Tracheostomy and Respiratory Care Quiz
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Questions and Answers

What is the maximum duration for suctioning in adults during a tracheostomy procedure?

  • 30 seconds
  • 5 seconds
  • 10-15 seconds (correct)
  • 20 seconds

    • What is the primary symptom of CO2 retention due to air trapping in the alveoli?

  • Cough with blood
  • Chest Pain
  • Increased respiratory rate
  • Shortness of Breath (SOB) (correct)

    • Which of the following is NOT a recommended practice during tracheostomy suctioning?

  • Suction for more than 15 seconds in adults (correct)
  • Rotate the catheter as you suction
  • Suction intermittently or continuously while pulling out
  • Hyperoxygenate the patient before and between passes

    • Which position is commonly adopted by individuals to improve breathing by expanding the rib cage?

    <p>Tripod Position</p> Signup and view all the answers

    What is an expected symptom of Congestive Heart Failure (CHF)?

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

    Which of the following describes the breathing pattern characterized by increased rate and depth followed by a period of apnea?

    <p>Cheyne-Stokes</p> Signup and view all the answers

    Which condition is characterized by the heart suddenly stopping?

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

    What causes the characteristic retractions seen in patients with respiratory distress?

    <p>Use of accessory muscles for breathing</p> Signup and view all the answers

    What type of breath sound is characterized by popping and bubbling that cannot be cleared by coughing?

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

    Which of the following is a possible complication of tracheostomy suctioning?

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

    Which condition is indicated by clubbing of the nail beds?

    <p>Severe or chronic hypoxia</p> Signup and view all the answers

    What should be kept at the bedside for emergencies related to tracheostomy?

    <p>Extra trachs (same size and smaller), kelly clamp, trach insertion kit, suction, and ambu bag</p> Signup and view all the answers

    What is a common symptom of a myocardial infarction (MI)?

    <p>Numbness/pain in the left arm</p> Signup and view all the answers

    What significant change occurs in barrel chest due to air trapping over time?

    <p>Changes in chest diameter</p> Signup and view all the answers

    Which lifestyle factor increases the risk of cardiovascular disease?

    <p>Sedentary lifestyle</p> Signup and view all the answers

    What does pulse oximetry measure in a non-invasive manner?

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

    What is the primary effect of cardiac glycosides on heart function?

    <p>Increase cardiac contractility</p> Signup and view all the answers

    Which nursing intervention is NOT typically associated with managing hypertension?

    <p>Performing heart surgery</p> Signup and view all the answers

    In an EKG, what does the 'ST' segment represent?

    <p>Complete depolarization of ventricles</p> Signup and view all the answers

    What characterizes Ventricular Fibrillation (V-Fib)?

    <p>Rapid, disorganized depolarization with no palpable pulse</p> Signup and view all the answers

    Which medication class is used to regulate heart rate?

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

    Which lead placement mnemonic represents the right arm and left arm leads?

    <p>Clouds over Grass</p> Signup and view all the answers

    What happens during Pulseless Electrical Activity (PEA)?

    <p>Electrical activity is present, but there is no effective contraction</p> Signup and view all the answers

    What is the typical heart rate range for Normal Sinus Rhythm (NSR)?

    <p>60-100 bpm</p> Signup and view all the answers

    What is the primary purpose of percussion in chest physiotherapy?

    <p>To produce mechanical waves for secretion removal</p> Signup and view all the answers

    Which oxygen delivery system is appropriate for a patient needing to re-breathe some CO2?

    <p>Partial Rebreather Face Mask</p> Signup and view all the answers

    What must be done with oxygen delivered at more than 3LPM?

    <p>Ensure it is humidified</p> Signup and view all the answers

    What setting is indicated for a patient requiring a controlled concentration of oxygen with humidification due to COPD?

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

    Which of the following is an indication for tracheal suctioning?

    <p>Audible upper airway noise or gurgling</p> Signup and view all the answers

    What is the purpose of using positional drainage in chest physiotherapy?

    <p>To drain secretions from the lungs</p> Signup and view all the answers

    What does the term 'weaning off of O2' refer to?

    <p>Gradually reducing O2 concentration</p> Signup and view all the answers

    Which oxygen delivery system delivers the highest concentration of oxygen?

    <p>Non-Rebreather Mask</p> Signup and view all the answers

    What is a common risk associated with the placement of a central venous access device in the neck?

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

    Which enteral diet is suitable for a patient who cannot consume anything by mouth?

    <p>Clear Liquid</p> Signup and view all the answers

    What must be done before using a nasogastric tube?

    <p>Check the pH of stomach contents</p> Signup and view all the answers

    What is the main function of the Decron sheath in a Hickman central line?

    <p>Allow tissue to grow around it</p> Signup and view all the answers

    What is the recommended head-of-bed position for a patient with a nasogastric tube?

    <p>30-45 degrees</p> Signup and view all the answers

    Which type of central line is used for long-term access and is placed in the operating room?

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

    What action should be taken if a Salem Sump tube leaks?

    <p>Use a chucks pad</p> Signup and view all the answers

    Which type of enteral diet includes pureed foods and is easy to swallow?

    <p>Soft-diet</p> Signup and view all the answers

    What occurs in response to increasing levels of CO2 in the blood?

    <p>Increased depth and rate of respirations</p> Signup and view all the answers

    Which of the following factors can negatively impact airway function?

    <p>Air pollution and allergens</p> Signup and view all the answers

    What condition is characterized by the build-up of mucous and fluid in the lungs?

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

    Which of the following best describes the effects of Chronic Obstructive Pulmonary Disease (COPD)?

    <p>It causes airway obstruction and increased gas retention.</p> Signup and view all the answers

    What happens to lung function as individuals age?

    <p>Decreased ciliary action and lung elasticity</p> Signup and view all the answers

    What is the maximum flow rate for a Non-Rebreather Mask (NRB)?

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

    During which scenario would tracheal suctioning be indicated?

    <p>Presence of crackling breath sounds</p> Signup and view all the answers

    Which oxygen delivery system is recommended for patients with COPD requiring controlled humidity?

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

    What is a key characteristic of the High Flow Nasal Cannula?

    <p>Meets the entire ventilatory demand of a patient</p> Signup and view all the answers

    Which of the following is true about postural drainage?

    <p>It involves positioning to facilitate drainage from specific lung areas.</p> Signup and view all the answers

    What should be done before applying any oxygen delivery device that uses more than 3 LPM?

    <p>Humidify the oxygen to prevent dryness.</p> Signup and view all the answers

    Which type of oxygen delivery system allows for re-breathing of some exhaled CO2?

    <p>Partial Rebreather Face Mask</p> Signup and view all the answers

    Which statement best describes the weaning process off of oxygen?

    <p>It involves gradual reductions while monitoring for distress.</p> Signup and view all the answers

    What is the primary treatment for asystole?

    <p>Begin CPR immediately</p> Signup and view all the answers

    What is the function of a Holter monitor?

    <p>To record heart activity during daily activities over time</p> Signup and view all the answers

    What is a primary indication for a pacemaker?

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

    What is the best vessel to use for a coronary artery bypass graft?

    <p>Left internal mammary artery</p> Signup and view all the answers

    Which intervention should be prioritized after a patient undergoes PTCA?

    <p>Monitor peripheral pulses</p> Signup and view all the answers

    What is the purpose of a coronary artery stent?

    <p>To hold a blocked artery open</p> Signup and view all the answers

    What must be monitored closely after deploying a peripheral IV?

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

    What does a stress test primarily assess?

    <p>Heart's response to physical activity</p> Signup and view all the answers

    Which medication class is primarily used to decrease blood pressure?

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

    What is the typical heart rate range for Ventricular Tachycardia (V-Tach)?

    <p>Above 150 bpm</p> Signup and view all the answers

    Which of the following is an intervention for managing heart failure?

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

    What does the 'T' wave represent in a normal EKG strip?

    <p>Ventricular repolarization</p> Signup and view all the answers

    In EKG lead placement, which mnemonic helps identify the left arm lead?

