Respiratory - PowerPoint PPT Presentation

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  1. Respiratory Respiratory Failure and ARDS

  2. Normal Respirations

  3. 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

  4. 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

  5. Causes of respiratory failure (p.1157) • Impaired ventilation • Impaired diffusion • Ventilation-perfusion mismatch (VQ) • COPD most common cause of resp failure

  6. Common manifestations/complications of respiratory failure • Hypoxemia • Hypercapnia • Underlying disease process symptoms (p. 1157)

  7. Cyanosis

  8. 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

  9. Tracheotomy

  10. Endotracheal tube

  11. Endotracheal tube

  12. Make sure airway attached to lungs

  13. Therapeutic interventions cont. • Mechanical ventilation • Adeq gas exchange & tissue perfusion • Criteria to put on • RR > 35-45 • pCO2 >45 • pO2 <50

  14. Mechanical ventilation cont • Types • Modes • PEEP; CPAP • Ventilator settings- including alarms • Complications • Ventilate one lung • Nosocomial pneumonia • Barotraumas • Cardiovascular • Gastrointestinal

  15. Nursing assessment specific to respiratory failure • Health history • Physical exam

  16. Pertinent nursing problems and interventions specific to respiratory failure • Impaired spontaneous ventilation • Ineffective airway clearance • Anxiety • Home care

  17. 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

  18. 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

  19. surfactant keeping alveoli open

  20. 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

  21. Therapeutic interventions for ARDS • Diagnostic tests • ABG’s- hypoxemia • Chest X-ray- snow storm effect • Pulmonary function tests • Hemodynamic monitoring

  22. 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’

  23. Independent Lung Ventilation

  24. Prone Device

  25. Benefits to Proning >

  26. Nursing assessment specific to ARDS • Health history • Physical exam

  27. 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