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264 Cards in this Set
- Front
- Back
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If you get a respiratory question what are the important parameters
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lung sounds and SaO2
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Ventilation is more about heart rate or lung sounds
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lung sounds and SaO2
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When should inhaled medications should be avoided
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around meal times
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Is Oxygen a medication
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Yes, keep oxygen concentrators open to air for adequate circulation, do not place near a wall or in a closed container
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Can a PCA initial O2
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NO only a nurse can
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Action of an antihistamine
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Block the immune system from reacting to a foreign substance
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SE of antihistamine
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Drowsiness and sedation with some, safety in pregnancy has nto been established, potentiated by alcohol.
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Common Antihistamines
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Azelastine (Astelin), Brompheniramine (LoHist), Certirizine (Zyrtec), Chlorpheniramine (Chlor-Trimeton), Clemastine (Tavist), Dexchlorpheniramine (Polaramine), Diphenhydramine (Benadryl), Fexofenadine (Allegra), Hydroxyzine (Vistaril, Atarax), Loratadine (Claritin, Clarinex), Phenindamine (Nolahist), Promethazine (Phenergan), Triprolidine (Zymine)
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Antitussives action
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relieve coughing by suppressing the cough center or numbing the nerves
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Benzonatate (Tessalon) Antitussive does what
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numbs the peripheral nerves, Swallow the medication whole to prevent numbness of the mouth and pharynx, DO NOT BITE THEM due to it will numb the throat
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Common Antitussives
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Codeine sulfate, Dextromethorphan (Robitussin, Drixoral, Sucrets), Dextromethorphan and benxocaine (Vicks Formula 44), Hydrocodone bitrartate (Hycodan)
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Bronchodilators actions
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open up the airways of the respiratory system to allow for air passage into and out of the lungs
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Major types of Bronchodilators include
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sympathomimetic agents and the xanthine derivatives
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Metaproterenol (Alupent and isoproterenol (Isuprel) are what type of agents
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Sympathomimetic Agents
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SE of Bronchodilators are
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Restlessness, hypertension, tachycardia, shaking, HA, N & V, Pupil dilation
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Xanthine derivatives include drugs such as
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aminophylline and theophylline
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What type of beverage is in the same class as Xanthine derivatives
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Caffeinated Beverages
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What do you need to watch for with Xanthine derivatives
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blood levels
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Signs of toxicity for the xanthine derivatives
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Agitation, tremors, insomnia, confusion, vomiting
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Therapeutic blood level for xanthine derivatives
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10-20
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How often should Ipratroptium (Atrovent) be taken
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around the clock for consistent response, NOT PRN
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Common Bronchodilators
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Albuterol (Preventil, Ventolin, Volmax), Epinephrine (Adrenalin, Primatene), Formoterol (Foradil), Levalbuterol (Xopenex), Pirbuterol acetate (Maxair), Salmeterol (Serevent), Terbutaline (Brethine), Theophylline (Theo-dur, Slo-bid, Uniphyl), Ipratropium (Atrovent), Tiotropium (Spiriva)
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Decongestant action
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decrease the swelling in clogged breathing passages through vasoconstriction of the blood vessels, they will also help to drain the sinus cavities of fluid, many are available over the counter
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SE of decongestants
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palpitations, hypertension, tachycardia
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Common Decongestants
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Deoxyephedrine (Vicks inhaler), Ephedrian (Vicks), Naphazoline (Privine), Oxymetazoline (Afrin), Phenylephrine (Neo-Synephrine), Pseudoephedrine (Sudafed, Dimetapp), Tetrahydrozoline (Tyzine), Xylometazoline (Otrivin)
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Expectorants action
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Thins secretions in the respiratory tract so they can be coughed up
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Expectorants will do what to PT and INR labs
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Increase them
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SE of expectorants
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Dizziness, drowsiness, metallic tast, nausea if taken on an empty stomach
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What will Guaifenesin (Robatussin) do to bleeding in clients who are taking anticoagluants
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increase bleeding
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Inhaled and nasal corticosteroids action
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block the ability of the body to respond to foreign substances resulting in a decrease in inflammation or swelling of the breathing passages
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What do we teach clients what to do after taking inhaled and nasal corticosteroids
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rinse and spit to decreast the incidence of fungal infections developing in the mouth
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Common inhaled and nsal corticosteroids
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Beclomethasone (Becanase, Beclovent, Vancenase, Vanceril), Budesonide (Pulmicort, Rhinocort), Dexamethasone (Decandron), Flunisolide (AeroBid, Nasalide), Fluticasone (Flonase, Flovent), Mometasone (Asmanex, Nasonex), Triamcinolone (Azmacort, Nasocort)
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Leukotriene Modifiers Action
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Prevent the release of chemicals during inflammation which can cause the airway passage of the bronchial tree to become constricted or narrower.
