Term
| Definition of Pulmonary Edema |
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Definition
An abnormal accumulation of fluid in the alveoli and interstitial spaces of the lungs
-interferes with gas exchange causing and alteration in 02 diffusion between the alveoli and the pulmonary capillaries. |
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Term
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Definition
| Large quantities of pink frothy sputum |
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Term
|
Definition
Cardiogenic pulmoary edema: very severe form of heart failure
Noncardiogenic pulmoary edema: primary or secondary lung disorder r/t critical event |
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Term
| Factors contributing to PE |
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Definition
Acute CHF
Acute MI
Overhydration
Mechanical Ventilation
Lymphatic malignancies
Anything causing decreased capillary permeability or hypoalbuminemia
pulmonary disorders: ARDS, Trauma, Sepsis, Shock, DIC |
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Term
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Definition
| ABG's, Chest X-Ray, EKG, Echocardiogram, VQ scan |
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Term
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Definition
| Paroxysmal nocturnal dyspnea, orthopnea, hypoxia, cyanosis, restlessness, dyspnea/air hunger, cool clammy skin, crackles, wet breath sounds, wheezing becoming harsher as condition worsens, cough with pink frothy or blood tinged sputum |
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Term
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Definition
Decrease intravascular volume/decrease preload diuretics (furosemide IV), IV nitroprusside (vasodilator to improve cardiac output by reducing after load)
Decrease venous return--elevate head of bed, dangle feet if possible.
Decrease Afterload (morphine sulfate also used for vasodilation of pulmonary and systemic vessels to reduce anxiety and dyspnea
Improve gas exchange
Improve cardiac function--decrease contractility w/o decreasing 02 consumption
Treat underlying cause |
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Term
| Definition Pulmonary Hypertension |
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Definition
| Increased pulmonary arterial pressure related to increased pulmonary vascular resistance to blood flow through small arterioles. Abnormal growth and remodeling of pulmonary vessels causes irreversible changes. |
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Term
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Definition
Plexiform Lesions (hallmark sign)
Endothelin 1 and Thromboxane A2-vasocontrictive substances produced in excess in PHTN
Nitric Oxide-vasodilator whose production is reduced in PHTN |
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Term
| Primary Pulmonary Hypertension |
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Definition
Rare
Genetic: form the bone morphogrnetic protein receptor (BMPR2) causes abnormal pulmonary vessel growth and remodeling
Also Idiopathic |
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Term
| Secondary Pulmonary Hypertension |
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Definition
| Related to underlying disease causes a chronic increase in pulmonary artery pressure |
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Term
| Symptoms of Pulmonary HTN |
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Definition
Dyspnea/fatigue initially during exertion
May also have extertional chest pain, decreased lung sounds, peripheral edema from Right heart failure, syncope and DOE
**as disease progresses symptoms also occur at rest |
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Term
| Complications of Pulmonary HTN |
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Definition
-Increased workload leads to righ ventricular hypertrophy or Cor Pulmonale
-will lead to Heart Failure
-Symptoms will be those of right sided heart failure and pulmonary disorder |
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Term
| Diagnosis of Pulmonary HTN |
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Definition
Cardiac Cath. to measure pressure
EKG
Chest X-ray
Echocardiogram
Root cause
Pulmonary artery pressure
ABG, O2sat.
CBC
Doppler/US |
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Term
| Prognosis for Primary Pulmonary HTN |
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Definition
poor prognosis, no cure
Pulmonary artery pressure >25 resting
>30 w/ exercise
Occurs more frequently in women 20-40yo
Treatment is symptomatic
Survival ~3years, but is improving |
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Term
| Treatment of Primary Pulmonary HTN |
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Definition
Bilateral lung and heart transplant is not responsive to meds.
