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Acute Respiratory Failure

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Acute Respiratory Failure Respiratory System Consists of two parts: Gas exchange organ (lung): responsible for OXYGENATION Pump (respiratory muscles and respiratory ... – PowerPoint PPT presentation

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Title: Acute Respiratory Failure


1
Acute Respiratory Failure
2
Respiratory System
  • Consists of two parts
  • Gas exchange organ (lung) responsible for
    OXYGENATION
  • Pump (respiratory muscles and respiratory control
    mechanism) responsible for VENTILATION
  • NB Alteration in function of gas exchange unit
    (oxygenation) OR of the pump mechanism
    (ventilation) can result in respiratory failure

3
Normal Lung
4
Lung Anatomy
5
Normal Alveoli
6
Gas Exchange Unit
Fig. 66-1
7
Normal ABGs
  • pH 7.35-7.45
  • CO2 35-45
  • HCO3 23-27

8
Respiratory and Metabolic Acidosis and Alkalosis
  • CO2 is an acid and is controlled by the
    Respiratory (Lung) system
  • HCO3 is an alkali and is controlled by the
    Metabolic (Renal) system
  • Respiratory response is immediate Metabolic
    response can take up to 72 hours to respond
    (except in patients with COPD who are in a
    constant state of Compensation!)

9
ABG Interpretation
  • Step 1
  • Check the pH Is it acidotic or alkalotic or
    normal? pH below 7.35 is acidotic pH above 7.45
    is alkalotic
  • If pH is normal, then the ABG is compensated if
    pH not normal, then the ABG is uncompensated

10
ABG Interpretation (contd)
  • Step 2.
  • Check the CO2 and HCO3
  • If the CO2 (acid) is above 45, the pt is
    acidotic if the CO2 is below 35, the pt is
    alkalotic
  • If the HCO3 is above 27, the patient is
    alkalotic if the HCO3 is below 23, the patient
    is acidotic

11
ABG Interpretation (contd)
  • Step 3
  • If the CO2 is high (above 45), then the patient
    is in Respiratory Acidosis if the CO2 is low
    (below 35), then the patients is in Respiratory
    Alkalosis.
  • If the HCO3 is high (above 27), then the patient
    is in Metabolic Alkalosis if the HCO3 is low
    (below 23), then the patient is in Metabolic
    Acidosis.

12
ABG Example 1
  • pH 7.36
  • CO2 41
  • HCO3 27
  • Diagnosis ?

13
ABG Example 2
  • pH 7.49
  • CO2 37
  • HCO3 32
  • Diagnosis ?

14
ABG Example 3
  • pH 7.29
  • CO2 50
  • HCO3 26
  • Diagnosis ?

15
ABG Example 4
  • pH 7.40
  • CO2 32
  • HCO3 30
  • Diagnosis ?

16
Acute Respiratory Failure
  • Results from inadequate gas exchange
  • Insufficient O2 transferred to the blood
  • Hypoxemia
  • Inadequate CO2 removal
  • Hypercapnia

17
Acute Respiratory Failure with Diffuse Bilateral
Infiltrates
18
Acute Respiratory Failure
  • Not a disease but a condition
  • Result of one or more diseases involving the
    lungs or other body systems
  • NB Acute Respiratory Failure when oxygenation
    and/or ventilation is inadequate to meet the
    bodys needs

19
Acute Respiratory Failure
  • Classification
  • Hypoxemic respiratory failure (Failure of
    oxygenation)
  • Hypercapnic respiratory failure (Failure of
    ventilation)

20
Classification of Respiratory Failure
Fig. 66-2
21
Acute Respiratory Failure
  • Hypoxemic Respiratory Failure
  • PaO2 of 60 mm Hg or less
  • (Normal 80 - 100 mm Hg)
  • Inspired O2 concentration of 60 or greater

22
Acute Respiratory Failure
  • Hypercapnic Respiratory Failure
  • PaCO2 above normal (gt45 mm Hg)
  • Acidemia (pH lt7.35)

23
Hypoxemic Respiratory FailureEtiology and
Pathophysiology
  • Causes
  • Ventilation-perfusion (V/Q) mismatch
  • Shunt
  • Diffusion limitation
  • Alveolar hypoventilation

