Concepts Exam #2 (Ch. 32) Flashcards
Pulmonary Embolism
Collection of particulate matter (solids, liquids, air) that enters venous circulation and lodges in the pulmonary vessels.
Major Risk Factors leading to PE (pulmonary embolism)
Prolonged immobility, central venous catheters, surgery, obesity, advancing age, conditions that increase blood clotting, Hx of thromboembolism.
Virchow’s Triad
3 Factors or elements that lead to thrombosis - Blood stasis, hyper coagulability, and intimal change or alteration to a vein wall.
Pulmonary Edema
Often caused by Congestive heart failure, it is a condition caused by excess fluid in the lungs, making it difficult to breathe.
Acute Respiratory Distress Syndrome (ARDS)
Its Features: Hypoxemia that persists even when 100% o2 is given, decreased pulmonary compliance, dyspnea, non cardiac-assoc. bilateral pulmonary edema.
ARDS
Increased genetic risk is suspected in ARDS.
How to Diagnose ARDS
Established by a lowered partial pressure of arterial oxygen (Pao2) value (decreased gas exchange and oxygenation), determined by arterial blood gas (ABG) measurements.
Interventions for ARDS patients
Intubation, mechanical ventilation with positive end-expiratory pressure (PEEP) or CPAP. Best position for patient is still controversial: Some pts. do better in prone position. Manually turn pts. q2h improves perfusion
Nursing Interventions or protocols for emergency intubation and ventilation
Bring code cart, airway equipment box, and suction equipment to bedside. Maintain patent airway (Head-tilt, chin-lift) and insertion of oral or nasopharyngeal airway until patient is intubated.
DOPE
Displaced tube, Obstructed tube (most often with secretions), Pneumothorax, and Equipment problems. If an intubated pt. shows manifestations of decreased oxygenation, check for DOPE.
Severe Acute Respiratory Syndrome (SARS)
Contagious and sometimes fatal respiratory illness, viral infection caused by a previously unrecognized virus from the Coronaviridae family. Symptoms: Fever, fatigue, headaches, chills, myalgia, dry cough, dyspnea.
Nursing Priorities for Mechanical Ventilation
Monitoring and evaluating patient responses, managing the ventilator system safely, and preventing complications. If patient develops respiratory distress, remove ventilator ASAP and provide ventilation with a bag-valve-mask device. This action allows quick determination of whether the problem is with ventilator or with patient.
Nursing Alert for Mechanical Ventilation
To prevent bacterial contamination, do NOT allow moisture and water in the ventilator tubing to enter the humidifier.
Nursing Alert if you hear stridor or other manifestations of obstruction occur after extubation
CALL Rapid Response Team ASAP before airway becomes completely obstructed.
Nurses to Monitors the patient for what during intubation
Vital signs, signs of hypoxia or hypoxemia, dysrhythmias, and aspiration.
How long should you take for each intubation attempt?
No longer than 30 seconds, preferably less than 15 seconds. After 30 seconds, provide oxygen by means of a mask and manual resuscitation bag to prevent hypoxia and cardiac arrest.
Fraction of Inspired Oxygen (FiO2)
Oxygen level delivered to the patient. Prescribed FiO2 is based on the ABG values and the patient’s condition. The range is 21% - 100% oxygen.
Tidal Volume
Volume of air the patient receives with each breath, as measured on either inspiration or expiration. Average prescribed volume ranges between 7-10mL/kg of body weight.
Pressure-Regulated Volume Control (PRVC)
Mode of mechanical ventilation, alternative to strict pressure control, representing an attempt to obtain the best of both volume and pressure control.
Synchronized intermittent mandatory ventilation (SIMV)
similar to AC ventilation in that tidal volume and ventilatory rate are preset. However, SIMV allows spontaneous breathing at the patient’s own rate and tidal volume between the ventilator breaths.
Assist-control Ventilation (AC)
Mode used often as a resting mode. Ventilator takes over the work of breathing for the patient. Tidal Volume and ventilatory rate are preset.
Positive End-expiratory Pressure (PEEP)
Positive pressure exerted during expiration. Improves oxygenation by enhancing gas exchange and preventing atelectasis. Treats persistent hypoxemia
Pressure Support Ventilation (PSV)
Allows patient’s respiratory effort to be augmented by a predetermined pressure assist from ventilator.
PSV
As the weaning process ensues, the amount of pressure applied to inspiration is gradually decreased. Another method of weaning with PSV is to maintain the pressure but gradually decrease the ventilator’s preset breaths/min rate.
