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Adult Hlth 2 Test 1
Respiratory ch 18-32
| Question | Answer |
|---|---|
| Hint: When studying focus on pt teaching!!! | Good Luck!! |
| What is the normal Arterial Blood Gas Range for pH? | 7.35-7.45 or if they are older than 90 then 7.25-7.45 |
| What is the normal ABGs range of PaO2? | 80-100 older than 90 then it is greater than 50 |
| What is the normal ABG range of PaCO2? | 35-45 |
| What is the normal range for Bicarbonate (HCO3)? | 22-26 |
| The pathophysiology of Acidosis is....? | Carbon Dioxide retention |
| The pathophysiology of Alkalosis is ....? | Excessive CO2 loss |
| Respiratory Depression can be caused by and respiratory depression can cause___? | Respiratory depression can be caused by opioids and respiratory depression can cause ACIDOSIS |
| Inadequate chest expansion can cause ___ and inadequate chest expansion can be caused by....? | Inadequate chest expansion can cause ACIDOSIS and inadequate chest expansion can be caused by trauma and respiratory depression |
| Airway obstruction can cause___ and can be caused by___? | Airway obstruction can cause ACIDOSIS and airway obstruction can be caused by foreign bodies, neck position... |
| Decreased alveolar-capill. diffusion can cause ____? | ACIDOSIS |
| Hperventilation can cause ____. What can cause hyperventilation? | Hperventilation can be caused by alkalosis. Anxiety, Improper ventilator settings can cause Hyperventilation |
| Hypoxemia can cause ___? What can cause Hypoxemia? | Hypoxemia can be cause ALKALOSIS. Hypoxemia can be caused by Asphyxiation, High altitudes, shock |
| Depresed CNS activity occurs in Acidosis or Alkalosis? | ACIDOSIS |
| There is Increased CNS activity, Anxiety, irritaility, tetany, seizures, + Chvostek's sign, + Trousseau's sign, & Paresthesias in Acidosis or Alkalosis? | ALKALOSIS |
| What are the CNS manifestations of Alkalosis? | Increased activity, Anxiety, irritability, tetany, seizures, + Chvostek's sign, + Trousseau's sign, and Paresthesias |
| Hyporeflexia, Skeletal muscle weakness and Flaccid paralysis are Neuromuscular manifestations of ____? | ACIDOSIS |
| Hyperreflexia, Muscle cramping and twitching and skeletal muscle weakness are Neuromuscular manifestations of _____? | ALKALOSIS |
| Delayed electrical conduction, tall T waves, Widened QRS complex, Prolonged PR interval, Hypotension, Thready peripheral pulses are Cardiovascular manifestation of ______? | ACIDOSIS |
| What are the cardiovascular manifestations of ALKALOSIS? | Increased Heart Rate; Normal or Low Blood Pressure; Increased digitalis toxicity |
| Kussmaul Respirations and Variable respirations are manifestations of what? | ACIDOSIS |
| Respiratory Manifestations: Increased rate and depth of ventialtion in respiratory _____; Hypokalemic... | Respiratory Alkalosis |
| Warm, flushed, dry skin occurs in ______? | metabolic acidosis |
| Pale to cyanotic and dry skin occurs in _____? | respiratory acidosis |
| What will the labs be for acidosis? | Low pH (<7.35); Low HCO3 (<21); Elevated/Normal PaCO2 |
| What will the labs be for alkalosis? | High pH (>7.45); Low Bicarbonate HCO3 (15-21); Low PaCO2 (<35) |
| What are the interventions for Acidosis? | Maintain Airway; O2 therapy; Drug therapy (increase airway diameter, thin secretion); Pulmonary hygiene; Vent support; Prevent complications; Monitor ABG, SaO2, resp. failure, neuro stats |
| What kind of diet will the Acidosis pt be on? | Low-Carb, High-Fat diet if indicated |
| What are the interventions for Alkalosis? | Monitor ABG, resp. failure, hyperventilation, arrhythmias, decreased cardiac output; O2 therapy; reduce O2 consumption to minimize hyperventialtion; mechanical vent if necessary. |
| What are the 5 steps of ABG Analysis? | 1. Assess pH 2. Assess PaCO2 3. Assess HCO3 4. Determine the level of compensation 5. Determine the potassium level. Hint: Acidosis causes K+ to leave the intercellular fluid. |
| The Upper Respiratory Tract Consists of ? | Nose, Sinuses, Pharynx (Nasopharynx, Oropharynx, Laryngopharynx (Voice box, Thyroid cartilage, Glottis, Epiglottis) |
| How do you know you have a sinus problem? | pain, teeth pain, pain when bending over... |
| The Trachea; 2 mainstem bronchi; Lobar, segmental, subsegmental bronchi; Bronchioles; Alveolar ducts and Alveoli all make up the ____? | Lower respiratory tract |
| Oxygen-poor blood travels from the ___ ventricle into where? | O2 poor blood travels from the RIGHT ventricle into the PULMONARY ARTERY into the arterioles, and into the capillary network surrounding the alveoli. |
