Med Surg Exam 2 Flashcards
1
Q
What is asthma?
A
A heterogeneous disease, usually characterized by chronic airway inflammation
2
Q
What 3 things does asthma cause?
think patho
A
airway hyperresponsiveness
- mucosal edema
- mucus production
3
Q
What does the inflammation of asthma lead to? (Symptoms)
A
cough
- chest tightness
- wheezing
- dyspnea
4
Q
What group of people are most prone to asthma?
A
African Americans and hispanics
5
Q
Is asthma reversible?
A
Yes
6
Q
What is the biggest predisposing factor for asthma?
A
Allergies
7
Q
What is the pathophysiology of asthma?
A
Mast cells, when activated, will release mediators (which are chemicals that contain histamine, bradykinin, etc.) that perpetuate the inflammatory response causing increase blood flow, vasoconstriction, fluid leak from vessels, attraction of WBC, mucus, and bronchoconstriction
8
Q
During acute exacerbations of asthma, ____ occurs quickly to narrow the airway in response to an exposure
A
bronchoconstriction
9
Q
What are the three most common symptoms of asthma?
A
cough
- dyspnea
- wheezing
10
Q
When do asthma attacks occur most often?
A
At night or early morning
11
Q
What Signs of progressing asthma exacerbations
A
- generalized wheezing,
- chest tightness,
- dyspnea
- sweating,
- tachycardia,
- widened pulse pressure,
- cyanosis,
- hypoxemia
12
Q
What labs might you see during asthma episodes?
A
- Increased eosinophils in blood and sputum
- Serum levels of IgE if allergy is present
- Hypoxemia, hypocapnia, respiratory acidosis, from ABG/O2 Sat
- Increase PaCO2 if condition worsens
13
Q
How do you prevent asthma?
A
Get tested and avoid triggers
- A detailed work history evaluation to identify occupational triggers
- Standard asthma meds
- Compensation systems
14
Q
What are major complications of asthma?
A
Status asthmaticus
- Respiratory failure
- Pneumonia
- Atelectasis
15
Q
Why do we give fluids to people with asthma?
A
They get dehydrated from sweating and insensible fluids loss with hyperventilation
16
Q
What 3 things does primary treatment of asthma focus on?
A
preventing impairment of lungs function
- minimizing symptoms
- preventing exacerbations
17
Q
What condition can substantially increase exacerbation of asthma and needs to be controlled?
A
Anxiety
18
Q
What is the first choice of meds for quick-relief of asthma?
A
Short-acting bet-2 adrenergic agonists (albuterol, levalbuterol, pirbuterol).
- These relax smooth muscle
19
Q
What meds do we give to patients who do not tolerate meds like albuterol well?
A
Anticholinergics like ipratropium
20
Q
What are long acting control meds for asthma?
What classes
A
- Corticosteroids
- Long-acting beta-2 adrenergic agoists
- Leukotriene modifiers or antileukotrienes
- Phosphodiesterase inhibitors
- Immunomodulators
21
Q
What kind of monitoring measures the highest airflow during a forced expiration and is given to moderate-severe asthma patients?
A
Peak flow monitoring
22
Q
When does a tension pneumothorax occur?
A
When air is drawn into the pleural space from a lacerated lung or through a small opening/wound in the chest wall
23
Q
What is different about tension pneumothorax compared to other forms?
A
The air that is breathed into the affected lung becomes trapped and cannot be expelled, causing a buildup of tension. This will cause the heart, trachea, and great vessels to shift to the unaffected side impacting both circulation and respiration
24
Q
If the pneumothorax is small and uncomplicated, what s/s would you see
A
- sudden pain
- minimal respiratory distress
- slight chest discomfort and tachypnea
25
If large or total lung collapse, what s/s would you see?
* Acute respiratory distress
- anxiety
- dyspnea and air hunger
- use of accessory muscles
- development of central cyanosis from hypoxemia
26
What to assess when lookin for a tension pneumothorax
* trachea shifted from affected side
- decreased or fixed chest expansion
- diminished or absent breath sounds
- percussion is hyper resonate
27
The goal of pneumothorax treatment is to
evacuate the air or blood from the pleural space
28
Treatment of tension pneumothorax
* Give high concentration of supplemental oxygen (hypoxemia)
- Pulse oximetry
29
In a tension pneumothorax emergency, what 3 things are done?
