Exam 2 Foundations
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Exam 2 Foundations

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Questions and Answers

What is the primary purpose of an infusion pump in IV therapy?

  • Connects secondary fluid bags to primary lines.
  • Flushes intravenous lines with normal saline.
  • Regulates the infusion of IV fluids. (correct)
  • Administers medications directly into the bloodstream.

    • Which type of IV line allows for the infusion of three incompatible fluids simultaneously?

  • Hickman catheter
  • External jugular IV
  • Triple lumen central line (correct)
  • PICC line

    • Which IV solution is indicated for the abrupt cessation of TPN/CPN?

  • D10W (10% Dextrose in Water) (correct)
  • D5W (5% Dextrose in Water)
  • NS (Normal Saline)
  • LR (Lactated Ringer's)

    • What is a notable feature of the Groshong catheter compared to other tunneled catheters?

    <p>Does not require heparin flushes.</p> Signup and view all the answers

    What complication is NOT commonly associated with TPN/CPN?

    <p>Electrolyte imbalance</p> Signup and view all the answers

    What becomes the primary stimulus for breathing in COPD patients?

    <p>Low oxygen levels</p> Signup and view all the answers

    What is the normal respiratory rate for adults?

    <p>12-20 breaths/minute</p> Signup and view all the answers

    Which condition is characterized by difficulty filling the lungs with air during inhalation?

    <p>Restrictive lung disease</p> Signup and view all the answers

    What key feature is associated with restrictive lung diseases?

    <p>Stiffening of the lungs</p> Signup and view all the answers

    Which symptom is NOT typically associated with COPD?

    <p>Increased lung elasticity</p> Signup and view all the answers

    What is the likely cause of increased work of breathing?

    <p>Obstruction in air passages</p> Signup and view all the answers

    Which intervention indicates respiratory distress due to accessory muscle use?

    <p>Utilization of neck and shoulder muscles</p> Signup and view all the answers

    What is a common characteristic of obstructive lung diseases?

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

    Which accessory muscle is commonly used to aid in breathing?

    <p>Pectoralis major</p> Signup and view all the answers

    What does Cheyne-Stokes breathing characterize?

    <p>Alternating periods of increased rate and depth followed by apnea</p> Signup and view all the answers

    Which symptom can indicate altered respiratory function?

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

    Which oxygen delivery system does NOT meet all of a patient's ventilatory demands?

    <p>Simple face mask</p> Signup and view all the answers

    What is the significance of the oxyhemoglobin curve's left shift?

    <p>Higher binding affinity of O2</p> Signup and view all the answers

    What common sign indicates upper airway obstruction?

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

    Which intervention is NOT appropriate for improving respiratory function?

    <p>Prolonged bed rest</p> Signup and view all the answers

    What is the function of a peak flow meter?

    <p>Records the peak expiratory flow rate</p> Signup and view all the answers

    What is the primary purpose of a Lopez Valve in tube feeding?

    <p>To allow access to feeding tubes without disconnecting the system.</p> Signup and view all the answers

    What characteristic defines isotonic solutions?

    <p>Same osmolarity as the cells.</p> Signup and view all the answers

    What is a possible complication associated with over-infusing IV fluids?

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

    What should be done if residual volume is between 250-500 cc during tube feeding?

    <p>Stop the feeding temporarily.</p> Signup and view all the answers

    Which type of solution should be used cautiously to prevent cardiovascular collapse due to fluid shifts?

    <p>Hypotonic solutions.</p> Signup and view all the answers

    What does KVO stand for in IV orders?

    <p>Keep Vein Open.</p> Signup and view all the answers

    What device is used for venous access to administer intravenous fluids?

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

    What is the appropriate action to take if infiltration occurs at the IV site?

    <p>Apply heat or cold and elevate the extremity.</p> Signup and view all the answers

    Which foods are suitable for a full liquid diet?

    <p>Broth and ice cream</p> Signup and view all the answers

    What is the primary purpose of a nasogastric tube (NGT)?

    <p>Provide gastric decompression and feeding</p> Signup and view all the answers

    Which of the following dietary options is considered a restrictive diet?

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

    What should be monitored after placing an NGT to confirm its position?

    <p>Aspiration characteristics and respiratory distress</p> Signup and view all the answers

    When administering tube feedings, what is the least advisable action?

    <p>Add medication directly to the tube feeding bag</p> Signup and view all the answers

    Which type of tube is used primarily for long-term tube feeding?

    <p>Percutaneous Endoscopic Gastrostomy (PEG) tube</p> Signup and view all the answers

    What characteristic can hypertonic feeding solutions cause if not monitored properly?

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

    In which scenario should tube feedings be held?

    <p>If residual is 1.5-2 times the feeding rate</p> Signup and view all the answers

    What can significantly increase the work of breathing in a patient?

    <p>Decreased lung capacity</p> Signup and view all the answers

    Which of the following factors most negatively impacts respiratory function?

    <p>Exposure to allergens</p> Signup and view all the answers

    Which characteristic is typical of restrictive lung diseases?

    <p>Decreased elasticity of the lungs</p> Signup and view all the answers

    Which condition is associated with bronchodilation and airway inflammation?

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

    What respiratory rate is considered bradypnea in adults?

    <p>10-12 breaths/minute</p> Signup and view all the answers

    In COPD patients, which gas level primarily stimulates breathing?

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

    What occurs during periods of increased respiratory distress in relation to muscle use?

    <p>Accessing additional muscle groups</p> Signup and view all the answers

    Which symptom is expected in a patient suffering from COPD?

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

    Which accessory muscle is NOT typically involved in respiration?

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

    Which symptom is NOT a sign of altered respiratory function?

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

    What does a left shift in the oxyhemoglobin curve indicate?

    <p>Higher binding affinity of oxygen</p> Signup and view all the answers

    Cheyne-Stokes breathing is characterized by which of the following patterns?

    <p>Alternating periods of deep and rapid breathing followed by apnea</p> Signup and view all the answers

    What is one function of a peak flow meter?

