Oxy/Cir Exam 3 pt 2

excessive bicarb;NaHCO3, m. blood transfusion (liver converts citrate HCO3), mild/mod ECV defecit (contraction alkalosis), <metabolic acid, e. or prolonged vomiting; gastric suctioning, hypokalmeia, excess aldosterone

metabolic alkalosis causes

ph less than 7.35, PaCO2 normal (uncompenstated), or less than 35 (compensated), HCO3 less than 22, K+ maybe elevated, anion gap n.; high, <LOC (lethargy, confused, coma), ab pain, cardiac dysrhythmias, >rr rate; depth (compensatory hyperventilation)

metabolic acidosis

A registered nurse is educating a client who has just undergone thoracentesis on the manifestations of pneumothorax. Which statements made by the client indicate effective learning? Select all that apply. Correct1 "I'll report any instance of blue skin right away." Correct2 "I'll report any feeling of air hunger immediately." 3 "I'll report any decrease in heart rate immediately." 4 "I'll call you right away if my nagging cough disappears." 5 "I'll call you right away if my shallow breathing goes away."

"I'll report any instance of blue skin right away." "I'll report any feeling of air hunger immediately." (Client teaching regarding the manifestations of pneumothorax, partial or complete collapse of the lung, which may occur in the 24 hours after thoracentesis, is important. Manifestations that require immediate contact with the nearest emergency department are cyanosis and a feeling of air hunger. Other findings that must be reported include rapid heart rate (not decreased), a new-onset nagging cough (rather than the disappearance of such a cough), and rapid and shallow respirations (not the cessation of such respirations).

A client's arterial blood gas report indicates that pH is 7.25, PCO2 is 35 mm Hg, and HCO3 is 20 mEq/L (20 mmol/L). Which client should the nurse consider is most likely to exhibit these results? A 54-year-old with vomiting A 17-year-old with panic attacks A 24-year-old with diabetic ketoacidosis A 65-year-old with advanced emphysema

A 24-year-old with diabetic ketoacidosis (The low pH and bicarbonate levels are consistent with metabolic acidosis, which can be caused by excess ketones, a result of diabetic ketoacidosis. A 54-year-old with vomiting most likely will experience metabolic alkalosis from loss of gastric hydrochloric acid. A 17-year-old with panic attacks most likely will experience respiratory alkalosis from hyperventilation. A 65-year-old with advanced emphysema most likely will experience respiratory acidosis.)

A client's arterial blood gas report indicates that pH is 7.25, Pco2 is 60 mm Hg, and HCO3 is 26 mEq/L (26 mmol/L). Which client should the nurse consider is most likely to exhibit these blood gas results? A 65-year-old with pulmonary fibrosis A 24-year-old with uncontrolled type 1 diabetes A 45-year-old who has been vomiting for 3 days A 54-year-old who takes sodium bicarbonate for indigestion

A 65-year-old with pulmonary fibrosis (The low pH and elevated Pco2 are consistent with respiratory acidosis, which can be caused by pulmonary fibrosis, which impedes the exchange of oxygen and carbon dioxide in the lung. A 24-year-old with uncontrolled type 1 diabetes most likely will experience metabolic acidosis from excess ketone bodies in the blood. A 45-year-old who has been vomiting for 3 days most likely will experience metabolic alkalosis from the loss of hydrochloric acid from vomiting. A 54-year-old who takes sodium bicarbonate for indigestion most likely will experience metabolic alkalosis from an excess of base bicarbonate.)

The surgeon placed two chest tubes and attached the tubes to a closed-chest drainage system in a client who underwent chest surgery. Mark the area the nurse should palpate to identify the hemothorax.

A hemothorax is common in clients who have sustained trauma. It is an accumulation of blood and fluid in the pleural cavity between the parietal and visceral pleura. It produces counterpressure and prevents the lung from full expansion. A blood drainage tube is placed, and the marked area is palpated to identify the hemothorax.

client reports left-sided chest pain after playing racquetball. The client is hospitalized and diagnosed with left pneumothorax. When assessing the client's left chest area, the nurse expects to identify which finding? Dull sound on percussion Vocal fremitus on palpation Rales with rhonchi on auscultation Absence of breath sounds on auscultation

Absence of breath sounds on auscultation (The left lung is collapsed; therefore, there are no breath sounds. A tympanic, not a dull, sound will be heard with a pneumothorax [1] [2]. There is no vocal fremitus because there is no airflow into the left lung as a result of the pneumothorax. Rales with rhonchi will not be heard because there is no airflow into the left lung as a result of the pneumothorax.)

