Respiratory Diagnostic Procedures Quiz
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Questions and Answers

What is the primary purpose of pulmonary function tests (PFTs)?

  • To monitor the effectiveness of oxygen therapy
  • To determine lung function and breathing difficulties (correct)
  • To evaluate the acid-base balance of the blood
  • To assess the presence of airway obstruction only

    • Which of the following actions must a nurse take before performing an arterial blood gas (ABG) sampling?

  • Administer oxygen to the client beforehand
  • Ensure the client is fasting for 12 hours
  • Ensure the client has no history of respiratory illness
  • Conduct an Allen’s test to verify circulation (correct)

    • Instructing a client not to smoke for 6 to 8 hours prior to a pulmonary function test is important because:

  • It is required to prevent respiratory infections
  • Smoking does not affect lung function
  • It helps to ensure accurate results (correct)
  • Smoking can reduce the client's anxiety during the test

    • What measurement is NOT included in an arterial blood gas (ABG) analysis?

    <p>Pulmonary flow rate</p> Signup and view all the answers

    What effect can respiratory conditions have on blood pH levels, as measured in an ABG?

    <p>Alter blood pH levels in conjunction with renal conditions</p> Signup and view all the answers

    What conclusion can be drawn if the SaO2 measurement from an ABG shows a low percentage?

    <p>There is a potential obstruction in the airway</p> Signup and view all the answers

    What is a critical nursing action to perform after conducting an arterial puncture for an ABG?

    <p>Apply pressure to the site for adequate time to prevent bleeding</p> Signup and view all the answers

    Which pulmonary function variable is NOT typically assessed during PFTs?

    <p>Arterial carbon dioxide levels</p> Signup and view all the answers

    What is the primary function of the kidneys in fluid balance?

    <p>Regulating fluid output</p> Signup and view all the answers

    Which type of dehydration involves a shift of water from plasma to the interstitial space?

    <p>Relative dehydration</p> Signup and view all the answers

    Which of the following could indicate hypovolemia?

    <p>Hypotension and decreased central venous pressure</p> Signup and view all the answers

    What is hypernatremia primarily a result of?

    <p>Water deficit in the body</p> Signup and view all the answers

    Which laboratory test result is typically increased in hypovolemia?

    <p>BUN level</p> Signup and view all the answers

    Which of the following are major compartments for body fluids?

    <p>Intracellular and extracellular fluids</p> Signup and view all the answers

    Excessive gastrointestinal loss due to vomiting or diarrhea can lead to which condition?

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

    What would be an expected finding in a client experiencing hypovolemia?

    <p>Dizziness and confusion</p> Signup and view all the answers

    What is one of the key actions to take when caring for a client in hypovolemic shock?

    <p>Monitor vital signs continuously</p> Signup and view all the answers

    Which condition involves both a lack of water and electrolytes?

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

    What is a potential complication of rapid or severe dehydration?

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

    How should nursing care address fluid replacement in dehydrated patients?

    <p>Monitor intake and output closely</p> Signup and view all the answers

    What typically happens to the body fluid percentage as adults age?

    <p>Decreases with age</p> Signup and view all the answers

    Which method does the body NOT use to maintain fluid balance?

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

    Which foods are recommended to increase oral potassium intake?

    <p>Potatoes, bananas, dairy products, and avocados</p> Signup and view all the answers

    What is the maximum recommended rate for IV potassium administration?

    <p>10 mEq/hr</p> Signup and view all the answers

    Which condition is NOT a risk factor for hyperkalemia?

    <p>Excessive water intake</p> Signup and view all the answers

    What is a common assessment finding in a patient with hyperkalemia?

    <p>Slow irregular pulse and hypotension</p> Signup and view all the answers

    Which of the following nursing actions is appropriate for a patient at risk of cardiac complications due to hyperkalemia?

    <p>Perform continuous cardiac monitoring</p> Signup and view all the answers

    What nursing intervention is appropriate for a patient experiencing mild hyperkalemia?

    <p>Administering sodium bicarbonate</p> Signup and view all the answers

    What is considered severe hyperkalemia requiring dialysis?

    <p>Potassium level greater than 6.0 mEq/L</p> Signup and view all the answers

    Which medication is often used to increase potassium excretion?

    <p>Loop diuretics</p> Signup and view all the answers

    Which dietary change should a patient with hyperkalemia consider?

    <p>Increase intake of refined grains</p> Signup and view all the answers

    Which of the following lab findings indicates kidney failure in relation to potassium levels?

    <p>Increased BUN and creatinine</p> Signup and view all the answers

    What should be monitored in a patient receiving potassium-lowering medications?

