Acute Exam 2 Lab

Water seal should be ___cm

2

Suction chamber should be ___cm

20

The middle water seal chamber allows air to exit pleural space on ____ and keeps air from entering pleural space in inspiration

exhalation

Tidaling def

rise and fall of fluid with inhalation and exhalation

Continuous bubbling indicates an

air leak

Water in the small arm of water seal rises as intrapleural pressure becomes more

negative

Traditional closed chest drains regulate amount of suction by height of

water

____ level in the suction control chamber regulates amount of negative pressure suction transmitted to the pleural cavity, NOT the setting on the source

water

Dry suction allows for ____ pressure levels

higher

Dry suction uses a control valve to balance force of suction with atmosphere so it can respond and adjust to changes in atmosphere

yes

Indications for high pressure dry suction

massive air leak, empyema, viscous pleural effusion

Sump port is for collection of _____ for autotransfusion

autologous blood

Heimlich valve is a one way ____ valve that allows air to ____ but wont let it back in

flutter, escape

Blue end connects to _____, transparent end has sterile dressing for tubes that have minimal/no ______ or connects to collection bag

chest tube, drainage

Arrow on the valve should always point ____ from patients chest

away

Heimlich valve is for small or partial _____ and does not collect fluid

ptx

Pneumostat is another one way valve for ______ with small amounts of ____

ptx, liquid

Pneumothax white end to ____, clear end is for _____ or removing drainage. Collects ____ of drainage

patient, sampling, 30mL

Pneumostat air leak well confirms air leak if there is bubbling after adding ____ of water to the well

1 ml

Empty pneumostat with a

plunger

Pleural space is a small cavity between ____ and ____ pleura that contains serous fluid that allows movement without friction during respiration

visceral, parietal

Fluid in lung can create _____ which prevent lungs from expanding fully

counterpressure

Tension ptx

injury to chest wall/lungs allows air to enter pleural space but keeps it from leaving

Tension ptx is

emergency

In tension ptx, the mediastinal shift displaces trachea towards the _____ side

unaffected

Diminished/absent lung sounds indicate that the lung has not

reexpanded

Chest chest tube dressing at least every

4 hrs

When to replace disposable chest tube drainage system?

when full

Drainage amount

Clamping chest tube is risk for

tension ptx

IF chest tube detaches from drainage system

Exhale and cough, submerge in 1 inch of sterile water

Palpate area around dressing to check for ____ or ____ which indicate that __ is leaking into subq tissue surrounding insertion site

crepitus, subq emphysema, air

During first 24 hrs of chest tube insertion check every

1 hr

Chest tube assess regular

character, consistency, amount of drainage

Mark drainage level by noting time and date at drainage level on chamber every

8 hrs

Assess fluid level q _____ because water can evaporate

shift

Tidaling expect ____cm of fluctuation

5-10 (2-4 inch)

keep sterile gauze at bedside to cover insertion site if tubing becomes dislodged

yes

Tubing should remain _____ level of insertion site or else fluid could go back into pleural space

below

stripping/milking tubing can increase negative pressure in the system to a level that can ____ pleural tissue

damage

report to providor

difficulty breathing, cyanosis, rapid/shallow breathing, subq emphysema, chest pain, bleeding

After lung has reexpanded and minimal drainage, can clamp or disconnect tube before removing to observe for distress. Can also verify ok by cxr

yes

Ambulate every _____ to allow lung expansion and drainage

4-6 hrs

If transporting and detaching suction source, should make sure

air vent is open

After first few hours, report any drainage over ___ml/hr, because losing 100mL of blood q16min might require autotransfusion

70

Nasal cannula Fio2 range is ____, liter flow rate is ____L

24-44, 1-10

high flow nasal cannula fio2 ____% and flow rate of up to ___L

100, 60

Oxygen conserving cannula/oximizer fio2 range ____%. Good because it has higher fio2 with lower ___ flow

24-60, o2

Face tent fio2 of ____%, ___L, good for ___

24-100, 10, humidification

Oxymask is Fio2 of ___%, and has low ___ high fio2 so good for long term use

24-90, flow

nono rebreather mask fio2 of ___% and uses a reservoir bag. It can administer almost 100% oxygen.

80-95

CPAP has fio2 of ___% at ___cm of water pressure. it is invasive and right before ventilation

21-100, 5-20

If chest tube is pulled out, apply ___ and tape only ___ sides so air can escape

occlusive, 3

Half life of norepi is very ___ so as soon as bag is used up the pt can crash right away

short

Sepsis vs septic shock diff by need/no need of

vasopressors

Rebound reaction within ___ hrs

72

3rd spacing means dry ___ but body still has fluid

intravascularly

norepi vasopresses the periphery so the ___ are safe but extremities are vulnerable

vital organs

chest tube breaks what to do

cut end of tube and put in ns/water

blebs that pop usually resolve on its own once the ___ __ is taken away

positive pressure

Leopald maneuvers help to determine

number of fetus, presenting part, fetal lie, fetal attitude, degree of descent, point of max intensity for fhr

Leopald maneuver prereqs/positioning

pee, supine, knees flexed, pillow under head and hip

Leopald maneuver steps

palpate fetal part at funds, fetal back, attitude of head

Leopald document

fetal lie, fetal presentation, attitude of head, presentation head and face for cephalic

First stage of labor def

initiation of regular uterine contractions and cervical dilation/effacement

First stage, latent phase characteristics

0-6 dilation, little effacement and descent

Latent phase contractions are mild-mod and are around q _____ mins, lasts ____ seconds

5-20, 30-60

Active phase characteristcs

6-10 dilation, significant descent

Active phase has mod-strong contractions q___mins that last ____seconds. THis is when mother feels desire to ___ ___

2-5, 40-90. bear down

Second stage of labor def

complete dilation and effacement-birth

Ferguson reflex def

spontaneously bear down

Second stage of labor equpment

radiant heat warmer, emergency neonatal equipment

Third stage of labor def

birth to placenta

Fourth stage of labor def

stabilization to 2 hrs after placenta delivery

Stage 4 monitor

vs, fundal location, bleeding, bladder, perineum

C section additional documentation

approximate edges, edema, ecchymosis

apgar check at min and _

1, 5

APGAR test

In newborns assess ____ first

rr

newborn VS top 3

rr, pulse/hr, temp

Newbor RR should be ___ bpm with breathless cessation under __ seconds

30-60, 19

INfant hr should be taken on apex for 1 min. Should be ___ and ___ with ___bpm when sleeping and ___ when awake

sharp, clear, 80-100, 110-160

Baby length should be ___cm

45-55

Head circumference right above ____ line and should be ___cm

brow, 32-37

Chest circumference taken at nipple line and should be _____cm, or ___cm less than head

30-33, 2-3

Bishop score

Target saturation table

Bubble assessment

Breast, uterus, bladder, bowels, lochia, episiostomy/lacerations extremeties emotions