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Medsurg 2 > exam 3 - respiratory > Flashcards

exam 3 - respiratory Flashcards

1
Q

what are the 3 diagnostic criteria for Acute respiratory distress syndome?

A

Pao2/Fio2 ratio of <200,
chest xray infiltration,
Pulmonary wedge (PAWP) pressure less than 18

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2
Q

what is the function of PEEP? what level should it be?

A

Positive end expiratory pressure, opens aveoli up and prevents the from collapsing to promote gas exchange

Level below 8, anything above = pathological problem, suction pt and see what is wrong

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3
Q

what is the pathophysiology of ARDs?

A

3 inflammatory mediators released: histamine, seratonin and bradykinins,
decreased surfactant + increased permeability =
end result of pulmonary fibrosis and multi system failure

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4
Q

what do we do if pt is fighting the vent?

A

give muscle relaxer/paralytic

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5
Q

what is the scale of oxygen?

A

NC: 6L
venturi mask (more prescise o2 titration = 50%)
NC+nonrebreather (6L + 15 L)
HFNC
CPAP
Mask Vent
ET Ventilator

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6
Q

what are ABG levels?

A

pH: 7.35-45
PaO2: 80-100
PaCo2: 35-45
HCo3: 22-26
BE: -1 to +1

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7
Q

early signs of acute respiratory distress

A

Restlessness (first sign), ir hunger, fatigue, tachypnea, tachycardia, ham dyspnea, anxiety

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8
Q

what are the late sings of respiratory failure

A

AMS, confusion, lethargy, tachypnea/cardia, central cyanosis, diaphoresis, decreased breath sounds, use of accessory muscles and respiratory arrest

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9
Q

what is a complication of PEEP?

A

increased intravascular pressure = decreased venous return = decreased BP and cardiac output

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10
Q

risk factors of PE

A

prolonged immobilization, central venous catheters, surgery, obesity, age, hx of thromboembolism, condition that increase clotting

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11
Q

PE tx?

A

o2 therapy, continious monitoring, IV access, drugs therapy (anticoags/fibrinolytics)

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12
Q

what are 2 important things to tell pt to prevent PE

A

do not massage/compress legs
If traveling for long periods of time, drink fluid regularly/get up

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13
Q

s/sx of PE?

A

respiratory: dyspnea, tachypnea, crackles, pleuritic chest, pain, dry cough, hemoptysis = HYPOXEMIA

Cardiad: tachy, distended neck vein, syncope, cyanosis, hypotension, s3/s4 heart sounds, abnromal ECG = HYPOTENSION + HEMORRHAGE RISK

ANXIETY and impending sense of doom triggered by hypoxemia

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14
Q

what is acute respiratory failure

A

sudden life threatening detoriation or gas exchange of lung (fails to provide adequate oxygenation/ventilaion for blood)

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15
Q

what does the ABG look like in acute respiratory failure

A

ABG: hypoxemia, hypercapnia, ph <7.35

paO2 <60, paCo2 = 45<

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16
Q

what are the s/sx of acute respiratory distress syndrome? (ARDs)

A

persisting hypoxia, decreased pulmonary compliance, dyspnea, bilateral pulmomary edema

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17
Q

what are the interventions of ARDS

A

PEEP, CPAP (intubation), drug/fluid therapy and nutrition

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18
Q

what are the worst complications of ARDS?

A

intrapulmonary shunting (aveoli collapse) due to deoxygenation but no oxygenation occuring)

End result = pulmonary fibrosis and multi system organ failure

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19
Q

what will fix pulmonary shunting?

A

PEEP or CPAP (open aveoli)

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20
Q

what is the testing we do for PE

A

pulmonary angiogram

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21
Q

health promotion for PE

A

stop smoking, loose weight, exercise,

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22
Q

lab values that considers a pt to be hypoxemic

A

paO2 less than 60% (normal is 80-100)

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23
Q

criteria for Acute respiratory failure

A

PaO2 less than 60
saO2 less than 90
PaCo2 more than 50
ph less than 7.3

pt always hypoxemiz= vent/oxygenation failure

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24
Q

what is ventilatory failure:

A

physcial problem of lung/chest (trauma pt)
defect in respiratory control (neuro issues)
poor function of respiratory muscles (diaphragm)

hypercapnic

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25
Q

what are extrapulmonary vs intrapulmonary causes of ventilatory failure

A

extra: any type of trauma that occurs to pt
Intra: PE, Covid, any internal issues

26
Q

what is gas exchange (oxygenation) failure?

A

insufficicient oxygenation in aveoli
lung perfusion decreased but normal ventilation
R to L shunting
Ventilation/perfusion mismatch
abnormal hgb

hypoxemia

27
Q

combined ventilatory and oxygenation failure occurs with pts with

A

abnormal lungs (bronchitis, emphysema, asthma attack)

decreased bronchioles/aveoli = o2 failure, increase work of breathing, respiratory muscles dont function well

28
Q

intubation: nursing actions

A

give sedative, and “Succ” that relaxes airway for a couple of minutes, restrain pt, use sedation (propofol, versed), pain meds (Fentanyl)

if pt is fighting vent: give paralytic

28
Q

intubation: how do we assess placement?

