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847 Cards in this Set
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Respiratory
I. Assessment A. Subjective Data 1. Past Health History--______, ________, _________, ________, previous hospitalizations, allergies, COPD, pneumonia, bronchitis, TB, weight loss (early lung cancer, TB, and COPD), sleep apnea, recent travel, flu vaccination 2. Symptoms--SOB (when, etc.), # of pillows for sleep, DOE (how far can they walk), associated symptoms (cough, changes, sputum, loose/dry, color, odor, blood), pain (what relieves it) 3. Medications--prescription and over the counter 169.254.115.213 |
Respiratory
I. Assessment A. Subjective Data 1. Past Health History--smoking, asthma, occupation, recent illnesses, previous hospitalizations, allergies, COPD, pneumonia, bronchitis, TB, weight loss (early lung cancer, TB, and COPD), sleep apnea, recent travel, flu vaccination 2. Symptoms--SOB (when, etc.), # of pillows for sleep, DOE (how far can they walk), associated symptoms (cough, changes, sputum, loose/dry, color, odor, blood), pain (what relieves it) 3. Medications--prescription and over the counter |
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Respiratory
I. Assessment A. Subjective Data 1. Past Health History--smoking, asthma, occupation, recent illnesses, ________, _________, _________, ________, bronchitis, TB, weight loss (early lung cancer, TB, and COPD), sleep apnea, recent travel, flu vaccination 2. Symptoms--SOB (when, etc.), # of pillows for sleep, DOE (how far can they walk), associated symptoms (cough, changes, sputum, loose/dry, color, odor, blood), pain (what relieves it) 3. Medications--prescription and over the counter |
Respiratory
I. Assessment A. Subjective Data 1. Past Health History--smoking, asthma, occupation, recent illnesses, previous hospitalizations, allergies, COPD, pneumonia, bronchitis, TB, weight loss (early lung cancer, TB, and COPD), sleep apnea, recent travel, flu vaccination 2. Symptoms--SOB (when, etc.), # of pillows for sleep, DOE (how far can they walk), associated symptoms (cough, changes, sputum, loose/dry, color, odor, blood), pain (what relieves it) 3. Medications--prescription and over the counter |
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Respiratory
I. Assessment A. Subjective Data 1. Past Health History--smoking, asthma, occupation, recent illnesses, previous hospitalizations, allergies, COPD, pneumonia, _____, ______, _______ (early lung cancer, TB, and COPD), _______, recent travel, flu vaccination 2. Symptoms--SOB (when, etc.), # of pillows for sleep, DOE (how far can they walk), associated symptoms (cough, changes, sputum, loose/dry, color, odor, blood), pain (what relieves it) 3. Medications--prescription and over the counter |
Respiratory
I. Assessment A. Subjective Data 1. Past Health History--smoking, asthma, occupation, recent illnesses, previous hospitalizations, allergies, COPD, pneumonia, bronchitis, TB, weight loss (early lung cancer, TB, and COPD), sleep apnea, recent travel, flu vaccination 2. Symptoms--SOB (when, etc.), # of pillows for sleep, DOE (how far can they walk), associated symptoms (cough, changes, sputum, loose/dry, color, odor, blood), pain (what relieves it) 3. Medications--prescription and over the counter |
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Respiratory
I. Assessment A. Subjective Data 1. Past Health History--smoking, asthma, occupation, recent illnesses, previous hospitalizations, allergies, COPD, pneumonia, bronchitis, TB, weight loss (early lung cancer, TB, and COPD), sleep apnea, ____,________ 2. Symptoms--SOB (when, etc.), # of pillows for sleep, DOE (how far can they walk), associated symptoms (cough, changes, sputum, loose/dry, color, odor, blood), pain (what relieves it) 3. Medications--prescription and over the counter |
Respiratory
I. Assessment A. Subjective Data 1. Past Health History--smoking, asthma, occupation, recent illnesses, previous hospitalizations, allergies, COPD, pneumonia, bronchitis, TB, weight loss (early lung cancer, TB, and COPD), sleep apnea, recent travel, flu vaccination 2. Symptoms--SOB (when, etc.), # of pillows for sleep, DOE (how far can they walk), associated symptoms (cough, changes, sputum, loose/dry, color, odor, blood), pain (what relieves it) 3. Medications--prescription and over the counter |
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Respiratory
I. Assessment A. Subjective Data 1. Past Health History--smoking, asthma, occupation, recent illnesses, previous hospitalizations, allergies, COPD, pneumonia, bronchitis, TB, weight loss (early lung cancer, TB, and COPD), sleep apnea, recent travel, flu vaccination 2. Symptoms--SOB (when, etc.), # of _______ for sleep, _____ (how far can they walk), associated symptoms (____, ______, sputum, loose/dry, color, odor, blood), pain (what relieves it) 3. Medications--prescription and over the counter |
Respiratory
I. Assessment A. Subjective Data 1. Past Health History--smoking, asthma, occupation, recent illnesses, previous hospitalizations, allergies, COPD, pneumonia, bronchitis, TB, weight loss (early lung cancer, TB, and COPD), sleep apnea, recent travel, flu vaccination 2. Symptoms--SOB (when, etc.), # of pillows for sleep, DOE (how far can they walk), associated symptoms (cough, changes, sputum, loose/dry, color, odor, blood), pain (what relieves it) 3. Medications--prescription and over the counter |
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Respiratory
I. Assessment A. Subjective Data 1. Past Health History--smoking, asthma, occupation, recent illnesses, previous hospitalizations, allergies, COPD, pneumonia, bronchitis, TB, weight loss (early lung cancer, TB, and COPD), sleep apnea, recent travel, flu vaccination 2. Symptoms--SOB (when, etc.), # of pillows for sleep, DOE (how far can they walk), associated symptoms (cough, changes, _____, ______, ______, ______, blood), pain (what relieves it) 3. Medications--prescription and over the counter |
Respiratory
I. Assessment A. Subjective Data 1. Past Health History--smoking, asthma, occupation, recent illnesses, previous hospitalizations, allergies, COPD, pneumonia, bronchitis, TB, weight loss (early lung cancer, TB, and COPD), sleep apnea, recent travel, flu vaccination 2. Symptoms--SOB (when, etc.), # of pillows for sleep, DOE (how far can they walk), associated symptoms (cough, changes, sputum, loose/dry, color, odor, blood), pain (what relieves it) 3. Medications--prescription and over the counter |
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Respiratory
I. Assessment A. Subjective Data 1. Past Health History--smoking, asthma, occupation, recent illnesses, previous hospitalizations, allergies, COPD, pneumonia, bronchitis, TB, weight loss (early lung cancer, TB, and COPD), sleep apnea, recent travel, flu vaccination 2. Symptoms--SOB (when, etc.), # of pillows for sleep, DOE (how far can they walk), associated symptoms (cough, changes, sputum, loose/dry, color, odor, ______), ______ (what relieves it) 3. Medications--prescription and over the counter |
Respiratory
I. Assessment A. Subjective Data 1. Past Health History--smoking, asthma, occupation, recent illnesses, previous hospitalizations, allergies, COPD, pneumonia, bronchitis, TB, weight loss (early lung cancer, TB, and COPD), sleep apnea, recent travel, flu vaccination 2. Symptoms--SOB (when, etc.), # of pillows for sleep, DOE (how far can they walk), associated symptoms (cough, changes, sputum, loose/dry, color, odor, blood), pain (what relieves it) 3. Medications--prescription and over the counter |
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Respiratory
I. Assessment A. Subjective Data 1. Past Health History--smoking, asthma, occupation, recent illnesses, previous hospitalizations, allergies, COPD, pneumonia, bronchitis, TB, weight loss (early lung cancer, TB, and COPD), sleep apnea, recent travel, flu vaccination 2. Symptoms--SOB (when, etc.), # of pillows for sleep, DOE (how far can they walk), associated symptoms (cough, changes, sputum, loose/dry, color, odor, blood), pain (what relieves it) 3. Medications--________ and _______ |
Respiratory
I. Assessment A. Subjective Data 1. Past Health History--smoking, asthma, occupation, recent illnesses, previous hospitalizations, allergies, COPD, pneumonia, bronchitis, TB, weight loss (early lung cancer, TB, and COPD), sleep apnea, recent travel, flu vaccination 2. Symptoms--SOB (when, etc.), # of pillows for sleep, DOE (how far can they walk), associated symptoms (cough, changes, sputum, loose/dry, color, odor, blood), pain (what relieves it) 3. Medications--prescription and over the counter |
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Respiratory
I. Assessment B. Objective Data 1. Inspection a. Signs of respiratory distress--_____, _______, ----------, ----------, ↑HR, accessory muscle use, pursed lip breathing, tracheal deviation b. Shape and symmetry of chest--bilaterally unequal, anterior-posterior diameter (ex. COPD-barrel), kyphosis, scoliosis, pectis exctavatum c. Ventilatory patterns--kussmals, chayne-stokes, rate, depth, etc. d. Evidence of clubbing--chronic hypoxia from COPD, lung cancer, and CF |
Respiratory
I. Assessment B. Objective Data 1. Inspection a. Signs of respiratory distress--cyanosis, diff breathing, anxiety, diaphoretic, ↑HR, accessory muscle use, pursed lip breathing, tracheal deviation b. Shape and symmetry of chest--bilaterally unequal, anterior-posterior diameter (ex. COPD-barrel), kyphosis, scoliosis, pectis exctavatum c. Ventilatory patterns--kussmals, chayne-stokes, rate, depth, etc. d. Evidence of clubbing--chronic hypoxia from COPD, lung cancer, and CF |
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Respiratory
I. Assessment B. Objective Data 1. Inspection a. Signs of respiratory distress--cyanosis, diff breathing, anxiety, diaphoretic, ↑-----, -------------, -----------, --------- b. Shape and symmetry of chest--bilaterally unequal, anterior-posterior diameter (ex. COPD-barrel), kyphosis, scoliosis, pectis exctavatum c. Ventilatory patterns--kussmals, chayne-stokes, rate, depth, etc. d. Evidence of clubbing--chronic hypoxia from COPD, lung cancer, and CF |
Respiratory
I. Assessment B. Objective Data 1. Inspection a. Signs of respiratory distress--cyanosis, diff breathing, anxiety, diaphoretic, ↑HR, accessory muscle use, pursed lip breathing, tracheal deviation b. Shape and symmetry of chest--bilaterally unequal, anterior-posterior diameter (ex. COPD-barrel), kyphosis, scoliosis, pectis exctavatum c. Ventilatory patterns--kussmals, chayne-stokes, rate, depth, etc. d. Evidence of clubbing--chronic hypoxia from COPD, lung cancer, and CF |
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Respiratory
I. Assessment B. Objective Data 1. Inspection a. Signs of respiratory distress--cyanosis, diff breathing, anxiety, diaphoretic, ↑HR, accessory muscle use, pursed lip breathing, tracheal deviation b. Shape and symmetry of chest: --------, ------------------ (ex. COPD-barrel), ------------, scoliosis, pectis exctavatum c. Ventilatory patterns--kussmals, chayne-stokes, rate, depth, etc. d. Evidence of clubbing--chronic hypoxia from COPD, lung cancer, and CF |
Respiratory
I. Assessment B. Objective Data 1. Inspection a. Signs of respiratory distress--cyanosis, diff breathing, anxiety, diaphoretic, ↑HR, accessory muscle use, pursed lip breathing, tracheal deviation b. Shape and symmetry of chest--bilaterally unequal, anterior-posterior diameter (ex. COPD-barrel), kyphosis, scoliosis, pectis exctavatum c. Ventilatory patterns--kussmals, chayne-stokes, rate, depth, etc. d. Evidence of clubbing--chronic hypoxia from COPD, lung cancer, and CF |
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Respiratory
I. Assessment B. Objective Data 1. Inspection a. Signs of respiratory distress--cyanosis, diff breathing, anxiety, diaphoretic, ↑HR, accessory muscle use, pursed lip breathing, tracheal deviation b. Shape and symmetry of chest--bilaterally unequal, anterior-posterior diameter (ex. COPD-barrel), kyphosis, ----------, ---------------- c. Ventilatory patterns--kussmals, chayne-stokes, rate, depth, etc. d. Evidence of clubbing--chronic hypoxia from COPD, lung cancer, and CF |
Respiratory
I. Assessment B. Objective Data 1. Inspection a. Signs of respiratory distress--cyanosis, diff breathing, anxiety, diaphoretic, ↑HR, accessory muscle use, pursed lip breathing, tracheal deviation b. Shape and symmetry of chest--bilaterally unequal, anterior-posterior diameter (ex. COPD-barrel), kyphosis, scoliosis, pectis exctavatum c. Ventilatory patterns--kussmals, chayne-stokes, rate, depth, etc. d. Evidence of clubbing--chronic hypoxia from COPD, lung cancer, and CF |
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Respiratory
I. Assessment B. Objective Data 1. Inspection a. Signs of respiratory distress--cyanosis, diff breathing, anxiety, diaphoretic, ↑HR, accessory muscle use, pursed lip breathing, tracheal deviation b. Shape and symmetry of chest--bilaterally unequal, anterior-posterior diameter (ex. COPD-barrel), kyphosis, scoliosis, pectis exctavatum c. Ventilatory patterns: ------------, ----------, --------, ---------, etc. d. Evidence of clubbing--chronic hypoxia from COPD, lung cancer, and CF |
Respiratory
I. Assessment B. Objective Data 1. Inspection a. Signs of respiratory distress--cyanosis, diff breathing, anxiety, diaphoretic, ↑HR, accessory muscle use, pursed lip breathing, tracheal deviation b. Shape and symmetry of chest--bilaterally unequal, anterior-posterior diameter (ex. COPD-barrel), kyphosis, scoliosis, pectis exctavatum c. Ventilatory patterns--kussmals, chayne-stokes, rate, depth, etc. d. Evidence of clubbing--chronic hypoxia from COPD, lung cancer, and CF |
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Respiratory
I. Assessment B. Objective Data 1. Inspection a. Signs of respiratory distress--cyanosis, diff breathing, anxiety, diaphoretic, ↑HR, accessory muscle use, pursed lip breathing, tracheal deviation b. Shape and symmetry of chest--bilaterally unequal, anterior-posterior diameter (ex. COPD-barrel), kyphosis, scoliosis, pectis exctavatum c. Ventilatory patterns--kussmals, chayne-stokes, rate, depth, etc. d. Evidence of clubbing: --------------- from --------, ---------, and ----- |
Respiratory
I. Assessment B. Objective Data 1. Inspection a. Signs of respiratory distress--cyanosis, diff breathing, anxiety, diaphoretic, ↑HR, accessory muscle use, pursed lip breathing, tracheal deviation b. Shape and symmetry of chest--bilaterally unequal, anterior-posterior diameter (ex. COPD-barrel), kyphosis, scoliosis, pectis exctavatum c. Ventilatory patterns--kussmals, chayne-stokes, rate, depth, etc. d. Evidence of clubbing--chronic hypoxia from COPD, lung cancer, and CF |
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Respiratory
I. Assessment B. Objective Data 2. Palpitation a. Assess trachea is -------, tracheal deviation indicated--------- b. Assess thoracic excursion/chest expansion--normally equal bilaterally i. Decreased bilaterally for emphysema ii. Decreased on effected side for pleural effusion and pneumothorax |
Respiratory
I. Assessment B. Objective Data 2. Palpitation a. Assess trachea is midline--tracheal deviation indicated tension pneumothorax b. Assess thoracic excursion/chest expansion--normally equal bilaterally i. Decreased bilaterally for emphysema ii. Decreased on effected side for pleural effusion and pneumothorax |
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Respiratory
I. Assessment B. Objective Data 2. Palpitation a. Assess trachea is midline--tracheal deviation indicated tension pneumothorax b. Assess ---------/chest expansion--normally equal --------- i. Decreased bilaterally for emphysema ii. Decreased on effected side for pleural effusion and pneumothorax |
Respiratory
I. Assessment B. Objective Data 2. Palpitation a. Assess trachea is midline--tracheal deviation indicated tension pneumothorax b. Assess thoracic excursion/chest expansion--normally equal bilaterally i. Decreased bilaterally for emphysema ii. Decreased on effected side for pleural effusion and pneumothorax |
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Respiratory
I. Assessment B. Objective Data 2. Palpitation a. Assess trachea is midline--tracheal deviation indicated tension pneumothorax b. Assess thoracic excursion/chest expansion--normally equal bilaterally i. Decreased --------- for --------- ii. Decreased on effected side for pleural effusion and pneumothorax |
Respiratory
I. Assessment B. Objective Data 2. Palpitation a. Assess trachea is midline--tracheal deviation indicated tension pneumothorax b. Assess thoracic excursion/chest expansion--normally equal bilaterally i. Decreased bilaterally for emphysema ii. Decreased on effected side for pleural effusion and pneumothorax |
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Respiratory
I. Assessment B. Objective Data 2. Palpitation a. Assess trachea is midline--tracheal deviation indicated tension pneumothorax b. Assess thoracic excursion/chest expansion--normally equal bilaterally i. Decreased bilaterally for emphysema ii. Decreased on effected side for --------- and --------- |
Respiratory
I. Assessment B. Objective Data 2. Palpitation a. Assess trachea is midline--tracheal deviation indicated tension pneumothorax b. Assess thoracic excursion/chest expansion--normally equal bilaterally i. Decreased bilaterally for emphysema ii. Decreased on effected side for pleural effusion and pneumothorax |
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Respiratory
I. Assessment B. Objective Data 2. Palpitation c. -----------: vibration of chest wall produced by vocalization (“Say 99” feel upper back) i. Decreased if lung is further away (pleural effusion, emphysema) ii. Increased if pneumonia, tumors, and fibrosis iii. Nothing felt if pneumothorax or severe atelectasis |
Respiratory
I. Assessment B. Objective Data 2. Palpitation c. Fremitis--vibration of chest wall produced by vocalization (“Say 99” feel upper back) i. Decreased if lung is further away (pleural effusion, emphysema) ii. Increased if pneumonia, tumors, and fibrosis iii. Nothing felt if pneumothorax or severe atelectasis |
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Respiratory
I. Assessment B. Objective Data 2. Palpitation c. Fremitis--vibration of chest wall produced by vocalization (“Say ----” feel upper back) i. Decreased if lung is ---------- (------------,------------) ii. Increased if pneumonia, tumors, and fibrosis iii. Nothing felt if pneumothorax or severe atelectasis |
Respiratory
I. Assessment B. Objective Data 2. Palpitation c. Fremitis--vibration of chest wall produced by vocalization (“Say 99” feel upper back) i. Decreased if lung is further away (pleural effusion, emphysema) ii. Increased if pneumonia, tumors, and fibrosis iii. Nothing felt if pneumothorax or severe atelectasis |
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Respiratory
I. Assessment B. Objective Data 2. Palpitation c. Fremitis--vibration of chest wall produced by vocalization (“Say 99” feel upper back) i. Decreased if lung is further away (pleural effusion, emphysema) ii. Increased if -------, -----------, and -------------- iii. Nothing felt if pneumothorax or severe atelectasis |
Respiratory
I. Assessment B. Objective Data 2. Palpitation c. Fremitis--vibration of chest wall produced by vocalization (“Say 99” feel upper back) i. Decreased if lung is further away (pleural effusion, emphysema) ii. Increased if pneumonia, tumors, and fibrosis iii. Nothing felt if pneumothorax or severe atelectasis |
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Respiratory
I. Assessment B. Objective Data 2. Palpitation c. Fremitis--vibration of chest wall produced by vocalization (“Say 99” feel upper back) i. Decreased if lung is further away (pleural effusion, emphysema) ii. Increased if pneumonia, tumors, and fibrosis iii. Nothing felt if ---------- or ----------- |
Respiratory
I. Assessment B. Objective Data 2. Palpitation c. Fremitis--vibration of chest wall produced by vocalization (“Say 99” feel upper back) i. Decreased if lung is further away (pleural effusion, emphysema) ii. Increased if pneumonia, tumors, and fibrosis iii. Nothing felt if pneumothorax or severe atelectasis |
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Respiratory
I. Assessment B. Objective Data 2. Palpitation d. ---------- (subcutaneous emphysema): crackling, crinkling, or grating feeling/sound under skin, around lungs, or in joints caused by escape of air (like bubble wrap) i. Common causes: chest tube leak, mechanical ventilation |
Respiratory
I. Assessment B. Objective Data 2. Palpitation d. Crepitus (subcutaneous emphysema)--crackling, crinkling, or grating feeling/sound under skin, around lungs, or in joints caused by escape of air (like bubble wrap) i. Common causes: chest tube leak, mechanical ventilation |
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Respiratory
I. Assessment B. Objective Data 2. Palpitation d. Crepitus (subcutaneous emphysema): ---------, -----------, or ------------------, around lungs, or in joints caused by escape of air (like bubble wrap) i. Common causes: chest tube leak, mechanical ventilation |
Respiratory
I. Assessment B. Objective Data 2. Palpitation d. Crepitus (subcutaneous emphysema)--crackling, crinkling, or grating feeling/sound under skin, around lungs, or in joints caused by escape of air (like bubble wrap) i. Common causes: chest tube leak, mechanical ventilation |
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Respiratory
I. Assessment B. Objective Data 2. Palpitation d. Crepitus (subcutaneous emphysema)--crackling, crinkling, or grating feeling/sound under skin, ---------, or in---------- caused by escape of air (like bubble wrap) i. Common causes: chest tube leak, mechanical ventilation |
Respiratory
I. Assessment B. Objective Data 2. Palpitation d. Crepitus (subcutaneous emphysema)--crackling, crinkling, or grating feeling/sound under skin, around lungs, or in joints caused by escape of air (like bubble wrap) i. Common causes: chest tube leak, mechanical ventilation |
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Respiratory
I. Assessment B. Objective Data 2. Palpitation d. Crepitus (subcutaneous emphysema)--crackling, crinkling, or grating feeling/sound under skin, around lungs, or in joints caused by escape of air (like bubble wrap) i. Common causes: ------------, ------------ |
Respiratory
I. Assessment B. Objective Data 2. Palpitation d. Crepitus (subcutaneous emphysema)--crackling, crinkling, or grating feeling/sound under skin, around lungs, or in joints caused by escape of air (like bubble wrap) i. Common causes: chest tube leak, mechanical ventilation |
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Respiratory
I. Assessment B. Objective Data 3. Percussion--assessment of --------- or ----------- of the lungs a. Resonance--air filled lung (normal) b. Hyperresonance--loud, lower pitched sound from increased air volume (ex. COPD) c. Tympany--drum like (ex. gastric air bubble) d. Dullness--consolidation in lung (ex. heart, top of liver, or pneumonia, hemothorax) e. Flat--soft, high pitched sound from large fluid mass (ex. thigh) |
Respiratory
I. Assessment B. Objective Data 3. Percussion--assessment of density or aeration of the lungs a. Resonance--air filled lung (normal) b. Hyperresonance--loud, lower pitched sound from increased air volume (ex. COPD) c. Tympany--drum like (ex. gastric air bubble) d. Dullness--consolidation in lung (ex. heart, top of liver, or pneumonia, hemothorax) e. Flat--soft, high pitched sound from large fluid mass (ex. thigh) |
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Respiratory
I. Assessment B. Objective Data 3. Percussion--assessment of density or aeration of the lungs a. Resonance: ---------- (normal) b. Hyperresonance: -----, lower pitched sound from --------------- (ex. COPD) c. Tympany--drum like (ex. gastric air bubble) d. Dullness--consolidation in lung (ex. heart, top of liver, or pneumonia, hemothorax) e. Flat--soft, high pitched sound from large fluid mass (ex. thigh) |
Respiratory
I. Assessment B. Objective Data 3. Percussion--assessment of density or aeration of the lungs a. Resonance--air filled lung (normal) b. Hyperresonance--loud, lower pitched sound from increased air volume (ex. COPD) c. Tympany--drum like (ex. gastric air bubble) d. Dullness--consolidation in lung (ex. heart, top of liver, or pneumonia, hemothorax) e. Flat--soft, high pitched sound from large fluid mass (ex. thigh) |
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Respiratory
I. Assessment B. Objective Data 3. Percussion--assessment of density or aeration of the lungs a. Resonance--air filled lung (normal) b. Hyperresonance--loud, lower pitched sound from increased air volume (ex. COPD) c. ----------: drum like (ex. gastric air bubble) d. Dullness--consolidation in ----------- (ex. heart, top of ---------, or pneumonia, ----------) e. Flat--soft, high pitched sound from large fluid mass (ex. thigh) |
Respiratory
I. Assessment B. Objective Data 3. Percussion--assessment of density or aeration of the lungs a. Resonance--air filled lung (normal) b. Hyperresonance--loud, lower pitched sound from increased air volume (ex. COPD) c. Tympany--drum like (ex. gastric air bubble) d. Dullness--consolidation in lung (ex. heart, top of liver, or pneumonia, hemothorax) e. Flat--soft, high pitched sound from large fluid mass (ex. thigh) |
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Respiratory
I. Assessment B. Objective Data 3. Percussion--assessment of density or aeration of the lungs a. Resonance--air filled lung (normal) b. Hyperresonance--loud, lower pitched sound from increased air volume (ex. COPD) c. Tympany--drum like (ex. gastric air bubble) d. Dullness--consolidation in lung (ex. heart, top of liver, or pneumonia, hemothorax) e. Flat--soft, high pitched sound from --------------- (ex. thigh) |
Respiratory
I. Assessment B. Objective Data 3. Percussion--assessment of density or aeration of the lungs a. Resonance--air filled lung (normal) b. Hyperresonance--loud, lower pitched sound from increased air volume (ex. COPD) c. Tympany--drum like (ex. gastric air bubble) d. Dullness--consolidation in lung (ex. heart, top of liver, or pneumonia, hemothorax) e. Flat--soft, high pitched sound from large fluid mass (ex. thigh) |
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Respiratory
I. Assessment B. Objective Data 4. Auscultation--to assess for ---------- and --------- sounds |
Respiratory
I. Assessment B. Objective Data 4. Auscultation--to assess for quality and adventitious sounds a. Adventitious Sounds i. Fine crackles--short lasting, high pitched at end of inspiration |
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Respiratory
I. Assessment B. Objective Data 4. Auscultation--to assess for quality and adventitious sounds a. Adventitious Sounds i. Fine crackles--short lasting, ---------- at -------------- |
Respiratory
I. Assessment B. Objective Data 4. Auscultation--to assess for quality and adventitious sounds a. Adventitious Sounds i. Fine crackles--short lasting, high pitched at end of inspiration |
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Respiratory
I. Assessment B. Objective Data 4. Auscultation--to assess for quality and adventitious sounds • Due to ---------- snapping open or movement of ---------- through a lot of ---------- • Post-op atelectasis, pulmonary edema ii. Course crackles--low pitched on inspiration and expiration that is not eliminated by cough (will not go away until disease process ends/gets better) • Due to air passing through airway intermittently occluded with mucus • Pulmonary edema, pneumonia, CHF • Do fluid assessment, I/Os, and O2Sat |
Respiratory
I. Assessment B. Objective Data 4. Auscultation--to assess for quality and adventitious sounds • Due to alveoli snapping open or movement of air through a lot of liquid • Post-op atelectasis, pulmonary edema ii. Course crackles--low pitched on inspiration and expiration that is not eliminated by cough (will not go away until disease process ends/gets better) • Due to air passing through airway intermittently occluded with mucus • Pulmonary edema, pneumonia, CHF • Do fluid assessment, I/Os, and O2Sat |
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Respiratory
I. Assessment B. Objective Data 4. Auscultation--to assess for quality and adventitious sounds • Due to alveoli snapping open or movement of air through a lot of liquid • Post-op -----------, pulmonary-------- ii. Course crackles--low pitched on inspiration and expiration that is not eliminated by cough (will not go away until disease process ends/gets better) • Due to air passing through airway intermittently occluded with mucus • Pulmonary edema, pneumonia, CHF • Do fluid assessment, I/Os, and O2Sat |
Respiratory
I. Assessment B. Objective Data 4. Auscultation--to assess for quality and adventitious sounds • Due to alveoli snapping open or movement of air through a lot of liquid • Post-op atelectasis, pulmonary edema ii. Course crackles--low pitched on inspiration and expiration that is not eliminated by cough (will not go away until disease process ends/gets better) • Due to air passing through airway intermittently occluded with mucus • Pulmonary edema, pneumonia, CHF • Do fluid assessment, I/Os, and O2Sat |
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Respiratory
I. Assessment B. Objective Data 4. Auscultation--to assess for quality and adventitious sounds • Due to alveoli snapping open or movement of air through a lot of liquid • Post-op atelectasis, pulmonary edema ii. Course crackles--low pitched on --------- and ----------- that is not eliminated by---------- (will not go away until disease process ends/gets better) • Due to air passing through airway intermittently occluded with mucus • Pulmonary edema, pneumonia, CHF • Do fluid assessment, I/Os, and O2Sat |
Respiratory
I. Assessment B. Objective Data 4. Auscultation--to assess for quality and adventitious sounds • Due to alveoli snapping open or movement of air through a lot of liquid • Post-op atelectasis, pulmonary edema ii. Course crackles--low pitched on inspiration and expiration that is not eliminated by cough (will not go away until disease process ends/gets better) • Due to air passing through airway intermittently occluded with mucus • Pulmonary edema, pneumonia, CHF • Do fluid assessment, I/Os, and O2Sat |
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Respiratory
I. Assessment B. Objective Data 4. Auscultation--to assess for quality and adventitious sounds • Due to alveoli snapping open or movement of air through a lot of liquid • Post-op atelectasis, pulmonary edema ii. Course crackles--low pitched on inspiration and expiration that is not eliminated by cough (will not go away until disease process ends/gets better) • Due to air passing through --------- intermittently occluded with--------- • Pulmonary ------, pneumonia, CHF • Do fluid assessment, I/Os, and O2Sat |
Respiratory
I. Assessment B. Objective Data 4. Auscultation--to assess for quality and adventitious sounds • Due to alveoli snapping open or movement of air through a lot of liquid • Post-op atelectasis, pulmonary edema ii. Course crackles--low pitched on inspiration and expiration that is not eliminated by cough (will not go away until disease process ends/gets better) • Due to air passing through airway intermittently occluded with mucus • Pulmonary edema, pneumonia, CHF • Do fluid assessment, I/Os, and O2Sat |
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Respiratory
I. Assessment B. Objective Data 4. Auscultation--to assess for quality and adventitious sounds • Due to alveoli snapping open or movement of air through a lot of liquid • Post-op atelectasis, pulmonary edema ii. Course crackles--low pitched on inspiration and expiration that is not eliminated by cough (will not go away until disease process ends/gets better) • Due to air passing through airway intermittently occluded with mucus • Pulmonary edema, pneumonia, CHF • Do -------- assessment, ------, and ------- |
Respiratory
I. Assessment B. Objective Data 4. Auscultation--to assess for quality and adventitious sounds • Due to alveoli snapping open or movement of air through a lot of liquid • Post-op atelectasis, pulmonary edema ii. Course crackles--low pitched on inspiration and expiration that is not eliminated by cough (will not go away until disease process ends/gets better) • Due to air passing through airway intermittently occluded with mucus • Pulmonary edema, pneumonia, CHF • Do fluid assessment, I/Os, and O2Sat |
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Respiratory
I. Assessment B. Objective Data 4. Auscultation--to assess for quality and adventitious sound iii. Rhonchi--harsh/----------, from large airway obstruction by -------- • Pneumonia • Can be cleared--have pt cough or suction if vented and listen for changes iv. Wheezes--mostly on inspiration (can also be expiration) • Asthma |
Respiratory
I. Assessment B. Objective Data 4. Auscultation--to assess for quality and adventitious sound iii. Rhonchi--harsh/course rattling, from large airway obstruction by mucus • Pneumonia • Can be cleared--have pt cough or suction if vented and listen for changes iv. Wheezes--mostly on inspiration (can also be expiration) • Asthma |
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Respiratory
I. Assessment B. Objective Data 4. Auscultation--to assess for quality and adventitious sound iii. Rhonchi--harsh/course rattling, from large airway obstruction by mucus • Pneumonia • Can be cleared--have pt ------- or --------- if vented and listen for ---------- iv. Wheezes--mostly on inspiration (can also be expiration) • Asthma |
Respiratory
I. Assessment B. Objective Data 4. Auscultation--to assess for quality and adventitious sound iii. Rhonchi--harsh/course rattling, from large airway obstruction by mucus • Pneumonia • Can be cleared--have pt cough or suction if vented and listen for changes iv. Wheezes--mostly on inspiration (can also be expiration) • Asthma |
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Respiratory
I. Assessment B. Objective Data 4. Auscultation--to assess for quality and adventitious sound • If stops w/out intervention could be diminished due to ------------ (bad) v. --------------: grating/leather rubbing sound stops when pt holds breath |
Respiratory
I. Assessment B. Objective Data 4. Auscultation--to assess for quality and adventitious sound • If stops w/out intervention could be diminished due to tightness (bad) v. Pleural friction rub--grating/leather rubbing sound stops when pt holds breath |
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Respiratory
I. Assessment B. Objective Data 4. Auscultation--to assess for quality and adventitious sound • If stops w/out intervention could be diminished due to tightness (bad) v. Pleural friction rub--grating/leather rubbing sound stops when pt ----------- |
Respiratory
I. Assessment B. Objective Data 4. Auscultation--to assess for quality and adventitious sound • If stops w/out intervention could be diminished due to tightness (bad) v. Pleural friction rub--grating/leather rubbing sound stops when pt holds breath |
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Respiratory
I. Assessment B. Objective Data 4. Auscultation--to assess for quality and adventitious sound • Diff from ----------- rub (continuous rub while holding breath) b. Normal--: ------------ breath sounds throughout (Moving down, sounds high to low pitch) i. Bronchial--heard over trachea; “wind through tube” (louder and higher pitch) ii. Bronchovesicular--heard over main bronchi (medium pitch) iii. Vesicular--heard over lobes (softer and lower pitched) iv. Patients can open mouth to breath deeper |
Respiratory
I. Assessment B. Objective Data 4. Auscultation--to assess for quality and adventitious sound • Diff from pericardial rub (continuous rub while holding breath) b. Normal--vesicular breath sounds throughout (Moving down, sounds high to low pitch) i. Bronchial--heard over trachea; “wind through tube” (louder and higher pitch) ii. Bronchovesicular--heard over main bronchi (medium pitch) iii. Vesicular--heard over lobes (softer and lower pitched) iv. Patients can open mouth to breath deeper |
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Respiratory
I. Assessment B. Objective Data 4. Auscultation--to assess for quality and adventitious sound • Diff from pericardial rub (continuous rub while holding breath) b. Normal--vesicular breath sounds throughout (Moving down, sounds high to low pitch) i. Bronchial--heard over -----------; “wind through ---------” (louder and higher pitch) ii. Bronchovesicular--heard over main bronchi (medium pitch) iii. Vesicular--heard over lobes (softer and lower pitched) iv. Patients can open mouth to breath deeper |
Respiratory
I. Assessment B. Objective Data 4. Auscultation--to assess for quality and adventitious sound • Diff from pericardial rub (continuous rub while holding breath) b. Normal--vesicular breath sounds throughout (Moving down, sounds high to low pitch) i. Bronchial--heard over trachea; “wind through tube” (louder and higher pitch) ii. Bronchovesicular--heard over main bronchi (medium pitch) iii. Vesicular--heard over lobes (softer and lower pitched) iv. Patients can open mouth to breath deeper |
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Respiratory
I. Assessment B. Objective Data 4. Auscultation--to assess for quality and adventitious sound • Diff from pericardial rub (continuous rub while holding breath) b. Normal--vesicular breath sounds throughout (Moving down, sounds high to low pitch) i. Bronchial--heard over trachea; “wind through tube” (louder and higher pitch) ii. Bronchovesicular--heard over ---------- (medium pitch) iii. Vesicular--heard over -------- (softer and ------- pitched) iv. Patients can open mouth to breath deeper |
Respiratory
I. Assessment B. Objective Data 4. Auscultation--to assess for quality and adventitious sound • Diff from pericardial rub (continuous rub while holding breath) b. Normal--vesicular breath sounds throughout (Moving down, sounds high to low pitch) i. Bronchial--heard over trachea; “wind through tube” (louder and higher pitch) ii. Bronchovesicular--heard over main bronchi (medium pitch) iii. Vesicular--heard over lobes (softer and lower pitched) iv. Patients can open mouth to breath deeper |
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Respiratory
I. Assessment B. Objective Data 4. Auscultation--to assess for quality and adventitious sound • Diff from pericardial rub (continuous rub while holding breath) b. Normal--vesicular breath sounds throughout (Moving down, sounds high to low pitch) i. Bronchial--heard over trachea; “wind through tube” (louder and higher pitch) ii. Bronchovesicular--heard over main bronchi (medium pitch) iii. Vesicular--heard over lobes (softer and lower pitched) iv. Patients can open ------- to breath deeper |
Respiratory
I. Assessment B. Objective Data 4. Auscultation--to assess for quality and adventitious sound • Diff from pericardial rub (continuous rub while holding breath) b. Normal--vesicular breath sounds throughout (Moving down, sounds high to low pitch) i. Bronchial--heard over trachea; “wind through tube” (louder and higher pitch) ii. Bronchovesicular--heard over main bronchi (medium pitch) iii. Vesicular--heard over lobes (softer and lower pitched) iv. Patients can open mouth to breath deeper |
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Respiratory
I. Assessment B. Objective Data 4. Auscultation--to assess for quality and adventitious sound • Diff from pericardial rub (continuous rub while holding breath) c. Abnormal--sound other than what is supposed to be there (diff from --------) d. Voice Sounds--can indicate need for --------- i. Whispered Pectoriloquy--the way words come across as the whisper “1, 2, 3” |
Respiratory
I. Assessment B. Objective Data 4. Auscultation--to assess for quality and adventitious sound • Diff from pericardial rub (continuous rub while holding breath) c. Abnormal--sound other than what is supposed to be there (diff from adventitious) d. Voice Sounds--can indicate need for CXR i. Whispered Pectoriloquy--the way words come across as the whisper “1, 2, 3” |
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Respiratory
I. Assessment B. Objective Data 4. Auscultation--to assess for quality and adventitious sound • Diff from pericardial rub (continuous rub while holding breath) c. Abnormal--sound other than what is supposed to be there (diff from adventitious) d. Voice Sounds--can indicate need for CXR i. -----------------: the way words come across as the whisper “1, 2, 3” |
Respiratory
I. Assessment B. Objective Data 4. Auscultation--to assess for quality and adventitious sound • Diff from pericardial rub (continuous rub while holding breath) c. Abnormal--sound other than what is supposed to be there (diff from adventitious) d. Voice Sounds--can indicate need for CXR i. Whispered Pectoriloquy--the way words come across as the whisper “1, 2, 3” |
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Respiratory
I. Assessment B. Objective Data 4. Auscultation--to assess for quality and adventitious sound • Normal to hear it muffled when listening to ---------------- • Abnormal to hear it clearly (---------,-----------) ii. Bronchophony--say “99” in louder tone (should sound muffled) iii. Egophony--say “E” abnormal if it sounds like “A” (should sound muffled) |
Respiratory
I. Assessment B. Objective Data 4. Auscultation--to assess for quality and adventitious sound • Normal to hear it muffled when listening to posterior chest wall • Abnormal to hear it clearly (pneumonia, atelectasis) ii. Bronchophony--say “99” in louder tone (should sound muffled) iii. Egophony--say “E” abnormal if it sounds like “A” (should sound muffled) |
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Respiratory
I. Assessment B. Objective Data 4. Auscultation--to assess for quality and adventitious sound • Normal to hear it muffled when listening to posterior chest wall • Abnormal to hear it clearly (pneumonia, atelectasis) ii. -------------: say “99” in louder tone (should sound muffled) iii. ------------: say “E” abnormal if it sounds like “A” (should sound muffled) |
Respiratory
I. Assessment B. Objective Data 4. Auscultation--to assess for quality and adventitious sound • Normal to hear it muffled when listening to posterior chest wall • Abnormal to hear it clearly (pneumonia, atelectasis) ii. Bronchophony--say “99” in louder tone (should sound muffled) iii. Egophony--say “E” abnormal if it sounds like “A” (should sound muffled) |
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Respiratory
I. Assessment B. Objective Data 4. Auscultation--to assess for quality and adventitious sound • Normal to hear it muffled when listening to posterior chest wall • Abnormal to hear it clearly (pneumonia, atelectasis) ii. Bronchophony--say “-----” in louder tone (should sound muffled) iii. Egophony--say “-----” abnormal if it sounds like “------” (should sound muffled) |
Respiratory
I. Assessment B. Objective Data 4. Auscultation--to assess for quality and adventitious sound • Normal to hear it muffled when listening to posterior chest wall • Abnormal to hear it clearly (pneumonia, atelectasis) ii. Bronchophony--say “99” in louder tone (should sound muffled) iii. Egophony--say “E” abnormal if it sounds like “A” (should sound muffled) |
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Respiratory
II. Artificial Airways A. ------------- Airway--used to keep tongue from occluding airway in unconscious pts (protection) 1. Techniques of Insertion a. Clear mouth of secretions and maintain head position b. Measure from corner of mouth to tragus 2. Precautions--cannot use with oral trauma or if patient has gag reflex |
Respiratory
II. Artificial Airways A. Oropharyngeal Airway--used to keep tongue from occluding airway in unconscious pts (protection) 1. Techniques of Insertion a. Clear mouth of secretions and maintain head position b. Measure from corner of mouth to tragus 2. Precautions--cannot use with oral trauma or if patient has gag reflex |
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Respiratory
II. Artificial Airways A. Oropharyngeal Airway--used to keep tongue from occluding airway in unconscious pts (protection) 1. Techniques of Insertion a. Clear mouth of ------ and maintain ------- b. Measure from corner of mouth to ------ 2. Precautions--cannot use with oral trauma or if patient has gag reflex |
Respiratory
II. Artificial Airways A. Oropharyngeal Airway--used to keep tongue from occluding airway in unconscious pts (protection) 1. Techniques of Insertion a. Clear mouth of secretions and maintain head position b. Measure from corner of mouth to tragus 2. Precautions--cannot use with oral trauma or if patient has gag reflex |
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Respiratory
II. Artificial Airways A. Oropharyngeal Airway--used to keep tongue from occluding airway in unconscious pts (protection) 1. Techniques of Insertion a. Clear mouth of secretions and maintain head position b. Measure from corner of mouth to tragus 2. Precautions--cannot use with -------- or if patient has ------- |
Respiratory
II. Artificial Airways A. Oropharyngeal Airway--used to keep tongue from occluding airway in unconscious pts (protection) 1. Techniques of Insertion a. Clear mouth of secretions and maintain head position b. Measure from corner of mouth to tragus 2. Precautions--cannot use with oral trauma or if patient has gag reflex |
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Respiratory
II. Artificial Airways B. ----------------- airway--provides patent airway without stimulating gag reflex (needs lubrication) 1. Precautions--cannot be used for facial trauma (basal skull fracture) |
Respiratory
II. Artificial Airways B. Nasopharyngeal Airway--provides patent airway without stimulating gag reflex (needs lubrication) 1. Precautions--cannot be used for facial trauma (basal skull fracture) |
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Respiratory
II. Artificial Airways B. Nasopharyngeal Airway--provides patent airway without stimulating -------- (needs lubrication) 1. Precautions--cannot be used for ----------- (basal skull fracture) |
Respiratory
II. Artificial Airways B. Nasopharyngeal Airway--provides patent airway without stimulating gag reflex (needs lubrication) 1. Precautions--cannot be used for facial trauma (basal skull fracture) |
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Respiratory
II. Artificial Airways C. ------------- Intubation--can be placed for 2 weeks, than tracheotomy or extubation 1. Oral--larger tube therefore less air resistance (preferred form) a. Disadvantage--pt can bit tube (need to use a bite block) |
Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 1. Oral--larger tube therefore less air resistance (preferred form) a. Disadvantage--pt can bit tube (need to use a bite block) |
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Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for ------ weeks, than tracheotomy or ------------ 1. Oral--larger tube therefore less air resistance (preferred form) a. Disadvantage--pt can bit tube (need to use a bite block) |
Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 1. Oral--larger tube therefore less air resistance (preferred form) a. Disadvantage--pt can bit tube (need to use a bite block) |
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Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 1. Oral--larger tube therefore less ------------- (preferred form) a. Disadvantage--pt can ---------- (need to use a ---------- block) |
Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 1. Oral--larger tube therefore less air resistance (preferred form) a. Disadvantage--pt can bit tube (need to use a bite block) |
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Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 2. Nasal--used if ------------ prevents moving neck for --------- intubation (more comfortable) a. Disadvantages--hard to suction (smaller tube diameter) b. Contraindicated in pts with facial trauma |
Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 2. Nasal--used if spinal cord injury prevents moving neck for oral intubation (more comfortable) a. Disadvantages--hard to suction (smaller tube diameter) b. Contraindicated in pts with facial trauma |
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Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 2. Nasal--used if spinal cord injury prevents moving neck for oral intubation (more comfortable) a. Disadvantages--hard to -------- (smaller tube --------) b. Contraindicated in pts with --------- trauma |
Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 2. Nasal--used if spinal cord injury prevents moving neck for oral intubation (more comfortable) a. Disadvantages--hard to suction (smaller tube diameter) b. Contraindicated in pts with facial trauma |
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Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 3. Indications a. Inadequate -------------- (↓arterial --------, etc.) that is not corrected by supplemental O2 i. Causes--barbiturate overdose, anesthesia, etc. |
Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 3. Indications a. Inadequate oxygenation (↓arterial PO2, etc.) that is not corrected by supplemental O2 i. Causes--barbiturate overdose, anesthesia, etc. |
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Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 3. Indications a. Inadequate oxygenation (↓arterial PO2, etc.) that is not corrected by supplemental ----------- i. Causes--: -------------, ------------, etc. |
Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 3. Indications a. Inadequate oxygenation (↓arterial PO2, etc.) that is not corrected by supplemental O2 i. Causes--barbiturate overdose, anesthesia, etc. |
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Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 3. Indications b. Inadequate ---------- (increased arterial ----------)--can’t move gas inside i. PCO2 >50 or pH <7.25 **Get ABG after to see if corrected |
Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 3. Indications b. Inadequate ventilation (increased arterial PCO2)--can’t move gas inside i. PCO2 >50 or pH <7.25 **Get ABG after to see if corrected |
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Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 3. Indications b. Inadequate ventilation (increased arterial PCO2)--can’t move gas inside i. PCO2 >-------- or pH <-------------- **Get ------------ after to see if corrected |
Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 3. Indications b. Inadequate ventilation (increased arterial PCO2)--can’t move gas inside i. PCO2 >50 or pH <7.25 **Get ABG after to see if corrected |
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Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 4. Procedure--need ----------- and --------- at bed side |
Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 4. Procedure--need suction and O2 at bed side |
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Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 4. Procedure--need suction and O2 at bed side a. Patient education i. Won’t be able to --------- (reassure needs will be met) ii. Assure that pt will be able to----------- better |
Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 4. Procedure--need suction and O2 at bed side a. Patient education i. Won’t be able to talk (reassure needs will be met) ii. Assure that pt will be able to breathe better |
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Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 4. Procedure--need suction and O2 at bed side b. Preparation for intubation--: -----------, ----------, -------, and sedation -------- (Versed) i. Assess for hypoxia (arrhythmias) and vomiting |
Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 4. Procedure--need suction and O2 at bed side b. Preparation for intubation--supplies, ambu bag, code cart, and sedation meds (Versed) i. Assess for hypoxia (arrhythmias) and vomiting |
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Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 4. Procedure--need suction and O2 at bed side b. Preparation for intubation--supplies, ambu bag, code cart, and sedation meds (Versed) i. Assess for ------- (arrhythmias) and ---------- |
Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 4. Procedure--need suction and O2 at bed side b. Preparation for intubation--supplies, ambu bag, code cart, and sedation meds (Versed) i. Assess for hypoxia (arrhythmias) and vomiting |
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Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 4. Procedure--need suction and O2 at bed side c. Hold breath to remember --------- of attempt (no more than ---------- to 1min) |
Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 4. Procedure--need suction and O2 at bed side c. Hold breath to remember length of attempt (no more than 30sec-1min) |
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Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 4. Procedure--need suction and O2 at bed side d. Checking placement--tape tube at ------ and record -------- i. Check tidal CO2 monitor (color or number change) ii. Listen for breath sounds iii. Visualize chest expansion |
Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 4. Procedure--need suction and O2 at bed side d. Checking placement--tape tube at lip and record line mark i. Check tidal CO2 monitor (color or number change) ii. Listen for breath sounds iii. Visualize chest expansion |
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Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 4. Procedure--need suction and O2 at bed side d. Checking placement--tape tube at lip and record line mark i. Check tidal -------- monitor (color or number change) ii. Listen for -------- iii. Visualize ---------- |
Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 4. Procedure--need suction and O2 at bed side d. Checking placement--tape tube at lip and record line mark i. Check tidal CO2 monitor (color or number change) ii. Listen for breath sounds iii. Visualize chest expansion |
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Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 4. Procedure--need suction and O2 at bed side 5. Post Intubation Assessment a. Assess end tidal --------- b. Assess for -----------, equal breath sounds, and ---------- c. Auscultation of gastric area (to determine if esophageal intubation instead of tracheal) d. Nurse, RT, or anesthetist stabilizes tube |
Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 4. Procedure--need suction and O2 at bed side 5. Post Intubation Assessment a. Assess end tidal CO2 b. Assess for bilateral, equal breath sounds, and chest expansion c. Auscultation of gastric area (to determine if esophageal intubation instead of tracheal) d. Nurse, RT, or anesthetist stabilizes tube |
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Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 4. Procedure--need suction and O2 at bed side 5. Post Intubation Assessment a. Assess end tidal CO2 b. Assess for bilateral, equal breath sounds, and chest expansion c. Auscultation of ----------- (to determine if esophageal intubation instead of ----------) d. Nurse, RT, or anesthetist stabilizes -------- |
Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 4. Procedure--need suction and O2 at bed side 5. Post Intubation Assessment a. Assess end tidal CO2 b. Assess for bilateral, equal breath sounds, and chest expansion c. Auscultation of gastric area (to determine if esophageal intubation instead of tracheal) d. Nurse, RT, or anesthetist stabilizes tube |
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Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 4. Procedure--need suction and O2 at bed side 5. Post Intubation Assessment e. Oral ETT positioned ------ or ------- side of mouth and changed q24hrs (safer with 2 people) i. Suction before deflating balloon so secretions do not flow into lungs f. Oral airway may need bite block to prevent pt from biting tube g. Stat CXR verifies correct placement (if it needs to move, deflate and reinflate balloon) i. Should be 2 finger breadths above carina |
Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 4. Procedure--need suction and O2 at bed side 5. Post Intubation Assessment e. Oral ETT positioned lf or rt side of mouth and changed q24hrs (safer with 2 people) i. Suction before deflating balloon so secretions do not flow into lungs f. Oral airway may need bite block to prevent pt from biting tube g. Stat CXR verifies correct placement (if it needs to move, deflate and reinflate balloon) i. Should be 2 finger breadths above carina |
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Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 4. Procedure--need suction and O2 at bed side 5. Post Intubation Assessment e. Oral ETT positioned lf or rt side of mouth and changed --------hrs (safer with 2 people) i. Suction before deflating ------------ so secretions do not flow into lungs f. Oral airway may need bite block to prevent pt from biting tube g. Stat CXR verifies correct placement (if it needs to move, deflate and reinflate balloon) i. Should be 2 finger breadths above carina |
Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 5. Post Intubation Assessment e. Oral ETT positioned lf or rt side of mouth and changed q24hrs (safer with 2 people) i. Suction before deflating balloon so secretions do not flow into lungs f. Oral airway may need bite block to prevent pt from biting tube g. Stat CXR verifies correct placement (if it needs to move, deflate and reinflate balloon) i. Should be 2 finger breadths above carina |
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Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 5. Post Intubation Assessment e. Oral ETT positioned lf or rt side of mouth and changed q24hrs (safer with 2 people) i. Suction before deflating balloon so secretions do not flow into lungs f. Oral airway may need ---------- to prevent pt from biting tube g. Stat ----------- verifies correct placement (if it needs to move, deflate and reinflate balloon) i. Should be 2 finger breadths above carina |
Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 5. Post Intubation Assessment e. Oral ETT positioned lf or rt side of mouth and changed q24hrs (safer with 2 people) i. Suction before deflating balloon so secretions do not flow into lungs f. Oral airway may need bite block to prevent pt from biting tube g. Stat CXR verifies correct placement (if it needs to move, deflate and reinflate balloon) i. Should be 2 finger breadths above carina |
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Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 5. Post Intubation Assessment e. Oral ETT positioned lf or rt side of mouth and changed q24hrs (safer with 2 people) i. Suction before deflating balloon so secretions do not flow into lungs f. Oral airway may need bite block to prevent pt from biting tube g. Stat CXR verifies correct placement (if it needs to move, deflate and ------------ balloon) i. Should be ------------ breadths above carina |
Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 5. Post Intubation Assessment e. Oral ETT positioned lf or rt side of mouth and changed q24hrs (safer with 2 people) i. Suction before deflating balloon so secretions do not flow into lungs f. Oral airway may need bite block to prevent pt from biting tube g. Stat CXR verifies correct placement (if it needs to move, deflate and reinflate balloon) i. Should be 2 finger breadths above carina |
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Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 6. Nursing Management a. Maintaining correct --------- placement (------- shift) b. Monitoring proper cuff inflation (20-25mmHg q8hr)--should not be 100% occlusive |
Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 6. Nursing Management a. Maintaining correct tube placement (q shift) b. Monitoring proper cuff inflation (20-25mmHg q8hr)--should not be 100% occlusive |
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Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 6. Nursing Management a. Maintaining correct tube placement (q shift) |
Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 6. Nursing Management a. Maintaining correct tube placement (q shift) b. Monitoring proper cuff inflation (20-25mmHg q8hr)--should not be 100% occlusive |
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Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 6. Nursing Management a. Maintaining correct tube placement (q shift) b. Monitoring proper cuff inflation (-------to ----------mmHg q-------hr)--should not be 100% occlusive |
Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 6. Nursing Management a. Maintaining correct tube placement (q shift) b. Monitoring proper cuff inflation (20-25mmHg q8hr)--should not be 100% occlusive |
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Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 6. Nursing Management a. Maintaining correct tube placement (q shift) b. Monitoring proper cuff inflation (20-25mmHg q8hr)--should not be ----------% occlusive |
Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 6. Nursing Management a. Maintaining correct tube placement (q shift) b. Monitoring proper cuff inflation (20-25mmHg q8hr)--should not be 100% occlusive |
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Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 6. Nursing Management b. Monitoring proper -------- inflation (20-25mmHg q8hr)--should not be 100% occlusive i. If <--------mmHg leak ii. If >----------mmHg damage to tissue iii. If able to talk air through vocal cords balloon deflated then ---------- |
Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 6. Nursing Management b. Monitoring proper -------- inflation (20-25mmHg q8hr)--should not be 100% occlusive i. If <20mmHg leak ii. If >20mmHg damage to tissue iii. If able to talk air through vocal cords balloon deflated reinflate |
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Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 6. Nursing Management c. Monitor ---------- and ---------- i. End tidal CO2 monitor--indicates correct placement ii. ABGs--SAO2 measures tissue oxygenation and gives info on CO iii. Peak inspiratory pressure--if increased suction |
Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 6. Nursing Management c. Monitor oxygenation and ventilation i. End tidal CO2 monitor--indicates correct placement ii. ABGs--SAO2 measures tissue oxygenation and gives info on CO iii. Peak inspiratory pressure--if increased suction |
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Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 6. Nursing Management c. Monitor oxygenation and ventilation i. End tidal CO2 monitor--indicates ------------ ii. ABGs: ------------ measures tissue oxygenation and gives info on CO iii. Peak ---------- pressure--if increased suction |
Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 6. Nursing Management c. Monitor oxygenation and ventilation i. End tidal CO2 monitor--indicates correct placement ii. ABGs--SAO2 measures tissue oxygenation and gives info on CO iii. Peak inspiratory pressure--if increased suction |
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Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 6. Nursing Management c. Monitor oxygenation and ventilation i. End tidal CO2 monitor--indicates correct placement ii. ABGs--SAO2 measures tissue oxygenation and gives info on CO iii. Peak inspiratory pressure--if increased ----------- |
Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 6. Nursing Management c. Monitor oxygenation and ventilation i. End tidal CO2 monitor--indicates correct placement ii. ABGs--SAO2 measures tissue oxygenation and gives info on CO iii. Peak inspiratory pressure--if increased suction |
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Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 6. Nursing Management d. Provide --------- and maintaining skin ------: tube positioning and oral care e. Comfort and communication--talk to pt/use meds (Versed, Propofol) to relieve anxiety i. When pt starts to wake up watch for pt pulling tube out and assess for mental status (takes time to get used to tube often pts kept sedated for a while) |
Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 6. Nursing Management d. Provide oral care and maintaining skin integrity--: tube positioning and oral care e. Comfort and communication--talk to pt/use meds (Versed, Propofol) to relieve anxiety i. When pt starts to wake up watch for pt pulling tube out and assess for mental status (takes time to get used to tube often pts kept sedated for a while) |
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Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 6. Nursing Management d. Provide oral care and maintaining skin integrity--: tube positioning and oral care e. Comfort and communication--talk to pt/use meds (---------, ----------) to relieve anxiety i. When pt starts to wake up watch for pt pulling ----------- and assess for ---------- (takes time to get used to tube often pts kept sedated for a while) |
FIX
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Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 6. Nursing Management f. Assess for complications: --------, ----------, decreased ------, etc. g. Maintain tube patency--suction as needed |
Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 6. Nursing Management f. Assess for complications--ALOC, arrhythmias, decreased O2, etc. g. Maintain tube patency--suction as needed |
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Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 6. Nursing Management f. Assess for complications--ALOC, arrhythmias, decreased O2, etc. g. Maintain tube --------: --suction as needed |
Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 6. Nursing Management f. Assess for complications--ALOC, arrhythmias, decreased O2, etc. g. Maintain tube patency--suction as needed |
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Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 6. Nursing Management h. Pt needs --------- assessment within ------hrs of intubation |
Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 6. Nursing Management h. Pt needs nutritional assessment within 72hrs of intubation |
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Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 7. Potential Complications a. Suctioning--suction for <--------sec and watch for ------------ i. Hypoxemia--preoxygenate (suctioning will drop O2Sats) ii. Bronchospasm--give pt break in between iii. Arrhythmias--stop if bradycardia (vaso-vagal response)--have atropine near by iv. HTN/hypotension |
Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 7. Potential Complications a. Suctioning--suction for <10sec and watch for arrhythmias i. Hypoxemia--preoxygenate (suctioning will drop O2Sats) ii. Bronchospasm--give pt break in between iii. Arrhythmias--stop if bradycardia (vaso-vagal response)--have atropine near by iv. HTN/hypotension |
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Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 7. Potential Complications a. Suctioning--suction for <10sec and watch for arrhythmias i. --------------: preoxygenate (suctioning will drop O2Sats) ii. B------------: give pt break in between iii. A-----------: stop if bradycardia (vaso-vagal response)--have atropine near by iv. HTN/------------- |
Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 7. Potential Complications a. Suctioning--suction for <10sec and watch for arrhythmias i. Hypoxemia--preoxygenate (suctioning will drop O2Sats) ii. Bronchospasm--give pt break in between iii. Arrhythmias--stop if bradycardia (vaso-vagal response)--have atropine near by iv. HTN/hypotension |
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Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 7. Potential Complications a. Suctioning--suction for <10sec and watch for arrhythmias i. Hypoxemia--preoxygenate (suctioning will drop O2Sats) ii. Bronchospasm--give pt --------- in between iii. Arrhythmias--stop if ------------- (vaso-vagal response)--have atropine near by iv. HTN/hypotension |
Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 7. Potential Complications a. Suctioning--suction for <10sec and watch for arrhythmias i. Hypoxemia--preoxygenate (suctioning will drop O2Sats) ii. Bronchospasm--give pt break in between iii. Arrhythmias--stop if bradycardia (vaso-vagal response)--have atropine near by iv. HTN/hypotension |
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Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 7. Potential Complications a. Suctioning--suction for <10sec and watch for arrhythmias v. ---------: can be too much suction (should be <120mmHg) vi. I------------ vii. Increase in ------------ pressure (in head trauma pts)--use minimal suctioning |
Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 7. Potential Complications a. Suctioning--suction for <10sec and watch for arrhythmias v. Pulmonary bleeding--can be too much suction (should be <120mmHg) vi. Infections vii. Increase in intracranial pressure (in head trauma pts)--use minimal suctioning |
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Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 7. Potential Complications a. Suctioning--suction for <10sec and watch for arrhythmias v. Pulmonary bleeding--can be too much suction (should be <---------mmHg) vi. Infections vii. Increase in intracranial pressure (in --------- trauma pts)--use minimal suctioning |
Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 7. Potential Complications a. Suctioning--suction for <10sec and watch for arrhythmias v. Pulmonary bleeding--can be too much suction (should be <120mmHg) vi. Infections vii. Increase in intracranial pressure (in head trauma pts)--use minimal suctioning |
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Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 7. Potential Complications b. Self-extubation--most pts --------- or ----------- for prevention (explain need to family) c. Aspiration--keep HOB >30° (likely tube fed--always check placement) |
Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 7. Potential Complications b. Self-extubation--most pts restrained or sedated for prevention (explain need to family) c. Aspiration--keep HOB >30° (likely tube fed--always check placement) |
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Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 7. Potential Complications b. Self-extubation--most pts restrained or sedated for prevention (explain need to family) c. Aspiration--keep HOB >------° (likely tube fed--always check ----------) |
Respiratory
II. Artificial Airways C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation 7. Potential Complications b. Self-extubation--most pts restrained or sedated for prevention (explain need to family) c. Aspiration--keep HOB >30° (likely tube fed--always check placement) |
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Respiratory
II. Artificial Airways D. ---------: stoma that results from a surgical incision (in OR or at bedside) into the trachea |
Respiratory
II. Artificial Airways D. Tracheostomy--stoma that results from a surgical incision (in OR or at bedside) into the trachea |
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Respiratory
II. Artificial Airways D. Tracheostomy--stoma that results from a surgical incision (in OR or at bedside) into the trachea 1. Indications a. Bypass an ----------- obstruction b. Facilitate removal of ----------- c. Permit long-term -------------- ventilation--after two weeks with ET tube i. Easier to ween from trach than from ET tube d. Permits oral ---------- |
Respiratory
II. Artificial Airways D. Tracheostomy--stoma that results from a surgical incision (in OR or at bedside) into the trachea 1. Indications a. Bypass an upper airway obstruction b. Facilitate removal of secretions c. Permit long-term mechanical ventilation--after two weeks with ET tube i. Easier to ween from trach than from ET tube d. Permits oral intake and speech |
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Respiratory
II. Artificial Airways D. Tracheostomy--stoma that results from a surgical incision (in OR or at bedside) into the trachea 1. Indications a. Bypass an upper airway obstruction b. Facilitate removal of secretions c. Permit long-term mechanical ventilation--after -------- weeks with--------tube i. Easier to ween from --------- than from ET tube |
Respiratory
II. Artificial Airways D. Tracheostomy--stoma that results from a surgical incision (in OR or at bedside) into the trachea 1. Indications a. Bypass an upper airway obstruction b. Facilitate removal of secretions c. Permit long-term mechanical ventilation--after two weeks with ET tube i. Easier to ween from trach than from ET tube d. Permits oral intake and speech |
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Respiratory
II. Artificial Airways D. Tracheostomy--stoma that results from a surgical incision (in OR or at bedside) into the trachea 2. Care a. Suctioning for ---------- b. ----------- care c. Changing --------- ties d. Inner cannula care (always have opterator at bed side to get it back in-then remove) |
Respiratory
II. Artificial Airways D. Tracheostomy--stoma that results from a surgical incision (in OR or at bedside) into the trachea 2. Care a. Suctioning for secretions b. Stoma care c. Changing tracheostomy ties d. Inner cannula care (always have opterator at bed side to get it back in-then remove) |
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Respiratory
II. Artificial Airways D. Tracheostomy--stoma that results from a surgical incision (in OR or at bedside) into the trachea 2. Care a. Suctioning for secretions b. Stoma care c. Changing tracheostomy ties d. Inner -------- care (always have ------------ at bed side to get it back in-then remove) |
Respiratory
II. Artificial Airways D. Tracheostomy--stoma that results from a surgical incision (in OR or at bedside) into the trachea 2. Care a. Suctioning for secretions b. Stoma care c. Changing tracheostomy ties d. Inner cannula care (always have opterator at bed side to get it back in-then remove) |
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Respiratory
III. Mechanical Ventilation A. Goals 1. Improve ------------ 2. Improve ------------- 3. Decrease work of ----------- (decreases oxygen consumption) 4. Permit sedation 5. Airway protection |
Respiratory
III. Mechanical Ventilation A. Goals 1. Improve oxygenation 2. Improve ventilation 3. Decrease work of breathing (decreases oxygen consumption) 4. Permit sedation 5. Airway protection |
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Respiratory
III. Mechanical Ventilation A. Goals 1. Improve oxygenation 2. Improve ventilation 3. Decrease work of breathing (decreases oxygen consumption) 4. Permit ---------- 5. Airway ------- |
Respiratory
III. Mechanical Ventilation A. Goals 1. Improve oxygenation 2. Improve ventilation 3. Decrease work of breathing (decreases oxygen consumption) 4. Permit sedation 5. Airway protection |
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Respiratory
III. Mechanical Ventilation B. Negative Pressure Ventilation--noninvasive --------- encase chest/body and provide intermittent negative pressure (ex. --------- wrap) |
Respiratory
III. Mechanical Ventilation B. Negative Pressure Ventilation--noninvasive chambers encase chest/body and provide intermittent negative pressure (ex. Pulmo-wrap) |
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Respiratory
III. Mechanical Ventilation B. Negative Pressure Ventilation--noninvasive chambers encase chest/body and provide intermittent negative pressure (ex. Pulmo-wrap) 1. Patient must be able to cough up own ---------- and have adequate lung ------------ 2. Indications--neuromuscular and ---------- disorders; severe COPD |
Respiratory
III. Mechanical Ventilation B. Negative Pressure Ventilation--noninvasive chambers encase chest/body and provide intermittent negative pressure (ex. Pulmo-wrap) 1. Patient must be able to cough up own secretions and have adequate lung elasticity 2. Indications--neuromuscular and spinal disorders; severe COPD |
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Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) 1. ---------- Ventilation--predetermined tidal volume w/ varied pressure (most common) a. Opposite of -------------- (passive exhalation) |
Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) 1. Volume Ventilation--predetermined tidal volume w/ varied pressure (most common) a. Opposite of normal volume (passive exhailation) |
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Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) 2. ------------ Ventilation--peak inspiratory pressure is predetermined w/ variable tidal volume a. Prevents adding too much ----------- |
Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) 2. Pressure Ventilation--peak inspiratory pressure is predetermined w/ variable tidal volume a. Prevents adding too much volume |
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Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) 3. Monitoring a. V---------- settings--program settings b. P-------: own rate, etc. c. A-----: customized based on needed parameters |
Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) 3. Monitoring a. Ventilator settings--program settings b. Patient data--own rate, etc. c. Alarms--customized based on needed parameters |
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Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) 4. Settings a. Rate--number of ------------ ventilations |
Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) 4. Settings a. Rate--number of delivered ventilations |
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Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) 4. Settings b. Tidal Volume (VT)--volume of------ delivered; generally weight based (___-____mL/kg) |
Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) 4. Settings b. Tidal Volume (VT)--volume of gas delivered; generally weight based (5-15mL/kg) |
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Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) 4. Settings c. FIO2--fraction of ------------- delivered (adjust for PAO2 to be at least >------) i. Room air is 21% |
Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) 4. Settings c. FIO2--fraction of inspired oxygen delivered (adjust for PAO2 to be at least >60) i. Room air is 21% |
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Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) 4. Settings c. FIO2--fraction of inspired oxygen delivered (adjust for PAO2 to be at least >60) i. Room air is ------% |
Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) 4. Settings c. FIO2--fraction of inspired oxygen delivered (adjust for PAO2 to be at least >60) i. Room air is 21% |
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Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) 4. Settings d. Flow Rate--speed ------ is delivered |
Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) 4. Settings d. Flow Rate--speed VT is delivered |
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Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) 4. Settings e. I:E ratio--duration of--------- to ---------- (normal is 1:2) |
Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) 4. Settings e. I:E ratio--duration of inspiration to expiration (normal is 1:2) |
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Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) 4. Settings e. I:E ratio--duration of inspiration to expiration (normal is ------:--------) |
Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) 4. Settings e. I:E ratio--duration of inspiration to expiration (normal is 1:2) |
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Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) 4. Settings f. Sensitivity (---------- pressure)--effort pt must generate to initiate -------- breath i. Higher sensitivity less work pt does ii. Lower sensitivity increase in pt’s muscular use to initiate breath |
Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) 4. Settings f. Sensitivity (trigger pressure)--effort pt must generate to initiate ventilator breath i. Higher sensitivity less work pt does ii. Lower sensitivity increase in pt’s muscular use to initiate breath |
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Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) 4. Settings f. Sensitivity (trigger pressure)--effort pt must generate to initiate ventilator breath i. ----------- sensitivity less work pt does ii. ---------- sensitivity increase in pt’s muscular use to initiate breath |
Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) 4. Settings f. Sensitivity (trigger pressure)--effort pt must generate to initiate ventilator breath i. Higher sensitivity less work pt does ii. Lower sensitivity increase in pt’s muscular use to initiate breath |
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Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) 4. Settings g. Pressure Limit--regulates -------- pressure ventilator can generate to deliver --------- |
Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) 4. Settings g. Pressure Limit--regulates maximal pressure ventilator can generate to deliver VT |
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Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) 5. Modes--based on ---------- status and dependent on resp. drive and --------- |
Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) 5. Modes--based on ventilatory status and dependent on resp. drive and ABGs |
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Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) 5. Modes--based on ventilatory status and dependent on resp. drive and ABGs a. Controlled ----------- Ventilation (CMV)--not used often i. Ventilator ---------- |
Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) 5. Modes--based on ventilatory status and dependent on resp. drive and ABGs a. Controlled Mandatory Ventilation (CMV)--not used often i. Ventilator parameters |
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Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) • Set rate • Set tidal --------- or pressure ii. Indication--pt with no -------- (spinal cord, anesthesia, neuromuscular disease) |
Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) • Set rate • Set tidal volume or pressure ii. Indication--pt with no drive (spinal cord, anesthesia, neuromuscular disease) |
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Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) • If pt has drive, ventilator can’t sense pt fight ventilator need sedation b. Assist-Control Mechanical Ventilation (AC) i. Ventilator parameters |
FIX
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Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) • If pt has drive, ventilator can’t sense pt ----------- need sedation b. Assist-Control ------------ Ventilation (AC) i. Ventilator parameters |
Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) • If pt has drive, ventilator can’t sense pt fight ventilator need sedation b. Assist-Control Mechanical Ventilation (AC) i. Ventilator parameters |
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Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) • Preset ------- volume/pressure--vent delivers breaths at preset --------- volume in response to pt’s own inspiratory drive (senses pt inspiration) |
Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) • Preset tidal volume/pressure--vent delivers breaths at preset tidal volume in response to pt’s own inspiratory drive (senses pt inspiration) |
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Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) • Preset rate--minimal setting (if pt does not ------------ a breath, vent will breathe so that pt receives the ------------- rate) |
Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) • Preset tidal volume/pressure--vent delivers breaths at preset tidal volume in response to pt’s own inspiratory drive (senses pt inspiration) |
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Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) ii. Potential disadvantages • Hyperventilation if pt is anxious (resp --------------) • Hypoventilation if monitor is set too ---------- (must monitor rate saturations) |
Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) ii. Potential disadvantages • Hyperventilation if pt is anxious (resp alkalosis) • Hypoventilation if monitor is set too low (must monitor rate saturations) |
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Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) ii. Potential disadvantages • Hypoventilation if monitor is set too low (must monitor rate saturations) c. Synchronized ------------ ------------ Ventilation (SIMV)--most common |
Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) ii. Potential disadvantages • Hypoventilation if monitor is set too low (must monitor rate saturations) c. Synchronized Intermittent Mandatory Ventilation (SIMV)--most common i. Ventilator parameters |
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Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) c. Synchronized Intermittent Mandatory Ventilation (SIMV)--most common i. Ventilator parameters • Preset---------- volume/pressure • Preset --------- |
Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) c. Synchronized Intermittent Mandatory Ventilation (SIMV)--most common i. Ventilator parameters • Preset tidal volume/pressure • Preset rate |
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Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) c. Synchronized Intermittent Mandatory Ventilation (SIMV)--most common i. Ventilator parameters • Pt can initiate ------------ breathing (in between vent breaths) with own tidal volume, but vent delivers full tidal volume for preset ---------- rate ii. Used for -------: --preset gradually lowered (better synchrony-pt no fight vent) |
Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) c. Synchronized Intermittent Mandatory Ventilation (SIMV)--most common i. Ventilator parameters • Preset tidal volume/pressure • Preset rate |
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Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) c. Synchronized Intermittent Mandatory Ventilation (SIMV)--most common i. Ventilator parameters • Can lead to --------- fatigue |
Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) c. Synchronized Intermittent Mandatory Ventilation (SIMV)--most common i. Ventilator parameters • Can lead to muscle fatigue |
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Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) d. Pressure ----------- Ventilation (PSV)--enhanced mode (can be used with SIMV) |
Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) d. Pressure support Ventilation (PSV)--enhanced mode (can be used with SIMV) |
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Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) d. Pressure Support Ventilation (PSV)--enhanced mode (can be used with SIMV) i. Positive pressure is applied to airway only during ------------ and is used in conjunction with pts spontaneous respirations |
Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) d. Pressure Support Ventilation (PSV)--enhanced mode (can be used with SIMV) i. Positive pressure is applied to airway only during inspiration and is used in conjunction with pts spontaneous respirations |
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Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) d. Pressure Support Ventilation (PSV)--enhanced mode (can be used with SIMV) ii. Pt must be able to----------- breath (only for spontaneous breathers) |
Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) d. Pressure Support Ventilation (PSV)--enhanced mode (can be used with SIMV) ii. Pt must be able to initiate breath (only for spontaneous breathers) |
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Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) d. Pressure Support Ventilation (PSV)--enhanced mode (can be used with SIMV) iii. Pt completely controls inspiratory ----------, tidal volume, and RR |
Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) d. Pressure Support Ventilation (PSV)--enhanced mode (can be used with SIMV) iii. Pt completely controls inspiratory length, tidal volume, and RR |
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Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) d. Pressure Support Ventilation (PSV)--enhanced mode (can be used with SIMV iv. Decreases pt work during ----------- (decreases effort) |
Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) d. Pressure Support Ventilation (PSV)--enhanced mode (can be used with SIMV iv. Decreases pt work during weaning (decreases effort) |
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Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) d. Pressure Support Ventilation (PSV)--enhanced mode (can be used with SIMV v. Advantages--↑ pt comfort and ↓-------- consumption (↓work) and ↑ ---------- |
Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) d. Pressure Support Ventilation (PSV)--enhanced mode (can be used with SIMV v. Advantages--↑ pt comfort and ↓O2 consumption (↓work) and ↑ endurance |
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Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) e. Pressure Controlled ------ ------- Ventilation (PC-IRV) |
Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) e. Pressure Controlled Inverse Ratio Ventilation (PC-IRV) |
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Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) e. Pressure Controlled Inverse Ratio Ventilation (PC-IRV) i. Prolonged (+)pressure applied↑--------------- time expands collapsed ----------- |
Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) e. Pressure Controlled Inverse Ratio Ventilation (PC-IRV) i. Prolonged (+)pressure applied↑inspiratory time expands collapsed alveoli |
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Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) e. Pressure Controlled Inverse Ratio Ventilation (PC-IRV) ii. Unnatural (causes anxiety paralyze/sedate) -------------- (2:1 4:1) |
Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) e. Pressure Controlled Inverse Ratio Ventilation (PC-IRV) ii. Unnatural (causes anxiety paralyze/sedate) nonphysiologic (2:1 4:1) |
|
Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) e. Pressure Controlled Inverse Ratio Ventilation (PC-IRV) ii. Unnatural (causes anxiety paralyze/sedate) nonphysiologic (-----:1 ------:1) |
Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) e. Pressure Controlled Inverse Ratio Ventilation (PC-IRV) ii. Unnatural (causes anxiety paralyze/sedate) nonphysiologic (2:1 4:1) |
|
Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) e. Pressure Controlled Inverse Ratio Ventilation (PC-IRV) iii. Used for pt still hypoxic after other measures (------ and --------) |
Respiratory
III. Mechanical Ventilation C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common) e. Pressure Controlled Inverse Ratio Ventilation (PC-IRV) iii. Used for pt still hypoxic after other measures (ARDS and neonates) |
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Respiratory
III. Mechanical Ventilation D. Other Ventilatory Maneuvers 1. Positive _____-______ Pressure (PEEP) |
Respiratory
III. Mechanical Ventilation D. Other Ventilatory Maneuvers 1. Positive End-Expiratory Pressure (PEEP) |
|
Respiratory
III. Mechanical Ventilation D. Other Ventilatory Maneuvers 1. Positive End-Expiratory Pressure (PEEP) a. (+) pressure exerted during -------- allows for better saturation with ↓------ |
Respiratory
III. Mechanical Ventilation D. Other Ventilatory Maneuvers 1. Positive End-Expiratory Pressure (PEEP) a. (+) pressure exerted during expiration allows for better saturation with ↓FiO2 |
|
Respiratory
III. Mechanical Ventilation D. Other Ventilatory Maneuvers 1. Positive End-Expiratory Pressure (PEEP) a. (+) pressure exerted during expiration allows for better saturation with ↓FiO2 i. Airway P is ------ at expiration end w/ atmospheric P (PEEP prevents this) |
Respiratory
III. Mechanical Ventilation D. Other Ventilatory Maneuvers 1. Positive End-Expiratory Pressure (PEEP) a. (+) pressure exerted during expiration allows for better saturation with ↓FiO2 i. Airway P is 0 at expiration end w/ atmospheric P (PEEP prevents this) |
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Respiratory
III. Mechanical Ventilation D. Other Ventilatory Maneuvers 1. Positive End-Expiratory Pressure (PEEP) a. (+) pressure exerted during expiration allows for better saturation with ↓FiO2 ii. Prevents ---------- and alveolar collapse |
Respiratory
III. Mechanical Ventilation D. Other Ventilatory Maneuvers 1. Positive End-Expiratory Pressure (PEEP) a. (+) pressure exerted during expiration allows for better saturation with ↓FiO2 ii. Prevents atelectasis and alveolar collapse |
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Respiratory
III. Mechanical Ventilation D. Other Ventilatory Maneuvers 1. Positive End-Expiratory Pressure (PEEP) b. ↑functional -------- capacity (FRC-volume at end of normal cresp) ↑oxygenation |
Respiratory
III. Mechanical Ventilation D. Other Ventilatory Maneuvers 1. Positive End-Expiratory Pressure (PEEP) b. ↑functional residual capacity (FRC-volume at end of normal cresp) ↑oxygenation |
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Respiratory
III. Mechanical Ventilation D. Other Ventilatory Maneuvers 1. Positive End-Expiratory Pressure (PEEP) b. ↑functional residual capacity (______-volume at end of normal cresp) ↑________ |
Respiratory
III. Mechanical Ventilation D. Other Ventilatory Maneuvers 1. Positive End-Expiratory Pressure (PEEP) b. ↑functional residual capacity (FRC-volume at end of normal cresp) ↑oxygenation |
|
Respiratory
III. Mechanical Ventilation D. Other Ventilatory Maneuvers 1. Positive End-Expiratory Pressure (PEEP) c. Uses--severe hypoxia that does not improve w/ FiO2 between ____-____% |
Respiratory
III. Mechanical Ventilation D. Other Ventilatory Maneuvers 1. Positive End-Expiratory Pressure (PEEP) c. Uses--severe hypoxia that does not improve w/ FiO2 between 50-70% |
|
Respiratory
III. Mechanical Ventilation D. Other Ventilatory Maneuvers 1. Positive End-Expiratory Pressure (PEEP) c. Uses--severe hypoxia that does not improve w/ FiO2 between 50-70% i. For hypoxia could breath faster, deeper, use PEEP or ↑____ (risk O2 toxicity) |
Respiratory
III. Mechanical Ventilation D. Other Ventilatory Maneuvers 1. Positive End-Expiratory Pressure (PEEP) c. Uses--severe hypoxia that does not improve w/ FiO2 between 50-70% i. For hypoxia could breath faster, deeper, use PEEP or ↑FiO2 (risk O2 toxicity) |
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Respiratory
III. Mechanical Ventilation D. Other Ventilatory Maneuvers 1. Positive End-Expiratory Pressure (PEEP) d. Indications i. Acute lung injury and ------- ii. Cardiogenic ---------- edema |
Respiratory
III. Mechanical Ventilation D. Other Ventilatory Maneuvers 1. Positive End-Expiratory Pressure (PEEP) d. Indications i. Acute lung injury and ARDS ii. Cardiogenic pulmonary edema |
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Respiratory
III. Mechanical Ventilation D. Other Ventilatory Maneuvers 1. Positive End-Expiratory Pressure (PEEP) d. Indications iii. Atelectasis associated with severe --------- iv. Diffuse pneumonia requiring --------- ventilation |
Respiratory
III. Mechanical Ventilation D. Other Ventilatory Maneuvers 1. Positive End-Expiratory Pressure (PEEP) d. Indications iii. Atelectasis associated with severe hypoxemia iv. Diffuse pneumonia requiring mechanical ventilation |
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Respiratory
III. Mechanical Ventilation D. Other Ventilatory Maneuvers 1. Positive End-Expiratory Pressure (PEEP) e. Contraindications i. Pneumothorax w/out --------- catheter (would worsen pneumo) |
Respiratory
III. Mechanical Ventilation D. Other Ventilatory Maneuvers 1. Positive End-Expiratory Pressure (PEEP) e. Contraindications i. Pneumothorax w/out pleural catheter (would worsen pneumo) |
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Respiratory
III. Mechanical Ventilation D. Other Ventilatory Maneuvers 1. Positive End-Expiratory Pressure (PEEP) e. Contraindications ii. Increased --------- pressure |
Respiratory
III. Mechanical Ventilation D. Other Ventilatory Maneuvers 1. Positive End-Expiratory Pressure (PEEP) e. Contraindications ii. Increased intracranial pressure |
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Respiratory
III. Mechanical Ventilation D. Other Ventilatory Maneuvers 1. Positive End-Expiratory Pressure (PEEP) e. Contraindications iii. Hypovolemia--↑---------- pressure ↓------- return ↓BP |
Respiratory
III. Mechanical Ventilation D. Other Ventilatory Maneuvers 1. Positive End-Expiratory Pressure (PEEP) e. Contraindications iii. Hypovolemia--↑intrathoracic pressure ↓venous return ↓BP |
