MED SURG 2 EXAM 2 REVIEW (respiratory system) CHAPTER 29 (2022 Solution)

MED SURG 2 EXAM 2 REVIEW (respiratory system) CHAPTER 29 (2022 Solution) • Pulmonary function test- measures the amount of air remaining in the lungs after normal expiration. Residual volume (RV) Air remaining in lungs after maximum exhalation 1,000–1,500 mL • Dyspneic scale: if pt experiences 7 out of 10 o 1ST: place the pt in a FOWLER’S position. Or tripod position (sit in a chair while leaning forward and placing their elbows on their knees or an over-the-bed table) • If you hear adventitious breath sounds on one side- ASCULTATE THE OTHER SIDE AND COMPARE TO DETERMINE IF ABNORMAL. Fine crackles (rales) Alveoli popping open on inspiration Velcro being torn apart, heard at end of inspiration Heart failure, atelectasis Stridor Airway obstruction Loud crowing noise heard without stethoscope obstruction from tumor or foreign body Pleural friction rub Inflamed pleura rubbing together Sound of leather rubbing together; grating sound Pleurisy, lung cancer, pneumonia, pleural irritation • If pt has a high PACO2 of 73? 1ST SIT PT IN A FOWLER’S POSISTION to assist with ventilation while someone calls the HCP. • The NORMAL PACO2= 35-45. If elevated that means the patient is holding onto CO2 and is shallow breathing. • FOWLER’S position gives the pt maximum lung capacity. • Nonrebreather mask- one or both side vents closed to limit the mixing of room air with oxygen. The vents open to allow exhalation but remain closed on inhalation. The reservoir bag has a valve to store oxygen for inhalation but does not allow entry of exhaled air. It is used to deliver oxygen concentrations of 70% to 100%. Patient is breathing 100% oxygen. • MDI inhaler-using it more than prescribed can cause rebound bronchoconstriction, which results in worsening symptoms and/or death. Adrenergic bronchodilators can cause severe rebound bronchoconstriction and even death when used more often than prescribed. • Nursing care for chest tube drainage- The drainage system must always be kept upright and below the level of the chest to prevent backflow. • Vigorous bubbling in the water sealed chamber of chest drainage- may indicate a large air leak. Examine the entire system and tubing for air leaks and anticipate changing the whole tubing. • Suctioning Trach- MAX TIME IS 15 SECONDS OR LESS! (10 secs would be correct) • Alarms for ventilators- 1st thing to do is ASSESS the patient. o High pressure alarm=obstruction/kinking of tubing. o High-pressure alarms sound for higher-than-normal resistance to air flow. This might occur if the patient needs to be suctioned; if the patient is biting on the tube, coughing, or trying to talk; if tubing is kinked or otherwise obstructed; or if worsening respiratory disease causes decreased lung compliance. o Disconnected tubing causes a low-pressure alarm. • Different techniques to clear airways o Huff coughing: Instruct the patient to deep breath and cough. Instead of closing the glottis to generate a forceful cough, the patient should keep the glottis and mouth open, and use the abdominal muscles to create a series of forced expirations, moving air and mucus up the bronchial tree o The shorter “huff” is used to clear larger airways, such as the bronchus and throat o The longer “huff” held out for several seconds helps open and clear smaller airways, such as the bronchioles, which connect the alveoli to the bronchus. • Is stridor a respiratory emergency? YES!!!! Stridor=foreign body in airways or bronchospasms. • COPD- issues with getting co2 out of the body = RESPIRATORY ACIDOSIS. • Crepitus (“subcutaneous emphysema”) Rice Krispies under the skin when felt with the fingers- occurs when air leaks into the subcutaneous tissues. • Noninvasive test to measure patients Oxygen saturation (pulse oximetry) place on patient finger or ear) measures Hgb saturated with oxygen • If patient is on 2L nasal canula and has SOB and wants oxygen increased? What should the LPN do? Contact RN or respiratory therapist for guidance. • Simple face mask delivers oxygen at 40-60%. • Soiled chest tube dressing- put clean bandage over soiled dressing and contact the HCP. • If tubing is occluded with clots- contact HCP for specific orders • Therapeutic measures to help mobilize secretions- o MOVE, TURN & AMBULATE PT EVERY 2 HOURS • It is important for older patients to receive their pneumococcal vaccine because o Aging decreases lung defensive mechanisms like effective clearance, coughing and lung expansion. • Respiratory acidosis causes chronic lung disease (COPD) & shallow breathing. • Patients with COPD-barrel chest, clubbing nails, weight loss.