respiratory exam

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185 Terms

1
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what is the upper respiratory tract responsible?
warms and filters inspired air
2
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what test is used to determine is a pt can undergo anesthesia?
pulmonary function test
3
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what does a PFT do?
measures volume and capacity of air to
4
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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
6
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How long before a PFT does a pt need to stop smoking?
6-8 hrs prior
7
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How long before a PFT does a pt need to stop taking bronchodilators?
4-6 hours prior
8
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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
9
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What test must be performed prior to getting an ABG?
ulnar test
ulnar test
10
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What is the most effective means of assessing effectiveness of an oxygen therapy?
ABG
11
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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
14
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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
15
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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
17
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What is a pt given during a bronchoscopy to reduce aspiration?
sedative & local anesthesia to numb gag reflex
18
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what is the purpose of a bronchoscopy?
permits visualization of the larynx, trachea, bronchi
19
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who can a bronchoscopy be performed on?
pts receiving mechanical ventilation by inserting scope thru endotracheal tube
20
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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.)
21
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what is a normal or expected finding of a pt who underwent a bronchoscopy?
absent gag reflex
22
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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.)
23
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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
25
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Thoracentesis is a ____ procedure.
sterile
26
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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
27
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what is a thoracentesis?
surgical perforation of the chest wall and pleural space with a large-bore needle
28
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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
29
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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
30
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what decreases the risk of complications during a thoracentesis?
ultrasound
31
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what is to be obtained to locate pleural effusion and determine/confirm insertion site?
x-ray
32
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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
33
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where are chest tubes inserted?
pleural space
34
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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
35
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what kind of problems is a chest tube inserted?
pneumothorax, post-op chest drainage, pleural effusion, pulmonary empyema
36
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A partial to complete collapse of the lung due to the accumulation of air in the pleural space is ____.
pneumothorax
37
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**Hemothorax is** partial to complete collapse of the lung due to ___.
to accumulation of blood in pleural space
38
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What are examples of post - op drains?
thoracotomy or open-heart surgery
39
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What is an abnormal accumulation of fluid in the pleural space?
pleural effusion
40
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**Pulmonary empyema is an** accumulation of what?
pus in the pleural space due to pulmonary infection
41
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What is the first chamber used for?
drainage collection
42
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What do you expect to see in the second chamber?
tidaling of water (sterile)
43
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what is tidaling?
movement of water caused by inhalation/exhalation
44
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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
45
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what is an expected finding in the third chamber?
continuous bubbling
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the third chamber is the ___/
suction control that can be wet/dry
47
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How do you create a water seal?
adding sterile fluid to 2 cm line
48
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where should the chest tube be kept at all times?
below chest tube insertion site with chamber upright
49
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What does cessation of tidaling signal/indicate?
lung re-expansion or an obstruction w/i the system
50
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Continuous bubbling is ONLY normal in the third chamber, but in the second chamber it may indicate:
air leak
51
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chest tube pt should always
deep breathe, cough, incentive spirometer
52
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how much excess drainage should an RN alert the physican?
70 ml/hr
53
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what should a nurse assess on a chest tube pt?
skin for any redness, pain, infection ,crepitus
54
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if a pt if encourage to ambulate with a chest tube:
administer pain meds prior to movement
55
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air leaks can result from?
connection is not taped securely
56
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what does rn do is air leak is detcted?
monitor water seal for bubbling, check all connections,
57
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Rn calls physician is she/he cannot ___
resolve air leak
58
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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
59
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where does rn place end of chest tube system if compromised?
sterile water (temporary water seal)
60
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what does rn do if chest tube is accidently removed?
dress area with petroleum gauze w dry sterile gauze and tape it
61
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what is an indicative of a tension pneumothorax?
tracheal deviation, absent breath sounds, distended neck veins
62
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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)
63
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tension pneumothorax requires
provider or rapid response team
64
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when removing chest tube, rn must tell client to
exhale and bear down (Valsalva maneuver)
65
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why does pt do Valsalva maneuver with removal of tube?
increase intrathoracic pressure and reduce risk of air emboli
66
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Oxygen is considered a med, therefore
provider order is needed
67
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Oxygen via nasal cannula can be used @ any time of pt stay to
improve O2 status due to standing order
68
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The goal of oxygen therapy is
provide adequate transport of oxygen in the blood
69
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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
71
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what is a big indicator that a pt has become hypoxic?
if pt states he/she is anxious
72
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The longer the extension tubing for an at home pt, the longer ___.
the long O2 takes to inhale
73
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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*
74
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PT must call provider if more liters of oxygen is needed. (T/F)
true, pt must follow prescription
75
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A nasal cannula breaks down the skin in the ___.
nose and ears
76
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A simple face mask is a low flow oxygen delivery method that has to be
sealed tightly around mouth
77
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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
78
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any type of masks are contradicted in pt who
have claustrophobia or anxiety
79
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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
80
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Why must the bag always have to be INFLATED with breather masks?
CO2 can build up
81
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What O2 delivery method gives the most amount of oxygen?
nonrebreather mask
82
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who benefits from NONrebreather masks?
best for those that may require intubation
83
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what advantages does a nonrebreather have?
inhale maximum O2 from the reservoir bag
84
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The venturi mask is a high flow and precise oxygen concentration best suited for
chronic lung dx pts
85
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disadvantage of venturi mask
expensive due to multiple parts
86
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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
87
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disadvantages of aerosol mask
high humidification requires frequent monitoring
88
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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
89
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What position should a patient be in for chest tube placement?
supine or semi-fowler's
90
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Provide pain medication ______ before removing chest tubes
30 mins
91
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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
92
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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
93
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What are advantages of a T-piece?
can be used for clients who have tracheostomies, laryngectomies, or endotracheal tubes
94
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Ensure that exhalation port is ___ and uncovered with t-piece.
open
95
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Ensure t-piece does not pull on ___ or ET tube.
tracheotomy
96
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Ensure that the __ *is evident during* __.
mist; inspiration and expiration
97
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Oxygen toxicity can result from what?
High concentrations of oxygen
98
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What clinal manifestations occur from oxygen toxicity?
cough, substemal pain, nasal stiffness, N/V, fatigue, HA, sore throat and hyperventilation
99
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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