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Complex Care Concepts > Respiritory > Flashcards

Respiritory Flashcards

1
Q

Risk factors

A 
Prolonged immobilization 
Sentra venous catheters 
Surgery 
Obesity 
Advancing age 
Conditions that increase blood clotting 
History of thromboembolism
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2
Q

Clinical manifestations

A 
Dyspnea 
Tachypnea 
Chest pain
Dry cough
Hemoptysis 
Distended neck veins 
Tachycardia 
Hypotension 
S3, s4
Fever, petechiae, flu-like
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3
Q

Labs

A

ABGs
D-dimer
BNP
Cardiac

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4
Q

Dx

A

CT

Gold standard: pulmonary angiography

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5
Q

No surgical management

A 
O2
Monitor 
20 gauge in AC
Continuous O2 sat
Drugs
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6
Q

Drugs

A

Anticoagulant

Fibrinolytics

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7
Q

Heparin drip

A

Check PTT

Goal: 1.5 to 2.5 times normal

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8
Q

INR

A

Goal 2-3

Takes 5 days

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9
Q

Critical values of acute respiratory failure

A

Pao2 <60
OR
Paco2 >45 with pH <7.35

AND

Sao2 <90 in both cases

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10
Q

Ventilatory failure

A problem with how air moves

A 
Physical problem with lungs or chest wall
Defect in brain
Poor diaphragm 
Extrapulmonary causes 
Intrapulminary causes
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11
Q

Oxygenation failure

A 
Ventilation normal, lung perfusion decreased 
Right to left shunting 
VQ mismatch 
Low O2
Abnormal hemoglobin 
At alveolar level *
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12
Q

Combined ventilatory and oxygenation failure

A

COPD

Asthma

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13
Q

Dyspnea intervention

A 
O2 therapy 
Position of comfort 
Relaxation 
Engraftment conserving measures 
Drugs
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14
Q

Drugs

Respiratory

A

Albuterol
Metered dose inhaler
Steroids

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15
Q

ARDS

A 
Persist despite 100% O2
Decreased compliance 
Dyspnea
Not cardiac related 
Ground glass on x ray
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16
Q

ARDS often occurs

A 
Lung injury
No hx of pulmonary problems 
Sepsis
Burns 
Pancreatitis 
Trauma
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17
Q

Causes of lung injury in ARDS

A

Systemic inflammatory response is common pathway

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18
Q

Alveolar capillary membrane injured

A

Intrinsic- sepsis, shock

Extrinsic- aspiration, inhalation

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19
Q

They key

A

Early recognition for those with increased risk

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20
Q

Dx of ARDS

A 
Low O2 on ABG
Refractory hypoxemia 
Ground glass
No cardiac involvement on ECG
Low to normal PCWP
21
Q

S/Sx of ARDS

A

Increased work of breathing
Change in mental status
Normal breath sounds
Cyanotic, pallor, intercostal retractions

22
Q

Why the normal breath sounds?

A

Changes in sound occur in interstitial spaces, not airways

23
Q

Interventions for ARDS

A 
Monitor VS hourly
Higher levels of O2 
Intubation 
Ventilation 
CXR
24
Q

Carina

A

Where the trachea splits off

25
Q

ET tube rests

A

2cm above carina

26
Q

When to do a tracheostomy

A

If ventilation is needed more than 10-14 days

27
Q

Verifying tube placement

A

End tidal carbon dioxide levels
CXR
Breath sounds bilaterally
Symmetrical chest movement

28
Q

ET nursing care

A 
Assess placement(tooth and nose)
Chest movement and sounds 
Check pilot balloon 
Soft wrist restraints 
Sedation
29
Q

Assist-control ventilation

A

Takes over breathing for pt

30
Q

Synchronized intermittent mandatory ventilation

A

Allows for spontaneous breathing at pts own rate

31
Q

BiPAP

A

Non invasive
Nasal or face mask

For OSA and muscle fatigue

32
Q

Tidal volume

A

Volume of air pt receives with each breath

33
Q

Rate

A

Usually 10-14

34
Q

Fraction inspired O2

A

Based in ABGs

21-100 of air

35
Q

CPAP

A

Keeps alveoli open during inspiration, prevents collapse during expiration

36
Q

PEEP

A

Positive-end expiratory pressure
Prevents alveoli from collapsing
Always partially filled

37
Q

Flow

A

How fast each breath is delivered

40L/min

38
Q

Complications

A 
GI
Nutritional 
Infections 
Atrophy 
Ventilator dependence
39
Q

Oral care

A

Every 2 hrs
Chlorahexidine
Sterile suction

40
Q

Extubation

A 
Hyperoxygenate
Suction
Deflate cuff 
Pull straight out at peak inspiration 
Cough 
Monitor every 5 minutes

Stridor

41
Q

Rib fracture

A

Not splinted
Decrease pain

Avoid analgesics that cause respiratory depression

42
Q

Flail chest

A

Sucking inward during inspiration

Puffing out during expiration

43
Q

Pneumothorax

A

Air in pleural space

44
Q

Pneumothorax assessment

A 
Decreased breath sounds 
Loud booming sound 
Chest expansion
Deviation of trachea away 
Pain 
Tachypnea 
Subq emphysema
45
Q

Tension pneumothorax

A

Air leak in lung or chest wall
Air enters, but does not leave
Compresses vessels and heart

46
Q

Tension pneumothorax assessment

A 
Asymmetry of thorax
Trachea movement 
Respiratory distress 
Absent breath sounds 
Distended neck veins 
Cyanosis
47
Q

Tension pneumothorax tx

A

Chest tube

Needle thoracoatomy

48
Q

Hemothorax

A

Simple less than 1000

Massive more than 1000

Complex Care Concepts (25 decks)

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