Mod 5 - Complex Resp Disorders Flashcards by Geneva Mai

What is a high VQ mismatch? Give an example of the cause

oxygen without blood
- Pulmonary embolism

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What is a low VQ mismatch? Give 3 examples of a cause

blood without oxygen
- pulmonary edema, pneumonia, asthma

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Acute Resp Failure can be caused by what disorders?

neuromuscular disorders such as myasthenia gravis

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What is Hypoxemia Resp Failure? What are some causes? (3)

gas exchange are blocked d/t VQ mismatch
pneumonia, pulmonary embolism, pulmonary edema

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What is Hypercapnic Resp Failure? What are some causes? (4)

lungs are unable to expand so CO2 cannot be eliminated
hypercapnia is followed by hypoxia
asthma, COPD, opioids, neuromuscular disorders

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What are the clinical manifestations of Hypoxemic Resp Failure?

tachypnea, then bradypnea
tachycardia
hypertension, then hypotension
decreased cerebral perfusion (leading to restlessness, confusion, and anxiety)

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What are the clinical manifestations of Hypercapnic Resp Failure?

tachycardia
headache
dizziness
confusion
DECREASED LOC
(*remember CO2 is more neuro symptoms)

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How would a patient be diagnosed with Acute Resp Failure? (4)

Arterial of Venous Blood Gas (hypoxemia vs hypercapnia)
chest Xray
Sputum cultures
Pt behavior

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What is the medical management for a patient with Acute Resp Failure?

O2 support (supplemental O2, positive pressure ventilation, mechanical ventilation)
Medications (bronchodilators, steroids, diuretics, sedation, antibiotics)
TREAT THE CAUSE

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What are examples of non-invasive positive pressure ventilation?

BiPAP and CPAP

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What is the difference between Endotracheal Tube and Tracheostomy?

Endotracheal Tube:
- placed by anesthesia, intensivist, or RT
- must be connect to ventilator or bag-valve mask
- short term (7-14 days)
- RN responsible for care, monitoring, suctioning (PRN), prevention of infection

Tracheostomy:
- surgical airway, may be life long
- may be connected to vent, O2, or atmosphere
- RN responsible for care, monitoring, suctioning (PRN), prevention of infection

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What is FiO2?

fraction of inspired O2
- amount of O2 delivered

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What is PEEP? What is the Physiologic PEEP?

Positive End-Expiratory Pressure
- pressure kept in the alveoli at end-expiration to prevent aveolar collapse
- Physiologic PEEP: 5 cm H20

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What is PIP? What is is naturally and during therapy?

Peak Inspiratory Pressure
- maximum pressure during inspiration
- naturally ~12, during therapy may be ~20-30

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What is Plateau Pressure? What is the goal?

measurement of compliance vs obstruction
- goal <30

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What is minute ventilation? What should it be at?

RR x TV
5-8 L/min

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For mechanical ventilation, what are the nursing actions?

maintain HOB >30-45 degrees
Assess ETT placement, resp status, vent data
manage sedation, as appropriate
suctioning (PRN)
daily awakening and Spontaneous Breathing Trial (SBT)
MOUTH CARE with chlorhexidine
GI ulcer and DVT prophylaxis

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What are some complications of Mechanical ventilation?

hypotension
infection, pneumonia
barotrauma
aspiration

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What is the ABCDEF bundle in prevention of mechanical ventilation complications?

A - assess, prevent, and manage pain
B - both Spontaneous awakening trials and SBT
C - choice of analegsia and sedation
D - delirium assessment, prevention, and management
E - early exercise/ambulation
F - family engagement and empowerment

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How should the nurse place the patient with Acute Resp Failure?

“good lungs down”
- lay on the good lung

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What is the most common cause of ARDS?

sepsis

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ARDS can lead to _____ which is the most common cause of death

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MODS

What are the elements of ARDS? (3)

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acute onset (<7 days)
refractory hypoxia
r/o cardiac causes (ex pulmonary edema)

What kind of process occurs in the lungs that leads to ARDS?

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inflammatory process

Describe what occurs in ARDS

massive vasodilation and capillary leak --> air cannot pass through "wet" alveoli --> alveolar damage and collapse --> fragile, stiff lungs

What is the P:F ratio? What is it used for?

it's the classification of ARDS (mild vs moderate vs severe)

How do you calculate P:F ratio?

PaO2/FiO2 (decimal format)

200-300 = what class of ARDS? 100-200 = what class of ARDS? <100 = what class of ARDS?

200-300 = mild 100-200 = moderate <100 = severe

What is the Exudative Phase of ARDS? (4)

- 24-48 hours after insult, lasts 7-10 days - inflammatory process causes disruption to aveolar-capillary membrane and vasodilation causing fluid to shift from interstitial space into the alveoli - alveolar collapse - blood but no O2 = low VQ mismatch

What is the Proliferative Phase of ARDS?

- lasts 2-3 weeks - resolution of pulmonary edema - proliferation of type 2 alveolar cells: damaged alveolar worsens VQ mismatch, pulmonary hypertension d/t vasoconstriction, fibrotic changes causing stiff lung and hypercapnia

What is the Fibrotic phase of ARDS?

- fibrosis and cyst formation which results in scarring and permanent lung injury - pulmonary hypertension, right sided HF * not all people develop this

What are the clinical manifestations of ARDS?

- increased work of breathing, then no breathing - tachypnea - tachycardia

What are the diagnostic tools used to diagnose ARDS?

- chest Xray: showing bilateral infiltrates and "ground glass" appearance - ABG q1hr and monitor P:F ratio - CBC - Cultures - Metabolic panel

What is the medical management for ARDS?

- mechanical ventilation: low tidal volume, high PEEP (prevent barotrauma); high pressure; high PEEP can lead to hypotension; driven by P:F ration; plateau pressure - Extra corporeal membrane (ECMO) - Prone positioning - Nutrition

ARDS - You hear crackles/rhonchi, what does this indicate?

fluid in the lungs

ARDS - You hear diminished/absent lung sounds, what does this indicate?

fibrotic changes

What are the 3 components of Virchow's Triad?

- Venous stasis/immobility - Vessel wall damage - Hyper-coagulability

What are the clinical manifestations of a Pulmonary Embolism?

- depends on the size/location of PE - dyspnea, pleuritic chest pain, tachypnea - pulmonary hypertension/RV failure (increased pulmonary vascular resistance; blood can't enter pulmonary circulation) - decreased CO --> hypotension --> hypoxia -- death?

What kinda of arrest can a PE cause?

PEA arrest

What is the medical management for a patient with a Pulmonary Embolism?

- Emergent: clot buster (tPa; systemic vs targeted) - Anticoag: prevents the growth of clot; heparin, warfarin, factor Xa inhibitor, enoxaparin - be careful with fluid because it will reduce the viscosity of the blood and may dislodge the clot

What is the surgical management for a Pulmonary Embolism?

Embolectomy: - catheter: intrapulmonary artery catheter surgical Inferior Vena Cava Filter: - anticoag contraindicated - recurrent clots - high risk (ex. cancer)

Why do you want to measure urine output for a patient with Pulmonary Embolism?

PE can affect organ perfusion and the kidneys and lungs are the first to be affected so monitoring UO will tell you if there is kidney perfusion

What lung disease can cause pneumothorax?

pulmonary fibrosis

What are the initial clinical manifestations of a pneumothorax?

- pleural pain - resp distress, tachypnea - decreased or absent breath sounds - chest wall asymmetry - agitation anxiety

What are the more emergent clinical manifestations of a pneumonthorax/hemothorax?

- tracheal deviation (tension pneumo) - hypoxia - narrow pulse pressure (indicates tension on the heart) - hemodynamic stability: hypotension, may indicate tension on heart, pulomary htn, and RV involvement, blood loss (hemothorax)

What are the complications of pneumo/hemothorax?

- pressure on heart - pressure on unaffected lung - PEA arrest - resp distress/failure - hemodynamic instability (d/t blood loss or pulmonary htn causing decreased CO)

Chest tube should be place ______ (low/high) for pneumothorax.

high

Chest tube should be placed ______ (low/high) for hemothorax.

low

Is tidaling ok in the chest tube chamber?

yes, the float ball may oscillate with respirations

Is continuous bubbling bad in the chest tube chamber?

yes -- means there's a leak and need to be fixed by the physician

What does intermittent bubbling in the chest tube chamber indicate?

it shows that the lungs have not yet re-expanded

What are some chest tube complications?

- bleeding - infection (site or into pleural space) - subcutaneous emphysema - dislodgment

What assessment would the nurse find for SQ emphysema?

crepitus

What should the nurse instruct the pt to do if the chest tube dislodges?

instruct pt to perform Valsalva - cover opening with vaseline gauze and dry gauze dressing, followed by occlusive tape - reattach or place end of chest tube in sterile water (establishes water seal)

Mod 5 - Complex Resp Disorders Flashcards

(54 cards)