What is atelectasis characterized by?
- Closure or collapse of alveoli
- Increased work of breathing
- Hypoxemia
- Decreased breath sounds and crackles
Acute atelectasis is most common in the postoperative setting.
What are the symptoms of acute atelectasis?
- Insidious increasing dyspnea
- Cough
- Sputum production
- Tachycardia
- Tachypnea
- Pleural pain
- Central cyanosis if large areas affected
Chronic atelectasis may present similarly with possible pulmonary infection.
What are the nursing interventions for atelectasis?
- Frequent turning
- Early mobilization
- Strategies to expand lungs
- Incentive spirometer
- Voluntary deep breathing
- Secretion management
- ICOUGH
What does ICOUGH stand for?
Incentive Spirometry
Coughing and deep breathing
Oral care
Understanding (pt. and staff education)
Getting out of bed at least 3x daily
Head-of-bed elevation
What are the typical COVID-19 symptoms?
- Fatigue
- Myalgia
- Congestion
- Sore throat
- Diarrhea
- Anosmia (loss of smell)
- Ageusia (loss of taste)
Symptoms can range from asymptomatic to severe viral pneumonia.
What are the risk factors for severe COVID-19 illness?
- Advanced age
- Medical comorbidities
- Sex
- Socioeconomic disparities
These factors increase vulnerability to severe outcomes.
What are the noninvasive respiratory support methods for hypoxia?
- Cardiorespiratory monitoring
- Supportive therapy
- Supplemental oxygen
- Self-proning
These methods are alternatives to endotracheal intubation.
What are the Invasive Respiratory Support methods for Hypoxia?
- Intubation (oral or nasal)
- Medications: Remdesivir, Corticosteroids, monoclonal antibodies, clinical trials
- Mechanical ventilation
- In-line or closed system suctioning
- ECMO
Daily assessment for extubation necessary
What is acute respiratory failure (ARF) characterized by?
Rapid deterioration
- Hypoxemia
- Hypercapnia
- Respiratory acidosis
- Impaired venitilation of perfusion mechanisms
- Decreased breath sounds
- Use of accessory muscles
Later signs:
- Confusion
- Lethargy
- Central cyanosis
- Diaphoresis
- Respiratory arrest
What are the early signs of acute respiratory failure?
- Restlessness
- Tachycardia
- Hypertension
- Fatigue
- Headache
What are some causes of Acute Respiratory Failure?
- Impaired function of CNS
- Drug overdose
- Infection
- Head trauma
- Hemorrhage
- Sleep apnea
What is the management for Acute Respiratory Failure?
- Identification and treatment of underlying cause
- Intubation, mechanical ventilation
- Nutritional support, enteral feedings preferred
- Reduce anxiety
- Provide patient a form of communication (while intubated)
- Prevent complications (turning, ROM, mouth care, skin care)
What are the nursing diagnoses for a patient receiving mechanical ventilation?
- Enhancing gas exchange
- Promoting effective airway clearance
- Preventing injury and infection
- Promoting optimal mobility
- Promoting optimal communication
- Promoting coping ability
What is the mortality rate of Acute Respiratory Distress Syndrome (ARDS)?
27% to 50%
ARDS is characterized by sudden pulmonary edema and severe dyspnea.
What are the risk factors for pulmonary embolism (PE)?
- Trauma
- Surgery
- Pregnancy
- Heart failure
- Hypercoagulability
- Immobility
- Venous stasis
- afib
What are the treatment measures for pulmonary embolism?
- Exercises to avoid venous stasis
- Early ambulation
- Anti-embolism stockings
- Anticoagulation therapy
- Thrombolytic therapy
- Surgical interventions
Prevention is key in managing PE.
What types of chest trauma are there?
- Blunt trauma
- Penetrating trauma
- Sternal fractures
- Rib fractures
- Flail chest
- Pulmonary contusion
- Pneumothorax
What are the components of a chest drainage system?
- Suction source
- Collection chamber for pleural drainage
- Mechanism to prevent air reentry
Three types:
- Traditional Water Seal
- Dry suction water seal
- Dry suction
What is Noninvasive Positive-Pressure Ventilation?
- Continuous Positive Airway Pressure (CPAP)
- Bilevel positive airway pressure (BiPAP)
- Method of positive pressure ventilation that can be given via facemasks that cover the nose and mouth, nasal masks, or other oral or nasal devices such as the nasal pillow
- Eliminates need for endotracheal intubation or tracheostomy
What are the indications for Noninvasive Positive Pressure Ventilation?
- Respiratory arrest
- Serious dysrhythmias
- Cognitive impairment
- Head/facial trauma
What should the cuff pressure be maintained to in endotracheal intubation?
20-25 mmHg
How long should a patient be intubated?
No longer than
14-21 days
Longer need? Tracheostomy
What should an assessment include for someone on Mechanical Ventilation?
- Systematic assessment of all body systems
- In depth respiratory assessment including all indicators of oxygenation status
- Neurologic status
- Effective coping and emotional needs
- Comfort level and ability to communicate needs
- Assessment of the equipment and settings
What are some of the reasons and solutions for an “Increase in Peak Airway Pressure” alarm on a ventilator?
Coughing or plugged airway tube: Suction airway for secretions; empty condensation fluid from circuit
Patient-ventilator dyssynchrony: Adjust sensitivity; consider sedatives
Decreasing lung compliance: Manually ventilate patient; Assess for hypoxia or bronchospasm; Check ABG values; Sedate only if necessary
Tubing kinked: Check tubing; reposition patient; insert oral airway if necessary
Pneumothorax: Manually ventilate patient; notify provider!
Atelectasis or bronchospasm: Clear secretions
