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100 Cards in this Set
- Front
- Back
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Normal PH |
7.35 - 7.45 |
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Normal PaCO2 |
35 - 45 |
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Normal HCO3 |
22 - 26 (28) |
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What Does ROME stand for? |
Respiratory Opposite Metabolic Equal |
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Compensated PH is? |
PH normal 7.35 - 7.45 |
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Non compensated PH is? |
Not normal PH < 7.35 >7.45 |
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What is a thoracostomy? |
Placement of a chest tube |
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When is a chest tube clinically indicated? |
Fluid (pleural effusion) Blood (hemothorax) Air (pneumothorax) |
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Prior to removing chest tube you should give? |
PRN pain meds |
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After HCP removes chest tube and secured the occlusive what does nurse assess? |
Lung sounds RR O2 SAT Pain level |
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How often do you change chest tube dressing? |
Every 24 hours |
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A closed water seal drainage system prevents what? |
Air from entering the chest |
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Causes of high pressure alarm? |
Biting the ET tube Excess secretions Kinked tubing |
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What lab value will be elevated when patient has a PE? |
D-dimer |
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The patient is scheduled for a thoracentesis. Prior to procedure action would nurse do? |
Position patient in upright position leaning over bedside table |
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Following chest tube placement, what items should be in patients room? |
O2, sterile water, 2 enclosed hemostat clamps, occlusive dressing |
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Normal finding of the water level in the water seal chamber? |
Tidaling/fluctuation the Rise and fall in the level of water with inspiration and expiration |
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Slow and consistent bubbling in the suction control chamber is a normal finding? T or F? |
True |
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After chest tube is removed what should nurse do? |
Place occlusive dressing over site |
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Following insertion of chest tube and drainage system. What should be included in plan of care? |
Encourage patient to cough and deep breath Check for constant bubbling in suction chamber Obtain chest X-ray |
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Risk factors for a PE? |
BMI > 25 Femur fracture (long bone fx) Chronic Afib |
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What does a chest X-ray in patient with ARDS show? |
White lungs |
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ARDS meds and treatment |
Ventilator Prone position 20 min every hour ( pronater bed or rotator bed) Increase O2 |
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Manifestations of ARDS? |
Rapid onset of severe dyspnea Tachycardia, tachypnea, cyanosis Frothy sputum, crackles Decreased LOC/coma Death |
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Diagnose ARDS |
ABG’s Chest X-ray |
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Risk for Pulmonary Embolism (PE) |
Post op, Afib, coagulation abnormalities, obesity Bed rest/immobility, long bone fractures (fat embolus) |
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Patient has a air embolism what position do you put them in? |
Place patient on left side head lowered |
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S/Sx of PE? |
Acute dyspnea, chest pain, cough, hemoptysis, palpitations Most common: tachycardia, tachypnea, crackles |
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What do you see with tension pneumothorax? |
So much air building up on one side the trachea deviates to the other side. |
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Treatment for PE? |
Thrombolytics/fibrinolytics used for massive PE to dissolve the clot. Anticoagulants: heparin usually 5 to 10 days, in 3 to 4 days begin warfarin continue both until INR is therapeutic level. Then stop heparin |
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Surgical removal of clot? |
Embolectomy |
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Deep rapid labored breathing? |
Kusmal |
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High pitched sound during breathing, obstruction of airway? |
Stridor |
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Rhythmic progressively deeper sometimes faster followed by gradual decrease and apnea. |
Cheyne stokes |
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Absent of breathing |
Apnea |
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Normal potassium levels |
3.5 to 5 |
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Normal sodium levels |
135 to 145 |
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Normal calcium levels |
8.5 to 10.2 |
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Normal magnesium levels |
1.5 to 2.5 |
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Causes of metabolic alkalosis |
Vomiting NG suction |
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Causes of metabolic acidosis |
Diarrhea Renal failure DKA |
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Risk factors for Respiratory acidosis (hypoventilation) |
Respiratory depression from opioids, poisons, anesthetics, stroke, overhydration, airway obstruction, ARDS, sleep apnea, obesity, pneumothorax, hemothorax |
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Risk factors of respiratory alkalosis (hyperventilation) |
Hyperventilation due to fear, anxiety, excessive mechanical ventilation |
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PH- 7.49 PaCO2- 38 HCO3- 30 |
Metabolic Alkalosis |
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PH- 7.50 PaCO2- 30 HCO3- 24 |
Respiratory Alkalosis |
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PH- 7.30 PaCO2- 40 HCO3- 18 |
Metabolic acidosis |
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PH- 7.31 PaCO2- 49 HCO3- 25 |
Respiratory Acidosis |
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Continuous bubbling in the water seal chamber indicates? |
Air leak |
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Continuous bubbling in the water seal chamber indicates? |
Air leak |
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Movement of the fluid level with respiration is called what? And is expected in the water seal chamber. |
Tidaling or fluctuation |
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Cessation of tidaling in the water seal chamber signals? |
Lung re expansion or an obstruction within the system |
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What is the easiest and quickest form of intubation? |
Oral intubation |
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What form of intubation is used for a patient with facial or oral trauma? |
