Podcast
Questions and Answers
What nursing action should be taken if a client shows signs of a pneumothorax post-thoracentesis?
What nursing action should be taken if a client shows signs of a pneumothorax post-thoracentesis?
Which complication of thoracentesis is characterized by the shift of thoracic structures to one side of the body?
Which complication of thoracentesis is characterized by the shift of thoracic structures to one side of the body?
What is the significance of the hand turning pink within 15 seconds after releasing pressure on the ulnar artery?
What is the significance of the hand turning pink within 15 seconds after releasing pressure on the ulnar artery?
Which of the following is a recommended action immediately after performing an arterial puncture?
Which of the following is a recommended action immediately after performing an arterial puncture?
Signup and view all the answers
What is the recommended client position during a thoracentesis procedure?
What is the recommended client position during a thoracentesis procedure?
Signup and view all the answers
What complication might occur if air enters the arterial system during catheter insertion?
What complication might occur if air enters the arterial system during catheter insertion?
Signup and view all the answers
What is one of the indications for performing a thoracentesis?
What is one of the indications for performing a thoracentesis?
Signup and view all the answers
Which nursing action is essential post-thoracentesis?
Which nursing action is essential post-thoracentesis?
Signup and view all the answers
Which of the following statements about post-bronchoscopy care is true?
Which of the following statements about post-bronchoscopy care is true?
Signup and view all the answers
What is the expected reference range for pH in an arterial blood gas (ABG) measurement?
What is the expected reference range for pH in an arterial blood gas (ABG) measurement?
Signup and view all the answers
What is the primary purpose of pulmonary function tests (PFTs)?
What is the primary purpose of pulmonary function tests (PFTs)?
Signup and view all the answers
Which of the following factors should a nurse verify prior to obtaining an arterial blood gas (ABG) sample?
Which of the following factors should a nurse verify prior to obtaining an arterial blood gas (ABG) sample?
Signup and view all the answers
What is important to advise clients who smoke prior to undergoing pulmonary function tests?
What is important to advise clients who smoke prior to undergoing pulmonary function tests?
Signup and view all the answers
What is measured in arterial blood gases (ABG) to assess oxygenation?
What is measured in arterial blood gases (ABG) to assess oxygenation?
Signup and view all the answers
Which of the following assessments can assist in monitoring the effectiveness of acidosis interventions?
Which of the following assessments can assist in monitoring the effectiveness of acidosis interventions?
Signup and view all the answers
What percentage of body weight is typically comprised of body fluid in a healthy adult client?
What percentage of body weight is typically comprised of body fluid in a healthy adult client?
Signup and view all the answers
How is fluid primarily transported between body compartments to maintain homeostasis?
How is fluid primarily transported between body compartments to maintain homeostasis?
Signup and view all the answers
What is hypernatremia an indication of in relation to body fluids?
What is hypernatremia an indication of in relation to body fluids?
Signup and view all the answers
Which renal-related factor primarily regulates fluid output in the body?
Which renal-related factor primarily regulates fluid output in the body?
Signup and view all the answers
What vital sign change is expected in a client experiencing hypovolemia?
What vital sign change is expected in a client experiencing hypovolemia?
Signup and view all the answers
Which of the following is NOT a cause of hypervolemia?
Which of the following is NOT a cause of hypervolemia?
Signup and view all the answers
What is a common laboratory finding associated with fluid overload?
What is a common laboratory finding associated with fluid overload?
Signup and view all the answers
Which sign is NOT typically associated with fluid volume overload?
Which sign is NOT typically associated with fluid volume overload?
Signup and view all the answers
What is the recommended position for a client experiencing pulmonary edema?
What is the recommended position for a client experiencing pulmonary edema?
Signup and view all the answers
Which medication type is NOT appropriate for a client with fluid volume excess?
Which medication type is NOT appropriate for a client with fluid volume excess?
Signup and view all the answers
What blood sodium level indicates hypernatremia?
What blood sodium level indicates hypernatremia?
Signup and view all the answers
Which fluid should be administered to gradually reduce blood sodium levels and minimize the risk of cerebral edema?
Which fluid should be administered to gradually reduce blood sodium levels and minimize the risk of cerebral edema?
Signup and view all the answers
What is a potential complication of severe hypernatremia if not treated promptly?
What is a potential complication of severe hypernatremia if not treated promptly?
Signup and view all the answers
What is a common sign of hypokalemia to observe in an ECG reading?
What is a common sign of hypokalemia to observe in an ECG reading?
Signup and view all the answers
Which of the following actions is essential when administering potassium to a client with hypokalemia?
Which of the following actions is essential when administering potassium to a client with hypokalemia?
Signup and view all the answers
What is the primary electrolyte that influences fluid retention and movement in the body?
What is the primary electrolyte that influences fluid retention and movement in the body?
Signup and view all the answers
Which condition can lead to a risk of hyponatremia in older adults?
Which condition can lead to a risk of hyponatremia in older adults?
Signup and view all the answers
Which of the following symptoms is expected in a patient with hyponatremia?
Which of the following symptoms is expected in a patient with hyponatremia?
Signup and view all the answers
What urine sodium level indicates sodium loss due to conditions like vomiting or diarrhea?
What urine sodium level indicates sodium loss due to conditions like vomiting or diarrhea?
Signup and view all the answers
What nursing action should be taken if a client with hyponatremia shows signs of neurological compromise?
What nursing action should be taken if a client with hyponatremia shows signs of neurological compromise?
Signup and view all the answers
What is the maximum recommended rate for IV potassium supplementation?
What is the maximum recommended rate for IV potassium supplementation?
Signup and view all the answers
Which of the following foods is high in potassium and should be encouraged for increased intake?
Which of the following foods is high in potassium and should be encouraged for increased intake?
Signup and view all the answers
What condition may result from an increased intake of potassium in a patient with kidney failure?
What condition may result from an increased intake of potassium in a patient with kidney failure?
Signup and view all the answers
What is a nursing intervention to prevent hyperkalemia in clients at risk?
What is a nursing intervention to prevent hyperkalemia in clients at risk?
Signup and view all the answers
What is one possible EKG finding in a patient with hyperkalemia?
What is one possible EKG finding in a patient with hyperkalemia?
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.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Description
Test your knowledge on respiratory diagnostic procedures including pulmonary function tests and arterial blood gases. Learn about the importance of each procedure, indications for their use, and patient preparation requirements. This quiz covers key concepts essential for understanding respiratory evaluations.
