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critical care exam 1 questions > acute LRT disorders > Flashcards

acute LRT disorders Flashcards

1
Q

what is pulmonary edema

A

Abnormal accumulation of fluid in the lung tissue, the alveolar space, or both

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2
Q

how does pulmonary edema present

A

Bilaterally
Pneumonia is usually localized to one side

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3
Q

what are cardiogenic causes of pulmonary edema

A

Coronary artery disease
Cardiomyopathy
Heart valve problems
HTN
Left side HF: blood volume and pressure build up in left atrium → increase in pulmonary venous pressure → increase in hydrostatic pressure that forces fluid out of the pulmonary capillaries
High brain natriuretic peptide (BNP)
`

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4
Q

What are non cardiac causes of pulmonary edema?

A

Lung infections
Exposure to certain toxins
Smoke inhalation
Adverse drug reaction
Chest trauma
Sepsis → extra fluid
Low oncotic pressure
- Not enough proteins
- Nephrotic syndrome

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5
Q

What are the clinical manifestations of pulmonary edema?

A

Fluid leaks into the alveoli and mixed with air
Foamy, frothy, or blood-tinged secretions

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6
Q

What are the assessment findings for pulmonary edema?

A

Crackles in the lung bases (posterior)
Rapidly progress toward the apices of the lungs
Tachycardia
Pulse oximetry values fall
ABG indicates worsening hypoxemia
X-ray: increased interstitial markings
Heart is working overtime to try and fix the hypoxemia

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7
Q

What is the medical management for pulmonary edema?

A

Correcting the underlying disorder
If cardiac, improve left ventricular function
if fluid overload, diuretics and fluid restriction
oxygen relieve hypoxemia and dyspnea
morhpone for anxiety

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8
Q

how do you improve left ventricular function in pulmonary edema

A

Vasodilators: IV nitroglycerin
Inotropic medications
Preload reducers (nitroglycerin and diuretics)
Afterload reducers (dilate blood vessels: nitroprusside, vasotec, captopril)
If no response, intra-aortic balloon pump
Contractility medications

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9
Q

What is the acute respiratory failure criteria?

A

Sudden and life-threatening deterioration of the gas exchange function of the lung
PaO2: <60 mmHg
SaO2: <90%
PaCO2: >50 mmHg
pH: <7.35
Respiratory acidosis!!!

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10
Q

What causes impaired ventilation?

A

Acute obstruction
CNS
Neuromuscular
Musculoskeletal

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11
Q

what are the CNS causes of impaired ventilation?

A

Drug overdose
Head trauma
Infection
Hemorrhage
Sleep apnea

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12
Q

What are the neuromuscular causes of impaired ventilation?

A

Myasthenia gravis
Guillain-Barre syndrome
ALS (amyotrophic lateral sclerosis)
Spinal cord trauma

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13
Q

What are the musculoskeletal causes of impaired ventilation?

A

Chest trauma → can’t expand the chest
Kyphoscoliosis
Malnutrition

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14
Q

What causes impaired oxygenation?

A

Perfusion
Post-op

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15
Q

What are the perfusion causes of impaired oxygenation?

A

Pneumonia
ARDS
Heart failure
COPD
Pulmonary embolism
Restrictive lung disease

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16
Q

What are the post-op causes of impaired oxygenation?

A

Anesthetic, analgesic, and sedative agents–depress respiration or enhance the effects of opioids and lead to hypoventilation
Pain: interfere with deep breathing and coughing
Ventilation-perfusion mismatch

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17
Q

What are the early clinical manifestations of acute respiratory failure?

A

Restlessness
Fatigue
HA
Dyspnea
Air hunger
Tachycardia
Increased BP

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18
Q

What are the late clinical manifestations of acute respiratory failure?