| Where is the site of gas exchange? | Alveoli sacs |
| Oxygenated blood travels from the ___ into the ___ ventricle to where? | O2 blood travels from the PULMONARY VEIN into the LEFT ventricle and is Pumped into systemic circulation |
| T/F When obtaining a family and genetic Hx it is important to get Hx related to cystic fibrosis, some lung CA, emphysema, asthma, allergies, and Respiratory illness. | True |
| When obtaing smoking history from clients what do you need to include? | Include second hand exposure. First hand: how long, how much; what type, has the cl quit (how long ago)... |
| T/F In obtaing cl Hx it is not important to get personal Hx, Drug use, allergies, residence and travel, diet Hx, Occupation and SES, Current Hlth problems, cough (sputum production); chest pain, dyspnea, ADL difficulties? | False It is important |
| When a cl complains of a cough what do you want to ask them? | Do they have any sputum production? ADL difficulties, Dyspnea, Chest pain? |
| How do you calculate pack-years? | Number of packs per day multiplied by number of years |
| What is the duration, pitch, amplitude, and normal location of bronchial (tubular, trachea) sounds? | Pitch=High; Amplitude=Loud; Duration 1:2 Inspiration to expiration; Normal Location=Trachea and larynx |
| What is the duration, pitch, amplitude, and normal location of Bronchovesicular sounds? | Pitch=Moderate; Amplitude=Moderate; Duration 1:1 equal; Normal Location=Over major bronchi where fewer alveoli are located; posterior, between scapula; anterior around upper sternum in 1st & 2nd intercostal spaces |
| What is the duration, pitch, amplitude, and normal location of Vesicular sounds? | Pitch=Low; Amplitude=soft; Duration 2:1 Inspiration:Expiration; Normal Location=over peripheral lung fields where air flows through smaller broncholes and alveoli (majority of long areas) |
| What aventitious sound can occur either early or late in inspiration and sounds like hair being rolled between fingers near the ear? | Fine crackles |
| What avententitous sound is more common on expiration but may be present early in inspiration. It is lower pitched, coarse, discontinous rattling sounds caused by fluid or secretions in large airways; likely to change with coughing or suctioning? | Coarse crackles |
| What aventitous sound is audible during either inspiration, expiration, or both? It is squeaky, musical, continuous sounds associated w/ air rushing through narrowed airways; may be heard w/o a stethoscope. It arise from the small airways. | Wheeze |
| T/F Wheezes usually clear with coughing? | False they do not clear with coughing. |
| What adventitous sound is audible during both inspiration & expiration but commonly more prominent on expiration. It is lower-pitched, coarse, continous snoring sounds and arise from the large airways. | Rhonchous (rhonchi) |
| ____ is heard during both inspiration & expiration, generally at the end of inspiration & the beinning of expiration. It is loud, rough, grating, scratching sounds caused by the inflammed surfaces of the pleura rubbing together. | Pleural Friction Rub |
| What is the normal range for adults for RBCs? | females: 3.8-5.3 males: 3.8-5.8 |
| ____ may be due to the excessive production of erythropoietin, which occurs in response to a hypoxic stimulus, as in COPD, and from living at a high altitude? | Eleveated RBC levels (polycythemia) |
| What is the normal hemoglobin range for males and females? | females: 11.7-16.1 males 13.1-17.3 |
| What is the normal hematocrit range for males and females? | females 35-47% males 37-51% |
| What is the normal WBC count? | 7.4 IRU |
| Elevations of ____ indicate possible acute infections or inflammations, pneumonia, meningitis, tonsilitis, or emphysema. | WBC |
| Decreased ____ levels may indicate an overwhelming infection, an autoimmune disorder, or immunosuppressant therapy. | WBC |
| What is the normal PaO2 range? | 83-100 mm Hg |
| Elevations of ___ indicate possible excessive O2 administration. | PaO2 |
| Decreased levels of ____ indicate possible COPD, asthma, chronic bronchitis, cancer of the bronchi and lungs, cystic fibrosis, respiratory distress syndrome, anemias, atelectasis, or any other cause of hypoxia. | PaO2 |
| ___ is used to assess for pathologic changes in the lungs such as: pneumonia, atelectasis, tumors, and pneumothorax. | CXR |
| What is used to check placement of ET tubes, chest tubes and it is typically done back to front and left lateral view. | CXR |
| What scan usually requires contrast, is used to study lesions found w/ x-ray and can be used to find clots? | CT |
| What type of scan identifies areas of lung being ventilated and the distribution of blood in the lungs? | V/Q scan |
| What type of scan may be used to support or reject Dx of PE? | V/Q scan |
| What scan is injected with radionuclide and takes 6 perfusion views: anterior, posterior, right & left lateral & 2 oblique views. If perfusion test is abnormal, cl inhales radioactive gas to see the ventilation of the lungs as gas makes it way in&out lung | V/Q scan |
| What is hypoxemia? | low levels of O2 in the blood |
| What is hypoxia? | Decreased tissue oxygenation |
| What is hypercarbia? | Increased partial pressure of CO2 |
| Nasal cannula, Simple Face Mask, Partial rebreather, and non rebreathers are all examples of _____ O2 vnetilation? | low flow rate |
| What low flow O2 delivery system delivers 1-6L/min and 24-44% O2 concentration? | Nasal Cannula |
| What O2 delivery system delivers 40-60% O2 concentration for short term usage and a minimum of 5 L/min? | Simple Face Mask |
| ____ O2 delivery system delivers 60-75% O2 concentration and 6-11 L/min? | Partial Rebreather |
| What low flow O2 delivery method delivers 90+% O2 concentration; 10-15 L/min and you MUST ASSESS FOR SAFETY? | Non rebreather |
| Venturi Mask; Face Tent; Aerosol Mask; Trach collar; and T-piece are all _____ flow O2 delivery systems? | High Flow O2 Delivery systems |
| What O2 delivery system is the most accurate and pulls proportionate room air w/ oxygen? | Venturi Mask |
| What High Flow delivery systme uses high humidity and is useful for facial trauma and burns? | Face Tent |
| What high flow O2 delivery system uses high humidity and is used after extubation or upper airway surgery or thick secretions. | Aerosol Mask |
| What High flow O2 delivery system is used for high humidity with tracheostomy? | Trach collar |
| What High flow O2 delivery system is used to deliver specific FiO2 with trach, endo, or laryngectomy? | T-piece |
| T/F it is important to Check the physician's order with the type of delivery system and liter flow or percentage of oxygen actually in use. | True |
| T/F It is not necessary to Obtain an order for humidification if oxygen is being delivered at 4 L/min or more. | False an order must be obtained for humidification if O2 is being delivered at 4 L/min or more |
| T/F It is not important to be sure the oxygen and humidification equipment is functioning properly. | False It is important |
| How often do you need to check the skin around the client's ears, back of the neck, and face for pressure points and signs of irritation? | every 4-8 hrs |
| T/F It is important to Provide mouth care every 8 hours and as needed; assess nasal and oral mucous membranes for cracks or other signs of dryness? | True |
| T/F It is important to Pad the elastic band and change its position frequently to prevent skin breakdown for O2 therapy. | True |
| In O2 therapy is it important to pad tubing in areas that put pressure on the skin? | Yes |
| How do you cleanse the cannula or mask? | by rinsing with clear, warm water every 4-8 hrs or as needed. |
| What areas of skin should one cleanse of a pt on O2 therapy? | Cleanse skin under the tubing, straps, and mask every 4-8 hrs or as needed. |
| Lubricate the client's nostrils, face, and lips with _____ cream to relieve the drying effects of oxygen? | nonpetroleum cream |
| T/F A nurse should always position the tubing so it does not pull on the client's face, nose, or artificial airway during O2 therapy? | True |
| T/F It is important during O2 therapy to ensure that there is no smoking and that no candles or matches are lit in the immediate area? | True |
| Is it important to assess and document the client's response to oxygen therapy? | Yes |
| Why should a nurse provide the client with ongoning teaching and reassurance? | to enhance the client's adherence with oxygen therapy |
| What is the difference between a tracheotomy and a tracheostomy? | Tracheotomy-surgical incision into the trachea for the purpose of establishing an airway. Tracheostomy-the stoma made from the tracheotomy |
| List 2-3 indications for a tracheostomy? | Acute airway obstruction when oral or nasal intubation is not feasible; 2. Airway protection 3. Prolonged intubation or need for mechanical vent 4. decreased airway dead space 5 control of Pulomary secretions 6. Obstructive sleep apnea |
