Respiratory

Question 1

pre-procedure for thoracentesis you need ___ and baseline ____

Answer 1

CXR

VS

Question 2

position for thoracentesis

Answer 2

sitting up leaning over bedside table

Question 3

if they can’t sit up what position for thoracentesis

Answer 3

lie on unaffected side with HOB at 45 degrees

Question 4

since you are removing fluid with a thoracentesis you may put the client into a fluid volume ____

Answer 4

deficit

Question 5

post procedure for thoracentesis

Answer 5

another CXR

Question 6

if a chest tube is placed in the upper anterior chest it is for the removal of ____

Answer 6

air

Question 7

if the chest tube is placed laterally in the lower chest then it is for the removal of _____

Answer 7

fluids

Question 8

3 chambers of the chest tube drainage system

Answer 8

drainage collection chamber
water seal chamber
suction control chamber

Question 9

you will see ____ in the water seal chamber

Answer 9

tidaling

Question 10

you want to see what in the suction control chamber

Answer 10

slow gentle continuous bubbling

Question 11

record drainage from a chest tube every hour for ___ hrs and then every ____ hrs

Answer 11

24 hrs

8hrs

Question 12

notify dr when there is ____ ml of drainage from chest tube in one hour

Answer 12

100

Question 13

who can transfer a client with a chest tube?

Answer 13

RN

LPN

Question 14

tidaling (fluctuations) will stop when what has occurred?

Answer 14

lung re-expansion

Question 15

what do you do if the tubing becomes disconnected?

Answer 15

another sterile connector at bedside

reconnect dirty one as fast as you can

Question 16

the water seal chamber has ___ml of water in it

Answer 16

2

Question 17

what if the chest tube is accidentally pulled out

Answer 17

occlusive dressing on 3 sides

Question 18

when is bubbling a problem?

Answer 18

if there is continuous bubbling in the water seal chamber

Question 19

how do you remove a chest tube?

Answer 19

have client take a deep breath and hold and place an occlusive dressing over the site

Question 20

sx of hemo/pneumothorax

Answer 20

SOB
increased HR
diminished breath sounds
less movement on affected side
chest pain
cough

Question 21

treatment for hemo/pneumothorax

Answer 21

thoracentesis
chest tubes
daily CXR

Question 22

if a pneumothorax is present and the client has a chest tube, what type of bubbling would be expected in the water seal chamber?

Answer 22

intermittent bubbling

Question 23

causes of tension pneumothorax

Answer 23

trauma
PEEP
clamping a chest tube
taping all 4 sides

Question 24

pressure has built up in the chest/pneural space and has collapsed the lung

pressure pushes everything to the opposite side

Answer 24

tension pneumothorax

Question 25

sx of tension pneumothorax

Answer 25

subQ emphysema absence of breath on one side asymmetry of thorax resp. distress

Question 26

treatment of tension pneumothorax

Answer 26

large bore needle is place into 2nd intercostal space

Question 27

opening through the chest allows air into the pleural space

Answer 27

open pneumothorax

Question 28

tx of open pneumothorax

Answer 28

valsava 3 sided petroleum gauze sit client up

Question 29

most common injuries from chest trauma

Answer 29

rib and sternum fracture

Question 30

sx of rib and sternum fractures

Answer 30

pain and tenderness crepitus shallow respirations respiratory acidosis

Question 31

treatment of rib and sternum fractures

Answer 31

non-narcotic analgesics nerve block support injured area with hands no chest binders

Question 32

flail chest occurs with multiple ___ fractures

Answer 32

rib

Question 33

sx of flail chest

Answer 33

pain paradoxical chest wall movement dyspnea increased pulse

Question 34

treatment of flail chest

Answer 34

stabilize area intubate ventilate (PEEP, CPAP, and BiPAP)

Question 35

with PEEP, the client is on the ____

Answer 35

vent

Question 36

on end expiration, the vent exerts pressure down into the lungs to keep the ____ open

Answer 36

alveoli

Question 37

the classic reason to use PEEP is for?

Answer 37

ARDS

Question 38

causes of pulmonary embolism

Answer 38

``` dehydration venous stasis BC pills clotting disorders A. fib ```

Question 39

sx of pulmonary embolism

Answer 39

``` hypoxemia SOB increased D-dimer positive VQ scan a positive CT ```

Question 40

treatment for pulmonary embolism

Answer 40

prevent oxygen ABGs decrease pain

Question 41

what are the common anticoagulant drugs?

Answer 41

heparin warfarin enoxaparin

Question 42

normal aPTT

Answer 42

30-40 seconds

Question 43

normal PT

Answer 43

11-12.5 seconds

Question 44

therapeutic INR

Answer 44

2-3