* Decompress it into a simple pneumothorax by inserting a large 14 gauge bore needle to relieve the pressure
- Then, apply a chest tube and underwater seal for suction and reestablishing negative pressure to expand the lung again.
- If air leaks continue, surgery may be necessary
30
What causes a post-procedure pneumothorax
This usually occurs when air escapes from a laceration in the lung itself and enters the pleural space from invasive procedures like a thorancetesis, transbronchial lung biopsy, and insertion of subclavian line.
31
What is pneumonia
inflammation of the lung parenchyma caused by bacteria, mycobacteria, fungi, and viruses.
32
Community Acquired Pneumonia
| When does it occur
occurs either in the community setting or within the first 48 hrs after hospitalization or institutionalization.
33
What is Health Care-Associated Pneumonia
The causative pathogens are often MDROs because o prior contact with a health care environment. Do not delay antibiotic treatment
34
Hospital-Acquired Pneumonia
| When does it develop?
Develops 48 or more hours after hospitalization and does not appear to be incubating at time of admission.
35
Ventilator-Associated Pneumonia
Subtype of hospital acquired but there is the pretense of an ET tube and has received mechanical ventilation for at least 48 hours.
36
Who is at risk for Immunocompromised Pneumonia?
Individuals who are immunocompromised drugs like corticosteroids, immunosuppressive agents, chemo, nutritional depletion, the use of broad-spectrum antimicrobial agents, etc. are at risk.
37
Immunocompromised pneumonia s/s
subtle onset with progressive dyspnea, fever, and a nonproductive cough
38
What is Aspiration pneumonia?
pulmonary consequences resulting from entry of endogenous or exogenous substances into lower airway.
38
How does aspiration pneumonia occur
bacterial infection residing in upper airway OR aspirating other contents like gastric contents may impair lung defenses, cause inflammation, and lead to bacterial growth resulting in pneumonia
39
Pneumonia implications/treatment
* Pneumococcal vaccine
- Appropriate antibiotics
- rest/hydration
- managing complications
- some patients - supplemental oxygen
- CHEST X-RAY
40
What is a Pulmonary embolism?
obstruction of pulmonary artery or one of its branches by a thrombus that originates somewheres in the venous system or in the right side of the heart
41
Most common causes of PE
dislodged or fragmented DVT, air, fat, amniotic fluid, and septic (from bacterial invasion)
42
What are assessment findings of PE?
Dyspnea,
chest pain,
substernal and may mimic angina, anxiety,
fever,
tachycardia,
apprehension,
cough,
diaphoresis,
hemoptysis, and syncope
43
What are the most frequent s/s of PE?
tachypnea; dyspnea
44
How do you manage PE?
| What do you do to help the patient?
* Semi-Folwer position
- Opioid analgesics for pain
- Continuous oxygen therapy
- Deep breathing, incentive spirometry
- Relieve anxiety
- Watch for cardiogenic shot or right ventricular failure
- Measure pulmonary arterial pressure and urinary output
- Elevate foot and encourage isometric exercises
- Compression devices
45
What are diagnostic findings related to PE?
| Not physical assessment
* Sinus tachycardia or pleural effusion
- Nonspecific ST-T wave abnormalities
- Hypoxemia, hypercapnia
46
What is aspiration?
inhalation of foreign material into the lungs leading to inflammatory reaction, hypoventilation, and ventilation-perfusion mismatch
47
What is a serous complication of aspiration?
broncho or lobar pneumonia
48
What is the key pathophysiology of aspiration?
the volume and character of aspirated contents (most often GI contents)
49
What are some practices to avoid aspiration?
Maintain head-of-bed elevation at an angle of 30 to 45 degrees, unless contraindicated
*Use sedatives as sparingly as possible
*Before initiating enteral tube feeding, confirm the tip location
*For patients receiving tube feedings, assess placement of the feeding tube at 4-hour intervals, assess for gastrointestinal residuals (<150 mL before next feeding) to the feedings at 4-hour intervals
*For patients receiving tube feedings, avoid bolus feedings in those at risk for aspiration
*Consult with primary provider about obtaining a swallowing evaluation before oral feedings are started for patients who were recently extubated but were previously intubated for >2 days
*Maintain endotracheal cuff pressures at an appropriate level, and ensure that secretions are cleared from above the cuff before it is deflated.
50
What are signs of pneumonia caused by aspiration?
tachycardia
- dyspnea
- central cyanosis
- hypertension
- hypotension
- potentially death
51
What are nursing interventions for aspiration?
