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Adult Health 3 > Test 2 - Hepatic, Pancreatic, Respiratory > Flashcards

Test 2 - Hepatic, Pancreatic, Respiratory Flashcards

1
Q

Define Hepatitis

A

Widespread inflammation of the liver cells, resulting in enlargement of the liver

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2
Q

What types of causes are there for Hepatitis?

A
  • Viral
  • Bacterial
  • Toxic Substances (ETOH, drugs, etc.)
  • Immune
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3
Q

How is Hepatitis A transmitted?

A

Fecal-orally

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4
Q

What does it take to kill Hepatitis A on surfaces/objects?

A

Bleach or very high temperatures

detergents and acids don’t work

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5
Q

What type of symptoms are seen with Hepatitis A?

A

Mainly GI symptoms

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6
Q

What is Hepatitis A pre-exposure treatment?

A

Hep A Virus Vaccine (2 doses, 6 months apart)

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7
Q

What is Hepatitis A post-exposure treatment?

A

Immune globulins within 2 weeks PLUS vaccination

Healthy pts (12 months - 40 years): only need vaccine post-exposure

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8
Q

How is Hepatitis B transmitted?

A

Blood and Body Fluids (semen, vaginal secretions, and perinatal exposure during birth)

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9
Q

Which Hepatitis do most adults develop immunity to if exposed?

A

Hepatitis B

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10
Q

What are patients with chronic hepatitis at increased risk for?

A

Cirrhosis and Liver Cancer

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11
Q

Who should be tested for Hepatitis B?

A

Pregnant women with each pregnancy

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12
Q

What is pre-exposure care for Hepatitis B?

A

Vaccination

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13
Q

What is post-exposure care for Hepatitis B?

A

Immune globulin (IG) + vaccination

  • Perinatal Exposure: treat within 12 hours
  • Exposure: treat within 2 weeks
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14
Q

How is Hepatitis C transmitted?

A

Blood

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15
Q

What activity results in the highest incidence of Hepatitis C?

A

IV drug abuse

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16
Q

Is breastfeeding allowed with Hepatitis C?

A

Only if nipples aren’t cracked and/or bleeding

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17
Q

Is there a vaccine for Hepatitis C?

A

No vaccine available, chronic condition if not cured

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18
Q

Who should be screened for Hepatitis C?

A

Anyone older than 18 (once), and pregnant women

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19
Q

How is Hepatitis D contracted?

A

It is contracted with Hepatitis B as a co-infection or superinfection

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20
Q

How does the Hepatitis D fatality compare with Hepatitis B?

A

Hepatitis D is much more fatal

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21
Q

Which variants of Hepatitis can a person be vaccinated for?

A

Hepatitis A, B, D (through B vaccination)

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22
Q

What are the functions of the liver?

A
  • Formation of Albumin
  • Formation of clotting factors such as Prothrombin
  • Convert ammonia to urea (BUN)
  • Vitamin Storage (A, D, E, K, B12)
  • Drug metabolism, breakdown, and excretion
  • Formation of Bile
  • Hormone homeostasis
  • Immunity through phagocytic cells
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23
Q

What is Bile used for?

A

Bile is used in fa metabolism and fat soluble vitamins

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24
Q

What does ammonia result from?

A

Protein metabolism results in a waste product of ammonia

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25
Q

Why is Vitamin K important?

A

It’s a key component for clotting factors

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26
Q

What are clinical manifestations for Liver Failure?

A
  • Mostly asymptomatic/flu-like, until the end stages
  • Abdominal pain
  • Joint/muscle pain
  • Lethargy/Malaise
  • Fever
  • Nausea/Vomiting
  • Pruritus
  • Jaundice (Icterus) - only in late stages
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27
Q

Hepatitis A Testing

A

IgM ant-HAV antibodies: current infection

IgG anti-HAV antibodies: immunity/recovery

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28
Q

Hepatitis B Testing

A

HBcAB (Core antibody) - exposure to virus/natural infection “presumptive infectious”

HBsAG (Surface antigen) - acute or chronic (after 6 months) infection

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29
Q

Hepatitis C Testing

A

HCV Antibody (+) - presumptive: past/current infection

HCV RNA (+) - currently infected

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30
Q

What are the diagnostic tests for assessing the degree of liver injury?

A
  • ALT
  • AST
  • ALT/AST Ratio
  • Albumin
  • Ammonia
  • BUN
  • PT, PTT, INR times
  • Bilirubin: conjugated ( cirrhosis) and unconjugated (obstruction and hepatitis)
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31
Q

What is the lifespan of RBCs?

