Term
| How do you know if the patients airway is patent? |
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Definition
| The patient will be alert and oriented, feel their breath, their skin color, and they will respond. |
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Term
| How do you know if breathing is occurring? |
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Definition
| Their chest will rise and fall, LOC, skin color, SPO2, feel their breath, condensating in facial mask. |
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Term
| What nursing interventions can help if a patient is showing signs of difficulty of breathing? |
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Definition
| Reposition the patient (high fowlers), O2, assist as necessary, coughing and deel breathing, remain calm. |
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Term
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Definition
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Term
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Definition
| There is a blockage by mucous |
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Term
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Definition
| There is constriction by inflammation. |
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Term
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Definition
| There is constriction of upper airway |
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Term
| Smokers will show ______ levels of carbon monoxide. |
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Definition
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Term
| Symptoms of hyperventilation |
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Definition
| Tetany, diaphoresis, anxious, tingling of fingers. |
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Term
| Capnography measures what? |
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Definition
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Term
| ______________ is useful when weaning from the vnet, in CPR, and to confirm endotracheal tube placement. |
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Definition
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Term
Normal values of ABGs
pH
pCO2
pO2
HCO3
COHB |
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Definition
pH: 7.35-7.45
pCO2: 35-45
pO2: 80-100
HCO3: 22-26
COHB: <5% |
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Term
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Definition
| Inadequate elimination of CO2 by lungs. |
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Term
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Definition
| Excessive elimination of CO2 by lungs. |
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Term
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Definition
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Term
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Definition
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Term
| SOB, hypoventilation, decreased LOC, restlessness, mental status change, and increased HR are symptoms of what acid-base disorder? |
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Definition
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Term
| Hyperventilation, anxious, tingling, lightheadedness, and tetany are symptoms of what acid-base disorder? |
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Definition
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Term
| Altered LOC, confusion, fruity breath, hyperventilation, increased respiratory rate, N/V, diaphoresis are symptoms of what acid-base disorder? |
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Definition
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Term
| Hypoventilation, tetany, dizziness, and N/V are symptoms of what acid-base disorder? |
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Definition
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Term
Manual airway patency techniques
Contraindications for these? |
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Definition
Head tilt, chin lift
Jaw thrust
Spinal cord injuries and babies |
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Term
| After ET tube is placed what should the nurse assess? |
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Definition
| Vitals, placement of ET tube/ measure placement, lung sounds at least q4hrs, CXR q24 hrs, skin/lip care, cough, respiratory distress= check tube! |
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Term
| When suctioning a ET tube... |
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Definition
- Explain procedure to patient.
- Always oxygenate prior to suctioning.
- Only apply suction when removing catheter.
- Assess for tolerance (desat., braycardia) |
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Term
| When ventilating ET tube patient... |
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Definition
- Raise HOB
- BVM or intubation may be needed. |
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Term
| Oxygen therapy is prescribed when? |
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Definition
| The oxygen needs of the patient cannot be met by "room air". |
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Term
| What % of atmospheric air is oxygen? |
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Definition
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Term
| What element is most abundant in atmospheric air? |
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Definition
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Term
Nasal cannula
L/ min?
% of O2 concentration? |
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Definition
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Term
Simple mask
L/min?
% of O2 concentration? |
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Definition
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Term
Partial rebreather mask
L/min?
% of O2 concentration? |
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Definition
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|
Term
Non-rebreather mask
L/min?
% of O2 concentration? |
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Definition
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|
Term
Venturi mask
L/min?
% of O2 concentration? |
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Definition
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Term
Provides hi/low levels of positive pressure
(improves tidal volume) |
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Definition
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Term
Provides continuous levels of positive pressure
(open collapsed aveoli) |
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Definition
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Term
| What is the danger of administering too much O2 to a COPD patient? |
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Definition
| Their body naturally tells them not to breathe. |
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Term
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Definition
| Nonproductive cough, substernal chest pain, GI upset, dyspnea |
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Term
| S/S of absorption atelectasis |
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Definition
| Crackles, decreased breath sounds |
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Term
In acute respiratory failure. These results are..
paO2 less than_________.
paCO2 more than__________. |
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Definition
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Term
Ventilation vs. Perfusion in ventilatory failure.
Treatment? |
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Definition
Ventilation is abnormal and perfusion is normal.
Ventilation |
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Term
Ventilation vs perfusion in Oxygenation failure.
