Ms2 - Exam 1 - Pulmonary

Front 1

Risk factors for pulmonary embolism

Back 1

immobility, surgery within the last 3 months (especially pelvic and lower extremity surgery), stroke, paralysis, hx of DVT, malignancy, obesity in women, heavy smoker, HTN

Front 2

What is it called when an embolus from DVT turns into a PE?

Back 2

Venous thromboembolism

Front 3

Where do most PE's arise from?

Back 3

DVT

Front 4

Where do most lethal PE's originate?

Back 4

femoral or iliac veins

Front 5

What lobe of the lungs are most frequently effected by PE?

Back 5

Lower lobes

Front 6

What commonly dislodges DVT embolisms?

Back 6

Standing or Valsalva maneuver

Front 7

What is the classic triad for PE?

Back 7

dyspnea, chest pain, hemoptysis

Front 8

S/S of PE

Back 8

cough, chest pain, crackles, fever, accentuation of the pulmonic heart sound, sudden change in mental status from hypoxemiaa

Front 9

S/S of massive PE

Back 9

hypotension, shock, pallor, severe dyspnea, hypoxemia. ECG and chest x-ray indicates rt ventricular hypertrophy due to pulmonary HTN.

Front 10

S/S of medium PE

Back 10

pleuritic chest pain, dyspnea, slight fever, productive cough with blood-streaked sputum

Tachycardia, pleural friction rub

Front 11

S/S of small PE

Back 11

none uncless pt has cardiopulmonary disease

Front 12

Complications of PE

Back 12

pulmonary infarction, pulmonary HTN

Front 13

How long do pts live with PE?

Back 13

May die soon or live for decades

Front 14

Most frequently used test for PE

Back 14

spiral CT then D-dimer/pulmonary angiography

Front 15

Measures for PE

Back 15

O2!! Maybe endotracheal tube.

Then turn, cough, deep breathe to prevent atelectasis

Front 16

Rx management of PE

Back 16

Clot busters like rPA in the acute, morphine for the pain

Then, start on Lovenox immediately and Coumadin for 3-6 months.

Front 17

Surgical tx for PE

Back 17

Embolectomy in acute (50% mortality rate)

Inferior vena cava filter later.

Front 18

Positioning of PE pt

Back 18

Semi-fowler's

Front 19

What kind of pts have the highest incidence of DVT?

Back 19

Spinal cord injury

Front 20

ABG's with PE

Back 20

hypoxemia and low PaCO2

Front 21

Activity level with PE should be

Back 21

limited

Front 22

aPTT

Back 22

25-40 sec

Front 23

INR

Back 23

Therapeutic is 2.0-3.0

Heart valve replacement 2.5-3.5

Front 24

What does d-Dimer test indicate?

Back 24

Amount of cross-linked fibrin fragments. Not normally in healthy people - found in stroke, DVT, acute MI, unstable angina, DIC, surgery up to post 2nd day, sickle cell crisis

Front 25

BNP

Back 25

<100

Front 26

Troponin

Back 26

<0.2-<1.0

Front 27

How is the dosage of heparin calculated?

Back 27

according to aPTT

Front 28

How is the dosage of coumadin calculated?

Back 28

INR

Front 29

Hypoxemic respiratory failure is from...

Back 29

Low blood perfusion

Ex. ARDS, PE, artery laceration, anatomic shunt, shock

Front 30

Hypercapnic respiratory failure is from...

Back 30

Not breathing enough

Ex. Asthma, COPD, brainstem injury, sedative overdose, thoracic trauma, MS

Front 31

PaCO2

Back 31

35-45

Front 32

Patho of hypoxemic respiratory failure

Back 32

V/Q (ventilation/perfusion) mismatch, shunt, diffusion limitation, hypoventilation

Front 33

Most common disease to have V/Q mismatch

Back 33

COPD, pneumonia, bronchospasm

Front 34

Early signs of respiratory failure

Back 34

Mental status changes (restlessness, confusion, combative)

tachycardia, tachypnea, mild HTN

Front 35

What does a severe a.m. headache suggest?

