medsurge test 4 respiratory

hypoxia or hypercapnia

what are the earliest signs of impaired gas exchange along with confusion

Raise HOB, ambulate, OOB to chair, IS, flowmeter/christmas tree, suction, pusle ox, emergency equipment check

what are your initial respiratory interventions

ambu bag with mask, oral airway, obturator, extra trach

what type of emergency equipment needs to be in the room for someone with potential impaired gas exchange

PEEP Positive End Expiratory Pressure

 the pressure applied by the ventilator at the end of expiration. keeps alveoli open. preventing atelectasis

 functional residual capacity

Positive End Expiratory Pressure (PEEP) improves oxygenation by increasing:

decreased cardiac output and hypotension

what using Positive End Expiratory Pressure (PEEP), you need to monitor for barotrauma including:

pneumonia

Acute infection of the lung parenchyma. Definition: Infection in alveoli causing inflammation

community acquired pneumonia

pneumonia gotten before the hospital <48 hrs. 

oral care

what should the NURSE do to avoid ventilator-associated pneumonia

those who can not cough, deep breathe, or protect their airway, altered LOC, AMS, Weak, Older adults, children

who is more at risk for getting pneumonia

exchanging gases

CO2 measures how well a person is _________________. if its low, theyre breathing too much, too fast. If too high, they’re not breathing enoguh

PaO2

what ABG should be measured for reading oxygen in the blood in a pneumonia patient

supplemental oxygen, fluid intake, IS, CONTROLLED coughing, monitor sputum, Raise HOB

what are nursing interventions for someone with pneumonia?

antibiotics, bronchodilators, mucolytics, metered dose inhalors(MBIs)

what Medications may be given for someone with pneumonia

fever, chills, productive cough, crackles

what are some symptoms of pneumonia

Stroke, dysphagia, decreased LOC

what puts someone at high risk of aspiration pneumonia

emphysema, chronic bronchitis

What two conditions fall under COPD?

mucus traps bacteria in lungs

Why do COPD patients have frequent respiratory infections?

overweight, cyanotic, elevated Hgb, peripheral edema, rhonchi and wheezing from mucus, orthopnea, clubbing, cor pulmonale, chronic cough

what are some symptoms of chronic bronchitis

older, thin, severe dyspnea, quiet chest, minimal cough, barrel chest, hyperinflation with flattened diaphragm, pursed lip breathing

what are some symptoms of emphysema

Monitor respiratory effort, signs of Cor pulmonale, tripod position, schedule rest, cautious O2 use, IS, encourage fluids to 3L, teach SMOKING CESATION

what are some important nursing interventions for COPD (chronic bronchitis and emphysema)

high calorie diet

what kind of diet is best for COPD (chronic bronchitis and emphysema)

bronchodilators, methylxanthines, antiinflammatories, mucolytics, chest physiotherapy,

what medications can be given for COPD (chronic bronchitis and emphysema)

potassium

what lab do you need to monitor with albuterol

imobility, fat emol, aterial embolism, air emoli

what are venous thromboembolisms caused by

petechia on chest

what is a sign of fat embol

pulmonary embolism

Blockage in pulmonary artery usually caused by a blood clot. When clot breaks off its an embolism. Goes to heart and lungs. Blocks blood flow. alveoli will become hypoxic, necrotic, no gas exchange. PaO2 low. Co2 high

saddle pulmonary embolism

a PE on both sides of the lungs; most dangerous type. 

reduced blood flow, blood vessel injury, increased coagulability

what are the aspects of virchows triad (describes the three main factors that contribute to thrombosis)

atrial fib, long distance travel, varicose veins, venous obstruction, immobility, ventricuarl/venous insufficiency

what can cause the reduced blood flow aspect of virchow’s triad

trauma (orthopedic), major surgery, hypertension, invasive procedures (canulation)

what causes the blood vessel injury aspect of virchow’s triad

sepsis, smoking, coagulation disorder, malignancy(cancer)

what can cause increased coagulability part of virchow’s triad

extreme SOB, rapid breathing and HR, chest pain that may increase with deep breath, lightheadedness or passing out, coughing up blood, anxiety

what are common symptoms of pulmonary embolism

CXR, V/Q scans, Spiral chest CT, pulmonary angiography, echocardiography 

what Imaging tests can be done for Pulmonary embolisms

CBC, ESR, D-dimer, ABGs

what Lab tests can be done for Pulmonary embolisms

elevated

in a pulmonary embolism, WBC and clotting factors will initially be

yes as needed but will not help if everythings blocked

should you give oxygen in a pulmonary emboli

oxygen, thrombolytic therapy, direct oral anticoagulants, heparin therapy, then lovenox 3 mo, catheter-directed thrombolysis, surgical embolectomy ,

what are treatments for pulmonary embolisms

recent surgery, hemorrhagic stroke, bleeding

Absolute contraindication to anticoagulants

direct oral anticoagulatns

considered the first-line treatment for PE and preferred over vitamin K antagonists (warfarin) for nearly all patients for 3 months

 Subcutaneous Emphysema

“rice Krispies” air in tissues- may indicate leak or poor seal 

yes, shows building negative pressure

are Fluid Variations (Tidaling) a good thing

no, could mean there is a leak

is a continuous bubble in the water seal chamber a good thing?

FOCA

what you should assess drainage for. stands for:

• Fluctuation (tidaling)

• Output Type and Amount

• Color of drainage (bloody, serous, purulent?)

• Air Leaks (bubbling)

chest x-ray

what do you use to visualize chest of those with chest tube to see if its getting better or worse

pigtail catheters

 less damaging, smaller, more comfortable, easier to put in than chest tubes . used in less critical citations 

Puss coming out, bright red, >100 ml/hr drainage

what are emergent situations with chest tubes

respiratory distress

Increased work of breathing, but still compensating.

• Signs/Symptoms: Tachypnea, nasal flaring, accessory muscle use, anxiety, cyanosis.

• Nursing Actions: Elevate HOB, oxygen therapy, monitor RR and SpO2, notify provider.

respiratory failure

Inadequate gas exchange (PaO₂ < 60 or PaCO₂ > 50).

• Types: Hypoxemic vs. Hypercapnic.

• Nursing Actions: Recognize signs, prepare for advanced airway, monitor ABGs.

60

PaO2 is < _____ in respiratory failure

50

PaCO2 is >____ in respiratory failure

hypercapnia

carbon dioxide retention. often affects people with COPD. symptoms: confusion, flushed skin, sweating, wheexing

hypoxia

low levels of oxygen in issues. body is not meeting perfusion needs. symtpoms: bradycardia, tachypnea, cyanosis, syncope,

high flow nasal cannula

Up to 100% humidified and HEATED oxygen at a flow rate of up to 60 liters per minute. They can still eat and drink 

Use for: acute hypoxemia, COVID-19

high flow nasal cannula, prepare for intubation, set ventilator to low tidal volume, PEEP, adminster vasopressors for hypotension, impelment sedation and analgesia as appropriate, monitor for multiorgan dysfunction

what interventions are done for respiratory failure

glass wrath/white out

what does an Acute respiratory distress chest x-ray look like

pneumonia, oxygen toxicity, aspiration, pancreatitis, shock, trauma, sepsis

what are some common causes of ARDS

Peep increase, Paralysis(intubate), prone positioning, pressure cycled ventilation, proteins - TPN

what are nursing interventions for ARDs

exudative “wet” phase (4-7 days)

what phase of ARDs is there lots of edema, increased neutrophils and cytokines

Proliferative “filling pus” phase (7-21 days)

what phase of ARDs are there cyst fibroblasts, filling of puss, fibrosis(hardening of lung) and pneumothorax risk

fibrotic “hardening” phase >21 days

What phase of ARDs is there fibrosis and loss of lung and alveoli, emphysematous lungs. "(charred “burnt” lung)

bipap

 Non-invasive ventilation (NIV) method that provides two levels of positive airway pressure. For COPD, CHF. do not use with vomiting

Inspiratory Positive Airway Pressure (IPAP)

part of the bipap that is what pushes air in. Assists with inhalation to improve ventilation.

Expiratory Positive Airway Pressure (EPAP)

part of bipap that Keeps the airways open during exhalation to improve oxygenation.

acute respiratory failure, CHF, sleep apnea, hypoxemic respiratory failure, prevent intubation

what are common indications for bipap use

unconscious, facial trauma or surgery, high aspiration risk, severe hypotension, pneumothorax, restraints

what are contraindications for bipap use

Assist with setup, ensure IV access, position patient, confirm placement, monitor continuously.

what are nursing responsibilities during intubation

ambubag, suction, oxygen, meds(paralytic and sedation), stethescope, ET, CO2 detector,

what equipment must the nurse make sure is ready to help prepare for intubation

no epigastric sounds, hear bilateral breath sounds, chest rise and fall, ETCO2 device after 6 breaths, Chest xray confirmation of depth

how is placement verified after intubation

teeth/gums NOT lips

where should intubation tube be measured at

ARD patients

what type of patients will continue to be sedated with paralytics after intubation

pressure support (PS)

what is the best ventilator mode for weaning a patient since breaths are patient initiated

airway pressure release ventilation (APRV)

what ventilator mode is great for ARDs bc it allows patient to breath spontaneously

synchronized intermittent mandatory ventilation (SIMV)

what ventilator mode is the traditional mode with delivers mandatory breaths with fixed volume.

something blocking it - secretions, biting, pneumothorax, coughing, bronchospasm

what does it mean when ventilator alarm is saying there is high airway pressure peak pressure >35)

disconnect/leak- loose circuit, cuff leak, extubation

what does it mean when ventilator alarm is saying there is low airway pressure )

assess patient first, ambu bag if needed, collaborate with RT

what is the correct nursing repsonse when the ventilator alarms go off?

Suction airway, reposition the patient, check tubing, call the provider if pneumothorax suspected

high-Pressure ventilator Alarm nursning interventions

Reconnect circuit, check ET tube cuff pressure, assess for signs of extubation.

Low-pressure ventilator alarm goes off. What interventions should be done?

Assess for sedation effects, increase ventilator support as needed

The apnea alarm goes off bc the patient is not initiating breaths (in spontaneous mode), what should the nurse do?

Proning: laying face down 

this position reduces pleural pressure gradients from non-dependent to dependent lung regions. protects against ventilator induced lung injury, consider in hypoxic patient. performed by trained team only.

face/neck trauma, elevated ICP, unstable pelvic/spinal, hemoptysis, imminent CPR 

what are contraindications to prone positioning

pressure ulcers, airway obstruction, increased abdominal pressure, loss of IV access, ETT dislodgment 

what are common complications from Proning

paralytics (-curonium)

Neuromuscular blocking agents cause muscle paralysis and improve patient ventilator synchrony. Minimizes muscle O2 consumption. lower incidence of pneumo,

risk of weakness and myopathy, delirium risk, diaphragm deconditioning

what are some common complications of paralytics

potassium level

what lab do you need to monitor for someone on succinylcholine

spontaneous breathing trial

method of weaning when patient spontaneously breaths through ETT for a set period of time (30-120 min). ventilator set to PSV 5 and PEEP 5

pressure support ventilation (PSV)

progressive decrease in pressure support.m alternative to patients who don’t tolerate SBTs(spontaneous breathing trial)

HOB up, chuck on chest, suction aggressively, deflate balloon, pt take deep breaths then exhale (pull out tube during exhale), apply oxygen device, freq resp system assessment

what are the steps for ET tube removal

on side for first 15 min

how should patients lie after ET tube removal

Awake, able to protect airway

what is the criteria for extubation

Monitor for stridor, provide humidified O2, prepare for re-intubation

what is the nursing focus during extubation

downsizing or partially plugging the trach, then full plugging, followed by removal. After removal, cover the stoma with gauze and provide meticulous pulmonary hygiene.

What are the key steps in tracheostomy weaning and post-removal care?