NUR 504: Exam 2 Respiratory and Renal

*Risk factors for ventilator associated pneumonia (VAP):*

-Age --> aging lowers immunity and patient who are on a vent are already compromised -chronic lung dz -previous antibiotics -reintubation -prolonged intubation -malnutrition --> hense the reasons TPN is essential for these patients -renal failure -anemia -ARDs

lab testing for COVID:

-PCR swab -CBC --> look at WBC count -creatinine/ BUN -D dimer --> for blood clots -ABG in times of respiratory distresss

Weaning parameters for mechanical ventilation:

-adequate O2 -adeqaute ventialtion -ability to maintain airway -stable neurological exam

end-stage kidney disease (ESKD):

-end stage kidney failure you cannot sustain life without treatment -the kidneys are no longer able to compensate and have a *GFR <15 mL/min*

Nursing interventions for pleural effusion:

-focused respiratory assessment -VS -elevate HOB -encourage coughing and deep breathing --> give them incentive spirometer and cough pillow -O2 admin as needed -activity as tolerated (bed rest will aggravate it) -administer meds and treat underlying cause -manage chest tube -assess for crepitus (aka emphysema) --> subcutaneous air under the skin (feels like rice krispies)

risk factors for end-stage kidney disease (ESKD):

-glomerular disease -tubular disease -vascular disease of the kidney -genetic conditions -infection --> tuberculosis -systemic vascular disease --> typically HTN -metabolic kidney disease --> diabetes -connective tissue disordes -obstructive urinary disease

S/S of ARDs:

-hypoxia -hypercapnia --> too much CO2 -acidosis -hypotension -tachycardia -dysrhythmias

transudate pleural effusion:

-occurs d/t increased hydrostatic pressure or low plasma oncotic pressure conditions that alter hydrostatic or oncotic pressure in the pleural space such as CHF, cirrhosis , nephrotic syndrome -a clear build up of fluid -low in protein and LDH

Peritoneal dialysis:

-occurs through diffusion and osmosis across the semipermeable peritoneal membrane capillaries -a catheter port is inserted into the abdomen and a bag of dialysate (1-2 L) is infused into the abdominal cavity -patients will have a hard time breathing because all of the fluid created pressure -the fluid sits in the abdomen for 20-30 min and the is drained out ; it may be repeated 2-3 x -dialysate can contain glucose

*Nursing interventions for mechanical ventilation:*

-oral care -restraints - daily sedation vacation --> once a day decrease pts sedation to see how they do -spontaneous breathing trials -ballard suctioning -turn q 2 hrs - chest PT -troubleshoot alarms -talk to the patient

other surgical treatment for pleural effusion:

-pleurodesis --> collapses the space between the layers of fluid preventing future accumulation -chest tube -pleurectomy --> surgical incision into the pleura to surgically remove affected pleura -pleuropneumonectomy --> full removal of the lung -pleuro lobectomy --> partial removal of the lung

*S/S ventilator associated pneumonia (VAP):*

-productive cough -rhonchi -wheezing -temp (febrile) -increased O2 requirements

risk factors for pulmonary HTN:

-women ages 20-40 -family hx --> 1st degree relative -environmental factors -medications (fenfluramine/ phentermine (med for wt loss), dasatinib (treats lukemia)

*Nursing interventions for AV fistulas:*

-you cannot take a BP on an arm that has a fistula -IV lines cannot be placed on an extremity that has aa fistula -palpate for thrills and auscultate for bruits over fistula (if there isnt one it can indicate that there is a clot) -assess pulses distal to fistula -when surgery is done keep limb elevated to prevent swelling -promote ROM -dont lift heavy objects with arm that has a fistula --> ALWAYS -cannot sleep on the side that has a fistula because it compresses the vessel -check the site for bleeding

what order should suctioning be taken for a client who is receiving mechanical ventilation?

1. obtain the vital signs 2. auscultate lung sounds 3. hyperoxygenate for 30 sec 4. suction for approximately 10 sec 5. rotate the catheter during its withdrawal

Respiratory Alkalosis causes:

Excessive loss of CO2: -*hyperventilation* -fear -*anxiety* -*pain* -salicylate toxicity -high altitudes -early stage acute -pulmonary problems

Pleural effusion:

an abnormal collection of fluid in the pleural space (space around lungs) -symptomatic >300 mL of fluid

The nurse is providing postoperative care to a client who is being weaned off of mechanical ventilation. which is a priority nursing action? a. assessing lung sounds every 15 minutes b. remaining with the client to evaluate for respiratory distress c. monitoring the oxygen saturation levels from the monitor at the desk d. teaching the family members about ways to keep the client calm

b. remaining with the client to evaluate for respiratory distress

*Hemodyalysis*

blood and dialysate flow in the opposite direction across an enclosed semipermeable membrane -patients are not mobile during this procedure so make sure they use the bathroom before starting

which body system will the nurse assess first to prevent harm for a client who has metabolic acidosis? a. GI system b. respiratory system c. cardiovascular system d. autonomic nervous system

c. cardiovascular system

which assessment finding on a client who has just had a thoracentesis for a right pleural effusion would require the most rapid action by the nurse? a. oxygen saturation of 93% b. BP of 160/94 c. decreased right side breath sounds d. ecchymosis at the site of the throacentesis

c. decreased right side breath sounds

a patient is suspected of having a pneumothorax. the nurse anticipates that this diagnosis will be confirmed by: a. auscultating breath sounds b. having the patient use an incentive spirometer c. reviewing the chest x-ray report d. preforming a thoracic puncture

c. reviewing the chest x-ray report

which finding by the nurse who is caring for a client who has a left pneumonectomy would be immediately communicated to the HCP? a. absent left sided breath sounds b. client report of 9 out of 10 incisional pain c. BP 162/90 d. crackles heard throughout the right lung

d. crackles heard throughout the right lung

which finding indicated that a clients kidney transplant is successful? a. increased specific gravity b. correction of hypotension c. elevated serum potassium d. decreasing serum creatinine

d. decreasing serum creatinine

the nurse is caring for a patient who had a chest tube inserted for the treatment of a pneumothorax. which assessment finding best indicates to the nurse that a chest tube is no longer needed? a. there is minimal drainage from the chest tube b. ABG results are within normal limits c. the patient states he is not experiencing dyspnea d. no fluctuation in the water seal chamber occurs when no suction is applied

d. no fluctuation in the water seal chamber occurs when no suction is applied

a patient with SOB has decreased-to-absent breath sounds from the apex to the base of the lung on the right side. how should the nurse interpret this assessment finding? a. acute asthma b. chronic bronchitis c. pneumonia d. pneumothorax

d. pneumothorax

*Acid base Balance normal Values:*

pH --> 7.35-7.45 CO2 --> 35-45 HCO3 --> 22-26 PaO2 --> 75 -100 SaO2 --> 95-100% ALWAYS look at PaO2 first if it is low place patient on oxygen immediately

