HCC 2008 Oxygenation, Rest and Sleep
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| What is Rest? how does it differ from sleep? | a state of physical and mental relaxation while being awake and alert
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| What is sleep? how does it differ from rest? | reversible behavioral state in which perceptions of and responses to environmental stimuli are decreased
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| RAS stands for | Reticular Activating System
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| What is RAS responsible for? | awareness, consciousness, wakefulness, and arousal
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| increased activity causes | wakefulness
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| decreased activity causes | sleep
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| what is the circadian rhythm | changes in mental and physical characteristics that occur throughout a day, "biological clock"
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| How many stages of NON REM sleep are there? | 5: Transitional, Stage II Non REM, Stage III, NREM Sleep- Delta, REM sleep
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| What might occur during Stage I Transitional Sleep? | 1. person is relaxed but still aware of surroundings 2. involuntary muscle twitching last only minutes 3. easily aroused 4. about 5% of total sleep
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| What occurs during Stage II Non REM? | 1. more relaxed 2 easily awakened 3. 50-55% of sleep times
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| What occurs during Stage III of sleep? | 1. Depth of sleep increases 2. arousal more difficult 3. loss of muscle tone- muscles are more relaxed 4. reflexes diminished 5. snoring occurs
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| What occurs during Stage IV NREM Sleep- Delta? | 1. Greatest depth of sleep? 2. Difficult to arouse 3. Slow brain waves 4. Pulse, RR, BP, and body temp all decrease 5. Muscles are relaxed 6. Metabolism slows 7. about 10% of sleep time
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| What occurs during REM sleep? | 1. Pulse, BP, Temp, and metabolic rate all increase 2. eyes dart back and forth 3. RR irregular, large muscle immobility, resembling paralysis 4. Skeletal muscles tone and deep tendon reflexes are depressed 5. 20-25% of sleep 6. Dreaming
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| How long to cycles last? | about 90 min., they lengthen closer to the morning, adults go through about 5-6 cycles a night
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| What are some factors affecting sleep? | developmental considerations, activity, stress, motivation, cultural, nutritional, smoking, environmental, lifestyle, exercise, illness hospitalization, medications
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| Dyssomnia | excessive sleepiness
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| Restless Leg Syndrome | creeping, crawling sensation in legs
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| Sleep Apnea | Temporary loss of breathing for 10-20 seconds, MAY be as long as 1 minute
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| Insomnia | inability to sleep while lying down
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| Narcolepsy | uncontrolled episodes of sleep and drowsiness
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| Sleep Deprivation | decreased amount, consistency or quality of sleep
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| Hypersomnia | excessive sleep during the day
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| What is a CPAP Device? | Constant Positive Airway Pressure- fits tight to the face and delivers a stream of compressed air that "splits" the airway open
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| What are Parasomnias? | abnormal activities during sleep mostly in children BEST
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| Bruxism | grinding of teeth during sleep
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| Enuresis | bed wetting
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| Somnambulism | sleep walking
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| Talking sleep | talking while sleeping
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| What are somethings to ask when taking a sleep history? | usual sleep and wake times, # of hrs undisturbed sleep, quality of sleep, how does lack of sleep affect everyday living, what are the related signs and symptoms
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| What is a sleep diary? | a detailed record of when patient retires to bed, when they fall asleep, when they wake up, relationship to stress, physical activity...taken over about 14 days
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| What are some medications that promote sleep? | Ambien, Antiolytics (valium, benedryl), Antidepressants
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| Airway is priority... | ONE
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| What are some factors affecting respiratory functioning? | levels of health, developmental considerations, medications, lifestyle, environmental, psychological health (anxiety)
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| What are developmental considerations for an infant | RR 30-60/mins; irregular, abdominal breathing, chest wall thin muscles not developed, crackles on inspiration
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| What are developmental considerations for someone over 65 yrs? | airways more rigid, respiratory muscles weakened
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| Medications that might affect respiratory functioning? | Opioids suck as; meperidine(demerol), Morphine (depress the rep center, decrease in the rate and depth of respirations)
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| How does smoking affect respiratory functioning? | greatest risk factor in pulmonary disease, increases airway resistance, reduces ciliary action, thickening of alveolar membrane
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| how does stress affect respiratory functioning? | anxiety interfere with breathing, breathing problems cause anxiety
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| how does activity affect respiratory functioning? | immobility leads to atelectasis, pooling of secretions, and risk for pneumonia
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| how does obesity affect respiratory functioning? | interferes with ling expansion, higher incidence of pulmonary disorders
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| what are some environmental risks that can affect respiratory functioning? | allergens, bronchospasms, pollution- chemicals, asbestos, fumes, stay inside use AC on high pollution days, wear mask when working with fumes and dust
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| how can psychological health affect respiratory functioning? | hyperventilation- caused by anxiety, fever... Low CO2 level-asthma, breath into a paper bag
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| What are the first symptoms of hypoxia for adults? | change in mental status- restlessness, anxiety, agitated, confused
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| What are the first symptoms of hypoxia for pediatrics? | feeding difficulty, inspiratory strider, nares flare, expiratory grunting, sternal retractions
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| What is hypoventilation? | decreased rate or depth of air movement
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| what causes hypoventilation? | narcotic analgesics, depressed respiratory center
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| What is atelectasis? | collapse of alveoli preventing exchange of oxygen and carbon dioxide
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| what condition(s) predispose a patient to atelectasis? | surgery, pnemonia, airway condition, pneumothorax
