https:\/\/learnexams.com\/search\/study?query=<\/a><\/p>\n\n\n\nWhere do you put the stethoscope when assessing lung sounds?
Over tissue, NOT bone<\/p>\n\n\n\n
What should you tell a patient before a respiratory assessment?
That they will tire easily<\/p>\n\n\n\n
Why do we listen to lung sounds?
To detect adventitious sounds.<\/p>\n\n\n\n
What are the different types of lung sounds?
Crackles (crinkled paper) – high pitched, heard during inspiration, not cleared by cough.<\/p>\n\n\n\n
Rhonchi (rough) – rumbling, course sounds like a snore, during inspiration or expiration, may clear with coughing or suctioning<\/p>\n\n\n\n
Wheeze – musical noise during inspiration or expiration, usually louder during expiration<\/p>\n\n\n\n
When do you hold narcotics?
When respirations are less than 8\/min<\/p>\n\n\n\n
What are the normal number of respirations per minute?
12-20<\/p>\n\n\n\n
What is hypoxemia?
Inadequate o2 for metabolism<\/p>\n\n\n\n
What are the early signs of hypoxemia?
RAT – restlessness, anxiety, tachycardia\/tan homes<\/p>\n\n\n\n
Catching early signs is very important in hypoxemia.<\/p>\n\n\n\n
What are late signs of hypoxemia?
BED – bradycardia, extreme restlessness, dyspnea<\/p>\n\n\n\n
What are signs of hypoxemia in PEDS?
FINES- feeding difficulty, inspiratory strider, nares flares, expiratory grunting, sternal retractions<\/p>\n\n\n\n
What are two common conditions associated with hypoxemia
Hydrocarbonate +hypercapnia present due to hypoventilation and retent CO2<\/p>\n\n\n\n
What does hypoventilation and retention of CO2 cause is patients who are hypoxemic?
Hydrocarbonate + hypercapnia<\/p>\n\n\n\n
What therapy should you expect to see a patient with hypoxemia on?
Oxygen therapy FIRST, then oxygen therapy<\/p>\n\n\n\n
When do you put oxygen on?
When O2 level is 92% and below<\/p>\n\n\n\n
What can cause pulmonary edema?
Left ventricular failure, acute MI, or chronic HF<\/p>\n\n\n\n
What are early signs of pulmonary edema?
Early stage is treated with diuretics and reducing preload by placing patients in an upright position with feet & legs dependent<\/p>\n\n\n\n
How do you you reduce preload in patients with pulmonary edema?
By placing patient upright position with feet & legs dependent<\/p>\n\n\n\n
What is used to treat pulmonary edema?
Oxygen \u2014 to relieve hypoxemia<\/p>\n\n\n\n
Diuretics \u2014 promise excretion of sodium and water, furosemide or another loop diuretic given IV push or as continuous infusion<\/p>\n\n\n\n
Vasodilators \u2014 Iv nitroglycerin or nitroprusside for symptom relief, contraindicated in patients who are hypotensive<\/p>\n\n\n\n
What teaching is important for patients who are hypoxemic using oxygen therapy?
Deep breathing techniques.<\/p>\n\n\n\n
For what patients are vasodilators contraindicated for?
Hypotensive<\/p>\n\n\n\n
Why are vasodilators are used in patients with pulmonary edema?
IV nitroglycerin or nitroprusside for symptom relief<\/p>\n\n\n\n
Patho phys of respiratory failure
Inadequate gas exchange<\/p>\n\n\n\n
Hypoxemia patho
Decrease in arterial oxygen tension (PaO2) to less than 60 mmHg.<\/p>\n\n\n\n
Decrease in arterial O2 saturations<\/p>\n\n\n\n
What is hypercapnia?
Increase in arterial carbon dioxide tension (PaCO2) to greater than 50 mmHg<\/p>\n\n\n\n
Increase in arterial O2<\/p>\n\n\n\n
What is the cause of hypoxemic respiratory failure
Oxygen failure aka lung failure<\/p>\n\n\n\n
O2 < 60 mmHg on 60% oxygen<\/p>\n\n\n\n
True or false: hypoxemic respiratory failure is acute, lasting from minutes to hours.
True<\/p>\n\n\n\n
True or false: chronic hypoxemic respiratory failure lasts several days or longer.
