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Respiratory Modalities - Jillapli
Terms in this set (129)
what is the effect of age related decreased skeletal muscle strength on the effectiveness of gas exchange?
A. reduced gas exchange as a result of decreased alveolar surface
B. reduced gas exchange as a result of longer relaxation of bronchiolar smooth muscles
C. reduced gas exchange as a result of decreased changes in pressures of the chest cavity
D. Reduced gas exchange as a result of failure of pulmonary circulation to fully perfuse lung tissue
rationale: chest muscles keep with pressure changes = effects gas exchange
oxygen therapy: hypoxia
abnormally low O2 content in any tissue or organ despite adequate perfusion of the tissue by blood
oxygen therapy: instrument used to measure hypoxia [hint: pulse ox or ABG?]
oxygen therapy: hypoxemia
insufficient oxygenation of arterial blood
oxygen therapy: hypoxemia instrument used [hint: pulse ox or ABG]
oxygen therapy is considered a drug for treatment - o2 concentration in room air should be
oxygen therapy: administer _______ amount of o2 to maintain SaO2 between _______ with no complications **
amount (%) of O2 delivered
Fi02 [fraction of O2]
O2 levels delivered are unique to the individual and there is no set amount to give. But you will need to wean higher or lower based on O2 stats
oxygen toxicity: High FiO2 **
>50% for >24-48 hrs
oxygen toxicity: high risk patients
intubated and mechanically intubated
oxygen toxicity: prevention
lowest fiO2 to keep SaO2 >95% and/or PaO2 >60mmhg
oxygen toxicity: manifestations **
behind the sternum (substernal) CP increased with deep breathing
infiltrates on CXR
HA, sore throat
oxygen toxicity: patho
high fi02 for prolonged periods --> increases o2 free radicals ---> damage alveolar capillary membrane --> lung parenchyma damage ---> ARDS [acute resp distress syndrome]
what do oxygen free radicals do the tissue and cells
oxygen induced hypercapnia: high risk patients
COPD, chronic low PO2 and increased PCO2, children with heart diseases
Risk for HYPERCAPNIA nor HYPOVENTILATION
hypoxic drive disproved : teaching points
you may need extra oxygen especially in cases of infection
oxygen induced hypercapnia: prevention
respiratory assessment, LOC, SaO2
lowest FiO2 needed to maintain SaO2 95% and above
s/s of resp depression
what mas is the most accurate and the best to use for chronic hypoexmia like COPD
s/s of resp depression
dec rr and dec loc. try to awaken first before assuming resp depression
the RN has received report about all of these clients. what client needs the most immediate assessment?
a. client admitted 3 hours ago for a scheduled thoracentesis in 30 minutes
b. client with acute asthma who has an oxygen sat of 89% by pulse ox
pulse oximetry: what is it?
non invasive, continuous or intermittent monitoring. hemoglobin O2 saturation
pulse oximetry: what percent of O2 is carried by hgb
pulse ox: normal SaO2:
who usually have slightly lower SaO2s
elderly, ppl of color
pulse ox: probe sites
what percentage of o2 stats does ABGs monitor
o2 binds to heme
pulse oximetry: detects desaturation BEFORE s/s appear. what are the s/s of desaturation?
dusky skin, pale mucosa, pale or blue nails and lips, restlessness, decreased sp02
pulse oximetry: what can create a false low reading?
decreased perip blood flow
ambient light (sunlight, infrared lights). edema
pulse oximetry: what is considered an EMERGENCY Sp02 reading?
<91%... esp. <86%
pulse oximetry: what is a life threatening reading?
pulse oximetry: what would constitute a unreliable result?
cardiac arrest. shock. low perfusion. Trust the pulse ox whatever it says in these people
pulse oximetry: if SaO2 is less than 90% (hypoxemia) what is the rx? what do you do first?
Raise HOB then give O2
pulse oximetry: what is the patient goes from a pulse ox reading of 90-80%?
FIRST give O2
stick note: a pt recieving O2 via Venturi mask, what indications are present that the pts O2 status has worsened? indications it has improved?
suctioning: oropharyngeal is a _____ technique
suctioning: tracheal is a ___ technique
suctioning: what should you do to the pt before and after suctioning?
suctioning: what is a appropriate suctioning pressure?
suctioning: what type of suctioning should be applied? intermittent or continuous?
suctioning: duration of each pass?
suctioning: limit number of passes ?
