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44 Cards in this Set

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What's the difference between hypoxia and hypoxemia?
Hypoxia is low level of O2 in tissues: Hypoxemia is low level of O2 in blood
What is the first sign of hypoxia?
Confusion
What are retractions?
Muscles move upward upon inspiration
Some patients with neuromuscular diseases develoop hypoxemia because of:
Weak respiratory muscles
In an unconscious patient what's the most common cause of airway obstruction?
Tongue
What is normal SaO2?
95-99 percent
In using a pulse oximeter how often do you rotate the sites?
Clip on every 4 hours; disposable probes every 24 hours
In administering the heimlich maneuver, where do you put your hands?
1/2 way between the xiphoid process and the umbilicus with the thumb of fist inward.
If you're doing the heimlich on an unconscious person, how many abdominal thrusts do you do?
5, then check the Jaw to see if there's a foreign body
If the choking victim is very obese or pregnant, what do you do?
Chest thrusts rather than abdominal thrusts.
Single rescuer rescue breathing is how often
12 X a minute
For postural drainage, how much should the patient drink?
1500-2000 CCs
To drain the apical segment of the upper lobe, what position do you have the patient in?
High Fowlers
How often should a patient deep breathe after surgery?
5-10 deep breaths every 2 hours
When are the best results from postural drainage?
In the AM and 45 to 60 mins before a meal
How much O2 can a nurse administer w/o dr involvement?
2 liters
What is the venturi mask?
Delivers O2 - most accurate - must be removed for eating and meds
What is the advantage of the non rebreathing mask?
Highest O2 delivery
The patient with COPD has what abmormality?
Decreased elasticity of the lung tissue.
In general, a safe level of O2 for someone with normal lungs is:
3 - 5 liters per minute
If the patient is showing restlessness and irritability, the nurse should:
TCDB
If a patient is undergoing O2 therapy, what must the nurse do?
Mouth care
If there is continuous bubbling in a water seal drainage system that is not hooked up to suction, the nurse knows that:
There's an air leak in the system
Many elderly pts have trouble breathing deep enough because of:
Arthritis of the rib cage
How often are the settings on respiratory support equipment checked?
Once a shift (at least)
When deep breathing, how long should they hold it?
at least 3 seconds
How does the incentive spirometer work
The pt takes a deep breath and the ball moves upward. Should do 10 X hour
Pts with difficulty breathing are in what position usually?
High fowlers
What is the orthopenic position?
Hunched over a table with 2 or 3 pillows
When O2 is in use, give oral hygiene how often
Every 3 to 4 hours
What is the obturator?
Guide for the tracheostomy tube to be inserted, then it is removed
When taking care of chest tubes, you should report drainage in excess of what?
100 ml per hour
Wall suction unit pressure is set to ??
80 to 120 mm HG
How is oxygen delivered?
Flowmeter
How often must a tracheostomy tube be deflated?
every 8 hours
Where is the chest drainage tube placed?
Intrapleural space
Pertinent nursing diagnoses are:
Ineffective airway clearance
Impaired gas exchange
Risk for infection
Knowledge deficit
Risk for injury
What is another name for COPD?
CAL (Chronic airflow limitation)
Evaluation is based on what?
Pulse OX, ABG, assessment findings
It is important to relieve anxiety in a patient with impaired lung function because:
tense muscles need more oxygen
For a disposable chest drainage unit, you know there has to be what?
Continuous bubbling in the suction chamber
Elderly more prone to problems because:
reduced elasticity of lung tissues
One nursing measure that can prevent respiratory insufficiency is to:
administer lo flow O2 constantly
What is a tension pneumothorax?
Air that enters the pleural space and is trapped there