Final Weeks 1-7.5 Flashcards

Question

PEFR

Answer 1

maximal airflow during expiration. red, yellow, green zones. helpful in moinitoring bronchoconstriction in asthmatics

Answer 2

used to check for presence of PE (not definitive, probable.) TNIs: undress to waist, no metal, informed consent, check for allergies, void, explain procedure. Inhaled (ventilation) and injected (perfusion) isotopes – diminished radioactivity suggests lack of perfusion of airflow

Answer 3

used in pleural effusion r/t heart failure (fluid fills the pleural space, can cause infection) to diagnose, remove fluid or instill meds; sterile technique. Chest xray always performed after procedure to check for pneumothorax. TNIs: signed consent, explain procedure, pain meds, baseline VS, position upright with elbows on overbed table, feet supported. Instruct not to cough or talk. Monitor vs and o2 sat. observe for hypoxia and pneumothorax afterwards. Verify breath sounds in all lung fields. Encourage deep breathing. Chest tube may be used for persistent pleural effusions instead of doing repeated pleural taps

Answer 4

1. bronchoconstriction 2. increased mucus produciton 3. inflammation

Answer 5

allergens, resp infections, homrones, exercise, ASA, NSAIDs, beta blockers, food additives, air pollution, GI reflux, emotional stress

Answer 6

meds: controllers, rescuers, IV corticosteroids. Focus on correcting hypoxemia and improving ventilation. TNIs: frequent LOC assessments, O2 therapy, monitor VS, ABGs, IV fluids, possible SC epi, HOB up, prepare for intubation

Answer 7

HOB 45 degrees, encourage incentive spirometer, monitor RR, ABGs, O2 levels, give O2, meds as ordered. Teach to perform daily PEFR measurements, when to call the doctor.

Answer 8

Albuterol (MDI/NEB): bronchodilator. SE: increased HR, tremors, anxiety, restlessness, insomnia. Atrovent (MDI, NEB): COPD, bronchodilator, anticholinergic. Dries up secretions. Not as rapid as albuterol. SE: anxiety, dizziness, HA, cough, N/A, bronchospasm

Answer 9

Flovent (MDI) – asthma, corticosteroid. SE: thrush, URI, angioedema, bronchospasm. Rinse mouth after use. Singulair (leukotriene blocker): asthma, bronchodilator. SE: dizziness, fatigue, HA, give in PM unless for exercise induced asthma. Advair (DPI, beta 2 adrenergic), bronchodilator/corticosteroid): SE: tremors, anxiety, increased HR, thrush, bronchospasm

Answer 10

shake well, slow inspiration, spacer can be used, often 2 inhalations per dose

Answer 11

don’t shake, rapid inspiration, no spacer, often 1 inhalation per dose (ADVAIR)

Answer 12

cor pulmonale (right sided back up of fluid), secondary polycythemia, resp. failure, depression, anxiety, GERD/peptic ulcers (COPD patients may develop GERD because they tend to trap air in their chest cavities, which may then increase pressure on the abdomen, which leads to gastric reflux), acute exacerbations r/t respiratory infections

Answer 13

increased PaCO2 levels with increased HCO3 levels and pH WNL. This is a compensated state when chronic – may be asymptomatic unless other problems occur with the primary disease. Assess VS, mental status, ABG before/during O2 treatment.

Answer 14

8-10 reps, 3-4 X/day

Answer 15

* monitor RR, depth, effort, O2 sat, * ABGs, * ascultate breath sounds * monitor client’s LOC * lean forward if acutely dyspneic * HOB up * adequate hydration to liquefy secretions * huff cough * controlled deep breathing * pursed lip breathing * bronchodilator/oral care before meals * high calorie/protein diet with supplements * O2 NC during meals

Answer 16

build up of CO2 causes carbonic acid to build up in the blood due to HYPOVENTILATION S/Sx: HA, dyspnea, HTN, tachycardia, fine tremors, warm flushed skin Associated with: COPD, ARDS, severe pneumonia, anesthesia, atelectasis, pneumothorax