3 or less
suctioning: DO NOT instill ______________
during nasotracheal suctioning, the client's heart rate changes fro 78 beats/min to 48 beats/min. what is the nurse's best FIRST action?
A. immediately stop suctioning
B. Gently pinch the client's cheek
C. administer O2 by mask at 2L/min
D. Document the change as the only action
vagal reactions have happened here.
what are vagal reactions?
tube obstruction S/S
difficulty inserting suction catheter
to prevent obstruction what should you do?
cough deep breath
to prevent tube dislodgement/accidental decannulation what should you do?
if you can not secure an airway then what do you do
call the RRT. extra tubes are at beside
post tracheostomy complications
subq emphysema (air in sq tissue)
if the skin around a new trach is puffy, crackling sensation on palpation
is bleeding expected post tracheostomy?
yes a small amount. with constant oozing apply pressure.
sterile technique, assess stoma skin care
within 72 hours decannulation is a MEDICAL EMERGENCY... why? what is the rx?
bc the tissues are still swollen so it will be difficult to replace..
rx is prevention
a new graduate RN discovers that her client, who had a tracheostomy placed the previous day has completely dislodged both obturator and trachestomy tube. which action should the nurse take first?
a. replace the obturator while reinserting the trach tube
b. auscultate the client's breath sounds while applying the nasal cannula
c. apply a 100% non rebreather mask while administering high flow oxygen
d. direct someone to call the rapid response team while using resuscitation bag and facemask. stay with pt maintaining the airway
A is done by RRT or an experienced RN not a new graduate
bronchoscopy: diagnostic uses
determines the problem or cause
stage lung cancers
directly visualize airway damage in trauma
biopsy and collect specimens
differentiate rejection from infx
bronchoscopy: therapeutic uses
aspirate retained secretions
control massive bleeding
remove foreign body
placement of stents
change endotracheal tube
what is bronchoalveolar lavage?
use bronchoscope to clean lungs and tubes. push fluid into to the lungs... pull it back out and may use fluid for labs
bronchoscopy: insertion sites
nares or oropharynx
bronchoscopy: pt care before
bronchoscopy: two pt identifiers
final verification before procedure
bronchoscopy: labs needed for invasive procedures as such ?
bronchoscopy: increased PT means long time to clot
bronchoscopy: decreased PT means short time to clot
bronchoscopy: need to be NPO
4-8hrs prior to decrease aspiration risk
bronchoscopy: pt care during procedure
endoscopy suite or bedside
premedication with benzodiazepines
topical anesthetic sprays - lidocaine
monitor vs, resp pattern, saO2, supp O2
bronchoscopy: duration of procedure
bronchoscopy: premedication used
bronchoscopy: topical anesthetic spray used
bronchoscopy: post procedure pt care
instruct pt not to eat or drink anything until gag reflex has returned
how long before gag reflex returns?
bronchoscopy: post procedure observations
breath sounds, VS swallowing, trach or bleeding, LOC, hemorrhage[blood tinged sputum], laryngospasms
what develops within 24hours after a bronchoscopy and is an EXPECTED finding? what else is a expected finding?
fever ; sore throat
bronchoscopy: need a chest xray to monitor for
bronchoscopy: tell families that biopsy and culture reports will be available in
salt water gargle/throat lozenges for sore throat
certain cardiac arrhythmias
bleeding or coagulation disorders
severe tracheal stenosis
bronchoscopy: potential complications
laryngospams and bronchospasms
hemorrhage - after biopsy
shock.. cardiac arhythmias
infection or bacterial sepsis
anaphylactic reactions to drugs
a nurse is assessing a client following a bronchoscopy. which of the following findings should the nurse report to the provider?
a. blood tinged sputum
b. dry non productive cough
c. sore throat
all the others are expected
thoracentesis: what is it
aspiration of pleural fluid for diagnostic or therapeutic purposes
removal of fluid and air from pleural cavity
aspiration of pleural fluid for analysis
instillation of meds into space -- comfort measure not a rx...pts with lung ca [pleurodesis/sclerosis]
transparent... 3rd spacing
neoplastic ...... [something idk]
what do aspirated fluid analysis analyze?
protein and glucose content
enzymes such as lactate dehydrogenase LDH
abnormal cells and culture
thoracentesis: procedure what do you need?
thoracentesis: what position should the patient be in?
sitting upright with arms and shoulders raised and supported on pillows over bed table
thoracentesis: instructions for during the procedure?
remain absolutely still (risk of accidental needle damage. throacic tissues are thick so you will feel like you are being pushed)
do not cough or talk unless instructed
surgical aseptic technique, need sterile count
thoracentesis: monitor what?
