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MS LEC MONTHLYS > Oxygenation Pt. 2 > Flashcards

Oxygenation Pt. 2 Flashcards

1
Q

What is Acute Biologic Crisis?

A

Conditions that could lead to death if di matreat agad

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2
Q

Examples of Acute biologic crisis?

A
  1. Acute Respiratory Distress Syndrome
  2. Pulmonary Embolism
  3. Acute Respiratory Failure
  4. Asphyxia
  5. Birth or Perinatal Asphyxia
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3
Q

What are the 4 criteria to say that the patient is in ARDS?

A
  • ARDS is a severe inflammatory process causing:
  1. Diffuse alveolar damage → sudden progressive pulmo edema
  2. Increasing bilateral infiltrates on CXR
  3. Hypoxemia unresponsive to O2 therapy regardless of the set PEEP on mechvent
  4. Absence of elevated left atrial pressure
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4
Q

If patient shows similar symptoms to ARDS but there is elevated left atrial pressure, this is?

A

More cardiogenic origin

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5
Q

What are the results of having ARDS?

A
  • Reduced lung compliance
  • Relatively high mortality rate (36-44%)
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6
Q

COVID-19 belongs to what acute biologic crisis?

A

ARDS

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7
Q

What are the risk factors of ARDS?

A
  • Aspiration (incl. gastric secretions; hydrocarbons like paint thinners, gasoline)
  • Drug ingestion + overdose
  • Hema disorders (incl. massive transfusions, cp bypass)
  • prolonged inhalation of O2, smoke, corrosive substances
  • localized infection
  • shock
  • trauma, major surgery (common is injury to lung parenchyma or alveoli)
  • fat, air embolism
  • systemic sepsis
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8
Q

The risk factors of ARDS all cause?

A

Acute lung injury

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9
Q

Manifestations of ARDS closely resembles?

A

Pulmonary edema

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10
Q

Manifestations of ARDS?

A
  • Rapid onset of severe Dyspnea occurring less than 72 hrs after precipitating event
  • Arterial hypoxemia na di na nagrerespond sa O2
  • CXR: bilateral infiltrates (same as PE)
  • Acute lung injury > fibroting alveolitis this w/ persistent severe hypoxemia
  • Increased alveolar dead space (nakakapasok naman ang air pero di makaexchange ang O2 and CO2 kasi weak ang blood flow ng alveoli where the exchange is meant to happen)
  • Decreased pulmo compliance (stiff lungs) d/t fibrosis
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11
Q

In ARDS, severe dyspnea occurs how many hours after the precipitating event?

A

Less than 72 hours

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12
Q

What are the assessment findings of ARDS?

A
  • Intercostal retractions
  • d/t hypoxemia; indication: DOB; accessory muscles at work (dapat diaphragm and external intercostal lang ang ginagamit)
  • Crackles
  • dahil some alveoli are partially filled w fluids
  • possible: supraclavicular retractions; central cyanosis (severe cyanosis)
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13
Q

What are the diagnostic findings for ARDS?

A

Echocardiography (2D Echo): r/o cardiogenic origin
Pulmonary Artery Catheterization (aka Swan-Ganz)
- measures O2 levels in heart and lungs
- ARDS: low O2 levels in arterial blood, increased pressure in pulmo artery

Plasma brain natriuretic peptide (BNP)
- blood test to help distinguish fr cardiogenic pulmo edema by looking at sodium levels
- Normal/Low = GOOD; r/o cardiogenic origin
- High = BAD; likely cardiogenic origin

ADDT’L CONTEXT:
- BNP: primarily produced by the heart esp when its under stress; if not pumping effectively si heart nagrerelease siya ng BNP to signal na may mail
- ^ BNP = heart is struggling to pump blood effectively; kaya nagrerelease ng BNP which promotes diuresis sa body as a means of getting rid of excess fluid and sodium para di mastrain si heart

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14
Q

What is the focus of medical management of ARDS?

A

Identify and treat underlying conditions

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15
Q

What is the supportive management for ARDS?

