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NURS 370 Midterm > Adult Respiratory > Flashcards

Adult Respiratory Flashcards

1
Q

How is sleep apnea and poor oxygenation status a risk factor for developing a PE?

A

Sleep apnea or poor oxygenation status can be a risk for DVT because the body compensates by increasing HR, BP, and RBC production which creates thicker blood – body is trying to comonstate because the body does not have enough O2 so the blood thickens up

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2
Q

Examples of an embolus?

A

Thrombus (blood)
Air
Fat
Amniotic fluid
Septic

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3
Q

What blood test can we run for a PE? WHat does it tell us?

A

D-dimer: This looks at clots – does not tell us for sure if we have a PE – this looks at if we have a clott going on in our body – if it is negative we DO NOT have a PE if it is positive it just tells us that there is clotting going on

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4
Q

What is the number one cause of a pulmonary embolus (PE)?

A

DVT of the legs

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5
Q

What breath sounds will we have with hemothoraxes?

A

Absent breath sounds

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6
Q

What can result from a hemothorax?

A

May result in a mediastinal shift, decreased venous return, and hypotension

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7
Q

How do we manage/treat a pneumothorax?

A

Administer oxygen
Change patient positioning
Manage pain
Chest X-ray to minor progression
Place chest tube
Occlusive dressing (dressing tapped over on 3 sides for open pneumothroaxs)

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8
Q

What happens to the lungs and heart in a tension pneumothorax?

A

Hemodynamic compromise with increasing air mass

Trachea, lung, heart and great vessels are progressively compressed and fail to function

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9
Q

What is a pleural effusion caused by?

A

Effusion is caused by a disruption in balance of hydrostatic osmotic pressure and pleuro-lymphatic drainage

Can be caused by pneumonia, Heart failure, lymph damage causing lymph fluid to go into the space

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10
Q

What are some clinical manifestations of a hemothorax?

A

Dyspnea
Tachypnea
Chest pain
Signs of hypovolemic shock
Lung compression and collapse, mediastinal shift with cardiac compression
Decreased or absent breath sounds on injured side
Dullness to percussion on injured side

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11
Q

How does infection cause an embolism?

A

Causes an embolism because it thickens the blood

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12
Q

What is a thrombi?

A

Thrombi is a blood clot that has formed within the vascular system

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13
Q

What is a closed pneumothorax?

A

Closed – the chest wall is intact – the air we are breathing in goes into the lungs and pleual space – no option for atmospheric air to enter – does not put pressure on the other lung

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14
Q

What do we do to manage a hemothorax?

A

Chest tube (point down)
High flow oxygen
Packed RBC administration is needed
Emergent thoracotomy
Autotransfusion (cell saver)

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15
Q

For a PE what bloodwork do we monitor?

A

aPTT and INR ((measures how long it takes your blood to form a clot)

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16
Q

Common causes of a PE? Why?

A

In trauma we can have one develop from bone breaks – going to release fat

-In surgery a PE can be caused because the patient is laying flat

-Pregnant is more at risk because of venue status - Ambiotic fluid rupture/fluid

-Heart failure: The heart is not forceful enough to push blood through so the blood pools

-Age (>50): Because the body is starting to slow down

Prolonged immobility: Due to blood pooling

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17
Q

What are the main diagnostic tests we can run for a PE? WHat does it tell us?

A

Spiral CT: Shows us the vascular (soft tissue) – this shows us one scan Vs angles – administer contrast – main indicator where we will actually see the embolism

VQ scan/mismatch: Vent perfusion: They put nucular in the blood and see how the – we have ventilation but no perfusion – O2 is coming in but there is no blood for there to perfuse it

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18
Q

Where is a chest tube inserted

A

Chest tube inserted in 2nd ICS mid-axillary line and attached to 20cm H20 suction

High flow oxygen (simple or non rebreather mask – titrate to patient)

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19
Q

What willa chest X-ray look like for a PE?

A

Usually normal

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20
Q

Examples of clinical manifestations for a pneumothorax?

