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Adult Health 2 > Respiratory Tract Disorders > Flashcards

Respiratory Tract Disorders Flashcards

1
Q

Tracheostomy

A

a surgical procedure to create an opening through the neck into the trachea

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2
Q

Why would a tracheostomy be performed?

A
  • remove excessive thick secretions
  • long-term mechanical ventilation (longer than 2 wks)
  • prevention of aspiration (unconscious, paralysis)
  • bypass obstruction of upper airway
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3
Q

3 Parts of a Trach Tube

A
  • obturator
  • outer canal
  • inner canal
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4
Q

What are the 3 types of trach tubes?

A
  • cuffed
  • uncuffed
  • fenestrated
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5
Q

Cuffed Trach Tube

A

seals the airway to prevent air from escaping through the nose and mouth

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6
Q

What type of tube allows talking when the end is covered?

A

uncuffed trach tube

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7
Q

Fenestrated Trach Tube

A

front of tube can be blocked to allow air to flow upwards to upper part of the trachea and larynx

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8
Q

Where can a tracheostomy be performed?

A

in the OR or at the bedside in critical care setting

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9
Q

What are the nursing responsibilities if a trach is placed at the bedside?

A
  • call respiratory therapy
  • record vitals
  • ensure existing IV is patent
  • assess bedside suction
  • position patient supine
  • administer analgesia/sedation
  • emergency equipment nearby (bag-valve mask)
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10
Q

Nursing Objectives after Trach is placed

A
  • keep patient calm
  • supply means for communication
  • prevent infection
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11
Q

How often should the trach be cleaned?

A

q 8 hours

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12
Q

What type of technique is used for cleaning a trach?

A

Sterile technique

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13
Q

Trach Care

A
  • inform patient/fam about procedure
  • hand hygiene
  • gather equipment, position patient, don PPE, set up equipment
  • don sterile gloves
  • unlock and remove inner cannula; place in sterile saline, cleanse, rinse, reinsert
  • cleanse stoma
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14
Q

Suctioning Trach

A
  • explain procedure
  • hand hygiene
  • connect suction catheter to tubing w/ nondominant hand (becomes nonsterile)
  • suctioning is done using sterile glove
  • hyper-oxygenate patient
  • DO NOT suction going in
  • remove catheter over 10-15 secs w/ circular motion
  • wait at least 1 min before going again
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15
Q

When is the greatest risk for accidental dislodgment of trach?

A

1st 5 days

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16
Q

What to do if Accidental Dislodgment Occurs

A
  • immediately call for help
  • spread the opening w/ a hemostat, insert replacement tube w/ obturator, remove obturator
  • or insert suction catheter to allow passage of air and guide insertion of replacement tube
  • ALWAYS keep extra tube of same size and original obturator at bedside
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17
Q

What to do is tube CAN NOT be replaced

A
  • assess levels of respiratory distress
  • position patient semi-fowlers position
  • severe distress may progress to respiratory arrest
  • cover stoma w/ sterile dressing and ventilate with bag valve mask until help arrives
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18
Q

You should always have second trach placed where?

A

Taped to the head of the bed

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19
Q

Speaking Valve/Passy-Muir Valve (PMV)

A
  • thin diaphragm that opens on inspiration and closes on expiration
  • air flows over vocal cords during exhalation
  • cuff must be deflated or use cuffless tube
  • evaluate ability to tolerate
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20
Q

Pleural Effusion

A

collection of fluid in the pleural space

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21
Q

How much humidification do you want for inspired air?

A

100%

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22
Q

When the fluid is pus what is a pleural effusion known as?

A

empyema

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23
Q

S/S of Pleural Effusion

A
  • fever/chills
  • chest pain (pleuritic) with inspiration/expiration
  • dyspnea
  • cough
  • diminished/absent breath sounds
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24
Q

How can a pleural effusion be diagnosed?

