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Anatomic Alterations of the Lungs with pneumothorax!
- Lung collapse
- Atelectasis
- Chest wall expansion
- Compression of the great veins and decreased cardiac venous return
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Traumatic pneumothorax!
Penetrating wounds to the chest wall
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Open pneumothorax or sucking chest wound!
The pleural space is in direct contact with the atmosphere and gas can move into and out of the pleural cavity
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Closed or tension pneumothorax!
- A one way valve like action of the ruptured parietal pleura
- Gas enters the pleural space during inspiration but cannot leave
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Spontaneous pneumothorax!
When a pneumothorax occurs suddenly and without any obvious underlying cause
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Iatrogenic Pneumothorax!
occurs during specific diagnostic or therapeutic procedures
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Cardiopulmonary Clinical Manifestations Associated with Pneumothorax!
Atelectasis
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Vital signs with pneumothorax!
- Increased respiratory rate
- Increased Heart rate (pulse)
- Increased Blood pressure
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Chest Assessment Findings with pneumothorax!
- Hyperresonant percussion note over the pneumothorax
- Diminished breath sounds over the pneumothorax
- Tracheal shift
- Displaced heart soundsIncreased thoracic volume on the affected side
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Chest radiograph with pneumothorax!
- Increased translucency on the side of pneumothorax
- Mediastinal shift to unaffected side in tension pneumothorax
- Depressed diaphragm
- Atelectasis
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Management of pneumothorax!
- The management of pneumothorax depends on the degree of lung collapse...
- When suction is used, the negative pressure need not exceed -12 cm H2O; -5 cm H2O is generally all that is needed.
- After the lung has reexpanded and bubbling from the chest tube has ceased, the tube is left in place without suction for another 24 to 48 hours
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Respiratory Care Treatment Protocols for pneumothorax!
- Oxygen Therapy Protocol (100 % increases rate of absorption of gas)
- Lung Expansion Therapy Protocol
- Mechanical Ventilation Protocol
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Anatomic Alterations of the Lungs with pneumonia!
- Inflammation of the alveoli
- Alveolar consolidation
- Atelectasis
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Gram positive causes of Pneumonia!
- Streptococcus
- Staphylococcus
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Gram negative causes of Pneumonia!
- Haemophilus influenzae
- Pseudomonas aeruginosa
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Cardiopulmonary Clinical Manifestations Associated with Pneumonia!
- Alveolar Consolidation
- Increased Alveolar-Capillary Membrane Thickness
- Atelectasis
- Excessive Bronchial Secretions
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Vital signs associated with pneumonia!
- Increased Respiratory rate (Tachypnea)
- Increased Heart rate (pulse)
- Increased Blood pressure
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The Physical Examination with pneumonia!
- Chest pain/decreased chest expansion
- Cyanosis
- Cough, sputum production, and hemoptysis
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Chest Assessment Findings with pneumonia!
- Increased tactile and vocal fremitus
- Dull percussion note
- Bronchial breath sounds
- Crackles and rhonchi
- Pleural friction rub
- Whispered pectoriloquy
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Chest Radiograph with pneumonia!
- Increased density
- Air bronchograms
- Pleural effusions
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CT Scan with pneumonia!
- Alveolar consolidation
- Air bronchograms
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The treatment of pneumonia is based on...
- The specific etiology of the pneumonia, and
- The severity of symptoms demonstrated by the patient.
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Respiratory Care Treatment Protocols for pneumonia!
- Oxygen Therapy Protocol
- Bronchopulmonary Hygiene Therapy Protocol
- Lung Expansion Therapy Protocol
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Anatomic Alterations of the Lungs with ARDS!
- Interstitial and intra-alveolar edema and hemorrhage
- Alveolar consolidation
- Intra-alveolar hyaline membrane
- Pulmonary surfactant deficiency or abnormality
- Atelectasis
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Cardiopulmonary Clinical Manifestations Associated with ARDS!
- Atelectasis
- Alveolar Consolidation
- Increased Alveolar-Capillary Membrane Thickness
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Vital signs with ARDS!