A client comes to the emergency department reporting chest pain and difficulty breathing. A chest x-ray reveals a pneumothorax. Which finding should the nurse expect to identify when assessing the client? 1 Distended neck veins 2 Paradoxical respirations 3 Increasing amounts of purulent sputum 4 Absence of breath sounds over the affected area

Absence of breath sounds over the affected area

A client is diagnosed with a spontaneous pneumothorax. Which physiologic effect of a spontaneous pneumothorax should the nurse include in a teaching plan for the client? Air will move from the lung into the pleural space. The heart and great vessels shift toward the affected side. There is greater negative pressure within the chest cavity. Collapse of the other lung will occur if not treated immediately.

Air will move from the lung into the pleural space. (As a person with a tear in the lung inhales, air moves through that opening into the intrapleural space; this creates a positive pressure and causes partial or complete collapse of the lung. Mediastinal shift occurs toward the unaffected side. Greater negative pressure within the chest cavity is normal; with a pneumothorax, there is a loss of intrathoracic negative pressure. Collapse of the other lung will occur if not treated immediately is not an impending problem.)

A client with a malignant parotid tumor is treated aggressively with radiation therapy and surgery. Postsurgical arterial blood gas results are as follows: pH 7.32, PCO2 53 mm Hg, and HCO3 25 mEq (25 mmol/L). The nurse should take which action? 1 Obtain a prescription and administer a diuretic. 2 Instruct the client to breathe into a rebreather bag at a slow rate. 3 Ask the client to cough forcefully and take deep breaths. 4 Obtain a prescription for sodium bicarbonate.

Ask the client to cough forcefully and take deep breaths. (The client is in respiratory acidosis probably caused by the depressant effects of anesthesia or a partially obstructed airway; these activities clear the airway and blow off CO2. Obtaining a prescription and administering a diuretic will not correct respiratory acidosis and may aggravate it if potassium is depleted. Having the client breathe into a rebreather bag at a slow rate is the treatment for respiratory alkalosis; the client is in respiratory acidosis. Obtaining a prescription for the administration of sodium bicarbonate is not necessary if clearing of the airway rectifies the problem.)

A client who experienced smoke inhalation has a negative chest x-ray and arterial blood gases that demonstrate PaO2 of 75 mm Hg, PaCO2 of 45 mm Hg, and pH of 7.35. Which intervention should the nurse anticipate will be prescribed by the healthcare provider? Deep suctioning 2 Bronchodilators 3 Breathing exercises 4 Mechanical ventilation

Breathing exercises (slow breathing or low O2. Breathing exercises are needed. The client has hypoxemia; the expected range for PaO2 is 80 to 100 mm Hg. This intervention expands the alveoli, moves secretions toward the mouth to be expectorated, and increases the amount of oxygen that is delivered to alveolar capillary beds. Routine suctioning may injure already traumatized tissues and is contraindicated. Bronchodilators and mechanical ventilation are not indicated at this time based upon the x-ray results and PaCO2 and pH results.)

A client has a pneumothorax, and a closed-chest drainage system is inserted to allow the lung to reinflate. Identify the chamber in the figure below that provides the water seal. A B C D

C (The water-seal chamber acts as a one-way valve that allows air from the pleural space to escape into the suction chamber but that prevents a backflow of air from within the system to the client. A provides suction control. B and D collect drainage from the client)

A nurse is caring for a client who has chest tubes inserted to treat a hemothorax that resulted from a crushing chest injury. While planning care for a stationary chest tube drainage system, which purpose of the first chamber will the nurse consider? Correct1 Collect drainage Incorrect2 Ensure adequate suction 3 Maintain negative pressure 4 Sustain a continuance of the water seal

Collect drainage (The chamber closest to the client in a three-chamber system [1] [2] is the first chamber; it collects drainage. Chamber 2 is the water seal that ensures that air does not enter the pleural space. Chamber 3 is the suction control chamber of the system. The third chamber in a three-chamber system is the suction regulator when it is attached to a source of suction. Chamber 1, the chamber closest to the client in a three-chamber system, does not maintain negative pressure. The second chamber is the water-seal chamber that prevents air from entering the client's pleural space.)

