Respiratory
Diagnostic Tests and Interventions
• Assessment: IPPA (inspection and auscultation are the most important)
• Pulse Oximetry: Assessment of oxygen sat with a probe
• Chest x-ray (cxr): Clinical diagnostic- pneumonia, ARDS,
• Sputum collection: Obtained through ET tube by suction or by expiration by pt
• Bronchoscopy
Clinical diagnostic- can be done at bedside or in specialty unit (broch suit) or special
Probe with light and camera that can take biopsy
Can be done in pt with severe pulmonary congestions from fluid or infection (COVID 19 pt
• Thoracentesis: Bedside procedure where DR goes in with needle and drains the pleural space
• Arterial blood gas (ABG)
Can be obtained by RN but usually done by RT
Blood sample from radial artery, femoral artery, for men a penile blood gas can be obtained
• Think about clinical indications- obtained informed consent
Flail chest
What is it?
• Occur when there is an impaired integrity of chest wall, usually due to blunt force trauma
• MEDICAL EMERGENCY
• Defined by: two rib fracture with two or more fractures per rib with loss of chest wall stability
Assessment Findings
• Cyanotic, agonal breathing
• Paradoxical Respirations- looks like wave in chest
• Pt c/o Severe Pain in the Chest
• Dyspnea
• Cyanosis
• Tachycardia- heart is trying to compensate
• Hypotension
• Tachypnea
• Diminished Breath Sounds over affected side
• Palpation for crepitus near rib fractures
• Impaired integrity of the chest wall. Respiratory distress, maybe associated with hemothorax,
pneumothorax, pulmonary contusion
Intervention
• Fowler’s Position- HOB 15- 45 degrees
• Administer Oxygen
,• Monitor for increased Respiratory Distress- what did pt look like when you walked into the room, has
it changed?
• Encourage Coughing and Deep Breathing- helps decrease risk of pneumonia or infection
• Administer Pain Medications- if pain isn’t properly managed pt will not breath the best they can
• Maintain bedrest and limit activity
• Prepare for intubation with mechanical ventilation- pt that need it are pt who have a weak heart, the
heart thinks that the blood does not have enough oxygen
• Stabilize flail segment with positive pressure ventilation (intubation and mechanical ventilation).
Treat associated injuries. Possible surgical fixation
Pulmonary Embolism
What is it?
• occurs when a blood clot gets lodged in an artery in the lung, blocking blood flow to part of the lung.
• Blockage of 1 or more pulmonary arteries by a thrombus, at, or air embolus, or tumor tissue
• A PE consists of material that gains access to the venous system and then to the pulmonary
circulation. The embolus travels with blood flow through ever- smaller blood vessels until it lodges
and obstructs perfusion of the alveoli
• Most PE arise from DVT
ASSESSMENT FINDINGS
• Dyspnea exacerbated by inspiration
• Small PE: may go undetected or have vague symptoms
• Massive PE: change in LOC, hypotension, and feeling of impending doom
• Restlessness
• Blood-Tinged Sputum
• Chest Pain
• Cough
• Crackles & Wheezes
• Cyanosis
• Distended Neck Veins
• Shallow Respirations
• Tachypnea
• Tachycardia
• Petechiae in the axilla when the obstruction occurs-- caused by decreased oxygen in the blood. RBC
die
• Purple from the nipple line up
Complications
• About 10% of pt with a massive PE die within the first hour
, • Pulmonary infarction: occlusion of a large or medium sized pulmonary vessel, insufficient collateral
blood flow form bronchial circulation, or preexisting lung disease. Infarction results in alveolar
necrosis and hemorrhage
• Pulmonary hypertension: results from hypoxemia or from involvement of more than 50% of the area
of the normal pulmonary bed
Diagnostics
• D-dimer: a lab test that measure the amount of cross linked fibrin fragments, which are the result of
clot degradation and are rarely found in healthy people. Test is not specific or sensitive
• Spiral CT: most common, an injection of contrast media is needed to view the pulmonary blood
vessels. This allows visualization of all anatomic regions of the lungs
• ABGs: are important but not diagnostic. PaO2 may be low because of inadequate oxygenation. Ph is
often normal unless respiratory alkalosis develops because of prolong hyperventilation or to
compensate
Interventions
• Recognize signs early- does pt have a feeling of impending doom
• Notify Rapid Response Team- MET team
• Reassure the Patient- pt is very scared when this happens
• Elevate the HOB
• Prepare to give oxygen
• Obtain VS & document
• assess Lung Sounds
• NOTIFY RT/obtain ABG
• Start preparing for possible interventions
Heparin therapy given continuously through IV, embolectomy done in special procedures
(obtained informed consent), vena cava filter (placed after the initial insult (pulmonary
embolism) is resolved))
Vena cava filter- treatment of choice for pt whom anticoagulation therapy is
contraindicated. The device is place percutaneously through the femoral vein, is
placed at the level of the renal veins in the inferior vena cava. The filter prevents
migration of large clots into the pulmonary system
EKOS- machine that goes at bedside, TPA or heparin can run through it, cath is placed
directly where clot is and aims thrombolytics directly at clot
Frequent lab testing and assessment is required, PT in ICU
Assessment is the deciding factor for what interventions will take place
• Monitor hgb and monitor pt for bleeding. Monitor activated PTT and INR ratios
• Pulmonary embolectomy in life threatening situations
• Drug therapy
Diagnostic Tests and Interventions
• Assessment: IPPA (inspection and auscultation are the most important)
• Pulse Oximetry: Assessment of oxygen sat with a probe
• Chest x-ray (cxr): Clinical diagnostic- pneumonia, ARDS,
• Sputum collection: Obtained through ET tube by suction or by expiration by pt
• Bronchoscopy
Clinical diagnostic- can be done at bedside or in specialty unit (broch suit) or special
Probe with light and camera that can take biopsy
Can be done in pt with severe pulmonary congestions from fluid or infection (COVID 19 pt
• Thoracentesis: Bedside procedure where DR goes in with needle and drains the pleural space
• Arterial blood gas (ABG)
Can be obtained by RN but usually done by RT
Blood sample from radial artery, femoral artery, for men a penile blood gas can be obtained
• Think about clinical indications- obtained informed consent
Flail chest
What is it?