A

120 days

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32
Q

Liver Biopsy Care: Before

A
  • NPO for 6 hours
  • Check clotting times
  • Admin “-phyton” PRN
  • Informed consent
  • V/S
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33
Q

Liver Biopsy Care: During

A
  • Instruct to exhale and hold

- DON’T move during procedure

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34
Q

Liver Biopsy Care: After

A
  • R side position
  • V/S
  • Assess for S/S of hemorrhage
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35
Q

Safety for Liver Failure Patients

A
  • Bleed risk: electric razor, no sticks
  • Vitamin supplements (Thiamine, B vitamins)
  • Diet: small, frequent, high carb meals
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36
Q

What can cause cirrhosis of the liver?

A

Hepatitis and alcohol (mainly), also any liver disease

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37
Q

What is Cirrhosis of the Liver?

A

A chronic, destructive course resulting in end-stage liver disease

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38
Q

What is a possible side-effect of Liver Cirrhosis?

A

Gynecomastia

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39
Q

What are the 4 basic types of Cirrhosis?

A

Laennec’s: r/t alcohol intake
Post Necrotic: r/t infectious or toxic hepatitis (most common world wide)
Biliary Cirrhosis: biliary obstruction or destructrion
Cardiac Cirrhosis: secondary to CHF

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40
Q

What are common assessment findings for Cirrhosis?

A
  • Jaundice
  • Ascites
  • Edema
  • Vitamin deficiency
  • Petechiae
  • Ecchymosis
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41
Q

What are complications of Cirrhosis?

A
  • Portal Hypertension
  • Bleeding esophageal varices
  • Coagulation defects
  • Jaundice
  • Ascites
  • Hepatic encephalopathy (leads to ammonia in the brain)
  • Gynecomastia
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42
Q

What is Portal Hypertension?

A

Increased pressure within the portal vein due to cirrhosis (liver scarring)

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43
Q

What can Portal Hypertension cause?

A
  • Splenomegaly
  • Varices (dilated veins)
  • Ascites (peritoneal fluid build-up and swelling)
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44
Q

How much blood flows through the liver?

A

1,500 mL/min

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45
Q

Where do varices commonly occur?

A
  • Distal esophagus
  • Stomach
  • Rectum
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46
Q

Why are varices a problem?

A

They are prone to leakage and rupture

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47
Q

What could cause rupture of varices?

A
  • Coughing
  • Strenuous exercise
  • Trauma
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48
Q

What does high levels of Ammonia cause?

A

Decreased LOC

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49
Q

What is the recommended treatment for Variceal Hemorrhage?

A
  • Maintain the airway
  • Replace volume (caution with LR - may elevate ammonia in sever liver disease)
  • Prep for emergent endoscopy
  • Insert NGT: assess new bleeding and lavage
  • Reduce hepatic blood flow (use “-pressin”, but nitro to counteract around the heart)
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50
Q

What is a common symptom of variceal hemorrhage?

A

Projectile vomiting

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51
Q

Long-term Varices Management

A
  • Screening endoscopies
  • Beta Blockers (“-lol”)
  • Monitor Hgb and Hct, anemia, melena (bloody stool), and coffee ground emesis
  • TIPS (Transjugular Intrahepatic Portosystemic Shunt): reduces portal venous pressure
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52
Q

Symptoms for Excess Bilirubin

A
  • Jaundice: skin, sclera, mucuos membranes
  • Pruritis (itching)
  • Clay colored stools: no bile in GI tract
  • Dark colored urine
  • Need to avoid high temperature = increased itch
  • Keep skin clean and moisturized
  • Use antihistamines
  • Keep nails short
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53
Q

What are the fat soluble vitamins?

A
  • A
  • D
  • E
  • K
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54
Q

Nursing Considerations for a Coagulation Defect

A
  • Monitor PT, PTT, INR
  • Monitor for s/s bleeding, coagulation studies
  • Vitamin K PRN (SubQ, IM, PO) “-phyton”
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55
Q

Where is Albumin produced?

A

The liver

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56
Q

What is ascites?

A

Fluid accumulation in the peritoneum

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57
Q

What does low albumin cause?

A

A fluid shift into the interstitial space

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58
Q

What is the best/most reliable way to assess ascites?

A

Ultrasound

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59
Q

Nursing Care for Ascites

A
  • Diuretics (lasix, aldactone)
  • Limit Na (0.5 - 2 g/day)
  • Limit PO and IVF (1,000 - 1,500 mL/day)
  • Check electrolytes
  • Elevate HOB
  • Check abdominal girth
  • Input/Output and daily weight
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60
Q

What is the purpose of a paracentesis?

