1
Q
Define ventilation
A
Movement of gas in and out of the lungs
2
Q
Define diffusion
A
Oxygenation or oxygen and CO2 exchange between alveoli and red blood cells
3
Q
Perfusion
A
Distribute newly oxygenated red blood cells to tissues out in body
4
Q
What is the passive process of breathing regulated by?
A
Oxygen, carbon dioxide, pH of blood
5
Q
What is it called when carbon dioxide is increased in the body?
A
Hypercarbia
6
Q
What does the body know to do when hypercarbia occurs?
A
Increase rate and depth of breathing
7
Q
What are lung volumes based on?
A
Age, gender, height
8
Q
Define tidal volume
A
Amount of air exhaled following normal inspiration
9
Q
What aspects affect tidal volume?
A
Health status, activity, pregnancy, exercise, obesity, obstructive / restrictive lung diseases
10
Q
Function of alveoli
A
Promote gas exchange that occurs at alveolar level
11
Q
WNL/WDL of respiration rate (ventilation)
A
12-20 breaths/min
12
Q
Abnormal (unexpected) findings related to respiration rate?
A
Bradypnea (less than 12 b/m), tachypnea (more than 20 b/m), shallow breathing (depth)
13
Q
What does an RR of over 27 indicate?
A
Risk for cardiac arrest
14
Q
True/false: it is normal to have a prolonged increased RR
A
False
15
Q
What does stress and exercise do to breathing?
A
Increased work of breathing, depth may increase
16
Q
Do babies breathe faster or slower?
A
Faster
17
Q
What muscles do males & children breathe with?
A
Abdominal muscles
18
Q
What muscles do women use to breathe?
A
Thoracic muscles
19
Q
Three types of breath sounds
A
Brochial, bronchovesicular, vesicular
20
Q
Bronchial sounds
A
Heard over trachea and larynx. High pitched. Expiration longer than inspiration
21
Q
Bronchovesicular sounds
A
Heard over anterior 1st ICS and 2nd ICS. Posteriorly between scapulae. Medium pitch. Inspiration = expiration
22
Q
Vesicular sounds
A
Heard over most of normal lung peripherally, anterior and posteriorly. Low pitch. Expiration shorter than inspiration
23
Q
Bradypnea
A
Rate of breathing regular but RR is less than 12
24
Q
Tachypnea
A
Rate of breathing is regular but abnormally rapid» RR is over 20
25
Apnea
Respirations stop for several seconds. If persistent, results in respiratory arrest
26
Hyperventilation
Rate and depth of respirations increase. Hypocarbia sometimes occurs
27
Hypoventilation
Respiratory rate is abnormally low, depth of ventilation is depressed. Hypercarbia sometimes occurs
28
SpO2
Peripheral oxygen saturations measures with light transmission
29
SaO2
Arterial measurement of oxygen
30
What is normal oxygen saturation?
95% -100%
31
Atelectasis
Collapse of alveoli that prevents normal gas exchange of oxygen and carbon dioxide
32
Inspiration is a _\_\_\_\_\ process
Active
33
What aspects lead to work of breathing?
Resistance, compliance, accessory muscle use
34
Healthy person effort is...
Quiet, minimal effort
35
Compliance
Ability of lungs to distend or expand in response to intraalveolar pressure; how easily the lungs can fill w/ air during inhalation
36
Expiration is a_\_\_\_\_\ process
Passive
37
What does expiration depend on?
Elastic recoil properties of the lungs, little to no muscle work to exhale
38
Decreased compliance, increased airway resistance, and/or increased accessory muscle use _\_\_\_\_\ work of breathing
Increase
39
Oxygen carrying capacity affects oxygenation in what way?
If it is decreased, causes poor oxygenation
40
Role of hemoglobin
Protein that carries most of oxygen to tissues;protein on red blood cells
41
Role of red blood cells in oxygenation
Transport the oxygen molecules on the hemoglobin on red blood cells throughout the body
42
How does carbon monoxide poisoning occur?
Hemoglobin binds to carbon monoxide and makes it unavailable for oxygen transport
43
What anemia is caused due to carbon monoxide poisoning?