*Dx testing for ventilator associated pneumonia (VAP):*

-sputum sample (collected by suctioning) -CBC -chest X-ray

risk factors for pneumothorax/ hemothroax:

-surgery -trauma -rib fracture -pulmonary contusion (can be from a hard hit or a fall) -flail chest (rib fractures) -COPD -ARDs -pneumonia -mechanical ventilation

PaO2:

-the partial pressure of oxygen dissolved in plasma -PaO2 measures oxygenation -normal ranges are 75-100 mmHg -ALWAYS look at PaO2 first --> if its low the patient needs urgent oxygenations

nursing interventions pre transplant:

-verify compatibility -admin immunosuppressive meds -maintain strict aseptic technique -verify hemodialysis of recipient was completed within 24 hrs before the transplant -assess to assure no infection is present -renal function studies

complications of hemodialysis:

*Disequilibrium Syndrome (DDS)* -mental status changes -N/V -restlessness -it is life threatening because it increases intracranial pressure -most at risk during first dialysis treatment Other risk factors: -children or elderly -high BUN >75 -hypernatremia -hyperglycemia -metabolic acidosis -pre existing neurological disorders -prexisiting cerebral edema -pruritus -headache -hypotension -dysrhythmias -infection -anemia -increases risk for subdural and intracranial hemorrhage from anticoagulation and changes in BP during procedure

dx testing for ARDs:

-chest X-ray -ECG

dx testing for pulmonary HTN:

-echocardiogram (wil see elevated pulmonary artery pressure) -right heart cardiac cath --> to measure pressures directly -pulmonary function test -CT scan -chest X-ray -rule out of PE as a different dx

*S/S end stage kidney disease (ESKD):*

-edema -pulmonary crackles -SOB -pleural/ pericardial effusion (friction rub on auscultation; decreased breath/ heart sounds) -progressive HF -fatigue -HTN --> unless its progresses to cardiac tamponade they will be hypotensive -azotemia --> build up of BUN in the kidneys -uremia --> uric acid build up seen on the skin (feels dry and itchy and looks like frost) -oliguria --> to anuria -*metabolic acidosis --> kussmal respirations*

preoperative care for a renal transplant:

-immunologic studies -dialysis 24 hrs before surgery -blood transfusion before surgery

dx testing for COVID:

CT scan: -bilateral diffuse ground glass opacities, multifocal patchy consolidation know as interstitial changes echocardiogram: -norma EF prior to late onset sudden cardiogenic shock with EF dropping to <10% chest X-ray: will see ground glass

*verifying tube placement for mechanical ventilation*

End tidal CO2: -tells us how much CO2 they're blowing off - (+) CO2 --> means we are in the airway - (-) CO2 --> means we are in the esophagus Chest x-ray --> gold standard for placement Lung sounds --> should be equal bilaterally

Medications for mechanical ventilation:

Paralytics --> if the patient has a gag reflex and is trying to work against you -succinycholine -rocuronium Sedation: -propofol -dexmedetomidine -versed Hnalgesics: -fentanyl Hypnotics: -ketamine

which lab value will the nurse check immediately to prevent harm for a client with metabolic alkalosis who now has a positive chovesteks sign? a. serum calcium b. serum magnesium c. serum glucose level d. serum sodium

a. serum calcium

which information is needed to determine oxygen administration for a client with COPD and an O2 saturation of 87%? a. level of orientation b. arterial blood gases c. bilateral lung sounds d. complete blood count

b. arterial blood gases

which prescribe medication would the nurse expect as maintenance therapy for a client with a kidney transplant? select all a. basiliximab b. azathioprine c. prednisone d. antithymocyte globulin (equine) e. erythropoietin

b. azathioprine c. prednisone

after thoracic surgery, a client has a chest tube connected to a water-seal drainage system that is attached to suction. when excessive bubbling is observed in the water-seal chamber, which action would the nurse take? a. strip the chest tube b. check the system for air leaks c. decrease the amount of suction pressure d. recognize that the system is functioning correctly

b. check the system for air leaks

which acute, life threatening complication would the nurse monitor for during the clients early postoperative period after a radical nephrectomy? a. sepsis b. hemorrhage c. renal failure d. paralytic ileus

b. hemorrhage

which assessment finding in a client who has had a lobectomy and placement of a chest tube 8 hrs ago requires immediate follow-up by the nurse? a. report of pain at the chest tube insertion site b. 3 cm area of red drainage on the incisional dressing c. 200 mL red drainage from chest tube over 2 hrs d. client sleepy but able to be aroused

c. 200 mL red drainage from chest tube over 2 hrs rationale: more than 70 mL/hr needs to be reported to the surgeon

the nurse anticipates that the priority treatment for a patient with a spontaneous pneumothorax is: a. antibiotics b. bronchodilators c. chest tube placement d. hyperbaric chamber

c. chest tube placement

when a client has a right pneumothorax, which type of breath sounds will the nurse expect to hear on the right chest? a. crackling b. wheezing c. decreased breath sounds d. vesicular sounds

c. decreased breath sounds

pneumothorax:

collection of air within the pleural cavity -results in the loss of negative pressure which reduces vital capacity and can lead to lung collapse *open pneumothorax:* -wound in the outer chest wall, exposed to outside air *closed pneumothorax:* -occurs spontaneously, caused by internal pressure or disease such as COPD *tension pneumothorax:* -air enters the pleural space with none existing on expiration -pressure builds up and draws across from the unaffected side -will have tracheal deviation -presses on the vena cava and can cause cardiovascular collapse -*911 medical emergency*

after change of shift report, which client would the nurse assess first? a. a client with possible lung cancer who is scheduled for bronchoscopy b. a client with left pleural effusion who is scheduled for a thoracentesis c. a client with hospital-aquired pneumonia and decreased breath sounds d. a client with an acute asthma exacerbation and 85% oxygen saturation

d. a client with an acute asthma exacerbation and 85% oxygen saturation

which clinical manifestation indicated the need for immediate hemodialysis in a client with chronic kidney disease? a. ascites b. acidosis c. HTN d. hyperkalemia

d. hyperkalemia

a client with a spontaneous pneumothorax asks "why did they put this tube into my chest?" which information would the nurse provide about the purpose of the chest tube? a. it checks for bleeding in the lung b. it monitors the function of the lung c. it drains fluid from the pleural space d. it removes air from the pleural space

d. it removes air from the pleural space

CPAP/ BiPAP:

delivers positive pressure to open up the airways -*less invasive than mechanical ventilation* CPAP --> continuous positive pressure at one level BiPAP --> airflow is administered at two different levels uses: -atelectasis after surgery -cardiac induced pulmonary edema -sleep apnea

phases of ARDs:

exudative: -early changes in dyspnea and tachypnea -pulmonary edema (productive cough with red/ pink sputum) and atelectasis form -lasts up to one week fibrosing alveolitis: -pulmonary HTN and fibrosis form resolution: -usually occurs after 14 days

metabolic alkalosis causes:

increase of base components: -antacids -blood transfusions -TPN -too much sodium bicarbonate decrease of acid components: -prolonged vomiting -nasogastric suctioning -large doses of diuretics

pharmological treatment for COVID:

medications to open up the airways -bronchodilators --> albuterol -steroids -expectorants (because we will hear rhonchi) -antibiotics --> if secondary infection such as pneumonia develops - anticoagulants --> only if pt develops a VTE -monoclonal antibodies

