Gas Exchange Flashcards
Nasal Cannula Flow rate
1-6 L/min
Disadvantage to NC
Actual O2 concentration that the pt. get varies.
Simple face mask flow rate
5-10 L/min
Simple face mask O2 concentration
40-60%
The concentration of O2 in a simple face mask is controlled by what?
The pt.’s respiratory pattern
Simple face mask is use for short/long term therapy?
Short term therapy use
Venturi mask flow rate
4-6 L/min
Venturi mask O2 concentration
24-60%
What type of pt. may a venturi mask be used for? Why?
COPD pt. in distress
Venturi mask is carefully controlled concentration of O2 nurse able to control the amount of O2 the pt. is getting
When should the O2 be humidified?
If the flow rate is greater than 3 L/min the O2 should be humidified
A COPD pt. is stable and able to move around on their own. What type of O2 device will the nurse provide if needed?
NC indicated for COPD pt. if stable
Venturi mask indicated if COPD pt. in distress
Flow rate for nonrebreather
Minimal flow rate of 10 L/min
Nonrebreather O2 concentration
up to 90%
What is a safety thing when administering O2 by nonrebreather mask?
Make sure the bag is inflated at all times
What are indications for an endotracheal tube?
Pt. that cannot maintain ventilation on their own
Ex. Coma, upper airway obstruction, respiratory distress, drowning
Choose issue with ventilation, transportation, or perfusion: COPD
Mainly ventilation
B/c prob with ventilation minor issue with perfusion
Choose issue with ventilation, transportation, or perfusion: Pneumonia
Mainly ventilation
B/c prob with ventilation minor issue with perfusion (b/c secretions)
Choose issue with ventilation, transportation, or perfusion: DVT/PE
Perfusion
Choose issue with ventilation, transportation, or perfusion: Anemia
Transportation
What assessments are critical for all exemplars (COPD, Pneumonia, DVT/PE, Anemia)
VS
Cardiac
Pulmonary
Priority VS for COPD
O2 Sat
Others: RR
Priority VS for Pneumonia
Temp.
Others: O2 Sat and RR
Priority VS for Anemia
O2 Sat
Others: RR, BP, HR
Priority VS for PE
O2 Sat
Others: RR
Priority VS for DVT
All VS will be normal
Pt. with history of COPD with SOB, cannot tolerate any activity, and anxious. What finding is expected? What would concern the nurse from this assessment?
SOB is expected with COPD
Concern: cannot tolerate any activity and being anxious
Pt. with a Hx of sickle cell anemia what is your priority intervention?
O2 admin - most likely will be SOB and low O2 Sat because sickle cells cannot carry as much O2
The nurse suspects anemia. What assessment findings support this diagnosis?
SOB, Fatigue,, weakness, pallor (esp. mucous membranes)
True/False: The pt. is suspected to have a PE. The nurse wants to see a chest x-ray. The x-ray looks clear so the pt. does not have PE
False, PE do not normally show up on chest x-rays because a PE is a circulatory problem not ventilation.
What lab is most important to look at with a pt. with COPD?
ABGs
A pt. comes in with new onset COPD. What lab values should the nurse order STAT? What lab does the nurse suspect to be off
ABGs
Nurse should expect CO2 to be elevated which leads to Respiratory acidosis - pH abnormal (New onset - kidneys have probably not started compensating yet)
The pt. comes in with SOB, thick green sputum, diminished lung sounds, and excessive resp. effort. What does the nurse suspect? What lab should be ordered STAT?
Pneumonia
CBC - look at WBC (infection) and Neutrophils (increase in neutros lets know it is bacterial and can be Tx with antibiotics)
If neutrophils are elevated on a CBC what is suspected?
Bacterial infection - can treat with antibiotics
Pt with pneumonia is able to tolerate little activity with small amount of supplemental O2 and eating a regular diet. The student nurse asked if ABGs are ordered. What is the nurses response?
ABGs are ordered only if the pneumonia pt. is unstable because it is painful and invasive.
Nurse recently discovered a suspected DVT/PE in her pt.’s left leg. What lab should the nurse order STAT? What med should the nurse call the HCP for? What lab would she monitor for that med?
D-dimer - lets nurse know there is an increase/decease in clotting going on in the body (ordered to determine if there is a clot for suspected DVT)
Med: Heparin (most likely) fast. Monitor PTT with heparin
Pt. with recent DVT was given Heparin in the hospital. Now ready for discharge the nurse understands that what med will most likely be sent home with pt. for decreasing clotting? What lab values will need to be monitored for that med?
Warfarin
PT and INR will need to be monitored
What is the antidote for Warfarin?
Vitamin K
Pt. with suspected anemia comes in. What lab is most critical for the nurse to order STAT?
