Ch. 22, 24, 25, 26 Flashcards
1
Q
COPD stands for
A
chronic obstructive pulmonary disease
- it is an umbrella term
2
Q
COPD encompasses
A
- chronic bronchitis (airway problem)
- pulmonary emphysema (alveolar problem)
^neither get better, can halt progression but cannot repair or turn it around once the damage has started
- tissue damage is not reversible, increases in severity, eventually leads to respiratory failure
3
Q
emphysema
A
- alveolar membranes (grape-like clusters, where gas exchange occurs) breakdown
- loss of lung elasticity and hyperinflation of the lung- get smoother, decreases surface area to have gas exchange, stiff- air-trapping
- typically from smoking, pollution, irritants in the airway
4
Q
chronic bronchitis
A
inflammation of the bronchi and bronchioles caused by chronic exposure to tobacco smoking, irritants to airway, pollution
- inflammation, vasodilation, congestion, mucosal edema, bronchospasm
- production of large amounts of thick mucous (when coughing)
- SOB, fatigue, coughing- bringing up phlegm**
5
Q
air-trapping
A
caused by loss of elastic recoil in the alveolar walls, overstretching and enlargement of the alveoli into bullae, and collapse of small airways (bronchioles)
- occurs with emphysema patients
6
Q
pursed lip breathing
A
emphysema patients classic presentation
- increases pressure in chest/abs
- increases pressure to push air trapped in alveoli into the lungs
7
Q
complications of COPD
A
- hypoxemia/ tissue anoxia- not good gas exchange = not good enough oxygen in bloodstream to perfuse the tissues
- tired, fatigued, achey legs
- acidosis b/c patients are retaining CO2 (seen in ABGs, < 7.35)
- respiratory infections b/c of mucous containing bacteria
- cardiac failure, especially cor pulmonale- R side of heart pumps to lungs-stiff, now R side of heart is working hard=floppy muscle and R-sided HF
- cardiac dysrhythmias- PVCs
8
Q
COPD clinical manifestations
A
- history- hx of smoking (past/current), SOB, difficulty on exertion, chronic cough w/ mucous (bronchitis)
- general appearance: barrel chest (emphysema), nail clubbing: bulbed fingernails
- respiratory changes: SOB, esp w/ exertion
- cardiac changes
9
Q
dyspnea assessment guide
A
indicates the amount of SOB you are having at this time by marking the line; basically a pain scale but for SOB
0- no shortness of breath
10- shortness of breath as bad as can be
10
Q
general s/sx of COPD
A
- prolonged expiratory time- longer breathing out time to push air that is trapped out of lungs
- easily fatigued
- frequent respiratory infections
- use of accessory muscles to breathe
- orthopneic
- cor pormonale (late in disease)
- wheezing
- pursed-lip breathing
- dyspnea
- digital clubbing
- anxious
11
Q
s/sx specific to emphysema
A
- barrel chest
- thin in appearance
- pursed-lip breathing
- pink skin (hyperventilate to compensate)
- CO2 retention
- minimal cyanosis
- talking in short/couple words/sentences
- hyperresonance on chest percussion
12
Q
s/sx specific to bronchitis
A
- chronic cough w/ increased sputum production
- dusky, cyanotic skin color
- resp acidosis
- will need to be on O2
- cor pormonale
- clubbing of fingers
- increased RR, Hbg
- hypercapnia (increased pCO2)
- leads to R-sided HF
13
Q
pink puffer is
A
emphysema
14
Q
blue boater is
A
chronic bronchitis
15
Q
COPD laboratory assessments
A
- ABG values for abnormal oxygenation, ventilation, and acid-base status (these hurt, usually radial artery- stay with patient, ensure that they are okay)
- sputum samples
- CBC (elevated WBC=infection)
- H&H blood tests (Hbg & Hct)
- serum electrolyte levels (not eating right because of difficulty to breathe)
- serum AAT level
- chest x-ray
- pulmonary function test (PFTs)
16
Q
COPD assessment: chest x-ray will show
A
can show effusion, PNA, opacity in lungs, cardiac enlargement
17
Q
COPD assessment: PFT
A
patient blows into “pipe” and PF reads on graph
(encourage patient to blow hard)
18
Q
why get a serum AAT level with a COPD patient?
