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Resp Failure

Resp Failure + ARDS+ Immune System

What does Tumor necrosis factor affect to inflammation response? vasodilation, endothelial cell dysfunction, chemotaxis
What does Tissue factor affect to inflammation response in immune system? clotting activation, platelet activation
What does Il-1, Il-6 affect to inflammation response in immune system? vasodilation platelet activation
Leukotrienes affect to inflammation response in immune system? bronchoconstriction,vasodilation, capillary leak
What does Prostaglandins affect to inflammation response in immune system? smooth muscle constriction; pain
Vasodilation cause what to inflammation response in immune system Redness
Increased blood flow cause what to inflammation response in immune system Redness, heat
Vessel permeability cause what to inflammation response in immune system Edema
what are 3 "I" Ischemia Inflammation Immune alteration
Primary role of respiratory system: Oxygen Delivery CO2 removal
System interdependence with respiratory system CNS Pulmonary system Heart Vascular system
what is Acute Respiratory Failure and PaO2? PaCO2 Inability of the body to meet tissue O2 need &/or CO2 removal PaO2 < 50mm Hg or PaCO2 > 50mm Hg on room air
Arterial hypoxemia definition Can not get O2 into bloodstream Alveolar/capillary membrane issue
Ventilatory or hypercapnic (high CO2)definition Can not get CO2 out of bloodstream Pulmonary structure or CNS issue
Examples of Arterial hypoxemia Pulmonary edema, ARDS, Drowning, Pulmonary Emobolism, lung tumors, bleeding
Arterial Hypoxemia Lower than normal amount of oxygen dissolved in plasma
Hypoxemia Moderate what level of PaO2 50-60mm Hg
what is Alveolar hypoventilation ? when it happen? Alveoli is receiving little or no oxygen, but has normal perfusion “Shunt Unit” Unoxygenated blood continues goes back to left side of the heart Alveolus = collapsed, blocked or filled with fluid. Low V/Q (ventilation/perfusion ratio)
What are some clinical examples for Alveolar hypoventilation Atelectatis, pneumonia, pulmonary edema
How much should your patient pull on the IS? What is a normal tidal volume? quietly talking about 500-700, big breaths sh/be 1000-1200.
What medical interventions help move mucous plugs? Breathing treatment to encourgage coughing, bronchoscopy:
what is Alveolar Dead Space Alveoli are fully ventilated, but blood is blocked in capillary. Alveolus unable to participate in gas exchange. Severe “wasted” ventilation = dead space.
What is a clinical example of alveoli ventilated, but not perfused PE
Hypoxemia: Signs and Symptoms? Increased RR Increased HR Dyspnea Agitation Increased WOB
what cause: Unable to support gas exchange = Hypoventilation Multiple causes CNS Depression (drugs) Neurological injury COPD or Status Asthmaticus
Hypercapnia: Signs and Symptoms? Lethargy Decreased LOC Decreased RR Low Tidal Volume (shallow breaths)
Continuum of Respiratory Deterioration? normal-> Resp distress-> Resp failure-> Resp arrest
what are you looking for when assess for Respiratory Deterioration Work of breathing HR RR Use of accessory muscles Tripod position Nasal flaring Unable to speak in full sentences
what is process when Hypoxemia and Hypercapnia most commonly occur together in Respiratory Distress  Failure PaO2 decreases first  Causes drive for more O2  RR increases  Initially drops PaCO2 levels  Patient tires  CO2 levels increase RESULT: Low PaO2 & high PaCO2
what is the result of Acute Resp. Failure ? Tissue Hypoxia
what are Demand Problems cause tissue hypoxia?  Oxygen requirements Fever Infection ADLs Agitation on mechanical ventilation
how Tissue Hypoxia effect on Cardiovascular? Tachycardia, Hypertension, Dysrhythmias, Polycythemia
how Tissue Hypoxia effect onRespiratory? Tachypnea, Hypoxemia (blood gas reading), Cyanosis
how Tissue Hypoxia effect on Renal? Low urinary output
how Tissue Hypoxia effect on Neurological? Anxiety & agitation , Confusion, Headache, Weakness & drowsiness, Double vision, Impaired judgment, Coma
How to treat for High CO2 ? Increase rate and depth of breathing (Get patients out and moving
