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Adult Health I final > Exam 2 Pulmonary part 3 > Flashcards

Exam 2 Pulmonary part 3 Flashcards

1
Q

Pneumonia interventions/nursing care

A
  • Elevate bed to 45 degrees
  • Incentive spirometer: 10x every hour
  • Hydration
  • Coughing and deep breathing
  • Repositioning patient
  • Nutrition: small frequent meals
  • Auscultate lung sounds
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2
Q

Tuberculosis diagnosis criteria

A
  • Induration of 10 mm or greater diameter = positive for exposure
  • Induration of 5 mm = positive in those with decreased immunity
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3
Q

Tuberculosis drug therapy

A

Combination drug therapy with strict adherence:

  • Isoniazid
  • Rifampin
  • Pyrazinamide
  • Ethambutol
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4
Q

Tuberculosis management

A
  • Airborne precautions in the hospital
    negative pressure room
    N95 masks
    Remains in isolation until there are 2 consecutive negative sputum cultures
  • Home care
    Not in isolation since exposure has already occurred
    family needs testing
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5
Q

Acute Respiratory Failure: Ventilatory failure etiology

A
  • Musculoskeletal or anatomical lung dysfunction or suppression
  • Airway pressure does not change enough to allow air movement in and out of lungs
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6
Q

Acute Respiratory Failure: Oxygenation Failure etiology

A
  • Breakdown of O2 transport from the alveolus to the arterial flow
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7
Q

Acute Respiratory Failure: Ventilatory failure diagnosis criteria

A
  • V/Q mismatch:
    air movement inadequate/perfusion ok

ABGs:
PaCO2 > 45 AND pH < 7.35
SaO2 < 90%
Respiratory acidosis

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8
Q

Acute Respiratory Failure: Oxygenation Failure diagnosis criteria

A
  • V/Q mismatch:
    air movement adequate/perfusion is decreased

ABGs:PaO2 < 60 mm Hg
SaO2 < 90%
PaCO2 34-45 Normal

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9
Q

Acute Respiratory Failure: Combined ventilatory and oxygenation failure etiology

A
  • Both ventilation and perfusion are inadequate

- abnormal lungs

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10
Q

Acute Respiratory Failure: Oxygenation management

A
  • Supplemental oxygen
    Invasive/non-invasive
  • Minimize oxygen consumption
    Sedation
    Neuromuscular paralysis
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11
Q

Acute Respiratory Failure: ventilation management

A

Mechanical ventilation

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12
Q

Acute Respiratory Failure: pharmacologic management

A
  • Bronchodilators
    Beta2 agonists
    Anticholinergics
  • Steroids
  • Sedation
  • Analgesics
  • Paralytics
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13
Q

Acute Respiratory Failure: Complications

A
  • Hypoxia complications
    Anoxic encephalopathy
    Cardiac dysrhythmias
  • Ventilator complications
    DVT (SCDs, heparin)
    GI bleeding (PPI)
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14
Q

Acute Respiratory Distress Syndrome (primarily oxygenation problem) (ARDS) Pathophysiology

A
  • Injury to the pulmonary vasculature or the airways which results in noncardiac pulmonary edema and disruption of the alveolar-capillary membrane.
  • Activation of neutrophils and macrophages, and release endotoxins
  • Release mediators Tumor necrosis factor, Interleukin 1, proteases
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15
Q

Acute Respiratory Distress Syndrome (primarily oxygenation problem) (ARDS) etiology: direct injury

A
  • Pulmonary contusion
  • Gastric aspiration
  • Near drowning
  • Inhalation injuries
  • Some infections
  • Radiation
  • Oxygen toxicity
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16
Q

Acute Respiratory Distress Syndrome (primarily oxygenation problem) (ARDS) etiology: indirect injury

A
  • Septicemia
  • Shock, prolonged hypotension
  • Nonthoracic trauma
  • CABG
  • Drug overdose
  • Head injury
  • Pancreatitis
  • Diabetic coma
  • Multiple blood transfusion
  • Fat embolus
  • Amniotic fluid embolus
17
Q

Acute Respiratory Distress Syndrome (primarily oxygenation problem) (ARDS) Diagnostic criteria: Mild

A

PaO2/FIO2 of 201-300 mm Hg with PEEP or continuous positive airway pressure (CPAP) of 5 cm H2O or greater.