A

To relieve abdominal pressure and to evaluate the peritoneal fluid

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61
Q

Paracentesis pre-procedure care

A
  • Consent form
  • Void prior to procedure
  • Upright position
  • Albumin IV
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62
Q

Paracentesis post-op care

A
  • V/S, including weight
  • Monitor for s/s hypovolemia
  • Albumin replace if ordered (for larger amount drained)
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63
Q

Long-term Management for Ascites

A
  • PleurX Drainage system (q 1-2 days)
  • Shunt Placement

High complication rate:
-Infection, Bleeding, Shunt Failure

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64
Q

What is a result of Portal-Systemic Encephalopathy (PSE)?

A

Altered mental capacity d/t high serum ammonia

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65
Q

What are the common precipitating factors for PSE?

A
  • Excessive protein intake and GI bleeds (protein digestion = higher ammonia)
  • Constipation (GI flora change increases ammonia)
  • Drugs (opioids, sedatives, analgesics)
  • Infection
  • Electrolyte imbalance (low K)
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66
Q

Symptoms of PSE

A
  • Restlessness, short attention span, LOC change
  • Asterixis “wrist flap” (unable to hyperextended wrist)
  • Fetor hapticus (liver breath)
  • Comatose
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67
Q

Treatment of PSE (Supportive care)

A
  • Protein restriction (plant proteins)
  • Avoid electrolyte imbalances and dehydration
  • Fall precautions
  • Vulnerable to over-sedation
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68
Q

Treatment of PSE (To lower ammonia)

A

-Administer “lactulose” (titrate to 2-4 stools/day)
-Lower colonic pH
S/E: Abd cramps, hyperglycemia, diarrhea -> hypokalemia and dehydration
-Antibiotics

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69
Q

What are the two types of Liver Cancer?

A
  • Primary Hepatic Cancer: originates in the liver

- Metastatic Hepatic Tumor: originates outside the liver

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70
Q

What are the main causes for Primary Hepatic Cancer?

A
  • Chronic Hepatitis B or C (most common)

- Cirrhosis

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71
Q

What are the symptoms of Liver Cancer?

A

They depend on the amount/size of damage

  • Early S/S: vague, until large tumor
  • Jaundice, ascites, hepatic encephalopathy
  • Elevated (AFP) alpha-fetoprotein levels
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72
Q

Treatment for Liver Cancer

A
  • Surgical management if contained to only 1 lobe, may increase survival by up to 5 years
  • Chemotherapy
  • Cryotherapy
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73
Q

Organ Transplants

A
  • Obesity leads to fatty liver = unable to donate

- Prioritized on a waiting list

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74
Q

Liver Transplant Considerations

A

Transplant not an option for:

  • Malignant cancer
  • Severe CVD
  • Inability to follow instructions about drug therapy or self-care
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75
Q

Post Transplant Care

A

-Monitor s/s of rejection
-Infection risk
-Hepatic or Renal complications
Bleeding
Petechiae
Ecchymosis
Elevated liver and renal function tests

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76
Q

What are the types of Pancreatitis?

A
  • Acute

- Chronic

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77
Q

What is Acute Pancreatitis?

A

Exocrine disorder

-Premature activation of pancreatic enzymes which leads to auto-digestion

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78
Q

What are symptoms of Pancreatitis?

A
  • Severe epigastic, L quadrant pain (most common)
  • Nausea/Vomiting
  • Abdominal distention
  • Jaundice
  • Low grade fever
  • Hypovolemic shock: tachycardia, hypotension r/t inflammation
  • Grey turner’s sign: flank
  • Cullen’s sign: belly button
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79
Q

Pancreatitis pain

A
  • “Boring” pain
  • Worsened in supine
  • Lessened in fetal position
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80
Q

Where is Cullen’s Sign found?

A

The belly button

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81
Q

Where is Grey Turner’s Sign found?

A

The flank

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82
Q

At what Hgb do you transfuse blood?

A

Hgb <9

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83
Q

Potential Complications of Pancreatitis

A
  • Jaundice
  • Hyperglycemia
  • Hypocalcemia (HALLMARK of pancreatic/fat necrosis)
  • Pulmonary complications (ARDS, pleural effusion, atelectasis, pneumonia)
  • Paralytic ileus d/t peritoneal irritation
  • Hypovolemic shock d/t fluid shift and/or hemorrhage
  • DIC (deactivated clotting factors)
  • Renal failure d/t hypovolemia
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84
Q

What are diagnostic tests for Pancreatitis?

