Chp 38 Oxygenation and Tissue Perfusion Study Guide Flashcards
1
Q
collapse of lung tissue in the still part of the lung
A
atelectasis
2
Q
an inflammation of the larger airways, increased production of mucus, and chronic cough
A
chronic bronchitis
3
Q
en enlargement of small air sacs in the distant end of terminal bronchioles
A
emphysema
4
Q
a reaction of airways to stimulation by irritant, allergens, pollutants or cold air thought constriction and spasms
A
asthma
5
Q
an infection in the lungs
A
pneumonia
6
Q
the normal heart rate is _______ beats per minute
A
60-100
7
Q
identify cardiovascular alterations that can influence oxygenation
A
Oxygenation can be inclined by atherosclerosis, arterial spasm or malformation blood clots, dysrhythmias, valvular issues, failure, and trauma
8
Q
what is the cause of emphysema
A
caused by smoking, pollution, or family history
9
Q
what is the cause of pneumonia
A
caused by infectious agent or aspiration
10
Q
what is the cause of atelectasis
A
caused by decreased diaphragmatic movement and hypoventilation
11
Q
how do scoliosis and kyphosis affect respiration
A
they are curvatures of the spine that limit thoracic movement and result in hypoventilation, retention of carbon dioxide, and reduced oxygenation
12
Q
Identify at least fie assessment question that the nurse should ask the patient in regards to cardiopulmonary function
A
the nurse should ask about chest pain shortness of breath, dyspnea, weight gain/loss, dizziness blood clots, weakness/fatigue, persistent cough, and a history of smoking or cardiopulmonary disease
13
Q
For the physical assessment , which areas will the nurse focus on to determine the patent’s oxygenation status
A
obtain vital signs auscultate heart and lung sounds evaluation peripheral pulses, and observe for changes in the skin (hairless, shiny extremities) or structure (barrel-chest) that would indicate alterations
14
Q
cyanosis
A
bluish discoloration of the skin r/t deoxygenation of hemoglobin
15
Q
define hemoptysis
A
blood in the sputum
16
Q
define hypercapnia
A
an abnormal high level of carbon dioxide in the blood
17
Q
define arrhythmia
A
abnormal rhythms of the heart
18
Q
define necrosis
A
tissue death
19
Q
define hypoxemia
A
low level of oxygen in the blood
20
Q
For the patient with emphysema the results of forced vital capacity (FVC), forced expiratory volume (FEV1), and forced expiratory flow (FEF are expected to be ______ than normal
A
lower/less
21
Q
the results of the residual volume (RV) and functional residual capacity (FRC) for a patient with emphysema is expected to be ________ than normal
A
higher/more than normal
22
Q
For the patient with heart failure hemoglobin levels may be? Potassium levels may be?
A
Decreased (dilution fro excess fluid)
Decreased (hypokalemia related to diuretics)
23
Q
What abnormalities can be found with a chest radiograph
A
abnormal findings on a chest radiograph are rib fractures, tumors, pneumothorax, pneumonia, pleural effusion, pericardial effusion, enlarged heart, and atelectasis
24
Q
What concerns does the nurse have for the patient undergoing a cardia catheterization
A
the patient will have contrast dye injected, which could result in an allergic reaction. The nurse also has to monitor for bleeding and circulation to the extremity used for access
25
Identify at least three nursing diagnoses r/t oxygenation
Impaired Gas Exchanged r/t destruction of alveolar walls AEB Sp02 of 90% and patient complaints of inability to breath
Ineffective Airway Clearance r/t low oxygen levels and need for more oxygen with activity, AEB complaints of fatigue with activity , slow gait, and dropping O2 saturation levels with activity
Ineffective Breathing Pattern r/t ineffective movement of air into an out of the lungs, AEB difficulty breathing with activity and at least, use of pursed lip breathing
26
Goals out comes statements for oxygenation
Patient will maintain SpO2 at 92% or greater by the end of the shift
Patients lungs will be clear to auscultation within 24 hours
Patient will report decreased fatigue during hospitalization
Etc
27
What measures can the nurse implement to promote a patient's oxygenation
posting in semi or high Fowler position, providing oxygen, maintaining airway clearance, instructing the patient in respiratory exercises (deep breathing, laughing, incentive spirometer use), providing adequate hydration, and administering medication to improve cardiovascular and pulmonary function
28
Oxygen saturation should be at least
90% or higher
29
What is required when oxygen is going to be sued by a patient at home
order from PCP, be instructed in the proper use and storage of the oxygen, have signs for No Smoking and determination of the type of deliver devise and tubing
30
For the Quality and Safety Education for Nurses competency of Teamwork and Collaboration, what other health team members will most likely be involved in the care of a patient with an oxygenation deficit
nurses, respiratory therapist, PCP, speech therapist (aspiration risk), and physical therapist (increase activity tolerance)
31
The patient is admitted to the hospital with an exacerbation of his emphysema. The patient's wife asks why the oxygen level is "not turned up high enough" to help her husband breathe better. The nurse response by explaining to the patient's spouse?
