Exam 2 Flashcards
Oral Pharyngeal Airway (OPA): Indications
Tongue and/or epiglottis fall back against the posterior pharynx in anesthetized on unconscious patients
Patients who do not have a cough, gag, or swallow reflex
Oral Pharyngeal Airway (OPA): Contraindications
Person who is conscious and intact cough, gag, or swallow reflex
Oral Pharyngeal Airway (OPA): Measurement
Measure from corner of patient’s mouth to the angle of the jaw
Oral Pharyngeal Airway (OPA): Assessment after placement
Feel for breathing and breath sounds every 2-4 hours and PRN
Naso Pharyngeal Airway (NPA): Indications
Patients with intact, weak cough and gag reflex who require frequent suctioning but unable to clear secretions
Naso Pharyngeal Airway (NPA): Contraindications
Patients who are anticoagulated, have low platelet count, bibasilar skull fracture, basel formities, facial trauma, sometimes children because of risk of epistaxis
Naso Pharyngeal Airway (NPA): Complications
Trauma to nares, airway obstruction, laryngospasm, gagging and vomiting
Naso Pharyngeal Airway (NPA): Measurement
Measure from nares to the tragus of the ear
Circumference smaller than diameter of nostril
Naso Pharyngeal Airway (NPA): Assessment after placement
Feel for breathing
Check posterior airway
Auscultate lung sounds
Remove and replace with a new NPA every 8 hours and examine nasal mucosa and nares
Most effective method to clear the airway
Coughing and deep breathing
Incentive spirometry use
To promote deep breathing and good inspiratory effort
Peak flow measurements
Provide baseline of best maximal expiration to evaluate airway diameter
To determine meds to minimize further asthma attacks
Postural drainage and cupping: Contraindications
Head injuries, intracranial pressure, COPD, history of cardiac disorders
Resuscitation breathing bags: indications
Hypoxia, decreased O2 sats that don’t recover with increasing oxygenation
Hypoventilation (RR
BVM ventilation
Deliver breaths over 1 second
Deliver one every 6-8 seconds or 8-10 breaths per minute
Sync with patient effort to breathe, or inbetween patient’s breaths
BVM ventilation oxygen flow
15 L for teens and adults
10 L for infants and children
Pleural space: definition
Lies between the parietal and visceral pleura of the chest wall and lung
Inspiration
Passive, involuntary activity
Intrapulmonary pressure is lower than atmospheric pressure, causing air to flow into the lungs
Expiration
Intrapulmonic pressure is greater than atmospheric pressure, causing the air to flow fro the lungs and out to the atmosphere
Functions of surfactant
Increase compliance
Repvent atalectasis
Reduce fluid accumulation thereby keeping surface dry
Pneumothorax: definition
Air in pleural space
Types of pneumothorax
Spontaneous
Closed
Open
Pneumothorax: signs and symptoms
Signs: tachypnea, tachycardia, decreased or absent breath sounds over affected area
Symptoms: pain which worsens with inspiration, dyspnea, cough, sudden stabbing pain on the side of the pneumothorax
Spontaneous pneumothorax: causes
Excessive coughing Smoking Tall, thin men COPD and CF Ruptured pulmonary blebs High impact stress from sports
Spontaneous pneumothorax: treatments
High flow O2
Chest tube
High fowler’s position
Closed pneumothorax: causes
Air enters the pleural space from within the lung
Rib fracture that punctures the lung
Result of a medical procedure such as insertion of a central line or cardiac pacemaker wires via the subclavian vein
Blunt trauma
Open pneumothorax: causes
Air enters the pleural space from the atmosphere
Penetrating trauma
Hemothorax: causes
Blood in the pleural space
Thoracic or heart surgery
Blood clotting disorder
Pulmonary infarction
Lung cancer
Tear of a blood vessel when placing a central venous catheter
Sever hypertension
TB
Hemopneumothorax
Collection of blood and air in the pleural space
Requires to chest tubes (one for air, one for blood)
Tension pneumothorax: definition
Air leaks into the pleural space through a tear in the lung and has no way to escape
With each breath, air accumulates in the pleural space, increasing positive pressure which compresses the lung and shifts the mediastinum to the unaffected side of the chest
Venous return and cardiac output ar edecreased
Tension pneumothorax: treatment
Chest tube will NOT prevent this
Thorocostomy
Tension pneumothorax: complications and signs/symptoms
Unaffected lung may collapse –> life threatening emergency
Rapid, labored respirations Tachycardia Cyanosis Hypoxemia Sudden chest pain that extends to the shoulders
Pleural effusion: causes
Excess fluid in the pleural space
Left ventricular failure, pulmonary embolism, pneumonia, cancer, tumors, complications of surgery, previously placed chest tube is removed prematurely
Chylothorax: causes
Accumulation of lymphatic fluid in the pleural space
Chest trauma, expanding tumor, surgery on mediastinal structures
Empyema
Purulent drainage of pus from an infection such as pneumonia or lung abscess
Empyema: signs and symptoms
Cough, chest pain, SOB, fever
Empyema: treatment
Thorocentesis “tap the lung”
High chest tube placement
2nd intercostal space
Low chest tube placement
5th or 6th intercostal spaces
Suction control chamber
Dry suction control
Automatic control valve inside the regulator adjusts to the patient and suction source
Expansion of the red bellows helps determine whether or not suction is operating
Suction tube