    <p>Smoke over Fire</p> Signup and view all the answers

    What is the primary treatment for Ventricular Fibrillation (V-Fib)?

    <p>Defibrillation and CPR</p> Signup and view all the answers

    Which nursing intervention is most appropriate for managing hypertension?

    <p>Monitoring vital signs frequently</p> Signup and view all the answers

    What is the primary characteristic of premature ventricular contraction (PVC)?

    <p>One-off beat</p> Signup and view all the answers

    What is the primary purpose of a PEG (Percutaneous Endoscopic Gastrostomy) tube?

    <p>Long-term nutritional support</p> Signup and view all the answers

    Which method is used to check residual volume before administering a bolus feed?

    <p>Checking with a stopcock or Lopez valve</p> Signup and view all the answers

    Which type of tube delivers feeds directly into the intestine and bypasses the stomach?

    <p>J-Tube</p> Signup and view all the answers

    What should you do if you aspirate a residual volume of 300 cc before feeding?

    <p>Hold the feed for 1 hour and check again</p> Signup and view all the answers

    What is a key consideration when using hypertonic solutions for feeding?

    <p>They may shift fluid into the intestines and potentially cause diarrhea.</p> Signup and view all the answers

    What is the purpose of keeping the head of the bed elevated between 30-45 degrees during feeding?

    <p>To reduce the risk of aspiration and vomiting</p> Signup and view all the answers

    Which IV solution is categorized as isotonic and commonly used for fluid replacement?

    <p>Normal Saline (0.9% NaCl)</p> Signup and view all the answers

    Which of the following describes the function of a Kangaroo/Patrol Pump in enteral feeding?

    <p>It controls the feeding rate but is not used for medications.</p> Signup and view all the answers

    What is the primary consequence of airway obstruction caused by asthma?

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

    How do aging factors impact lung function in older adults?

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

    What physiological adaptation occurs in response to rising CO2 levels in the blood?

    <p>Increased respiratory rate</p> Signup and view all the answers

    Which of the following conditions is associated with a build-up of mucus and potential lung collapse?

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

    Which condition is characterized by progressive airway obstruction and resistance with limited reversibility?

    <p>Chronic Obstructive Pulmonary Disease (COPD)</p> Signup and view all the answers

    What is the primary purpose of pursed lip breathing in patients with COPD?

    <p>To help airways stay open longer</p> Signup and view all the answers

    How should fluids be administered to a patient to maximize hydration while minimizing secretions?

    <p>Clear fluids, avoiding milk and thick fluids</p> Signup and view all the answers

    What is the purpose of using incentive spirometry in patient care?

    <p>To encourage deep breathing and measure progress</p> Signup and view all the answers

    When using a peak flow meter, what is essential for obtaining accurate readings?

    <p>The patient should forcefully exhale out</p> Signup and view all the answers

    What is the expected outcome of ambulation as a nursing intervention?

    <p>Improved airway expansion</p> Signup and view all the answers

    What is a common characteristic of aerosol or nebulizer medications?

    <p>Delivers liquid droplets in air or O2 directly to lungs</p> Signup and view all the answers

    Which of the following is a benefit of using a metered dose inhaler (MDI) with a spacer?

    <p>Improves medication delivery and minimizes side effects</p> Signup and view all the answers

    What is indicated by a chest X-Ray showing fluid in the lungs?

    <p>Possible conditions such as pneumonia or atelectasis</p> Signup and view all the answers

    What is the primary function of percussion in chest physiotherapy?

    <p>To produce mechanical waves that help remove secretions</p> Signup and view all the answers

    Which oxygen delivery system allows for the highest oxygen concentration at flow rates between 10-15 LPM?

    <p>Non-Rebreather Mask</p> Signup and view all the answers

    What must be done to oxygen delivered at flow rates exceeding 3LPM?

    <p>Ensure it is humidified</p> Signup and view all the answers

    When weaning a patient off oxygen, what should be monitored closely?

    <p>SpO2, work of breathing, and respiratory rate</p> Signup and view all the answers

    In which scenario would a partial rebreather face mask be used?

    <p>For patients who are hyperventilating or anxious</p> Signup and view all the answers

    What is the purpose of postural drainage in chest physiotherapy?

    <p>To drain secretions by positioning the body appropriately</p> Signup and view all the answers

    What condition indicates the need for tracheal suctioning?

    <p>Audible upper airway noise or gurgling</p> Signup and view all the answers

    Which oxygen delivery system is specifically designed to reduce dead space and deliver heated, humidified oxygen?

    <p>High Flow Nasal Cannula</p> Signup and view all the answers

    What is the primary reason hypertonic solutions should only be administered in an ICU setting?

    <p>They require intense monitoring due to potential complications.</p> Signup and view all the answers

    Which condition is a contraindication for administering hypertonic saline?

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

    What is the primary purpose of a roller clamp in IV administration sets?

    <p>To adjust the flow rate of the IV fluid.</p> Signup and view all the answers

    What are the typical symptoms of infiltration during IV therapy?

    <p>Pain, burning, and swelling of the surrounding tissue.</p> Signup and view all the answers

    What is the recommended frequency for changing IV tubing used for continuous infusions?

    <p>Every 96 hours.</p> Signup and view all the answers

    What is the primary use of a PEG tube?

    <p>For long-term feeding directly into the stomach</p> Signup and view all the answers

    What is the purpose of a Kangaroo/Patrol Pump?

    <p>To control the rate of enteral feeding</p> Signup and view all the answers

    What is a characteristic of the G-J tube?

    <p>It has separate ports for suction and feeding</p> Signup and view all the answers

    What type of IV solution is isotonic?

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

    What should be monitored carefully when using a hypotonic IV solution?

    <p>Fluid shifts into the cells</p> Signup and view all the answers

    What is a common indication for the use of gastric lavage?

    <p>For emergency treatment of poisoning or overdose</p> Signup and view all the answers

    When administering feeds via a G/J tube, what is the recommended action if aspirated residual is found to be 300 cc?

    <p>Hold feed for 1 hour and recheck</p> Signup and view all the answers

    What is the main function of flushes for enteral feeding tubes?

    <p>To keep the tube patent or open</p> Signup and view all the answers

    What breathing pattern is characterized by alternating periods of increased respiration and apnea?

    <p>Cheyne-Stokes respiration</p> Signup and view all the answers

    What is the primary reason for clubbing of the nail beds in patients with respiratory conditions?

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

    What is a key characteristic of crackles in breath sounds?

    <p>Popping and bubbling noises</p> Signup and view all the answers

    Which symptom may indicate retractions in a patient with respiratory distress?

    <p>Use of accessory muscles for breathing</p> Signup and view all the answers

    What does the presence of hemoptysis indicate?

    <p>Presence of blood in sputum</p> Signup and view all the answers

    What is likely indicated by stridor in a patient?

    <p>Upper airway obstruction</p> Signup and view all the answers

    How is pulse oximetry used in clinical settings?

    <p>To assess blood oxygen saturation levels</p> Signup and view all the answers

    Which of the following best describes the tripod position in respiratory distress?

    <p>Leaning forward to expand the ribcage</p> Signup and view all the answers

    What occurs when the SPO2 drops below 90%?

    <p>Rapid decrease in PaO2</p> Signup and view all the answers

    Which nursing intervention is most effective for promoting lung expansion?

    <p>Encouraging deep breathing</p> Signup and view all the answers

    How does pursed lip breathing benefit patients with COPD?

    <p>Minimizes alveolar collapse</p> Signup and view all the answers

    What is the primary purpose of using incentive spirometry?

    <p>To encourage forceful inhalation</p> Signup and view all the answers

    What does a Peak Flow Meter measure?

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

    Which type of cough technique involves taking a deep breath followed by a series of coughs?

    <p>Stacked cough</p> Signup and view all the answers

    Which intervention is best suited for managing secretion drainage in patients with respiratory conditions?

    <p>Positioning the patient upright</p> Signup and view all the answers

    Which technique is most beneficial for clients with respiratory distress to enhance airway pressure?

    <p>Pursed lip breathing</p> Signup and view all the answers

    What is the primary reason hypertonic solutions like 3% or 5% sodium chloride are used only in ICU settings?

