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z Here you go, Alexis! > respiratory > Flashcards

respiratory Flashcards

1
Q

hemothorax/pneumothorax: definition

A

blood or air has accumulated in pleural space and lung has collapsed

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2
Q

hemothorax/pneumothorax: s/s

A
  • shortness of breath
  • diminished breath sounds (affected side)
  • increased heart rate
  • less movement on the affected side
  • chest pain
  • cough
  • blood (dark) or air (light) shows up on the chest xray
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3
Q

subcutaneous emphysema

A

air trapped in the tissue (usually neck, face, chest)

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4
Q

hemothorax/pneumothorax: treatment

A

thoracentesis
chest tubes
daily chest xray

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5
Q

if pneumothorax is present and client has chest tube, what type of bubbling expected in water seal chamber?

A

intermittent

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6
Q

tension pneumothorax: causes

A

trauma
PEEP
clamping a chest tube
taping an open pneumothorax on all 4 sides without air valve

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7
Q

tension pneumothorax: pathophys

A

lung has collapsed due to pressure build up in chest/pleural space

pressure causes mediastinal shift

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8
Q

tension pneumothorax: s/s

A 
SQ emphysema
absence of breath
sounds on one side of lung
asymmetry of thorax
respiratory distress
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9
Q

tension pneumothorax: can be fatal…

A

as accumulating pressure compresses vessels which decreases venous return and ultimately CO

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10
Q

tension pneumothorax: treatment

A

large bore needle in 2nd ICS
- allows excess air to escape

find the cause

chest tube insertion

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11
Q

open pneumothorax aka

A

sucking wound

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12
Q

open pneumothorax: pathophys

A

opening through chest allows air into pleural space

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13
Q

open pneumothorax: treatment

A

have client inhale and hold/Valsalva (hum)
- increases intrathoracic pressure so no more air can get inside

place petroleum gauze over area + tape down 3 sides
- 4th sied acts like air vent/flutter valve

have client sit up to expand lungs
- trauma clients stay flat until evaluated for other injuries

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14
Q

most common injuries from chest trauma

A

rib/sternum fracture

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15
Q

rib/sternum fracture: s/s

A 
pain, tenderness
crepitus
shallow respirations
- will eventually lead to...
respiratory acidosis
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16
Q

rib/sternum fracture: treatment

A

non-narcotic analgesic
nerve block to assist with productive coughing
support injured area with hands

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17
Q

rib/sternum fracture: treatment NOT recommended + why

A

immobilization with chest binders/straps

  • could lead to shallow breathing, atelectasis, pneumonia
  • respiratory acidosis quickly
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18
Q

rib/sternum fracture: observe for which complications?

A

pneumothorax
hemothorax
flail chest

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19
Q

flail chest: definition

A

multiple rib fractures; paradoxical chest wall movement (see-saw chest) - chest sucks inwardly on inspiration and puffs out on expiration

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20
Q

to assess flail chest symmetry, do what

A

stand at foot of bed to observe how chest is rising and falling

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21
Q

flail chest: s/s

A

dyspnea
cyanosis
increased pulse
paradoxical chest wall movement

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22
Q

flail chest: treatment

A

stabilize area, intubate, ventilate

positive pressure ventilation stabilizes the area
- PEEP, BiPAP, CPAP

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23
Q

PEEP: definition

A

positive end expiratory pressure

  • client is on vent
  • on end expiration, vent exerts pressure into lungs to keep alveoli open
  • improves gas exchange and decreases work of breathing
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24
Q

PEEP: uses

A

flail chest (expands and realigns the ribs so they can start growing back together)
pulmonary edema
severe hypoxemia
ARDS (acute respiratory distress syndrome) classic

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25
Q

BiPAP: definition

A

bi-level positive airway pressure
-exerts different levels of positive pressure support, along with oxygen

over nose and mouth

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26
Q

BiPAP: uses

A

ARDS in clients with COPD
heart failure
sleep apnea

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27
Q

CPAP: definition

A

continuous positive airway pressure
- pressure delivered continuously during spontaneous breathing for both inspiration and expiration

nasal cannula

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28
Q

CPAP uses

A

obstructive sleep apnea

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29
Q

any time you see PEEP, CPAP, Bi-PAP, priority nursing assessment is…?

A

checking bilateral lung sounds

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30
Q

pulmonary embolism: cause

A

can occur if dehydrated, venous stasis from prolonged immobility or surgery, birth control pills, clotting disorders, heart arrhythmias (a fib)

31
Q

pulmonary embolism: s/s

A 
hypoxemia, decreased PO2 (100% O2 will not work)
shortness of breath
cough
increased RR, HR
hemoptysis
pulmonary hypertension
sharp, stabbing chest pain
32
Q

1 sign of pulmonary embolism

A

hypoexmia

33
Q

D-dimer test: purposes

A

reveals if there is a clot anywhere in the body

- often used for pulmonary embolism

34
Q

pulmonary embolism: labs/diagnostics

A

D-dimer (increased)
VQ scan (positive
spiral CT or CT angiography (positive)
chest x-ray (shows atelectasis)

35
Q

VQ scan: definition

A

ventilation/perfusion scan (blood flow to lungs) done by radiology that can detect embolus

36
Q

VQ scan: teaching point

A

remove jewelry from chest area to avoid false results

37
Q

D-dimer test is not ideal for post-surgical patient PE diagnosis why?

