Unite 1 Adult

what is the primary underlying issue in acute respiratory failure?

deterioration of gas exchange function

what arterial blood gas criteria define acute respiratory failure?

• PaO2​ < 60 mmHg

• PaCO2​ > 50 mmHg

• pH < 7.35

what are the 5 common causes of acute respiratory failure?

impaired function of the CNS

neuromuscular dysfunction

musculoskeletal dysfunction

pulmonary dysfunction

surgery

what are the clinical manifestations associated with acute respiratory failure?

restlessness, fatigue, headache, dyspnea, air hunger, tachycardia, hypertension, confusion, lethargy, tachypnea, cyanosis, diaphoresis, and respiratory arrest

What physical assessment findings indicate acute respiratory failure?

use of accessory muscles and decreased breath sounds

what are the primary goals of managing acute respiratory failure?

treat the underlying cause and restore adequate gas exchange

what advanced airway management interventions are used in acute respiratory failure management?

endotracheal intubation and mechanical ventilation

what parameters should be monitored to evaluate a patient’s respiratory status?

level of consciousness, arterial blood gases, pulse oximetry, vital signs, and work of breathing

how frequently should a patient be repositioned to prevent complications, and what actions should accompany turning if possible?

every 2 hours and have them cough and deep breath if possible

what specific supportive care interventions are included in the acute respiratory failure management to prevent complications?

mouth care, skin care, passive range of motion

what diagnostics test can be use to diagnose acute respiratory failure?

ABGs, ECG, cultures, chest x-ray, CT, bronchoscopy, thoracentesis, and pulmonary function tests

what happens sequentially if the initial cause of respiratory failure is not corrected?

cause is not corrected

failure worsens

increase WOB

muscle/ body fatigues

failure and arrest

what is the immediate physiological response as respiratory failure worsens in acute respiratory failure?

an increase in WOB

what occurs after prolonged increased work of breathing remains unaddressed with acute respiratory failure?

muscle/ body fatigue sets in

what is the end result of uncorrected respiratory failure and muscle fatigue?

respiratory failure leading to respiratory arrest

what severity range does acute respiratory distress fatigue encompass?

spectrum of mild to severe

what primary alveolar pathology and complications characterize acute respiratory distress syndrome?

diffuse alveolar damage leading to pulmonary edema

what physiological abnormality occurs regarding ventilation and blood flow in acute respiratory distress syndrome?

ventilations/ perfusion mismatches

into what two main categories are risk factors for acute respiratory distress syndrome divided?

direct injury vs. indirect injury

what primary pathological process in acute respiratory distress syndrome leads to sudden and progressive pulmonary edema?

diffuse alveolar damage

what is the hallmark term for hypoxemia in acute respiratory distress syndrome that does not improve even with supplemental oxygen administration?

hypoxemia unresponsive to oxygen (refractory hypoxemia)

what key characteristic finding is seen on a chest x-ray in a patient with acute respiratory distress syndrome?

bilateral infiltrates (often referred to as “white lung”

how is decreased lung compliance defined in the context of acute respiratory distress syndrome?

a reduction in the lungs’s ability to stretch

what adventitious breath sounds are classic for acute respiratory distress syndrome upon auscultation?

crackles

what physical sign of increased work of breathing involves the tissue pulling in between the ribs?

intercostal retractions

what are the signs and symptoms of acute respiratory distress syndrome?

tachypnea, dyspnea, retractions, hypoxia, tachycardia, crackles

what are the underlying causes of acute respiratory distress syndrome?

massive trauma, severe respiratory disorder, prolonged mechanical ventilation, hemorrhagic shock, fat emboli, and septic conditions

what primary airway and mechanical ventilation interventions are required for management?

intubation + mechanical ventilations + PEEP (positive end-expiratory pressure)

what two components are included under circulatory support?

adequate fluid volume and nutritional support

what class of medications is used for the treatment of hypotension?

inotropic or vasopressor agents

what physical care strategy is included in management to help optimize oxygenation and ventilation?

positioning (prone positioning)

what specific types of medications management are utilized for ventilated acute respiratory distress syndrome patients?

sedations ± paralytics, emotional support, and treatment of pain

what initial baseline imaging test is used during a pulmonary embolism evaluation?

chest x-ray

what diagnostic tool is used to evaluate cardiac rhythm and rule out myocardial infarction in patient presenting with pulmonary embolism symptoms?

EKG

what laboratory test measures arterial oxygenation, carbon dioxide, and acid-base status in pulmonary embolism?

multidector-row CT

what invasive imaging procedure is considered the historic gold standard for visualizing pulmonary vessel occlusion?

pulmonary angiography

where does the pulmonary embolism go?

the pulmonary artery or one of it’s branches

what kind of pulmonary embolism can it be?

air, blood,

what nuclear medicine scan measures ventilation and perfusion when CT is contraindicated?

V/Q scan

what blood test measures fibrin degradation products to help rule out a pulmonary embolism?

D-dimer assay

what immediate supportive therapy is administered to treat hypoxemia in a pulmonary embolism patient?

oxygen

what two main categories of medications are used in the pharmacological management of pulmonary embolism?

anticoagulants and thrombolytics

what invasive management option may be required for large, life-threatening emboli?

embolectomy surgery

what continuous clinical processes are essential for evaluating patient status and treatment effectiveness?

assessment and monitoring

what long-term nursing and clinical focus is required to prevent recurrent pulmonary embolism?

prevention

what are the risk factors for pulmonary embolism?

immobility, obesity, DVT (deep vein thrombosis), postoperative, postpartum, and oral contraceptives

what process occurs in the lower extremities that leads to embolus formation?

venous pooling (stasis) with emboli formation

what pathway do emboli travel through to reach the pulmonary vasculature?

peripheral veins directly to the lungs

what type of pain do patient with pulmonary embolism have?

sudden, sharp chest pain

what respiratory signs and symptoms are common with pulmonary embolism?

tachypnea, dyspnea, hypoxia, and hemoptysis

what cardiovascular sign is depicted by the running heart graphic?

tachycardia

what two main intravenous therapies are illustrated at the top of the diagram?

IV heparin and thrombolytic therapy with normal saline

what critical safety sign. precautions is highlighted regarding IV administration of heparin and thrombolytic therapy?

separate lines don’t mix. must be administered through dedicated separate IV lines

what supportive therapy is being administered to manage hypoxia and dyspnea?

supplemental oxygen

What is the primary purpose and timing of initiation for Anticoagulation Therapy?

Prevention (prevents new clots from forming or existing clots from enlarging) and should begin immediately.

What are examples of Anticoagulation Therapy medications?

• Unfractionated Heparin (IV)

• Low-Molecular-Weight Heparin (LMWH, e.g., enoxaparin)

• Warfarin

• Direct Oral Anticoagulants (DOACs, e.g., apixaban, rivaroxaban)

What are the key monitoring considerations for Anticoagulation Therapy?

• Lab values: aPTT (for Heparin) and PT/INR (for Warfarin)

• Signs of bleeding (gums, hematuria, stool, ecchymosis)

• Platelet count (to monitor for Heparin-Induced Thrombocytopenia / HIT)

What term describes the mechanism of Thrombolytic Therapy, and in which patient population is it indicated?

Known as "Clot-busters" (actively dissolve existing clots); indicated for unstable patients / massive PE.

What are examples of Thrombolytic Therapy medications?

• Alteplase (tPA)

• Reteplase

• Tenecteplase

What are the key monitoring considerations for Thrombolytic Therapy?

• Vital signs and neurological status (monitor closely for intracranial hemorrhage)

• High risk for severe bleeding/hemorrhage (avoid invasive procedures, arterial punctures, or IM injections)

• Coagulation studies, hemoglobin, and hematocrit

What are the two main categories of medications used to manage PE as shown on this slide?

• Anticoagulation Therapy (Prevention, begin immediately)

• Thrombolytic Therapy (Clot-busters, unstable patients/massive PE)

What is a primary indication for placing an IVC filter?

Recurrent PEs (Pulmonary Embolisms).

What anatomical site is commonly used to access the inferior vena cava for filter placement?

Accessed through the groin (femoral vein)

What are the two duration options for IVC filter placement?

Permanent or removable.

What major venous vessel is the filter placed in?

Inferior vena cava.

What major arterial vessel runs adjacent to the inferior vena cava in the diagram?

Aorta

What endocrine structures are situated directly superior to each kidney in the diagram?

Right adrenal gland and Left adrenal gland.

What renal veins branch off the inferior vena cava to connect to the kidneys?

Right renal vein and Left renal vein.

What two key components of the insertion device and filter device are labeled at the bottom of the diagram?

• Applicator

• Umbrella (the filter itself)1t

What primary ventilation/perfusion defect occurs in the pulmonary arterial system during a PE?

Ventilation occurs without perfusion ("no perfusion"), meaning lung tissue is ventilated but not perfused, causing impaired gas exchange.

What occurs at the alveolar level as a result of a PE, and what is its physiological effect?

Alveoli collapse, which worsens hypoxia.

A decreased cross-section of the pulmonary arterial bed leads to what two major hemodynamic changes?

• ↑ Pulmonary arterial pressure

• ↓ Cardiac output

What are the respiratory findings and rate cutoff for PE?

Dyspnoea and tachypnoea (RR>20).

What heart rate value defines tachycardia in PE?

Heart rate >100 bpm.

What systolic blood pressure reading indicates hypotension on this slide?

Systolic BP≤110 mmHg.

What are all the clinical features listed for PE?

• Dyspnoea & tachypnoea (RR>20)

• Tachycardia (>100)

• Pleuritic chest pain

• Signs/symptoms of DVT

• Hypotension (Systolic BP≤110)

• Fever

• Haemoptysis

• Syncope

How far back does surgical history count as a significant risk factor for PE?

Surgery within the last 2 months.

How long post-partum is pregnancy considered a risk factor for PE?

Up to 6 weeks post-partum.

What are all 8 risk factors listed for PE?

• Previous thrombotic event / current DVT

• Surgery within the last 2 months

• Recent lower limb trauma

• Sedentary travel

• Pregnancy (up to 6 weeks post-partum)

• Combined oral contraceptives / hormone replacement therapy

• Active malignancy

• Thrombotic disorders

What is the definition of a pneumothorax?

Air in the pleural cavity, resulting in lung collapse.

What happens to the pleura during a pneumothorax, and what pressure is the pleural space exposed to?

The parietal or visceral pleura is breached, and the pleural space is exposed to positive atmospheric pressure.

What type of pressure is normally in the pleural space, and what is its purpose?

Normal pressure in the pleural space is negative, which is required to maintain lung inflation.

What are the symptoms and clinical manifestations associated with a pneumothorax?

Dyspnea, anxiety, tachycardia, pleural pain, asymmetrical chest wall expansion, and decreased breath sounds.

What are the four causes of a pneumothorax shown on the slide?

Ruptured bleb (associated with COPD), thoracentesis, trauma, and secondary infection.

What methods are used to diagnose a pneumothorax?

Chest X-ray and ABGs (Arterial Blood Gases).

What is the treatment for a pneumothorax?

Placement of a chest tube.

what is tension pneumothorax?

air enters the pleural space, compresses the lungs, and shifts the mediastinum

how is tension pneumothorax treated?

with needle decompression in the second intercostal space at the midclavicular line, followed by tube thoracotomy

what are the clinical manifestations of pneumothorax?

sudden pleuritic pain, tachypnea and mild distress, lung collapse and acute respiratory distress, hypotension, tachycardia, profuse diaphoresis. anxiety, dyspnea, air hunger, accessory muscle use, central cyanosis

what are chest tubes for?

removes excess air, fluid, and blood

what are the managements for the chest tube?

placement of chamber, drainage and output, air leak, bubbling in water seal chamber, dressing, site, assessment, pain, and education

what is pleural effusion?

collection of fluid in pleural space

what is the normal amount of fluid in the lungs?

5-15 mL

what kind of fluid might be in the pleural space?

clear, bloody, or purulent

what could cause pleural effusion?

heart failure, TB, pneumonia, infection, or tumors

what are the clinical manifestations of pleural effusion?

underlying causes, severity of effusion, physical assessment

how do you manage pleural effusion?

thoracentesis or chest tube