Podcast
Questions and Answers
During inhalation, what physiological changes occur in the thoracic cavity and lungs?
During inhalation, what physiological changes occur in the thoracic cavity and lungs?
- The diaphragm lowers, chest volume decreases, and pressure increases, causing air to flow out of the lungs.
- The diaphragm rises, chest volume decreases, and pressure increases, causing air to flow into the lungs.
- The diaphragm remains stationary, chest volume remains constant, and pressure equalizes with the atmosphere.
- The diaphragm lowers, chest volume expands, and pressure decreases, causing air to flow into the lungs. (correct)
A patient is experiencing rapid breathing at a rate of 25 breaths per minute. Which of the following terms best describes this condition?
A patient is experiencing rapid breathing at a rate of 25 breaths per minute. Which of the following terms best describes this condition?
- Eupnea
- Tachypnea (correct)
- Bradypnea
- Apnea
What is the primary purpose of pulmonary function tests (PFTs)?
What is the primary purpose of pulmonary function tests (PFTs)?
- To visualize the structures of the lungs and detect abnormalities such as tumors or infections
- To diagnose lung diseases such as asthma and COPD by measuring airflow, lung volume, and lung capacity (correct)
- To assess the strength and endurance of the respiratory muscles
- To measure the levels of oxygen and carbon dioxide in the blood
Why is it important to exercise caution when ordering a chest X-ray for a pregnant patient?
Why is it important to exercise caution when ordering a chest X-ray for a pregnant patient?
A patient is scheduled for a bronchoscopy. What pre-procedure nursing intervention is essential to ensure patient safety?
A patient is scheduled for a bronchoscopy. What pre-procedure nursing intervention is essential to ensure patient safety?
Following a bronchoscopy, a patient exhibits a weak gag reflex. What is the priority nursing intervention?
Following a bronchoscopy, a patient exhibits a weak gag reflex. What is the priority nursing intervention?
A ventilation/perfusion (V/Q) scan is ordered for a patient suspected of having a pulmonary embolism. What does the ventilation scan specifically assess?
A ventilation/perfusion (V/Q) scan is ordered for a patient suspected of having a pulmonary embolism. What does the ventilation scan specifically assess?
Surfactant is a serous fluid that lines the alveoli in the lungs. What critical role does surfactant play in respiratory function?
Surfactant is a serous fluid that lines the alveoli in the lungs. What critical role does surfactant play in respiratory function?
A patient undergoing thoracentesis suddenly develops an uncontrollable cough and appears cyanotic. What is the MOST likely immediate complication?
A patient undergoing thoracentesis suddenly develops an uncontrollable cough and appears cyanotic. What is the MOST likely immediate complication?
When performing a thoracentesis, what is the maximum amount of fluid that should typically be drained within a 30-minute period to minimize the risk of complications?
When performing a thoracentesis, what is the maximum amount of fluid that should typically be drained within a 30-minute period to minimize the risk of complications?
An elderly patient is prescribed diphenhydramine (Benadryl) for seasonal allergies. What potential side effect is MOST important for the nurse to monitor, considering the patient's age?
An elderly patient is prescribed diphenhydramine (Benadryl) for seasonal allergies. What potential side effect is MOST important for the nurse to monitor, considering the patient's age?
What is the PRIMARY reason why over-the-counter cough and cold medications are generally NOT recommended for children under 6 years old?
What is the PRIMARY reason why over-the-counter cough and cold medications are generally NOT recommended for children under 6 years old?
Following a tonsillectomy and adenoidectomy (T & A), a child is frequently swallowing. What is the MOST appropriate nursing action?
Following a tonsillectomy and adenoidectomy (T & A), a child is frequently swallowing. What is the MOST appropriate nursing action?
A patient with sleep apnea is prescribed CPAP therapy. What physiological outcome indicates the treatment is effective?
A patient with sleep apnea is prescribed CPAP therapy. What physiological outcome indicates the treatment is effective?
An elderly patient with a history of cardiovascular disease is prescribed fexofenadine (Allegra) for seasonal allergies. Why is fexofenadine preferred over diphenhydramine (Benadryl) in this case?
An elderly patient with a history of cardiovascular disease is prescribed fexofenadine (Allegra) for seasonal allergies. Why is fexofenadine preferred over diphenhydramine (Benadryl) in this case?
A patient is diagnosed with sleep apnea. Which symptom is MOST indicative of this disorder?
A patient is diagnosed with sleep apnea. Which symptom is MOST indicative of this disorder?
A parent is seeking advice on managing their child's common cold symptoms. Which intervention should the nurse recommend?
A parent is seeking advice on managing their child's common cold symptoms. Which intervention should the nurse recommend?
What is the underlying reason children are at a higher risk for airway obstruction compared to adults?
What is the underlying reason children are at a higher risk for airway obstruction compared to adults?
A patient with epistaxis is being provided first aid. Which action should the patient avoid during this time?
A patient with epistaxis is being provided first aid. Which action should the patient avoid during this time?