True.<\/p>\n\n\n\n
What are the causes of respiratory failure?
Ventilation-perfusion mismatch.
Shunt
Diffusion
Alveolar hypoventilation<\/p>\n\n\n\n
What is hypercapnic respiratory failure?
AKA ventilation failure (pump failure)<\/p>\n\n\n\n
It is caused by an imbalance between ventilator supply or demands<\/p>\n\n\n\n
O2 >45 mmHg and pH <7.35<\/p>\n\n\n\n
What are the causes of hypercapnic respiratory failure?
Imbalance between ventilators supply and demand<\/p>\n\n\n\n
Airway\/alveoli (emphysema, asthma, cystic fibrosis)<\/p>\n\n\n\n
CNS (drug OD, brain stem infarction, spinal injury<\/p>\n\n\n\n
Chest wall and neuromuscular conditions<\/p>\n\n\n\n
Can a patient have both hypoxemic respiratory failure and hypercapnic respiratory failure at the same time?
Yes<\/p>\n\n\n\n
What are the diagnostic studies for respiratory failure?
1st – history and physical assessment
Most definitive \u2014 ABG analysis<\/p>\n\n\n\n
What is the most definitive diagnostic study for respiratory failure?
ABG analysis<\/p>\n\n\n\n
What is the treatment of respiratory failure?
Bronchodilators to reduce inflammation<\/p>\n\n\n\n
Corticosteroids to reduce pulmonary congestion<\/p>\n\n\n\n
Diuretics, nitrates if HR present<\/p>\n\n\n\n
IV antibiotics if treating underlying pulmonary infection<\/p>\n\n\n\n
Benzodiazepines and narcotics to reduce anxiety, pain, agitation<\/p>\n\n\n\n
pulmonary embolism (PE) patho phys
Refers to the obstruction of the pulmonary artery or one of its branches by a thrombus (or thrombi) that originates somewhere in the venous system or in the right side of the heart; common disorders of DVT<\/p>\n\n\n\n
DVT pathophysiology
A related condition, refers to thrombus formation in the deep veins, usually in the calf or thigh but sometimes the arm, especially in patients with peripherally inserted central veins<\/p>\n\n\n\n
VTE (venous thromboembolism)
Is a term that includes both DVT and PE<\/p>\n\n\n\n
the biggest concern of VTE is the clot breaking off<\/p>\n\n\n\n
What is the treatment of a pulmonary embolism<\/p>\n\n\n\n
1 priority is to give the patient oxygen via nasal cannula to relieve hypoxemia, respiratory distress, and central cyanosis<\/h1>\n\n\n\n
What is the surgical management for patients who have pulmonary embolisms?
Surgical embolectomy indicated for massive PE or hemp dynamic instability or contraindications to thrombolytic therapy<\/p>\n\n\n\n
Inferior Vena Cava (IVC) filter
May be inserted in patients who have contraindications to therapeutic anti coagulation or in recurrent PE occurs<\/p>\n\n\n\n
When is a inferior vena cava filter recommended?
If the patient has recurrent PEs<\/p>\n\n\n\n
How do you prevent thrombus formation?
Encourage ambulation,
Acting + passive exercises if bedridden
Advise patients not to lie or sit for prolonged periods, cross legs, or west constrictive clothing
Intermittent pneumatic compression (IPC) devises – sleeves place on legs that inflate
Keep patient supine, legs should not dangle, feet resting on floor or chair
DONT leave IV Caths in for long periods of time
All increase venous flow and decrease venous stasis<\/p>\n\n\n\n
What are the signs and symptoms of anPE
Extremities evaluated for warmth, redness, inflammation<\/p>\n\n\n\n
Pleurititc chest pain, hemoptysis, shortness of breath and collapse, features of DVT, hypotension, tachypnea, raised jugular venous pressure, focal chest signs<\/p>\n\n\n\n
1 is shortness of breath, anxiety, fever, tachycardia, cough, diaphoresis, syncope, hemoptysis<\/h1>\n\n\n\n
What is long term treatment for pulmonary embolism?
Long term: Warfarin (Coumadin)<\/p>\n\n\n\n
What labs does a patient on warfarin need and how often do they need them?
They need their labs drawn for INR and they have a higher risk for bleeding risks<\/p>\n\n\n\n
What is given if INR is high and there is a risk for bleeding?
