respiratory Flashcards
what can kill my pt the quickest
- ABC
- medical emergencies
- loss of life: ABC issues
- lodd of limb: no distal pulse, compartment syndrome, priapism
- loss of sensory organ: vision loss, hearing/balance chages/loss, ototoxicity
- maslows heirarchy
angioedema
sx?
interventions?
- s/sx: edema/swelling of eyes, lips, tongue, mouth, hands, feel genitals, itchy rash
- interventions: histamine blockers, steroids, epi
Epiglottitis
sx?
interventions?
- s/sx: difficult swallowing, dyspnea, stridor (early)…quiet stridor (BAD), drooling and loss of consciousness (late), tachycardia, fever
- interventions: emergency intubation, trach as BS, IV fluids, do NOT examine throat
penumothorax
sx:
interventions?
- patho: air in pleural space
- s/sx: dyspnea, dec O@, displaced PMI, dec/absent breath sounds, hypoxemia
- interventions: thorocentesis, chest tube
air embolism
patho?
causes?
sx?
interventions?-positioning?
- patho: gas bubble that blocks blood flow
- can be caused by trauma, surgery, PICC/CL complication or insertion
- s/sx: dyspnea, chest pain, dec LOC, cyanpsis, hypotension, petechiae, arrhythmia, inc CVP and PAP, “imdepnding doom”
- interventions: left lateral trendelelburg position, clamp tubing, O2, occlusive dressing if CVC got disloged
severe pneumonia
patho?
sx?
interventions?
- patho: droplet transmission, can cause fluid accumulation in lungs
- s/sx: fever/chills, dyspnea, cough, inc WBC, pleuritic chest pain, hemoptysis, crackles
- interventions: bed rest, elevate HOB, O2, breathing tx, abx, CXR, intubation if declining
respiratory failure
patho? type 1-3
sx?
interventions?
ABG?
- patho: type 1= hypoxia, type 2= hypoxia w/hypercapnia, type 3= periop RF (pt gets atelectasis)
- s/sx: SOB, paradoxical breathing, mental status chnages, single word dyspnea, absence of wheezing and silent chest, resp distress, confusion, lethary, hypoxia, hypercapnia, cyanosis, inc WOB, inc or dec RR, arrhythmias
- interventions: maintain patient airway, ABG, high conc O2, positioning, resp assessment, maybe PPMV
- ABG:
- paO2: _<_60
- paCO2: > 50
- pH: _<_7.30
ARDS
patho?
common causes?
sx?
interventions? positioning?
- patho: fluid gets into alveoli causing impaired gas exchange, fast onset, high mortality rate
- common causes: sepsis, burns, blood transfusion, pancreatitis, drug OD, pneumonia, aspiration, embolism
- s/sx: dyspnea, air hinger, inc RR, dec O2, major hypoxemia (despite O2 admin), crackles, inc PaCO2, tachycardia, dec LOC, retractions,
- interventions: MV with PEEP, monitor ABGs, remove secretions PRONE TO SUPINE POSITIONING
severe croup
patho?
sx?
interventions?
- patho: upper airway infection, virus, tracheal swelling
- s/sx: barking cough, stridor (becomes hard to hear is late), fever, dyspnea, cold sx, hoarse, retractions
- interventions: oral corticosteroids, nebulixed adrenaline, O2, possible intubation
fail chest
patho?
Sx?
interventions?
- patho: floating rib caused by trauma
- s/sx: chest pain, bruising of chest, dyspnea, uneven chest rise (paradoxical chest movements)
- interventions: O2, surgery, pain control
pulmonary embolism
(venous thromboembolism= PE+DVT)
most pts woith a DVT have an asymptomatic PE
patho?
sx?
interventions?
- patho: blood clot, air, fat travels via venous circulation and obstructs blood flow
- sx: pleuritic chest pain, dyspnea, hypoxemia, tachypnea, tachycardia, unilateral leg swelling and erythema r/t DVT, anxiety, cough
- interventions: CT pulmonary angiogram,a nticoags, O2
lung sounds
vesicular
crackles (rales)
wheezing (rhonci)
stridor
pleural friction rub
bronchial
- vesicular: normal
- crackles (rales)
- popping sound
- fine: pulmonary edema
- coarse: pneumonia
- wheezing (rhonci)
- continuous
- typically louder during expiration
- commin in asthma, COPD, bronchitis
- stridor
- high pitched during inspiration
- sign of obstruction
- common symptom in croup
- pleural friction rub
- crunching sounds
- pain increases with inspiration or cough
- common in inflammatory dieases of lungs, especially pleural linign
- bronchial
- heard over trachea
COPD
patho?
sx?
tx?
does it inc or dec RBC
normal O2 levels
what to do if SOB?
good breathing technique?
- patho: emphysema (baloon alveoli)… air trapping
- sx:
- dyspnea, barrell chest, chronic resp acidosis, chronic hypoxia
- tx:
- low O2
- bronchodilators/inhaled glucocorticoids
- inc RBCs: polycythemia
- 88-92%
- SOB= use labuterol inhaler
- pursed lip breathing: dec SOB and air trapping and inc CO2 elimination
at what age can you do abdominal thrusts (heimlich maneuver)
>1 year old
suctioning endotracheal tubes (artificial airway)
when do you apply suction?
how long can you suction for?
how long do you wait between passes?
pressure for adults/kids?
apply suction when removing cath
no more than 10sec
wait 1-2min between passes
adults: 100-120
kids: 50-75
Chest tubes
- suction control chamber
- what is it set at?
- what will we see when it is applied?
- water seal chamber
- what does it do?
- how do we know if it is working?
- how do we know if there is an air leak?
- when can the CT be removed?
- What to do if CT falls over?
- what do we do if the CT comes out of the pt?
- what 2 things should you not do with the CT?
- what about of drainage and color should be reported?
(A) suction control chamber: set at -20cm H2O, we will see bubbling when suction is applied
(B) water seal chamber: prevents air from entering chest. the water will rise/fall with inspiraition/expiration
(C) air leak gauge: continuous bubbling in the air leak gauge/water seal chamber
(D) collection chamber: drainage is <200mL/24hrs and air leak is present or lung has reexpanded
- submerge distal end in 1-2in below surface level of a 250mL bottle of sterile water
- if it comes out of pt, apply petrolatum (vaseline) gauze
- strip it (clot) and clamp it (tension pneumo)
- drainage of >100mL/hr and frank/bright red blood, dark is okay