A
AAT is a protein that we have in our body that protects the lungs from enzymes (coats them)
- some people have congenital lack of AAT, so they are more prone to COPD
19
Q
COPD patient problems: how is the patient impacted by COPD?
A
- decreased gas exchange
- weight loss
- anxiety (d/t SOB, chronic illness)
- decreased endurance
- potential for PNA: avoid large crowds, PNA vaccine, yearly influenza vaccine
*think ABCs first, then psychosocial
20
Q
nursing management for COPD
A
- no smoking!
- airway management: deep breathing, purse-lip breathing
- cough enhancement: how to cough
- drug therapy
- oxygen therapy: at home oxygen, teaching
- positioning/breathing techniques- no lying flat
- pulmonary rehab: exercise on monitors to increase endurance level baseline
21
Q
COPD drug therapy
A
corticosteroids (help inflammation in respiratory tract, increases space to allow better airflow)
- fluticasone
- prednisone
- inhaled steroid and long-acting dilator: Advair (wash mouth out! ,not a rescue)
mucolytics
- acetylcysteine (Mucomyst/Mucinex)
- guaifenesin: thins mucous
short-acting beta agonist
- albuterol (Ventolin): rescue med
long-acting beta agonist
- salmeterol (Serevent)
cholinergic antagonist
- ipratropium (Atrovent)
- tiotropium (Spiriva)
22
Q
rescue medication for COPD
A
short-acting beta agonist
- albuterol (Ventolin)
23
Q
COPD med: long-acting beta agonist
A
Salmeterol (Serevent)
23
Q
COPD evaluation of (ideal) outcomes
A
- attain and maintain gas exchange at a level within his/her chronic baseline values
- achieve an effective breathing pattern that decreases the work of breathing
- maintain a patent airway
- achieve and maintain a body weight within 10% of his or her ideal weight
- have decreased anxiety
- increase activity to a level acceptable to him or her
- avoid serious respiratory infections (crowds, grandkids with illnesses)
- patient may need/be on palliative or hospice care- decrease anxiety and improve quality of life
- med compliant
- nutritional regimen
- include patient and family in plan of care
24
influenza sx
- severe HA
- muscle ache (myalgia)
- fever
- chills
- fatigue
- weakness
- anorexia
25
influenza: contagious window
when patient presents with sore throat, cough, rhinorrhea
- little kids and elderly most at risk
- droplet precautions (mask)
- viral infection
26
influenza vaccine
- annual
- makes sx lesser if get the flu
- extra layer of protection/prevention
27
influenza interventions (drugs)
- antivirals if within certain window to minimize symptoms: oseltamivir (tamiflu), zanamivir (relenza)
- treat by symptom management: tylenol, fluids
28
pulmonary tuberculosis
- highly communicable disease caused by mycobacterium tubericulosis
29
pulmonary tuberculosis: incidence and prevalence
- 10 million people dx in 2017
- 1.6 million died from TB in 2017
- incidence steadily decreasing in North America
- increase related to onset of HIV* (HIV and TB go hand in hand, TB kills people with HIV)
- seen in poor areas
30
pulmonary tuberculosis is transmitted via (think type of precaution)
aerosolization (airborne: N95)
- bacterial infection
- bacteria is sucked into lungs (breathed in), causing tissue to die/be coughed up, ends up spreading to whole body
31
pulmonary tuberculosis risk factors
- TB and HIV (HIV patients)
- anyone that is immunocompromised (ie post-chemo)
- older, elderly, babies
- incarcerated persons, multi family homes (living in crowded settings)
32
TB assessment: history
- living arrangements
- have HIV
- any recent exposure
33
TB assessment: s/sx
- progressive fatigue
- anorexia
- malaise
- SOB*
- unintentional weight loss*
- chronic, productive cough*
- rusty sputum*
- night sweats*
- hemoptysis (advanced state)
- low-grade temp (late afternoon)
- pleuritic chest pain (not typical)
34
TB assessment: laboratory tests
- TB skin tests (screening)
- chest x-ray
- sputum studies (3 specimens collected on 3 different days)
35
diagnostic assessment for TB
- NAA test (most accurate and rapid)
- sputum culture confirms dx
- tuberculin (mantoux) test: PPD given intradermally in forearm
- blood analysis
- chest x-ray (look for granulomas on the lungs)
36
TB diagnostics: PPD tests
- induration of >10 mm diameter = positive exposure
- must be checked/read after 48-72 hours from plant* (wait the 72 hr for someone suspicious of TB)
- PPD implanted right under the skin
37
TB diagnostics: blood analysis
- QuantiFERON-TB Gold** ( this tells you if you have antibodies for TB- positive means need chest x-ray to confirm)
- T-SPOT TB
- GeneXpert Omni
38
TB diagnostics: positive PPD findings
area of induration is swollen (NOT red or inflamed) (measure the lump not the redness)
- >5mm: HIV + group or recent close contact with active TB (super high risk)
- >10mm: residents of long-term care facilities, IV drug abusers and medically underserved populations, health care workers (a little higher risk)
- >15mm: general public without risk factors (super low risk)
39
what does a positive PPD skin test mean?
