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98 Cards in this Set
- Front
- Back
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What is the electrical and mechanical actions of a P wave? What does it look like on a monitor strip?
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The P waves signify atrial depolarization and atrial contraction. The P waves are generally small, round positive deflections from the baseline and occur before the QRS complex.
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Why are P waves round in shape rather than sharp spikes?
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Because there is a slight delay between depolarization of the right atria and the left atria.
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What is the PR interval and what does it represent? What is the normal range for the PRI?
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The period of time from the beginning of the P wave to the beginning of the QRS complex and represents the time from atrial depolarization to the start of ventricular depolarization. The normal range is 0.12 to 0.20 seconds.
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What is the electrical and mechanical actions of the QRS complex? What does it look like and what is the normal range?
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The QRS complex represents ventricular depolarization and ventricular contraction. It is usually the largest part of the tracing on the EKG tracing and ranges from 0.04 to 0.10 seconds.
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What is the T wave?
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T waves represent ventricular repolarization and are usually a upright deflection following the QRS complex.
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What is paroxysmal nocturnal dyspnea?
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The pt wakes up in the middle of the night unable to sleep because of intense SOB. It's caused by a fluid shift from the tissues into the intravascular compartment as a result of recumbancy.
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What is a PE characterized by?
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By the production of pink frothy sputum. It's a medical emergency.
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What is the least reliable sign of CHF?
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Edema
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What are some general respiratory interventions?
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Semi-fowler's position with head and chest elevated, pillow behind back lengthwise.
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How can the environment be adjusted to be better suited for a resp pt?
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- NO Flowers, they could contain microorganisms (pseudomonas)
- Provide cool environment (most comfortable) |
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What diet is best for resp pts? And how many meals a day?
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- Small frequent meals (it's less stressful on the CV and Resp systems)
- Decrease CHO and increase fat - A high CHO diet can increase the amount CO2 produced and it could lead to resp failure. |
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What should be done in regards to fluid intake with renal or cardiac insufficiency?
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Restrict fluids with renal or cardiac insufficiency. Otherwise, encourage 3,000 - 4,000mL
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Why should milk be avoided?
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It can cause thick sputum
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What are some measures to prevent infections?
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- Turn and reposition pt frequently
- Encourage deep breathing and coughing - Change resp equipment daily, keep tubing off of the floor - Don't room pts with pts with URIs - Nurses get flu shots - Assist persons on steroids, antibiotics for superinfections |
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What are the goals of pulmonary drug intervention?
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- Relief of bronchoconstriction and promotion of bronchodilation
- Improve mucociliary transport and removal of secretions from lungs - Improve alveolar ventilation and oxygenation - Promotion of a normal breathing pattern |
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What is included with pulmonary hygiene methods?
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Turn, cough, deep breath, postural drainage
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What do adrenergic sympathomimetic drugs do?
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They mimic the sympathetic response:
- relax bronchi - Pupil dilation - increase HR - increase b/p - decrease gastric motility - skin pallor |
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*On Test*
Methylxanthine (theophylline): What is it? What's it used for? How may it be administered? |
It's a resp and cardiac stimulant
- used for acute and chronic problems - May be given IV and PO, never IM |
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If Methylanthine (theophylline) is given IV, what must be done? What are the therapeutic levels?
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- It must be on a pump.
- Must check levels: >20 is toxic 10-20 is a therapeutic level |
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What is a first line drug for resp problems? What does it do?
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Corticosteroids
- It's an antiinflammatory - anti-bronco constrictor effects - reduces swelling - used with acute asthma, COPD, interstitial lung disease, ARDs, fatal infection. - Immune suppression is a serious S/E |
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What condition can corticosteroids cause? What is a reliable sign of this?
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It can cause high blood sugars.
A good sign of this is increased urinary output. |
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What is the drug of choice to stop a cough?
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Codeine
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cromolyn sodium (Intal)
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- prevents type 1 hypersensitivity
- used in chronic asthma - Inhaled |
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Prior to giving an antibiotic what should always be checked?
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Check for allergies
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What shouldn't be done when taking an antitussive?
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Don't drink water as it may lose it's local effects.
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What is the best mucolytic?
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water
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What mucolytic is commonly used?
