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What mechanisms result in inhalation?
diaphragm contracts in response to the phrenic nerve
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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
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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
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How would you document a pt who becomes SOB while ambulating to the bathroom?
- Exertional dyspnea
- o2 sat
- o2 literage
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What does othropneic position mean?
Sitting upright, leaning forwards, arms over table top to make it easier to breath
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Your patient has a productive cough, what color sputum would concern you the most if seen?
Pink & Frothy
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Patient with pneumonia is expectorating thick green sputum. What is your highest priority?
Offer fluids
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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
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You enter a room to find your pt breathing rapidly & gasping. What should you do first?
- Call for help
- Assess reasoning
- Calm pt down
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Which pt with which diagnoses would you place at highest priority?
25, diaphroetic, hypoxia, and pneumonia
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Your pt has a RR of 22 & appears pale. What would be your first action?
Check the pulse ox
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Your pt has an ineffective week cough. How would you obtain a specimen?
Attempt to collect in the morning
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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
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How do you draw an ABG?
- 90 degree angle
- radial artery
- needle & syringe
- ice
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how would you teach your pt to use their incentive spirometer?
- slow & deep breathe
- q 1hr x 10
- 3 balls up
- repeat demo
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Explain how you use a nebulizer
- close lips on mouth piece
- breathe in through mouth, out through nose
- turn on & see mist for prep
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You notice a trach cuff is deflated. What would be your first action?
inflate the cuff
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How would you suction a pt with an ET tube?
Using sterile procedure because you are going deep in the trachea
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Trach pt is coughing thin, pale green mucus. What would be your first action?
Suction
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Why is there more drainage in the upper chest tube?
The upper tube is for air, the lower tube is for blood & pus
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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
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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
- Respirations
- Pulse ox
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Chest tube pt is hooked up to 20cm suction. What sign would be most concerning to you?
chamber must be filled to 20
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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
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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
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What signs would you look for that would require you to suction a pharyngeal airway?
- SOB
- crackling
- rattling
- ineffective cough
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With nasopharyngeal and oropharyngeal suctioning, how long would you keep your thumb on the suction vavle?
10 seconds
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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
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What stimulates the COPD pt to breath?
low o2 in blood
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what is incentive spirometry used for?
- lung expansion
- prevents atelectasis and pneumona
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what has to happen in order for the lungs to expand when the chest expands?
maintain neg. pressure in the pleural cavity
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when caring for a trach pt, what information would you need to review prior to meeting the pt?
purpose & type
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your pt has pseudomonas pneumonia and is expectorating thick secretions. what signs would you be most concerned about?
s&s of hypoxia
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what should a respiratory assessment include?
- color of skin and mucous membrane
- cough
- o2 sat
- resp. effort
- chest
- appearance
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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
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how many liters of o2 would a copder be placed on?
2 to 3
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what is the purpose of teaching your pt about purse lip breathing?
- blows of excessive CO2
- facilitates max expiration
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name conditions where impaired oxygenation could happen?
- obstruction
- anemia
- atelectasis
- decreased cardiac output
- increased altitude
- hypoventilation
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What does an ABG tell you about the pts blood level
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