Respiratory Disorders & Arterial Blood Gases PDF

# Care of the Patient with a Respiratory Disorder ## Arterial Blood Gases This video will discuss the care of a patient with a respiratory disorder. This is part one of a two-part video. We will talk about arterial blood gases. Arterial blood gases measure several factors including: - pH (Acid ba...

# Care of the Patient with a Respiratory Disorder ## Arterial Blood Gases This video will discuss the care of a patient with a respiratory disorder. This is part one of a two-part video. We will talk about arterial blood gases. Arterial blood gases measure several factors including: - pH (Acid based balance) - $CO_2$ (respiratory component, acidic) - $HCO_3$ (renal component, basic, also known as metabolic) $CO_2$ and Bicarb work together to balance pH. Compensation attempts to bring pH back to normal. An ABG (arterial blood gas) can detect four main states other than normal: ### Metabolic Conditions * **Metabolic Acidosis:** An accumulation of acid in the body related to kidney issues. * **Metabolic Alkalosis:** Too much bicarbonate related to excessive diuretics or vomiting. ### Respiratory Conditions * **Respiratory Acidosis:** Retention of $CO_2$ related to a decreased respiratory rate or airway obstruction. * **Respiratory Alkalosis:** Over removal of $CO_2$ typically related to hyperventilation. ## Blood Gas Normals - **pH:** 7.35 to 7.45 - **$CO_2$:** 35 to 45 - **Bicarb:** 22 to 26 ## Six Steps to Analyze an ABG 1. **Examine pH** 2. **Examine $CO_2$ level** 3. **Look at ROME (respiratory opposite, metabolic even, or equal)** 4. **Check if $CO_2$ or Bicarb go in the opposite direction of pH.** This would indicate that compensation is not occurring. 5. **Evaluate P$O_2$ and $O_2$ saturation.** 6. **A normal P$O_2$ is between 80 - 100 mm of mercury.** ## ROME * **Respiratory Opposite:** The respiratory system compensates for a metabolic problem * **Metabolic Even:** Both systems are contributing to the imbalance. * **Equal:** The patient has a respiratory and a metabolic imbalance. ## Causes of Acidosis and Alkalosis ### Respiratory Acidosis - Lung disease - Conditions that affect normal breathing: asthma, COPD, pneumonia, sleep apnea - Obstructed airway diseases - Cardiac arrest - Sedative overdose ### Respiratory Alkalosis - Commonly found in critically ill patients - Usually caused by hyperventilation - Shift of electrolytes, decreasing potassium and calcium - Examples of conditions: panic attacks, anxiety, pain, heart attack, drug use, fever, CHF, fear, or asthma. ### Metabolic Acidosis - Usually a reduction in bicarb - Related to renal failure, or DKA (diabetic ketoacidosis) because keytones are an acid. - Medications or toxin adjustment ### Metabolic Alkalosis - Loss of too much acid or gain of too much base - Vomiting - Overuse of diuretics - NG suctioning - Adrenal disease - Laxatives - Alcohol use - Accidental ingestion of bicarbonate (like baking soda) ## Disorders of the Upper Airway ### Epistaxis (Nosebleeds) - Bleeding from the nose - Congestion of the nasal membranes leads to capillary rupture - Can be primary or secondary - Clinical manifestations: bright red bleeding from one or both nostrils, can lose as much as one liter per hour. #### Medical Management for Epistaxis - **Position:** Sit upright, lean forward - **Direct pressure:** Pinch the nose - **Ice compress:** Apply to the nose - **Nasal packing:** Can help tamponade any bleeds. - **Rhinoscopy:** Can be used to identify the source of the bleeding - **Antibiotics:** May be required for any bleeding. #### Patient Teaching for Epistaxis - Avoid irritation to the nose: no picking, scratching, or putting anything into the nostril - Blow their nose gently - Use a vaporizer or nasal lubricants to keep the nasal mucous membranes moist - Causes for dry nasal membranes: hypertension or trauma ### Areas Of Epistaxis - Anterior: Most common and less severe - Posterior: Less common and more severe ### Treatment for Anterior Epistaxis - Have the patient sit upright and lean forward. <h3>Treatment for Posterior Epistaxis</h3> * Rhinoscopy * Packing or balloon tamponade * **Important Note:** A patient presenting with frequent swallowing indicates increased bleeding. ### Deviated Septum - Typically congenital but can be caused by an injury. - The nasal septum deviates from the midline, partially obstructing airflow. - Can cause prolonged inflammation. #### Clinical Manifestations of Deviated Septum - Strenuous respirations (snoring) - Shortness of breath - Postnasal drip #### Medical Management