Critical Care Nursing Test 1 Arf

Front 1

Clinical Syndrome:

• Discrete or widespread collapsed alveoli
• Can lead to ARF (shunting)
• Predisposes to pneumonia!!!!
• Usually caused by a mucous plug or hypoventilation

Back 1

Atelectasis

Front 2

S&S of Atelectasis

Back 2

• Cough
• Sputum
• Low grade fever
• Usually appears dense on an xray

Front 3

Treatment for Atelectasis

Back 3

Implement pulmonary toilet (ambulation, suction, inc. spirometry, percussion)

Front 4

Infection of lung parenchyma from bacteria, viruses, mycoplasma

Back 4

Pneumonia

Front 5

• Inflammation of the pulmonary pleurae secondary to virus, bacteria, chest trauma or neoplasm
• Causes the layers of the pleura to rub together and which causes pain

Back 5

Pleurisy

ex/ pneumonia, TB

Front 6

S&S of Pleurisy

Back 6

Pleuritic pain (Sharp knife like pain - Usually one sided)
Low grade fever
Pleural friction rub may be heart

Front 7

Treatment for Pleurisy

Back 7

• Treat cause
• NSAIDS
• Rest
• Hydration

Front 8

Inflammatory lung disorder with acute onset of ARF
• 50-60% mortality
• If u get pneumonia the mortality rate increases to 90%
• Must check PAWP to rule out left sided heart failure. This checks the pressure in the left ventricle
• Sudden and progressive pulmonary edema
• Fluid filled alveoli
• Hypoxia and decreased lung compliance
• These people can’t get oxygenated due to alveoli sticking together or being filled with fluid
• “white lung”

Back 8

Acute Respiratory Distress Syndrom (ARDS)

Front 9

Treatment for ARDS

Back 9

Intubate and mechanically ventilate

Front 10

Condition secondary to other disease process:
• Build up of fluid in the pleural cavity
• Clear or bloody (hemothorax)
• Purulent filled (empyema)
• Diagnose by a CXR

Back 10

Pleural Effusion

Front 11

Treatement for Pleural Effusion

Back 11

• For a small pleural effusion treat the cause
• For a large a thoracentesis may need to be done

Front 12

Any type of acute lethal pulmonary condition, disease, or syndrome that results in hypoxemia (pO2 <or=50-60 mmHg) and usually hypercapnea (> or = 50mmHg)

Back 12

Acute Respiratory Failure (ARF)

Front 13

Curve that describes relationship between available oxygen and amount of oxygen carried by hemoglobin

Back 13

SaO2 = vertical - POX (how saturated is hgb (>94% is normal)
PaO2 = horrizontal -find by ABGs (80-100 is normal)

Front 14

Oxygen's attraction to hemoglobin

Back 14

Affinity

Front 15

What changes oxygens affinity?

Back 15

variation in pH
Temp
CO2

Front 16

Changes from the normal:
pH 7.4
Temp 37 C
PaCO2 40
on the OxyHemoglobin Dissociation Curve is called a

Back 16

Shift

Left or Right

Front 17

Left shift conditions

Back 17

Alkalosis, hypothermia
_ increase in oxygen's affinity for hemoglobin
_more of the O2 stays on the hgb and rides back through the lungs without being used
___Can cause tissue HYPOXIA

Front 18

Right shift conditions

Back 18

Acidosis, fever
__oxygen has lower affinity for hemoglobin
___more O2 will be released to the cells but less O2 will be carried from the lungs!!!

Front 19

Blood in pleura (pleural effusion)

Back 19

hemothorax

Front 20

Purulent fluid in pleura (pleural effusion)

Back 20

Empyema

Front 21

Diagnosis of pleural effusion

Back 21

CT or Chest Xray (decubetus) on patients side to look for fluid line

May have crepitus - bubble crackes on skin

Front 22

Treatment of pleural effusion

Back 22

Thoracentesis
__procedure where fluid and/or air is removed from pleural space with needle (may do at bedside to get specimen or relieve symptoms)

Front 23

Post thoracentesis nursing intervention

Back 23

lie on unaffected side after for 1 hr

Front 24

Bilateral pulmonary infiltrates, No left sided heart failure, hypoxemia

Back 24

Acute Respiratory distress syndrome

__Supplemental O2 does not help!!!

Front 25

Treatment of ARDS

Back 25

Intubate and mechanically ventilate with PEEP
• Limit attempts to 30 secs
• Check placement to make sure it’s not in the esophagus with a CO2 monitor(should turn purple)
• Avoid right side placement

Front 26

Intubation by mouth

Back 26

endotracheal - easy access

Front 27

Intubation by nose

Back 27

Nasotracheal

Front 28

Complications to monitor for with intubation ballon that holds tube in place

Back 28

if >25mm of pressure --it can cause erosion of endotracheal wall

if <25mm or pressure --can cause aspiration of secretions

Front 29

To verify placement of intubation tube

Back 29

1) listen to breath sounds bilateraly
2) check if CO2 is expirated
3) Capnography
4)want end of tube 3-4cm above Carina (bronchiolle junction)

Front 30

%inspired oxygen (vent)

