NFDN 1002 Unit 6 & 8
Oropharyngeal/ Nasal Pharyngeal Suctioning - correct answer ✔Assess:
S&S of upper and lower airway obstruction
:S&S associated with hypoxia and hypercapnia (decrease Spo2, increase
pulse and BP, increase resps, anxiety, decrease concentration,
lethargy,dizziness, cyanosis)
:fluid status, lack of humidity, COPD, changes in LOC, decrease cough
gagreflex
:examine sputum, encourage client to cough, semi-fowlers position, use pulse
oximeter, place towel on clients chest,
Suction kit: open with aseptic (clean) technique,don't let suction catheter touch
anything, place sterile basin on bedside and fill with 100 mL sterile normal
saline or water
: turn on device and set to 100-150 mm Hg for adults
Low-Flow vs High-Flow - correct answer ✔Low-flow Devices: eg. nasal
cannulas, simple face masks, and reservoir masks provide oxygen in
concentrations that vary with persons respiratory patterns
High-flow Devices: eg. venturi mask delivers oxygen rates above normal
inspiratory flow rate and maintain a fixed FiO2(fraction of inspired oxygen)
regardless of the clients inspiratory flow rate and breathing pattern
low-flow device used for oxygen delivery - correct answer ✔nasal cannula
(check every 8 hrs) (1-6mL/min)
device used to administer oxygen, humidity, heated humidity - correct answer
✔oxygen masks (make sure bags are always inflated)
Simple face mask - correct answer ✔short-term oxygen therapy
, 30-60% oxygen (5-10mL/min)
contraindicated for CO2 retaining clients because it can be worsened
Partial Re-breathing vs Non-Re-breathing Masks - correct answer ✔Partial:
low-flow with reservoir bag, 35-60% O2, 6-10mL/min
Non-breather: 60-100%O2, 6-10mL/min, oxygen flows into mask and reservoir
during inhalation; a valve on on-breather prevents expired air from flowing
back into bag.
Breathing Exercises - correct answer ✔Pursed-Lip Breathing: deep
inspiration and prolonged expiration through pursed lips to prevent alveolar
collapse; client must be sitting up.
Diaphragmatic Breathing: client relax intercostal and accessory respiratory
muscles while taking deep inspirations. Expand diaphragm during controlled
inspiration and place one hand flat below breast bone and above waist, and
other hand 2-3 cm below the first, lower hand moves outward on inhale.; client
begins in supine and gradually sitting up.
Principles of Body Mechanics - correct answer ✔-the wider the base of
support, the greater the stability
-the lower the center of gravity, the greater the stability
-the equilibrium of an object is maintained as long as the line of gravity passes
through its base of support
-facing the direction of movement prevents abnormal twisting of the spine
-dividing balanced activity between arms and legs reduces the risk of back
injury
-leverage, rolling, turning, or pivoting requires less work than lifting. When
friction is reduced between the object to be moved and the surface over which
it is moved, less force is required to move it.
-reducing the force of work reduces the risk of injury.
-maintaining good body mechanics reduces fatigue of the muscle groups
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