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ADN002 MED SURG > Week 5 Respiratory Care > Flashcards

Week 5 Respiratory Care Flashcards

1
Q

Respiratory has two main functions

A

Brings oxygen into the lungs -inspiration

CO2 goes out- exhalation

Breathe through mouth and nose- nose preferred

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2
Q

Oro

A

Mouth

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3
Q

Phreno-

A

Diagram

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4
Q

Pleuro-, Pulmono

A

Lung

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5
Q

Pneumo, Pheumono-

A

Air or Lung

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6
Q

Air filled spaces in the skull

A

Sinuses

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7
Q

Structure that warms and moistens and filters air as it enters the respiratory tract

A

Nose

Has olfactory receptors for smell

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8
Q

Roof of the mouth, portion between the oral and nasal cavities two parts

A

palate

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9
Q

Hard Palate

A

Bony anterior front portion of roof of mouth 3/4ths

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10
Q

Soft Palate

A

Muscular posterior back of palate last 1/4th portion of your mouth

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11
Q

Oval Lymphatic tissue on each side of the pharynx that filter air to protect the body from bacterial invasion also called palatine tonsils

A

Tonsils

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12
Q

Adenoid

A

Lymphatic tissue on each side of the pharynx behind the nose, also called the pharyngeal tonsil

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13
Q

Small projection hanging from the back middle edge of the soft palate, name for grape like shape

A

Uvula

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14
Q

Pharynx

A

Throat
Passage for food to the esophagus and for air to the larynx

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15
Q

Nasopharynx

A

Part of the pharynx directly behind the nasal passage

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16
Q

Oropharynx

A

Central portion of the pharynx between the roof of the mouth and the upper edge of the epiglottis

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17
Q

Lower portion of the pharynx, just below the oropharyngeal opening in to the larynx and esophagus

A

Laryngopharynx

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18
Q

Voice box, passage for air moving from the pharynx to the trachea, contains vocal cords

A

Larynx

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19
Q

Glottis

A

Opening between the vocal cords in the larynx

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20
Q

Lid like structure that covers the larynx during swallowing to prevent food from entering the airway

A

Epiglottis

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21
Q

Windpipe, passage for air from the pharynx to the area of the carina, where it splits into the R and L bronchi

A

Trachea

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22
Q

Anatomical Dead Space

A

Portion of inspired air that does not take part of gas exchange

Nose to terminal bronchiole

Value 150 ml

Advantage of anatomical dead space- Conditioning of inspired air- warming, humidification, and filtration

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23
Q

Tidal Volume

A

Amount of air that moves in and out of lung with each cycle

500ml Males
400ml Females

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24
Q

Physiological Dead Space

A

Equal anatomic dead space plus alveolar dead space is volume of air in respiratory zone that does not take place for gas exchange

Resp. Zone= resp. bronchioles, alveolar duct, alveolar sac, and alveoli

Alveolar dead space is negligible, physological=anatomical

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25
Q

Branched airways that lead from the trachea to the microscopic air sacs called alveoli

A

Bronchial Tree

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26
Q

Increase in physiological dead space is in

A

Disease state where diffusion of membrane of alveoli does not function

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27
Q

Right and Left Bronchus

A

Two primary airways branching from the area of the Corina into the lungs

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28
Q

Bronchioles

A

Progressively smaller tubular branches of the airway

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29
Q

Thin walled, microscopic air sacs that exchange gases

A

Alveoli

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30
Q

Alveoli are like …

A

Leaves of a tree upside down

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31
Q

Two spongy organs in the thoracic cavity enclosed by the diaphragm and rib cage, responsible for respiration

A

Lungs

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32
Q

Lobes

A

Subdivisions of the lung, two on the left and three on the right

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33
Q

Membrane enclosing the lung (visceral pleura) and lining the thoracic cavity (parietal pleura)

A

Pleura

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34
Q

Pleura Cavity

A

Potential Space between the visceral and parietal layers

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35
Q

Muscular portion that separates the thoracic cavity and the abdominal cavity which moves upward and downward to aid in respiration

A

Diaphragm

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36
Q

Mediastinum

A

Partition that separates the thorax into to compartments containing the right and left lung. Encloses the heart, esophagus, trachea, and thymus gland.