Treatment? |
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Definition
Ventilation is normal and perfusion is decreased.
Increasing O2 will not help. |
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Term
|
Definition
Both ventilation and perfusion are abnormal.
Common in COPD patients. |
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Term
What percentage of O2 will a NC deliver to a pt. if set at 4L/min?
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|
Definition
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Term
|
Definition
- Dyspnea
- Hypoxia, hypoxemia, and hypercarbia
- Abnormal lung sounds |
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Term
| Diagnosis of ARF is done by? |
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Definition
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|
Term
Progressive type of acute respiratory failure, 50%-60% mortality rate, and 40% of survivors have permanent changes in pulmonary function.
What does this patient have? |
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Definition
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Term
Previous damage causes protein build up, pulling fluid into the alveolar spaces and causes non-cardiac pulmonary edema. The edema and reduced surfactant levels further compromise gas exchange. Progressive alveolitis and fibrosis occur in the lungs.
What does this patient have? |
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Definition
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Term
|
Definition
| Dyspnea, tachypnea, dry cough possibly progressing to a cough producing frothy pink sputum, fatigue, and tachycardia |
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Term
Anyone who has a hx of a lung assault who develops profound dyspnea and tachypnea... or
who doesn't respond to increases in O2 therapy...
You should suspect what? |
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Definition
|
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Term
|
Definition
Maintain airway
Provide adequate oxygenation
Support hemodynamic functioning |
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Term
| Drug therapy for adequate oxygenation? |
|
Definition
Bronchodilators (albuterol, zopenex): opens airway
Corticosteroids: decreases inflammation
Antibiotics: if infection is present |
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Term
| Mechanical ventilation provides what? |
|
Definition
| adequate ventilation and oxygenation while decreasing patient's work of breathing. |
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Term
| Benefits of positive pressure ventilation? |
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Definition
| forced/enhanced lung expansion, improved gas exchange, decreased work for breathing, and delivers lower amounts of O2. |
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Term
Preset ventilator rate and tidal volume, pt. can initiate, pt controls own rate, but ventilator can take over.
What ventilator mode is described? |
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Definition
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Term
Client initiated breaths, TV is patients own. Ventilator initiated breaths synchronized (helpful for weaning).
What ventilator mode is described?
|
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Definition
| SIMV (synchronized intermittent mechanical ventilation) |
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Term
Preset pressure delivered during spontaneous inspirator (reduces work).
What ventilator mode is described? |
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Definition
| PSV (pressure support ventilation) |
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Term
pressure applied at end of expiration to keep alveoli open (used with AC or SIMV, cannot be used alone)
What ventilator mode is described? |
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Definition
| PEEP (positive end expiratory pressure) |
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Term
| Monitoring of ventilators |
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Definition
10-15 minutes after any ventilator changes (ABG)
SpO2 monitor continuous
Observe for restlessness, lethargy
Ventilator alarms should be on at all times
When in doubt.... VENTILATE!! |
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Term
| Low exhaled volume due to disconnection, cuff leak, or tube displacement are all indications of what type of ventilator alarm? |
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Definition
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Term
| Excess secretions, client biting on tubing, kinks, client coughing, and bronchospasms are all indications of what ventilator alarm? |
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Definition
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|
Term
| Ventilator does not detect spontaneous breathing is an indication for what ventilator alarm? |
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Definition
|
|
Term
Sedation for a ventilator..
Medication of choice for sedation?
Assessments? Times?
Ramsay Scale scoring? |
|
Definition
Propofol
Neuro assessment q8hrs.
Wake up assessment q24hrs.
Continuous BP, HR, ECG, SpO2, and hemodynamic monitoring.