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Respiratory
III. Mechanical Ventilation D. Other Ventilatory Maneuvers 1. Positive End-Expiratory Pressure (PEEP) e. Contraindications iv. Low ------- output |
Respiratory
III. Mechanical Ventilation D. Other Ventilatory Maneuvers 1. Positive End-Expiratory Pressure (PEEP) e. Contraindications iv. Low cardiac output |
|
Respiratory
III. Mechanical Ventilation D. Other Ventilatory Maneuvers 1. Positive End-Expiratory Pressure (PEEP) f. -------------- considerations--decreases venous return and CO |
Respiratory
III. Mechanical Ventilation D. Other Ventilatory Maneuvers 1. Positive End-Expiratory Pressure (PEEP) f. Hemodynamic considerations--decreases venous return and CO |
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Respiratory
III. Mechanical Ventilation D. Other Ventilatory Maneuvers 1. Positive End-Expiratory Pressure (PEEP) g. Normal setting:____-____cm H2O |
Respiratory
III. Mechanical Ventilation D. Other Ventilatory Maneuvers 1. Positive End-Expiratory Pressure (PEEP) f. Hemodynamic considerations--decreases venous return and CO |
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Respiratory
III. Mechanical Ventilation D. Other Ventilatory Maneuvers 2. Continuous ----------- ----------- Pressure (CPAP) |
Respiratory
III. Mechanical Ventilation D. Other Ventilatory Maneuvers 2. Continuous Positive Airway Pressure (CPAP) |
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Respiratory
III. Mechanical Ventilation D. Other Ventilatory Maneuvers 2. Continuous Positive Airway Pressure (CPAP) a. Continuous (+) pressure during entire ------- cycle--prevents airway P from reaching ---------- |
Respiratory
III. Mechanical Ventilation D. Other Ventilatory Maneuvers 2. Continuous Positive Airway Pressure (CPAP) a. Continuous (+) pressure during entire resp. cycle--prevents airway P from reaching 0 |
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Respiratory
III. Mechanical Ventilation D. Other Ventilatory Maneuvers 2. Continuous Positive Airway Pressure (CPAP) b. No breaths by vent--must be ----------- breather (rate determined by pt own ----------) |
Respiratory
III. Mechanical Ventilation D. Other Ventilatory Maneuvers 2. Continuous Positive Airway Pressure (CPAP) b. No breaths by vent--must be spontaneous breather (rate determined by pt own RR) |
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Respiratory
III. Mechanical Ventilation D. Other Ventilatory Maneuvers 2. Continuous Positive Airway Pressure (CPAP) b. No breaths by vent--must be spontaneous breather (rate determined by pt own RR) i. Pt is doing all the work--increases ----------- |
Respiratory
III. Mechanical Ventilation D. Other Ventilatory Maneuvers 2. Continuous Positive Airway Pressure (CPAP) b. No breaths by vent--must be spontaneous breather (rate determined by pt own RR) i. Pt is doing all the work--increases WOB |
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Respiratory
III. Mechanical Ventilation D. Other Ventilatory Maneuvers 2. Continuous Positive Airway Pressure (CPAP) c. Commonly used for ------------- and primarily in the weaning process (do CPAP trials) |
Respiratory
III. Mechanical Ventilation D. Other Ventilatory Maneuvers 2. Continuous Positive Airway Pressure (CPAP) c. Commonly used for sleep apnea and primarily in the weaning process (do CPAP trials) |
|
Respiratory
III. Mechanical Ventilation D. Other Ventilatory Maneuvers 3. High ---------- Ventilation |
Respiratory
III. Mechanical Ventilation D. Other Ventilatory Maneuvers 3. High Frequency Ventilation |
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Respiratory
III. Mechanical Ventilation E. Complications 1. Cardiovascular a. Decreased venous return--from increased ------------ pressure |
Respiratory
III. Mechanical Ventilation E. Complications 1. Cardiovascular a. Decreased venous return--from increased intrathoracic pressure |
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Respiratory
III. Mechanical Ventilation E. Complications 1. Cardiovascular b. Decreased ________--preload c. Decreased _______ output |
Respiratory
III. Mechanical Ventilation E. Complications 1. Cardiovascular b. Decreased LVEDV--preload c. Decreased cardiac output |
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Respiratory
III. Mechanical Ventilation E. Complications 1. Cardiovascular d. Hypotension **Further impairment with -------- |
Respiratory
III. Mechanical Ventilation E. Complications 1. Cardiovascular d. Hypotension **Further impairment with PEEP |
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Respiratory
III. Mechanical Ventilation E. Complications 2. Pulmonary--_____% of vented pts have some lung damage |
Respiratory
III. Mechanical Ventilation E. Complications 2. Pulmonary--65% of vented pts have some lung damage |
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Respiratory
III. Mechanical Ventilation E. Complications 2. Pulmonary--65% of vented pts have some lung damage a. ___________--damage to lungs by excessive pressure |
Respiratory
III. Mechanical Ventilation E. Complications 2. Pulmonary--65% of vented pts have some lung damage a. Barotrauma--damage to lungs by excessive pressure |
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Respiratory
III. Mechanical Ventilation E. Complications 2. Pulmonary--65% of vented pts have some lung damage a. Barotrauma--damage to lungs by excessive pressure i. Lungs can be over extended and rupture w/ high ----------- pressure |
Respiratory
III. Mechanical Ventilation E. Complications 2. Pulmonary--65% of vented pts have some lung damage a. Barotrauma--damage to lungs by excessive pressure i. Lungs can be over extended and rupture w/ high peak inspiratory pressure |
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Respiratory
III. Mechanical Ventilation E. Complications 2. Pulmonary--65% of vented pts have some lung damage a. Barotrauma--damage to lungs by excessive pressure ii. Can cause pneumothorax, subcutaneous ------------, and ------------- |
Respiratory
III. Mechanical Ventilation E. Complications 2. Pulmonary--65% of vented pts have some lung damage a. Barotrauma--damage to lungs by excessive pressure ii. Can cause pneumothorax, subcutaneous emphysema, and pneumomediastinum |
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Respiratory
III. Mechanical Ventilation E. Complications 2. Pulmonary--65% of vented pts have some lung damage a. Barotrauma--damage to lungs by excessive pressure iii. Risk to pt w/----------- lungs (ex. COPD) |
Respiratory
III. Mechanical Ventilation E. Complications 2. Pulmonary--65% of vented pts have some lung damage a. Barotrauma--damage to lungs by excessive pressure iii. Risk to pt w/ compliant lungs (ex. COPD) |
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Respiratory
III. Mechanical Ventilation E. Complications 2. Pulmonary--65% of vented pts have some lung damage b. Volu-trauma--injury from ↑-------- volume on pt with -------------/stiff lungs (ARDS) |
Respiratory
III. Mechanical Ventilation E. Complications 2. Pulmonary--65% of vented pts have some lung damage b. Volu-trauma--injury from ↑tidal volume on pt with noncompliant/stiff lungs (ARDS) |
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Respiratory
III. Mechanical Ventilation E. Complications 2. Pulmonary--65% of vented pts have some lung damage c. Alveolar _________--excessive lung secretions, leaking cuff, etc. |
Respiratory
III. Mechanical Ventilation E. Complications 2. Pulmonary--65% of vented pts have some lung damage c. Alveolar Hypoventilation--excessive lung secretions, leaking cuff, etc. |
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Respiratory
III. Mechanical Ventilation E. Complications 2. Pulmonary--65% of vented pts have some lung damage d. Alveolar _________--pt anxious ↑tidal volumes |
Respiratory
III. Mechanical Ventilation E. Complications 2. Pulmonary--65% of vented pts have some lung damage d. Alveolar Hyperventilation--pt anxious ↑tidal volumes |
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Respiratory
III. Mechanical Ventilation E. Complications 2. Pulmonary--65% of vented pts have some lung damage e. Ventilator-assisted pneumonia--ET tube bypasses ------------ defenses |
III. Mechanical Ventilation
E. Complications 2. Pulmonary--65% of vented pts have some lung damage e. Ventilator-assisted pneumonia--ET tube bypasses normal upper airway defenses |
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III. Mechanical Ventilation
E. Complications 2. Pulmonary--65% of vented pts have some lung damage e. Ventilator-assisted pneumonia--ET tube bypasses normal upper airway defenses i. Critical care pt at risk because of -------- and poor -------- status |
III. Mechanical Ventilation
E. Complications 2. Pulmonary--65% of vented pts have some lung damage e. Ventilator-assisted pneumonia--ET tube bypasses normal upper airway defenses i. Critical care pt at risk because of immobility and poor nutritional status |
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III. Mechanical Ventilation
E. Complications 2. Pulmonary--65% of vented pts have some lung damage e. Ventilator-assisted pneumonia--ET tube bypasses normal upper airway defenses ii. Sputum cultures often grow ----------- (pseudomonas, serratia, klebsiella) |
III. Mechanical Ventilation
E. Complications 2. Pulmonary--65% of vented pts have some lung damage e. Ventilator-assisted pneumonia--ET tube bypasses normal upper airway defenses ii. Sputum cultures often grow gram(-)bacteria (pseudomonas, serratia, klebsiella) |
|
III. Mechanical Ventilation
E. Complications 2. Pulmonary--65% of vented pts have some lung damage e. Ventilator-assisted pneumonia--ET tube bypasses normal upper airway defenses ii. Sputum cultures often grow gram(-)bacteria (pseudomonas, ---------, ----------) |
FIX
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III. Mechanical Ventilation
E. Complications 2. Pulmonary--65% of vented pts have some lung damage e. Ventilator-assisted pneumonia--ET tube bypasses normal upper airway defenses iii. Decrease risk by using strict ------------ technique while suctioning (hand washing, drain condensation from tubes, etc.) |
III. Mechanical Ventilation
E. Complications 2. Pulmonary--65% of vented pts have some lung damage e. Ventilator-assisted pneumonia--ET tube bypasses normal upper airway defenses iii. Decrease risk by using strict aseptic technique while suctioning (hand washing, drain condensation from tubes, etc.) |
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III. Mechanical Ventilation
E. Complications 3. Gastrointestinal a. Risk of stress ulcers and ----------- bleeding |
III. Mechanical Ventilation
E. Complications 3. Gastrointestinal a. Risk of stress ulcers and GI bleeding |
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III. Mechanical Ventilation
E. Complications 3. Gastrointestinal b. Nursing Implication--______receptor blockers or PPIs and monitor pH of gastric aspirate |
III. Mechanical Ventilation
E. Complications 3. Gastrointestinal b. Nursing Implication--H2-receptor blockers or PPIs and monitor pH of gastric aspirate |
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III. Mechanical Ventilation
E. Complications 3. Gastrointestinal b. Nursing Implication--H2-receptor blockers or ----------- and monitor pH of gastric ---------- |
III. Mechanical Ventilation
E. Complications 3. Gastrointestinal b. Nursing Implication--H2-receptor blockers or PPIs and monitor pH of gastric aspirate |
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III. Mechanical Ventilation
E. Complications 4. Neurologic a. Potential for increase in intracranial pressure from ↓ _______ return (keep HOB ____-45°) |
III. Mechanical Ventilation
E. Complications 4. Neurologic a. Potential for increase in intracranial pressure from ↓ venous return (keep HOB 30-45°) |
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III. Mechanical Ventilation
E. Complications 5. Fluid_________--fluid overload potential (↓CO↓kidney flow↑ReninNa/H2O retention) |
III. Mechanical Ventilation
E. Complications 5. Fluid Imbalance--fluid overload potential (↓CO↓kidney flow↑ReninNa/H2O retention) |
|
III. Mechanical Ventilation
E. Complications 5. Fluid Imbalance--fluid overload potential (↓---------↓-----------↑ReninNa/H2O retention) |
III. Mechanical Ventilation
E. Complications 5. Fluid Imbalance--fluid overload potential (↓CO↓kidney flow↑ReninNa/H2O retention) |
|
III. Mechanical Ventilation
E. Complications 5. Fluid Imbalance--fluid overload potential (↓CO↓kidney flow↑-------------/H2O retention) |
III. Mechanical Ventilation
E. Complications 5. Fluid Imbalance--fluid overload potential (↓CO↓kidney flow↑ReninNa/H2O retention) |
|
III. Mechanical Ventilation
E. Complications 6. Musculoskeletal Problems--due to -------- |
III. Mechanical Ventilation
E. Complications 6. Musculoskeletal Problems--due to immobility |
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III. Mechanical Ventilation
E. Complications 7. Psychosocial Effects--assess for causes of ----------- and meeting basic needs |
III. Mechanical Ventilation
E. Complications 7. Psychosocial Effects--assess for causes of anxiety and meeting basic needs |
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Respiratory Disruptions
I. Laryngeal Polyps A. Etiology and Pathophysiology--more common in men, ----------, talkers/yellers, ----------, and ----------- |
Respiratory Disruptions
I. Laryngeal Polyps A. Etiology and Pathophysiology--more common in men, singers, talkers/yellers, smokers, and GERD |
|
Respiratory Disruptions
I. Laryngeal Polyps B. Clinical Manifestations 1. _______--not going to go away 2. Continuously ________ (breathy, harsh, and low in quality) |
Respiratory Disruptions
I. Laryngeal Polyps B. Clinical Manifestations 1. Cough--not going to go away 2. Continuously change voice (breathy, harsh, and low in quality) |
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Respiratory Disruptions
I. Laryngeal Polyps C. Medical Management 1. Rest vocal cords and maybe a course of --------- 2. If long enough ------------ (rare) and surgically removed (could become malignant) |
Respiratory Disruptions
I. Laryngeal Polyps C. Medical Management 1. Rest vocal cords and maybe a course of steroids 2. If long enough biopsied (rare) and surgically removed (could become malignant) |
|
Respiratory Disruptions
I. Laryngeal Polyps C. Medical Management 1. Rest vocal cords and maybe a course of steroids 2. If long enough biopsied (rare) and surgically removed (could become malignant) i. Potential for voice quality to ---------- after surgery |
Respiratory Disruptions
I. Laryngeal Polyps C. Medical Management 1. Rest vocal cords and maybe a course of steroids 2. If long enough biopsied (rare) and surgically removed (could become malignant) i. Potential for voice quality to not be same after surgery |
|
Respiratory Disruptions
II. Laryngeal Cancer A. Etiology and Pathophysiology--squamous cell ----------- |
Respiratory Disruptions
II. Laryngeal Cancer A. Etiology and Pathophysiology--squamous cell carcinomas |
|
Respiratory Disruptions
II. Laryngeal Cancer A. Etiology and Pathophysiology--squamous cell carcinomas 1. Found in smokers and ------------ users (can be prevented) 2. Prevalence--_____% of head and neck cancers in pts >_______yrs |
Respiratory Disruptions
II. Laryngeal Cancer A. Etiology and Pathophysiology--squamous cell carcinomas 1. Found in smokers and ETOH users (can be prevented) 2. Prevalence--90% of head and neck cancers in pts >50yrs |
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Respiratory Disruptions
II. Laryngeal Cancer B. Clinical Manifestations--hoarseness, persistent -----------, change in --------- quality |
Respiratory Disruptions
II. Laryngeal Cancer B. Clinical Manifestations--hoarseness, persistent sore throat, change in voice quality |
|
Respiratory Disruptions
II. Laryngeal Cancer B. Clinical Manifestations--hoarseness, persistent sore throat, change in voice quality 1. Eventually pain and difficulty ---------------- (late presentation) |
Respiratory Disruptions
II. Laryngeal Cancer B. Clinical Manifestations--hoarseness, persistent sore throat, change in voice quality 1. Eventually pain and difficulty swallowing (late presentation) |
|
Respiratory Disruptions
II. Laryngeal Cancer C. Diagnostic Studies--visualize -----------, biopsies, ------------- (determine spread) |
Respiratory Disruptions
II. Laryngeal Cancer C. Diagnostic Studies--visualize cancer, biopsies, CT/MRI (determine spread) |
|
Respiratory Disruptions
II. Laryngeal Cancer C. Diagnostic Studies--visualize cancer, biopsies, CT/MRI (determine spread) 1. If diagnosed early--good cure rate (after partial/total -------------, laser treatment/---------) |
Respiratory Disruptions
II. Laryngeal Cancer C. Diagnostic Studies--visualize cancer, biopsies, CT/MRI (determine spread) 1. If diagnosed early--good cure rate (after partial/total laryngectomy, laser treatment/chemo) |
|
Respiratory Disruptions
II. Laryngeal Cancer D. Medical Management 1. _____________--partial/complete surgical removal of larynx usually from cancer (disfiguring) |
Respiratory Disruptions
II. Laryngeal Cancer D. Medical Management 1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring) |
|
Respiratory Disruptions
II. Laryngeal Cancer D. Medical Management 1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring) a. Often try other ----------- first b. Partial when ---------- limited to 1 spot (may be able to speak, but quality will be different) |
Respiratory Disruptions
II. Laryngeal Cancer D. Medical Management 1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring) a. Often try other methods first b. Partial when CA limited to 1 spot (may be able to speak, but quality will be different) |
|
Respiratory Disruptions
II. Laryngeal Cancer D. Medical Management 1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring) c. Total--radical surgery creating permanent airway through---------- (no speech) |
Respiratory Disruptions
II. Laryngeal Cancer D. Medical Management 1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring) c. Total--radical surgery creating permanent airway through trachea (no speech) |
|
Respiratory Disruptions
II. Laryngeal Cancer D. Medical Management 1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring) d. Nursing Management i. Pre-___________ |
Respiratory Disruptions
II. Laryngeal Cancer D. Medical Management 1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring) d. Nursing Management i. Pre-Laryngectomy |
|
Respiratory Disruptions
II. Laryngeal Cancer D. Medical Management 1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring) d. Nursing Management i. Pre-Laryngectomy • Assessment of ---------- • Pre-op --------- |
Respiratory Disruptions
II. Laryngeal Cancer D. Medical Management 1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring) d. Nursing Management i. Pre-Laryngectomy • Assessment of knowledge • Pre-op teaching |
|
Respiratory Disruptions
II. Laryngeal Cancer D. Medical Management 1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring) d. Nursing Management i. Pre-Laryngectomy • Expected goals for ------- |
Respiratory Disruptions
II. Laryngeal Cancer D. Medical Management 1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring) d. Nursing Management i. Pre-Laryngectomy • Expected goals for pts |
|
Respiratory Disruptions
II. Laryngeal Cancer D. Medical Management 1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring) d. Nursing Management i. Pre-Laryngectomy • Post-op expectations (J-Ps/---------/suction/pain/---------/---------) |
Respiratory Disruptions
II. Laryngeal Cancer D. Medical Management 1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring) d. Nursing Management i. Pre-Laryngectomy • Post-op expectations (J-Ps/ventilation/suction/pain/catheters/feeding tube) |
|
Respiratory Disruptions
II. Laryngeal Cancer D. Medical Management 1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring) d. Nursing Management ii. Post-Laryngectomy • Maintain patient airway (administer ------------, clean --------- tubes TID) |
Respiratory Disruptions
II. Laryngeal Cancer D. Medical Management 1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring) d. Nursing Management ii. Post-Laryngectomy • Maintain patient airway (administer humidified air, clean trach tubes TID) |
|
Respiratory Disruptions
II. Laryngeal Cancer D. Medical Management 1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring) d. Nursing Management ii. Post-Laryngectomy • Prevention of infection (dressing changes q---------h, ------- hygiene) |
Respiratory Disruptions
II. Laryngeal Cancer D. Medical Management 1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring) d. Nursing Management ii. Post-Laryngectomy • Prevention of infection (dressing changes q8h, oral hygiene) |
|
Respiratory Disruptions
II. Laryngeal Cancer D. Medical Management 1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring) d. Nursing Management ii. Post-Laryngectomy • ---------- control • Maintain adequate nutritional support --NG tube for -------- days |
Respiratory Disruptions
II. Laryngeal Cancer D. Medical Management 1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring) d. Nursing Management ii. Post-Laryngectomy • Pain control • Maintain adequate nutritional support --NG tube for 7 days |
|
Respiratory Disruptions
II. Laryngeal Cancer D. Medical Management 1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring) d. Nursing Management ii. Post-Laryngectomy • Effective comm.--__________ speech to make sounds/artificial voice box |
Respiratory Disruptions
II. Laryngeal Cancer D. Medical Management 1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring) d. Nursing Management ii. Post-Laryngectomy • Effective comm.--esophageal speech to make sounds/artificial voice box |
|
Respiratory Disruptions
II. Laryngeal Cancer D. Medical Management 1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring) d. Nursing Management iii. Home Care--teaching so that they can manage themselves at home • S---------- • Daily cleaning of ----------- |
Respiratory Disruptions
II. Laryngeal Cancer D. Medical Management 1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring) d. Nursing Management iii. Home Care--teaching so that they can manage themselves at home • Suctioning • Daily cleaning of trach |
|
Respiratory Disruptions
II. Laryngeal Cancer D. Medical Management 1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring) d. Nursing Management iii. Home Care--teaching so that they can manage themselves at home • ________________--steam filled shower, moistened cover over stoma (prevent tracheal bronchitis) • Use of _________ covers--to protect during shower, etc. |
Respiratory Disruptions
II. Laryngeal Cancer D. Medical Management 1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring) d. Nursing Management iii. Home Care--teaching so that they can manage themselves at home • Humidification--steam filled shower, moistened cover over stoma (prevent tracheal bronchitis) • Use of stoma covers--to protect during shower, etc. |
|
Respiratory Disruptions
II. Laryngeal Cancer D. Medical Management 1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring) d. Nursing Management iii. Home Care--teaching so that they can manage themselves at home • Changing --------- ties or Velcro-type holders • ------------: should have ID band stating that they are neck breathers |
Respiratory Disruptions
II. Laryngeal Cancer D. Medical Management 1. Laryngectomy--partial/complete surgical removal of larynx usually from cancer (disfiguring) d. Nursing Management iii. Home Care--teaching so that they can manage themselves at home • Changing twill ties or Velcro-type holders • Resuscitation--should have ID band stating that they are neck breathers |
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Respiratory Disruptions
II. Laryngeal Cancer D. Medical Management 2. Radial Neck Dissection--remove as much cancer as possible and ↓risk of ---------- spread |
Respiratory Disruptions
II. Laryngeal Cancer D. Medical Management 2. Radial Neck Dissection--remove as much cancer as possible and ↓risk of lymphatic spread |
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Respiratory Disruptions
II. Laryngeal Cancer D. Medical Management 2. Radial Neck Dissection--remove as much cancer as possible and ↓risk of lymphatic spread a. Removal of all --------- nodes and --------- channels |
Respiratory Disruptions
II. Laryngeal Cancer D. Medical Management 2. Radial Neck Dissection--remove as much cancer as possible and ↓risk of lymphatic spread a. Removal of all lymph nodes and lymphatic channels |
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Respiratory Disruptions
II. Laryngeal Cancer D. Medical Management 2. Radial Neck Dissection--remove as much cancer as possible and ↓risk of lymphatic spread b. May involve -------- muscle, internal jugular vein, ------------ gland, part of thyroid/parathyroid, --------- accessory nerve (controls speech/swallowing) removal |
Respiratory Disruptions
II. Laryngeal Cancer D. Medical Management 2. Radial Neck Dissection--remove as much cancer as possible and ↓risk of lymphatic spread b. May involve sternocleidomastoid muscle, internal jugular vein, submxillary gland, part of thyroid/parathyroid, spinal accessory nerve (controls speech/swallowing) removal |
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Respiratory Disruptions
II. Laryngeal Cancer D. Medical Management 2. Radial Neck Dissection--remove as much cancer as possible and ↓risk of lymphatic spread c. Usually involves ------- side of neck, but can have -------- (very disfiguring and long recovery) |
Respiratory Disruptions
II. Laryngeal Cancer D. Medical Management 2. Radial Neck Dissection--remove as much cancer as possible and ↓risk of lymphatic spread c. Usually involves 1 side of neck, but can have 2 (very disfiguring and long recovery) |
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Respiratory Disruptions
II. Laryngeal Cancer D. Medical Management 2. Radial Neck Dissection--remove as much cancer as possible and ↓risk of lymphatic spread d. Operation should not be preformed if it has spread further (surgery won’t ----------) |
Respiratory Disruptions
II. Laryngeal Cancer D. Medical Management 2. Radial Neck Dissection--remove as much cancer as possible and ↓risk of lymphatic spread d. Operation should not be preformed if it has spread further (surgery won’t contain) |
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Respiratory Disruptions
III. Lung Cancer A. Epidemiology--leading cause of ------------- related death in men and women (survival rate --------%) |
Respiratory Disruptions
III. Lung Cancer A. Epidemiology--leading cause of CA related death in men and women (survival rate 15%) |
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Respiratory Disruptions
III. Lung Cancer B. Etiology-->________yrs w/ long smoking hx (also 2nd hand) is most sig. risk factor (80-______% of lung CA) |
Respiratory Disruptions
III. Lung Cancer B. Etiology-->50yrs w/ long smoking hx (also 2nd hand) is most sig. risk factor (80-90% of lung CA) |
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Respiratory Disruptions
III. Lung Cancer B. Etiology-->50yrs w/ long smoking hx (also 2nd hand) is most sig. risk factor (80-90% of lung CA) 1. Total exposure to ------------- (asbestos, --------, ---------, radiation) |
Respiratory Disruptions
III. Lung Cancer B. Etiology-->50yrs w/ long smoking hx (also 2nd hand) is most sig. risk factor (80-90% of lung CA) 1. Total exposure to carcinogens (asbestos, Ni, Fe, radiation) 2. If stop smoking for 10yrs decrease risk by 30-50% |
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Respiratory Disruptions
III. Lung Cancer B. Etiology-->50yrs w/ long smoking hx (also 2nd hand) is most sig. risk factor (80-90% of lung CA) 2. If stop smoking for _________yrs decrease risk by 30-_____% |
Respiratory Disruptions
III. Lung Cancer B. Etiology-->50yrs w/ long smoking hx (also 2nd hand) is most sig. risk factor (80-90% of lung CA) 2. If stop smoking for 10yrs decrease risk by 30-50% |
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Respiratory Disruptions
III. Lung Cancer C. Pathophysiology 1. Occurs primarily in ------------- or beyond and have preference for upper lobes |
Respiratory Disruptions
III. Lung Cancer C. Pathophysiology 1. Occurs primarily in segmental bronchi or beyond and have preference for upper lobes |
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Respiratory Disruptions
III. Lung Cancer C. Pathophysiology 1. Occurs primarily in segmental bronchi or beyond and have preference for upper lobes a. ---------% originate from ---------- and are very slow growing (8-10yrs to show on XR) |
Respiratory Disruptions
III. Lung Cancer C. Pathophysiology 1. Occurs primarily in segmental bronchi or beyond and have preference for upper lobes a. 90% originate from epithelium and are very slow growing (8-10yrs to show on XR) |
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Respiratory Disruptions
III. Lung Cancer C. Pathophysiology 2. Primary Lung Cancers a. ____________ (20%)--caused by smoking (most malignant w/ poor prognosis-_______m) |
Respiratory Disruptions
III. Lung Cancer C. Pathophysiology 2. Primary Lung Cancers a. Small cell CA (20%)--caused by smoking (most malignant w/ poor prognosis-16m) |
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Respiratory Disruptions
III. Lung Cancer C. Pathophysiology 2. Primary Lung Cancers b. ____________ (80%)--Staged (TNM--_______, node, metastasis) |
Respiratory Disruptions
III. Lung Cancer C. Pathophysiology 2. Primary Lung Cancers a. Small cell CA (20%)--caused by smoking (most malignant w/ poor prognosis-16m) |
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Respiratory Disruptions
III. Lung Cancer C. Pathophysiology 2. Primary Lung Cancers a. Small cell CA (20%)--caused by smoking (most malignant w/ poor prognosis-16m) i. _____________--most common (more common in women) |
Respiratory Disruptions
III. Lung Cancer C. Pathophysiology 2. Primary Lung Cancers a. Small cell CA (20%)--caused by smoking (most malignant w/ poor prognosis-16m) i. Adnocarcinoma--most common (more common in women) |
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Respiratory Disruptions
III. Lung Cancer C. Pathophysiology 2. Primary Lung Cancers a. Small cell CA (20%)--caused by smoking (most malignant w/ poor prognosis-16m) i. Adnocarcinoma--most common (more common in women) • Not related to ---------- • Nonclinical manifestations until it ----------- |
Respiratory Disruptions
III. Lung Cancer C. Pathophysiology 2. Primary Lung Cancers a. Small cell CA (20%)--caused by smoking (most malignant w/ poor prognosis-16m) i. Adnocarcinoma--most common (more common in women) • Not related to smoking • Nonclinical manifestations until it metastasizes |
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Respiratory Disruptions
III. Lung Cancer C. Pathophysiology 2. Primary Lung Cancers a. Small cell CA (20%)--caused by smoking (most malignant w/ poor prognosis-16m) i. Adnocarcinoma--most common (more common in women) • Not related to smoking • Nonclinical manifestations until it metastasizes • Does not respond well to ----------- |
Respiratory Disruptions
III. Lung Cancer C. Pathophysiology 2. Primary Lung Cancers a. Small cell CA (20%)--caused by smoking (most malignant w/ poor prognosis-16m) i. Adnocarcinoma--most common (more common in women) • Not related to smoking • Nonclinical manifestations until it metastasizes • Does not respond well to chemo/treatment |
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Respiratory Disruptions
III. Lung Cancer C. Pathophysiology 2. Primary Lung Cancers a. Small cell CA (20%)--caused by smoking (most malignant w/ poor prognosis-16m) ii. ________ cell--30-_____% of CAs (associated with smoking) |
Respiratory Disruptions
III. Lung Cancer C. Pathophysiology 2. Primary Lung Cancers a. Small cell CA (20%)--caused by smoking (most malignant w/ poor prognosis-16m) ii. Squamous cell--30-35% of CAs (associated with smoking) |
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Respiratory Disruptions
III. Lung Cancer C. Pathophysiology 2. Primary Lung Cancers a. Small cell CA (20%)--caused by smoking (most malignant w/ poor prognosis-16m) iii. Large cell--correlated with --------- |
Respiratory Disruptions
III. Lung Cancer C. Pathophysiology 2. Primary Lung Cancers a. Small cell CA (20%)--caused by smoking (most malignant w/ poor prognosis-16m) iii. Large cell--correlated with smoking |
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Respiratory Disruptions
III. Lung Cancer D. Clinical Manifestations--late in disease, especially with ----------- 1. -------------- (most common-74% of pts)--can cause chest pain from sore muscles 2. --------------: not always |
Respiratory Disruptions
III. Lung Cancer D. Clinical Manifestations--late in disease, especially with adnocarcinoma 1. Persistent cough (most common-74% of pts)--can cause chest pain from sore muscles 2. Hemoptysis--not always |
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Respiratory Disruptions
III. Lung Cancer D. Clinical Manifestations--late in disease, especially with adnocarcinoma 3. D---------- 4. H----------- |
Respiratory Disruptions
III. Lung Cancer D. Clinical Manifestations--late in disease, especially with adnocarcinoma 3. Dyspnea 4. Hoarsness, |
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Respiratory Disruptions
III. Lung Cancer D. Clinical Manifestations--late in disease, especially with adnocarcinoma 5. -------------- or stridor and recurrent pneumonia or ------------ |
Respiratory Disruptions
III. Lung Cancer D. Clinical Manifestations--late in disease, especially with adnocarcinoma 5. Wheezing or stridor and recurrent pneumonia or bronchitis 6. Difficulty swallowing anorexia/weight loss/fatigue (late manifestation) |
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Respiratory Disruptions
III. Lung Cancer D. Clinical Manifestations--late in disease, especially with adnocarcinoma 6. Difficulty ------------, -------------/weight loss/fatigue (late manifestation) |
Respiratory Disruptions
III. Lung Cancer D. Clinical Manifestations--late in disease, especially with adnocarcinoma 6. Difficulty swallowing anorexia/weight loss/fatigue (late manifestation) |
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Respiratory Disruptions
III. Lung Cancer D. Clinical Manifestations--late in disease, especially with adnocarcinoma 7. Pleural ---------, pericardial ------------- (if mediasternum), cardiac ----------- |
Respiratory Disruptions
III. Lung Cancer D. Clinical Manifestations--late in disease, especially with adnocarcinoma 7. Pleural effusion, pericardial effusion (if mediasternum), cardiac tamponade |
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Respiratory Disruptions
III. Lung Cancer D. Clinical Manifestations--late in disease, especially with adnocarcinoma 8. Superior ------------- syndrome--swelling in ---------, neck, and face |
Respiratory Disruptions
III. Lung Cancer D. Clinical Manifestations--late in disease, especially with adnocarcinoma 8. Superior vena cava syndrome--swelling in arms, neck, and face |
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Respiratory Disruptions
III. Lung Cancer D. Clinical Manifestations--late in disease, especially with adnocarcinoma 9. Swollen lymph nodes--swell with ----------- |
Respiratory Disruptions
III. Lung Cancer D. Clinical Manifestations--late in disease, especially with adnocarcinoma 9. Swollen lymph nodes--swell with metastasis |
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Respiratory Disruptions
III. Lung Cancer E. Diagnosis 1. History and --------- 2. CXR--detect -------, pleural effusions, and -------- (1-2sonometers) |
Respiratory Disruptions
III. Lung Cancer E. Diagnosis 1. History and physical 2. CXR--detect metastasis, pleural effusions, and tumors (1-2sonometers) |
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Respiratory Disruptions
III. Lung Cancer E. Diagnosis 2. CXR--detect metastasis, pleural effusions, and tumors (1-2sonometers) a. Routing CXRs often lead to --------- of lung ---------- |
Respiratory Disruptions
III. Lung Cancer E. Diagnosis 2. CXR--detect metastasis, pleural effusions, and tumors (1-2sonometers) a. Routing CXRs often lead to Dx of lung CA |
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Respiratory Disruptions
III. Lung Cancer E. Diagnosis 3. ________--single most effective noninvasive test to determine CA and metastasis |
Respiratory Disruptions
III. Lung Cancer E. Diagnosis 3. CT--single most effective noninvasive test to determine CA and metastasis |
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Respiratory Disruptions
III. Lung Cancer E. Diagnosis 4. Biopsy--definitive --------- (must have ----------- cells) |
Respiratory Disruptions
III. Lung Cancer E. Diagnosis 4. Biopsy--definitive Dx (must have malignant cells) |
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Respiratory Disruptions
III. Lung Cancer E. Diagnosis 4. Biopsy--definitive Dx (must have malignant cells) a. From morning ---------- sample, bronchoscopy, needle ----------, tap pleural --------- |
Respiratory Disruptions
III. Lung Cancer E. Diagnosis 4. Biopsy--definitive Dx (must have malignant cells) a. From morning sputum sample, bronchoscopy, needle biopsy, tap pleural effusion |
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Respiratory Disruptions
III. Lung Cancer E. Diagnosis 4. Biopsy--definitive Dx (must have malignant cells) b. Brain and ---------- most common metastasis sites |
Respiratory Disruptions
III. Lung Cancer E. Diagnosis 4. Biopsy--definitive Dx (must have malignant cells) b. Brain and bone most common metastasis sites |
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Respiratory Disruptions
III. Lung Cancer F. Treatment--based on staging (early ----------- is not helpful) 1. Surgery--only hope (------------ more likely to be resected) |
Respiratory Disruptions
III. Lung Cancer F. Treatment--based on staging (early detection is not helpful) 1. Surgery--only hope (squamous cells more likely to be resected) |
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Respiratory Disruptions
III. Lung Cancer F. Treatment--based on staging (early detection is not helpful) 1. Surgery--only hope (squamous cells more likely to be resected) a. ----------- (part of lung) vs. ------------ (whole lung) |
Respiratory Disruptions
III. Lung Cancer F. Treatment--based on staging (early detection is not helpful) 1. Surgery--only hope (squamous cells more likely to be resected) a. Lobectomy (part of lung) vs. pneumonectomy (whole lung) |
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Respiratory Disruptions
III. Lung Cancer F. Treatment--based on staging (early detection is not helpful) 1. Surgery--only hope (squamous cells more likely to be resected) b. Many times not possible if already ----------- |
Respiratory Disruptions
III. Lung Cancer F. Treatment--based on staging (early detection is not helpful) 1. Surgery--only hope (squamous cells more likely to be resected) b. Many times not possible if already metastasized |
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Respiratory Disruptions
III. Lung Cancer F. Treatment--based on staging (early detection is not helpful) 2. Radiation--when used with surgery and -------- (not beneficial for --------- cell) a. Sometimes just for --------- measures |
Respiratory Disruptions
III. Lung Cancer F. Treatment--based on staging (early detection is not helpful) 2. Radiation--when used with surgery and chemo (not beneficial for small cell) a. Sometimes just for palliative measures |
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Respiratory Disruptions
III. Lung Cancer F. Treatment--based on staging (early detection is not helpful) 3. Chemotherapy--standard treatment for advanced ---------- CA |
Respiratory Disruptions
III. Lung Cancer F. Treatment--based on staging (early detection is not helpful) 3. Chemotherapy--standard treatment for advanced non-small cell CA |
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Respiratory Disruptions
III. Lung Cancer G. Nursing Management 1. Assess level of ----------- related to disease 2. Provide pre-op/post-op procedure and ------------- teaching 3. Assess --------- system |
Respiratory Disruptions
III. Lung Cancer G. Nursing Management 1. Assess level of knowledge related to disease 2. Provide pre-op/post-op procedure and intervention teaching 3. Assess support system |
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Respiratory Disruptions
III. Lung Cancer G. Nursing Management 4. Assess pain and provide --------- measures 5. Assess ------------ status (pts easily lose wt) 6. Be able to provide------------ in the community |
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Respiratory Disruptions
IV. Traumatic Injuries of the Chest and Thorax A. Blunt--body is struck by a blunt object (ex. MVAs chest wall in contact with steering wheel) 1. --------------- trauma--impact of parts of the body against other objects |
Respiratory Disruptions
IV. Traumatic Injuries of the Chest and Thorax A. Blunt--body is struck by a blunt object (ex. MVAs chest wall in contact with steering wheel) 1. Countrecoup trauma--impact of parts of the body against other objects |
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Respiratory Disruptions
IV. Traumatic Injuries of the Chest and Thorax A. Blunt--body is struck by a blunt object (ex. MVAs chest wall in contact with steering wheel) 2. Pulmonary ---------, vessel ------------- (great vessel tears), cardiac tamponade, crush ---------- |
Respiratory Disruptions
IV. Traumatic Injuries of the Chest and Thorax A. Blunt--body is struck by a blunt object (ex. MVAs chest wall in contact with steering wheel) 2. Pulmonary contusions, vessel ruptures (great vessel tears), cardiac tamponade, crush injuries |
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Respiratory Disruptions
IV. Traumatic Injuries of the Chest and Thorax B. ___________--foreign body impales or passes through body tissues C. _____________--air/fluid in pleural space (have a tendency to reoccur) |
Respiratory Disruptions
IV. Traumatic Injuries of the Chest and Thorax B. Penetrating--foreign body impales or passes through body tissues C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur) |
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Respiratory Disruptions
IV. Traumatic Injuries of the Chest and Thorax C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur) • If >_____% of lung resp. distress, if <________% they can still function (may need chest tube) |
IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur) • If >40% of lung resp. distress, if <25% they can still function (may need chest tube) |
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IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur) 1. Closed--caused by -------- rupture on lung a. Characteristics--no associated open ---------, no underlying disease |
IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur) 1. Closed--caused by bleb rupture on lung a. Characteristics--no associated open wound, no underlying disease |
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IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur) 1. Closed--caused by bleb rupture on lung a. Characteristics--no associated open wound, no underlying disease i. -------------- pneumothorax--no clear cause (tall, thin, 20-_____yr men who smoke) |
IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur) 1. Closed--caused by bleb rupture on lung a. Characteristics--no associated open wound, no underlying disease i. Sponaneous pneumothorax--no clear cause (tall, thin, 20-40yr men who smoke) |
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IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur) 1. Closed--caused by bleb rupture on lung a. Characteristics--no associated open wound, no underlying disease ii. Injury from ----------- ventilation (PEEP) iii. Injury from broken -------- |
IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur) 1. Closed--caused by bleb rupture on lung a. Characteristics--no associated open wound, no underlying disease ii. Injury from mechanical ventilation (PEEP) iii. Injury from broken ribs |
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IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur) 1. Closed--caused by bleb rupture on lung a. Characteristics--no associated open wound, no underlying disease iv. S/P ------------- insertion--always follow w/ ----------- to check for pneumo |
IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur) 1. Closed--caused by bleb rupture on lung a. Characteristics--no associated open wound, no underlying disease iv. S/P subclavian catheter insertion--always follow w/ CXR to check for pneumo |
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IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur) 2. Open--air enters pleural space from opening in chest wall and gets trapped (“sucking wound”) a. Causes--stab/--------- wound; s/p ---------- |
IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur) 2. Open--air enters pleural space from opening in chest wall and gets trapped (“sucking wound”) a. Causes--stab/gunshot wound; s/p thoracotomy |
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IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur) 2. Open--air enters pleural space from opening in chest wall and gets trapped (“sucking wound”) b. Manifestations--SOB, ----------------/hyperresonance on affected side, see ------------ |
IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur) 2. Open--air enters pleural space from opening in chest wall and gets trapped (“sucking wound”) b. Manifestations--SOB, shallow breaths/hyperresonance on affected side, see bubbling |
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IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur) 2. Open--air enters pleural space from opening in chest wall and gets trapped (“sucking wound”) c. Management--cover w/ ---------- dressing and taped on ------------ sides (creates 1 way valve) |
IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur) 2. Open--air enters pleural space from opening in chest wall and gets trapped (“sucking wound”) c. Management--cover w/ vented dressing and taped on 3 sides (creates 1 way valve) |
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IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur) 2. Open--air enters pleural space from opening in chest wall and gets trapped (“sucking wound”) c. Management--cover w/ vented dressing and taped on 3 sides (creates 1 way valve) i. If taped on all ----------- sides pneumo gets bigger tension ----------- |
IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur) 2. Open--air enters pleural space from opening in chest wall and gets trapped (“sucking wound”) c. Management--cover w/ vented dressing and taped on 3 sides (creates 1 way valve) i. If taped on all 4 sides pneumo gets bigger tension pneumo |
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IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur) 2. Open--air enters pleural space from opening in chest wall and gets trapped (“sucking wound”) c. Management--cover w/ vented dressing and taped on 3 sides (creates 1 way valve) ii. Give ----------- until ---------- placement |
IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur) 2. Open--air enters pleural space from opening in chest wall and gets trapped (“sucking wound”) c. Management--cover w/ vented dressing and taped on 3 sides (creates 1 way valve) ii. Give oxygen until chest tube placement |
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IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur) 3. Tension--pneumothorax w/ rapid ------------- of air in pleural space causing severely high ---------------- pressures w/ resultant tension on heart and great vessels (life threatening) |
IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur) 3. Tension--pneumothorax w/ rapid accumulation of air in pleural space causing severely high intrapleural pressures w/ resultant tension on heart and great vessels (life threatening) |
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IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur) 3. Tension--pneumothorax w/ rapid accumulation of air in pleural space causing severely high intrapleural pressures w/ resultant tension on heart and great vessels (life threatening) a. Clinical Manifestations (can occur due to blunt or ----------- object) |
IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur) 3. Tension--pneumothorax w/ rapid accumulation of air in pleural space causing severely high intrapleural pressures w/ resultant tension on heart and great vessels (life threatening) a. Clinical Manifestations (can occur due to blunt or penetrating object) |
