Oxygen/Trach/Respiratory Assessment Flashcards

1
Q

PaO2 range

A

80-100 mmHg

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2
Q

pH range

A

7.35-7.45

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3
Q

PaCO2 range

A

35-45 mmHg

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4
Q

HCO3 range

A

22-26 mEq/L

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5
Q

Respiratory acidosis

A

results when respiratory function is impaired and causes retention of CO2

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6
Q

Conditions that result in Respiratory acidosis

A

respiratory depression due to anesthetics
electrolyte imbalance
inadequate chest expansion
airway obstruction
reduced alveolar capillary diffusion

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7
Q

treatment for respiratory acidosis

A

focus on improving ventilation and oxygenation and maintaining a patent airway

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8
Q

metabolic acidosis

A

state of excess acid or reduced base bicarbonate in the body

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9
Q

conditions that result in metabolic acidosis

A

excessive oxidation of fatty acids
hyper metabolism
excessive ingestion of acids
kidney failure
pancreatitis, liver failure, or dehydration
diarrhea

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10
Q

treatment for metabolic acidosis

A

focused on hydration and drugs or treatments to control the problem causing the acidosis: IV sodium bicarbonate

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11
Q

Respiratory alkalosis

A

caused by an excessive loss of CO2 through hyperventilation

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12
Q

conditions that result in respiratory alkalosis

A

fear, anxiety, mechanical ventilation, salicylate toxicity, high altitudes, shock, early stage acute pulmonary problems

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13
Q

treatment for respiratory alkalosis

A

correct the underlying cause; if due to hyperventilation/anxiety and panic attack- instruct breathing exercises.

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14
Q

metabolic alkalosis

A

caused by either an increase of bases (base excess) or a decrease of acids (acid deficit)

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15
Q

conditions that result in metabolic alkalosis

A

increase of base components (oral ingestion of antacids, blood transfusion, sodium bicarbonate, TPN)

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16
Q

treatment of metabolic alkalosis

A

correct underlying cause

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17
Q

non invasive positive airway pressure

A

uses positive pressure to keep alveoli open and improve gas exchange
uses a tightly fitting mask around nose or nose and mouth
can be with or without oxygen

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18
Q

indications for non invasive positive airway pressure

A

sleep apnea
hypercarbia (increase of CO2 in blood stream)
acute COPD
manage acute dyspnea
pulmonary edema

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19
Q

CPAP

A

continuous positive airway pressure
one set pressure or volume is delivered with each cycle of inhalation/exhalation

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20
Q

BiPAP

A

bi-level positive airway pressure
different pressure is set for inhalation and exhalation

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21
Q

Nursing consideration for non invasive positive airway pressure

A

ensure mask has an adequate seal, monitor for skin breakdown, monitor for vomiting/aspiration

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22
Q

transtracheal oxygen

A

oxygen delivered through a small flexible catheter that is places in the trachea through a small incision
used for patients with long term O2 needs
avoids irritation that nasal prongs cause
typically require less O2 when delivered in this method