CBC - assess RBCs, Hgb, Hct, and presence of sickle cells
What other labs may be necessary but not critical for a pt. with a PE
ABGs
BMP
Pt. with COPD asks if he can have a gatorade. Whats nurse’s response?
Yes, I encourage PO fluids to thin your secretions. IV fluids may be required only low-moderate rates
What should the nurse teach a pt. with COPD about activity after discharge?
Activity is okay as tolerated. But space activities out to decrease fatigue r/t poor gas exchange
What meds are usually ordered for a pt. with COPD?
Steroids (decrease inflammation)
Bronchodilators (Open airways)
Pt. orders a burger from mcdonalds to be sent to his room. This pt. has Hx of COPD, Hypernatremia, and Hypokalemia. What is important to teach this pt. about nutrition?
With COPD you want to have small frequent meals higher in calories b/c resp. effort is high
You should stay away from fast food because they are usually high in Sodium which does not help your hypernatremia and may be causing the hypokalemia has well
What meds should the nurse expect to be ordered for a pt. with Pneumonia?
Antibiotics and Guaifenesin (most common)
What does Guaifenesin do?
Thins secretions
A pt. with pneumonia is eating a regular diet, ambulating, and on fluid restrictions. What should the nurse talk to the HCP about?
The pt. should not be on fluid restrictions. They should be hydrating as much as can because of fever, secretions, and infection
Pt. with PE is SOB and O2 reads 89% what i priority nursing intervention?
Raise HOB and admin O2 Nasal cannula
Pt. with PE want to walk down the hall. She said she feel cooped up. After eating her breakfast the nurse finds her getting out of bed. What is nurse action?
Get her back in bed. Educate about why she cannot get out of bed. PE/DVT - activity should be very restricted.
PE - avoid increase O2 demand
DVT - prevent PE
What is the priority education point for a pt. recently put on Warfarin to reduce clotting
#1 risk of bleeding #2 Do not change regular intake of dark leafy greens b/c contain vitamin K
Is O2 required for pt. with anemia
Only nasal cannula 1-6 L/min required if O2 sat is below 92%
What type of IV fluids would the nurse expect to give to a pt. with anemia?
Packed RBCs
True/False: Iron can be given IVP or piggyback
True
What are risks associated with a bronchoscopy biopsy?
Bleeding - bright red sputum
Perforation - decreased or changes in breath sounds unilaterally
A pt. with a Hx of anemia get a CBC done. The pt.’s MCV is 66 what kind of anemia does the nurse suspect?
Iron deficiency
Normal range for MCV
80-95
A pt. with a Hx of anemia get a CBC done. The pt.’s MCV is 98 what kind of anemia does the nurse suspect?
B12 deficiency
A pt. with a Hx of anemia get a CBC done. The pt.’s MCV is 90 what kind of anemia does the nurse suspect?
Blood loss
Anemia r/t chronic disease
What cultural backgrounds put pt. at higher risk for sickle cells anemia?
Caribbean, Mediterranean, African
Why does sickle cell anemia cause decreased transport and perfusion?
Transport - irregular shape cannot hold as much O2
Perfusion - usually clump together and develop clots which cause ischemia (pain)
What are 3 priority interventions for a pt. with sickle cell anemia?
O2 - to prevent further sickling
Fluids - dilute cells to prevent occlusions
Pain management
What can trigger sickle cell anemia?
Exercise
Extreme hot/cold temp.
High altitude than use to
No sleep/eating well - stressed nursing/college students
Caution giving Guaifenesin to a pt. on what kind of precaution?
Aspiration precautions
Education about Guaifenesin
Should not drive when taking Guaifenesin. Make you dizzy and drowsy
What lab do you want to monitor while your pt. is taking Albuterol for COPD
Potassium***
Albuterol can lower K+ (Heart monitor)
Can increase glucose levels
At what time of day should a pt. take their Glucocorticoid?
AM with food
Important educational point with inhaled Glucocorticoid
Rinse mouth after use
How should you instruct a pt. to take Albuterol and a steroid medication?
Use the Albuterol first (bronchodilator)
Then the steroid
Foods high in B12
Meat
Seafood
Eggs
Dairy
Foods high in Iron
Dark green veggies Beets Dried beans Fortified grains/cereals Meat Clams
Food high in Folic Acid
Dark green veggies Dried beans Fortified grains/cereals Nuts Bran Yeast
Pt diagnosed with a stable PE, the HCP orders a thrombolytic to be given. BP 119/70 HR 98 O2 94 Temp 98 RR 18. Whats the nurse’s action?
Question the thrombolytic order. This med class has high risk of bleeding. If pt. with PE is stable other methods should be tried first.