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IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur) 3. Tension--pneumothorax w/ rapid accumulation of air in pleural space causing severely high intrapleural pressures w/ resultant tension on heart and great vessels (life threatening) a. Clinical Manifestations (can occur due to blunt or penetrating object) i. Triad of symptoms--resp ----------, look ------------ (↓BP), no breath sounds |
IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur) 3. Tension--pneumothorax w/ rapid accumulation of air in pleural space causing severely high intrapleural pressures w/ resultant tension on heart and great vessels (life threatening) a. Clinical Manifestations (can occur due to blunt or penetrating object) i. Triad of symptoms--resp distress, look shocky (↓BP), no breath sounds |
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IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur) 3. Tension--pneumothorax w/ rapid accumulation of air in pleural space causing severely high intrapleural pressures w/ resultant tension on heart and great vessels (life threatening) a. Clinical Manifestations (can occur due to blunt or penetrating object) ii. Interferes with ----------- shock ↓BP hypoxic ↓---------, etc. |
IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur) 3. Tension--pneumothorax w/ rapid accumulation of air in pleural space causing severely high intrapleural pressures w/ resultant tension on heart and great vessels (life threatening) a. Clinical Manifestations (can occur due to blunt or penetrating object) ii. Interferes with venous return shock ↓BP hypoxic ↓CO, etc. |
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IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur) 3. Tension--pneumothorax w/ rapid accumulation of air in pleural space causing severely high intrapleural pressures w/ resultant tension on heart and great vessels (life threatening) a. Clinical Manifestations (can occur due to blunt or penetrating object) iii. Complete collapse -------------- shift (tracheal -----------) |
IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur) 3. Tension--pneumothorax w/ rapid accumulation of air in pleural space causing severely high intrapleural pressures w/ resultant tension on heart and great vessels (life threatening) a. Clinical Manifestations (can occur due to blunt or penetrating object) iii. Complete collapse mediastinal shift (tracheal deviation) |
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IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur) 3. Tension--pneumothorax w/ rapid accumulation of air in pleural space causing severely high intrapleural pressures w/ resultant tension on heart and great vessels (life threatening) b. Diagnosis--on clinical grounds (do NOT need ----------) |
IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur) 3. Tension--pneumothorax w/ rapid accumulation of air in pleural space causing severely high intrapleural pressures w/ resultant tension on heart and great vessels (life threatening) b. Diagnosis--on clinical grounds (do NOT need CXR) |
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IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur) 3. Tension--pneumothorax w/ rapid accumulation of air in pleural space causing severely high intrapleural pressures w/ resultant tension on heart and great vessels (life threatening) b. Diagnosis--on clinical grounds (do NOT need CXR) c. Treatment--large gauge needle --------------- (if air comes out pt will need chest tube) |
IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur) 3. Tension--pneumothorax w/ rapid accumulation of air in pleural space causing severely high intrapleural pressures w/ resultant tension on heart and great vessels (life threatening) b. Diagnosis--on clinical grounds (do NOT need CXR) c. Treatment--large gauge needle decompression (if air comes out pt will need chest tube) |
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IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur) 4. __________--blood accumulates in intrapleural space (blood and air-hemopneumothroax) |
IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur) 4. Hemothorax--blood accumulates in intrapleural space (blood and air-hemopneumothroax) |
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IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur) 4. Hemothorax--blood accumulates in intrapleural space (blood and air-hemopneumothroax) a. Causes--massive bleeding from major chest ---------- or ----------- vessel rupture |
IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur) 4. Hemothorax--blood accumulates in intrapleural space (blood and air-hemopneumothroax) a. Causes--massive bleeding from major chest vessel or intercostal vessel rupture |
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IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur) 4. Hemothorax--blood accumulates in intrapleural space (blood and air-hemopneumothroax) a. Causes--massive bleeding from major chest vessel or intercostal vessel rupture i. Can accumulate up to -----------L of blood from blunt or ------------ trauma |
IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur) 4. Hemothorax--blood accumulates in intrapleural space (blood and air-hemopneumothroax) a. Causes--massive bleeding from major chest vessel or intercostal vessel rupture i. Can accumulate up to 1L of blood from blunt or penetrating trauma |
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IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur) 4. Hemothorax--blood accumulates in intrapleural space (blood and air-hemopneumothroax) a. Causes--massive bleeding from major chest vessel or intercostal vessel rupture ii. Pulmonary ------------, -------------- therapy, TB, etc. |
IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur) 4. Hemothorax--blood accumulates in intrapleural space (blood and air-hemopneumothroax) a. Causes--massive bleeding from major chest vessel or intercostal vessel rupture ii. Pulmonary embolus, coagulation therapy, TB, etc. |
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IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur) 4. Hemothorax--blood accumulates in intrapleural space (blood and air-hemopneumothroax). b. Clinical Manifestations--dull ------------, shock (from ↓---------) |
IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur) 4. Hemothorax--blood accumulates in intrapleural space (blood and air-hemopneumothroax). b. Clinical Manifestations--dull percussion, shock (from ↓blood) |
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IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur) 4. Hemothorax--blood accumulates in intrapleural space (blood and air-hemopneumothroax). c. Treatment--CXR, ↑------------, chest tube, ----------------- devices (diverts blood back into pt) |
IV. Traumatic Injuries of the Chest and Thorax
C. Pneumothorax--air/fluid in pleural space (have a tendency to reoccur) 4. Hemothorax--blood accumulates in intrapleural space (blood and air-hemopneumothroax). c. Treatment--CXR, ↑HR, chest tube, autotransfusion devices (diverts blood back into pt) |
|
IV. Traumatic Injuries of the Chest and Thorax
D. Fractured Ribs--blunt/penetrating injuries (most common from trauma) 1 Clinical Manifestations--pain, --------------, bruising, tenderness, some ------------ bleeding, hurts to take --------------- (increased risk for atalectasis), splinting ----------- side |
IV. Traumatic Injuries of the Chest and Thorax
D. Fractured Ribs--blunt/penetrating injuries (most common from trauma) 1 Clinical Manifestations--pain, swelling, bruising, tenderness, some internal bleeding, hurts to take deep breath (increased risk for atalectasis), splinting affected side |
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IV. Traumatic Injuries of the Chest and Thorax
D. Fractured Ribs--blunt/penetrating injuries (most common from trauma) 2. Diagnosis--________ 3. Treatment--↓pain (more apt to take deep breaths) w/ ASA, _________, _______ |
IV. Traumatic Injuries of the Chest and Thorax
D. Fractured Ribs--blunt/penetrating injuries (most common from trauma) 2. Diagnosis--CXR 3. Treatment--↓pain (more apt to take deep breaths) w/ ASA, NSAIDS, narcotics |
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IV. Traumatic Injuries of the Chest and Thorax
D. Fractured Ribs--blunt/penetrating injuries (most common from trauma) 2. Diagnosis--CXR 3. Treatment--↓pain (more apt to take deep breaths) w/ ASA, NSAIDS, narcotics a. -------------- if in resp distress (possible pneumothorax) |
IV. Traumatic Injuries of the Chest and Thorax
D. Fractured Ribs--blunt/penetrating injuries (most common from trauma) 2. Diagnosis--CXR 3. Treatment--↓pain (more apt to take deep breaths) w/ ASA, NSAIDS, narcotics a. Intubation if in resp distress (possible pneumothorax) |
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IV. Traumatic Injuries of the Chest and Thorax
D. Fractured Ribs--blunt/penetrating injuries (most common from trauma) 2. Diagnosis--CXR 3. Treatment--↓pain (more apt to take deep breaths) w/ ASA, NSAIDS, narcotics b. -------------- chest tubes if fractures and intubation |
IV. Traumatic Injuries of the Chest and Thorax
D. Fractured Ribs--blunt/penetrating injuries (most common from trauma) 2. Diagnosis--CXR 3. Treatment--↓pain (more apt to take deep breaths) w/ ASA, NSAIDS, narcotics b. Prophylactic chest tubes if fractures and intubation |
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IV. Traumatic Injuries of the Chest and Thorax
E. Flail Chest--from multiple -------------- fractures causing instability of chest wall |
IV. Traumatic Injuries of the Chest and Thorax
E. Flail Chest--from multiple rib fractures causing instability of chest wall 1. Clinical Manifestations--crepitis, paradoxical chest movement, ↑RR, shallow breaths, ↑HR |
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IV. Traumatic Injuries of the Chest and Thorax
E. Flail Chest--from multiple rib fractures causing instability of chest wall 1. Clinical Manifestations--crepitis, ---------- chest movement, ↑---------, shallow breaths, ↑--------- |
IV. Traumatic Injuries of the Chest and Thorax
E. Flail Chest--from multiple rib fractures causing instability of chest wall 1. Clinical Manifestations--crepitis, paradoxical chest movement, ↑RR, shallow breaths, ↑HR |
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IV. Traumatic Injuries of the Chest and Thorax
E. Flail Chest--from multiple rib fractures causing instability of chest wall 1. Clinical Manifestations--crepitis, paradoxical chest movement, ↑RR, shallow breaths, ↑HR a. Breathe in ------------- pressure sucks chest wall in (opposite when breathing out) |
IV. Traumatic Injuries of the Chest and Thorax
E. Flail Chest--from multiple rib fractures causing instability of chest wall 1. Clinical Manifestations--crepitis, paradoxical chest movement, ↑RR, shallow breaths, ↑HR a. Breathe in negative pressure sucks chest wall in (opposite when breathing out) |
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IV. Traumatic Injuries of the Chest and Thorax
E. Flail Chest--from multiple rib fractures causing instability of chest wall 1. Clinical Manifestations--crepitis, paradoxical chest movement, ↑RR, shallow breaths, ↑HR b. Often have ------------- contusion and/or ------------- |
IV. Traumatic Injuries of the Chest and Thorax
E. Flail Chest--from multiple rib fractures causing instability of chest wall 1. Clinical Manifestations--crepitis, paradoxical chest movement, ↑RR, shallow breaths, ↑HR b. Often have pulmonary contusion and/or pneumothorax |
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IV. Traumatic Injuries of the Chest and Thorax
E. Flail Chest--from multiple rib fractures causing instability of chest wall 2. Diagnosis--fractures on -------- (visual diagnosis) |
IV. Traumatic Injuries of the Chest and Thorax
E. Flail Chest--from multiple rib fractures causing instability of chest wall 2. Diagnosis--fractures on CXR (visual diagnosis) |
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IV. Traumatic Injuries of the Chest and Thorax
E. Flail Chest--from multiple rib fractures causing instability of chest wall 3. Treatment--stabilize-----------, ----------- (put on ventilator for flail chest) |
IV. Traumatic Injuries of the Chest and Thorax
E. Flail Chest--from multiple rib fractures causing instability of chest wall 3. Treatment--stabilize chest wall, oxygenate (put on ventilator for flail chest) |
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V. Pleural Drainage System
A. Purpose--evacuate ----------/air/pus/fluid from ------------- and reestablish ----------- pressure in intrapleural space so lungs can reexpand |
V. Pleural Drainage System
A. Purpose--evacuate blood/air/pus/fluid from thoracic cavity and reestablish negative pressure in intrapleural space so lungs can reexpand |
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V. Pleural Drainage System
B. Chambers 1. Collection chamber--collects ---------- that drains into chest tub through -------ft connecting tube |
V. Pleural Drainage System
B. Chambers 1. Collection chamber--collects fluid that drains into chest tub through 6ft connecting tube |
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V. Pleural Drainage System
B. Chambers 1. Collection chamber--collects fluid that drains into chest tub through 6ft connecting tube a. Holds up to ------------mL |
V. Pleural Drainage System
B. Chambers 1. Collection chamber--collects fluid that drains into chest tub through 6ft connecting tube a. Holds up to 2000mL |
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V. Pleural Drainage System
B. Chambers 2. Water-Seal Chamber--______cm water act as 1-way valve (air drains from______, but not back to pt) |
V. Pleural Drainage System
B. Chambers 2. Water-Seal Chamber--2cm water act as 1-way valve (air drains from chest, but not back to pt) |
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V. Pleural Drainage System
B. Chambers 2. Water-Seal Chamber--2cm water act as 1-way valve (air drains from chest, but not back to pt) a. B---------- b. T---------: fluctuations on inspiration and expiration (when pt is off suction) |
V. Pleural Drainage System
B. Chambers 2. Water-Seal Chamber--2cm water act as 1-way valve (air drains from chest, but not back to pt) a. Bubbling b. Tidaling--fluctuations on inspiration and expiration (when pt is off suction) |
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V. Pleural Drainage System
B. Chambers 2. Water-Seal Chamber--2cm water act as 1-way valve (air drains from chest, but not back to pt) b. Tidaling--fluctuations on inspiration and expiration (when pt is off suction) i. Deep breath in with -------------- breathing water moves up |
V. Pleural Drainage System
B. Chambers 2. Water-Seal Chamber--2cm water act as 1-way valve (air drains from chest, but not back to pt) b. Tidaling--fluctuations on inspiration and expiration (when pt is off suction) i. Deep breath in with normal breathing water moves up |
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V. Pleural Drainage System
B. Chambers 2. Water-Seal Chamber--2cm water act as 1-way valve (air drains from chest, but not back to pt) b. Tidaling--fluctuations on inspiration and expiration (when pt is off suction) ii. Deep breath on -------------- water moves down iii. No ----------: full lung expansion |
V. Pleural Drainage System
B. Chambers 2. Water-Seal Chamber--2cm water act as 1-way valve (air drains from chest, but not back to pt) b. Tidaling--fluctuations on inspiration and expiration (when pt is off suction) ii. Deep breath on vent water moves down iii. No tidaling--full lung expansion |
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V. Pleural Drainage System
B. Chambers 3. ------------- Chamber--applies controlled suction to chest drainage system |
V. Pleural Drainage System
B. Chambers 3. Suction Control Chamber--applies controlled suction to chest drainage system |
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V. Pleural Drainage System
B. Chambers 3. Suction Control Chamber--applies controlled suction to chest drainage system a. To regulate suction, connect ------------- line tubing to wall suction and set at ordered level |
V. Pleural Drainage System
B. Chambers 3. Suction Control Chamber--applies controlled suction to chest drainage system a. To regulate suction, connect vacuum line tubing to wall suction and set at ordered level |
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V. Pleural Drainage System
B. Chambers 3. Suction Control Chamber--applies controlled suction to chest drainage system b. Suction order must be written by ---------- (usually ----------sonometers in suction chamber) |
V. Pleural Drainage System
B. Chambers 3. Suction Control Chamber--applies controlled suction to chest drainage system b. Suction order must be written by physician (usually 20sonometers in suction chamber) |
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V. Pleural Drainage System
C. Nursing Management 1. Keep tubing coiled loosely below ------------ level and do not let pt lie on it 2. Check ------------ and tape them |
V. Pleural Drainage System
C. Nursing Management 1. Keep tubing coiled loosely below chest level and do not let pt lie on it 2. Check connections and tape them |
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V. Pleural Drainage System
C. Nursing Management 3. Mark -------------- levels--time depends on drainage (check q5-_______min post-surgery) |
V. Pleural Drainage System
C. Nursing Management 3. Mark drainage levels--time depends on drainage (check q5-10min post-surgery) |
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V. Pleural Drainage System
C. Nursing Management 4. Assess ---------- level in water seal chamber q-------h (suction regulated by water amount in chamber) |
V. Pleural Drainage System
C. Nursing Management 4. Assess water level in water seal chamber q8h (suction regulated by water amount in chamber) |
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V. Pleural Drainage System
C. Nursing Management 5. Observe for ----------- bubbling in water seal chamber and ------------- (tidaling) |
V. Pleural Drainage System
C. Nursing Management 5. Observe for air bubbling in water seal chamber and fluctuations (tidaling) 6. Never elevate drainage system to level of pts chest |
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V. Pleural Drainage System
C. Nursing Management 6. Never ------------ drainage system to level of pts chest 7. Never ---------- tubes--except for changing drainage system |
V. Pleural Drainage System
C. Nursing Management 6. Never elevate drainage system to level of pts chest 7. Never clamp tubes--except for changing drainage system |
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V. Pleural Drainage System
C. Nursing Management 8. If continuous ---------- in water seal chamber, assess for air leak (assess appropriateness) a. Use ------------ to find leak’s location |
V. Pleural Drainage System
C. Nursing Management 8. If continuous bubbling in water seal chamber, assess for air leak (assess appropriateness) a. Use clamp to find leak’s location |
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V. Pleural Drainage System
C. Nursing Management 9. Daily ---------- to determine if totally reinflated (before taking out try ----------- suction and assess) |
V. Pleural Drainage System
C. Nursing Management 9. Daily CXR to determine if totally reinflated (before taking out try gravity suction and assess) |
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V. Pleural Drainage System
C. Nursing Management 10. Premedicate w/ chest tube ----------- (morphine)--take deep breath in and ------------, pull |
V. Pleural Drainage System
C. Nursing Management 10. Premedicate w/ chest tube removal (morphine)--take deep breath in and blow out pull |
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VI. Acute Respiratory Failure
A. Clinical Manifestations 1. Change in ------------ status (early sign) 2. Dyspnea,-----------, mild --------- |
VI. Acute Respiratory Failure
A. Clinical Manifestations 1. Change in mental status (early sign) 2. Dyspnea, tachypnea, mild HTN |
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VI. Acute Respiratory Failure
A. Clinical Manifestations 2. Dyspnea, tachypnea, mild HTN a. ----------- breathing slowed w/ no -------------, unable to ----------- (bad) intubate |
VI. Acute Respiratory Failure
A. Clinical Manifestations 2. Dyspnea, tachypnea, mild HTN a. Fast breathing slowed w/ no intervention unable to compensate (bad) intubate |
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VI. Acute Respiratory Failure
A. Clinical Manifestations 3. Skin cool, clammy, and ---------- 4. ---------: if PaO2 <45 (late sign) |
VI. Acute Respiratory Failure
A. Clinical Manifestations 3. Skin cool, clammy, and diaphoretic 4. Cyanosis--if PaO2 <45 (late sign) |
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VI. Acute Respiratory Failure
A. Clinical Manifestations 4. Cyanosis--if PaO2 <---------- (late sign) |
VI. Acute Respiratory Failure
A. Clinical Manifestations 4. Cyanosis--if PaO2 <45 (late sign) |
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VI. Acute Respiratory Failure
A. Clinical Manifestations 5. Assess pt for comfort position breathing (ab breathing, ---------- lip, --------- muscles, high --------) |
VI. Acute Respiratory Failure
A. Clinical Manifestations 5. Assess pt for comfort position breathing (ab breathing, pursed lip, IC muscles, high fowlers) |
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VI. Acute Respiratory Failure
A. Clinical Manifestations 6. --------- breath sounds and ------------- upon percussion |
VI. Acute Respiratory Failure
A. Clinical Manifestations 6. Adventitious breath sounds and hyperresonance upon percussion |
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VI. Acute Respiratory Failure
A. Clinical Manifestations 7. Prolonged expiration (I:E ratio)--1:-------, 1:--------- |
VI. Acute Respiratory Failure
A. Clinical Manifestations 7. Prolonged expiration (I:E ratio)--1:3, 1:4 |
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VI. Acute Respiratory Failure
B. Diagnosis 1. ------------- assessment 2. Lab values--ABGs (checks both --------- and -----------) |
VI. Acute Respiratory Failure
B. Diagnosis 1. Physical assessment 2. Lab values--ABGs (checks both oxygenation and ventilation) |
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VI. Acute Respiratory Failure
B. Diagnosis 3. -------: diagnosis and see changes 4. Mixed venous blood gases--amount of -------- delivered to tissues |
VI. Acute Respiratory Failure
B. Diagnosis 3. CXR--diagnosis and see changes 4. Mixed venous blood gases--amount of O2 delivered to tissues |
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VI. Acute Respiratory Failure
B. Diagnosis 4. Mixed venous blood gases--amount of O2 delivered to tissues a. ----------- (venous 38-42) and ---------- (venous 60-80%) from pulmonary artery catheter |
VI. Acute Respiratory Failure
B. Diagnosis 4. Mixed venous blood gases--amount of O2 delivered to tissues a. PVO2 (venous 38-42) and SVO2 (venous 60-80%) from pulmonary artery catheter |
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VI. Acute Respiratory Failure
B. Diagnosis 4. Mixed venous blood gases--amount of O2 delivered to tissues a. PVO2 (venous _____-42) and SVO2 (venous ____-80%) from pulmonary artery catheter |
VI. Acute Respiratory Failure
B. Diagnosis 4. Mixed venous blood gases--amount of O2 delivered to tissues a. PVO2 (venous 38-42) and SVO2 (venous 60-80%) from pulmonary artery catheter |
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VI. Acute Respiratory Failure
B. Diagnosis 4. Mixed venous blood gases--amount of O2 delivered to tissues b. ------------ measure tissue consumption |
VI. Acute Respiratory Failure
B. Diagnosis 4. Mixed venous blood gases--amount of O2 delivered to tissues b. SWANs measure tissue consumption |
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VI. Acute Respiratory Failure
B. Diagnosis 5. Pulse oximetry (---------2)--if poor (<---------%) get ABG **want >---------% |
VI. Acute Respiratory Failure
B. Diagnosis 5. Pulse oximetry (SpO2)--if poor (<95%) get ABG **want >90% |
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VI. Acute Respiratory Failure
B. Diagnosis 6. V/Q lung scan--acute ------------- embolus |
VI. Acute Respiratory Failure
B. Diagnosis 6. V/Q lung scan--acute pulmonary embolus |
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VI. Acute Respiratory Failure
B. Diagnosis 7. Pulmonary ---------: rule out pulmonary embolism |
VI. Acute Respiratory Failure
B. Diagnosis 7. Pulmonary angiography--rule out pulmonary embolism |
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VI. Acute Respiratory Failure
B. Diagnosis 8. Possible insertion of ---------- to monitor 9. ---------- status ↑ or ↓ |
VI. Acute Respiratory Failure
B. Diagnosis 8. Possible insertion of PA catheter to monitor 9. Fluid status ↑ or ↓ |
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VI. Acute Respiratory Failure
C. Categories **------------- and -----------: physiologic mechanism for hypoxemia (1-4) |
VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4) |
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VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4) 1. Hypoxemic Respiratory Failure--alteration in ---------- transport between alveoli and-------------- capillary bed (gas exchange) resulting in ----------2 <60mmHg w/ FiO2 >60% due to problems with lungs (ex. pneumonia, pulmonary edema, pulmonary emboli, CHF, shock) |
VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4) 1. Hypoxemic Respiratory Failure--alteration in O2 transport between alveoli and pulmonary capillary bed (gas exchange) resulting in PaO2 <60mmHg w/ FiO2 >60% due to problems with lungs (ex. pneumonia, pulmonary edema, pulmonary emboli, CHF, shock) |
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VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4) 1. Hypoxemic Respiratory Failure--alteration in O2 transport between alveoli and pulmonary capillary bed (gas exchange) resulting in PaO2 <-----------mmHg w/ --------------2 >60% due to problems with lungs (ex. pneumonia, pulmonary edema, pulmonary emboli, CHF, shock) |
VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4) 1. Hypoxemic Respiratory Failure--alteration in O2 transport between alveoli and pulmonary capillary bed (gas exchange) resulting in PaO2 <60mmHg w/ FiO2 >60% due to problems with lungs (ex. pneumonia, pulmonary edema, pulmonary emboli, CHF, shock) |
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VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4) 1. Hypoxemic Respiratory Failure--alteration in O2 transport between alveoli and pulmonary capillary bed (gas exchange) resulting in PaO2 <60mmHg w/ FiO2 >60% due to problems with lungs (ex. ------------, pulmonary -----------, pulmonary ------------, CHF, ---------) |
VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4) 1. Hypoxemic Respiratory Failure--alteration in O2 transport between alveoli and pulmonary capillary bed (gas exchange) resulting in PaO2 <60mmHg w/ FiO2 >60% due to problems with lungs (ex. pneumonia, pulmonary edema, pulmonary emboli, CHF, shock) |
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VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4) 1. Hypoxemic Respiratory Failure a. -------------- Mismatch--alteration in ratio of ventilation to perfusion (should have 4-5L/min blood to alveoli and 4/5L of gas into lungs 1:1) |
VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4) 1. Hypoxemic Respiratory Failure a. Ventilation-Perfusion Mismatch--alteration in ratio of ventilation to perfusion (should have 4-5L/min blood to alveoli and 4/5L of gas into lungs 1:1) |
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VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4) 1. Hypoxemic Respiratory Failure a. Ventilation-Perfusion Mismatch--alteration in ratio of ventilation to perfusion (should have 4-________L/min blood to alveoli and 4/_______L of gas into lungs 1:____) |
VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4) 1. Hypoxemic Respiratory Failure a. Ventilation-Perfusion Mismatch--alteration in ratio of ventilation to perfusion (should have 4-5L/min blood to alveoli and 4/5L of gas into lungs 1:1) |
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VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4) 1. Hypoxemic Respiratory Failure a. Ventilation-Perfusion Mismatch--alteration in ratio of ventilation to perfusion (should have 4-5L/min blood to alveoli and 4/5L of gas into lungs 1:1) i. ↑secretions in --------------- (COPD, --------------, asthma)-↓ventilation w/ same blood |
VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4) 1. Hypoxemic Respiratory Failure a. Ventilation-Perfusion Mismatch--alteration in ratio of ventilation to perfusion (should have 4-5L/min blood to alveoli and 4/5L of gas into lungs 1:1) i. ↑secretions in airway (COPD, pneumonia, asthma)-↓ventilation w/ same blood |
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VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4) 1. Hypoxemic Respiratory Failure a. Ventilation-Perfusion Mismatch--alteration in ratio of ventilation to perfusion (should have 4-5L/min blood to alveoli and 4/5L of gas into lungs 1:1) ii. Conditions resulting in ---------------- collapse (---------: not taking in enough air) |
VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4) 1. Hypoxemic Respiratory Failure a. Ventilation-Perfusion Mismatch--alteration in ratio of ventilation to perfusion (should have 4-5L/min blood to alveoli and 4/5L of gas into lungs 1:1) ii. Conditions resulting in alveolar collapse (atelectasis--not taking in enough air) |
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VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4) 1. Hypoxemic Respiratory Failure a. Ventilation-Perfusion Mismatch--alteration in ratio of ventilation to perfusion (should have 4-5L/min blood to alveoli and 4/5L of gas into lungs 1:1) iii. ↓-------------- flow (pulmonary ----------: blood can’t get to area ↓perfusion) |
VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4) 1. Hypoxemic Respiratory Failure a. Ventilation-Perfusion Mismatch--alteration in ratio of ventilation to perfusion (should have 4-5L/min blood to alveoli and 4/5L of gas into lungs 1:1) iii. ↓blood flow (pulmonary embolism--blood can’t get to area ↓perfusion) |
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VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4) 1. Hypoxemic Respiratory Failure b. _________-blood exits heart w/o gas exchange (severe hypoxia extreme VQ mismatch) |
VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4) 1. Hypoxemic Respiratory Failure b. Shunt-blood exits heart w/o gas exchange (severe hypoxia extreme VQ mismatch) |
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VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4) 1. Hypoxemic Respiratory Failure b. Shunt-blood exits heart w/o gas exchange (severe hypoxia extreme --------- mismatch) |
VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4) 1. Hypoxemic Respiratory Failure b. Shunt-blood exits heart w/o gas exchange (severe hypoxia extreme VQ mismatch) |
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VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4) 1. Hypoxemic Respiratory Failure b. Shunt-blood exits heart w/o gas exchange (severe hypoxia extreme VQ mismatch) i. ----------: bypasses lungs through ventricular septal defect (↓oxygenation) |
VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4) 1. Hypoxemic Respiratory Failure b. Shunt-blood exits heart w/o gas exchange (severe hypoxia extreme VQ mismatch) i. Anatomic--bypasses lungs through ventricular septal defect (↓oxygenation) |
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VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4) 1. Hypoxemic Respiratory Failure b. Shunt-blood exits heart w/o gas exchange (severe hypoxia extreme VQ mismatch) ii. --------------: flow through pulmonary capillaries w/out gas exchange |
VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4) 1. Hypoxemic Respiratory Failure b. Shunt-blood exits heart w/o gas exchange (severe hypoxia extreme VQ mismatch) i. Anatomic--bypasses lungs through ventricular septal defect (↓oxygenation) |
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VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4) 1. Hypoxemic Respiratory Failure b. Shunt-blood exits heart w/o gas exchange (severe hypoxia extreme VQ mismatch) i. Anatomic--bypasses lungs through ventricular septal defect (↓oxygenation) • ARDS, ------------, pulmonary ----------- |
VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4) 1. Hypoxemic Respiratory Failure b. Shunt-blood exits heart w/o gas exchange (severe hypoxia extreme VQ mismatch) i. Anatomic--bypasses lungs through ventricular septal defect (↓oxygenation) • ARDS, pneumonia, pulmonary edema |
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VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4) 1. Hypoxemic Respiratory Failure c. ---------------: gas exchange across alveolar-capillary membrane is compromised by process that thickens/destroys membranes (not permeable) |
VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4) 1. Hypoxemic Respiratory Failure c. Diffusion Impairment--gas exchange across alveolar-capillary membrane is compromised by process that thickens/destroys membranes (not permeable) |
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VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4) 1. Hypoxemic Respiratory Failure c. Diffusion Impairment-- i. Takes longer for ---------- to exchange ii. Pts are ok when at rest, but have no --------- tolerance |
VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4) 1. Hypoxemic Respiratory Failure c. Diffusion Impairment-- i. Takes longer for gas to exchange ii. Pts are ok when at rest, but have no exercise tolerance |
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VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4) 1. Hypoxemic Respiratory Failure c. Diffusion Impairment-- iii. _________--thickening of membrane with fibrosis and scarring (main problem) |
VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4) 1. Hypoxemic Respiratory Failure c. Diffusion Impairment-- iii. ARDS--thickening of membrane with fibrosis and scarring (main problem) |
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VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4) 1. Hypoxemic Respiratory Failure d. ----------------: generalized ↓ ventilation resulting in ↑PaCO2 and ↓PaO2 (not enough air into lungs) |
VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4) 1. Hypoxemic Respiratory Failure d. Alveolar Hypoventilation--generalized ↓ ventilation resulting in ↑PaCO2 and ↓PaO2 (not enough air into lungs) |
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VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4) 1. Hypoxemic Respiratory Failure d. Alveolar Hypoventilation--generalized ↓ ventilation resulting in ↑-----------2 and ↓-----------2 (not enough air into lungs) |
VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4) 1. Hypoxemic Respiratory Failure d. Alveolar Hypoventilation--generalized ↓ ventilation resulting in ↑PaCO2 and ↓PaO2 (not enough air into lungs) |
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VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4) 1. Hypoxemic Respiratory Failure d. Alveolar Hypoventilation--generalized ↓ ventilation resulting in ↑PaCO2 and ↓PaO2 (not enough air into lungs) i. Can cause --------- |
VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4) 1. Hypoxemic Respiratory Failure d. Alveolar Hypoventilation--generalized ↓ ventilation resulting in ↑PaCO2 and ↓PaO2 (not enough air into lungs) i. Can cause hypoxia |
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VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4) 1. Hypoxemic Respiratory Failure d. Alveolar Hypoventilation--generalized ↓ ventilation resulting in ↑PaCO2 and ↓PaO2 (not enough air into lungs) ii. Restrictive ------------ disease (asthma), chest wall ------------, neuromuscular disease (------------ brae) |
VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4) 1. Hypoxemic Respiratory Failure d. Alveolar Hypoventilation--generalized ↓ ventilation resulting in ↑PaCO2 and ↓PaO2 (not enough air into lungs) ii. Restrictive lung disease (asthma), chest wall dysfunction, neuromuscular disease (Gyron brae) |
|
VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4) 2. ---------------: CO2 transport alteration from ventilatory factor (good lungs, but air can’t get in/out hypercapnia main problem, but will have hypoxia too) |
VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4) 2. Hypercapnic Respiratory Failure--CO2 transport alteration from ventilatory factor (good lungs, but air can’t get in/out hypercapnia main problem, but will have hypoxia too) |
|
VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4) 2. Hypercapnic Respiratory Failure--CO2 transport alteration from ventilatory factor (good lungs, but air can’t get in/out, ---------- main problem, but will have ---------- too) |
VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4) 2. Hypercapnic Respiratory Failure--CO2 transport alteration from ventilatory factor (good lungs, but air can’t get in/out hypercapnia main problem, but will have hypoxia too) |
|
VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4) 2. Hypercapnic Respiratory Failure-- a. Abnormalities of the---------- and --------: CF, asthma, emphazema |
VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4) 2. Hypercapnic Respiratory Failure-- a. Abnormalities of the airways and alveoli--CF, asthma, emphazema |
|
VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4) 2. Hypercapnic Respiratory Failure-- b. Abnormalities of the ------: narcotic overdose, brain stem infarct |
VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4) 2. Hypercapnic Respiratory Failure-- b. Abnormalities of the CNS--narcotic overdose, brain stem infarct |
|
VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4) 2. Hypercapnic Respiratory Failure-- c. Abnormalities of the ---------: flail chest, morbidly obese, rib fractures |
VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4) 2. Hypercapnic Respiratory Failure-- c. Abnormalities of the chest wall--flail chest, morbidly obese, rib fractures |
|
VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4) 2. Hypercapnic Respiratory Failure-- d. Neuromuscular Conditions--MS, -------------, ----------- |
VI. Acute Respiratory Failure
C. Categories **etiology and pathophysiology--physiologic mechanism for hypoxemia (1-4) 2. Hypercapnic Respiratory Failure-- d. Neuromuscular Conditions--MS, muscular dystrophy, dyron-brae |
|
VI. Acute Respiratory Failure
D. Tissue ------------ Needs--major threat of underlying resp. failure (------------ or -----------) is inability to meet oxygen demands of tissues |
VI. Acute Respiratory Failure
D. Tissue Oxygen Needs--major threat of underlying resp. failure (hypoxic or hypercapnia) is inability to meet oxygen demands of tissues |
|
VI. Acute Respiratory Failure
D. Tissue Oxygen Needs- 1. Inadequate tissue ------------ delivery--valvular disease, -------------, CHF (pump problem) |
VI. Acute Respiratory Failure
D. Tissue Oxygen Needs- 1. Inadequate tissue O2 delivery--valvular disease, anemia, CHF (pump problem) |
|
VI. Acute Respiratory Failure
D. Tissue Oxygen Needs- 2. Inadequate usage, ---------- shock (tissues don’t know what to do w/ it or not using appropriately) |
VI. Acute Respiratory Failure
D. Tissue Oxygen Needs- 2. Inadequate usage-septic shock (tissues don’t know what to do w/ it or not using appropriately) |
|
VI. Acute Respiratory Failure
E. Arterial Blood Gases (ABGs) 1. Normal a. pH: 7.35-_______ b. PaO2: 80-_______mmHg |
VI. Acute Respiratory Failure
E. Arterial Blood Gases (ABGs) 1. Normal a. pH: 7.35-7.45 b. PaO2: 80-100mmHg |
|
VI. Acute Respiratory Failure
E. Arterial Blood Gases (ABGs) 1. Normal c. PaCO2: 35-______mmHg d. SaO2: 95-______% |
VI. Acute Respiratory Failure
E. Arterial Blood Gases (ABGs) 1. Normal c. PaCO2: 35-45mmHg d. SaO2: 95-100% |
|
VI. Acute Respiratory Failure
E. Arterial Blood Gases (ABGs) 1. Normal e. HCO3: 22-_______mEq/L f. Base Excess/Deficit: +/______ |
VI. Acute Respiratory Failure
E. Arterial Blood Gases (ABGs) 1. Normal e. HCO3: 22-26mEq/L f. Base Excess/Deficit: +/-2 |
|
VI. Acute Respiratory Failure
E. Arterial Blood Gases (ABGs) 1. Normal f. Base Excess/Deficit: +/-2 i. Amount of buffering ---------- in blood (from all buffer systems: --------- greatest) |
VI. Acute Respiratory Failure
E. Arterial Blood Gases (ABGs) 1. Normal f. Base Excess/Deficit: +/-2 i. Amount of buffering anions in blood (from all buffer systems-bicarb greatest) |
|
VI. Acute Respiratory Failure
E. Arterial Blood Gases (ABGs) 1. Normal f. Base Excess/Deficit: +/-2 ii. Describes amount of --------- needed to bring blood back to normal pH iii. Excess--metabolic ------------ or compensation |
VI. Acute Respiratory Failure
E. Arterial Blood Gases (ABGs) 1. Normal f. Base Excess/Deficit: +/-2 ii. Describes amount of acid/base needed to bring blood back to normal pH iii. Excess--metabolic alkalosis or compensation |
|
VI. Acute Respiratory Failure
E. Arterial Blood Gases (ABGs) 2. Analysis a. What is primary disturbance--acidosis/-----------? b. What is primary cause--respiratory/----------? |
VI. Acute Respiratory Failure
E. Arterial Blood Gases (ABGs) 2. Analysis a. What is primary disturbance--acidosis/alkalosis? b. What is primary cause--respiratory/metabolic? |
|
VI. Acute Respiratory Failure
E. Arterial Blood Gases (ABGs) 2. Analysis c. Is there -------------? |
VI. Acute Respiratory Failure
E. Arterial Blood Gases (ABGs) 2. Analysis c. Is there compensation? |
|
VI. Acute Respiratory Failure
F. Respiratory Therapy 1. Oxygen therapy--goal PaO2 >--------- and SaO2 >---------- |
VI. Acute Respiratory Failure
F. Respiratory Therapy 1. Oxygen therapy--goal PaO2 >60 and SaO2 >90 |
|
VI. Acute Respiratory Failure
F. Respiratory Therapy 1. Oxygen therapy a. Risk of oxygen ------------ (strive for oxygenation w/ minimum ---------2) |
VI. Acute Respiratory Failure
F. Respiratory Therapy 1. Oxygen therapy a. Risk of oxygen toxicity (strive for oxygenation w/ minimum FiO2) |
|
VI. Acute Respiratory Failure
F. Respiratory Therapy 1. Oxygen therapy b. ---------- mismatch may respond well to ↑O2 (2-4L via nasal cannula) |
VI. Acute Respiratory Failure
F. Respiratory Therapy 1. Oxygen therapy b. VQ mismatch may respond well to ↑O2 (2-4L via nasal cannula) |
|
VI. Acute Respiratory Failure
F. Respiratory Therapy 1. Oxygen therapy b. VQ mismatch may respond well to ↑O2 (2-_______L via nasal cannula) |
VI. Acute Respiratory Failure
F. Respiratory Therapy 1. Oxygen therapy b. VQ mismatch may respond well to ↑O2 (2-4L via nasal cannula) |
|
VI. Acute Respiratory Failure
F. Respiratory Therapy 1. Oxygen therapy c. Shunt will likely need--------- or ----------- |
VI. Acute Respiratory Failure
F. Respiratory Therapy 1. Oxygen therapy c. Shunt will likely need facemask or intubation |
|
VI. Acute Respiratory Failure
F. Respiratory Therapy 2. Mobilization of secretions a. Coughing and positioning--good lung ----------, postural ----------- |
VI. Acute Respiratory Failure
F. Respiratory Therapy 2. Mobilization of secretions a. Coughing and positioning--good lung down, postural drainage b. Hydration and humidification--fluids help thin secretions out |
|
VI. Acute Respiratory Failure
F. Respiratory Therapy 2. Mobilization of secretions b. ------------ and ------------: fluids help thin secretions out |
VI. Acute Respiratory Failure
F. Respiratory Therapy 2. Mobilization of secretions b. Hydration and humidification--fluids help thin secretions out |
|
VI. Acute Respiratory Failure
F. Respiratory Therapy 2. Mobilization of secretions c. Chest ---------- therapy d. Airway ----------- |
VI. Acute Respiratory Failure
F. Respiratory Therapy 2. Mobilization of secretions c. Chest physical therapy d. Airway suctioning |
|
VI. Acute Respiratory Failure
F. Respiratory Therapy 3. -------------- ventilation |
VI. Acute Respiratory Failure
F. Respiratory Therapy 3. Positive pressure ventilation |
|
VI. Acute Respiratory Failure
G. Pharmacologic Therapy--Goals 1. Relief of bronchospasm: ------------ or -------- (severe) |
VI. Acute Respiratory Failure
G. Pharmacologic Therapy--Goals 1. Relief of bronchospasm--Albuterol or Anophelin (severe) |
|
VI. Acute Respiratory Failure
G. Pharmacologic Therapy--Goals 2. Airway inflammation reduction (-----------, asthma)--: ------------ (quick acting, IV if acute) |
VI. Acute Respiratory Failure
G. Pharmacologic Therapy--Goals 2. Airway inflammation reduction (COPD, asthma)--Corticosteroids (quick acting, IV if acute) |
|
VI. Acute Respiratory Failure
G. Pharmacologic Therapy--Goals 3. Reduction of pulmonary congestions--: ----------- (Lasix), ------------ (↑contractility for A-fib) |
VI. Acute Respiratory Failure
G. Pharmacologic Therapy--Goals 3. Reduction of pulmonary congestions--diuretics (Lasix), Digoxin (↑contractility for A-fib) |
|
VI. Acute Respiratory Failure
G. Pharmacologic Therapy--Goals 4. Treatment of pulmonary infection--IV -----------, frequent ----------- samples |
VI. Acute Respiratory Failure
G. Pharmacologic Therapy--Goals 4. Treatment of pulmonary infection--IV antibiotics, frequent sputum samples |
|
VI. Acute Respiratory Failure
G. Pharmacologic Therapy--Goals 5. Reduction of severe anxiety--↑--------- and ---------2 consumption (Propofol, Atavan, ----------) |
VI. Acute Respiratory Failure
G. Pharmacologic Therapy--Goals 5. Reduction of severe anxiety--↑RR and O2 consumption (Propofol, Atavan, Versed) |
|
VI. Acute Respiratory Failure
H. Supportive Care Interventions 1. Treat ----------- cause (need ---------- at cellular level)--primary goal |
VI. Acute Respiratory Failure
H. Supportive Care Interventions 1. Treat underlying cause (need O2 at cellular level)--primary goal |
|
VI. Acute Respiratory Failure
H. Supportive Care Interventions 2. Maintain adequate cardiac output--BP indicates cardiac function (check MAP >---------- and ---------2) |
VI. Acute Respiratory Failure
H. Supportive Care Interventions 2. Maintain adequate cardiac output--BP indicates cardiac function (check MAP >60 and SVO2) |
|
VI. Acute Respiratory Failure
H. Supportive Care Interventions 3. Maintain adequate----------- concentration (ex. if anemic give blood) |
VI. Acute Respiratory Failure
H. Supportive Care Interventions 3. Maintain adequate hemoglobin concentration (ex. if anemic give blood) |
|
VI. Acute Respiratory Failure
H. Supportive Care Interventions 4. Nutritional Therapy--avoid ↑------------ (metabolizes into CO2); --------------- (↑protein ↓CHO) |
VI. Acute Respiratory Failure
H. Supportive Care Interventions 4. Nutritional Therapy--avoid ↑CHO (metabolizes into CO2); pulmonary diet (↑protein ↓CHO) |
|
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--sudden and progressive form of ------------ where alveolar capillary membrane becomes ----------- and more permeable to ------------- fluid |
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)--sudden and progressive form of ARF where alveolar capillary membrane becomes damaged and more permeable to intravascular fluid |
|
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 1. ARF can become---------- (----------% mortality) |
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 1. ARF can become ARDs (40% mortality) |
|
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 2. Etiology--predisposing factors stimulate inflammatory/immune response (cause unknown) a. Aspiration of -------- contents b. Viral/bacterial --------- |
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 2. Etiology--predisposing factors stimulate inflammatory/immune response (cause unknown) a. Aspiration of gastric contents b. Viral/bacterial pneumonia |
|
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 2. Etiology--predisposing factors stimulate inflammatory/immune response (cause unknown) c.------------ (esp. gram (-) infection)--most common cause w/ greatest mortality (70-90%) |
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 2. Etiology--predisposing factors stimulate inflammatory/immune response (cause unknown) c. Sepsis (esp. gram (-) infection)--most common cause w/ greatest mortality (70-90%) |
|
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 2. Etiology--predisposing factors stimulate inflammatory/immune response (cause unknown) c. Sepsis (esp. gram (-) infection)--most common cause w/ greatest mortality (70-_____%) |
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 2. Etiology--predisposing factors stimulate inflammatory/immune response (cause unknown) c. Sepsis (esp. gram (-) infection)--most common cause w/ greatest mortality (70-90%) |