    <p>Blood potassium levels</p> Signup and view all the answers

    How can patients reduce potassium content in vegetables before cooking?

    <p>Slice, peel, soak overnight, then boil</p> Signup and view all the answers

    Which condition significantly increases the risk of potassium excess in older adults?

    <p>Decreased aldosterone levels</p> Signup and view all the answers

    What should be avoided to prevent hyperkalemia in patients with impaired kidney function?

    <p>Use of potassium salt substitutes</p> Signup and view all the answers

    What is the expected time for a client's hand to turn pink after releasing pressure on the ulnar artery?

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

    Which of the following measures is crucial to preserve the pH levels and oxygen pressure of an ABG specimen after collection?

    <p>Place the specimen in a basin of ice and water</p> Signup and view all the answers

    What is a potential complication of arterial puncture that involves blood accumulating under the skin?

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

    What should a nurse monitor immediately after an arterial puncture?

    <p>ABG sampling site for bleeding</p> Signup and view all the answers

    During a bronchoscopy procedure, which position should the client typically be in?

    <p>Sitting or supine position</p> Signup and view all the answers

    What is the appropriate postprocedure nursing action for a client who has undergone a bronchoscopy?

    <p>Monitor for return of gag reflex</p> Signup and view all the answers

    Which of the following ABG pH levels indicates acidosis?

    <p>7.30</p> Signup and view all the answers

    What should be done if an air embolism occurs during catheter insertion?

    <p>Use the Valsalva maneuver</p> Signup and view all the answers

    Which nursing action is essential prior to performing a bronchoscopy?

    <p>Administer local anesthetic throat spray</p> Signup and view all the answers

    During recovery after a bronchoscopy, what should be continuously monitored?

    <p>Level of consciousness and vital signs</p> Signup and view all the answers

    What is the recommended duration for holding direct pressure over the site after arterial puncture?

    <p>5 minutes</p> Signup and view all the answers

    Which of the following is not an expected reference range for ABG measures?

    <p>PAO2 40 to 60 mm Hg</p> Signup and view all the answers

    What does the presence of significant hemoptysis post-bronchoscopy indicate?

    <p>Potential hemorrhage</p> Signup and view all the answers

    What is the significance of monitoring for changes in temperature, swelling, or color at the ABG sampling site?

    <p>To assess for complications like infection or hematoma</p> Signup and view all the answers

    What compound in medications promotes the excretion of excess fluid in patients with hypernatremia?

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

    What blood sodium level is considered hypernatremia?

    <p>145 mEq/L</p> Signup and view all the answers

    Which of the following is an expected finding in a patient with hypernatremia?

    <p>Dry mucous membranes</p> Signup and view all the answers

    Which solution is preferred for gradually reducing blood sodium levels in hypernatremia?

    <p>0.3% sodium chloride</p> Signup and view all the answers

    What is a common neurological symptom of hypernatremia?

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

    Which of the following is NOT a risk factor for hypernatremia?

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

    What laboratory finding would indicate hypokalemia?

    <p>Potassium level less than 3.5 mEq/L</p> Signup and view all the answers

    Which of the following conditions could result in a potassium deficit?

    <p>Chronic kidney disease</p> Signup and view all the answers

    What is an expected cardiovascular finding in a patient with hypokalemia?

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

    In treating hypokalemia, how should potassium be administered?

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

    Which of the following describes the relationship between sodium and potassium within the body?

    <p>Sodium levels are inversely related to potassium levels.</p> Signup and view all the answers

    A nurse assesses a patient with hypokalemia. Which muscle response is likely to be diminished?

    <p>Knee-jerk reflexes</p> Signup and view all the answers

    What is a critical complication of severe hypernatremia?

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

    What vital sign changes may occur in a patient experiencing hypokalemia?

    <p>Decreased blood pressure and a weak pulse</p> Signup and view all the answers

    Which of the following is an example of a crystalloid solution?

    <p>Normal saline</p> Signup and view all the answers

    What is a potential complication of fluid overload?

    <p>Pulmonary edema</p> Signup and view all the answers

    What vital sign might indicate fluid volume excess?

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

    Which factor can contribute to hypervolemia?

    <p>Increased sodium intake</p> Signup and view all the answers

    What is the primary risk factor for developing hyponatremia?

    <p>Excessive sweating</p> Signup and view all the answers

    In cases of fluid overload, what nursing intervention is critical?

    <p>Monitor daily weight</p> Signup and view all the answers

    Which electrolyte imbalance can cause cells to swell due to water moving into the cells?

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

    Which of the following laboratory values would likely be decreased in fluid overload?

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

    What is a common clinical finding associated with hypervolemic hyponatremia?