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23
Q

tracheotomy

A

surgical incision into trachea for purpose of establishing an airway

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24
Q

tracheostomy

A

stoma that results from tracheotomy
may be temporary or permanent

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25
indications for a tracheostomy
stenosis of airway obstruction of airway laryngeal or neck trauma neck cancer extended need for mechanical ventilation
26
complications of tracheostomy
dislodgment obstruction (mucus plugging) SQ emphysema skin breakdown (moisture and pressure) infection (lung infection) bleeding (from mucosal irritation)
27
features of tracheostomy tubes
single lumen and dual lumen cuffed and un-cuffed reusable and disposable fenestrated and un-fenestrated
28
nursing care with trachs
stoma care humification of airway suctioning ensure placement and patency monitor cuff pressures maintain extra trach and obturator at bedside frequent oral care aspiration precaution
29
complications of trach suctioning
hypoxia tissue trauma infection vagal stimulation and bronchospasm cardiac dysrhythmias
30
nutritional concerns with trachs
aspiration- inflated cuff can interfere with passage of food through the esophagus and weakened muscles elevate HOB 30 min after eating may need enteral feeding tube
31
weaning from trach tubes
trials of cuff deflation gradual decrease in size of trach tube may change from cuffed to un-cuffed may change to fenestrated tube cap trach with speaking valve or trach button
32
psychosocial considerations with trachs
communication support for patients and families become involved in self care activities
33
room air is what percent O2
21%
34
hypoxemia
low 02 levels in blood
35
hypoxia
low O2 levels in tissue
36
O2 therapy
the purpose of oxygen therapy is to use the lowest fraction of inspired oxygen (Fio2) to have acceptable blood oxygen level without causing harmful side effects measured in FiO2 or L/min
37
Means to monitor oxygen
ABGs SpO2 Capnography
38
ABG
most accurate, invasive, obtained by arterial blood draw
39
SpO2
non invasive, easy to obtain, use pulse oximetry to measure
40
capnography
non invasive, measures exhaled CO2
41
hazards of oxygen therapy
combustion, oxygen induced hypoventilation, oxygen toxicity, absorption atelectasis, dry mucous membranes, infection
42
oxygen delivery systems
low flow high flow non invasive positive pressure ventilation invasive ventilation type of ventilation is determined by O2 need, patient comfort, expense and mobility
43
low flow oxygen types
nasal cannula, simple face mask, partial non rebreather, non rebreather
44
high flow oxygen types
venturi mask, aerosol mask and face tent, tracheostomy mask, t tube/t piece
45
nursing considerations for O2 therapy
ensure humidification asses for skin breakdown assess mucous membranes for dryness and bleeding asses for patency of tubing education patients regarding oxygen safety
46
Health promotion and maintenance of respiratory assesment
asses smoking habits promote smoking cessation determine exposure to other inhalation irritants protect the respiratory system
47
changes in respiratory system related to aging
alveoli (decreased SA, decrease diffusion capacity, decrease elastic recoil) lungs (increased residual volume, vital capacity decreases, elasticity decreases) pharynx and larynx (muscles atrophy, vocal cords become slack, airway lose cartilage) pulmonary vasculature (resistance to blood flow through pulmonary vascular system increases) exercise intolerance muscle strength (decrease in strength of diaphragm and intercostals) increase susceptibility to infection (decrease cilia effectiveness) Chest wall (AP diameter increases, thorax is shorter, progressive kypho-scoliosis)
48
psychosocial assessment
shortness of air often induces anxiety and anxiety can exacerbate shortness of air
49
RBC count
data about the transport of oxygen
50
Hemoglobin
transports oxygen to the tissues deficiency could cause hypoxemia
51
WBC count
indication of infection
52
ABG
data on oxygenation as well as acid base balance
53
sputum
culture and sensitivity cytology
54
chest x-rays
very common diagnostic tool typically one of the first tools
55
CT chest
with contrast or without
56
pulse oximetry
normal 95-100 below 91 requires immediate assessment and treatment below 85 body tissues have a difficult time becoming oxygenated
57
Pulmonary function test
PFTs: forced vital capacity, forced expiratory volume, peak expiratory flow
58
forced vital capacity
volume of air exhaled from the full inhalation to full exhalation
59
forced expiratory volume
volume of air blown out as hard and fast as possible during the first second of the most forceful exhalation after the greatest inhalation
60
peak expiratory flow
fastest airflow rate reached at any time during exhalation
61
Laryngoscopy
scope inserted into larynx to asses the function of the vocal cords
62
mediastinoscopy
insertion of a flexible tube through the chest wall just above the sternum into the area between the lungs
63
bronchoscopy
insertion of a tube in the airways usually as far as the secondary bronchi
64
thoracentesis
needle aspiration of pleural fluid or air from the pleural space for diagnostic or management purposes
65
lung biopsy
performed to obtain tissue for histologic analysis, culture, cytologic examination
66
Which condition will increase the body’s need for more oxygen? (select all that apply) – A. Hypothyroid – B. Infection in blood – C. Diabetes Mellitus – D. Temperature of 101 F – E. Hbg of 8.7 g/dL
BDE
67
Which parameters does the nurse monitor to ensure that a patient’s response to oxygen therapy is adequate? (select all that apply) – A. Level of consciousness – B. Respiratory pattern – C. Oxygen flow rate – D. Pulse oximetry – E. Adequate humidification of O2
ABD
68
When a patient is requiring oxygen therapy what is most important for the nurse to know? – A. Patients require 1-10 L/min by nasal cannula for oxygen to be effective – B. Oxygen induced hypoventilation is the priority when the pCO2 levels are unknown – C. Why the patient is receiving oxygen, expected outcomes and complications – D. The highest FiO2 possible for the particular device being used
C
69
What are considered hazards of oxygen therapy? (select all that apply) – A. Increased combustion – B. Oxygen narcosis – C. Oxygen toxicity – D. Absorption atelectasis – E. Oxygen induced hypoventilation
ACDE
70
