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262 Cards in this Set
- Front
- Back
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H and pH Have what type of relationship?
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An inverse relationship
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What effect does insulin have on the K and H in cells?
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Insulin pulls K into the cells and kicks out H into the blood, making the blood more acidotic
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what affects do alterations in balance have on the body?
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Hormones and enzymes may no longer function
F & E imbalances Heart, nerve, and skeletal muscles (excitable membranes) are affected Alters the effectiveness of many drugs |
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How do alterations in balance affect the effectiveness of drugs?
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mostly by decreasing the uptake, but also alters the activity and distribution of many drugs or hormones
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Acid: Substance that _______ hydrogen ions when dissolved in water
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releases
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Most abundant acid in the human body is _____________
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carbonic acid (H2CO3)
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Base: Substance that ___________ hydrogen ions when dissolved in water
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binds with
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Most abundant base in the human body is ______
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bicarbonate (HCO3) z (aka bicarb)
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There is a relationship between CO2 and H+.... what is it?
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they are directly related)
An increase in one yields an increase in the other |
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What are examples of blood buffers?
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Hemoglobin and albumin
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What are sources of acid in the body?
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food metabolism (carbs, fats, proteins),
metabolism under anerobic conditions (lactic acid), destruction of cells (CELL DEATH) |
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What are sources of bases in the body?
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ingested bicarb,
pancreatic production, renal re-absorption, breakdown of carbonic acid |
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What is the relationship of CO2 and pH?
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Inverse relationship, one goes up the other goes down
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What ratio of carbonic acid to bicarb must be maintained in the body?
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1:20 (1 carbonic acid to 20 bicarb)
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Blood Buffers are?
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• chemical control to balance solution- neutralzer
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How fast do blood buffers react?
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very FAST; within a FRACTION of a second
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The respiratory system is under control of the....
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CNS and chemoreceptors
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How long does it take the respiratory system to react when acid/base not in balance?
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takes MINUTES to respond
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What happens when there is an increase in CO2?
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stimulate respiratory center in brain causing: ↑ RR and depth to blow off (↓) excess CO2 and ↓H ions
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What happens when there is an decrease in CO2?
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inhibits respiratory center in brain causing: ↓ RR and depth to retain (↑) CO2 and ↑ H ions
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What happens to breathing when H returns to normal?
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Breathing returns to normal
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What is the most powerful regulator in the body?
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Renal control
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How long does the renal system take to respond to acid/base imbalances?
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SLOWEST to respond; 24-48 hrs
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How do kidneys work to compensate for imbalances?
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• excrete or reabsorb bicarb ( KIDNEYS CAN ALSO MAKE BICARB)
• excrete or reabsorb H |
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Lungs work to compensate for acid/base imbalance how?
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Gets rid of or retains CO2 by slowing or increasing respiratory rate
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As the CO2 increases = pH_____
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drops
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As the CO2 decreases = pH ______
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rises
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As the bicarb increases = pH _____
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rises
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As the bicarb decreases = pH _____
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drops
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pH and Bicarb have what type of relationship?
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direct relationship
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The _____ control CO2
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lungs
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The ______ control bicarb
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kidneys
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When fluid is too acidic, buffers ______ H+
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bind to
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When too alkaline, buffers ______ H+
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release
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Buffers are ______ or ______
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chemicals or proteins
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What are the most common blood buffers?
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proteins
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When you blow off CO2 you get rid of __ Ions
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H ions
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What is acidosis and what does it do to H and K in relation to cells?
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abundance of H in plasma, causes H to move INTO cells → K moves OUT of the cell into blood
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Acidosis always leads to _____kalemia
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hyperkalemia
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Symptoms of acidosis are very similar to what other imbalance?
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hyperkalemia
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Why does the increase of H ions in the cell cause the K ions to move out?
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Both are (+), cell cannot have too many (+) ions inside
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What is alkalosis and what does it do to H and K in relation to cells and blood?
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Because the blood has a low number of H+ ions, H+ ions move out of cell and into the plasma.
This shift causes K+ to move from the plasma into cell. |
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What happens to Ca in alkalosis?
