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461-Foundations > ATI - Chapter 53 > Flashcards

ATI - Chapter 53 Flashcards

1
Q

Oxygen helps maintain adequate _____ for clients who have many acute and chronic respiratory problems (hypoxemia, cystic ribrosis, asthma). or are at risk for developing hypoxia.

A

cellular oxygenation

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2
Q

Maintaining a patient ____ is a nursing priority. It involves mobilizing secretions, suctioning the airway, and managing artificial airways (endotracheal tubes, tracheostomy tubes) to promote adquate gas exhange and lung expansion.

A

airway

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3
Q

A ___ is a device with a sensor probe that attaches securely to the fingertip, to =, birdge of nose, earlobe, or froehead with a clip or band.

A

pulse oximeter

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4
Q

A pulse oximeter measure pulse saturation (______) via a wave of infrared light that measures light absorption by oxygenated and deoxygenated hemoglboin in arterial blood.

A

SpO2

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5
Q

SpO2 reliably reflects the precent of saturation of ______ (sSaO2) when the SaO2 is greater than ____%

A

hemoglobin

70%

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6
Q

Oxygen is tasteless and colorless gas that accounts for 21% of ____.

A

atmospheric air

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7
Q

Oxygen flow rates vary to maintain an SpO2 of _____% to ___% using the lowest amount of oxygen to achieve the goal without risking complications.

A

95 - 100%

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8
Q

The fraction of inspired oxygen (FIO2) is the percentage of oxygen the client ____.

A

receives

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9
Q

Noninvasive measurment of the oxygen saturation of the blood for monitoring respiratory status when assessment finding inlcude any of the following.

A 
increased work of breathing
wheezing
coughing
cyanosis
changes in respiratory rate or rhythm
adventitious breath sounds
restlessness, irritability, confusion
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10
Q

Interventions for readings less than 90% (indicating hypoxemia)

A

confirm probe placement

confirm that the oxygen delivery system is functioning and that the lcient is receiving the prescribed oxygen levels

place the client in semi-fowler’s or fowler’s position to promote chest expansion and to maximize ventilation

Encrougae deep breathing

Remain with the client and provide emotional support to decrease anxiety

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11
Q

The SpO2 expected reference range

A

95 -100

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12
Q

The SpO2 accepted levels reference range

A

91-100

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13
Q

Some illness states can allow for ____ to ____. Readings less than 90% reflect hypoxemia.

A

85-89

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14
Q

SpO2 values can be slightly lower for older adult clients and client who have ___.

A

dark skin

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15
Q

Additional reasons for low SpO2 levels include hypothermia, por peripheral blood flow, too much light (sun, infrared lamps), low hemoglobin levels, ______, movement, edema and nail polish.

A

jaundice

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16
Q

Oxygen is a thrapeutic gas that treats _____(low levels of arterial oxygen). Administering and adjusting it requires a prescription.

A

hypoxemia

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17
Q

Manifestations of early hypoxemia

A 
tachypnea
tachycardia
restlessness, anxiety, confusion
pale skin, mucous membranes
elevated bp
use of accessory muscles, nsala flaring, tracheal tugging, adventitious lung sounds
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18
Q

Manifestations of late hypoxemia

A 
stupor
cyonotic skin, mucous membranes
bradypnea
bradycardia
hypotension
cardiac dysrhythmias
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19
Q

Monitor respiratory rate and pattern, level of consciousness, SpO2, and _____ when giving oxygen therapy.

A

arterial blood gas

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20
Q

Provide oxygen therapy at the ___ liter flow that will correct hypoxemia.

A

lowest

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21
Q

Maske sure the mask creates a secure seal over the ______.

A

nose and mouth

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22
Q

Assess/monitor hypoxemia and hypercarbia (elevated levels of CO2); restlessness, hypertension and _____.

A

headache

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23
Q

Ausculate the lungs for breath sounds and adventitious sounds, such as _____.

