Respiratory (Exam One) Flashcards
List the primary respiratory assessment techniques.
- Auscultation of lung sounds
- Palpation of thoracic cavity
What is tactile fremitus?
Vibration of the chest wall
How is tactile fremitus assessed?
Posterior chest is palpated while the patient says “99”
List conditions in which fremitus is increased?
- Pleural effusion
- Pneumonia
- Tumors
- Thick secretions
Will fremitus be increased or decreased if the lungs are hyper-inflated?
Decreased
How would a patient with low or decreased fremitus appear?
Barrel chested
The absence of fremitus is indicative of what condition(s)? What should the nurse do if fremitus is absent?
- Pneumothorax
- Atelectasis
-Auscultate for breath sounds
List the priority nursing interventions for a patient with increased respirations.
- Apply oxygen
- Administer medications
Describe clear/vesicular lung sounds.
- Breath sounds are normal
- No adventitious noises heard
Describe course crackles. What is the cause of this sound? Is this sound heard upon inspiration or expiration? What disorders are associated with this sound?
- Moist, low pitch bubbling sound
- Caused by fluid in airway
- Heard upon inspiration
- Pulmonary edema, bronchitis, pneumonia
Describe fine crackles. What is the cause of this sound? Is this sound heard upon inspiration or expiration? What disorders are associated with this sound?
- Sound of velcro being town apart
- Sound of hair being rolled between fingers
- Caused by alveoli popping open on inspiration
- Heart failure and atelectasis
Describe wheezes. What is the cause of this sound? Is this sound heard upon inspiration or expiration? What disorders are associated with this sound?
- High pitched, squeaky, musical sound
- Caused by narrow airways
- Heard upon inspiration or expiration
- Asthma
Describe pleural friction rub. What is the cause of this sound? Is this sound heard upon inspiration or expiration?
- Creaking or grating sound
- Caused by rough, inflamed pleural surfaces rubbing together
- Heard on inspiration or expiration
What does serum/metabolic CO2 measure?
Amount of carbonic acid and bicarbonate dissolved in the blood
Why is serum/metabolic CO2 often inaccurate?
Results are altered if the sample is exposed to air
List the different methods used to obtain a sputum sample.
- Expectoration
- Tracheal suction
- Bronchoscopy
Who is responsible for obtaining a sputum sample?
The nurse
When is the best time of day to obtain a sputum sample?
Morning
Describe sputum induction.
Patient inhales an irritating hypertonic solution that causes them to cough
What type of solution is used during a sputum induction?
Hypertonic solution
A sputum culture cannot contain _________.
Saliva
The nurse should observe the patients sputum for what?
- Color
- Amount
- Consistency
- Presence of blood
A culture and sensitivity (C&S) study is used to diagnose what? What does a culture and sensitivity (C&S) study help identify?
- Diagnoses bacterial infection
- Identifies infecting organism
When would an acid fast bacteria smear (AFB) be obtained?
- Culture and sensitivity (C&S) study is positive for organisms
- Diagnose TB
Cytology is utilized to determine the presence of what? What might this indicate?
Abnormal cells that may indicate cancer
How are gram stain results utilized in relation to patient therapy?
Guide patient treatment until culture and sensitivity (C&S) results are complete
A skin test determines if the patient has been exposed to what disease?
Tuberculosis (TB)
When might a skin test give a false reading?
Serum is injected too deep into the skin
List nursing responsibilities prior to a bronchoscopy procedure?
- Obtain signed consent
- Baseline respiratory assessment
- NPO for 6-12 hours prior to test
- Administer sedative
What is the priority nursing care management for a patient following a bronchoscopy procedure?
- NPO until gag reflex returns
- Semi-fowlers position
List nursing responsibilities for a patient who has had a transthoracic needle aspiration (TTNA)?
- Monitor lung sounds every four hours for 24 hours
- Monitor incision for signs and symptoms of infection
A patient who has had a transthoracic needle aspiration (TTNA) is at an increased risk for developing what condition?
Pneumothorax
List nursing responsibilities for a patient who has had a video-assisted thoracic surgery (VATS)?
- Monitor chest tube
- Monitor lung sounds
- Encourage deep breathing
Why would a patient have a chest x-ray following a video-assisted thoracic surgery (VATS) or transthoracic needle aspiration (TTNA)?
Verify a pneumothorax has not occurred
The nurse must ensure what has been completed before a transthoracic needle aspiration (TTNA) or video-assisted thoracic surgery (VATS) is performed?
Patient has signed a consent form
If a patient has a pneumothorax what type of lung sounds will be heard upon auscultation?
- Nothing
- Absent lung sounds
Describe a thoracentesis.
Insertion of large bore needle into chest wall to aspirate intrapleural fluid
What is the primary nursing responsibility during a thoracentesis?
Ensure position is maintained
The nurse should assess for what condition following a thoracentesis if the patients oxygen saturation is less than 90%?
Pneumothorax
How much fluid is typically removed during a thoracentesis?
