NUR 265 EXAM 2 STUDY GUIDE EXAM LATEST UPDATE
I I I I I I I I I
LungsIPhysiologyI●I2IPleural,I1IattachedItoIoutsideIofIlungsIandI1IattachedItoIinsi
deIofIribs.
● SpaceIbetweenItheI2IpleuralIisInegativeItoIatmosphere
● WhenIinhaleIbecomesImoreIpositiveIandIatmosphereImoreInegative.IExhalingIisIpassiveI
● MostIofIlowerIlobesIareIposterior,ImustIlistenItoIlungsIposteriorlyI
● BreathIsoundsIoIBronchial:IHighIpitchedI&Iloud,InormalIinItrachealI&Ilarynx
o Bronchovesicular:IModerateIpitchedI&Iamplitude,InormalIoverImajorIbronchi
o Vesicular:ILowIpitchedI&Isoft,IlikeIwindIthroughItrees,InormalIinIlowerIlungIfieldsIwhereIsmallerIbronchiolesII&Ialve
oliIare.
PulmonaryIEmboliI(PI603)I●IOcclusionIofIportionIofIpulmonaryIarteryIbyIaIbloodIclotI–IfromIvenousIcirculationI–
lowerIextremitiesIorIheart.
I
● CausesIventilation-perfusionImismatchI(V/Q)I–IVentilatedIalveoliInoIlongerIperfusedIdueItoIclottedIartery.
● RiskIFactorsIoIVenousIstasisI(w/prolongedIimmobility);ICentralIvenousIcatheters;ISurgeryI(NPO,Idehydrated,Iimmobilize
dIpts);IObesity;IAdvancedIage;IHypercoagulabilityI(PlateletsI>400KIandInotIenoughIfluids;IstickyIblood);IHxIofIthromboem
bolism.
o GreatestIr/fIinItheIyoungIisItheIcomboIofIsmokingIandIhormoneIbasedIcontraceptives.I
● NursingIAssessmentIFindingsIoIRespiratoryIClassicIManifestationsI(HypoxiaIdrivesIallIs/s)
▪IDyspneaI(suddenIonset);IChestIpainI(sharpI&Istabbing);IApprehension,Irestlessness;IFeelingIofIimpendingIdo
om;ICough;IHemoptysisI(bloodIinIsputum).
o RespiratoryISigns
▪IPleuralIfrictionIrubI(scratchingIsoundsIfromIpleuraIrubbingItogetherI&IpainIonIdeepIinspiration);ITachypnea;I
CracklesI(orInormal);IS3IorIS4;IDiaphoresis;ILowIgradeIfever;IPetechiaeIoverIchestIandIaxillae;IDecreasedIar
terialIoxygenIsaturationI(SaO2)
o ManyIptsIw/IaIPEIdoInotIhaveI“classic”IsxI(i.e.Ihypoxia),IbutIinsteadIhaveIvagueIsxIresemblingItheIfluI(n/vI&IgeneralI
malaise)
o CardiacIManifestations
▪IDecreasedItissueIperfusion:Itachycardia,IJVD,ISyncopeI(lossIofIconsciousness),ICyanosis,I&IHypotension.I
o InIpatientsIwithIr/fIforIPE,IJVDI(RSHF),IsyncopeI(decreasedIbloodIflowItoIbrain),IcyanosisI(severeIhypoxia)IandIhypot
ensionItogether,INEEDIRAPIDIRESPONSEITEAMICALLED.IHAVEIHELPIONIWAYIB4IO2IAPPLIED
o WhenIptIhasIsuddenIonsetIofIdyspnea,IchestIpain,Iand/orIhypotension,IimmediatelyInotifyIRapidIResponseI
Team.IReassureIpt.IandIelevateIHOB.IPrepareIforIO2ItherapyIandIABGIanalysisIoISaddleIEmboliI–
IIEmbolismIatIsplitIofIpulmonaryIarteryIthatIblocksIbothIbranchesItoItheIlungs
● MedicalIDx
o ChestIX-rayI–IMayIshowIPEIifIlargeIbutIwillIhelpIr/oIotherIthingsIoICTIscanI–IMostIoftenIusedItoIdxIPE
o TEEII(TransesophagealIEchocardiography)I–ISeeIifIthereIareIclotsIinItheIatriaIoIVentilationIPerfusionIscanI(V/Q)I
▪IConsideredIifIptIisIallergicItoIcontrastIdyeIdoneIw/CTIscan
▪IRadioactiveIsubstanceItoIseeIifIairIisIgettingIintoItheIalveoli;IinjectedIintoIbloodItoIlookIatIclotIandIcanIalsoIdete
ctIpneumothorax.IDoneI2x
o ABGs
PageI1IofI28
, ▪IRespiratoryIAlkalosisIFIRSTIfromIhyperventilationI▪ITHE
NIRespiratoryIAcidosisIfromIshunting
● ShuntingIofIbloodIfromItheIrightIsideIofItheIheartItoItheIleftIsideIw/oIpickingIupIO2IfromIlungsI–
IcausesIPaCO2IlevelItoIriseIresultingIinIrespiratoryIacidosis.