The nurse plans interventions for a client with smoke inhalation based on a negative chest x-ray and arterial blood gases that show a PO2 of 85 mm Hg, a PCO2 of 45 mm Hg, and a pH of 7.35. Which interventions should the nurse anticipate will be prescribed? Select all that apply. Coughing Deep breathing Bronchodilators Humidified oxygen Bronchial suctioning

Coughing Deep breathing Humidified oxygen (Coughing moves secretions toward the mouth to be expectorated. Deep breathing expands the alveoli and increases the amount of oxygen being delivered to the alveolar capillary beds. Humidified oxygen increases the amount of oxygen that is being delivered to the alveolar capillary beds. Bronchodilators are not indicated at this time because the x-ray, PCO2, and pH are still within acceptable limits. Bronchial suctioning is not indicated at this time because the x-ray, PCO2, and pH results are still within acceptable limits)

After a gastrectomy, a client has a nasogastric tube to low continuous suction. The client begins to hyperventilate. How does the nurse anticipate that this breathing pattern will alter the client's arterial blood gases? Increase the PO2 level Decrease the pH level Increase the HCO3 level Decrease the Pco2 level

Decrease the Pco2 level (Hyperventilation results in the increased elimination of carbon dioxide from the blood. The PO2 level is not affected. The pH level will increase. The carbonic acid level will decrease.)

A preterm infant with respiratory distress syndrome (RDS) has blood drawn for an arterial blood gas analysis. Which test result should the nurse anticipate for this infant? Increased Po2 Lowered HCO3 Decreased Pco2 Decreased blood pH

Decreased blood pH (In addition to increased Pco2, hypoxia from inadequate oxygen/carbon dioxide exchange leads to anaerobic metabolism with an accumulation of acid by-products; both lower blood pH. Po2 is decreased, because inadequate lung surface area is available for diffusion of gases. Acidosis, not alkalosis, is present; bicarbonate will be normal or increased in the body's attempt to compensate. Pco2 increases, because inadequate lung surface area is available for the diffusion of gases.)

When a client suffers a complete pneumothorax, there is danger of a mediastinal shift. If such a shift occurs, what potential effect is a cause for concern? 1 Rupture of the pericardium 2 Infection of the subpleural lining 3 Decreased filling of the right side of the heart 4 Increased volume of the unaffected lung

Decreased filling of the right side of the heart (Pressure within the pleural cavity causes a shift of the heart and great vessels to the unaffected side. This not only decreases the capacity of the unaffected lung but also impedes the filling of the right side of the heart and leads to a decreased cardiac output. Rupture of the pericardium might occur with severe chest trauma, not with a mediastinal shift. Infection is not caused by a mediastinal shift. The volume of the unaffected lung may decrease because of pressure from the shift)

A client with emphysema is admitted to the hospital with pneumonia. On the third hospital day, the client complains of a sharp pain on the right side of the chest. The nurse suspects a pneumothorax. What breath sound is most likely to be present when the nurse assesses the client's right side? Crackling Wheezing Decreased sounds Adventitious sounds

Decreased sounds (Because the affected lung will not expand, aeration of the lung is not complete, and breath sounds are diminished. Crackling sounds occur with pulmonary edema, not with a pneumothorax; with a pneumothorax there is no air in the alveoli to produce crackles. Wheezing sounds occur with asthma, not with a pneumothorax. "Adventitious sounds" is a broad term that includes all abnormal breath sounds; it is not specific to pneumothorax.)

A nurse is caring for a client with a pneumothorax who has a chest tube in place. What should the nurse do when caring for this client? Encourage range of motion to the client's arm on the affected side Administer the prescribed cough suppressant at the prescribed times Empty and measure the drainage in the collection chamber each shift Apply clamps below the insertion site when getting the client out of bed

Encourage range of motion to the client's arm on the affected side (Range-of-motion exercises to the client's arm on the affected side promote maintenance of function in the arm and shoulder. Cough suppressants are not indicated because coughing and deep breathing are encouraged to help reexpand the lung. Drainage is marked with time taped on the side of the device. The closed system is not entered for emptying; when full, the entire device is replaced. Clamps are not necessary and should be avoided because of the danger of precipitating a tension pneumothorax.)

Surgery is performed on a client with a parotid tumor. Postoperative arterial blood gas values are pH 7.32, PCO2 53 mm Hg, and HCO3 25 mEq/L (25 mmol/L). Which action should the nurse take? Administer a potent diuretic Obtain a prescription for an alkalinizing agent Have the client breathe into a rebreather bag at a slow rate Encourage the client to cough and then take deep breaths between coughs

Encourage the client to cough and then take deep breaths between coughs (resp acidosis) (The client is in respiratory acidosis, probably caused by depressant effects of the anesthetic or a plugged airway; coughing clears the airway, and deep breaths blow off carbon dioxide. Administering a diuretic will not correct respiratory acidosis and may aggravate hypokalemia if present. An alkalinizing agent is not necessary if clearing the airway rectifies the problem. Having the client breathe into a rebreather bag at a slow rate is the treatment for respiratory alkalosis; the client is in respiratory acidosis.)

