acute resp failure

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Author:
jam110007
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286455
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acute resp failure
Updated:
2014-10-20 22:11:34
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acute resp failure
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medsurg resp exam 3
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acute resp failure
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  1. Normal Ventilation
    • Occurs through negative pressure ventilation
    • - Diaphragm contract (drops) More negative in lung vs. atmosphere
    • - Intercostal muscles move rib cage out
  2. Normal Respiration
    - Alveolar sac -Functional space – participates in gas exchange

    - Pulmonary - Diffusion of O2(binds w. Hgb) and CO2 across the alveolar membrane (300 million – tennis court)

    - Cellular/Tissue – diffusion of O2(released from Hgb) and CO2 across the cellular membrane
  3. Ventilation-Perfusion
    • - Total atmospheric pressure at sea level = 760 mm Hg
    • - O2 provide partial pressure of 160 mm Hg at sea level
    • - 21% ambient air
    • - Nares 160 mmHg
    • - Trachea 150 mm Hg
    • - Alveolar 100 mmHg
    • - Diffusion (High to Low)
    • - Need adequate PaO2 & perfusion VQ = 0.8
  4. CO2
    • - Is an ACID
    • - CO2 (70%)transported in plasma dissolved as HCO3
    • - CO2 (30%) transported bound to globin in RBC as Carbaminohemoglobin

    CO2 + H20 ↔ H2CO3 (carbonic acid)  ↔ HCO3 - + H+
  5. buffers
    • - bicarb 
    • - hemoglobin 
    • - plasma protein 
    • - phosphate
  6. Normal Breathing
    • - Respiratory Rate (RR) = 10 – 20 breaths per minute
    • - Effortless, Expiratory Pause
    • - Sigh breaths – important in alveolar expansion; Help with the movement of surfactant in the alveolar sac keeping them open and preventing them from collapsing

    • Tidal volume VT = 400-800 mL – depends on lung compliance
    • - VT a (alveolar level) = 250-650 mL
    • - VT d (dead space) = 150 mL

    • Minute Ventilation
    • - RR x VT = Minute Ventilation
    • - Normal = 5 – 8 Liters/Minute
  7. Type 1: resp failure
    • - Hypoxemia at the tissue level - decreased  PaO2
    • - Caused by a ventilation perfusion mismatch in the lung
    • - CO2 remains same
    • - TV and RR increase ( Minute ventilation) => increase of work of breathing (depend of accessory muscle) => lead to tired muscles and resp depression
  8. Type 1: resp failure common causes
    • Pneumonia
    • - Mucous prevents gas exchange

    • Pulmonary Edema
    • - Fluid prevents gas exchange

    • Atelectasis
    • - In the bases of the lungs to begin with creating more dead space not participating in gas exchange
  9. Type 2: resp failure
    • - Hypercapnemia increased PaCO2 with or without hypoxemia
    • - Caused by a reduction in amt of gas inhaled or exhaled over time
    • - HYPOventilation
    • - increase PaCO2 effects organs and cellular metabolism => Death
  10. Type 2: resp failure common causes
    decrease respiratory center (medulla oblongata) R/T sedatives/opiate use

    • Acute chest disease
    • - Asthma = Bronchoconstriction making it more difficult to release CO2
    • - Pneumonia
    • - COPD

    Spinal Injury

    • Neuromuscular disease
    • - Myasthenia Gravis
    • - Guillian BarreAirway obstruction

    Pneumo or hemothorax
  11. Respiratory Response with increased CO2
    increase CO2 => increased H+ => decreased pH => stimulates resp center => increased resp depth and rate (increase minute ventilation) => blow off CO2 => decrease in h+ => increase pH
  12. Patient Presentation
    • - Dyspnea
    • - Abnormal Breathing Patterns
    • - Hypo/Hyperventilation
    • - Cough
    • - Hemoptysis
    • - Cyanosis
    • - Pain
    • - Clubbing
  13. Dyspnea
    • - Air Hunger
    • - Altered ventilation & Gas Exchange

    • S&S
    • - Accessory muscle use
    • - Flaring of nostrils
  14. Dyspnea types
    • DOE - dyspnea on exertion 
    • - Pneumonia
    • - Altalectasis