We want a level of 2 or 3. |
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Term
Mechanical ventilation complications:
Cardiac complications and respiratory complications |
|
Definition
Cardiac (hypotension and fluid retention)
Respiratory (oxygen toxicity, risk for aspiration, ventilator induced lung injury)
Nutrition
Infection
Stress Ulcer |
|
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Term
|
Definition
| Air, fat, blood, amniotic |
|
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Term
|
Definition
| Post-surgical, immobility, heart disease, fractures |
|
|
Term
|
Definition
| Restlessness, apprehension, chest pain, sudden onset dyspnea, tachypnea, decreased breath sounds, and hemoptysis |
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Term
| Physical assessment findings for PE include |
|
Definition
| Tachypnea, crackles, pleural friction rubs, tachycardia, S3 or S4, diaphoresis, and petechiae |
|
|
Term
|
Definition
ABG (decreased PaO2)
D-Dimer test
CT Scan with contrast (positive D-Dimer)
TEE |
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|
Term
| Nursing diagnosis for PEs |
|
Definition
Impaired gas exchange
Pain
Anxiety
Confusion
Risk for Bleeding |
|
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Term
|
Definition
Heparin (antidote: Protamine Sulfate)
Coumadin (antidote: Vitamin K)
Thrombolytics |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
Pulmonary Contusion
S/S
Treatment |
|
Definition
difficulty breathing, rhonchi or crackles, CXR, hx. of trauma
O2, prevention of symptoms |
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Term
|
Definition
| pain management (ibprophen) |
|
|
Term
Flail chest
S/S
Treatment |
|
Definition
See saw respirations
pain and intense respiratory management |
|
|
Term
| Collection of air (blood, exudate) in the pleural space |
|
Definition
|
|
Term
|
Definition
acute onset of dyspnea
tachypnea
decreased breath sounds
crepitus |
|
|
Term
|
Definition
chest tube.
HOB 30 degrees
Pain control |
|
|
Term
| When ambulating pt., keep collection device __________ level of insertion site. |
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Definition
|
|
Term
| If chest tube accidentally becomes dislodged.. |
|
Definition
cover sit with occlusive dressing
listen to lung sounds
observe for respiratory distress
notify physician |
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|
Term
| Indications for epidural anesthesia |
|
Definition
acute post-op pain
labor and delivery
chronic pain
multiple trauma
therapy which may last 48 hours to several weeks |
|
|
Term
Medications used for epidural anesthesia
SE?
Antidote? |
|
Definition
Fentanyl and Meperdine
Sufenta ( 7x more concentrated than fentanyl)
Morphine and Hydromorphone
chest rigidity, itching, urinary retention
NARCAN |
|
|
Term
| Epidural anesthesia complications |
|
Definition
Hypotension
Respiratory distress
N/V
Urinary retention |
|
|
Term
| Nursing care for epidural anesthesia includes |
|
Definition
checking the catheter site
changing the tubing and medication bag
assessing the patient, including VS
checking the pump and assessing the alarms |
|
|
Term
| Nursing actions for epidural anesthesia |
|
Definition
- place a sign on the head of bed "epidural analgesia only"
- two ampules of Narcan at bed
- assure pateint IV or saline lock in place during and until 6 hours after catheter removal
- assess respiratory rate every 1 hr
- effectiveness of pain relief and side effects every 2 hrs.
- insertion side every 8 hrs.
- I&O
- evaluate urinary bladder distention
- maintain a sterile, occlusive dressing |
|
|
Term
|
Definition
- metallic taste
- numbness of tongue or lips
- tinnitus
- dizziness
|
|
|
Term
| Partial or complete loss of sensation with or without LOC |
|
Definition
|
|
Term
| How is it decided which type of anesthesia to use? |
|
Definition
| Type of procedure and duration, area of body, emergency or not, time since last eaten, position needed for OR |
|
|
Term
| Complications of regional anesthesia |
|
Definition
| Local irritation, systemic absorption, and anaphylaxis |
|
|
Term
| Administered when the needle passes between the vertebrae of the spinal column through the dura where the CSF is located |
|
Definition
|
|
Term
| Spinal Anesthesia complications |
|
Definition
Hypotension
Respiratory depression
N/V
Urinary retention |
|
|
Term
| When the needle is inserted between the vertebrae to the epidual space. contains fat which functions as a depot for opiods and local anesthetics. |
|
Definition
|
|
Term
| Patient must be able to manage own respirations and respond. |
|
Definition
|
|
Term
| Characterizations of general anesthesia |
|
Definition
| Analgesia, amnesia, unconsciousness, loss of muscle tone, and reflexes |
|
|
Term
|
Definition
Sedation and relaxation
Hearing is exaggerated
QUIET |
|
|
Term
|
Definition
Excitement
Irregular breathing, increased muscle tone, laryngospasms
Stay beside patient, keep from harm, assist CRNA |
|
|
Term
|
Definition
|
|
Term
|
Definition
Danger
OVERDOSE
Prepare for and assist with resuscitation |
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