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97 Cards in this Set

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ARDs

What is ARDs?
Which organs are most effected? Why?
Who normally develops this?
What are the common causes of it?
1) A lung condition that leads to low blood oxygen levels and could be life threatening.
2) Kidneys and brain b/c they need oxygen rich blood.
3) People who are very ill or who have major injuries
4) Sepsis, trauma and pulmonary infections
ARDs

Pathophysiology?
1st: Infection and injures cause the lung capillaries to leak more fluid than normal into alveoli.
2nd: This prevents the lungs from filling with air.
3rd: Prevents enough oxygen into the blood stream.
ARDs

Clinical Manifestations?
Criteria for ARDs dx?
Long term effects?
When could death occur?
1) Dyspnea, profound hypoxia, decreased lung compliance, diffuse bilateral infiltrates
2) Acute onset, B/L pulm. infiltrates,
Pulm. artery wedge pressure <18 mm/Hg, no evidence of left atrial HTN
3) Some people recover completely
4) Death can occur due to MULTI system failure
ARDs

How is it managed?
Which complications need to be identified and treated promptly?
1) Supplemental oxygen
Lung rest
Could require mechanical ventilation
A low tidal volume and low pressure ventilator setting – done to prevent ventilator assisted injury.
2) pneumothorax, effusions and pneumonia
ARDs

Risk Factors?
Indirect lung injury (Sepsis, Severe trauma, Acute pancreatitis, Cardiopulm. bypass, massive transfusions, drug od.)
ARDs

What are the 3 phases called?
1) Exudative, proliferated and fibrotic
ARDs

Describe the Exudative phase?
--Damage to the alveolar epithelium and vascular endothelium produce leakage of water, protein, white and red blood cells into the interstitial and alveolar lumen.
--Inflammation occurs.
ARDs

Describe the Proliferated phase?
--Type I alveolar cells are irreversibly damaged.
--The alveolar space is replaced with proteins, fibrin, cellular debris.
--This produces hyaline membranes and injures the surfactant causing alveolar collapse.
ARDs

Describe the Fibrotic phase?
Irreversible stage: collagen deposits in the alveolar, vascular and interstitial beds causing development of microcysts.
ARDs

When does s/s develop?
--Can develop within 24 hours of the initial injury
--After 72 hours, 85% of the patients can present with symptoms
--Elderly patients can present with change in mental status
ARDs

How is it dx?
Chest X-ray
Pulmonary edema develops with diffuse infiltrates
CT scan
Over distention of the lungs due to high ventilator pressure
ABG’s
Bronchoscopy
ARDs

How can it be prevented?
PEEP – positive end-expiratory pressure assist in preventing alveolar collapse
Antibiotics for infections
Fluid for adequate profusion
Nutrition – enteral route recommended
ARDs

What's the prognosis?
--Recovery for survivors can start within 2 weeks of diagnosis
--Higher mortality rates in the elderly, immunosuppresed and chronic liver failure
--Don't forget this is a
ABG

1) pH 7.34, PaCO2 33.9, HCO3 18.2
2) pH 7.34, PaCO2 40.3, HCO3 21.4
3) pH 7.59, PaCO2 49.0, HCO3 48.2
4) pH 7.17, PaCO2 69.3, HCO3 21.0
1) Partially compensated metabolic acidosis
2) Uncompensated metabolic acidosis
3) Partially compensated metabolic alkalosis
4) Combined metabolic and respiratory acidosis
ABG

1) pH 7.07, PaCO2 11.4, HCO3 3.1
2) pH 7.25, PaCO2 74.3, HCO3 12.4
3) pH 7.45, PaCO2 27.0, HCO3 19.1
4) pH 7.28, PaCO2 79.5, HCO3 37.1
1) Partially compensated metabolic acidosis- hyperventilating
2) Combined metabolic and respiratory acidosis
3) Fully compensated respiratory alkalosis
4) Partially compensated respiratory acidosis
ABG