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37
Q

Thin sheets of tissue that line the respiratory passages and secrete mucous, a viscid fluid that affects artificial airways

A

Mucous Membranes

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38
Q

Cilia

A

Hair like processes from the surface of the epithelial cells, such as those of the bronchi, to move the mucous cell secretions upward( affected by artificial airways)

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39
Q

Parenchyma

A

Functional Tissues of any organ such as tissues of the bronchioles, alveoli, ducts, and sacs, that perform respirations

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40
Q

Pooping sounds heard on auscultation of the lung when air enters diseased airways and alveoli

A

Crackles/ Rales

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41
Q

Wheezes/ Rhonchi

A

High pitched musical sound heard on auscultation of the lungs as air flows through narrowed airways

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42
Q

Stridor

A

High pitched sound that occurs with an obstruction or swelling in the upper airway

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43
Q

Gradual increase in depth and sometimes rate to max level followed by a decrease resulting in apnea

A

Cheyne Stokes Pattern

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44
Q

Normal Breathing

A

Eupnea

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45
Q

Slow Breathing

A

Bradypnea

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46
Q

Tachypnea

A

Fast Breathing

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47
Q

Shallow Breathing

A

Hypopnea

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48
Q

Deep Breathing

A

Hyperpnea

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49
Q

Dyspnea

A

Difficult Breathing

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50
Q

Apnea

A

Inability to breath

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51
Q

Orthopnea

A

Ability to breathe only in upright position

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52
Q

Respiratory Assessment

A

Inspection
-Chest Shape
Flail- Due to trauma
-Funnel or Barrel chested

Respiratory rate and pattern
Skin Color- mucous membranes and nail beds

Patient Position
-Tripoding, orthopnea, dyspnea with exertion

Signs of Respiratory Distress
- Accessory muscle use
-Retractions
-Supraclavicular, sternal
-Nasal Flaring

Ability to Speak
- Full Sentences, short phrases, single words

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53
Q

Fremitus

A

Assessment- Examiner feels changes in intensity of fremitus by palpating the chest wall

Vibration of the chest wall
- sound transmitting through the lung tissue

Causes decreased Fremitus - Excess Air in the lung
- Increased thickness of chest wall

Causes of Increased Fremitus
-Lung consolidation
Air in healthy lung replaced with something else

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54
Q

Diaphragmatic Excursion

A

Movement of the thoracic diaphragm during breathing. Measures contraction of the diaphragm.

Normal is is 3-5cm but can be 7-8 cm in well conditioned people

less than 3-5 cm patient may have pneumonia or pneumothorax in which need a chest xray for either

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55
Q

Auscultation

A

Lung Sounds

Right Lung
Upper lobe
Middle lobe
Lower lobe

Left Lung
Upper lobe
Lower Lobe

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56
Q

Non Invasive way of estimating oxygen in the blood

A

Pulse Oximetry

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57
Q

Radiology

A

Department that studies/ performs radiographic tests

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58
Q

Chest Xray

A

Film of entire chest
PA- Back to front
AP- Front to back
Lateral toward the side

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59
Q

Cyanosis

A

Bluish coloration of skin caused by deficient amount of oxygen

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60
Q

Hoariness

A

Dysphonia

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61
Q

Nosebleed

A

Epistaxis

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62
Q

Thin watery discharge from the nose

A

Rhinorrhea

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63
Q

Expectorant

A

Sputum- Material expelled from the lungs by coughing
Hemoptysis- Coughing up or spitting out blood that originates from the lungs

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64
Q

Excessive Level of CO2

A

Hypercapnia

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65
Q

Deficient level of CO2

A

Hypocapnia

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66
Q

Either of these will disrupt the pH of the blood either causing what?

A

Acidosis or Alkalosis

Both are driven by excessive or severely decreased breathing

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67
Q

Excessive Movement of air into and out of the lungs causing hypocapnia

A

Hyperventilation

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68
Q

Deficient amount of oxygen in the blood

A

Hypoxemia

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69
Q

Deficient movement of air into and out of the lungs

A

Hypoventilation

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70
Q

Deficient amount of oxygen in the tissue cells

A

Causes Anaerobic Cellular Metabolism

Causes lactic acid production= death

Build up in the muscles and you feel the burn

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71
Q

Condition blocking flow of air moving out of the lungs

A

Obstructive Lung disorder - COPDP

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72
Q

Pulmonary Fibrosis

A

Restrictive Lung disorder conditioning restricting the intake of air into the lungs

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73
Q

Reactive Airway

A

Asthma

Reversible narrowing of the airways in response to a stimulus

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74
Q

Fluid filling the spaces around the alveoli and eventually flooding the alveoli

A

Pulmonary Edema

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75
Q

Pulmonary Infiltrate

A

Density on an x-ray image representing the consolidation of matter within the air spaces of the lungs, usually resulting from inflammatory