Answer 17

pH: 7.35-7.45 pCO2: 35-45 HCO3: 24-30 pO2: 80-100 O2: 92-100%

Answer 18

1. Buffer system: immediate change based on hydrogen ions in the body 2. Respiratory system: in acidosis, INCREASE in respiratory rate and depth in an attempt to exhale acids 3. Kidneys: takes hours to days but controls HCO3 by either reabsorbing or excreting hydrogen ions in urine

Answer 19

pH is low High PaCO2 Normal HCO3

Answer 20

pH is low High PaCO2 High HCO3

Answer 21

pH is normal high paCO2 High HCO3

Answer 22

acute respiratory failure where alveolar capillary membrane becomes damaged and more permeable to intravascular fluid

Answer 23

correct underlying cause first, intubation, CPAP, BiPAP, O2, med: bronchodilator, corticosteroid, Lasix (remove pulmonary congestion), antibiotics if infection decrease in carbs in diet in patient who retains CO2, prevent infection \*\*assess LOC maintain HCT/HBG (maximize O2 carrying capacity of blood) pulmonary toileting to expectorate secretions monitor CV status, resp status, ABGs, EKG, lytes

Answer 24

drooling, agitation, tripod position. Do NOT use tongue depressor to examine throat – can cause bronchospasm. Airway protection, corticosteroids, antibiotics. Most dangerous for peds.

Answer 25

stridor, retractions, barking cough. Maintain airway, cool mist humidifier, nebulized epi, corticosteroids. Rest, fluids, monitor respiratory status.

Answer 26

URI symptoms, mild fever, copious secretions (TNI: suction with bulb syringe), caused by RSV. High humidity, rest, fluids, O2 if hospitalized, aerosolized ribavirin if severe. Separate room, good hand washing, contact and droplet precautions if RSV (mask within 3 feet of patient) If in mist tent, watch for hypothermia and change linens frequently (keep them dry); must be a dense fog, patient sitting up

Answer 27

Common with COPD fever, unproductive cough, rhonchi/crackles, exudates form in lung lobules. Antibiotics, O2, cool mist, fluids, rest, chest physiotherapy, antipyretics. Monitor VS, rsp status, avoid aspiration from frequent coughing, may require suctioning.

Answer 28

early identification/treatment for suspected TB cases. Airborne isolation. Negative pressure isolation with protective respirators. TB infection – latent disease. TB disease: clinically active TB. Miliary TB: standard precautions, in bloodstream but not in pulmonary system (no airborne precautions needed) Isoniazid – antitubercular. Taken for six months, issue is compliance. Hepatic studies weekly: avoid triamines/antacids within 1 hour of med, no alchohol, no aluminum based antacids, no tyramine (chocolate, cheese) with meals, antiemetic, vision changes). TB is no longer contagious after 3 negative AFBs, 2 weeks of meds, reduction of symptoms. Encourage adequate rest and nutrition, set up follow up care.

Answer 29

lack of or diminished reaction to an antigen. Common in older adults.

Answer 30

two tests done so second test may have a greater reaction, whereas a first test may have given a false negative.

Answer 31

postural draining and percussion/cupping to move secretions into central airways for expectoration. Done 1 hour before or 1-3 hours after meal Give bronchodilator 15 minutes before Watch for color changes, hypoxemia, mucous plug, Percuss over ribs only Evaluate sputum, auscultate lung sounds.

Answer 32

open tent as little as possible. Monitor temp inside tent to reduce hypothermia/cold stress. Keep child warm and dry, assess for air leaks in tent

Answer 33

to deliver a high concentration of O2 to an infant. O2 can’t blow directly on child’s face, hood shouldn’t rub on neck, head, or shoulders

Answer 34

to moisten airways, minimize fluid loss from lungs, liquefy secretions, allow for small to moderate O2 administration. Monitor respiratory status, semi-fowlers, frequent temps, empty moisture chamber when full. At least 10 mL/minute of air or O2 must be supplied at all times to prevent excessive CO2 accumulation

