Exam 3 Gas Exchange, Perfusion, Flashcards
OSA-Obstructive Sleep Apnea
-episodes of upper airway obstruction
-reduced ventilation
-snoring
-5 obstructive events an hour during sleep
-breathing cessation greater than 10 seconds
-freq. arousals w/loud snort O2 desats during sleep
OSA CAUSES
Reduced diameter of upper airway or dynamic changes in upper airway during sleep
OSA RISK FACTORS
-overweight older male
-post menopausal obese women
-neck obesity
-tonsillar hypertrophy
-excessive fat deposits in pharynx walls
OSA INCREASED RISK FOR:
-MI
-stroke
-death
-increased insulin resistance
-vascular disease
-CAD CHF
-metabolic syndrome
-type 2 diabetes
OSA Screening
Stop bang questionnaire
Note Severity of Symptoms
-excess daytime sleepiness
-frequent nocturnal awakening
-insomnia
-loud snoring
-morning headaches
Sleep study
Polysomnography
Treatment
-weight loss
-avoid alcohol/hypnotics
-oral appliance/CPAP (full detention required) noninvasive
-surgery
-implanted device
Post-Procedural Respiratory Complications
-hypoxemia
-atelectasis
-pneumonia
-MI
-cardiac arrythmias
-ICU transfers
PCA-Patient Controlled Analgesia
-Smart pump: pt pushes button when light is green
-Meds:morphine, hydromorphone/dilaudid, fentanyl
-Two nurse co-sign approval; start PAC, shift change, syringe, D/C’ing
PCA-patient controlled analgesia cont’d
-ETCO2 required for PCA to monitor wave form (35-45mmHg)
-early indicator of sedation
-Q4 hours record amount infused/attempted
PCA IMPORTANT TERMS
-loading dose:given at start of PCA
-basal rate:amount automatically given
-PCA dose:amount pt receives when button is pushed
-lockout time:frequency pt can receive dose
-RN bolus dose:extra dose than can be given
-max limit:total amount in 4 hours
OIRD
-Opioid induced respiratory depression
-MOSS
-PASERO
OIRD NALOXONE protocol
-give according to protocol
-0.04 mg IV PRN stay Q 2minutes
-repeat in 2 minutes PRN until all 4 criteria met: pt alert, RR greater than 10/min, O2 sat. greater than 92% 2/L via nasal cannula, capnography WNL
NARCAN TIPS
-giving according to protocol
-dilute/label syringe
-give in small increments
-stay/monitor client
-NARCAN will wear off before opioid
ATELECTASIS
Airway inflammation + Edema=alveolar collapse
-reversible collapse of lobe/lung
-obstructive:block airway via tumor, foreign body, mucous plug
-nonobstructive:compression/LOSS OF SURFACTANT
ATELECTASIS RISK FACTORS
-anesthesia
-ETT endotracheal tube
-pneumonia
-foreign object
-lung disease/mucus plug/tumor in airway
-prolonged bed rest/few position changes/shallow breathing
-pleural effusion:fluid buildup causing pressure on lung
ATELECTASIS DIAGNOSTICS
-auscultation/percussion(dull sound)
-chest X-ray(density)
-bronchoscopy(remove mucus plugs)
-chest CTI/MRI/ultrasound
ATELECTASIS PREVENTION
-incentive spirometry
-up to chair for meals
-early ambulatory post-op
-ambulate TID
-deep breathing exercises
ATELECTASIS MANIFESTATIONS
-dyspnea
-chest pain
-cough
-hypoxemia(late sign of distress)
-absent/diminished breath sounds/crackles
-tactile fremitus
-may/may not fever
TREATMENT
-broncoscopy (remove mucus plugs)
-postural drainage/head tilt lower than chest ( trendelenburg)
-lie on healthy side
-inhaled medicine ( bronchodilators)
Treat cause of pleural effusion (thoracentesis), empyema (pocket of puss relieved w/chest tube/antibiotics)
OUTCOMES
PERFUSION
Stroke/CVA
*Alteration in perfusion (blockage)
*block blood flow to the brain
*no blood, no O2, no nutrients
*cell death (doesn’t regenerate)
Stroke/CVA
HEEMORRHAGIC:vessel bursts, blood in brain increases ICP
*CEREBRAL ANEURYSM:emergent
*AVM-arterio venous malformation
