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1 Critical Care > 27 - Respiratory > Flashcards

27 - Respiratory Flashcards

1
Q

Blunt Trauma

A

when chest stricks or is struck by an object
-external injury may appear minor but internal organs may be severely damaged
-rib + sternum can lacerate lung tissue

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2
Q

Penetrating Trauma

A

foreign object impales or passes thru body tissues
-creates an open wound
-ex) gunshot, stab

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3
Q

Flail Chest

A

fracture of 2 or more adjacent ribs in 2 or more places w loss of chest stability

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4
Q

Flail Chest
Manifestations

A

paradoxical breathing
the flailed area is sucked in during inhale, + bulge out during exhale

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5
Q

Pneumothorax

A

air entering the pleural cavity
-pleural cavity is normally neg,
-when air enters, becomes pos
-cause collapse of lung

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6
Q

types of pneumothorax

A

OPEN> air enters thru opening in chest wall

CLOSED> no external wound

TENSION> air enters pleural space but cannot escape

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7
Q

penetrating chest wound aka…

A

sucking chest wound
bc air enters pleural space thru chest wall during inspiration

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8
Q

Tension Pneumothorax

A

air enters pleural space but cant escape
-mediastinum shifts towards unaffected side
»compresses good lung + heart
»medical emergency

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9
Q

Tension Pneumothorax
manifestations

A

-severe dyspnea
-marked tachycardia
-tracheal deviation
-decr/absent breath sounds on affected side
-neck vein distention
-cyanosis
-profuse diaphoresis

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10
Q

Hemothorax

A

accum of blood in pleural space fr injury to chest wall, diaphragm, lung, blood vssls, mediastinum
-can occur w pnmthrx

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11
Q

Pneumothorax
emergency Tx

A

-vent dressing
-chest tube to water-seal drainage
-if object is still in place, do not remove> stabilize w bulky dressing
-thoracentesis

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12
Q

____ pneumothorax is a medical emergency requiring urgent ________ followed by __________

A

tension;
needle decompression;
chest tube insertion to water-deal drainage

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13
Q

vent dressing

A

occlusive dressing that is secured on 3 sides
INSPIRATION: neg pressure is created> dressing pulls against wound> prevents air fr entering

EXPIRATION: pressure rises> dressing is pushed out> air escapes thru wound under dressing

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14
Q

repeated spontaneous thorax may need…

A

surgical tx w…
-partial pleurectomy
-stapling
-pleurodesis

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15
Q

chest tube effects

A

-drain the pleural space
-re-establish neg pressure
-allow for proper lung expansion

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16
Q

chest tube
sizes + purpose

A

about 20 in long

LARGE 36-40F: drain blood
MED 24-36F: drain fluid
SMALL 12-24: drain air

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17
Q

chest tube
standard site for insertion

A

midaxillary

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18
Q

flutter/heimlech valve

A

used to remove air fr pleural space

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19
Q

drainage unit
3 compartments

A

1 Collection Chamber
2 Water-Seal Chamber
3 Suction Control Chamber

20
Q

Drainage Unit
Collection Chamber

A

receives fluid + air fr pleural space
-fluid stays in chamber
-air moves on to 2nd compartment (water-seal chamber)

21
Q

Drainage Unit
Water-Seal Chamber

A

contains 2 cm of water
»acts as one-way valve
»incoming air bubbles thru

22
Q

Tidaling

A

fluctuation of water w/in water-seal chamber
»up+down reflects respiration
»as lung re-expands, tidaling should slow + eventually stops

23
Q

if tidaling stops suddenly..

A

assess chest tube
-there might be an OCCLUSION

24
Q

normal bubbling in water-seal chamber

A

-brisk bubbling when first applied
-intermittent bubbling during exhalation, cough, sneeze
-ceases when air leak is resolved

25
Q

Drainage Unit
Suction Control Chamber

A

applies suction to chest tube
-regulated by amt of water in the chamber
-normally -20cm
-normal pressure needed for delicate tissue or older/frail

26
Q

if chest tube becomes disconnected…

A

re-establish water-seal by immersing chest tube in sterile water

27
Q

when can chest tubes be clamped?

A

-switching to new drain unit
-checking for air leaks
-no more than 10 secs?

28
Q

if volume of 1-1.5L of fluids is removed rapidly…

A

following can occur:
-reexpansion pulmo edema
-severe hypotension

29
Q

expected draining amt

A

<200mL in first hour
<100mL after

30
Q

Thoracotomy

A

surgical incision into chest
-to gain access to heart, lungs, esophagus, thoracic aorta, or anterior spineT

31
Q

Thoracentesis

A

aspiration of intrapleural fluid for dx or therapeutic purpose

32
Q

Pulmonary Embolism

A

blockage of 1 or more pulmo arteries by a thrombus, air, fat, or tumor

33
Q

most common site for PE

A

lower lobes

34
Q

most PEs are derived from…

A

DVT

35
Q

Saddle Embolus

A

large thrombus lodged at an arterial bifurcation

36
Q

PE
risk factord

A

-immobility
-surgery (esp pelvic + lower extremity)
-hx VTE
-cancer
-obesity
-smoking
-prolonged air travel
-HF
-pregnancy
-clotting disorders

37
Q

PE
manifestation

A

varies depending on extent
dyspnea
-mild-mod hypoxemia
-tachypnea
-cough
-chest pain
-hemoptysis
-crackles
-wheezing
-fever
-tachycardia
-syncope

38
Q

PE
complications

A

10% mortality
-pulmo infarction
-pulmo HTN
»>dilatn or hypertrophy of R ventricle

39
Q

PE
dx

A

-D-dimer
-Spiral/Helical CT Scan
-ventilation perfusion VQ Scan

-ABG is important but not dx

40
Q

Spiral/Helical CT Scan

A

-IV injection of contrast to view blood vssls

41
Q

ventricular perfusion V./Q Scan

A

2 parts:
1 perfusion scanning : IV injection of radioisotope>scan pulmo circltn
2 ventricular scanning: inhalation of radioactive gas

42
Q

PE
nursing actions

A

-bedrest in semi-fowler
-O2 therapy
-maintain IV line
-turning
-coughing
-deep breathing
-incentive spirometry

43
Q

PE drug therapy

A

-diuretics if HF
-anticoag like heparin or lovenox, warfarin
-fibrinolytics (tissue plasminogen activator tpa, or alteplase)
-

44
Q

PE
surgery

A

-embolectomy

45
Q

heparin… monitor…

A

aPTT, platelet

46
Q

warfarin… monitor…

A

INR

47
Q

anticoag for PE lasts for…

A

3 months
indefinitely for recurrent

1 Critical Care (17 decks)

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