    <p>They can cause significant circulatory overload without supervision.</p> Signup and view all the answers

    Which of the following is a correct intervention when infiltration occurs during IV therapy?

    <p>Stop the infusion and remove the IV.</p> Signup and view all the answers

    In which situation is the use of hypertonic saline contraindicated?

    <p>Patients with hypernatremia.</p> Signup and view all the answers

    What is the standard infusion rate when maintaining a KVO (Keep Vein Open) status?

    <p>10-20 cc per hour.</p> Signup and view all the answers

    Which device is typically used to stop IV fluid from flowing and requires frequent cleaning?

    <p>Clave connector.</p> Signup and view all the answers

    What is the primary purpose of the Decron sheath in a Hickman central line?

    <p>To provide a plug for tissue growth</p> Signup and view all the answers

    What must be done before using a nasogastric tube?

    <p>Insert air and listen over the stomach</p> Signup and view all the answers

    Which type of enteral diet is suitable for a patient that has specific dietary restrictions, such as cardiac or diabetic issues?

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

    What is a characteristic of the Salem Sump tube?

    <p>Includes a blue pigtail for air exchange</p> Signup and view all the answers

    What is the correct head-of-bed position for a patient with a nasogastric tube in place?

    <p>Elevated at 30-45 degrees</p> Signup and view all the answers

    How is a Hickman central line typically accessed?

    <p>With surgical placement in the operating room</p> Signup and view all the answers

    What intervention should be performed to check the residual volume in a patient with a nasogastric tube?

    <p>Aspirate the contents of the tube</p> Signup and view all the answers

    Which type of central line is specifically designed for patients who require long-term venous access?

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

    What is the primary purpose of a PEG tube?

    <p>Providing long-term nutritional support</p> Signup and view all the answers

    How should a Kangaroo/Patrol pump be used regarding medication?

    <p>No medications should be delivered through it</p> Signup and view all the answers

    In what situation is a G-J tube particularly beneficial?

    <p>To decrease the risk of aspiration while feeding</p> Signup and view all the answers

    Which of the following statements about parenteral nutrition is correct?

    <p>It is indicated for patients who cannot get nutrition through their GI tract</p> Signup and view all the answers

    What is an important consideration when using hypertonic solutions for feeding?

    <p>They can cause diarrhea due to fluid shifting into the intestines</p> Signup and view all the answers

    What should be done if a residual of 250-500 cc is found during a bolus feed check?

    <p>Hold the feed for one hour and check again</p> Signup and view all the answers

    What is a common flushing recommendation for a G-J tube?

    <p>Flush with 30-50 cc according to order</p> Signup and view all the answers

    What type of IV solution is considered isotonic and commonly used to replace lost fluids?

    <p>Lactated ringers (LR)</p> Signup and view all the answers

    Study Notes

    Respiratory System

    • Air trapped in alveoli leads to difficulty rebuilding and stretching, resulting in carbon dioxide retention.
    • Symptoms of air trapping include shortness of breath, coughing with mucus production, fatigue, and frequent lung infections.
    • Barrel chest is a sign of air trapping, causing a change in chest diameter over time.
    • Tripod position, leaning forward to expand the rib cage, can help improve breathing.

    Altered Respiratory Function

    • Coughing is a response to irritation in the airways, classified as acute or chronic, and further characterized by strength and dryness/wetness.
    • Sputum production can originate from the nose, throat, or lungs, with assessments focusing on color, consistency, and amount. Hemoptysis indicates bloody mucous.
    • Dyspnea refers to shortness of breath.
    • Bradypnea is a slowed respiratory rate, typically below 12 breaths per minute.
    • Cheyne-Stokes respirations involve a cyclical pattern of increasing rate and depth of respiration followed by apnea (no breathing) lasting 15-20 seconds. This pattern is common at the end stage of illnesses.
    • Chest pain can be caused by inflammatory mediators stimulating nerve endings.
    • Adventitious breath sounds are abnormal sounds during respiration:
      • Crackles: popping or bubbling sounds that are not cleared by coughing.
      • Rhonchi: rumbling, coarse sounds, resembling snoring.
      • Wheezes: high-pitched musical noises resulting from air passing through constricted airways.
      • Stridor: a high-pitched, audible sound during inspiration, indicating an upper airway obstruction, commonly seen in infants.
    • Retractions involve using accessory muscles for breathing. This can be observed by: leaning forward to breathe, movement between ribs and at the sternum, straining in the neck or shoulders, nasal flaring, agitation, and altered level of consciousness.
    • Cyanosis, a blue or gray skin discoloration, can be central (lips and mucous membranes) or peripheral (nails, fingers, toes). It is a sign of poor oxygen saturation.
    • Clubbing, characterized by elongated, narrowed, and bulbous nail beds, is a compensatory mechanism caused by conditions that result in poor oxygenation and perfusion, such as respiratory or cardiac disease, and severe or chronic hypoxia.

    Diagnostic Procedures

    • Pulse oximetry uses an infrared sensor for non-invasive oxygen saturation measurement.
    • Chest physiotherapy involves techniques to remove secretions:
      • Percussion: clapping to produce mechanical waves.
      • Postural drainage: positioning the patient to drain secretions, for example, head down for lower lobes.
      • Vibration: loosening secretions, achieved through methods like flutter valve, Acapella, or high-frequency pulsator vest.

    Oxygen Delivery Systems

    • Aim to maintain SpO2 greater than 93% and PaO2 greater than 60 mmHg.
    • Use the lowest oxygen concentration for the shortest duration.
    • Humidify any oxygen flow greater than 3 LPM.
    • Fill the oxygen bag before placing the mask on the patient's face.
    • Low-flow systems mix oxygen with room air and do not meet the patient's inspiratory demand.
      • Nasal cannula (NC): 1-6 LPM (24-60% oxygen), comfortable and convenient.
      • Simple face mask: 5-10 LPM (40-60% oxygen), covers mouth and nose.
      • Partial rebreather face mask: 10-15 LPM (30-60% oxygen), allows the patient to re-breathe approximately 1/3 of their exhaled carbon dioxide, useful for hyperventilating, anxious patients, or those with a stab wound.
      • Non-rebreather mask (NRB): 10-15 LPM (55-90% oxygen), includes a one-way valve preventing re-breathing of carbon dioxide, used for patients experiencing hypoxia or acute respiratory distress.
    • High-flow systems deliver a pre-mixed ratio of oxygen to air, exceeding the patient's inspiratory demand.
      • High flow nasal cannula: up to 60 LPM, placed by a respiratory therapist, often used for premature infants, reduces dead space, and provides heated and humidified air.
      • Venturi mask: 24-60% oxygen, colored valves control concentration, used for patients with low oxygen requiring humidification, like those with COPD, limiting the amount of oxygen received to maintain the stimulus to breathe.
      • Tracheostomy collar: 28-98% oxygen, provides high humidity.
      • Oxygen hood: greater than 60%, delivers very high humidity.
    • Weaning off oxygen: done incrementally, reduce flow slightly, monitor the patient for distress, SpO2, work of breathing, and respiratory rate, then lower again when the patient is stable.

    Tracheal Suctioning

    • Removal of secretions through a tube inserted into a surgical opening (stoma).
    • Indications include: audible upper airway noise/gurgling, adventitious breath sounds (crackles/rhonchi), cyanosis, decreased pulse ox/PaO2, hypoxia (restlessness/anxiety), increased work of breathing (retractions, nasal flaring, tachypnea, shortness of breath).
    • Principles:
      • Suction to the end of the tracheostomy and 1 cm beyond, but never exceeding this maximum.
      • Suction only on the way out, intermittently or continuously, to avoid damaging the mucous membrane.
      • Rotate the catheter in a circular motion during suctioning.
      • Do not suction for more than 10-15 seconds in adults or 5-10 seconds in infants/children, as the airway is occluded during suctioning, preventing oxygenation.
      • Hyperoxygenate the patient before and between suctioning passes.
      • Perform no more than three suctioning passes in one session.
      • Always keep extra tracheostomy tubes (one of the same size and one smaller), a Kelly clamp, tracheostomy insertion kit, suction equipment, and an Ambu bag at the bedside.
    • Complications: edema, obstruction (secretions or foreign body), hypoxia/bronchospasm, infection, hemorrhage, skin breakdown, expulsion of the tracheostomy tube/decannulation.

