Gas Exchange/Perfusion Mediasites

Suctioning Guidelines

* High fowler's * Know baseline VS * Use caution with a head injury * Perform tracheal before pharyngeal suctioning

right sided heart failure

1. Jungular Vein Distention 2. Ascending Dependent Edema 3. Weight Gain 4. Hepatomegaly (Liver Enlargement)

Normal newborn RR

30-60 breaths/min

Which amount is the normal value of a client's inspiratory reserve volume? 1 0.5 L 2 1.0 L 3 1.5 L 4 3.0 L

4 3.0 L

Minimum number of liters for simple facemask

5 L/min.

Which comes first: A2 or P2?

A2(LeftLeads)

Complications of suctioning

Hypoxia Tissue trauma Infection

Which lung disease: restrictive or obstructive, affects exhalation?

Obstructive (O for Out)

Which autoimmune disease can result in damage to the heart? Uveitis Rheumatic fever Myasthenia gravis Graves disease

Rheumatic fever

sweat chloride test

Used in the diagnosis of cystic fibrosis

oropharyngeal & nasopharyngeal airway

Used when pt. can cough effectively but can't clear secretions

Suddenly stopping beta blockers can cause:

angina, MI, and rebound HTN

A pt is admitted with pneumonia. You hear low pitched, continuous sounds over the bronchi: 1. crackles b. rhonchi c. wheezes d. friction rub

b. rhonchi

Absorptive atelectasis

occurs by surfactant inactivation or when less than normal levels of inhaled nitrogen ( nitrogen wash-out ) are present in the alveoli.

Heart valves open actively/passively

passively

S2: end of ______

systole

Never suction longer than ______ seconds

10-15

Hyper-oxygenate with __% O2 before AND after suctioning

100

Trach cuff pressure

14-20 mmHg

Which generation of antihistamines cause anticholinergic sx., such as drowsiness & dry mouth?

1st generation (such as diphenhydramine)

Pt with hx of COPD c/o SOB. Which nursing intervention is most appropriate? 1. Don't administer O2 2. Administer O2 via venti mask 3. Use nasal cannula to administer high flow O2 4. Administer O2 at 6L via simple face mask

2. Administer O2 via venti mask (MOST PRECISE) *Remember: you don't want O2 to be too high with someone with COPD (Low blood levels are actually their stimulus to breathe)

Right lung: __% of activity / Left lung: __% of activity

55 / 45

If there are absent DP & PT pulse, you should calculate the ____.

ABI (ankle systolic/brachial systolic) Normal valve is at least 1.

What adventitious sound is r/t sub-Q emphysema?

Crepitus

Medication of choice for an MI

Morphine -- relieves pain quickly and reduces anxiety. It also decreases cardiac workload.

_______ is a drug given in the sweat chloride test for CF

Pilocarpine

The nurse has administered sublingual nitroglycerin. Which outcome would the nurse use to determine the effectiveness of sublingual nitroglycerin? Relief of anginal pain Improved cardiac output Decreased blood pressure Ease in respiratory effort

Relief of anginal pain

A client with chronic obstructive pulmonary disease (COPD) has a blood pH of 7.25 and a partial pressure of carbon dioxide (PCO 2) of 60 mm Hg. Which complication would the nurse suspect the client is experiencing? Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis

Respiratory acidosis pH is very low (acidic) & CO2 is very high (should be 35-45)

Which complication will occur as the result of administering sildenafil to a client who takes isosorbide dinitrate?

Severe hypotension

Which lung sound is the quietest: bronchial, bronchovesicular, or vesicular?

