A7 Exam 2 PDF

lOMoARcPSD|42527654 Exam 2 (modules 3& 4) Inspiration v. Expiration (“If you’re not breathing, you’re dying”) PRIORITY: MAKE SURE THE PT. Inspiration: pressure in the lungs goes down - inc. volume of lungs IS BREATHING (Safety) causes dec. pressure achieved...

lOMoARcPSD|42527654 Exam 2 (modules 3& 4) Inspiration v. Expiration (“If you’re not breathing, you’re dying”) PRIORITY: MAKE SURE THE PT. Inspiration: pressure in the lungs goes down - inc. volume of lungs IS BREATHING (Safety) causes dec. pressure achieved by contraction of the lungs Expiration: when muscles are relaxed, air is forced out as space in lungs dec. BEST WAY TO DETERMINE THE NEED FOR O2 THERAPY: ABG ANALYSIS What is Stridor? Remember: - pH: 7.35 - 7.45 High-pitched breathe d/t narrow or partially blocked airway - PCO2: 35 - 45 Loudest when you breathe in - PO2: 80 - 100 Inspiratory = airway obstruction = airway collapse - HCO3: 21 - 28 Expiratory = intrathoracic obstruction = lower airway collapse PRIORITY: identify cause & threat Oxygenation: exchange of O2 and CO2 assessments: assess RR, breath sounds, skin, pulse oximetry N/I: watch for use of accessory muscles, listen for clear lung sounds, patient must swallow effectively, capillary refill under 3 seconds, trachea midline, thorax expand bilaterally, supplement O2, place pt. In high fowlers Perfusion: CO delivers O2 to all cells via blood flow through arteries and capillaries assessments: assess s/s of impaired central & local perfusion (inc. BP, shock, hair loss, ischemia), document s/s of impaired CO N/I: collaborate w/ healthcare team to determine cause of perfusion, vasodilator drugs = promote blood flow, poss. Vascular intervention (stent) O2 therapy = relieves hypoxia - GOAL: use the lowest amount of O2 for acceptable blood oxygen level w/out causing harmful side effect - Hypoxia: dec. tissue oxygenation - S/S: R- restlessness B- bradycardia (Peds pts.) F- feeding difficulty A- anxiety E- extreme restlessness I- inspiratory stridor T- tachycardia/tachypnea D- dyspnea (severe) N- nares flare E- expiratory grunting S- sternal retractions - N/I: O2 is combustable (O2 hazards) Requires MD order Use humidification - if delivered 4L/min (or more) = dries mucous membrane - Provide mouth care - lubricate nostrils, face, lips Assess skin for pressure points in existing pressure areas Clean cannula/mask - remove existing debris Collaborate w/ respiratory therapist Downloaded by Katie Bridgeman ([email protected])  lOMoARcPSD|42527654 O2 delivery systems: Nasal cannula - 2-6 L/min - Provides O2 at low flow rate - Pt. is able to still do ADLs Simple face mask - 5-8 L/min Venturi mask - 4-10 L/min (8 L/min) - gives a specific amount of O2 Partial rebreather mask - 6-10 L/min - Reservoir bag - Used for anxiety, rapid RR, & Tx respiratory alkalosis Non-rebreather mask - 8-10 L/min (or higher) - Delivers THE HIGHEST O2 CONCENTRATION (close to 100%) - Used for CPR, surgery, & post-op care Face tent - 4-8 L/min (or higher) - used in pt. With fractured mandible & dental surgery CPAP airflow BiPAP airflow continuous (+) airway BiLevel (+) airway pressure pressure 2 distinct pressure settings Single set pressure (inhale & exhale) More affordable Tx more complex sleep & Not great w/ breathing disorders accommodating change in breathing Downloaded by Katie Bridgeman ([email protected])  lOMoARcPSD|42527654 Respiratory Disorders: COPD (Chronic Obstructive Pulmonary Disorder): Irreversible damage = respiratory failure - Includes: Emphysema & Chronic Bronchitis - Emphysema: Damaged alveoli (inner wall rupture = large air spaces = reduce O2 reaching blood = unable to exhale CO2, it becomes trapped = dec. gas exchange - Chronic Bronchitis: Disease of bronchial epithelium - activates neutrophils & lymphocytes - Airways inflamed = chronic mucus hyper secretion - Cause: Alpha 1-antitrypsin deficiency (protein protect lungs from chronic inflammation), asthma - R/F: Smoking/inhaling tobacco - S/S: Hypoxia & Hypoxemia Cyanosis (hands & feet) Dependent edema Clubbing fingers Use of access. muscles (pursed lip breathing) Barrel- chest Hepatomegaly (enlarged liver) Distended neck veins (cor pumlonale) Pulmonary HTN Resp. Acidosis Inc. Dyspnea (wheeze, chronic cough) Fatigue GI disturbances Orthopnea position Poor sleep pattern Nervousness RR ease w/ tripod position Dec. appetite - N/I: Diagnostics (i.e., chest x-ray, CT scan of chest, pulmonary function test, ABG, sputum C&S) Improve gas exchange & reduce CO2 retention Prevent