Amores Reviewer Ko Gawa
Amores Reviewer Ko Gawa
Amores Reviewer Ko Gawa
Level 3 By Specialty
- It is a tertiary referral unit, capable of - Medical
managing all aspects of critical - Surgical
care medicine - Respiratory
- Has a medical director with - Neurosurgical
specialist critical/intensive care - Cardio-thoracic
qualification and a duty specialist - Trauma
available exclusively to the unit - Cardiac
and medical staff with an
appropriate level of experience By Specialty Operation
always present in the unit - Open System
- Patient ratio 1:1 for all critically ill - The admitting and other
patients attending doctors make
decisions without
consulting or
Critical Care Environment communicating with a
Critical Care Specialist.
CRITICAL CARE UNIT (CCU) - Closed System
- Also known as Intensive Care Unit - Patient care is provided by a
(ICU) or Intensive Treatment Unit dedicated ICU team that
(ITU)
includes a critical care Nurse practitioner, Clinical nurse
physician. specialist, Nurse researcher
- Ventilation - Gas
distribution into and out of
the pulmonary airways
1. SHUNTING Respiratory Distress
- Reduced causes Syndrome)
unoxygenated blood to
move from the right side of OXYGEN TRANSPORT
the heart to the left side of - Most oxygen collected in the lungs
the heart and into systemic binds with hemoglobin to form
circulation. oxyhemoglobin.
- Shunting may result from a - The portion of oxygen that dissolves
physical defect that allows in plasma can be measured as the
unoxygenated blood to partial pressure of arterial oxygen
bypass fully functioning (Pao2) in blood
alveoli. - Internal respiration occurs by
- airway obstruction prevents cellular diffusion when RBCs release
oxygen from reaching an oxygen and absorb the carbon
adequately perfused area of dioxide produced by cellular
the lung. metabolism.
- Common causes of shunting
include acute respiratory ACID-BASE BALANCE
distress syndrome (ARDS), Carbon dioxide is 20 times more soluble
atelectasis, pneumonia, than oxygen, it dissolves in the blood,
and pulmonary edema where most of it forms bicarbonate (a
base) and smaller amounts form carbonic
2. DEAD-SPACE VENTILATION acid
- reduced perfusion to a lung
unit - Acid-Base Controller
- alveoli don’t have adequate - The lungs control
blood supply for gas bicarbonate levels by
exchange to occur converting BICARBONATE
- Not all air that enters the to CARBON DIOXIDE AND
airway would reach the WATER for excretion. In
alveoli. response to signals from the
- The part of tidal volume that MEDULLA
does not participate in - In metabolic alkalosis,
alveoli gas exchange is which results from excess
called dead-space bicarbonate retention, This
ventilation. increases carbonic acid
levels.
3. SILENT UNIT - In metabolic acidosis, the
- combination of shunting and lungs increase the rate and
dead space ventilation depth of ventilation to exhale
- little or no ventilation and excess CO2, thereby
perfusion are present reducing carbonic acid
- Cases of pneumothorax and levels.
severe ARDS (Acute
- Inadequately functioning sickle cell anemia, heart
lungs can produce acid base disease, or chronic illness,
imbalances, For example, such as asthma or
hypoventilation results in emphysema.
carbon dioxide retention, - Determine whether the
causing respiratory patient lives with anyone
acidosis. who has infectious disease,
- hyperventilation leads to such as TB or influenza.
increased exhalation of - Lifestyle Patterns
carbon dioxide and causes - Ask about the px’s
respiratory alkalosis. workplace
- Also ask about the px’s
RESPIRATORY ASSESSMENT home, community and
other environmental
- HISTORY factors
- Build your patient’s health - Ask about the px’s sex
history by asking short, open habits and drug use
ended questions. - Current Health Status
- Respiratory disorders may - Begin by asking why your
be caused or exacerbated patient is seeking care
by obesity, smoking, and because many respiratory
workplace conditions so be disorders are chronic.
sure to ask about these - Ask how the patient’s latest
conditions. acute episode compares with
- Previous health status previous episodes
- Look at the patient’s health (compared to previous
history, being especially episodes) and what relief
watchful for: measures are helpful and
- A smoking habit unhelpful.
- Exposure to
secondhand smoke COMMON CHRONIC COMPLAINTS
- Allergies - Dyspnea
- Previous surgeries - Is commonly seen in patient
- Respiratory diseases with pulmonary or cardiac
such as pneumonia compromise
and tuberculosis (TB) - Assess your patient’s
- Ask about current shortness of breath, to rate
immunizations, such as a his usual level of dyspnea
FLU SHOT or by asking him from a scale
PNEUMOCOCCAL of 0 to 10
VACCINE. - Then ask him to rate his
- Family History current level of dyspnea.
- Ask the patient if he has a Other scales grade
family history of cancer, dyspnea as it relates to
activity, such as climbing a - Sputum Production
set of stairs or walking a city - A pulmonary illness often
block. results in the production of
- Grading dyspnea: sputum.
- Grade 0: not - Also ask these questions:
troubled by - color and consistency
breathlessness - Has it changed
except with strenuous recently (if chronic)?
exercise If so, how?
- Grade 1: troubled by - Do you cough up
shortness of breath blood? If so, how
when hurrying on a much and how often?
level path or walking - AMOUNT and COLOR of the
up a slight hill sputum produced in 24h
- Grade 2: walks more
slowly on a level - The color of the sputum
path (because of provides information about
breathlessness) than the infection
people of the same - YELLOW, GREEN,
age or has to stop to BROWN – signifies
breathe when walking bacterial infection
on a level path at his - YELLOW may occur
own pace (more eosinophils)
- Grade 3: stops to ALLERGY rather
breathe after walking than INFECTION
about 100 yards (91 - RUST COLORED
m) on a level path (yellow sputum mixed
- Grade 4: too with blood) – may
breathless to leave signify tuberculosis
the house or - MUCOID, VISCID or
breathless when BLOOD STREAKED
dressing or – often sign of a
undressing VIRAL INFECTION
- ORTHOPNEA - Persistent
- Refers to shortness of SLIGHTLY BLOOD
breath when lying STREAKED –
down present in patient with
- COUGH CARCINOMA
- frequent respiratory - Large amount of
symptom with CLOTTED BLOOD –
varying significance present in patient with
PULMONARY
INFARCT
- Chest pain for your nursing assessment.
- Chest pain due to a Don't assume the obvious.
respiratory problem - If you don't have time to go
- It may also be the result of through each step of the
indigestion. nursing process, make sure
- Less common causes of pain you gather enough data to
include rib or vertebral answer vital questions
fractures caused by - The FOUR STEPS for conducting a
coughing or osteoporosis. physical examination of the
respiratory system are: (IPPA)
- Sleep Disturbance 1. INSPECTION
- may be related to 2. PALPATION
obstructive sleep apnea or 3. PERCUSSION
another sleep disorder 4. AUSCULTATION
COMMON ABNORMALITIES
- Barrel chest
- result of overinflation of the
lungs, which increases the
anteroposterior diameter of
the thorax
- occurs with aging and is a
hallmark sign of
emphysema and COPD
- occurs as a result of COPD,
this is due to lungs that have
lost their elasticity.
- Pectus Carinatum (Pigeon chest)
- Sternum protrudes
- when there is a depression
in the lower portion of the
sternum
- May occur with rickets or
Marfan syndrome
- Thoracic kyphoscoliosis
- spine curves to one side
and the vertebrae are
rotated
- BIOT’S RESPIRATION
- Irregular pattern
characterized by varying
depth and rate of respirations
followed by periods of apnea.