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Ca follows K, moving from the plasma into the cell
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Alkalosis always results in ___kalemia and ____ calcemia
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Hypokalemia
Hypocalcemia |
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S/S of alkalosis are similar to S/S of ___________
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Hypokalemia
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Respiratory Acidosis Clinical Manifestations:
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CNS depression
Neuromuscular – bilateral weakness → flaccid paralysis Cardiovascular – HR ↓, BP ↓ Respiratory – rapid( d/t hypoxia) shallow breathing (d/t retained CO2 is stimulating brain) Skin – pale, cyanotic |
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Respiratory Acidosis Causes
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• CO2 Retention caused by:
• Respiratory depression – drug induced, anesthesia • Inadequate chest expansion – chest trauma • Airway Obstruction – COPD, PE, Chest Trauma • Reduced alveolar diffusion- pneumonia, COPD, smoking, pulmonary edema, atelectasis |
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Respiratory Acidosis ABG VALUES:
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• pH < 7.35
• CO2 > 45 • HCO3 – Normal • pO2 - usually decreased • Serum K ↑ |
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Respiratory Acidosis Treatments:
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• increase ventilation (O2 id pO2 is low < 80)
• airway clearance • positioning ( sitting up ) • breathing- deep breathing techniques |
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Why do elderly have more problems with acid base imbalance than do younger?
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d/t preexisting conditions- Can go “down-hill” VERY FAST
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What factors can increase compensation time?
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Kidney disease ↑ compensation time, Lung Disease ↑ compensation time, Medication usage
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Respiratory system and compensation
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Respiratory system is MORE SENSITIVE to acid base changes, reacts within SECONDS to MINUTES, but the compensatory effects of the respiratory system are limited and can be overwhelmed easily
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Renal system and compensation
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Renal system is MORE POWERFUL and can have DRAMATIC CHANGES, but are slow to be stimulated until imbalance has been present for 24-48 hrs.
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Why do we need to be careful with cardiac patients when prescribing beta agonists?
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They are Beta 2 selective, and there are beta 2 receptors in the heart, they can have cardiac responses.
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COPD includes what diseases?
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bronchodilators
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CAL (chronic airway limitation)
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COPD, Asthma, emphysema
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What is chronic bronchitis?
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an airway problem
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What does emphysema affect?
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The alveoli
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*2 major things that happen with emphysema?
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Loss of lung elasticity
Hyperinflation of the lung |
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Pathophysiology of emphysema
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An increase in protease damages the alveoli and small airways, breaking down elastin. When the alveoli are destroyed , they become flabby, which decreases the effectiveness of gas exchange and causes air trapping. This air trapping is caused by the loss of recoil in the alveolar walls, overstretching and enlargement of alveoli into air filled spaces called “bullae” and the collapse of small airways (bronchioles)
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Risk factors/causes of emphysema
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*smoking, genetic (AAT deficiency), occupational
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What is AAT deficiency?
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alpha anti trypsin deficiency- a condition in which the body does not make enough of a protein that protects the lungs and liver from damage
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What are the protease that are involved in emphysema?
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enzymes that breakdown lung tissue- digests the elastin
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How does smoking cause emphysema?
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smoking increases the enzyme protease which then breaks down the elastin in the lungs
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Clinical manifestations of emphysema
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Chronic cough
Sputum production Dyspnea on exertion and at rest |
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What do emphysema pts look/sound like?
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Wt. loss
Rapid shallow respirations (w/ prolonged exp. phase) Crackles, rhonchi (increased secretions) Compensated resp. acidosis (advanced disease) “pink puffer” |
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What is a pink puffer?
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Emphysema pt, because of accessory muscle use, they have to exert a lot of energy in order to breathe, and they are puffing in order to hyperventilate (body tries to bring in more o2 because of the poor gas exchange at the alveolar level)
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tactile fremitis
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pts with emphysema- Put your hands on the back of the pt and have them say "99" if you feel vibrations there is no obstruction.
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Chronic Bronchitis
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Inflammation of the bronchi and bronchioles caused by chronic exposure to infection or inhaled irritants, esp. cigarette smoke.
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Chronic Bronchitis Pathophysiology
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inhaled smoke triggers increased amounts of protease, which leads to decreased elastin and cilia function impairment which inhibits clearing of mucus, debris, and fluid. Chronic bronchitis hinders air flow and gas exchange because of mucus plugs and infection, which narrow the airways.
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Biggest risk factor for chronic bronchitis?
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Cigarette smoking
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How does inhaled smoke lead to chronic brochitis?
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Inhaled smoke triggers increased amounts of proteasedecreased elastinimpairs function of ciliainhibits clearing of mucous, debris, fluid.