for Deviated Septum - **Nasal polypectomy:** Removal of nasal polyps - **Packing:** Placed for 24 hours post-operatively. - **Saline sprays and ointments:** Help keep the nasal passages moist. - **Corticosteroids:** Decrease the size and irritation of the nasal polyps. - **Nasioplasty:** Reconstructs the septum. - **Packing:** 24 hours post-operatively. - **Nasal sprays and ointments:** Help with moisture. ### Allergic Rhinitis and Conjunctivitis (Hay Fever) - An antigen-antibody reaction in the nasal membranes, nasopharynx, and conjunctiva. - Caused by allergens which trigger a decrease in the body's ability to move mucus - Increase in mucus production #### Common Allergens - Trees - Grass - Pollen - Dust - Insects - Foods #### Diagnostic Tests - **Skin tests:** Determine allergy via a scratch or exposure to an allergen on the skin - **Radioallergosorbent test (RAST):** Determines allergy via blood sample. #### Clinical Manifestations - **Ocular:** Dema, photophobia, excessive tearing, blurred vision, itching. - **Rhinitis:** Excessive secretions, congestion, sneezing, cough, headache, decreased hearing, otitis media (ear infection), sinusitis, bronchitis or pneumonia. #### Medical Management for Allergic Rhinitis and Conjunctivitis - **Antihistamines:** Allegra, Claritin, Benadryl - **Decongestants:** Pseudafed, Actifed. - **Steroids:** Used for 3 -5 days, then tapered to a quarter dose for the next few days. - **Analgesics:** Used for discomfort. - **Antibiotics:** May be used if a secondary bacterial infection occurs. - **Warm packs:** Used over the sinuses to increase dilation and drainage. - **Eyedrops:** Antihistamines or corticosteroids, help treat conjunctivitis. - **Air conditioning:** Helps keep things cool ### Obstructive Sleep Apnea - Characterized by a partial or complete upper airway obstruction during sleep. - **Apnea:** Cessation of spontaneous respirations. - **Hypopnea:** Unusually shallow or slow respirations. #### Causes of Obstructive Sleep Apnea - Tongue and soft palate falling backwards - **Risk factors:** Male, older age, obesity, nasal allergies, polyps, deviated septum, receding chin, structural abnormalities, or sleeping on one's back. #### Clinical Manifestations - **Sleep:** Frequent awakenings, insomnia, excessive daytime fatigue, difficulty falling asleep. - **Witnessed by others:** Snoring, hypercapnia, personality changes, irritability, impaired memory, depression, and hypertension. - **Medical:** Stroke or cardiac arrhythmias #### Diagnostic Tests - **Polysomnography:** Assesses chest, abdominal, and brain wave activity during sleep. #### Medical Management for Obstructive Sleep Apnea - **Mild:** Avoid sedatives, alcohol, work on weight loss, use oral devices to keep the airway open. - **Severe:** CPAP (Continuous Positive Airway Pressure) or BiPAP (Bilevel Positive Airway Pressure). ### Cancer of the Larynx - Typically squamous cell carcinoma. - **Risk factors:** Over 60 years of age, male, smoker, alcoholic. ### Laryngitis - Inflammation of the larynx. - Caused by a virus or bacteria. - Can be caused by excessive use of the voice. #### Clinical Manifestations of Laryngitis - Respiratory distress, especially in children under 5 years of age. - Hoarseness - Voice loss - Irritated throat or persistent cough. #### Medical Management - **Bacterial:** Analgesics, antipyretics, antitussives and antibiotics. - **Viral:** Supportive care. ### Sinusitis - Inflammation of the sinuses (air cavities in the skull). - Begins with an upper respiratory infection, which can be viral or bacterial. #### Clinical Manifestations of Sinusitis - Headaches - Tenderness in the involved sinus region. - Sinus drainage - Fatigue #### Medical Management for Sinusitis - **Bacterial:** Antibiotics. - **Analgesics:** Reduce pain. - **Antihistamines:** Decrease histamine reaction, reduce symptoms. - **Vasoconstriction:** Nasal spray like Afrin. - **Saline nasal irrigation:** Used to thin mucus. - **Warm, moist compresses:** Applied to the sinuses to promote drainage. #### Complications of Sinusitis - Spread of infection - Meningitis - Osteomyelitis ### Pharyngitis - Inflammation of the pharynx (throat). - Can be chronic or acute. - Frequently accompanies the common cold. - Most commonly viral. - Bacterial: Usually caused by strep. #### Clinical Manifestations of Pharyngitis - Dry cough - Tender tonsils - Sore throat - Fever #### Medical Management for Pharyngitis - **Bacterial:** Antibiotics. - **Analgesics:** For discomfort. - **Antipyretics:** Decrease fever. - **Warm or cool mist vaporizer:** Help