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Are Leukotriene Modifiers used to prevent asthma attacks or treat acute exacerbations
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prevent asthma attacks
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SE of Leukotriene Modifiers
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HA and flu like symptoms
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To remember Leukotriene Modifiers what is the numonic
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“ Single Flow likes chocolate” Montelukast (Singulair), Zileuton (Zyflow), Zafirlukast (Accolate)
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Common Mast cell Stabilizers
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Cromolyn sodium (Intal) and nedocromil (Tilade)
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What are mast cell stabilizers are also used
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to prevent asthma attacks especially ones that are caused by exercise
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Mucolytics Acetylcysteine (Mucomyst) (N-acetylcysteine) (NAC) smells like
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rotten eggs
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Mucolytics Acetylcysteine (Mucomyst) (N-acetylcysteine) (NAC) action is
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nebulized medication that is primarily used for cystic fibrosis clients, loosen respiratory secretions so they can be coughed up
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What is Mucolytics Acetylcysteine (Mucomyst) (N-acetylcysteine) (NAC) taken orally for
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acetaminophen poisoning, mix with OJ
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Antitubercular agents lab effects
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Increased AST, ALT, ALP, bilirubin, BUN and creatinine with steptomycin, Uric acid and pyrazinamide (PZA)
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What type of function studies are needed prior to taking Antitubercular Agents
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Liver function studies prior to therapy and monthly during therapy, toxic to the liver
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Mast cell Stabilizers action
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Prevent the release of histamine from cells in the body known as mast cells Preventing this release blocks the immune system from reacting to foreign substance.
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Isoniazide (INH) drug for TB, can cause what as a side effect as it form a complex with B6 in the body
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peripheral neuropathy so give Vitamin B6 (Pyridozine) to eliminate the neuropathy
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What does Isoniazid (INH) drug for TB, do to phenytoin (Dilantin) levels
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increases
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Ethambutol (Myambutol) drug for TB, what do I check before starting
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check vision before starting therapy and monthly thereafter, may need to take for up to 24 months
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Remember red orange with what drug
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Rifampin (Rifadin) it will cause the urine, sweat, tears, and saliva to become red-orange color, soft contacts may be permanently damaged. Nausea also a frequent complaint, can cause severe flu-like symptoms, best on empty stomach but if nausea, take with food. Usually on this medication for 12 months even if cultures come back negative for TB. Will interfere with oral contraceptives
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Pyrazinamide (PZA) is what type of drug and used for what
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Antitubercular Agents for tx of TB
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Is Streptomycin nephrotoxic
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YES
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What is a Potentially serious disease which primarily affects the lungs
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Tuberculosis
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How is Tuberculosis transmitted
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DROPLETS
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Do most people infected with the bacteria develop symptoms of TB
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NO
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Lab effects of TB
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Positive Mantoux, AFB
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Clinical Manifestations of TB
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Fatigue, Malaise, Anorexia, Weight Loss, Night Sweats, Chronic, Productive Cough, Hemoptysis in advanced State, Low grade temperature in the afternoon
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What type of Doctor manages TB
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Pulmonologist
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How long is drug therapy for TB
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6-12 months
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What do we for tx until no symptoms
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bedrest
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When is client considered noninfectious
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after 3 sputum cultures every 2-4 weeks come back negative
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What type of room for a TB patient
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Private, negative pressure room
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How many air exchanges per hour for TB patient
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6 air exchanges every hour to the outside.
