Study respiratory rn 204 Flash Cards
log in to save your progress
Pile Management Card
respiratory rn 204
respiratory rn 204
| a filter placed in the inferior vena cava under fluoroscopic guidance. It is used in patients who are particularly vulnerable to pulmonary embolism, such as those diagnosed with deep venous thrombosis with contraindications to anticoagulation, to prevent venous emboli from entering the pulmonary circulation. |
| green filter |
|
CREATING ADHESIONS BETWEEN VISCERAL AND PARIETAL PLEURA
USED FOR RECURRENTS PNEUMOTHORAX INSTILING CHEMICAL AGENT (DOXYCYCLINE) INFLAMMATORY RESPONSE CREATES SCAR TISSUE AND ADHESIONS |
| PLEURODESIS |
| Never do what to a chest tube |
| NEVER CLAMP THE CHEST TUBE IF THERE IS AN AIR LEAK FROM THE PATIENT |
|
1 chest tube make suer the dressing is
2 the connection are 3 is the tubing 4 is the drainage 5. In the first chamber in the chest is 6 how much and is it and does the unit need 7wall suction on and bubbling in the |
|
1 Is the dressing airtight and dry?
2 Are all the connections taped securely? 3 Is the tubing lying on the bed coiled without any dependent loops hanging down on the floor? 4 Is the drainage flowing freely down the tubes? 5 In the first chamber in the chest drainage setup--the drainage collection chamber--what is the nature of the drainage? 6 How much per hour? Is it marked? Does the unit need to be changed? Is the wall suction only gently bubbling in this chamber? |
| Nursing management of client with chest tube |
|
Look and listen for signs of respiratory distress and adequate level of oxygenation
Have patient turn from back to affected side to promote drainage control pain so that the patient will cooperate Encourage arm exercises |
|
chest tubes do what to the lungs
1 2 3 they areplaced in the 4. sealed withe 5 suction level is 6 the drainage system is |
|
1 Re-expand the lung
2 Reestablish negative pressure 3 Placed in pleural cavity 4 Sealed with Heimlich valve (one way) 5 Low level suction 6 Closed drainage system |
| treatment of choice for pneumothorax is |
| placement of a closed chest catherter allwoing the lung to reexpand chest tube |
| creation of adhesion between the parietal and viseral pleura may be used to prevent recurrent pneumothorax. This procedure invloves instilling a chemicla agent such as soxycycline into the pleural space. The subsequent inflammaroty response creates scar tissue and adhesion between teh pleural layers. is called |
| Pleurodesis treatemtn (controversial) |
| TREATMENT OF PNEUMOTHORAX |
|
CHEST TUBES
PLEURODESIS SURGERY OXYGEN PAIN MEDICATIONS |
| DIAGNOSIS OF PNEUMOTHORAX |
|
CHEST X-RAY
ABG’s |
|
thers are symptoms of
DYSPENA TACHYCARDIA CARDIAC OUTUT AFFECTED HYPOTENSION DISTENDED NECK VEINS DIMINDHED BREATHING SOUNDS PAIN CHEST WALL MOVEMENT DIMINSHED ON AFFECTED SIDE MEDIASTINAL SHIFT SIGNS OF SHOCK MAY BE PRESENT |
| TENSION PNEUMOTHORAX |
|
this type of phneumothorax is
Air is allowed in only, trapped in the pleural space Severely compromised ventilation Shift of thoracic organs to the unaffected side Venous return impaired Medical emergency |
| TENSION PNEUMOTHORAX |
| symptoms of SYMPTOMS OF TRAUMATIC PNEUMOTHORAX |
|
PAIN
DYSPNEA TACHYCARDIA CHEST WALL MOVEMENT ANXIETY HEMORRHAGE |
| reasons for TRAUMATIC PNEUMOTHORAX |
|
BLUNT OR PENETRATING INJURY
CLOSED PNEUMOTHORAX -rib fracture, injury of esophagus, alveoli rupture OPEN PNEUMOTHORAX –SUCKING WALL -air moves freely between the pleural space and atmosphere IATROGENIC PNEUMOTHORAX -during central line placement, CPR, mechanical ventilation |
| SYMPTOMS OF TRAUMATIC PNEUMOTHORAX |
|
PAIN
DYSPNEA TACHYCARDIA CHEST WALL MOVEMENT ANXIETY HEMORRHAGE |
| SYMPTOMS OF SPONTANEOUS PNEUMOTHORAX |
|
DEPENDING ON : SIZE
EXTENT OF LUNG COLLAPSE UNDERLYING DISEAS Pleuritic chest pain (begins abruptly) Shortness of breath ( while at rest ) Asymmetrical chest movement Hyper resonant affected side Tachycardia Diminished breath sounds or absent Hypoxemia |
|
Underlying lung disease
Rupture of alveolus Life threatening this type of pneumothorax sysmptoms are Risk factors: asthma cystic fibrosis ARDS TBC |
| SPONTANEOUS PNEUMOTHORAX SECONDARY- COMPLICATED |