    <p>Bounding pulse</p> Signup and view all the answers

    Which of the following is NOT a typical finding in laboratory tests for hyponatremia?

    <p>Increased blood osmolarity</p> Signup and view all the answers

    What dietary modification is recommended for clients with fluid volume excess?

    <p>Consume a low-sodium diet</p> Signup and view all the answers

    What nursing intervention is appropriate for a client with hyponatremia who can tolerate oral intake?

    <p>Encourage fluids high in sodium</p> Signup and view all the answers

    What condition is most likely to lead to overhydration?

    <p>Psychogenic polydipsia</p> Signup and view all the answers

    Which of the following conditions can lead to relative sodium deficits due to dilution?

    <p>Psychogenic polydipsia</p> Signup and view all the answers

    Which sign is indicative of fluid volume overload?

    <p>Pitting edema</p> Signup and view all the answers

    When replacing sodium levels in a client, what is the recommended maximum increase per day?

    <p>12 mEq/L</p> Signup and view all the answers

    Which medication is commonly used as a positive inotropic agent?

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

    Which of the following is considered a compensatory mechanism for hyponatremia?

    <p>Excretion of sodium-free water</p> Signup and view all the answers

    During hemodynamic monitoring, which of the following is a sign of fluid overload?

    <p>Increased central venous pressure</p> Signup and view all the answers

    What is a symptom of severe sodium excess in the body?

    <p>Altered level of consciousness</p> Signup and view all the answers

    What condition can result from severe hyponatremia if not treated quickly?

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

    Which of the following nursing actions is relevant for managing a client with hyponatremia?

    <p>Monitor vital signs and level of consciousness</p> Signup and view all the answers

    What should a nurse prioritize when caring for a patient with suspected fluid overload?

    <p>Limit sodium intake</p> Signup and view all the answers

    Which electrolyte has the expected reference range of 3.5 to 5.0 mEq/L?

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

    Which nursing action is appropriate when managing pulmonary edema in a client?

    <p>Administer diuretics as prescribed</p> Signup and view all the answers

    What is a common cause of hypernatremia?

    <p>Inadequate water intake</p> Signup and view all the answers

    How does the body maintain electrical neutrality in body fluids?

    <p>By balancing positive and negative ions</p> Signup and view all the answers

    What role does sodium play in the extracellular fluid (ECF)?

    <p>Regulates ECF osmolarity</p> Signup and view all the answers

    Which condition can lead to respiratory acidosis due to inadequate chest expansion?

    <p>Obesity and sleep apnea</p> Signup and view all the answers

    What vital sign change could indicate worsening respiratory acidosis?

    <p>Initial tachycardia</p> Signup and view all the answers

    Which of the following is a common manifestation of metabolic acidosis?

    <p>Rapid and deep respirations</p> Signup and view all the answers

    What is a potential nursing intervention for a patient experiencing respiratory alkalosis?

    <p>Implement anxiety reduction techniques</p> Signup and view all the answers

    In metabolic alkalosis, what could cause a loss of gastric secretions?

    <p>Prolonged vomiting</p> Signup and view all the answers

    What is an expected result of respiratory acidosis on H+ concentration?

    <p>Increased H+ concentration</p> Signup and view all the answers

    What is the initial response in vital signs for a patient with respiratory acidosis?

    <p>Tachycardia and hypertension</p> Signup and view all the answers

    How is metabolic acidosis primarily characterized in terms of bicarbonate concentration?

    <p>Decreased HCO3- concentration</p> Signup and view all the answers

    What type of compensation can be identified if the pH is within normal range, while both HCO3- and PaCO2 are abnormal?

    <p>Fully compensated</p> Signup and view all the answers

    Which symptom is associated with respiratory alkalosis due to hyperventilation?

    <p>Numbness and tingling</p> Signup and view all the answers

    What condition can lead to inadequate mechanical ventilation?

    <p>Neurologic diseases</p> Signup and view all the answers

    What intervention would be appropriate for a patient with metabolic acidosis related to diabetic ketoacidosis (DKA)?

    <p>Administer insulin</p> Signup and view all the answers

    What diagnostic step involves looking at both PaCO2 and HCO3- simultaneously?

    <p>Determining origin of imbalance</p> Signup and view all the answers

    What is the maximum infusion rate for magnesium sulfate administration for severe hypomagnesemia?

    <p>150 mg/min</p> Signup and view all the answers

    Which type of acid-base imbalance is associated with decreased H+ concentration?

    <p>Respiratory alkalosis</p> Signup and view all the answers

    Which interprofessional service should be consulted for nutritional advice on magnesium intake?

    <p>Nutritional services</p> Signup and view all the answers

    Which food is high in potassium and should be encouraged for a client with hypokalemia?

