Ch 21 Respiratory Care Modalities
A nurse observes constant bubbling in the water-seal chamber of a closed chest drainage system. What should the nurse conclude?
The system has an air leak.
Read this ABG. pH=7.60 Co2=37 HCO3=35
This is metabolic alkalosis w/ no compensation.
Read this ABG. pH= 7.27 CO2=53 HCO3=24
This is respiratory acidosis with no compensation.
a nurse provides care for a client receiving oxygen from a nonrebreather mask. which nursing intervention has the highest priority?
assessing the client's respiratory status, orientation, and skin color.
A nurse prepares to perform postural drainage. How should the nurse ascertain the best position to facilitate clearing the lungs?
auscultation
Before weaning a client from a ventilator, which assessment parameter is the most important for the nurse to obtain?
baseline arterial blood gas levels (ABGs)
fraction of inspired oxygen (FiO2)
concentration of oxygen delivered (1.0 = 100% oxygen)
Hypoxia
decrease in oxygen supply to the tissues and cells
A pt is being educated in the use of incentive spirometry prior to having a surgical procedure. What should the nurse be sure to include in the education?
encourage the patient to take approximately 10 breaths per hour while awake
A home health nurse is visiting a home care client with advanced lung cancer. Upon assessing the client, the nurse discovers wheezing, bradycardia, and a respiratory rate of 10 breaths per minute. These signs are associated with which condition?
hypoxia. (As the respiratory center in the brain becomes depressed, hypoxia occurs, producing wheezing, bradycardia, and a decreased respiratory rate.)
endotracheal intubation
insertion of a breathing tube through the nose or mouth into the trachea
A client recovering from an acute asthma attack experiences respiratory alkalosis. The nurse measures a respiratory rate of 46 breaths/minute, a heart rate of 110 beats/minute, a blood pressure of 162/90 mm Hg, and a temperature of 98.6° F (37° C). To help correct respiratory alkalosis, the nurse should:
instruct the client to breathe into a paper bag.
A client w/ COPD is intubated and placed on continuous mechanical ventilation. Which equipment is most important for the nurse to keep at this client's bedside?
manual resuscitation bag
airway pressure release ventilation (APRV)
mode of mechanical ventilation that allows unrestricted, spontaneous breaths throughout the ventilatory cycle; on inspiration the patient receives a preset level of continuous positive airway pressure, and pressure is periodically released to aid expiration
When assessing a client, which adaptation indicates the presence of respiratory distress?
orthopnea
continuous positive airway pressure (CPAP)
positive pressure applied throughout the respiratory cycle to a spontaneously breathing patient to promote alveolar and airway stability; may be administered with endotracheal or tracheostomy tube or by mask
Which of the following electrolytes is the primary determinant of extracellular fluid (ECF) osmolality?
sodium (Sodium is the primary determinant of ECF osmolality. Sodium plays a major role in controlling water distribution throughout the body because it does not easily cross the intracellular wall membrane and because of its abundance and high concentration in the body. Potassium, calcium, and magnesium are not primary determinants of ECF osmolality.)
The nurse is assisting a physician with an endotracheal intubation for a client in respiratory failure. It is most important for the nurse to assess for
symmetry of the client's chest expansion
A client is prescribed postural drainage because secretions are accumulating in the upper lobes of the lungs. The nurse instructs the client to ___
take prescribed albuterol (Ventolin) before performing postural drainage
chest drainage system
the use of a chest tube and closed drainage system to re-expand the lung and to remove excess air, fluid, and blood
Chest physiotherapy (CPT)
therapy used to remove bronchial secretions, improve ventilation, and increase the efficiency of the respiratory muscles; types include postural drainage, chest percussion, and vibration
After lobectomy for lung cancer, a client receives a chest tube connected to a disposable chest drainage system. The nurse observes that the drainage system is functioning correctly when she notes tidal movements or fluctuations in which compartment of the system as the client breathes?
water-seal chamber
When performing ET suctioning, the nurse applies suctioning while withdrawing and gently rotating the catheter 360 degrees for how long?
10 to 15 seconds
Below which serum sodium concentration might convulsions or coma occur?
135 mEq/L (135 mol/L)
What is the normal HCO3 level?
22-26
What is the normal CO2?
35-45
What is normal pH?
7.35-7.45
For a client who has a chest tube connected to a closed water-seal drainage system, the nurse should include which action in the care plan?
Measuring and documenting the drainage in the collection chamber.
The nurse is preparing to perform tracheostomy care for a client with a newly inserted tracheostomy tube. Which action, if performed by the nurse, indicates the need for further review of the procedure?
Places clean tracheostomy ties then removes soiled ties after the new ties are in place. (For a new tracheostomy, two people should assist with tie changes.)
The nurse is preparing to perform chest physiotherapy (CPT) on a client. Which statement by the client tells the nurse that the procedure is contraindicated?
"I just finished eating my lunch, I'm ready for CPT now."
The nurse works on a unit with elderly clients. Which of the following clients would the nurse visit first? The client who reports
"It feels like I have food stuck in my throat."
A client with a respiratory condition is receiving oxygen therapy. While assessing the client's PaO2, the nurse knows that the therapy has been effective based on which of the following readings?
84 mm Hg. (In general, clients with respiratory conditions are given oxygen therapy only to increased the arterial oxygen pressure AKA PaO2 back to the client's normal baseline, which may vary from 60 to 95 mm Hg.)
A pt is diagnosed with mild OSA after having a sleep study performed. What treatment modality will be the most effective for this patient?