* Keep HOB elevated and endotracheal cuff elevated (if intubated)
- Avoid stimulation of gag reflex with suctioning or other procedures
- Check for placement before tube feedings
- Soft diet, small bites, no straws
52
What is COPD acute exacerbation?
increased dyspnea that is a result of amplified hyperinflation and air trapping.
53
What Primary causes of an acute COPD exacerbation are usually related to?
viral infections, particularly human rhinovirus (i.e., the common cold). However, bacterial infections and environmental factors have also been linked to the development of acute exacerbations
54
What Treatment of acute COPD exacerbation?
Bronchodilator meds (first line)
- Or corticosteroids, antibiotic agents, oxygen therapy, and intensive respiratory interventions
55
What are Indications for hospitalization of COPD acute exacerbation
* dyspnea
- confusion/lethargy
- respiratory muscle fatigue
- paradoxical chest wall movement
- edema/cyanosis
- hypoxemia
56
What is Chronic condition of COPD?
slowly progressive respiratory disease of airflow obstruction involving airways, pulmonary parenchyma (lung tissue, bronchioles, bronchi, blood vessels, interstitial, and alveoli), or both
57
COPD may include disease that cause airflow obstruction like
emphysema, chronic bronchitis
58
What does chronic bronchitis look like?
| physically
Blue bloater on chart
59
What does emphysema look like?
Pink Puffer on chart
60
What Five primary symptoms of COPD?
chronic cough
- sputum production
- dyspnea
- weight loss
- barrel chest
61
What does treatment of COPD include?
Smoking cessation
- Supplemental oxygen
- Prescribing medications
- Managing exacerbation
- Incentive spirometry
62
How do you treat mild COPD?
short acting bronchodilator
63
What is treatment for moderate to severe COPD?
short acting bronchodilator with one or more long acting bronchodilator
64
What is treatment for severe to very severe treatment of COPD?
long acting bronchodilator or inhaled corticosteroids for repeated exacerbations
65
Wheat is oxygen toxicity?
when too high concentration of oxygen is given for an extended period (generally 24 hours)
66
What causes oxygen toxicity?
Overproduction of oxygen free radicals that mediate a severe inflammatory response that leads pulmonary edema and cell death
67
What are s/s of oxygen toxicity?
* substernal discomfort
- paresthesias
- dyspnea
- restless
- fatigue
- malaise
- progressive respiratory difficulty
- refractory hypoxemia
- alveolar atelectasis
- alveolar infiltrates evident on chest x-ray
68
What is treatment/prevention of oxygen toxicity?
Use lowest amount of oxygen needed to maintain acceptable PaO2 level and treating the underlying condition the patient has
69
Compare hypoxemia vs hypoxia?
Low oxygen in blood vs low oxygen in tissues
70
What is an example Low-Flow Systems (oxygen)
Nasal Cannula
- Nasal Oropharngeal catheter
- Masks- Simple, partial-rebreathing, non-rebreathing
- No control over concentration given
71
What are examples of high flow oxygen systems?
Venturi mask
- Trans-tracheal catheter
- Aerosol Mask
72
Do we put a patient on a Bi-pap? When do we use it
No, respiratory therapy does. When patient's ABGs show acidosis so it can be removed
73
How do we apply a non-rebreather mask?
Inflate first (or they will receive CO2)
- Humidify air
- Turn on first
Down sides- claustrophobia, not precise on what you give
74
What are benefits of a Venturi mask?
Can know exact concentration given
- Good for weening patients off oxygen because you can turn it down and know exactly the amount you are giving
75
What causes acute sinusitis?
Nasal congestion caused by inflammation, edema, and translation of fluid second to URI that leads to obstruction of sinus cavities. (allergies, virus, or bacterial)
76
What are signs of ABRS?
* purulent nasal drainage
- nasal obstruction or a combination of facial pain, pressure, or sense of fullness
- Cloudy or colored nasal discharge, congestion, blockage or stuffiness
- High fever
- Occurrence of symptoms for 10 days or more
77
Signs of AVRS (viral)?
similar to those of ABRS, except the patient does not present with a high fever, nor with the same intensity of symptoms (e.g., there tends to be an absence of facial pain-pressure-fullness), nor with symptoms that persist for as long a period of time. Symptoms of AVRS occur for fewer than 10 days after the onset of upper respiratory symptoms and do not worsen
78
What Treatment/Implications of Acute Sinusitis?
