Respiratory Disorders & Oxygenation Resp Care Study Guide Flashcards
1
Q
What are nursing intervention for influenza, strep throat, laryngitis, acute rhinitis?
A
- Influenza
- Rest, fluids, and symptomatic medications are the most common approach to treatment.
- Rest can be in bed, on the couch watching TV, or wherever the client does not have to exert energy.
- Clients should keep warm and avoid exposure to other diseases.
- To promote healing and avoid dehydration, encourage the client to drink adequate quantities of fluids, including fruit juices, soups, and plenty of water.
- Fluids help the body to flush out wastes created by the virus.
- Milk may not be helpful because it can form a film in the throat.
- Clients may follow a regular diet, although they may be anorexic (without appetite). Soups can provide calories and fluids.
- Symptomatic medications include over the counter (OTC) analgesics such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin IB), which help with muscle aches and general pain.
- Do not give aspirin to children or teens because of the risk of Reye syndrome, which is a rare but potentially fatal illness.
- Strep throat
- Many adults who have recurrent streptococcal throat infections have permanently plugged Eustachian tubes;
- any change in atmospheric pressure is uncomfortable for them.
- Penicillin is the specific antibiotic prescribed for strep throat unless the person has an allergy or a penicillin-resistant streptococcal infection.
- Many adults who have recurrent streptococcal throat infections have permanently plugged Eustachian tubes;
- Laryngitis- inflammation of the larynx (voice Box)
- They should avoid talking and smoking and should receive high-humidity inhalations to soothe the throat’s mucous membranes.
- If laryngitis is a complication of another infection, antibiotics may be prescribed.
- If laryngitis is viral in origin, it is highly contagious.
- the client should avoid exposing others.
- They should avoid talking and smoking and should receive high-humidity inhalations to soothe the throat’s mucous membranes.
- Acute rhinitis (Common Cold)
- The most important treatment for a cold is rest.
- Rest also keeps the person from infecting others.
- Rest during a cold is especially important for infants, older adults, and debilitated clients because they are more susceptible to serious complications.
- Drinking plenty of fluids is essential to help reduce fever, replace lost fluids, and thin secretions.
- Aspirin, acetaminophen, or ibuprofen helps to relieve discomfort and reduce fever. Some authorities believe that vitamin C is helpful in preventing and treating colds.
- Remind the client to give strict attention to handwashing and using disposable tissues to prevent spreading the infection to others.
- The client should blow the nose gently to prevent the infection from spreading into the sinuses, ears, or Eustachian tubes.
- Antibiotics are not effective against cold viruses; however, antiviral agents may be prescribed.
- Sometimes, a throat culture is done.
- Culture can indicate strep throat, but a negative culture for streptococci does not necessarily mean that a strep infection is not present. (See the section on Throat Culture.)
- The person with a chronic respiratory condition, such as asthma, should consult a healthcare provider at the first sign of a cold. If the infection enters the lower respiratory tract, complications, such as laryngitis, bronchitis (inflammation of the bronchi), and pneumonia, can result.
2
Q
What are nursing intervention for patients with difficulty breathing?
A
- Orthopneic position is a position in which a person who has difficulty breathing (orthopnea) may utilize positioning to lessen the physical weight and gravity of the body during breathing.
- In orthopneic position, the intrathoracic spaces are opened and breathing is easier for the client with chronic lung diseases.
- In a hospital, the client may be in a high Fowler position leaning over pillows on top of a bedside table
3
Q
What are the normal range of Oxygen saturation?
A
95-100%
4
Q
Define the following, and what are the nursing instructions for those conditions.
- Hypoxia
- Hyperventilation
- Aspiration
- Hypoxemic Hypoxia
A
- Hypoxia:
- The tissue cells must have a constant oxygen supply to remain alive.
- Because the body does not store oxygen, the person normally obtains oxygen from the air (air is approximately 21% oxygen).
- In some types of illness, the body is unable to take in sufficient oxygen or cannot use it effectively.
