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Adult Heath 3 Exam 2: Care of the Client with Alteration in Respiratory Function
Terms in this set (78)
________________ ________________ is blockage of pulmonary arteries that obstructs alveolar perfusion and most commonly affects lower lobes
What are the risk factors of Pulmonary Embolism ?
Deep vein thrombosis (90%)
Immobility or reduced mobility
History of DVT
Central venous catheters
What are the 3 components of Virchow's Triad ?
What are the Clinical Manifestations of Pulmonary Embolism ?
Pleuritic chest pain
Stabbing pain on inspiration
S3 and S4 hear sounds
What are the complications of Pulmonary Embolism ?
Alveolar necrosis and hemorrhage
Hypoxemia associated with massive or recurrent emboli
Right ventricular hypertrophy
What diagnostic test can bu used to diagnose a Pulmonary Embolism?
CT Angiography (shows pulmonary abnormalities...can see where blockage is at)
_________________ ____________________ is the GOLD STANDARD and most definitive diagnostic tool to diagnose Pulmonary Embolism.
__________ __________________ _______________ results from inadequate gas exchange either _______________ (insufficient O2 transferred to the blood
or ________________ (inadequate CO2 removal).
Acute Respiratory Failure (ARF); Hypoxemia; Hypercapnia
_______________ is oxygenation failure resulting in decreased oxygen levels in the blood PaO2 < 60 mmHg.
Hypercapnia is ventilatory failure resulting in increased levels of CO2 in the blood PaCO2 _______________.
> 45 mmHg
What ABG results are seen in patients with Acute Respiratory Failure (ARF) ?
Pressure of arterial Oxygen (PaO2) < 60 mm Hg
Arterial oxygen saturation (SaO2) < 90%
Partial pressure of arterial carbon dioxide (PaCO2) >50 mm Hg
What are the possible causes of Ventilatory Failure (Hypercapnic) ?
Physical problem of lungs or chest wall
Central nervous system abnormalities
-----Drug overdose, Stroke, ICP, Meningitis,Spinal cord injuries
Chest wall abnormalities
-----Flail chest, Kyphoscoliosis, Severe obesity,Fractures
-----Muscular dystrophy, Polio, Guillain-Barré syndrome, Multiple sclerosis, Exposure to toxins
Defect in respiratory control center in brain
Poor function of respiratory muscles, especially diaphragm
Airways and alveoli abnormalities
-----Asthma, COPD, Cystic Fibrosis, Pulmonary Embolism
_____________ is the hallmark symptoms seen in Acute Respiratory Failure (ARF).
What are the early seen in Acute Respiratory Failure (ARF) ?
In patients with _______________ the key feature/ cardinal sign is hypoxemia.
ARDS (Acute Respiratory Distress Syndrome)
What are the causes of ARDS (Acute Respiratory Distress Syndrome)?
Direct or indirect lung injuries
Sepsis Most common
Damage to alveolar-capillary membrane (decreased surfactant)
Stimulation of inflammatory and immune systems
What are the 3 pathophysiologic phase changes in ARDS (Acute Respiratory Distress Syndrome) ? What is seen in each phase ?
1 injury or exudative phase (tachypnea, dyspneic, congested alveoli)
2 reparative or proliferative phase (pulmonary hypertension, fibrosis)
3 fibrotic/resolution phase
The hallmark Clinical Manifestation in ARDS (Acute Respiratory Distress Syndrome) is refractory HYPOXEMIA that:
doesn't reverse with even 100% O2 therapy
How is the alveolar damaged in ARDS (Acute Respiratory Distress Syndrome) ?
decreased surfactant and alveoli can rupture and collapse ("white out" appearance to CXR a lot of infiltrate)
How does the use of proning and kinetic bed help in patients with ARDS (Acute Respiratory Distress Syndrome) ?
By continuously rotating to decrease respiratory complications
_________________ ________________ _________________ is the second leading hospital associated infection with patiennts over 65 or with underlying illness at increased risk.
Ventilator Associated Pneumonia (VAP)
What are causes of Ventilator Associated Pneumonia (VAP) ?
Patient on mechanical ventilation
Patient had Endotracheal or Gastric tube tube placed for too long
What are prevention strategies for Ventilator Associated Pneumonia (VAP) ?
Head of Bead elevated
Ulcer prophylaxis to avoid aspiration
Turning and Repositioning
___________ ________________ is an acute life-threatening narrowing of the airways that does not respond to normal asthma interventions.
What should a nurse do if a patient with Status Asthmaticus who was previously wheezing no longer has wheezing upon reassessment ?
Know that patient is deteriorating to total airway obstruction and needs emergency intervention
What are the Clinical Manifestations of Status Asthmaticus ?
Use of accessory muscles
What treatment should be provided to patients with Status Asthmaticus ?
Emergency Intubation if airway becomes fully obstructed
What are the 5 Mechanical Ventilation Settings ?
Tidal volume (Vt)
Rate (breaths/min 10-14)
Fraction of inspired oxygen (Fio2)
PIP (peak inspiratory pressure)
PEEP (positive end expiratory pressure)
What is the Tidal volume setting on Mechanical Ventilation ?
amount of volume going in to lungs from ventilator
Has to be calculated 6-8mL/kg body weight
What is the FiO2 (Fraction of inspired oxygen) setting on Mechanical Ventilation ?
Amount of oxygen that is being delivered to patient determined by assess ABG levels (21% - 100%)
What is the PIP (peak inspiratory pressure) setting on Mechanical Ventilation ?
delivers set amount of pressure to keep lungs compliant
What is the PEEP (positive end expiratory pressure) normal range and function in mechanical ventilation ?
To keep alveoli OPEN during expiration
What is the Flow rate setting on Mechanical Ventilation ?
how fast breath will be delivered L/min
What are the 4 Ventilator Alarms a nurse should monitor ?
Change in Respiratory Rate Alarm
-----High RR could be from water in the ventilator tubing
High Pressure Alarm
Sudden decrease in maximal inspiratory pressure Alarm
What are reasons the High Pressure Alarm on a Mechanical Ventilator would go off ?
What is the troubleshooting for the Apnea alarm on a Mechanical Ventilator ?
Ventilator will deliver a default amount of breaths
How does the Synchronized intermittent mandatory ventilation (SIMV) mode work ?
By delivering preset rate, preset tidal volume or preset pressure. Patients initiate own breaths, tidal volumes provided between the ventilator breaths allowing ventilator to be in synchrony with patient
Synchronized intermittent mandatory ventilation (SIMV) is used prior to ______________ patient from a ventilator.
What does should the nurse do prior to extubation from Mechanical Ventilation ?
Thoroughly suction ET and oral cavity
Rapidly deflate ET cuff
Remove tube at peak inspiration
Instruct patient to cough
Monitor patient every 5 min; assess ventilatory pattern for respiratory distress
What does the Diagnostic Test for Amylase show ?
condition of pancreas, level of inflammation
What are the liver function tests?
LDH (lactic acid dehydrogenase)
AST (aspartate amino transferase)
ALT (alanine aminotransferase)
What does the Diagnostic Test of Ammonia levels show ?
Hepatic (liver function) High levels when malfunction of liver
The Normal range of Serum Ammonia is ________________.
What does Jaundice indicate ?
Accumulation of bilirubin due to liver disease
What causes Hepatocellular jaundice ?
Results when liver cells cannot efficiently excrete bilirubin resulting in it accumulating
______________ _______________ ______________ occurs a result of edema and fibrosis of liver cells resulting in scarred and blocked ducts in the liver.
Intrahepatic obstructive jaundice
______________ _____________ results from increased destruction of RBCs into plasma causing flooding with bilirubin and liver cannot excrete it quickly enough so it accumulates.
