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Pulmonary embolism
- is when one or more pulmonary arteries in the lung is blocked
- O2 ASAP- cause blocking oxygen
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Pulmonary embolism
- how one gets this
- fat from bone marrow, after fracture, thombi in deep calf, femoral, politeal, iliac veins, air IV
- embolus/thrombi clot occludes part of pulmonary blood vessels
- affecting airflow to areas of lung where blood flow is dec
- depending on size, mild resp distress to lethal
- dead space- ventiliation, no perfusion= ventilation perfusion mismatch
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Pulmonary embolism
- how to detect
- VQ scan
- spiral CT scan
- Pulmonary Angiogram
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Pulmonary embolism
- management- before and during
- *** prevention in susceptible patients
- - assess well
- - post op pts
- - get moving
- -immobilize fracture
- prompt recognition, immediate tx
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Pulmonary embolism
- nursing and medical management
- Anticoagulation- heparin to coumadin
- ** avoid IM**
- Thrombolytic therapy - if hemodynamic unstable
- - may not improve mortality
- Cardiopulmonary support- O2, IVF
- analgesia- IV MSO4 PRN
- positioning- avoid sitting for long period of times, elevate leg above the heart level- inc venous flow- monitor bc it may cause hemodynamic challenges
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Pulmonary embolism
- surgical management
- Vena cava interruption with filter insertion
- - Greenfield fliter
- Pulmonary embolectomy
- - Surgical removal- for significant HD instability, massive PE, pt c/i for thrombolytic therapy
- - complication- 30% mortality rate
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Pulmonary HTN
- Pulmonary htn is a type of high blood pressure that affect the arteries of the lungs and right side of the heart
- progressive disorder xterized by abnormally high b/p in pulmonary artery
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Pulmonary HTN
- how it develops
- htn develops when most small a arteries in the lungs narrows- inc resistance to blood flow to the lungs
- the inc pressure- abnormally very high bp in the pulmonary artery
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Pulmonary HTN
- two types
- primary (idiopathic)- young adults- progressive
- secondary- underlining heart/lung disease
- not curable but treatable**
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Pulmonary HTN
- manifestation
- Exerional dyspnea
- fatigue/lethargy
- angina
- syncope
- raynaud's dx
- - poor circulation to hands- in between fingers
- narrow arteries- decrease o2
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Pulmonary HTN
- Diagnostic
- ECG
- CXR- RVH, enlarged pulmonary arteries
- cardiac cath- inc pulmonary artery pressure (PAP)
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Pulmonary HTN
- medical/surgical tx
- Ca channel blockers-
- Continuous IV epopostenol (inhibits platelet activation/vasodilator)
- Anticoagulants
- digoxin- toxicity
- diuretics- lytes
- lung transplant
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Atelectasis
- patho
- obstructed aveoli collapse causing impaired gas exchange
- - trapped alveoli air absorbed in blood
- - no additional air to alveoli b/c blockage
- - affected part of lungs- airless and alveoli collapse
- Microatelectasis may occur, with small airway closure (not seen on CXR)
- Macroatelectasis0 loss of segmental, lobar, or overall lung volume
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Atelectasis
- manifestation
- usually first seen on cxr
- tachycardia- compensate
- inc dyspnea- sob
- tachyapnea
- dec breath sounds =/- crackles bc of surfactant (lack)
- cough/sputum
- resp distress if significant hypoxia
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Atelectasis
- nursing interventions
- prevention in high risk pt is key
- freq position changes
- CPT/postural drainage
- incentive spirometer
- splinting of incision site
- early ambulation
- turn, cough, deep breathe
- secretion removal
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Atelectasis
- management
- treat underlying cause
- - o2
- - cpt
- - suctioning
- - bronchoscopy
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Pneumonia
- Inflammatory process in lung parenchyma as associated w/marked increase in interstitial and alveolar fluid
- 6th most common cause of death in all ages
- highest mortality rate of all nosocomial infe
- CAP vs HAP, aspiration pna
- Causive organism
- bacteria, virus, fungu, protozoa, mycoplasma, aspiration
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Pneumonia
- patho- explanation purpose only
- 4 stages
- 1. congestion- inflamm pulm resposen
- - lung defense mechanism lose effectiveness
- 2. red hepatixation- massive capillary dilation leads to alveoli filled w/organisms, neuts, RBC's, fibrin
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Pneumonia
- patho 3-4
- 3. gray hepatization- alveolar exudate consolidates & hard to expectorate
- 4. resolution- occurs completely if no complication
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Pneumonia
- manisfestations
- fever
- sweats
- pleuritic CP
- hemoptysis
- elderly- change in MS
- bronchial breath sounds
- rhonchi, lethargic
- inc tactile fremitus
- tachycardia
- rapid breath
- chills
- dyspnea
- productive thick cough
- fatigue
- inc fluid 3000-4000 cause with HF pt
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Pneumonia
- diagnostic
- assessment
- sputum culture and sensitivity
- bronchscopy
- skin test for TB
- blood culture (blood stream invasion)
- CXR
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Pneumonia
- medical management
- +/- hospitalization
- hydration
- antibiotics
- pneumococcal vaccine
- mucolytics
- cough suppressants (carefully)
- gram +- pne levaquin
- gram - uti- cipro
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Nursing responsibilities
- CAP
- blood cultures (if ordered0 must be drawn and labeled approriately prior to giving antibiotic
- antibiotics must be given within 6 hrs of arrival (ED pts and direct admit pts)
- antibiotics must be given by correct route
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nx responsibilities
- CAP 2
- administer pne and flu vaccine as approriate
- if pt is a candidate for pne or flu and they do not get it before d/c this is considered a med error
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nx responsibilities
- CAP 3
- has pt smoked cigs in the past 12 months? if so, pt needs smoking cessation. a simple notes " I advised the pt to quite smoking" will suffice
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General nx interventions fo PNE
- resp assessment
- inc fluids***
- turn. cough deep breath
- position in distress- turn to the side
- HOB >45
- encourage rest
- bronchodilators as ordered
- +/- CPT, suctioning, artificial airway
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Pneumonia
- nursing interventions
- monitor ABG's
- rest periods in b/w activities
- O2prn
- psychological support- involve family
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Pneumonia
- nx diagnoses
- ineffective airway clearance
- ineffective breathing pattern
- activity intolerance
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influenza flu
- This is a respiratory illness that is caused by a virus- highly contagious
- 2 types A/B
- viruses able to change over time, therefore an annual vaccine
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influenza flu
- manifestation
- abrupt onset of cough/fever
- sore throat
- headache
- malaise
- nasal drainage
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influenza flu
- what to do
- subside in 7days
- pne most common complication
- symtomatic tx
- antivirals for some- tamiflu
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influenza flu
- vaccine
- high risk
- 70-90% effective
- offered october- march
- contraindicated- h/o GBS (Guillian barre syndrome) allery to egg
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