Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
57 Cards in this Set
- Front
- Back
Clinical Syndrome:
• Discrete or widespread collapsed alveoli • Can lead to ARF (shunting) • Predisposes to pneumonia!!!! • Usually caused by a mucous plug or hypoventilation |
Atelectasis
|
|
S&S of Atelectasis
|
• Cough
• Sputum • Low grade fever • Usually appears dense on an xray |
|
Treatment for Atelectasis
|
Implement pulmonary toilet (ambulation, suction, inc. spirometry, percussion)
|
|
Infection of lung parenchyma from bacteria, viruses, mycoplasma
|
Pneumonia
|
|
• Inflammation of the pulmonary pleurae secondary to virus, bacteria, chest trauma or neoplasm
• Causes the layers of the pleura to rub together and which causes pain |
Pleurisy
ex/ pneumonia, TB |
|
S&S of Pleurisy
|
Pleuritic pain (Sharp knife like pain - Usually one sided)
Low grade fever Pleural friction rub may be heart |
|
Treatment for Pleurisy
|
• Treat cause
• NSAIDS • Rest • Hydration |
|
Inflammatory lung disorder with acute onset of ARF
• 50-60% mortality • If u get pneumonia the mortality rate increases to 90% • Must check PAWP to rule out left sided heart failure. This checks the pressure in the left ventricle • Sudden and progressive pulmonary edema • Fluid filled alveoli • Hypoxia and decreased lung compliance • These people can’t get oxygenated due to alveoli sticking together or being filled with fluid • “white lung” |
Acute Respiratory Distress Syndrom (ARDS)
|
|
Treatment for ARDS
|
Intubate and mechanically ventilate
|
|
Condition secondary to other disease process:
• Build up of fluid in the pleural cavity • Clear or bloody (hemothorax) • Purulent filled (empyema) • Diagnose by a CXR |
Pleural Effusion
|
|
Treatement for Pleural Effusion
|
• For a small pleural effusion treat the cause
• For a large a thoracentesis may need to be done |
|
Any type of acute lethal pulmonary condition, disease, or syndrome that results in hypoxemia (pO2 <or=50-60 mmHg) and usually hypercapnea (> or = 50mmHg)
|
Acute Respiratory Failure (ARF)
|
|
Curve that describes relationship between available oxygen and amount of oxygen carried by hemoglobin
|
SaO2 = vertical - POX (how saturated is hgb (>94% is normal)
PaO2 = horrizontal -find by ABGs (80-100 is normal) |
|
Oxygen's attraction to hemoglobin
|
Affinity
|
|
What changes oxygens affinity?
|
variation in pH
Temp CO2 |
|
Changes from the normal:
pH 7.4 Temp 37 C PaCO2 40 on the OxyHemoglobin Dissociation Curve is called a |
Shift
Left or Right |
|
Left shift conditions
|
Alkalosis, hypothermia
_ increase in oxygen's affinity for hemoglobin _more of the O2 stays on the hgb and rides back through the lungs without being used ___Can cause tissue HYPOXIA |
|
Right shift conditions
|
Acidosis, fever
__oxygen has lower affinity for hemoglobin ___more O2 will be released to the cells but less O2 will be carried from the lungs!!! |
|
Blood in pleura (pleural effusion)
|
hemothorax
|
|
Purulent fluid in pleura (pleural effusion)
|
Empyema
|
|
Diagnosis of pleural effusion
|
CT or Chest Xray (decubetus) on patients side to look for fluid line
May have crepitus - bubble crackes on skin |
|
Treatment of pleural effusion
|
Thoracentesis
__procedure where fluid and/or air is removed from pleural space with needle (may do at bedside to get specimen or relieve symptoms) |
|
Post thoracentesis nursing intervention
|
lie on unaffected side after for 1 hr
|
|
Bilateral pulmonary infiltrates, No left sided heart failure, hypoxemia
|
Acute Respiratory distress syndrome
__Supplemental O2 does not help!!! |
|
Treatment of ARDS
|
Intubate and mechanically ventilate with PEEP
• Limit attempts to 30 secs • Check placement to make sure it’s not in the esophagus with a CO2 monitor(should turn purple) • Avoid right side placement |
|
Intubation by mouth
|
endotracheal - easy access
|
|
Intubation by nose
|
Nasotracheal
|
|
Complications to monitor for with intubation ballon that holds tube in place
|
if >25mm of pressure --it can cause erosion of endotracheal wall
if <25mm or pressure --can cause aspiration of secretions |
|
To verify placement of intubation tube
|
1) listen to breath sounds bilateraly
2) check if CO2 is expirated 3) Capnography 4)want end of tube 3-4cm above Carina (bronchiolle junction) |
|
%inspired oxygen (vent)
|
• FiO2
|
|
size of the breath, usually 500 cc’s
|
Tidal Volume
|
|
