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NCLEX > Respiratory > Flashcards

Respiratory Flashcards

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1
Q

What do you need prior to a thoracentesis

A

Chest xray

Vitals

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2
Q

How do you position the client during a thoracentesis

A

Sitting up leaning over side table.
Sit in a chair backwards propped up over the chair.
Lie on unaffected side with HOB at 45degrees

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3
Q

What occurs in a thoracentesis

A

Fluid/blood/exudate is being removed from pleural space

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4
Q

What do you expect to occur as a result of a thoracentesis

A

The lungs to expand

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5
Q

What do you want to monitor as a result of thoracentesis

A

Vital signs

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6
Q

After a thoracentesis what should you do

A

get an cxr

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7
Q

Why would a client need a chest tube?

A

The lung have collapsed

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8
Q

If a chest tube is placed in the 2nd intercostal space what do you expect to be removed

A

air

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9
Q

If a chest tube is placed in the 8th or 9th intercostal space what do you expect to be removed

A

drainage

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10
Q

What is the purpose of a cdu

A

to restore normal vacuum pressure in the pleural space.

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11
Q

What do you do if the drainage chamber fills up

A

change it

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12
Q

What is the purpose of the water seal chamber

A

to promote one way flow and prevent air from going into patient

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13
Q

What do you do if you see bubbling/tidalling in the water seal chamber

A

It is normal when the client is breathing, coughing, sneezes or exhales.
It should be intermittent

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14
Q

What happens if a patient was on dry suction system, do you expect bubbling

A

No because there is no water to regulate the pressure. Instead a dial is used to give negative pressure.

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15
Q

As a nurse what are some things you need to assess for in a patient with a CDU

A
  1. Assess Dressing must be tight and intact
  2. Auscultate Lung sounds bilaterally
  3. Vitals-monitor o2 sats report anything 100 in the first hour and if there is a change in color to bright red
    Record drainage for first 24 hours and then every 8 hours. Notify physciain if drainage is greater than 100 in the first hour and if there is a change in color to bright red
  4. Encourage deep breath, cough, insentive spirometer
  5. Lab- watch for increased wbc, fever, and daily cxr
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16
Q

Where should the CDU be kept

A

below the level of the chest, if too high drainage will go back into patient

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17
Q

What do you monitor with the CDU system

A

Make sure there are no kinks, and it is a closed system. monitor water levers and tidaling.

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18
Q

What happens when tidalling stops?

A

Check the tubing, or is there a dependent loop present in the system then…
Check to see if the lung has re-expanded

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19
Q

What do you do if the tubing gets disconnected

A

Use sterile water that would be at the bedside, and reconnect as fast as you can

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20
Q

What happens if the water seal chamber falls over

A

Re-establish a water seal, set cdu upright and fill chamber to 2cm water.
Have client deep breath and cough in case any air went into pleural space

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21
Q

What if the chest tube was accidently pulled out

A

Maintain a 3 way valve opening with gauze

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22
Q

Is bubbling normal when chest tube is connected to suction and you see continous bubbling in the suction chamber

A

yes

23
Q

Is bubbling normal when your client coughs and you see intermittent bubbling in the water seal chamber

A

yes

24
Q

Is bubbling normal when you have continous bubbling in the water seal chamber

A

NO

25
Q

What do you need in order to clamp a chest tube and why

A

An order, because it could cause a tension pneumothorax

26
Q

When removing a chest tube, what do you ask the client to do

A

Deep breath, valsalva, and then place an occlusive dressing over site

27
Q

What has happend to the lung that you need a pneumothorax/hemothorax and how?

