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Ethics medical notes, Study notes of Medical ethics

Galen Health Institute - Tampa BayMedical ethics

Ethics medical surgical notes 2

Typology: Study notes

2024/2025

Uploaded on 06/25/2026

ashley-drew
ashley-drew 🇺🇸

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The lungs play a crucial role in the respiratory
system, serving several vital functions
essential for sustaining life.
Gas Exchange: They allow oxygen to enter the
blood while removing carbon dioxide, a waste
product of metabolism.
Regulation of Blood pH: the lungs help
maintain the acid-base balance, which is
critical for normal cellular functions.
Blood Filtration: The lungs also serve as a filter
for small blood clots that may form in the
veins, preventing them from reaching vital
organs such as the brain or heart.
Metabolic Functions: The lungs are involved in
various metabolic processes, including the
conversion of angiotensin I to angiotensin II, a
critical step in regulating blood pressure.
Pulmonary Embolism (PE)
A blockage in one of the pulmonary arteries in
the lungs, most commonly caused by blood
clots that travel from the legs or other parts of
the body. PE can be life-threatening, so early
diagnosis and treatment are crucial.
AMBULATION is the number one preventative
Signs and Symptoms of PE:
1. Sudden feeling of doom/hyperventilation -
Respiratory Alkalosis
2. Chest pain that may become worse with
deep breathing
3. Cough, sometimes with bloody sputum
4. Tachycardia (rapid heart rate)
5. Hypotension (low blood pressure)
6. Cyanosis (bluish skin)
Diagnostic
1. CT Pulmonary Angiography (GOLD
STANDARD)
2. Ventilation/Perfusion Scan
3. D-Dimer
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The lungs play a crucial role in the respiratory system, serving several vital functions essential for sustaining life. Gas Exchange: They allow oxygen to enter the blood while removing carbon dioxide, a waste product of metabolism. Regulation of Blood pH: the lungs help maintain the acid-base balance, which is critical for normal cellular functions. Blood Filtration: The lungs also serve as a filter for small blood clots that may form in the veins, preventing them from reaching vital organs such as the brain or heart. Metabolic Functions: The lungs are involved in various metabolic processes, including the conversion of angiotensin I to angiotensin II, a critical step in regulating blood pressure.

Pulmonary Embolism (PE)

A blockage in one of the pulmonary arteries in the lungs, most commonly caused by blood clots that travel from the legs or other parts of the body. PE can be life-threatening, so early diagnosis and treatment are crucial. AMBULATION is the number one preventative

Signs and Symptoms of PE:

  1. Sudden feeling of doom/hyperventilation - Respiratory Alkalosis
  2. Chest pain that may become worse with deep breathing
  3. Cough, sometimes with bloody sputum
  4. Tachycardia (rapid heart rate)
  5. Hypotension (low blood pressure)
  6. Cyanosis (bluish skin)

Diagnostic

  1. CT Pulmonary Angiography (GOLD STANDARD)
  2. Ventilation/Perfusion Scan
  3. D-Dimer

Medications

  1. Heparin IV- Must know the patients aPTT to titrate correctly-Therapeutic normally between 60-80seconds. Must know Antidote -Protamine Sulfate
  2. D/C home they will convert to Warfarin(Teach Vitamin K safety)- Must know the patients INR levels therapeutic (2-3).

Treatment

  1. Anticoagulation Therapy
    1. Thrombolytic Therapy
  2. Inferior Vena Cava Filter (High risk patients)-this prevents clots from traveling
  3. Embolectomy

Pneumothorax (Open/Closed)&

Hemothorax

Involve the presence of air or blood in the pleural space, respectively, which compromises lung expansion and can lead to respiratory distress. Signs & Symptoms:

  1. Closed Tension: Sharp chest pain
  2. Closed Tension: Decreased breath sounds
  3. Closed Tension: Tachycardia, LATE SIGN: Tracheal Deviation
  4. Open: Visible hole (sucking chest wound) Diagnostics
  5. Closed: Chest X Ray
  6. CT Medications
  7. Analgesics
  8. IV Fluids and Blood Treatment
  9. Closed: Thorocentesis-Needle Aspiration to remove fluid/blood
  10. Closed: Chest Tube
  11. Thoracotomy: If bleeding is significant
  12. Open: 3-sided non-occlusive dressing (e.g., Vaseline gauze or sterile plastic) is applied over the wound to create a "one-way valve." This allows air to escape but prevents further air entry.
  13. Open: Chest Tube

Chest Tube Care ALWAYS ON THE FLOOR

  1. Monitoring and Assessment: Regularly monitor the patient's vital signs and respiratory status. Assess the insertion site for signs of infection, such as redness, swelling, or discharge, and ensure the dressing is clean and intact.
  2. Drainage System Management: Ensure the drainage system is below the level of the chest to facilitate gravity drainage. Check the drainage chamber for the amount, color, and consistency of fluid, and record these observations regularly.
  3. Maintaining Tube Patency: Avoid any kinks or obstructions in the chest tube to maintain patency. Ensure the tube is securely attached to the drainage system and check for any air leaks by observing the water seal for continuous bubbling. Gentle tidaling in the Water Seal chamber is normal with inhalation/exhalation. NEVER should see bubbling in Air leak monitor.
  4. Patient Positioning: Position the patient to optimize lung expansion and drainage. Elevating the head of the bed and encouraging deep breathing exercises can help improve respiratory function and promote drainage.
  5. Emergency Protocols: Accidental dislodgement or a sudden increase in drainage output. Have supplies ready to clamp the tube if necessary. You should never be able to see Visability of the eyelets of the tube. NEVER STRIP the chest tube