Vesicular

S2

closure of aortic and pulmonic valves

examples of vasopressors

epinephrine dopamine ephedrine pseudoephedrine

Barrel chest: AP diameter greater than/less than 90 degrees

greater than

chest physiotherapy and postural drainage

helping loosen mucus and moving it into large airways

Normal stimulus to breathe

hypercapnia

Stimulus to breathe in COPD

hypoxemia (they are used to hypercapnia)

People with _______ are unable to lie flat.

hypoxia

Clients taking ________ should avoid foods containing tyramine such as red wine, tuna fish, and hard cheese.

isoniazid

Nitrogen function

maintains patent airway & alveoli

Hemophilia affects mostly males/females

males

upper respiratory tract

nasal cavity, pharynx, larynx

Causes of hypoventilation

neuro. injury, OD, obesity, COPD

Is COPD reversible?

not fully reversible

PFTS

pulmonary function tests, estimate the quality of a patient's respiratory function

For a ________ acidosis, the pCO2 is greater than 40 to 45 due to decreased ventilation.

respiratory

Which lung is shorter?

right

Causes of rhonchi

secretions in large airways, muscular spasms, or fluid

S1: beginning of ______

systole

lower respiratory tract

trachea, bronchial tree, lungs

tracheal suctioning

used with an artificial airway

isometric contraction

ventricles contract when all 4 valves are closed

After surgery, cough and deep breathe at least every _ hours

2

Limit the introduction of the catheter to __ times with each suctioning procedure

2

The heart is 1/2 pumps

2 (each side of the heart is its own pump)

When caring for a client with emphysema who becomes more restless, which action would the nurse take first? 1 Auscultate lung sounds. 2 Check oxygen saturation. 3 Observe for increased respiratory effort. 4 Ask about any increased shortness of breath.

2 Check oxygen saturation (restlessness is an early sign of < oxygenation)

Which clinical manifestation would the nurse expect when a client experiences fat embolism syndrome (FES)? 1 Nausea 2 Dyspnea 3 Orthopnea 4 Paresthesia

2 Dyspnea FES is clinically manifested by dyspnea because of low levels of arterial oxygen. Tachypnea, headache, and lethargy are seen in clients with FES.

A client is extubated in the postanesthesia care unit after surgery. For which common response would the nurse be alert when monitoring the client for acute respiratory distress? 1 Bradycardia 2 Restlessness 3 Constricted pupils 4 Clubbing of the fingers

2 Restlessness

Typically time needed in between suctionings

2-3 hours

Limit salt intake to no more than _____ mg a day for heart health

2400

Which type of adventitious breath sound would the nurse expect when auscultating the posterior chest of a client with pleurisy who is reporting sharp chest pain with deep breathing? 1 Stridor 2 Rhonchi 3 Pleural friction rub 4 High-pitched crackles

3 Pleural friction rub

A client is experiencing severe acute respiratory distress. Which response would the nurse expect the client to exhibit? 1 Tremors 2 Anasarca 3 Bradypnea 4 Tachycardia

4 Tachycardia

Normal CO

5L/min

Normal APGAR score

7-10

Normal FEV1/FVC ratio

75-80%

What is our SPO2 goal for pts with COPD (who are used to hypercarbia?)

88-92%

If O2 falls below __% while suctioning, stop & hyper oxygenate

90

nonrebreather can deliver a FiO2 over ___%

90

The nurse is caring for a client admitted with chronic obstructive pulmonary disease (COPD). Which laboratory test would the nurse monitor for hypoxia? 1 Red blood cell count 2 Sputum culture 3 Arterial blood gas 4 Total hemoglobin

ABG

Suction mouth or nose after/before suctioning trachea

After (you don't want to introduce that bacteria deeper in the body)

How often should you perform incentive spirometry?

At least 5-10 breaths/hour

Presystole/atrial systole/atrial kick

At the end of diastole when the atria contracts one more time to push the last amount of blood into the ventricles

Which medication prescribed for a client with an acute episode of heart failure would the nurse question? Diuretic Beta blocker Long-acting nitrate Angiotensin receptor blocker

Beta blocker *Beta blockers reduce cardiac output and are contraindicated for clients with acute heart failure, although they are frequently used to prevent progression of chronic heart failure.

Caffeine

Can > ectopic beats

Where are chemoreceptors located?

