Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NCLEX > Respiratory > Flashcards

Respiratory Flashcards

You may prefer our related Brainscape-certified flashcards:
NCLEX-RN® flashcards NCLEX-PN® flashcards
1
Q

Position for a thoracentesis?
Can’t do what during it?

What if they can’t sit up?

Good lung where?

Where is the fluid/blood/exudate being removed from and allowing what?

A

Sit up, leaning over or backwards on a chair
NO coughing of deep breathing

Lie on unaffected sided with HOB up 45 degrees

*Good lung DOWN

Removed from pleural space, allowing the lung to expand

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Thoracentesis at risk for what?

Post op do what?

A

Fluid volume deficit: check vitals!

CXR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Reason for chest tube?

Where are they placed to remove air vs fluid?

Can they have both?

A

Collapsed lung

Air: 2nd IC space
Fluid: 8-9th IC space

YES - Y connected

May be midaxillary for air and drainage***: have to cut through pectoral muscles and have longer healing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What kind of dressing is over a chest tube?

What does the CDU do?

A

Air-tight

CDU: Restore normal vacuum pressure in the pleural space through a 1-way system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Purpose of water seal?

How much water is in it?

A

Prevent back flow of air by a 1-way flow

2cm water

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Where does air vs drainage go in the CDU?

A

Drainage: 1st chamber
Air: Goes through water seal and vented out of suction chamber

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Suction chamber

What kind of where is place how high?
What does this do?

Turn up the wall suction until when?

A

Sterile water to 20 cm line

This prevents too much negative pressure in the pleural space

Until you have slow, gentle, continuous suctioning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Report pulse ox when?
How often to report drainage?
Want this patient to do what to help reexpand the lungs?

When should you report to the physician?

A

Below 90%
First 24 hours, then every 8
Cough, deeb breathe, IS (prevent pneumonia/atelectasis)

*Assess BOTH lungs

REPORT IF there is over 100ml in the first hour, or if there is a change in color to bright red

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

S/S infection of chest tube

A

Fever, WBC, drainage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What to watch daily in chest tube patient?

A

CXR for lung re-expansion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What happens if the chest tube is not below the chest?

A

No gravity drainage and fluid will go back in

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What does tidaling mean?

What does it mean when they stop?

A

There are no kinks or disruption in the tubing - tape all connections

The lung has re-expanded (usually)
May also stop if there is a kink/clot in the tubing, of if there is a defendant loop

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What do you do if the chest tube tubing becomes disconnected?

A

Have another sterile connector at the bed side and reconnect is ASAP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What do you do if the CDU falls over and water leaks out or goes into the drainage department?

What happens if there isn’t water in the water seal chamber?

Have the patient do what?

A

Do WHATEVER to re-establish that water seal! Because we NEED water in that water seal to 2 cm! You can even stick the water seal tubing end in a glass of water

Air can cause LUNG COLLAPSE!

Have patient deep and cough in case any air went into the pleural space

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What if the chest tube gets pulled out?

No gauze?

A

Sterile gauze 3 sided tape

Put your hand there and YELL

If nothing: every time they breathe, they will pull air into the pleural space

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

BUBBLING NORMALS

Suction chamber
Water seal

A

Suction Chamber: gentle continuous bubbling

Water Seal: intermittent in pneumo pt that is coughing, sneezing, or taking a deep breath
Continuous water seal: air leak
- MD may want you to clamp the tube

As long as the intermittent bubbling is there, air is still leaking out and the chest tube needs to remain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Never do what to a chest tube without an order? Why?

A

Clamp!! Could lead to a tension pneuma

NEED AN ORDER!!!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How to remove a chest tube

A

Have patient take a deep breath and hold

Place occlusive petroleum dressing over the site

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

S/S of hemo/pneumothorax

Lungs?
Pain?
Vitals?
Movement?
XR results show what?
A 
SOB, cough
Tachycardia
Diminished lung and less movement on affected side
Chest pain
SC emphysema`in neck/face/chest

XR: Air or fluid/blood

20
Q

RULE about a penetrating object

What about eye injury?

A

NEVER pull it out!!

Cover both eyes

21
Q

How to treat hemo/pneumo?

A

Thracentesis, Chest tube, Daily CXR

22
Q

Causes of a Tension Pneumo

What is happening?

A

Trauma
PEEP
Clamping a chest tube
Taping all 4 sides of pneumothorax

*Pressure causes collapsed lung, air can’t get out, pressure pushes everything to unaffected side

23
Q

S/S Tention pneumo

How is this fatal?