A

chest xray, listen to lung sounds, monitor sat levels, look for chest wall movement, check end tidal Co2 level

29
Q

respiratory distress =

A

increased work of breathing

30
Q

interventions of dyspnea

A

o2 therapy, position of comfort (tripod, leaning forward), relaxation/diversion, energy conserving measures, medications (may need benzo to calm down)

31
Q

extubation: nursing actions

A

hyperoxygenate pt, suction, deflate ET cuff, ambuu bag/o2 set up, remove tube at peak inspiration, cough/deep breathe to prevent stridor, monitor q5 for respiratory distress

32
Q

what is stridor?

A

medical emergency = collapsed airway
(BRONCHOSPAMS)

can occur if pt self extubates due to balloon being intact

33
Q

what is VAP? How do we prevent it?

A

ventilator associated pneumonia

prevention: oral care, suction/manage secretions, HOB above 30 degrees, tube feed

34
Q

how long can pt be on vent for

A

2 weeks, then switch them over to trach

35
Q

Pao2/FiO2 ratio: what is the normal? when do we intubate?

A

300-400 normal
intubate: 200 or less, means pt is going to ARDS

36
Q

what is tidal volume based on

A

Pt weight and height

37
Q

what is a normal rate on a vent

A

16-18, but pt can breath over if needed

38
Q

What are the correct FIo2 levels? what does it need to be to extubate? what is too high?

A

fraction of inspired air, concentration of o2 in the air we breathe

30-35% before extubation

60% for less than 6hrs, can cause lung damage if longer = oxygen toxicity and worsening hypoxia = hypoxemia

39
Q

what is PaO2? normal PaO2?

A

partial oxygen of oxygen in arterial blood

normal 80-100

COPD = lower paO2 due to fibrosis

40
Q

what is a complication of high PIP

A

over 40 = barotrauma

40
Q

What is PIP? what is normal range?

A

peak inspiratory pressure

40 is normal range, greater than = lung issues or tube dislodgement

41
Q

shunting causes ___ level to rise = respiratory acidosis

A

PaCo2

42
Q

what are complications of the ventilator?

A

cardiac: hypotension (from high PEEP), fluid retention, valsalva maneuver

Infections: VAP

respiratory: vent dependence, baro/volutrauma

muscle deconditioning (takes 3-4 days)

43
Q

what is cpap? what is it used for?

A

continous positive airway pressure: functions similar to PEEP, doesnt cycle, pt must initiate all breaths

Used to open collapsed aveoli after atelectasis after surgery or cardiac induced pulmonary edema or sleep apnea

44
Q

trach complications? how do we prevent tissue injury

A

pneumothroax, subcutaenous emphysema, bleeding, infection, tissue injury

cuff pressure can cause mucosal ischemia, check pressure for leak, prevent friction rubbing

45
Q

how do we wean pt off trach?

A

smaller tube size gradually, cuff deflayed when pt can manage secretions/doesnt need ventilation

46
Q

25% of deaths in trauma are due to what?

A

chest trauma

47
Q

what is barotrauma:

A

induced damage to the lungs from positive pressure= enlarging lungs/aveoli (occurs to ARDS pts who get positive pressure vents)

48
Q

what is volutrauma?

A

vent induced damage to lungs by excess volume delivered to one lung over other

49
Q

what is pulmonary contusion? s/sx of pulmonary contusion? tx?

A

LETHAL (asymptomatic at first -> respiratory failure) due to bruising of the lung

bloody sputum, decreased breath sounds, crackles, wheezing

tx: o2, ventilation

50
Q

what happens with a rib fracture? nursing interventions?

A

ventilation compromised by pain

DO NOT SPLINT/BIND
tell pt to cough/deep breathe, mobilize, use IS, to prevent pneumonia
Decrease pain = adequate breathing

51
Q

what is flail chest? nursing interventions?

A

paradoxical movement (sucking in of loose chest during inspiration, puffing out of same area during expiration)

Intubate if true paradoxical

52
Q

what is a tension pneumothroax? S/Sx? tx?

A

medical EMERGENCY
asymmetry of thorax, tracheal deviation (moves away from midline),

s/sx: distended neck veins, cyanosis, hyper tympanic, absence of breath sounds on one side

chest tube for tx

53
Q

what is a pneumothorax?

A

air in pleural cavity

s/sx: rapid breathing, sharb stabbing pain, SOB, hyper resonance

54
Q

what is trachebobronchial trauma? S/sx?

A

due to being hit/trauma = medical emergency

s/sx: subq emphysema, stridor, surgery needed

55
Q

what is a hemothorax?
s/sx? what should nurse monitor?

A

blood in pleural cavity

s/sx: decreased BP, pale/cool/clammy skin, increased RR/HR, hypovolemic shock can occur

monitor H&H, plts, clotting factors

56
Q

hypoxemia vs hypoxia
s/sx?

A

hypoxemia: low levels of 02 in blood

Hypoxia: decreased tissue oxygenation

s/sx: dyspnea, nasal flaring, use of accessory muscles, pursed lip breathing, decreased endurance, pallor/cyanosis

57
Q

if something is wrong with the vent, what should the nurse do?

A

assess pt first, then the vent

58
Q
A

Medsurg 2 (6 decks)

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