Carotid and aortic bodies and medulla oblongata

A client is admitted to the intensive care unit with pulmonary edema. Which clinical finding would the nurse expect when performing the admission assessment? Weak, rapid pulse Decreased blood pressure Radiating anterior chest pain Crackles at bases of the lungs

Crackles at bases of the lungs

What should you NOT do after a rhinoplasty?

Do not take NSAIDS, in order to prevent bleeding

Which complication is prevented by coaching a client in the second stage of labor to take a breath at least every 6 seconds while pushing with each contraction? Fetal hypoxia Perineal lacerations Carpopedal spasms Maternal hypertension

Fetal hypoxia

HC-associated vs. Hosp-Acquired pneumonia

HC-associated is within 48 hours of admission, and hospital-acquired occurs after 48 hours.

A low pitched booming sound found when too much air is present in the lungs as in emphysema or pneumothorax

Hyperresonance

Which physiological alteration would be expected with a higher-than-normal red blood cell (RBC) count? Increased blood pH Decreased hematocrit Increased blood viscosity Decreased immune response

Increased blood viscosity

How does Digoxin affect CO?

Increases it.

Which type of intercostals draw ribs in and down?

Internal intercostals

Why should the use of baby powder on an infant be avoided? 1 Skin irritation 2 Skin infection 3 Lung irritation 4 Respiratory infection

Lung irritation

Which comes first: M1 or T1?

M1 (LeftLeads)

______ are the most frequent cause of pneumonia

Microbes

How does the Fowler''s position help breathing?

Moves diaphragm away from the lungs to help breathing

Should we use normal saline instillation before suctioning to loosen secretions?

No -- saline might actually stay in lungs. This is contraindicated.

Pilocarpine is used as part of the diagnostic process of a toddler suspected of cystic fibrosis. The nurse knows that the pilocarpine would stimulate which process? 1 Secretion of mucus 2 Activity of sweat glands 3 Excretion of pancreatic enzymes 4 Release of bile from the gallbladder

Pilocarpine is a cholinergic agonist!

What does nitrogen do?

Prevents alveolar collapse (which is why we should not overoxygenate)

Factors affecting type of O2 therapy used

Pt. comfort Importance of humidity Pt mobility SPO2 levels

What class of medication does pseudoephedrine/Sudafed belong to?

Systemic decongestants

Which actions will the nurse include when doing tracheostomy care? Select all that apply. One, some, or all responses may be correct. 1 Suction the client before starting tracheostomy care. 2 Use sterile technique when cleaning the inner cannula. 3 Use sterile cotton-tipped swabs to clean the inner cannula. 4 Don sterile gloves before removing the inner cannula. 5 Use hydrogen peroxide to clean the skin around the stoma.

Use sterile technique when cleaning the inner cannula. Don sterile gloves before removing the inner cannula. There is no need to suction the client before starting tracheostomy care, although the client may be preoxygenated before removing the inner cannula. A brush is used to clean the inner cannula. Hydrogen peroxide is used to clean secretions from the inner cannula, the cannula is rinsed with normal saline. Because hydrogen peroxide can be irritating to tissue, normal saline is used to clean the skin around the tracheostomy stoma.

orotracheal and nasotracheal suctioning

Used when the patient is unable to manage secretions by coughing and does not have an artificial airway

2/3 of cardiac cycle

diastole

Use _____ amount of O2 necessary in O2 therapy

lowest

Spider nevi

r/t liver disease & portal HTN

Cerebral cortex

regulates the VOLUNTARY control of respiration

Normal sound heard during percussion over lungs

resonance

S1

the first heart sound, heard when the atrioventricular (mitral and tricuspid) valves close

early/protodiastolic filling

the first passive filling phase of diastole

Perfusion

the flow of blood through arteries and capillaries delivering nutrients and oxygen to cells

Gas exchange

the process by which oxygen is transported to CELLS and carbon dioxide is transported from CELLS