W10: Pulmonary Disorders Flashcards
Failure to maintain adequate gas exchange include
fluid in alveoli sac
collapsed alveoli spaces
decrease in lung compliance
What are the 4 parts to ARDS?
Timing - sudden onset of SOB
Xray - the diagnostic tool, will show that it affects both lungs
Not heart failure - have to ensure it is not HF due to the fluid buildup
PF ratio - partial pressure of oxygen divided by the oxygen you are receiving
What is direct lung injury?
the source is coming from the lungs directly
What are common causes of direct lung injury?
pneumonia
aspiration of gastric contents
What is indirect lung injury?
the source is coming from other factors/conditions outside of the lung that impact the lung
What are common causes of indirect lung injury?
Sepsis
severe trauma with shock and multiple transfusions
Exudative Phase of ARDs
24 hours after initial insult; humoral mediators damage alveolar capillary membrane
restlessness, apprehension, tachypnea
capillary membrane surrounds the alveoli - the cap membranes starts to leak fluid into alveoli resulting in them becoming unstable following by collapsing
CO2 will decrease due to tachypnea - the patient will be in respiratory alkalosis
once patient becomes fatigue - the patient respiratory rate decreases and in result CO2 increases and the patient becomes respiratory acidosis
Proliferative Phase of ARDs
7-10 disordered healing begins; type II cells multiply
The body is attempting to reabsorb the fluid - body trying to repair structures
the lung tissue becomes very dense - the elasticity becomes a lot worse
Fibrotic Phase of ARDs
2-3 weeks; cellular granulation and collagen deposition resulting in pulmonary fibrosis
increased dead space inn the lung - outcome becomes very poor at this stage
major lung damage
Refractory hypoxemia
here the patient will maintain a low blood oxygen level even though they are receiving high amounts of oxygen! Early: Due to all this the patient will experience an increase in breathing (still have hypoxemia). WHY? The body is trying to increase the oxygen level, but it won’t be able to!
Describe ARDs
A - Atelectasis - fluid in the lung, reduce ability of alveoli
R - refractory hypoxemia
D - decrease in lung compliance - lungs become stiff
S - surfactant - cells damaged
S/s of ARDs
early - normal breath sounds to random crackles
later: increased RR, decrease oxygen levels, air hungry/ DIB, pulmonary edema, most patient become intubated
S/s of Pulmonary Edema
cyanosis
mental status changes
tachycardia
retractions
crackles
Why is PEEP important?
To keep the alveoli open so gas exchange can occur
What the 8 P’s
Prevention - infection
PEEP - help with gas exchange, decrease tidal volume and increasing CO2 levels to help with ARDs
Pipes and pumps - BP is not a good indicator of fluid status - the pipes have to be filled however we do not want to fluid overload patient so monitor fluid status.
Paralysis - not all get on paralytics - if the patient is getting a paralytic make sure you are giving a pain medication as well - patient cannot talk or move however can monitor everything
Positioning - prone position
Protein - need nutrition - initially they may not be excited for tube feeding however even 10ml/hr can reduce stress on the gut - it keeps the bowel functioning and reduce complications
Protocol - A thru F bundle - decrease concentration and improve outcome
Pharmacology - steroids are important to decrease inflammation
