Ch 25 - Resp
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| This is process of admin O2 @ concentrations greater than room air? | O2 Therapy
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| What factors determine the ability to transport O2 to the tissue? | Cardic Output
Concentration of the hemoglobin
Arterial O2 content
metabolic requirements.
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| What is the term that decribes a reduction of oxygen in the arterial blood? | Hypoxemia
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| Define Hypoxia | Reduction of oxygen levels being supplied to the tissue
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| You have two pt one suffering from hypoxemia and one from hypoxia. Which pt is suffering from a life threating condition? | The pt who is has hypoxia.
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| What are the types of hypoxia? | Hypoxemic, Circulatory, Anemic, and Histotoxic Hypoxia.
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| What SS would you expect a person suffering from acute hypoxia would display? | The pt would appear as if they have alcohol intoxication, due to CNS disterbances.
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| What SS would you expect from a pt suffering from chronic hypoxia? | Fatigue, drowsiness, apthay, delayed reaction.
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| What should you monitor if you are told to increase the amount of oxygen given to a COPD pt? | You should monitor their breathing and signs of inadequate oxygenation.
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| You have a pt who has been placed on oxygen and has been in the hospital for 2 + days. The pt begins to complain of paresthesias, restlessness, malaise, fatigue. Upon x-ray alveolar infiltrates are seen. Why do you expect this pt is suffering from? | O2 toxicity, which can occur when a pt is receiving a concentration of oxygen greater than 50% for longer than 48 hrs.
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| First what is oxygen toxicity and how is it treated? | First, oxygen toxicity is is the overproduction of oxygen free radicals. It is treated by increasing antioxidants, such as vitamin E & C, also beta-carotene.
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| Other than oxygen toxicity what are other concerns with administering oxygen? | Fire, Bacterial cross infection (change tubbing), suppressed ventilation (COPD).
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| Oxygen administration devices (OAD) fall into two general types, which are? | High flow and low flow.
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| Low flow OAD do not provide constant or know concentration of oxygen. What devices fall into this category? | Nasal cannula, Oropharyngeal catheter,
Mask: Simple, partial rebreather, non-rebreather.
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| High flow OAD provides specific % of oxygen. What devices fall into this category? | Transtracheal catheter, Tracheostomy collar, T-piece, Face tent.
Mask: Venturi, aerosol.
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| What is the negative of using a nasal cannula? | The pt could swallow air.
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| What nursing management should be preformed when using an oropharyngeal catheter | It should be changed q 8 hrs and alternate nostrils.
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| What are the negatives to using a simple oxygen mask? | It can cause claustrophobia and skin breakdown.
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| When using a partial-rebreathing and non-rebreathing mask what should you make sure occurs? | That the reservior bag remain inflated at all time.
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| Which of the AOD is the most reliable, accurate and noninvasive? | Venturi mask
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| What type of pt will commonly have a venturi mask? | A Venturi mask is primarly used with COPD pt.
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| What type of pt would you expect to see with a transtracheal oxygen catheter and what is the benefit? | Pt with this AOD normally require chronic oxygen therpay. It delivers high O2% at reduced rates, making it cheaper to use.
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| This AOD is commonly used to wean pt off mechanical ventilation? | T-piece
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| What is demand oxygen delivery system (DODS)? | It interrupts the low of oxygen during exhalation, when other wise the oxygen would be wasted.
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| When would you expect hyperbaric oxygen therapy to be preformed? | It is used for an air embolism, CO poisoning, hemorrhage, gangrene, & tissue necrosis.
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| What are the side effect of hyperbaric oxygen therapy? | Ear trama, CNS disorders, Oxygen toxicity.
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| What changes to the lung would you expect in a elderly pt? | Decrease gas exchange, due to enlarged bronchi & Alveoli. (Also weaken muscles)
Increase risk for aspiration and infection. due to decrease cilia and cough reflex.
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| Normally most oxygen devices require humidified air. Which device does not this? | Portable devices.
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| What follow up should occur once a pt goes home with O2? | There should be a follow up q 6 mo with ABG yearly.