A

Chest pain (sudden and pleuritic)

Decreased or absent breath/lung sounds on the injured side

Subcutaneous emphysema (Air goes under the skin and creates small air pockets – air is leaving into sub Q space – this doesn’t cause damage but this tell us that there is a leak – will will monitor it and see if it grows)

Hyperreonase when we percus

Tachypnea

Tachycardia

Asymmetric chest wall movement

Central cyanosis (: Our body will be hypoxic – hypoxia outside of the normal areas)

Open, sucking wound on inspiration (open pneumothorax)

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21
Q

What is a pleural effusion?

A

Abnormal collection of fluid in the pleural space (We have someone who has cardiac or resp issues that’s causing fluid to go into the space)

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22
Q

Complications of Thoracentesis?

A

Complications include dyspnea, tachycardia, dizziness, arrythmias, chest and/or shoulder pain, hypotension, decreased breath sounds, or cyanosis

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23
Q

Where do we insert a chest tube for a hemothorax?

A

between the 4th and 5th intercostal space along the mid axillary line

24
Q

What are some lifestyle risk factors for developing a pulmonary embolus?

A

Sedentary lifestyle
Oral contraceptives – increases clotting factors
Smoking (hardens the vesicles)
High fat diet
Obesity
Diabetes (its from the decrease in sensation, athsclarosis, etc)

25
Q

What is the most common scan done to diagnosis a PE (Pulmonary embolism)? If this test cannot be done what is the second most commonly used scan?

A

A spiral CT (if contrast from CT cant be used a VQ scan will be done)

26
Q

What is a massive hemothorax?

A

Massive hemothorax is a rapid accumulation of 1500mls or more in the intrapleural space

27
Q

What type of pneumothorax do we use an occlusive dressing for?

A

For an open pneumothorax

28
Q

What causes a hemothorax?

A

Caused by trauma to blood vessels, causing them to rupture

29
Q

What is a Thoracentesis?What is it used for?What do we monitor diring this procedure?

A

A needle is inserted into the intercostal space that is determined via chest X-ray. FLuid is then aspirated with a syringe, or tubing can be connected to allow fluid to drain into a sterile collection bag (1000 - 1200mL is typically removed - MAX 1-1.5L removed)

-During procedure the patient should be monitored for manifestations of respiratory distress

30
Q

What are the clinical manifestations of a PE?

A

Generally we are also looking for a history of DVT

*Dysnpnea
*Tachypnea (we still have air coming in)
*Fever (comes due to the infla story response kicking in)
Chest pain (from the inflammation)
Cough (they will cough up pink spetum)
Diaphoresis
Hemoptysis
Syncope

31
Q

What does failure in ventilation and cardiac constriction lead to in a tension pneumothorax

A

Failure in ventilation and cardiac constriction leads to preload + cardiac output and BP leading to death

32
Q

What is a pulmonary embolus (PE)?

A

Obstruction of the pulmonary artery or one of its branches

33
Q

What are the clinical manifestations of a tension pneumothorax?

A

-The same symptoms that we saw in our open pneumothoraxes, except we will specifically see:

Tracheal shift
Distended neck veins
Signs and symptoms of shock

34
Q

At what hemoglobin level do we start to administer packed red blood cells? Why don’t we administer blood right away?

A

70 - 80 or lower hemoglobin we administer blood (we want their hemoglobin to be 70 – 80) – we don’t give blood right away because we want the body to pick up the pace and start to create more blood

35
Q

Where can a embolus originate from?

A

Deep veins in legs

Atrial fibrillation (Pooling in the atria which can cause a clot to form and then it gets sent to other parts of the body)

Venous stasis

36
Q

What must be used for treatment of a tension pneumothorax?

A

Chest tube - must go in ASAP so aie can escape and pressure will be released

37
Q

What is an autotransfusion for a hemothorax? Why is it better then a blood transfusion?

A

Cell saver – we suck the blood out of the body and hepranize the bllod – comes when we have MASSIVE amounts of blood that have been incapsulated (pooled/pocket of blood) – better then blood transfusion because it is the patients own blood and there is no risk for rejection

38
Q

What is the clinical management for a tension pneumothorax?