A
  1. Endotracheal Intubation and Mech Vent (PEEP Support) - assist doctor; maintain patent airway
  2. Circulatory support - adequate fluids; maintain hydration + medication route
  3. Nutritional support - enteral/parenteral
  4. Manage systemic hypotension - inotropics (increases force / pumping of heart) or vasopressin (presses on blood vessels para magconstrict)
  5. Prone position
  6. High frequency oscillatory ventilation, low dose corticosteroid (first 14 days)
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16
Q

What is the pharmacological management for ARDS?

A
  • neuromuscular blocking agents: provide temp paralysis to pt para di sila magresist sa ventilation
  • analgesics: synchronize vent rhythm and pt’s respi rhythm
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17
Q

What is the nursing management for ARDS?

A
  • ICU monitoring (esp yung O2 admin Nya)
  • prone position (+ turn frequently)
  • monitor cardio - PEEP
  • sedatives
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18
Q

Why is prone position recommended for ARDS?

A
  • shifts weight of heart off lungs which reduces pressure on them
  • gravity allows for redistribution of secretions away sa likod (which can bring problems)
  • redistributes blood flow sa less swollen areas
  • expands capacity ng lungs
  • increases lung volume (air that can be held sa lungs after breathing out)
  • alters movement of diaphragm
19
Q

What is pulmonary embolism?

A

Basically, sa CVS may continuous flow of blood kaya there’s a risk palagi na Baka yung thrombus (blood clot na nakakabit sa vessels) will dislodge and become an emboli (set free); SO in pulmo embo, may obstruction of pulmonary artery or isa sa branches niya BY a thrombus o thrombi, na galing sa venous system or R Side ng heart

20
Q

What are the different types of emboli?

A

Air
Fat
Amniotic fluid
Septic

21
Q

Risk factors for pulmonary emboli?

A

Venous stasis, hypercoagulability, venous endothelial disease

+ certain disease states and other predisposing conditions (obesity, pregnancy, advanced age, contraceptive use)

22
Q

What are the stages of blood clotting?

A
  1. Inactive clotting factors
  2. Connective tissues are exposed
  3. Inactive clotting factors become activated

*Thrombin will activate fibrinogen to form into a fibrin, which is a clot

23
Q

Manifestations of pulmonary embolism?

A

Tachypnea
Dyspnea - duration depends on extent of embolization
Chest pain - sudden and pleuritic (substernal and mimics MI or angina pectoris)

Other:
- anxiety, fever cough, diaphoresis, tachycardia, apprehension, hemoptysis (coughing blood), syncope (temp loss of consciousness d/t drop in BP)

24
Q

Most frequent sign of pulmonary embolism?

A

Tachypnea

25
Q

Most frequent symptoms of pulmonary embolism?

A

Dyspnea

26
Q

What is found upon assessment for Pulmonary Embolism?

A

Sudden onset of pain and/or swelling and warmth of proximal or distal extremity, skin discoloration, and superficial vein distention (origin ng thrombus)

Compare right leg from left; pain is usually relieved with elevation

Manifestation starts to occur within an hour and could become fatal if not assessed

27
Q

What is the diagnostic work up for pulmonary embolism ?

A

Multi detector row computed tomography angiography (MDCTA)
- criterion standard for diagnosis of PE
- invasive; need to intro a contrast agent

Pulmonary Angiography
- NI: assess if pt is allergic to iodine content
- Dating gold standard before MDCTA, now alternative na siya
- Visualizes vessels of lungs w/ contrast

Ventilation-perfusion scan
- determines if may dead space

28
Q

What is the medical management for pulmonary embolism?

A
  • Oxygen (thru NC or mask)
  • IV lines for add’tl fluid and meds
  • ABG, Perfusion scan, ECG
  • Intubated and placed on mechvent
  • Slow infusion of dobutamine (Dobutrex)
  • Indwelling UC if massive embo and hypotension
  • Small doses of IV morphine or sedatives
29
Q

What is the nursing management for Pulmonary Embolism?