    <p>Assess peak expiratory flow rate</p> Signup and view all the answers

    Which of the following oxygen delivery systems meets all of a patient's ventilatory demands?

    <p>Venturi mask</p> Signup and view all the answers

    A blue discoloration of the skin due to low oxygen levels is known as what?

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

    Which of the following interventions is NOT typically used to improve respiratory function?

    <p>Bed rest in a supine position</p> Signup and view all the answers

    Which oxygen delivery system is specifically designed to meet the demands of COPD patients?

    <p>Venturi mask</p> Signup and view all the answers

    What maximum suctioning duration is recommended during tracheal suctioning?

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

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

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

    What is the recommended flow rate for a high-flow nasal cannula system?

    <p>60 L/min</p> Signup and view all the answers

    What should be done before and between suctioning passes during tracheal suctioning?

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

    Which oxygen delivery system has the highest humidity level and can deliver 28-98% oxygen?

    <p>Oxygen hood/tent</p> Signup and view all the answers

    What is a key consideration when selecting an oxygen delivery system for a patient?

    <p>The patient's ventilatory demands</p> Signup and view all the answers

    Which type of diet is defined by 'nothing by mouth'?

    <p>NPO diet</p> Signup and view all the answers

    What is the primary function of a stopcock (Lopez Valve) in feeding management?

    <p>To allow access to tube feeding systems without disconnection</p> Signup and view all the answers

    Which type of IV solution is safe to use for treating hypovolemia?

    <p>0.9% sodium chloride</p> Signup and view all the answers

    What should be done if fluid overload is suspected during IV therapy?

    <p>Slow down or stop the infusion</p> Signup and view all the answers

    What is a characteristic sign of phlebitis at an IV site?

    <p>Warmth and redness along the vein</p> Signup and view all the answers

    What is the intended action when administering a bolus in IV therapy?

    <p>To provide a large amount of fluid quickly</p> Signup and view all the answers

    What potential complication may occur as a result of air embolism during IV placement?

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

    What is the recommended action if infiltration occurs at an IV site?

    <p>Elevate the affected limb and apply heat or cold</p> Signup and view all the answers

    When adjusting the drip rate for gravity infusion, what should the practitioner do?

    <p>Count drips for one minute or 30 seconds x 2</p> Signup and view all the answers

    What is a key characteristic of a soft diet?

    <p>Comprises foods that require minimal chewing</p> Signup and view all the answers

    Which diet is designed specifically for patients with renal issues?

    <p>Renal Diet</p> Signup and view all the answers

    What should be monitored to confirm the placement of a nasogastric tube (NGT) after insertion?

    <p>X-ray confirmation and aspirate characteristics</p> Signup and view all the answers

    What is the appropriate patient positioning during tube feeding?

    <p>Minimally semi-Fowler's (30-45 degrees)</p> Signup and view all the answers

    What complication may occur with hypertonic feeding solutions if not properly monitored?

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

    Which is a common indication to hold tube feedings?

    <p>Residual is 1.5-2 times the feeding rate</p> Signup and view all the answers

    What type of tube is used primarily for short-term gastric suctioning?

    <p>Salem Sump</p> Signup and view all the answers

    What should never be added to tube feeding bags?

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

    What is the primary function of a non-rebreather mask?

    <p>Supplies 10-15L of oxygen to meet majority of patient's needs.</p> Signup and view all the answers

    Which oxygen delivery system is specifically designed to assist COPD patients?

    <p>Venturi mask with colored valves</p> Signup and view all the answers

    What is a key consideration when weaning a patient from oxygen therapy?

    <p>Monitor the patient's response closely during the process.</p> Signup and view all the answers

    What is the correct suctioning procedure for a patient with a tracheostomy tube?

    <p>Limit suctioning to three passes per session.</p> Signup and view all the answers

    Which of the following is NOT a likely complication of tracheal suctioning?

    <p>Normalization of oxygen saturation levels</p> Signup and view all the answers

    What is a characteristic of enteral nutrition?

    <p>Provides nutrition directly through the gastrointestinal system.</p> Signup and view all the answers

    What should be monitored prior to performing tracheal suctioning?

    <p>Respiratory rate and oxygen saturation.</p> Signup and view all the answers

    Which oxygen delivery system provides the highest humidity level?

    <p>Tracheostomy collar</p> Signup and view all the answers

    What is a common cause of clubbing in fingers?

    <p>Chronic hypoxia in cardiac or respiratory diseases</p> Signup and view all the answers

    Which of the following is NOT a principle of oxygen therapy?

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

    What is the significance of a right shift in the oxyhemoglobin curve?

    <p>Lower binding affinity of O2</p> Signup and view all the answers

    Which intervention is most effective for improving respiratory function?

    <p>Deep breathing exercises</p> Signup and view all the answers

    What characterizes Cheyne-Stokes breathing?

    <p>Cyclic pattern of increasing and decreasing breathing followed by apnea</p> Signup and view all the answers

    Which device is specifically designed to deliver aerosolized medication directly to the lungs?

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

    Which of the following symptoms is primarily indicative of upper airway obstruction?

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

    What is the purpose of using a peak flow meter?

    <p>To monitor peak expiratory flow during forced exhalation</p> Signup and view all the answers

    What is the primary indicator of respiratory distress related to breathing effort?

    <p>Increased work of breathing</p> Signup and view all the answers

    Which of the following best describes the term 'eupnea'?

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

    Which condition is primarily characterized by airway obstruction and increased resistance during expiration?

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

    What impact does a patient's upright posture have on lung function?

    <p>Promotes ease of lung expansion</p> Signup and view all the answers

    Which factor is least likely to negatively affect respiratory function?

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

    In restrictive lung diseases, what happens to total lung volume and capacity?

    <p>Both decrease</p> Signup and view all the answers

    Which symptom is specifically associated with Chronic Obstructive Pulmonary Disease (COPD)?

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

    What change occurs to the air passages in obstructive lung diseases?

