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65 Cards in this Set
- Front
- Back
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rationale for incentive spirometer
how to use it |
- deep breathing/coughing helps alveoli fully expand
- this prevents atelectasis, and pulmonary infection - spirometer helps you keep track of how well you are inflating your lungs 1. semi fowlers position 2. place mouthpiece in mouth, inspire slowly and as deep as possible 3. hold breath for 3 sec 4. exhale slowly 5. cough during and after each session 6. perform 10 times in a row, each hour |
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hallmarks of atelectasis
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- tachypnea
- dyspnea - mild to moderate hypoxemia |
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atelectasis definition
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closure or collapse of alveoli
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causes of atelectasis
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= anything that causes obstruction or impedes flow to alveoli
- mucus plugs - reduced ventilation - excessive pressure on lung tissue (pleural effusion, pneumothorax, hemothorax) - abdominal pressure |
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teaching for post-op patient to maintain healthy lungs
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- pt's post-op are at risk for atelectasis - collapse of alveoli and lung infection
- deep breathing, frequent turning, early mobilzation, sitting upright, incentive spirometer |
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pathophysiology of atelectasis
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- occurs from any blockage or reduced ventilation
- trapped alveolar air is absorbed into blood, affected portion becomes airless and collapses |
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who is at high risk for atelectasis
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- post op patients, especially from anesthesia
- also those in supine position for long periods, since supine is not conducive for deep breathing - those with painful breathing may limit inspiration, reducing airflow |
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pneumothorax vs pleural effusion
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- pneumothorax - air in plural space
- pleural effusion - fluid in pleural space |
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complete ss of atelectasis
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- hallmark: dyspnea, tachypnea, hypoxemia
- characterisitic is central cyanosis, and dyspnea while supine and anxiety |
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pt's with atelectasis are predisposed for
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- pulmonary infection
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How to treat atelectasis (first line measures)?
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- goal: improve ventilation and remove secretions
- frequent turning - chair to bed, then early ambulation - encourage deep breathing excercises, incentive spir, coughing |
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PEEP and IPPB
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PEEP = positive end expiratory pressure
- mask with one way valve - expiration against pressure IPPB = intermittent positive pressure breathing - lung expansion therapy |
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second line measures for treatment of atelectasis
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- suctioning, nebulizer, chest physiotherapy
- PEEP and IPPB, bronchoscopy |
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pulmonary infiltrate
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- filling alveoli with fluid aka edema
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refractory hypoxemia
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- hypoxemia that cannot be corrected with O2
- ie ARDS |
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pathophysiology of ARDS
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- lungs receive some kind of acute injury, such as drug overdose, smoke, shock, trauma etc.
- the lungs respond with acute inflammatory response, causing edema and infiltrate - infiltrate causes collapse of alveoli, decreased lung compliance - refractory hypoxemia results |
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symptoms of ARDS
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- sudden severe onset of dyspnea
- refractory hypoxemia - does not respond to supplemental oxygen |
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How is ARDS usually treated?
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- main focus is identification of cause and treating the underlying condition
- however, immediate supportive treatment is almost always necessary - intubation and mechanical ventilation |
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Nursing management of ARDS
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- treatment is usually mechanical ventilation and intubation with PEEP
- nurses - frequent positioning, and prone-lying has been proven helpful for ARDS |
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Ca Channel blockers effect
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vasodilation
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norvasc
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Ca channel blocker
- vasodilator - treats pulm arterial htn |
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cardizem
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Ca channel blocker
- vasodilator - treats pulm arterial htn |
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viagra aka
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phosphodiesterase-5 inhibitors
- pulm vasodilation |
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phosphodiesterase-5 inhibitors
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viagra
- pulm vasodilation |
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Bosentan
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aka Tracleer
- endothelin receptor antagonist - vasodilator |
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Prostanoids
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- Flolan
- cont IV - half life 3 min |
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Flolan
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- a prostanoid
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Tracleer
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aka bosentan
- vasodiltor |
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patho of pulm art htn
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- primary idiopathic - usually death within 5 years
- secondary - known cause, ie COPD causing hypoxemia, causes htn |
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Medical mangement of pulmonary arterial hypertension
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vasodilators
Ca channel blockers - Norvasc, Cardizem Phosphodiesterase-5 inhibitors (Viagra) Enothelin Receptor Antagonist (Tracleer) Porstanoids (Flolan) also Lung transplant |
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signs of right sided heart failure
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- peripheral edeama
- ascites - distended neck vains - enlarged liver |
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cor pulmonale
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= right side cardiac hypertrophy as a result of pulmonary hypertension
- usually caused by COPD - symptoms - symp of r hf, symptoms of hypercapnia |
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somnolence
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drowsiness
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drowsiness aka
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somnolence
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pathophysiology of cor pulmonale
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- any disease causing hypercapnia and hypoxemia causes pulmonary artery vasocontriction
- pulm htn causes right side hypertrophy and eventually failure |
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symptoms of hypercapnia
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- headache
- confusion - somnolence |
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most common cause of cor pulmonale
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- copd
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effects of digoxin
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- decrease conductivity
- decrease HR - increase contractility |
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how to treat cor pulmonale
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- objective is to improve ventilation and treat underlying lung disease
1. O2 - also reduces pulm htn 2. chest PT and bronchodilators improve ventilation 3. diuretics for edema 4. digoxin for HF |
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What diseases put you at risk for pulm embolism?