Exudative pleural effusion:

occurs d/t inflammation or infection -ex. pneumonia, cancer, viral infection, PE -high in protein and LDL -will be a thick purulent fluid dx test: fluid culture

Risk factors for ARF:

perfusion/ O2 failure: -high altitude -pneumonia -PE -hypovolemic shock ventilation failure: extrapulmonary: -neurological -pharmological --> opioids and respiratory depression intrapulmonary: -COPD -PE -pneumothorax -pulmonary edema

Endotracheal tube:

polyvinyl tube is positioned into the airway - for *short term* use contraindications for use: -unstable spine -inability to open the mouth

*hyperacute renal rejection:*

rejection that happens within 48 hrs after surgery -pain at the transplant site -increased BP and temperature -the kidney will need to be removed

treatment for spontaneous pneumothorax/ hemothorax:

respiratory support -bed rest -if recurrent --> thoracotomy

*Securement of mechanical ventilation:*

this is done so the tube doesn't dislodge -tube is marked where it touches the teeth -bite block is put into place -the tube is secured with protectants to prevent skin breakdown

labs for end-stage kidney disease (ESKD):

*GFR is the gold standard test for kidney failure* -*normal GFR: 60-120* -*normal BUN: 10-20* -*normal creatinine: 0.6-1.2* -in chronic kidney failure both creatinine and BUN are elevated -a GFR below 15 is considered kidney failure and when we need to look at dialysis -if only BUN is elevated (high and dry) the cause is most likely d/t dehydration -if only the creatinine is high the cause is most likely d/t an AKI -elevated BUN and creatinine = chronic renal failure Creatinine and BUN Electrolytes: -hyperkalemia -hypernatremia -hypermagnesemia -hypocalcemia and hyperphosphatemia (these are filtered by the kidneys so if the kidney is failing levels will be low) CBC: -H&H will be low and form proliferative anemia ABG: -in times of kussmal respirations

*Ventilator Alarms:*

*Low Pressure: means there is a leak* -circuit leaks -airway leaks -chest tube leaks -patient disconnection *High Pressure: means something is occluding the tube* -coughing -patient is biting the tube -fighting the ventilator -secretions/ mucus in the airway -airway problems -reduced lung compliance -water in the circuit -kink *-never turn alarms off* *- assess the patient 1st not the alarm*

nursing interventions for ARDs:

*repositioning:* -*q 2 hrs for postural drainage* -*include proning* respiratory, cardiovascular and neurological assessment -administer oxygen therapy via appropriate device -administer medications -monitor renal function and intake and output --> d/t it being a systemic problem -nutritional support -conserve energy

*prevention of ventilator associated pneumonia (VAP):*

-*mouth care* -HOB elevated >30 -peptic ulcer prophylaxis --> PPIs -minimal effective sedation -maintaining cuff pressure between 20-30 cm H20 -changing the tubing only when visibly soiled -closed suction systems

dx testing for end-stage kidney disease (ESKD):

-KUB --> an X-ray of the kidneys, ureters, and bladder -CT w/ or w/out contrast -MRI -ultrasound -nuclear renal scan --> to evaluate renal perfusion -cytoscopy --> scope of the bladder and urethral structures -PET scan --> if we are suspecting is there are any tumors or cancerous lesions

potential complications for pulmonary HTN:

-R sided HF -cor pulmonale -irreversible condition pregression to the need for a transplant or death (treat early on with medications) -without treatment --> death in about 2 yrs

Nursing interventions for COVID:

-VS -focused respiratory and cardiac assessment -precautions --> N95 -promote rest -assist with pulmonary hygiene -*position to optimize gas exchange --> PRONE* -obtain advanced directives

renal transplant canidate selection criteria:

-advanced kidney disease -reasonable life expectancy - medically and surgically fit for procedure -in the US the waiting list if when the GFR is <20 mL/min

potential complications for mechanical ventilation:

-air leak --> low pressure alarm -tube obstruction --> high pressure alarm -dislodgement -pneumothorax -infection --> pneumonia

*Treatment for ventilator associated pneumonia (VAP):*

-antibiotics -bronchoscopy

Complications of mechanical ventilation:

-asynchrony --> "bucking" -increase in intrathoracic pressure -muscle atrophy --> vent dependence -barotrauma (damage to the lungs by positive pressure) -*gastric ulcers/ gastritis* -*nosocomial infection --> (VAP) ventilator associated pneumonia*

dx testing for a pleural effusion:

-chest X-ray (to see if there is fluid accumulation) -CT scan -pleural fluid sample via thoracentesis -ultrasound -pleural biopsy -thoracoscopy -bronchoscopy

potential complications for pleural effusion:

-chest tube disconnects from drainage system or falls out -tension pneumothorax -subcutaneous emphysema -infection

treatment for traumatic pneumothorax/ hemothroax:

-chest tube or surgical repair

Labs for hemothorax/ pneumothorax:

-chest x-ray -ABGs --> they are at high risk for an acid base disorder -assessment of the contents (blood or air)

dx testing for ARF:

-chest x-ray -pulmonary function test -ECG -echocardiogram -bronchoscopy

Labs for pleural effusion:

-culture and sensitivity (to look for bacteria or infection) -CBC (will see elevated monocytes (inflammation), elevated neutrophils (bacterial), elevated lymphocytes (viral) -lactate -cytology analysis (if malignancy is suspected)

S/S pleural effusion:

-dyspnea -*non-productive cough* -pleuritic chest pain (worsens with deep breathing; we can give them a pillow for relief) -decreased chest wall movement (because they have shallow respirations and constriction) severe symptoms: over 300 mL of fluid -tachypnea -tachycardia -decreased breath sounds -dullness on percussion -egophony (increased resonance of voice sounds heard when auscultating the lungs)

*S/S ARF:*

-dyspnea -tachypnea -confusion --> d/t hypoxia -HTN -dysrhythmias -change in LOC -accessory muscle use -tripoding -cyanosis -inability to speak full sentences -impending doom