1) pH 7.51, PaCO2 39.4, HCO3 31.3
2) pH 7.39, PaCO2 39.0, HCO3 23.4
3) pH 7.31, PaCO2 58.5, HCO3 26.1
4) pH 7.46, PaCo2 34.0, HCO3 26.0
1) Uncompensated metabolic alkalosis
2) normal
3) Uncompensated respiratory acidosis
4) Uncompensated respiratory alkalosis
ABG

1) pH 7.44, PaCO2 27.8, HCO3 19.2
2) pH 7.36, PaCO2 75.1, HCO3 40.6
3) pH 7.44. PaCO2 48.0, HCO3 32.6
4) pH 7.18, PaCO2 42.0, HCO3 15.0
1) Fully compensated respiratory alkalosis
2) Fully compensated respiratory acidosis
3) Fully compensated metabolic alkalosis
4) Uncompensated metabolic acidosis
ABG

1) pH 7.36, PaCO2 30.0, HCO3 15.0
2) pH 7.42, PaCO2 39.0, HCO3 25.4
3) pH 7.52, PaCO2 31.0, HCO3 26.4
4) pH 7.08, PaCO2 54.0, HCO3 15.0
1) Fully compensated metabolic acidosis
2) Normal
3) Combined alkalosis
4) Combined acidosis
Temporary Pacemakers

1) What does a pacemaker do?
2) What types are there?
3) What does a pacer spike on an EKG represent?
4) Where's the pacer spike seen if atrial?
5) Where's the pacer spike seen if ventricular?
1) Non surgical intervention provides a timed electrical stimuli to the heart
2) Single chamber or dual-chamber stimuli (Atrial and ventricular)
3) a pacing stimuli
4) Before P wave
5) Before QRS
Temporary Pacing

1) What's a capture?
2) Is used when the pt presents with what?
1) When spikes are seen on the EKG
2) Sx of atropine- refractory bradydysrhythmias: second degree heart block type II, Third degree heart blocks and asystole
Temporary Pacing

1) When is an atrial override needed?
2) Why is the done?
3) When is a ventricular override needed.
1) Aflutter or Afib
2) Stimulate the atrium to gain control of the heart
3) Not done often. Done in the cath lab.
Modes of Pacing

1) What types of pacing are there?
2) Which is considered "demand pacing"?
1) Synchronous and asynchronous
2) Synchronized
Modes of Pacing

Synchronous Pacing
1) How should the pacers be set?
2) When will the pacer fire?
3) When will the pacer NOT fire?
1) Sensitivity is set to sense the patients' beats.
2) When the patients' rate drops below the set rate?
3) No pacing when the heart is beating at the set rate.
Modes of Pacing

Asynchronous Pacing
1) What type of pacer is this?
2) What patient conditions is this used?
3) When does it fire?
1) Fixed rate pacing
2) Asystole, profound bradycardia, or post open-heart surgery.
3) Fires at the set rate irregardless of the rhythm. Doesn't sense the patients' own beats.
Modes of Pacing

Asynchronous Pacing
1) What could this pacer cause?
2) What's the biggest risk of this type of pacemaker?
1) R-on-T phenomenom
2) Fires on the T wave, can cause V fib.
Noninvasive temporary pacing

1) How's noninvasive temporary pacing done?
2) When's it used?
1) Application of 2 large external electrodes transcutanoeusly pacing.
2) An emergency measure to provide demand ventricular pacing.
Noninvasive temporary pacing

1) When is it used?
2) When will it pace?
1) symptomatic bradycardia
2) Stimulation of ventricular depolorization, heart rate slower than rate of pacemaker.
Pacemaker

Complications (Prevention)
Pain or discomfort (use analgesia)
Skin irritation (ensure good contact with the skin)
Diaphoresis
Loss of capture (pacing spike is not followed by the QRS)
Pacemaker does not sense the intrinsic QRS complex
Invasive Temporary Pacing

1) How is it achieved?
2) Does this pacing hurt?
3) Where's the patient when this happens?
1) External battery operated pulse generator and pacing electrodes.
Attach to the generator on one end and in the patient on the other end.
2) Discomfort is felt NOT pain.
3) Normally in the unit when this is placed the patient will need to go to the OR for a permanent pacer.
Invasive temporary pacer

