NSG 3040 respiratory | 43 questions and answers | 2025 latest update | Pass Guranteed

what is the normal percentage of oxygen that we breathe room air

21%

hypoxemia

a decrease in the arterial oxygen tension in the blood. hypoxemia turns into hypoxia

hypoxia

a decrease in oxygen supply to the tissues and cells that can also be caused by problems outside the respiratory system. this can be life threatening. organ systems are not being well perfused.

oxygen toxicity

may occur when too high a concentration of oxygen (greater than 50%) is administered for an extended period of time.

symptoms of oxygen toxicity

-Substernal discomfort

-Paresthesias

-Dyspnea

-Restlessness

-Fatigue

-Malaise

-Progressive respiratory difficulty

-Refractory hypoxemia

-Alveolar atelectasis

-Alveolar infiltrates on x-ray

prevention of oxygen toxicity

-Use lowest effective concentrations of oxygen

-PEEP or CPAP prevent or reverse atelectasis and allow lower oxygen percentages to be used

what is incentive spirometry? used to prevent what? indications?

device encourages patient to inhale slowly and deeply to maximize lung inflation and alveoli expansion.

- used to prevent or treat atelectasis

- indications: post surgery

- make sure patient is sitting up. patient education.

what is mini nebulizer therapy? indications? nursing care?

A hand-held apparatus that disperses a moisturizing agent or medication such as a bronchodilator into the lungs. The device must make a visible mist.

- indication: difficulty in clearing secretions, reduced vital capacity, and unsuccessful with simpler methods.

- instruct patient to take slow deep breaths through the mouth and hold a few seconds. enocurage patient to cough.

- educate patient to not reinoculate themself with infection. they should clean it and make sure there is no water.

chest physiotherapy includes:

- postural drainage

- chest percussion and vibration

- breathing retraining

goal of chest physiotherapy

Remove secretions

Improve ventilation

Increased efficiency of respiratory muscles

chest percussion

carried out by cupping the hands and lightly striking the chest wall in a rhythmic fashion over the lung segment to be drained

vibration

technique of applying manual compression and tremor to the chest wall during the exhalation phase of respiration

high frequency chest wall oscillation

airway clearance technique in which external chest wall oscillations are applied to the chest using an inflatable vest that wraps around the chest. These machines produce vibrations at variable frequencies and intensities, helping to loosen and thin mucus and separate it from airway walls.

postural drainage

use of body positioning to assist in removal of secretions from specific lobes of the lung, bronchi, or lung cavities

management of upper airway obstruction

- partial obstruction = still making sounds through vocal cords.

- if not sounds -> look into oral cavity and see if you can pull anything out then do back blows and Heimlich

endotracheal intubation

placement of a tube through the mouth into the pharynx, larynx, and trachea to establish an airway

- shouldn't be in longer than 14 days

- prone to infection, lip breakdown, and pulm infection

- should be checking for skin breakdown with tape used.

tracheostomy

surgical procedure in which an opening is made into the trachea

- it is reversible

what is the purpose of a tracheostomy

To provide an open airway during an upper airway obstruction.

suctioning and oral care when patient has endotracheal intubation or tracheostomy

- suctioning is PRN

- oral care every 2-4 hours to prevent infection

- must be sterile

- should be in semi fowler position

- must provide an effective means of communication

noninvasive positive pressure ventilation

-Method of positive-pressure ventilation that can be given via facemasks that cover the nose and mouth, nasal masks, or other oral or nasal devices such as the nasal pillow

-Eliminates need for endotracheal intubation or tracheostomy

-Continuous positive airway pressure (CPAP)

-Bilevel positive airway pressure (BiPAP)

indications for noninvasive positive pressure ventilation

-Indications: respiratory arrest, serious dysrhythmias, cognitive impairment, head/facial trauma

CPAP

continuous pressure whether inhaling or exhaling. used at home.

BIPAP

inhalation pressure higher than exhalation pressure

assessment of patient recieving mechanical ventilation

- in depth respiratory assessment including all indicators of oxygenation status

- neuro status

- effective coping and emotional needs

- comfort leel and ability to communicate needs

weaning from the vent

- process of withdrawl of dependence upon the ventilator

three stages:

1. patient is gradually removed from the ventilator

2. then from either endotracheal or tracheostomy tube

3. and finally from oxygen

chest tube drainage systems have:

- a suction source

- a collection chamber for pleural drainage

- and a mechanism to prevent air from reentering the chest with inhalation

what is the purpose of a chest tube

used in removal of air and fluid from the pleural space and re-expansion of the lungs.

hypercapnic respiratory failure

INCREASED CO2 (greater than 45mm Hg) and DECREASED pH (less than 7.35), Telling us it's a VENTILATION problem, pt either not breathing enough or has an airtrapping diagnosis such as asthma or COPD

hypoxemic respiratory failure

PaO2 less than 55

acute respiratory distress syndrome

sudden, progressive pulmonary edema, increasing bilateral lung infiltrates visible on chest x ray and absence of an elevated left atrial pressure

- rapid onset of severe dyspnea. characterized by hypoxemia that does not respond to supplemental oxygen therapy

ARDS stages

first stage: exudative phase with edema and hemorrhage

second stage: proliferative phase with organization and repair

third stage: fibrotic phase with end stage fibrosis

some risk factors for ARDS.

direct lung injury: pneumonia, aspiration of gastric contents

indirect lung injury: sepsis, severe trauma with shock and multiple transfusions

assessment of ARDS

no specific test to identify ARDS. diagnosis is based on the physical exam, chest x ray, and oxygen levels and by ruling out other diseases and conditions (for example certain heart problems)

arterial blood gas ABG

an arterial blood gases test measures the acidity (PH) and the levels of oxygen and carbon dioxide in the blood from an artery. tests how well lungs can move oxygen into the blood and remove CO2 from the blood.

PH normal values

7.35-7.45

CO2 normal values

35-45

bicarb normal values

22-26

O2 normal values

80-100

acidosis

pH below 7.35

CO2 above 45

HCO3 below 22

alkalosis

PH above 7.45

CO2 below 35

bicarb above 26

hypoxemia oxygen level

below 80

respiratory acidosis

A drop in blood pH due to hypoventilation (too little breathing) and a resulting accumulation of Co2.

from: drugs/anesthesia, asthma, COPD

respiratory alkalosis

high pH, low CO2.

Arise in blood pH due to hyperventilation (excessive breathing) and a resulting decrease in CO2.

from: anxiety, infection, pulmonary embolus

metabolic acidosis

low pH, low HCO3

from: diabetic ketoacidosis, shock, renal disease, salicylate toxicity (ASA overdose)

metabolic alkalosis

high pH, high HCO3

from: prolonged vomiting

fully compensated if

PH is normal

partially compensated if

all three values are abnormal

uncompensated if

PaCO2 or HCO3 is normal and the other is abnormal