the higher levels of oxygen may create respiratory depression. In patients with emphysema who have high levels of carbon dioxide, low oxygen levels drive respiration. Higher amounts of oxygen will drop the respiratory status
32
Safety consideration associated with nasal cannula
Correct application involves placing the prongs in the patient's nares with the curved side at the top and the prongs pointing toward the back of the head; looping the tubing around the patient's ears (gauze or special tubing covers may be used as a cushion where the tubing rests on the ear to prevent sores and protect the skin); and tucking the tubing under the patient;s chin and securing it with sliding adjustment piece. Encourage the patient to breathe through the nose. Do not administer oxygen through a nasal cannula at greater than 6L per minute. Consider humidification at all levels, especially at flow rates of 4L per minute and higher
33
Safety considerations associated with simple face mask
If there is a bag reservoir, ensure it is filled before placing the mask on the patient. Always humidify oxygen delivered via mask. If the patient is able to eat, obtain an order for a nasal cannula during meals. Correct application involves the following: Pace the ask over the patient's nose and mouth. Secure the mask around the back of the head with the adjustable strap, pulling evenly from both ends of the strap to secure it in place. If the straps are around the ears where thy may chafe, fusion the ears with gauze. Adjust the nosepiece by pinching it to provide for comfort and to ensure fit. There are several types of oxygen masks but no reservoir bag is used for a smile face mask
34
Continuous positive airway pressure (CPAP) is used for?
treating obstructive sleep apnea and to prevent atelectasis
35
Barriers to CPAP compliance include
dry nares, skin irritation claustrophobia, perception of an inability to breath and nose of the devise
36
What is the difference between CPAP and biphasic positive airway pressure (BIPAP)
BiPAP provides two pressures - higher during inhalant and lower during exhalation, whereas CPAP maintains the same pressure throughout
37
When would a bag-valve mask (BVM) or Ambu bag be used
to ventilate and oxygenation a patient who needs ventilatory support in an emergency situation
38
Oropharyngeal Airway Size, Insertion, and Nursing care?
Size - 90mm
Insertion - Insert the airway while direction the curve of the airway at the rood of the mouth and then rotate the airway 180 degrees once it reached the back of the throat
Nursing care - Secure the airway in place with a hole or tape. Remove the airway every 4-8 hours. Provide oral care
https://www.youtube.com/watch?v=vgqOrmBskaw
39
Nasopharyngeal Airway Size, Insertion, and Nursing Care
Size - 28 French
Insertion - Lubricate the airway before attempting insertion. The airway is inserted gently; if resistance is encountered, try the other nostril
Nursing care - Secure the airway in place with holder or tape. Remove the airway every 8-24 hours, and alternate nares. Provide oral and Nasal care
40
What emergency equipment should be in the room of a patient with a tracheostomy
Abu Bag, endotracheal and oropharyngeal suction equipment, waterproof adhesive tape, an extra tracheostomy care kit, two extra inner cannulas (one the same size as worn by the patient, and one size smaller) with obturators, scissors, extra tracheostomy ties, oxygenation equipment
41
Indicate interventions that can be used to promote cardiopulmonary function
```
diets high in fiber and low fat
exercise
medications
chest physiotherapy
anti embolism stockings
sequential compression devise
smoking cessation
immunizations
chest tubes, tracheostomies, airways suctioning
```
42
Identify at least three medications that are expected to be part of the treatment for pulmonary disease
bronchodilators, anticholinergic agents, corticosteroids, vaccines, antibiotics, mucolytic therapy, leukotriene modifiers
43
Medication to be expected with cardiovascular disease
diuretics, angiotensin-converting enzyme inhibitors, angiotensin II receptor antagonists, beta blockers, calcium channel blockers, vasodilators, antiarrhythmics, anticoagulants
44
The UAP is checking on the patient with a nasopharyngeal airway who has oxygen in place and requires frequent suctioning. What do you tell the UAP to report to you regarding the patient's status
Changes in vital signs respiratory status, or level of conscienceless
Pain or discomfort noted by the patient
Skin breakdown
Excessive secretions
Difficulties encountered with any of the treatments
45
The patient who needs nasotracheal suctioning has an excessive amount of secretions. How does the nurse ventilate this patient before suctioning
pre suctioning ventilation is done with a tracheostomy oxygenation mask set for 100% Fi02 for several respiratory cycles
46
Suctioning through patient's nares is contraindicated for the patient who has?