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| When should you expect to see a pt assigned an incentive spirometry? | After surgery to prevent or tx atelectasis.
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| How can you tell that a nebulizer is working? | You will be able to see a visible mist.
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| What action must a pt be able to preform before a nebulizer can be used and what technique can enhance it's effects? | The pt must be able to generate a deep breath and diaphragmatic breathing can be helpful.
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| Intermittent Positive-Pressure Breathing (IPPB) is a device that delivers compressed gas under positive pressure. What are some of the complications? | Pneumothorax
Hemoptysis
Increase intracranial pressure
gastric distention (vomiting)
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| What are the 5 positions of postural drainaging? | Head down, Prone, R&L lateral, sitting upright.
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| What can you do to increase the effectiveness of postural drainage? | Admin bronchodilators and mucolytic agents before the proceedure. Also used pursed lip breathing.
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| If you have fluid in multiple lobes, which lobes should you treat first? | You should attempt to drain the lowest to highest lobes.
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| What are some of the nursing care when providing chest percussion and vibration? | First a towel can be use to reduce skin irritation.
Second, vibrate during exhalation.
Third pt should cough after 3-4 vibrations.
Avoid percussion over organs or breast.
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| If you wish to increase the amount of sputum a pt produces what should you do? | Provide hydration.
Turn cough & deep breath
Use a flutter valve.
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| T or F. A pt using HFCWO (inflatable compression vest) needs to be in a specific position during tx? | No, the pt is only limited by the length of the tubes attached to the vest.
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| Before compression tx occurs what should a nurse check for? | That the pt has not just eaten.
That they have no restrictive clothing.
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| What signs or symptoms indicate that you need to stop compression therapy? | Increase in pain or SOB, weakness, lightheadness, hemoptysis.
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| What are the types of breathing retraining or exercises? | Diaphragatic Breathing and Pursed-lip Breathing.
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| Which type of breathing exercise would you encourage with a pt suffering from emphysema or emphysema like changes related to aging? | Pursed-lip breathing, as it increase oxygen transport, while slowing breathing rates.
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| When teaching someone about breathing, why is it important that the person breaths in through their nose? | It filters, humidifes and warms air.
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| What changes can a person make to reduce the dust found in their home? | Adequate humidification.
Airfilter
Remove draps and upholstered furniture.
Wash / vacumm the floors often.
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| What advice can you provide a person concerning meals, who suffers from low oxygen levels? | Rest before meals.
Avoid gas producing foods.
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| If a pt has an endotracheal intubation, what is the pressure should be maintained on the cuff? | Cuff pressure should be 15-20 mm Hg and should be check q 8 hrs.
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| What could happen if the endotracheal intubation cuff pressure was either too high or too low? | If the pressure is too high the pt is at an increase risk for tracheal bleeding, ischema, necrosis.
If it is too low the pt is at an increase risk for aspiration.
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| What is a life threatening condition that is commonly encounter with endotracheal intubation? | Early or unintentional removal of the tube.
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| What is the longest period an endotracheal intubation can be use and what as some of the disavantages of it's use? | The device can use used upto 3 wks.
Disavantages: decrease cough reflex, thicken secreation, decrease swallow reflex, inability to talk.
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| What are some of the care provide to a pt after extubation? | Pt should be in a high fowler's position.
Monitor respiratory rate and quality of chest excursions, be aware of mental alertness or behavior changes.
NPO for few hours, turn cough deep breah, provide mouth care.
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| This is a proceedure which is used to bypass an upper airway obstruction. | Tracheostomy
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| What are some of the early complication of a tracheostomy? | Bleeding, air embolism, pneumothorax, aspiration.
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| What are some of the late complications of a tracheostomy? | Air way obstruction, rupture of the innominate artery, infection.
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| When can the late complication of a tracheostomy occur? | At any point even years after a procedure.
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| What nursing management should be preformed on a post opertive tracheostomy pt? | Place in a semi-flower (after pt stablizes)
Admin analigesia & seditives with care.
Suction secretions as needed.
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| When is trachael suctioning required? | When adventitious breath sounds occur or when secretions are present.
