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Certified Emergency Nurse (CEN) Exam Review RESPIRATORY EMERGENCIES

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Objectives: At the completion of this section, the learner will be able to:  Analyze a blood gas abnormality by looking at blood gas values  List side effects of drugs used to treat chronic o... bstructive pulmonary disease  Differentiate between types of pulmonary emboli based on presenting symptomatology  Verbalize treatment strategies for pulmonary edema  List nursing interventions for various types of pneumothoraces The CEN exam contains eighteen questions on respiratory emergencies which involve the following topics:  Aspiration  Asthma  Chronic Obstructive Pulmonary Disease (COPD)  Infections  Inhalation Injuries  Obstruction  Pleural Effusion  Pneumothorax  Pulmonary Edema – non-cardiac  Pulmonary Embolus  Respiratory Distress Syndrome  Tension Pneumothorax  Trauma  Airway Interventions (Suctioning) o Limit suctioning to 10 seconds per pass o Suctioning can stimulate the vagal response (bradycardia and hypotension) esp. in the infant. o Place head in sniffing position for nasopharyngeal suctioning; any position for oropharyngeal suctioning. o Nasopharyngeal suctioning: use catheter with a diameter of no more than ½ diameter of the nari. o Bulb suctioning – depress bulb before inserting, release when in area of secretions. For oral suctioning, aim toward inside of cheeks not back of throat.  Breathing Interventions (Oxygen Therapy) Device Oxygen flow rate (L/minute) FiO2 Notes Nasal cannula 1 24%  FiO2 increases 3 – 4% per liter increase in flow rate.  Decreased effectiveness for mouth breathers  May dry out nasal mucosa 2 28% 3 32% 4 36% 5 40% 6 44% Simple mask 5 to 6 40%  Flow rate should be at least 5-6 L/minute to minimize rebreathing of CO2  Effective for mouth breathers or those with nasal obstruction  May cause drying of the eyes 6 to 7 50% 7 to 8 60% Non-rebreathing mask Greater than 10 liters per minute 80% up to 100%  Insufficient oxygen flow may lead to re-breathing of CO2; therefore oxygen level should be high enough that reservoir bag never collapses.  This method allows the highest oxygen concentration of any method.  May cause drying of the eyes. [Show More]

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