Potential complications for pneumothorax/ hemothorax:

-infection -bleeding -lung collapse -compression of venous blood vessels impeeding circulatory return (reduces cardiac output)

surgical treatment for pulmonary HTN:

-lung transplant -heart/lung transplant for cor pulmonale

nursing interventions for ESKD:

-monitor VS -monitor labs -monitor I &O --> maintain fluid restriction and daily wts -educate and assist on dietary restrictions -advocate for palliative care

nursing interventions for pulmonary HTN:

-monitor and trend VS and labs -focused respiratory assessment -focused cardiac assessment -administer medication as ordered -promote rest (cluster care) -assess with positioning to optimize gas exchange --> high fowlers, orthopnic, or prone -assist with adequate nutrition

treatment for tension pneumothorax:

-needle thoracotomy at bedside -large bore needle (16-18 G) inserted into the 2nd intercostal space of the affected area (air will come out) -*positions the patient with their arm above their head* -pain is expected -purpose: to maintain perfusion chest tube --> likely after we've release tension open thoracotomy for massive hemothorax

*Acute renal transplant rejection:*

-occurs within 1 wk of the transplant (usually means that the kidney failed) S/S: -oliguria -increase in BP -lethargy -elevated creatinine and BUN -fluid retetnion usually when this happens we try and increase the amount of immunosuppresent drugs

potential complications of peritoneal dialysis:

-protein loss -*peritonitis* -respiratory distress -inflammatory bowel disease -bowel perforation -infection -wt gain and discomfort (wt of dialysis solution)

Continuous renal replacement therapy (CRRT):

-pt is in ICU critical care -it requires venous access via a central line -it provides continuous removal of solutes and fluids 24/7 at high risk for: -fluid imbalance -electrolyte imbalance -hypothermia -anemia -blood clots

risk factors for ARDs:

-pulmonary infection -COVID -aspiration -sepsis -trauma -massive transfusion -drowning -fat embolism -toxic fume inhalation -pancreatitis

S/S pneumothorax/ hemothorax:

-reduced/ absent breath sounds on the affected side -hyperresonance on percussion -asymmetrical chest movement -tracheal deviation away from midline *towards unaffected side* (usually only seen in tension) -respiratory distress -cyanosis -distended neck veins -hemodynamic instability

risk factors for a pleural effusion:

-trauma --> causes inflammation and irritates the pleural lining -increased pressure in the lungs --> HF, PE, end stage liver failure, post open heart surgery -infection --> complication of pneumonia, cancer, or inflammatory disorders

Indications for emergency intervention with COVID:

-trouble breathing -presistent pain or pressure in the chest -new confusion --> can indicate hypoxia -inability to wake or stay awake -bluish lips or face

nursing interventions for peritoneal dialysis:

-warm the dialysate -if we instill 1 L expect 1 L to come out but if only 800 comes out we aren't overly concerned -the fluid (affluent) that comes back out should be clear; if it comes out cloudy then they could have peritonitis so we need to get a culture and sensitivity of the fluid -we cannot use the abdominal cavity if its infected -patients can get up and walk around during this treatment -peritoneal dialysis is not as effective as hemodialysis -use aseptic technique -assess for s/s of infection such as swelling, redness, or discharge around the catheter site

Which instruction on infection prevention would the nurse include when providing discharge edcuation to a client who received a cadaveric renal transplant? select all a. avoid eating from buffets b. obtain an annual flu vaccine c. preform regular hand hygiene d. stay away from crowded areas e. report a temp greater than 100.5

a client who received a cadaveric renal transplant? select all a. avoid eating from buffets b. obtain an annual flu vaccine c. preform regular hand hygiene d. stay away from crowded areas e. report a temp greater than 100.5

transmission of COVID:

a novel disease (a new virus that has not been previously identified) --> no heard immunity and no antibodies cross reacting -incubation 2-14 days -high viral shedding occurs early in the disease course even with mild symptoms -respiratory droplets; airborne

Acute respiratory failure (ARF)

a symptom of a disease -perfusion and gas exchange are unequal -V (ventilation)/ Q (perfusion) mismatch results from: -ventilatory failure --> too little oxygen reaching the alveoli -perfusion/ oxygenation failure --> too little blood is circulated to get oxygen

at which frequency would the nurse assess the urinary output of a client with end-stage renal disease (ESRD) who received a kidney transplant and is transferred ti the postanesthesia care unit? a. 1 hr b. 2 hr c. 15 min d. 30 min

a. 1 hr

a client is diagnosed with a spontaneous pneumothorax. which physiological effect of a spontaneous pneumothorax would the nurse include in a teaching plan for the client? a. air will move from the lung into the pleural space b. the heart and great vessels shift towards the affected side c. there is greater negative pressure within the chest cavity d. collapse of the other lung will occur if not treated immediately

a. air will move from the lung into the pleural space

which problem does the nurse expect resulted in a clients acid-base imbalance during an illness that causes vomiting for 2 days? a. alkalosis from overelimination of hydrogen ions b. acidosis from overproduction of hydrogen ions c. alkalosis from overproduction of bicarbonate ions d. acidosis from underelimination of bicarbonate ions

a. alkalosis from overelimination of hydrogen ions

a 24 yr old patient comes into the clinic reporting sudden-onset, right-sided chest pain and SOB. while assessing the patient, the nurse determines that the most important intervention is to: a. auscultate breath sounds b. order a chest X-ray c. order an echocardiogram d. order an ECG

a. auscultate breath sounds

how does the corresponding increase in carbon dioxide levels that occurs when arterial pH drops assist in maintaining acid-base balance? a. carbon dioxide loss through exhalation can raise arterial pressure b. carbon dioxide retention during exhalation can lower arterial pH levels c. carbon dioxide is a buffer that can bind free hydrogen ions and form a neutral substance d. carbon dioxide is a buffer that can bind free hydrogen ions and form a neutral substance

a. carbon dioxide loss through exhalation can raise arterial pressure

which clinical manifestation will the nurse expect when caring a client with pulmonary edema? select all a. crackles b. coughing c. orthopnea d. yellow sputum e. dependent edema

a. crackles b. coughing c. orthopnea

a client being mechanically ventilated has all of the following changes. which changes are most relevant in helping the nurse determine whether suctioning is needed at this time? select all a. decreased SpO2 b. elevated temperature c. crackles auscultated over the trachea d. crackles auscultated in the lung periphery e. high-pressure ventilator alarm sounds f. presence of fluid within the ventilator tubing

a. decreased SpO2 c. crackles auscultated over the trachea e. high-pressure ventilator alarm sounds f. presence of fluid within the ventilator tubing