- When the oxygen level in body tissues is inadequate, the client is said to have hypoxia
- Hyperventilation
- In hyperventilation, the person breathes abnormally quickly or deeply, resulting in too little carbon dioxide in the blood.
- The usual cause is anxiety or overexcitement.
- The hyperventilating person may have muscle spasms, dizziness, or faintness because of excessive oxygen and the depletion of carbon dioxide in the body.
- The easiest treatment is asking the client to breathe into a bag.
- The air the client rebreathes will contain excess carbon dioxide, replacing that which was lost.
- Aspiration:
- Pathologic aspiration is the inhalation or movement of fluid, mucus, or another unwanted substance into the lungs.
- It can cause lung disorders or death.
- Hypoxemic Hypoxia
- Hypoxemic hypoxia is a state of decreased blood oxygen level, leading to a decreased amount of oxygen in the tissues.
- Many situations can result in hypoxemic hypoxia:
- The client’s airway may be blocked, in which case respiration ceases or is ineffective.
- the lungs may be congested, in which case respiration is difficult and gradually worsens.
- an injury to the chest or lungs may cause difficulty in breathing.
- or chronic or acute infections in the lungs may interfere with breathing.
5
Q
What are the effects of aging in the respiratory system?
A
- Increased rigidity of thorax and diaphragm; chest wall loses mobility
- Decreased numbers of alveoli and diffusion ability, lungs more rigid
- Decreased strength in breathing and coughing, reduced muscle strength
- Size of chest wall decreases, because of kyphosis and osteoporosis.
- Immobility is common
- Atrophy of tonsils or removal of tonsils as a child; reduced mucous production
- Deviated septum, enlargement of nasal septum, excess cartilage growth, nasal enlargement
6
Q
Resulting disorders with loss of elasticity
A
- COPD
7
Q
What are nursing guidelines for oxygen administration?
A
- Explain about the dangers of lighting matches or smoking cigarettes, cigars, or pipes. Be sure the client has no matches, cigarettes, or smoking materials in the bedside table.
- Make sure that warning signs are posted on the client’s door and above the client’s bed (even if the entire facility is nonsmoking).
- Use caution with all electrical devices, such as heating pads, electric blankets, or the ordinary call light. Many healthcare facilities provide call lights with grounding devices or give such clients tap bells instead.
- Do not use oil on oxygen equipment. Be sure no traces of oil are on hands before adjusting an oxygen apparatus.
- Be aware of all potential sources of sparks, especially when administering oxygen by means of a containment device (e.g., a tent or isolate). Note: Items that appear innocuous (e.g., friction toys, electric razors) have caused explosive fire.
- With all oxygen delivery systems, turn the oxygen on before applying the mask.
- Gain the client’s cooperation. Inform the client of the therapeutic uses of oxygen before bringing equipment into the room. Reassure the client and family.
- Instruct the client not to change the position of the mask, cannula, or any of the equipment after it is in place.
- Maintain a constant oxygen concentration for the client to breathe; monitor equipment at regular intervals.
- Give pain medications, as needed; prevent chilling and try to ensure that the client gets needed rest. Be alert to cues about hunger and elimination.
- Watch for respiratory depression or distress.
- Encourage or assist the client to move about in bed. Many clients are reluctant to move because they are afraid of the oxygen apparatus.
- Make sure the tubing is patent at all times and that the equipment is working properly.
- Monitor, document, and report the client’s condition regularly.
- Provide frequent mouth care. Make sure the oxygen contains proper humidification.
- Keep in mind that oxygen does not control every breathing difficulty, but where it is indicated, it can dramatically improve a client’s condition. The person breathes more easily, the pulse rate drops, and an anxious attitude may change to a relaxed one.
- Discontinue oxygen use only after a healthcare provider has evaluated the client. Generally, you should not abruptly discontinue oxygen given in medium to high concentrations (>30%). Gradually decrease it in stages, and monitor the client’s arterial blood gases or oxygen saturation level.
