Resp Failure + ARDS+ Immune System
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
|
|
||||
|---|---|---|---|---|---|
| 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 PaCO2increasing 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
🗑
|
Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Created by:
tp667
Popular Nursing sets