A patient is diagnosed with viral rhinitis. What is the most important nursing intervention to educate the patient on?
A patient is diagnosed with viral rhinitis. What is the most important nursing intervention to educate the patient on?
A patient reports symptoms consistent with rhinitis for 15 days. What is the most appropriate nursing action?
A patient reports symptoms consistent with rhinitis for 15 days. What is the most appropriate nursing action?
Following general anesthesia, a patient is at risk for atelectasis. Which intervention is most appropriate to prevent this complication?
Following general anesthesia, a patient is at risk for atelectasis. Which intervention is most appropriate to prevent this complication?
A patient with a history of COPD is admitted with increased dyspnea. What is the priority nursing action?
A patient with a history of COPD is admitted with increased dyspnea. What is the priority nursing action?
A patient with atelectasis has thick mucus secretions. Which intervention would be most effective in mobilizing these secretions?
A patient with atelectasis has thick mucus secretions. Which intervention would be most effective in mobilizing these secretions?
What is the underlying pathophysiology of emphysema that leads to impaired gas exchange?
What is the underlying pathophysiology of emphysema that leads to impaired gas exchange?
A patient with COPD is prescribed pursed-lip breathing. What is the purpose of this technique?
A patient with COPD is prescribed pursed-lip breathing. What is the purpose of this technique?
A patient with COPD has a chronic, mucus-producing cough. What characteristic of this cough is most indicative of chronic bronchitis?
A patient with COPD has a chronic, mucus-producing cough. What characteristic of this cough is most indicative of chronic bronchitis?
What is the primary physiological reason for the 'blue bloater' appearance in patients with chronic bronchitis?
What is the primary physiological reason for the 'blue bloater' appearance in patients with chronic bronchitis?
A patient with COPD is being discharged. Which environmental factor should they be educated to avoid to prevent exacerbations?
A patient with COPD is being discharged. Which environmental factor should they be educated to avoid to prevent exacerbations?
During an assessment of a patient with advanced COPD, the nurse notes an increased anterior-posterior chest diameter. This finding is consistent with which condition?
During an assessment of a patient with advanced COPD, the nurse notes an increased anterior-posterior chest diameter. This finding is consistent with which condition?
A patient with chronic bronchitis is prescribed mucolytics. What is the primary expected outcome of this medication?
A patient with chronic bronchitis is prescribed mucolytics. What is the primary expected outcome of this medication?
What is the significance of pursed-lip breathing for patients with COPD in terms of respiratory mechanics?
What is the significance of pursed-lip breathing for patients with COPD in terms of respiratory mechanics?
A patient is being evaluated for possible COPD. Which diagnostic test would provide the most comprehensive assessment of their lung function?
A patient is being evaluated for possible COPD. Which diagnostic test would provide the most comprehensive assessment of their lung function?
A patient with advanced emphysema is likely to exhibit which of the following compensatory mechanisms to maintain relatively normal arterial blood gases?
A patient with advanced emphysema is likely to exhibit which of the following compensatory mechanisms to maintain relatively normal arterial blood gases?
A patient with chronic bronchitis is diagnosed with polycythemia. How does chronic bronchitis lead to the development of polycythemia?
A patient with chronic bronchitis is diagnosed with polycythemia. How does chronic bronchitis lead to the development of polycythemia?
Which of the following assessment findings would be most indicative of a patient with advanced emphysema?
Which of the following assessment findings would be most indicative of a patient with advanced emphysema?
What is the primary rationale for administering oxygen at a low flow rate (1-2 LPM) to patients with chronic obstructive pulmonary disease (COPD)?
What is the primary rationale for administering oxygen at a low flow rate (1-2 LPM) to patients with chronic obstructive pulmonary disease (COPD)?
A patient with a known history of asthma presents with cyanosis, decreased level of consciousness, and extreme shortness of breath. Which intervention is the highest priority?
A patient with a known history of asthma presents with cyanosis, decreased level of consciousness, and extreme shortness of breath. Which intervention is the highest priority?
The nurse is teaching a patient about managing their asthma and avoiding triggers. Which statement by the patient indicates a need for further teaching?
The nurse is teaching a patient about managing their asthma and avoiding triggers. Which statement by the patient indicates a need for further teaching?
A patient with asthma is prescribed montelukast (Singulair). What should the nurse emphasize when educating the patient about this medication?
A patient with asthma is prescribed montelukast (Singulair). What should the nurse emphasize when educating the patient about this medication?
A patient with asthma is prescribed theophylline. Which assessment finding would warrant immediate notification of the healthcare provider?
A patient with asthma is prescribed theophylline. Which assessment finding would warrant immediate notification of the healthcare provider?
A patient is prescribed albuterol (Proventil) via metered-dose inhaler. What information is most important for the nurse to include in the patient's teaching?
A patient is prescribed albuterol (Proventil) via metered-dose inhaler. What information is most important for the nurse to include in the patient's teaching?
How does emphysema contribute to an increased risk of heart failure?
How does emphysema contribute to an increased risk of heart failure?
