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Acute - Respiratory (Exam 2) > Respiratory Disorders > Flashcards

Respiratory Disorders Flashcards

1
Q

ventilation-perfusion (V/Q)

A

V — ventilation — the air that reaches the alveoli.
Q — perfusion — the blood that reaches the alveoli via the capillaries.

Want the ratio to be 1:1

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2
Q

V/Q imbalance

A

when one is higher than the other = “shunting”

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3
Q

physiological shunt (low V/Q ratio)

A

perfusion (Q) > ventilation (V)

Ex: pneumonia, atelectasis, tumor, mucus plug

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4
Q

alveolar dead space (high V/Q ratio)

A

ventilation (V) > perfusion (Q)

Ex: PE, pulmonary infarction, cardiogenic shock, mech vents w/high TV

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5
Q

V/Q imbalance - silent unit

A

both V and Q are inadequate

ex. tension PTX, severe ARDS, chronic bronchitis, emphysema, cystic fibrosis, asthma attack

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6
Q 
assessing oxygenation (ratio?)
** diagnostic criteria for lung injury and ARDS
A

PaO2 / FiO2 ratio
normal = > 400
acute lung injury = 200-300
ARDS = < 200

ex.
PO2 85 mmHg; FiO2 21% = 85/.21=404 (good)

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7
Q

acute respiratory failure criteria

A

PaO2 < 60 mmHg
OR
PaCo2 > 45 mmHg w/pH <7.35 AND SaO2 <90%
= hypoxemic

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8
Q

acute respiratory failure (ARF) - s/s

A

check ABGs
dyspnea
hypoxic - restlessness, irritability or agitation, confusion, tachycardia
hypercarbia - decr LOC, HA, drowsiness, lethargy, possible seizures

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9
Q

hallmark of ARF

A
  • hypoxemia
  • “50-50 rule” (PaO2 < 60 mmHg and/or PaCO2 > 50 mmHg, pH < 7.3)

type 1 = hypoxemic, normocapnic resp failure
type 2 = hypoxemic, hypercapnic resp failure

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10
Q

ventilatory failure

A

ventilatory failure = problem in O2 intake
= perfusion is normal but air movement is inadequate
- CO2 is retained
- causes: physical problem of lungs/chest wall; defect in resp center of brain; poor function of diaphragm; atelectasis; mucus plug
- defined by PaCO2 > 45 mmHg + pH < 7.35

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11
Q

oxygenation failure

A

air moves in and out, but does not oxygenate the pulmonary blood sufficiently (lung blood flow is decreased)

  • shunting
  • causes: low atmospheric O2; pneumonia; CHF w/PEdema; PEmbolism; ARDS; abnormal hemoglobin; hypovolemic shock; hypoventilation
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12
Q

combined ventilatory and oxygenation failure

A

involves hypoventilation
CO2 retention
more profound hypoxemia

Who: chronic bronchitis; emphysema; cystic fibrosis, asthma attack

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13
Q

ARF management

A
  1. promote adequate gas exchange (supplemental O2, mech vent)
  2. correct acidosis (O2, sodium bicarb [if pH < 7.2]
  3. Medications (bronchodilators, steroids, mucolytics, analgesics, sedation, paralytics)
  4. Nutrition Support
  5. Promote Secretion Clearance
  6. Prevent Complications
  7. Prevent Desaturation
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14
Q

ARF management - positioning

Pts w/V/Q mismatch

A

place them on the least affected side

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15
Q

ARF management - positioning

Pts w/unilateral lung disease

A

Place healthy lung in dependent position

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16
Q

ARF management - positioning

Pts w/diffuse lung disease

A

R lung b/c it’s bigger w/a better lung supply

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17
Q

Pulmonary embolism - s/s

A
  • clot lodged in the pulmonary artery or one of its branches
  • s/s occur suddenly
  • Classic: dyspnea, sharp, stabbing chest pain, apprehension, restlessness, feeling of impending doom, cough, hemoptysis
  • tachypnea
  • crackles
  • pleural friction rub
  • tachycardia
  • S3 or S4 heart sound
  • diaphoresis
  • fever, low grade
  • PETECHIAE OVER CHEST AND AXILLAE
  • decreased arterial SaO2
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18
Q

Gold standard for diagnosing PE

A

pulmonary angiogram

19
Q

V/Q scan

A
  • diagnostic for PE

- can show that there IS a clot, but not where it is

20
Q

PE: emergency management

A

Stabiize cardiopulmonary system

  1. O2 - relieve hypoxemia, pulm vasoconstriction, resp distress, central cyanosis
  2. IV infusion lines - fluid, meds, route for IV contrast studies
  3. urinary cathether - urine output, vital organ perfusion
  4. diagnostic scans and tests - pulm angiogram
  5. intubate/mechanical vent
  6. EKG monitoring
  7. Labs - CBC, electrolyes, HCT, ABGs, coag tests
21
Q

PE - emergency management - meds

A

dobutamine - vasodilator; incr CO
dopamine - vasopressor; incr CO
morphine or sedatives - for anxiety; improves tolerance to ETT and vent

22
Q

PE - anticoagulants

A 
IV Heparin 5-10 days
 - bolus, then infusion
- GOAL: PTT 1.5-2.5 x normal (= 25-35 sec)
  = 60-70 sec
Warfarin (Coumadin) x3-6 months
 - PO begun 3rd day of Heparin use
- GOAL: INR of 2-3
23
Q

