Oxygenation & Perfusion

Question 1

Arrhythmia

Answer 1

No heart rhythm

Question 2

Dysrhythimia

A FIB– atrium does not have contractile force

Answer 2

If symptomatic –> SOB
Chest Pain
Check for clotting

Question 3

Why more worried about V- fib?

Answer 3

Blood pressure is decreased, less blood to lungs and body

Question 4

What organ is responsible for gas exchange in the body?

Answer 4

Alveoli

Question 5

What is myocardial ischemia?

Answer 5

Lack of blood flow to heart –> turns off nutrition to heart –> tissues dying
Interventions: get to cath lab as fast as can to decrease tissue loss and scar tissue formation

Question 6

What is angina?

Answer 6

Chest pain.
Men- present with chest pain and SOB
Women- presents differently, maybe not pain

Question 7

Why is retaining fluid a problem in heart failure?

Answer 7

Heart isn’t pumping it out

Question 8

What needs effect cardiopulmonary?

Answer 8

Blood thinners

Inhalers

Question 9

What factors are different in infants?

Answer 9

Airways short
RR = rapid and abdominal. (36)
Crackles normal
Landmarks less prominent

Question 10

Respiratory function in older adult

Answer 10

Bonylandmarks less prominent
Kyphosis
Barrel chest
Tissues and airways more rigid
Increased risk for disease esp. Pneumonia (from decreased pneumonia

Question 11

Vesicular Breath Sounds
Bronchial
Bronchiovesicular

Answer 11

Low-pitched, soft sounds during expiration

B: High pitched and longer. Over trachea

Bronchioles ocular: upper anterior chest

Question 12

Difference between crackles and wheezes

Answer 12

Crackles = fluid. Inhalation

Wheezes= expiration from constriction of airway

Question 13

To promote comfort in Resp patients

Answer 13

Position- full fowler so
Maintain fluid intake--> thins out mucus
Good nutrition
Pacing physical activities --> 
Humidified air --> less dry and irritating

Question 14

Metered dose inhaler

Answer 14

Gives certain dose of medicine each puff

Question 15

Types of artificial airways

Answer 15

Oropharyngeal
Nasopharyngeal
Endotracheal- 
Tracheostomy- for long term vent patients 
 -cuff less & cuffed

Question 16

What is the process of ventilation?

Answer 16

Movement of air in and out

• active inspiration (diaphragm contracts and descends –> lengthens cavity –> increases lung volume –> decreases lung pressure –> air goes to lower pressure from outside lungs)
• passive expiration (diaphragm retracts, pressure increases)

Question 17

What is respiration vs internal respiration?

Answer 17

Resp: Process of gas exchange. O2 in –> CO2 out via diffusion

Internal: exchange in circulating blood and tissue cells
Os to Toes

Question 18

Hypoxemia

Answer 18

Deficiency of O2 in blood (usually from decreased respiration)

Question 19

Hypercapnia

Answer 19

Excess Co2 in blood

• exhilaration
• decreased respiration

Question 20

What can amuse alveolar hypo ventilation

Answer 20

Spinal cord dysfunction (MS, ALS, Injury)
Respiratiory Dysfunction (CNS depression)
Upper airway structural problems (obstructions or swelling)
Lower airway structural problems (ribs, obesity, emphysema/asthma)

Question 21

What causes Ventilation and Perfusion mismatching? (V/Q)
Ex breathing fine but alveoli not working
Either blood flow is limited or blocked but airway is proficient
Air flow block but blood flow fine

Answer 21

Pulmonary edema- fluid accumulates in alveoli
Atelectasis (collapse of lung –> won’t get air to blood)
Pneumonia– lungs filled with puss, alveoli can’t work well
COPD- alveoli not working
Asthma -

Question 22

Diagnostic Tests * LOOK UP*

Answer 22

Chest X-Ray
 Bronchoscopy 
Chest CT 
Spiral chest CT
V/Q scan

Question 23

What are clinical manifestations of

Answer 23

Restlessness
Agitation
Confusion
Impaired judgement
Tachycardia
Bounding pulse 
HTN
Dysrhythmias 
Cool clammy skin
Active accessory muscles/ 
Cyanosis

Question 24

A nurse caring for a patient with COPD knows that hypoxia may occur in patients with respiratory problems. what are the signs of this serious condition?

Answer 24

Dyspnea (difficulty breathing)
Small pulse pressure with elevated BP
pallor
Cyanosis
increased pulse rate
increased respiratory rate

• hypoxia may occur from problems with ventilation, respiration, or perfusion
• inadequate amount of oxygen is available to cells

Question 25

What condition would a nurse anticipate the need for a nasal trumpet while suctioning the Nasopharyngeal airway of a patient to maintain patency?