___________ ____________ _______________ is sudden and severe massive hepatocellular necrosis in 1-3 weeks resulting in hepatic encephalopathy and/or bleeding.
Acute Liver Failure
Which drugs are hepatotoxic to women ?
Which drugs are hepatotoxic to men ?
Amoxicillin-clavulanic acid (Augmentin)
Which drugs are hepatotoxic to elderly ?
Which drugs are hepatotoxic to young patients ?
Which drugs are hepatotoxic to obese patient ?
Which drugs are hepatotoxic to diabetics ?
Which drugs are hepatotoxic to patients in renal failure ?
Which drugs are hepatotoxic to patients with AIDs ?
Which drugs are hepatotoxic to patients with hepatitis C ?
Which drugs are hepatotoxic to patients with preexisting liver disease ?
Niacin, tetracycline, methotrexate
______________ _____________________ is a complex cognitive syndrome of a decline in brain function that results from liver failure/cirrhosis of the liver causing a buildup of toxins in your bloodstream, which can lead to brain damage.
What clinical manifestations are seen in Stage II Hepatic Encephalopathy (Acute Liver Failure) ?
Continuing mental changes (MORE PRONOUNCED)
Disorientation to time, place, or person
Asterixis (hand flapping tremor)
What clinical manifestations are seen in Stage IV Hepatic Encephalopathy (Acute Liver Failure) ?
Positive Babinski's sign
Fetor hepaticus (HALLMARK)
__________ ______________ is a metabolic smell to the breath, "musty, sweet odor" seen in Stage IV Hepatic Encephalopathy.
What nursing management and pharmacological intervention should be provided for Hepatic Encephalopathy ?
Assess changes on level of conciseness and cognitive function
Ensure patent Airway
Decrease protein intake
Lactulose: laxative to excrete the ammonia
Monitor potassium levels
Neomycin: antibiotic to decrease protein and ammonia levels (Can cause kidney toxicity)
What clinical manifestations are seen in Acute Liver Failure ?
__________ _________ _____________ enlarged inflamed liver with widespread fibrotic (scarred) bands and damaged liver cells resulting in impairments in blood and lymph flow
What are the 3 types of chronic liver failure ?
Laennec's Cirrhosis: Alcoholism
Which types of chronic liver failure results from chronic Alcoholism ?
________________ ______________ results from viral hepatitis (Hepatitis C)
drug abuse or hepatotoxic drug induced.
What is the etiology of Biliary Cirrhosis ?
Inflammation of intrahepatic bile ducts resulting in biliary obstruction in liver
What results from portal hypertension ?
Body tries to find other places so get collateral circulations (alternative paths)
Backflow (into spleen for example)
Dilation of organs, hemorrhoids
Dilated veins in esophagus, stomach, intestines, abdomen, and rectum
___________ ___________________ results when persistent increased pressure in the portal veins due to increased resistance from block of flow through portal venous system.
_____________ is a collection of fluid shifted from vascular system into abdomen's peritoneal cavity from increased hydrostatic pressure.
What nursing management should be are used to treat and assess Ascites ?
Abdominal Girth (diagnose and assess progression)
Paracentesis (Diagnose as well as removes fluid)
What are complication of Ascites ?
What is Esophageal Varices ?
Back up of blood from the liver causing blood to enter the esophageal and gastric veins then the fragile, thin-walled esophageal veins become distended from increased pressure
Esophageal Varices Treatment
Non-Selective Beta Blocker-Propranolol
Vasoactive Medications-Vasopressin, Octreotide acetate
PRBCs, FFP, Dextran, Albumin, Platelets
Ligation with Sclerotherapy-EST, EVL
Transjugular Intrahepatic Portal-Systemic Shunt-TIPS
What is the goal of treatment for Esophageal Varices ?
Decrease the portal pressure
Decrease the bleeding
Stage IV Hepatic Encephalopathy
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