Respiratory Care Quiz

Adventitious Breath Sounds

• Crackles: indicate fluid, mucous, or pus in the lungs
• Rhonchi (snoring): indicate secretions in large airways
• Wheezes: indicate airway constriction
• Diminished: indicate shallowed or restricted breathing
• Stridor (high-pitched): indicate upper airway obstruction

Respiratory Support

• Low Flow:
  • Nasal Cannula
  • Simple Face Mask (35-45%)
  • Non-rebreather (100%): ensure reservoir bag is filled up
• High Flow:
  • Venturi Mask (4-6L, up to 40L)
  • High flow nasal cannula
• CPAP:
  • For Obstructive Sleep Apnea (OSA)
• BiPAP:
  • Allows for lower pressure during exhalation (for complex breathing pressures)
• Invasive Ventilation:
  • Endotracheal tube
  • Tracheostomy
  • Mechanical ventilator

Ventilator Alarms

• High: obstruction
• Low: leak
• For a alarm: assess client first, assess machine, call resp support
• If patient is distressed, give sedation

Endotracheal Tubes

• Verify placement with a chest X-ray (gold standard)
• Assess for equal breath sounds
• End-tidal capnography (CO2 detector): ensure paper changes to a yellow color

Tracheostomies

• Long-term trach tube
• Stoma made into the neck, breathing through the neck
• Tracheostomy Care:
  • 1-2 fingers fit under straps
  • Infection prevention (inpatient only, daily care is a sterile procedure)
  • Fowler/Semi position
  • Use gauze soaked with NS, then dry skin, apply new sterile dressing, change trach ties
  • Suctioning: only do it to the pre-measured depth, no longer than 10 seconds, and pre-hyperoxygenate

Chest Tubes

• Drainage System Chambers:
  • Suction Control Chamber: no tidaling, gentle bubbling, replace fluid with NS
  • Water Seal Chamber: tidaling, intermittent bubbling, stop tidaling indicates obstruction or lung re-expansion
  • Drainage Collection Chamber: no tidaling/bubbling, pink drainage
• Nursing Considerations:
  • Keep below chest level
  • No dependent loops
  • Drainage should be no more than 100 ml/hr
  • What to do if the chest tube comes out: cover the site with a sterile dressing, tape on 3 sides, call the PCP, and stay with the client

Bronchodilators/Albuterol

• Bronchodilators:
  • Albuterol
  • Terbutaline
  • Ipratropium (anticholinergic, COPD/asthma): smooth muscle relaxation
• Considerations:
  • Cautious with patients who have heart disease, diabetes, glaucoma, or seizures
  • Causes tachycardia, only discontinue if it causes severe problems

Terbutaline

• Rescue/relief and maintenance drug for wheezing, SOB, and coughing caused by asthma
• Nursing Considerations:
  • Side effects: shakiness, jitteriness, dizziness, drowsiness, sleep disturbances, weakness, headache, vomiting, tachycardia, hypertension, hyperglycemia, CNS overstimulation
  • Assess HR, BP, EKG, BG
  • Given orally, SC, or by inhaler, lasts 4-6 hours
  • More side effects with oral administration
  • Teach proper inhaler use

Inhalers and Spacers

• Inhaler Education:
  • Hold with mouthpiece down, do not hold upside down
  • Seal lips tightly around mouthpiece
  • Press down on inhaler one time, one breath in = one puff of medication
  • Continue inhaling while medication is dispensed, breathe slowly and as deeply as possible
  • Shake prior to use
• Spacer Education:
  • Connects to the mouthpiece of the inhaler
  • Timing of the breath is less important
  • Wastes less medication
  • Mostly used in pediatrics

Miscellaneous Respiratory Medications

• Montelukast: for allergies/asthma, long-term control (not rescue medication)
• Guaifenesin: expectorant, to get patient coughing to bring out secretions
• Acetylcysteine: mucolytic, breaks up mucus
• Pseudoephedrine, phenylephrine: reduces edema/decongestant
• Antitussives: dextromethorphan, codeine

Steroids (Respiratory)

• SONE (Steroids in Obstructive Narrowing of the airways)
• Betamethasone
• Dexamethasone