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What type of light is helpful to treat peripheral neuropathy with TB
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Ultraviolet light
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A chronic disease that causes the airway to become swollen which decreases the amount of air which can be inhaled and exhaled by the lungs
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Asthma
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Acute exacerbation that does not respond to standard treatment
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Status Asthmaticus
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Clinical manifestations of Status Asthmaticua
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Chest tightness, Rapidly progressive dyspnea, Dry cough, Use of accessory muscles, Extreme Wheezing, Respiratory Acidosis
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Treatment includes bronchodilators such as IV Aminophylline and corticosteroids for
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Status Asthmaticus
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A term used to describe the symptoms of emphysema and chronic bronchitis since these two conditions occur frequently together. It is long term and progressive
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COPD
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What is the primary cause of COPD
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tobacco smoke
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Inflammation of the bronchioles with a narrowing of the air passageways
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Bronchitis
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What type of person do you see with Bronchitis skinny or heavy set
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heavy set
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What do we call clients with Bronchitis
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Blue Bloaters
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Higher risk for hypoxia due to large amounts of secretions they produce for what disease
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Bronchitis, they have huge amounts of mucus/sputum
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What does Bronchitis leads to
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right sided heart failure known as corpulmonally
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Destruction of the lung tissue in the alveoli resulting in an inability of the alveoli to return to their normal size with exhalation
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Emphysema
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Late stages leads to carbon dioxide retention in
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Emphysema
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Emphysema patients are called
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Pink Puffers
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Symptoms of Emphysema
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occipital HA, drowsiness, and inability to concentrate
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What do Emphysemas retain
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CO2, they are usually skinny
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A genetic disease causing the body to produce very thick, sticky mucus which clogs the lungs and ducts of the pancrease
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Cystic Fibrosis
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This disease can lead to pulmonary infections and malabsorption
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Cystic Fibrosis
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What type of diet is needed with Cystic Fibrosis
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High in protein and high calorie, moderate to low in carbohydrates
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What type of vitamins will I supplement with Cystic Fibrosis
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Fat soluble vitamins
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What type of enzymes are given to Cystic Fibrosis patients
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Pancreatic Enzymes and give WITH FOOD
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If a Cystic Fibrosis patient is severely compromised what will I need to do
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G tub feedings or TPN
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Will Cystic Fibrosis patient have fat restrictions
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NO unless steatorrhea is not controlled
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What is good to clear secretions in the lungs for Cystic Fibrosis
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Postural drainage followed by breathing exercises
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Inflammation of the lungs caused by an infection
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Pneumonia
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What can cause Pneumonia
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many different organisms including bacteria, viruses, and fungi. May also be aspiration pneumonia which can be lethal due to the extensive lung injury which occurs
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Pathology of Pneumonia
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Obstruction of the bronchioles, decreased gas exchange, increased exudate
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Anytime you have diarrhea you have
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malnutrition
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Clinical manifestations with Pneumonia
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Yellow, blood streaked, rusty sputum = infection, fever, chills, tachycardia, tachypnea, productive cough, dry cough in pneumonocystis, dyspnea, pleural pain, malaise, respiratory distress, decreased breath sounds, bronchial breath sounds
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Autosomial Recessive means 1 parent has the gene or 2
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2, both parents have the gene
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Risk for aspiration pneumonia
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Altered LOC, depressed gag or cough reflex, Alcoholics, Anesthetized clients, brain injury, drug overdose, stroke victims
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When feeding high risk clients I need to
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raise the head of the bed, position on the side, tip the chin down with swallowing
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Why are elderly at an increased risk for pneumonia
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due to loss of elasticity, decreased vital capacity, and decreased muscle strength
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Lung disorder caused by long-term inhalation of silicon
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Silicosis
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Where is Silicon found
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sands and stones, will see Silicosis with pottery makers and stone masonary workers
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Where is finely ground silica found
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soaps, polishes and filters
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Multisystem, granulomatous disease of unknown origin
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Sarcoidosis
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What does Sarcoidosis involve
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lungs, lymph nodes, liver, spleen, and other organs
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How often does a Sarcoidosis patient need an CXR
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every 6 months
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What is Obstruction of blood flow to the pulmonary vasculature caused by an embolus
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Pulmonary or fat embolus
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Lab effects for PE
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increased PH and decreased pO2, pCo2
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What is the predisposing factors to DVT and pulmonary embolus
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Virchow’s Triad which is = Venous stasis, Hypercoagulation, Vascular Injury
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What is a fat emboli
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a piece of bone fat
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How soon can a fat emboli happen
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most common within 36 hours of a fracture
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Fat emboli are more common with
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multiple fractures, fractures of long bones, and fractures of the pelvis
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Clinical Manifestations for Fat Emboli
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Hypoxemia and confusion, Fever, Petechiae on the upper chest
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Clinical Manifestations for Pulmonary Embolus
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Chest pain, Dyspnea, Hemoptysis, Tachycardia, Fever
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Movement restrictions for Fat Emboli and Pulmonary Embolus
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bedrest or limited movement initially which prevents dislodgement of any other clots.