- Wear gloves any time there is a possibility of coming into contact with the client’s respiratory secretions.
8
Q
For asthmatic patients, what are the nursing guidelines and patient education?
A
- Patient education
- Educate the client about the importance of avoiding triggers, increasing his use of inhaled medications, and using his peak flow meter daily
- Assist the client with his coughing efforts by gently tapping him on the back, raising his head during expiration, and instructing him to take slow deep breaths.
- Educate client regarding the importance of good nutrition in maintaining overall health and wellness and its effect on asthma symptoms.
- Nursing intervention
- The nurse also should frequently check the client’s pulse oximetry readings, blood pressure, heart rate, respiratory rate, and capillary refill time.
- Review all environmental exposures that may irritate or aggravate asthma, such as cold air drafts from windows, allergens, cigarette smoke, high pollen count, and pets.
- Use a spacer when administering medications for the treatment of asthma or have the patient take deep breaths using short puffs of air from their inhaler through pursed lips.
9
Q
Documentation for oxygen administration or inhalation. What does it entail?
A
- Monitor, document, and report the client’s condition regularly.
- Rationale: Regular observations and detection of potential or existing problems are necessary to determine the effectiveness of oxygen therapy.
- Observe the client’s respirations. Determine their rate, depth, and character.
- Document difficulty in breathing: abnormal movements, retractions, irregular breathing patterns, and abnormal breathing sounds.
- Auscultate lung sounds and document adventitious (abnormal) lung sounds.
- Determine the client’s level of comfort.
- Pain may lead to hyper- or hypoventilation.
- Be aware of conditions such as anxiety or restlessness.
- Lack of oxygen may be the cause of these symptoms.
- Measure the client’s pulse rate often.
- In respiratory distress, the pulse rate often rises.
- Monitor results of arterial blood gases (ABGs).
- Check pulse oximeter readings frequently.
- If indicated, monitor the client electronically (pulse, respiration, blood pressure, oxygen saturation).
- Observe for evidence of cyanosis.
- Monitor the oxygen delivery device for proper fit and usage.
- Check for signs of leakage.
- Document the settings of any equipment being used and your observations related to the client’s condition.
- Closely observe the client whose oxygen has been discontinued.
- If the client becomes short of breath, shows signs of cyanosis, or has a markedly increased pulse rate, resume oxygen, and call the healthcare provider at once.
10
Q
What are the causes of aspiration and types of pneumonia patients will be predisposed to?
A
- Pathologic aspiration
- is the inhalation or movement of fluid, mucus, or another unwanted substance into the lungs. It can cause lung disorders or death.
- Bacterial Pneumonia Streptococcus pneumoniae
- is the most common causative agent and can occur as a consequence of a cold or the flu. It typically affects one lobe of the lung, referred to as lobar pneumonia.
- Persons who are in poor general health, or who are physically inactive, as well as older people and those with chronic lung disorders, are most susceptible to bacterial pneumonia.
- Substance abuse, which may be a risk factor, becomes part of the overall problem because the individual tends to ignore personal health in lieu of lifestyle choices.
- Bacterial-Like Organisms
- Some pathogens are not specifically labeled bacteria or viruses.
- Mycoplasma pneumoniae, which may be called walking pneumonia, results in milder symptoms.
- Viral Pneumonia
- A variant of the influenza virus causes viral pneumonia.
- The person is treated symptomatically.
- Viral pneumonia is rarely fatal, but it may leave the client in a weakened condition.
- However, viral pneumonia can occasionally be very serious.
- A virus is the most common cause of pneumonia in children younger than 5 years.
- Fungal Pneumonia
- Individuals with chronic health conditions or who are immunocompromised are most likely to be contaminated by an inhaled fungus.
- The organisms are found in soil or bird droppings.
- Pneumocystis jiroveci pneumonia (PJP), formerly called pneumocystis carinii pneumonia (PCP), is caused by a fungus whose mechanisms are not totally understood. PJP is most commonly seen as one of the opportunistic diseases in the person with HIV/ AIDS infection, or with other individuals receiving immunotherapy, such as cancer or organ replacement.
