Chest Physiotherapy and Oxygen Delivery Systems
40 Questions
0 Views

Chest Physiotherapy and Oxygen Delivery Systems

Created by
@AmiableMinimalism8020

Podcast Beta

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the primary purpose of percussion in chest physiotherapy?

  • To measure the patient's oxygen saturation
  • To assess lung capacity
  • To administer oxygen to the patient
  • To produce mechanical waves to remove secretions (correct)

    • Which of the following oxygen delivery systems is most appropriate for a patient requiring the highest concentration of oxygen?

  • Non-Rebreather Mask (correct)
  • High Flow Nasal Cannula
  • Nasal Cannula
  • Simple Face Mask

    • What is the primary consideration when using oxygen flow rates above 3 LPM?

  • They do not require humidification
  • They are only used for patients with COPD
  • They must be humidified (correct)
  • They automatically meet inspiratory demand

    • What is the recommended starting flow rate for a nasal cannula?

    <p>1-6 LPM</p> Signup and view all the answers

    In which situation is tracheal suctioning indicated?

    <p>The patient shows signs of cyanosis and increased work of breathing</p> Signup and view all the answers

    Which of the following statements regarding the Venturi mask is true?

    <p>It delivers a fixed, precise concentration of oxygen.</p> Signup and view all the answers

    What is the most appropriate action to take when weaning a patient off oxygen?

    <p>Monitor the patient for distress and adjust slowly.</p> Signup and view all the answers

    What is a key characteristic of the High Flow Nasal Cannula?

    <p>It can deliver up to 60 LPM of heated and humidified gas.</p> Signup and view all the answers

    What is the maximum suction depth for tracheostomy care?

    <p>1 cm beyond the tracheostomy</p> Signup and view all the answers

    How long should suctioning last for adults during a single pass?

    <p>10-15 seconds</p> Signup and view all the answers

    What should be done before and between suctioning passes?

    <p>Hyperoxygenate the patient</p> Signup and view all the answers

    What is the initial treatment for asystole?

    <p>Start CPR</p> Signup and view all the answers

    Which of the following is NOT a complication associated with tracheostomy suctioning?

    <p>Euphoria</p> Signup and view all the answers

    Which device is designed to help with bradycardia and tachycardia?

    <p>Pacemaker</p> Signup and view all the answers

    What is a common symptom of Congestive Heart Failure (CHF)?

    <p>Shortness of breath</p> Signup and view all the answers

    What is the purpose of a stress test?

    <p>Record heart activity during physical activity</p> Signup and view all the answers

    Which symptom is associated with a myocardial infarction (MI)?

    <p>Chest pain</p> Signup and view all the answers

    What lifestyle factor is NOT linked to heart disease risk?

    <p>Regular exercise</p> Signup and view all the answers

    Which procedure involves using a balloon to compress a blockage in the coronary arteries?

    <p>Percutaneous transluminal coronary angioplasty (PTCA)</p> Signup and view all the answers

    Which of the following symptoms would most likely indicate a stroke?

    <p>Difficulty with balance</p> Signup and view all the answers

    What is a contraindication when using an Automated External Defibrillator (AED)?

    <p>Patient has a pacemaker</p> Signup and view all the answers

    What should be monitored at the insertion site after a cardiac intervention?

    <p>Bleeding</p> Signup and view all the answers

    What do DNR and DNI stand for in life-sustaining orders?

    <p>Do Not Resuscitate and Do Not Intubate</p> Signup and view all the answers

    Which type of vascular access device is typically used for long-term antibiotic therapy?

    <p>Peripherally Inserted Central Catheter (PICC)</p> Signup and view all the answers

    What is the primary function of antihypertensive medications?

    <p>Decrease blood pressure</p> Signup and view all the answers

    Which of the following medications is primarily used to prevent and resolve blood clots?

    <p>Anticoagulants</p> Signup and view all the answers

    In EKG lead placement, which color is associated with the Right Arm?

    <p>White</p> Signup and view all the answers

    What characterizes Ventricular Fibrillation (V-Fib) and its treatment approach?

    <p>Rapid depolarization; defibrillation needed</p> Signup and view all the answers

    Which of the following describes Normal Sinus Rhythm (NSR)?

    <p>60-100 bpm</p> Signup and view all the answers

    What is the primary concern with Pulseless Electrical Activity (PEA)?

    <p>Electrical activity without any contraction</p> Signup and view all the answers

    What is the primary role of cardiac glycosides in patient care?

    <p>Decrease heart rate</p> Signup and view all the answers

    What does V-Tach indicate in terms of heart rhythm and necessary intervention?