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76
Q

RAD

A

Reactive airways disease - Asthma

Caused by spasm of the bronchial tubes or by swelling of the mucous membrane

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77
Q

Collapse of the lung tissue at the alveolar level

A

Atelectasis

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78
Q

Abnormal dilation of the bronchi with accumulation of mucous

A

Bronchiectasis

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79
Q

Inflammation of the bronchi

A

Bronchitis

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80
Q

Lung cancer originating in the bronchi

A

Bronchogenic Carcinoma

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81
Q

Constriction of the bronchi caused by spasm

A

Bronchospasm

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82
Q

Obstructive pulmonary disease characterized by overexpansion of the alveoli with air and destructive changes to their walls, resulting in loss of elasticity and gas exchange

A

Emphysema

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83
Q

COPD

A

Permanent destructive pulmonary disorder that is a combination of chronic bronchitis and emphysema

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84
Q

Inherited condition of exocrine gland malfunction causing abnormally thick mucous that obstructs passageways within the body, commonly affecting the lungs and digestive tract

A

Cystic Fibrosis

These obstruction of mucous in the lung/ airways lead to inflammation, infection, and damage to lung tissue

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85
Q

Can either be passed from both parents or long term exposure to certain substances such as silica dust, asbestos fibers, hard metals, coal dust, grain dust, and prolonged animal and bird droppings

A

Cystic Fibrosis

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86
Q

Accumulation of fluid in the pleural cavity

A

Pleural Effusion

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87
Q

Accumulation of pus in the pleural cavity

A

Empyema

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88
Q

Blood in the pleural cavity

A

Hemothorax

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89
Q

Air in the pleural cavity

A

Pneumothorax
- Can be due to trauma

Left side trachial deviation

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90
Q

Both blood and air you have…

A

Pneumohemothorax

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91
Q

Mycobacterium Tuberculosis

A

In the lungs. Called Pulmonary tuberculosis

Characterized by the formation of tubercles, inflammation, and necrotizing( cellular death) caseous lesions

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92
Q

ABG

A

Arterial Blood Gas
Used to determine the adequacy of lung function and gas exchange

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93
Q

pH

A

Level of acidity

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94
Q

Procedure using a scope to look inside the body either down the throat to the stomach or up to the rectum

A

Endoscopy

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95
Q

Procedure using a scope examine the airway and bronchus

A

Bronchoscopy

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96
Q

Procedure using a scope to go into the nose and down to the pharynx

A

Nasopharyngoscopy

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97
Q

Bronchoscopy Procedure can detect …

A

Area of carina
Blood Clot
Mucous Plug
Foreign Body

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98
Q

Occlusion in the pulmonary circulation caused by an embolism

A

PE

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99
Q

Periods of breathing cessation of 10 seconds or more that occur during sleep, often resulting in snoring

A

Sleep Apnea

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100
Q

URI

A

Upper Respiratory Infection

Infectious disease of the upper respiratory tract involving the nasal passages, pharynx, and bronchi.

101
Q

X ray image of the blood vessels of the lungs after injection of contrast

A

Pulmonary Angiogram

Detect PE

102
Q

VQ Scan

A

Ventilation/ Perfusion scan used to look at both air and blood movement through the lungs - uses radiopaque dye

Detect PE

103
Q

Also used for COPD, Pneumonia, Post Lobectomy

A

Pulmonary Angiogram

VQ Scan

104
Q

Ability for air to reach all parts of the lungs

A

Ventilation

105
Q

How well blood circulates within the lungs

A

Q= Perfusion

V/Q mismatch when either one is altered

106
Q

Nasal Polypectomy

A

Removal of nasal polyp

107
Q

Operative Terms

A

Adenoidectomy
Lobectomy
Pneumonectomy
Nasal Polypectomy

108
Q

Puncture through the chest wall for aspiration of fluid in the chest wall

A

Thoracentesis

109
Q

Repair of the chest wall involving the fixation of the ribs

A

Thoracoplasty

110
Q

Creating a whole in the chest wall for a tube insertion

A

Thoracostomy

111
Q

Incision into the chest through all layers to access lungs

A

Thoracotomy

112
Q

Incision into the trachea

A

Tracheotomy

113
Q

Creation of an opening in the trachea, usually to insert a tube

A

Tracheostomy

114
Q

CPR

A

Artificial respiration and chest compressions to move oxygenated blood through out the body when breathing and the heart has stopped