    Cardiac System

    • Heart disease: affects vessels, valves, and the heart itself.
    • Cardiovascular disease: affects organs and the entire body.
    • Risk factors: age, sex, race, high cholesterol, diabetes, hypertension, family history.
    • Lifestyle factors: poor diet, sedentary lifestyle, obesity, smoking, drug use, excessive alcohol consumption, high stress/anger.

    Altered Cardiac Function

    • Congestive heart failure (CHF): insufficient pumping capacity of the heart.
      • Symptoms include shortness of breath, fatigue, weakness, lower extremity edema, weight gain, tachycardia, dysrhythmias, persistent cough/wheeze.
    • Arrhythmia: irregular heartbeat.
      • Symptoms include fluttering in the chest, tachycardia/bradycardia, chest pain, shortness of breath, dizziness, fainting.
    • Stroke: damage to the brain caused by an interruption of blood flow.
      • Symptoms include numbness, difficulty with balance, speech, and understanding, blurred vision, facial drooping, difficulty swallowing.
    • Myocardial infarction (MI): lack of blood flow to the heart.
      • Symptoms include chest pain, numbness/pain in the left arm, jaw or back pain.
    • Cardiac arrest: sudden, complete cessation of the heart's function. May occur without warning.
    • Hypertension (HTN): high blood pressure, or the force of blood against artery walls.
      • Symptoms include headache, fatigue, vision problems, chest pain, dyspnea, dysrhythmias.

    Medications

    • Cardiac glycosides: increase cardiac contractility and decrease heart rate.
    • Antihypertensives: lower blood pressure.
    • Vasopressors: increase blood pressure.
    • Antiarrhythmics: regulate heart rate.
    • Nitrates: relieve angina (chest pain).
    • Antilipids: decrease cholesterol levels.
    • Diuretics: reduce fluid volume.
    • Anticoagulants: prevent or resolve blood clots.

    EKG Lead Placement

    • Artifact: movement during an EKG recording.
    • 5-lead: Telemetry (used for continuous monitoring).
      • "Clouds over Grass" (RA - white, RL - green)
      • "Smoke over Fire" (LA - black, LL - red)
      • "Chocolate is good for the heart" (V1 - 5th ICS, right side).
    • 12-lead: includes RA, LA, RL, LL, plus 6 chest leads.
      • V1: 4th ICS, right side.
      • V2: 4th ICS, left side.
      • V3: midway between V2 and V4, not on bone.
      • V4: 5th ICS, midclavicular, left side.
      • V5: midway between V4 and V6, not on bone.
      • V6: 5th ICS, midaxillary, left side.

    Nursing Interventions

    • EKG, Telemetry monitoring.
    • Leg exercises, positioning.
    • TEDs/SCIDs (compression stockings).
    • Medications: anticoagulants, diuretics.
    • Patient assessment and education.

    Cardiac Rhythm Strips

    • Normal Sinus Rhythm (NSR): 60-100 bpm.
    • NSR bradycardia: below 60 bpm.
      • P wave: atrial depolarization.
      • QRS complex: ventricular depolarization.
      • ST segment: complete ventricular depolarization.
      • T Wave: ventricular repolarization.

    Cardiac Rhythms

    • Ventricular Tachycardia (V-Tach): rapid, coordinated heart rhythm originating from the ventricles (sawtooth pattern), fast enough to be uncountable, resulting in decreased cardiac output.
      • Treatment: cardioversion, CPR, antiarrhythmic drugs.
      • Shockable rhythm.
    • Ventricular Fibrillation (V-Fib): rapid, disorganized depolarization of the ventricles, no palpable pulse.
      • Treatment: defibrillation and CPR.
      • Shockable rhythm.
      • Long-term implantable cardioverter-defibrillator (LT ICD) may be indicated.
    • Ventricular Dysrhythmia: ectopic foci (impulses originating from locations where they shouldn't be) in the ventricular walls, leading to decreased cardiac output, ventricular rate of only 20-40 bpm, not sustainable for life.
    • Premature Ventricular Contraction (PVC): single, abnormal heart beat originating from the ventricle, not a rhythm, more frequent in bradycardia.
    • Pulseless Electrical Activity (PEA): electrical activity in the heart is present, but no contractions occur.
      • Bedside placement requires specialized nurse and confirmation by X-ray before use.

    Central Lines

    • Central Venous Access Device (CVAD): internal jugular access, confirmed by X-ray.
      • Triple lumen: short-term, multiple lumens terminating in different places for administration of non-compatible medications simultaneously, placed in the neck by a provider at the bedside.
        • Increased risk of pneumothorax or air embolism.
      • Hickman Central Line: triple lumen, long-term, placed in the operating room, terminates in the superior vena cava.
        • Tunnelled through subcutaneous tissue to the arm.
        • Decron sheath: plug for tissue to grow around the line.
      • Groshong: double lumen, rarely used, indicated for heparin allergy.
      • Mediport: long-term, placed in the operating room, terminated in the superior vena cava.
        • Self-healing, accessed through a Huber needle.

    Enteral Nutrition

    • Nutrition delivered via the GI system, including nutrition through gastric tubes.
    • Diets:
      • NPO: nothing by mouth.
      • Clear liquid: tea, soda (ginger ale), light-color Jell-O, clear broth, typically following NPO or after surgery.
      • Full liquid: clear liquid plus liquids at room temperature (e.g., ice cream, sherbet).
      • Soft diet: pureed or mechanically soft diet.
      • As tolerated: determined by the patient's ability to digest and tolerate food.
      • Restrictive: modified for conditions like cardiac or diabetic issues.

    Nasogastric Tube (NG Tube)

    • Confirmation: X-ray before use, medical order required for placement. Verification: insufflate air into the tube and listen over the stomach, aspirate pH.
    • Insertion: have the patient sip water to help advance the tube.
      • Infants with cleft lip/palate cannot suck, which can lead to heart and lung problems due to fatigue.
    • Interventions
      • Head of bed elevated 30-45 degrees at all times.
      • Check and document tube placement regularly.
      • Administer tube feeds as ordered.
      • Check residual volume (GRV) and replace it.
      • Flush the tube to maintain patency.
      • Assess tolerance (tube placement, markings on the tube, patient comfort).
    • Salem Sump: two lumens, a pigtail, short-term, suction. Should not be used for feeding.
      • Blue pigtail helps prevent suction from sticking to membranes and allows air exchange. Do not tie a knot in the pigtail, use a clamp if leakage occurs.
    • Levin: one lumen.

    Respiratory System

    • Increased CO2 levels stimulate chemoreceptors, leading to increased depth and rate of respirations to compensate.
    • Older adult considerations: decreased lung elasticity, ciliary action, and muscle strength.
    • Children/infants: increased BMR leads to increased RR and immature lungs.
    • Airway: negatively impacted by air pollution, allergens, smoking, drugs, and alcohol.
    • Increased work of breathing (WOB): restricted lung movement and airway obstruction.
      • Results in decreased lung expansion, reduced lung volume and capacity, stiffening of lungs, swelling of lung tissue, and reduced airway diameter.
      • Examples of airway obstruction: pneumonia, atelectasis, foreign body aspiration, toxins (asbestos/radiation).
    • Airway obstruction: any process that decreases the diameter of airways and increases airway resistance.
      • Asthma: symptoms include shortness of breath, bronchoconstriction, inflammation, and mucous production.
      • Pneumonia: build-up of mucous/fluid, can lead to atelectasis (collapse).
      • COPD (Chronic Obstructive Pulmonary Disease): airway obstruction, airway resistance, decreased gas exchange, and CO2 retention. Worsens over time, rarely reversible.

