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critical care > lower respiratory disorders > Flashcards

lower respiratory disorders Flashcards

1
Q

pulmonary edema

A

bilateral fluid in the lungs, alveoli, or both
differs from pneumonia because its on both sides

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2
Q

cardiogenic pulmonary edema

A

CAD
cardiomyopathy
heart valve problems
HTN
left sided heart failure –> increase in pulmonary venous pressure that forces fluid into the capillaries

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3
Q

Cardiogenic pulmonary edema medical management

A

improve left ventricular function
vasodilators–> nitro
preload reduces
ionotropic meds
after load reducers –> vasotec catopril
intra aortic balloon pump
contractility meds

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4
Q

noncardiogenic pulmonary edema

A

lung infection
toxin exposure
sepsis
smoke inhalation
chest trauma
adverse drug reaction
low oncotic pressure

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5
Q

pulm edema clinical manifestations

A

BLOOD TINGED FROTHY SPUTUM

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6
Q

pulm edema assessment

A

crackles
rapidly progresses towards apices of lungs
x rays –> increased interstitial markings
tachycardia –> heart working overtime
pulse ox falls
abg worsens

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7
Q

pulm edema noncardiogenic medical management

A

correct underlying cause
diuretics
fluid restriction
sup oxygen to relieve hypoxemia and dyspnea non rebreather–> cpap–> intubation
morphine for anxiety

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8
Q

acute respiratory failure

A

sudden and life threatening deterioration of gas exchange function of lung

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9
Q

acute respiratory failure abg

A

respiratory acidosis
PaO2 less than 60
SaO2 less than 90
PaCO2 more than 50
pH less than 7.35

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10
Q

Acute respiratory failure impaired ventilation: respiratory

A

acute obstruction

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11
Q

ARF impaired ventilation: CNS

A

drug overdose
head trauma
infection
hemorrhage
sleep apnea

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12
Q

ARF Impaired Ventilation: neuromuscular

A

myasthenia gravis
guillian barre syndrome
ALS
spinal cord trauma

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13
Q

ARF impaired ventilation: musculoskeletal

A

chest trauma –> cant expand chest
kyphosis
malnutrition

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14
Q

ARF impaired oxygenation: perfusion

A

pneumonia
ARDS
heart failure
COPD
Pulmonary embolism
restrictive lung disease

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15
Q

ARF impaired oxygenation: post op

A

analgesia –> resp depression
pain –> cant deep breathe or cough
ventilation perfusion mismatch

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16
Q

ARF early clinical manifestations

A

restlessness
air hunger
headache
tachycardia
increased BP
fatigue

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17
Q

ARF late clinical manifestations

A

confusion
lethargy
central cyanosis
tachypnea
diaphoresis
resp arrest
use of accessory muscles
decreased breath sounds

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18
Q

ARF medical management

A

correct underlying cause
intubation and MV
oxygenation

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19
Q

ARF nursing management

A

ICU monitoring
- ABG
- pulse ox
- vitals
- levels of consciousness

20
Q

ARF intubation: preventing complications

A
  • turn schedule
  • skin care
  • mouth care
  • range of motion
21
Q

ARDS acute respiratory distress syndrome

A

inflammation of the alveoli that results in severe and progressive pulm edema
high mortality rate

22
Q

ARDS diagnosis

A

refractory hypoxemia –> sup o2 doesn’t work, o2 tox
chest x ray with bilat infiltrates
exclusion of cardiogenic pulm

23
Q

ARDS patho

A

damage of cap membranes that cause transfer of blood and fluid into the lungs
makes lungs stiff
impaired ventilation

24
Q

ARDS acute phase clinical manifestation

A

rapid onset of severe dyspnea

25
Q

Causes 12-48 before ARDS

A
  • aspiration
  • drug overdose
  • hematologic disorders
  • oxygen toxicity
  • shock
  • trauma or major surgery
  • fat or air embolism
26
Q

ARDS 24-48 hours

A

hyaline membranes form

27
Q

ARDS 7 days

A

fibrosis

28
Q

ARDS assessment

A

intercostal retractions
crackles

29
Q

ARDS diagnosis: BNP

A

high levels is heart involvement
rules out hemodynamic pulm edema (heart failure

30
Q

ARDS Diagnosis: echo

A

structure and size of the heart

31
Q

ARDS diagnosis: pulm artery cath

A

definitive distinguish between hemodynamic (heart failure) and permeability (ARDS)

32
Q

ARDS med management

A

intubation and MV
circulatory support
adequate fluid volume
nutritional support
supp oxygen –> hypoxemia

33
Q

ARDS management PEEP

A

increase functional capacity
PaO2 above 60 and SaO2 about 90 at lowest FiO2

34
Q

ARDS systemic hypotension

A

less fluid in the blood vessels –> hypovolemia
decreased cardiac output due to pressure

35
Q

Pulmonary embolism

A

obstruction of the pulmonary artery
air, fat, amniotic fluid, bacteria from thrombus
regional vasoconstriction

36
Q

Pulmonary embolism diagnosis

A

D Dimer
High V/Q high ventilation no perfusion

37
Q

Pulmonary embolism risk factors

A

immobility
obesity
postpartum
oral contraceptives
post op
DVT
venous pooling with emboli formation

38
Q

pulmonary embolism clinical manifestation

A

SUDDEN SHARP CHEST PAIN
hemoptysis
hypoxia
decreased PaO2
dyspnea
Respiratory alkalosis
tachycardia

39
Q

Pulmonary embolism treatment

A

heparin drip
don’t mix heparin and saline lines

40
Q

Pulmonary hypertension

A

reconstructing vascular of the lungs increasing resistance
mean pressure greater than 25 (normal 15-18)
primary women 20-40 fatal in 5 years
secondary adults with COPD

41
Q

Pulmonary Hyptertension patho

A

Progressive remodeling
- collagen vascular disease
- congenital heart disease
- anorexigens
- chronic stimulant use
- portal hypertension
- HIV
- vascular inury

42
Q

Pulmonary Hypertension clinical manifestations

A

DYSPNEA
substernal chest pain
weakness
fatigue
syncope
occasional hemoptysis
anorexia and right upper quadrant pain
signs of right sided heart failure
- distended neck veins
- liver engorgement
- peripheral edema
- crackles in the lungs

43
Q

Pulmonary Hypertension assessment and diagnostic

A

chest x ray
pulm function test
EKG
ECG
sleep study
liver function test
antibody tests (Lupus)
V/Q scan checking for emboli
cardiac Cath –> rule out right sided heart failure

44
Q

pulm hypertension medical management

A

sidenafil (vasodilator)
calcium channel blocker
antigoag
supp oxygen with exercise
flonan epoprostenol (continuous, need backup everything)
-jaw pain, cramps, nausea, diarrhea
ventavis iloprost
- Q3 nebulizer
- really expensive
- not for pregnant or breastfeeding
- chest pain, HA, nausea, breathlessness

44
Q

pulm hypertension EKG findings

A

right ventricular hypertrophy
right axis deviation
tall peaked p waves
tall r waves
st segment depression
inverted t waves

45
Q

respiratory track meds

A

mucolytics: hypertonic saline
acetylcystine mucomyst sulfur, bronchospasm

anticholinergics: atrovent (ipratropium) dry mouth, increase IOP

Albuterol (preventil)
tachy, angina, tremor

critical care (8 decks)

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