Unit 7: Gas Exchange, Oxygenation, Elimination, and Gastric Intubation

Comprehensive practice flashcards reviewing respiratory care, oxygenation devices, tracheostomy management, urinary elimination, catheter care, bowel elimination, ostomy care, and gastric intubation.

Which anatomical structure and lobe divisions are depicted in this diagram?

The right lung with three lobes (superior, middle, and inferior) and the left lung with two lobes (superior and inferior).

What is the difference between ventilation and perfusion?

Ventilation is the flow of air inside or outside of the alveoli, whereas perfusion is the flow of blood by the cardiopulmonary system into the alveolar capillaries.

How is hypoxemia defined and clinically determined?

Hypoxemia is a limited amount of oxygen in the blood and is determined by an arterial blood gas sample.

What clinical condition do intercostal retractions indicate?

They indicate that the airway is blocked.

What are the early signs of hypoxia?

Tachycardia, tachypnea, restlessness, confusion, and dyspnea.

What are the late signs of hypoxia?

Decreased consciousness, cyanosis, bradycardia, and bradypnea leading to apnea or respiratory arrest.

What clinical finding is shown on the client's tongue and lips?

Cyanosis (central cyanosis), which is a late sign of hypoxia.

What physical manifestation of chronic hypoxia is shown in this image?

Clubbing of the fingers.

What is the maximum oxygen flow rate recommended for a client with COPD relying on hypoxic drive?

No more than $2\,L/min$.

What oxygen-related actions can be delegated to unlicensed assistive personnel?

Unlicensed personnel cannot assess or adjust oxygen; they can only place the device on the face or reposition the device.

Why should wool clothing and blankets be avoided around oxygen therapy?

Because they can generate sparks from friction or static electricity, which poses a severe hazard since oxygen supports combustion.

What is the flow rate range for a nasal cannula, and when should humidification be added?

The flow rate is $1\text{ to }6\,LPM$, and humidification should be added for flow rates greater than $4\,LPM$.

What oxygen delivery device is shown in this illustration?

A nasal cannula.

What oxygen delivery device is depicted here?

A simple face mask.

Why must the flow rate on a simple face mask not be set below 6 LPM?

A flow rate less than $6\,LPM$ can cause carbon dioxide buildup in the mask.

What oxygen delivery device is pictured in this diagram?

A nonrebreather mask.

What oxygen concentration can a nonrebreather mask provide at a flow rate of 10 to 15 LPM?

$100\%$ oxygen concentration.

What oxygen delivery device is shown in this illustration?

A Venturi mask (venti mask).

What range of oxygen concentrations can Venturi mask adaptors deliver?

$24\%\text{ to }50\%$ oxygen concentrations.

What emergency equipment must always be present at the bedside of a client with a tracheostomy?

A manual resuscitation bag, a replacement tracheostomy tube of the same size, and an obturator.

What suction pressure should be set when suctioning a tracheostomy in adult and pediatric clients?

$80\text{ to }120\,mmHg$ for adults and $50\text{ to }100\,mmHg$ for children.

What is the proper technique for applying suction during tracheostomy catheter insertion and withdrawal?

Do not apply suction during catheter insertion; apply intermittent suction while rotating and withdrawing the catheter over no more than $15\text{ to }20\text{ seconds}$.

Under what heart rate change must tracheostomy suctioning be immediately discontinued?

If the heart rate decreases $20\,BPM$ below baseline.

What is the name and purpose of the suction device pictured here?

A Yankauer (tonsil tip) suction catheter, used to remove secretions from the mouth and oropharynx using clean technique.

What is the expected normal urinary output per hour and per day in an adult?

At least $30\,mL/hr$ or $720\text{ to }2{,}000\,mL$ per day.

What is the normal reference range for urine specific gravity?

$1.005\text{ to }1.030$.

How are anuria, oliguria, and polyuria defined?

Anuria is producing $100\,mL$ or less per day; oliguria is producing less than $20\,mL/hr$ or less than $400\,mL$ per day; polyuria is producing more than $2.5\text{ liters}$ per day.

What must be done if a client misses a void during a 24-hour timed urine collection?

The collection must start over from the beginning.

What expected side effect should the nurse educate a client about when taking phenazopyridine?

It changes urine color to reddish-orange (and clients should wear panty liners to prevent staining).

Which renal replacement therapy is illustrated in this diagram?

Peritoneal dialysis.

