Respiratory Flashcards
How many liters of O2 can you give through a nasal cannula?
1-6 LPM
How much O2 does a nasal cannula delliver?
24-40%
How many liters of O2 can you give through a simple mask?
5-8 liters
Minimum of 5 liters to flush co2 from mask
What % O2 does a simple mask deliver?
40-60%
What % O2 does a partial rebreather mask deliver?
60-75%
How many liters of O2 can you give through a partial rebreather mask?
6-11 LPM
How full should a partial rebreather bag be?
It should be 2/3 full, cover valve to inflate
Must know how to do
How much O2 does a Non-rebreather mask deliver?
80-95%
How many liters of O2 can you give through a Non-rebreather mask?
8-15 LPM
What % of O2 is room air?
21%
How many liters of O2 can go through a venturi mask?
4-10 LPM
What % of O2 is delivered through a venturi mask?
24-50%
How do you wean a patient off O2?
You switch to a different device you do NOT turn down the flowmeter. You will send your patient into respiratory distress
What should you do for patients with chronic copd?
Give very small amounts of O2 (1-2 L with venturi mask). If you give to much it will tell there body to stop breathing because they have a loss of sensitivity to high levels of CO2 (CO2 narcosis) There drive to breathe is low O2 levels ours is high CO2
TEST QUESTION
What are signs of low O2 levels?
Agitated and restlessness
Sleep apnea
Stop breathing for 10 seconds 5 times an hour
Can have high blood pressure from it, elevated cortisol levels
What is the strongest bone in the body?
The mandible
Are varicose veins a preceptor to blood clots?
no, only deep veins can form blood clots?
Risk factors for DVT
- Surgery
- Obesity
- Advancing age
- Hyper-coagulation
- Cancer
- Prolonged immobilization
- History of thromoembolism
Manifestations of Pulmonary embolism
- Dyspnea
- Chest pain
- Restless
- Cough
- Crackles
- Tachypnea
- Tachycardia
- Diaphoresis
- pleural friction rub
- S3 & S4 heart sounds (normal would be 2 sounds)
- Hemoptysis (blood in sputum)
What is the normal co2 level?
35-45%
Which of these clients should the charge nurse assign to the LPN/LVN working on the medical-surgical unit?
Client with pulmonary tuberculosis who is receiving multiple medications
The RN is caring for a client with severe acute respiratory syndrome (SARS) who is receiving mechanical ventilation. Which nursing action should the nurse delegate to a nursing assistant?
Keeping the head of the bed elevated 30 to 45 degrees
A client with pneumonia caused by aspiration after alcohol intoxication has just been admitted. The client is febrile and agitated. Which physician order should the nurse implement first?
Draw aerobic and anaerobic blood cultures
The medical-surgical unit has one negative airflow room. Which of these four clients who have just arrived on the unit should the charge nurse admit to this room?
Client with possible pulmonary tuberculosis who currently has hemoptysis
An older adult resident in a long-term care facility becomes confused and agitated, telling the nurse “Get out of here! You’re going to kill me!” Which action will the nurse take first?
Check the resident’s oxygen saturation.
A client is admitted to the emergency department (ED) with a possible diagnosis of avian influenza (“bird flu”). Which of these actions included in the hospital protocol for avian influenza will the nurse take first?
Place the client in a negative air pressure room.
The community health nurse is planning tuberculosis treatment for a client who is homeless and heroin addicted. Which action will be most effective in ensuring that the client completes treatment?
Arrange for a health care worker to watch the client take the medication.
An older client presents to the emergency department (ED) with a 2-day history of cough, pain on inspiration, shortness of breath, and dyspnea. The client never had a pneumococcal vaccine. The client’s chest x-ray shows density in both bases. The client has wheezing upon auscultation of both lungs. Would a bronchodilator be beneficial for this client?
A bronchodilator would help decrease the bronchospasm
Your client has been homeless and has spent the past 6 months living in shelters. The client has been diagnosed with confirmed tuberculosis (TB). You are completing your medication teaching with this client. About which medications will the nurse teach the client?
Isoniazid (INH), rifampin (Rifadin), pyrazinamide (Tebrazid), ethambutol (Myambutol)
A client is taking INH, rifampin, pyrazinamide, and ethambutol for tuberculosis. The client calls to report visual changes, including blurred vision and reduced visual fields. Which medication may be causing these changes?