VS, skin color, and SaO2
measure and record amount of fluid removed
thoracentesis: how much fluid should be removed at a time?
<1L at a time to prevent aspiration and re-expansion... pulm edema
pneumothorax.. tension pneumothorax
monitor s/s of ptx
post procedure xray
Document air movement
what are the s/s of ptx?
diminished breath sounds
thoracentesis: bleeding monitor
coughing and or hemoptysis
vs and labs [dec BP and h/h]
maintain sterile technique
monitor temp following procedure
low grade fevers are ok but once getting to 101.4 call HCP
a nurse is caring for a client following a thoracentesis. which of the following manifestations should the nurse recognize as risks for complications? SATA
b. localized bloody drainage contained on dressing
d. hypotension [intrathoracic bleeding]
e. report of pain at the puncture site
a and d
lung biopsy - not a therapeutic measure.. diagnostic. what is it
obtain lung tissue samples to diagnose: cancer type, infections, inflammation or lung disease
lung biopsy: during a bronchoscopy what might be done
transbronchial biopsy... transbronchial needle aspiration
lung biopsy: transbronchial needle aspiration you need to premedicate with what
sedative for anxiety
lung biopsy: transthoracic needle aspiration
percutaneous with local anesthesia
lung biopsy: open lung biopsy
lung biopsy: what is the positioning for percutaneous
same as thoracentesis or side lying
lung biopsy: post procedure
monitor vs, breath sounds[*
includes air movement]
*, hemoptysis, s/s of resp distress
s/s of resp distress
lung biopsy: report*
reduced or absent breath sounds or air movement IMMEDIATELY *
lung biopsy: why do you get a chest xray? **
to rule out PTX ... DUH **
airway maintenance: what is the goal?
improve gas exchange
airway maintenance: what do you do?
keep head, neck and chest in alignment
liquefy secretions so their is easy removal
impaired gas exchange: what is the goal
SaO2 at least 95% or within patient's normal range
absence of cyanosis
impaired gas exchange: oxygen therapy
appropriate device and flow rate - make sure applied correctly and humidify O2
no smoking signs - esp with home therapy
maintain patent airway
impaired gas exchange: oxygen therapy --- monitor
s.s of oxygen toxicity
areas of skin breakdown
patient's tolerance of device and rx
SaO2 or ABGS
ineffective airway clearance: goal
effective cough. SaO2 ?95%
no pallor or cyanosis
no crackles and wheezes
ineffective airway clearance: ways to prevent and rx
cough and deep breath
at least 3L fluids each day: i/o
bronchodilators (beta agonists) for bronchospasms
inhaled steriods for airway swelling
what is the proper use and technique for incentive spirometer as well as CDB
q2h when awake .. do not wake them
why 3l fluids daily?
to thin secretions.. makes for easy removal
ineffective breathing pattern: goal
RR normal for patients age
synchronous thoracoabdominal movement
use of accessory muscles appropriate to activity level
increased activity tolerance
ineffective airway clearance: breathing techniques *
look at charts
diaphragmatic/abdominal and pursed lip breathing
ineffective airway clearance: determine contributing factors
treat underlying conditions
ineffective airway clearance: positioning
ineffective airway clearance: energy conservations TEACH
avoid working with arms raised- can effect breathing
assist with ADLS
limit talking during activities
adaptive tools for house work
activity intolerance: goal
maintain baseline SaO2 with activity
perform adls with no or minimal assistance
perform activities with minimal dyspnea or tachycardia
paticipate in family, work, social activities
what is activity intolerance?
how fast VS return to baseline. faster to normal the better tolerance... being out of breath is fine but depending on how fast you recover determines tolerance or intolerance
activity intolerance: acute phase
assistance with ADLE
need suppl. O2 duing periods of high energy use
activity intolerance: chronic phase
pace activities - need suppl. O2 duing periods of high energy use
perform most self care
activity intolerance: monitor
wob [work of breath]
lung biopsy: why do you get a chest xray?
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