115
Q

CPAP

A

Use of a device with a mask that pumps constant pressurized flow of air through the nasal passages, commonly used when sleeping (sleep apnea)

116
Q

BIPAP

A

Similar to CPAP
For more acutely ill patients
COPD exacerbation
CHF exacerbation

117
Q

CPAP

A

Constant positive airway pressure

CPAP used by paramedics and used for sleep apnea

118
Q

BiPAP

A

Needs constant monitoring of the different pressures

Used to treat severely ill patients with respiratory problems ( COPD and CHF)

May be used prior to intubation if patient can maintain airway

119
Q

Common postoperative breathing using a specially designed spirometer to encourage the patient to inhale and hold an inspiratory volume to exercise the lungs and prevent pulmonary complications

A

Incentive Spirometer

120
Q

Endotracheal Intubation

A

Passage of a tube into the trachea via nose or mouth to open the airway for delivering gas mixtures into the lung

Requires mechanical breathing with a ventilator

121
Q

Drug that kills or inhibits the growth of microbes

A

Antibiotic

122
Q

Drug that dissolves or prevents the formation of thrombi or emboli in the blood vessels

A

Anticoagulant
- Heparin

123
Q

Antihistamine

A

Drug that neutralizes or inhibits histamine

Histamine is released by injured cells during an allergic reaction , inflammation, causing constriction of bronchial smooth muscles and dilation of blood vessels

ex: Diphenhydramine
Cetitizine- Zyrtex

124
Q

Antiinflammatory examples

A

Corticosteroids
Leukotriene Antagonists- Montelukast

125
Q

Bronchodilator

A

Drug that dilates the muscular wall

Beta 2 agonist- Albuterol
Cholinergic antagonist- Atrovent
Methylxanthines- Theophylline, Aminophylline

126
Q

Pumps air or oxygen through the liquid medication to turn into vapor

A

Commonly used with albuterol and atrovent

127
Q

Expectorant and Antitussives

A

Anti Cough
Drug that breaks up mucous and promotes coughing
Dextromethorphan= Robitussin
Guaifenesin- Robitussin

G+D= Mucinex

128
Q

Mucolytics

A

Acetylcysteine- Mucomyst

129
Q

Methods of Oxygenation/ Ventilation

A

Breathing Room air
Supplemental Oxygen
O2 Delivery devices
CPAP
BIPAP
Mechanical Ventilation

130
Q

FiO2

A

Fraction of Inspired Oxygen

Breathing room air is 21%

Each liter plus 4%

131
Q

HFNC

A

Bridge between the conventional oxygen therapy and the mechanical ventilation

Up to 60lpm

Bridge between oxygen therapy and mechanical ventilation

132
Q

Reactive Airway disease caused by a spasm of the bronchial tubes or by swelling of the mucous membrane

A

Asthma

Caused by triggers; allergens example

133
Q

Atrovent

A

Bronchdilator
Anticholinergic
Inhaled

134
Q

Beta 2 Agonist

A

Albuterol
Bronchodilator
Inhaled

135
Q

Spiriva

A

Anticholinergic
Bronchodilator
Inhaled

136
Q

Singulair

A

Montelukast
PO
Block Leukotrienes

137
Q

Corticosteroids

A

PO
Prednisone
Prednisolone

138
Q

Inhaled Steroids

A

Budesonide
Pulmicort
Qvar
Fluticasone

139
Q

Collapse or airless condition of alveoli caused by hypoventilation, obstruction to airways or compression

A

Atelectasis

140
Q

Causes of Atelectasis

A

Bronchial obstruction by secretions due to impaired cough mechanism or conditions that restrict normal lung expansion on inspiration

141
Q

What Pt at high risk for Atelectasis?