A

crackles and wheezes

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24
Q

Assess/Monitor ______- status with pulse oximetery and arterial blood gases (ABGs)

A

oxygenation

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25
When on oxygen therapy promote good ____.
oral hygiene
26
Encourage turning, coughing, deep breathing, and the use of incentive spirometry and _____.
suctioning
27
When on oxygen therapy promote rest and ____.
decrease environmental stimuli
28
When on oxygen therapy provide ____ support.
emotional
29
When on oxygen therapy assess nutritoinal status and provide ______.
supplements as needed
30
When on oxygen therapy assess skin integrity. Provide moisture and _____.
pressure relief devices
31
When on oxygen therapy assess and _____ response to therapy.
document
32
When on oxygen therapy titrate oxygen to maintain the recommended ____.
oxygen saturation
33
When on oxygen therapy discountinue _____.
gradually
34
When on oxygen therapy monitor for respiratory ______ (decreased resp rate and level of consciouness)
depression
35
Low flow oxygen delivery systems deliver varying amounts of oxygen based on the ______ and the client's breathing pattern.
delivery method
36
Low flow oxygen delivery through a ______ is tubing with two small prongs for insertion into the nares.
nasal cannula
37
Fraction of inspired oxygen (FIO2) via a nasal cannula ranges from 24% to 44% at a flow rate of ____.
1 to 6 L/min
38
A cannula is a safe, simple, and _____ method.
easy to apply
39
A cannula is comfortable and ____.
well tolerated
40
With a ____ a client is able to eat, talk, and ambulate.
cannula
41
The FIO2 varies with the flow rate, and rate and depth of the client's breathing which is a disadvantage when using a ____.
cannula
42
Extended use of a cannula can lead to ___ and dry mucous membranes.
skin breakdown
43
A disadvantage to a ______ is that it is easily dislodged.
cannula
44
When using a nasal cannula make sure to assess the patency of the nares. Ensure that the prongs fit in the nares properly. Use _____ to prevent dry nares. Provide humidification for flow rates of _____ or greater.
water soluble gel | 4L or greater
45
A ______ covers the client's nose and mouth.
simple face mask
46
A simple face mask delivers an FIO2 of _____ to _____ at a flow rate of 5 to 8 L/min.
40 to 60%
47
The minimum flow rate is _____ to ensure flushing of CO2 from the mask when using a simple face mask.
5 L/min
48
Advantages to a simple face mask is that it is easy to apply and can be more comfortable than a ____.
nasal cannula
49
The simple face mask is a simple _____.
delivery method
50
The simple face mask provides _____ oxygen
humidified
51
With a ______ flow rates less than 5L/min can result in rebreathing CO2.
simple face mask
52
Clients who have anxiety or claustrophobia do not tolerate a _____ well.
simple face mask
53
Eating, drinking, and ____ are imparied when using a simple face mask.
talking
54
Moisture and pressure can ___ under the simple face mask and cause skin breakdown.
collect
55
When using a simple face mask assess proper fit to ensure a secure seal over the nose and mouth. make sure the client wears a nasal cannula during meals. Use with caution for clients who have a high risk of _______ or airway obstruction.
aspiration
56
When using a simple face mask monitor for ____.
skin breakdown.
57
A _____ mask covers the clients nose and mouth.
partial rebreather
58
A partial rebreather mask delivers an FiO2 of ___ to ____ at flow rates of 6 -10 L/min.
40 to 70%
59
An advantage to a partial rebreather mask is that it has a reservoir bag attached with no valve, which allows the client to rebreathe up to ____ of exhaled air together with the room air.
1/3
60
With a ____ mask complete deflation of the reservoir bag during inspiration causes CO2 buildup.
partial rebreather
61
The FiO2 varies with the client's _____ with a partial rebreather mask.
breathing pattern
62
Clients who have ____ or claustrophobia do not tolerate the partial rebreather mask well.
anxiety
63
With a partial rebreather mask eating, ____, and talking is impaired.
breathing
64
With a _____ mask it is necessary to keep the reservoir bag from deflating by adjusting the oxygen flow rate to keep the reservoir bag 1/2 to 1/3 full on inspiration
partial rebreather
65
With a _____ mask it is necessary to assess proper fit to ensure a secure seal over teh nose and mouth. Assess for skin breakdown beneath the edges of the mask and _____.
partial rebreather | bridge of the nose
66
Make sure the client uses a _____ during meals with a partial rebreather.
nasal cannula
67
A partial rebreather mask should be used with caution for patients who have a high risk of aspiration or ______.
