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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
what are extrapulmonary vs intrapulmonary causes of ventilatory failure
extra: any type of trauma that occurs to pt Intra: PE, Covid, any internal issues
26
what is gas exchange (oxygenation) failure?
insufficicient oxygenation in aveoli lung perfusion decreased but normal ventilation R to L shunting Ventilation/perfusion mismatch abnormal hgb hypoxemia
27
combined ventilatory and oxygenation failure occurs with pts with
abnormal lungs (bronchitis, emphysema, asthma attack) decreased bronchioles/aveoli = o2 failure, increase work of breathing, respiratory muscles dont function well
28
intubation: nursing actions
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
intubation: how do we assess placement?
chest xray, listen to lung sounds, monitor sat levels, look for chest wall movement, check end tidal Co2 level
29
respiratory distress =
increased work of breathing
30
interventions of dyspnea
o2 therapy, position of comfort (tripod, leaning forward), relaxation/diversion, energy conserving measures, medications (may need benzo to calm down)
31
extubation: nursing actions
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
what is stridor?
medical emergency = collapsed airway (BRONCHOSPAMS) can occur if pt self extubates due to balloon being intact
33
what is VAP? How do we prevent it?
ventilator associated pneumonia prevention: oral care, suction/manage secretions, HOB above 30 degrees, tube feed
34
how long can pt be on vent for
2 weeks, then switch them over to trach
35
Pao2/FiO2 ratio: what is the normal? when do we intubate?
300-400 normal intubate: 200 or less, means pt is going to ARDS
36
what is tidal volume based on
Pt weight and height
37
what is a normal rate on a vent
16-18, but pt can breath over if needed
38
What are the correct FIo2 levels? what does it need to be to extubate? what is too high?
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
what is PaO2? normal PaO2?
partial oxygen of oxygen in arterial blood normal 80-100 COPD = lower paO2 due to fibrosis
40
what is a complication of high PIP
over 40 = barotrauma
40
What is PIP? what is normal range?
peak inspiratory pressure 40 is normal range, greater than = lung issues or tube dislodgement
41
shunting causes ___ level to rise = respiratory acidosis
PaCo2
42
what are complications of the ventilator?
cardiac: hypotension (from high PEEP), fluid retention, valsalva maneuver Infections: VAP respiratory: vent dependence, baro/volutrauma muscle deconditioning (takes 3-4 days)
43
what is cpap? what is it used for?
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
trach complications? how do we prevent tissue injury
pneumothroax, subcutaenous emphysema, bleeding, infection, tissue injury cuff pressure can cause mucosal ischemia, check pressure for leak, prevent friction rubbing
45
how do we wean pt off trach?
smaller tube size gradually, cuff deflayed when pt can manage secretions/doesnt need ventilation
46
25% of deaths in trauma are due to what?
chest trauma
47
what is barotrauma:
induced damage to the lungs from positive pressure= enlarging lungs/aveoli (occurs to ARDS pts who get positive pressure vents)
48
what is volutrauma?
vent induced damage to lungs by excess volume delivered to one lung over other
49
what is pulmonary contusion? s/sx of pulmonary contusion? tx?
LETHAL (asymptomatic at first -> respiratory failure) due to bruising of the lung bloody sputum, decreased breath sounds, crackles, wheezing tx: o2, ventilation
50
what happens with a rib fracture? nursing interventions?
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
what is flail chest? nursing interventions?
paradoxical movement (sucking in of loose chest during inspiration, puffing out of same area during expiration) Intubate if true paradoxical
52
what is a tension pneumothroax? S/Sx? tx?
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
what is a pneumothorax?
air in pleural cavity s/sx: rapid breathing, sharb stabbing pain, SOB, hyper resonance
54
what is trachebobronchial trauma? S/sx?
due to being hit/trauma = medical emergency s/sx: subq emphysema, stridor, surgery needed
55
what is a hemothorax? s/sx? what should nurse monitor?
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
hypoxemia vs hypoxia s/sx?
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
if something is wrong with the vent, what should the nurse do?
assess pt first, then the vent
58

Medsurg 2 (8 decks)

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