Respiratory failure

is a serious condition where the respiratory system fails to adequately exchange gases, resulting in dangerously low oxygen levels (hypoxemia) or high carbon dioxide levels (hypercapnia). TYPES OF RESPIRATORY FAILURE TYPE I – HYPOXEMIC RESPIRATORY FAILURE Oxygen problem Key Feature PaO₂ < 60 mm Hg CO₂ is normal or low Common Causes ARDS Pneumonia Pulmonary edema Pulmonary embolism COVID- Atelectasis ABG Pattern ↓ PaO₂ Normal or ↓ PaCO₂ Possible respiratory alkalosis early (from tachypnea) Clinical Clues Severe dyspnea Restlessness, anxiety Tachypnea Cyanosis Use of accessory muscles

TYPE II – HYPERCAPNIC RESPIRATORY FAILURE

Ventilation problem Key Feature PaCO₂ > 45 mm Hg Often with hypoxemia Common Causes COPD exacerbation Drug overdose (opioids, sedatives) Neuromuscular disorders (ALS, GBS, MG) Chest wall deformities Obesity hypoventilation syndrome ABG Pattern ↑ PaCO₂ ↓ PaO₂ Respiratory acidosis (↓ pH unless compensated) Clinical Clues Hypoventilation Drowsiness Headache Confusion CO₂ narcosis Warm, flushed skin (late) EARLY vs LATE SIGNS EARLY SIGNS (PRIORITY) Restlessness Anxiety Tachypnea Tachycardia Mild hypoxemia LATE SIGNS (DANGER) Cyanosis Confusion Bradycardia Hypotension Decreased LOC Respiratory arrest

PRIORITY NURSING INTERVENTIONS (NCLEX

FAVORITE)

FIRST

Maintain airway Position in High-Fowler’s Apply oxygen therapy NEXT Continuous pulse oximetry Obtain ABGs Prepare for noninvasive ventilation (BiPAP/CPAP) Suction airway if needed IF DETERIORATION Prepare for endotracheal intubation Mechanical ventilation Collaborate with respiratory therapy

Intubation Process

Preparation

Ensure all necessary equipment is available

and functioning, including the endotracheal

tube (ET tube), laryngoscope, suction

apparatus, and oxygen supply.

Verify the patient's identity and explain the

procedure, if possible, to obtain informed

consent.

Position the patient in the "sniffing" position,

which involves aligning the ear with the sternal

notch to optimize visualization of the vocal

cords.

Pre-Oxygenation

Administer 100% oxygen to the patient for 3-

minutes to increase oxygen reserves and delay

desaturation during the procedure.

Use a non-rebreather mask or bag-valve-mask

(BVM) with a good seal to ensure effective pre-

oxygenation.

Medications

Administer sedative and paralytic agents as

prescribed to facilitate intubation and reduce

discomfort.

Common medications include sedatives like

midazolam or propofol and paralytics like

succinylcholine or rocuronium.

Ventilator Management in Advanced Respiratory Care

Ventilator Settings and Adjustments Don’t mess with the settings unless you have been properly trained on that particular Ventilator. Regularly assess and adjust ventilator settings based on the patient's needs and physician's orders. Parameters such as tidal volume, respiratory rate, and oxygen concentration should be customized to optimize patient ventilation and oxygenation. Assist Control (AC): Provides a set number of breaths and a set tidal volume. If the patient initiates a breath, the ventilator still delivers a full, preset tidal volume. Useful for patients needing full ventilatory support. Synchronized Intermittent Mandatory Ventilation (SIMV): Delivers a preset number of breaths with a set tidal volume. Allows the patient to take spontaneous breaths between the ventilator breaths without assistance. Often used in weaning because it encourages the patient to breathe independently. Tidal Volume (VT): The amount of air delivered with each ventilator breath, usually set between 6-8 mL/kg of ideal body weight. Lower tidal volumes are often used in ARDS to prevent lung injury. Respiratory Rate (RR): The number of breaths delivered by the ventilator per minute. Adjusted based on the patient’s oxygen and carbon dioxide levels. Fraction of Inspired Oxygen (FiO₂): The percentage of oxygen in the air mixture delivered to the patient. Usually starts at 100% for critically ill patients, then adjusted to maintain oxygen saturation levels between 90-94%. Positive End-Expiratory Pressure (PEEP): Pressure applied at the end of expiration to keep alveoli open and improve oxygenation. Range is 10-15 for damaged lungs. Inspiratory to Expiratory Ratio (I Ratio): Determines the duration of inspiration compared to expiration. Usually set at 1:2 (inspiration is half as long as expiration); can be adjusted in conditions like ARDS.

Ventilator Alarms High Pressure: PEEP INCREASING!!! LATE SIGN^ TRACHEAL DEVIATION

1.^ Blocked airway (Suctioning) 2.^ Biting tube 3.^ Kinks in tubing 4.^ Coughing 5.^ Tension Pneumothorax 6.^ Pulmonary Edema Assess the patient not the monitor and not the vent Low Pressure: NOT ENOUGH PEEP!!!

  1. Not getting enough air (in or out)
  2. Air leak in the cuff
  3. Disconnected tubing
  4. Patient not breathing