Which assessment finding would differentiate chronic bronchitis from emphysema?
Which assessment finding would differentiate chronic bronchitis from emphysema?
A patient with longstanding COPD is admitted with complaints of headache, drowsiness, and confusion. The ABG results show a PaCO2 of 65 mm Hg. What condition is the patient most likely experiencing?
A patient with longstanding COPD is admitted with complaints of headache, drowsiness, and confusion. The ABG results show a PaCO2 of 65 mm Hg. What condition is the patient most likely experiencing?
Which of the following findings would indicate that a patient with asthma is experiencing an improvement in their condition after receiving a bronchodilator?
Which of the following findings would indicate that a patient with asthma is experiencing an improvement in their condition after receiving a bronchodilator?
A patient with known asthma and a history of anaphylaxis to peanuts is prescribed a beta-agonist inhaler. What additional instruction is most important for the nurse to provide?
A patient with known asthma and a history of anaphylaxis to peanuts is prescribed a beta-agonist inhaler. What additional instruction is most important for the nurse to provide?
What is the primary mechanism by which inhaled corticosteroids help to manage asthma symptoms?
What is the primary mechanism by which inhaled corticosteroids help to manage asthma symptoms?
A patient with a hemopneumothorax requires a chest tube. What is the primary purpose of inserting a chest tube in this scenario?
A patient with a hemopneumothorax requires a chest tube. What is the primary purpose of inserting a chest tube in this scenario?
Following chest tube insertion, a nurse observes continuous bubbling in the water seal chamber of the drainage system. What does this indicate?
Following chest tube insertion, a nurse observes continuous bubbling in the water seal chamber of the drainage system. What does this indicate?
A nurse is caring for a patient with a chest tube connected to a water-seal drainage system. Which of the following actions is most important to prevent complications?
A nurse is caring for a patient with a chest tube connected to a water-seal drainage system. Which of the following actions is most important to prevent complications?
A patient with a chest tube is being transported to radiology for a CT scan. What is the MOST appropriate action regarding the suction?
A patient with a chest tube is being transported to radiology for a CT scan. What is the MOST appropriate action regarding the suction?
A patient taking Ipratropium Bromide (Atrovent) for COPD reports experiencing a sore throat and blurred vision. Which of the following actions is most appropriate?
A patient taking Ipratropium Bromide (Atrovent) for COPD reports experiencing a sore throat and blurred vision. Which of the following actions is most appropriate?
A patient’s chest tube is accidentally dislodged from the chest drainage system. What is the nurse's immediate priority intervention?
A patient’s chest tube is accidentally dislodged from the chest drainage system. What is the nurse's immediate priority intervention?
A patient with asthma is prescribed a metered-dose inhaler (MDI) with a spacer. Which instruction regarding the use of the spacer is most accurate?
A patient with asthma is prescribed a metered-dose inhaler (MDI) with a spacer. Which instruction regarding the use of the spacer is most accurate?
Which of the following conditions would MOST likely require a large-bore chest tube for effective drainage?
Which of the following conditions would MOST likely require a large-bore chest tube for effective drainage?
A nurse notes that there is no tidaling in the water seal chamber of a patient's chest tube drainage system. What could be a potential cause for this finding?
A nurse notes that there is no tidaling in the water seal chamber of a patient's chest tube drainage system. What could be a potential cause for this finding?
Following a motor vehicle accident, a patient is diagnosed with fractured ribs 5 through 9 on the right side. The nurse should be most vigilant in assessing for potential injury to which organ?
Following a motor vehicle accident, a patient is diagnosed with fractured ribs 5 through 9 on the right side. The nurse should be most vigilant in assessing for potential injury to which organ?
A patient is suspected of having a pulmonary embolism (PE). Which of the following diagnostic tests is the most definitive for confirming this condition?
A patient is suspected of having a pulmonary embolism (PE). Which of the following diagnostic tests is the most definitive for confirming this condition?
A patient with a chest tube is being discharged home. What instructions should the nurse emphasize regarding the drainage system?
A patient with a chest tube is being discharged home. What instructions should the nurse emphasize regarding the drainage system?
A patient with a chest tube develops subcutaneous emphysema around the insertion site. What is the MOST appropriate initial nursing intervention?
A patient with a chest tube develops subcutaneous emphysema around the insertion site. What is the MOST appropriate initial nursing intervention?
A patient presents with sudden onset of sharp, pleuritic chest pain, shortness of breath, and a pleural friction rub is auscultated. Which condition is most consistent with these findings??
A patient presents with sudden onset of sharp, pleuritic chest pain, shortness of breath, and a pleural friction rub is auscultated. Which condition is most consistent with these findings??
A patient with a known history of COPD is admitted with increasing shortness of breath and is suspected of having a pulmonary embolism. Which of the following clinical manifestations would be most indicative of a pulmonary embolism rather than just an exacerbation of their COPD?
A patient with a known history of COPD is admitted with increasing shortness of breath and is suspected of having a pulmonary embolism. Which of the following clinical manifestations would be most indicative of a pulmonary embolism rather than just an exacerbation of their COPD?
