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Nursing 283 > Week 2 Respiratory > Flashcards

Week 2 Respiratory Flashcards

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1
Q

Hemoptysis

A

bloody sputum, often seen in PE

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2
Q

Assessment finding in a PE

A

dyspnea, tachycardia, sharp pain on inspiration, dry cough, crackles, S3/4 heart sounds, diaphoresis, distended neck veins, syncope, hypotension, petechiae, low grade fever

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3
Q

What causes hypotension in a PE PT?

A

pulmonary HTN and reduced forward flow of blood

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4
Q

Early signs of PE (lab)

A

hypoxea leads to hyperventilation, PaCO2 levels decrease resulting in respiratory alkalosis

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5
Q

What is “shunting: in regards to PE process

A

shifting of blood from the left to the right side of the heart, bypassing the lungs and oxygenation

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6
Q

Later signs of PE (lab)

A

PaO2-FiO2 drops due to shunting, PaCO2 levels rise resulting in acidosis
Lactic acid build up due to hypoxea leads to metabolic acidosis

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7
Q

Priority nursing interventions for PE

A

Apply O2

Give anticoagulant or fibrinolytic

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8
Q

Antidote for Heparin

A

protamine sulfate

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9
Q

antidote for warfarin

A

Vitamin K

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10
Q

Critical ABG values

A

PaO2 50

pH <7.3

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11
Q

How is acute respiratory failure classified?

A

By blood gas abnormalities

This PT will always be hypoxemic

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12
Q

Causes of acute respiratory failure

A

Ventilatory failure
Oxygenation failure
Combination ventilatory and oxygenation failure

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13
Q

Ventilatory failure

A

a problem with O2 intake (ventilation) and blood delivery (perfusion)
Ventilation is inadequate but perfusion is ok
Leads to hypoxemia

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14
Q

PaCO2 level seen in ventilatory failure

A

PaCO2 >50 mmHg

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15
Q

Causes of ventilatory failure

A

Extrapulmonary: neuromuscular disorders, SCI, CVA, increased ICP, chemical depression, obesity, sleep apnea
Intrapulmonary: lung disease, PE, pneumothorax, ARDS, pulmonary edema

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16
Q

Oxygenation failure

A

blood fails to oxygenate properly despite adequate O2 intake

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17
Q

Result of O2 application in oxygenation failure

A

even delivery of 100% O2 will not increase oxygenation levels

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18
Q

Causes of oxygenation failure

A

right to left shunting of blood, air has low O2, V/Q mismatch, abnormal hemoglobin that fails to bind to O2
Most common: ARDS

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19
Q

Who is more likely to have combined ventilatory and oxygenation failure?

A

PTs with abnormal lungs (chronic bronchitis, emphysema, asthma)

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20
Q

Orthopnea

A

finding it easier to breathe when sitting up

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21
Q

Key features of ARDS

A 
hypoxemia even with 100% O2
< pulmonary compliance
Dyspnea
pulmonary edema (non-cardiac)
x-ray shows dense pulmonary infiltrates
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22
Q

When does ARDS occur

A

Most often after an acute lung injury

Can be during sepsis, PE, shock, aspiration or inhalation injury

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23
Q

ARDS pathophysiology

A

surfactant production is reduced. Alveoli either collapse or fill with fluid and are unable to exchange gases resulting in hypoxemia and V/Q mismatch

