6.1 Respirations Flashcards
3 Parts of Respirations
Ventilation - Movement of air into lungs
Diffusion - Movement of oxygen and CO2 between alveoli and pulmonary capillaries
Perfusion - Circulation of blood through pulmonary circulation
Hypoxemia
- Decreased PaO2
- Caused by respiratory disease, neurological dysfunction, circulatory function
Mild Manifestations
- Increased HR, Peripheral vasoconstriction, diaphoresis, mildly increased BP.
- May also cause mental impairment, increased RR, and decreased visual acuity
Worsening Hypoxemia
- Personality change
- Restlessness, agitation, combativeness
- Decreased muscle coordination
- Euphoria
- Impaired judgment, delirium
- Eventually stupor/coma
Cyanosis
- Bluing of the skin and mucous membranes due to excessive concentration of deoxygenated hemoglobin
Central
- Tongue and lips
- Caused by deoxygenation of arterial blood due to pulmonary disease or right/left cardiac shunts
Peripheral
- Extremities, tip of nose, ears
- Caused by vasoconstriction and decreased peripheral blood flow
Clubbing
- Enlargement of distal segment of digits
- Severity graded on extent of nail bed hypertrophy
- Usually associated with diseases that cause chronic hypoxemia
- Usually painless
Hypercapnia
- Increased PaCO2
- Caused by decreased ventilation or ventilation/perfusion mismatch
Manifestations
- Respiratory acidosis
- CNS depression
- Vasodilation
- Impaired renal function
Pulmonary Embolism
- Blood clot of lungs
- Obstruction of pulmonary artery or one of the branches by thrombus that originated somewhere in the venous system or right side of the heart
Types of Emboli
- Air, fat, amniotic, septic (from bacterial infection)
Venous Thromboembolism
- Includes both DVT and PE
- Formation of any thrombus in the vein
AT RISK
- Highest risk is those with a-fib or other cardiac disorders
- Clients with chest pain, dyspnea from workload will not want to get up and move around.
MANAGEMENT
- Teach about need for anticoagulation therapy for 3-6 months
- Reduce risk by early ambulation, incentive spirometry, cough, deep breathing
- Educate prevention, medications, follow-up appointments, pain management
INR VALUES - Normal is 1.1
INR on Anticoagulation - 2-3
PT-INR - Prothrombin time that measures how much time it takes for patient’s blood to clot
TREATMENT
- Anticoagulation or Thrombolytic Therapy
- Low molecular heparin and fondaparinux are the cornerstone of therapy
INITIAL PHASE
- IV Unfractionated Heparin
EARLY MAINTENANCE
- Overlapping regimes of heparin or fondaparinux for 5 days with oral vitamin K antagonist (warfarin)
LONG TERM MAINTENANCE
- 3-6 months of Warfarin depending on reoccurrence of bleeding (re-evaluated after this time)
THROMBOLYTIC THERAPY
- Uses Tissue-Plasminogen-Activator (TPA)
- Anticoagulants are stopped before administering TPA
- ONLY ESSENTIAL INVASIVE PROCEDURES DUE TO RISK OF POTENTIAL BLEEDING
- Fresh whole blood, packed red cells, cryoprecipitate, or frozen plasma may be administered to replace blood loss and reverse bleeding tendencies
- AFTER THROMBOLYTIC INFUSION ANTICOAGULATION IS INITIATED
ABG’s
- Sample arterial blood tells you state of gas exchange in lungs
- Measures pH, PaO2, HCO3, SaO2, PaCO2, Base Excess
Values
pH - 7.35-7.45
PaO2 - 80-100 mmHg
PaCO2 - 35-45 mmHg
HCO3 - 22-26 mEq/L
SaO2 - >95%
Base Excess - +/- 2
Acute Respiratory Failure
- NOT A SPECIFIC DISEASE
- It is direct lung injury or injury to another body system (can occur in normal lungs or chronic disease lungs)
- Can occur in normal lungs such as injury to spinal cord can cause apnea which leads to respiratory failure
Definition
- Sudden life-threatening deterioration of gas exchange function of the lungs which indicates failure of the lungs to provide adequate oxygenation or ventilation for the blood.
Acute Respiratory Failure
- Decreased in PaO2 (arterial oxygen tension) to less than 50 mmHg (hypoxemia) and increase in arterial CO2 tension (PaCO2) to greater than 50 mmHg (hypercapnia) with arterial pH less than 7.35
- Caused by VQ mismatch (ventilation and perfusion mismatch)
- Caused by impairment of ventilation/perfusion mismatch
Chronic Respiratory Failure
- Deterioration in gas exchange function that has persisted a long time or developed insidiously after an episode of acute respiratory failure
- CHRONIC COPD or EMPHYESEMA PATIENTS CAN DEVELOP ACUTE RF
Hypoxemia
- Failure of gas exchange
- COPD, Restrictive Lung Disease, Severe Pneumonia, Atelectasis, Pulmonary Edema, ALI/ARDS (acute lung injury or acute respiratory distress syndrome)
Primary Hypercapenia
- Inadequate alveolar ventilation (requires ventilatory support)
Hypercapnic/Hypoxemic Failure
- Upper airway obstruction
- Weakness/Paralysis of respiratory muscles
Assessment of Hypoxemia
Early Signs
- Restlessness, fatigue, headache, dyspnea, air hunger
- Tachycardia and increased BP
Late Signs
- Confusion, Lethargy, Diaphoresis
- Tachycardia, Tachypnea
- Central Cyanosis
- Eventually respiratory arrest
INTERVENTIONS
- Monitor LOC, ABG’s, Pulse Ox, VS
- Assess entire respiratory system and implement strategies (turning schedules, mouth care, skincare, range of motion for extremities) to prevent complications
- Assess patient’s understanding of management strategies to enable patients to express concerns to healthcare team
Patient Presentation
- Rapid, shallow breathing
- Tripod position
- Dyspnea
- Pursed lip breathing with prolonged expiratory time
- Retractions
- Pale/Dusky around the mouth and extremities
- Change in LOC
Drug Therapy
- Bronchodilators (albuterol) to relieve bronchospasms
- Corticosteroids (methylprednisone) to reduce airway inflammation
- Diuretics (Furosemide) to reduce pulmonary congestion (nitrates if HF is present)
- IV Antibiotics to treat pulmonary infections
- Benzodiazepines (Lorazepam) or narcotics to reduce severe anxiety, agitation, and pain
Ventilator Associated Pneumonia
- Most common hospital acquired infection in ICU
Medical Treatment
- Treat underlying cause and restore adequate gas exchange (endotracheal tube or mechanical ventilation)
Nursing Management
- NUMBER 1 WAY TO PREVENT IS EDUCATION
- Monitor LOC, RR, Skin/Oral Care