    Chest Physiotherapy for COPD:

    • Percussion: mechanical waves produced by clapping to remove secretions.
    • Postural drainage: positioning to drain secretions (lower lobes = head down).
    • Vibration: loosens secretions (flutter valve/acapella, high frequency pulsator vest).

    Oxygen Delivery Systems

    • Maintain: SPO2 >93%, PaO2 >60 mmHg.
    • Use: LOWEST concentration for the SHORTEST amount of time.
    • Humidify: anything higher than 3LPM.
    • Fill bag: BEFORE placing on patient's face.

    Low-flow Oxygen Delivery:

    • Mixes with room air (RA) (does NOT meet patient’s inspiratory demand).
    • Nasal Cannula (NC): 1-6LPM (24-60% O2), comfortable and convenient.
    • Simple Face Mask: 5-10 LPM (40-60% O2), covers mouth and nose.
    • Partial Rebreather Face Mask: 10-15 LPM (30-60% O2), patient needs to re-breathe 1/3 of their CO2 (hyperventilating, anxious, stab wound).
    • Non-Rebreather Mask (NRB): 10-15 LPM (55-90% O2), one-way valve prevents patient from rebreathing CO2 (hypoxia, acute respiratory distress, pure O2).

    High-flow Oxygen Delivery:

    • Entire ventilatory demand of patient is met (fixed-precise concentration of O2).
    • Pre-mixes ratio of O2 to air BEFORE delivery to patient.
    • Delivers gas at flow rates that EXCEED patient’s inspiratory demand.
    • High Flow Nasal Cannula: up to 60 LPM, placed by respiratory therapist (premie infants).
      • Reduces dead space, heated and humidified.
    • Venturi Mask: 24-60% O2, colored valves control concentration.
      • Used in patients with low O2 who need humidification, COPD (limits amount of O2 so patient does not lose stimulus to breathe).
    • Tracheostomy Collar: 28-98%, high humidity.
    • Oxygen Hood: >60%, high humidity.

    Weaning off Oxygen

    • Done incrementally by reducing slightly, monitoring patient for distress, SPO2, WOB, RR, then lowering again when stable.

    Tracheal Suctioning

    • Removal of secretions through a tube placed in surgical opening (stoma).
    • Indications: audible upper airway noise/gurgling, adventitious breath sounds (crackles/rhonchi), cyanosis, decreased pulse ox/PaO2, hypoxia (restlessness/anxiety), increased work of breathing (WOB) (retractions, nasal flaring, tachypnea, SOB).

    Hypertension (HTN):

    • Force of blood against artery walls.
    • Symptoms: headache, fatigue, vision problems, chest pain, dyspnea, dysrhythmia.

    Medications:

    • Cardiac glycosides: increase cardiac contractility, decrease HR.
    • Antihypertensives: decrease BP.
    • Vasopressors: increase BP.
    • Antiarrhythmics: regulate HR.
    • Nitrates: relieve angina (chest pain).
    • Antilipids: decrease cholesterol levels.
    • Diuretics: reduce fluid volume.
    • Anticoagulants: prevent/resolve blood clots.

    EKG Lead Placement:

    • Artifact: movement.

    5 Lead Telemetry:

    • Clouds over Grass:
      • RA (white)
      • RL (green)
    • Smoke over Fire:
      • LA (black)
      • LL (red)
    • Chocolate is good for the heart:
      • V1: 5th ICS, Right side

    12 Lead EKG:

    • + RA, LA, RL, LL.
    • V1: 4th ICS, Right side.
    • V2: 4th ICS, Left side.
    • V3: between V2/V4, not on bone.
    • V4: 5th ICS, Midclavicular, Left side.
    • V5: between V4/V6, not on bone.
    • V6: 5th ICS, Midaxillary, Left side.

    Nursing Interventions:

    • EKG, telemetry.
    • Leg exercises, positioning.
    • TEDS/SCIDS (compression stockings).
    • Medications: anticoagulants, diuretics.
    • Assessment and education.

    Cardiac Rhythm Strips:

    • Normal Sinus Rhythm (NSR): 60-100 bpm.
    • NSR Bradycardia: <60 bpm.
      • P: atrial depolarization.
      • QRS: ventricular depolarization.
      • ST: complete depolarization of ventricles.
      • T: ventricular repolarization.

    Cardiac Rhythms:

    • Ventricular Tachycardia (V-Tach): foci in ventricles take over and beat too fast to count, SHOCKABLE.
      • Treatment: cardioversion, CPR, antiarrhythmic drugs (sawtooth).
    • Ventricular Fibrillation (V-Fib): rapid, disorganized depolarization of ventricles, NO palpable pulse, SHOCKABLE.
      • Treatment: Defibrillation and CPR, long-term implantable cardioverter-defibrillator (LT ICD).
    • Ventricular Dysrhythmia: ectopic foci in walls of ventricles (impulses from places there shouldn’t be), decreased cardiac output (not able to fill before contracting again), ventricular rate is only 20-40 bpm (cannot sustain life).
    • Premature Ventricular Contraction: ONE-OFF beat, NOT a rhythm (more in bradycardia).
    • Pulseless Electrical Activity (PEA): electricity works but no contraction, if no pulse then no CO → no tissue perfusion → death.
      • Treatment: Start CPR, hope heart starts contracting.
    • Asystole: no electrical activity, immediate loss of O2 to brain/heart/tissues.
      • Treatment: CPR (hopefully get some rhythm back then shock).

    Cardiac Tests/Monitoring:

    • Duplex Ultrasound: how blood moves through arteries and veins (US + doppler).
    • Stress test: monitor and record heart activity during physical activity.
    • Echocardiogram: visualize how heart is pumping and valves work through ultrasound (detects structural abnormalities).
    • Holter Monitor: worn 1-3 days at home, records activity of heart during ADLs.
    • Angiogram/angiography: dye to look for blockage or narrowing.
    • Percutaneous transluminal coronary angioplasty (PTCA): catheter in arm/neck/groin.
      • Uses a balloon to inflate and compress blockage. Sometimes a coronary artery stent is placed to hold the vessel open.
    • Coronary artery stent: placed with balloon catheter, locks open to hold vessel open.
      • Monitor dysrhythmias and administer anticoagulants.
    • Coronary artery bypass graft (CABG): uses another vessel to bypass a damaged vessel.
      • LIMA (left internal mammary artery): best moved over, live vessel, no valves.
      • LAD (left anterior descending) artery: “widow maker”.
      • Greater saphenous vein: veins are not built to handle the pressure.

    Interventions for Cardiac Tests/Monitoring:

    • Monitor VS (watch for dysrhythmias).
    • Monitor for bleeding at insertion site.
    • Check peripheral pulses.
    • Immobilize limb for 6 hours (dye-kidney function) and maintain pressure dressing.
      • If bleeding through dressing, DO NOT remove old one, apply another on top.
    • Monitor I&O (urinate within 6 hours of procedure), administer fluids.

    Cardiac Rhythm Devices:

    • Pacemaker: augments or replaces natural pacemaker of heart.
      • Indications: bradycardia, tachycardia, damage to heart from MI, CHF.
      • DO NOT put AED pads directly over pacemaker.
    • Implantable Cardiac Defibrillator (ICD):
      • Indications: treatment of V Tach and V Fib (feels like being kicked in chest).

    Life-Sustaining Orders:

    • DNR: do not resuscitate.
    • DNI: do not intubate.
    • MOLST: medical orders for life-sustaining treatment.

    Cardiovascular Access Devices:

    • Peripheral IV (PIV): short term, placed at bedside by nurse in peripheral vein.
    • Peripherally Inserted Central Catheter (PICC): long term, typically used for abx, terminates at superior vena cava (SVC) or subclavian artery. Short term. Primarily for feeding (can be used to suction).

    Gastric Decompression:

    • Drain fluid or air from stomach via suction.

    Gastric Lavage:

    • Irrigation of the stomach (poison/overdose).

    PEG (Percutaneous Endoscopic Gastronomy):

    • Long term (many years) for bolus or continuous feeds.
      • PEG/MIC Key: enters through the abdominal wall into the stomach held in place by a balloon (PEG). (MIC key-flatter version with special piece to snap on).
        • Patient is often able to use on their own at home.