24
V-Q Mismatching
  • I) V/Q mismatch
  • Normal ventilation of alveoli is comparable to
    amount of perfusion
  • Normal V/Q ratio is 0.8 (more perfusion than
    ventilation)
  • Mismatch d/t
  • Inadequate ventilation
  • Poor perfusion

25
Range of V/Q Relationships
Fig. 66-4
26
Hypoxemic Respiratory FailureEtiology and
Pathophysiology
  • Causes V/Q mismatch
  • COPD
  • Pneumonia
  • Asthma
  • Atelectasis
  • Pulmonary embolus

27
Hypoxemic Respiratory FailureEtiology and
Pathophysiology
  • II) Shunt
  • An extreme V/Q mismatch
  • Blood passes through parts of respiratory system
    that receives no ventilation
  • d/t obstruction OR fluid accumulation
  • Not Correctable with 100 O2

28
Diffusion Limitations
  • III) Diffusion Limitations
  • Distance between alveoli and pulmonary capillary
    is one- two cells thick
  • With diffusion abnormalities there is an
    increased distance between alveoli (may be d/t
    fluid)
  • Correctable with 100 O2

29
Hypoxemic Respiratory FailureEtiology and
Pathophysiology
  • Causes Diffusion limitations
  • Severe emphysema
  • Recurrent pulmonary emboli
  • Pulmonary fibrosis
  • Hypoxemia present during exercise

30
Diffusion Limitation
Fig. 66-5
31
Alveolar Hypoventilation
  • IV) Alveolar Hypoventilation
  • Is a generalized decrease in ventilation of lungs
    and resultant buildup of CO2

32
Hypoxemic Respiratory FailureEtiology and
Pathophysiology
  • Causes Alveolar hypoventilation
  • Restrictive lung disease
  • CNS disease
  • Chest wall dysfunction
  • Neuromuscular disease

33
Hypoxemic Respiratory FailureEtiology and
Pathophysiology
  • Interrelationship of mechanisms
  • Hypoxemic respiratory failure is frequently
    caused by a combination of two or more of these
    four mechanisms
  • Effects of hypoxemia
  • Build up of lactic acid ? metabolic acidosis ?
    cell death
  • CNS depression
  • Heart tries to compensate ? ? HR and CO
  • If no compensation ? O2, ? acid, heart fails,
    shock, multi-system organ failure

34
Hypercapnic Respiratory FailureEtiology and
Pathophysiology
  • Imbalance between ventilatory supply and demand
  • Occurs when CO2 is increased

35
Causes Hypercapnic Respiratory Failure
  • I) Alveolar Hypoventilation and VQ Mismatch
  • Ventilation not adequate to eliminate CO2
  • Leads to respiratory acidosis
  • Eg. Narcotic OD Guillian-Barre, ALS, COPD,
    asthma

36
Causes Hypercapnic Respiratory Failure
  • II) VQ Mismatch
  • - Leads to increased work of breathing
  • - Insufficient energy to overcome resistance
    ventilation falls ?PCO2 respiratory acidosis

37
Hypercapnic Respiratory FailureCategories of
Causative Conditions
  • I) Airways and alveoli
  • Asthma
  • Emphysema
  • Chronic bronchitis
  • Cystic fibrosis

38
Hypercapnic Respiratory Failure Categories of
Causative Conditions
  • II) Central nervous system
  • Drug overdose
  • Brainstem infarction
  • Spinal cord injuries

39
Hypercapnic Respiratory Failure Categories of
Causative Conditions
  • III) Chest wall
  • Flail chest
  • Fractures
  • Mechanical restriction
  • Muscle spasm

40
Hypercapnic Respiratory Failure Categories of
Causative Conditions
  • IV) Neuromuscular conditions
  • Muscular dystrophy
  • Multiple sclerosis

41
Respiratory FailureTissue Oxygen Needs
  • Major threat is the inability of the lungs to
    meet the oxygen demands of the tissues

42
Respiratory FailureClinical Manifestations
  • Sudden or gradual onset
  • A sudden ? in PaO2 or rapid ? in PaCO2 is a
    serious condition