18
Q

Acute Respiratory Distress Syndrome (primarily oxygenation problem) (ARDS) Diagnostic criteria: moderate

A

PaO2/FIO2 of 101-200 mm Hg with PEEP of 5 cm H2O or greater

19
Q

Acute Respiratory Distress Syndrome (primarily oxygenation problem) (ARDS) Diagnostic criteria: Severe

A

PaO2/FIO2 of 100 mm Hg or less with PEEP of 5 cm H2O or greater.

20
Q

Acute Respiratory Distress Syndrome (primarily oxygenation problem) (ARDS): Phase 1

A
  • Exudative phase
    First 72 hours after injury

Mediators are causing injury to pulmonary capillaries

Increased capillary membrane permeability

Development of microemboli

Increased pulmonary pressures, but PAOP can remain low or normal

Results in interstitial edema, alveolar edema

Type I and Type II cells are damaged, leading to alveolar collapse

21
Q

Acute Respiratory Distress Syndrome (primarily oxygenation problem) (ARDS): Phase 2

A
  • Fibroproliferative phase
    Disordered healing begins

Cellular granulation, collagen deposition

Fibrotic alveoli, pulmonary capillaries scarred

Increased stiffening and increased pulmonary HTN

22
Q

Acute Respiratory Distress Syndrome (primarily oxygenation problem) (ARDS): Phase 3

A
  • Resolution phase
    Structural and vascular remodeling

Restoration of the alveolus

Macrophages remove debri

Type II cells multiply & some convert to Type I

23
Q

Acute Respiratory Distress Syndrome (primarily oxygenation problem) (ARDS): Phase 4

A
  • Late or Chronic ARDS
  • Permanent lung damage common
  • Problems may include cough, limited exercise tolerance and fatigue.
  • Anxiety, depression and flashback memories of their critical illness
24
Q

Acute Respiratory Distress Syndrome (primarily oxygenation problem) (ARDS) mechanical ventilation treatment

A

O2 at the lowest level needed
FIO2: Goal SaO2 90 with FIO2 <65%

Mode: Assist Control Allows vent to do most the work
Pressure Control for worsening ARDS

Tidal volume
Smaller tidal volumes with higher respiratory rates
6-10 ml/kg

PEEP: Recruits collapsed alveoli, decreases pulmonary shunting and improves gas exchange
Decreases venous return, Barotrauma

25
Q

Acute Respiratory Distress Syndrome (primarily oxygenation problem) (ARDS) Treatment

A
  • Inverse ratio
  • Permissive hypercapnea
  • Pressure control ventilation
  • Inhaled nitric oxide
  • Partial liquid ventilation
  • ECMO
26
Q

Acute Respiratory Distress Syndrome (primarily oxygenation problem) (ARDS) complications

A
  • Severe dyspnea, using accessory muscles
  • Dry cough
  • Altered LOC, restlessness, anxiety, confusion
  • Lung expansion reduced
  • Vocal fremitus increased
  • Increased density from diffuse pulmonary edema
  • Bronchiovesicular BS over most lung fields
  • Adventitious sounds-diffuse crackles over all lung fields
27
Q

Pulmonary embolism risk factors/etiology

A

Virchow’s triad:

  1. Hypercoagualbility
  2. Injury to vascular endothelium
  3. Venous stasis
28
Q

Pulmonary embolism treatment/management

A
  • O2
  • Positive Inotropic drugs, fluids
  • Systemic Thrombolytic Therapy
  • Anticoagulation therapy
    Heparin IV drip
  • Pulmonary Embolectomy
  • Prophylaxis:
    Anticoagulation:
    Greenfield Filter: Umbrella shaped filter placed in inferior vena cava to catch traveling blood clots from lower extremities.
29
Q

Chest trauma: Tension pneumothorax

A
  • Air admitted in pleural space through rupture in lung or hole in chest wall.
  • Flap of tissue in lung or hole acts as flutter valve allowing air in and not out.
  • Pressure in pleural space increases
30
Q

Chest trauma: Hemothorax

A
  • Collapse of lung due to blood in pleural space

- Chest trauma, complication anticoagulant therapy, lung malignancy

31
Q

Flail Chest

A
  • Caused by fractured ribs
  • Leads to chest wall instability
  • Results in opposite chest movement with respirations
  • Prevents adequate ventilation of injured area
32
Q

Chest tube nursing care

A
  • No stripping, gentle milking “only” if needed
  • Monitor for air leak
  • Observe for excessive bloody drainage
  • Monitor q 15 min for first 1-2 hours

Adult Health I final (16 decks)

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