Pulmonary Flashcards
aPPT, PTT
Partial prothrombin time-heparin
Range is 20-30 seconds
Therapeutic range is 1.5-2.5 times normal range
PT
Protime-Coumadin
Normal range 11-12.5 seconds
Therapeutic range 1.5-2 times normal range
INR
International normalized range-Coumadin
Normal range 0.8-1.1
PE 2.5-3 Reoccurring PE 3-4.5
Physical assessment of PE
Dyspnea
Pleuritic chest pain on inspiration
Auscultation: crackles or clear, wheezes or rubs
Tachycardia and low grade fever (early sign)
Diaphoresis (shock)
Hypotension
Transient ekg
Psychosocial assessment of PE
Anxiety
Restlessness
“Impending doom”
Changes in LOC (decrease in o2)
Laboratory assessment of PE
Respiratory alkalosis(low PaCo2)-early
Respiratory acidosis followed by metabolic acidosis-later
Low 02
Need metabolic panel, troponin, BNP, d dimer (will be increased if PE) base line clotting studies
Imaging assessment for PE
Pulmonary angiography-main
CT-PA
Chest X-ray
PE prevention
PROM or AROM for immobilized patients TCDB&A post op Ted hose, SCDs Prevent compression in popliteal space Assess need for anticoagulant therapy Smoking cessation
Managing hypotension in PE
IV fluids- isotonic
ECG monitoringCVP helps determine hydration
Monitor output, skin turgor, moisture of mucous membranes
Reversal agent for heparin
Protamine sulfate
Reversal agent for Coumadin
Vitamin k
Minimizing bleeding in PE
Assure proper antidote to drug therapy available
Assess for bleeding every two hours
Check emesis, stools, urine, IV site
Avoid IM injections, blowing nose, rectal strain
Bleeding precautions
Minimize anxiety in PE
02
Communication
Drug therapy-anti anxiety meds, pain meds (no NSAIDs)
Thoracic trauma
1st approach to all chest injuries
Breathing
Airway
Circulation
Pulmonary contusion
OCCURS MOST OFTEN BY DECELERATION DURING CAR CRASHES
Hemorrhage and edema can occur in/between alveoli reducing lung movement and gas exchange
Hypoxia, dyspnea over time, bruising on chest, cough, tachycardia, increased HR
Normal chest X-ray-first
Opacities develop later in X-ray
Rib fractures
RESULT FROM BLUNT FORCE TRAUMA TO THE CHEST
Presents with pain on movement and splints affected side
Preexisting lung conditions increased risk for pneumonia
Analgesics for treatment to reduce pain and promote breathing
Flail chest
BREATH IN CHEST COLLAPSES, 2 NEIGHBORING RIBS IN 2 OR MORE PLACES CAUSE PARADOXAL CHEST WALL MOVEMENT
Assessment: dyspnea, cyanosis, tachycardia, hypotension, paradoxical chest wall movement
Flail chest interventions and management
Humidified o2 Pain management TCDB Tracheal suctioning PEEP ABGs
Pneumothorax
ANY INJURY THAT ALLOWS AIR TO ENTER THE PLEURAL SPACE-BETWEEN THE VISCERAL AND PARIETAL
Lung can’t expand
Caused by blunt chest trauma
Open or closed
Pneumothorax assessment findings
Decreased breath sounds Lack of chest wall movements Pleuritic pain Tachypnea SubQ emphysema-rice krispies under skin
Pneumothorax interventions/management
Chest X-ray for diagnosis
Chest tube
Pain control
Continual assessment-respiratory failure
Tension pneumothorax
RAPIDLY DEVELOPING COMPLICATION OF BLUNT CHEST TRAUMA RESULTS FROM AIR LEAK IN LUNG OR CHEST WALL
Complete collapse of affected lung
Air entering cavity upon inspiration doesn’t exit during expiration
Causes-chest trauma, PEEP, chest tubes
Tension pneumothorax assessment findings
Asymmetry of thorax Tracheal movement away from midline DNV Cyanosis Hypoxia Respiratory alkalosis
Tension pneumothorax emergency management
Needle thoracostomy with large bore needle
Chest tube
Pain control
Hemothorax
BLOOD ACCUMULATING INSTEAD OF AIR
Common after blunt chest trauma or penetrating injuries
Bleeding from injury to lung tissue or fx of ribs or sternum, trauma to heart, great vessels, or intercostal arteries
Hemothorax assessment findings
Respiratory distress with decreased breath sounds
Dull percussion
Chest X-ray reveals blood in pleural space
Hemothorax management and interventions
Focus on removing blood-improve breathing/prevent infection Chest tube to drain pleural cavity Aggressive pain management Frequent vitals and I&Os Transfusions and fluid replacement Mechanical vent
Chest tubes
Drain air, blood, or fluid from pleural space or thoracic cavity
May or may not be attached to suction
Chest tubes placement and care
Insertion site protected with airtight dressing
6 ft of tubing-allows for pt movement
3 chambers/parts-collection, water seal, suction regulator
Chest tubes-collection chamber
Collects fluid draining from pt and is checked hourly for 24 hours
More than 200 ml per hour call doc
Chest tubes-water seal
Prevents air from reentering the pt pleural space
Air trapped in water creates bubbling, fill with 2cm of water
Bubbling will stop when air is removed from cavity or kink in tubing/problem with the chest tube collection
Chest tubes-suction regulator
Suction control, wet or dry suction available
Chest tubes management-QSEN
Maintain patency and sterility of the drainage system
Keep manipulation of tubing to a minimum
Frequently check resp assessment of pt and check device
Pain management
TCDB&A
Flutter valve or heimlich for palliative home treatment