Complications?
Infections or hematomas at the insertion site
Increased PVC’s due to the irritability from the lead wires
Lose of capture
Under sensing
Over sensing
Interference from other electronics
Permanent Pacing

1) What conditions is it used to treat?
2) How's it powered?
3) What's the lifetime of this pacer?
4) Then, what should the patient do?
1) Complete heart block and sick sinus syndrome
2) lithium battery
3) 10 years
4) Some can be charged externally, patients sd call the manufacturer and have the battery charged and interrogated.
P wave

1) Indicates what?
2) Normal duration of it?
3) What does it strongly suggest?
1) atrial depolarization: atrium contraction.
2) < 0.11 sec. (< 3 sm. squares)
3) The atria have followed through with a contraction.
PR interval

1) How's it measured?
2) Why's it significant?
3) What happens during this interval?
1) Start of the P wave to the start of the QRS complex.
2) Provides clues to the location of the originating impulse and integrity of the conduction pathways of the heart.
PR interval

1) What happens during this interval?
2) Indicates what?
3) Normal duration of it?
1) Covers the time taken for the impulse to travel from the SA node through the atria and the AV junction through the Perkinje network
2) AV conduction time
3) 0.12 to 0.20 seconds
QRS complex

1) Indicates what?
2) Normal duration of it?
1) ventricular depolarization= ventricles contraction
2) < 0.10 sec.
T wave

1) Indicates what?
2) What does these waves look like?
1) ventricular repolarization
2) <5 mm in amplitude in standard leads and 10 mm in precordial leads.
Rounded and asymmetrical.
ST segment

1) Indicates what?
2) Characteristics of it?
1) Early ventricular repolarization.
2) Not depressed more than 0.5 mm. May be elevated slightly in some leads (no more than 1 mm).
PR interval

1) Indicates what?
2) Duration?
1) AV conduction time
2) 0.12 to 0.20 seconds
QT interval

1) How's it measured?
2) Represents what?
3) Describe the electrolytes involved?
1) From the Q to the end of the T.
2) Ventricular depolarization and repolarization
3) Na influx and K efflux.
QT interval

Duration?
1) < 1/2 the R-R interval (0.32-0.40 seconds when rate is 65-90/minute. QT varies with rate. Correct for rate by dividing QT by the square root of the RR interval.
2)
QT interval

1) What situations would cause a prolonged QT interval or torsades de pointe?
2) Describe causes?
1) Inherited, acquired, and meds.
2)--Inherited - defective sodium or potassium channels
--Acquired - drugs, electrolyte imbalance or MI
--At least, 50 drugs known to affect QT (including: quinidine, amiodarone and dofetilide).
Bradydsyrhythmias

1) Is what?
2) This results in what?
3) How is coronary perfusion time effected?
1) Rate's less than 60 bpm
2) Myocardial oxygen demand is reduced due to the slow rate.
3) Adequate d/t prolonged diastole.
Sinus Bradycardia

1) What causes it?
2) What type of meds can cause this?
1) Parasympathetic nervous system, Excessive vagal stimulation, Occurs in well conditioned athletes, Carotid sinus massage, Vomiting, Gagging, Suctioning, Ocular pressure, meds.
2) Hypoxia, inferior wall MI, beta-adrenergic blocking agents, calcium channel blockers and digitalis.
Dysrhythmias

1) Why do they happen?
2) What are 2 usual problems?
1) Disruption in the relationship between electrical conductivity and the mechanical response of the myocardium.
2) Impulse formation-- rate or focus
Impulse conduction-- delays and blocks.
Or combo of two.
Dysrhythmias

1) What are the symptoms?
1) Chest pain, pressure, discomfort
Anxiety, Confusion, Syncope
Palpations, SOB, hypotension, Delayed cap refill, n/v, diaphoresis, pulse deficit, tachypnea, crackles, JVD
Sinus Dysrhythmias