▪ILATERIMetabolicIAcidosisI&IlacticIacidIbuildupIfromItissueIhypoxia
▪IEvenIifIABGsI&IPulseIOxIshowsIhypoxemiaIitIisInotIenoughItoIdxIPEIaloneIasIPEIisInotItheIonlyIcauseIofIhypoxem
ia.II
● MedicalIManagementIoIGIVEIO2,IIVIFLUIDS,IINOTROPESI(DOBUTAMINE/MILRINONE)
▪IOxygenItherapyItoImaintainIO2IsatIatI95%IorIpatientIbaseline
▪IHypotensionI-
ITxIw/IIVIfluidsI(isotonic)I&IInotropesI(Dobutamine/Milrinone,ImakeIheartIcontractImoreIforcefully);Ivasop
ressorsI(norepi,Iepi,Idopamine)IwhenIhypotensionIpersistsIafterIfluids.
o AnticoagulationIw/IHeparinIdripI–IGoalIisIPTTI1.5-2.5IxInormalI(60-70Isec)I=I90-175IsecI
▪IMinimizeIgrowthIofIexistingIclotsIandIpreventInewIones
▪IAntidoteIProtamineISulfate
▪IDoInotIuseIw/salicylatesI(Aspirin)IoIConvertItoIWarfarinIwhenIstableI–
rd
IOnI3 IdayIofIHeparinIuse,IoverlapI–IINRItargetI2-3I(0.9-1.2Inormal)
▪IAntidoteI–IVitIKI–IphytonadioneI(Mephyton)II
▪ITeachIptsItoIavoidIfoodsIhighIinIKI(leafyIdarkIgreenIvegis,Iherbs,IspringIonions,IBrusselIsprouts,Ibroccoli,Icabba
ge,Iasparagus,Ipotatoes,I&IwinterIsquash).
o EnoxaparinIorIdalteparin
o FibrinolyticI(tPA)ItoItxImassiveIPEIorIhemodynamicIinstability
▪IAntidotesI–IclottingIfactors,IFFP,I&IaminocaproicIacidI(Amicar)
▪IDissolveItheIclotIitselfIoIEmbolectomyI–IsurgicalIremovalIofItheIembolusI–
IWhenItPAIcan’tIbeIusedIorIforImassiveIPEIw/shockIoIInferiorIVenaICavaIFilterI–
ItoIpreventIDVTsIfromImovingItoItheIlungsII
**BleedingIprecautionsIwithIallIbloodIthinnersIoIPreven
tIinjuryItoIptIonIanticoagulationItherapy
▪IUseIliftIsheet;IfirmIpressureIonIneedleIstickIforI10Iminutes;IApplyIiceItoItraumaIareas;IAvoidItraumaItoIrectalIti
ssues;InoIrazorI(electricIonly);Isoft-
bristledItoothbrush;INOIfloss;INotIblowInoseIforcefully;IshoesIwithIfirmIsoles;IAssessIIVIsitesIq4IhrsIforIblee
ding,ImeasureIabdIgirthIq8IhrsI–IinternalIbleeding
● NursingIManagementIoIMonitorIforIhypoxemiaI&IrespiratoryIcompromiseIeveryI1-2Ihrs.
