postural drainage using gravity.

Question 28

What the functions of respiratory system?

Answer 28

• Nose
  
  • Air enters it has 4 sinuses on each side of the nose (8 in total )
• Pharynx
  
  • Air and food passage
• Nasopharynx
  
  • Air only
• Oropharynx
  
  • Throat to carry food to the esophagus and air to the trachea
• Larynx
  
  • Voice box (where vocal cords are at)
• Laryngopharynx-
  
  • Divides larynx and esophagus
• Trachea
  
  • Windpipe transports air to and from the lungs
• Bronchi
  
  • Trachea division into 2
• Tracheobronchial tree
  
  • Is the division of bronchi to smaller bronchioles
• Lung
  
  • Oxygen is delivered and carbon dioxide is removed

Question 29

What are signs and symptoms for hypoxia?

Answer 29

• Restlessness, apprehension, anxious facial expressions, panic, fatigue, impaired coordination
• Headache.
• Difficulty breathing or shortness of breath (dyspnea).
• Rapid heart rate (tachycardia). Coughing.
• Wheezing.
• Confusion.
• Bluish color in skin, fingernails and lips (cyanosis)

Question 30

What safety precautions are needed when administering/caring for a client with an oxygen tank?

Answer 30

• Explain dangers of lighting matches or smoking cigarettes, cigars, or pipes
• Makes sure warning signs are posted
• Use caution with all electrical devices
• Be aware of all potential sources of sparks
• Turn oxygen on before applying mask
• Inform client of therapeutic use before bringing equipment into room
• Maintain constant oxygen concentration; monitor equipment at regular intervals
• Instruct client not to change the position of mask, cannula, or any equipment after in place

Question 31

Proper procedure for knowing how to suction while caring for a trach (10 seconds) (Skills packet)

Question 32

What should you ask a client prior to an X-ray?

Answer 32

• Pregnant?
• Metal in body?
• Jewelry on the body anywhere.

Question 33

Why do administer pulmonary functions test?

Answer 33

• To check lung function in those with lung or heart problems & to assess treatment for chronic lung problems
• Determines how much air a client inhales and exhales in one breath and assesses the client’s general respiratory system

Question 34

What sort of test would you do for a client with an oxygen deficiency?

Answer 34

Pulse oximetry