Respiratory and MH flashcards
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| What are the indications for a Tracheostomy? | 1-Upper Airway obstruction
2-Tumor
3-Chronic Respiratory failure
4-Long term treatment (more than 10-14 days
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| What are the advantages of a tracheostomoy over an ET tube for periods longer than 10-14 days? | 1-Avoiding further laryngeal suctioning
2-Allows the patient to eat
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| What are the advantages of percutaneous dilational tracheostomy ofver a standard tracheostomy insertion? | 1-Small incision and dilator for hole
2-Done at bedside with local anesthetic
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| What are early complications of a tracheostomy? | 1-Airway obstruction from secretions
2-Posterior trach wall penetration
3-Bleeding
4-Pneumothorax
5-Air embolism
6-Aspiration
7-Subq or mediastinal emphysema
8-Laryngeal nerve damage
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| What are long term complications of a tracheostomy? | (T=Trachea)
1-T Erosion
2-T Ischemia
3-T Necrosis
4-Airway obstruction from accumulation of secretions or protrusion of the cuff over the opening of the tube
5-Infection
6-Rupture of innominate artery
7-Dysphagia
8-T Dilation
9-Tracheoesophageal
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| What should the med-surg nurse do if a new trach becomes dislodged? | 1-Call rapid response team
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| What nursing interventions will prevent complications in careing for a tracheostomy patient? | 1-Cleaning inner cannula
2-Use disposable inner cannula
3-Change qshift and PRN or every 8 hours
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| How should a mechanically ventilated trach patient by hyperoxygenated before suctioning? | With the ventilator because it will give the appropriate amount. You should momentarily turn up the oxygen for hyperoxygenation.
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| Why is a chest tube inserted? | To remove air, blood, or excess fluid from the PLEURAL space that can compromise normal pressure changes of the pulmonary system, and reexpand the involved lung.
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| What does constant or intermittend bubbling of a water-seal chamber indicate? | Leaks in the drainage system.
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| When should subcutaneous emphysema be reported to the physician? | When it is worsening. This is because in extreme cases, it can spread to the neck area and compromise the airway.
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| How should you monitor subcutaneous emphysema? | By marking the skin at the furthest point the subcutaneous emphysema was felt and reassessing for spreading PRN.
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| What should you encourage a client with a chest tube to do. | Deep breathing, coughing and incentive spirometry.
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| What should you do to prevent air from entering the pleural space after a chest tube has been removed? | Immediately apply a sterile occlusive petroleum gauze dressing over the site.
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| What should you note in the water seal chamber if the system is workng properly? | Fluctuating, or tidaling of the fluid level.
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| What shouldn't you do to a chest tube? | 1-Let it kink or interfere with the patients movements.
2-Clamp it (unless you are replacing the CDU, assesing for an air leak, or assessing for the patient's tolerance of chest tube removal, or removing the chest tube.)
3-Strip, or milk.
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| What are some indications for chest tube insertion? | 1-Pneumo/hemothorax
2-Post-op thoracotomy (including open heart surgery)
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| Where might a chest tube be inserted? | In the pleural space or mediastinum.
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| If a specific suction level of drainage is not ordered ______cm is used. | 20
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| Assess all chest tube dressings and drainage for _______? | COCA (Color, Odor, Consitency and Amount in tubing)
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| Where should the fluid collection chamber be placed at ALL TIMES? | Below the chest level of the patient
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| What should you do if a water seal chamber is spilled? | Clamp the chest tube or place it in a botle of sterile water to prevent air from entering the pleural space.
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| What is the difference between wet and dry systems? (besides the noise and that one has water and the other doesn't.) | In water seal systems you must assess in the water seal is intact whereas in dry systems, a regulator dial is available for you.
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| What is Pleurisy? | Inflammation of both layers of pleurae. (Inflamed surfaces rub together with respirations, cause sharp pain intensified with inspiration.)
