Respiratory Flashcards
What are expected symptoms for a client admitted for heart failure-related fluid overload?
Dyspnea, orthopnea (laboured breathing in supine position), and paroxysmal noctural dyspnea (waking suddenly with difficulty breathing)
Rales or crackles
What are risks associated with suctioning?
Hypoxemia, microatelectasis, cardiac dysrhythmias
What is done to minimze both the amount of oxygen removed and mucosal trauma when suctioning?
Suction is only applied when removing, not inserting, the catheter into the artificial airway
What types of aerosols can be useful for thinning out secretions in patients with mechanical ventilators?
Sterile NS aerosols
Acetylcysteine (Mucomyst) aerosol
Aerosol therapy may induce ________ in certain individuals and can be relieved by the use of a __________.
bronchospasm
bronchodilator
What is the purpose of morphine administration in patients on a mechanical ventilator?
Promote breathing syncrhony, reduce anxiety and promote comfort
What is recommended prior to suctioning to reduce risks of hypoxemia, microatelectasis and cardiac dysrhythmias?
Preoxygenation with 100% oxygen for 30 seconds prior to suctioning
Suctioning time should be limited to how long?
10-15 seconds
Describe peak expiratory flow measurements.
- Before each use, slide the indicator on the numbered scale on the flow meter to 0 (or the lowest value), and stand or sit as upright as possible
- Inhale deeply, place the mouthpiece in the mouth, and close the lips tightly around the mouthpiece to form a seal
- Exhale as quickly and completely as possible and note the reading on the numbered scale.
- Repeat the procedure 2 more times, with a 5-10 second rest period between exhalations.
- Record the highest reading in the peak flow log.
Oxygen delivery apparatus used in a medical emergency
What should the liter flow be?
Non-rebreather mask
15L/min
Device recommended in post-op clients to prevent atelectasis assocaited with incisional pain
Incetive spirometry
What are guidelines prior to use of incentive spirometry?
Adequate pain medication administration
5-10 breaths per session every hour while awake
What are the instructions for using an incentive spirometer?
- Assume a sitting or high Fowler position (promotes lung expansion), and exhale normally
- While holding the device at an even level, seal the lips tightly on the mouthpiece to prevent leakage of air around it
- Inhale deeply through the mouth until the piston is elevated to the predetermined tidal volum.
- Hold the breath for at least 2-3 seconds as this maintains maximual inhalation
- Exhale slowly to prevent hyperventilation
- Breathe normally for several breaths before repeating the process
- Cough at the end of the session to help with secretion expectoration
Patients with CF are at great risk for these two conditions.
recurrent lung infections
pneumothorax
What signs and symptoms may indicate pneumothorax in a patient with CF?
What may be the only early sign?
sudden, worsening dyspnea, tachypnea, tachycardia, sudden drop in SpO2
Sudden drop in SpO2 may be the only early sign
Why do CF patients suffer from constpiation?
Why do they suffer from malnutrition?
reduced salt and water secretion in intestines
lack of enzyme secretion in GI tract
Describe the steps for tracheostomy suctioning.
- Place the client in semi-Fowler’s position, if not contraindicated to promote lung expansion and oxygenation
- Preoxygenate with 100% oxygen to prevent hypoxemia and microatelectasis; alternatively, have the patient take 3-4 deep breaths
- Insert the catheter gently the length of the airway without applying suction to prevent mucosal tissue damage.
- Withdraw the catheter slightly if resistance is felt at the carina (bronchi bifurcation)
- Apply intermittent suction while rotating the suction catheter during withdrawal to prevent mucosal tissue damage. Limit suction time to 5-10 seconds with each suction pass to prevent mucosal tissue damage and limit hypoxia
How is TB transmitted?
What precautions are used?
Airborne
N95 respirator, negative pressure isolation room with HEPA filter
gloves, gowns, google and face shield as needed
How is chicken pox spread?
How about shingles?
Airborne if lesions are uncrusted
Shingles is only spread by airborne routes in disseminated disease or immunocompromised clients
What is done in the event of accidental dislodgement of a tracheostomy?
If the tracheostomy is mature (> 7 days), the nurse should attempt to open the airway by inserting curved hemostat to maintain stoma patency and insert a new tracheostomy tube with an obturator
if the stoma is immature, or the nurse cannot get a tube in, the nurse may need to place an occlusive dressing over the stoma and bag-valve mask to ventilate the lungs
What are interventions to facilitate airway clearance for pneumonia?
Hydration - 2-3L/day Huff coughing pain management Chest PT Fowlers position or side lying with good lung in dependent position
Pursed lip breathing is helpful for these patients.
COPD patients
What signs and symptoms are expected in patients with pneumonia?
Lung crackles (fine or coarse)
Increased vocal/tactile fremitus
Bronchial breath sounds in peripheral lung fields
Unequal chest expansion (on palpation)
Dullness (on percussion)
Fever, chills, productive cough, dyspnea, pleuritic chest pain
When would hyperresonance be heard?
Pneumothorax (air in pleural space) or in asthma/emphysema (over-inflated lung)
Which condition would lead to tracheal deviation?
Tension pneumothorax