A

Post Op

142
Q

Insidious, cough, sputum production, lo grade fever, crackles

A

Symptoms of Atelectasis

143
Q

Respiratory distress, anxiety, symptoms of hypoxia occur if large areas of lung are affected with …

A

Atelectasis

144
Q

Nursing Management Prevention for Atelectasis

A

Prevention

Frequent Turning, early ambulation
Strategies to improve ventilation, deep breathing exercises at least every two hours, incentive spirometer, chest/ Abd pain- splint chest/ ABD with inspiration

Strategies to remove secretions : coughing exercises, suctioning, aerosol therapy, chest physiotherapy

Cough and deep breathing

Always think basic nursing interventions first

145
Q

Tx for Atelectasis

A

Strategies to improve ventilation, remove secretions

May include PEEP
IPPB
Bronchoscopy may be used to remove obstruction

146
Q

Patient Teaching and Home Care Considerations for Atelectasis

A

Breathing and coughing techniques
Positioning
Addressing pain and discomfort
Promoting mobility and arm shoulder exercises
Diet
Prevention of infection
Signs and Symptoms to report

147
Q

Acute event in which the heart’s left ventricle can not handle an overload of blood volume

A

Pulmonary Edema

Pressure increases in the pulmonary vasculature, causing fluid movement out of the pulmonary capillaries and into the intestinal space of lungs and alveoli

Results in hypoxemia

148
Q

Clinical Manifestations of Pulmonary Edema

A

Restlessness, anxiety, dyspnea, cool and clammy skin, cyanosis, weak and rapid pulse, cough, lung congestion ( moist or wet), course or crackles,

Increased sputum production- May be frothy and blood tinged or pink frothy sputum

Decreased Level of LOC

149
Q

Early recognition of Pulmonary Edema

A

Monitor lung sounds and for signs of decreased activity tolerance and increased fluid retention

Place Pt upright and dangle legs
Minimize exertion and stress

Oxygen

150
Q

Medications and Emergency Tx

A

Vasodilators- Nitroglycerin
Diuretics- Furosemide
Addition with BIPAP

Dilate pulmonary vessels, pull fluid from tissue into the vascular system and urinate out and positive pressure to force fluid back into the vascular system

151
Q

What is ARDS?

A

Acute Lung Injury

Syndrome characterized by sudden, progressive pulmonary edema, increasing bilateral lung infiltrates on CXR, hypoxemia refractory to oxygen therapy, decreased lung compliance

36-44 mortality rate

152
Q

Patho of ARDS

A

Develops from variety of direct or indirect lung injuries
- Most common cause is sepsis

Exact cause for damage to alveolar capillary membrane not known

153
Q

Pathophysiological changes of ARDS thought to be due to stimulation of inflammatory and immune systems

A

TRUE

154
Q

Stages of Edema Formation in ARDS

A

Normal Alveolus and Pulmonary Capillary

Interstitial edema occurs with increased flow of fluid into the interstitials space

Alveolar edema occurs when the fluid crosses the blood gas barrier

155
Q

Early Clinical Manifestations of RDS

A

Dyspnea, tachypnea, cough, restlessness

Chest Auscultation may be normal or reveal fine scattered crackles

156
Q

For ARDS use …. what tools?

A

ABGs

Chest X Ray

ABG- Mild hypoxemia respiratory alkalosis caused by hyperventilation

Chest X-Ray- May be normal or show minimal scattered interstitial infiltrates

Edema may not show until 30% of lungs are filled with fluid

157
Q

Name Causes of ARDS

A

Pneumonia
Near drowning
Massive Blood transfusions
Pancreatitis
Trauma
Sepsis

158
Q

S/S of ARDS

A

Dyspnea
Tachypnea
Anxiety and Restlessness
Decrease in o2 sat.
Tachycardia
Cyanosis

159
Q

Late Clinical Manifestations of ARDS

A

Symptoms worsen with progression of fluid accumulation and decreased lung compliance

Pulmonary Function Tests reveal decreased compliance and lung volume

Suprasternal Retractions

Tachycardia, Diaphoresis, changes in sensorium with decreased mentation, cyanosis, and pallor
Hypoxemia despite increased FIO2

160
Q

Diagnostics of ARDS

A

“White Out” - CXR

Decreased PFTs

Resp. Alkalosis- Resp. Acidosis

Increased pulmonary artery pressure

161
Q

Management of ARDS

A

Intubation, mechanical ventilation with PEEP to treat progressive hypoxemia

Positioning- Frequent Position changes

Nutritional Support

General Supportive Care

162
Q

ARDS complications of Tx

A

Hospital Acquired Pneumonia

Barotrauma - Duet to mechanical ventilation
- Positive Pressure

High risk for stress ulcers
Renal Failure

163
Q

Nursing Dx for ARDS

A

Ineffective Airway Clearance
Ineffective Breathing Pattern
Impaired Gas Exchange
Impaired Tissue Perfusion
Activity Intolerance
Risk for Infection
Imbalanced nutrition, less than

164
Q

Sudden Life threatening decrease of gas exchange function of lung and indicates failure of lungs to provide oxygenation or ventilation for blood

Results from inadequate gas exchange
- Insufficient O2 transferred to the blood
- Hypoxemia

Inadequate CO2 removal
- Hypercapnia

A

ARF

165
Q

ARF is not a _____________ but a ________

A

disease, condition

Results of one or more diseases involving th elungs or other body systems

166
Q

Increased PaCO2 greater than 50mm Hg is

A

Hypercapnia , pH less 7.35

167
Q

Decreased in PaO2 less than 50mmHg is

A

Hypoxemia,

168
Q

Ventilatory Failure and Oxygenation Failure is what pathos?

