Galen NUR 265 Exam 2

- Dyspnea, sudden onset, sharp stabbing chest pain, restlessness, impending doom, cough, Hemoptysis, Tachypnea, crackles, plural friction rub, s2 or s4 heart sound, tachycardia, low-grade fever, diaphoresis, petechiae over the chest and axillae, decreased SaO2 - Signs and sx of pulmonary embolism - High D-Dimer - DVT, PE, DIC labs all have - BNP, D dimer, metabolic panel, troponin - Labs to draw for pulmonary embolus - pulmonary angiography - Diagnostic test for PE - Yes. - Does the patient with PE have adequate tissue perfusion - Heparin or enoxaparin, alteplase if shock of hemodynamic collapse - Drug therapy used for PE - Management for MASSIVE PE - Sx and management of submissive PE- Phytonadione - Injectable vitamin K - Clotting Factors, fresh frozen plasma, and aminocaproic acid - Antidote for alteplase - 2.5-3 - Therapeutic INR for PE - 0.8-1.1 seconds - Normal INR - PT: 11-12.5 seconds PTT: 20-30 APTT: 30-40 Therapeutic is 1.5 x2 baseline - Normal PT, PTT, and aPTT - Norepinephrine, epinephrine, dopamine - Vasopressors used when hypertension occurs in PE - Acute Respiratory Failure - PaO2 60 or PaCO2 45 & pH 7.35 O2 90 in both cases - acute respiratory distress syndrome (ARDS) - ARF with refractory hypoxemia, lung infiltrates, noncardiac associated pulmonary edema, larger molecules able to pass through alveoli because of injured lung tissue. Can be caused be shock, burns, aspiration, blood transfusion, etc - refractory hypoxemia - hypoxemia that does not respond to O2 therapy - Common causes of ARDS- Abnormal lung sounds not heard bc edema happens in interstitial spaces first. Assess VS hourly for hypotension, tachycardia, and dysrhythmias, temperature abnormalities. Better outcome if temp is elevated instead of lowered. - Assessing a patient with ARDS - Exudative phase of ARDS - Phase of ARDS with dyspnea and tachycardia. Give O2 - Fibroproliferative phase of ARDS - after inflammatory injury(fibrosis and pulmonary HTN) to the lung is established and the initiating events are controlled, a process of lung repair begins (3 to 7 days), focus on O2 and preventing complications. Other organ involvement can occur - Resolution phase of ARDS - Usually after 14 days. Fibrosis May or May not occur. Many survivors end up with neuropsychological deficits - Intubation, mechanical ventilation with PEEP or CPAP to treat progressive hypoxemia Sedation or paralysis may be needed to meet oxygen needs. Early mobility and repositioning q2h helps lung perfusion. Probe position helps breathing. Small amounts of IV fluids along with diuretics to maintain fluid balance, pt at risk for malnutrition