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| What can occur is unnecessary suctioning is preformed? | Bronchospasm
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| If you are introducing something into the lower airway, such as equipment what must be observed? | Sterile procedure.
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| Mechanical Ventilation can provide ventilation and oxygen delivery. This is accomplished by one of two general methods. What are those methods? | Either through negative or positive pressure devices.
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| What mechanical ventilation devices operate through negative pressure? | Iron lung also Body Wrap & Chest Cuirass
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| What type of pt would you expect to see use an iron lung? | Pt with either chronic or neuromuscular disorder (polio, muscular dystrophy, etc.)
If the pt is unstable they can not use this device.
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| What is the benefit and negative to the Body Wrap & Chest Cuirass? | Benefit - portable
Negative - Problems with proper fit and system leaks.
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| What ventilators use positive pressure? | Pressure-Cycled, Time-cycled, Volume-cycled, and noninvasive positive-pressure ventilation.
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| Which type of ventilator has passive expiration? | Positive-pressure ventilators.
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| What is the most common type of pressure-cycled ventilator and what is one of the negatives to this type of ventilator? | The negative to this type of ventilator is that it is intended for only short term use and tidal volume deliver may be inconsistent.
The most common type is the IPPB.
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| What type of pt would you generally see with a time-cycled bentilator? | Newborn and infants.
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| What type of positive-pressure ventilator is commonly used? | Volume-cycled ventilator
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| CPAP & Bi-PAP are both types of this ventilator? It is also the most comfortable ventilator. | Noninvasive positive-pressure ventilation.
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| If you are to adjust the ventilator what is the goal you are trying to reach? | To make the pt comfortable and breathes "in sync" with the machine.
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| This for of ventilation mode delivers a preset tidal volume and resp rate. The cycle does not adapt to the pt spontaneous efforts. | Assist-control ventilation.
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| Since intermittent mandatory ventilation (IMV) allow some breathing by the pt, but still delivers a set interval and preselected tidal volume. What are negatives and positives to this system? | Positives: allows some use of pt muscle for breathing and the pt change change the resp rate.
Negative: Bucking may be increased.
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| What are the characterics of Synchronized intermittent mandatory ventilation (SIMV)? | It delivers a preset tidal volume & number of breaths per min, which allow pt to breath on their own between delivers. Can be used for full or partial ventilatory support.
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| What nursing interventions for pt receiving IMV & SIMV? | Monitor Resp rate, Min. volume, Spontaneous and machine-generated tidal volume, FiO2, and arterial blood gas levels.
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| What must the nurse monitor with a pt on Pressure support ventilation (PSV)? | Monitor respiratory rate and tidal volume.
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| How does the Airway pressure release ventilation (APRV) work? | It produces tidal ventilation by releasing of airway pressure, which simulate expiration. It allow unrestricted, spontaneous breathing.
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| What is the normal tidal volume for ventilation? | 6-12 mL/kg
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| What should the nurse do if the ventilator malfunctions and the issue can not be resolved right away? | Preform manual ventilation with a manual resuscitation bag.
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| What is "bucking"? | It is when the thoracic expansion does not coincide with the inspiratory phase of the machine.
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| There are three pt problems that can occur due to positive pressure being appliced to the lungs. What are those? | 1. Cardiovascular compromise. The pressure decreases venous return.
2. Barotrauma / pneumothorax, due to a rupture of the alveolar.
3. Pulmonary infection.
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| If you see a decrease in pressure of loss of volume with a ventilator what should you check? | Increase in complaince, which there is nothing you can do.
Link in system. Check entire ventilator circuit.
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| Your pt who is on a ventilator is having s/s of pneumothorax. What should you do? | Manually ventilate pt, notify physician.
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| What are the general nursing interventions that are important in the care of the mechanically ventilated pt? | Pulmonary auscultation & interpretation of arterial blood gass measurements.
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| What is the purpose of mechanical ventilation? | Is to optimize gas exchange by maintaining alveolar ventilation and oxygen delivery.