PE - thrombolytics

A

clot busters!
- Alteplase, tPA
Indicated for hemodynamically UNSTABLE patients - lysis of the DVT and PR
S/E - bleeding
Contraindicated:
- Hx of CVA
- Intracranial or intraspinal injury or trauma w/in 3 month

24
Q

antidote to Heparin

A

protamine sulfate

25
Q

antidote to Warfarin

A

vitamin K

26
Q

antidote for thrombolytics

A

clotting factors
fresh frozen plasma
cryoprecipitate

27
Q

NI for thrombolytic

A
  • monitor VS Q2H
  • PT and PTT –> 3-4 hours after thrombolytic infusion started.
  • hematocrit
  • platelet counts
  • watch for bleeding Q2H
  • limit invasive procedures
  • apply pressure to IV sites at least 30 minutes
  • STOP HEPARIN BEFORE STARTING THROMBOLYTICS
  • start anticoags after thrombolytics
28
Q

heparin induced thrombocytopenia

A

HIT is caused by the formation of abnormal antibodies that activate platelets
- platelet drop is sudden!

29
Q

ARDs - acute respiratory distress

A

Hallmark: pulmonary edema in absence of cardiac failure

  • initiated by stimulation of inflammatory-immune system as result of acute lung injury
  • may have UTI - bacteria travels
30
Q

Criteria to diagnose ARDs

A
  1. acute onset
  2. PaO2/FiO2 ratio = 200 mmHg (normal >400)
  3. “white out” on CXR - bilateral
  4. Pulmonary artery wedge pressure (PAWP) is = 18 mmHg (normal 8-12)
31
Q

Causes of ARDs

A
  1. direct injury to lung
  2. indirect injury - injury somewhere else, mediators travel via blood to lungs
  3. major risk factors
    - sepsis
    - aspiration of gastric contents
    - diffuse pneumonia
    - trauma
    - smoking
    - chronic alcholism
    - COPD
    - age > 65 years
32
Q

3 phases of ARDs

A
  1. Exudative phase
  2. Proliferative phase
  3. Fibrotic phase
33
Q

Exudative phase (pus)

A
  • Usually, clear lung sounds
  • restlessness
  • apprehension
  • progressive dyspnea & tachypnea
  • moderate use of accessory muscles
  • ABGs - mild resp. alkalosis
34
Q

Proliferative phase

A
  • lungs sounds - fine crackles
  • agitation
  • increased respiratory distress
  • excessive accessory muscle use
  • fatigue
  • ABGs = hypoxemia, hypercapnia = respiratory acidosis = not getting better no matter how much O2 they get
35
Q

Fibrotic phase

A
  • occurs after about 14 days
  • deteriorating mental status
  • increased HR
  • decreased BP
  • decreased urine output
  • increased liver enzymes
  • lung heals, but has scar tissue
36
Q

survival of ARDs

A
  • permanent loss of lung tissue
  • impaired gas exchange & restrictive lung defects
  • difficulty w/ADLs
  • recovery lasts from weeks to months
37
Q

ventilation strategy for ARDs patients

A

PEEP = 5 cm H2O (SE is tension pneumothorax = assess lung sounds hourly & suction PRN)
low Tidal Volume = 6 ml/kg
APRV (airway pressure-release ventilation)

38
Q

nursing management of ARDs

A
  1. Turn continuously - at least Q2H
  2. “Proning” - improves V/Q mismatch & shunts
    - place lease affected area in most dependent position
39
Q

Pulmonary Edema - s/s

A
  • crackles in lungs
  • dyspnea @ rest
  • disorientation or acute confusion in older adults
  • tachycardia
  • hyper- or hypo-tension
  • reduced urine output
  • cough w/frothy pink-tinged sputum
  • PVC and other dysrhythmias
  • anxiety
  • restlessness
  • lethargy
40
Q

P Edema management

A
  1. high-Fowler’s w/legs dependent (if not hypotensive)
  2. high flow O2 [5-6L/min via facemask OR 10-15 L/min via non-rebreather mask] = keep SaO2 > 90%
  3. if SBP > 100 bpm = SL nitroglycerin (while waiting for IV access)
  4. rapid acting diuretic (Lasix or Bumex) = monitor VS frequently
  5. If BP OK => IV morphine 1-2 mg = monitor BP and RR
    DO NOT LEAVE ROOM
41
Q

flail chest

A

3 > ribs fractured
paradoxical chest movement = segment pulled inward w/inspiration; bulges out on expiration
1. pain management
2. secretion mngmt - trach suction and coughing
3. may need mech vent w/positive pressure
4. Monitor:
- ABGs
- VS
- watch for hypovolemic shock

42
Q

tension pneumothorax

A

mediastinum pushed to side

  • large bore needle into 2nd ICS = large gush of air confirms diagnosis
  • chest tube to suction
43
Q

open pneumothorax

A
  • mediastinum shifts toward uninjured site w/inspiration
  • moves to opposite direction w/expiration
    Management:
  • pain control
  • pulmonary hygiene
  • monitor for respiratory failure

Acute - Respiratory (Exam 2) (5 decks)

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