which symptom or change is assessment of a client with 4 broken rubs on the right side indicated to the nurse the possibility of a tension pneumothorax? a. distended neck veins b. mediastinal shift toward the left side c. right sided pain on deep inhalation d. right side of the chest more prominent than the left

a. distended neck veins

which condition, sign or symptom foes the nurse consider most relevant in assessing a patient suspected to have ARDs? select all a. dyspnea b. electrocardiogram shows ST elevation c. intercostal retractions d. PaO2 84% on oxygen at 6 L/min e. substernal pain or rubbing f. wheezing on exhalation

a. dyspnea c. intercostal retractions d. PaO2 84% on oxygen at 6 L/min

which assessment finding is associated with rejection of a kidney transplant? select all a. fever b. oliguria c. jaundice d. polydipsia e. wt gain

a. fever b. oliguria e. wt gain

Which lab value would the nurse assess when preparing a client for a renal biopsy? select all a. hematocrit b. hemoglobin c. platelet count d. prothrombin time (PT) with international normalized ratio (INR) e. partial thromboplastin time (PTT)

a. hematocrit b. hemoglobin c. platelet count d. prothrombin time (PT) with international normalized ratio (INR) e. partial thromboplastin time (PTT)

which statement explains why metabolic acidosis develops with kidney failure? a. inability of the renal tubules to secrete hydrogen ions and conserve bicarbonate b. depressed respiratory rate due to metabolic wastes, causing carbon dioxide retention c.inability of the renal tubules to reabsorb water to dilute the acid contents of blood d.impaired glomerular filtration, causing retention of sodium and metabolic waste

a. inability of the renal tubules to secrete hydrogen ions and conserve bicarbonate

when arterial blood gas results for an alert client who is in the postanesthesia care unit (PACU) after abdominal surgery are pH 7.37, PaCO2 42 mmHg, HCO3 25 mEq, PaO2 65 mmHg, and SaO2 90%, which action would the nurse take? a. increase the oxygen flow rate b. insert an oropharyngeal airway c. suction the oropharynx and upper trachea d. prepare to transfer the client out of the PACU

a. increase the oxygen flow rate

which factor affects the clients ability to preform postoperative deep breathing and coughing requirements after a nephrectomy for renal cancer? a. location of the clients surgical incision b. increased anxiety about the prognosis c. inflammatory process associated with surgery d. pulmonary congestion from preoperative medications

a. location of the clients surgical incision

which response would the nurse give to a client with end-stage renal disease who states "I heard that it is inevitable that I will need a kidney transplant. if so, which one of my kidneys will be removed?" a. neither of your kidneys will be removed unless they become infected b. the kidney that is the most diseased is removed and replaced with a new one c. your primary HCP determines which kidney is replaced with a new one d. your right kidney will be removed, because it has a longer renal vein, making transplantation easier

a. neither of your kidneys will be removed unless they become infected

which statement would the nurse include in the preoperative teaching plan of a client who after receiving hemodialysis for several years has a kidney transplant scheduled? select all a. the kidney may not function immediately b. precautions are needed to prevent infection c. a urinary catheter will be present postoperatively d. immunosuppressive medications will be given preoperatively e. the arteriovenous fistula will be used for drawing blood specimens preoperatively

a. the kidney may not function immediately b. precautions are needed to prevent infection c. a urinary catheter will be present postoperatively

a client is intubated and receiving mechanical ventilation. the nurse reports to the clients room when the ventilator alarms. which nursing action indicated that the ventilator was signaling a high pressure alarm? a. the nurse removes secretions by suctioning b. the nurse lowers the setting of the tidal volume c. the nurse checks that tubing connections are secure d. the nurse obtains a specimen for arterial blood gases (ABGs)

a. the nurse removes secretions by suctioning

which action would the nurse implement to assess for signs of hemorrhage when a client arrives in the postanesthesia care unit in the supine position after a nephrectomy? a. turn the client to observe the dressings b. press the clients nail beds to assess capillary refill c. observe the client for hemoptysis when suctioning d. monitor the clients BP for rapid increase

a. turn the client to observe the dressings

which conditions cause a client to develop acidosis? select all a. ventilator at too low a tidal volume b. sepsis c. severe diarrhea d. hypovolemic shock e. prolonged nasogastric suctioning f. hyperventilation

a. ventilator at too low a tidal volume b. sepsis c. severe diarrhea d. hypovolemic shock

S/S acidosis:

acidosis = slow respiratory rate and not blowing off enough CO2 -pts are at risk for dysrhythmias (we need to get and EKG) -hypotension -thready peripheral pulses (d/t decreased cardiac output) -decreased LOC (lethargy, confusion, stupor, coma) -neuromuscular (hyporeflexia, skeletal muscle weakness, flaccid paralysis) -kussmal respirations --> high fast respirations with a fruity smell (seen a lot with metabolic acidosis) -variable respirations (priority is to listen to LS and put 2L oxygen via nasal cannula) -warm,flushed,dry skin --> metabolic acidosis -pale or cyanotic and dry skin --> respiratory acidosis do cardiovascular, respiratory, and neuro assessment

An unconscious client with an opioid overdose is triaged in the ED. ABG values reflect respiratory acidosis. Which of the following interventions address the cause of this clients respiratory acidosis? a. initiate BiPAP b. administer naloxone c. administer salmeterol d. give oxygen at 4 LPM

b. administer naloxone

the client is 24 hrs post op after a right lobectomy has two chest tubes in place, reports intense burning pain in his lower chest. on assessment, the nurse notes there is no bubbling on exhalation in the water seal chamber. what action will the nurse preform first? a. immediately notify either the rapid response team or the thoracic surgical resident b. assist the client to side lysing position and reassess the water seal chamber for bubbling c. administer the prescribed opioid analgesic immediately, and then reassess the chest tube system d. no action is needed because these response are normal for the first port op day after a lobectomy

b. assist the client to side lysing position and reassess the water seal chamber for bubbling

which actions will the nurse include in the plan of care for a client with a left pneumothorax who has a chest tube in place? select all a. immobilize the left arm in a sling b. check the water seal chamber for air bubbling c. avoid use of nonsteroidal anti-inflammatory drugs d. keep the client on best rest in a semi-fowler position e. observe frequently for drainage in the collection chamber f. assist the client to cough and deep breathe every hours while awake

b. check the water seal chamber for air bubbling f. assist the client to cough and deep breathe every hours while awake

which finding during peritoneal dialysis would the nurse act on as a sign of infection? a. pain with instillation b. cloudy return of dialysate c. complaints of constipation d. leakage of dialysate around the catheter

b. cloudy return of dialysate

which client statement indicates that the nurse's preoperative teaching about right upper lobectomy has been effective? a. my entire right lung will be gone after this surgery b. i will have chest tubes to help with drainage after surgery c. there is usually minimal incisional discomfort after this procedure d. oxygen therapy will probably be needed chronically when i go home

b. i will have chest tubes to help with drainage after surgery

the client develops bacterial pneumonia and is admitted to the emergency department. the clients initial PaO2 is 80. when the arterial blood gases are drawn again the level is 65. which action would the nurse take first? a. ensure that intubation equipment is available b. increase the oxygen flow rate per facility protocol c. notify the HCP provider to request a chest x-ray d. recheck the arterial blood gases to verify accuracy

b. increase the oxygen flow rate per facility protocol

which intervention would the nurse implement during a peritoneal fluid exchange of a client with end-stage renal disease receiving peritoneal dialysis? a. maintain the client in the supine position during the entire procedure b. position the client from side to side if fluid is not draining adequately c. remove the cannula at the end of the procedure and apply a dry, sterile dressing d. notify the primary HCP if there is a deficit of 100 mL in the drainage return

b. position the client from side to side if fluid is not draining adequately

Which change in the arterial blood gas would the nurse expect in a client with hyperventilation due to anxiety? a. respiratory acidosis b. respiratory alkalosis c. respiratory compensation d. respiratory decompensation

b. respiratory alkalosis

which test would the nurse monitor when determining whether a clients new kidney transplanted kidney works effectively? a. renal scan b. serum creatinine c. 24 hr urine output d. WBC count

b. serum creatinine

which laboratroy test provides evidence consistent with a client having renal impairment? select all a. serum albumin 4.7 b. serum creatinine 2.0 c. serum potassium 5.9 d. serum cholesterol 120 e. blood urea nitrogen (BUN) 32

b. serum creatinine 2.0 c. serum potassium 5.9 e. blood urea nitrogen (BUN) 32

which action would the nurse take before a clients scheduled for hemodialysis treatment? a. obtain the clients urine specimen to evaluate kidney function b. weigh the client to establish a baseline for later comparison c. administer medications that are scheduled to be given within the next hour d. explain that the peritoneum serves as a semipermeable membrane to remove wastes

b. weigh the client to establish a baseline for later comparison

which explanation would the nurse include when teaching a client who is waiting for a kidney transplant? a. production of urine will be delayed after surgery b. you will require immunosuppressive drugs daily for the rest of your life c. symptoms of rejection include a decrease in temperature and BP d. you will need to adopt a sedentary lifestlye

b. you will require immunosuppressive drugs daily for the rest of your life

*Acid Base Balance:* key points

balance between the input of hydrogen atoms and the output (elimination) of hydrogen atoms --> the body is maintaining homeostasis lower pH = more acidic higher pH = more alkaline CO2 = acid HCO3 = alkaline the respiratory system is able to compensate immediately when theres an imbalance the metabolic system (kidneys) take hours to days to compensate a pH within normal range = fully compensated a pH working toward normal range = partially compensated

which prescribed hemodialysis protocol would the nurse implement when a client with end-stage renal failure, begining hemodialysis for the first time, reports nausea and a headache, and then appears to become confused? a. administer an analgesic for the headache b. administer an antiemetic for the nausea c. decrease the rate of the hemodialysis exchange d. discontinue the procedure immediately

c. decrease the rate of the hemodialysis exchange

a client experiences a complete pneumothorax. the nurse recognizes that there is danger of a mediastinal shift, which could cause which life -threatening condition? a. rupture of the pericardium b. infection of the subpleural lining c. decreased filling of the right side of the heart d. increased volume of the unaffected lung

c. decreased filling of the right side of the heart

which sign of organ rejection would a nurse include when teaching a client with a recent renal transplant? a. wt loss b. subnormal temperature c. elevated BP d. increased urinary output

c. elevated BP

which collaborative action would the nurse anticipate when caring for a client with pneumonia whose arterial blood gases pH 7.24, PaCO2 60 mmHg, HCO3 20 mEq/L, PaO2 54 mmHg, and O2 88%? a. oxygen at 6 L/min by nasal cannula b. nebulized albuterol treatment c. intubation and mechanical ventilation d. sodium bicarbonate intravenously

c. intubation and mechanical ventilation

Which actions does the nurse ensure are preformed for a client being mechanically ventilated to prevent ventilator associated pneumonia (VAP)? select all a. assessing temperature q 4 hrs b. getting the patient out of bed as soon as possible c. keeping the HOB elevated to 30 degrees or above d. maintaining the client in the prone position e. providing adequate humidification f. providing meticulous mouth care q 12 hrs g. suggesting that the pneumonia vaccine be prescribed

c. keeping the HOB elevated to 30 degrees or above d. maintaining the client in the prone position g. suggesting that the pneumonia vaccine be prescribed

a client has a tracheostomy tube with a high volume, low-pressure cuff. the nurse understands that type of cuff is designed to prevent which occurrence? a. any leakage of air b. lung infection c. mucosal necrosis d. tracheal secretions

c. mucosal necrosis

the nurse is caring for a client with the following arterial blood gas (ABG) values: PO2 89 mmHg, PCo2 35 mmHg ,pH of 7.37. these findings indicate that the client is experiencing which condition? a. respiratory alkalosis b. poor oxygen perfusion c. normal acid-base balance d. compensated metabolic acidosis

c. normal acid-base balance

which test result would the nurse anticipate in the laboratory reports of a client with a diagnosis of end stage renal disease? a. arterial pH of 7.5 b. hematocrit of 54% c. potassium of 6.3 d. creatinine of 1.2

c. potassium of 6.3

which response will the nurse provide when a family member asks why a client who is intubated and receiving mechanical ventilation has restraints in place? a. the restraints will be removed once the client is extubated b. we are requires to restrain all clients with breathing tubes c. restraints are a last resort to prevent accidental extubation d. it is routine for us to restrain all intubated clients

c. restraints are a last resort to prevent accidental extubation

a client is admitted to the ICU with confirmed opioid overdose. The ABG results reflect a pH of 7.27, PaCO2 of 55, and HCO3 of 26. Based on the client's condition and blood gas analysis, the nurse must work to correct which of the following? a. decreased GI motility b. rapid respirations c. shallow respirations d. decreased level of consciousness

c. shallow respirations

for which potential complication would the nurse monitor a client receiving continuous ambulatory peritoneal dialysis for end-stage kidney disease? select all a. pruritus b. oliguria c. tachycardia d. cloudy outflow e. abdominal pain

c. tachycardia d. cloudy outflow e. abdominal pain

when caring for a sedated client who is being mechanically ventilated, which action will the nurse take first when the low flow alarm is persistently sounding? a. adjust the alarm settings b. notify the respiratory therapist c. ventilate manually and call for assistance d. check all connection and ventilator tubing

c. ventilate manually and call for assistance

hemothorax:

collection of blood within the pleural cavity -results in the loss of negative pressure which reduces vital capacity and can lead to lung collapse