positive pressure on end expiration to prevent alveoli from collapsing. High levels of this can lead to decreased CO and barotraumas. Usually 5 cm H2O
|
• PEEP
(positive end expiratory pressure) |
|
positive pressure on inspiration to augment the size of the patients on breath
|
• Pressure Support
(helps patient pull breath in from vent) |
|
How many breaths per minute
|
Rate
|
|
4 Modes of mechanical ventilation
|
Assist Control
Synchronized Intermittnet Mandatory Ventilation CPAP BiPAP |
|
The patient is given a preset tidal volume and a set rate. They can initiate their own breath which triggers the vent to deliver the preset volume. *controling pt's breath*
|
Assist Control (AC)
__Tidal Volume (500cc/min) x Rate (12breaths/min) x FiO2 (30%) x PEEP (5cm H2O) |
|
The patient is given a preset tidal volume and a set rate, but patient must pull their own tidal volume so gives pressure support. (if pt triggers r>12/min then must pull own volume so give pressure support)
|
SIMV (synchronized intermittent mandatory ventilation)
__Tidal Volume (500cc/min) x Rate (12breaths/min) x FiO2 (30%) x PEEP (5cm H2O) x RPS |
|
May be given by face mask or airway. Pt makes their own volume and rate and therefore must be breathing on their own
|
CPAP
__FiO2 (30%) x PEEP (5cm H2O) x RPS |
|
Ventilation with mask at home
|
BiPAP
|
|
Place to prevent paralitic ileus
|
NG Tube
|
|
2 types of chest trauma
|
Blunt - hitting stering wheel
Penetrating - stab |
|
Chest trauma defined as 2 or more sites on 2 or more ribs (free floating segment)
• Chest wall looses stability and usually results in respiratory distress • Results in less tidal volume and a harder time getting air out • Most likely will lead to atelactasis and then pneumonia |
Flail Chest
|
|
S&S of Flail Chest
|
* tachypnea (fast breathing)
• dyspnea • pain • paradoxical chest wall movement • hypoxia • cyanosis |
|
Treatment of flail chest
|
• supplemental O2
• may need CPAP or vent • careful use of fluids • watch for ARDS • sandbags/splints maybe • intercostals blocks and/or epidurals for pain * Surgery rare |
|
• not trauma related
• partial or total collapse of the lung secondary to air in the pleural space • may happen in the ICU when failure to place a line occurs • could be as a result of a ruptured bleb on the lung |
Simple/Spontaneous Pneumothorax
|
|
S&S of Simple/Spontaneous Pneumothorax
|
• dyspnea
• chest pain that radiates to the shoulder • decreased breath sounds on the injured side • hyperressonance on the injured side (cuz it's hollow) |
|
Treatment of Simple/Spontaneous Pneumothorax
|
• if <10 % none
• if > 10% and symptomatic a chest tube may be used • if it happens multiple times they may surgically remove the blister |
|
Bleb is a
|
Blister
|
|
• not spontaneous
• blunt or penetrating • partial or total collapse of the lung due to blood in the pleural space |
Hemothorax
|
|
Treatment of Hemothorax
|
• <250ccs and controlled nothing
• >250 and not controlled a chest tube is used • May do a thoractomy by opeing the chest wall or an autotransfusion which removes the blood and gives it back to the patient |
|
• Sucking chest wall wound (immediate lung deflation)
|
Open Pneumothorax
|
|
S&S of Open Pneumothorax
|
• Dyspnea
• Chest pain • Characteristic sound • May see bubbling • Decreased breath sounds on injured side • Hyperressonance on injured side • SQ crepitus |
|
Treatment of Open Pneumothorax
|
• Cover with sterile 3 way flap dressing to prevent a tension pneumothorax. Air can escape on expiration
• Prepare for chest tube insertion |
|
• Bad emergency
• Progressive lethal syndrome- as air continues to infiltrate pleural space on inspiration but doesn’t escape on expiration |
Tension Pneumothorax
|
|
• Usually secondary to acceleration/deceleration injury
• Results in localized alveolocapillary damage (bruised alveoli and edema), and diffuse patchy infiltrates • Usually happens 24-48 hrs after the damage occurs |
Pulmonary Contusion
|
|
Treatment of Pulmonary Contusion
|
• Judicious use of fluids
• Possible vent support, high flow O2 • Early ambulation, deep breathing and incentive spirometry |
|
3 chambers of Chest Drainage Systems
|
• Collection: drainage
• Water seal: uses 2 ml’s sterile water, don’t want to see bubbling which means an air leak, tidaling is normal. To test for tubing problem clamp the tube for 1 sec and if there is still bubbling the tube has a problem • Suction regulator: want constant bubbling, about 20 cm suction, constant wall suctioning |