Ca+ channel blocker to decrease PVR and improve CO
Bostenan (endothelin receptor antagonist)
Viagra
Sodium/H20 restriction and diaretics for Cor Pulmonale
Coumadin
Therapeutic Phlebotomy
Smoking Cessation
Vasodilators--Epoprostenol (flolan) or prostinol (remodulin) also decreases vascular resistance
--must be continuous, short half life |
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Term
| Causes of Secondary Pulmonary HTN |
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Definition
Hypoxemia r/t underlying lung disease (COPD, sleep apnea, obesity)
Recurrent emboli
left ventricular failure
mitral stenosis
HIV
Liver disease (portal HTN)
Collagen vascular disorders (scleroderma, lupus)
Drugs or toxins (cocaine) |
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Term
| Nursing DX for Pulmonary HTN |
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Definition
Impaired gas exchange r/t active inflammatory process
Ineffective breathing pattern r/t PHTN
Activity Intolerance r/t increased metabolic demands
Anxiety r/t situational fear from PHTN |
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Term
| Nursing Care of Pulmonary HTN |
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Definition
Maintain ventilation, oxygenation and perfusion
Improve quality of life
--educate, elevate HOB, rest periods |
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Term
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Definition
the body is struck by a blunt object
-external damage may be minimal but internal may be extensive |
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Term
Contrecoup Injury
or
Acceleration-Deceleration Injury |
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Definition
| Rapid change in velocity leading to damage to both sides of the brain. |
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Term
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Definition
lung tissue injury r/t blunt trauma resulting rupture alveoli or pulmonary arterioles
--alveolar hemorrhage
--interstitial and bronchial edema
---airway obstruction, atelectasis, impaired gas exchange |
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Term
| Symptoms of Pulmonary Contusion |
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Definition
Dyspnea
Restlessness
Chest pain
Tachycardia
Copious sputum (possibly blood tinged) |
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Term
| Treatment of Pulmonary Contusion |
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Definition
Possible ET intubation and mechanical ventilation with a PEEP (positive end expiratory pressure)
Fluid monitoring
Pulmonary artery pressure monitoring
Frequent ABG
Bronchoscopy |
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Term
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Definition
| When a foreign body passes through tissue causing damage |
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Term
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Definition
most common type of chest injury from trauma
--may result in damage to pleura, lung, blood vessels, or spleen |
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Term
|
Definition
| pain, especially on inspiration, splinting, shallow respirations |
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Term
| Treatment of Rib fracture |
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Definition
pain management
intercostal nerve block
cautious use of narcotics
aggressive use of incentive spirometer |
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Term
|
Definition
| instability of chest wall due to fracture of 2 or more adjacent ribs. |
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Term
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Definition
Paradoxical respirations: during inspirations the free floating area is sucked in and during expiration it bulges out, preventing adequate ventilation and gas exchange
Pain
Rapid, shallow respirations
loss of compliance
Hypoxia
Tachycardia |
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Term
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Definition
Palpation of respiratory movement
Asymmetrical expansion
Crepitus of ribs
CXR
ABG
more noticeable in the unconscious patient |
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Term
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Definition
Oxygenation
Adequate ventilation
Re-expand lungs
Possible mechanical ventilation with PEEP
Pain Management
May require internal or external fixation |
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Term
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Definition
| Presence of air in the pleural space prohibiting lung expansion, complete or partial collapse of lung can be spontaneous or related to and open or blunt trauma |
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Term
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Definition
blunt/closed object Trauma: MVA, fall, CPR (r/t rib fracture)
Open trauma: (sucking chest wound) stab wound, gunshot wound--cause lung to rapidly collapse
latrogenic: result of damage to visceral pleura during a procedure such as a central line placement or thoracentesis |
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Term
| Primary Cause of Spontaneous Pneumothorax |
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Definition
Occurs in tall slender males between 16-24 yo
--smoking and heredity may increase risk |
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Term
| Secondary cause of Spontaenous Pneumothorax |
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Definition
Over distention and rupture of alveolus
--more serious life threatening r/t COPD and other underlying lung conditions
--often in mid or old age |
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Term
| Symptoms of Spontaneous Pneumothorax |
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Definition
Assymetrical chest expansion
Diminished breath sounds
change in tactile fremitus
Cyanosis, SOB, Pain
Tachypnea, Tachycardia, Dyspnea
On affected side: decreased or absent breath sounds, decreased chest wall movement, sudden sharp pain with movement, coughing, breathing |
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Term
| Diagnosis of Spontaneous Pneumothorax |
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Definition
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Term
| Treatment of Spontaneous Pneumothorax |
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Definition
Chest tube
recurring pneumo may require surgery: partial pleurectomy, pleurodesis
--small amounts of air or fluid may not require treatment |
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Term
| Definition Tension Pneumothorax |
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Definition
EMERGENCY!