A

SC emphysema
Absent breath sounds on affected side
RR distress
Thorax moved

Accumulating pressure compresses vessels, decreasing venous return, thus decreasing CO

24
Q

How to treat a tension pneumo

A

Large Bore needle placed at 2nd ICS to allow air to escape

THEN the cause is found and patient gets a chest tube

25
Q

Open Pneumo (sucking wound)

Treatment

Positioning?

A

DON’T PULL STUFF OUT

Have patient valsalva to decrease air coming in
3-sided tape

Sit up if they can to expand the lungs
Stay flat if they are a trauma to prevent other injuries

26
Q

S/S Fib fractures

Hemodynamics

A

PAIN - splinting
Crepitus (bones grinding)
Shallow RR

Respiratory Acidosis

27
Q

How to treat rib fractures—

What kind of pain meds?
What will assist with coughing?
How to splint?

What is not recommended to use? Why?

Observe for what?

A

Non-narcotics
Nerve blocks
Support area with hands

Not recommended to use immobilizers like chest binders and straps because it could lead to shallow breathing, atelectasis, and pneumonia

Observe for Cx like Pneuma/Hemo, flail chest

28
Q

S/S Flail chest

A 
PAIN
See-saw (Paradoxical)
SOB
Cyanosis
Increased pulse
29
Q

Flail chest - how to assess for symmetry?

A

Stand at the foot of the bed

30
Q

How do you treat flail chest?

A

MV

PEEP

31
Q

How does PEEP work?

Reasons for use?
Classic reason?

A

Positive pressure on end expiration to keep alveoli open

Flail chest: Expands and realigns the ribs so they will grow back together

May be used for pulmonary edema or severe hypoxemia

Classic reason: ARDS

32
Q

Bi-Pap mechanism?

Who uses this?

A

Different levels of positive pressure support + O2

ARDS, COPD, HF, sleep apnea, coming off vent

33
Q

C-PAP mechanism?

Used for who?

A

Continuous positive airway pressure

Used for obstructive sleep apnea

34
Q

PRIORITY ASSESSMENT when you have a patient on PEEP, CPAP/BiPAP????

A

LUNG SOUNDS!!! - The pressure could cause a pneumo!!

35
Q

Causes of PE

What can this lead to that causes HF?

A 
Dehydration
Immobile - venous stasis
Clotting disorders
Arrhythmias (a-fib)
Heart problems (DVT 90%)
Birth control pills

pulmonary HTN

36
Q

1?

S/S PE

PaO2?
Vitals?
Pain? Kind?

A

1 Hypoxemia: 100% can’t perfuse! Ventilation problem!

Restlessness
SOB
Cough - Hemoptysis
Decreased PaO2
Increase P and RR (because hypoxic)
Pulmonary HTN - leads to cor pulmonate (Enlarged R side heart)
Chest pain (sharp/stabbing)
37
Q

Diagnostics for PE

A

D-Dimer +
VQ scan +
Spiral CT / CT angiogram
CXR - atelectasis

38
Q

What does D-Dimer tell us?

A

Tells us if there is a clot ANYWHERE in the body… not just in the lungs

Can be positive from things like surgery!

39
Q

What does a VQ scan show?

What does it use?

Remove what?

A

Looks at blood flow to the lungs

DYE
Remove jewelry from chest area

40
Q

Best way to prevent PE

A

PREVENT!
Ambulate and hydrate
Do isometric exercises to decrease stasis

41
Q

Treatment of PE

Give what ASAP?
Meds?
Monitor what?
What precautions?
Surgery?
A

OXYGEN! - according to ABG

Anti-coagulants - usually start on Hep and go home on Warfarin (can be on both)

Pain meds

Monitor ABG
Monitor clotting factors

Bleeding precautions

Can do surgery

42
Q

Position after a PE?

A

BED REST - worry about dislodging a clot!

Elevate extremities to increased venous return and decrease pooling

43
Q

What else can be used to increase venous return and decrease pooling?

What if they have a clot?

Size?

How often to remove?

A

TED hose

NEVER USE ON A CLOT

Need to be fitted

Twice a day

44
Q

PE what will decrease inflammation?

A

Warm, moist heat

NEVER put cold on a vein

45
Q

What do we need to limit when taking Warfarin?

A

Green leafy veggies
Foods high in K!

No more than 3 times per week

46
Q

Normal clotting times

aPTT
PT
INR

A

aPTT: 30-40
PT: 11-13
INR: 2-3

47
Q

Who can transport a patient with a chest tube?

A

RN
LPN for STABLE patient

*Ongoing monitoring while they are being transported

NCLEX (23 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions