Week 2: Gas Exchange & Respiratory Function Flashcards

1
Q

what is the upper respiratory tract made up of? (5)

A

nose, paranasal sinuses, pharnx, tonsils, adenoids, larynx, trachea

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2
Q

function of the nose

A

filters, warms, & moistens air

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3
Q

what are the sphenoid sinuses? (4)

A

frontal, ephnoid, spenoid, maxillary

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4
Q

function of the pharynx, tonsils, & adenoids

A

filter the immune system; epiglottis blocks food from going into the trachea

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5
Q

function of the trachea

A

warms & filters inspired air

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6
Q

what is contained in the lower respiratory tract?

A

lungs (pleura), mediastinum, bronchi / bronchioles, alveoli

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7
Q

what is the function of the lungs?

A

site of gas exchange

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8
Q

different between the visceral pleura & priorital pleura

A

visceral: hugs the actual lung
priorital: outside of the lung

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9
Q

what is the mediastinum? what does it house? (5)

A

chest cavity; houses the lungs, heart, thymus gland, aorta, vena cava, & esophagus

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10
Q

what is bronchi / bronchioles?

A

large airways that come off trachea & attach to the lung / smaller branches that go throughout the lungs (contain mucus, lined w cilia)

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11
Q

where does gas exchange occur?

A

the alveoli

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12
Q

what do macrophages do?

A

ingest foreign materials that we breathe in (part of our defense mechanism)

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13
Q

respiration takes place at the ___ level

A

cellular

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14
Q

difference between inspiration & expiration (what type of processes are they? is energy being used?)

A

inspiration: active process, uses energy
expiration: passive process, no energy used

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15
Q

what is ventilation? what can it be altered by? (4)

A

air moving in & out
can be altered by: asthma, bronchitis, COPD, inflammation

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16
Q

difference between diffusion & perfusion

A

diffusion: oxygen and blood are exchanged at the air-blood interface
perfusion: blood flow through the pulmonary circulation (lungs)

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17
Q

ventilation & perfusion must….

A

“match”

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18
Q

what diffuses more easily than oxygen?

A

carbon dioxide

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19
Q

VQ scan
- which type of patients is it for?
- what does it measure?
- how does it work?

A

for patients suspected of having pulmonary emboli; measures ventilation and perfusion (inject dye to light up, breath in radioactive gas)

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20
Q

what is gas exchange measured by?

A

ABGs

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21
Q

where is CO2 exchanged? where is it transported?

A

capillaries; transported from tissues to blood & transported to lungs

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22
Q

where is oxygen transported?

A

from the blood into the tissue

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23
Q

which nerve excites muscles to keep you breathing? where is it located?

A

phrenic nerve; respiratory centers in the brain

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24
Q

central chemical receptors

A

in medulla respond to change in CSF from chemical changes in blood from high to low in pH to correct imbalance

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25
Q

peripheral chemical receptors

A

in aortic arch and carotid arteries first responders to changes in PaO2, then to PaCO2 and pH

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26
Q

mechanoreceptors

A

include stretch, irritant, juxta capillary receptors
Respond to changes in resistance

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27
Q

proprioceptors

A

in muscles and chest wall respond to body movements = increased respiration

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28
Q

baroreceptors

A

in aortic arch and carotid bodies respond to increase & decrease in arterial blood pressure and cause either hypo or hyperventilation

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29
Q

resting respirations

A

excitation of the muscles by the phrenic nerve

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30
Q

what does increased CO2 levels do to pH?

A

decreases pH

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31
Q

what is the dead space?

A

area in the lungs where nothing is happening

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32
Q

what does sharp stabbing chest pain mean on inspiration?

A

pleurisy

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33
Q

what does wheezing indicate?

A

airway constriction (asthma)

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34
Q

what is hemoptysis? what does it indicate?

A

coughing up blood; could indicate a blood clot, cancer, or pneumonia

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35
Q

what does it mean when a patient’s skin is dusky?

A

blueish, gray color skin

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36
Q

which type of patients are often positioned a specific way to expand their lungs?

A

emphysema patients

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37
Q

what does a barrel chest indicate?

A

chronic overinflation of alveoli due to emphysema

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38
Q

what does a funnel chest indicate?

A

depressed breast bone caused by heart surgery

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39
Q

what does a pigeon chest indicate?

A

upper chest flares out caused by abnormal bone growth

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40
Q

what is seen when a patient is using their accessory muscles to breathe?

A

large abdominal breaths & using everything in their neck trying to breathe

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41
Q

pulmonary function tests
- what does it measure?

A

aids in diagnosis & assessment of respiratory function; how well we can breathe in & out, measure tidal volume & vital capacity

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42
Q

list the arterial blood gas values (4)

A

PaCO2: 35-45
pH: 7.35-7.45
PaO2 (oxygen in arteries): should be greater than 80
Bicarb: 22-26

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43
Q

venous blood gasses
- what does it measure?

A

measures the balance of oxygen used by tissues & amount of oxygen returning to right side of the heart (deoxygenated blood on rt. Side of the heart) - goes through pulmonary arteries!

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44
Q

pulse oximetry
- what does it measure?

A

noninvasive measures O2 saturation of hemoglobin <90% (tissues not getting enough O2)

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45
Q

end-tidal carbon dioxide
- what does it measure?

A

non-invasive method of monitoring partial pressure of CO2 at end exhalation

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46
Q

what is important when getting a culture / sputum collection?

A

need to make sure to get a deep specimen - not saliva! Get specimen before starting any antibiotics!

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47
Q

what is an image study?

A

chest x-ray (PA & lateral (side view), posterior / anterior, looking for densities in lungs; primarily pneumonia

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48
Q

CT scan
- done w contrast or w out?
- what should be checked before contrast media?

A

may be done w & w/out contrast; check patient’s kidney function before contrast media!!

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49
Q

pulmonary angiography
- what does it go into?
- pretest (5) how to educate / prep the patient
- post procedure (6) what to monitor for as a nurse

A
  • going into artery
  • pretest: Need informed consent, check allergies, Coagulation studies, Monitor renal function d/t dye, usually NPO for 6-8 hours before. May get warm flushed feeling with administration of the dye.
  • post procedure: Monitor for bleeding, check pulses distal to site, monitor skin color / temperature, VS, level of consciousness, O2 sat.
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50
Q

MRI
- what does it look at?
- what should you ask patients?

A

Looking at tissues in a more detailed manner; ask patient if they’ve had any pieces of metal in body or eyes or have had open heart surgery

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51
Q

Fluoroscopy
- what does it show & look at?
- what may be expected from a patient afterwards?

A

Tells how lungs are working – Looks at the various parts of the respiratory tract in a live X-ray via video screen. Assists with biopsies
May expect some pain & coughing up blood

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52
Q

VQ scan
- what should be done before?
- how does this procedure work?

A

Do chest X-ray before; Inject radioactive dye in the vein (Perfusion) / Takes 20-40 minutes; Then inhale radioactive gas with oxygen (Ventilation)

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53
Q

what does a gallium scan assess for?

A

inflammation

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54
Q

PET scan
- what does it look at?
- pretest (5)
- post test (1)

A

Looks at nodules
Pretest: Avoid caffeine, alcohol, tobacco for 24 hours before; NPO 4 hours before; Need to empty bladder
Posttest: Encourage fluids

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55
Q

bronchoscopy
- pretest (5)
- posttest (4)

A
  • Signed Consent
  • Pretest: NPO 4-8 hours before, pre-op meds to calm patient / May need prophylactic antibiotic to prevent a bacterial infection. Remove dentures or partial plates
  • Posttest: NPO until gag reflex returns; Start with ice chips. Then cold water then applesauce or pudding, then a sandwich. NO HOT liquids for 24 hours due to throat being numbed
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56
Q

thoracoscopy
- where is this placed?
- pretest (7)
- post test (1)

A

Scope placed in the intercostal space to examine pleural cavity.
going in through the ribs & examining the thoracic cavity or chest
Pretest: Consent; NPO; Monitor VS, pain, respiratory status, bleeding, signs of infection
Posttest: May have chest tube after

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57
Q

thoracentesis
- what does it do?
- what should nurses obtain specimens of fluid for?
- what position is the patient in?

A

Removal of fluid / air from the pleural space. Obtain specimen of fluid for: gram stain, Culture and Sensitivity (C & S), cytology, pH, total protein, glucose, cancer markers.
- Patient leans over bedside table or on their side curled up in a ball on the bed

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58
Q

what can a thoracentesis also be used for?

A

may be used to instill medication

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59
Q

what is a biopsy?
- what are the 3 types?

A

Excision of small amount of tissue for examination of cells
- Pleural biopsy
- Lung biopsy
- Lymph node biopsy

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60
Q

hypercapnea R/T ABGs
- what is it considered?
- what are S/Sx (4)
- what are some causes? (3)

A
  • respiratory acidosis
  • S/Sx: Lethargy, flushed dry skin, headache, narcosis
  • causes: narcotics, anesthesia, high CO2 level
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61
Q

hypocapnia R/T ABGs
- what is it considered?
- what are s/sx (2)
- causes (1)

A
  • respiratory alkalosis
  • s/sx: Increased neuromuscular irritability, cardiac arrhythmias due to hyperventilation & anxiety
  • causes: decreased CO2
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62
Q

as respiratory rate & depth change, what also changes?

A

CO2 levels

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63
Q

difference between hypoxemia & hypoxia
- what are they & what are they measured by?

A

hypoxemia: decreased O2 in blood; ABGs
Hypoxia: decreased O2 to tissue & cell; pulse ox

64
Q

list some s/sx of hypoxia (5)

A
  • change in mental status
  • tachycardia or bradycardia
  • diaphoresis
  • hypertension
  • dusky color
65
Q

what is circulatory hypoxia?

A

inadequate capillary circulation

66
Q

what is anemia hypoxia?

A

lack of hemoglobin to carry oxygen

67
Q

what is histotoxic hypoxia?

A

given cyanide interfere w tissues ability to use oxygen (cyanide poisoning)

68
Q

what is tidal volume?

A

the volume of air that normally moves in and out of the lungs in one quiet breath

69
Q

what is inspiratory reserve volume?

A

the maximum volume of air that can be inhaled after a normal tidal volume inhalation

70
Q

what is expiratory reserve volume?

A

the maximum volume of air that can be exhaled after a normal tidal volume exhalation

71
Q

what is residual volume?

A

the amount of air remaining in the lungs after maximum exhalation; air that cannot be exhaled

72
Q

what is vital capacity?

A

the maximum volume of air that can be exhaled after a maximum inspiration

73
Q

what is inspiratory capacity?

A

the volume of air that can be inhaled after a normal exhalation;

74
Q

what is functional residual capacity?

A

the volume of air remaining in the lungs after normal exhalation

75
Q

what is total lung capacity?

A

the maximum amount of air that the lungs can accommodate

76
Q

lung volume & capacity vary with… (4)

A

age, race, height, & gender

77
Q

what type of infection of rhinitis?

A

viral

78
Q

what is rhinosinusitis?
- which population is it common in?

A

scared sinuses & less airflow
common in elderly population

79
Q

what can rhinosinusitis not be treated w?

A

antibiotics

80
Q

what is pharyngitis?

A

sore throat

81
Q

what is tonsillitis / adenoiditis?

A

collecting garbage

82
Q

what is peritonsillar abscess?

A

tonsils can touch each other

83
Q

what is laryngitis?

A

vocal chords get inflamed and you can’t talk

84
Q

what is Epistaxis?

A

nose bleed

85
Q

what can a nasal obstruction be caused by? (5)

A

polyps, deviated septum, food, dentures, tumor (cancers)

86
Q

is oxygen therapy considered a medication?

A

yes! needs an order (usually is a standing order)

87
Q

what can occur if a COPD patient is given too much O2? (O2 toxicity)
- list 3 S/Sx

A

respiratory alkalosis
- lethargic, agitated, can stop drive to breathe

88
Q

when teaching patients to use an incentive spirometer, what is a good analogy?

A

smell the flowers, blow out the candles

89
Q

what does a small-volume neubulizer do?

A

delivers medication down deep into their lungs

90
Q

what does postural drainage do in chest physiotherapy?

A

patient puts head downward and pounds on their back to cough up drainage

91
Q

what does chest percussion / vibration do? what type of patients is this commonly seen in?

A

pounding on back to cough up drainage; vest to loosen secretions; seen in a lot of cystic fibrosis patients

92
Q

what does pulmonary rehabilitation treatment do?

A

build endurance; have patient walk around

93
Q

how does an endotracheal intubation work?

A

blow up balloon past vocal cord, at lip line

94
Q

what is the bottom piece of a tracheostomy called & what is it used for?

A

obturator: kept at bedside if the patient accidently pulls out the trach

95
Q

what is the purpose of mechanical ventilation?

A

will breathe for the patient; can be set at different settings (intermittent or if patient stops breathing all together)

96
Q

difference between a trachoetomy & tracheostomy

A

tracheotomy: surgical procedure in which an opening is made into the trachea
tracheostomy: the actual opening

97
Q

how often should trach care be done?

A

Q8

98
Q

to prevent infection, patients w trachs should do sterile or clean care?

A

sterile care while in hospital
clean care at home

99
Q

how do prevent accidental decannulation in a patient w a trach? (3)

A

monitor pulse ox
- give O2 before and between suction attempts
- do not instill NS into trach to stimulate cough

100
Q

do not attempt to change or remove trach tubing until stoma is established which is usually when?

A

> 96 hours

101
Q

what is obstructive sleep apnea?
- what are patients at risk for? (3)

A

Recurrent episodes of upper airway obstruction & a reduction in ventilation during sleep
at risk for: HTN, MI, stroke

102
Q

what is the biggest increased risk for a patient when they have sleep apnea?

A

pulmonary hypertension

103
Q

what is a common accident in patients w sleep apnea?

A

increased insulin resistance (type 2 diabetes)

104
Q

what is the difference between CIPAP & BIPAP?

A

CIPAP: continuous positive airway pressure
BIPAP: bilevel positive airway pressure

105
Q

what is the common med used for sleep apnea? how does it help these patients? what is it also used for?

A

Modafinil; used for excessive daytime sleepiness
used for narcolepsy as well

106
Q

how should sleep apnea patients sleep?

A

on their side

107
Q

atelectasis

A

a collapsed lung because alveoli has sticky mucus

108
Q

trachobronchitis

A

inflammation in the trachea & bronchus

109
Q

pneumonia
- what can prevent it? (3)

A

fluid in the lungs; incentive spirometry, ambulating, deep breathing can all prevent

110
Q

aspiration
- what is the defense mechanism?

A

“something going down the wrong pipe”; coughing is the defense mechanism

111
Q

what is pulmonary TB caused by?

A

a mycobacterium

112
Q

which type of patients have an increased risk for atelectasis?

A

surgical patients

113
Q

what is community acquired pneumonia?

A

out in public, symptoms have occured 48 hours less than admitted

114
Q

what is healthcare associated pneumonia?

A

in non hospital areas like nursing homes, rehab centers, long term acute care centers, acquired in another health care setting

115
Q

what is hospital-acquired pneumonia?

A

happens after 48 hours after admission; blamed on hospital

116
Q

what is ventilation associated pneumonia?

A

48 hours after patient was intubated
Oneymonia in the immunocompromised host: HIV, AIDs, cancer patients

117
Q

what is aspiration pneumonia?

A

water down in the lungs, couldn’t get it out

118
Q

name 4 s/sx of pneumonia

A

pulse ox low, hemoglobin levels low, WBC count high, green sputum

119
Q

what should always be checked before giving antibiotics, antifungals, or antivirals?

A

cultures!!

120
Q

what is pleural effusion?

A

too much fluid in this space; prevents the lung from expanding properly

121
Q

what is a CBC differential?

A

WBC count broken into different types of white blood cells

122
Q

if a patient has covid, what are they at a higher risk of developing?

A

bloot clots

123
Q

is WBC is low, what can that indicate?

A

chronic stress or a viral infection

124
Q

is WBC is high, what can this indicate?

A

bacterial infection or acute stress

125
Q

patients w pulmonary TB should be placed in which kind of environment?

A

negative pressure room

126
Q

what are 3 serious s/sx of pulmonary TB? how is this tested? when do these s/sx occur after exposure?

A
  • night sweats, “rust” colored sputum, weight loss
  • tested by sputum specimen (acid fast bacillus smear)
  • s/sx occur 2-10 days after exposure
127
Q

the TB blood test is preferred for which patients?

A

patients who received BCG vaccine – Results in 24-36 hours

128
Q

what is the interferon-gamma release assay test used for?