Air enters the pleural space with each inspiration, becomes trapped there and can't escape. Pressure builds as the lung collapses the mediastinum shifts toward the unaffected side compressing the trachea, heart, lungs and great vessels. |
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Term
| Causes of Tensions Pneumothorax |
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Definition
| Clamped or kinked chest tubes, trauma, mechanical ventilation or CPR, open or closed pneumothorax |
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Term
| Symptoms of Tension Pneumothorax |
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Definition
Severe respiratory distress
severe agitation
Laryngeal/tracheal shift to unaffected side (mediastinal shift)
Severe hypotension/shock/cyanosis
Tachycardia
JVD |
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Term
| Treatment of Tension Pneumothorax |
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Definition
Insertion of large bore needles and chest tubes to relieve pressure (lifesaving measure)
Unclamping or relief of obstructed chest tube
Use vented dressing on wounds and don't remove objects without physician |
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Term
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Definition
| an accumulation of blood in the pleural space, frequently associated with open pneumothorax |
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Term
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Definition
| Chest trauma, lung tumor, complications from anticoagulant therapy, pulmonary embolus |
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Term
| Symptoms and Treatment of Hemothorax |
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Definition
Similar to pneumothorax
thoracentesis to remove blood
--may use autotransfer to reinfuse blood |
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Term
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Definition
| removes air/fluid and restores normal intrapleural pressure so the lungs can rexpand |
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Term
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Definition
To remove air: 2nd intercostal space
To remove fluid/blood: 8th/9th intercostal space |
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Term
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Definition
| receives fluid and sir from the chest |
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Term
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Definition
sir from collection chamber vents into sterile water in this chamber through a one way valve (causes bubbling in intrathoracic pressure)
-Tidaling is normal
Assess for continuous bubbling (leak) or no bubbling (obstruction) |
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Term
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Definition
| applies suction that allows re-expansion. bubbles at all times in a wet system, not in a dry system |
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Term
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Definition
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Term
| Nursing Implications r/t chest tubes |
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Definition
Always keep drainage system below the level of the drain or fluid may back up into pt.
Keep H2O seal and suction control chamber compartments at proper water levels
Monitor amount of drainage by marking levels and checking for bubbling in water seal chamber
report drainage that is cloudy or red in color or in excess of 70 ml/hr
Tape connections
Don't clamp, milk or stripe tubing
know policy for disconnection
assist client w/ movement to prevent removal |
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Term
| Definition of Pleural effusion |
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Definition
| A collection of excess fluid in the pleural space which can be caused by systemic or local disease |
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Term
| Causes of Pleural Effusion |
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Definition
Transudate: Heart failure, renal failure, liver failure, malignancy
Exudate: infection, systemic inflammation (RA, SLE), Pulmonary infarction, malignancy |
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Term
| Signs and Symptoms of Pleural Effusion |
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Definition
Symptoms: pain, dyspnea
Assessment: diminished or absent breath sounds over affected area
dull percussion tone over affected area
chest wall movement may be limited |
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Term
| Diagnosis and Treatment of Pleural Effusion |
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Definition
Diagnosis: CXR, CT scan, US
TX: treat underlying condition, thoracentesis to remove fluid |
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Term
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Definition
| Atrial depolarization and contraction |
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Term
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Definition
| time required for the sinus impulse to travel to the AV node and into the perkinge fibers (.12-.20 seconds) |
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Term
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Definition
| Ventricular depolarization and contraction (.06-.12seconds) |
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Term
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Definition
| Beginning of ventricular repolarization |
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Term
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Definition
| ventricular repolarization |
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Term
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Definition
| Ventricular depolarization and repolarization (.32-.44 seconds) |
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Term
|
Definition
PR interval is >than .20 seconds
Found in Heart Blocks |
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Term
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Definition
depression: hypokalemia, ischemia
elevated: myocardial injury, pericarditis, ventricular aneurysm |
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Term
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Definition
| Risk for life threatening arrhythmia |
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Term
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Definition
Inverted T wave: myocardial ischemia, cerebral hemorrhage
Peaked T wave: hyperkalemia |
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Term
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Definition
Origin in the Sinus Node
Bradycardia: <60b/m
Tachycardia: AV rate >100b/m
Sinus Arrythmia: AV rhythm irregular, rates are the same
Sinus Pause: one or more PQRST cycles is missing, SA node discharge is interrupted |
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Term
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Definition
Treat only is symptomatic
-atropine
-isoproterenol
-pacemaker therapy
-adjust medications |
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Term
| Precipitating factors to Sinus Brady. |
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Definition
increased vagal activity
depressed automaticity
sleep
increased ICP
Acute MI
Pain
Sinus Node disease
Medications |
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Term
| Precipitating Factors to Sinus Tachycardia |
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Definition
Exercise
excitement
Caffeine
PE
Hypoxia
Hypovolemia
MI
CHF
Medications |
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Term
| Treatment for Sinus Tachy |
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Definition
Only if symptomatic
tx underlying cause
beta blockers
verpamil |
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Term
| Premature Atrial Complexes |
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Definition
| PAC-ectopic beats, come early, have an upright atrial p wave |
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Term
| Paroxysmal Supreventricular tachycardia |
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Definition
PSVT- narrow QRS tachycardia, SUDDEN onset and SUDDEN stop, V rhythm is regular
--note pt. history |
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Term
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Definition
F waves (saw tooth pattern)
atrial rates are regular and at least 300x/min
V rhythm can be regular or irregular depending on ratio of flutter waves to QRS complexes |
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Term
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Definition
| No Discernible P waves and V rhythm is irregular |
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Term
| Precipitating Factors in PSVT |
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Definition
More common in women
May be associated with CHD, rheumatic heart disease, myocarditis or acute pericarditis |
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Term
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Definition
If symptomatic!
