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NURS124 > Resp disorders > Flashcards

Resp disorders Flashcards

1
Q

what is pleural effusion

A

fluid in pleural space caused by transudative or exudative effusion

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2
Q

transudative vs. exudative effusion

A

transudative: increased hydrostatic pressure or low oncotic pressure from HF, cirrhosis
exudative: increase in capillary permeability from inflammation - infection, tumors, hemothorax

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3
Q

why are the elderly at risk for pleural effusion

A
  • decreased elasticity of the lungs -> enlarged air spaces
  • increased anteroposterior diameter, shortened thorax
  • altered mobility
  • decreased vital capacity (max air inhaled)
  • decreased chest wall compliance
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4
Q

classic pleural effusion s/s

A
  • dyspnea
  • pleuritic chest pain (esp. on inspiration) referred to shoulder or abdomen
  • cough: nonproductive
  • decreased breath sounds, pleural friction rub
  • dullness/hyperresonance when percussed
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5
Q

how to diagnose pleural effusion

A
  • CXR: blunting of costophrenic angle (typically used to diagnose)
  • CT scan
  • thoracentesis
  • ultrasound to ensure needle placement
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6
Q

what can rapid removal of fluids via thoracentesis cause

A

hypotension, hypoxemia, or reexpansion pulmonary edema
so remove 1,000 - 1,200 mLs at a time

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7
Q

what does diff pleural fluid mean:
- bloody
- milky
- purulent
- viscous
- clear straw colored

A
  • bloody: trauma
  • milky: effusion there a long time
  • purulent: infection
  • viscous: mesothelioma
  • clear straw colored: normal
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8
Q

what is pneumothorax

A

trapped air in pleural space and pressure is exerted in nearby structures such as trachea and heart

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9
Q

closed vs. open vs. tension pneumothorax

A

closed: air entering remains the same
open: air circulates freely
tension: air accumulates

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10
Q

causes for pneumothorax

A
  • primary: without underlying lung disease
  • secondary: with lung disease
  • trauma, scuba diving
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11
Q

what procedures puts pt at risk for pneumothroax

A
  • central line placement
  • mechanical ventilation
  • tracheostomy
  • bronchoscopy
  • intercostal nerve blocks
  • pacemaker placement
  • CPR
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12
Q

classic signs of pneumothorax

A
  • tracheal deviation, mediastinum shift
  • JVD
  • sharp pleuritic pain radiating
  • hypotension, tachycardia, dyspnea
  • cardiac arrest
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13
Q

how to diagnose pneumothorax

A
  • ultrasound -> CXR -> CT
  • EKG, cardiac enzymes
  • ABG
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14
Q

treatment of pneumothorax

A
  • needle decompression slow
  • chest tube placement
  • pain meds
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15
Q

PaO2 normal level

A

80-100 mmHg

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16
Q

fully compensated vs. partially compensated vs. uncompensated ABG

A

fully compensated: pH normal
partially compensated: all values abnormal
uncompensated: PaCO2 or HCO3 is one normal one abnormal, pH out of range

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17
Q

what to prepare for chest tube placement

A
  • informed consent obtained
  • sterile environment
  • pt sitting up leaning across table
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18
Q

what is flail chest

A

trauma where 3+ ribs broken in at least 2 places
the chest moves independently from chest wall

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19
Q

s/s of flail chest

A
  • paradoxical chest movement
  • pain & splinting
  • dyspnea, tachypnea
  • bruising, bleeding, edema in injured area
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20
Q

severity of flail chest depend on which 3 factors

A
  1. pleural pressure
  2. extent of the flail
  3. movement of intercostal muscles during inspiration
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21
Q

what does flail segment of the chest lead to in terms of damage

A

hypoventilation w/ atelectasis + pulmonary contusion (bruising), which leads to edema and hemorrhage
in turn, reduces lung space

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22
Q

diagnosis for flail chest

A

CT> CXR
- ABG

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23
Q

treatment for flail chest

A

probably mechanical ventilation, but try hiflow O2, CPAP/BiPAP first
endotracheal tube

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24
Q

what are long-terms effects of flail chest

A
  • permanent chest wall deformity
  • exercise intolerance
  • stiffened thoracic cavity
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25
Q

what can flail chest lead to

A
  • resp failure
  • pneumothorax, hemothorax
  • pulmonary contusion
  • atelectasis -> hypoventilation
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26
Q

what are some unexpected findings in flail chest

A
  • tachycardia, hypotension
  • hypoxia, respiratory distress
  • ALOC
  • increased pain
  • abnormal ABG or cardiac enzymes
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27
Q

what is saddle embolism

A

a large clot that blocks the bifurcation of the main pulmonary artery

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28
Q

how does embolism affect BP

A

clot blocks blood supply -> increased pulmonary arterial pressure -> harder to pump -> dead space -> high V/Q

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29
Q

how does pulmonary embolism affect V/Q mismatch

A

high V/Q >0.8
dead space created from lack of blood flow while ventilation remains the same
serotonin released -> vessels contract -> reduced bloodflow to lungs

30
Q

what ABG would you expect from pulmonary embolism

A
  • hyperventilation attempts to compensate, leading to hypocapnia
  • respiratory alkalosis
31
Q

how does pulmonary embolism affect the heart

A

increased vascular resistance increases right ventricular afterload and causes dilation & R ventricular failure

32
Q

normal V/Q value

A

4/5 = 0.8

33
Q

shunt vs. dead space

A

shunt: NO ventilation, has perfusion
dead space: has ventilation, NO perfusion

34
Q

how does pulmonary embolism affect ABGs

A

hyperventilation & inflammation leads to:
- hypoxemia
- hypocapnia
- respiratory alkalosis

