Respi p.2 Flashcards
closure / colapse of alveoli
atelectasis
causes of atelectasis
sx (thoracic or abdominal sx) result of anethesia
excess secretion of mucuos - blockage
Atelectasis obstructive
Blockage
atelectasis non obstructive
decrease ventilation
s/sx of atelectasis
Dyspnea / sputum prod / Cough / increase HR / increase RR / central cyanosis
when you auscultate atelectatis what sound will you heard?
crackles
when you chest xray pt. atelectasis what will you see
patchy infiltrates or consolidated areas
when you pulse ox patient with atelectasis what will you observe?
Decrease o2 saturation
Prevention of atelectasis?
Early ambulation
Turning
voluntary deep breathing every 2 hrs
used of incentive spirometry
coughing excercise
suctioning
CPT
Metered dose inhalers
goal of treatment of atelectasis
improve ventilation and remove secretion
inflam of the lung parenchoma
pneumonia
pneumonia cause
Bacteria / Virus / Fungi
4 types of pneumonia
- CAP - happen before 48 hrs / after 48hrs
- S. pnemoniae / H. Influenza - HCAP - Intial antibiotic Treatment should not be delayed
- HAP - 48 hrs or more after hospital
- F. coli / H influenzae / Pseudomonas / Kles Pneumonae - VAP - 48 hrs atleast
s/sx of pneumonia
fever / Increase RR / SOB / Sputum: purulent / rusty blood tinged sputum / crackels
dx of pneumonia
culture
cxr
sputum exam
Prevention of pneumonia
vaccination
Mngt of pneumonia
antibiotics
antipyretics
anti histamines
decongestant
02
hydration
bedrest
intubation
Warm moist inhalations
inflamation of the both layers of the pleurae
pleurisy
s/sx of pleurisy
Pleuritic pain / when deep breathing / coughing / sneezing worsing the pain
what finding when you ausculte patiet with pleurisy
pleural effeusion
mngt of pleurisy
discover cause / relieve pain
- analgesic / nsaid / Intercostal nerve block
nx Intervention Pleurisy
Splinting / turning frequently on affected side
Collection of fluid in the pleural space
Pleural effusion
normal pleural space
5-15 ml
s/sx of pleural effusion
dyspnea / difficulty of breathing
when assessing pleural effusion what should you assess?
auscultation: Decrease breath sound
Percusstion: Premitus
Inspection: Tracheal Deviation
CAR / VT scan : (+) presence of fluid
dx and treatment of choice of pleural effusion
thoracentesis
guidance of thoracentesis
UTZ ; avoid puncture of the lungs
when you repeat thoracentesis what happen to you?
can cause depletion of protein and electrolytes
obliterate the pleural space
chemical pleurodesis
use of agent that in chemical pleurodesis and instilled in??
Prevent accumulation of fluids that instilled into the pleural space with the use of chest tube using thorascopic approach / aerosolized
Pleural effusion clamped: for? time and change position??
tube for 60-90 mins ; Side side then unclamped
consist of 2 cath. that connects a pump chamber containing 2 one valves
pleuroperitoneal shunt
oleuroperitoneal shunt used
fluid moves from pleural cavity to peritoneal cavity
nx Intervention of pleural effusion
Position: sitting leaning forward
Fluid : recorded
Pain mngt: Analgesic frequent movement
sudden and life threatening deteroration of gas exchange fxn
Acutre respiratory failure
Define acute respiratory failure
Hypoxemia: decrease 60 mmhg or 02
Hypercapnia: Decrease 50 mmhg of Co2
with acidosis : Ph decrease 7.35
s/sx of acute respiratory failure
Restlessness / fatigue / HA / Dyspnea / Air Hunger / Tachycardia / Increase BP / Progression of hypoxemia : earlyy : restless ness increase HR and RR / Late: Cyanosis / Decrease RR
mngt of Acute respiratory failure and how to do it and define
- ET intubation
Insection: Aid by laryngoscope
Positioned: 2cnm above the carina
Balloon: Iflated
Cuffe pressure: 20-25 mmhg
Can be used no longer than 14-21 day - increase - tracheostomy - Mech vent
-* Increase alarm : for the tubes for kinks
* decrease alaram: For connections : Detach to reconnect
extubation of acute respiratory failure
Ambu bag and 02 at bedside
Pathophy of acute respiratory distress syndrome
severe inflam - process - diffuse alveolar damaged - sudden progressive pulmo edema / increase bilateral infiltrates / hypoxemia - unresponsive to oxygen supplementation
causes of acute respiratory distress syndrome
Aspiration / covid 19 pneumonia / drug overdose / fat embolism / hematologic disorder / infection / major surgeries / metabolic disorder / sepsis / shock / trauma
physical assessment of acute repisratory distress syndrome
Intercostal retractions
Auscultate: Crackles
PEEP improves?
O2 - keep the alveoli open to prevent collapse
improve arterial oxygenation
acute respiratory distress syndrome has no pharmacologic syndrome
true
what position when having acute respiratory distress syndrome?
prone
mech vent in acutre respiratory distress syndrome decrease what?
anxiety : sedation
if peep cannot be maintained despite the use of sedatives what to do?
neuromuscular blocking agents
Abnormal accumulation of fluid in the lung tissue
Pulmonary edema
pulmonary edema damage of pulmonary capillary edema
pulmonary edema
what increase in pulmonary edema
hydrostatic pressure
mngt pulmonary edema
02 / diuretics / antihypertensives / inotropes / airway / intubation / morphine / positioning / cardiac monitoring / fluid restriction
obstruction of the pulmo artery
pulmonary embolismcau
causes of pulmonary embolism
DVT / Atrial fibrial / air bubbles / fat embolism
s/sx of pulmonary emblism
SOB / chest pain / fainting / lightheadedness / bloody streaked mucus / dizziness / cold clammy skin / cyanosis
mngt for pulmonary embolism
anticoagulant
thrombolytics
vena cava filter
Pulmonary embolectomy
Slow progressive respiratory disease of airflow obstruction involving airways
chronic obstructive pulmonary disease
presence cough and sputum production for atleast 3 months in each of 2 consecutive years
chronic bronchitis
hypersecretion of mucus
mucus plug
impaired gas exchange result from obstruction of the walls of over distended alveoli
emphysema
emphysema chest
barrel chest
chronic airway inflammation leads to?
astma
airway hyperresponsiveness - mucosal edema - mucus production - cough / chest tightness / wheezing / dyspnea
is the key to asthma care
knowledge
complication of asthma
status asthamaticus / respi failure / pneumonia / atelectasis
mngt of asthma
pulmonary treatment focus: prevent impairment of lung function
- decrease surgeries
- prevent exacerbation
medications of asthma
- short acting beta 2 adrenergic agonist - albuterol - bronchodilation
- anticholinergic - ipratoprium - decrease secretion
- corticostroids - prednisone - decrease inflam
- long acting - @night ; 12 hrs
- leukotrine modifiers - montelukast
best manage by early treatment and education
astma exacerbation
Nx interventions of asthma
assess airyway for the first 12-24 hrs
- increase oral fluid intake 3-4 L /dday
- avoid irritants
more common than penetrating
blunt trauma
common cause of blunt trauma
vehicular accident