Ethambutol
A client is being admitted for pneumonia. The sputum culture is positive for Streptococcus. The client asks about the length of the treatment. On what does the nurse base the answer?
The client may be switched from IV to oral antibiotics in 2 to 3 days
The client is homeless and has been living in shelters for the past 6 months. The client asks the nurse why he must take so many medications. What information will the nurse provide in answering this question? Select all that apply.
- Combination drug therapy is effective in preventing transmission.
- Combination drug therapy is the most effective method of treating tuberculosis (TB).
- Multiple drug regimens destroy organisms as quickly as possible.
- The use of multiple drugs reduces the emergence of drug-resistant organisms
A local hunter is admitted to the intensive care unit with a diagnosis of inhalational anthrax. Which of the following medications will the RN anticipate as a physician request?
Ciprofloxacin (Cipro) 400 mg IV every 12 hours
The nurse has taught the client about influenza infection control. Which client statement indicates the need for further teaching?
The intranasal vaccine can be given to everybody in the family.”
The nurse notices a visitor walking into the room of a client on airborne isolation with no protective gear. What does the nurse do?
Provides a mask to the visitor
Which components belong to the ventilator bundle approach to prevent ventilator-associated pneumonia (VAP)? Select all that apply.
- Continuous removal of subglottic secretions
- Elevating the head of the bed at least 30 degrees whenever possible
- Handwashing before and after contact with the client
The client is being discharged home with active tuberculosis. Which information does the nurse include in the discharge teaching plan?
You will not be contagious to the people you have been living with.”
Which method is the best way to prevent outbreaks of pandemic influenza?
Early recognition and quarantine
Community health nurses are tasked with providing education on prevention of respiratory infection for diseases such as the flu. Which target audience is given the highest priority?
Prison staff and inmates
A 70-year-old client has a complicated medical history including chronic obstructive pulmonary disease (COPD). Which client statement indicates the need for further teaching about the disease?
“I am here to receive the yearly pneumonia shot again.”
The nurse plans discharge teaching for the client who is recovering from pneumonia. When is the best time to accomplish this?
Midmorning or midafternoon
A client who has recently traveled to Vietnam comes to the emergency department with fatigue, lethargy, night sweats, and a low-grade fever. What is the nurse’s first action?
Places a respiratory mask on the client
The client comes to the emergency department with a sore throat. Examination reveals redness and swelling of the pharyngeal mucous membranes. Which diagnostic test does the nurse expect will be requested first?
Throat culture
Which symptom of pneumonia may present differently in the older adult than in the younger adult?
Fever
The oxygen saturation monitor of the client recovering from an empyema indicates periodic decreased perfusion, yet the client is talking and laughing with a visitor. The client’s respirations are even and unlabored, and the nail beds are pink. What does the nurse do first?
Ensures that the pulse oximetry probe is in place
What is the difference between hypoxemia and hypoxia?
Hypoxemia is low levels of oxygen in the blood
Hypoxia is decreased tissue oxygenation
Can Non-respiratory conditions affect oxygenation?
Yes, heart failure, sepsis, fever and some poisions, decreased hemoglobin or poor hemoglobin quality can all affect oxygenation. Their presence is an indication for oxygen therapy.
Why does a patient who is hypoxemic and has chronic hypercarbia (increased partial pressure of arterial carbon dioxide PaCo2 levels) in need of lower levels of O2?
Because a low PaO2 is this patients primary drive to breathe
What is the best measure for determining the need for oxygen therapy and for evaluating its effects?
Arterial blood gas analysis
When does O2 need to be humidified?
When it is being delivered at 4 liters or more
How often should you cleanse the cannula, mask, tubing or skin under?
every 4-8 hours or as needed
When should you assess for oxygen induced hypoventilation?
In patients whose main respiratory drive is hypoxia such as in the patient with chronic lung disease who also has carbon dioxide retention (hypercarbia). The arterial carbon dioxide level for these patients gradually rises over time. The central chemoreceptors in the brain are normally sensitive to increased Paco2 levels.
What is Co2 narcosis and why does it occur?