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Clinical manifestations of chronic bronchitis
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Productive cough, **COPIUS SECRETIONS**
Infection SOB Characteristic position of sitting leaning over a table “blue boater” |
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Why do chronic bronchitis have chronic infection?
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it is due to the inflammation and the damage
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Blue Bloater
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Chronic Bronchitis pts- mucus blocks the airway so they become much more hypoxic than emphysema its, so they have more cyanosis (blue), pulm vessels constrict during hypoxia which leads to inc pressure in lungs and then fluid back up in R side heart, which leads to HF and then edema, JVD, abd distention, etc (bloaters)
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What pts have a big upper body?
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Chronic bronchitis- they use a lot of accessory muscles which leads to a big upper body
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Clinical Manifestations-Emphysema & Chronic Bronchitis
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Dyspnea
Orthopnea Increased work of breathing Accessory muscles Inhalation starts before exhalation=uncoordinated breathing pattern Hyperinflated lungs and flattened diaphragm Barrel Chest Clubbing Hypoxemia |
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how does barrel chest happen?
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overinflation of lungs leads to diaphragm being flattened
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What do ABGs look like in COPD pts?
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patients start in resp. acidosis → met. Alkalosis → Resp. Alkalosis→ Met. Acidosis → Resp. Acidosis
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Why do we look at CBC in COPD pts?
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Infection=WBC
RBCs will increase as the body tries to compensate for the low O2 levels |
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Why do we look at Xrays for COPD pts
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late end diagnosis to rule out other diseases, and to see if the diaphragm has flattened
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That are PFTs?
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pulmonary funstion tests help to confirm COPD dx. Distinguishes between mild to mod disease. Monitor PFTs progression, monitor airflow obstruction
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COPD causes
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Smoking
Chronic exposure to inhaled irritants (huffing- glue, cleaners, paint thinners, propane, etc) |
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Complications of COPD
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Hypoxemia & Acidosis
Resp. infection Cardiac dysrhythmias Cardiac Failure- esp. Cor Pulmonale |
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What does Hypoxemia & Acidosis cause?
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reduced cellular function
Less able to exchange gasses, increased CO2, Decreased O2 |
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How come COPD pts get Resp. infections?
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increased mucous, poor oxygenation and lack of cilia
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Cor Pulmonale
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failure of the right side of the heart brought on by long-term high blood pressure in the pulmonary arteries and right ventricle of the heart.
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Key features of Cor Pulmonale:
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Fatigue, increasing dypnea, cyanotic lips, hands, and feet, JVD, enlarged liver, GI prob. (nausea, anorexia), dependant edema
Metabolic & respiratory acidosis Pulmonary hypertension |
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How to treat COPD?
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*Airway Maintenance *
Cough enhancement Breathing techniques Oxygen therapy- low flow 1-2ml/min. If increased, may stop the respiratory drive. Medications: Beta-adrenergics agonists, Cholinergic antagonists, xanthines derivatives, corticosteriods, NSAIDS, Mucolytics. Lung resection or transplantation |
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Most important treatment for COPD?
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Airway Maintenance
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2 types of breathing to teach COPD pts?
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Abdominal breathing
Pursed lip breathing |
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Interstitial Pulmonary Diseases (2 types)
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Sarcoidosis
Idiopathic Pulmonary Fibrosis |
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Interstitial Pulmonary Diseases affect what?
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Affect the interstitium of lungs rather than airways
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Interstitial Pulmonary Diseases AKA
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Aka fibrotic lung diseases (fibrosis=scar tissue)
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Sarcoidosis is what type of disorder?
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autoimmune
Restrictive |
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What happens in Sarcoidosis?
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In this disease, a granuloma forms in the lungs. Granulomas contain lymphocytes, macrophages, epitheliod cells, and giant cells. It can affect any organ, but usually targets the lungs. Fibrotic tissue loses its elasticity and lung compliance and gas exchange are impaired.
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What is a granuloma?
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collection of lymphocytes and other things like macrophages and epithelial cells
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What may develop as a result of sarcoidosis?
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Cor pulmonale
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Clinical Manifestations of sarcoidosis
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Dyspnea- most common
Fatigue Cough hemoptysis- coughing up blood Chest pain Enlarged lyph nodes d/t autoimmune response Decreased PFTs |
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*What drugs to treat sarcoidosis?
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*Corticosteroids daily
Tx is targeted to lessen symptoms and prevent fibrosis Teach about side effects of corticosteroids (hyperglycemia, osteoporosis, HTN, DM) |
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What is the good news regarding sarcoidosis??