A

because it detects clots and there is definitely a clot in a post-surgical patient

38
Q

95% of PE come from

A

DVT

39
Q

100% O2 application works and doesn’t work for…?

A

works: COPD, coding patient

doesn’t: pulmonary embolism

40
Q

pulmonary embolism: treatment

A 
oxygen
ABG
decrease pain
heparin, warfarin/Coumadin, enoxaparin/Lovenox + bleeding precautions
surgery
bedrest
41
Q

pulmonary embolism: prevention

A

ambulate and hydrate
SCDs
isometric exercise (decreases stasis)

42
Q

decrease risk of DVT

A

increase venous blood return + decrease pooling

  • elevate extremities
  • TED hose
  • SCDs

with known clot, used TED/SCD on unaffected extremity or not at all

43
Q

warm, moist heat on DVT why?

A

improves circulation by decreasing inflammation

44
Q

DVT: never put cold on a vein, why?

A

excessive vasoconstriction

45
Q

DVT: never put hot on a vein, why?

A

excessive vasodilation

46
Q

thoracentesis: definition

A

removal of fluid/blood/exudate from pleural space

- as fluid is removed, lung should re-expand

47
Q

thoracentesis: monitor for ? and how

A

you are removing fluid: monitor for fluid volume deficit by monitoring vitals

48
Q

thoracentesis: pre-procedure and post-procedure

A

pre

  • chest x-ray
  • baseline vitals

post
- chest x-ray

49
Q

thoracentesis: positioning x3

A
  • sitting up leaning over bedside table
  • sitting in chair backwards, propped up over back
  • can’t sit up: lie on unaffected side with HOB 45*
50
Q

why are chest tubes inserted?

A

collapsed lung

51
Q

chest tube: placed where for removal of AIR?

A

upper anterior chest, 2nd intercostal space

air rises!

52
Q

chest tube: placed where for removal of BLOOD?

A

laterally in lower chest, 8th or 9th intercostal space

drainage settles!

53
Q

can client have chest tubes placed for both air and blood?

A

yes - they are y-connected together and attached to CDU

54
Q

chest tube securement how?

A

sutured to chest wall
vaseline or air tight dressing applied around exit site
then connected to CDU

55
Q

CDU: definition

A

closed chest drainage unit; restores normal vacuum pressure in pleural space by removing all air and fluid in a closed one-way system until problem is corrected

56
Q

CDU: three chambers + purpose

A

1 - drainage collection
duh

2 - water seal
promotes one way flow out of pleural space which prevents air moving from system and back into chest

3 - suction control
controls the amount of pressure applied if client needs suction to remove air and fluid: suction regulator - NOT WALL VACUUM SUCTION

57
Q

what happens if drainage collection chamber of CDU fills up?

A

get a new CDU

58
Q

what bubbling is normal in the water seal chamber of a CDU?

A

intermittent bubbling when client coughs, breathes deeply, sneezes, exhales

59
Q

tidaling

A

seen with CDUs: slight rise and fall of water in water seal tube as client breathes

60
Q

tidaling ceases - indicates what?

A

usually means that lung has re-expanded

OR

kink/clot in tubing or dependent loop present in system

61
Q

CDU assessment

A
  • dressing intact and air tight
  • bilateral lung sounds
  • pulse ox
62
Q

CDU: drainage + notify provider

A

record drainage q hour for 24 hours then q 8’

notify provider:

  • greater than 100 mL drainage in 1 hour (think: if this, 1200 a shift!)
  • change in color to bright red
63
Q

CDU: watch patient for

A

fever, increased WBC, drainage: could develop infection at insertion site

daily chest x-rays for lung re-expansion

64
Q

CDU level: where and why?

A

below level of chest

why: gravity drainage. if lifted too high, drainage will go back in!

65
Q

CDU: what do you do if tubing becomes disconnected?

A

reconnect as fast as you can (air into pleural space results in collapsed lung)

keep another sterile connector at bedside

66
Q

CDU: what do you do if CDU falls over and water leaks out or shifts to drainage compartment?

A

do whatever you can to maintain water seal (bedside cup with water in it if you have to trololololol)

set CDU upright, check all chambers, fill water seal chamber to 2cm water

have client deep breathe and cough in case any air went into pleural space

67
Q

CDU: if there is not water in the water seal chamber then air can do what?

A

collapse lung

68
Q

what if chest tube is accidentally pulled out?

A

sterile vaseline gauze taped down on 3 sides (otherwise with every breath air will be pulled into pleural space)

69
Q

CDU: when is bubbling normal?

A

chest tube connected to suction - gentle continuous bubbling in suction chamber

client with pneumothorax coughs, sneezes, deep breath and exhalation - intermittent bubbling in water seal chamber

70
Q

client still needs the chest tube if…

A

intermittent bubbling; air is still leaking out of pleural space

71
Q

CDU: when is bubbling a problem?

A

continuous bubbling in water seal chamber (air leak in system) - try to fix before calling provider

72
Q

never clamp a chest tube without an order why?

A

risk of tension pneumothorax

73
Q

chest tube removal - how?

A

have client take a deep breath and hum (Valsalva)

place occlusive petroleum dressing over site

z Here you go, Alexis! (23 decks)

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