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Adults 2 > Module 2 Exam 1- > Flashcards

Module 2 Exam 1- Flashcards

1
Q

Acute Respiratory Distress Syndrome (ARDS)

A

severe form of respiratory failure with rapidly progressing hypoxemia; causes alveolar injury and damage to endothelial lining; reduction of lung compliance, volume, and gas exchange; d/t pneumonia, sepsis, or multiorgan failure; most fatal in 24-48 hours

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2
Q

common causes of ARDS

A

aspiration of gastric contents, shock, sepsis

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3
Q

signs and symptoms of ARDS

A

hypoxia that doesn’t improve with O2 is major sign; tachypnea, increased dyspnea, tachycardia, HTN, restlessness, xray shows visible bilateral infiltrates and pulmonary edema (BNP distinguished from pulmonary edema)

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4
Q

prone positioning for ARDS

A

improves oxygenation, increases end-expiratory lung volume, improves bronchial drainage, improves functional residual capacity, improves gas exchange; use of rotoprone

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5
Q

high pressure alarm on ventilator

A

coughing, mucus plug, kinked tubing, decreased lung compliance (bucking the vent), atelectasis or bronchospasm

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6
Q

low pressure alarm ventilator

A

increase in lung compliance; leak in ventilator tube; leak in ET cuff

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7
Q

suctioning when pt intubated

A

not a routine thing; suctioned if - visible secretions in ET tube, onset of respiratory distress, suspected aspiration, increased airway pressure, adventitious breath sounds over trachea or bronchi, increased RR, sustained coughing, sudden decrease in O2 levels, or for sputum culture

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8
Q

sedation vacation

A

once a shift to observe neuro status

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9
Q

if cause of ventilator alarm cannot be determined…

A

ventilate manually until problem corrected

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10
Q

nursing management of epistaxis

A

pinch and lean forward for 5-10 minutes

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11
Q

obstructive sleep apnea

A

obstruction of upper airway causing decreased ventilation and gas exchange; intermittent breathing

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12
Q

clinical manifestations of obstructive sleep apnea

A

as described by parter- loud snoring/snorting, apneic events, gasping, recurrent waking, sleep disruption, choking; as reported by pt- excessive daytime sleepiness, workplace or car accidents, decreased cognitive functioning, retention and performance compromise

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13
Q

risk factors for obstructive sleep apnea

A

obesity, DMII, heart failure, pulmonary HTN, large neck circumference

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14
Q

diagnosis of obstructive sleep apnea

A

health history and sleep study

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15
Q

treating obstructive sleep apnea

A

lifestyle modifications, CPAP (constant positive airway pressure), surgery

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16
Q

polysomnography

A

overnight sleep study to monitor number, duration, and frequency of apneic episodes

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17
Q

nursing management of epistaxis

A

pinch soft portion of nose and lean forward 5-10 min; maintain adequate ABCs; vital signs (cardiac and pulse ox); teach pt to avoid nasal trauma, increase humidity if dry air, and seek health care attention if continues after 15 min

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18
Q

laryngectomy

A

removal oof whole or partial larynx/voice box

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19
Q

laryngectomy nursing intervention

A

preop teaching, reduce anxiety, maintain airway, control secretions, decide alternative communications d/t loss of communication following surgery, promote adequate nutrition and hydration, positive body image

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20
Q

complications with laryngectomy

A

respiratory distress, hemorrhage (leads to aspiration of blood), wound breakdown, aspiration, hoarse voice, edema

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21
Q

pulmonary embolism

A

clot in pulmonary artery or branch that occludes blood flow; can be fat, air, thrombus, amniotic, or septic; severity based on size; increased vascular resistance and pulmonary arterial pressureris

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22
Q

risk factors for developing ppulmonary embolism

A

virchows triad, DVT in legs arms or pelvis

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23
Q

virchows triad

A

venous stasis, hypercoagulative state (pregnant or COPD), endothelial damage (diabetes or HTN)

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24
Q

saddle PE

A

clots forms at biforkation of lungs blocking bloodflow to both lungs

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25
Q

clot busting drug for PE

A

altiplase

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26
Q

clot preventing drug for PE

A

warfarin

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27
Q

pulmonary embolism clinical manifestations

A

sudden dyspnea, pleuritic chest pain, anxiety/impending doom, tachycardia, cough, diaphoresis (profuse), hemoptysis, syncope, petechiae

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28
Q

diagnostic test for pulmonary embolism

A

elevated d-dimer, ekg, chest xray, ABG, spiral CT, VQ scan (ventilation/perfusion), pulmonary arteriogram (golden standard)

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29
Q

preventing PE in hospital

A

active leg exercises, mobility with PT, early ambulation, anticoag (heparin and warfarin), sequential compression device or “pressing gas”

30
Q

if develop HIT…

A

switch to argatroban

31
Q

treatment of PE

A

improve resp. and vascular status via O2, IV access, EKG monitoring; anticoag therapy with heparin or warfarin; thrombolytic therapy w/ streptokinase and alteplase (monitor for bleeding with labs, assess., vitals); surgical embolectomy, IVC filter in inferior vena cava, EKOS ultrasonic waves

32
Q

nursing management of PE

A

assessment to identify high risk pt; prevent thrombus formation with early ambulation and passive leg exercise, manage O2 therapy with pulse ox and deep breathing etc.; monitor for complications (shock, bleeding, hypoxia); monitor thrombolytic therapy via VS and PTT (q4)