- PJP does not respond to antifungal treatment.
- PJP is best treated with trimethoprim/ sulfamethoxazole (TMP/ SMX).
- Chemical Pneumonia
- Chemical pneumonia is largely associated with aspiration of a chemical substance.
- Be aware that a person may aspirate into the lungs without any obvious evidence of vomiting.
- Some people are at an extremely high risk, including older adult or postoperative clients, clients who abuse substances or are debilitated, and those with swallowing impairments.
- Aspiration Pneumonia
- If the person vomits or inhales a foreign object or substances, such as water or large amounts of mucus, the material may be drawn into the lungs.
- Complications also occur because gastric contents contain high acidity, which further irritates the lung tissues.
- Aspiration initiates the inflammatory process, which causes fluid accumulation and edema with a resulting pneumonia.
- Typical foreign materials may include emesis, saliva, food, drink, or, on occasion, a reaction to an irritant in gaseous form that is inhaled, such as gas fumes.
11
Q
What are the nursing intervention for patients with pneumonia?
A
- Always wash your hands and wear gloves, if indicated.
- Rationale: Proper handwashing and gloves help to prevent the spread of infection.
- Be alert for increasingly labored respirations.
- Rationale: If the person has difficulty breathing, they are given oxygen, usually by mask or cannula.
- Adjust the client’s position. An orthopneic position may be necessary.
- Rationale: Proper positioning helps the person to be more comfortable and to breathe more easily.
- Place a pillow lengthwise under the back.
- Rationale: This action encourages fuller chest expansion.
- Place a blanket around the shoulders if the person has chills.
- Rationale: A blanket provides comfort and warmth, minimizing energy expenditure.
- Keep the client’s bed dry.
- Rationale: Wet bed linens can chill the client.
- Take the client’s vital signs at least every 4 hr.
- Rationale: Frequent monitoring is necessary to allow for prompt detection and early intervention if problems arise.
- Attempt to control fever and discomfort with acetaminophen or ibuprofen, if ordered. Tepid sponges may also be ordered.
- Rationale: Fever is often very high and can be dangerous.
- Maintain the intravenous (IV) site or heparin lock.
- Rationale: This client is probably receiving IV antibiotics.
- Consider putting up the side rails if any sign of confusion exists. The clinical facility should have specific policies regarding limitation of movement and raised bedrails. Specific circumstances might need to exist, that is, a hazard or unsafe environment for the client. Safety is a priority nursing concern.
- Rationale: Elevated side rails can be considered a type of restraint, that is, a legal consideration.
- However the safety of the client must also be considered.
- You need to follow facility policy and consult with your supervisor if any questions or concerns arise.
- Encourage the client to cough and to expectorate secretions while splinting the chest.
- Rationale: Keep the lungs as free of secretions as possible. Splinting the chest helps to relieve the discomfort of coughing.
- Encourage deep breathing. Aerosolized treatments or incentive spirometry may be prescribed.
- Rationale: The lungs must be expanded as much as possible.
- Measure intake and output (I& O) and daily weights, if ordered.
- Rationale: Some clients may have edema. Others will need total parenteral nutrition (TPN) to maintain hydration and nutrition. Give small amounts of fluids frequently. Rationale: Fluids help to encourage hydration.
- Provide frequent mouth care; put water-soluble lubricant (not oily) on the client’s lips.
- Rationale: A fever causes the mucous membranes to be very dry; probably, this person also has been breathing through the mouth. Oil might be aspirated and is not used with oxygen.
- Keep the client’s surroundings quiet.
- Rationale: Rest promotes healing.
12
Q
What are nursing intervention for patients with chest trauma?
A
- Always wash hands and wear gloves.
- Rationale: Handwashing and gloves help to prevent infection transmission.
- Turn the client often.
