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