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| If you have a pt on positive pressure ventilation, should you monitor for excess secretions and how often? | All pt with positive-pressure ventilation will have increase secretions. You will need to auscultate at least q 2 - 4 hrs.
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| What should you think before admin suctioning? | Does the pt need this. Suctioning can damage the airway mucosa and impair cilia action, causing more secretions.
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| What is the sign feature and why would it not be used frequently? | It is a tidal volume of 1.5 times normal delivered at 1-3 / hr, to prevent atelectasis and retention of secretions. Is not used very often due to risk of hyperventilationa dn trauma.
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| How often if tracheostomy care preformed? | q 8 hrs or sooner.
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| How many stages are there when preforming respiratory weaning from a ventilator? | Three, remove from the ventilator, remove from the tube, remove from oxygen.
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| What are the criteria for weaning a pt? | Vital capacity 10-15 mL/kg
Tidal volum 7-9 mL/kg
Minute ventilation 6L/Min
Breathing index below 100 breaths/min.
PaO2 >60, with FiO2 <40%.
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| How often should vital signs, pulse oximetry, ECG, and resp pattern be monitored? | Constantly for 20-30 min then q 5 min until weaning is complete.
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| What conditions would indicate an adverse reaction to the weaning process? | HR increase of 20 beats/min.
Systolic BP increase of 20.
Decrease in oxygen saturation < 90%
Resp rate < 8 or > than 20 breaths/min.
Dysrhythmias, fatigue, panic, cyanosis, erratic or labor breathing, paradoxical chect movements.
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| What conditions indicate that the pt may be ready to be weaned from tube? | Breathing spontaneously, effectely caughing up secretions, swallowing, and moving jaw.
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| This is a surgical procedure where an oping is created in the thoracic cavity, generally for diagnose purposes. | Thoracotomy.
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| Pneumonectomy | Is the removal of the entire lung.
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| The removal of which lung is more dangerous to remove? | The right lung is more dangerous, due to it having a larger vascular bed and it cause a greater physiologic burden.
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| What is the name of the procedure that removes an area with in the lobe of the lung that acts like an individual unit? | Segmentectomy (Segmental Resection)
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| With wedge resection, what procedure is preformed due to possibility of an air or blood leak? | Pleural cavity is usually drained.
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| During a lung bolum reduction, what amount of the lung is removed? | 20-30% and is preformed through a midsternal incision or video thoracoscopy.
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| Before a pt undergoes a pneumonectomy. This test is given to see if they can toterate the removal of the lung? | Exercise tolerance test.
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| What are some of the strategies to reduce the risk for atelectasis and infection after lung surgery? | humidification, postural drainage, and chest percussion after bronchodilators are admin.
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| Risk factors for surgery-related atelectasis and pneumonia. (Pre-Op) | Increase age, Obesity, Poor nutritional status, Smoking, abnormal pulmonary function test, comorbid state, disability.
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| Risk factors for surgery-related atelectasis and pneumonia. (Intra-op) | Thoracic incision
Prolonged anesthesia
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| Risk factors for surgery-related atelectasis and pneumonia. (Post-op) | Immobilization, supine position, decrease consciousness. Inadequate pain management, prolong intubation, presence of nasogastric tube. Inadequate pre-op ed.
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| What should you teach a pt about coughing routine? | That it may be uncomfortable.
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| What can you suggest for a pt if they refused to cough? | The huffing technique or forced expiration technique (FET).
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| If the pt is suffering from reduced lung capacity what effect will this have on fluid admin? | May be given a low hourly rate to prevent fluid overload and pulmonary edema.
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| What should you do with a pt who has under went a pneumonectomy after they become stable and why? | Place them in a flower's position and turn them from their back to the unoperated side every hour. This allow the fluid to consolidate and prevents mediastinal shift toward the operative side.
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| Which lung surgery can you turn a pt from side to side? | Lobectomy.
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| If a pt is showing complications of cyanosis, dyspnea, and acute chest pain after surgery what may they be suffering from. | Atelectasis and it should be reported immediately.
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| Pallor and increase pulse rate may indicate what post-op lung surgery complication? | Hemorrhage.