    <p>Narrowing of the airways</p> Signup and view all the answers

    Which dietary options are appropriate for a full liquid diet?

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

    What is the primary characteristic of a restrictive diet?

    <p>It limits intake of specific food items.</p> Signup and view all the answers

    What procedure is necessary to confirm the placement of a nasogastric tube (NGT)?

    <p>Assessment of aspirate characteristics.</p> Signup and view all the answers

    Which of the following diets is specifically tailored for diabetic patients?

    <p>Consistent carbohydrates with low sugar</p> Signup and view all the answers

    When should tube feedings typically be held?

    <p>If residual is 1.5-2 times the feeding rate.</p> Signup and view all the answers

    What type of nasogastric tube is primarily used for suctioning?

    <p>Salem Sump</p> Signup and view all the answers

    Which characteristic of hypertonic feeding solutions can lead to complications if not monitored?

    <p>They can cause diarrhea due to osmotic effects.</p> Signup and view all the answers

    What is the appropriate patient positioning for tube feeding administration?

    <p>Minimally semi-Fowler's (30-45 degrees).</p> Signup and view all the answers

    What is the maximum residual volume that should trigger holding tube feedings?

    <p>500 cc</p> Signup and view all the answers

    Which condition is associated with fluid pulled from cells into the intravascular space?

    <p>Hypertonic solution administration</p> Signup and view all the answers

    What is a potential risk of rapidly administering hypertonic solutions?

    <p>Fluid overload</p> Signup and view all the answers

    Which IV complication is characterized by redness, warmth, and hardness at the IV site?

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

    What should be done to ensure proper function before using IV tubing?

    <p>Prime the tubing</p> Signup and view all the answers

    What is the typical purpose of a bolus in IV orders?

    <p>Delivering a large volume of fluid quickly</p> Signup and view all the answers

    Which IV fluid solution has the same osmolarity as body cells?

    <p>0.9% sodium chloride</p> Signup and view all the answers

    How should fluid overload manifest in a patient?

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

    Study Notes

    Respiratory Mechanics & Assessment

    • Normal Breathing Stimulus: Carbon dioxide (CO2) levels typically trigger breathing.
    • COPD Breathing Stimulus: In patients with Chronic Obstructive Pulmonary Disease (COPD), oxygen (O2) levels become the primary breathing trigger due to chronic CO2 retention.
    • Normal Respiration Rates:
      • Adults: 12-20 breaths per minute
      • Infants: 30-60 breaths per minute
    • Eupnea: Refers to normal breathing.
    • Bradypnea: Slow respiratory rate.
    • Inspiratory/Expiratory Ratio: A normal ratio is 1:2, indicating inspiration is shorter than expiration.
    • Body Position: Upright posture facilitates easier lung expansion.
    • Environmental Factors: Factors like pollution, allergens, and humidity can impact respiratory function.
    • Lifestyle Habits: Smoking, drug use, and alcohol consumption negatively affect respiratory function.
    • Work of Breathing (WOB): Represents the effort required to breathe; increased WOB is a key sign of respiratory distress.
    • Conditions Increasing WOB:
      • Restrictive lung movement (e.g., idiopathic pulmonary fibrosis)
      • Airway obstruction (e.g., asthma, COPD)

    Restrictive Lung Diseases

    • Characteristics: Difficulty filling the lungs with air during inhalation, leading to shortness of breath.
    • Key Features:
      • Decreased total lung volume and capacity
      • Reduced lung elasticity
      • Decreased chest wall expansion during inhalation
      • Lung stiffening (as seen in idiopathic pulmonary fibrosis)
    • Pneumonia: Accumulation of pus or fluid in the alveoli due to inflammation (consolidation).
    • Atelectasis: Partial or complete collapse of a lung or lobe.

    Obstructive Lung Diseases

    • Characteristics: Obstruction in the air passages, making exhaling difficult and increasing residual air volume.
    • Airway Changes: The diameter of the airway decreases, and resistance increases.
    • Asthma:
      • Bronchoconstriction
      • Inflammation
      • Mucus production
      • Airway obstruction
    • COPD (Chronic Obstructive Pulmonary Disease):
      • Includes chronic bronchitis and emphysema.
      • Airways become inflamed and thickened.
      • Tissue responsible for oxygen exchange is damaged.
      • Symptoms include:
        • Shortness of breath (SOB)
        • Cough with mucus
        • Fatigue
        • Frequent lung infections

    Advanced Respiratory Concepts & Interventions

    • Accessory Muscle Use: Using muscles other than the diaphragm and intercostal muscles to breathe, indicating respiratory distress.
      • Accessory muscles include:
        • Sternocleidomastoid
        • Pectoralis major
        • Trapezius
        • Intercostal muscles
        • Abdominal muscles
    • Tripod Position: Often adopted to facilitate breathing.
    • Signs & Symptoms of Altered Respiratory Function:
      • Cough
      • SOB/dyspnea
      • Sputum production
      • Bradypnea/tachypnea/Cheyne-Stokes breathing
      • Chest pain
      • Use of accessory muscles
      • Adventitious breath sounds
    • Cheyne-Stokes Breathing: Alternating periods of increased rate and depth of respirations followed by apnea (cyclic pattern)
    • Stridor: High-pitched sound heard on inspiration, indicating upper airway obstruction or edema.
    • Cyanosis: Bluish discoloration of the skin, lips, mucous membranes, or nail beds due to low oxygen levels.
    • Clubbing: Enlargement and rounding of the fingertips, associated with chronic hypoxia in cardiac or respiratory diseases.
    • Pulse Oximetry: Normal readings are 95-100%; COPD patients may have lower readings. A baseline is crucial for monitoring.
    • Oxyhemoglobin Curve:
      • Left shift: Higher binding affinity of oxygen (O2)
      • Right shift: Lower binding affinity of oxygen (O2)
    • Interventions to Improve Respiratory Function:
      • Hydration
      • Positioning (upright)
      • Ambulation
      • Deep breathing
      • Pursed-lip breathing
      • Stacked/huff cough
      • Incentive spirometry
    • Peak flow meter: Measures peak expiratory volume with forced exhalation. Used before and after treatment.
    • Spacer: Ensures the patient receives all medication from an inhaler.
    • Acapella: Uses positive expiratory pressure to force air behind sputum, moving it forward.
    • Nebulizer treatment: Delivers aerosolized medication directly to the lungs.
    • Metered dose inhaler: Measures delivery of respiratory medication to the lungs.

