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101 Cards in this Set
- Front
- Back
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Trap dust and microorganisms
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nasal hairs and turbinates
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warm and moisten inhaled air; trap inhaled particles
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mucous membranes
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move particles toward pharynx to be swallowed or coughed out
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cilia
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trigger sneeze and cough to remove foreign debris
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irritant receptors in nose and airways
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phagocytize foreign particles and bacteria
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alveolar macrophages
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Reduced number of alveoli
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decreased gas exchange
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reduced effectiveness of alveolar macrophages
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increased risk of respiratory infections
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decreased cough reflex
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increased risk of respiratory infections
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deteriorating cilia
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increased risk of respiratory infections
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reduced elastic recoil of lung tissue
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decreased force of cough (causing increased risk of respiratory infections) PLUS air trapping (causing decreased gas exchange)
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weakened and atrophied respiratory muscles
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decreased force of cough (causing increased risk of respiratory infections)
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Do you often have headaches or sinus tenderness?
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may indicate sinusitis
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Do you often experience nosebleeds?
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a history of nosebleeds may indicate an abnormality that can predispose to future nosebleeds
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has your voice changed?
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voice change may indicate a variety of disorders of the nose or throat, including cancer. Further investigation is necessary
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Do you ever feel SOB, like you cant get enough air?
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many respiratory and cardiac problems result in SOB
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Do you have a cough? Is it productive?
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a cough indicates respiratory irritation or excessive secretions
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what does the sputum look like?
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yellow or green sputum may accompany an infection. Blood in the sputum may occur with tuberculosis, pulmonary embolism, or cancer
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Have you recently experienced night sweats, chills, fever?
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These are symptoms of tuberculosis
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Do you ever feel confused, light headed, or restless?
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These symptoms might indicates a low PO2, reducing oxygen to the brain
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Have you had any chest surgeries?
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this may reveal problem areas the patient has not yet mentioned
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Do you have any allergies that cause respiratory symptoms? How do you treat them?
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The patient may take over the counter medications for allergies that affect respiratory function or interact with prescribed medications
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Do you smoke? How many packs per day? For how many years? Are you exposed to second hand smoke?
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many respiratory disorders are caused or aggravated by exposure to tobacco smoke
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are you or have you ever been exposed to airborne pollutants at work?
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pollutants such as asbestos, coal dust, or chemicals can cause lung disease
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Do you take any medications or use inhalers (prescribed or OTC) for your respiratory problems?
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Information about medications gives further information about disorders, severity, and treatment. You should also consider drug interactions and side effects
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Do you use home oxygen or other home respiratory treatments?
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This helps determine the severity of disease and the severity of disease and the treatment
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Do any of your blood relatives have emphysema, asthma, or tuberculosis
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some respiratory disorders have a hereditary tendency. Tuberculosis is contagious
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Pulmonary diseases associated with Japanese people include asthma related to dust mites in the straw mats that cover floors in Japanese homes and air pollution from living in urban areas. The nurse should encourage patients who have straw mats and who wish to keep them to have them sterilized.
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Patients from Poland, Ireland, or other countries where mining is a primary occupation may have an increased incidence of respiratory disease. It is essential that health care providers carefully screen Polish and Irish immigrants for respiratory conditions.
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Healthcare practitioners should be aware of the variations among ethnic peoples of color when assessing for cyanosis. Cyanosis and decreased blood hemoglobin levels in darker skinned individuals gives the skin an ashen color instead of a bluish color. Thus, the nurse must examine the sclerae, conjunctivae, buccal mucosa, tongue, lips, nailbeds, and palms and soles of the feet to assess for lowered oxygen levels.
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Smoking is deeply ingrained in the Arab American culture. Offering cigarettes is a rits of Arab hospitality. Arabs may have difficulty stopping smoking because of these cultural rituals.
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Populations living in inner cities are at increased risk for respiratory diseases related to pollution. Strategies to increase the effectiveness of smoking cessation in African Americans include working with community and church groups in African American communities.
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Respiratory patterns
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when assessing a patient's respirations, the nurse should determine their rate, thythm, and depth. These schematic diagrams show different respiratory patterns.