A
  • Chest x-ray
  • CT scan
  • thoracentesis to obtain fluid for culture
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25
Q

Nursing Role for Thoracentesis

A
  • position patient
  • provide support/keep calm
  • order lab
  • monitory respiratory status
  • document patient tolerance
  • administer antibiotics
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26
Q

Goals for Pleural Effusion

A
  • prevent fluid from reaccumulating
  • relieve/decrease discomfort and dyspnea
  • treat infection if present
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27
Q

Acute Respiratory Distress Syndrome (ARDS)

A
  • fluid builds up in the alveoli, preventing the lungs from filling with enough air
  • less oxygen reaches the bloodstream, depriving the organs of oxygen they need to function
  • life threatening
  • MUST IDENTIFY CAUSE
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28
Q

S/S of ARDS

A
  • pulmonary edema
  • bilateral lung infiltrates
  • worsening hypoxemia
  • diminishing lung compliance
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29
Q

What are the most common risk factors/causes for ARDS?

A
  • sepsis
  • aspiration/near drowning
  • smoke/chemical inhalation
  • chest trauma
  • severe pneumonia
  • massive blood transfusion
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30
Q

What is a pleural effusion most often caused by?

A

Pneumonia or chest trauma

31
Q

Treatment for ARDS

A
  • aggressive mechanical ventilation w/ oxygenation
  • circulatory support
  • fluid/electrolyte maintenance
  • nutritional support
  • pain meds
  • sedatives
  • prophylaxis to prevent DVT
32
Q

What vasopressors are used to maintain BP for a patient w/ ARDS?

A

dopamine/dobutamine

33
Q

Complications of ARDS

A
  • blood clots
  • collapsed lung (pneumothorax)
  • infection
  • scarring (pulmonary fibrosis)
  • chronic breathing probs
  • depression
34
Q

Pulmonary Embolism

A

occurs when blood clot gets lodged in an artery in the lung blocking flow to part of the lung
-often leads to sudden death

35
Q

Where to pulmonary embolism often originate from?

A

Most often originate in the legs and travel up through the right side of the heart and into the lungs

36
Q

Cause of Pulmonary Embolism

A
  • disease or injury leading to prolonged immobility

- major surgeries

37
Q

Thrombus

A

blood clot that forms in a vein and reduces blood flow beyond that area

38
Q

Embolus

A

anything that travels through the blood vessels until it reaches a vessel that is too small to let it pass and proceeds to occlude blood flow beyond that area

39
Q

S/S of Pulmonary Embolism

A
  • sudden onset of embolism
  • sharp, stabbing, burning chest pain w/ inhalation and exhalation
  • persistent cough
  • hemoptysis
  • tachypnea
  • tachycardia
40
Q

PEEP for ARDS

A

keeping positive expiratory pressure in the lungs to keep alveoli open and improve gas exchange

41
Q

How to Diagnosis Pulmonary Embolism

A
  • chest x-ray
  • venous doppler
  • ABG’s
  • D-dimer
  • Spiral CT
  • VQ Scan
42
Q

VQ scan

A
  • uses an IV/inhaled radioactive agent
  • uses a ventilation (V) scan to measure air flow in your lungs and a perfusion (Q) scan to see where blood flows in the lungs
43
Q

Saddle embolus

A

massive PE that straddles the main pulmonary artery trunk at its bifurcation

  • medical emergency
  • death can occur immediately or within hours
44
Q

Nursing Management for Saddle Embolus

A
  • stabilize
  • oxygen
  • IV lines
  • ABGs/scans
  • vasopressors to treat hypotension
  • daily labs
  • intubation if indicated
  • foley catheter
  • IV sedatives
  • IV thrombolytics
45
Q

Pharmacological Prevention Meds of PE

A
  • heparin
  • lovenox
  • coumadin
  • Xarelto
46
Q

Heparin

A
  • IV drip
  • weight based protocol
  • aPTT daily/ CBC at least weekly
  • may continue until blood levels are therapeutic
47
Q

Lovenox

A
  • SUBQ every day or q 12 hours

- may be used in conjunction w/ oral meds until blood levels are therapeutic

48
Q

Coumadin

A
  • requires frequent blood draws

- INR 2-3; target is usually around 2.5/NOT > 3.5

49
Q

Embolectomy

A
  • surgical removal of embolus
  • Rare
  • high mortality rate
  • involves cardiac bypass
50
Q

IVC Filter

A
  • small mesh-like trap placed in the inferior vena cava to trap emboli before they reach the lungs
  • placed by radiology interventionist
  • temporary or permanent
51
Q

Pneumothorax

A

opening in the pleural space results in positive pressure leaving the lungs on the affected side unable to maintain inflation

52
Q

What are the 3 types of pneumothorax?