Vitamin K<\/p>\n\n\n\n
acute respiratory distress syndrome (ARDS) patho phys
Severe: characterized by alveolar damage that results in hypoxemia that is unresponsive to supplemental oxygen<\/p>\n\n\n\n
Associated factors in development if ARDS
Direct injury to lungs: smoking, pneumonia, aspiration, inhaling toxins, drowning, embolism<\/p>\n\n\n\n
Or indirect injury to lungs (shock)<\/p>\n\n\n\n
Nursing management for ARDS
Patient is critically ill and requires close monitoring in ICU. If patient is on ventilator then will need frequent assessment, monitoring, and repositioning<\/p>\n\n\n\n
Repositioning patient improves ventilation + perfusion in lungs & enhances secretion drainageC closest monitor patient for deterioration in o2 status with position changes<\/p>\n\n\n\n
What position should you place a patient with ARDS in to improve ventilation?
Prone position (upright position by RN) leaning, legs dangles, decreases venous return shunting blood away from the lungs<\/p>\n\n\n\n
True or false: patients may be anxious and fight the ventilator
True<\/p>\n\n\n\n
If PEEP can’t be maintained despite using sedatives, whag is given to the patient that will paralyze them?
Vecuronium (paralytic agent)<\/p>\n\n\n\n
Takes effect in 3-5 minutes, lasts 25-45 minutes<\/p>\n\n\n\n
Allow the patient to ventilate easier, paralyzes them so they appear unconscious, can’t breath, talk, blink independently although they are awake and able to hear<\/p>\n\n\n\n
Used for the shortest time possible<\/p>\n\n\n\n
RELAXES vocal cords<\/p>\n\n\n\n
What is the “train-of-four” test?
It is used to measure the level of neuromuscular blockade<\/p>\n\n\n\n
Four consecutive stimuli are delivered along the path of the nerve and response of the muscle is measured. Tells us whether stimuli are effectively blocked. If no twitches, then muscle is effectively blocked.<\/p>\n\n\n\n
What is the medical management for ARDS?
Supplemental oxygen used as patient begins initial sporran, then endotracheal intubation and mechanical ventilation are intimated.<\/p>\n\n\n\n
How do you treat respiratory acidosis
With sodium bicard<\/p>\n\n\n\n
How do you treat respiratory alkalosis:
Have patient inhale 5% of CO2 or rebreather expired air<\/p>\n\n\n\n
What are normal ranges for hemoglobin and hematocrit?
HbG: women: 12.0-15.5) men are 14.5-17.5
HcT: 35%-47% and for men it’s 39-40<\/p>\n\n\n\n
Dehydration is commonly seen in?
Older adults on lots of diuretics<\/p>\n\n\n\n
What is a normal sodium level:
135-145 mEq\/L<\/p>\n\n\n\n
Suctioning
FVD and hyponatremia<\/p>\n\n\n\n
Hypernatremia
: when sodium bicarbonate is administered to the patient with acid-base imbalance. It increases the risk for having hypernatremja<\/p>\n\n\n\n
What do you give to patients who have hyperkalemia?
Kayexalate \u2014 polystyrene. If the insulin is too high then we result to insulin after works<\/p>\n\n\n\n
Medication is brown tan and smells bad<\/p>\n\n\n\n
Insulin moves potassium back into the cell. From ECF to ICF<\/p>\n\n\n\n
Magnesium:
1.5-2.5<\/p>\n\n\n\n
What will develop with hypermagnesium
Renal failure<\/p>\n\n\n\n
Hypomagnesemia
Associated with neuromuscular irritability which suggests that a patient may be at risk for seizures<\/p>\n\n\n\n
VTE
Is a tweak that includes both DVT and PE<\/p>\n\n\n\n
What is the #1 treatment of PE?
The first priority is oxygen via nasal cannula to relieve hypoxemia, respiratory distress, and central cyanosis’<\/p>\n\n\n\n
When is a inferior Vena cava (IVC) filter used?
It is used if the patient has a contraindication to anticoagulants, or if the patient has had a recurrent PE<\/p>\n\n\n\n
What is a inferior vena cava filter?
