Respiratory Failure part 2 Flashcards
is a syndrome of inadequate gas exchange due to dysfunction of one or more essential components of the respiratory system.
Respiratory Failure
Respiratory system
Chest wall (including pleura and diaphragm)
Airways
Alveolar – capillary unit Pulmonary circulation
Nerves
CNS or Brain Stem
Classification
Acute
Chronic
Acute on chronic
Causes
Type I
Type II
Type III
Type I respiratory failure
Pneumonia
Cardiogenic pulmonary edema
Non-cardigenic pulmonary edema
Pulmonary embolism
Atelectasis
Pulmonary fibrosis
Type II respiratory failure
Central hypoventilation
Asthma
COPD
Neuromasculr chest wall disorders
Myopathies
Neuropathies
Kyphoscoliosis
Myasthenia gravis
Obesity hypoventilation syndrome
Type III respiratory failure
Inadequate post - operative analgesia, upper abdominal incisio
Obesity, ascites
Excessive airway secretions
tobacco smoking
Type IV respiratory failure
Cardiogenic shock
Septic shock
Hypovolemic shock
Diagnosis: History
Sepsis
Pneumonia
Pulmonary embolus
COPD exacerbation
Cardiogenic pulmonary edema
suggested by sudden onset of shortness of breath or chest pain
Pulmonary embolus
suggested by history of heavy smoking, cough, sputum production
COPD exacerbation
suggested by chest pain, paroxysmal nocturnal dyspnea, and orthopnea.
Cardiogenic pulmonary edema
Diagnosis: Physical Findings
Hypotension
Hypertension
Wheezing
Stridor
Elevated jugular venous pressure
Tachycardia and arrhythmias
usually with signs of poor perfusion suggests severe sepsis or massive pulmonary embolus.
Hypotension
usually with signs of poor perfusion suggests cardiogenic pulmonary edema.
Hypertension
Wheezing suggests airway obstruction:
Bronchospasm
Secretions
Pulmonary edema
suggests upper airway obstruction
Stridor
suggests right ventricular dysfunction due to accompanying pulmonary hypertension
Elevated jugular venous pressure
may be the cause of cardiogenic pulmonary edema
Tachycardia and arrhythmias
Diagnosis: Laboratory Workup
ABG
Complete blood count
Cardiac serologic markers
Microbiology
Diagnostic Investigations
Pulmonary function tests/bedside spirometry
Bronchoscopy
Chest radiography
Electrocardiogram
Echocardiography
Respiratory Failure: Management
ABC’s
Ensure airway is adequate
Ensure adequate supplemental oxygen and assisted ventilation, if indicated
Support circulation as needed
Infection tx
Antimicrobials, source control .
Airway obstruction
Bronchodilators, glucocorticoids
Improve cardiac function
Positive airway pressure, diuretics, vasodilators, morphine, inotropes .
Management
Mechanical ventilation
Non - invasive
Mask: usually orofacial to start
Invasive
Endotracheal tube (ETT)
Tracheostomy – if upper airway is obstructed
Indications for Mechanical Ventilation
Cardiac or respiratory arrest. Tachypnea or bradypnea with respiratory fatigue. Acute respiratory acidosis. Inability to protect the airway associated with depressed level of consciousness of consciousness Shock associated with excessive respiratory work Inability to clear secretions with impaired gas exchange Short term adjunct in management of acutely increased intracranial pressure (ICP)
Non Invasive Ventilation
COPD exacerbation
Cardiogenic pulmonary edema
Obesity hypoventilation syndrome
Nursing Management.
Assess the patient’s tissue oxygenation status regularly. Evaluate ABG results To enhance V/Q matching, turn the patient on a regular and timely basis to rotate and maximize lung zones. Regular, effective use of incentive spirometry Regular patient turning and repositioning enhances diffusion by promoting a healthy, wellperfused alveolar surface. These actions, as well as suctioning, help mobilize sputum or secretions.
