NSG 310 Foundations Exam III Blueprint Spring 2020
Med Math – 6
Po meds
Sliding Scale Insulin
Oxygenation and Perfusion – 12
Orthopnea –difficulty breathing while lying down- typically in obese, COPD, heart failure, and
pregnant women
Hypoxia- inadequate tissue oxygenation at the cellular level, life threatening, causes: anemia, carbon
monoxide poisoning, septic shock, cyanide poisoning, pneumonia atelectasis, cardiomyopathy, spinal
cord injury, head trauma. Sign and symptoms: rapid pulse, rapid shallow respirations, dyspnea,
increased restlessness or light headedness, nasal flaring, substernal or intercostal retractions,
cyanosis, anxious, tired, leaning forward, fatigue, lethargy, clubbing
Hypoxemia- inadequate oxygen levels in the blood
Respiratory assessment
• Assess for risk factors
• Physical Exam: Assess pain, fatigue, dyspnea, rapid pulse, rapid respirations, nasal
flaring, substernal or intercostal retractions, cyanosis, breathing patterns, cough,
• Diagnostic testing: blood oxygenation, lab test, cardiac monitoring, spirometer,
sputum sample
Suctioning and follow-up assessment
When evaluating the patient after suctioning, assess and document physiologic and psychological
responses to the procedure. Convey your findings verbally during nurse-to-nurse shift report and to
the interdisciplinary team during daily rounds.
Oxygen therapy- Medication ordered by a physician, used to relieve or prevent hypoxia, may be
administered by nurse in an emergency situation, Safety issues (flammability, humidification,
transporting tanks), room air is 21%, sign needs to be places saying keep 10 ft away from open flame,
no smoking, secure cylinders, grounded equipment so no sparks, check tank levels before transporting
Methods: Nasal cannula or prongs: ¼-6 LPM, 23-45% O2
Face Mask: simple: 6-8 LPM, 40-50% O2
Partial rebreather: 6-15 LPM, 50-80% O2
Non-rebreather: 6-15 LPM, 70-100% O2-physical trauma, smoke
inhalation, CO poisoning
Venturi: vent weaning, COPD patients
, Face tent: facial trauma, claustrophobia, vent weaning
Oxyhood/oxygen tent
Role of carbon dioxide as a driver to breathe
Increasing Levels of CO2 in the blood drives the stimulus to breathe. Neurons in the
respiratory center in pons and medulla respond to the increase of CO2 of H+ ions.
Factors that positively and negatively affect circulation and perfusion
• Advanced age- with increased age= decreased elasticity, decreased exchanged air,
decreased reflexes; drier mucous membranes, diminished muscle strength, decreased
chest expansion, decreased immune function, increased risk of GE reflux to aspiration
calcification of valves, SA node; atherosclerosis, osteoporosis changes in thorax;
calcification of airways. Alveoli enlarge, decreased surface area for gas exchange,
decreased functional cilia so decreased cough mechanics and increased risk for
respiratory infections, fib
• Lifestyle: nutrition (risk for anemia, muscle wasting, increased CO2 retention with high
carb diets), exercise, smoking, substance abuse, stress, pregnancy
• Occupation
• Health Status
• Meds
• Stress – hyperventilation
• Pollution
• Altitude – decreased pO2 in air
Types of airways and suctioning and when each is used
Oropharyngeal and nasopharyngeal: used when the client can cough effectively but is not able to clear
secretions
YanKauer Suction Catheter: for the mouth, not the nose
Orotracheal and nasotracheal: used when the client is unable to manage secretions in lower airways
Tracheal: Used with an artificial airway
Trach care
1. Position patient in semi-Fowler’s position and place a towel or linen-saver pad over the
patient’s chest.
2. Don clean gloves.
3. Hyperoxygenate the patient as needed, and suction the tracheostomy.
4. Remove and discard the soiled tracheostomy dressing in the appropriate receptacle, and then
remove and discard your gloves. Perform hand hygiene.
5. Place the tracheostomy care equipment on the bedside table, and prepare equipment, using
sterile technique.