Functional anemia
44
Define hypovolemia
Decreased circulating blood volume
45
Why does hypovolemia affect oxygenation?
Causes hypoxia
46
What factors could decrease inspired oxygen concentration?
Altitude, hypotentilation, airway obstructions
47
What does decreased inspired oxygen concentration cause?
Decreased oxygen carrying capacity
48
What does exercise, wound healing and fever do to our oxygenation?
Increases metabolic demand. Increases our oxygen demand
49
Conditions that reduce chest wall movement cause what?
Decreased ventilation
50
What conditions affect chest wall movement?
Pregnancy, obesity, MSK diseases, trauma, neuromuscular diseases, central nervous system alterations
51
How does pregnancy affect chest wall movement?
Pushes up against diaphragm
52
How does obesity affect chest wall movement?
Decreased lung compliance, decreased lung volume
53
How do rib fractures (trauma) affect oxygenation?
Decreased ventilation
54
What neuromuscular diseases affect oxygenation and how?
Myasthenia Gravis, Guillain barre syndrome because of decreased ability to contract the chest wall
55
How do CNS alterations affect oxygenation?
Medulla oblongata or spinal cord impairment = impaired ventilation
56
What nerve innervates T3 and T5?
Phrenic nerve
57
What does the phrenic nerve control?
Breathing and diaphragm
58
What is the goal of ventilation?
Normal arterial Carbon dioxide tension and normal arterial oxygenation tension
59
Normal labs: PaO2
80 - 100 (arterial)
60
Normal labs: PaCO2
35-45 (venous)
61
Normal labs: SpO2
Greater than 95%
62
Normal labs: EtCO2
35-45
63
Pa =
Partial pressure
64
Venous blood is
Deoxygenated
65
Arterial blood is
Oxygenated
66
Hypoventilation is due to
Inadequate alveolar ventilation to meet demand
67
What are carbon dioxide and oxygen levels in hypoventilation
Low oxygen, high carbon dioxide
68
Causes of hypoventilation
Medications (sedatives, anesthesia) and alveolar collapse (atelectasis) (lung diseases)
69
S/S of hypotentilation
Mental status changes, dysrhythmias
70
What can hypoventilation lead to
Cardiac arrest, convulsions, unconsciousness, death
71
How does hyperventilation happen?
Removes carbon dioxide faster than it is produced by cellular metabolism
72
What are oxygen and carbon dioxide levels in hyperventilation?
High oxygen, low carbon dioxide
73
Causes of hyperventilation
Anxiety attacks, infection/fever, drugs, acid-base imbalance, aspirin poisoning, amphetamine use
74
S/S of hyperventilation
Rapid respirations, sighing breaths, numbness/ tingling of hands and feet, lightheadedness, loss of consciousness
75
Work of breathing is _\_\_\_\ with hyperventilation
Increased
76
What happens in atelectasis?
Alveoli collapse, making less of your lung available for oxygen and carbon dioxide exchange
77
What conditions are associated with atelectasis?
Immobility, obesity, sleep apnea, chronic lung conditions
78
Atelectasis is diagnosed on a _\_\_\_
Chest X-ray
79
What can atelectasis lead to?
Lung collapse
80
What can happen when lungs collapse?
Respiratory distress syndromes, pneumonias, respiratory failure
81
How do we prevent atelectasis?
Encourage ambulating, pulmonary toilet, incentive spirometry
82
Hypoxia
Inadequate tissue oxygenation
83
Hypoxia (at the cellular level)
Not enough oxygen to meet needs
84
What can happen if hypoxia goes untreated?
Cardiac dysrhythmias
85
Cardiac dysrhythmias can occur in untreated hypoxia because
Heart needs oxygen to function
86
A cause of hypoxia is _\_\_\_
Decreased hemoglobin levels/ low oxygen- carrying capability (WOB)
87
A cause of hypoxia is _\_\_\_
Diminished oxygen concentration of inspired oxygen (altitude)
88
A cause of hypoxia is _\_\_\_
Inability of tissues to get oxygen from blood (cyanide poisoning)
89
A cause of hypoxia is _\_\_\_
Decreased diffusion of oxygen from alveoli to blood (infections/pneumonia)
90
A cause of hypoxia is _\_\_\_
Poor perfusion with oxygenated blood (shock)
91
A cause of hypoxia is _\_\_\_
Impaired ventilation from traumas (rib fractures)
92
S/S of hypoxia
Apprehension, restless*, inability to concentrate, decreased LOC, dizziness, behavioral changes
93
More signs and symptoms of hypoxia
Difficulty staying still, lying flat, orthopnea
94
Orthopnea
Patients needing to sit up to sleep
95
More signs and symptoms of hypoxia
Fatigue, but agitated
96
What happens to pulse (HR) and respirations in hypoxia?
