Medsurg hesi 1 respiratory Flashcards
___ measure lung volumes and capacities, diffusion capacity, gas exchange, flow rates, airway
resistance along with distribution of ventilation
PFTs (pulmonary function tests)
Dx test Commonly performed for clients who have dyspnea
PFTs (pulmonary function tests)
PFTs: instruct client not to ___6 to 8 hr prior to testing.
smoke
PFTs: withhold___ for 4 to 6 hr prior to testing
inhalers
ABG: PaO2 range
80 to 100 mm Hg
ABG: PaCO2 range
35 to 45 mm Hg
Arterial Puncture (for ABG): Obtain a ___ syringe for the sample collection
heparinized
Arterial Puncture (for ABG): perform a ___ test prior to the stick
Allen’s
Arterial Puncture (for ABG): Place the collected and capped specimen into a basin of ___ and ___ to preserve it
ice and water
also should be transported to the lab immediately
Arterial Puncture (for ABG): Accessing the radial artery for sampling may be more difficult with ___ clients because of impaired peripheral vasculature
older
Immediately after an arterial puncture,
hold direct pressure over the site for at least 5 min.
Immediately after an arterial puncture, hold direct pressure over the site for at least 5 min.
Pressure must be maintained for at least 20 min if the client is
receiving anticoagulant
therapy
Arterial puncture is frequently done by a ___ therapist in hospital settings.
respiratory
Arterial Puncture (for ABG): Collect waste and specimen. Place ___ on ice for transport to the laboratory immediately.
both
Arterial Puncture (for ABG): Assess the arterial ___ upon completion
waveform
A _____ is when blood accumulates under the skin at the IV site.
hematoma
Arterial Puncture (for ABG): Complication: if a hematoma develops
Apply pressure to the hematoma site.
Air embolism: positioning of the client
left side, trendelenburg
Monitor the client for a sudden onset of shortness of breath, decrease in SaO2 levels, chest
pain, anxiety, and air hunger.
These indicate
air embolism
Bronchoscopy can be performed on clients who are receiving mechanical ventilation by
inserting the scope through the client’s ET tube
Bronchoscopy: before the procedure assess for routine use of
anticoagulants (risk for bleeding with this procedure)
Bronchoscopy position
sitting
Common types of meds for bronchoscopy (beside the anesthesia)
sedatives, antianxiety agents, and/or atropine
Bronchoscopy: atropine is used to reduce
oral secretions
after Bronchoscopy, assess the client’s level of consciousness, presence of gag reflex, and ability to swallow prior to resuming oral intake (usually takes about __ hours).
2
Bronchoscopy: Once the cough reflex returns, the nurse may offer
ice chips to the client and eventually fluids
Bronchoscopy: a small amount of ___ ___ ___ is expected afterwards
blood tinged sputum
Bronchoscopy: Instruct clients that gargling with __ ___ or using throat lozenges may provide comfort for
soreness of the throat
salt water
Administer oxygen therapy to the client as prescribed. _____ can decrease the likelihood of laryngeal edema
Humidification
Pneumothorax can occur following a ____ bronchoscopy.
rigid
Thoracentesis: Use of an ___ for guidance decreases the risk of complications
ultrasound
the collection of pus in a cavity in the body, especially in the pleural cavity.
Empyema
Thoracentesis: Percussion, auscultation, ____, or ____ is used to locate the effusion and needle
insertion site
radiography, or sonography
Thoracentesis: Changes in ___ ____ in many older adult clients may make it difficult for the provider to
identify the landmarks for insertion of the thoracentesis needle
fat deposition
Thoracentesis: The amount of fluid removed is limited to __ L at a time to prevent cardiovascular collapse.
1
Chest tubes are removed when
the lungs have reexpanded and/or there is no more fluid drainage
Chest Tube 3 chamber Systems: First chamber is for
drainage collection
Chest Tube 3 chamber Systems: second chamber is for
water seal
Chest Tube 3 chamber Systems: 3rd chamber is for
suction control
Chest Tube: The water seal allows air to exit from the pleural space on exhalation and
stops air from entering with inhalation
Chest Tube: The height of the sterile fluid in the suction control chamber determines
the amount of suction transmitted to the pleural space
Chest Tube: A suction pressure of ___ H2O is common
-20 cm
Chest Tube: The application of suction results in continuous
bubbling in the suction chamber
Chest Tube: the movement of the fluid level with respiration
Tidaling
Chest Tube: Cessation of tidaling in the water seal chamber signals
lung reexpansion or an obstruction within the system
prior to the chest tube insertion, fill the
water seal chamber
Chest Tube insertion: Prep the insertion site with
povidone-iodine
For a pneumothorax, the chest tube tip is positioned
up toward the shoulder
For a hemothorax or pleural effusion, the chest tube tip is positioned
down
Chest tube insertion: The chest tube is ___ to the chest wall
sutured
Chest Tube: Report excessive drainage (greater than __ mL/hr)
70
Chest Tube: Report drainage that is
cloudy
Chest Tube: Check for expected findings of tidaling in the water seal chamber and continuous bubbling only in the
suction chamber
Chest Tube: verify the chest tube’s placement with an
x ray
Chest Tube: Keep two enclosed ___ at the bedside
hemostats (those scissor/forceps like things)
Chest Tube: Do not strip or ___ tubing; only perform this action when prescribed by the provider
milk
Chest Tube: Monitor the water seal chamber for continuous bubbling; this indicates
an air leak
Chest Tube: If the tubing separates, the client is instructed to
exhale as much as possible and to cough to remove as much air as possible from the pleural space
Chest Tube: If the chest tube drainage system is compromised, the nurse
immerses the end of the tube in sterile water to restore the water seal.
