Oxygenation & Gas Exchange Flashcards
A 4-m.o. infant has been admitted for moderate to severe resp. distress secondary to bronchiolitis. The infant has been suctioned, placed on oxygen via nasal cannula at 3 liters per minute, and is receiving IV fluid at 20 mL per hour via pump. After an hour, the infant’s O2 saturation has increased from 86% to 92%. What actions should the nurse take based on this assessment?
A. Decrease IV fluid rate and decrease the oxygen to 2 liters per hour
B. Notify the health care provider and anticipate weaning the infant from O2
C. Document assessment findings and continue to monitor infant
D. Increase the oxygen to 4 L per hour and suction infant as needed.
C. 92% is the minimum acceptable level. The infant should be monitored to make sure the level can be maintained. No changes are necessary at this time.
What would be the physiologic bases for a placenta previa?
A. a uterus with a midseptum
B. a loose placental implantation
C. low placental implantation
D. a placenta with multiple lobes.
C.
cause unknown but is usually implanted low within uterus rather than higher up.
Which nursing diagnosis would BEST apply to a child with allergic rhinitis?
A. Pain related to sinus edema and headache
B. Risk for infection related to blocked eustachian tubes
C. Irritation from multiple nose bleeds
D. Low self-esteem due to inherited proneness to illness
A.
Many children with allergic rhinitis develop sinus headaches from edema of the upper airway.
Younger children= maxillary and ethmoid sinuses are involved.
Children 10 years and older = frontal sinuses involved.
Allergic rhinitis nor sinusitis are inherited.
Fetal circulation differs from the circulatory path of the newborn infant. In utero, the fetus has a hold connecting the right and left atria of the heart. This allows oxygenated blood to quickly pass to the major organs of the body. What is this hole called?
Foramen ovale
In which position should the client be placed for a thoracentesis?
A. prone
B. supine
C. lateral recumbent
D. sitting on the edge of the bed
D: Place client upright or sitting on the edge of bed with feet supported and arms and head on a padded over-the-bed-table.
Other positions include straddling a chair with arms and head resting on the back of the chair, or lying on the unaffected side with the head of the bed elevated 30-45 degrees (if the client is unable to assume a sitting a position).
A nurse in the operating room has a client who just underwent gastric bypass surgery and weighs 243 kilograms (534.6 pounds). Upon extubation, the client’s oxygen saturation drops to 84% and the client has difficulty catching her breath. What could be causing these problems?
A. Anesthesia, which is causing the client to be more sleepy than usual
B. Progressive loss of muscle function
C. Pain is causing the pt. to have difficulty breathing
D. Obesity, which can limit chest wall expansion and compromise breathing
D. Extreme obesity can limit chest wall expansion (and thus compromise breathing).
-progressive loss of muscle function is related to muscular dystrophy
-pain and anesthesia would not cause decreased oxygen saturation and breathing difficulty???????
The nurse if providing education to a 65-y.o. female client with pneumococcal pneumonia being discharged from the health clinic on oral antibiotics. The client is a nonsmoker, takes levothyroxine for Hashimoto disease, and is otherwise in good health.
For each client statement, click to specify if the findings indicates understanding or need for reinforcement of teaching.
A. I should get the PPSV23 this year because I got the PCV13 last year.
B. I will drink 1 liter of fluid each day.
C. I will perform deep breathing exercises once a day.
A: understanding
B. requires reinforcement (drink 2-3 liters of fluid per day)
C. requires reinforcement (not enough to inflate alveoli and prevent atelectasis)
A nurse is caring for a 9-y.o. child experiencing a severe asthma exacerbation with a dry hacking cough and wheezing. The child’s pulse oximeter reading is 88% (o.88). What is the nurse’s PRIORITY in caring for the child?
A. Administer oxygen as prescribed
B. Suction the nasopharynx
C. Auscultate the lungs
D. Educate the family on prevention methods.
A.
Think airway, breathing, and circulation. “ABC” = top priorities
A client reports recent onset of chest pain that occurs sporadically with exertion. The client also has fatigue and mild ankle swelling, which is most pronounced at the end of the day. The nurse suspects a cardiovascular disorder. What other client report increases the likelihood of a cardiovascular disorder?
A. insomnia
B. shortness of breath
C. Lower substernal pain
D. irritability
B.
Classic signs of cardiovascular dysfunction - shortness of breath, chest pain, palpitations, fainting, fatigue, and peripheral edema.
- Irritability can occur if cardiovascular dysfunction leads to cerebral oxygen deprivation (usually represents respiratory or neurologic dysfunction)
- lower substernal pain = some GI disorders
A critical care nurse is caring for a patient with an endotracheal tube who is on a ventilator. The nurse knows that meticulous management of this patient’s needs is necessary. What is the rationale for this?
A. Maintaining a patent airway
B. Preventing the need for suctioning
C. Decreasing the patient’s time on the ventilator
D. Increasing the patient’s lung compliance
A: Achieved through meticulous airway management.
A school-age child with asthma has had an inhaled corticosteroid added to their treatment. Which instruction should the nurse ensure is included in the teaching session?
A. Use this medication with a metered-dose inhaler
B. This medication is to be used no more than twice in one week.
C. Take when feeling short of breath
A. Should be used on a daily basis, as they are “controller” or “maintenance” medications. Should be used via a meter-dosed inhaler, even if no symptoms are present.
Short-acting beta-agonists should not be used more than twice a week. (SABAs)
True or False: Mucolytics are often used for patients with cystic fibrosis, COPD, or tuberculosis.
True. Mucolytics increase/liquefy respiratory secretions to aid the clearing of the airways in high-risk respiratory patients who are coughing up thick, tenacious secretions.