    Oxygen Therapy

    • Three Principles:
      • Lowest concentration
      • Shortest duration
      • Continuous monitoring of ABGs (Arterial Blood Gases) and O2 saturation

    Oxygen Delivery Systems

    • Low-flow systems: Do not meet all the patient's ventilatory demands and mix with room air.
      • Nasal cannula (1-6 L = 24-60%)
      • Simple face mask (5-10 L = 40-60%)
      • Partial rebreather mask (10-15 L = 30-60%)
      • Non-rebreather mask (10-15 L = 60-90%)

    Diet

    • Full Liquid Diet: Includes tea, soda, Jell-O, broth, ice cream, sherbet, anything that becomes liquid at room temperature.
    • Soft Diet: Includes pureed foods, foods not requiring chewing (e.g., soft pasta, pudding, applesauce, yogurt, eggs). Suitable for patients with poor dentition or difficulty swallowing.
    • "As Tolerated" Diet: Determined by the patient's individual tolerance.
    • Restrictive Diets: Limit certain food items. Examples include:
      • Cardiac Diet: Low sodium, low fat
      • Diabetic Diet: Low sugar, consistent carbohydrates (e.g., 60 grams/meal)
      • Obese Patient Diet: Restricted calories
      • Renal Diet: Low protein, low sodium, low potassium, fluid restriction

    Nasogastric (NG) Tube

    • Definition: A tube inserted through the nose into the stomach.
    • Uses: Gastric decompression, gastric lavage, and gastric feeding.
    • Confirmation: Placement must be confirmed by X-ray and a "ready to use" order. Auscultation with air insertion is no longer used to check placement.
    • NGT Confirmation (Post-X-Ray): Assess aspirate characteristics, observe for respiratory distress, and confirm exit site markings.
    • NGT Insertion: Can be performed by a provider, nurse, or nursing student.
    • Checking Residual: Use a syringe to withdraw gastric contents to determine if the patient is absorbing the tube feeding. Return any residual to the stomach.
    • Salem Sump: An NGT used for suctioning. The pigtail is an air filter preventing the tube from adhering to the stomach mucosa. Short-term use.
    • Levine Tube: An NGT used for tube feeding.
    • Percutaneous Endoscopic Gastrostomy (PEG) Tube: A surgically placed tube for long-term tube feeding, accessed through the abdomen.
    • Gastrojejunostomy Tube: Similar to a PEG tube but has three lumens (compared to PEG's two), allowing for tube feeding through the jejunal port while connecting the gastric port to suction. Long-term use.

    Tube Feeding

    • Kangaroo (Patrol) Pump: Controls the amount and rate of tube feed administration. Use only 8 hours' worth of tube feed in a bag with this pump.
    • Medication in Tube Feeding Bags: Never add medication to a tube feeding bag.
    • Tube Feed Bag Changes: Every 24 hours
    • Patient Positioning (Tube Feeding): Minimally semi-Fowler's (30-45 degrees)
    • Holding Tube Feedings: Hold if residual is 1.5-2 times the rate.
    • Hypertonic Feeding Solutions: Can cause diarrhea due to osmotic gradient drawing fluid from the body into the GI tract. Adjust feeding as needed.
    • Stopcock (Lopez Valve): Allows access to NGT/PEG/GJ tubes without disconnecting the system.
    • Bolus Tube Feeding: A specific amount of tube feed administered at once, rather than continuously via a pump. Hold if residual is 250-500 cc.

    Parenteral Nutrition

    • Definition: Intravenous delivery of fluids.
    • Examples of Parenteral Fluids: IV fluids, electrolytes, nutrition, medication, blood products.
    • Isotonic Solutions: Same osmolarity as cells (e.g., 0.9% sodium chloride, Lactated Ringer's). Used for hypovolemia.
    • Hypotonic Solutions:
      • Lower osmolarity than cells (e.g., 0.45% sodium chloride).
      • Fluid shifts into cells; use cautiously to prevent fluid depletion and cardiovascular collapse.
    • Hypertonic Solutions:
      • Higher osmolarity than cells (e.g., 3%, 5% sodium chloride).
      • Requires strict monitoring in ICU due to risks of circulatory overload, hypertension, and pulmonary/cerebral edema.
      • Fluid is pulled from cells into the intravascular space.
    • Angiocath: Device used for venous access (peripheral IV).
    • IV Tubing Preparation: Prime the tubing before use to remove air.
    • Gravity Infusion Rate: Fill the drip chamber halfway; count drips for one minute (or 30 seconds x 2) to determine the drip rate.
    • IV Complications:
      • Infiltration: IV fluid leaks into surrounding tissue; may present with pain, burning, soft swelling. Apply heat or cold, elevate extremity.
      • Phlebitis: Inflammation of a vein; causes redness, warmth, and hardness at the IV site. May be caused by catheter size, infusion duration, irritating fluids, or poor vein selection. Can lead to thrombophlebitis (blood clot formation).
      • Infection: Redness, pain, warmth, pus at the IV site.
      • Fluid Overload: Too much fluid infused or infused too quickly; symptoms include hypertension, edema, dyspnea, and heart issues.
      • Air Embolism: Air entering the cardiovascular system, often due to insufficiently primed IV tubing or during central line placement.
    • IV Orders:
      • Maintenance Fluid: Fluid administered at a prescribed rate to maintain homeostatic fluid status.
      • Bolus: A large amount of fluid given in a short time (sometimes called a fluid challenge).
      • KVO (Keep Vein Open): 10-20 cc per hour, preventing IV clotting.
    • Banana Bag/Osler Bag: Yellow in color; contains vitamins and minerals in an isotonic solution.
    • Infusion Pump: Regulates IV fluid infusion.
      • Pump Occlusion (Fluid Side): Problem above the pump.
      • Pump Occlusion (Patient Side): Problem below the pump.
    • Piggyback Tubing (Secondary Tubing): Connects a secondary fluid bag to the primary line.
    • IV Push: Administering medication directly into a PIV or primary line via a syringe. Always flush with normal saline before and after an IV push.
    • IV Push Chart Importance: Details how much of what medication can be pushed, if dilution is needed, and possible adverse effects.
    • Triple Lumen Central Line: A short-term central line allowing infusion of three incompatible fluids simultaneously.
    • External Jugular IV: A peripheral line, not a central line.
    • Hickman and Groshong Catheters: Long-term tunneled central catheters; Groshong does not require heparin flushes to keep the line patent.
    • Central Line Placement Confirmation: X-ray
    • Dacron Sheath: A cuff anchoring the central line and acting as a barrier against microorganisms.
    • PICC (Peripherally Inserted Central Catheter): A long-term central catheter inserted into the arm and threaded into the superior vena cava. A specially trained nurse can place this bedside, and placement is verified by X-ray.
    • TPN/CPN (Total Parenteral Nutrition/Complete Parenteral Nutrition): Contains >10% dextrose and/or >5% protein. Infused through a central line. Complications include infection, fluid overload, and hyperglycemia. Use D10W if TPN/CPN needs to be stopped abruptly. Patients receive finger sticks to monitor for hyperglycemia.
    • PPN (Peripheral Parenteral Nutrition/Partial Parenteral Nutrition): Contains <10% dextrose and <5% protein. Can be infused through a PIV.