A
  • Elevated serum Amylase
  • Elevated serum Lipase
  • Elevated WBC
  • Decreased Hgb and Hct
  • Elevated ALT
  • Elevated glucose r/t insulin production stopping
  • Decreased potassium r/t N/V
  • Decreased calcium r/t lipolysis
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85
Q

Pancreatitis Interventions

A 
-A,B,C
     ICS, Cough and Deep Breathe
     Fluid replacement
-Pain control - morphine (demerol by old HCPs)
-Input and Output
-Monitor labs
-Nutrition: TPN, enteral or PO feeds (assess peristalsis)
-Histamine blockers/PPI
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86
Q

Invasive Pancreatitis Treatments

A
  • Drain pancreatic abscess to remove necrotic tissue

- ERCP to remove gallstones

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87
Q

How survivable is Pancreatitis?

A

90% recover with just supportive care in 5-7 days

10% die from acute pancreatitis r/t severe respiratory issues -> left lower lung issues

“Ranson criteria” to evaluate chance of outcome

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88
Q

What is Chronic Pancreatitis?

A

A progressive, destructive disease that goes through phases of remission and exacerbation

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89
Q

What is the primary risk factor for Chronic Pancreatitis?

A

Alcoholism

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90
Q

What (besides alcoholism) causes Chronic Pancreatitis?

A

Autoimmune issues, obstruction of the sphincter of oddi

91
Q

What affects the sphincter of oddi?

A

Alcohol - causes spasms

92
Q

What are symptoms of Chronic Pancreatitis?

A

-Abdominal pain (lower amount than acute)
-Insufficient enzyme production
Malnutrition (decreased fats and proteins)
Steatorrhea (fatty stools)
-Diabetes
-Ascites

93
Q

What is steatorrhea?

A

fatty stool

94
Q

What do you focuss on for Chronic Pancreatitis interventions?

A

Pain, nutrition, and prevention of reoccurrences

Don’t assume pancreatitis = alcoholism

95
Q

What are specific interventions for Chronic Pancreatitis?

A

-Nutrition (main focus)
High caloric intake: 4,000 - 6,000 calories (high protein and carbs, low fat)
-TPN (or J Tube)
-Insulin (even for non-diabetic patients)
-Enzyme Replacement Therapy

96
Q

What drugs can enhance PERT (Pancreatic Enzyme Replacement Therapy)?

A

H2 Blockers or PPIs

97
Q

When should you not take PERT?

A
  • On an empty stomach
  • With drinks that contain <1/2 milk = tea, squash, fizzy drinks
  • If you eat only small quantities of food
98
Q

Enzyme Replacement Therapy (PERT)

A
  • Take with food at meals, follow PERT with glass of water
  • Take after H2 blockers or antacids
  • Don’t chew
  • If can’t swallow pill, use with applesauce
  • Don’t mix with protein foods
  • Wipe lips after
  • Don’t crush
  • Follow up
99
Q

When might it be appropriate to alter own dose of PERT?

A

If experiencing loose stools or failing to gain weight

100
Q

Education for PERT

A
  • Monitor uric acid levels
  • Monitor for fatty stools
  • Prevent exacerbations of pancreatitis (avoid ETOH and caffeine)
101
Q

What is a risk from PERT?

A

PERT = increased uric acid = chance of gout

102
Q

Pancreatic Carcinoma

A
  • Survival is extremely rare

- Cause is unknown

103
Q

What is the purpose of a “Whipple”?

A

Redirects the body’s pancreatic enzymes when part of the pancreas has to be removed

104
Q

Whipple Post-op Care

A

-NPO, NGT with contiuous suction

expect serosanguineous drainage (pink/yellow)

105
Q

What are Whipple Post-op complications?

A
  • Hemorrhage
  • Diabetes
  • Wound infection, dehiscence
  • Bowel obstruction
106
Q

How o you know when NGT can be removed?

A
  • Turn off suction and listen for BS

- Stool or gas passage

107
Q

Total Pancreatectomy Diet

A
  • Lentils
  • Chick peas
  • Garbanzos
108
Q

Will a total pancreatectomy resolve a carcinoma?

A
  • No, the cancer often returns

- A successful surgery only adds 5-6 more years

109
Q

Lung Sounds: Crackles

A
  • Air passing through fluid
  • Clear by suctioning
  • Heard on inspiration
110
Q

Lung Sounds: Wheezes

A
  • Narrowed airway
  • High pitched
  • Whistling sound
111
Q

Lung Sounds: Rhonchus

A
  • Coarse, snoring
  • Larger Airway
  • Air passing over solid, thick sputum
  • Heard on expiration
  • Cleared by coughing
112
Q

Lung Sounds: Stridor

A

-Louder noise of the neck than over the chest wall

113
Q

Lung Sounds: Bronchial

A
  • Trachea

- Main stem brochi

114
Q

Lung Sounds: Bronchovesicular

A

-Branching bronchi

115
Q

Lung Sounds: Vesicular

A

-Small bronchi

116
Q

What are risk factors for Lung Cancer?