Surgery is performed on a client. The postoperative arterial blood gas values are pH 7.32, PCO2 53 mm Hg, and HCO3 25 mEq/L (25 mmol/L). Which action should the nurse take? 1 Obtain a prescription for a diuretic. 2 Have the client breathe into a rebreather bag. 3 Encourage the client to take deep, cleansing breaths. 4 Request a prescription for the administration of sodium bicarbonate.

Encourage the client to take deep, cleansing breaths. (The client is in respiratory acidosis, probably caused by the depressant effects of an anesthetic or a compromised airway; deep breaths blow off CO2 and encourage coughing. Obtaining a prescription for a diuretic will not correct respiratory acidosis and may aggravate hypokalemia if present. Having the client breathe into a rebreather bag is the treatment for respiratory alkalosis; the client is in respiratory acidosis. Obtaining a medical prescription for the administration of sodium bicarbonate is not necessary if clearing of the airway corrects the problem. Topics)

A client's arterial blood gas report indicates the pH is 7.52, PCO2 is 32 mm Hg, and HCO3 is 24 mEq/L. What does the nurse identify as a possible cause of these results? 1 Airway obstruction 2 Inadequate nutrition 3 Prolonged gastric suction 4 Excessive mechanical ventilation

Excessive mechanical ventilation (The high pH and low carbon dioxide level are consistent with respiratory alkalosis, which can be caused by mechanical ventilation that is too aggressive. Airway obstruction causes carbon dioxide buildup, which leads to respiratory acidosis. Inadequate nutrition causes excess ketones, which can lead to metabolic acidosis. Prolonged gastric suction causes loss of hydrochloric acid, which can lead to metabolic alkalosis.)

A spontaneous pneumothorax is suspected in a client with a history of emphysema. In addition to calling the healthcare provider, which action should the nurse take? Place the client on the unaffected side Administer 60% oxygen via a Venturi mask Give oxygen at 2 L per minute via nasal cannula Prepare for intravenous (IV) administration of electrolytes

Give oxygen at 2 L per minute via nasal cannula (Oxygen is supplied to prevent anoxia, but not in high concentrations without a prescription. In an individual with emphysema, a low oxygen level, not high carbon dioxide level, may be the respiratory stimulus. Placing the client on the unaffected side might increase the risk for mediastinal shift and interfere with expansion of the unaffected lung. Although oxygen is administered to prevent hypoxia, this concentration is too high for a client with emphysema because it may precipitate carbon dioxide narcosis. Preparing for an IV administration of electrolytes requires prescriptions as to specific electrolytes.)

After a spontaneous pneumothorax, the client becomes extremely drowsy, and the pulse and respirations increase. What do these client responses indicate to the nurse? Hypercapnia Hypokalemia Increased PO2 Respiratory alkalosis

Hypercapnia (Pneumothorax results in decreased surface area for gas exchange. If unaffected pleural regions cannot compensate, carbon dioxide builds up in the blood (hypercapnia). The client will become drowsy and may lose consciousness. The body attempts to compensate by increasing respiratory and pulse rates, and by the kidneys retaining bicarbonate. Hypokalemia causes extreme muscle weakness, abdominal distention, and changes in the ECG pattern. The PO2 is decreased with a pneumothorax because of the decreased surface area for gas exchange. Respiratory acidosis occurs with an elevated PCO2.)

A client who has acquired human immunodeficiency syndrome (HIV) develops bacterial pneumonia. On admission to the emergency department, the client's PaO2 is 80 mm Hg. When the arterial blood gases are drawn again, the level is determined to be 65 mm Hg. What should the nurse do first? Prepare to intubate the client. Increase the oxygen flow rate per facility protocol. Decrease the tension of oxygen in the plasma. Have the arterial blood gases redone to verify accuracy.

Increase the oxygen flow rate per facility protocol. (This decrease in PaO2 indicates respiratory failure; it warrants immediate medical evaluation. Most facilities have a protocol to increase the oxygen flow rate to keep oxygen saturation greater than 92%. The client PaO2 of 65 mm Hg is not severe enough to intubate the client without first increasing flow rate to determine if the client improves. Decreasing the tension of oxygen in the plasma is inappropriate and will compound the problem. The PaO2 is a measure of the pressure (tension) of oxygen in the plasma; this level is decreased in individuals who have perfusion difficulties, such as those with pneumonia. Having the arterial blood gases redone to verify accuracy is negligent and dangerous; a falling PaO2 level is a serious indication of worsening pulmonary status and must be addressed immediately. Drawing another blood sample and waiting for results will take too long.)