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Progress: It can resolve on its own!!!
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Idiopathic Pulmonary Fibrosis
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More common than sarcoidosis. It has slow onset and is highly lethal. Inflammation of the alveolar tissue causes scarring, making gas exchange difficult.
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Idiopathic Pulmonary Fibrosis Causes
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Is an example of excessive wound healing- inflammatory response goes beyond wound healing- just keep sgoing to form car tissue in the lungs
- It is typical in patients with a long history of smoking or exposure to dust, smoke, or chemicals. |
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Is Idiopathic Pulmonary Fibrosis an obstructive or restrictive disease?
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Restrictive disease
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What is the survival rate of Idiopathic Pulmonary Fibrosis?
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Very lethal, survival rate <5 years
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Symptoms of Idiopathic Pulmonary Fibrosis
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Slow onset,
Beginning with mild dyspnea on exertion, PFTs are decreased, Hypoxemia. Respirations are rapid and shallow. (Low O2 sats, cyanosis, clubbing, lowered L.O.C., pale, blue lips) |
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Treatments for Idiopathic Pulmonary Fibrosis
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Goals 1) slow progress of fibrosis with corticosteroids and immunosuppressants.
2) Manage dyspnea with O2 administration and morphine (which vasodilates and increases comfort level. The only cure is a lung transplant but availability and cost make this treatment prohibitive. 3)Teach about energy conservation methods, prevention of respiratory infection. (Avoiding crowds, sick people) |
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Occupational Pulmonary Disease
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Exposure to mineral dusts usually associated with occupational fumes. (dust, vapors, gases, bacterial, fungal antigens)
Results in a restrictive lung disease. |
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Occupational Pulmonary Disease Causes
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Occupational hazards- (occupational asthmas, asbestosis, coal miners disease/black lung)
Fine particles/dust lodge in parenchyma of lung |
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Is Occupational Pulmonary Disease an obstructive or restrictive disease?
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restrictive disease
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Clinical manifestation of Occupational Pulmonary Disease
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Ranges in each person, from asymptomatic to resp. failure
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How to manage Occupational Pulmonary Disease
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Removal from site of irritant
use of respirator mask |
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Treatments for Occupational Pulmonary Disease
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Tx: similar to asthma or COPD pts (bronchodilators, steroids)
Pt. education (to prevent disease w/ use of mask |
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Pulmonary HTN affects what age group primarily?
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20s-40s
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Causes of Pulmonary Hypertension
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Cause is unknown, it is a genetic issue, and occurs in absence of other pulmonary diseases
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Pathophysiology of Pulmonary Hypertension
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Blood vessels constrict, inc vascular resistance in lungs, more pressure, blood flow decreases, poor perfusion, hypoxemia, heart trying to pump against really high pressure, R sided HF cor pulmonale, without tx death in a couple yrs
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Clinical manifestations of Pulmonary Hypertension
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SOB, always tired, chest pain
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Assessment and Diagnostic Findings of Pulmonary Hypertension
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PFTs, R sided Heart cath (to show increased pulmonary pressure)
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Medical management of Pulmonary Hypertension
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Drugs to dilate pulmonary vessels and prevent clots
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Major drugs to treat Pulmonary Hypertension?
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Diuretics, dig, coumdin
Ca Channel Blockers Lasix (for volume reduction) |
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Pneumothorax
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Chest injury that allows air to enter the pleural space, can be OPEN, CLOSED, or SPONTANEOUS
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Causes of pneumothorax
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Often caused by blunt trauma
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Symptoms of pneumothorax
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• Decreased or absent breath sounds
• Hyper-resonance on percussion • Decreased chest movement on affected side • Deviated trachea → closed=away from affected side ; open=toward affected side • Pleuritic pain- chest wall pain- “rubbing” • Tachypnea • Subcutaneous emphysema |
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Deviated trachea will move ______ affected side in pneumothorax
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away from affected side (toward unaffected side)
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Tension Pneumothorax
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Results from air leak in the lung. Air collects in plural space during inspiration phase but does not leave during expiration phase
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Tension Pneumothorax Causes
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Blunt trauma
Ventilation Chest tubes Central Venous Catheter – fatal if not detected and treated early |
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What do you do if a patient returns from having a CVC inserted, and is complaining of chest pain?
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Call MD!! Could have caused a pneumothorax!
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How serious is a tension pneumothorax?
