Personal Study Guide
Units 4,5,6,7 Notes [Exam 2]
Respiratory Unit 4
PE: PULMONARY EMBOLISM- RESP ALKALOSIS. Blockage of pulmonary artery by
blood clot, air, fat, amniotic fluid, or septic thrombus. Inflammation then obstructs the area
causing decreased blood flow. Ventilation infusion imbalance -> right ventricular failure ->
shock. Can be related to DVT – thrombus formation in deep vein usually calf or thigh
traveling upward. (Increase in pulmonary arterial pressure increasing right ventricular work to
maintain pulmonary blood flow. (PE=MEDICAL EMERGENCY)
Risk factors CAUSING PE: old age, pneumonia, Immobility, DM, TRAUMA, COPD, Obesity,
Hypercoagulability, venous endothelial disease, heart disease, contraceptives, hx of
thrombophlebitis, prolonged air travel
Prevention: Anticoags, thrombolytic therapy, compression stockings, early and freq.
ambulation after surgery, exercising, avoid sitting, bed rest in semi fowlers, 4L 02, PT INR labs,
monitor vitals, incentive spirometer, tele
Chronic Emboli Interventions: Umbrella filter procedure placed into veins to catch any clots so
they don’t get any further
S&S: Tachypnea (Rapid breathing), chest pain, hypoxia (low O2), SOB worse on exertion.
Tachycardia, Bloody sputum, clammy cyanosis skin, heart palpitations
Nursing Interventions: Educate pt DO NOT DANGLE LEGS, Monitor labs while pt is on anticoags
(INR for coumadin therapeutic levels, PTT for heparin), implement prevention and educate
patient on recognizing s&s, teach use of anticouags for long term use and follow up appts
Heparin therapy 1.5-2.5 times higher (normal 25-35) needs to be 45-70sec for pt on heparin
therapy, Falls Risks
TX: thrombolytics-dissolve clot, Vit K antagonist, Anticoagulant Low molecular heparin,
embolectomy, Pt complain of trouble breathing or chest pain 1 st action by RN INCREASE
HOB-sit up
Massive PE TX: 02, IV LINE, Vasopressor therapy, Pulse ox-ABGs, Ecg, Blood Draw, Catheter, Iv
morphine or sedatives
Dx: Chest Xray, ECG, Pulse Ox, ABGs, V/Q scan- ventilation perfusion examining flow and blood
flow in lungs, Pul angiogram, D-dimer
Lab Normal Value Therapeutic Values
aPTT 25-35 seconds 45-70 seconds
Measures how long it takes your blood to 1.5-2.5 times higher
, Resp Acidosis,
DOES NOT
form a clot] speeds up the times and gives a
narrow range of what’s considered normal to
more tightly managed situation
PT 10- 13.5 seconds 1.5-2 times higher
[looks how fast blood clots]
PTT 60-70 seconds 1.5-2.5 times higher
[ How long it takes for blood to form a clot]
INR prothrombin time 0.8-1.2 Warfarin therapy: 2-3
[Time is takes for blood to form a clot] Blood clot: 2-3
Coronary Stent: 2.5-3.5
A Fib: 2-3
ARDS- ACUTE RESPIRATORY DISTRESS SYNDROME: fluid buildup
in air sac ”alveoli”, fluid keeps lung from filling w/ enough air. R SIDE,
RESPOND TO OXYGEN THERAPY, refractory hypoxemia-low 02 in blood. MEDICAL
EMERGENCY!
[Visual: alveoli goes from grape looking to raisin]
Risk Factors: Injury to lung, smoke inhalation, shock, trauma, pneumonia, sepsis, burns,
aspiration, inhaling chemicals
S&S: Severe SOB, Shallow Rapid labored breathing Tachypnea, Low BP, Confusion,
Severe Hypoxemia that does NOT respond so supplemental O2, crackles, air hunger breathing,
Units 4,5,6,7 Notes [Exam 2]
Respiratory Unit 4
PE: PULMONARY EMBOLISM- RESP ALKALOSIS. Blockage of pulmonary artery by
blood clot, air, fat, amniotic fluid, or septic thrombus. Inflammation then obstructs the area
causing decreased blood flow. Ventilation infusion imbalance -> right ventricular failure ->
shock. Can be related to DVT – thrombus formation in deep vein usually calf or thigh
traveling upward. (Increase in pulmonary arterial pressure increasing right ventricular work to
maintain pulmonary blood flow. (PE=MEDICAL EMERGENCY)
Risk factors CAUSING PE: old age, pneumonia, Immobility, DM, TRAUMA, COPD, Obesity,
Hypercoagulability, venous endothelial disease, heart disease, contraceptives, hx of
thrombophlebitis, prolonged air travel
Prevention: Anticoags, thrombolytic therapy, compression stockings, early and freq.
ambulation after surgery, exercising, avoid sitting, bed rest in semi fowlers, 4L 02, PT INR labs,
monitor vitals, incentive spirometer, tele
Chronic Emboli Interventions: Umbrella filter procedure placed into veins to catch any clots so
they don’t get any further
S&S: Tachypnea (Rapid breathing), chest pain, hypoxia (low O2), SOB worse on exertion.
Tachycardia, Bloody sputum, clammy cyanosis skin, heart palpitations
Nursing Interventions: Educate pt DO NOT DANGLE LEGS, Monitor labs while pt is on anticoags
(INR for coumadin therapeutic levels, PTT for heparin), implement prevention and educate
patient on recognizing s&s, teach use of anticouags for long term use and follow up appts
Heparin therapy 1.5-2.5 times higher (normal 25-35) needs to be 45-70sec for pt on heparin
therapy, Falls Risks
TX: thrombolytics-dissolve clot, Vit K antagonist, Anticoagulant Low molecular heparin,
embolectomy, Pt complain of trouble breathing or chest pain 1 st action by RN INCREASE
HOB-sit up
Massive PE TX: 02, IV LINE, Vasopressor therapy, Pulse ox-ABGs, Ecg, Blood Draw, Catheter, Iv
morphine or sedatives
Dx: Chest Xray, ECG, Pulse Ox, ABGs, V/Q scan- ventilation perfusion examining flow and blood
flow in lungs, Pul angiogram, D-dimer
Lab Normal Value Therapeutic Values
aPTT 25-35 seconds 45-70 seconds
Measures how long it takes your blood to 1.5-2.5 times higher
, Resp Acidosis,
DOES NOT
form a clot] speeds up the times and gives a
narrow range of what’s considered normal to
more tightly managed situation
PT 10- 13.5 seconds 1.5-2 times higher
[looks how fast blood clots]
PTT 60-70 seconds 1.5-2.5 times higher
[ How long it takes for blood to form a clot]
INR prothrombin time 0.8-1.2 Warfarin therapy: 2-3
[Time is takes for blood to form a clot] Blood clot: 2-3
Coronary Stent: 2.5-3.5
A Fib: 2-3
ARDS- ACUTE RESPIRATORY DISTRESS SYNDROME: fluid buildup
in air sac ”alveoli”, fluid keeps lung from filling w/ enough air. R SIDE,
RESPOND TO OXYGEN THERAPY, refractory hypoxemia-low 02 in blood. MEDICAL
EMERGENCY!
[Visual: alveoli goes from grape looking to raisin]
Risk Factors: Injury to lung, smoke inhalation, shock, trauma, pneumonia, sepsis, burns,
aspiration, inhaling chemicals
S&S: Severe SOB, Shallow Rapid labored breathing Tachypnea, Low BP, Confusion,
Severe Hypoxemia that does NOT respond so supplemental O2, crackles, air hunger breathing,