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| What is Pleural Effusion? | Collection fluid in pleural space usually secondary to another disease process. (Large effusions impair lung expansion, cause dyspnea)
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| What is Empyema? | Accumulation of thick, purulent fluid in pleural space. (Patient usually acutely ill; fluid, fibrin development, loculation impair lung expansion. Resolution is a prolonged process)
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| What is ARDS? Acute Respiratory Distress Syndrome (NON-CARDIOGENIC PULMONARY EDEMA) | Severe form of acute lung injury. Syndrome characterized by sudden, progressive pulmonary edema, increasing bilateral lung infiltrates of CXR, hypoxemia refractory to oxygen therapy, decreased lung compliance.
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| What are the symptoms of ARDS? | Rapid onset of devere dyspnea, and hypoxemia that does not respond to supplemental oxygen.
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| What is the cause of pulmonary edema? | Massive inflammatory response or prolonged hypoxia->Increased capillary permiability->fluid leaks in between capillary and alveoli->Decrease in gas exchange->Alveolar hypoxia and damage->PULMONARY EDEMA
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| What are the hypoxia/refractory hypoxia symptoms of Pulmonary edema? | Pallor, tachypnea, dyspnea, low O2 sat not responsive to increasing O2 supplementation, and marked respiratory distress and effort.
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| What is the difference between Bipap and Mechanical ventilation? | Mechanical ventilators can be positive or negative pressure, whereas BiPap is a type of mechanical ventilatory that uses positive pressure.
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| What is the normal breathing pressure of humans and how does it work? | Neg pressure breathing is where we increase the volume of our thoracic cavity (your chest expands bc your diaphragm contracts and your intercostal muscles relax). Since the volume increases, the lungs expand which makes the pressure drop, & air rushes in.
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| What is positive pressure breathing? | Where air is being forced into the lungs, instead of naturally brought in through the negative pressures normally created during inspiration.
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| How is ARDS medically managed? | Intubation, mechanicali ventilation with PEEP to treat progressive hypoxemia. OR BiPap with inspiratory and expiratory changes, positioning, and Nutritional support.
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| What is pulmonary hypertension? | Increase in pulmonary pressures unrelated to fluid volume. (Right side of the heart fails because deoxygenated blood is pushed out of it too quickly)
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| What are some causes of pulmonary hypertension? | Can be drug induced (phen phen), congenital, and idiopathic (No known cause).
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| Where are most thrombus clots formed? | In the leg veins
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| What is a pulmonary embolism? | Obstruction of pulmonary artry or branch by blood clot, air, far, amniotic fluid, or septic thrombus. Regional blood vessels and bronchioles constrict, further increasing pulm vascular resistance, Pulm artery pressure, & R. ventricular workload.
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| What causes shock in patients with Pulmonary embolism? | The clot diminishes blood flow to the area, so although the area is receiving adequate ventilation, no gas exchange occurs. The right ventricle then fails, and shock occurs.
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| What medication can be used to treat pulmonary hypertension? | Viagra
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| Treatment of pulmonary Emboli includes measures to improve CV status, true or false. | TRUE
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| What conditions place you at a higher risk of Pulmonary Embolism? | Pregnancy, obesity, oral contraceptive use,a and constrictive clothing.
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| What disease states place you at higher risk of Pulmonary Embolism? | Heart disease, trauma, postoperative/postpartum, diabetes mellitus, COPD, venous endothelial diseas, and previous hx of thrombophlebitis.
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| What is the most common sign for a possible pulmonary embolism? | Tachypnea
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| What is the difference between blunt trauma and penetrating trauma? | Blunt trauma leaves no open wound (no external bleeding), where as penetrating trauma results in an open wound.
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| What is flail chest? | When 3 or more adjacent ribs (multiple contiguous ribs) are fractured at 2 or more sites, resulting in free-floating rib segments. As a result, the chest loses stability, & causes severe respiratory distress bc the lungs can't produce enough neg pressure
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| What is a Pneumothorax? | When the parietal or visceral pleura is breached and the pleaural space is exposed to positive atmospheric pressure.
