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AHIV - ch 29
| Question | Answer |
|---|---|
| Pulmonary embolism | Collection of particulate matter (solids, liquids, or air) that enters venous circulation & lodges in the pulmonary vessels; an embolism is a blood clot (thrombus) or other object that is carried in the bloodstream & lodges in another area |
| Risk factors for pulmonary embolism | - Prolonged immobility - Central venous catheters - Surgery - Pregnancy - Obesity - Age - Conditions that increase blood clotting - Hx of thromboembolism - Smoking, estrogen therapy, HF, stroke, cancer, & trauma |
| VTE or DVT | PE occurs when DVT is formed in the vein in the legs or pelvis & a clot breaks off & travels to the right side of the heart -> then lodges in the pulmonary artery or within one or more of its branches, obstructing the alveolar perfusion -> hypoxemia |
| PE prevention | - Smoking cessation, weight reduction, increased physical activity, no sitting for long periods of time, & refrain from massaging/compressing the leg muscles - Heparin or placement of IVC filter for those with high risk |
| PE S/S | - Restlessness (1st sign) - Sudden onset of dyspnea - Chest pain - Impending doom - Cough - Hemoptysis - Diaphoresis - Increased RR - Crackles - Pleural friction rub - Tachycardia/S3 & S4 heart sound - Low grade fever |
| PE interventions | - Call rapid response - High-fowler - O2 - Tele - Obtain venous access - Assess oxygenation via pulse ox - Cardiac & respiratory assessments - Labs & imaging - Examine for petechiae in chest - Anticoagulants - Bleeding precautions |
| PE testing | - D-dimer (blood test that tells you if there’s any clotting happening in the body) - CT scan - Chest x-ray - ABGs - Pulmonary angiogram (most definitive test) |
| PE labs | RBCs, PT, PTT, PT, INR, platelets |
| PE IV/meds | 18g; LR or vasopressors (for hypotension), heparin, & tPA (if in shock) |
| PE PO meds | Warfarin (given together with IV meds); typically given at 1400 in consideration of lab draws |
| Normal clotting labs (without taking anything) | PTT: 25 - 35 PT: 11 - 12.5 INR: less than 1 |
| Normal clotting labs (with taking meds) | INR: 2.5 - 3 PTT: 1.5 - 2 x their normal |
| Heparin antidote | Protamine sulfate |
| Warfarin antidote | Vitamin K |
| PE surgical management | Embolectomy (removing the clot) |
| Acute respiratory failure | Ventilatory failure, oxygenation failure, or a combination of both; classified by abnormal blood gas values: PaO2 < 60 or PaCO2 > 45 occurring with < 7.35 & SaO2 less than 90% |
| Ventilatory failure | Lungs not working; blood flow (perfusion) is normal but air movement (ventilation) is inadequate; decreased oxygen intake |
| Oxygenation (gas exchange) failure | Lungs work (air moves in & out without difficulty), but does not oxygenate the pulmonary blood sufficiently (perfusion) |
| Acute respiratory failure treatment | Oxygen, call rapid response, positioning, mechanical ventilation, meds (corticosteroids & nebulizers), & breathing exercises |
| Causes of ventilatory failure | Extrapulmonary - involving no pulmonary tissues but affecting respiratory function (ex: neuro disorders) Intrapulmonary - disorders of the respiratory tract (ex: PE or ARDS) |
| Combined ventilatory & oxygenation failure | Involves hypoventilation (poor respiratory movements); abnormal lungs causing the respiratory muscles to not function effectively |
| Acute respiratory failure s/s | Related to systemic effects of hypoxia, hypercapnia, & acidosis; dyspnea is the hallmark of respiratory failure |
| Acute respiratory distress syndrome (ARDS) | - Hypoxemia persists even when 100% oxygen is given (refractory hypoxemia) - Decreased pulmonary compliance - Dyspnea - Bilateral pulmonary edema - Dense pulmonary infiltrates seen on x-ray |
| Causes of ARDS | Alveoli fill with fluid & collapse (surfactant is reduced - usually increases lung compliance); lung injury & sepsis |
| ARDS s/s | Dyspnea, may not hear crackles because fluid is in interstitial spaces, white-out on chest x-ray, tachycardia, increased RR, & hypotension; monitor for labored/difficulty breathing |
| ARDS treatment phases | Exudative phase - supporting patient & providing oxygen Fibrosing alveolitis phase - deliver adequate oxygen, prevent complications, & support the lungs Resolution phase - often have neuropsychologic deficits |
| Specific ARDS treatment | Intubation & mechanical ventilation Positioning Severe cases -> ECMO Antibiotics & conservative fluid therapy (infusing smaller amounts of fluid & utilizing diuretics to maintain fluid balance) Enteral nutrition (tube feeding) or parenteral |
| Endotracheal tube | Short-term (less than 2 weeks of use) Nurses role: oxygen between attempts Verify placement by chest x-ray Should have soft restraints |
| DOPE (things to look out for in ET tube) | Displaced tube Obstruction Pneumothorax Equipment problem |
| Tidal volume (Vt) | The volume of air the patient receives with each breath, as measured on either inspiration or expiration (6 - 8 mL/kg based on body weight & height) |
| Rate: breaths/min | The number of ventilator breaths delivered per minute (10 - 14 breaths/min) |
| Fraction of inspired oxygen (FiO2) | Oxygen level delivered to the patient; based on the patients ABGs & condition; 21% - 100%; warmed & humidified to prevent mucosal damage |
| Peak airway (inspiratory) pressure (PIP) | The pressure used by the ventilator to deliver a set tidal volume at a given lung compliance; highest pressure reached during inspiration; increased PIP means increased airway resistance |
| Positive end-expiratory pressure (PEEP) | Positive pressure exerted during expiration; improves oxygenation by enhancing gas exchange & preventing atelectasis; mostly set to 5 - 6, but in severe cases 15 or greater |
| Flow rate | How fast each breath is delivered & the range is usually set between 40 & 60; increasing the flow should be used before chemical restraints |
| Nursing management of ventilators | Check patient before machine; may need suction or relaxation |
| Increased pressure alarm | Obstruction |
| Decreased pressure alarm | Leak |
| Mechanical ventilation complications | Pneumothorax, hypotension, & avoid valsalva maneuvers (preventing constipation & infection) |
| Mechanical ventilation nutrition | |
| Extubation | Have oxygen & crash cart at bedside, monitor for respiratory distress, & teach that a sore throat is expected, semi-fowler position, deep breaths every half-hour, use an incentive spirometer every 2 hours, & limit speaking |
| Flail chest | Result of fractures of three or more adjacent ribs in two or more places causing paradoxical chest wall movement (inward movement of the thorax during inspiration, with outward movement during expiration); results from blunt chest trauma |
| Flail chest treatment | Mechanical ventilation |
| Tension pneumothorax | Life-threatening complication of pneumothorax in which air continues to enter the pleural space during inspiration & does not exit during expiration |
Created by:
tatianalopez03
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