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MedSurge-Respiratory

QuestionAnswer
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
Created by: fluency