exam 3 - respiratory Flashcards
what are the 3 diagnostic criteria for Acute respiratory distress syndome?
Pao2/Fio2 ratio of <200,
chest xray infiltration,
Pulmonary wedge (PAWP) pressure less than 18
what is the function of PEEP? what level should it be?
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
what is the pathophysiology of ARDs?
3 inflammatory mediators released: histamine, seratonin and bradykinins,
decreased surfactant + increased permeability =
end result of pulmonary fibrosis and multi system failure
what do we do if pt is fighting the vent?
give muscle relaxer/paralytic
what is the scale of oxygen?
NC: 6L
venturi mask (more prescise o2 titration = 50%)
NC+nonrebreather (6L + 15 L)
HFNC
CPAP
Mask Vent
ET Ventilator
what are ABG levels?
pH: 7.35-45
PaO2: 80-100
PaCo2: 35-45
HCo3: 22-26
BE: -1 to +1
early signs of acute respiratory distress
Restlessness (first sign), ir hunger, fatigue, tachypnea, tachycardia, ham dyspnea, anxiety
what are the late sings of respiratory failure
AMS, confusion, lethargy, tachypnea/cardia, central cyanosis, diaphoresis, decreased breath sounds, use of accessory muscles and respiratory arrest
what is a complication of PEEP?
increased intravascular pressure = decreased venous return = decreased BP and cardiac output
risk factors of PE
prolonged immobilization, central venous catheters, surgery, obesity, age, hx of thromboembolism, condition that increase clotting
PE tx?
o2 therapy, continious monitoring, IV access, drugs therapy (anticoags/fibrinolytics)
what are 2 important things to tell pt to prevent PE
do not massage/compress legs
If traveling for long periods of time, drink fluid regularly/get up
s/sx of PE?
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
what is acute respiratory failure
sudden life threatening detoriation or gas exchange of lung (fails to provide adequate oxygenation/ventilaion for blood)
what does the ABG look like in acute respiratory failure
ABG: hypoxemia, hypercapnia, ph <7.35
paO2 <60, paCo2 = 45<
what are the s/sx of acute respiratory distress syndrome? (ARDs)
persisting hypoxia, decreased pulmonary compliance, dyspnea, bilateral pulmomary edema
what are the interventions of ARDS
PEEP, CPAP (intubation), drug/fluid therapy and nutrition
what are the worst complications of ARDS?
intrapulmonary shunting (aveoli collapse) due to deoxygenation but no oxygenation occuring)
End result = pulmonary fibrosis and multi system organ failure
what will fix pulmonary shunting?
PEEP or CPAP (open aveoli)
what is the testing we do for PE
pulmonary angiogram
health promotion for PE
stop smoking, loose weight, exercise,
lab values that considers a pt to be hypoxemic
paO2 less than 60% (normal is 80-100)
criteria for Acute respiratory failure
PaO2 less than 60
saO2 less than 90
PaCo2 more than 50
ph less than 7.3
pt always hypoxemiz= vent/oxygenation failure
what is ventilatory failure:
physcial problem of lung/chest (trauma pt)
defect in respiratory control (neuro issues)
poor function of respiratory muscles (diaphragm)
hypercapnic
what are extrapulmonary vs intrapulmonary causes of ventilatory failure
extra: any type of trauma that occurs to pt
Intra: PE, Covid, any internal issues
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
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
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
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
respiratory distress =
increased work of breathing
interventions of dyspnea
o2 therapy, position of comfort (tripod, leaning forward), relaxation/diversion, energy conserving measures, medications (may need benzo to calm down)
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
what is stridor?
medical emergency = collapsed airway
(BRONCHOSPAMS)
can occur if pt self extubates due to balloon being intact
what is VAP? How do we prevent it?
ventilator associated pneumonia
prevention: oral care, suction/manage secretions, HOB above 30 degrees, tube feed
how long can pt be on vent for
2 weeks, then switch them over to trach
Pao2/FiO2 ratio: what is the normal? when do we intubate?
300-400 normal
intubate: 200 or less, means pt is going to ARDS
what is tidal volume based on
Pt weight and height
what is a normal rate on a vent
16-18, but pt can breath over if needed
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
what is PaO2? normal PaO2?
partial oxygen of oxygen in arterial blood
normal 80-100
COPD = lower paO2 due to fibrosis
what is a complication of high PIP
over 40 = barotrauma
What is PIP? what is normal range?
peak inspiratory pressure
40 is normal range, greater than = lung issues or tube dislodgement
shunting causes ___ level to rise = respiratory acidosis
PaCo2
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)
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
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
how do we wean pt off trach?
smaller tube size gradually, cuff deflayed when pt can manage secretions/doesnt need ventilation
25% of deaths in trauma are due to what?
chest trauma
what is barotrauma:
induced damage to the lungs from positive pressure= enlarging lungs/aveoli (occurs to ARDS pts who get positive pressure vents)
what is volutrauma?
vent induced damage to lungs by excess volume delivered to one lung over other
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
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
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
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
what is a pneumothorax?
air in pleural cavity
s/sx: rapid breathing, sharb stabbing pain, SOB, hyper resonance
what is trachebobronchial trauma? S/sx?
due to being hit/trauma = medical emergency
s/sx: subq emphysema, stridor, surgery needed
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
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
if something is wrong with the vent, what should the nurse do?
assess pt first, then the vent