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Fatal if not detected early
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Tension Pneumothorax Symptoms
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Hyperresonance
Asymmetry of chest Tracheal deviation away from midline toward the affected area Absent breath sounds on affected side Distended neck veins Cyanosis |
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Tension Pneumothorax Treatment
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Treated with needle decompression in the 2nd intercostal space mid-clavicular line (MCL), then chest tube at the 4th intercostal space to water seal.
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Hemothorax
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blood collecting in the pleural space causing the lung to collapse, commonly occurs after blunt chest trauma or penetrating injuries.
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A simple hemothorax
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blood loss less than 1500mL
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Massive hemothorax
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blood loss of more than 1500mL
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What causes the bleeding in a hemothorax?
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Bleeding is caused by injury to the lung tissue, such as lung contusions or lacerations.
Massive internal chest bleeding in blunt chest trauma may stem from the heart, great vessels, or intercostal arteries. |
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Hemothorax Symptoms
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Decreased Breath sounds
Respiratory distress If hemothorax is small, patient may be asymptomatic Dull percussion Visible blood in pleural space on X-ray |
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Hemothorax Treatments
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Interventions are aimed at removing blood from pleural space
Front and back chest tubes Open thoracotomy when initial blood loss is 1500-2000mL or consistent bleeding of 200mL/hr over 3hrs Replace blood loss |
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Pleural fluid normally
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seeps into pleural space and is reabsorped by verceralpleural capillaries and lymph system
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Pleural effusion is
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accumulation of fluid in pleural space
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Is pleural effusion a disease?
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Not a disease
Usually a sign of another disease |
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causes of Pleural Effusion
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• Heart Failure
• Pneumonia • TB • Pulmonary Embolus |
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Two types of fluid can be present with pleural effusions
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trasudative & exudative
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Transudative pleural effusion
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Usually caused by disorder in nl hydrostatic or oncotic pressures in lung
Congestive heart failure most common cause of this type of effusion |
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Exudative pleural effusion
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Result of bacterial invasion of pleura
Often caused by lung disease Other causes include: cancer, pneumonia, TB, sarcoidosis |
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#1cause of Transudative pleural effusion
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CHF
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Clinical manifestations of pleural effusions
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SOB- depends on amount of fluid built up
Chest pain- worse as fluid builds up Sharp pain Worse with cough or deep breaths Cough ~May be no symptoms |
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What will lungs sound like with pleural effusions?
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Diminished/absent breath sounds
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Treatments for pleural effusions
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Address the underlying cause
Remove Fluid (Chest tubes, Thoracentesis) Relieve discomfort Pleurectomy |
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Thoracentesis
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aspiration of pleural fluid or air from the pleural space
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Pleurectomy (pleural stripping)
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Obliterate pleural space
Surgically stripping parietal pleura away from visceral pleura Produces an intense inflammotory reaction that promotes adhesion between layer during healing |
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Pleurisy
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inflammation of the lining of the lungs and chest (the pleura)
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Complications of pleural effusions?
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Empyema
Pneumothorax Recurrent effusions pleurisy |
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Empyema
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Pus in the plural space
Increased WBCs, pleural fluid is purulent |
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What happens if the pus in the pleural space is not drained?
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If not drained, becomes thick (almost solidified), significantly restricting lung expansion
This is called fibrothorax May require surgical intervention (“decortication”) |
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What is a chest tube?
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a drain placed in the pleural space to restore intrapleural pressure, and allow reexpansion of the lung, it also prevents air and fluid from returning to the chest
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What mechanism of action helps to drain from chest tubes?
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gravity
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In the suction chamber, what controls the suction of the chest tube?
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The amount of water in the suction chamber, not the amount of wall suction
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What level of water is used for wet suction?
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It has to be MD prescribed
Usually -20cm |
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What is the purpose of the water seal in the suction unit?
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Prevents air from entering back into the patient (must always be under water level)
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What to observe for in the water seal chamber?
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Tidaling (intermittent bubbling and fluctuation)- will rise with inspiration and fall on expiration
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What if you see continuous rapid bubbling in the water seal chamber?
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Locate the leak- start at pt and work your way to the unit.
CALL MD if there is no air leak!! Need to prevent collapse of lung and mediastinal shift |
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What if you see no tidaling with respirations?
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Listen to lung sounds because they have either re-expanded or the tubes are kinked/obstructed
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Where must the chest tube collection unit remain?