    Gastrojejunostomy (G-J) Tube and Jejunostomy (J) Tube:

    • Long-term.
    • J-tube: bypasses stomach and goes directly into intestine.
    • G-J tube: G port=suction in stomach, J-port=feeds/meds in jejunum.
      • Enters via jejunum - decreases the risk of aspiration.
    • Flush with 30-50 cc according to order. Q4H, between feeds and medications. Three ports: G-port, J-port, balloon port.

    Kangaroo/Patrol Pump:

    • Control the rate at which feeding is delivered, NO MEDS.
    • **Bag EXPIRES after 24 hours - throw remaining feed away. **
    • HOB 30-45 degrees (decrease aspiration and vomiting).
    • Flush to keep patent.
    • If you aspirated 1.2-2.5x hourly rate, hold feed for 1 hour and check again.
    • Hypertonic solutions: feeds shift fluid into the intestines and may cause diarrhea.

    Bolus Feed:

    • Gravity feed, no pump.
    • Check residual (250-500 cc = HOLD).

    Stopcock/Lopez Valve:

    • Do not have to remove feeding tube to check for residual or give meds.

    Parenteral:

    • Delivered intravenously.
    • Indications: for patients who cannot get nutrition via the GI tract.
      • Nutritional support: proteins, carbs, fats, electrolytes (K, P), vitamins, minerals.
      • Medication administration.

    IV Solutions:

    • Isotonic: normal saline (NS) (0.9% NaCl)/(0.9% sodium chloride).
      • Iso=equal, same osmolarity as blood=replacement fluid.
      • Examples: lactated ringers (LR).
      • Who? Patients bleeding, vomiting, diarrhea Replace lost fluid.
    • Hypotonic: ½ NS (0.45% sodium chloride).
      • Hypo=lower, osmotic pressure is LESS than in cells=fluid shifts INTO cells=cells swell.
      • MONITOR CAREFULLY.

    Respiratory System

    • Stimulus for Breathing: Increased CO2 levels stimulate chemoreceptors, increasing depth and rate of respirations to compensate.
    • Consideration for Older Adults: Decreased lung elasticity, ciliary action, and muscle strength affect breathing.
    • Consideration for Children/Infants: Increased basal metabolic rate (BMR) leads to an increased respiratory rate. Immature lungs also impact breathing.
    • Airway Negatively Impacted by: Air pollution, allergens, smoking, drugs, and alcohol.
    • Increased Work of Breathing (WOB): Caused by restricted lung movement and airway obstruction. Results in decreased lung expansion, reduced lung volume and capacity, lung stiffening, swelling of lung tissue, and reduced airway diameter.
    • Examples of Airway Obstruction: Pneumonia, atelectasis, foreign body aspiration, toxins (asbestos/radiation).
    • Airway Obstruction: Any process that decreases the diameter of airways and increases airway resistance.
    • Asthma: Symptoms include shortness of breath (SOB), bronchoconstriction, inflammation, and mucus production.
    • Pneumonia: Build-up of mucus/fluid. Can lead to lung collapse (atelectasis).
    • Chronic Obstructive Pulmonary Disease (COPD): Airway obstruction, airway resistance, decreased gas exchange, and CO2 retention. Worsens over time and is rarely reversible.
    • Oxygen Saturation (SPO2): The percentage of hemoglobin carrying oxygen. Normal SPO2 is greater than 94%.
    • Oxyhemoglobin Curve: The percentage of hemoglobin saturated with oxygen relative to the partial pressure of oxygen in the blood (PaO2). A rapid decrease in PaO2 occurs when SPO2 falls below 90%.

    Diagnostic Testing

    • Chest X-ray: Detects fluid, air, and tumors (atelectasis, pneumonia, lung collapse).
    • Bronchoscopy: Visualizes the airway directly through a scope inserted into the trachea and bronchi.
    • Sputum Culture: A Gram stain identifies infection and determines antibiotic sensitivity.
    • Arterial Blood Gas (ABG): Measures oxygen, carbon dioxide, and blood pH.
    • Pulmonary Function Tests: Evaluates lung volume and capacity, determining severity and treatment efficacy.

    Nursing Interventions

    • Hydration: Encourage fluids. Avoid caffeine and alcohol (diuretics). Clear fluids are best (avoid milk or thick fluids).
    • Positioning: Semi-Fowler's position, elevate the head of the bed (HOB), change positions frequently (every 2 hours), and encourage the "good side down" position.
    • Ambulation: Encourage upright position, out of bed (OOB), and walking activities.
    • Deep Breathing: Expands alveoli, promotes coughing, and encourages slow inhalation through the nose.
    • Coughing: Deep cough, splinting, stacked cough, low-flow or "huff" cough.
    • Pursed Lip Breathing: Used for clients with COPD, increases airway pressure, helps keep airways open longer, and facilitates air escape. Minimizes alveolar collapse and air trapping.
    • Aerosol/Nebulizer Medications: Suspended liquid droplets in air or oxygen (mist) delivered directly to the lungs.
    • Incentive Spirometry: Promotes deep (forceful) inhalation and provides visual measurement of progress.
    • Metered Dose Inhaler (MDI): Measures medication dose in powder or gas form.
    • Spacer: Increases medication delivery to the lungs and reduces bad taste in the mouth.
    • Peak Flow Meter: Measures peak expiratory flow rate, indicating changes in airway diameter. Record daily measurements in the morning and evening, and before and after treatment.
    • Chest Physiotherapy: Involves percussion, postural drainage, and vibration to mobilize secretions.
    • Percussion: Mechanical waves produced by clapping to remove secretions.
    • Postural Drainage: Positioning to drain secretions (head down for lower lobes).
    • Vibration: Loosens secretions (flutter valve/acapella, high-frequency pulsator vest).

    Oxygen Delivery Systems

    • Oxygen Delivery System Goal: Maintain SPO2 greater than 93% and PaO2 greater than 60 mmHg.
    • Oxygen Delivery System Rule: Use the LOWEST concentration for the SHORTEST amount of time.
    • Oxygen Delivery System Rule: Anything higher than 3 LPM must be humidified.
    • Oxygen Delivery System Rule: Fill the bag BEFORE placing it on the patient's face.
    • Low-Flow Oxygen Delivery Systems: Mix with room air (DO NOT meet the patient's inspiratory demand).
      • Nasal Cannula (NC): 1-6 LPM (24-60% O2). Comfortable and convenient.
      • Simple Face Mask: 5-10 LPM (40-60% O2). Covers mouth and nose.
      • Partial Rebreather Face Mask: 10-15 LPM (30-60% O2). Patient needs to re-breathe approximately 1/3 of their CO2 (for hyperventilating, anxious patients, and those with stab wounds).
      • Non-Rebreather Mask (NRB): 10-15 LPM (55-90% O2). One-way valve prevents the patient from re-breathing CO2 (for hypoxia, acute respiratory distress, and pure oxygen needs).
    • High-Flow Oxygen Delivery Systems: Meet the patient's entire ventilatory demand (fixed-precise concentration of oxygen). Pre-mixes oxygen to air ratio before delivery to the patient. Delivers gas at flow rates that exceed the patient's inspiratory demand.
      • High-Flow Nasal Cannula: Up to 60 LPM. Placed by a respiratory therapist (common for premature infants). Reduces dead space. Heated and humidified.
      • Venturi Mask: 24-60% O2 (colored valves control concentration). Used for patients with low oxygen needs and requires humidification. Useful for patients with COPD (limits oxygen to prevent loss of breathing stimulus).
      • Tracheostomy Collar: 28-98% O2 (high humidity).
      • Oxygen Hood: Greater than 60% (high humidity).

    Oxygen Weaning

    • Weaning off of oxygen is accomplished incrementally.
    • Reduce oxygen levels gradually, monitor the patient for distress, SPO2, WOB, and RR, and further lower oxygen when stable.