    Respiratory Mechanics & Assessment

    • Carbon dioxide levels are the usual trigger for breathing.
    • In patients with Chronic Obstructive Pulmonary Disease (COPD), oxygen levels become the main trigger due to the body's inability to eliminate carbon dioxide.
    • Normal breathing rate for adults is 12-20 breaths per minute.
    • Normal breathing rate for infants is 30-60 breaths per minute.
    • Eupnea refers to normal breathing.
    • Bradypnea refers to slow breathing.
    • A normal inspiration/expiration ratio is 1:2, with inspiration shorter than expiration.
    • Upright posture facilitates lung expansion.
    • Pollution, allergens, and humidity can affect respiration.
    • Smoking, drug use, and alcohol negatively impact respiratory function.
    • The work of breathing (WOB) is the effort needed to breathe.
    • Increased WOB is a key indicator of respiratory distress.
    • Conditions increasing WOB include restrictive lung movement (e.g., idiopathic pulmonary fibrosis) and airway obstruction (e.g., asthma, COPD).

    Restrictive Lung Diseases

    • These diseases make inhaling difficult due to decreased lung capacity.
    • Restrictive lung diseases are characterized by:
      • decreased total lung volume and capacity,
      • decreased elasticity of the lungs,
      • decreased chest wall expansion during inhalation,
      • stiffening of the lungs, as seen in idiopathic pulmonary fibrosis.
    • Pneumonia is an inflammation of the alveoli caused by pus or fluid accumulation.
    • Atelectasis is a partial or complete collapse of a lung or lung lobe.

    Obstructive Lung Diseases

    • These diseases make exhaling difficult due to airway obstruction, increasing residual air volume.
    • Obstructive lung diseases are characterized by:
      • decreasing airway diameter,
      • increasing airway resistance.
    • Asthma is characterized by:
      • bronchoconstriction.
      • inflammation.
      • mucus production.
      • airway obstruction.
    • Chronic Obstructive Pulmonary Disease (COPD) is characterized by:
      • chronic bronchitis and emphysema.
      • inflamed and thickened airways.
      • damaged lung tissue responsible for oxygen exchange.
    • COPD symptoms include:
      • shortness of breath,
      • cough with mucus,
      • fatigue,
      • frequent lung infections.

    Advanced Respiratory Concepts & Interventions

    • Accessory muscle use is a sign of respiratory distress, where the body uses muscles beyond the diaphragm and intercostal muscles to breathe.
    • These muscles include:
      • the sternocleidomastoid,
      • the pectoralis major,
      • the trapezius,
      • the intercostal muscles,
      • the abdominal muscles.
    • The tripod position is often adopted to facilitate breathing.
    • Signs and symptoms of altered respiratory function include:
      • cough,
      • shortness of breath (SOB) or dyspnea,
      • sputum production,
      • bradypnea, tachypnea, or Cheyne-Stokes breathing,
      • chest pain,
      • use of accessory muscles,
      • adventitious breath sounds.
    • Cheyne-Stokes breathing is a cyclic breathing pattern alternating periods of increased rate and depth of respirations followed by apnea.
    • Stridor is a high-pitched sound heard during inspiration, indicating upper airway obstruction or edema.
    • Cyanosis is a bluish discoloration of the skin, lips, mucous membranes, or nail beds due to low oxygen levels.
    • Clubbing is enlargement and rounding of the fingertips, associated with chronic hypoxia in cardiac or respiratory diseases.
    • Normal pulse oximetry readings are 95-100%, but COPD patients may have lower readings.
    • It is crucial to establish a baseline for pulse oximetry monitoring.
    • The oxyhemoglobin curve describes the relationship between oxygen saturation and partial pressure of oxygen.
      • A left shift indicates higher binding affinity of oxygen (LOVING).
      • A right shift indicates a lesser binding affinity of oxygen.
    • Interventions to improve respiratory function include:
      • hydration,
      • positioning (upright),
      • ambulation,
      • deep breathing,
      • pursed-lip breathing,
      • stacked/huff cough,
      • incentive spirometry.
    • A peak flow meter measures the peak expiratory volume with forced exhalation, used before and after therapy.
    • A spacer ensures the patient receives all medication from an inhaler.
    • An Acapella device uses positive expiratory pressure to force air behind sputum, helping to move it forward.
    • Nebulizer treatment delivers aerosolized medication directly to the lungs.
    • A metered-dose inhaler measures the delivery of respiratory medication to the lungs.
    • Oxygen therapy follows three principles:
      • lowest concentration,
      • shortest duration,
      • continuous monitoring of ABGs and O2 saturation.
    • Oxygen delivery systems can be low-flow or high-flow:
      • Low-flow systems mix with room air and do not meet all the patient's ventilatory demands:
        • Nasal cannula (1-6L = 24-60%)
        • Simple face mask (5-10L = 40-60%)
        • Partial rebreather mask (10-15L = 30-60%)
        • Non-rebreather mask (10-15L = 55-90%)
      • High-flow systems provide a precise FiO2 and meet all the patient's ventilatory demands:
        • High-flow nasal cannula (60l/min), increases flow of oxygen air.
        • Venturi mask (colored valves 24-60%), meets demands of COPD patients.
        • Tracheostomy collar (28-98%), high humidity.
        • Oxygen hood/tent (greater than 60%), high humidity.