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Below the patient, for gravity
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What do you do if the chest tube comes out?
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Have sterile gauze nearby, apply to site
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What do you do if the chest tubing detacheds from the collection unit?
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Put the tube under sterile water!
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Do we ever strip the chest tubing?
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No, it can cause increased pressure in the pleural space
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How often do we assess pts with chest tubes?
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Every hour!!!!!
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What to assess for with pts with chest tubes?
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Occlusive dressing must be tight and intact
Assess difficulty breathing Check pulse ox frequently Listen to lung sounds Check for alignment of trachea Check skin around tube insertion site Check for signs of infection Assist patient to use incentive spirometer Check for pain Reposition the patient who reports BURNING in chest |
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What to keep near the chest tube pt bedside in case of system interruption?
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Keep padded clamps at bedside for use if the drainage system becomes interrupted
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What to keep near the bed in case of chest tube dislodgment?
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Keep sterile gauze near bedside if the chest tube becomes dislodged
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How to remove blood clots from chest tubing?
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If blood clots occur in the tubing use a milking technique and pause in between each hand hold
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What to document for chest tubes?
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CHECK AND DOCUMENT AMOUNT, COLOR, AND CHARACTERISITCS OF FLUID IN THE COLLECTION CHAMBER AS OFTEN AS NEEDED
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When to empty chest tube collection chamber?
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EMPTY COLLECTION CHAMBER BEFORE THE FLUID MAKES CONTACT WITH THE BOTTOM OF THE TUBE
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Where do we obtain samples from the chest tube system?
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OBTAIN SAMPLES FROM THE CHEST TUBE, NEVER FROM THE COLLECTION CHAMBER (CLEAN CHEST TUBE USE 20G SYRINGE AND DRAW UP)
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How often to assess chest tube drainage?
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After the first 24 hours assess drainage every 8 hours
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For chest tube pts... IMMEDIATELY NOTIFY MD OR RAPID RESPONSE TEAM FOR:
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Trachel deviation
Sudden onset or increased dyspnea O2 sat less than 90% Drainage greater than 70-100 ml/hr Visible eyelets on chest tube Chest tube falls out of the patient’s chest (immediately cover with dry sterile gauze) Chest tube disconnects from drainage system (immediately put end of tube in sterile water and keep below patient’s chest) Drainage in tube stops in the FIRST 24 HOURS. |
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What amount of chest tube drainage requires an immediate call to the doctor?
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Drainage greater than 70-100 ml/hr
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What to do if chest tube pt's O2 sats drop below 90%?
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Call MD
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Is it normal to see the eyelets on the chest tube?
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No! Call MD!
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What to do if chest tube drainage stops within the first 24 hrs?
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Call MD!
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What is the Most common acute pulmonary disease among hospitalized patients
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Pulmonary embolism
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What is an embolism made of?
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A collection of particulate (solids, liquids, air)
Blood clot is most frequent |
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Wht does a PE do to pulmonary flow--> rest of body-->tissues-->posssible outcome?
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Obstruct pulmonary blood flow
Reduced oxygenation of the whole body Pulmonary tissue hypoxia Potential death (may occur in as little as 1 hr) |
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What is the most common cause of a PE?
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Usually due to deep vein thrombosis (DVT)
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Major Risk Factors for PE?
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Long Flight!- prolonged mobility
CVCs Surgery Obesity Advancing age Conditions that increase blood clotting Hx of thromboembolism |
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Other PE risk factors?
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Smoking
Pregnancy Estrogen therapy Heart failure Stroke Cancer ( lung, prostate) Trauma |
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What makes a PE?
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Fat
Oil Air Tumor cells Amniotic fluid Foreign Objects Injected Particles Infected clots or pus |
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Things one can do to help prevent a PE?
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Prevent venous stasis
Passive ROM Early ambulation Antiembolism or pneumatic compression stockings Avoid tight clothing Prevent pressure on popliteal space (no crossing legs) ↑ LE to improve venous return No leg massage Avoid Valsalva maneuver Smoking cessation |
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What drugs to prevent PE?
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Administer prophylactic low-dose anticoagulant and anti-platelet drugs.
Lovenox, Plavix, Asprin, Heparin Effient, Ticlin |
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PE symptoms
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Dyspnea – sudden onset
Pleuritic chest pain Apprehension, restless, abrupt anxious, fearful Feeling of impending doom Cough Hemoptysis |
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PE, what will lungs sound like?
