NCLEX RN -Respiratory Care Modalities

Oxygen concentration in room air21%
Hypoxemia vs. HypoxiaEmia:decreased oxygen in blood, Oxia:decreased oxygen supply to tissues
Manifestation r/t HypoxemiaChanges in mental status, Dyspnea, Increased BP, Changes in HR, Dysrhythmias
Late sign r/t HypoxemiaCentral cyanosis
Oxygen toxicity occurs whenToo high O concentration for an extended period of time



Hypoxemic vs. Circulatory vs. Anemic vs. Histotoxic HypoxiasHyp:decreased O in blood, C:inadequate capillary circulation, A:ineffective hemoglobin concentration, Histo:caused by toxic substance
Stimulus for respiration r/t COPDDecrease in blood O
Normal stimulus r/t RespirationElevated CO2
Cannula vs. Partial rebreather vs. Non-rebreather vs. Venturi r/t O flow rateC:1-6 L/min, P:8-11 L/min, N:12 L/min, V:4-8 L/min
Low-flow vs. High-flow oxygen delivery systemsLF:combines O w/Pt's inspiration & inspired O changes, HF:Pt's that require constant and precise amount of O
Reservoir bags must remain inflated duringInspiration and expiration
Non-rebreathing masks preventRoom air from entering mask during inhalation
Noninvasive mask that provides most reliable/accurate O concentrationVenturi mask
Venturi mask r/t COPDAccurate O supplementation avoid suppressing hypoxic drive
Amount of O dissolved in plasma r/t Hyperbaric O therapyO level in plasma increases, O levels in tissues increases
Humidity r/t O therapyCounteracts dry, irritating effects of compressed O, Moistens secretions
Method of deep breathing encouraging Pt to inhale slowly and deeplyIncentive spirometry
Incentive spirometry functionsMaximize lung inflation, Prevent/reduce atelectasis
Volume vs. Flow spirometersV:increases volume of inhaled air gradully & volume is pre-set, F:same function but volume is not pre-set
Proper breathing/Incentive spirometer positioningAt least semi-Fowlers
Breathing technique to prepare for nebulizer useDiaphragmatic breathing
Area of body r/t Diaphragmatic breathingAbd protrudes as far as possible
Time r/t Postural drainage2-4x a day, Before meals, Bedtime
Intervention d/t Pt inability to coughSunction secretions
Percussion technique r/t Secretion looseningCup hands and lightly strike chest wall, Wrists are alternately flexed
Technique that applies compression to chest wallVibration
Vibration is done while Pt isExhaling
Breathing retraining are exercises and practices to achieve more efficient and controlledVentilation & decrease work of breathing
Pt's in which breathing retraining is indicatedCOPD and dyspnea
Examples r/t breathing retraining exercisesDiaphragmatic breathing, Pursed-lip breathing
Pt's w/altered level of consciousness are at risk for ________ d/t _______Upper airway obstructions, Loss of protective reflexes and tone of pharyngeal muscles
Endotracheal intubation Pt indicationsCannot maintain adequate airway, Need mechanical ventilation, Secretion suctioning of pulmonary tree
Cuff pressures are checkedEvery 6-8 hours
Intubation is used no longer than3 weeks
Disadvantages r/t Endotracheal/Tracheostomy tubesDepressed cough reflex, Thicker secretions, Depressed swallowing reflex
Preventing tube removal by PtExplain purpose of tube, Distract Pt w/one-to-one interaction, Maintain comfort
Tracheostomy incision locationB/w 2nd and 3rd tracheal rings
Inflated portion of tracheostomy tubeCuff
Long-term complication r/t Tracheostomy tubeAirway obstruction, Infection, Innominate artery rupture, Dysphagia, Tracheoesophageal fistula, Ischemia, Necrosis
May develop after tracheostomy tube is removedTracheal stenosis
Tracheostomy tube is kept patent bySunctioning
Semi-fowler's position r/t Tracheostomy tubeFacilitate ventilation, Promote drainage, Minimize edema, Prevent strain on sutures
Sterility r/t Tracheostomy tubesPrevent pulmonary and systemic infections
Cuff pressure limits> 15 mm Hg, <25 mm Hg
Preventing complications r/t Tracheostomy tubesMaintain skin integrity, Maintain adequate hydration
Cotton applicators moistened w/__________ during wound cleansingHydrogen peroxide
Turned on before opening suction catheter kitSuction source
Suction catheter insertion depthJust far enough to stimulate cough reflex
Suction is applied whileWithdrawing
Mechanical ventilation indicationsContinuous decrease in PaO(hypoxemia), Increase in PaCO2(hypercapnia), Persistent acidosis
Most commonly used Positive-pressure ventilatorVolume-cycled ventilator
Volume-cycled ventilator r/t O deliveryVolume of air delivered is relatively constant
Examples r/t Noninvasive Positive-pressure VentilatorsNasal cannula and all masks
Bucking the ventilatorPt is out of sync w/ventilator
Humidifier levels are checked3x a day
Continuous positive-pressure ventilation r/t SecretionsSecretion production is always increased
Method to assess for secretionsLung ascultation at least every 2-4 hours
Prevent atelectasis and retention of secretions r/t VentilatorsPeriodic sighs
Permits talking r/t Mechanical ventilationPassy-Muir valve
Order r/t Respiratory weaningGradual removal of ventilator, Tube, Oxygen
Indications r/t Tube weaningPt can breathe spontaneously, Maintain patent airway, Effectively cough, Swallow, Move jaw
Supplemental O recommended when, PaO < 70 mm Hg on room air(blank)
PaO level r/t Medicare/Medicaid reimbursement< 55 mm Hg
Metabolism of fat vs. Metabolism of carbohydrates r/t CO2 productionFat metabolism produces less CO2
Postoperative risk factors r/t Surgery-related Atelectasis/PneumoniaImmobilization, Supine, Decreased consciousness, Prolonged intubation/mechanical ventilation
Re-expands lungs and Removes excess air/fluid/blood from pleural spacesChest tubes, Closed drainage systems
Fluid fluctuations stop whenLung has reexpanded, Tubing is obstructed, Suction is not properly working
Constant bubbling r/t Water seal chamberAir leak in drainage system
Drainage system r/t Pt chest levelSystem is kept below Pt chest level
Water level r/t InspirationWater level increase
Normal bubblingIntermittent

Previous Post
Next Post