A
  • identify pts at high risk and minimize risk
  • prevent thrombus formation via anticoagulants, ambulation, active/passive exercises; avoid crossing of legs and wearing constrictive clothing
  • assessing for potential:
    (+) Homan’s sign - pain when finlex ung knee and nagdorsiflex bigla
    Tenderness (symptom) vs Pain (homans sign)
  • monitoring thrombolytic therapy
    VS q2, PT or PTT after 3-4h of tx, heparin/warfarin
  • Pulse ox
  • Semi-Fowlers (esp if fr lower ex yung thrombus para di sya umakyat)
  • managing O2 therapy via DBE, incentive spirometry, percussion, coughing, nebulizer, postural drainage
  • relieve anxiety, monitor for compli, postop care, home and community care
30
Q

Prevention of pulmonary embolism?

A

Anticoagulant therapy (e.g. Heparin)
NR: monitor pt kasi Baka sumobra

Intermittent pneumatic leg compression to prevent stasis of blood

31
Q

Antidotes for heparin and warfarin?

A

H: Protamine sulfate
W: Vitamin K

32
Q

Acute Respiratory Failure is?

A

Sudden, fatal deterioration of gas exchange function of lung and indicates failure of lungs to provide adequate oxygenation or ventilation for blood

Bali: di na kaya magGE so walang mabigay sa blood

33
Q

Early manifestations of ARF?

A
  • restlessness, fatigue
  • headache
  • dyspnea
  • air hunger
  • tachycardia, increased BP
34
Q

Late manifestations of ARF?

A
  • confusion, lethargy
  • tachycardia, Tachypnea
  • central cyanosis
  • diaphoresis
  • respi arrest
35
Q

Med management for ARF?

A

Endotrache intubation and mechvent

36
Q

Nursing mgmt for ARF?

A

Asssess respi status via ABG, RR
Manage pain: semi-Fowlers, opioid analgesics
O2 therapy: DBE, incentive spiro, neb, percussion/postural drainage

37
Q

Preventive mgmt for ARF?

A

Anticoagulant therapy - heparin pero monitor mo dapat pt kasi kung excess, may cause bleeding

Intermittent pneumatic leg compression to prevent status in blood

38
Q

What is asphyxia?

A

When body doesnt get enough O2 kasi may nag interfere sa respi (pwedeng substance like CO) or general lack of O2 kaya organs and tissues are deprived of it.

Suffocation; air supply to body is blocked

39
Q

Etiology of asphyxia?

A

Drowning
Chemical substances
Anaphylaxis
Asthma
Choking, Strangulation
Drug overdose

40
Q

Birth or Perinatal asphyxia is

A

Kulang na blood or O2 flow sa fetus; can happen before, during, or after childbirth pero most is during

41
Q

Possible causes of perinatal asphyxia

A

Lack of O2 in mothers blood
Reduced breathing ni mom d/t anesthesia
Fever/low BP ni mom
Umbilical cord compression
Poor placental function
Placental abruption

42
Q

Clincal effects of asphyxia?

A
  • Cyanosis
  • Unconsciouness
  • Tardieu’s spots
  • Pulmonary edema
  • Voiding of urine, stools, semen
43
Q

Stages of Asphyxia?

A

1. Forced Respiration: d/t stimu of respi center; CP: dyspnea, acidosis
2. Convulsions: d/t cerebral irritation; CP: convulsions, cyanosis, HTN, loc, constricted pupils
3. Paralysis: death occurs in 3-5 mins; breathing stops w/i 20 seconds of cardiac arrest and heart stops within 20 mins of stoppage of breathing
CP: loc, flaccid muscles, lost reflexes, deep cyanosis, dilated pupils, irregular breathing (Cheyne-Strokes respi)

44
Q

Mgmt for asphyxia?

A
  • determine cause
  • CPR
  • heimlich if cause is obstruction
  • O2 therapy in 3-5 mins to avoid brain deterioration
  • Medications (if d/t anaphylaxis, asthma, drug OD)

MS LEC MONTHLYS (7 decks)

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