Exam 3: Respiratory

Question 1

What is Fi02?

Answer 1

Percentage of oxygen in the air that is available to the client

Question 2

What is the first sign of hypoxia?

Answer 2

neurological deficits like altered mental status, restlessness, confusion, or anxiety

Question 3

What are the signs and symptoms of hypoxia?

Answer 3

Restlessness
Decreased LOC
Dizziness
Behavioral changes
Fatigue
Agitation
Tachycardia
Cyanosis – Not a reliable indicator

Question 4

Why is cyanosis not a reliable indicator of hypoxia?

Answer 4

can be difficult in darker skinned clients

Question 5

How do we assess for cyanosis is darker skinned clients?

Answer 5

Central Cyanosis in the tongue and conjunctiva. The bluish appearance of either is a more reliable indicator of hypoxia.

Question 6

What are signs that your client has an airway obstruction?

Answer 6

Not talking, stridor, unconscious (tongue)

Question 7

What are some common airway obstructions?

Answer 7

Tongue
FBO
Vomit, secretions, mucus
Toys, nails, cereal

Question 8

How is a foreign body removed from the airway?

Answer 8

CPR, Heimlich, backblows

Question 9

What are interventions to address airway issues?

Answer 9

suctioning, pulmonary hygiene, artificial airway, intubation, trach

Question 10

What are indications for suctioning?

Answer 10

when patients are unable to clear respiratory secretions from the airways by coughing or other less invasive procedures

Question 11

What is the purpose of pulmonary hygiene/toilet?

Answer 11

the action of mobilizing respiratory secretions for removal

Question 12

What is the benefit of hydration in pulmonary hygiene?

Answer 12

Adequate hydration helps to maintain the ability to clear secretions by liquifying the sputum making it thin and easily removable with minimal coughing

Question 13

How would you hydrate a client who is NPO?

Answer 13

IV hydration

Question 14

What are the dangers of retained mucus?

Answer 14

Increases WOB
Traps bacteria allowing them to colonize
Leads to excessive coughing
Can lead to formation of mucus plugs which hinder gas exchange

Question 15

What is the purpose of incentive spirometry?

Answer 15

encourages voluntary deep breathing by providing visual feedback to patients about inspiratory volume

prevent atelectasis

Question 16

What is atelectasis?

Answer 16

condition that prevents the alveoli from expanding causeing portions of the lungs to collapse and is a complication when recovering from surgery

Question 17

What are the benefits of ambulation in pulmonary hygiene?

Answer 17

increase the general strength of the client as well as increase lung expansion. This expansion shifts mucus to the larger airways and is easier to expectorate.

Question 18

Which clients are candidates for early ambulation?

Answer 18

Critically ill clients can be placed into early ambulation programs with assistance from respiratory therapy and physical therapy

Question 19

When is an artificial airway indicated?

Answer 19

Anytime you use BVM

decreased level of consciousness or airway obstruction

Question 20

What are indications and contraindications for an oropharyngeal and nasopharyngeal airway?

Answer 20

OPA

Displaces tongue
Unconscious - cannot have a gag reflex

NPA

Patient can be conscious
Cannot suspect a facial fracture

Question 21

What is the nurse’s role in endotracheal intubation?

Answer 21

Call provider to update on status and potential need for further respiratory intervention
Inform and educate patient and family – this is a major event in the care of the patient and family should be notified
Confirm that the patient and/or family wants further intervention
Gather supplies for intubation procedure
Notify respiratory therapist for mechanical ventilator to be brought to room

Question 22

What is the most common complication of a tracheostomy tube?

Answer 22

partial or total airway obstruction caused by buildup of respiratory secretions

Question 23

What are safety precautions that we take with tracheostomy clients?

Answer 23

Always know the size of your clients trach –
Always have a new trach usually a size below your patients current trach at the bedside for emergencies – if the trach comes out you can place the smaller trach in the stoma to provide ventilation an oxygenation

Question 24

How is oxygen administered to a client with a tracheostomy?

Answer 24

Oxygen delivery for trach is via a trach collar which is a specific device designed to fit over the trach
Oxygen delivery is through a humidification cylinder and communicated and regulated as FiO2 % as opposed to Liters of oxygen
Example: 40% TC (trach collar) as opposed to 6 L NC (nasal cannula)

Question 25

What are the signs that a client requires suctioning?