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

    What is the risk associated with administering potassium via IV bolus?

    <p>Cardiac arrest</p> Signup and view all the answers

    What condition results from a decrease in potassium levels below 3.5 mEq/L?

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

    How does hyperventilation affect hydrogen ion levels in the body?

    <p>Decreases hydrogen ions</p> Signup and view all the answers

    What is the primary role of the kidneys in maintaining acid-base balance?

    <p>Reabsorbing bicarbonate</p> Signup and view all the answers

    What defines full compensation in acid-base imbalances?

    <p>Complete return of pH to normal</p> Signup and view all the answers

    Which acid-base imbalance results from increased CO2 due to hypoventilation?

    <p>Respiratory acidosis</p> Signup and view all the answers

    What is the first line of defense in maintaining acid-base balance?

    <p>Chemical buffers</p> Signup and view all the answers

    Which symptom indicates a risk for digoxin toxicity related to potassium levels?

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

    The presence of which electrolyte condition can lead to abnormal deep tendon reflexes?

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

    What should clients be educated about to avoid a decrease in potassium levels?

    <p>Avoiding diuretics and laxatives</p> Signup and view all the answers

    What is a common consequence of uncorrected acid-base imbalances in the body?

    <p>Organ dysfunction</p> Signup and view all the answers

    What manifestation is indicative of potential fluid and electrolyte imbalances?

    <p>Confusion and seizures</p> Signup and view all the answers

    What should a nurse anticipate if a patient experiences weight gain greater than 1 kg/day?

    <p>Decrease in the volume of lipid emulsion</p> Signup and view all the answers

    What is the primary mechanism by which IV Insulin and Glucose lower blood potassium levels?

    <p>They cause potassium to shift into intracellular space.</p> Signup and view all the answers

    Which action is essential when changing the central line dressing?

    <p>Use sterile technique to avoid infection</p> Signup and view all the answers

    Which of the following findings is the most indicative of hypocalcemia?

    <p>Prolonged QT interval on ECG.</p> Signup and view all the answers

    What nursing action is essential for a client with suspected hypomagnesemia?

    <p>Monitor for signs of increased nerve excitability.</p> Signup and view all the answers

    Which intervention is most appropriate for managing hyperglycemia in a patient receiving TPN?

    <p>Plan for insulin to be added to the TPN solution</p> Signup and view all the answers

    Which client education point is vital for someone managing chronic hyperkalemia?

    <p>Read food labels to avoid potassium-containing products.</p> Signup and view all the answers

    When should a nurse monitor blood glucose levels in a TPN patient?

    <p>Per prescription or facility policy</p> Signup and view all the answers

    What can a nurse do to assist in preventing complications in a client with hypocalcemia?

    <p>Implement seizure and fall precautions.</p> Signup and view all the answers

    Which condition is associated with a risk of cerum potassium elevation?

    <p>End-stage kidney disease.</p> Signup and view all the answers

    What are the early manifestations of hypocalcemia?

    <p>Tetany and paresthesia of the fingers and lips.</p> Signup and view all the answers

    What is a common treatment modality for a client with severe hypocalcemia?

    <p>Calcium gluconate or calcium chloride.</p> Signup and view all the answers

    Which nursing intervention should be prioritized for a client showing signs of hypomagnesemia?

    <p>Discontinue drugs that contribute to magnesium loss.</p> Signup and view all the answers

    Which dietary recommendation should be made to a client with hypocalcemia?

    <p>Consume high-calcium foods.</p> Signup and view all the answers

    Which sign is indicative of hypocalcemia when assessing nerve function?

    <p>Positive Chvostek’s sign.</p> Signup and view all the answers

    What is a significant risk factor for developing hypomagnesemia?

    <p>Chronic laxative use.</p> Signup and view all the answers

    What cardiac complication might arise from untreated hypocalcemia?

    <p>Risks of torsades de pointes.</p> Signup and view all the answers

    What is a unique feature of hypomagnesemia when assessing the client?

    <p>Presence of flat/inverted T waves.</p> Signup and view all the answers

    Which electrolyte imbalance might occur concurrently with hypomagnesemia?

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

    What is the primary condition indicated by an arterial blood gas (ABG) result showing a pH less than 7.35 and a PaCO2 greater than 45?

    <p>Respiratory acidosis</p> Signup and view all the answers

    Which type of nutritional support is indicated for clients who cannot consume sufficient nutrients orally and require long-term therapy?

    <p>Total parenteral nutrition (TPN)</p> Signup and view all the answers

    Which of the following complications can result from metabolic acidosis?

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

    What is the recommended action for a client who experiences a 3-lb weight gain in one week?