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24
Q

Greatest risk factor for developing ADRS

A

aspiration of gastric contents

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25
Lung sounds in ARDS
lung sounds will not be heard on auscultation because edema occurs in the interstitial space
26
Diagnostic criteria for ARDS
Lowered PaO2 higher need for O2 Decreased/no response to increased O2 (refractory hypoxemia) hazy "ground glass" look of lung x-ray
27
main difference between ARDS and cardiac induced pulmonary edema
ARDS pulmonary capillary wedge pressure is low to normal while in cardiac induced pulmonary edema, it is > 18mm Hg
28
ARDS interventions
Intubation (PEEP) | CPAP
29
Side effect of PEEP therapy
tension pneumothorax, evaluate lung sounds and suction hourly
30
ARDS drug and fluid therapy
Corticosteroids < inflammation and stabilize capillary membranes Conservative fluid therapy has better results than liberal fluids
31
ARDS nutrition
Likely tube feedings will be needed
32
ARDS phase 1
early changes of dyspnea and tachypnea | PT will need O2
33
ARDS phase 2
edema increases | mechanical ventilation is needed
34
ARDS phase 3
Occurs between days 2-10, hypoxemia increases despite increased O2
35
ARDS phase 4
Pulmonary fibrosis occurs after 10 days, this is irreversible If the PT survives, they will have chronic lung problems PT will be dependent on the ventilator in this phase
36
Most common uses for mechanical ventilation
hypoxemia and progressive alveolar hypoventilation with respiratory acidosis
37
What is the most common cause of ventilator complications
positive pressure from the ventilator
38
Cardiac problems from mechanical ventilation
hypotension: increased pressure inhibits blood return to the heart which reduces CO Fluid retention: decreased CO triggers RAAS to retain fluid
39
Lung problems caused by mechanical ventilation
Barotrauma: damage to lungs by positive pressure (pneumothorax and sub Q emphysema) Volutrauma: damage to the lungs by one lung getting a larger volume than the other Acid base imbalance
40
GI and nutritional problems caused by mechanical ventilation
Stress ulcers increase the risk for infection | Paralytic ileus reduces nutrient absorption
41
Dietary changes for COPD and mechanical ventilation
Carbohydrates must be reduced | Excessive carbohydrates increase CO2 production
42
Ventilator associated pneumonia
a common infection threat to vent PTs and increases mortality rates Perform oral care Q2, promote postural drainage, turn and re-position Q2
43
Ventilation removal
``` Hyperoxygenate PT Suction tube and oral cavity Deflate cuff remove tube at peak inspiration Instruct PT to cough ```
44
Stridor
high pitched noise during inspiration caused by a laryngospasm or edema and indicates a narrowed airway Reintubation may be needed
45
Respiratory failure development after pulmonary contusion
develops over time rather than immediately
46
Injuries classified as " deep chest" injuries
injury to 1st or 2nd ribs, flail chest 7+ fractured ribs or expired volumes < 15mL/kg prognosis is poor
47
Paradoxic chest movement
sucking inward of the loose chest area on inspiration and the puffing out of the area on expiration
48
ABG result of a tension pneumothorax
hypoxia and resp alkalosis
49
Treatment of a tension pneumothorax
large bore needle inserted into 2nd intercostal space, mid clavicular line A chest tube is inserted into the 4th intercostal space
50
Simple hemothorax
blood loss of <1500mL
51
Massive hemothorax
blood loss of >1500mL
52
When is an open thoracotamy needed to treat a hemothorax?
when blood loss is 1500-2000mL or persistant bleeding at 200mL over 3 hours
53
Complications of a torn mainstem bronchus
tension pneumothorax with intubation necessary | Hypotension and shock are likely
54
What cluter of sx seen in a PT at risk for PE required rapid response
distended neck veins, syncope, cyanisis and hypotension
55
Nursing priorities in caring for a patient on mechanical ventilation
monitoring and evaluation PT response, managing ventilator system and preventing complications
56
What should the nurse do if the PT develops respiratory distress during mechanical ventilation
remove the ventilator and provide ventilation via bag valve mask so you can best determine if the problem is with the PT or the ventilator
57
What should you do if stridor develops after extubation
call rapid response in any indication of airway obstruction so the airway does not become completely obstructed
58
For what drug is PTT and aPTT monitored
Heparin
59
For what drug is PT monitored
Coumadin (Warfarin)
60
Average PT range
11-12.5 seconds | Will be 1.5-2x normal on Warfarin
61
Risk factors for VTE
Age (#1), immobility, obesity, smoking, pregnancy, estrogen tx, trauma, oral contraceptives
62
What diagnostic tests are needed for VTE
ABGs (need CO2 and pH) CXR CT of thorax (MDCTA) Transesophageal echocardiography (TEE)
63
Nursing interventions for VTE
``` elevate HOB O2 Monitor VS, breathing, lung and heart sounds 2nd IV Monitor labs ```
64
ABGs in ARF
PaO2 50 | O2 SAT <90
65
Signs and Symptoms of Respiratory Compromise
``` Dyspnea Shallow, irregular breathing Rapid RR Abdominal breathing Use of intercostal muscles Tachycardia Confused Diaphoretic Cyanotic Irritable Headaches and Lethargic ```
66
Minimum O2 flow on a simple face mask
5L/min
67
Diagnostic tests used in ARDS
``` ABGs CXR 12 lead ECG Sputum cultures PA catheter to evaluate fluid & heart status ```
68
ARDS nursing interventions
Assist with intubation/ventilation Maintian fluid balance/nutrition Administer antibiotics
69
OXYGENATION GOAL using mechanical ventilation in ARDS
PaO2 55-80mmHg or SpO2 88-95%
70
Goals of mechanical ventilation
Improve oxygenation and ventilation | Decrease work of breathing
71
Non invasive ventilator modes
BIPAP, CPAP and Pressure support, you don’t have to have an endotracheal tube
72
Why does phosphorus need to be WNL on ventilated PTs
If you don’t have enough phosphorus you are not going to have enough energy to get off the ventilator (ATP for cell energy)
73
HOB elevation with ventilator use
30 degrees
74
Ventilator use cardiac complications
hypotension, fluid retention
75
Ventilator use lung complications
barotrauma, volutrauma, acid-base imbalance
76
Ventilator use GI complications
nutrition, nutrition, nutrition, stress ulcer prevention, replace electrolytes
77
ABGs criteria for respiratory failure
PaO2 < 60 | PaCO2 > 50

Nursing 283 (10 decks)

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