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Acute Care Exam 1 > Ch 10, 38: Chest and Respiratory Issues > Flashcards

Ch 10, 38: Chest and Respiratory Issues Flashcards

1
Q

Severe allergic reaction with rapid onset

A

anaphylaxis

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2
Q

patho of anaphylaxis

A

Immune system produces IgE antibodies that is normally not toxic and antibodies
Antibodies are stored for future exposure and releases histamine
Histamine  flushing, urticaria, angioedema, hypotension, and bronchoconstriction
Occurs within seconds/minutes of exposure
Dx made by objective findings

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3
Q

common triggers for anaphylaxis

A

seafood
latex
drugs
eggs
insects
nuts

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4
Q

mild clinical manifestations of anaphylaxis

A

Warmth,
tingling,
mouth fullness,
nasal congestion,
periorbital swelling,
sneezing,
eye tearing,
pruritis

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5
Q

moderate clinical manifestations of anaphylaxis

A

Flushing,
warmth,
anxiety,
itching,
dyspnea,
cough,
wheezing

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6
Q

severe clinical manifestations of anaphylaxis

A

Bronchospasm,
laryngeal edema,
severe dyspnea,
cyanosis,
hypotension,
dysphagia,
abdominal cramping,
vomiting,
diarrhea,
seizures

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7
Q

prevention of anaphylaxis

A

Strict avoidance of potential allergen
Carry and administer epi - Teach back method
Always carry an emergency kit
Screen for allergies
Wear medical alert bracelet
Desensitization

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8
Q

medical management of anaphylaxis

A

ABC support
-Ensure airway patency
-Oxygenation
-Epi 1:1000 dilution first line treatment
-Antihistamines and corticosteroids
-IVF
-Pressors
-Aminophylline to improve breathing/airway
Be aware of rebound reaction 4-10 hours after initial reaction

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9
Q

nursing management of anaphylaxis

A

Assess for s/s
Prompt notification to provider or EMS
Prepare for emergency procedures
–ET intubation may be difficult; prepare for cricothyrotomy
Education on prevention
Proper management of chronic conditions (asthma)
Be aware of adverse effects from epi

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10
Q

Obstruction of the pulmonary artery by a thrombus/thrombi that originates in the venous system

A

pulmonary embolism

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11
Q

what in a pulmonary embolism leads to impaired gas exchange

A

The embolus travels through venous systems and into the pulmonary circulation and cuts off the blood supply to the alveoli

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12
Q

what in a pulmonary embolism lead to decreased cardiac output

A

Obstruction of pulmonary causes increases pressure and puts a strain on the right ventricle

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13
Q

causes of PE

A

clot,
air,
fat,
amniotic fluid,
tumor cells,
bacteria (vegetation)
injected particles

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14
Q

What is virchow’s triad (PE)

A

blood venous stasis
changes in coagulation
damage to the vessel

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15
Q

third leading cause of death in a hospital

A

pulmonary embolism

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16
Q

risk factors for PE

A

Acute medical illness (a-fib, etc.)
Major surgery
Trauma
Cancer (including therapies)
Hx of VTE
Obesity
Immobility for more than 2 days
Age >40
Hypercoagulable conditions
Prolonged mechanical ventilation
Neuromuscular paralytic use
Central venous catheters
Severe sepsis
Heparin-induced thrombocytopenia
Oral contraceptive use and estrogen therapy
Pregnancy
Tobacco use
Long bone fractures

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17
Q

clinical manifestations of PE

A

Dyspnea
Pleuritic chest pain - have to rule out MI
Anxiety; feeling of impending doom
Syncope
Cough
Hemoptysis
Palpitations
Tachypnea
Crackles
Tachycardia
Presence of S4
Can be asymptomatic
Death can occur within hours

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18
Q

lab and diagnostics for PE

A
  • chest x-ray
  • ABGs - show hypoxemia and hypocapnia (from tachypnea)
  • D-dimer - occurs from fibrin lysis; normal <0.4 mcg/mL; elevated with thromboembolic events
  • ECG - to assess right ventricle function
  • doppler ultrasonography - displays DVT -cause of PE
  • V/Q scan - comparison of ventilation and perfusion
  • CTPA - standard for detecting PE - visualizes pulmonary angiography with IV contrast
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19
Q

prevention of PE

A

Prevent DVT!!
-Active leg exercises
-Early ambulation
-Elastic compression stockings or electronic compression devices (SCD)
-Prophylactic anticoagulation with expected immobilization
–Low dose heparin
–Low-molecular weight heparin
-Patient education
-Smoking cessation
-Avoid crossing legs
-Avoid long periods of immobility
-Prevent PE with traveling
-Stay hydrated
Early recognition of problems!!!

