Respiritory Flashcards
Risk factors
Prolonged immobilization Sentra venous catheters Surgery Obesity Advancing age Conditions that increase blood clotting History of thromboembolism
Clinical manifestations
Dyspnea Tachypnea Chest pain Dry cough Hemoptysis Distended neck veins Tachycardia Hypotension S3, s4 Fever, petechiae, flu-like
Labs
ABGs
D-dimer
BNP
Cardiac
Dx
CT
Gold standard: pulmonary angiography
No surgical management
O2 Monitor 20 gauge in AC Continuous O2 sat Drugs
Drugs
Anticoagulant
Fibrinolytics
Heparin drip
Check PTT
Goal: 1.5 to 2.5 times normal
INR
Goal 2-3
Takes 5 days
Critical values of acute respiratory failure
Pao2 <60
OR
Paco2 >45 with pH <7.35
AND
Sao2 <90 in both cases
Ventilatory failure
A problem with how air moves
Physical problem with lungs or chest wall Defect in brain Poor diaphragm Extrapulmonary causes Intrapulminary causes
Oxygenation failure
Ventilation normal, lung perfusion decreased Right to left shunting VQ mismatch Low O2 Abnormal hemoglobin At alveolar level *
Combined ventilatory and oxygenation failure
COPD
Asthma
Dyspnea intervention
O2 therapy Position of comfort Relaxation Engraftment conserving measures Drugs
Drugs
Respiratory
Albuterol
Metered dose inhaler
Steroids
ARDS
Persist despite 100% O2 Decreased compliance Dyspnea Not cardiac related Ground glass on x ray
ARDS often occurs
Lung injury No hx of pulmonary problems Sepsis Burns Pancreatitis Trauma
Causes of lung injury in ARDS
Systemic inflammatory response is common pathway
Alveolar capillary membrane injured
Intrinsic- sepsis, shock
Extrinsic- aspiration, inhalation
They key
Early recognition for those with increased risk
Dx of ARDS
Low O2 on ABG Refractory hypoxemia Ground glass No cardiac involvement on ECG Low to normal PCWP
S/Sx of ARDS
Increased work of breathing
Change in mental status
Normal breath sounds
Cyanotic, pallor, intercostal retractions
Why the normal breath sounds?
Changes in sound occur in interstitial spaces, not airways
Interventions for ARDS
Monitor VS hourly Higher levels of O2 Intubation Ventilation CXR
Carina
Where the trachea splits off
ET tube rests
2cm above carina
When to do a tracheostomy
If ventilation is needed more than 10-14 days
Verifying tube placement
End tidal carbon dioxide levels
CXR
Breath sounds bilaterally
Symmetrical chest movement
ET nursing care
Assess placement(tooth and nose) Chest movement and sounds Check pilot balloon Soft wrist restraints Sedation
Assist-control ventilation
Takes over breathing for pt
Synchronized intermittent mandatory ventilation
Allows for spontaneous breathing at pts own rate
BiPAP
Non invasive
Nasal or face mask
For OSA and muscle fatigue
Tidal volume
Volume of air pt receives with each breath
Rate
Usually 10-14
Fraction inspired O2
Based in ABGs
21-100 of air
CPAP
Keeps alveoli open during inspiration, prevents collapse during expiration
PEEP
Positive-end expiratory pressure
Prevents alveoli from collapsing
Always partially filled
Flow
How fast each breath is delivered
40L/min
Complications
GI Nutritional Infections Atrophy Ventilator dependence
Oral care
Every 2 hrs
Chlorahexidine
Sterile suction
Extubation
Hyperoxygenate Suction Deflate cuff Pull straight out at peak inspiration Cough Monitor every 5 minutes
Stridor
Rib fracture
Not splinted
Decrease pain
Avoid analgesics that cause respiratory depression
Flail chest
Sucking inward during inspiration
Puffing out during expiration
Pneumothorax
Air in pleural space
Pneumothorax assessment
Decreased breath sounds Loud booming sound Chest expansion Deviation of trachea away Pain Tachypnea Subq emphysema
Tension pneumothorax
Air leak in lung or chest wall
Air enters, but does not leave
Compresses vessels and heart
Tension pneumothorax assessment
Asymmetry of thorax Trachea movement Respiratory distress Absent breath sounds Distended neck veins Cyanosis
Tension pneumothorax tx
Chest tube
Needle thoracoatomy
Hemothorax
Simple less than 1000
Massive more than 1000