    <p>Rapid ventricular rate; requires shockable intervention</p> Signup and view all the answers

    What is a key difference between a Hickman Central Line and a Groshong?

    <p>Groshong is used when a patient is allergic to heparin, while Hickman is not.</p> Signup and view all the answers

    Which of the following diets would be appropriate for a patient recovering from surgery on their first postoperative day?

    <p>Full-liquid</p> Signup and view all the answers

    What must always be verified before using a Nasogastric Tube?

    <p>The placement of the tube by X Ray.</p> Signup and view all the answers

    What is a critical intervention when administering tube feeds via a nasogastric tube?

    <p>Maintain the head of bed at 30-45 degrees.</p> Signup and view all the answers

    Which type of central venous access device is placed in the arm and tunnels through subcutaneous tissue?

    <p>Hickman.</p> Signup and view all the answers

    What is the primary purpose of the blue pigtail in a Salem Sump tube?

    <p>To prevent suction from sticking to membranes and allow air exchange.</p> Signup and view all the answers

    What should be done to assess the patency of a nasogastric tube?

    <p>Aspirate pH and listen over the stomach after inserting air.</p> Signup and view all the answers

    What is the role of a Decron Sheath in a Hickman Central Line?

    <p>Provides a plug for tissue growth around the catheter.</p> Signup and view all the answers

    Study Notes

    Chest Physiotherapy

    • Percussion: mechanical waves created by clapping to remove secretions
    • Postural drainage: positioning to drain secretions (head down for lower lobes)
    • Vibration: loosens secretions (flutter valve, acapella, high frequency pulsator vest)

    Oxygen Delivery Systems

    • Maintain SpO2 >93%, PaO2 >60 mmHg
    • Use the LOWEST concentration for the SHORTEST amount of time
    • Anything higher than 3LPM must be humidified
    • Fill the oxygen bag BEFORE placing on the patient’s face

    Low-Flow Oxygen Delivery Systems

    • Nasal Cannula (NC): 1-6LPM (24-60% O2)
      • Comfortable and convenient
    • Simple Face Mask: 5-10 LPM (40-60% O2)
      • Covers mouth and nose
    • Partial Rebreather Face Mask: 10-15 LPM (30-60% O2)
      • Patient needs to re-breathe 1/3 of their CO2 (hyperventilating, anxious, stab wound)
    • Non-Rebreather Mask (NRB): 10-15 LPM (55-90% O2)
      • One way valve prevents the patient from re-breathing CO2 (hypoxia, acute respiratory distress - pure O2)

    High-Flow Oxygen Delivery Systems

    • Entire ventilatory demand of the patient is met (fixed-precise concentration of O2)
    • Pre-mixes ratio of O2 to air before delivery to the patient
    • Delivers gas at flow rates that exceed the patient’s inspiratory demand
    • High Flow Nasal Cannula: up to 60 LPM
      • Placed by respiratory therapist (premature infants)
      • Reduces dead space, heated and humidified
    • Venturi Mask: 24-60% O2
      • Colored valves to control concentration
      • Used in patients with low O2 that need humidification, COPD (limits the amount of O2 so the patient does not lose the stimulus to breathe)
    • Tracheostomy Collar: 28-98%
      • High humidity
    • Oxygen Hood: >60%
      • High humidity

    Weaning off of Oxygen

    • Done incrementally:
      • Reduce slightly, monitor the patient for distress, SpO2, work of breathing, respiratory rate, and then lower again when stable

    Tracheal Suctioning

    • Removal of secretions through a tube placed in a surgical opening (stoma)
    • Indications: audible upper airway noise/gurgling, adventitious breath sounds (crackles/rhonchi), cyanosis, decreased pulse ox/PaO2, hypoxia (restlessness/anxiety), increased work of breathing (WOB) (retractions, nasal flaring, tachypnea, shortness of breath)
    • Principles:
      • Suction to the end of the tracheostomy and 1 cm beyond MAX
      • Suction on the way OUT only
      • Rotate the catheter in a circular motion as you suction
      • DO NOT suction more than 10-15 seconds in adults, or 5-10 seconds in infants/children (airway is occluded, they are not being oxygenated during that time)
      • Hyperoxygenate the patient before and between passes
      • NO MORE than 3 passes in one session
      • Always keep extra trachs (1 same size + 1 smaller), a Kelly clamp, trach insertion kit, suction, and an Ambu bag at bedside
    • Complications: edema, obstruction (secretions or foreign body), hypoxia/bronchospasm, infection, hemorrhage, skin breakdown, expulsion of trach/decannulation