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Which is better bathroom privledges or bedside commode
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bathroom privledges
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Drugs to treat Fat Emboli, Pulmonary Embolus
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Heparin or enoxaparin (Lovenox) and warfarin (Coumadin)
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Treatment for Pulmonary Embolus and Fat Emboli
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inferior vena cava filter
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Treatment for Fat Emboli
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intubate and ventilate
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Collection of fluid in the pleural space
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Pleural Effusion
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Is Pleural effusion always secondar to something else
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yes always such as surgery, cancer
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What will I see with Pleural effusion
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dyspnea or exertion and dry, non productive cough
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If the pleural effusion is drained and then recurs what will the client feel
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may see a sharp, stabbing pain with deep inspiration due to tension on the pleura
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What is the procedure to drain an effusion
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Thoracentesis, a potential complication is a pneumothorax
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If Pleural Effusion continues to recure what can be done
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Pleurodesis is injecting a sclerosing agent through a chest tube and into the pleural space, the chest tube is clampled after the injection, will need to turn every 15 minutes to distribute the pleurodesis agent
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Air in the pleural space usually due to trauma
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Pneumothorax
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Clinical Manifestation of early signs Pneumothorax
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ALWAYS SUDDEN CHEST PAIN, dyspnea, cough, decreased Unilateral breath sounds, asymmetrical chest movement, anxiety, subcutaneous emphysema
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Clinical Manifestations of late signs of Pneumothorax
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distended neck veins, hypotension, weak pulse, tracheal deviation ot the unaffected side
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Pneumothorax Treatment
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is insertion of a chest tube to remove the air, location will be high in the chest because air rises
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Blood in pleural space
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Hemothorax, treatment is insertion of a chest tube, location will be low in chest “remember air rises and fluid falls” for chest tube placement
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Inflamed tissue, pus, and debris in the pleural space
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Empyema
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What is done to remove the inflamed tissue, pus and debris
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Decortication
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Chest tubes will be in place after surgery for short time or long time
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long time because the healing process is slow
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Inflammation of the pleural lining
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Pleurisy
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With Pleurisy what is the major issue
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pain and is the hallmark symptom, need to splint the chest wall with coughing and deep breathing
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How do you position a Pleurisy patient at night
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affected side
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Can Pleurisy develop pneumonia due to
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hypoventilation
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Pleurisy will you hear anything when listening to lung sounds
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may hear friction rub early in the course, once fluid accumulates in the inflamed area, there is less friction and the rub disappears
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Instability of the chest wall due to multiple rib fractures sustained by considerable force
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Flail chest, fractures usually occur on the anterior and posterior segments of the ribs
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Teachings with flail chest
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support the chest with the hands in an emergency, rib fractures usually have pain over the fracture site with inspiration and to palpation
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For every rib broken the patient has a ____ % of dying
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10%
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What type of respirations are usually what with Flail chest
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shallow and guarding is present, bruising may or may not be present
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Removal of a lobe of the lung
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Lobectomy, may be done for lung cancer, will usually have a chest tube afterwards
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Removal of the entire lung
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Pneumonectomy due to extensive disease
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What fills the space after a pneumonectomy
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fluid, the fluid will eventually become solid
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What nerve is severed with a Pneumonectomy
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The Phrenic nerve is severed on the side of the surgery which decreased the amount of elevation of the diaphragm on the operative side
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What can happen to the heart after a pneumonectomy
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Cardiac overload
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What can happen after a pneumonectomy
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subcutaneous emphysema
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How often do they cough and deep breath after a pneumonectomy or lobectomy
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every hour for 1st 24 hours then every 2 hours
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How do you do post-thoracotomy exercises
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extend the arm up and back and to the side, climbing a wall with fingers of the hand fully extending the arm, tying a rope to a doorknob and swinging the rope in wide circles, shrugging the shoulders and moving them back and forth, holding the arms crossed in front and then raising them over the head
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Replacement of O2 in the blood with carbon monoxide
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Carbon monoxide poisoning
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What is the most common cause of death by posining
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Carbon monoxide poisoning, can occur due to faulty equipment, during a house fire, or intentionally in suicide
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Clinical manifestation of Carbon Monoxide Poisoning