Chest Tube: If a chest tube is accidentally removed,
an occlusive dressing taped on only three sides of the site
Sucking chest wounds, prolonged clamping of the tubing, kinks in the tubing, or obstruction may cause a ___ ____
tension pneumothorax
Chest Tube removal: one option is to Instruct the client to take a deep breath, exhale, and
bear down
Chest Tube removal: one option is to Instruct the client to
take a deep breath and hold it during chest tube removal.
Chest Tube: after removal of the tube, Apply airtight sterile ___ jelly gauze dressing
petroleum
Liters of O2 for a nasal cannula
1 to 6
Nasal cannula: Provide humidification for flow rates of __ L/min and above
4
Disadvantage of a simple face mask: Flow rates of 5 L/min or lower can result in
rebreathing of CO2
Disadvantage of a simple face mask: Device is poorly tolerated by clients who have
anxiety or claustrophobia
simple face mask: Use caution with clients who have a high risk of
aspiration or airway obstruction
Liters of O2 delivered with Partial rebreather mask
6 to 11
Disadvantage of Partial rebreather mask: Complete deflation of the reservoir bag during inspiration causes
CO2 buildup
Partial rebreather mask: Keep the reservoir bag from deflating by
adjusting the oxygen flow rate
Liters of O2 delivered with Nonrebreather mask
10 to 15 (highest amount possible except for intubation)
Which mask is this: A one-way valve situated between the mask and reservoir allows the client to inhale maximum O2 from the reservoir bag
Nonrebreather mask
Nonrebreather mask: A ___ ___ ___ situated between the mask and reservoir allows the client to inhale maximum O2 from the reservoir bag
one-way valve
Which mask is this: The two exhalation ports have flaps covering them that prevent room air from entering the mask.
Nonrebreather mask
advantage of Venturi mask: delivers
the most precise oxygen concentration.
advantage of Venturi mask: ___ is not required.
Humidification
Venturi mask is best suited for clients with
chronic lung disease
Disadvantages of Venturi mask
expensive.
Good for clients who do not tolerate masks well
Aerosol mask, face tent (fits loosely around the face and neck), and tracheostomy collar
Nursing action for Aerosol mask, face tent (fits loosely around the face and neck), and tracheostomy collar: Empty ___ from the tubing often.
condensation
Nursing action for Aerosol mask, face tent (fits loosely around the face and neck), and tracheostomy collar: Ensure that ___ ___ leaves from the vents during inspiration and expiration.
aerosol mist
T-piece: This device can be used for clients who have tracheostomies, laryngectomies, or
endotracheal tubes (ET)
T-piece: Ensure that the exhalation port is ___ and ____
open and uncovered
3 Signs and symptoms of hypercarbia
restlessness, hypertension, and headache
Use an oxygen mask with continuous positive airway pressure (CPAP), bilevel positive airway pressure (BiPAP), or positive end expiratory pressure (PEEP) as prescribed while the client is on a mechanical ventilator to help decrease the amount of needed
oxygen
Clients who have COPD rely on ___ ___ of ___ ___ as their primary drive for breathing
low levels of arterial oxygen
Who is this: Providing supplemental oxygen at high levels can decrease or eliminate their respiratory drive.
COPD patients
A tube is inserted through the client’s nose or mouth into the trachea. This allows for emergency airway management of the client.
ET tube
Nasal intubation: This route is not used if the client has a ___ problem.
clotting
Mechanical ventilation provides __% humidified oxygen
100
Positive-pressure ventilators deliver air to the lungs under pressure throughout inspiration and/or expiration to
keep the alveoli open during inspiration and to prevent alveolar collapse during expiration
Mode of ventilation: Client initiates breath and ventilator takes over
Assist-control (AC)
Mode of ventilation: Client initiates breath and tidal volume will depend upon client’s effort
Synchronized intermittent mandatory ventilation (SIMV)
Mode of ventilation: Works to keep the alveoli from collapsing during expiration.
Positive end expiratory pressure (PEEP)
Positive end expiratory pressure (PEEP) allows for ___ levels of oxygen to be used
lower
Mode of ventilation: Positive pressure supplied during spontaneous breathing. No ventilator breaths delivered unless in conjunction with SIMV.
