NUR2755 / NUR 2755 Multidimensional Care IV Exam 2 Review | Rated A Guide | LATEST, 2021 / 2022 | Rasmussen College

NUR2755 / NUR 2755 Multidimensional Care IV Exam 2 Review | Rated A Guide | LATEST, 2021 / 2022 | Rasmussen College Week 5 – Chapter 32: Respiratory Problems 1) Acute Respiratory Failure (ARF): -Diagnosed by ABGs, patient will always by hypoxemic - PaO2 60mmHg and O2 90%, or PaCO2 50mmHg occurring w/ acidemia - Can l/t ARDS - Give O2 to keep PaO2 above 60mmHg •S/S: dyspnea is a hallmark symptom, changes in respiratory rate - Hypoxic resp. failure: restlessness, irritability/agitation, confusion, tachycardia - Hypercapnic failure:  LOC, drowsiness, confusion, HA, lethargy, seizures. • Inter: elevate HOB, bronchodilators, energy-conserving measures, encourage deep breathing 2) ARDS: acute respiratory failure w/ hypoxemia even w/ 100% O2 (refractory hypoxemia) -Features:  pulmonary compliance, dyspnea, bilateral pulmonary edema, dense pulmonary infiltrates on X-ray • Risk Factors: sepsis, burns, pancreatitis, trauma, transfusion, aspiration, drowning. Direct injury to lung tissue. • S/S: dyspnea, inter/substernal retractions, change in mental status. • Dx: low PaO2 and widening alveolar oxygen gradient, determined by ABG measurements • Inter: Early recognition of pts at high risk. Young man, trauma 20-40yo -O2, elevate HOB, incentive spirometer, positioning, I&Os - Hourly assessments: O2 sats, VS changes, indication of  work of breathing, cyanosis, pallor, retractions - Laying prone to  perfusion, institute PEEP (holds alveoli open) 3) Chest Trauma: - Protect airway, cervical spine until ruled-out (log roll) • Flail chest: paradoxical inward movement of the thorax during inspiration w/ outward movement during expiration (paradoxical chest movement) - Older adults have a higher mortality rate • S/S: dyspnea, cyanosis, tachycardia, hypotension, pain, anxiety, SOB, clear secretions when coughing,  work of breathing • Inter: O2 (humidified), pain management, • Pneumothorax: air in the pleural space causing loss of negative pressure in chest cavity - Rise in chest pressure, and a reduction in vital capacity l/t lung collapse - Deviation of the trachea away from midline - Reduced or absent breath sounds,  cx expansion unilaterally •Tension Pneumothorax: extreme respiratory distress and cyanosis - Distended neck veins - S/S: hypotension, tachycardia/pnea, dyspnea, sharp cx pain, cyanotic - Tx is a needle thoracostomy (2nd intercoastal midclavicular space) and chest tube (4th intercoastal space) • Hemothorax: Bleeding into the chest cavity -S/S: hypotension, tachycardia 4) Intubation and Ventilation: ET tubes can be in for 10-14 days, longer l/t vocal cord damage - If the Pt cannot maintain airway after extubation, tracheostomy is needed - Assess mouth, elevate HOB, O2, ET tube, - DOPE: Displaced tube, Obstructed tube, Pneumothorax, Equipment problems