lower respiratory disorders Flashcards
pulmonary edema
bilateral fluid in the lungs, alveoli, or both
differs from pneumonia because its on both sides
cardiogenic pulmonary edema
CAD
cardiomyopathy
heart valve problems
HTN
left sided heart failure –> increase in pulmonary venous pressure that forces fluid into the capillaries
Cardiogenic pulmonary edema medical management
improve left ventricular function
vasodilators–> nitro
preload reduces
ionotropic meds
after load reducers –> vasotec catopril
intra aortic balloon pump
contractility meds
noncardiogenic pulmonary edema
lung infection
toxin exposure
sepsis
smoke inhalation
chest trauma
adverse drug reaction
low oncotic pressure
pulm edema clinical manifestations
BLOOD TINGED FROTHY SPUTUM
pulm edema assessment
crackles
rapidly progresses towards apices of lungs
x rays –> increased interstitial markings
tachycardia –> heart working overtime
pulse ox falls
abg worsens
pulm edema noncardiogenic medical management
correct underlying cause
diuretics
fluid restriction
sup oxygen to relieve hypoxemia and dyspnea non rebreather–> cpap–> intubation
morphine for anxiety
acute respiratory failure
sudden and life threatening deterioration of gas exchange function of lung
acute respiratory failure abg
respiratory acidosis
PaO2 less than 60
SaO2 less than 90
PaCO2 more than 50
pH less than 7.35
Acute respiratory failure impaired ventilation: respiratory
acute obstruction
ARF impaired ventilation: CNS
drug overdose
head trauma
infection
hemorrhage
sleep apnea
ARF Impaired Ventilation: neuromuscular
myasthenia gravis
guillian barre syndrome
ALS
spinal cord trauma
ARF impaired ventilation: musculoskeletal
chest trauma –> cant expand chest
kyphosis
malnutrition
ARF impaired oxygenation: perfusion
pneumonia
ARDS
heart failure
COPD
Pulmonary embolism
restrictive lung disease
ARF impaired oxygenation: post op
analgesia –> resp depression
pain –> cant deep breathe or cough
ventilation perfusion mismatch
ARF early clinical manifestations
restlessness
air hunger
headache
tachycardia
increased BP
fatigue
ARF late clinical manifestations
confusion
lethargy
central cyanosis
tachypnea
diaphoresis
resp arrest
use of accessory muscles
decreased breath sounds
ARF medical management
correct underlying cause
intubation and MV
oxygenation
ARF nursing management
ICU monitoring
- ABG
- pulse ox
- vitals
- levels of consciousness
ARF intubation: preventing complications
- turn schedule
- skin care
- mouth care
- range of motion
ARDS acute respiratory distress syndrome
inflammation of the alveoli that results in severe and progressive pulm edema
high mortality rate
ARDS diagnosis
refractory hypoxemia –> sup o2 doesn’t work, o2 tox
chest x ray with bilat infiltrates
exclusion of cardiogenic pulm
ARDS patho
damage of cap membranes that cause transfer of blood and fluid into the lungs
makes lungs stiff
impaired ventilation
ARDS acute phase clinical manifestation
rapid onset of severe dyspnea
Causes 12-48 before ARDS
- aspiration
- drug overdose
- hematologic disorders
- oxygen toxicity
- shock
- trauma or major surgery
- fat or air embolism
ARDS 24-48 hours
hyaline membranes form
ARDS 7 days
fibrosis
ARDS assessment
intercostal retractions
crackles
ARDS diagnosis: BNP
high levels is heart involvement
rules out hemodynamic pulm edema (heart failure
ARDS Diagnosis: echo
structure and size of the heart
ARDS diagnosis: pulm artery cath
definitive distinguish between hemodynamic (heart failure) and permeability (ARDS)
ARDS med management
intubation and MV
circulatory support
adequate fluid volume
nutritional support
supp oxygen –> hypoxemia
ARDS management PEEP
increase functional capacity
PaO2 above 60 and SaO2 about 90 at lowest FiO2
ARDS systemic hypotension
less fluid in the blood vessels –> hypovolemia
decreased cardiac output due to pressure
Pulmonary embolism
obstruction of the pulmonary artery
air, fat, amniotic fluid, bacteria from thrombus
regional vasoconstriction
Pulmonary embolism diagnosis
D Dimer
High V/Q high ventilation no perfusion
Pulmonary embolism risk factors
immobility
obesity
postpartum
oral contraceptives
post op
DVT
venous pooling with emboli formation
pulmonary embolism clinical manifestation
SUDDEN SHARP CHEST PAIN
hemoptysis
hypoxia
decreased PaO2
dyspnea
Respiratory alkalosis
tachycardia
Pulmonary embolism treatment
heparin drip
don’t mix heparin and saline lines
Pulmonary hypertension
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
Pulmonary Hyptertension patho
Progressive remodeling
- collagen vascular disease
- congenital heart disease
- anorexigens
- chronic stimulant use
- portal hypertension
- HIV
- vascular inury
Pulmonary Hypertension clinical manifestations
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
Pulmonary Hypertension assessment and diagnostic
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
pulm hypertension medical management
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
pulm hypertension EKG findings
right ventricular hypertrophy
right axis deviation
tall peaked p waves
tall r waves
st segment depression
inverted t waves
respiratory track meds
mucolytics: hypertonic saline
acetylcystine mucomyst sulfur, bronchospasm
anticholinergics: atrovent (ipratropium) dry mouth, increase IOP
Albuterol (preventil)
tachy, angina, tremor
