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54/64 unit 3 > Care Of Client With Pulmonary Conditions > Flashcards

Care Of Client With Pulmonary Conditions Flashcards

1
Q

Examples of artificial or advanced airways

A

Endotracheal (ET) tube and Trach

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2
Q

External chest wall manipulation, broadly classified as airway clearance therapy (ACT), that loosens and removes secretions from patients’ airways

A

Chest Physiotherapy (CPT)

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3
Q

Examples of chest physiotherapy (CPT)

A

Percussion, vibration, postural drainage (PD) therapy, and acapella device

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4
Q

What do acapella devices measure?

A

Expiration pressure

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5
Q

How to use incentive spirometer

A

Set goal for patient, instruct patient to take deep breath in and “aim for the smiley face”

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6
Q

Purpose of incentive spirometer

A

Preventing build-up of fluid and bacteria that can cause pneumonia

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7
Q

High frequency chest wall oscillators are commonly used in

A

Patients with cystic fibrosis

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8
Q

Managing secretions nursing care

A

Turn/repostion q1-2h, early ambulation and out-of-bed activities, cough and deep breathe, CPT (percussion, vibration, postural drainage)

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9
Q

Oral care for patients with pulmonary conditions

A

Sponge tooth cleaner or soft-bristle toothbrush moistened in water; avoid glycerin swabs or mouthwash containing alcohol

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10
Q

Emergency airway that maintains airway patency by displacing the tongue forward and toward the oral cavity floor

A

Oropharyngeal airway (OPA)

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11
Q

How to determine correct OPA size

A

Hold flange parallel to the front teeth and the end of the OPA should reach he angle of the jaw

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12
Q

Airway used for unconscious patient? Airway used for conscious patient?

A

OPA; nasal trumpet

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13
Q

Inserting an OPA

A

Insert upside down or sideways, then flip it

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14
Q

What should be done if a patient with an OPA continually coughs and gags when it is inserted?

A

Remove OPA and turn patient to side; nasal trumpet may be a better option

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15
Q

What kind of technique should be used for oral suctioning?

A

Clean

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16
Q

Describe nasotracheal suctioning

A

Use sterile technique; one sterile hand (dominant) and one clean hand; no more than 3 passes and for no more than 10 seconds each; suction on WITHDRAW; use sterile saline to clear suction

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17
Q

How much room should the nurse leave between the start and end of suction catheter?

A

About a fist

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18
Q

Suctioning unexpected outcomes

A

Decrease in cardiopulmonary status as evidenced by decreased SpO2, increased EtCO2, tachypnea, increased work of breathing, and cardiac dysrhythmias

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19
Q

Interventions to address unexpected outcomes related to suctioning

A

Limit length of suctioning, more frequent suction with shorter duration, supplemental oxygen, supply oxygen between suctioning passes, notify health care provider

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20
Q

Prior to suctioning, the nurse should

A

Hyperoxygenate the client; set ventilator to 100% oxygen

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21
Q

Signs that a patient needs oxygen

A

Low pulse ox, rapid and hard respirations, confusion/agitation, cyanosis, changes in HR and rhythm and BP

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22
Q

Oxygen safety considerations

A

Fall risk, skin breakdown (on top of nose, behind ears)

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23
Q

Nasal cannula flow

A

2-6 L (can add humidification at 4 L)

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24
Q

Simple face mask flow

A

6-10 L

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25
Q

Nonrebreather face mask flow

A

10-15 L

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26
Q

Nonrebreather mask nursing consideration

A

Do not place on patient unless the bag is filled some (risk for suffocation); this device is more emergent, for patients that are no doing well

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27
Q

Benefit of Venturi mask

A

Allows for administration of a very specific amount of oxygen (% instead of L)

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28
Q

Benefit of high-flow nasal cannula

A

Gives high amount of oxygen and patient can still talk, eat, and move around

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29
Q

How can the nurse tell the type and size of a trach tube

A

By looking at the trach plate

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30
Q

T or F: nurse can change a tracheostomy tube

A

False: nurses can only change the inner cannula

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31
Q

Changing/cleaning an inner cannula

A

Sterile procedure; only touch the outer portion (knob); use sterile water/saline and brush to clean inner then outer cannula

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32
Q

What supplies should be kept at the HOB for patients with tracheostomy tubes?

