Ch. 26: Common Respiratory Disorders Flashcards
Acute Respiratory Failure (ARF)
Hypoxemic (Type 1) - Low PaO2, normal PaCO2
Hypercapnic (Type 2) - Low PaO2, High PaCO2
Causes of ARF
Obstruction Bronchial Disease Parenchymal disease CVD Extrapulmonary disorders Muscular/neuromuscular junction disorders Peripheral nerve/spinal cord disorders CNS disorders
Hallmark signs of ARF?
Hypoxemia and Hypoventilation:
Ventilation/perfusion mismatch and/or intrapulmonary shunting
Intrapulmonary shunting?
Uncommon, but is when blood is shunted away from alveoli in pulmonary system. Main point is that high O2 delivery does NOT improve SaO2 by that much, very little improvement.
V/Q mismatch
Most common cause of ARF. There are areas of the lung in which V/Q is high and V/Q is low. O2 delivery DOES increase SaO2 because everywhere gets high O2 concentrations in lungs. Except in a pulmonary embolism case, then the other areas of the lung compensate for the lost area where the PE is blocking.
Initial Assessment of ARF?
ABCs, drowsiness, confusion, silent chest. If any of these are abnormal or present, do: Consult ICU Start short-acting beta agonist O2 Prepare for intubation
Mild-moderate signs of ARF
Talks in phrases Sitting Non agitated Increased RR Tachycardic
Severe signs of ARF
Talks in words Sits hunched forward Agitated Tachypneic >30 Tachycardic >120 O2 <90%
Medical Management for ARF?
Bronchodialators Mucolytics Sedatives (vent only) Paralytics (vent only) Bicarb therapy for acidosis if vent is not correcting fast enough Nutritional support
Nutritional support for ARF, what is included?
Normal balanced diet, but in ARF r/t ARDS, high carb solutions are avoided to prevent excess CO2 production
Nursing Management for ARF?
Continual respiratory assessment Vent management Positioning Prevent Desatting Promoting secretion clearance
The triad, and components, of risk for pulmonary emboli
Virchow’s Triad:
Hypercoagulability
Vascular endothelium damage
Venous stasis
Other risk factors for PE
Trauma Cancer Pregnancy Hormone therapy Recent surgery Venous stasis Inherited thrombophilias
Assessment for PE
Chest pain Dyspnea Sustained hypotension w/o other explanations Tachycardia Hypoxia Vague S/S Hemodynamic changes V/Q scan CTPA (Computed pulmonary angiography)
Treatment for PE
Low molecular weight heparin (lovenox) Unfractionated IV heparin Oral anticoagulation Thrombolytic therapy Inferior Vena Cava Filter
