Vascular Lung Disorders Flashcards
What is the definition of pulmonary edema?
abnormal accumulation of fluid in alveoli and interstital spaces
what is the difference between pleural effusion and pulmonary edema ?
pleural effusion
- abnormal amount of fluid in pleural space
- so fluid is in the chest cavity below the lung and it pushes up the lung, resulting in pneumothorax
pulmonary edema
- fluid is already INSIDE the lung between the alveoli
pulmonary edema usually is a complication of what ?
most common cause of pulmonary edema is what?
heart and lung disease
left sided heart failure
what are some common manifestations of pulmonary edema ?
dyspnea
crackles
wheezing
chest pain
patients with pulmonary edema have a very specific type of productive cough, what is it ?
pink frothy sputum
test question
if you see a patient in respiratory distress what are we doing to do first?
give them oxygen?
raise the rest of the bed ?
raise the head of the bed
- this will help with lung expansion
then give them oxygen
what does pulmonary embolism (PE) mean ?
blockage of one or more pulmonary arteries by thrombus, fat or air embolus or tumor tissue
what does embolism mean ?
a clot, usually from the venous system goes dislodges itself and travels up into the pulmonary circulation then lodges into the small blood vessels and obstructs alveolar perfusion
most of the time, pulmonary embolism is often found and effect what part of the lung ?
lower lobes
who are at the most risk of developing a pulmonary embolism?
bed ridden patients
trauma patients
what is the mainly the cause of pulmonary embolism, or think about how most of the time it happens ?
you already had a clot before hand, typically a DVT and then it dislodged and traveled up into the pulmonary circulation, causing the pe
Where does venous thromboembolism (VTE) originate ?
what are some other forms that VTE can occur ? think of medical procedures
deep veins of legs, femoral or iliac veins, right side of the heart
central venous cetherters, IV lines
what is a saddle embolus ?
large thrombus at aerial bifurcation
- large clot affecting both lungs
does a pulmonary embolism happen fast or slow ? and explain the patho behind this ?
fast
reason why is because it usually comes from the DVT already formed and most of the time patients can’t really tell its in there legs cause the lack of symptoms, but the second it goes into your lungs, you are out of breath almost instant
the bigger the clot the more likely you are to see what within a patient ?
the severity of symptoms, so like the complications are going to be more worse
what are some common manifestations you will see with patients who just got a pulmonary embolism, so think of them one second they are fine and now the clot is in their chest? (4)
change in mental status
hypotension
impending sense of doom
dyspnea
what are 2 complications that occur from pulmonary embolism ?
pulmonary infarction
pulmonary hypertension
what is pulmonary infarction ?
explain to me the patho
occlusion of medium or large sized vessel, inadequate collateral blood flow and preexisting lung disease results in alveolar necrosis and hemorrhage which may results in abscess and pleural effusions
so with pulmonary embolism, we have a clot that is preventing proper perfusion and circulation of blood and oxygen, when the body doesn’t receive either of these things, it will begin to die or in other words necrosis, causing your alveoli to usually collapsing and furthering the complications
what is pulmonary hypertension ?
explain the patho behind this for pulmonary embolism
most of the time though, it takes about 50% or more for your body to go through hypertension because of the hypoxemia in your tissues
your body is having to work 100x harder to try to get blood and oxygen across this clot, usually resulting in patients to get right ventricular hypertrophy
circulation test
the right side of your heart pumps blood and oxygen to your ?
the left side of your heart pumps blood and oxygen to your ?
lungs
the rest of the body
what is the first and most effective method of testing out if the patient has pulmonary embolism ?
D-dimer tests
what are the other 2 forms of testing other than the D-dimer we use to test for a pulmonary embolism?
Spiral (Helical)
V/Q scan
how does a d-dimer help us rule out if there is a pulmonary embolism effecting our patient ?
elevated d-dimer in the body
what if there is a negative d-dimer, what do we do as nurses?
try doing other exams and rule out anything else unless proven otherwise
what does a spiral helical ct scan do to help us find out a pulmonary embolism?
we give patients IV contrast media and take a 3d picture of the pulmonary vasculature to see any clots present, but we try not to do this anymore because some clots can be very small and go unnoticed
what does v/q contrast help us identify a pulmonary embolism?
perfusion scanning - pulmonary circulation
ventilation scanning - distribution of gas in lungs
usually it will be mismatched and uneven
notes
some other form of assessments we can do that aren’t those tests mentioned previously are like
abgs - artieral blood gas
chest x-ray
electrocardiogram
why are Abg Importance in helping us figure out pulmonary embolism ?
ABG measure the amount fo carbon dioxide in the patient, so if the patient isn’t perfusing well, we can find it here
why do we do troponin levels for patients who have pulmonary embolism?
normally we do this for patients who are having heart attack but with pulmonary embolism, we can see a slight increase as time continues with the pe
Additional information
why do we use b-natriuretic peptide ?
testing out for heart failure
what is the goal of treatment for patients who are having a pulmonary embolism?
to have adequate tissue perfusion and respiratory function
what are some intern-profession care we are trying to prevent with patients who have a PE? dont over think it
further growth of the clot
prevent embolization from upper or lower extremities
prevent further recurrence of pe
What are the 5 ways we are going to support cardiopulmonary status ?
