respiratory exam

what is the upper respiratory tract responsible?

what is the upper respiratory tract responsible?

warms and filters inspired air

what test is used to determine is a pt can undergo anesthesia?

pulmonary function test

what does a PFT do?

measures volume and capacity of air to

what does a PFT DETERMINE?

lung function and breathing difficulties

who commonly gets PFTs done?

clients who have dyspnea

How long before a PFT does a pt need to stop smoking?

6-8 hrs prior

How long before a PFT does a pt need to stop taking bronchodilators?

4-6 hours prior

Why is it important to stop bronchodilators before a PFT test?

they alter the test results by showing inaccurate pulmonary function

What test must be performed prior to getting an ABG?

ulnar test

What is the most effective means of assessing effectiveness of an oxygen therapy?

ABG

An ABG is an invasive procedure. What interventions can a RN do before doing an ABG?

make sure O2 pulse reader is working correctly, no nail polish on fingernail, if it’s on the finger, etc.

What artery is an ABG usually drawn from?

radial or arterial line

what does an ABG report?

oxygen and acid-base balance of the blood

what do the results of an ABG indicate if a pt is on oxygen therapy?

it will tell you if the oxygen therapy if working for the pt

before a bronchoscopy, the nurse must verify:

allergies, informed consent, use of meds like anticoagulants

A pt must be NPO how many hours prior to bronchoscopy?

4-8 hours prior

What is a pt given during a bronchoscopy to reduce aspiration?

sedative & local anesthesia to numb gag reflex

what is the purpose of a bronchoscopy?

permits visualization of the larynx, trachea, bronchi

who can a bronchoscopy be performed on?

pts receiving mechanical ventilation by inserting scope thru endotracheal tube

what kind of problems is a bronchoscopy performed?

tumors, inflammation, strictures, biopsies, aspiration of deep sputum or lung abscesses for culture and sensitivity (pneu.)

what is a normal or expected finding of a pt who underwent a bronchoscopy?

absent gag reflex

what has to be assessed in order for a pt to resume oral intake?

gag reflex & ability to swallow (due to aspiration pneu.)

what can indicate a pneumothorax is a post op bronchoscopy pt?

high fever, cough, hemoptysis, hypoxemia

Why should hemoptysis be reported IMMEDIATELY?

patient is coughing up blood

Thoracentesis is a ____ procedure.

sterile

what position must the pt be in while throacentesis?

upright position with arms and shoulders raised supported on pillows on overbed table with feet and legs supported

what is a thoracentesis?

surgical perforation of the chest wall and pleural space with a large-bore needle

why is a thoracentesis performed?

diagnostic evaluation, instill medications into the pleural space and remove fluid or air from the pleural space for therapeutic relief of pleural pressure

how is a thoracentesis performed?

under local anesthesia by a provider at the client's bedside, in a procedure room, or in a provider’s office

what decreases the risk of complications during a thoracentesis?

ultrasound

what is to be obtained to locate pleural effusion and determine/confirm insertion site?

x-ray

what must a nurse do of a post op thoracentesis?

•Apply a dressing over the puncture site and assess dressing for bleeding and drainage

•Obtain a post procedure x-ray to rule out possible pneumothorax

where are chest tubes inserted?

pleural space

why is a chest tube needed?

drain fluid, blood or air; reestablish a negative pressure; facilitate lung expansion and restore normal intrapleural pressure

what kind of problems is a chest tube inserted?

pneumothorax, post-op chest drainage, pleural effusion, pulmonary empyema

A partial to complete collapse of the lung due to the accumulation of air in the pleural space is ____.

pneumothorax

Hemothorax is partial to complete collapse of the lung due to ___.

to accumulation of blood in pleural space

What are examples of post - op drains?

thoracotomy or open-heart surgery

What is an abnormal accumulation of fluid in the pleural space?

pleural effusion

Pulmonary empyema is an accumulation of what?

pus in the pleural space due to pulmonary infection

What is the first chamber used for?

drainage collection

What do you expect to see in the second chamber?

tidaling of water (sterile)

what is tidaling?

movement of water caused by inhalation/exhalation

what is the purpose of the 2nd chamber/water seal?

allows air to exit pleural space via exhalation, stops the air form entering via inhalation

what is an expected finding in the third chamber?

continuous bubbling

the third chamber is the ___/

suction control that can be wet/dry

How do you create a water seal?

adding sterile fluid to 2 cm line

where should the chest tube be kept at all times?

below chest tube insertion site with chamber upright

What does cessation of tidaling signal/indicate?

lung re-expansion or an obstruction w/i the system

Continuous bubbling is ONLY normal in the third chamber, but in the second chamber it may indicate:

air leak

chest tube pt should always

deep breathe, cough, incentive spirometer

how much excess drainage should an RN alert the physican?