| Name 6 complications after a tracheostomy? | 1. Tube obstruction 2. Tube dislodgement & accidental decannulation 3. pneumothorax 4. Subcutaneous emphysema 5. Infection 6. Bleeding |
| ____ - Constant pressure exerted by cuff causes tracheal dilation & erosin of cartilage. It is a MAJOR Complication following a tracheostomy. | Tracheomalacia |
| ____-Narrowed tracheal lumen due to scar formation from irritation of tracheal mucosa by cuff. It is a MAJOR Complication of a _____? | Tracheal stenosis and it is a major complication after a tracheostomy |
| ___-Excessive cuff pressure causes erosion or posterior wall of trachea. A hole is created between trachea and esophagus. It is a major complication of ___? | Tracheoesophageal fistula and a major complication of a tracheostomy |
| ____- Malpositioned tube causes distal tip to push against lateral wall of tracheostomy causing necrosis and erosion of innominate artery. THIS IS A MEDICAL EMERGENCY!!!! | tRACHEA-INNOMINATE ARTERY FISTULA is a medical emergency and a major complication following a tracheostomy |
| What are the three parts of a double-lumen tube? | Outer cannula, Inner cannula and a obturator |
| ____-fits into the stoma and keeps the airway open, a part of the double-lumen tube. | Outer Cannula |
| ____-fits snugly into the outer cannula & locks into place. Provides the universal adaptor for use with the ventilator & other RT equipment. | Inner Cannula |
| ___-is a stylet with a blunt end used to facilitate the direction of the tube when inserting or changing a tracheostomy tube. (Double-Lumen Tube) | Obturator |
| What tube is used piror to removing a tracheostomy and it allows them to speak. It has a precut opening in the upper posterior wall of the outer cannula. | Fenestrated Tube |
| What type of tube is used when mechanical ventialtion is required occasionally and it allows for speech? T/F Never use it for weaning off from a tracheostomy!!!! | Cuffed fenstrated tube and TRUE Never use it when weaning from a tracheostomy becausee the cuff, even fully deflated, may partially obstruct the airway. |
| ____ is a long tube used for cl w/ long or extra-thick necks. Often called a "bull neck trach" because of the long distance from the skin to the trachea or the longer lenght of the trachea in large people. | Single-Lumen Tube |
| What type of tube is used for permanent tracheostomy. It is a cuffless double-lumen tube and can be cleaned and reused indefinitely. A special adaptor attaches manual resuscitation bag. | Metal Tracheostomy Tube |
| ____, when inflated, seals the airway. Used with mechanical ventialation to prevent aspiration of oral or gastric secretions or for tube feeding. A pilot ballon attached to the outside of the tube indicates the presence or absence of air in the cuff. | Cuffed Tube |
| ____ provides a means of cumminication for the cl who is using a ventilator on a long-term basis. | Talking Tracheostomy Tube |
| ___ is a plastic, silicone-like (Silastic) tube or a metal tube, usually double lumen, used for long-term airway management in cl who require a tracheostomy, who can protect themselves from aspirations, & who don,t require mechanical vent Many Speak w/ it | Cuffless Tube |
| In caring for a Tracheostomy, What do you do prior to seting up a sterile field? | 1. Assemble necessary equipment. 2. Wash hands. Maintain standard precautions or body substance precautions 3. Suction the tracheostomy tube if necessary. 4 Remove old dressings and excess secretions |
| Once a sterile field is set up for caring for the tracheostomy what do you do to care for the inner cannula? | Remove & clean inner cannula. Use half-strength hydrogen peroxide to clean the cannula & sterile saline to rinse it. If the inner cannula is disposable, remove the cannula and replace it with a new one. |
| After setting up a sterile field how do you clean the stoma site and tracheostomy plate? | Clean the stoma site & then the tracheostomy plate w/ Half-strength hydrogen peroxide followed by sterile saline. Ensure that none of the solutions enters the tracheostomy. |
| In caring for a tracheostomy what should a nurse do if ties are soiled? | Secure the new ties in place before removing soiled ones to prevent accidental decannulation. If a knot is needed, tie a square knot that is visible on the side of the neck. One or two fingers should be able to be placed between tie & neck |
| What is the last thing you should do when providing tracheostomy care? | Document the type and amount of secretions and the gen. condition of the stoma & surrounding skin. Document the cl response to the procedure & any teaching or learning that occured. |
