Respiratory Respiratory Failure and ARDS
Jan 05, 2016
Respiratory
Respiratory Failure and ARDS
Normal Respirations
Respiratory Failure Not a disease process, sign of severe dysfunction Lungs unable to oxygenate blood & remove CO2 Alveolar ventilation is inadequate to meet the
body’s need Commonly defined in terms of ABG’s
PO2 of less than 50 mmHg PCO2 greater than 50 mmHg Arterial pH of less than 7.35
Respiratory failure & affect on acid-base balance
1. Hypoxemia resp failure is failure of oxygenation. PO2 significantly reduced and PCO2 is at or below
normal Metabolic acidosis results from tissue hypoxia
2. Hypercapnia resp failure results from hypoventilation. PCO2 rises rapidly and resp acidosis develops PO2 drops more slowly
Causes of respiratory failure (p.1157)
Impaired ventilation Impaired diffusion Ventilation-perfusion mismatch (VQ) COPD most common cause of resp failure
Common manifestations/complications of respiratory failure
Hypoxemia Hypercapnia Underlying disease process symptoms (p. 1157)
Cyanosis
Therapeutic interventions for Resp Failure
Diagnostic tests- ABG’s; ETCO2; chest X-ray Main treatment- correct underlying cause &
restore adequate gas exchange in lung Elevate HOB Medications Oxygen therapy (O2 sat 90%; PaO2 60 mmHg) Airway management
Tracheotomy
Endotracheal tube
Endotracheal tube
Make sure airway attached to lungs
Therapeutic interventions cont.
Mechanical ventilation
Adeq gas exchange & tissue perfusion
Criteria to put on RR > 35-45 pCO2 >45 pO2 <50
Mechanical ventilation cont Types Modes PEEP; CPAP Ventilator settings- including alarms Complications
Ventilate one lung Nosocomial pneumonia Barotraumas Cardiovascular Gastrointestinal
Nursing assessment specific to respiratory failure
Health history Physical exam
Pertinent nursing problems and interventions specific to respiratory failure
Impaired spontaneous ventilation Ineffective airway clearance Anxiety Home care
Acute respiratory distress syndrome- ARDS Syndrome, sudden &
progressive acute resp failure- not primary
Alveolar capillary membranes damaged more permeable> noncardiac pulmonary edema & progressive refractory hypoxemia
Pathophysiology of ARDS- Stages
Refer to BB course documents Module 2 for video
Page 1170-1 illustrations of stages Initiation of ARDS; onset pulmonary edema;
alveolar collapse; end-stage ARDS
surfactant keeping alveoli open
Common manifestations/complications of ARDS
Symptoms develop 24-48 hrs after initial insult Early symptoms Later symptoms Hallmark sign- progressive refractory hypoxemia Noncardiac pulmonary edema
Therapeutic interventions for ARDS
Diagnostic tests ABG’s- hypoxemia Chest X-ray- snow
storm effect Pulmonary function
tests Hemodynamic
monitoring
Therapeutic intervention for ARDS cont.
Medications Mainstay of treatment---Mechanical ventilation
with intubation Correct underlying condition Fluid replacement keep vascular volume Nutrition positive protein balance Heparin prevent thrombothebitis ‘Proning’
Independent Lung Ventilation
Prone Device
Benefits to Proning >
Nursing assessment specific to ARDS
Health history Physical exam
Pertinent Nursing problems and interventions for ARDS
Decreased cardiac output Ineffective airway clearance; impaired tissue
perfusion; imbalance nutrition: less than body requirements; risk for infection
Dysfunctional ventilatory weaning response Home care