A
  • Smoking (90% of cases)
  • Second hand smoke
  • Radon exposure
  • Occupational pollutants
  • Asbestos
117
Q

Tobacco Use Calculation

A

packs per day x years of smoking = pack years

118
Q

How long does it take for lungs to fully recover and cancer risk to be normal again?

A

15 years post-cessation of smoking

119
Q

What are the two classifications for Lung Cancer?

A

Non-small cell (NSCLC)

Small Cell (Oat cell)

120
Q

Non-Small Cell Lung Cancer (NSCLC)

A

85% of all Lung Cancers

-3 types

121
Q

Small Cell (Oat Cell) Lung Cancer

A

Most Malignant

  • 5 year survival is 5-10%
  • Causes paraneoplastic syndrome (endocrine issues)
122
Q

Clinical Manifestations of Lung Cancer

A
  • New chronic cough
  • Hemoptysis
  • SOB
  • Wheezing
  • Hoarse
  • Chest pain
  • Unexplained weight loss
  • Frequent respiratory infections
  • Headache
  • Bone pain
123
Q

Common sites for lung cancer metastasis

A
  • Bone
  • Liver
  • Adrenal Glands
124
Q

Diagnostics for Lung Cancer

A
  • Sputum Cytology
  • X Ray, CT, MRI, PET
  • Fiber optic bronchoscopy with biopsy**
  • Thoracoscopy
  • Percutaneous lung biopsy
  • Thoracentesis with fluid evaluation
125
Q

Fiber Optic Bronchoscopy with Biopsy - post op care

A
  • Monitor for respiratory distress
  • Keep the patient NPO until gag reflex returns
  • Monitor for s/s bleeding
126
Q

Lung Cancer Screening for at risk population

A

Yearly “low-dose” CT scans

127
Q

What is a lobectomy?

A

Removal of a lobe of the lung

128
Q

What is a pneumonectomy?

A

Removal of an entire lung

129
Q

What is decortication of a lung?

A

Surgical removal of the surface layer of a lung

130
Q

Which needs chest tubes: Lobectomy or Pneumonectomy?

A

Lobectomy

131
Q

Where will chest tubes be post-lobectomy?

A

Apex and Base of the lung

Apex- little drainage
Base- most of the drainage d/t gravity

132
Q

Lobectomy Post-op Care: Pain Managing

A
  • PCA
  • Epidural
  • On-Q Soaker
133
Q

What is Crepitus?

A

Subcutaneous Emphysema: air between skin layers “Rice Krispies”

  • Common immediately post-op
  • Mark the area to track size
134
Q

Positioning of Patient: Pneumonectomy

A

Operated side or supine

135
Q

Positioning of Patient: Lobectomy

A

Non-operated side or supine

136
Q

Post-op Care: Pneumonectomy/Lobectomy

A
  • Maintain chest tube patency
  • Monitor for complications
  • Exercise affected arm & shoulder (no heavy lifting 6 months)
137
Q

What are complications from a Pneumonectomy or Lobectomy?

A
  • Sudden SOB
  • Trachea shift (mediastinal shift)
  • Pain
  • Low CO
  • Cardiac herniation (RARE)
138
Q

Order of Steps to Address with Patients Who Smoke

A
  • Ask
  • Advise
  • Assess willingness
  • Refer

Help arrange follow-up

139
Q

Options to Help Quit Smoking

A

-Replace smoking with healthy habits
-Nicotine patches
-Nicotine gum
-Zyban (wellbutrin), bupropion)
-Chantix
S/E:
Anger
Nightmares
Etc.

140
Q

Lung Cancer = end of life care

A
  • Overall 5 year survival is only 14%

- Requires palliative and/or hospice care

141
Q

What can a clamped chest tube cause?

A

Tension pneumothorax

142
Q

What is the purpose of a chest tube?

A

To re-inflate the lung; removal of air (pneumothorax) or fluid (hemothorax) from pleural space

143
Q

Chest Tube System - Chamber #1: Drainage

A
  • Collects fluids
  • Assess for sudden increase/cessation of output
  • Normal: 100 ml/hr
  • Output decreases as healing occurs
  • After first day, check q8h
144
Q

Chest Tube System - Chamber #2: Water Seal

A
  • Prevents air from entering pleural space “one-way valve”
  • Bubbles during forceful expiration or cough = draining air
  • Contiuous bubbling = broken system
  • Bubbling completely stops = healed or tube kinked
145
Q

Tidaling in the Water Seal Chamber

A

Water level ^/v with respiration

146
Q

Chest Tube System - Chamber #3: Suction Control

A

-Wet or Dry Suction Control

Recommnded Suction: 20 cm H2O

147
Q

Wet Suction Control

A

Suction controlled by water level

-water will gently bubble when connected to wall suctioning

148
Q

Dry Suction Control

A

Suction controlled by dial

149
Q

Chest Tube Care Principles

A
  • Call HCP if sat <90%
  • Document drainage per protocol, Intake and Output
  • Avoid vigorous stripping
150
Q

What do you do if Chest Tube is pulled from the chest wall?