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Dull HA, Dizziness, N & V, Chest pain, Confusion, Irritability, Impaired Judgment, Loss of Consciousness
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Normal Carboxyhemoglobin level in an adult
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less then 5%
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Normal Carboxyhemoglobin level in an adult who smokes heavily
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5-10%
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What will Carboxyhemoglobin level be after exposure
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elevated
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Procedure to remove cancer from the head and neck along with lymph nodes, veins, muscles, and nerves which may be involved
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Radical neck dissection
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What is a first sign of laryngeal cancer
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hoarsness
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How does the tongue and mouth appear with laryngeal cancer or tongue cancer
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white, gray, dark brown, or black, and my appear patchy
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What might be done for laryngeal and tongue cancer
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Radical neck dissection
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How do I maintain a patent airway with a radical neck dissection
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suction frequently
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With a radical neck dissection a jackson pratt drain may be used how much drainage and what type of drainage in the first 24 hours
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80 to 120 mL of serosanguinous in the 1st 24 hours
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What type of activity after a radical neck
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bedrest is recommended because lymphatic flow will increase with activity, may have a leak of the thoracic duct after surgery
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With a radical neck will client be able to swallow and eat
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YES but start with semisolid foods after the surgery, TPN may be indicated
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Acute lung injury resulting from various causes
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Acute respiratory distress syndrome to have this clinet must not have a hx of previous respiratory problems, will find profound hypoxia
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What is the mortality with ARDS
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50%
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Lab effects in ARDS
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Decreased PH and pO2, increased pC02
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When does ARDS usually developed
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24-48 hours after pulmonary trauma
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Clinical manifestations with ARDS
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Tachypnea and dyspnea are the earliest signs, crackles and pink frothy sputum will also be seen later, altered mental status common due to hypoxia, dense pulmonary infiltrates on CXR
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Usual treatment for ARDS
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Intubation and ventilation, PEEP applied at 5-10 cm of water
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What will any pressure to the chest do to cardiac output
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DECREASE cardiac output
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Proper way to get a sputum specimen
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rinse mouth, best first thing in the monring, (a must for acid-fast and cytology specimens)
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What does yellow, blood streaked, or rusty sputum indicate
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infection
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When do I read a PPD test
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after 48-72 hours
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PPD abnormal results in general public without risk factors
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10-15 mm
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PPD abnormal results in residents of long term care facilities, drug users, and medically underserved populations
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10 mm
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PPD abnormal results in HIV, AIDs or recent close contact with active TB
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5 mm
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Vaccine for TB
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BCG anyone getting this vaccine will always test positive, evaluate with a CXR
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Can you have a false positive or a false negative reading with someone who has received the BCG vaccine
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YES willneed to do a CXR
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If a Tine test is positive, then what is done to confirm TB
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PPD but due it intradermal
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If a positive reading of PPD
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Notify Dr. CXR should follow determine if there is walled off bacteria, nodules or cavities caused by active TB, or old, healed lesions
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What is a Gallium scan
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Nuclear medicine scan which uses radioactive material to usually look for infection in the body
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Do I have to remove all metal objects for a Gallium scan
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YES
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Any injection with a Gallium scan
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yes isotope are painful and a signed consent is necessary
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How often is the Gallium scan taken
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24, 48, 72 hours, may be done at 4-6 hours if an inflammatory process is suspected
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Scope inserted to see the mainstem bronchus
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Bronchoscopy, no dye injected with this procedure
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This allows visualization of the anterior mediastinum or hilum extrapleurally
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Mediastinoscopy
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Can a biopsy be taken during a Mediastinoscopy
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YES
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A lighted scope is inserted through the neck or chest to examin the structures in the upper chest cavity under general anesthesia
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Mediastinoscopy
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NPO rules for a Mediastinoscopy
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8 hours before ti minimize the risk of aspiration
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This allows visualization of the pulmonary vasculature after injection with a dye
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Pulmonary angiography
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How is a Pulmonary angiography done
