W4 D2 - Respiratory issues Flashcards
pulmonary edema, emboli, pneumothorax, VAP, ARDS, pleural effusion
Classify pulmonary edema
Cardiogenic pulmonary edema
* left ventricular failure
* MI
* cardiomyopathy
* mitral/aortic valve stenosis
Non-cardiogenic pulmonary edema
* infection, sepsis
* pnemonia, aspiration
* multiple transfusions
Explain the patho for causes of pulmonary edema and classify
Pulmonary edema is a back up of fluid into the lungs
Stage 1 - dry interstitium. Fluid moves into interstitium, but lymphatic system removes it
Stage 2 - interstitial fluid. Lymphatic system is overworked
Stage 3 - fluid in alveoli. Fluid moves to alveoli and they may collapse
Cardiogenic pulmonary edema
Blood backs up into the lungs from a heart related issue
* left ventricular failure
* MI
* cardiomyopathy
* mitral/aortic valve stenosis
Non-cardiogenic pulmonary edema
Fluid/blood backs up into the lungs d/t a systemic issue
* infection, sepsis
* pnemonia, aspiration
* multiple transfusions, TRALI
*
Explain the patho of TRALI
Explain assessments, labs, test, & management of pulmonary edema
Assessment
Onset - gradual or sudden
Inspection - increase WOB, SOB, RR, JVD, tachy, ^BP
Auscultation - extra heart sounds, crackles
Results
* Chest xray
* echocardiogram
Managment
* BIPAP/CPAP
* ventilation/PEEP
* meds to decrease preload / hydrostatic pressure
* fluid restriction
Explain the patho of a PE
Massive PE = clot resulting in 50% occlusion in pulmonary circulation
Results in
* impaired gas exchange - bronchoconstriction
* cardiac dysfunction
Affected lung
* hypoxemia - VQ mismatch
Unaffected lung
* ^ perfusion
* v time to oxygenate
* ^ hypoxemia
Cardiac dysfunction
* RV ^ afterload - dysfunction
* pulmonary vasoconstriction
What are the types of emboli?
What are the classifications of PEs?
finish
Massive
* acute
Submassive
* acute stable
Low risk
* normal BP
* no evidence of MI
What are some risk factors for PE?
Virchows triad
* venous stasis - immobility, afib, prenancy, vLOC
* hypercoagulability - contraceptives, coagulation disorders, malignancy
* Vessel damage - trauma, surgery
Why would a patient develop right ventricular failure d/t PE?
Primarily because of the increase in afterload
* too tired to keep pushing against the resistance of smaller vessels
What assessments findings would you expect for a patient with PE?
- respiratory distress
- wheezes
- v air entry
- pleuritic chest pain
- respiratory alkalosis/acidosis
- tachycardia
- hypotension
- distended neck veins
- hemoptysis
- arrhythmias
- DVT signs
How do you diagnose a PE?
Spiral CT w/ contrast
V/Q scan to assess lung
Chest xray - atelectasis, dilated pulmonary vessels
Echo - assess RV
Doppler ultrasound - assess for DVT
ABG - respiratory alkalosis/acidosis, metabolic acidosis
What assessment findings will you see in pneumothorax?
Inspection/palpation
* decreased chest expansion
* respiratory distress
* tracheal shift
* asymmetrical chest expansion
* subcut emphysema
* respiratory distress
Auscultation
*
Mechanical ventilation
*
Differentiate open, closed, tension pneumothorax
Open
* laceration of chest wall and pleural cavity
* fractured ribs
Closed
* tear in visceral pleura
* high peep causing barotrauma
Tension
* air enters but cannot exit on expiration
* open or closed
* causes mediastinal shift, tracheal deviation
How would you manage a patient with PE?
Ventilation - mode, peep, FiO2
Hemodynamics - inotropes, fluids, BP support
Anticoagulants - IV heparin, LMWH
* prevention and thinning but not to break down
Thombolysis for massive PE - alteplase, risk of bleeding
Catheter directed treatment - thrombectomy
IVC filter
What is the treatment for pneumothorax?
Greater than 15% of lung requires treatment
Open/closed
* chest tube
Tension
* needle thoracentesis
* chest tube
Hemothorax
* chest tube
* blood products
