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25 Cards in this Set
- Front
- Back
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Who are you likely to see a pulmonary embolism in?
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A-fib, post surgical pt, somebody w/ a DVT
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S/S of PE?
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sudden SOB
hypoxia initially respiratory alkalosis petechie anxiety CP |
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what diagnostic testing is done for a PE?
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gold standard is a spiral CT. then pulm. angiography, ABGs S1Q3 pattern,
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how do you manage a PE?
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heparin/lovenox
coumadin thrombolytics greenfield filter embolectomy |
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what do you monitor in PE?
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respiratory status
sa02 abgs hemodynamics |
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Atelectasis--what is it?
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a reduction of air in part of the lung. see in post op pt or pt on BR and have obstructed air exchange.
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S/S atelectasis?
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dyspnea
cough crackles wheezes that dont clear changes in chest xray |
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how do you diagnose atelectasis?
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Chest xray
Treatment: tcdb, vital signs, sa02, fluids, pt education |
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patho of asthma?
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narrowing of airways. hypertrophy of smooth muscle, mucosal edema, thickening of basement membrane, acute inflammation and plugging of airways with thick viscous mucus. need fluid!
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S/S asthma?
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cant finish sentence because arent moving air.
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What would you treat a community acquired pneumonia with?
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strep pneumonae is most common etiologic agent. Aso mycoplasm.
if > 60 or co-morbidities consider a 2nd gen cephalosporin or Bactrim 160/800 q 12H 14 days if < 60 erythromycin 250-500 mg QID 10-14 days |
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what would you treat a HAP with?
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2nd generation cephalosporin-ceclor; if on vent 3rd generation cephalosporin (rocephin) and aminoglycoside
culture sputum, may do blood cultures change antibiotics according to culture |
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s/s PNA
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fever, lung consolidation or infiltrates, decreased BS
dullness on percussion incr WBC, purulent sputum |
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management?
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get xray-look for consolidation or lobar infiltrate-, blood cultures, WBC,. give fluids. if>60 or co-morbidities treat aggressively
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What does CURB 65 stand for?
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confusion
uremia respiratory > 30 low BP (DBP < 60) Age 65 if have 2 out of 5--hospitalize |
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S/S of a pneumothorax
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SOB/dyspnea
abrupt onset if on vent, sudden rise in PIP absent or decreased BS CP on the affected side or shoulder pain decrease in tactile fremitus hyper-resonance on percussion on the affected side tachypnea resp distress diaphoresis cyanosis hypotension chest xray confirms |
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causes of a pneumothorax?
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trauma
spontaneous secondary spontaneous (like emphysema) iatrogenic pneumo--line placement, bx, thoracentesis, barotraum from vent |
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S/S of a tension Pneumothorax
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extreme SOB
Drop in Sa02 Tracheal deviation Mediastinal shift deviates to the opposite side of the pneumo |
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Treatment of a pneumo?
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Bed rest if small (< 15% of lung)
pain meds and cough meds body will reabsort 1.5% pneumo daily so a small pneumo may take 10 days to resolve Moderate size and mild symptoms-heimlich valve larger than 15% or tension pneumo--CT |
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Transudative Pleural Effusion
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change in hydrostatic or oncotic pressure--HF is an increase in hydrostatic pressure, cirrhosis (decrease in oncotic pressure)
oncotic pulls fluid in hydrostatic pushes fluid out protein determines the pressure so if albumin is low you have a decrease |
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what is a pleural effusion?
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excessive fluid released into the pleural space OR obstruction of lymphatic drainage
normally pleural space has only a few millileters of fluid-its a potential space-composed of the visceral and parietal plurae. when rate of fluid production exceeds the rate of fluid reabsorption, a pleural effusion develops |
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whats an exudative pleural effusion?
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disruption of normal pleural membrane or capillary membrane leading to increase in capillary permeability or decrease in lymphatic drainage--from trauma, infection, tumor.
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S/S pleural Effusion
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Pleuritic chest pain
Sob incr RR splinting referred pain to shoulder tachypnea decrease in tactile fremitus dullness to percussion over the effusion diminished or absent breath sounds friction rub!! |
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diagnostic testing for pleural effusion?
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will see blunting of costophrenic angle or opacity at the base of hemithorax
use Us too cbc, pancreatic and liver enzmes, Ca-125, CT scan, thoracentesis, thorascopy |
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treatment for pleural effusion
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supportive measures
02 iv fluids-keep pt hydrated treat underlyig cause antibiotic therapy depending on etiology thoracentesis--removal of more than 1L at a time might cause re-expasion CT for continual drainage |