what are S/S of Pulmonary Embolism? Dyspnea • Tachypnea • Apprehension • Diaphoresis • Syncope • Chest pain • Hemoptysis • Cough
PE Diagnosis? Physical exam with history: Does patient have risk factors?; ABG analysis; Low O2; Initial low PaCO2increasing PaCO2; Doppler ultrasound: Presence of DVT; Spiral CT ; V/Q scan (older test, not as valid); Pulmonary angiogram
what do you do if PE Suspected? Thorough respiratory assessment; Report onset of symptoms immediately; Administer increasing O2 immediately  Goal O2 stat > 94%
how to treat PE? Pain control: Narcotics & NSAIDS; Heparin therapy (continuous IV infusion); Adjust dose according to PTT results; Goal: 2-2.5 x normal; Thrombolytic therapy to break clot up; Surgically placed filters; Surgical embolectomy;
what is Acute Respiratory Distress Syndrome (ARDS) Sudden progressive respiratory failure.; Severe dyspnea; Hypoxemia despite increasing FiO2; Diffuse infiltrates
what are some of direct cause for ARDS? Pneumonias ; Shock; Aspiration ; Chest trauma
what is ARDS Etiology injury to lungs that causes ischemia or inflammation that traumatizes the alveolar capillary membrane
what are some of in direct cause for ARDS? Pancreatitis ; Sepsis ; Trauma
ARDS Pathophysiology? Massive inflammatory response by the lungs  Changes permeability of pulmonary capillary membrane; Alveoli fill with fluid  Loss of surfactant ; Loss of pulmonary compliance Impaired oxygenation
what are 3 phase of ARDS Pathophysiology Phase 1: Exudative phase; Phase 2: Proliferative ; Phase 3: Fibrotic
Phase 1: Exudative phase Starts ~24 hours post initial insult; Damage to capillary membrane and fluid leaking ; Microemboli; Inflammatory mediators released
Phase 2: Proliferative Day 7-10 surfactant changes ; Type II Alveoli surfactant cells that secrete surfactant are damaged; Remember back to Phyiology: What is surfactant? Lipoprotien substance that decreased the surface tension of the alveloi, increase lung compliance and
Phase 3: Fibrotic 2-3 weeks fibrin develops in lung ; the inflammatory changes cause the development of fibin deposits in the lung….fibrin does not allow gas exchange. Long term damage that can not be reversed.
Early Signs of ARDS ? Restlessness, change in LOC ; increase HR ; increae RR with normal lung sounds ; Dyspnea ; Resp Alkalosis, increase PaCO2
Late Signs of ARDS ? decrease PaO2 (despite incsrease levels of O2 ); Chest X-ray: Bilateral infiltrates “White Out” ; Severe dyspnea and WOB ; PIP,  functional residual capacity Cyanosis, pallor (grunting, retractions); Lungs with crackles, rhonchi; Hypercapnia a
What are we doing to maximize oxygenation? FiO2 ; PEEP; PS
How do we maximize ventilation? Rate ; Volume
ARDS: What do we do? Identify those patients at risk. ; Treat cause. ; Prevent further alveolar capillary membrane damage… ; Change the mode to pressure control to keep PIP under 25cm/H2O; Support tissue oxygenation
What are the value to set the vent for Oxygenation and ventilation support? Tidal volume? PS? PEEP? FiO2? Small tidal volumes (6mL/kg); Keep inspiratory pressure < 25 by changing to pressure control ventilation ; Goal: FiO2 < 70% with PaO2 60-70% ; Position HOB 30 degrees ; Exquisite oral care (q 2-4 hrs) ;
How to prevent complications of ARDS? Handwashing ; Prevent stress ulcers ; Prevent DVT ; Prevent VAP ; Prevent skin breakdown ; ROM ; Monitor for symptoms of infection: Trend WBCs, Chest Xray ; Provide psychosocial support to patient and family
what are criteria to Wean Mechanical Ventilation? Mode to Spontaneous: Volumes > 500 ; FiO2 to 40% ; PEEP 5 ; PS 10 ; Minimal secretions ; Clear chest X-ray ; CPAP trials
What will be the nursing responsibilities post extubation? remain with patient assess o2 sat, work of breathing, stridor.
what is the bigest concern of Fractured Ribs ? Atelectasis
what is Pulmonary Contusion? Damaged lung parenchyma with impaired gas exchange ; Interstitial hemorrhage, alveolar collapse, and alveolar flooding ; Continued perfusion of unventilated lung portions  shunting and hypoxia
treatment for flail chest? Position good lung down Provide adequate ; oxygenation and ventilation… May require intubation. ; Closed chest drainage ; Frequent respiratory assessments ; Pain control
Created by: tp667