The physician orders -20 cm H2O suction for a patient connected to a dry suction water seal chest drainage system. How should the nurse set up the system?
The physician orders -20 cm H2O suction for a patient connected to a dry suction water seal chest drainage system. How should the nurse set up the system?
What supplies should a nurse keep at the bedside for a patient with a chest tube?
What supplies should a nurse keep at the bedside for a patient with a chest tube?
A patient is admitted with a diagnosis of empyema. Which assessment finding is most consistent with this condition?
A patient is admitted with a diagnosis of empyema. Which assessment finding is most consistent with this condition?
A patient is diagnosed with a tension pneumothorax following a traumatic injury. Which of the following clinical findings requires the most immediate intervention?
A patient is diagnosed with a tension pneumothorax following a traumatic injury. Which of the following clinical findings requires the most immediate intervention?
A nurse is assessing a patient with a chest tube and notices a large amount of bright red drainage suddenly appearing in the collection chamber. What is the priority nursing action?
A nurse is assessing a patient with a chest tube and notices a large amount of bright red drainage suddenly appearing in the collection chamber. What is the priority nursing action?
In a water seal chest drainage system, what is the appropriate action if the collection chamber is full?
In a water seal chest drainage system, what is the appropriate action if the collection chamber is full?
A patient with a pulmonary embolism is started on anticoagulant therapy with heparin. Which laboratory value is most important for the nurse to monitor during heparin therapy?
A patient with a pulmonary embolism is started on anticoagulant therapy with heparin. Which laboratory value is most important for the nurse to monitor during heparin therapy?
A patient with a chest tube is complaining of pain at the insertion site. What should the nurse do FIRST?
A patient with a chest tube is complaining of pain at the insertion site. What should the nurse do FIRST?
A patient is being discharged on Warfarin (Coumadin) after being treated for a pulmonary embolism. Which statement by the patient indicates a need for further teaching regarding this medication?
A patient is being discharged on Warfarin (Coumadin) after being treated for a pulmonary embolism. Which statement by the patient indicates a need for further teaching regarding this medication?
What does the 'tidaling' in the water seal chamber of a chest drainage system represent?
What does the 'tidaling' in the water seal chamber of a chest drainage system represent?
A patient has a chest tube inserted due to a pneumothorax. What is the most important nursing intervention related to the chest tube?
A patient has a chest tube inserted due to a pneumothorax. What is the most important nursing intervention related to the chest tube?
A patient is being treated for pleurisy secondary to a bacterial infection. What is the primary goal of treatment?
A patient is being treated for pleurisy secondary to a bacterial infection. What is the primary goal of treatment?
A patient with a history of prolonged immobility following surgery is at high risk for developing a pulmonary embolism. Which nursing intervention is most effective in preventing this complication?
A patient with a history of prolonged immobility following surgery is at high risk for developing a pulmonary embolism. Which nursing intervention is most effective in preventing this complication?
A tall, thin, young male is admitted to the emergency department with a spontaneous pneumothorax. Which assessment finding is most consistent with this condition?
A tall, thin, young male is admitted to the emergency department with a spontaneous pneumothorax. Which assessment finding is most consistent with this condition?
A patient with multiple rib fractures is at risk for developing atelectasis. Which intervention is most important to prevent this complication?
A patient with multiple rib fractures is at risk for developing atelectasis. Which intervention is most important to prevent this complication?
During chest tube management, what action should a nurse take when encountering continuous bubbling in the water seal chamber?
During chest tube management, what action should a nurse take when encountering continuous bubbling in the water seal chamber?
A nurse is caring for a patient with a chest tube. Which of the following findings indicates that the connection to the pleural space is effective?
A nurse is caring for a patient with a chest tube. Which of the following findings indicates that the connection to the pleural space is effective?
Under what circumstances is it appropriate for a nurse to clamp a patient's chest tube?
Under what circumstances is it appropriate for a nurse to clamp a patient's chest tube?
What is the MOST important IMMEDIATE nursing action if a patient's chest tube is accidentally dislodged from the chest?
What is the MOST important IMMEDIATE nursing action if a patient's chest tube is accidentally dislodged from the chest?
During tracheostomy care, which action is MOST critical for a nurse to perform to ensure patient safety after accidental decannulation?
During tracheostomy care, which action is MOST critical for a nurse to perform to ensure patient safety after accidental decannulation?
What is the MOST important reason for maintaining aseptic technique during tracheostomy suctioning?
What is the MOST important reason for maintaining aseptic technique during tracheostomy suctioning?
A patient with a new tracheostomy is experiencing frequent, small amounts of bloody drainage from the site. What is the appropriate nursing intervention?
A patient with a new tracheostomy is experiencing frequent, small amounts of bloody drainage from the site. What is the appropriate nursing intervention?
What is the primary reason for encouraging adequate humidification and fluid intake in a patient with a tracheostomy?
