NR_341 Exam Preparation Summary

NR_341 Exam Preparation Summary Acute respiratory failure  Diagnostic Tests o ABGs, Chest x-rays, CT, pulmonary function tests, end tidal CO2 monitoring, bronchoscopy.  Assessments o Lung sounds, work of breathing, use of accessory muscles, chest expansion, nasal flaring, respiratory rate, pulse ox  Interventions o Ineffective airway clearance reposition patient o ARF  Causes: pulmonary edema, atelectasis, pneumonia, COPD, asthma, ARDS, thoracic, spinal or head injuries, drug overdose, neuromuscular disorders  Type 1 - hypoxemic or oxygenation failure  PAO2 less th  an 60 MMHG o Normal PaO2 = 80 - 100  Hypoventilation o Hyperventilation causes further issues when trying to correct this  Intrapulmonary shunting o Blood did not get oxygenated and dispersed to rest of body system o Blood that is shunted from the right side of the heart to the left without oxygenation. o Based on rate ventilation and perfusion: Rate of ventilation= rate of perfusion; ratio of VQ = 1 o Based on amount of ventilation and perfusion:  Normal ventilation (V) IS 4 L/MIN  Normal perfusion (Q) IS 5L/Min  Normal V/Q Ratio IS 4/5 or 0.8  VQ scan patient must lie for 30 minutes o Tissue hypoxia anaerobic metabolism and lactic acidosis o Normal Cardiac output  600 – 1000 ML/MIN of O2  Low cardiac output decrease O2 blood to tissues anaerobic metabolism production of lactic acid metabolic acidosis  Type 2 - hypercapnic or ventilator failure  PACO2 > 50 MM HG  Increase in PaCO2 (hypercapnia) due to decrease O2 in body and CO2 can be blown off  Increase in ventilation excess CO2 blown off (hypocapnia)  VQ mismatch not 1:1  Assessment of respirator failure: most common hypoxemia restlessness  Medical management: O2, bronchodilators, corticosteroids, ventilators, transfusion, nutritional support, hemodynamic monitoring 2  HGB 12- 16  Anemic is less than 8 HGB o Respiratory failure causes  Failure to ventilate  Failure to oxygenate  Failure to protect airway Acute Respiratory Distress Syndrome (ARDS)  Noncardiogenic pulmonary edema- pulmonary edema not caused by a cardiac problem.  Diagnostic criteria o 1. PaO2/FiO2(decimal) ratio of less than 200 – PaO2 divided by Fi02 … 100 divided 21 =  Optimal Ratio 476.19  ***Decreasing PA02 levels despite increased FIO2 administration o 2. Bilateral infiltrates not explained by something else. (Normally air should be black, you will see white puffy stuff all over if you have this)  Risk Factors. 4 Factors o Sepsis #1*** o Pneumonia o Trauma o Aspiration of Gastric contents  Pathophysiology o Basic underlying patho: damage to type II pneumocyte, which produces surfactant o 4 steps  1. Injury to the lung that stimulates the inflammatory response (either direct or indirect) with stimulates inflammatory response. Inflammatory cells and their mediators damage the alveolocapillary membrane.  2. Onset of pulmonary edema (blood cell, cell debris, stuff)  3. Alveoli start to collapse. Production of surfactant stop and alveoli collapse. Lungs become less compliant.  4.Lungs become stiff and noncompliant. Lung becomes fibrotic. Severe gas exchange impairment.  Diagnostic Tests o Chest x-ray  Symptoms or ARDS: o Dyspnea and tachypnea and hypoxemia, that does not improve with supplemental oxygen therapy. o Elevated PACO2 > 50 MM of HG o Decreased PAO2 < 60 MM of HG o V/Q mismatch o O2 Satureation < 90% o Hyperventilation with normal breath sounds o Respiratory alkalosis o Increased temperature and pulse o Worsening chest x-rays that progress to “white out” o Increased PIP on ventilation o Eventual severe hypoxemia not improved with O2 therapy o Late stages -> Eventually will hypoventilate -> respiratory acidosis 3  Treatment of ARDS o Treat the cause, more supportive care o Oxygenation and ventilation**KEY to treating ARDS  Positive end-expiratory pressure (PEEP) – high amounts of PEEP 10-15cm of peep.  Possible non-traditional modes of ventilation – oscillator or nvrp  Decrease Oxygen consumption o Comfort  Sedation  Pain relief  Neuromuscular blockade o Positioning  Prone positioning  Better profusion to posterior part of the lung. Takes weight of heart off of the lungs  Protect airway! Face down.. In regular bed patient will be with head on side.  Skin integrity – different pressure points (hips, knees)  Continuous lateral rotation therapy  Complications: DIC, long term pulmonary affect, organ failure, death o Fluid and electrolyte balance o Adequate nutrition o Psychosocial support – more for family o Prevention of complications  Thrombus or embolus formation, DIC, death, Organ failure, pulmonary affects  Acute Respiratory Failure as a result of Underlying Disease o Several conditions both acute and chronic can result in Acute Respiratory Failure  COPD  Asthma Exacerbation  Pneumonia - All types  Pulmonary Embolism pulmonary angiogram is a definitive diagnosis o Treatment of ARF in Chronic Diseases (not really going to study this)  Treat the underlying cause  COPD - Bronchodilators, corticosteroids, antibiotics (infection)  Asthma - IV corticosteroids, bronchodilators  Pneumonia - Antibiotics, fluids  Pulmonary Embolism - DVT prophylaxis, thrombolytics, heparin, vena cava filter Maintain Oxygenation - Administer oxygen, ventilate if needed, minimize demands