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MedSurge-Respiratory
| Question | Answer |
|---|---|
| ABG - pH, value: | 7.35 - 7.45 |
| ABG - PaO2 | 80 - 100 mmHg |
| ABG - SaO2 | >95% |
| ABG - PaCo2 | 32 - 48 mmHg |
| HCO3 | 22 - 26 mEq/L |
| Tissue hypoxia and cardiac dysrhythmias can be expected at PaO2 /SpO2 values? | <40 PaO2 / <75 SpO2 |
| SpO2 is? | hemoglobin saturation (the degree to which oxygen is bound to hemoglobin) |
| PaO2 is? | plasma saturation (how much oxygen is avail. in the alveoli to dissolve in the blood) |
| PaCO2 is? | the measurement of the partial pressure of carbon dioxide dissolved in the plasma |
| Resonance: sound / location? | low-pitch / over normal lungs |
| Hyperresonance: sound / location? | loud, low-pitch / hyperinflated lungs (eg. asthma, chronic obstructive lung disease) |
| Dull: sound / location? | medium intensity pitch / solid and lung tissue, liver, pneumonia, fluid filled pleural space |
| Flat: sound / location? | soft, high-pitch / dense tissue w/no air (posterior chest below diaphragn) |
| Lung tissue, sound? | resonant |
| Liver, sound? | dull |
| Heavy muscles and bones, sound? | flat |
| Stomach, sound? | tympany |
| Spinous process, sound? | flat |
| Scapula, sound? | flat |
| viscera, sound? | flat |
| The body's oxygen is carried attached to? | hemoglobin molecules |
| Formula for SpO2? | (maximum oxygen capacity/actual oxygen content) x 100 |
| Oxygen's affinity for hemoglobin changes depending on? | pH, temperature, CO2, 2,3-DPG |
| 2,3,-DPG is a? | metabolic by-product which competes with O2 for binding sites |
| In a left shift, O2's affinity for hemoglobin? | increases; more hemoglobin saturated w/O2 |
| Tissue hypoxia | result of very high SpO2, but O2 rides back to lungs without being used |
| Left shift conditions? | alkalosis, hypothermia |
| Right shift conditions? | acidosis, fever |
| In a right shift, O2's affinity for hemoglobin? | decreases; less O2 carried from the lungs |
| Mechanical ventilation can be delivered via? | endotracheal tube / tracheostomy tube / nasal or face mask |
| Volume in endotracheal cuff should be checked every ____ hours? | 8 |
| Pressure of endotracheal cuff should be maintained below ____ mm Hg? | 20; to reduce the risk of tracheal necrosis, inadequate oxygenation and/or accidental extubation |
| Reposition the oral endotracheal tube every ____ hours? | 24 (minimum); check for skin breakdown |
| Following extubation, monitor clients for signs of respiratory distress, such as? | ineffective cough, dyspnea, and stridor |
| Endotracheal Suctioning (ETS) should be performed wearing a ____ ____ and ____ ____. | face mask / STERILE gloves |
| Suctioning should be applied while? | withdrawing the catheter and rotating it with the thumb and forefinger |
| Suctioning of non-sterile oropharyngeal cavity should be performed (before / after) endotracheal? | after; to prevent cross contamination |
| Constant suctioning can result in? | hypoxia |
| ABG sample, nursing intervention? | perform Allen test prior to obtaining the sample / aspirate in heparinized syringe / hold pressure at site for 5 min |
| Structural changes in the skeletal system of cancer pts., result in a decrease in _____ _____. | diaphragmatic expansion |
| Assessment finding of pt. with lung cancer? | rust-colored or blood-tinged sputum / Hoarseness / Dyspnea / Unilateral wheezing / Muffled heart sounds / Fatigue, weight loss, or anorexia / Fever / Clubbing of fingers |
| Tactile Fermitus usually (increases / decreases) with lung cancer? | increases; due to air spaces being replaced with tumor tissue or fluid |
| Masses in lungs will sound? | dull or flat |
| Best position to promote breathing in pt. with emphysema | high Fowler's with arms supported on the over-bed table |
| For active tuberculosis, nurse should implement _____ precautions? | airborne |
| Tachypnea is? | an abnormally rapid rate of breathing |
| A pneumothorax is? | the presence of air or gas in the pleural space that causes lung collapse |
| In tension pneumothorax tracheal deviation is toward the (affected / unaffected) side? | unaffected |
| Effectiveness of mechanical ventilation is assessed best via? | ABG testing |
| Chronic bronchitis (blue bloaters), S/S... | obese, frequent cough, use of accessory muscles, coarse rhonchi and wheezing, may have signs of right HF |
| Emphysema (pink puffers), S/S... | may be very thin with a barrel chest, no cough, may adopt the tripod sitting position, breathing w/purses lips & accessory muscles, wheezing, heart sounds very distant |
