Respiratory part 2 Flashcards
Patients who are higher risk of upper airway obstruction?
altered mental status and level of consciousness, are dehydrated, are unable to communicate, are unable to cough effectively, or are at risk for aspiration.
What are sx of a partial obstruction of the airway?
diaphoresis, tachycardia, anxiety, decreased O2, elevated blood pressure, rising end tidal CO2 levels. Stridor or crowing. Drooling or an inability to swallow oral secretion.
What are sx of complete obstruction?
hypoxia and hypercarbia, restlessness, increasing anxiety, sternal retractions, a “seesawing” chest motion, abdominal movements, or a feeling of impending doom from air hunger.
Emergency procedures performed when obstruction cannot be removed quickly?
cricothyroidotomy or tracheotomy
Sx often seen as a result of chronic sleep apnea?
chronic excessive daytime sleepiness, an inability to concentrate, morning headache, and irritability
What are long-term effects of OSA?
risk for hypertension, stroke, cognitive deficits, weight gain, diabetes, and pulmonary and cardiovascular disease
Causes of OSA?
Obstruction by soft palate or tongue, obesity, large uvula, short neck, smoking, large tonsils or adenoids, and oropharyngeal edema
Physical findings of OSA?
retracted lower jaw, smaller chin, and shorter neck, swollen or enlarged oropharyngeal structure
What are some diagnostic tests for OSA?
sleep apnea questionnaires, “at home” sleep study, polysomnography, monitoring devices
What is the primary problem with OSA?
Poor gas exchange and hypoxia d/t abnormal sleep pattern
If you suspect a partial obstruction of the airway what should be your first priority?
Call Rapid Response team to prevent a complete obstruction
Why is posterior nasal bleeding an emergency?
Because the bleed cannot be reached with anterior packing and the patient may lose a lot of blood
What education should we teach the patients after tube or packing removal s/p epistaxis?
- Apply petroleum jelly sparingly to the nares for comfort.
- Use saline nasal sprays after healing to add moisture and prevent rebleeding.
- Avoid vigorous nose blowing, the use of aspirin or other NSAIDs, and strenuous activities such as heavy lifting for at least 1 month.
How is COVID-19 spread?
Via droplet transmission
When is the contagious period of the flu?
24 hours before sx and up to 5 days after they begin
Which antivirals may be prescribed for the tx of flu?
Amantadine, rimantadine, and ribavirin
Antivirals must begin within what time frame in order to be effective?
24-48 hours
DKA, seizures, respiratory problems, starvation, and kidney failure all cause which acid base imbalance?
Acidosis
How do pancreatitis, dehydration, kidney and liver failure affect acid base imbalance?
underproduce bases → acidosis
Can you have respiratory and metabolic acidosis at the same time?
Yes; patient with DKA and COPD
If your patient is at risk for acidosis which system do you assess first and why?
Cardiovascular because of the hyperkalemia that can lead to cardiac arrest
What MSK changes may be seen in acidosis d/t hyperkalemia?
Msl weakness and reduced DTR’s
Changes in what system may be the first sign of acidosis?
cognitive like confusion
Is cyanosis in the nail beds and mucous membranes and early or late finding of acidosis?
Late
TPN, blood transfusions, and thiazide diuretics can cause acidosis or alkalosis?
Metabolic alkalosis
Two common electrolyte imbalances associated with alkalosis?
low K and Ca
What is the first treatment for a patient with metabolic acidosis?
fluids first then reassess before giving bicarb
What imbalance does a high anion gap indicate?
Metabolic acidosis
What does a low anion gap indicate?
lab error or Lithium meds
Under what conditions do we give bicarb first?
if pH less than 6.9/base deficit