1000 mL to 1200 mL
What conditions may occur if too much fluid is removed or if the fluid is removed too quickly during a thoracentesis?
- Hypertension
- Hypoxemia
- Pulmonary edema
Describe the patients oxygen saturation following a thoracentesis.
Improve to >90%
What is the most common complication of a thoracentesis?
Pneumothorax
How will the nurse position a patient fixing to undergo a thoracentesis?
Sitting up on side of bed leaning forward on bedside table with pillows
A pulmonary function test is used to determine what?
- Diagnose pulmonary disease
- Monitor disease progression
- Assess response to bronchodilators
What is the nurses responsibility in relation to a pulmonary function test?
Educate patient on how to perform the test
Describe how to perform a pulmonary function test.
- Mouthpiece in place
- Take a deep breath
- Exhale as hard, as fast, and for as long as possible
The six minute walking test is commonly performed on patients with type of disease?
Heart disease
The nurse can best determine adequate arterial oxygenation of the blood by assessing
A. Heart rate
B. Hemoglobin level
C. Arterial oxygen partial pressure (PaO2)
D. Arterial carbon dioxide partial pressure
C
A student nurse asks the RN what can be measured by arterial blood gas (ABG). The RN tells the student that ABG can measure? (SATA) A. Acid-base balance B. Oxygenation status C. Acidity of the blood D. Bicarbonate (HCO3) E. Compliance and resistance
A, B, C, D
To detect early signs or symptoms of inadequate oxygenation, the nurse would examine the patient for?
A. Dyspnea and hypotension
B. Apprehension and restlessness
C. Cyanosis and cool, clammy skin
D. Increased urine output and diaphoresis
B
Which respiratory assessment finding does the nurse interpret as abnormal?
A. Inspiratory chest expansion of 1 inch
B. Symmetric chest expansion and contraction
C. Resonance (to percussion) over the lung bases
D. Bronchial breath sounds in the lower lung fields
D
The nurse is preparing the patient for a diagnostic procedure to remove pleural fluid for analysis. The nurse would prepare the patient for which test? A. Thoracentesis B. Bronchoscopy C. Pulmonary angiography D. Sputum culture and sensitivity
A
When assessing subjective data related to the respiratory health of a patient with emphysema, the nurse should ask about what?
- Dyspnea during rest or exercise
- Ability to sleep through the entire night
- Prescription and OTC medication
What diagnostic study is the least invasive?
Chest x-ray
List the nursing management for a patient who has had a CT scan with contrast?
- Hydration
- Monitor kidney function
- Assess for shellfish allergy
A spiral CT assess’s for what condition?
Pulmonary embolism
What is necessary to perform a spiral CT?
- Contrast
- 20 gauge IV
What type of medication is used during a V/Q scan?
Nuclear medication
The nurse should do what to maintain their own health and safety when administering a nuclear medication?
- Be aware of pregnancy
- Wear PPE
- Carefully dispose of patient urine
Describe the process of a V/Q scan.
Nuclear medication is injected into a vein that spreads to help visualize the lungs
List the nursing management for a patient undergoing an MRI?
- Ensure no metal is present
- Assess for contrast allergies
- Monitor renal function
What medication must be held if the patient has received contrast dye? How long is this medication held?
- Metformin
- 24 to 48 hours
List the three mechanisms for acid-base regulation.
- Buffer system
- Respiratory system
- Renal system
Describe the action of the buffer system.
Changes stronger acids into weaker acids or binds them so they neutralize
What systems must be adequately working in order for the buffer system to work properly?
- Respiratory system
- Renal system
Which acid-base regulation mechanism has the fastest and most immediate reaction?
Buffer system
Which of the three acid-base regulation mechanisms is considered the primary regulator?
Buffer system
The respiratory system will respond within _________ if the buffer system fails to correct the body pH.
Minutes
How long does it take the respiratory system to reach max capacity?
Hours
What anatomical structure within the brain controls the respiratory system and the rate of CO2 excretion?
Medulla
If the CO2 level is elevated within the body, how will the respiratory system respond?
Increase respiratory rate to blow off excess CO2
If the CO2 level is decreased within the body, how will the respiratory system respond?
Decrease respiratory rate to retain CO2
The renal system will respond within _________ ___ _______ if the respiratory system fails to correct the body pH.
Hours to days
Describe the functions of the renal system in relation to acid-base regulation.
- Absorb bicarbonate
- Increase blood pH
- Decrease urine acidity
What is the normal range for pH?
7.35 - 7.45
What is the normal range for PCO2?
35 - 45
What is the normal range for HCO3?
22 - 26
A pH less than 7.35 is referred to as what?
Acidosis
A pH greater than 7.45 is referred to as what?
Alkalosis
A PaCO2 less than 35 is referred to as what?
Alkalosis
A PaCO2 greater than 45 is referred to as what?
Acidosis
An HCO3 less than 22 is referred to as what?
Acidosis
An HCO3 greater than 26 is referred to as what?
Alkalosis
PaCO2 is regulated by the __________ system.
