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Respiratory. Respiratory Failure and ARDS. Normal Respirations. Respiratory Failure. Not a disease process, sign of severe dysfunction Lungs unable to oxygenate blood & remove CO2 Alveolar ventilation is inadequate to meet the body’s need Commonly defined in terms of ABG’s

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respiratory

Respiratory

Respiratory Failure and ARDS

respiratory failure
Respiratory Failure
  • Not a disease process, sign of severe dysfunction
  • Lungs unable to oxygenate blood & remove CO2
  • Alveolar ventilation is inadequate to meet the body’s need
  • Commonly defined in terms of ABG’s
    • PO2 of less than 50 mmHg
    • PCO2 greater than 50 mmHg
    • Arterial pH of less than 7.35
respiratory failure affect on acid base balance
Respiratory failure & affect on acid-base balance
  • 1. Hypoxemia resp failure is failure of oxygenation.
    • PO2 significantly reduced and PCO2 is at or below normal
    • Metabolic acidosis results from tissue hypoxia
  • 2. Hypercapnia resp failure results from hypoventilation.
    • PCO2 rises rapidly and resp acidosis develops
    • PO2 drops more slowly
causes of respiratory failure p 1157
Causes of respiratory failure (p.1157)
  • Impaired ventilation
  • Impaired diffusion
  • Ventilation-perfusion mismatch (VQ)
  • COPD most common cause of resp failure
slide7

Common manifestations/complications of respiratory failure

  • Hypoxemia
  • Hypercapnia
  • Underlying disease process symptoms (p. 1157)
therapeutic interventions for resp failure
Therapeutic interventions for Resp Failure
  • Diagnostic tests- ABG’s; ETCO2; chest X-ray
  • Main treatment- correct underlying cause & restore adequate gas exchange in lung
  • Elevate HOB
  • Medications
  • Oxygen therapy (O2 sat 90%; PaO2 60 mmHg)
  • Airway management
therapeutic interventions cont
Therapeutic interventions cont.
  • Mechanical ventilation
  • Adeq gas exchange & tissue perfusion
  • Criteria to put on
    • RR > 35-45
    • pCO2 >45
    • pO2 <50
mechanical ventilation cont
Mechanical ventilation cont
  • Types
  • Modes
  • PEEP; CPAP
  • Ventilator settings- including alarms
  • Complications
    • Ventilate one lung
    • Nosocomial pneumonia
    • Barotraumas
    • Cardiovascular
    • Gastrointestinal
nursing assessment specific to respiratory failure
Nursing assessment specific to respiratory failure
  • Health history
  • Physical exam
pertinent nursing problems and interventions specific to respiratory failure
Pertinent nursing problems and interventions specific to respiratory failure
  • Impaired spontaneous ventilation
  • Ineffective airway clearance
  • Anxiety
  • Home care
acute respiratory distress syndrome ards
Acute respiratory distress syndrome- ARDS
  • Syndrome, sudden & progressive acute resp failure- not primary
  • Alveolar capillary membranes damaged more permeable> noncardiac pulmonary edema & progressive refractory hypoxemia
pathophysiology of ards stages
Pathophysiology of ARDS- Stages
  • Refer to BB course documents Module 2 for video
  • Page 1170-1 illustrations of stages
  • Initiation of ARDS; onset pulmonary edema; alveolar collapse; end-stage ARDS
common manifestations complications of ards
Common manifestations/complications of ARDS
  • Symptoms develop 24-48 hrs after initial insult
  • Early symptoms
  • Later symptoms
  • Hallmark sign- progressive refractory hypoxemia
  • Noncardiac pulmonary edema
therapeutic interventions for ards
Therapeutic interventions for ARDS
  • Diagnostic tests
    • ABG’s- hypoxemia
    • Chest X-ray- snow storm effect
    • Pulmonary function tests
    • Hemodynamic monitoring
therapeutic intervention for ards cont
Therapeutic intervention for ARDS cont.
  • Medications
  • Mainstay of treatment---Mechanical ventilation with intubation
  • Correct underlying condition
  • Fluid replacement keep vascular volume
  • Nutrition positive protein balance
  • Heparin prevent thrombothebitis
  • ‘Proning’
nursing assessment specific to ards
Nursing assessment specific to ARDS
  • Health history
  • Physical exam
pertinent nursing problems and interventions for ards
Pertinent Nursing problems and interventions for ARDS
  • Decreased cardiac output
  • Ineffective airway clearance; impaired tissue perfusion; imbalance nutrition: less than body requirements; risk for infection
  • Dysfunctional ventilatory weaning response
  • Home care