Med/Surg 374 test 1
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- Explain what a pulmonary function test tells you?
- They will provide information about respiratory function by measuring lung volumes, lung mechanics, and diffusion capabilities of the lungs.
- A measure of expiratory flow obtained with a handheld device is called a -------------------.
- Peak Flow
- What is a normal feeling after doing a PFT??
- Shortness of breath
- Clients should not do which two things for 6 hours before a PFT???
- Smoke or use a bronchodilator.
- In assessing respiratory function: Define Hypoxia
- Inadequate utilization of oxygen by cells.
- Define Hypoxemia:
- Abnormally low oxygen in the blood
- Define TLC:
- total lung capacity
- Define TV:
- tidal volume-- volume inhaled and exhaled with normal breaths
- Define VC:
- Vital capacity--most out to most in
- Define RV:
- Reserve volume-- whats left in the lungs between breaths
- Define IRV and ERV:
- the extra you can inhale or exhale (reserve volume)
- Normal peak flow values for adults are based on what 4 things??
- Age, weight, gender, and if you have any underlying lung disorders.
- Normal ranges for a PFT are what?
-
300-700 L/minute (the important thing is that they are in the green zone)
**Hint** The bigger the person, the higher the numbers. - What two tests are performed to test your blood flow when determining your respiratory function?
-
V/Q scan (ventilation and perfusion scan)
Pulmonay Angiogram - When assessing tissue oxygenation, what as nurses do we do with every patient?
-
*Pulse Oximetry
You can also do:
*Oxyhemoglobin dissociation curve
*Acid-Base Balance (ABG's) - Factors that can influence the oximetry reading? (3)
-
1.Dark nail polish
2.Low perfusion (hypothermia, or hypovolemia)
3.Peripheral vasoconstrictors (poor circulation) - What location are you going to draw an ABG on??
- Radial or femoral artery (Art line of they have one)
- What test is performed BEFORE you draw an ABG??
- Allen test-- occlude both the radial and the ulnar, and let go and see how fast the circulation returns to the hand.
- What is the biggest concern when drawing an ABG??
-
Bleeding!!!
(you can also cause nerve damage) - After recieving the blood for the ABG, then what do you do??
- Pressure for 5-10 minutes, and send specimen directly to the lab ON ICE.
-
Normal ranges for:
1.Ph
2.PaCO2
3.HCO3
4.PAO2 -
1. 7.35-7.45
2. 35-45 mmHg
3. 22-26 mEq/L
4. 65-80 (80-100 at sea level) -
If the Ph is 7.32
CO2 is 48
HCO3 is 26
what does this look like??? - Respiratory Acidosis
- 5 causes of oxygen deficiency or hypoxia??
-
1. Breathing a hypoxic mixture of gases
2. Inability of lung to oxygenate the blood
3. Interference of O2 delivery to tissues
4. Inability of tissues to use O2
5. Decrease in O2 content in blood -
5 things that might cause respiratory acidosis
(an increase in CO2) - COPD, ARDS, Guillian Barre, anesthesia, and pneumonia
-
8 things that might cause Respiratory alkalosis
(a decrease in CO2) - Tylenol toxicity, anxiety, hysteria, tetany, strenuous exercise, DT's, pulmonary embolism, fever
-
7 things that may cause metabolic acidosis
(decrease in HCO3) - DKA, sever diarrhea, starvation, kidney failure, burns, shock, and acute MI
-
5 things that may cause metabolic alkalosis
(increase in HCO3) - Severe vomiting, gastric secretion, hypokalemia, excess administration of NA+ or Bicarb, and hepatic failure
- What % of oxygen can you deliver through a cannula??
-
22% -- 44%
**Room air is 21%, and its an increase of 4% per Liter. - What are the 4 warning signs of cancer of the larynx??
-
1. Hoarsness for > 2 weeks
2. Throat pain
3. Voice changes
4. Difficulty swallowing - What is the largest cause of cancer of the larynx??
- SMOKING!!!!!
- What are the 3 surgeries you can have to help with cancer of the larynx??
- Total, Partial, and a node dissection
- 6 things we are concerned about with a post op client after a removal of larynx cancer??
-
1. Airway
2. Nutrition
3. Infection
4. Self care
5. Body image
6. Communication - After removal of the larynx, a new opening must be made for air passage--what two things are separated??
- The trachea and the esophagus.
- After a laryngectomy-- they can put in what kind of trach tue so they can talk??
- A fenestrated trach tube (with an opening)
- Explain the machanism of emphysema:
- Damaged or restroyed alveolar walls no longer support and hold open the airways, and the alveoli lose their property of passive elastic recoil. So you get a collapse with expiration......BAD
- 7 things that contribute to getting COPD:
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1. SMOKING
2. Infection
3. Air pollution
4. Heredity
5. Aging
6. Farmers
7. If you have had TB in the past - Define chronic bronchitis:
- Air tubes narrow as a result of swollen tissues and excessive mucus production.