| ____is breathing disruption during sleep that lasts at least 10 seconds & occurs a minimum of 5x an hr caused by upper-airway obstruction by the soft palat or tongue. | Obstructive Sleep Apnea |
| Obstructive sleep apnea is caused by ___-airway obstruction by the ____ or ____. | Obstructive sleep apnea is caused by upper-airway obstruction by the soft palat or tongue |
| What factors contribute to sleep apena? | Obesity, Lg uvula, short neck, smoking, Enlarged tonsils/adenoids, Oropharyngeal edema, Men more then women, risk increases with AGE. |
| What is the nonsurgical management of sleep apnea? | Change in sleep position, Wt loss, Position fixing devices to prevent subluxation of tongue & neck, Noninvasive + pressure ventialtion i.e. BiPAP or CPAP, Drug therapy. |
| Name two noninvasive positive pressure ventialtion devices that can be used as a nonsurgical managment of sleep apnea? | BiPAP or CPAP |
| Name two drugs that can be used as a nonsurgical means to treat sleep apnea? | Xyrem and Provigil |
| ___ is a CNS depressant and does not treat the cause of sleep apnea. | Xyrem |
| ___ Treats narcolepsy from sleep apnea by promoting daytime wakefulness | Provigil |
| Adenoidextomy, Uvulectomy, Remodeling of the posterior oropharynx (uvulopalatopharyngoplasy UPP), and Tracheostomy may be needed for severe cases. All are surgical management for ___________? | Sleep apnea |
| ____ is a life threatening emergency in which there is an interruption in airflow through the nose, mouth, pharynx, or larynx. | Upper Airway Obstruction |
| Give 3-4 causes of upper airway obstruction. | Tongue edema, Occlusion by the tongue, Laryngeal edema, Peritonsillar & pharyngeal abscess, Head & Neck CA, Thick secretions, stroke & cerebral edema, Facial, tracheal, or laryngeal trauma, aspiration, burns of head/neck, & anaphylaxis |
| What do you do if the obstruction is due to the tongue falling back? | Extend head & neck (reposition pt) and insert a nasal or oral airway. Accumulation of secretions present then suction. |
| What if the upper airway obstruction is due to a foreign body? | Abdominal thrust (Hymlick manover) |
| If the person has a foreign body obstructing their airway, they are concious and sitting/standing how do you help them? | place your fist between the victims lower rib cage and navel. Wrap the palm of your hand around your fist. A quick inward, upward thrust expels the air remaining in the vitims lungs, & foreign body should come out. Thrust rapidly until it does. |
| How do you provide thrust to an unconcious victim? | lying supine, straddle the victims thighs. Place one hand on top of the other as shown, with the heel of the bottom hand just above the victims navel. Quickly thrust inward and upward, toward the victims head. |
| List three emergency procedures for upper airway obstruction? | Cricothyroidotomy, endotracheal intubation, and tracheostomy |
| ___ is an emergency procedure for upper airway obstruction and a incision & hole is made in between the cricoiod cartlige and tyroid ring | cricothyroidotomy |
| In ___ a tube obstruction can occur from mucus build up. | Tracheostomy |
| What are the sypmtoms that a tracheostomy has fallen out? | difficult breathing, agitation |
| Why might you have trouble reinserting a tracheostomy tube that has fallen out? | they might have a luggie |
| How do you care for a tracheostomy pt the first 72 hrs when the tracheostomy tube falls out? | First 72 hrs post op ventilate pt and call for help if tube falls out. |
| How do you care for a tracheostomy pt AFTER 72 hours post op when the tube falls out? | After 72 hrs replace the tube extend the neck, insert obturator in tube. Replace the tube and remove obturator. |
| What is the priority nursing intervention in a respiratory arrest situation? | Ventilate Client |
| What type of lung surgery do you NOT need a chest tube? (Was on my test!!!) | pneumnectomy, or surgical removal of a lung-it is performed usually due to lung cancer. It is the complete removal of one lung. |
| What do you assess in an upper airway obstruction? | Assess for the obstruction |
| With Respiratiory disorders why is their an increase in erythropoietin and where is erythropoietin produced? | Produced by the kidneys; to increase O2 levels in the blood |
| PHARYNGITIS IS BASICALLY A ____? | SOARE THROAT |
Created by:
cgwayland
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