Respiratory Flashcards
Kussmaul breathing (very deep breathing) is associated with __________
diabetic ketoacidosis
When should sputum specimens be collected?
early in the morning because secretions develop during the night; the nurse should have the pt cough deeply and expectorate into a container upon awakening.
What is the purpose of the cuff on the tracheostomy tube?
to decrease the chance of aspiration in the trachea
If a pt has full thickness burns to the face, neck, chest or abdomen burns this results in ______
severe edema causing airway restriction
Pts that abuse marijuana experience cravings for __________ and ____________
sweets and carbohydrates
Nasal septum disruption is indicative of __________
cocaine use
Chronic inhalation of cocaine creates ________
sores
burns
disruption of mucous membranes
holes in the nasal septum
Extension of the neck could obstruct airway because _________
the tongue falls in the back of the mouth
What is pertusis?
a contagious disease characterized by paroxysmal coughing; vomiting follows that cough and a whooping inspiration
What kind of precaution is needed for pertusis?
droplet precaution; a private room and a distance of 3 feet between patient and visitor
How do you palpate the uterine when in active labor?
nurse should only use the finger tips, not palm of hand
What is status asthamticus?
Persistent and intractable asthma. It’s life threatening that can last longer than 24 hours
What happens with an increase in respiratory rate of more than 20?
it decreases the oxygenation towards the tissues
What do you do after a pneumonectomy (excision of an entire lung) postoperatively?
- the position of the trachea should be evaluated
- a tracheal shift occurs because an increase in pressure occurs on the operative side and causes pressure against the mediastinal area
3 things to know about respiratory acidosis (lungs):
- increased PaCO2
- decreased pH
- indicates respiratory failure because too much carbon dioxide is building up
3 things to know about respiratory alkalosis (lungs):
- decreased PaCo2
- increased pH
- indicates hyperventilation
2 things to know about metabolic acidosis (kidneys):
- decreased HCO3-
2. decreased pH
2 things to know about metabolic alkalosis (kidneys):
- increased HCO3-
2. increased pH
Interpreting arterial blood gas (ABG) is all about:
- pH
- PaCo2
- HCO3-
What do you do right after a bronchoscopy?
check if gag reflex is back
How can the gag reflex be assessed after a bronchoscopy?
by touching the back of the pt’s throat with a tongue depressor
What else can be assessed after a bronchoscopy?
symptoms of respiratory distress from swelling due to the procedure.
Respiratory distress signs after a bronchoscopy include:
- tachypnea
- tachycardia
- respiratory stridor
- retractions
What position should a pt be placed after a bronchoscopy?
Semi-fowler position
A chest tube that drains 100 ml/hr indicates…
abnormality and needs to be reported
When the fluctuation stops with a chest tube that indicates…
re-expansion of the lung; a chest x-ray will be needed to confirm re-expansion
_________ decreases oxygen levels
Suctioning
When is suctioning performed?
as needed
When suctioning the nurse should put pressure between __________ and _________
90 - 120 mmHg
The suction catheter # should be?
12 or #14
What should the nurse suction first?
the trachea then the mouth
How do you assess the effectiveness of suctioning?
auscultate the pt’s chest to determine if adventitious sounds are cleared and to ensure that the airway is clear
What is the proper procedure for suctioning?
- insert suctioning catheter until resistance is met without applying suction
- withdraw 1 - 2 cm and apply intermittent suction with twirling motion
How do you clean the intubation blade (laryngoscope)?
gas sterilized after use
What does tactile fremitus assess?
air vibrations in the bronchial tubes as they are transmitted to the chest wall; pt is instructed to say 99
What do you do with a pt diagnosed with active TB?
pt must be placed on airborne precaution, negative air pressure room with the door closed
What medications are given for TB?
- Isoniazid (INH)
- Rifampin (Rifadin)
- Ethambutol (Myambultol)
Meds for TB are required to be taken for how long?
6 - 9 months
Signs and symptoms of active TB:
- low grade fever and night sweats
- fatigue
- lethargy
- nausea
- anorexia
- weight loss
____________ is an anti-inflammatory used to prevent asthma attacks
Beclomethasone
Research links clubbing with ___________
physiology of platelet production
Clubbing of nails occurs with _____________
congenital cyanotic heart disease
Neo-plastic disease
Pulmonary disease
Cyanosis associated with stenosis occurs with:
Pulmonary artery orifice
Ventricular septal defect
Patent foramen ovale
Ductus arteriosus
3 things that may occur with early clubbing:
- the angle straightens out to 180 degrees
- the nail base feels spongy to palpation
- the nails are convex as the digit grows
What is considered normal angle at the nail base?
