Respiratory failure, ARDS, SARS, Pulmonary embolism
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What is Acute respiratory failure (ARF)?
- Previously called - Adult respiratory distress syndrome When 1 or both gas-exchange functions are inadequate Occurs when insufficient O2 is transported to the blood or inadequate CO2 is remove from the lungs and the client's compensatory mechanisms falls
- sudden and life-threatening
Chronic respiratory failure Vs. ARF
Chronic resp failure is deterioration in the gas exchange that has developed insidiously after episodes of ARF
Common causes of ARF are:
- decrease respiratory drive
- dysfunction of the chest wall
- dysfunction of the lung parenchyma ((functional tissue of an organ as distinguished)
- defect in the respiratory control center in the brain
- impairment in the function of the respiratory muscles
What are the 2 component of Acute Respiratory failure?
What is Hypoxemia?
- -Insufficinet O2 transferred to the blood or oxygen failure
- -Resulting in PaO2 < 60 mm Hg
- -SaO2 < 90%
Acute Hypoxemia & hypercapnia occur?
minutes to hours
Chronic Hypoxemia & hypercapnia occur?
several days or longer
Hypoxemic respiratory failure is most likely to occur in patient who has:
A massive pulmonary embolism
How to treat progressive Hypocemia?
PEEP (positive end-expiratory pressure)
What is hypercapnia?
- -Inadequate CO2 removal
- -Ventilatory failure
- -PaCO2 >45 mm Hg
- -pH <7.35
Manifestation of respiratory failure related to a sudden decrease in PaO2 or rapid increase in PaCO2 are:
- dysrhythmias - irrigular heart beat
- decrease LOC
- alteration in respirations and breathing sounds
- administer O2 to maintain PaO2 >60 to 70 mm Hg
- high Fowler's position
- deep breathing
- Administer broncodilators
- Prepair for mechanical ventilation if supplementary O2 cannot maintail acceptable PaO2 and PaCO2 levels
characteristics would NOT be indicative of acute respiratory failure (ARF)?
Hypocapnia - because AFR is characterizes by hypoxemia and Hypercapnia
What is Acute Respiratory Distress Syndrome (ARDS)?
- -A severe form of acute lung injury -Also a form of Acute Respiratory Failure (ARF) that occurs as a complication of some other condition. It is caused by a diffuse lung injury and leads to extra-vascular lung fluid
- -Sudden and progressive pulmonary edema
- -Bilateral lung infiltration on CXR
- -hypoxemia refractory to O2 therapy and decrease lung compliance
- -Alveoli collapse because of the inflammatory infiltrate, blood, fluid, and surfactant dysfunction
- --with ARDS, lungs filled with fluid becomme stiffer and dense like a wet sponge
- -fluid interferes lung’s to release CO2
What are ARDS symptoms
- rapid onset severe dyspnea
- hypoxemina that doesn't response to supplemental O2
ARDS major site of injury is?
Alveolar capillary membrane
Acute respiratory failure or (ARDS) Risk factor:
- develops in patient being treated for 1 previous causes
- No prediction
- Cigarette smokers
- people with Chronic lung disease
- Over 65 are more prone
What causes ARDS?
- Sepsis - fatal whole body inflammation caused by severe infection [Atelectasis(blockage if the air passage), aspiration,Infection, Pneumonia]
- fluid overload
- Shock - failure of O2 occurs in septic shock
- trauma - head
- neurological injuries
- disseminated intravascular coagulation
- drug overdose - legal or illegal
- Inhalation of toxic substance
- Hematologic disorders - massive transfusion and bypassAsthma, COPDPancreatic, uremia
- major surgery
- fat or air embolism
- lung and bone marrow transplant - prone to develop ARDS
In ARDS Interstitial edema causes what?
- obliteration(total dystruction) of the terminal airway
- all leads to reduce lung volume and compliance
ARDS ABG's test identify?
respiratory acidosis and hypoxemia that doesn't response to and increase percentage of oxygen
ARDS chest X-ray identify?
- Bilateral interstitial and alveolar infiltrates.
- Interstitial edema may not show until there is a 30% increase in fluid content
ARDS important assessments:
- Intercostal retraction (sucking breathing)
- Crackles and wheezing
- Acute onset respiratory distress - tachypnea, dyspnea, decrease breath sounds
- absence of CHF
- severe hypoxemia - high concentrations of delivered O2
- deteriorating (progressively worse) arterial blood gas level
- Pulmonary infiltrates
What are the Early signs (acute phase) of ARDS
- severe dyspnea, fast laboured breathing, and tachycardia - 12 to 40 hours after initial event
- Arterial hypoxemia doesn't responds to supplementary O2 - bluish fingernails, increase pulse, fever, chills, heachache, and dry cough
- Mild hypertension
- Chest X-ray -pulmonary edema
- increase alveolar dead space (stiff lungs, difficult to ventilate)
What is the late sign of ARDS?
ARDS patient requires?
