Critical care lecture one (ALF and ARDS) Flashcards
what are the 3 determinants of pulmonary function
- ventilation
- perfusion
- respiration
ventilation
mechanical movement of airflow to and from the atmosphere and the alveoli
work of breathing
amount of work required to overcome elastic and resistive properties of the lungs
anatomic dead space
the conduting airways (upper airways) that do not partcipate in gas exchange
alveolar dead space
non-perfused alveoli that do not partcipate in gas exchange
physiologic dead space
anatomic and alevolar dead space together
why does respiratory failure occur
- ventilation-perfusion mismatch
what are the four ways that a V/Q mismatch can occur
- Absolute shutn by no ventilation from accumulation of fluid
- V.Q mismacth from mucus secretion leading to a mucus plug
- V/q mismacth from decreased perfusion from emboli
- dead space from no perfusion from obstruction of pulmonary capillary
acute lung failure `
AKA acute respiratory failure that happens suddenly from failure of oxygention versus ventilation
Type 1 ALF
- hypoxemic (low oxygen)
- normocapnic (normal carbonx dioxide)
- pa o2 is less than 60mmhg
- oxygen saturation are less than 80%
Type II ALF
- hypoxemic
- hypercapnic
- usually with patient who have a history of copd and a dignosis of pneumonia
- pa co2 above 45mmhg
- ph is less than 7.35 (acidodic state)
signs and symptoms of ALF I
- dyspnea
- tachypnea
- cyanosis
- acessory muscle use
- decrease spo2
- agitation
what are signs and symptoms of ALF II
- dyspnea
- drowsiness
- bradypnea
- shallow breathing
- decrease minute ventilation
- decrease inhaled volume
what is the nursing interventions/assessments to be done for ALF
- resp assessment
- hemoglobin, blood hases
- chest X-ray
- bronchoscopy, CT scan, sputum cultures
what are non-invasive ways to monitor gas exchange
- pulse oximetry
- capnography - graphic display of carbon dioxide concentration that is exhaled by the patient during breathing
what are the six steps for interpreting an ABG
- are the pa02 and sa02 normal
- is the ph normal
- is the carbon dioxide normal
- is the bicarb. normal
- does the co2 or the bicarb. match the ph
- does the carbon or the bicarb. go to the opposite direction of the ph
mild hypoxemia
pa02 60-75
moderate hypoxemia
pao2 45-59
severe hypoxemia
less than 45
what are contraindications for high flow nasal cannulas
- facial trauma
- airway compromise
- svere shock
- altered mental status
- anythign requiring intubation
non-invasive positive pressure ventilation
- provides ventilatory support without the use of an artifical airway
who is NPPV usually used for
- patient who have type II ALF who do not wish to have invsaive procedures
- people who only need intermittent or support at night
- cardiogenic pulmonary edema with heart failure patients
- oncology patients
what is the criteria for NIPPV to be used
- moderate to severe dyspnea
- tachypnea
- acessory muscle use
- ph less than 7.35 and co2 greater than 45
what are contraindication for NIPPV
- respiratory arrest
- medically unstable such as hypotension or bleeds
- unable to pprtect their own airwat
- excessive scretion
- agitation and uncrooperative
- facial trauma