1) What's the pacemaker of the heart?
2) What could cause dysrhythmias?
3) How/when is a dysrhythmia treated?
4) S/S?
1) SA node
2) Sympathetic NS stim. or vagel stim. increase the heart rate.
3) Treat cause for tachys (fever, hypovolemia, pain, anxiety, or CHF), treat brady only if symptomic (atropine, epi, pacemaker).
4) Fatigue, weakness, SOB
Tachydysrhythmias

1) Rate
2) Concerns?
3) Why?
1) >100 bpm
2) Serious hemodynamic issues
--Dec. the diastole time and coronary perfusion
--Inc. cardiac output and BP, dec. the stroke volume
--Inc. the workload of the heart, inc. oxygen demand of the myocardium
3) Coronary artery blood flow occurs mostly during diastole when the aortic valve is closed.
Tachydysrhythmias

Interventions?
Oxygen
Rest
NTG and Morphine as ordered
Diuretics
Fluids for hypovolemia
Antipyretics and antibotics- fever and infection
Teaching
Premature complexes

1) What type of rhythm is this?
2) When does it occur?
3) What abnorm. foci generates this?
1) Early rhythm complex
2) When a cardiac cell or cell group other than the SA node becomes irritable and fires impulses before the next sinus impulse is produced.
3) atrial, junctional or ventricular tissue.
Premature complexes

1) What happens after the premie complex?
2) Sx?
3) Names of premie complexes.
1) Premie complex, then a pause before the next norm. complex. Which creates an irreg. rhythm.
2) c/w symptoms. Palpations.
3) Bigeminy, Trigeminy, Quadrigeminy.
Premature complexes

Describe Bigeminy
2) Trigeminy
3) Quadrigeminy
Exists when norm. complexes and premie complexes alternate in a repetitive two-beat pattern, with a pause occurs after each complex- occurs in pairs
Premature complexes

Describe Trigeminy
A repeated three-beat pattern, usually occurs as a two sequential normal complexes followed by a premature complex then a pause. Triplets.
Premature complexes

Describe Quadrigeminy
A repeated four-beat pattern, occur as three sequential normal beats followed by a premature complex and a pause, four beat pattern
SVT

1) What is it?
2) EKG changes?
3) s/s of SVT
4) Treatments for SVT?
1) Rapid stimulation of atrial tissue at a rate of 100-280 beats/min.
2) P waves are shaped differently.
3) Palpations, sob, weakness, fatigue, hypotension and syncope.
4) Vagel stimulation, oxygen, dilt. (cardizem), adenosine, amiodarone
Atrial dysrhythmias

1) What is this?
2) EKG changes?
3) Most common atrial dysrhythmias?
4) Cause of atrial dysrhythmias?
1) Impulse is from the atrial tissue not the SA node, acts like an ectopic pacemaker.
2) P wave looks different due to the different conduction path.
3) most common: PAC’s, SVT, a flutter and a fib.
Atrial dysrhythmias

1) Cause of atrial dysrhythmias?
2) Meds?
1) Arterial irritability can be caused by: stress, fatigue, anxiety, infection, inflammation, caffeine, nicotine, alcohol, myocardial ischemia, hypermetabolic states, electrolyte
imbalance, atrial stretch, CHF, valvaular disease, pulmonary hypertension with cor pulmonale.
2) Meds catchilamines, digitalis, sympathomimetics, anethetic agents. and amphetaminines.
Atrial Flutter

1) What is it?
2) What happens?
1) Rapid atrial depolarization occurring at a rate of 250-350 times per min.
2) The AV node blocks the number of impulses traveling to the ventricle can result in a 2:1 block if left untreated
Atrial Flutter

1) Causes of it?
2) Assessment?
3) Interventions?
1) rheumatic or ischemic heart disease, CHF, AV valve disease, septal defects, pulmonary embolism, alcoholism, pericarditis
2) Palpations ,Weakness, Fatigue, SOB, anxiety, angina, heart failure and shock
3) oxygen, corvert, amiodarone, cardizem, cardioversion if unstable
Cardioversion/Defibrillation

