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129 Cards in this Set
- Front
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what is pulmonary emboism
4 |
thrombi trapped in pulmonary vessel
originates as DVT can be thrombi fat long bone fractures air |
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what is the most common pulmonary
complication of hospitalized pt 4 |
pulmonary embolism
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what are the physical aspects of the lungs
4 |
right side-3 lobes
can hear middle lobe posteriorly left side-2 lobes this side has room for heart |
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what are the 2 parts of respiration
4 |
gas exchange-at alveoli
airway-air moving in and out of the lungs |
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how does pt present with a PE
4 |
anxiety
sudden onset dyspnea tachypnea tachycardia cough hemoptysis pleuritic chest pain crackles/rales change in level of consciousness |
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what are the pulmonary Dx studies
4 |
V-Q scan
venous studies to dx DVT ABG see both V and Q pulmonary angiography ECG for dysrhythmia |
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what is a V-Q scan
4 |
scan to diagnosis PE
V=ventilation Q=perfusion high probability have PE thrombi causing blood not to go to area in lungs |
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what is treatment for PE
4 |
O2
intubation also use treatment for shock DVT heparin bed rest greenfield filter-inferior vena cava ASA Plavix |
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what are the complications of a
PE 4 |
death
pulmonary infarction death of tissue can't use anymore pulmonary hypertension right side of heart loss of vascular bed in lungs cor pulmonale-rt side of heart |
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how do you prevent PE
4 |
OOB to chair
bed rest-dorsiflex change positions rotate ankles TED hose compression boots (stimulate walking) SC heparin BID |
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what are the 3 types of chest trauma
4 |
blunt
penetrating contra-coup |
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what it blunt trauma
4 |
body struck with blunt objects
ie steering wheel hits chest |
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what is penetrating trauma
4 |
foreign body impales body tissue
ie knife |
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what is contra-coup
4 |
internal organs are injured in two places
front and back side point of impact is the opposite side of the body |
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what is the most common chest injury
4 |
rib fractures
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how does pt know that they have
a rib fracture 4 |
pt has pain in inspiration
pt breathes shallow |
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how are rib fractures diagnosed
4 |
CXR
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what is goal in treatment of rib fracture
4 |
decrease pain so pt can breath
decrease chance of atelectasis |
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why is drug therapy important for
lung surgery or fractures 4 |
to decrease pain so pt can breath
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what is flail chest
4 |
multiple rib fractures
causes instability of chest wall |
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how is flail chest characterized
4 |
parodoxical breathing
tachycardia-low O2 blood rapid shallow breathing crepitus-air escaping under the skin |
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what can flail chest lead to
4 |
pneumothorax
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how is flail chest diagnosed
4 |
CXR
ABGs visual exam-parodoxical breathing |
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how do lungs appear in CXR
4 |
normal=clear and grayish
disease=white consolidation-pneumonia |
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what are the 4 types of pneumothorax
4 |
closed/spontaneous
open tension hemothorax |
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what is spontaneous/closed
pneumothorax 4 |
no communication with outside
breath in, air goes into pleural space and lungs can't expand rupture bleb-COPD CVP insertion perforate esophagus (TEE) broken ribs-injure lungs mech vent too much pressure |
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what is open pneumothorax
4 |
communication with the outside
breath in air rushes in and lung collapses breath out air escapes and lung re-expands stab wound gunshot surgical thoracotomies this creates pneumothorax |
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what is tension pneumothorax
4 |
worst kind-with every breath
pneumothorax gets bigger cause air can't escape flap of skin creates one way valve air enters and can't escape air pushes lungs and heart to other side low cardiac output and low air exchange in healthy lung |
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what is hemothorax
4 |
chest trauma
anticoagulants lung malignancy |
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how is pt assessed for pneumothorax
4 |
respiratory distress
chest pain no breath sounds unaffected side tachycardia cyanosis tracheal shift-to unaffected side due to air collected in affected side |
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where is placement of chest tube in
the pleural space for air and fluid 4 |
2nd ICS to remove air
8th and 9th ICS to remove fluid and blood |
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what does a pneumothorax create
4 |
mediastinal shift way from
midline to unaffected side |
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what is nursing care for chest tube
4 |
know placement for air and fluid
sedate pt fill water seal chamber 20 cm suction attached-orange ball observe for bubbling measure drainage keep tubes straight keep system below chest level assist with removal |