43
Respiratory FailureClinical Manifestations
  • When compensatory mechanisms fail, respiratory
    failure occurs
  • Signs may be specific or nonspecific

44
Respiratory FailureClinical Manifestations
  • Severe morning headache
  • Cyanosis
  • Late sign
  • Tachycardia and mild hypertension
  • Early signs

45
Respiratory FailureClinical Manifestations
  • Consequences of hypoxemia and hypoxia
  • Metabolic acidosis and cell death
  • ? Cardiac output
  • Impaired renal function

46
Respiratory FailureClinical Manifestations
  • Specific clinical manifestations
  • Rapid, shallow breathing pattern
  • Sitting upright
  • Dyspnea

47
Respiratory FailureClinical Manifestations
  • Specific clinical manifestations
  • Pursed-lip breathing
  • Retractions
  • Change in InspiratoryExpiratory ratio

48
Respiratory FailureDiagnostic Studies
  • Physical assessment
  • ABG analysis
  • Chest x-ray
  • CBC
  • ECG

49
Respiratory FailureDiagnostic Studies
  • Serum electrolytes
  • Urinalysis
  • V/Q lung scan
  • Pulmonary artery catheter (severe cases)

50
Acute Respiratory FailureNursing and
Collaborative Management
  • Nursing Assessment
  • Past health history
  • Medications
  • Surgery
  • Tachycardia

51
Acute Respiratory FailureNursing and
Collaborative Management
  • Nursing Assessment
  • Fatigue
  • Sleep pattern changes
  • Headache
  • Restlessness

52
Acute Respiratory FailureNursing and
Collaborative Management
  • Nursing Diagnoses
  • Ineffective airway clearance
  • Ineffective breathing pattern
  • Risk for imbalanced fluid volume
  • Anxiety

53
Acute Respiratory FailureNursing and
Collaborative Management
  • Nursing Diagnoses
  • Impaired gas exchange
  • Imbalanced nutrition less than body requirements

54
Acute Respiratory FailureNursing and
Collaborative Management
  • Planning
  • Overall goals
  • ABGs and breath sounds within baseline
  • No dyspnea
  • Effective cough

55
Acute Respiratory FailureNursing and
Collaborative Management
  • Prevention
  • Thorough physical assessment
  • History

56
Acute Respiratory FailureNursing and
Collaborative Management
  • Respiratory Therapy
  • Oxygen therapy
  • Mobilization of secretions
  • Effective coughing and positioning

57
Acute Respiratory FailureNursing and
Collaborative Management
  • Respiratory Therapy
  • Mobilization of secretions
  • Hydration and humidification
  • Chest physical therapy
  • Airway suctioning

58
Acute Respiratory FailureNursing and
Collaborative Management
  • Respiratory Therapy
  • Positive pressure ventilation (PPV)

59
Acute Respiratory FailureNursing and
Collaborative Management
  • Drug Therapy
  • Relief of bronchospasm
  • Bronchodilators

60
Acute Respiratory FailureNursing and
Collaborative Management
  • Drug Therapy
  • Reduction of airway inflammation
  • Corticosteroids

61
Acute Respiratory FailureNursing and
Collaborative Management
  • Drug Therapy
  • Reduction of pulmonary congestion
  • IV diuretics

62
Acute Respiratory FailureNursing and
Collaborative Management
  • Drug Therapy
  • Treatment of pulmonary infections
  • IV antibiotics

63
Acute Respiratory FailureNursing and
Collaborative Management
  • Drug Therapy
  • Reduction of severe anxiety, pain, and agitation
  • Benzodiazepines
  • Narcotics

64
Acute Respiratory FailureNursing and
Collaborative Management
  • Medical Supportive Therapy
  • Treat the underlying cause
  • Maintain adequate cardiac output and hemoglobin
    concentration
  • Monitor BP, O2 saturation, urine output

65
Acute Respiratory FailureNursing and
Collaborative Management
  • Nutritional Therapy
  • Maintain protein and energy stores
  • Enteral or parenteral nutrition
  • Supplements
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