ARDS Flashcards
Acute Respiratory Failure Pathophysiology
Ventilatory failure:
Impaired CNS (drug overdose, head trauma, infection, hemorrhage, and sleep apnea)
Neuromuscular dysfunction (myasthenia gravis, Guillian-Barre syndrome, ALS, and spinal cord trauma)
Musculoskeletal dysfunction (chest trauma, kyphoscoliosis, and malnutrition)
Pulmonary dysfunction (COPD, asthma, and cystic fibrosis)
Oxygenation failure:
Pneumonia
ARDS
Heart failure
COPD
PE
Restrictive lung diseases (diseases that decrease in lung volumes)
Acute Respiratory Failure: Clinical Manifestations
Early S/sx: Restlessness
Headache
Fatigue
Dyspnea
Air hunger
Increased BP
Tachycardia (mild
Later S/sx: (as hypoxia increases):
Tachycardia
Tachypnea
Central cyanosis
Diaphoresis (on the head) skin will usually be cool & clammy
Confusion & Lethargy
Respiratory arrest
Acute Respiratory Failure Diagnostics:
Remember:
paO2 < 60 mmHg
paCO2 > 50 mmHg
PH < 7.35
O2 saturation < 90% on room air
ABGs
Remember your values?
pH: 7.35-7,45
paCO2: 35-45
HCO3: 22-26
paO2: 80-100
Respiratory Acidosis (too much CO2)
Respiratory Alkalosis (low level of CO2 in the blood)
Metabolic Acidosis (too much acid in the body fluids)
Metabolic Alkalosis (elevated serum bicarbonate)
Pulse Oximetry
Acute Respiratory Failure Nursing Management
Assisting with intubation and mechanical ventilation
ET (endotracheal tube)
Tracheostomy (surgically placed)
Respiratory assessments
Move to ICU for monitoring
Monitor LOC
ABGs
Pulse oximetry
VS
Implement ICU protocols
Turning/repositioning
Mouth care
Skin care
ROM
Address the cause that lead to acute respiratory distress and treat
ARDS
A severe inflammatory process causing diffuse alveolar damage that results in:
sudden and progressive pulmonary edema
increasing bilateral infiltrates on chest x-ray
hypoxemia unresponsive to oxygen supplementation regardless of the amount of PEEP.
PEEP: Positive End Expiratory Pressure
Positive pressure maintained at the end of exhalation (instead of normal zero pressure)
Increases functional residual capacity & opens collapsed alveoli
ARDS continued
Initially ARDS resembles severe pulmonary edema; however, ARDS is marked by a rapid onset of severe dyspnea less than 72 hours after precipitating event
Arterial hypoxemia does not respond to supplemental oxygen which leads to:
fibrosing alveolitis
severe hypoxemia
Increased alveolar dead space (poor perfusion) and decreased pulmonary compliance (stiff lungs
ARDS Risk Factors:
Aspiration (gastric secretions, drowning, hydrocarbons)
COVID 19 pneumonia
Drug ingestion and overdose
Hematologic disorders (disseminated intravascular coagulopathy, massive transfusions, cardiopulmonary bypass)
Prolonged inhalation of high concentrations of oxygen, smoke, or corrosive substances
Localized infection (bacterial, fungal, viral pneumonia)
Metabolic disorders (pancreatitis, uremia)
Shock (any cause)
Trauma (pulmonary contusion, multiple fractures, head injury)
Major surgery
Fat or air embolism
Sepsis
ARDS Clinical Manifestations
Severe dyspnea ( rapid onset)
hypoxemia
bilateral infiltrates on CXR
progresses to fibrosing alveolitis
Increased alveolar dead space
poor Perfusion (with adequate ventilation
Clinical Manifestations #s:
Mild ARDS
P/F ratio: >200 mmHg - </= 300 mmHg
Moderate ARDS
P/F ratio: >100 mmHg - </= 200 mmHg
Severe ARDS
P/F ratio: </= 100 mmHg
PaO2 (partial pressure of oxygen) divided by FIO2 (fraction of inspired oxygen
ARDS Diagnostics
Audible crackles & intercostal retractions
ABGs
BNP levels (high levels show decreased odds for ARDS)
Result > 100 is abnormal
</= 200 pg/mL (range)
Echocardiogram
Pulmonary artery catheterization
ARDS Medical Management
Intubation and mechanical ventilation
Utilization of PEEP
PEEP increases functionality by keeping the alveoli open
Circulatory support, adequate fluid volume, and nutritional support
Systemic hypotension may occur secondary to hypovolemia
Inotropic or vasopressors may be required (to treat hypovolemia and not cause further overload)
Inhaled nitric oxide
Prone positioning
Sedation
Paralytics
Nutritional support
Nursing Management
Frequent respiratory assessments
Repositioning at least every 2 hours
Changes occur frequently with repositioning…be cautious
Positioning client into the prone position is commonly performed
Improved oxygenation especially in COVID 19 pts
REST
Common interventions:
O2 administration
Nebulizer
Chest physiotherapy
Endotracheal intubation
Tracheostomy
Mechanical ventilation
Suctioning
Bronchoscopy
Reducing anxiety
Common Interventions for ARDS
O2 administration
Nebulizer
Chest physiotherapy
Endotracheal intubation
Tracheostomy
Mechanical ventilation
Suctioning
Bronchoscopy
Reducing anxiety
PEEP Delivery Systems
Continuous Positive Airway Pressure (CPAP):
Positive pressure applied throughout the respiratory cycle to a spontaneously breathing client to promote alveolar and airway stability and increase functional residual capacity
Bi-level Positive Airway Pressure (BIPAP):
Also known as non-invasive positive pressure ventilation (NIPPV)
Noninvasive spontaneous breath mode of mechanical ventilation that allows for the separate control of inspiratory and expiratory pressures; given via a mask
Mechanical Ventilation:
Intubated with an endotracheal tube
A positive or negative pressure breathing device that supports ventilation and oxygenation
CPAP AND BIPAP notes
Cpap – patient must be breathing independently
bipap - breathing is initiated either by the patient or the back up setting (which ensures the patient gets a certain amount of breaths per minute)
