Oxygenation Pt. 2

Question 1

What is Acute Biologic Crisis?

Answer 1

Conditions that could lead to death if di matreat agad

Question 2

Examples of Acute biologic crisis?

Answer 2

1. Acute Respiratory Distress Syndrome
2. Pulmonary Embolism
3. Acute Respiratory Failure
4. Asphyxia
5. Birth or Perinatal Asphyxia

Question 3

What are the 4 criteria to say that the patient is in ARDS?

Answer 3

• ARDS is a severe inflammatory process causing:

1. Diffuse alveolar damage → sudden progressive pulmo edema
2. Increasing bilateral infiltrates on CXR
3. Hypoxemia unresponsive to O2 therapy regardless of the set PEEP on mechvent
4. Absence of elevated left atrial pressure

Question 4

If patient shows similar symptoms to ARDS but there is elevated left atrial pressure, this is?

Answer 4

More cardiogenic origin

Question 5

What are the results of having ARDS?

Answer 5

• Reduced lung compliance
• Relatively high mortality rate (36-44%)

Question 6

COVID-19 belongs to what acute biologic crisis?

Answer 6

ARDS

Question 7

What are the risk factors of ARDS?

Answer 7

• Aspiration (incl. gastric secretions; hydrocarbons like paint thinners, gasoline)
• Drug ingestion + overdose
• Hema disorders (incl. massive transfusions, cp bypass)
• prolonged inhalation of O2, smoke, corrosive substances
• localized infection
• shock
• trauma, major surgery (common is injury to lung parenchyma or alveoli)
• fat, air embolism
• systemic sepsis

Question 8

The risk factors of ARDS all cause?

Answer 8

Acute lung injury

Question 9

Manifestations of ARDS closely resembles?

Answer 9

Pulmonary edema

Question 10

Manifestations of ARDS?

Answer 10

• Rapid onset of severe Dyspnea occurring less than 72 hrs after precipitating event
• Arterial hypoxemia na di na nagrerespond sa O2
• CXR: bilateral infiltrates (same as PE)
• Acute lung injury > fibroting alveolitis this w/ persistent severe hypoxemia
• Increased alveolar dead space (nakakapasok naman ang air pero di makaexchange ang O2 and CO2 kasi weak ang blood flow ng alveoli where the exchange is meant to happen)
• Decreased pulmo compliance (stiff lungs) d/t fibrosis

Question 11

In ARDS, severe dyspnea occurs how many hours after the precipitating event?

Answer 11

Less than 72 hours

Question 12

What are the assessment findings of ARDS?

Answer 12

• Intercostal retractions
• d/t hypoxemia; indication: DOB; accessory muscles at work (dapat diaphragm and external intercostal lang ang ginagamit)
• Crackles
• dahil some alveoli are partially filled w fluids
• possible: supraclavicular retractions; central cyanosis (severe cyanosis)

Question 13

What are the diagnostic findings for ARDS?

Answer 13

Echocardiography (2D Echo): r/o cardiogenic origin
Pulmonary Artery Catheterization (aka Swan-Ganz)
- measures O2 levels in heart and lungs
- ARDS: low O2 levels in arterial blood, increased pressure in pulmo artery

Plasma brain natriuretic peptide (BNP)
- blood test to help distinguish fr cardiogenic pulmo edema by looking at sodium levels
- Normal/Low = GOOD; r/o cardiogenic origin
- High = BAD; likely cardiogenic origin

ADDT’L CONTEXT:
- BNP: primarily produced by the heart esp when its under stress; if not pumping effectively si heart nagrerelease siya ng BNP to signal na may mail
- ^ BNP = heart is struggling to pump blood effectively; kaya nagrerelease ng BNP which promotes diuresis sa body as a means of getting rid of excess fluid and sodium para di mastrain si heart

Question 14

What is the focus of medical management of ARDS?

Answer 14

Identify and treat underlying conditions

Question 15

What is the supportive management for ARDS?