    Clinical Scenarios & Case Studies

    • During the assessment of patients:
      • Identify key signs and symptoms,
      • monitor respiratory rate,
      • measure oxygen saturation levels,
      • consider other relevant data.
    • Choose the appropriate low-flow or high-flow oxygen delivery system based on the patient's condition.
    • Weaning from oxygen should be gradual and closely monitored for patient response.
    • Tracheal suctioning aims to remove secretions and maintain a patent airway.

    Tracheal Suctioning

    • The purpose of tracheal suctioning is to remove secretions through a tracheostomy tube or other airway access device.
    • Assess the need for suctioning by:
      • listening for adventitious breath sounds,
      • monitoring oxygen saturation and respiratory rate,
      • assessing for signs of respiratory distress.
    • The tracheal suctioning procedure includes:
      • Suctioning only when withdrawing the catheter.
      • Suctioning to the end of the tracheostomy tube, max 1 cm below.
      • Using intermittent suction.
      • Rotating the catheter.
      • Limiting suctioning to 10-15 seconds.
      • Hyperoxygenating the patient before and between suction passes.
      • Limiting suction passes to 3 per session.
      • Monitoring for complications.
    • Complications of tracheal suctioning include:
      • edema,
      • obstruction,
      • hypoxia/bronchospasms,
      • expulsion of the tracheostomy tube,
      • infection,
      • hemorrhage,
      • skin breakdown.

    Enteral Nutrition

    • Enteral nutrition refers to feeding through the gastrointestinal system.
    • "NPO" stands for "nil per os" and indicates nothing by mouth.
    • Clear liquid diet includes tea, soda, light-colored Jell-O, and clear broth.
    • Full liquid diet includes tea, soda, Jell-O, broth, ice cream, sherbet, and anything that becomes liquid at room temperature.
    • Soft diet consists of pureed foods and foods not requiring chewing, suitable for patients with poor dentition or difficulty swallowing.
    • "As tolerated" diet is determined by the patient's individual tolerance.
    • Restrictive diets limit certain food items, such as:
      • Cardiac diet: low sodium, low fat.
      • Diabetic diet: low sugar, consistent carbohydrates.
      • Obese patient diet: restricted calories.
      • Renal diet: low protein, low sodium, low potassium, and fluid restriction.
    • A nasogastric tube (NGT) is inserted through the nose into the stomach.
    • Uses for NGT include gastric decompression, gastric lavage, and gastric feeding.
    • NGT placement must be confirmed by an X-ray and a "ready to use" order.
    • Auscultation with air insertion is no longer used to check NGT placement.
    • Post-X-ray confirmation of NGT placement involves assessing aspirate characteristics, observing for respiratory distress, and confirming exit site markings.
    • NGT insertion can be performed by a provider, nurse, or nursing student.
    • Checking residual involves withdrawing gastric contents using a syringe to determine absorption of tube feedings. Return any residual to the stomach.
    • A Salem Sump is an NGT used for suctioning. The pigtail functions as an air filter, preventing the tube from adhering to the stomach mucosa. It is used short-term.
    • A Levine tube is an NGT used for tube feedings.
    • A percutaneous endoscopic gastrostomy (PEG) tube is surgically placed for long-term tube feedings, accessed through the abdomen.
    • A gastrojejunostomy tube (GJ) is similar to a PEG tube but has three lumens, allowing for tube feeding through the jejunal port while connecting the gastric port to suction. It is used long-term.
    • A Kangaroo (Patrol) pump controls the amount and rate of tube feeding administration. Only an 8-hour supply of tube feed should be placed in the bag with this pump.
    • Never add medication to a tube feeding bag.
    • Change tube feed bags every 24 hours.
    • For tube feeding, a minimally semi-Fowler's positioning (30-45 degrees) is recommended.
    • Hold tube feedings if residual is 1.5-2 times the rate.
    • Hypertonic feeding solutions can cause diarrhea due to osmotic gradient drawing fluid from the body into the GI tract. Adjust feeding as needed.
    • Stopcock (Lopez Valve) allows access to NGT/PEG/GJ tubes without disconnecting the system.
    • Bolus tube feeding is a specific amount of tube feed administered at once, rather than continuously via a pump.
    • Hold bolus feeding if residual is 250-500 cc.

    Parenteral Nutrition

    • Parenteral nutrition refers to intravenous delivery of fluids including:
      • IV fluids,
      • electrolytes,
      • nutrition,
      • medication,
      • blood products.
    • Isotonic solutions have the same osmolarity as cells, used for hypovolemia.
    • Hypotonic solutions have a lower osmolarity than cells, used cautiously to prevent fluid depletion and cardiovascular collapse.
    • Hypertonic solutions have a higher osmolarity than cells, requiring strict monitoring in ICU due to risks of circulatory overload, hypertension, and pulmonary/cerebral edema.
    • An angiocath is a device used for venous access (peripheral IV).
    • Prime IV tubing before use to remove air.
    • For gravity infusion rate, fill the drip chamber halfway and count drops per minute to determine the drip rate.
    • Potential IV complications include:
      • Infiltration: IV fluid leaks into surrounding tissue.
      • Phlebitis: inflammation of a vein.
      • Infection.
      • Fluid overload.
      • Air embolism.
    • IV orders can include:
      • Maintenance fluid: fluid administered at a prescribed rate.
      • Bolus: a large amount of fluid given in a short time.
      • KVO (Keep Vein Open): 10-20 cc per hour, preventing IV clotting.

