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Respiratory Skills

What is the goal of O2 therapy? Prevent hypoxia
What is O2 therapy used for? Patients with impaired tissue oxygenation
What should O2 be treated as? Drug
Oxygen therapy is NOT a __________ for other treatments and should only be used when ______________. Substitute; Indicated
Oxygen is ___________ and can have ____________ side effects. Expensive; Dangerous
Dosage or ___________ should be ordered and continuously ____________. Concentration; Monitored
What should you check regularly as part of your assessment? Flow setting
What does oxygen support? Combustion
Describe oxygen Colorless, odorless, and tasteless gas that will not burn or explode
Who frequently initiates oxygen therapy? Respiratory Therapist (RT)
What are early symptoms of hypoxia? RAT - Restlessness, Anxiety, Tachycardia/Tachypnea
What are late symptoms of hypoxia? BED - Bradycardia, Extreme restlessness, Dyspnea (severe)
What are signs of hypoxia in pediatrics? FINES - Feeding difficulty, Inspiratory stridor, Nares flare, Expiratory grunting, Sternal retractions
Name some methods of O2 delivery Nasal cannula, Face mask, Transtracheal Catheter, Tracheostomy, ET Tube, Non-rebreather mask
Describe a nasal cannula (be able to label pic) 2 prong plastic device, watch for skin break down, can eat with it in place, flow rate is usually 2-4 LPM
Describe transtracheal catheter (be able to label pic) Catheter in between 2nd and 3rd tracheal cartilage
Describe a non-rebreather mask (be able to label pic) Used mostly by paramedics, no mixing of exhaled air
Describe face mask Fits over the nose and mouth; flow rate is usually 6-10 LPM
Describe tracheostomy Tube inserted in trachea
Describe ET tube Endotracheal tube for patients on a ventilator
What does a pulse oximetry measure? The amount of oxygen bound to hemoglobin compared to amount available
What is normal O2 saturation? 90%-100%
What is respirations driven by? Carbon dioxide
In COPD, what is respirations driven by? Hypoxia
What is normal pH? 7.35-7.45
What is pH over 7.45 called? Alkalotic
What is pH below 7.35 called? Acidotic
If patient has high blood level of CO2, what will respiratory rates do to compensate? Increase
What is the path of O2? UnO2ated blood enters RA, unO2ated blood enters RV, PA takes blood to capillary system of alveoli, CO2 diffuses & O2 infuses into the blood in the alveoli, Blood enters LA via PV, blood enters LV, blood enters aorta
How does blood circulate? Through the lungs via the pulmonary artery & pulmonary vein
Is tracheostomy suctioning a sterile or non-sterile procedure? Sterile
Is oropharyngeal & nasopharyngeal suctioning a sterile or non-sterile procedure? Non-sterile
Where do sputum collections come from? Lungs
What does sputum contain? Mucus, cellular debris, and microorganisms that may contain blood or pus
When is the best time to collect a sputum specimen? Early morning, because patient hasn't had time to clear respiratory passages
What is the best way to break up sputum? Water; push fluids
When collecting a sputum specimen, what do you instruct patient to do? Cough from deep in the lungs
What are the steps to collecting a throat specimen? Tilt head back, say "ah", insert sway w/o touching lips, teeth, tongue, or cheeks, gently swab tonsillar area side to side (making contact w/ inflamed or purulent sites), carefully withdrawal swab w/o touching oral structures, place swab in tube, label
What does TB require? AFB precautions which includes a negative pressure room & PAPR mask (N95 respirator mask for healthcare workers)
What is TB? Lung infection that is transmitted by air, contact, and droplets
Do all positive TB results require you to be isolated? No - Many have been exposed to TB but only 10% lead to active TB
How do you prevent post-op respiratory complications? Turning, Deep breathing, & coughing
What is an IS (Incentive Spirometry)? Inexpensive device that measures inspiration
What are the steps of use for IS? Hold IS level, Maintain firm seal w/lips around the mouthpiece during inhalation, Inhale slowly, Keep visual indicator at the inspiratory goal for several seconds, remove the mouthpiece, Exhale normally
What is a pneumothorax? Collection of air or gas in the pleural space, diagnosed w/xray, ABG's show abnormalities, pt. may complain of SOB, chest pain, or air hunger.