When Paco2 levels increase to above 60-65 mm hg, this normal mechanism to trigger breathing no longer works. The central chemoreceptors lose sensitivity to increased levels of Paco2, and do not respond by increasing the rate and depth of respiration. This loss of sensitivity to high levels of PaCo2 is called CO2 narcosis. For these patients the stimulus to breathe is a decreased arterial oxygen level. The low O2 levels are sensed by peripheral chemoreceptors in the carotid sinus areas and aortic arch
When does the hypoxic drive to breathe occur?
The hypoxic drive to breathe occurs only in the presence of severely elevated Paco2 levels that have occurred slowly over years
When are manifestations of hypoventilation usually seen?
Within the first 30 min of oxygen therapy
True or false
Although oxygen induced hypoventilation is a serious concern, untreated or inadequately treated hypoxemia is a greater threat to life
True
At what % could O2 cause damage to the lungs?
An O2 level of greater than 50% given continuously for more than 24-48 hours may damage the lungs
What are initial symptoms of lung injury?
Dyspnea, noon productive cough, chest pain beneath the sternum, and GI upset
More severe symptoms include decreased vital capacity, decreased compliance, crackles, and hypoxemia, atelectasis, pulmonary edema, hemorrhage
What is nitrogens role in respiration?
Nitrogen in the air helps maintain patent airways and alveoli. Making up 79% of room air, nitrogen prevents alveolar collapse
How are oxygen delivery systems classified?
By the rate of oxygen delivery; low flow or high flow systems
What are low flow systems?
- Nasal cannula
- Simple face mask
- Partial rebreather mask
- Non rebreather mask
What are high flow systems?
- Venturi mask
- Aerosol mask
- Face tent
- Trach collar
- T- piece
What is noninvasive positive pressure ventilation (NPPV)?
It is a technique using positive pressure ventilaion to keep alveoli open and improve gas exchange without the need for airway intubation. It is now being used to manage dyspnea, hypercarbia and COPD. NPPV prevents the complications caused by intubation including ventilator associated pneumonia
What are the 3 most common modes of delivery for NNPV?
- CPAP, which delivers a set positive airway pressure throughout each cycle of inhalation and exhalation
- Volume limited or flow limited, which delivers a set tidal volume with the patients inspiratory efforts
- Pressure limited
For medicare to cover the cost of home oxygen…
The patient must have severe hypoxemia defined as partial pressure of arterial O2 level of less than 55 mm hg or an arterial O2 sat of less than 88%
True or false
NNPV is used for sleep apnea
True
At what times is oxygen therapy needed for a patient?
- To treat hypoxia
- To treat hypoxemia
- When the normal 21% oxygen level in the air inadequate
Which conditions can increase the bodys need for more oxygen?
- Sickle cell disease
- Infection in the blood
- Body temp of 101 f
- Hemoglobin level of 8.7 g/dl
What are the hazards of administering oxygen therapy?
- Oxygen supports and enhances combustion
- All electrical equipment in the room must be grounded
- Solutions with high concentrations of alcohol or oil cannot be used in the room
A patient requires home oxygen therapy. When the home health nurse enters the patients home for the intial visit, he observes several issues that are safety hazards related to the patients oxygen therapy. What hazards do these include?
- Package of cigarettes
- Decorative candles
- Electric fan with frayed cord
Before completing the morning assessment, the nurse concludes that a patient is experiencing inadequate oxygenation and tissue perfusion as a result of resp. problems. Which assessment findings support the nurses conclusion?
- Patient must take a breath after every third or fourth word
- Patient appears strained and fatigued
- Pulse of 95 beats/min, resp. rate 30 min
The nurse is caring for several patients on a general surgical unit. The nurse would question the necessity of oxygen therapy for a patient with which condition?
Valve replacement with increased cardiac output
When a patient is requiring oxygen therapy, what is important for the nurse to know?
Why the patient is receiving oxygen, expected outcomes, and complications
A patient with COPD is admitted to the hospital with oxygen induced hypoventilation. What is the resp. stimulus to breathe for this patient?
Low levels of oxygen concentration in the blood, as sensed by the peripheral chemoreceptors
The nurse is adminstering O2 to a patient who is hypoxic and has chronic high levels of carbon dioxide. Which oxygen therapy prevents a resp. complication for this patient?
Lower concentrations of O2 (1-2 l min) per nasal cannula
A patient is at high risk or unknown risk for oxygen induced hypoventilation. What must the nurse monitor for?