|
this type of pneumothorax sysmptoms are
Previously healthy people Tall, slender men 16-24 Cause unknown Risk factors: smoking high altitude lying, diving scuba diving |
| SPONTANEOUS PNEUMOTHORAX primary simple |
| air is trapped inside what type of pneumothorax |
| TENSION PNEUMOTHORAX |
|
blunt or penetrating trauma (MVA,CPR)
what type of pneumothorax |
| TRAUMATIC PNEUMOTHORAX |
|
rupture of air-filled bleb, blister
what type of pneumothorax |
| spontaneous pneumothorax |
| Pneumothorax can occur |
| spontaneoulsy without apparent cause as complication of preexisting disease as a result of blunt or penetrating trauma to chest or from an iatrogenic cause ( follwoing thoracentesis) |
| ACCUMULATION OF AIR IN PLEURAL SPACE is |
| Pneumothorax |
| nursing diagnosis for inhaled injury is |
|
1.Impaired gas exchange
2.Ineffective airway clearance 3.Anxiety |
| nursing management of inhaled injury |
|
Administer oxygen
Coughing Suctioning Medication administration Fluid administration Monitor ABG’s Monitor Carboxyhemoglobin levels Chest PT with percussion Postural drainage Observe for ARDS symptoms |
| Hyperbaric oxygen therapy is |
| ( 100% oxygen |
| treatment of inhaled injury is |
|
Supportive
Endotracheal intubation Mechanical ventilation Oxygen therapy Hyperbaric oxygen therapy ( 100% oxygen) Bronchodilators Fluid management |
|
inhaled toxic chemicals causes
ards may develop in sloughing of damaged mococsa leads to airway obstrucion and ___is common following smoke inhalation |
|
bronchospasm edema of the airway and alveili
1 - 2 days atelectasis Pneumonia |
| diagnosistic test for inhaled injury's are |
|
ABG’s
CARBOXYHEMOGLOBIN LEVELS Normal level - less than 5% (nonsmoker) less than 10% (smoker) |
| carbon monoxide sysmptoms are |
|
HEADACHE
DYSPNEA DIZZINESS NAUSEA “CHERRY RED” COLOR OF THE MUCOUSA CONFUSION VISUALL DISTURBANCE HYPOTENSION SEIZURES COMA ** permanent neurologic deficit can occur in survivoprs of severe, acute carbond monoxide posing |
| Carbon monoxide reacts on the body by |
|
BINDS WITH HEMOGLOBIN
200 -500 times stronger REDUCTION OF OXYGEN CARRIED BY HEMOGLOBIN BRONCHOSPAMS EDEMA OF AIRWAYS AND ALVEOLI ARDS MAY DEVELOP IN 1-2 DAYS |
| Steam inhalation can cause |
| theraml damage to tissue to the lwoer respiratory tract |
| Teh lower airway of he luns are typically protected from __ damage by cooling the inhaled gases in the uper airway and laryngeal spasm. Upper airway obstruction due to tissue edema and laryngeal spasm can occure quickly however causing ___ |
|
Thermal damage to lower airways
causing asphyxiation or oxygen deprivation |
|
smoke inhaltation can significantly affect nromal respiratory functon in three ways
1. __ __ to airways leading to impaired ventilation 2__ __ or __ poisoning resultin in tissue hypoxia 3__ __ to the lung from nixious gases, which can lead to impaired gas exchange |
|
1 thermal damage
2 carbon monoxide or cyanide poisoning 3 chemical damage |
|
pulmonary injury due to inhaltion the cause are
**smoke inhalation affects up to 1/3 of pt admited to burn units |
|
Smoke inhalation
-hot air -toxic gases |
| nursing diagnosis for pulmonary contusions are |
|
1.Acute pain
2.Ineffective airway clearance 3.Impaired gas exchange |
| with pulmonary contusion monitor |
|
Monitor :
pain – administer medications very important Breathing sounds ABG’s CBC Vital signs Sputum (color, amount) Positioning for optimal lung expansion (elevate the head of bed) Coughing, deep breathing, chest PT Administer oxygen Mechanical ventilation settings |
| treatment of pulmonary contusion include |
|
Supportive treatment
Mechanical ventilation PEEP Bronchoscopy – remove sputum, cellular debris , preventing atelectasis Fluid management ABG’s measurement |
| later manifestion of pulmonary contusion are |
| tachycardia, tachypena, dyspena and cyanosis. |
| Early manifestion of pulmonary contusion are |
| increased sob, restlessness, apprehaension and chest pain and copius sputum |
| Manifestation of pulmonary contusion may not be apparent unitl __ - __ hours after njury |
| 12 to 24 hours after injury |
| in pulmonary contusion what happens |
