MED Surg Test 2

HOW TO: prevent Complications with Intubation and Tracheostomy

1. Admin adequate warmed humidity 2. maintain correct cuff pressure 3. suction prn 4. maintain skin integrity 5. ausculate lung sounds 6. monitor for infection 7. admin o2 per protocol and prn 8. monitor for cyanosis 9. maintain hydration 10. sterile technique with suction

Care of the client with an Endotracheal tube post immediate intubation

1. Check symmetry of chest expansion 2. Auscultate breath sounds of anterior and later chest BILAT 3. obtain order for chest x-ray for placemtn 4. monitor for s/s of aspiration 5. check cuff pressure q6-8 hrs 6. ensure high humidity 7. admin oxygen per MD order 8. secure tube to patient's face and mark proximal end 9. Sterile suction 10. reposition q2h 11. provide oral care prn

NI: Extubation

1. explain procedure 2. have bag and mask ready in case this is unsuccessful 3. suction, remove tape securement, deflate cuff 4. give 100% O2 for a few breaths, then insert new sterile suction cath inside tube 5. Have patient INHALE; at peak inspiration remove tube while suctioning the airway through the tube as it's pulled out

Care of client post extubation

1. give heated, humid o2 via facemask @ high fowlers 2. monitor respiratory resp. status 3. pulse ox 4. keep patinet NPO for est few hours 5. provide oral care 6.educate on deep breathing and coughing

When peefroming endotracheal suctioning the nurse should apply suction while whitdrawing and gently removing the cath 360 for how long?

10 to 15 sec

Inspiratory pressure limit norm on ventilation setting

15-20 cm of H20

Which range of water pressure within the endotracheal tube cuff is believed to prevent both injury and aspiration?

15-20 mm Hg

HOW TO: Correctly used an incentive spirometer, nursing edition

1st administer assess and admin pain meds prn; patient should position up right breathe in slowly and steadily, and hold his breath for 3 seconds after inhalation. do 10 breaths qh

What water level for dry suction system?

2 cm

Correct endotracheal tube cuff pressure

20 to 25 mm Hg

What water level for water seal systems?

20cm H2O

PEEP normal pressure setting on vent

5 - 15 cm H2O

A client has a tracheostomy but doesn't require continuous mechanical ventilation. When weaning the client from the tracheostomy tube, the nurse initially should plug the opening in the tube for:

5 to 20 minutes

Post op: Endotracheal Tube how often do you check cuff pressure?

6-8 hours

What is the most effective treatment for obstructive sleep apnea?

CPAP

commonly used mast cell stabilizer for the treatment of asthma

Cromolyn sodium

While assessing a thoracotomy incision site form which a chest tube exits, the nurse feels a crackling sensation along the entire incision. What is the priority nursing action?

Mark the area with a kin pencil at the outer periphery of the crackling

How long should endotracheal tube be used?

No longer than 14 to 21 days

Dry suction (one-way valve system)

No need to fill suction chamber with fluid; thus, can be set up quickly in an emergency Works even if knocked over, making it ideal for patients who are ambulatory

Changing the oxygen concentration without resetting the oxygen level alarm would trigger which vent alarm?

Oxygen alarm

How to Perform diaphragmatic breathing

Place one hand on abd and middle of chest, breathe in slow n deep thru nose (protruding abd far as can); breathe out through pursed lips while tightening abd muscles; press firmly inward and upward on the abd while breathing out; repeat for 1 min and follow withw a 2min rest

A nurse is caring for a client with a chest tube. If the chest drainage system is accidentally disconnected, what should the nurse plan to do?

Place the end of the chest tube in a container of sterile saline.

Dry suction water seal (dry suction)

Requires that sterile fluid be instilled in water seal chamber at 2-cm level No need to fill suction chamber with fluid Suction pressure is set with a regulator. Has positive- and negative-pressure release valves Has an indicator to signify that the suction pressure is adequate Quieter than traditional water seal systems

Tradition water seal (wet suction)

Requires that sterile fluid be instilled into water seal and suction chambers Has positive- and negative-pressure release valves Intermittent bubbling indicates that the system is functioning properly. Additional suction can be added by connecting system to a suction source.

incentive spirometer use

Sit in an upright position. Place the mouthpiece of the spirometer in the mouth. Breathe air in through the mouth. Hold breath for about 3 seconds. Exhale air slowly through the mouth.