- Define asthma:
- Edema of the respiratory mucosa, excessive mucus production and muscle spasms obstruct the airways.
- In comparing bronchitis and emphysema, what are the S/S of bronchitis??
-
Frequent productive cough, especially in the winter months--Bronchospasms--Bluish color--frequent respiratory infections, normal weight to being obese.
(Good hell, i think this is what i have had--especially the obese part) - S/S of emphysema:
- Dyspnea, minimal cough, little or no sputum, hypoxemia, thin and underweight.(Nope--not me)
- 5 things that signal that its emphysema(pink puffer)
- increase in alveolar ventilation, normal/low CO2, near or normal O2, they are breathless and NOT CYANOTIC
- 7 things that signal that its bronchitis (blue bloaters)
- decrease in alveolar ventilation, high CO2, low O2, they are CYANOTIC,bloated (cor pulmonale), giving O2 can be very dangerous, NOT BREATHLESS
- Positioning for a client with impaired gas exchange going on.....
-
Tripod
Semi Fowlers to High Fowlers - Breathing techniques for a client with impaired gas exchange......
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Pursed Lip
Diaphragmatic - FOR A PATIENT WITH IMPAIRED GAS EXCHANGE, WHAT ARE THE 3 MEDICAL INTERVENTIONS?
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1. Medications
2. Oxygen
3. Surgery - Medications for impaired gas exchange....
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*Bronchodilators--short acting Beta2 adrenergic agonists (albuterol)
*Long acting Beta2 agonists (Serevent)
*Anticholinergics agents (Atrovent) - Medications for impaired gas exchange.....
-
Methylxanthine derivatives--(Theophylline)--this mostly helps to improve contraction of the diaphragm, not used much because of narrow safety margin, side effects are tremors, tachycardia, and anxiety.
*Steroids-- start with inhaled, then go to oral ones.
--Inhaled is Vanceril
--Oral is Prednisone - Order of use for inhalers:
-
1. beta Agonists
2. Anticholinergic
3. Corticosteroid - 3 things that are important to remember when using an inhaler...
-
Wait 1 minute between each puff
Oral care--so they dont get thrush!!
Cleansing and checking for fullness everytime you use the inhaler. -
Which order should you give these in?
Albuterol
Vanceril
Atrovent -
1. albuterol--to open the windpipe
2. Atrovent-- to decrease the secretion of mucus
3. Vanceril-- this is inhaled,and then go to an oral medication - What does the "theobromine" in chocolate do to help your lungs??
-
It acts to relax smooth muscle including those of the beonchioles. Milk chocolate has 5-10mg/Ounce
Dark has 35mg/Ounce - You dont want to oversaturate these clients with too much O2--what is the rule with a client with altered gas exchange?/
- Just enough O2 to to maintain the O2 within acceptable levels for the client. (all are different)
- Altered Nutrition with these clients with altered gas exchange... what are some srategies to improve nutrition??
- Smaller meals, change to cannula during meals, supplement high fat foods, avoid high carbs, meal preperation and timing are important.
- Complications with COPD:
-
Peptic ulcers and GERD
Acute exacerbations
Pneumonia
Pneumothorax
Acute Respiratory failure
Cor Pulmonale - 3 things that should be taught in order to assist a pt. w/COPD in dealing with activity intolerance.
-
1. Locate things at waist level
2. Pacing activities throughout the day
3. Pursed lip breathing - 2 types of pleural effusion:
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Transudative ( substance passed through the membrane like in CHF)
Exudative (PE, cancer) - Treatment for pleural space disorders:
-
Primary-- thorancentesis
Recurrent-- Pleurodisis (which is when you inject the irritant to help create an infalmmatory process in the lung and makes it sticky. It stays expanded so the pleural effusion cant some back) - 4 causes of a pneumothorax--
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Air in pleural space
In COPD--rupture of an emphysema bleb
Spontaneous pneumothorax
Trauma - What clients are in the highest risk group for pneumothroax?
-
Tall, thinner, people
(Finally something I am not at risk for) - A tension pneumothorax is life threatening--what do you watch for to signal this?
- A deviated trachea
- Causes of pleural effusion:
-
*Increased hydrostatic pressure (CHF)
*Reduced capillary oncotic pressure (liver or renal failure)
*Increased capillary permeability (Infections)
*Impaired lymphatic function (lymph obstruction or tumor) - Manifestations of pleural effusion:
- SOB, chest pain, tachypnea, hypoxemia, pleural rub
- PNEUMOTHORAX
-
*Sudden onset of pleuretic chest pain, this will worsen with each deep breath.
*Dyspnea, SOB, increased work to breathe
**Diagnostic test is CXR
*Mangement is O2 and possible placement of a chest tube.