Changes in level of consciousness, apnea, and resp. pattern
A patient is receiving a high concentration of O2 as a temporary emergency measure. Which nursing action is the most appropriate to prevent complications associated with high flow oxygen?
Monitor the prescribed oxygen level and length of therapy
Increased risk for oxygen toxicity is related to which factors?
- Continuous delivery of oxygen at greater than 50% concentration
- Delivery of high concentration oxygen over 24 to 48 hours
- The severity and extent of lung disease
- Neglecting to monitor the patients status and reducing oxygen concentration as soon as possible
- Excluding measures such as continuous positive airway pressure
The patient is receiving humidified oxygen which places the patient at high risk for which problem?
Infection related to the condensation in the tubing
A patient is receiving warmed and humidified oxygen. The respiratory therapist informs the nurse that several other patients on other units have developed hospital required infections and pseudomonas aeruginosa has been identified as the organism. What does the nurse do?
Change the humidifier every 24 hours
Nursing interventions to prevent infection in patients with humidified oxygen include which actions?
Drain condensation from the water tap
Which factors are considered hazards associated with oxygen therapy?
- Increased combustion
- Oxygen toxicity
- Absorption Atelectasis
- Oxygen induced hypoventilation
A patient is receiving warmed and humidified oxygen. In discarding the moisture formed by condensation, why does the nurse minimize the time that the tubing is disconnected?
To prevent the patient from desaturating
What is the best description of the nurses role in the delivery of oxygen therapy?
Being familiar with the devices and techniques used in order to provide proper care
A patient with an oxygen delivery device would like to ambulate to the bathroom but the tubing is too short. What is the max length of the tubing that can be added in order to deliver the amount of oxygen needed for that device?
50 ft
A patient is being discharged and requires home oxygen therpay with a reservoir type nasal cannula. He asks why cant i just take the nasal cannula i have been using in the hospital. What is the nurses best response?
This special nasal cannula allows you to decrease the O2 flow by 50%
A patient is receiving O2 therapy through a non rebreather mask. What is the correct nursing intervention?
Ensure that valves and rubber flaps are patent, functional, and not stuck
A patient with a facemask at 5 ml min is able to eat. Which nursing intervention is performed at mealtimes?
Obtain a physician order to remove the mask at meals
For a patient who is having an anaphylactic reaction, which common symptoms will manifest almost immediately after being exposed to an allergen?
- Angioedema
- Apprehension
- Urticaria
A patient in anaphylaxis who is going into respiratory failure will demonstrate which symptoms?
- Laryngeal edema
- Hypoxemia
- Crackles
- Wheezing
True or false
After the proper dose of epinephrine is administered to a patient having an anaphylactic reaction, the nurse must wait 60 minutes before repeating the dose
False, after the proper dose of epinephrine is administered to a patient having a reaction the same dose may be repeated every 15-20 minutes if needed
True or false
Latex allergies are manifested only in dermatitis, so latex free gloves are the only necessary precaution for those with a latex allergy
False, latex allergens may enter the body through direct contact, inhalation
True or false
A patient who is allergic to bananas could possibly develop a latex allergy
True
Drug therapy with antihistamines and decongestants to treat sinusitis are used with caution in older adults because of which possible side effects?
- Vertigo
- Hypertension
- Insomnia
- Blurred vision
Which factors can account for acute pharyngitis?
- Viruses
- Irritants
- Bacteria
- Alcohol
Which patients are at risk for developing hospital acquired pneumonia?
- Confused patient
- Patient with gram negative colonization of the mouth
- Malnourished patient
The nurse is teaching the patient and family about care of a peritonsillar abscess at home. For what symptoms does the nurse indicate the need for a patient to go to the emergency dept immediately?
- Stridor
2. Drooling
A patient with COPD needs instruction in the measures to prevent pneumonia. What info does the nurse include?
- Clean all respiratory equipment you have at home
- Avoid indoor pollutants such as dust and aerosol
- Get plenty of rest and sleep daily
Patient has the flu what measures should he take to protect his wife who has several chronic health problems?
- Wash hands
- Avoid kissing
- Cough or sneeze into upper sleeve
- Use disposable tissues
A patient is seen in the office and is diagnosed with community acquired pneumonia. What are the most common symptoms the patient will have?
- Dyspnea
- Hypoxemia
- Chest discomfort
Which diagnostic tests are most likely to be done on a patient suspected of having community acquired pnemonia?