Nasal intubation |
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Analgesics given to vent patients? |
Morphine and fetanyl |
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Sedatives given to vent patients? |
Propofol and Benzodiazepines (diazepam, lorazepam, midazolam) |
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Neuromuscular blocking agents (paralytics) given to vent patients? |
Pancuronium (Pavulon), anectine (succinylcholine), Atracurium and vecuronium |
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Ulcer preventing agents given to vent patients? |
Famotidine or lansoprazole |
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How often do you reposition the oral endotracheal tube? |
Every 24 hours Assess for skin breakdown |
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What should be kept at bedside of a vented patient? |
Suction, water, ambu bag (bag,valve,mask), extra ties |
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Nursing actions when patient comes off vent ? |
HOB elevated at least 30 degrees. No talking, it’s ok to say a few words. Don’t use your O2 we need to make sure all is well. Relax and deep breath V/S Q 5 min x 15 then Q 15min |
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What do you do before you suction patient? |
Oxygenate patient |
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What is the name for complete or partial collapse of a lung or part (lobe) of a lung. |
Atelectasis |
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Kusmal respirations are associated with? |
DKA Metabolic acidosis |
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Main prevention of sleep apnea? |
Lose weight |
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Main treatment for sleep apnea? |
CPAP continuous |
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Emboli (definition) |
Anything that blocks blood supply |
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Risks for emboli’s |
Post op Bed rest Dehydrated |
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Fat emboli risk |
Lower extremity bone fracture |
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Treatment for PE? |
Thrombolytic/fibrinolytic if large Anticoagulants- heparin d/t quick - IV- then start on PO Coumadin or other. Stop heparin once therapeutic levels reached. Embolectomy - remove clot Umbrella filter (vena cava filter) strainer to collect the clots to prevent PE, DVT, MI, Stroke |
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Patient teaching for emboli’s |
Dorsi planter exercise (gas pedal type) SCD’s, Ted hose, early ambulation |
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Positive diagnosis for emboli is? |
CT for positive |
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Antidote for heparin? |
Protamine Sulfate |
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Antidote for warfarin (Coumadin) |
Vitamin K |
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What to give when doing a chest tube or needle decompression? |
Morphine and sedative (Valium) |
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What is the most common invasive procedure to cause pneumothorax? |
Subclavian IV triple lumen |
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Where is a chest tube/needle compression put in with a hemothorax? |
5th intercostal space |
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With a pneumothorax where is the chest tube or needle placed? |
2nd intercostal space |
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If patient has both pneumothorax and hemothorax where is tube or needle placed? |
5th intercostal space |
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Patient teaching for chest tube |
Will have pain when chest tube is inserted. Use of incentive spirometer, cough and deep breathing |
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What is done when inserting chest tube to prevent air from getting in? |
Make sure the eyelets on the tube is under the skin |
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What are the 2 reasons for needing a chest tube? |
Hemothorax or pneumothorax |
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Side effect of heparin? |
Thrombocytopenia |
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When is it ok to see bubbling in the water seal chamber? |
A new pneumothorax d/t need to get air out. |
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Patient has had chest tube in for 4 days with no bubbling in water chamber, now there is bubbling. Is this ok or not? |
It’s not ok |
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If you see bubbling in water chamber what do you do? |
First check connections all should be taped and connected. Check for holes. If all is secure go to the dressing check to make sure no air is getting in. |
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What can clamping the chest tube cause? |
Lung to collapse |
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How many clamps are used in emergency clamping the chest tube? |
2 and they are clamped in opposite directions |
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Where is the chest tube container kept? |
Below chest level |
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How often does the nurse need to check the amount of drainage from chest tube? |
Once a shift |
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Should you see bubbling in the drainage chamber? |
Never have bubbling in drainage chamber |
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What do you feel if air gets under the skin? |
Crepitus |
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Which chamber has slow continuous bubbling? |
Suction chamber |
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Which chamber never has bubbling? |
Drainage chamber |
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A nurse is instructing a group of clients who will require continued mechanical ventilation upon discharge from hospital. Which of the following items is essential to have in the home Incase of a power failure? A. Ambu bag B. Flashlight C. Generator D. Suction device |
A. Ambu bag |
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What is the mnemonic for cancer? |
C change in bowel/bladder habi A sore that doesn’t heal………….. U unusual bleeding/discharge… T thickening lump in breast or… I indigestion dysphagia N/V…….. O obvious change in wart/mole. N nagging cough/hoarseness….. U unexplained weight loss ……… P pernicious anemia |
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Side effects of chemo? |
Neutropenia, N/V, diarrhea |
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Side effects from radiation? |
Hair loss, burn of skin, bone loss illness/infection bone marrow suppression |
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Neutropenia precautions? |
No- Fresh flowers, fresh fruit, raw meat, salad bar, live vaccines Drink bottled water, visitors wear masks in patients room |
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Head and neck cancer |
Radiation therapy- xerostomia (dry mouth, sores) |
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Laryngeal cancer |
Not painful Smokers get this type a lot Chew also causes |