160 degrees or less
What is schamroth method?
to place the fingernails of the ring finger together and hold them to light; if a diamond shape is visible between the nails, then there is no clubbing.
Chronic iron deficiency anemia may show ________
“spoon” nails (koilonychias)
What is Beau’s line?
a transverse furrow or groove
3 things to know about Beau’s line:
- there are depressions across the nail that extends down to the nail bed
- they occur with any trauma that impairs nail formation such as: acute illness, toxic reaction and local trauma
- dents appear first at the cuticle and then moves forward as the nail grows
Pitting and crumbling of the nails with distal detachment often occurs with ________
psoriasis (red papules and scaly silvery plaques with sharply defined borders.
Influenza requires what kind of precaution?
droplet precaution (3 feet away)
Droplet precautions last for ___________
5 days; longer for immunocompromised pts
_________ are triggers of asthma.
dust mites
Fabric from bedding on the upper bunk bed can harbor _________
dust mites
Encourage asthmatic pts not to sleep of lie down on _____________
upholstered furniture; only furniture that can be wiped with a damp cloth (wood, plastic, vinyl or leather)
With asthmatic pts mattresses and pillows need to be ________
encased and zippered with an allergen-impermeable cover
If the pollen count is high, pts with asthma should ___________
wash their hair every night and change clothes after playing outside
5 symptoms of asthma:
- dyspnea
- wheezing
- nonproductive cough
- tachycardia
- tachypnea
The main cause of asthma is __________
inhaled allergens (animal dander, mold, pollen and dust)
If a pt is receiving TPN, an __________ can occur.
air embolism
If a pt receiving TPN gets an air embolism, pt needs to be placed in what position?
lateral Trendelenburg postion on the left side to displace air away from the pulmonary artery and into the apex of the heart; notify the physician.
When giving TPN, air enters the body via ________
CVP catheter
Symptoms of air embolism:
- dyspnea
- diaphoretic
- anxious
- restlessness
- coughing
- chest pain
Symptoms of hyperglycemic reactions with TPN:
- headache
- weakness
- nausea
- vomiting
- dehydration
- osmotic dieresis
- hypovolemic shock
Whenever a pt is receiving TPN what should be checked?
serum glucose every 6 hours and electrolytes every several times a week
If a TPN line is unable to be flushed, what should you do?
the lumen should be labeled as clotted off, a Luer -Lock cap should be placed and a physical should be notified
__________should never be used for a pt with a tracheostomy.
Powder, it could occlude the airway
Why should tracheostomy dressing never be cut?
it could leave fibers that would occlude the airway
Tracheostomy dressing needs to be __________
pre-cut
After intubation what needs to be assessed?
bilateral lung sounds and bilateral chest excursion
Flail chest is caused by ________
a free floating segment of rib resulting from multiple rib cage fractures
___________is a common thoracic injury and is frequently associated with flail chest.
pulmonary contusion
Mild to moderate flail chest is treated by?
monitoring fluid intake and appropriate fluid replacement with relieving chest pain.
How is severe flail chest treated?
endotracheal intubation and mechanical ventilation are required to provide internal pneumatic stabilization and to correct abnormalities is gas exchange.
Flail chest is frequently a complication of ___________
blunt chest trauma from steering wheel injury
What frequently accompanies a flail chest?
retention of airway secretion and atelectasis
Vital signs must be monitored on pts with flail chest for _________
shock
2 Nursing recommendations for its with flail chest:
- give pain meds
2. pt should be encouraged to turn, cough and deep breath to promote lung expansion
If a pt has flail chest, you must assess for ___________ and __________
hypoxemia and hypercapnia
What is nasal polyps?
a grape-like swelling in the mucus membranes of the sinuses; may cause obstructions and chronic infection
A pt with respiratory rate about 20 and oxygen saturation about 90% on room air is _______
stable
A pt with two inhalers, one is a bronchodilator and the other one is a steroid. Which one goes first and why?
the bronchodilator should be used first because if will open the passageways so that the steroid medication can get into the bronchioles
How long should you wait from the time you use the bronchodilator and the steroid?