A

An extra trach kit and obturator (used in emergency situations to maintain patency should the trach be misplaced)

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33
Q

Attachment that delivers desired FIO2 to clients with tracheostomy, laryngectomy, and ET tubes

A

T-piece

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34
Q

__________ should appear on exhalation side of T-piece

A

Aerosol

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35
Q

Preoperative interventions for tracheostomy

A

NPO, hold anticoagulants, stop TF as ordered, clean site with chlorhexidine, witness informed consent

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36
Q

Postoperative interventions tracheostomy

A

Monitor for bleeding

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37
Q

Tracheostomy can be inserted at _________ or in the ___

A

Bedside; OR

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38
Q

Tracheostomy complications

A

Tube obstruction, tube dislodgement/accidental decannulation, pneumothorax, subcutaneous emphysema, bleeding, infection

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39
Q

Preventing tracheostomy complications

A

Prevent tissue injury by keeping area clean and dry, ensure air warming and humidification, suction as needed

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40
Q

Tracheostomy complications characterized by air-trapping in the subcutaneous area; feels and sounds like rice-crispy

A

Subcutaneous emphysema

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41
Q

Supporting the psychosocial needs and self-esteem of patients with tracheostomy

A

Aknowledge frustration, allow sufficient time for communication, use normal tone of voice, address changes in self-image, provide social contact, nutritional needs

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42
Q

Alternate forms of communication in patients with tracheostomy

A

Writing tablet, picture board w/ letters, flashcards, hand signals, smart phones, yes/no questions, mark central call light to indicate patient cannot speak, collaborate with SLP

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43
Q

Swallowing can be difficult for the patient with a tracheostomy. Educate the patient to keep the HOB elevated for at least ___ min after eating

A

30

44
Q

Trach weaning

A

Gradual decrease in tube size until ultimate removal of tube; deflate cud when patient can manage secretions and does not need assisted ventilation; change from cuffed to uncuffed tube; capping, tracheostomy button

45
Q

Example of non-invasive ventilation

A

Bipap

46
Q

Bipap safety considerations

A

High risk for aspiration (DO NOT restrain these patients; patient may need to be NPO or have an NGT)

47
Q

Bipap assessment

A

Mentation, skin, mucus membranes

48
Q

Ventilation that uses positive pressure to keep alveoli open and improve gas exchange

A

Noninvasive positive-pressure ventilation (CPAP, volume-limited or flow-limited, BiPAP)

49
Q

Ventilation that provides continuous positive airway pressure and is the most effective treatment for sleep apnea because the positive pressure acts as a splint to keep upper airway and trachea open during sleep

A

CPAP

50
Q

Ventilation the provides bilevel (inspiratory and expiratory) positive airway pressure

A

BiPAP

51
Q

Describe how a BiPAP works

A

Indicated for patients who need help ventilating; Machine cycles to provide a set positive inspiratory pressure when inspiration takes place and a lower set end-pressure during expiration

52
Q

Interventions for prevention of ventilator assisted pneumonia

A

Proper hand hygiene, elevate HOB (unless contraindicated), oral hygiene w/ chlorhexidine, peptic ulcer and VTE prophylaxis, provide daily disruption of sedation, early mobilization, initiate enteric feedings earlier, provide subglottic secretion drainage

53
Q

Flexible, plastic tubes placed in the mouth or through the nose and advanced down into the trachea

A

Endotracheal tubes

54
Q

Endotracheal tubes indications

A

Short-term for mechanical ventilation, relieving upper airway obstruction, protecting against aspiration, and clearing secretions

55
Q

ET routine care

A

Maintain correct position of tube, monitor cuff pressures, prevent complications

56
Q

Unexpected outcomes related to ET tubes

A

Accidental extubation, cuff leaks

57
Q

Interventions for accidental ET tube extubation

A

Remain w/ patient while calling for help, notify health care provider, ventilate with bag-valve mask as needed, assess: airway patency, spontaneous breathing, vital signs, prepare for reintubation

58
Q

What health care professionals can intubate?

A

CRNA, anesthesiologist, ER/Critical Care Physician, pulmonologist (intensivist)

59
Q

Who should the nurse always call as a right-hand man for intubation?

A

Respiratory Therapist (RT)

60
Q

Supplies needed for intubation

A

Glidescope, med kit (whatever sedative/paralytic doc wants), orders in place, OG, lube, tape, meds, ambu bag

61
Q

Intubation should not be attempted longer than _____ without oxygenating the patient

A

30 sec

62
Q

Intubation nursing interventions

A

Monitor VS, color change, chest rise, breath sounds, assist with stabilizing tube, CXR to ensure placement

63
Q

When intubating, sedatives and paralytics are administered? Which is administered first?

A

Sedative first, followed by paralytic

64
Q

Interventions for and prevention of ventilator alarms and equipment malfunctions

A

Ensure alarms are appropriately set and respond to alarms promptly. Prevent malfunctions by regularly checking equipment and performing maintenance

65
Q

What does a low tidal volume alarm indicate?

A

Low exhaled volume d/t disconnection, cuff leak, and/or tube displacement

66
Q

What does a high peak pressure alarm indicate?

A

Excessive secretions, biting the tube, kinks in tubing, coughing, pulm edema, bronchospasm or pneumothorax

67
Q

Mnemonic for complications of mechanical ventilation

A

DOPE: displacement, obstruction, pneumothorax, equipment failure

68
Q

How does positive pressure ventilation (PPV) work?

