Cor Pulmonale and Artifical Airways Flashcards
(36 cards)
What is cor pulmonale?
enlargement of right ventricle
What is the most common cause of cor pulmonale?
most common cause is COPD because of airway collapse, air trapping , and still alveoli –> increased pulmonary pressure
What are clinical manifestations of cor pulmonale?
- dyspnea on exertion
- lethargy
- low O2
- right sided HF signs such as JVD, peripheral edema, ascites, and hepatomegaly
What is apnea?
absence of breathing
What is dyspnea?
shortness of breath
What is orthopnea?
difficulty breathing when supine
What are Kussmaul breathing patterns?
rapid, deep breathing and is a compensatory mechanism to blow off CO2, and this is body’s response to acidosis so this is normal for these patients (DKA is an example)
What are Biot respirations?
rapid, shallow breathing followed by apnea every 4-5 cycles . pattern appears normal with a sudden stop in breathing
What does biot respirations progress into?
progresses to Cheyne-Stokes
What is Cheyne-Stokes breathing pattern?
irregular breathing with apnea every 4-5 cycles, pattern looks like a football. can cause poor perfusion to brain stem
What are the routes of placement for mechanical ventilation?
oral and nasal
Explain nasal route of placement for mechanical ventilation?
- patient must be awake and breathing
- never used with facial/head trauma
- placed blindly
What is the rapid sequence that is used in emergent situations where a ventilator is needed?
- sedative hypnotics such as etomidate, midazolam, and propofol - FIRST
- paralytics (succinylcholine)
- opioid analagesic (fentanyl)
- positioning
- preoxygenate
How should nurse intervene if patient is crying in rapid sequence of ventilator set up?
if patient is crying, give more sedatives and then give more pain medications to relax the muscle and relieve pain
how should the patient be positioned prior to ventilation?
position should be supine with head extended and neck flexed
how should the nurse help preoxygenate the patient prior to ventilation?
limit each attempt to less than 30 seconds and ventilate between attempts with AMBU bag
What is the End Tial CO2 (ETCO) monitor?
It is a monitor that will change from purple to yellow as it touches CO2 which indicates the tube is in the lungs, if it stays purple the tube is in the esophagus
How can the nurse confirm the ventilation tube location?
Confirm tube placement with ABGs and chest x-ray
Why is a cuff important in mechanical ventilation of a patient?
leave cuff inflated inside the trachea because the cuff makes sure that air is entering the lungs and not escaping through the nose and mouth.
What are important suctioning points that a nurse should follow when taking care of a patient on mechanical ventilation?
- hyperoxygenate
- limit each attempt to 10 seconds or less
- only suction on the way out
How can nurse provide oral care with a mechanical ventilation patient?
- change ET tube position and tape every 24 hours
2. Provide good oral care with mouth moisturizers every 2-4 hours
How can the nurse prevent ventilator associated pneumonia from occurring?
- HOB at 30-45 degree angle (semi fowlers)
- No routine changes of circuit tubing, keep the system closed
- ET tube with dorsal lumen above cuff to allow continuous suctioning
- drain tubing condensate away from patient
- always wash hands and wear gloves
What is Vt on a ventilator?
tidal volume which is the amount of air delivered in one breath to the patient, this is also set on the vent
What happens if there is a high tidal volume?
higher the tidal volume, higher the positive pressure in the lungs which can cause barotrauma –> pneumothorax