* Humidification of air in home
- Warm compresses to relieve pressure
- Education on nasal spray (corticosteroid med)
- Stop smoking
- NSAIDs for pain relief
- Begin decongestants at first sign of sinusitis
79
If sinusitis last more than 4 weeks it is deemed chronic and ___ can be performed. Less than is acute
surgery
80
What is pleural effusion?
Fluid collection in pleural space usually secondary to heart failure, TB, pneumonia, pulmonary infections
81
What are Signs of pleural effusion if caused by pneumonia?
* fever
- chills
- pleuritic chest pain
82
What to hear/feel/look for if listening for pleural effusion?
* Decreased or absent breath sounds;
* decreased fremitus; and a dull, flat sound on percussion
- May have tracheal deviation away from affected side
- Chest x-ray, chest CT, and thoracentesis (fluid analysis)
83
How do you treat pleural effusion?
* Underlying cause
- Pleurodesis (giving meds to stick lung to chest wall to prevent fluid or air from building up)
- Support medial regiment and patient education
- Chest tube if secondary to malignancy
- Frequent turning and movement to facilitate adequate spreading to talc over pleural surface
- Administer analgesic and monitor pain level
84
What is atelectasis?
Closure or collapse of alveoli
85
What is the most common form of actelectasis?
Acute
86
What is Difference between acute and chronic atelectasis?
chronic you may have a pulmonary infection
87
What Obstructive and Non-obstructive atelectasis differences?
* Obstructive is the common type and results from reabsorption gas from an obstruction.
* Nonobstructive occurs as a result of reduced ventilation
88
What General symptoms of atelectasis
insidious, increasing dyspnea,
cough, and sputum production
89
What are Acute atelectasis symptoms?
* tachycardia,
* tachypnea,
* pleural pain, and central cyanosis if large areas of the lung are affected
90
What Chronic atelectasis symptoms?
| If it is chronic it is more serious
similar to acute, pulmonary infection may be present
91
How do you treat atelectasis?
| Lying still won't do them any good
* Position changes
- Turn, cough, deep breath
- Mobilization
- Incentive spirometry
- Postural drainage
92
What causes TB?
| and how does it spread?
Spreads by airborne transmission through droplets then moves to other parts of the body such as the kidneys, bones, and cerebral cortex.
93
What are precautions for TB?
private room
- negative pressure
94
How is TB diagnosed?
diagnosed with TB skin test or chest x-ray
95
What are TB diagnostics (what is performed)?
* History and physical
- TB skin test; Mantoux method: See Figure 19-3
oSignificant versus nonsignificant reactions
- TB blood tests
- Sputum culture
- Sputum testing
96
What is DVT prophylaxis?
SCDs
Lovenox
TEDS
97
How often do we perform oral care?
Every 4 hours
98
What does med management look like for TB?
* Treated for 6 to 12 months
- Drug resistance is primary concern
- Initiate treatment with four or more medications
- Complete all therapy
- Initial treatment phase (8 weeks)
- Continuation phase (4 to 7 months)
99
What kind of nursing management is done for TB?
* Promoting airway clearance
- Advocating adherence to the treatment regimen (important!!!)
- Promoting activity and nutrition
- Preventing transmission
100
What Acute Respiratory Distress Syndrome (ARDS)?
Characterized by sudden, progressive pulmonary edema, increasing bilateral lung infiltrates visible on chest x-ray, and absence of an elevated left atrial pressure
101
What are s/s of ARDS?
* Rapid onset of severe dyspnea and V/Q mismatch <72 hours after precipitating event
- Classified by severity of hypoxemia that does not respond to supplemental oxygen therapy
- Crackles, intercostal retractions and BNP levels
102
How do you medically manage ARDS?
| What do we do to treat it?
* Identification and treatment of underlying cause
- Intubation, mechanical ventilation with PEEP to keep alveoli open
- Treat hypovolemia to keep hemodynamically stable
- Prone positioning is best for oxygenation, frequent repositioning to safeguard integumentary system
- Nutritional support, enteral feedings preferred
- Reduce anxiety, sedation, paralysis
- Supportive care
103
What are causes Chest Blunt Trauma ?
Sternal, rib fractures
- Flail chest
- Pulmonary contusion
104
What are Pathological states that can occur from blunt trauma?