one minute for best effect
What are Cheyne-Stokes respirations?
breathing pattern marked by a period of apnea lasting 10 - 60 seconds followed by hyperventilation
If a pt has Cheyne-stroke respirations that means that they may be __________
dying
Tachypnea is associated with _________
pneumothorax
_______ or ________ can occur with pneumothorax
absent or restricted movements
What happens with pts that have subcutaneous emphysema?
you hear crackling under the skin; pts need to be observed for respiratory distress
Hyperpnea (deep, rapid respirations) causes:
metabolic acidosis and diabetic ketoacidosis
2 manifestations of lung cancer:
- pain comes from the tumor invading perivascular nerves
2. blood tinged sputum comes from bleeding of the malignant tumor
________ is a common cause of SIADH.
Lung cancer
Signs and symptoms of SIADH:
- confusion
2. urine output of
What should be given to pts with SIADH:
diuretics to promote fluid loss
What will a tumor in the pituitary gland cause?
lack of ADH, causing diabetes insipidus and diuresis with very low specific gravity
What it tidal volume?
the volume of air inspired and expired in a normal breath
5 things to know about mechanical ventilators:
- no water should be in tubing
- check tubing for water and remove; use humidifier
- settings should be set at 1.5 times tidal volume and occur every 1 - 3 hrs
- settings are based on findings of ABG
- machine is adjusted to deliver the lower concentration of oxygen to maintain normal ABG
What is croup?
an acute viral disease that is marked by a barking cough, stridor and respiratory distress
What kind of precaution do you need with croup?
contact precaution
What does stridor indicate?
an upper airway obstruction
What kind of sound do you hear if a pt has stridor?
a harsh, high pitch noise on inspiration
What do you do before you do Heimlich maneuver?
ask the pt if he can speak first, if not then perform Heimlich maneuver
If the pt is unconscious and you need to perform Heimilch maneuver what position do you take?
straddle victim’s thighs, place hands one over the other with heel of the bottom hand just about the victim’s navel, quickly thrust inward and upward
There are ______ valves to auscultate
4
Valvular sounds of the heart radiates with the ____________
direction of the blood flow
Which are the four valves?
Aortic valve
Pulmonic valve
Tricuspid valve
Mitral valve
Where is the aortic valve?
2nd right inter space
Where is the pulmonic valve?
2nd left inter space
Where is the tricuspid valve?
Left lower sterna border
Where is the mitral valve?
5th intercostal space, left mid clavicular line
Cystic fibrosis causes ________ and ________.
COPD and pancreatic exocrine deficiency
Cystic fibrosis in inherited by ______
autosomal recessive trait
Pain from fractured ribs causes _________ breathing patters
shallow
_________ decreased lung expansion
Bed rest
_________ indicates a decrease in pneumonia.
White sputum
First sign of tension pneumothorax is ___________.
left sided tracheal shift from midline
What is tension pneumothorax?
air enters the pleural space but cannot escape leading to increased pressure, resulting in lung collapse.
Proper treatment of epiglottis includes:
- moist air
- IV antibiotics to decrease swelling
- use pulse oximetry
2 things to avoid if a pt has epiglottis:
- the insertion of a tongue blade; gag reflex can cause complete obstruction
- crying of child, which can obstruct the airway
When a pt comes to acute respiratory distress, pt may experience __________
hypotension from decreased cardiac output; monitor blood pressure closely
_________ indicates acute respiratory distress.
absence of a wheeze
Crackles is the same as __________
rales
Crackles and rales are caused by ____________
air through fluids, NOT usually seen with asthma
Rhonchi occurs when _________
there is a partial non fluid airway obstruction; NOT expected with asthma.
A sucking sound on inspiration and expiration describes a _______
sucking chest wound
What is the best thing to do with a sucking chest wound?
place a sterile dressing loosely over the wound, which will allow air to escape but not re-enter the pleural spasm. This is an open pneumothorax
What is Hantavirus pulmonary syndrome (HPS)?
an acute respiratory illness characterized by acute non-cardiogenic pulmonary edema
Pts with hantavirus pulmonary syndrome must be assessed for: (5 things)
- thrombocytopenia
- hematuria
- hematemesis (vomiting blood)
- bleeding gums
- melena (black tarry feces)
HPS is caused by:
rodents
Symptoms of HPS include:
- fever
- aching
- nausea
- no seizures
3 things to know about lead:
- hot water dissolved lead in pipes, so it contains a higher level of lead than cold water. Use cold water for drinking and cooking.
