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NUR 430 > Exam 1 Caring for Clients with Chest and Respiratory Issues > Flashcards

Exam 1 Caring for Clients with Chest and Respiratory Issues Flashcards

1
Q

What is anaphylaxis?

A

Severe allergic reaction with rapid onset
Occurs within seconds/minutes of exposure
Dx made by objective findings

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2
Q

What does immune system produce in anaphylaxis?

A

produces IgE antibodies that is normally not toxic and antibodies
Antibodies are stored for future exposure and release histamine
Histamine  flushing, urticaria, angioedema, hypotension, and bronchoconstriction

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3
Q

What are mild clinical manifestations of anaphylaxis?

A

Warmth, tingling, mouth fullness, nasal congestion, periorbital swelling, sneezing, eye tearing, pruritis

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4
Q

What are moderate clinical manifestations of anaphylaxis?

A

Flushing, warmth, anxiety, itching, dyspnea, cough, wheezing

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5
Q

What are severe clinical manifestations of anaphylaxis?

A

Bronchospasm, laryngeal edema, severe dyspnea, cyanosis, hypotension, dysphagia, abdominal cramping, vomiting, diarrhea, seizures

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6
Q

How to PREVENT anaphylaxis?

A

Strict avoidance of potential allergen
Carry and administer epi
Teach back method
Always carry an emergency kit
Screen for allergies
Wear a medical alert bracelet
Desensitization

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7
Q

What is medical management for anaphylaxis?

A

ABC support
Ensure airway patency
Oxygenation
Epi 1:1000 dilution first line treatment
Antihistamines and corticosteroids: (IV or inhaled)
IVF
Pressors
Aminophylline to improve breathing/airway

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8
Q

What should nurses be aware of in anaphylaxis after management?

A

Be aware of rebound reaction 4-10 hours after initial reaction

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9
Q

What is first line treatment for anaphylaxis?

A

Epi 1:1000 dilution

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10
Q

What is nursing management for anaphylaxis?

A

Assess for s/s
Prompt notification to provider or EMS
Prepare for emergency procedures
ET intubation may be difficult; prepare for cricothyrotomy
Education on prevention
Proper management of chronic conditions (asthma) (COPD)
Be aware of adverse effects from epi
- INC HR

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11
Q

What is pulmonary embolism?

A

Obstruction of the pulmonary artery by a thrombus/thrombi that originates in the venous system
The embolus travels through venous systems and into the pulmonary circulation and cuts off the blood supply to the alveoli
Leads to impaired gas exchange

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12
Q

What does obstruction of pulmonary cause in PE?

A

causes increases pressure and puts a strain on the right ventricle
Leads to decreased cardiac output

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13
Q

What is pulmonary embolism caused by?

A

clot, air, fat, amniotic fluid, tumor cells, bacteria (vegetation), and injected particles

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14
Q

What does pulmonary embolism result from?

A

blood venous stasis, changes in coagulation, damage to the vessel (Virchow’s triad)
The third leading cause of death in the hospital

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15
Q

What are risk factors for PE?

A

Acute medical illness (a-fib, etc.)
Major surgery
Trauma
Cancer (including therapies)
Hx of VTE
Obesity
Immobility for more than 2 days
Age >40
Hypercoagulable conditions
Prolonged mechanical ventilation
Neuromuscular paralytic use
Central venous catheters
Severe sepsis
Heparin-induced thrombocytopenia
Oral contraceptive use and estrogen therapy
Pregnancy
Tobacco use
Long bone fractures

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16
Q

What are clinical manifestations of Pulmonary Embolism?

A

Dyspnea
Pleuritic chest pain
Anxiety; feeling of impending doom
Syncope
Cough
Hemoptysis
Palpitations
Tachypnea
Crackles
Tachycardia
Presence of S4
Can be asymptomatic
Death can occur within hours

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17
Q

What does chest x ray show in pulmonary embolism?

A

Helps identify PE or other causes of s/s

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18
Q

What do ABG show in pulmonary embolism?

A

Show hypoxemia and hypocapnia (from tachypnea)
As it progresses, can turn to hypoxemia and hypercapnia

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19
Q

What happens to D-dimer in pulmonary embolism?