▪IVS,IlungIsounds,IcardiacI&IrespiratoryIstatus,I&IurineIoutputI(bcIhypotensiveIcanIcauseIAKI)IoIEleva
teIHOBItoIhighIfowlersIifIBPItolerates.
o ObtainIvenousIaccessIandImonitorIheparinIdrip/LMWH/CoumadinIoIPainIandIanxietyImanagementIw/morphineI(
vasodilator)I–
st
IO2I1 IthenIotherIthingsIb4Imorphine.I▪ICommunicationIisIcriticalIinIallayingIanxiety.IAcknowledgeItheIanxietyI&IptI
perceptionIofIaIlifethreateningIsituation.IStayIwithIthem,IspeakIcalmly,IandIclearly,IprovidingIassurances.
o BleedingIprecautions,IoralIcareI–IespeciallyIifImouthIbreather.
● PreventionIMeasuresIoIMeasuresIthatIpreventIvenousIstasisIandIVTEIoIPassiveIandIactiveIROMIforIpostopI&Iimmobilized
Ipts
o Post-opIambulationIASAP
o SCDsIorIPlexipulseIcompressionI–IforIprevention,InotIforIactiveIDVTIoIPtIrepositioningIq2Ihrs
PageI2IofI28
, o LowIdoseIanticoagulantI&IantiplateletImedsIoISmokingIcessationI(especiallyIfemalesIonIhormoneIbasedIcontrace
ptives)IbcIincreasesIriskIforIDVTsIoITravelingI–
IdrinkIplentyIofIH2O,IchangeIpositions,IavoidIcrossingIlegs,IgetIupIandImoveIeveryI1hrIforI5Imin.
● NANDAIDiagnoses
o ImpairedIGasIExchange;IAcuteIPain,IAnxiety;IIRiskIforIBleedingI(whenIonItreatment)
PleuralIEffusionI(PI504-505)
● CollectionIofIfluidI(tooImuch)IinItheIpleuralIspaceI–
IclearItransudative,IorIexudativeI(outsideItheIlungs)IoICleatItransudativeI–IsimilarItoIfluidInormallyIpresentIinIpleuraIspace
o ExudativeI–IExcessIprotein,Iblood,IorIevidenceIofIinflammationIorIinfectionI(white,Igreen,IcloudyIisIbad)
● CanIcauseIpleurisyIsxIoIPleuralIfrictionIrub,IscratchingIsoundsIcausedIbyIinflamedIpleuraIrubbingItogether,IpainIonIdeepIi
nspiration.
● CausedIbyI–
IHFI(mediastinalIfluidIleaksIintoIpleuralIspace);ILiverIorIrenalIfailure;IInfections;IchestItraumaI(inflammationIresponse;Ism
ackIlungsIonIribsIinIMVA);ILymphaticIdestructionIbyIlungItumor;IPNA
● AssessmentIFindingsIoIDyspneaI(lungsIcan’tIexpand)
o DecreasedIorIabsentIlungIsoundsI(soundsIdoInotItransmitIthroughIfluidsIwell)
▪INOICRACKLESIBCIOCCURSIOUTSIDEITHEILUNGSIoIDul
lIflatIsoundIonIpercussionI(percussIbetweenIribs)
o DecreasedItactileIfremitusI(vibrationIofIchestIwallIproducedIwhenIptIspeaks)I–
IhandsIaroundIptIribsIoIChestIpainIw/respirationsIifIpleurisyIdevelops
● MedicalIManagementI
o ThoracentesisI–INeedleIaspirationIofIpleuralIspaceItoIremoveIfluidIforIsxIreliefI&IdxIofIcausativeIfactor.