What is the primary reason for encouraging adequate humidification and fluid intake in a patient with a tracheostomy?
For a patient with a cuffed tracheostomy tube, what is the primary purpose of the cuff?
For a patient with a cuffed tracheostomy tube, what is the primary purpose of the cuff?
A nurse is teaching a family about preventing the spread of Pertussis. What crucial information should be included?
A nurse is teaching a family about preventing the spread of Pertussis. What crucial information should be included?
You are caring for an elderly patient with a tracheostomy. Which age-related physiological change MOST increases this patient's risk for respiratory complications
You are caring for an elderly patient with a tracheostomy. Which age-related physiological change MOST increases this patient's risk for respiratory complications
When communicating with a patient who has a new tracheostomy and is unable to speak, which intervention is LEAST helpful:
When communicating with a patient who has a new tracheostomy and is unable to speak, which intervention is LEAST helpful:
Which of the following interventions is MOST important when caring for a patient at risk for ineffective airway clearance related to increased respiratory secretions?
Which of the following interventions is MOST important when caring for a patient at risk for ineffective airway clearance related to increased respiratory secretions?
What would be a sign of a Tension Pneumothorax in a patient with a chest tube that requires immediate action?
What would be a sign of a Tension Pneumothorax in a patient with a chest tube that requires immediate action?
What is the rationale behind the recommendation to avoid stripping or milking chest tubes?
What is the rationale behind the recommendation to avoid stripping or milking chest tubes?
Flashcards
Respiration
Respiration
The exchange of oxygen from the environment for carbon dioxide from the cells.
Inspiration (Inhalation)
Inspiration (Inhalation)
The act of breathing in.
Expiration (Exhalation)
Expiration (Exhalation)
The act of breathing out.
Alveoli
Alveoli
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Compliance (Lung)
Compliance (Lung)
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Surfactant (Lungs)
Surfactant (Lungs)
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Tachypnea
Tachypnea
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Peak Expiratory Flow Rate (PEFR)
Peak Expiratory Flow Rate (PEFR)
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Fluid Drainage Limit
Fluid Drainage Limit
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Adverse Reaction Post Drainage
Adverse Reaction Post Drainage
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Child Airway Differences
Child Airway Differences
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Elderly Respiratory Changes
Elderly Respiratory Changes
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Common Cold Treatment
Common Cold Treatment
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Diphenhydramine (Benadryl)
Diphenhydramine (Benadryl)
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Fexofenadine (Allegra)
Fexofenadine (Allegra)
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Tonsillitis/Adenoiditis Symptoms
Tonsillitis/Adenoiditis Symptoms
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Post-T & A Care
Post-T & A Care
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Sleep Apnea
Sleep Apnea
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Epistaxis
Epistaxis
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Rhinitis
Rhinitis
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Pharyngitis
Pharyngitis
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Atelectasis
Atelectasis
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Pleurisy
Pleurisy
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COPD
COPD
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Chronic Bronchitis
Chronic Bronchitis
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Emphysema
Emphysema
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Hypercapnia
Hypercapnia
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Barrel Chest
Barrel Chest
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Pursed-lip breathing
Pursed-lip breathing
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Cyanosis
Cyanosis
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Peripheral edema
Peripheral edema
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Atelectasis Cause
Atelectasis Cause
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Residual Lung Volume
Residual Lung Volume
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Hypoxemic - Cyanotic
Hypoxemic - Cyanotic
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Pink Puffer
Pink Puffer
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Oxygen Therapy in COPD
Oxygen Therapy in COPD
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Asthma
Asthma
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Possible Asthma Triggers
Possible Asthma Triggers
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Asthma Symptoms
Asthma Symptoms
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Asthma Medications
Asthma Medications
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Short-Acting/ Rescue Medications
Short-Acting/ Rescue Medications
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Long-Acting/ Maintenance Asthma Meds
Long-Acting/ Maintenance Asthma Meds
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Theophylline
Theophylline
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Montelukast/ Singulair
Montelukast/ Singulair
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Adverse Reactions/Side Effects
Adverse Reactions/Side Effects
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Ipratropium Bromide (Atrovent)
Ipratropium Bromide (Atrovent)
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Metered Dose Inhaler (MDI)
Metered Dose Inhaler (MDI)
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Dry Powder Inhaler (DPI)
Dry Powder Inhaler (DPI)
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Inhaler Spacer
Inhaler Spacer
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Pulmonary Embolism (PE)
Pulmonary Embolism (PE)
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Pulmonary Embolism Manifestations
Pulmonary Embolism Manifestations
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Pulmonary Embolism Prevention
Pulmonary Embolism Prevention
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Pulmonary Embolism Treatment
Pulmonary Embolism Treatment
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Sternal/Rib Fracture Manifestations
Sternal/Rib Fracture Manifestations
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Pleurisy (Pleuritis)
Pleurisy (Pleuritis)
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Pleurisy Manifestations
Pleurisy Manifestations
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Pleural Effusion
Pleural Effusion
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Pneumothorax
Pneumothorax
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Chest Drainage
Chest Drainage
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Hemothorax
Hemothorax
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Hemopneumothorax
Hemopneumothorax
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Pyothorax/Empyema
Pyothorax/Empyema
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Chylothorax
Chylothorax
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Cardiac Tamponade
Cardiac Tamponade
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Purpose of Chest Drainage Systems
Purpose of Chest Drainage Systems
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Chest Tube Placement
Chest Tube Placement
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Collection Chamber Function
Collection Chamber Function
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Steps After Chest Tube Insertion
Steps After Chest Tube Insertion
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Tidaling
Tidaling
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Bubbling
Bubbling
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Suction
Suction
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Fluid Fluctuations Stop When?