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small incision is made in a vein in the groin or arm and a catheter is advanced through the right side of the heart and into the pulmonary artery, it is painless although may have some discomfort with the insertion of the needle that is used for the dye injection, minimal exposure to radiation
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How to take ABGs
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pressure to the site for 5 minutes after removal, do Allens test before to assess collateral circulation, use a heparinized syringe and place the specimen in a bag of ice,
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If ABG is ordered on room air
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remove the oxygen right before it is done
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If a Sweat chloride test is greater than 60 mEq/L what is it positive for
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cystic fibrosis
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Pulse oximeter for adults critical % is
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less than 90%
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Pulse oximeter for peds critical % is
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less than 95%
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Early signs of Hypoxia
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restless, increased HR, increased RR, increased agitation and anxiety, Diaphoresis, Retractions, Altered LOC, HA, Capillary refill less 3 seconds
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Late signs of Hypoxia
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Increased restlessness, decreased HR, decreased RR which leads to Cyanosis, Decreased LOC which leads to Stupor and somnolence
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Respirtory failure pC02 will be
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greater then 45 or pO2 decreased 60 on 50% oxygen
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Pediatrics clinical manifestations for Hypoxia
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Agitation, restlessness, increased HR, Increased RR, Diaphoresis, Nasal Flaring, Grunting, Stridor, Feeding problems
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What will you see with Chronic hypoxia
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Clubbing of the fingernails and then the fingers
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Common complaint in respiratory disorders
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Dyspnea
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Common causes of dyspnea
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All P’s, P=pulmonary asthma, possible foreign body, pulmonary embolism, pneumothorax, pneumonia, pump failure, pericardial tamponade, peak seekers, psychogenic, poisons
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What do I do before putting the inner cannula back into the tracheostomy when doing trach care
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tap the watter off, butterfly folded dressings
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What type of cuff will a tracheostomy patient have
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high volume, low pressure to decrease the incidence of tracheal necrosis
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Anytime the air is dry and the mucous membranes of the repiratory system become dry what will the tracheal bronchial tree do
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compensate by producing copious amounts of secretions
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Does a tracheostomy interfere with the ability to cough effectively
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YES must suction
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How long do I keep the cuff inflated on a Tracheostomy after feedings
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30 minutes minimum
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O2 of more then 4 L needs to be what
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humidified
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Laryngectomy clients will have a
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tracheostomy
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Does a laryngectomy tub have a large or small lumen
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large and is shorter than a normal tracheostomy tube
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What type of bleeding will you have right after a laryngectomy
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bright red in the first few hours after the procedure, Call Dr. IF bleeding after the first few hours
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Observe for what with a Laryngectomy during the first 24 hours
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bleeding or obstuction
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Laryngectomy secretions may be crusty if O2 is not
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humidified
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Laryngectomy clients have a fear of
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chocking due to glottis is gone, teach glottal stop technigue to remove secretions
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Glottal stop technique teaching
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take a deep breath, occlude the tracheostomy, cough and remove the finger at the same time
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Suction only when
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secretions are present
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What position is best for suctioning
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Semi Fowler is best
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Insert the suction catheter until
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coughing or resistance
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How long do I suction
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10-15 seconds only a maximum of 3 times
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What do I do prior to suctioning always
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hyper oxygenate
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Suction levels for a Neonate
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60-80 mmHg
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Suction levels for an infant
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80-100 mmHg
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Suction levels from a large child and adult
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100-120 mmHg
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What are chest tubes used for
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reestablish negative pressure in the pleural space, removes air or fluid from the pleural space, insterted when a client has a pneumothorax, hemothorax, and after thoracic surgery
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What side do I position the client on after a chest tube
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on the back and the non-operative side when chest tubs are in place
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Should the chest drainage system ever be raised above the level of the chest
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NO
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Chest tube has how many chambers
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Three, suction, water, drainage
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What Chest tube chamber has continuous bubbling expected
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Suction control Chamber, if intermittent, check the suction, may need to add water to the chamber to keep at current sonometers of suction
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What Chest tube chamber has intermittent bubbling
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Water seal Chamber, (with a massive pneumo, may bubble for 2 hours) but if persistent bubbling any other time, check for a leak, this chamber will fluctuate with breathing when pneumo is present (tideling is normal), if stopes check for obstruction