    <p>Notify the provider.</p> Signup and view all the answers

    What is one of the primary components included in parenteral nutrition solutions?

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

    Which of the following factors can contribute to metabolic acidosis?

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

    Which statement accurately describes peripheral parenteral nutrition (PPN)?

    <p>It provides a nutritionally incomplete solution.</p> Signup and view all the answers

    What action should be taken if blood bicarbonate is low due to metabolic acidosis?

    <p>Administer sodium bicarbonate.</p> Signup and view all the answers

    What kind of lipids are commonly added to parenteral nutrition solutions?

    <p>Soybean oil and safflower oil</p> Signup and view all the answers

    Which electrolyte is crucial for normal body functions and included in parenteral nutrition solutions based on individual needs?

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

    In which scenario should seizure precautions be implemented in a nursing context?

    <p>Conditions leading to metabolic acidosis</p> Signup and view all the answers

    What indicates adequate respiratory management status as per ABG results?

    <p>Normal pH range with normal HCO3-</p> Signup and view all the answers

    What should be done if a client experiences respiratory arrest?

    <p>Implement life-support interventions.</p> Signup and view all the answers

    Which conditions are commonly treated with Total Parenteral Nutrition (TPN)?

    <p>Cancer and extensive burns</p> Signup and view all the answers

    What is one primary goal when administering Parenteral Nutrition (PN)?

    <p>To ensure a positive nitrogen balance</p> Signup and view all the answers

    Which laboratory value indicates a successful response to PN therapy?

    <p>Increased prealbumin levels</p> Signup and view all the answers

    What is a critical nursing action prior to the administration of PN?

    <p>Verify the PN prescription with a second nurse</p> Signup and view all the answers

    When monitoring a client on PN, which complication should a nurse be particularly vigilant for?

    <p>Hyperkalemia leading to cardiac issues</p> Signup and view all the answers

    What is a key consideration when transitioning a client off PN?

    <p>Initiate oral nutrition before stopping PN</p> Signup and view all the answers

    What action should be taken if a client on TPN displays signs of 'cracking' in the solution?

    <p>Discard the solution and notify a provider</p> Signup and view all the answers

    Which of these techniques is essential when changing central line dressings?

    <p>Use a sterile technique</p> Signup and view all the answers

    What is a possible metabolic complication associated with the use of PN?

    <p>Refeeding syndrome</p> Signup and view all the answers

    What should you monitor for to help prevent hyperglycemia in a client receiving PN?

    <p>Regular blood glucose levels</p> Signup and view all the answers

    What is the significance of using a micron filter when administering PN solutions?

    <p>To remove bacteria and particulate matter</p> Signup and view all the answers

    When should intravenous lipid infusions be stopped prior to obtaining a blood specimen for triglycerides?

    <p>12 hours prior</p> Signup and view all the answers

    Which parameter is typically monitored while a patient is on PN?

    <p>Daily weights and laboratory values</p> Signup and view all the answers

    What is a common complication of thoracentesis that can impact respiratory function?

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

    Which sign should a nurse monitor for to indicate potential pneumothorax after thoracentesis?

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

    Which statement is true regarding the management of respiratory complications in older adults?

    <p>Older adults have a higher risk of respiratory infections.</p> Signup and view all the answers

    What should a client avoid during a thoracentesis to minimize risks?

    <p>Moving or coughing</p> Signup and view all the answers

    What does a nurse need to ensure is signed before performing a thoracentesis?

    <p>Informed consent form</p> Signup and view all the answers

    What are signs of mediastinal shift following thoracentesis that a nurse should monitor?

    <p>Decreased breath sounds on one side</p> Signup and view all the answers

    Which fluid analysis component is important for determining the cause of pleural effusion?

    <p>Presence of enzymes such as LDH</p> Signup and view all the answers

    How long should oral fluids or food be withheld after a procedure to prevent aspiration?

    <p>2 hours</p> Signup and view all the answers

    Why is ultrasound guidance used during thoracentesis?

    <p>To decrease the risk of complications</p> Signup and view all the answers

    What is a key nursing action during the postprocedure phase of thoracentesis?

    <p>Apply a dressing over the puncture site</p> Signup and view all the answers

    Which age-related factor increases the risk of respiratory infections in older adults?

    <p>Decreased cough effectiveness</p> Signup and view all the answers

    What complication can occur if more than 1 liter of fluid is removed during thoracentesis?

    <p>Re-expansion pulmonary edema</p> Signup and view all the answers

    Which precaution is important during the procedure to prevent infection?