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| What is the purpose of pulmonary function tests? | measure lung capacity, lung volume and flow rate
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| What is the purpose of Sputum Analysis? | to determine the presence of abnormal cells, with sensitivity when suspect pneumonia, Sputum for AFB detects Tuberculosis
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| When is the best time to collect a sputum specimen? | in the morning, rinse mouth prior to collecting specimen
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| What is an Endoscopy? | a direct visualization of the body cavity
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| what is a bronchoscopy? | examination of the bronchi
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| What is a endoscopy/bronchoscopy used for? | to look for tumors of lesions, obtain a biopsy, remove foreign substances
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| What patient prep is required for an endoscopy? | informed consent, patient teaching, NPO 6-8 hrs before procedure, sedative may be prescribed
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| What is required for post-procedure care after and endoscopy? | NPO until gag reflex returns, check vital signs, observe for respiratory distress, warm saline gargles to relieve throat irritation
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| What views are needed for a chest x-ray? | PA (posterior-anterior) and Lateral
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| What are some nursing implications for a chest x-ray? | no clothing or jewelry from waist up, client hold their breath for a clear image
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| What is a VQ scan? | Ventilation and Perfusion scan, used to identify areas of lung not receiving airflow or blood flow and to diagnose pulmonary emboli
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| What happens during a VQ scan? | radioscope is injected into vein, client inhales radioactive gas
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| What is a Thoracentesis used for? | to diagnosis or to remove excess fluid in the lung
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| What is the position for a thoracentesis? | sit at bedside with arms folded over bedside stand. Lie on unaffected side with opposite arm raised above shoulder
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| What are the nurses responsibilities for a thoracentesis? | instruct patient not to cough or deep breath during the procedure, position the patient, baseline VS and SaO2, monitor respiratory status, CXR after procedure
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| What are signs and Symptoms of Punctured lung? | dyspnea, bloody sputum, cough, absent breath sounds
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| What is the best position for lung expansion? | High Fowlers; dont let patient slouch over
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| What is Deep breathing? | breath deeply enough to move bottom ribs, inspire through nose hold for 3 seconds, expire slowly through the mouth YOGA
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| What is Pursed-lip breathing? | prolonged exhailation, promotes removal of CO2, purse lips(blow out candle or whistle), inhale slowly (count to three), exhale slowly for count of 7 against pursed lips
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| What is Diaphragmatic breathing? | expand diaphragm on inspiration,
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| What is splinting? | pillow/blanket to support painful are when moving or during breathing exercises, enables client to participate in C & DB and incentive spirometry
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| What is a Incentive Spirometry? | meant to help you breath more deeply, measures strength/depth of inspiration, re-expnads collapsed alveoli
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| What is the purpose of coughing? | clears the airway of secretions, voluntary coughing for post-operative clients
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| What is the difference between a dry and a productive cough? | a productive cough has secretions
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| What does Suctioning do? | removes pooled secretions
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| What does Chest Physiotherapy do? | helps loosen secretions with percussion and vibration
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| What is Postural Drainage? | position the patient to promote drainage of secretions from smaller to larger pulmonary branches
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| How can Nutrition help with drainage? | fluids help liquefy and thin secretions, meal schedule
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| What does an oxygen order include? | type of device, amount; flow rate in liters per minute or percentage, frequency
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| What are some safety precautions when using oxygen? | signs on door "oxygen in use", no combustible or flammable chemicals, no smoking, check equipment, use water-soluble lubricant on nares, store tanks safely-upright in stand and use correctly
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| What is a nasal cannula? | flow rate 1-6 L/min, goes straight into nares and used for clients requiring low doses, does not interfere with speaking or eating, easily dislodged, can cause dryness of nasal mucosa, portable systems; used in home setting
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| Face mask? | concentration 35-60%, set low rate to at least 5L/min to prevent rebreathing exhaled air...snug fit to patients face; cover nose and mouth, disadvantages; interfere with eating and talking, need an MDs order to switch to NC while eating, pressure and mois
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| Venturi mask | precise concentrations of O2, port and flow rate are adjusted to deliver prescribed concentration; ex 28% Venturi mask flow rate is set at 4L/min, adjustable ports must always remain open/uncovered
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| Partial Rebreather Mask | reservoir bag collects part of exhaled air and mixes it with O2 remaining exhaled air goes through vents, set flow rates so that reservoir bag remains 2/3rd full during inspiration, bag fills on expiration, flow rate; 6-15 L/min, concentration up to 90%
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| Non Rebreather Mask | used to deliver highest concentrations of O2 for severe hypoxia, valve b/w mask and bag that closes on expiration so no exhaled air is being re-breathed, exhaled air escapes through side vents, flow rate: 15L/min concentration is up to 100%
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| How are partial rebreather and Non rebreather masks similar? | both have reservoir bags, both use high flow rates
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| How are NRB and PRB masks different? | NRM has valve; reservoir bag remains inflated with O2...PRM has no valve; reservoir bag should deflate slightly with each inspiration
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| Metered Dose Inhaler | important to teach and review correct technique, improper technique equals an inadequate does of medications, worsening of respiratory status, label/mark inhalers to avoid confusing medications
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| Instructions for a MDI... | shake well, exhale, inhale slowly and deeply (3-5 seconds) while administering one puff, hold breath for 5-10 seconds, remove MDI from mouth before exhaling
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| How can you tell is an MDi is empty? | calculate number of doses left in canister
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| nebulizer | liquid medication is added to nebulizer cup. Patient inhales mist until medication is gone
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