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why is there occassional bubbling in the water seal chamber
4 |
as air empties out of pleural space and lung re-inflates
if continuous bubbling=air leak |
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what are pt instructions for
chest tube removal 4 |
take deep breathe in
exhale valsalva if breathe in will put air back into pleural space and another pneumothorax and need another chest tube |
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what is tidaling
4 |
movement in the water seal chamber
from breathing |
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how long does it take for a lung to
re-inflate 4 |
24-36 hours
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how much water needs to be maintained in the water seal
chamber 4 |
20 cc
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what is atelectasis
4 |
collapsed airless alveoli
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who is at risk for atelectasis
4 |
pts with pneumonia
abdominal pain acute respiratory distress syndrome chronic lung disorder (COPD) post op pts due to anesthesia |
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what is the purpose of the water seal
4 |
lets air out of the pleural space
but will not let air in |
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how can tell pt is ready for chest
tube removal 4 |
if turn suction off and air does not re-enter lung can take chest tube
out will also do CXR |
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what can atelectasis lead to
4 |
respiratory failure
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what is acute respiratory failure
4 |
condition not disease
one or more diseases involving lungs or other body systems results in hypoxemia pt can't exhange gas and needs intubation |
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what are the 2 types of respiratory
failure 4 |
one of the two pieces need for breathing are missing
breathing gas exchange hypoxemia respiratory failure PaO2 60 mmHg or less hypercapnic respiratory failure low PaCO2 acidemia pH less than 7.35 |
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how does pt present with acute
respiratory failure 4 |
rapid, shallow breathing
tripod position dyspnea/orthopnea speak short jerky sentences change level of consciousness fatigue cyanosis pursed lip breathing retractions crackles/rhonchi pleural friction rub tachycardia restlessness/agitated change I:E ratio |
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how are crackles and rhonchi taken care of in acute respiratory failure
4 |
rhonchi-suction
crackles-lasix |
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what is patho of pulmonary embolism
4 |
lungs can't exchange O2 and CO2 due to water around alveoli
need to be intubated need lasix to get rid of fluids |
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what are the diagnostic tests for
respiratory failure 4 |
H and P (smoking/CHF)
ABG (? retain CO2) CXR (white out) CBC (Hgb-carries O2) ECG-(dysrhythmias/hypoxia) electrolytes urinalysis-urosepsis #1 cause of respiratory failure over 65 and over V/Q to R/O PE |
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what is mechanical ventilation
4 |
positive pressure ventilation
thru an artificial airway |
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what is airways used for mechanical
ventilation 4 |
endotracheal tube
(ETT) short time tracheostomy longer-1 month or more |
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what do you need to administer
O2 4 |
an order daily
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what are 3 ways O2 is delivered
via vent 4 |
pressure
volume time |
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what are the terms used for
vent settings 4 |
FIO2
PEEP/CPAP Rate Tidal Volume |
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what is the definition of FIO2
4 |
Fraction of Inspired Oxygen
RA=21% Oxygen oxygen concentration delivered to pt may start of 40%-100% do not leave on 100% and can be toxic put at lowest concentration to get good PaO2 |
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what is definition of PEEP/CPAP
4 |
preset positive pressure to keep
alveoli open |
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what is the definition of the rate
4 |
number of ventilator breathes
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what is the definition of Tidal
Volume 4 |
the volume of air moved in and
out of lungs during breathing 7-10 ml/kg |
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what are the Vent Modes
4 |
Assist
Control Assist-Control-AC Synchronous Intermittent Mandatory Ventilation-SIMY |
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what is definition of Assist in Vent
Mode 4 |
does all the for the pt
who are unconscious who are unanesthesia only delivers breathes pt startw sensitive to pts inspiratory efforts |
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what is definition of Control for Vent Modes
4 |
delivers breathes at preset rate
not sensitive to pts inspiratory efforts |
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what is definition of Assist-Control
for Vent Modes 4 |
best choice
every breath is a ventilator breathe set rate |
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what is definition of Synchronous
Intermittent Mandatory Ventilation (SIMV) 4 |
weaning mode
pt spontaneous breathes synchronizeds mandatory preset breathes with pts own breathes |
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what is the goal of SIMV
4 |
decrease the risk of risk of
hyperventilation facilitates vent weaning |
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whar are hemodynamic efforts of
mechanical ventilation 4 |
forcing air into lungs puts high pressure on thoraic cavity
all pulmonary artery measurements are increased except CO Cardiac Output is decreased |
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what are the complications
of mechanical ventilations 4 |
decreased CO
