RLE: FINALS Flashcards
is a critical medical condition
characterized by an inability to adequately
remove carbon dioxide (CO2) from the
bloodstream, resulting in elevated levels of
CO2 in the blood (hypercapnia).
Acute Hypercapnic Respiratory Failure
(AHRF)
It is typically
marked by an increase in the partial
pressure of arterial carbon dioxide (PaCO2)
beyond the normal range of
35-45 mm Hg.
AHRF can be caused by various factors,
arises from bronchoconstriction and airway
inflammation, leading to impaired ventilation
and increased CO2 levels, causing
respiratory distress
In severe asthma exacerbation, acute
hypercapnic respiratory failure (AHRF)
complicates respiratory
status due to cardiac impacts on the lungs,
including pulmonary edema and
cardiovascular stress, indirectly affecting
breathing.
High-risk acute coronary syndrome,
especially NSTEMI,
TYPES of ACUTE HYPERCAPNIC RESPIRATORY FAILURE
HYPOXEMIC RESPIRATORY FAILURE
Represented by inadequate oxygenation of
the blood, resulting in diminished oxygen
levels throughout the body. Frequently, it
originates from underlying diseases such as
pneumonia or acute respiratory distress
syndrome (ARDS).
HYPOXEMIC RESPIRATORY FAILURE
COMMON SIGNS OF ACUTE HYPERCAPNIC RESPIRATORY
FAILURE: PCTAC
Pale conjunctiva
● Cyanosis
● Tachypnea
● Asymmetric chest expansion
● Crackles left
FIRST 3 NURSING MANAGEMENT for AHRF
RESPIRATORY SUPPORT
AIRWAY MANAGEMENT
CARDIOVASCULAR MONITORING
NURSING MANAGEMENT
RESPIRATORY SUPPORT
● Encompasses continuous monitoring of
respiratory rate and oxygen saturation,
administering oxygen therapy as prescribed,
AIRWAY MANAGEMENT
● Effective airway management include
assessing and maintaining airway patency,
administering bronchodilators as prescribed,
CARDIOVASCULAR MONITORING
● Cardiovascular management involves
closely monitoring the patient’s
heart rate,
blood pressure, and rhythm, administering
prescribed medications, and collaborating
with the healthcare team
Medication management involves
administering prescribed medications
including (AHRF)
bronchodilators, antibiotics for
pneumonia, and medications for
cardiovascular support, most significantly
monitoring for potential drug interactions and
side effects
medical management for the presented
patient, who is experiencing acute
hypercapnic respiratory failure (AHRF)
alongside severe asthma exacerbation,
pneumonia, and high-risk acute coronary
syndrome (NSTEMI),
Non-invasive
ventilation (NIV) emerges as a pivotal
component of the management plan
are administered
to manage severe asthma exacerbation
Expectorants Bronchodilators, such as
beta-agonists and anticholinergics,
is the buildup of extra
fluid in the space around the heart. If too
much fluid builds up, it can put pressure on
the heart. This can prevent it from pumping
normally.
Pericardial effusion
A little fluid won’t cause much of a problem.
But if too much fluid builds up, it can make it
hard for the heart to expand normally. This
condition is called
cardiac tamponade.
Chronic pericardial effusion occurs
when cardiac effusion happens more than
once over time. Some different types of
effusion are
transudative effusion
exudative effusion
hemorrhagic
effusion
due to
non-inflammatory causes (congestive heart
failure, myxoedema, nephrotic syndrome)
transudative effusion
: inflammatory or
malignant causes (tuberculosis, spread from
empyema, metastasis)
exudative effusion
high blood concentration (trauma,
rupture of aneurysms, malignant effusion).
hemorrhagic
effusion
most commonly
results from heart failure. This usually results
from inflammation by bacterial products or
tumors involving the pleural surfaces
TRANSUDATIVE EFFUSION
n results from increased
capillary permeability due to an inflammatory
reaction. They most often occur with an
infection or cancer
EXUDATIVE EFFUSION
is caused by bleeding
into the pericardial space due to trauma or
rupture of a vessel in this area.
HEMORRHAGIC EFFUSION
Beck’s triad is
Hypotension
● Muffled heart tones
● Increase in CVP
Nursing Management one of the most
important aspects of care of the patient who
is experiencing Massive Pericardial Effusion
Assess vital signs,
assess for oxygenation and ventilation, input
and output
r medical management treatment depends
on the underlying cause and the severity of
the
e heart impairment
Fluid can be drained via needle
pericardiocentesis as discussed above or
surgical procedures, such as a pericardial
window
the choice of treatment
in unstable patients: it can be performed at
the bedside and in a timely manner
Pericardiocentesis
collision involving a
motor vehicle and another object, such as a
person, another vehicle, or a stationary
object.
vehicular crash
These occur when one vehicle strikes the
rear of another vehicle
most common
REAR-END COLLISIONS
These occur when two
vehicles traveling in opposite directions
collide.
HEAD-ON COLLISIONS
These occur when one vehicle strikes the
side of another vehicle.
SIDE-IMPACT COLLISIONS
Fixed object collisions: These occur when a
vehicle strikes a stationary object, such as a
tree, a light pole, or a building.
FIXED OBJECT COLLISIONS
These involve only one vehicle. They can be
caused by a variety of factors, such as driver
error, mechanical failure, or adverse weather
conditions.
