Respiratory 2 Flashcards
What are the indications for a thoracentesis
diagnostic or management, microscopic examination, relief pressure on blood vessel or lung compression, relieve respiratory distress, to give meds
what are the nursing considerations for a thoracentesis
verify consent, assess for allergies, stress importance of not coughing moving or deep breathing to avoid lung puncture, remove more than 1000 milliliters to prevent reexpansion, apply pressure to site follow up with chest X-ray, assess site for bleeding and drainage, assess for pneumothorax it can occur up to 24 hours after procedure
what should you document after a thoracentesis
procedure, response, fluid remove, specimens, site, respiratory assessment
what are the complications of a thoracentesis
fluid accumulation, subcutaneous emphysema, infection, attention pneumothorax
what are the cardiovascular changes with acidosis
heart rhythm changes (Brady cardia, heart block), tall T waves, widened QRS complex, prolonged PR interval, hypotension, thready peripheral pulses
what are the respiratory changes with acidosis
kussmaul respirations (metabolic), variable respirations (respiratory)
what are the CNS changes with acidosis
depressed activity like lethargy, confusion, stupor, coma
what are the neuromuscular changes with acidosis
hyporeflexia, skeletal muscle weakness, flacid paralysis
what are the skin changes with acidosis
warm, flushed, dry skin in metabolic and pale cyanotic forespore
what is a pneumothorax
air enters pleural cavity, opened or closed, loss of negative pressure, spontaneous rupture of bleb, iatrogenic secondary to medical procedure
what is a tension pneumothorax
complication of pneumothorax life threatening, air enters but doesn’t exit, increase pressure collapses lungs and compresses blood vessels which decreases cardiac output
what is a hemothorax
bleeding in chest cavity, may occur with pneumothorax
what is a simple hemothorax
blood loss less than 1000 milliliters
what is a massive hemothorax
blood loss over 1000 milliliters
what are the risk factors for pneumothorax
tall thin males, history of chronic respiratory disease
how do you diagnose pneumothorax
chest X-ray, CT, ultrasound, ABGs
what is the treatment for pneumothorax
needle decompression, chest tube
what are the signs and symptoms of pneumothorax
reduced or absent breath sounds, hyperresonance, dull (hemo), asymmetrical chest movement, tracheal deviation
what are the signs of symptoms specific for tension pneumothorax
extreme respiratory distress, cyanosis, distended neck veins, hemodynamic instability
what is a pleural effusion
fluid in pleural space
what is the normal amount of fluid in the pleural space
5 to 15
what are the risk factors for pleural effusion
transudate (left sided heart failure, chronic liver disease, malnourished), exudate (infections or malignancy),
what is the treatment for pleural effusion
spontaneous resolution, chest tube, diuretics, antibiotics, surgery
what are the nursing interventions for pleural effusion
positioning for optimal gas exchange, pain management, monitor respiratory status
how do you diagnose pleural effusion
chest X-ray, thoracentesis
what is pleurisy
inflammation of the pleural space
what are the risk factors for pleurisy
infection, cancer, trauma
what are the signs and symptoms of pleurisy
sharp pain with inspiration, shallow rapid breathing, plural friction rub
what is the treatment for pleurisy
treat underlining cause, anti inflammatories, splinting, pain control
what is a pulmonary embolism
blockage of pulmonary arteries (thrombus, fat, air, tumor), saddle embolus (large embolus lodged arterial bifurcation)
what are the risk factors for pulmonary embolism
prolonged immobilization, central venous catheter, surgery, obesity, older, disorder that affects increased blood clotting, history of thromboembolism
what are the signs and symptoms of pulmonary embolism
sudden dyspnea, hypoxemia, tachypnea, dry cough, pleuritic chest pain, increased heart rate, distended neck veins, syncope, hemoptysis, cyanosis, abnormal heart sounds, abnormal ECG, impending doom
how do you diagnose pulmonary embolism
d-dimer (quick but not specific), CT with contrast looks at blood vessels in the pulmonary system, V/Q scan inhalation of radioactive gas look at air flow, IV injection of radiootope to look at blood flow, pulmonary angiography most invasive done in the Cath lab, ABGs
what is the treatment for pulmonary embolism
heparin drip, full dose Lovenox with oral anticoagulant for three months, thrombolytics if large PE, severe may require surgical intervention like pulmonary embolectomy, EKO, IVC filter
what are the nursing interventions for pulmonary embolism
give O2, position for maximum ventilation, initiate and maintain IV access, assess cardiac and respiratory status every 30 minutes, provide emotional support