A

Collapsed lung, due to accumulated blood or air in the pleural space

28
Q

What s/s do you see in a hemo/pneumothorax

A 
SOB
Increase HR
Decreased breath sounds to affected side
less movement on affected side
Chest pain
Cough
Subcutaneous emphysema
29
Q

What would you see on the CXR of someone with a pneumo or hemothorax

A

air or fluid

30
Q

What treatment options available for a person with a pneumothorax or hemothorax

A

Thoracentesis
Chest tubes
Daily cxr

31
Q

Do you see intermittent bubbling in the water seal chamber of someone with a pneumothorax

A

yes

32
Q

What occurs in a Tension Pneumothorax

A

Pressure build up in the plueral space and collapsed the lung, pressure pushes everything to opposite side, mediastinal shift

33
Q

What can cause a tension pneumothorax

A

Trauma
PEEP
Clamping a chest tube
taping an open pneumothorax on all 4 sides

34
Q

What are the S/S of a Tension pneumothorax

A 
Subcutaneous emphysema
Absent breath sounds 
Asymetry of thorax
respiratory distress
Eventually can lead to decreased cardiac output
35
Q

What is the treatment plan for a tension pneumo

A

Large bore needle in the 2nd intercostal space to allow air to escape,
Then find the cause
Chest tubes will be inserted

36
Q

What occurs in an open pneumothorax

A

The opening in the chest allow

37
Q

What are treatment options for someone with an open pneumothorax

A
  • Have client inhale and hold it
  • Then place a gauze and tape on 3 sides
  • Have the client sit up if possible to expand lungs, unless trauma patient
38
Q

What is the most common injury from a chest trauma

A

Fractured ribs and sternum

39
Q 
When someone has:
Pain and tenderness
Crepitus 
Shallow resps
and resp acidosis what could these be a sign of
A

Fractured rib and sternum

40
Q

What treatment options are there for a fractured rib and sternum

A

Non-narcotic analgesic
nerve block to assist with productive cough
support injured area
Do not immobilize chest it could lead to shallow breathing, atelectasis and pneumonia

41
Q

What complications could occur with a fractured rib and sternum

A

Pneumo/hemothorax

Flail chest

42
Q

What is a flail chest

A

Multiple rib fractures

43
Q 
When a person has:
pain
paradoxical chest wall movement 
chest sucks inward on inspiration and puffs on expiration
Dyspnea, cyanosis
increased pulse
What are these s/s related to
A

Flail chest

44
Q

What are some treatment options for someone with a flail chest

A
  1. stabilize area, intubate, ventilate

2. Positive pressure ventilation stabilizes area

45
Q

What are some types of positive pressure ventilation

A
  1. PEEP (positive end expiratory pressure)
  2. BiPap(Bi-level positive airway pressure)
  3. CPAP (continuous positive airway pressure)
46
Q

Out of PEEP, BiPap, and CPAP which system would you use for someone on a ventilator

A

PEEP

47
Q

Out of PEEP, BiPap, and CPAP which system would you use for someone with Sleep Apnea

A

CPAP or BiPap

48
Q

Out of PEEP, BiPap, and CPAP which system would you use for someone with ARDS

A

PEEP

49
Q

Out of PEEP, BiPap, and CPAP which system would you use for someone with COPD, heart failure

A

BiPap

50
Q

Out of PEEP, BiPap, and CPAP which system would you use for someone with pulmonary edema or severe hypoxia

A

PEEP

51
Q

If a person becomes dehydrated, has had a surgery and is immobile or is taking birth control pills, what are they at risk for

A

pulmonary embolism

52
Q

What are some common s/s related to PE

A
  1. Hypoxemia
  2. Low PO2
  3. SOB, Cough and increased RR and Pulse and BP
  4. Increased D-Dimer
  5. Positive VQ Scan (dye is used)
  6. Positive spiral CT or CT angiograpy
  7. Hemoptysis
  8. Chest Pain
  9. CXR shows atelactasis
53
Q

What do you do to prevent a PE

A

Early ambulation and hydration

Isometric exercises

54
Q

What are some treatment options for PE

A 
oxygen
decrease pain
anticoagulant - bleeding precautions
surgery
bed rest
elevate extremities
TED hose/SCD's
Warm moist head decreases inflammation

NCLEX (21 decks)

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