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| What is a Simple/spontaneous pneumothorax? | Air enters the pleural space through a breach of either the parietal or visceral pleura.
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| What is a traumatic pneumothorax? | When air escapes from a laceration in the lung itself and enters the pleural space of from a wound in the chets wall (rib fractures, stab/gunshot wounds, thoracentesis. transbronchial lung biopsy, and insertion of a subclavian line.
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| What is a tension pneumothorax? | When air is drawn into the pleural space from a lacerated lung or through a small opening or wound in the chest wall. This may result as complication from other types of pneumothorax.
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| Clinical manifestations of Pneumothorax? | Usually sudden, may be pleuritic. May only have minimal resp distress w/ slight chest discomfort and tachypnea w/ a small simple or uncomplicated pneumothorax.
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| How would an assessment of a simple thorax differ from a tension pneumothorax? | In a tension pneumothorax, the trachea would be midline and chest expansion would be decreased. In a tension pneumo, the trachea would be shifted AWAY FROM THE AFFECTED SIDE, and chest expansion would be decreased or fixed in a hyperexpansive state.
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| What is the difference between open and tension Pneumothorax? | In open pneumo, air enters the chest w/ inhalation and exits w/ exhalation. In tension pneumo, air enters, but cannot leave the chest. The trachea is then pushed toward the unaffected lung, compressing the <3, great vessels, and unaffected lung as well.
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| What is an initial characteristic symptom of simple Pneumothorax? | Sudden onset of chest pain.
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| What is Oxygen Therapy? | Administration of oxygen greater than 21% (the concentration of oxygen to room air)
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| What is oxygen toxicity? | Oxygen level greater than 50% for an extended period of time (over 48 hours)
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| What are high flow oxygen administration systems and the indication for this category of systems? | VENTURI MASK, TRACHEOSTOMY COLLAR, Face tent, T piece, Aerosol mask, and Transtracheal catheter. These are indicated for patients who require constant and precise amounts of oxygen.
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| What are low flow oxygen administration systems and the indication for this category of systems? | NASAL CANNULA, SIMPLE FACE MASK, PARTIAL REBREATHER, NON-REBREATHER, and oropharyngeal catheter. The patient breathes in some room air along with the oxygen. These systems do not provide constant or known concentrations of O2.
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| What are the indications for Non-rebreather/Partial rebreather masks? | During a medical emergency where the patient can breathe unassisted, but requires a high amount of oxygen
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| What disease process is the Venturi mask most commonly used for? | COPD, because it can accurately provide appropriate levels of supplemental oxygen.
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| What face mask is the most reliable and accurate method for delivering precise concentrations of oxygen? | The Venturi mask
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| What is the indication for Endotracheal intubation? | It provides a patent airway when the patient is having respiratory distress that cannot be treated with simpler methods and is the method of choice in emergency care.(Comatose patients w/ an Upper Airway obstruction)
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| What is the indication for a Tracheostomy? | Used to bypass and Upper Airway obstruction, allow removal of tracheobru=onchial secretions, long-term use of mechanical ventilation, prevent aspiration in an unconscious, or paralyzed client.
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| What is the indication for IPPB? (Intermittent Positive Pressure Breathing) | Patients who need to increase lung expansion. (RARELY USED)
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| What should you monitor for in a patient with an IPPB? (Intermittent Positive Pressure Breathing) | Pneumothorax, increased intracranial pressure, hemoptysis, gastric distention, psychological dependency, hyperventilation, excessive oxygen administration, and CV problems.
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| How often should you provide Tracheostomy care? | Q4-8H
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| What is the purpose of a T-piece? | Used to wean patients from mechanical ventilation and to provide adequate moisture to the airway. (Tracheostomy masks also provide moisture to the airway)
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| What are the disadvantages of ET tubes? | They are uncomfortable and supress the swallowing reflexes (glottic, pharyngeal, and laryngeal). This puts the patient at a higher risk for aspiration. Ulceration & stricture of the larynx or trachea may also develop.