A

Confusion
Lethargy
Tachypnea
Central cyanosis
Diaphoresis
Respiratory arrest
Use of accessory muscles
Decreased breath sounds

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19
Q

what is the medical management for acute respiratory failure

A

Correct underlying cause
Intubation and mechanical ventilation
Oxygenation

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20
Q

what is the nursing management for acute respiratory failure

A

Patients are managed in ICU
Monitoring Level of responsiveness, ABG, Pulse oximetry, Vital signs
Prevent complications
Turning schedule → sedated and can’t turn themselves
Mouth care to prevent pneumonia
Skin care
Range of motion exercises

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21
Q

What is acute respiratory distress syndrome (ARDS)?

A

A severe inflammatory process causing diffuse alveolar damage that results in severe and progressive pulmonary edemaj

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22
Q

how is ARDS diagnosed

A

Refractory hypoxemia
Oxygenation doesn’t work → oxygen toxicity
Chest X-ray with bilateral infiltrates
Exclusion of cardiogenic pulmonary edema

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23
Q

what is the pathophysiology of ARDS

A

Damaged capillary membrane greatly increase capillary membrane permeability
Fluids, proteins, and blood cells leak from the capillary bed into the pulmonary interstitium and alveoli
Reduced lung compliance: “stiff lungs”
Impaired alveolar ventilation

24
Q

What are the manifestations of the acute phases of ARDS?

A

Rapid onset of severe dyspnea
Aspiration
Drug ingestion and overdose
Hematologic disorders
Prolonged inhalation of high concentration of O2
Shock
Trauma or major surgery
Fat or air embolism
Systemic sepsis
Hyaline membranes form

25
Q

what happens 7 days after ARDS starts

A

fibrosis develops

26
Q

what are the assessment findings of ARDS

A

Intercostal retractions
Crackles
BNP (brain natriuretic peptide) Rule out hemodynamic pulmonary edema (heart failure)
Increased: heart is involved
Echocardiography: Evaluate the size and structure of the heart
Pulmonary artery catheterization: definitive method to distinguish between hemodynamic (heart failure) and permeability pulmonary edema (ARDS)

27
Q

what is the medical management of ARDS

A

Intubation and mechanical ventilation
Circulatory support
Adequate fluid volume
Nutritional support
Supplemental oxygen: initial spiral of hypoxemia
Positive end-expiratory pressure (PEEP)

28
Q

What does PEEP do?

A

Increase functional residual capacity
Reverse alveolar collapse
A lower FiO2
Goal: PaO2 >60 mmHg or an oxygen saturation level of greater than 90% at the lowest possible FiO2

29
Q

what symptoms may occur from PEEP

A

Reduced CO
Hypovolemia → less fluid in the blood vessels

30
Q

What is a pulmonary embolism?

A

Obstruction of the pulmonary artery
Air, fat, amniotic fluid, and septic (bacteria invasion of the thrombus)
Alveolar dead space
Substances released from the clot and surrounding area → regional vasoconstriction

31
Q

What does a D-dimer do?

A

Normal D-dimer can rule out a PE

32
Q

How is a pulmonary embolism treated?

A

Heparin drip
Do not mix heparin and saline lines

33
Q

what are the clinical manifestations of PE

A

Tachypnea
Decrease PCO2
Respiratory alkalosis
Hypoxia
Decreased PO2
Dyspnea
Tachycardia
Hemoptysis
Sudden sharp chest pain

34
Q

What are the risk factors for a PE?

A

Immobility
Obesity
DVT
Postoperative
Postpartum
Oral contraceptives
Venous pooling (stasis) with emboli formation

35
Q

What is pulmonary hypertension?

A

Mean pulmonary artery pressure exceeds 25 mmH

36
Q

what is normal pulmonary artery pressure

A

15-18 mmHg

37
Q

How is pulmonary hypertension diagnosed?

A

Right heart catheterization to confirm the diagnosis
Syringe can only push 2.5 mL of air in order prevent overinflation
Need to deflate it after use in order to prevent obstruction

38
Q

What is primary pulmonary hypertension?

A

Women 20-40 → fatal in 5 years (rare)

39
Q

What is secondary pulmonary hypertension?