|
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 2. Etiology--predisposing factors stimulate inflammatory/immune response (cause unknown) d. Severe massive ---------- e. Multiple ---------- transfusions f. ----------------- bypass |
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 2. Etiology--predisposing factors stimulate inflammatory/immune response (cause unknown) d. Severe massive trauma e. Multiple blood transfusions f. Cardiopulmonary bypass |
|
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 2. Etiology--predisposing factors stimulate inflammatory/immune response (cause unknown) g. Consequence of multiple ------------- dysfunction syndrome (MODS) |
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 2. Etiology--predisposing factors stimulate inflammatory/immune response (cause unknown) g. Consequence of multiple organ dysfunction syndrome (MODS) |
|
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 3. Pathophysiology a. Injury (Exudative Phase)--1-_______days after insult/injury (usually within ______hrs) |
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 3. Pathophysiology a. Injury (Exudative Phase)--1-7days after insult/injury (usually within 24hrs) |
|
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 3. Pathophysiology a. Injury (Exudative Phase)- i. Injury inflammatory mediators ↑ cap ------------, interstitial edema, ----------- edema, ---------------- shunting (fluid filled alveoli exchange gas) V/Q mismatch ↓gas exchange refractory hypoxemia |
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 3. Pathophysiology a. Injury (Exudative Phase)- i. Injury inflammatory mediators ↑ cap permeability interstitial edema alveolar edema intrapulmonary shunting (fluid filled alveoli exchange gas) V/Q mismatch ↓gas exchange refractory hypoxemia |
|
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 3. Pathophysiology a. Injury (Exudative Phase)- i. Injury inflammatory mediators ↑ cap permeability interstitial edema alveolar edema intrapulmonary shunting (fluid filled alveoli exchange gas) ------------- mismatch, ↓----------- exchange, refractory ------------ |
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 3. Pathophysiology a. Injury (Exudative Phase)- i. Injury inflammatory mediators ↑ cap permeability interstitial edema alveolar edema intrapulmonary shunting (fluid filled alveoli exchange gas) V/Q mismatch ↓gas exchange refractory hypoxemia |
|
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 3. Pathophysiology a. Injury (Exudative Phase)- ii. ------------- 1 2 (produce surfactant) cell damage, ↓------------, ↓----------- compliance and recall widespread atelectasis ↓lung compliance |
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 3. Pathophysiology a. Injury (Exudative Phase)- ii. Alveolar 1 2 (produce surfactant) cell damage ↓surfactant ↓alveolar compliance and recall widespread atelectasis ↓lung compliance |
|
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 3. Pathophysiology a. Injury (Exudative Phase)- ii. Alveolar 1 2 (produce surfactant) cell damage ↓surfactant ↓alveolar compliance and recall, widespread -------------, ↓lung ------------ |
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 3. Pathophysiology a. Injury (Exudative Phase)- ii. Alveolar 1 2 (produce surfactant) cell damage ↓surfactant ↓alveolar compliance and recall widespread atelectasis ↓lung compliance |
|
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 3. Pathophysiology a. Injury (Exudative Phase)- iii. ----------- membrane lines alveoli fibrosis, ↓--------- exchange ↓ --------------- (stiff lung-need high pressure to get air into) |
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 3. Pathophysiology a. Injury (Exudative Phase)- iii. Hyaline membrane lines alveoli fibrosis ↓gas exchange ↓ compliance (stiff lung-need high pressure to get air into) |
|
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 3. Pathophysiology b. ---------------(Proliferative Phase)--1-2weeks after initial injury |
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 3. Pathophysiology b. Reparative (Proliferative Phase)--1-2weeks after initial injury |
|
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 3. Pathophysiology b. Reparative (Proliferative Phase)--1-2weeks after initial injury i. Inflammatory response dense, ---------- tissue ↑pulmonary ------------ resistance, pulmonary ------------, ↓lung compliance hypoxia |
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 3. Pathophysiology b. Reparative (Proliferative Phase)--1-2weeks after initial injury i. Inflammatory response dense, fibrous tissue ↑pulmonary vascular resistance, pulmonary HTN, ↓lung compliance hypoxia |
|
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 3. Pathophysiology b. Reparative (Proliferative Phase)--1-2weeks after initial injury ii. If phase ends ------------ resolve iii. If phase persists widespread ----------- |
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 3. Pathophysiology b. Reparative (Proliferative Phase)--1-2weeks after initial injury ii. If phase ends lesions resolve iii. If phase persists widespread fibrosis |
|
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 3. Pathophysiology c. ----------- (Chronic/Late Phase)--2-3 weeks after initial injury (irreversible changes) |
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 3. Pathophysiology c. Fibrotic (Chronic/Late Phase)--2-3 weeks after initial injury (irreversible changes) |
|
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 3. Pathophysiology c. Fibrotic (Chronic/Late Phase)--2-3 weeks after initial injury (irreversible changes) i. Lung remodeled by sparsely ------------ and ------------ tissues (diffuse scarring and fibrosis) ↓lung compliance (stiff lung) and ↓ gas exchange surface area hypoxia and pulmonary HTN |
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 3. Pathophysiology c. Fibrotic (Chronic/Late Phase)--2-3 weeks after initial injury (irreversible changes) i. Lung remodeled by sparsely collagenous and fibrous tissues (diffuse scarring and fibrosis) ↓lung compliance (stiff lung) and ↓ gas exchange surface area hypoxia and pulmonary HTN |
|
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 3. Pathophysiology c. Fibrotic (Chronic/Late Phase)--2-3 weeks after initial injury (irreversible changes) i. Lung remodeled by sparsely collagenous and fibrous tissues (diffuse scarring and fibrosis) ↓---------- (stiff lung) and ↓ --------- exchange surface area hypoxia and pulmonary --------- |
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 3. Pathophysiology c. Fibrotic (Chronic/Late Phase)--2-3 weeks after initial injury (irreversible changes) i. Lung remodeled by sparsely collagenous and fibrous tissues (diffuse scarring and fibrosis) ↓lung compliance (stiff lung) and ↓ gas exchange surface area hypoxia and pulmonary HTN |
|
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 3. Pathophysiology c. Fibrotic (Chronic/Late Phase)--2-3 weeks after initial injury (irreversible changes) ii. Survival rate poor and will need long term------------- ventilation |
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 3. Pathophysiology c. Fibrotic (Chronic/Late Phase)--2-3 weeks after initial injury (irreversible changes) ii. Survival rate poor and will need long term mechanical ventilation |
|
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 4. Clinical Manifestations a. ↑---------- (work of breathing), tachypnea b. T----------- |
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 4. Clinical Manifestations a. ↑WOB (work of breathing), tachypnea b. Tachycardia |
|
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 4. Clinical Manifestations c. ----------, pallor, ------------ d. ↓---------- |
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 4. Clinical Manifestations c. Cyanosis, pallor, diaphoresis d. ↓Mentation |
|
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 4. Clinical Manifestations e. Diffuse ----------- and rhonchi f. CXR--“------------” |
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 4. Clinical Manifestations e. Diffuse crackles and rhonchi f. CXR--“white out” |
|
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 4. Clinical Manifestations g. ABGs--resp -------------- (initially) decompensates to combined met and resp ------------ |
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 4. Clinical Manifestations g. ABGs--resp alkalosis (initially) decompensates to combined met and resp acidosis |
|
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 4. Clinical Manifestations h. Elevated---------- with normal ---------: --key finding |
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 4. Clinical Manifestations h. Elevated PAP with normal PAWP--key finding |
|
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 4. Clinical Manifestations h. Elevated PAP with normal PAWP--key finding i. Can’t ----------- w/ ↑------------ b/c could be something else (heart prob fluid overload) |
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 4. Clinical Manifestations h. Elevated PAP with normal PAWP--key finding i. Can’t Dx w/ ↑PAWP b/c could be something else (heart prob fluid overload) |
|
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 4. Clinical Manifestations h. Elevated PAP with normal PAWP--key finding ii. If fluid overloaded ↑-------------- (backing up of fluids causing too much preload) give diuretics, ---------2 improves not ARDS |
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 4. Clinical Manifestations h. Elevated PAP with normal PAWP--key finding i. Can’t Dx w/ ↑PAWP b/c could be something else (heart prob fluid overload) |
|
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 5. Diagnosis Criteria a. --------------: --do not respond to ↑FiO2 |
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 5. Diagnosis Criteria a. Refractory hypoxia--do not respond to ↑FiO2 |
|
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 5. Diagnosis Criteria b. CXR with new bilateral -----------/--------------- infiltrates (“white out”) |
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 5. Diagnosis Criteria b. CXR with new bilateral interstitial/alveolar infiltrates (“white out”) |
|
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 5. Diagnosis Criteria c. PAWP of --------------mmHg or less and no evidence of heart failure d. Must have predisposing condition for ARDS within -----------hrs (need trigger) |
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 5. Diagnosis Criteria c. PAWP of 18mmHg or less and no evidence of heart failure d. Must have predisposing condition for ARDS within 48hrs (need trigger) |
|
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 6. Treatment a. Prevention of further ---------- b. Maintain adequate -----------: --mechanical ventilation (5-6mL/kg w/ lowest FiO2) |
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 6. Treatment a. Prevention of further injury b. Maintain adequate oxygenation--mechanical ventilation (5-6mL/kg w/ lowest FiO2) |
|
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 6. Treatment b. Maintain adequate oxygenation--mechanical ventilation (5-_________mL/kg w/ lowest ______2) |
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 6. Treatment b. Maintain adequate oxygenation--mechanical ventilation (5-6mL/kg w/ lowest FiO2) |
|
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 6. Treatment b. Maintain adequate oxygenation- i.-------------- Ventilatory--high frequency (100-_________breath/min) |
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 6. Treatment b. Maintain adequate oxygenation- i. Jet Ventilatory--high frequency (100-300breath/min) |
|
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 6. Treatment b. Maintain adequate oxygenation- ii.---------------- ratio--sedate and paralyze iii. --------------- strategies |
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 6. Treatment b. Maintain adequate oxygenation- ii. Inverse ratio--sedate and paralyze iii. Positioning strategies |
|
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 6. Treatment c. Optimize oxygen delivery--keep PaO2 >----------- and SaO2 >----------- |
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 6. Treatment c. Optimize oxygen delivery--keep PaO2 >60 and SaO2 >90 |
|
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 7. Management a. Mechanical ----------- b. -------------- strategies |
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 7. Management a. Mechanical ventilation b. Positioning strategies |
|
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 7. Management b. Positioning strategies i. Lateral ------------ ii. ------------ position (-----------)--lungs down |
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 7. Management b. Positioning strategies i. Lateral decubitus ii. Prone position (proning)--lungs down |
|
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 7. Management b. Positioning strategies ii. Prone position (proning)--lungs down • ↓----------------, improves perfusion and ventilation, reduces lung constriction |
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 7. Management b. Positioning strategies ii. Prone position (proning)--lungs down • ↓atelectasis, improves perfusion and ventilation, reduces lung constriction |
|
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 7. Management c. Drug Therapy--no good drug i. _________--antifungal ii. ________--controversial iii. ________ oxide--dilate pulmonary vasculature |
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 7. Management c. Drug Therapy--no good drug i. Ketoconadol--antifungal ii. Steroids--controversial iii. Nitrous oxide--dilate pulmonary vasculature |
|
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 8. Complications a. Noscomial --------- b. --------: --can cause and also lead to c. Pulmonary ------- |
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 8. Complications a. Noscomial pneumonia b. Sepsis--can cause and also lead to c. Pulmonary emboli |
|
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 8. Complications d. Pulmonary --------- f. Stress ------------ and hemorrhage g. Acute --------- failure |
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 8. Complications d. Pulmonary fibrosis f. Stress ulceration and hemorrhage g. Acute renal failure |
|
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 8. Complications h. A---------- i. Decreased ------- |
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 8. Complications h. Arrhythmias i. Decreased CO |
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VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 8. Complications j. DIC (disseminated------------ coagulation-often in sepsis)/T-------------- |
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 8. Complications j. DIC (disseminated intravascular coagulation-often in sepsis)/Thrombocytopenia |
|
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 8. Complications k. MODS (multiple ------------ dysfunction syndrome) |
VI. Acute Respiratory Failure
I. Acute Respiratory Distress Syndrome (ARDS)-- 8. Complications k. MODS (multiple organ dysfunction syndrome) |
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Burns
I. Skin’s Function--all care for burns in reflective of skin’s purpose (largest body organ) A. Protection (impairment leads to ------------) |
Burns
I. Skin’s Function--all care for burns in reflective of skin’s purpose (largest body organ) A. Protection (impairment leads to infection) |
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Burns
I. Skin’s Function--all care for burns in reflective of skin’s purpose (largest body organ) B. Temperature Regulation (impairment leads to inability to maintain ------------) |
Burns
I. Skin’s Function--all care for burns in reflective of skin’s purpose (largest body organ) B. Temperature Regulation (impairment leads to inability to maintain body temp) |
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Burns
I. Skin’s Function--all care for burns in reflective of skin’s purpose (largest body organ) C. Keep body fluids in (impairment leads to inability to maintain ---------) |
Burns
I. Skin’s Function--all care for burns in reflective of skin’s purpose (largest body organ) C. Keep body fluids in (impairment leads to inability to maintain fluid balance) |
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Burns
II. Types--most injuries take place at ---------- (need prevention); highest fatalities in ----------- and elderly |
Burns
II. Types--most injuries take place at home (need prevention); highest fatalities in children and elderly |
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Burns
II. Types-- A. Thermal--flame, -------------, ------------, steam, and contact with ----------- objects (most common) 1. Major causes of fire in home--smoking, cooking, space heaters, and chemicals |
Burns
II. Types-- A. Thermal--flame, flash/explosion, scald, steam, and contact with hot objects (most common) 1. Major causes of fire in home--smoking, cooking, space heaters, and chemicals |
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Burns
II. Types-- A. Thermal--flame, flash/explosion, scald, steam, and contact with hot objects (most common) 1. Major causes of fire in home--smoking, -------------, ---------------, and chemicals |
Burns
II. Types-- A. Thermal--flame, flash/explosion, scald, steam, and contact with hot objects (most common) 1. Major causes of fire in home--smoking, cooking, space heaters, and chemicals |
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Burns
II. Types-- B. Chemical--result of ------------ injury and destruction from ------------- substances (most commonly acids) |
Burns
II. Types-- B. Chemical--result of tissue injury and destruction from necrotizing substances (most commonly acids) |
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Burns
II. Types-- B. Chemical--result of tissue injury and destruction from necrotizing substances (most commonly acids) 1. Causative agents: things with -----------, paint removers, drain cleaners (acids and ------------) |
Burns
II. Types-- B. Chemical--result of tissue injury and destruction from necrotizing substances (most commonly acids) 1. Causative agents: things with lye, paint removers, drain cleaners (acids and alkaloids) |
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Burns
II. Types-- B. Chemical--result of tissue injury and destruction from necrotizing substances (most commonly acids) 2. Can cause respiratory problems and ----------- manifestations (usually smaller extent) |
Burns
II. Types-- B. Chemical--result of tissue injury and destruction from necrotizing substances (most commonly acids) 2. Can cause respiratory problems and systemic manifestations (usually smaller extent) |
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Burns
II. Types-- B. Chemical--result of tissue injury and destruction from necrotizing substances (most commonly acids) 3. Looks ----------- pink and slightly wet (can continuously burn for -----------hrs after chemicals removed) |
Burns
II. Types-- B. Chemical--result of tissue injury and destruction from necrotizing substances (most commonly acids) 3. Looks cherry pink and slightly wet (can continuously burn for 72hrs after chemicals removed) |
|
Burns
II. Types-- B. Chemical--result of tissue injury and destruction from necrotizing substances (most commonly acids) 4. Tissue damage based on concentration, --------------, time on skin, and extent of ------------ |
Burns
II. Types-- B. Chemical--result of tissue injury and destruction from necrotizing substances (most commonly acids) 4. Tissue damage based on concentration, quantity, time on skin, and extent of penetration |
|
Burns
II. Types-- B. Chemical--result of tissue injury and destruction from necrotizing substances (most commonly acids) 5. Treatment a. Remove ------------ of burn (brush off powder or remove clothing/jewelry, etc.) b. Wash for ---------min with--------- water or until not complaining of pain c. Wrap area in sterile dressing |
Burns
II. Types-- B. Chemical--result of tissue injury and destruction from necrotizing substances (most commonly acids) 5. Treatment a. Remove cause of burn (brush off powder or remove clothing/jewelry, etc.) b. Wash for min 20min with cold water or until not complaining of pain c. Wrap area in sterile dressing |
|
Burns
II. Types-- B. Chemical--result of tissue injury and destruction from necrotizing substances (most commonly acids) 5. Treatment c. Wrap area in ---------- dressing |
Burns
II. Types-- B. Chemical--result of tissue injury and destruction from necrotizing substances (most commonly acids) 5. Treatment c. Wrap area in sterile dressing |
|
Burns
II. Types-- C. Smoke and Inhalation 1. Types a. Inhalation injury ↑ ---------- (inhale hot air/steam/smoke ------------- obstruction) |
Burns
II. Types-- C. Smoke and Inhalation 1. Types a. Inhalation injury ↑ glottis (inhale hot air/steam/smokeedemaairway obstruction) |
|
Burns
II. Types-- C. Smoke and Inhalation 1. Types b. Inhalation injury ↓---------- (inhale hot air , ------------ swelling can’t exchange gases) |
Burns
II. Types-- C. Smoke and Inhalation 1. Types b. Inhalation injury ↓ glottis (inhale hot airalveolar swellingcan’t exchange gases) |
|
Burns
II. Types-- C. Smoke and Inhalation 1. Types b. Inhalation injury ↓ glottis (inhale hot airalveolar swellingcan’t exchange gases) i. Chemically produced (depends on -------------- exposed) |
Burns
II. Types-- C. Smoke and Inhalation 1. Types b. Inhalation injury ↓ glottis (inhale hot airalveolar swellingcan’t exchange gases) i. Chemically produced (depends on amount of time exposed) |
|
Burns
II. Types-- C. Smoke and Inhalation 1. Types b. Inhalation injury ↓ glottis (inhale hot airalveolar swellingcan’t exchange gases) ii. Symptoms usually present ____-______hrs after and can cause ARDS |
Burns
II. Types-- C. Smoke and Inhalation 1. Types b. Inhalation injury ↓ glottis (inhale hot airalveolar swellingcan’t exchange gases) ii. Symptoms usually present 12-24hrs after and can cause ARDS |
|
Burns
II. Types-- C. Smoke and Inhalation 1. Types b. Inhalation injury ↓ glottis (inhale hot airalveolar swellingcan’t exchange gases) iii. Check for coughing up soot, diff -----------, forced voice, singed ------------, facial burns, and fume---------- (if fire was in enclosed space) |
Burns
II. Types-- C. Smoke and Inhalation 1. Types b. Inhalation injury ↓ glottis (inhale hot airalveolar swellingcan’t exchange gases) iii. Check for coughing up soot, diff swallowing, forced voice, singed nose hairs, facial burns, and fume inhalation (if fire was in enclosed space) |
|
Burns
II. Types-- C. Smoke and Inhalation 1. Types c. CO Poisoning--CO displaces -------- on Hg w/ ---------x affinity hypoxia death |
Burns
II. Types-- C. Smoke and Inhalation 1. Types c. CO Poisoning--CO displaces O2 on Hg w/ 250x affinity hypoxia death |
|
Burns
II. Types-- C. Smoke and Inhalation 1. Types c. CO Poisoning--CO displaces O2 on ------- w/ 250x affinity ----------- death |
Burns
II. Types-- C. Smoke and Inhalation 1. Types c. CO Poisoning--CO displaces O2 on Hg w/ 250x affinity hypoxia death |
|
Burns
II. Types-- C. Smoke and Inhalation 1. Types c. CO Poisoning--CO displaces O2 on Hg w/ 250x affinity hypoxia death i. Manifestations: HA, N/V, -----------, confusion, ----------- damage, --------- |
Burns
II. Types-- C. Smoke and Inhalation 1. Types c. CO Poisoning--CO displaces O2 on Hg w/ 250x affinity hypoxia death i. Manifestations: HA, N/V, fatigue, confusion, brain damage, death |
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Burns
II. Types-- C. Smoke and Inhalation 1. Types c. CO Poisoning--CO displaces O2 on Hg w/ 250x affinity hypoxia death ii. Fatigue lay down to sleep, -------- in sleep |
FIX
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Burns
II. Types-- C. Smoke and Inhalation 1. Types c. CO Poisoning--CO displaces O2 on Hg w/ 250x affinity hypoxia death iii. Caused by inappropriate burnings of wood, ----------, grilling -----------, etc. |
Burns
II. Types-- C. Smoke and Inhalation 1. Types c. CO Poisoning--CO displaces O2 on Hg w/ 250x affinity hypoxia death iii. Caused by inappropriate burnings of wood, kerosene, grilling inside, etc. |
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Burns
II. Types-- C. Smoke and Inhalation 1. Types c. CO Poisoning--CO displaces O2 on Hg w/ 250x affinity hypoxia death iv. Treatment--100% ---------- w/ NR mask in high --------- (may need to intubate) |
Burns
II. Types-- C. Smoke and Inhalation 1. Types c. CO Poisoning--CO displaces O2 on Hg w/ 250x affinity hypoxia death iv. Treatment--100% O2 w/ NR mask in high fowlers (may need to intubate) |
|
Burns
II. Types-- C. Smoke and Inhalation 1. Types c. CO Poisoning--CO displaces O2 on Hg w/ 250x affinity hypoxia death iv. Treatment--100% O2 w/ ---------- mask in high fowlers (may need to -----------) |
Burns
II. Types-- C. Smoke and Inhalation 1. Types c. CO Poisoning--CO displaces O2 on Hg w/ 250x affinity hypoxia death iv. Treatment--100% O2 w/ NR mask in high fowlers (may need to intubate) |
|
Burns
II. Types-- C. Smoke and Inhalation 2. Treatment a. Administration of ----------- air |
Burns
II. Types-- C. Smoke and Inhalation 2. Treatment a. Administration of humidified air |
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Burns
II. Types-- C. Smoke and Inhalation 2. Treatment b. Position in high ----------- |
Burns
II. Types-- C. Smoke and Inhalation 2. Treatment b. Position in high fowler’s |
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Burns
II. Types-- C. Smoke and Inhalation 2. Treatment c. Cough and -------- breath q----------hr |
Burns
II. Types-- C. Smoke and Inhalation 2. Treatment c. Cough and deep breath q1hr |
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Burns
II. Types-- C. Smoke and Inhalation 2. Treatment d. Use of -------------- |
Burns
II. Types-- C. Smoke and Inhalation 2. Treatment d. Use of bronchodilators |
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Burns
II. Types-- C. Smoke and Inhalation 2. Treatment e. Suction -------- |
Burns
II. Types-- C. Smoke and Inhalation 2. Treatment e. Suction prn |
|
Burns
II. Types-- C. Smoke and Inhalation 2. Treatment f. Continuous ------------- of resp. status/prep for ----------- (swelling is greatest danger) |
Burns
II. Types-- C. Smoke and Inhalation 2. Treatment f. Continuous monitoring of resp. status/prep for intubation (swelling is greatest danger) |
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Burns
II. Types-- C. Smoke and Inhalation 2. Treatment g. Indications for immediate intubation i. Full thickness burns to ---------- ii. Circumferential---------- burns iii. Acute ---------- distress |
Burns
II. Types-- C. Smoke and Inhalation 2. Treatment g. Indications for immediate intubation i. Full thickness burns to face ii. Circumferential neck burns iii. Acute respiratory distress |
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Burns
II. Types-- C. Smoke and Inhalation 2. Treatment g. Indications for immediate intubation iv. Respiratory ------------- or altered mental status v. --------------- edema and inflammation noted on bronchoscopy |
Burns
II. Types-- C. Smoke and Inhalation 2. Treatment g. Indications for immediate intubation iv. Respiratory depression or altered mental status v. Supraglottic edema and inflammation noted on bronchoscopy |
|
Burns
II. Types-- D. Electrical--coagulation ---------- caused by intense heat from electrical current (less common, ____-9%) |
Burns
II. Types-- D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%) |
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Burns
II. Types-- D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%) 1. Severity--burn will not look that bad (most destruction is within ---------) |
Burns
II. Types-- D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%) 1. Severity--burn will not look that bad (most destruction is within body) |
|
Burns
II. Types-- D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%) 1. Severity--burn will not look that bad (most destruction is within body) a. Amount of voltage i. <------------V (low)--energy can’t enter body unless opening exists (not hospitalized) |
FIX
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Burns
II. Types-- D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%) 1. Severity--burn will not look that bad (most destruction is within body) a. Amount of voltage i. <1000V (low)--energy can’t enter body unless ------------ exists (not hospitalized) |
Burns
II. Types-- D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%) 1. Severity--burn will not look that bad (most destruction is within body) a. Amount of voltage i. <1000V (low)--energy can’t enter body unless opening exists (not hospitalized) |
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Burns
II. Types-- D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%) 1. Severity--burn will not look that bad (most destruction is within body) a. Amount of voltage ii. >------------V (high)--entry exit wound (damp/sweaty areas-hands, feet, axillaries) |
Burns
II. Types-- D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%) 1. Severity--burn will not look that bad (most destruction is within body) a. Amount of voltage ii. >1000V (high)--entry exit wound (-------------- areas-hands, feet, axillaries) |
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Burns
II. Types-- D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%) 1. Severity--burn will not look that bad (most destruction is within body b. Tissue resistance--fat and ----------- more resistant (most damage done to ----------- vessels) |
Burns
II. Types-- D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%) 1. Severity--burn will not look that bad (most destruction is within body b. Tissue resistance--fat and bone more resistant (most damage done to nerves vessels) |
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Burns
II. Types-- D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%) 1. Severity--burn will not look that bad (most destruction is within body c. Current pathways--goes through---------- resistant path (were ----------- organs in the way?) |
Burns
II. Types-- D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%) 1. Severity--burn will not look that bad (most destruction is within body c. Current pathways--goes through least resistant path (were vital organs in the way?) |
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Burns
II. Types-- D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%) 1. Severity--burn will not look that bad (most destruction is within body c. Current pathways--goes through least resistant path (were vital organs in the way?) i. Hand to hand goes through ------------ (burns across hands --------x great for arrhythmias) |
Burns
II. Types-- D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%) 1. Severity--burn will not look that bad (most destruction is within body c. Current pathways--goes through least resistant path (were vital organs in the way?) i. Hand to hand goes through heart (burns across hands 3x great for arrhythmias) |
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Burns
II. Types-- D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%) 1. Severity--burn will not look that bad (most destruction is within body d. ------------- area in contact with current--look at skin carefully |
Burns
II. Types-- D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%) 1. Severity--burn will not look that bad (most destruction is within body d. Surface area in contact with current--look at skin carefully |
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Burns
II. Types-- D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%) 1. Severity--burn will not look that bad (most destruction is within body e. -------------- current flow was sustained |
Burns
II. Types-- D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%) 1. Severity--burn will not look that bad (most destruction is within body e. Length of time current flow was sustained |
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Burns
II. Types-- D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%) 2. Complications--can occur during and after burn a. Risk for cardiac arrest/arrhythmias (massive --------------cardiac standstill/----------) |
Burns
II. Types-- D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%) 2. Complications--can occur during and after burn a. Risk for cardiac arrest/arrhythmias (massive depolarization-cardiac standstill/asystole) |
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Burns
II. Types-- D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%) 2. Complications--can occur during and after burn b. Acid-base imbalance--metabolic ----------- as cells rupture |
Burns
II. Types-- D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%) 2. Complications--can occur during and after burn b. Acid-base imbalance--metabolic acidosis as cells rupture |
|
Burns
II. Types-- D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%) 2. Complications--can occur during and after burn c. Kidney failure--massive ------------- |
Burns
II. Types-- D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%) 2. Complications--can occur during and after burn c. Kidney failure--massive myoglobinuria |
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Burns
II. Types-- D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%) 2. Complications--can occur during and after burn i. Big proteins from ------------- tissues block renal ----------, renal failure |
Burns
II. Types-- D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%) 2. Complications--can occur during and after burn i. Big proteins from damaged tissues block renal tubules renal failure |
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Burns
II. Types-- D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%) 2. Complications--can occur during and after burn d. Injury to CNS--coma, ----------, epilepsy, -----------------, spinal injury (falls) |
Burns
II. Types-- D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%) 2. Complications--can occur during and after burn d. Injury to CNS--coma, aphasia, epilepsy, peripheral neuropathy, spinal injury (falls) |
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Burns
II. Types-- D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%) 2. Complications--can occur during and after burn d. Injury to CNS--________, aphasia, _________, peripheral neuropathy, _______ injury (falls) |
Burns
II. Types-- D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%) 2. Complications--can occur during and after burn d. Injury to CNS--coma, aphasia, epilepsy, peripheral neuropathy, spinal injury (falls) |
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Burns
II. Types-- D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%) 2. Complications--can occur during and after burn e. ------------- injury--muscle spasms due to current causing bones to break, trauma |
Burns
II. Types-- D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%) 2. Complications--can occur during and after burn e. Musculoskeletal injury--muscle spasms due to current causing bones to break, trauma |
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Burns
II. Types-- D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%) 2. Complications--can occur during and after burn f. ----------- shock |
Burns
II. Types-- D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%) 2. Complications--can occur during and after burn f. Hypovolemic shock |
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Burns
II. Types-- D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%) 3. Treatment--LR with urine output at _____-______mL/hr (all electrical burns go to burn ________) |
Burns
II. Types-- D. Electrical--coagulation necrosis caused by intense heat from electrical current (less common, 3-9%) 3. Treatment--LR with urine output at 75-100mL/hr (all electrical burns go to burn center) |
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Burns
II. Types-- E. Cold Thermal--frostbite 1. Pathophysiology--ice crystals in --------- and cells ↓-------- flow and destry cell membrane |
Burns
II. Types-- E. Cold Thermal--frostbite 1. Pathophysiology--ice crystals in tissue and cells ↓blood flow and destry cell membrane |
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Burns
II. Types-- E. Cold Thermal--frostbite 2. Depth--result of ----------- temperature, length of-----------, and type/condition of clothing |
Burns
II. Types-- E. Cold Thermal--frostbite 2. Depth--result of ambient temperature, length of exposure, and type/condition of clothing |
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Burns
II. Types-- E. Cold Thermal--frostbite 2. Depth--result of ambient temperature, length of exposure, and type/condition of clothing a. Superficial--skin, ---------- tissue (ears, cheeks, ---------, toes) |
Burns
II. Types-- E. Cold Thermal--frostbite 2. Depth--result of ambient temperature, length of exposure, and type/condition of clothing a. Superficial--skin, SQ tissue (ears, cheeks, fingers, toes) |
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Burns
II. Types-- E. Cold Thermal--frostbite 2. Depth--result of ambient temperature, length of exposure, and type/condition of clothing a. Superficial--skin, SQ tissue (ears, cheeks, fingers, toes) i. Treatment--immerse in bath water at ______-______° blisters will form after |
Burns
II. Types-- E. Cold Thermal--frostbite 2. Depth--result of ambient temperature, length of exposure, and type/condition of clothing a. Superficial--skin, SQ tissue (ears, cheeks, fingers, toes) i. Treatment--immerse in bath water at 102-108° blisters will form after |
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Burns
II. Types-- E. Cold Thermal--frostbite 2. Depth--result of ambient temperature, length of exposure, and type/condition of clothing ii. Re-warming is very painful (pain can continue for-------- to --------- after injury) |
Burns
II. Types-- E. Cold Thermal--frostbite 2. Depth--result of ambient temperature, length of exposure, and type/condition of clothing ii. Re-warming is very painful (pain can continue for weeks to years after injury) |
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Burns
II. Types-- E. Cold Thermal--frostbite 2. Depth--result of ambient temperature, length of exposure, and type/condition of clothing b. Deep--muscles, ---------, tendons (skin mottled ---------) |
Burns
II. Types-- E. Cold Thermal--frostbite 2. Depth--result of ambient temperature, length of exposure, and type/condition of clothing b. Deep--muscles, bones, tendons (skin mottled gangrene) |
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Burns
II. Types-- E. Cold Thermal--frostbite 2. Depth--result of ambient temperature, length of exposure, and type/condition of clothing b. Deep--muscles, bones, tendons (skin mottled gangrene) i. Treatment--usually requires ------------- |
Burns
II. Types-- E. Cold Thermal--frostbite 2. Depth--result of ambient temperature, length of exposure, and type/condition of clothing b. Deep--muscles, bones, tendons (skin mottled gangrene) i. Treatment--usually requires amputation |
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Burns
III. Severity A. Depth--know ----------- of skin |
Burns
III. Severity A. Depth--know layers of skin |
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Burns
III. Severity A. Depth--know layers of skin 1. Superficial --------- Thickness (1st degree) |
Burns
III. Severity A. Depth--know layers of skin 1. Superficial Partial Thickness (1st degree) |
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Burns
III. Severity A. Depth--know layers of skin 1. Superficial Partial Thickness (1st degree) a. Involves mainly ------------- and uppermost part of dermis |
Burns
III. Severity A. Depth--know layers of skin 1. Superficial Partial Thickness (1st degree) a. Involves mainly epidermis and uppermost part of dermis |
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Burns
III. Severity A. Depth--know layers of skin 1. Superficial Partial Thickness (1st degree) b. Manifestations--redness, --------, blanches under pressure, mild swelling w/ ------------ |
Burns
III. Severity A. Depth--know layers of skin 1. Superficial Partial Thickness (1st degree) b. Manifestations--redness, --------, blanches under pressure, mild swelling w/ ------------ |
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Burns
III. Severity A. Depth--know layers of skin 1. Superficial Partial Thickness (1st degree) c. Heals in about-------- days (may peel after ---------hrs) |
Burns
III. Severity A. Depth--know layers of skin 1. Superficial Partial Thickness (1st degree) c. Heals in about 7 days (may peel after 24hrs) |
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Burns
III. Severity A. Depth--know layers of skin 2. --------- Partial Thickness (2nd degree) |
Burns
III. Severity A. Depth--know layers of skin 2. Deep Partial Thickness (2nd degree) |
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Burns
III. Severity A. Depth--know layers of skin 2. Deep Partial Thickness (2nd degree) a. Damage through epidermis into ------------ |
Burns
III. Severity A. Depth--know layers of skin 2. Deep Partial Thickness (2nd degree) a. Damage through epidermis into dermis |
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Burns
III. Severity A. Depth--know layers of skin 2. Deep Partial Thickness (2nd degree) b. Manifestations--salmon pink/cherry red w/ red, shiny/wet --------------, blanches under pressure,------------, mild-moderate --------- |
Burns
III. Severity A. Depth--know layers of skin 2. Deep Partial Thickness (2nd degree) b. Manifestations--salmon pink/cherry red w/ red, shiny/wet fluid-filled vesicles, blanches under pressure, severe pain, mild-moderate edema |
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Burns
III. Severity A. Depth--know layers of skin 2. Deep Partial Thickness (2nd degree) b. Manifestations--salmon pink/------------, shiny/wet fluid-filled vesicles, ---------- under pressure, severe pain, mild-moderate edema |
Burns
III. Severity A. Depth--know layers of skin 2. Deep Partial Thickness (2nd degree) b. Manifestations--salmon pink/cherry red w/ red, shiny/wet fluid-filled vesicles, blanches under pressure, severe pain, mild-moderate edema |
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Burns
III. Severity A. Depth--know layers of skin 2. Deep Partial Thickness (2nd degree) c. Heals in ____-______days |
Burns
III. Severity A. Depth--know layers of skin 2. Deep Partial Thickness (2nd degree) c. Heals in 7-21days |
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Burns
III. Severity A. Depth--know layers of skin 3. --------- Thickness (3rd degree) |
Burns
III. Severity A. Depth--know layers of skin 3. Full Thickness (3rd degree) |
|
Burns
III. Severity A. Depth--know layers of skin 3. Full Thickness (3rd degree) a. Destruction of epidermis -------------- (can be into fat, muscle, and bone) |
Burns
III. Severity A. Depth--know layers of skin 3. Full Thickness (3rd degree) a. Destruction of epidermis through dermis (can be into fat, muscle, and bone) |
|
Burns
III. Severity A. Depth--know layers of skin 3. Full Thickness (3rd degree) c. Manifestations--dry, ----------, ------------, charred black, insensitive to ----------- |
Burns
III. Severity A. Depth--know layers of skin 3. Full Thickness (3rd degree) c. Manifestations--dry, leathery, waxy white, charred black, insensitive to pain/pressure |
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Burns
III. Severity A. Depth--know layers of skin 3. Full Thickness (3rd degree) d. Will require skin --------- |
Burns
III. Severity A. Depth--know layers of skin 3. Full Thickness (3rd degree) d. Will require skin grafting |
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Burns
III. Severity B. Extent--need to know in order to calculate needed fluid replacement 1. Rule of ---------(faster) |
Burns
III. Severity B. Extent--need to know in order to calculate needed fluid replacement 1. Rule of 9s (faster) |
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Burns
III. Severity B. Extent--need to know in order to calculate needed fluid replacement 1. Rule of 9s (faster) a. Head/neck--_____% b. Arms--_____% c. Anterior trunk--_____% |
Burns
III. Severity B. Extent--need to know in order to calculate needed fluid replacement 1. Rule of 9s (faster) a. Head/neck--9% b. Arms--9% c. Anterior trunk--18% |
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Burns
III. Severity B. Extent--need to know in order to calculate needed fluid replacement 1. Rule of 9s (faster) d. Posterior trunk--______% e. Legs--____% f. Perineum--_____% |
Burns
III. Severity B. Extent--need to know in order to calculate needed fluid replacement 1. Rule of 9s (faster) d. Posterior trunk--18% e. Legs--18% f. Perineum--1% |
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Burns
III. Severity B. Extent--need to know in order to calculate needed fluid replacement 2. --------------- Chart (more detailed and more accurate) **Cut off age--need to be >6yrs |
Burns
III. Severity B. Extent--need to know in order to calculate needed fluid replacement 2. Lund-Browder Chart (more detailed and more accurate) **Cut off age--need to be >6yrs |
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Burns
III. Severity B. Extent--need to know in order to calculate needed fluid replacement 2. Lund-Browder Chart (more detailed and more accurate) **Cut off age--need to be >______yrs |
Burns
III. Severity B. Extent--need to know in order to calculate needed fluid replacement 2. Lund-Browder Chart (more detailed and more accurate) **Cut off age--need to be >6yrs |
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Burns
III. Severity C. Location 1. Face,------------, and circumferential chest--severe b/ increase possibility of --------- compromise |
Burns
III. Severity C. Location 1. Face, neck, and circumferential chest--severe b/ increase possibility of resp. compromise |
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Burns
III. Severity C. Location 2. Hands, feet, ---------, eyes, and -------: difficult to treat (high movement ↑ ----------) |
Burns
III. Severity C. Location 2. Hands, feet, joints, eyes, and perineum--difficult to treat (high movement ↑ complications) |
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Burns
III. Severity C. Location 3. Ears, nose--susceptible to infection b/c -------------- to cartilage |
Burns
III. Severity C. Location 3. Ears, nose--susceptible to infection b/c poor blood supply to cartilage |
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Burns
III. Severity C. Location 4. Circumferential extremities--risk of ------------- syndrome (↓blood supply to distal region) |
Burns
III. Severity C. Location 4. Circumferential extremities--risk of compartment syndrome (↓blood supply to distal region) |
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Burns
III. Severity D. Patient Risk Factors 1. Age--<_______yrs (not full development of immune system) and >_______yrs |
Burns
III. Severity D. Patient Risk Factors 1. Age--<2yrs (not full development of immune system) and >60yrs |
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Burns
III. Severity D. Patient Risk Factors 2. Pre-existing cardiovascular, -----------, or --------- disease--can be worsened |
Burns
III. Severity D. Patient Risk Factors 2. Pre-existing cardiovascular, respiratory, or renal disease--can be worsened |
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Burns
III. Severity D. Patient Risk Factors 3. ------------ or PVD--↓healing and ↑infection |
Burns
III. Severity D. Patient Risk Factors 3. Diabetes or PVD--↓healing and ↑infection |
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Burns
III. Severity D. Patient Risk Factors 4. Debilitating states--chronic ---------, history of ---------, malnutrition |
Burns
III. Severity D. Patient Risk Factors 4. Debilitating states--chronic disease, history of ETOH, malnutrition |
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Burns
III. Severity D. Patient Risk Factors 5. Concurrent injuries--often ------------- injuries (need to know circumstances of injury) |
Burns
III. Severity D. Patient Risk Factors 5. Concurrent injuries--often traumatic injuries (need to know circumstances of injury) |
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Burns
IV. Burn Center Referral Criteria (check book) A. Partial thickness burns >_________% of total body surface area (TBSA) B. All ------------- burns C. Electrical and ---------- burns |
Burns
IV. Burn Center Referral Criteria (check book) A. Partial thickness burns >10% of total body surface area (TBSA) B. All full thickness burns C. Electrical and chemical burns |
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Burns