- Rationale: Turning helps to facilitate drainage and prevent hypostatic pneumonia and other complications. The wound will drain the most when the client is lying on the affected side; however, because this can be uncomfortable, coordinate turning to this side with the time when the pain medication effectiveness is optimum.
- Be sure the client turns and coughs and uses the incentive spirometer, as ordered.
- Rationale: These actions help to prevent stasis of secretions.
- Monitor for signs of dyspnea, changes in rate of respiration, cyanosis, increased heart rate, chest pain, restlessness, orthopnea, or hemoptysis.
- Rationale: These symptoms could indicate that the chest suction is malfunctioning.
- Help the client to sit comfortably in the chair while the chest suction is operating.
- Rationale: Getting the client out of bed helps to minimize the risk for developing complications, in particular, respiratory complications. Sitting in the chair helps to promote lung expansion.
- If the client is up walking with tubes and drainage bags or bottles, be sure that the hemostatic clamps go along.
- Rationale: The client must always be within reach of the clamps in case of accidental dislodgement of tubes.
- Make sure the client is passing flatus rather than having gas pains or distention difficulties.
- Rationale: Abdominal distention can cause difficulty in breathing and extreme discomfort.
- Encourage ambulation and exercise.
- Rationale: Ambulation and exercise help the client recover more quickly and decrease any risks of complications.
- Maintain a level of comfort acceptable to the client, so that deep breathing and coughing can and will be done.
- Rationale: Ease of breathing enhances the client’s ability to comply with treatment.
- Remove and discard gloves and wash hands.
- Rationale: Washing hands is the most effective method of preventing cross contamination, even if gloves are worn during a procedure.
13
Q
What is patient education regarding Pulmonary Embolism, Pleura Effusion, Cystic Fibrosis and Asthma?
A
- Pulmonary Embolism:
- Prevent PE by encouraging clients to ambulate and to perform active exercises.
- Administer prophylactic anticoagulant therapy, as ordered. Pneumatic compression devices may be used on the legs.
- Antiembolism stockings or hose, such as TEDS, must be removed at least every 8 hr and reapplied.
- PE is an emergency that requires immediate reporting and corrective action.
- Administer oxygen to relieve hypoxemia and dyspnea. Obtain blood gases, as ordered.
- Other common treatments include anticoagulation therapy and thrombolytic therapy.
- Emergency surgery to remove the embolus may or may not be lifesaving.
- Give clients emotional support and calmly explain what is being done.
- Pleura Effusion:
- Treatment of pleurisy is similar to that of pneumonia: bed rest and restriction of activity, along with anti-inflammatory agents.
- Encourage the person to cough, but because coughing may be painful, apply hot or cold packs over the area or have the person lie on the affected side for comfort.
- Cystic Fibrosis:
- Treatment for maintaining optimum pulmonary function includes chest physical therapy, inhalation therapy, antibacterial drugs for the prophylaxis or treatment of infection, as indicated, and immunization against childhood communicable diseases.
- All immunizations should be maintained and given at appropriate intervals. Encourage physical activity because it improves mucus secretion as well as a positive self-image. Encourage the child to participate in any aerobic activity they enjoy. Limit activity, along with physical
- Asthma:
- Teaching must include the following:
- Use of routine (maintenance) medications and emergency (rescue) medications
- Use of a peak flow meter,
- a small piece of equipment used to determine lung function by showing how fast a person can exhale after deep inhalation
- When to call the healthcare provider When to go to the hospital for emergency care
- Have an action plan for asthma management.
- Know what medications you are using.
- Use the peak flow meter to determine how your lungs are functioning.
- Know your values for your personal best lung function and when you are at 50%–80% of your personal best.
- Check with your primary healthcare provider about situations in which you should start adding or changing medications, notify the provider, or seek emergency care.
- Know what triggers your asthma and take steps to identify and avoid things that may trigger an asthma attack.
- Rinse your mouth with water after using a steroid inhaler to help prevent fungal infections of the mouth.
