Respiration (AQ)

Oxygen given to clients during stage 4 of chronic obstructive pulmonary disease (COPD) should be administered in which manner? 1 to 2 L via nasal cannula to keep SaO 2 above 90%. 1 to 2 L via nasal cannula to maintain SaO 2 at or above 95%. 3 L via mask to maintain SaO 2 at 95%. Do not give oxygen because it may suppress hypoxic drive in client.

1 to 2 L via nasal cannula to keep SaO 2 above 90%. Rationale Oxygen therapy usually is delayed until stage 4, which is very severe COPD. Usually it is administered at 1 to 2 L per minute to maintain SaO 2 at or above 90%. One to 2 L to maintain the SaO 2 above 95% is not necessary. Oxygen administration may not be necessary. Three liters of oxygen via a mask is unnecessary, and a level of 95% may suppress the hypoxic drive in clients who are chronic CO 2 retainers. Oxygen should not be given unless the chronic saturation level is less than 88%.

penumothorax

A collapsed lung.

In addition to treatment of the underlying cause, which medical intervention should the nurse anticipate will be included in the management of a client with acute respiratory distress syndrome (ARDS)? Chest tube insertion Aggressive diuretic therapy Administration of beta-blockers Positive end-expiratory pressure (PEEP)

Mechanical ventilation with PEEP will help prevent alveolar collapse and improve oxygenation. Fluid is not in the pleural space, so chest tube insertion is not indicated. Aggressive diuretic therapy and administration of beta-blockers are contraindicated because of severe hypotension from the fluid shift into the interstitial spaces in the lungs.

Pectus carinatum

Prominent abnormal protrusion of the sternum

Kussmaul breathing

Rapid and deep breathing abnormality.

asphyxia

a condition arising when the body is deprived of oxygen, causing unconsciousness or death; suffocation.

Cor pulmonale

ght ventricular failure caused by pulmonary congestion; edema results from increasing venous pressure. A productive cough is symptomatic of the original condition, COPD. Although twitching of the extremities and lethargy progressing to coma may be caused by alterations in oxygen and hydrogen ion levels and their effects on the central nervous system, it is the sign of peripheral edema that directly indicates increasing venous pressure secondary to cor pulmonale.

A nurse is caring for a client with a Venturi mask who is receiving 40% oxygen. What nursing actions are indicated? Select all that apply. Keep the oxygen source higher than the client's airway. Adjust the liter flow according to the oxygen saturation. Prevent the client's blanket from covering the adaptor's orifices. Ensure that the bag does not deflate completely during inspiration. Check that the appropriate adaptor to deliver the prescribed FiO 2 is attached to the mask.

- Prevent the client's blanket from covering the adaptor's orifices. - Check that the appropriate adaptor to deliver the prescribed FiO 2 is attached to the mask. Rationale The adaptor's orifices allow room air to combine with the oxygen to provide a specific oxygen concentration. A Venturi mask uses one of several adaptors, which are usually color-coded, to deliver the prescribed FiO 2. The oxygen source does not need to be higher than the client's airway because its flow does not depend on gravity. The liter flow is adjusted according to the flow rate that corresponds to the percent of oxygen prescribed; this usually is identified on the base of each adaptor. A Venturi mask does not have a bag like a rebreather mask.

Pectus excavatum

Abnormal indentation of the lower sternum above the xiphoid process

Cheyne-Stokes respirations

Alternating periods of Apnea and deep rapid breathing

While a nurse is conducting an initial assessment on a client, which classic sign would alert the nurse that the client has chronic obstructive pulmonary disease (COPD)?

Barrel Chest Clients with COPD often develop a barrel chest over time because of air being trapped, thus resulting in enlarged lungs and thoracic cavity. This also causes the lungs to have less flexibility.

A client has been admitted for an upper respiratory tract infection secondary to chronic obstructive pulmonary disease (COPD). The nurse should expect which findings when auscultating the client's breath sounds?

Coarse crackles and rhonchi most often are auscultated in COPD clients who have had an exacerbation. Clients will exhibit prolonged expiration, not prolonged inspiration. The client would not exhibit short, rapid inspiration or normal breath sounds with COPD.

What data about the fluid in the water-seal chamber of a closed chest drainage system provide support for the nurse's conclusion that the system is functioning correctly? Contains many small air bubbles Bubbles vigorously on inspiration Rises with inspiration and falls with expiration Remains at a consistent level during the respiratory cycle

During inspiration, negative pressure in the pleural space increases, causing fluid to rise in the chamber; during expiration, negative pressure in the pleural space decreases, causing fluid to drop in the chamber. If the system is closed to the atmosphere, as it should be, bubbles will not be present. Changes in intrapleural pressure cause fluid to rise on inspiration and fall on expiration (tidaling).

A client with a chest tube is to be transported via a stretcher. When transporting the client, what should the nurse do?

Keep collection device below the level of the client's chest The collection device must be kept below the level of the chest to prevent backflow of fluid into the pleural space. A chest tube clamped distal to the water-seal chamber is contraindicated. The chest tube should not be clamped because it may precipitate a tension pneumothorax. A chest tube end covered with sterile gauze pads taped to the client is contraindicated. There is no reason to disconnect the chest tube from the water-seal system; this will allow atmospheric air to enter the pleural space, causing a pneumothorax.

A client is scheduled for a pulmonary function test. The nurse explains that during the test one of the instructions the respiratory therapist will give the client is to breathe normally. What should the nurse teach is being measured when the client follows these directions? Tidal volume Vital capacity Expiratory reserve Inspiratory reserve

Tidal Volume Rationale The tidal volume is the amount of air inhaled and exhaled while breathing normally. Vital capacity is air that can be forcibly expired after maximum inspiration. Expiratory reserve is the maximum amount of air that can be forcefully expired after a normal expiration. Inspiratory reserve is the maximum amount of air that can be inspired after a normal inspiration.

Atelectasis

collapse of alveoli; breath sounds over the area are diminished.

Naloxone

given for decreased respirations caused by opioid overdose The amount given is determined by the respiratory status, not the level of consciousness. Undesirable side effects of naloxone are pain and rapid heart rate with dysrhythmias.

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.