A

Occurs from fibrin lysis; normal <0.4 mcg/mL; elevated with thromboembolic events

Used only to rule out a PE!

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20
Q

Why is ECG used in pulmonary embolism?

A

To assess right ventricle function

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21
Q

What does doppler ultrasonography show in pulmonary embolism?

A

displays DVT

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22
Q

What is V/Q scan in pulmonary embolism?

A

Comparisons of ventilation and perfusion in each area of the lung; not for clients with underlying resp. issue

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23
Q

What is Computed tomographic pulmonary angiography (CTPA) in pulmonary embolism?

A

Standard for detecting PE; visualizes the pulmonary angiography with IV contrast

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24
Q

How to prevent pulmonary embolism?

A

Prevent DVT!!
Active leg exercises
Early ambulation
Elastic compression stockings or electronic compression devices (SCD)
Prophylactic anticoagulation with expected immobilization
-Low dose heparin
-Low-molecular weight heparin
Patient Education
Smoking cessation
Avoid crossing legs
Avoid long periods of immobility
Prevent PE with traveling
Stay hydrated
Early recognition of problems!!!

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25
What is emergency management for pulmonary embolism?
Oxygen IVF Perfusion scans, ABGs, CT angiogram, ECG, echo Vasopressors or inotropes Dig, IV diuretics, antiarrhythmics if appropriate Labs Coagulation studies (PT, PTT, INR, d-dimer) Serum electrolytes CBC Possible intubation and mechanical ventilation Indwelling catheter to monitor urinary output!! IV morphine or sedatives IV thrombolytics Anticoagulants: PUT IN CATHETER EARLY AS YOU CAN
26
What is goal of continuous heparin infusion?
Therapeutic PTT to reduce risk and recurrence of PE
27
How is PTT dosed?
By weight
28
What is the initial bolus IV dose?
80 units/kg then a continuous infusion of 18 units/kg/hr
29
How should PTT be maintained?
1.5-2.5 times the control (21-35 sec; for heparin therapy 50-70 sec)
30
How is heparin titrated?
based on PTT (drawn Q6 hours) Monitor and report s/s of bleeding Have antidote available: Protamine sulfate
31
What is LMWH used for?
For hemodynamically stable clients (with stable PE) No need to monitor labs
32
Warfarin in PE
Can be added to IV therapy (bridge therapy) Monitor INR (normal 1, goal with warfarin is 2-3) The higher the INR the longer it takes for blood to clot Have antidote available Monitor amount of vit K in diet
33
What are some orals in anticoag therapy?
Apixaban (Eliquis), dabigatran (Pradaxa), rivaroxaban (Xarelto) No lab monitoring
34
Thrombolytic therapy?
DISSOLVES clots Examples: urokinase, streptokinase, alteplase, reteplase
35
What are indications for thrombolytic therapy?
Severe, unstable PE/DVT (hypotensive, right ventricle dysfunction, large/saddle embolism, significant hypoxemia despite supplemental 02)
36
Is thrombolytic therapy continuous?
No, it is single time dose
37
What are ABSOLUTE contraindications for thrombolytic therapy?
Hx of hemorrhagic CVA, active intracranial neoplasm, recent brain/spinal surgery (< 2 months), internal bleeding within 6 months
38
What are RELATIVE contraindications for thrombolytic therapy?
Bleeding tendency, uncontrolled HTN, nonhemorrhagic CVA within 2 months, post surgery <10 days ago, thrombocytopenia
39
What is a big side effect of thrombolytic therapy?
Bleeding/Hemorrhage Invasive procedures are avoided during therapy and 24 hours after
40
What is Embolectomy?
Rarely done; only for massive PE or hemodynamic instability Removes the clot surgically with cardiopulmonary bypass
41
What is IVC filter?
Mesh-like devices to trap thrombi from lower extremities and pelvis to prevent them from traveling to lungs Used for people with recurrent PE and absolute contraindication to anticoags
42
What are nursing interventions for pulmonary embolism?
43
What is flail chest?
Three or more adjacent ribs are fractured in two or more sites  free floating rib segments Caused by blunt force trauma to the chest (MVC, CPR in elderly, contact sports) Chest wall loses stability  resp impairment  resp distress Detached part of rib is pulled inward during inspiration Detached part of rib is pushed outward during expiration
44
