what test is used to determine is a pt can undergo anesthesia?
pulmonary function test
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what does a PFT do?
measures volume and capacity of air to
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what does a PFT DETERMINE?
lung function and breathing difficulties
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who commonly gets PFTs done?
clients who have dyspnea
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How long before a PFT does a pt need to stop smoking?
6-8 hrs prior
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How long before a PFT does a pt need to stop taking bronchodilators?
4-6 hours prior
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Why is it important to stop bronchodilators before a PFT test?
they alter the test results by showing inaccurate pulmonary function
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What test must be performed prior to getting an ABG?
ulnar test
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What is the most effective means of assessing effectiveness of an oxygen therapy?
ABG
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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.
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What artery is an ABG usually drawn from?
radial or arterial line
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what does an ABG report?
oxygen and acid-base balance of the blood
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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
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before a bronchoscopy, the nurse must verify:
allergies, informed consent, use of meds like anticoagulants
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A pt must be NPO how many hours prior to bronchoscopy?
4-8 hours prior
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What is a pt given during a bronchoscopy to reduce aspiration?
sedative & local anesthesia to numb gag reflex
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what is the purpose of a bronchoscopy?
permits visualization of the larynx, trachea, bronchi
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who can a bronchoscopy be performed on?
pts receiving mechanical ventilation by inserting scope thru endotracheal tube
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what kind of problems is a bronchoscopy performed?
tumors, inflammation, strictures, biopsies, aspiration of deep sputum or lung abscesses for culture and sensitivity (pneu.)
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what is a normal or expected finding of a pt who underwent a bronchoscopy?
absent gag reflex
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what has to be assessed in order for a pt to resume oral intake?
gag reflex & ability to swallow (due to aspiration pneu.)
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what can indicate a pneumothorax is a post op bronchoscopy pt?
high fever, cough, hemoptysis, hypoxemia
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Why should hemoptysis be reported IMMEDIATELY?
patient is coughing up blood
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Thoracentesis is a ____ procedure.
sterile
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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
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what is a thoracentesis?
surgical perforation of the chest wall and pleural space with a large-bore needle
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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
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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
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what decreases the risk of complications during a thoracentesis?
ultrasound
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what is to be obtained to locate pleural effusion and determine/confirm insertion site?
x-ray
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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
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where are chest tubes inserted?
pleural space
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why is a chest tube needed?
drain fluid, blood or air; reestablish a negative pressure; facilitate lung expansion and restore normal intrapleural pressure
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)
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tension pneumothorax requires
provider or rapid response team
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when removing chest tube, rn must tell client to
exhale and bear down (Valsalva maneuver)
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why does pt do Valsalva maneuver with removal of tube?
increase intrathoracic pressure and reduce risk of air emboli
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Oxygen is considered a med, therefore
provider order is needed
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Oxygen via nasal cannula can be used @ any time of pt stay to
improve O2 status due to standing order
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The goal of oxygen therapy is
provide adequate transport of oxygen in the blood
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Early findings of hypoxemia/hypoxia:
EARLY=HIGH
tachypnea, tachycardia, restlessness, pale skin and mucous \n membranes, ELEVATED blood pressure, findings of respiratory distress
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Late findings of hypoxemia.hypoxia:
LATE=LOW
Confusion and stupor, cyanosis, \n bradypnea, bradycardia, hypotension and cardiac dysthymias
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what is a big indicator that a pt has become hypoxic?
if pt states he/she is anxious
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The longer the extension tubing for an at home pt, the longer ___.
the long O2 takes to inhale
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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*
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PT must call provider if more liters of oxygen is needed. (T/F)
true, pt must follow prescription
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A nasal cannula breaks down the skin in the ___.
nose and ears
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A simple face mask is a low flow oxygen delivery method that has to be
sealed tightly around mouth
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When a pt is not wearing delivery methods other than nasal cannula, a nasal cannula is still neded to
eat/drink
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any type of masks are contradicted in pt who
have claustrophobia or anxiety
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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
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Why must the bag always have to be INFLATED with breather masks?
CO2 can build up
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What O2 delivery method gives the most amount of oxygen?
nonrebreather mask
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who benefits from NONrebreather masks?
best for those that may require intubation
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what advantages does a nonrebreather have?
inhale maximum O2 from the reservoir bag
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The venturi mask is a high flow and precise oxygen concentration best suited for
chronic lung dx pts
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disadvantage of venturi mask
expensive due to multiple parts
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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
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disadvantages of aerosol mask
high humidification requires frequent monitoring
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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
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What position should a patient be in for chest tube placement?
supine or semi-fowler's
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Provide pain medication ______ before removing chest tubes
30 mins
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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
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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
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What are advantages of a T-piece?
can be used for clients who have tracheostomies, laryngectomies, or endotracheal tubes
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Ensure that exhalation port is ___ and uncovered with t-piece.
open
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Ensure t-piece does not pull on ___ or ET tube.
tracheotomy
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Ensure that the __ *is evident during* __.
mist; inspiration and expiration
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Oxygen toxicity can result from what?
High concentrations of oxygen
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What clinal manifestations occur from oxygen toxicity?
cough, substemal pain, nasal stiffness, N/V, fatigue, HA, sore throat and hyperventilation
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Oxygen-induced hypoventilation can develop in client who:
have COPD and hypoxemia
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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