418 CU5 PPT

• Pulmonary Embolism:

  • Obstruction of the base or one or more branches of the pulmonary arteries by a thrombus (or thrombi) – venous system or Right side of the heart
  • Massive pulmonary embolism is life-threatening, with death occurring 1 to 2 hours after the embolic event
  • Large or multiple blood clots can be fatal
• Pulmonary Embolism can damage the lung due to Restricted Blood Flow, Decrease Oxygen Levels in the Blood, and Affect Other Organs
• Clinical manifestations of Pulmonary Embolism:

  • Dyspnea (most common symptom)
  • Tachypnea (most frequent sign)
  • Chest pain (common, sudden in onset, pleuritic in nature, substernal – may mimic angina pectoris)
  • Other symptoms include fever, tachycardia, cough, diaphoresis, apprehension, clammy or bluish skin, hemoptysis, syncope, shock, and sudden death
• Virchow’s Triad for Pulmonary Embolism includes venous stasis, coagulation problems, and vessel wall injury
• Assessment and diagnostic methods for Pulmonary Embolism:

  • Ventilation-perfusion scan
  • Pulmonary angiography
  • Chest radiograph to rule out other disorders with the same presenting manifestations
  • Electrocardiogram to check for tachycardia, PR interval, and T-wave changes
  • Arterial blood gas (ABG) to assess hypoxemia
  • D-dimer test to detect clot fragments from clot lysis
• Medical management for Pulmonary Embolism:

  • Immediate objective is to stabilize the cardiorespiratory system
  • Treatments include nasal oxygen, IV infusion, insertion of indwelling urethral catheter, dobutamine or dopamine infusion, ECG monitoring, digitalis glycosides, diuretics, antiarrhythmic drugs, and blood tests
• Nursing management for Pulmonary Embolism:

  • Assessment includes identifying high-risk patients and monitoring for signs of hypoxia
  • Nursing interventions involve providing nebulizers, incentive spirometry, percussion or postural drainage, encouraging deep breathing exercises, ambulation, active and passive leg exercises, and more
• Acute Respiratory Distress Syndrome (ARDS):

  • Lung injury leading to noncardiogenic pulmonary edema
  • Clinical syndrome with inflammation and increased permeability of the alveolocapillary membrane
  • Risk factors include critically ill patients, age 60 years old and above, malignancy (lung cancer), cigarette smoking, and COPD
• Clinical manifestations of ARDS:

  • Rapid onset of severe dyspnea 12 to 48 hours after an initiating event
  • Intercostal retractions and crackles
  • Arterial hypoxemia
  • Hyperventilation, tachypnea, tachycardia
  • Severe cases may present with hypotension, cyanosis, and decreased urine output
• Medical management for ARDS involves:

  • Identifying and treating the underlying condition early
  • Preventing infection through intubation and mechanical ventilation
  • Using aggressive supportive treatment
  • Monitoring arterial blood gas values, pulse oximetry, and pulmonary function testing
  • Considering neuromuscular blocking agents like PANCURONIUM (Pavulon) and VECURONIUM (Norcuron) for easier ventilation
• In Acute Respiratory Failure, there are two types:

  • Type 1 (HYPOXEMIC): low oxygen levels, normal or low carbon dioxide levels, associated with acute diseases of the lungs like pulmonary edema, ARDS, and pneumonia
  • Type 2 (HYPERCAPNIC): low oxygen levels, high carbon dioxide levels, associated with pump failure, ventilatory failure, and conditions like drug overdose, neuromuscular disease, chest wall deformity, and COPD
• Virchow's triad includes factors that contribute to thrombosis: endothelial injury, stasis or turbulence of blood flow, and hypercoagulability

  
• Ventilator-Associated Pneumonia (VAP) develops 48 hours or later after the commencement of mechanical ventilation via endotracheal tube or tracheostomy

  
• Factors contributing to VAP include:

  • Colonization of pathogens on the lower respiratory tract and lung tissues
  • Intubation compromising the integrity of the oropharynx and trachea, allowing oral and gastric secretions to enter the airways
  • It is the most frequent post-admission infection
• Risk factors for VAP:

  • Immunocompromised status
  • Elderly age
  • Co-morbidities such as chronic illnesses
• Diagnosis of VAP includes:

  • Radiology to identify infiltrates
  • Clinical signs like fever (>38°C), raised or reduced white blood cell count, new-onset purulent sputum, increased respiratory secretions, and worsening gas exchange
• Management of VAP involves a care bundle approach for prevention, elevation of the head of the bed, sedation level assessment, oral hygiene, subglottic aspiration, monitoring tube cuff pressure, stress ulcer prophylaxis, and scoring the severity of pneumonia
• COVID-19 is caused by the SARS-CoV-2 virus, a new strain of coronavirus not previously identified in humans, with origins possibly from bats or pangolins
• Common symptoms of COVID-19 include fever, dry cough, and shortness of breath, while serious symptoms may include difficulty breathing, chest pain or pressure, loss of speech, and loss of movement
• Management of COVID-19 includes optimal supportive care, oxygen therapy for severely ill patients, advanced respiratory support like mechanical ventilation, pharmacologic therapy including dexamethasone, antiviral agents like remdesivir, tocilizumab, and others