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Nursing Semester 3 > Cyndi - Week 11 - Exam 5 > Flashcards

Cyndi - Week 11 - Exam 5 Flashcards

1
Q

what are the 4 characteristics of alveolar gas exchange?

A
  • 1 cell thick alveolar wall
  • thin film of moisture
  • blood capillary
  • oxyhemoglobin
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2
Q

what is respiratory failure?

A
  • not a disease

* *due to underly8ing acute or chronic disease

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3
Q

what is hypoxemic failure?

A
  • PO2 < 60 with FIO2 60% or more
  • O2 doesn’t diffuse into blood from lungs
  • At a PO2 of 60, hgb starts to release all its O2 molecles, placing the pt in a state of severe hypoxemmia
  • *ex: HF, PE, asthma, pulmonary edema
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4
Q

what is hypercapnic failure?

A

CO2 > 45, with a pH <7.35
• PaCO2 doesn’t diffuse out of blood into lungs
• Inadequate ventilation or any cause of obstructed gas exchange can cause hypercapnia
• Examples: COPD, chest muscle paralysis, opiate toxicity

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5
Q

what is oxygenation failure? (hypoxemic respiratory failure)

A

Inadequate O2 transfer between alveoli and capillary
• Decreased PaO2 (<60 mmHg) onABG
• Decreased SaO2 with peripheral check

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6
Q

hypoxemic repiratory failure: hypoxemic failure may occur to what four factors?

A
  • ventilation - perfusion mismatch (not 1:1)
  • shunt - respiratory shunt
  • diffusion limitation - alveolar capillary membrane
  • hypoventilation
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7
Q

what is the main problem with hypercapnic respiratory failure?

A

ventilation failure

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8
Q

what is ventilation failure?

A

Inadequate CO2 diffusion between capillary and alveoli
• Insufficient CO2 removal
• Increased PaCO2

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9
Q

what are the possible reasons for hypercapnic/ventilation failure?

A
  • Airways and alveoli (ARDS, asthma, COPD)
  • CNS ‐ decreased drive to breathe
  • Chest wall abnormalities – fracture, obesity
  • Neuromuscular conditions
  • Respiratory muscle weakness, paralysis
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10
Q

what is the direct acute lung injury?

A
  • aspiration
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11
Q

what is the indirect acute lung injury?

A
  • ARDS
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12
Q

what are the diagnostic tests for respiratory failure?

A
  • ABGs and labs ‐ CBC, lytes, D‐dimer, sputum cultures
  • End tidal (ET) CO2 monitoring – aka capnography
  • EKG
  • Hemodynamic monitoring (Arterial lines, central venous pressure, Swanz‐Gantz catheter)
  • SVO2 monitoring – mixed venous
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13
Q

what radiologic tests will be used for respiratory failure?

A
  • CT chest
  • Chest X‐ray
  • V/Q scan
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14
Q

what are the early sxs of respiratory failure (distress)?

A
  • Δ LOC, restlessness, confusion, agitation
  • Dyspnea, tachypnea,
  • Nasal flaring, accessory muscle use
  • Tripod position, pursed lip breathing
  • Fatigue, cool clammy skin
  • Tachycardia, HTN, dysrhythmias
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15
Q

what are the late sxs of respiratory failure (failure)?

A
  • Cyanosis
  • Paradoxical breathing, bradypnea, apnea
  • PaO2 less than 45
  • Hypotension
  • Comas, tremors, seizures
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16
Q

what is acute respiratory distress?

A

sudden onset without previous problem

• ex: smoke inhalation

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17
Q

what is chronic respiratory distress?

A

have respiratory disease normally

• Example ‐ COPD ‐ Live at the edge of chronic respiratory insufficiency

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18
Q

what is acute on chronic respiratory distress?

A

Sudden worsening of chronic situation

• COPD or asthma exacerbation

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19
Q

T/F: Hypoxemia that is refractory to increased oxygen is life threatening

A

TRUE
• What is the work of breathing – RR, use of access muscles, body position, LOC
• What is the trend of serial ABG’s?
• Do not withhold oxygen from COPD when needed, or from any hypoxic patient

20
Q

what is the tx for respiratory failure?

A

• Oxygenate adequately and monitor closely
• Medications
• Position (HOB >45 degrees)
• Suction prn, chest physiotherapy – vibration/percussion
• Frequent evaluation of overall respiratory status – serial ABGs
• If refractory to treatment, prepare for Bipap or intubation
12

21
Q

what are the characteristics of oxygenation for respiratory failure?

A
  • Work of breathing (WOB)
  • Auscultate breath sounds frequently
  • Monitor effect of activity on O2 sat, rate, effort
22
Q

what are the meds used for tx of respiratory failure?

A 
• Oxygen delivery sufficient to maintain tissue oxygen demands
- LOC, SVO2, end organ perfusion indicators
• Treatment of pulmonary infections
- Antibiotics, antivirals, antifungals
• Reduction of severe anxiety, pain, and agitation – but carefully!!
- Benzodiazepines and opiates
• Relief of bronchospasm
- Albuterol, atrovent
• Reduction of airway inflammation
- Corticosteroid
• Reduction of pulmonary congestion
- Diuretics, nitrates
23
Q

what are the two methods for an advanced airway?