    Respiratory Mechanics & Assessment

    • Normal Respiration Rates:
      • Adults: 12-20 breaths/minute
      • Infants: 30-60 breaths/minute
    • Eupnea: Normal breathing.
    • Bradypnea: Slow respiratory rate.
    • Inspiratory/Expiratory Ratio:
      • A 1:2 ratio (inspiration shorter than expiration) is normal.
    • Work of Breathing (WOB):
      • The effort required to breathe.
      • Increased WOB indicates respiratory distress.
    • Conditions Increasing WOB:
      • Restrictive lung movement (e.g., idiopathic pulmonary fibrosis)
      • Airway obstruction (e.g., asthma, COPD)

    Restrictive Lung Diseases

    • Characteristics: Difficulty filling the lungs with air during inhalation, leading to shortness of breath.
    • Key Features:
      • Decreased total lung volume and capacity
      • Decreased elasticity of the lungs
      • Decreased chest wall expansion during inhalation
      • Stiffening of the lungs (as seen in idiopathic pulmonary fibrosis).
    • Pneumonia: Accumulation of pus or fluid in the alveoli due to inflammation (consolidation).
    • Atelectasis: Partial or complete collapse of a lung or lobe.

    Obstructive Lung Diseases

    • Characteristics: Obstruction in the air passages, making exhaling difficult and increasing residual air volume.
    • Asthma:
      • Bronchoconstriction
      • Inflammation
      • Mucus production
      • Airway obstruction
    • COPD (Chronic Obstructive Pulmonary Disease):
      • Chronic bronchitis and emphysema
      • Airways become inflamed and thickened
      • Tissue where oxygen exchange occurs is damaged
      • Symptoms:
        • Shortness of breath (SOB)
        • Cough with mucus
        • Fatigue
        • Frequent lung infections

    Advanced Respiratory Concepts & Interventions

    • Accessory Muscle Use: Using muscles other than the diaphragm and intercostal muscles to breathe, indicating respiratory distress.
      • Accessory muscles include:
        • Sternocleidomastoid
        • Pectoralis major
        • Trapezius
        • Intercostal muscles
        • Abdominal muscles.
    • Tripod Position: Often adopted to facilitate breathing
    • Signs & Symptoms of Altered Respiratory Function:
      • Cough
      • SOB/dyspnea
      • Sputum production
      • Bradypnea/tachypnea/Cheyne-Stokes breathing
      • Chest pain
      • Use of accessory muscles
      • Adventitious breath sounds
    • Cheyne-Stokes Breathing: Alternating periods of increased rate and depth of respirations followed by apnea (cyclic pattern)
    • Stridor: High-pitched sound heard on inspiration, indicating upper airway obstruction or edema.
    • Cyanosis: Bluish discoloration of the skin, lips, mucous membranes, or nail beds due to low oxygen levels.
    • Clubbing: Enlargement and rounding of the fingertips, associated with chronic hypoxia in cardiac or respiratory diseases.
    • Pulse Oximetry: Normal readings are 95-100%, but COPD patients may have lower readings.
    • Oxyhemoglobin Curve:
      • Left shift - LOVING, higher binding affinity of O2
      • Right shift - lesser binding affinity of O2
    • Interventions to Improve Respiratory Function:
      • Hydration, positioning (upright), ambulation, deep breathing, pursed-lip breathing, stacked/huff cough, incentive spirometry.
      • Peak flow meter: measures the peak expiratory volume with forced exhalation.
        • BEFORE AND AFTER TREATMENT
      • Spacer: ensures patient receives all medication from inhaler
      • Acapella: uses positive expiratory pressure to force air behind the sputum and move it forward
      • Nebulizer treatment: delivers aerosolized medication directly to the lungs
      • Metered dose inhaler: measures delivery of respiratory medication to the lungs
    • Oxygen Therapy:
      • Three principles:
        • Lowest concentration
        • Shortest duration
        • Continuous monitoring of ABGs and O2 saturation.
    • Oxygen Delivery Systems:
      • Low-flow:
        • These systems do not meet all the patient's ventilatory demands and mix with room air.
        • 1.Nasal cannula (1-6 L = 24-60%)
        • 2.Simple face mask (5-10L = 40-60%)
        • 3.Partial rebreather mask (10-15L = 30-60%)
        • 4.Non-rebreather mask (10-15L = 55-90%)
      • High-flow:
        • These systems provide a precise FiO2 and meet all the patient's ventilatory demands.
        • 1.High-flow nasal cannula (60l/min)
          • Increases flow of O2, premixed air, heated and humitified
        • 2.Venturi mask colored valves (24-60%)
          • Meets demands of COPD patients
          • Requires humidification, precise and accurate
        • 3.Tracheostomy collar (28-98%)
          • High humidity
        • 4.Oxygen hood/tent (GREATER THAN 60%)
          • High humidity

    Clinical Scenarios & Case Studies

    • Patient Assessment:
      • Identify the key signs and symptoms, respiratory rates, oxygen saturation levels, and other relevant data.
    • Oxygen Delivery System Selection:
      • Choose the appropriate low-flow or high-flow oxygen delivery system based on the patient's condition and needs.
    • Weaning from Oxygen:
      • The process should be incremental, with close monitoring of the patient's response.
    • Tracheal Suctioning:
      • This procedure aims to clear secretions and maintain a patent airway.

