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Med Surg 1 > chapter 29: care of pt. with respiratory emergencies > Flashcards

chapter 29: care of pt. with respiratory emergencies Flashcards

1
Q

pulmonary embolism (PE)

A
  • collection of particulate matter that enetrs venous circulation and lodges in pulmonary vessels
  • embolism is a blood clot (thrombus) or other object
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2
Q

what causes an embolism?

A
  • any substance but blood clot is most common
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3
Q

infarction

A

tissue death or necorsis

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4
Q

risk factor for pe

A
  • prolonged immoblization
  • central venous catheters
  • surgery
  • obesity
  • advancing age
  • GENETIC conditions that increase blood clotting
  • history of thromboembolism
  • SMOKING
  • ESTROGEN THERAPY
  • heart failure
  • stroke
  • cancer
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5
Q

lifestyle changes with pe

A
  • smoking cessation
  • reducing weight
  • physically active
  • herarin or indirect thrombin inhibitor
  • IVC filter
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6
Q

if traveling with a pe

A
  • drink plently of water
  • change positions often
  • avoid crossing legs
  • get up from sitting for 5 mins each hour
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7
Q

s/s of pe

A
  • onset of dyspnea
  • sharp stabbing chest pain
  • restlessness
  • impending doom
  • cough
  • hemoptysis- coughing up blood
  • diaphoresis
  • increased rr
  • crackles
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8
Q

s/s of pe (heart&lungs)

A
  • pleural friction rub
  • tachycardia
  • s3 or s4 heart sound
  • petechiae over chest
  • arterial oxygen stat
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9
Q

lab assessment for pe

A
  • low PaCO2 on ABG
  • general metabolic panel, TROPONIN, brain natriuretic peptide, D-DIMER

imaging assessment
- CT-PA or helical CT

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10
Q

PE analysis & prioritze

A
  • hypoxemia due to mismatch of lung perfusion and alveolar gas exchange with oxygenation
  • hypotension due to inadequate circulation to the left ventricle
  • potential for excessive bleeding due to anticoagulation or fibrinolytic therapy causing inadequate clotting
  • anxiety due to hypoxemia and life-threatening illness
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11
Q

managing hypoxemia in pe

A
  • sudden onset of dyspnea: activate rapid response team
  • apply oxygen, elevate the HOB and reassure the pt
  • oxygen therapy
  • monitor pt
  • admin anticoagulation or fibronolytic therapy
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12
Q

ptt time

A

1.3-2.5

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13
Q

warfarin diet

A

no green leafy vegies
cranberries juice
alc

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14
Q

tpa

A

breaks down existing clots

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15
Q

managing hypotension in pe

A
  • iv therapy (crystalloid substance) to restore plasma volume and prevent shock
  • drug therapy with vasopressors (norepinephrine, epinephrine, dopamine) used if iv therapy doesn’t work
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16
Q

controlling bleeding in pe

A
  • assess for s/s of bleeding
  • ensure correct dosage and timing of medication
  • monitor, lab values (INR)
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17
Q

minimizing anxiety in pe

A
  • proper communication
  • antianxiety meds
  • pain meds
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18
Q

home care management with pe

A
  • need assistance with adls
  • home care services
  • may have diminished lung sounds
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19
Q

self management education w pe

A
  • may need continues anticoagulation therapy
  • teach family and pt. about bleeding precaustions
  • activities to reduce risk of VTE and PE
  • follow up care
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20
Q

health care resources in pe

A
  • seen in clinic
  • home oxygen
  • respiratory treatment
  • services coordinated by nurse or case manager
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21
Q

pe outcomes

A
  • attains and maintains adequate gas exchnage and oxygenation
  • does not experience hypovolemia and shock
  • remains free from bleeding ep
  • states that the level of anxiety is reduced
  • uses effective coping strategies
22
Q

acute respiratory failure

A

pa02 <60 hg or paco2 >45 mm hg with ph <7.35 with sa02 <90%

  • ventilatory failure
  • oxygenation (gas exchange failure)
  • combination ventilatory/ oxygenation failure
23
Q

acute respiratory failure assessment clues

A
  • dyspnea: perceived diffculty breathing
  • orthopnea: shortness of breath or difficulty breathing when laying down
  • ABGs= hypoxia and hypercarbia
  • hypoxic respiratory failure includes restlessness, irritability or agitation, confusion and tachycardia
  • hypercapnia failure: includes decreased loc, headache, drowsiness, lethargy, seizures
  • effects of acidosis lead to decreased LOC, drowsiness, confusion, hypotension, bradycardia, and weak peripheral pulses
24
Q

acute respiratory failure oxygen therapy

A
  • should be considered if hypoexmia

- mechanical vent may be needed

25
Q

acute respiratory failure drug therapy

A
  • nebs or by meter dose inhaler to dilate the bronchioles and decrease inflammation to increase gas exchange
  • corticosteroids may be prescribed, benefits still inconclusive -NOT FIRST LINE OF DEFENSE
  • analgesics used for pain management
26
Q

acute respiratory failure position of comfort

A
  • pt. in upright position

- consider relaxation techniques, diversion, and guided imagery

27
Q

acute respiratory distress syndrome (ards) patho

A
  • hypoxemia that persists even when 100% oxygen is given
  • decreased pulmonary compliance
  • dyspnea
  • noncardiac- associated bilateral pulmonary edema
  • dense pulmonary infiltrates on xray
28
Q

priority prevention for acute respiratory distress syndrome (ards)

