Term
|
Definition
Airway and breathing
-includes entire respiratory system except alveoli |
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Term
|
Definition
Gas Exchange
-Alveoli only |
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Term
| What can cause O2 to dissociate more or less rapidly? |
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Definition
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Term
| What are normal values for ABGs? |
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Definition
pH: 7.35-7.45
PaCO2: 35-45
HCO3: 22-26
PaO2: 80-100 |
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Term
| What are signs and symptoms of impaired gas exchange? |
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Definition
| Restlessness, irritability, confusion, significant decrease in oximetry results, decreased PaO2, and increased PaCO2 levels |
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Term
| What are respiratory nursing priorities? |
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Definition
-Early identification
-Prompt response to dyspnea--immediate respiratory support
-Clear communication with physician and care team (resp therapy, pharmacy, dietary, chaplaincy)
-Competent delivery of care interventions
-Close monitoring for response to treatment or worsening of condition |
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Term
| Steps of a pulmonary embolism |
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Definition
1. A blood clot forms in a vein and breaks free from the vessel wall
2. The embolus travels through bloodstream and heart into the vessels of the lung
3. The embolus obstructs a vessel in the lung and deprives tissue of blood |
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Term
| Pathophysiology of pulmonary embolism |
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Definition
-Ischemia/infarct of affected tissue past occlusion
-90% from DVT |
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Term
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Definition
Risk factors for VTE
1. Circulatory stasis
2. Endothelial injury
3. Hypercoagulable state |
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Term
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Definition
| Protein present in blood after coagulation cascade triggered. Negative result usually RULES OUT thrombus (Positive result requires follow up testing as also increased in DIC) |
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Term
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Definition
-Follow aPTTs closely: check 6 hours after every dose change, every 12-24 hours when stable. Goal: 1.5-2.5 times control
-Always get independent double-check
-Works quickly: half-life one hour
-Reversal agent: Protamine sulfate |
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Term
| Why would you only use Lovenox or LMWH if patient is stable? |
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Definition
| Because Lovenox lasts much longer than heparin (half a day as opposed to an hour) |
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Term
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Definition
| Newer class of anticoagulant--can be used with history of HIT |
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Term
|
Definition
-For outpatient therapy and then long-term prophylaxis (6 mos)
-Therapeutic INR 2.0-3.0 |
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Term
|
Definition
-DVT/PE with contraindication to anticoagulation
-DVT/PE despite anticoagulation
-Chronic DVT/PE |
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Term
| Acute Respiratory Failure |
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Definition
-Unable to maintain gas exchange for adequate tissue perfusion
--PaO2<60; PaCO2>50, acidosis
-May be ventilatory or alverolar or mixed etiology |
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Term
| Acute Respiratory Distress Syndrome |
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Definition
Acute respiratory failure with these indicators
-Hypoxemia that persists even when 100% oxygen is given
-Progressive respiratory distress 24-48 hrs after ALI
-Symptoms based on alveolar dysfunction and massive inflammatory response
-Often r/t acute lung injury
-High mortality rate
-Treatment is symptomatic and supportive |
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Term
| What are causes of ARDS (direct injury factors)? |
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Definition
-Pulmonary infection
-Aspiration
-Near-drowning
-Inhalation of toxic gases or smake
-Lung contusion |
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Term
| What are causes of ARDS (indirect injury factors)? |
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Definition
-Sepsis
-TRALI or massive transfusion
-Cardiopulmonary bypass
-Pancreatitis
-Burns
-Shocks |
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Term
|
Definition
Accumulation of fluid in pulmonary interstitial spaces (lung tissue) and then in alveoli r/t fluid overload or pump failure.
-cardiogenic: usually a severe form of left-sided heart failure
-Non-cardiogenic: r/t ARDS |
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Term
| Signs and symptoms of pulmonary edema |
|
Definition
-MEDICAL EMERGENCY!
-Sudden onset of dyspnea
-Crackles usually to lung apex and that do not clear with cough
-Cough with frothy pink sputum
-Anxiety, restlessness, agitation, cool and moist skin, tachycardia, JVD |
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Term
| Pulmonary edema treatment |
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Definition
-Oxygen, positioning
-Diuretics-usually start with IV lasix stat!
