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109: U5: Acute Respiratory > 109: U5: Critical Resp Problems > Flashcards

109: U5: Critical Resp Problems Flashcards

1
Q

Pulmonary Embolus Definition

A

Obstruction of blood flow in part of the pulmonary vascular system by an embolus.

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2
Q

Pulmonary Embolus Pathophys

A

Clot (DVT) breaks loose -> thru vena cave and right side of heart -> lodges in smaller vessel off pulmonary artery -> platelets collect -> serotonin and thromboxane A2 released -> vasoconstriction and pulmonary HTN -> impaired ventilation & perfusion -> hypoxia -> possible death.

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3
Q

Pulmonary Embolus Etiology

A 
Immobilization - long term
Surgery, fractures
Obesity
Advancing age
Hypercoagulability
H/O thromboembolism
Smoking, pregnancy, estrogen tx, CHF, CVA
CA, tumor cells
Fat, oil, air
Amniotic fluid
Foreign objects, injected particles
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4
Q

Pulmonary Embolus Common S/S

A

Dyspnea and mild to moderate hypoxemia with low PaCo2.. Symptoms may begin slowly or suddenly.

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5
Q

Pulmonary Embolus Other S/S

A 
Cough
Pleuritic chest pain
Hemoptysis
Crackles
Fever
Loud pulmonic heart sound
Sudden change in mental status (secondary to hypoxemia)
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6
Q

Pulmonary Embolus Medium Sized Emboli

A 
Pleuritic chest pain
Dyspnea
Slight fever
Productive cough for blood streaked sputum
Tachycardia
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7
Q

Pulmonary Embolus Massive Emboli

A 
Abrupt hypotension
Pallor
Severe dyspnea
Hypoxemia
Chest pain
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8
Q

Pulmonary Embolus Dx

A 
VQ Scan (Ventilation-Perfusion)
Pulmonary angiography MRI
Spiral CT
D-Dimer
ABG
Venous Doppler
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9
Q

Pulmonary Embolus Tx

A 
Prevention!
Oxygen
Anticoagulation (Heparin, Coumadin, Lovenox)
Thrombolytics
Embolectomy
Vena Cava filter
Mechanical Ventilation
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10
Q

Pulmonary Embolus PCs

A

Hypoxemia
Pulmonary Infarction
Acute Cor Pulmonale
Death

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11
Q

Chest Trauma/Pneumothorax Definition

A

Accumulation of atmospheric air in the pleural space.

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12
Q

Chest Trauma/Pneumothorax Pathophys

A

Injury -> atmospheric air in pleural space -> increased intrathroacic pressure and decreased vital capacity -> lung collapses

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13
Q

Chest Trauma/Pneumothorax Etiology

A

Open-air enters pleural space through opening in chest wall - stabs, GSW, surgery.
Closed - no association with external wound. Bleb rupture, ventilation, central line, broken ribs.
Ruptured bleb d/t COPD, CF or smoking (chronic inflammation damages lung lining).

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14
Q

Chest Trauma/Pneumothorax S/S

A 
If small - Increased HR and dyspnea
Decreased breath sounds on affected side
Hyperresonance
Prominence of involved side, which moves poorly with respirations
Pleuritic pain
Tachypnea
Crepitus (SubQ Emphysema)
Cough
Dyspnea, air hunger, decreased O2 sats
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15
Q

Chest Trauma/Pneumothorax Tension Pneumo S/S

A

Rapid accumulation of air with tension on heart and blood vessels, lung collapses with mediastinal and tracheal shift. Decreased cardiac output.

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16
Q

Chest Trauma/Pneumothorax Dx

A

CXR - air on affected side

17
Q

Chest Trauma/Pneumothorax Tx

A

Chest tubes

Heimlich valves

18
Q

Chest Trauma/Pneumothorax Tension Pneumo Tx

A

Large bore needle to release trapped air

19
Q

Chest Trauma/Pneumothorax PCs

A

Hypoxemia

20
Q

Hypoxemic Respiratory Failure Definition

A

Oxygenation failure.

Not a disease - occurs secondary to something else.

21
Q

Hypoxemic Respiratory Failure Pathophys

A

Thoracic pressure changes are normal, lungs can move air sufficiently but cannot oxygenate the pulmonary blood properly.
Inadequate O2 transfer between alveoli and pulmonary capillary bed.
PaO2 60%

22
Q

Hypoxemic Respiratory Failure Etiologies

A 
VQ mismatch
Secretions in alveoli
Bronchospasm
Alveolar collapse
Mucus plug in bronchioles
Clot in pulmonary capillary
Thickened alveolar-capillary membrane
Restrictive lung disease
Toxic inhalation
Pneumonia
Shock
Low atmospheric oxygen
23
Q

Hypoxemic Respiratory Failure S/S

A

Tachypnea
Restlessness, confusion, agitation, combativeness
Prolonged expiration
Nasal flaring
Retractions
Use of accessory muscles
Paradoxic chest or abdominal wall movement
Decreased SpO2 (<80%)
Unable to speak full sentences without pausing to breathe
Cyanosis (late)

24
Q

Hypercapnic Resp Failure Definition

A

Ventilatory Failure

Not a disease, it occurs secondary to something else.

25
Q

Hypercapnic Resp Failure Pathophys

A

Thoracic pressures can’t be changed sufficiently to permit adequate air movement in and out of lungs -> insufficient O2 to alveoli and increased CO2
PaCO2 >48mmHg with pH <7.35

26
Q

Hypercapnic Resp Failure Etiologies

A 
Air trapping with asthma, COPD, CF
CNS: suppressed drive to breathe, defect in respiratory control center in brain
Impaired function of respiratory muscles
Chest wall abnormalities
Neuromuscular conditions
27
Q

Hypercapnic Resp Failure S/S

A 
Low RR or High & shallow RR
Morning headache
Muscle weakness
Decreased DTR's
Pursed lip breathing
Tripod position
Progressive somnolence
28
Q

S/S to BOTH Hypoxemic & Hypercapnic Resp Failure

A 
Dyspnea
Disorientation
HTN
Tachycardia
Coma (late)
29
Q

Hypoxemic & Hypercapnic Resp Failure Interventions

A 
Treat underlying cause!
O2 to correct hypoxemia: use lowest concentration possible to maintain PaO2 90%
Positioning: side lying (good side down), Elevate HOB 45 degrees.
Ventilation: PPV (positive pressure ventilation; CPAP (continuous positive airway pressure); BiPAP (Bilevel positive airway pressure, higher inspiratory, lower expiratory); ETT with mechanical vent
Chest PT
Suctioning
Cough/Deep breathe
Hydration and Humidification
Pulmonary meds
Maintain cardiac output
Maintain Hg
Energy conservation
Nutrition
Monitor for complications
30
Q

Hypoxemic & Hypercapnic Resp Failure PCs

A

Hypoxia
O2 toxicity (in intubated patients, increased O2 for >48 hours)
Respiratory arrest
Death

109: U5: Acute Respiratory (4 decks)

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