1) Describe what it is?
2) Describe cardioversion?
3) Describe defib?
1) Lg amt of electricity are applied to the heart through the chest wall to depolarize the heart and allow the SA node to again control the rhythm normally.
2)defibrillator synchronizes w/ventricular depolarization (QRS) 50-200 joules
3) Defibrillation is asynchronized 100-400 joules
Atrial Fibrillation

1) What is it?
2) EKG changes?
1) Atrial is quivering. Multiple rapid impulses from many different atrial foci rate can be 300-600 times per min.
2) Chaotic rhythm NO P wave, no atrial contraction, loss of the atrial kick, and irregular ventricular response
Atrial Fibrillation

1) Complications of A.Fib.
2) is a common dysrhythm, who commonly develops it?
3) What are common causes of it?
1) Dilation and stagnation of blood cause thrombus formation and increased risk for CVA’s
2) >80 yo. men>women. those with cardiac damage.
3) Rheumatic heart disease with mitral stenosis, atrial septal defect, heart failure, cardiomyopathy, hyperthyroidism, PE, WPW syndrome, congential heart disease
Atrial Fibrillation

1) S/S
1) Pulse deficit, Weakness, SOB, JVD, Dizziness, Anxiety, Syncope, Chest pain, Palpations, hypotension, decreased exercise tolerance, increased risk for PE, report any change in mental status.
Atrial Fibrillation

1) Interventions
1) Anticoagulants, heparin, lovenox, elective cardioversion (if stable), TEE.
Anticoagulants

1) Why are they used?
2) What type of patient sd get it?
3) What's the drug of choice?
1) Erratic contraction of the heart leads to areas of the heart where blood can pool and clot.
2) Afib, and Aflutter
3) Coumadin
Aneurysm

1) What is it?
2) What's a fusiform aneurysm?
3) What's a sacular aneurysm?
1) Permanent localized dilation of an artery. It can enlg. to at least 2 times the normal size.
2) a diffuse dilation affecting the circumference of the artery
3) an outpouching affecting only a portion of the artery.
Aneurysm

1) What's a false aneurysm?
2) Where does it usually happen?
1) Occurs upon injury or trauma to all 3 layers of the arterial wall.
2) At a point where there lacks support from skeletal muscles or at flexion sites in the arterial tree.
Aneurysms

1) Where does it form, why?
2) What causes more dilation?
3) What happens when the artery ruptures?
1) Forms in the middle layer of the artery is weakened. Allowing the inner and outer artery stretch. Tension increases in the artery wall.
2) Hypertension
3) Lg. amount of blood loss and lack of blood flow to organs.
Aneurysms

1) Which location do aneurysms occur 75%.
2) Which aneurysms have a 50% chance of rupture?
1) AAA.
2) AAA >6 cm
3)
Thoracic aortic aneurysm

1) Account for how much of an aneurysms?
2) Why important to know?
3) Where does it norm. develop?
1) 25%
2) Frequently misdx
3) Between the left subclavian artery and diaphragm. Located in the descending, ascending and transverse section of the aorta.
Thoracic aortic aneurysm

1) What's the treatment for this.
2) What should the nurse assess for?
1) Depends on type and location of the aneurysm. Approach involves either thorocotmy or median sternotomy. Decron graft into the aorta.
2) Assess for bleeding, ischemic colitis, cerebral and spinal cord ischemia, respiratory distress and arrhythmias post op.
Aneurysm

1) What are possible causes?
2) What are the s/s.
1) Atherosclerosis, Hypertension, Cigarette smoking, Syphilis, Genetic disorders (Ehler-Danlos
Marfans (an autoimune disease)).
2) back pain, SOB, hoarseness and difficulty swallowing.
AAA

1) What are the usual sx?
2) You know your pt has AAA, what sd the nurse assess for?
3) When the AAA is rupturing, what will the pt. experience?
1) Asymptotic. Found during routine screening or by accidental findings.
2) back pain, flank pain, abdominal pain, pulsation in the upper abd., ausculate for a bruit, sudden onset of pain.
3) will be very ill, hypotension, severe pain in the back and abd area, diaphoresis, oliguria, dysrhythmia and mental obtundation.
AAA

