Term
What are the normal lab values of ABGs?
ph, PaO2, SaO2, PaCO2, HCO2 |
|
Definition
ph: 7.35-7.45
PaO2: 80-100
SaO2: 95%+
PaCO2: 32-48
HCO2: 22-26 |
|
|
Term
| Who assesses gag reflex for pt with trach? |
|
Definition
|
|
Term
| What would the RN cover the stoma with after the MD removes the trach? |
|
Definition
|
|
Term
| What must the RN teach the pt with a trach stoma to do when coughing, speaking, or swallowing? |
|
Definition
|
|
Term
| What is the earliest that trach ties can be changed? |
|
Definition
|
|
Term
| What important piece of equipment must be available IN THE ROOM in case a trach is accidentally removed? |
|
Definition
|
|
Term
| What are the nursing actions in the event a pt's trach comes out? |
|
Definition
| use obturator to reinsert trach, assess pt, place in semi Fowlers, page MD |
|
|
Term
| What should the RN do if a pt's trach comes out, the trach can't be reinserted, and the pt is in distress? |
|
Definition
| 4X4 sterile gauze to stoma and manually bag the pt |
|
|
Term
| What is the purpose of a chest tube at the superior pleural space? |
|
Definition
|
|
Term
| What is the purpose of a chest tube at the inferior pleural space? |
|
Definition
|
|
Term
| What type of dressing is placed around the chest tube? |
|
Definition
| vasoline gauze and covered with a sterile dressing |
|
|
Term
| The RN should call the MD if drainage from a chest tube is greater than or equal to what in mL/hr? |
|
Definition
|
|
Term
| What indicates an air leak in the chest tube drainage system? |
|
Definition
| continuous bubbles in the water seal |
|
|
Term
| How would a specimen be obtained from the chest tube? |
|
Definition
| by making a loop in the line and aspirating contents using a 20g or smaller needle (22g, 24g) or also from a port on the line |
|
|
Term
| The numbers on the water seal of the chest tube drainage system indicate what? |
|
Definition
| the extent of an air leak; 1 being the smallest and 5 being the largest |
|
|
Term
| How is the volume of water in the water seal chamber adjusted? |
|
Definition
| sterile water can be removed or injected with a 20g needle via the back of the chest tube drainage system |
|
|
Term
|
Definition
| raising and lowering of the water in the water seal chamber with breathing; raises with inhalation and lowers with expiration |
|
|
Term
| What is the protocol for chest tube suction and clamping pertaining to removal of the tube? |
|
Definition
d/c suction 24 hrs prior to removal and clamp 4-6 hrs prior to removal
(this is dependent upon institution and MD preferences) |
|
|
Term
| What size chest tube would be used for a pneumothorax? |
|
Definition
| 14F-22F (the smaller the number the smaller the diameter) |
|
|
Term
| What size chest tube would be used for fluid? |
|
Definition
| 28F-40F (the larger the number the larger the diameter) |
|
|
Term
| A chest tube can be inserted in the OR, ER, or pt room, how is the pt positioned if the tube is to be inserted in the pt room? |
|
Definition
| either sitting on the edge of the bed with arms resting on a bed side table or, most likely, lying supine with the midaxillary area of the affected side exposed |
|
|
Term
| What is the flutter or Heimlich valve used for? |
|
Definition
| air evacuation from the pleural space, it is a ONE WAY valve with a tube and small pouch that can be worn after leaving the hospital and worn under clothes |
|
|
Term
| What is the purpose of the first chamber in the chest tube suction device? |
|
Definition
| This is the collection chamber; air or fluid evacuated from the pleural space enters here. Fluid stays here while air, from a pneumothorax, enters the water seal chamber |
|
|
Term
| What is the purpose of the second chamber of the chest tube suction device? |
|
Definition
| this is the water seal chamber and acts as a one way valve for air evacuated from the pleural space |
|
|
Term
| How much water should be kept in the water seal chamber? |
|
Definition
| the level should be kept at 2 cm |
|
|
Term
| Why is clamping of the chest tube contraindicated when moving a pt or if accidental disconnection occurs? |
|
Definition