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What Chest tube chamber never bubles
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Drainage collection chamber, mark the level of drainage each shift,
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When drainage stops in the drainage collection chamber of a chest tube what does that mean
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problem is resolved
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Chest tube drainage after cardiac surgery for 1st 2 hours
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100 mL
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How do I locate a leak in a chest tube
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brief clamping of the tube starting at the CHEST, when clamping never longer than 15 seconds without an order, use a rubber tip double clamp
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When is milking of the chest tube done
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only when an occlusion is suspected such as a small clot, if the chest tub becomes obstructed, pressure will increase in the chest and cause decreased cardiac output due to medistinal shift
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If the collection chamber gets kicked over what do I do
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set it back up and have them take a couple of deep breaths
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If the water seal is ever broken what do I do
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put the chest tube that is connected to the patient under water
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To remove the chest tube
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have patient take a deep breath, exhale and bear down (The Valsalva maneuver), apply sterile Vaseline qauze and a dressing to the site, avoid heavy lifting for 4-6 weeks after discharge to facilitate healing
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When on mechanical ventilation how to I teach communication
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provide a picture or word board
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When time to wean from the ventilator do I sedate
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NO
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Do I empty condensation from the tubing with mechanical ventilation
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YES
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Breath sounds listen with what part of the stethoscope
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diagram
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Breat sounds stop at T ___ with end expiration
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T10
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Where are Bronchial sounds heard
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over the trachea
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If bronchial sounds are heard over periphery what does that mean
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consolidation and pneumonia
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Where are Bronchovesicular heard
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over the main bronchi
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When do you hear crackles
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inspiration and hear with heart failure
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When do you hear Rhonchi or gurfles
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moist sounds that clear with coughing
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How do you assess Stridor
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assess by listening over the trachea, will hear with croup
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What does wheezing indicate
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air moving through narrow air passages
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When is a pleural friction rub heard
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early in pleurisy
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Chest tube drainage after cardiac surgery for 24 hours
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500 mL
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Chest tube drainage after cardiac surgery has a sudden decrease
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check for blood clots
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What type of respiration is deep and most often rapid, associated with metabolic acidosis
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Kussmauls
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What type of regular periodic pattern of breathing, with intervals of apnea followed by a crescendo/decrescendo sequence of repirstions
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Cheyne Stokes, can be indicative of ICP or brain damage at the cerbral level
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Teaching on nebulizers
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form a tight seal aound the mouthpeice, inhale slowly and hold the breath for 2 seconds, exhale with the mouthpeice out
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How often should you do incentive spirometer and nebulizers
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10 time per hour
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Are nebulizers often used to give medications
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YES
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With proper coughing and deep breathing
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should feel the abdomen rise with inhalation
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Proper coughing and deep breathing with COPD
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have them hold their breath for two seconds prior to exhalation
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What can decrease episodes of dyspnea
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proper positioning includes sitting upright while leaning on an over bed table, sitting up upright in a chair with the arms resting on the knees, and leaning against a wall while standing, always put the client in a position to expand good lung tissue
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What type of position lowers the diaphragm and allows the better chest expansion
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Orthopneic position (upright or full fowlers, or standing)
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What helps to mobilize and clear secretions
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chest physical theraphy
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What is the first step in smoking cessation
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cutting back
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COPD clients should eat what
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six small meals a day and a controlled amount of carbs
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Oxyhemoglobin dissociation curve is the chart that shows the affinity that ______ has for _____
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hemoglobin has for oxygen
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Shift of the curve to the right on the Oxyhemoglobin means
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increased unloading of oxygen from the hemoglobin molecules to ischemic tissues, decreased PH, High PcO2 Increased Temp
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Shift of the curve to the left on the Oxyhemoglobin means
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increased affinity of hemoglobin to hold onto the oxygen and not released to the tissues, Acute alkalosis Increased PH, decreased PC02 Decreased temp
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