lecture 2 - pulmonary

Question 1

what causes shunting?

Answer 1

compromised intraventricular septum (impaired gas exchange)

Question 2

what are the clinical manifestations of acidosis?

Answer 2

• CNS depression
• hyperkalemia
• hyperventilation

Question 3

what are the clinical manifestations of alkalosis?

Answer 3

• CNS excitement
• hypokalemia
• hypoventilation

Question 4

suctioning is only PRN for patients on ventilation

Answer 4

true

Question 5

what is the most important thing to look out for in mech vent patients?

Answer 5

infection–they are at a higher risk for VAP

Question 6

measures for preventing VAP

Answer 6

• oral care q12h
• oral swabs q2-4h

Question 7

what does excessive suctioning lead to?

Answer 7

tissue damage

Question 8

what causes positive expiratory pressure?

Answer 8

high peak settings of the ventilator

Question 9

ventilators can exert a lot of pressure on the thoracic blood vessels

Answer 9

true

Question 10

manifestations of occluded thoracic blood vessels

Answer 10

• decreased cardiac output
• hypotension

Question 11

unplanned extubation is a medical emergency and needs to be prevented

Answer 11

true

Question 12

what are the nursing priorities for planned extubations?

Answer 12

• secure the airway
• assess for stridor (high pitched lung sound)

Question 13

what does stridor indicate for planned extubations?

Answer 13

• intolerance to procedure
• need for a secure airway

Question 14

how is lung hygiene managed?

Answer 14

• incentive spirometer
• TCDB
• thin secretions w/ fluids
• ambulation

Question 15

ventilated patients are at risk for which conditions?

Answer 15

• gastric ulcers
• VTE
• acute kidney injury

Question 16

VAP is considered a never event

Answer 16

true

Question 17

what are the breath sounds for a patient with pneumothorax?

Answer 17

diminished

Question 18

why are neurovascular assessments critical to respiratory assessments?

Answer 18

indicates status of perfusion

Question 19

what are the manifestations for pneumothorax?

Answer 19

• SOB
• CP
• hypoxia
• diminished breath sounds

Question 20

what are the types of pneumothorax?

Answer 20

• tension
• open
• spontaneous

Question 21

why does tension pneumothorax occur subsequent to spontaneous pneumothorax?

Answer 21

built up air pressure in the pleural space can cause a tracheal shift

Question 22

tracheal shift is an emergency

Answer 22

true

Question 23

what makes open pneumothorax different from others?

Answer 23

there is no built-up air, the lung is punctured all the way through–air exits the body

Question 24

what is the intervention for open pneumothorax?

Answer 24

use a dressing taped on 3 sides

Question 25

what does the dressing for an *open pneumothorax* do?

Answer 25

lets air out without letting it back in

Question 26

what is the average *tidal volume* of the lung?

Answer 26

7-9mL / kg

Question 27

which conditions can cause *respiratory acidosis*?

Answer 27

* respiratory depression * spinal cord injuries * pulmonary edema * pneumonia

Question 28

what are some causes of **metabolic acidosis**?

Answer 28

* renal failure * excessive diarrhea * DKA

Question 29

what can cause *respiratory alkalosis*?

Answer 29

* **hyperventilation** * high fever * thyroid toxicity * psychogenic responses

Question 30

which events can cause ***metabolic*** *alkalosis*?

Answer 30

* vomiting * excessive gastric suctioning * excessive antacids

Question 31

respiratory compensation | full, partial, uncompensated

Answer 31

Question 32

what are the nursing actions after a *planned extubation*?

Answer 32

* warm, humidified O2 via facemask * oral care * NPO for extended period * high fowler's position

Question 33

which conditions is the patient at risk for after a *planned extubation*?

Answer 33

* atelectasis * pneumonia

Question 34

what is the nursing action for *stridor*?

Answer 34

reintubation | need to secure airway due to present adventitious sounds (stridor)