| tension pneumothorax is of greater concern than a small amount of air entering the pleural space |
|
|
Term
| What is the one reason for clamping a chest tube? |
|
Definition
| to assess if the pt can have the chest tube removed; requires a MD order |
|
|
Term
| What is the initial action by the RN if the chest tube becomes disconnected from the drainage system? |
|
Definition
| Place the end of the tube in 2 cm of sterile water to reestablish a water seal |
|
|
Term
| What can occur if greater than 1L of fluid is removed rapidly by the chest tube? |
|
Definition
| reexpansion pulmonary edema |
|
|
Term
| During the 24 hrs prior to removal of the chest tube, how much suction will be applied? |
|
Definition
| none, typically will be left to drain to gravity |
|
|
Term
| What is the pt's responsibility while the chest tube is being removed? |
|
Definition
| the pt will either hold his or her breath or bear down (Valsalva manuever) |
|
|
Term
| What is the chest tube site covered with immediately following removal? |
|
Definition
| immediately covered with an airtight petroleum dressing and covered with sterile gauze |
|
|
Term
| How long does it take for the chest tube site (pleura and wound) to heal? |
|
Definition
|
|
Term
| Why would a chest x-ray be used following a chest tube removal? |
|
Definition
| to assess for a pneumothorax |
|
|
Term
| What condition should always be suspected following blunt force trauma of the chest? |
|
Definition
|
|
Term
| What is emergency treatment of an open pneumothorax? |
|
Definition
covering the wound with an occlusive dressing taped on THREE sides
-during inspiration negative pressure is created in the chest and pulls the dressing preventing air from entering
-during expiration pressure rises in the pleural space and air is pushed out |
|
|
Term
| What are the S&S of a tension pneumothorax? |
|
Definition
| dyspnea, chest pain radiating to the shoulder, tracheal deviation, decreased or absent breath sounds on the affected side, neck vein distention, cyanosis |
|
|
Term
| What are the S&S of a pneumothorax? |
|
Definition
| dyspnea, decreased movement of involved chest wall, diminished or absent breath sounds on affected side, hyperresonance to percussion |
|
|
Term
| What are the S&S of hemothorax? |
|
Definition
| dyspnea, diminished breath sounds on affected side, dullness to percussion, decreased hemoglobin |
|
|
Term
| What are the S&S of flail chest? |
|
Definition
| paradoxic movement of the chest wall, resp distress |
|
|
Term
| What are S&S of cardiac tamponade? |
|
Definition
| muffled/distant heart sounds, hypotension, neck vein distension, increased central venous pressure |
|
|
Term
| What is the emergency management of flail chest? |
|
Definition
| supplemental O2, stabilize flail segment with positive pressure ventilation (BiPAP, CPAP)or intubation and mechanical ventilation, treat associated injuries |
|
|
Term
| What may be the only symptoms associated with a small pneumothorax? |
|
Definition
| mild tachycardia and dyspnea |
|
|
Term
| What is a pleural effusion? |
|
Definition
| an abnormal collection of fluid in in the pleural space |
|
|
Term
| What are the 5 possible causes of pleural effusion? |
|
Definition
1. increased production of fluid d/t decreased oncotic pressure
2. increased production of fluid d/t increased capillary permeability
3. bleeding into the space
4. decreased lymphatic clearance of pleural fluid
5. infection |
|
|
Term
| What are the 2 types of pleural effusion? |
|
Definition
| transudative and exudative |
|
|
Term
| When do transudative pleural effusions occur? |
|
Definition
| primarily in noninflammatory conditions and is an accumulation of protein-poor, cell-poor fluid |
|
|
Term
| What causes transudative pleural effusions? |
|
Definition
increased hydrostatic pressure found in heart failure or decreased oncotic pressure found in chronic kidney or liver disease
-in these situations fluid movement is facilitated out of the capillaries and into the pleural space |
|
|
Term
| What causes exudative pleural effusions? |
|
Definition
increased permmiability of capillaries characteristic of the inflammatory reaction.