1) What diagnostic tests cd be done?
2) How's it managed?
Abdominal xray- appears like a eggshell
CT – used often for diagnosis
Chest X-ray
U/S
Monitor size (is it getting bigger?)
2) Nonsurgical management is used for smaller sizes
Patients are monitored for any increase in size
Surgery
AAA

1) When's surgery indicated?
2) Describe the surgery?
1) At 6 cm.
2)--Excising the aneurysm
--Secure stable aortic integrity and tissue perfusion through out the body.
--Midline incision from the xiphoid process to the symphysis pubis.
--Clamps applied above and below the site.
--A preclotted dacron graft is applied in an end to end fashion
AAA

Post-Op complications?
1) MI, Graft occlusion, Hemorrhage,
Hypovolemia, renal failure, respiratory distress (early mobility), paralytic ileus- NG tube to low cont. suction.
AAA

What should the nurse assess for post-op?
Monitor BP w/arterial catheter, cardiac monitoring for dysrhythmias, chest pain, sob, diaphoresis, and anxiety.
Assess for graft occlusion or rupture: assess pulses, extremities, pain, severe pain, abdominal distention, decreased urinary output.
Head of bead elevated to 45 degrees or less to avoid flexion of the graft site.
Hypovolemia and renal failure occur due to the blood loss during surgery or during rupture.
Urine output should be 50 ml or more per hour, assess BUN and creatine levels
Dissecting

1) How are they formed?
2) How often do they occur?
3) What s/s would the patient have?
1) Blood accumulates in the artery.
2) Common occurence.
3) Pain (ripping or tearing feeling),
Diaphorisis, N/V, decreased or absent pulses, altered LOC.
Chest Tubes

1) Where's it inserted?
2) What does it do?
1)The right lower mid-axillary line and a second in the 3rd intercostal space a the midclavicular line. Lower mid-axillary line and a second in the 3rd intercostal space at the midclavicular line
2) Drains fluid from the pleural space.
Intubation

1) How's the patient prepared for intubation?
2) Pre-intubation meds?
3) Post-intubation meds?
4) What sd be monitored during intubation?
1) They need to be properly sedatated with a sedative and paralytic.
2) Sedative (Etomidate), Paralytic (Succinylcholine).
3) Versed, vecurronium.
4) vital signs: BP, heart rate, O2 saturation.
Each attempt should not last longer than 30 seconds or pt has a decrease in saturation
Intubation

1) What sd the nurse be prepared for post-intubation?
2) How's placement verified?
1) OG tube placement
2) Assess lung sounds.
Listen to anterior chest B/L.
Ausculate stomach- why????
Co2 monitoring
Respiratory must be present
Tube stabilization
Intubation

Nursing Assessment for vented patients?
--Assess vital signs and breath sounds q 30-60 mins AT THE MINIMUM.
--Monitor Saturation, ABG’s.
--Assess tube placement after each movement.
--Assess endotube area at least every 4 hours for color, tenderness, skin irritation, and drainage.
--Evaluate and implement care for anxiety in the family and the patient.
Intubation

Nursing care for vented patients?
--Assess and plan for a means to communicate with the patient
--Attempt to anticipate the needs of the patient
--Frequent ventilator checks (settings, water for humiliation, secretions in the tube and mouth, kinks in the tubing, alarms are ON)
--Alarms are there for a reason- never turn them off without assessing your patient, do not ignore the alarms- THIS IS YOUR PATIENTS AIRWAY
--2 causes for the alarms: high pressure or low exhaled volume
Intubation

ET tube care
1) When do you suction?
2) What other care sd be done?
1) Secretions, Increased peak airway pressure (PIP), Presence of rhonchi (wheezes), Decreased breath sounds.
2) Frequent mouth care. Position the endotube at least every 4 hours to prevent skin break down at the site of insertion.
Intubation

