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Nursing 283 > Week 2 Respiratory > Flashcards

Week 2 Respiratory Flashcards

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1
Q

Hemoptysis

A

bloody sputum, often seen in PE

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2
Q

Assessment finding in a PE

A

dyspnea, tachycardia, sharp pain on inspiration, dry cough, crackles, S3/4 heart sounds, diaphoresis, distended neck veins, syncope, hypotension, petechiae, low grade fever

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3
Q

What causes hypotension in a PE PT?

A

pulmonary HTN and reduced forward flow of blood

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4
Q

Early signs of PE (lab)

A

hypoxea leads to hyperventilation, PaCO2 levels decrease resulting in respiratory alkalosis

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5
Q

What is “shunting: in regards to PE process

A

shifting of blood from the left to the right side of the heart, bypassing the lungs and oxygenation

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6
Q

Later signs of PE (lab)

A

PaO2-FiO2 drops due to shunting, PaCO2 levels rise resulting in acidosis
Lactic acid build up due to hypoxea leads to metabolic acidosis

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7
Q

Priority nursing interventions for PE

A

Apply O2

Give anticoagulant or fibrinolytic

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8
Q

Antidote for Heparin

A

protamine sulfate

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9
Q

antidote for warfarin

A

Vitamin K

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10
Q

Critical ABG values

A

PaO2 50

pH <7.3

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11
Q

How is acute respiratory failure classified?

A

By blood gas abnormalities

This PT will always be hypoxemic

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12
Q

Causes of acute respiratory failure

A

Ventilatory failure
Oxygenation failure
Combination ventilatory and oxygenation failure

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13
Q

Ventilatory failure

A

a problem with O2 intake (ventilation) and blood delivery (perfusion)
Ventilation is inadequate but perfusion is ok
Leads to hypoxemia

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14
Q

PaCO2 level seen in ventilatory failure

A

PaCO2 >50 mmHg

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15
Q

Causes of ventilatory failure

A

Extrapulmonary: neuromuscular disorders, SCI, CVA, increased ICP, chemical depression, obesity, sleep apnea
Intrapulmonary: lung disease, PE, pneumothorax, ARDS, pulmonary edema

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16
Q

Oxygenation failure

A

blood fails to oxygenate properly despite adequate O2 intake

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17
Q

Result of O2 application in oxygenation failure

A

even delivery of 100% O2 will not increase oxygenation levels

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18
Q

Causes of oxygenation failure

A

right to left shunting of blood, air has low O2, V/Q mismatch, abnormal hemoglobin that fails to bind to O2
Most common: ARDS

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19
Q

Who is more likely to have combined ventilatory and oxygenation failure?

A

PTs with abnormal lungs (chronic bronchitis, emphysema, asthma)

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20
Q

Orthopnea

A

finding it easier to breathe when sitting up

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21
Q

Key features of ARDS

A 
hypoxemia even with 100% O2
< pulmonary compliance
Dyspnea
pulmonary edema (non-cardiac)
x-ray shows dense pulmonary infiltrates
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22
Q

When does ARDS occur

A

Most often after an acute lung injury

Can be during sepsis, PE, shock, aspiration or inhalation injury

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23
Q

ARDS pathophysiology

A

surfactant production is reduced. Alveoli either collapse or fill with fluid and are unable to exchange gases resulting in hypoxemia and V/Q mismatch

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24
Q

Greatest risk factor for developing ADRS

A

aspiration of gastric contents

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25
Q

Lung sounds in ARDS

A

lung sounds will not be heard on auscultation because edema occurs in the interstitial space

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26
Q

Diagnostic criteria for ARDS

A

Lowered PaO2
higher need for O2
Decreased/no response to increased O2 (refractory hypoxemia)
hazy “ground glass” look of lung x-ray

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27
Q

main difference between ARDS and cardiac induced pulmonary edema

A

ARDS pulmonary capillary wedge pressure is low to normal while in cardiac induced pulmonary edema, it is > 18mm Hg

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28
Q

ARDS interventions

A

Intubation (PEEP)

CPAP

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29
Q

Side effect of PEEP therapy

A

tension pneumothorax, evaluate lung sounds and suction hourly

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30
Q

ARDS drug and fluid therapy

A

Corticosteroids < inflammation and stabilize capillary membranes
Conservative fluid therapy has better results than liberal fluids

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31
Q

ARDS nutrition

A

Likely tube feedings will be needed

32
Q

ARDS phase 1

A

early changes of dyspnea and tachypnea

PT will need O2

33
Q

ARDS phase 2

A

edema increases

mechanical ventilation is needed

34
Q

ARDS phase 3

A

Occurs between days 2-10, hypoxemia increases despite increased O2

35
Q

ARDS phase 4

A

Pulmonary fibrosis occurs after 10 days, this is irreversible
If the PT survives, they will have chronic lung problems
PT will be dependent on the ventilator in this phase

36
Q

Most common uses for mechanical ventilation

A

hypoxemia and progressive alveolar hypoventilation with respiratory acidosis

37
Q

What is the most common cause of ventilator complications

A

positive pressure from the ventilator

38
Q

Cardiac problems from mechanical ventilation

A

hypotension: increased pressure inhibits blood return to the heart which reduces CO
Fluid retention: decreased CO triggers RAAS to retain fluid

