resp disorders- pulmonary

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  1. Pulmonary embolism
    • is when one or more pulmonary arteries in the lung is blocked
    • O2 ASAP- cause blocking oxygen
  2. Pulmonary embolism
    • how one gets this
    • fat from bone marrow, after fracture, thombi in deep calf, femoral, politeal, iliac veins, air IV
    • embolus/thrombi clot occludes part of pulmonary blood vessels
    • affecting airflow to areas of lung where blood flow is dec
    • depending on size, mild resp distress to lethal
    • dead space- ventiliation, no perfusion= ventilation perfusion mismatch
  3. Pulmonary embolism
    • how to detect
    • VQ scan
    • spiral CT scan
    • Pulmonary Angiogram
  4. Pulmonary embolism
    • management- before and during
    • *** prevention in susceptible patients
    • - assess well
    • - post op pts
    • - get moving
    • -immobilize fracture
    • prompt recognition, immediate tx
  5. Pulmonary embolism
    • nursing and medical management
    • Anticoagulation- heparin to coumadin
    • ** avoid IM**
    • Thrombolytic therapy - if hemodynamic unstable
    • - may not improve mortality
    • Cardiopulmonary support- O2, IVF
    • analgesia- IV MSO4 PRN
    • positioning- avoid sitting for long period of times, elevate leg above the heart level- inc venous flow- monitor bc it may cause hemodynamic challenges
  6. Pulmonary embolism
    • surgical management
    • Vena cava interruption with filter insertion
    • - Greenfield fliter
    • Pulmonary embolectomy
    • - Surgical removal- for significant HD instability, massive PE, pt c/i for thrombolytic therapy
    • - complication- 30% mortality rate
  7. Pulmonary HTN
    • Pulmonary htn is a type of high blood pressure that affect the arteries of the lungs and right side of the heart
    • progressive disorder xterized by abnormally high b/p in pulmonary artery
  8. Pulmonary HTN
    • how it develops
    • htn develops when most small a arteries in the lungs narrows- inc resistance to blood flow to the lungs
    • the inc pressure- abnormally very high bp in the pulmonary artery
  9. Pulmonary HTN
    • two types
    • primary (idiopathic)- young adults- progressive
    • secondary- underlining heart/lung disease
    • not curable but treatable**
  10. Pulmonary HTN
    • manifestation
    • Exerional dyspnea
    • fatigue/lethargy
    • angina
    • syncope
    • raynaud's dx
    • - poor circulation to hands- in between fingers
    • narrow arteries- decrease o2
  11. Pulmonary HTN
    • Diagnostic
    • ECG
    • CXR- RVH,  enlarged pulmonary arteries
    • cardiac cath- inc pulmonary artery pressure (PAP)
  12. Pulmonary HTN
    • medical/surgical tx
    • Ca channel blockers-
    • Continuous IV epopostenol (inhibits platelet activation/vasodilator)
    • Anticoagulants
    • digoxin- toxicity
    • diuretics- lytes
    • lung transplant
  13. Atelectasis
    • patho
    • obstructed aveoli collapse causing impaired gas exchange
    • - trapped alveoli air absorbed in blood
    • - no additional air to alveoli b/c blockage
    • - affected part of lungs- airless and alveoli collapse
    • Microatelectasis may occur, with small airway closure (not seen on CXR)
    • Macroatelectasis0 loss of segmental, lobar, or overall lung volume
  14. Atelectasis
    • manifestation
    • usually first seen on cxr
    • tachycardia- compensate
    • inc dyspnea- sob
    • tachyapnea
    • dec breath sounds =/- crackles bc of surfactant (lack)
    • cough/sputum
    • resp distress if significant hypoxia
  15. Atelectasis
    • nursing interventions
    • prevention in high risk pt is key
    • freq position changes
    • CPT/postural drainage
    • incentive spirometer
    • splinting of incision site
    • early ambulation
    • turn, cough, deep breathe
