Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
EXAM 2 - MED SURG II
ARDS, PE, Respiratory Failure
| Question | Answer |
|---|---|
| Pulmonary Embolism Pathophysiology | The obstruction of the pulmonary artery, or one of its branches by a thrombus that originates somewhere in the venous system or in the right side of the heart. Most commonly due to a dislodged or fragmented DVT. The area receives little or no blood flow, therefore gas exchange is impaired or absent in the area. |
| Pulmonary Embolism Risk Factors | Can be associated with trauma, surgery (orthopedic, major abdominal, pelvic, or gynecologic), pregnancy, HF, age, older than 50 years, hypercoagulable states, and prolonged immobility. |
| Pulmonary Embolism Signs & Symptoms | Dyspnea, tachypnea, chest pain usually pleuritic in origin, but may be substernal and mimic angina. Other symptoms include anxiety, fever, tachycardia, apprehension, cough, diaphoresis, hemoptysis, and syncope. In serious cases can lead to pronounced dyspnea, sudden substernal pain, rapid weak pulse, shock, syncope, and sudden death |
| Pulmonary Embolism Medical Management | If the patient is stable immediate anticoagulation therapy is indicated to prevent recurrence or extension of the thrombus, and should be continued for 10 days. Long-term up to 6 months following a PE is sometimes needed in critical cases. Can include LMWH (enoxaparin), unfractionated heparin, or a direct oral anticoagulant (DOAC) such as a Direct Thrombin Inhibitor (Dabigatran) or a Factor Xa inhibitor (fondaparinux, rivaroxaban, apixaban, edoxaban) |
| NURSING MANAGEMENT | PREVENT VENOUS STASIS, encourage ambulation, avoid sitting too long. Encourage leg pumps. DO NOT DANGLE LEGS, manage oxygen therapy, monitor pulse ox for hypoxemia, encourage incentive spirometer, monitor response to meds (INR & aPTT). Monitor for chest pain (semi-fowlers), turn and reposition, opioids and analgesics. Monitor for anxiety and shock |
| CHEST X-RAY (PE) | to rule out atelectasis (may show infiltrates, atelectasis, pleural effusion) |
| ECHO (PE) | Check for enlarged right-sided heart chambers, or tricuspid regurgitation |
| ECG (PE) | Rule out an MI (abnormality is nonspecific ST & T wave abnormalities) |
| PULSE OX (PE) | Monitor for hypoxic |
| ABG (PE) | to monitor for hypoxemia and hypocapnia ( may be normal) |
| V.Q. SCAN (PE) | compares the amount of perfusion in a lung segment with the degree fo ventilation in the segment |
| PULMONARY ANGIOGRAM (PE) | allows for direct visualization under fluoroscopy of the arterial obstruction and accurate assessment of the perfusion deficit |
| MULTIDETECTOR COMPUTED TOMOGRAPHIC ANGIOGRAPHY (MDCTA) (PE) | The standard for diagnosis. Can be performed quickly and provide the advantage of high-quality visualization of the lung parenchyma. If it is not available pulmonary angiography is considered reasonable for diagnosis |
| D-DIMER (PE) | Assessing fibrin |
| INFERIOR VENA CAVA (IVC) Filters (PE) | Used for those that have recurrent PE, despite anticoagulant intervention. It is a filter that is inserted with a screen, which allows blood to flow unobstructed while large emboli from the pelvis or lower extremities are blocked or fragmented before reaching the lungs |
| Embolectomy (PE) | Rarely performed but may be indicated if there are contraindications to thrombolytic therapy. Can be performed using catheters or surgically. Surgical remove requires cardiovascular team and patient on cardiopulmonary bypass. |
| Fibrinolytic Therapy | to restore pulmonary artery perfusion. - They are used to dissolve thrombi and limit tissue damage in selected thromboembolic disorders. |
| Anticoagulant Therapy | clots and extension of already existing clots, but they do not dissolve clots that have already formed. - it often accompanies thrombolytic therapy either before or following initiation. |