Fluid Fluctuations Stop When?
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Care of the Patient
Care of the Patient
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Chest tube clamps
Chest tube clamps
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Tidaling in water seal chamber
Tidaling in water seal chamber
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First step for an air leak
First step for an air leak
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When to clamp chest tubes?
When to clamp chest tubes?
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Post chest tube removal dressing
Post chest tube removal dressing
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Tracheostomy Placement
Tracheostomy Placement
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Key trach item at bedside
Key trach item at bedside
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Fenestrated Trach Tubes
Fenestrated Trach Tubes
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Bleeding post "Fresh" Trach
Bleeding post "Fresh" Trach
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Trach complications
Trach complications
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Accidental Decannulation
Accidental Decannulation
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Trach Suctioning
Trach Suctioning
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Pertussis Precautions
Pertussis Precautions
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Pertussis Presentation
Pertussis Presentation
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Pertussis Treatment
Pertussis Treatment
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Study Notes
The Respiratory System
- Respiration involves the exchange of oxygen from the environment for carbon dioxide from cells.
- Inspiration refers to inhalation.
- Expiration refers to exhalation.
- The upper airway includes the nasal air passage, nasopharynx, mouth, and oropharynx.
- Alveoli are the location in the lungs where gas exchange takes place.
- Compliance is a measure of the lungs' elasticity, expandability, and ability to distend.
- Surfactant is a serous fluid lining alveoli that increases elasticity.
Diaphragm Function and Breathing Mechanics
- Normal atmospheric pressure is 760 mm Hg.
- During inhalation, the diaphragm lowers, chest volume expands, pressure lowers, and air flows into the lungs.
- During exhalation, the diaphragm rises, allowing elastic recoil of alveoli, chest volume decreases, pressure increases, and air exits the lungs.
Altered Breathing Patterns
- Tachypnea is a rapid breathing rate greater than 20 breaths per minute.
- Bradypnea is a slow breathing rate, less than a specific normal value.
- Measures such as airflow, lung volume, and lung capacity are used to diagnose lung diseases like asthma and COPD.
- Measures how much one can exhale; varies gender, age and weight.
Diagnostic Tests
- Chest X-rays use radiation to visualize the lungs; dark areas indicate air, while white spots may indicate congestion or pneumonia.
- Lung scans are nuclear scanning tests that include ventilation and perfusion scans, sometimes combined into a V/Q scan.
- Ventilation scans use radioactive tracer gas instilled into the lungs.
- Perfusion scans inject radioactive tracers into a vein to show perfusion in the lungs.
- CT scans emit high levels of radiation; MRI does not but can use contrast dyes.
- Sputum studies involve examining coughed-up specimens in a lab, ideally obtained in the morning.
- Bronchoscopy involves sedating the patient and using a scope to visualize the airways for obstructions or blockages.
- Before bronchoscopy, the patient must be NPO for 6 hours, and numbing with lidocaine can minimize gagging.
- After bronchoscopy, monitor vital signs and ensure consent is obtained.
- Thoracentesis is an invasive procedure to test fluid around the lung, draining fluid into a bag.
- During thoracentesis, no more than 1500 ml should be drained in 30 minutes to avoid mediastinal shift and lung collapse.
- Following thoracentesis, assess the dressing, monitor lung sounds, and position the patient with the puncture side up.
- Risks of thoracentesis include pneumothorax and reactions like crackles around the insertion site, asymmetrical breathing, or uncontrollable coughing.
Age-Specific Variations – Child
- Infants breathe more with their abdomen until ages 6-7 when respiratory pattern normal.
Age-Specific Variations – Elderly
- In elderly individuals, chest rigidity increases, kyphosis may occur, lung elasticity decreases, airway resistance increases, and pulmonary blood flow decreases.
- Vital capacity and tidal volume decrease in the elderly, leading to longer recovery times.
The Common Cold
- Treatment is focused on managing symptoms, such as congestion, and increasing water intake.
- OTC cough and cold medicines not recommended for kids under 6 -use humidifier sit up to help sleep.
- Chicken soup-warm opens up airway.
Medications for Respiratory Conditions
- Diphenhydramine (Benadryl): Is a first-generation H1 receptor antagonist, for seasonal allergic rhinitis, but causes drowsiness and dry mouth.
- Fexofenadine (Allegra): second-generation H2 receptor antagonist that is safer with fewer side effects like headache and nausea.
