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Rasmussen College: Week 5 _Chapter 32: Respiratory
Problems MDC 4 _Exam 2 Review _LATEST 2021
♢ Week 5 – Chapter 32: Respiratory Problems
1) Pulmonary Embolism (PE): collection of particulate matter that enters venous
circulation and lodges in the pulmonary vessels.
- Most PE occurs d/t inappropriate blood clotting forms a VTE (aka DVT)
- Clot breaks off and travels through the vena cava into the right side of the heart
• Risk Factors: dehydration, prolonged immobility/travel, central venous
catheters, Sx, obesity, advanced age, 𝖳 blood clotting, Hx of thromboembolism
- Smoking, pregnancy, estrogen therapy, HF, CVA, Ca (lung/prostate), trauma 𝖳 risk
for VTE/PE
• S/S: dyspnea, acute confusion, 𝖳 HR, pleuritic cx pain on inspiration
(sharp/stabbing). Tachycardia, distended neck vein, syncope, cyanosis,
hypotension, feeling of impending doom, hemoptysis
• Dx: CT pulmonary angiography (CT-PA) of the chest, D-dimer
• Inter: elevate HOB, O2 via NC, high-Fowler’s, telemetry, assess pulse, O2, LOC,
distended neck veins, ABGs, administer heparin/lovenox
2) 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
3) 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,
,2
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
, 3
- Hourly assessments: O2 sats, VS changes, indication of 𝖳 work of breathing,
cyanosis, pallor, retractions
- Laying prone to 𝖳 perfusion, institute PEEP (holds alveoli open)
4) 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, 𝖳 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
5) 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
- Perform mouth care q2h w/ chx, inspect mouth for sores
- Aseptic technic
• Preventing VAP: HOB at least 30º, suctioning, prevent aspiration
- Ulcer/DVT prophylaxis, pulmonary hygiene
Rasmussen College: Week 5 _Chapter 32: Respiratory
Problems MDC 4 _Exam 2 Review _LATEST 2021
♢ Week 5 – Chapter 32: Respiratory Problems
1) Pulmonary Embolism (PE): collection of particulate matter that enters venous
circulation and lodges in the pulmonary vessels.
- Most PE occurs d/t inappropriate blood clotting forms a VTE (aka DVT)
- Clot breaks off and travels through the vena cava into the right side of the heart
• Risk Factors: dehydration, prolonged immobility/travel, central venous
catheters, Sx, obesity, advanced age, 𝖳 blood clotting, Hx of thromboembolism
- Smoking, pregnancy, estrogen therapy, HF, CVA, Ca (lung/prostate), trauma 𝖳 risk
for VTE/PE
• S/S: dyspnea, acute confusion, 𝖳 HR, pleuritic cx pain on inspiration
(sharp/stabbing). Tachycardia, distended neck vein, syncope, cyanosis,
hypotension, feeling of impending doom, hemoptysis
• Dx: CT pulmonary angiography (CT-PA) of the chest, D-dimer
• Inter: elevate HOB, O2 via NC, high-Fowler’s, telemetry, assess pulse, O2, LOC,
distended neck veins, ABGs, administer heparin/lovenox
2) 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
3) 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,
,2
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
, 3
- Hourly assessments: O2 sats, VS changes, indication of 𝖳 work of breathing,
cyanosis, pallor, retractions
- Laying prone to 𝖳 perfusion, institute PEEP (holds alveoli open)
4) 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, 𝖳 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
5) 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
- Perform mouth care q2h w/ chx, inspect mouth for sores
- Aseptic technic
• Preventing VAP: HOB at least 30º, suctioning, prevent aspiration
- Ulcer/DVT prophylaxis, pulmonary hygiene