(decreased Urinary Output/BP) O2 toxicity-respiratory distress Barotrauma-popped lung pulmonary infection stress ulcers malnutrition immobility increased ICP |
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what are nutritional considerations for mech vent pts
4 |
feeding must be started within
24 hrs enteral feedings or TPN pts need to be able to sit up to get enteral feedings |
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what is done for low pressure mech
vent alarms 4 |
alarms because does not sense
pressure of pt exhaling check connections |
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what is done for high pressure mech vent alarms
4 |
alarms because senses high
pressure of pt exhaling= secretions suction pt to get rid of secretions |
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what is done if not sure of mech vent alarms
4 |
take pt off vent
use ambu bag call respiratory |
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what is nursing care for mech
vent pts 4 |
airway clearance-ausculate
check for rhonchi protect airway-protect from pulling safefy-infection,change dressings anxiety-sedation impaired communication pad, message board family support |
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what is trach
4 |
surgical opening in trachea for
airway |
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what is purpose of trach
4 |
bypass upper airway obstruction
facilitate removal of secretions for long term vent use |
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*what is trach care
4 |
cleaned every shift
spare trach at bedside trach ties to stabilize personal protection gear balloon inflation pressure 14 ml |
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*what is cleaning care for trach
4 |
cleaned every 8 hrs
could have disposable cannula clean cannula in saline clean outside with peroxide suction is sterile technique only suction on withdrawal |
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what is pt education for
trach pt 4 |
smoking cessation
humidify air at home S/S infection cough, change secretion, fever stoma care shower/swim use cover loss of senses-smell/taste medic alert tag feeding method education |
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what are screening criteria for
weaning pt from vent 4 |
how well take breath
how well breath without SOB normal pulse ox |
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what are some weaning
methods from vents 4 |
SIMV
pressure support-for alveoli T piece-O2 in tube post extubation follow up |
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what is post extubation follow up
from mech vent 4 |
nurse extubates
pt sits up pt inhales deeply next nurse uses syringe to deflate balloon and pulls tube out quickly pt coughs deeply and leans forward mask-FIO2 @ 40% then nasal cannula |
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what is pulmonary hygiene for
follow up after vent care 4 |
coughing
deep breathing incentive spirometry aerosol therapy percussion postural drainage |
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what is non-invasion ventilation
for follow up care after mech vent 4 |
BiPAP
CPAP |
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what is important to do after mech
vent extubation 4 |
swallowing study
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what is instruction for BiPAP or
CPAP 4 |
mouth has to be shut to while inhaling
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what is important information about
BiPAP and CPAP 4 |
does not provide assisted ventilation
on inspiration improves oxygenation by opening alveoli used for sleep apnea pulmonary edema |
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what is acute respiratory distress
syndrome ARDS 4 |
extreme respiratory disorder
non cardiac pulmonary edema shock lung 50% mortality rate |
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what causes ARDS
4 |
result of shock to lung
prolonged mech vent trauma MODS SIRS severe infection fat emboli pancreatitis |
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what is patho of ARDS
4 |
lung injury with increased
membrane permeability leading to impaired alveoli gas exchange and tissue hypoxia decreased surfactant=collapse alveoli atelectasis |
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what does ARDS look like
on CXR 4 |
looks like pulmonary edema on
CXR but ARDS not cardiogenic, so LASIX will not move fluide out |
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how is pt assessed in ARDS
4 |
profound respiratory distress that
cannot be reversed crackles restlessness/anxiety dyspnea respiratory alkalosis from hyperventilating until intubated tachycardia cyanosis retractions hypotension pulmonary shunting refractory hypoxemia |
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what is pulmonary shunting
4 |
blood passes thru capillary but
cannot deposit O2 |
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what is refractory hypoxemia
4 |
hypoxemia that does not change
no matter how much O2 you give to pt |
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what diagnostic studies for ARDS
4 |
ABGs
increased CO2 decreased PaO2 CXR looks like pulmonary edema hemodynamic monitoring normal PCWP if have fluid overload in heart, pressures would be high from all the extra fluid |
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how do u distinguish between
PE and ARDS 4 |
both will look the same on CXR
but ARDS will not respond to LASIX |
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what is hemoglobin
dissociation curve 4 |
when O2 leaves hemoglobin and
goes to tissue or not has shift to left or shift to right |
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what is shift to left in HSC
4 |
body has more O2 on hemoglobin
molecule but does not give O2 to tissue ie hypothermia |
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what is pt education for
trach pt 4 |
smoking cessation
humidify air at home S/S infection cough, change secretion, fever stoma care shower/swim use cover loss of senses-smell/taste medic alert tag feeding method education |
