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A comprehensive overview of atelectasis, a common respiratory condition that occurs when part of the lung collapses or fails to inflate. It covers the causes, symptoms, and diagnostic methods for both acute and chronic atelectasis, as well as the nursing interventions and medical management strategies. The document also discusses acute respiratory failure, its causes, clinical manifestations, and the nursing and medical management approaches. Additionally, it covers topics related to mechanical ventilation, including ventilator-associated pneumonia, acute respiratory distress syndrome (ards), and pulmonary embolism. The information presented in this document can be valuable for healthcare professionals, particularly nurses, in understanding and managing respiratory conditions and their complications.
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atelectasis - correct answer Closure or collapse of alveoli Caused by hypoventilation, obstruction to the airway or compressions. Most common is acute atelectasis, which occurs in the postoperative setting Symptoms: insidious, increasing dyspnea, cough, and sputum production Acute: tachycardia, tachypnea, pleural pain, and central cyanosis if large areas of the lung are affected Chronic: similar to acute, pulmonary infection may be present Aspiration - correct answer the inhalation of food, fluid, or foreign material into the lower airway symptoms of atelectasis - correct answer insidious, increasing dyspnea, cough, and sputum production Acute: tachy cardia, tachypnea, pleural pain, and central cyanosis if large areas of the lung are affected Chronic: similar to acute, pulmonary infection may be present Assessment and Diagnosis for Atelectasis - correct answer Characterized by increased work of breathing and hypoxemia Decreased breath sounds and crackles over the affected area Chest x-ray may suggest a diagnosis of atelectasis before clinical symptoms appear Pulse oximetry (SpO2) may demonstrate a low saturation of hemoglobin with oxygen (less than 90%) Nursing Interventions for Atelectasis - correct answer Prevention Frequent turning Early mobilization Strategies to expand lungs and manage secretions Incentive spirometer Voluntary deep breathing Secretion management Pressurized metered-dose inhaler Administer prescribed opioids to prevent respiratory depression Improve ventilation and remove secretions First‐line measures: Frequent turning, early ambulation, lung volume expansion maneuvers and coughing Multidisciplinary: ICOUGH (see Chart 19‐3) PEEP, CPAB, bronchoscopy CPT
Endotracheal intubation and mechanical ventilation Thoracentesis to relieve compression BiPAP (bilevel positive airway pressure) - correct answer a noninvasive, spontaneous breath mode of mechanical ventilation-assistance provides higher airway pressure during inspiration and lower pressure during expiration, usually delivered by a face mask CPAP (continuous positive airway pressure) - correct answer positive pressure applied throughout the respiratory cycle to a spontaneously breathing patient to promote alveolar and airway stability and increase functional residual capacity; may be given with endotracheal or tracheostomy tube or by mask hemothorax - correct answer a collection of blood in the pleural cavity may occur after surgery hypoxemia vs hypoxia - correct answer hypoxemia: low oxygen arterial blood (low PaO2) hypoxia: deficiency in the amount of oxygen reaching the tissues and cell orthopnea - correct answer difficulty breathing when lying down / supine position Mechanical ventilator - correct answer a positive- or negative-pressure breathing device that supports ventilation and oxygenation pneumothorax - correct answer A partial or complete accumulation of air in the pleural space. (Positive pressure ) PEEP - correct answer positive end-expiratory pressure - positive pressure common mechanical ventilator setting in which airway pressure is maintained above atmospheric pressure. Pressure Support Ventilation (PSV) - correct answer mode of mechanical ventilation in which preset positive pressure is delivered with spontaneous breaths to decrease work of breathing Respiratory weaning - correct answer process of gradual, systematic withdrawal or removal of ventilator, breathing tube, and oxygen tidal volume - correct answer The volume of air breathed in and out without conscious effort. ICOUGH - correct answer I - Incentive Spirometry. C - Coughing & deep breathing. O - Oral care (brush teeth and use mouthwash 2x a day). U - Understanding (pt and staff education). G - Getting out of bed at least 3x a day.