    <p>Using surgical aseptic technique</p> Signup and view all the answers

    Study Notes

    Respiratory Diagnostic Procedures

    • Evaluates respiratory status by assessing blood oxygenation, lung function, and airway integrity.
    • Common procedures include pulmonary function tests, arterial blood gases, bronchoscopy, and thoracentesis.
    • Informed consent must be obtained prior to any diagnostic procedure.

    Pulmonary Function Tests (PFTs)

    • Assess lung function including volumes, capacities, diffusion capacity, and flow rates.
    • Important for diagnosing lung diseases and evaluating respiratory risk before surgery.
    • Smoking cessation required for 6-8 hours prior to testing; withhold inhalers for 4-6 hours.

    Arterial Blood Gases (ABGs)

    • Evaluates oxygenation and acid-base balance of the blood.
    • Measures essential parameters: pH, PaO2, PaCO2, HCO3¯, and SaO2.
    • Can be obtained via arterial puncture or arterial line.

    Indications for ABGs

    • Helps monitor treatment effects (e.g., for acidosis) and guide oxygen therapy.
    • Abnormal blood pH can indicate respiratory, metabolic, or renal conditions.

    ABG Collection Procedures

    • Preprocedure: Use a heparinized syringe; perform Allen’s test to ensure circulation.
    • Intraprocedure: Use aseptic technique for arterial puncture and transport samples to lab on ice.
    • Postprocedure: Apply direct pressure to the site for at least 5 minutes; longer if on anticoagulants, and monitor for bleeding or pulse loss.

    Interpretation of ABGs

    • Normal pH: 7.35 to 7.45; acidosis is <7.35, alkalosis is >7.45.
    • Reference ranges:
      • PaO2: 80 to 100 mm Hg
      • PaCO2: 35 to 45 mm Hg
      • HCO3¯: 21 to 28 mEq/L
      • SaO2: 95% to 100%

    Complications of ABG Collection

    • Hematoma and arterial occlusion; monitor for symptoms at the puncture site.
    • Air embolism can occur—place client in Trendelenburg position if suspected.

    Bronchoscopy

    • Technique to visualize larynx, trachea, and bronchi; can be done under anesthesia.
    • Used for diagnosis (tumors, biopsies) and therapeutic interventions (removal of foreign bodies, secretions).
    • Must ensure informed consent and monitor for respiratory complications post-procedure.

    Thoracentesis

    • Procedure to remove fluid or air from pleural space for diagnosis or relief.
    • Performed under local anesthesia; ultrasound may assist in guiding needle placement.
    • Large volume fluid removal is limited to mitigate the risk of pulmonary edema.

    Indications and Assessments for Thoracentesis

    • Diagnoses pleural effusion causes: transudates or exudates due to various medical conditions.
    • Clinical signs include pain, shortness of breath, abnormal lung sounds, and dull percussion.

    Pre- and Postprocedure Nursing Actions for Thoracentesis

    • Preprocedure: Confirm informed consent, prepare supplies, and position the client for optimal access.
    • Intraprocedure: Monitor vital signs, ensure sterile technique, and label samples accurately.
    • Postprocedure: Dress the puncture site, monitor for respiratory function and potential complications.

    Potential Complications of Thoracentesis

    • Mediastinal shift, pneumothorax, bleeding, and infection; monitor vital signs and lung sounds.
    • Recognize pneumothorax symptoms: diminished breath sounds, chest wall asymmetry, respiratory distress.

    Body Fluids and Dehydration

    • 55% to 60% of body weight consists of fluid; this decreases in older adults due to physiological changes.
    • Fluid compartments include intracellular (ICF) and extracellular (ECF); ECF is further divided into intravascular, interstitial, and transcellular fluids.

    Assessment and Management of Dehydration

    • Dehydration can be due to excessive loss of fluids from GI, skin, renal systems, or inadequate intake.
    • Assessment findings include hypovolemia symptoms: tachycardia, hypotension, dizziness, and dry tongue.
    • Laboratory tests may show elevated hematocrit and sodium levels in dehydration situations.

    Nursing Considerations for Fluid Imbalance

    • Provide oral or IV rehydration, monitor intake/output and vital signs, and assess for confusion.
    • Collaborate for fluid volume replacement; educate clients on hydration importance and signs of dehydration complications.

    Complications of Fluid Imbalance

    • Hypovolemic shock is critical; monitor for signs and respond by administering oxygen and assessing vital signs.### Vital Signs and Fluid Management
    • Monitor vital signs every 15 minutes for timely assessment.
    • Colloids for fluid replacement include whole blood, packed RBCs, plasma, and synthetic plasma expanders.
    • Crystalloids such as lactated Ringer's and normal saline are also used for fluid replacement.
    • Administer vasoconstrictors (dopamine, norepinephrine, phenylephrine) and agents to improve myocardial perfusion (sodium nitroprusside).
    • Positive inotropic medications (dobutamine, milrinone) can enhance cardiac output.

