Ex 1: ARF/ARDS/Trauma/VAP Flashcards
Acute Respiratory Failure (ARF)
Altered gas exchange affecting acid- base balance
What are the PaO2 and SaO2 values?
Pao2 <60 mm Hg, Sao2; <90%;
With or without Paco2 >50 mm Hg
Other conditions requiring MV
Oxygen Failure Intrapulmonary Shunting Pulmonary Embolism Inadequate amount of O2 available Failure of Ventilation V/Q Mismatch
(A V/Q mismatch happens when part of your lung receives oxygen without blood flow or blood flow without oxygen)
Respiratory Failure Concerns
resp muscle fatigue
Cerebral hypoxia and carbon dioxide narcosis
from increased Co2 retention
Respiratory Failure
s/s
- diaphoresis
- nasal flaring
- tachycardia
- central cyanosis
Respiratory Failure
Cerebral hypoxia and carbon dioxide narcosis
s/s?
- lethargy
- somnolence (excess sleepiness)
- Coma
- resp acidosis
Respiratory Failure
Cerebral hypoxia and carbon dioxide narcosis
Nursing actions in response to condition?
- Maintain airway patency
- Prepare for possible intubation and mech vent
When does ARDS occur
after Acute Lung Injury (ALI)
ALI direct injuries
aspiration,
inhalation injury,
pneumonia,
oxygen toxicity
ALI indirect injuries
sepsis, shock, trauma, TRALI, severe pancreatitis
ARDS Definition
Acute Respiratory Failure with:
- Persistent hypoxia despite high oxygen delivery (FiO2 up to 100%)
- Dyspnea and tachypnea
- Decreased pulmonary compliance
- Non-cardiac bilateral pulmonary edema
- Diffuse bilateral infiltrates on chest x-ray
ARDS: Collaborative Treatment
How to decrease oxygen consumption
Sedation
Paralytics (neuromuscular blockers)
(Always with sedation!)
Normothermia
ARDS: Collaborative Treatment
What are the necessary TX after decreasing O2 consumption?
Nutritional support
- Enteral nutrition preferred
Fluid balance (often conservative fluid balance)
Cardiac Support
Psychosocial support
ARDS: Collaborative Treatment
What are the Investigational Therapies?
- ventilations
- medication types
- positioning
High frequency oscillation ventilation
Inverse-ratio ventilation
Nitric oxide Vasodilators ECMO Corticosteroids Alveolar surfactant
Barotrauma
examples
Pneumothorax
Tension pneumothorax
Barotrauma
How to detect barotrauma?
- High PAP, mean airway pressure
- Decreased breath sounds
- Tracheal shift
- Subcutaneous crepitus
- Hypoxemia
