Adult Health 3 - ADVANCED
CLINICAL CONCEPTS
Acute Respiratory Distress Syndrome (ARDS)
Inadequate exchange of gas.
Characteristics:
1. Hypoxemia persists with 100% oxygen being given
2. Decreased pulmonary compliance
3. Dyspnea
4. NON-CARDIAC associated bilateral pulmonary edema
5. Dense pulmonary infiltrates on the radiography
-No Abnormal lung sounds because edema occurs first in the interstitial space, not the airways.
-ARDS is unexpected, catastrophic pulmonary complication with a person who has no previous
pulmonary problems. Patients are critically ill and in ICU. 50% mortality rate!
ARDS Interventions
Elevate HOB
Assist with daily awakening ("Sedation Holiday")
ORAL HYGEINE
Comprehensive mobilization program
Common causes of respiratory failure
1.Exacerbation of COPD
2. Pneumonia
3. TB
4. Contusion
5. Aspiration
etc. etc. etc.
DISSEMINTATED INTRAVASCULAR COAGULATION (DIC)
SHOCK
Assessing for Respiratory Failure
Dyspnea (hyperpnea, crackles, etc.)
Intercostal retractions
Cyanosis, pallor
*HYPOXEMIA*
Po2 <50mmHg FiO2 >60%
,Diffuse pulmonary infiltrates on chest radiograph: "White-out" appearance
Pt. Verbalizing anxiety, restlessness
Interventions for Respiratory Failure
SUCTION PATIENT ONLY SECRETIONS ARE PRESENT
-Elevate HOB
-monitor for hypoxemia
-monitor for breath sounds for Pneumthorax
-provide emotional support to decrease anxiety so the ventilator "work" the lungs
-Monitor ABGs
-Monitor LOC, F/E balance
ABG Box
Before drawing an ABG from the radial artery, perform the ALLLEN TEST:
-Make the clients hand blanch by obliterating both radio and ulnar pulses. Release pressure from Ulnar
only. If flow through the ulnar artery is good flushing will occur immediately. This is considered a
positive test and means that the radial artery can be used for puncture.
-If the test is negative repeat it on the other arm. If it is still negative then find another place to to do the
arterial puncture.
What is the blood values that indicates hypercapnia
PCO2 above 45
What PO2 value indicates respiratory failure in adults
Po2 below 60
What condition exists when the Po2 <50 and FiO2 >60%
Hypoxemia
List three symptoms of respiratory failure in adults
Dyspnea, tachypnea
intercostal and sternal retractions
Cyanosis
Severe Shock
this leads to widespread cellular injury and impairs the integrity of the capillary membranes. Fluid and
osmotic proteins seep into the extravascular space, further reducing cardiac output.
A viscous circle of decreased perfusion to all cellular level activities ensure. All organs are damaged,
and if perfusion problems persists, the damage can be permanent.
, All shock can lead to Systemic Inflammatory Response Syndrome (SIRS) and result in multiple organ
dysfunction syndrome (MODS)
Early sign of shock
agitation and restlessness resulting from cerebral hypoxia
Cariogenic Shock
If it presents in the presence of pulmonary edema (i.e. from pump failure) position client to reduce
venous return (high Fowler position with legs down) to decrease further venous return to the left
ventricle.
It is important to differentiate between hypovolemic and cariogenic shock. How might you determine
the existence of cardiogenic shock?
History of MI with left ventricular failure or possible cardiomyopathy, with symptoms of pulmonary
edema
If cardiogenic shock exists with the presence of pulmonary edema what do you do?
If cardiogenic shock exists with the presence of pulmonary edema, i.e., from pump failure, position
client to REDUCE venous return (HIGH FOWLER's with legs down) in order to decrease venous
return further to the left ventricle.
People at risk for Shock
1. very young and very old
2. Post MI
3. people with severe Dysrhythmia
4. Adrenocortical Dysfunction
5. History of recent hemorrhage or blood loss
6. Burn Victims
7. Serious Massive Infections
Types of Shock
1. Hypovolemic
external or internal blood or fluid loss
2. Cariogenic
Ischemia or impaired tissue perfusion resulting from MI, serious arrhythmia, or HF (Which all cause
decreased cardiac output)
3. Distributive Shock
(Anaphylactic, Neurogenic, and Septic)- Excessive vasodilation impairing distribution of blood flow.
a. Anaphylactic- (Allergic reaction). Acute or life threatening respiratory distress related to bronchial
constriction leading to airway obstruction; vascular collapse may follow.