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- heart disease - esp HF
- COPD - diabetes mellitus - Trauma - postpartum/postop state |
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What are risk factors for pulm embolus
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- venous stasis (varicose veins, prolonged immobilzation)
- hypercoagulability (injury, surgery, tumor) - venous endothelial disease - certain diseases others - advanced age, obesity, pregnancy, oralcontraceptives |
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PE patho
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- embolus obstructs (branch of) pulm artery
- (impaired circulation and gas exchange below obstruction) - clot releases substances that cause arterioconstriction, causing pulm htn - R HF, dec CO, dec pressure and shock |
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symptoms of PE
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- dypsnea and tachypnea most common manifestation
- sudden chest pain - anxiety and apprehension |
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PE death
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- occurs within 1 hr
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emergency management of PE
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- first, nasal O2
- insert IVs for meds/fluids - blood tests, CT, perfusion scan, ABG - treat hypotension - dobutamine/dopamine - cardiac monitoring for R vent failure - digitalis, diurteics, antiarrhythmics - prep for potent intubation/mech ventilation - f/c to monitor UO - morphine/sedatives relieves anxiety |
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dobutamine
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dilates pulm vessels and bronchi
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radon gas
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- potential inhaled carcinogen
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important sign of lung cancer
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- a cough that changes in character - ie dry to productive
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nursing diagnoses for lung cancer
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impaired gas exchange r/t
- altered o2 supplyk hypovent - removal of lung tissue ineffective airway clearance - secretions - restricted chest movements, pain - fatigue, weakness acute pain fear/anxiety |
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kinds of chest trauma
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- blunt - ie baseball bat
- penetrating - ie knife |
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manifestations of chest trauma
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- hypoxemia
- hypovolumia - from massive fluid loss from great vessels/cardiac rupture - cardiac failure - from cardiac tamponade, cardiac contusion |
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flail chest
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- when a section of ribs breaks off on both sides
- result is free floating section of ribs that is drawn in during inspiration, and bulges out during expiration - aka paradoxical movement |
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free floating section of ribs that is drawn in during inspiration, and bulges out during expiration
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flail chest
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damage to lung tissues causing hemorrhage and edema
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pulm contusion
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pulm contusion patho
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- damage to parenchyma causes hemorrhage and edema
- accumulation of fluid interferes with gasexchange - inc pulm vasc resistance and pulm artery pressure - results in hypoxemia and hypercapnia |
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sucking chest wound
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- aka open pneumothorax
- wound in chest is large enough for air to be sucked in and out during respriation - lung expands and deflates - also causes shifting of heart and great vessels, causing circ problems - lifesaving to stop airflow |
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cause of pneumothorax
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- laceration of chest wall and parietal pleura causing room air to go in
- laceration of visceral pleura, causing inspired air to leak into pleural space |
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open pneumothorax vs tension pneumothorax - patho
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- open - basically a hole in parietal/visceral pleura that allows air in and out during respirations
- traumatic - air only enters in during inspirations, gradually causing lung collapse |
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effects of pneumothorax
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- air enter pleural space, lung collapses
- mediastinal swing - heart and great vessels shift toward unaffected side due to inc pressure in pleural space |
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where is a chest tube inserted and why?
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- for pneumothorax, 2nd intercostal
- thinnest part of chest wall - for hemothorax - 4th or 5th intercostal because tube is larger |
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how to assess chest for pneumothorax
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- assess tracheal alignment - shifted in tension pneum
- assess expansion of chest - diminished - assess breath sounds - diminished or absent depending on extent of collapse - percuss chest - hyperresonance |
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what to do when there is a sucking chest wound
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- occlude the flow of air
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treatment for pneumothorax
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chest tube - sucks air, creates neg pressure, re inflates lung
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subcutaneous emphysema
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- any chest trauma may result in air traveling underskin
- subcutaneous air is spontaneously absorbed - not dangerous (unless reaches trachea) |
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prolapse
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= balooning of valve into atrium during systole
- balooning indicates stretching, not regurgitation - may have some regurgitation too |
