Anticoagulant Complications and OSA Overview

Anticoagulant Complications

• Stop the anticoagulant immediately if bleeding occurs. Contact the healthcare provider or Rapid Response Team.
• Heparin-induced thrombocytopenia can lead to decreased platelet count, impaired gas exchange, increased blood carbon dioxide levels, and decreased pH.

Obstructive Sleep Apnea (OSA)

• OSA is most commonly caused by upper airway obstruction by the soft palate or tongue.
• Contributing factors include obesity, large uvula, short neck, smoking, enlarged tonsils or adenoids, and oropharyngeal edema.
• OSA disrupts sleep, preventing deep sleep needed for physiological restoration.
• Apneic periods can result in arterial blood oxygenation levels below 80%.
• Common symptoms include excessive daytime sleepiness, inability to concentrate, morning headaches, irritability, and nocturia.
• Long-term effects include increased risk for hypertension, stroke, cognitive deficits, weight gain, diabetes, and pulmonary/cardiovascular disease.

Asthma

• The most important pulmonary function tests (PFTs) for asthma are forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1), measured using a spirometer.
• Asthma is diagnosed when these values increase by 12% or more after treatment with bronchodilators.
• Status asthmaticus is an emergent condition where normal asthma treatment fails to resolve the attack.
• Asthma therapy aims to control and prevent episodes, improve airflow and gas exchange, and relieve symptoms.
• Control therapy drugs are used daily regardless of symptoms; Laba (corticosteroid).
• Reliever drugs are used to stop an attack; SABA (corticosteroid).

Chronic Obstructive Pulmonary Disease (COPD)

• COPD encompasses lower airway disorders that interfere with airflow and gas exchange, including emphysema and chronic bronchitis.
• Emphysema is an alveolar problem, while chronic bronchitis affects the airways.
• Chronic bronchitis involves inflammation of the bronchi and bronchioles, leading to excess mucus production and thickened bronchial walls, impairing airflow.
• Cigarette smoking is the primary risk factor for COPD, alongside asthma.
• COPD compromises gas exchange and oxygenation of tissues, leading to hypoxemia and acidosis.
• Bacterial infections exacerbate COPD symptoms, increasing inflammation, mucus production, and bronchospasm.
• Patients with emphysema have limited diaphragmatic movement due to diaphragmatic flattening.

Pulmonary Embolism (PE)

• PE is a clot originating from a different site that travels and lodges in the lungs.
• A DVT is a clot forming in the leg that can become an embolism upon breaking off.
• Patients at risk for PE should be monitored for shortness of breath, chest pain, and hypotension.
• Symptoms can include a feeling of impending doom due to hypoxemia.
• Patient safety measures include oxygen therapy, high-Fowler positioning, telemonitoring, IV access, and frequent assessment of vital signs and lung sounds.

Pleural Effusions, Pneumothorax, and Hemothorax

• A mediastinal shift is a sign of pressure on the lungs, often caused by pleural effusions, pneumothorax, or hemothorax.
• A tracheal shift indicates a shift of the trachea, usually caused by trauma to the neck or hemo/pneumothorax.
• Both conditions are considered medical emergencies.
• Auscultation can reveal pleural friction rub (scraping sound) in pleural effusions and gurgling sounds (like a washing machine) in pulmonary edema.
• Diagnostic testing includes chest x-ray, CT, MRI, and ABG.

Chest Drainage Systems

• Purpose: Removal of air or fluid from the lungs
• Types: Three-bottle system (most common), water seal, and dry suction water seal.
• Components: Suction control chamber/dry suction chamber, water seal chamber, and collection chamber.
• Bubbling: Gentle bubbling is normal, excessive bubbling indicates an air leak.
• Tidaling: Rise and fall of fluid in the water seal chamber with each breath.
• Complications: Bleeding, pneumothorax, re-accumulation of fluid, subcutaneous emphysema.
• Nursing care: Monitoring vital signs, drainage, and system integrity.

Influenza (Flu) and COVID-19

• Flu is an airborne virus, prevalent during fall and winter.

• It causes acute respiratory infection, which can last for weeks.

• Prevention: Vaccination (inactivated, recombinant, live attenuated, injection, or nasal spray); hand hygiene.

• Diagnosis: Rapid Influenza Diagnostic Test.

• Treatment: Antivirals (Tamiflu), started within 2 days of symptom onset.

• COVID-19:

  • Prevention: Vaccination, hand hygiene.
  • Diagnosis: Nasal swabs (home or clinic).
  • Treatment: Antiviral therapy, supportive care.
  • Isolation: Quarantine until fever-free for 24 hours; hospital isolation in negative pressure room.

Pneumonia

• Risk Factors: Elderly, immunocompromised, GERD patients.
• Causes: Infectious (bacteria, viruses, fungi) and non-infectious (toxins, smoke, aspiration).
• Pathophysiology: Inflammation of alveoli filled with fluid/pus, inhibiting gas exchange, leading to coughing, fever, and dyspnea.
• Diagnosis: Labs (CBC, CMP, sputum culture), imaging (x-ray, thoracentesis).
• Treatment: Oxygen therapy, bronchodilators, HOB elevation, antibiotics.

Tuberculosis (TB)

• Transmission: Airborne/droplet transmission.
• Infection:
  • Latent: Non-infectious phase.
  • Active: Contagious, causing inflammation in the lungs and lymph nodes.
• Risk Factors: Developing countries, close contact with infected individuals, immunocompromised
• Diagnosis: TB skin test, chest X-ray.
• Treatment: Anti-tuberculosis medications.

Pneumohemothorax

• Definition: A condition where air and blood accumulate in the space between the lung and the chest wall (pleural space).
• Causes: Trauma, coronary artery bypass surgery
• Symptoms:
  • Respiratory distress
  • Diminished lung sounds in one area
  • Air hunger (gulping for breath)
  • Tension pneumothorax can cause tracheal or mediastinal deviation which requires immediate medical attention.
• Diagnosis:
  • Arterial blood gases (ABGs)
  • Complete blood count (CBC) with differential (to identify possible infection)
  • Coagulation studies (to assess clotting ability)
  • D-dimer (to check for inflammation)
  • Chest X-ray
• Management:
  • Thoracentesis and/or chest tube placement are usually required.

Chest Injury

• Types:
  • Blunt trauma (e.g., car accident)
  • No open, external wounds.
• Symptoms:
  • Pain from trauma
  • Respiratory distress
  • Paradoxical chest wall movement (chest wall moves inward during inhalation and outward during exhalation)
  • Flail chest (a section of the rib cage breaks and moves independently)
• Management:
  • Flail chest requires mechanical ventilation with humidified air to support breathing.
• Monitoring:
  • ABGs, vital capacity, and signs of worsening hypoxemia/hypercarbia.

Open Pneumothorax ("Sucking Wound")

• Definition: An open wound penetrating the chest wall allowing air to enter and exit the pleural space.
• Causes: Penetrating trauma (e.g., gunshot, stab wound)
• Characteristics:
  • Audible air rushing in and out of the wound with each breath.
  • The chest wound does not directly puncture the lung, but the loss of pressure prevents air from entering the lung.
• Recognition:
  • Chest wound with or without bleeding/foaming
  • Audible hissing/sucking sound
  • Mediastinal shift (alternating with ventilation)
  • Respiratory distress
  • Hemoptysis (blood in sputum)
• Management:
  • Immediately seal the wound with a one-way valve (three sides sealed) to allow air to escape on inhalation and seal on exhalation.
• Monitoring:
  • Closely monitor for tension pneumothorax, blood pressure, heart rate, and pulse patterns.