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MCC Susan resp lectu
respiratory diseas lecture
| Question | Answer |
|---|---|
| pneumonia who at risk | over age 65, immunocompromised, lack of nutrition, HIV. Aspiration pneumonia affects elderly. |
| pneumonia 4 types | community acquired, nosocomial (VAP ventilator assisted pneumonia); immunocompromised host, aspiration (place in HOB minimum 30 decrease). |
| pneumonia patho | bug has entered bronchus. Bronchitis can lead to pneumonia |
| pneumonia s & s | fever, pleuritic chest pain - increases/decreases with breathing. Increase respirations, dyspnea, pulse ox is going down. |
| pneumonia appearance on x-ray | white. It's an area of consolidation. There is no aeration. |
| pneumonia dx tests | chest x-ray, sputum culture, bronchoscopy (NPO for this test). blood cultures at days 5-10 to look for sepsis (spike in temp also indicates sepsis) |
| pneumonia interventions | Poor appetite, inadequate nutrition, may get tube feed (TPN is used for GI issues). Sit patient up, encourage expel, humidify, antibiotics, |
| Diet for respiratory patient | Low carb because they need protein. Tube feed, not TPN. |
| surfactant - pneumonia related | opens up alveoli to keep oxygen moving, like a lube. Increases with "sighs", on vents "sighs" are given to increase surfactant |
| swelling alveoli from - pneumonia related | lack of profusion. phagocytes, histomines, mast cells, inflammatory mediators |
| aspiration pneumonia patho | gastric contents in lungs. Inflammatory response. Gastric pH: check NG tube, s/b highly acidic, if miscplaced can cause aspiration pneumonia |
| aspiration pneumonia s & s | tachycardia, dyspnea, central cyanosis, death |
| tube feed what do to prevent aspiration pneumonia | check for residual Q4H. Hold if greater than 1 hrs worth. Check peg on x-ray |
| Atelectasis | collapse of alveoli where gas exchange occurs. Incentive spirometer after surgery prevents atelectasis. Need to do deep breaths to keep air from being trapped. |
| which surgeries are most at risk for atlectasis | open heart, abdominal, breast. Use a pillow splint (pillow over incision to cough and deep breath). abdominal binder when out of bed. |
| pneumonia tx | prevention: sterile technique, correct tube feeding, immunization for 65 yrs and up, , antibiotics, bronchodilators (beta agonist), O2, hydrate, tube feed protein yes, carbs no |
| atelectasis tx | IS, pain meds |
| hypoxia s & s | early signs: restless, anxiety, tachycardia, tachypnea, Late signs: bradycardia, dyspnea |
| cheyne stokes breathing who? | dying patients |
| kussmahls breathing who? | diabetics, acidosis. Breath some then stop |
| tachypnea | over 22 breaths/min. |
| bradypnea | less than 10 breaths/min. |
| biots breathing | irregular, pauses, CNS disorders, drugs |
| pneumonia s & s | obstruction from clog of mucous blocks gas exchange, mediators are producing more secretions. Green - strep, yellow - staph. psuedonomas is in water, don't bathe ICU patients cuz it's in water |
| pneumonia dx | sputum culture and chest x-ray |
| SIRS Systemic inflammatory response syndrome | inflammatory response to injury or illness, infection eg MRSA, sepis can lead to MODS but SIRS is first |
| MODS multi organ dysfunction syndrome | after SIRS. Multiple body organs shut down. DIC, thrombocytopenia. Lungs, renal, elevation in liver function (AST, ALT) |
| ARDS acute respiratory distress syndrome aka "non-cardiac pulmonary edema" | damage to alveolar membrane, fluid leaks into membrane. Increase fluid = decrease gas exchange = hypoxia. Damage to lungs |
| DIC | always occurs with another disease |
| Hypoxia s & s | anxiety, restlessness, SOB |
| Hypoxia refractory to O2 | hypoxia does not get fixed by giving more O2 because there is fluid in the way, lasix won't help because it's in the alveoli. No tx, intubation, vent may help |
| peep positive end expiratory pressure | helps open alveoli |
| ARDS path | injury to lungs, alveolar capillary membrane damage, inflammation, interstitial pulmonary edema, release of mediators |
| ARDS S & S | dyspnea, tachypnea, hypoxemia resistant to O2, decrease in lung compliance "stiff lungs", resp alk, diffues rales, bilat infiltrates "white out". refractory hypoxia |
| hypoxemia | low O2 in blood resistant to O2 (can't fix with increase of O2) |
| ARDS dx | chest x-ray with "WHITE OUT (bilateral infiltrates)" and patchy infiltrates, low PaO2 on ABG. Pulse ox, EKG (make sure not heart problem). PT, PTT because DIC can result. Sputum culture to rule out pneumonia. PAP to ensure non-cardiac pulmonary edema |
| ARDS s & s | start in respiratory alkalosis then after breathing off the CO2 (HYPOVENTILATE), go into respiratory acidosis, then the lactic acid turns into metabolic acidosis. Rales |
| ARDS tx | mech vent or peep, corticoid steroids to decrease inflammation, inhaled nitrous oxide (Blue knob) which vasodilates, bronchodilates. place endotracheal tube for vent, if not work after 5-21 days, then trach. Pavulon and Ativan to relax |
| ARDS diet | NO CARBS, do give protein |
| ARDS tx | CPT: chest physiotherapy, Postureal Drainage: Change position of bed, put head down to get fluid toward the tube, difficult on patients because they are SOB, ativan to relax, |
| pavulon | induces coma. neuromuscular blockage to keep people still on vent eg ARDS. Risks: pneumonia, skin breakdown, dvt, stasis |
| ARDS diet | PEG (TPN is reserved for GI issues) and NO CARBS. Risk: aspiration pneumona. Precaution: raise HOB, check for placement, free water in peg |
| ARDS position in bed | prone (face down). risks: corneal abrasion, decubitous sores on shoulder, iliac crest, knees, toes |
| trach tube | always on nebulizer for humidity |
| ARDS complications | DIC, stress ulcer (35% of vented pts get these, give pepcid and protonix to prevent), renal failure, pneumonia (high risk cuz of intubation eg do not suction w/ tap water), Barotrauma leads to SQ emphysema (crackles under skin, it's air pockets) |
| atelectasis s & s | cough and low grade temp |
Created by:
bryantd9
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