A patient is receiving preoperative teaching for a partial laryngectomy and will have a tracheostomy. How does the nurse define a tracheostomy to the patient? – A. Opening in the trachea that enables breathing – B. Temporary procedure that will be reversed later – C. Technique using positive pressure to improve gas exchange – D. Procedure that holds the airway open
A
71
A patient returns from the operating room after a tracheostomy placement. While assessing the patient which observations by the nurse warrant immediate notification to the provider? – A. Patient is alert but unable to speak – B. Small amount of bleeding present at incision – C. Skin is puffy at the neck area with a crackling sensation – D. Respirations are audible and noisy with increased respiratory rate
C
72
To prevent accidental decannulation of a tracheostomy tube, what does the nurse do? – A. Obtain an order for continuous upper extremity restraints – B. Secure the tube in place using ties or fabric fasteners – C. Allow some flexibility in motion of the tube while coughing – D. Instruct the patient to hold the tube with a tissue while coughing
B
73
A patient has a recent tracheostomy. What necessary equipment does the nurse ensure is kept at the bedside? (select all that apply) – A. Ambu bag – B. Pair of wire cutters – C. Oxygen tubing – D. Suction equipment – E. Tracheostomy tube with obturator
ACDE
74
A patient currently has an artificial airway in place. Oxygen is administered directly from the wall source. Why would warmed and humidified oxygen be a more appropriate choice for this patient? – A. Prevent drying damage of mucous membranes – B. Promotes thick secretions which are easier to suction – C. Is more comfortable for the patient – D. Is less likely to cause oxygen toxicity
A
75
A nurse is educating a client who will be going home with a tracheostomy. When discussing suctioning frequency, what should be included in the education? – A. The tracheostomy should be suctioned every 4 hours – B. The tracheostomy should be suctioned when secretions can not be cleared and physical symptoms are present – C. The tracheostomy should only be suctioned in an emergency – D. The tracheostomy should only be suctioned at times when the home health nurse is available.
B
76
A patient with a tracheostomy is unable to speak. He is not in acute distress, but is gesturing and trying to communicate with the nurse. Which nursing intervention is the best approach to the situation? – A. Rely on the family to interpret for the patient – B. Ask questions that can be answered with a yes or no – C. Obtain an immediate speech consult – D. Encourage the patient to rest rather than struggle with communication
B
77
steps for trach suction
1. Assess the need for suctioning (routine unnecessary suctioning causes mucosal damage, bleeding, and bronchospasm). 2. Wash hands. Don protective eyewear. Maintain Standard Precautions. 3. Explain to the patient that sensations such as shortness of breath and coughing are to be expected but that any discomfort will be very brief. 4. Check the suction source. 5. Set up a sterile field. 6. Preoxygenate (hyperventilate) the patient with 100% oxygen for 3 ventilations prior to suction. 7. Quickly insert the suction catheter until resistance is met. Do not apply suction during insertion. 8. Withdraw the catheter 1 to 2 m, and begin to apply suction. Apply suction and use a twirling motion of the catheter during withdrawal. Never suction longer than 10 to 15 seconds. 9. Hyperoxygenate for 1 to 5 minutes or until the patient's baseline heart rate and oxygen saturation are within normal limits.
78
Which of the following is true about changes in the respiratory system associated with aging? (Select all that apply) A. Exercise tolerance decreases B. Respiratory muscle strength increases C. Cough reflex increases D. Airways lose cartilage and elasticity E. Response to hypoxia and hypoxemia decreases F. Vocal cords become stronger
ADE
79
The nurse is inspecting a patient’s chest and observes an increase in anteroposterior diameter of the chest. When is this an expected finding? A. In older adults B. With a pulmonary mass C. Upon deep inhalation D. With chest trauma
A
80
A patient reports smoking a pack of cigarettes a day for 9 years. He then quit for 2 years, and then smoked 2 packs a day for the last 30 years. What are the pack-years for this patient? A. 19.5 years B. 39 years C. 41 years D. 69 years
D
81
Which assessment finding is an objective sign of chronic oxygen deprivation? A. Continuous cough productive of clear sputum B. Clubbing of fingernails and a barrel- shaped chest C. Audible inspiratory and expiratory wheeze D. Chest pain that increases with deep inspiration
B
82
A patient reports fatigue and shortness of breath when getting up to walk to the bathroom; however, the pulse oximetry reading is 99%. The nurse identifies a diagnosis of activity intolerance. Which laboratory value is consistent with the patient’s subjective symptoms? A. Hemoglobin of 9 g/dL B. BUN of 15 mg/dL C. White blood cell count (WBC) of 8000/mm3 D. Glucose 160 mg/dL
A
83
What is a pulse oximeter used to measure? A. Oxygen perfusion in the extremities B. Pulse and perfusion in the extremities C. Hemoglobin saturation D. Generalized tissue perfusion
C
84
The nurse is caring for several patients who had diagnostic testing for respiratory disorders. Which diagnostic test has the highest risk for the post procedure complication of pneumothorax? A. Bronchoscopy B. Laryngoscopy C. Computed tomography of lungs D. Lung biopsy
D
85
After a bronchoscopy procedure, the patient coughs up bright red blood. What is the best nursing action at this time? A. Assess vital signs and respiratory status and notify the provider of the findings B. Monitor the patient for 24 hours to see if blood continues in the sputum C. Send the sputum to lab for cytology for possible lung cancer D. Reassure the patient this is a normal response after a bronchoscopy
A
86
What is the best position for a patient to assume for a thoracentesis? A. Side-lying, affected side exposed, head slightly raised B. Sitting up, leaning over a bedside table C. Lying flat with arm on affected side across the chest D. Prone position with arms above the head
B
87
A patient is recovering after laryngoscopy and bronchoscopy. Which of the following is important to assess in the immediate post-procedure phase of recovery? (Select all that apply) A. Vital signs B. Level of consciousness C. Breath sounds D. Chest X-ray E. Presence of bleeding F. Ability to talk G. Gag reflex
ABCDEFG
88
APAP
automatic positive airway pressure machine adjusts pressure based on patient needs