weight loss & resp. infections Minimize anxiety Inc. endurance O2 therapy (min. 88% maintain cog. Orientation) Pursed lip breathing Effective cough = clear secretion Positioning = improved lung expansion, release excess CO2 Exercise Hydration = thins out secretions, maintain fluid balance - Meds that Tx COPD: Albuterol Sulfate Ipratropium Bromide Fluticasone Prednisone Guaifensin Theophylline Downloaded by Katie Bridgeman ([email protected])  lOMoARcPSD|42527654 Asthma: reversible airflow obstruction (inflammation, hyper-responsiveness d/t exercise) affecting airways - Cause: Allergies & general irritants Microorganisms (i.e., dust mites), aspirin Upper resp. Infection - S/S: Audible wheezing Inc. RR & cough Use of access. Muscles Barrel chest = air trapping Long breathing cycle Cyanosis Hypoxemia - N/I: Diagnostics (i.e., ABGs, elevated eosinophil, immunoglobin E lvl, sputum w/ eosinophil, mucous) Use of spacer/mask ensure med. is inhaled (alternative nebulizer) Focus pt. education about personal asthma action plan (PRIORITY) = drug therapy, lifestyle mgt. Self mgt. education (assess RR., adjust freq. & dose of prescribed drug, when to consult PCP) Omron device (measure peak expiratory flow rate - help detect pending asthma attack) - Meds that Tx Asthma: Albuterol Sulfate Fluticasone Excess predisone causes : Cushing's Syndrome Prednisone watch for S/S of Cushing's Disease : & truncal obesity , face, BG Nat, ↓Cat, Water retention , Predisone Theophylline moon muscle atrophy , Poor wound healing/thin skin Blood glucose - Montelulast ↳ Pulmonary/Kidney/liver dysfunction goal : prevent fluid overload, Don't give to diabetic pts ↳ TX : mifepristone. Status Asthmaticus: SEVERE, LIFE-THREATENING, acute episodes of airway obstruction - Intensifies once begun - does NOT respond to common therapy - Risk of developing pneumothrorax & cardiac/respiratory arrest - Continuous resp. distress - Concurrent infection in some cases - N/I: Improve ventilation Medications - Tx: IV fluids Potent bronchodilator Albuterol Steroids Epinephrine Respiratory Syncytial Virus (RSV): common, acute viral infection occur primarily in winter and early spring - S/S: Coughing/wheezing ** REMEMBER: DON’T GIVE Fever ANTIBIOTICS UNLESS Tachypnea over 70 bpm (SEVERE) CONFIRMED BACTERIAL Poor air exchange (SEVERE) INFECTION! Dec. breath sounds (SEVERE) Rhinorrhea Pharyngitis Eye/ear drainage Cyanosis Retractions Downloaded by Katie Bridgeman ([email protected])  lOMoARcPSD|42527654 - N/I: Humidified O2 Encourage fluid intake Maintain airway O2 stat monitoring Hydration Bronchodilator & corticosteroids ** Ribavirin (antiviral): only specific therapy approved for hospitalized kids - controversial d/t high cost, aerosol route of admin.. potential toxic effects on exposed health care workers, conflicting results in efficiency Central Perfusion Tissue - Local Perfusion amount of blood volume of blood that pumped by heart each flows to target tissue min Req. patent vessels, Req. adequate cardiac adequate hydrostatic function, BP, BV pressure, capillary CO = stroke volume x permeability HR S/S: ischemia S/S: inc. BP Poss. Necrosis if Shock untreated Ischemia, cell injury, death if untreated Hypertension (aka. “The silent killer”): blood pressure of 140/90 or higher Cause: vital organ damage (d/t thickened BV) Dec. perfusion = PVD, MI, kidney perfusion Cushing’s syndrome Corticosteroids Disease & drugs that inc. pt. Susceptibility to HTN R/F: Obesity Smoking Stress Family Hx Above 60 YO or postmenopausal Excess sodium & caffeine intake Low K+, Ca+, Mg+ Continued stress - Meds that Tx HTN: Lisinopril (ACE) African American ethnicity Losartan (ARBs) Metoprolol (beta blocker) N/I: Dietary changes (DASH diet) Nifedipine (CCB) Reduce sodium, alcohol, stress lvl, weight, smoking Phentolamine (local effects) Exercise Furosemide (K+ wasting) Complementary & alternative therapy Spironolactone (K+ sparing) Downloaded by Katie Bridgeman ([email protected])  lOMoARcPSD|42527654 Malignant Hypertension: Severe elevated BP that progresses rapidly (BP 180/120) - caused by NS disorders, TBI, cerebral infarct/hemorrhage - withdrawal of HTN meds, renovascular disease S/S: Morning headache Blurred vision Dyspnea Uremia ** may experience kidney failure, LV HF, stroke or death Atherosclerosis: formation of plaque within arterial wall - leading R/F for cardiovascular disease Assessment: BP in both arms Palpate carotid artery separately Capillary refill Bruits Cholesterol & Triglycerides Total Cholesterol