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|
what are screening criteria for
weaning pt from vent 4 |
how well take breath
how well breath without SOB normal pulse ox |
|
|
what are some weaning
methods from vents 4 |
SIMV
pressure support-for alveoli T piece-O2 in tube post extubation follow up |
|
|
what is post extubation follow up
from mech vent 4 |
nurse extubates
pt sits up pt inhales deeply next nurse uses syringe to deflate balloon and pulls tube out quickly pt coughs deeply and leans forward mask-FIO2 @ 40% then nasal cannula |
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what is pulmonary hygiene for
follow up after vent care 4 |
coughing
deep breathing incentive spirometry aerosol therapy percussion postural drainage |
|
|
what is non-invasion ventilation
for follow up care after mech vent 4 |
BiPAP
CPAP |
|
|
what is important to do after mech
vent extubation 4 |
swallowing study
|
|
|
what is instruction for BiPAP or
CPAP 4 |
mouth has to be shut to while inhaling
|
|
|
what is important information about
BiPAP and CPAP 4 |
does not provide assisted ventilation
on inspiration improves oxygenation by opening alveoli used for sleep apnea pulmonary edema |
|
|
what is acute respiratory distress
syndrome ARDS 4 |
extreme respiratory disorder
non cardiac pulmonary edema shock lung 50% mortality rate |
|
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what are causes of ARDS
4 |
shock to lung tissue
prolonged mech vent trauma MODS SIRS severe infection fat emboli pancreatitis |
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what is ARDS patho
4 |
lung injure that increases
membrane permeability that leads impaired alveoli gas exchange and tissue hypoxia decreased surfactant leads to alveoli collapse atelectasis |
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what does ARDS look like on CXR
4 |
looks like pulmonary edema on
CXR but not cardiogenic so LASIX will not move fluid out |
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what does pt look like in ARDS
4 |
profound respiratory distress that
cannot be reversed crackles restlessness/anxiety dyspnea respiratory alkalosis from hypervenilating until intubation tachycardia cyanosis retractions hypotension pulmonary shunting refractory hypoxemia |
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what is pulmonary shunting
4 |
blood goes thru capillary but
cannot deposit O2 in alveoli |
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what is refractory hypoxemia
4 |
hypoxemia does not change no
matter how much O2 is given to pt |
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what are diagnosis test for ARDS
4 |
ABG
increased CO2 decreased PaO2 CXR looks like PE but LASIX not working hemodynamic monitoring normal PCWP if fluid overload in heart pressures would be high from all the extra fluid |
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how do you distinguish between
PE and ARDS 4 |
looks alike on CXR-white out
ARDS does not respond to LASIX |
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*what is O2 hemoglobin
dissociation curve 4 |
O2 leaves hemoglobin and goes
to tissues or not |
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*what is shift to left of O2 HDC
4 |
more O2 on hemoglobin molecule
but does not give it up to tissue |
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*what is shift to right of O2 HDC
4 |
less O2 on hemoglobin molecule
but more readilly gives it up to tissues |
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*what is example of shift to left
of O2 HDC 4 |
hypothermia
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*what is example of shift to right
of O2 HDC 4 |
septic shock
ARDS |
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*what is shift on O2 HDC for
ARDS 4 |
shirt to right
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what is nursing care for pt
with impaired gas exhange 4 |
oxygen therapy
intubation with mech vent mobilization of secretions |
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what are some protective strategies
for the lungs in ARDS 4 |
PEEP
low tidal volume low FIO2-no O2 toxicity low pressure setting |
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what does mobilization of secretions
involve 4 |
coughing and positioning
hydration/humidification any amount of 2L airway suction chest PT done by RN percussion-cup hands vibration-lung Ca drainage-side that has mucous goes up and unaffected side lays fown |
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what is the drug therapy for
impaired gas exchange 4 |
bronchodilator
DOC-albuterol corticosteroids-decrease inflammation inotropic/vasoprssors-decrease BP IV diurectic DOC LASIX IV abx Narcotic-pain Benzodiazepines-sedation neuromuscular paralyzing agent-esp on vents so pt won't fight |
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what is mouth care for impaired
gas exchange 4 |
every 2 hrs
antiseptic |
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what are two important
assessments in impaired gas exchange 4 |
neuro assessments
early recognize cerbral hypoxia lung assessment early recognize pneumothorax |
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what is it important to try to
maintain in impaired gas exchange 4 |
cardiac output
hemoglobin level-if not transfusion treat pt in blocks of care to not tired out |
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what is positioning for ARDS pt
4 |
pronation
use to open up alveoli in front of lungs |
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what should nurse do to follow CDC
recommendations against nosocomial infection for pt 4 |
strict handwashing
gloves sterile technique with ET suctioning HOB 45o prevents aspiration oral hygiene with antiseptic stress ulcer prophylaxis |
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what is done for CO2 levels in
impaired gas exchange 4 |
to get rid of excess CO2 increase
rate of breathing to retain more CO2 decrease rate of breathing |