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20
Q

emergency management of PE

A
  • oxygen
  • IVF
  • Perfusion scans, ABGs, CT, angiogram, ECG, echo
    -Vasopressors or inotropes
    -Dig, IV diuretics, antiarrhythmics if appropriate
    -Labs
    –Coagulation studies (PT, PTT, INR, d-dimer)
    –Serum electrolytes
    –CBC
    -Possible intubation and mechanical ventilation
    -Indwelling catheter
    -IV morphine or sedatives
    -IV thrombolytics
    -Anticoagulants
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21
Q

anticoagulant therapy for PE (heparin)

A

PREVENTS does not DISSOLVE
Continuous heparin infusion
-Goal: Therapeutic PTT to reduce risk and recurrence of PE
-Dosed by weight
-Initial bolus IV dose 80 units/kg then a continuous infusion of 18 units/kg/hr
-Maintain PTT 1.5-2.5 times the control (21-35 sec; for heparin therapy 50-70 sec)
-Titrated based on PTT (drawn Q6 hours)
-Monitor and report s/s of bleeding
-Have antidote available
LMWH
-For hemodynamically stable clients (with stable PE)
-No need to monitor labs

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22
Q

Anticoagulant therapy for PE (Warfarin)

A

Prevent does NOT dissolve
Warfarin
-Can be added to IV therapy (bridge therapy)
-Monitor INR (normal 1, goal with warfarin is 2-3)
-The higher the INR the longer it takes for blood to clot
-Have antidote available
-Monitor amount of vit K in diet
Other orals
-Apixaban (Eliquis), dabigatran (Pradaxa), rivaroxaban (Xarelto)