What are complications of flail chest?
Retained airway secretions Atelectasis Hypoxemia Impaired gas exchange Respiratory acidosis Decreased cardiac output
45
What are clinical manifestations of the flail chest?
Unequal chest expansion Paradoxical chest wall movement: AUTOMATICALLY THING FLAIL CHEST Tachycardia Hypotension Dyspnea Cyanosis Anxiety Chest pain
46
What is medical and nursing management for flail chest?
-Providing ventilatory support Oxygenation Intubation and mechanical ventilation for severe injury Surgery for severe -Clear secretions from lungs Positioning, coughing, deep breathing, IVF, suctioning, pulmonary chest physiotherapy, IS, nebs with bronchodilators and mucolytics -Control pain Intercostal nerve blocks, cautious use of opioids, PCA, epidural analgesia -Monitor CXR, ABG, pulse ox, and pulmonary function test
47
What is pneumothorax?
Pleura are punctured and pleural space is exposed to positive atmospheric pressure Presence of air or gas in the pleural space that causes lung collapse
48
What is simple (spontaneous) pneumothorax?
Air enters pleural cavity through a ruptured bleb (blister) Can occur in a healthy person
49
What is traumatic pneumothorax?
Air enters pleural space from a trauma or thoracic procedures
50
What is hemothorax?
Blood enters pleural cavity from lung lacerations or lacerations of great vessels
51
What is tension pneumothroax?
-Air enters pleural cavity with inspiration but cant escape with expiration -From penetration -Causes increased pressure on heart and lung leading to decreased cardiac output, tracheal shift to unaffected side, collapsed lung
52
How is pneumothrax diagnosed?
by chest x-ray and ABG; thoracentesis for hemothorax
53
What are clinical manifestations of tension pneumo?
Trachea deviation to unaffected side Decreased chest expansion Diminished or absent breath sounds Hyperresonance Air hunger Agitation Increasing hypoxemia Central cyanosis Hypotension Tachycardia
54
What is medical management for pneumothorax?
Goal = evacuate air/blood from pleural space Chest tube to drain fluid and air Tension pneumo Inserting large-bore 14 gauge needle at second intercostal space, midclavicular line on affected side; then chest tube Emergency thoracotomy If injury is suspected through trauma Done if more than 1500 mL of blood is aspirated by thoracentesis OR if chest tube output >200 ml/hr Pain management with opioids
55
What is nursing management for pneumothorax?
Administer 02 Astute assessment Monitor ABGs, Sp02, CBC, and CXR Positioning for maximum ventilation Emotional support Administer meds Encourage rest periods Encourage coughing, deep breathing, IS Collaboration with interdisciplinary team Chest tube management
56
What are indications for chest tube?
Drain fluid, blood, lymph, pus, or air; Re-establish a negative pressure; Facilitate lung expansion; Restore normal intrapleural pressure
57
What is chest tube used for?
pneumothorax, hemothorax, post-op drainage for open heart surgery, pleural effusion, pulmonary empysema
58
How is chest tube inserted?
Can be inserted in right or left pleural spaces or mediastinum Inserted in ER, bedside, or OR Three chambers Drainage collection Water seal Suction control (wet or dry) Can drain by suction or gravity
59
What is nursing management for chest tube?
Position in semi-high fowlers to promote ventilation Keep two hemostats, sterile water, and occlusive dressing at bedside ALWAYS Only milk or clamp tubing when prescribed If leak suspected, determine the location by using clamps, notify MD, and tighten connections or change system Mark drainage hourly/daily Frequent reposition ROM of affected arms/shoulder CXR daily
60
When is chest tube removed indicated?
No more fluid fluctuations in water seal chamber Clear CXR Slowed drainage
61
What is process of chest tube removal?
Assist provider Pain medication 30 min before Instruct the client to take a deep breathe, exhale, and bear down (Valsalva) OR take a deep breath and hold it Tube is then clamped and removed quickly by provider Immediately after, place an airtight petroleum gauze dressing and thoroughly cover with nonporous tape (same with accidental removal and then immediately notify provider) If chest tube drainage system is compromised  immerse end of chest tube in sterile water for temp water seal Obtain CXR

NUR 430 (3 decks)

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