    • Orthopnea
    • - Positional change affecting breath

    • PND - Peroxmisnal nocturnal Dyspnea 
    • - Comes and goes
    • - Sleep supine at night due to fluid overload
  15. Obstructed Breathing
    • - Acute -Chronic
    • - decrease VR
    • - Large VT in COPD
    • - increase effort
    • - Prolonged inspiration/expiratory phase
    • - Snoring/Wheezing/ Stridor
  16. Restricted Breathing
    • - Rapid VR – tachypnea
    • - Small VT
    • - decrease tissue compliance
    • - Caused by stiffing of the lung
    • - Example: Pulmonary Fibrosis (stiffening of lung tissues)
  17. Altered Breathing Patterns
    • - Kussmal (fast and deep)
    • - Cheyne-Stokes
    • - Biots – cluster breathing
    • - Agonal VR (3-4/min) irreg, VT - death
  18. Kussmal (fast and deep)
    • - Slight increase VR, VT large, no pause
    • - Cause: Exercise, Metabolic Acidosis (diabetes)
  19. Cheyne-Stokes
    Alternating deep/shallow with regular periods of apnea, Stroke, TBI, CHF
  20. Biots – cluster breathing
    Quick shallow respirations followed by irregular periods of apnea,  ICP
  21. Hypoventilation
    • - Hypercapnia PaCO2 >45 mm Hg
    • - decrease VR
    • - decrease Diaphragmatic Excursion
    • - decrease BECE (bilat equal chest expansion)
    • - decrease MV
    • - CNS effects:Lethargy, Somnolence, Obtunded (hard to arouse, not responding)
  22. Hyperventilation
    • - Hypocapnia PaCO2 < 35 mm Hg
    • - increase VR
    • - increase MV
    • - increase BECE
    • - increase Diaphragmatic excusion
    • - CNS effect:Lightheaded, Dizziness, Fainting, blowing off CO2
  23. Hemoptysis
    • Frothy pink – (L) CHF
    • - Fluid crosses over the alveolar membrane and mixes w/ surfactant, thin bubbly

    • Bright red, alkaline w/ sputum, maybe clots (coming from respiratory tract)
    • - Sig tracheal/bronchial irritation
    • - Lung CA

    If dark red, acidtic w/ food = vomitus (GI tract)
  24. Central Cyanosis
    • Decrease PaO2;
    • - O2 not binding to Hgb

    check Buccal mucous membranes, lips

    **Need adequate Hgb – is not present in pts w/ anemia
  25. sources of CO2 poisoning
    • –Gasoline engines in closed garages
    • –Blocked chimney
    • –Fuel-burning space heaters
    • –Propane
    • –Wood burning fires/fireplaces
    • –Improper venting
  26. CO2 Poisoning S&S: MILD
    • - SOB
    • - mild nausea
    • - mild headache
  27. CO2 Poisoning S&S: MODERATE
    • - Headache
    • - dizzy
    • - nausea,
    • - lightheaded
    • - confusion,
    • - unstable gait
  28. CO2 Poisoning S&S: SEVERE
    • - Seizure
    • - Unconsciousness
    • - Cardiopulmonary arrest
    • - Death
  29. CO2 Poisoning TX
    Fresh air, 100% O2, hyperbaric oxygen therapy
  30. Hypoxemia
    • - decrease PaO2
    • - Restless
    • - Confusion
    • - Impaired
    • - Judgment
    • - Dyspnea
    • - Hypotension
    • - Central Cyanosis
    • - Vasodilation = Dec. BP
  31. Hypercapnia
    • - increase Pa CO2
    • - Headache
    • - Lethary
    • - Reduced Concentation
    • - Irritability
    • - Hypertension
    • - Muscle twitching
    • - Obtunded
    • - Coma
    • - Vasoconstriction = inc. BP
  32. Cor Pulmonale
    - also known as right sided hear failure 

    - RV Failure R/T pulmonary restrictive, obstructive or vascular disorder

    - decrease PaO2 & increase PaCO2 => Acidosis => Pulmonary Vascular Resistance => Pulmonary HTN => Right Ventricular Hypertrophy => CHF

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