▪IWantIfluidItoIbeIclear,IifIcloudyIorIanotherIcolor,IsendIcultureIforIcellIcounts.IoIRecur
rentIeffusionsImayIneedIchestItubeIw/closedIdrainageIuntilIsourceItxI
o SevereIcasesIcausedIbyIlungItumorsImayIneedIpleuralIstrippingIorIpleurodesisItoIcauseIpleuraItoIadhereItogetherIto
IpreventIfurtherIeffusions.
▪ICausesItheI2IpleuraItoISCARItogetherItoIdecreaseIinflammation,Ipain,IdecreasesIdyspneaI&IpleuritisI▪IPalliati
veIforIterminalIptsIonlyIforIpainIrelief.
o HeartImonitorIneeded
AcuteIRespiratoryIFailureI(PI610-612)
● SuddenIdeteriorationIofIgasIexchangeIfunctionIofItheIlungs
● VentilatoryIfailure,IoxygenationI(gasIexchange)Ifailure,IorIcomboIofIboth,IclassifiedIbyIabnormalIABGsI(pa)
● FailureIofItheIpulmonaryIsystemItoIcarryIoutIitsIownImajorIfunctionsIoIDeliveryIofIadequateIamountIofIO2ItoItheIarterialIb
loodI(paO2I<60Ihypoxemia)
o RemovalIofIcorrespondingIamountIofICO2IfromIbloodI(paCO2I>45IhypercapniaIANDIpHI<7.35Iacidemia)I●INOIMAT
TERITHEIPROBLEM,IPTIISIALWAYSIHYPOXEMICI(lowIarterialIbloodIO2Ilevels)
● PathophysiologyIoIVentilatoryIFailure
▪IBloodIflowI(perfusion)IisInormalIbutIAIRIMOVEMENTI(VENTILATION)IISIINADEQUATEI▪IToIlitt
leIO2IreachesIalveoliIandICO2IisIretained.I
▪IPhysicalIproblemsIofIlungsIorIchestIwall,IbrainIdefect,IpoorIrespiratoryImuscleIfunctionI–
IdiaphragmI▪IPaCO2I>45IANDIpHI<7.35I(acidemia)
PageI3IofI28
I I I I I I I I I
LungsIPhysiologyI●I2IPleural,I1IattachedItoIoutsideIofIlungsIandI1IattachedItoIinsi
deIofIribs.
● SpaceIbetweenItheI2IpleuralIisInegativeItoIatmosphere
● WhenIinhaleIbecomesImoreIpositiveIandIatmosphereImoreInegative.IExhalingIisIpassiveI
● MostIofIlowerIlobesIareIposterior,ImustIlistenItoIlungsIposteriorlyI
● BreathIsoundsIoIBronchial:IHighIpitchedI&Iloud,InormalIinItrachealI&Ilarynx
o Bronchovesicular:IModerateIpitchedI&Iamplitude,InormalIoverImajorIbronchi
o Vesicular:ILowIpitchedI&Isoft,IlikeIwindIthroughItrees,InormalIinIlowerIlungIfieldsIwhereIsmallerIbronchiolesII&Ialve
oliIare.
PulmonaryIEmboliI(PI603)I●IOcclusionIofIportionIofIpulmonaryIarteryIbyIaIbloodIclotI–IfromIvenousIcirculationI–
lowerIextremitiesIorIheart.
I
● CausesIventilation-perfusionImismatchI(V/Q)I–IVentilatedIalveoliInoIlongerIperfusedIdueItoIclottedIartery.
● RiskIFactorsIoIVenousIstasisI(w/prolongedIimmobility);ICentralIvenousIcatheters;ISurgeryI(NPO,Idehydrated,Iimmobilize
dIpts);IObesity;IAdvancedIage;IHypercoagulabilityI(PlateletsI>400KIandInotIenoughIfluids;IstickyIblood);IHxIofIthromboem
bolism.
o GreatestIr/fIinItheIyoungIisItheIcomboIofIsmokingIandIhormoneIbasedIcontraceptives.I
● NursingIAssessmentIFindingsIoIRespiratoryIClassicIManifestationsI(HypoxiaIdrivesIallIs/s)
▪IDyspneaI(suddenIonset);IChestIpainI(sharpI&Istabbing);IApprehension,Irestlessness;IFeelingIofIimpendingIdo
om;ICough;IHemoptysisI(bloodIinIsputum).