A 5-year-old child is admitted to the pediatric intensive care unit with a diagnosis of acute asthma. A blood sample is obtained to measure the child's arterial blood gases. What finding does the nurse expect? 1 High oxygen level 2 Increased alkalinity 3 Decreased bicarbonate 4 Increased carbon dioxide level

Increased carbon dioxide level (Gas exchange is limited because of narrowing and swelling of the bronchi; the carbon dioxide level increases. The oxygen level will be decreased, not increased. The pH will decrease; the child is in respiratory acidosis, not alkalosis. The bicarbonate level will be increased to compensate for acidosis.)

A client with a spontaneous pneumothorax asks, "Why did they put this tube into my chest?" Which information should the nurse provide about the purpose of the chest tube? It checks for bleeding in the lung. It monitors the function of the lung. It drains fluid from the pleural space. It removes air from the pleural space

It removes air from the pleural space (With a pneumothorax, a chest tube attached to a closed chest drainage system removes trapped air and helps to reestablish negative pressure within the pleural space; this results in lung reinflation. A closed chest drainage system may be inserted to remove blood related to a hemothorax, not to assess for bleeding. Monitoring the function of the lung is not the purpose of inserting chest tubes; the function of the lungs is monitored through the assessment of vital signs, breath sounds, arterial blood gases, and chest x-ray. Draining fluid from the pleural space is the reason for use of a closed chest drainage system when there is fluid in the pleural space.)

A nurse is caring for a client with a pneumothorax who has a chest tube in place with a closed drainage system. Which of these actions by the nurse is correct? Strip the chest tube periodically. Administer the prescribed cough suppressant at the scheduled times. Empty and measure the drainage in the collection chamber each shift. Keep the drainage system lower than the level of the client's chest.

Keep the drainage system lower than the level of the client's chest. (The drainage system is kept below the chest to allow gravity to drain the pleural space. The chest tube should not be stripped because this action can cause negative pressure and damage lung tissue. Cough suppressants are not indicated because coughing and deep breathing are encouraged to help reexpand the lung. The closed system is not entered for emptying; when full, the entire device is replaced.)

The arterial blood gases of a client with chronic obstructive pulmonary disease (COPD) deteriorate, and respiratory failure is impending. Which clinical indicator should the nurse assess first? Cyanosis Bradycardia Mental confusion Distended neck veins

Mental confusion (Decreased oxygen to the vital centers in the brain results in restlessness and confusion. Cyanosis is a late sign of respiratory failure. Tachycardia, not bradycardia, will occur as a compensatory mechanism to help increase oxygen to body cells. Distended neck veins occur with fluid volume excess (e.g., pulmonary edema).)

A 3-month-old infant who has a 3-day history of diarrhea is admitted to the pediatric unit. The nurse obtains the infant's vital signs, performs a physical assessment, and reviews the infant's arterial blood gas results. Which acid-base imbalance does the nurse suspect? Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis

Metabolic acidosis (he pH indicates acidosis, not alkalosis; the HCO3- level is further from the expected range than is the Pco2 level, indicating a metabolic, not respiratory, origin (losses from diarrhea).

A nurse assesses a client who is experiencing profound (late) hypovolemic shock. When monitoring the client's arterial blood gas results, which response does the nurse expect? Hypokalemia Metabolic acidosis Respiratory alkalosis Decreased carbon dioxide level

Metabolic acidosis (no fluid, like diarrhea, Decreased oxygen promotes the conversion of pyruvic acid to lactic acid, resulting in metabolic acidosis. Arterial blood gases do not assess serum potassium levels. Hyperkalemia will occur with shock because of renal shutdown. Respiratory alkalosis may occur in early shock because of rapid, shallow breathing, but in late shock metabolic or respiratory acidosis occurs. The carbon dioxide level will be increased in profound shock.

The laboratory data for a client with prolonged vomiting reveal arterial blood gases of pH 7.51, Pco2 of 50 mm Hg, HCO3 of 58 mEq/L (59 mmol/L), and a serum potassium level of 3.8 mEq/L (3.8 mmol/L). The nurse concludes that the findings support what diagnosis? Hypocapnia Hyperkalemia Metabolic alkalosis Respiratory acidosis

Metabolic alkalosis (Elevated plasma pH and elevated bicarbonate levels support metabolic alkalosis. The arterial carbon dioxide level of 50 mm Hg is elevated more than the expected value of 35 to 45 mm Hg; hypercapnia, not hypocapnia, is present. The client's serum potassium level is within the expected level of 3.5 to 5 mEq/L (3.5 to 5 mmol/L). With respiratory acidosis the pH will be less than 7.35.)

