Respiratory Flashcards
Chest tubes nurse alert
- Ensure that the tubing is patent and free of
dependent loops (drainage accumulating in dependent
loops obstructs chest drainage into the collecting
system and increases pressure within the lung. - Asses for air leaks in the system as indicated by
constant bubbling in the water seal chamber. - Assess for patent system: note the fluctuations or
tidaling of water in the water seal chamber. - Do not turn off the suction control stopcock OFF
when transporting the patient (to prevent tension
pneumothorax). - Dislodgement of chest tube/drainage system.
At the junction of chest tube/drainage system
immerse the end of the chest tube into a glass of water
to maintain water seal.
at the insertion site- instruct patient to take a deep
breath and hold it until site is sealed. - Immediately cover with Vaseline gauze and sterile
4×4 dressing and tape in place.
Chest tube documentation
- Collection chamber: amount and appearance of
drainage - Water seal chamber: water level, bubbling, and
fluctuations of tidaling - Suction chamber: water level
- Monitor chest tube drainage every 2 hours or more
frequently in the immediate post operative period.
Chest tube trouble shooting
Sudden experiences of trouble breathing
1. Check for occlusion/kinking of the tube and integrity
of the line.
2. Ensure that suction control stopcock is in ON
position
Constant bubbling in the water seal chamber
Assess for air leaks in the system. To assess location
of a leak, intermittently occlude for a moment (< 1
minute) the chest tube or drainage tubing beginning at
the insertion site of progressing to the chest drainage
unit.
Tubing obstruction
Scan length of tubes for signs of mechanical
obstruction
2. If clots exists call MD, milking and stripping of chest
tubes is only performed with a specific physician order.
Theophylline side effects
Tachycardia, anxiety, headache, cramps, nausea and
vomiting
Theophylline, drink to avoid
Soda, coffee, tea, chocolate due to the caffeine, as it
increases CNS effect.
Spiriva handi-haler (tiotropium bromide) sides effects
Spiriva is a bronchodilator, maintenance treatment for
COPD. Most common side effect - dry mouth.
Other side effects: constipation and urinary retention
Barrel chest is commonly seen in condition called.
COPD
Client with emphysema
Instruct purse- lip breathing
Part of tracheostomy tube removed while cleaning.
Inner cannula
Mechanical ventilator alarming due to increased pressure
Check for tubing for kinks
Signs and symptoms of fat emboli
Petechiae in chest and abdomen, shortness of breath,
chest pain,
hypotension, decreased Pa)2 and increased PCO2.
Protamine Sulfate indication.
Reverses the anticoagulant effect of Heparin.
Protamine sulfate is administered intravenously.
Side effects of Protamine Sulfate
Hypertension or hypotension and pulmonary
hypertension
bradycardia, dyspnea
Caution with Protamine
Receiving Protamine-containing insulin
Vasectomy men, allergy to fish
Streptomycin indication and possible adverse reaction to watch:
Anti-PTB (pulmonary tuberculosis),
watch for auditory nerve damage, (8th cranial nerve)
TB patient being transported for Chest X-ray
Apply mask on patient when transporting.
Mechanical ventilation to observe other than ventilator
alarm.
Kinks and condensation of water in the tubing.
Patient is taking INH, what to monitor?
Monitor intake and output due to urinary retention.
Medication to decreases bronchial secretions
Atropine Sulfate
Acute pulmonary edema medicine to avoid
Coumadin
Assessment with patient taking narcotics.
Respiratory rate (Bradypnea)
Tracheostomy care what to intervene
Tracheostomy care what to intervene - removal of old
trachea ties
Side effects of Aminophylline
Gastric irritation, nausea, arrhythmias
Asthma prophylaxis, exercise induced-asthma
Sodium Intal (discontinue use during acute attack)
Red-green color discrimination, optic neuritis is a Side effect
of what antituberculous medication?
Ethambutol (myambutol)
Confirms a positive pulmonary tuberculosis (PTB)
A positive culture for M. tuberculosis
What blood gas disorder associated with hyperventilation
as in anxiety reaction?
Respiratory alkalosis
What blood gad disorder associated with hypoventilation as in opiate overdose?
Respiratory acidosis
Increased in liver enzyme and peripheral neuropathy is a
side of what antituberculous medication?
Isoniazid (INH)
Asbestosis exposure linked to diseases including
Mesothelioma is a lung cancer associated with asbestos exposure.
Monitor tracheostomy cuff pressure every ___ hours.
4 hours
Tracheostomy tube cuffs also should be inflated continuously in patients on.
Mechanical ventilator or continuous positive airway Pressure (CPAP)
ET tube cuffs should be inflated continuously and deflated only during
Intubation, extubation, and tube repositioning
Tracheostomized patients who are breathing spontaneously may have the cuff inflated continuously..
In patient with decreased level of consciousness without ability to fully protect airway. Deflated continuously or inflated only for feeding if the patient is at risk of aspiration.
Thoracentesis indication
Pleural effusion
Pt teaching when the paracentesis needle is about to be pulled out or removed.
Ask pt to hold still and pull it out during the end of expiration.
Amount of pleural fluid that can be removed in one given time.
No more than 1.5 liters
Purpose of thoracentesis
- Diagnostic (to determine the cause)
- Therapeutic (to relieve discomforts)
Thoracentesis is performed when PT level is
Less than 1.5
Laboratory test need to confirm pulmonary blood clot.
Serum D-Dimer
Retraction is a sign of respiratory distress:
Breath sounds
Breath sounds
Anthrax _____ acute infectious caused ___ anthracis.
There are three ways in which humans can be infected by anthrax spores:
Cutaneous - Trasmission based : Standard Precautions
Inhalation -
Intestinal -
Drug of choice :
doxycycline (Vibramycin)
- a tetracycline family
Ciprafloxin (Cipro)
Asbestosis
Asthma
Metered dose inhaler:
Acute bronchitis
Cor Pulmonale - Right sided heart failure
Emphysema
Histoplasmosis
Pneumonia
Types of pneumonia:
Pulmonary edema
Pulmonary Edema - MAD DOG
Pleural Effusion
Pulmonary Embolism
Coagulation Study VAlues
Clot buster
DVT:
Warfarin interactions with herbals : can increase INR
Substance can decrease INR
Safety Precautions When Administering Heparin
Hepa drip Calculation :
PT NCLEX question
DVT question :
Pulmonary Hypertension:
Sarcoidosis:
Obstructive apnea :
Latent TB infection :
Tuberculosis
Mantaux Test for Tuberculosis
Airborne and droplet
Oxygen administration
Oxygen administration: Nursing intervention
Bronchodilators
When to refill aerosol prescription?
______________is a device to measure the airflow through the
bronchi and thus the degree of obstruction in the airways.
Mainly used by asthmatic patients.
/Pt teachings: take a deep breath and blow thru your mouth,
Purposes:
/1. Evaluate the presence and degree of lung disease.
2. Determine severity of asthma.
13. Evaluate responses to change in therapy.
4. Diagnose exercise-induced asthma.
______ is a device for measuring lung capacity and
keeping the lungs clear. IS
ABG
Metabolic Acidosis :
ABG Interpretation based on effect of disease conditions