    Fluid Overload and Risks

    • Overhydration results from excessive fluid intake or ineffective removal from the body.
    • Fluid overload can lead to pulmonary edema or congestive heart failure, particularly in older adults.
    • Fluid volume excess includes hemodilution, causing a perceived reduction in blood components.

    Health Promotion and Prevention

    • Clients with heart disease or kidney impairment should follow a low sodium diet and fluid intake restrictions.
    • Overhydration risk factors include heart failure, kidney disease, cirrhosis, and fluid overdose.

    Assessment of Fluid Volume Excess

    • Expected findings include tachycardia, hypertension, and increased central venous pressure.
    • Neuromuscular symptoms: weakness, visual changes, altered consciousness, and seizures.
    • Gastrointestinal signs: ascites and liver enlargement.
    • Respiratory symptoms: crackles, cough, and dyspnea.

    Laboratory Tests for Fluid Imbalance

    • Decreased hematocrit (Hct) and hemoglobin (Hgb) levels indicate hemodilution.
    • Blood osmolarity decreases with excess fluid.
    • Urine sodium and specific gravity are useful indicators of fluid status.
    • Chest X-ray may reveal pulmonary congestion.

    Nursing Care for Fluid Overload

    • Monitor intake and output, and daily weights; a weight change of 1 kg corresponds to 1 L of fluid.
    • Assess breath sounds and peripheral edema; consider semi-Fowler's positioning.
    • Administer diuretics as prescribed, and engage the client in discussions about over-the-counter medications.

    Client Education on Fluid Management

    • Daily weight monitoring and prompt reporting of weight gain are crucial.
    • Adhere to fluid and sodium restrictions, and educate on reading sodium content in food labels.

    Complications of Fluid Overload

    • Pulmonary edema symptoms include dyspnea at rest and frothy pink sputum.
    • Nursing interventions include positioning the client for ventilation and administering prescribed medications.

    Electrolyte Imbalances Overview

    • Electrolytes maintain cell excitability and nerve transmission.
    • Cations (sodium, potassium) and anions (chloride, bicarbonate) play critical roles in fluid balance.
    • Hyponatremia results from water excess or sodium loss.

    Hyponatremia

    • Defined as sodium levels <136 mEq/L, causing cellular edema and neurological symptoms.
    • Risk factors include excessive sweating, diuretics, and inadequate sodium intake.
    • Symptoms range from confusion and lethargy to gastrointestinal disturbances.

    Management of Hyponatremia

    • Sodium replacement through diet or IV fluids should be gradual to avoid complications.
    • Monitor vital signs, level of consciousness, and administer fluids as prescribed.

    Hypernatremia

    • Sodium levels >145 mEq/L lead to dehydration and cellular dysfunction.
    • Thirst and laboratory findings will indicate hypernatremia.
    • Care involves fluid replacement and monitoring of symptoms related to hypervolemia.

    Potassium Imbalances

    • Potassium maintains cellular function; levels must stay between 3.5 and 5.0 mEq/L.
    • Hypokalemia (<3.5 mEq/L) presents symptoms of muscle weakness and cardiac disturbances.
    • Risk factors are often linked to diuretic use and gastrointestinal losses.

    Management of Hypokalemia

    • Oral or IV potassium supplementation must be monitored closely, with maximum rates in IV administration.
    • Encourage potassium-rich foods and implement safety precautions for muscle weakness.

    Hyperkalemia

    • Higher potassium levels (>5.0 mEq/L) signal potential cardiac arrest risk.
    • Monitor for muscle twitching and altered vital signs; emergency interventions are crucial for severe cases.

    Summary of Interprofessional Care

    • Collaborative approaches include consulting nephrology for electrolyte management and dieticians for dietary adjustments.
    • Safety monitoring is vital across all stages of fluid and electrolyte imbalances.### Assessment of Electrolyte Imbalances

    Risk Factors for Hyperkalemia

    • Chronic illnesses
    • Elderly clients due to hormonal changes and medications
    • Overconsumption of potassium-rich foods or salt substitutes
    • Rapid potassium replacement via oral or IV routes
    • Red blood cell transfusions
    • Adrenal insufficiency and use of potassium-sparing diuretics
    • Kidney failure

    Expected Findings in Hyperkalemia

    • Vital signs: Slow irregular pulse, hypotension
    • Neuromusculoskeletal: Weakness, restlessness, flaccid paralysis, paresthesia
    • ECG changes: Premature ventricular contractions, peaked T waves, widened QRS
    • Gastrointestinal: Increased motility, diarrhea, hyperactive bowel sounds
    • Other: Oliguria

