Exam 2 Flashcards
______________________:
- Usually occurs after an acute traumatic event in those w/no previous pulmonary disease
- 50% mortality rate
- Alveolar capillary membrane becomes damaged & more permeable to intravascular fluid, alveoli fill w/fluid
- Lung Inflammation & injury to the lung itself
Acute Respiratory Distress Syndrome (ARDS)
In terms of Respiratory…
Q = ____________ (Hypoxemic)
V = ____________(Hypercapnic)
Q= O2 exchange failure
V= Ventilator Failure
Mechanical act of breathing failure
What occurs with Hypoxic ARF?
- “Q” is the problem
- Hypoxemia/normocapnia/hypocapnia
- PaO2 <60
- Restlessness, △LOC
- HTN, Tachycardia
- DYSPNEA, TACHYPNEA
- Nasal Flaring/Retractions
- Breaths to finish sentence
- Cool/Clammy/Diaphoretic
- Cyanosis (Late)
_________ is a type of ARF where the O2 being transferred between the alveoli and the capillary bed in the lungs is insufficient for the body’s needs.
Hypoxemic (O2) Failure
__________ is a type of ARF that happens when the actual mechanics of the lungs become insufficient to provide an adequate O2/CO2 exchange.
Hypercapnic (Ventilatory) Failure
What occurs with Hypercapnic (Vent) ARF?
- DYSPNEA, ↘️ RR/Rapid shallow RR
- PaCO2 >48, pH<7.35
- Morning headache/↗️ ICP/bounding pulse
- Muscle weakness, ↘️DTR
- Flushed/warm
- Pursed lip breathing
- Seizures (Late)
___________ is a life-threatening lung condition that prevents enough oxygen from getting to the lungs and into the blood. Characterized by noncardiogenic pulmonary edema; Increased-permeability pulmonary edema
ARDS; Acute Respiratory Distress Syndrome.
Early General Symptoms of ARDS?
- Dyspnea
- Restlessness
- Tachypnea
- Cough
- Crackles
- Hypoxemia
- Resp alkalosis d/t hyperventilation
- Change in LOC
Late General Symptoms of ARDS?
- Noisy respiration
- Sterna retractions
- Bradycardia/↘️ BP
- Oliguria
- Cyanosis
- Hypercapnia; resp/metabolic acidosis
- V-fib/ asystole
_________ _________: Hypoxemia despite increased O2 by mask, cannula, or ET is Hallmark of ARDS, b/c lungs are filled w/water & O2 can’t pass through fluid
Refractory Hypoxemia
4 key elements of ARDS?
- Refractory Hypoxemia
- Dense Pulmonary Infiltrates (Drowning in own fluids) on CXR
- NONcardiogenic pulmonary edema
What occurs in Phase 1 (Exudative Phase) of ARDS?
a. Occurs 1-7 days after injury (Primary Patho △’s)
b. Respiratory alkalosis- hyperventilating (loss of CO2)
c. Increased CO
d. Increased RR
e. Refractory Hypoxemia
f. Decrease tidal volume
g. Atelectasis*
h. Pulmonary edema (not r/t cardiac)- interstitial & alveolar*
i. Decrease in surfactant b/c fluid inactivates it, causing “stiff lungs”
What occurs in Phase 2 (Reparative/Proliferative) of ARDS?
a. occurs 1-2 wks after injury
b. Increased pulmonary vascular resistance & pulmonary HTN
c. Lung compliance continues to decrease d/t interstitial fibrosis & hypoxemia
d. Thickened alveolar membranes cause diffusion limitation & shunting worsening hypoxemia
What occurs in phase 3 (Fibrotic/Chronic) of ARDS?
a. Occurs approx. 3 wks after injury
b. Pulmonary vessels destroyed
c. Tissue is fibrotic & leads to vascular occlusion & pulmonary HTN
d. Decreased lung compliance
e. Surface area for gas exchange significantly reduce & hypoxemia continues
These are all examples of ______ injuries that can cause ARDS?
- Pneumonia**
- Gastric aspiration**
- Lung contusion
- Fat emboli
- Near drowning
- Inhalation injury
- Reperfusion (lung transplant, pulmonary embolectomy)
Direct injuries
These are all examples of _______ injuries that can cause ARDS
- Sepsis*
- Severe trauma w/shock & DIC, multi-transfusions*
- Cardiopulmonary bypass
- Drug overdose
- Acute pancreatitis
- Blood transfusion
- Burns
Indirect injuries
____________?serious condition in which proteins that control blood clotting become abnormally active. Small blood clots form in blood vessels. Can clog up vessels & cut off flow to organs like brain, liver, kidneys. Overtime, clotting proteins are consumed & pt is at high risk for bleeding even without injury.
DIC; Disseminated Intravascular Coagulation
What nutritional support do we offer those with ARF?
a. 35-45 kcal/kg/day: they are in high metabolic demand & need the nutrition
b. High protein
c. Watch milk products- cause high secretions
d. Low carbs (d/t breakdown into CO2)
e. High fluids
Name this equipment:
i. One setting, you have to be able to breathe out at the same pressure as it is blowing in
ii. Good for pt w/MS or problem w/muscle strength, must be able to blow out strongly on your own
CPAP (Cont Pos Airway Pressure)
Name this equipment:
i. Allows you to set level of pressure to blow in at one level & pressure to blow out at another level (usually lower).
ii. Better suited for those w/neuromuscular diseases
BiPAP (Bilevel Pos Airway Pressure)
Drug Therapy for ARF?