A

Cover with sterile dressing and tape of 3 sides*

151
Q

What do you do if chest tube is disconnected from the drainage system?

A

Submerge the tube in H20 (temporary water seal); call for help

152
Q

Nursing Actions for Chest Tube

A
  • Monitor for Crepitus
  • Encourage cough and deep breathing
  • Secure all connections
  • Monitor for complications
153
Q

Removal of Chest Tube

A

Cover with vaseline gauze (controversial) or Tegaderm

154
Q

What is the purpose of an ET Tube?

A

To maintain a patent ariway

155
Q

What is the purpose of a mechanical ventilator?

A

To breathe for the patient when they aren’t able to

156
Q

Define Tidal Volume

A

The amount of air moved by each respiration

157
Q

PEEP vs. CPAP

A

PEEP is only pressure during expiration. CPAP is constant pressure through inspiration AND expiration

158
Q

What are possible complications from a Ventilator?

A
  • Hypotension
  • Aspiration
  • Infection
  • Ventilator Associated Pneumonia (VAP)
  • Barotrauma (overdistention of alveoli)
159
Q

What are some nurse care examples for a Ventilator?

A
  • HOB 30 to 45 degrees
  • Suction PRN
  • Monitor for S/S of infection (VAP, aspiration pneumonia, etc.)
  • DVT Prevention
  • NPO, TPN
160
Q

What are risk factors for Acute Respiratory Failure?

A
  • Pulmonary edema
  • Pneumonia
  • Pulmonary embolism
  • Hypercapnic respiratory failure
  • Asthma
  • Narcotics overdose
  • Myasthenia gravis
161
Q

Types of Acute Respiratory Failure

A

-Impaired ventilation/hypoventilation
Airway obstruction, OD

-Ventilation perfusion mismatch (lungs functioning, but not perfused)
Pulmonary embolism

-Impaired O2 diffusion at alveolar level
ARDS, pulmonary edema, fluid in alveoli

162
Q

What are clinical manifestations of Acute Respiratory Failure?

A

Main Symptoms: dyspnea, orthopnea or DOE (dyspnea on exertion)

-Hypercapnia/ Hypercarbia (high CO2)/ Hypoxia (low O2)
Changes in RR, HR, BP
HA, confusion, decreased LOC

163
Q

Cyanosis vs. Clubbed Fingers

A

Cyanosis - acute hypoxia

Clubbbing - chronic hypoxia

164
Q

Acute Respiratory Distress Syndrome (ARDS)

A

Criteria:

  • Acute onset (<7 days)
  • Refractory hypoxemia (doesn’t respond to noninvasive O2 therapies
  • Bilateral infiltrates on X Ray (white out)
  • No evidence of CHF
165
Q

Precipitating Factors for ARDS

A
  • Shock
  • Trauma
  • Pancreatitis
  • Sepsis
  • Pulmonary Aspiration
  • Toxin Inhalation
  • Multiple blood transfusions (within 6 hrs of transfusion time)
166
Q

What causes ARDS?

A

Release of chemical inflammatory mediators leads to lung injuries (increased capillary permeability = fluid into alveoli)

167
Q

What are clinical manifestations of ARDS?

A
  • Rapid onset of sever dyspnea
  • Increased alveolar deadspace
  • Hypoxemia that doesn’t respond to supplemental O2
  • Abnormal lung sounds
  • Altered LOC
  • Cyanosis
  • Intercostal and/or substernal retractions
  • Tachycardia
  • Hypotension
168
Q

Nursing Implications for ARDS

A
  • Strict infection control
  • Intubation and ventilation with PEEP, CPAP< or APRV
  • Corticosteroids = decreased inflammation
  • Prone positioning (controversial)
  • Nutrition
  • Fluids as ordered
  • Inhaled Nitric Oxide
  • Surfactant Replacement
169
Q

What is the functino of Nitric Oxide?