Upper Respiratory Tract Disorders
- Include tonsillitis, adenoiditis, sleep apnea, and epistaxis.
Tonsillitis & Adenoiditis
- Symptoms for tonsillitis and adenoiditis are sore throat, fever, halitosis, difficulty swallowing, and swollen glands.
- Treatment may include tonsillectomy and adenoidectomy (T & A), or antibiotics if bacterial.
- Post-T & A, monitor for hemorrhage, manage pain, and start with a liquid to soft diet.
- Educate patients post T & A to avoid acidic foods/drinks.
- Any sign of bleeding-Go to ED!!!
- Severe symptoms post-op include frequent swallowing (needs immediate action).
Sleep Apnea
- Symptoms of sleep apnea include insomnia, snoring, dry mouth/throat, morning headache, memory loss, attention deficit, depression/moody, fatigue, nocturia, impotence.
- CPAP (continuous positive airway pressure).
- Risks of sleep apnea include stroke and heart attack.
Epistaxis and Upper Respiratory Infections
- Epistaxis (nosebleeds) can be caused by dry weather, trauma, or sinus irritation.
- First aid for epistaxis involves pinching the nose and avoiding leaning back.
- Patients with epistaxis should avoid contact sports, high altitudes, and smoking.
- Rhinitis: Symptoms can persists for more than 2 weeks go to doctor;Increase fluid intake.
- Rhinosinusitis Pharyngitis: lots of fluids, humidify your air.
Lower Respiratory Tract Disorders
- Includes atelectasis, pleural conditions (pleurisy, pleural effusion, empyema), pulmonary embolism, sternal & rib fractures, pneumothorax, COPD (chronic bronchitis, emphysema), and asthma.
Atelectasis
- This can be caused by blockage of mucous
- Risk Factors: pt who have been on anesthesia, foreign objects, mucous from chronic diseases, pressure in the pleural space can press on the lungs and cause a collapse, painful breathing, shallow; tremor
- Treatment: goal is to expand lung tissue; if there’s fluid outside lung we are going to take that fluid away
Chronic Obstructive Pulmonary Disease (COPD)
- COPD: COPD is a combination of chronic bronchitis and/or emphysema, often caused by smoking or air pollution.
- Risk Factors: smoking/secondhand smoke, air pollution; cooking grease and oils without ventilation.
- Chronic Bronchitis: Symptoms include Chronic cough, fatigue, SOB, wheezing, and frequent infections.
- Emphysema: alveoli does work properly and does not let air to come in and out, hardens.
- Patients with COPD may exhibit barrel chest and clubbing of nails.
- COPD Treatment: Exercise, Smoking Cessation, bronchodilators, steroids, anti-inflammatory, antibiotics.
- COPD Treatment: Purses lip breathing; Avoiding very cold air; Avoid second-hand smoke; Increase PO fluids: 2L of fluid a day ; Encourage ambulation.
Chronic Bronchitis
- Mucus-producing cough
- Worse in AM, damp, cold weather
- Wheezing & crackles
- Peripheral edema, productive cough.
- Bluish lips and faces: Cyanosis (“blue bloater”)
- Reduced breath sounds, wheeze and crackles.
- Causes: smoking, coal mining, chronic viral/bacterial infections, exposure to industrial chemical, high air pollution environments
Emphysema
- SOB with minimal exertion
- Nicotine staining (fingernails, teeth) Muscle wasting and weight loss (skinny)
Emphysema – S/S
- SOB, Tachypnea (hyperventilation = puffing; pink puffer)
- Will have prolonged expiratory time= long expiration than inspiration= take longer to breath out bc alveoli are fibrose
- Compensation by hyperventilation
- High-protein, high calorie diet
Hypercapnia
- Increased CO2 level in blood > 45 mm Hg.
- Headache, drowsiness, increased respirations, high HR, muscle twitching occur.
- Treatment: CPAP, BiPaP if other measures fail.
Oxygen Therapy in COPD
- Administer O2 carefully and only at ordered rate
- The Respiratory Drive: hypoxia is driving force.
Asthma
- It is characterized by airway inflammation, swelling, chest tightness, SOB, and coughing.
- More severe at night
- Anxiety- panic attacks.
- Emergency Symptoms: Cyanosis, ↓LOC, Extreme SOB, Tachycardia, Anxiety, Diaphoresis, Chest pain/tightness
Asthma – Diagnostic
- Allergy testing
- ABG
- Lab tests let us know if an infection is possible and IgE- immune system
Asthma – Treatment
- Avoid triggers
- Quick-Relief Drugs; Bronchodilators
- Types of Medications: Short–acting/Rescue & Long-acting/Maintenance.
- Medication: Levalbuterol HFA; inhaled short-acting inhaler, for Relief of acute s/s.
- Medication: Albuterol, a Bronchodilator/Sympathomimetic agent; control & prevention of reversible airway obstruction caused by asthma or COPD.