33
Q

pneumothorax

A

partial or complete collapse of lung due to positive pressure in pleural space; can be hemothorax or tension pneumo

34
Q

tension pneumothorax

A

emergency situation when pneumothorax increases pressure in pleural space and displaces heart and lungs; can be opened or closed; open is one way air in but not out (ex. GSW or stabbing)

35
Q

manifestations of tension pneumothorax

A

TD, resp distress, JVD

36
Q

treatment of pneumothorax

A

chest tube/dart in 2nd intercostal space prior to intubating

37
Q

diagnosing pneumothorax

A

presentation and assessment; related history; x-ray; ABG shows respiratory acidosis (decrease PaO2 and increased PaCO2)

38
Q

if open pneumothorax…

A

3 sided occlusive dressing to allow blood and air out but no air in

39
Q

pneumectomy post op care

A

assess breath sounds, O2 sat, vitals, cardiac rhythm; elevate HOB 30-45; change pt position from back to side often; incentive spirometry, cough, deep breath; assess and monitor drainage; arm and shoulder exercise to alleviate shoulder pain; pain relief modality; balancing rest and activity; smoke cessation, avoid bronchial irritants; keep airway patent and suction when needed

40
Q

nursing care of chest tube

A

narcotics and local anesthetic for tube placement; NSAIDs for tube duration; anxiety meds PRN; keep tubing connections patent and kink free; drainage below chest level; monitor levels of fluid and suction control; vitals, pulmonary assessment, site eval; daily xray

41
Q

bubbling in chest tube…

A

not good means there is an air leak; tidaling is ok

42
Q

chest tube removal

A

suction is discontinued for 6-24 hurs prior; chest xray prior; ensure lungs re-expanded and no more pleural drainage; pre medicate; cut sutures holding tube; remove tube on exhale; occlusive dressing over wound; wound self heals; NSAIDs PRN

43
Q

if chest tube becomes disconnected…

A

place other end in sterile water for seal

44
Q

monitoring fluid from chest tube

A

measure; quality of drainage

45
Q

normal pH value

A

7.35-7.45 (7.4 is middle)

46
Q

normal PaCO2

A

35-45; regulated to the lungs

47
Q

normal HCO3

A

22-26; regulated by kidneys

48
Q

whern looking at ABGs

A

check pH to see if acidic or alkalotic; then evaluate PaCO2; then evaluate HCO3; (then for entire clinical picture look at PaO2 and O2 for hypoxemia and impaired oxygenation)

49
Q

acidotic values

A

CO2 > 45 ; HCO3 < 22

50
Q

alkalotic values

A

CO2 < 35 ; HCO3 > 26

51
Q

Rome method

A

Respiratory opposite (pH and CO2 are opposite); Metabolic equal (pH and HCO3 are equal)

52
Q

uncompensated values…

A

when pH is out of rand and one of CO2 or HCO3 is in range

53
Q

partially compensated values…

A

CO2, pH, and HCO3 all out of range

54
Q

fully compensated values

A

pH is in range

55
Q

respiratory compensation

A

body can partially compensate for metabolic imbalances by adjusting ventilation

56
Q

metabolic compensation

A

respiratory imbalances can be compensated through changes in bicarbonate levels

57
Q

causes for respiratory acidosis

A

lungs retain too much CO2; kidneys excrete excess hydrogen and retain HCO3

58
Q

DEPRESS breathing

A

cause for retaining CO2; drugs, edema, pneumonia, respiratory center of brain damaged, emboli, spasms of bronchial, sac elasticity damaged

59
Q

interventions for respiratory acidosis

A

admin O2, semi-fowlers, turn cough deep breath, increase of fluid and antibx in pneumonia, if CO2 > 50 intubate, monitor potassium

60
Q

causes for respiratory alkalosis

A

lungs lose too much CO2, kidneys excrete too much bicarb and retain hydrogen; increased temp, aspirin toxicity, hyperventilation all cause

61
Q

interventions for respiratory alkalosis

A

emotional support, fix breathing problem, encourage good breathing pattern, rebreathing into paper bag to retain CO2, anti-anxiety meds or sedatives, monitor K and Ca levels

62
Q

metabolic acidosis causes

A

kidney hold too much hydrogen and release too much bicarb, lungs blow off CO2’; caused by DKA, AKI/CKD, malnutrition, severe diarrhea

63
Q

interventions for metabolic acidosis

A

monitor I/O, admin IV solution of sodium bicarb, initiate seizure precautions, monitor K; if diabetic issue give insulin

64
Q

causes of metabolic alkalosis

A

kidneys release too much HCO3 and remove too much H+; lungs compensate by retaining CO2; too many antacids, diuretics, excess vomiting or GI suctioning, hyperaldosteronism

65
Q

interventions for metabolic alkalosis

A

monitor k and Ca, admin IV fluids to help kidneys get rid of bicarb, replace K, give antiemetics for vomiting, watch for signs of respiratory distress

66
Q

metabolic alkalosis values

A

pH > 7.45 and HCO3 > 26

67
Q

metabolic acidosis values

A

pH < 7.35 and HCO3 < 22

68
Q

respiratory acidosis values

A

pH < 7.35 and CO2 > 45

69
Q

respiratory alkalosis values

A

pH > 7.45 and CO2 < 35

70
Q

SaO2 normal levels

A

95-100%; if lower than 90 then supplement

Adults 2 (7 decks)

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