Med Math – 6
Po meds
Sliding Scale Insulin
Oxygenation and Perfusion – 12
Orthopnea –difficulty breathing while lying down- typically in obese, COPD, heart failure, and
pregnant women
Hypoxia- inadequate tissue oxygenation at the cellular level, life threatening, causes: anemia, carbon
monoxide poisoning, septic shock, cyanide poisoning, pneumonia atelectasis, cardiomyopathy, spinal
cord injury, head trauma. Sign and symptoms: rapid pulse, rapid shallow respirations, dyspnea,
increased restlessness or light headedness, nasal flaring, substernal or intercostal retractions,
cyanosis, anxious, tired, leaning forward, fatigue, lethargy, clubbing
Hypoxemia- inadequate oxygen levels in the blood
Respiratory assessment
• Assess for risk factors
• Physical Exam: Assess pain, fatigue, dyspnea, rapid pulse, rapid respirations, nasal
flaring, substernal or intercostal retractions, cyanosis, breathing patterns, cough,
• Diagnostic testing: blood oxygenation, lab test, cardiac monitoring, spirometer,
sputum sample
Suctioning and follow-up assessment
When evaluating the patient after suctioning, assess and document physiologic and psychological
responses to the procedure. Convey your findings verbally during nurse-to-nurse shift report and to
the interdisciplinary team during daily rounds.
Oxygen therapy- Medication ordered by a physician, used to relieve or prevent hypoxia, may be
administered by nurse in an emergency situation, Safety issues (flammability, humidification,
transporting tanks), room air is 21%, sign needs to be places saying keep 10 ft away from open flame,
no smoking, secure cylinders, grounded equipment so no sparks, check tank levels before transporting
Methods: Nasal cannula or prongs: ¼-6 LPM, 23-45% O2
Face Mask: simple: 6-8 LPM, 40-50% O2
Partial rebreather: 6-15 LPM, 50-80% O2
Non-rebreather: 6-15 LPM, 70-100% O2-physical trauma, smoke
inhalation, CO poisoning
Venturi: vent weaning, COPD patients
, Face tent: facial trauma, claustrophobia, vent weaning
Oxyhood/oxygen tent
Role of carbon dioxide as a driver to breathe
Increasing Levels of CO2 in the blood drives the stimulus to breathe. Neurons in the
respiratory center in pons and medulla respond to the increase of CO2 of H+ ions.
Factors that positively and negatively affect circulation and perfusion
• Advanced age- with increased age= decreased elasticity, decreased exchanged air,
decreased reflexes; drier mucous membranes, diminished muscle strength, decreased
chest expansion, decreased immune function, increased risk of GE reflux to aspiration
calcification of valves, SA node; atherosclerosis, osteoporosis changes in thorax;
calcification of airways. Alveoli enlarge, decreased surface area for gas exchange,
decreased functional cilia so decreased cough mechanics and increased risk for
respiratory infections, fib
• Lifestyle: nutrition (risk for anemia, muscle wasting, increased CO2 retention with high
carb diets), exercise, smoking, substance abuse, stress, pregnancy
• Occupation
• Health Status
• Meds
• Stress – hyperventilation
• Pollution
• Altitude – decreased pO2 in air
Types of airways and suctioning and when each is used
Oropharyngeal and nasopharyngeal: used when the client can cough effectively but is not able to clear
secretions
YanKauer Suction Catheter: for the mouth, not the nose
Orotracheal and nasotracheal: used when the client is unable to manage secretions in lower airways
Tracheal: Used with an artificial airway
Trach care
1. Position patient in semi-Fowler’s position and place a towel or linen-saver pad over the
patient’s chest.
2. Don clean gloves.
3. Hyperoxygenate the patient as needed, and suction the tracheostomy.
4. Remove and discard the soiled tracheostomy dressing in the appropriate receptacle, and then
remove and discard your gloves. Perform hand hygiene.
5. Place the tracheostomy care equipment on the bedside table, and prepare equipment, using
sterile technique.