* Hypoxemia from disruption of the airway;
* injury to the lung parenchyma, rib cage, and respiratory musculature;
*massive hemorrhage; collapsed lung; and pneumothorax
- Hypovolemia from massive fluid loss from the great vessels, cardiac rupture, or hemothorax
- Cardiac failure from cardiac tamponade, cardiac contusion, or increased intrathoracic pressure
105
what is Respiratory Failure/Acute Respiratory Distress
| Something is impaired, so what signs will you see?
Rapid deterioration that indicates hypoxemia, hypercapnia, and respiratory acidosis (impaired ventilation of perfusion mechanisms)
106
What Early sings of Acute Respiratory failure?
Early signs: restlessness, tachycardia, hypertension, fatigue, headache
107
What Late signs of Acute Respiratory Distress?
confusion, lethargy, central cyanosis, diaphoresis, respiratory arrest
108
What are Clinical Manifestations of Acute Respiratory failure
| They are having trouble breathing, so what will they do?
use of accessory muscles, decreased breath sounds
109
How do we manage Acute Respiratory Failure
* Identification and treatment of underlying cause
- Intubation, mechanical ventilation
- Nutritional support, enteral feedings preferred
- Reduce anxiety
- Provide patient a form of communication
- Prevent complications (turning, ROM, mouth care, skin care)
110
What is bronchiectasis?
Chronic, irreversible dilation of bronchi, bronchioles that occur from detraction of muscles and elastic connective tissue
111
What are s/s of bronchiectasis?
| interesting secretions
* hronic cough
- production of purulent sputum
- hemoptysis
- clubbing
- repeated episodes of pulmonary infection
112
what is nursing management of bronchiectasis?
* Alleviating symptoms
- Clear secretions
- Eliminate factors like smoking that can worsen mucus
- Educate on signs of respiratory infections and nutrition strategies
113
What is bronchoscopy?
direct inspection and examination of the larynx, trachea, and bronchi through either a flexible fiberoptic bronchoscope or a rigid bronchoscope
114
What is Purpose of diagnostic bronchoscopy?
1) to visualize tissues and determine the nature, location, and extent of the pathologic process
(2) to collect secretions for analysis and to obtain a tissue sample for diagnosis
(3) to determine whether a tumor can be resected surgically
(4) to diagnose sources of hemoptysis.
115
What is Purpose of therapeutic bronchoscopy
* remove foreign bodies or secretions from the tracheobronchial tree
- control bleeding
- treat postoperative atelectasis
- destroy and excise lesions
- provide brachytherapy (endobronchial radiation therapy)
116
What actions are taken before a bronchoscopy?
* Informed consent
- Food and fluids withheld for 4-8 hours before test (aspiration)
- Remove dentures and prostheses
- Explain procedure and give preoperative meds
- After procedure, patient must be NPO until cough reflex returns as this is done under local anesthesia typically. Sometimes general
- Small amount of blood-tinged sputum and fever expected within first 24 hours.
117
bronchoscopy expected findings (what disease processes do we use it for?)
atelectasis
- pneumonia
- TB
- lung abscess
118
How are ABGs obtained
through an arterial puncture at the radial, brachial, or femoral artery or through an indwelling arterial catheter
119
Do nurses obtain ABGs
No, respiratory therapy typically does this
120
What are some Complications of ABGs
Pain (related to nerve injury or noxious stimulation), infection, hematoma, and hemorrhage
121
Normal ABG levels
pH: 7.35-7.45
PCO2: 35-45
HCO3: 22-26
PaO2: 80-100
122
What is Thoracentesis?
insertion of a needle or catheter into the pleural space to remove fluid that has accumulated and decrease pressure on the lung tissue; may also be used diagnostically to identify potential causes of a pleural effusion
123
Studies of the pleural fluid removed from a thoracentesis include
Gram stain culture and sensitivity
- acid-fast staining and culture
- differential cell count
- cytology
- pH
- total protein
- lactic dehydrogenase
- glucose
- amylase
- triglycerides
- cancer markers such as carcinoembryonic antigen.
124
What conditions would you use a thoracentesis for?
* Atelectasis (pleural effusion causing alveolar collapse)
- COVID (pleural effusion is a complication)
- Bacterial Pneumonia (pleural effusion develops)
- Pleurisy (diagnostic test)
- Empyema (diagnostic test)
125
What is Tonsillectomy?
preferred surgical procedure for chronic tonsillitis and recurrent streptococcal infections
126
What Indications for tonsillectomy?