Answer 35

upper airway obstruction, apnea, high risk of aspiration, ineffective clearance of secretions, respiratory distress Placement confirmed with CO2 detector (if no CO2, tube is in the esophagus) Assess for bilateral breath sounds, symmetrical chest movement, monitor for tube placement every 2-4 hours Secured with hydrocolloid membrane over cheeks to protect skin. Tube secured with tape to skin. TNIs: HOB in semi fowelers unless medically contraindicated, avoid emesis (risk for aspiration), sedation, analgesic, anti-anxiety meds, provide frequent oral care to prevent VAP, provide alternative ways of communicating (picture boards, note pad, computer) inadvertent extubation: assess LOC, call for help and stay with patient, manually vent with 100% O2

Answer 36

to bypass upper airway obstructor, remove secretions, long term mechanical ventilation, permit oral intake and speech in the patient that requires long-term mechanical ventilation TNIS: humidify inspired air because normal airway humidification through nose/mouth isn’t present. Cuffed trach: for patient at risk for aspiration or on mechanical vent. Keep cuff inflated to maintain seal. Uncuffed: no risk for aspiration, no mechanical vent, can speak with uncuffed trach Inner/outer cannulas: to secure tube to faceplate, keep clean. Speaking valve (passy-muir): cuff must be deflated, allows patient to speak. Removed for sleep. Suctioning: preoxygenate with 100% O2 for 3-4 breaths, sterile technique, keep to less than 10 seconds, 2-3 times/session, suction 4-6 inches.

Answer 37

to prevent infection and occlusion of trach. Leave obturator at bedside at all times in case of accidental decannulation. Patient in semi fowelers: auscultate to see if suction needed Clean inner cannula with hydrogen peroxide, then rinse with 4X4 soaked in sterile saline. Don’t cut 4X4s. maintain position of trach retention sutures. Apply new ties before removing old ties to prevent accidental deccanulation of the trach. With tie changes, leave one fingerbreadth underneath

Answer 38

PaO2 less than 60 on 60% oxygen. ARDS, pneumonia, smoke inhalation, PE (others)

Answer 39

Asthma COPD CF

Answer 40

in normal lung, ventilation/perfusion is 1:1. With PE, the embolus limits blood flow, but has no effect on airflow to the effect on airflow to the alveoli, causing V/Q mismatch

Answer 41

sudden onset chest pain, dyspnea, hemoptysis, anxiety, tachypnea, tachycardia, LOC changes. TNIs: prevent DVTs: hydration, SCDs/TEDs, early ambulation, prophylactic anticoagulants. HOB up, IV access, continuous SaO2 monitor, telemetry, LOC monitoring, O2 therapy, ABGs, mechanical ventilation, anticoagulation therapy, medication therapy.

Answer 42

Treat underlying cause, HOB O2 therapy, continuous monitoring, possible bronchodilators, chest PT if applicable, fluids, med therapy (corticosteroid therapy), mechanical ventilation (later stages), fluids, monitor pulmonary/cardiac functioning, nutritional support with protein balance

Answer 43

bilevel positive airway pressure (higher for inspiration, lower for expiration)

Answer 44

continuous positive airway pressure

Answer 45

volume of air inspired/expired with each normal respiration

Answer 46

positive end-expiratory pressure, positive pressure applied at the end of expiration to keep alveoli open in between respirations

Answer 47

oxygen concentration. from 21% (room air) to 100%

Answer 48

DO NOT TURN OFF VENT ALARMS! Position patient for comfort and maximum alveolar ventilation, possible soft restraints to avoid accidental extubation, monitor respiratory status for any changes in respiratory effort, ABGs, continuous O2, maintain vent setting as ordered, nutritional/fluid support as ordered, provide frequent oral care, q 2-4 hours to prevent VAP (sedation vacation, high fowlers, peptic ulcer, DVT prophylaxis), suction only as needed with sterile technique, keep ambu bag connected to O2 source at all times, respond to vent alarms immediately – check the client first and then check the vent

Final Weeks 1-7.5 Flashcards

(73 cards)