Med/surg 374 Test 1

Front 1

Explain what a pulmonary function test tells you?

Back 1

They will provide information about respiratory function by measuring lung volumes, lung mechanics, and diffusion capabilities of the lungs.

Front 2

A measure of expiratory flow obtained with a handheld device is called a -------------------.

Back 2

Peak Flow

Front 3

What is a normal feeling after doing a PFT??

Back 3

Shortness of breath

Front 4

Clients should not do which two things for 6 hours before a PFT???

Back 4

Smoke or use a bronchodilator.

Front 5

In assessing respiratory function: Define Hypoxia

Back 5

Inadequate utilization of oxygen by cells.

Front 6

Define Hypoxemia:

Back 6

Abnormally low oxygen in the blood

Front 7

Define TLC:

Back 7

total lung capacity

Front 8

Define TV:

Back 8

tidal volume-- volume inhaled and exhaled with normal breaths

Front 9

Define VC:

Back 9

Vital capacity--most out to most in

Front 10

Define RV:

Back 10

Reserve volume-- whats left in the lungs between breaths

Front 11

Define IRV and ERV:

Back 11

the extra you can inhale or exhale (reserve volume)

Front 12

Normal peak flow values for adults are based on what 4 things??

Back 12

Age, weight, gender, and if you have any underlying lung disorders.

Front 13

Normal ranges for a PFT are what?

Back 13

300-700 L/minute (the important thing is that they are in the green zone)

**Hint** The bigger the person, the higher the numbers.

Front 14

What two tests are performed to test your blood flow when determining your respiratory function?

Back 14

V/Q scan (ventilation and perfusion scan)

Pulmonay Angiogram

Front 15

When assessing tissue oxygenation, what as nurses do we do with every patient?

Back 15

*Pulse Oximetry

You can also do:
*Oxyhemoglobin dissociation curve
*Acid-Base Balance (ABG's)

Front 16

Factors that can influence the oximetry reading? (3)

Back 16

1.Dark nail polish
2.Low perfusion (hypothermia, or hypovolemia)
3.Peripheral vasoconstrictors (poor circulation)

Front 17

What location are you going to draw an ABG on??

Back 17

Radial or femoral artery (Art line of they have one)

Front 18

What test is performed BEFORE you draw an ABG??

Back 18

Allen test-- occlude both the radial and the ulnar, and let go and see how fast the circulation returns to the hand.

Front 19

What is the biggest concern when drawing an ABG??

Back 19

Bleeding!!!

(you can also cause nerve damage)

Front 20

After recieving the blood for the ABG, then what do you do??

Back 20

Pressure for 5-10 minutes, and send specimen directly to the lab ON ICE.

Front 21

Normal ranges for:
1.Ph
2.PaCO2
3.HCO3
4.PAO2

Back 21

1. 7.35-7.45
2. 35-45 mmHg
3. 22-26 mEq/L
4. 65-80 (80-100 at sea level)

Front 22

If the Ph is 7.32

CO2 is 48

HCO3 is 26

what does this look like???

Back 22

Respiratory Acidosis

Front 23

5 causes of oxygen deficiency or hypoxia??

Back 23

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

Front 24

5 things that might cause respiratory acidosis
(an increase in CO2)

Back 24

COPD, ARDS, Guillian Barre, anesthesia, and pneumonia

Front 25

8 things that might cause Respiratory alkalosis
(a decrease in CO2)

Back 25

Tylenol toxicity, anxiety, hysteria, tetany, strenuous exercise, DT's, pulmonary embolism, fever

Front 26

7 things that may cause metabolic acidosis
(decrease in HCO3)

Back 26

DKA, sever diarrhea, starvation, kidney failure, burns, shock, and acute MI

Front 27

5 things that may cause metabolic alkalosis
(increase in HCO3)

Back 27

Severe vomiting, gastric secretion, hypokalemia, excess administration of NA+ or Bicarb, and hepatic failure

Front 28

What % of oxygen can you deliver through a cannula??

Back 28

22% -- 44%
**Room air is 21%, and its an increase of 4% per Liter.

Front 29

What are the 4 warning signs of cancer of the larynx??

Back 29

1. Hoarsness for > 2 weeks
2. Throat pain
3. Voice changes
4. Difficulty swallowing

Front 30

What is the largest cause of cancer of the larynx??

Back 30

SMOKING!!!!!

Front 31

What are the 3 surgeries you can have to help with cancer of the larynx??

Back 31

Total, Partial, and a node dissection

Front 32

6 things we are concerned about with a post op client after a removal of larynx cancer??

Back 32

1. Airway
2. Nutrition
3. Infection
4. Self care
5. Body image
6. Communication

Front 33

After removal of the larynx, a new opening must be made for air passage--what two things are separated??

Back 33

The trachea and the esophagus.

Front 34

After a laryngectomy-- they can put in what kind of trach tue so they can talk??