    Laboratory Tests

    • Blood potassium level >5.0 mEq/L
    • Hemoglobin and hematocrit levels vary with hydration status
    • Increased BUN and creatinine indicating kidney failure
    • Arterial blood gases showing metabolic acidosis (pH <7.35)

    Diagnostic and Patient-Centered Care

    Diagnostic Procedures

    • ECG shows peaked T waves, absent P waves, potential ventricular dysrhythmias

    Nursing Care Priorities

    • Fall prevention, cardiac monitoring, health education
    • Stop potassium IV infusions, maintain IV access
    • Promote potassium-restricted diet and monitor potassium levels
    • Administer calcium gluconate for severe hyperkalemia; dialysis may be needed in chronic cases

    Prevention of Hyperkalemia

    • Avoid blood products in clients with kidney issues
    • Educate on low-potassium foods: raw apples, cranberries, cucumbers, and refined grains
    • Avoid potassium-sparing diuretics with supplements

    Medications for Hyperkalemia

    • Loop diuretics (Furosemide) for potassium depletion
    • Sodium polystyrene sulfonate to excrete potassium
    • IV Insulin and glucose to shift potassium into cells
    • Beta-2 agonists (Albuterol) for potassium shift

    Complications of Electrolyte Imbalances

    Cardiac Complications

    • Cardiac arrest from severe electrolyte imbalances
    • Continuous cardiac monitoring necessary for symptomatic patients

    Hypocalcemia

    Risk Factors

    • Inadequate calcium intake, malabsorption, vitamin D deficiency
    • End-stage kidney disease, alkalosis, and certain medical treatments
    • Parathyroid surgery risks

    Expected Findings

    • Tetany, paresthesia, muscle spasms, and seizures
    • Cardiovascular: Prolonged QT interval and decreased contractility
    • Gastrointestinal: Hyperactive bowel sounds and abdominal cramps

    Nursing Care for Hypocalcemia

    • Administer calcium supplements; vitamin D to enhance absorption
    • Seizure precautions and a calm environment
    • Encourage high-calcium foods like dairy and leafy greens
    • Rapid treatment of life-threatening hypocalcemia with IV calcium gluconate

    Hypomagnesemia

    Risk Factors

    • Celiac disease, malnutrition, alcohol use, and renal dysfunction
    • Concurrent electrolyte imbalances

    Expected Findings

    • Increased blood pressure, dysrhythmias, muscle tetany, and seizures
    • Gastrointestinal: Constipation and abdominal distension

    Nursing Care for Hypomagnesemia

    • Correct other electrolyte imbalances
    • Administer dietary magnesium and consider IV magnesium sulfate for severe cases
    • Monitor patients for signs of digitalis toxicity

    Hypokalemia

    Cause and Nursing Care

    • Result of increased potassium loss or movement into cells; potassium <3.5 mEq/L
    • Encourage dietary intake of potassium-rich foods and administer oral/IV potassium supplements
    • Never administer IV potassium as a bolus to prevent cardiac arrest; monitor closely for complications

    Acid-Base Balance

    Overview of pH Regulation

    • Homeostasis depends on hydrogen ion concentration, affected by respiratory and renal systems
    • Normal arterial pH: 7.35 to 7.45; assessed using arterial blood gas (ABG) analysis

    Compensation Mechanisms

    • Chemical buffers (immediate response), respiratory buffers (intermediate), and renal buffers (long-term response)
    • Full compensation normalizes pH; partial compensation does not

    Respiratory and Metabolic Disorders

    Respiratory Acidosis

    • Caused by hypoventilation and inadequate ventilation leading to increased CO2 and H+ concentration
    • Symptoms include tachycardia, confusion, and cyanosis; nursing care focuses on enhancing gas exchange and oxygen therapy

    Respiratory Alkalosis

    • Results from hyperventilation and results in decreased CO2 and H+ concentration
    • Symptoms: tachypnea, inability to concentrate; nursing care includes anxiety reduction and oxygen therapy

    Metabolic Acidosis

    • Excess hydrogen production or inadequate elimination leading to a decrease in HCO3-
    • Symptoms include dyspnea, bradycardia, and altered mental status; treat underlying causes with specific interventions.

    Health Promotion

    • Encourage a balanced diet, hydration, moderation in alcohol consumption, and smoking cessation for overall health and electrolyte balance.

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    Test your knowledge on various respiratory diagnostic procedures including pulmonary function tests and arterial blood gases. This quiz covers essential concepts, indications, and preparations for these assessments. Perfect for healthcare students and professionals looking to validate their understanding in respiratory diagnostics.

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