| aveloi and pulmonary arterioles rupture causing intravelor hemmorrhage and interstitial and bronchial edema. the inflamation and edema impair production of surfactant. Pulmary vascular ristance increases and blood flow decreases |
| Pulmonary contusion are mostly likly from |
|
MVA
Significant fall or crush injury |
| Treatment of Flail chest is |
|
Intercostal spinal block
Epidural anesthesia Oxygen therapy Internal or external fixation Preferred treatment is intubation and PEEP ventilation |
| flail chest caused |
|
1 dyspnea
2 pain espically during inspiration 3 paradoxic chest movement 4 palpalbe crepitus 5 unequal chest expansion 6 breath sounds are diminished and crackles may be heard |
| flaif chest is frequesntly assiced with underlying |
| pulmonary contusions |
|
In flail chest the flail segment is sucked in during ___
and moves outward during this is know as |
|
in during inhalation
outward during exhale paradoxic movement |
| multiple rib fractures may impair chest wall stability and normal chest function. Two ore more consecutive ribs are fractured in multiple places a free flating segment of chest wall this is known as |
| flail chest |
| Treatment of rib fracture |
|
Heal uneventfully - one rib
Providing analgesia Promote coughing deep breathing |
|
symptoms of rib fracatures
1____ breathing pain 2___ coughing pain 3coughing 4___ respirations 5 ___ cough 6 skin can ___ 7 under skin you can may feel and hear 8Breath sounds are ___ 9 voluntary ____ |
|
1Inspiratory pain
2 Inspiratory coughing 3 Coughing 4 Shallow respirations 5 Inhibited cough 6 Bruising 7 Crepitus 8 Breaths sounds diminished 9 Voluntary splinting |
|
1 Simple rib fracture-
2 Displaced rib- 3 First and second rib fracture can damage 4 Seventh- Tenth – can 5 complication of rib fractures can lead to |
|
1. one rib
2. can penetrate plura 3 intrathoracic vessels 4 liver spleen injury 5. (atelectasis, pneumonia, respiratory failure) |
| in pe decreased urinary output is often and early indicator of |
| decreased cardiac output |
| postion to put person in if they have a pe |
| fowlers or high fowlers pistion with lower extremities dependant |
|
Hypoxemia often causes __ and __.
Hypercapnia may reduce ___ . Cyanosis indicates significatn ___ |
|
confusion and agitation
LOC hopoxemia |
|
PE results in ares of the lungs that are ventilated but not perfused; they receive no ___ blood flow. if the embolous is large and a major segment of the lung is unperfused __ __ is significantly affeced
Nursing intervention are directed towards |
|
capillary blood flow
gas exchange impaired gas exchange |
| Large PE can cause significant mismatch between pulmonary ___ and ___ |
| pulmonary ventilation and circulation |
| nursing interventions for PE |
|
Early ambulation
External pneumatic device ( SCD) Anti-embolism stockings (TED’s) fitted Exercise- legs Physical therapy consult Discouraging crossing legs, using pillows under legs |
| if you notice the following what do you do hemathuria, Hemoptysis, bleeding gums, back or abdominal pain |
| Promptly report |
|
what type of therapy is used to treat massive PE and hypotension
name the durgs |
|
Fibrinolytic
Streptokinase, urokinase or plasminogen activator to lyse embolus |
| what is used to stop anticoagulant effects in heparin if bleeding occurs |
| protamine |
| Risk associated with bleeding with heparin are |
| cardiac, hepatic, renal disease and over age of 60 |
| coumadin is iniated same time as heparin and alther the sythesis of vitamin __ and requires __ - __ days to be fully effective. Therapy is continued for __ - __ months |
|
K
5 -7 day 2-3 months |
|
Heparin Therapy for PE Intially is bolus of __ to __ units followd by continous infusion at the rate of __ to __ units per hour
what is monitored how long does heparin therapy last |
|
5000 to 1000 bolus
1000 to 1500 units per hour aPTT or PTT monitored 5 days until oral anticoagulatn theray is effective |
| Treatment of PE |
|
MEDICATIONS
-anticoagulant therapy –HEPARIN SURGERY -venous trombectomy Use of Filters - Venal caval filter, Greenfield Filter |
| PE manifestation usually develop __ over a period of ___. Most common symptom are __ ____ __ |
|
abruptly, with in minutes.