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| What is the Iron Lung (Chest Cuirass)? | A negative pressure chamber used for ventilation. (Commonly used for Polio survivors and patients with other neuromuscular disorders)
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| What is pressure cycled ventilation and what are the advantages of it? | The pressure is the endpoint rather than the volume. Thus, inspiration ends when a preset pressure is reached, regardless of the volume delivered. Increasing airway pressure by prolonging inspiration recruits more alveoli than volume controlled ventilati
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| What is volume controlled ventilation? | Most Common! The vent is programmed to deliver a preset volume of oxygen and air, regardless of the amount of pressure required to deliver the volume (an alarm goes off if pressure is too high).
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| What are non-invasive forms of Positive-Pressure ventilation? | C-pap (Continuous Positive Airway Pressure), and Bi-Pap (Bi-level Positive Airway Pressure)
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| What are differences between C-Pap and Bi-Pap? | In BiPAP 2 different pressures are used. The higher pressure is experienced on inspiration and the lower pressure on expiration. Note that both pressures are always above ambient.
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| What is C-Pap mostly used for? | Chronic Obstructive Sleep Apnea.
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| What are the indications of Bi-Pap? | Sleep Apnea with chronic CO2 retention. Pulmonary edema or COPD exacerbation, when there is CO2 retention and a desire to avoid endotracheal intubation.
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| What is SIMV (Synchronized intermittent mandatory ventilation) mode and some of its benefits? | Not all spontaneous breaths are assisted, leaving the patient to draw some breaths on their own. Helps to preserve te strength og respiratory musculature, decreases the risk of hyperventilation, and barotrauma, and facilitates weaning.
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| What is AC (Assist Control) ventilation and some of its indications for usage? | The ventilator supports every breath, whether it's initiated by the patient or the ventilator. This high level of resp support is frequently required in patients who have been resuscitated, have ARDS, or are paralyzed or sedated.
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| What is PEEP (Positive End-Expiratory Pressure) used for? | Can be used in AC or SIMV ventilation to increase oxygenation. PEEP keeps the alveolie from closing completely upon expiration by blowing a small amount of air into the lungs. (Like a balloon that doesn't deflate completely)
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| What is pressure support? | Used alone or added to SIMV, this provides a small amount of pressure during inspiration to help the patient draw in spontaneous breath. This makes it easier 4 the patient to overcome the resistance of the ET tube and is often used during weaning.
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| What is Barotrauma? | Barotrauma is physical damage to body tissues caused by a difference in pressure between a gas space inside, or in contact with the body, and the surrounding fluid.
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| What are some goals for patients who are mechanically ventilated? | Optimal gas exchange, Patent airway maintenance, attainment of optimal mobility, absense of trauma or infection, adjustment to nonverbal methods of communication, successful coping measures and absence of complications.
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| How often should you assess lung sounds in a mechanically ventilated patient and what measures to promote airway clearance can be used? | Q2-4H. Suctioning, CPT, position changes, promote mobility
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| Critera for weaning from ventilator | 1-Vital capacity of 10-15 ml/kg
2-Maximum inspiratory pressure at least 20 cm
3-Tidal volume 7-9 ml/kg
4-Minute ventilation:6L/min
5-Rapid/shallow breathing index: below 100 breaths/minute/L; PaO2 >60mm Hg with FiO2 less than 40%
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| Methods of weaning | SIMV, PAV (Partial ventilatory support), CPAP, T-piece.
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| What is the difference between ARDS (Non-cardiogenic) and Cardiogenic pulmonary edema) | Cardiogenic occurs from left sided heart failure (fluid overload, kidney failure, myocarditis, cardiomyopathy) and noncardiogenic occurs due to changes in capillary permeability (any type of shock, drowning,DIC, trauma, major surgery, embolism, sepsis)
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