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

TV setting and rate norms for ventilation settings

TV = 6 - 12ml/kg; rate 12-16

minute volume

TV x RR = aprrox. 6-8 L/min

What is the most precipitating factors of an acute asthma attack?

Viral respiratory infections

Which compartment shows tidal movements or fluctuations of a normally function system as the client breathes?

Water-seal chamber

albuterol trade names

[AccuNeb, Proventil, Ventolin

Arterial blood gases should be obtained how often after initiating continuous mechanical ventilation?

after 20 minutes of continuous mechanical ventilation

Long-Term complications of tracheostomy

airway obstruction due to built up secretions, infection, tracheoesophageal fistula, tracheal dilation; tracheal ischemia, necrosis

Short-acting beta2-adrenergic agonists

albuterol, levalbuterol, and pirbutero

What complication can arise from low cuff pressure?

aspiration pnuemonia

When should the client taking leukotriene receptor antagonists take the drug in respect to meals?

at least an hour ac or 2hr pc

chest presentation of client c COPD

barrel

Where should the chest tube and water-seal apparatus be located?

below the client's chest level

EARLY Complications of tracheostomy

bleeding, pneumothorax, air embolism, aspiration, subcutaneous/ mediastinal emphysema, recurrent laryngeal nerve damage

What benefits does inline (closed) suction have for the patient?

decreases hypoxemia, decreased patient anxiety, Sustains PEEP

Advantages of tracheostomy vs prolonged Intubation

decreases irritation of and trauma to the tracheal lining, reduces the incidence of vocal cord paralysis, and decreased WOB

What conditions trigger low-pressure vent. alarms?

disconnected ventilator circuit or an ET cuff leak would trigger the low-pressure alarm

If the water-seal column of the chest tube apparatus has stopped fluctuating, what should the nurse determine?

full expansion of the lung; chest tube isn't positioned correctly

What chest tube drainage amount to report to MD

greater than 150ml/hr

Which type of oxygen therapy includes the administration of oxygen at pressure greater than atmospheric pressure?

hyperbaric

Purpose of pursed lip breathing

improves oxygen transport, helps induce a slow, deep breathing pattern and assists the client to control breathing

What could happen if you put more than 2 cm of H2O in a dry suction chest tube system?

increased intrathoracic pressure

Why is routine deflation of the cuff contraindicated?

increased risk of aspiration and hypoxia

Hyperbaric oxygen therapy

increases the blood's capacity to carry and deliver oxygen to compromised tissues

Why is pursed lip breathing effective?

it prolongs exhalation and increases airway pressure during expiratin to reduce the amount of trapped air and amount of airway resistance

Which conditions triggers the high-pressure vent. alarm?

kinking of the ventilator tubing, bronchospasm, pulmonary embolus, mucus plugging, water in the tube, and coughing or biting on the ET tube

1st line therapy for smoking cessation

nicotine gum, nortriptyline, and buproprion SR

Which oxygen administration device has the advantage of providing a high oxygen concentration?

nonrebreathing mask

How often to turn the chest tubed patient?

q1.5-2 hours

What acid-base imbalance is caused by hyperventilation?

resp. alkalosis

Indication for mechanical ventilation

respiratory failure/ compromised airway PaO2 <55 mm Hg PaCO2 >50 mm Hg with pH <7.32 vital capacity < 10ml/kg Negative inspiratory force <25 cm H2O FEV1 <10 mL/kg Apneic or bradypnic Circulatory shock

cor pulmonae

right-sided HF

A nurse observes constant bubbling in the water-seal chamber of a closed chest drainage system. What should the nurse conclude?

system has an air leak

The nurse is preparing to assist the health care provider to remove a client's chest tube. What instruction will the nurse correctly give to the client?

take a deep breath, exhale, and bear dear when tube is being removed; OR breath quicly

complications of high cuff pressure

tracheal bleeding, ischemia, pressure necrosis