CPAP
Mode of ventilation: Often used for obstructive sleep apnea
CPAP
Mode of ventilation: Positive pressure delivered during spontaneous breaths. Different pressures delivered for inspiration and expiration
BiPAP
BiPAP: No
No spontaneous breaths delivered.
Mode of ventilation: Often used to wean client from ventilator
BiPAP
ventilation: Apply protective barriers (___ ___ ___) according to hospital protocol to prevent self-extubation.
soft wrist restraints
ventilator alarms: Volume (low pressure) alarms indicate a low exhaled volume due to a ___ or ___ ___
disconnection or cuff leak
ventilator alarms: Pressure (high pressure) alarms indicate
excess secretions, kinks, client coughing, pulmonary edema, bronchospasm, and/or pneumothorax.
ventilator alarms: Apnea alarms indicate that the ventilator does not detect
spontaneous respiration in a preset time period
ventilator: Maintain the cuff pressure below __ mm Hg to reduce the risk of tracheal necrosis.
20
ventilator: Reposition the oral endotracheal tube every __ hr or according to protocol
24
damage to the lungs by positive pressure
Barotramua
damage to the lungs by volume delivered from one lung to the other
Volutrauma
Oxygen toxicity can result from high concentrations of oxygen (typically above __%), long durations of oxygen therapy (typically more than _________)
above 50%
more than 24 to 48 hr
Mechanical ventilation has a risk of increased thoracic pressure (positive pressure), which can result in ___ ___ ___
decreased venous return
___ ulcers can be evident in clients receiving mechanical ventilation
Gastric ulcers
Pneumonia is an inflammatory process in the lungs that __ ___ ___
produces excess fluid
Pneumonia is triggered by
infectious organisms or by the aspiration of an irritant
rhinorrhea
runny nose
Rhinitis: Decongestants, such as _____, constrict blood vessels and decrease edema.
phenylephrine
the most effective for prevention and treatment of seasonal and perennial rhinitis.
Intranasal glucocorticoid sprays (Flonase)
rhinitis: Complementary therapies may be helpful such as e____, vitamin __, z___
echinacea, vitamin C, and zinc
Facial pressure or pain (worse when head is tilted forward)
Sinusitis
Endoscopic sinus cavity lavage or surgery to relieve the obstruction and promote drainage of secretions may be done as a diagnostic procedure.
Sinusitis
Clients should be encouraged to begin over-the-counter ____ use at the first
manifestation of sinusitis
decongestant
Sinusitis: Sinus ___ and ___ ___ sprays are an effective alternative to antibiotics for relieving nasal congestion
irrigation and saline nasal
Sinusitis: ___ and ____ can occur if pathogens enter the bloodstream from the sinus cavity.
Meningitis and encephalitis
influenza: Adults are contagious from __ __ before manifestations develop and up to 5 days after they begin
1 day
Maintain ____ and ____ precautions for hospitalized clients with pandemic influenza.
airborne and contact
Encourage clients to begin antiviral medications within ___ to ___ hr after the onset
of manifestations
24 to 48
Influenza Vaccination is encouraged for everyone over
6 months of age
Influenza Vaccination: pregnant women, and health care providers
are at higher risk and require vaccination
pneumonia: Obtain specimen before starting
abx
pneumonia finding: ABGs – Hypoxemia (decreased PaO2 less than __ mm Hg)
80
albuterol provides
rapid relief
Cholinergic antagonists (anticholinergic medications), such as ipratropium (Atrovent), block the parasympathetic nervous system, allowing for increased bronchodilation and
decreased pulmonary secretions
Methylxanthines, such as theophylline (Theo-24), require
close monitoring of serum levels due to the narrow therapeutic range.
Watch for ___ and ___ for clients taking albuterol.
tremors and tachycardia
aphthous lesions
canker sores
aphthous lesions (canker sores) can occur with what kind of med
steroid
Encourage the client to take glucocorticosteroids with
food
Hypoxemia that persists despite oxygen therapy is a sign of
Acute Respiratory Distress Syndrome (ARDS)
Acute Respiratory Distress Syndrome (ARDS) signs include ____ pulmonary edema
bilateral
A chest x-ray shows an area of density with a “ground glass” appearance
Acute Respiratory Distress Syndrome (ARDS)
Acute Respiratory Distress Syndrome (ARDS): Blood gas findings demonstrate high levels of carbon dioxide (hypercarbia) even though
pulse oximetry shows decreased saturation (so despite what the POX says, they do in fact have high CO2)
a chronic inflammatory disorder of the airways that results in intermittent and reversible airflow obstruction of the bronchioles.
Asthma
Asthma: The obstruction occurs either by
inflammation or airway hyperresponsiveness.
Manifestations of asthma: excessive ____ production
mucus
early in an asthma attack, the CO2 level will be
low
late in an asthma attack, the CO2 level will be
high
the most accurate tests for diagnosing asthma and its severity.
PFTs (pulmonary function tests)
