Respiratory - Ch 21

Question 1

Hypoxemic hypoxia

Answer 1

Decreased O2 level in blood due to decreased oxygen perfusion

Question 2

Hypoxemic hypoxia

Causes

Answer 2

Hypoventilation, high altitude, ventilation-perfusion mismatch, atelactasis

Question 3

Hypoxemic hypoxia

Treatment

Answer 3

Increase alveolar ventilation by providing supplemental oxygen

Question 4

Circulatory hypoxia

Answer 4

Results from inadequate capillary circulation

Question 5

Circulatory hypoxia

Causes

Answer 5

Decreased CO, local vascular obstruction, low-flow states (shock, cardiac arrest)

Question 6

Anemic hypoxia

Answer 6

Result of decreased effective hgb concentration —> decrease in oxygen-carrying capacity of blood

Question 7

Anemic hypoxia

Causes

Answer 7

Carbon monoxide poisoning

Question 8

Histotoxic hypoxia

Answer 8

Occurs when toxic substance (cyanide) interferes w/ability of tissues to use available O2 —> reduction in ATP production

Question 9

Oxygen toxicity

Cause

Answer 9

Too high concentration of O2 (50% or higher) for extended period of time

Question 10

Oxygen toxicity

S/S

Answer 10

Substernal discomfort, paresthesias, dyspnea, restlessness, fatigue, malaise, progressive respiratory difficulty, refractory hypoxemia, alveolar atelactasis, alveolar infiltrates on XR

Question 11

Nasal cannula

Flow rates

Answer 11

1-6 L/min

Question 12

Nasal cannula

O2 % settings

Answer 12

24-44%

Question 13

Nasal catheter

Flow rate

Answer 13

1-6 L/min

Question 14

Nasal catheter

O2 % setting

Answer 14

24-44

Question 15

Mask, simple

Flow rate

Answer 15

5-8 L/min

Question 16

Mask, simple

O2 % setting

Answer 16

40-60

Question 17

Mask, partial rebreathing

Flow rate

Answer 17

8-11

Question 18

Mask, partial rebreathing

O2 % setting

Answer 18

50-75%

Question 19

Mask, non-rebreathing

Flow rate

Answer 19

10-15

Question 20

Mask, non-rebreathing

O2 % settings

Answer 20

80-95

Question 21

Mask, Venturi

Flow rate

Answer 21

4-8

Question 22

Mask, Venturi

O2 % setting

Answer 22

24, 26, 28, 30, 35, 40

Question 23

Tracheal catheter

Flow rate

Answer 23

1/4-4

Question 24

Tracheal catheter

O2 % setting

Answer 24

60-100

Question 25

How to use IS

Answer 25

1. Semi-Fowler’s position 2. Diaphragmatic breathing 3. Place mouthpiece firmly in mouth, breathing in slowly through mouth, hold breath for 3 sec, exhale slowly through mouthpiece 4. Cough during & after each session, splint incision if coughing postop 5. Perform procedure 10x/hr while awake

Question 26

Mini-nebulizer therapy | Indication

Answer 26

Difficulty clearing secretions, reduced vital capacity, unsuccessful with simpler methods

Question 27

Postural drainage position | Anterior lower lobes, basal segments

Answer 27

Right side lying w/2 pillows under hip

Question 28

Postural drainage position | Anterior upper lobes

Answer 28

On back w/2 pillows under butt

Question 29

Postural drainage position | Anterior lower lobes w/lateral basal segments

Answer 29

L side lying on 2 pillows under hip

Question 30

Postural drainage position | Anterior upper lobes, apical segments

Answer 30

Semi-Fowler’s w/pillows behind back

Question 31

Postural drainage position | Posterior lower lobes, superior segments

Answer 31

Prone w/2 pillows under hips

Question 32

Postural drainage position | Posterior upper lobes, posterior segments

Answer 32

Sitting up, leaning slightly forward, holding pillow against stomach

Question 33

HFCWO

Answer 33

High-frequency chest wall oscillation | Type of percussion/vibration to break up secretions

