ATI Unit 3 Respiratory

Question 1

Pulmonary Functions Tests (PFTs)

Answer 1

these determine lung function and breathing difficulties

• if client is a smoker, instruct not to smoke 6-8 hours prior, if client uses inhalers, withhold 4-6 hours prior to testing

Question 2

what does an ABG measure

Answer 2

pH: amount of free hydrogen ions in arterial blood
PaO2: partial pressure of oxygen
PaCO2: partial pressure of carbon dioxide
HCO3-: concentration of bicarbonate in arterial blood
SaO2: percentage of oxygen bound to Hgb as compared with total amount than can be carried

Question 3

how can an ABG be obtained

Answer 3

through venipuncture or arterial line

Question 4

Preprocedure for ABG arterial puncture

Answer 4

1. obtain heparinized syringe
2. perform Allent Test (occlude ulnar and radial arteries with balled fist then release one each)
3. can be painful so let patient know what an ABG is

Question 5

Intraprocedure

Answer 5

1. perform an arterial puncture using aseptic technique acquiring into heparinized syringe
2. put syringe into container with ice and water to maintain pH and oxygen pressure transport immediately to lab
3. radial sampling in older clientscanbehardb/c of decreased peripheral vasculature

Question 6

Postprocedure for arterial puncture

Answer 6

1. hold pressure/gauze for 5 minutes, 20 if on anticoags
2. assess for swelling, temperature, loss of pulse, pallor
3. document
4. notify provider of results
5. admin O2 and change ventilator settings if needed

***note: arterial puncture often performed by respiratory therapist

Question 7

Arterial Line Procedure

Answer 7

Pre: get two syringes, heparinized for sampling and standard for waste (verify line can be used)

Intra: collect waste and sampling and put on ice to transport to lab; flush line with flushing system

Post: assess the arterial waveform upon completion, document/notify, admin O2 and adjust ventilator settings

Question 8

Complications of Arterial line/arterial venipuncture

Answer 8

1) hematoma

2) air embolism

Question 9

what’s important before performing a bronchoscopy

Answer 9

that client maintained on NPO status usually 8-12 hours to reduce aspiration risk and when cough reflex is blocked by anesthesia

Question 10

what does atropine do

Answer 10

reduces oral secretions

Question 11

what position is a bronchoscopy performed in

Answer 11

sitting

Question 12

patient after a bronchoscopy has a mild, short fever nd a small amount of blood-tinged sputum, what does the nurse suscpect

Answer 12

nothing this is normal

Question 13

when is a client discharged from bronschoscopy

Answer 13

when cough reflex and resp effort are adequate

Question 14

what can ease a sore throat

Answer 14

gargling salt water and throat lozenges

Question 15

what are complications of bronchoscopy

Answer 15

1. laryngospasm: laryngeal cords (vocal cords) contract and impede client’s ability to inhale
2. pneumothorax (obtain follow up x-ray)
3. AspirationL can occur if client chokes on oral or gastric secretions

Question 16

reasons for thoracentesis

Answer 16

1. transudates (heart failure, cirrhosis, nephritic syndrome)
2. exudates (inflammatory, infection, neoplastic conditions)
3. empyema
4. pneumonia
5. trauma or invasive surgery

Question 17

assessment of effusion area

Answer 17

decreased breath sounds, dull percussion sounds, decreased chest wall expansion

Question 18

how much can you remove during a thoracentesis

Answer 18

1L at a time to prevent cardiovascular collapse

Question 19

Complications of a thoracentesis

Answer 19

1. mediastinal shift
2. pneumothorax (deviated trachea, pain on affected side worse on exhale, affected side doesn’t move in and out, increased HR, rapid shallow resp, cough
3. bleeding
4. infection: with needle puncture (thoracentsis is aseptic

Question 20

what are the three chambers for chest tube drainage system

Answer 20

1st chamger: drainage collection
2nd chamber: water seal
3rd: suction control

Question 21

water seal

Answer 21

add up to 2cm line allows air to exit but not enter with inhale (level must be maintained, lies on the ground)

• tidaling movement is expected in water seal, with normal inspirations the fluid level rises with inspiration and vice versa expiration (but for pos-pressure mechanical ventilation it’s the opposite)
• cessation of tidaling in water seal chamber signals lung reexpansion or obstruction

Question 22

suction control chamger important fact

Answer 22

heigh of sterile fluid determines amount of suction (usually -20cm H2O), results in continuous bubbling in suctino chamber