A nurse is caring for a client with a pneumothorax who has a chest tube attached to a closed chest drainage system. If the chest tube and closed chest drainage system are effective, what type of pressure will be reestablished? Neutral pressure in the pleural space Negative pressure in the pleural space Atmospheric pressure in the thoracic cavity Intrapulmonic pressure in the thoracic cavity

Negative pressure in the pleural space (Removal of air and fluid from the pleural space reestablishes negative pressure, resulting in lung expansion. Neutral pressure in the pleural space will cause collapse of the lung. Atmospheric pressure in the thoracic cavity will cause collapse of the lung. Intrapulmonic pressure refers to pressure within the lung itself, not the pressure within the thoracic cavity.)

The nurse is caring for a client with the following arterial blood gas (ABG) values: PO2 89 mm Hg, PCO2 35 mm Hg, and pH of 7.37. These findings indicate that the client is experiencing which condition? Respiratory alkalosis Poor oxygen perfusion Normal acid-base balance Compensated metabolic acidosis

Normal acid-base balance (All data are within expected limits; PO2 is 80 to 100 mm Hg, PCO2 is 35 to 45 mm Hg, and the pH is 7.35 to 7.45. None of the data are indicators of fluid balance, but of acid-base balance. Oxygen is within the expected limits of 80 to 100 mm Hg. With metabolic acidosis, the pH is less than 7.35.)

The nurse is caring for a client with type 1 diabetes who is developing ketoacidosis. Which arterial blood gas report is indicative of diabetic ketoacidosis? PCO2: 49, HCO3: 32, pH: 7.50 PCO2: 26, HCO3: 20, pH: 7.52 PCO2: 54, HCO3: 28, pH: 7.30 PCO2: 28, HCO3: 18, pH: 7.28

PCO2: 28, HCO3: 18, pH: 7.28 (Decreased pH and bicarbonate values reflect metabolic acidosis; a decreased PCO2 value indicates compensatory hyperventilation. Increased pH and bicarbonate values reflect metabolic alkalosis; an increased PCO2 value indicates compensatory hypoventilation. Increased pH and decreased PCO2 values reflect hyperventilation and respiratory alkalosis. Decreased pH and increased PCO2 values reflect hypoventilation and respiratory acidosis.)

A client develops subcutaneous emphysema after a chest injury with a suspected pneumothorax. What assessment by the nurse is the best method for assessing this complication? Percussing the neck and chest Palpating the neck or face Auscultating for abnormal breath sounds Observing for asymmetry of chest movement

Palpating the neck or face (Subcutaneous emphysema refers to the presence of air in the tissue that surrounds an opening in the normally closed respiratory tract; the tissue appears puffy and a crackling sensation is detected when trapped air is compressed between the nurse's palpating fingertips and the client's tissue. Percussion is not an appropriate method for assessment; breath sounds are not affected. Asymmetry of chest movements may occur because of the pneumothorax but is not indicative of subcutaneous emphysema)

A client with a pneumothorax has a chest tube inserted and attached to a closed chest drainage system. The client asks, "Why is the tube in my chest hooked up to a contraption with water in it?" How does the nurse explain the function of the water? Promotes pleural drainage via gravity Measures the pressures in the chest wall Prevents reflux of air back into the chest Ensures bubbling in the water-seal chamber

Prevents reflux of air back into the chest (Water acts as a seal, preventing air from entering the pleural space, which will interfere with expansion of the lung. Removal of air (drainage) is promoted by negative pressure, not gravity, in the closed chest drainage system. Water in the system does not facilitate measurement of pressures in the chest wall; this is not the purpose of a water-seal drainage system. Although air exiting the pleural space will cause bubbling in the water-seal chamber, water in the system does not ensure bubbling in the water-seal chamber; this is not the purpose of the water-seal chamber)

A client has a chest tube for a pneumothorax. The nurse finds the client in respiratory difficulty, with the chest tube separated from the drainage system. What should the nurse do? Obtain a new sterile drainage system. Use two clamps to close the drainage tube. Place the client in the high-Fowler position. Reconnect the client's tube to the drainage system.

Reconnect the client's tube to the drainage system. (To prevent further possibility of pneumothorax, the nurse should reconnect the tube immediately. Obtaining a new sterile drainage system is unnecessary. Clamping the tube is appropriate when changing a broken drainage system or when checking for an air leak. The high-Fowler position is appropriate for a client in respiratory distress, but it does not remedy the problem.)

