RLE: FINALS Flashcards by Renren Dominguez

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)

How well did you know this?

Not at all

Perfectly

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,

How well did you know this?

Not at all

Perfectly

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)

How well did you know this?

Not at all

Perfectly

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,

How well did you know this?

Not at all

Perfectly

TYPES of ACUTE HYPERCAPNIC RESPIRATORY FAILURE

HYPOXEMIC RESPIRATORY FAILURE

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

COMMON SIGNS OF ACUTE HYPERCAPNIC RESPIRATORY
FAILURE: PCTAC

Pale conjunctiva
● Cyanosis
● Tachypnea
● Asymmetric chest expansion
● Crackles left

How well did you know this?

Not at all

Perfectly

FIRST 3 NURSING MANAGEMENT for AHRF

RESPIRATORY SUPPORT
AIRWAY MANAGEMENT
CARDIOVASCULAR MONITORING

How well did you know this?

Not at all

Perfectly

NURSING MANAGEMENT
RESPIRATORY SUPPORT
● Encompasses continuous monitoring of

respiratory rate and oxygen saturation,
administering oxygen therapy as prescribed,

How well did you know this?

Not at all

Perfectly

AIRWAY MANAGEMENT
● Effective airway management include

assessing and maintaining airway patency,
administering bronchodilators as prescribed,

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

are administered
to manage severe asthma exacerbation

Expectorants Bronchodilators, such as
beta-agonists and anticholinergics,

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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.

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

due to
non-inflammatory causes (congestive heart
failure, myxoedema, nephrotic syndrome)

transudative effusion

How well did you know this?

Not at all

Perfectly

: inflammatory or
malignant causes (tuberculosis, spread from
empyema, metastasis)

exudative effusion

How well did you know this?

Not at all

Perfectly

high blood concentration (trauma,
rupture of aneurysms, malignant effusion).

hemorrhagic
effusion

How well did you know this?

Not at all

Perfectly

most commonly
results from heart failure. This usually results
from inflammation by bacterial products or
tumors involving the pleural surfaces

TRANSUDATIVE EFFUSION

How well did you know this?

Not at all

Perfectly

n results from increased
capillary permeability due to an inflammatory
reaction. They most often occur with an
infection or cancer

EXUDATIVE EFFUSION

How well did you know this?

Not at all

Perfectly

is caused by bleeding
into the pericardial space due to trauma or
rupture of a vessel in this area.

HEMORRHAGIC EFFUSION

How well did you know this?

Not at all

Perfectly

Beck’s triad is

Hypotension
● Muffled heart tones
● Increase in CVP

How well did you know this?

Not at all

Perfectly

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