Mechanical Ventilation
Use of this leads to improved gas exchange and allows for lower concentrations of oxygen use.
What is PEEP?
Vessel Wall Injury, coagulation problems and venous stasis
What is Virchow's Triad?
Increased permeability in ARDS increases fluid accumulation in this area.
What are alveoli?
Major concern/side effect associated with the administration of thrombolytic therapy?
What is hemorrhage?
Administer oxygen, provide intubation, Provide mechanical ventilation.
What is the first line treatment for hypoxia?
At high PEEP levels >7.5 the nurse monitors for this complication.
What is pneumothorax?
Results from release of mediators at the injury site and from hypoxia
What is pulmonary vasoconstriction?
Patients often exhibit symptoms 24-48 hours after lung injury
What is white-out and respiratory distress signs?
Started with a bolus (weight based), continuous infusion adjusted every 4-6 hours (see protocol). Lab value maintained 1.5-2x normal value
Heparin Infusion
Device used in an attempt to prevent a PE from occuring in patients with a known venous thrombus or high risk for developing thrombus
What is a vena cava filter?
The addition of PEEP ventilatory mode may cause this to occur in ARDS patients.
What is decreased cardiac output?
Common diagnostic tools to diagnose PE.
What is XR, ABG, DS-Dimer, V/Q scan, Echocardiogram, CT scan, ECG findings
Improve/maintain oxygenation, maintain fluid/electrolyte imbalances, adequate nutrition, prevent respiratory/metabolic complications
What is the treatment for ARDS?
Thrombolic therapy used for patients who have had a major PE and those who present in shock and are hemodynamically unstable.
Streptokinase, Tenectaplase, urokinase, tissue plasminogen activator(t-PA).
Patient and family education for PE patients receiving anticogulant therapy.
What is explain, signs/symptoms/prevention of PE, Medication review with side effects and risks for bleeding, food/drug interactions, antiembolic leg hose, avoiding prolonged sitting.
Increased airway pressures, inflammation, and lung tissue distention.
What are common complications of mechanical ventilation?
Caused by the decrease in CO2 related to ventilation-perfusion mismatch.
What is bronchoconstriction?
First step in treatment of ARDS.
What is provide supplemental oxygen?
Medications used in thrombolic therapy reversal
Protamine Sulfate- Heparin
Vitamin K, FFP- Coumadin
Common arrhythmias that predispose a patient to thrombi formation.
What are atrial fibrillation and flutter?
Treatment used for patients with ARDS with refractory hypoxemia and who do not improve with other maximal respiratory care.
What is extracorporeal membrane oxygenation (ECMO)
Dyspnea
What is a classic clinical manifestation of PE?
When lung injury occurs this response stimulates neutrophil activation, macrophages and endotoxins. Causes increased alveolocapillary permeability and alveoli collapse.
What is inflammatory response?
Maintains tissue perfusion during periods of low cardiac output.
Dobutamine
Intervention that may improve oxygenation by decreasing atelectasis and edema. Requires many medical professionals to complete safely. Hemodynamic instability is a concern.
What is prone positioning?