Back 35

Hypercapnia in the night

Front 36

Later signs of respiratory failure

Back 36

acidosis, dysrhythmias, angina, impaired renal function (edema, increased Na and uremia)

Front 37

What does a change from tachypnea to bradypnea in an ARDS pt suggest?

Back 37

Extreme fatigue and impending respiratory arrest

Front 38

Inspiratory/expiratory ratio

Back 38

Normal is 1:2

ARDS - 1: 3or4

Front 39

What signifies moderate respiratory distress?
Severe respiratory distress?

Back 39

Accessory muscle use

paradoxic breathing

Front 40

Augmented coughing

Back 40

For the pt to weak to effectively cough

Place hands below xiphoid process. As pt ends deep inspiration and begins expirations, move your hands forcefully downward, increasing abdominal pressure and facilitating the cough.

Front 41

Rx for ARDS

Back 41

Bronchodialators (albuterol) given at 15-30min intervals

Corticosteroids for chronic respiratory failure

IV diuretics and mitroglycerin (Lasix) to decrease pulmonary congestion. If a fib is present, Ca channel blockers and beta blockers

Antibiotics for infections

Sedatives for anxiety - monitor for respiratory and cardio depression

Front 42

S/S of hypoxemic and hypercapnic breathing

Back 42

Hypoxemic - tachypnea, cyanosis, paradoxic breathing

Hypercapnic - a.m. headache, pursed-lip breathing

Front 43

Maintainence of fluid balance with ARDS

Back 43

mild fluid restriction and diuretics as necessary

Front 44

minimal leak technique with trach

Back 44

inflate cuff until no leak is heard over trachea, then deflate 0.1mm of air

Front 45

When should minimal leak technique not be used?

Back 45

when there is risk of aspiration

Front 46

How much should trach cuff pressure be?

Back 46

<20mm Hg or <25mm H2O

Front 47

Care of pt with inflated cuff

Back 47

Monitor and record cuff pressure q8h.

Never insert decannulation tube until cuff is deflated.

Monitor for increased air pressures required for cuff.

When removing, have pt swallow grape juice or H2O with blue food dye and cough to assess aspiration.

Wait two days after trachostomy tube is inserted to use.

Deflate cuff daily to check integrity of the cuff. If it returns with air, cuff needs to be replaced.

Tubing good up to 1 month in pts on home mechanical ventilation

Front 48

How often do you do trach care?

Back 48

tid and prn

Front 49

Ideal suction pressure

Back 49

120-150mm with the tubing occluded

Front 50

How long do you suction?

Back 50

<10sec

Stop if HR decreases 20bpm, increases 40bpm, dysrhythmia, or SpO2 <90%

Front 51

What do you instruct the pt to do before and during cuff deflation on trach?

Back 51

Cough before, exhale during

Front 52

What should the pt do during cuff inflation?

Back 52

inhale

Front 53

Trach dislodgement precautions

Back 53

1. Keep replacement tube at bedside
2. Do not change trach tapes for at least 24 hours after trach insertion.
3. Physician does first tube change no sooner than a week after insertion.

Front 54

What do you do if a trach becomes dislodged?

Back 54

Grab retention sutures and try to put the new trach in. If you can't get it, cover ostomy with sterile saline gauze and resuscitate with Ambu bag until help arrives.

Front 55

What kind of air do trach pts receive?

Back 55

humidified

Front 56

Nursing dx for trach tube

Back 56

Ineffective airway clearance
Risk of aspiration
Impaired verbal communication
Ineffective self-health management
Risk for infection

Front 57

How do you evaluate a trach pt for aspiration?

Back 57

add blue food coloring to clear liquid or test tacheobronchial secretions for glucose

Front 58

Decannulation of trach

Back 58

When pt can swallow and breathe, tape the stoma closed with occlusive dressive. Pt splints stoma when coughing, swallowing, speaking. Surgical intervention is not required.

Front 59

Tx for laryngeal polyps

Back 59

Rest vocal cords and stay hydrated.