-can also be secondary to malignancies, infections, necrosis, pancreatitis, or esophageal perforation |
|
|
Term
|
Definition
| pneumonia, TB, lung abscess, and infection |
|
|
Term
| What is trapped lung a result of? and describe |
|
Definition
empyema;
-the lung becomes fibrous d/t an encasing peel or rind causing severe restriction of movement |
|
|
Term
| The common S&S of pleural effusion are? the S&S of empyema? |
|
Definition
progressive dyspnea and decreased movement of the chest wall
-empyema is the same as pleural effusion plus fever, night sweats, cough, and weight loss |
|
|
Term
| What can happen if more than 1L of fluid is removed during a single thoracentesis? |
|
Definition
| hypotension, hypoxemia, or pulmonary edema |
|
|
Term
| Why is a follow chest x-ray needed following a thoracentesis? |
|
Definition
| to detect a possible pneumothorax caused by accidental perforation of the visceral pleura |
|
|
Term
| What is the appropriate treatment for pleural effusion caused by heart failure? |
|
Definition
| treating the HF with diuretics and sodium restrictions |
|
|
Term
| Why are malignant pleural effusions harder to treat than those brought on by heart failure? |
|
Definition
| they are frequently recurrent and rapidly accumulate following thoracentesis |
|
|
Term
| What is a thoracentesis used to treat? |
|
Definition
|
|
Term
| What is the purpose of a chemical pleurodesis? What are the two drugs most commonly used? |
|
Definition
-to obliterate the pleural space and prevent reaccumulation of effusion fluid
-Talc (most effective); doxycycline (also works) |
|
|
Term
| Chest tubes are placed following a pleurodesis until fluid drainage is less than what per day? |
|
Definition
| 150 mL and no air leaks are noted |
|
|
Term
| What is the usual treatment for empyema? |
|
Definition
| chest tube drainage and antibiotic treatment for the causative agent |
|
|
Term
|
Definition
| inflammation of the pleura (typically caused by pneumonia, TB, chest trauma, pulmonary infarctions, and neoplasms |
|
|
Term
| Pleurisy is typically rapid in onset. What are the S&S? |
|
Definition
| rapid/shallow breathing, aggravated by inspiration, possibly a friction rub |
|
|
Term
|
Definition
| treat the underlying cause, analgesics, lying on or splinting the affected side may cause relief |
|
|
Term
| What is the most common cause atelectesis? |
|
Definition
obstruction of the alveoli by fluid
-seen in bedridden pts and pts post op abd and thoracic surgery |
|
|
Term
| What normally creates collateral passage of air in instances of atelectasis? |
|
Definition
|
|
Term
| Why nursing interventions are important to prevent atelectasis? |
|
Definition
| deep-breathing exercises and coughing |
|
|
Term
| Give one example of low pressure pulmonary edema. One example of high pressure pulmonary edema. |
|
Definition
low pressure: ARDS
high pressure: CHF |
|
|
Term
|
Definition
| abnormal accumulation of fluid in the alveoli and interstitual spaces of the lungs |
|
|
Term
| What is the interstitial edema phase of pulmonary edema? |
|
Definition
| the hydrostatic pressure increases or the colloidal oncotic pressure decreases, causing fluid to leave the pulmonary capillaries and enter the interstitial space |
|
|
Term
| What normal body process usually drains away the excess fluid in the interstitial phase of pulmonary edema? |
|
Definition
|
|
Term
| What stage follows the interstitial phase of pulmonary edema? |
|
Definition
| the alveoli phase; during this phase the fluid that has left the capillaries and entered the interstitial space now fills the alveoli |
|
|
Term
| A pulmonary embolism is a blockage of what? |
|
Definition
|
|
Term
| What is the most common cause of PE? |
|
Definition
|
|
Term
| Where do most lethal PE originate? |
|
Definition
| the femoral or iliac veins |
|
|
Term
| What are other possible causes of PE other than DVT? |
|
Definition
| fat emboli, air emboli, bacterial vegetations, amniotic fluid, and tumors |
|
|
Term
| What are the most common risk factors for PE? |
|
Definition
| immobility, surgery within the last 3 months, stroke, paresis, paralysis, history of DVT, malignancy, obesity in women, heavy cigarette smoking, and HTN |
|
|
Term
| S&S of PE are varied and nonspecific, what are some of these? |
|
Definition
dyspnea, chest pain, hemoptysis, cough, crackles, fever, changes in LOC r/t hypoxemia
-a low PaO2 is also common |
|
|
Term
| What are the CV manifestations with a massive PE? |
|
Definition
| tachycardia and ECG will show right heart strain |
|
|
Term
| What three major factors contribute to pulmonary infarction? |
|
Definition
1. occlusion of a pulmonary vessel greater than 2mm in diameter
2. insufficient collateral blood flow
3. preexisting lung disease |
|
|
Term
| What is the most frequently used test to diagnosis PE? |
|
Definition
|
|
Term
| What are some treatments for the pt with PE? |
|
Definition
| supplemental O2, turning, coughing, deep breathing, incentive spirometer, tPA or alterplase to dissolve the clot, embolectomy (which is rare and 50% don't survive the surgery) |
|
|
Term
|
Definition
| DVT prophylaxsis, anticoagulants, filter placed in the inferior vena cava |
|
|
Term
| What is the level of activity recommended for pts with PE? |
|
Definition
|
|
Term