- Albuterol, Proventil: relief of bronchospasm
- Steriods: reduction of airway inflammation (watch for infection & high blood sugar)
- Treatment of pulmonary congestion and infections
- Ativan: treat anxiety & ease work of breathing
This organ removes the soluble waste products and access fluid from the blood, helps maintain Ca and phosphate levels, activate vit D to stimulate the intestinal absorption of Ca, helps control BP by secreting renin, helps control acid base balance, and stimulates RBC production.
Kidneys
__________: removal from the body.
Ex: H+ ions if acidodic or K+
Excretion
__________: substances being produced & discharged from a cell, gland, or organ for particular use or function, things the kidneys release.
Ex: Erythropoietin, Calictriol, aldosterone
Secretion
__________: end product of protein breakdown (BUN)
Normal Level?
- Urea
- 10-20
____________: end product of muscle breakdown ←good indicator of kidney function; Best indicator of AKI.
Normal Level?
- Creatinine
- 0.6-1.3
________: urine output <100ml/day
________: build up of nitrogenous wastes
- Oliguria
- Anuria
- Azotemia (Uremia when it affects other systems)
_________: rate at which kidneys are filtering blood.
Normal Levels?
- GFR
- 125mL/min
________: max concentrating ability of kidne; should flux throughout the day.
Normal Levels?
-1-1.03
Prerenal causes of AKI?
Systemic Causes
- Hypovolemia
- ↘️ CO (Renals need 25% of CO)
- ↘️ Periph Vascular Resistance
- ↘️ Renal Perfusion
Intrarenal Causes of AKI?
Damage to renal tissue
- Prolonged prerenal ischemia**
- Nephrotoxic injury
- Acute Glomerulonephritis
- Malignant HTN
- Systemic Lupus
- Acute Tubular Necrosis
Postrenal causes of AKI?
Backflow; Obstruction
-Build-up of pressure which leads to ↘️ in function & damage.
Ex: BPH, Cancer, Trauma
Phase 1 of AKF?
- Begins at time of insult.
- UO<20mL/hr
- Pt may not notice
- not excreting H+
Phase 2 of AKF (Oliguria phase)?
- Kidneys are “Insulted”
- Azotemia apears 1-7days
- UO< 400mL/24hr
- lasts 10-14 days
- GFR fixed
Phase 3 of AKF (Diuretic phase)?
- The “Back Up Plan”
- ↗️ OU & Dilute urine
- lasts 1-3 weeks
- Renal tubules begin to heal
Phase 4 of AKF (ESRD “or” Recovery phase)?
- Lab values return to normal
- GFR normalizes
- Extremely vulnerable
- 12 months until stabilization
Stage 1 of Chronic Kidney Disease (CKD)?
GFR>/=90 Normal Kidney function, urine & albumin point to kidney disease
- Tx: Observe, control BP, restrict proteins, watch infection, hydrate well
- Goal: to stay in stage 1 or 2 through BP control, BS control, weight loss, etc.
Stage 2 of Chronic Kidney Disease (CKD)?
GFR= 60-89, mildly reduced kidney function, urine or other abnormalities point to kidney disease
-Tx: BP control, monitoring, find out why, watch weight for water retention
Stage 3 of Chronic Kidney Disease (CKD)?
GFR= 30-59, moderately reduced kidney function
-Control BP, probable diagnosis of CKD if not already, watch weight for water retention
Stage 4 of Chronic Kidney Disease (CKD)?
GFR= 15-29, severely reduced function
-Planning for ESRD, RRT
Stage 5 of Chronic Kidney Disease (CKD)?
GFR= 14 or less, very severe or ESRD, uremic syndrome develops
-Tx choices for ESRD, RRT or transplant
3 Conditions Caused by Chronic Kidney Disorder (CKD)?
- Metastatic Calcification: deposits of calcium salts in otherwise normal tissue.
- Osteomalacia: Softening of bone via Vit D deficiency.
- Osteitis Fibrosa: excessive parathyroid hormone production, in which bone tissue becomes soft and deformed.
Jumpstarting the kidneys... H:\_\_\_\_\_\_\_ D:\_\_\_\_\_\_\_ T:\_\_\_\_\_\_\_ V:\_\_\_\_\_\_\_
- Hyperkalemia; address it.
- Dopamine; ↗️ Renal Perfusion/MAP (Vasodialates intrarenal/ Vasoconstricts Periph)
- Total Vol; Fluid challenge test; admin 500-1000 bolus to flush out kidney to try and jump-start it.
- Volume Excess: Pull out spare fluid; Mannitol/Lasix/Bumex
___________ is the most common cause of death in those with AKI.
Infection (UTI/Respiratory)
Nutrition in those with AKI?
- Proteins limited: 0.8-1.0gm/kg during to minimize protein breakdown & prevent accumulation of toxic end products
- Spare proteins: LIMIT NUTS, BEANS, MEATS b/c break down into urea nitrogen
- Increase carbohydrates, fats, essential amino acids to spare proteins
- Restrict: Na+, K+, PO4 depending on the serum levels
- No salt substitute d/t potassium (watch WHITE POTATOES, BANANAS, CANTALOUPES, GRAPES d/t potassium
- Pt NEEDS Calcium: DAIRY!
- Reduce metabolic state through: rest, cluster activities, calm, avoid infection, physiological support
BUN
DILANTIN
THEOPHYLLINE
10 - 20
SERUM CREATINE
0.5 - 1.2
pH
pCO2
HCO3
pO2
7.35-7.45
35-45
21-28
80-100
Glucose
Specific gravity
BUN
Serum creatinine
70-110
1.005-1.03
10-20
0.5-1.2