A

Bipap and Intubation with an endotracheal tube

24
Q

what are the characteristics of Bipap?

A
  • Noninvasive
  • Does not protect airway
  • Facilitates efficiency
  • Pressurized external mask
  • Not for pt who is not breathing
25
what are the characteristics of intubation with an endotracheal tube?
``` • Invasive • Protects airway • Machine for respiratory control • Usually needs sedation ```
26
what are the interventions for bipap patients?
``` • Monitor for improving or worsening respiratory status • Provide frequent oral care • Pts may feel anxiety with mask on • Foster comfort and communication • Assist with hydration • Assist with nutrition • VTE prevention mandatory ** Bipap will not provide sufficient oxygenation for a pt not breathing! ```
27
what are the indictions for intubation patients?
``` • Upper airway obstruction • Apnea • Aspiration • Respiratory distress: - Intractable dyspnea - Worsening hypercapnia - Refractory hypoxemia - Inability to protect airway (Secretions/Bleeding) ```
28
what are the benefits of intubation?
* Relieves respiratory distress * Decreases work of breathing * Maintains airway * Improves pulmonary gases * Rests respiratory muscles * Permits lung healing
29
what are the interventions for intubated patients?
* Maintain tube patency * Keep ambubag at head of bed in case of obstruction * Provide frequent oral care * Turn Q2H to maintain skin integrity * Foster comfort and communication * Suction * Prevent self‐extubation andVentilator Associated Pneumonia!
30
what are the characteristics of suction for intubation?
* When secretions present, for increased work of breathing or pressure * For less than 10 seconds * Pre‐oxygenate * In‐line suctioning ‐ do not instill saline!
31
what is acute respiratory distress syndrome? (ARDS)
sudden, progressive respiratory failure • Alveolar capillary membrane becomes damaged • Severe and refractory hypoxemia • Bilateral interstitial pulmonary infiltrates
32
T/F the exact cause of damage to the alveolar capillary membrane is unknown
TRUE | • Inflammation, stimulation of immune system (SIRS) – many possible causes
33
what is the most common cause of ARDS?
sepsis
34
what are the characteristics of ARDS?
* Failure of the capillary‐alveolar membrane * Initial interstitial edema → alveolar edema * Acute Lung Injury (ALI) * Direct lung injury ‐ aspiration * Indirect lung injury ‐ARDS
35
what are the sxs of the initial resp distress of ARDS?
Onset may be insidious – initial resp distress: • Dyspnea, tachypnea, cough, restlessness, crackles • ABG’s reveal mild hypoxemia, respiratory alkalosis
36
what are the later clinical manifestations of ARDS?
As symptoms worsen, refractory hypoxemia: • Profound respiratory distress • Requires intubation with increasing oxygenation needs • CXR – shows “whiteout” • ABGs show severe hypoxemia and respiratory acidosis • Diagnostic tests are same as in respiratory failure
37
what are the three phases of ARDS?
1. Exudative phase – days 1‐7 (damage to endothelium) 2. Proliferative phase - weeks 1-2 (repairing) 3. Fibrotic phase – 2‐3 weeks (remodeled, fibrotic)
38
what are the complications of ARDS?
* Respiratory * GI * Renal * CV * Hematological * Longterm Intubation
39
what is the tx for ARDS?
* Manage airway by preparing for or managing ventilator * Sedation as indicated for situation (Includes sedation vacation when stable) * Proning video ‐ * Medication * Monitor: activity tolerance, I&O’s, wt,VS, SpO2, ABG, hemodynamics pressures * High calorie, high protein diet – PPN/TPN * Psychosocial – communication, emotional support, family support
40
How is the airway managed?
* VAP prevention bundle * HOB 35‐45 degrees * Suction prn, chest PT – vibration/percussion * Supine placement per hospital protocol
41
what meds are used for tx for ARDS?
- bronchodilator - mucolytic - ATBs - steroids - pain - other
42
what are the two types of lung cancers?
non-small cell (over long time; from smoking; 85%) | small cell
43
what are the risk factors of lung cancer?
smoking, asbestos, ethnic differences, environmental | **Approximately 70% have local or advanced spread at diagnosis
44
what are the diagnostic tests used for lung cancer?
* Chest X‐Ray * CT chest, with contrast * Sputum for cytology * Bronchoscopy * FNA (fine needle aspiration) – CT guided * Assess for metastasis * CT * MRI * PE
45
what are the sxs of lung cancer?
• Respiratory problems/dyspnea • Persistent cough • Abnormal sputum ( Blood tinged, Rust colored, Purulent sputum, Frank hemoptysis) • Pain (persistent) chest, shoulder, or arm • Recurring pleural effusion, pneumonia, or bronchitis • Dyspnea (unexplained) • Swelling in neck or face • “Tanned” appearance
46
what is the tx for lung cancer?
``` • Surgical interventions - Thoracotomy - Video assisted (VATS) • Chemotherapy • Targeted therapy • Radiation therapy ```
47
what is the post op thoracotomy care?
``` • Assessments - Respiratory status - Pain - Anxiety - Wound care - Activity - Nutrition • Monitor chest drainage system • Discharge planning • Treatment plan • Smoking cessation • Home health (home O2?) • Complications - pneumonia and infection ```

Nursing Semester 3 (29 decks)

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