How do you decompress a pneumothorax? Chest tube
What are the nursing interventions for pneumothorax? Treating pain, promoting oxygenation, assisting in procedures, and providing patient education
What does a chest tube do? Restores negative intra-pleural pressure
What is tidaling? Water bubbling that indicates the lung is re-expanding
What do you do if chest tube accidentally comes out? Place a petroleum gauze dressing over site on the chest and notify physician immediately!
What is Chest Percussion Therapy (CPT)? High frequency chest wall oscillations and postural drainage. Facilitates removal of secretions
When is the best time to do CPT? In the morning, 2hrs before meals, at bedtime
What patients may CPT not be for? Elderly or those with osteoporosis
Define tracheostomy Artificial opening in the tracheal made by surgical incision, can be permanent or temporary, due to obstruction in airway, require frequent suctioning, impairs ability to speak. Is possible to eat w/ trach in place
What are the steps of trach care? Don sterile gloves, adjust the suction to 100-150mmHg, pre-oxygenate pt., check function of suction catheter, insert catheter w/out suction, apply intermittent suction while rotating catheter, assess for secretion clearance
Which nursing assessment best indicates a patient's ability to tolerate activity? V/S take three minutes to return to pre-activity level
A nurse is caring for at pt. who has a chest tube after thoracic surgery. What should the nurse do when caring for this pt.? Maintain an airtight dressing over puncture wound
What should the nurse do first if a patient is choking on food? Determine if the patient can make any verbal sounds
A nurse is assessing a pt. with a respiratory problem. Which clinical manifestation is most reflective of an early response to hypoxia? Restlessness
The nurse teaches a pt. how to use an IS. What pt. outcome will support the conclusion that the use of the IS was effective? Inspiratory volume will be increased
A patient w/ a tracheostomy has been assessed & needs suctioning. How long will the nurse perform the suction? Maximum of 10 seconds
Today the nurse is assigned to care for a pt. who has TB. What equipment should the nurse routinely use when caring for this patient? N-95 respirator
A nurse is caring for a patient receiving O2 via nasal cannula. What should the nurse do? Reassess nares, cheeks, and ears for signs of pressure every 2 hours
A patient informs the nurse that she cannot breathe while laying flat and must sleep w/ two pillows. What should the nurse use to document this condition? Orthopnea
Which outcome best reflects achievement of the goal. "The patient will expectorate lung secretions w/no signs of respiratory complications"? Absence of adventitious breath sounds
A meal tray arrives for a patient who is receiving 24% O2 via a venturi mask. What should the nurse do to meet this patient's needs? Request an order to use a nasal cannula during meals
A practitioner orders CPT and vibration for a newly admitted patient. Which information obtained by the nurse during the health history should alert the nurse to question the practitioner's order? Osteoporosis
A nurse in the PACU in monitoring several patients who received general anesthesia. Which patient response causes the most concern? Stridor
A nurse is assessing a patient. Which clinical manifestation indicates respiratory distress? Orthopnea
A patients hemoglobin saturation via pulse oximetry indicates inadequate oxygenation. What should the nurse do first? Raise the head of the bed
What is the next step performed by the nurse after a specimen has been obtained? Properly identify it
The physician has ordered a sputum specimen to be collected on a patient. Which statement is an appropriate teaching for this patient? The sputum can not contain any saliva
What is true regarding a patient who receives oxygen via the transtracheal method? Oxygenation is usually achieved with less oxygen flow than with other systems
A unconscious patient who had oral surgery is admitted to the PACU. In which position should the nurse place the patient? Lateral
What are the structures of the lung called in which gas exchange occurs? Alveoli
Created by: tandkhopkins
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