    Cardiac System

    • Heart Disease: vessels, valves, heart itself
    • Cardiovascular Disease: organs, body
    • Risk Factors for Heart Disease: age, sex, race, high cholesterol, diabetes, hypertension, family history
    • Lifestyle Risk Factors for Heart Disease: poor diet, sedentary lifestyle, obesity, smoking, drug use, excessive alcohol, high stress/anger

    Altered Cardiac System

    • Can lead to heart disease
    • Congestive Heart Failure (CHF): insufficient pumping of the heart
      • Symptoms: shortness of breath, fatigue, weakness, lower extremity edema, weight gain, tachycardia, dysrhythmias, persistent cough/wheeze
    • Arrhythmia: improper beating of the heart
      • Symptoms: fluttering in chest, tachycardia/bradycardia, chest pain, shortness of breath, dizziness, fainting
    • Stroke: damage to the brain from an interruption of blood flow
      • Symptoms: numbness, difficulty with balance, speech, and understanding, blurred vision, facial drooping, difficulty swallowing
    • Myocardial Infarction (MI): lack of blood flow to the heart
      • Symptoms: chest pain, numbness/pain in left arm, jaw, or back pain
    • Cardiac Arrest: heart suddenly stops, may occur without warning
    • Hypertension (HTN): force of blood against artery walls
      • Symptoms: headache, fatigue, vision problems, chest pain, dyspnea, dysrhythmia

    Cardiac Medications

    • Cardiac Glycosides: increase cardiac contractility, decrease heart rate
    • Antihypertensives: decrease blood pressure
    • Vasopressors: increase blood pressure
    • Antiarrhythmics: regulate heart rate
    • Nitrates: relieve angina (chest pain)
    • Antilipids: decrease cholesterol levels
    • Diuretics: reduce fluid volume
    • Anticoagulants: prevent/resolve blood clots

    EKG Lead Placement

    • Artifact = movement
    • 5 Lead (Telemetry):
      • Clouds over Grass:
        • RA (white)
        • RL (green)
      • Smoke over Fire:
        • LA (black)
        • LL (red)
      • Chocolate is good for the heart:
        • V1: 5th ICS, Right side
    • 12 Lead: + RA, LA, RL, LL
      • V1: 4th ICS, Right side
      • V2: 4th ICS, Left side
      • V3: between V2/V4, not on bone
      • V4: 5th ICS, Midclavicular, Left side
      • V5: between V4/V6, not on bone
      • V6: 5th ICS, Midaxillary, Left side

    Nursing Interventions

    • EKG, telemetry
    • Leg exercises, positioning
    • TEDS/SCIDS
    • Medications: anticoagulants, diuretics
    • Assessment and education

    Cardiac Rhythm Strips

    • Normal Sinus Rhythm (NSR): 60-100 bpm
    • NSR Bradycardia: <60 bpm
      • P: atrial depolarization
      • QRS: ventricular depolarization
      • ST: complete depolarization of ventricles
      • T: ventricular repolarization

    Cardiac Rhythms

    • Ventricular Tachycardia (V-Tach): foci in ventricles take over and beat too fast to count (sawtooth)
      • Shockable
      • Treatment: cardioversion, CPR, antiarrhythmic drugs
    • Ventricular Fibrillation (V-Fib): rapid, disorganized depolarization of ventricles, no palpable pulse
      • Shockable
      • Treatment: defibrillation & CPR, long-term implantable cardioverter-defibrillator (LT ICD)
    • Ventricular Dysrhythmia: ectopic foci in the walls of ventricles, decreased cardiac output, ventricular rate is only 20-40 bpm (cannot sustain life)
    • Premature Ventricular Contraction: one-off beat, not a rhythm (more in bradycardia)
    • Pulseless Electrical Activity (PEA): electricity works but no contraction, if no pulse, then no cardiac output → no tissue perfusion → death
      • Treatment: start CPR, hope the heart starts contracting
    • Asystole: no electrical activity, immediate loss of O2 to brain/heart/tissues
      • Treatment: CPR (hopefully get some rhythm back and then shock)

