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50 Cards in this Set

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Failure of Oxygenation:
Criteria
PaO2 < 60 mmHg
Failure of Ventilation:
Criteria
PaCO2 > 50 mmHg
Ventilatory failure
Common Causes
exacerbations of asthma and COPD
overdoses of drugs that suppress ventilatorydrive
Guillain-Barrésyndrome myasthenia gravis
botulism
Hypoxemia
Def
–The reduction of arterial PaO2 –a lower than normal amount of O2 is disscolvedin the blood plasma
Hypoxia
Def
–A reduction in the amount of O2 that is delivered to the tissue.
HYPOXEMIA
•Clinical Manifestations
Change in LOC: confusion, apprehension–often the first sign
–HTN changing to Hypotension
–Tachycardia, possible dysrhythmias
–Tachypnea
–Skin color pale (early sign)
–Cyanosis (late sign)
–Clubbing of fingertips (late sign)
–Patient c/o SOB, dyspnea & fatigue
Atelectasis
•Clinical Manifestations:
–Dyspnea
–Hypoxemia (low O2 Saturation)
–Yanosis
–Tachypnea
–Auscultation reveals diminished breath sounds
–Younger clients may be febrile
Acute Tracheobronchitis
•Clinical Manifestations:
–Dry cough and small amount of sputum.
–Fever, chills night sweats, H/A or general malaise.
–SOB, inspiratorystridorand expiratory wheeze. Purulent sputum
–Severe: blood-streaked secretions due to irritation to airway.
Acute Tracheobronchitis
Management:
–Sputum culture
–Antibiotic tx
–Increase fluids
–Mild analgesics or antipretics
–AntihistminesNOT prescribed (excessive drying)
Acute Tracheobronchitis
Nursing Mgmt:
–Education:
•Increase fluid intake, coughing, rest, complete antibiotic regimen.
Clinical ManifestationsPneumonia
•Fever, shaking, and chills
•Shortness of breath
•Productive cough (purulent sputum)
•Pleuritic chest pain
•Confusion or stupor as a result of hypoxemia (seen mostly in the elderly)
•Headache, myalgia, fatigue, nausea, sore throat, vomiting and diarrhea
Complications of Pneumonia
•Pleurisy
•Pleural effusion
•Atelectasis
•Bacteremia
•Lung abscess
•Empyema
•Pericarditis
•Meningitis
•Endocarditis
•Continuing symptoms after initiation of therapy
•Shock
•Respiratory failure
•Atelectasis
•Confusion
•Superinfection
Pleurisy
Med used to tx pain
Indocin
Pneumonia
Abx used
Macrolide
Streptococcal pneumonia (pneumococcal)
abx used
Penicillins
Alternative antibiotic therapy, such as cefotaxime or ceftriaxone; antipseudomonal fluuoroquinolones (levofloxacin, gatifloxacin, moxifloxacin).
Haemophilus influenzae
Abx used
Ampicillin, third- or fourth-generation cephalosporin, macrolides (azithromycin, clarithromycin), fluoroquinolones
Legionnaires' disease
abx used
Erythromycin +/-rifampin (in severely compromised patient) or clarithromycin, or a macrolide (azithromycin), or a fluoroquinolone (ofloxacin, levofloxacin, sparfloxacin
Mycoplasma pneumoniae
abx used
Doxycycline, macrolidefluoroquinolone.
Viral pneumonia
tx
Type A: amantadine and rimantadine
Type A/B: zanamivir, oseltamivir phosphate.
Treated symptomatically.
Does not respond to treatment with currently available antimicrobials.
Pneumothorax
Def
Occurs when the pleural space is exposed to + atmospheric pressure
Either the parital or visceral pleura has been breached and air enters the pleural cavity and increases intra thoacis pressure and the results is collapse of a portion of the lung.
Closed Pneumothorax
Def
No associated external wound, most common is spontaneous which is an accumlation of air.
Closed Pneumothorax
Cause
Rupture of small blebs on the visceral pleural space
Common in underweight male smokers
Open Pneumothorax
cause
occurs when air enters the pleural space by an opening from trauma or surgery
Open Pneumothorax
emergent tx
Cover the the wound with a vented dressing allowing air to escape and decreasing the likeleyhood of reoccurance
If the object is in place it should be stabilized and covered until the MD is present
Tension Pneumothorax
def
Rapid accumulation of air in the pleural space and as a results causes tension on the heart and great vessels(either from and open or closed pneumothorax)
The pressure in the thorasic cavity increases and the lung collapse and the mediastinum shifts toward the unaffected side.
Hemothorax
def
Blood in the intra pleural space
Hemothorax
causes
chest trauma, lung ca, complications of anticoagulants, PE or pleural adhesions
Chylothorax
def
Lymphatic tissue in the plural space
Chylothorax
causes
trauma surgical procedure sand malignancy
Pneumothorax
Assessment
Reduced Breath sounds on the affected side
hyperresonace on percussion of the chest
Prominence of the affected side of the chest
Tracheal deviation away(closed) or toward(open) the affected side
Tachypnea, resp distress or cyanosis
Pleuritic pain
SC emphysena in some cases
Distended neck veins
Chest Drainage Management
Verify that all connection tubes are patent and connected securely.
