Problems of Oxygenation - Part 3

Question 1

Fluctuation of fluid that occurs during respiration

Answer 1

Tidaling

Question 2

If tidaling is not occurring, what does this indicate?

Answer 2

That there is a block in the system (chest tube)

Question 3

When checking bubbling in the water compartment of the chest tube, what is normal, what is not?

Answer 3

Occasional bubbling is normal, continuous indicates air leak

Question 4

What is the purpose of milking the tubing?

Answer 4

Used to dislodge fragments of blood clots or lung tissue that are blocking the tubing

Question 5

Why should milking the tubing not be done regularly?

Answer 5

Because it increases intrapleural and intrapulmonary pressures

Question 6

Although clamping the drainage tube of a chest tube is often contraindicated, when is it appropriate?

Answer 6

Appropraite when assessing the readiness for the removal of the chest tube and when changing the drainage system

Question 7

It is best to clamp the drainage tube during _______.

Answer 7

expiration

Question 8

Clamping the drainage tube:
- if the tubing becomes unattached, it is best to try to _______ or immerse in bottle of sterile _______ to reestablish seal.

Answer 8

reattach

saline

Question 9

Removing the chest tube:

• _______ decision
• Not to be removed if > ___-____ mL of drainage daily
• the sooner the tube is removed, the faster the improvement in post-operative _____
• removal can be moderately painful so, __-_______
• One should have equipment to apply ________ dressing over the site immediately to ensure ________ does not occur

Answer 9

physician decision (although a trained nurse can remove it)
50-70mL
pain
pre-medicate
occlusive; pneumothorax

Question 10

Collection of fluid in the pleural space

Answer 10

pleural effusion

Question 11

Pleural effusion occuring in non-inflammatory connditions - CHF, chronic liver or renal disease

Answer 11

Transudative effusion (hydrothorax)

Question 12

Pleural effusion that occurs in an area of inflammation with pulmonary malignancies, pulmonary infections, pulmonary embolization and GI disease (pancreatitis)

Answer 12

Exudative effusion

Question 13

A pleural effusion containing pus

Answer 13

Empyema

Question 14

Complication of empyema, where there is a fibrous fusion of the visceral and parietal pleura

Answer 14

Fibrothorax

Question 15

Procedure done when there is too much fluid in the pleural space. This allows pleural fluid analysis to be performed in lab to figure out the cause of fluid accumulation around one or both of the lungs.

Answer 15

Thoracentesis

Question 16

Describe thoracentesis.

Answer 16

Use a large needle (with a 60mL syringe) to pull out fluid

Question 17

What is another name for thoracentesis.

Answer 17

Pleural tap

Question 18

Abnormal accumulation of fluid in the alveoli and interstitial spaces of the lungs.

Answer 18

Pulmonary edema

Question 19

What is the most common cause of pulmonary edema?

Answer 19

Left sided congestive heart failure

Question 20

Pulmonary HTN: can be primary, or secondary.

Secondary results from a complication of a ______ or ________ disorder.

Answer 20

respirator, cardiac

Question 21

Enlargement of the right side of the heart secondary to respiratory system disorders./

Answer 21

Cor pulmonale

Question 22

The most common cause of Cor pulmonary is what?

May also result from this.

Answer 22

COPD

may also result from pulmonary HTN

Question 23

IF pulmonary HTN goes unchecked, this cardiac disorder will occur.

Answer 23

CHF

Question 24

If we cannot fix cor pulmonale, the patient will go into _______.

Answer 24

arrest

Question 25

Chronic inflammatory disorder of the airway causing hyper-responsiveness and broncho-constriction.

Answer 25

Asthma

Question 26

What are the obstructive pulmonary diseases we learn about in class?

Answer 26

Asthma, COPD, CF

Question 27

Asthma is a result of environmental effects on the airway, ______, ______ and _______ agents trigger airway inflammation and airway narrowing.

Answer 27

allergens, chemicals, infectious agents

Question 28

Bronchospasm that occurs after vigorous exercise, cold or dry climate may also trigger the response.

Answer 28

Exercise-induced asthma

Question 29

What are symptoms of asthma?

Answer 29

Wheezing, breathlessness, chest tightness, cough (At night and early morning)

Question 30

What is something we can teach parents to help with their child's asthma during the winter months?

Answer 30

Cover the mouth of the child with a scarf

Question 31

Describe how the bronchioles are narrowed in asthma.

Answer 31

Inflammatory response narrows the lumen, and mucus further occludes it.

Question 32

Looks at the literature on a specific topic and an expert panel uses the information to inform practice

Answer 32

Cochrane review

Question 33

What is the most common drug that may trigger asthma response in children?

Answer 33

Asparin (may cause Reye's syndrome and asthma in kids)

Question 34

What do we give instead of aspirin to a feverish child?

Answer 34

Tylenol

Question 35

What dyes may cause allergic reaction in certain individuals?

Answer 35

Blue 1, Red 40, yellow 5 and yellow 6

Question 36

Which dyes are the most notorious for triggering asthmatic responses?

Answer 36

Yellow 5 (and 6)

Question 37

These internal triggers may trigger asthmatic response.

