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Semester One - Nursing 111 > Week Nine > Flashcards

Flashcards in Week Nine Deck (173)
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151

Signs of hypoxia

mental status change, restlessness, tachypnea, dyspnea, lightheadedness, tachycardia, cyanosis

152

What information to be collected when assessing cough?

occurrence, triggers, productive or non-productive, sounds, presence of sputum-productive

153

Sputum

Normal lung and airway secretions that may increase to compensate for disease

154

Note sputum

color, amount, odor, consistency, presence of blood

155

Definition of ineffective airway clearance

inability to clear secretions or obstructions from the R tract r/t obstructed airways (mucous, foreign body), R disease, smoke, airway spasm

156

Defining characteristics of ineffective airway clearance

adventitious breath sounds, diminished breath sounds, cough, increase sputum, cyanosis, change in R depth (deep or shallow), dyspnea, orthopnea, tachypnea or bradypnea

157

Definition of ineffective breathing pattern

Inspiration and/or expiration that does not provide adequate ventilation R/T fatigue, impairment of musculoskeletal, respiratory, neuromuscular systems, anxiety

158

Defining characteristics of ineffective breathing pattern

dyspnea, othopnea, tachypnea, bradypnea, use of accessory muscles, increase A/P diameter, change in respiratory depth (increase or decrease)

159

Definition for risk for activity intolerance

At risk for experiencing insufficient energy to complete ADLs

160

Defining characteristics for risk for activity intolerance

respiratory signs and symptoms, cardiac signs and symptoms, de-conditioned status

161

nursing interventions for oxygenation related nur dx

position patient to optimize R (fowlers), assist with deep breathing and coughing techniques, promote fluid intake, humidification, administer medications for cough/sputum production

162

Why promote fluid intake?

liquefies secretions, facilitates expectoration, moistens mucous membranes

163

Why humidification?

moistens airway, facilitates cough and expectoration

164

Expectoration

coughing up and spitting out of material from the lungs

165

Guaifenesin indication

productive and non-productive cough

166

Guaifenesin action

increase volume of secretions, decrease viscosity of secretions

167

Dextromethorphan Indication

non-productive cough due to irritation of airways

168

Dextromethorphan action

suppresses cough center in medulla oblongata

169

Nursing implications for dextromethorphan

treat other symptoms, decrease oxygen demand, monitor R, breathing, breath sounds, cough, sputum

170

Health promotion measures that relate to healthy breathing?

change position frequently, exercise, ambulate, no smoking, avoid exposure to toxins, safety in the home, furnaces, gas appliances, smoke, and CO detectors

171

What are the reasons for supplemental oxygenation

increase the amount of oxygen available for transport. based on symptoms, blood work, 02 sat

172

Ferrous gluconate

more expensive than ferrous sulfate, easier on the stomach

173

ferrous gluconate and sulfate

replaces iron stores necessary for RBC development for iron deficient anemia