Assess that the water seal is intact when using a wet suction system and assess the regulator dial in dry suction systems.
Monitor characteristics of drainage including color, amount, and consistency. Assess for significant increases or decreases in drainage output.
Note fluctuations in the water seal chamber for wet suction systems and the air leak indicator for dry suction systems.
Keep system below the patient's chest level.
Assess suction control chamber for bubbling in wet suction systems.
Keep suction at prescribed level.
Maintain appropriate fluid in water seal for wet suction systems.
Keep air vent open when suction is off.
Pleurisy
Def
Pleurisy (pleuritis) refers to inflammation of both layers of the pleurae (parietal and visceral).
Pleurisy
clinical manifestations
Severe, one sided pain on inspiration.
Taking a deep breath, coughing, or sneezing worsens the pain.
The pain may become minimal or absent when the breath is held. It may be localized or radiate to the shoulder or abdomen.
Later, as pleural fluid develops, the pain decreases.
Pleural Effusion
•Accumulation of the pleural fluid >250cc and seen on CXR.
ARDS
def
•A severe form of acute lung injury
•A syndrome characterized by sudden and progressive pulmonary edema, increasing bilateral lung infiltrates on CXR, hypoxemia refractory to oxygen therapy, and decreased lung compliance
ARDS
symptoms
–Rapid onset of severe dyspnea
–Hypoxemia that does not respond to supplemental oxygen
ARDS
abg's
•PaO2 < 50 mmHg (Hypoxemia)
PaCO2 > 50 mmHg (Hypercapnia) and arterial pH <7.35
ARDS
Factors related to:
Aspiration (gastric secretions, drowning, hydrocarbons)
Drug ingestion and overdose
Hematologic disorders (disseminated intravascular coagulopathy [DIC], massive transfusions, cardiopulmonary bypass)
Prolonged inhalation of high concentrations of oxygen, smoke, or corrosive substances
Localized infection (bacterial, fungal, viral pneumonia)
Metabolic disorders (pancreatitis, uremia)
Shock (any cause)
Trauma (pulmonary contusion, multiple fractures, head injury)
Major surgery
Fat or air embolism
Systemic sepsis
ARDS
major cause of death
non pulm mulit system organ failure with sepis
ARDS
s/s
rapid onset of severe dyspnea that usually occurs 12 to 48 hours after the initiating event
arterial hypoxemia that does not respond to O2
Intercostal retractions and crackles
Ventilatory Failure
def
(Defined as a PCO2above 45mmHg)
•Perfusion is normal but ventilation is inadequate
Ventilatory Failure
Causes:
•A mechanical abnormality of the lungs or chest wall
•A defect in the respiratory control center in the brain
•An impairment in the function of the respiratory muscles/diaphragm
Causes of Ventilatory Failure
•Extrapulmonary:
•Multiple sclerosis
•Guillain-Barre syndrome
•Stroke, Cerebral edema, Increased ICP
Causes of Vent failure
Intrapulmonary:
Chronic Obstructive Pulmonary Disease
•Asthma & Pneumothorax
Causes of Oxygenation Failure
•Pneumonia
•Pulmonary embolism & Pulmonary edema
•ARDS & Mechanical Obstruction
•CHF
•Hypoventilation
•Carbon monoxide poisoning
•Smoke inhalation
O2 failure
Clinical Manifestations
•Anxiety, Restlessness, Agitation
•Diaphoresis, increased VS, arrhythmias
•Change in mental status (impaired judgment, confusion, disorientation)
•Lethargy, confusion, progressing to coma
•Dyspnea
•Nasal flaring
•Use of accessory muscles
•Speaks only a few words at a time.
•Bronchospasms
Causes: ARDS
Direct Pulmonary Trauma
•Viral, bacterial or fungal pneumonias
•Lung contusion (bruising)
•Fat embolus
•Aspiration (GI contents)
•Massive smoke inhalation & inhaled toxins
•Prolonged exposure to high concentrations of oxygen (oxygen toxicity-O2at >50% for 24-48 hours may damage the
Oxygen ToxicitySigns & Symptoms
•Early signs:
fatigue, weakness, nausea & vomiting, restlessness
Oxygen ToxicitySigns & Symptoms
Late signs:
tachypnea, tachycardia, dyspnea, crackles, cyanosis
Causes: ARDS
Indirect Pulmonary Trauma
Causes: •Sepsis & shock
•Multi-system trauma
•Disseminated intravascular coagulation (DIC)
•Pancreatitis & Uremia
•Drug Overdose & Anaphylaxis
•Increased intracranial pressure
•Radiation therapy
•Massive blood transfusions