o RespiratoryISigns
▪IPleuralIfrictionIrubI(scratchingIsoundsIfromIpleuraIrubbingItogetherI&IpainIonIdeepIinspiration);ITachypnea;I
CracklesI(orInormal);IS3IorIS4;IDiaphoresis;ILowIgradeIfever;IPetechiaeIoverIchestIandIaxillae;IDecreasedIar
terialIoxygenIsaturationI(SaO2)
o ManyIptsIw/IaIPEIdoInotIhaveI“classic”IsxI(i.e.Ihypoxia),IbutIinsteadIhaveIvagueIsxIresemblingItheIfluI(n/vI&IgeneralI
malaise)
o CardiacIManifestations
▪IDecreasedItissueIperfusion:Itachycardia,IJVD,ISyncopeI(lossIofIconsciousness),ICyanosis,I&IHypotension.I
o InIpatientsIwithIr/fIforIPE,IJVDI(RSHF),IsyncopeI(decreasedIbloodIflowItoIbrain),IcyanosisI(severeIhypoxia)IandIhypot
ensionItogether,INEEDIRAPIDIRESPONSEITEAMICALLED.IHAVEIHELPIONIWAYIB4IO2IAPPLIED
o WhenIptIhasIsuddenIonsetIofIdyspnea,IchestIpain,Iand/orIhypotension,IimmediatelyInotifyIRapidIResponseI
Team.IReassureIpt.IandIelevateIHOB.IPrepareIforIO2ItherapyIandIABGIanalysisIoISaddleIEmboliI–
IIEmbolismIatIsplitIofIpulmonaryIarteryIthatIblocksIbothIbranchesItoItheIlungs
● MedicalIDx
o ChestIX-rayI–IMayIshowIPEIifIlargeIbutIwillIhelpIr/oIotherIthingsIoICTIscanI–IMostIoftenIusedItoIdxIPE
o TEEII(TransesophagealIEchocardiography)I–ISeeIifIthereIareIclotsIinItheIatriaIoIVentilationIPerfusionIscanI(V/Q)I
▪IConsideredIifIptIisIallergicItoIcontrastIdyeIdoneIw/CTIscan
▪IRadioactiveIsubstanceItoIseeIifIairIisIgettingIintoItheIalveoli;IinjectedIintoIbloodItoIlookIatIclotIandIcanIalsoIdete
ctIpneumothorax.IDoneI2x
o ABGs
PageI1IofI28
, ▪IRespiratoryIAlkalosisIFIRSTIfromIhyperventilationI▪ITHE
NIRespiratoryIAcidosisIfromIshunting
● ShuntingIofIbloodIfromItheIrightIsideIofItheIheartItoItheIleftIsideIw/oIpickingIupIO2IfromIlungsI–
IcausesIPaCO2IlevelItoIriseIresultingIinIrespiratoryIacidosis.
▪ILATERIMetabolicIAcidosisI&IlacticIacidIbuildupIfromItissueIhypoxia
▪IEvenIifIABGsI&IPulseIOxIshowsIhypoxemiaIitIisInotIenoughItoIdxIPEIaloneIasIPEIisInotItheIonlyIcauseIofIhypoxem
ia.II
● MedicalIManagementIoIGIVEIO2,IIVIFLUIDS,IINOTROPESI(DOBUTAMINE/MILRINONE)
▪IOxygenItherapyItoImaintainIO2IsatIatI95%IorIpatientIbaseline
▪IHypotensionI-
ITxIw/IIVIfluidsI(isotonic)I&IInotropesI(Dobutamine/Milrinone,ImakeIheartIcontractImoreIforcefully);Ivasop
ressorsI(norepi,Iepi,Idopamine)IwhenIhypotensionIpersistsIafterIfluids.