- positive reaction does not mean active TB infection is present, but it does indicate EXPOSURE to TB or dormant disease
- a positive PPD means that the person needs to go into the next stage of testing (airborne precautions, bloodwork/sputum/chest x-ray next)
40
interpreting TB: patient problems
- potential airway obstruction
- potential for development of drug-resistant disease and spread infection
- anxiety
- weight loss
- fatigue
41
TB interventions
- safety and infection control
- combination drug therapy with strict adherence (for 6-12 (4-6) months)
- negative sputum culture indicative of patient no longer being infectious; respiratory isolation until negative sputum culture (need 3 consecutive negative sputum cultures on different days)
- decreased activity
- frequently on out-patient basis
42
drug therapy for TB
- isoniazid (INH)
- rifampin (RIF)
- pyrazinamide (PZA)
- ethambutol (EMB)
taken daily for 4-6 months
no alcohol, turn secretions orange (normal), nausea
hard on liver (worry about jaundice (yellow eyes))
compliance with treatment is very tough (DOT "babysitting taking their pills")
43
pulmonary embolism
a collection of particulate matter- solids, liquids, or air- enters venous circulation and lodges in the pulmonary vessels
- thrombus: a blood clot in the lung
- DVT broke off, traveled through the vein, got stuck in the vasculature of the lungs
- fat embolus: with bone fractures
44
onset of PE
can be abrupt or slow (smaller)
45
risk factors for PE
- prolonged immobilization (static blood)*
- smoker*
- birth control/hormones*
- central venous catheters*
- surgery*
- pregnancy*
- obesity
- advancing age
- general and genetic conditions that increase blood clotting
- hx of thromboembolism
46
dx of PE
- pulmonary angiogram
- MRI
- V/Q scan
47
PE s/sx
respiratory:
- dyspnea*
- low SpO2*
- tachypnea*
- pleuritic chest pain
- dry cough
- hemoptysis: coughing up blood*
cardiac:
- distended neck veins* (d/t back up of blood)
- tachycardia
- syncope
- cyanosis
- systemic hypotension* (will go into shock)
- abnormal heart sounds
- abnormal EKG
- low grade fever
- petechiae (pinpoint red spots, chest or on body)
- flu-like sx
48
PE lab tests
- ABGs
- PaO2 - FiO2 ratio falls (low- pt on O2 and not perking up)
- pulse ox
- imaging assessment: chest CT scan
49
PE analysis (patient problems)
- hypoxemia
- hypotension
- potential for excessive bleeding (b/c DIC and treatment is blood thinners)
- anxiety (going into shock)
50
PE interventions
- patient problems
- rapid response team: if patient was fine a minute ago now they are SOB, hypotensive, has petechiae
- non-surgical management
- surgical management
51
PE non-surgical management
- ongoing assessments: bloodwork, imaging
- meds: blood-thinners- warfarin (coumadin) PO, heparin IV, lovenox
52
antidotes for warfarin and heparin
- warfarin: vit K
- heparin: protamine sulfate
53
PE surgical management
- embolectomy
- vena cava filter (greenfield filter): traps blood clots as they travel up the vena cava, preventing them from reaching the lungs. the cone-shaped design alls blood to flow around the captured clot (patient is on blood thinners, this patient has probably had multiple blood clots, this is removable)
54
PE health promotion and illness prevention (patient teaching)
- stop smoking
- reduce weight
- increase PA (take little walks, calf pumps)
- if traveling or sitting for long periods, get up frequently and drink plenty of fluids
- refrain from massaging or compressing leg muscles (refrain from crossing legs on long trips)
55
PE: outcomes
- attains and maintains adequate gas exchange and oxygenation
- does not experience hypovolemia or shock
- refrains from bleeding episodes
- states that the level of anxiety is reduced
- uses effective coping strategies
56