A

-Supplemental O2 (mask)
-Rapid needle decompression
-Chest tube insertion
-Explore cause of injury

39
Q

Why do we have chest pain with a hemothorax?

A

We have pain from the blood that is irritating the lining

40
Q

What is our first priority/what must we do for hemothorax?

A

We need to stop bleeding because we have a circulatory issues from loss of fluid and breathing issues because of compression on lungs

41
Q

What does a ECG tell us about a patient with a PE?

A

Tells us how the patients heart is reacting/responding to the PE

42
Q

Where is the chest pain coming from with a pleural effusion?

A

Chest pain is coming from the inflammation that is occurring (two inflamed areas going on because the inflammatory process is occurring)

43
Q

What is a pneumothorax? What does it impacts?

A

Air in pleural space

Impacts the negative intrapleural pressure pressure

Partial or total collapse of the lung

44
Q

What diagnostic tests can we run for pleural effusion?

A

*Chest x-ray / Lateral decubitus x-ray
Ultrasound
CT scan

45
Q

What is a tension pneumothorax?

A

air can go in but cant go out – the person can breath in but when they go to breath out it collapses the lung more and more to the point where it is going to push on surrounding tissues – Emergency

46
Q

What is considered to be the “Classic Triad” of symptoms for a PE?

A

Dyspnea, Chest pain, and hemopytsis (coughing up blood from some part of the lungs)

47
Q

What is an open pneumothorax?

A

we have a cut in the skin and air can enter into the space (not the lung) and increase the pressure – air goes in and out

48
Q

What do we do to manage a pulmonary embolus (PE) in a emergent situation?

A

Oxygen - respiratory distress / hypoxemia
-Intubation if needed

Hemodynamic support (IV fluids, vasopressors, ionotropes)

Inotropes (dobutamine or dopamine)

Foley catheter

Analgesic and sedatives

Thrombolytic therapy (works on thrombus)
Urokinase, Streptokinase, Alteplase – Contraindications

Venous filter

Anticoagulation therapy (prevents further clots):
-Heparin / Coumadin (only for prevention of DVT prior to PE)
-NOACs

49
Q

In a PE (Pulmonary embolus) when blockage of the pulmonary artery or its branches occurs, alveolar dead space is increased what happens to gas exchange, vascular resistance, BP, and cardiac output?

A

Gas exchange is impaired

It Increases pulmonary vascular resistance

It causes a Increased right ventricular workload of heart

Right sided heart failure leads to decreased cardiac output, decreased in blood pressure and eventually shock

50
Q

Where is the rapid needle decompression placed/inserted?

A

Rapid needle decompression – 2nd intercostal space mid-clavicular line (large bore – 14 gauge IV catheter)

51
Q

What are some common causes of a pneumothorax?

A

Biggest cause is fractured ribs (causes a closed pneumothorax)

Pulmonary blebs – interior – on the coating of the lung there is blisters that rupture and causes a collapse in the lung - will go in and surgicaly remove if they belive that a person is at risk for rupture

In a hospital we can cause one from a central line – patient can recover on own if needle is removed and opening is sealed up

Vent – it is like a bleb but they have high pressures that can cause a rupture in the avilio which causes a simple pneumothorax

52
Q

What are the objectives to treatment of a PE?

A

1.) Prevent further growth of multipation of thromi in the lower extremities

2.) Prevent embolization from upper or lower extremities to the pulmonary vascular system

3.) Provide cardiopulmonary support if indicated

53
Q

What is an emboli?

A

Moblie clots that generally do not stop moving until they lodge at a narrowed part of the circulatory system

54
Q

What happens when to the air pressure when we inhale and exhale air with a pneumothorax?

A

When we inhale in we increase the pressure when we exhale we relax the lungs/decrease pressure in lungs

55
Q

How can we have patients go into shock when chest tube is placed?

A

We can have patients go into shock from us placing the tube and causing a pneumothorax

NURS 370 Midterm (4 decks)

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