    Tracheal Suctioning

    • Tracheal Suctioning Indication: Audible upper airway noise/gurgling, adventitious breath sounds (crackles/rhonchi), cyanosis, decreased pulse ox/PaO2, hypoxia (restlessness/anxiety), and increased WOB (retractions, nasal flaring, tachypnea, SOB).
    • Tracheal Suctioning: Removal of secretions through a tube placed in a surgical opening (stoma).
    • Tracheal Suctioning: Short-term procedure, primarily used for feeding (can be used to suction).

    Gastric Decompression, Lavage, and Feeding Tubes

    • Gastric Decompression: Drains fluid or air from the stomach using suction.
    • Gastric Lavage: Irrigation of the stomach (used for poisoning or overdose).
    • Percutaneous Endoscopic Gastronomy (PEG) Tube: Long-term (years). Used for bolus or continuous feeds.
    • PEG/MIC Key: Tube inserted through the abdominal wall into the stomach and held in place by a balloon (PEG). (MIC key is a flatter version with a special piece to snap on). Patients can often use this independently at home.
    • Gastrojejunostomy (G-J) Tube and Jejunostomy (J) Tube: Long-term.
      • J-tube: Bypasses the stomach and goes directly into the intestine.
      • G-J tube: G port is for suction in the stomach, and J port is for feeds/medications in the jejunum.
      • G-J tube: Enters via the jejunum, reducing the risk of aspiration.
      • Flush: Flush with 30-50 cc according to order every 4 hours and between feeds and medications.
      • Three ports: G-port, J-port, and balloon port.
    • Kangaroo/Patrol Pump: Controls the rate of feeding delivery (NO MEDICATIONS).
      • Bag Expiration: Bag expires after 24 hours, discard remaining feed.
      • HOB Elevation: HOB at 30-45 degrees (decreases aspiration and vomiting).
      • Flush: Flush to keep the tube patent.
      • Aspiration Management: If aspirated 1.2-2.5x hourly rate, hold feed for 1 hour and recheck.
      • Hypertonic Solutions: Feeds shift fluid into intestines, potentially causing diarrhea.
    • Bolus Feed: Gravity feed (no pump). Check residual (250-500 cc = HOLD).
    • Stopcock/Lopez Valve: Allows checking for residual or administering medications without removing the feeding tube.

    Parenteral Nutrition

    • Parenteral Nutrition: Delivered intravenously.
    • Parenteral Nutrition Indications: For patients unable to receive nutrition via the GI tract.
      • Nutritional Support: Provides proteins, carbohydrates, fats, electrolytes (K, P), vitamins, and minerals.
      • Medications Administration: Delivers medications intravenously.
    • IV Solutions:
      • Isotonic: Normal saline (NS) (0.9% NaCl) or 0.9% sodium chloride.
        • Isotonic: Equal osmolarity as blood. Used for fluid replacement.
        • Examples: Lactated Ringer's (LR) solution.
        • Patient Use: Used for patients experiencing bleeding, vomiting, or diarrhea. Replaces lost fluids.
      • Hypotonic: ½ NS (0.45% sodium chloride).
        • Hypotonic: Lower osmotic pressure than in cells. Fluid shifts into cells, causing cell swelling.
        • Monitor: Careful monitoring is essential. Dangerous, can cause intravenous fluid depletion and cardiovascular collapse (decrease in blood pressure).
        • Contraindication: Never give to patients with increased intracranial pressure (ICP).
      • Hypertonic: 3% sodium chloride and 5% sodium chloride solutions.
        • Hypertonic: Higher osmotic pressure than in cells. Fluid shifts out of cells, increasing pressure in the intravascular space (increases blood pressure, causes edema, and circulatory overload).
        • Administration: Given only in the Intensive Care Unit (ICU) under close monitoring. Most dangerous.
        • Contraindication: Hypernatremia.
    • IV Access:
      • Butterfly Needle: Needle remains in place.
      • Angiocath: Hollow tubes for injecting contrast dye.
      • Medlock/Heplock/Saline Lock: Needle removed, catheter remains in place.
    • Administration Sets:
      • Primary Administration Set: Spike + tube connected to intravenous access.
      • Piggyback/Secondary Set: Administer electrolytes/medications.
      • Extension Set: Extends the peripheral intravenous access.
      • Clave Connector: End of tubing with a cork for stopping fluid flow (clean carefully!).
      • Roller Clamp: Adjusts the rate of flow.
      • Tubing Change: Replace tubing every 96 hours for continuous administration. (Every 24 hours for antibiotics or short-term infusions).
    • IV Flow Rates:
      • Keep Vein Open (KVO): 10/20 cc per hour.
      • Bolus: Wide open ("999" in pump).
      • Maintenance: Continuous.
    • IV Interventions:
      • Monitor infusion rate and amount (using pump or gravity drip factor).
      • I&O monitoring (at least every 4 hours).
      • Review laboratory values.
      • Exercise common sense (for ambulatory patients, ensure easy access to the bathroom).

    IV Complications

    • Infiltration: Fluid enters surrounding tissues.
      • Symptoms: Pain, burning, blister, pale, cool, swollen, and taught skin.
      • Treatment: Stop the infusion, remove the IV, and insert a new IV at a different site.

    Respiratory Function

    • Air trapping in alveoli leads to:
      • Decreased ability to rebuild and stretch
      • Carbon dioxide retention
      • Symptoms: shortness of breath, cough with mucus production, fatigue, frequent lung infections
    • Barrel chest:
      • Causes changes in the diameter of the chest over time due to air trapping
    • Tripod position:
      • Leaning forward expands the rib cage and improves breathing

    Respiratory Signs & Symptoms

    • Cough:
      • Response to irritation in airways
      • May be acute or chronic
      • Can be weak or strong, dry or wet
    • Sputum production:
      • Can occur in the nose, throat, or lungs
      • Color, consistency, and amount are important
    • Hemoptysis:
      • Bloody mucus production
    • Dyspnea:
      • Shortness of breath
    • Bradypnea:
      • Slowed respiratory rate (less than 12 breaths per minute)
    • Cheyne-Stokes:
      • Increased rate and depth of respiration followed by a period of apnea (no breathing, 15-20 seconds) in a cyclical pattern
      • Common at the end stage of illness
    • Chest pain:
      • Inflammatory mediators stimulate nerve endings
    • Adventitious breath sounds:
      • Abnormal breath sounds
      • Crackles: popping, bubbling sounds, not cleared by coughing
      • Rhonchi: rumbling, coarse sounds (like snoring)
      • Wheezes: high-pitched musical noises, air trying to pass through constricted passages
      • Stridor: high-pitched sound audible on inspiration, indicative of upper airway obstruction (common in infants)
    • Retractions:
      • Accessory muscle use
      • Characterized by leaning forward to breathe, movement between the ribs, at the sternum, and straining in the neck or shoulders.
      • Nasal flaring, agitation, and altered level of consciousness may also be present
    • Cyanosis:
      • Blue or gray skin discoloration
      • Central cyanosis (lips and mucous membranes) indicates poor oxygen saturation
      • Peripheral cyanosis (nails, fingers, and toes) can be caused by vasoconstriction and cold
    • Clubbing:
      • Nail beds elongate, narrow, and become bulbous due to vasodilation and increased blood flow to extremities
      • Compensatory mechanism for poor oxygenation and perfusion (respiratory and/or cardiac disease, chronic hypoxia)

    Diagnostic Procedures

    • Pulse oximetry:
      • Noninvasive measurement of oxygen saturation
      • Infrared sensor measures the percentage of hemoglobin carrying oxygen
      • Normal: greater than 94%
      • Patients with underlying conditions (e.g., COPD) may have lower baselines
      • The oxyhemoglobin curve shows the percentage of hemoglobin saturated with oxygen relative to partial pressure of oxygen in the blood (PaO2)
    • Chest X-ray:
      • Identifies fluid, air, or tumors in the lungs
      • May reveal atelectasis, pneumonia, lung collapse
    • Bronchoscopy:
      • Allows direct visualization of the airway using a scope inserted into the trachea and bronchi
    • Sputum culture:
      • Gram stain helps detect infection and determine sensitivities to antibiotics
    • Arterial blood gas:
      • Measures blood oxygen levels, carbon dioxide levels, and pH
    • Pulmonary function tests:
      • Evaluate lung volume and capacity
      • Used to assess severity of disease and effectiveness of treatment