symptoms are dyspnea, pleuritic chest pain, anxiety and a sense of impending doom, and cough are also commmone |
| obstruction fo pulmonary blood flow by an embolus affects both __ and ___ |
| perfusion and ventilation |
| in large pulmonary artery PE the gas exchange is signifacantly reduced or preventd and cardiac out ___ as the blood fails to move through the pulmonary vasuclar systema nd retun to the __ __ |
|
falls
does not return to the left heart |
| this type of test for pe are hightly specific to the presence of thormbus. the ___-___ is a fragment of fibrin formaed during lysis of blood clot; elevated blood levels indicate thrombus formation and lysis |
| Plasma D-dimer |
| diagnostic test for pe |
|
Chest CT scan
Pulmonary Angiography Chest X-RAY ECG ABG’s Plasma D-dimer |
| Signs and symptoms of PE |
|
Dyspnea
Shortness of breath Chest pain Anxiety Cough Tachycardia Tachypnea Crackles ( rales) Low grade fever Diaphoresis Hemoptysis Cyanosis |
|
reason for PE During child birth
Release of amniotic fluid in circulation |
| AMNIOTIC FLUID EMBOLISM |
|
Most common nonthrombotic emboli
Long bones typically femur Release of bone marrow and fat in circulation |
| Fat Embolism |
| Patho for PE |
|
Thrombus formation
Embolus development Entering Pulmonary Arterial System |
|
Large pulmonary artery PE would cause?
Lung tissue PE would cause Small segment obstruction would cause |
|
-large pulmonary artery – sudden death
-lung tissue infarction- significantly less flow -small segment obstruction-no permanent injury |
| PE is the ___ leading cause of death |
| 3rd |
| Risk factors are for PE |
|
DVT(stasis of venous blood flow, vessel wall damage, altered blood coagulation)
Prolonged immobility Trauma (hip, femur) Surgery MI, heart failure Obesity Age Oral contraceptives Pregnancy, child birth and broken FEmur bone |
|
Frequent cause of PE are
Other causes are |
|
Thromboemboli or blood clots that developt in the venous system dvt or right sid eof the heart are the most frequent causes of pe
Blood cloths DVT Tumors Right side heart thrombus Fat Bone marrow Amniotic fluid Intravenous injection of air |
|
OBSTRUCTION OF A BLOOD FLOW IN PART OF THE PULMONARY VASCULAR SYSTEM
by an embolus |
| pulmonary embolism |
| nursing diagnosis for ards would be |
|
IMPAIRED GASS EXCHANGE
INEFFECTIVE BREATHING PATTERN |
| Nursing managment of ards would include |
|
PREVENTION
-early recognition -preventing spread pathogens -attention to line care -preventing nosocomial infection Sedated client or paralyzed client – care for sedated or paralyzed client Prone positioning- Vollman prone positioner - 30 minutes Lubricate eyes before turning Secure lines and drains |
| PHARMACOLOGICAL SUPPORT for ards would include |
|
ANTI-INFLAMATORY –CORTICOSTEROIDS
VASODILATORS- NITRIC OXIDE inhalation SURFACTANT AND BETA-AGONIST – via endotracheal tube CYTOKININE INHIBITORS-Lisofylline |
| Treatment of ARDS is |
|
OXYGENATION
VENTILATION FLUID MANAGEMENT PHARMALOGICAL SUPPORT ANTI-INFLAMATORY MEDICATIONS VASODILATOR MEDICATIONS SURFACTANT AND BETA-AGONISTS CYTOKINE INHIBITORS |
|
In final stage of ards CArbon dioxide can not diffuse across the __ __
PACO2 levels PAO2 levels |
|
Hyaline membrane
PACO2 rise PA02 fall |
|
More debris from damaged cells and hyaline membrane
Further reduced gas exchange Carbon dioxide cannot diffuse across hyaline membrane paCO2 level rise paO2 level falls Respiratory acidosis can develop What stage of ards Without respiratory support respiratory failure will develop Almost 50% of patients die even with aggressive treatment |
| Final stage |
|
this phase is
Fluid rich in protein accumulates in alveoli Inactivation of surfactant Further damage of surfactant producing cells Alveoli stiffen and collapse Atelectasis Breathing effort increases Gas exchange impairment Blood oxygen levels fall Carbon dioxide levels fall initially – because of tachypnea |
| ALVEOLAR COLLAPS |
|
what stage of ards is
