Med-Surg: Respiratory System/3

Question 1

nasal cannula

Answer 1

24-44

1-6L

Question 2

simple face mask

Answer 2

40-60

6-8L

Question 3

partial rebreather mask

Answer 3

50-75

8-11L

Question 4

nonrebreather mask

Answer 4

80-100

12L

Question 5

clinical manifestations indicating a need for suctioning

7

Answer 5

1. restlessness
2. tachypnea
3. tachycardia
4. decreased sao2
5. adventitious breath sounds
6. secretions
7. absence of spontaneous cough

Question 6

suctioning

3

Answer 6

10-15 seconds with rotating motion, 2-3 attempts, allow recovery between at 20-30 seconds

Question 7

trach care - keep how many extra tubes

Answer 7

at all times, keep two extra trach tubes (one the client’s size and one smaller size) at the bedside in the event of accidental decannulation

Question 8

trach suction when?

Answer 8

only when clinically indicated, never on routine schedule

Question 9

___ asepsis is used for tracheal suctioning

Answer 9

surigcal

Question 10

provide trach care how often

Answer 10

q8h

Question 11

mechanical vent - check tube placement how

Answer 11

in cm at lips or teeth

Question 12

mech. vent - assess respiratory status how often

Answer 12

q1-2H

Question 13

mechanical vent - low pressure alarm indicates

3

Answer 13

indicates low volume and is usually associated with tube disconnection, cuff leak, or tube dislodgement

Question 14

mechanical vent - high pressure alarm indicates

Answer 14

increased pressure

Question 15

mechanical vent - high pressure can be from

4

Answer 15

1. secretions
2. kinking of tube
3. pulmonary edema
4. client coughing or biting tube

Question 16

mechanical vent - apnea alarm

Answer 16

indicates there has been no spontaneous breath within a preset time period

Question 17

mech vent cuff pressure

Answer 17

less than 20 mm hg is recommended to reduce risk of tracheal necrosis

Question 18

mech vent. - reposition trach tube how often

Answer 18

q24h, or by protocol; monitor for skin breakdown

Question 19

mech vent. - prevent pneumothorax
2
-caused by
-requires

Answer 19

1. can be caused by high ventilator pressures

2. requires immediate chest tube