T3: Unstable Respiratory Conditions Flashcards
status asthmaticus
a severe, life-threatening asthma attack that is refractory to usual treatment and places the patient at risk for developing respiratory failure.
Severe and life-threatening exacerbations of asthma
*Respiratory rate >30/min
*Dyspnea at rest, feeling of suffocation
*Pulse >120/min
*PEFR is 40% at best
*Usually seen in ED or hospitalized
Life-threatening asthma
*Too dyspneic to speak
*Perspiring profusely
*Drowsy/confused
*PEFR <25%
*Require hospital care and often admitted to ICU
HINT HINT Peak Expiratory Flow Rate (PEFR)
measured by the peak flow meter (at home or in a health care setting) is an aid to diagnose and monitor asthma
clinical manifestations of asthma/status asthmaticus
*Recurrent episodes of wheezing, breathlessness, cough, and tight chest
*May be abrupt or gradual
*use of accessory mucles
diaphoresis
cyanosis
triggers of asthma/status asthmaticus
allergens, exercise, URI, foods, emotions, NSAIDS, Beta Blockers, ACEI
early vs late phase in asthma/status asthmaticus
*Early Phase-initial inflammatory response
*Late Phase-4-6 hours after initial attack, occurs in 50% of patients and last longer than 24 hours
Nasal cannula flow rate
1-6 L/min
Simple mask flow rate
5-10 L/min (add humidity)
nonrebreather mask flow rate
10-15 L/min
Venturi mask
A face mask and reservoir bag device that delivers specific concentrations of oxygen by mixing oxygen with inhaled air.
how do we determine the size of the ET tube for a patient
look at the size of their pinky
red zone of asthma plan
the red zone means you are experiencing severe asthma symptoms or an asthma flare-up. Follow the steps in your asthma action plan and get immediate medical treatment if your symptoms do not improve.
Assessment during acute exacerbation of asthma
*Respiratory and heart rate, Use of accessory muscles
*Percussion and auscultation of lungs
*PEFR to monitor airflow obstruction
*ABGs & Pulse oximetry
For any classification of asthma, in a “rescue plan” patients are instructed to take…
*2 to 4 puffs of albuterol every 20 minutes 3 times to gain rapid control of symptoms.
plan of care for status asthmaticus
-O2 given via nasal cannula or mask to achieve a PaO2 of at least 60 mm Hg or O2 saturation greater than 90%
*Continuous oxygen monitoring with pulse oximetry
*Bronchodilator treatment (SABA)
-tripod positon to maximize the diaphragmatic movement
silent chest
*Severely diminished breath sounds
*Absence of wheeze after patient has been wheezing, breathing
emergency priory bc air is not moving in lungs
interventions for silent chest
*Requires ED and possible ICU
*IV magnesium sulfate
*100% oxygen
*Hourly or continuous nebulized SABA
*IV corticosteroids
IV magnesium sulfate use
person has depleted magnesium supply so you need to replenish it for the muscles
IV corticosteroids use
for inflammation (use in caution with patients who have diabetes)
Pulmonary embolism (PE)
*Blockage of one or more pulmonary arteries by thrombus, fat or air embolus, or tumor tissue
*Obstructs alveolar perfusion
*Most commonly affects lower lobes
what treatment significantly reduces mortality with Pulmonary embolism (PE)
Treatment with anticoagulants
Clinical Manifestations of Pulmonary embolism (PE)
*Dyspnea most common
*Tachypnea, cough, chest pain, hemoptysis, crackles, wheezing, fever, tachycardia, syncope, change in LOC, sense of impending doom
(Dependent on size and extent of emboli)
diagnostics for Pulmonary embolism (PE)
-Ventilation-perfusion (V/Q) scan
-Pulmonary angiography
-Arterial blood gases (ABGs)
Ventilation-perfusion (V/Q) scan is
used if…
patient cannot have contrast
Two components of Ventilation-perfusion (V/Q) scan
*Perfusion scanning
*Ventilation scanning
Perfusion scanning
involves IV injection of a radioisotope. A scanning device images the pulmonary circulation.
Ventilation scanning
involves inhalation of a radioactive gas such as xenon. Scanning reflects the distribution of gas through the lung.
Pulmonary angiography
x-ray imaging of the blood vessels of the lungs after the injection of contrast material, involves the insertion of a catheter through the antecubital or femoral vein
an individual may be allergic to contrast if they are allergic to…
shellfish
after coming from an angiogram, what should be checked
LIFT UP SHEETS after coming from angiogram, LOOK where puncture site is because they could bleed out
plan of care for Pulmonary embolism (PE)
Prevention of DVT—the key!
*Sequential compression devices
*Early ambulation
*Prophylactic anticoagulation
interventions for Pulmonary embolism (PE)
*Oxygen → mechanical ventilation
*Pulmonary toilet
*Fluids, diuretics, analgesics
*Pulmonary embolectomy for massive PE
*Inferior vena cava (IVC) filter
pulmonary toilet
attempts to clear mucus and secretions from the trachea and bronchial tree by deep breathing, incentive spiratomy, postural drainage, and percussion, suction
Inferior vena cava (IVC) filter
inserted percutaneously via the femoral vein, is placed at the level of the diaphragm in the inferior vena cava. Once inserted, the stent expands and prevents migration of large clots into the pulmonary system.
drug therapy for anticoagulation
*Low-molecular-weight heparin (LMWH)
*Unfractionated IV heparin
*Warfarin (Coumadin)
drug therapy for fibrinolytic agent
*Tissue plasminogen activator (tPA)
*Alteplase (Activase)
nurse management for PE
*Semi-Fowler’s position
*Oxygen therapy
*Frequent assessments
*IV access
*Monitor laboratory results
*Emotional support and reassurance
patient teaching for PE
*Regarding long-term anticoagulant therapy
*Measures to prevent DVT
*Importance of follow-up exams
pH normal range
7.35-7.45
PaCO2 normal range
35-45 mm Hg
HCO3 normal range
22-26
pH; acidic
<7.35
pH; basic
> 7.45
PaCO2 acidic
> 45
PaCO2 basic
<35
HCO3 acidic
<22
HCO3 basic
> 26