Increased pulse, increased respirations (rate & depth)
97
During hypoxia, BP _\_\_\_ and then leads to _\_\_\_
Initially increases; then shock/low BP
98
Cyanosis is a _\_\_\_ of hypoxia
Late sign
99
Cyanosis
Blue discoloration of skin/mucous membranes
100
True/false: cyanosis is a reliable measure of oxygen status
False
101
Central cyanosis
Tongue, soft palate, conjunctiva of eye
102
Central cyanosis indicates _\_\_\_
Hypoxemia
103
Peripheral cyanosis
Extremities, nail beds, earlobes
104
Peripheral cyanosis indicates _\_\_\_
Vasoconstriction, NOT an oxygenation issue
105
Generalized signs and symptoms of hypoxia are _\_\_\_\_
Dyspnea, tachypnea, altered mental status, chest pain, tachycardia, abdominal discomfort, nausea, vomiting
106
Early symptoms of hypoxia
RAT: restlessness, agitation, tachypnea, tachycardia
107
Late symptoms of hypoxia
BED: bradycardia, extreme restlessness, dyspnea
108
Chronic hypoxia is associated with _\_\_\_\_ and most commonly _\_\_\_\_
Chronic lung conditions; COPD
109
Common assessment findings of chronic hypoxia
Cyanotic nail beds, sluggish capillary refill, clubbing, barrel chest
110
What two conditions are associated with barrel chest?
Chronic hypoxia, COPD
111
Young & middle adult focus about oxygenation
Avoidance of oxygenation problem risk factors → smoking, unhealthy lifestyle, environmental considerations
112
Older adult considerations of oxygenation
First sign of any issues → mental status changes!!!
More susceptible to respiratory infections and compromise
Low reserve → once compromised, can deteriorate quickly!!!
113
Lifestyle factors affecting oxygenation
Smoking & secondhand smoke, obesity, air pollution & quality, malnourished, sedentary, substance use, occupation
114
How does malnourishment affect oxygenation?
Muscle weakness and weak coughs
115
How does exercising affect oxygenation?
Increases metabolic activity, helps promote increased oxygen consumption
116
How does one's occupation affect oxygenation?
Breathing in coal as a coal miner, working at a factory and breathing in chemical inhalants (exposure!!!!)
117
Assessment of oxygenation (physical)
Cough, dysprea, pain, SOB, breath sounds
118
Assessment of oxygenation (history)
Pulmonary hx, environmental exposures, occupational exposures, smoking hx, medication use.
119
Dyspnea
Difficulty breathing
120
DOE stands for
Dyspnea on exertion
121
Dyspnea is associated with
Hypoxia
122
S/S of dyspnea
Use of accessory muscles, nasal flaring, increased rate/depth
123
What can you use to score dyspnea?
Visual analog scale
124
Questions to ask if patient experiencing dyspnea?
When does it occur? What improves it? Worsened by something? Lying down?
125
Cough
Protective reflex to clear trachea, bronchi, and lungs of irritants and secretions
126
Questions to ask if patient is experiencing a cough?
Strong or weak? How often (frequency)? Productive or non productive? What does sputum look like? Is it thick/thin? Is it bloody? Is it odorous?..
127
What would a productive cough indicate?
Disease processes or illness (ex :pneumonia)
128
What would a dry cough indicate/ be associated with?
Allergies, asthma, GERD, acid reflux, post nasal drip
129
Hemoptysis
Bloody sputum
130
What rote does hydration playin coughing?
Helps thin secretions
131
What does splinting a cough mean?