    Tracheal Suctioning

    • Purpose: Remove secretions through a tracheostomy tube or other airway access device.
    • Assessment for Need:
      • Listen for adventitious breath sounds (like gurgling or wheezing)
      • Monitor oxygen saturation and respiratory rate
      • Assess for signs of respiratory distress such as increased work of breathing, retractions, or cyanosis
    • Procedure:
      • Suction only on the way out of the airway
      • Suction to the end of the tracheostomy tube, maximum 1 cm below
      • Use intermittent suction
      • Rotate the catheter
      • Do not suction longer than 10-15 seconds
      • Hyperoxygenate the patient before and between passes
      • Limit to 3 passes per session
      • Monitor for complications
    • Complications: Edema, obstruction, hypoxia/bronchospasms, expulsion of the tracheostomy tube, infection, hemorrhage, and skin breakdown.

    Enteral Nutrition

    • Enteral Nutrition Definition: Nutrition delivered through the GI system.
    • NPO Diet: Nothing by mouth (Nil per os).
    • Clear Liquid Diet: Tea, soda, light-colored Jell-O, clear broth.
    • Full Liquid Diet: Tea, soda, Jell-O, broth, ice cream, sherbet, anything that becomes liquid at room temperature.
    • Soft Diet: Pureed foods, foods not requiring chewing (e.g., soft pasta, pudding, applesauce, yogurt, eggs). Suitable for patients with poor dentition or difficulty swallowing.
    • "As Tolerated" Diet: Determined by the patient's individual tolerance.
    • Restrictive Diets: Limit certain food items. Examples include:
      • Cardiac Diet: Low sodium, low fat.
      • Diabetic Diet: Low sugar, consistent carbohydrates (e.g., 60 grams/meal).
      • Obese Patient Diet: Restricted calories.
      • Renal Diet: Low protein, low sodium, low potassium, fluid restriction.
    • Nasogastric Tube (NGT): A tube inserted through the nose into the stomach.
      • Uses include gastric decompression, gastric lavage, and gastric feeding.
      • Placement must be confirmed by X-ray and a "ready to use" order.
      • Auscultation with air insertion is no longer used to check placement.
    • NGT Confirmation (Post-X-Ray): Assess aspirate characteristics, observe for respiratory distress, and confirm exit site markings.
    • NGT Insertion: Can be performed by a provider, nurse, or nursing student.
    • Checking Residual: Use a syringe to withdraw gastric contents to determine if the patient is absorbing the tube feeding. Return any residual to the stomach.
    • Salem Sump:
      • An NGT used for suctioning.
      • The pigtail is an air filter preventing the tube from adhering to the stomach mucosa.
      • Short-term use.
    • Levine Tube:
      • An NGT used for tube feeding.
    • Percutaneous Endoscopic Gastrostomy (PEG) Tube:
      • A surgically placed tube for long-term tube feeding, accessed through the abdomen.
    • Gastrojejunostomy Tube:
      • Similar to a PEG tube but has three lumens (compared to PEG's two), allowing for tube feeding through the jejunal port while connecting the gastric port to suction.
      • Long-term use.
    • Kangaroo (Patrol) Pump: Controls the amount and rate of tube feed administration. Use only 8 hours' worth of tube feed in a bag with this pump.
    • Medication in Tube Feeding Bags: Never add medication to a tube feeding bag.
    • Tube Feed Bag Changes: Every 24 hours.
    • Patient Positioning (Tube Feeding):
      • Minimally semi-Fowler's (30-45 degrees).
    • Holding Tube Feedings:
      • Hold if residual is 1.5-2 times the rate.
    • Hypertonic Feeding Solutions: Can cause diarrhea due to osmotic gradient drawing fluid from the body into the GI tract. Adjust feeding as needed.
    • Stopcock (Lopez Valve): Allows access to NGT/PEG/GJ tubes without disconnecting the system.
    • Bolus Tube Feeding:
      • A specific amount of tube feed administered at once, rather than continuously via a pump.
      • Hold if residual is 250-500 cc.

    Parenteral Nutrition

    • Parenteral Nutrition Definition: Intravenous delivery of fluids.
    • Examples of Parenteral Fluids: IV fluids, electrolytes, nutrition, medication, blood products.
    • Isotonic Solutions: Same osmolarity as cells (e.g., 0.9% sodium chloride, Lactated Ringer's). Used for hypovolemia.
    • Hypotonic Solutions:
      • Lower osmolarity than cells (e.g., 0.45% sodium chloride).
      • Fluid shifts into cells; use cautiously to prevent fluid depletion and cardiovascular collapse.
    • Hypertonic Solutions:
      • Higher osmolarity than cells (e.g., 3%, 5% sodium chloride).
      • Requires strict monitoring in ICU due to risks of circulatory overload, hypertension, and pulmonary/cerebral edema.
      • Fluid is pulled from cells into the intravascular space.
    • Angiocath: Device used for venous access (peripheral IV).
    • IV Tubing Preparation: Prime the tubing before use to remove air.
    • Gravity Infusion Rate: Fill the drip chamber halfway; count drips for one minute (or 30 seconds x 2) to determine the drip rate.
    • IV Complications:
      • Infiltration: IV fluid leaks into surrounding tissue; may present with pain, burning, soft swelling. Apply heat or cold, elevate extremity.
      • Phlebitis: Inflammation of a vein; causes redness, warmth, and hardness at the IV site. May be caused by catheter size, infusion duration, irritating fluids, or poor vein selection. Can lead to thrombophlebitis (blood clot formation).
      • Infection: Redness, pain, warmth, pus at the IV site.
      • Fluid Overload: Too much fluid infused or infused too quickly; symptoms include hypertension, edema, dyspnea, and heart issues.
      • Air Embolism: Air entering the cardiovascular system, often due to insufficiently primed IV tubing or during central line placement.
    • IV Orders:
      • Maintenance Fluid: Fluid administered at a prescribed rate to maintain homeostatic fluid status.
      • Bolus: A large amount of fluid given in a short time (sometimes called a fluid challenge).
      • KVO (Keep Vein Open): 10-20 cc per hour, preventing IV clotting.

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