It provides a screen in the IVC, allowing bood to pass through while large emboli from pelvis or lower extremities are blocked or fragmented before reaching the lung<\/p>\n\n\n\n
Patient ARDS is critically I’ll and requires close monitoring in ICU \u2014 true or false and
true<\/p>\n\n\n\n
What position are patients with ARDS put in?
The prone position, this improves oxygenation. Devices, specialty beds assist RN in placing patient in this position.<\/p>\n\n\n\n
Place the patient in a prone position (upright<\/p>\n\n\n\n
What is the prone position and why?
Upright position, leaning, legs dangling, decreases Venous position return by shunting blood away from the lungs<\/p>\n\n\n\n
True or false: patients may be anxious and fight the ventilator
True<\/p>\n\n\n\n
What is PEEP?
positive end expiratory pressure<\/p>\n\n\n\n
If PEEP cannot be maintained patient with ARDS despite sedatives, what is commonly used?
Paralytic agents, typically vecuronium<\/p>\n\n\n\n
Vecuronium
Takes effect in 3-5 minutes and lasts about 25-44 minutes<\/p>\n\n\n\n
Allows patient to ventilate easier, paralyzes them so they appear unconscious, can’t breath, talk, blink independently although they are awake and can’t hear<\/p>\n\n\n\n
Reassure patient that this feeling is temporary and used for the shortest time possible<\/p>\n\n\n\n
This relaxes the vocal cords<\/p>\n\n\n\n
Use a train of four method<\/p>\n\n\n\n
What is the train of four?
It is used to test the level of neuromuscular blockade<\/p>\n\n\n\n
4 consecutive stimuli are delivered along the path of a nerve and the response of the muscle is measured to detect if the nerve is blocked effectively<\/p>\n\n\n\n
How do you know if a nerve is effectively blocked?
Using the train of 4 \u2014 if there are no twitches then 100% of the receptors are blocked<\/p>\n\n\n\n
When is endotracheal intubation for ARDS?
When the hypoxemia progresses, endotracheal intubation and mechanical ventilation are initiated<\/p>\n\n\n\n
What does PEEP do?
Peep increases functional residual capacity and reserves alveolar collapse by keeping the alveoli open, resulting in improved arterial oxygenation and reduced severity of the V\/Q imbalance<\/p>\n\n\n\n
Ventilator associate pneumonia
Occurs in 70% of patients with ARDS<\/p>\n\n\n\n
Commonly develops after 48 hours or more of mechanical ventilation<\/p>\n\n\n\n
Most cases result from aspiration of bacteria from mouth or GI tract<\/p>\n\n\n\n
This complicated ARDS patients recovery, requires longer duration of ventilation, longer staying<\/p>\n\n\n\n
Pharmacological management of ARDS
ARDS causes pulmonary edema, so we give looo diuretics \u2014 Furosemide<\/p>\n\n\n\n
NORMAL arterial blood pH
7.35-7.45<\/p>\n\n\n\n
normal ABG O2
Measures partial pressure of oxygen that is dissolved in plasma<\/p>\n\n\n\n
80-100<\/p>\n\n\n\n
Normal ABG CO2 level
Partial pressure of CO2 in arterial blood 35-45<\/p>\n\n\n\n
Normal ABG HCO3
22-26<\/p>\n\n\n\n
What are the three lines of defense the body has for fluid imbalance
1st line of defense = buffers<\/p>\n\n\n\n
Acts as sponge, soaks up hydrogen ions when too much present \u2014 squeezes them out when too little are present<\/p>\n\n\n\n
2nd line of defense = respiratory system<\/p>\n\n\n\n
After hypo\/hyperventilating changes amount of CO2, compensated within seconds after change in pH.<\/p>\n\n\n\n
If the patient has COPD, this fails and patient only has 2 lines of defense<\/p>\n\n\n\n
3rd line of defense = renal system<\/p>\n\n\n\n
More powerful, kicks in 24-48 hours, kidneys move bicarb, form acids, form ammonium which all can increase excretion and reabsorption rates of acids or bases, depending of the direction of the PH<\/p>\n\n\n\n
If the patient has kidney disease, this system fails. If the patient has COPD + kidney disease the patient is in trouble<\/p>\n\n\n\n
What lab levels do acute and chronic metabolic acidosis?
Calcium. Metabolic acidosis can result in low calcium levels<\/p>\n\n\n\n
What can low calcium lead to, and why is it important to be supplemented before correcting acidosis?