A

ARF

169
Q

Ventilatory Failure includes

A

Impaired CNS
Neuromuscular
Musculoskeletal
Pulmonary

Oxygenation Failure
PNA
ARDS
HF
COPD
PE
Restrictive Lung Disease
Asthma

170
Q

Early Manifestations of ARDS include

A

Early
Restlessness, Fatigue, Headache, Dyspnea, Air hunger, tachycardia, HTN

171
Q

ARF manifestations of hypoxemia progresses include

A

Confusion
Lethargy
Tachycardia, tachypnea
Central cyanosis
Diaphoresis
Resp. Arrest

172
Q

Medical Management of ARF include

A

Correct Cause
Restore adequate gas exchange in lung
Intubation/ Mechanical Ventilation

173
Q

ARF Nursing Management

A

Maintaining mech. ventilation
Monitoring responsiveness
ABGs
Vital Signs

Turning, skin care, SCDs, DVT prophylaxis, oral care, hygiene, nutrition- all preventative measures

Address etiology of ARF

174
Q

Placement of a tube to provide a patient airway for mechanical ventilation and for removal of secretions

A

Endotracheal Tube

175
Q

Endotracheal Tube

A

Purpose and complications related to the tube cuff

Assessment of cuff pressure
Pt assessment
Risk for injury/ airway compromise related to tube removal

Pt and family teaching

176
Q

RSI

A

Rapid Sequence Intubation

Rapid concurrent administration of a paralytic agent and a sedative agent during emergency airway management

Increased risk for aspiration, combativeness, and injury to the patient

  • Not indicated for comatose or cardiac arrest patients
177
Q

Name Muscle Paralytics

A

Succinylcholine
Pancuronium
Vercuronium

178
Q

NAme Sedation Drugs

A

Etomidate
Ketamine
Versed
Fentanyl
Propofol

179
Q

Exhaled CO2 will change CO2 detector from what to what

A

Purple to yellow

180
Q

Following intubation

A

Inflate cuff and confirm placement of ET tube while manually ventilating patient with 100% O2

181
Q

End- Tidal CO2 detector measures amount of

A

Exhaled CO2 from the lungs

Place between BVM and ET tube

Observe the color change

182
Q

If no CO2 is detected then

A

Endotracheal tube is in the esophagus

Auscultate lung bases and apices for bilateral breath sounds

Yellow color change is good

183
Q

Following ET intubation

A

Observe chest for symmetric wall movement
Obtain portable chest xray to confirm placement

Connect ET tube to either humidified air, O2, or mechanical ventilator

Obtain ABGs with 25 min after intubation to determine oxygenation and ventilation status

Continue monitor pulse oximetry as estimate of arterial oxygenation

184
Q

Nursing Management Artificial Airway

A

Maintaining correct tube placement
- Monitor ET tube every 2-4 hours

Confirm exit mark on ET tube remains constant while
- at rest
- during pt care
- repositioning
- transporting patient

Maintaining proper cuff inflation
Incorrect tube placement is an emergency
- Stay with the patient and maintain airway
Support Ventilation

185
Q

Nursing Management Artificial Airway

A

Maintain tube patency
- Assess pt. routinely to determine need for suctioning, but do not suction routinely

Indication for suction
-Visible Secretions
- Sudden onset of respiratory distress
- Suspected aspiration of secretions

186
Q

Nursing Management Artificial Airway

A

Providing oral care and maintaining skin integrity
- Brush teeth BID
Oral care every 2-4 hours

Suction oral/ pharyngeal cavity

Reposition and re tape ET tube

If Pt is anxious or uncooperative, two caregivers needed for reposition

187
Q

Nursing management Artificial Airway

A

Fostering comfor and communication

  • Anxiety due to inability to communicate requires emotional support
  • Physical discomfort associated with ET intubation and mechanical ventilation necessitates sedation and analgesia

Consider alternative therapies to compliment drug therapy

188
Q

What are some complications of ET intubation?