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Normal respiratory rate and rhythm
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Eupnea
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Deeper respirations; normal rate
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Hyperventilation
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Increased respiratory rate
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Tachypnea
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Slow but regular respirations
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Bradypnea
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Absence of breathing (may be periodic)
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Apnea
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Respirations that gradually become faster and deeper than normal, then slower; alternates with periods of apnea
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Cheyne-Stokes
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Faster and deeper respirations without pauses
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Kussmaul's
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Name the paranasal sinuses
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Frontal, Ethmoid, Sphenoid, Maxillary
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Possible cause of Respiratory rate < 12
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respiratory depression, possibly from opioid or sedative use
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Possible cause of Respiratory rate > 24
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Respiratory distress from underlying disorder
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Possible cause for use of accessory muscles
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restrictive or obstructive disorder (COPD)
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Possible cause for Barrel chest
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air trapping from COPD
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Possible cause for cough
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airway irritation or secretions
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Possible causes for green, yellow, tan or bloody sputum
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green, yellow, or tan sputum may indicate infection. Blood in sputum can indicate tuberculosis, cancer, or pulmonary embolism
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Possible cause for Cyanosis
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tissue hypoxia
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possible cause for nail clubbing
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chronic tissue hypoxia
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possible respiratory cause for confusion
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lack of oxygen to the brain
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possible cause for weight loss
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dypsnea interfering with eating; use of calories for breathing
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Fluid in airways, sounds like moist bubbling, heard on inspiration or expiration associated w/ pulmonary edema, bronchitis, and pneumonia
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course crackles (sometimes called rales)
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Alveoli popping open on inspiration, sounds like velcro being torn apart, heard at the end of inspiration, associated w/ heart failure and atelectasis
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fine crackles (rales)
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narrowed airways, sounds like fine high pitched violins, mostly on expiration, associated w/ asthma
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wheezes
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airway obstruction sounds like a loud crowing noise heard without stethescope, associated with obstruction from tumor or foreign body
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pleura rubbing together, sounds like leather rubbing together, grating, associated with pleurisy, lung cancer, pneumonia or pleural irritation
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pleural friction rub
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decreased air movement with faint lung sounds, associated with emphysema, hypoventilation, obesity, muscular chest wall
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diminished
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no air movement, no sound heard, associated with pneumothorax or pneumectomy
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absent
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If you remember that a normal blood pH is 7.35 to 7.45 then its easy to remember that:
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a normal PaCO2 is 35 to 45 mm Hg
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Normal value for RBCs
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4.5 - 6.2 (male) and 4.2 - 5.4 (female)
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Conditions associated with an increase/decrease in RBCs
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increased in chronic lung disease or dehydration, decreased in anemia, hemorrhage, overhydration with intravenous fluids
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Normal value for Hemoglobin
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13.5-18 (male) 12-16 (female)
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Conditions associated with hemoglobin increase/decrease
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same as RBCs - increased in chronic lung disease or dehydration, decreased in anemia, hemorrhage, overhydration with intravenous fluids
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Normal WBC count
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5000-10,000
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Conditions associated with abnormal WBC count
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increased in infection
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What condition is suspected if the doctor orders a "sputum for AFB"?
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tuberculosis: ask if the patient should be isolated while waiting for test results
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Test defined as air inspired and expired in one breath
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Tidal volume
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Defined as air remaining in lungs after maximum exhalation
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Residual Volume
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defined as air remaining in lungs after normal expiration
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Functional residual capacity (FRC)
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Defined as amount of air beyond tidal volume that can be taken in with the deepest possible inhalation
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Inspiratory reserve
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Defined as amount of air beyond tidal volume in the most forceful exhalation
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expiratory reserve
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Defined as maximum amount of air expired forcefully after maximum inspiration
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Forced vital capacity (FVC)
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Defined as amount of air expired in first second of forced exhalation, expressed as percent of FVC
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Forced expiratory volume in one second (FEV1)
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Defined as maximum flow of air expired during FVC (this is a rate rather than a volume)
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Peak expiratory flow rate (PEFR)
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Normal TV value
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400-600 mL at rest
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Normal RV value
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1000-1500 mL
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Normal FRC value
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2300 mL
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Normal Inspiratory reserve
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2000-3000 mL
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Normal expiratory reserve
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1000-1500 mL
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Normal FVC
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3000-5000 mL
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normal FEV1
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65%-85% of the FVC
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Normal PEFR
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450 L/min
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Drugs that assist with smoking cessation
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bupropion (Zyban), buspirone (BuSpar)
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Types of oxygen masks
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simple, partial rebreather, nonrebreathing, venturi
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Steps to use a metered dose inhaler
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1) gently twist the canister into the inhaler unit, shake the inhaler, and remove the cap NEWLINE 2) exhale NEWLINE 3) place the inhaler mouthpiece in your mouth NEWLINE 4) Press the canister down to actuate a dose of mediation, simultaneously breathe in slowly and deeply, timing the dose and breath so the meds go into the lungs and not onto the tongue NEWLINE 5) hold breath for 5-10 seconds, repeat as ordered
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Safety tip!