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Mucomyst
- helps to liquify secretions - can cause severe bronchospasm - It's the antidote for tylenol overdose - Usually given prior to contrast media to protect the kidneys |
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What must be done if you're giving over 4L of O2?
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It needs to be humidified
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What is a must for resp rehab?
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Incentive spirometry
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Who should not have chest PT?
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- pt who has had lung cancer
- look into fraility of the pt |
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What 2 types of breathing is done with resp rehab?
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- diaphragmatic breathing procedure
- pursed lip breathing |
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What can ineffective coughing do?
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It can collapse airways, rupture thin walled alveoli, causea pneumothorax, and it is dangerous for cardiac and neuro pts b/c it can increase ICP.
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What may need to be given prior to having the pt cough?
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pain meds
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While administering postural drainage, what must be done if the pt b/c tired, dyspneic, tachycardic, or cyanotic?
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stop or change position
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What is included in a rapid respiratory assessment?
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- symmetrical chest expansion
- LOC - no retractions in breathing - auscultate breath sounds bilat - stridor - gag reflex - change in skin color or temp. - inability to speak, breathe, or cough - check for hypocalcemia |
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What signs would tell you that a pt is at risk for aspiration?
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The inability to speak, breathe, or cough
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What should never be done with an oral airway tube?
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It should never be taped in place as the pt can aspirate if he vomits
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How does an endotracheal tube differ from an oral airway tube?
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The tube is taped in place. Equal chest expansion shall be noted.
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What is the purpose of the cuff?
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To prevent aspiration and to create a seal.
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What must be done immediately after the placement of an oral airway tube or tracheal tube?
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Auscultate breath sounds
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What is the benefit of a tracheostomy?
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It produces less damage to the respiratory tract than endotubes.
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What is needed to change tracheostomy ties?
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2 nurses
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What can lead to acidity in a pt?
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An increase in H+ concentration
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What can lead to alkalinity?
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A decrease in H+ concentration
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What are some manifestations of hypoxemia?
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- heart increases cardiac output
- blood vessels constrict which increases the venous return and providing the heart with more blood. - SOB - drop in b/p & HR - change in LOC - pt becomes restless, disorientated, or anxious - cyanosis |
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What are some nursing interventions for resp acidosis?
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Frequent repositioning, coughing, and deep breathing
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What is a very important sign of resp acidosis?
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disorientation, restlessness
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Hypoxemia
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Lower than normal partial pressure of O2 in arterial blood. A PAO2 lower than 60mm hg hypoxia. It can be caused by lung disease, poor blood flow to the lungs, and poor ventilation of the lung or a decrease of O2 in the air.
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Hypoxia
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Insufficient tissue oxygenation for normal metabolic function. Hypoxia is not directly measurable. Hypoxia may be due to circulatory problems, hemoglobin abnormalities or insufficiencies, and poisons. Hypoxemia is the most common cause of hypoxia.
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What must always be correlated with a change in resp rate?
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The activity level of the pt
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What was designed to limit the O2 delivery to a precise set percentage between 24-50%?
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The Venturi mask
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What are some nursing care for patients receiving O2 therapy?
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- Good body alignment; semi to high fowler position.
- Frequent mouth care - Monitor I&O - Correlate RR with activity level and O2 sat |
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What is CO2 narcosis in COPD patients?
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Diminished resp drive in patients who retain CO2 as a result of COPD.
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When does O2 become toxic?
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In concentrations of O2 over 60% will damage lungs within 3 to 4 days. 100% for 24 to 48 hours will cause pulmonary damage. It's one causitive factor in the development of resp distress syndrome.
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Transtracheal Oxygen
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Offers pts with chronic resp disorders a more comfortable and effective approach to long term O2 therapy than traditional approaches.
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What warms and humidifies the air as it enters the body?
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The nose, pharynx, & larynx
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What is an indirect measure of O2 saturation?
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PulseOx
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Functional residual capacity
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The volume of air in the lungs at resting and exhalation.
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Forced expiratory volume
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The amount of gas you can exhale during 1 second.
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Tidal volume
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The volume of air normally inhaled or exhaled with each breath.
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Respiratory risk factors
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- smoking
- Resp disorders in pt's history - Family hx - Environmental responses |
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Stridor
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Airway obstruction that is a high-pitched sound resulting from turbulent gas flow in the upper airway. It's a potential medical emergency.
