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Respiratory Exam 1 Flashcards

1
Q

pulmonary embolism s/s

A

sudden onset dyspnea
pleuritic chest pain
tachypnea
anxious
scared

-hypoxemia
-cough
-hemoptysis
-wheezing
-shallow respirations
-edema (lower)
-crackles

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2
Q

pulmonary embolism vitals

A

tachycardia
tachypnea
hypotension
low fever
low O2 sat

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3
Q

pulmonary embolism risks

A

smoking
air travel
reduced activity
hx of clotting disorder
hx of DVT
hx of cancer
HTN
obesity

-hx of a-fib
-oral contraceptives
-recent surgery / trauma
-older age

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4
Q

Pulmonary embolism labs

A

d-dimer
CBC
ABG
BNP
EKG
CXR
Spiral chest CT

-coagulation study
-duplex ultrasonography
-pulmonary angiography
- v/q scan

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5
Q

pulmonary embolism patho

A

occlusion of pulmonary arteries from a clot , decreased blood flow to alveoli allowing no gas exchange

-v/q mismatch prevents gas exchange

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6
Q

PE can lead to….

A

increase pulmonary vascular resistance because blood flow cannot move past the clot

**lead to HTN –> back flow of blood to R ventricle –> R sided HF

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7
Q

v / q scan

A

identifies lungs are ventilated but not perfused

*high probability = clot

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8
Q

pulmonary angiography

A

definitive PE study , invasive , only done when pt is stable and other tests are inconclusive

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9
Q

Pulmonary embolism action

A
  1. Provide O2 and ventilation
  2. anticoagulants
  3. IV fluids
  4. baseline aPTT / INR
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10
Q

pulmonary embolism meds

A
  1. oral xa inhibitors
  2. lovenox
  3. warfarin
  4. heparin
  5. tPA
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11
Q

oral xa inhibitors

A

used in asymptomatic PE pts w/ low risk clot

-eliquis , xarelto , prodaxa

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12
Q

lovenox

A

anticoagulant , low molecular weight heparin

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13
Q

heparin

A

anticoagulant , IV admin in emergency

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14
Q

heparin antidoate

A

protamine sulfate

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15
Q

tPA

A

dissolve current clot , occurs within 3 hours of event

given to UNSTABLE PTS

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16
Q

IV heparin

A

given for emergency PE
-complaints of chest pain
-hypoxemia
-tachypnea
-tachycardia

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17
Q

Heparin admin considerations

A

-bleeding precautions
-IV access
-protamine sulfate on hand
-aPTT levels

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18
Q

venous doppler US

A

evaluate blood flow of vessels
-check for DVT

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19
Q

inferior vena cava filter

A

allows for blood passage and traps other emboli
-used when pts have recurrent PE despite therapies

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20
Q

PE lifestyle change

A
  1. exercise
  2. cardiac diet
  3. adequate fluids
  4. no smoking

-bleeding precautions

21
Q

PE home medications

A

explain Coumadin
follow ups for INR check
lasix and s/s of hypokalemia

22
Q

PE bleeding precautions

A

soft toothbrushes
electric razor
limit activity with bleeding risk
fall precautions

23
Q

warfarin antidote

24
Q

s/s of DVT

A

lower edema
redness / warmth

25
Q

warfarin and vit k foods

A

need to be limited
-leafy greens
-kale
-broccoli
-spinach
-cabbage
-lettuce

26
Q

acute respiratory failure s/s

A

SOB
fever
cough
altered mental status
dyspnea
rapid shallow breathing
accessory muscle use
flushed skin

27
Q

acute respiratory failure vitals

A

hypertension
tachycardia
tachypnea
low O2 sat
temp

28
Q

ARF can include both what…

A

hypoxemia and hypercapnia

29
Q

acute respiratory failure interventions

A

oxygen : NRBM 100%
cardiac monitoring
immediate IV access
HOB elevated

-neuro assessment
-vitals
-breath sounds
-IV fluids

30
Q

acute respiratory failure oxygen option

A

BiPAP if nonrebreather isn’t enough

-maintains high pressure

31
Q

acute respiratory failure labs

A
  1. CXR
  2. ABGs
  3. CBC
  4. EKG
  5. cardiac enzymes
  6. BNP
  7. sputum culture
  8. blood culture
32
Q

acute respiratory failure meds

A
  1. IV antibiotics
  2. bronchodilators: albuterol
  3. corticosteroids : solumedtrol , solucortef
  4. sedatives : ativan
  5. diuretics : lasix
33
Q

ARF complications

A
  1. sepsis
  2. dysrhythmias and decreased CO
  3. VAP
  4. stress ulcers
34
Q

ARF sepsis complication

A

underlying pneumonia with hypoxemia and decrease CO leads to MODS

35
Q

VAP prevention

A

sterile technique
handwashing
oral care
suctioning

36
Q

ARDS interventions

A
  1. monitor vitals
  2. monitor O2 sat
  3. neuro assessment
  4. resp assessment
  5. monitor UO
  6. monitor ventilation
37
Q

ARDS labs

A

ABGs
CBC
serum lactate
renal / liver tests
blood and sputum culture

38
Q

ARDS meds

A
  1. antibiotics
  2. corticosteroids
  3. bronchodilators
  4. sedatives
  5. paralytic agent
  6. analgesics
  7. inotropic agents
39
Q

ARDS tx

A

PRONING POSITION
-allows for better alveoli recruitment

ECMO

40
Q

ECMO

A

pump that circulates blood through artificial lung , CO2 is removed and oxygenation happens

-blood is returned to pt

41
Q

obstructive sleep apnea s/s

A

fatigue
daytime sleepiness
restless sleep
loud snoring
snorting
witnessed apnea during sleep
gasping / choking during sleep

42
Q

OSA risks

A

type II DM
HTN
hyperlipidemia
obesity
smoking
male
a-fib
nocturnal dysrhythmias
HF
age 40-65

43
Q

OSA patho

A

upper airway is obstructed / narrowed during sleep related to pressure being put on airway

44
Q

OSA complication

A
  1. can lead to cardiovascular disease
  2. endothelial damage
  3. cardiac ischemia, MI , ED , a-fib , HF , cardiac death
45
Q

OSA tests

A

polysomnography
-EKG
-pulse ox
-eye / skeletal muscle movement
-EEG
-apnea - hypoapnea events
-respiratory airflow

46
Q

OSA tests

A

-CXR : R ventricle
-echo : R ventricle measurement
-12 lead EKG
-R heart cath : HTN check

47
Q

OSA treatment

A

CPAP
-prevents collapse of airway using continues positive pressure

48
Q

OSA education

A
  1. weight loss
  2. DM management
  3. disease process
  4. med compliance
  5. CPAP use

Critical Care (15 decks)

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