A
  • simple/spontaneous
  • traumatic
  • tension
53
Q

What type of pneumothorax is usually the result of a bleb rupturing?

A

Simple/spontaneous

54
Q

Traumatic Pneumothorax

A
  • air enters the pleural space through a lung laceration

- air passes in and out freely with each breath taken

55
Q

Tension Pneumothorax

A

Air enters the pleural space through a lung laceration, but the pleural membrane acts as a one-way valve and does not allow the air to escape back out w/ expiration

56
Q

Mild/Severe Pneumothorax Symptoms

A
  • sudden pleuritic pain
  • dyspnea
  • tachypnea
57
Q

Large Pneumothorax w/ total lung collapse S/S

A
  • anxiety/air hunger
  • hypoxemia
  • high use of accessory muscles
58
Q

Goal for Pneumothorax

A
  • remove air and reexpand lung
  • chest tube
  • needle aspiration
  • monitor breathing/vitals
  • help w/ anxiety
59
Q

Why is a chest tube inserted?

A

drain air (pneumothorax) or fluid (hemothorax) from the pleural space

60
Q

What does placement of a chest tube help?

A

Helps to restore negative pressure so that lung can reexpand

61
Q

What are two types of drainage systems?

A

Wet and Dry Suction Control

62
Q

Wet Suction Control (Water Seal)

A

suction is controlled by amount of water in water seal chamber

63
Q

Dry Suction Control

A
  • use one-way valve

- usually have a suction dial on collection apparatus

64
Q

Suction Control Chamber

A
  • common setting is 20 cm H2O
  • more water=higher suction
  • less water=lower suction
  • may see bubbling
65
Q

Water Seal Chamber

A
  • one-way valve to prevent air from entering the pleural space w/ inhalation
  • fill w/ water to 2 cm line
  • water level gently rises and falls w/ breathing
  • bubbling indicates air leak
66
Q

Collection Chamber

A

may be to gravity or connected to wall suction

67
Q

Nursing Management for Drainage System

A
  • mark drainage q shift
  • monitor for kinks, loops, occlusions
  • turn q 2 hours
  • pain meds prn
  • gently milk tubing to prevent clots if blood appears
  • monitor for s/s of respiratory distress
  • encourage coughing/deep breaths
  • encourage IS use
68
Q

Important Chest Tube Considerations

A
  • NEVER clamp tube unless ordered by provider or to change system
  • change dressing in 24 hrs then q 48 or prn
  • keep emergency supplies at bedside
69
Q

Emergency Supplies for Chest Tube

A
  • two guarded clamps
  • sterile water
  • Vaseline gauze
  • 4x4 sterile dressing
  • waterproof tape
  • extra collection system
70
Q

What to do if Chest Tube falls out

A
  • immediately apply pressure to insertion site and apply sterile gauze or Vaseline gauze and dry dressing over insertions site and ensure tight seal
  • notify provider to reinsert new chest tube
  • monitor for respiratory distress
71
Q

What to do if Chest Tube becomes disconnected from collection chamber

A

place end of tube in sterile water until collection system can be reconnected

72
Q

What to do if leak is suspected in Chest Tube

A
  • check all connections
  • assess collection system
  • using padded clamp, clamp momentarily
  • when you place clamp b/t source of air and chamber bubbling will stop
73
Q

If bubbling stops the first type you clamp the tube with a suspected leak what could that mean?

A

Air must be at the insertion site or the lung

74
Q

What can cause a collapsed lung with ARDS?

A

PEEP

Adult Health 2 (5 decks)

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