- more lead is absorbed in an empty stomach
- old houses have lead
It is good to attempt to wean a pt’s supplemental oxygen supply to _______
room air
Normal SaO2 is _________
95 - 100 %
What SaO2 percentage is considered an emergency?
below 86 - 91%
What SaO2 percentage is considered life threatening?
below 70%
Pts with COPD who have hypercapnia is at risk for _______
oxygen-induced hypoventilation because the stimulus for breathing is a low oxygen level instead of a high CO2 level like in normal pts.
Signs of hypoventilation appear _________of O2 administration.
30 minutes; color will improve due to the increase of PaO2 levels, going from gray to ashen to pink before becoming apneic or or going into respiratory distress.
Heaviness of the chest may be a sign of ______
pulmonary embolus and requires immediate attention.
What do you assess for if you suspect pulmonary embolus?
SOB and chest pain
After a laryngectomy, _________ is used around the stoma to soften the crust so that they can remove with sterile tweezer.
A & D ointment
4 things to know about a laryngectomy:
- humidifier or nebulizer should be provided
- leave stoma uncovered when taking a bubble bath for humidification to liquefy secretion
- cover stoma when taking a shower to prevent water from entering the airway
- cover the stoma with a cotton scarf when outside to provide protection and prevent mucus from soiling clothing
How do its with a laryngectomy initially communicate after surgery?
in writing
How do its with a laryngectomy later on communicate?
by artificial larynx or esophageal speech (modulation of air expelled from the esophagus to produce speech)
The nurse must teach the pt how to use esophageal speech. What do you instruct the pt?
have the pt swallow air and then eructates it while forming words with the mouth
Pt will require a __________ to prevent scar tissue contractures.
laryngectomy tube
Pts with a laryngectomy will develop difficulty with ________ and ________
taste and smell
Pts with laryngectomy require nutritional support for _______ until wound heals
10 days
Will a patient be able to sing, whistle or laugh using laryngeal communication?
no
A bad, hoarse voice is related to _________
tracheal esophageal fistula
What is the purpose of the incentive spirometer?
to promote lung expansion
How do you use the incentive spirometer?
- pt should inhale and hold breath for 3 sec.
2. encourage pt to cough after using spirometer
Spirometer prevents respiratory ________
acidosis
When ___________ a child will be better able to use the incentive spirometer.
pain is decreased
The correct position to give CPR:
- elbows should be locked
- arms straight
- shoulders directly over hands when doing compressions
- the heel of the hand should be on the lower half of the sternum
- pts pulse should be checked every minute
CPR is considered ___________
trauma
TPA should not be used in pts with have experience trauma and ___________ is trauma
CPR
Best way to heal laryngitis?
rest of voice for at least 24 hrs
Post op complication of laryngectomy?
respiratory difficulties
Pneumocystitis jiroveci pneumonia causes progressive ______ and __________
hypoxemia and cyanosis
Pursed lip breathing prevents _______
collapse of the lungs
6 things that suggest a pt is experiencing hypoxia while on a mechanical ventilator:
- confusion and agitation
- cyanosis
- anxiety
- tachycardia
- increased respiratory rate
- the nurse should manually ventilate at 100% oxygen
Symptoms of pulmonary embolism is the feeling of ______ and _______
chest pain and doom
3 things that contribute to the development of pulmonary emboli:
- obesity
- immobility
- pooling of blood in the pelvic cavity
9 complications from thoracentesis:
- pulmonary edema
- hypoxia
- hemothorax
- pneumothorax
- subcutaneous emphysema
- SOB
- faintness
- chest pain
- blood sputum
What is synchronized intermittent mandatory ventilation (SIMV) for?
it allows pt to be weaned from the ventilator, it allows for spontaneous breaths at his own rate and tidal volumes between ventilator breaths.
What does is mean if the abdomen is distended and food like material is in the endotracheal tube?
It indicates that the ET tube is in the stomach
If a pt has COPD the oxygen rate cannot be too fast because…
the pt can develop hypercapnia (hypercarbia), which will require a lower rate of oxygen administration, 1 - 2 L/min; oxygen needs to be titrated to the lowest dose possible
