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Nursing 202 - Midterm > Respiratory - Ch 21 > Flashcards

Respiratory - Ch 21 Flashcards

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1
Q

Hypoxemic hypoxia

A

Decreased O2 level in blood due to decreased oxygen perfusion

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2
Q

Hypoxemic hypoxia

Causes

A

Hypoventilation, high altitude, ventilation-perfusion mismatch, atelactasis

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3
Q

Hypoxemic hypoxia

Treatment

A

Increase alveolar ventilation by providing supplemental oxygen

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4
Q

Circulatory hypoxia

A

Results from inadequate capillary circulation

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5
Q

Circulatory hypoxia

Causes

A

Decreased CO, local vascular obstruction, low-flow states (shock, cardiac arrest)

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6
Q

Anemic hypoxia

A

Result of decreased effective hgb concentration —> decrease in oxygen-carrying capacity of blood

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7
Q

Anemic hypoxia

Causes

A

Carbon monoxide poisoning

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8
Q

Histotoxic hypoxia

A

Occurs when toxic substance (cyanide) interferes w/ability of tissues to use available O2 —> reduction in ATP production

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9
Q

Oxygen toxicity

Cause

A

Too high concentration of O2 (50% or higher) for extended period of time

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10
Q

Oxygen toxicity

S/S

A

Substernal discomfort, paresthesias, dyspnea, restlessness, fatigue, malaise, progressive respiratory difficulty, refractory hypoxemia, alveolar atelactasis, alveolar infiltrates on XR

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11
Q

Nasal cannula

Flow rates

A

1-6 L/min

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12
Q

Nasal cannula

O2 % settings

A

24-44%

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13
Q

Nasal catheter

Flow rate

A

1-6 L/min

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14
Q

Nasal catheter

O2 % setting

A

24-44

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15
Q

Mask, simple

Flow rate

A

5-8 L/min

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16
Q

Mask, simple

O2 % setting

A

40-60

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17
Q

Mask, partial rebreathing

Flow rate

A

8-11

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18
Q

Mask, partial rebreathing

O2 % setting

A

50-75%

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19
Q

Mask, non-rebreathing

Flow rate

A

10-15

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20
Q

Mask, non-rebreathing

O2 % settings

A

80-95

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21
Q

Mask, Venturi

Flow rate

A

4-8

22
Q

Mask, Venturi

O2 % setting

A

24, 26, 28, 30, 35, 40

23
Q

Tracheal catheter

Flow rate

A

1/4-4

24
Q

Tracheal catheter

O2 % setting

A

60-100

25
Q

How to use IS

A
  1. Semi-Fowler’s position
  2. Diaphragmatic breathing
  3. Place mouthpiece firmly in mouth, breathing in slowly through mouth, hold breath for 3 sec, exhale slowly through mouthpiece
  4. Cough during & after each session, splint incision if coughing postop
  5. Perform procedure 10x/hr while awake
26
Q

Mini-nebulizer therapy

Indication

A

Difficulty clearing secretions, reduced vital capacity, unsuccessful with simpler methods

27
Q

Postural drainage position

Anterior lower lobes, basal segments

A

Right side lying w/2 pillows under hip

28
Q

Postural drainage position

Anterior upper lobes

A

On back w/2 pillows under butt

29
Q

Postural drainage position

Anterior lower lobes w/lateral basal segments

A

L side lying on 2 pillows under hip

30
Q

Postural drainage position

Anterior upper lobes, apical segments

A

Semi-Fowler’s w/pillows behind back

31
Q

Postural drainage position

Posterior lower lobes, superior segments

A

Prone w/2 pillows under hips

32
Q

Postural drainage position

Posterior upper lobes, posterior segments

A

Sitting up, leaning slightly forward, holding pillow against stomach

33
Q

HFCWO

A

High-frequency chest wall oscillation

Type of percussion/vibration to break up secretions

34
Q

ET intubation

Nursing interventions

A
  • Check symmetry of chest expansion, auscultate breath sounds
  • Obtain capnography & end-tital CO2
  • CXR to ensure proper tube placement
  • Check cuff Q6-8 hrs
  • Monitor for S/S of aspiration
  • Ensure high-humidity (visible mist should appear in T piece)
  • Admin O2 as RX’d
  • Oral hygiene & oropharynx suction
35
Q