- Rinse your inhaler mouthpiece daily.
- Use your inhaler properly as shown.
- Inhalers are not helpful if used incorrectly.
- Take your medications on time.
- Using medications regularly helps to prevent difficulties and complications.
- Teaching must include the following:
14
Q
What is the purposes of the following lab tests Throat culture, Sputum culture, Lavage specimen and Blood gas determination?
A
- Throat culture
- A sore throat, or pharyngitis, is inflammation, but not necessarily infection, of the pharynx.
- It is most commonly due to a virus, which does not respond to antibiotics.
- However, a significant proportion of children with pharyngitis and many adults have bacterial infections of the throat that can have significant consequences if not treated.
- To test for the presence of infection, a sample of both mucus and secretions from the back of the client’s throat is obtained.
- A specimen collection system consisting of a sterile cotton-tipped applicator inside a specimen tube is used.
- The back of the throat is swabbed with the cotton tip and inserted back into the closed system.
- The specimen needs to be sent to the laboratory quickly, usually in less than 30 min, or the bacteria can dehydrate and not be useful.
- In the laboratory, the cotton tip is swiped onto a slide or culture medium, which is then incubated to determine the presence of organisms.
- Sputum culture
- Sputum specimens help determine the presence of organisms or blood in a person’s sputum.
- Specimens are best early in the morning, when they are most likely to contain sputum, rather than just saliva
- Lavage specimen
- If the client is unable to cough up sputum, the healthcare provider may order that either the nurse or the respiratory therapist obtain a specimen by bronchoalveolar lavage.
- In this procedure, sterile saline is instilled into a bronchus.
- Then, cells and fluid from the bronchioles and alveoli are removed by endoscopy along with the saline.
- The cells are analyzed in the laboratory, most often to diagnose pulmonary tuberculosis.
- Blood gas determination
- The best indicator of oxygen deficiency is the level of arterial blood gases (ABGs).
- The partial pressure of oxygen (PaO2) value is generally considered normal when it is between 80- and 100-mm Hg (millimeters of mercury).
- The laboratory can analyze an arterial blood sample and determine the PaO 2, partial pressure of carbon dioxide (PaCO2), and hydrogen ion concentration (pH) of the blood.
- The healthcare provider, nurse, and respiratory therapist then evaluate the blood gas results and plan the most effective treatment for the client.
- A noninvasive method for continually or intermittently monitoring oxygen saturation of hemoglobin, without the use of a blood sample, is pulse oximetry.
15
Q
What are the reasons you would need a Chest X-Ray, CT Scan, Lung Scan, Lung Perfusion Scan, Pulmonary Angiography?
A
- Chest X-Ray
- The chest x-ray (CXR) examination is no longer done routinely for all clients who are admitted to acute care facilities.
- It is ordered to determine lung or heart abnormalities.
- Abnormalities that can be observed on x-ray study include lung tumors or other growths, lung abscesses, pulmonary tuberculosis, foreign objects in the lungs, pneumonia, or an enlarged heart
- Computer Tomography Scan (CT Scan)
- The computed tomography (CT) scan is a series of x-ray films taken to provide a cross-sectional view of the chest or other body part.
- CT scanning is valuable in the diagnosis of TB, lung abscesses, or tumors
- Lung Scan
- After a radioactive medication is introduced into the system by injection or inhalation, a lung scan (scintiscan) is done.
- This test yields a two-dimensional map of various organs and tissues.
- Disorders are revealed as a difference in density from normal tissue.
- After the client inhales a special gas, this scan is called a ventilation scan.
- Lung Perfusion Scan
- Albumin tagged with a radioactive material is injected intravenously.
- These particles pass through the client’s venous system and heart, but when they reach the lungs, they lodge in the capillaries.
- The lung perfusion scan illustrates different views through which lesions, pneumonia, and other disorders can be located
- Pulmonary Angiography
- Pulmonary angiography involves injection of radiopaque dye into the pulmonary blood vessels to determine pathology.