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Label all medicaitons, medication containers (syringes, med cups, basins, ect) or other solutions on and off the sterile field in perioperative and other procedural settings
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The diagrammed chest drainage system has this part of the system on the left:
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suction chamber
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Thediagrammed chest drainage system has this part on the right
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drainage collection chamber
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the diagrammed chest drainage system has this part in the middle
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water seal chamber
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When caring for the patient w/ a chest drainage system where do you begin?
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start at the patient and move toward the drainage system
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Caring for a patient w/ a chest drainage system: patient assessment
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observe respiratory rate, effort, and symmetry, assess for SOB, pain, other discomforts, ascultate lung sounds, confirm dressing is intact, observe for drainage, if necessary reinforce the dressing and notify the physician, palpate around insertion sites for crepitus
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Caring for a patient w/ a chest drainage system: system assessment
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check tubing, ensure no excess loops, verify no cracks or leaks in bottles, verify water level for tidaling (unless lung reinflated), check suction control chamber for gentle bubbling and confirm correct amt of water, check and mark amount of drainage in collection chamber every 8 hrs and prn as needed
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When using a chest drainage system, notify the RN or physician if:
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patient suddenly complains of increasing dyspnea or chamber is full and needs to be changed
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How often should you check and mark the drainage collection chamber?
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every 8 hours and PRN or as ordered (report marked increase in bloody drainage)
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In what situation would you not have tidaling in the water seal chamber?
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if the lung reinflated
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If continuous bubbling is present in the water seal chamber:
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check for leaks and notify physician
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Where should the drainage system be located?
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below patient chest at all times
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Where does excess tubing go?
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should be coiled on the bed
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What are you looking for when you palpate around chest drainage system insertion sites?
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crepitus
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What do you do if the chest drainage system dressing is soaked with drainage?
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reinforce and notify physician…do NOT change dressing
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How would you expect lung sounds to sound in a patient w/ a chest drainage system?
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may initially be muffled or absent on the side of a collapsed lung but should gradually return to normal as the lung reinflates
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Trach cleaning proceedure:
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1) assemble equipment, trach care kit, sterile water or saline, suction equipment, hydrogen peroxide NEWLINE 2) explain the procedure to the patient NEWLINE 3) suction inner cannula if necessary NEWLINE 4) open and prepare the kit keeping all equipment sterile. Fill one side of basin w/ half peroxide and half saline and the other with saline
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Trach cleaning proceedure:
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5) Don clean gloves NEWLINE 6) remove old tracheostomy dressing NEWLINE 7) remove inner cannula from tracheostomy tube and place it in peroxide solution NEWLINE 8) while inner cannula is removed, patient may be suctioned if necessary NEWLINE 9) don sterile gloves
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Trach cleaning proceedure:
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10) use brush and pipe cleaners to clean inner cannula Place in water or saline to rinse. Dry inside of cannula with pipe cleaner. Reinsert into trach tube NEWLINE 11) use cotton swab and sterile gause w/ sterile peroxide and saline to clean around trach site. Rinse w/ saline to prevent skin irritation NEWLINE 12) replace ties, remove old ties after new ties are securely in place NEWLINE 13) apply sterile trach dressing (drain spong or "trach pants"). Use precut or folded dressing. Cutting gause creates fibers that can enter trach
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