A

Vasodilation

170
Q

Extra-Corporeal Membrane Oxygenation (ECMO)

A

Oxygenates the blood and allows lung rest and healing (lung dialysis)

171
Q

Pulmoary Embolism

A

Obstruction of the pulmoary artery or one of its branches, (by solid, liquid, air) usually by a blood clot

Pts. may die within 1 hr of onset

172
Q

Pulmonary Embolism Predisposing Factors

A
  • Prolonged immobility (venous stasis)
  • CVC
  • Surgery (vessel damage, clotting)
  • Obesity
  • Age
  • Increased clotting conditions (pregnant, sickle cell, estrogen tx)
  • History of thromboembolism
173
Q

Symptoms of Pulmonary Embolism - Classic

A
  • Sudden dyspnea
  • Pleuritic chest pain
  • Tachypnea
  • Anxiety
  • Feeling of impending doom/unwell
  • New cough
  • Hemoptysis
174
Q

Symptoms of Pulmonary Embolism - Severe

A
  • Tachycardia
  • JVD
  • Hypotension d/t no right side circulation
175
Q

Any idiopathic: SOB, Chest Pain, and/or hypotension

A

Call HCP immediately

176
Q

Prevention for a PE

A 
-Prevention of DVT
     Homan's sign - can't rely on
     Notice unilateral swelling
-Passive, active ROM
-Ambulate ASAP
-Antiembolism, compression stockings/device
-Anticoagulants/Antiplatelets
-Avoid smoking
177
Q

Diagnostics for PE

A

-CT scan
Know kidney function (BUN/Cr, UOP >30 ml/hr)
-Ventilation perfusion scan (VQ scan)
-D dimer

178
Q

PE Drug Therapy

A

Anticoagulants

  • Heparin: PTT 1.5-2.5 x normal
  • Coumadin (Warfarin): INR 2-3
  • Lovenox (enoxparin): SubQ q12h
  • Xarelto (rivaroxaban):

Thrombolytics: “-ase”

179
Q

Presentation for Laryngeal Trauma

A
  • Hoarseness
  • Difficulty swallowing
  • Dyspnea
  • Hemoptysis
  • Hematoma/edema of neck
180
Q

Nursing Interventions for Laryngeal Trauma

A
  • Monitor airway patency
  • Trach tray and emergency equipment at bedside
  • Humidified air
  • HOB >45 degrees
  • Aspiration precautions
  • Voice rest
181
Q

Laryngeal Trauma: Prep for Surgery

A
  • Evacuation of hematoma
  • Repair lacerations
  • Stabilization of fractures
  • Total laryngectomy (won’t be able to speak after)
182
Q

PaO2 in acute care

A

> 60 mmHg

183
Q

CPAP Modes

A
  • Invasive

- Noninvasive

184
Q

Invasive interventions for Acute Respiratory Failure

A

ET Tube (Invasive, last resort) - Advantages

  • Decreased airway resistence
  • Decreased work of breathing
  • Improved oral care
  • Improved suctioning
  • Improved patient comfort
185
Q

ET Intubation

A

Provide O2 if attempt >30 seconds

Monitor for:

  • V/S
  • Signs of hypoxia or hypoxemia
  • Dysrhythmias
  • Aspirations
186
Q

Verification of ET Tube Placement

A

Clinical Assessment:

  • Chest Rise
  • Bilateral Breath Sounds
  • Gurgling in Stomach (misplacement into esophagus)
  • Waveform capnography**

Stabilize the ET tube

187
Q

Waveform Capnography - ETCO Value

A

35 - 45 mmHg

188
Q

Pressure Alarms with ETT (Low/High)

A

Low Pressure: leakage; pt stopped breathing (if on CPAP or SIMV)

High Pressure: Blockage; biting/couhging/mucus plug/kink/water collection -> fix with suction

189
Q

Mechanical Ventilator Complications

A
  • Hypotension (especially PEEP): increased intrathoracic pressure = decreased CO
  • Aspiration: epiglottis not functioning
  • Infection
  • VAP (48 hr or more after intubation)
  • Barotrauma: alveolar rupture
  • Friable lungs
190
Q

What can chronic use of corticosteroids cause?

A

Decreased healing

191
Q

Weaning of Mechanical Vent/ETT

A

Criteria:

  • Individualized
  • Ability to breathe spontaneuously
  • Ability to maintain adequate O2
  • Hemodynamically stable

Must DC sedation, assess VS and LOC

192
Q

Extubation

A

Monitor:

  • VS
  • S/S resp. distress: SOB, coughing, stridor, inability to cough up secretinos, aspiration
  • Limit speaking
  • Semi Fowler’s
  • ICS
193
Q

Modes of Ventilator

A
  • Tidal Volume: amount of air in each respiration
  • Rate: bpm
  • FiO2: oxygen concentration to patient (RA is 21%)
194
Q