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Crackles
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PE, what will breathing look like?
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Fast- tachyonea, then eventually slows down
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What will pt physically feel in chest area if PE occurs?
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Pleural friction rub
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What will cardiac signs be if PE occurs?
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Fast HR- Tachycardia, then Vtach because Lytes are all out of whack
BP first goes up, then drops |
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What heart sounds if PE occurs?
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S3 or S4 heart sound
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What will pts skin look like if PE occurs?
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excessive sweating- diaphoresis
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PE pts O2 SATS?
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LOW, even if on O2, there is a blockage, it cant get through
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ABGs for PE pt?
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Hyperventilation leads to respiratory alkalosis (↓ Paco2)
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What electrolyte labs to look for in PE?
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Ca, K, Mg
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What can result in the heart from a PE?
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R sided Heart failure
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What does A-a gradient increased mean in relation to PE labs?
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Blood is shunted without picking up O2 in the lungs
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What type of scan is the best to detect/diagnose a PE?
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Spiral CT
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Hypoxemia is characterized by...
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Sudden onset of dyspnea & chest pain
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What to do in case of hypoxemia??
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Call RRT
Reassure Pt Assist to position of comfort – HOB elevated O2 therapy ABG Monitor and assess |
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Goals of managing PE?
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Increase gas exchange
Improve lung perfusion Reduce risk of more clot formation Prevent complications |
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Treatments for PE?
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O2 Therapy
Administer anticoagulants or fibrinolytic |
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How often to assess and monitor PE pts?
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Q5 mintues
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How often to monitor for changes in status with PE pt, once they are stable?
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Monitor for changes in status AT LEAST every 1-2 hours (PROBABLY MORE)
Vital signs Lung sounds |
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Wh would morphine be prescribed for PE pts?
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Morphine for pain
Will decrease pain and anxiety |
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Surgical Intervention for PE
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Embolectomy
Inferior vena cava interruption Placement of a filter |
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Patient teaching for anticoagulants or fibrinolytic therapy?
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Use electric shaver
Soft tooth brush – don’t floss No dental work without MD ok No ASA or ASA containing products No contact sports – or any activity with risk of injury If bumped – apply ice x1hr Avoid hard foods – might scrape mouth Eat warm, cool or cold foods Check skin & mouth daily for bruising, swelling |
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How long is Heparin given after a PE?
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About a week
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How long is Coumadin therapy given after a PE?
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Started around 3rd day of Heparin therapy, on med for about 6 weeks if not longer
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Arterial thrombus
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Occurs under high flow conditions
Consists of mostly platelet aggregates held together by fibrin strands |
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Venous Thrombus:
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Formed by stasis
Constists mostly of red cells, fibrin and few platelets |
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Arterial Thrombosis results from
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Results from a ruptured atherosclerotic plaque
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How does an arterial thrombus form?
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The thrombus travels and adheres to the vessel wall. Fibrin and platelets attach to the site and cause occlusion, which obstructs blood flow.
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What does an arterial thrombus often cause?
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MI, Stroke
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Venous Thrombosis results from?
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Results from overstimulation of coagulation factors, vessel wall damage, stasis.
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Where do most venous thrombosis occur?
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Most often occur in the deep vessels of legs, in patients with A Fib
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Venous thrombosis most often causes?
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DVT, PE
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Goal of anticoagulation drug therapy
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Prevent new clots from forming, avoid extension of the thrombus, deter thromboembolism
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Where does lung cancer arise from?
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Most arise from the bronchial epithilium.
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What are the usual outcomes for lung cancer?
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Out comes usually poor (unless tumar can be surgically removed), metastasis has usually spread by the time it is detected. treatment usually geared toward comfort palliative care
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There are two main types of lung cancer
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Small-cell lung cancer
Non-small-cell lung cancer (Epidermoid Adenocarcinoma) large cell lung cancer |
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Which lung cancer is more aggressive?
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Small-cell lung cancer
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Small-cell lung cancer
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more aggressive of the two
can spread quickly (during early part of disease) to other parts of the body early in the disease. It is strongly tied to cigarette use and rarely seen in nonsmokers. |
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Non-small-cell lung cancer (Epidermoid Adenocarcinoma) large cell lung cancer
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grows more slowly
more common |
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Which type of lung cancer accounts for 90% of cases?
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Non-small-cell lung cancer (Epidermoid Adenocarcinoma) large cell lung cancer
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How does lung cell metastasis occur?
