day 2 Flashcards
Potential Alterations in Respiratory Function post op
obstruction – mucus plug
hypoxemia – Low levels of O2 in the blood
hypoventilation.
Atelectasis (alveolar collapse)
Pulmonary edema
Aspiration of gastric contents
Potential Alterations in Cardiovascular Function post op
Postoperative fluid and electrolyte imbalances
combination of
the body’s normal response to the stress of surgery,
excessive fluid losses,
improper IV fluid replacement.
Potential GI Problems post op
Nausea and vomiting are significant problems in the postoperative period. (most pronounced after abdominal surgery)
Paralytic ileus
postoperative nausea and vomiting (PONV)
Age < 50 years
Female patients
Why is pain undertreated?
Inadequate skills to assess and treat pain
Misconceptions about pain
Inaccurate information about addiction and other adverse effects of opioids
pain meds cause Respiratory depression
Clients underreporting pain
types of pain
acute,
chronic
intractable
neuropathic
Acute Pain:
pain directly related to tissue injury, resolves when tissue heals
Chronic (Persistent) Pain:
pain that persists beyond three months secondary to chronic disorders, or damaged nerves after healing is complete
Intractable Pain:
A pain state that is usually severe in which there is no cure, after accepted medical treatments have been offered (i.e. Refractory Angina)
Neuropathic Pain:
Pain that is related to malfunctioning or damaged nervous tissue
Shingles, fibro
types of pain
nociceptive
somatic
visceral
pain threshold
phantom pain
Nociceptive - caused by damage to somatic or visceral tissue
Somatic - localized to areas such as bone, joint, muscle or skin
Aching or throbbing
Visceral - activation of nociceptors of the thoracic, pelvic, or abdominal viscera (organs).
Pain Threshold:
The process of recognizing, defining, and responding to pain
Phantom Pain:
Painful sensations experienced from a limb that has been removed (amputated)
Breakthrough Pain
Transient; moderate to severe
Occurs beyond treated pain
Usually rapid onset and brief duration with variable frequency and intensity
opioids in pain treatment
Tylenol
Opioid analgesics commonly used for severe pain;
Morphine
Morphine-like agonists
hydromorphone {synthetic stronger 6x stronger}, methadone, fentanyl, ketamine
Tylenol 3 has 30mg codiene
Tylenol 2 has 15mg codeine
Tylenol 1 has 7mg codeine
Allergy to codiene can take percocet
routes of pain management
Routes
Oral:
Subcutaneous:
Intramuscular:
Intravenous:
Transnasal:
Transdermal:
Rectal:
Intraspinal:
ASA Physical status classification system
ASA I: A normal healthy patient
ASA II: A patient with mild systemic disease
ASA III: A patient with severe systemic disease
ASA IV: A patient with severe systemic disease that is a constant threat to life
ASA V: A moribund patient who is not expected to survive without the operation
ASA VI: A declared brain-dead patient
Meds for scale of pain (1-10)
Medication for mild pain (1-3)
NSAIDs
nonopioid analgesics
Tylenol → acetaminophen
Advil → ibuprofen
Mild to moderate pain (4-6)
prescriptions for opioids are often combined with a nonopioid analgesic (tylenol 3 EG)
Moderate to severe pain (6-10)
Morphine is one of the opioids most commonly prescribed for moderate to severe pain, although fentanyl (Duragesic), hydromorphone (Dilaudid), methadone (Metadol), and oxycodone also are used extensively.
3 mechanisms of breathing
what are they dependant upon
VDP
Ventilation: mechanical movement of airflow between atmosphere and alveoli role of compliance
Diffusion: vital mechanism for internal and external respiration
Perfusion: pumping/flow of blood into tissues and organs-systemic and pulmonic systems
Dependent upon:
Cardiac output - MAP
Gravity
Pulmonary vascular resistance
epistaxis
causes and drugs that affect it
Nosebleed
most commonly posterior bleeding
Causes: Trauma, non-humidified oxygen therapy, nasal spray misuse, alcohol use, street drug use, allergy, tumours
Aspirin, NSAIDs, and conditions prolonging bleeding time or altering platelet counts predispose patients to epistaxis.
airway obstruction
tyes, caused by? Symptoms
Airway Obstruction
May be complete or partial
Complete obstruction is a medical emergency.
Partial obstruction may occur as a result of aspiration of food or a foreign body;
laryngeal edema following extubation; laryngeal or tracheal stenosis; central nervous system (CNS) depression; or allergic reactions.
Symptoms: Stridor; use of accessory muscles; wheezing; restlessness; tachycardia; cyanosis
tracheotomy
Tracheostomy
Surgical incision into the trachea to establish an airway
Indications
To bypass an upper airway obstruction
To facilitate removal of secretions
To enable long-term mechanical ventilation
To facilitate oral intake and speech in the patient requiring long-term mechanical ventilation
Lung capacity
todal volume, inspiratory reserve, expiratory reserve, vital capacity
Lung Capacity (important)
Tidal volume (TV or VT): air volume of each breath (500ml)
Inspiratory reserve volume (IRV): maximum volume that can be inhaled after a normal inhalation
Expiratory reserve volume (ERV): maximum volume exhaled after a normal exhalation
Vital capacity (VC): the maximum volume of air exhaled from a maximal inspiration, VC = TV + IRV + ERV (average is 6L)
restrictive vs obstructive pulmonary diseases
Pulmonary Diseases
Restrictive: problem with inflow of air
Obstructive: problem with outflow of air
what causes a restricted Pulmonary Disorder
caused by
Decreased lung compliance and decreased lung expansion
Problem of volume rather than airflow (speed)
Caused by:
Decreased number of functioning alveoli
Lung tissue loss (lobectomy/tumour)
External problems (morbid obesity)
Hypoxemia – low oxygen in blood
Hypoxia – low oxygen in tissue
clinical manifestations of restrictive Pulmonary Disorder
Increased resp rate (tachypnea)
Decreased tial volume
Normal to decreased PaO2
Shortness of breath
Cough
Chest pain
Fatigue
Weight loss
classifications of Pneumonia
what type of bacteria
Classification often based on where acquired
Hospital-acquired (nosocomial) pneumonia (HAP)
Ventilator-associated pneumonia (VAP)
Health care-associated pneumonia (HCAP)
Community-acquired pneumonia (CAP)
CAP: Streptococcus pneumoniae (gram +ve)
HAP: Pseudomonas (gram –ve, opportunistic),
restrictive
what is pneumnia
S/S
Inflammation of lung tissue
Treatment options can vary because of different pathogens
Classic Signs and Symptoms
Tachypnea
Productive cough
Pleuritic pain
Fever
Dyspnea
Cyanosis
Mental status changes
Crackles, decreased breath sounds
ABGs indicative of hypoxemia (o2 level and Co2 level)
restrictive
Viral pneumonia
what causes primary and secondary? Other types
Primary viral: caused by influenza A virus (H1N1)
most severe and deadly
Secondary bacterial: develops following influenza
other types
Avian influenza(H5N1)
Severe Acute Respiratory Syndrome (SARS)
SARS-CoV2 virus (COVID)
restrictive
Opportunistic Pneumonia
what is it? What are the symptoms?
P. jiroveci is an opportunistic pathogen commonly found in lungs
Affects 70% of HIV-infected individuals
Most common opportunistic infection in patients with AIDS
Symptoms
fever
tachypnea
tachycardia
