oxygen

Question 1

what is impaired gas exchange

Answer 1

high altitudes
hypoventilation altered oxygen carrying capacity from blood
reduced hemoglobin
pt who smokes
pulmonary issues prolonged periods of immobility
chest and upper abdominal incisions at risk

Question 2

what is ineffective airway clearance

Answer 2

acute (post op)
chronic (CVA or spinal injury)
older adults with increased incident of emphysema and chronic cough/sputum

s/s:
abnormal RR/rhythm/depth
dyspnea
cyanosis

Question 3

what is ineffective breathing pattern

Answer 3

abdominal wall during inhalation and expiration, do not maintain optimum ventilation
causes HF hypoxia
diaphragmatic paralysis
trauma
surgery airway obstruction

Question 4

what are adventitious lung sounds

Answer 4

abnormal breath sounds

Question 5

COPD

Answer 5

progressive disorder that alters structure of respiratory system over time
irreversible but manageable
repeated exacerbations

s/s:
dyspnea, sputum production, chronic bronchitis, emphysema
80% due to cigarette smoking
barrel chest, diminished breath sounds, sputum, pursed lip breathing/clubbing

Question 6

alterations

Answer 6

cystic fibrosis
pneumonia
respiratory syncytial virus (RSV)
bronchiolitis
acute respiratory distress syndrome (ARDS)
sudden infant death syndrom

Question 7

barrel chest

Answer 7

chronic emphysema

Question 8

pigeon chest

Answer 8

forward protrusion of chest

Question 9

funnel chest

Answer 9

sunken sternum and adjacent cartilages

Question 10

pnuemothorax

Answer 10

air entry into plueral space

Question 11

lung collapses

Answer 11

manifestations:
sudden pleuritic pain worsened by breathing, coughing
decreasing absent breath sounds over affected side
asymmetrical chest wall movement
SOB
cyanosis

treatment: chest tube

Question 12

asthma

Answer 12

inflammation of the lung characterized by recurrent episodes by difficulty breathing SOB, wheezing, chest tightening - pressure, coughing

s/s:
tachypnea, tachycardia, anxiety, apprehension
mild brief period may resolve spontaneously

Question 13

asthma triggers

Answer 13

common allergens
exercise
cold/hot air
viral infections
stress
genetic factors
air pollution
allergies
pets
smoking

Question 14

diagnostic tests for asthma

Answer 14

peak expiratory flow reading
allergy testing
ABGs
prevent/control symptoms
pulmonary function test
chest x-ray
CO2 and O2 saturation monitor
reduce frequency and severity of exacerbation

Question 15

asthma treatment

Answer 15

metered dose inhaler
nebulizer
bronchodilators
avoid beta blockers = causes bronchospasm
ex. atenolol and NSIDS (Ibuprofen)

Question 16

nasal cannula

Answer 16

1 -6 L/min
greater than 3 humidify

Question 17

simple face mask

Answer 17

5 - 10 L/min
40 - 60%
mouth breathers

Question 18

partial rebreather

Answer 18

6 - 15 L/min
70 - 100%

Question 19

venturi mask

Answer 19

24 - 50%

Question 20

other oxygen devices

Answer 20

trach collar
T-piece
ventilators

Question 21

room air

Answer 21

21%

Question 22

conversational dyspnea

Answer 22

trouble when talking
keeping conversation

Question 23

paroxysmal noctural dyspnea

Answer 23

trouble breathing at night

Question 24

orthophea

Answer 24

difficulty breathing while lying down

Question 25

apnea

Answer 25

absence of breathing requires immediate CPR

Question 26

Cheyne-Stokes

Answer 26

gradual increase in depth followed by decrease in depth then period of apnea

Question 27

biot's

Answer 27

irregular, shallow alternating apnea damage to respiratory center

Question 28

kussmaul

Answer 28

regular but increased rate and abnormally deep may be caused by fear, anxiety, panic, metabolic disorder

Question 29

bradypnea

Answer 29

slow breaths < 10 per min

Question 30

tachypnea

Answer 30

fast and shallow > 24 per min

Question 31

eupnea

Answer 31

normal breathing 12 - 20 per min

Question 32

tridor

Answer 32

high pitched, with narrowing

Question 33

crackles

Answer 33

popping - high pitched

Question 34

rhonchi

Answer 34

coarse - low pitched

Question 35

wheezing

Answer 35

high pitched whistling

Question 36

plural friction rub

Answer 36

low pitched crackles

Question 37

bronchial

Answer 37

loud high pitched sounds over trachea longer on exhalation than inhalation

Question 38

broncho vesicular

Answer 38

soft low pitched sounds peripheral lung field ventilation: inhaling and exhaling air through lungs to make adequate oxygen in alveoli

Question 39

alveoli

Answer 39

tiny air sacs thin walls of capillaries where oxygen and CO2 pass back and forth produces surfactant

Question 40

surfactant

Answer 40

lipoprotein lowers surface tension and allows then to inflate while breathing specialized cells prevents collapse and stick alevoli collapse = affect ventilation (RR/depth) hypo vs hyper

Question 41

peak flow monitoring

Answer 41

measures the amount of air that can be exhaled with forcible effort asthma pt use to monitor subtle changes L/min

Question 42

green

Answer 42

all clear

Question 43

yellow

Answer 43

20 - 50% reduction increase maintenance meds rescue bronchodilators call DR

Question 44

red

Answer 44

< 50% baseline reduce bronchodilators immediate treatment - emergency care

Question 45

interventions for pt with respiratory distress

Answer 45

administer respiration medication provide oxygen promote optimal respiration function stop smoking high fowlers spirometer aspiration monitor activity tolerance

Question 46

Beta 2 Agonist

Answer 46

"-buterol" brutal asthma attacks albuterol amps the body first drug in asthma attacks increases airflow and increase flow in the heart = rapid heart rate SE: tachycardia, palpitations, tremor, toss/turn @ night, difficulty sleeping teaching: avoid beta blockers and NSAIDS 2 - 4 puffs/20 min 3 Xs - notify HCP post if effective: decreases RR, O2 @ 90% or more

Question 47

anticholinergics

Answer 47

"tropium" itratropium / tiotropium moderate to severe asthma COPD 2nd drug in asthma attack anticholinergics, antisecretion, acetycholine SE: dry mouth, hoarseness pt who can't see, pee, shit, or spit do not give

Question 48

methylaxthines

Answer 48

"-phylline" theophyline caffeine = HR toxic if more than 20 mcg/mL toxic clonic seizures 1st priority SE: anorexia, insomnia, tachycardia, dsyrthmias, alert HCP of tachycardia by next dose teach: take in M, avoid beta blockers b/c HR decreases - atenolol, NSAIDS, naproxen/ibuprofen, decrease HR; stop before cardiac stress test, avoid caffeine

Question 49

2 drugs that increase toxic risk

Answer 49

cimetidine (H2 blocker) = heart burn ciprofloxin (ABX) do not give tropium to pt who can't see, pee, shit, spit