Continuous positive airway pressure. (CPAP. CPAP provides positive airway pressure to the airways throughout the respiratory cycle. Although it can be used as an adjunct to mechanical ventilation with a cuffed Et tube or tracheostomy tube to open the alveoli, it is also used with a leak-proof mask to keep alveoli open, thereby preventing respiratory failure.)
The nurse is admitting a patient with COPD. The decrease of what substance in the blood gas analysis would indicate to the nurse that the patient is experiencing hypoxemia?
PaO2. (Hypoxemic hypoxia, or hypoxemia, is a decreased oxygen level in the blood-- PaO2-- resulting in decreased oxygen diffusion into the tissues.)
A client is on a ventilator. Alarms are sounding, indicating an increase in peak airway pressure. The nurse assesses first for
a kink in the ventilator tubing. (One event that could cause the ventilator's peak-airway-pressure alarm to sound is a kink in the ventilator tubing. After making this and other assessments without correction, then it could be a malfunction of the alarm button. Higher than normal ET cuff pressure could cause client tissue damage but would not make the ventilator alarms sound. A cut or slice in the tubing from the ventilator would result in decreased pressure.)
A new ICU nurse is observed by her preceptor entering a patient's room to suction the tracheostomy after performing the task 15 minutes before. What should the preceptor educate the new nurse to do to ensure that the pt needs to be suctioned?
auscultate the lungs for adventitious sounds
The nurse assesses a pt with a HR of 42 and a bp of 70/46. what type of hypoxia does the nurse determine the pt is displaying?
circulatory hypoxia. (given this pt's VS, he appears to be in shock. Circulatory hypoxia results from inadequate capillary circulation. It may be caused by decreased cardiac output, local vascular obstruction, low-flow states such as shock, or cardiac arrest. Although tissue partial pressure of oxygen (PO2) is reduced, arterial oxygen (PaO2) remains normal. Circulatory hypoxia is corrected by identifying and treating the underlying cause.)
chest percussion
manually cupping hands over the chest wall and using vibration to mobilize secretions by mechanically dislodging viscous or adherent secretions in the lungs
assist-control (A/C) ventilation
mode of mechanical ventilation in which the patient's breathing pattern may trigger the ventilator to deliver a preset tidal volume; in the absence of spontaneous breathing, the machine delivers a controlled breath at a preset minimum rate and tidal volume
continuous mandatory ventilation (CMV)
mode of mechanical ventilation in which the ventilator completely controls the patient's ventilation according to preset tidal volumes and respiratory rate; because of problems with synchrony, it is rarely used except in paralyzed or anesthetized patients
A client is receiving supplemental oxygen. When determining the effectiveness of oxygen therapy, which arterial blood gas value is most important?
partial pressure of arterial oxygen (PaO2). (The most significant and direct indicator of the effectiveness of oxygen therapy is the PaO2 value. Based on the PaO2 value, the nurse may adjust the type of oxygen delivery, flow rate, and oxygen percentage. PaO2 shows how well oxygen is able to move from the lungs to the blood.)
A client with COPD has been receiving oxygen therapy for an extended period. What symptoms would be indicators that the client is experiencing oxygen toxicity? Select all that apply.
substernal pain, dyspnea, fatigue. (Oxygen toxicity can occur when clients receive too high a concentration of oxygen for an extended period. Symptoms include dyspnea, substernal pain, restlessness, fatigue, progressive respiratory difficulty. NOT BRADYCARDIA.)
The nurse suctions a pt through the ET tube for 20 seconds and observes dysrhythmias on the monitor. What does the nurse determine is occurring with the pt?
the pt is hypoxic from suctioning.
The nurse is caring for a client with an endotracheal tube (ET). Which nursing intervention is contraindicated?
Routinely deflating the cuff. (Routine cuff deflation is not recommended because of the increased risk of aspiration an hypoxia. The cuff is deflated before the ET tube is removed. Cuff pressures should be checked every 6-8 hrs. Humidified oxygen should always be introduced through the tube.)
What is the normal PaO2 level?
The normal PaO2, or arterial oxygen pressure, may vary normally from 60 to 95 mm Hg.
Read this ABG. pH=7.30 CO2=30 HCO3=14
metabolic acidosis w/ partial compensation. (Metabolic acidosis with partial compensation and the client is experiencing some hypoxemia. Some Possible causes: renal failure, diarrhea, poisonings, DKA.)
A client is on a positive-pressure ventilator with a synchronized intermittent mandatory ventilation (SIMV) setting. the ventilator is set for 8 breaths per minute. The client is taking 6 breaths per minute independently. The nurse ___
continues assessing the client's respiratory status frequently. (The SIMV setting on a ventilator allows the client to breathe spontaneously with no assistance from the ventilator for those extra breaths. Data in the stem suggest that the ventilator is working correctly. The nurse would continue making frequent respiratory assessments of the client. There is not enough data to suggest that the client could be removed from the ventilator. There is no reason to increase the ventilator's setting to 14 breaths per minute or to contact respiratory therapy to report the machine is not working properly.)
A client suffers from ARDS because of shock. The client's condition deteriorates rapidly and endotracheal (ET) intubation and mechanical ventilation are initiated. When the high-pressure alarm on the mechanical ventilator sounds, the nurse starts to check for the cause. Which condition triggers the high-pressure alarm?
kinking of the ventilator tubing. (Conditions that trigger the high-pressure alarm include kinking of the ventilator tubing, bronchospasm, pulmonary embolus, mucus plugging, water in the tube, and coughing or biting of the ET tube. The alarm may also be triggered when the client's breathing is out of rhythm with the ventilator. A disconnected ventilator circuit or an ET cuff leak would trigger the low-pressure alarm. Changing the oxygen concentration without resetting the oxygen level alarm would trigger the oxygen alarm, not the high pressure alarm.)