-Morphine
-Nitroglycerin: decreases preload and afterload
-Inotropes to increase contractility--dobutamine |
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Term
| Pleural effusion and its causes |
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Definition
Collection of fluid between visceral & parietal pleura
-HF
-Pneumonia
-PE
-Malignancy
-Cirrhosis
-Pancreatitis |
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Term
| Pleural effusion caused by transudate |
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Definition
| fluid from fluid overload |
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Term
| Pleural Effusion caused by exudate |
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Definition
| Fluid from inflammatory process in pleura |
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Term
| Signs and symptoms of pleural effusion |
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Definition
-Dyspnea
-Cough, non-productive unless underlying pneumonia
-Pleuritic chest pain
-Decreased or absent breath sounds
-Pleural friction rub
-Signs of generalized fluid overload (if transudative) |
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Term
| Diagnosis and treatment of pleural effusion |
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Definition
-Diagnosed with CXR
-Treatment: Drain effusion (thoracentesis, chest tube); treat cause |
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Term
| What are two types of chest trauma? |
|
Definition
-Blunt force
-Penetrating injury
-CXR standard and effective for diagnosing chest trauma |
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Term
|
Definition
| Loss of integrity of pleura, loss of negative pressure, collapse of affected lung or lobe. |
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Term
| What is tension pneumothorax in blunt trauma? |
|
Definition
-Complication of pneumothorax
-Fatal if left untreated: air enters pleural space but can't leave
-Pressure accumulates and pushes toward/compresses unaffected lung and heart including great vessels. Seen in tracheal deviation towards unaffected side.
-Decreased CO and cardiopulmonary collapse. |
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Term
| Assessment of pneumothorax |
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Definition
-Inspection: Resp effort, rate, chest wall motion, obvious trauma
-Auscultation: decreased BS over affected area
-Palpation: Subcutaneous emphysema (crepitus), fractures (grating or unstable ribs) |
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Term
| Treatment of pneumothorax |
|
Definition
-Urgent/Emergent: Needle aspiration
-Chest tube insertion for continuous negative pressure suction to reinflate lung. |
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Term
|
Definition
-Massive vs simple blood loss into thoracic cavity-1500 ml dividing point
-Treat with insertion of chest tube; surgery indicated if more than 1500-2000 ml initial drainage or 2000ml/hr x3 hrs |
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Term
|
Definition
-Placement varies depending on whether hemo- or pneumothorax
-May have multiple chest tubes
-Often placed at bedsid
-Nursing responsibilities are to monitor the patient |
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Term
| What are the different purposes of each chamber in a Chest Tube Drainage system? |
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Definition
-Chamber 1: collects fluid draining from patient
-Chamber 2: water seal prevents air from re-entering patient's pleural space and shows if pt. has air leak
-Chamber 3: suction control of system |
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Term
| Management of chest tube drainage systems |
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Definition
Patient: Resp assessment; dressing q 48 hrs, vasoline gauze for airtight seal; site
Drainage system: Do not "strip" chest tube. Can increase intrathoracic pressure.
-Keep lower than patient's chest
-Assess for air leak (bubbling in water seal chamber) |
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Term
| What is a signal for tension pneumothorax? |
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Definition
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Term
| What should you do if chest tube falls out or tubing separates? |
|
Definition
-Vaseline gauze dressing for chest tube falling out
-If tubing separates you could clamp for a minute-but risk for tension pneumothorax; most likely just reconnect it |
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Term
| What are the major concerns of rib fractures and flail chest and what is the treatment for this? |
|
Definition
-They could cause more damage
-Treatment is usually to stabilize chest and let ribs heal on own |
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Term
|
Definition
-Higher levels of oxygen delivery--control of amount of oxygen is determined by dial, not just flow meter setting.
-More controlled and precise deliver (24-50%)
-Control is not at flow meter, it's on the dial on the mask |
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Term
|
Definition
-100% FiO2 when flowmeter at 15L and flaps intact
-Bag should remain slightly inflated
-No humidifier
-Patients on 100% NRB are considered unstable--monitor closely and escalate appropriately |
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Term
| Nursing management for patient requiring intubation |
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Definition
-Maintina aggressive respiratory support (bag with flow meter at 15L) until intubation
-Verify tube placement (end-tibal CO2 and CXR as well as breath sounds).
-Stabilize the tube and mark the depth to monitor placement. |
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Term
|
Definition
-Long term mechanical ventilation, patient intubated for more than 2 weeks
-Facial trauma
-Head and neck surgery
-Failed ET intubation |
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Term
| What are the indications for having a cuffed or uncuffed trach tube? |
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Definition
Must have cuffed tube for mechanical ventilation; when getting better will uncuff so you can breath around trach.
-Fenestrated tube so you can talk |
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Term
| Care for the patient with a tracheostomy |
|
Definition
-Trach care every shift (clean or sterile procedure?)
-Cuff pressure can cause mucosal ischemia. Prevent tissue damage.
