SOPN Upper Resp Test 7 (2 of 2)
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| Permanent dilation and distortion of bronchi and or bronchioles | Bronchiectasis
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| Seen in Cystic Fibrosis, asthma and bronchities if severe | Bronchiectasis
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| Cough with large sputnum, hemoptyis, malise, fatigue, DOE signs of what | Bronchiectasis
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| DX: *CT scan of th ebronchi showing the dilated airways* | Bronchiectasis
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| Collapse of aveolie which were previously expanded, commonly associated with different pulmonary diseases | Atelectasis
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| NI: TCDB, ambulation, incentive spirometer, Chest PT if ordered, | Atelectasis
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| Greatest Risk for Pulmonary Embolism | Immobilized patients with heart failure, long bone fractures, abdominal surgery, others: Preg, varicose, Ca, obestity, sickel cell anemia.
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| Most common risk for Pulmonary Embolism | Detached Deep Vein Thrombi
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| Virchow's Triad: 3 factors predispose person for a thrombus formation: | Damanged venous epithelium, Venus Statis, Hypercoagubility of blood (from surgery, increarsed pltelet, trauma, dyhydration).
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| Occlusion of Pulmonary Artery: | Pulmonary Embolism carried in blood stream for a veinor right side of the heart to the lungs.
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| VQ Scan: | Diminished or absent radioacivity suggest lack of perfusion or air flow greater than 1.
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| Signs of Pulmonary Embolism | Increase RR, HR, and DECREASE BP. *GENERLIZED CHEST DISCOMFOR AND PLUEURITIC TYPE CHEST PAIN CRUSHING SUSTERNAL CHEST PAIN AND TACKYCARDIA*
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| DX of Embolism: | Difficult mimics other disorders VQ scan, ABG's *PULMONARY ATERIOGRAPHY IS DEFINITIVE DIAGNOSIS*
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| Treatment Embolism | Ambulation, elevation, leg exercise, elastic stockings, hydration, low dose heparing sc, asprin and coumadin
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| What to give with decrased BP with Embolsim: | Dobutamine or Dopamine IV
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| Drugs Embolism: | Streptokinase, Urokinase TPA, Throbolytics are quicker than heparin but higher risk for bleeding *Monitor PT*
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| Greenfield Filer for what | Embolism, inserted in Vena Cava allows blood to flow but prevents passage of thrombi
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| NI Embolism: | Check Homans sign, RR, Chest Pain, JVD.
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| What is Normal Systolic Pulmonary Pressure? | Less than 12 mm Hg
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| What is Normal Dystolic Pulmonary artery pressure? | 20-30 mm Hg
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| PA pressure greater than 30/16 is what | Pulmonary Hypertension
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| Increase resistance to blood flow in the pulmonary vessels resulting increased pulmonary artery pressure: | Pulmonary Hypertension
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| Cause of Pulmonary Hypertension | Emphysema, hypoxemia, chronic bronchitis
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| DX of Pulmonary Hypertension | Heart catheterization, lung scans, pulmonary angiography
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| NI Pulmonary Hypertension | Adequate oxygenation, monitor RR
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| Severe hypoxemia and decreased lung compliance due to pulmonary edema, Not heart failure | Adult Respiratory Distress Syndrome, ARDS is life threatening.
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| Cause of ARDS | injury to lung, cuases increased pulmonary vascular permeability.
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| At risk for ARDS | CABG, sepis, transfussions, CVA, brain tumor, ICP, Smoke inhalation
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| Latent Stage of ARDS | 1st stage: damage at the level of cell membranes
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| Interstitial Edema Stage of ARDS | 2nd stage: aveoli elasticity reduced, dyspnea, increase RR, restlessness
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| Acute Intra Aveolar Edema stage of ARDS | 3rd stage: fluid accumulation around the aveoli and aveoli becomes flooded, decrease mental status
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| Fibrotic Stage of ARDS | 4th stage: scarring occurs and pt remains hypoxemic, despite aggressive 02 and mechanical ventilation
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| DX ARDS | ABG, CXR, DECREASING PA02, INCREASING PaCO2
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| Lesion in mostly lower lobes lead to brochogenic carcinoma or pulmonarry fibrosis | Abestosis
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| Silicosis | Coal miners disease, silca nodules in lungs especially upper lobes
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| Black Lung | Prolonged exposure to coal dust.
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| Complications of Black Lung | Pulmonary Hypertension and severe destructive lung disease
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| NI Coal Workers Pneumoconiosis | Fowlers postion, ventilators, space activities, rest periods
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| Fractured Ribs: | Perforates lung causing hemothorax, pneumothorax, and laceration of liver, lung and spleen DX: XRAY
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| What to avoid with factured Ribs | Narcotics, decrease respirations, heal 3-6 weeks Do not wrap chest
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| Flail Chest | when 3 or more ribs are fractured in 2 or more places, causing free floating rib segments
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| NI Flail Chest | Watch for pneumothorax, hydration, 02
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| Pneumothorax | Air enter the pleural space from the lung, increased intrapleural pressure can be from Emphysema
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| Tension Pneumothorax | Air leaks into the pleural space during inspiration but prevented from escaping during exhalation therfore air pressure increases = MEDIASTINAL SHIFT, impairing venous return.
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| When would you hear a sucking sound audible on inspiration with varying degress of respiratory distress on severity | Tension Pneumothorax
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| Accumulation of blood in the pleural space, from internal bledding | Hemothorax
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| SS: Mediastinal shift, signs of shock, Increased HR, Increased RR, decrased BR, Pallor | Hemothorax
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| Chest tube tor restablish intra pleural pressure as well as drainage in a hemothorax | Hemothorax Chest Tube, or Thoractomy
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| NI: Hemothorax & Pneumothorax | RR, 02 sats, assess respiratory, observe for dyspnea, assess for deviation of the trachea
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| Crushing and brusing of the lung | Pulmonary Contusion
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| DX of Pulmonary Contusion | Hx of trauma, CXR reveal area of atelectasis
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| Neoplasms | Lung Cancer
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| Management Neoplasms | Decreased fluid if damaged vessels, antibiotics to prevent septicemia, high fowlers
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| Air which has escaped lung enters subcutaneous tissue. Popping sounds under skin | Subcutaneous Emphysema
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| Squamous Cell Neoplasms | From large bronchi, obstruction of airways, spread to bowel and thorax, poor prognosis.
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| Adenocarcinoma Neoplasms | Most Common. Arise in lungs, spread to brain
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| Large Cell Carcinomas | Arise in Peripheral Bronchi, mass tumor, spread to CNS
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| Small Cell Carcinomas | Most malignant of lung cancers, they metastasize early via blood stream and lymph system, secrete ADH 9 antidiuretic hormone leads to hyponatremia.
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| SS Neoplasms | Blood tinged sputnum, wheeze, chest pain, hoarse, anorexia, wt lose, anemia.
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| DX Neoplasms | CXR CT MRI, Confirmed sputnum cytology or biopsy or broncoscopy
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| Treatment Subcutaneous Emphysema |
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