Answer 37

GERD and emotional stress

Question 38

Asthma treatment: - Limit exposure to ______ - Educate patients and family - Drugs - which ones? - continuous asssessment of asthma control and severity - Have an action plan - Regular follow up with HCPs

Answer 38

triggers Drugs - short-acting B2-agonist inhaled bronchodilators (e.g. salbutamol, terbutaline) - inhaled or oral corticosteroids

Question 39

Why is the patient's mouth rinsed after steroid inhalation?

Answer 39

To prevent oropharyngeal candidiasis

Question 40

What would an action plan entail for an person with asthma?

Answer 40

Having an epipen ready if the temperature drops, warm up the child Want to stress having a plan to the patient

Question 41

What is given first for asthma treatment, the bronchodilators or corticosteroids?

Answer 41

B before C | bronchodilators before corticosteroids

Question 42

How does one know if the bronchodilator canister is full?

Answer 42

Sumerge it in water - if it sinks it is full, if it floats it is empty

Question 43

What is the purpose of shaking the canister?

Answer 43

Evenly distributes the medication

Question 44

What is the person's mouth washed with after corticosteroid inhalation?

Answer 44

diluted mouthwash or water

Question 45

When using an inhaler, where should it be positioned? | In what cases would this not be possible? What is done?

Answer 45

4cm or 2 inches away from mouth For some patients with respiratory decline, will have to put mouth over inhaler or use a spacer

Question 46

If a patient will have a second puff, how long should they wait before taking the other?

Answer 46

1-2 minutes

Question 47

Describe the steps for teaching a client to use an inhaler.

Answer 47

Shake inhaler vigorously Discharge a dose if inhaler has not been used in last 24 hr. Breathe out to end of normal breath Position inhaler 4 cm from mouth Open mouth, tilt head slightly back, at the same time as you start to breathe in depress the inhaler Continue breathing in for about 5 sec, hold for 8-10 sec, then breathe out. Wait 1-2 min in between puffs Oral rinse pc steroid inhaler to avoid oropharyngeal candida

Question 48

Describe the tongue position when using an aero chamber spacer

Answer 48

keep tongue down and relaxed

Question 49

What are the causes of COPD?

Answer 49

smoking (number one cause), reoccuring RTI, heredity and aging

Question 50

What are the cardinal symptoms of COPD?

Answer 50

SOB and limitations in activity

Question 51

Hyperinflation of alveoli, destruction of alveolar walls and capillary walls, narrowed, tortuous, small airways and loss of lung elasticity, Barrel-chest due to alveolar distension

Answer 51

Emphysema

Question 52

Excessive production of mucus in the bronchi, recurrent persistent cough

Answer 52

Chronic bronchitis

Question 53

A person with emphysema will have oxygen at what frequency?

Answer 53

24 hours a day

Question 54

What is the mainstay of treatment for COPD?

Answer 54

Bronchodilators and steroids

Question 55

Why are COPD patients given drugs before their meals?

Answer 55

Makes eating less labourous and makes eating more successful

Question 56

What vaccines are given to COPD patients? Describe hydration goals for these patients. Describe O2 therapy for these individuals.

Answer 56

Flu and pneumovax vaccines Try for 3L per day to thin secretions Use lowest flow rate for oxygen therapy

Question 57

Describe the physical exercise plan for COPD patients. | What do we implore patients stop doing?

Answer 57

provide exercises that are doable - e.g. walking | stop smoking

Question 58

What are some patient and family teaching we provide centered around COPD?

Answer 58

Huff coughing, small frequent meals, rest periods, take meds before meals and exercise, energy conserving strategies (e.g. sitting while doing tasks)

Question 59

What does CPAP stand for? IPAP?

Answer 59

Continuous positive airway pressure | inspiratory positive airway pressure

Question 60

Respiratory ventilation used primarily in the treatment of sleep apnea and for those critically ill in hospital with respiratory failure, and with neonates

Answer 60

PAP - positive airway pressure

Question 61

How does IPAP help?

Answer 61

Decreases work done by respiratory muscles | bronchioles and alveoli are prevented from collapsing at the end of expiration

Question 62

Autosomal recessive, multi-system disease of endocrine glands involving primarily the lungs, pancreas and sweat glands. It causes abnormally thick, abundant secretions from mucus glands which can lead to obstructive pulmonary disorder.

Answer 62

CF

Question 63

CF genetics? Carrier rate? Found in what proportion of births? Most children diagnosed by?

Answer 63

autosomal recessive 1:25 carrier rate 1:300 live births (1:2000 on slide) Most diagnosed by age 2

Question 64

What are parents of CF children taught to do as a treatment?

Answer 64

Postural drainage - feet higher than head, drain mucus out of lungs - also use clapping back and anterior chest to help move secretions Also taught how to suction mucus out

Question 65

What machines are used in CF treatment?

Answer 65

PEP - positive expiratory pressure breathing machines

Question 66

What type of drugs are CF patients on?

Answer 66

Bronchodilators, steroids, antibiotics (prophylactically) and handfuls of pancreatic enzymes (digest mucus) vitamins as well due to malabsorption

Question 67

Why does a lung transplant not cure a patient?

Answer 67

There are still sweat gland and GI issues

Question 68

worn over the chest, vest is attached to an air generator that inflates and deflates the vest very quickly. This motion vibrates the chest and loosens mucus.

Answer 68

Vibrating vest for CF treatment