| Total hip arthroplasty, places pt. at risk for a ____ ____ | pulmonary embolus; due to surgery & decreased mobility of affected extremity |
| Surfactant is? | a lipoprotein that lowers the surface tension in the alveoli |
| Surfactant function? | reduces the amount of pressure needed to inflate the alveoli and decreases the tendency of the alveoli to collapse |
| During inspiration, the diaphragm? | contracts; increasing intrathoracic volume and pushing the abdominal contents downward |
| During inspiration, the external intercostal muscles and scalene muscle? | contract; increasing the lateral and anterioposterior dimension of the chest |
| The ability of the lungs to oxygenate arterial blood adequately is determined by examination of? | the partial pressure of oxygen in arterial blood (PaO2) and arterial oxygen saturation (SaO2) |
| Respiratory defense mechanisms include? | filtration of air, the mucociliary clearance system, the cough reflex, reflex bronchoconstriction, and alveolar macrophages |
| When the curve shifts to the right? | blood picks up oxygen less rapidly in the lungs but delivers oxygen more readily to the tissues |
| The right shift is seen? | in cases of acidosis and hyperthermia and when the PaCO2 is increased |
| Early symptoms of inadequate oxygenation include? | unexplained restlessness and irritability |
| With aging, costal cartilages? | calcify; interfere with chest expansion |
| Auscultation should proceed from the lung ... | apices to the bases; if pt. will tire, start at the base |
| The term abnormal breath sounds is used to describe? | bronchial or bronchovesicular sounds heard in the peripheral lung fields |
| Thoracentesis is? | the insertion of a large-bore needle through the chest wall into the pleural space to obtain specimens for evaluation, remove pleural fluid, or instill medication |
| Kussmaul respirations, possible etiology? | Metbolic acidosis; ↑ rate aids in CO2 exertion |
| Abdominal paradox is? | inward instead of outward movement on inspiration |
| COPD, usual inspection finding? | barrel chest, cyanosis, tripod position, use of accessory muscles |
| Hematocrit Hematocrit finding in chronuc hypoxemia? | ↑ hematocrit |
| Hemoglobin values | M: 13.2 - 17.3 F: 11.7 - 16.0 |
| Hematocrit values | M: 39 - 50% F: 35 - 47% |
| ABGs test syringe to use for collection? | heparinized |
| Gram stain sputum collection, best done when? | A.M., after mouth care |
| Prior to CT Scan insure pt. is not allergic to? | shellfish (test is iodine based) |
| Ventilation/Perfusion (V/P) test performed to? | access V/P of lungs; V w/o P suggests pulmonary embolus |
| Positron Emission Tomography (PET) performed to? | distinguish between benign and malignant pulmonary nodules |
| Bronchoscopy, nursing interventions? | pt. NPO 6 - 12 hrs prior / get signed consent / after, keep pt. NPO until gag reflex returns |
| Test performed after Thoracentesis? | chest x-ray, tk check for pheumothorax |
| Positive TB response is? | >= 5 mm induration |
| False negative TB test can occur within? | 8 - 10 weeks of infection |
| False positive TB test can occur with previous? | BCG Vaccine |
| Tidal Volume is? | volume of air inhaled/ exhaled during each breath |
| Normal Tidal Volume is? | 0.5 L |
| Max lung capacity is? | 6.0 L |
| FEV is? | forced expiratory volume |
| PEFR is? | peak expiratory flow rate (max airflow during expiration |
| In allergic rhinitis, Corticosteroid and Mast Cell Stabilizer nasal sprays should be started? | 2 weeks prior to pollen season, 10 - 15 min prior to exposure to trigger |
| 1st generation antihistamines cross the? | Blood-Brain barrier, causing sedation |
| 2nd generation antihistamines dont take with? | MAOIs |
| Nasal spray, don't take longer than? | 3 days, longer can cause rebound |
| Temperature of ________ indicates _______? | 100.4, Infection |
| Pt. position to alleviate dyspnea? | low fowler's - 30 - 40 degrees |
| Pt. position to decrease aspiration risk? | high fowler's - 90 degrees |
| Inflation of endotracheal/tracheostoma cuff should be kept between _____ and _____ mm Hg. | 15, 20 |
| Examples of equipment that can allow speech with trachea tube? | small cuffless tube / fenestrated tube, speaking valve / speaking track tube |
| Trachea care should be done every ____ to ____ hrs as appropriate | 4, 8 |
| When a supraglottic laryngectomy is performed, pt (can / cannot) speak? | CAN speak; true vocal cords remain intact, but pt. must lean a new way to swallow |