IV. Burn Center Referral Criteria (check book) D. --------------- injury E. All burns involving injury to --------, eyes, face, ---------, feet, -----------, and joints |
Burns
IV. Burn Center Referral Criteria (check book) D. Inhalation injury E. All burns involving injury to ears, eyes, face, hands, feet, perineum, and joints |
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Burns
V. Treatment A. ------------- process--mostly prehospital |
Burns
V. Treatment A. Stop burning process--mostly prehospital |
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Burns
V. Treatment A. Stop burning process--mostly prehospital 1. Removal of ---------- and jewelry (especially w/ --------- burns) |
Burns
V. Treatment A. Stop burning process--mostly prehospital 1. Removal of clothing and jewelry (especially w/ chemical burns) 2. Cut around areas where clothing is stuck to skin |
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Burns
V. Treatment A. Stop burning process--mostly prehospital 2. Cut around areas where clothing is -------- to skin |
Burns
V. Treatment A. Stop burning process--mostly prehospital 2. Cut around areas where clothing is stuck to skin |
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Burns
V. Treatment A. Stop burning process--mostly prehospital 3. Brush -------------- off skin followed by lavage w/ water for at least -------min (for chemical) |
Burns
V. Treatment A. Stop burning process--mostly prehospital 3. Brush solid particles off skin followed by lavage w/ water for at least 20min (for chemical) |
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Burns
V. Treatment A. Stop burning process--mostly prehospital 4. Cover and ---------- dressing or clean sheet to prevent -------- loss (for thermal) |
Burns
V. Treatment A. Stop burning process--mostly prehospital 4. Cover and dry dressing or clean sheet to prevent heat loss (for thermal) |
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Burns
V. Treatment B. Assess ABCs--burns to airway can cause swelling that blocks flow of air into lungs 1. A--keep ---------- patent |
Burns
V. Treatment B. Assess ABCs--burns to airway can cause swelling that blocks flow of air into lungs 1. A--keep airway patent |
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Burns
V. Treatment B. Assess ABCs--burns to airway can cause swelling that blocks flow of air into lungs 2. B--assess ------- and ------- |
Burns
V. Treatment B. Assess ABCs--burns to airway can cause swelling that blocks flow of air into lungs 2. B--assess RR and O2Sat |
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Burns
V. Treatment B. Assess ABCs--burns to airway can cause swelling that blocks flow of air into lungs 3. C--assess --------- and look for ------------ burns |
Burns
V. Treatment B. Assess ABCs--burns to airway can cause swelling that blocks flow of air into lungs 3. C--assess pulses and look for circumferential burns |
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Burns
V. Treatment C. Assess for __________--circumstances of injury |
Burns
V. Treatment C. Assess for other injuries--circumstances of injury |
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Burns
V. Treatment C. Assess for other injuries--circumstances of injury 1. -------------- burns--concurrent w/ spinal injuries due to falls |
Burns
V. Treatment C. Assess for other injuries--circumstances of injury 1. High voltage burns--concurrent w/ spinal injuries due to falls |
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Burns
VI. Phases A. --------------- Phase--period of time required to resolve immediate problems (usually 24-48hrs) |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) |
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Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 1. ------------------- formation and continues until mobilization and diuresis begins |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 1. Initial fluid loss and edema formation and continues until mobilization and diuresis begins |
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Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 2. Changes--systemic response (w/ burns >____%) |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 2. Changes--systemic response (w/ burns >30%) |
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Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 2. Changes--systemic response (w/ burns >30%) a. ---------- and ------------ shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days) |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 2. Changes--systemic response (w/ burns >30%) a. Fluid and electrolyte shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days) |
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Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 2. Changes--systemic response (w/ burns >30%) a. Fluid and electrolyte shifts (------------- greatest risk)--leads to formation of edema (as early as -------min and can last 7-10days) |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 2. Changes--systemic response (w/ burns >30%) a. Fluid and electrolyte shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days) |
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Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 2. Changes--systemic response (w/ burns >30%) a. Fluid and electrolyte shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days) i. Larger burns ↑---------- shift (↑----------- volume loss insensible skin loss) |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 2. Changes--systemic response (w/ burns >30%) a. Fluid and electrolyte shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days) i. Larger burns ↑fluid shift (↑intravascular volume loss insensible skin loss) |
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Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 2. Changes--systemic response (w/ burns >30%) a. Fluid and electrolyte shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days) ii. ____________--Na moves into the interstitial spaces |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 2. Changes--systemic response (w/ burns >30%) a. Fluid and electrolyte shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days) ii. Hyponatremia--Na moves into the interstitial spaces |
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Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 2. Changes--systemic response (w/ burns >30%) a. Fluid and electrolyte shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days) iii. ----------------: released from injured cells and hemolysed RBCs vasculature |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 2. Changes--systemic response (w/ burns >30%) a. Fluid and electrolyte shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days) iii. Hyperkalemia-released from injured cells and hemolysed RBCs vasculature |
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Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 2. Changes--systemic response (w/ burns >30%) a. Fluid and electrolyte shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days) iv. ---------------- (↑Hct)--blood is more viscous |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 2. Changes--systemic response (w/ burns >30%) a. Fluid and electrolyte shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days) iv. Hemoconcentration (↑Hct)--blood is more viscous |
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Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 2. Changes--systemic response (w/ burns >30%) a. Fluid and electrolyte shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days) v. -------------- (↓albumin)--↑permeability fluid from intravascular to interstitial space ↓colloidal vascular pressure 2nd and 3rd spacing |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 2. Changes--systemic response (w/ burns >30%) a. Fluid and electrolyte shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days) v. Hypotproteinemia (↓albumin)--↑permeability fluid from intravascular to interstitial space ↓colloidal vascular pressure 2nd and 3rd spacing |
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Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 2. Changes--systemic response (w/ burns >30%) a. Fluid and electrolyte shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days) v. Hypotproteinemia (↓-------------)--↑permeability fluid from ------------- to interstitial space ↓---------- vascular pressure 2nd and 3rd spacing |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 2. Changes--systemic response (w/ burns >30%) a. Fluid and electrolyte shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days) v. Hypotproteinemia (↓albumin)--↑permeability fluid from intravascular to interstitial space ↓colloidal vascular pressure 2nd and 3rd spacing |
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Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 2. Changes--systemic response (w/ burns >30%) a. Fluid and electrolyte shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days) vi. At end of stage--restored ------------ (still creates problems) |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 2. Changes--systemic response (w/ burns >30%) a. Fluid and electrolyte shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days) vi. At end of stage--restored capillary permeability (still creates problems) |
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Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 2. Changes--systemic response (w/ burns >30%) • Proteins can’t return to ------------- |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 2. Changes--systemic response (w/ burns >30%) • Proteins can’t return to vascular space |
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Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 2. Changes--systemic response (w/ burns >30%) • ----------- can move back into vascular space |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 2. Changes--systemic response (w/ burns >30%) • Fluids can move back into vascular space |
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Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 2. Changes--systemic response (w/ burns >30%) • Assess for ↓------- (as --------- moves back into cell and pt. diureses hypokalemia) |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 2. Changes--systemic response (w/ burns >30%) • Assess for ↓K (as K moves back into cell and pt. diureses hypokalemia) |
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Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 2. Changes--systemic response (w/ burns >30%) • Assess for ↓K (as K moves back into cell and pt. diureses hypokalemia) b. Immunologic--widespread impairment causing susceptibility to --------- |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 2. Changes--systemic response (w/ burns >30%) • Assess for ↓K (as K moves back into cell and pt. diureses hypokalemia) b. Immunologic--widespread impairment causing susceptibility to infection |
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Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 2. Changes--systemic response (w/ burns >30%) b. Immunologic--widespread impairment causing susceptibility to infection i. ↑Release------------ ---------------- markers ↑permeability (severe w/ >---------%) |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 2. Changes--systemic response (w/ burns >30%) b. Immunologic--widespread impairment causing susceptibility to infection i. ↑Release cytokines inflammatory markers ↑permeability (severe w/ >30%) |
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Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 2. Changes--systemic response (w/ burns >30%) b. Immunologic--widespread impairment causing susceptibility to infection ii. ------------ suppression and ↓circulating WBCs |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 2. Changes--systemic response (w/ burns >30%) b. Immunologic--widespread impairment causing susceptibility to infection ii. Bone marrow suppression and ↓circulating WBCs |
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Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 2. Changes--systemic response (w/ burns >30%) c. Cardiovascular--volume depletion ↑-------------- ↑SVR ↓--------- |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 2. Changes--systemic response (w/ burns >30%) c. Cardiovascular--volume depletion ↑cardiac workload ↑SVR ↓CO |
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Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 2. Changes--systemic response (w/ burns >30%) c. Cardiovascular--volume depletion ↑cardiac workload ↑SVR ↓CO i. Release of tumor necrosis factor --------------- depression (↓contractility) |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 2. Changes--systemic response (w/ burns >30%) c. Cardiovascular--volume depletion ↑cardiac workload ↑SVR ↓CO i. Release of tumor necrosis factor myocardial depression (↓contractility) |
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Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 2. Changes--systemic response (w/ burns >30%) c. Cardiovascular--volume depletion ↑cardiac workload ↑SVR ↓CO ii. ↓BP ↓----------- |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 2. Changes--systemic response (w/ burns >30%) c. Cardiovascular--volume depletion ↑cardiac workload ↑SVR ↓CO ii. ↓BP ↓organ perfusion |
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Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 2. Changes--systemic response (w/ burns >30%) d. Respiratory--_____________; ARDS (__________ is a risk factor) |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 2. Changes--systemic response (w/ burns >30%) d. Respiratory--brochoconstriction; ARDS (trauma is a risk factor) |
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Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 2. Changes--systemic response (w/ burns >30%) e. Metabolic--basic metabolic rate ↑-------x need ↑------------ (aggressive w/ caloric intake) |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 2. Changes--systemic response (w/ burns >30%) e. Metabolic--basic metabolic rate ↑3x need ↑nutrition (aggressive w/ caloric intake) |
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Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 3. Clinical Manifestations a. -------------- shock--↓BP, ↑HR |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 3. Clinical Manifestations a. Hypovolemic shock--↓BP, ↑HR |
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Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 3. Clinical Manifestations b. ____________--fluid overload need fluids b/c all fluid is not where it needs to be |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 3. Clinical Manifestations b. Edematous--fluid overload need fluids b/c all fluid is not where it needs to be |
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Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 3. Clinical Manifestations c. Pain--__________ and ___________ burns |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 3. Clinical Manifestations c. Pain--superficial and partial thickness burns |
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Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 3. Clinical Manifestations d. Shivering--heat loss (can lead to -----------) ↑---------- requirements |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 3. Clinical Manifestations d. Shivering--heat loss (can lead to hypothermia) ↑energy requirements |
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Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 3. Clinical Manifestations e. ______________-- massive trauma response and occurs from K shifts (must assess gut) |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 3. Clinical Manifestations e. Adynamic ilius-- massive trauma response and occurs from K shifts (must assess gut) |
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Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 4. Complications a. Cardiovascular i._____________--electrolyte shifts (especially electrical burns through heart) |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 4. Complications a. Cardiovascular i. Dysrhythmias--electrolyte shifts (especially electrical burns through heart) |
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Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 4. Complications a. Cardiovascular ii. ______________ shock--can become irreversible shock end organ failure |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 4. Complications a. Cardiovascular ii. Hypovolemic shock--can become irreversible shock end organ failure |
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Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 4. Complications a. Cardiovascular iii. Impaired --------------- circulation--especially w/ circumferential burns (compartment syndrome need escoratomy-burns or fashiotomy-nonburns) |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 4. Complications a. Cardiovascular iii. Impaired peripheral circulation--especially w/ circumferential burns (compartment syndrome need escoratomy-burns or fashiotomy-nonburns) |
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Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 4. Complications a. Cardiovascular iii. Impaired peripheral circulation--especially w/ circumferential burns (compartment syndrome need --------------- or --------------) |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 4. Complications a. Cardiovascular iii. Impaired peripheral circulation--especially w/ circumferential burns (compartment syndrome need escoratomy-burns or fashiotomy-nonburns) |
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Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 4. Complications b. Respiratory (can occur ---------- days after initial injury)--inflammatory ------------ release |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 4. Complications b. Respiratory (can occur 2 days after initial injury)--inflammatory marker release |
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Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 4. Complications b. Respiratory (can occur 2 days after initial injury)--inflammatory marker release i. Upper respiratory tract injury--___________ airway |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 4. Complications b. Respiratory (can occur 2 days after initial injury)--inflammatory marker release i. Upper respiratory tract injury--swelling/blocking airway |
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Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 4. Complications • Pneumonia risk ii. Inhalation injury--___________ and ↓______ diffusion |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 4. Complications • Pneumonia risk ii. Inhalation injury--interstitial edema and ↓gas diffusion |
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Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 4. Complications • Inflammatory marker release ↑--------------- permeability, ↑------------, ↑PVR, and ↑-------------- constriction |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 4. Complications • Inflammatory marker release ↑capillary permeability, ↑SVR, ↑PVR, and ↑peripheral constriction |
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Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 4. Complications c. Urinary--Acute -------------- Necrosis (most common complication in this phase) |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 4. Complications c. Urinary--Acute Tubular Necrosis (most common complication in this phase) |
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Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 4. Complications c. Urinary--Acute Tubular Necrosis (most common complication in this phase) i. Can result from --------------- shock |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 4. Complications c. Urinary--Acute Tubular Necrosis (most common complication in this phase) i. Can result from hypovolemic shock |
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Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 4. Complications c. Urinary--Acute Tubular Necrosis (most common complication in this phase) ii. Electrical burns ↑------------- and ------------- release block renal tubules |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 4. Complications c. Urinary--Acute Tubular Necrosis (most common complication in this phase) ii. Electrical burns ↑Myoglobin and hemoglobin release block renal tubules |
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Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 4. Complications c. Urinary--Acute Tubular Necrosis (most common complication in this phase) iii. Treatment--__________ and diuretics, flush ___________ out |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 4. Complications c. Urinary--Acute Tubular Necrosis (most common complication in this phase) iii. Treatment--fluids and diuretics flush myoglobin out |
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Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 5. Nursing Management a. Airway Management i. Assessment of ---------- and ------------ |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 5. Nursing Management a. Airway Management i. Assessment of ventilation and oxygenation |
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Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 5. Nursing Management a. Airway Management ii. Early ------------ and ventilatory management within 1-______hrs (ABGs) |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 5. Nursing Management a. Airway Management ii. Early intubation and ventilatory management within 1-2hrs (ABGs) |
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Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 5. Nursing Management a. Airway Management iii. B__________ |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 5. Nursing Management a. Airway Management iii. Bronchoscopy |
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Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 5. Nursing Management a. Airway Management iv. Inhalation injury: humidified ----------% O2, ↑-----------, CDB, chest PT, ------------- |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 5. Nursing Management a. Airway Management iv. Inhalation injury: humidified 100% O2, ↑Fowlers, CDB, chest PT, suction |
|
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 5. Nursing Management a. Airway Management v. CO poisoning: ------------% O2 |
FIX
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Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 5. Nursing Management b. Fluid therapy i. Establish IV access--2 ------------- IVs and maybe central line |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 5. Nursing Management b. Fluid therapy i. Establish IV access--2 large bore IVs and maybe central line |
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Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 5. Nursing Management b. Fluid therapy ii. Consider therapy for burns >------------% TBSA |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 5. Nursing Management b. Fluid therapy ii. Consider therapy for burns >15% TBSA |
|
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 5. Nursing Management b. Fluid therapy iii. 1st -----------hrs colloids generally not given (leak out w/ ↑------------- cost more) |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 5. Nursing Management b. Fluid therapy iii. 1st 12hrs colloids generally not given (leak out w/ ↑permeability cost more) |
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Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 5. Nursing Management • Usually give ---------- instead |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 5. Nursing Management • Usually give LR instead |
|
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 5. Nursing Management • b. Fluid therapy iv. --------------- Formula: 4mL/kg/%TBSA = total fluid replacement in 24hrs |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 5. Nursing Management • b. Fluid therapy iv. Parkland Burn Formula: 4mL/kg/%TBSA = total fluid replacement in 24hrs |
|
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 5. Nursing Management • b. Fluid therapy iv. Parkland Burn Formula: ---------mL/kg/%TBSA = total ---------- replacement in 24hrs |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 5. Nursing Management • b. Fluid therapy iv. Parkland Burn Formula: 4mL/kg/%TBSA = total fluid replacement in 24hrs |
|
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 5. Nursing Management • b. Fluid therapy • ½ given in first -----------hrs from time of burn |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 5. Nursing Management • b. Fluid therapy • ½ given in first 8hrs from time of burn |
|
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 5. Nursing Management • b. Fluid therapy • ½ given over next -----------hrs |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 5. Nursing Management • b. Fluid therapy • ½ given over next 16hrs |
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Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 5. Nursing Management • b. Fluid therapy v. Monitory response to ------------ therapy |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 5. Nursing Management • b. Fluid therapy v. Monitory response to fluid therapy |
|
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 5. Nursing Management • b. Fluid therapy • Urine output should be ______-50mL/hr (if electrical _____-100mL/hr) |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 5. Nursing Management • b. Fluid therapy • Urine output should be 30-50mL/hr (if electrical 75-100mL/hr) |
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Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 5. Nursing Management • b. Fluid therapy • BP >____ • HR <_____ |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 5. Nursing Management • b. Fluid therapy • BP >90 • HR <120 |
|
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 5. Nursing Management c. Wound Care--done after --------- and IV ------- replacement (low priority) PAINFUL |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 5. Nursing Management c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL |
|
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 5. Nursing Management c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL i. Cleaning and debridement--remove -------- ------------skin (should not see blood) |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 5. Nursing Management c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL i. Cleaning and debridement--remove escar necrotic skin (should not see blood) |
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Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 5. Nursing Management c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL ii. Hydrotherapy--immersed in ------------/NA water bath or showered no longer than ______-30min/day to flush off loose necrotic skin |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 5. Nursing Management c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL ii. Hydrotherapy--immersed in isotonic/NA water bath or showered no longer than 20-30min/day to flush off loose necrotic skin |
|
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 5. Nursing Management c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL • Can cause --------------- (not sterile water) |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 5. Nursing Management c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL • Can cause cross contamination (not sterile water) |
|
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 5. Nursing Management c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL • May cause too much ------------ shift (pulls Na out) • For chemical burns flush w/ water no hotter than -----------° |
FIX
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Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 5. Nursing Management c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL iii. Open Method--exposing and ------------ wound w/ thin layer of topical ----------- |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 5. Nursing Management c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL iii. Open Method--exposing and covering wound w/ thin layer of topical antibiotic |
|
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 5. Nursing Management c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL iv. Closed Method--multiple dressing changes q-----------hrs (acticote can stay ---------- days) |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 5. Nursing Management c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL iv. Closed Method--multiple dressing changes q8hrs (acticote can stay 3 days) |
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Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 5. Nursing Management c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL v. Prevention of ____________--primary goal (some__________ from pts own flora) |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 5. Nursing Management c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL v. Prevention of infection--primary goal (some infections from pts own flora) |
|
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 5. Nursing Management c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL • Always gowned,-------------, and masked (strict visitor handwashing/gowning) • Remove dirty bandages ------------ sterile gloves, but put on ---------- sterile gloves |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 5. Nursing Management c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL • Always gowned, gloved, and masked (strict visitor handwashing/gowning) • Remove dirty bandages w/out sterile gloves, but put on w/ sterile gloves |
|
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 5. Nursing Management c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL • Clean ------------ infected wounds first (clean to dirty) • Antibiotics (------------, NaNO3, ---------------)--topical penetrates; can develop resistance (requires changing antibiotics) |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 5. Nursing Management c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL • Clean less infected wounds first (clean to dirty) • Antibiotics (Silvidine, NaNO3, Sulfamyoline)--topical penetrates; can develop resistance (requires changing antibiotics) |
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Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 5. Nursing Management c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL vi. Adequate pain control--IV -------------- before dressing changes (oral meds difficult w/ slow gut) |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 5. Nursing Management c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL vi. Adequate pain control--IV morphine before dressing changes (oral meds difficult w/ slow gut) |
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Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 5. Nursing Management c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL vii. Avoid hypothermia--room >-------------° and wound changes under ------------ |
Burns
VI. Phases A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs) 5. Nursing Management c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL vii. Avoid hypothermia--room >85° and wound changes under heat lamp |
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Burns
VI. Phases B. Acute Phase--occurs until wound is ------------ or completely covered by ------------- (weeks to months) |
Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) |
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Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 1. Pathophysiology--extracellular ------------ mobilization into ---------------- space pt diureses begins |
Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 1. Pathophysiology--extracellular fluid mobilization into intravascular space pt diureses begins |
|
Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 1. Pathophysiology--extracellular fluid mobilization into intravascular space pt diureses begins a. ---------------- (necrotic tissue) separates and begins to slough off formation of -------------- tissue (for partial thickness buns) |
Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 1. Pathophysiology--extracellular fluid mobilization into intravascular space pt diureses begins a. Escar (necrotic tissue) separates and begins to slough off formation of granulation tissue (for partial thickness buns) |
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Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 1. Pathophysiology--extracellular fluid mobilization into intravascular space pt diureses begins b. Full thickness burns must be covered by ---------- c. Return of ----------- sounds |
Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 1. Pathophysiology--extracellular fluid mobilization into intravascular space pt diureses begins b. Full thickness burns must be covered by skin grafts c. Return of bowel sounds |
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Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 2. Complications a. Alterations in Electrolytes--potential for all sorts of shifting (know -------- and -------- values) |
Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 2. Complications a. Alterations in Electrolytes--potential for all sorts of shifting (know K and Na values) |
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Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 2. Complications a. Alterations in Electrolytes--potential for all sorts of shifting (know K and Na values) i. Hyponatremia--excess-------------, ---------- suctioning, diarrhea, excess ----------- replacement, excess dieresis |
Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 2. Complications a. Alterations in Electrolytes--potential for all sorts of shifting (know K and Na values) i. Hyponatremia--excess hydrotherapy, NG suctioning, diarrhea, excess fluid replacement, excess dieresis |
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Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 2. Complications a. Alterations in Electrolytes--potential for all sorts of shifting (know K and Na values) • Muscle cramps, fatigue, weakness, HA, ------------ (think O2, --------, or ↑---------) |
Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 2. Complications a. Alterations in Electrolytes--potential for all sorts of shifting (know K and Na values) • Muscle cramps, fatigue, weakness, HA, confusion (think O2, Na, or ↑HR) |
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Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 2. Complications a. Alterations in Electrolytes--potential for all sorts of shifting (know K and Na values) ii. Hypernatremia--too much--------------- solution or not enough ----------- (dehydrated) |
Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 2. Complications a. Alterations in Electrolytes--potential for all sorts of shifting (know K and Na values) ii. Hypernatremia--too much hypertonic solution or not enough fluid (dehydrated) |
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Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 2. Complications a. Alterations in Electrolytes--potential for all sorts of shifting (know K and Na values) • Thirsty, dried --------------, -------------, seizures |
Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 2. Complications a. Alterations in Electrolytes--potential for all sorts of shifting (know K and Na values) • Thirsty, dried furrowed tongue, confusion, seizures |
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Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 2. Complications a. Alterations in Electrolytes--potential for all sorts of shifting (know K and Na values) iii. Hyperkalemia--Tissue -------------- (electrical burns ATN -------------- can’t filter out K) • Dysrhythmias, muscle weakness |
Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 2. Complications a. Alterations in Electrolytes--potential for all sorts of shifting (know K and Na values) iii. Hyperkalemia--Tissue destruction (electrical burns ATN kidney damage can’t filter out K) • Dysrhythmias, muscle weakness |
|
Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 2. Complications a. Alterations in Electrolytes--potential for all sorts of shifting (know K and Na values) iii. Hyperkalemia--Tissue destruction (electrical burns ATN kidney damage can’t filter out ----------) • ------------, muscle weakness |
Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 2. Complications a. Alterations in Electrolytes--potential for all sorts of shifting (know K and Na values) iii. Hyperkalemia--Tissue destruction (electrical burns ATN kidney damage can’t filter out K) • Dysrhythmias, muscle weakness |
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Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 2. Complications a. Alterations in Electrolytes--potential for all sorts of shifting (know K and Na values) iv. Hypokalemia--excess hydrotherapy, -------------, ------------ suction, wound ----------- • Dysrhythmias |
Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 2. Complications a. Alterations in Electrolytes--potential for all sorts of shifting (know K and Na values) iv. Hypokalemia--excess hydrotherapy, vomiting, GI suction, wound drainage • Dysrhythmias |
|
Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 2. Complications b. Infections--often gram (-) -------------- (leading death cause in hospitalized burn pts) |
Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 2. Complications b. Infections--often gram (-) pseudomonas (leading death cause in hospitalized burn pts) |
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Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 2. Complications b. Infections--often gram (-) pseudomonas (leading death cause in hospitalized burn pts) i. Risk factors: >---------% full thickness burns, children, ------------, preexisting disease |
Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 2. Complications b. Infections--often gram (-) pseudomonas (leading death cause in hospitalized burn pts) i. Risk factors: >30% full thickness burns, children, elderly, preexisting disease |
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Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 2. Complications b. Infections--often gram (-) pseudomonas (leading death cause in hospitalized burn pts) ii. ↑---------, ↑HR, ↑---------, ↓BP, ↓--------- output, mild confusion, ---------, ↓appetite, WBCs 10-20,000 (pt becomes immunosuppressed) can spread to blood (sepsis) |
Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 2. Complications b. Infections--often gram (-) pseudomonas (leading death cause in hospitalized burn pts) ii. ↑temp, ↑HR, ↑RR, ↓BP, ↓urine output, mild confusion, chills, ↓appetite, WBCs 10-20,000 (pt becomes immunosuppressed) can spread to blood (sepsis) |
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Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 2. Complications b. Infections--often gram (-) pseudomonas (leading death cause in hospitalized burn pts) ii. ↑temp, ↑----------, ↑RR, ↓BP, ↓urine output, ----------- confusion, chills, ↓-------------, WBCs 10-20,000 (pt becomes immunosuppressed) can spread to blood (-----------) |
Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 2. Complications b. Infections--often gram (-) pseudomonas (leading death cause in hospitalized burn pts) ii. ↑temp, ↑HR, ↑RR, ↓BP, ↓urine output, mild confusion, chills, ↓appetite, WBCs 10-20,000 (pt becomes immunosuppressed) can spread to blood (sepsis) |
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Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 2. Complications b. Infections--often gram (-) pseudomonas (leading death cause in hospitalized burn pts) ii. ↑temp, ↑HR, ↑RR, ↓BP, ↓urine output, mild confusion, chills, ↓appetite, WBCs 10-_________ (pt becomes immunosuppressed) can spread to blood (sepsis) |
Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 2. Complications b. Infections--often gram (-) pseudomonas (leading death cause in hospitalized burn pts) ii. ↑temp, ↑HR, ↑RR, ↓BP, ↓urine output, mild confusion, chills, ↓appetite, WBCs 10-20,000 (pt becomes immunosuppressed) can spread to blood (sepsis) |
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Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 2. Complications b. Infections--often gram (-) pseudomonas (leading death cause in hospitalized burn pts) iii. Burn can worsen--2nd degree can convert to ----------- degree |
Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 2. Complications b. Infections--often gram (-) pseudomonas (leading death cause in hospitalized burn pts) iii. Burn can worsen--2nd degree can convert to 3rd degree |
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Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 2. Complications b. Infections--often gram (-) pseudomonas (leading death cause in hospitalized burn pts) iv. Treatment--remove -------------- tissue early and wound ------------ as soon as possible |
Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 2. Complications b. Infections--often gram (-) pseudomonas (leading death cause in hospitalized burn pts) iv. Treatment--remove necrotic tissue early and wound closure as soon as possible |
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Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 2. Complications b. Infections--often gram (-) pseudomonas (leading death cause in hospitalized burn pts) iv. Treatment--remove necrotic tissue early and wound closure as soon as possible • IV antibiotics not given unless pt is truly ------------- (can create resistance) • ------------ everything if sepsis is suspected |
Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 2. Complications b. Infections--often gram (-) pseudomonas (leading death cause in hospitalized burn pts) iv. Treatment--remove necrotic tissue early and wound closure as soon as possible • IV antibiotics not given unless pt is truly septic (can create resistance) • Culture everything if sepsis is suspected |
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Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 2. Complications c. Neurologic--extreme disorientation i. ---------------- if no underlying cause of confusion (---------------’s Syndrome) |
Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 2. Complications c. Neurologic--extreme disorientation i. ICU psychosis if no underlying cause of confusion (Sundowner’s Syndrome) |
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Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 2. Complications d. Musculoskeletal--prevention of --------------- (frequent ----------, make pt/family aware) |
Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 2. Complications d. Musculoskeletal--prevention of contractions (frequent ROB, make pt/family aware) |
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Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 2. Complications e. G__________ i. IV antibiotics and -------------- can cause diarrhea |
Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 2. Complications e. Gastrointestinal i. IV antibiotics and tube feedings can cause diarrhea |
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Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 2. Complications e. Gastrointestinal ii. Too much ----------- + ------------ ↓motility constipation |
Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 2. Complications e. Gastrointestinal ii. Too much narcotics + bed rest ↓motility constipation |
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Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 2. Complications e. Gastrointestinal iii. High risk for _________--↓blood flow to ________ track (_________’s ulcer-burn specific) |
Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 2. Complications e. Gastrointestinal iii. High risk for ulcers--↓blood flow to GI track (Curling’s ulcer-burn specific) |
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Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 2. Complications e. Gastrointestinal • Tx w/ ___________, -__________-blocker (Zantac, etc.) |
Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 2. Complications e. Gastrointestinal • Tx w/ antacid, H2-blocker (Zantac, etc.) |
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Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 2. Complications f. ___________--risk for ↑blood sugar (check frequently-often need ________ coverage) |
Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 2. Complications f. Endocrine--risk for ↑blood sugar (check frequently-often need insulin coverage) |
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Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 3. Skin Grafting a. Biological Dressings--temp wound closure prevents ------------- -------------- protects ------------- tissue until autogafting is possible (will be rejected due to diff DNA) |
Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 3. Skin Grafting a. Biological Dressings--temp wound closure prevents infection fluid loss protects granulation tissue until autogafting is possible (will be rejected due to diff DNA) |
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Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 3. Skin Grafting a. Biological Dressings--temp wound closure prevents infection fluid loss protects granulation tissue until autogafting is possible (will be rejected due to diff DNA) • Used until ----------------- established (48hrs) and up to several weeks |
Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 3. Skin Grafting a. Biological Dressings--temp wound closure prevents infection fluid loss protects granulation tissue until autogafting is possible (will be rejected due to diff DNA) • Used until revascularization established (48hrs) and up to several weeks |
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Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 3. Skin Grafting a. Biological Dressings--temp wound closure prevents infection fluid loss protects granulation tissue until autogafting is possible (will be rejected due to diff DNA) i. Homografts (--------------)--skin from --------- (skin bank-fresh or frozen) |
Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 3. Skin Grafting a. Biological Dressings--temp wound closure prevents infection fluid loss protects granulation tissue until autogafting is possible (will be rejected due to diff DNA) i. Homografts (Allografts)--skin from humans (skin bank-fresh or frozen) |
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Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 3. Skin Grafting a. Biological Dressings--temp wound closure prevents infection fluid loss protects granulation tissue until autogafting is possible (will be rejected due to diff DNA) ii. Heterografts (-----------)--from ------------- (mostly pigs) |
Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 3. Skin Grafting a. Biological Dressings--temp wound closure prevents infection fluid loss protects granulation tissue until autogafting is possible (will be rejected due to diff DNA) ii. Heterografts (xenografts)--from animals (mostly pigs) |
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Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 3. Skin Grafting b. Synthetic Dressings (------------)--dermalayer becomes permanent part of ------------ (absorbed) and top later removed in ~______weeks when autograft is placed (less costly) |
Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 3. Skin Grafting b. Synthetic Dressings (Integra)--dermalayer becomes permanent part of wound (absorbed) and top later removed in ~2weeks when autograft is placed (less costly) |
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Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 3. Skin Grafting c. Autograft--unburned skin removed w/ ------------ (donor site take _______-15days to heal) |
Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 3. Skin Grafting c. Autograft--unburned skin removed w/ dermatome (donor site take 10-15days to heal) |
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Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 3. Skin Grafting c. Autograft--unburned skin removed w/ dermatome (donor site take 10-15days to heal) i. Donor sites ii. Cultured ---------------- autografts--pt w/out enough own skin (>----------% body need) |
Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 3. Skin Grafting c. Autograft--unburned skin removed w/ dermatome (donor site take 10-15days to heal) i. Donor sites ii. Cultured epithelial autografts--pt w/out enough own skin (>50% body need) |
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Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 3. Skin Grafting c. Autograft--unburned skin removed w/ dermatome (donor site take 10-15days to heal) • Remove skin sample and culture in medium w/ ------------- growth factor • Takes _________-4 weeks for skin to grow (use __________ graft during this time) |
Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 3. Skin Grafting c. Autograft--unburned skin removed w/ dermatome (donor site take 10-15days to heal) • Remove skin sample and culture in medium w/ epidermal growth factor • Takes 3-4 weeks for skin to grow (use temporary graft during this time) |
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Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 4. Nursing Management a. Wound Management/Care i. Cleanse and ----------- to prevent bacterial growth ii. Minimize further destruction of ----------- skin iii. Promote wound ----------------/successful skin grafting |
Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 4. Nursing Management a. Wound Management/Care i. Cleanse and debride to prevent bacterial growth ii. Minimize further destruction of viable skin iii. Promote wound reepithelialization/successful skin grafting |
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Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 4. Nursing Management b. Pain management--PCA (document effectiveness and assess for changes) i. ----------------- methods esp. useful in burn (distractions, visualization, etc.) |
Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 4. Nursing Management b. Pain management--PCA (document effectiveness and assess for changes) i. Nonpharmacologic methods esp. useful in burn (distractions, visualization, etc.) |
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Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 4. Nursing Management c. PT and OT--prevents ------------- (get pt family involved) |
Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 4. Nursing Management c. PT and OT--prevents contractures (get pt family involved) |
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Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 4. Nursing Management d. Nutritional therapy--hypermetabolic ---------------- state worsens w/ anxiety/pain i. Need nutrition consultation (need food w/in -----------hrs) |
Burns
VI. Phases B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months) 4. Nursing Management d. Nutritional therapy--hypermetabolic hypercatabolic state worsens w/ anxiety/pain i. Need nutrition consultation (need food w/in 72hrs) |
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Burns
VI. Phases C. Rehabilitation Phase--wounds are healed/grafts are in place 1. Scar control--prevent hypertrophic scaring due to ↑------------ deposit a. Apply pressure garments (-----------hr/day for 1-2yrs until complete healing) to scar and ---------------- to prevent collagen deposit and keep scar fat |
Burns
VI. Phases C. Rehabilitation Phase--wounds are healed/grafts are in place 1. Scar control--prevent hypertrophic scaring due to ↑collagen deposit a. Apply pressure garments (23hr/day for 1-2yrs until complete healing) to scar and massage to prevent collagen deposit and keep scar fat |
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Burns
VI. Phases C. Rehabilitation Phase--wounds are healed/grafts are in place 1. Scar control--prevent hypertrophic scaring due to ↑collagen deposit b. Keep out of sun for ----------yr (to prevent ---------------) |
Burns
VI. Phases C. Rehabilitation Phase--wounds are healed/grafts are in place 1. Scar control--prevent hypertrophic scaring due to ↑collagen deposit b. Keep out of sun for 1yr (to prevent hyperpigmentation) |
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Burns
VI. Phases C. Rehabilitation Phase--wounds are healed/grafts are in place 2. Prevent ___________--need PT, splinting, exercise/positioning a. Occur due to tendons shortening and CT replaced by scar tissue limits mobility |
Burns
VI. Phases C. Rehabilitation Phase--wounds are healed/grafts are in place 2. Prevent contractures--need PT, splinting, exercise/positioning a. Occur due to tendons shortening and CT replaced by scar tissue limits mobility |
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Burns
VI. Phases C. Rehabilitation Phase--wounds are healed/grafts are in place 2. Prevent contractures--need PT, splinting, exercise/positioning a. Occur due to tendons--------------- and CT replaced by ------------ limits mobility |
Burns
VI. Phases C. Rehabilitation Phase--wounds are healed/grafts are in place 2. Prevent contractures--need PT, splinting, exercise/positioning a. Occur due to tendons shortening and CT replaced by scar tissue limits mobility |
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Burns
VII. Psychosocial Care--very important A. Physical and ------------- scars (array of emotions) B. Team effort--support from nurses, -------------, PT, OT, ------------ workers |
Burns
VII. Psychosocial Care--very important A. Physical and emotional scars (array of emotions) B. Team effort--support from nurses, physicians, PT, OT, social workers |
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Burns
VII. Psychosocial Care--very important C. Family and patient ------------ groups D. Psychiatric treatment--__________ |
Burns
VII. Psychosocial Care--very important C. Family and patient support groups D. Psychiatric treatment--depression |
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Burns
VII. Psychosocial Care--very important E. Nursing diagnosis--disturbed body image related to --------------- secondary to burn 1. Goal--pt sets realistic goals regarding ------------ lifestyle 2. Goal--acceptance of ----------- body image |
Burns
VII. Psychosocial Care--very important E. Nursing diagnosis--disturbed body image related to disfigurement secondary to burn 1. Goal--pt sets realistic goals regarding future lifestyle 2. Goal--acceptance of altered body image |
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Shock
I. Definition--syndrome characterized by ↓--------- perfusion and impaired --------------- (imbalance btw supply and demand for O2 and nutrients) |
Shock
I. Definition--syndrome characterized by ↓tissue perfusion and impaired cellular metabolism (imbalance btw supply and demand for O2 and nutrients) |
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Shock
II. Low Blood Flow Shock A. Cardiogenic--systolic/diastolic myocardium dysfunction compromised CO cell hypoperfusion 1. Types (mortality rates 50-______%) a. Systolic--heart can’t pump blood _________ (L ventricle problem) b. Diastolic--heart can’t relax and get enough preload (cardiac tamppnade) |
Shock
II. Low Blood Flow Shock A. Cardiogenic--systolic/diastolic myocardium dysfunction compromised CO cell hypoperfusion 1. Types (mortality rates 50-80%) a. Systolic--heart can’t pump blood forward (L ventricle problem) |
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Shock
II. Low Blood Flow Shock A. Cardiogenic--systolic/diastolic myocardium dysfunction compromised CO cell hypoperfusion 1. Types (mortality rates 50-80%) a. Systolic--heart can’t pump blood forward (L ventricle problem) b. Diastolic--heart can’t relax and get enough ---------- (cardiac -----------) **Can have occurance w/ ---------- ventricle if it is severe enough |
Shock
II. Low Blood Flow Shock A. Cardiogenic--systolic/diastolic myocardium dysfunction compromised CO cell hypoperfusion 1. Types (mortality rates 50-80%) a. Systolic--heart can’t pump blood forward (L ventricle problem) b. Diastolic--heart can’t relax and get enough preload (cardiac tamppnade) **Can have occurance w/ R ventricle if it is severe enough |
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Shock
II. Low Blood Flow Shock A. Cardiogenic- 2. Causes a. MI--dysrhythmias and ------------- muscles rupture (5-______% pts develop shock w/in 48hrs) b. Cardiomyopathy--viral --------- failure |
Shock
II. Low Blood Flow Shock A. Cardiogenic- 2. Causes a. MI--dysrhythmias and papillary muscles rupture (5-10% pts develop shock w/in 48hrs) b. Cardiomyopathy--viral heart failure |
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Shock
II. Low Blood Flow Shock A. Cardiogenic- 2. Causes c. ----------- (L ventricular dysfunction) or ------------ (R ventricular dysfunction) HTN d. Blunt -------------- injury--briusing of heart |
Shock
II. Low Blood Flow Shock A. Cardiogenic- 2. Causes c. Systemic (L ventricular dysfunction) or Pulmonary (R ventricular dysfunction) HTN d. Blunt cardiac injury--briusing of heart |
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Shock
II. Low Blood Flow Shock A. Cardiogenic- 2. Causes e. Myocardial ------------ from sepsis--inflammatory markers release (TNF) ↓--------, ↓-------- |
Shock
II. Low Blood Flow Shock 2. Causes e. Myocardial depression from sepsis--inflammatory markers release (TNF) ↓SV, ↓CO |
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Shock
II. Low Blood Flow Shock A. Cardiogenic- 3. Clinical Manifestations--similar to ----------- failure |
Shock
II. Low Blood Flow Shock 3. Clinical Manifestations--similar to acute heart failure |
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Shock
II. Low Blood Flow Shock A. Cardiogenic- 3. Clinical Manifestations--similar to acute heart failure a. ↑----------, ↓---------- w. narrowed pulse pressure |
Shock
II. Low Blood Flow Shock 3. Clinical Manifestations--similar to acute heart failure a. ↑HR, ↓BP w. narrowed pulse pressure b. Tachypneic w/ crackles on auscultation |
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Shock
II. Low Blood Flow Shock A. Cardiogenic- 3. Clinical Manifestations--similar to acute heart failure b. -------------- w/ crackles on auscultation |
Shock
II. Low Blood Flow Shock 3. Clinical Manifestations--similar to acute heart failure b. Tachypneic w/ crackles on auscultation |
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Shock
II. Low Blood Flow Shock A. Cardiogenic- 3. Clinical Manifestations--similar to acute heart failure c. Signs of peripheral ------------- (cyanosis, -----------, ↓cap refill) |
Shock
II. Low Blood Flow Shock 3. Clinical Manifestations--similar to acute heart failure c. Signs of peripheral hypoperfusion (cyanosis, pallor, ↓cap refill) |
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Shock
II. Low Blood Flow Shock A. Cardiogenic- 3. Clinical Manifestations--similar to acute heart failure d. Hemodynamic findings (↑----------, ↑PVR, ↓-------, ↑-------: due to body clamping down) |
Shock
II. Low Blood Flow Shock 3. Clinical Manifestations--similar to acute heart failure d. Hemodynamic findings (↑PAWP, ↑PVR, ↓CO, ↑SVR-due to body clamping down) |
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Shock
II. Low Blood Flow Shock A. Cardiogenic- 3. Clinical Manifestations--similar to acute heart failure e. ↓------- output (↓-------- perfusion) |
Shock
II. Low Blood Flow Shock 3. Clinical Manifestations--similar to acute heart failure e. ↓Urine output (↓renal perfusion) |
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Shock
II. Low Blood Flow Shock A. Cardiogenic- 3. Clinical Manifestations--similar to acute heart failure f. ---------- and water retention (renin-_________-aldosterone activation) |
Shock
II. Low Blood Flow Shock 3. Clinical Manifestations--similar to acute heart failure f. Na and water retention (renin-angiotensin-aldosterone activation) |
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Shock
II. Low Blood Flow Shock A. Cardiogenic- 3. Clinical Manifestations--similar to acute heart failure g. Confusion and ---------- |
Shock
II. Low Blood Flow Shock 3. Clinical Manifestations--similar to acute heart failure g. Confusion and anxiety |
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Shock
II. Low Blood Flow Shock A. Cardiogenic- 3. Diagnostic Studies a. Cardiac _________ b. E_______ |
Shock
II. Low Blood Flow Shock 3. Diagnostic Studies a. Cardiac enzymes b. EKG |
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Shock
II. Low Blood Flow Shock A. Cardiogenic- 3. Diagnostic Studies c. C______ d. _________--valular dysfunction and EF |
Shock
II. Low Blood Flow Shock 3. Diagnostic Studies c. CXR d. ECHO--valular dysfunction and EF |
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Shock
II. Low Blood Flow Shock A. Cardiogenic- 3. Diagnostic Studies e. Insertion of _________--monitor fluid status f. Emergent __________ |
Shock
II. Low Blood Flow Shock A. Cardiogenic- 3. Diagnostic Studies e. Insertion of PA catheter--monitor fluid status f. Emergent catheterization |
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Shock
II. Low Blood Flow Shock B. ____________--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met. |
Shock
II. Low Blood Flow Shock B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met. |
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Shock
II. Low Blood Flow Shock B. Hypovolemic--intravascular fluid volume loss ------------- to rapid blood loss (internal or external) low blood flow ↓---------- return ↓tissue ------------/impaired cell met. |
Shock
II. Low Blood Flow Shock B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met. |
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Shock
II. Low Blood Flow Shock B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met. 1. -------------- loss--true loss of fluid from vascular space (hemorrhage, vomiting, diarrhea) |
Shock
II. Low Blood Flow Shock B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met. 1. Absolute loss--true loss of fluid from vascular space (hemorrhage, vomiting, diarrhea) |
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Shock
II. Low Blood Flow Shock B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met. 1. Absolute loss--true loss of fluid from vascular space (-----------, vomiting, ----------) |
Shock
II. Low Blood Flow Shock B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met. 1. Absolute loss--true loss of fluid from vascular space (hemorrhage, vomiting, diarrhea) |
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Shock
II. Low Blood Flow Shock B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met. 2. Relative loss--fluid there but moved elsewhere from ↑---------- in burn/sepsis (---------- spacing) |
Shock
II. Low Blood Flow Shock B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met. 2. Relative loss--fluid there but moved elsewhere from ↑cap perm. in burn/sepsis (2nd spacing) |
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Shock
II. Low Blood Flow Shock B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met. 3. Ability to compensate (if <---------% loss body is able to compensate w/out ---------- symptoms) |
Shock
II. Low Blood Flow Shock B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met. 3. Ability to compensate (if <15% loss body is able to compensate w/out outward symptoms) |
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Shock
II. Low Blood Flow Shock B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met. 3. Ability to compensate (if <15% loss body is able to compensate w/out outward symptoms) a. 15-______%--sympathetic venous system response b. >_____% loss--volume must be replaced with blood |
Shock
II. Low Blood Flow Shock B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met. 3. Ability to compensate (if <15% loss body is able to compensate w/out outward symptoms) a. 15-30%--sympathetic venous system response b. >30% loss--volume must be replaced with blood |
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Shock
II. Low Blood Flow Shock B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met. 3. Ability to compensate (if <15% loss body is able to compensate w/out outward symptoms) a. 15-30%--sympathetic ------------ system response b. >30% loss--volume must be replaced with ----------- |
Shock
II. Low Blood Flow Shock B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met. 3. Ability to compensate (if <15% loss body is able to compensate w/out outward symptoms) a. 15-30%--sympathetic venous system response b. >30% loss--volume must be replaced with blood |
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Shock
II. Low Blood Flow Shock B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met. 3. Ability to compensate (if <15% loss body is able to compensate w/out outward symptoms) c. >_____% loss--irreversible damage to tissues |
Shock
II. Low Blood Flow Shock B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met. 3. Ability to compensate (if <15% loss body is able to compensate w/out outward symptoms) c. >40% loss--irreversible damage to tissues |
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Shock
II. Low Blood Flow Shock B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met. 3. Ability to compensate (if <15% loss body is able to compensate w/out outward symptoms) c. >40% loss--irreversible damage to -------- |
Shock
II. Low Blood Flow Shock B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met. 3. Ability to compensate (if <15% loss body is able to compensate w/out outward symptoms) c. >40% loss--irreversible damage to tissues |
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Shock
II. Low Blood Flow Shock B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met. 3. Causes a. _______--external penetrating b. Severe ______ bleeding--2nd main cause |
Shock
II. Low Blood Flow Shock B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met. 3. Causes a. Trauma--external penetrating b. Severe GI bleeding--2nd main cause |
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Shock
II. Low Blood Flow Shock B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met. 3. Causes c. ----------- pregnancy d. ------------ fracture |
Shock
II. Low Blood Flow Shock B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met. 3. Causes c. Ectopic pregnancy d. Pelvic fracture |
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Shock
II. Low Blood Flow Shock B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met. 3. Causes d. Pelvic fracture e. ---------- obstruction--fluid in colon f. Ascites due to --------- dysfunction |
Shock
II. Low Blood Flow Shock B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met. 3. Causes d. Pelvic fracture e. Colon obstruction--fluid in colon f. Ascites due to liver dysfunction |
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Shock
II. Low Blood Flow Shock B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met. 4. Clinical Manifestations--result of ------------- mechanisms (can support BP if <---------% loss) |
Shock
II. Low Blood Flow Shock B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met. 4. Clinical Manifestations--result of compensatory mechanisms (can support BP if <30% loss) |
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Shock
II. Low Blood Flow Shock B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met. 4. Clinical Manifestations--result of compensatory mechanisms (can support BP if <30% loss) a. Initial symptoms--_________ i. ↑______ (careful b/c some meds keep HR lower than expected--blunting effect) |
Shock
II. Low Blood Flow Shock B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met. 4. Clinical Manifestations--result of compensatory mechanisms (can support BP if <30% loss) a. Initial symptoms--compensating i. ↑HR (careful b/c some meds keep HR lower than expected--blunting effect) |
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Shock
II. Low Blood Flow Shock B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met. 4. Clinical Manifestations--result of compensatory mechanisms (can support BP if <30% loss) a. Initial symptoms--compensating ii. ↑-------- iii. ↑------- (not a pump problem) |
Shock
II. Low Blood Flow Shock B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met. 4. Clinical Manifestations--result of compensatory mechanisms (can support BP if <30% loss) a. Initial symptoms--compensating ii. ↑RR iii. ↑CO (not a pump problem) |
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Shock
II. Low Blood Flow Shock B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met. 4. Clinical Manifestations--result of compensatory mechanisms (can support BP if <30% loss) a. Initial symptoms--compensating iv. ↓-------- (due to ↑HR) and ↓---------- |
Shock
II. Low Blood Flow Shock B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met. 4. Clinical Manifestations--result of compensatory mechanisms (can support BP if <30% loss) a. Initial symptoms--compensating iv. ↓SV (due to ↑HR) and ↓PCWP |
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Shock
II. Low Blood Flow Shock B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met. 4. Clinical Manifestations--result of compensatory mechanisms (can support BP if <30% loss) b. Later symptoms--as compensatory mechanisms fail i. ↓--------- ii, ↓-------- output iii. Skin --------, cool, clammy |
Shock
II. Low Blood Flow Shock B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met. 4. Clinical Manifestations--result of compensatory mechanisms (can support BP if <30% loss) b. Later symptoms--as compensatory mechanisms fail i. ↓CO ii, ↓urine output iii. Skin pale, cool, clammy |
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Shock
II. Low Blood Flow Shock B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met. 5. Diagnostic Studies a. Hg/______--initially normal (get ________) ↓ after give fluids (reflection of actual values) |
Shock
II. Low Blood Flow Shock B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met. 5. Diagnostic Studies a. Hg/Ht--initially normal (get baseline) ↓ after give fluids (reflection of actual values) |
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Shock
II. Low Blood Flow Shock B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met. 5. Diagnostic Studies a. Hg/Ht--initially normal (get baseline) ↓ after give ------------ (reflection of ----------- values) |
Shock
II. Low Blood Flow Shock B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met. 5. Diagnostic Studies a. Hg/Ht--initially normal (get baseline) ↓ after give fluids (reflection of actual values) |
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Shock
II. Low Blood Flow Shock B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met. 5. Diagnostic Studies b. Urine--↓--------- output (↓------------ perfusion), ↑specific ---------- (renin-aldosterone release) |
Shock
II. Low Blood Flow Shock B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met. 5. Diagnostic Studies b. Urine--↓urine output (↓kidney perfusion), ↑specific gravity (renin-aldosterone release) |
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Shock
II. Low Blood Flow Shock B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met. 5. Diagnostic Studies c. Elevated lactic acid levels--acidotic due to ----------- metabolism in tissue from ↓-------- |
Shock
II. Low Blood Flow Shock B. Hypovolemic--intravascular fluid volume loss secondary to rapid blood loss (internal or external) low blood flow ↓venous return ↓tissue perfusion/impaired cell met. 5. Diagnostic Studies c. Elevated lactic acid levels--acidotic due to anaerobic metabolism in tissue from ↓O2 |
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Shock
III. Misdistribution of Blood Flow Shock A. ____________--hemodynamic phenomenon that occurs after spinal cord injury at or above T5 resulting in massive vasodilation w/out compensation (onset can occur in 30min and last up to 6 weeks) |
Shock
III. Misdistribution of Blood Flow Shock A. Neurogenic--hemodynamic phenomenon that occurs after spinal cord injury at or above T5 resulting in massive vasodilation w/out compensation (onset can occur in 30min and last up to 6 weeks) |
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Shock
III. Misdistribution of Blood Flow Shock A. Neurogenic--hemodynamic phenomenon that occurs after ------------- injury at or above --------- resulting in massive vasodilation w/out compensation (onset can occur in --------min and last up to 6 weeks) |
Shock
III. Misdistribution of Blood Flow Shock A. Neurogenic--hemodynamic phenomenon that occurs after spinal cord injury at or above T5 resulting in massive vasodilation w/out compensation (onset can occur in 30min and last up to 6 weeks) |
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Shock
III. Misdistribution of Blood Flow Shock A. Neurogenic-- 1. Causes--loss of ----------- vasoconstrictor tone pooling of blood in vessels |
Shock
III. Misdistribution of Blood Flow Shock A. Neurogenic-- 1. Causes--loss of SNS vasoconstrictor tone pooling of blood in vessels |
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Shock
III. Misdistribution of Blood Flow Shock A. Neurogenic-- 1. Causes--loss of SNS vasoconstrictor tone pooling of blood in vessels a. ----------- injury b. ----------- anesthesia c. Drugs: -------------- |
Shock
III. Misdistribution of Blood Flow Shock A. Neurogenic-- 1. Causes--loss of SNS vasoconstrictor tone pooling of blood in vessels a. Spinal cord injury b. Spinal anesthesia c. Drugs--benzodiazepines |
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Shock
III. Misdistribution of Blood Flow Shock A. Neurogenic-- 2. Clinical Manifestations a. H_________ b. ↓________ (no compensation) ↓_____ (PNS takes over b/c no SNS stimulation) |
Shock
III. Misdistribution of Blood Flow Shock A. Neurogenic-- 2. Clinical Manifestations a. Hypotension b. ↓HR (no compensation) ↓CO (PNS takes over b/c no SNS stimulation) |
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Shock
III. Misdistribution of Blood Flow Shock A. Neurogenic-- 2. Clinical Manifestations c. ---------------- (take on room’s temp) due to hypothalamic dysfunction (can’t regulate) |
Shock
III. Misdistribution of Blood Flow Shock A. Neurogenic-- 2. Clinical Manifestations c. Poikilpthermia (take on room’s temp) due to hypothalamic dysfunction (can’t regulate) |
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Shock
III. Misdistribution of Blood Flow Shock A. Neurogenic-- 2. Clinical Manifestations c. Poikilpthermia (take on room’s temp) due to hypothalamic dysfunction (can’t regulate) i. Massive ----------- (often cold) |
FIX
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Shock
III. Misdistribution of Blood Flow Shock B. Septic--presence of sepsis w/ ----------- despite fluid resuscitation w/ presence of tissue ---------- abnormalities (mortality rates 28-50%) |
Shock
III. Misdistribution of Blood Flow Shock B. Septic--presence of sepsis w/ hypotension despite fluid resuscitation w/ presence of tissue perfusion abnormalities (mortality rates 28-50%) |
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Shock
III. Misdistribution of Blood Flow Shock B. Septic--presence of sepsis w/ hypotension despite fluid resuscitation w/ presence of tissue perfusion abnormalities (mortality rates 28-____%) |
Shock
III. Misdistribution of Blood Flow Shock B. Septic--presence of sepsis w/ hypotension despite fluid resuscitation w/ presence of tissue perfusion abnormalities (mortality rates 28-50%) |
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Shock
III. Misdistribution of Blood Flow Shock B. Septic--presence of sepsis w/ hypotension despite fluid resuscitation w/ presence of tissue perfusion abnormalities (mortality rates 28-50%) 1. Sepsis--systemic inflammatory response to a documented/suspected -------- |
Shock
III. Misdistribution of Blood Flow Shock B. Septic--presence of sepsis w/ hypotension despite fluid resuscitation w/ presence of tissue perfusion abnormalities (mortality rates 28-50%) 1. Sepsis--systemic inflammatory response to a documented/suspected infection |
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Shock
III. Misdistribution of Blood Flow Shock 2. Pathophysiology--caused mostly --------- (-) bacteria (higher ---------- rates) |
Shock
III. Misdistribution of Blood Flow Shock 2. Pathophysiology--caused mostly gram (-) bacteria (higher mortality rates) |
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Shock
III. Misdistribution of Blood Flow Shock 2. Pathophysiology-- a. Release of --------- inflammatory response ↑cap ------------ and vasodilation |
Shock
III. Misdistribution of Blood Flow Shock 2. Pathophysiology-- a. Release of endotoxins inflammatory response ↑cap permeability and vasodilation |
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Shock
III. Misdistribution of Blood Flow Shock 2. Pathophysiology-- b. Microthrombi ------------- intravascular ------------- (DIC) |
Shock
III. Misdistribution of Blood Flow Shock 2. Pathophysiology-- b. Microthrombi disseminated intravascular coagulation (DIC) |
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Shock
III. Misdistribution of Blood Flow Shock 2. Pathophysiology-- c. Pts are in---------------- state (like burns) |
Shock
III. Misdistribution of Blood Flow Shock 2. Pathophysiology-- c. Pts are in hypermetabolic state (like burns) |
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Shock
III. Misdistribution of Blood Flow Shock 3. Clinical Manifestations--systemic response (everything just starts to ----------) |
Shock
III. Misdistribution of Blood Flow Shock 3. Clinical Manifestations--systemic response (everything just starts to shut down) |
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Shock
III. Misdistribution of Blood Flow Shock a. Alteration in --------- status (early) |
Shock
III. Misdistribution of Blood Flow Shock a. Alteration in mental status (early) |
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Shock
III. Misdistribution of Blood Flow Shock b. Skin warm and flushed--due to --------------- (early) |
Shock
III. Misdistribution of Blood Flow Shock b. Skin warm and flushed--due to vasodilation (early) |
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Shock
III. Misdistribution of Blood Flow Shock d. Significant ↑_______--overcompensation (early) |
Shock
III. Misdistribution of Blood Flow Shock d. Significant ↑CO--overcompensation (early) |
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Shock
III. Misdistribution of Blood Flow Shock e. ↑_______2--tissues not properly utilizing available O2 seen w/ pulmonary catheter (early) |
Shock
III. Misdistribution of Blood Flow Shock e. ↑SvO2--tissues not properly utilizing available O2 seen w/ pulmonary catheter (early) |
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Shock
III. Misdistribution of Blood Flow Shock e. ↑SvO2--tissues not properly utilizing available --------2 seen w/ ---------- catheter (early) |
Shock
III. Misdistribution of Blood Flow Shock e. ↑SvO2--tissues not properly utilizing available O2 seen w/ pulmonary catheter (early) |
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Shock
III. Misdistribution of Blood Flow Shock f. ↓_____--dilation |
Shock
III. Misdistribution of Blood Flow Shock f. ↓SVR--dilation |
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Shock
III. Misdistribution of Blood Flow Shock g. H_________ h. GI bleeding/_________ ileus |
Shock
III. Misdistribution of Blood Flow Shock g. Hypotension h. GI bleeding/paralytic ileus |
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Shock
III. Misdistribution of Blood Flow Shock i. Hypoxemia w/ resp failure/ARDS (_____% will go on to resp failure and ______% to ARDS) |
Shock
III. Misdistribution of Blood Flow Shock i. Hypoxemia w/ resp failure/ARDS (85% will go on to resp failure and 40% to ARDS) |
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Shock
III. Misdistribution of Blood Flow Shock i. ---------- w/ resp failure/ARDS (85% will go on to resp failure and 40% to ARDS) |
Shock
III. Misdistribution of Blood Flow Shock j. ↓------- (late) ↓---------- output; skin cool (clamping down) and mottled (very late) |
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Shock
III. Misdistribution of Blood Flow Shock C. Anaphylactic--acute, life-threatening - (allergic) reaction to sensitizing substance resulting in massive ------------, release of vasoactive -------------, and ↑-------------- permeability |
III. Misdistribution of Blood Flow Shock
C. Anaphylactic--acute, life-threatening hypersensitivity (allergic) reaction to sensitizing substance resulting in massive vasodilation, release of vasoactive mediators, and ↑capillary permeability |
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Shock
III. Misdistribution of Blood Flow Shock C. Anaphylactic 1. Causes--Drug (also IV drug infusions), ------------, vaccine, --------, or insect --------- |
III. Misdistribution of Blood Flow Shock
C. Anaphylactic 1. Causes--Drug (also IV drug infusions), chemical, vaccine, food, or insect venom |
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Shock
III. Misdistribution of Blood Flow Shock C. Anaphylactic 2. Clinical Manifestations--sudden onset a. Hypotension, ---------- |
III. Misdistribution of Blood Flow Shock
C. Anaphylactic 2. Clinical Manifestations--sudden onset a. Hypotension, chest pain |
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Shock
III. Misdistribution of Blood Flow Shock C. Anaphylactic 2. Clinical Manifestations--sudden onset b. Swelling of ------- and -------- |
III. Misdistribution of Blood Flow Shock
C. Anaphylactic 2. Clinical Manifestations--sudden onset b. Swelling of lips and tongue |
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Shock
III. Misdistribution of Blood Flow Shock C. Anaphylactic 2. Clinical Manifestations--sudden onset c. Wheezing and stridor due to ------------ edema and --------------- resp distress |
III. Misdistribution of Blood Flow Shock
C. Anaphylactic 2. Clinical Manifestations--sudden onset c. Wheezing and stridor due to laryngeal edema and bronchoconstriction resp distress |
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Shock
III. Misdistribution of Blood Flow Shock C. Anaphylactic 2. Clinical Manifestations--sudden onset d. Skin--flushing, ----------, -------- |
III. Misdistribution of Blood Flow Shock
C. Anaphylactic 2. Clinical Manifestations--sudden onset d. Skin--flushing, pruritus, uticaria |
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Shock
III. Misdistribution of Blood Flow Shock C. Anaphylactic 2. Clinical Manifestations--sudden onset e. A________ f. Edema from fluid leaking into _______ |
III. Misdistribution of Blood Flow Shock
C. Anaphylactic 2. Clinical Manifestations--sudden onset e. Angioedema f. Edema from fluid leaking into interstitial space |
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Shock
III. Misdistribution of Blood Flow Shock C. Anaphylactic 3. Patient education--find cause of -----------, carry -------- pen, and wear --------- bracelet |
III. Misdistribution of Blood Flow Shock
C. Anaphylactic 3. Patient education--find cause of allergy, carry epi pen, and wear med alert bracelet |
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Shock
IV. Stages A. Initial Stage--body responding at cellular level by utilizing ---------- metabolism (no outward signs) |
Shock
IV. Stages A. Initial Stage--body responding at cellular level by utilizing anaerobic metabolism (no outward signs) |
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Shock
IV. Stages B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain --------- |
Shock
IV. Stages B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis |
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Shock
IV. Stages B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis 1. If recovery occurs at this stage little ---------- done |
Shock
IV. Stages B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis 1. If recovery occurs at this stage little damage done |
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Shock
IV. Stages B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis 2. Clinical Manifestations--reflect body’s response to imbalance in -----------2 supply and demand (chemo and baroreceptros sense ↓--------- and attempt to raise it) |
Shock
IV. Stages B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis 2. Clinical Manifestations--reflect body’s response to imbalance in O2 supply and demand (chemo and baroreceptros sense ↓BP and attempt to raise it) |
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Shock
IV. Stages B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis 2. Clinical Manifestations--reflect body’s response to imbalance in O2 supply and demand (chemo and baroreceptros sense ↓BP and attempt to raise it) a. Neurogenic--subtle -----------, agitation, mild ------- |
Shock
IV. Stages B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis 2. Clinical Manifestations--reflect body’s response to imbalance in O2 supply and demand (chemo and baroreceptros sense ↓BP and attempt to raise it) a. Neurogenic--subtle restlessness, agitation, mild ALOC |
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Shock
IV. Stages B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis 2. Clinical Manifestations--reflect body’s response to imbalance in O2 supply and demand (chemo and baroreceptros sense ↓BP and attempt to raise it b. Cardiovascular--selective ------------ (norepinephrine) ↑-------- and contractility; ß-adrenergic stimulation dilate coronary arteries |
Shock
IV. Stages B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis 2. Clinical Manifestations--reflect body’s response to imbalance in O2 supply and demand (chemo and baroreceptros sense ↓BP and attempt to raise it b. Cardiovascular--selective vasoconstriction (norepinephrine) ↑HR and contractility; ß-adrenergic stimulation dilate coronary arteries |
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Shock
IV. Stages B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis 2. Clinical Manifestations--reflect body’s response to imbalance in O2 supply and demand (chemo and baroreceptros sense ↓BP and attempt to raise it b. Cardiovascular--selective vasoconstriction (norepinephrine) ↑HR and contractility; ß----------- stimulation dilate ----------- arteries |
Shock
IV. Stages B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis 2. Clinical Manifestations--reflect body’s response to imbalance in O2 supply and demand (chemo and baroreceptros sense ↓BP and attempt to raise it b. Cardiovascular--selective vasoconstriction (norepinephrine) ↑HR and contractility; ß-adrenergic stimulation dilate coronary arteries |
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Shock
IV. Stages B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis 2. Clinical Manifestations--reflect body’s response to imbalance in O2 supply and demand (chemo and baroreceptros sense ↓BP and attempt to raise it c. Respiratory--↑------------ dead space (some areas not leading to gas exchange) ------ mismatch ↑--------- and depth |
Shock
IV. Stages B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis 2. Clinical Manifestations--reflect body’s response to imbalance in O2 supply and demand (chemo and baroreceptros sense ↓BP and attempt to raise it c. Respiratory--↑physiological dead space (some areas not leading to gas exchange) VQ mismatch ↑RR and depth |
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Shock
IV. Stages B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis 2. Clinical Manifestations--reflect body’s response to imbalance in O2 supply and demand (chemo and baroreceptros sense ↓BP and attempt to raise it d. GI--constriction ---------------- bowel sounds, --------- |
Shock
IV. Stages B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis 2. Clinical Manifestations--reflect body’s response to imbalance in O2 supply and demand (chemo and baroreceptros sense ↓BP and attempt to raise it d. GI--constriction hypoactive bowel sounds, ileus |
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Shock
IV. Stages B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis 2. Clinical Manifestations--reflect body’s response to imbalance in O2 supply and demand (chemo and baroreceptros sense ↓BP and attempt to raise it e. Renal--vasoconstriction ↓------------ release of renin ↑--------- |
Shock
IV. Stages B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis 2. Clinical Manifestations--reflect body’s response to imbalance in O2 supply and demand (chemo and baroreceptros sense ↓BP and attempt to raise it e. Renal--vasoconstriction ↓blood flow release of renin ↑aldosterone |
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Shock
IV. Stages B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis 2. Clinical Manifestations--reflect body’s response to imbalance in O2 supply and demand (chemo and baroreceptros sense ↓BP and attempt to raise it e. Renal--vasoconstriction ↓blood flow release of renin ↑aldosterone i. Renin --------------- 1 2 (most potent vasoconstrictor in body) Aldosterone (retains -------) |
Shock
IV. Stages B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis 2. Clinical Manifestations--reflect body’s response to imbalance in O2 supply and demand (chemo and baroreceptros sense ↓BP and attempt to raise it e. Renal--vasoconstriction ↓blood flow release of renin ↑aldosterone i. Renin Angiotensin 1 2 (most potent vasoconstrictor in body) Aldosterone (retains Na) |
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Shock
IV. Stages B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis 2. Clinical Manifestations--reflect body’s response to imbalance in O2 supply and demand (chemo and baroreceptros sense ↓BP and attempt to raise i f. Temperature--not -------- finding g. Skin--pale, ---------- (septic will be warm) |
Shock
IV. Stages B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis 2. Clinical Manifestations--reflect body’s response to imbalance in O2 supply and demand (chemo and baroreceptros sense ↓BP and attempt to raise i f. Temperature--not early finding g. Skin--pale, cool (septic will be warm) |
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Shock
IV. Stages B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis 2. Clinical Manifestations--reflect body’s response to imbalance in O2 supply and demand (chemo and baroreceptros sense ↓BP and attempt to raise h. Labs--↓-----------2 and ------------ (due to ↑resp state) |
Shock
IV. Stages B. Compensatory Stage--activation of compensatory mechanisms in attempt to maintain homeostasis 2. Clinical Manifestations--reflect body’s response to imbalance in O2 supply and demand (chemo and baroreceptros sense ↓BP and attempt to raise h. Labs--↓PaO2 and alkalosis (due to ↑resp state) |
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Shock
IV. Stages C. Progressive Stage--↓--------------- altered cap perm (begins as comp mechanisms fail) |
Shock
IV. Stages C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail) |
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Shock
IV. Stages C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail) 1. Must be presence of ------------ cause |
Shock
IV. Stages C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail) 1. Must be presence of precipitating cause |
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Shock
IV. Stages C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail) 2. Massive ---------- stimulation (compensatory mechanisms not working) |
Shock
IV. Stages C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail) 2. Massive SNS stimulation (compensatory mechanisms not working) |
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Shock
IV. Stages C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail)) 3. Pathophysiology and Manifestations a. Neurologic--↓-------------- pressure ↓------------- blood flow listless, agitated, ↓ responsiveness to stimuli |
Shock
IV. Stages C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail)) 3. Pathophysiology and Manifestations a. Neurologic--↓cerebral perfusion pressure ↓cerebral blood flow listless, agitated, ↓ responsiveness to stimuli |
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Shock
IV. Stages C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail)) 3. Pathophysiology and Manifestations a. Neurologic--↓cerebral perfusion pressure ↓cerebral blood flow listless, ------------, ↓ -------------- to stimuli |
Shock
IV. Stages C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail)) 3. Pathophysiology and Manifestations a. Neurologic--↓cerebral perfusion pressure ↓cerebral blood flow listless, agitated, ↓ responsiveness to stimuli |
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Shock
IV. Stages C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail)) 3. Pathophysiology and Manifestations b. Respiratory--pulmonary arterioles constriction (to ↑--------) ↑------------ ↓---------- blood flow worsening VQ mismatch ↑cap perm interstitial edema alveolar edema ↓gas exchange tachypnea, crackles, ↓compliance |
Shock
IV. Stages C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail)) 3. Pathophysiology and Manifestations b. Respiratory--pulmonary arterioles constriction (to ↑BP) ↑PAP ↓pulm blood flow worsening VQ mismatch ↑cap perm interstitial edema alveolar edema ↓gas exchange tachypnea, crackles, ↓compliance |
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Shock
IV. Stages C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail)) 3. Pathophysiology and Manifestations b. Respiratory--pulmonary arterioles constriction (to ↑BP) ↑PAP ↓pulm blood flow worsening ---------- mismatch ↑cap perm, -------------, -------- edema ↓gas exchange tachypnea, crackles, ↓compliance |
Shock
IV. Stages C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail)) 3. Pathophysiology and Manifestations b. Respiratory--pulmonary arterioles constriction (to ↑BP) ↑PAP ↓pulm blood flow worsening VQ mismatch ↑cap perm interstitial edema alveolar edema ↓gas exchange tachypnea, crackles, ↓compliance |
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Shock
IV. Stages C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail)) 3. Pathophysiology and Manifestations b. Respiratory--pulmonary arterioles constriction (to ↑BP) ↑PAP ↓pulm blood flow worsening VQ mismatch ↑cap perm interstitial edema alveolar edema ↓gas exchange -----------, ----------, ↓---------- |
Shock
IV. Stages C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail)) 3. Pathophysiology and Manifestations b. Respiratory--pulmonary arterioles constriction (to ↑BP) ↑PAP ↓pulm blood flow worsening VQ mismatch ↑cap perm interstitial edema alveolar edema ↓gas exchange tachypnea, crackles, ↓compliance |
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Shock
IV. Stages C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail)) 3. Pathophysiology and Manifestations c. Cardiogenic--↑cap perm ↓-------------- and ↓---------------, progressive tissue --------- ß-adrenergic receptor stimulation CO begins to fail (heart can’t keep up) ↑HR ↓BP ↓peripheral perfusion (MAP) ↓coronary perfusion arrhythmias ischemia potential MI (can be nonatherosclerotic) |
Shock
IV. Stages C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail)) 3. Pathophysiology and Manifestations c. Cardiogenic--↑cap perm ↓circulating volume and ↓myocardial function progressive tissue hypoxia ß-adrenergic receptor stimulation CO begins to fail (heart can’t keep up) ↑HR ↓BP ↓peripheral perfusion (MAP) ↓coronary perfusion arrhythmias ischemia potential MI (can be nonatherosclerotic) |
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Shock
IV. Stages C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail)) 3. Pathophysiology and Manifestations c. Cardiogenic--↑cap perm ↓circulating volume and ↓myocardial function progressive tissue hypoxia ß-adrenergic ------------- stimulation, ------- begins to fail (heart can’t keep up) ↑-------- ↓BP ↓peripheral perfusion (MAP) ↓coronary perfusion arrhythmias ischemia potential MI (can be nonatherosclerotic) |
Shock
IV. Stages C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail)) 3. Pathophysiology and Manifestations c. Cardiogenic--↑cap perm ↓circulating volume and ↓myocardial function progressive tissue hypoxia ß-adrenergic receptor stimulation CO begins to fail (heart can’t keep up) ↑HR ↓BP ↓peripheral perfusion (MAP) ↓coronary perfusion arrhythmias ischemia potential MI (can be nonatherosclerotic) |
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Shock
IV. Stages C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail)) 3. Pathophysiology and Manifestations c. Cardiogenic--↑cap perm ↓circulating volume and ↓myocardial function progressive tissue hypoxia ß-adrenergic receptor stimulation CO begins to fail (heart can’t keep up) ↑HR ↓-------- ↓------------- (MAP) ↓--------- perfusion arrhythmias ischemia potential MI (can be nonatherosclerotic) |
Shock