CLINICAL CONCEPTS
Acute Respiratory Distress Syndrome (ARDS)
Inadequate exchange of gas.
Characteristics:
1. Hypoxemia persists with 100% oxygen being given
2. Decreased pulmonary compliance
3. Dyspnea
4. NON-CARDIAC associated bilateral pulmonary edema
5. Dense pulmonary infiltrates on the radiography
-No Abnormal lung sounds because edema occurs first in the interstitial space, not the airways.
-ARDS is unexpected, catastrophic pulmonary complication with a person who has no previous
pulmonary problems. Patients are critically ill and in ICU. 50% mortality rate!
ARDS Interventions
Elevate HOB
Assist with daily awakening ("Sedation Holiday")
ORAL HYGEINE
Comprehensive mobilization program
Common causes of respiratory failure
1.Exacerbation of COPD
2. Pneumonia
3. TB
4. Contusion
5. Aspiration
etc. etc. etc.
DISSEMINTATED INTRAVASCULAR COAGULATION (DIC)
SHOCK
Assessing for Respiratory Failure
Dyspnea (hyperpnea, crackles, etc.)
Intercostal retractions
Cyanosis, pallor
*HYPOXEMIA*
Po2 <50mmHg FiO2 >60%
,Diffuse pulmonary infiltrates on chest radiograph: "White-out" appearance
Pt. Verbalizing anxiety, restlessness
Interventions for Respiratory Failure
SUCTION PATIENT ONLY SECRETIONS ARE PRESENT
-Elevate HOB
-monitor for hypoxemia
-monitor for breath sounds for Pneumthorax
-provide emotional support to decrease anxiety so the ventilator "work" the lungs
-Monitor ABGs
-Monitor LOC, F/E balance
ABG Box
Before drawing an ABG from the radial artery, perform the ALLLEN TEST:
-Make the clients hand blanch by obliterating both radio and ulnar pulses. Release pressure from Ulnar
only. If flow through the ulnar artery is good flushing will occur immediately. This is considered a
positive test and means that the radial artery can be used for puncture.
-If the test is negative repeat it on the other arm. If it is still negative then find another place to to do the
arterial puncture.
What is the blood values that indicates hypercapnia
PCO2 above 45
What PO2 value indicates respiratory failure in adults
Po2 below 60
What condition exists when the Po2 <50 and FiO2 >60%
Hypoxemia
List three symptoms of respiratory failure in adults
Dyspnea, tachypnea
intercostal and sternal retractions
Cyanosis
Severe Shock
this leads to widespread cellular injury and impairs the integrity of the capillary membranes. Fluid and
osmotic proteins seep into the extravascular space, further reducing cardiac output.
A viscous circle of decreased perfusion to all cellular level activities ensure. All organs are damaged,
and if perfusion problems persists, the damage can be permanent.
, All shock can lead to Systemic Inflammatory Response Syndrome (SIRS) and result in multiple organ
dysfunction syndrome (MODS)
Early sign of shock
agitation and restlessness resulting from cerebral hypoxia
Cariogenic Shock
If it presents in the presence of pulmonary edema (i.e. from pump failure) position client to reduce
venous return (high Fowler position with legs down) to decrease further venous return to the left
ventricle.
It is important to differentiate between hypovolemic and cariogenic shock. How might you determine
the existence of cardiogenic shock?
History of MI with left ventricular failure or possible cardiomyopathy, with symptoms of pulmonary
edema
If cardiogenic shock exists with the presence of pulmonary edema what do you do?
If cardiogenic shock exists with the presence of pulmonary edema, i.e., from pump failure, position
client to REDUCE venous return (HIGH FOWLER's with legs down) in order to decrease venous
return further to the left ventricle.
People at risk for Shock
1. very young and very old
2. Post MI
3. people with severe Dysrhythmia
4. Adrenocortical Dysfunction
5. History of recent hemorrhage or blood loss
6. Burn Victims
7. Serious Massive Infections
Types of Shock
1. Hypovolemic
external or internal blood or fluid loss
2. Cariogenic
Ischemia or impaired tissue perfusion resulting from MI, serious arrhythmia, or HF (Which all cause
decreased cardiac output)
3. Distributive Shock
(Anaphylactic, Neurogenic, and Septic)- Excessive vasodilation impairing distribution of blood flow.
a. Anaphylactic- (Allergic reaction). Acute or life threatening respiratory distress related to bronchial
constriction leading to airway obstruction; vascular collapse may follow.