- Sputum gram stain
2. Chest x-ray
Which people are at greatest risk for developing TB in the US?
- An alcoholic homeless man
- A person with immune dysfunction or HIV
- Foreign immigrants
After several weeks of not feeling a patient is seen for possible TB. If TB is present, which assessment findings does the nurse expect to observe?
- Fatigue
- Night sweats
- Low grade fever
What does a nurse monitor for in a person with a PE?
- Cyanosis
- Rapid heart rate
- Dyspnea
- Crackles
What are extrapulmonary causes of ventilatory failure?
- Stroke
- Use of opiod analegics
- Morbid obesity
Which interventions does a nurse use to prevent PE in post op patients?
- Start passive and active range of motion
- Ambulate asap
- Use antiemolism stockings
- Administer drugs to prevent valsalva maneuver
What is epitaxis?
Epitaxis is a nosebleed, common problem because of the many capillaries within the nose
What is aphonia?
Inability to produce sound
What is hemoptysis?
Bleeding from the airway
What is the role of the upper respiratory system?
That’s the respiratory system filters, moistens, and warms air during inspiration. It includes the nose, paranasal sinuses, pharynx, larynx, and trachea
What is the role of the lower portion of the respiratory system?
The lower portion of the respiratory system consists of Lungs, which enable exchange of gases between blood and air to regulate arterial oxygen, CO2, and pH. The left lung has two lobes and the right lung has three lobes. It consists of bronchi, bronchioles, alveoli, and the covering of the lungs
What stimulates the mechanism of breathing?
- Following phrenic nerve stimulation, diaphragm and other respiratory muscles contract
- The thorax increases in size
- Intrathoracic and intrapulmonic pressure decrease
- Air rushes from positive pressure in the atmosphere to negative pressure in the Alveoli
- Inspiration is completed with stimulation of stretch receptors
- Expiration occurs passively as a result of recoil of elastic lung tissue
What controls respiration?
- Alveolar stretch receptors respond inspiration by sending inhibitory impulses to inspiratory neurons in the brainstem that prevent lung over distention ( Hering-Breur reflex)
- Central and peripheral chemoreceptors stimulate respirations in response to lower pH, increased CO2, or decreased oxygen
- The medulla oblongata and pons control the rate and depth of respiration
What part of the brain controls the rate and depth of respiration?
The Medulla and pons
What is plural friction rub?
- It is the result of roughened pleural surfaces rubbing across each other
- Sounds are crackling, grating
- Commonly heard on the height of inspiration
What are wheezes?
- The result of air passing through narrow small airways
- Sounds are high-pitched and musical, or low pitched and rumbling
- Most commonly heard on expiration
What are coarse crackles?
- The rush of air passing through an airway intermittently occluded by mucus
- Short, low pitch bubbling sound
- Most common on inspiration
What are fine crackles?
- The result of sudden opening of small airways and alveoli that contain fluid
- Short, high-pitched bubbling sounds
- Most common during height of inspiration
What are normal breath sounds?
Bronchial sounds, vesicular sounds, bronchialvesicular sounds
What are adventitious breath sounds?
- Fine crackles
- Course crackles
- Wheezes
- Pleural friction rub
What is the direction of diffusion of gases?
- Oxygen, net diffusion toward lower oxygen pressure gradient is …….from alveolar air to blood
- Carbon dioxide, net diffusion toward lower carbon dioxide pressure gradient…..from blood alveolar air
How does blood transport oxygen?
Blood transports oxygen as a solute and primarily as oxyhemoglobin, oxygen saturation of hemoglobin is 95 100%
How does blood transport carbon dioxide?
- Primarily as a bicarbonate ion HCO3 formed by ionization of carbonic acids
- As a solute in plasma
- In combination with hemoglobin
What is total lung capacity?
The amount of air in lungs after maximum inhalation. Is equal to the sum of tidal volume, residual volume, and inspiratory/ expiratory reserve volumes. The expected capacity is about 5800 mL
What is tidal volume?
The average amount expired after a regular inspiration. The expected volume is approximately 500 mL
What is vital capacity?
The amount of air that can be forcibly expired after forcible inspiration. The expected capacity is about 4600 mL
What are signs of hypoxia?
Agitation, confusion, lethargy, pallor, diaphoresis, tachycardia, cyanosis