| How long is anticoagulant therapy continued for pts recovering from PE? |
|
Definition
| at least 3-6 months; if clotting is a recurrent problem treatment is indefinate |
|
|
Term
| ARDS is what type of Pulmonary Edema, high or low pressure? |
|
Definition
|
|
Term
| What is the most common cause of ARDS? |
|
Definition
|
|
Term
| What type of reaction occurs that exacerbates ARDS? |
|
Definition
|
|
Term
| What are the three phases of ARDS? |
|
Definition
1. injury phase
2. reparative phase
3. fibrotic phase |
|
|
Term
| Which type of immune cell migrates to the lungs eventually leading to a shift in fluid to the alveoli in ARDS? |
|
Definition
|
|
Term
| How long does the injury phase last? |
|
Definition
|
|
Term
| What fills the alveolar space damaging them in ARDS? |
|
Definition
|
|
Term
| How is surfactant affected by ARDS? |
|
Definition
| the alveoli that produce surfactant are damaged causing surfactant dysfunction and this leads to atelectasis |
|
|
Term
| Why is higher inspiratory pressure needed during ventilator management of ARDS? |
|
Definition
| a decrease in lung compliance and fluid filling the alveoli space cause the alveoli to remain closed on inspiration; PEEP is usually used to keep them open |
|
|
Term
| Describe what happens to the RR and TV in the injury phase of ARDS. |
|
Definition
| RR increases and TV decreases |
|
|
Term
| When does the reparative phase of ARDS usually begin? |
|
Definition
| usually 1-2 weeks after initial injury |
|
|
Term
| What is characteristic of the reparative phase of ARDS? |
|
Definition
| the lung becomes fibrous and compliance worsenes, hypoxemia worsens as the alveolar membrane thickens |
|
|
Term
| When does the fibrotic phase of ARDS usually begin? |
|
Definition
| 2-3 weeks after initial injury |
|
|
Term
| What is the condition of the lung in the fibrotic phase of ARDS? |
|
Definition
| the lung is completely remodeled by collagenous and fibrous tissue, there is diffuse scarring and fibrosis |
|
|
Term
| What are the respiratory manifestations of ARDS? |
|
Definition
| tachypnea, retractions, and a decrease in lung compliance lung volume and functional residual capacity; possible rhonchi or crackles |
|
|
Term
| What are the nonrespiratory manifestations of ARDS? |
|
Definition
| tachycardia, diaphoresis, cyanosis, pallor |
|
|
Term
| How does the body with ARDS respond to an increase in FiO2? |
|
Definition
| it doesn't respond, hypoxemia doesn't improve d/t impaired gas exchange |
|
|
Term
| What does the chest xray look like of a pt with ARDS? |
|
Definition
|
|
Term
| MODS is a fatal complication of ARDS, which organs are usually involved? |
|
Definition
| kidneys, liver, and heart |
|
|
Term
| With ARDS what is the goal to keep PaO2 above? |
|
Definition
|
|
Term
| How should supplemental O2 be delivered to the pt recovering from ARDS? |
|
Definition
| initially use masks with high flow systems to deliver a higher concentration of O2; simple face mask or nasal cannula are inadequate |
|
|
Term
| At what concentration and for how long of oxygen will lead to oxygen toxicity in the pt with ARDS? |
|
Definition
| FiO2 of 60% or greater for 48 hrs or more |
|
|
Term
| What are some adverse effects of PEEP? |
|
Definition
| decreased preload, CO, and BP |
|
|
Term
| Aside from Semi-Fowlers what position may pts with ARDS be put in? |
|
Definition
|
|
Term
| Pts with ARDS require enteral or parenteral feedings to meet their high energy requirements. What specifically added to these may improve clinical outcomes? |
|
Definition
|
|
Term
| How long does it take for lung cancer tumors to reach a size of 1mm (which is the smallest lesion detectable by xray)? |
|
Definition
|
|
Term
| What are the two primary categories or lung cancer? |
|
Definition
| non-small cell lung cancer and small cell lung cancer |
|
|
Term
| What is usually the first reported sign of lung cancer? |
|
Definition
| persistent cough that produces sputum |
|
|
Term
| What is the most effective non-invasive technique to diagnose lung cancer? |
|
Definition
|
|
Term
| How does a PET scan identify tumors? |
|
Definition
| PET scans measure metabolic activity, malignant cells are more metabolically active so they show up well on PET scans |
|
|
Term
| What is the single most definitive test for cancer? |
|
Definition
|
|
Term
| Which lung cancers can be treated with resection? |
|
Definition
| non-small cell lung cancer stages I and II |
|
|
Term
| What is the treatment for Adenocarcinoma? |
|
Definition
| resection may be attempted based on staging; DOES NOT RESPOND WELL TO CHEMO |
|
|
Term
| Which lung cancer are prone to metastasize? |
|
Definition
|
|
Term
| Which lung cancer is not prone to metastasize? |
|
Definition
|
|
Term
| What is the treatment of squamous cell carcinoma? |
|
Definition
| surgical resection may be attempted |
|
|
Term
| What is the treatment of large cell carcinoma? |
|
Definition
| surgery not usually attempted; may be radiosensitive but usually recur |
|
|
Term
| What is the treatment of small cell carcinoma? |
|
Definition
| chemotherapy is usual treatment but prognosis not good; radiation can be used as an adjuvant treatment or palliative |
|
|
Term
| Should range of motion exercises be used on the operative side of pts having chest surgery? |
|
Definition
|
|
