Respiratory Skills
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| What is the goal of O2 therapy? | Prevent hypoxia
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| What is O2 therapy used for? | Patients with impaired tissue oxygenation
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| What should O2 be treated as? | Drug
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| Oxygen therapy is NOT a __________ for other treatments and should only be used when ______________. | Substitute; Indicated
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| Oxygen is ___________ and can have ____________ side effects. | Expensive; Dangerous
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| Dosage or ___________ should be ordered and continuously ____________. | Concentration; Monitored
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| What should you check regularly as part of your assessment? | Flow setting
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| What does oxygen support? | Combustion
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| Describe oxygen | Colorless, odorless, and tasteless gas that will not burn or explode
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| Who frequently initiates oxygen therapy? | Respiratory Therapist (RT)
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| What are early symptoms of hypoxia? | RAT - Restlessness, Anxiety, Tachycardia/Tachypnea
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| What are late symptoms of hypoxia? | BED - Bradycardia, Extreme restlessness, Dyspnea (severe)
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| What are signs of hypoxia in pediatrics? | FINES - Feeding difficulty, Inspiratory stridor, Nares flare, Expiratory grunting, Sternal retractions
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| Name some methods of O2 delivery | Nasal cannula, Face mask, Transtracheal Catheter, Tracheostomy, ET Tube, Non-rebreather mask
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| 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
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| Describe transtracheal catheter (be able to label pic) | Catheter in between 2nd and 3rd tracheal cartilage
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| Describe a non-rebreather mask (be able to label pic) | Used mostly by paramedics, no mixing of exhaled air
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| Describe face mask | Fits over the nose and mouth; flow rate is usually 6-10 LPM
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| Describe tracheostomy | Tube inserted in trachea
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| Describe ET tube | Endotracheal tube for patients on a ventilator
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| What does a pulse oximetry measure? | The amount of oxygen bound to hemoglobin compared to amount available
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| What is normal O2 saturation? | 90%-100%
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| What is respirations driven by? | Carbon dioxide
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| In COPD, what is respirations driven by? | Hypoxia
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| What is normal pH? | 7.35-7.45
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| What is pH over 7.45 called? | Alkalotic
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| What is pH below 7.35 called? | Acidotic
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| If patient has high blood level of CO2, what will respiratory rates do to compensate? | Increase
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| 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
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| How does blood circulate? | Through the lungs via the pulmonary artery & pulmonary vein
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| Is tracheostomy suctioning a sterile or non-sterile procedure? | Sterile
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| Is oropharyngeal & nasopharyngeal suctioning a sterile or non-sterile procedure? | Non-sterile
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| Where do sputum collections come from? | Lungs
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| What does sputum contain? | Mucus, cellular debris, and microorganisms that may contain blood or pus
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| When is the best time to collect a sputum specimen? | Early morning, because patient hasn't had time to clear respiratory passages
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| What is the best way to break up sputum? | Water; push fluids
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| When collecting a sputum specimen, what do you instruct patient to do? | Cough from deep in the lungs
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| 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
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| What does TB require? | AFB precautions which includes a negative pressure room & PAPR mask (N95 respirator mask for healthcare workers)
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| What is TB? | Lung infection that is transmitted by air, contact, and droplets
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| Do all positive TB results require you to be isolated? | No - Many have been exposed to TB but only 10% lead to active TB
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| How do you prevent post-op respiratory complications? | Turning, Deep breathing, & coughing
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| What is an IS (Incentive Spirometry)? | Inexpensive device that measures inspiration
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| 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
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| 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.
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| How do you decompress a pneumothorax? | Chest tube
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| What are the nursing interventions for pneumothorax? | Treating pain, promoting oxygenation, assisting in procedures, and providing patient education
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| What does a chest tube do? | Restores negative intra-pleural pressure
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| What is tidaling? | Water bubbling that indicates the lung is re-expanding
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| What do you do if chest tube accidentally comes out? | Place a petroleum gauze dressing over site on the chest and notify physician immediately!
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| What is Chest Percussion Therapy (CPT)? | High frequency chest wall oscillations and postural drainage. Facilitates removal of secretions
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| When is the best time to do CPT? | In the morning, 2hrs before meals, at bedtime
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| What patients may CPT not be for? | Elderly or those with osteoporosis
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| 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
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| 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
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| Which nursing assessment best indicates a patient's ability to tolerate activity? | V/S take three minutes to return to pre-activity level
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| 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
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| What should the nurse do first if a patient is choking on food? | Determine if the patient can make any verbal sounds
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| A nurse is assessing a pt. with a respiratory problem. Which clinical manifestation is most reflective of an early response to hypoxia? | Restlessness
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| 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
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| A patient w/ a tracheostomy has been assessed & needs suctioning. How long will the nurse perform the suction? | Maximum of 10 seconds
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| 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
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| 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
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| 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
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| 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
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| 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
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| 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
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| A nurse in the PACU in monitoring several patients who received general anesthesia. Which patient response causes the most concern? | Stridor
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| A nurse is assessing a patient. Which clinical manifestation indicates respiratory distress? | Orthopnea
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| A patients hemoglobin saturation via pulse oximetry indicates inadequate oxygenation. What should the nurse do first? | Raise the head of the bed
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| What is the next step performed by the nurse after a specimen has been obtained? | Properly identify it
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| 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
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| 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
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| A unconscious patient who had oral surgery is admitted to the PACU. In which position should the nurse place the patient? | Lateral
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| What are the structures of the lung called in which gas exchange occurs? | Alveoli
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