IV. Stages C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail)) 3. Pathophysiology and Manifestations c. Cardiogenic--↑cap perm ↓circulating volume and ↓myocardial function progressive tissue hypoxia ß-adrenergic receptor stimulation CO begins to fail (heart can’t keep up) ↑HR ↓BP ↓peripheral perfusion (MAP) ↓coronary perfusion arrhythmias ischemia potential MI (can be nonatherosclerotic) |
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Shock
IV. Stages C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail)) 3. Pathophysiology and Manifestations c. Cardiogenic--↑cap perm ↓circulating volume and ↓myocardial function progressive tissue hypoxia ß-adrenergic receptor stimulation CO begins to fail (heart can’t keep up) ↑HR ↓BP ↓peripheral perfusion (MAP) ↓coronary perfusion --------------- ischemia potential ---------- (can be nonatherosclerotic) |
Shock
IV. Stages C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail)) 3. Pathophysiology and Manifestations c. Cardiogenic--↑cap perm ↓circulating volume and ↓myocardial function progressive tissue hypoxia ß-adrenergic receptor stimulation CO begins to fail (heart can’t keep up) ↑HR ↓BP ↓peripheral perfusion (MAP) ↓coronary perfusion arrhythmias ischemia potential MI (can be nonatherosclerotic) |
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Shock
IV. Stages C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail)) 3. Pathophysiology and Manifestations c. Cardiogenic-- i. --------- cannot be maintained (unlike compensatory stage) |
Shock
IV. Stages C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail)) 3. Pathophysiology and Manifestations c. Cardiogenic-- i. CO cannot be maintained (unlike compensatory stage) |
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Shock
IV. Stages C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail)) 3. Pathophysiology and Manifestations d. Renal--↓perfusion to ---------- ↓--------- output ↑------- fxn tests (BUN/CR) ATN ARF ↓ability to excrete acids and absorb bicarb metabolic acidosis |
Shock
IV. Stages C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail)) 3. Pathophysiology and Manifestations d. Renal--↓perfusion to kidney ↓urine output ↑renal fxn tests (BUN/CR) ATN ARF ↓ability to excrete acids and absorb bicarb metabolic acidosis |
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Shock
IV. Stages C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail)) 3. Pathophysiology and Manifestations d. Renal--↓perfusion to kidney ↓urine output ↑renal fxn tests (BUN/CR) ------, -------, ↓ability to excrete ------- and absorb bicarb metabolic acidosis |
Shock
IV. Stages C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail)) 3. Pathophysiology and Manifestations d. Renal--↓perfusion to kidney ↓urine output ↑renal fxn tests (BUN/CR) ATN ARF ↓ability to excrete acids and absorb bicarb metabolic acidosis |
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Shock
IV. Stages C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail)) 3. Pathophysiology and Manifestations d. Renal--↓perfusion to kidney ↓urine output ↑renal fxn tests (BUN/CR) ATN ARF ↓ability to excrete acids and absorb -----, metabolic ------- |
Shock
IV. Stages C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail)) 3. Pathophysiology and Manifestations d. Renal--↓perfusion to kidney ↓urine output ↑renal fxn tests (BUN/CR) ATN ARF ↓ability to excrete acids and absorb bicarb metabolic acidosis |
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Shock
IV. Stages C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail)) 3. Pathophysiology and Manifestations e. GI--extended ↓-------------- 2° to vasoconstriction, mucosal ----------, ↓-------- absorption and ulcers/GI bleeding ↑risk of bacteria to blood (sepsis) |
Shock
IV. Stages C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail)) 3. Pathophysiology and Manifestations e. GI--extended ↓tissue perfusion 2° to vasoconstriction mucosal barrier ischemia ↓nutrient absorption and ulcers/GI bleeding ↑risk of bacteria to blood (sepsis) |
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Shock
IV. Stages C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail)) 3. Pathophysiology and Manifestations e. GI--extended ↓tissue perfusion 2° to vasoconstriction mucosal barrier ischemia ↓nutrient absorption and ulcers/------- bleeding ↑risk of -------- to blood (sepsis) |
Shock
IV. Stages C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail)) 3. Pathophysiology and Manifestations e. GI--extended ↓tissue perfusion 2° to vasoconstriction mucosal barrier ischemia ↓nutrient absorption and ulcers/GI bleeding ↑risk of bacteria to blood (sepsis) |
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Shock
IV. Stages C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail)) 3. Pathophysiology and Manifestations f. Hepatic--↓----------- to liver ↓ability to ------------- drugs and waste products ↑-------3 lactate accumulation of bilirubin ↑LFTs (ALT, AST, GGT) |
Shock
IV. Stages C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail)) 3. Pathophysiology and Manifestations f. Hepatic--↓perfusion to liver ↓ability to metabolize drugs and waste products ↑NH3 lactate accumulation of bilirubin ↑LFTs (ALT, AST, GGT) |
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Shock
IV. Stages C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail)) 3. Pathophysiology and Manifestations f. Hepatic--↓perfusion to liver ↓ability to metabolize drugs and waste products ↑NH3 lactate accumulation of ---------- ↑---------s (ALT, AST, GGT) |
Shock
IV. Stages C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail)) 3. Pathophysiology and Manifestations f. Hepatic--↓perfusion to liver ↓ability to metabolize drugs and waste products ↑NH3 lactate accumulation of bilirubin ↑LFTs (ALT, AST, GGT) |
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Shock
IV. Stages C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail)) 3. Pathophysiology and Manifestations f. Hepatic--↓perfusion to liver ↓ability to metabolize drugs and waste products ↑NH3 lactate accumulation of bilirubin ↑LFTs (ALT, ------, ------) |
Shock
IV. Stages C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail)) 3. Pathophysiology and Manifestations f. Hepatic--↓perfusion to liver ↓ability to metabolize drugs and waste products ↑NH3 lactate accumulation of bilirubin ↑LFTs (ALT, AST, GGT) |
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Shock
IV. Stages C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail)) 3. Pathophysiology and Manifestations g. Hematologic--platelets and clotting factor consumption ----------, ↑--------, ↑PTT, ↓-------- DIC risk widespread bleeding (GI, lungs, puncture sites) |
Shock
IV. Stages C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail)) 3. Pathophysiology and Manifestations g. Hematologic--platelets and clotting factor consumption thrombocytopenia, ↑PT, ↑PTT, ↓fibrinogen DIC risk widespread bleeding (GI, lungs, puncture sites) |
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Shock
IV. Stages C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail)) 3. Pathophysiology and Manifestations g. Hematologic--platelets and clotting factor consumption thrombocytopenia, ↑PT, ↑-------, ↓fibrinogen ---------- risk widespread bleeding (GI, -------, puncture sites) |
Shock
IV. Stages C. Progressive Stage--↓cellular perfusion altered cap perm (begins as comp mechanisms fail)) 3. Pathophysiology and Manifestations g. Hematologic--platelets and clotting factor consumption thrombocytopenia, ↑PT, ↑PTT, ↓fibrinogen DIC risk widespread bleeding (GI, lungs, puncture sites) |
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Shock
IV. Stages D. Refractory Stage--high likelihood of ------- (can sometimes be reversed) |
Shock
IV. Stages D. Refractory Stage--high likelihood of death (can sometimes be reversed) |
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Shock
IV. Stages D. Refractory Stage--high likelihood of death (can sometimes be reversed) 1. ↓---------- ↓------ anaerobic metabolism ↑-------- acid ↑cap perm interstitial fluid transfer worsens ↓intravascular volume ↓BP worsens myocardial depression worsens ↑HR ischemia further ↓CO ↓ cerebral flow cerebral ischemia |
Shock
IV. Stages D. Refractory Stage--high likelihood of death (can sometimes be reversed) 1. ↓Perfusion ↓CO anaerobic metabolism ↑lactic acid ↑cap perm interstitial fluid transfer worsens ↓intravascular volume ↓BP worsens myocardial depression worsens ↑HR ischemia further ↓CO ↓ cerebral flow cerebral ischemia |
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Shock
IV. Stages D. Refractory Stage--high likelihood of death (can sometimes be reversed) 1. ↓Perfusion ↓CO anaerobic ----------- ↑lactic acid ↑cap perm interstitial ------------ worsens ↓---------- volume ↓BP worsens myocardial depression worsens ↑HR ischemia further ↓CO ↓ cerebral flow cerebral ischemia |
Shock
IV. Stages D. Refractory Stage--high likelihood of death (can sometimes be reversed) 1. ↓Perfusion ↓CO anaerobic metabolism ↑lactic acid ↑cap perm interstitial fluid transfer worsens ↓intravascular volume ↓BP worsens myocardial depression worsens ↑HR ischemia further ↓CO ↓ cerebral flow cerebral ischemia |
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Shock
IV. Stages D. Refractory Stage--high likelihood of death (can sometimes be reversed) 1. ↓Perfusion ↓CO anaerobic metabolism ↑lactic acid ↑cap perm interstitial fluid transfer worsens ↓intravascular volume ↓--------- worsens myocardial ----------- worsens ↑---------- ischemia further ↓CO ↓ cerebral flow cerebral ischemia |
Shock
IV. Stages D. Refractory Stage--high likelihood of death (can sometimes be reversed) 1. ↓Perfusion ↓CO anaerobic metabolism ↑lactic acid ↑cap perm interstitial fluid transfer worsens ↓intravascular volume ↓BP worsens myocardial depression worsens ↑HR ischemia further ↓CO ↓ cerebral flow cerebral ischemia |
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Shock
IV. Stages D. Refractory Stage--high likelihood of death (can sometimes be reversed) 1. ↓Perfusion ↓CO anaerobic metabolism ↑lactic acid ↑cap perm interstitial fluid transfer worsens ↓intravascular volume ↓BP worsens myocardial depression worsens ↑HR ischemia further ↓----------- ↓ ------------ flow cerebral -------- |
Shock
IV. Stages D. Refractory Stage--high likelihood of death (can sometimes be reversed) 1. ↓Perfusion ↓CO anaerobic metabolism ↑lactic acid ↑cap perm interstitial fluid transfer worsens ↓intravascular volume ↓BP worsens myocardial depression worsens ↑HR ischemia further ↓CO ↓ cerebral flow cerebral ischemia |
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Shock
IV. Stages D. Refractory Stage--high likelihood of death (can sometimes be reversed) 2. Pathophysiology--recovery is -------- (pt will code quickly) |
Shock
IV. Stages D. Refractory Stage--high likelihood of death (can sometimes be reversed) 2. Pathophysiology--recovery is unlikely (pt will code quickly) |
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IV. Stages D. Refractory Stage--high likelihood of death (can sometimes be reversed) 2. Pathophysiology--recovery is unlikely (pt will code quickly) a. Neurologic--unresponsive, pupils ------------ and dilated, --------- (loss of reflexes) |
Shock
IV. Stages D. Refractory Stage--high likelihood of death (can sometimes be reversed) 2. Pathophysiology--recovery is unlikely (pt will code quickly) a. Neurologic--unresponsive, pupils nonreactive and dilated, areflexia (loss of reflexes) |
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Shock
IV. Stages D. Refractory Stage--high likelihood of death (can sometimes be reversed) 2. Pathophysiology--recovery is unlikely (pt will code quickly) b. Respiratory--severe refractory ----------- (despite intubation ↑---------2) and resp failure |
Shock
IV. Stages D. Refractory Stage--high likelihood of death (can sometimes be reversed) 2. Pathophysiology--recovery is unlikely (pt will code quickly) b. Respiratory--severe refractory hypoxemia (despite intubation ↑FiO2) and resp failure |
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Shock
IV. Stages D. Refractory Stage--high likelihood of death (can sometimes be reversed) 2. Pathophysiology--recovery is unlikely (pt will code quickly) c. Cardiogenic--profound ------------ (can’t get it back up), ↓----------, bradycardia |
Shock
IV. Stages D. Refractory Stage--high likelihood of death (can sometimes be reversed) 2. Pathophysiology--recovery is unlikely (pt will code quickly) c. Cardiogenic--profound hypotension (can’t get it back up), ↓CO, bradycardia |
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Shock
IV. Stages D. Refractory Stage--high likelihood of death (can sometimes be reversed) 2. Pathophysiology--recovery is unlikely (pt will code quickly) i. ---------- can only compensate for so long then if begins to drop |
Shock
IV. Stages D. Refractory Stage--high likelihood of death (can sometimes be reversed) 2. Pathophysiology--recovery is unlikely (pt will code quickly) i. HR can only compensate for so long then if begins to drop |
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IV. Stages D. Refractory Stage--high likelihood of death (can sometimes be reversed) 2. Pathophysiology--recovery is unlikely (pt will code quickly) d. Renal--anuria; need ------------ or they will die (everything is shut down) |
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IV. Stages D. Refractory Stage--high likelihood of death (can sometimes be reversed) 2. Pathophysiology--recovery is unlikely (pt will code quickly) d. Renal--anuria; need dialysis or they will die (everything is shut down) |
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IV. Stages D. Refractory Stage--high likelihood of death (can sometimes be reversed) 2. Pathophysiology--recovery is unlikely (pt will code quickly) e. GI--_________ |
Shock
IV. Stages D. Refractory Stage--high likelihood of death (can sometimes be reversed) 2. Pathophysiology--recovery is unlikely (pt will code quickly) e. GI--ischemic gut |
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IV. Stages D. Refractory Stage--high likelihood of death (can sometimes be reversed) 2. Pathophysiology--recovery is unlikely (pt will code quickly) f. Hepatic--accumulation of ----------- products (including ↑---------3 and lactate) |
Shock
IV. Stages D. Refractory Stage--high likelihood of death (can sometimes be reversed) 2. Pathophysiology--recovery is unlikely (pt will code quickly) f. Hepatic--accumulation of waste products (including ↑NH3 and lactate) |
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Shock
IV. Stages D. Refractory Stage--high likelihood of death (can sometimes be reversed) 2. Pathophysiology--recovery is unlikely (pt will code quickly) g. Skin--mottled and ---------- |
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IV. Stages D. Refractory Stage--high likelihood of death (can sometimes be reversed) 2. Pathophysiology--recovery is unlikely (pt will code quickly) g. Skin--mottled and cyanotic |
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Shock
IV. Stages D. Refractory Stage--high likelihood of death (can sometimes be reversed) 3. Residual Deficits (if live through stage) a. Gangrene and amputations from ----------- b. Kidney and ----------- problems (possibly need transplants) |
Shock
IV. Stages D. Refractory Stage--high likelihood of death (can sometimes be reversed) 3. Residual Deficits (if live through stage) a. Gangrene and amputations from vasoconstriction |
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Shock
V. Diagnostic Studies--no single ---------- test |
Shock
V. Diagnostic Studies--no single diagnostic test |
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Shock
V. Diagnostic Studies--no single diagnostic test A. ↑----------- levels and base deficit--from ↓--------- perfusion and anaerobic metabolism |
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V. Diagnostic Studies--no single diagnostic test A. ↑lactate levels and base deficit--from ↓tissue perfusion and anaerobic metabolism |
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V. Diagnostic Studies--no single diagnostic test B. EKG--if ------------- shock |
Shock
V. Diagnostic Studies--no single diagnostic test B. EKG--if cardiogenic shock |
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V. Diagnostic Studies--no single diagnostic test C. C______ D. ____________ monitoring |
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V. Diagnostic Studies--no single diagnostic test C. CXR D. Hemodynamic monitoring |
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V. Diagnostic Studies--no single diagnostic test E. Continuous--------- oximeter F. ----------2 |
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V. Diagnostic Studies--no single diagnostic test E. Continuous pulse oximeter F. SVO2 |
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V. Diagnostic Studies--no single diagnostic test G. Labs 1. Electrolytes--↑-------- (↑-----------), early ↓-------- (↑aldoseterone), later ↑K (cells die ↓kidney fxn) |
Shock
V. Diagnostic Studies--no single diagnostic test G. Labs 1. Electrolytes--↑Na (↑aldosterone), early ↓K (↑aldoseterone), later ↑K (cells die ↓kidney fxn) |
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Shock
V. Diagnostic Studies--no single diagnostic test G. Labs 1. Electrolytes--↑Na (↑aldosterone), early ↓K (↑------------), later ↑K (cells die ↓---------- fxn) |
Shock
V. Diagnostic Studies--no single diagnostic test G. Labs 1. Electrolytes--↑Na (↑aldosterone), early ↓K (↑aldoseterone), later ↑K (cells die ↓kidney fxn) |
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Shock
V. Diagnostic Studies--no single diagnostic test G. Labs 2. Blood--↓-------/Hg after volume replacement (if ---------) |
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V. Diagnostic Studies--no single diagnostic test G. Labs 2. Blood--↓Ht/Hg after volume replacement (if hemorrhagic) |
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Shock
V. Diagnostic Studies--no single diagnostic test G. Labs 3. ABGs--late metabolic ----------- (anaerobic ----------) |
Shock
V. Diagnostic Studies--no single diagnostic test G. Labs 3. ABGs--late metabolic acidosis (anaerobic metabolism) |
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Shock
V. Diagnostic Studies--no single diagnostic test G. Labs 4. Renal function tests--↑----------/Cr |
Shock
V. Diagnostic Studies--no single diagnostic test G. Labs 4. Renal function tests--↑BUN/Cr |
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Shock
V. Diagnostic Studies--no single diagnostic test G. Labs 5. LFTs--increased (only in -------------- stages) |
Shock
V. Diagnostic Studies--no single diagnostic test G. Labs 5. LFTs--increased (only in progressive stages) |
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Shock
V. Diagnostic Studies--no single diagnostic test G. Labs 5. LFTs--_________ (only in progressive stages) |
Shock
V. Diagnostic Studies--no single diagnostic test G. Labs 5. LFTs--increased (only in progressive stages) |
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Shock
V. Diagnostic Studies--no single diagnostic test G. Labs 6. Cardiac --------- |
Shock
V. Diagnostic Studies--no single diagnostic test G. Labs 6. Cardiac enzymes |
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V. Diagnostic Studies--no single diagnostic test G. Labs 7. DIC panel--↓----------, ↓-----------, ↑PT/PTT |
Shock
V. Diagnostic Studies--no single diagnostic test G. Labs 7. DIC panel--↓fibrinogen, ↓platelets, ↑PT/PTT |
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Shock
V. Diagnostic Studies--no single diagnostic test G. Labs 8. Glucose a. Early--SNS stimulation, liver releases ------------ and stress response releases ----------- to maintain glucose levelsshock continues↓cells responsive to insulin↑glucose |
Shock
V. Diagnostic Studies--no single diagnostic test G. Labs 8. Glucose a. Early--SNS stimulationliver releases glycogen and stress response releases cortisol to maintain glucose levelsshock continues↓cells responsive to insulin↑glucose |
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V. Diagnostic Studies--no single diagnostic test G. Labs 8. Glucose a. Early--SNS stimulationliver releases glycogen and stress response releases cortisol to maintain glucose levelsshock continues↓--------- responsive to insulin↑---------- |
Shock
V. Diagnostic Studies--no single diagnostic test G. Labs 8. Glucose a. Early--SNS stimulationliver releases glycogen and stress response releases cortisol to maintain glucose levelsshock continues↓cells responsive to insulin↑glucose |
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Shock
V. Diagnostic Studies--no single diagnostic test G. Labs 8. Glucose b. Late--depleted ---------- stores and no --------- from kidney ↓glucose |
Shock
V. Diagnostic Studies--no single diagnostic test G. Labs 8. Glucose b. Late--depleted glycogen stores and no cortisol from kidney ↓glucose |
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Shock
VI. Management A. Oxygenation and Ventilation--goal is to ↑O2 ----------- and ↓ O2 --------- |
Shock
VI. Management A. Oxygenation and Ventilation--goal is to ↑O2 supply and ↓ O2 demand |
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VI. Management A. Oxygenation and Ventilation--goal is to ↑O2 supply and ↓ O2 demand 1. Optimize O2 delivery--NR mask, ----------, ↑---------2 |
Shock
VI. Management A. Oxygenation and Ventilation--goal is to ↑O2 supply and ↓ O2 demand 1. Optimize O2 delivery--NR mask, intubation, ↑FiO2 |
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VI. Management A. Oxygenation and Ventilation--goal is to ↑O2 supply and ↓ O2 demand 2. Ensure pt has patent ----------- 3. Provide ---------- O2 |
Shock
VI. Management A. Oxygenation and Ventilation--goal is to ↑O2 supply and ↓ O2 demand 2. Ensure pt has patent airway 3. Provide supplemental O2 |
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VI. Management A. Oxygenation and Ventilation--goal is to ↑O2 supply and ↓ O2 demand 4. Optimize cardiac output--drug therapy (------------, debutamine, -----------) |
Shock
VI. Management A. Oxygenation and Ventilation--goal is to ↑O2 supply and ↓ O2 demand 4. Optimize cardiac output--drug therapy (epinephrine, debutamine, levofed) |
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Shock
VI. Management A. Oxygenation and Ventilation--goal is to ↑O2 supply and ↓ O2 demand 4. Optimize cardiac output--drug therapy (epinephrine, debutamine, ---------) |
Shock
VI. Management A. Oxygenation and Ventilation--goal is to ↑O2 supply and ↓ O2 demand 4. Optimize cardiac output--drug therapy (epinephrine, debutamine, levofed) |
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Shock
VI. Management A. Oxygenation and Ventilation--goal is to ↑O2 supply and ↓ O2 demand 5. Assess labs including ----------/Ht, ---------2 |
Shock
VI. Management A. Oxygenation and Ventilation--goal is to ↑O2 supply and ↓ O2 demand 5. Assess labs including Hg/Ht, SaO2 |
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Shock
VI. Management A. Oxygenation and Ventilation--goal is to ↑O2 supply and ↓ O2 demand 6. Hemodynamic monitoring to assess ---------2 (assesses ----------- at level of tissues) |
Shock
VI. Management A. Oxygenation and Ventilation--goal is to ↑O2 supply and ↓ O2 demand 6. Hemodynamic monitoring to assess SVO2 (assesses oxygenation at level of tissues) |
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Shock
VI. Management B. Fluid therapy--not ------------- (good volume w/ bad pump) or ---------- (good volume w/ vasodil.) |
Shock
VI. Management B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.) |
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VI. Management B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.) 1. Establish ----------- access (14 to -------G) |
Shock
VI. Management B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.) 1. Establish IV access (14-16G) |
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Shock
VI. Management B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.) 2. Hemodynamic monitoring to assess --------- status |
Shock
VI. Management B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.) 2. Hemodynamic monitoring to assess fluid status |
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Shock
VI. Management B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.) 3. Fluid choice--think about what has been ------- |
Shock
VI. Management B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.) 3. Fluid choice--think about what has been lost |
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Shock
VI. Management B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.) 3. Fluid choice--think about what has been lost a. RBCs--give w/ ----------- b/c RBCs do not have ------------ factors (1-2U FFP for 5U RBCs) |
Shock
VI. Management B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.) 3. Fluid choice--think about what has been lost a. RBCs--give w/ FFP b/c RBCs do not have clotting factors (1-2U FFP for 5U RBCs) |
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Shock
VI. Management B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.) 3. Fluid choice--think about what has been lost a. RBCs--give w/ FFP b/c RBCs do not have clotting factors (1-______U FFP for 5_______ RBCs) |
Shock
VI. Management B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.) 3. Fluid choice--think about what has been lost a. RBCs--give w/ FFP b/c RBCs do not have clotting factors (1-2U FFP for 5U RBCs) |
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Shock
VI. Management B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.) 3. Fluid choice--think about what has been lost a. Crystalloid (NS, LR)--2/3rd diffuse into ------------ space (require more -----------) |
Shock
VI. Management B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.) 3. Fluid choice--think about what has been lost a. Crystalloid (NS, LR)--2/3rd diffuse into interstitial space (require more volume) |
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Shock
VI. Management B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.) 3. Fluid choice--think about what has been lost a. Crystalloid (---------, -----------)--2/3rd diffuse into interstitial space (require more volume) |
Shock
VI. Management B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.) 3. Fluid choice--think about what has been lost a. Crystalloid (NS, LR)--2/3rd diffuse into interstitial space (require more volume) |
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Shock
VI. Management B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.) 3. Fluid choice--think about what has been lost b. Colloid (----------, -----------)--large therefore fluids stay in vascular space better |
Shock
VI. Management B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.) 3. Fluid choice--think about what has been lost b. Colloid (Albumin, Hespain)--large therefore fluids stay in vascular space better |
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Shock
VI. Management B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.) 3. Fluid choice--think about what has been lost b. Colloid (Albumin, Hespain)--large therefore fluids stay in --------- space better |
Shock
VI. Management B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.) 3. Fluid choice--think about what has been lost b. Colloid (Albumin, Hespain)--large therefore fluids stay in vascular space better |
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Shock
VI. Management B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.) 3. Fluid choice--think about what has been lost b. Colloid (Albumin, Hespain)--large therefore fluids stay in vascular space better a. Can be given in concentrated space (esp. w/ ↑------------)--careful w/ ----------- |
Shock
VI. Management B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.) 3. Fluid choice--think about what has been lost b. Colloid (Albumin, Hespain)--large therefore fluids stay in vascular space better a. Can be given in concentrated space (esp. w/ ↑permeability)--careful w/ CHF |
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Shock
VI. Management B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.) 3. Fluid choice--think about what has been lost b. Colloid (Albumin, Hespain)--large therefore fluids stay in vascular space better b. More --------- |
Shock
VI. Management B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.) 3. Fluid choice--think about what has been lost b. Colloid (Albumin, Hespain)--large therefore fluids stay in vascular space better b. More costly |
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Shock
VI. Management B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.) 3. Fluid choice--think about what has been lost c. Avoid in first 24-_______hrs w/ burn pts |
Shock
VI. Management B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.) 3. Fluid choice--think about what has been lost c. Avoid in first 24-48hrs w/ burn pts |
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Shock
VI. Management B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.) 4. Monitor for ------------ (try to get warm fluids) |
Shock
VI. Management B. Fluid therapy--not cardiogenic (good volume w/ bad pump) or neurogenic (good volume w/ vasodil.) 4. Monitor for hypothermia (try to get warm fluids) |
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Shock
VI. Management C. Drug Therapy--goal is to correct decreased ---------- |
Shock
VI. Management C. Drug Therapy--goal is to correct decreased tissue perfusion |
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Shock
VI. Management C. Drug Therapy--goal is to correct decreased tissue perfusion 1. Utilized if ------------- replacement does not work |
Shock
VI. Management C. Drug Therapy--goal is to correct decreased tissue perfusion 1. Utilized if volume replacement does not work |
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Shock
VI. Management C. Drug Therapy--goal is to correct decreased tissue perfusion 1. Utilized if volume replacement does not work a. Good response is seen w/ --------- output of 30-50mL/hr (0.5mL/kg/hr for critical care) |
Shock
VI. Management C. Drug Therapy--goal is to correct decreased tissue perfusion 1. Utilized if volume replacement does not work a. Good response is seen w/ urine output of 30-50mL/hr (0.5mL/kg/hr for critical care) |
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Shock
VI. Management C. Drug Therapy--goal is to correct decreased tissue perfusion 1. Utilized if volume replacement does not work a. Good response is seen w/ urine output of 30-______mL/hr (_______mL/kg/hr for critical care) |
Shock
VI. Management C. Drug Therapy--goal is to correct decreased tissue perfusion 1. Utilized if volume replacement does not work a. Good response is seen w/ urine output of 30-50mL/hr (0.5mL/kg/hr for critical care) |
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Shock
VI. Management C. Drug Therapy--goal is to correct decreased tissue perfusion 2. Types a. -------------- drugs b. Vasopressors--cause vasoconstriction |
Shock
VI. Management C. Drug Therapy--goal is to correct decreased tissue perfusion 2. Types a. Sympathomimetic drugs b. Vasopressors--cause vasoconstriction |
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Shock
VI. Management C. Drug Therapy--goal is to correct decreased tissue perfusion 2. Types a. Sympathomimetic drugs b. Vasopressors--cause ------------ |
Shock
VI. Management C. Drug Therapy--goal is to correct decreased tissue perfusion 2. Types a. Sympathomimetic drugs b. Vasopressors--cause vasoconstriction |
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Shock
VI. Management C. Drug Therapy--goal is to correct decreased tissue perfusion 2. Types a. Sympathomimetic drugs b. Vasopressors--cause vasoconstriction i. Dobutamine (---------) |
Shock
VI. Management C. Drug Therapy--goal is to correct decreased tissue perfusion 2. Types a. Sympathomimetic drugs b. Vasopressors--cause vasoconstriction i. Dobutamine (Dobutrex) |
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Shock
VI. Management C. Drug Therapy--goal is to correct decreased tissue perfusion 2. Types a. Sympathomimetic drugs b. Vasopressors--cause vasoconstriction ii. D________ iii. E________ |
Shock
VI. Management C. Drug Therapy--goal is to correct decreased tissue perfusion 2. Types a. Sympathomimetic drugs b. Vasopressors--cause vasoconstriction ii. Dopamine iii. Epinephrine |
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Shock
VI. Management C. Drug Therapy--goal is to correct decreased tissue perfusion 2. Types a. Sympathomimetic drugs b. Vasopressors--cause vasoconstriction iv. ---------- (Levophed) v. _________ |
Shock
VI. Management C. Drug Therapy--goal is to correct decreased tissue perfusion 2. Types a. Sympathomimetic drugs b. Vasopressors--cause vasoconstriction iv. Norepinephrine (Levophed) v. Neo-Synephrine |
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Shock
VI. Management C. Drug Therapy--goal is to correct decreased tissue perfusion 3. ----------Effects--balancing act |
Shock
VI. Management C. Drug Therapy--goal is to correct decreased tissue perfusion 3. Detrimental Effects--balancing act |
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Shock
VII. Specific Interventions A. Cardiogenic--restore blood flow to ----------- by restoring balance between --------2 supply and demand |
Shock
VII. Specific Interventions A. Cardiogenic--restore blood flow to myocardium by restoring balance between O2 supply and demand |
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Shock
VII. Specific Interventions A. Cardiogenic-- 1. Hemodynamic goal--decrease ----------- of heart 2. --------- therapy |
Shock
VII. Specific Interventions A. Cardiogenic-- 1. Hemodynamic goal--decrease workload of heart 2. Drug therapy |
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Shock
VII. Specific Interventions A. Cardiogenic-- 2. Drug therapy a. ------------ therapy b. Decrease --------- |
Shock
VII. Specific Interventions A. Cardiogenic-- 2. Drug therapy a. Thrombolytic therapy b. Decrease preload |
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Shock
VII. Specific Interventions A. Cardiogenic-- 2. Drug therapy i. Nitrates ii. M_______ iii. D_______ |
Shock
VII. Specific Interventions A. Cardiogenic-- 2. Drug therapy i. Nitrates ii. Morphine iii. Diuretics |
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Shock
VII. Specific Interventions A. Cardiogenic-- 2. Drug therapy c. Reduce __________--be careful with reducing afterload ↓_________ |
Shock
VII. Specific Interventions A. Cardiogenic-- 2. Drug therapy c. Reduce afterload--be careful with reducing afterload ↓BP |
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Shock
VII. Specific Interventions A. Cardiogenic-- 2. Drug therapy i. Inotropic drugs (------------, ------------ Epinephrine) |
Shock
VII. Specific Interventions A. Cardiogenic-- 2. Drug therapy i. Inotropic drugs (Dobutamine, Dopamine Epinephrine) |
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Shock
VII. Specific Interventions A. Cardiogenic-- 2. Drug therapy i. Inotropic drugs (Dobutamine, Dopamine Epinephrine) ii. N--------- |
Shock
VII. Specific Interventions A. Cardiogenic-- 2. Drug therapy i. Inotropic drugs (Dobutamine, Dopamine Epinephrine) ii. Nipride |
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Shock
VII. Specific Interventions A. Cardiogenic-- 2. Drug therapy d. ß-blockers, ---------: ↓--------- to allow for ↑ filling time |
Shock
VII. Specific Interventions A. Cardiogenic-- 2. Drug therapy i. Inotropic drugs (Dobutamine, Dopamine Epinephrine) ii. Nipride |
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Shock
VII. Specific Interventions A. Cardiogenic-- 3. Correct --------- |
Shock
VII. Specific Interventions A. Cardiogenic-- 3. Correct arrhythmias |
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Shock
VII. Specific Interventions A. Cardiogenic-- 4. Stents, emergency ---------- 5. ------------ assist devices (only in critical care) |
Shock
VII. Specific Interventions A. Cardiogenic-- 4. Stents, emergency revascularization 5. Circulatory assist devices (only in critical care) |
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Shock
VII. Specific Interventions A. Cardiogenic-- 5. Circulatory assist devices (only in critical care) a. IABP--↓----------- and ↑---------- blood flow |
Shock
VII. Specific Interventions A. Cardiogenic-- 5. Circulatory assist devices (only in critical care) a. IABP--↓afterload and ↑coronary blood flow |
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Shock
VII. Specific Interventions A. Cardiogenic-- 5. Circulatory assist devices (only in critical care) b. VAD--outside pump ------------ blood (likely need ----------) |
Shock
VII. Specific Interventions A. Cardiogenic-- 5. Circulatory assist devices (only in critical care) b. VAD--outside pump diverts blood (likely need transplant) |
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Shock
VII. Specific Interventions B. Hypovolemic--restore ------------- volume and stop fluid loss restore ---------- |
Shock
VII. Specific Interventions B. Hypovolemic--restore circulating volume and stop fluid loss restore perfusion |
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Shock
VII. Specific Interventions B. Hypovolemic--restore circulating volume and stop fluid loss restore perfusion 1. Optimize ---------- 2. ---------- cause |
Shock
VII. Specific Interventions B. Hypovolemic--restore circulating volume and stop fluid loss restore perfusion 1. Optimize oxygenation 2. Correct cause |
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Shock
VII. Specific Interventions B. Hypovolemic--restore circulating volume and stop fluid loss restore perfusion 3. Volume replacement--warm to prevent --------- |
Shock
VII. Specific Interventions B. Hypovolemic--restore circulating volume and stop fluid loss restore perfusion 3. Volume replacement--warm to prevent hypothermia a. Fresh frozen plasma (FFP) |
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Shock
VII. Specific Interventions B. Hypovolemic--restore circulating volume and stop fluid loss restore perfusion 3. Volume replacement--warm to prevent hypothermia a. Fresh ---------- ----------- (FFP) |
Shock
VII. Specific Interventions B. Hypovolemic--restore circulating volume and stop fluid loss restore perfusion 3. Volume replacement--warm to prevent hypothermia a. Fresh frozen plasma (FFP) |
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Shock
VII. Specific Interventions B. Hypovolemic--restore circulating volume and stop fluid loss restore perfusion 4. Monitor response to --------------- (↑PAWP and central venous pressures from 0 12) |
Shock
VII. Specific Interventions B. Hypovolemic--restore circulating volume and stop fluid loss restore perfusion 4. Monitor response to fluid replacement (↑PAWP and central venous pressures from 0 12) |
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Shock
VII. Specific Interventions B. Hypovolemic--restore circulating volume and stop fluid loss restore perfusion 4. Monitor response to fluid replacement (↑------------ and central venous pressures from 0 to -------) |
Shock
VII. Specific Interventions B. Hypovolemic--restore circulating volume and stop fluid loss restore perfusion 4. Monitor response to fluid replacement (↑PAWP and central venous pressures from 0 12) |
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Shock
VII. Specific Interventions C. Septic--: --------- O2 supply and ------------ O2 demand |
Shock
VII. Specific Interventions C. Septic--optimize O2 supply and decrease O2 demand |
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Shock
VII. Specific Interventions C. Septic--optimize O2 supply and decrease O2 demand 1. Large amounts of fluid replacement (6-______L crystalloids or 2-______L colloids) |
Shock
VII. Specific Interventions C. Septic--optimize O2 supply and decrease O2 demand 1. Large amounts of fluid replacement (6-10L crystalloids or 2-4L colloids) |
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Shock
VII. Specific Interventions C. Septic--optimize O2 supply and decrease O2 demand 1. Large amounts of fluid replacement (6-10L --------- or 2-4L ----------) |
Shock
VII. Specific Interventions C. Septic--optimize O2 supply and decrease O2 demand 1. Large amounts of fluid replacement (6-10L crystalloids or 2-4L colloids) |
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VII. Specific Interventions C. Septic--optimize O2 supply and decrease O2 demand 1. Large amounts of fluid replacement (6-10L crystalloids or 2-4L colloids) a. Endotoxins ↑----------- lose lots of fluids to -------- space |
Shock
VII. Specific Interventions C. Septic--optimize O2 supply and decrease O2 demand 1. Large amounts of fluid replacement (6-10L crystalloids or 2-4L colloids) a. Endotoxins ↑cap perm lose lots of fluids to interstitial space |
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VII. Specific Interventions C. Septic--optimize O2 supply and decrease O2 demand 2. Optimize ---------- |
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VII. Specific Interventions C. Septic--optimize O2 supply and decrease O2 demand 2. Optimize CO |
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VII. Specific Interventions C. Septic--optimize O2 supply and decrease O2 demand 2. Optimize CO a. V--------- b. Vasopressors to ↑---------- c. I----------- |
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VII. Specific Interventions C. Septic--optimize O2 supply and decrease O2 demand 2. Optimize CO a. Volume b. Vasopressors to ↑BP c. Inotropes |
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VII. Specific Interventions C. Septic--optimize O2 supply and decrease O2 demand 3. Correct ----------- 4. Antibiotics (------------ before beginning) |
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VII. Specific Interventions C. Septic--optimize O2 supply and decrease O2 demand 3. Correct acidosis 4. Antibiotics (cultures before beginning) |
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VII. Specific Interventions D. Neurogenic 1. Use ----------- precautions |
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VII. Specific Interventions D. Neurogenic 1. Use spinal precautions |
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VII. Specific Interventions D. Neurogenic 2. Treatment of ↓BP w/ --------- and --------- therapy |
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VII. Specific Interventions D. Neurogenic 2. Treatment of ↓BP w/ fluids and drug therapy a. Dopamine--↑BP and is (+) cornotrope (↑HR) |
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VII. Specific Interventions D. Neurogenic 2. Treatment of ↓BP w/ fluids and drug therapy a. Dopamine--↑------- and is (+) --------- (↑HR) |
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VII. Specific Interventions D. Neurogenic 2. Treatment of ↓BP w/ fluids and drug therapy a. Dopamine--↑BP and is (+) cornotrope (↑HR) |
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VII. Specific Interventions D. Neurogenic 2. Treatment of ↓BP w/ fluids and drug therapy b. E--------- |
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VII. Specific Interventions D. Neurogenic 2. Treatment of ↓BP w/ fluids and drug therapy b. Epinephrine |
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VII. Specific Interventions D. Neurogenic 3. Monitor for --------- |
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VII. Specific Interventions D. Neurogenic 3. Monitor for hypothermia |
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VII. Specific Intervention E. Anaphylactic--can generally be ------------ if treated promptly |
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VII. Specific Intervention E. Anaphylactic--can generally be reverse if treated promptly |
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VII. Specific Intervention E. Anaphylactic--can generally be reverse if treated promptly 1. Prevention--avoidance of known --------- |
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VII. Specific Intervention E. Anaphylactic--can generally be reverse if treated promptly 1. Prevention--avoidance of known allergen 2. Treatment |
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VII. Specific Intervention E. Anaphylactic--can generally be reverse if treated promptly 2. Treatment a. Maintain patient ---------- |
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VII. Specific Intervention E. Anaphylactic--can generally be reverse if treated promptly 2. Treatment a. Maintain patient airway b. Drugs |
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VII. Specific Intervention E. Anaphylactic--can generally be reverse if treated promptly 2. Treatment b. Drugs i. --------------- (drug of choice)--peripheral vasoconstriction and bronchodilation |
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VII. Specific Intervention E. Anaphylactic--can generally be reverse if treated promptly 2. Treatment b. Drugs i. Epinephrine (drug of choice)--peripheral vasoconstriction and bronchodilation |
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VII. Specific Intervention E. Anaphylactic--can generally be reverse if treated promptly 2. Treatment b. Drugs i. Epinephrine (drug of choice)--peripheral ------------ and ------------ |
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VII. Specific Intervention E. Anaphylactic--can generally be reverse if treated promptly 2. Treatment b. Drugs i. Epinephrine (drug of choice)--peripheral vasoconstriction and bronchodilation |
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VII. Specific Intervention E. Anaphylactic--can generally be reverse if treated promptly 2. Treatment b. Drugs i. Epinephrine (drug of choice)--peripheral vasoconstriction and bronchodilation ii. Benadryl--blocks release of --------- iii. IV steroids--↓------------ response |
Shock
VII. Specific Intervention E. Anaphylactic--can generally be reverse if treated promptly 2. Treatment b. Drugs i. Epinephrine (drug of choice)--peripheral vasoconstriction and bronchodilation ii. Benadryl--blocks release of histamine iii. IV steroids--↓allergic response |
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VII. Specific Intervention E. Anaphylactic--can generally be reverse if treated promptly 2. Treatment c. Aggressive --------- replacement (colloids) to combat ---------- |
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VII. Specific Intervention E. Anaphylactic--can generally be reverse if treated promptly 2. Treatment c. Aggressive fluid replacement (colloids) to combat hypotension |
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VIII. Nursing Management A. Goals 1. Assurance of adequate -------- perfusion 2. Restoration of normal ---------- |
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VIII. Nursing Management A. Goals 1. Assurance of adequate tissue perfusion 2. Restoration of normal BP |
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VIII. Nursing Management A. Goals 3. Return/Recovery of -------- function 4. Avoidance of complications from prolonged states of ----------- |
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VIII. Nursing Management A. Goals 3. Return/Recovery of organ function 4. Avoidance of complications from prolonged states of hypoperfusion |
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VIII. Nursing Management B. Acute Interventions 1. ------------ status 2. ---------- status 3. ----------- status |
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VIII. Nursing Management B. Acute Interventions 1. Neurologic status 2. Cardiovascular status 3. Respiratory status |
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VIII. Nursing Management B. Acute Interventions 4.-------- status 5. G--------- 6. Skin and ---------- |
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VIII. Nursing Management B. Acute Interventions 4. Renal status 5. GI 6. Skin and temperature |
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VIII. Nursing Management B. Acute Interventions 7. Emotional --------- or comfort |
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VIII. Nursing Management B. Acute Interventions 7. Emotional support or comfort |
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VIII. Nursing Management C. Health Promotion Strategies 1. Prevention--identify patients at ------- 2. Interventions aimed at decreasing --------- demand |
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VIII. Nursing Management C. Health Promotion Strategies 1. Prevention--identify patients at risk 2. Interventions aimed at decreasing O2 demand |
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VIII. Nursing Management C. Health Promotion Strategies 3. Monitoring of ------------ balance to prevent hypovolemic shock 4. Prevention of ------------- |
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VIII. Nursing Management C. Health Promotion Strategies 3. Monitoring of fluid balance to prevent hypovolemic shock 4. Prevention of infection |