Mechanism of compensation and regulation for acid base balance:

compensation is a good thing metabolic controls HCO3 (bicarbonate) --> kidney function respiratory controls CO2--> respiratory rate and volume inhaled/ exhaled breath

the nurse is caring for a client 36 hrs after the insertion of a chest tube. the tube is attached to a 3 chamber, closed-drainage system. the nurse identifies that the water in the underwater seal tube is not fluctuating. which action should the nurse take? a. take the clients vitals b. inform the HCP c. turn the client to the unaffected side d. check the tube to ensure that it is not kinked

d. check the tube to ensure that it is not kinked

for which client does the nurse remain alert for the possibility of respiratory acidosis? a. client with increased urinary output b. client who is anxious and breathing rapidly c. client receiving IV normal saline bolus d. client with multiple rib fractures

d. client with multiple rib fractures rationale: they may have shallow breathing d/t pain resulting in poor gas exchange

A client admitted with a hx of emphysema and a diagnosis of acute respiratory failure with respiratory acidosis has oxygen at 3 L/min nasal cannula. four hrs after admission, the client exhibits increases restlessness and confusion followed by a decreased respiratory rate and lethargy. which intervention would the nurse implement at this time? a. question the client about the confusion b. change the method of oxygen delivery c. percuss and vibrate the clients chest wall d. discontinue or decrease the oxygen flow rate

d. discontinue or decrease the oxygen flow rate

which action is most appropriate for the nurse to take first when the water seal chamber of the chest drainage device in a client who has a lobectomy has small bubbles when the clients coughs the appropriate action by the nurse is to? a. add additional sterile water to the water seal chamber b. checking the tubing for blood clots c. briefly increasing the amount of suction d. documenting the finding in the medical record

d. documenting the finding in the medical record

During the infusion of dialysate during peritoneal dialysis, the client exhibits symptoms of severe respiratory difficulty. which action would the nurse take? a. slow the rate of the clients infusion b. place the client in a low-fowler position c. auscultate the clients lungs for breath sounds d. drain the fluid from the clients peritoneal cavity

d. drain the fluid from the clients peritoneal cavity rationale: the dialysate is causing upward displacement of the diaphragm

which action would the nurse take to prevent complications when caring for a client with a chest tube to water seal drainage system for a pneumothorax? a. emptying the drainage system when full b. keeping the drainage system at heart level c. notifying the HCP of drainage greater than 50 mL/hr d. marking the time on the drainage unit every shift

d. marking the time on the drainage unit every shift

which medical intervention would the nurse anticipate will be included in the management of a client with acute respiratory distress syndrome (ARDs)? a. chest tube insertion b. aggressive diuretic therapy c. administration of beta blockers d. positive end-expiratory pressure (PEEP)

d. positive end-expiratory pressure (PEEP)

non-surgical treatment for pulmonary HTN:

medications: edothelin receptor antagonist --> *teratogenic*, do not give to women of child bearing age even is they dont plan on becoming pregnant *prostacylin agonists* --> IV -*continuous infusion* -pt will be on an external IV pump at home -*NOT compatible with anything* -*dedicated IV line* phosphodiesterase 5 inhibitors (PDEs) -PO -relaxation and vasodilation *anticoagulants* *oxygen*

Causes of Metabolic Acidosis:

occurs because theres too much acid overproduction of hydrogen ions: -*diabetic ketoacidosis (DKA)* -starvation -seizures -excessive exercise -fever --> a high fever thats been prolonged -poisonings -salicylate intoxication --> aspirin overdose underproduction of bicarbonate: -kidney failure -liver failure and pancreatitis -dehydration overproduction of bicarbonate: -diarrhea

non-surgical treatment for ARDs:

oxygen support: -BPAP/ CPAP -mechanical ventialtion -ECMO --> extracorporeal membrane oxygenation pharmological support: -bronchodilators -corticosteroids -conservative IV fluids w/ diuretics (because they have pulmonary edema) -mucolytics -antibiotics if infection is suspected nutrition support: -enteral feeding --> most likely TPN

Acute respiratory distress syndrome (ARDs):

progression of ARF a symptom not a disease -acute respiratory failures +plus -hypoxemia that persists even when theres 100% oxygen -decreased pulmonary compliance -dyspnea -non cardiac associated bilateral pulmonary edema -inflammatory systemic response: -triggered by cytokine storm --> swollen tissue that hinders gas exchanges and promotes formation of scar tissue -when the lungs are injured surfactant is not produced leading to excess fluid in the lungs --> leads to unstable alveoli prone to collapse ; edema forms around terminal airway increasing pulmonary edema further

*chronic renal transplant rejection:*

-occurs gradually over months or years S/S: -gradual increase in BUN and creatinine -gradual increase in edema -fatigue try to manage with medications (conservative management until dialysis is required)

nursing interventions post renal transplant:

-monitor urine output --> will start producing within 1 hr after transplant -VS -daily wt -semi fowlers position -make sure urinary catheter is patent -strict aseptic technique -oral hygiene -encourage coughing and deep breathing -avoid grapefruit juice -take medications at the same time every day (anti rejection medications)

Hemodialysis nursing interventions:

-weigh the patient before and after -we want to know the patients dry weight (after dialysis) --> patient should weigh the least after treatment -hold meds until after dialysis -ask pts about their hx r/t to previous dialysis treatments -look for signs of orthostatic hypotension -observe for bleeding -they receive heparin as part of the treatment --> they are at risk for oozing / bleeding at insertion site -*assess pts LOC, look for headache, nausea, and vomiting --> for increased intracranial pressure -look at serum lab values --> CMP before, during, and after treatment (this will tell us if we are effectively removing the waste but not removing too much of other things)

lab for ARDs:

ABGs

labs for ARF:

ABGs -respiratory acidosis -*PaO2 < 60 mmHg*

types of vascular access for hemodialysis:

AV fistula --> permanent -an internal anastosmosis of an artery to vein (artery and vein are fused together) -a surgical procedure that takes 2-3 months to heal before use AV graft --> permanent Dialysis catheter --> temporary -usually a central line --> an xray is taken to confirm placement and then it can be used immediately subcutaneous catheter --> temporary

a client with COPD has a blood pH of 7.25 and PCO2 of 60. these blood gas results require nursing attention because this would indicate which condition? a. metabolic acidosis b. metabolic alkalosis c. respiratory acidosis d. respiratory alkalosis

c. respiratory acidosis

The handgrasp strength of a client with metabolic acidosis has diminished since the previous assessment 1 hour ago. What is the nurse's best first action? A. Measure the client's pulse and blood pressure B. Apply humidified oxygen by nasal cannula C. Assess the client's oxygen saturation D. Notify the Rapid Response Team

