nursing practice Flashcards
what is the requirement to use a metered dose inhaler ?
need coordination (press and breathe at the same time) need ensure a tight seal
what is the requirement to use spacer mask?
dont need coordination, just breathe normally
what is the requirement to use nebulizer?
dont need coordination
but not portable
what are the requirement to use dry powder inhaler?
no need coordination
but need forceful suction (not for patient with COPD)
what are the requirement for respimat?
need ensure tight seal
what are the steps for using metered dose inhaler?
- shake the bottle
- prime (spray one or more puffs into the air)
- exhale fully
- put inhaler in mouth and press
- inhale deeply for 2-3 seconds ( to help draw medication into lungs)
- remove mouth piece and hold breath for 10 sec (to allow medication to reach to alveoli)
- exhale slowly with pursed lips (keep distal bronchioles open and allowing increased absorption and diffusion of the drug)
for quick relief medication like SAMA and SABA , what to do between puffs ?
wait about 15-30 seconds between puffs to allow the bronchodilators to open the air passage for maximum effectiveness
for other medications like LAMA and LABA what to do between puffs?
do not need to wait between puffs as it takes about 10-20 min to work
what to do when more than one medication is prescribed?
wait 2 mins between each medication
what to do when patient is on steroid inhaler?
use bronchodilator first then wait 5 mins before using steroid
this is to allow bronchiole dilator to open the air passage for maximum effectiveness
who are metered dose inhaler with spacer recommended for?
children and elderly with coordination difficulties
what to do when new spacer is used?
prime it by firing at least 10 puffs
what are the steps to use MDI with spacer?
- press down inhaler and breathe and hold breath for 5-10 sec then breath out slowly (if cannot hold breath can breathe in and out slowly 3-5 times)
Do not press the inhaler more than 1 times each time
when do you need to clean a spacer?
clean one a month or when required
static electricity builds up in the spacer and makes medication stick inside and not much will go down the lungs
what are the instructions to clean the spacer?
soak the spacer completely in a container of mild warm soapy water
shake out the excess water and allow it to dry
do not scrub or rinse the spacer after removing from soapy water
(detergent is good to reduce static charges)
when do you usually replace spacer?
every year
what is the flow to set for nebulizer?
at least 6-7 liter per min
what are the instruction to give patient using nebulizer ?
instruct the patient to breath normally and take deep inspiration every 4-5 breathes
take about 10 mins
what to do when patient is using nebulizer and is hypercapnic or acidotic ?
use nebulizer driven by compressed air to prevent worsening of hypercapnia
if oxygen therapy is needed for patient using nebulizer ?
can be administered with nasal cannula
what is the recommended suctioning pressure to set for suctioning ?
100-120mmHg
too high pressure will cause excessive trauma without enhancing secretion removal
what are the steps for oral insertion of catheter ?
without applying suction gently insert catheter into mouth
advance 3”-4” along side the mouth until reach the pool of secretion or when patient starts to cough
apply suction for no longer than 10 sec each time
withdraw the catheter with continuous motion
repeat procedure up to three times or until gurgling or bubbling sounds stop
allow 30 sec to 1 min between suctioning to allow reoxygenation and ventilation
what are the steps for nasal insertion ?
raise the tip of patient of nose with non dorminant hand to straighten the passage way and facilitate insertion
without applying suction gently insert in nose
advance to approximate 5”-6” until you reach a pool of secretion or patient starts to cough
what is incentive spirometry used for?
to help expand patient’s lungs by helping them to breathe more deeply and fully
what are the steps and instruction for incentive spirometry ?
- ask patient to sit upright
- close lips tightly (weak seal will affect readings )
- inhale slowly as deeply as possible (suck like sucking straw)
- ask patient to retain the entire volume of air for 5 seconds
what will happen when incentive spirometry is used ?
- piston rise inside the large column (as high as possible)
- indicator should move upwards (stay between the two arrows)
if not its too fast or slow
when should patient do incentive spirometry ?
10 breaths every 1-2 hours while awake
10 breathes 5 times a day
15 breathes every 4 hours
how to diagnose patient with copd ?
- older than 40, current or ex smoker
- cough regularly
- cough up phlegm regularly
- simple chores cause SOB
- wheeze when exerting yourself
- have frequent colds that persist longer than other people,
what are some physical assessment of patient with copd ?
- heart and respiration rate increased (compensatory mechanism)
- o2 saturation 89-92 (impaired gas exchange)
- anxious pale, hands and feet cold to touch, capillary refill time more than 3 sec (lack of oxygenation)
- decreased breath sounds and presence of rhonchi (gurgling sounds)
- fever
what is diagnostic spirometry used for?
help diagnose and measure breathing difficulties like SOB, to measure airflow obstruction
severity of copd
FEv1/ FVC ratio less than70%
- mild copd FEV1 at least 80%
- moderate : FEV1 50-80%
- severe : FEV1 30-50%
- very severe : FEV1 less than 30% or less than 50% with severe chronic symptoms
what are the non pharmacological treatment of COPD?
- long term O2 therapy (saturation lower than 88%)
- surgical treatment
- lung volume reduction surgery
- bullectomy (for younger people with potential of good life)
- bronchoscopic lung volume reduction
- lung transplant - annual vaccination
how to check the signs of servere exacerbation of patient with COPD ?
- marked dyspnea and tachycardia (more than 30 respirations per min)
- accessory muscles
- cyanosis
- confusion
- sao2 less than 90%
what to do when there is persistant hypercapnic ventilary failure for COPD ?
administer non-invasive positive pressure ventilation
what is non-invasive ventilation?
delivers intermittent positive airway pressure which gives ventilatory support using face mask
less labored breathing
positive pressure encourages a steady flow of oxygen
allows the lungs to more efficiently transport O2 to the rest of the body and remove excess carbondioxide
when to use non -invasive ventilation?
PH less than 7.35 and or Paco2 more than 45
severe dyspnea
what are 2 levels of air pressure for non- invasive ventilation?
- inspiratory positive airway pressure (higher level of pressure assist ventilation by lowering Co2 level)
- expiratory positive airway pressure (lower level maintains airway patency during expiration which increases oxygen level)
what are the lab test to diagnose pneumonia?
- blood
- wbc count increase
- blood culture test are positive for causative organism
- ABG shows hypoxemia - sputum culture
- have infecting organism - xray
- cloudy