Side Effects of PEEP

A
  • Additional intrthoracic pressure = decreased CO
  • Pneumothorax
  • Barotrauma in friable tissue
  • Low CO
195
Q

Controlled Mechanical Ventilation (CMV)

A

Machine completely controls all aspects of breathing

-severe spinal injury, sedation/paralytic agent

196
Q

Synchronized Intermittent Mandatory Ventilation (SIMV)

A

Pt can take sponteaneous b/w ventilator breaths

As patient is able to take more spontaneous breaths, resp. alk. risk increases

197
Q

Assist-Control Ventilation

A

SIMV but pressure support added on spontaneous breaths

Ideal for respiratory muscle recovery

198
Q

CPAP

A

Invasive or Noninvasive

Keeps alveoli open; patient breathes spontaneously

199
Q

Allen’s Test before obtaining ABG from ______ Artery

A

Radial Artery

Occlude one side, then the other and check blood return

Firm pressure of site: Radial = 5 min, Femoral = 10 min

200
Q

Symptom of Aortic damage

A

cough d/t laryngeal nerve stimulation

201
Q

Primary Assessment

A

To rule out or identify life-threatening conditions

202
Q

ABCDE of Primary Assessing

A

A - Airway (C4 & C5 innervate diaphragm = C-spine precautions)

B- Breathing (equal/ breath sounds/ chest wall movement)
C- Circulation (HR, BP, IVF)
D- Disability (GCS or AVPU scales)
E- Expose (Remove clothing to get clear visualisation, but prevent hypothermia)

203
Q

What would a pulse at only: radial, femoral, or carotid, indicate?

A

Radial - BP >80
Femoral - BP >70
Carotid - BP >60

204
Q

What 3 components make up the Triad of Death?

A

Hypothermia, Metabolic Acidosis, Coagulopathy

These all are positive feedback looped resulting from hemorrhage

205
Q

Secondary Assessment: AMPLE

A 
A - Allergies
M - Medication Use
P - Past Medical History
L - Last Meal
E - Events/Environment b4 injury
206
Q

Clues for Potential Injuries: Diminished Breath Sounds, Bowel Sounds in Lower Mid Chestr, Bruit, Muffled Heart Sounds

A

Diminished Breath Sounds: pneumothorax
Bowel Sounds in Chest: ruptured diaphragm
Bruit: vascular injury
Muffled Heart Sounds: cardiac tamponade, pericardial bleed

207
Q

When is the only time that a bruit is a good thing?

A

In assessing a fistula

208
Q

What can JVD indicate?

A

Tension pneumothorax

Paricardial tamponade

209
Q

What can Flat JV indicate?

A

Hypovolemia

210
Q

What does a shifted trachea indicate?

A

Tension pneumothorax

Massive hemothorax

211
Q

What is the most common blunt chest injury?

A

Rib fx

212
Q

What is a Flail Chest?

A

Ribs are broken in two places, resulting a free-floating piece of the ribcage

213
Q

What can 1st and 2nd rib fx injure?

A

Blood vessels and nerves

214
Q

What can fractures of ribs 9-12 injure?

A

Liver, Spleen or Diaphragm

215
Q

S/S of Flail Chest

A
  • Paradoxical respirations
  • Chest wall pain
  • Respiratory complication (r/t pain on respiration)
216
Q

Interventions for Rib fx

A

Pain meds (carefully) to lessen pain and improve ventilation ability

217
Q

What is a Pulmonary Contusion?

A

Hemorrhage b/w alveoli resulting in pulmoary edema and respiratory failure (may develop over time)

218
Q

Nursing Care for Pulmonary Contusion

A
  • O2
  • Chest Tube if pneumo/hemo-thorax
  • GCS <8 requires intubation
219
Q

S/S of pneumothorax

A
  • Dyspnea
  • Tachycardia
  • Hyper resonance on INJURED side
  • Decreased breath sounds on INJURED side
  • Pleuritic chest pain
  • Subcutaneous emphysema (crepitus)
  • Tracheal deviation
220
Q

S/S of Tension Pneumothorax (order)

A
  • Tachycardia
  • Severe respiratory distress
  • Hypotension
  • JVD
  • Angina
  • Tracheal Deviation
  • Cyanosis
221
Q

S/S of Hemothorax

A

Dullness on INJURED side (with percussion)

222
Q

Thoracotomy/Chest Tube

A

Pneumothorax: 2nd or 3rd intercostal space at midclavicular line

Hemothorax: 4th to 8th intercostal space at midaxillary line

223
Q

5 P’s

A
  • Pain
  • Parasthesia
  • Pallor
  • Pulse
  • Paralysis

Adult Health 3 (12 decks)

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