acute respiratory failure can be due to
- ventilation failure
- oxygenation (gas exchange) failure
- or combined ventilatory/oxygenation failure
57
acute respiratory failure: patho (values)
- SpO2 < 90% (normal 90-100)
- PaO2 < 60mmHg (normal 80-100) or PaCo2 > 45 mmHg (normal 35-45)
- pH < 7.35/acidic (normal 7.35-7.45)
58
acute respiratory failure: ventilatory failure
physical problem of the lungs or chest wall
- defect in the respiratory control center in the brain
- poor function of the respiratory muscles, especially the diaphragm
- extrapulmonary and intrapulmonary causes
*problem with the actual movement of the air
ie broken ribs- not trying to expand as much to breath
59
ventilatory failure: extrapulmonary causes*
- sepsis
- blood transfusion
- pancreatitis
- polytrauma
- hemorrhagic shock
- hypothyroidism
60
ventilatory failure: intrapulmonary causes*
- asthma
- COPD
- fluid build-up in lungs
- PNA
- PE
- ARDS
61
acute respiratory failure: oxygenation failure
thoracic pressure changes are normal, and air moves in and out without difficulty but does not oxygenate the pulmonary blood sufficiently
- ventilation is normal, but lung perfusion is decreased
- impaired diffusion of oxygen at the alveolar level
ie house fire, mountain climbing
62
acute respiratory failure: combined ventilatory/oxygenation failure
diseased bronchioles and alveoli cause oxygenation failure; work of breathing increases; respiratory muscles unable to function effectively
- often occurs in patients with abnormal lungs: chronic bronchitis, emphysema, asthma attack (has COPD)
63
acute resp failure interventions
- oxygen!
- position of comfort (sit up-right)
- nice, deep breaths
- pursed-lip breathing is OK! keeps the alveoli open
- stop talking and focus on breathing
- relaxation, diversion, guided imagery
- energy-conserving measures
- medications
64
acute resp failure medications
- oxygen
- bronchodilators: long-acting and short-acting: albuterol
- steroids (IV or inhaled): help with inflammation
- antibiotics (if cause is from PNA, bacterial infection)
65
acute resp distress syndrome (ARDS)
hypoxia that persists even when oxygen is administered at 100%
- decreased pulmonary compliance
- dyspnea
- noncardiac-associated bilateral pulmonary edema
- dense pulmonary infiltrates seen on x-ray
*stiff lungs, COVID, flu, alveoli have crap in them, happens through trauma (an overreaction inflammatory response goes to the lungs, they get ARDS)
66
ARDS dx assessment
- lower PaO2 value on ABG
- refractory hypoxemia (it keeps going down, cant get SpO2 levels up even when you give O2)
- whited-out (ground glass) appearance to chest x-ray (means tissue not air in lungs)
- no cardiac involvement on EKG
- low-to-normal PCWP
67
ARDS interventions
- endotracheal intubation and mechanical ventilation with positive end-expiratory pressure (PEEP) or continuous positive airway pressure (CPAP)
- sick patient on the vent, in the ICU, on O2, pressure in ventilator, unconscious, sedated
- drug and fluid therapy
- nutrition therapy
- people can die from this
68
ARDS drug therapy
- O2
- sedation ( because we are intubating them )
69
ARDs nutrition
TPN because cant feed orally
70
endotracheal tube
- tube that goes down the trachea
- come in sizes, provider puts it in and decides (we just have to grab the size that the provider asks for, size=diameter)
- stylet: metal tube that is in trach tube
- 10cc air inflation (need 10cc syringe)
- patient needs to be sedated
- laryngoscope & blades: mac (curved) or miller (straight)
71
stabilizing ETT/nursing interventions for endotracheal tube
- assess tube placement (don't play with depth of tube but move L/R sides of mouth)
- HOB to 30°
- oral hygiene
- mechanical sedation: diprivan (propofol), s/e of sedation
- restraints
- pain assessment!
- communication, for patients not sedated/on minimal sedation
72
mechanical ventilators: types
- negative & positive pressure
73
mechanical ventilator: negative pressure
(old technique)
- wont see these anymore
"iron lung"
74
mechanical ventilator: positive pressure
- pressure-cycled ventilators
- time-cycled ventilators
- volume-cycled ventilators
*pressure pushes air into lungs- pressure changes in chest, affects blood
75
mechanical ventilator works to give the patient breathes by (levels of ventilation)
- assist control ventilation (AC)
- synchronized intermittent mandatory ventilation (SIMV)
- pressure support
- Bi-level positive airway pressure (BiPAP)
76
ventilator controls and settings
- tidal volume (Vt): how much air the vent gives pt
- rate: breaths/min (RR 12-20)
- fraction of inspired oxygen (FiO2)
- peak airway inspiratory pressure (PIP)
- continuous positive airway pressure (CPAP)
- positive end-expiratory pressure (PEEP): vent keeps alveoli a little bit open
77
nursing management of ventilators
- monitoring/evaluating patient responses
- managing alarms/ventilator
- preventing complications
78
mechanical vent complications: barotrauma
too much pressure
78
complications of mechanical ventilators
- cardiac problems (hypotensive, blood return inhibited)
- GI problems (always place NGT/OGT to empty stomach)
- nutritional problems (use TPN)
- musculoskeletal problems
- VAP
- ventilator dependence
79
mechanical vent complications: volutrauma
too much volume
80
chest trauma includes
- tension pneumothorax
- hemothorax
- pneumothorax
- flail chest
- rib fracture
- pulmonary contusion
81
chest trauma is a contributing factor in ____% of deaths of patients who experience unintentional traumatic injuries
about 50%
82
extubation
removal of the endotracheal tube
83
process of extubation
- Hyperoxygenate patient
- Thoroughly suction ET and oral cavity
- Rapidly deflate cuff of ET
- Remove tube at peak inspiration
- Instruct patient to cough
84
tracheotomy
surgical incision into trachea to create an airway to maintain gas exchange
85
tracheoSTOMy
stoma (opening) that results from tracheotomy
- can be temporary or permanent
86
tracheostomy complications
- Tube obstruction
- Tube dislodgement and accidental decannulation
- Pneumothorax
- Subcutaneous emphysema
- Bleeding
- Infection
87
tracheostomy tubes
- plastic or metal
- most are disposable
- cuffed tube
- inner cannula
- fenestrated tube
- trach care is sterile
88
care issues for patient with tracheostomy tube
- preventing tissue injury
- ensuring air warming and humidification** (keeps the mucus moist/flowing, easier to suction, ask resp therapy for humidified O2)
- suctioning
89
providing tracheostomy care
- assess
- secure tracheostomy tubes in place
- prevent accidental decannulation
90
flail chest
Paradoxical chest movement—“sucking inward” of the loose chest area during inspiration and “puffing out” of the same area during expiration
- this happens with broken ribs (3 or more ribs in a row broke at both ends, free floating ribs)
- big potential to pop the lung
- often sedated and intubated for pain control
91
pneumothorax
air starts filling into pleural space, air leaking compresses the lung
92
causes of pneumothorax
- trauma
- blunt trauma
- rib fracture
- COPD
- punctured lung
93
pneumothorax s/sx
- absent lung sounds
- SpO2 low
- graded by percent, determines treatment
94
closed pneumothorax
lung puncture, hole inside only
- rib fracture
- COPD patient with blebs
- blunt trauma
95
open pneumothorax
shot, hole on inside and outside
*worse
- trauma
96
tension pneumothorax
- tracheal deviation (no longer midline)
- mediastinal shift
- EMERGENCY!!
- lung is collapsed and still leaking into pleural cavity, good lung is pulling collapsed lung
97
when would a pneumothorax require a chest tube?
- air in pleural place
- blood or fluid in pleural space
- tension pneumothorax needs chest tube
98
chest tube placement
- confirm placement with an xray
- super painful
- sterile technique (inserted tube, area of placement)
- occlusive dressing, stitched in
- chest tube drainage system
- poke tube into chest space, put sterile tube into hole, stitch into chest wall, attaches to suction container to pull air or blood out
99
how does chest tube drainage work?
- bottles and straws
100
chest tube drainage system
- chamber 1: collects fluid draining from patient
- chamber 2: water seal prevents air from enter patient pleural space
- chamber 3: suction control of system
101
dry suction*
- silent system, bubbling indicates leak
- faster set up
- more vent settings than wet suction
- negative pressure, self-setting
102
water seal CDU
- suction is pulling, water seal helps not let atmospheric air go back into patient
- 1st insertion good amount of bubbles, then decreases
- constant bubbling bad, intermittent bubbling okay
- tidaling is good: occurs when coughs; dont see it- report it
103
portable chest tube drainage unit (where do you want it)
want below chest level so it drains out
104
nursing management of chest tubes
Assess cardiopulmonary and vital signs every 1 to 4 hours and as needed.
Monitor output every 1 to 4 hours and record amount and color.
- Reportable condition(s): Bloody drainage of 200 ml/hr or greater, sudden cessation of drainage, change in character of drainage
Maintain semi-fowler’s 30-45 degrees or position of comfort
- Rationale: Semi-fowler’s assists in drainage, lung expansion, & comfort
Encourage deep breathing and coughing
- Rationale: Assists lung to reexpand
Ambulation requires use of portable suction and CDU must remain below insertion site
assess and treat and reassess for pain
Evaluate the chest-drainage system for rise and fall (tidaling) or bubbling in water-seal chamber. Check connections.
- Rationale: Water level will normally rise and fall with respiration until lung is expanded. Bubbling immediately after insertion signifies that air is being removed from the pleural space; bubbling with exhalation and coughing is normal. Persistent bubbling indicates an air leak either in the patient's lung or in the chest-drainage system.
- Reportable condition(s): Absence of tidaling in water-seal chamber or persistent bubbling
Ensure that CDU is at least 1 foot below the chest tube insertion site and free of dependent loops and kink
maintain supplies at bedside and on unit
105
supplies needed at bedside for chest tubes
- Betadine Swabs
- Gauze
- Clamps (Padded)
- Sterile Gloves
- 4x4s and ABDs
- Sterile water
- Adhesive tape
106
why not "strip" a chest tube?
can cause tension pneumothorax
- If tube manipulations is needed, tubes may be “milked” with a hand over hand method (Some facilities may require that milking be done by MD)
107
emergency management: disconnection of chest tube from CDU
- Clamp tubing and call MD STAT
- Cleanse both exposed ends with rubbing alcohol and reconnect.