Hold pillow or blanket over incision site to help lessen pain
132
Adequate hydration and coughing help the patient _\_\_\_\_
Maintain airway patency
133
Most effective way to move secretions through airways:
Coughing → encourage!!!
134
Before coughing, a patient should _\_\_\_
Take deep breaths
135
If a pt is experiencing pain, we should _\_\_\_
Instruct them to take tiny and shallow breaths, and help them splint
136
Purpose of sputum (specimen) collection
Analyze for pathogens
137
What are we normally looking for with specimen collection?
Pneumonia, cytology
138
Best time to collect sputum:
Early morning
139
Time to wait to collect specimen if pt has eaten?
1-2 hours
140
The specimen container is:
Sterile → do not touch inside or let pt touch inside. No one touches inside.
141
What pt education should we provide regarding sputum collection?
Cough into container, get as much sputum inside as possible
142
What do we do if the pt is too weak or cannot expectorate into container?
Suction (potentially)
143
Diagnostic testing: nasal aspirate/swabs
RSV, influenza
144
Diagnostic testing: Sputum culture and sensitivity
Identify specific microorganism or organism growing in sputum → drug resistance sensitives to determine appropriate antibiotic therapy
145
Diagnostic test: sputum for acid-fast bacillus (AFB)
Early morning specimens 3 consecutive days → Presence of AFB for detecting TB.
146
Diagnostic testing: sputum for cytology
Identifies lung cancers → differentiate types of cancer cells (small, oat, large)
147
Diagnostic testing: pulmonary function tests
Ability of lungs to efficiently exchange oxygen and carbon dioxide → differentiates pulmonary obstructive vs. Restrictive disease
148
In a pulmonary function test (basic ventilation studies)- what is a key factor to keep in mind?
Pulmonary functions vary on ethnicity
149
Basic way to describe basic ventilation studies
How quickly/efficiently gas exchange is occurring
150
Diagnostic testing: peak expiratory flow rate (PEFR)
Point of highest flow during maximal expiration
151
What does PEFR reflect in testing?
Changes in large airway sizes→ shows overall airway resistance in a pt with asthma
Daily measurement for early detection of asthma
152
Diagnostic testing: bronchoscopy (what it is)
Visual examination of tracheobronchial tree through narrow, flexible, fiberoptic bronchoscope → pt is sedated most of time
153
Diagnostic testing: bronchoscopy (what it obtains)
Obtain fluid, sputum, biopsy samples; remove mucus plugs or foreign bodies
154
Expected finding of bronchoscopy:
Normal airways without masses, pus, to foreign bodies -
155
Nurse role in bronchoscopy:
Provide meds, help support HCP
156
Diagnostic testing: lung scan (what it does)
Nuclear scanning test used to identify abnormal masses by size and location
157
Diagnostic testing: lung scan (what it obtains)
Identifies masses →helps plan therapy and treatments
Finds blood clots that are preventing normal perfusion or ventilation
158
Nursing diagnoses related to oxygenation
Ineffective airway clearance, risk for aspiration, impaired gas exchange, activity intolerance
159
Ineffective airway clearance
Pt has thick secretions, difficulty moving secretions, weak cough
160
Risk for aspiration
Pts who have weak cough, can get things up a little bit, decreased gag reflex
161
Impaired gas exchange
Pts who have chronic lung disease, atelectasis, respiratory infections
162
Activity intolerance
Pts who have chronically low shortness of air, oxygen level decreases when getting up OR HR increases when getting up
163
Long term /preventative measures to improve oxygenation
Vaccinations, healthy lifestyle, environmental & occupational exposures
164
Vaccinations
Flu vaccine annually
Pneumonia vaccine (over 65 years old, immunocompromised)
165
Healthy lifestyle
Nutrition & exercise!
166
Environmental and occupational exposures
Stop smoking, stop vaping
May need to change jobs if reaction to exposure
167
What affect does obesity have on oxygenation?
Big contributor to SOB, dyspnea, activity intolerance
168
What does smoking and vaping do to airways?
Causes airway inflammation
169
Is dyspnea easy or difficult to treat?
Difficult
170
How do you manage dyspnea?
Treat underlying condition!
171
What therapy can we do for dyspnea?