airway obstruction
68
A nonrebreather mask covers the clients _____.
nose and mouth.
69
Fraction of inspired oxygen delivers ___ to ____ at flow rates of 10 - 15 L/min to keep the reservoir bag 2/3rds full during inspiration and expiration
60 to 100 %
70
A ____ mask delivers the highest O2 concentration possible (except for intubation).
nonrebreather
71
A one way valve situated between the mask and resrvoir allows the client to inhale maximum O2 from the reservoir bag. The two exhalation ports have flaps covering them that prevent room air from entering the _____ mask,
nonrebreather
72
The valve and flap on the mask must be intact and functional during each breath with a _____ mask.
nonrebreather
73
A nonrebreather mask is poorly tolerated by clients who have anxiety or ____.
claustrophobia
74
Eating, drinking, and ____ are impaired with a nonrebreather mask.
talking
75
Nonrebreather masks should be used with caution for clients who have a high risk of ____ or airway obstrction.
aspiration
76
Perform an ____ assessment on the valve and flap of a nonrebreather mask.
hourly
77
Assess proper fit ensure seal over the nose and mouth. Assess for skin breakdown ____ of the mask and the bridge of the nose with a nonrebreather mask.
beneath the edges
78
Low Flow oxygen delivery systems
nasal cannula simple face mask partial rebreather nonrebreather
79
A venturi mask is a ____ flow oxygen delivery system that covers the client's noe and mouth.
high
80
A venturi mask delivers an FiO2 of ___ to ___ flow rates of 4 to 12 L/min via different size adapters, which allows specific amounts of air to mix with oxygen.
24% to 60^
81
A ___ mask delivers the most precise oxygen concentration.
venturi
82
Humidification is not necessary with a ____ mask.
venturi
83
A _____ mask is best for clients who have chronic lung disease.
venturi
84
A disadvantage to a ___ mask it that it is expensive.
venturi
85
A venturi mask impairs ____, drinking, and talking.
eating
86
Assessment of a venturi mask needs to be frequent to ensure an ______ flow rate.
accurate
87
Assess proper fit to ensure a secure seal over teh nose and mouth. Assess for skin breakdown beneath the edges of the mask particularly on the ____ when using a venturi mask.
nares
88
Two types of aerosol masks
face tent | trachostomy collar
89
A ____ fits loosely around the face and neck.
face tent
90
A _____ is a small mask that covers the surgically created opening of the trachea.
tracheostomy collar
91
An ____ mask delivers an FiO2 of ____ to ____ at flow rates of at least 10 L/min.
aersol (face tent or tracheostomy collar)
92
An aerosol mask provides high ____ with oxygen delivery.
humidification
93
An _____ mask is a good option for those that do not tolerate masks well.
aersol mask | face tent or tracheostomy collar
94
_____ masks are useful for clients who have facial trauma, burns, and thick secretions.
aersol mask
95
A drawback to an aersol mask is that the high humidification requires ____.
frequent monitoring
96
Nurses need to empty ____ from the tubing often with aerosol masks.
condensation
97
Nurses need to ensure adequate water in the ____ _canister with aersol masks.
humidification
98
Nurses need to ensure that the ___ leaves from the vents during inspiration and expiration.
aerosol mist
99
Make sure the tubing does not pull on the _____ with a tracheostomy collar.
tracheostomy
100
______ can result from high concentrations of oxygen (typically greater than 50%), long durations of oxygen therapy (typically more than 24 to 48 hours) and the severity of lung disease.
oxygen toxicity
101
Nonproductive cough, substernal pain, nasal stuffiness, nausea, vomiting, fatigue, headache, ____ and hypoventilation are manifestations of oxygen toxicity.
sore throat
102
With oxygen toxcity use the lowest level of oxygen necessary to maintain an adequate ____.
SpO2
103
Monitor _____ and notify the provider if SpO2 levels are outside the expected reference range to make sure oxygen toxicity.
ABGs
104
To prevent oxygen toxicity decrease the FiO2 as teh client _____ improves.
SpO2
105
Clients who have conditions that cause alveolar ________ can be sensitive to the administration of oxygen.
hypoventilation
106
In oxygen-induced hypoventilation monitor respiratory rate and pattern, level of consciousness , and _____.
SpO2
107
In oxygen-induced hypoventilation provide oxygen therapy at the lowest liter flow rate that manages ______.
hypoxemia
108
In oxygen-induced hypoventilation monitor if the client tolerates it, use a ______ to deliver precise oxygen levels.
Venturi mask

461-Foundations (45 decks)

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