--Use minimal leak and occlusive techniques.
--Check cuff pressure often.
--Prevent tube friction and movement.
-Prevent/treat malnutrition, hemodynamic instability, hypoxia |
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Term
| Complications of suctioning |
|
Definition
-Hypoxia
-Tissue (mucosal) trauma
-Infection
--Sterile vs. clean, home vs. hospital
-Vagal stimulation, bronchospasm (if happens, stop suctioning)
-Cardiac dysrhythmias from induced hypoxia (if happens, stop suctioning) |
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Term
| Why would a patient experience hypoxia from suctioning trach? |
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Definition
-Ineffective oxygenation before, during and after suctioning
-Prolonged suctioning time
-Excessive suction pressure
-Too frequent suctioning
-Use of catheter that is too large for the airway (pediatric) |
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Term
| What is the difference between CPAP and BiPAP? |
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Definition
| CPAP is one pressure, and BiPAP is two pressures |
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Term
|
Definition
-Most positive pressure
--During inspiration pressure generated pushes air into lungs
--Bipap also with preset expiratory (PEEP) positive end expiratory pressure
-Most often used for patients with hypoxemia and progressive alveolar hypoventilation with respiratory acidosis |
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Term
| Potential ventilator complications |
|
Definition
-Cardiac: hypotension and fluid retention; hypotension caused by pp that increases chest pressure and inhibits blood return to the heart.
-Lung: barotrauma-trauma to lungs from positive pressure
-GI: stress ulcers
-Infection: ventilator-acquired pneumonia (VAP)
-Muscle deconditioning |
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Term
| Nursing management of ventilator |
|
Definition
-Care for patient first, ventilator second
-Monitoring and evaluating patient response
-Managing ventilator safely
-Preventing complications |
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|
Term
|
Definition
-leading cause of cancer deaths worldwide
-Poor long-term survival due to late-stage diagnosis
-Bronchogenic carcinomas: arises from bronchial epithelium, most primary lung cancers from here
-Paraneoplastic syndromes
-Staged to assess size/extent of disease
-Etiology and genetic risk |
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Term
|
Definition
| Low levels of oxygen in the blood |
|
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Term
|
Definition
| Decreased tissue oxygenation |
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Term
|
Definition
| Use the lowest fraction of inspired oxygen to have an acceptable blood oxygen level without harmful side effects |
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Term
| Low-flow oxygen delivery systems |
|
Definition
O2 delivery is variable and depends on patient's breathing pattern since room air dilution occurs
-Nasal cannula
-Simple face mask
-Partial rebreather mask
-Non-rebreather mask |
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Term
|
Definition
Deliver accurate O2 levels that meet patient's O2 needs when properly filtered (delivers concentration from 24% to 100% at 8L to 15L/min)
-Venturi mask
-Aerosol mask
-Face tent
-Tracheostomy collar
-T-piece |
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Term
| How does noninvasive positive-pressure ventilation (NPPV) work? |
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Definition
| Uses positive pressure to keep alveoli open and improve gas exchange without the need for airway intubation, using O2 and just room air |
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Term
|
Definition
To manage:
-Dyspnea
-Hyperabia
-Acute exacerbations of COPD
-Cardiogenic Pulmonary edema
-Acute asthma attacks |
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|
Term
| What are the 3 ways that home O2 therapy can be provided? |
|
Definition
1. Via an O2 concentrator
2. Compressed gas in a tank or cylinder
3. Liquid O2 in a reservoir |
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Term
| What is the difference between a tracheotomy and a tracheostomy? |
|
Definition
-Tracheotomy is the surgical incision into the trachea to create an airway
-Tracheostomy is the stoma or opening that results from the tracheotomy |
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|
Term
| Patient instructions for home trachostomy care |
|
Definition
-Instruct patient to use shower shield over trach tube when bathing to prevent water from entering airway
-Teach to cover airway to protect it during the day, filter the air entering the stoma, keep humidity in airway, and enhance appearance
-Teach to increase humidity in home and instruct pt. to instill normal saline into artificial airway 10-15 times a day
-Wear medical alert bracelet |
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|
Term
| Hallmark of respiratory failure |
|
Definition
|
|
Term
|
Definition
Inward movement of the thorax during inspiration, with outward movement during expiration
-Often occurs in high-speed vehicular crashes, is more common in older patients, and has a high mortality rate |
|
|
Term
|
Definition
-A potentially lethal injury and the most common chest injury
-Often follows injuries caused by rapid deceleration during vehicular accidents with hemorrhage occurring in and between the alveoli
-The resultant respiratory failure develops over time rather than immediately |
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