Oxygen therapy → can improve gas exchange
172
Pharmacology treatment for dyspnea
Bronchodilators, inhaled steroids, mucolytic, anti-anxiety medication
173
Anxiety can make dyspnea _\_\_\_
Worse
174
Order of priority in hospital
Airway, breathing, circulation
175
Nursing priority
Maintaining patent airway
176
What should you keep at the bedside if the patient has risk for loss of airway latency?
Oral airways
177
Reasons that an airway can be blocked
Foreign objects, infections, mucus plugs, traumas, swelling, allergies, structural issues
178
Managing pulmonary secretions
Mobilize, hydrate, humidification, medications
179
Purpose of mobilizing patients when managing pulmonary secretions
Promotes lung expansion and gas exchange!!!
180
Purpose of hydrating when managing pulmonary secretions
Helps reduce viscosity of secretions
181
Purpose of humidification when managing pulmonary secretions
High humidity keeps airways moist and loosens secretions
182
Medications to manage pulmonary secretions
Mucolytics
Last resort!!! Used to supplement interventions
183
Position for maximum respiratory function:
Sitting up! → expands thoracic cavity, lungs expand better
184
Bed position to promote best respiratory function
High Fowler'S (60-90°)
Fowler'S (45 -60°)
185
Positioning helps prevent _\_\_\_\_
Atelectasis
186
Positioning helps _\_\_\_
Mobilize secretions
187
Patients should be repositioned every _\_\_\_
2 hours
188
Optimal positioning
Upright, unsupported position
189
Coughing helps:
Keep airways clear and getting rid of sputum
190
Encourage patient to cough every _\_\_\_ when experiencing lung conditions / upper respiratory problems
2 hours
191
Purpose of deep breathing
Increase air to lower lobes of lungs
192
Physiology behind deep breathing:
Opens small pores between alveoli
193
Overall purpose of deep breathing
Help promote gas exchange
194
Techniques of coughing
Cascade coughing, huff coughing, quad cough
195
Cough etiquette
Cover mouth when coughing, hand hygiene
196
Pulmonary toilet
Turn, cough, deep breathe → Nursing's best defense
197
Is CPT an independent or dependent nursing action?
Dependent → need an order
198
Goal of CPT:
Mobilize pulmonary secretions
199
What activities does CPT include?
Postural drainage, chest percussion, chest vibration
200
What is postural drainage?
Positioning
201
How is chest percussion performed?
Cupped hands
202
What is used for chest vibrations?
Vest
203
CPT activities should be followed up with:
Coughing & deep breathing
204
Indications for CPT:
Patients with thick secretions & cystic fibrosis pts
205
Contraindications of CPT
Pregnancy, rib/chest injuries, increased intracranial pressure, recent abdominal/thoracic surgery, bleeding disorders, osteoporosis
206
True/false: CPT can be ordered at home
True
207
Who collaborates to determine need for CPT?
Nurse, respiratory therapist collaborate w/ HCP
208
The first guideline for chest physiotherapy is
Complete respiratory assessment including: sputum production, effectiveness of cough, Hx of pulmonary problems successfully relieved w/ CPT, abnormal lung sounds, documented conditions such as atelectasis, complicated pneumonia, vital signs, or change in oxygenation status
209
The second guideline of chest physiotherapy is
Know the pt’s meds!!!
Diuretics and antihypertensives cause fluid and hemodynamics changes. Decrease pt tolerance to positional changes and postural drainage. Long term steroid use causes risk for pathological rib fractures and are contraindicated for vibration
210
The third guideline of chest physiotherapy is
Know the pts med Hx!!!
Increased intracranial pressure, spinal cord injuries, abdominal aneurysm resection contraindicatethe positional changes of postural drainage. Thoracic surgery contraindicates percussion and vibration.
211
The fourth guideline of CPT is
Know the pts level of cognitive function!!!
Participation in controlled coughing techniques requires him/her to follow instructions. Congenital or acquired cognitive limitations alter a pts ability to learn and participate in these techniques
212
The fifth guideline of chest physiotherapy is
Be aware of pts exercise tolerance!!!