Monitoring Oral care Positioning Placement Explain the cuff Weaning Develop a care plan for a patient with an ET tube Maintain cuff pressure between 20 and 25 mm Hg Intubation for no longer than 14 to 21 days (after will require a tracheostomy) For ET tube Maintain cuff pressure between - correct answer Maintain cuff pressure between 20 and 25 mm Hg Intubation for no longer than _ to _ after will require what? - correct answer Intubation for no longer than 14 to 21 days (after will require a tracheostomy) Mechanical Ventilation - correct answer mechanical breathing using a ventilator Positive or negative pressure device to maintain ventilation and oxygenation for a prolonged period INDICATIONS MANIFESTATIONS POSITIVE PRESSURE INVASIVE AND NONINVASIVE CMV IMV SIMV PEEP SETTING AND EQUIPMENT: WHAT IS THE NURSES ROLE? Weaning WHAT IS THE NURSES ROLE Mechanical venitlation? - correct answer Weaning Noninvasive Positive-Pressure Ventilation - correct answer Technique uses positive pressure to keep alveoli open and improve gas exchange without airway intubation Method of positive-pressure ventilation that can be given via facemasks that cover the nose and mouth, nasal masks, or other oral or nasal devices such as the nasal pillow
Eliminates need for endotracheal intubation or tracheostomy Continuous positive airway pressure (CPAP) Bilevel positive airway pressure (BiPAP) Indications: respiratory arrest, serious dysrhythmias, cognitive impairment, head/facial trauma Assessment of the Patient Receiving Mechanical Ventilation - correct answer Systematic assessment of all body systems: In-depth respiratory assessment including all indicators of oxygenation status Neurologic status Effective coping and emotional needs Comfort level and ability to communicate needs Assessment of the equipment and settings Alarm fatigue Problems/Complications of the Patient Receiving Mechanical Ventilation - correct answer Ventilator problems Alterations in cardiac function Barotrauma and pneumothorax Pulmonary infection and sepsis Delirium and postintensive care syndrome Planning and Goals for the Patient Receiving Mechanical Ventilation - correct answer Maintenance of patent airway Optimal gas exchange Absence of trauma or infection Attainment of optimal mobility Adjustment to nonverbal methods of communication Successful coping measures Nursing Interventions for the Patient Receiving Mechanical Ventilation - correct answer Enhancing gas exchange Promoting effective airway clearance Preventing injury and infection Promoting optimal level of mobility Promoting optimal communication Promoting coping ability Nursing Intervention: Enhancing Gas Exchange - correct answer Judicious use of analgesics to relieve pain without suppressing respiratory drive Frequent repositioning to diminish the pulmonary effects of immobility
Nutritional support, enteral feedings preferred Reduce anxiety, sedation, paralysis Supportive care Pulmonary embolism: - correct answer Obstruction of the pulmonary artery or one of its branches by a thrombus (or thrombi) that originates somewhere in the venous system or in the right side of the heart Inflammatory process obstructs area, results in diminished or absent blood flow Bronchioles constrict, further increasing pulmonary vascular resistance, pulmonary arterial pressure, and right ventricular workload Ventilation-perfusion imbalance, right ventricular failure, shock occurs Risk Factors for PE - correct answer Trauma Surgery Pregnancy Heart failure Hypercoagulability Immobility, venous stasis Dyspnea is the most common symptom Prevention and Treatment of a PE - correct answer Early ambulation Anti-embolism stockings pulmonary ebolism treatment - correct answer Measures to improve respiratory and vascular status Anticoagulation and thrombolytic therapy Surgical interventions Early Prevention and Interventions of a PE - correct answer Application of graduated compression stockings Pneumatic compression devices Early ambulation Subcutaneous heparin or LMWH Lifestyle changes Weight loss Smoking cessation Regular exercise Chest Trauma - correct answer Blunt trauma (Sternal, rib fractures Flail chest
Pulmonary contusion) Penetrating trauma Pneumothorax (Simple or spontaneous traumatic Tension) pleural effusion s&s - correct answer fluid in the pleural space ( second to other disease ) S&s (decrease or absent breath sound, decrease fremitus, dull or flat sound in percussion ) Chest x ray, thoracentesis (to confirm the present of fluid) Tidal volume how much it should be - correct answer 6-8ml/kg