• Occur when there is an impaired integrity of chest wall, usually due to blunt force trauma
• MEDICAL EMERGENCY
• Defined by: two rib fracture with two or more fractures per rib with loss of chest wall stability
Assessment Findings
• Cyanotic, agonal breathing
• Paradoxical Respirations- looks like wave in chest
• Pt c/o Severe Pain in the Chest
• Dyspnea
• Cyanosis
• Tachycardia- heart is trying to compensate
• Hypotension
• Tachypnea
• Diminished Breath Sounds over affected side
• Palpation for crepitus near rib fractures
• Impaired integrity of the chest wall. Respiratory distress, maybe associated with hemothorax,
pneumothorax, pulmonary contusion
Intervention
• Fowler’s Position- HOB 15- 45 degrees
• Administer Oxygen
,• Monitor for increased Respiratory Distress- what did pt look like when you walked into the room, has
it changed?
• Encourage Coughing and Deep Breathing- helps decrease risk of pneumonia or infection
• Administer Pain Medications- if pain isn’t properly managed pt will not breath the best they can
• Maintain bedrest and limit activity
• Prepare for intubation with mechanical ventilation- pt that need it are pt who have a weak heart, the
heart thinks that the blood does not have enough oxygen
• Stabilize flail segment with positive pressure ventilation (intubation and mechanical ventilation).
Treat associated injuries. Possible surgical fixation
Pulmonary Embolism
What is it?
• occurs when a blood clot gets lodged in an artery in the lung, blocking blood flow to part of the lung.
• Blockage of 1 or more pulmonary arteries by a thrombus, at, or air embolus, or tumor tissue
• A PE consists of material that gains access to the venous system and then to the pulmonary
circulation. The embolus travels with blood flow through ever- smaller blood vessels until it lodges
and obstructs perfusion of the alveoli
• Most PE arise from DVT
ASSESSMENT FINDINGS
• Dyspnea exacerbated by inspiration
• Small PE: may go undetected or have vague symptoms
• Massive PE: change in LOC, hypotension, and feeling of impending doom
• Restlessness
• Blood-Tinged Sputum
• Chest Pain
• Cough
• Crackles & Wheezes
• Cyanosis
• Distended Neck Veins
• Shallow Respirations
• Tachypnea
• Tachycardia
• Petechiae in the axilla when the obstruction occurs-- caused by decreased oxygen in the blood. RBC
die
• Purple from the nipple line up
Complications
• About 10% of pt with a massive PE die within the first hour
, • Pulmonary infarction: occlusion of a large or medium sized pulmonary vessel, insufficient collateral
blood flow form bronchial circulation, or preexisting lung disease. Infarction results in alveolar
necrosis and hemorrhage
• Pulmonary hypertension: results from hypoxemia or from involvement of more than 50% of the area
of the normal pulmonary bed
Diagnostics
• D-dimer: a lab test that measure the amount of cross linked fibrin fragments, which are the result of
clot degradation and are rarely found in healthy people. Test is not specific or sensitive
• Spiral CT: most common, an injection of contrast media is needed to view the pulmonary blood
vessels. This allows visualization of all anatomic regions of the lungs
• ABGs: are important but not diagnostic. PaO2 may be low because of inadequate oxygenation. Ph is
often normal unless respiratory alkalosis develops because of prolong hyperventilation or to
compensate
Interventions
• Recognize signs early- does pt have a feeling of impending doom
• Notify Rapid Response Team- MET team
• Reassure the Patient- pt is very scared when this happens
• Elevate the HOB
• Prepare to give oxygen
• Obtain VS & document
• assess Lung Sounds
• NOTIFY RT/obtain ABG
• Start preparing for possible interventions
Heparin therapy given continuously through IV, embolectomy done in special procedures
(obtained informed consent), vena cava filter (placed after the initial insult (pulmonary
embolism) is resolved))
Vena cava filter- treatment of choice for pt whom anticoagulation therapy is
contraindicated. The device is place percutaneously through the femoral vein, is
placed at the level of the renal veins in the inferior vena cava. The filter prevents
migration of large clots into the pulmonary system
EKOS- machine that goes at bedside, TPA or heparin can run through it, cath is placed
directly where clot is and aims thrombolytics directly at clot
Frequent lab testing and assessment is required, PT in ICU
Assessment is the deciding factor for what interventions will take place
• Monitor hgb and monitor pt for bleeding. Monitor activated PTT and INR ratios
• Pulmonary embolectomy in life threatening situations
• Drug therapy
