Respiratory Flashcards
Acute Respiratory Failure
failure of the lungs to provide adequate V/Q, PAO2 <60 mm, PACO2 >50 mm, Ph <7.35
Causes of oxygenation failure
pneumonia, ARDS, HF, COPD, PE
Causes of Ventilation failure
CNS depression (drug overdose, head trauma, sleep apnea); Neuromuscular dysfunction (SCI, ALS, myasthenia gravis); Musculoskeletal dysfunction (Chest trauma)
Range of V/Q Relationships
A, Absolute shunt, no ventilation
due to fluid filling the alveoli.
B, V/Q mismatch, ventilation partially compromised by secretions in
the airway.
C, Normal lung unit.
D, V/Q mismatch, perfusion partially compromised by emboli
obstructing blood flow.
E, Dead space, no perfusion due to obstruction of the pulmonary capillary.
Early signs of ARF
restlessness, fatigue, headache, increased BP (non descript)
Late Signs
confusion, tachypnea, tachycardia, cyanosis, diaphoresis, use of accessory muscles
Medical and Nursing Management of ARF
Correct underlying cause, restore adequate gas exchange with intubation and mechanical ventilation
Lung assessment, ABGs, continuous pulse ox and VS, turning, mouth care, skin care, ROM, Communication, VAP bundles
Acute Respiratory Distress Syndrome
severe form of acute lung injury characterized by sudden, progressive pulmonary edema, increasing bilateral lung infiltrates visible on CXR, decreased lung compliance, occurs within 72 hrs of a precipitating event
Manifestations include rapid onset of severe dyspnea, and hypoxemia that does not respond to supplemental oxygen
Risk Factors for ARDs
Aspiration, drug ingestion and OD, Hematologic disorders, prolonged inhalation of high concentrations of oxygen, smoke or corrosive substances, localized infection, metabolic disorders, shock, trauma, major surgery, fat/ air embolism, sepsis
Med management for ARDs
intubation, mechanical ventilation with PEEP to keep alveoli open, identify and treat underlying condition, circulatory support, possibly ECMO
PEEP with ARDs
lower tidal volume, lower airway pressure, permissive hypercapnia, high PEEP, ensure gas exchange while limiting injury to vili
ARDs Nursing Management
Nutritional support (enteral perferred), prone positioning best (monitored by practitioners, extra care to face and ETT obstruction)
Management and monitoring of sedation and neuromuscular blocking agents
alarms, eye care, VTE prophylaxis, skin care, preventing foot drop, H2 blockers, TOF
Train of Four Monitor
peripheral nerve stimulator, assesses depth of neuromuscular blockade
ECMO
Extracorporeal membrane oxygenation- if it helps, think of it as dialysis for the lungs
Normals for pH
7.35-7.45