Which renal replacement process is depicted in this illustration?

Hemodialysis.

What is reflex incontinence and what underlying disorders cause it?

Urine leakage resulting from an impaired central nervous system caused by conditions such as stroke, multiple sclerosis (MS), or spinal cord injury.

What type of urinary diversion procedure is shown in this medical drawing?

A percutaneous nephrostomy (with nephrostomy tube, catheter drainage bag, and ureteral stent).

Which continent urinary diversion is depicted in this anatomical diagram?

A Kock pouch (continent ileal bladder conduit).

Which urinary diversion made from small bowel is illustrated here?

A neobladder.

Why is a Coudé catheter indicated for male clients with benign prostatic hyperplasia (BPH)?

Its curved tip facilitates easier insertion past an enlarged prostate.

How much space must be left at the tip when applying a condom catheter, and why?

Allow $1\text{ to }2\text{ inches}$ at the tip to prevent urine from pooling and sitting against the skin.

What external female collection device is shown in this image?

The PureWick urine collection system (PureWick female external catheter).

How far should an indwelling catheter be advanced after urine appears in the tubing for female versus male clients?

In females, advance another $2\text{ inches}$; in males, advance all the way to the tubing bifurcation before inflating the balloon.

Within how many hours should a patient void after the discontinuation of an indwelling catheter?

In less than $6\text{ hours}$.

What technique is taught to clients performing self-catheterization at home?

Clean technique.

What type of bedpan is shown, and what clients is it used for?

A fracture bedpan, used for clients who have body or leg casts or who are unable to lift their hips.

At what fullness level must an indwelling catheter drainage bag be emptied to prevent CAUTI?

Before it is half full.

Why must vagus nerve stimulation be avoided during digital fecal disimpaction, and what is the nurse's response if it occurs?

Vagus nerve stimulation can drop heart rate or alter cardiac rhythm; stop the procedure immediately if the heart rate drops significantly or heart rhythm changes.

What foods and medications can cause a false positive result on a fecal occult blood test (FOBT)?

Beets, red meat, broccoli, turnips, aspirin, ibuprofen, and vitamin C supplements.

What is the proper positioning, insertion depth, and bag elevation for enema administration?

Position the client in Sims position (left lateral with top leg bent), insert tubing $3\text{ to }4\text{ inches}$ toward the umbilicus, and elevate the bag $18\text{ inches}$ above the anus.

What action should the nurse take if a client expresses an immediate urge to defecate during enema instillation?

Lower the bag or clamp the tubing momentarily, and instruct the client to pant or take several small, fast breaths until the urge passes.

What type of stoma is depicted in this illustration?

An ileostomy stoma.

Why is an ileostomy client at greater risk for electrolyte depletion compared to a colostomy client?

An ileostomy discharges continuous liquid to semi-liquid stool from the small intestine, increasing the risk of dehydration and potassium depletion.

What stoma colors indicate ischemia and require immediate reporting?

Pale, grey, brown, black, or purple color.

How should an ostomy wafer appliance be sized, and when should the ostomy pouch be emptied?

Cut the opening $\frac{1}{8}\text{ inch}$ larger than the stoma, and empty the pouch when it is $\frac{1}{3}\text{ to }\frac{1}{2}$ full.

Why should cold water gastric lavage be avoided in a client with gastrointestinal bleeding?

Cold water lavage impairs platelet production and will not stop the bleeding.

What are the major contraindications to nasogastric (NG) tube insertion?

Basal skull fracture, head trauma / brain surgery, recent nasal surgery, and esophageal perforation.

How is a nasogastric tube measured before insertion?

From the tip of the nose to the earlobe, and then from the earlobe to the xiphoid process.

What is the gold standard for verifying initial nasogastric tube placement?

Radiologic confirmation (X-ray).

What pH and visual appearance confirm that NG aspirate is gastric rather than respiratory fluid?

Gastric aspirate has a pH of less than $5.5$ and is grassy green or tan; respiratory aspirate has a pH of $6$ or greater and is clear.

What instruction should the nurse give the client during nasogastric tube removal to prevent aspiration?

Ask the client to inhale and hold their breath to close the glottis.

What is the minimum head-of-bed elevation required while a client is receiving enteral feedings?

The head of the bed must not be below $30\text{ degrees}$.

How much water is flushed through an enteral feeding tube before and after intermittent feedings or every 4 hours during continuous feedings?

$30\,mL$ of water.