CPT maneuvers are fatiguing
213
In postural drainage, the patient is supposed to lay on the _\_\_\_\_
Unaffected side
214
Postural drainage promotes _\_\_\_
Drainage of one particular or both lobes
215
It a pt has infiltration seen on the right lower lobe, how should they be positioned?
Left trendelenburg
216
It a pt has infiltration seen on the left lower lobe, how should they be positioned?
Right trendelenburg
217
When is suctioning indicated?
When pt cannot clear secretions on their own neither by coughing or CPT
218
Suctioning is a _\_\_\_ procedure
Sterile
219
2 most common suctioning types:
Orotracheal and nasotracheal
220
Suctioning should be _\_\_\_\_
Less than 10 seconds
221
Purpose of incentive spirometry
Promote lung expansion through deep breathing
222
Incentive spirometry is used to
Prevent or treat atelectasis → helps pop open alveoli
223
What setting is incentive spirometry used most in?
Post operative
224
Goal of oxygen therapy:
Prevent or relieve hypoxia
225
FiO2
Fraction of inspired air →% of O2 in inspired air
226
FiO2 of room air
21%
227
T/f: we should be giving pts O2 ATA higher concentration than our ambient air (21%)
True
228
Administering oxygen therapy is a _\_\_\_\_
Dependent intervention → must have HCP order
229
When does oxygen therapy become an independent intervention?
Emergency situations!!!
230
T/f: 6 rights of med administration must be followed during oxygen therapy
True
231
As a nurse, what can not be delegated to CNA/UAPs
Assessment, teaching, evaluation
232
Can a nurse delegate a CNA to apply nasal cannula or oxygen masks?
Yes → but nurse must assess respiratory system, response to therapy, set up, adjustment responses
233
Oxygen is a _\_\_\_\_ substance
Highly flammable
234
What should you teach to a pt who is on oxygen therapy?
Don't have open flames around oxygen, no smoking
235
Pts on oxygen should have a _\_\_\_\_ on door
Oxygen in use sign
236
Nasal cannula: FiO2
1-6 l/m
24-44%
237
When should humidification be used?
Greater than 4 L/M of flow
238
Nasal cannulas are _\_\_\_\_
Safe and well tolerated
239
Nasal cannula's are _\_\_\_\_ flow delivery
Low
240
Disadvantages of nasal cannula's
FiO2 can vary, can cause skin breakdown, tubing dislodges easily
241
Simple face mask: FiO2
6-12 L/M
35-50%
242
Simple face masks are best for
Short periods, transportation
243
Disadvantages of simple face mask
Not great for claustrophobic pts, skin breakdown, higher risk of aspiration
244
When a pt is using a simple face mask, the nurse should
Assess for fit, watch for aspiration risk
245
Simple face masks are _\_\_\_\_ delivery devices
Low flow
246
Partial rebreather masks: FiO2
6 - 11 L/M
60-75%
247
Partial rebreather masks are used for
Short periods of dyspnea or other increased oxygen needs
248
Patients w/ partial rebreather masks rebreathe up to _\_\_\_\_ of exhaled air. This helps with _\_\_\_\_
1/3; humidification
249
When a pt is using a partial rebreather mask, the reservoir bag should be
Partially inflated
250
Non-rebreather mask: FiO2
10-15 L/M
80-95%
251
A non-rebreather mask is best for _\_\_\_\_
Patients in critical need of oxygen, steps before intubation
252
What part of non-rebreather masks allow for a pt to inhale maximum oxygen concentration?
One way valve
253
The purpose of the two exhalation ports on the non-rebreather mask is
Restrict exhaled air from being rebreathed
254
Patients with partial and non-rebreather masks should NOT
Eat food → risk for aspiration
255
Patients with partial and non-rebreather masks should be assessed every
1 hour!
256
A _\_\_\_\_ rebreather has flaps
Non
257
A _\_\_\_\_ rebreather has no flaps
Partial
258
Venturi mask: FiO2
4-12 L/M
24-60%
259
A Venturi mask is a _\_\_\_\_ flow oxygen delivery system
High
260
What is the biggest advantage of using a Venturi mask?
Ability to provide precise oxygen concentration with humidity
261
T/f: Venturi masks are preferable for long periods of time
False!