| Leukoplakia / Erythoplakia patches are? | white / red patches inside the mouth |
| Comprehensive pain assessment should include? | location, characteristics, onset/duration, frequency, quality, intensity, precipitating factors |
| Laryngectomy/Radical Neck Surgery speech aides include? | tracheal-esophageal prosthesis / artificial larynx / electrolarynx / esophageal speech |
| Tracheal stenosis is? | a narrowing of the trachea that causes breathing problems |
| Esophageal speech involves? | swallowing air, trapping it in the esophagus, then releasing to create sounds |
| LPNs can do trachea care on pts. who are? | stable with non-acute airway problems |
| PORT (Pneumonia Patient Outcomes Research Team), SI (Severity Index) used to? | supplement clinical judgment as to where (home or hospital) to treat patient |
| PORT Scale - Low Risk : Outpatient | None - Class I / <70 - Class II / 71-90 - Class III |
| PORT Scale - Moderate Risk : Inpatient | 91 - 130 - Class IV |
| PORT Scale - High Risk : Inpatient | >130 - Class V |
| Asplenia is? | absence of normal spleen function and is associated with some serious infection risks |
| Patients with high gastric residuals are at risk for? | |
| Reaction to TB occurs ____ to ____ weeks after initial exposure? An induration reading of ____ is considered positive. | 2, 12, induration >=5 mm |
| TB Drug : Isonizaid (INH), S/E? | hepatitis |
| TB Drug : Rifampin (Rifadin), S/E? | hepatitis, thrombocytopenia, orange secretions |
| TB Drug : Pyrazinamide (PZA), S/E? | hepatitis, arthralgias, hyperuricemia |
| TB Drug : Ethambutol (Myambutol), S/E? | ocular toxicity (decreased red/green color discrimination / acuity) |
| QuantiFERON-TB (QFT) is a ____ ____ ____? | rapid diagnostic test for TB |
| The A___ F___ B___ test is done for ___ consecutive days to test for TB? | Acid Fast Bacilli, 3 days (A.M.) |
| What two TB drugs cannot be used together for latent TB? | Rifampin and Pyrazinamide; severe liver injury/death |
| Fungal Infection: HISTOPLASMOSIS | found in soil of N.America / generally self-limiting |
| Fungal Infection: COCCIDIODOMYCOSIS | found in semiarid regions SW-US / symptomatic in 1/3 exposures |
| Fungal Infection: BLASTOMYCOSIS | SW-US & NW-US / insidious progression, skin involvement |
| Fungal Infection: CRYPTOCCOSIS | true yeast, worldwide soil, pigeon excreta / possible meningitis |
| Fungal Infection: ASPERGILLOSIS | true mold in mouth / risk of necrotizing pneumonia |
| Fungal Infection: CANDIDIASIS | leading cause mycotic infections, upper respiratory & GI tract |
| Fungal Infection: ACTINOMYCOSIS | not a true fungus (anaerobic) / lower lobes w/abscess or emphysema |
| Fungal Infection: NOCARDIOSIS | not a true fungus (aerobic) / infection from nature / rarely in sputum |
| Fungal Infection: PNEUMOCYSTIC PNEUMONIA (PCP) | fungus in environment / opportunistic |
| Oxygen-hemoglobin Dissociation curve right shift caused by? | Increased acid / CO2 / temperature / BPG |
| SAO2 on tissue level, when right shift is (improved / worsened)? | Improved; More O2 loose for quicker binding in tissues |
| Possible causes of left shift? | Alkalosis / hypothermia |
| Oxygen-hemoglobin Dissociation curve left caused by? | Decreased acid / CO2 / temperature / BPG |
| Intravesical indicates what type of cancer? | bladder |
| Intrarterial indicates what type of cancer? | osteogenic sarcoma |
| Intrathecal indicates what type of cancer? | brain |
| Intraperitoneal indicates what type of cancer? | colorectal |
| Intravenous indicates what type of cancer? | leukemia |
| Chest tubes are inserted through what type of incision? | thoracotomy |
| Chest tube water seal allows air to? | exit pleural space on exhalation; stop air from entering on inhalation |
| For chest tube intra-procedure, position pt. in? | supine or semi-Fowler's position |
| For chest tube post-procedure, position pt. in? | Fowler's or semi-Fowler's position |
| Asthma and emphysema pts. chest presentation? | barrel chest |
| COPD pts. usually have _____-sided heart failure? | right |
| Right sided heart failure is when? | this side of the heart cannot effectively return blood from the body, or the veins, to the lungs |
| Right sided heart failure, S/S? | abdominal pain, nausea, and loss of appetite, unintentional weight gain, edema |
| Tracheostomy care - accidental decannulation within first 72 hrs. post-surgery, nursing action | call for assistance, this is a medical emergency; tract has not matured and replacement is difficult |
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