Respiratory
HCO3 is regulated by the _________ system.
Renal
List the three steps in ABG interpretation.
- Determine acidosis or alkalosis of pH
- Determine if its respiratory or metabolic
- Determine if its compensated or uncompensated
If the PaCO2 is within normal range, but the HCO3 is abnormal, the problem is __________.
Metabolic
If the HCO3 is within normal range, but the PaCO2 is abnormal, the problem is __________.
Respiratory
Complete the acid-base balance example:
pH = 7.56
PaCO2 = 28
HCO3 = 22
Respiratory Alkalosis
Complete the acid-base balance example:
pH = 7.56
PaCO2 = 40
HCO3 = 35
Metabolic Alkalosis
If the pH, PaCO2, and HCO3 values are all abnormal, is the problem compensated, partially compensated, or uncompensated?
Partially compensated
If the pH is normal, but the PaCO2 and HCO3 values are abnormal, is the problem compensated, partially compensated, or uncompensated?
Compensated
If the pH is normal or abnormal, and there is a normal PaCO2 or normal HCO3 value present, is the problem compensated, partially compensated, or uncompensated?
Uncompensated
Complete the acid-base balance example:
pH = 7.30
PaCO2 = 50
HCO3 = 49
What is the primary problem? What is the type of compensation?
What is the level of compensation?
- Primary: Respiratory acidosis
- Type: Metabolic alkalosis
- Level: Partial compensation
Complete the acid-base balance example:
pH = 7.50
PaCO2 = 51
HCO3 = 41
What is the primary problem? What is the type of compensation?
What is the level of compensation?
- Primary: Metabolic alkalosis
- Type: Respiratory acidosis
- Level: Partial compensation
Complete the acid-base balance example:
pH = 7.35
PaCO2 = 49
HCO3 = 30
What is the primary problem? What is the type of compensation?
What is the level of compensation?
- Primary: Respiratory acidosis
- Type: Metabolic alkalosis
- Level: Full compensation
Complete the acid-base balance example:
pH = 7.42
PaCO2 = 30
HCO3 = 20
What is the primary problem? What is the type of compensation?
What is the level of compensation?
- Primary: Respiratory alkalosis
- Type: Metabolic acidosis
- Level: Full compensation
Complete the acid-base balance example:
pH = 7.25
PaCO2 = 32
HCO3 = 20
What is the primary problem? What is the type of compensation?
What is the level of compensation?
- Primary: Metabolic acidosis
- Type: Respiratory alkalosis
- Level: Partial compensation
Complete the acid-base balance example:
pH = 7.35
PaCO2 = 42
HCO3 = 25
What is the primary problem? What is the type of compensation?
What is the level of compensation?
-Primary: None
-Type: None
-Level: None
Normal!
Complete the acid-base balance example:
pH = 7.52
PaCO2 = 38
HCO3 = 30
What is the primary problem? What is the type of compensation?
What is the level of compensation?
- Primary: Metabolic alkalosis
- Type: None
- Level: Uncompensated
Respiratory acidosis is common in what type of diagnoses?
- COPD
- Respiratory failure
Oversedation, such as taking too many opioids or barbiturates, may result in what type of complication?
Respiratory acidosis
List health conditions related to respiratory acidosis.
- Brain stem trauma
- Immobility
- Respiratory muscle paralysis
- Pulmonary edema
- Emphysema
- Bronchitis
List the signs and symptoms of respiratory acidosis.
- Lethargy
- Dizziness
- Headache
- Blurred vision
- Restlessness
- Hypoventilation with hypoxia
- Hypotension
- Seizure activity
- Ventricular fibrillation
- Extracellular fluid shift in potassium
Is respiratory acidosis a consequence of hypoventilation or hyperventilation?
Hypoventilation
Describe the workload on the lungs during respiratory acidosis.
Lungs are working too hard and not effectively
What is the primary goal when attempting to correct respiratory acidosis?
- Improve respirations
- Increase the release of CO2
List examples of medications used to correct a patients respiratory rate during respiratory acidosis.
- Albuterol
- Ipratropium bromide
List examples of medications used to increase a patients respiratory drive during respiratory acidosis.
-Diamox/acetazolamide
What is the antidote for opioids?
Narcan/naloxone
What is the antidote for benzodiazepines?
Flumazenil
What is considered as a last resort to correct respiratory rate during respiratory acidosis?
- Endotracheal tube
- Ventilation support
What is the main drive for breathing?
CO2
What is the main cause of respiratory alkalosis?
Hypoxemia
List the causes of hypoxemia.
- Hyperventilation
- Pneumonia
- Pulmonary embolism
Respiratory alkalosis is a ________ ________ during pregnancy.
Normal finding
List the signs and symptoms of respiratory alkalosis.
- Tachypnea
- Confusion
- Lightheadedness
- Seizure activity
- Dysrhythmias
- Epigastric pain
- Numbness/tingling of extremities
What types of medications are used in the correction of respiratory alkalosis?
Antidepressants