Epistaxis
Coagulation disorder
reactive airway disease
an upper neck injury
47
To clear the suction catheter and check that the suction is functioning, the nurse uses
sterile normal saline
48
Identify the pressure to be set for suction of tracheostomy
80-12 mm Hg continuous
49
Identify the pressure to be set for suction of Oropharyngeal
120-150 mm Hg continuous
50
Identify the correct sequence for cleaning the tracheostomy once the sterile field and solutions are prepared
Apply Sterile gloves
Dip the cotton swab into the sterile normal saline solution
Gently clean the outer area of the tracheostomy from the stoma outward
Pat the outer area of the tracheostomy dry with sterile gauze
Clean the inner cannula, if non disposable
51
For a patient with a chest tube, indicate what the nurse should do for positioning for a patient with a pneumothorax
Semifowler position is used for a pneumothorax
52
For a patient with a chest tube, indicate what the nurse should do for bubbling in the water seal chamber
Notify the PCP
53
For a patient with a chest tube, indicate what the nurse should do for drainage is collecting in the coiled tube
lift the tubing up to clear the drainage. Do not lift the system above chest level
54
For a patient with a chest tube, indicate what the nurse should do for assessment of the draining system should be done at least every
4 hours
55
The nurse is working on a respiratory care unit in the hospital. Upon entering the room of a patient with emphysema, it is noted that the patient is experience=ign respiratory distress. The nurse should?
provide oxygen at 2L/minute via nasal cannula
56
An older patient has developed kyphosis and is at a greater risk for developing pneumonia primarily because the:
abnormal chest shape prevents efficient ventilatory movement
57
The patient has experience a MI resulting in damage to the left ventricle. A possible complication the patient may experience is?
pulmonary congestion
58
A patient has recently had a mitral valve replacement. To prevent excess serosanguinous fluid accumulation, the nurse anticipates that care will include
chest tube placement in the thoracic cavity
59
Chest percussion is indicated for
cystic fibrosis
60
The nurse is working on a pulmonary unit at the local hospital. The nurse is alert to one of the early signs of hypoxia in patients, which is
restlessness
61
in teaching a patient about an upcoming diagnostic test, the nurse identifies that which one of the following uses an injection of contrast material
cardiac catheterization
62
At a community health fair, the nurse informs the residents that the pneumococcal vaccine is recommended for patients
of any age who have chronic lung disease
63
an appropriate technique for nasotracheal suctioning
applying intermittent suction for 10 - 15 seconds during catheter removal
64
The patient's a chest tube in place following thoracic surgery. In working with patient who has a chest tube, the nurse should
keep drainage devise upright
65
The patient has supplemental oxygen in place and requires suctioning to remove excess secretions fro the airway. In order to promote maximum oxygenation, an appropriate action by the nurse is to
replace the oxygen and allow rest in between suctioning passes
66
During transport, a chest tube pulls out from the pleural space. The nurse immediately
covers the site with an occlusive dressing
67
patient admitted with right sided heart failure. during assessment nurse expects to find?
peripheral edema
68
A flow rate of oxygen of 2L per minute is providing what percent of oxygen
28%
69
Left-sided heart failure signs
praoxysmal nocturnal dyspnea, restlessness, confusion orthopnea, tachycardia, exertional dyspnea, fatigue, cyanosis, elevated pulmonary capillary wedge pressure, pulmonary congestion (cough, crackles, wheezes, blood tinged sputum, tachypnea)
70
Right-sided heart failure signs
fatigue, peripheral venous pressure, ascites, enlarged liver and spleen, may be secondary to chronic pulmonary problems, distended jugular veins, anorexia and complaints of GI distress, weight gain dependent edema
71
signs of emphysema
CO2 increase retention (pink), minimal cyanosis, purse lip breathing, dyspnea, hyper resonance on chest precision orthopneic, barrel chest, exertion dyspnea, prolonged expiratory time, speaks in short jerky sentences, anxious, use of accessory muscles to breathe, thin appearance
72
myocardium receives blood from
coronary arteries
73
Left sided heart failure assessment
This side usually happens first. How many pillows needed? Are you short of breath at night? (Think of drowning inside)
74
Right sided heart failure assessment
weigh daily. Pills may help relieve water build up, but you have to monitor levels because potassium may leave with fluid when taking them.
75
Lab tests from lecture mentioned
Pulmonary Functioning Test (PFT), CBC (hemoglobin, hematocrit (Hgb, Hct), WBC), BMP (renal, glucose, electrolytes), ABG should be 7.35-7.45