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Metastasis occurs through the blood, and occurs by invading lymph glands and vessels. In lungs tumors can obstruct airways, or even compress airways
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Lung cancer occurs from?
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“Occurs from repeated exposure to inhaled substances that cause chronic tissue irritation or inflammation”
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#1 cause of lung cancer?
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Smoking is the #1 cause.
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Other causes of lung cancer?
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Other causes include: secondhand smoke, asbestos, radiation, air pollution, exposure to cancer causing chemicals/gases (uranium, coal products, diesel exhaust, gasoline)
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After 15 yrs of no smoking- the incidence of lung cancer...
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is the same as someone who has never smoked.
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Pack yr hx
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Pulmonary doctors want to know the pack-year smoking history. #years smoked X #of packs perday to get pack year total
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S/S lung cancer?
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Chest pain
Cough Sputum- blood tinged, rust colored, purulent Fatigue Weight loss Loss of appetite SOB wheezing |
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What does chemo do?
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Chemo kills cancer cells and keeps new ones from growing
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What does radiation do?
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Radiation helps shrink tumors before surgery to make it easier for resection- usually daily for about a month and a half
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Is chemo and radiation ever combined?
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If surgery not possible, chemo will be combined with radiation
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Laser therapy for lung cancer
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uses a small beam of light to kill cancer cells
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Surgeries for LungCancer?
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Lobectomy: removal of one of the lobes of the lung
Wedge or segment removal: removal of a small part of the lung Pneumonectomy: removal of the entire lung |
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After lung surgery, why will pt be in A LOT of pain?
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Because of the use of retractors during durgery
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What will pts coming back from lung surgery come back with?
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chest tubes
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Staging cancer is based on what scale?
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TMN system scale- T- looks at primary tumor, M- looks at any metastasis (distant), L- looks at any lymph node involvement
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What is the most thourough way to look at the lung?
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PET scanning
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Alpha rays
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aren’t used for cancer treatment
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Beta rays
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don’t penetrate tissues very well must be placed directly over targeted cells
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Gamma rays
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deeply penetrate tissues
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Teletherapy
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distant treatment, external to the patient
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Bracytherapy
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- internal to the patient, patient will admit radiation rays and is hazardous to others, when given via the oral of IV route waste products from the patient must be avoided because they contain radioactive rays, when given a sealed device patient will still emit rays. Caution should be taken
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What caution should nurses take when caring for pts on bracytherapy?
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Nurses must work quick and wear a dosimeter to scale how much radiation they are exposed to. No pregnant nurses should care for pts undergoing radiation treatment. Stand approx.. 6 ft away from the patient. Visitors need to be 18 yrs or older and can only visit for up to 30 minutes a day. Wear a lead apron, save all linens and dressings until after the device is removed, keep the door closed as often as possible, and use forceps if the device becomes dislodged.
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Therapeutic communication for pts with lung cancer
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Lung cancer is a scary diagnosis.
Patient may feel pain, anxiety, shame, and or guilt regarding smoking or other choices they have made. Our job is to care for them in a NONJUDGMENTAL WAY, and convey acceptance. ENCOURAGE patient and family to express their feelings. Be an ACTIVE LISTENER and empathetic |
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Head and neck cancer...curable?
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Yes, when treated early
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Head and neck cancer, 80% are...?
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80% are squamous cell carcinoma and appear as ulcers- leukoplakia or erythroplasia
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What causes head and neck cancers?
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Cause is unknown
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2 important risk factors for head and neck cancers?
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tobacco and alcohol use.
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Radiation causes what S/E of the mouth and throat?
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causes hoarseness, sore throat, dry mouth (xerostomia).
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2 types of radiation
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Internal
External |
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nternal- brachy therapy
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radiation put inside the body in solid form in seeds or capsules, or liquid that travels through the body seeking out and killing the cancer cells
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Trach face plate
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(stays in front of the patient’s throat and is tied around the neck
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Trach Outer Cannula with cuff
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(cuff is inflatable and fenestrations may be there as well to allow for speech.
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Trach Inner Cannula
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May be disposable or if it’s made of metal, needs to be cleaned during trach care.
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Trach teaching
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1) Humidify air
2) Teach suctioning technique, importance of coughing and what you will be doing during the procedure. 3) Importance of oral hygiene 4) Nutrition (swallowing can be difficult) 5) Use a shower shield over the tracheostomy tube, don’t go swimming 6) Recognize signs of infection. |