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What is an ominous resp sign?
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Stridor
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How does blood from the GI tract appear?
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Acidotic
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How does blood from the lungs appear?
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It's usually frothy, bright red, and alkaline.
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What is hemoptysis?
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Coughing up blood or blood tinged sputum,
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What is hematemesis?
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Vomitting up blood.
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How is TB diagnosed?
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Send the first AM sputum to state lab for 3 consecutive days for acid fast bacillus (AFB).
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What does normal sputum look like? How much is produced in a day?
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Thin and clear.
An average of 100mL/day is produced. |
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What kind of change is significant in a COPD patient?
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A change in the character of the cough.
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When should a cough be investigated?
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A cough lasting more than 3 weeks.
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What drugs could precipitate a cough?
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ACE inhibitors
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What should dyspnea always be related to?
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- to activity level at rest, walking, a running
- should be quantified on a scale from 0 to 10. - note the pt's position |
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Common respiratory symptoms, subjective
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Dyspnea, cough, change in sputum production, hemoptysis, wheezing, stridor
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What is also called a stiff lung?
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ARDS
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What is lung compliance?
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It's a measure of how easily the lungs can be stretched.
It's the amount of pressure required to stretch the lung determined by elastic properties. |
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How is airway resistance determined?
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By the size of the bronchial diameter.
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Bronchoscopy
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- Direct visualization of the tracheobronchial tree, larynx, trachea, and bronchi with a flexible fiberoptic bronchoscope.
- Can be done bedside or in the OR. - Local xylocaine spray in conjunction with IV valium. |
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What test is done if cancer is suspected?
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Cytologic sputum studies
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What does rust colored sputum indicate?
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pneumonia
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What does yellow-green sputum indicate?
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Infection
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What tool may be used with a thoracentesis?
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Ultrasound
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What scan is valuable in the diagnosis of a PE?
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Lung scan - ventilation - perfusion scan
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What are some basic precautions with MRIs?
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No metal in the room, ask patient about ortho devices, brain clips, or pacemakers
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*On Test*
VQ Scan |
The ventilation-perfusion scan is a nuclear scan so named because it studies both airflow (ventilation) and blood flow (perfusion) in the lungs. The initials V-Q are used in mathematical equations that calculate airflow and blood flow. The purpose of this test is to look for evidence of a blood clot in the lungs, called a pulmonary embolus, that lowers oxygen levels, causes shortness of breath, and sometimes is fatal.
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PET Scan
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Uses high energy computer techniques. Useful for studying ventilation-perfusion relationships
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What should a normal O2 sat be above? When does a low O2 sat require immediate attention?
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The normal O2 sat should be above 95% Results lower than 91% require immediate treatment.
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Which bronchus gets aspirated most?
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the right lung
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Describe the right bronchus versus the left branches?
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The right bronchus is wider and shorter than the left. It extends almost vertically from the trachea.
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Nursing interventions prior to bronchoscope
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- Informed consent
- NPO for 6 hours before test |
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Nursing interventions post bronchoscope
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- NPO until return of the gag reflex
- position on their side which facilitates secretion drainage - semi-fowler's position - monitor vs, airway - provide O2 and humidify - Equipment at the bedside for emergency airway management to treat tracheal edema |
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What is a thoracentesis?
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A simple procedure for the removal of fluid from the pleural space
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Pre-pocedure thoracentesis
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- Informed consent
- Explain procedure to pt - Assess BS, b/p, pulse, RR - Patient is positioned sitting upright with elbows on or over a bed table - Feet and legs well supported - Clean skin and give local - Instruct patient not to talk or cough |
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What is the limit to the fluid that is removed during a thoracentesis?
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Usually not more than 1200cc
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Why is a max of 1200cc removed during a thoracentesis?
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This reduces the danger of circulatory collapse or pulmonary edema. Also, a rapid removal of fluid does not allow the lung enough time to re-expand and may produce SOB, cough, and chest pain.
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What could occur from or result from a thoracentesis?
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- pneumothorax
- lung puncture |
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Pneumothorax
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It's a collapsed lung
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What must be documented during a thoracentesis?
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- time and place of aspiration
- amount and character of fluid removed - person's toleration of the procedure - patient's resp status - chest x-ray to assess foe residual fluid, chest re-expansion, or pneumothorax |
