med surge exam 7 Flashcards
tripod position facilitates
easier breathing by displacing the diaphragm
Compare sounds on each side, can help identify
normal vs abnormal sounds (lungs
Coarse crackles
moist bubbling sounds heard on inspiration and expiration
placing a patient in high fowlers position will help with
ventilation while contacting HCP. Patient’s immediate needs come 1st
place people in high fowlers position for
maximum lung expansion
Non-rebreathers work properly when both
side vents are closed during inhalation and reservoir bag is inflated
Know that use of an adrenergic bronchodilator, MDI, more often than prescribed can
worsen symptoms
chest tube drainage system goes
below chest level
vigorous bubbling in water seal chamber indicates
an air leak
Maximum time for suctioning a trach is
15 seconds
• If you hear a ventilator alarm in a patient’s room check
the patient, then the machine
resting tidal volume is
400 – 600 mL
wheezes and stridor indicate
airflow obstruction
Crepitus
air leaking into chest wall and feels like rice krispies
how to care for a patient with epistaxis
lean forward not back( the stomach does not like blood)
post op nasal, tonsil, or thyroid surgery, a patient that swallows frequently
could be bleeding
• No sedatives for
sleep apnea patients, worsens sleep apnea by relaxing muscles of pharynx
strepp throat can lead to
glomerulitis
warm or hot fluids can cause dilation of
blood vessels (epistaxis)
• Pt diagnosed with influenza that develops wheezes and crackles may indicate
pneumonia
in post op the nurse will reinforce careful use of
narcotics to promote deep breathing and coughing
pollutants such as powders, chemical and hair can enter a trach and
cause irritation or infection
after a laryngectomy, the nurse will conclude the nutritional status is
adequate if alternative feeding methods are tolerated.
when a patient with West Nile virus is improving, they are
alert and oriented