    • secretion removal
  16. Atelectasis
    • management
    • treat underlying cause
    • - o2
    • - cpt
    • - suctioning
    • - bronchoscopy
  17. Pneumonia
    • Inflammatory process in lung parenchyma as associated w/marked increase in interstitial and alveolar fluid
    • 6th most common cause of death in all ages
    • highest mortality rate of all nosocomial infe
    • CAP vs HAP, aspiration pna
    • Causive organism
    • bacteria, virus, fungu, protozoa, mycoplasma, aspiration
  18. Pneumonia
    • patho- explanation purpose only
    • 4 stages
    • 1. congestion- inflamm pulm resposen
    • - lung defense mechanism lose effectiveness
    • 2. red hepatixation- massive capillary dilation leads to alveoli filled w/organisms, neuts, RBC's, fibrin
  19. Pneumonia
    • patho 3-4
    • 3. gray hepatization- alveolar exudate consolidates & hard to expectorate
    • 4. resolution- occurs completely if no complication
  20. Pneumonia
    • manisfestations
    • fever
    • sweats
    • pleuritic CP
    • hemoptysis
    • elderly- change in MS
    • bronchial breath sounds
    • rhonchi, lethargic
    • inc tactile fremitus
    • tachycardia
    • rapid breath
    • chills
    • dyspnea
    • productive thick cough
    • fatigue
    • inc fluid 3000-4000 cause with HF pt
  21. Pneumonia
    • diagnostic
    • assessment
    • sputum culture and sensitivity
    • bronchscopy
    • skin test for TB
    • blood culture (blood stream invasion)
    • CXR
  22. Pneumonia
    • medical management
    • +/- hospitalization
    • hydration
    • antibiotics
    • pneumococcal vaccine
    • mucolytics
    • cough suppressants (carefully)
    • gram +- pne levaquin
    • gram - uti- cipro
  23. Nursing responsibilities
    • CAP
    • blood cultures (if ordered0 must be drawn and labeled approriately prior to giving antibiotic
    • antibiotics must be given within 6 hrs of arrival (ED pts and direct admit pts)
    • antibiotics must be given by correct route
  24. nx responsibilities
    • CAP 2
    • administer pne and flu vaccine as approriate
    • if pt is a candidate for pne or flu and they do not get it before d/c this is considered a med error
  25. nx responsibilities
    • CAP 3
    • has pt smoked cigs in the past 12 months? if so, pt needs smoking cessation.  a simple notes " I advised the pt to quite smoking" will suffice
  26. General nx interventions fo PNE
    • resp assessment
    • inc fluids***
    • turn. cough deep breath
    • position in distress- turn to the side
    • HOB >45
    • encourage rest
    • bronchodilators as ordered
    • +/- CPT, suctioning, artificial airway
  27. Pneumonia
    • nursing interventions
    • monitor ABG's
    • rest periods in b/w activities
    • O2prn
    • psychological support- involve family
  28. Pneumonia
    • nx diagnoses
    • ineffective airway clearance
    • ineffective breathing pattern
    • activity intolerance
  29. influenza flu
    • This is a respiratory illness that is caused by a virus- highly contagious
    • 2 types A/B
    • viruses able to change over time, therefore an annual vaccine
  30. influenza flu
    • manifestation
    • abrupt onset of cough/fever
    • sore throat
    • headache
    • malaise
    • nasal drainage
  31. influenza flu
    • what to do
    • subside in 7days
    • pne most common complication
    • symtomatic tx
    • antivirals for some- tamiflu
  32. influenza flu
    • vaccine
    • high risk
    • 70-90% effective
    • offered october- march
    • contraindicated- h/o GBS (Guillian barre syndrome) allery to egg

Card Set Information

Author:
Prittyrick
ID:
327966
Filename:
resp disorders- pulmonary
Updated:
2017-01-31 15:12:06
Tags:
pulmonary
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pe, etc
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