NEVER kink or clamp
May be milked w/o order to remove clots
Collection chamber
Fluid/blood drains here
Checked every hour initially
Notify provider if there is >100mL/hr drainage
Water seal chamber: normal intermittent bubbling
Normal if chest tube drainage unit is on suction
Caused by fluid being displaced by air or when there is an air leak in the pleural space, coughing or exhaling
Water seal chamber: large amount of bubbling
Usually caused by a large patient leak or a leak in the system
Water seal chamber: unexpected absence of bubbling
May be a blockage in the tubing
Verify tubing is attached, water level is filled to prescribed level and check wall suction
Tidaling
Fluctuations in fluid level indicates pressure changes in pleural space
Fluctuates up with inspiration, down with expiration
Diminishes as lung re-expands
Leaks
Evidenced by continuous rapid bubbling in the water seal chamber
Jackson Pratt
Use to remove fluids from a surgical area
Removes fluids by creating suction in the tube/bulb. The bulb expands as it fills with fluid
Removed when
Penrose
Open drainage system
Acts like a straw to pull fluids out of the wound and rain outside the wound
Hemovac
Portable wound suction device that is compressed to provide gentle suction
Creates a negative pressure of ~45mmHg
Closed drainage system
VAC device
Negative pressure wound therapy
Area covered with a transparent adhesive membrane
Foam placed within wound area
Causes blood vessels to dilate and greater cell proliferation
Enhances the formation of granulation tissue
P wave represents…
atrial depolarization
QRS complex represents…
ventricular depolarization
R wave represents…
ventricular repolarization
U wave represents…
repolarization of Purkinje fibers
May indicate an old MI
PR interval normal duration
0.12-0.20 seconds
QRS complex normal duration
= 0.12 seconds
QT interval normal duration
0.35-0.40 seconds
ST interval
isoelectric, above or below isoelectric
TP interval
isoelectric
PP interval signifies…
atrial rhythm and rate
RR interval signifies…
ventricular rhythm and rate
Five steps to analyze a strip:
- Determine regularity
- Determine rate
- Presence and quality of P waves
- PR interval consistency
- QRS duration
Sinus Bradycardia: description
Rate
Sinus Bradycardia: causes
Athletic rate, hypoxia, hypothermia, drug reactions, excessive vagal stimulation
Sinus Bradycardia: management
Depends on cause: atropine, dopamine, epinephrine
Sinus Bradycardia: S&S
May be asymptomatic; syncope, dizziness/weakness, hypotension, diaphoresis, SOB, chest pain
Sinus Tachycardia: description
Rate > 100
Sinus Tachycardia: causes
Exercise, infection, hypovolemia, hypoxia, MI, increased tissue oxygen demand, fever, vagal inhibition, stimulant meds (catecholamines, atropine, caffeine, alcohol, nicotine, aminophylline, thyroid meds)
Sinus Tachycardia: management
Depends on cause
Sinus Tachycardia: S&S
May be asymptomatic; fatigue, weakness, SOB, orthopnea, neck vein distension, decrease O2 sat, decreased BP, restlessness, anxiety, impaired renal function
PAC’s: description
Occur when atrial tissue becomes irritable
Ectopic focus is fired before the next sinus episode is due
PAC’s: causes
Stress, fatigue, anxiety, infection, caffeine, meds, ischemia, electrolyte imbalance, nicotine, alcohol
PAC’s: management
If symptomatic, treat with anti-arrhythmic drugs
Atrial Fibrillation: description
- Irregular rhythm and rate
- F waves
- Indeterminate PRI
- Most common dysrhythmia
Atrial Fibrillation: causes
Hypertension, ischemic, rheumatic, mitral, myocardial and pericardial disease, thyrotoxicosis, aging
Atrial Fibrillation: risks
Blood pooling may lead to embolic event
Decreased CO
Atrial Fibrillation: S&S
Decreased BP, SOB, fatigue, angina, syncope, inconsistent peripheral pulses
Atrial Fibrillation: management
- Drugs to slow conduction (amiodarone) or calcium channel blockers (cardizem)
- Anticoagulation to decrease risk of thrombus formation
- Synchronized cardioversion
Atrial Flutter: description
- Regularly rhythm
- Variable rhythm
- F waves
Atrial Flutter: causes
Hypertension, ischemic, mitral, myocardial and pericardial disease, aging
Atrial Flutter: management
- Drugs to slow conduction
2. Synchronized cardioversion
Atrial flutter: S&S
Palpitations, weakness, fatigue, SOB, nervousness, anxiety, syncope, angina, signs of heart failure, shock
Supraventricular Tachycardia: description
- Regular or irregular rhythm
- Elevated rate
- No P wave
Supraventricular Tachycardia: causes
Hypoxia, stimulant drugs, ischemia, mitral valve disease
Supraventricular Tachycardia: management
Vagal maneuvers, antidysrhythmic drugs, synchronized cardioversion, ablation,
Supraventricular Tachycardia: S&S
Same as Atrial Flutter: palpitations, weakness, fatigue, SOB, nervousness, anxiety, syncope, angina, signs of heart failure, shock
Tracheostomy: Indications
Bypass severe recurrent upper airway obstruct: (repeated aspiration, anatomic narrowing/stenosis, tracheal malacia); Prolonged mechanical ventilation after failure to wean/extubate; facial trauma, inability to remove secretions from airway; head and neck surgery
Tracheostomy: Risks/Complications
Bleeding, infection, erosion of mucosal lining with granuloma formation, compromised breathing, plugging with mucus/secretions, tracheal esophogeal fistula, accidental decannulation, “false pocket” when reinserting tube, subcutaneous emphysema/crepitus