A

Existing cardiac or pulmonary disease (COPD)
Increases the volume or pressure of blood entering the pulmonary arteries
Narrows or obstructs the pulmonary arteries

40
Q

What is the pathophysiology of pulmonary hypertension?

A

Progressive remodeling of pulmonary vasculature → increase resistance of pulmonary vasculature)
Collagen vascular disease
Congenital heart disease
Anorexigens: drugs reduced appetite
Chronic use of stimulants
Portal hypertension
HIV
Vascular injury

41
Q

What are the clinical manifestations of pulmonary hypertension?

A

Dyspnea
Substernal chest pain
Weakness
Fatigue
Syncope
Occasional hemoptysis
Signs of right-sided heart failure
Peripheral edema, ascites, distended neck veins, liver engorgement, crackles, heart murmur
Anorexia and abdominal pain in the right upper quadrant (RUQ)

42
Q

what are the assessments done for pulmonary hypertension

A

Chest X-ray
Pulmonary function studies
ECG
Echocardiogram
V/Q scan
Sleep studies
Autoantibody tests
HIV tests
Liver function tests
Cardiac catheterization

43
Q

what does a pulmonary function study show for a patient with pulmonary hypertension

A

May be normal or slight decrease in vital capacity and lung compliance, with a mild decrease in the diffusing capacity

44
Q

What does an ECG show for a patient with pulmonary hypertension?

A

Right ventricular hypertrophy
Right axis deviation (increase the chance of MI)
Tall peaked P waves in inferior leads
Tall anterior R waves
ST segment depression
T wave inversion

45
Q

What does an echocardiogram show for a patient with pulmonary hypertension?

A

Assess the progression of the disease and rule out other conditions with similar signs and symptoms

46
Q

What does a V/Q scan show for a patient with pulmonary hypertension?

A

Detects defects in pulmonary vasculature, such as pulmonary emboli

47
Q

What does a sleep study show for a patient with pulmonary hypertension?

A

Rules out sleep apnea

48
Q

What does an antibody test show for a patient with pulmonary hypertension?

A

Identify diseases of collagen vascular origin
Rule out lupus

49
Q

What does a liver function test show for a patient with pulmonary hypertension?

A

Rules out portal hypertension

50
Q

What does a cardiac catheterization show for a patient with pulmonary hypertension?

A

Right side of the heart: elevated pulmonary arterial pressure
Determine whether there is a vasoactive component to the pulmonary hypertension by using vasodilating medications such as nitric oxide

51
Q

What is the medical management for pulmonary hypertension?

A

Vasodilation
Phosphodiesterase-5 inhibitors → sildenafil
Anticoagulation
Intrapulmonary thrombosis
Supplemental oxygen with exercise
Diuretics
Calcium channel blockers
Inhibit the calcium-dependent smooth muscle contraction
Epoprostenol (Flolan)
Iloprost (Ventavis)

52
Q

how is epoprostenol (flolan) administered

A

Continuously injected through an IV
Ensure that the patient has two WORKING IVs
Keep an extra pump and bag handy
Make sure IV pump is fully charged in case they need to go off the unit for testings

53
Q

what are the potential side effects of epoprostenol

A

Jaw pain, nausea, diarrhea, leg cramps

54
Q

how is iloprost ventavis adminstered

A

Inhaled every three hours through a nebulizer

55
Q

What are the side effects of iloprost (ventavis)?

A

Chest pain, HA, nausea, and breathlessness

56
Q

When should iloprost (ventavis) be avoided?

A

Pregnant or breastfeeding

57
Q

What are the respiratory tract medications?

A

Mucolytics
- Hypertonic saline (3%) inhalation
- Acetylcysteine (Mucomyst) inhalation (sulfur content, smelling like rotten eggs)
- Can trigger bronchospasm
Anticholinergics
- Ipratropium (Atrovent)
Adverse effect: dry mouth and irritation of pharynx
Too much can raise intraocular pressure in patients with glaucoma
Albuterol (Proventil)
Adverse effect: tachycardia, angina, tremor

critical care exam 1 questions (5 decks)

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