A

Unplanned extubating
- Patient vocalization
Activation low- pressure ventilator alarm
Diminished or absent breath sounds
Respiratory Distress
Gastric Distention

189
Q

Aspiration RF of Artificial Airway

A

Improper Cuff Inflation
Patient positioning
Tracheoesophageal Fistula

Suction oral cavity frequently

  • Insert orogastric or nasogastric tube and connect to low intermittent suction

If receiving enteral feedings, elevate HOB 30-45 degrees
Provide continuous suction of secretions above cuff

190
Q

Risk for Pressure Ulcer

A

Lowering HOB decreases pressure on coccyx but increases risk for aspiration

Continual monitoring of HOB

191
Q

Complications of tracheostomy

A

Bleeding
Pneumothorax
Aspiration
Emphysema; subcutaneous or mediastinal, laryngeal nerve damage, posterior tracheal wall penetration

192
Q

Long term complications include airways obstruction, infection, rupture of the innominate artery, dysphagia, fistula formation, tracheal dilation, and tracheal ischemia, and necrosis

A

Tracheostomy Long term complications

193
Q

Tracheostomy

A

Bypasses the upper airway to bypass an obstruction, allow removal of secretions, permit long term ventilation, prevent aspirations and secretions, or to replace endotracheal tube

194
Q

Purpose of Cuff in Tracheostomy

A

Maintain air delivered in mechanical ventilation to the lungs

Important to keep inflated so air can go to lungs and back to ventilator and can be measured

195
Q

If the patient does not require air from vent be monitored then…

A

Tolerate cuff deflation without respiratory distress; then CUFFLESS tracheostomy tube may be placed

Pediatric and neonatal pt have cuffless to prevent mucosal injury

196
Q

Cuffless Trach air may

A

Leak out

Some speech is possible depending ho much space is around the trach for airflow through the upper airway

197
Q

Nursing Dx for Pt with endotracheal intubation or tracheostomy

A

Ineffective communication
Anxiety
Knowledge Deficit
Ineffective airway clearance
Potential for Infection

198
Q

NIPPV

A

Non invasive positive pressure ventilation

Use of mask or other device to maintain seal and permit ventilation
Indications
CPAP
BIPAP

199
Q

Positive or negative pressures breathing device to maintain ventilation or oxygenation

A

Mechanical Ventilation

-Negative Pressure
-Iron Lung - rare

Positive Pressure
- Pressure cycled
- Timed cycle
- Volume- Cycled

200
Q

Mechanical Ventilation

A

Process by which fraction inspired oxygen at > 21% room air is moved into and out of lungs by mechanical ventilator

201
Q

Indications for mechanical ventilation

A

Apnea or inability to breathe
ARF
Severe hypoxia
Respiratory muscle fatigue

202
Q

Settings of mechanical ventilators

A

Regulate rate, depth, and other characteristics

Based on Pt status ( ABGs, body weight, LOC, muscle strength)

Ventilator is tuned to match pt. ventilatory pattern

203
Q

Mechanical Ventilation

A

PPV- Positive Pressure Ventilation

Used primarily in acutely ill patients
Pushes air into lungs under positive pressure during inspiration
Expiration occurs passively

204
Q

IMV

A

Intermittent mandatory vent

Preset tidal volume at preset rate

205
Q

ACV

A

Assist Control Vent

Preset volume for every breath set and taken by client

206
Q

CMV

A

Controlled Mandatory Vent

Preset volume at preset rate for pt. with no ventilatory effort

207
Q

SIMV

A

Synchronized Intermittent Mandatory Vent

Preset mandatory volume that syncs with client inspiratory effort - most common

208
Q

APRV

A

Volume of gas to preset insp. pressure and allows exhalation to a second preset pressure

209
Q

Vent Settings

A

Rate- breaths per minute

FiO2- amount of O2 in inhaled air

Tidal Volume- Amount of air delivered with each breath ( ml or L)

210
Q

PEEP

A

Positive end respiratory expiratory pressure

Amount of positive pressure at the end of exhalation

  • Keeps the alveoli open

Typical if 5mmhg- higher levels increase risk for pneumothorax

211
Q

IPAP

A

Inspiratory positive airway pressure: controls the peak inspiratory pressure during inspiration

212
Q

EPAP

A

Expiratory positive airway pressure, controls the end expiratory pressure

213
Q

Bipap or mechanical ventilator is used as CPAP when

A

IPAP=EPAP

214
Q

Enhancing AGs Exchange

A

Monitor ABGs and other indicators of hypoxia. Note trends

Auscultate lung sounds frequently
Judicious use of analgesics
Monitor fluid balance
Complex Dx that requires a collaborative approach

215
Q

Promoting Effective Airway Clearance

A

Assess Lung sounds at least every 2-4 hours

Measures to clear airway: suction, position changes, promote mobility, also CPT
- Chest physical therapy may include percussion, vibration, deep breathing, huffing or coughing.