SINGLE-VEHICLE CRASHES
These involve two or more vehicles. They
can be caused by a variety of factors, such
as driver error, inattentiveness, or distracted
driving
MULTIPLE VEHICLE COLLISIONS
These involve a
vehicle and a pedestrian. They are often
caused by driver error, such as failing to
yield to pedestrians, speeding, or driving
under the influence of alcohol or drugs.
PEDESTRIAN VEHICLE COLLISIONS
These involve a vehicle and
a bicycle. They are often caused by driver error, such
as failing to see a bicyclist, or by bicyclist error,
BICYCLE VEHICLE COLLISIONS
Distracted driving crashes: These involve a
driver who is distracted from driving by
something else, such as using a cell phone,
DISTRACTED DRIVING CRASHES
These can range from mild
concussions to severe brain damage. Head
injuries are the leading cause of death in
vehicular crashes, and can also cause
long-term disabilities
Head injuries
These can cause
paralysis and other serious complications.
Neck and spine injuries:
These can include collapsed
lungs, broken ribs, and internal bleeding.
Chest injuries:
the most common type of injury
in vehicular crashes, and typically involve the
arms, legs, hands, and feet.
Extremity injuries
These fractures are
the most common type.
Complete fractures:
These fractures are common
in children. They occur when the bone is bent but
does not break completely.
Greenstick fractures
These fractures occur from
repeated stress over time
Stress fractures
These fractures are the
most serious type. They occur when the
bone breaks through the skin.
Compound fractures
These fractures are
the most complex type. They occur when the
bone is broken into many pieces.
Comminuted fractures
In a healthy individual, the pericardial sac contains
between
15 and 50 milliliters (mL) of serous fluid
Transudative Effusion
Fluid Characteristics:
Protein-poor, cell-
poor, clear, pale yellow.
Exudative Effusion
Fluid Characteristics:
Higher protein
content.
(due to accumulation of
fluid around the heart)
Muffled heart sounds
Left-Sided Heart Failure:
● Symptoms:
a) Dyspnea
b) Orthopnea
c) Tachycardia
d) Pulmonary congestion
e) Cyanosis
f) Fatigue
g) Cough
h) Crackles
Signs of Pulmonary Edema
PACCS
● Pallor
Anxiety
● Cyanosis
● Clammy and cold skin
● Severe dyspnea
Right-Sided Heart Failure:
● Fibrotic lungs, “stiff lungs”
● Symptoms:
SEWDA
a) Swelling in the legs, ankles, or
abdomen (edema)
b) Enlarged liver or spleen
c) Weight gain (3lbs in 1 day or 5lbs in 7
days)
d) Distended jugular vein
e) Ascites
refers to the percentage of blood pumped out
of the heart’s left ventricle with each
contraction.
Ejection Fraction
A S3 heart sound indicates
left ventricular failure
and is considered an emergency situation.
Factors that increase the risk of heart failure:
● >65 years of age
● Hypertension
● Coronary Artery Disease (CAD)
● Diabetes
● Obesity
GOLD standard diagnostic test for pericardial
effusion
2D ECHO
GOLD standard diagnostic test for heart
failure
NT‐proBNP (N-terminal pro–B-type natriuretic
peptide)
High levels of NT-proBNP are a sign that the heart
has
to work too hard to pump blood
BNP Levels
<100 = Normal
300+ = Mild
600+ = Moderate
900+ = Severa
First line management for pericardial
effusion
Pericardiocentesis or Pericardial window
This procedure involves inserting a needle
through the chest wall into the pericardial space
to drain excess fluid that has accumulated
around the heart.
Pericardiocentesis
creates a small opening or “window” in the
pericardium to allow ongoing drainage of fluid
from the pericardial space.
A pericardial window is a surgical procedure.
FIRST LINE or NUMBER ONE CHOICE IN
MANAGING HEART FAILURE WITH REDUCED
EJECTION FRACTION (HFREF):
ACE Inhibitors (Angiotensin-Converting
Enzyme Inhibitors)
● ARBS (Angiotensin II Receptor Blockers)
● ARNI (Angiotensin Receptor Neprilysin Inhibitor)
DIET for a patient with pericardial effusion with
heart failure
Low salt and low-fat diet, Low fluid intake
A type of closed-suction medical device that’s
used to remove fluids from the pericardium.
Jackson-Pratt (JP) Drain
This refers to the buildup
of fluid in the pericardial space around the
heart. It might be asymptomatic and can range
from mild to massive.
Pericardial Effusion:
is a critical
condition and a potential complication of
pericardial effusion.
Cardiac Tamponade:
A patient with left-sided heart failure is having
difficulty breathing. Which of the following is the
most appropriate nursing intervention?
Assist the patient into High Fowler’s position
The client diagnosed with congestive heart failure
is complaining of leg cramps at night. Which
nursing interventions should be implemented?
Monitor the client’s potassium level
Pericardial sac around the heart fills with fluid,
causing and increase in
intrapericardial
pressure, that compresses the heart so it can NO
LONGER FILL with blood
Will show “enlargement of pericardial
sac”
CXR
Will show moderate to large effusion
and/or swinging of heart in the chest
cavity
Echocardiogram
QRS complexes, short & uneven height
ECG