Theophylline (aminophylline)
- Bronchodilator/Anti-asthmatics/Xanthine’s
- Therapeutic serum drug levels range from 5-15 mcg/mL
- CNS: seizures, anxiety, HA
Montelukast – Singulair
- Prevents asthma attacks, exercise-induced bronchoconstriction
- Leukotriene Inhibitor; Not for rescue, given for long term
Ipratropium Bromide – Atrovent.
- For maintenance therapy- for asthma and COPD
- Bronchodilator/Anticholinergic
Inhalers
MDI’s: “meter dose inhaler DPI’s: “dry powder inhaler
- Client Education: if second dose is required, wait 60 seconds until next dose
- Age appropriate education and equipment
Pulmonary Embolism (PE)
- Obstruction of pulmonary artery or one of its branches by a thrombus that originates in the venous system or in Rt side of heart
- Clinical Manifestations: Dyspnea, chest pain, anxiety, fever, tachycardia, cough, diaphoresis, hemoptysis (coughing up blood), tachypnea
- Medical Management: Goal is to lyse (dissolve) existing emboli & prevent new.
Sternal & Rib Fractures
- Clinical Manifestations: Anterior chest pain, ecchymosis, crepitus, swelling, dyspnea
- Medical Management: Most benign and treated conservatively.
Pleurisy
- Clinical Manifestations: sharp chest pain especially when deep breath, SOB, tachypnea, cyanotic.
- Treatment: treatment course (symptoms), if lots of volume in pleurisy might need to remove some fluid to allow adequate respiration
Pleural Effusion
- Clinical Manifestations: sharp pain that worsen with coughing and breathing, fever (febrile), rapid breathing, SOB.
Empyema
- Etiology: Collection of pus that abcesses
- Clinical Manifestations: sharp pain breathing; infection s/s- fever, chills, night sweats; SOB; unintentional weight loss
Pneumothorax
- Clinical Manifestations: SOB, chest pain, decreased for absent breath sounds, sponteonous lung drop- common in tall white males
- Types: tension pneumo
Tension Pneumothorax
- Etiology: air enters chest wall, but cannot exit
- Sharp pleuritic pain.
- Nursing Actions: Release chest tube clamps. Call physician and prepare for another chest tube insertion.
Chest Tubes & Drainage Systems
- Purpose of Chest Drainage Systems: Removal of air or drainage of blood or fluid from the intrapleural or mediastinal space.
- Chest tube is inserted into pleural space between parietal pleura & visceral pleura
Chest Drainage Insertion
- Drainage system must remain seal to prevent air from entering chest cavity via the tube
- 3 chambers: collection, water seal (middle), and wet suction control.
- Traditional Water Seal System: Intermittent bubbling indicates system is functioning properly.
- Atrium: Collects Drainage; Measure and Document amount, color, and time.
- 3 Chambers are combined in one container. Each has it own purpose: Collection, Water Seal, Suction
Chest Tube Insertion – Nurse’s Responsibilities
Gather supplies (chest tube, sterile gloves)
- Setting Up the System: All connections should be secured
- Chest Tube: Points to remember Tape connections (cloth tape only); Keep at bedside: 2 Kelly clamps; Keep all kinks out of chest tubing; Keep collection chamber below level of lungs.
- Water seal chamber - Bubbling: possible air leak.
Suction
Only remove chest drainage system from suction with a physician’s orde
Nursing Management
Fluid fluctuations in water seal chamber will stop when: Lung has re-expanded Tubing is obstructed Top of tubing hangs below rest of tubing Suction is not working Air Leak: Tighten all connections----. Changing Collection Device & Chest Tube Removal: provider removes and you assist, When can you clamp chest tubes?: To assess air leak; Changing Collection Device
Tracheostomy
Parts Inner Cannula
- VERY IMPORTSNT: Obturator— HAVE AT BEDSIDE
- Single Lumen, Double Lumen, Cuffed, Uncuffed, Fenestrated, Disposable
Age Related Considerations:
- Increased risk -Elderly
- Respiratory infection, Pneumonia, Dehydration
- Complications: Accidental Decannulation: INSERT OBTURATOR AND CALL FOR HELP!!!
- Assess/Monitor, Humidification/Hydration
Nursing Interventions
- Use Aseptic technique for suctioning— encourage deep breaths, or give O2
- DO NOT SUCTION MORE THAN 10 MINUTES,
- DO NOT TURN SUCTION HIGHER THAN 100-120 mmHg, NO MORE THAN 3 PASSES WITH SUCTION CATHETER!
- Tracheostomy Care: STERILE technique!.
- Discharge Teaching
Pertussis: Aka Whooping cough
Patients present with paroxysmal cough with a “whoop” sound (high-pitched noise when inhaling. Tx: erythromycin, clarithromycin or sulfamethaxasol
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Description
Explore respiratory physiology, diagnostic tests, and nursing interventions. Topics include breathing mechanics, pulmonary function tests, bronchoscopy care, and V/Q scans. Understand the importance of surfactant and precautions for chest X-rays during pregnancy.