C. Assess the client's oxygen saturation

S/S alkalosis:

CNS s/s: -increased anxiety -irritable, tetany, seizures -positive chovesteks and trosseaus neuromuscular s/s: -hyperreflexia -muscle cramping and twitching -muscle weakness cardiovascular s/s: -increased HR --> tachycardia -normal or low BP -increased digoxin toxicity --> if they take digoxin we need a therapeutic level drawn because they are super sensitive to it respiratory s/s: -hyperventilation -decreased respiratory effort associated with skeletal weakness in metabolic alkalosis

*thoracentesis:*

surgical treatment for a pleural effusion -patient is positioned in an orthopnic position -fluid is extracted at the base of the lung because fluid gravitates toward the bottom -a collection bag may be needed if there is a large amount of fluid extracted

labs for pulmonary HTN:

there are no specific labs values associated with the diagnosis of pulmonary HTN -ABGs are done in times of respiratory failure -PT/ INR is done depending on anticoagulant use

when caring for a client who has acute respiratory distress syndrome (ARDs) the nurse would implement which measure to promote effective airway clearance? a. administer sedatives as frequently as possible b. turn the client q 4 hrs c. increase ventilator settings every 2 hrs d. suction as needed

d. suction as needed

Non surgical treatment for end-stage kidney disease (ESKD):

Medications: -antihypertensives -epotein alfa (epogen) --> becuase the kidneys arent making any; we expect an increase in H&H -loop diuretics --> to manage fluid volume overload id urinary elimination is still present (anuria = NO diuretics \) fluid restriction dietary modifications -protein, P, K, NA, restrictions -increase in Ca dialysis

*Ventilator associated pneumonia (VAP):*

Pathogens enter the lungs through the ETT (endotracheal tube) via healthcare workers, ventilator circuit, or oral bacteria Most common pathogens: - gram positive --> staphylococcus aureus -gram negative --> pseudomonas, E.coli, klebsiella pneumonia

*Chest tubes:*

Purpose --> to drain fluid, blood or air from the lung or pleural cavity Use --> pleural effusion, hemothorax, pneumothorax -First chamber: drainage collection chamber -Second chamber: water seal (prevents air from moving back up the tubing into the chest) -third chamber: suction regulator absence of tidaling = the lung has fully re-expanded or there is an obstruction in the chest tube continuous bubbling = air leak

which findings would the nurse expect when caring for a client with cor pulmonale? select all a. wt loss b. neck vein distention c. lower extremity edema d. right upper quadrant abdominal tenderness e. lower than normal hemoglobin and hematocrit f. elevated B-type natriuretic peptide (BNP) levels

b. neck vein distention c. lower extremity edema d. right upper quadrant abdominal tenderness f. elevated B-type natriuretic peptide (BNP) levels

following a motor vehicle collision, a patient has a chest tube inserted to the left upper chest. the tube begins to drain dark red fluid. what does the nurse determine? a. the chest tube was inserted improperly b. this is an expected result for this patient c. an artery was nicked when the chest tube was placed d. the patient is experiencing a hemothorax

d. the patient is experiencing a hemothorax

Pulmonary HTN:

a chronic increase in vascular pressure in the pulmonary arteries (greater than 25 mmHg) -primary = unknown cause -secondary = COPD, pulmonary fibrosis (amiodarone can give you this), emphysema pulmonary HTN is irreversible the goal of treatment is management to keep it from progressing

a nurse is caring for a client with a pneumothorax who has a chest tube attached to a close drainage system. if the chest tube and closed drainage system are effective, which type of pressure will be reestablished? a. neutral pressure in the pleural space b. negative pressure in the pleural space c. atmospheric pressure in the thoracic cavity d. intrapulmonic pressure in the thoracic cavity

b. negative pressure in the pleural space

the nurse is caring for a client who us caring for a client who has a tracheostomy tube and is receiving mechanical ventilation. the plan of care for the tube would include which nursing intervention? a. verify that an inner cannula is in place b. change the tracheostomy tube every week c. clean the tracheotomy once a day d. verify that a low pressure cuff is in place

d. verify that a low pressure cuff is in place

S/S pulmonary HTN:

early mild symptoms: -dyspnea with exertion -fatigue late signs: -dyspnea at rest progressing to severe dyspnea -s/s decreased cardiac output -s/s right sided HF (JVD, hepatomegaly, peripheral edema) -*cor pulmonale --> an advanced stage of R sided HF leading to R ventricular enlargement* -hypoxia

renal transplant medications:

immunosuppressive meds (lifelong) --> anti rejection meds -*cyclosporine* --> decreased T cell activity SE--> seizures, gingival hyperplasia, HTN, hepatotoxic, N/V -taken concurrently with corticosteroids -avoid grapefruit juice -assess for signs of organ rejection -instruct patient how to take their BP Glucocorticoid --> prednisone Cytotoxic meds --> antibodies, diuretics, osmotic agents

potential complication of ARF:

progression to ARDs

Chest tube interventions:

tidaling: -fluid should fluctuate with respirations (Bubbling) -fluid should be measured hourly at first and then q 4-8 hrs per policy air leak: -continuous bubbling in the water seal chamber (second chamber) -check the tubing and the site of insertion -assess pts lung sounds and respiratory effort -NEVER strip or clamp the tubing -copious amounts of drainage/ purulent drainage on the dressing is NOT normal -when removing a chest tube encourage coughing at regular intervals to prevent an air embolism -keep the drainage system lower than the patients chest accidental removal of the chest tube from insertion site: -cover site with a 3 sided occlusive dressing, pretroleum dressing to give an air seal accidental removal of tubing from the collection chamber: -put tubing in sterile water immediately notify surgeon or rapid response team when: -tracheal deviation occurs -sudden onset dyspnea or increased intensity of dyspnea -O2 sat lower than 90 % -drainage greater than 70 mL/hr -chest tube falls out of patients chest -chest tube disconnects from the drainage system -drainage in the tube stops within the first 24 hrs

non-surgical treatment for pleural effusion:

treat the underlying condition -diuretics (to get rid of excess fluid) -antibiotics (if its caused by an infection) -albumin (because they have low protein) -corticosteroids (for inflammation) -anti-inflammatory agents -immunosupressents

non-surgical treatment for ARF:

treat underlying cause -position upright *Oxygen --> 1st line of treatment* -use non rebreather mechanical ventilation medications: -bronchodilators and steroids -diuretics (if there is fluid in the lungs) -antibiotics -anticoagulants

Respiratory acidosis causes:

under elimination of hydrogen ions: -respiratory depression --> opioids, anesthetics, electrolyte imbalances -inadeqaute chest expansion --> muscle weakness, COPD, airway obstruction, alveolar capillary block, multiple rib fractures