Question 34

ET intubation | Nursing interventions

Answer 34

- Check symmetry of chest expansion, auscultate breath sounds - Obtain capnography & end-tital CO2 - CXR to ensure proper tube placement - Check cuff Q6-8 hrs - Monitor for S/S of aspiration - Ensure high-humidity (visible mist should appear in T piece) - Admin O2 as RX’d - Oral hygiene & oropharynx suction

Question 35

Indications for mechanical ventilation

Answer 35

Labs: PaO2 <55, PaCO2 >50, pH <7.32, vital capacity <10, negative inspiratory force <25, FEV1 <10 S/S: apnea/bradypnea, respiratory distress w/confusion, increased work of breathing not relieved by other interventions, circulatory shock, controlled hyperventilation (patient w/TBI)

Question 36

Positive-pressure ventilators

Answer 36

Inflate lungs by exerting positive pressure on airway, pushing air in, and forcing alveoli to expand during inspiration Volume-cycled ventilators, pressure-cycled ventilators, high-frequency oscillatory ventilators, noninvasive positive-pressure ventilation

Question 37

Volume-cycled ventilator

Answer 37

Deliver a preset vol of air w/each inspiration

Question 38

Pressure-cycled ventilator

Answer 38

Delivers a flow of air (inspiration) until it reaches a preset pressure and then cycles off, expiration occurs

Question 39

High-frequency oscillatory support ventilators

Answer 39

Deliver very high respiratory rates (180-900 breaths/min) that are accompanied by low tidal volumes & high airway pressures Used to open alveoli in situations with closed airways —> atelectasis & ARDS

Question 40

Non-invasive positive-pressure ventilation

Answer 40

Given via facial mask/cannula/oral airway device For patients that can breathe on their own but need a little help, provides backup care for pts with periods of apnea CPAP, BiPAP, PEEP

Question 41

Interventions to prevent VAP

Answer 41

- Elevation of bed 30-45 - Daily “sedation vacations” and assessment of readiness to extubate - Peptic ulcer disease prophylaxis - DVT prophylaxis - Daily oral care with chlorhexidine (0.12% oral rinses)

Question 42

Controlled mechanical ventilation (CMV)

Answer 42

Provides full ventilatory support by delivering preset tidal vol and respiratory rate

Question 43

Intermittent mechanical ventilation (IMV)

Answer 43

Combination of mechanically assisted breaths and spontaneous breaths

Question 44

Synchronized intermittent mandatory vent (SIMV)

Answer 44

Delivers a preset tidal vol and # of breaths per min. B/t ventilator-delivered breaths, patient can breathe spontaneously w/no assistance from vent on those extra breaths

Question 45

Gas exchange | Nursing interventions

Answer 45

- Use of analgesics to relieve pain w/o suppressing respiratory drive - Frequent repositioning - Monitor fluid balance: peripheral edema, I&O, daily weight - Admin meds to control primary disease

Question 46

Effective airway clearance | Nursing interventions

Answer 46

- Assess lung sounds Q2-4 hrs - Measures to clear airway: suction, CPT, positioning, promote increased mobility - Humidification of airway - Admin meds

Question 47

Trauma & infection | Nursing interventions

Answer 47

- Infection control measures - Tube care - Cuff management - Oral care - Elevation of head of bed

Question 48

Potential complications for mechanical vent

Answer 48

- Alterations in cardiac function - Barotrauma, pneumothorax - Pulmonary infection - Delirium

Question 49

Weaning criteria

Answer 49

- Vital capacity 10-15 - Maximum inspiratory pressure (MIP) at least -20 - Tidal volume 7-9 - Minute ventilation 6L/min - Rapid/shallow breathing index: below 100 breaths/min, PaO2 >60, FiO2 <40%

Question 50

Criteria to terminate weaning process

Answer 50

- HR increase of 20 bpm, systolic BP increase of 20 - Decrease in SpO2 <90%, RR <8 or >20 - Ventricular dysrhythmias - Fatigue, panic, cyanosis, erratic/labored breathing, paradoxical chest movement

Question 51

How often should nurse monitor chest tube drainage? What should be documented?

Answer 51

-Q2hrs, document amt & character

Question 52

When to notify HCP of chest tube drainage

Answer 52

> 150 mL/hr