* repeated episodes of tonsillitis despite antibiotic therapy; hypertrophy of the tonsils and adenoids that could cause obstruction and obstructive sleep apnea (OSA)
- repeated attacks of purulent otitis media
- suspected hearing loss due to serous otitis media that has occurred in association with enlarged tonsils and adenoids.
127
What are nursing implications for tonsillectomy?
| What should we do to help the patient?
* Continuous monitoring after surgery because of hemorrhage risk which could compromise airway
- Prone position is best post-op with patient's head turned to side
- Do not remove oral airway until gag and swallow reflexes come back
- Apply ice collar to neck, and a basin and tissues for expectoration of blood and mucus
- Have items ready for bleeding at surgical site: a light, a mirror, gauze, curved hemostats, waste basin
128
What Partial Laryngectomy?
often used for patients in the early stages of cancer in the glottic area when only one vocal cord is involved. It may also be performed for recurrence when high-dose radiation has failed.
129
What Partial laryngectomy procedure and results
A portion of the larynx is removed, along with one vocal cord and the tumor; all other structures remain. The airway remains intact, and the patient is expected to have no difficulty swallowing. The voice quality may change, or the patient may sound hoarse.
130
What is Total laryngectomy?
Complete removal of larynx
131
What Indications for total laryngectomy
can provide a cure in most advanced laryngeal cancers, when the tumor extends beyond the vocal cords, or for cancer that recurs or persists after radiation therapy.
132
What are Total laryngectomy procedure/results?
the laryngeal structures are removed, including the hyoid bone, epiglottis, cricoid cartilage, and two or three rings of the trachea. The tongue, pharyngeal walls, and most of the trachea are preserved. A total laryngectomy results in permanent loss of the voice and a change in the airway, requiring a permanent tracheostomy
133
What is FEV1
Forced expiratory volume- Volume of air exhaled in the specified time during the performance of forced vital capacity; FEV1 is volume exhaled in 1 s
134
FEV1 is a valuable cue to what?
the severity of the expiratory airway obstruction
135
What is FEV1/FVC ratio?
Ratio of timed forced expiratory volume to forced vital capacity- expressed as a percentage of the forced vital capacity
136
FEV1/FVC ratio is another way of expressing what?
the presence or absence of airway obstruction
137
Pulmonary Function Tests in general are used with what disorders and are performed by who
chronic respiratory disorders or ARDS; respiratory therapy using a spirometer that has a volume collecting device attached.
138
What is Thoracotomy
surgical opening into the chest cavity
139
What Indications for thoracotomy?
* treats lung cancer
- empyema to remove thickened pleura, pus, debris, and diseased tissue
140
What Nursing management of patient having thoracotomy?
* Performing preoperative assessment and education for alleging anxiety of patient and family
- Postoperatively- successfully managing transition in care for the patient from ICU to other inpatient acute care settings
141
What is endotracheal intubation?
nsertion of a breathing tube (type of artificial airway) through the nose or mouth into the trachea
142
What Indications for Intubation
Ateletasis
- Pneumonia
- COVID
- Acute Respiratory Failure
143
what extubation steps?
1.Explain procedure.
2.Have self-inflating bag and mask ready in case ventilatory assistance is required immediately after extubation.
3.Suction the tracheobronchial tree and oropharynx, remove tape, and then deflate the cuff.
4.Give 100% oxygen for a few breaths, then insert a new, sterile suction catheter inside tube.
5.Have the patient inhale. At peak inspiration, remove the tube, suctioning the airway through the tube as it is pulled out.
144
what is Care of a patient following extubation?
1.Give heated humidity and oxygen by facemask and maintain the patient in a sitting or high-Fowler position.
2.Monitor respiratory rate and quality of chest excursions. Note stridor, color change, and change in mental alertness or behavior.
3.Monitor the patient's oxygen level using a pulse oximeter.
4.Keep patient NPO (nothing by mouth), or give only ice chips for next few hours.
5.Provide mouth care.
6.Educate the patient about how to perform coughing and deep-breathing exercises.
145
What Nursing interventions for ventilation?
* Enhancing gas exchange
- Promoting effective airway clearance
- Preventing injury and infection
- Promoting optimal level of mobility
- Promoting optimal communication
- Promoting coping ability
146
How do we prevent ventilator associated pnuemonia?
elevate head of bed to 30-40 degrees
sedation vacation
peptic ulcer disease prophylaxis
DVT prophylaxis
daily oral care