Back 30

• FiO2

Front 31

size of the breath, usually 500 cc’s

Back 31

Tidal Volume

Front 32

positive pressure on end expiration to prevent alveoli from collapsing. High levels of this can lead to decreased CO and barotraumas. Usually 5 cm H2O

Back 32

• PEEP
(positive end expiratory pressure)

Front 33

positive pressure on inspiration to augment the size of the patients on breath

Back 33

• Pressure Support
(helps patient pull breath in from vent)

Front 34

How many breaths per minute

Back 34

Rate

Front 35

4 Modes of mechanical ventilation

Back 35

Assist Control
Synchronized Intermittnet Mandatory Ventilation
CPAP
BiPAP

Front 36

The patient is given a preset tidal volume and a set rate. They can initiate their own breath which triggers the vent to deliver the preset volume. *controling pt's breath*

Back 36

Assist Control (AC)
__Tidal Volume (500cc/min) x Rate (12breaths/min) x FiO2 (30%) x PEEP (5cm H2O)

Front 37

The patient is given a preset tidal volume and a set rate, but patient must pull their own tidal volume so gives pressure support. (if pt triggers r>12/min then must pull own volume so give pressure support)

Back 37

SIMV (synchronized intermittent mandatory ventilation)
__Tidal Volume (500cc/min) x Rate (12breaths/min) x FiO2 (30%) x PEEP (5cm H2O) x RPS

Front 38

May be given by face mask or airway. Pt makes their own volume and rate and therefore must be breathing on their own

Back 38

CPAP
__FiO2 (30%) x PEEP (5cm H2O) x RPS

Front 39

Ventilation with mask at home

Back 39

BiPAP

Front 40

Place to prevent paralitic ileus

Back 40

NG Tube

Front 41

2 types of chest trauma

Back 41

Blunt - hitting stering wheel

Penetrating - stab

Front 42

Chest trauma defined as 2 or more sites on 2 or more ribs (free floating segment)
• Chest wall looses stability and usually results in respiratory distress
• Results in less tidal volume and a harder time getting air out
• Most likely will lead to atelactasis and then pneumonia

Back 42

Flail Chest

Front 43

S&S of Flail Chest

Back 43

* tachypnea (fast breathing)
• dyspnea
• pain
• paradoxical chest wall movement
• hypoxia
• cyanosis

Front 44

Treatment of flail chest

Back 44

• supplemental O2
• may need CPAP or vent
• careful use of fluids
• watch for ARDS
• sandbags/splints maybe
• intercostals blocks and/or epidurals for pain
* Surgery rare

Front 45

• not trauma related
• partial or total collapse of the lung secondary to air in the pleural space
• may happen in the ICU when failure to place a line occurs
• could be as a result of a ruptured bleb on the lung

Back 45

Simple/Spontaneous Pneumothorax

Front 46

S&S of Simple/Spontaneous Pneumothorax

Back 46

• dyspnea
• chest pain that radiates to the shoulder
• decreased breath sounds on the injured side
• hyperressonance on the injured side (cuz it's hollow)

Front 47

Treatment of Simple/Spontaneous Pneumothorax

Back 47

• if <10 % none
• if > 10% and symptomatic a chest tube may be used
• if it happens multiple times they may surgically remove the blister

Front 48

Bleb is a

Back 48

Blister

Front 49

• not spontaneous
• blunt or penetrating
• partial or total collapse of the lung due to blood in the pleural space

Back 49

Hemothorax

Front 50

Treatment of Hemothorax

Back 50

• <250ccs and controlled nothing
• >250 and not controlled a chest tube is used
• May do a thoractomy by opeing the chest wall or an autotransfusion which removes the blood and gives it back to the patient

Front 51

• Sucking chest wall wound (immediate lung deflation)

Back 51

Open Pneumothorax

Front 52

S&S of Open Pneumothorax

Back 52

• Dyspnea
• Chest pain
• Characteristic sound
• May see bubbling
• Decreased breath sounds on injured side
• Hyperressonance on injured side
• SQ crepitus

Front 53

Treatment of Open Pneumothorax

Back 53

• Cover with sterile 3 way flap dressing to prevent a tension pneumothorax. Air can escape on expiration
• Prepare for chest tube insertion

Front 54

• Bad emergency
• Progressive lethal syndrome- as air continues to infiltrate pleural space on inspiration but doesn’t escape on expiration

Back 54

Tension Pneumothorax

Front 55

• Usually secondary to acceleration/deceleration injury
• Results in localized alveolocapillary damage (bruised alveoli and edema), and diffuse patchy infiltrates
• Usually happens 24-48 hrs after the damage occurs

Back 55

Pulmonary Contusion

Front 56

Treatment of Pulmonary Contusion

Back 56

• Judicious use of fluids
• Possible vent support, high flow O2
• Early ambulation, deep breathing and incentive spirometry

Front 57

3 chambers of Chest Drainage Systems

Back 57

• Collection: drainage
• Water seal: uses 2 ml’s sterile water, don’t want to see bubbling which means an air leak, tidaling is normal. To test for tubing problem clamp the tube for 1 sec and if there is still bubbling the tube has a problem
• Suction regulator: want constant bubbling, about 20 cm suction, constant wall suctioning