Humidification

Medications- Mucomyst

216
Q

Preventing Trauma and Infection

A

Infection control measures
Tube Care
Cuff management
Oral Care
Elevation of HOB

217
Q

PPV and hypermetabolism can contribute to

A

Inadequate nutrition

218
Q

Pt is likely to be without food for

A

3-5 days, a nutritional program should be initiated

219
Q

Poor nutrition and disuse of respiratory muscles

A

Contributes to decreased muscle strength

220
Q

Inadequate Nutrition can

A

Delay warning
Decrease resistance to infection
Decrease speed of recovery

221
Q

Enteral Feeding Via small bore feeding tube is preferred method to meet caloric needs on ventilated patients

A

TRUE

222
Q

Mechanical Ventilation Complication

A

Machine disconnection or malfunction
- Most frequent site for disconnection is between tracheal tube and adapter

223
Q

Pause alarms during suctioning or removal from ventilator

A

Reactivate alarms before leaving

224
Q

Malfunction may be due to

A

Power failure, failure of O2 supply

225
Q

If machine malfunctions

A

Disconnect pt from ventilator
Manually ventilate 100% O2

226
Q

Process of withdrawal of dependence upon the ventilator

A

Weaning

227
Q

Successful weaning is a collaborative process

A

TRUE

228
Q

Methods of weaning

A

Process of

decreasing ventilator support
resuming spontaneous ventilation

229
Q

Weaning Outcome Phase

A

Weaning stops and patient is extubated

Weaning is stopped because no further progress is made

230
Q

After extubating

A

Encourage deep breathing and coughing
Pharynx should be suctioned as needed

Supplemental oxygen should be applied and naso oral care provided

231
Q

Monitor VS, resp. status, and oxygenation immediately within 1 hour

A

After extubation

232
Q

Other Interventions Respiratory

A

ROM mobility; get out of bed
Communication methods
Stress reduction techniques

233
Q

Interventions to promote coping

A

Include in care: family teaching, and emotional and coping support of the family

Home ventilator care

234
Q

CO2 is also converted to what in the blood

A

HCO3

235
Q

Why is CO2 important?

A

Source of acid.
co2 and h2o- carbonic acid- then can become HCO3

pH measurement of free hydrogens

236
Q

ABG

A

Monitor pt ability to oxygenate

237
Q

Partial Pressures of CO2

A

PCO2 35-45

CO2- is produced from cellular respiration and eliminated through lungs ( respiratory function)

238
Q

HCO3

A

Bicarbonate 22-26
Produced and reabsorbed in kidneys

239
Q

Partial Pressure of O2

A

pO2- 80-100

240
Q

BE

A

Base Excess
Amount of anions or cations needed to correct acid/ base imbalance (if present)

oxygen saturation above 94%

241
Q

CO2 increase with

A

Hypoventilation
Infection (Pneumonia)
CNS depression

242
Q

Ventilation Perfusion Conditions

A

ARF
COPD
PE
Rebreathing CO2
Trauma -pneumothorax

243
Q

CO2 decreases with

A

Hyperventilation
Anxiety
Fat embolism
PE
Metabolic Acidosis
Aspirin Overdose

244
Q

S/S of Hypocapnia

A

Cerebral vasoconstriction
Hypocalcemia
Carpal Pedal Spasms
Shift in O2-HgB dissociation curve
Decreased oxygenation

245
Q

High HCO3 can be seen with

A

Gastric conditions
Vomiting
Dehydration
Gastric suctioning

246
Q

Low HCO3 seen with

A

DKA
Diarrhea
Liver failure
Kidney Disease

Acidosis condition that resulted in the use of the body’s HCO3 reserves

247
Q

Allen’s Test

A

Prior to an ABG, an Allen’s Test should be performed

248
Q

Allens Test

A

You want positive Allens test

Means ulnar artery can sufficiently profuse the hand if the radial artery is altered in any way

249
Q
A

ADN002 MED SURG (18 decks)

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