Mod 4: Oxygenation Flashcards
Cause of Influenza
Viral infections
Signs and symptoms of Influenza
High fever, secondary infection (bronchitis pneumonia), acute respiratory failure, ARDS
Labs for Influenza
Viral culture
Interventions for Influenza
Relief of symptoms, prevention of secondary infection, hand washing, encourage rest and hydration, encourage annual influenza vaccine for prevention.
Orders anticipated for Influenza
- Antiviral drugs if given within 24–48 hrs of onset.
- Acetaminophen or ibuprofen for headache, aches, and pains.
Cause of Bronchitis
Inflammation of the bronchi in the lower respiratory tract
Caused by viruses, air pollution, dust, inhalation of chemicals, smoking, chronic sinusitis, and asthma.
Signs and symptoms of Bronchitis
High fever, secondary infection (bronchitis, pneumonia), acute respiratory failure, and ARDS.
Labs for Bronchitis
Generally, none needed - may have a CBC or CXR to rule out an infection.
Interventions for Bronchitis
Provide symptoms relief and prevent secondary infection – cough suppressants, bronchodilator, encourage fluids, use of humidifier, avoid smoke, and good hand washing.
Orders anticipated for Bronchitis
Dextromethorphan for cough suppression
Albuterol inhaler for bronchodilation.
Causes of Pneumonia
Acute bacterial or viral infection of the lung parenchyma. Community-acquired or Hospital-acquired. Pathogens that cause pneumonia reach the lung in 3 ways:
1. Aspiration of normal flora from the nasopharynx or oropharynx. Many organisms that cause pneumonia are normal inhabitants of the pharynx in healthy adults.
2. Inhalation of microbes present in the air. Examples include Mycoplasma pneumoniae and fungal pneumonias.
3. Hematogenous spread from a primary infection elsewhere in the body. Examples are streptococci and Staphylococcus aureus from infective endocarditis.
Signs and symptoms of Pneumonia
Atelectasis, pleurisy, pleural effusion, bacteremia, pneumothorax, sepsis, and septic shock.
Labs for Pneumonia
CXR, sputum culture, pulse oximetry, CBC, and blood cultures.
Interventions for Pneumonia
Increased fluid intake (at least 3 L/day), administer IV fluids, balance between activity and rest, monitor vital signs including pulse oximetry, provide O2 therapy, physiotherapy, VTE prophylaxis, critical care management, with mechanical ventilation as needed.
Orders for Pneumonia
- IV fluids – 0.9% sodium chloride for hydration.
- O2 therapy
- Antipyretics for fever.
- Analgesics for pain.
- NSAIDS for pain and fever.
- Antibiotics to treat the infection – based on sputum culture results.
Metabolic Acidosis
pH = less than 7.35 and HC03 = less than 22
Metabolic Alkalosis
pH = more than 7.45 and HC03 = more than 26
Respiratory Acidosis
pH = less than 7.35 and PaC02 = greater than 40
Respiratory Alkalosis
pH = more than 45 and PaC02 = less than 40
Causes of Metabolic Acidosis
DKA, Renal Failure, lactic acidosis from sepsis, excessive diarrhea or liver failure
Symptoms of Metabolic Acidosis
COMA; hypovolemic shock (from osmotic diuresis) and potassium disturbances (Hyperkalemia)
Labs for Metabolic Acidosis
If DKA, glucose and potassium
If renal failure, BUN, Creat/eGFR, and potassium
If liver failure, liver enzymes, ABGs, and potassium
Interventions for Metabolic Acidosis
If DKA, administer fluids and insulin (REGULAR) IV. Assess for rapid, deep respirations (Kussmaul respirations)
If renal failure –> dialysis
Orders for Metabolic Acidosis
DKA: Regular Insulin & Fluids
Renal Failure: Dialysis & Potassium Protocol
Cause for Metabolic Alkalosis
Clients who have vomiting and diarrhea or an NG tube suction (loss of gastric acid) – loss of hydrogen
Clients who have consumed too many antacids; Potassium depletion (thiazide diuretics)
Symptoms of Metabolic Alkalosis
Electrolyte imbalances & fluid volume deficit (hypovolemic shock)
Labs for Metabolic Alkalosis
Electrolytes, ABGs, BUN, Hct, Na, and Creatinine
Interventions for Metabolic Alkalosis
Treat the underlying cause
Orders for Metabolic Alkalosis
If GI losses –> antiemetics, fluids, and electrolyte replacements
If r/t potassium depletion –> stop diuretics
Cause for Respiratory Acidosis
COPD, any client with respiratory depression (think opioids/narcotics), clients with inadequate chest expansion (think respiratory trauma like pneumo or flail chest), clients with PE and clients with brain injury
Symptoms of Respiratory Acidosis
Lethargy, confusion, headache, dizziness, coma, hypotension, ventricular fibrillation related to hyperkalemia, warm, flushed skin, and seizures
Labs for Respiratory Acidosis
ABGs
Interventions for Respiratory Acidosis
Treat underlying cause
Orders for Respiratory Acidosis
Bronchodilators, oxygen, and treat the underlying cause so if it is opioid/narcotic overdose, stop the PCA, if it is PE, treat or pneumothorax
Cause for Respiratory Alkalosis
Any process that causes prolonged tachypnea or hypoxemia
Symptoms for Respiratory Alkalosis
Assess for circumoral numbness and tingling or numbness and tingling of the fingers
Labs for Respiratory Alkalosis
ABGs
Interventions for Respiratory Alkalosis
Oxygen therapy, anxiety reduction and rebreathing techniques (breathing into a paper bag)
Orders for Respiratory Alkalosis
Anti-anxiety medications and oxygen
priority problem for pneumonia
impaired gas exchange –> respiratory acidosis
S&S for Atelectasis
Collapsed lung and airless alveoli
S&S: Decreased/absent breath sounds, dullness in percussion on affected area
Cause of atelectasis
Airway obstruction
Interventions for atelectasis
Interventions: deep breathing, coughing, incentive spirometry, early mobility
S&S of Pleural Effusion
chest pain, SOB, pleural friction rub
Interventions for pleural effusion
thoracentesis –> drains fluid out
normal wbc
4,500-11,000
urine output bad if its
less than 0.50
normal calcium
8.5-10
normal magnesium
1.7-2.2
normal BUN
6-20
6=hypervolemic (low-wet)
20=hypovolemic (high-dry)
normal hematocrit
M: 42-50
W: 37-47
normal albumin
3.5-5