    Cardiac Tests/Monitoring

    • Duplex Ultrasound: how blood moves through arteries and veins (US + doppler)
    • Stress Test: monitor and record heart activity during physical activity
    • Echocardiogram: visualize how the heart is pumping and valves work through ultrasound (detects structural abnormalities)
    • Holter Monitor: worn 1-3 days at home, records activity of the heart during activities of daily living
    • Angiogram/Angiography: dye to look for blockage or narrowing
    • Percutaneous Transluminal Coronary Angioplasty (PTCA): catheter in arm/neck/groin
      • Uses a balloon to inflate and compress blockage, sometimes a coronary artery stent is placed to hold the vessel open
    • Coronary Artery Stent: placed with a balloon catheter, locks open to hold the vessel open
      • Monitor dysrhythmias and administer anticoagulants
    • Coronary Artery Bypass Graft (CABG): uses another vessel to bypass a damaged vessel
      • LIMA (left internal mammary artery): best moved over, live vessel, no valves
      • LAD (left anterior descending) artery: “widow maker”
      • Greater saphenous vein: veins are not built to handle the pressure
    • Interventions:
      • Monitor vital signs (watch for dysrhythmias)
      • Monitor for bleeding at the insertion site
      • Check peripheral pulses
      • Immobilize limb for 6 hours (dye-kidney function) and maintain pressure dressing
        • IF bleeding through dressing, DO NOT remove old, apply another on top
      • Monitor I&O (urinate within 6 hours of procedure)
      • Administer fluids

    Cardiac Rhythm Devices

    • Pacemaker: augments or replaces the natural pacemaker of the heart
      • Indications: bradycardia, tachycardia, damage to heart from MI, CHF
      • DO NOT put AED pads directly over the pacemaker
    • Implantable Cardiac Defibrillator (ICD):
      • Indications: treatment of V Tach and V Fib (feels like being kicked in the chest)

    Life-Sustaining Orders

    • DNR: do not resuscitate
    • DNI: do not intubate
    • MOLST: medical orders for life-sustaining treatment

    Cardiovascular Access Device

    • Peripheral IV (PIV): short term, placed at bedside by nurse in peripheral vein
    • Peripherally Inserted Central Catheter (PICC): long term, typically used for antibiotics, terminates at superior vena cava (SVC) or subclavian artery
      • Placed at bedside by specialized nurse
      • Checked by X-ray before use
    • Central Line (Central Venous Access Device (CVAD)):
      • Internal Jugular confirm by X-ray
      • Triple Lumen: short term, multiple lumens that terminate in different places to administer non-compatible meds at the same time, placed in neck by provider at bedside
        • Increased risk of pneumothorax or air embolism
      • Hickman Central Line: triple lumen, long term, placed in OR in SVC, Internal Jugular
        • Tunnels through subcutaneous tissue from arm
        • Decron Sheath: plug for tissue to grow around
      • Groshong: double lumen, rare, used when the patient is allergic to heparin
      • Mediport: long term, placed in OR, terminated in SVC
        • Self healing: Huber needle used to access

    Enteral Nutrition

    • Nutrition delivered via the GI system (includes nutrition through gastric tubes)
    • Diets:
      • NPO: nothing per os/nothing by mouth
      • Clear Liquid: tea, soda (ginger ale), light-color Jell-O, clear broth
        • Pre- and post-op and/or first day after being NPO
      • Full Liquid: clear liquid/liquids at room temperature (ice cream and sherbet)
      • Soft Diet: puree diet/mechanical soft
      • As Tolerated: indicated by the patient
      • Restrictive: cardiac, diabetic

    Nasogastric Tube (NG Tube)

    • MUST be checked by X-ray before use, MD order OK to use, future placement verification: insert air into tube and listen over stomach, aspirate pH
    • During insertion, have the patient sip water to help advance the tube
      • Infants with cleft lip/palate cannot suck, which can cause heart/lung problems because they are too tired
    • Interventions:
      • HOB 30-45 degrees at all times
      • Check placement
      • Administer tube feeds
      • Check residual (GRV) and replace
      • Flush tube to maintain patency
      • Assess (is it in place? Markings on the tube. Is the patient tolerating well?)
    • Salem Sump: two lumens/pigtail, short term, suction (should not be used for feeding)
      • Blue pigtail helps suction from sticking to membranes and allows air exchange
      • DO NOT tie a knot in pigtail, use a chucks if it is leaking
    • Levin: one lumen

    Studying That Suits You

    Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

    Quiz Team

    Related Documents

    Foundations In Nursing Exam 2 Review PDF

    Description

    Test your knowledge on chest physiotherapy techniques and the various oxygen delivery systems. This quiz covers essential methods like percussion, postural drainage, and low-flow oxygen options to maintain patient wellbeing. Understand how to effectively manage oxygen levels and support respiratory function.

    More Like This

    Use Quizgecko on...
    Browser
    Open
    Browser
    Browser