Answer 15

1. Endotracheal Intubation and Mech Vent (PEEP Support) - assist doctor; maintain patent airway
2. Circulatory support - adequate fluids; maintain hydration + medication route
3. Nutritional support - enteral/parenteral
4. Manage systemic hypotension - inotropics (increases force / pumping of heart) or vasopressin (presses on blood vessels para magconstrict)
5. Prone position
6. High frequency oscillatory ventilation, low dose corticosteroid (first 14 days)

Question 16

What is the pharmacological management for ARDS?

Answer 16

• neuromuscular blocking agents: provide temp paralysis to pt para di sila magresist sa ventilation
• analgesics: synchronize vent rhythm and pt’s respi rhythm

Question 17

What is the nursing management for ARDS?

Answer 17

• ICU monitoring (esp yung O2 admin Nya)
• prone position (+ turn frequently)
• monitor cardio - PEEP
• sedatives

Question 18

Why is prone position recommended for ARDS?

Answer 18

• shifts weight of heart off lungs which reduces pressure on them
• gravity allows for redistribution of secretions away sa likod (which can bring problems)
• redistributes blood flow sa less swollen areas
• expands capacity ng lungs
• increases lung volume (air that can be held sa lungs after breathing out)
• alters movement of diaphragm

Question 19

What is pulmonary embolism?

Answer 19

Basically, sa CVS may continuous flow of blood kaya there’s a risk palagi na Baka yung thrombus (blood clot na nakakabit sa vessels) will dislodge and become an emboli (set free); SO in pulmo embo, may obstruction of pulmonary artery or isa sa branches niya BY a thrombus o thrombi, na galing sa venous system or R Side ng heart

Question 20

What are the different types of emboli?

Answer 20

Air
Fat
Amniotic fluid
Septic

Question 21

Risk factors for pulmonary emboli?

Answer 21

Venous stasis, hypercoagulability, venous endothelial disease

+ certain disease states and other predisposing conditions (obesity, pregnancy, advanced age, contraceptive use)

Question 22

What are the stages of blood clotting?

Answer 22

1. Inactive clotting factors
2. Connective tissues are exposed
3. Inactive clotting factors become activated

*Thrombin will activate fibrinogen to form into a fibrin, which is a clot

Question 23

Manifestations of pulmonary embolism?

Answer 23

Tachypnea
Dyspnea - duration depends on extent of embolization
Chest pain - sudden and pleuritic (substernal and mimics MI or angina pectoris)

Other:
- anxiety, fever cough, diaphoresis, tachycardia, apprehension, hemoptysis (coughing blood), syncope (temp loss of consciousness d/t drop in BP)

Question 24

Most frequent sign of pulmonary embolism?

Answer 24

Tachypnea

Question 25

Most frequent symptoms of pulmonary embolism?

Answer 25

Dyspnea

Question 26

What is found upon assessment for Pulmonary Embolism?

Answer 26

**Sudden onset** of pain and/or swelling and warmth of proximal or distal extremity, skin discoloration, and superficial vein distention (origin ng thrombus) Compare right leg from left; pain is usually relieved with elevation Manifestation starts to occur within an hour and could become fatal if not assessed

Question 27

What is the diagnostic work up for pulmonary embolism ?

Answer 27

Multi detector row computed tomography angiography (MDCTA) - **criterion standard for diagnosis of PE** - invasive; need to intro a contrast agent Pulmonary Angiography - NI: assess if pt is allergic to iodine content - Dating gold standard before MDCTA, now alternative na siya - Visualizes vessels of lungs w/ contrast Ventilation-perfusion scan - determines if may dead space

Question 28

What is the medical management for pulmonary embolism?

Answer 28

- Oxygen (thru NC or mask) - IV lines for add’tl fluid and meds - ABG, Perfusion scan, ECG - Intubated and placed on mechvent - Slow infusion of dobutamine (Dobutrex) - Indwelling UC if massive embo and hypotension - Small doses of IV morphine or sedatives

Question 29

What is the nursing management for Pulmonary Embolism?

