Skills Ch. 28
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. What would you like to do?
What mechanisms result in inhalation?
diaphragm contracts in response to the phrenic nerve
What sings would you look for while caring for a pt with elevated CO2 blood level?
- Blood acidic
- chemo receptors->medulla->Res. increase to blow off CO2
While caring for a pt with a long standing history of COPD, what signs would you most be concerned about?
Agitation, anxiety, change in LOC, HA, disoriented, irritability, restlessness, tachypnea, bradycardia, cyanosis, retraction
How would you document a pt who becomes SOB while ambulating to the bathroom?
- Exertional dyspnea
- o2 sat
- o2 literage
What does othropneic position mean?
Sitting upright, leaning forwards, arms over table top to make it easier to breath
Your patient has a productive cough, what color sputum would concern you the most if seen?
Pink & Frothy
Patient with pneumonia is expectorating thick green sputum. What is your highest priority?
Your pt has a chest tube in place. On assessment you palpate crepitus at chest tube site. Your pt is very upset. What would be your reply to the pt?
- Explain the pt has air in the subcutaneous tissue
- Call MD to check
You enter a room to find your pt breathing rapidly & gasping. What should you do first?
- Call for help
- Assess reasoning
- Calm pt down
Which pt with which diagnoses would you place at highest priority?
25, diaphroetic, hypoxia, and pneumonia
Your pt has a RR of 22 & appears pale. What would be your first action?
Check the pulse ox
Your pt has an ineffective week cough. How would you obtain a specimen?
Attempt to collect in the morning
Pt or family questions you about why a throat culture needs to be obtained. How would you response?
a culture is done to determine which med will be effective
How do you draw an ABG?
- 90 degree angle
- radial artery
- needle & syringe
how would you teach your pt to use their incentive spirometer?
- slow & deep breathe
- q 1hr x 10
- 3 balls up
- repeat demo
Explain how you use a nebulizer
- close lips on mouth piece
- breathe in through mouth, out through nose
- turn on & see mist for prep
You notice a trach cuff is deflated. What would be your first action?
inflate the cuff
How would you suction a pt with an ET tube?
Using sterile procedure because you are going deep in the trachea
Trach pt is coughing thin, pale green mucus. What would be your first action?
Why is there more drainage in the upper chest tube?
The upper tube is for air, the lower tube is for blood & pus
The pts saO2 is 87% while on O2 @ 6L/min & is beginning with early stages of hypoxia. What should you do first?
Simple face mask
Before you ambulate a pt who has severe COPD to the bathroom, what assessment would you do to first see if he is able to tolerate the activity?
- lung soungs
- S&S of hypoxia
- Pulse ox
Chest tube pt is hooked up to 20cm suction. What sign would be most concerning to you?
chamber must be filled to 20
you are caring ofr a pt with pneumothorax & newly inserted chest tube to dry suction. you notice bubbles in middle chamber. what would be observed on rationale for the bubbles being present?
- air is leaving the chest cavity
- no bubbles = pneumothorax resolved
A pt has a history of allergies and allergy to pets. What diagnostic instrument would be useful for the family to use to monitor pts condition?
peak flow meter
What signs would you look for that would require you to suction a pharyngeal airway?
- ineffective cough
With nasopharyngeal and oropharyngeal suctioning, how long would you keep your thumb on the suction vavle?
What would your observation while caring for a pt who has a chest tube & hooked to 20 cm? What signs would concern you the most?
- water level
- kinks in tubing
- asses for clots
- assess tube patency
What stimulates the COPD pt to breath?
low o2 in blood
what is incentive spirometry used for?
- lung expansion
- prevents atelectasis and pneumona
what has to happen in order for the lungs to expand when the chest expands?
maintain neg. pressure in the pleural cavity
when caring for a trach pt, what information would you need to review prior to meeting the pt?
purpose & type
your pt has pseudomonas pneumonia and is expectorating thick secretions. what signs would you be most concerned about?
s&s of hypoxia
what should a respiratory assessment include?
- color of skin and mucous membrane
- o2 sat
- resp. effort
what would you include in your plan of care for a pt who has COPD and is going home with follow up services?
- energy conservation
- shower chair
- frequent rest periods
- sm. frequent meals
- teach fam. to asses for retractions
how many liters of o2 would a copder be placed on?
2 to 3
what is the purpose of teaching your pt about purse lip breathing?
- blows of excessive CO2
- facilitates max expiration
name conditions where impaired oxygenation could happen?
- decreased cardiac output
- increased altitude
What does an ABG tell you about the pts blood level
What would you like to do?
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