what is blunt trauma
appears minor is a striking or being struck by an object
what is a penetrating trauma
open wound, a foreign object impales or passes through the body
what do chest injuries include
pulmonary contusion, rib fracture, flail chest, thoraxs, trauma
what is the respiratory assessment for someone with a chest trauma
dyspnea, cough, tracheal deviation, diminished breast sounds, hypoxemia asymmetric chest movement subcutaneous emphysema, cyanosis
what are the signs and symptoms of a pulmonary contusion
asymptomatic early then rest then, diminished breath sounds, crackles, wheezing, increased heart rate, tachypnea, dry cough, dullness to percussion, bruising over injury
What are the diagnostics of pulmonary contusion
visual assessment, chest X-ray
what is the treatment for a pulmonary contusion
high fowlers or good lung down, frequent respiratory assessment, focused on maintaining ventilation and oxygenation
what are the signs and symptoms of a rib fracture
pain with movement, splints chest defensively, shallow breathing
what are the complications of a rib fracture
deep chest injuries with poor prognosis (first or second rib, flail chest, over 7 fractures), pulmonary contusion, hemothorax
what is the treatment for an uncomplicated rib fracture
ribs unite spontaneously, chest usually not splinted, pain is treated with intercostal nerve block and patient controlled analgesia
What is a flail chest
fracture of equal to or more than three adjacent ribs and equal to or more than two locations, related to blunt force trauma may have additional injuries
what are the signs and symptoms of flail chest
paradoxical chest movement, one side involvement, impaired gas exchange, dyspnea, cyanosis, increased heart rate, decreased blood pressure
what is the treatment for flail chest
mechanical vent, stabilized with PPV
what are the nursing interventions for flail chest
monitor fluid and electrolytes, give IV fluids, humidified O2, pain management, promote deep breathing, position for optimal gas exchange, promote cough, suction secretions as needed
what is acute respiratory distress
sudden and progressive acute lung injury, alveolar capillary membranes are damaged causes increased permeability to intravascular fluid, noncardiogenic pulmonary edema, imbalance of ventilation and perfusion related to chanting no gas exchange occurring
what are the signs and symptoms of acute respiratory distress
shortness of breath dyspnea with or without exertion, orthopnea, rapid shallow breathing, cyanotic molted dusky skin, increased heart rate, decreased blood pressure, retractions, decreased S BO2, adventitious breath sounds, cardiac arrhythmias, confusion, pulmonary edema, decreased lung compliance, severe hypoxemia even with O2 at 100%
what are the risk factors for acute respiratory distress syndrome
localized lung damage secondary to a systemic worsening problem like aspiration near drowning damage to CNS transfusion reaction sepsis pneumonia or PE
what is the diagnostic testing for acute respiratory distress syndrome
X-ray shows pulmonary edema, ECG to rule out cardiac involvement
what is the treatment for acute respiratory distress syndrome
intubation and mechanical vent, monitor ECG, S PO2, lung sounds, skin color, suction as needed, kinetic therapy, extracorporeal membrane oxygenation
there’s a complication that can occur to the vocal cords because of acute respiratory distress syndrome
traumatic or long term intubation cause damage to vocal cords placement of the tube check placement queue one to two hours, assess lung sounds, chest movement and SP O2 frequently secured tube per policy
what is barotrauma
vent with positive pressure subq emphysema so monitor O2 assess for subq emphysema document all vent changes high pressure vent alarm may mean pneumothorax
What is a weaning method for mechanical ventilation
spontaneous breathing trials(spontaneously breathing through artificial airway for a set time), pressure support ventilation (tolerates progressive decrease in pressure support),
what is weaning criteria
the cause of respiratory compromise has improved, able to initiate respiratory effort, adequate oxygenation hemodynamically stable
What is the surgical management for lung cancer
lobectomy, pneumoectomy, segmenectomy, wedge resection
what are the lung transplant indications
emphysema, cystic fibrosis, pulmonary fibrosis, pulmonary hypertension, sarcoidosis
what are the risk factors for lung cancer
genetic exposure, smoking
what is the nonsurgical management for lung cancer
chemo, targeted therapy (thorocentesis or pleurodesis), radiation therapy, photodynamic therapy
what are the risks for lung transplant
bleeding, infection, PE, severe pulmonary edema, rejection