35
Q

what is included in Virchow’s triad

A
  1. hypercoagulability
  2. vessel wall injury
  3. venous stasis
36
Q

what defines venous thromboembolism (VTE)

A

when pt has both pulmonary embolism & DVT

37
Q

list some risk factors for pulmonary embolism

A
  • male, black americans
  • HF, A.fib, A. flutter
  • indwelling venous catheter
  • air pollution
  • trauma, lower limb fracture -> immobilization
38
Q

what are the typical s/s for pulmonary embolism

A
  • dyspnea, cough
  • chest pain
  • syncope
  • JVD
    If more severe:
  • arrhythmia, right ventricle failure
  • hemodynamic collapse, shock
39
Q

diagnostic tests for pulmonary embolism

A
  • troponin (0 - 0.04) & BNP (<100)
  • d-dimer for clot (<0.5 normal)
  • EKG, CXR, ultrasound
  • lung scintigraphy (V/Q scan)
  • ABG
40
Q

what are the anticoagulants used for pulmonary embolism

A
  • LMWH, fondaparinux (Atrixtra)
  • dalteparin (Fragmin)
  • alteplase (Activase)
41
Q

what is fondaprinux contraindicated in

A

renal issues

42
Q

what should pts taking fondaprinux avoid

A

NSAIDS

43
Q

what are the adverse effects of alteplase

A
  • hives
  • difficulty breathing
  • swelling of face
44
Q

what are the 2 classifications of resp failure

A

hypoxemic or hypercapnic

45
Q

define hypoxemic vs. hypercapnic resp failure

A
  • hypoxemic: PaO2 <60mmHg caused by lung failure (Q) - think lung dxs, PE, COPD, asthma
  • hypercapnic: PaCO2 >50mmHg caused by ventilation failure (V) - think MS, sedatives, flail chest, spinal cord injuries
46
Q

what classification of resp failure is more common

A

hypoxemic is more common than hypercapnic

47
Q

what are the 2 causes of resp failure

A
  1. V/Q mismatch - low from hypoxemia or hypercapnia
  2. shunt - hypoxemia even with 100% O2 inhaled from poor ventilation
48
Q

acute vs. chronic resp failure

A

acute: developed in mins to hours
chronic: developed over several days or longer

49
Q

diagnostic tests for resp failure

A
  • thyroid function tests
  • pulmonary function tests spirometry FEV1/FVC (80-100%)
  • electrolytes
  • CXR
  • CBC
  • EKG
50
Q

what is FEV1/FVC test

A

forced expiratory volume in 1 second after full inspiration / forced vital capacity (max exp)

51
Q

signs of hypoxemic resp failure

A
  • dyspnea
  • confusion
  • increased HR, RR
  • arrhythmia
  • cyanosis, somnolence
52
Q

signs of hypercapnic resp failure

A
  • headache
  • asterixis (hand flap tremor)
  • warm extremities
  • papilledema (optic disc swelling) -> change in vision
  • coma
53
Q

when should a pt w/ resp failure be put on mechanical ventilation

A
  • RR>30
  • SpO2 <90% doesn’t respond to O2
  • shock symptoms
  • extreme ABGs
54
Q

what defines ARDS

A
  • within 7 days after trauma
  • fibrotic tissue makes lungs stiff -> increased pulmonary arterial pressure, decreased pulmonary compliance from stiffness
  • inflammation increased permeability -> alveoli edema
  • deadspace -> hypercapnia
  • shunt -> hypoxemia

key: doesn’t respond to O2

55
Q

what position to place a pt with ARDS

A

prone position (lying down) so affected lung can expand

56
Q

common causes of ARDS

A
  • sepsis most common
  • pneumonia
  • aspiration
  • in ICU
57
Q

impact of ARDS long-term

A

cognitive change from prolonged hypoxia
muscle wasting, wt loss, tracheostomy - MV

58
Q

what is included in the Berlin criteria for ARDS

A
  • onset within 7 days
  • noncardiac origin
  • bilateral lung infiltrates in imaging
  • abnormal O2
  • PaO2/FiO ratio less than 300mmHg
59
Q

s/s of ARDS

A
  • dyspnea worsening
  • increased HR, RR
  • crackles, rales lung sounds
  • low O2 saturation
60
Q

CXR tube placement should show how far down the tube is placed

A

20-22cm for females
22-24cm for males

61
Q

what s/s could indicate inappropriate endotracheal tube placement

A
  • asymmetrical lung sounds
  • no rise of chest wall
  • lung sounds in abdomen
62
Q

ventilator abbreviations:
AC

A

assisted control
takes over if RR falls below settings

63
Q

ventilator abbreviations:
HME

A

heat & moisture exchanger

64
Q

ventilator abbreviations:
PEEP

A

positive end-expiratory pressure
pressure left in lungs after expiration

65
Q

ventilator abbreviations:
PIP

A

peak inspiratory pressure

66
Q

ventilator abbreviations:
PSV

A

pressure support ventilation

67
Q

ventilator abbreviations:
SIMV

A

synchronized intermittent mandatory ventilation
ventilation + pt’s own efforts
not all breaths helped

68
Q

ventilator abbreviations:
TV

A

tidal volume
air in n out

69
Q

richmond agitation & sedation scale (RASS) tells you what

A

+4 combative —- 0 alert&calm —– -5 unarousable
while on MV

70
Q

purpose of ECMO

A

artificial circulation where blood is pumped out to oxygenate and remove CO2 and return to the body
venoarterial or venovenous

71
Q

pathophys of emphysema

A

alveoli damaged and eventually rupture
diffusion issue

NURS124 (6 decks)

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