o AnticoagulationIw/IHeparinIdripI–IGoalIisIPTTI1.5-2.5IxInormalI(60-70Isec)I=I90-175IsecI
▪IMinimizeIgrowthIofIexistingIclotsIandIpreventInewIones
▪IAntidoteIProtamineISulfate
▪IDoInotIuseIw/salicylatesI(Aspirin)IoIConvertItoIWarfarinIwhenIstableI–
rd
IOnI3 IdayIofIHeparinIuse,IoverlapI–IINRItargetI2-3I(0.9-1.2Inormal)
▪IAntidoteI–IVitIKI–IphytonadioneI(Mephyton)II
▪ITeachIptsItoIavoidIfoodsIhighIinIKI(leafyIdarkIgreenIvegis,Iherbs,IspringIonions,IBrusselIsprouts,Ibroccoli,Icabba
ge,Iasparagus,Ipotatoes,I&IwinterIsquash).
o EnoxaparinIorIdalteparin
o FibrinolyticI(tPA)ItoItxImassiveIPEIorIhemodynamicIinstability
▪IAntidotesI–IclottingIfactors,IFFP,I&IaminocaproicIacidI(Amicar)
▪IDissolveItheIclotIitselfIoIEmbolectomyI–IsurgicalIremovalIofItheIembolusI–
IWhenItPAIcan’tIbeIusedIorIforImassiveIPEIw/shockIoIInferiorIVenaICavaIFilterI–
ItoIpreventIDVTsIfromImovingItoItheIlungsII
**BleedingIprecautionsIwithIallIbloodIthinnersIoIPreven
tIinjuryItoIptIonIanticoagulationItherapy
▪IUseIliftIsheet;IfirmIpressureIonIneedleIstickIforI10Iminutes;IApplyIiceItoItraumaIareas;IAvoidItraumaItoIrectalIti
ssues;InoIrazorI(electricIonly);Isoft-
bristledItoothbrush;INOIfloss;INotIblowInoseIforcefully;IshoesIwithIfirmIsoles;IAssessIIVIsitesIq4IhrsIforIblee
ding,ImeasureIabdIgirthIq8IhrsI–IinternalIbleeding
● NursingIManagementIoIMonitorIforIhypoxemiaI&IrespiratoryIcompromiseIeveryI1-2Ihrs.
▪IVS,IlungIsounds,IcardiacI&IrespiratoryIstatus,I&IurineIoutputI(bcIhypotensiveIcanIcauseIAKI)IoIEleva
teIHOBItoIhighIfowlersIifIBPItolerates.
o ObtainIvenousIaccessIandImonitorIheparinIdrip/LMWH/CoumadinIoIPainIandIanxietyImanagementIw/morphineI(
vasodilator)I–
st
IO2I1 IthenIotherIthingsIb4Imorphine.I▪ICommunicationIisIcriticalIinIallayingIanxiety.IAcknowledgeItheIanxietyI&IptI
perceptionIofIaIlifethreateningIsituation.IStayIwithIthem,IspeakIcalmly,IandIclearly,IprovidingIassurances.
o BleedingIprecautions,IoralIcareI–IespeciallyIifImouthIbreather.
● PreventionIMeasuresIoIMeasuresIthatIpreventIvenousIstasisIandIVTEIoIPassiveIandIactiveIROMIforIpostopI&Iimmobilized
Ipts
o Post-opIambulationIASAP
o SCDsIorIPlexipulseIcompressionI–IforIprevention,InotIforIactiveIDVTIoIPtIrepositioningIq2Ihrs
PageI2IofI28
, o LowIdoseIanticoagulantI&IantiplateletImedsIoISmokingIcessationI(especiallyIfemalesIonIhormoneIbasedIcontrace
ptives)IbcIincreasesIriskIforIDVTsIoITravelingI–
IdrinkIplentyIofIH2O,IchangeIpositions,IavoidIcrossingIlegs,IgetIupIandImoveIeveryI1hrIforI5Imin.