Vagal maneuvers
O2 therapy
Adenosine
Beta Blockers
Temporary pacemaker or synchronized cardioversion (w/ natural HR) |
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Term
| Precipitating Factors to Atrial Fib. |
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Definition
CHF
Rheumatic Heart Disease
CHD
HTN
Hyperthyroidism |
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Term
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Definition
Synchronized cardioversion
Mertropolol, diltiazem, digoxin
Anticoagulant therapy |
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Term
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Definition
AV juntion origin
fires between 40-60x/min
-Premature juntional complexes
-juntional escapes beats
-accelerated juntional rhythm
-juntional tachycardia |
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Term
| Premature Ventricular Complexes |
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Definition
PVC
No P wave and wide random QRS
--more than 3 is VT |
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Term
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Definition
| Wide random Tachycardia (more than 3) |
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Term
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Definition
VF
electrical chaos, no cardiac output |
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Term
| Precipitating factors to PVC |
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Definition
Anxiety, stress
tobacco
alcohol
caffeine
hypoxia, acidosis
electrolyte imbalances
CAD
Mechanical Stimulation of the heart |
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Term
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Definition
Without heart disease it is considered insignificant
Advise against stimulation
Treat electrolyte imbalance
beta blockers |
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Term
| Precipitating Factors to Ventricular Tachycardia |
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Definition
Myocardial Ischemia
Myocardial Infarction
Cardiac structural disease
Anorexia nervosa, metabolic disorders or drug toxicity |
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Term
| Treatment of Ventricular Tachycardia |
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Definition
if sustained and symptomatic or with heart disease
--cardioversion
--procainamide, lidocaine
--surgical ablation
--implanted cardioverter/defibrillator |
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Term
| Preparation for Intubation process |
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Definition
medications used: Versed (sedative)
Popofol (sedative)
Succinylcholine (skeletal muscle paralysis)
Pre oxygenate with ambubag for 3-5 mins with 100% O2 |
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Term
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Definition
Continuous positive airway pressure (CPAP)
tight mask
client spontaneously breaths
positive pressure |
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Term
|
Definition
Bilevel Ventilators
tight mask
can be spontaneous or timed
pt needs additional airway pressure, airway support and possibly machine delivered breaths. |
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Term
|
Definition
Controlled Mechanical Ventillation
pts. with NO drive to breath or are unable to breath
breaths given regularly independent of pts. efforts |
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Term
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Definition
Assist Control Mechanical Ventillation
delivers preset tidal volume at preset frequency
pt. can initiate breaths by attempting to inhale or ventilator can initiate breathes. |
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Term
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Definition
Synchronized Intermittent Mandatory Ventilation
preset tidal volume synchronized with pts. spontaneous breathing
rate and depth of breathes is based on pts. self regulation |
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Term
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Definition
Pressure Support Ventilation
positive pressure applied when the pt. spontaneously breathes.
pts. determines tidal volume and rate |
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Term
|
Definition
Positive End Expiratory Support
keeps alveoli open and improves oxygenation
-Used with ACMV/SIMV
--decreased cardiac output and work to breath
--Increases ICP and risk of volutrauma |
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Term
| Ventilator Associated Pneumonia |
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Definition
| (VAP) pneumonia associated with mechanical ventilation |
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