An arterial blood gas report indicates the client's pH is 7.25, PCO2 is 35 mm Hg, and HCO3 is 20 mEq/L. Which disturbance should the nurse identify based on these results? Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis

metabolic acidosis (A low pH and low bicarbonate level are consistent with metabolic acidosis. The pH indicates acidosis, not alkalosis. The CO2 concentration is within normal limits, which is inconsistent with respiratory acidosis; it is elevated with respiratory acidosis.)

A nurse is caring for a client with a history of chronic obstructive pulmonary disease (COPD) who develops a pneumothorax and has a chest tube inserted. Which primary purpose of the chest tube will the nurse consider when planning care? Lessens the client's chest discomfort Restores negative pressure in the pleural space Drains accumulated fluid from the pleural cavity Prevents subcutaneous emphysema in the chest wall

Restores negative pressure in the pleural space (Negative pressure is exerted by gravity drainage or by suction through the closed system. Though the discomfort may be lessened as a result of the insertion of the chest tube, this is not the primary purpose. There is an accumulation of air, not fluid, when a pneumothorax occurs in a client with COPD. Subcutaneous emphysema in the chest wall is associated most commonly with clients receiving air under pressure, such as that received from a ventilator; subcutaneous emphysema can also occur with a chest tube.)

The nurse is caring for a client with a pneumothorax and chest tube. To evaluate the effectiveness of a chest tube, the nurse assesses for which finding? Productive coughing Return of breath sounds Increased pleural drainage in the chamber Constant bubbling in the water-seal chamber

Return of breath sounds (The return of breath sounds indicates that the lung has reinflated. A cough that raises sputum (productive cough) may indicate a complication, such as infection. The drainage should decrease, not increase. Constant bubbling in the water-seal chamber indicates that there is a leak in the closed chest drainage system. Bubbling may occur in this chamber when air exits the pleural space with a cough or forceful expiration; the fluid will rise and fall in this chamber with pleural pressure changes associated with inspiration and expiration (tidaling).)

A client with emphysema experiences a sudden episode of shortness of breath and is diagnosed with a spontaneous pneumothorax. The client asks, "How could this have happened?" The nurse's response is based on what likely cause of the spontaneous pneumothorax? Pleural friction rub Tracheoesophageal fistula Rupture of a subpleural bleb Puncture wound of the chest wall

Rupture of a subpleural bleb (The etiology of a spontaneous pneumothorax is commonly the rupture of blebs on the lung surface. Blebs are similar to blisters, but are filled with air. Pleural friction rub results in pain on inspiration, not a pneumothorax. A tracheoesophageal fistula causes aspiration of food and saliva, resulting in respiratory distress. The client has no history of trauma.)

When providing discharge teaching for a young female client who had a pneumothorax, it is important that the nurse include the signs and symptoms of a recurring pneumothorax. What is the most important symptom that the nurse should teach the client to report to the healthcare provider? Substernal chest pain Episodes of palpitation Severe shortness of breath Dizziness when standing up

Severe shortness of breath (Severe shortness of breath may indicate a recurrence of the pneumothorax because one lung is unable to meet the oxygen demands of the body. A pneumothorax causes sharp chest pain on the involved side, not substernally. Usually palpitations reflect a cardiac, not a respiratory problem. Dizziness when standing up is not specific to a pneumothorax; this is orthostatic hypotension, which may be related to a variety of medical problems.)

What clinical indicators should the nurse expect to identify when assessing an individual with a spontaneous pneumothorax? Select all that apply. Hematemesis Shortness of breath Unilateral chest pain Increased thoracic motion Mediastinal shift toward the involved side

Shortness of breath Unilateral chest pain (With the reduction of surface area for gaseous exchange, the client experiences shortness of breath, tachycardia, and rapid, shallow respirations. Sudden chest pain occurs on the affected side; it may also involve the arm and shoulder. Bloody vomitus is unrelated to pneumothorax. Decreased chest motion occurs because of failure to inflate the involved lung. The shift toward the unaffected side results from pressure with the pneumothorax.)

