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
Barotrauma
How to treat tension pneumothorax emergently?
Manually ventilate
Needle thoracostomy
Volutrauma
How does it affect the body?
Overdistension of alveoli
Damages the lung similar to early ARDS
Volutrauma
How to treat it?
Keep PIP < 40 cm H2O
Volutrauma
How to treat it?
Keep PIP < 40 cm H2O
*Peak inspiratory pressure is the highest level of pressure applied to the lungs during inhalation
Ventilator Associated Pneumonia (VAP) Prevention
What are the strategies to prevent VAP?
- relating to pt position
- sanitation
- safe practice
- Elevate head of bed 30 to 45 degrees
- Prevent drainage of condensate back to patient
- Hand hygiene
- ETT with subglottic suction capability
- Aspirate secretions from above ETT
- Oral hygiene program
- Noninvasive ventilation as possible
ARF
3 ways to manage resp therapy?
- O2 therapy
- mobilize secretions
- positive pressure vents
ARF mobilize secretions
best positions
- HOB 30 degrees
- side lye - good lung down
