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
nasopharyngeal airway
who is it used in?
never insert in clients with what?
maintains upper airway patency
Used in alert or semiconscious clients bc they are less likely to cause gagging
Never insert in clients with heads trauma
oropharyngeal airway
purpose?
what do we want to ensure? what do we NEVER do?
how do we measure it?
what do we do before placement?
how do we insert it?
- Purpose: Prevents tongue displacement and tracheal obstruction in sedated/unconscious clients
- Ensure it is easily removable
- client will cough or gag it out
- Never tape an OPA= aspiration risk
- Measure size next to client’s cheek
- Suction upper airway before placement,
- Insert with distal end pointing upward then rotate it downward toward esophagus to push tongue forward
suctioning an artificial airway (ET tube)
steps?
how long can we suction for?
time between suction passes?
pressure for adults and kids?
when do we suction?
- 1) suction oropharynx/perform oral care
- 2) hyper oxygenate using 100% FiO2
- 3)advanced cath into trach until resistance is met and retract 1cm
- 4) do NOT suction while advancing the cath in, remove the cath in a circular motion while suctioning
- do not suction more than 10 seconds, wait 1-2min between passes
- 100-120mmHg for adults and 50-75mmHg for kids
- When to suction: low O2 sat, altered mental status (irritability lethargy), inc HR, RR, & WOB, pallor/cyanotic
trach care
changing as trach?
when do we infalte the cuff?
what is the priority with a new trach?
changing as trach:
- semi fowlers
- clean stoma w sterile water or saline
- this is a sterile procedure after we remove old dressing
inflate cuff if client is at risk for aspiration (unconscious, mechanical vent)…do NOT inflate the cuff if the client is awake
New tracheostomy priority: prevent accidental dislodgement
- need to check the tightness of the ties and allow for 1 finger to go under ties
carbon monoxide toxicity
sx?
dx?
tx?
- Nonspecific sx: dull HA (early sign), confusion, malaise, dizzy, nausea, seizure, syncope, coma, MI, arrhythmia
- Dx: ABG carboxyhemoglobin level, ECG + for dysrhythmia
- Tx: high flow 100% O2 using at nonrebreather at 15L/min
esophageal varices
what to do in balloon becomes displaced?
If it becomes displaced cut the tube with scissors for rapid balloon deflation to stop airway obstruction
pneumonia
positioning?
sx?
if a client has left lobar pneumonia should be positioned in right lateral position
sx: pleuritic chest pain, fever/chills, hemoptysis
cystic fibrosis
patho?
sx?
what do CF clients have a difficult time doing?
life span?
risk for?
tx?
chnace of offspring getting CF?
dx?
- patho: resp secretions are thicker = plugging airway passages and GI tract ducts
- result= ineffective absorption of essential nutrients and chronic lung disease
- sx:
- cough w/ or w/o phlegm
- frequent lung infections
- pancreatitis
- hard to gain weight
- steatorrhea
- CF client have a difficult time maintaining their weight due to malabsorption of carbs, fats, and proteins because of impaired enzyme secretions in the G.I. tract
- constipation is common due to decreased water and salt secretion into the intestines
- Life span: 30s
- Risk for: alveoli rupture which results in sudden pneumothorax
- Tx:
- chest physiotherapy
- aerobic exercise
- diet high in fat and calories
- liberal intake of fluids
- flutter valve
- Autosomal recessive inheritance
- offspring have a 25% chance of being affected
- child must receive 2 abnormal genes (1 from each parent)
- dx: sweat test measures chloride)
huff coughing?
- Sit upright with feet apart and lean forward
- slow deep inhalation, hold breath for 2-3 seconds and quickly/forcefully exhale, repeat 1-2 times
what are the 4 different setting mechanical ventilation can regulate?
- RR
- TV (volume in a breath)
- FiO2
- PEEP
3 modes of mechanical ventilation
assist control
SIMV
pressure support (CPAP)
- assist control
- complete control of all 4 settings
- used in critically ill and in OR
- SIMV
- demand/backup setting
- vent is set at 14 breaths/min if pt goes below that it will kick in
- pressure support (CPAP)
- provides inward pressure to aid breathing but does not trigger a rate or TV
- used before extubation to test for readiness to wean
high pressure MV alarm?
low pressure MV alarm?
- high: obstruction, biting tube, mucous plug, kinked tube
- low: air leak, disconnection
ventilator assisted pneumonia (VAP)
interventions?
- elevate HOB
- admin PPI
- oral care q4hrs
- mointor residuals and distension
- do not overfeed
- maintain endotracheal cuff pressure
non-invasive pressure support ventialtion (NIPPV)
BiPAP?
CPAP?
- BiPAP
- Pressure support during inhalation and exhalation
- Commonly used as a last resort before intubation is necessary
- may deliver added oxygen if needed
- improvement of oxygenation is the goal even if the patient is in restraints do not think safety physiology is a priority
- CPAP
- continuous pressure support
- used for sleep apnea
oxygen support
rebreather mask
nonrebreather mask
simple mask/venturi mask
NC
- rebreather mask
- Reservoir bag holds patient CO2
- patient brings back some CO2
- used in respiratory alkalosis
- similar to using a brown paper bag
- nonrebreather mask
- CO2 escapes mask during exhalation
- pt breathes higher conc of O2
- simple mask/venturi mask
- deliver set amount of O2
- RN may start w/o order but LPN may initiate if order exists (same w NC)
early vs late hypoxia?
- early: anxiety, pallor, discoloration of mucous mem
- late: delirum, mottled skin, clubbing
- anoxia: complete lack of O2 to cellular tissues
- after 5 min permant damage occurs (MI, brain injury)