Answer 25

Coughing Mucus in the tube Alarms Patient request

Question 26

Describe the process of using in-line suction on a client?

Answer 26

Suction catheter is advanced into the endotracheal tube. Suction is engaged by pressing a button on the end of the catheter. Suction is engaged intermittently as the nurse slowly retracts the catheter out of the ET tube. 1 to 3 passes may be necessary to clear all the secretions. Never suction more than 10 seconds. Allow your client to rest between suction procedures.

Question 27

Why is VAP a concern?

Answer 27

because the ET tube gives harmful bacteria a pathway to bypass all of the anatomical defenses in the upper airway and go directly to the client’s lungs leading cause of death in HAIs -> pts are already critically ill to need vent

Question 28

What are components of a VAP bundle?

Answer 28

Elevate HOB to at least 30 degrees Daily Sedation Vacations and weaning assessment Daily Oral Care Delirium Monitoring Early Mobilization PUD prophylaxis – Doesn’t directly prevent VAP DVT prophylaxis – Doesn’t’ directly prevent VAP

Question 29

What are the head of bed degrees for the different Fowler’s positions?

Answer 29

30° for semi-Fowler's 45° to 60° for Fowler's 90° for high Fowler's

Question 30

Which Head of bed position is recommended for clients with difficulty breathing?

Answer 30

High Fowlers

Question 31

How do we know that a client requires supplemental oxygen?

Answer 31

assessment data - SpO2, WOB, dyspnea

Question 32

Why is an airway assessment important prior to providing supplemental oxygen?

Answer 32

b/c blocked airway needs to be cleared first

Question 33

How do we know what adjunct to use and how many liters to place on the client?

Answer 33

Follow the O2 protocol but use lowest amount necessary for shortest period of time (2L NC) Indicators of effectiveness: color, LOC, HT, WOB, ABGs, SPO2

Question 34

What should we do if our client has a sudden increase in their supplemental oxygen requirement?

Answer 34

Call RRT and increase per protocol

Question 35

What is the Fi02 delivered by a nasal cannula and a nonrebreather mask?

Answer 35

NC = 22-44% NRB = 90-100%

Question 36

What flow rate should you use when applying a nonrebreather mask?

Answer 36

15LPM

Question 37

What are indications that your client requires bag valve mask ventilations?

Answer 37

clients breathing less than ten times a minute with shallow respirations. It is also used to provide oxygen to the lower airways prior to suctioning or endotracheal intubation.

Question 38

How are in hospital cardiac arrests avoidable?

Answer 38

There are often clear physiological warning signs that begin appearing several hours before an arrest situation – cardiac or respiratory need early interventions at first sign of decline - trend vitals

Question 39

What should you do if you notice a deterioration in vital signs?

Answer 39

Go up the chain, start with other nurse -> provider -> RRT

Question 40

What are the criteria for activating the rapid response team?

Answer 40

Heartrate over 140 or less than 40 Respiratory rate over 28 or less than 8 Systolic blood pressure greater than 180 or less than 90 Oxygen saturation less than 90% despite supplementation – or a significant increase in oxygen demands Acute change in mental status Urine output less than 50mL over 4 hours Nurse, staff member, family or patient have a significant concern about the patient condition Additional criteria may include: chest pain, threatened loss of airway, seizures, stroke, or sepsis.

Question 41

What decisions does the Rapid Response team make?

Answer 41

Whether the pt can stay on that floor with further interventions or if they need a higher level of care

Question 42

Who may be included on a code team?

Answer 42

Charge RN – Usually ICU Charge nurse Respiratory Therapist MD(s): anesthesiologist, pulmonary MD, critical care MD ICU or unit nurses CPR Compressors

Question 43

What should you do if your client is unresponsive?

Answer 43

Sternal rub, check pulse/breathing

Question 44

When do you push a code blue button?

Answer 44

Unresponsive w/ no pulse and not breathing

Question 45

Describe the various roles of the code team members.

Answer 45

Team Leader Airway Recorder Compressors – CPR Monitor IV/Medications

Question 46

What is closed loop communication?

Answer 46

Repeat order to confirm heard/understand Confirm order has been carried out/completed Helps to reduce/eliminate errors Concise and clear language -> Calm, controlled, confident