Answer 29

- identify pts at high risk and minimize risk - prevent thrombus formation via anticoagulants, ambulation, active/passive exercises; avoid crossing of legs and wearing constrictive clothing - assessing for potential: (+) Homan’s sign - pain when finlex ung knee and nagdorsiflex bigla Tenderness (symptom) vs Pain (homans sign) - monitoring thrombolytic therapy VS q2, PT or PTT after 3-4h of tx, heparin/warfarin - Pulse ox - Semi-Fowlers (esp if fr lower ex yung thrombus para di sya umakyat) - managing O2 therapy via DBE, incentive spirometry, percussion, coughing, nebulizer, postural drainage - relieve anxiety, monitor for compli, postop care, home and community care

Question 30

Prevention of pulmonary embolism?

Answer 30

Anticoagulant therapy (e.g. Heparin) NR: monitor pt kasi Baka sumobra Intermittent pneumatic leg compression to prevent stasis of blood

Question 31

Antidotes for heparin and warfarin?

Answer 31

H: Protamine sulfate W: Vitamin K

Question 32

Acute Respiratory Failure is?

Answer 32

Sudden, fatal deterioration of gas exchange function of lung and indicates failure of lungs to provide adequate oxygenation or ventilation for blood Bali: di na kaya magGE so walang mabigay sa blood

Question 33

Early manifestations of ARF?

Answer 33

- restlessness, fatigue - headache - dyspnea - air hunger - tachycardia, increased BP

Question 34

Late manifestations of ARF?

Answer 34

- confusion, lethargy - tachycardia, Tachypnea - central cyanosis - diaphoresis - respi arrest

Question 35

Med management for ARF?

Answer 35

Endotrache intubation and mechvent

Question 36

Nursing mgmt for ARF?

Answer 36

Asssess respi status via ABG, RR Manage pain: semi-Fowlers, opioid analgesics O2 therapy: DBE, incentive spiro, neb, percussion/postural drainage

Question 37

Preventive mgmt for ARF?

Answer 37

Anticoagulant therapy - heparin pero monitor mo dapat pt kasi kung excess, may cause bleeding Intermittent pneumatic leg compression to prevent status in blood

Question 38

What is asphyxia?

Answer 38

When body doesnt get enough O2 kasi may nag interfere sa respi (pwedeng substance like CO) or general lack of O2 kaya organs and tissues are deprived of it. Suffocation; air supply to body is blocked

Question 39

Etiology of asphyxia?

Answer 39

Drowning Chemical substances Anaphylaxis Asthma Choking, Strangulation Drug overdose

Question 40

Birth or Perinatal asphyxia is

Answer 40

Kulang na blood or O2 flow sa fetus; can happen before, during, or after childbirth pero most is during

Question 41

Possible causes of perinatal asphyxia

Answer 41

Lack of O2 in mothers blood Reduced breathing ni mom d/t anesthesia Fever/low BP ni mom Umbilical cord compression Poor placental function Placental abruption

Question 42

Clincal effects of asphyxia?

Answer 42

- Cyanosis - Unconsciouness - Tardieu’s spots - Pulmonary edema - Voiding of urine, stools, semen

Question 43

Stages of Asphyxia?

Answer 43

**1. Forced Respiration:** d/t stimu of respi center; CP: dyspnea, acidosis **2. Convulsions:** d/t cerebral irritation; CP: convulsions, cyanosis, HTN, loc, constricted pupils **3. Paralysis:** death occurs in 3-5 mins; breathing stops w/i 20 seconds of cardiac arrest and heart stops within 20 mins of stoppage of breathing CP: loc, flaccid muscles, lost reflexes, deep cyanosis, dilated pupils, irregular breathing (Cheyne-Strokes respi)

Question 44

Mgmt for asphyxia?

Answer 44

- determine cause - CPR - heimlich if cause is obstruction - O2 therapy in 3-5 mins to avoid brain deterioration - Medications (if d/t anaphylaxis, asthma, drug OD)