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1210 > resp exam 2 > Flashcards

resp exam 2 Flashcards

1
Q

What is the normal pH range of the body?

A

7.35-7.45

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2
Q

What is considered the perfect pH?

A

7.4

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3
Q

What is a pH <7.2 related to?

A

Death

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4
Q

Is CO2 acidic or basic?

A

Acidic

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5
Q

What is the normal range of CO2?

A

35-45

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6
Q

If CO2 is increased, will acidosis or alkalosis occur?

A

Acidosis

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7
Q

Is HCO3 acidic or basic?

A

Basic

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8
Q

What is the normal range of HCO3?

A

22-26

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9
Q

If HCO3 is increased, will acidosis or alkalosis occur?

A

Alkalosis

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10
Q

What is the normal range for oxygen?

A

80-100

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11
Q

What are the values for respiratory acidosis?

A

pH <7.35

CO2 >45

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12
Q
  • Hypoxia due to hypoventilation (retaining more CO2 in the blood)
  • Rapid, shallow respirations
  • Decreased BP
  • Skin/mucosa pale to cyanotic
  • Headache
  • Hyperkalemia
  • Dysrhythmias (due to hyperkalemia)
  • Drowsiness, dizziness, disorientation
  • Muscle weakness, hyperreflexia
A

What are s/sx of respiratory acidosis?

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13
Q
  • Respiratory depression (due to anesthesia or overdose)
  • Airway obstruction
  • Decreased alveolar capillary diffusion (due to pneumonia, COPD, emphysema, pulmonary embolism)
  • Respiratory failure/acute respiratory distress
A

What are some causes of respiratory acidosis?

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14
Q
  • Fix respirations: assess for hypoxemia, deep breathing exercises, coughing, semi-Fowler’s
  • Bronchodilators: albuterol, budesonide, albuteral & ipratropium
  • Respiratory stimulants
  • Drug antagonists (narcan if due to overdose)
  • Oxygen: to overcompensate for CO2
  • Ventilator support
A

What are some nursing interventions for respiratory acidosis?

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15
Q

What are the values for respiratory alkalosis?

A

pH >7.45

CO2 <35

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16
Q
  • Hyperventilation
  • Hypoxemia (due to pneumonia or pulmonary embolism)
  • Pregnancy (normal finding, due to breathing out more than breathing in/pressure in diaphragm)
  • Ventilatory settings too high or too fast
  • High altitudes
  • Liver failure
  • Septicemia (fever)
  • Stroke
  • Overdose of salicylates or progesterone
A

What are some causes of respiratory alkalosis?

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17
Q
  • Seizures
  • Lethargy and confusion
  • Deep, rapid breathing
  • Hyperventilation
  • Tachycardia
  • Hypotension (or normal BP)
  • Hypokalemia
  • Numbness & tingling of extremities
  • Light headedness
  • Nausea/vomiting
A

What are s/sx of respiratory alkalosis?

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18
Q
  • Treat underlying cause
  • Encourage slow, deep breaths (decrease tidal volume/resp rate)
  • Pain control (to decrease hyperventilation)
  • Breathe into paper bag (so they can keep more CO2)
  • Antidepressants
  • Correct CO2 slowly
A

What are some nursing interventions for respiratory alkalosis?

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19
Q

What are the values for metabolic acidosis?

A

pH <735

HCO3 <22

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20
Q
  • Diabetic ketoacidosis
  • Lactic acidosis
  • Starvation
  • Diarrhea
  • Renal tubular acidosis
  • Renal failure
  • GI fistulas
  • Shock
  • Ileostomy
A

What are some causes of metabolic acidosis?

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21
Q
  • Headache
  • Decreased BP
  • Hyperkalemia
  • Muscle twitching
  • Warm, flushed skin (vasodilation)
  • Nausea/vomiting/diarrhea
  • Changes in LOC (confusion, increased drowsiness)
  • Kussmaul respirations
A

What are some s/sx of metabolic acidosis?

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22
Q
  • Raise plasma pH >7.20
  • Treat underlying cause
  • Sodium bicarb (tums)
  • Monitor patient
A

What are some nursing interventions for metabolic acidosis?

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23
Q

What are the values for metabolic alkalosis?

A

ph >7.45

HCO3 >26

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24
Q
  • Vomiting
  • NG suctioning
  • Diuretic therapy
  • Hypokalemia
  • Excess bicarb intake
  • GI aspiration (removing acid from stomach)
A

What are some causes of metabolic alkalosis?

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25
Q
  • Restlessness followed by lethargy
  • Dysrhythmias (tachycardia)
  • Compensatory hypoventilation
  • Confusion (decreased LOC, dizziness, irritability)
  • Nausea, vomiting, diarrhea
  • Tremors, muscle cramps, tingling of fingers and toes
  • Hypokalemia
A

What are s/sx of metabolic alkalosis?

