NSG 3040: respiratory care modalities and management of chest and lower respiratory tract disorders | 57 questions and answers | 2025 latest update | Pass Guranteed

greater than 21% to provide adequate transport of oxygen in the blood while: Decreasing the work of breathing and reducing stress on the myocardium

what % oxygen should oxygen therapy provide?

hypoxemia

a decrease in the arterial oxygen tension in the blood (availability)

hypoxia

- Severe hypoxia can be life threatening

- a GLOBAL issue, at the organ level

a decrease in oxygen supply to the tissues and cells that can also be caused by problems outside the respiratory system

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

when can oxygen toxicity occur?

substernal discomfort, paresthesias, dyspnea, restlessness, fatigue, malaise, progressive respiratory difficulty, refractory hypoxemia, alveolar atelectasis, and alveolar infiltrates on x-ray

oxygen toxicity symptoms

- Use lowest effective concentrations of oxygen

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

oxygen toxicity prevention:

volume or flow

what are the two types of incentive spirometry?

COPD patients

who is more susceptible to O2 toxicity?

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

- Used to prevent or treat atelectasis

- helps alveoli stay OPEN, strengthened

- gets rid of moisture to allow gasses to better travel through, prevents it from sitting at the bottom of the lungs

what does IS encourage?

post surgery

IS indications:

Positioning of patient, encourage use, set realistic goals, and record outcomes

Patient education

IS nursing considerations:

mini nebulizer therapy

Handheld apparatus that disperses a moisturizing agent or medication into the lungs

Difficulty in clearing secretions, reduced vital capacity, and unsuccessful with simpler methods

mini nebulizer therapy indications:

- Instruct patient to take slow, deep breaths through the mouth and hold a few seconds

- Encourage patient to cough

- Monitor effectiveness of therapy

mini nebulizer nursing care:

chest physiotherapy

CPT

Postural drainage

Chest percussion and vibration

Breathing retraining

what does CPT include?

Remove secretions

Improve ventilation

Increased efficiency of respiratory muscles

CPT goals:

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

how are chest percussions carried out?

vibration

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

An inflatable HFCWO vest

what may also aid with CPT?

- Allows force of gravity to assist in removal of bronchial secretions

- Secretions drain from the affected bronchioles into the bronchi and trachea and are removed by coughing or suctioning

- Used to prevent or relieve bronchial obstruction caused by accumulation of secretions

- stops fluids from settling in the body, changing positions enables this

postural drainage:

the lower parts of the lungs

- because a patient usually sits in an upright position

where are secretions likely to accumulate in the lungs?

partial vs full

what are the two types of upper airway obstructions?

food particles, vomitus, blood clots, or anything that obstructs the larynx or trachea

what can acute upper airway obstructions be caused by?

ET tube

Passing a tube through the nose or mouth into the trachea

- used in emergent situations

- most invasive method of O2 delivery

Provides patent airway, access for mechanical ventilation, facilitates removal of secretions

what does an ET tube provide?

- up to 14 days (tissue breakdown/damage)

- DO ORAL CARE AND SUCTIONING

how many days can an ET tube be used for?

- Surgical procedure in which an opening is made into the trachea

- The indwelling tube inserted into the trachea is called a tracheostomy tube

- ET tubes often advanced to tracheostomy, more long term

tracheostomy:

- Continuous monitoring and assessment

- Maintain patency by proper suctioning

- Semi-Fowler

- Administer analgesia and sedatives

- Provide an effective means of communication

nursing management of tracheostomy:

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

ET tubes or a tracheostomy

what does noninvasive positive pressure ventilation eliminate the need for?

- CPAP

- BiPAP

examples of noninvasive positive pressure ventilation:

respiratory arrest, serious dysrhythmias, cognitive impairment, head/facial trauma

what are some indications for the use of noninvasive positive-pressure ventilation tools?

mechanical ventilation

Positive or negative pressure device to maintain ventilation and oxygenation for a prolonged period

Maintenance of patent airway

Optimal gas exchange

Absence of trauma or infection

Attainment of optimal mobility

Adjustment to nonverbal methods of communication

Successful coping measures

nursing respiratory goals:

- Patient is gradually removed from the ventilator

- Then from either the endotracheal or tracheostomy tube

- And finally, from oxygen

what are the three stages of weaning from the vent?

- A suction source

- A collection chamber for pleural drainage

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

what do chest drainage systems have?

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

when are chest tube drainage systems used?

- PaCO2 over 45 mm Hg

- develops in min to hours

- develops over several days or longer

hypercapnic respiratory failure:

- PaO2 under 55 mm Hg

- develops in min hours

- develops over several days or longer

hypoxemic respiratory failure:

- Characterized by sudden, progressive pulmonary edema, increasing bilateral lung infiltrates visible on chest x-ray, and absence of an elevated left atrial pressure (stagnant blood in pulmonary circut)

- Rapid onset of severe dyspnea

- Hypoxemia that does not respond to supplemental oxygen therapy

what is ARDS characterized by?

Exudative phase (edema and hemorrhage)

Proliferative phase (organization and repair)

Fibrotic phase (end-stage fibrosis)

3 phases of ARDS:

There's no specific test to identify ARDS. The 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 — that can produce similar symptoms.

- Chest X-Ray

- CT scan of chest

-Echocardiogram Labs (Blood cultures, BNP, ABG)

-Visual inspection of chest

-Auscultation of lung fields

- Current oxygenation levels VS. requirements

ARDS dx process:

- Vital signs and hemodynamic monitoring

- Intubation, mechanical ventilation with PEEP to keep alveoli open

- Pulmonary toileting and Chest PT

- Fluid and electrolyte management

- Prone positioning is best for oxygenation, frequent repositioning to safeguard integumentary

- Nutritional support, enteral feedings preferred

- Reduce anxiety

management of ARDS:

An arterial blood gases (ABG) test measures the acidity (pH) and the levels of oxygen and carbon dioxide in the blood from an artery

ABG:

used to find out how well your lungs can move oxygen into the blood and remove carbon dioxide from the blood. Abnormal values signify a situation of acidosis or alkalosis

what is an ABG used for?

pH normal values are 7.35-7.45 <7.35 = acidosis >7.45 = alkalosis

ph and ABG interpretation:

CO2 (pCO2) normal values are 35-45 <35 = alkalosis >45 = acidosis

CO2 and ABG interpretation:

Bicarb (HCO3) normal values are 22-26 <22 = acidosis >26 = alkalosis

HCO3 and ABG interpretation:

O2 (pO2) normal values are 80-100 <80 = hypoxemia

O2 and ABG interpretation:

Hypoventilation from Drugs/Anesthesia Asthma COPD

respiratory acidosis:

Hyperventilation from Anxiety Infection Pulmonary Embolus

respiratory alkalosis:

Diabetic Ketoacidosis

Shock

Renal Disease

Salicylate toxicity (ASA overdose)

metabolic acidosis:

Prolonged vomiting

metabolic alkalosis:

If the pH is not within or close to the normal ranges, then a partial-compensation exists.

- Either CO2 or Bicarb is normal

-The normal molecule (CO=resp / HCO3=meta) must the opposite of the organ system causing the disturbance Example: pH 7.56 CO2 45 HCO3 39 Metabolic Alkalosis w/ partial compensation

partial compensation:

If the pH is back within normal ranges, then a full-compensation has occurred

full compensation:

A non-compensated or uncompensated abnormality usually represents an acute change occurring in the body.

noncompensated: