resp

How does infection happen?

Respiratory epithelium damaged
• Airborne & suspended for long time
• # pathogens high enough to overpower
• Infection takes over

droplet precautions

influenza

COVID-19

gold standard for flu dx

viral culture but rapid influenza diagnostic test is most common bc take <30min

allery to eggs means that the patient should not recieve which vaccine

flu

serious complications of flu

viral pneumonia or secondary pneumonia

with the flu what is the fiest compensatory mechanism to decreased 02 delivery

tachypnea

NEGATIVE PRESSURE ROOM

COVID

What is the major pathogen associated with HAP

pseudomonas aeruginosa

empyema

collection of purulent material in pleural space

pleurodesis

seals the pleural space to prevent fluid or air from reaccumulating

pneumonia will have what type of pulse

weak tachy

pneumonia pt positioning

Airborne precautions

TB

rust-colored or blood-streaked sputum

TB

have to have TB test read after how many hours

48-72hr

TB s/s

unexplained wt loss, night loss, fever, chills

assess what TB

sputum

Meds used in the tx of TB

asthma patho

intermittent reversible airway obstruction resulting from infalmmation

status asthmaticus

unresponsive to typical to rescue tx

bronchospasm, inflammation, increased mucus or mucus or mucus plugging

s/s chest tihgtnedd, wheezing, dry cough, sob, severe respiratory distress

chronic bronchitis

the presence of cough and sputum production for at least 3 months in each of 2 consecutive years

COPD complications

secondary spontaneous pneumothorax

Right heart failure

Cor pulmonale

COPD changes in skin color

reddish

cystic fibrosis is caused by what genes

defective gene carried by both parents

cystic fibrosis surgical interventions

lung transplant

pancreas transplant

what kind of inhaled med should SF pt take and what kind of vitamins

upper respiratory tract

nose and larynx

lower respiratory

trachea and alveoli

delivering too much oxygen to a COPD pt may do what

interfere with hypoxic drive for breathing leading to decreased respiratory effort and ultimately rate

how to tell if 02 sat is accurate

waveforam and take manula pulse and if it is the same as the pulse ox then the 02 is probablly accurate

what kind of oxygen does a trach patient need?

humidified

what face mask is used for facial trauma

face tent

what is the advantages of using a high flow nasal cannula

A high-flow nasal cannula uses an air-oxygen blender (blends 02 with compressed air), active humidifier and a single hated tube and it delivers medical gas up to 60L/min. advantages are reduced anatomical dead space, PEEP, constant FI02, and humidification.

what does CPAP do

keep the alveoli open during

what does BIPAP do

provides a higher pressure during during inhalation

oxygen toxicity

damage alveoli cap membranes and inactivates surfactent

absorption atelectasis

high levels of 02 given which washes out nitrogen in alveoli which causes alveoli collapse

at what rate may a patient esxperiense dry mucous membranes due to oxygen

4L/min ( masks can also be a source of bacteria)

collapse of the alveoli makes it difficult to reiflate the alveolibecause they can become filled with fluid or blood if there is damage to the alveoli. which can lead to what complications

pulmonary edema, atelectasis, hemorrhage which can progress to ARDS

what is the role of the nurse regarding ETT managment?

maintaining a patent airway, monitoring the pt for complications, maintaining proper cuff inflation, providing oral care and suctioning as need, maintaining correct tube placement, monitoring oxygenation and vital signs, and education the patient and family.

when is artificial airways such as a trach indicated

when a patient needs ventilation for 7-14 days to prevent laryngeal and upper airway damage r/t porlinged ett use. bc it providesa a stable airway for pt who need it long term, to allow access to the lower airway for suctioning

trach complications

accidental decannulation, pneumothorax, subq emphysema, infection, tracheal stenosis, tracheoesophageal fistula

why is decannulation in the first 72 hours considered an emergency

because the trach isnt mature and during reinsertion there is a large risk for tisssue damage and unsuccessful ventilation

how can a pneumothorax happen with a trach

during trach porcedure if lung is pierced during procedure

how does subq emphysema happen with trach

puncture near the trachea allows air around the surrounding tissue and can move into neck face chest etc

tracheal stenosis

narrowing of the trachea due to scar tissue that forms from irritation of the mucosal lining of the trachea from cuff

tracheoesophageal fistula

can result from overinflating the cuff. the extra pressure causes a hole or fistula to occur between trache and esophagus

chest physiotherapy

Consists of percussion, vibration, and postural drainage. After CPT, the patient is encouraged to breathe deeply and cough to clear the airway.

goal for a pt on mechanical ventilation

support the patient until the underlying pathophysiological process is corrected

fraction of inspired oxygen

amount of 02 the patient recieves per minute

tidal volume

amount of preset air that is delivered with each breath measured in mL

Provides a combination of ventilator-assisted breaths and spontaneous breaths

intermittent mandatory ventilation

Used for patients being weaned from the ventilator. If the patient does not initiate a breath, the ventilator delivers a preset volume and rate per minute.

synchronized intermittent mandetor ventilation

Designed for spontaneously breathing patients who need high pressure to recruit alveoli

airway pressure release ventilation

Gives a set positive pressure during spontaneous respirations

pressure-support ventilation

complications of mechanical ventilation

Hypotension – Increased intrathoracic pressure decreases venous return to the right side of the heart and ultimately decreases cardiac output

 

Ventilator-associated pneumonia – A serious healthcare-associated infection resulting in high morbidity, high mortality, and high costs of treatment. Aspiration of oropharyngeal and/or gastric fluids is presumed to be an essential step in the development of VAP, and it typically develops 48 hours or more after endotracheal intubation.

Infection – The normal defenses of the upper and lower respiratory systems are bypassed.

Barotrauma – A complication of the mechanical ventilator due to the increased positive pressure applied to the lungs, which can cause alveolar rupture. Overdistention of the alveoli can lead to an excessive amount of air entering into the pleural space, causing a tension pneumothorax.

HOB at waht degree for mech ventilation

30-45 degree

weaning criteria

ability to breath spontaneously

ability to support adequate oxygenations

ability to maintain hemodynamic stability

weaning methods

CPAP

T-piece

pressure support

weaning complications

re-intubation

aspiration

stridor

what should be determined before weaning the pt from the vent

the pt should demonstrate evidence that the underlying cause of resp failure has been reversed

epiglottis

is a leaf-shaped flap that covers the opening of the larynx and provides a tight seal over the larynx when an individual is swallowing food or liquids to prevent aspiration

bronchoscopy NPO

NPO for 8 hours prior to procedure

rigid vs flexible bronchoscopies

Flexible bronchoscopies are used to take tissue specimens or replace an endotracheal tube.

Rigid bronchoscopy is used to remove obstructions or large amounts of secretions from the respiratory tract.

thoracentesis

Description and Rationale — A thoracentesis can be used as a diagnostic test or treatment depending on the disease process. During a thoracentesis, a needle is inserted into the pleural space to remove a specimen or excess fluid/air.

Significance of Abnormal Values, pg 473

**Fluid can be analyzed to determine if microorganisms or abnormal cells are present. If air  is aspirated from the pleural space, this is consistent with a pneumothorax diagnosis. Thoracentesis can be used as a treatment option to remove fluid and/or air from the pleural space. 

Signs and symptoms of complications. Patients should be told to immediately report any of the following symptoms to their provider:

• Elevated heart rate/heart palpitations

• Dyspnea/shortness of breath (SOB)

• Chest pain

• Hemoptysis (bloody secretions)

watch for what in pt with heart diseas

Watch for pseudoephedrine in patients with heart disease and HBP