PH &FV
oxygen
pulmonary hygiene
fluids/vasopressores
diuretics
opioids
how is oxygen going to help support cardiopulmonary status for patients with pe??
They are going to be struggling to breathe, so we need to give them some oxygen to help that
how is pulmonary hygiene going to help us support cardiopulmonary status for patients with PE?
by teaching them to use incentive spirometer, coughing and ambulation techs to avoid getting atelectasis
how is fluid and vasopressers going to help us support cardiopulmonary status for patients with PE?
to try to keep the volume up from where the blood clot is preventing blood and oxygen from passing
how is diuretics going to help us support cardiopulmonary status for patients with PE?
most of the time patients will end up getting heart failure, and that results in pulmonary edema because the blood just accumulates in one area, so we need to flush that part out
how is opioids going to help us support cardiopulmonary status for patients with PE?
pain will be reduced causing the patient to feel less anxious and need to breathe so hard
remember pulmonary embolism not a ___issue its a ___issue
gas exchange issue
perfusion issue
can you explain why pulmonary embolism is a perfusion issue ?
the reason is because gas exchange is happening to the rest of the body, like oxygen and carbon are leaving and staying, however the blood, the perfusion is not being met and moved
what are the 2 types of drug therapy we are going to be giving these patients who have pulmonary embolism ?
anticoagulation
fibrinolytic agents
what does anticoagulants do ?
they dont dissolve the clot, they simply prevent from clots from forming
if you have a clot already is an anticoagulant going to do anything to it ?
nope
what are the 3 anticoauglaties we need to know to help with pulmonary embolism?
heparin
unfrationated iv heparin
warfarin ( Coumadin )
what does fibrinolytic agents do for pulmonary embolism?
dissolve the clots
what are the 2 fibrinolytic agents we need to know for pulmonary embolism?
tissue plasminogen activator (tpa)
alteplase (activase)
what’s the last Resort for a patient who can’t take a fibrinolytic agent or anticoagulted ?
surgery to remove the clot
heparin is ___
warfarin is __
PTT&APTT
PT & INR
what is warfarin normal range ?
what happens if its higher than that
what happens if its lower than that
what happen if its normal
2-3
bleeding
clotting
give them the medication
what is the surgery called for patients with pulmonary embolismism ?
pulmonary embolectomy
- catheter enters and removes it
most of the time we also insert a IVC filter to catch any other clots that could form if a patient is at high risk of making more clots
what are some prevention methods we are going to tell patients to do to prevent PE?
ambulation
compression devices
anticoagulation
signs and symptoms
what the immediate treatment for PE?
bed rest in semi-fowlers position
administration oxygen and fluids
assesses cardiopulmonary status
coagulation and complications
notes
patent support
- anxiety, pain, dyspnea, fear of death
patient education
- regarding long term-anticoagulant therpay
-measures to prevent VTE
- importance of follow up exams
how long are people on anticoagulation medications ?
6-9 months then get off of it
if patients are in critical care, what do we want to do ?
have 2 big bore ivs inside them
can patients be on warfarin and heparin at the same time ?
yes
heparin usually is the better options patients are on rather than warfarin because what?
because it has a shorter half life
if someone is on an anticoaulagate, what do we tell them ?
careful of bruising, falls, using electric razor and soft toothbrush
what is pulmonary hypertension ?
elevated pulmonary artery pressure due to an increase in resistance to blood flow through the pulmonary ciruculation
what does pulmonary hypertension do to the body ?
mainly affects your body, right side of your heart to do more effort to try to push blood and oxygen in your lungs
what is idiopathic pulmonary arterial hypertension (IPAH)?
pulmonary hypertension without cause results in right HF and death if untreated
what are some clinical manifestations behind pulmonary hypertension ?
dyspnea on exertion and fatigue
chest pain
dizziness
abnormal heart sounds
most of the time, people with pulmonary hypertension have what?
another underlying condition causing it
what are some diagnostic studies to test for pulmonary hypertension ?
right side heart catheriation
ecg
chest x-ray
most of the time its really hard to treat pulmonary hypertension, so early recognition is the best way to stop progression, so go to the doctors if any ___happens?
change in breatihing
chest discomfort
edema
notes
drug therapy
pulmonary vasodilation, reduce right ventricular overload, and reverse remolding
manage the edema
prevent thrombi
prevent hypoxic
surgical interventions
Artial septostomy
lung transplant
pulmonary thromboendarterectomy
what is secondary pulmonary arterial hypertension (SPAH)?
chronic increase in pulmonary artery pressure from another disease
treatment behind SPAH?
treat underlying cause and same as IPAH
what is cor pulmonale ?
enlarged right ventricle secondary to disorder of respiratory system
- COPD
heart failure because it started with a problem with your lungs
what are some heart failure manifestions ?
edema
weight gain
distend neck veins
full bounding pulse
most of the time patients who are diagnosed with for pulmonale usually have to be on long term what?
oxygen
cor pulmonale notes
early identification is crucial as irreversible heart changes can happen
want to determine and treat underlying cause
manifestations are the same as any other before
- exertion dyspnea, tachypnea,cough , fatigue