- Best used for chronic obstructive pulmonary disease (COPD), cystic fibrosis, pneumonia, or tuberculosis.
The nurse is caring for a client status post adenoidectomy. The nurse finds the client in severe respiratory distress when entering the room. What does the nurse suspect?
A. Edema of the upper airway
B. infection
C. plugged tracheostomy tube
D. postoperative bleeding
A
When is a ventricular septal defect typically diagnosed?
4-8 weeks (not always evident at birth)
Depending on the size of the defect, ventricular septal defect (VSD) symptoms can include:
tachypnea; tiring easily with feeding; presence of a left sternal murmur; failure to thrive; pulmonary circulatory overload ; rales or wheezing; grunting; (congestion, and frequent respiratory infections).; mild subcostal retractions
What should be checked first when suspected ventricular septal defect?
-electrocardiogram
-electrolyte levels
What is prescribed after ventricular septal defect is suspected (IV)?
Digoxin: assess vital signs every 15 minutes to evaluate response, update care plans, and implement additional interventions.
Why would a nurse need to monitor capillary refill time?
Refill time less than 3 seconds indicates adequacy of perfusion. Which factor is most likely to precipitate an asthmatic attack in a child with extrinsic, or atopic, asthma?
-Pallor and prolonged refill time suggests heart failure or reduced blood pressure with reactive vasoconstriction.
Best oxygen supply mechanism for an infant?
Simple mask (only if under normal %)
Most atrial septal defects are asymptomatic. A very large defect can lead to what?
Heart failure; poor feeding; inability to keep up with peers; and difficulty growing.
What is a patent ductus arteriosus?
Failure of the ductus arteriosus to close with the first weeks of life.
How might a ductus arteriosus be identified?
May be identified at birth with a systolic murmur located at the second intercostal space, left clavicular area.
If large = rales, difficulty feeding, or failure to thrive.
Atrioventricular septal defect is comprised of several defects. What may one see with this condition?
increased pulmonary blood flow = symptoms of significant heart failure (can present early). May also have rales and loud murmur.
Digoxin dosage rules:
Initial dosage = 20 mcg/kg (approximately 50% of total dose for an infant initially)
EX: Infant weight = 4.54 kg
(4.54 kg x 20 mcg/kg = 90.8 mcg)
90.8 mcg x 0.50 = 45.4 mcg
Differences between
-ventricular septal defect;
-atrial septal defects;
-patent ductus arteriosus;
-atrioventricular septal defect
-Ventricular septal defect: hole in the wall that separates the heart’s two lower chambers (ventricles) *congenital
-Atrial septal defect: hole in the wall separating heart’s two upper chambers (atria) *congenital
-patent ductus arteriosus: ductus arteriosus hole (a hole in between the pulmonary artery and the aorta) does not close within first week of life.
-atrioventricular septal defect: all four heart chambers are not distinctly formed and separated
If ventricular septal defect is large enough, it can present with what?
Heart failure.
What must happen to the workload when congestive heart failure is present?
Workload MUST be decreased.
How is workload on the heart decreased in the case of heart failure?
-Removing excess sodium & fluids
-slowing heart rate
-decreasing demands on the heart
Normal urine output
2 ml/kg/hour
Edema of the extremities are seen in heart failure, but also which organ impairment?
Renal impairment.
The student nurse reports that the breath sounds of an infant are loud and harsh. How should the nurse best respond?
A. This is an indication of respiratory distress in infants
B. Administer oxygen
C. Request physician approval for a short course of antibiotics
D. Consider the report normal due to infants having a thinner chest wall.
D: breath sounds are typically louder and more bronchial in infants.
The client with cardiac failure is taught to report which symptom to the health care provider or clinic immediately?
A. Increased appetite
B. Insomnia
C. persistent cough
C. = may indicate onset of left-sided heart failure.
-loss of appetite. - weight gain -interrupted sleep - unusual shortness of breath -increased swelling
ALL need immediate report
What two procedures can e done to improve the overall quality of life of a client with COPD?
-lung transplant (also for treating end-stage emphysema)
-bullectomy (for treating pt. with bullous emphysema)
Which organism most commonly causes community-acquired pneumonia?
Streptococcus pneumoniae
Which bacterial organism is gram-positive, resides in the upper respiratory tract, colonizes the upper resp. tract and can cause disseminated invasive infections, pneumonia, and other lower respiratory tract infections, as well as upper respiratory tract infections such as otitis media and rhinosinusitis?
Streptococcus pneumoniae
The nurse is caring for a 5-y.o. client and notes respiratory rate of 45 breaths per minute, blood pressure 100/70 mm Hg, heart rate 115, temperature 101 F (38.3 C) and oxygen saturation 86%. Which diagnostic test is priority for the nurse to complete?
A. Pulmonary function test
B. Arterial blood gas (ABG)
C. CBC blood test
D. EEG
B: most useful diagnostic test in respiratory distress = allows for evaluation and proper treatment.
A CBC blood test is used to test for disorders including:
anemia, infection, leukemia
What condition can be found in a child with sickle cell anemia and can be caused by infection?
Acute chest syndrome.
A child with sickle cell anemia experiencing acute chest syndrome should have what interventions?
IV fluids admin to help with the sickling process and prevent hypovolemia (when body loses too much fluid such as water or blood)
-pain medication as needed (monitor vitals after admin)
An x-ray would show what if one has splenic sequestration (when sickled red blood cells get trapped in the spleen)
Enlargement of the spleen.
Dactylitis is:
swelling of the hands and fingers
When is tissue plasminogen activator (tPA) administered?
If pt presents with signs of a stroke.