    Nursing Interventions

    • Hydration:
      • Encourage fluids
      • Avoid caffeine and alcohol (diuretics that can cause dehydration)
      • Clear fluids are preferred (avoid milk and thick fluids)
    • Positioning:
      • Semi-Fowler's position, raise head of bed, frequent position changes
      • "Good side down" to promote drainage and expansion
    • Ambulation:
      • Encourage upright position, out of bed, and walking
    • Deep breathing:
      • Expands alveoli
      • Promotes coughing
      • Inhale slowly through the nose
    • Coughing:
      • Encourage deep, effective coughing
      • Consider techniques like stacked coughs and huff coughs
    • Pursed lip breathing:
      • Helpful for clients with COPD
      • Increases airway pressure in the bronchi, keeping the airways open longer and allowing more air to escape, minimizing alveolar collapse and air trapping
    • Aerosol/nebulizer medications:
      • Suspend liquid droplets in air or oxygen
      • Delivers medication directly to the lungs
    • Incentive spirometry:
      • Visual tool encouraging deep breaths
    • Metered dose inhalers (MDI):
      • Deliver measured doses of medication (powdered or gas)
      • Spacers can increase delivery to the lungs and reduce bad taste in mouth
    • Peak flow meter:
      • Measure peak expiratory flow rate
      • Indicates changes in airway diameter
      • Daily monitoring is important (AM/PM and before/after treatment)
      • Green, red, and yellow zones based on personal best
      • Placed at bedside by a specialized nurse and checked with X-ray before use

    Central Lines

    • Central venous access devices (CVAD): inserted into the internal jugular vein, confirmed by X-ray
      • Triple lumen:
        • Short term
        • Multiple lumens terminate in different places, allowing administration of non-compatible medications at the same time
        • Increased risk of pneumothorax or air embolism
      • Hickman central line:
        • Triple lumen
        • Long term
        • Placed in the operating room into the superior vena cava (SVC)
        • Tunnels through subcutaneous tissue from the arm
        • Decron sheath: plug for tissue to grow around
      • Groshong:
        • Double lumen (rare)
        • Used when patients are allergic to heparin
      • Mediport:
        • Long term
        • Placed in the operating room, terminated in the SVC
        • Self healing
        • Huber needle used to access

    Enteral Nutrition

    • Nutrition delivered via the GI system (including gastric tube)
    • Diets:
      • NPO (nothing per os): nothing by mouth
      • Clear liquid: tea, soda (ginger ale), light-color Jell-O, clear broth (pre- and post-op, or first day after NPO)
      • Full-liquid: includes clear liquids and liquids at room temperature (ice cream, sherbert)
      • Soft diet: puree diet or mechanically soft diet
      • As tolerated: indicated by the patient's tolerance
      • Restrictive: cardiac, diabetic
    • Nasogastric tube (NG tube):
      • Must be checked with X-ray before use
      • MD order is required for use
      • Future placement verification:
        • Insert air into the tube and listen over the stomach
        • Aspirate pH
      • During insertion, have the patient sip water to help advance the tube
      • Interventions:
        • Head of bed (HOB) 30-45 degrees at all times
        • Check placement frequently
        • Administer tube feeds
        • Check residual volume (GRV) and replace
        • Flush the tube to maintain patency
        • Assess placement (check markings on the tube, is the patient tolerating the tube well?)
    • Salem Sump:
      • Two lumens, with one lumen containing a pigtail
      • Short term
      • Suction
      • Should not be used for feeding
      • The blue pigtail helps suction from sticking to membranes and allows air exchange
      • Do not tie a knot in the pigtail, use a chuck if leaking
    • Levin:
      • Single lumen
      • Short term
      • Primarily for feeding, but can be used for suction
    • Gastric decompression:
      • Drains fluid or air from the stomach via suction
    • Gastric lavage:
      • Irrigation of the stomach (used in poisonings or overdoses)
    • Percutaneous endoscopic gastrostomy (PEG):
      • Long term (many years)
      • Used for bolus or continuous feeds
      • PEG/MIC key: enters through the abdominal wall into the stomach, held in place by a balloon (PEG)
      • MIC key is a flatter version with a special piece that snaps on
      • Patients can often use it independently at home
      • Gastrojejunostomy (G-J) tube and jejunostomy (J) tube: long-term
      • J tube: bypasses the stomach and goes directly into the intestine
      • G-J tube:
        • G port: suction in the stomach
        • J port: feeds and medications in the jejunum
      • Enters via the jejunum, decreasing aspiration risk
      • Flush with 30-50 cc as ordered
      • Q4H, between feeds and medications
      • Three ports: G-port, J-port, and balloon port

    Enteral Feeding

    • Kangaroo/patrol pump: controls the rate of feeding delivery (no medications)
      • Bag expires after 24 hours (discard remaining feed)
      • HOB 30-45 degrees (decreases aspiration and vomiting)
      • Periodically flush to maintain patency
      • If aspirated volume is 1.2-2.5 times the hourly rate, hold feed for one hour and check again
      • Hypertonic solutions can shift fluid into the intestines, causing diarrhea
    • Bolus feed: gravity feed, no pump—check residual (250-500 cc = HOLD)
    • Stopcock/Lopez valve: allows checks for residual or medication administration without removing the feeding tube

    Parenteral Nutrition

    • Delivered intravenously
    • Indications: patients who cannot get nutrition via the GI tract
    • Used for: nutritional support (proteins, carbohydrates, fats, electrolytes, vitamins, minerals), medication administration
    • IV Solutions:
      • Isotonic:
        • Normal saline (NS) (0.9% NaCl), 0.9% sodium chloride
        • Iso=equal, same osmolarity as blood, for fluid replacement
        • Ex: lactated ringers (LR)
        • Who: patients with bleeding, vomiting, or diarrhea (replaces lost fluid)
      • Hypotonic:
        • ½ NS (0.45% sodium chloride)
        • Hypo=lower, osmotic pressure is less than in cells, fluid shifts into cells, cells swell
        • Monitor carefully, as it can cause intravascular fluid depletion and cardiovascular collapse
        • NEVER give to patients with increased intracranial pressure (ICP)
      • Hypertonic:
        • 3% sodium chloride, 5% sodium chloride
        • Hyper=higher, osmotic pressure is greater than in cells, fluid shifts out of cells, increased pressure in the intravascular space
        • Only given in the ICU, requires intense monitoring (most dangerous)
        • Contraindications: hypernatremia
    • IV Access:
      • Butterfly needle: needle remains
      • Angiocath: hollow tube for contrast dye
      • Medlock/heplock/saline lock: needle removed, catheter remains
    • Administration sets:
      • Primary administration set: spike + tube to IV
      • Piggyback/secondary set: electrolytes/medications
      • Extension set: makes peripheral IV longer
      • Clave connector: end of tubing to stop fluid flow (cork)
      • Roller clamp: adjusts the rate of flow
      • Change tubing every 96 hours for continuous infusion, every 24 hours for antibiotics or short-term use
    • IV Flow Rates:
      • KVO (keep vein open): 10-20 cc per hour
      • Bolus: wide open ("999" in pump)
      • Maintenance: continuous
    • Interventions:
      • Monitor infusion rate and amount (via pump or gravity drip)
      • Monitor input and output (at least Q4H)
      • Check laboratory values
      • Use common sense (if ambulatory, make it easy to get to the bathroom)

    IV Complications

    • Infiltration: fluid enters surrounding tissues
      • Symptoms: pain, burning sensation, blisters, pale, cool, swollen, or taut skin
      • Treatment: stop the infusion, remove the IV, insert a new IV at a different site

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    Description

    Test your knowledge on tracheostomy procedures and respiratory care. This quiz covers suctioning techniques, signs of respiratory distress, and complications associated with tracheostomy. Ideal for nursing students and healthcare professionals looking to enhance their understanding of respiratory management.

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