| Acute Respiratory Distress Syndrome (ARDS) Pathophysiology | Clinical syndrome characterized by a severe inflammatory process causing diffuse alveolar damage that results in sudden and progressive pulmonary edema, increasing bilateral infiltrates on chest X-Ray, hypoxemia that is unresponsible to oxygen supplementation regardless of the amount of PEEP, and the absence of an elevated left atrial pressure. Often have reduced lung compliance. |
| ARDS Risk Factors | Associated with the development, including direct injury to the lungs (smoking), or indirect insults (shock). |
| ARDS Medical Management | Nebulizer therapy, oxygen administration, chest physiotherapy, endotracheal intubation or tracheostomy, mechanical ventilation, suctioning, bronchoscopy, adequate nutrition. |
| ARDS Nursing Management | turn the patient frequently to improve ventilation and perfusion in the lungs and enhance secretion drainage. HOWEVER the nurse must monitor any changes in oxygenation with position changes. |
| ARDS Positioning | PRONE |
| Chest X-Ray (ARDS) | Bilateral infiltrates that quickly worsen. Increased alveolar dead space (ventilation to alveoli but poor perfusion). |
| Physical Exam (ARDS) | Intercostal retractions and crackles present as fluid begins to leak into alveolar interstitial space. |
| BNP (ARDS) | To rule out pulmonary edema |
| EKG (ARDS) | To determine arrhythmias or ischemia |
| Causes of ARDS | Sepsis, Inhalation of toxins, Severe pneumonia, Burns, COVID |
| Bronchoscopy (AEDS) | Identifies the cause |
| ARDS Symptoms | SOB, Fast breathing, coughing up phlegm, cyanosis of fingernails or skin/lips, extreme tiredness, chest pain when breathing deeply |
| PEEP (ARDS) | Positive pressure maintained by ventilator at the end of exhalation. Increased functional residual capacity. Opens collapsed alveoli Improves oxygenation with a lower fraction of inspired oxygen. |
| Mechanical Ventilator (ARDS) | A Positive or negative pressure breathing device. Maintains ventilation and oxygen delivery for a prolonged period. Patients may fight the vent, give sedatives or paralytics. Assess for malfunctions, and pneumothorax |
| ARDS Nutrition | Requires 35-45 kcal/kg/day to meet caloric requirements. Enteral feeding is first choice, but parenteral may be needed. Patients should follow a HIGH fat, LOW carb diet |
| Neuromuscular Blocking Agent (Vecuronium) | Max blockade occurs within 3-5 minutes. Duration is 25-40 minutes. Dose dependent |
| Neuromuscular Blocking Agent (Succinylcholine) | Helps facilitate easy tracheal intubation and mechanical ventilation by relaxing the vocal cords, jaw, and associated respiratory muscles. |
| Respiratory Failure Nursing Management | Assisting with intubation, and maintaining mechanical ventilation. The nurse assesses the patient's respiratory status by monitoring the level of responsiveness, arterial blood gases, pulse oximetry, and vital signs. Providing care to prevent complications such as a turning schedule, mouth care, skin care, and ROM. |
| Respiratory Failure Medical Management | The objectives of treatment are to correct the underlying cause and to restore adequate gas exchange in the lungs. ET intubation and mechanical ventilation may be required to maintain adequate ventilation and oxygenation while the underlying cause is corrected. |
| Respiratory Failure | Sudden and life-threatening deterioration of the gas exchange function of the lungs and indicates their failure to provide adequate oxygenation or ventilation for the blood |
| Acute Respiratory Failure | Defined as hypoxemia (decrease in arterial [PaO2] to less than 60 mm Hg) and hypercapnia (an increase in arterial carbon dioxide tension [PaCO2] to greater than 50 mm Hg), with acidosis (an arterial pH of less than 7.35) |
| Respiratory Failure Pharmacological Management | Furosemide IV push or continuous infusion. Rapid effect. BP monitored closely, I&O, daily weight. Monitor electrolytes and creatinine. Vasodilators/Organic Nitrates |
Created by:
Nursing.Student.Help
Popular Nursing sets