- Mechanical ventilation with PEEP (positive end-expiratory pressure) to treat progressive hypoxemia
What are ARDS Intervention:
- -Place high fowler’s position
- -ABG test
- -Chest x-ray
- -Sputum/ blood cultures
- -V/Q lung scan-Pulmonary artery catheter (severe cases)
- -O2 administration-Positioning and coughing -Decrease anxiety-Administer diuretics, anticoagulants, or corticosteroids
- -prepair for mechanical ventilation with PEEP-restrict fluid intake
- -provide respiratory treatment
- -maintain PaO2 at 55 to 60 mm Hg or more
- -maintain SaO2 at 90% or more at the lowest O2 concentration possible
- **Mobilization of secretion
- -hydration and humidification
- -Chest physical therapy
- -Airway suction
What is Augmented Cough?
Perform by placing hand on the abdominal muscle below xiphoid. Pushing hand with force to help patient cough
What is Noninvasive PPV?
Positive-pressure ventilation (mask) that help decreasing the work of breathing
ARDS Drug therapies are?
- Bronchodilators – for broncho spasm
- Corticosteroid – for airway inflammation
- Diuretics nitrate – for pulmonary congestion
- IV antibiotics
- Vancomycin – for anxiety
- Ativan – for agitation
- Benzodiazepine – psychoactive
- Narcotics (morphine and phentinol/fenta;yn) – for pain
ARDS nutritional therapy
- extra caloric needs
ARDS medical support therapy
- treat underlying cause
- cardiac output
- hemoglobin concentration
ARDS age related conciderations
- decrease ventilatory capacity
- alveolar dilation
- larger air space
- loss of surfactant area
- diminished elastic recoil
- decrease respiratory muscles strength
- decrease chest wall compliance
- lifelong smoking
- Poor nutrition
A patient with severe chronic lung disease is hospitalized with respiratory distress. the nurse suspects rapid decompensation of the patient upon finding
Agitation and confusion
What is SARS (Severe Acute Respiratory Syndrome)?
A viral respiratory illness caused by a corona virus
SARS begins with?
- overall feeling of discomfort
- body aches
- mild respiratory symptoms - dry cough and dyspnea after 2-7 days
SARS prevention are:
- avoid contact with suspected of having SARS
- avoid travel to countries with outbreaks
- avoid close contact with crowds where SARS exist
- frequent hand washing
What is pulmonary Embolism?
- -An obstruction of pulmonary artery or branch by blood clot, air, fat, amniotic fluid or septic thrombus
- -Also occurs when a thrombus forms (most commonly in deep veins), detaches and travels to the right side of the heart and then lodges in a branch of the pulmonary artery
In pulmonary embolism, Most thrombi are blood clots from?
veins of the legs
Pulmonary embolism Obstructed area has diminished or absent blood flow, therefore?
This area is ventilated and no gas exchange takes place
Pulmonary Embolism Inflammatory process causes?
regional blood vessels and bronchioles to contrict, which increases pulmonary vascular resistance, pulmonary arterial pressure and right ventricular workload
What are the Risk factors of Pulmonary embolism?
- hypercoagulability or venous statis - slow blood flow in the vein
- venous indothelial disease
- diabetes mellitus
- oral contraceptive use
- constrictive clothing
- previous history of thrombophlebitis
- deep vein thrombosis
- underwent surgery
- prolong immobilize
- advance age
In Pulmonary Embolism, Fat emboli can occur as a complication after ____________?
fracture of a long bone which can cause pulmonary emboli.
Assessment for Pulmonary Embolism are?
- dyspnea - shallow respiration
- tachypnea and tachcardia
- hemoptysis - coughing up blood
- syncope - fainting or passing out
- chest pain
- crackles and wheezing
- distended neck vein
- feeling of impending doom or hypotension
- petechiae - is a small (1 - 2 mm) red or purple spot
What are the Pulmonary embolisms Interventions?
- death may occur within 1 hour
- V/Q scan - IV agent used
- D-dimer assay - blood test looking for clots
- Spiral CT scan - 3D imaging
- CXR - atelectasis ( blockage of the air passages)
- ECH - sinus tachycardia
- Arterial blood gas - hypoxemia and hypocapnea
- Pulmonary angiogram - best method to DXEarly ambulation or Exercise (AROM and PROM)
- Anticoagulant and thrombolytic therapy
- sequential compression devices (SCDs)
- Elevated HOB or semi-fowlers
- Prepair O2 administration
- obtain VS and check lung sounds
- Prepare heparin administration or embolectomy, placement of a vena cava filters
What is PT (Prothombin time)?
done to elevate the blood for its ability to clot for warfarin (coumadin) therapy
What is INR (International Normalized Ratio)?
used to make sure the results from a PT test is the same at one lab as it is at another lab
What is PTT ( partial Thromboplastin time)
performed primarily to determine if heparin (blood thinning) therapy is effective
Which of the following medication is available as the antidote for Coumadin?
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