262
What pts are indicated for use of Venturi masks?
Pts who need highly regulated oxygen concentrations → chronic lung disease
263
What gives Venturi masks the ability to precisely deliver oxygen?
Venturi devices/venturi mask valves → different colors provide different flow rates!
264
Blue valve (Venturi mask): FiO2
24%
2 L/M
265
White valve (Venturi mask): FiO2
28%
4 L/M
266
Orange valve (Venturi mask): FiO2
31%
6 L/M
267
Yellow valve (Venturi mask): FiO2
35%
8 L/M
268
Red valve (Venturi mask): FiO2
40%
10 L/M
269
Green valve (Venturi mask): FiO2
60%
(12 L/M) 15 L/M
270
Face tent: FiO2
24 -100%
271
Face tents are also referred to as
Aerosol masks
272
Fit of face tents:
Loosely around face and neck
273
Face tents provide _\_\_\_\_ because they just _\_\_\_
Relatively high humidity; blow air up
274
Where are face tents usually seen?
Post - operative setting
275
High flow nasal cannula: FiO2
Up to 100%
276
High flow nasal cannulas are very _\_\_\_
Precise
277
High flow nasal cannulas are used for pts who are
Critical care
278
Some nasal cannulas have an ETCO2 monitor. What is the purpose?
Measures the concentration of carbon dioxide the pt is exhaling
279
Purpose of humidification:
Prevents drying out of mucous membranes
280
Indications for using humidification:
ALWAYS USE WHEN: delivery is greater than 4 L/M -OR- pt is receiving supplemental oxygen for more than 24 hours
281
What liquid is used to provide humidity?
Sterile water
282
Oxygen humidification is often referred to as
Bubbler or bubble humidifier
283
Complications of oxygen therapy
Drying effects of respiratory mucous membranes, oxygen toxicity, skin breakdown
284
Define oxygen toxicity
Too much oxygen in system
285
S/S of oxygen toxicity
Pleuritic chest pain, chest heaviness, coughing, dyspnea, muscle twitching, nausea/GI upset
286
We always want to use the _\_\_\_ that we can to get the benefit that is desired to get best results for pt
Lowest amount of oxygen
287
Example of an oxygen order for 2 L/M nasal cannula
Oxygen by NC prn @ 2 LPM
288
Example of an oxygen order that can be titrated to keep oxygen saturation at a certain range
O2 @ 2-4 LPM per nasal cannula (NC) prn to keep pulse ox 88%-92%
289
What are abnormal breath sounds called?
Adventitious breath sounds
290
Rhonchi
Obstruction or fluid accumulation (usually sputum)
Rumbling, coarse sounds, a snore
Loud low pitched rumbling
Junky!!!
291
Conditions associated w/ rhonchi
Cops, pneumonia, viral illnesses
292
Rhonchi treatments
Cough!!! Can cough it out
Pulmonary toilet
Ambulation
Incentive spirometry
Nebulizer/inhaler
Antibiotic
293
Wheeze
Constriction → air passing through narrow passage
Can be inspiratory or expiratory
High pitched whistling
Narrow obstructed airways
294
Conditions associated w/ wheezes
Asthma
Emphysema
Chronic bronchitis
Allergic reaction
295
Wheeze treatments
Humidifier
Nebs/inhalers
Steroids
Antihistamines
296
Crackles/rates
Can be coarse or fine
Fluid in lungs, high pitched
Bubbly sounds, associated w/ air passing through fluid or collapsed small airways
Fine: hair rubbing in fingers
Coarse: Velcro sound
297
Conditions associated w/ crackles/rales
CHF → congestive heart failure
Pneumonia
Fluid overload
298
Crackles/rales treatment
Pulmonary toilet
Diuretics
Antibiotics
Oxygen
Nebulizers/inhalers
299
Stridor
Heard over upper airway over trachea
Choking
Children
300
Conditions associated w/ Stridor
Foreign airway obstruction
301
Stridor breath sounds is an _\_\_\_\_
Emergency!
302
Stridor treatment
Oxygen
Steroids
Nebs
Trach
303
Chronic hypoxia is
Low oxygen over a long period of time
304
What conditions are contraindicated for trendelenburg position?
