Unit 4 Flashcards
What is the risk factors for Acute lung failure?
Problems in the lung or chest wall
Pneumonia
Pulmonary embolism
Asthma
Cystic fibrosis
High altitude
Hypoventilation
Hypovolemic shock
What is the pathophysiology of acute lung failure?
When gas exchange is reduced due to ventilation failure (chest pressure doesn’t change enough to allow for adequate air movement) or oxygenation failure (air movement is normal but the blood isn’t oxygenated properly) or both.
What is the s/s of acute lung failure?
Dyspnea
Hypercapnia (high CO2) - headache, seizures, drowsiness, decreased level of consciousness
Hypoxemia - restlessness, confusion, irritability, tachycardia
What is the diagnosis of acute lung failure?
CO2 is the thing to watch - it will cause most problems because it means that the blood isn’t oxygenated, leaving the organs and tissues (including the brain) without oxygen.
Monitor their PaO2 (will be <60) or PaCO2 (will be >45)
Monitor pH (will be <7.35)
Monitor SaO2 (>90% is normal)
What is the medical and nursing management of acute lung failure?
Oxygen therapy
Position patient to a comfortable position (usually upright)
Encourage deep breathing
Start minimal self-care
Decrease dyspnea (relaxation, diversion, guided imagery)
What is the risk factors for ARDS?
Sepsis
Burns
Pancreatitis
Trauma
Blood transfusion
Only occurs after acute lung injury
What is the pathophysiology of ARDS?
The lungs are swollen and cause fluid to fill the alveoli, which decreases the oxygen perfusion, leading to organ hypoxemia.
What is the s/s of ARDS?
Severe Dyspnea
Restlessness
Tachycardia
Hypoxemia that does not respond to supplemental oxygen
Abnormal sounds are not heard due to edema being interstitial, not in the airway.
What is the diagnosis of ARDS?
Plasma brain natriuretic peptide (BNP) level will be elevated when the heart has issues, but not the lung!
Chest X-ray or CT scan that show bilateral infiltrates (fluid spots) - these often are described as ground-glass opacities
For the infiltrates make sure they are not explained by other causes (heart failure)
What is the care management of ARDS?
Enteral nutrition
Fluid therapy
Repositioning
Extracorporeal membrane oxygenation
Support the lungs
Ventilation - WILL ALWAYS NEED INTUBATION
Treat underlying complication - WATCH FOR RESTLESSNESS
What is the basic care essentials for ventilator patients?
- Review communications among care providers
- Check ventilator settings and modes
- Suction appropriately
- Assess pain and sedation needs
- Prevent infection
- Prevent hemodynamic instability
- Manage the airway
- Meet nutritional needs
- Wean the patient from the ventilator appropriately
- Educate the patient and family
How is gas exchange altered with pulmonary embolism or pneumothorax?
It is poor perfusion because there isn’t enough blood getting to the lungs in order to be oxygenation.
What is the management of care for pulmonary embolism or pneumothorax?
Give Heparin or warfarin
Reverse side effects of pulmonary HTN
Promote gas exchange
Monitor bleeding
Monitor for complications (WATCH FOR RESTLESSNESS)
What is the s/s of pneumothorax or pulmonary embolism?
Poor perfusion
Chest pain
Right shift of heart
What is the concept of ventilation-perfusion?
If the perfusion and ventilation are off we have a airway obstruction or a pulmonary embolism
What are the drug types used with mechanical ventilation?
Sedation
Pain Management
Neuromuscular blocking agents
What is fraction of inspired oxygen?
The amount of oxygen delivered to the patient.
Normal RA is 21%. Every L of O2 is another 4%
FiO2 = RA + (4%*L)
What is tidal volume?
Based on ideal body weight for height.
Volume of air patient receives with each breath
Low volume causes hypercapnic acidosis
High volume causes lung injury
What is PIP?
Max pressure reached during inspiration
What is PEEP?
Normal is 5-6
Recents alveoli collapse
Displaces alveolar fluid into interstitium
Risk for over inflation of lung
What is assist-control (A/C)?
Every breath is ventilator generated or assisted
What is synchronized intermittent mandatory ventilation (SIMV)?
Provides full tidal volume for ventilator breath frequency, allows for patient to take unassisted breaths between
What is pressure support ventilation (PSV)?
Used for spontaneous breathing patients
Usually at 10
Provides preset pressure to augment tidal volume of each spontaneous breathing patients l
What is ventilator complications?
Oxygen toxicity
Pneumonia
Stress ulcers leading to GI bleeding
Hypotension due to decreased cardiac output
Increased intracranial pressure from reduced venous return
What is the pathophysiology of heart failure?
Inability of the heart to pump sufficient blood to meet the needs of the tissues for oxygen and nutrients.
Is progressive with a few reversible cases.
Caused by fluid overload or inadequate tissue perfusion
What is the assessment of heart failure?
Right sided: extra fluids everywhere - peripheral edema, hepatomegaly (liver enlargement), ascites (fluid in abdomen), anorexia, nausea, weakness, weight gain
Left sided: lung damage - cough, crackles, pulmonary congestion, increase venous pressures, dyspnea
What is the management of care for heart failure?
MAWDS - medication, activity, weight, diet, symptoms (bloating, weight gain, SOB, swelling in extremities, excessive fatigue)
Eliminate contributing factors
Reduce workload
Optimize therapeutic regimens
Prevent exacerbations
Medications
What is acute vs chronic heart failure?
Chronic us biventricular
What is the nursing care for ventilated patients?
HOB at 30 degrees
Suction
Wean as fast as possible
Oral care every 2 hours
Humidify
What are the black box warning for medications for heart failure?
Digoxin toxicity - use digiband
Watch heart rate and BP for beta blockers
Watch electrolytes for diuretics
Watch for Hypotension with ACE, Sartans, and alternative vasodilators
