NCLEX-RN Flashcards: Respiratory Nursing, Oxygen Therapy, Chest Tubes, Tracheostomy

Supplemental oxygen is indicated when pulse oximetry shows oxygen saturation below 94 percent in most adults, or below 88 to 92 percent in patients with chronic obstructive pulmonary disease who retain carbon dioxide. Delivery devices range from nasal cannula at 1 to 6 liters per minute delivering 24 to 44 percent oxygen, to simple face mask at 6 to 10 liters, to non-rebreather mask at 10 to 15 liters delivering up to 90 percent. Oxygen is a medication that requires a prescription. For COPD patients, excessive oxygen can suppress hypoxic drive and worsen carbon dioxide retention.

A chest tube is inserted into the pleural space to drain air, blood, or fluid and restore negative pressure for lung re-expansion. Key nursing assessments include monitoring for tidaling in the water seal chamber, which is normal fluctuation with respirations confirming tube patency. Continuous bubbling in the water seal chamber indicates an air leak. Check drainage color, amount, and consistency, reporting more than 200 milliliters per hour. Keep the drainage system below chest level at all times. Never clamp a chest tube without a provider order.

A pneumothorax is a collection of air in the pleural space that collapses the lung, caused by trauma, surgery, or spontaneous rupture of a bleb. Signs include sudden sharp chest pain, dyspnea, absent breath sounds on the affected side, tracheal deviation toward the unaffected side in tension pneumothorax, and hyperresonance to percussion. A hemothorax is a collection of blood in the pleural space, usually from chest trauma or surgery. Signs include dyspnea, decreased breath sounds, dullness to percussion, and signs of hypovolemia like tachycardia and hypotension.

Tracheostomy care includes maintaining a patent airway through suctioning as needed using sterile technique, cleaning the inner cannula at least every eight hours or more frequently, assessing the stoma site for redness, swelling, drainage, or skin breakdown, securing the ties snugly enough that only one to two fingers fit beneath them, keeping a spare tracheostomy tube of the same size and one size smaller at the bedside along with an obturator for emergency reinsertion. Humidified air or oxygen prevents drying and crusting of secretions.

Suctioning an artificial airway uses sterile technique. Hyperoxygenate the patient with 100 percent oxygen before suctioning. Insert the suction catheter without suction applied until resistance is met or the patient coughs, then withdraw slowly while applying intermittent suction, rotating the catheter. Limit each suctioning pass to 10 to 15 seconds to prevent hypoxia. Allow the patient to recover and reoxygenate between passes. Assess breath sounds before and after to evaluate effectiveness.

Incentive spirometry encourages deep breathing to prevent postoperative pulmonary complications, particularly atelectasis, which is the collapse of lung tissue from shallow breathing, pain-related splinting, and immobility after surgery. The patient takes a slow, deep breath through the mouthpiece, trying to raise the indicator to the prescribed level, holds the breath for three to five seconds to keep alveoli open, then exhales slowly. The exercise should be repeated 10 times per hour while awake. The nurse teaches proper technique preoperatively and assesses adherence postoperatively. ---