70 ml/hr

what should a nurse assess on a chest tube pt?

skin for any redness, pain, infection ,crepitus

if a pt if encourage to ambulate with a chest tube:

administer pain meds prior to movement

air leaks can result from?

connection is not taped securely

what does rn do is air leak is detcted?

monitor water seal for bubbling, check all connections,

Rn calls physician is she/he cannot ___

resolve air leak

If disconnection of tube occurs, nurse instructs pt to:

to exhale as much as possible and to cough to remove as much air as possible from the pleural space

where does rn place end of chest tube system if compromised?

sterile water (temporary water seal)

what does rn do if chest tube is accidently removed?

dress area with petroleum gauze w dry sterile gauze and tape it

what is an indicative of a tension pneumothorax?

tracheal deviation, absent breath sounds, distended neck veins

what causes a tension pneumothorax?

sucking chest wounds, prolonged clamping of the tubing, kinks or obstruction in the tubing, or mechanical ventilation with high levels of positive end expiratory pressure (PEEP)

tension pneumothorax requires

provider or rapid response team

when removing chest tube, rn must tell client to

exhale and bear down (Valsalva maneuver)

why does pt do Valsalva maneuver with removal of tube?

increase intrathoracic pressure and reduce risk of air emboli

Oxygen is considered a med, therefore

provider order is needed

Oxygen via nasal cannula can be used @ any time of pt stay to

improve O2 status due to standing order

The goal of oxygen therapy is

provide adequate transport of oxygen in the blood

Early findings of hypoxemia/hypoxia:

EARLY=HIGH

tachypnea, tachycardia, restlessness, pale skin and mucous \n membranes, ELEVATED blood pressure, findings of respiratory distress

Late findings of hypoxemia.hypoxia:

LATE=LOW

Confusion and stupor, cyanosis, \n bradypnea, bradycardia, hypotension and cardiac dysthymias

what is a big indicator that a pt has become hypoxic?

if pt states he/she is anxious

The longer the extension tubing for an at home pt, the longer ___.

the long O2 takes to inhale

What are things a pt MUST do if he/she is receiving oxygen at home?

wear cotton clothes, put “NO SMOKING” signs, refrain from smoking, no alcohol (or acetone), have fire extinguisher

PT must call provider if more liters of oxygen is needed. (T/F)

true, pt must follow prescription

A nasal cannula breaks down the skin in the ___.

nose and ears

A simple face mask is a low flow oxygen delivery method that has to be

sealed tightly around mouth

When a pt is not wearing delivery methods other than nasal cannula, a nasal cannula is still neded to

eat/drink

any type of masks are contradicted in pt who

have claustrophobia or anxiety

partial rebreather mask:

has reservoir bag attached with no valve, which allows the patient to rebreathe up to one third of exhaled air together with room air

Why must the bag always have to be INFLATED with breather masks?

CO2 can build up

What O2 delivery method gives the most amount of oxygen?

nonrebreather mask

who benefits from NONrebreather masks?

best for those that may require intubation

what advantages does a nonrebreather have?

inhale maximum O2 from the reservoir bag

The venturi mask is a high flow and precise oxygen concentration best suited for

chronic lung dx pts

disadvantage of venturi mask

expensive due to multiple parts

Aerosol mask, face tent and tracheostomy collar is a high Flow that is good for

pts. who do not tolerate masks well, useful for clients who have facial trauma, burns or thick secretions

disadvantages of aerosol mask

high humidification requires frequent monitoring

nursing actions for aerosol mask

Empty condensation from the tubing often

Ensure that there is adequate water in the humidification canister

Ensure that the aerosol mist leaves from the vents during inspiration and expiration

Make sure the tubing does not pull on the tracheostomy

What position should a patient be in for chest tube placement?

supine or semi-fowler's

Provide pain medication ______ before removing chest tubes

30 mins

What are important nursing actions for nasal cannulas?

assess nostril latency, ensure prongs fit nares properly, use water-soluble gel to prevent dry nares, provide humidification

In case of a chest tube accidently came out, how many pieces of tape are need when re-inserting?

3 because there needs to be a side that allows air out

What are advantages of a T-piece?

can be used for clients who have tracheostomies, laryngectomies, or endotracheal tubes

Ensure that exhalation port is ___ and uncovered with t-piece.

open

Ensure t-piece does not pull on ___ or ET tube.

tracheotomy

Ensure that the __ is evident during __.

mist; inspiration and expiration

Oxygen toxicity can result from what?

High concentrations of oxygen

What clinal manifestations occur from oxygen toxicity?

cough, substemal pain, nasal stiffness, N/V, fatigue, HA, sore throat and hyperventilation

Oxygen-induced hypoventilation can develop in client who:

have COPD and hypoxemia

What is another teaching factor for patients on oxygen?

must also educate family members about dangers of smkoing during O2 use, ensure electric devices are grounded and working