- Once connected, a full chest assessment is need, including chest x-ray
108
emergency management: dislodgment of chest tube
- If tube is pulled out, promptly apply pressure dressing using several 4x4s
- Stay with patient to observe for respiratory distress
- Call MD STAT
- Prepare for new tube insertion
109
emergency management: tension pneumothorax
- s/sx include: acute respiratory distress, tachypnea, shallow respirations, cyanosis, decreased breath sounds, asymmetrical breathing, decreased BP, tachycardia, marked deviation of trachea
- Start O2 at 4 liters
- Call MD STAT
- Monitor vital signs
- Prepare for new insertion
- Patient may need chest x-ray and ABG
110
emergency management: air leak
Excessive bubbling indicates an air leak
Check the system and all connections
Apply pressure around insertion site using both hands. If bubbling diminishes notify MD and prepare for dressing change
111
trouble shooting chest tubes
Air Leaks
Tidaling is good but bubbling in water or dry suction seal is bad = air leaks
Dependent Loop
Positioning
Ambulating
Insertion site
Emergency! Falls out
Tracheal Deviation
Weaning
112
air leaks
- airleaks= continuous bubbling
- chamber-water seal chamber
113
tension pneumothorax s/sx
- acute respiratory distress
- tachypnea
- shallow respirations
- cyanosis
- decreased breath sounds
- asymmetrical breathing
- decreased BP
- tachycardia
- marked deviation of trachea
114
open pneumothorax s/sx
- chest pain
- SOB
- rapid breathing
- racing heart
- shock
115
closed pneumothorax s/sx
- chest pain
- SOB
- bluish skin
- tachycardia
- dry cough
- light headed
- fatigue
116
tension pneumothorax interventions
- oxygen
- position/reposition: sit up
- chest tube care
- vitals
- breathing: pt should report difficulty
- pain
117
open pneumothorax interventions
- may require surgery
- maybe chest tube
- O2
- high fowlers position
- cover open chest wound
118
closed pneumothorax interventions
- O2
- chest tube care
- resp support
- communication
- prep for chest tube placement
119
if the nurse is suspicious of an immunocompromised patient having TB but there is no reaction after 48 hours, what does the nurse do?
- tell the patient to come back at the 72 hour mark
120
BCG vaccine
vaccine for TB
- if patient received this, they need to be tested for TB differently
- will come back positive PPD
- need to test through bloodwork/sputum and chest x-ray
121
latent TB
- exposed to TB but immune system is fighting it
- asymptomatic
- does not spread (not contagious)
- yes you have TB, but its sleeping/dormant
- can have it for years, not contagious just hanging out
- it will wake and become active TB if you have a change in your immune system (start having symptoms and contagious now)
122
patient teaching for TB patient who lives in multi family home
- cover cough
- sputum tissues in plastic bag into trash
- test family (maybe preventative antibiotics depending on hospital)
123
an embolus is in the vein or artery?
vein
- won't feel it traveling
124
why does a patient with a PE have petechiae?
because the clot makes the body loose its ability to clot, and puts them at a higher risk for bleeding
125
positive pressure ventilation: the AC (assist control)
- the most control of the patient
- used when patient cannot breathe at all or are sedated
- program Vt and RR
- patient controls no breathing
- vent breathes for patient the whole time
126
positive pressure ventilation: synchronized intermittent mandatory ventilation (SIMV)
- middle control level of the patient
- for patient coming/weaning off AC
- still program Vt and RR
- vent lets patient take a little breath
- allows independent breathes with supportive oxygen
- can wean the RR from the vent down, the vent may give patient 10 breathes/min, but patient takes 5 breathes/min
127
pressure support
- least supportive measure with ET tube
- last step before extubation
128
why is it problematic if a patient on AC starts to come off sedation and can breathe a little on his own?
(patient is breathing over the vent)
hyperventilation: too much O2!
- pH will be alkalotic/increased (pH >7.45) (resp alkalosis)
- need to sedate or wean off sedation and change vent
129
what do we always monitor with patients on ventilators?
- ABGs!
(pH, pCO2, pO2)
130
positive pressure ventilation: Bi-level positive airway pressure BiPAP
- lowest level of positive pressure ventilation
- refined (in hospital)
- give O2 via mask, no tube but still on ventilator for settings
- very pressurized air
- one level of pressure on inspiration, a second level of pressure on expiration
- patient has to be totally controlling RR- awake and alert (not sedated or unconscious)
- cant give to vomiting patient
131
CPAP vs BiPAP
BiPAP: seen in hospital, more refined, tight fitting mask
CPAP: seen in home, less refined, tight fitting mask
132
when ventilator alarm is going off, think DOPE
- Dislodgment/displacement (pulls out)
- Obstruction (mucus, bites tube, pinched tubing)
- Pneumothorax (blow the lung, will see SpO2 low, collapsed lung with no lung sounds)
- Equipment (is vent broken, not plugged in)
133
persistant bubbling with chest tube
not good, report
134
tidaling with chest tube
good, report if none
135
bloody drainage with chest tube: reportable conditions
> 70 mL/hr, sudden cessation of drainage or change in character of drainage