thin mucus. - **Throat rinses or gargles:** Reduce irritation. - **Fluids:** Help thin mucus. ### Tonsillitis - Inflammation of the tonsils, located at the back of the throat. - Can be viral or bacterial. #### Clinical Manifestations of Tonsillitis - Enlarged, tender tonsils. - Sore throat, lasting longer than 48 hours. - Fever - Chills - Purulent tonsils - Elevated white blood cell count - Headache - Joint pain - General malaise - Anorexia - Difficulty swallowing (dysphagia) - Halitosis (Bad breath) #### Medical Management for Tonsillitis - **Antibiotics:** Penicillin or amoxicillin. - **Warm saline gargles:** For discomfort. #### Tonsillectomy - Surgical removal of the tonsils. - Usually done along with adenoidectomy. - **Note:** Assess for excessive bleeding. #### Post-Tonsillectomy Patient Care - **Liquids:** Avoid cold liquids (ice cream, chocolate). - **Milk:** Avoid milk which thickens secretions - **Minimize irritation:** Avoid ice collar, coughing, sneezing, vigorous nose blowing, and aspirin ### Tonsillitis Complications - Peritonsillar abscess - Acute glomerulonephritis - Sinusitis - Rheumatic fever - Otitis media (ear infection) ### Laryngotracheitis (Croup) - Inflammation of the larynx and trachea. - Caused by a virus or bacteria. - Can be triggered by excessive use of the voice. #### Clinical Manifestations of Croup - Respiratory distress, especially in children younger than 5 years old. - Hoarseness - Voice loss - Irritated throat - Persistent, dry cough #### Medical Management for Croup - **Bacterial:** Antibiotics. - **Viral:** Supportive care. - **Antipyretics:** Decrease fever. - **Analgesics:** For discomfort. - **Antitussives:** For cough suppression. ### Acute Otitis Media (Ear Infection) - Usually associated with strep. - Causes an inflammation of the middle ear. ## Artificial Airway In cases of airway obstruction, an artificial airway may be used to restore airflow. Several options include: - **Tracheostomy:** A surgical opening in the trachea for insertion of a breathing tube. - **Tricky astomy:** A temporary opening in the trachea for insertion of a breathing tube. - **Heimlich maneuver:** Used to expel an object blocking the airway. # Respiratory Infections ## Acute Rhinitis (The Common Cold) - Inflammation of the nasal mucous membranes and the nose. - Viral in nature. - Can be complicated by a secondary bacterial infection. - Spread via droplet transmission. #### Clinical Manifestations of Acute Rhinitis - Begins 24-48 hours after exposure. - **Nasal:** Runny nose, thick nasal discharge, postnasal drip. - **Respiratory:** Cough - **Fever:** Sore throat - **Ocular:** Watery eyes, headache, earache. #### Diagnostic Testing for Acute Rhinitis - A throat culture and sensitivity may be done to rule out a bacterial infection. #### Medical Management for Acute Rhinitis - **Analgesics:** For pain. - **Antipyretics:** Decrease fever. - **Cough suppressants:** For cough control. - **Expectorants:** Help remove mucus. - **Antibiotics:** Prescribed for bacterial infections. - **Fluids:** Encourage increased fluid intake to thin mucus. - **Vaporizer or compresses:** Helps loosen mucus. - **Rest:** For symptom relief. - **Handwashing:** Reduce the spread of infection. - **Cough etiquette:** Help prevent the spread of infection. ### Influenza (The Flu) - Viral infection that spreads via droplet transmission. - Contagious 24 hours prior to symptom onset and up to 5 days afterwards. #### Clinical Manifestations of Influenza - Sudden onset of illness - Muscle pain - Headache - Fever - Photosensitivity - Extreme fatigue & weakness - Cough - Chest pressure - Nausea - Vomiting - Diarrhea #### Medical Management for Influenza - **Antiviral medications:** Tamiflu, help reduce the length of illness by 3 days. - **Fluids:** Help prevent dehydration. - **Analgesics:** For pain. - **Rest:** For symptom relief. - **Humidifier:** For dry coughs. #### Complications - Sinusitis - Pneumonia - Otitis media (ear infection) ## Verrucous Tonsillitis - Inflammation of the tonsils, usually viral onset. - Can be prolonged and cause a bacterial infection. #### Clinical Manifestations of Verrucous Tonsillitis - Enlarged, tender tonsils - Sore throat, lasting longer than 48 hours. - Fever - Chills - Purulent tonsils - White blood cell count - Headache - Joint pain - General malaise - Anorexia - Difficulty swallowing (dysphagia) - Halitosis (bad breath) #### Medical Management for Verrucous Tonsillitis - **Antibiotics:** Penicillin or amoxicillin. - **Warm saline gargles:** For discomfort. - **Rest:** For symptoms.