Increase metabolic acid, ketoacidosis (DM, alcoholism, starvation), hypermetabolic state (s.hyperthyroidism, burns, s.infection), oliguric RD (AKI, ESRD), circulatory shock (lactic acidosis) acid;acid precusors (methanol, ethylene glycol, boric acid, salicylate OD), < bicarbs, diarrhea, pancreatic fistula; intestinal decompression, renal tubular acidosis

metabolic acidosis causes

pH greater 7.45, PaCO2 normal (uncompensated),high >45 (compensated), high HCO3 >26, anion gap n.;high, K+; Ca maybe decreased, light headedness, numbness, tingling, circumoral region (paresthesia), poss. excitement and confusion followed by <LOC, cardiac dysrhythmias

metabolic alkalosis

electrolytes, energy, too much carbon

alkalosis excess

collect drainage water seal suction control

collect drainage 1 water seal 2 suction control 3

Dyspnea, diminished or absent breath sounds, dullness to percussion, decreased Hgb, shock depending on blood volume

hemothorax

chest tube insertion with chest drainage system. Autotransfusion of collected blood, treatment of hypovolemia as necessary

hemothorax intervention

A nurse in the pediatric unit is reviewing the arterial blood gas values of a 4-year-old child recovering from severe dehydration. Which results most accurately reflect the child's recovery? pH 7.40, Po2 85 mm Hg, Pco2 40 mm Hg pH 7.50, Po2 85 mm Hg,Pco2 35 mm Hg pH 7.25, Po2 60 mm Hg, Pco2 50 mm Hg pH 7.45, Po2 70 mm Hg, Pco2 25 mm Hg

pH 7.40, Po2 85 mm Hg, Pco2 40 mm Hg (Expected arterial blood gas values are pH of 7.35 to 7.45, Po2 of 83 to 108 mm Hg, and Pco2 of 35 to 45 mm Hg; thus these gases are within normal limits. A pH of 7.5 indicates alkalosis. A pH of 7.25 indicates acidosis, a Po2 of 60 mm Hg indicates hypoxia, and a Pco2 of 50 mm Hg indicates hypercapnia. A Po2 of 70 mm Hg indicates hypoxia, and a Pco2 of 25 indicates hypocapnia.)

The nurse is caring for a client with a diagnosis of diabetic ketoacidosis. Which arterial blood gas results are associated with this diagnosis? pH: 7.28; PCO2: 28; HCO3: 18 pH: 7.30; PCO2: 54; HCO3: 28 pH: 7.50; PCO2: 49; HCO3: 32 pH: 7.52; PCO2: 26; HCO3: 20

pH: 7.28; PCO2: 28; HCO3: 18 (A low pH and bicarbonate reflect metabolic acidosis; a low PCO2 indicates compensatory hyperventilation. A low pH and elevated PCO2 reflect hypoventilation and respiratory acidosis. An elevated pH and bicarbonate reflect metabolic alkalosis; an elevated PCO2 indicates compensatory hypoventilation. An elevated pH and low PCO2 reflect hyperventilation and respiratory alkalosis.)

Dyspnea, decreased movement of involved chest wall, diminshed or absent breath sounds on the affected side, hyperresonance to percussion

pneumothorax

chest tube insertion with flutter valve or chest drainage system

pneumothorax intervention

low ph, but high PaCo2 & HCO3 high ph, PaCO2 & HCO3 low ph, n. PaCO2, low HCO3 high ph, low PaCO2, HCO3 (n, or high)

resp. acidosis metabolic alkalosis c metabolic acidosis

HA, light headedness, <LOC, (confusion lethargy, coma), cardia dysrhythmias, WARM and FLUSHED skin, m. twitching, pH low <7.35, high PaCO2 >45, HCO3 normal (uncompensated) or high > 26 (compensated)

respiratory acidosis

impaired gas exchange, COPD (b), COPD (emphysema), pneumonia, s.acute asthma, airway obstruction, extensive atelectasis, obstructive sleep apnea, impaired neuromuscular funct, resp m. weakness or paralysis hypokalemia or neurological dys, resp m. fatigue, resp failure, chest injury or surgery pain respiration, dys. brainstem resp control, OD w/ resp depressant, central sleep apnea

respiratory acidosis causes

low carbon dioxide (too much oxygen)

respiratory alkalosis (ie ph 7.52, pco2 32, HCO3 24, pco2 less than 35, hco3 normal, ph high, K+ & Ca+ maybe decreased, alveolar hyperventilation, hyperventilation, light headedness, numbness & tingling, circumoral region (paresthesias), excitment and confusion)

hypoxemia, acute pain, anxiety, psychological distress, prolonged sobbing, inappropriate mechanical ventillator settings, stimulation of brainstem resp control, head injuries, meningitis, gram - sepsis, salicylate OD

respiratory alkalosis causes

cyanosis, air hunger, violent agitation, tracheal deviation away fromt the affected side, subcutaneous emphysema, neck vein distention, hyperresonance to percussion

tension pneumothorax

medical emergency, needle decompression followed by chest tube insertion with chest drainage system

tension pneumothorax intervention

external manifestation of the mediastinal shift

trachea deviation