Head injuries, heart failure, pulmonary embolus
305
A pt should be put in _\_\_\_ position if they have bilateral lung segment infiltration
High Fowler
306
A pt should be in _\_\_\_ position if they have apical segment infiltration
Sitting on side of bed
307
A pt should be in _\_\_\_ position if they have anterior right upper lobe segment infiltration
Supine with head elevated
308
A pt should be in _\_\_\_ position if they have anterior left upper lobe segment infiltration
Supine with head elevated
309
A pt should be in _\_\_\_ position if they have posterior right upper lobe segment infiltration
Side -lying with right side of chest elevated on pillow (sims)
310
A pt should be in _\_\_\_ position if they have posterior left upper lobe segment infiltration
Side-lying with left side of chest elevated on pillows (sims) → head elevated!
311
A pt should be in _\_\_\_ position if they have anterior right middle lobe segment infiltration
3/4th supine position with dependent lung in trendelenburg position
312
A pt should be in _\_\_\_ position if they have lateral left lower lobe segment infiltration
Right side lying in trendelenburg position
313
A pt should be in _\_\_\_ position if they have lateral right lower lobe segment infiltration
Left side lying in trendelenburg position
314
A pt should be in _\_\_\_ position if they have posterior right lower lobe segment infiltration
Prone with right side of chest elevated in trendelenburg position
315
A pt should be in _\_\_\_ position if they have posterior right middle lobe segment infiltration
Prone with thorax and abdomen elevated
316
A pt should be in _\_\_\_ position if they have anterior both lower lobes segment infiltration
Supine in trendelenburg position
317
A pt should be in _\_\_\_ position if they have posterior both lower lobes segment infiltration
Prone in trendelenburg position
318
Pleural friction rub
Inflamed pleural space
Stops when pt holds breath
Sounds like walking on fresh snow or rubbing leather
Heard in pleurisy
319
Huff coughing → steps
1. Pt inhales deeply
2. Hold breath 2-3 seconds
3. Forcefully exhale and say "huff" → this opens the glottis
320
Huff coughing→ purpose/indications
Stimulate natural cough reflex
Move secretions to larger airways
321
Cascade coughing→ steps
1. Pt take slow, deep breath
2. Hold breath 1-2 seconds
3. Open mouth & perform series of coughs throughout exhalation
322
Cascade coughing → purpose/indications
Pts w/ large amounts of sputum → cystic fibrosis pts
323
Quad cough→ steps
1. Pt breathes out w/ maximal respiratory effort
2. Nurse pushes inward & upward on abdominal muscles towards diaphragm
324
Quad cough→ purpose/indications
Pts w/ no abdominal muscle control → spinal cord injuries
325
Quad cough is also called _\_\_\_\_
Manually assisted cough technique
326
Diaphragmatic breathing → steps
1. Deep nasal inspiration
2. Diaphragm descends (belly mores out) when breathing in
3. Diaphragm ascends (belly mores in) when breathing out
327
Diaphragmatic breathing → purpose/indications
Increase air flow to lower lungs
For pts w/ COPD, it increases pts tidal volume & oxygen sat, reduces dyspnea, improves gas exchange
NUR 333 ABSN
flashcards
Decks in class (25)
# Cards
-
Oxygenation327
-
Tracheostomy64
-
Cardio (333E2)100
-
Diabetic Care (333E2)66
-
Nutrition (333E2)64
-
Bowel Elimination (Exam 2)57
-
Urinary Elimination (Exam 2)39
-
Neurnseosory (Exam 3)40
-
Integumentary System Pt. 2 (Exam 3)30
-
Integumentary System (Exam 3)46
-
Bowel Elimination57
-
Urinary Elimination41
-
Neuro55
-
Skin71
-
Wound Managment29
-
Elimination17
-
Wound Managment COPY29
-
Pain and Comfort (Final)29
-
Older Adults Misconceptions (Final)26
-
Discharge and Planning (Final)16
-
Sherpath: Death and Dying19
-
Nursing Care Older Adults (Final)34
-
Palliative, Hospice, and EOL care (Final)37
-
End of Life Care81
-
Pharmacologic Treatment of Pain (Final Exam)16