A

early recognition of pt. at high risk for syndrome

29
Q

acute respiratory distress syndrome (ards) health promotion

A
  • monitor those receving tube feedings to prevent aspiration
  • infection control guidelines such as handwashing, invasive catheter and wound care, and contact precautions
  • use a suction toothbrush for oral care for pt. with swallowing problems or poor gag reflex
30
Q

acute respiratory distress syndrome (ards) s/s

A
  • HYPERPNEA- increase rr
  • noisy respiration
  • CYANOSIS
  • PALOR
  • RETRACTION INTERCOSTALLY OR SUBSTERNALLY
  • check vitals at least every hour for hypotension, tachycardia, and dysrhthmias
31
Q

acute respiratory distress syndrome (ards) diagnoistic assessment

A
  • lowered partial pressure of arterial oxygen
  • p/f ratio <200
  • sputum cultures
  • CHEST XRAYS
  • ECG
32
Q

acute respiratory distress syndrome (ards) interventions and phases

A
  • exudative phase
  • fibrosing alveolitis phase
  • resolution phase
  • et intubation and mechanical ventilation with PEEP or CPAP
  • drug and fluid therapy
  • nutrition therapy
33
Q

acute respiratory distress syndrome (ards) exudative phase

A
  • early changes of dyspna and tachypnea. interventions focus on supporting the pt. and providing oxygen
34
Q

acute respiratory distress syndrome (ards) fibrosing alveolitis phase

A
  • increased lung injury leads to pulmonary hypertension and fibrosis. interventions focus on delivering adequate oxygen, preventing complications, and supporting the lungs
35
Q

acute respiratory distress syndrome (ards) resolution phase

A

usually, after 14 days, resolution of the injury is possible, if not, the pt. dies or has chronic disease

36
Q

acute respiratory distress syndrome (ards) drug and fluid therapy

A
  • antibiotics
  • vitamin c, e,n
  • acetylcysteine
  • nitric oxide
  • conservative fluid therapy improves lung function
37
Q

endotracheal tube placement

A
  • end tidal carbon dioxide levels
  • chest x ray
  • assess for breath sounds bilaterally, symmetrical chest movement, air emerging from et tube
38
Q

et intubation

A
  • know to contact intubation personell in an emergency

- tube placement and verification and tube stabilization

39
Q

maintaining pt. airway in et tubuation

A
  • assess tube placement
  • cuff leak
  • breath sounds
  • indications of adequate gas exchange and oxygenation
  • chest wall movement
40
Q

et intubation monitor for complications

A
  • monitor for tube obstruction
  • tube dislodgement
  • pneumothorax
  • tracheal tear
  • bleeding
  • infection
  • trauma
41
Q

nursing management for mechanical ventilation: monitoring patient response

A
  • assess PATIENT first
  • assess vitals and listen to lung sounds every 30-60 mins
  • monitor respiratory staus and abg values
  • determine need for functioning
  • assess area around the et tube or tracheostomy
  • consider communication needs
42
Q

nursing management for mechanical ventilation: managing ventilator system

A
  • perform and document ventilator checks
  • check the level of the humidifier and temperature of the humifdying system
  • pay attention to alarms
  • assess and care for et tube or tracheostomy
  • provide oral care at least every 12 hours
43
Q

complications of mechanical ventilation: cardiac problems

A

hypotension and fluid retention

44
Q

complications of mechanical ventilation: lung problems

A
  • barotrauma
  • volutrauma
  • atelectrauma
  • biotrauma
  • ventilator-associated injury
45
Q

complications of mechanical ventilation: gi and nutrition problems

A
  • stress ulcers

- malnutrition

46
Q

complications of mechanical ventilation: infection

A
  • bacteria can enter low respiratory system through the ET or tracheostomy tube
47
Q

complications of mechanical ventilation: muscle deconditioning

A

occurs due to immobility

48
Q

complications of mechanical ventilation: ventilator dependence

A

inability to wean off of ventilation

49
Q

barotrauma

A

damage to the lung by POSITIVE pressure

50
Q

volutrauma

A

damage to the lung by excess volume delivered to one lung over the other

51
Q

extubation

A
  • hyperoxygenate pt
  • thoroughly suction ET tube and oral cavity
  • rapidly deflate ET cuff
  • remove tube during exhalation
  • instruct pt. to immediately cough
  • continue oxygen by facemask or nasal cannula
  • monitor client every 5 mins
  • assess ventilatory pattern for respiratory distress
  • incentive spirometer every 20 mins

Med Surg 1 (25 decks)

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