MDC 4 Exam 2 1. Pulmonary embolism - Collection of particulate matter (solids, liquid or air) entering the venous system and lodges in pulm. vessels Can obstruct blood flow resulting in reduced gas exchange, reduced oxygenation, lung tissue hypoxia, decreased perfusion, and death 2. Fat emboli - Occurs with a fracture of femur. Does not impede blood flow but injures blood vessels and causes ARDS. 3. Nursing intervention for fat emboli - Immobilize injury to prevent from dislodging 4. PE s/s - Dyspnea, tachypnea, tachycardia, sudden pleuritic chest pain, dry cough, hemoptysis, distended neck veins, syncope, cyanosis, hypotension, abnormal heart sounds, abnormal ECG, sense of impending doom 5. PE ABGs - Resp. alkalosis initially due to anxiety, and then resp. acidosis PaO2 low, PaCO2 high 6. PE imaging - CT or pulmonary angiography 7. PE nursing interventions - High-fowlers, assess for bleeding, anticoagulants, BP compared on R and L arm, assess lung sounds 8. PE drug therapy and surgical management - Anticoagulants, fibrinolytics Embolectomy, inferior vena cava filtration 9. Acute respiratory failure (ARF) - inadequate gas exchange 10. Types of ARF - Ventilator failure, oxygenation failure (gas exchange), or both 11. ARF ABGs - PaO2 < 60 PaCO2 > 45 pH < 7.35 SaO2 < 90% 12. ARF - ventilatory failure definition - Air movement/intake is inadequate resulting in too little oxygen to the alveoli resulting in CO2 retention and hypoxemia 13. ARF - ventilatory failure causes - COPD, ARDS, PE, stroke, opioid use, sleep apnea, high cervical spinal cord injury, Guillain Barre, physical problems of lung or chest wall, defect in respiratory control center of the brain, poor function of respiratory muscles 14. ARF - oxygenation failure definition - Air moves in and out without difficulty, but does not oxygenate the blood sufficiently (no exchange at the alveoli) 15. ARF - oxygenation failure causes - Breathing air with low oxygen level, abnormal Hgb, pneumonia, CHF with pulmonary edema, ARDS, hypovolemic shock 16. ARF s/s - Dyspnea, orthopnea, change in resp rate/pattern, changes in lung sounds, decreased O2 saturation, acidosis per ABGs, elevated PaCO2 levels, restlessness, irritability, confusion, tachycardia, decreased LOC, headache, drowsiness 17. ARF meds - Nebulizers, inhalers, corticosteroids, diuretics, antibiotics (if infection) 18. ARF nursing interventions - Assist to comfortable position (upright if possible), relaxation, guided imagery, conserve energy, encourage deep breathing, IS 19. ARDS - ARF symptoms with hypoxia (even when given 100% oxygen), decreased lung elasticity, dyspnea, bilateral non-cardiac pulmonary edema, dense pulmonary infiltrates Poor surfactant in alveoli 20. ARDS causes - Post acute lung injury in people with no pulmonary disease as a result of sepsis, burns, pancreatitis, trauma, and transfusions