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| What are the two types of chest tubes? | Small or large bore. Large bore is used to collect pleural fluid and monitor for air leaks.
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| In a water seal drainage system, what indicates the strength of suctioning? | The amounts of bubbling in the suction chamber.
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| What is the normal suctioning pressure for a traditional water seal system? | 20 cm h2o.
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| What is tidaling? | It is an increase of water level with inspiration and a return to baseline during exhalation.
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| What can continuous bubbling indicate? | Air leak.
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| If a pt only require a gravity drainage, what type of system will be used? | A two-chamber system.
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| What should the nurse do if the wall vacuum is turned off? | The drainage system must be open to the atmosphere, so that intrapleural air can escape.
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| Your pt has disconnected the chest tube from the drainage system. What complication can occur and what what can you do to prevent this? | If the tube is disconnected from the drainage system, the pt can develop pneumothorax. This can be prevented by creating a temporary water seal by immersing the chest tune open end into a sterile bottle of water.
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| Does a dry suction contain a water seal? | Yes and one of the negative of the system is that if the chamber is knocked over the water seal can be loss.
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| If water levels of a dry suction system should increase what does this indicate and how would you resolve this issue. | It indicates an increase in intrathoracic pressure. This can be fixed by pressing the manual high-negativity bent until the indicator appears and the water level returns to the desire level.
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| If a pt is on gravity drainage and you notice an increase water level how long should you press the manual bent? | You don't. with gravity drainage, intrathoracic pressue is equal to the pressure in the water seal.
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| What system lacks a water seal? | Dry suction system with a one-way valve and so it is the quickest set up in emergency situations and works even when knocked over.
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| What is the negative of the dry suction system with a one-way valve and how will you accomdate this negative? | There is no way to tell by inspection if the pressure in the chest has changed. (air leak)
If an air leak is supected, 30 ml of whater is injected into the air leak indicator. If bubbles appear a leak is present.
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| What interventions should a nurse preform post-op of a thoracic or cardiac surgery? | Monitor HR and rhythm by auscultation and ECG, b/c dysrhythmias are common.
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| If a pt has a FEV1 of less than 40%, what is the pt at risk for? | Resp failure, other morbidity, and death.
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| How is gas exchange determined post-op and how often should it occur? | Measure vital signs q 15 min for the first 1-2 hrs.
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| How often shoudl breathing techniques be preformed? | q 2 hrs to expand the alveoli and jto prevent atelectasis.
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| What suctioning may be needed to stimulate a deep cough for a pt who is post-op thoracic surgery? | Nasotracheal suctioning., but should be used only after other methods have been unsuccessful.
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| How often should the pt cough post-op and which position is best? | The pt should cough q hr during the first 24hrs. The best position is sitting up with feet on the floor.
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| Diminish breath sounds after a pt has cough could indicate what condition? | collapsed or hypoventilated alveoli.
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| If you see a pt who is restlessness who is post-op. What may he be experincing? | It could be hypoxia, but it could also be caused by pain!
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| Why is shoulder mobilization as soon as possible (8-12hrs) important after a thoracotomy? | Because the girdle muscle is transected during a thoracotomy.
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| If a post-op thoracic pt has pneumothorax, what other condition should you be monitor for s/s? | Hemothorax. It is common for pneumothorax to be accompanied by hemothorax.
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| What are the s/s of pneumothorax? | Increase SOB, tachycardia, increase respiratory rate, and increase respiratory distress.
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| If you have a pt who lungs will not re-expand and can not obtain a negative intrathoracic pressure. What rare and serious complication may this pt have? | Bronchopleural fistula. It is tx by drainage, mechanical bentilation, and possibly talc pleurodesis.
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| What should the nurse emphasize with home community-base care? | the importance of progressively increase activity, including shoulder exercises, which should be preformed 5 times a day.
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| What amount of drainage should you contact a physician? | If the drainage is 150 mL/hr or greater.
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| How can the nurse prevent sensory overload, which may increase anxiety? | Turn off all unnecessary alrams.
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