A

Works opposite of normal dynamics of lungs (negative pressure) and pumps air into lungs

69
Q

A lung infection that can occur when bacteria enter the lower respiratory tract through the endotracheal tube

A

Ventilator associated pneumonia (VAP)

70
Q

Correct of VAP

A

Follow strict infection control measures, hand hygiene, ET tube care, oral hygiene, HOB 30-45 degrees to prevent aspiration

71
Q

Complication of mechanical ventilation that refers to lung or airway injury due to excessive airway pressure that can lead to pneumothorax or air leakage into the surrounding tissues

A

Barotrauma

72
Q

Correction of barotrauma

A

Adjust ventilator setting to limit peak inspiratory pressure and tidal volume

73
Q

Damage to the lung tissue caused by mechanical ventilation that can lead to increased inflammation and impaired oxygenation

A

Ventilator-induced lung injury (VILI)

74
Q

Correction of VILI

A

Lung-protective ventilation strategies such as low tidal volume and low plateau pressure; adjust ventilator settings to minimize overdistention and atelectrauma

75
Q

Inadequate oxygenation (_________) and excessive carbon dioxide retention (__________) can occur if ventilator settings are not optimized

A

Hypoxemia; hypercapnia

76
Q

Correction of hypoxemia and hypercapnia related to mechanical ventilation

A

Adjust FiO2 (fraction of inspired oxygen), PEEP (positive end-expiratory pressure), tidal volume, and RR to achieve oxygen saturation and end-tidal CO2 levels; frequent ABG analysis

77
Q

A range of mechanical ventilation complications including ventilator associated conditions (VAC), infection related ventilator associated complications (IVAC), and possible VAP

A

Ventilator associated events (VAE)

78
Q

Correction of ventilator associated events (VAE)

A

Follow strict infection control, monitor for signs of VAE, document changes in ventilator parameters (EARLY recognition and intervention are CRUCIAL!)

79
Q

_____-sedation can lead to prolonged mechanical ventilation, while _____-sedation may result in patient agitation and increased work of breathing

A

Over; under

80
Q

Correction of sedation and delirium related to mechanical ventilation

A

Use sedation protocols and daily sedation interruption to assess sedation needs, early mobilization, address pain and discomfort

81
Q

Mechanical ventilation complication that occurs when the patient’s breathing does not match the ventilator settings, leading to discomfort and increased work of breathing

A

Ventilator asynchrony

82
Q

Correction of ventilator asynchrony

A

Adjust ventilator settings to better match the patient’s respiratory efforts, consider using modes that allow or better synchronization like pressure support ventilation

83
Q

Correction of malposition of ET tube or tracheostomy tube

A

Ensure proper placement and securement of airway tube; regular assessments and CXR can confirm correct positioning

84
Q

Mechanical ventilation mode with preset rate and tidal volume by which the client initiates breath, but then the vent takes over

A

Assist control (AC)

85
Q

Hyperventilation can result in what acid-base imbalance?

A

Respiratory alkalosis

86
Q

Tidal volume is based on what two factors?

A

Height and gender

87
Q

Pressure being fed to keep alveoli open

A

PEEP

88
Q

Standard PEEP

A

5-15; the higher the PEEP, the sicker the patient

89
Q

The amount of oxygen the patient is on

A

NFiO2; lowest is 21% (room air)

90
Q

Preset rate and tidal volume for machine breaths by which the client initiates breath and volume depends on client effort, synched to reduce competition for breathing and can be used regular or for weaning

A

Synchronized Intermittent Mandatory Ventilation (SIMV)

91
Q

Adverse effects of SIMV mode

A

Can increase work of breathing and cause fatigue

92
Q

Things to give in report for a client on mechanical ventilation

A

Mode (usually ACVC), tidal volume (usually 4-6 mL/kg), PEEP (typically 5-10cm H2O), FiO2 (21-100%), and rate

93
Q

What does VT stand for

A

Tidal volume

94
Q

What does F RR stand for

A

Frequency of respirations

95
Q

FiO2

A

Oxygen concentration

96
Q

What does PS stand for

A

Pressure support

97
Q

What does Ve stand for

A

Minute ventilation

98
Q

What does PIP stand for

A

Peak inspiratory pressure

99
Q

What does Pplat stand for

A

Plateau pressure

100
Q

Vent complication that can occur when the patient is unable to breathe effectively without ventilatory support

A

Weaning failure

101
Q

Correction of weaning failure

A

Evaluate patient readiness for weaning considering factors such as oxygenation, hemodynamics, and respiratory effort; use weaning protocols and techniques like spontaneous breathing trials to assess readiness

102
Q

Chest tube indications

A

Draining air, fluid, blood

103
Q

Chest tube safety considerations

A

Keep sterile occlusive dressings and sterile water at bedside at all times (if tube becomes dislodged, place in sterile water)

104
Q

Chest tube nursing considerations

A

Only clamp if ordered, some bubbling w/ inspiration and expiration is normal but CONTINUOUS bubbling indicates air leak, chest tube should remain upright and below level of chest (WATCH CT VIDEO SLIDE 36)

105
Q

What solutions should be used to clean the inner cannula of tracheostomy?

A

Half-strength hydrogen peroxide followed by sterile saline

54/64 unit 3 (8 decks)

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