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23
Q

antidote for heparin

A

protamine sulfate

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24
Q

antidote for warfarin

A

Vit K

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25
thrombolytic therapy for PE
DISSOLVES clots Examples: urokinase, streptokinase, alteplase, reteplase Indications --Severe, unstable PE/DVT (hypotensive, right ventricle dysfunction, large/saddle embolism, significant hypoxemia despite supplemental 02) Not continuous therapy, single time dose Absolute contraindications --Hx of hemorrhagic CVA, active intracranial neoplasm, recent brain/spinal surgery (< 2 months), internal bleeding within 6 months Relative contraindications --Bleeding tendency, uncontrolled HTN, nonhemorrhagic CVA within 2 months, post surgery <10 days ago, thrombocytopenia BIG SIDE EFFECT OF BLEEDING/HEMORRHAGE Invasive procedures are avoided during therapy and 24 hours after
26
emobolectomy: surgery for PE
Rarely done; only for massive PE or hemodynamic instability Removes the clot surgically with cardiopulmonary bypass
27
IVC Filter: surgery for PE
Mesh-like devices to trap thrombi from lower extremities and pelvis to prevent them from traveling to lungs Used for people with recurrent PE and absolute contraindication to anticoags
28
nursing interventions for PE
-minimize the risk and evaluate potential for PE -prevent thrombus formation -monitor pharmacological therapy -manage pain and anxiety - managing oxygen therapy - post-op care and monitor for complications
29
how to prevent thrombus formation
-ambulation -pumping of leg exercises -positioning - dont cross legs, stasis, no restrictive clothing -do not leave IV catheters for prolonged periods
30
how to manage manage pain and anxiety for PE
- semi-fowler - turn and reposition - opioids - therapeutic communication
31
managing oxygen therapy for PE
-assess for s/s of hypoxemia -deep breathing, IS -nebs and postural drainage
32
what is a flail chest
Three or more adjacent ribs are fractured in two or more sites  free floating rib segments
33
what causes flail chest
blunt force trauma to the chest (MVC, CPR in elderly, contact sports)
34
process of flail chest
Chest wall loses stability  resp impairment  resp distress
35
expiration and inspiration of flail chest
Detached part of rib is pulled inward during inspiration Detached part of rib is pushed outward during expiration
36
complications of flail chest
Retained airway secretions Atelectasis Hypoxemia Impaired gas exchange Respiratory acidosis Decreased cardiac output
37
clinical manifestations of flail chest
Unequal chest expansion Paradoxical chest wall movement Tachycardia Hypotension Dyspnea Cyanosis Anxiety Chest pain
38
medical and nursing management for flail chest
Providing ventilatory support --Oxygenation --Intubation and mechanical ventilation for severe injury --Surgery for severe Clear secretions from lungs --Positioning, coughing, deep breathing, IVF, suctioning, pulmonary chest physiotherapy, IS, nebs with bronchodilators and mucolytics Control pain --Intercostal nerve blocks, cautious use of opioids, PCA, epidural analgesia Monitor CXR, ABG, pulse ox, and pulmonary function test
39
what is a pneumothorax
Pleura are punctured and pleural space is exposed to positive atmospheric pressure Presence of air or gas in the pleural space that causes lung collapse
40
what is a simple pneumothorax
Air enters pleural cavity through a ruptured bleb (blister) Can occur in a healthy person hemodynamically stable**
41
what is a traumatic pneumothorax
Air enters pleural space from a trauma or thoracic procedures
42
what is a hemothorax
Blood enters pleural cavity from lung lacerations or lacerations of great vessels
43
what is a tension pneumothorax
air enters the pleural cavity with inspiration but can't escape with expiration from penetrating trauma causes increased pressure on heart and lung leading to decreased cardiac output, tracheal shift to unaffected side and collapsed lung hemodynamically unstable**
44
how do we diagnose a pneumothorax
chest x-ray and ABG; thoracentesis for hemothorax
45
clinical manifestations of pneumothorax
Depend on size and cause Sudden, pleuritic chest pain Diminished breath sounds Hyperresonance in lungs Decreased chest expansion Subcutaneous emphysema
46
clinical manifestations of simple or uncomplicated pneumo
Slight chest discomfort and tachypnea Minimal resp. distress
47
clinical manifestations for large pneumo
Anxious Dyspnea Air hunger Use of accessory muscles Severe hypoxemia
48
clinical manifestations of tension pneumo
Trachea deviation to unaffected side Decreased chest expansion Diminished or absent breath sounds Hyperresonance Air hunger Agitation Increasing hypoxemia Central cyanosis Hypotension Tachycardia
49
medical management of pneumothorax
Goal = evacuate air/blood from pleural space Chest tube to drain fluid and air Pain management with opioids
50
medical management of tension pneumo
Inserting large-bore 14 gauge needle at second intercostal space - needle decompression midclavicular line on affected side; THEN chest tube
51
indications of medical management of emergency thoracotomy
If injury is suspected through trauma Done if more than 1500 mL of blood is aspirated by thoracentesis OR if chest tube output >200 ml/hr
52
nursing management of pneumothorax
Administer 02 Astute assessment Monitor ABGs, Sp02, CBC, and CXR Positioning for maximum ventilation Emotional support Administer meds Encourage rest periods Encourage coughing, deep breathing, IS Collaboration with interdisciplinary team Chest tube management
53
indications of chest tube
Drain fluid, blood, lymph, pus, or air; Re-establish a negative pressure; Facilitate lung expansion; Restore normal intrapleural pressure
54
uses of a chest tube
Used for pneumothorax, hemothorax, post-op drainage for open heart surgery, pleural effusion, pulmonary empyema
55
insertion of chest tube
Inserted in ER, bedside, or OR Can be inserted in right or left pleural spaces or mediastinum
56
three chambers for chest tube
Drainage collection Water seal Suction control (wet or dry
57
ways of drainage for chest tube
drain by suction or gravity
58
continuous bubbling in the water seal chamber of chest tube drainage means:
air leak
59
additional interventions for chest tube
Position in semi-high fowlers to promote ventilation Keep two hemostats, sterile water, and occlusive dressing at bedside ALWAYS Only milk or clamp tubing when prescribed If leak suspected, determine the location by using clamps, notify MD, and tighten connections or change system Mark drainage hourly/daily Frequent reposition ROM of affected arms/shoulder CXR daily
60
when is it indicated to remove chest tube
No more fluid fluctuations in water seal chamber Clear CXR Slowed drainage
61
process of removing chest tube
Assist provider Pain medication 30 min before Instruct the client to take a deep breathe, exhale, and bear down (Valsalva) OR take a deep breath and hold it Tube is then clamped and removed quickly by provider Immediately after, place an airtight petroleum gauze dressing and thoroughly cover with nonporous tape (same with accidental removal and then immediately notify provider) If chest tube drainage system is compromised  immerse end of chest tube in sterile water for temp water seal Obtain CXR

Acute Care Exam 1 (3 decks)

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