39
Q

Lung problems caused by mechanical ventilation

A

Barotrauma: damage to lungs by positive pressure (pneumothorax and sub Q emphysema)
Volutrauma: damage to the lungs by one lung getting a larger volume than the other
Acid base imbalance

40
Q

GI and nutritional problems caused by mechanical ventilation

A

Stress ulcers increase the risk for infection

Paralytic ileus reduces nutrient absorption

41
Q

Dietary changes for COPD and mechanical ventilation

A

Carbohydrates must be reduced

Excessive carbohydrates increase CO2 production

42
Q

Ventilator associated pneumonia

A

a common infection threat to vent PTs and increases mortality rates
Perform oral care Q2, promote postural drainage, turn and re-position Q2

43
Q

Ventilation removal

A 
Hyperoxygenate PT
Suction tube and oral cavity
Deflate cuff
remove tube at peak inspiration
Instruct PT to cough
44
Q

Stridor

A

high pitched noise during inspiration caused by a laryngospasm or edema and indicates a narrowed airway
Reintubation may be needed

45
Q

Respiratory failure development after pulmonary contusion

A

develops over time rather than immediately

46
Q

Injuries classified as “ deep chest” injuries

A

injury to 1st or 2nd ribs, flail chest 7+ fractured ribs or expired volumes < 15mL/kg
prognosis is poor

47
Q

Paradoxic chest movement

A

sucking inward of the loose chest area on inspiration and the puffing out of the area on expiration

48
Q

ABG result of a tension pneumothorax

A

hypoxia and resp alkalosis

49
Q

Treatment of a tension pneumothorax

A

large bore needle inserted into 2nd intercostal space, mid clavicular line
A chest tube is inserted into the 4th intercostal space

50
Q

Simple hemothorax

A

blood loss of <1500mL

51
Q

Massive hemothorax

A

blood loss of >1500mL

52
Q

When is an open thoracotamy needed to treat a hemothorax?

A

when blood loss is 1500-2000mL or persistant bleeding at 200mL over 3 hours

53
Q

Complications of a torn mainstem bronchus

A

tension pneumothorax with intubation necessary

Hypotension and shock are likely

54
Q

What cluter of sx seen in a PT at risk for PE required rapid response

A

distended neck veins, syncope, cyanisis and hypotension

55
Q

Nursing priorities in caring for a patient on mechanical ventilation

A

monitoring and evaluation PT response, managing ventilator system and preventing complications

56
Q

What should the nurse do if the PT develops respiratory distress during mechanical ventilation

A

remove the ventilator and provide ventilation via bag valve mask so you can best determine if the problem is with the PT or the ventilator

57
Q

What should you do if stridor develops after extubation

A

call rapid response in any indication of airway obstruction so the airway does not become completely obstructed

58
Q

For what drug is PTT and aPTT monitored

A

Heparin

59
Q

For what drug is PT monitored

A

Coumadin (Warfarin)

60
Q

Average PT range

A

11-12.5 seconds

Will be 1.5-2x normal on Warfarin

61
Q

Risk factors for VTE

A

Age (#1), immobility, obesity, smoking, pregnancy, estrogen tx, trauma, oral contraceptives

62
Q

What diagnostic tests are needed for VTE

A

ABGs (need CO2 and pH)
CXR
CT of thorax (MDCTA)
Transesophageal echocardiography (TEE)

63
Q

Nursing interventions for VTE

A 
elevate HOB
O2
Monitor VS, breathing, lung and heart sounds
2nd IV
Monitor labs
64
Q

ABGs in ARF

A

PaO2 50

O2 SAT <90

65
Q

Signs and Symptoms of Respiratory Compromise

A 
Dyspnea
Shallow, irregular breathing
Rapid RR
Abdominal breathing
Use of intercostal muscles
Tachycardia
Confused
Diaphoretic
Cyanotic 
Irritable
Headaches and 
Lethargic
66
Q

Minimum O2 flow on a simple face mask

A

5L/min

67
Q

Diagnostic tests used in ARDS

A 
ABGs
CXR
12 lead ECG
Sputum cultures
PA catheter to evaluate fluid & heart status
68
Q

ARDS nursing interventions

A

Assist with intubation/ventilation
Maintian fluid balance/nutrition
Administer antibiotics

69
Q

OXYGENATION GOAL using mechanical ventilation in ARDS

A

PaO2 55-80mmHg or SpO2 88-95%

70
Q

Goals of mechanical ventilation

A

Improve oxygenation and ventilation

Decrease work of breathing

71
Q

Non invasive ventilator modes

A

BIPAP, CPAP and Pressure support, you don’t have to have an endotracheal tube

72
Q

Why does phosphorus need to be WNL on ventilated PTs

A

If you don’t have enough phosphorus you are not going to have enough energy to get off the ventilator (ATP for cell energy)

73
Q

HOB elevation with ventilator use

A

30 degrees

74
Q

Ventilator use cardiac complications

A

hypotension, fluid retention

75
Q

Ventilator use lung complications

A

barotrauma, volutrauma, acid-base imbalance

76
Q

Ventilator use GI complications

A

nutrition, nutrition, nutrition, stress ulcer prevention, replace electrolytes

77
Q

ABGs criteria for respiratory failure

A

PaO2 < 60

PaCO2 > 50

Nursing 283 (10 decks)

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