What's the purpose of mechanical ventilation?
1) Supports and maintains respiratory function.
Improve oxygenation and ventilation
Decrease work needed for effective breathing. Used to support patients lung function until either the acute episode has passed or lung function improves.
Intubation

Nursing Dx?
--Impaired verbal communication related to physical barrier
--Disturbed sleep pattern related to interruptions for monitoring, noisy environment
--Death anxiety related to loss of independent breathing ability
--Impaired oral mucous membranes related to presence of endotracheal tube
--Potential for ventilator- assisted pneumonia
Intubation

Cardiac Complications
--Hypotension: Usually occurs with dehydration and need for a high PIP. Causes increased thoracic pressure and prevents blood return to the heart l/t decreased cardiac output.
--Fluid retention d/t the decreased cardiac output, kidneys receive less blood flow, stimulating renin-angiotension-aldostrone system, humidified air can play a part in fluid retention, airway can become dry, secretions solidify
Intubation

Respiratory Complications?
--Baratrauma- damage to the lungs from the positive pressure, examples include: pneumonthorax, subcutaneous emphysema, and pneumomediastium.
--AT RISK patients: chronic airflow limitation, have blebs, hyperinflation, require high pressure settings on the vent, like in ARDS
--Volutrauma- damage to the lungs due to excessive volume delivered to one lung over the other
--Acid-base balances
Intubation

GI and Nutritional complications?
1) Common problems
1) Stress ulcers occur in 25% of patients, changes in the thoracic and abdominal paralytic ilieus
2) Antacids, sucralfate (Carafate, Sulcrate), Histamine blockers- Zantac, ranitidine, Proton-pump inhibitors – nexium, esomeprazole
Intubation

Why's malnutrition a problem?
A common problem
Malnutrition can cause problems with weaning off the vent
Loss of respiratory muscle tone and strength
Ineffective breathing occurs
Fatigue results
Electrolytes replacement is also very important
Monitor potassium, calcium, magnesium, and phosphate levels.
Intubation

Why's infection a problem?
--Within 48 hours of implementation of an artificial airway bacteria can be colonized causing pneumonia
--Aspiration of the bacteria can cause infection which causes a longer hospital stay.
--Increases morbidity
--PREVENTION includes
HANDWASHING, ORAL care, good pulmonary hygiene: chest physiotherapy, postural drainage, turning and positioning.
Intubation

Best practices for patients requiring ventilation assistance?
Assess respiratory status, VS, Color,
B/L chest expansion, tube placement, pulse ox, ABG’s, vent. settings, alarm are on, empty vent. tubing, cuff inflated, lung sounds, need suction, GI problems, I/O, turning, monitor progress (can they be be weaned?), relaxtion techniques, admin. sedation, paralytic, narcotics. Explain all procedures
Maintain HOB greater 30 degrees
Thoracic surgery

Pre- and Post-Op teaching
1) Why do it?
2) What teaching should be done?
1) Done to assist in elevation of fear and anxiety. Decreases complications.
2) Complications associated with surgery. Sign consent form. Breathing exercises who, what, where, how. Coughing with splinting, leg exercises and TED hose, Jobst stockings, and why.
Thoracic surgery

Prevention of complications
Jobst stocking, TED hose, Early ambulation, ROM exercises,
Monitoring of vital signs- What are you looking for??
Thoracic surgery

Breathing exercises
Are important in assisting with lung expansion
And strengthen the accessory muscles
Assist in loosening of secretions
Maintains adequate air exchange
Thoracic surgery

Risk factors for DVT
Obesity, Over 40 years old, Cancer
Community Health Nursing

What's a needs assessment based on?
How should the client be assessed?
1) Implementation of the goals of the community health nurse, Assessment findings, Patient and family environment, Culture resources
2) What is the client’s expectation of the outcome of care
Basic care needs
Medications
Nutrition
Comfort with technology
Ability to understand emergency equipment
Supplemental oxygen, cane walking, other assistive devices
Preventive Care

What's tertiary care?
Examples?
1) Rehab once the dx is stabilized?
2) Following the cardiac rehab program
Pursing rehab services post injury
CVA, head injury, ect