● NANDAIDiagnoses
o ImpairedIGasIExchange;IAcuteIPain,IAnxiety;IIRiskIforIBleedingI(whenIonItreatment)
PleuralIEffusionI(PI504-505)
● CollectionIofIfluidI(tooImuch)IinItheIpleuralIspaceI–
IclearItransudative,IorIexudativeI(outsideItheIlungs)IoICleatItransudativeI–IsimilarItoIfluidInormallyIpresentIinIpleuraIspace
o ExudativeI–IExcessIprotein,Iblood,IorIevidenceIofIinflammationIorIinfectionI(white,Igreen,IcloudyIisIbad)
● CanIcauseIpleurisyIsxIoIPleuralIfrictionIrub,IscratchingIsoundsIcausedIbyIinflamedIpleuraIrubbingItogether,IpainIonIdeepIi
nspiration.
● CausedIbyI–
IHFI(mediastinalIfluidIleaksIintoIpleuralIspace);ILiverIorIrenalIfailure;IInfections;IchestItraumaI(inflammationIresponse;Ism
ackIlungsIonIribsIinIMVA);ILymphaticIdestructionIbyIlungItumor;IPNA
● AssessmentIFindingsIoIDyspneaI(lungsIcan’tIexpand)
o DecreasedIorIabsentIlungIsoundsI(soundsIdoInotItransmitIthroughIfluidsIwell)
▪INOICRACKLESIBCIOCCURSIOUTSIDEITHEILUNGSIoIDul
lIflatIsoundIonIpercussionI(percussIbetweenIribs)
o DecreasedItactileIfremitusI(vibrationIofIchestIwallIproducedIwhenIptIspeaks)I–
IhandsIaroundIptIribsIoIChestIpainIw/respirationsIifIpleurisyIdevelops
● MedicalIManagementI
o ThoracentesisI–INeedleIaspirationIofIpleuralIspaceItoIremoveIfluidIforIsxIreliefI&IdxIofIcausativeIfactor.
▪IWantIfluidItoIbeIclear,IifIcloudyIorIanotherIcolor,IsendIcultureIforIcellIcounts.IoIRecur
rentIeffusionsImayIneedIchestItubeIw/closedIdrainageIuntilIsourceItxI
o SevereIcasesIcausedIbyIlungItumorsImayIneedIpleuralIstrippingIorIpleurodesisItoIcauseIpleuraItoIadhereItogetherIto
IpreventIfurtherIeffusions.
▪ICausesItheI2IpleuraItoISCARItogetherItoIdecreaseIinflammation,Ipain,IdecreasesIdyspneaI&IpleuritisI▪IPalliati
veIforIterminalIptsIonlyIforIpainIrelief.
o HeartImonitorIneeded
AcuteIRespiratoryIFailureI(PI610-612)
● SuddenIdeteriorationIofIgasIexchangeIfunctionIofItheIlungs
● VentilatoryIfailure,IoxygenationI(gasIexchange)Ifailure,IorIcomboIofIboth,IclassifiedIbyIabnormalIABGsI(pa)
● FailureIofItheIpulmonaryIsystemItoIcarryIoutIitsIownImajorIfunctionsIoIDeliveryIofIadequateIamountIofIO2ItoItheIarterialIb
loodI(paO2I<60Ihypoxemia)
o RemovalIofIcorrespondingIamountIofICO2IfromIbloodI(paCO2I>45IhypercapniaIANDIpHI<7.35Iacidemia)I●INOIMAT
TERITHEIPROBLEM,IPTIISIALWAYSIHYPOXEMICI(lowIarterialIbloodIO2Ilevels)
● PathophysiologyIoIVentilatoryIFailure
▪IBloodIflowI(perfusion)IisInormalIbutIAIRIMOVEMENTI(VENTILATION)IISIINADEQUATEI▪IToIlitt
leIO2IreachesIalveoliIandICO2IisIretained.I
▪IPhysicalIproblemsIofIlungsIorIchestIwall,IbrainIdefect,IpoorIrespiratoryImuscleIfunctionI–
IdiaphragmI▪IPaCO2I>45IANDIpHI<7.35I(acidemia)
PageI3IofI28
