Respiratory

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Respiratory

• Respiratory Failure and ARDS

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Normal Respirations
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Respiratory Failure

• Not a disease process, sign of severe dysfunction
• Lungs unable to oxygenate blood remove CO2
• Alveolar ventilation is inadequate to meet the
  bodys need
• Commonly defined in terms of ABGs
• PO2 of less than 50 mmHg
• PCO2 greater than 50 mmHg
• Arterial pH of less than 7.35

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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

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Causes of respiratory failure (p.1157)

• Impaired ventilation
• Impaired diffusion
• Ventilation-perfusion mismatch (VQ)
• COPD most common cause of resp failure

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Common manifestations/complications of


respiratory failure

• Hypoxemia
• Hypercapnia
• Underlying disease process symptoms (p. 1157)

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Cyanosis
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Therapeutic interventions for Resp Failure

• Diagnostic tests- ABGs 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

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Tracheotomy
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Endotracheal tube
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Endotracheal tube
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Make sure airway attached to lungs
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Therapeutic interventions cont.

• Mechanical ventilation
• Adeq gas exchange tissue perfusion
• Criteria to put on
• RR gt 35-45
• pCO2 gt45
• pO2 lt50

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Mechanical ventilation cont

• Types
• Modes
• PEEP CPAP
• Ventilator settings- including alarms
• Complications
• Ventilate one lung
• Nosocomial pneumonia
• Barotraumas
• Cardiovascular
• Gastrointestinal

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Nursing assessment specific to
respiratory failure

• Health history
• Physical exam

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Pertinent nursing problems and interventions
specific to respiratory failure

• Impaired spontaneous ventilation
• Ineffective airway clearance
• Anxiety
• Home care

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Acute respiratory distress syndrome- ARDS

• Syndrome, sudden progressive acute resp
  failure- not primary
• Alveolar capillary membranes damaged more
  permeablegt noncardiac pulmonary edema
  progressive refractory hypoxemia

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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

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surfactant keeping alveoli open
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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

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Therapeutic interventions for ARDS

• Diagnostic tests
• ABGs- hypoxemia
• Chest X-ray- snow storm effect
• Pulmonary function tests
• Hemodynamic monitoring

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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

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Independent Lung Ventilation
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Prone Device
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Benefits to Proning gt
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Nursing assessment specific to ARDS

• Health history
• Physical exam

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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

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