ARDS Flashcards
acute respiratory failure is the failure of
oxygenation, ventilation, or both
if a pt vomits/aspirates (direct injury) we have a problem with oxygenation or ventilation
ventilation?
hypoxemia/hypoxic PaO2 values
metabolic hypercapnia PaCO2 value
PaCO2 >50mmHg
acidotic value
pH
how failure of oxygenation happens
hypo-ventilation intrapulmonary shunting*** no oxygenation going on ventilation-perfusion mismatch diffusion defects low cardiac output low hemoglobin level tissue hypoxia
intrapulmonary shunting results in
ards
what is hypo-ventilation
increased CO2
what causes hypo-ventilation
drug overdose
neurological disorders (SCI - trauma)
abd/thoracic surgery r/t pain
low cardiac output
what is intrapulmonary shunting
blood shunted from rt to lt side of heart w/o oxygenation
what causes intrapulmonary shunting
pneumonia, pulmonary edema
***why doesn’t oxygen administrations help shunt disorder
no connection/transfer with aveoli
what is ventilation/perfusion mismatch
ventilation or perfusion is decreased it causes mismatch
what causes ventilation/perfusion mismatch
clot - prevent
what is a diffusion defect
fluid in alveoli - towards end of ARDS
what causes low cardiac output
low cardiac output, low hemoglobin (95% of oxygen is bound)
what is necessary to transport oxygen
hemoglobin
tissue hypoxia results in
anaerobic metabolism and lactic acidosis
respiratory failure secondary to hypo-ventilation with
neuromuscular disease
what is failure of ventilation
hypercapnia - elevated carbon dioxide r/t decreased ventilation causing mismatch
when assessing respiratory failure look for these signs
hypoxemia (restlessness, anxiousness) respiratory (tachypnea) cardiovascular (increased HR) metabolic expenditure - feed patients! ABG's Pulse Ox
interventions for resp. failure
maintain airway ensure oxygenation identify/trt cause prevent complications pain relief bed rest high fowlers position
mgmt of resp failure
bronchodilators
O2
steroids (reduce inflammation)
resp failure concerns
improve O2 delivery; decrease O2 demands
what does pt look like in resp failure
tachycardia
diaphoresis
nasal flare
muscle working
to maximize airway clearance
re-position pt every 2 hrs (mobilize secretions)
*what is good lung down
fluids/inflammation in lungs - allows oxygenation to occur
mobilizes secretions
how to calculate ratio to determine acute resp distress
PaO2/FiO2
what is ARDS
noncardiogenic pulmonary edema
dx criteria for ARDS
bilateral infiltrates
PaO2/FiO2 less than 200
if a chest xray shows bilateral “white out’ how do we trt
intubate (on our way to MODS)
ARDS patho
SIRS stiff lungs release of mediators/histamines pulmonary edema damage to alveolar-capillary membrane increased capillary permeability shunting
whose at risk for ARDS
smoker w/trauma accident
elderly
**s/s of ARDS
hyperventilation dyspnea and tachypnea resp alkalosis increased temp/pulse white out on xray severe hypoxemia
trt of ARDS
trt cause oxygenation and ventilation (peep) start w/non-invasive first trt pain/anxiety position (prone - good lung down) fluid/electrolyte balance support nutrition
normal value for peep
5-10
pressure on the lungs causes decreased cardiac output with peep, what is end result
hypotension
complications of ARDS
DIC
renal failure
MODS
the most avoidable preventable processes
VAP - ventilator assisted pneumonia
proper hand-washing*
cause of VAP
dental plaque
oral bacteria
cross-colonization of hand/glove
***VAP Bundle
elevate HOB 30-45 degrees awaken daily to assess readiness to wean/extubate (cough/deep breath) trt stress ulcers oral care (chlorhexedine 2x's/day) hand washing embolism prophylaxis
what does pt look like with resp acidosis
anxiety
restlessness
*what does pt look like with resp alkalosis
hyperventilation dizzy confused light-headed dry mouth SOB
what does pt look like with metabolic acidosis
dehydrated
cause (liver/alcohol)
what does pt look like with metabolic alkalosis
n/v
