Acute resp failure Flashcards
Parameters for Hypoxemia
PAO2<60 on 60% O2
focuses on Oxygenation
Parameters for hypercapnia
PaCO2 >45
pH<7.35
Focuses on ventilation
What can cause hypoxemia/oxygenation failure
Pneumonia, Pulmonary embolism, pulmonary edema, ARDS
What can cause hypercapnic/ventilatory failure
Asthma • COPD • Pain • Drug overdose • Neurological disorders – MG – GB – MS
Failure of Oxygenation
Hypoxemic Failure Physiological changes
-Low CO
-Low HGB
-Ventilation-perfusion mismatch (V/Q
mismatch)
– Intrapulmonary shunting
– Increased dead space ventilation
• Diffusion defects
High V/Q & ex
Deadspace
alveoli ventilated but not perfused, can occur with PE
Low V/Q & ex
Shunt, alveoli perfused but not ventilated
Fluid in alveoli (pneumonia)
Anatomic shunt
blood passes throughout an anatomic channel in the heart bypassing the lungs– ventricular septal defect
Physiologic shunt
Blood flows through the pulmonary capillaries without participating in gas exchange Low VQ
Pneumonia/ards
Diffusion limitations
thickened alveolar capillary membrane impairs gas exchange
What can cause failure of ventilation/hypercapnic failure
Alveolar hypoventilation • Respiratory muscle fatigue • CNS depressants • Head injury • Chest wall abnormalities • Neuromuscular conditions
Signs of hypoxemia
Tachycardia/Tachypneia Inc BP Restlessness Confusion Anxiety
Signs of hypercapnia
Tachycardiac/tachypneia Headache Dec LOC Inc Somnolence Dizzy (maybe pink) Flushed
Why do patients go into tripod position
Increases AP diameter &decreases work of breathing
General Resp failure
Physical symptoms
Pursed-lip breathing • Retractions • Orthopnea • Tripod position – increases AP diameter – decreases work of breathing • Inability to speak in full sentences (severe asthma & other resp failure)
Diagnostic Blood work for resp failure
Blood work
– Arterial blood gases (severe distress only due to invasive nature)
– SvO2 (severe distress only due to invasive nature)
– Hbg & Hct
– Sputum cultures (infection)
Pulse ox
Diagnostic imaging for resp failure
CXR
Medical management of Respiratory distress & why
• Oxygen/Respiratory Management
- Bronchodilators (ease and help movement of air in and out)
- Corticosteroids (Dec inflammatory process)
- Diuretics (excess volume)
- Hydration (prevent secretions from getting dry, dry secretions are hard to cough up)
- Nutrition
- Treatment of underlying cause
Respiratory management of Acute resp failure (oxygen delivery devices)
Nasal cannula (2-4L)
Face mask (25-40% O2) if nasal cannula isnt doing the job
Venturi mask
Nonrebreather
Noninvasive PPV
BiPAP
CPAP
PPV
Non rebreather
Pt with SOB, sats low
Provide 100% to patient
Turn O2 up high so that it fills up with O2.
When pt breathes they inhale O2 and prevents CO2 from being rebreathed
Venturi
Color coded for FIO2
Bipap/CPAP
Positive pressure ventilation in non invasive way, tightly fit.
CPAP: Helps keep lungs/alveoli inflated.Continuous pressure at all time.
Bipap: more pressure on inhalation to inflate alveoli less pressure on exhalation to help exhale
What assesments would you do as the nurse to for acute respiratory failure
Vitals (SPO2) ABGS/Svo2 Neurological assessment (hypercapnic/O2 failure LOC) Breath sounds Cardiac monitoring
Secretion managment
Chest physical therapy
Airway suctioning/effective coughing
Positioning: HOB, OOB,
good lung down (optimize ventilation perfusion ratio)
How to Hydration and humification
Adequate fluid intake
IV hydration
Humidification devices
What is Pneumothorax/Hemothorax
collection of air/blood in the pleural space
reduction in the negative thoracic pressure and poor lung expansion
Reduction of gas exchange at the alveolar level resulting in hypoxemia
Manifestations of hemo/pneumo thorax
Dec O2 Tachypnea= Resp alkalosis Later=Resp acidosi Pain (CXR & ECG r.o MI) SOB Agitation, anxiety Later - Dec LOC
How do you treat hemo/pneumo thorax
Chest tube
Dry (water seal chamber, traps air)
What should you monitor as the nurse for a hemo/pneumo thorax (Chest tube considerations
Monitor vital signs/spo2 pain SOB, secure connections (chest tube & container & chest & any connections),
(bubbling on expiration is good, and still air in pleural space that is being emptied) Continuous bubbling is a leak!
tidaling in the water seal chamber (air move up and down in inspiration/exp no more bubbling but still disruption).
Disruption healed, no movement.
Monitor drainage to report if excessive
If there is a break, place distal end, place in water to maintain sterile water seal
Positioning of a hemo/pneumo thorax drain
Hemo: low to drop by gravity
Pneumo: up high bc air rises
What should you monitor as the nurse for a hemo/pneumo thorax (vitals)
Monitor vital signs/spo2 pain SOB,
What happens if there is a break in the chest tube system
If there is a break, place distal end, place in water to maintain sterile water seal, immediately hook the system back up, DONT CLAMP!!!! Can cause pressure on the heart (tension pneumothorax)
Risk factors DVT (PE)
Virchow’s triad
• Venous stasis/prolonged immobility**
• Vessel wall damage
• Hypercoagulability
General PE risk factors
-DVT – Virchow’s triad • Venous stasis/prolonged immobility • Vessel wall damage • Hypercoagulability • Obesity • Smoking • Fracture (hip/leg) • Major surgery/trauma • Malignancy
Types of PE
-Blood clot • Fat embolus • Air embolus • Amniotic fluid • Tumor particles
PE Patho
Obstruction in Pulmonary Artery->Ventilation‐ Perfusion Mismatch (high V/Q/dead space ventilation)->Hypoxemia Local Vasoconstriction
Classification of PE
Massive
submassive
low risk
Massive PE
– Profound hypotension
– R & L ventricular dysfunction
– Shock/cardiac arrest
Submassive PE
–Normotensive
– R ventricular dysfunction
– Elevated cardiac markers
Low Risk
Normotensive/No ventricular dysfunction or elevation in cardiac
markers
Initial PE Symptoms
-Dyspnea
• Chest pain**
• Tachypnea
• Tachycardia
Submassive/Massive
PE symptoms
• R heart failure with JVD • Hypotension • Anxious/restless/confused • Hypoxia • Poor peripheral perfusion • Hemoptysis with pulmonary infarction
Diagnosis of PE
Imaging CXR r/o other causes CT Scan Lab Testing D-Dimer: Fibrin degredation? ABG Cardiac markers
Treatment/medical management of PE
Anticoagulation (factor X, hep, warfarin)
• IVC filters - prevent recurrence
• Cautious fluid management (careful of R heart failure)
• Hemodynamically compromised (break down clot)
– Thrombolytics
– Embolectomy
– Vasoactive/inotropic support
Tests that nurse should monitor PE
Oxyfenation Chest pain VS Labs: ABGs Lactate Coag studies, cardiac markers UO: marker for CO
Nursing actions for PE
Provide O2 • Elevate HOB • Medication Management • Fluid management • Bleeding precautions