Answer 25

Epistaxis (nose bleed) | nasal tumpets protet the nasal mucosa from further trauma related to suctioning. epistaxis is a sign

Question 26

a nurse is inserting an oropharyngeal airway for a pt who vomits when it is inserted. what action would be the first that should be taken?

Answer 26

immediately position the patient on his or her side to prevent aspiration, 2. remove the oral airway 3. suction the mouth if needed

Question 27

a nurse is choosing a catheter to use to suction a pt endotracheal tube via na open system. which variable does the nurse base the size of the catheter?

Answer 27

base the size of suctioning catheter on the size of the endotracheal tube. external diameter of the catheter should not exceed half the internal diameter of ednotracheal tube. larger catheters can contribute to trauma and hypoxemia

Question 28

16 yr old male hopitalizedfor an acute asthma exacerbation. which methods might the nurse use to measure the patients Oxygen saturation?

Answer 28

pulse oximetry- obtain baseline information about the patients oxygen saturation level Peak expiratory flow rate (PEFR)- used for asthma spirometry- monitor health status of pt with respiratory disorders

Question 29

PT with COPD cannot complete ADLs. what nursing diagnosis describes alteration in oxygenation as etiology?

Answer 29

Fatigue r/t impaired oxygen transport system.

Question 30

what measures of teaching would nurse recommend to pt in long term care facility with asthma & COPD

Answer 30

reduce anxiety eat a high-protein/ high calorie diet maintain a high-Fowlers position when possible --> most comfortable for people with dyspnea and orthopnea meals taken 1-2 hours after breathing treatments and exercises drink 2-3 quarts of clear fluids daily pace physical activities and schedule frequent rest periods to conserve energy

Question 31

what position would be best for postural drainage of right lobe of lung?

Answer 31

lying on the left side with a pillow under the chest wall t. high fowlers to drain apical sections of upper lobes trendelenburg to drain lower lobes posterior section of upper lobes-- lying half on the abdomen and half on the side.

Question 32

meter dosed inhaler

Answer 32

continue to inhale when the cold propellant is in throat only inhale one spray with one breath active the device while continuing to inhale

Question 33

what should a nurse expect with a patient recieving oxygen through a nasal cannula with chronic lung disease?

Answer 33

rate is no more than 2-3 L min because it may destroy the hypoxic drive that stimulates repsirations. o2 delivered at low rates doesnt not always have to be humidified arteriol blood gases are not required at regular intervals to determine the flow rate

Question 34

What action would a nurse take if pts endotracheal tube changes depth during retaping.

Answer 34

remove the tape and djust the depth to the ordered depth and reapply tape *should be maintained at the same level unless ordered by the physician

Question 35

What is safe technique when using a portable oxygen cylinder

Answer 35

check the cylinder befroe using to ensure enough oxygen is available for the patient. should not be 500 psi or less --> not enough oxygen reamins for a patient transfer -if not secured properly --> may injusre patient -o2 flow is discontinued by turning the valve clockwise until tight

Question 36

What would be the first action if a pt chest tube has become sparated from the drainage device

Answer 36

put on gloves, put in sterile saline or water - creates a water seal until new draiage unit can be attached - THEN assess vital signs and notify physician

Question 37

How to use manual resuscitation bag

Answer 37

tilt pts head back, pull jaw forward, airway clear, mask held tightly over the patients nose and mouth -compress at a rate that approximates normal respiratory rate

Question 38

what interventions does a nurse perform while tracheal suctioning?

Answer 38

- assess patient before, during, and after the procedure - hyperoxygenate before and after suctioning - limit application to 10-20 seconds - take pulse frequently to detect effects of hypoxia and stimulation of vagus nerve - suction pressure 80-150 mm Hg (prevents atelectasis) - insert no further than 1cm past the length of the tracheal tube

Question 39

what are risks associated with traceal suctioning?

Answer 39

``` hypoxia infection tracheal tissue/mucosa damage dysrhythmias atelectasis loss of cilia edema, fibrosis in trach ```

Question 40

What factors are essential to normal functioning of respiratory system?

Answer 40

- integrity of airways system (air to and from lungs) - functioning alvelolar system (oxygenates venous blood & removes CO2 from blood) - functioning cardiovascular and hematologic systems(carry nutrients and wastes to and from body cells)

Question 41

what factors influence diffusion of gases in lungs?

Answer 41

surface area available thickness of alveolar-capillary membrane partial pressures solubility and molecular weight of gas

Question 42

what makes the right lung easier to intubate?

Answer 42

it has 3 lobes

Question 43

what happens in lower airway?

Answer 43

production of pulmonary surfactant | muco cilliary clearance