A

if a patient is positively infected w TB and needs further testing

129
Q

QuantiFERON-TB Gold (QFT-Plus) test

A

best test!!
detects TB or if it’s just an antibody

130
Q

mantoux testing

A

does not tell us if patients have active TB, only tells us if they were exposed!!
- intradermal infection of PPD
positive = induration (hardening) at site

131
Q

prophylaxis

A

isoniazid given; most common treatment for TB; pt. also given vitamin B6 because it prevents neuritis

132
Q

what 4 drugs are given for treatment of TB? how long is the treatment?

A

INH, Rifampin, Pyrazinamide (PZA), ethambutol
- treatment for 8 weeks

133
Q

after 8 weeks of treatment for TB, which two drugs are used and for how much longer?

A

INH & rifampin
- used for 4-7 months more

134
Q

what is the #1 side effect of INH? which organ is it also hard on?

A

polyneuropathy or neuritis; very hard on liver as well

135
Q

what is the #1 side effect of Rifampin? what is important to be monitored?

A

orange urine, secretions, stain contacts
monitor liver function!!!

136
Q

what is the #1 side effect of ethambutol? what should be monitored?

A

optic neuritis (monitor for vision changes) & monitor renal & liver function

137
Q

what is the #1 side effect of pyrazinamide (PZA)? what should be monitored?

A

joint pain; monitor uric acid because it can cause hyperuricemia & AST/ALT & monitor liver function!!

138
Q

what is pleurisy?

A

sharp stabbing pain on inhalation

139
Q

what is pleural effusion?

A

too much fluid in that space; does not allow lungs to expand

140
Q

what could a pneumothorax cause?

A

pressure on the heart or tracheal deviation

141
Q

heimlich valve

A

comes outside of chest wall; one way valve, does not come back into the chest cavity (emergent)

142
Q

thoracotomy
- what is it?
- what is it used for?

A

surgical opening into the thoracic cavity
used to diagnose, cure, treat lung disease, chest disease, or obtain a biopsy

143
Q

what is done pre op for thoracic surgery? (6)

A
  • assess functional reserve
  • determine likelihood of recovery & survival
  • ensure optimal condition for surgery
  • determine baseline
  • prep-op testing
144
Q

what is done post-op for thoracic surgery? (5)

A
  • may be on ventilator / may have chest tube
  • promote airway clearance
  • manage pain
  • maintain fluid volume
  • monitor for complications
145
Q

list some complications of a thoractomy (6)

A
  • immobility
  • bleeding
  • pneumothorax
  • infection
  • respiratory and or HF
  • fistula formation
146
Q

chest tubes
- purpose
- where they are placed
- nursing management (4)
- complications

A

drain fluid, air, blood
placed in pleural space
(upper for air removal & lower for fluid / blood removal)
nursing management: must be one way system to allow air or fluid out of cavity and none back in, keep below level of chest, site assessment, pain control!!, assess & maintain patency (do not rely on bubbling), caution before clamping, assess and manage pain,
complications (atelectasis, infection, re-accumulation of air in pleural space)
-

147
Q

what is the leading cause of cancer death & 2nd most common cancer in both men & women?

A

lung cancer

148
Q

what is a pneumothorax?
list some s/sx
tx

A

Occurs when the pleural space is exposed to positive atmospheric pressure
s/sx: acute distress, gasping for air, absent breath sounds on the side where the lung collapsed, using accessory muscles
tx: chest tube & O2 for tension pneumothorax

149
Q

what is the A on the chest tube mean?

A

suction chamber; should be very gentle bubbling (not boiling fluid); will lose suction; water up to 2 cm of suction

150
Q

what is the B on a chest tube?

A

– water seal: you should see water from arow down, patient breathes, will see fluid going up and down (tidaling) up and down

151
Q

if there’s blank in ___ of the chest tube, something is leaking

A

C

152
Q

what is D on the chest tube?

A

3 columns = the drainage that’s coming out of patient (measured every shift)
Drainage: sanquaneous, sarosanquneous, serous

153
Q

what is a pulmonary embolism associated w? (7)

A

Associated with trauma, surgery, pregnancy, heart failure, >50 years, hypercoagulable states, & prolonged immobility

153
Q

what is a pulmonary embolism associated w? (7)

A

Associated with trauma, surgery, pregnancy, heart failure, >50 years, hypercoagulable states, & prolonged immobility

154
Q

how to prevent pulmonary embolisms? (3)

A

active leg exercises, early ambulation, anti-embolism hose