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26
Q
  • Treat underlying cause
  • Stop K+ wasting diuretics
  • Spironolactone
  • Acetazolamide (inhibits bicarb, pulls it to the kidneys for excretion)
  • IV fluids (isotonic solution)
  • Sodium chloride (increases excretion by kidneys)
  • Replace K+
  • Monitor RR
  • Monitor HR
  • Seizure precautions
A

What are some nursing interventions for metabolic alkalosis?

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27
Q

What are some reasons why someone would get a tracheostomy?

A
  • Establish a patent airway
  • Bypass an upper airway obstruction
  • Facilitate removal of secretions
  • Permit long term mechanical ventilation
  • Facilitate weaning from mechanical vent

Can be permanent but not always, they can be healed it just depends on what they need it for

28
Q

How often should you assess a patient with a tracheostomy?

A

Listen to lung sounds q 2 hours, preferably every time you go into the room - ideally they would have a continuous pulse ox

29
Q

What are specific precautions for tracheostomy care?

A
  • Requires a sterile field and use of solutions from non-sterile containers
  • Requires oxygen and suction
  • Use only sterile manufacture precut dressing, never use cotton filled gauze sponge (pt may aspirate cotton or gauze fibers)

Established trachs may be delegated to unlicensed personnel, but RN’s must perform care and assess new fresh trachs

30
Q

What assessments should be performed on a patient with a tracheostomy?

A
  • Assess respiratory status prior to care: rate, depth, rhythm, breath sounds, color, pulse ox
  • Assess trach site for indications of infection (drainage, redness, or swelling)
  • Assess when patient last ate, schedule care at least 3 hours after meal to decrease risk of vomiting or aspirating stomach contents
31
Q

What is a fenestrator?

A

A hole in the trach that can be covered in order to allow the patient to talk

32
Q

What is an outer cannula?

A

The actual attachment and tube portion of the trach, secured by ties

33
Q

What is an inner cannula?

A

Clear plastic tube, removable and should be cleaned

34
Q

What is an obturator?

A

Used to insert the trach, has a base at the end to make sure the airway is not perforated

35
Q

What should be documented after trach care?

A
  • Date and time performed
  • Color, amount and consistency of secretions
  • Condition of stoma and skin around stoma site, any s/sx of infection (drainage, redness, swelling)
  • Respiratory status before and after
  • Patient’s tolerance of procedure
  • Any problems that arose and interventions provided for those problems
36
Q

How big should the suction catheter be?

A

No more than 1/2 size of internal diameter of airway tube

37
Q

What suction setting should you use?

A

Adult: 100-150 mmHg
Child: 100-120 mmHG
Infant: 50-95 mmHg

38
Q

What position should the bed be in during suctioning?

A

Semi fowler’s

39
Q

What should be documented after trach suction?

A

Same as trach care, except instead of assessing stoma assess suction technique (“applied per policy) and catheter size used

40
Q

What is epistaxis?

A

Nosebleed

41
Q

What are the conceptual concerns attached to epistaxis?

A
  • Clotting (due to bleeding)

- Gas exchange (due to packing or nasal tampons)

42
Q

What is the etiology of epistaxis?

A
  • Caused by dry cracked mucous membranes
  • Trauma, forceful nose blowing, nose picking, and tumors

Can also be caused by cocaine or anything that reduces clotting factors

43
Q
  • Sit upright leaning forward
  • Educate not to blow nose for 48 hours, avoid nose picking or bending over
  • Monitor vitals and bleeding
  • Pack with petroleum or iodoform gauze, apply nasal tampons
  • Apply pressure and ice packs
  • Monitor Hgb and hct
  • Phenylephrine: clears out pressure in nasal passages
  • Silver nitrate: cauterizes the nosebleed
  • Antibiotic ointment applied to packing to reduce risk of infection, oral antibiotics may be ordered
  • Nasal saline: moisturizes nose
A

What are therapeutic interventions taken for epistaxis?

44
Q

When will epistaxis be treated in the hospital setting?

A
  • If bleeding continues non-stop
  • Posterior epistaxis
  • Nasal packing will be used
  • Local anesthetics will be applied
45
Q

What is sinusitis?

A

Inflammation of sinuses

46
Q

What is the etiology of sinusitis?