Damaged capillary and alveolar walls are now more permeable Plasma-Proteins-Red blood cells – enter the interstitial space- causing edema Damage of surfactant producing cells Pressure in interstitial space increases Fluid leaks into alveoli Balance disrupted between osmotic and hydrostatic pressure Imbalance causes more fluid to enter alveoli |
| Pulmonary Edema |
|
This stage of ARDS is
Alveoli and capillaries are damaged with chemical released during inflammation process Damaging chemical are released from macrophages (oxidants, inflammatory mediators, enzymes, peptides) Lysosomes release lysosomal enzymes causing further damage |
| Initation phase |
|
Inflammation of lung ____
Leading to impair gas exchange Causing hypoxemia Resulting in multiple organ failure Requiring mechanical ventilation Disease is Condition often fatal |
|
parenchyma
ARDS |
|
Manifestation of cor pulmonale are those of underlying pulmonary disorders and right sided heart failure. the signs and symptoms are
the signs of right sided heart failure are |
|
chronic productive cough, progressive dyspnea and wheezing are common
pheripheral edema and distended neck vein skin is warm moist and both ruddy and cyanotic becaused of increased number of RBC and hypoxemia |
|
a condition of right ventricular hypertorpy and failure resulting from long standing pulmonary hyptertions.
The most common cause of this is |
|
COR pulmonale
COPD |
|
1. in pulmonary htn cbc commonly show
2. ABGs and o2 saturation measures 3. chest xray shows 4. ECG shows |
|
1. polycythemia (increased number of red blood cells
2 hpoxemia 3 right heart enlargement and dilation of central pulmonary arteries 4 changes of right ventricular hypertrophy |
| drugs to treat pulmonary hyptertinosion are |
| Calcium channel blockers nifedipine, or diltiazem, epoprostenol or trepostinol or bosentan and coumadin |
| signs of pulmonary hypertenstion are |
| dyspnea, fatigue, angina and syncope with exertion |
|
this si the sum of TV + IRV + ERV is called. It is approx.
how much Toltal lung capacity (TLC) is |
|
vital capacity VC 4500 ml notes have 4800
6000 ml |
| Approximately the air that can be foreced out over the tidle volumne is called. the amount is |
|
Expiratory reserve volumne ERV
1000 ml notes have 1200 ml |
|
The amount of air that can be in haled forcibly over the tidle volume is ?
Amount is |
|
Inspiratory Reserve Volume IRV
2100 to 3100 ml notes have 3100 ml |
| the volume of air that remains in the lungs after a forced expiration is called and the amt is |
| Risidual volume 1100 ml to 1200 ml |
| Volume left in lungs after normal exhalation is and it is called |
| 2400 ml Functional risedual capacity FCR |
| atrerial bloos is colled in a ___ ___ ___ . samples is placed on iceb ag and taken immediately to lab. apply presures on puccture site for __ -__ **do nto collect blood from the same arem used for an IV Infusion |
|
heparinized needle and syringe
apply pressure 2 - 5 minutes |
|
1 If ph is less than 7.35 it indicates
2 if more than 7.45 it is 3 paco2 increased it is 4 paco2 decreseased |
|
1 acidosis
2 alkalosis 3 acidosis 4 alkalosis |
|
ABGs normal values
Ph PaCo2 pao2 HCo3 BE |
|
Ph 7.35 - 7.45
Paco2 35 - 45 Pao2 75 100 hco3 24 - 28 BE 2meq/l |
| Active cells produce about how much carbon dioxide each minute. ***this is the exact amount that is excreated by lungs each minute |
| 200ml |
| a lipoprotein produced by the aveolar cells interfers with this adheiveness of water molecules, reducing surface tension and helping expand the lungs is |
| Surfactant |
| approx how much air never reaches the aveoli the amount remain in the passageways is called and the amt is |
| Anatomic dead space volume 150 ml |
| the amount of air moved in and out of the lungs with each nromal, quiet breath is called? approxiamately how much air is moved |
|
1 Tidal volume TV
500 ml |
| Respiratory Volume and capacity are affected by |
| gender, age, weight and health status |
Place this card into pile:
Copyright © Jadence, LLC 2007 - 2012. All Rights Reserved.