Indications for mechanical ventilation

A

Labs: PaO2 <55, PaCO2 >50, pH <7.32, vital capacity <10, negative inspiratory force <25, FEV1 <10

S/S: apnea/bradypnea, respiratory distress w/confusion, increased work of breathing not relieved by other interventions, circulatory shock, controlled hyperventilation (patient w/TBI)

36
Q

Positive-pressure ventilators

A

Inflate lungs by exerting positive pressure on airway, pushing air in, and forcing alveoli to expand during inspiration

Volume-cycled ventilators, pressure-cycled ventilators, high-frequency oscillatory ventilators, noninvasive positive-pressure ventilation

37
Q

Volume-cycled ventilator

A

Deliver a preset vol of air w/each inspiration

38
Q

Pressure-cycled ventilator

A

Delivers a flow of air (inspiration) until it reaches a preset pressure and then cycles off, expiration occurs

39
Q

High-frequency oscillatory support ventilators

A

Deliver very high respiratory rates (180-900 breaths/min) that are accompanied by low tidal volumes & high airway pressures

Used to open alveoli in situations with closed airways —> atelectasis & ARDS

40
Q

Non-invasive positive-pressure ventilation

A

Given via facial mask/cannula/oral airway device
For patients that can breathe on their own but need a little help, provides backup care for pts with periods of apnea

CPAP, BiPAP, PEEP

41
Q

Interventions to prevent VAP

A
  • Elevation of bed 30-45
  • Daily “sedation vacations” and assessment of readiness to extubate
  • Peptic ulcer disease prophylaxis
  • DVT prophylaxis
  • Daily oral care with chlorhexidine (0.12% oral rinses)
42
Q

Controlled mechanical ventilation (CMV)

A

Provides full ventilatory support by delivering preset tidal vol and respiratory rate

43
Q

Intermittent mechanical ventilation (IMV)

A

Combination of mechanically assisted breaths and spontaneous breaths

44
Q

Synchronized intermittent mandatory vent (SIMV)

A

Delivers a preset tidal vol and # of breaths per min. B/t ventilator-delivered breaths, patient can breathe spontaneously w/no assistance from vent on those extra breaths

45
Q

Gas exchange

Nursing interventions

A
  • Use of analgesics to relieve pain w/o suppressing respiratory drive
  • Frequent repositioning
  • Monitor fluid balance: peripheral edema, I&O, daily weight
  • Admin meds to control primary disease
46
Q

Effective airway clearance

Nursing interventions

A
  • Assess lung sounds Q2-4 hrs
  • Measures to clear airway: suction, CPT, positioning, promote increased mobility
  • Humidification of airway
  • Admin meds
47
Q

Trauma & infection

Nursing interventions

A
  • Infection control measures
  • Tube care
  • Cuff management
  • Oral care
  • Elevation of head of bed
48
Q

Potential complications for mechanical vent

A
  • Alterations in cardiac function
  • Barotrauma, pneumothorax
  • Pulmonary infection
  • Delirium
49
Q

Weaning criteria

A
  • Vital capacity 10-15
  • Maximum inspiratory pressure (MIP) at least -20
  • Tidal volume 7-9
  • Minute ventilation 6L/min
  • Rapid/shallow breathing index: below 100 breaths/min, PaO2 >60, FiO2 <40%
50
Q

Criteria to terminate weaning process

A
  • HR increase of 20 bpm, systolic BP increase of 20
  • Decrease in SpO2 <90%, RR <8 or >20
  • Ventricular dysrhythmias
  • Fatigue, panic, cyanosis, erratic/labored breathing, paradoxical chest movement
51
Q

How often should nurse monitor chest tube drainage? What should be documented?

A

-Q2hrs, document amt & character

52
Q

When to notify HCP of chest tube drainage

A

> 150 mL/hr

Nursing 202 - Midterm (12 decks)

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