Low calcium can result in tetany and death, so it should be supplemented prior to correcting acidosis<\/p>\n\n\n\n
Chronic metabolic acidosis is associated with?
Hypocalcemia. Treat this before chronic metabolic acidosis is treated to avoid tetany resulting from any increase in pH and decrease in ionized calcium<\/p>\n\n\n\n
What is given with metabolic acidosis?
Alkalizing agents<\/p>\n\n\n\n
Acute and chronic metabolic alkalosis
Metabolic equal, respirations normal<\/p>\n\n\n\n
What symptoms should you focus on?
Tingling of fingers and toes can indicate patients has this<\/p>\n\n\n\n
Chronic metabolic alkalosis due to long-term loss of acid (long-term use of diuretics<\/p>\n\n\n\n
What is a common cause of metabolic alkalosis
vomiting or gastric suction<\/p>\n\n\n\n
Acute and chronic respiratory acidosis
Respiratory opposite<\/p>\n\n\n\n
What conditions lead to chronic respiratory acidosis?
Emphysema, sleep apnea, bronchitis, obesity can impair gas exchange and can cause retention of carbon dioxide with leads to respiratory chronic respiratory acidosis (can not get rid of these diseases)<\/p>\n\n\n\n
COPD and respiratory acidosis
Gradually accumulate CO2 over prolonged days to months, may not develop symptoms of hypercapnic due to compensatory renal changes have time to occur<\/p>\n\n\n\n
Acute and chronic respiratory alkalosis
Caused by hyper ventilation \u2014 patient blows off excessive amounts of carbon dioxide which creates an alkaline environment<\/p>\n\n\n\n
As an RN it is my job to monitor for respiratory acidosis<\/p>\n\n\n\n
How do you treat metabolic acidosis?
Treat with sodium bicarbonate<\/p>\n\n\n\n
Correct respiratory impairment<\/p>\n\n\n\n
How do treat respiratory alkalosis?
Treat by having patient inhale 5% CO2 or rebreathe their expired air<\/p>\n\n\n\n
When do hemoglobin and hematocrit levels change?
At age 65+<\/p>\n\n\n\n
What are normal ranges for hemoglobin?
Women: 12.0-15.5<\/p>\n\n\n\n
Men: 13.5 – 17.5<\/p>\n\n\n\n
What are normal hematocrit levels?
Women: 35-47%<\/p>\n\n\n\n
Men: 39-50%<\/p>\n\n\n\n
Fluid volume deficit \u2014 aka dehydration are common in what patients?
Patients who are 65+ and on diuretics<\/p>\n\n\n\n
What can suctioning lead to?
Fluid volume deficit and hyponatremia<\/p>\n\n\n\n
What is normal sodium levels?
135-145<\/p>\n\n\n\n
What is a concern when administering sodium bicarbonate to a patient with an acid-base imbalance?
Hypernatremja<\/p>\n\n\n\n
How does insulin affect potassium?
It moves the potassium from ECF back into the ICF<\/p>\n\n\n\n
How do you treat metabolic alkalosis?
Treat it with an infusion of sodium chloride plus potassium chloride<\/p>\n\n\n\n
Severe cases – infused .1% hydrochloric acid of ammonium chloride<\/p>\n\n\n\n
Why is insulin given to patients with hyperkalemia?
Insulin is given if the patient does not respond to kayexalate.<\/p>\n\n\n\n
\n- <\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"
Exam 2: NSG223\/ NSG 223 (Latest 2024\/ 2025 Update) Med Surg 2 Exam| Questions and Verified Answers| 100% Correct| Grade A- Herzing Exam 2: NSG223\/ NSG 223 (Latest 2024\/2025 Update) Med Surg 2 Exam| Questionsand Verified Answers| 100% Correct| GradeA- HerzingQ: What does hypoventilation and retention of CO2 cause is patients who are hypoxemic?Answer:Hydrocarbonate + […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[25],"tags":[],"class_list":["post-131398","post","type-post","status-publish","format-standard","hentry","category-exams-certification"],"_links":{"self":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts\/131398","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/comments?post=131398"}],"version-history":[{"count":0,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts\/131398\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/media?parent=131398"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/categories?post=131398"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/tags?post=131398"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}