A
  • Can be result of bacteria/virus/fungus
  • Can come from allergies
  • Irritated by NG tube
47
Q
  • Warm moist packs: decreases inflammation of sinus membranes, vasodilation moves things along
  • Corticosteroids (flonase) to decrease inflammation
  • Adrenergic nasal spray (afrin) for inflammation: educate to use for up to 3 days
  • 8 to 10 glasses of water humidifier and nasal irrigation: clears out nasal discharge due to bacteria/virus/fungus
  • Semi-fowler’s position: relieves pressure and pain
  • Analgesics (acetaminophen/ibuprofen) to relieve pain
  • Antibiotics if due to bacterial infection (get culture)
A

What are therapeutic interventions for sinusitis?

48
Q
  • Slow onset
  • None/low grade fever
  • Headache rarely
  • Myalgia (body ache) less common
  • Cough
  • No chest pain
  • Slight fatigue
  • Runny nose and sore throat commonly
  • Complications are rare
  • Treated with rest and fluids
A

S/sx of cold:

49
Q
  • Sudden onset
  • Fever and headache commonly
  • Severe myalgia commonly present
  • Dry cough present
  • Chest pain and prolonged fatigue common
  • Runny nose and sore throat less common
  • Can turn into pneumonia
  • Treated with rest, fluids, and antivirals
A

S/sx of influenza:

50
Q
  • Usually slow onset
  • Fever is common
  • Headache and myalgia is less common
  • Dry or productive cough present
  • Chest pain and fatigue common
  • Runny nose and sore throat less common
  • Can turn into pneumonia
  • Treated by antibiotics
A

S/sx of bacterial infection

51
Q

Why would you avoid aspirin while you have the flu?

A

RAAS syndrome

52
Q
  • Oxygen
  • Prevent infection with flu and pneumonia vaccines and azithromycin
  • Chest physiotherapy
  • Encourage fluids
  • Corticosteroids/leukotriene inhibitors (montelukast)
  • Bronchodilators
A

What are therapeutic interventions for bronchiectasis?

53
Q
  • Smoking cessation
  • Oxygen
  • Flu and pneumonia vaccines
  • Antifibrotics (pirfenidone, nintendanib)
A

What are therapeutic interventions for pulmonary fibrosis?

54
Q
  • Injury to alveoli = chronic inflammation

- Scarring and fibrosis of lung tissue

A

What is the etiology of pulmonary fibrosis?

55
Q
  • Clubbing
  • Inspiratory crackles
  • Cough
  • Flu like symptoms
  • SOB
  • Fatigue
A

What are the s/sx of pulmonary fibrosis?

56
Q

What kind of diet is encouraged for a client diagnosed with COPD?

A

High protein, high fat, low carb

57
Q

What is the green zone of PEFR?

A

80 to 100% of personal best, remain on medications

58
Q

What is the yellow zone of PEFR?

A

50 to 80% of personal best, indicates caution, asthma triggers are present

59
Q

What is the red zone of PEFR?

A

50% or less of persona best, indicates problem, action must be taken

60
Q

What is flovent and budesonide?

A

Inhaled corticosteroid, inhibits inflammatory process

61
Q

What is salmeterol, formoterol, and arfomoterol?

A

Long acting beta agonist

62
Q

Bronchodilator
>20 = toxic

Toxicity s/sx: N/V, rapid hr, seizures, dysrhythmias

A

What is Theophylline?

63
Q
  • Xolair
  • Reduces sensitivity to allergens
  • Used when corticosteroids do not work, not a rescue med
  • Subcut q 2 to 4 weeks
A

What is omalizumab?

64
Q
  • Autosomal recessive disorder
  • Mutation in CFTR gene
  • Causes chronic respiratory infections and antibiotic resistance
  • Plugs exocrine ducts
  • Enzymes deficient = decreased absorption of nutrients
A

What is cystic fibrosis?

65
Q
  • Promote clearance of secretions
  • Control infection in the lungs
  • Provide adequate nutrition
A

How is cystic fibrosis treated?

66
Q
  • Clinical presentation and family history
  • Sweat chloride test with pilocarpine iontophoresis method: Pilocarpine carried by electric current is used to stimulate sweat production, sweat chloride values >60 mmol/L are considered positive for CF
  • Genetic testing
A

How is cystic fibrosis diagnosed?

67
Q
  • Cough with Thick/sticky (viscous, tenacious) mucus
  • Wheezing
  • Exercise intolerance
  • Recurrent lung infections (pneumonia)
  • Inflamed nasal passages
  • Recurrent sinusitis
  • Bronchiectesi
  • Decreased ability to absorb nutrient
  • Foul-smelling greasy stools (Steatorrhea)
  • Poor weight gain and growth
  • Intestinal blockage, particularly in newborns (meconium ileus)
  • Chronic or severe constipation,
  • Rectal prolapse
  • Abdominal distention
A

What are the clinical manifestations of cystic fibrosis?

1210 (4 decks)

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