Front 60

S/s of tension pneumothorax

Back 60

tracheal deviation

Front 61

If pt has confusion/agitation. What do you do first?

Back 61

Assess VS and pulse ox FIRST!!!!

Front 62

Causes of respiratory acidosis

Back 62

Drugs, cardiac arrest, pulmonary edema, muscle weakness (MG, ALS, GB)

Front 63

Causes of respiratory alkalosis

Back 63

Hypoxemia, CNS disorder, high altitude, cirrhosis, anxiety, hyperventilation

Front 64

Causes of metabolic acidosis

Back 64

Ketoacidosis, GI loss (diarrhea), renal failure, sepsis, shock

Front 65

Causes of metabolic alkalosis

Back 65

Antacid OD, GI losses, blood transfusion, not enough K+

Front 66

What stimulates COPD pt to breathe?

Back 66

O2 level, so be careful with O2 administration b/c they lose the drive to breathe.

Front 67

What is a biot respiratory pattern?

Back 67

irregular

Front 68

Rt shift

Back 68

O2 less attracted to hemoglobin and more available to tissues. Elevated temp, acidosis

Front 69

Lft shift

Back 69

O2 more attracted to hemoglobin and less available to the tissues. Cold pt, shock, alkalosis

Front 70

What do we never give tracheostomy pts?

Back 70

STRAWS

Front 71

How often do you do trach care?

Back 71

Once a shift

Front 72

What do you do before doing trach care?

Back 72

Sterile procedure, suctioning

Front 73

What hand do you use for suctioning?

Back 73

Nondominant

Front 74

When do you lavage when suctioning?

Back 74

ONLY when there are THICK secretions

Front 75

How often do we go down with suctioning?

Back 75

As often as needed

Front 76

How do you change trach ties?

Back 76

Don't take off old ones before you put on the new ones

Front 77

What concentration do you mix the NS and H2O2 for trach care?

Back 77

50/50

Front 78

Trach care, sterile or clean procedure?

Back 78

Sterile in the hospital

Clean at home

Front 79

How far do you insert the suction cathetar when suctioning?

Back 79

Until you meet resistance and then withdraw 0.5in

Front 80

What is a pneumothorax?

Back 80

Air in pleural space causing collapsed lung

Front 81

What is tension pneumothorax?

Back 81

caused by rapid accumulation of air in pleural space. Causes shift away from the collapsed lung.

Front 82

S/S of tension pneumothorax

Back 82

Dyspneic, tachycardic, sharp chest pain, cough from irritated pleural, absence breath sounds, tracheal shift

Front 83

Flail chest is defined as

Back 83

2 or more rib fractures on same side, paradoxical respirations

Front 84

Who sets up the suction for chest tube?

Back 84

RN

Front 85

When setting up suctioning for chest tube...

Back 85

-20 sontometers of suction.

Pour sterile water in until it goes to 20 sontometer mark.

3 sontometers in middle chamber.

Clean procedure. Only adjust suction in wall. Low wall suction. GENTLE BUBBLING.

Colored dye where we put the water.

Front 86

Size of chest tube...

Small for...
Large for...

Back 86

Large tube for pus drainage

Small tube for air drainage

Front 87

Type of gauze around chest tube

Back 87

Vasoline gauze

Front 88

Positioning of pleurisy

Back 88

Lay on affected side to splint it

Front 89

Most important intervention to prevent atelectasis

Back 89

Cough, deep breathe

Front 90

Pulmonary Fibrosis

Back 90

Scar tissue in lungs from inflammation or irritant
Environmental or occupational exposure, smoking
Coal mine workers
Mesothelioma
Poor prognosis – terminal illness
Lung transplant option
Exertional dyspnea, clubbing, hard to oxygenate.

Front 91

Sarcodosis

Back 91

Granulomatous dz of unknown cause
Acute, sub-acute, or chronic
Most better with symptomatic treatment
20% develop lung damage
More common in African-Americans
NSAID's, methotrexate