Back 34

A fenestrated trach tube (with an opening)

Front 35

Explain the machanism of emphysema:

Back 35

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

Front 36

7 things that contribute to getting COPD:

Back 36

1. SMOKING
2. Infection
3. Air pollution
4. Heredity
5. Aging
6. Farmers
7. If you have had TB in the past

Front 37

Define chronic bronchitis:

Back 37

Air tubes narrow as a result of swollen tissues and excessive mucus production.

Front 38

Define asthma:

Back 38

Edema of the respiratory mucosa, excessive mucus production and muscle spasms obstruct the airways.

Front 39

In comparing bronchitis and emphysema, what are the S/S of bronchitis??

Back 39

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)

Front 40

S/S of emphysema:

Back 40

Dyspnea, minimal cough, little or no sputum, hypoxemia, thin and underweight.(Nope--not me)

Front 41

5 things that signal that its emphysema(pink puffer)

Back 41

increase in alveolar ventilation, normal/low CO2, near or normal O2, they are breathless and NOT CYANOTIC

Front 42

7 things that signal that its bronchitis (blue bloaters)

Back 42

decrease in alveolar ventilation, high CO2, low O2, they are CYANOTIC,bloated (cor pulmonale), giving O2 can be very dangerous, NOT BREATHLESS

Front 43

Positioning for a client with impaired gas exchange going on.....

Back 43

Tripod
Semi Fowlers to High Fowlers

Front 44

Breathing techniques for a client with impaired gas exchange......

Back 44

Pursed Lip
Diaphragmatic

Front 45

FOR A PATIENT WITH IMPAIRED GAS EXCHANGE, WHAT ARE THE 3 MEDICAL INTERVENTIONS?

Back 45

1. Medications
2. Oxygen
3. Surgery

Front 46

Medications for impaired gas exchange....

Back 46

*Mucolytics (Mucomyst)
-- break down mucoproteins
*Leukotriene Modifiers (Accolate)-- bronchodilators and anti-inflammatory
*Mast cell stabalizers (Nasalcrom)--Inhibit inflammatory response, block bronchoconstriction.

Front 47

Medications for impaired gas exchange....

Back 47

*Bronchodilators--short acting Beta2 adrenergic agonists (albuterol)
*Long acting Beta2 agonists (Serevent)
*Anticholinergics agents (Atrovent)

Front 48

Medications for impaired gas exchange.....

Back 48

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

Front 49

Order of use for inhalers:

Back 49

1. beta Agonists
2. Anticholinergic
3. Corticosteroid

Front 50

3 things that are important to remember when using an inhaler...

Back 50

Wait 1 minute between each puff
Oral care--so they dont get thrush!!
Cleansing and checking for fullness everytime you use the inhaler.

Front 51

Which order should you give these in?
Albuterol
Vanceril
Atrovent

Back 51

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

Front 52

What does the "theobromine" in chocolate do to help your lungs??

Back 52

It acts to relax smooth muscle including those of the beonchioles. Milk chocolate has 5-10mg/Ounce
Dark has 35mg/Ounce

Front 53

You dont want to oversaturate these clients with too much O2--what is the rule with a client with altered gas exchange?/

Back 53

Just enough O2 to to maintain the O2 within acceptable levels for the client. (all are different)

Front 54

Altered Nutrition with these clients with altered gas exchange... what are some srategies to improve nutrition??

Back 54

Smaller meals, change to cannula during meals, supplement high fat foods, avoid high carbs, meal preperation and timing are important.

Front 55

Complications with COPD:

Back 55

Peptic ulcers and GERD
Acute exacerbations
Pneumonia
Pneumothorax
Acute Respiratory failure
Cor Pulmonale

Front 56

3 things that should be taught in order to assist a pt. w/COPD in dealing with activity intolerance.

Back 56

1. Locate things at waist level
2. Pacing activities throughout the day
3. Pursed lip breathing

Front 57

2 types of pleural effusion:

Back 57

Transudative ( substance passed through the membrane like in CHF)
Exudative (PE, cancer)

Front 58

Treatment for pleural space disorders:

Back 58

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)

Front 59

4 causes of a pneumothorax--

Back 59

Air in pleural space
In COPD--rupture of an emphysema bleb
Spontaneous pneumothorax
Trauma

Front 60

What clients are in the highest risk group for pneumothroax?

Back 60

Tall, thinner, people
(Finally something I am not at risk for)

Front 61

A tension pneumothorax is life threatening--what do you watch for to signal this?

Back 61

A deviated trachea

Front 62

Causes of pleural effusion:

Back 62

*Increased hydrostatic pressure (CHF)
*Reduced capillary oncotic pressure (liver or renal failure)
*Increased capillary permeability (Infections)
*Impaired lymphatic function (lymph obstruction or tumor)

Front 63

Manifestations of pleural effusion:

Back 63

SOB, chest pain, tachypnea, hypoxemia, pleural rub

Front 64

PNEUMOTHORAX

Back 64

*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.