- Increased Respiratory rate
- Increased Heart rate
- Increased Blood pressure
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Chest Assessment Findings with ARDS!
- Dull percussion note
- Bronchial breath sounds
- Crackles
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Chest Radiograph with ARDS!
Increased opacity
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Respiratory Care Treatment Protocols with ARDS!
- Oxygen Therapy Protocol
- Lung Expansion Therapy Protocol
- Mechanical Ventilation Protocol
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Common ARDS mechanical ventilation
strategy!
- Low-tidal volumes and high respiratory rates
- Ø5 to 7 mL/kg
- ØVentilatory rates between 20 and 25 bpm
- Ventilatory rates as high as 35 bpm may be needed.
- PEEP and/or CPAP
- Permissive hypercapnia is often allowed
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The therapeutic goals of low-tidal volume
ventilation with ARDS!
- Decrease high transpulmonary pressure Reduce overdistention of the lungs
- Decrease barotrauma
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Anatomic Alterations of the Lungs associated with Myasthenia Gravis!
- Mucous accumulation
- Airway obstruction
- Alveolar consolidation
- Atelectasis
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Screening and Diagnosis for Myasthenia Gravis!
- The clinical history
- Neurologic examination
- Electromyography
- Blood analysis
- Edrophonium test
- Ice pack test
- Sleep test
- Computed tomography or magnetic resonance imaging
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Cardiopulmonary Clinical Manifestations Associated with Myasthenia Gravis!
- Atelectasis
- Alveolar Consolidation
- Excessive Bronchial Secretions
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Vital signs with Myasthenia Gravis!
- Respiratory rate
- ØVaries with the degree of respiratory muscle paralysis
- Ø Apnea (in severe cases)
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Chest Assessment Findings with Myasthenia Gravis!
- Diminished breath sounds
- Crackles and rhonchi
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Chest Radiograph with Myasthenia Gravis!
- Normal in early stage
- Increased opacity (when atelectasis is present)
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General Management of Myasthenia Gravis!
- Frequent measurements of the patient’s:
- VC
- NIF
- Blood pressure
- Pulse oxygenation saturation
- ABG's
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Respiratory Care Treatment Protocols for Myasthenia Gravis!
- Oxygen Therapy Protocol
- Bronchopulmonary Hygiene Therapy Protocol
- Lung Expansion Therapy Protocol
- Mechanical Ventilation Protocol
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Anatomic alterations of the lungs with flail chest!
- Double fracture of numerous adjacent ribs
- Rib instability
- Lung volume restriction
- Atelectasis
- Lung collapse
- Lung contusion
- Secondary pneumonia
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Flail chest!
The result of double fractures of at least three or more adjacent ribs, which causes the thoracic cage to become unstable
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Vitals signs with flail chest!
- Increased respiratory rate
- Increased heart rate
- Increased Blood pressure
- Paradoxical movement of the chest wall
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Chest assessment findinf with flail chest!
Diminished breath sounds, on both the affected and the unaffected sides
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Chest radiograph with flail chest!
- Increased opacity
- Rib fractures
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Respiratory care treatment protocol!
- Oxygen therapy protocol
- Lung expansion therapy protocol
- Mechanical ventilation protocol
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Factors that increase risk of hospital acquried infections!
- Long hospital stay
- Indwelling catheters, central lines, and ventilators
- Complications following surgery
- Failure of healthcare workers to wash hands
- Overuse of antibiotics.
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Role of the RT in Preventing hospital acquried infections in ventilated Patients!
- Humidification and Filtration
- Avoiding manipulation of the ETT
- Ventilator circuit changes
- Maintenance of ETT Cuff Pressures
- Endotracheal Tube Modifications
- Hand Hygiene and Glove / Gown Adherence
- Head of Bed elevated 30 degrees or greater Oral Hygiene
- Use of Non-invasive Ventilation
- Assessment for Daily SBTs
- Infection Control- Disinfecting equipment
- Use of Ventilator Bundles
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