COPD and PE
Explain chronic bronchitis vs emphysema
bronchitis: daily productive cough for 3 months or more. overweight, cyanotic, edema, rhonchi, wheezing. "blue bloaters"
emphysema: older, thin, severe dyspnea, quiet chest, xray with hyperinflation. "Pink puffers"
What is the goal for interventions for flail chest?
focused on treating hypoxemia via mechanical ventilation to both maintain a patent airway & have adequate pain management. very painful condition.
Where and how long can you clamp a chest tube?
As close to the chest as possible for less than 1 min.
A patient with ARDS shows a P/F ratio of 150. How is this classified?
a) Mild ARDS
b) Moderate ARDS
c) Severe ARDS
d) Normal oxygenation
b) Moderate ARDS
Rationale: A P/F ratio between 100-200 indicates moderate ARDS
Which intervention is most appropriate for respiratory alkalosis caused by hyperventilation?
a) Administer bronchodilators
b) Encourage slow, deep breathing
c) Increase FiO₂
d) Start sodium bicarbonate infusion
b) Encourage slow, deep breathing
Rationale: Slowing the respiratory rate helps retain CO₂, correcting respiratory alkalosis.
Where do most PEs come from?
Bonus 100: explain virchows triad.
DVTs
Virchow’s triad- puts patients at a higher risk for thromboembolism
Venous stasis, Hypercoagulability, Venous (endothelial) injury
What symptoms do you see with flail chest?
paradoxical movement of part of the chest wall, crepitus & hypoxemia
What is the indication for a thoracentesis?
pleural effusion
A nurse observes a client on mechanical ventilation developing sudden hypotension. The ventilator settings include PEEP of 15 cm H2O. What should the nurse suspect?
A. Hypovolemia
B. Barotrauma
C. Ventilator-associated pneumonia
D. Pulmonary embolism
B. Barotrauma
Rationale: High PEEP levels can cause barotrauma or tension pneumothorax, leading to hypotension from reduced venous return.
Which patient is at the highest risk for developing a pulmonary embolism?
a) A 50-year-old male with pneumonia
b) A 45-year-old female on birth control pills who recently had surgery
c) A 20-year-old athlete with a sprained ankle
d) A 70-year-old male with a history of asthma
b) A 45-year-old female on birth control pills who recently had surgery
Rationale: Surgery, immobility, and estrogen-containing medications increase the risk of thromboembolism.
What are long term effects of PEs?
Pulmonary HTN
Pulmonary infarction: can lead to alveolar necrosis, hemorrhage, pleural effusions, or abscesses
Right sided heart failure
A patient has a BP of 186/110, HR of 100, O2 of 89 on RA, RR of 23 and shallow. They report bilateral chest pain and severe anxiety and begin to cough up pink, frothy sputum. What is the suspected diagnosis of this patient?
Bonus 100: How would you treat it?
Flash pulmonary edema
Bonus 100: supplemental oxygen, IV diuretics, potentially mechanical ventilation & intubation
What happens if you remove too much fluid using a thoracentesis?
hypotension, hypoxemia, or re-expansion pulmonary edema
A nurse is caring for a client with ARDS who requires prone positioning. What is the primary goal of this intervention?
A. Reduce pulmonary edema
B. Improve perfusion to ventilated alveoli
C. Decrease FiO2 requirements
D. Facilitate secretion clearance
Answer: B. Improve perfusion to ventilated alveoli
Rationale: Prone positioning improves oxygenation by redistributing blood flow to better-ventilated lung areas.
What is the primary goal of mechanical ventilation in an asthmatic patient?
a) To increase tidal volume and respiratory rate
b) To prevent barotrauma and air trapping
c) To suppress the cough reflex
d) To increase oxygen saturation to 100%
b) To prevent barotrauma and air trapping
Rationale: Low tidal volumes and prolonged expiratory phases help prevent complications in mechanically ventilated asthma patients.
How do you diagnose a PE?
Bonus 100: What kind of patients can't handle this type of diagnostic and what would you use to diagnose them instead?
Gold standard is a spiral CT (CT angiogram/CTA) of the chest
Bonus: If patient is allergic to contrast or has kidney issues. VQ scan if pt cant handle contrast
Explain the difference between transudative and exudative pleural effusions.
transudative: full of protein poor fluid, caused by heart failure (increased hydrostatic pressure) and liver disease (hypoalbuminemia)
exudative: from inflammation (normally from infection) - usually an infective process accompanied by empyema (purulent fluid in pleural space)
Name the steps to take if a chest tube is removed on accident.
Cover site with sterile dressing with tape on 3 out of the 4 sides of the chest to allow air to escape if needed. Call a rapid and call RT. Stay with pt and monitor for respiratory distress.
A client with severe COPD is receiving BiPAP therapy. Which parameter indicates the therapy is effective?
A. Decreased respiratory rate
B. Increased FiO2 requirement
C. Reduced arterial pH
D. Elevated PaCO2 levels
A. Decreased respiratory rate
Rationale: BiPAP therapy improves ventilation, reduces the work of breathing, and decreases respiratory rate in clients with COPD exacerbations.
A nurse is assessing a patient with a tension pneumothorax. Which finding requires immediate intervention?
a) Absent breath sounds on one side
b) Tracheal deviation
c) Oxygen saturation of 92%
d) Complaints of chest pain
b) Tracheal deviation
Rationale: Tracheal deviation is a late and life-threatening sign of tension pneumothorax.
How do you treat a PE?
Anticoagulation therapy: Heparin/LMWH should be started immediately. Warfarin initiated in hospital alongside heparin tx and then outpatient. Vena cava filter, Thrombolytic therapy in severe cases, Embolectomy: Surgical removal of the clot, indicated when thrombolytic therapy is unsuccessful
A patient presents to the ED after a MVA. Their BP is 119/72 HR is 110, RR 24 shallow, and labored, O2 93 on 2L NC. Left lung sounds are absent and patient states sharp chest pain with that side. Their ABG levels show pH of 7.50, CO2 of 28, and bicarb of 24. What is your suspected diagnosis? How do you treat this patient?
Pneumothorax or hemothorax.
Immediate chest tube insertion, watch respirations, manage pain.
Name the 3 parts of a chest tube and what should be happening in each part.
Suction ctrl chamber. gentle, steady, continuous bubbling. indicates a good amount of suction that is happening
Water seal chamber: tidaling - steady flow of water goes up and down. indicates good negative pressure. tidaling should decrease as the lung reinflates. continuous bubbling indicates an air leak.
Collection chamber: shows color and amount of drainage. Don't want more than 100 ml/hr of drainage (notify provider)
Which nursing action helps prevent ventilator-associated pneumonia (VAP) in an intubated patient?
a) Suctioning every hour
b) Maintaining the head of the bed at 30-45 degrees
c) Administering antibiotics prophylactically
d) Changing ventilator tubing daily
b) Maintaining the head of the bed at 30-45 degrees
Rationale: Elevating the head reduces the risk of aspiration, a major cause of VAP.
A patient with flail chest is experiencing respiratory distress. Which action should the nurse take first?
a) Prepare for intubation
b) Apply an abdominal binder
c) Encourage deep breathing
d) Administer bronchodilators
a) Prepare for intubation
Rationale: Flail chest can cause severe respiratory distress requiring mechanical ventilation.